[Prospective study of the outcome at one year of patients with chronic low back pain in a program of intensive functional restoration and ergonomic intervention. Factors predicting their return to work]. / Etude du devenir à un an de lombalgiques chroniques inclus dans un programme associant reconditionnement à l'effort et action ergonomique. Recherche de facteurs prédictifs de retour et de maintien au travail.

OBJECTIVES: Evaluation of 1-year outcome after patients with chronic low back pain participated in an intensive functional restoration program associated with an ergonomic intervention on the workplace. Study of the factors predicts a return to work. METHODS: Prospective study of a cohort of 87 patients face major difficulties due to low back pain at work. Patients who visited a multidisciplinary clinic were included. Parameters, evaluating physical and psychological status, quality of life, presence at work, length of sick leaves, were determined before and after the program and at 6 and 12 months' followup. The correlation between these parameters and presence at work at 1 year was studied. RESULTS: A total of 86 patients completed the program; three were lost to followup at 1 year. Ergonomic interventions were tried in 53 patients. All parameters were improved at the end of the program and remained significantly improved at 12 months. A total of 90% of the patients returned to work at the end of the program, whereas only 17% were at work before; 72% were at work in 1 year. The number of sick leave days decreased by 60%. The Dallas index at the beginning and the end of the program, the number of sick leave days before the program and score on the item "feels able to work" correlated with the presence at work in 1 year. There was no correlation between presence at work and physical parameters. CONCLUSION: This study shows the effect of the program and determines factors predictive of successful return to work for patients with chronic low back pain. Further data are necessary to discuss the specific effect of ergonomic interventions.

[Impact of functional restoration programs on fears, avoidance and beliefs in chronic low back pain patients]. / Impact de programmes de restauration fonctionnelle sur les peurs, croyances et conduites d'évitement du lombalgique chronique.

OBJECTIVE: To assess the impact of functional restoration programs on fears, avoidance and beliefs in chronic low back pain. METHODS: Open prospective study in eight spine centers. Seventy patients enrolled in several restoration programs were evaluated before and at the end of the program. Variables recorded were pain (VAS), disability (Quebec back pain disability scale), handicap (VAS), anxiety and depression (HAD scale), and fears, avoidance and beliefs (FABQ). RESULTS: All variables recorded significantly improved at the end of the programs except for fears about professional activities (FABQ1) and lumbar mobility. Fears about physical activities (FABQ2) significantly decreased after these programs. Variations in FABQ1 and FABQ2 scores were not correlated with variations in scores of outcome measures assessing impairment, disability, and handicap. CONCLUSION: Functional restoration programs in their current form in France do not decrease fears and beliefs about professional activities in chronic low back pain patients. Adding psychosocial intervention at the work place to the functional restoration programs may lead to a better impact on fears about work thus reducing work loss.