The Evidence

A 5-Year Follow-Up Evaluation of the Health and Economic Consequences of an Early Cognitive Behavioral Intervention for Back Pain: RCT

S J. Linton, PhD, E Nordin, MA. Spine 31(8):853-858, 2006.

213 participants randomized to:

1. cognitive-behavioral group
2. usual care plus information on self-care (information comparison group)

97% completed a follow-up questionnaire 5 years after the intervention.

The cognitive behavioral group (relative to the information comparison group) had:

• significantly less pain
• was more active
• enjoyed better quality of life
• better general health
• lower risk of long-term sick leave (3 times  less)
• significantly less lost productivity costs
• lower total cost per person

Meta-analysis of Psychological Interventions for Chronic Low Back Pain

1. Examined 22 randomized trials published between 1982 and 2003
2. low back pain that had persisted for at least three months (avg. 7.5 yrs)

Positive effects of psychological interventions (especially Cognitive-behavioral and self-regulatory treatments) vs. various control groups were noted for:

1. pain intensity
2. pain-related interference
3. health-related quality of life
4. depression

The results demonstrated positive effects of psychological interventions for CLBP. The rigor of the methods used, as well as the results that reflect mild to moderate heterogeneity and minimal publication bias, suggest confidence in the conclusions of this review.

“Surgery, opioids, nerve blocks, spinal cord stimulators, implantable drug delivery systems every one of those particular alternatives is much more expensive and has poorer or at best equal outcomes compared to rehabilitation programs that include psychological components”.

Functional Restoration Programme Brings Staff Back to Work

Published on the Government’s Health and Safety Executive’s website: www.hse.gov.uk/Msd/experience/restoration.htm

• The Royal Mail decided to introduce a biopsychosocial Functional Restoration Programme (FRP) at Royal Mail. The trial ran for 24 months at the Mount Pleasant Sorting Office. 
• Before the programme, the estimated cost to the Royal Mail of the absence and restricted duties of clients in the study group was £1,384,501.
• Since the programme, this has fallen to £127,738.
• On the premise that absence and restricted duties would have continued at similar rates without the rehabilitation programme the saving is in excess of £1million a year.

Effectiveness and Cost-Effectiveness of Three Types of Physiotherapy Used to Reduce Chronic Low Back Pain Disability: A Pragmatic Randomized Trial With Economic Evaluation.

Critchley, DJ. et al. Spine. 32(14):1474-1481, June 15, 2007.

212 patients referred to physiotherapy with chronic low back pain, randomized to receive:

• usual outpatient physiotherapy
• spinal stabilization classes
• physiotherapist-led pain management classes

Outcomes at 18 months from baseline:

• Roland Disability Questionnaire
• Pain
• Health-related quality of life
• Time off work
• Healthcare costs associated with low back pain
• Quality-adjusted life years

All three physiotherapy regimens improved disability and other relevant health outcomes, regardless of their content. Participants in the pain management arm had fewer:

• secondary care visits (4 times less)
• inpatient procedures
• investigations
• markedly lower costs in ‘other’ health care visits

• a cost-effective alternative to usual outpatient physiotherapy      
• is associated with less healthcare use

A more widespread adoption of physiotherapist-led pain management could result in considerable cost savings for healthcare providers.

‘Extrapolating our results, changing physiotherapy practice in 50% of patients with low back pain from individual treatment to physiotherapy-led outpatient pain management programmes would result in savings to the UK. public health service of 126 million per year (2003-2004 prices)’.