title: Change in pain, disability and influence of fear-avoidance in a work-focused intervention on neck and back pain: a randomized controlled trial.
abstract: BACKGROUND
  Neck and back pain are among the most common causes of prolonged disability, and development of interventions with effect on pain, disability and return to work is important. Reduction of fear avoidance might be one mechanism behind improvement after interventions. The aim of the present study was to evaluate changes in pain and disability at the 12-month follow-up of patients with neck and back pain treated with a work-focused intervention compared to patients treated with standard interventions, and the influence of improvement fear avoidance beliefs during the interventions on pain, disability and return to work at 12-month follow-up.
  
  
  METHODS
  413 employed patients with back or neck pain referred to secondary care, and sick-listed between 4 weeks and 12 months, were randomized to a work-focused rehabilitation or control interventions. Follow-up was conducted 4 and 12 months after inclusion. The groups were compared (independent sample t-test) regarding differences in disability scores (Oswestry disability index/neck disability index) and pain (numeric rating scale) from baseline to 12-month follow-up. Changes in fear avoidance beliefs (FABQ) from baseline to 4 month follow-up were calculated, and the association between this change and return to work, pain and disability at 12 months were tested in stepwise multiple logistic regression models.
  
  
  RESULTS
  Pain and, disability scores decreased to in both the work-focused and control intervention to 12-month follow-up, and there were no significant differences between the groups. FABQ decreased similarly in both groups to 4 month follow-up. The logistic regression model revealed an association between a reduced FABQ work score at 4 months and return to work within one year (adjusted OR 3.60, 95% CI 1.19 to 10.88). Reduced FABQ physical activity score at 4 months was associated with decreased disability after 12 months (adjusted OR (3.65. 95% CI 1.43 to 9.28).
  
  
  CONCLUSIONS
  Short work-focused rehabilitation had the same effect on pain and disability as control interventions. Reduction in FABQ-W score after treatment seems to be an important predictor for return to work in both groups.
  
  
  BACKGROUND
  Clinicaltrials.gov NCT00840697.
authors.affiliation: Department of Neuroscience, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway. gunn.hege.marchand@ntnu.no.|Department of Physical Medicine and Rehabilitation, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway. gunn.hege.marchand@ntnu.no.
authors.forename: Gunn Hege
authors.initials: GH
authors.lastname: Marchand
authors.affiliation: Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Ulleval, Oslo, Norway. kjersti.myhre@medisin.uio.no.
authors.forename: Kjersti
authors.initials: K
authors.lastname: Myhre
authors.affiliation: Department of Neuroscience, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway. gunnar.leivseth@uit.no.|Institute of Clinical Medicine, Neuromuscular Disorders Research Group, UiT The Arctic University of Norway, Tromsø, Norway. gunnar.leivseth@uit.no.
authors.forename: Gunnar
authors.initials: G
authors.lastname: Leivseth
authors.affiliation: Department of Biostatistics and Epidemiology, Oslo University Hospital, Ulleval, Oslo, Norway. leiv.sandvik@ous-hf.no.
authors.forename: Leiv
authors.initials: L
authors.lastname: Sandvik
authors.affiliation: Lovisenberg Diakonale Hospital, Oslo, Norway. bjornlau2002@yahoo.no.|National Institute of Occupational Health, Oslo, Norway. bjornlau2002@yahoo.no.
authors.forename: Bjørn
authors.initials: B
authors.lastname: Lau
authors.affiliation: Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Ulleval, Oslo, Norway. erik.bautz-holter@medisin.uio.no.|Faculty of Medicine, University of Oslo, Oslo, Norway. erik.bautz-holter@medisin.uio.no.
authors.forename: Erik
authors.initials: E
authors.lastname: Bautz-Holter
authors.affiliation: Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Ulleval, Oslo, Norway. e.c.t.roe@medisin.uio.no.|Faculty of Medicine, University of Oslo, Oslo, Norway. e.c.t.roe@medisin.uio.no.
authors.forename: Cecilie
authors.initials: C
authors.lastname: Røe
mesh_terms: D000328:Adult; D001362:Avoidance Learning; D001416:Back Pain / Q000175:diagnosis / Q000523:psychology / Q000534:rehabilitation*; D004185:Disability Evaluation; D006233:Persons with Disabilities / Q000523:psychology / Q000534:rehabilitation*; D005239:Fear / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019547:Neck Pain / Q000175:diagnosis / Q000523:psychology / Q000534:rehabilitation*; D016272:Occupational Health