Recovering the capability to work among patients with chronic low Back pain after a four-week, multidisciplinary biopsychosocial rehabilitation program: 18-month follow-up study

Abstract

Background Chronic low back pain (LBP) is a leading cause of disability worldwide. Biopsychosocial rehabilitation programs have been advocated for its management, especially since the widespread acceptance of the biopsychosocial model of chronic pain. Despite extensive evidence of its short-term benefits, few studies have reported on its long-term effect and more specifically on indirect outcomes such as return to work and quality of life (QoL). The present study evaluated the long-term effect of a multidisciplinary biopsychosocial rehabilitation (MBR) program for patients with chronic LBP, for which short- and intermediate-term efficacy had been established, with an emphasis on recovering work capability. Methods This prospective cohort study enrolled 201 patients on a four-week MBR program incorporating physical and occupational therapies and psychological counselling. Assessments occurred at program admission and discharge and at 6 and 18 months. Work capability, Oswestry Disability Index, Tampa Scale for Kinesiophobia, Core Outcome Measures Index (COMI), and Hospital Anxiety and Depression Scale were assessed. Multiple mixed models were used to detect changes in each outcome. Logistic regressions were calculated to identify predictors of recovery of work capability. Results Of the 201 patients who fulfilled the eligibility criteria, 160 (79.8%) attended the discharge assessment, 127 (63.2%) attended the 6-month follow-up, and 107 (53.3%) continued to the 18-month follow-up. Initially, 128 patients (71.5%) had been on sick leave. At 6 and 18 months, 72 (56.7%) and 84 (78.5%) participants had recovered their work capability, respectively. There were significant improvements in pain, disability, kinesiophobia, and anxiety and depression scores over time. Patients who recovered work capability showed significantly greater improvements in their total COMI score, general QoL, and disability, which were the best three predictors of recovering work capability. Conclusions This study extends previous results confirming the program’s contribution to recovering work capability among chronic LBP patients.

Frequently repeated measurements -our experience of collecting data with SMS

“…However, in the great scheme of clinical research, an overall compliance of around 90% is quite remarkable. Further, a compliance around 70% at the end of a study period of 52 weeks (the lowest compliance of the Weekly studies) is in line with previous studies using SMS to collect data [7,9], and must be considered a high figure in comparison with other means of collecting data [22,23]. The included populations were intentionally different, in order to get a variety of factors where compliance with the SMS methodology could be explored.…”

Unmet Needs in the Management of Functional Impairment in Patients with Chronic Pain: A Multinational Survey

“…Our survey results also emphasize the importance of multidisciplinary care, which facilitates improvements in functional capacity in patients with chronic pain [55][56][57][58]. The structure of multidisciplinary teams varies, but the core team generally includes a group of physicians (e.g., a primary care physicians, pain specialists, and psychiatrists) and nonphysicians (e.g., psychologists, physiotherapists and nurses) [59].…”

A scoping review to ascertain the parameters for an evidence synthesis of psychological interventions to improve work and wellbeing outcomes among employees with chronic pain

“…The interventions tended to be complex, including multimodal elements for example physiological rehabilitation, exercise or medication management, in addition to psychological components. The psychological components of interventions often contained multiple components that drew explicitly upon approaches such as cognitive behavioural therapy (CBT) (30% of studies) (Angst et al, 2014 ; Asih, Neblett, Mayer, & Gatchel, 2018 ; Bergström, Jensen, Hagberg, Busch, & Bergstrom, 2012 ; Busch, Bodin, Bergstrom, & Jensen, 2011 ; Campello et al, 2012 ; Coole, Drummond, & Watson, 2013 ; Harris et al, 2017 ; Hartzell, Mayer, & Asih, 2014 ; Ibrahim, Weber, Courvoisier, & Genevay, 2019 ; Irvine et al, 2015 ; Johansen et al, 2019 ; Jorgensen et al, 2011 ; Lambeek et al, 2010 ; Linton et al, 2016 ; Luthi et al, 2018 ; Marchand et al, 2015 ; Mayer, Choi, Howard, & Gatchel, 2013 ; Mochari-Greenberger, Andreopoulos, Peters, & Pande, 2020 ; Myhre et al, 2014 ; Pato et al, 2010 ; Poulain et al, 2010 ; Rasmussen et al, 2016 ; Reme et al, 2016 ; Sander et al, 2020 ; Schlicker et al, 2020 ; Stein & Miclescu, 2013 ; Vindholmen, Hoigaard, & Haugen, 2016 ), counselling (8% of studies) (Calner et al, 2017 ; Ernsen & Lellefjell, 2014; Howard, Mayer, & Gatchel, 2012 ; Jensen et al, 2012b ; Knappe, Briest, & Bethge, 2015; Kold, Hansen, Vedsted-Hansen, & Forman, 2012 ; Sjöström, Asplund, & Alricsson, 2013 ), acceptance and commitment therapy (4% of studies) (Berglund et al, 2018 ; Gismervik et al, 2020 ; Hara, Bjørngaard, Brage et al, 2018 ; Hara, Bjørngaard, Jacobsen et al, 2018 ), motivational interviewing (2% of studies) (Gross et al, 2017 ; Park et al, 2018 ) or mindfulness-based stress reduction (1% of studies) (Soler-Font et al, 2019 ). Other interventions adopted explicit educational approaches (27.5% of studies) (Andersen et al, 2015...…”