Multidisciplinary Rehabilitation Treatment of Patients With Chronic Low Back Pain: A Prognostic Model for Its Outcome Prediction of Success From a Multidisciplinary Treatment Program for Chronic Low Back Pain The Therapeutic Alliance Between Clinicians and Patients Predicts Outcome in Chronic Low Back Pain Differences in outcome of a multidisciplinary treatment between subgroups of chronic low back pain patients defined using two multiaxial assessment instruments: the Multidimensional Pain Inventory and lumbar dynamometry Multidisciplinary rehabilitation for chronic back pain in an outpatient setting: a controlled randomized trial. The value of physical performance tests for predicting therapy outcome in patients with subacute low back pain: a prospective cohort study Predictors of compliance with short-term treatment among patients with back pain. A Clinical Prediction Rule for Classifying Patients with Low Back Pain Who Demonstrate Short-Term Improvement With Spinal Manipulation Predictors of functional outcome in patients with chronic low back pain undergoing back school, individual physiotherapy or spinal manipulation. Clinical effectiveness of behavioral signs for screening chronic low-back pain patients in a work-oriented physical rehabilitation program. Testing minimal clinically important difference: consensus or conundrum? Randomized Controlled Trial of Back School With and Without Peer Support Preliminary development of a clinical prediction rule for determining which patients with low back pain will respond to a stabilization exercise program. The role of patients' expectation of appropriate initial manual therapy treatment in outcomes for patients with low back pain. Study protocol of effectiveness of a biopsychosocial multidisciplinary intervention in the evolution of non-speficic sub-acute low back pain in the working population: cluster randomised trial Which Prognostic Factors for Low Back Pain Are Generic Predictors of Outcome Across a Range of Recovery Domains? Predictors of efficacy in treatment of chronic low back pain.
Objectives ( 1 ) To determine if treatment outcome in chronic low back pain can be predicted by a predefined multivariate prognostic model based on consistent predictors from the literature and ( 2 ) to explore the value of potentially prognostic factors further . Methods Data were derived from a r and omized controlled trial on the effect of a multidisciplinary rehabilitation program for chronic low back pain compared with usual care .  The primary outcome measure was the Rol and and Morris Disability Question naire and secondary outcomes were the Physical and Mental Component Summary Scales , derived from the Short Form Health Survey . Outcomes were expressed as the differences between baseline and follow-up ( 8 wk and 6 mo ) values . A confirmatory and an exploratory model were defined . Baseline predictors included in the confirmatory model were pain intensity , work status , and Multidimensional Pain Inventory subgroup membership . The exploratory model included sick leave , compensation , depression , and fear-avoidance beliefs . Statistical analysis was performed using multiple linear regression analysis . Results One hundred and sixty-three patients participated in the study . More pain was prognostic for more improvement in the rehabilitation group . No value was found for work status or the Multidimensional Pain Inventory subgroups . For the exploratory model , more depression and fear-avoidance beliefs predicted more improvement after rehabilitation . The explained variance ranged from 18.5 % to 43.8 % depending on the length of follow-up evaluation , the treatment group , and the outcome variable of interest . Discussion The results of this study do not support the construction of a clinical prediction model . Future confirmative studies of homogeneous rehabilitation treatments and outcome measures are needed to shed more light on relevant prognostic factors Study Design . The study included 90 disabled patients with chronic low back pain recruited from a pain clinic who were admitted to an 8-week program of functional restoration and behavioral support .  Initial evaluations included a medical examination , rating of the physical impairment , a personal interview , a visual analogue scale to record pain intensity , an assessment of limitations for daily activities , a pain disability index , a depression and psychovegetative scale , and a scale to evaluate general living st and ards . The physical assessment included different flexibility measurements , measurement of power and endurance through st and ardized exercises , and measurements of isokinetic trunk and lifting strength and general endurance . The measurements were repeated at the end of the 8-week program and thereafter at intervals of 6 and 12 months . Final analyses were carried out on 82 patients . Objectives . To determine whether objective or subjective signs most influence the outcome of rehabilitation . Summary of Background Data . In recent years , several studies have