PREDICTION OF SUCCESS FROM A MULTIDISCIPLINARY TREATMENT PROGRAM FOR CHRONIC LOW-BACK-PAIN

Study Design. The study included 90 disabled patients with chronic low back pain recruited from a pain clinic who were admitted to an 8-week program of functional restoration and behavioral support. Initial eva luations included a medical examination, rating of the physical impair ment, a personal interview, a visual analogue scale to record pain int ensity, an assessment of limitations for daily activities, a pain disa bility index,a depression and psychovegetative scale, and a scale to e valuate general living standards. The physical assessment included dif ferent flexibility measurements, measurement of power and endurance th rough standardized exercises, and measurements of isokinetic trunk and lifting strength and general endurance. The measurements were repeale d at the end of the 8-week program and thereafter al intervals of 6 an d 12 months. Final analyses were carried out on 82 patients. Objective s. To determine whether objective or subjective signs most influence t he outcome of rehabilitation. Summary of Background Data. In recent ye ars, several studies have shown that active and intensive multimodal t reatment of chronic low back pain is successful. Until now there has b een lack of information about which patients will respond to the thera py and what is the most effective part of treatment. Methods. Prognost ic factors (return to work, pain intensity, self-assessment of treatme nt success by pa tients) were tested by studying variance and regressi on analyses for their ability to predict treatment outcome. Results. C ertain factors were identified that had a significant impact on determ ining the probability of a patient's return to work and the reduction of pain intensity. These factors included self-evaluation for predicti ng a return to work, the length of absence from work, application for pension, and a decrease in disability after treatment. Overall satisfa ction with treatment was best determined by the number of medical cons ultations before treatment, the extent of disability, previous measure s taken for coping with the disease, and reduction of disability durin g treatment. Medical background, medical diagnosis, and physical impai rment had no predictive value, Physical variables (ie., mobility, stre ngth, endurance, and physical performance) also demonstrated only limi ted predictive value. Conclusion. This study has demonstrated that the most important variable in determining a successful treatment of chro nic low back pain is the reduction of subjective feelings of disabilit y in patients.