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European Journal of Physical and Rehabilitation Medicine 2021 December;57(6):959-67

DOI: 10.23736/S1973-9087.21.06696-X

Copyright © 2021 EDIZIONI MINERVA MEDICA

lingua: Inglese

Multidisciplinary program based on early management of psychological factors reduces disability of patients with subacute low back pain: one-year results of a randomized controlled study

Marco MONTICONE 1, 2 , Emilia AMBROSINI 3, Igor PORTOGHESE 1, Barbara ROCCA 4

1 Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy; 2 Unit of Neurorehabilitation, Department of Neuroscience and Rehabilitation, G. Brotzu Hospital, Cagliari, Italy; 3 Laboratory of Neuroengineering and Medical Robotics, Department of Electronics, Information and Bioengineering, Polytechnic University Milano, Milan, Italy; 4 Unit of Physical Medicine and Rehabilitation, Scientific Institute of Lissone, Maugeri Clinical and Scientific Institutes, Lissone, Monza Brianza, Italy



BACKGROUND: Multidisciplinary rehabilitation induces disability improvement, pain reduction and favors return-to-work in patients with subacute low back pain (LBP). Current research advises additional high-quality trials.
AIM: The aim of this study is to test the effect of a multidisciplinary rehabilitative program incorporating cognitive-behavioral 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: One hundred and fifty patients with subacute LBP.
METHODS: Patients were assigned randomly to a 10-week individual-based multimodal program of task-oriented exercises integrated with cognitive-behavioral 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 favor 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.
CLINICAL REHABILITATION IMPACT: Treatment of subacute LBP requires cognitive modifications closely linked to physical performances in order to achieve mental adjustments and guarantee cognitive-behavioral and motor lasting changes.


KEY WORDS: Disability evaluation; Pain perception; Psychological adaptation; Exercise; Cognitive behavioral therapy

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