Sustainability of return to work in sick-listed employees with low-back pain. Two-year follow-up in a randomized clinical trial comparing multidisciplinary and brief intervention

Chris Jensen, Ole Kudsk Jensen, Claus Vinther Nielsen, Chris Jensen, Ole Kudsk Jensen, Claus Vinther Nielsen

Abstract

Background: Sick-listed employees with low back pain had similar return to work (RTW) rates at one-year follow-up in a randomized trial comparing two interventions, but the effects were modified by specific workplace related factors. The present study addressed the sustainability of the intervention effects by performing a two-year follow-up and by using different outcome measures.

Methods: A total of 351 employees sick-listed for 3-16 weeks due to LBP were recruited from their general practitioners and were randomly allocated to a hospital-based brief or multidisciplinary intervention. Outcome measures were based on sick leave registered in a national database of social and health-related benefits. RTW rates, RTW status, sick leave weeks and sick leave relapse were studied.

Results: During the two-year follow-up 80.0% and 77.3% had RTW for at least four weeks continuously, and the percentages with RTW at the 104th week were 61.1% and 58.0% in the brief and multidisciplinary intervention groups, respectively. At the 104th week 16.6% and 18.8% were on sick leave in the two groups, respectively, and about 12% were employed in modified jobs or participated in job training. The number of weeks on sick leave in the first year was significantly lower in the brief intervention group (median 14 weeks) than in the multidisciplinary intervention group (median 20 weeks), but during the second year the number of weeks on sick leave were not significantly different between intervention groups. Subgroups characterised by specific work related factors modified the effect of the intervention groups on RTW rates (p = 0.017). No difference in sick leave relapse was found between the intervention groups.

Conclusion: The effects of the brief and multidisciplinary interventions at the two-year follow-up were in general similar to the effects at one-year follow-up.

Trial registration: Current Controlled Trials ISRCTN18609003.

References

    1. Jensen C, Jensen OK, Christiansen DH, Nielsen CV. One-year follow-up in employees sick-listed because of low back pain: Randomised clinical trial comparing multidisciplinary and brief intervention. Spine. 2011;36(15):1180–1189. doi: 10.1097/BRS.0b013e3181eba711.
    1. Stapelfeldt CM, Christiansen DH, Jensen OK, Nielsen CV, Petersen KD, Jensen C. Subgroup analyses on return to work in sick-listed employees with low back pain in a randomised trial comparing brief and multidisciplinary intervention. BMC Musculoskeletal Disorders. 2011;12:112. doi: 10.1186/1471-2474-12-112.
    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. doi: 10.1136/bmj.c1035.
    1. Hoedeman R, Blankenstein AH, Krol B, Koopmans PC, Groothoff JW. The contribution of high levels of somatic symptom severity to sickness absence duration, disability and discharge. J Occup Rehabil. 2010;20:264–273. doi: 10.1007/s10926-010-9239-3.
    1. Heymans MW, de Vet HC, Bongers PM, Knol DL, Koes BW, Van MW. The effectiveness of high-intensity versus low-intensity back schools in an occupational setting: a pragmatic randomized controlled trial. Spine (Phila Pa 1976) 2006;31:1075–1082. doi: 10.1097/01.brs.0000216443.46783.4d.
    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. 2007;32:291–298. doi: 10.1097/.
    1. Indahl A, Velund L, Reikeraas O. Good prognosis for low back pain when left untampered. A randomized clinical trial. Spine. 1995;20:473–477. doi: 10.1097/00007632-199502001-00011.
    1. Haldorsen EM, Grasdal AL, Skouen JS, Risa AE, Kronholm K, Ursin H. Is there a right treatment for a particular patient group? Comparison of ordinary treatment, light multidisciplinary treatment, and extensive multidisciplinary treatment for long-term sick-listed employees with musculoskeletal pain. Pain. 2002;95:49–63. doi: 10.1016/S0304-3959(01)00374-8.
    1. Bultmann U, Sherson D, Olsen J, Hansen CL, Lund T, Kilsgaard J. Coordinated and Tailored Work Rehabilitation: A Randomized Controlled Trial with Economic Evaluation Undertaken with Workers on Sick Leave Due to Musculoskeletal Disorders. J Occup Rehabil. 2009;19(1):81–93. doi: 10.1007/s10926-009-9162-7.
    1. Hagen EM, Grasdal A, Eriksen HR. Does early intervention with a light mobilization program reduce long-term sick leave for low back pain: A 3-year follow-up study. Spine. 2003;28:2309–2315. doi: 10.1097/01.BRS.0000085817.33211.3F.
    1. Arnetz BB, Sjogren B, Rydehn B, Meisel R. Early workplace intervention for employees with musculoskeletal-related absenteeism: a prospective controlled intervention study. J Occup Environ Med. 2003;45:499–506. doi: 10.1097/01.jom.0000063628.37065.45.
    1. Loisel P, Lemaire J, Poitras S, Durand MJ, Champagne F, Stock S. et al.Cost-benefit and cost-effectiveness analysis of a disability prevention model for back pain management: a six year follow up study. Occup Environ Med. 2002;59:807–815. doi: 10.1136/oem.59.12.807.
    1. Indahl A, Haldorsen EH, Holm S, Reikeras O, Ursin H. Five-year follow-up study of a controlled clinical trial using light mobilization and an informative approach to low back pain. Spine (Phila Pa 1976) 1998;23:2625–2630. doi: 10.1097/00007632-199812010-00018.
    1. Hedegaard J. DREAM database. [14] The National Labour Market Authority. Denmark: The national Labour Authority, Ministry of Employment; 2007.
    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. 2002;27:901–909. doi: 10.1097/00007632-200205010-00002.
    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. 1997;22:2911–2918. doi: 10.1097/00007632-199712150-00014.
    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. 2012;51(2):230–242. doi: 10.1093/rheumatology/ker086.
    1. Steenstra IA, Knol DL, Bongers PM, Anema JR, van Mechelen W, de Vet HCW. What works best for whom? An exploratory, subgroup analysis in a randomized, controlled trial on the effectiveness of a workplace intervention in low back pain patients on return to work. Spine. 2009;34:1243–1249. doi: 10.1097/BRS.0b013e3181a09631.

Source: PubMed

Спонсоры и соавторы

Заболевания

Медикаментозные вмешательства

Подписаться