Prediction of function in daily life following multidisciplinary rehabilitation for individuals with chronic musculoskeletal pain; a prospective study Role of Physical Exercise in Low Back Pain Rehabilitation: A Randomized Controlled Trial of a Three-Month Exercise Program in Patients Who Have Completed Multidisciplinary Rehabilitation Course and prognosis of recovery for chronic non-specific low back pain: design, therapy program and baseline data of a prospective cohort study Rehabilitation for people with multiple sclerosis: an overview of Cochrane Reviews. Multidisciplinary Rehabilitation Treatment of Patients With Chronic Low Back Pain: A Prognostic Model for Its Outcome Multidisciplinary Group Rehabilitation Versus Individual Physiotherapy for Chronic Nonspecific Low Back Pain: A Randomized Trial Does Teaching Physical Therapists to Deliver a Biopsychosocial Treatment Program Result in Better Patient Outcomes? A Randomized Controlled Trial Can inpatient multidisciplinary rehabilitation improve health-related quality of life in MS patients on the long term - The Danish MS Hospitals Rehabilitation Study. Functional multidisciplinary rehabilitation versus outpatient physiotherapy for non specific low back pain: randomized controlled trial. Effects of Multidisciplinary Rehabilitation on Chronic Fatigue in Multiple Sclerosis: A Randomized Controlled Trial Prognostic factors associated with return to work following multidisciplinary vocational rehabilitation. Effectiveness of workplace interventions in rehabilitating musculoskeletal disorders and preventing its consequences among workers with physical and sedentary employment: systematic review protocol A randomized prospective study of vocational outcome in rehabilitation of patients with non-specific musculoskeletal pain: a multidisciplinary approach to patients identified after 90 days of sick-leave. Rehabilitation in rheumatoid arthritis: a critical review. Multidisciplinary rehabilitation for chronic back pain in an outpatient setting: a controlled randomized trial. Massage for Low Back Pain: An Updated Systematic Review Within the Framework of the Cochrane Back Review Group [Long-term efficiency of orthopedic rehabilitation in chronic back pain--the integrative orthopedic psychosomatic concept (IopKo)]. Treatment of Chronic Low Back Pain: A Randomized, Clinical Trial Comparing Group-Based Multidisciplinary Biopsychosocial Rehabilitation and Intensive Individual Therapist-Assisted Back Muscle Strengthening Exercises What Risk Factors Are Associated With Musculoskeletal Injury in US Army Rangers? A Prospective Prognostic Study Effects of intensified work-related multidisciplinary rehabilitation on occupational participation: a randomized-controlled trial in patients with chronic musculoskeletal disorders Medial branch neurotomy in management of chronic spinal pain: systematic review of the evidence. Prognosis and Course of Disability in Patients With Chronic Nonspecific Low Back Pain: A 5- and 12-Month Follow-up Cohort Study Long-term effects of home rehabilitation on physical performance in chronic obstructive pulmonary disease.
Background The prevalence of chronic musculoskeletal pain is high , with widespread negative economic , psychological , and social consequences for the individual . It is therefore important to find ways to predict the outcome of rehabilitation programmes in terms of function in daily life . The aims of this study were to investigate the improvements over time from multidisciplinary rehabilitation in terms of pain and function , and analyse the relative impact of individual and psychosocial factors as predictors of function in daily life in individuals with chronic musculoskeletal pain . Methods A prospect i ve study was conducted among one hundred and forty three ( N = 143 ) musculoskeletal pain patients .  Measures of pain , function , and functional health status were obtained at baseline , after 5 weeks of intensive training , at the end of the 57-week rehabilitation programme , and at a 1 year follow-up , using vali date d self-administrated measures . Linear regression analysis was applied to investigate the relative impact of musculoskeletal pain , individual- , and psychosocial factors in function . Results The participants studied showed a significant increase in function during the 57 weeks rehabilitation period . There was also a significant increase in function from the end of the rehabilitation period ( 57th week ) to the one year follow-up measures . Pain intensity associated significantly with pain experience over all measurement periods . High levels of pain intensity ( β = .42 * * ) and pain experience ( β = .37 * ) , and poor psychological capacity ( β = -.68 * ) at baseline , as well as poor physiological capacity ( β = -.44 * * ) and high levels of anxiety ( β = .48 * * ) and depression ( β = .58 * * * ) at the end of the rehabilitation program were the most important prognostic factors of variance in functioning over the 4 measurement periods . Conclusion The data suggest that physical capacity , emotional distress and coping skills should be priority areas in rehabilitation programmes to improve functioning in daily life Study Design . R and omized controlled trial with 1-year follow-up . Objective . To analyze the effects of an exercise program or routine follow-up on patients with chronic low back pain who have completed functional multidisciplinary rehabilitation . The short- and long-term outcome in terms of symptoms and physical and social functioning was compared . Summary of Background Data . Systematic review s have shown that functional multidisciplinary rehabilitation improves physical function and reduces pain in patients with chronic low back pain . However , long-term maintenance of these improvements is inconsistent and the role of exercise in achieving this goal is unclear . Methods . One hundred five chronic patients with low back pain who had completed a 3-week functional multidisciplinary rehabilitation program were r and omized to either a 3-month exercise program ( n = 56 ) or routine follow-up ( n = 49 ) . The exercise program consisted of 24 training sessions during 12 weeks . Patients underwent evaluations of trunk muscle endurance , cardiovascular endurance , lumbar spine mobility ( flexion and extension range-of-motion , fingertip-to-floor distance ) , pain and perceived functional ability at the beginning and the end of functional multidisciplinary rehabilitation , at the end of the exercise program ( 3 months ) and at 1-year follow-up . Disability was also assessed at the same time points except at the beginning of functional multidisciplinary rehabilitation . Results . At the end of the functional multidisciplinary rehabilitation , both groups improved significantly in all physical parameters except flexion and extension range-of-motion . At the 3 month and 1 year follow-up , both groups maintained improvements in all parameters except for cardiovascular endurance . Only the exercise program group improved in disability score and trunk muscle endurance . No differences between groups were found . Conclusion . A favorable long-term outcome was observed after functional multidisciplinary rehabilitation in both patient groups . Patients who participated in an exercise program obtained some additional benefits . The relevance of these benefits to overall health status need to be further investigated Background There has been increasing focus on factors predicting the development of chronic musculoskeletal disorders . For patients already experiencing chronic non-specific low back pain it is also relevant to investigate which prognostic factors predict recovery . We present the design of a cohort study that aims to determine the course and prognostic factors for recovery in patients with chronic non-specific low back pain . Methods / Design All participating patients were recruited ( Jan 2003-Dec 2008 ) from the same rehabilitation centre and were evaluated by means of ( postal ) question naires and physical examinations at baseline , during the 2-month therapy program , and at 5 and 12 months after start of therapy . The therapy protocol at the rehabilitation centre used a bio-psychosocial approach to stimulate patients to adopt adequate ( movement ) behaviour aim ed at physical and functional recovery . The program is part of regular care and consists of 16 sessions of 3 hours each , over an 8-week period ( in total 48 hours ) , followed by a 3-month self-management program . The primary outcomes are low back pain intensity , disability , quality of life , patient 's global perceived effect of recovery , and participation in work . Baseline characteristics include information on socio-demographics , low back pain , employment status , and additional clinical items status such as fatigue , duration of activities , and fear of kinesiophobia . Prognostic variables are determined for recovery at short-term ( 5 months ) and long-term ( 12 months ) follow-up after start of therapy . Discussion In a routine clinical setting it is important to provide patients suffering from chronic non-specific low back pain with adequate information about the prognosis of their complaint BACKGROUND Multiple sclerosis ( MS ) is a major cause of chronic , neurological disability , with a significant long-term disability burden , often requiring comprehensive rehabilitation . OBJECTIVES To systematic ally evaluate evidence from published Cochrane Review s of clinical trials to summarise the evidence regarding the effectiveness and safety of rehabilitation interventions for people with MS ( pwMS ) , to improve patient outcomes , and to highlight current gaps in knowledge . METHODS We search ed the Cochrane Data base of Systematic Review s up to December 2017 , to identify Cochrane Review s that assessed the effectiveness of organised rehabilitation interventions for pwMS . Two review ers independently assessed the quality of included review s , using the Revised Assessment of Multiple Systematic Review s ( R-AMSTAR ) tool , and the quality of the evidence for reported outcomes , using the GRADE framework . MAIN RESULTS Overall , we included 15 review s published in the Cochrane Library , comprising 164 r and omised controlled trials ( RCTs ) and four controlled clinical trials , with a total of 10,396 participants . The included review s evaluated a wide range of rehabilitation interventions , including : physical activity and exercise therapy , hyperbaric oxygen therapy ( HBOT ) , whole-body vibration , occupational therapy , cognitive and psychological interventions , nutritional and dietary supplements , vocational rehabilitation , information provision , telerehabilitation , and interventions for the management of spasticity . We assessed all review s to be of high to moderate method ological quality , based on R-AMSTAR criteria .Moderate- quality evidence suggested that physical therapeutic modalities ( exercise and physical activities ) improved functional outcomes ( mobility , muscular strength ) , reduced impairment ( fatigue ) , and improved participation ( quality of life ) . Moderate- quality evidence suggested that inpatient or outpatient multidisciplinary rehabilitation programmes led to longer-term gains at the levels of activity and participation , and interventions that provided information improved patient knowledge . Low-qualitty evidence suggested that neuropsychological interventions , symptom-management programmes ( spasticity ) , whole body vibration , and telerehabilitation improved some patient outcomes . Evidence for other rehabilitation modalities was inconclusive , due to lack of robust studies . AUTHORS ' CONCLUSIONS The evidence suggests that regular specialist evaluation and follow-up to assess the needs of patients with all types of MS for appropriate rehabilitation interventions may be of benefit , although the certainty of evidence varies across the different types of interventions evaluated by the review s. Structured , multidisciplinary rehabilitation programmes and physical therapy ( exercise or physical activities ) can improve functional outcomes ( mobility , muscle strength , aerobic capacity ) , and quality of life . Overall , the evidence for many rehabilitation interventions should be interpreted cautiously , as the majority of included review s did not include data from current studies . More studies , with appropriate design , which report the type and intensity of modalities and their cost-effectiveness are needed to address the current gaps in knowledge Objectives ( 1 ) To determine if treatment outcome in chronic low back pain can be predicted by a predefined multivariate prognostic model based on consistent predictors from the literature and ( 2 ) to explore the value of potentially prognostic factors further . Methods Data were derived from a r and omized controlled trial on the effect of a multidisciplinary rehabilitation program for chronic low back pain compared with usual care .  