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What predicts outcome in non-operative treatments of chronic low back pain? A systematic review

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Abstract

Systematic reviews have shown that as non-operative treatments exercise, behavioural and multimodal treatment programs are effective for chronic low back pain. There is, however, a lack of knowledge concerning the association between changes in treatment process variables and changes in outcome for the three treatment forms. The objective of this systematic review was to evaluate which changes in treatment process variables predict outcome of exercise, behavioural and multimodal treatment of chronic low back pain. Medline, Embase and PsychInfo were systematically searched. A descriptive analysis was used to summarize the results regarding the outcomes pain, disability and return to work (RTW). 13 studies were identified. The results showed that functional coping mechanisms and pain reduction were associated with a decrease in disability and increase in RTW, and physical performance factors were not. Related to pain reduction decreases in disability, functional coping mechanisms as well as physical performance factors were associated. Strong conclusions cannot be drawn from this review, because of the heterogeneity and the limited number of studies. The results of this review raise the question if changes in behavioural variables and reductions of disability which facilitate an improvement in function, may be more important than physical performance factors for successful treatment of chronic low back pain. This is relevant for the refinement of future treatment programs.

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References

  1. Altmaier EM, Russell DW, Kao CF et al (1993) Role of self-efficacy in rehabilitation outcome among chronic low back pain patients. J Consult Clin Psychol 40:335–339

    Google Scholar 

  2. Ariëns GA, van Mechelen W, Bongers P et al (2001) Psychosocial risk factors for neck pain: a systematic review. Am J Ind Med 39:180–193

    Article  PubMed  Google Scholar 

  3. Borghouts JA, Koes B, Bouter LM (1998) The clinical course and prognostic factors of non-specific neck pain: a systematic review. Pain 77:1–13

    Article  PubMed  CAS  Google Scholar 

  4. Burton AK, Tillotson KM, Main CJ et al (1995) Psychosocial predictors of outcome in acute and subchronic low back pain. Spine 20:722–728

    Article  PubMed  CAS  Google Scholar 

  5. Cassisi JE, Robinson ME, O´Connor P et al (1993) Trunk strength and lumbar paraspinal muscle activity during isometric exercise in chronic-low back pain. Spine 18:245–251

    Article  PubMed  CAS  Google Scholar 

  6. Christensen FB, Laurberg I, Bünger C (2003) Importance of the back-café concept to rehabilitation after lumbal spinal fusion: a randomised clinical study with a 2-year follow up. Spine 28:2561–2569

    Article  PubMed  Google Scholar 

  7. Dozois DJ, Dobson KS, Wong M et al (1995) Factors associated with rehabilitation outcome in patients with low back pain (LBP): Prediction of employment outcome at 9-month follow-up. Rehabil Psychol 40:243–259

    Article  Google Scholar 

  8. Fisher K, Johnston M (1998) Emotional distress and control cognitions as mediators of the impact of chronic pain on disability. Br J Health Psychol 3:225–236

    Google Scholar 

  9. Gatchel RJ, Polatin PB, Mayer TG (1995) The dominant role of psychosocial risk factors in the development of chronic low back pain disability. Spine 20:2702–2709

    Article  PubMed  CAS  Google Scholar 

  10. Guzman J, Esmail R, Karjalainen K et al (2004) Multidisciplinary bio-psycho-social rehabilitation for chronic low back pain. (Cochrane Review). In: The Cochrane Library, Issue 3. Wiley, Chichester

  11. Hasenbring M (1998) Predictors of efficacy in treatment of chronic low back pain. Curr Opin Anaesthesiol 11:553–558

    Article  PubMed  CAS  Google Scholar 

  12. Hildebrandt J, Pfingsten M, Saur P et al (1997) Prediction of success from a multidisciplinary treatment program for chronic low back pain. Spine 22:990–1001

    Article  PubMed  CAS  Google Scholar 

  13. Hoogendorn WE, Van Poppel MN, Bongers P et al (2000) Systematic review of psychosocial factors at work and private life as risk factors for back pain. Spine 25:2114–2125

    Article  PubMed  Google Scholar 

  14. Hythornthwaite JA, Sieber WJ, Kerns RD (1991) Depression and the chronic pain experience. Pain 46:177–184

    Article  PubMed  Google Scholar 

  15. Jensen MP, Turner JA, Romano JM (1994) Correlates of improvement in multidisciplinary treatment of chronic pain. J Consult Clin Psychol 62:172–179

    Article  PubMed  CAS  Google Scholar 

  16. Jüni P, Witschi A, Bloch R et al (1999) The hazards of scoring the quality of clinical trials for meta-analysis. JAMA 282:1054–1060

    Article  PubMed  Google Scholar 

  17. Käser L, Mannion AF, Rhyner A et al (2001) Active therapy for chronic low back pain. Part 2: Effects on paraspinal muscle cross-sectional area, fiber type size, and distribution. Spine 26:909–919

    Article  PubMed  Google Scholar 

  18. Karjalainen K, Malmivaara A, van Tulder M (2004) Multidisciplinary rehabilitation for subacute low back pain among working age adults (Cochrane review). In: The Cochrane library, Issue 2. Wiley, Chichester

