Over 20 years of experience of a multidisciplinary programme for rehabilitation of chronic low back pain: factors predicting successful reintegration and return to work

Abstract

Purpose: Low back pain (LBP) is highly disabling with significant health cost worldwide. Since 1996, we have adopted a 14-week intensive multidisciplinary programme targeting patients with chronic LBP, providing functional rehabilitation and reintegration back to the society. This study aims to identify factors predicting successful return to work. Materials and Methods: 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 standing, standing and walking tolerance, straight leg raise test, Oswestry Disability Index (ODI), and Spinal Function Sort Score (SFSS). Results: One hundred and ninety-one 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, and performance in straight leg raising test all improved significantly (p<0.01). After training, 41.9% of the patients met their work demand. Multivariate logistic regression model showed gender and initial job demand (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. Conclusion: This programme is effective in improving outcomes of patients with chronic LBP. There was significant improvement in physical tolerance of daily activities despite persistent negative cognition and low mood. However, they were more accepting towards chronic LBP, and enjoyed better general well-being. Male patients with higher job demand were more likely to return to their work. From our data, we have constructed a viable tool to determine patients most suitable for this intensive rehabilitation programme.