Méthodes de rééducation physique et de psychothérapie associées contre le mal de dos

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A Swedish randomized controlled trial of Jensen and colleagues, published in the journal Pain in 2005, compared to 3 years of follow up the effectiveness of medical and behavioral rehabilitation program compared with usual care on sick leave, early retirement and quality of life related to health in people suffering from back pain. The multidisciplinary rehabilitation program shows superior results to other conditions.

The Study Rationale

Studies evaluating the effectiveness of multidisciplinary interventions on back pain lack long-term monitoring. The evidence for benefit of these NPI on the cost-effectiveness and duration of sick leave also missing. Thus, this study aims to fill these gaps by assessing the effects of a multidisciplinary program after three years of follow-up.

The Question

A multidisciplinary rehabilitation program support, after 3 years of follow-up, to reduce the duration of sickness absence, reduce disability and improve the quality of life related to health compared to standard care?

The Protocol

The randomized controlled trial of Jensen and colleagues, evaluated the effectiveness of a long-term collaborative program. The study includes 97 men and 117 women aged between 18 and 60 years. The clinical trial included people with back pain nonspecific. The pain must be current and ongoing dating back at least one month and a maximum of six months. Participants were randomly placed in either the group with medical and behavioral rehabilitation program, either in the physical activity group or in the cognitive behavioral therapy group or the control group following routine care.

The main measures related work absences (sick leave and disability pensions), the use of health care (consultations, medication …) and health-related quality of life (SF-36). Participants were evaluated early intervention and the end of surgery and at 6, 18 and 36 month follow-up.

The tested Non-Pharmacological Intervention (NPI)

The three interventions lasted a month and were conducted in groups of 4 to 8 participants. They included a medical consultation, six educational sessions dealing with the psychological aspects of chronic pain, ergonomics and medical aspects of chronic pain and a visit to the workplace. Six sessions “booster” were offered to participants one year after the program.

The intervention in Adapted Physical Activity (APA) aimed to improve physical function and to facilitate sustainable behavior change of the individual. Each participant received a personalized program of 20 hours per week. It included the establishment of individual goals, muscle strengthening with gradual intensity exercises, endurance training, swimming lessons, relaxation sessions using the method of Jacobson and Westin and body awareness.

The intervention of cognitive behavioral therapy lasted on average 13-14 hours a week for a month. INM was to improve participants’ ability to manage their pain and resume normal life. The program included business planning tasks, an establishment of objectives, problem solving, relaxation, cognitive coping techniques, techniques to break the vicious circle, a reflection on the role of spouses and the assertiveness training.

Intervention included the combination of the two for a month.

Main Results

The results showed that the combined intervention is more effective than disciplinary interventions. The combined intervention is more beneficial to women than men. They bring a better quality of life related to health and a quicker return to work. The results also show greater cost-effectiveness of the combined program, with a reduction of 137,509 euros for each woman at the end of the 3 years of monitoring compared to the control group.

What it means for Patients

A multidisciplinary rehabilitation program combining the practice of physical activity (with cognitive behavioral therapy improves health-related quality of life and reduce absences from work and especially among women.

What it means for Healthcare Professionals

The multidisciplinary rehabilitation program is a cost-effective intervention in terms of cost-effectiveness to improve the health and raise the return to work in people suffering from back pain.

What it means for Researchers

This clinical trial was designed to evaluate the effectiveness after three years, a multidisciplinary rehabilitation program a month on work absences, quality of life related to health and cost-effectiveness. The most favorable results in women than in men deserve to understand why. This non-drug intervention study is exemplary in terms of methodology.

What it means for Policymakers

Productivity losses due to back pain interfere with the growth of a country. The cost effectiveness of the tested INM shows that an investment in this type of intervention improves the quality of life of people, reduces the number of work stoppages and reduced healthcare spending.

The reference

Jensen IB, Bergström G, Ljungquist T, Bodin L (2005). A 3-year follow-up of a multidisciplinary rehabilitation programme for back and neck pain. Pain, 115, 273-283.

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To reference this Blog en Sante © article.

Ninot G (2016). Utility to associate a method of rehabilitation and psychotherapy for treating back pain. Blog en Sante, A82.

© Copyright 2016 Grégory Ninot. All rights reserved.