The primary outcome measure was the Rol and and Morris Disability Question naire and secondary outcomes were the Physical and Mental Component Summary Scales , derived from the Short Form Health Survey . Outcomes were expressed as the differences between baseline and follow-up ( 8 wk and 6 mo ) values . A confirmatory and an exploratory model were defined . Baseline predictors included in the confirmatory model were pain intensity , work status , and Multidimensional Pain Inventory subgroup membership . The exploratory model included sick leave , compensation , depression , and fear-avoidance beliefs . Statistical analysis was performed using multiple linear regression analysis . Results One hundred and sixty-three patients participated in the study . More pain was prognostic for more improvement in the rehabilitation group . No value was found for work status or the Multidimensional Pain Inventory subgroups . For the exploratory model , more depression and fear-avoidance beliefs predicted more improvement after rehabilitation . The explained variance ranged from 18.5 % to 43.8 % depending on the length of follow-up evaluation , the treatment group , and the outcome variable of interest . Discussion The results of this study do not support the construction of a clinical prediction model . Future confirmative studies of homogeneous rehabilitation treatments and outcome measures are needed to shed more light on relevant prognostic factors Study Design . A r and omized trial . Objective . To evaluate the effectiveness of a semi-intensive multidisciplinary rehabilitation for patients with chronic low back pain in an outpatient setting . Summary and Background Data . Systematic review s have shown that there is strong evidence that intensive multidisciplinary treatment ( > 100 hours ) , which includes functional restoration , improves function among chronic patients with low back pain , and moderate evidence that it reduces pain but contradictory evidence regarding improvement of working ability . However , there is paucity of data whether semi-intensive outpatient multidisciplinary rehabilitation in groups is more effective than individual physiotherapy . Material s and Methods . A total of 120 women employed as healthcare and social care professionals with nonspecific chronic low back pain were recruited from two occupational healthcare centers . The patients were r and omized into two intervention programs . Multidisciplinary rehabilitation ( n = 59 ) was conducted in groups and comprised of physical training , workplace interventions , back school , relaxation training , and cognitive-behavioral stress management methods for 70 hours . The individual physiotherapy ( n = 61 ) included physical exercise and passive treatment methods administered for 10 hours . Main outcome measures were : back pain and sciatic pain intensity , disability , sick leaves , healthcare consumption , symptoms of depression , and beliefs of working ability after 2 years . Results . There were no statistically significant differences between the two treatment groups in main outcome measures just after rehabilitation , at 6- , at 12- , or 24-month follow-up . In both intervention arms , however , the before- and -after comparison showed favorable effects , and the effects were still maintained at 2 years follow-up . Conclusions . The results of this study indicate that semilight outpatient multidisciplinary rehabilitation program for female chronic low back pain patients does not offer incremental benefits when compared with rehabilitation carried out by a physiotherapist having a cognitive-behavioral way of administering the treatment Background Psychosocial prognostic factors are important in the development of chronic pain , but treatment providers often lack knowledge and skills to assess and address these risk factors . Objective The aim of this study was to examine the effects on outcomes ( pain and disability ) in patients of a course about psychosocial prognostic factors for physical therapists . Design This study was a r and omized , controlled trial . Setting The setting was primary care practice . Participants Forty-two primary care physical therapists attended an 8-day university course ( over 8 weeks ) aim ed at identifying and addressing psychosocial risk factors . Intervention The physical therapists were r and omly assigned to either the course or a waiting list . They treated consecutive patients with acute and subacute musculoskeletal pain both before and after the course . Measurements We measured physical therapists ' attitudes and beliefs about psychosocial factors , knowledge , and skills before and after the course . We measured patients ' pain , disability , catastrophizing , and mood at the start of treatment and at a 6-month follow-up . Methods The physical therapists were r and omly assigned to either the course or a waiting list . They treated consecutive patients with acute and subacute musculoskeletal pain both before and after the course . Results Pain and disability outcomes in all patients of physical therapists who had participated in the course or in patients at risk of developing long-term disability who had higher levels of catastrophizing or depression were not significantly different from those outcomes in patients of physical therapists who had not participated in the course . Pain and disability outcomes in patients with a low risk of developing long-term disability— and pain outcomes in patients with a high risk of developing long-term disability — were not dependent upon whether the attitudes and beliefs of their physical therapists changed during the course . However , disability outcomes in patients with a high risk of developing long-term disability may have been influenced by whether the attitudes and beliefs of their physical therapists changed . Limitations A limitation of this study was that actual practice behavior was not measured . Conclusions An 8-day university course for physical therapists did not improve outcomes in a group of patients as a whole or in patients with a risk of developing long-term disability . However , patients who had a risk of developing long-term disability and had higher levels of catastrophizing or depression may have shown greater reductions in disability if the attitudes and beliefs of their physical therapists changed during the course BACKGROUND Inpatient multidisciplinary rehabilitation ( MDR ) can improve health-related quality of life ( HRQoL ) in multiple sclerosis ( MS ) patients . However , the evidence of a long-term