title: The influence of the grade of chronicity on the outcome of multidisciplinary therapy for chronic low back pain.
abstract: METHODS
  Prospective longitudinal clinical study.
  
  
  OBJECTIVE
  The objective of the study was to analyze the outcome of different stages of chronicity in patients with chronic low back pain treated with a multidisciplinary therapy.
  
  
  BACKGROUND
  Results of studies comparing different grades of chronicity in therapy for chronic low back pain have not been published so far.
  
  
  METHODS
  A total of 387 patients with chronic low back pain for 3 months or longer and a corresponding sick leave for longer than 6 weeks underwent a 3-week standardized multidisciplinary therapy. At baseline (T0), patients were assigned into 3 groups of chronicity grades according to the classification of von Korff et al (Group A, Grades I and II; Group B, Grade III; Group C, Grade IV) and were prospectively followed. At the the 6-month follow-up (T1), 5 different therapy outcomes were analyzed and compared in the 3 groups: back-to-work status, generic health status (SF-36), pain intensity (visual analogue scale), functional capacity (Hannover back capacity score), and satisfaction with the therapy.
  
  
  RESULTS
  At T0, patients in Group C had a higher pain level, a longer history of pain, and more general and more psychosomatic comorbidities than patients with lower levels of chronicity. All 3 treatment groups improved significantly in all outcome criteria between T0 and T1. In the total group, the back-to-work rate was 67.4%. At the final follow-up, there were significantly better results in terms of functional capacity and pain level in patients with lower grades of chronicity but mostly due also to worse initial baseline values. Back-to-work rate, satisfaction with therapy, and the Mental Component Summary of the SF-36 did not show a significant difference at T1 between the groups analyzed.
  
  
  CONCLUSIONS
  According to the results of this study, patients with chronic low back pain also derive significant benefit from a multidisciplinary treatment strategy in higher stages of chronicity. Therefore, therapy should not be limited to the patients in lower stages of chronicity.
authors: Department of Orthopaedic Surgery, University of Heidelberg, Heidelberg, Germany. Matthias.Buchner@t-online.de
authors: Matthias
authors: M
authors: Buchner
authors: Eva
authors: E
authors: Neubauer
authors: Anita
authors: A
authors: Zahlten-Hinguranage
authors: Marcus
authors: M
authors: Schiltenwolf
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002908:Chronic Disease; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D017116:Low Back Pain / Q000145:classification* / Q000523:psychology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D018710:Pain Clinics / Q000639:trends*; D010147:Pain Measurement / Q000639:trends; D011446:Prospective Studies; D016896:Treatment Outcome