Functional restoration. Returning patients with chronic low back pain to work--revolution or fad?

Abstract

Study design: A review was performed to assess the basis for functional restoration programs in returning patients with chronic low back pain to work.

Objective: To review and assess the effectiveness of functional restoration programs in the treatment of chronic low back pain.

Summary of background data: Functional restoration programs generally use an aggressive program of physical exercises and psychosocial support with the focus on improving function despite the pain.

Methods: A review was conducted of significant papers presenting results of large clinical trials that used functional restoration programs.

Results: Several influential studies have reported statistically significant improvement in return-to-work rates of treated patients. The comparison groups consisted of treatment failures and/or patients refused entry to the programs because of insurers refusal to pay. Selection bias, incomplete follow-up, and inappropriate allocation of compared patients cast doubt on the effectiveness of these functional restoration programs. The only published prospective randomized clinical trial failed to demonstrate the efficacy of a functional restoration program.

Conclusions: Further clinical trials based on sound methodology are needed.