benefit is limited . OBJECTIVES To investigate the long-term effectiveness of inpatient MDR on HRQoL in MS patients . METHODS We conducted a r and omized controlled partial crossover trial with 427 MS patients . RESULTS Statistical significant long-term improvements in HRQoL were found in three of the six outcome measures at 12-month follow-up . Three in four suggested minimal clinical ly important differences ( MCIDs ) were unmet . CONCLUSION These results indicate that the administration of inpatient MDR may lead to long-lasting improvements in HRQoL in MS patients INTRODUCTION In recent decades the treatment of non-specific low back pain has turned to active modalities , some of which were based on cognitive-behavioural principles . Non-r and omised studies clearly favour functional multidisciplinary rehabilitation over outpatient physiotherapy . However , systematic review s and meta- analysis provide contradictory evidence regarding the effects on return to work and functional status . The aim of the present r and omised study was to compare long-term functional and work status after 3-week functional multidisciplinary rehabilitation or 18 supervised outpatient physiotherapy sessions . METHODS 109 patients with non-specific low back pain were r and omised to either a 3-week functional multidisciplinary rehabilitation programme , including physical and ergonomic training , psychological pain management , back school and information , or 18 sessions of active outpatient physiotherapy over 9 weeks . Primary outcomes were functional disability ( Oswestry ) and work status . Secondary outcomes were lifting capacity ( Spinal Function Sort and PILE test ) , lumbar range-of-motion ( modified-modified Schöber and fingertip-to-floor tests ) , trunk muscle endurance ( Shirado and Biering-Sörensen tests ) and aerobic capacity ( modified Bruce test ) . RESULTS Oswestry disability index was improved to a significantly greater extent after functional multidisciplinary rehabilitation compared to outpatient physiotherapy at follow-up of 9 weeks ( P = 0.012 ) , 9 months ( P = 0.023 ) and 12 months ( P = 0.011 ) . Work status was significantly improved after functional multidisciplinary rehabilitation only ( P = 0.012 ) , result ing in a significant difference compared to outpatient physiotherapy at 12 months ' follow-up ( P = 0.012 ) . Secondary outcome results were more contrasted . CONCLUSIONS Functional multidisciplinary rehabilitation was better than outpatient physiotherapy in improving functional and work status . From an economic point of view , these results should be backed up by a cost-effectiveness study Background Several rehabilitation programmes aim at reducing the impact of fatigue in MS patients . Acute and chronic fatigue should require different management . Objectives To assess the effects of individually tailored , multidisciplinary outpatient rehabilitation ( MDR ) on chronic fatigue . Methods Forty-eight ambulatory MS patients with chronic fatigue were r and omized to MDR or to  MS – nurse consultation .  Fatigue was assessed by the Checklist Individual Strength ( CIS-20R ) . Secondary outcomes included the Modified Fatigue Impact Scale , Fatigue Severity Scale , Functional Independence Measure , Disability and Impact Profile ( DIP ) , Multiple Sclerosis Impact Scale and the Impact on Participation and Autonomy ( IPA ) . Results The primary outcome measure CIS-20R overall score showed no significant differences between groups at 12 weeks ( P = 0.39 ) and 24 weeks follow-up ( P = 0.14 ) , nor for subscales ( t = 12 and t = 24 , 0.19≤P≤0.88 ) . No significant within-group effects were found for both groups with respect to the primary ( 0.57≤p≤0.97 ) and secondary ( 0.11≤p≤0.92 ) outcome measures from baseline to 12 or 24 weeks . Conclusion Multidisciplinary rehabilitation was not more effective in terms of reducing self-reported fatigue  in MS patients  compared to MS-nurse consultation . Our results suggest that chronic fatigue in patients with MS may be highly invariant over time , irrespective of interventions . Trial Registration controlled-trials.com IS RCT OBJECTIVES The number of people in Western countries on long-term sick-leave and disability pension due to musculoskeletal complaints and psychological health problems is increasing . The main objective of this study was to examine whether fear-avoidance beliefs , illness perceptions , subjective health complaints , and coping are prognostic factors for return to work after multidisciplinary vocational rehabilitation , and to assess the relative importance and inter-relationship of these factors . METHODS A prospect i ve cohort study with a 1-year follow-up period was performed . A total of 135 individuals on long-term sick-leave ( 87 women , mean age 45 years ) participated in a 4-week inpatient multidisciplinary vocational rehabilitation programme . The participants had been out of work for an average of 10.5 months . RESULTS Fear-avoidance beliefs about work was the most important risk factor for not returning to work , both at 3 months ( odds ratio ( OR ) 3.8 ; confidence interval ( CI ) 1.30 - 11.32 ) and 1 year ( OR 9.5 ; CI 2.40 - 37.53 ) after the intervention . Forty-eight percent of the variance in fear-avoidance beliefs was explained by subjective health complaints , illness perceptions and education . Coping explained only 1 % of the variance . CONCLUSION These findings indicate that interventions for these patients should target fear of returning to work and illness perceptions about subjective health complaints Background Musculoskeletal disorders ( MSDs ) are the leading cause of work disability and sickness absence worldwide . The prevalence of MSDs increases with age , consequently challenging sustainable employability among the growing ageing workforce . Knowledge of feasible and efficient workplace-based interventions to rehabilitate MSD or prevent its consequences is therefore warranted . This systematic review will evaluate the effectiveness of workplace-based interventions on MSDs and its consequences among adult workers with physical and sedentary work tasks , respectively . Methods We will search the following bibliographic data bases : PubMed ( including the data base ‘ MEDLINE ’ ) and Web of Science Core Collection ( including the data bases ‘ Science Citation Index Exp and ed ’ , ‘ Social Sciences Citation Index ’ and ‘ Arts & Humanities Citation Index ’ ) . Manual search es will also be performed . We will include r and omised controlled trials ( RCTs ) and non- RCTs reported in English in which ( 1 ) participants are adult workers with MSD , ( 2 ) interventions are aim ing at rehabilitating pain symptoms of MSD or preventing the consequences of MSD and ( 3 ) interventions are initiated and /or carried out at the workplace . The review will adhere to the ‘ Preferred Reporting Items for Systematic review s and Meta-Analyses ’ ( PRISMA ) guidelines for reporting systematic review s and the Institute for Work and Health ( IWH ) guidelines for workplace-based interventions . For the primary evaluation of the review , the quality assessment and evidence synthesis will conform to the IWH guidelines . Secondary evaluation will include a meta- analysis ( unless the included studies do not allow this due to heterogeneity ) and employ the risk of bias domains recommended by Cochrane along with the Grading of Recommendations , Assessment , Development and Evaluations ( GRADE ) approach on the studies with pain intensity as an outcome . Discussion This systematic review will provide knowledge on effective workplace-based interventions among physical and sedentary workers with MSD . RCTs are considered the most powerful experimental design in clinical trials , but solely including these may be too restrictive to underst and effective workplace-based interventions where r and omised and carefully controlled trials ( RCTs ) are not always possible . In order to maximize practical relevance , the selection process will , therefore , include both RCTs and non- RCTs and the quality assessment and evidence synthesis will conform to IWH guidelines focusing on developing practical guidelines for stakeholders . The result of this work will form the basis for industry-specific evidence -based recommendations on effective workplace-based interventions for rehabilitation of MSDs and its consequences that will later be operationalised into concrete and user-friendly practical tools for workplaces . Systematic review registration International Prospect i ve Register of Systematic Review s ( PROSPERO ) number CRD42018116752 This study was design ed to evaluate the effectiveness of a multidisciplinary rehabilitation programme offered to a general population with 90 days of sick-leave due to non-specific musculoskeletal pain . The results concerning return to work and re-sick-listing during a follow-up period of five years were evaluated for Swedes and immigrants separately . Compared to a control group , the rehabilitation offer result ed in improved work stability after work return among the Swedes . The immigrants , as a group , did not benefit from the programme compared to the controls in primary care This article considers the evidence for effectiveness and timing of rehabilitation  for people with rheumatoid arthritis ( RA ) . The Cochrane Library , DARE , Medline , Embase , CINAHL and AMED were search ed to identify systematic review s and r and omized controlled trials evaluating rehabilitation interventions for people with rheumatoid arthritis . Many trials identified had method ological limitations ( e.g. short follow-up periods , small sample sizes ) . Evidence to date is that symptomatic relief results from thermotherapy , laser therapy , acupuncture and assistive devices . In the short-term , comprehensive occupational therapy ( in established rheumatoid arthritis ) , orthoses , and mind-body approaches can help maintain function . Over at least a one-year period , the following are effective in reducing pain and maintaining function :  patient education and joint protection training using behavioural approaches ; dynamic exercise therapy , h and exercises and hydrotherapy ; and cognitive-behavioural therapy ( in people with poorer psychological status ) . Many trials have recruited people with moderate to severe , established RA and relatively little is known about the long-term effectiveness of early rehabilitation , although this is becoming much more common in practice . Despite the increased availability of guidelines and systematic review s , most conclude there is insufficient evidence for many areas of rheumatology rehabilitation . Further well- design ed clinical trials are needed recruiting people with early disease using patient-centred outcomes Based on existing models for pain chronicity and effective treatment strategies for patients with chronic low back pain , a multidisciplinary rehabilitation programme for an outpatient group setting was developed . The main treatment components address the patient 's physical functional capacity ( functional restoring ) , cognitive and affective processes ( pain management strategies ) , and behavioural and ergonomical aspects ( back school elements ) . Short-term ( immediately after intervention ) and long-term effects ( at 6-months follow-up ) of the intervention were assessed in a r and omized controlled study . Dependent variables were pain measures , functional capacity , disability , muscular strength and endurance , pain and posture-related self-efficacy , attitudes , depression , well-being , behavioural habits and posture assessed by a st and ardized behavioural observation method . Immediately after the intervention , patients in the treatment group ( n=36 ) showed significant improvement over patients in the control group ( n=29 ) in all variables except depression and muscular strength and endurance . At 6-months follow-up , compared to pretreatment scores , patients continued to show beneficial effects in pain intensity and frequency , posture , posture-related self-efficacy and well-being . In contrast to post-treatment results , there were also significant improvements in strength and endurance . Overall results testify to the effectiveness of the intervention programme . Future studies ( with larger sample sizes ) should aim at a further improvement of functional capacity and disability perception , an analysis of differential treatment effects , and strategies for an improved long-term maintenance of the changes induced by the programme Study Design . Systematic Review . Objectives . To assess the effects of massage therapy for nonspecific low back pain . Summary of Background Data . Low back pain is one of the most common and costly musculoskeletal problems in modern society . Proponents of massage therapy cl aim it can minimize pain and disability , and speed return to normal function . Methods . We search ed MEDLINE , EMBASE , CINAHL from their beginning to May 2008 . We also search ed the Cochrane Central Register of