Outcomes of a multidisciplinary treatment program for chronic low back pain patients in Hong Kong

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Outcomes of a multidisciplinary treatment program for chronic low back pain patients in Hong Kong


Author: Wan, Wai-man
Title: Outcomes of a multidisciplinary treatment program for chronic low back pain patients in Hong Kong
Degree: M.Sc.
Year: 2003
Subject: Hong Kong Polytechnic University -- Dissertations
Backache -- Treatment
Backache -- Patients -- Rehabilitation
Department: Multi-disciplinary Studies
Dept. of Rehabilitation Sciences
Pages: vii, 107 leaves : col. ill. ; 30 cm
Language: English
InnoPac Record: http://library.polyu.edu.hk/record=b1710668
URI: http://theses.lib.polyu.edu.hk/handle/200/3408
Abstract: Chronic low back pain is a long-term illness affecting the western societies as well as Hong Kong. Ten percent of the low back pain population do not recover within 12 months and become chronic suffers. Most of them continue to suffer from persistent pain and disability. Their demand on the health care resources is large and the rate of absence from work is high. This chronic illness becomes a burden on the society in the social, economic and medical aspects. Many chronic pain sufferers reduce their physical activities due to the fear of getting re-injuries. This results in 'disuse-induced deconditioning syndrome'. The conventional treatments are concentrated on passive approach which was shown to be ineffective in reducing chronic pain and disability. The multimodal rehabilitation program adopted the 'Functional Restoration approach' was demonstrated to improve physical disability and pain alleviation. A high return-to-work rate of the chronic back pain sufferers was also shown in many previous studies. However, contradictory results in vocational outcome were found in some studies. Facing the economic constraint, the medical resource is shrinking. The cost-effectiveness of a program should be seriously considered. A better prediction model of vocational outcomes would be useful to screen the suitable subjects to be admitted into the multimodal rehabilitation program. Although many studies have been done in the western countries and demonstrated the effectiveness of the multimodal rehabilitation program, no study has been done in Hong Kong. Therefore, the objectives of this study were: (i) to examine the effectiveness of a multidisciplinary functional restoration program for patients with chronic low back pain in Hong Kong; and (ii) to identify the associated factors that can predict the vocational outcomes of the treatment program. Sixty-five eligible subjects participated in a 12-week multidisciplinary treatment program. The design of the training program was based on the 'functional restoration approach'. All subjects were assessed before the program, midway of the training period, immediately after the program, and 6-month follow-up. Outcome measures included the pain intensity, self-perception of disability, physical function, psychological performance and vocational outcomes. Repeated measures of analysis of variance was used for data analysis. The subjects were identified into two outcome groups according to their vocational outcomes. The baseline factors including demographic, social and psychological data were used to correlate with the vocational outcomes. Univariate analysis was used to identify the associated factors. By the Classification and Regression Tree analysis, the prediction model was built from the associated factors. Eight subjects dropped out from the study. Among the remaining program graduates (n=54), 52% returned to work at the 6-month follow-up. The rehabilitation program demonstrated the effectiveness on regaining the physical function and return-to-work. The results also indicated the long-term effect of pain reduction, reduction in self-perception of disability index, improvement in physical function. However no obvious improvement was shown in the psychological performance during the training period. The return-to-work graduates showed better improvement in the self-perception of disability and physical function. We identified two social and one demographic factors that were correlated with the vocational outcome. The prediction model correctly classified 71% and 77% of the program graduates who returned to work and did not return to work respectively.

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