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Schmidt A.M.1,2, Terkildsen Maindal H.3,4, Bay Laurberg T.1,5, Schiøttz-Christensen B.6,7, Ibsen C.2,6, Bak Gulstad K.1, Maribo T.2,8
1Sano, Aarhus, Højbjerg, Denmark, 2Central Denmark Region, DEFACTUM, Aarhus C, Denmark, 3Aarhus University, Department of Public Health - Section for Health Promotion and Health Services, Aarhus C, Denmark, 4Capital Region, Steno Diabetes Center Copenhagen, The Health Promotion Centre, Gentofte, Denmark, 5Aarhus University Hospital, Department of Rheumatology, Aarhus C, Denmark, 6Hospital Lillebælt, Spine Centre of Southern Denmark, Middelfart, Denmark, 7University of Southern Denmark, Institute for Regional Health Research, Middelfart, Denmark, 8Aarhus University, Department of Public Health, Clinical Social Medicine and Rehabilitation Section,, Aarhus C, Denmark
Background: Chronic low back pain (CLBP) is a highly prevalent health condition, and the leading cause of years lived with disability. CLBP causes a substantial impact on patients and their families, communities and health-care systems, as well as a financial burden. Beside pain and disability, people with CLBP often experience psychosocial consequences affecting social, leisure, and work life. Recognition of the physical, psychological and social consequences of CLBP led to the development of the widely accepted biopsychosocial model in the understanding and managing of CLBP.
Disability itself arises through complex and multi-factorial mechanisms, and therefore rehabilitation processes are defined as complex interventions undertaken in a complex environment. A multidisciplinary team including physiotherapists, most effectively manages the complex problems seen in rehabilitation of patients with CLBP. Rehabilitation of patients with CLBP has many potential active components including physiotherapy, and combining the different components in a whole is more than the sum of its parts.
Disability itself arises through complex and multi-factorial mechanisms, and therefore rehabilitation processes are defined as complex interventions undertaken in a complex environment. A multidisciplinary team including physiotherapists, most effectively manages the complex problems seen in rehabilitation of patients with CLBP. Rehabilitation of patients with CLBP has many potential active components including physiotherapy, and combining the different components in a whole is more than the sum of its parts.
Purpose: To develop, test and systematic describe two complex interventions before evaluating them in a randomized controlled trial. This is done to promote the organization and planning of a multidisciplinary rehabilitation intervention aiming for the best possible transferability to the everyday life of patients with disability caused by CLBP.
Methods: Medical Research Councils guideline on complex interventions was used in the description of the development and test stages of the intervention. Quantitative and qualitative method was used in both stages, and patients as well as the multidisciplinary team consisting of physiotherapists, occupational therapists, nurses and a rheumatologist were involved. The TIDIeR checklist was used to systematically describe the interventions.
Results: In the development stage the relevant existing evidence base was identified in a systematic literature search and assessment. Furthermore, the biopsychosocial reference frame ICF and Wades theory about rehabilitation were identified as appropriate theories. Finally, the components in the intervention, the composition of the intervention and the chosen outcomes were identified via interviews with providers and patients.
The test stage included testing procedures, interviews with patients in order to estimate the likely rates of recruitment and retention of subjects, and finally test of the primary patient reported outcome measure in order to calculate appropriate sample size.
Conclusion(s): The intervention is likely to succeed in a future full-scale randomized controlled trial.
Implications: The project is closely linked with clinical practice and expected to be valuable for patients with CLBP participating in a multidisciplinary rehabilitation intervention. It will contribute with valuable information about and set standards for how to organize multidisciplinary rehabilitation interventions in the future clinical practice. The project is expected to have transferability to other patient groups and sectors than the described.
Funding acknowledgements: Sano, Aarhus University and The Danish Rheumatism Association
Topic: Disability & rehabilitation
Ethics approval: The Central Denmark Region Committees on Biomedical and Research Ethics has approved the study (journal number: 1-10-72-117-16)
All authors, affiliations and abstracts have been published as submitted.
