A population-based, randomized clinical trial on back pain management.
METHODS
Population-based randomized clinical trial.


OBJECTIVE
To develop and test a model of management of subacute back pain, to prevent prolonged disability.


BACKGROUND
The present management of back pain seems inadequate, and development of innovative models has been urged.


METHODS
A model for the treatment of subacute work-related back pain has been developed and evaluated in a population-based randomized clinical trial. Workers (n = 130) from eligible workplaces in the Sherbrooke area (N = 31), who had been absent from work for more than 4 weeks for back pain, were randomized, based on their workplace, in one of four treatment groups: usual care, clinical intervention, occupational intervention, and full intervention (a combination of the last two). The duration of absence from regular work and from any work was evaluated using survival analysis. Functional status and pain were compared at study entry and after 1 year of follow-up.


RESULTS
The full intervention group returned to regular work 2.41 times faster than the usual care intervention group (95% confidence interval 1.19-4.89; P < 0.01). The specific effect of the occupational intervention accounted for the most important part of this result, with a rate ratio of return to regular work of 1.91 (95% confidence interval = 1.18-3.10; P < 0.01). Pain and disability scales demonstrated either a statistically significant reduction or a trend toward reduction in the three intervention groups, compared with the trend in the usual care intervention group.


CONCLUSIONS
Close association of occupational intervention with clinical care is of primary importance in impeding progression toward chronicity of low back pain.
Loisel
P
P
Department of Surgery, Hôpital Charles LeMoyne, Greenfield Park Université de Sherbrooke, Québec, Canada.
Abenhaim
L
L
Durand
P
P
Esdaile
J M
JM
Suissa
S
S
Gosselin
L
L
Simard
R
R
Turcotte
J
J
Lemaire
J
J
D000293:Adolescent; D000328:Adult; D000368:Aged; D001416:Back Pain / Q000534:rehabilitation / Q000628:therapy*; D003661:Decision Support Techniques; D004185:Disability Evaluation; D019468:Disease Management; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009784:Occupational Diseases / Q000534:rehabilitation / Q000628:therapy*; D016016:Proportional Hazards Models; D016896:Treatment Outcome