title: Effectiveness of three treatment strategies on occupational limitations and quality of life for patients with non-specific chronic low back pain: Is a multidisciplinary approach the key feature to success: study protocol for a randomized controlled trial.
abstract: BACKGROUND
  Chronic low back pain (cLBP) is a significant public health problem, being the primary cause of work absenteeism, as well as affecting sufferers' quality of life, in industrialized society. International guidelines recommend intensive multidisciplinary approaches for patients with cLBP. However, these costly and time-consuming programs can only be offered to a minority of the most heavily affected patients and therefore do not seem likely to respond to public health requirements. Lighter programs may be an alternative to full time hospital-based programs with valuable results in terms of disability and occupational activity for cLBP patients. It is therefore important to define both what the determining components of management to improve activity restriction are and how to treat a larger number of patients more effectively at a lower cost. The aim of this study is to compare three programs with various levels of intensity and multidisciplinary.
  
  
  METHODS
  This paper describes the protocol for a prospective, randomized, controlled, clinical trial in working aged patients with cLBP. Three treatment strategies are compared: (1) intensive and multidisciplinary program conducted in a rehabilitation center; (2) less intensive outpatient program conducted by a private physiotherapist; (3) mixed strategy combining the same out program with a multidisciplinary intervention. The primary outcome of the trial is the impact of the mixed strategy on being able to work compared to hospital centered-program and out program. The secondary outcome is the impact of the mixed strategy on quality of life and social ability compared to the two others programs. The intervention part of the trial programs will take 5 weeks and observational follow-up will take 12 months. The sample size will be 180 participants (60 for each arm). The project has been approved by the Ethical Committee of Angers Hospital, France.
  
  
  CONCLUSIONS
  On the hypothesis that a multidisciplinary approach is the key feature to programs success in reducing social and occupational impairment in cLBP patients, we suggest that it is possible to achieve the same results with less intensive strategies if a multidisciplinary approach is maintained.
  
  
  BACKGROUND
  Current Controlled Trials NCT02030171.
authors.affiliation: LUNAM University, Laboratory of Ergonomics and Epidemiology in Occupational health, (LEEST), University of Angers, Faculty of Medicine, Rue Haute de Reculé, Angers cedex 01 49045, France. aupetit@chu-angers.fr.
authors.forename: Audrey
authors.initials: A
authors.lastname: Petit
authors.forename: Ghislaine
authors.initials: G
authors.lastname: Roche-Leboucher
authors.forename: Luc
authors.initials: L
authors.lastname: Bontoux
authors.forename: Valérie
authors.initials: V
authors.lastname: Dubus
authors.forename: Yohann
authors.initials: Y
authors.lastname: Ronzi
authors.forename: Yves
authors.initials: Y
authors.lastname: Roquelaure
authors.forename: Isabelle
authors.initials: I
authors.lastname: Richard
mesh_terms: D000293:Adolescent; D000328:Adult; D002908:Chronic Disease; D003131:Combined Modality Therapy / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D017116:Low Back Pain / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D016272:Occupational Health; D010147:Pain Measurement / Q000379:methods* / Q000523:psychology; D011446:Prospective Studies; D011788:Quality of Life / Q000523:psychology; D016896:Treatment Outcome; D055815:Young Adult
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