Multidisciplinary rehabilitation for subacute low back pain: graded activity or workplace intervention or both? A randomized controlled trial.
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.
Anema
Johannes R
JR
Body@Work, Research Centre Physical Activity, Work and Health, Amsterdam, The Netherlands. h.anema@vumc.nl
Steenstra
Ivan A
IA
Bongers
Paulien M
PM
de Vet
Henrica C W
HC
Knol
Dirk L
DL
Loisel
Patrick
P
van Mechelen
Willem
W
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