Effects of an early multidisciplinary intervention on sickness absence in patients with persistent low back pain-a randomized controlled trial

Annette Fisker, Henning Langberg, Tom Petersen, Ole Steen Mortensen, Annette Fisker, Henning Langberg, Tom Petersen, Ole Steen Mortensen

Abstract

Background: Multidisciplinary rehabilitation is recommended to reduce sickness absence and disability in patients with subacute or chronic low back pain (LBP). This study aimed to investigate whether a 12-week coordinated work oriented multidisciplinary rehabilitation intervention was effective on return to work and number of days off work during one-year follow-up when compared to usual care.

Methods: This study is a randomized controlled trial comparing the effectiveness of a 12-week multidisciplinary vocational rehabilitation program in addition to usual treatment. 770 patients with LBP, who were sick-listed, or at risk of being sick-listed were included in the study. The primary outcome was number of days off work due to LBP. The secondary outcomes were disability, health-related quality of life, pain, psychological distress and fear avoidance behavior. Data were collected at baseline, at the end of treatment, and at 6- and 12-months follow-up. Analyses were carried out according to the "intention-to-treat" principles.

Results: A significant decrease in the number of patients who were on sick-leave was found in both groups at the end of treatment and at 6- and 12-months follow-up. Additionally, disability, pain, health related quality of life, psychological distress, and fear avoidance beliefs improved in both groups. No statistically significant differences were found between the groups on any of the outcomes.

Conclusions: The coordinated multidisciplinary intervention had no additional effect on sickness absence, disability, pain, or health related quality of life as compared with that of usual care.

Trial registration: This study was retrospectively registered in ClinicalTrials.gov (registration ID: NCT01690234). The study was approved by The Danish Regional Ethics Committee (file no: H-C-2008-112) as well as registered at and approved by the Danish Data Protection Agency.

Keywords: Back pain; Low back pain; Multidisciplinary intervention; Occupational health; Randomized controlled trial; Rehabilitation; Return to work; Sick leave.

Conflict of interest statement

All authors declare that they have no competing interests.

© 2022. The Author(s).

Figures

Fig. 1
Fig. 1
Patient flow throughout the study. Screened patients and group allocation

