All patients with a diagnosis of single-level Lumbar Degenerative Spondylolisthesis who present to the DHMC Spine Center.

Spondylolisthesis

Dartmouth-Hitchcock Medical Center

Validation of Appropriateness Criteria for the Surgical Treatment of Lumbar Degenerative Spondylolisthesis

Questions with 5 response categories, dichotomized to "good" and "poor"

Adam M. Pearson

Staff Physician

Low-back Pain

The intervention will follow current care i.e. guideline informed intervention used by physiotherapists in the treatment of LBP in primary health care. The intervention will use a pragmatic approach and follow a framework of: 1) information of return to activity and to stay active 2) instruction on posture in loaded and unloaded positions 3) information on work and leisure based positions in activity and sitting 4) information on good sleeping position 4) instruction of an individualized exercise program based on findings from the examination enhancing core control 5) a choice of exercises as a home training program. Manual methods may if necessary be used. Choice of treatment, choice of exercises (loaded, unloaded) and also number of treatments is logged and noted.

Guideline recommended physiotherapy care

Rehabtjänst

Markers of Outcome - a Cohort Study of LBP in Primary Health Care

Self-assessed pain for the last 24 hours on NRS Numeric Rating Scale (0-10) . A successful outcome will be defines as >2 measured on NRS. This cut off was previously used in a smaller study of prognosis following an exercise intervention

Disability will be measured using Oswestry Disability Questionnaire (0-100). A successful outcome will be defines as >20 measured on ODI. This cut off was previously used in a smaller study of prognosis following an exercise intervention

Generic health related will be measured with EQ5D

Fear Avoidance Behavior will be measured with the Fear Avoidance Behavior Questionnaire (FABQ)

Self Efficacy scale for physical activity will be used

A general question on global expectation on recovery will be used (0-100)

A general question will be used scored on a likert scale (1-5)

Eva Rasmussen Barr

Associate professor

Karolinska Institutet

Through a flow chart the investigators in detail specify the medical and work place interventions (all according to evidence-based guidelines). Red, yellow and blue flags, and motivational factors are identified in a screening investigation. The aim of the screening is to individually tailor the rehabilitation interventions. Physiotherapy interventions are based on a bio-psychosocial and cognitive behavioural therapy perspective. Behavioural medicine treatment principles include careful examination and treatments such as advice to stay active, instructions, OMI, OMT, MDT. The investigators apply interventions based on ergonomics, motivational factors and work place changes according to Convergence Dialogue Meetings (CDM).

Patients follows the PHCs standard schedule and procedures including the so called rehabilitation guarantee

Back Pain

Neck Pain

In addition to structured care a workplace intervention named Convergence Dialogue Meetings (CDM) are carried out. CDM is a three step structured dialogue and meeting model supporting the patient, health care professionals and employer to summarize concrete suggestions to support sustainable work ability and a return to work if sick listed.

Structured care & workplace intervention

Patients will follow the primary health care's standard time schedule and procedures as of ordinary care and the rehabilitation guarantee. For each patient all treatment measures are recorded in a manual, regarding number of treatments, time used per treatment and type of treatment.

Treatment as Usual

WorkUp. Structured Care With Workplace Interventions to Improve Work Ability in Patients With Neck and/or Low Back Pain

WorkUp. Early Structured Care Including Workplace Interventions to Improve Work Ability in Patients With Neck and/or Back Pain. A Prospective Pare Wise Cluster Randomized Controlled Trial in Primary Care With One Year Follow up

Work ability (defined as being at work or being eligible to the labour market during at least four weeks in a row) and time of sickness absence and Return to work. Year 2 and 3 follow-up by register data

Measured by the Oswestry Disability Index (ODI) in low back pain patients (Fairbank & Pynsent 2000) and by the Neck Disability Index (NDI) in patients with neck pain (MacDermid et al 2009)

Measured by the Pain mannequin (Bergman et al 2001) and VAS (Sieper et al 2009)

Measured by questions focusing on known risk factors according to Lindell´s thesis (2010) and the ULF questionnaire

Measured by use of the Client Satisfaction Questionnaire (CSQ) (Bjelland 2002)

Birgitta Grahn

PhD, Assoc. Professor

Lund University

Region Skane

Kronoberg County Council

Blekinge County Council Hospital

Guided kundalini yoga sessions specific for low back pain for 1 hour, twice a week (120 minutes of instructor-led yoga) for 6 weeks. Cd recording for home practice recommended once per day.A written self care pamphlet "The Back book"

Evidence based advice from caregiver to stay active and exercise

Guided exercise at a gym focusing on strength training. Twice a week during 6 weeks. A written self care pamphlet "The Back book"

Guided exercise at a gym focusing on strength training. Twice a week during 6 weeks. A written self care pamphlet

Exercise

Evidence based advice from caregiver to stay active and exercise
Self care advice : Evidence based advice from caregiver about keeping active, exercise and a written self care pamphlet

Self Care Advice to Stay Active

Guided kundalini yoga sessions specific for low back pain for 2 hours, twice a week for 6 weeks. Cd recording for home practice recommended once per day.A written self care pamphlet

Medical Yoga

Total

Sex: Female, Male

Region of Enrollment

Sick leave using self-reported data on number of days on sick leave

Guided kundalini yoga sessions specific for low back pain for 1 hour, twice a week (120 minutes each week of instructor-led yoga) for 6 weeks. Cd recording for home practice recommended once per day.A written self care pamphlet

Number of Days on Sick Leave

Assessments of direct and indirect cost. Further, assessments of performance is used to calculate production losses.

Cost Effectiveness

Guided kundalini yoga sessions specific for low back pain for 1 hour, twice a week (120 minutes of intructor-led yoga each week) for 6 weeks. Cd recording for home practice recommended once per day.A written self care pamphlet

Overall Study

Dr. Irene Jensen

Guided kundalini yoga sessions specific for low back pain for twice a week for 6 weeks. Cd recording for home practice recommended once per day.A written self care pamphlet

Low Back Pain

Guided training twice a week for six weeks. Self instructing cd for home practice

Kundalini yoga

Evidence based advice from caregiver about keeping active, exercise and a written self care pamphlet "The Back book"

Self care advice

Strength training at a gym supervised by a physical therapist twice a week during 6 weeks. Self training instruction was provided. A written self care pamphlet "The Back book"

Friskis och svettis

Institute of medical yoga

Karolinska instituet

Cost Effectiveness of Medical Yoga Therapy on Low Back Pain

Cost Effectiveness of Early Interventions for Non-specific Low Back Pain: A Randomized Controlled Study Investigating Medical Yoga, Exercise Therapy and Evidence Based Advice

iris pseudacorus/lumbàlgia

Validation of Appropriateness Criteria for the Surgical Treatment of Lumbar Degenerative Spondylolisthesis

Markers of Outcome - a Cohort Study of LBP in Primary Health Care

WorkUp. Structured Care With Workplace Interventions to Improve Work Ability in Patients With Neck and/or Low Back Pain

Cost Effectiveness of Medical Yoga Therapy on Low Back Pain

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