Multidisciplinary rehabilitation for subacute low back pain: graded activity or workplace intervention or both? A randomized controlled trial. Multidisciplinary group rehabilitation versus individual physiotherapy for chronic nonspecific low back pain: a randomized trial. Physical performance, pain, pain behavior and subjective disability in patients with subacute low back pain. Multidisciplinary intensive treatment for chronic low back pain: a randomized, prospective study. Evaluation of a specific home exercise program for low back pain. Effectiveness of four conservative treatments for subacute low back pain: a randomized clinical trial. Increasing days at work using function-centered rehabilitation in nonacute nonspecific low back pain: a randomized controlled trial. Mobility, strength, and fitness after a graded activity program for patients with subacute low back pain. A randomized prospective clinical study with a behavioral therapy approach. Relative cost-effectiveness of extensive and light multidisciplinary treatment programs versus treatment as usual for patients with chronic low back pain on long-term sick leave: randomized controlled study.
Population-based randomized controlled trial.
                To assess the effectiveness of workplace intervention and graded activity, separately and combined, for multidisciplinary rehabilitation of low back pain (LBP).
                Effective components for multidisciplinary rehabilitation of LBP are not yet established.
                Participants sick-listed 2 to 6 weeks due to nonspecific LBP were randomized to workplace intervention (n = 96) or usual care (n = 100). Workplace intervention consisted of workplace assessment, work modifications, and case management involving all stakeholders. Participants still sick-listed at 8 weeks were randomized for graded activity (n = 55) or usual care (n = 57). Graded activity comprised biweekly 1-hour exercise sessions based on operant-conditioning principles. Outcomes were lasting return to work, pain intensity and functional status, assessed at baseline, and at 12, 26, and 52 weeks after the start of sick leave.
                Time until return to work for workers with workplace intervention was 77 versus 104 days (median) for workers without this intervention (P = 0.02). Workplace intervention was effective on return to work (hazard ratio = 1.7; 95% CI, 1.2-2.3; P = 0.002). Graded activity had a negative effect on return to work (hazard ratio = 0.4; 95% CI, 0.3-0.6; P < 0.001) and functional status. Combined intervention had no effect.
                Workplace intervention is advised for multidisciplinary rehabilitation of subacute LBP. Graded activity or combined intervention is not advised. A randomized trial.
                To evaluate the effectiveness of a semi-intensive multidisciplinary rehabilitation for patients with chronic low back pain in an outpatient setting.
                Systematic reviews have shown that there is strong evidence that intensive multidisciplinary treatment (>100 hours), which includes functional restoration, improves function among chronic patients with low back pain, and moderate evidence that it reduces pain but contradictory evidence regarding improvement of working ability. However, there is paucity of data whether semi-intensive outpatient multidisciplinary rehabilitation in groups is more effective than individual physiotherapy.
                A total of 120 women employed as healthcare and social care professionals with nonspecific chronic low back pain were recruited from two occupational healthcare centers. The patients were randomized into two intervention programs. Multidisciplinary rehabilitation (n = 59) was conducted in groups and comprised of physical training, workplace interventions, back school, relaxation training, and cognitive-behavioral stress management methods for 70 hours. The individual physiotherapy (n = 61) included physical exercise and passive treatment methods administered for 10 hours. Main outcome measures were: back pain and sciatic pain intensity, disability, sick leaves, healthcare consumption, symptoms of depression, and beliefs of working ability after 2 years.
                There were no statistically significant differences between the two treatment groups in main outcome measures just after rehabilitation, at 6-, at 12-, or 24-month follow-up. In both intervention arms, however, the before-and-after comparison showed favorable effects, and the effects were still maintained at 2 years follow-up.
                The results of this study indicate that semilight outpatient multidisciplinary rehabilitation program for female chronic low back pain patients does not offer incremental benefits when compared with rehabilitation carried out by a physiotherapist having a cognitive-behavioral way of administering the treatment. The aim of this paper was to study the physical performance, pain, pain behavior and disability in patients with subacute low back pain (LBP). The patients were blue-collar workers and had been sick-listed for 8 weeks due to subacute low back pain. A total of 103 patients were randomized, 51 of them to the intervention group and the other to a control group. Recordings of physical performance and complaints of LBP were done before and after treatment in the intervention group. The proportion of patients with no complaints of LBP was significantly greater in the intervention group than in the control group at the one-year follow-up. The patients who intra-individually improved their physical performance also intra-individually decreased their complaints of LBP. The intra-individual improvements were suggested to be important for the individual return to work. Americans with low back pain have been helped to return to work by multidisciplinary intensive treatment programs. Whether this treatment method will succeed in countries with a more generous social welfare system, where the incentive to return to work might be less, is not proven.