References

    1. Vos T, Lim SS, Abbafati C, Abbas KM, Abbasi M, et al. Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet. 2020;396(10258):1204–22.
    1. Wu A, March L, Zheng X, Huang J, Wang X, Zhao J, et al. Global low back pain prevalence and years lived with disability from 1990 to 2017: estimates from the Global Burden of Disease Study 2017. Ann Transl Med. 2020;8(6):299. doi: 10.21037/atm.2020.02.175.
    1. OECD . Sickness, Disability and Work. Breaking the barriers. A synthesis of Findings across OECD Countries. Paris. 2010.
    1. Cieza A, Causey K, Kamenov K, Hanson SW, Chatterji S, Vos T. Global estimates of the need for rehabilitation based on the global burden of disease study 2019: a systematic analysis for the global burden of disease study 2019. Lancet. 2021;396(10267):2006–2017. doi: 10.1016/S0140-6736(20)32340-0.
    1. Bernstein IA, Malik Q, Carville S, Ward S. Low back pain and sciatica: summary of NICE guidance. BMJ. 2017;356:i6748. doi: 10.1136/bmj.i6748.
    1. National Guideline C . National Institute for Health and Care Excellence: Clinical Guidelines. Low Back Pain and Sciatica in Over 16s: Assessment and Management. London: National Institute for Health and Care Excellence (UK) Copyright (c) NICE; 2016.
    1. Qaseem A, Wilt TJ, McLean RM, Forciea MA. Noninvasive treatments for acute, subacute, and chronic low back pain: a clinical practice guideline from the american college of physicians. Ann Intern Med. 2017;166(7):514–530. doi: 10.7326/M16-2367.
    1. Corp N, Mansell G, Stynes S, Wynne-Jones G, Morsø L, Hill JC, et al. Evidence-based treatment recommendations for neck and low back pain across Europe: a systematic review of guidelines. Eur J Pain. 2021;25(2):275–295. doi: 10.1002/ejp.1679.
    1. Kamper SJ, Apeldoorn AT, Chiarotto A, Smeets RJ, Ostelo RW, Guzman J, et al. Multidisciplinary biopsychosocial rehabilitation for chronic low back pain: Cochrane systematic review and meta-analysis. BMJ. 2015;350:h444. doi: 10.1136/bmj.h444.
    1. Oliveira CB, Maher CG, Pinto RZ, Traeger AC, Lin CC, Chenot JF, et al. Clinical practice guidelines for the management of non-specific low back pain in primary care: an updated overview. Eur Spine J. 2018;27(11):2791–2803. doi: 10.1007/s00586-018-5673-2.
    1. van Erp RMA, Huijnen IPJ, Jakobs MLG, Kleijnen J, Smeets R. Effectiveness of primary care interventions using a biopsychosocial approach in chronic low back pain: a systematic review. Pain Pract . 2019;19(2):224–241. doi: 10.1111/papr.12735.
    1. Anema JR, Steenstra IA, Bongers PM, de Vet HC, Knol DL, Loisel P, et al. Multidisciplinary rehabilitation for subacute low back pain: graded activity or workplace intervention or both? a randomized controlled trial. Spine(Phila Pa 1976) 2007;32(3):291–8. doi: 10.1097/.
    1. Dufour N, Thamsborg G, Oefeldt A, Lundsgaard C. Treatment of chronic low back pain multidisciplinary biopsychosocial rehabilitation and intensive individual therapist-assisted back muscle strengthening exercises. Spine (Phila Pa 1976). 2010;35(5):469-76
    1. Henchoz Y, de Goumoens P, So AK, Paillex R. Functional multidisciplinary rehabilitation versus outpatient physiotherapy for non specific low back pain: randomized controlled trial. Swiss Med Wkly. 2010;140:w13133.
    1. Norlund A, Ropponen A, Alexanderson K. Multidisciplinary interventions: review of studies of return to work after rehabilitation for low back pain. J Rehabil Med. 2009;41(3):115–121. doi: 10.2340/16501977-0297.
    1. Loisel P, Abenhaim L, Durand P, Esdaile JM, Suissa S, Gosselin L, et al. A population-based, randomized clinical trial on back pain management. Spine (Phila Pa 1976) 1997;22(24):2911–8. doi: 10.1097/00007632-199712150-00014.
    1. Jensen C, Jensen OK, Christiansen DH, Nielsen CV. One-year follow-up in employees sick-listed because of low back pain: randomized clinical trial comparing multidisciplinary and brief intervention. Spine (Phila Pa 1976) 2011;36(15):1180–9. doi: 10.1097/BRS.0b013e3181eba711.
    1. Ravenek MJ, Hughes ID, Ivanovich N, Tyrer K, Desrochers C, Klinger L, et al. A systematic review of multidisciplinary outcomes in the management of chronic low back pain. Work. 2010;35(3):349–367. doi: 10.3233/WOR-2010-0995.
