Comparative Effectiveness of an Interdisciplinary Pain Program for Chronic Low Back Pain, Compared to Physical Therapy Alone

Sara Davin, PsyD, MPH; Brittany Lapin, PhD, MPH; Desimir Mijatovic, MD; Robert Fox, MD; Edward Benzel, MD; Mary Stilphen, PT, DPT; Andre Machado, MD; Irene L. Katzan, MD

Disclosures

Spine. 2019;44(24):1715-1722. 

In This Article

Abstract and Introduction

Abstract

Study Design: This is an observational cohort study.

Objective: The aim of this study was to compare the effectiveness of PT to an interdisciplinary treatment approach in patients with chronic low back pain (CLBP).

Summary of Background Data: CLBP is a costly and potentially disabling condition. Physical therapy (PT), cognitive behavioral therapy, and interdisciplinary pain programs (IPPs) are superior to usual care. Empirical evidence is lacking to clearly support one treatment approach over another in patients with CLBP.

Methods: One hundred seventeen adult patients who completed an IPP for individuals with ≥3 months of back pain were compared to 214 adult patients with similar characteristics who completed PT. The Modified Low Back Pain Disability Questionnaire was the primary outcome measure. Additional measures included: PROMIS physical function, global health, social role satisfaction, pain interference, anxiety, fatigue, sleep disturbance, and Patient Health Questionnaire. Patients who completed the IPP were matched by propensity score to a historical control group of patients who completed a course of PT. Change in functional disability was compared between IPP patients and matched controls. Patient-reported outcome measures were assessed pre to post participation in the IPP using paired t test and by calculating the proportion with clinically meaningful improvement.

Results: Propensity score matching generated 81 IPP and 81 PT patients. Patients enrolled in the IPP had significantly greater improvement in MDQ scores upon completion compared to patients in PT (15.8 vs. 7.1, P < 0.001). The majority of IPP patients reached the threshold for clinically meaningful change of ≥10 point reduction (60.5%) compared to 34.6% of PT patients, P < 0.01. Patients in the IPP also showed statistically and clinically significant improvement in social role satisfaction, fatigue, and sleep disturbance.

Conclusion: CLBP patients in an IPP demonstrated greater functional improvements compared to similar patients participating in PT.

Level of Evidence: 3

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