Background Functional restoration programs (FRP) improve patients' functional capacity and return to work in non specific low back pain (LBP). The mechanism underlying the improvement is debated: muscle mass increase, improvement in coping skills, and/or optimized physical behaviours.
Objectives To assess the change in muscle and fat masses in chronic LBP patients undergoing FRP.
Methods An observational prospective study was conducted in a single tertiary centre and included all patients with chronic LBP who took part in our centre's FRP from January 2010 to March 2013 and underwent a dual X-ray absorptiometry (DXA) at baseline, 1 month and 6 months. FRP included 7-hours daily physical training, psychological support and therapeutic education, 5 days a week, over a period of 4 weeks. The endpoint was the absolute change in the lean (muscle) and fat masses, on DXA between the 3 timepoints as well as overall body weight. The statistical analysis relied on parametric paired tests (student's t) on the total population.
Results 95 patients were included, 40 men and 55 women: mean age was 41±8 years, mean body mass index 26.6 kg/m2, 38 patients (60%) where overweight or obese. Mean lumbar pain visual analogic scale (0-100 VAS) was 52 (±22). 76% patients were on sick leave with a mean duration of 9 months. At 6 months after FRP, functional scores were significantly improved after the FRP and 62% patients were back in the work force.
At 1 month, there was an increase in lean mass (average 1.3 kg) and a decrease in fat mass (average 0.6 kg) (p<0.001 both). At 6 months however, patients had experienced no significant weight loss (- 0.3 kg versus baseline, p=0.44) nor increase in lean mass (+ 0.3 kg versus baseline, p=0.08) or decrease in fat mass (- 0.5 kg versus baseline, p=0.10).
Conclusions Although FRP had clinically relevant effects on functional and working capacity, body weight and fat and lean masses were not significantly modified at 6 months. This suggests that FRP is not only a “sports facility” and that the benefits of FRP can also be attributed to improvement in patient knowledge, as well as coping skills.
Poulain C et al. Long-term return to work after a functional restoration program for chronic low-back pain patients: a prospective study. Eur Spine J. 2010 Jul;19(7):1153-61.
Disclosure of Interest : None declared