shown that active and intensive multimodal treatment of chronic low back pain is successful . Until now there has been lack of information about which patients will respond to the therapy and what is the most effective part of treatment . Methods . Prognostic factors ( return to work , pain intensity , self- assessment of treatment success by patients ) were tested by study ing variance and regression analyses for their ability to predict treatment outcome . Results . Certain factors were identified that had a significant impact on determining the probability of a patient 's return to work and the reduction of pain intensity . These factors included self-evaluation for predicting a return to work , the length of absence from work , application for pension , and a decrease in disability after treatment . Overall satisfaction with treatment was best determined by the number of medical consultations before treatment , the extent of disability , previous measures taken for coping with the disease , and reduction of disability during treatment . Medical background , medical diagnosis , and physical impairment had no predictive value . Physical variables ( i.e. , mobility , strength , endurance , and physical performance ) also demonstrated only limited predictive value . Conclusion . This study has demonstrated that the most important variable in determining a successful treatment of chronic low back pain is the reduction of subjective feelings of disability in patients Background The impact of the relationship ( therapeutic alliance ) between patients and physical therapists on treatment outcome in the rehabilitation of patients with chronic low back pain ( LBP ) has not been previously investigated . Objective The purpose of this study was to investigate whether the therapeutic alliance between physical therapists and patients with chronic LBP predicts clinical outcomes . Design This was a retrospective observational study nested within a r and omized controlled trial . Methods One hundred eighty-two patients with chronic LBP who volunteered for a r and omized controlled trial that compared the efficacy of exercises and spinal manipulative therapy  rated their alliance with physical therapists by completing the Working Alliance Inventory at the second treatment session . The primary outcomes of function , global perceived effect of treatment , pain , and disability were assessed before and after 8 weeks of treatment . Linear regression models were used to investigate whether the alliance was a predictor of outcome or moderated the effect of treatment . Results The therapeutic alliance was consistently a predictor of outcome for all the measures of treatment outcome . The therapeutic alliance moderated the effect of treatment on global perceived effect for 2 of 3 treatment contrasts ( general exercise versus motor control exercise , spinal manipulative therapy versus motor control exercise ) . There was no treatment effect modification when outcome was measured with function , pain , and disability measures . Limitations Therapeutic alliance was measured at the second treatment session , which might have biased the interaction during initial stages of treatment . Data analysis was restricted to primary outcomes at 8 weeks . Conclusions Positive therapeutic alliance ratings between physical therapists and patients are associated with improvements of outcomes in LBP . Future research should investigate the factors explaining this relationship and the impact of training interventions aim ed at optimizing the alliance Objective : To investigate the effects of a multidisciplinary back school programme ( Roessingh Back Rehabilitation Programme , RRP ) compared with usual care , as well as differences in treatment outcome between subgroups defined using two multiaxial assessment instruments : the Multidimensional Pain Inventory ( MPI-DLV ) and lumbar dynamometry . Design : R and omized controlled trial . Setting : Rehabilitation . Subjects : One hundred and sixty-three patients with chronic , aspecific low back pain . Intervention : All subjects were r and omly assigned either to a multidisciplinary , physically oriented group treatment or to their usual care . Main outcome measures : The Rol and Disability Question naire and health-related quality of life ( EuroQol , EQ5-D ) were measured as primary outcomes before r and omization and after eight weeks and six months follow-up . Result : Only 30 - 50 % of the patients in the RRP group showed improvement and this number is not significantly different from the control group . Subgroup analyses give some first indications that multiaxial measurement instruments can be used to identify subgroups with differences in treatment effects . Conclusion : The overall effect of a multidisciplinary treatment is disappointing , however multiaxial assessment before admission might be valuable in clinical practice , result ing in more effective treatments for patients with chronic low back pain Based on existing models for pain chronicity and effective treatment