What is the efficacy of functional restoration for the treatment of low back pain (LBP)?

Updated: Aug 22, 2018
  • Author: Jasvinder Chawla, MD, MBA; Chief Editor: Stephen A Berman, MD, PhD, MBA  more...
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In 1987, Mayer et al reported the results of a 2-year prospective study of FR to treat industrial lower-back injuries. Although patients were not truly randomly assigned to treatment or comparison groups, nor did they represent the general population, 87% of the treated group who could be contacted were working 1 year after completing the program. At 1 year, only 41% of the comparison group (composed of patients who could not obtain insurance approval to enter the program) and 25% of those who dropped out of the program were working. Mayer et al also demonstrated a reduced need for additional surgical and medical care in the treatment group compared with the other groups.

Another FR program that was similar to the one above demonstrated similar results; however, other similar programs have not replicated that degree of success. An FR study involving 11 treatment centers in 7 states, which emphasized work-hardening and excluded structured psychosocial programs, showed statistically significant increased return-to-work rates with FR versus a comparison group at 6-month (66%) and 12-month (77%) follow-up (P< .0001). Furthermore, postsurgical patients had a return-to-work rate similar to that of nonsurgical patients. Moderate evidence suggests that these programs reduce pain and strong evidence suggests that they improve function when compared with the usual rehabilitation techniques and other conservative care methods. [106, 59]

A systematic review of long-term outcomes (eg, 5 years or less) showed strong evidence for the long-term effects of intensive FR programs on quality of life and return to work. Programs with less intensive physical therapy requirements (eg, < 100 hours of total time) did not demonstrate similar efficacy. [273]

FR treatment for spine-related pain and disability, especially from cLBP, appears appropriate for selected patients. However, predicting which patients will respond favorably is not yet possible. Although data suggest that these intensive programs may save money, the treatment is still costly by most standards.

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