Introduction: Functional restoration is a multidisciplinary treatment for non-specific chronic low back pain (NSCLBP). There is little data on the effects of Modic type 1 changes, which are more frequent in people with NSCLBP than the general population, on the response to functional restoration. Therefore, this study of a case-control nature aimed to investigate the response profile of patients diagnosed with NSCLBP with and without Modic type 1 changes who underwent functional restoration.
Methods: This study included NSCLBP individuals who participated in a functional restoration program for five weeks at a tertiary care hospital in France between 2009 and 2019. Patients had low back pain for at least three months. Modic type 1 changes were assessed by two spine specialists on a lumbar spine magnetic resonance imaging performed prior to the inclusion into the program. NSCLBP patients with Modic type 1 changes (cases) were matched (1:1 or 1:2) to NSCLBP patients without Modic type 1 changes (controls) by sex, working incapacity, and lumbar spine surgery history. Patients were evaluated before the functional restoration program, at the end of the program, and three months after the program. The Quebec Back Pain Disability Scale (QBPDS) score was the primary effectiveness outcome, with scores ranging from 0 (no disability) to 100 (maximal disability). The study also included several secondary outcomes (e.g., subjective improvement, return to work, and consumption of analgesics).
Results: There were 83 participants included in the study. In cases, the median (interquartile range) age was 47.8 (11.6) years, and there were 77.4% of women. In controls, the median (interquartile range) age was 46.0 (16.2) years, while the proportion of women was 75.0%. At the end of the functional restoration program, the median (interquartile range) QBPDS score was 29.0 (25.5) in cases and 28.0 (22.5) (p-value=0.799), while the prevalence of subjective improvement was 96.8% and 82.4% (p-value=0.082). Three months after the program, the median (interquartile range) QBPDS score was 34.0 (24.5) in cases and 31.5 (22.0) in controls (p-value=0.366). The proportion of people reporting subjective improvement was 67.7% and 69.2% in the two groups (p-value=0.865). Among patients who were on sick or work-related injury leave at the inclusion, 72.7% of cases and 52.6% of controls returned to work at three months. Finally, there were no statistically significant differences for most analgesics between the two groups.
Conclusion: This study showed that Modic type 1 changes had no significant effects on the response to functional restoration in people with NSCLBP. Provided these findings are corroborated by further studies, they indicate that NSCLBP patients may benefit from functional restoration programs irrespective of the presence of Modic type 1 changes.
Note: A related manuscript has been submitted for publication to the European Spine Journal and is currently under review.