title: Early coordinated multidisciplinary intervention to prevent sickness absence and labour market exclusion in patients with low back pain: study protocol of a randomized controlled trial.
abstract: BACKGROUND
  Musculoskeletal disorders account for one third of the long-term absenteeism in Denmark and the number of individuals sick listed for more than four weeks is increasing. Compared to other diagnoses, patients with musculoskeletal diseases, including low back pain, are less likely to return to work after a period of sick leave. It seems that a multidisciplinary intervention, including cooperation between the health sector, the social sector and in the work place, has a positive effect on days off work due to musculoskeletal disorders and particularly low back pain. It is a challenge to coordinate this type of intervention, and the implementation of a return-to-work (RTW)-coordinator is suggested as an effective strategy in this process. The purpose of this paper is to describe the study protocol and present a new type of intervention, where the physiotherapist both has the role as RTW-coordinator and treating the patient.
  
  
  METHODS
  A randomized controlled trial (RCT) is currently on-going. The RCT includes 770 patients with low back pain of minimum four weeks who are referred to an outpatient back centre. The study population consists of patients, who are sick-listed or at risk of sick-leave due to LBP. The control group is treated with usual care in a team of a physiotherapist, a chiropractor, a rheumatologist and a social worker employed at the centre. The Intervention group is treated with usual care and in addition intervention of a psychologist, an occupational physician, an ergonomist, a case manager from the municipal sickness benefit office, who has the authority in the actual case concerning sickness benefit payment and contact to the patients employer/work place. The treating physiotherapist is the RTW-coordinator. Outcome will be reported at the end of treatment as well as 6 and 12 months follow up. The primary outcome is number of days off work. Secondary outcomes are disability, pain, and quality of life. The study will follow the recommendations in CONSORT-statement in designing and reporting RCTs.
  
  
  CONCLUSIONS
  This large RCT is testing the effectiveness of a preventive intervention targeting patients on short term sick leave or at risk being sick listed because of low back pain. We have developed a novel multidisciplinary team structure using the treating physiotherapist as the return to work coordinator, and having the case manager from the municipal sickness benefit office participating in team meetings. The study has the potential to contribute to the knowledge about how to target the challenges in the treatment of LBP. The aim is to prevent sickness absence and labour market exclusion--both on the individual level and economic costs at community level. Short term results will be available in 2014.This study is approved by the Danish Regional Ethics Committee (J.nr: H-C-2008-112) and is registered at
  
  
  BACKGROUND
  ClinicalTrials.gov: NCT01690234.
authors.affiliation: Department of Public Health, CopenRehab, University of Copenhagen, Øster Farimagsgade 5, DK-1014, Copenhagen K, Denmark. fiskerannette@gmail.com
authors.forename: Annette
authors.initials: A
authors.lastname: Fisker
authors.forename: Henning
authors.initials: H
authors.lastname: Langberg
authors.forename: Tom
authors.initials: T
authors.lastname: Petersen
authors.forename: Ole Steen
authors.initials: OS
authors.lastname: Mortensen
mesh_terms: D000041:Absenteeism; D000293:Adolescent; D000328:Adult; D000368:Aged; D000553:Ambulatory Care; D003718:Denmark; D004185:Disability Evaluation; D017048:Health Care Costs; D006801:Humans; D017116:Low Back Pain / Q000175:diagnosis / Q000191:economics / Q000503:physiopathology / Q000523:psychology / Q000628:therapy*; D008875:Middle Aged; D010147:Pain Measurement; D010346:Patient Care Management; D010348:Patient Care Team / Q000191:economics; D059825:Physical Therapists; D026741:Physical Therapy Modalities / Q000191:economics; D024382:Professional Role; D011788:Quality of Life; D020127:Recovery of Function; D012107:Research Design; D062707:Return to Work; D018582:Sick Leave; D013997:Time Factors; D016896:Treatment Outcome; D014478:Unemployment; D055815:Young Adult