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.

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

MONTICONE, MARCO;
2008-01-01

Abstract

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.
2008
Chronic low back pain; Cognitive-behavioural therapy; Disability; Quality of life; Rehabilitation; Public Health, Environmental and Occupational Health
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11584/168363
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