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Multidisciplinary program based on early management of psychological factors reduces disability of patients with subacute low back pain. Results of a randomised controlled study with one year follow-up [with consumer summary]
Monticone M, Ambrosini E, Portoghese I, Rocca B
European Journal of Physical and Rehabilitation Medicine 2021 Dec;57(6):959-967
clinical trial
7/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: Yes; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: No; Adequate follow-up: Yes; Intention-to-treat analysis: Yes; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

BACKGROUND: Multidisciplinary rehabilitation induces disability improvement, pain reduction and favours return-to-work in patients with subacute low back pain (LBP). Current research advises additional high-quality trials. AIM: To test the effect of a multidisciplinary rehabilitative programme incorporating cognitivebehavioural interventions compared to general physiotherapy alone to treat subacute LBP, and to appraise its long-term extent. DESIGN: Randomised parallel-group superiority-controlled trial. SETTING: Outpatient rehabilitation hospital. POPULATION: 150 patients with subacute LBP. METHODS: Patients were assigned randomly to a 10-week individual-based multimodal programme of task-oriented exercises integrated with cognitive-behavioural therapy (experimental group, 75 patients) or individual-based general physiotherapy (control group, 75 patients). Before treatment, 10 weeks later (post-treatment), and 12 months after treatment, the staff administered the Oswestry Disability Index (ODI, primary outcome), a pain intensity numerical rating scale (NRS), the Tampa Scale for Kinesiophobia (TSK), the Pain Beliefs and Perception Inventory (PBAPI), the Hospital and Anxiety Depression Score (HADS) and the Coping Strategies Questionnaire-revised (CSQ-R). Linear mixed model analysis for repeated measures was carried out for each outcome measure. RESULTS: Significant group (p < 0.001), time (p = 0.002), and time-by-group interaction (p < 0.001) effects were found for ODI, with a between-group difference (standard error) after training of 11.5 (1.0) and at follow-up of 15.7 (0.9), in favour of the experimental group. A significant interaction effect (p < 0.001) was found for all secondary outcome measures, with significantly greater improvements in the experimental group, after rehabilitation and at follow-up. CONCLUSIONS: The multidisciplinary intervention was superior to general physiotherapy in reducing disability, pain, psychological factors and coping strategies of patients with subacute LBP. The effects were reinforced after one year.

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