What Functional Aspects Explain Patients’ Impression of Change after Rehabilitation for Low Back Pain?

Physical tests and self-report measures are being used to measure physical functioning. The latter tends to be preferred in intervention studies. The study was conducted to investigate whether the patients’ global impression of change (PGIC) after rehabilitation could be attributed change in pain, daily functioning, fear-avoidance of activities and various physical aspects, expecting contribution mainly by the self-reported measures. The study consisted of 96 patients with long-lasting low back pain who were consecutively recruited from an outpatient spine clinic, assessed by three self-report questionnaires and seven physical tests at inclusion and after 3.5 weeks of multidisciplinary treatment. With PGIC as the dependent variable, linear regression analyses of all variables were performed. In unadjusted analysis, change in pain, daily functioning and change in six physical tests added to the explained variance (R2: 6-24%). In the adjusted analysis, only pain and back endurance strength contributed (adjusted R2: 48%). In the final backward stepwise blockwise analyses, daily functioning and spinal mobility were also found to contribute to the explained variance (R2: 48%). The time span of 3.5 weeks of training is too short to give a lasting effect, but the contribution to explained variance of PGIC of self-report measures and physical tests were the focus of this study, not the effect of training.

Most measures showed change that was of importance to the patients after rehabilitation. Change in spinal mobility and back strength assessed by physical tests contributed to explain the patients’ impression of change after controlling for change in pain and daily life functioning and may be valuable to assess along with the self-report measures in intervention studies.