© Springer International Publishing Switzerland 2015Ingrid Söderback (ed.)International Handbook of Occupational Therapy Interventions10.1007/978-3-319-08141-0_48
48. Pain Management: Functional Restoration for Chronic Low-Back-Pain Clients
Departement de medecine physique et readaptation CHU-C3RF, University of Angers, Angers, France
Functional restoration is a concept for intervention of low back pain that has been developed by Mayer et al. (Spine 10:765–772, 1985). It relies on the concept that disability and participation restriction among clients with low back pain is the result of complex interactions among pain, physical deconditioning induced by inactivity, and psychosocial issues. The social cost, mainly indirect costs, induced by sick leave payments for chronic low back pain is high, and this has led to the development of multidisciplinary programs that include occupational therapy interventions.
KeywordsCoping behaviorErgonomicsLow back painSick leaveWeight lifting
Movement is not that dangerous, I can make it!Client
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Chronic low back pain
is pain of the lumbar region lasting for more than 3 months.
is the intervention program for nonspecific low back pain (i.e., infectious and tumor diseases are excluded) and other musculoskeletal diseases. The program is not aimed at reducing the level of pain , but rather focuses on physical reconditioning and coping strategies (Schonstein et al. 2003).
Low back pain is a biopsychosocial issue. Treatments exclusively aimed at the biomedical aspects of low back pain, such as prescription of analgesic medicine, surgery, and corsets, are effective in the acute phase.
Multidisciplinary functional restoration programs have been used in the chronic phase of low back pain since the 1980s. Although differences among the various programs exist, they share a common framework, including (1) physical reconditioning, which is achieved by the clients’ participation in intensive physical activities; (2) psychological counseling aimed at the development of coping mechanisms; and (3) modifications of the work environment (Poireaudeau et al. 2007; Schonstein et al. 2003).
The objective of the functional restoration programs is that the clients return to work and resume social and leisure activities.
Candidates for the Intervention
Functional restoration is indicated for clients suffering from chronic low back pain of nonspecific origin . Some programs are embedded in public policies aimed at reducing sick leave and enrolling only clients with work contracts (Loisel et al. 2003).
The incidence of chronic low back pain in developed countries ranges between 60 and 90 %. The prevalence is estimated at 5 %. In the majority of cases (85–95 %), pain and disability disappear within 3 months (Müllersdorf and Soderback 2000).
The functional restoration programs are conducted by multidisciplinary teams and provided in rehabilitation outpatient facilities. They usually last for 3–5 weeks, and clients participate full time or part time.
The Role of the Occupational Therapist
Occupational therapists (OTs) are responsible for the following:
Assessments of activity limitations and participation restrictions using various available assessment instruments (e.g., Dallas pain questionnaire, Lawlis et al. 1989; Oswestry Low Back Pain Questionnaire, Fairbanks et al. 1980; or Capability to Perform Daily Occupations, an assessment adapted to occupational performances, Schult 2002).
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