Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy -
Unit of Neurorehabilitation, Department of Neuroscience and Rehabilitation, G. Brotzu Hospital, Cagliari, Italy -
Eur J Phys Rehabil Med. 2021 Dec;57(6):959-967. doi: 10.23736/S1973-9087.21.06696-X. Epub 2021 May 5.
Multidisciplinary rehabilitation induces disability improvement, pain reduction and favors return-to-work in patients with subacute low back pain (LBP). Current research advises additional high-quality trials.
The aim of this study is to test the effect of a multidisciplinary rehabilitative program incorporating cognitive-behavioral interventions compared to general physiotherapy alone to treat subacute LBP, and to appraise its long-term extent.
Randomised parallel-group superiority-controlled trial.
Outpatient rehabilitation hospital.
One hundred and fifty patients with subacute LBP.
Patients were assigned randomly to a 10-week individual-based multimodal program of task-oriented exercises integrated with cognitive-behavioral therapy (experimental group, 75 patients) or individual-based general physiotherapy (control group, 75 patients). Before treatment, 10 weeks later (post-treatment), and 12 months after treatment, the staff administered the Oswestry Disability Index (ODI, primary outcome), a pain intensity numerical rating scale (NRS), the Tampa Scale for Kinesiophobia (TSK), the Pain Beliefs and Perception Inventory (PBAPI), the Hospital and Anxiety Depression Score (HADS) and the Coping Strategies Questionnaire-revised (CSQ-R). Linear mixed model analysis for repeated measures was carried out for each outcome measure.
Significant group (P<0.001), time (P=0.002), and time-by-group interaction (P<0.001) effects were found for ODI, with a between-group difference (standard error) after training of 11.5 (1.0) and at follow-up of 15.7 (0.9), in favor of the experimental group. A significant interaction effect (P<0.001) was found for all secondary outcome measures, with significantly greater improvements in the experimental group, after rehabilitation and at follow-up.
The multidisciplinary intervention was superior to general physiotherapy in reducing disability, pain, psychological factors and coping strategies of patients with subacute LBP. The effects were reinforced after one year.
Treatment of subacute LBP requires cognitive modifications closely linked to physical performances in order to achieve mental adjustments and guarantee cognitive-behavioral and motor lasting changes.
多学科康复可改善亚急性腰痛（LBP）患者的残疾程度、减轻疼痛并促进其重返工作岗位。目前的研究建议开展更多高质量的试验。
本研究旨在测试多学科康复计划（包含认知行为干预）与单纯常规物理治疗相比治疗亚急性 LBP 的效果，并评估其长期效果。
随机平行组优效对照试验。
门诊康复医院。
150 名亚急性 LBP 患者。
患者被随机分配至 10 周的个体化、以任务为导向的运动为基础的多模态方案，同时结合认知行为疗法（实验组，75 名患者）或个体化常规物理治疗（对照组，75 名患者）。在治疗前、治疗 10 周后（治疗后）和治疗 12 个月后，工作人员使用 Oswestry 残疾指数（ODI，主要结局）、疼痛强度数字评分量表（NRS）、坦帕运动恐惧调查问卷（TSK）、疼痛信念和感知问卷（PBAPI）、医院焦虑抑郁量表（HADS）和修订后的应对策略问卷（CSQ-R）进行评估。对每个结局测量值进行重复测量线性混合模型分析。
ODI 存在显著的组间（P<0.001）、时间（P=0.002）和时间-组间交互作用（P<0.001）效应，在训练后和随访时，实验组的组间差异（标准误）分别为 11.5（1.0）和 15.7（0.9），对实验组有利。所有次要结局测量值均存在显著的交互作用效应（P<0.001），实验组在康复后和随访时的改善更为显著。
多学科干预在降低亚急性 LBP 患者的残疾程度、疼痛、心理因素和应对策略方面优于常规物理治疗。一年后效果得到了加强。
治疗亚急性 LBP 需要对认知进行调整，使其与身体机能紧密结合，以实现心理调整并保证认知行为和运动的持久改变。