Controlled Trials ( The Cochrane Library 2006 , issue 3 ) , HealthSTAR and Dissertation abstract s up to 2006 . There were no language restrictions . References in the included studies and in review s of the literature were screened . The studies had to be r and omized or quasi-r and omized trials investigating the use of any type of massage ( using the h and s or a mechanical device ) as a treatment for nonspecific low back pain . Two review authors selected the studies , assessed the risk of bias using the criteria recommended by the Cochrane Back Review Group , and extracted the data using st and ardized forms . Both qualitative and meta-analyses were performed . Results . Thirteen r and omized trials were included . Eight had a high risk and 5 had a low risk of bias . One study was published in German and the rest in English . Massage was compared to an inert therapy ( sham treatment ) in 2 studies that showed that massage was superior for pain and function on both short- and long-term follow-ups . In 8 studies , massage was compared to other active treatments . They showed that massage was similar to exercises , and massage was superior to joint mobilization , relaxation therapy , physical therapy , acupuncture , and self-care education . One study showed that reflexology on the feet had no effect on pain and functioning . The beneficial effects of massage in patients with chronic low back pain  lasted at least 1 year after the end of the treatment . Two studies compared 2 different techniques of massage . One concluded that acupuncture massage produces better results than classic ( Swedish ) massage and another concluded that Thai massage produces similar results to classic ( Swedish ) massage . Conclusion . Massage might be beneficial for patients with subacute and chronic nonspecific low back pain , especially when combined with exercises and education . The evidence suggests that acupuncture massage is more effective than classic massage , but this need confirmation . More studies are needed to confirm these conclusions , to assess the impact of massage on return-to-work , and to determine cost-effectiveness of massage  as an intervention for low back pain UNLABELLED Chronic diseases of the musculoskeletal system rank first as causes of early retirement in Germany . Therefore orthopaedic rehabilitation has to identify patients with work-related problems and to promote return to work through differential treatment and vocational counselling . In the framework of the IopKo-Project such measures were developed and evaluated . These measures encompass : ( 1 ) an intensive and multiprofessional diagnostic pathway which allows early detection and treatment of mental disorders and job related problems ; ( 2 ) homogeneous treatment groups based on multiprofessional diagnostics ; ( 3 ) differential treatments , among these a multidisciplinary programme for patients with chronic low back pain or high risk of chronification ( Rückenfit ) ; ( 4 ) interactive training modules which mediate principles of performance and disability expertise , the legal bases of retirement pensioning , and measures to support occupational rehabilitation ; and ( 5 ) a work hardening training programme . METHOD To evaluate the effects of these measures in comparison to a control group with usual care , a prospect i ve longitudinal study was conducted . A total of 307 patients were assigned to the multidisciplinary in-patient treatment programme , whereas 176 patients in the control group had a st and ard rehabilitation programme .  RESULTS The results show positive moderate and strong effects in the intervention group concerning function , pain , psychic strains as well as the number of sick days and return to work rates 10 months after discharge . The effects in the intervention group exceeded the effects achieved in the control group . PATIENTS WITH HIGH RISK OF CHRONIFICATION : Beside the full sample , a subgroup of patients with chronic pain or high risk of chronification was analyzed , who had received a multidisciplinary functional restoration treatment . Also for this subgroup we found moderate and strong effects of treatment for function , psychic strains and sick days superior to those in the control group . CONCLUSION By this study we were able to show that orthopedic rehabilitation in a multimodal and multidisciplinary setting with a focus on activating and motivating therapy can have sustainable positive effects on pain , function and psychic well-being as well as on economic parameters . We interpret these persistent and superior effects in the treatment group ( 1 ) as a result of multiprofessional diagnosis and assignment which helps to subdivide the inhomogeneous group of patients with unspecific back pain into more homogeneous and thus more effective subgroups , ( 2 ) as a result of increased motivation by closed treatment groups , ( 3 ) as a result of intense and multilevel counselling of work related problems , ( 4 ) as a result of work hardening modules , and ( 5 ) as a result of direct and efficient treatment of psychic strains . The results also demonstrate the significance of inpatient rehabilitation , which will be efficient if differential treatment - adequate to the problems of the patient - is offered Study Design . A stratified r and omized single-blinded clinical trial . Objective . To compare the efficacies of 2 active therapies for chronic low back pain ( CLBP ) . Summary of Background Data . Both a multidisciplinary biopsychosocial rehabilitation program and an intensive individual therapist-assisted back muscle strengthening exercise program used in Denmark have been reported to be effective for the treatment of CLBP . Methods . A total of 286 patients with CLBP were r and omized to either a group-based 12-week program comprising 73 hours of therapist exposure ( approximately 12 h/patient ) : 35 hours of hard physical exercise , 22 hours of light exercise/occupational therapy , and 16 hours of education ( group A ) or a 12-week program comprising 1 hour of personal training twice a week , i.e. , therapist exposure 24 h/patient ( group B ) . At baseline and at 3 , 6 , 12 , and 24 months , patients filled out question naires on pain ( visual analogue scale [VAS]-pain average , which was the primary outcome measure ) , Rol and -Morris disability question naire , global perceived outcome , and 36-Item Short-Form General Health Survey . Data were analyzed using the intention-to-treat principle . Results . Of the 286 patients , 14 patients