Secondary Logo

Institutional members access full text with Ovid®

Share this article on:

Multidisciplinary Rehabilitation for Subacute Low Back Pain: Graded Activity or Workplace Intervention or Both?: A Randomized Controlled Trial

Anema, Johannes R., MD, PhD*†‡§; Steenstra, Ivan A., PhD*†‡§; Bongers, Paulien M., PhD*‡; de Vet, Henrica C. W., PhD§; Knol, Dirk L., PhD§∥; Loisel, Patrick, MD, FRCSC; van Mechelen, Willem, MD, PhD*†§

doi: 10.1097/01.brs.0000253604.90039.ad
Randomized Trial

Study design. Population-based randomized controlled trial.

Objective. 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.

The effectiveness of workplace intervention and graded activity was evaluated in a multidisciplinary biopsychosocial rehabilitation program for workers sick-listed 2 to 6 weeks due to low back pain. Workplace intervention was effective on return to work. Graded activity had a negative effect on return to work and functional status. A combination of both interventions had no effect.

From the *Body@Work, Research Centre Physical Activity, Work and Health; TNO-VUmc; †Department of Public and Occupational Health and Institute for Research in Extramural Medicine, VU University Medical Center; ‡Research Center for Insurance Medicine AMC-UWV-VUmc; §Institute for Research in Extramural Medicine, VU University Medical Center; ∥Department of Clinical Epidemiology and Biostatistics, VU University Medical Center; and ¶Disability Prevention Research and Training Centre, Université de Sherbrooke, Longueuil.

Acknowledgment date: December 5, 2005. First revision date: March 1, 2006. Acceptance date: April 24, 2006.

Supported by the Netherlands Organization for Health Research and Development (ZonMw), Dutch Ministries of Health, Welfare and Sports and of Social Affairs.

The manuscript submitted does not contain information about medical device(s)/drug(s).

Federal funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

Trial registry information: International Standard Randomized Controlled Trial No. 60233560.

Address correspondence and reprint requests to Johannes R. Anema, MD, PhD, Department of Public and Occupational Health and Institute for Research in Extramural Medicine, VU University Medical Center, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands; E-mail: h.anema@vumc.nl

© 2007 Lippincott Williams & Wilkins, Inc.