                To evaluate a Danish program of functional restoration combined with behavioral support.
                Patients who had experienced at least 6 months of disabling low back pain were randomly assigned to either a 3-week intensive treatment program (n = 55) or an untreated control group (n = 51).
                Of the 106 patients randomized, 94 (89%) returned for a 4-month follow-up visit. At that time, 29 (64%) of the 45 treated patients were able to work, compared with 14 of 49 (29%) in the control group. The treated patients had used fewer days of sick leave (P < .02), had contacted health care. professionals fewer times (P < .001), and had lower pain and disability scores.
                Although such programs are expensive, they can reduce pension expenditures, sick leave days, health care contacts, and pain. The prescription of exercise as a conservative treatment for lumbar pain is frequent and seems effective for the chronic cases of nonspecific low back pain. However, there is no evidence favoring one type of exercise over another. Often, exercise programs are prescribed without adequate evaluation of the individual characteristics like posture, muscular force, and extensibility. Patients with totally different causes of low back pain will often be given the same type of exercises.
                Our objective was to compare the effectiveness of 2 home exercise programs in decreasing disability and pain related to subacute and chronic nonspecific low back pain. To do so we compared a specific (individualized) exercise program with a program of commonly prescribed exercises for low back pain.
                In a control group study, 20 patients with chronic or subacute nonspecific low back pain participated after giving their informed consent. All subjects were evaluated (physical evaluation of lumbar and pelvic muscles [1] force and [2] extensibility, [3] trunk range of motion) and then divided in 2 groups: 10 patients received specific exercises (experimental group) based on their evaluation, and 10 patients received a commonly prescribed exercise program for low back pain (control group). Six weeks later a second physical evaluation was conducted. Pain (visual analog pain scale) and disability (modified Oswestry) questionnaires were also completed by each subject at both evaluations.
                This was a randomized experimental study.
                Both groups had similar age, weight, and sex characteristics. The experimental group showed significant improvements for some components targeted by the program. The control group significantly had improvement of some physical characteristics not related to their initial deficits. Even if both groups showed some improvements in muscular force and extensibility, only the members of the group who received specific exercises significantly reduced their level of pain and disability. Both groups showed a similar rate of participation in the program.
                The results of this study suggest that applying a specific physical evaluation and exercise prescription is an appropriate treatment for people having subacute or chronic nonspecific pain. Thus clinicians should prescribe exercise programs based on individual muscular deficits rather than most commonly prescribed exercise programs. A randomized, assessor-blinded clinical trial was conducted.
                To investigate the relative effectiveness of three manual treatments and back school for patients with subacute low back pain.
                Literature comparing the relative effectiveness of specific therapies for low back pain is limited.
                Among the 5925 inquiries, 206 patients met the specific admission criteria, and 200 patients randomly received one of four treatments for 3 weeks: back school, joint manipulation, myofascial therapy, and combined joint manipulation and myofascial therapy. These patients received assessments at baseline, after 3 weeks of therapy, and 6 months after the completion of therapy. The primary outcomes were evaluated using visual analog pain scales and Roland-Morris activity scales.
                All four groups showed significant improvement in pain and activity scores after 3 weeks of care, but did not show further significant improvement at the 6-month follow-up assessment. No statistically significant between-group differences were found either at the 3-week or 6-month reassessments.
                For subacute low back pain, combined joint manipulation and myofascial therapy was as effective as joint manipulation or myofascial therapy alone. Additionally, back school was as effective as three manual treatments. To evaluate the effect of function-centered compared with pain-centered inpatient rehabilitation in patients whose absence from work is due to chronic nonspecific low back pain (LBP).
                Single-blinded randomized controlled trial with follow-up assessments immediately after treatment and at 3 months.
