Abstract
Purpose
This longitudinal study investigated long-term effects of a multidisciplinary rehabilitation program consisting of resistance and sensorimotor training, patient education, and stress management over 6 months in patients with chronic low back pain.
Methods
Ninety-six patients with chronic recurrent low back pain performed a multidisciplinary rehabilitation program. We assessed pain-free lumbar spine range of motion (ROM), strength of the lumbar extensor muscles, and pain by visual analog scale (VAS). Furthermore, the Roland–Morris (RM) questionnaire and SF-36 were used. The examinations were performed before and after rehabilitation, and a long-term follow-up was performed after 18 months.
Results
All outcome measurements (ROM, VAS, RM, muscle strength, and SF-36 scores) improved significantly from baseline to the post-rehabilitation evaluation. These improvements were found to persist until a follow-up evaluation 18 months after cessation of the intervention.
Conclusions
Our findings confirm the results of former studies evaluating the short-term effects of multidisciplinary rehabilitation programs. In addition, our data demonstrate that well-balanced outpatient rehabilitation programs may induce persistent improvements in muscle strength, pain, function and quality of life in patients with chronic low back pain.
Similar content being viewed by others
References
Hauptverband der österreichischen Sozialversicherungsträger (2008) Statistisches Handbuch der österreichischen Sozialversicherung. pp 85
Koes BW, van Tulder M, Lin CW, Macedo LG, McAuley J, Maher C (2010) An updated overview of clinical guidelines for the management of non-specific low back pain in primary care. Eur Spine J: Off Publ Eur Spine Soc Eur Spinal Deform Soc Eur Sect Cerv Spine Res Soc 19:2075–2094. doi:10.1007/s00586-010-1502-y
Frymoyer JW, Pope MH, Clements JH, Wilder DG, MacPherson B, Ashikaga T (1983) Risk factors in low-back pain. An epidemiological survey. J Bone Joint Surg Am 65:213–218
Biering-Sorensen F (1984) Physical measurements as risk indicators for low-back trouble over a one-year period. Spine (Phila Pa 1976) 9:106–119
Hides JA, Stokes MJ, Saide M, Jull GA, Cooper DH (1994) Evidence of lumbar multifidus muscle wasting ipsilateral to symptoms in patients with acute/subacute low back pain. Spine (Phila Pa 1976) 19:165–172
Thorstensson A, Arvidson A (1982) Trunk muscle strength and low back pain. Scand J Rehabil Med 14:69–75
Lee JH, Hoshino Y, Nakamura K, Kariya Y, Saita K, Ito K (1999) Trunk muscle weakness as a risk factor for low back pain. A 5-year prospective study. Spine 24:54–57
Lang E, Liebig K, Kastner S, Neundorfer B, Heuschmann P (2003) Multidisciplinary rehabilitation versus usual care for chronic low back pain in the community: effects on quality of life. Spine J: Off J North Am Spine Soc 3:270–276
Kell RT, Asmundson GJ (2009) A comparison of two forms of periodized exercise rehabilitation programs in the management of chronic nonspecific low-back pain. J Strength Cond Res/Natl Strength Cond Assoc 23:513–523. doi:10.1519/JSC.0b013e3181918a6e
Graves JE, Pollock ML, Foster D, Leggett SH, Carpenter DM, Vuoso R, Jones A (1990) Effect of training frequency and specificity on isometric lumbar extension strength. Spine (Phila Pa 1976) 15:504–509
Risch SV, Norvell NK, Pollock ML, Risch ED, Langer H, Fulton M, Graves JE, Leggett SH (1993) Lumbar strengthening in chronic low back pain patients physiologic and psychological benefits. Spine 18:232–238
Harts CC, Helmhout PH, de Bie RA, Staal JB (2008) A high-intensity lumbar extensor strengthening program is little better than a low-intensity program or a waiting list control group for chronic low back pain: a randomised clinical trial. Aust J Physiother 54:23–31
Jackson JK, Shepherd TR, Kell RT (2011) The influence of periodized resistance training on recreationally active males with chronic nonspecific low back pain. J Strength Cond Res/Natl Strength Cond Assoc 25:242–251. doi:10.1519/JSC.0b013e3181b2c83d
Holmes B, Leggett S, Mooney V, Nichols J, Negri S, Hoeyberghs A (1996) Comparison of female geriatric lumbar-extension strength: asymptotic versus chronic low back pain patients and their response to active rehabilitation. J Spinal Disord 9:17–22
