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.

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.