title: The effectiveness of high-intensity versus low-intensity back schools in an occupational setting: a pragmatic randomized controlled trial.
abstract: METHODS
  Randomized controlled trial.
  
  
  OBJECTIVE
  To compare high- and low-intensity back schools with usual care in occupational health care.
  
  
  BACKGROUND
  The content and intensity of back schools vary widely and the methodologic quality of randomized controlled trials is generally weak. Until now, no back school has proven to be superior for workers sick-listed because of subacute nonspecific low back pain.
  
  
  METHODS
  Workers (n = 299) sick-listed for a period of 3 to 6 weeks because of nonspecific low back pain were recruited by the occupational physician and randomly assigned to a high-intensity back school, a low-intensity back school, or care as usual. Outcome measures were days until return to work, total days of sick-leave, pain, functional status, kinesiophobia, and perceived recovery and were assessed at baseline and at 3 and 6 months of follow-up. Principal analyses were performed according to the intention-to-treat principle.
  
  
  RESULTS
  We randomly allocated 299 workers. Workers in the low-intensity back school returned to work faster compared with usual care and the high-intensity back school, with hazard ratios of 1.4 (P = 0.06) and 1.3 (P = 0.09), respectively. The comparison between high-intensity back school and usual care resulted in a hazard ratio of 1.0 (P = 0.83). The median number of sick-leave days was 68, 75, and 85 in the low-intensity back school, usual care, and high-intensity back school, respectively. Beneficial effects on functional status and kinesiophobia were found at 3 months in favor of the low-intensity back school. No substantial differences on pain and perceived recovery were found between groups.
  
  
  CONCLUSIONS
  The low-intensity back school was most effective in reducing work absence, functional disability, and kinesiophobia, and more workers in this group scored a higher perceived recovery during the 6-month follow-up.
authors.affiliation: Body@Work, Research Center Physical Activity, Work and Health, TNO-VUmc, Amsterdam, The Netherlands.
authors.forename: Martijn W
authors.initials: MW
authors.lastname: Heymans
authors.forename: Henrica C W
authors.initials: HC
authors.lastname: de Vet
authors.forename: Paulien M
authors.initials: PM
authors.lastname: Bongers
authors.forename: Dirk L
authors.initials: DL
authors.lastname: Knol
authors.forename: Bart W
authors.initials: BW
authors.lastname: Koes
authors.forename: Willem
authors.initials: W
authors.lastname: van Mechelen
mesh_terms: D000328:Adult; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D017116:Low Back Pain / Q000503:physiopathology / Q000628:therapy*; D008297:Male; D009786:Occupational Health Services; D010147:Pain Measurement; D010353:Patient Education as Topic / Q000379:methods*; D026741:Physical Therapy Modalities; D018582:Sick Leave / Q000706:statistics & numerical data; D016896:Treatment Outcome; D014938:Work Capacity Evaluation