The effect of an integrated multidisciplinary rehabilitation programme for patients with chronic low back pain: Long-term follow up of a randomised controlled trial.

The trial was single-centre in Denmark, so the programmes and team mix may not match every clinic. Adherence to home-based activities was not measured, so it is unclear whether patients in the integrated programme actually did the home-based parts. The integrated programme faced implementation problems, including challenges with the pamphlet and phone calls, postponements and low adherence to the six-month follow-up visit. Providers and patients were not blinded and shared the same centre, so cross-learning between programmes is possible. One-year outcome data were reported for fewer patients than were randomised, and an extreme missing-data analysis changed the primary result. The primary outcome measured disability, not directly whether knowledge, skills and behaviours were integrated into daily life.

The authors declared no conflicts of interest. The trial was funded by Sano, Aarhus University, the Danish Rheumatism Association and Familien Hede Nielsens Fond. The paper states that none of the funders had influence on the trial.

Do not read the 19.79 mean difference from the extreme missing-data analysis as evidence that the integrated programme works. The primary analysis found no significant difference, and that sensitivity analysis assumed the worst possible outcome for the integrated programme and the best possible outcome for the existing programme.