Efficiency of three treatment strategies on occupational and quality of life impairments for chronic low back pain patients: is the multidisciplinary approach the key feature to success?

Objective: To compare the effectiveness of three treatment strategies for chronic low back pain with varying biomechanical intensity and multidisciplinary approach. Methods: 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. Results: 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. Conclusion: 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.