Evidence-Based Review of the Efficacy of Functional Restoration for the Management of Chronic Low Back Pain

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Gatchel, Robert J.; Mayer, Tom G.
Department of Psychology, The University of Texas at Arlington
Functional restoration; chronic pain; disability; workers' compensation; chronic low back pain; chronic spinal disorders; return to work; health utilization; recurrent injury; biopsychosocial approach; chronic pain/disability management
article description
There are now almost 20 years of evidence-based clinical outcome data, from the United States as well as from other countries around the world, demonstrating the therapeutic effectiveness of functional restoration, a specific form of interdisciplinary rehabilitation, in successfully managing chronic low back pain (CLBP) and disability. Purpose. This article comprehensively reviews all the available evidence evaluating the therapeutic effectiveness of functional restoration for CLBP. Study Design. Searches of the CLBP and functional restoration literature during the past 20 years were conducted, using MEDLINE, PSYCHLIT and the Cochrane Database of Systematic Reviews. Patient Sample. All studies evaluating CLBP patients who were administered functional restoration were included in this review. Outcome Measures. Studies reporting treatment-outcome data for variables such as self-reported pain and disability, functional measures such as strength and range-of-motion, medication use, and socioeconomic outcomes such as work return/retention, health care utilization, insurance claim resolution, and recurrent injuries were used in this review. Results. The scientific literature is quite clear in demonstrating the therapeutic effectiveness of functional restoration for the management of CLBP, not only for traditional measures of self-reported pain and disability, but also for important socioeconomic-outcome variables. Conclusions. The significant advantage of functional restoration relative to traditional unimodal methods of treating CLBP is that it simultaneously addresses, and has a positive impact on, multiple outcome measures: traditional self-report indices of pain and disability; more objective Manuscripts\functionalrestoration-evidence-based-review.611\6/14/2010 3 physical functional measures; and important socioeconomic outcomes that often “drive up” the societal economic costs of this prevalent chronic pain disorder.