[fr] Objectifs. – Cette étude souhaite apprécier l’efficacité d’un programme pluridisciplinaire ambulatoire semi-intensif, élaboré en fonction des exigences des organismes mutualistes belges et destiné aux patients lombalgiques chroniques.
Méthodes. – Parmi 262 patients souffrant de lombalgie chronique non spécifique inclus dans cette étude, 136 (73 femmes et 63hommes présentant des douleurs depuis 11,3 ans en moyenne) ont achevé un programme ambulatoire (36 séances de deux heures) comportant une éducation à l’économie rachidienne, une approche ergonomique et psychologique ainsi que des séances de reconditionnement physique. Trois séances (initiale [séance 1], intermédiaire (séance 18) et finale [séance 36]) évaluent les paramètres d’intensité de la douleur, d’incapacité fonctionnelle, de kinésiophobie, de connaissances cognitives et gestuelles ainsi que les performances physiques (force et endurance des muscles du tronc, mobilité du complexe lombo-pelvi-fémoral, endurance cardiorespiratoire).
Résultats. – Tous les paramètres sont significativement améliorés lors de l’évaluation finale : diminution de l’intensité de la douleur (−44 %), des répercussions fonctionnelles (−40 %) et de la kinésiophobie (−11 %), amélioration des connaissances (+59 %) et de la gestuelle vertébrale (+95 %), augmentation de la force des muscles du tronc (+40 % en moyenne), de l’endurance des extenseurs du tronc (+90 %), de la mobilité (+8 %) et de l’endurance cardiorespiratoire (+18 %).
Conclusions. – Une prise en charge pluridisciplinaire ambulatoire semi-intensive s’avère bénéfique pour les patients lombalgiques chroniques. Une adaptation des critères d’inclusion et une implication accrue du patient dans sa rééducation contribueraient à améliorer l’observance du programme.
Disciplines :
Orthopedics, rehabilitation & sports medicine
Author, co-author :
Demoulin, Christophe ; Université de Liège - ULiège > Département des sciences de la motricité > Kinésithérapie spécifique et réadaptation motrice
Grosdent, Stéphanie ; Université de Liège - ULiège > Médecine de l'appareil locomoteur
capron, Lucile
Tomasella, Marco ; Université de Liège - ULiège > Médecine de l'appareil locomoteur
Somville, Pierre-René ; Université de Liège - ULiège > Médecine de l'appareil locomoteur
Crielaard, Jean-Michel ; Université de Liège - ULiège > Département des sciences de la motricité > Evaluation et entraînement des aptitudes physiques - Médecine physique et réadaptation fonctionnelle
Vanderthommen, Marc ; Université de Liège - ULiège > Département des sciences de la motricité > Kinésithérapie spécifique et réadaptation motrice
Language :
French
Title :
Intérêt d'une prise en charge multidisciplinaire ambulatoire semi-intensive dans la lombalgie chronique
Airaksinen O., Brox J.I., Cedraschi C., et al. European guidelines for the management of chronic nonspecific low back pain. Eur Spine J 15 Suppl. 2 (2006) S192-S300 Chapter 4
Gatchel R.J., and Mayer T.G. Evidence-informed management of chronic low back pain with functional restoration. Spine J 8 (2008) 65-69
Guzman J., Esmail R., Karjalainen K., et al. Multidisciplinary rehabilitation for chronic low back pain: systematic review. BMJ 322 (2001) 1511-1516
Mayer T., and Gatchel R. Functional restoration for spinal disorders: The sports medicine approach (1988), Lea & Febiger, Philadelphia
Bendix T., Bendix A., Labriola M., et al. Functional restoration versus outpatient physical training in chronic low back pain: a randomized comparative study. Spine 25 (2000) 2494-2500
Lang E., Liebig K., Kastner S., et al. Multidisciplinary rehabilitation versus usual care for chronic low back pain in the community: effects on quality of life. Spine J 3 (2003) 270-276
Mannion A.F., Muntener M., Taimela S., et al. A randomized clinical trial of three active therapies for chronic low back pain. Spine 24 (1999) 2435-2448
Woby S.R., Roach N.K., Urmston M., et al. The relation between cognitive factors and levels of pain and disability in chronic low back pain patients presenting for physiotherapy. Eur J Pain 11 (2007) 869-877
Anema J.R., Cuelenaere B., and van der Beek A.J. The effectiveness of ergonomic interventions on return-to-work after low back pain; a prospective two year cohort study in six countries on low back pain patients sicklisted for 3-4 months. Occup Environ Med 61 (2004) 289-294
Hayden J.A., van Tulder M.W., and Tomlinson G. Systematic review: strategies for using exercise therapy to improve outcomes in chronic low back pain. Ann Intern Med 142 (2005) 776-785
Kankaanpaa M., Taimela S., Airaksinen O., et al. The efficacy of active rehabilitation in chronic low back pain. Effect on pain intensity, self-experienced disability, and lumbar fatigability. Spine 24 (1999) 1034-1042
Iversen M.D., Fossel A.H., and Katz J.N. Enhancing function in older adults with chronic low back pain: a pilot study of endurance training. Arch Phys Med Rehabil 84 (2003) 1324-1331
van Sluijs E.M., van Poppel M.N., Twisk J.W., et al. Physical activity measurements affected participants' behavior in a randomized controlled trial. J Clin Epidemiol 59 (2006) 404-411
