Effectiveness of a Multidisciplinary Occupational Training Program for Chronic Low Back Pain

Objective: To evaluate the effectiveness of a 12-wk multidisciplinary occupational training program for patients with chronic low back pain and to identify prognostic factors for treatment success. Design: A total of 51 participants were evaluated at baseline, at discharge, and at 1 yr after conclusion of the program. The evaluation included a physical examination and assessment of functional disability, psychological factors, and coping styles. The main target of the program is full work resumption. The central outcome measures therefore are three variables on return to work. Results: Analysis of variance for repeated measures revealed significant beneficial changes during the program for all measures except for several coping-style variables. The acquired level of maximum oxygen uptake, trunk flexibility, functional disability, and catastrophizing were maintained at 1-yr follow-up. At 1-yr follow-up, >60% of the participants had fully returned to work, which is an increase of >40% compared with baseline. Regression analyses showed that sex, age, the baseline values of reinterpretation of pain sensations, and functional disability and changes in trunk flexibility scores during the program are important prognostic factors for complete return to work. Conclusions: Based on the current findings, the program seems to be efficacious in the short term. Future attention must be directed toward maintaining these results, although work resumption rates improved considerably 1 yr after conclusion of the program

Habitat matching and spatial heterogeneity of phenotypes: implications for metapopulation and metacommunity functioning

Spatial heterogeneity in the distribution of phenotypes among populations is of major importance for species evolution and ecosystem functioning. Dispersal has long been assumed to homogenise populations in structured landscapes by generating maladapted gene flows, making spatial heterogeneity of phenotypes traditionally considered resulting from local adaptation or plasticity. However, there is accumulating evidence that individuals, instead of dispersing randomly in the landscapes, adjust their dispersal decisions according to their phenotype and the environmental conditions. Specifically, individuals might move in the landscape to find and settle in the environmental conditions that best match their phenotype, therefore maximizing their fitness, a hypothesis named habitat matching. Although habitat matching and associated non-random gene flows can produce spatial phenotypic heterogeneity, their potential consequences for metapopulation and metacommunity functioning are still poorly understood. Here, we discuss evidence for intra and interspecific drivers of habitat matching, and highlight the potential consequences of this process for metapopulation and metacommunity functioning. We conclude that habitat matching might deeply affect the eco-evolutionary dynamics of meta-systems, pointing out the need for further empirical and theoretical research on its incidence and implications for species and communities evolution under environmental change