Population-based randomized controlled trial.
To assess the effectiveness
of workplace intervention
and graded activity
, separately and combined, for multidisciplinary rehabilitation of low back pain
Summary of Background Data.
Effective components for multidisciplinary rehabilitation of LBP are not yet established.
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.
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.