Kaapa E.H., Frantsi K., Sarna S., et al. Multidisciplinary group rehabilitation versus individual physiotherapy for chronic nonspecific low back pain: a randomized trial. Spine 31 (2006) 371-376
Huskisson E.C. Measurement of pain. Lancet 2 (1974) 1127-1131
Coste J., Le Parc J.M., Berge E., et al. French validation of a disability rating scale for the evaluation of low back pain (EIFEL questionnaire). Rev Rhum Ed Fr 60 (1993) 335-341
Marty M., Blotman F., Avouac B., et al. Validation of the French version of the Dallas Pain Questionnaire in chronic low back pain patients. Rev Rhum Engl Ed 65 (1998) 126-134
French D., Roach P., and Mayes S. Fear of movement in injured workers: The Tampa Scale of Kinesiophobia. Can J Behav Sci 34 (2002) 28-33
Vanderthommen M., Boulanger A.S., Defaweux M., et al. Validation of an evaluation test of activities of daily living behaviour for patients with chronic low back pain. Ann Readapt Med Phys 44 (2001) 281-290
Demoulin C., Fauconnier C., Vanderthommen M., et al. Recommendations for a basic functional assessment of low back pain. Rev Med Liege 60 (2005) 661-668
Nielens H., and Plaghki L. Evaluation of physical adaptation to exercise of chronic pain patients by a step-test procedure. Pain Clin 4 (1991) 21-28
Bontoux L., Roquelaure Y., Billabert C., et al. Prospective study of the outcome at one year of patients with chronic low back pain in a program of intensive functional restoration and ergonomic intervention. Factors predicting their return to work. Ann Readapt Med Phys 47 (2004) 563-572
Nordin M., and Campello M. Physical therapy: exercises and the modalities: when, what, and Why? Neurol Clin 17 (1999) 75-89
Henchoz Y., and Kai-Lik So A. Exercise and nonspecific low back pain: A literature review. Joint Bone Spine 75 (2008) 533-539
Hartung G.H., Smolensky M.H., Harrist R.B., et al. Effects of varied durations of training on improvement in cardiorespiratory endurance. J Hum Ergol (Tokyo) 6 (1977) 61-68
Roche G., Ponthieux A., Parot-Shinkel E., et al. Comparison of a functional restoration program with active individual physical therapy for patients with chronic low back pain: a randomized controlled trial. Arch Phys Med Rehabil 88 (2007) 1229-1235
Ostelo R.W., de Vet H.C., Vlaeyen J.W., et al. Behavioral graded activity following first-time lumbar disc surgery: 1-year results of a randomized clinical trial. Spine 28 (2003) 1757-1765
Smeets R.J., Vlaeyen J.W., Hidding A., et al. Active rehabilitation for chronic low back pain: cognitive-behavioral, physical, or both? First direct post-treatment results from a randomized controlled trial [ISRCTN22714229]. BMC Musculoskelet Disord 7 (2006) 5
Rainville J., Hartigan C., Martinez E., et al. Exercise as a treatment for chronic low back pain. Spine J 4 (2004) 106-115
Roland M., and Fairbank J. The Roland-Morris Disability Questionnaire and the Oswestry Disability Questionnaire. Spine 25 (2000) 3115-3124
Sullivan M.J., and Stanish W.D. Psychologically based occupational rehabilitation: the Pain-Disability Prevention Program. Clin J Pain 19 (2003) 97-104
Demoulin C., Maquet D., Tomasella M., et al. Benefits of a physical training program after back school for chronic low back pain patients. J Musculoskeletal Pain 14 (2006) 21-31
Sculco A.D., Paup D.C., Fernhall B., et al. Effects of aerobic exercise on low back pain patients in treatment. Spine J 1 (2001) 95-101
Jousset N., Fanello S., Bontoux L., et al. Effects of functional restoration versus 3 hours per week physical therapy: a randomized controlled study. Spine 29 (2004) 487-494
Pfingsten M., Hildebrandt J., Leibing E., et al. Effectiveness of a multimodal treatment program for chronic low-back pain. Pain 73 (1997) 77-85
Rainville J., Hartigan C., Jouve C., et al. The influence of intense exercise-based physical therapy program on back pain anticipated before and induced by physical activities. Spine J 4 (2004) 176-183
Hakkinen K. Neuromuscular and hormonal adaptations during strength and power training. A review. J Sports Med Phys Fitness 29 (1989) 9-26
Woby S.R., Watson P.J., Roach N.K., et al. Are changes in fear-avoidance beliefs, catastrophizing, and appraisals of control, predictive of changes in chronic low back pain and disability?. Eur J Pain 8 (2004) 201-210
Leggett S., Mooney V., Matheson L.N., et al. Restorative exercise for clinical low back pain. A prospective two-center study with 1-year follow-up. Spine 24 (1999) 889-898
Gale J.B., Eckhoff W.T., Mogel S.F., et al. Factors related to adherence to an exercise program for healthy adults. Med Sci Sports Exerc 16 (1984) 544-549
Carosella A.M., Lackner J.M., and Feuerstein M. Factors associated with early discharge from a multidisciplinary work rehabilitation program for chronic low back pain. Pain 57 (1994) 69-76
Fredrickson B.E., Trief P.M., VanBeveren P., et al. Rehabilitation of the patient with chronic back pain. A search for outcome predictors. Spine 13 (1988) 351-353
Hicks G.E., Fritz J.M., Delitto A., et al. Preliminary development of a clinical prediction rule for determining which patients with low back pain will respond to a stabilization exercise program. Arch Phys Med Rehabil 86 (2005) 1753-1762
