INTRODUCTION: Previous research had established the efficacy of a functional restoration programme (FRP) for patients with chronic back pain (Fairbank 2005). Implementing this programme in normal clinical practice presented issues with patient attendance and the capacity to cope with increased referrals within existing resources. We introduced 2 two new programmes of shorter duration and lesser intensity (ARP) and (SMP), with a selection algorithm to allocate patients to each programme.
METHODS: Observational study of 3 consecutive cohorts each of 40 patients attending one of 3 programmes. Patients were allocated to a programme based on their preference and their score on the HAD scale and Oswestry Disability Index. Standard outcome assessments ‐ pain VAS, pain catastrophising scale (PCS), pain self efficacy questionnaire (PSEQ), Tampa scale for kinesiphobia (TSK) and physical tests of timed sit to stand and 5 minute walk test were completed at entry and 6 months.
RESULTS: Analysis by paired t tests. Patients attending the ‘gold standard’ FRP programme showed statistically and clinically significant improvements in mean change scores for PCS, TSK, PSEQ, sit to stand and 5 minute walk test ‐ all p<0.001 and decreased VAS pain score from 5.45 to 4 (p<0.021). For the ARP there were significant improvements in the mean change for PCS, TSK ((p0.000), PSEQ (p0.001) and sit to stand (p0.004). For the SMP there were significant improvements in the mean change for PCS (p 0.002), TSK, PESQ ( p0.001), sit to stand (p0.004) and walking (p0.000).
DISCUSSION: Clinically and statistically significant improvements in outcome were demonstrated in cohorts of patients undergoing programmes of lesser duration and intensity.Implementing gold standard research findings may not be possible within limited public funded resources but findings can be translated into standard clinical practice by adhering to key principles but varying intensity and duration.