The Feasibility and Effectiveness of a New Practical Multidisciplinary Treatment for Low-Back Pain: A Randomized Controlled Trial

Abstract

Low-back pain is a major health problem exacerbated by the fact that most treatments are not suitable for self-management in everyday life. Particularly, interdisciplinary programs consist of intensive therapy lasting several weeks. Additionally, therapy components are rarely coordinated regarding reinforcing effects, which would improve complaints in persons with higher pain. This study assesses the effectiveness of a self-management program, firstly for persons suffering from higher pain and secondly compared to regular routines. Study objectives were treated in a single-blind multicenter controlled trial. A total of n = 439 volunteers (age 18–65 years) were randomly assigned to a twelve-week multidisciplinary sensorimotor training (3-weeks-center- and 9-weeks-homebased) or control group. The primary outcome pain (Chronic-Pain-Grade) as well as mental health were assessed by questionnaires at baseline and follow-up (3/6/12/24 weeks, M2-M5). For statistical analysis, multiple linear regression models were used. N = 291 (age 39.7 ± 12.7 years, female = 61.1%, 77% CPG = 1) completed training (M1/M4/M5), showing a significantly stronger reduction of mental health complaints (anxiety, vital exhaustion) in people with higher than those with lower pain in multidisciplinary treatment. Compared to regular routines, the self-management–multidisciplinary treatment led to a clinically relevant reduction of pain–disability and significant mental health improvements. Low-cost exercise programs may provide enormous relief for therapeutic processes, rehabilitation aftercare, and thus, cost savings for the health system.

Personalized Treatment Suggestions: The Validity and Applicability of the Risk-Prevention-Index Social in Low Back Pain Exercise Treatments

“…Study objectives were pursued in a subsample of a multicentre single-blind 3-armed randomised controlled trial (RCT, trial No. DRKS00004977, study design see [26,27] within the MiSpEx network (https://mispex.de/machbarkeit-multimodales-training/). The 24-week study comprised five measurements: baseline (M1), after 3 weeks (M2), after 6 weeks (M3), after 12 weeks (M4) and after 24 weeks (M5), whereby only results related to M4 and M5 were reported here.…”

“…The exercise intervention included four different sensorimotor exercises, of which two directly trained the core stabilizing and core surrounding muscles, while the other two indirectly trained upper and/or lower extremities (detailed description see [27,29,30]). At the centre-based phase, the subjects were guided by sports-and physiotherapists, while the home training was audio-guided by a DVD.…”

“…Therapists provided support by phone, e-mail or face-to-face contact for all participants at any time. The additional Behavioral-Therapy module (BT module) included an education film, cognitive distraction tasks (while practicing sensorimotor training) and body scan tasks provided by a DVD (for detailed description see [27]). The educational film (to be watched with the life partner) focussed on the social environment of the participant's inclusive partnership task and three units: I) an education phase (explanation of social and personal risk factors and the bio-psycho-social model of chronic pain), II) an exercise phase (coping strategies and tasks), and III) a transfer phase (reflection on and improvement of daily life routines).…”

“…The exclusion criteria were pregnancy, acute pain during the past seven days, being unable to stand upright, not able to give outcome sick leave information, or showing signs of acute risk factors referred to as "red flags" (inflammatory, traumatic or systematic processes). All participants signed a written informed consent after receiving written and oral information about the study (Flow chart of Enrolment see [27] and S1).…”

Effects of the Multidimensional Treatment on Pain, Disability, and Sitting Posture in Patients with Low Back Pain: A Randomized Controlled Trial

“…Low back pain (LBP) is one of the most common musculoskeletal disorders in the world, and about 90% of patients have nonspecific LBP with no obvious cause [1]. Lifestyle factors, such as sedentary jobs and obesity, have further increased the incidence of back pain [2]. Keegan suggested that decreased lordosis in the lumbar spine is the chief contributing factor in LBP caused by extensive sitting [3].…”