Chronic low back pain (CLBP) is associated with persistent or recurrent disability, which results in high costs for society. Cognitive behavioral treatments produce clinically relevant benefits for patients with CLBP. Nevertheless, no clear evidence for the most appropriate intervention is yet available. The purpose of a study by van Hooff and colleagues was to evaluate the mid-term effects of treatment in a cohort of patients with CLBP participating in an intensive pain management program. The program, provided by RealHealth-Netherlands, is based on cognitive behavioral principles and executed in collaboration with orthopedic surgeons. Main outcome parameters were daily functioning (Roland and Morris Disability Questionnaire and Oswestry Disability Questionnaire), self-efficacy (Pain Self-Efficacy Questionnaire), and quality of life (Short Form 36 Physical Component Score). All parameters were measured at baseline, last day of residential program, and at one and 12 months follow-up. Repeated measures analysis was applied to examine changes over time. Clinical relevance was examined using minimal clinical important differences (MCID) estimates for main outcomes. To compare results with literature effect sizes (Cohen's d) and Standardized Morbidity Ratios (SMR) were determined. 107 patients with CLBP participated in this program. Mean scores on outcome measures showed a similar pattern: improvement after residential program and maintenance of results over time. Effect sizes were 0.9 for functioning, 0.8 for self-efficacy, and 1.3 for physical functioning-related quality of life. Clinical relevancy: 79% reached MCID on functioning, 53% on self-efficacy, and 80% on quality of life. Results on functioning were found to be 36% better and 2% worse when related to previous research on, respectively, rehabilitation programs and spinal surgery for similar conditions (SMR 136 and 98%, respectively).

WHAT THE STUDY MAY MEAN TO YOU AS A HEALTH CARE PROVIDER: The participants of this evidence-based program learned to manage CLBP, improved in daily functioning, and quality of life. The study results are meaningful and comparable with results of spinal surgery. They were even better than results from less intensive rehabilitation programs.

WHAT THE STUDY MAY MEAN TO YOU AS A HEALTH CARE CONSUMER:
The results of the study are impressive. The investigators should now replicate their study, but collect further long-term data (at least two years of results). The procedure sounds highly promising, particularly compared to spinal surgery.

ML van Hooff et al. Daily functioning and self-management in patients with chronic low back pain after an intensive cognitive behavioral programme for pain management. European Spine Journal, May 27, 2010