Efficacia di un intervento riabilitativo ed occupazionale di gruppo ad impronta cognitivo comportamentale per la lombalgia cronica a bassa disabilità. Studio prospettico, con follow-up a sei mesi

Background. Literature suggests a bio-psycho-social approach to chronic low back pain, heralding disability. A multidisciptinary combination of motor, occupational and cognitive behavioural therapies constitutes a rehabilitative approach provided with growing evidence in the clinic field of spinal chronic pain. Objectives. To evaluate the effectiveness of a motor, occupational and cognitive behavioural approach, carried out in group, for subjects with low disability chronic low back pain. Methods. Prospective trial, with a six-month follow-up. We selected patients with chronic low back pain considered at low disability (Roland Morris Disability Questionnaire, RMDQ, score lower than 12/24), in the absence of serious co-morbidities, consecutively admitted to a Physical Medicine and Rehabilitation Unit. The patients underwent ten sessions of a rehabilitative and cognitive behavioural treatment, made in group. We identified the following outcome measures, administered pre-treatment, post-treatment and during six-month follow-up: pain (VAS), disability (RMDQ), health status (SF-36). We performed a parametric analysis for repeated measures (Student t test, significance: p<0.05); we also searched the clinical importance for pain and disability. Results. Population: 37 subjects, 21 females, 16 males, mean age 52 ± 11 years old, low back pain mean duration 10 ± 4 months. The described approach was successful (VAS p=0.001, RMDQ p=0.001, SF-36 domains 0.001<0.014), with persistence of results at the six-month follow-up for Physical Role, Pain, Emotional Role and Mental Health SF-36 domains; further significance increase was achieved for Physical Activities (p=0.009), General Health (p=0.006), and Vitality SF-36 domains (p=0.007). The Social Activities domain of the SF-36 questionnaire was not significant (p=0260) at the end of the trial, getting significance at the six-month follow-up (p=0.001). Clinical significance was furthermore achieved for pain and disability outcome measures, unchanging six months later. Conclusions. The trial showed evidence in favour of a combined motor, occupational and cognitive-behavioural approach, carried out in group, for low disability chronic low back pain. Considering methodological biases of the study, we recommend confirmation of these results through randomized controlled trial.