- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT02609750
WorkUp. Structured Care With Workplace Interventions to Improve Work Ability in Patients With Neck and/or Low Back Pain (WorkUp)
WorkUp. Early Structured Care Including Workplace Interventions to Improve Work Ability in Patients With Neck and/or Back Pain. A Prospective Pare Wise Cluster Randomized Controlled Trial in Primary Care With One Year Follow up
Study Overview
Status
Intervention / Treatment
Detailed Description
Musculoskeletal disorders are the most common reasons for sick leave in western countries. Identifying risk factors and predictors for a stable return to work (RTW ) is essential. An evidence-based safe care includes systems for detecting medical conditions with urgent need for care (red flags) and psycho-social risk factors (yellow flags). To maintain work ability, also requires different capacities related to work demands, (physical, mental and social) as well as work environment aspects covered by a "blue flag system".
Since motivation is assumed to drive and sustain human behaviour, patients with back pain seek health care when motivation reaches a threshold level. Patients want to be examined, get treatment and self-care advice to resume normal daily activities. This might lead to improved long-standing results in terms of health, function and work ability.
The investigators hypothesize that WorkUp, a timely tailor-made and evidence-based intervention leads to a faster recovery of health, function and RTW as compared to standard care. This includes the identification of both the patient's risk factors (red, yellow and blue flags) and motivational factors. Based on this screening, a structured tailored intervention will be offered. The WorkUp model comprise of evidence-based treatment and interaction between patient, health care and work place interventions.
The main purpose is to test WorkUp in a comparison study with treatment as usual (TAU) in primary health care (PHC).
Design: A prospective paire wise cluster randomized trial in PHC including a one year clinical follow-up and a three year register follow-up.
Intervention: Through a flow chart the investigators in detail specify the medical and work place interventions (all according to evidence-based guidelines). Red, yellow and blue flags, and motivational factors are identified in a screening investigation. The aim of the screening is to individually tailor the rehabilitation interventions. Physiotherapy interventions are based on a bio-psychosocial and cognitive behavioural therapy perspective. Behavioural medicine treatment principles will include careful examination and treatments such as advice to stay active, instructions, OMI, OMT, MDT. The investigators apply interventions based on ergonomics, motivational factors and work place changes according to Convergence Dialogue Meetings(CDM). CDM is a three step structured dialogue and meeting model supporting the patient, health care professionals and employer to summarize concrete suggestions to support a RTW .
TAU patients follow the PHC's standard schedule and procedures including the so called rehabilitation guarantee.
For each patient all treatment measures are recorded in a protocol.
A power analysis indicated that the investigators needed to recruit a minimum of 20 PHCs and 500 patients.
This type of structured routine primary care can facilitate an adequate treatment for patients with musculoskeletal pain and how to allocate sparse resources. If beneficial results emerge a structured implementation program will follow.
Study Type
Enrollment (Actual)
Phase
- Not Applicable
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Description
Inclusion Criteria:
- acute and subacute neck and/or back pain (less than three months of duration)
- a working history of at least four weeks during the last year
- being at risk for sick leave according to the short form of the Örebro Musculoskeletal Pain Screening Questionnaire (ÖMPSQ) (cut off >40)
- if sickness absent < 60 days.
Exclusion Criteria:
- identified abuse
- retirement pension
- ongoing acute medical treatment
- pregnancy
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Single Group Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: Structured care & workplace intervention
Through a flow chart the investigators in detail specify the medical and work place interventions (all according to evidence-based guidelines).
Red, yellow and blue flags, and motivational factors are identified in a screening investigation.
The aim of the screening is to individually tailor the rehabilitation interventions.
Physiotherapy interventions are based on a bio-psychosocial and cognitive behavioural therapy perspective.
Behavioural medicine treatment principles include careful examination and treatments such as advice to stay active, instructions, OMI, OMT, MDT.
The investigators apply interventions based on ergonomics, motivational factors and work place changes according to Convergence Dialogue Meetings (CDM).
|
In addition to structured care a workplace intervention named Convergence Dialogue Meetings (CDM) are carried out.
CDM is a three step structured dialogue and meeting model supporting the patient, health care professionals and employer to summarize concrete suggestions to support sustainable work ability and a return to work if sick listed.
|
Active Comparator: Treatment as Usual
Patients follows the PHCs standard schedule and procedures including the so called rehabilitation guarantee
|
Patients will follow the primary health care's standard time schedule and procedures as of ordinary care and the rehabilitation guarantee.
For each patient all treatment measures are recorded in a manual, regarding number of treatments, time used per treatment and type of treatment.
