Randomised controlled trial of integrated care to reduce disability from chronic low back pain in working and private life.

Abstract:

OBJECTIVE:To evaluate the effectiveness of an integrated care programme, combining a patient directed and a workplace directed intervention, for patients with chronic low back pain. DESIGN:Population based randomised controlled trial. SETTING:Primary care (10 physiotherapy practices, one occupational health service, one occupational therapy practice) and secondary care (five hospitals). PARTICIPANTS:134 adults aged 18-65 sick listed for at least 12 weeks owing to low back pain. INTERVENTION:Patients were randomly assigned to usual care (n=68) or integrated care (n=66). Integrated care consisted of a workplace intervention based on participatory ergonomics, involving a supervisor, and a graded activity programme based on cognitive behavioural principles. MAIN OUTCOME MEASURES:The primary outcome was the duration of time off work (work disability) due to low back pain until full sustainable return to work. Secondary outcome measures were intensity of pain and functional status. RESULTS:The median duration until sustainable return to work was 88 days in the integrated care group compared with 208 days in the usual care group (P=0.003). Integrated care was effective on return to work (hazard ratio 1.9, 95% confidence interval 1.2 to 2.8, P=0.004). After 12 months, patients in the integrated care group improved significantly more on functional status compared with patients in the usual care group (P=0.01). Improvement of pain between the groups did not differ significantly. CONCLUSION:The integrated care programme substantially reduced disability due to chronic low back pain in private and working life. Trial registration Current Controlled Trials ISRCTN28478651.

journal_name

BMJ

authors

Lambeek LC,van Mechelen W,Knol DL,Loisel P,Anema JR

doi

10.1136/bmj.c1035

subject

Has Abstract

pub_date

2010-03-16 00:00:00

pages

c1035

eissn

0959-8138

issn

1756-1833

journal_volume

340

pub_type

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