Comparison of short- and long-term outcomes for aggressive spine rehabilitation delivered two versus three times per week.
BACKGROUND
Rehabilitation services using intensive exercise for the treatment of chronic spinal pain have traditionally been scheduled at a frequency of three times per week.


OBJECTIVE
In an attempt to reduce the cost of rehabilitation services, this study was designed to determine whether treatment offered two times per week could produce similar outcomes when compared with an established three times per week spine therapy program.


METHODS
Prospective cohort study.


METHODS
Seventy-seven consecutive patients with chronic spinal pain were treated with aggressive spine rehabilitation either two or three times per week.


METHODS
Flexibility, trunk strength and lifting capacity were quantified before and after treatment. Pain visual analog scores and Oswestry disability scores were measured before and after treatment, as well as 12 months after treatment.


METHODS
A two times per week physical therapy program was developed to be identical in its treatment method to an established three times per week, group-oriented physical therapy program used for the treatment of chronic spinal pain. Patients with spinal pain who continued to work despite chronic pain complaints were allowed to choose between the two therapy programs based on availability of treatment slots and convenience. Treatment consisted of non-pain contingent quota-based exercises targeting identified physical impairments. Treatment sessions lasted for 2 hours and consisted of 30 minutes of stretching, 30 minutes of low-impact step aerobics class and 1 hour of exercise on strength and endurance equipment. Therapy occurred in groups consisting of a maximum of eight patients who were closely supervised by two therapists. Targeted treatment time was 6 weeks. At 12 months after treatment, subjects were surveyed by mailed questionnaires.


RESULTS
Seventy-seven patients with chronic spinal pain with a mean duration of symptoms of 32 months underwent treatment. Twenty-four subjects opted for the twice per week and 53 opted for the three times per week treatment. Seventy-one percent of subjects responded to the 12-month follow-up questionnaire. Physical and self-reported measures improved with both treatment frequencies. There were no differences in outcomes between treatment frequencies for measured flexibility, trunk strength, lifting capacity, pain intensity scores or Oswestry scores at the completion of treatment. At 12-month follow-up, no differences were noted between treatment frequencies for pain scores, Oswestry scores, patients' perceptions of adequacy of treatment, posttreatment exercise compliance or use of other treatments for their spinal problem. Total therapy visits were less in the two than three times per week groups (12 vs 15 visits).


CONCLUSIONS
Similar outcomes were obtained from aggressive spine rehabilitation occurring two versus three times per week in patients presenting with moderate levels of chronic spinal pain. Reduction in physical therapy services and therefore cost did not adversely affect clinical outcomes in the treatment of this patient population.
The Spine Center at New England Baptist Bone and Joint Institute, 125 Parker Hill Avenue, Boston, MA 02120, USA. jrainvil@caregroup.harvard.edu
James
J
Rainville
Cristin A
CA
Jouve
Carol
C
Hartigan
Eugenio
E
Martinez
Mark
M
Hipona
D000328:Adult; D000367:Age Factors; D000704:Analysis of Variance; D002908:Chronic Disease; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D017116:Low Back Pain / Q000175:diagnosis* / Q000534:rehabilitation*; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D017060:Patient Satisfaction; D026741:Physical Therapy Modalities / Q000379:methods*; D011446:Prospective Studies; D020127:Recovery of Function; D012307:Risk Factors; D012720:Severity of Illness Index; D012737:Sex Factors; D013997:Time Factors; D016896:Treatment Outcome