Multidisciplinary rehabilitation for subacute low back pain: Graded activity or workplace intervention or both?: A randomized controlled trial | Knowledge Translation for Employment Research Center

Authors:	Anema, J. R., Steenstra, I. A., Bongers, P. M., de Vet, H. C. W., Knol, D. L., Loisel, P., & van Mechelen, W.
Year Published	2007
Publication	Spine
Volume	32
Number	3
Pages	291-298
Publisher	Lippincott Williams & Wilkins, Inc.
Background	Low back pain (LBP) is the most common and expensive musculoskeletal disorder in industrialized countries. LBP is frequently associated with persistent or recurrent disability and absence from work. High costs are mainly due to sick leave and disability. Effective interventions for LBP are needed to prevent long-term disability and promote early and safe return to work.
Purpose	To assess the effectiveness of workplace intervention and graded activity, separately and combined, for multidisciplinary rehabilitation of low back pain (LBP).
Setting	The setting was Dutch occupational health services and physiotherapy centers.
Sample	Participants sick-listed 2 to 6 weeks due to nonspecific LBP were randomized to workplace intervention (n = 96) or usual care (n = 100).
Data Collection	Workplace intervention consisted of workplace assessment, work modifications, and case management involving all stakeholders. Participants still sick-listed at 8 weeks were randomized for graded activity (n = 55) or usual care (n = 57). Graded activity comprised biweekly 1-hour exercise sessions based on operant-conditioning principles. Outcomes were lasting return to work, pain intensity and functional status, assessed at baseline, and at 12, 26, and 52 weeks after the start of sick leave.
Control	The comparison was usual care.
Findings	Time until return to work for workers with workplace intervention was 77 versus 104 days (median) for workers without this intervention (P = 0.02). Workplace intervention was effective on return to work (hazard ratio = 1.7; 95% CI, 1.2‚Äì2.3; P = 0.002). Graded activity had a negative effect on return to work (hazard ratio = 0.4; 95% CI, 0.3‚Äì0.6; P < 0.001) and functional status. Combined intervention had no effect.
Conclusions	Workplace intervention is advised for multidisciplinary rehabilitation of subacute LBP. Graded activity or combined intervention is not advised.
URL	http://www.ncbi.nlm.nih.gov/pubmed/17268258
Disabilities
Populations	Male \| Female
Outcomes	Full-time employment \| Part-time employment \| Return to work
NIDILRR Funded	No
Research Design	Randomized Controlled Trials (RCTs)
Peer Reviewed	Yes

Year Published

2007

Publication

Spine

Volume

32

Number

3

Pages

291-298

Publisher

Lippincott Williams & Wilkins, Inc.

Background

Low back pain (LBP) is the most common and expensive musculoskeletal disorder in industrialized countries. LBP is frequently associated with persistent or recurrent disability and absence from work. High costs are mainly due to sick leave and disability. Effective interventions for LBP are needed to prevent long-term disability and promote early and safe return to work.

Purpose

To assess the effectiveness of workplace intervention and graded activity, separately and combined, for multidisciplinary rehabilitation of low back pain (LBP).

Setting

The setting was Dutch occupational health services and physiotherapy centers.

Sample

Participants sick-listed 2 to 6 weeks due to nonspecific LBP were randomized to workplace intervention (n = 96) or usual care (n = 100).

Data Collection

Workplace intervention consisted of workplace assessment, work modifications, and case management involving all stakeholders. Participants still sick-listed at 8 weeks were randomized for graded activity (n = 55) or usual care (n = 57). Graded activity comprised biweekly 1-hour exercise sessions based on operant-conditioning principles. Outcomes were lasting return to work, pain intensity and functional status, assessed at baseline, and at 12, 26, and 52 weeks after the start of sick leave.

Control

The comparison was usual care.

Findings

Time until return to work for workers with workplace intervention was 77 versus 104 days (median) for workers without this intervention (P = 0.02). Workplace intervention was effective on return to work (hazard ratio = 1.7; 95% CI, 1.2‚Äì2.3; P = 0.002). Graded activity had a negative effect on return to work (hazard ratio = 0.4; 95% CI, 0.3‚Äì0.6; P < 0.001) and functional status. Combined intervention had no effect.

Conclusions

Workplace intervention is advised for multidisciplinary rehabilitation of subacute LBP. Graded activity or combined intervention is not advised.

URL

http://www.ncbi.nlm.nih.gov/pubmed/17268258

Disabilities

Populations

Male | Female

Outcomes

Full-time employment | Part-time employment | Return to work

NIDILRR Funded

No

Research Design

Randomized Controlled Trials (RCTs)

Peer Reviewed

Yes