Long-term effectiveness and costs of a brief self-management intervention in women with pregnancy-related low back pain after delivery.
BACKGROUND
Pregnancy-related low back pain is considered an important health problem and potentially leads to long-lasting pain and disability. Investigators draw particular attention to biomedical factors but there is growing evidence that psychosocial and social factors might be important. It prompted us to start a large cohort study (n = 7526) during pregnancy until one year after delivery and a nested randomized controlled intervention study in the Netherlands.


METHODS
A randomized controlled trial (n = 126) nested within a cohort study, of brief self-management techniques versus usual care for treatment of women with persisting non-specific pregnancy-related low back pain three weeks after delivery. Women in the intervention group were referred to a participating physiotherapist. Women in the usual care group were free to choose physiotherapy, guidance by a general practitioner or no treatment. Follow up took place at 3 months, 6 months and one year after delivery.Outcomes included change in limitations in activities (RDQ), pain (VAS), severity of main complaints (MC), global feeling of recovery (GPE), impact on participation and autonomy (IPA), pain-related fear (TSK), SF-36, EuroQol and a cost diary. For the outcome measures, series of mixed models were considered. For the outcome variable global perceived effect (GPE) a logistic regression analysis is performed.


RESULTS
Intention-to-treat outcomes showed a statistical significant better estimated regression coefficient RDQ -1.6 {-2.9;-0.5} associated with treatment, as well as better IPA subscale autonomy in self-care -1.0 {-1.9;-0.03} and TSK -2.4 {-3.8;-1.1} but were not clinical relevant over time. Average total costs in the intervention group were much lower than in usual care, primarily due to differences in utilization of sick leave but not statistically significant.


CONCLUSIONS
Brief self-management techniques applied in the first 3 months after delivery may be a more viable first-line approach but further research is needed to draw inference on costs and to determine whether no care is a better option in the long term.


BACKGROUND
[ISRCTN08477490].
Bastiaenen
Caroline H G
CH
Department of Epidemiology, Maastricht University, P,O,Box 616, 6200 MD Maastricht, The Netherlands. chg.bastiaenen@epid.unimaas.nl
de Bie
Rob A
RA
Vlaeyen
Johan W S
JW
Goossens
Mariëlle E J B
ME
Leffers
Pieter
P
Wolters
Pieter M J C
PM
Bastiaanssen
Janneke M
JM
Brandt
Piet A van den
PA
Essed
Gerard G M
GG
D000328:Adult; D015331:Cohort Studies; D003131:Combined Modality Therapy; D003362:Cost-Benefit Analysis; D004311:Double-Blind Method; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D016015:Logistic Models; D017116:Low Back Pain / Q000191:economics / Q000628:therapy*; D017063:Outcome Assessment, Health Care; D010147:Pain Measurement / Q000379:methods; D010353:Patient Education as Topic / Q000191:economics / Q000379:methods*; D017060:Patient Satisfaction; D026741:Physical Therapy Modalities / Q000191:economics / Q000458:organization & administration*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000191:economics / Q000628:therapy*; D011788:Quality of Life; D012648:Self Care / Q000379:methods*; D016896:Treatment Outcome