Change in pain, disability and influence of fear-avoidance in a work-focused intervention on neck and back pain: a randomized controlled trial

Gunn Hege Marchand, Kjersti Myhre, Gunnar Leivseth, Leiv Sandvik, Bjørn Lau, Erik Bautz-Holter, Cecilie Røe, Gunn Hege Marchand, Kjersti Myhre, Gunnar Leivseth, Leiv Sandvik, Bjørn Lau, Erik Bautz-Holter, Cecilie Røe

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.

Trial registration: Clinicaltrials.gov NCT00840697.

Figures

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Figure 1
Flow chart.

References

    1. Vos T, Flaxman AD, Naghavi M, Lozano R, Michaud C, Ezzati M, et al. Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012;380:2163–2196. doi: 10.1016/S0140-6736(12)61729-2.
    1. Hashemi L, Webster BS, Clancy EA, Volinn E. Length of disability and cost of workers’ compensation low back pain claims. J Occup Environ Med. 1997;39:937–945. doi: 10.1097/00043764-199710000-00005.
    1. Choi BK, Verbeek JH, Tam WW, Jiang JY. Exercises for prevention of recurrences of low-back pain. Cochrane Database Syst Rev. 2010;1:CD006555.
    1. Karjalainen K, Malmivaara A, van Tulder M, Roine R, Jauhiainen M, Hurri H, et al. Multidisciplinary biopsychosocial rehabilitation for neck and shoulder pain among working age adults. Cochrane Database Syst Rev. 2003;2:Cd002194.
    1. Hayden JA, van Tulder MW, Malmivaara A, Koes BW. Exercise therapy for treatment of non-specific low back pain. Cochrane Database Syst Rev. 2005;5:CD000335.
    1. Airaksinen O, Brox JI, Cedraschi C, Hildebrandt J, Klaber-Moffett J, Kovacs F, et al. Chapter 4. European guidelines for the management of chronic nonspecific low back pain. Eur Spine J. 2006;15(Suppl 2):S192–300. doi: 10.1007/s00586-006-1072-1.
    1. Brox JI, Storheim K, Grotle M, Tveito TH, Indahl A, Eriksen HR. Systematic review of back schools, brief education, and fear-avoidance training for chronic low back pain. Spine J. 2008;8:948–958. doi: 10.1016/j.spinee.2007.07.389.
    1. Hoefsmit N, Houkes I, Nijhuis FJ. Intervention characteristics that facilitate return to work after sickness absence: a systematic literature review. J Occup Rehabil. 2012;22:462–477. doi: 10.1007/s10926-012-9359-z.
    1. Franche RL, 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;15:607–631. doi: 10.1007/s10926-005-8038-8.
    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;22:2911–2918. doi: 10.1097/00007632-199712150-00014.
    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;32:291–298. doi: 10.1097/.
    1. Lambeek LC, van Mechelen W, Knol DL, Loisel P, Anema JR. Randomised controlled trial of integrated care to reduce disability from chronic low back pain in working and private life. BMJ. 2010;340:c1035–5.
    1. van Oostrom SH, Driessen MT, de Vet HC, Franche RL, Schonstein E, Loisel P, et al. Workplace interventions for preventing work disability. Cochrane Database Syst Rev. 2009;2:CD006955.
    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;36:1180–1189. doi: 10.1097/BRS.0b013e3181eba711.
    1. Myhre K, Marchand GH, Leivseth G, Keller A, Bautz-Holter E, Sandvik L, et al. The Effect of Work-Focused Rehabilitation among Patients with neck and back pain: A Randomised Controlled Trial. Spine (Phila Pa 1976). 2014;39:1999–2006.
    1. Verbeek JH, van der Weide WE, van Dijk FJ. Early occupational health management of patients with back pain: a randomized controlled trial. Spine (Phila Pa 1976) 2002;27:1844–1851. doi: 10.1097/00007632-200209010-00006.
    1. Dziura JD, Post LA, Zhao Q, Fu Z, Peduzzi P. Strategies for dealing with missing data in clinical trials: from design to analysis. Yale J Biol Med. 2013;86:343–358.
    1. Marshall A, Altman DG, Holder RL, Royston P. Combining estimates of interest in prognostic modelling studies after multiple imputation: current practice and guidelines. BMC Med Res Methodol. 2009;9:57. doi: 10.1186/1471-2288-9-57.
    1. Du Bois M, Szpalski M, Donceel P. Patients at risk for long-term sick leave because of low back pain. Spine J. 2009;9:350–359. doi: 10.1016/j.spinee.2008.07.003.
    1. Schaafsma F, Schonstein E, Whelan KM, Ulvestad E, Kenny DT, Verbeek JH. Physical conditioning programs for improving work outcomes in workers with back pain. Cochrane Database Syst Rev. 2010;1:CD001822.
    1. Rainville J, Smeets RJ, Bendix T, Tveito TH, Poiraudeau S, Indahl AJ. Fear-avoidance beliefs and pain avoidance in low back pain–translating research into clinical practice. Spine J. 2011;11:895–903. doi: 10.1016/j.spinee.2011.08.006.
