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Informative Approach to Low Back Pain

This study tested the long-term effects of a light mobilization program and informative approach to low back pain (LBP). The authors compared 245 patients in an intervention group to 244 patients in a control group, to gauge the benefits of such a program, and to determine the factors that would indicate eventual return to work.

The intervention included an exam and clinical advice, and 3 hours of a "Mini Back School." The information covered the basics of coping with LBP amidst everyday living, discussed the link between pain and emotions, and stressed the importance of continuing normal activity. The program attempted to heighten awareness, rather than ordering instructions.
198 (81%) of the patients in the intervention group returned to work within five years; 160 (65%) in the control group. The control group patients were nearly twice as likely to end up permanently disabled.

After the five-year study, the researchers went back to determine the predictors of return or nonreturn to work. Nonreturners had more children, less income, and feelings of no control or power over their health status.

The authors conclude with the benefits of the program:

"The thorough examination coupled with the assurance that the patient's situation was not serious, gave the patient the confidence needed to follow the advice and resume light normal activity. Lasting behavioral modification is achieved only through experience. It is believed that it was the patient's positive experience that resulted in the favorable long-term effect. The outcome supports the view that a substantial part of LBP may be a functional disturbance, and that light normal activity may restore normal function."

Indahl A, Haldorsen E, Holm S, et al. Five-year follow-up study of a controlled clinical trial using light mobilization and an informative approach to low back pain. Spine 1998; 23(23):2625-2630.