Early occupational health management of patients with back pain: a randomized controlled trial.
METHODS
A randomized controlled trial in occupational health practice was conducted.


OBJECTIVE
To study the efficacy of early management of workers with low back pain by occupational physicians, as compared with management by the supervisor only.


BACKGROUND
Health care and university workers with back pain and on sick leave for less than 1 month were included in the study.


METHODS
Patients with low back pain for at least 10 days on sick leave were randomly assigned to early management by the occupational physician (n = 61) or to a reference group with management by the worker's supervisor during the first 3 months of sick leave (n = 59). The patients were observed for 1 year and compared in terms of time until return to work, pain intensity, functional disability, and general health perception. The occupational physicians were provided with management guidelines.


RESULTS
No significant differences were found after 3 and 12 months of follow-up evaluation in terms of time until return to work (hazard ratio, 1.3; 95% CI, 0.90-1.90) or in terms of other health outcomes. Recurrences, however, occurred more frequently in the intervention group, but the total duration of sick leave in 1 year did not differ between the groups.


CONCLUSIONS
The findings do not show a significant positive effect of an early intervention by occupational physicians on workers with low back pain. This might reflect the early phase of disability or the low intensity of the intervention resulting from overestimation of the physicians' compliance with the guidelines.
Verbeek
Jos H
JH
Coronel Institute for Occupational and Environmental Health, Academic Medical Center, Division of Public Health, University of Amsterdam, The Netherlands. j.h.verbeek@amc.uva.nl
van der Weide
Willeke E
WE
van Dijk
Frank J
FJ
D000328:Adult; D001416:Back Pain / Q000534:rehabilitation*; D004185:Disability Evaluation; D019468:Disease Management; D005260:Female; D005500:Follow-Up Studies; D019983:Guideline Adherence; D006304:Health Status; D006801:Humans; D008297:Male; D009426:Netherlands; D009786:Occupational Health Services / Q000379:methods* / Q000592:standards; D010043:Outcome and Process Assessment, Health Care; D010147:Pain Measurement; D012008:Recurrence; D018582:Sick Leave / Q000706:statistics & numerical data