Evaluation of back education programme at the Medical Rehabilitation Unit, Palmerston North Hospital : a thesis presented in partial fulfilment of the requirements for the degree of Master of Arts in Psychology at Massey University

Abstract

Chronic low back pain is a significant health care problem and is frequently one of the most difficult conditions to treat. For the individual, chronic low back pain evolves into a constellation of problems involving psychological and behavioural symptoms as a result of the recurrent pain. Numerous pain clinics have been established providing a multidisciplinary approach to the treatment of chronic pain. A considerable amount of evidence has attested to the efficacy of a comprehensive treatment approach for the management of chronic pain. Despite the support for pain clinics, many outcome studies have been plagued by methodological difficulties. The present study was designed to improve on previous methodological shortcomings and evaluate the efficacy of a multidisciplinary treatment for chronic back pain. The programme, carried out over four mornings per week for three weeks, was conducted in an outpatient clinic of a public hospital. Twenty-four patients consecutively referred to the pain clinic were randomly assigned to treatment and waitlist control conditions. The treatment group was assessed four times and the waitlist control group assessed six times throughout the study. The two groups were compared for differences on a variety of outcome measures on three separate occasions; at pretreatment, immediately after treatment and at follow-up. Outcome measures included self-reported pain intensity, mood, coping skills and physical disability; and objective measures of physical impairments. Multivariate analyses of variance (MANOVA) for outcome measures were carried out. Results suggested significant improvements were achieved after treatment in depression levels and muscle strength. No significant gains were reported in physical functioning such as everyday activities, flexibility, spinal functioning, or pain intensity. When assessed at follow-up six months later, the original gains in mood were maintained but a significant decline in muscle strength was reported. The goals of the programme to improve physical functioning and return to work were not achieved, thus predictions for the efficacy of the chronic back pain programme were not supported. Implications of these findings are discussed together with recommendations for improving outcomes, especially the importance of physical reactivation.