Feasibility of the biopsychosocial primary care intervention ‘Back on Track’ for patients with chronic low back pain: a process and effect-evaluation

Abstract

Purpose

Literature shows promising effects for interdisciplinary biopsychosocial rehabilitation programs in patients with chronic low back pain (CLBP). Not every patient needs an interdisciplinary rehabilitation trajectory provided in a secondary care setting. Patients with moderate complex psychosocial complaints might benefit from biopsychosocial interventions offered in primary care under supervision of a physician in rehabilitation medicine (i.e. biopsychosocial integrated care intervention). This study investigated the feasibility and effectiveness of such intervention in patients with CLBP with moderate complex psychosocial complaints.

Methods

mixed-method. Patients (aged 18–65 years, low back pain ≥12 weeks, moderate complex psychosocial complaints) received the intervention (4 individual sessions, 8 group sessions) provided by trained primary care physiotherapists. Physicians in rehabilitation medicine provided one consultation afterwards. Data from patients (n = 18), physicians (n = 4) and physiotherapists (n = 12) were used.

Results

Physiotherapists were satisfied with the training. Patient attendance was good for individual sessions, less for groups. Physiotherapists sufficiently delivered the intervention, although recruitment and contextual factors influenced delivery. Patients reported significantly reduced functional disability (Quebec Back Pain Disability Scale) post-treatment (−8.3, 95% CI −13.3 to −2.7) and at 3 months follow-up (−7.6, 95% CI −12.9 to −2.2).

Conclusions

A biopsychosocial integrated intervention is feasible and potentially effective in patients with CLBP.

Keywords:

• Chronic low back pain
• process evaluation
• treatment fidelity
• cognitive behavioural therapy
• primary health care
• physiotherapists

Acknowledgements

First, the authors thank Marion de Mooij for her support and assistance during study. The authors acknowledge Paul Willems, Frans Abbink and Marlies den Hollander for their help in the development of Back on Track, and thank all participating patients for receiving the intervention and to express their experiences. Thanks to the participating physiotherapists, especially those who delivered Back on Track, audio recorded therapy sessions, and participated in the focus groups (Tom Hameleers, Frans Abbink, Remco Reijnders and Germaine Neumann). The authors thank the Department of Rehabilitation in medicine MUMC+, Spine Center MUMC + and Fy’net Collaboration for facilitating the delivery of the Back on Track intervention, as well as physicians (Marieke van Beugen and Robin Strackke) for delivering the Back on Track consultations and participating in the focus groups. Many thanks to Celine Kieftenburg and Jana Naumann who rated the audio recordings, and Arjan Kooistra who conducted the focus groups and the related analysis. Also, The authors thank Ton Ambergen for his help performing the statistical analyses, and to interpret and report the results.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

Adelante (Centre of Expertise in Rehabilitation and Audiology), the Province of Limburg, and CZ Foundation. All funding sources had no involvement in the study design; the collection, analysis and interpretation of data; in the writing of the report; and in the decision to submit the article for publication.