Over 20-years of experience of a multidisciplinary programme for rehabilitation of chronic low back pain – factors predicting successful re-integration and return to work

Abstract

Introduction: Low back pain (LBP) is highly disabling with significant health cost worldwide and in Hong Kong. Since 1996, we have adopted a 14-week intensive multidisciplinary programme targeting patients with chronic LBP, providing functional rehabilitation aiming at re-integration back to the society. This study aims to review its outcomes, as well as to identify factors predicting successful return to work. Methodology: This is an assessment of a prospectively collected cohort of chronic LBP patients consecutively enrolled into the programme from 1996–2014. Rigorous pre-admission assessment was performed to identify patients with functional deficits while excluding patients with surgically treatable diseases or psychological disorders. All recruited patients failed to return to work previously despite a prolonged period of conservative treatment. Assessments were performed at baseline, 8-weeks and 14-weeks for sitting, standing and walking tolerance, and straight leg raise test, Oswestry Disability Index (ODI) and Spinal Function Sort Score (SFSS). Results and Analysis: 191 patients were recruited. Significant improvement was found in ODI (46.9 to 43.9, p<0.05) and SFSS (98.3 to 108.1, p<0.05). Sitting, standing, walking tolerance, performance in straight leg raising test all improved significantly (p<0.01). After training, 41.9% of patients met their work demand. Multivariate logistic regression model showed gender and initial job demand level (by Physical Demands Classification) correlated with meeting work demand level (R2=62.4%). Male Patients were 5.92 times (p<0.05) more likely to meet work demand level. Discussion and Conclusion: This staple multidisciplinary programme has been effective in re-integrating patients back to work by improving self-perceived disability. Predictors of good outcome included male gender and lower initial job demand level.