strategies for patients with chronic low back pain , a multidisciplinary rehabilitation programme for an outpatient group setting was developed . The main treatment components address the patient 's physical functional capacity ( functional restoring ) , cognitive and affective processes ( pain management strategies ) , and behavioural and ergonomical aspects ( back school elements ) . Short-term ( immediately after intervention ) and long-term effects ( at 6-months follow-up ) of the intervention were assessed in a r and omized controlled study . Dependent variables were pain measures , functional capacity , disability , muscular strength and endurance , pain and posture-related self-efficacy , attitudes , depression , well-being , behavioural habits and posture assessed by a st and ardized behavioural observation method . Immediately after the intervention , patients in the treatment group ( n=36 ) showed significant improvement over patients in the control group ( n=29 ) in all variables except depression and muscular strength and endurance . At 6-months follow-up , compared to pretreatment scores , patients continued to show beneficial effects in pain intensity and frequency , posture , posture-related self-efficacy and well-being . In contrast to post-treatment results , there were also significant improvements in strength and endurance . Overall results testify to the effectiveness of the intervention programme . Future studies ( with larger sample sizes ) should aim at a further improvement of functional capacity and disability perception , an analysis of differential treatment effects , and strategies for an improved long-term maintenance of the changes induced by the programme Considering the enormous costs of intensive multidisciplinary treatment , predictive tests for therapy outcome are needed to evaluate patients ’ performance potential and increase cost effectiveness . Somatic parameters are commonly used to evaluate health status and serve as an additional means of forecasting the prognosis , yet little is known of their validity . In this study , we investigated the prognostic value of somatic parameters regarding the outcome of multidisciplinary treatment in patients with subacute low back pain . The study was design ed as a prospect i ve cohort study of 162 patients .  Somatic parameters were assessed with three physical performance tests ( Villiger test , Oesch test , Biering – Sørensen test ) before treatment ( T0 ) , after 3 weeks ’ inpatient therapy ( T1 ) and at 6-month follow-up ( T2 ) . Psychometric characteristics of subjective pain perception ( VAS ) , a pain disability index ( PDI ) and a physical capability index ( FFbH-R ) were recorded . Correlation coefficients between the physical performance test scores and psychometric characteristics were calculated . To predict therapy outcome , discriminant analyses were performed . A control group ( n = 30 ) was evaluated at similar time points without receiving any therapy . Our results demonstrate good discrimination between patients and controls by means of the investigated performance tests and exhibit a significant negative correlation with the psychometric data . Lower outcome values at study entry correlated with higher pain intensity and disability after multidisciplinary treatment . However , the statistical magnitude of correlation was relatively low and further discriminant analysis did not reveal any predictive value . Consequently the physical performance tests do not have a prognostic value regarding therapy outcome OBJECTIVE Great efforts have been made to find effective treatments for back pain . Nevertheless , the effectiveness of a particular treatment can depend on patient compliance . The objective of this study was to prospect ively investigate whether patients ' demographic factors , clinical factors , external barriers in following the treatment , and perceptions of disability , quality of life , depression , and control over health were predictive of compliance with a physical therapy program carried out with patients with low back pain . METHODS This was an exploratory prospect i ve cohort study that was carried out in New York City during 1999 . All study participants answered a question naire at the initial clinical evaluation by a physical therapist and were followed during the treatment . The study assessed compliance with the three treatment regimens that were prescribed for every patient : attending scheduled physical therapy sessions , following a program of home exercises , and watching back-education videotapes . Depending on the individual patient , the planned treatment program could last from 2 to 6 weeks . The study employed a battery of instruments to measure patient characteristics that included perceived functional limitations , perceived quality of life , depression , and their beliefs about their health . Student 's t tests and chi-square tests were used to determine if non- and low-compliant patients differed significantly from high-compliant patients . Logistic