    1. Pedersen P, Nielsen CV, Jensen OK, Jensen C, Labriola M. Employment status five years after a randomised controlled trial comparing multidisciplinary and brief intervention in employees on sick leave due to low back pain. Scand J Public Health. 2018;46(3):383–388. doi: 10.1177/1403494817722290.
    1. Rosenberg NR, Petersen SB, Begtrup LM, Flachs EM, Petersen JA, Hansen BB, et al. Early Occupational intervention for people with low back pain in physically demanding jobs: 1-year follow-up results of the randomized controlled goback trial. Spine (Phila Pa 1976) 2021;46(6):347–55. doi: 10.1097/BRS.0000000000003793.
    1. Flachs EME, L.; Koch,M.B.; Ryd,J.T.; Dibba,E.; Skov-Ettrup,L.; Juel, K. SYGDOMSBYRDEN I DANMARK – SYGDOMME. Copenhagen, Denmark: Statens Institut for Folkesundhed, Syddansk Universitet; 2015.
    1. Aust B, Helverskov T, Nielsen MB, Bjorner JB, Rugulies R, Nielsen K, et al. The Danish national return-to-work program–aims, content, and design of the process and effect evaluation. Scand J Work Environ Health. 2012;38(2):120–133. doi: 10.5271/sjweh.3272.
    1. Bekendtgørelse om lov af sygedagpenge Denmark: The Ministry of Employment; 2020 [Available from: .
    1. Palmer KT, Harris EC, Linaker C, Barker M, Lawrence W, Cooper C, et al. Effectiveness of community- and workplace-based interventions to manage musculoskeletal-related sickness absence and job loss: a systematic review. Rheumatology(Oxford) 2012;51(2):230–42. doi: 10.1093/rheumatology/ker086.
    1. Steenstra IA, Munhall C, Irvin E, Oranye N, Passmore S, Van Eerd D, et al. Systematic review of prognostic factors for return to work in workers with Sub Acute and chronic low back pain. J Occup Rehabil. 2017;27(3):369–381. doi: 10.1007/s10926-016-9666-x.
    1. Cullen KL, Irvin E, Collie A, Clay F, Gensby U, Jennings PA, et al. Effectiveness of workplace interventions in return-to-work for musculoskeletal, pain-related and mental health conditions: an update of the evidence and messages for practitioners. J Occup Rehabil. 2018;28(1):1–15. doi: 10.1007/s10926-016-9690-x.
    1. Shaw W, Hong QN, Pransky G, Loisel P. A literature review describing the role of return-to-work coordinators in trial programs and interventions designed to prevent workplace disability. JOccupRehabil. 2008;18(1):2–15.
    1. Franche R-L, Cullen K, Clarke J, Irvin E, Sinclair S, Frank J. Workplace-based return-to-work interventions: a systematic review of the quantitative literature. J Occup Rehabil. 2005;15(4):607–631. doi: 10.1007/s10926-005-8038-8.
    1. Moher D, Hopewell S, Schulz KF, Montori V, Gotzsche PC, Devereaux PJ, et al. CONSORT 2010 Explanation and Elaboration: updated guidelines for reporting parallel group randomised trials. Bmj. 2010;340(mar23 1):c869. doi: 10.1136/bmj.c869.
    1. Boutron I, Altman DG, Moher D, Schulz KF, Ravaud P. CONSORT Statement for Randomized Trials of Nonpharmacologic Treatments: A 2017 Update and a CONSORT Extension for Nonpharmacologic Trial Abstracts. Ann Intern Med. 2017;167(1):40–47. doi: 10.7326/M17-0046.
    1. Fisker A, Langberg H, Petersen T, Mortensen OS. 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. BMC musculoskelet Disord. 2013;14(1):93. doi: 10.1186/1471-2474-14-93.
    1. Lerner DA, B.C.; Rogers, W. H.; Malspeis, S.; Bungay, K.; Cynn, D. The Work Limitations Questionnaire. Medical care. 2001;39(1):72-85
    1. Holtermann A, Jorgensen MB, Gram B, Christensen JR, Faber A, Overgaard K, et al. Worksite interventions for preventing physical deterioration among employees in job-groups with high physical work demands: background, design and conceptual model of FINALE. BMC Public Health. 2010;10:120. doi: 10.1186/1471-2458-10-120.
    1. COST Action B13 . European guidelines for the management of chronic non-specific low back pain. 2004.
    1. van Vilsteren M, van Oostrom SH, de Vet HC, Franche RL, Boot CR, Anema JR. Workplace interventions to prevent work disability in workers on sick leave. Cochrane Database Syst Rev. 2015;10:Cd006955.
    1. Williams DA, Urban B, Keefe FJ, Shutty MS, France R. Cluster analyses of pain patients' responses to the SCL-90R. Pain. 1995;61(1):81–91. doi: 10.1016/0304-3959(94)00165-B.
