Predictors of response and adherence to outpatient multimodal rehabilitation in patients with chronic low back pain

BACKGROUND AND AIMS: There is a growing need to identify patient pre-treatment characteristics that could predict the responsiveness to specific interventions. Therefore this study aimed to identify predictors of response to outpatient multimodal rehabilitation (favourable versus non-favourable outcome) and predictors of therapeutic adherence (drop-out versus adherence to therapy) in patients with chronic low back pain. METHODS: A total of 273 chronic low back patients participated in an exercise-based rehabilitation program of an outpatient rehabilitation centre in Belgium between September 2013 and February 2015. A univariate and a multivariate logistic regression analysis were performed to analyse predictors. A linear mixed model was used for analysis of repeated measures. RESULTS: A higher age (OR=0.962) and a higher Tampa Scale of Kinesiophobia score (OR=0.870) increased the odds to complete the treatment program, whereas higher levels of back pain intensity (OR=1.247) increased the odds for non-adherence. A higher Oswestry Disability Index score (OR=0.963) decreased the odds for a favorable outcome. The treatment program had significant group, time, and time-by-group interaction effects on back pain intensity, catastrophizing, kinesiophobia and depressive symptoms, with the favorable outcome group showing a significant improvement after treatment. CONCLUSIONS: Assessment of chronic low back pain patient pre-treatment characteristics such as age, degree of kinesiophobia, back pain intensity and disability levels is of great importance as they may allow therapists to identify patients with a good prognosis or patients at risk for non-responding to multimodal treatment program. Directing the treatment according to those characteristics could function as a tool to optimize treatment benefits. At the same time, patients at risk for non-responding could be identified and referred to a different treatment approach.