Evidence-based care for low back pain in workers eligible for compensation.
BACKGROUND
Although guidelines for the management of low back pain have been promoted, few studies have assessed their effectiveness. One previous study did not include patients with workers' compensation claims.


OBJECTIVE
To assess the efficacy of evidence-based care for acute low back pain in patients eligible for workers' compensation.


METHODS
In a prospective audit, workers in a health service who presented with acute low back pain were offered the option of usual care from their general practitioner or care provided by a staff specialist who practiced according to evidence-based guidelines. Outcomes were measured in terms of return to normal duties, time off work, recurrence of pain or persistence of pain.


RESULTS
Evidence-based care was accepted by 65% of injured workers. Compared with those who elected usual care, these workers had less time off work, spent less time on modified duties and had fewer recurrences. A significantly greater proportion (70%) resumed normal duties immediately, and fewer developed chronic pain, than those managed under usual care. Three types of patients were identified: those who complied readily with evidence-based care, those who initially expressed firm beliefs about how they should be managed and those with occupational psychosocial factors.


CONCLUSIONS
Evidence-based care can be successful in retaining patients at work, reducing time off work or on modified duties and reducing recurrences and chronicity. The gains are achieved by conscientiously talking to the patients, and not by any particular or special passive interventions.
McGuirk
Brian
B
Department of Clinical Research, University of Newcastle, Royal Newcastle Hospital, Newcastle, New South Wales, Australia. michelle.gillam@newcastle.edu.au
Bogduk
Nikolai
N
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D019317:Evidence-Based Medicine; D005260:Female; D006282:Health Personnel; D006801:Humans; D017116:Low Back Pain / Q000534:rehabilitation*; D008297:Male; D008875:Middle Aged; D009784:Occupational Diseases / Q000534:rehabilitation*; D009786:Occupational Health Services / Q000458:organization & administration; D011446:Prospective Studies; D014942:Workers' Compensation