Low back pain is one of the most common medical conditions. Although rarely fatal it has an important effect on quality of life and economy, as it is one of the leading causes of disability and absence from work. Several guidelines and clinical studies suggest physical therapy, exercise and manual therapy as one of the first measures to be implemented in patients complaining of low back pain in spite of a lack of high-grade evidence to support this recommendation. Spinal Cognitive and Motor Retraining (SCMR) is a special type of therapy that involves a multidisciplinary approach, including position exercises, strengthening exercises and a psychological evaluation and counselling.
We set out to review the outcomes of patients that underwent SCMR therapy in Spine Service of St George Hospital and Clinical School between the years 2010 and 2014. A retrospective analysis was performed of the patients that underwent SCMR in this period for a minimum period of three months and a follow-up of up to 12 months was established. The population for this study complained of low back pain for a minimum of 3 months and up to 204 months, the average duration of symptoms was 24 months and the median length of symptoms was 5 months, Information about age, gender, BMI, smoking status, workers compensation status, VAS, functional performance in daily activities, current work status and procedures received by those patients were collected. VAS scores and the functional performance were collected at 0 months, 3, 6 and 12 months after the beginning of SCMR. Statistical analysis was performed to assess success with treatment, determined as an improvement of 20% of VAS scores or improvement of 20% of functional performance. A characterization of the patients that benefitted from SCMR was performed using student T test to compare underlying parameters in the SCMR responders and non-responders.
Forty-four patients fulfilled our inclusion criteria for this review. Twenty-two patients improved their VAS scores (48%), 14 at 3 months and 8 at 6 months. No new patients showed improvement at 12 months. Gender, BMI and workers compensation status did not affect the outcome of SCMR in terms of VAS score. Active smoking status negatively affects the outcomes of SCMR.
Eighteen patients (40%) showed an improvement in their functional status with SCMR. Only one patient improved after 3 months, 13 patients improved after 6 months and 4 after 12 months. Workers compensation status or BMI do not affect the outcomes, although an active smoking status did negatively affect the outcomes of SCMR. A working status positively affects the results of SCMR.
Smoking negatively affects the outcome of the SCMR therapy. Workers compensation status, BMI or gender does not influence the outcome of SCMR. Patients over 50 years benefit more of SCMR than younger patients. The patient who would benefit the most from SCMR is an employed, non-smoker, older-than-50-years patient, regardless of their BMI or workers compensation status.