    1. Saltin B, Grimby G. Physiological analysis of middle-aged and old former athletes. Comparison with still active athletes of the same ages. Circulation. 1968;38(6):1104–15. doi: 10.1161/01.CIR.38.6.1104.
    1. Albert HB, Jensen AM, Dahl D, Rasmussen MN. Criteria validation of the Roland Morris questionnaire. A Danish translation of the international scale for the assessment of functional level in patients with low back pain and sciatica. UgeskrLaeger. 2003;165(18):1875–80.
    1. Manniche C, Asmussen K, Lauritsen B, Vinterberg H, Kreiner S, Jordan A. Low back pain rating scale: validation of a tool for assessment of low back pain. Pain. 1994;57(3):317–326. doi: 10.1016/0304-3959(94)90007-8.
    1. Ware JE, Jr, Sherbourne CD. The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. MedCare. 1992;30(6):473–83.
    1. Bjørner J, al e. Dansk manual til SF-36. Et spørgeskema om helbredsstatus. Copenhagen, Denmark: Lægemiddelindustriforeningen.; 1997.
    1. Olsen LR, Mortensen EL, Bech P. The SCL-90 and SCL-90R versions validated by item response models in a Danish community sample. Acta Psychiatr Scand. 2004;110(3):225–229. doi: 10.1111/j.1600-0447.2004.00399.x.
    1. Derogatis LR, Lipman RS, Covi L. SCL-90: an outpatient psychiatric rating scale–preliminary report. PsychopharmacolBull. 1973;9(1):13–28.
    1. Waddell G, Newton M, Henderson I, Somerville D, Main CJ. A fear-avoidance beliefs questionnaire (FABQ) and the role of fear-avoidance beliefs in chronic low back pain and disability. Pain. 1993;52(2):157–168. doi: 10.1016/0304-3959(93)90127-B.
    1. Hall A, Richmond H, Copsey B, Hansen Z, Williamson E, Jones G, et al. Physiotherapist-delivered cognitive-behavioural interventions are effective for low back pain, but can they be replicated in clinical practice? A systematic review. Disabil Rehabil. 2016;40:1–9.
    1. Christensen J, Fisker A, Mortensen EL, Olsen LR, Mortensen OS, Hartvigsen J, et al. Comparison of mental distress in patients with low back pain and a population-based control group measured by symptoms check list - a case-referent study. Scand J Public Health. 2015;43(6):638–47. doi: 10.1177/1403494815581697.
    1. Pincus T, McCracken LM. Psychological factors and treatment opportunities in low back pain. BestPractResClinRheumatol. 2013;27(5):625–635.
    1. Strand LI, Ljunggren AE, Haldorsen EM, Espehaug B. The impact of physical function and pain on work status at 1-year follow-up in patients with back pain. Spine (Phila Pa 1976) 2001;26(7):800–8. doi: 10.1097/00007632-200104010-00022.
    1. Skouen JS, Grasdal AL, Haldorsen EM, Ursin H. Relative cost-effectiveness of extensive and light multidisciplinary treatment programs versus treatment as usual for patients with chronic low back pain on long-term sick leave: randomized controlled study. Spine (Phila Pa 1976). 2002;27(9):901–9. doi: 10.1097/00007632-200205010-00002.
    1. Lindstrom I, Ohlund C, Eek C, Wallin L, Peterson LE, Nachemson A. Mobility, strength, and fitness after a graded activity program for patients with subacute low back pain. A randomized prospective clinical study with a behavioral therapy approach. Spine (Phila Pa 1976) 1992;17(6):641–52. doi: 10.1097/00007632-199206000-00003.
    1. van den Hout JH, Vlaeyen JW, Heuts PH, Zijlema JH, Wijnen JA. Secondary prevention of work-related disability in nonspecific low back pain: does problem-solving therapy help? A randomized clinical trial. Clin J Pain. 2003;19(2):87–96. doi: 10.1097/00002508-200303000-00003.
    1. Waterschoot FP, Dijkstra PU, Hollak N, de Vries HJ, Geertzen JH, Reneman MF. Dose or content? Effectiveness of pain rehabilitation programs for patients with chronic low back pain: a systematic review. Pain. 2014;155(1):179–189. doi: 10.1016/j.pain.2013.10.006.
    1. Jensen LD, Maribo T, Schiottz-Christensen B, Madsen FH, Gonge B, Christensen M, et al. Counselling low-back-pain patients in secondary healthcare: a randomised trial addressing experienced workplace barriers and physical activity. OccupEnvironMed. 2012;69(1):21–28.
    1. Bell ML, Kenward MG, Fairclough DL, Horton NJ. Differential dropout and bias in randomised controlled trials: when it matters and when it may not. BMJ. 2013;346:e8668. doi: 10.1136/bmj.e8668.

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