title: Multidisciplinary rehabilitation for subacute low back pain: graded activity or workplace intervention or both? A randomized controlled trial.
abstract: METHODS
  Population-based randomized controlled trial.
  
  
  OBJECTIVE
  To assess the effectiveness of workplace intervention and graded activity, separately and combined, for multidisciplinary rehabilitation of low back pain (LBP).
  
  
  BACKGROUND
  Effective components for multidisciplinary rehabilitation of LBP are not yet established.
  
  
  METHODS
  Participants sick-listed 2 to 6 weeks due to nonspecific LBP were randomized to workplace intervention (n = 96) or usual care (n = 100). Workplace intervention consisted of workplace assessment, work modifications, and case management involving all stakeholders. Participants still sick-listed at 8 weeks were randomized for graded activity (n = 55) or usual care (n = 57). Graded activity comprised biweekly 1-hour exercise sessions based on operant-conditioning principles. Outcomes were lasting return to work, pain intensity and functional status, assessed at baseline, and at 12, 26, and 52 weeks after the start of sick leave.
  
  
  RESULTS
  Time until return to work for workers with workplace intervention was 77 versus 104 days (median) for workers without this intervention (P = 0.02). Workplace intervention was effective on return to work (hazard ratio = 1.7; 95% CI, 1.2-2.3; P = 0.002). Graded activity had a negative effect on return to work (hazard ratio = 0.4; 95% CI, 0.3-0.6; P < 0.001) and functional status. Combined intervention had no effect.
  
  
  CONCLUSIONS
  Workplace intervention is advised for multidisciplinary rehabilitation of subacute LBP. Graded activity or combined intervention is not advised.
authors.affiliation: Body@Work, Research Centre Physical Activity, Work and Health, Amsterdam, The Netherlands. h.anema@vumc.nl
authors.forename: Johannes R
authors.initials: JR
authors.lastname: Anema
authors.forename: Ivan A
authors.initials: IA
authors.lastname: Steenstra
authors.forename: Paulien M
authors.initials: PM
authors.lastname: Bongers
authors.forename: Henrica C W
authors.initials: HC
authors.lastname: de Vet
authors.forename: Dirk L
authors.initials: DL
authors.lastname: Knol
authors.forename: Patrick
authors.initials: P
authors.lastname: Loisel
authors.forename: Willem
authors.initials: W
authors.lastname: van Mechelen
mesh_terms: D000208:Acute Disease; D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D017116:Low Back Pain / Q000453:epidemiology* / Q000534:rehabilitation*; D008297:Male; D008875:Middle Aged; D009784:Occupational Diseases / Q000453:epidemiology* / Q000534:rehabilitation*; D009786:Occupational Health Services / Q000379:methods; D018582:Sick Leave; D016037:Single-Blind Method; D017132:Workplace