title: Functional multidisciplinary rehabilitation versus outpatient physiotherapy for non specific low back pain: randomized controlled trial.
abstract: BACKGROUND
  In recent decades the treatment of non-specific low back pain has turned to active modalities, some of which were based on cognitive-behavioural principles. Non-randomised studies clearly favour functional multidisciplinary rehabilitation over outpatient physiotherapy. However, systematic reviews and meta-analysis provide contradictory evidence regarding the effects on return to work and functional status. The aim of the present randomised study was to compare long-term functional and work status after 3-week functional multidisciplinary rehabilitation or 18 supervised outpatient physiotherapy sessions.
  
  
  METHODS
  109 patients with non-specific low back pain were randomised to either a 3-week functional multidisciplinary rehabilitation programme, including physical and ergonomic training, psychological pain management, back school and information, or 18 sessions of active outpatient physiotherapy over 9 weeks. Primary outcomes were functional disability (Oswestry) and work status. Secondary outcomes were lifting capacity (Spinal Function Sort and PILE test), lumbar range-of-motion (modified-modified Schöber and fingertip-to-floor tests), trunk muscle endurance (Shirado and Biering-Sörensen tests) and aerobic capacity (modified Bruce test).
  
  
  RESULTS
  Oswestry disability index was improved to a significantly greater extent after functional multidisciplinary rehabilitation compared to outpatient physiotherapy at follow-up of 9 weeks (P = 0.012), 9 months (P = 0.023) and 12 months (P = 0.011). Work status was significantly improved after functional multidisciplinary rehabilitation only (P = 0.012), resulting in a significant difference compared to outpatient physiotherapy at 12 months' follow-up (P = 0.012). Secondary outcome results were more contrasted.
  
  
  CONCLUSIONS
  Functional multidisciplinary rehabilitation was better than outpatient physiotherapy in improving functional and work status. From an economic point of view, these results should be backed up by a cost-effectiveness study.
authors.affiliation: Service de Rhumatologie, Département de l'Appareil Locomoteur (DAL), Centre Hospitalier Universitaire Vaudois, Av. Pierre-Decker 4, 1011 Lausanne, Suisse. yves.henchoz@chuv.ch
authors.forename: Yves
authors.initials: Y
authors.lastname: Henchoz
authors.forename: Pierre
authors.initials: P
authors.lastname: de Goumoëns
authors.forename: Alexander Kai Lik
authors.initials: AK
authors.lastname: So
authors.forename: Roland
authors.initials: R
authors.lastname: Paillex
mesh_terms: D000328:Adult; D000553:Ambulatory Care; D005260:Female; D006801:Humans; D017116:Low Back Pain / Q000534:rehabilitation* / Q000628:therapy; D008297:Male; D026741:Physical Therapy Modalities; D011446:Prospective Studies