regression was used to estimate adjusted odds ratios expressing the association of selected variables with compliance . RESULTS We found that 51 % of the patients were either noncompliant or low-compliant overall with the low back pain treatment program . There were differences in compliance behavior among the three treatment regimens , with compliance being highest for watching the back-education videotapes and lowest for doing the home exercises . Poor compliance overall was positively associated with the expectation of barriers in following the proposed treatment , with comorbidity , and with longer duration of treatment in this program . CONCLUSIONS The findings of our study indicate that patient compliance with back pain treatment is a serious and complex problem . Nevertheless , while this study was only an exploratory one , we believe that the results of this study can be used by care providers to identify patients likely to become noncompliant and also by research ers to plan specific studies on the effectiveness of treatment programs for patients with low back pain Study Design . A prospect i ve , cohort study of patients with nonradicular low back pain referred to physical therapy . Objective . Develop a clinical prediction rule for identifying patients with low back pain who improve with spinal manipulation .  Summary of Background Data . Development of clinical prediction rules for classifying patients with low back pain who are likely to respond to a particular intervention , such as manipulation  , would improve clinical decision-making and research . Methods . Patients with nonradicular low back pain underwent a st and ardized examination and then underwent a st and ardized spinal manipulation treatment program . Success with treatment was determined using percent change in disability scores over three sessions and served as the reference st and ard for determining the accuracy of examination variables . Examination variables were first analyzed for univariate accuracy in predicting success and then combined into a multivariate clinical prediction rule . Results . Seventy-one patients participated . Thirty-two had success with the manipulation intervention . A clinical prediction rule with five variables ( symptom duration , fear – avoidance beliefs , lumbar hypomobility , hip internal rotation range of motion , and no symptoms distal to the knee ) was identified . The presence of four of five of these variables ( positive likelihood ratio = 24.38 ) increased the probability of success with  manipulation  from 45 % to 95 % . Conclusion . It appears that patients with low back pain likely to respond to manipulation can be accurately identified before treatment BACKGROUND Recent studies on chronic low back pain ( cLBP ) rehabilitation suggest that predictors of treatment outcome may be differ according to the considered conservative treatment . AIM To identify predictors of response to back school ( BS ) , individual physiotherapy ( IP ) or spinal manipulation ( SM ) for cLBP . POPULATION out patients with cLBP . SETTING Outpatient rehabilitation department . DESIGN Retrospective analysis from a r and omized trial . METHODS Two hundred and ten patients with cLBP were r and omly assigned to either BS , IP or SM ; the Rol and Morris Disability Question naire ( RM ) was assessed before and after treatment : those who decreased their RM score < 2.5 were considered non-responders . Baseline potential predictors of outcome included demographics , general and cLBP history , life satisfaction . RESULTS Of the 205 patients who completed treatment ( 140/205 women , age 58 + 14 years ) , non-responders were 72 ( 34.2 % ) . SM showed the highest functional improvement and the lowest non-response rate . In a multivariable logistic regression , lower baseline RM score ( OR 0.82 , 95 % CI 0.76 - 0.89 , P<0.001 ) and received treatment ( OR 0.32 , 95 % CI 0.21 - 0.50 , P<0.001 ) were independent predictors of non-response . Being in the lowest tertile of baseline RM score ( < 6 ) predicted non response to treatment for BS and IP , but not for SM ( same risk for all tertiles ) . CONCLUSIONS In our patients with cLBP lower baseline pain-related disability predicted non-response to physiotherapy , but not to spinal manipulation . CLINICAL REHABILITATION IMPACT Our results suggest that , independent form other characteristics , patients with cLBP and low pain-related disability should first consider spinal manipulation as a conservative treatment This prospect i ve study investigated the relationship between behavioral sign scores ( from Waddell ) and the return to work status of chronic low-back pain patients who completed a work-oriented physical rehabilitation program without formal facility-related psychologic or social services . Further , the authors monitored the effect of this program on changing these scores . The program consisted of physical reconditioning through resistive exercises , flexibility and aerobic training , posture and body mechanics education , and progressive work simulation tasks and activities of daily living .  