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Guiding Low Back Claimants to Work: A Randomized Controlled Trial

Du Bois, Marc, MD; Donceel, Peter, MD, PhD

doi: 10.1097/BRS.0b013e31824e4ada
Randomized Trial

Study Design. A single-blinded, randomized controlled trial.

Objective. To determine the impact of information and advice during a disability evaluation by medical advisers on the return to work (RTW) rate and recurrence of sick leave of claimants with low back pain (LBP).

Summary of Background Data. There is evidence on the importance of advice during the course of subacute LBP. The effect of informative interventions on RTW rates in workers receiving sickness benefit is not clear.

Methods. A total of 506 claimants with LBP were randomly assigned to the control group (disability evaluation) or the intervention group (combined counseling and disability evaluation). RTW, sick leave recurrence, subsequent surgery, and sick leave duration were measured during a 12-month follow-up.

Results. Patients who were provided information and advice showed a higher RTW rate, which was statistically significant at 1 year. That result is mainly attributable to the lower relapse rate in the intervention group (38%) than in the control group (60%). There were no differences between the 2 groups regarding subsequent surgery for LBP and duration of sick leave.

Conclusion. Claimants should be routinely reassured and advised about LBP to allow early and safe RTW during a disability evaluation before any side effects of being sick-listed have settled.

The current randomized controlled trial investigated the impact of information and advice by medical advisers during a disability evaluation of claimants with low back pain. Combined counseling and disability evaluation resulted in a higher return to work rate due to a lower sick leave recurrence than disability evaluation.

From the Occupational, Environmental and Insurance Medicine, Department of Public Health, Leuven; Katholieke Universiteit, Leuven, Belgium.

Address correspondence and reprint requests to Peter Donceel, MD, PhD, Occupational, Environmental and Insurance Medicine, Department of Public Health, Katholieke Universiteit Leuven, Kapucijnenvoer 35, Block D, Box 7001, 3000 Leuven, Belgium; E-mail:

Acknowledgment date: August 16, 2011. First revision date: December 1, 2011. Second revision date: January 23, 2012. Acceptance date: January 30, 2012.

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

No 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.

© 2012 Lippincott Williams & Wilkins, Inc.