  19. Kerns RD, Rosenberg R (2000) Predicting response to self-management treatments for chronic pain: application of the pain stages of change model. Pain 84:49–55

    Article  PubMed  CAS  Google Scholar 

  20. Klaber Moffett JA, Carr J, Howarth E (2004) High fear-avoiders of physical activity benefit from an exercise program for patients with back pain. Spine 29:1167–1173

    Article  PubMed  Google Scholar 

  21. Koopman FS, Edelaar M, Slikker R et al (2004) Effectiveness of a multidisciplinary occupational training program for chronic low back pain: a prospective cohort study. Am J Phys Med Rehabil 8:94–103

    Article  Google Scholar 

  22. Latimer J, Maher CG, Refshauge K et al (1999) The reliability and validity of the Biering-Sørensen test in asymptomatic subjects and subjects reporting current or previous non-specific low back pain. Spine 24:2085–2089

    Article  PubMed  CAS  Google Scholar 

  23. Le Fort SM, Hannah TW (1994) Return to work following an aquafitness and muscle strengthening program for the low back injured. Arch Phys Med Rehabil 75:1247–1255

    Article  PubMed  CAS  Google Scholar 

  24. Lehmann TR, Brand RA, Gorman TW (1983) A low-back rating scale. Spine 8:305–315

    Article  PubMed  Google Scholar 

  25. Lethem J, Slade PD, Troup JD et al (1983) Outline of a fear-avoidance model of exaggerated pain perceptions. Behav Res Ther 21:401–408

    Article  PubMed  CAS  Google Scholar 

  26. Linton SJ (2000) A review of psychological risk factors in back and neck pain. Spine 25:1148–1156

    Article  PubMed  CAS  Google Scholar 

  27. Linton SJ (1994) The role of psychological factors in back pain and its remediation. Pain Rev 1:231–243

    Google Scholar 

  28. Manniche C, Lundberg E, Christensen I et al (1983) Intensive dynamic back exercises with or without hyperextension in chronic back pain after surgery for lumbar disc protrusion. Spine 18:560–567

    Article  Google Scholar 

  29. Mannion A, Müntener M, Taimela S et al (1999) A randomised clinical trial of three active therapies fore chronic low back pain. Spine 24:2435–2448

    Article  PubMed  CAS  Google Scholar 

  30. Mannion AF, Dvorak J, Taimela S et al (2001) Kraftzuwachs nach aktiver Therapie bei Patienten mit chronischen Rückenschmerzen (LBP). Schmerz 15:468–473

    Article  PubMed  CAS  Google Scholar 

  31. Mannion AF, Junge A, Simo T et al (2001) Active therapy for chronic low back pain: part 3. Factors influencing self-rated disability and its change following therapy. Spine 26:920–929

    Article  PubMed  CAS  Google Scholar 

  32. Mayer T, Gatchel RJ, Keeley J et al (1994) A male incumbant worker industrial database. Part 1: Lumbar spinal physical capacity. Spine 19:755–761

    PubMed  CAS  Google Scholar 

  33. McCracken LM, Gross RT, Eccleston C et al (2002) Multimethod assessment of treatment process in chronic low back pain: comparison of reported pain-related anxiety with directly measured physical capacity. Behav Res Ther 40:585–594

    Article  PubMed  CAS  Google Scholar 

  34. McCracken LM, Turk DC (2002) Behavioral and cognitive-behavioral treatment for chronic pain – outcomes, predictors of outcome and treatment process. Spine 27:2564–2573

    Article  PubMed  Google Scholar 

  35. Mellin G, Härkäpää K, Vanharanta H et al (1993) Outcome of a multimodal treatment including intensive physical training of patients with chronic low back pain. Spine 18:825–829

    Article  PubMed  CAS  Google Scholar 

  36. Morley S, Eccleston C, Williams A (1999) Systematic review and meta-analysis of randomised controlled trials of cognitive behavior therapy and behavior therapy for chronic pain in adults, excluding headache. Pain 80:1–13

    Article  PubMed  CAS  Google Scholar 

  37. Pfingsten M, Hildebrandt J, Leibing E et al (1997) Effectiveness of a multimodal treatment program for chronic low-back pain. Pain 73:77–85

    Article  PubMed  CAS  Google Scholar 

  38. Pfingsten M, Hildebrandt J, Saur P et al (1997) Das Göttinger Rücken Intensiv Programm (GRIP). Ein multimodales Behandlungsprogramm für Patienten mit chronischen Rückenschmerzen. Teil 4 Prognostik und Fazit. Schmerz 11:30–41

    Article  PubMed  CAS  Google Scholar 

  39. Rainville J, Ahern DK, Phalen L et al (1992) The association of pain with physical activities in chronic low back pain. Spine 17:1060–1064

    Article  PubMed  CAS  Google Scholar 

  40. Robert JJ, Blide RW, McWorther K et al (1995) The effects of a work hardening program on cardiovascular fitness and muscular strength. Spine 20:1187–1193

