Randomised controlled trial of integrated care to reduce disability from chronic low back pain in working and private life.
OBJECTIVE
To evaluate the effectiveness of an integrated care programme, combining a patient directed and a workplace directed intervention, for patients with chronic low back pain.


METHODS
Population based randomised controlled trial.


METHODS
Primary care (10 physiotherapy practices, one occupational health service, one occupational therapy practice) and secondary care (five hospitals).


METHODS
134 adults aged 18-65 sick listed for at least 12 weeks owing to low back pain.


METHODS
Patients were randomly assigned to usual care (n=68) or integrated care (n=66). Integrated care consisted of a workplace intervention based on participatory ergonomics, involving a supervisor, and a graded activity programme based on cognitive behavioural principles.


METHODS
The primary outcome was the duration of time off work (work disability) due to low back pain until full sustainable return to work. Secondary outcome measures were intensity of pain and functional status.


RESULTS
The median duration until sustainable return to work was 88 days in the integrated care group compared with 208 days in the usual care group (P=0.003). Integrated care was effective on return to work (hazard ratio 1.9, 95% confidence interval 1.2 to 2.8, P=0.004). After 12 months, patients in the integrated care group improved significantly more on functional status compared with patients in the usual care group (P=0.01). Improvement of pain between the groups did not differ significantly.


CONCLUSIONS
The integrated care programme substantially reduced disability due to chronic low back pain in private and working life. Trial registration Current Controlled Trials ISRCTN28478651.
Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, Netherlands.
Ludeke C
LC
Lambeek
Willem
W
van Mechelen
Dirk L
DL
Knol
Patrick
P
Loisel
Johannes R
JR
Anema
D000293:Adolescent; D000328:Adult; D000368:Aged; D002908:Chronic Disease; D019033:Delivery of Health Care, Integrated / Q000706:statistics & numerical data*; D006233:Persons with Disabilities; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D017116:Low Back Pain / Q000534:rehabilitation*; D008297:Male; D008875:Middle Aged; D009786:Occupational Health Services / Q000706:statistics & numerical data; D009788:Occupational Therapy / Q000706:statistics & numerical data; D010349:Patient Compliance; D026741:Physical Therapy Modalities / Q000706:statistics & numerical data; D015397:Program Evaluation; D012050:Rehabilitation, Vocational; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D055815:Young Adult