Low back pain as a multidisciplinary problem

Abstract

Purpose. The assess of the effectiveness of the multidisciplinary team in the treatment of cases of chronic low back pain Materials and methods. The study was conducted on the basis of Expert Health Medical Center (Odessa, Ukraine) in 2020-2023. We examine 368 patients with chronic low back pain who sought help at a medical center and were treated using a multidisciplinary approach (main group). As a control, the results of treatment of 50 patients who sought help from primary health care centers in Odesa and Mykolaiv were analyzed. The effectiveness of the treatment was evaluated by the intensity of pain according to the visual-analog scale, the dynamics of indicators according to the Roland-Maurice disability scale, the functional scale of LBP, and the clinical picture. A neurologist, a physical therapist, a massage therapist, a physiotherapist, a psychotherapist and a nurse were involved in the multidisciplinary team. The term of catamnetic observation is 3 months. Statistical processing of the obtained results was carried out by methods of variance analysis using MS Excel software (Microsoft Inc., USA). Results. The average age of the examined patients was 45.1±0.5 years in the main group and 47.6±1.4 years in the control group. The structure of both groups was dominated by men - 57.3% (211 out of 368) in the main group and 62.0% (31 out of 50) in the control group. At the time of application, all patients had complaints of lower back pain that worsened with physical exertion and tension symptoms. There were no statistically significant differences in both clinical groups when assessing the degree of disability according to the Roland-Morris scale and the BP functional scale. Thus, in the main group, the average RMQ score was 19.6±0.3 points, and in the control group -19.1±0.9 points (p>0.05). Accordingly, the BPFS score at the time of application was 11.1±0.1 points in the main group, and 11.8±0.6 points in the control group (p>0.05). As a result of the treatment, pain intensity significantly decreased in both clinical groups, however, patients in the control group often complained of discomfort during prolonged sitting and standing, as well as in the morning immediately after waking up. Only 3 (0.8%) patients from the main group had to seek medical help again due to acute lower back pain. There were 8 (16.0%) of these in the control group. Thus, the control group was significantly ahead of the main group in terms of relapse frequency (χ2=36.5 p<0.001). The RMQ index decreased in the main group to 6.2±0.1 points, and in the control group – 8.3±0.4 points (p<0.001), and the BPFS index increased, respectively, to 44.5±0.3 and 32.6±0.5 points (p<0.001). Conclusions. 1. The frequency of LBP recurrence was 0.8% in the main group and 16.0% in the control group (χ2=36.5 p<0.001). 2. The RMQ indicator decreased in the main group from 19.6±0.3 to 6.2±0.1 points, and in the control group – from 19.1±0.9 to 8.3±0.4 points (p< 0.001), and the BPFS indicator increased from 11.1±0.1 to 44.5±0.3 in the main group and from 11.8±0.6 points to 32.6±0.5 points in the control group (p<0.001). 3. The use of a multidisciplinary approach gives better functional results in the treatment of low back pain