Study Design. A randomized parallel-group comparative trial with a 1-year follow-up period was performed.Objective. To compare the effect of a comprehensive functional restoration program involving intensive physical training, ergonomic training, and behavioral support (39 hours per week for 3 weeks) with the effect of outpatient intensive physical training (1.5 hours three times per week far a weeks).Summary of Background Data. Nonrandomized studies conducted in the United States favor functional restoration for patients with chronic low back pain. Two previously reported randomized studies from the authors' Back Center in Copenhagen concur with this recommendation, although the positive effects in one of the studies had faded out after 2 years. Randomized functional restoration studies in Canada and Finland have failed to demonstrate any substantive effect.Methods. Initially, 138 patients with chronic low back pain were included in the current study. They then were randomized to either functional restoration (n = 64) or outpatient intensive physical training (n = 74). Of the initial 138 patients, 11 never started (5 and 6, respectively); 21 dropped out during treatment (8 and 13); and 7 of the graduates did not take part in the I-year follow-up evaluation (3 and 4). The conclusions were drawn from the 99 patients (48 and 51, respectively) who graduated and participated in a 1-year follow-up evaluation. The median age of the patients was 42 years (range, 21-55 years) The female-to-male ratio was 68 to 31, and the median sick leave days during the preceding 3 years was 180 (range, 0-1080 days). The average back pain was rated 5.5 on a scale of 0 (no pain) to 10 (maximal pain). For these variables, there were no important differences between the groups. However, the functional restoration group tended to be more capable of work at baseline (58% vs 42%; P = 0.09).Results. At the 1-year follow-up evaluation, overall assessment favored functional restoration. Otherwise, no significant differences were observed regarding work capability, sick leave for those at work, health care contacts,back pain, leg pain, or self-reported activities of daily living.Conclusions. Only in terms of overall assessment, the functional restoration program was superior to a comparatively short time-consuming outpatient physical training program.Discussion. It may be that lower economic benefits during sick leave in the United States lead to favorable results from functional restoration programs, whereas greater benefits in Canada, Finland, and Denmark result in different conclusions. Finally, it may be that the difference in results across studies points simply to whether the studies were randomized.

When patients with chronic back trouble are improved after intensive rehabilitation, in all likelihood it is due more to changes in pain behaviour than to physiological effects of treatment. The Copenhagen Spine Center at the Danish national hospital, Rigshospitalet has launched an eight hours a day, three-week programme of cardiovascular fitness, progressive weight training, stretching, ergonomics, psychology and an extended back school, with a view to modifying the self-image and pain behaviour of long term sick-certificated patients with back problems, in order to enable them to return to work.

Many of the individual biological, psychological, and social factors attributed to low-back disability have been tested previously for their ability to predict treatment outcomes. To test the assumption that disability exaggeration affects treatment outcomes, models were developed to quantify this complex characteristic and to test its predictive value. Two hundred fifty-eight patients with chronic back disability entering a program of functional restoration were initially evaluated with a battery of tests, including measurements of trunk flexibility, lifting capacity, cycling endurance, self-assessments of pain and disability, and psychological attributes. On the basis of these measurements, patients were characterized as disability exaggerators if by peer comparison their self-assessments of pain and disability were in the most severe range despite high levels of physical capacity. Program completion and work status 1 and 2 years after treatment were compared between disability exaggerators and their peers. Individual initial attributes associated with program completion included pain intensity and Million Visual Analogue scores, lifting capacity, trunk flexibility, some Minnesota Multiphasic Personality Inventory and Million Behavioral Health Inventory scales, and cigarette smoking. One-year re-employment was associated with Minnesota Multiphasic Personality Inventory Scale 8, Wechsler Adult Intelligence Score-Revised, and cycling endurance. There were no significant associations between any individual factor and 2-year work status. Only two of the 12 disability exaggeration models distinguished between program graduates and dropouts, and none of the models accurately predicted return to work following treatment. Prescription of intensive multidisciplinary treatment should not be denied on the basis of any individual patient attribute or of disability exaggeration, as measured in this study. Measurement of disability exaggeration may be improved by the use of taskspecific comparisons of self-perceived and observed physical capacities. Disability exaggeration may be more useful in predicting outcomes of treatments that neglect its psychosocial components.

Sitting postures on a knee-support (Balans®) chair and a tiltable chair were investigated with 12 healthy subjects during office work and simulated assembly work. After at least 3 weeks' adaptation to each chair, the subjects were investigated for 1 hour on each chair in stratified sequence. Postures were evaluated by means of a statometric method. Spinal load was further estimated by measuring stature shrinkage over each sitting period. Energy consumption was roughly assessed by pulse measurements. Finally, subjective acceptability was rated by a 5-point scale. Posture effects of the Balans® chair, taken in relation to the tiltable chair, were primarily a forward tilt of the pelvis and a change toward lumbar lordosis. Secondly, the trunk was vertical compared to the slightly backward-inclined position in the tiltable chair. The head was most vertical in the Balans® chair. No effect on spinal shrinkage or pulse was observed. The subjective rating seemed to favour the tiltable chair if used over longer periods. However, the Balans® chair may be a good alternative for some seated periods and special tasks.