Comparison of a Functional Restoration Program With Active Individual Physical Therapy for Patients With Chronic Low Back Pain: A Randomized Controlled Trial

Abstract 

Roche G, Ponthieux A, Parot-Shinkel E, Jousset N, Bontoux L, Dubus V, Penneau-Fontbonne D, Roquelaure Y, Legrand E, Colin D, Richard I, Fanello S. Comparison of a functional restoration program with active individual physical therapy for patients with chronic low back pain: a randomized controlled trial.

Objective

To compare the short-term outcomes of active individual therapy (AIT) with those of a functional restoration program (FRP).

Design

Prospective randomized controlled study.

Setting

Two rehabilitation centers and private ambulatory physiotherapy facilities.

Participants

One hundred thirty-two adults with chronic low back pain. Fifty-one percent of patients on sick leave or out of work (mean duration, 180d in the 2y before treatment).

Interventions

For 5 weeks, FRP (at 25h/wk) or AIT (at 3h/wk).

Main Outcome Measures

Trunk flexibility, back flexor, and extensor endurance (Ito and Sorensen tests), general endurance, pain intensity, Dallas Pain Questionnaire (DPQ) scores, daily activities, anxiety depression, social interest, and work and leisure activities, and self-reported improvement (work ability, resumption of sport and leisure activities).

Results

All outcome measures improved after treatment except endurance in AIT. There was no between-group difference for pain intensity or DPQ daily activities or work and leisure activities scores. Better results were observed in FRP for all other outcome measures. There was a significant effect of treatment and the initial value for the gain of the Sorensen score with a treatment or initial value interaction; a significant effect of treatment and initial value on the gains of Ito, endurance, and DPQ social interest and anxiety depression scores, with no treatment or initial value interaction; and a significant effect of initial value but not treatment for the gains of DPQ daily activities and work and leisure activities scores.

Conclusions

Low-cost ambulatory AIT is effective. The main advantage of FRP is improved endurance. We speculate that this may be linked to better self-reported work ability and more frequent resumption of sports and leisure activities.

Key Words: Low back pain, Physical therapy modalities, Rehabilitation, Randomized clinical trial