                Center for work rehabilitation in Switzerland.
                Patients with more than 6 weeks of work absence due to chronic nonspecific LBP (N=174; 137 men, 37 women; mean age +/- standard deviation, 42+/-8 y; mean sick leave before study, 6.5 mo).
                Function-centered treatment (FCT) (4h/d, 6d/wk, for 3 wk) consisted of work simulation, strength, endurance, and cardiovascular training. Pain-centered treatment (PCT) (2.5h/d, 6d/wk, for 3 wk) used a mini back school, individually selected passive and active mobilization, stretching, and low-intensity strength training.
                The number of days at work in 3 months after treatment, self-efficacy, lifting capacity, pain, mobility, strength, and global perceived effect. Effect sizes (ESs) (Cohen d ) were defined as small (ES range, 0.2-0.5), moderate (ES range, 0.5-0.8), and large (ES, >0.8).
                Groups were comparable at baseline. Moderate ESs for the FCT group versus PCT group were found for days at work (25.9 d vs 15.8d, ES=.36, P =.029), self-efficacy (5.9 points vs -7.4 points, ES=.55, P =.003), and lifting capacity (2.3 kg vs 0.2 kg, ES=.54, P =.004).
                Function-centered rehabilitation increases the number of work days, self-efficacy, and lifting capacity in patients with nonacute nonspecific LBP. Patients with nonspecific mechanical low back pain (n = 103), examined by an orthopaedic surgeon and a social worker, were randomized to an activity group (n = 51) and a control group (n = 52). Patients with defined orthopaedic, medical, or psychiatric diagnoses were excluded before randomization. No patients were excluded due to place of birth or difficulties in speaking or understanding the Swedish language. The purpose of the study was to compare mobility, strength and fitness after traditional care and after traditional care plus a graded activity program with a behavioral therapy approach. A graded activity program, with a behavioral therapy approach was given under the guidance of a physical therapist. The endpoint of the graded activity program was return to work. This program significantly increased mobility, strength, and fitness more than could be explained by only a time recovery effect, especially in males. The patients in the activity group returned to work earlier than did the patients in the control group. Spinal rotation, abdominal muscle endurance time and lifting capacity were significantly correlated to rate of return to work. Traditional care plus a graded activity program were superior to only traditional care, evaluated in terms of mobility, strength and fitness. The graded activity program proved to be a successful method of restoring occupational function and facilitating return to work in subacute low back pain patients. The patients in the graded activity program learned that it is safe to move, while regaining function. A subgroup of 195 patients with chronic low back pain, being part of a larger study of other musculoskeletal patients, were included in a randomized controlled prospective clinical study.
                To evaluate the outcome in terms of return to work and cost-effectiveness of a light multidisciplinary treatment program with an extensive multidisciplinary program and treatment as usual initiated by their general practitioner.
                Light multidisciplinary programs seem to reduce sick leave in patients with subacute low back pain. There are few, if any, previous studies of the effectiveness of light versus extensive multidisciplinary treatment on return to work in patients with chronic low back pain.
                Patients with chronic low back pain (n = 195), on an average sick-listed for 3 months, were included. The patients were randomized to a light multidisciplinary treatment program, an extensive multidisciplinary program, or treatment as usual by their primary physician. Full return to work was used as outcome response, and follow-up was 26 months after the end of treatment. Cost-benefit was calculated for the treatment programs.
                In men significantly better results for full return to work were found for the light multidisciplinary treatment compared with treatment as usual, but no differences were found between extensive multidisciplinary treatment and treatment as usual. No significant differences between any of the two multidisciplinary treatment programs and the controls were found for women. Productivity gains for the society from light multidisciplinary treatment versus "treatment as usual" of 57 male patients with low back pain would during the first 2 years accumulate to U.S. $852.000.
                The light multidisciplinary treatment model is a cost-effective treatment for men with chronic low back pain.
We conclude that there is moderate evidence of positive effectiveness of multidisciplinary rehabilitation for subacute low back pain and that a workplace visit increases the effectiveness. But because this evidence is based on trials that had some methodological shortcomings, and several expensive multidisciplinary rehabilitation programmes are commonly used for uncomplicated/non-specific subacute low back problems, there is an obvious need for high quality trials in this field.