Abstract
Purpose: The long term effects of treatment in a cohort of patients with chronic low back pain (CLBP) participating in an intensive pain management program.
Background: Cognitive behavioral treatments produce clinically relevant benefits for patients with CLBP.
Methods: The program provided by RealHealth-Netherlands is based on cognitive behavioral principles and executed in collaboration with orthopedic surgeons. Primary outcomes were daily functioning and self-efficacy. Measurements were at baseline, last day of residential program and at 1 and 12 months follow-up. A GLM procedure with repeated measures was applied to examine changes over time and to explore possible unwanted side effects. Effect sizes are analyzed using cohen’s d. Clinical relevance was examined using minimal clinical important differences (MCID) estimates for primary outcomes and quality of life. To compare results with literature Standardized Morbidity Ratios (SMR) were determined.
Results: 107 patients with CLBP participated. Mean scores on primary and secondary outcomes showed a similar pattern: improvement immediately after following the program and maintenance of results over time. Effect sizes were 0.9 for functioning and 0.8 for self-efficacy. Clinical relevancy: 79% reached MCID on functioning, 53% on self-efficacy and 80% on quality of life. Found study results were 36% better and 2% worse when related to previous research on respectively rehabilitation programs and spinal surgery for similar conditions (SMR 136% and 98%respectively).
Conclusion: The participants of this evidence based program learned to manage CLBP, improved in daily functioning and quality of life. The study results are comparable with results of spinal surgery and even better than results from less intensive rehabilitation programs.
Conflict of Interest: None
Sources of Funding: None
Correspondence should be addressed to: SBPR at the Royal College of Surgeons, 35–43 Lincoln’s Inn Fields, London WC2A 3PE, England.
