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Prediction of Success From a Multidisciplinary Treatment Program for Chronic Low Back Pain

Hildebrandt, Jan, MD*; Pfingsten, Michael, PhD*; Saur, Petra, MD*; Jansen, Jürgen, MD, PhD†*

Functional Restoration

Study Design. The study included 90 disabled patients with chronic low back pain recruited from a pain clinic who were admitted to an 8-week program of functional restoration and behavioral support. Initial evaluations included a medical examination, rating of the physical impairment, a personal interview, a visual analogue scale to record pain intensity, an assessment of limitations for daily activities, a pain disability index, a depression and psychovegetative scale, and a scale to evaluate general living standards. The physical assessment included different flexibility measurements, measurement of power and endurance through standardized exercises, and measurements of isokinetic trunk and lifting strength and general endurance. The measurements were repeated at the end of the 8-week program and thereafter at intervals of 6 and 12 months. Final analyses were carried out on 82 patients.

Objectives. To determine whether objective or subjective signs most influence the outcome of rehabilitation.

Summary of Background Data. In recent years, several studies have shown that active and intensive multimodal treatment of chronic low back pain is successful. Until now there has been lack of information about which patients will respond to the therapy and what is the most effective part of treatment.

Methods. Prognostic factors (return to work, pain intensity, self-assessment of treatment success by patients) were tested by studying variance and regression analyses for their ability to predict treatment outcome.

Results. Certain factors were identified that had a significant impact on determining the probability of a patient's return to work and the reduction of pain intensity. These factors included self-evaluation for predicting a return to work, the length of absence from work, application for pension, and a decrease in disability after treatment. Overall satisfaction with treatment was best determined by the number of medical consultations before treatment, the extent of disability, previous measures taken for coping with the disease, and reduction of disability during treatment. Medical background, medical diagnosis, and physical impairment had no predictive value. Physical variables (i.e., mobility, strength, endurance, and physical performance) also demonstrated only limited predictive value.

Conclusion. This study has demonstrated that the most important variable in determining a successful treatment of chronic low back pain is the reduction of subjective feelings of disability in patients.

From the *Department of Algesiology, Center of Anesthesiology and the †Department of Neurosurgery, Georg-August-University of Göttingen, FRG, Göttingen, Germany.

Supported by the German Ministry of Education, Research and Technology, No. 0701506.

Acknowledgment date: November 20, 1995.

First revision date: May 1, 1996.

Acceptance date: September 18, 1996.

Device status category: 1.

Address reprint requests to: Jan Hildebrandt, MD; Department of Algesiology; Center of Anesthesiology; Georg-August-University of Göttingen; Robert-Koch-Str. 40; D - 37075 Göttingen; Germany.

© Lippincott-Raven Publishers.