Non-surgical treatment for adult spinal deformity: results of an intensive combined physical and psychological programme for patients with adult spinal deformity and chronic low back pain—a treatment-based cohort study

Objectives No evidence-based treatment exists for adult spinal deformity (ASD) patients with chronic low back pain (CLBP).

Aim of this study: evaluate a combined physical and psychological programme (CPPP) for ASD patients with CLBP and to compare this with a non-ASD-cohort with CLBP.

Methods Data were extracted from the database of CLBP-patients for whom surgery is not an option and completed CPPP.

Two cohorts were selected: an ASD-cohort ( n  = 80) based on a Cobb angle of > 10° and a consecutive age- and gender-matched non-ASD-cohort ( n  = 240).

Primary outcome: functional status (Oswestry Disability Index; ODI).

Secondary outcomes: pain intensity, self-efficacy and quality of life.

Assessments: pre and post treatment, one-month and one-year follow-up (FU).

Clinical relevance: minimal important clinical change (MCIC; ODI 10 points), patient acceptable symptom state (PASS; ODI ≤ 22).

Results Demographics ASD-cohort: 79% female, mean age 50.9 (± 14.1) years, mean CLBP duration 15.5 (± 12.5) years, mean Cobb angle 21.4 (± 9.4)°.

Non-ASD-cohort: not significantly different.

Both cohorts improved in functional status (F[1,318] = 142.982, p  < .001; r  = 0.31).

The ASD-cohort improved from mean ODI 39.5(± 12.0) at baseline to mean ODI 31.8(± 16.5) at one-year FU.

Clinical relevance: 51% of the ASD patients reached MCIC and 33% reached a PASS.

An interaction effect is shown between time and both cohorts (F[1,318] = 8.2, p  = .004; r  = 0.03); however, not clinically relevant.

All secondary outcomes: improvement at one-year FU.

Conclusion This is the first study showing beneficial outcomes of a non-surgical treatment in selected ASD patients with longstanding CLBP.

Improvement is shown in functional status, and appeared equivalent to the non-ASD cohort.

Level of Evidence 1 Diagnostic: individual cross-sectional studies with the consistently applied reference standard and blinding.