    Article  PubMed  CAS  Google Scholar 

  41. Spinhoven P, Linssen AC (1991) Behavioral treatment of chronic low back pain. I. Relation of coping strategy use to outcome. Pain 45:29–34

    Article  PubMed  CAS  Google Scholar 

  42. Strategier LD, Chwalisz K, Altmaier EM et al (1997) Multidimensional assessment of chronic low back pain: predicting treatment outcomes. J Clin Psychol Med Settings 4:91–110

    Article  Google Scholar 

  43. Stucki G, Ewert T, Cieza A (2003) Value and application of the ICF in rehabilitation medicine. Disabil Rehabil 25:628–634

    Article  PubMed  Google Scholar 

  44. Sullivan MJ, Stanish WD (2003) Psychologically based occupational rehabilitation: the pain-disability prevention program. Clin J Pain 19:97–104

    Article  PubMed  Google Scholar 

  45. Van Tulder MW, Koes B, Bombardier C (2002) Low back pain. Best Pract Res Clin Rheumatol 16:761–775

    Article  PubMed  Google Scholar 

  46. Van Tulder MW, Malmivaara A, Esmail R et al (2004) Exercise therapy for low back pain (Cochrane Review)1. In: The Cochrane Library, Issue 3. Wiley, Chichester

  47. Van Tulder MW, Ostelo RW, Vlaeyen JW et al (2004) Behavioural treatment for chronic low back pain. (Cochrane Review)2. In: The Cochrane Library, Issue 3. Wiley, Chichester

  48. Vlaeyen JW, Kole-Snijders AM, Boeren RG et al (1995) Fear of movement/(re)injury in chronic low back pain and its relation to behavioural performance. Pain 62:363–372

    Article  PubMed  CAS  Google Scholar 

  49. Vlaeyen JW, Linton SJ (2000) Fear-avoidance and its consequences in chronic musculoskeletal pain: a state of the art. Pain 85:317–332

    Article  PubMed  CAS  Google Scholar 

  50. Vlaeyen JW, Morley S (2005) Cognitive-behavioral treatments for chronic pain. What works for whom. Clin J Pain 21:1–8

    Article  PubMed  Google Scholar 

  51. Waddell G, Burton K (2004) Occupational health guidelines. In: Waddell G (ed) The back pain revolution. Churchill Livingstone, Edinburgh

    Google Scholar 

  52. Waddell G, Newton M, Henderson I et al (1993) A fear-avoidance belief questionnaire (FABQ) and the role of fear-avoidance beliefs in chronic low back pain and disability. Pain 52:157–168

    Article  PubMed  CAS  Google Scholar 

  53. Waddell G, Somerville D, Henderson I et al (1992) Objective clinical evaluation of physical impairment in chronic low back pain. Spine 17:617–628

    Article  PubMed  CAS  Google Scholar 

  54. Waddell G (2004) The biopsychosocial model. In: Waddell G (ed) The back pain revolution. Churchill Livingston, Edinburgh

    Google Scholar 

  55. WHO (2000) International classification of functioning, disability and health (ICF). World Health Organization, Geneva

    Google Scholar 

  56. Woby SR, Watson PJ, Roach NK et al (2004) Adjustment to chronic low back pain—the relative influence of fear-avoidance beliefs, catastrophizing and appraisals of control. Behav Res Ther 42:761–774

    Article  PubMed  Google Scholar 

  57. Woby SR, Watson PJ, Roach NK et al (2004) Are changes in fear-avoidance beliefs, catastrophizing, and appraisals of control predictive of changes in chronic low back pain and disability? Eur J Pain 8:201–210

    Article  PubMed  Google Scholar 

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Acknowledgements

This article was written as part of a dissertation to achieve a doctoral degree at the Ludwig-Maximilians University, Munich.

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Authors and Affiliations

  1. Department of Physical Medicine and Rehabilitation, Ludwig-Maximilans University, Marchioninistr. 15, 81377, Munich, Germany

    Tina Wessels, Tanja Sigl, Thomas Ewert, Heribert Limm & Gerold Stucki

  2. Institute for Research in Extramural Medicine, VU University Medical Center, Amsterdam, The Netherlands

    Maurits van Tulder

  3. Institute for Health Sciences, VU University, Amsterdam, The Netherlands

    Maurits van Tulder

Authors
  1. Tina Wessels
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  2. Maurits van Tulder
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  3. Tanja Sigl
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  4. Thomas Ewert
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  6. Gerold Stucki
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Corresponding author

Correspondence to Gerold Stucki.

Additional information

This work was part of a founded project by the german federal ministry for health and social security. (Grant No. 124-43164-1/527).

Appendix

Appendix

Table 5, Table 6, Table 7

Table 5 Treatment process variables predicting reduction in pain
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Table 6 Treatment process variables predicting reduction in disability
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Table 7 Treatment process variables predicting return to work
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Wessels, T., van Tulder, M., Sigl, T. et al. What predicts outcome in non-operative treatments of chronic low back pain? A systematic review. Eur Spine J 15, 1633–1644 (2006). https://doi.org/10.1007/s00586-006-0073-4

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