Comparison of three intensive programs for chronic low back pain patients: a prospective, randomized, observer-blinded study with one-year follow-up.

In a randomized, blinded study, we compared the outcome from a full-time functional restoration program with the outcome from shorter active rehabilitation programs for patients with chronic, disabling low back pain. The study initially included 132 patients, randomized into one of three treatment programs: (1) an intensive 3-week multidisciplinary program; (2) active physical training and back school; or (3) psychological pain management and active physical training. Nine of the randomized patients never started in any program, so the studied population consisted of 123 patients. Of these, 14 patients (11%) dropped out. The results presented here are at 1 year following treatment, where we achieved a 92% response rate, including the drop-outs. The functional restoration program was superior to the shorter programs as to work-ready rate, health care contacts, back pain level, disability level, staying physically active, and reduction in analgesics. There was no significant difference between Programs 2 and 3 in most of these parameters. As for sick leave and leg pain, there was no significant difference between Programs 1 and 2, although a difference was observed when comparing Program 3 with each of the other two. Conclusively, it seems that there is human, as well as economical, benefit from a functional restoration program compared to less intensive programs for these patients.

[Intensive multidisciplinary treatment of back pain--2 controlled prospective studies]. / Intensiv tvaerfaglig rygbehandling--to kontrollerede, prospektive undersøgelser.

The aim of this study was to evaluate an intensive, multidisciplinary functional restoration program for people with chronic low back pain. The program was compared to a non-treated control group in project A, and to less intensive treatment programs in project B. Both projects were randomized and observer blinded. Two hundred and thirty-eight patients were included, 106 entering project A and 132 project B. All had had chronic low back disability of at least six months duration, with an average of one year's sick leave due to low back pain over the last three years. Their average age was 41 years. The results at follow-up (conducted four months after treatment, follow-up rate 90% in project A and 86% in project B) showed that 67% of the treated patients in project A were able to work compared to 28% in the control group. In project B, 75% of the patients treated in the functional restoration program were able to work, the corresponding numbers from the less intensive programs being 48% and 40%. Numbers of days of sick leave, contacts to the health-care system and pain- and disability-scores were significantly lower for the patients treated in the functional restoration program compared to the other groups in both projects. Functional restoration is more expensive to carry out, but the long-term benefits in form of reductions in pensions, sick leave and contacts to the health-care system, not to mention reduced pain for the patients, seems to justify this expenditure.