Conceptual analysis demonstrates superior outcomes with active rehabilitation over bed rest for low-back pain, indicating the necessity of a biopsychosocial model.
Key Points
To construct a new biopsychosocial theoretical framework for low-back pain management that contrasts traditional disease paradigms with active rehabilitation.
Analyzed epidemiological and natural history data on the emergence of low-back disability in Western populations.
Evaluated the mathematical and clinical relationships between components of illness in chronic low-back disorders.
Compared experimental and clinical evidence regarding the therapeutic efficacy of bed rest versus controlled active exercise programs.
Prolonged bed rest provides no evidence of lasting therapeutic benefit and produces measurable harmful effects.
Controlled exercise and active rehabilitation restore physical function, diminish pain intensity, reduce psychological distress and illness behavior, and facilitate return to work.
A biopsychosocial framework provides an operational model that differentiates nominal anatomical disease from disabling illness behavior.