title: The effects of cognitive-behavioral and physical therapy preventive interventions on pain-related sick leave: a randomized controlled trial.
abstract: OBJECTIVE
  Recent recommendations suggest that reassuring patients with an acute bout of low back pain and encouraging a return to normal activities may be helpful in preventing the development of chronic disability. There is also a question as to whether psychologic or physical therapy interventions actually add anything to such reassurance and advice in terms of preventing chronicity. This study aimed to ascertain the preventive effects on future sick leave and health-care utilization of adding on a cognitive-behavioral group intervention or a cognitive-behavioral group intervention and preventive physical therapy (focused on activity and exercise) relative to a minimal treatment group (examination, reassurance, and activity advice).
  
  
  METHODS
  A total of 185 patients seeking care for nonspecific back or neck pain who were employed and at risk for developing long-term disability volunteered to participate in the study. Of these 185, 158 (85%) completed the pre- and 1-year follow-up assessments.
  
  
  RESULTS
  Significant differences were observed on the key outcome variables of future health-care utilization and work absenteeism. For health-care utilization, the cognitive-behavioral intervention group and preventive physical therapy group had significantly fewer healthcare visits than did the Minimal Treatment Group. For work absenteeism, the cognitive-behavioral intervention group and cognitive-behavioral intervention and preventive physical therapy group had fewer days during the 12-month follow-up than did the Minimal Treatment Group. The risk for developing long-term sick disability leave was more than five-fold higher in the Minimal Group as compared with the other 2 groups. However, there was no difference between the cognitive-behavioral intervention group and cognitive-behavioral intervention and preventive physical therapy group on sick leave.
  
  
  CONCLUSIONS
  Taken as a whole, this study shows that adding cognitive-behavioral intervention and cognitive-behavioral intervention and preventive physical therapy can enhance the prevention of long-term disability. There was no substantial difference in the results between the cognitive-behavioral intervention group and cognitive-behavioral intervention and preventive physical therapy group.
authors.affiliation: Department of Occupational and Environmental Medicine, Orebro University Hospital, Orebro, Sweden. steven.linton@orebroll.se
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Linton
authors.forename: Katja
authors.initials: K
authors.lastname: Boersma
authors.forename: Markus
authors.initials: M
authors.lastname: Jansson
authors.forename: Lennart
authors.initials: L
authors.lastname: Svärd
authors.forename: Marianne
authors.initials: M
authors.lastname: Botvalde
mesh_terms: D001416:Back Pain / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control*; D015928:Cognitive Behavioral Therapy / Q000706:statistics & numerical data*; D003131:Combined Modality Therapy / Q000706:statistics & numerical data; D004185:Disability Evaluation; D004651:Employment; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019547:Neck Pain / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control*; D017063:Outcome Assessment, Health Care / Q000379:methods; D026761:Physical Therapy Specialty / Q000706:statistics & numerical data*; D011379:Prognosis; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D018582:Sick Leave / Q000706:statistics & numerical data*; D013548:Sweden / Q000453:epidemiology; D016896:Treatment Outcome