    1. Gheldof EL, Vinck J, Vlaeyen JW, Hidding A, Crombez G. The differential role of pain, work characteristics and pain-related fear in explaining back pain and sick leave in occupational settings. Pain. 2005;113:71–81. doi: 10.1016/j.pain.2004.09.040.
    1. Jensen JN, Karpatschof B, Labriola M, Albertsen K. Do fear-avoidance beliefs play a role on the association between low back pain and sickness absence? A prospective cohort study among female health care workers. J Occup Environ Med. 2010;52:85–90. doi: 10.1097/JOM.0b013e3181c95b9e.
    1. Wertli MM, Rasmussen-Barr E, Weiser S, Bachmann LM, Brunner F. The role of fear avoidance beliefs as a prognostic factor for outcome in patients with nonspecific low back pain: a systematic review. Spine J. 2014;14:816–36 e14. doi: 10.1016/j.spinee.2013.09.036.
    1. Iles RA, Davidson M, Taylor NF. Psychosocial predictors of failure to return to work in non-chronic non-specific low back pain: a systematic review. Occup Environ Med. 2008;65:507–517. doi: 10.1136/oem.2007.036046.
    1. Oyeflaten I, Hysing M, Eriksen HR. Prognostic factors associated with return to work following multidisciplinary vocational rehabilitation. J Rehabil Med. 2008;40:548–554. doi: 10.2340/16501977-0202.
    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;52:157–168. doi: 10.1016/0304-3959(93)90127-B.
    1. Miller RP, Kori SH, Todd DD. The Tampa Scale: a Measure of Kinisophobia. Clin J Pain. 1991;7:51–2. doi: 10.1097/00002508-199103000-00053.
    1. George SZ, Zeppieri G, Jr, Cere AL, Cere MR, Borut MS, Hodges MJ, et al. A randomized trial of behavioral physical therapy interventions for acute and sub-acute low back pain ( NCT00373867 ) Pain. 2008;140:145–157. doi: 10.1016/j.pain.2008.07.029.
    1. Mannion AF, Muntener M, Taimela S, Dvorak J. A randomized clinical trial of three active therapies for chronic low back pain. Spine (Phila Pa 1976) 1999;24:2435–2448. doi: 10.1097/00007632-199912010-00004.
    1. Staal JB, Hlobil H, Koke AJ, Twisk JW, Smid T, van Mechelen W. Graded activity for workers with low back pain: who benefits most and how does it work? Arthritis Rheum. 2008;59:642–649. doi: 10.1002/art.23570.
    1. Burton AK, Waddell G, Tillotson KM, Summerton N. Information and advice to patients with back pain can have a positive effect. A randomized controlled trial of a novel educational booklet in primary care. Spine (Phila Pa 1976) 1999;24:2484–2491. doi: 10.1097/00007632-199912010-00010.
    1. Wertli MM, Rasmussen-Barr E, Held U, Weiser S, Bachmann LM, Brunner F. Fear Avoidance Beliefs -A Moderator of Treatment Efficacy in Patients with Low Back Pain: A Systematic Review. Spine J. 2014;14:2658–78. doi: 10.1016/j.spinee.2014.02.033.
    1. Brox JI, Sorensen R, Friis A, Nygaard O, Indahl A, Keller A, et al. Randomized clinical trial of lumbar instrumented fusion and cognitive intervention and exercises in patients with chronic low back pain and disc degeneration. Spine (Phila Pa 1976) 2003;28:1913–1921. doi: 10.1097/01.BRS.0000083234.62751.7A.
    1. Indahl A, Velund L, Reikeraas O. Good prognosis for low back pain when left untampered. A randomized clinical trial. Spine (Phila Pa 1976) 1995;20:473–477. doi: 10.1097/00007632-199502001-00011.
    1. Lau B. Effort-reward imbalance and overcommitment in employees in a Norwegian municipality: a cross sectional study. J Occup Med Toxicol. 2008;3:9. doi: 10.1186/1745-6673-3-9.
    1. Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983;67:361–370. doi: 10.1111/j.1600-0447.1983.tb09716.x.
    1. Von Korff M, Jensen MP, Karoly P. Assessing global pain severity by self-report in clinical and health services research. Spine. 2000;25:3140–3151. doi: 10.1097/00007632-200012150-00009.
    1. Cleland JA, Childs JD, Whitman JM. Psychometric properties of the Neck Disability Index and Numeric Pain Rating Scale in patients with mechanical neck pain. Arch Phys Med Rehabil. 2008;89:69–74. doi: 10.1016/j.apmr.2007.08.126.
    1. Salaffi F, Stancati A, Silvestri CA, Ciapetti A, Grassi W. Minimal clinically important changes in chronic musculoskeletal pain intensity measured on a numerical rating scale. Eur J Pain. 2004;8:283–291. doi: 10.1016/j.ejpain.2003.09.004.
    1. Fairbank JC, Couper J, Davies JB, O’Brien JP. The Oswestry low back pain disability questionnaire. Physiotherapy. 1980;66:271–273.