One hundred eighty-three nonworking or partially disabled low-back pain patients with an average duration of 8.7 months ' disability were included in the study . The presence of each of eight behavioral signs was tested for on entry and again on completion of the program . Analysis showed a significant drop in behavioral sign scores for patients who successfully returned to work . There was no significant reduction in scores for patients who did not return to work . The results suggest these signs may predict the effectiveness of treating chronic low-back pain patients in a return-to-work physical rehabilitation program . Conversely , screening for behavioral signs may identify low-back pain patients who would benefit from intensive behavioral and psychiatric testing and intervention efforts BACKGROUND CONTEXT Various method ologies have been used in attempting to eluci date a st and ard method for calculating minimal clinical ly important difference ( MCID ) . A consensus-based decision ( Initiative on Methods , Measurement , and Pain Assessment in Clinical Trials [ IMMPACT ] group ) suggested a 30 % reduction from baseline as a means to define the MCID of self-report back pain measures . Additionally , important psychometric issues need to be addressed regarding use of an independent measure of the same construct as an external criterion , instead of simply using another self-report measure , when using an anchor-based approach to MCID . PURPOSE The purpose was to test the validity of recently published guidelines regarding MCID using self-report back pain measures and objective socioeconomic outcomes . STUDY DESIGN / SETTING This is a prospect i ve study assessing change scores on commonly used spinal pain assessment measures in patients with chronic disabling occupational spinal disorders ( CDOSDs ) treated in a regional referral rehabilitation center performing interdisciplinary functional restoration . PATIENT SAMPLE The study consisted of consecutive cohort of patients ( N=1,180 ) with CDOSDs completing a functional restoration program . OUTCOMES MEASURES Self-report measures including the Oswestry Disability Index ( ODI ) and the physical component summary ( PCS ) and mental component summary ( MCS ) of the Short Form-36 ( SF-36 ) obtained before and after treatment , were compared with objective socioeconomically relevant outcomes obtained 1 year after treatment ( ie , work status and additional health-care utilization ) , that were the external criteria for evaluating MCID . METHODS Pre- to posttreatment improvement was calculated separately for each measure , and subjects were divided into two groups based on the change in scores relative to baseline : 30 % or greater versus less than 30 % improvement . One-year posttreatment objective socioeconomic outcomes were used as independent external criteria relevant to the CDOSD population . This population is often studied as the most costly and problematic cohort in spine care . RESULTS The ODI and SF-36 MCS were not associated with any of the objective 1-year outcomes used as external criteria . Reduced post-rehabilitation health-care utilization ( based on the percentage of patients pursuing health care from a new provider ) was weakly associated with 30 % or greater improvement on the SF-36 PCS , relative to patients whose scores changed by less than 30 % relative to baseline ( 17.0 % vs. 21.1 % ) . The same was true for the ODI and return-to-work . CONCLUSIONS When objective and independent criteria are used ( socioeconomic outcomes ) in a CDOSD cohort , the 30 % improvement in the ODI and SF-36 may not be a valid MCID index . This replicates similar conclusions made by an independent research group using a distribution-based approach to MCID . The validity of the MCID concept rests on future research using objective external criteria . Moreover , there remains a question whether the term " important " in MCID can be unequivocally and operationally defined as a reliable construct The aim of this trial was to determine whether social interaction between patients with long-lasting nonspecific back pain reduces subjective or objective disability .  The participants were selected from persons visiting an occupational health care unit because of back pain . After a clinical examination in a university clinic , subjects without a specific diagnosis and having no disabilities preventing active rehabilitation were selected for study . The subjects ( n = 108 ) were r and omized into treatment ( n = 54 ) and  control groups ( n = 54 ) . Altogether 18 study groups , 9 treatment groups and 9 groups for controls , were formed . Before starting the back schools altogether 15 subjects dropped out . Both the treatment groups ( n = 47 ) and the controls ( n = 46 ) attended a back school consisting of 10 lessons and demonstrations supervised by a physiotherapist . The participants in treatment groups , but not the controls , had physical exercise and social intercourse with other members within