Recovering the capability to work among patients with chronic low Back pain after a four-week, multidisciplinary biopsychosocial rehabilitation program: 18-month follow-up study

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Abstract

Background

Chronic low back pain (LBP) is a leading cause of disability worldwide. Biopsychosocial rehabilitation programs have been advocated for its management, especially since the widespread acceptance of the biopsychosocial model of chronic pain. Despite extensive evidence of its short-term benefits, few studies have reported on its long-term effect and more specifically on indirect outcomes such as return to work and quality of life (QoL). The present study evaluated the long-term effect of a multidisciplinary biopsychosocial rehabilitation (MBR) program for patients with chronic LBP, for which short- and intermediate-term efficacy had been established, with an emphasis on recovering work capability.

Methods

This prospective cohort study enrolled 201 patients on a four-week MBR program incorporating physical and occupational therapies and psychological counselling. Assessments occurred at program admission and discharge and at 6 and 18 months. Work capability, Oswestry Disability Index, Tampa Scale for Kinesiophobia, Core Outcome Measures Index (COMI), and Hospital Anxiety and Depression Scale were assessed. Multiple mixed models were used to detect changes in each outcome. Logistic regressions were calculated to identify predictors of recovery of work capability.

Results

Of the 201 patients who fulfilled the eligibility criteria, 160 (79.8%) attended the discharge assessment, 127 (63.2%) attended the 6-month follow-up, and 107 (53.3%) continued to the 18-month follow-up. Initially, 128 patients (71.5%) had been on sick leave. At 6 and 18 months, 72 (56.7%) and 84 (78.5%) participants had recovered their work capability, respectively. There were significant improvements in pain, disability, kinesiophobia, and anxiety and depression scores over time. Patients who recovered work capability showed significantly greater improvements in their total COMI score, general QoL, and disability, which were the best three predictors of recovering work capability.

Conclusions

This study extends previous results confirming the program’s contribution to recovering work capability among chronic LBP patients.

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Most cited references 22

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The French SF-36 Health Survey: translation, cultural adaptation and preliminary psychometric evaluation.

T Perneger, A Leplege, A Marques Verdier … (1998)

This article reports on the main developmental stages and on the preliminary psychometric assessment of the final French version of the SF-36. A standard forward/backward translation procedure was followed. When translating survey items, the emphasis was placed on conceptual equivalence. When translating response choices, we attempted to select a set of response choices that replicate the U.S. version. The distance between the response choices was checked using visual analogue scales (N = 30). The adaptation procedure also included formal ratings of the difficulty of the translation, of the quality of the translation, and of the equivalence between the American source version and the French target version. The face validity was checked during lay panel sessions at which the translated questionnaire was administered to subjects from the general public, hospital employees, and subjects with a low level of education. Standard psychometric techniques were used to evaluate the cultural adaptation of the SF-36, using data from a general population survey. The main objective of this analysis was to determine how well the scaling assumptions (summated rating or Likert-type scaling construction) of the SF-36 were satisfied. The results support the claim that the scaling properties of the French version of the SF-36 are adequate and that health outcomes may be reliably assessed using this version of the instrument.

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Low back pain and sciatica: summary of NICE guidance.

Ian Bernstein, Qudsia Malik, Serena Carville … (2017)

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Intervention Characteristics that Facilitate Return to Work After Sickness Absence: A Systematic Literature Review

Nicole Hoefsmit, Inge Houkes, Frans Nijhuis (2012)

Introduction In many Western countries, a vast amount of interventions exist that aim to facilitate return to work (RTW) after sickness absence. These interventions are usually focused on specific target populations such as employees with low back pain, stress-related complaints or adjustment disorders. The aim of the present study is to detect and identify characteristics of RTW interventions that generally facilitate return to work (i.e. in multiple target populations and across interventions). This type of knowledge is highly relevant to policy makers and health practitioners who want to deliver evidence based care that supports the employee’s health and participation in labour. Methods We performed a keyword search (systematic literature review) in seven databases (period: 1994–2010). In total, 23 articles were included and assessed for their methodological quality. The characteristics of the interventions were evaluated as well. Results Early interventions, initiated in the first 6 weeks of the RTW process were scarce. These were effective to support RTW though. Multidisciplinary interventions appeared effective to support RTW in multiple target groups (e.g. back pain and adjustment disorders). Time contingent interventions in which activities followed a pre-defined schedule were effective in all physical complaints studied in this review. Activating interventions such as gradual RTW were effective in physical complaints. They have not been studied for people with psychological complaints. Conclusions Early- and multidisciplinary intervention and time-contingent-, activating interventions appear most effective to support RTW.

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Author and article information

Contributors

Maha E. Ibrahim:

ORCID: http://orcid.org/0000-0003-2577-1111

+41 79 737 1813 , maha.ibrahim@med.suez.edu.eg

Kerstin Weber: kerstin.weber@hcuge.ch

Delphine S. Courvoisier: delphine.courvoisier@hcuge.ch

Stéphane Genevay: stephane.genevay@hcuge.ch

Journal

Journal ID (nlm-ta): BMC Musculoskelet Disord

Journal ID (iso-abbrev): BMC Musculoskelet Disord

Title: BMC Musculoskeletal Disorders

Publisher: BioMed Central (London )

ISSN (Electronic): 1471-2474

Publication date (Electronic): 10 October 2019

Publication date PMC-release: 10 October 2019

Publication date Collection: 2019

Volume: 20

Electronic Location Identifier: 439

Affiliations

[1 ]ISNI 0000 0001 0721 9812, GRID grid.150338.c, Division of Rheumatology, , University Hospitals of Geneva, ; Beau Séjour Hospital, CH-1205, 14 Geneva, Switzerland

[2 ]ISNI 0000 0000 9889 5690, GRID grid.33003.33, Department of Physical Medicine, Rheumatology and Rehabilitation, , Suez Canal University, ; Ismailia, Egypt

[3 ]ISNI 0000 0001 0721 9812, GRID grid.150338.c, Medical Direction, , University Hospitals of Geneva, ; Geneva, Switzerland

[4 ]ISNI 0000 0001 0721 9812, GRID grid.150338.c, Quality of Care Service, , University Hospitals of Geneva, ; Geneva, Switzerland

[5 ]ISNI 0000 0001 2322 4988, GRID grid.8591.5, Department of General Internal Medicine, Rehabilitation and Geriatrics, , University of Geneva, ; Geneva, Switzerland

Author information

Maha E. Ibrahim http://orcid.org/0000-0003-2577-1111

Article

Publisher ID: 2831

DOI: 10.1186/s12891-019-2831-6

PMC ID: 6785904

PubMed ID: 31597562

SO-VID: 266eda7c-ed7b-4721-96ac-21c116585e98

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

History

Date received : 1 April 2019

Date accepted : 12 September 2019

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ScienceOpen disciplines: Orthopedics

Keywords: return to work,multidisciplinary rehabilitation,chronic low back pain,work readiness

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ScienceOpen disciplines: Orthopedics

Keywords: return to work, multidisciplinary rehabilitation, chronic low back pain, work readiness

Recovering the capability to work among patients with chronic low Back pain after a four-week, multidisciplinary biopsychosocial rehabilitation program: 18-month follow-up study

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Most cited references 22

The French SF-36 Health Survey: translation, cultural adaptation and preliminary psychometric evaluation.

Low back pain and sciatica: summary of NICE guidance.

Intervention Characteristics that Facilitate Return to Work After Sickness Absence: A Systematic Literature Review

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