Functional restoration. Returning patients with chronic low back pain to work--revolution or fad?

A review was performed to assess the basis for functional restoration programs in returning patients with chronic low back pain to work.

To review and assess the effectiveness of functional restoration programs in the treatment of chronic low back pain.

Functional restoration programs generally use an aggressive program of physical exercises and psychosocial support with the focus on improving function despite the pain.

A review was conducted of significant papers presenting results of large clinical trials that used functional restoration programs.

Several influential studies have reported statistically significant improvement in return-to-work rates of treated patients. The comparison groups consisted of treatment failures and/or patients refused entry to the programs because of insurers refusal to pay. Selection bias, incomplete follow-up, and inappropriate allocation of compared patients cast doubt on the effectiveness of these functional restoration programs. The only published prospective randomized clinical trial failed to demonstrate the efficacy of a functional restoration program.

Further clinical trials based on sound methodology are needed.