Group treatment for patient with chronic low backpain: 10 or 20 session exercise programme?

Introduction. Some authoritative sources in literature suggest to prolong the rehabilitative treatment for patients with chronic low back pain well beyond the traditional 10 session. We have, therefore, started a study to evaluate the effectiveness of a group treatment program with 10 and 20 sessions and, in parallel, recorded the compliance of the same patients. Materials and methods. 34 patients, 15 male and 19 female, affected by chronic low back pain (since more than 6 months) have been consecutively recruited with an average age of 45 years (24-74 range). Criteria to be excluded were the contemporary presence of other severe pathologies, the spondylolisis and spondylolisthesis, or their need to carry out other treatments at the same time. The treatment program, lasting 20 biweekly 1-hour-sessions, is based on the Feldenkrais’s method associated with a cognitive behavioural treatment. It has been run by the same physiotherapist. Physical disability and pain have been evaluated at the beginning, after 10 and after 20 sessions through two questionnaires: the Back Ill (BI) and the Roland and Morris Disability Questionnaire (RMDQ). In the BI a change larger than 15%, both toward improvement or worsening, is considered significant. Results. Out of the 34 patients, screened within the study, 23 (equivalent to 68%) have carried out 10 sessions, 19 at least 17 and 7 (15%) have stopped after 5 sessions (1-8). The differences between the results of the BI test after 10 and 20 sessions have not shown any statistical relevance. The RMDQ have not shown statistically significant differences between the tenth and twentieth session. Conclusion. In spite the poorness of the statistical sample, we have to reconsider whether it is the case or not to extend the cycle beyond the tenth session. The compliance among patients is good, as the abandonment takes place well before 10 sessions.