1 Department of Physical Medicine and Rehabilitation, University Hospital of Angers, Angers, France.
2 Department of General Practice, University of Angers, Angers, France.
Clin Rehabil. 2017 Oct;31(10):1364-1373. doi: 10.1177/0269215517691086. Epub 2017 Feb 13.
To compare the effectiveness of three treatment strategies for chronic low back pain with varying biomechanical intensity and multidisciplinary approach.
A monocentric randomized controlled trial with a 12-months follow-up, conducted in the French Valley Loire region from May 2009 to April 2013. Participants were working-aged patients with chronic low back pain referred to a French chronic low back pain care-network to support medical and occupational issues. Three treatment strategies, each for five weeks were compared: (i) intensive and multidisciplinary program conducted in a rehabilitation center; (ii) less intensive outpatient program conducted by a trained private physiotherapist; (iii) mixed strategy combining the same outpatient program associated with a weekly multidisciplinary intervention. The effects of treatment conditions were compared using an "intention to treat" approach: Number of days' sick leave during the 12-months following treatment, and quality of life and social ability assessed by auto-questionnaires.
A total of 159 patients (58.9% men, 41.5 ± 10.3 years old, median duration of sick leave = 221.0 days (127.5-319.0)) were included. Sick leave duration significantly decreased during the 12-months following treatment in the three groups. There was no significant difference for the evolution of participants' quality of life, social ability, and personal beliefs between the three groups.
This study confirms that disparate treatments might show similar effectiveness because they could all work through concomitant changes in beliefs, attitudes, and coping mechanisms. The original mixed strategy can treat a larger number of chronic low back pain patients, at a lower cost and provide local community-based care.
NCT02030171.
比较三种治疗策略对慢性下背痛的疗效，这些策略在生物力学强度和多学科方法上有所不同。
这是一项单中心、随机对照试验，随访时间为 12 个月，于 2009 年 5 月至 2013 年 4 月在法国卢瓦尔河谷地区进行。参与者为有慢性下背痛的工作年龄患者，他们被转诊到法国慢性下背痛护理网络，以支持医疗和职业问题。比较了三种治疗策略，每种策略持续五周：（i）在康复中心进行的强化和多学科方案；（ii）由经过培训的私人物理治疗师进行的非强化门诊方案；（iii）混合策略，将相同的门诊方案与每周的多学科干预相结合。使用“意向治疗”方法比较治疗条件的效果：治疗后 12 个月内的病假天数，以及通过自我问卷评估的生活质量和社会能力。
共纳入 159 名患者（58.9%为男性，41.5±10.3 岁，中位数病假天数=221.0 天（127.5-319.0））。在三组中，治疗后 12 个月内的病假天数均显著减少。三组间参与者生活质量、社会能力和个人信念的演变无显著差异。
这项研究证实，不同的治疗方法可能显示出相似的疗效，因为它们都可以通过同时改变信念、态度和应对机制来发挥作用。原始的混合策略可以治疗更多的慢性下背痛患者，成本更低，并提供基于社区的本地护理。
NCT02030171。
