Daily functioning and self-management in patients with chronic low back pain after an intensive cognitive behavioral programme for pain management

• Published in: European spine journal Vol. 19; no. 9; pp. 1517 - 1526
• Main Authors: van Hooff, Miranda L., van der Merwe, Johannes D., O’Dowd, John, Pavlov, Paul W., Spruit, Maarten, de Kleuver, Marinus, van Limbeek, Jacques
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer-Verlag 01.09.2010; Springer Nature B.V
• Subjects: Adult; Chronic Disease; Cognitive Behavioral Therapy - methods; Cohort Studies; Disability Evaluation; Female; Humans; Low Back Pain - rehabilitation; Male; Medicine; Medicine & Public Health; Middle Aged; Neurosurgery; Original; Original Article; Outcome Assessment, Health Care - methods; Quality of Life; Recovery of Function; Self Care - methods; Surgical Orthopedics; Surveys and Questionnaires; Young Adult; Disability; Self-management; Chronic low back pain; Clinical relevance; Cognitive behavioral programme; Cohort study
• DOI: 10.1007/s00586-010-1435-5
• ISSN: 0940-6719

Chronic low back pain (CLBP) is associated with persistent or recurrent disability which results in high costs for society. Cognitive behavioral treatments produce clinically relevant benefits for patients with CLBP. Nevertheless, no clear evidence for the most appropriate intervention is yet available. The purpose of this study is to evaluate the mid-term effects of treatment in a cohort of patients with CLBP participating in an intensive pain management programme. The programme provided by RealHealth-Netherlands is based on cognitive behavioral principles and executed in collaboration with orthopedic surgeons. Main outcome parameters were daily functioning (Roland and Morris Disability Questionnaire and Oswestry Disability Questionnaire), self-efficacy (Pain Self-Efficacy Questionnaire) and quality of life (Short Form 36 Physical Component Score). All parameters were measured at baseline, last day of residential programme and at 1 and 12 months follow-up. Repeated measures analysis was applied to examine changes over time. Clinical relevance was examined using minimal clinical important differences (MCID) estimates for main outcomes. To compare results with literature effect sizes (Cohen’s d ) and Standardized Morbidity Ratios (SMR) were determined. 107 patients with CLBP participated in this programme. Mean scores on outcome measures showed a similar pattern: improvement after residential programme and maintenance of results over time. Effect sizes were 0.9 for functioning, 0.8 for self-efficacy and 1.3 for physical functioning related quality of life. Clinical relevancy: 79% reached MCID on functioning, 53% on self-efficacy and 80% on quality of life. Study results on functioning were found to be 36% better and 2% worse when related to previous research on, respectively, rehabilitation programmes and spinal surgery for similar conditions (SMR 136 and 98%, respectively). The participants of this evidence-based programme learned to manage CLBP, improved in daily functioning and quality of life. The study results are meaningful and comparable with results of spinal surgery and even better than results from less intensive rehabilitation programmes.