Helmhout PH, Harts CC, Staal JB, Candel MJ, de Bie RA (2004) Comparison of a high-intensity and a low-intensity lumbar extensor training program as minimal intervention treatment in low back pain: a randomized trial. Eur Spine J: Off Publ Eur Spine Soc Eur Spinal Deform Soc Eur Sect Cerv Spine Res Soc 13:537–547. doi:10.1007/s00586-004-0671-y
Airaksinen O, Brox JI, Cedraschi C, Hildebrandt J, Klaber-Moffett J, Kovacs F, Mannion AF, Reis S, Staal JB, Ursin H, Zanoli G (2006) Chapter 4. European guidelines for the management of chronic nonspecific low back pain. Eur Spine J: Off Publ Eur Spine Soc Eur Spinal Deform Soc Eur Sect Cerv Spine Res Soc 15(Suppl 2):S192–S300. doi:10.1007/s00586-006-1072-1
Graves JE, Pollock ML, Carpenter DM, Leggett SH, Jones A, MacMillan M, Fulton M (1990) Quantitative assessment of full range-of-motion isometric lumbar extension strength. Spine (Phila Pa 1976) 15:289–294
Graves JE, Webb DC, Pollock ML, Matkozich J, Leggett SH, Carpenter DM, Foster DN, Cirulli J (1994) Pelvic stabilization during resistance training: its effect on the development of lumbar extension strength. Arch Phys Med Rehabil 75:210–215
Robinson ME, Greene AF, O’Connor P, Graves JE, MacMillan M (1992) Reliability of lumbar isometric torque in patients with chronic low back pain. Phys Ther 72:186–190
Wiesinger GF, Nuhr M, Quittan M, Ebenbichler G, Wolfl G, Fialka-Moser V (1999) Cross-cultural adaptation of the Roland–Morris questionnaire for German-speaking patients with low back pain. Spine (Phila Pa 1976) 24:1099–1103
Bullinger M (1995) German translation and psychometric testing of the SF-36 Health Survey: preliminary results from the IQOLA project. International quality of life assessment. Soc Sci Med 41:1359–1366
Bullinger M (1996) Assessment of health related quality of life with the SF-36 Health Survey. Rehabilitation (Stuttg) 35:XVII–XXVII (quiz XXVII–XXIX)
Choi G, Raiturker PP, Kim MJ, Chung DJ, Chae YS, Lee SH (2005) The effect of early isolated lumbar extension exercise program for patients with herniated disc undergoing lumbar discectomy. Neurosurgery 57:764–772 (discussion 764–772)
Vincent KR, Braith RW, Feldman RA, Kallas HE, Lowenthal DT (2002) Improved cardiorespiratory endurance following 6 months of resistance exercise in elderly men and women. Arch Intern Med 162:673–678
Smith D, Bissell G, Bruce-Low S, Wakefield C (2011) The effect of lumbar extension training with and without pelvic stabilization on lumbar strength and low back pain. J Back Musculoskelet Rehabil 24:241–249. doi:10.3233/BMR-2011-0301
American College of Sports Medicine Position Stand (1998) The recommended quantity and quality of exercise for developing and maintaining cardiorespiratory and muscular fitness, and flexibility in healthy adults. Med Sci Sports Exerc 30:975–991
Guzman J, Esmail R, Karjalainen K, Malmivaara A, Irvin E, Bombardier C (2002) Multidisciplinary bio-psycho-social rehabilitation for chronic low back pain. Cochrane Database Syst Rev 1:CD000963. doi:10.1002/14651858.CD000963
van Tulder MW, Koes B, Malmivaara A (2006) Outcome of non-invasive treatment modalities on back pain: an evidence-based review. Eur Spine J: Off Publ Eur Spine Soc Eur Spinal Deform Soc Eur Sect Cerv Spine Res Soc 15(Suppl 1):S64–S81. doi:10.1007/s00586-005-1048-6
Hayden JA, van Tulder MW, Tomlinson G (2005) Systematic review: strategies for using exercise therapy to improve outcomes in chronic low back pain. Ann Intern Med 142:776–785
van Middelkoop M, Rubinstein SM, Kuijpers T, Verhagen AP, Ostelo R, Koes BW, van Tulder MW (2011) A systematic review on the effectiveness of physical and rehabilitation interventions for chronic non-specific low back pain. Eur Spine J 20:19–39. doi:10.1007/s00586-010-1518-3
Carpenter DM, Nelson BW (1999) Low back strengthening for the prevention and treatment of low back pain. Med Sci Sports Exerc 31:18–24
Acknowledgments
We thank Alexandra Eßler from the Institute of Physical Medicine and Rehabilitation in Vienna for her assistance with the data collection in this study.
Conflict of interest
None declared.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Pieber, K., Herceg, M., Quittan, M. et al. Long-term effects of an outpatient rehabilitation program in patients with chronic recurrent low back pain. Eur Spine J 23, 779–785 (2014). https://doi.org/10.1007/s00586-013-3156-z
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00586-013-3156-z