Randomised controlled trial of integrated care to reduce disability from chronic low back pain in working and private life
Abstract
Objective
To evaluate the effectiveness of an integrated care programme,
combining a patient directed and a workplace directed intervention, for
patients with chronic low back pain.
Design Population based randomised controlled trial.
Setting
Primary care (10 physiotherapy practices, one occupational health
service, one occupational therapy practice) and secondary care (five
hospitals).
Participants 134 adults aged 18-65 sick listed for at least 12 weeks owing to low back pain.
Intervention
Patients were randomly assigned to usual care (n=68) or integrated care
(n=66). Integrated care consisted of a workplace intervention based on
participatory ergonomics, involving a supervisor, and a graded activity
programme based on cognitive behavioural principles.
Main outcome measures
The primary outcome was the duration of time off work (work disability)
due to low back pain until full sustainable return to work. Secondary
outcome measures were intensity of pain and functional status.
Results
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
(P=0.003). Integrated care was effective on return to work (hazard ratio
1.9, 95% confidence interval 1.2 to 2.8, P=0.004). After 12 months,
patients in the integrated care group improved significantly more on
functional status compared with patients in the usual care group
(P=0.01). Improvement of pain between the groups did not differ
significantly.
Conclusion The integrated care programme substantially reduced disability due to chronic low back pain in private and working life.
Trial registration Current Controlled Trials ISRCTN28478651.
Edited from bmj.com
Picture from chiropractor.blog.co.uk
#disability #pain
