A randomized controlled trial of two strategies to implement active sick leave for patients with low back pain.
METHODS
Cluster randomized controlled trial.


OBJECTIVE
To evaluate the effectiveness of two strategies to improve the use of active sick leave (ASL) for patients with low back pain.


BACKGROUND
ASL is a public sickness benefit scheme offered to promote early return to modified work for temporarily disabled workers. It was poorly used, and the authors designed two community interventions to strengthen the implementation of ASL based on the results of a study of barriers to use among back pain patients, employers, general practitioners (GPs), and local National Insurance Administration staff.


METHODS
Sixty-five municipalities in three counties in Norway, randomly assigned to a passive intervention, a proactive intervention, or a control group. The interventions were targeted at patients on sick leave for low back pain for more than 16 days (n = 6176), their GPs, employers, and local insurance officers. The passive intervention included reminders about ASL on the sick leave form that GPs must complete, a standard agreement to facilitate ASL, targeted information, and a desktop summary for GPs of clinical practice guidelines for low back pain, emphasizing the importance of advice to stay active. The proactive intervention included these elements plus a resource person to facilitate the use of ASL and a continuing education workshop for GPs. The main outcome measure reported here is the proportion of eligible patients that used ASL.


RESULTS
ASL was used significantly more in the proactive intervention municipalities (17.7%) compared with the passive intervention and control municipalities (11.5%, P = 0.018).


CONCLUSIONS
A passive intervention that addressed identified barriers to the use of ASL did not increase its use. Although modest, a proactive intervention did increase its use. The main impact of the intervention was through direct contact and motivating telephone calls to patients. To the extent that GPs' practice was changed, it was either patient mediated or by patients bypassing their GP.
Scheel
Inger B
IB
Health Services Research Unit, National Institute of Public Health, Oslo, Norway. inger.scheel@folkehelsa.no
Hagen
Kåre Birger
KB
Herrin
Jeph
J
Oxman
Andrew D
AD
D016000:Cluster Analysis; D003154:Community Medicine; D003159:Community-Institutional Relations; D004502:Education, Medical, Continuing; D006801:Humans; D017116:Low Back Pain / Q000534:rehabilitation*; D009313:National Health Programs; D009664:Norway; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data*; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D010821:Physicians, Family / Q000193:education / Q000706:statistics & numerical data; D017410:Practice Guidelines as Topic; D018582:Sick Leave / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data*