Chronic back pain can be a particularly vexing complaint. These Dutch and Canadian researchers evaluated the effectiveness of an integrated care program that involved a patient directed and a workplace directed intervention, in patients with chronic low back pain. The performed a randomized controlled trial enrolling 134 adults aged 18-65 with low back pain affecting work for least 12 weeks. The patients were randomly assigned to usual care (n=68) or integrated care (n=66). Integrated care consisted of a workplace intervention included participatory ergonomics, involving a supervisor, and a graded activity program based on cognitive behavioral principles.
The researchers report: "The median duration until sustainable return to work was 88 days in the integrated care group compared with 208 days in the usual care group. Integrated care was effective on return to work (hazard ratio 1.9). After 12 months, patients in the integrated care group improved significantly more on functional status compared with patients in the usual care group. Improvement of pain between the groups did not differ significantly."
The authors concluded: "The integrated care programme substantially reduced disability due to chronic low back pain in private and working life."
This method of treating back pain appears to hold promise in terms of disability and return to work, but reproducibility of findings and their cost-effectiveness remain to be seen.
For the full abstract, click here.
BMJ 340:c1035, 16 March 2010 © 2010 Lambeek et al.
Randomised controlled trial of integrated care to reduce disability from chronic low back pain in working and private life. Ludeke C Lambeek, Willem van Mechelen, Dirk L Knol, Patrick Loisel, Johannes R Anema. Correspondence to J R Anema: firstname.lastname@example.org
Category: M .Musculoskeletal. Keywords: low back pain, chronic low back pain, integrated care, work, disability, randomized controlled trial, journal watch.
Synopsis edited by Dr Paul Schaefer, Toledo, Ohio. Posted on Global Family Doctor 13 April 2010