    1. MacDermid JC, Walton DM, Avery S, Blanchard A, Etruw E, McAlpine C, et al. Measurement properties of the neck disability index: a systematic review. J Orthop Sports Phys Ther. 2009;39:400–417. doi: 10.2519/jospt.2009.2930.
    1. Copay AG, Glassman SD, Subach BR, Berven S, Schuler TC, Carreon LY. Minimum clinically important difference in lumbar spine surgery patients: a choice of methods using the Oswestry Disability Index, Medical Outcomes Study questionnaire Short Form 36, and pain scales. Spine J. 2008;8:968–974. doi: 10.1016/j.spinee.2007.11.006.
    1. Grotle M, Brox JI, Vollestad NK. Reliability, validity and responsiveness of the fear-avoidance beliefs questionnaire: methodological aspects of the Norwegian version. J Rehabil Med. 2006;38:346–353. doi: 10.1080/16501970600722403.
    1. Smeets RJ, Vlaeyen JW, Hidding A, Kester AD, van der Heijden GJ, van Geel AC, et al. Active rehabilitation for chronic low back pain: cognitive-behavioral, physical, or both? First direct post-treatment results from a randomized controlled trial [ ISRCTN22714229 ] BMC Musculoskelet Disord. 2006;7:5. doi: 10.1186/1471-2474-7-5.
    1. Hellum C, Johnsen LG, Storheim K, Nygaard OP, Brox JI, Rossvoll I, et al. Surgery with disc prosthesis versus rehabilitation in patients with low back pain and degenerative disc: two year follow-up of randomised study. BMJ. 2011;342:d2786. doi: 10.1136/bmj.d2786.
    1. Monticone M, Ferrante S, Rocca B, Baiardi P, Farra FD, Foti C. Effect of a Long-lasting Multidisciplinary Program on Disability and Fear-Avoidance Behaviors in Patients With Chronic Low Back Pain: Results of a Randomized Controlled Trial. Clin J Pain. 2013;29:929–938. doi: 10.1097/AJP.0b013e31827fef7e.
    1. Vibe Fersum K, O’Sullivan P, Skouen JS, Smith A, Kvale A. Efficacy of classification-based cognitive functional therapy in patients with non-specific chronic low back pain: a randomized controlled trial. Eur J Pain. 2013;17:916–928. doi: 10.1002/j.1532-2149.2012.00252.x.
    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. Johnsen LG, Hellum C, Nygaard OP, Storheim K, Brox JI, Rossvoll I, et al. Comparison of the SF6D, the EQ5D, and the oswestry disability index in patients with chronic low back pain and degenerative disc disease. BMC Musculoskelet Disord. 2013;14:148. doi: 10.1186/1471-2474-14-148.
    1. van Middelkoop M, Rubinstein SM, Kuijpers T, Verhagen AP, Ostelo R, Koes BW, et al. A systematic review on the effectiveness of physical and rehabilitation interventions for chronic non-specific low back pain. Eur Spine J. 2011;20:19–39. doi: 10.1007/s00586-010-1518-3.
    1. Haukka E, Kaila-Kangas L, Ojajarvi A, Saastamoinen P, Holtermann A, Jorgensen MB, et al. Multisite musculoskeletal pain predicts medically certified disability retirement among Finns. Eur J Pain 2014;doi:10.1002/ejp.635.
    1. Hagen EM, Svensen E, Eriksen HR, Ihlebaek CM, Ursin H. Comorbid subjective health complaints in low back pain. Spine (Phila Pa 1976) 2006;31:1491–1495. doi: 10.1097/01.brs.0000219947.71168.08.
    1. Hartvigsen J, Natvig B, Ferreira M. Is it all about a pain in the back? Best Pract Res Clin Rheumatol. 2013;27:613–623. doi: 10.1016/j.berh.2013.09.008.
    1. Kamper SJ, Apeldoorn AT, Chiarotto A, Smeets RJ, Ostelo RW, Guzman J, et al. Multidisciplinary biopsychosocial rehabilitation for chronic low back pain. Cochrane Database Syst Rev. 2014;9:Cd000963.
    1. Bergbom S, Boersma K, Linton SJ. Both early and late changes in psychological variables relate to treatment outcome for musculoskeletal pain patients at risk for disability. Behav Res Ther. 2012;50:726–734. doi: 10.1016/j.brat.2012.08.008.
    1. Ramond A, Bouton C, Richard I, Roquelaure Y, Baufreton C, Legrand E, et al. Psychosocial risk factors for chronic low back pain in primary care–a systematic review. Fam Pract. 2011;28:12–21. doi: 10.1093/fampra/cmq072.
    1. Smeets RJ, Vlaeyen JW, Kester AD, Knottnerus JA. Reduction of pain catastrophizing mediates the outcome of both physical and cognitive-behavioral treatment in chronic low back pain. J Pain. 2006;7:261–271. doi: 10.1016/j.jpain.2005.10.011.
    1. Lundberg M, Grimby-Ekman A, Verbunt J, Simmonds MJ. Pain-related fear: a critical review of the related measures. Pain Res Treat. 2011;2011:494196.
    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;27:901–909. doi: 10.1097/00007632-200205010-00002.

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