Secondary prevention of work-related disability in nonspecific low back pain: does problem-solving therapy help? A randomized clinical trial.
OBJECTIVE
Given the individual and economic burden of chronic work disability in low back pain patients, there is a need for effective preventive interventions. The aim of the present study was to investigate whether problem-solving therapy had a supplemental value when added to behavioral graded activity, regarding days of sick leave and work status.


METHODS
Randomized controlled trial.


METHODS
Employees who were recently on sick leave as a result of nonspecific low back pain were referred to the rehabilitation center by general practitioner, occupational physician, or rehabilitation physician. Forty-five employees had been randomly assigned to the experimental treatment condition that included behavioral graded activity and problem-solving therapy (GAPS), and 39 employees had been randomly assigned to behavioral graded activity and group education (GAGE).


METHODS
Days of sick leave and work status. Data were retrieved from occupational health services.


RESULTS
Data analyses showed that employees in the GAPS group had significantly fewer days of sick leave in the second half-year after the intervention. Moreover, work status was more favorable for employees in this condition, in that more employees had a 100% return-to-work and fewer patients ended up receiving disability pensions one year after the intervention. Sensitivity analyses confirmed these results.


CONCLUSIONS
The addition of problem-solving therapy to behavioral graded activity had supplemental value in employees with nonspecific low back pain.
van den Hout
Johanna H C
JH
Department of Medical, Clinical and Experimental Psychology, Maastricht University, 6200 MD Maastricht, The Netherlands. a.vandenhout@zw.unimaas.nl
Vlaeyen
Johan W S
JW
Heuts
Peter H T G
PH
Zijlema
Johan H L
JH
Wijnen
Joseph A G
JA
D000328:Adult; D001521:Behavior Therapy / Q000379:methods*; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003131:Combined Modality Therapy; D004185:Disability Evaluation; D019468:Disease Management; D004651:Employment / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D017116:Low Back Pain / Q000145:classification / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D008297:Male; D009784:Occupational Diseases / Q000150:complications / Q000517:prevention & control; D010353:Patient Education as Topic / Q000379:methods; D011340:Problem Solving; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D018582:Sick Leave / Q000706:statistics & numerical data; D016896:Treatment Outcome