300 Section - Impact of chronification risk to the benefits after comprehensive back pain rehabilitation

The Keele STarT Back Screening Tool is a questionnaire that was translated in multiple languages. It validly categorizes back pain patients into low, medium and high pain chronification risk. This study aims to analyze whether these risk groups differ in their benefits from a widely used comprehensive biopsychosocial back pain rehabilitation.

Design:

A total of 279 [68% female; mean age (SD) = 53.2 (6.6)] back pain patients participated in this longitudinal observational study. They underwent a program focussing on progressive muscle strength training (six months, twice weekly) accompanied by education, psychological assessment and psychological counselings. Before and after the program patients completed questionnaires, took part in semi-structured interviews led by clinical psychologists, and underwent bodily physical assessments. Linear models with age, gender, and body mass index as covariates were calculated to analyze group differences after the intervention and in change scores. 

Results:

After the intervention overall significant group differences (p< 0.001) with worst results were found in the high risk group for pain (Visual Analog Scale) and all the psychosocial outcomes (Quality of Life, Pain Disability Index, and the Hospital Anxiety and Depression Score) except for the Avoidance Endurance Questionnaire score. The number of patients in the medium and the high risk group decreased from 67 to 41 and from 33 to 30 respectively for the benefit of the low risk group. Physical measures were mostly influenced by covariates (higher maximum isometric flexion and extension strength in males and higher body mass index; higher trunk range of motion in youngers, females, and those with lower body mass index).

Conclusion:

The high chronification risk group seems not to benefit equally from a biopsychosocial back pain rehabilitation program. In these patients individualized interventions (i.e. targeting fear from bodily activity, anxiety, and depression) seem important before starting the strength training for optimization of therapeutic outcomes.