title: A model of integrative care for low-back pain.
abstract: OBJECTIVE
  While previous studies focused on the effectiveness of individual complementary and alternative medical (CAM) therapies, the value of providing patients access to an integrated program involving multiple CAM and conventional therapies remains unknown. The objective of this study is to explore the feasibility and effects of a model of multidisciplinary integrative care for subacute low-back pain (LBP) in an academic teaching hospital.
  
  
  METHODS
  This was a pilot randomized trial comparing an individualized program of integrative care (IC) plus usual care to usual care (UC) alone for adults with LBP.
  
  
  METHODS
  Twenty (20) individuals with LPB of 3-12 weeks' duration were recruited from an occupational health clinic and community health center.
  
  
  METHODS
  Participants were randomized to 12 weeks of individualized IC plus usual care versus UC alone. IC was provided by a trained multidisciplinary team offering CAM therapies and conventional medical care.
  
  
  METHODS
  The outcome measures were symptoms (pain, bothersomeness), functional status (Roland-Morris score), SF-12, worry, and difficulty performing three self-selected activities.
  
  
  RESULTS
  Over 12 weeks, participants in the IC group had a median of 12.0 visits (range 5-25). IC participants experienced significantly greater improvements at 12 weeks than those receiving UC alone in symptom bothersomeness (p=0.02) and pain (p=0.005), and showed greater improvement in functional status (p=0.08). Rates of improvement were greater for patients in IC than UC in functional status (p=0.02), bothersomeness (p=0.002), and pain scores (p=0.001). Secondary outcomes of self-selected most challenging activity, worry, and the SF-12 also showed improvement in the IC group at 12 weeks. These differences persisted at 26 weeks, but were no longer statistically significant.
  
  
  CONCLUSIONS
  It was feasible for a multidisciplinary, outpatient IC team to deliver coordinated, individualized intervention to patients with subacute LBP. Results showed a promising trend for benefit of treating patients with persistent LBP with this IC model, and warrant evaluation in a full-scale study.
authors.affiliation: Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02115, USA. David_Eisenberg@hms.harvard.edu
authors.forename: David M
authors.initials: DM
authors.lastname: Eisenberg
authors.forename: Julie E
authors.initials: JE
authors.lastname: Buring
authors.forename: Andrea L
authors.initials: AL
authors.lastname: Hrbek
authors.forename: Roger B
authors.initials: RB
authors.lastname: Davis
authors.forename: Maureen T
authors.initials: MT
authors.lastname: Connelly
authors.forename: Daniel C
authors.initials: DC
authors.lastname: Cherkin
authors.forename: Donald B
authors.initials: DB
authors.lastname: Levy
authors.forename: Mark
authors.initials: M
authors.lastname: Cunningham
authors.forename: Bonnie
authors.initials: B
authors.lastname: O'Connor
authors.forename: Diana E
authors.initials: DE
authors.lastname: Post
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D000529:Complementary Therapies; D005260:Female; D006801:Humans; D055048:Integrative Medicine; D017116:Low Back Pain / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D059408:Pain Management; D010348:Patient Care Team; D010865:Pilot Projects