did not start treatment . Of the remaining patients , 25 ( 9 % ) dropped out of therapy . The 2 groups were comparable regarding baseline characteristic . After treatment , significant improvements were observed with regard to pain , disability , and most of the quality of life dimensions . These effects were sustained over the 24-month follow-up period . There were some statistically significant differences between the 2 groups relating to secondary end points , Rol and -Morris disability question naire , and in the MOS 36-Item Short-Form Health Survey the “ physical functioning ” dimension and the “ physical component summary . ” Conclusion . Both groups showed long-term improvements in pain and disability scores , with only minor statistically significant differences between the 2 groups . The minor outcome difference in favor of the group-based multidisciplinary rehabilitation program is hardly of clinical interest for individual patients Background Musculoskeletal injury is the most common reason that soldiers are medically not ready to deploy . Underst and ing intrinsic risk factors that may place an elite soldier at risk of musculoskeletal injury may be beneficial in preventing musculoskeletal injury and maintaining operational military readiness . Findings from this population may also be useful as hypothesis-generating work for particular civilian setting s such as law enforcement officers ( SWAT teams ) , firefighters ( smoke jumpers ) , or others in physically dem and ing professions . Questions / purpose sThe purpose s of this study were ( 1 ) to examine whether using baseline measures of self-report and physical performance can identify musculoskeletal injury risk ; and ( 2 ) to determine whether a combination of predictors would enhance the accuracy for determining future musculoskeletal injury risk in US Army Rangers . Methods Our study was a planned secondary analysis from a prospect i ve cohort examining how baseline factors predict musculoskeletal injury . Baseline predictors associated with musculoskeletal injury were collected using surveys and physical performance measures . Survey data included demographic variables , injury history , and biopsychosocial questions . Physical performance measures included  ankle dorsiflexion , Functional Movement Screen , lower and upper quarter Y-balance test , hop testing , pain provocation , and the Army Physical Fitness Test ( consisting of a 2-mile run and 2 minutes of sit-ups and push-ups ) . A total of 320 Rangers were invited to enroll and 211 participated ( 66 % ) . Occurrence of musculoskeletal injury was tracked for 1 year using monthly injury surveillance surveys , medical record review s , and a query of the Department of Defense healthcare utilization data base . Injury surveillance data were available on 100 % of the subjects . Receiver operator characteristic curves and accuracy statistics were calculated to identify predictors of interest . A logistic regression equation was then calculated to find the most pertinent set of predictors . Of the 188 Rangers ( age , 23.3 ± 3.7 years ; body mass index , 26.0 ± 2.4 kg/m2 ) remaining in the cohort , 85 ( 45.2 % ) sustained a musculoskeletal injury of interest .  Results Smoking , prior surgery , recurrent prior musculoskeletal injury , limited-duty days in the prior year for musculoskeletal injury , asymmetrical ankle dorsiflexion , pain with Functional Movement Screen clearing tests , and decreased performance on the 2-mile run and 2-minute sit-up test were associated with increased injury risk . Presenting with one or fewer predictors result ed in a sensitivity of 0.90 ( 95 % confidence interval [ CI ] , 0.83–0.95 ) , and having three or more predictors result ed in a specificity of 0.98 ( 95 % CI , 0.93–0.99 ) . The combined factors that contribute to the final multivariable logistic regression equation yielded an odds ratio of 4.3 ( 95 % CI , 2.0–9.2 ) , relative risk of 1.9 ( 95 % CI , 1.4–2.6 ) , and an area under the curve of 0.64 . Conclusions Multiple factors ( musculoskeletal injury history , smoking , pain provocation , movement tests , and lower scores on physical performance measures ) were associated with individuals at risk for musculoskeletal injury . The summation of the number of risk factors produced a highly sensitive ( one or less factor ) and specific ( three or more factors ) model that could potentially be used to effectively identify and intervene in those persons with elevated risk for musculoskeletal injury . Future research should establish if screening and intervening can improve musculoskeletal health and if our findings among US Army Rangers translate to other occupations or athletes . Level of Evidence Level II , prognostic study This study examined the effects of work-related multidisciplinary rehabilitation ( MR ) on occupational participation in patients with chronic musculoskeletal disorders . A r and omized-controlled trial was carried out . The sample included patients with chronic musculoskeletal disorders and severe restrictions of work ability ( n=222 ) . Participants in the intervention group received a work-related rehabilitation programme following a comprehensive functional capacity evaluation ( FCE MR ) . Controls completed a conventional MR . The analysis was based on 1-year follow-up data . The primary outcome was stable occupational participation ( SOP ) , defined as employment with at most 6 months of sick leave after rehabilitation . The secondary outcomes were the duration of sick leave , employment status and the Pain Disability Index .  