title: Can group-based reassuring information alter low back pain behavior? A cluster-randomized controlled trial.
abstract: BACKGROUND
  Low back pain (LBP) is common in the population and multifactorial in nature, often involving negative consequences. Reassuring information to improve coping is recommended for reducing the negative consequences of LBP. Adding a simple non-threatening explanation for the pain (temporary muscular dysfunction) has been successful at altering beliefs and behavior when delivered with other intervention elements. This study investigates the isolated effect of this specific information on future occupational behavior outcomes when delivered to the workforce.
  
  
  METHODS
  A cluster-randomized controlled trial.
  
  
  METHODS
  Publically employed workers (n = 505) from 11 Danish municipality centers were randomized at center-level (cluster) to either intervention (two 1-hour group-based talks at the workplace) or control. The talks provided reassuring information together with a simple non-threatening explanation for LBP-the 'functional-disturbance'-model. Data collections took place monthly over a 1-year period using text message tracking (SMS). Primary outcomes were self-reported days of cutting down usual activities and work participation. Secondary outcomes were self-reported back beliefs, work ability, number of healthcare visits, bothersomeness, restricted activity, use of pain medication, and sadness/depression.
  
  
  RESULTS
  There was no between-group difference in the development of LBP during follow-up. Cumulative logistic regression analyses showed no between-group difference on days of cutting down activities, but increased odds for more days of work participation in the intervention group (OR = 1.83 95% CI: 1.08-3.12). Furthermore, the intervention group was more likely to report: higher work ability, reduced visits to healthcare professionals, lower bothersomeness, lower levels of sadness/depression, and positive back beliefs.
  
  
  CONCLUSIONS
  Reassuring information involving a simple non-threatening explanation for LBP significantly increased the odds for days of work participation and higher work ability among workers who went on to experience LBP during the 12-month follow-up. Our results confirm the potential for public-health education for LBP, and add to the discussion of simple versus multidisciplinary interventions.
authors.affiliation: Copenhagen Center for Back Research (COPE BACK), Centre for Rheumatology and Spine Diseases, Glostrup, Denmark.|Metropolitan University College, Copenhagen, Denmark.|Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Pernille
authors.identifier: http://orcid.org/0000-0001-9528-0735
authors.initials: P
authors.lastname: Frederiksen
authors.affiliation: Uni Health, University of Bergen, Bergen, Norway.|Department of Research and Development, Clinic Physical Medicine and Rehabilitation, Vestfold Hospital Trust, Stavern, Norway.
authors.forename: Aage
authors.initials: A
authors.lastname: Indahl
authors.affiliation: National Research Centre for the Working Environment, Copenhagen, Denmark.|Physical Activity and Human Performance group, Center for Sensory-Motor Interaction, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark.
authors.forename: Lars L
authors.initials: LL
authors.lastname: Andersen
authors.affiliation: Centre for Applied Psychological and Health Research, University of Huddersfield, Huddersfield, United Kingdom.
authors.forename: Kim
authors.initials: K
authors.lastname: Burton
authors.affiliation: Danish Cancer Society Research and Data, Copenhagen, Denmark.
authors.forename: Rasmus
authors.initials: R
authors.lastname: Hertzum-Larsen
authors.affiliation: Copenhagen Center for Back Research (COPE BACK), Centre for Rheumatology and Spine Diseases, Glostrup, Denmark.|Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Tom
authors.initials: T
authors.lastname: Bendix
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D003718:Denmark / Q000453:epidemiology; D004526:Efficiency; D005260:Female; D005500:Follow-Up Studies; D006266:Health Education; D006801:Humans; D017116:Low Back Pain / Q000150:complications* / Q000453:epidemiology* / Q000503:physiopathology / Q000523:psychology; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D057566:Self Report; D018582:Sick Leave; D017132:Workplace