the group . The clinical examination was repeated after 6 and 12 months . Both the treatment groups and the controls showed improvement in perceived functional capacity ( assessed with Oswestry disability question naire ) and in perceived life quality ( assessed with 15D score ) . At the 6-month follow-up life quality had improved statistically significantly more among the participants in treatment groups than among the controls , and at the 12-month follow-up the Oswestry index showed corresponding improvement . Among subjects suffering from nonspecific back pain , social support improves the results of active rehabilitation OBJECTIVE To develop a clinical prediction rule to predict treatment response to a stabilization exercise program for patients with low back pain ( LBP ) . DESIGN A prospect i ve , cohort study of patients with nonradicular LBP referred to physical therapy ( PT ) . SETTING Outpatient PT clinics . PARTICIPANTS Fifty-four patients with nonradicular LBP . INTERVENTION A st and ardized stabilization exercise program . MAIN OUTCOME MEASURE Treatment response ( success or failure ) was categorized based on changes in the Oswestry Disability Question naire scores after 8 weeks . RESULTS Eighteen subjects were categorized as treatment successes , 15 as treatment failures , and 21 as somewhat improved . After using regression analyses to determine the association between st and ardized examination variables and treatment response status , preliminary clinical prediction rules were developed for predicting success ( positive likelihood ratio [ LR ] , 4.0 ) and failure ( negative LR , .18 ) . The most important variables were age , straight-leg raise , prone instability test , aberrant motions , lumbar hypermobility , and fear-avoidance beliefs . CONCLUSIONS It appears that the response to a stabilization exercise program in patients with LBP can be predicted from variables collected from the clinical examination . The prediction rules could be used to determine whether patients with LBP are likely to benefit from stabilization exercises OBJECTIVES The purpose of this study was to compare the outcomes of patients with low back pain who had a matched , unmatched , or were indifferent with their pretreatment expectation/preference to the manual therapy thrust or nonthrust intervention .  A secondary purpose was to explore baseline patient characteristics affiliated with a preference of manual therapy treatment type ( thrust or nonthrust manipulation ) . METHODS The study is a secondary analysis of a prospect i ve r and omized controlled trial that enrolled 149 patients with low back pain , from 16 distinct outpatient physical therapy practice s within the United States . Patient 's pretreatment expectations were identified before r and omization . The intervention included manual therapy ( thrust or nonthrust manipulation ) with a st and ardized exercise program , which was carried out for 2 treatment sessions . Six outcomes captured the constructs of ( a ) disability , ( b ) pain perception , ( c ) care intensity , ( d ) fear avoidance behaviors , and ( e ) perception of extent of recovery . Descriptive statistics , analysis of variance ( and Tukey , a post hoc test ) , Fisher exact test , and a multivariate logistic regression analysis were used for analysis . RESULTS There were no statistical differences in any of the 6 dedicated outcomes measures between the matched , unmatched , and no preference groups . Therapist-determined patient " irritability " was associated with patient preference of nonthrust treatment , and higher body mass index was associated with patient preference of thrust treatment . CONCLUSIONS This study shows that patients demonstrated no statistical difference in disability or pain outcome measures when matched , unmatched , or indifferent to the intervention Background Non-specific low back pain is a common cause for consultation with the general practitioner , generating increased health and social costs . This study will analyse the effectiveness of a multidisciplinary intervention to reduce disability , severity of pain , anxiety and depression , to improve quality of life and to reduce the incidence of chronic  low back pain in the working population with non-specific low back pain , compared to usual clinical care . Methods / Design A Cluster r and omised clinical trial will be conducted in 38 Primary Health Care Centres located in Barcelona , Spain and its surrounding areas . The centres are r and omly allocated to the multidisciplinary intervention or to usual clinical care .  Patients between 18 and 65 years old ( n = 932 ; 466 per arm ) and with a diagnostic of a non-specific sub-acute low back pain are included .  