We included 102 patients in our analysis ( intervention : n=55 ,  control : n=47 ) . Despite r and omization there were group differences . Adjusting these differences , patients of the FCE MR had 3.5 times higher odds of SOP [ 95 % confidence interval ( CI ) : 1.2–9.8 , P=0.018 ] . However , there was neither a significant difference in the duration of sick leave between both groups ( b=−8.0 weeks , 95 % CI : −17.4 to 1.4 , P=0.095 ) nor higher odds of employment in favour of the FCE MR after 1 year ( odds ratio=2.3 , 95 % CI : 0.9–5.8 , P=0.088 ) . Participants in the FCE MR reported less pain-related disabilities ( b=−6.5 , 95 % CI : −12.6 to −0.4 , P=0.038 ) . The study had a limitation in terms of group balance . However , the findings indicate that the work-related FCE MR was more effective for SOP , but did not significantly affect employment rate and sick leave duration Zygapophysial or facet joints have been implicated as cause of low back , mid back , upper back and neck pain with referred pain . Cervical , thoracic and lumbar facet joints are innervated by the medial branches of the dorsal rami . Zygapophysial ( facet ) joints have been implicated as the source of chronic pain in 15 % to 45 % of the patients with chronic low back pain , 54 % to 60 % of the patients with chronic neck pain and 48 % of the patients with thoracic pain . A systematic review of the evidence of effectiveness of radiofrequency denervation in the management of chronic spinal pain was undertaken . This review included r and omized clinical trials , as well as non-r and omized or observational studies in the analysis . Literature search included MEDLINE , EMBASE , systematic review s , narrative review s , cross-references to the review s and various published trials ; and peer review ed abstract s from scientific meetings during the past two years . An algorithmic approach was followed in study evaluation with a description of inclusion and exclusion criteria . A set of high-performing scales or checklists pertaining to r and omized clinical trials and observational trials derived from the Agency for Healthcare Research and Quality ( AHRQ ) was utilized ; Systems to Rate the Strength of Scientific Evidence . Qualitative analysis was conducted , using five levels of evidence for effectiveness of medial branch neurotomy . Our search strategy identified over 1,000 citations as the result of electronic and manual screening . A total of 7 r and omized trials of radiofrequency neurotomy for spinal pain were identified . However , only 4 related to medial branch neurotomy . Two of the four met the inclusion criteria . Among the multiple observational studies considered for inclusion , 4 prospect i ve evaluations were included in the systematic review . In addition , 3 retrospective evaluations were also included . Two r and omized trials comprised of 27 patients receiving active treatment . The first study consisted of cervical facet joint pain and the second consisted of lumbar facet joint pain . Both studies showed positive results . Similar to r and omized trials , prospect i ve , as well as retrospective evaluations showed positive evidence , both in short-term and long-term . The results of this systematic review of 2 well- design ed r and omized trials , 4 prospect i ve well- design ed trials without r and omization and 3 retrospective evaluations provided strong evidence that radiofrequency denervation offers short-term relief and moderate evidence of long-term pain relief of facet joint origin Background Few data are available on the course of and predictors for disability in patients with chronic nonspecific low back pain ( CNSLBP ) . Objective The purpose of this study was to describe the course of disability and identify clinical ly important prognostic factors of low-back-pain – specific disability in patients with CNSLBP receiving multidisciplinary therapy .  Design A prospect i ve cohort study was conducted . Methods A total of 1,760 patients with CNSLBP who received multidisciplinary therapy  were evaluated for their course of disability and prognostic factors at baseline and at 2- , 5- , and 12-month follow-ups . Recovery was defined as 30 % reduction in low back pain – specific disability at follow-up compared with baseline and as absolute recovery if the score on the Quebec Back Pain Disability Scale ( QBPDS ) was ≤20 points at follow-up . Potential prognostic factors were identified using multivariable logistic regression analysis . Results Mean patient-reported disability scores on the QBPDS ranged from 51.7 ( SD=15.6 ) at baseline to 31.7 ( SD=15.2 ) , 31.1 ( SD=18.2 ) , and 29.1 ( SD=20.0 ) at 2 , 5 , and 12 months , respectively . The prognostic factors identified for recovery at 5 and 12 months were younger age and high scores on disability and on the 36-Item Short-Form Health Survey ( SF-36 ) ( Physical and Mental Component Summaries ) at baseline . In addition , at 5-month follow-up , a shorter duration of complaints was a positive predictor , and having no comorbidity and less pain at baseline were additional predictors at 12-month follow-up . Limitations Missing values at 5- and 12-month follow-ups were 11.1 % and 45.2 % , respectively . Conclusion After multidisciplinary treatment , the course of disability in patients with CNSLBP continued to decline over a 12-month period . At 5- and 12-month follow-ups , prognostic factors were identified for a clinical ly relevant decrease in disability scores on the QBPDS A pilot study was set up to assess the long-term effects of once weekly versus once monthly follow-up of pulmonary rehabilitation after a comprehensive home rehabilitation program on physical performance in patients with chronic obstructive pulmonary disease ( COPD ) during an 18-mo period . Thirty-six patients with a mean FEV1 of 1.3 + /- 0.4 L ( 43 % pred ) were included in the study . Groups A and B ( n = 23 ) visited the physical therapist twice weekly for 3 mo . Thereafter , 11 patients ( Group A ) had a follow-up of pulmonary rehabilitation once a week , and 12 patients ( Group B ) had a follow-up once a month . Thirteen patients received no rehabilitation at all ( Group C ) . Long-term home rehabilitation does not appear to improve exercise tolerance ; however , on the other h and , there is a deterioration in vital capacity ( p < 0.01 ) , walking distance ( p < 0.01 ) , and maximal work load ( p < 0.05 ) , as shown in the control group . A small improvement in exertional dyspnea ( p < 0.01 ) after 18 mo and inspiratory muscle function ( p < 0.05 ) after 12 mo was shown only in Group A. Because of the insufficient number of patients enrolled in this pilot study , no clear benefit on physical performance of long-term home rehabilitation with either weekly or monthly supervision could be demonstrated
Discussion : While pain intensity and long-term chronicity did not predict physical functioning in chronic pain patients after MDR , poor pretreatment physical and psychological functioning influenced the prognosis negatively .
Thus , treatment should further target and optimize these modifiable factors and an increased focus on positive , psychological protective factors may perhaps provide an opening for yet untapped clinical gains
Objectives : This systematic review aim ed to identify and evaluate prognostic factors for long-term ( ≥6 mo ) physical functioning in patients with chronic musculoskeletal pain following multidisciplinary rehabilitation ( MDR ) .