Effectiveness of Multidisciplinary Rehabilitation in Chronic Low Back Pain: A Pragmatic Study With a Waiting List Control Group

Abstract

Introduction: Small-scale care providers often encounter challenges in demonstrating the effectiveness of treatments through randomised controlled trials (RCTs) because of the high costs and organisational demands of RCTs. The current study examines the feasibility of evaluating a multidisciplinary treatment for chronic low back pain using a waiting list as a control group. Material and Methods: Of 344 chronic pain patients referred to a Dutch outpatient rehabilitation clinic, 123 received treatment, while 88 were on a waiting list. The main effect parameters were pain (visual analogue scale), daily limitations (Quebec Back Pain Disability Scale), and fear of motion (Tampa Scale for Kinesiophobia). Data were collected at the beginning of treatment, after 8 weeks, and after 3 months (follow-up), or after another 8 weeks for waitlist patients receiving treatment after the waiting list period. Results: The intervention group showed significant persistent improvement in relation to pain (54.1 ± 22.0 to 34.8 ± 23.6), daily limitations (45.1 ± 15.3 to 32.9 ± 15.4), and fear of motion (36.5 ± 8.5 to 30.0 ± 7.3). Subsequently, 51 subjects on the waiting list received treatment, with results similar to those of the initial intervention group. Dysfunctional pain coping strategies diminished during therapy. Discussion: Multidisciplinary rehabilitation was shown to be more effective than being placed on a waiting list, even when participants were receiving other treatments. Small-scale, high-quality effect studies using a waiting list control group may have scientific potential. Significance: RCT's are considered the gold standard in effect studies; however, due to financial, organisational, and ethical concerns, performing RCT's can be difficult for small-sized care settings that provide multidisciplinary rehabilitation for chronic back pain. As a result, these treatment options often do not receive sufficient scientific or clinical attention. This study demonstrates that alternative methodologically transparent effect studies using a “waiting list” control can be conducted in small-scale clinical settings with limited means.