Effectiveness of a multidisciplinary BIOPSYCHOSOCIAL intervention for non-specific SUBACUTE low back pain in a working population : a cluster randomized clinical trial

Autor: Montse Balagué-Corbella, Ester Núñez Juárez, Jenny Moix-Queraltó, Miguel-Angel Muñoz, Maria Isabel Fernandez San Martin, Anna Berenguera, Tomàs López-Jiménez, Teresa Rodriguez-Blanco, Enriqueta Pujol-Ribera, Elena Montiel-Morillo, Magda Pie-Oncins, Romina Raczy Mas, Marc Casajuana-Closas, Montse Núñez Juárez, Mercè Roura-Olivan, M J González-Moneo, Concepción Violán, Raquel Martin-Peñacoba
Rok vydání: 2019
Předmět:
Adult
Male
Biopsychosocial model
Quality of life
medicine.medical_specialty
Adolescent
Pain
Disease cluster
law.invention
Young Adult
03 medical and health sciences
0302 clinical medicine
Randomized controlled trial
law
Surveys and Questionnaires
Intervention (counseling)
Cognitive-behavioural therapy
medicine
Humans
Disabled Persons
030212 general & internal medicine
Non-specific subacute low back pain
Multidisciplinary biopsychosocial intervention
Physical Therapy Modalities
Aged
Pain Measurement
Primary health care
Disability
Cognitive Behavioral Therapy
Primary Health Care
business.industry
lcsh:Public aspects of medicine
Health Policy
Minimal clinically important difference
lcsh:RA1-1270
Middle Aged
Low back pain
Treatment Outcome
Roland Morris Disability Questionnaire
Physical therapy
Female
medicine.symptom
business
Low Back Pain
030217 neurology & neurosurgery
Research Article
Zdroj: Dipòsit Digital de Documents de la UAB
Universitat Autònoma de Barcelona
BMC HEALTH SERVICES RESEARCH
r-IIB SANT PAU. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pau
instname
BMC Health Services Research
BMC Health Services Research, Vol 19, Iss 1, Pp 1-9 (2019)
ISSN: 1472-6963
Popis: Background Low back pain (LBP) is a multifactorial condition with individual and societal impact that affects populations globally. Current guidelines for the treatment of LBP recommend pharmacological and non-pharmacological strategies. The aim of this study was to compare usual clinical practice with the effectiveness of a biopsychosocial multidisciplinary intervention in reducing disability, severity of pain and improving quality of life in a working population of patients with subacute (2–12 weeks), non-specific LBP. Methods Longitudinal cluster randomized clinical trial conducted in 39 Primary Health Care Centres (PHCC) of Barcelona, with patients aged 18–65 years (n = 501; control group = 239; 26 PHCC, intervention group = 262; 13 PHCC). The control group received usual clinical care. The intervention group received usual clinical care plus a biopsychosocial multidisciplinary intervention, which consisted of physiotherapy, cognitive-behavioural therapy and medication. The main outcomes were changes in the Roland Morris Disability Questionnaire (RMDQ), and the minimal clinically important differences. Secondary outcomes were changes in the McGill Pain (MGPQ) and Quality of Life (SF-12) questionnaires. Assessment was conducted at baseline, 3 and 12 months. Analysis was by intention-to-treat and analyst-blinded. Multiple imputations were used. Results Of the 501 enrolled patients, 421 (84%) provided data at 3 months, and 387 (77.2%) at 12 months. Mean age was 46.8 years (SD: 11.5) and 64.7% were women. In the adjusted analysis of the RMDQ outcome, only the intervention group showed significant changes at 3 months (− 1.33 points, p = 0.005) and at 12 months (− 1.11 points, p = 0.027), but minimal clinically important difference were detected in both groups. In the adjusted analysis of the RMDQ outcome, the intervention group improvement more than the control group at 3 months (− 1.33 points, p = 0.005) and at 12 months (− 1.11 points, p = 0.027). The intervention group presented a significant difference. Both groups presented a minimal clinically important difference, but more difference in the intervention group. The intervention group presented significant differences in the MGPQ scales of current pain intensity and VAS scores at 3 months. No statistically significant differences were found in the physical and mental domains of the SF-12. Conclusions A multidisciplinary biopsychosocial intervention in a working population with non-specific subacute LBP has a small positive impact on disability, and on the level of pain, mainly at short-term, but no difference on quality of life. Trial registration ISRCTN21392091 (17 oct 2018) (Prospectively registred).
Databáze: OpenAIRE
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