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Do Patients With Chronic Low Back Pain Benefit From Early Intervention Regarding Absence From Work?: A Randomized, Controlled, Single-Center Pilot Study.

ABSTRACT: A randomized, controlled, single-center pilot study.The aim of this study was to investigate the feasibility of running a trial to explore if early intervention in individuals with chronic low back pain (CLBP) would lead to an early return to work (RTW) and reduce sick leave during 12 months of follow-up compared with patients on a 3-month waiting list.Back pain is the reason for numerous absent days from work. In Norway, the government initiated a priority program, Earlier Return to Work (ERTW), to reduce work absences through early intervention. However, no proper evaluation has been performed on populations with CLBP. There is no consensus on how RTW should be measured. Only a few studies have examined how waiting time affects RTW.Fifty-eight patients were included in the study. The group with early intervention was examined within 2 weeks, and the group on the waiting list was examined after 12 weeks. The intervention was identical in both groups and consisted of an outpatient, intensive back school. The data were obtained by questionnaire after 3, 6, and 12 months. The primary outcome was absence from work.The sample size in a full-scale study must comprise at least 382 patients on the basis of the assumptions in the pilot. In the pilot study, early intervention directly compared with an ordinary waiting list did not significantly affect the number of sick leave days after 12 months of follow-up.A prerequisite for launching a full-scale clinical trial is a redesign of the intervention, an improvement of procedures concerning inclusion and randomization, and finally a more precise definition of RTW.3.

SUBMITTER: Norbye AD

PROVIDER: S-EPMC5113231 | biostudies-literature | 2016 Nov

REPOSITORIES: biostudies-literature

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Do Patients With Chronic Low Back Pain Benefit From Early Intervention Regarding Absence From Work?: A Randomized, Controlled, Single-Center Pilot Study.

Norbye Anja Davis AD Omdal Aina Vedvik AV Nygaard Marit Eikrem ME Romild Ulla U Eldøen Guttorm G Midgard Rune R

Spine 20161101 21

<h4>Study design</h4>A randomized, controlled, single-center pilot study.<h4>Objective</h4>The aim of this study was to investigate the feasibility of running a trial to explore if early intervention in individuals with chronic low back pain (CLBP) would lead to an early return to work (RTW) and reduce sick leave during 12 months of follow-up compared with patients on a 3-month waiting list.<h4>Summary of background data</h4>Back pain is the reason for numerous absent days from work. In Norway, ...[more]

PMID: 27802253

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Project description:BackgroundMany studies on low back pain (LBP) have identified prognostic factors, but prediction models for use in secondary health care are not available. The purpose of this cohort study, based on a randomised clinical study, was to identify risk factors for unsuccessful return to work (U-RTW) in sick-listed LBP patients with or without radiculopathy and to validate a prediction model for U-RTW.Methods325 sick-listed LBP patients with or without radiculopathy were included in an intervention study and followed for one year. Afterwards, 117 other LBP patients were recruited similarly, included in a validation study and also followed for one year. All patients were subjected to identical procedures and interventions and received a brief intervention by the same rehabilitation doctor and physiotherapist. Half of them received case manager guidance within a multidisciplinary setting. At baseline, they completed a questionnaire and went through a clinical low-back examination. Sciatica was investigated by magnetic resonance imaging (MRI). U-RTW was registered in a national database both initially and at 1-year.ResultsNeither initial U-RTW (24.0%) nor one-year U-RTW (38.2%) were statistically significantly different in the two intervention groups nor in patients with and without radiculopathy. Multivariate logistic regression analysis identified two clinical and five psychosocial baseline predictors for one-year U-RTW (primary outcome). The clinical predictors included pain score (back+leg pain) and side-flexion. The five psychosocial predictors included 'bodily distress' 'low expectations of RTW', 'blaming the work for pain', 'no home ownership' and 'drinking alcohol less than once/month'. These predictors were not statistically significantly different in patients with and without radiculopathy, and they also predicted initial U-RTW (secondary outcome). Obesity and older age were only supplementary predictors in patients with radiculopathy. A prediction model was established and tested in the validation study group. The model predicted one-year U-RWT in patients with intermediate and high risk, but only partially in patients with low risk. The model predicted all three risk categories in initial U-RTW.ConclusionsA prediction model combining baseline clinical and psychosocial risk factors predicted patients with low, intermediate and high risk for unsuccessful return to work, both initially and at 1-year.

Dataset Information

Do Patients With Chronic Low Back Pain Benefit From Early Intervention Regarding Absence From Work?: A Randomized, Controlled, Single-Center Pilot Study.

Publications

Do Patients With Chronic Low Back Pain Benefit From Early Intervention Regarding Absence From Work?: A Randomized, Controlled, Single-Center Pilot Study.

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