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Work ability
Time Frame: Changes from baseline to after treatment (3, 6, 12 months and 2 and 3 years)
|
Work ability (defined as being at work or being eligible to the labour market during at least four weeks in a row) and time of sickness absence and Return to work.
Year 2 and 3 follow-up by register data
|
Changes from baseline to after treatment (3, 6, 12 months and 2 and 3 years)
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Health-related quality of life
Time Frame: Changes from baseline to after treatment (3, 6 and 12 months)
|
Measured by EQ-5D (Euroqol 2011 EQ-5D)
|
Changes from baseline to after treatment (3, 6 and 12 months)
|
Functional ability
Time Frame: Changes from baseline to after treatment (3, 6 and 12 months)
|
Measured by the Oswestry Disability Index (ODI) in low back pain patients (Fairbank & Pynsent 2000) and by the Neck Disability Index (NDI) in patients with neck pain (MacDermid et al 2009)
|
Changes from baseline to after treatment (3, 6 and 12 months)
|
Pain (distribution and intensity)
Time Frame: Changes from baseline to after treatment (3, 6 and 12 months)
|
Measured by the Pain mannequin (Bergman et al 2001) and VAS (Sieper et al 2009)
|
Changes from baseline to after treatment (3, 6 and 12 months)
|
Physical and psycho-social work environment
Time Frame: Changes from baseline to after treatment (3, 6 and 12 months)
|
Measured by questions focusing on known risk factors according to Lindell´s thesis (2010) and the ULF questionnaire
|
Changes from baseline to after treatment (3, 6 and 12 months)
|
Patient´s satisfaction
Time Frame: Changes from baseline to after treatemnt (3, 6 and 12 months)
|
Measured by use of the Client Satisfaction Questionnaire (CSQ) (Bjelland 2002)
|
Changes from baseline to after treatemnt (3, 6 and 12 months)
|
Collaborators and Investigators
Sponsor
Investigators
- Principal Investigator: Birgitta EM Grahn, AssProfessor, Dep of Clinical Sciences Lund, Orthopedics, Lund University, and FoU Kronoberg, Region Kronoberg
Publications and helpful links
General Publications
- Axen I, Sennehed CP, Eek F, Stigmar K. Can a workplace dialogue impact the perceived influence of neck and/or backpain on everyday activities and performance at work? A secondary analysis from the randomized controlled trial WorkUp. BMC Musculoskelet Disord. 2022 Sep 15;23(1):861. doi: 10.1186/s12891-022-05812-w.
- Forsbrand MH, Turkiewicz A, Petersson IF, Sennehed CP, Stigmar K. Long-term effects on function, health-related quality of life and work ability after structured physiotherapy including a workplace intervention. A secondary analysis of a randomised controlled trial (WorkUp) in primary care for patients with neck and/or back pain. Scand J Prim Health Care. 2020 Mar;38(1):92-100. doi: 10.1080/02813432.2020.1717081. Epub 2020 Jan 30.
- Forsbrand MH, Grahn B, Hill JC, Petersson IF, Post Sennehed C, Stigmar K. Can the STarT Back Tool predict health-related quality of life and work ability after an acute/subacute episode with back or neck pain? A psychometric validation study in primary care. BMJ Open. 2018 Dec 22;8(12):e021748. doi: 10.1136/bmjopen-2018-021748.
- Saha S, Grahn B, Gerdtham UG, Stigmar K, Holmberg S, Jarl J. Structured physiotherapy including a work place intervention for patients with neck and/or back pain in primary care: an economic evaluation. Eur J Health Econ. 2019 Mar;20(2):317-327. doi: 10.1007/s10198-018-1003-1. Epub 2018 Aug 31.
- Sennehed CP, Holmberg S, Axen I, Stigmar K, Forsbrand M, Petersson IF, Grahn B. Early workplace dialogue in physiotherapy practice improved work ability at 1-year follow-up-WorkUp, a randomised controlled trial in primary care. Pain. 2018 Aug;159(8):1456-1464. doi: 10.1097/j.pain.0000000000001216.
- Forsbrand M, Grahn B, Hill JC, Petersson IF, Sennehed CP, Stigmar K. Comparison of the Swedish STarT Back Screening Tool and the Short Form of the Orebro Musculoskeletal Pain Screening Questionnaire in patients with acute or subacute back and neck pain. BMC Musculoskelet Disord. 2017 Feb 21;18(1):89. doi: 10.1186/s12891-017-1449-9.
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Actual)
Study Completion (Estimated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Estimated)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- RS2011/005
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