Title
Multidisciplinary rehabilitation for subacute low back pain : graded activity or workplace intervention or both? : a randomized controlled trial
Author
Anema, J.R.
Steenstra, I.A.
Bongers, P.M.
de Vet, H.C.W.
Knol, D.L.
Loisel, P.
TNO Kwaliteit van Leven
Publication year
2007
Abstract
To assess the effectiveness of workplace intervention and graded activity, separately and combined, for multidisciplinary rehabilitation of low back pain (LBP). Summary of Background Data. Effective components for multidisciplinary rehabilitation of LBP are not yet established. Methods: Participants sick-listed 2 to 6 weeks due to nonspecific LBP were randomized to workplace intervention (n = 96) or usual care (n = 100). 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. Results: 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, 1.2-2.3; P = 0.002). Graded activity had a negative effect on return to work (hazard ratio = 0.4; 95% CI, 0.3-0.6; P < 0.001) and functional status. Combined intervention had no effect. Conclusion: Workplace intervention is advised for multidisciplinary rehabilitation of subacute LBP. Graded activity or combined intervention is not advised.
Subject
Workplace
Effectiveness
Graded activity
Low back pain
Return to work
Workplace intervention
Adult
Case management
Clinical trial
Controlled clinical trial
Controlled study
Exercise
Female
Functional status
Human
Instrumental conditioning
Major clinical study
Male
Medical leave
Randomization
Randomized controlled trial
Single blind procedure
Workplace
To reference this document use:
http://resolver.tudelft.nl/uuid:4b743901-c612-4bc1-8c67-e7e235440b3c
TNO identifier
278193
Source
Spine, 32 (3), 291-298
Document type
article