Function-centered rehabilitation increases work days in patients with nonacute nonspecific low back pain: 1-year results from a randomized controlled trial.
OBJECTIVE
To compare the effect of function-centered treatment (FCT) and pain-centered treatment (PCT) on the number of work days, permanent disability, and the unemployment rate.


METHODS
Randomized controlled trial.


METHODS
Inpatient rehabilitation center.


METHODS
Patients (N=174; 79% male; mean age, 42 y) with previous sick leave of 6 weeks or more.


METHODS
FCT (4 h/d for 3 wk) emphasized activity despite pain by using work simulation, strength, endurance, and cardiovascular training. PCT (2.5h/d for 3 wk) emphasized pain reduction and included passive and active mobilization, stretching, strength training, and a 4-hour mini back school with education and exercise. Analysis was by intention to treat.


METHODS
Work days, return to work, rate of patients receiving financial compensation for permanent disability, and unemployment rate. Effect sizes (Cohen d) were defined as small (0.2-0.5), moderate (0.5-0.8), and large (>0.8).


RESULTS
After 1 year, the FCT group had significantly more work days (mean, 118; median, 39.5; interquartile range [IQR], 0-198) than the PCT group (mean, 74; median, 0; IQR, 0-160; Mann-Whitney U test, P=.011). The odds ratio of returning to work in the FCT group relative to the PCT group was 2.1 (95% confidence interval, 1.1-3.9). The differences in unemployment rates and in the numbers of patients receiving compensation for permanent disability were not significant.


CONCLUSIONS
FCT is more effective than PCT for increasing work days.
Kool
Jan
J
Department of Rheumatology, Rehabilitation Centre Valens, Valens, Switzerland. jan.kool@zhwin.ch
Bachmann
Stefan
S
Oesch
Peter
P
Knuesel
Otto
O
Ambergen
Ton
T
de Bie
Rob
R
van den Brandt
Piet
P
D000328:Adult; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007297:Inpatients; D017116:Low Back Pain / Q000503:physiopathology / Q000534:rehabilitation*; D008297:Male; D009784:Occupational Diseases / Q000503:physiopathology / Q000534:rehabilitation*; D010349:Patient Compliance; D012047:Rehabilitation Centers; D018582:Sick Leave / Q000639:trends; D013997:Time Factors; D016896:Treatment Outcome; D014940:Work Schedule Tolerance / Q000502:physiology*; D016526:Workload