Patients in the intervention group are receiving the recommendations of clinical practice guidelines , in addition to a biopsychosocial multidisciplinary intervention consisting of group educational sessions lasting a total of 10 hours . The main outcome is change in the score in the Rol and Morris disability question naire at three months after onset of pain . Other outcomes are severity of pain , quality of life , duration of current non-specific low back pain episode , work sick leave and duration , Fear Avoidance Beliefs and Goldberg Question naires . Outcomes will be assessed at baseline , 3 , 6 and 12 months . Analysis will be by intention to treat . The intervention effect will be assessed through the st and ard error of measurement and the effect-size . Responsiveness of each scale will be evaluated by st and ardised response mean and receiver-operating characteristic method . Recovery according to the patient will be used as an external criterion . A multilevel regression will be performed on repeated measures . The time until the current episode of low back pain takes to subside will be analysed by Cox regression . Discussion We hope to provide evidence of the effectiveness of the proposed biopsychosocial multidisciplinary intervention in avoiding the chronification of low back pain , and to reduce the duration of non-specific low back pain episodes . If the intervention is effective , it could be applied to Primary Health Care Centres . Trial Registration IS RCT Background Recovery from low back pain ( LBP ) is multidimensional and requires the use of multiple-response ( outcome ) measures to fully reflect these many dimensions . Predictive prognostic variables that are present or stable in all or most predictive models that use different outcome measures could be considered “ universal ” prognostic variables . Objective The aim of this study was to explore the potential of universal prognostic variables in predictive models for 4 different outcome measures in patients with mechanical LBP . Design Predictive modeling was performed using data extracted from a r and omized controlled trial . Four prognostic models were created using backward stepwise deletion logistic , Poisson , and linear regression . Methods Data were collected from 16 outpatient physical therapy facilities in 10 states . All 149 patients with LBP were treated with manual therapy and spine strengthening exercises until discharge . Four different measures of response were used : Oswestry Disability Index and Numeric Pain Rating Scale change scores , total visits , and report of rate of recovery . Results The set of statistically significant predictors was dependent on the definition of response . All regression models were significant . Within both forms of the 4 models , meeting the clinical prediction rule for manipulation at baseline was present in all 4 models , whereas no irritability at baseline and diagnosis of sprains and strains were present in 2 of 4 of the predictive models . Limitations The primary limitation is that this study evaluated only 4 of the multiple outcome measures that are pertinent for patients with LBP . Conclusions Meeting the clinical prediction rule was prognostic for all outcome measures and should be considered a universal prognostic predictor . Other predictive variables were dependent on the outcomes measure used in the predictive model The investigation of predictors for therapy outcome in patients with chronic low back pain date back to the early 1970s . Numerous well controlled prospect i ve longitudinal studies have confirmed the predominant predictive power of several psychological factors , which are in addition to objective work related , medical and sociodemographic variables . Studies published in the review period have reported markedly improved method ological st and ards . Further progress is seen with the enhanced search for predictors of working situation in chronic low back pain patients . Finally , there is a shift toward the investigation of predictors for efficacy of primary care in acute and subchronic low back pain patients
Consistent evidence was found for the predictive value of pain intensity ( more pain-- > worse outcome ) , several work-related parameters ( e.g. , high satisfaction-- > better outcome ) , and coping style ( less active coping-- > better outcome ) .
Other sociodemographic and physical variables consistently lacked predictive value .
No consistent evidence was found for other psychological variables .
CONCLUSIONS It is impossible to define a generic set of predictors of outcome of multidisciplinary rehabilitation and back schools for patients with chronic low back pain because the review ed studies were descriptive or exploratory in nature , and most predictors were only studied once .
Nevertheless , for several predictors , consistent evidence was found .
OBJECTIVE To determine predictors of outcome of multidisciplinary rehabilitation-or back school treatment  for patients with chronic low back pain .
SUMMARY OF BACKGROUND DATA Numerous review s have been performed to gain insight into which patients benefit from which treatment .
However , no review has systematic ally focused on predictors from multiple domains ( i.e. , sociodemographic , physical , and psychological ) , or on treatment outcome measured as activity limitation or participation restriction .