BackgroundWe assessed the effectiveness of three interventions that were aimed to reduce non-acute low back pain (LBP) related symptoms in the occupational health setting.MethodsBased on a survey (n = 2480; response rate 71%) on LBP, we selected a cohort of 193 employees who reported moderate LBP (Visual Analogue Scale VAS > 34 mm) and fulfilled at least one of the following criteria during the past 12 months: sciatica, recurrence of LBP ≥ 2 times, LBP ≥ 2 weeks, or previous sickness absence. A random sample was extracted from the cohort as a control group (Control, n = 50), representing the natural course of LBP. The remaining 143 employees were invited to participate in a randomised controlled trial (RCT) of three 1:1:1 allocated parallel intervention arms: multidisciplinary rehabilitation (Rehab, n = 43); progressive exercises (Physio, n = 43) and self-care advice (Advice, n = 40). Seventeen employees declined participation in the intervention. The primary outcome measures were physical impairment (PHI), LBP intensity (Visual Analogue Scale), health related quality of life (QoL), and accumulated sickness absence days. We imputed missing values with multiple imputation procedure. We assessed all comparisons between the intervention groups and the Control group by analysing questionnaire outcomes at 2 years with ANOVA and sickness absence at 4 years by using negative binomial model with a logarithmic link function.ResultsMean differences between the Rehab and Control groups were − 3 [95% CI -5 to − 1] for PHI, − 13 [− 24 to − 1] for pain intensity, and 0.06 [0.00 to 0.12] for QoL. Mean differences between the Physio and Control groups were − 3 [95% CI -5 to − 1] for PHI, − 13 [− 29 to 2] for pain intensity, and 0.07 [0.01 to 0.13] for QoL. The main effects sizes were from 0.4 to 0.6. The interventions were not effective in reducing sickness absence.ConclusionsRehab and Physio interventions improved health related quality of life, decreased low back pain and physical impairment in non-acute, moderate LBP, but we found no differences between the Advice and Control group results. No effectiveness on sickness absence was observed.Trial registrationNumber NCT00908102 Clinicaltrials.gov
Face-to-face information combined with a booklet versus a booklet alone for treatment of mild low-back pain: a randomized controlled trial by Rantonen J, Vehtari A, Karppinen J, Luoto S, Viikari-Juntura E, Hupli M, Malmivaara A, Taimela S Respondents with mild LB symptoms were randomized into the Back Book (control) Back Book+Advice (intervention) groups. Both occupational health (OH) interventions were effective, but supplementary oral information was not more effective compared to the booklet alone. Policy implications: Patient advice is important in the OH setting, but we need more evidence of the effectiveness of various types of information. Original article Scand J Work Environ Health. 2014;40(2):156-166. doi:10.5271/sjweh.3398 Face-to-face information combined with a booklet versus a booklet alone for treatment of mild low-back pain: a randomized controlled trial by Jarmo Rantonen, MD, 1 Aki Vehtari, DrTech, 2 Jaro Karppinen, MD, PhD,1, 4 Satu Luoto, MD, PhD, MD, PhD, 1 Markku Hupli, MD, PhD, 3 Antti Malmivaara, MD, PhD, 5 Simo Taimela, MD, PhD 6,7 Rantonen J, Vehtari A, Karppinen J, Luoto S, Viikari-Juntura E, Hupli M, Malmivaara A, Taimela S. Face-to-face information combined with a booklet versus a booklet alone for treating mild low-back pain: a randomized controlled trial. Scand J Work Environ Health. 2014;40(2):156-166, doi:10.5271/sjweh.3398 AffiliationObjective The aim of this study was to determine the effectiveness of face-to-face information for the treatment of mild low-back pain (LBP) in an occupational health (OH) setting. MethodsWe conducted a 48-month randomized controlled trial (RCT) with two 1:1 allocated parallel groups of forestry company employees. Eligibility criteria included permanent employment, age <57 years, and mild LBP [visual analogue scale (VAS) 10-34 mm] in a survey. The intervention group received the Back Book, an information booklet on how to manage LBP, with an additional face-to-face review of the booklet by an OH nurse. The control group received the booklet only. Primary outcomes were physical impairment (Roland-Morris 18-item (RM-18) Disability Questionnaire), LBP (VAS 100 mm), health-related quality of life [15-dimensional quality of life (15-D)] during two years and sickness absence (SA) up to four years. Participants were assigned using block randomization with a computer-generated scheme. ResultsThe RCT comprised 181 participants (72% male, mean age 44 years). There were no differences between the treatment arms in any of the primary outcomes at any time point. At 24 months, the mean group differences (intervention versus control) were: RM-18: 0 [95% confidence interval (95% CI) -1-1], VAS: 3 mm (95% CI -3-8), and 15-D 0.00 (95% CI -0.02-0.02). The difference in cumulative sickness absence days at 48 months were -3 (95% CI -28-21) for total and 1 (95% CI -3-5) for LBP specific sick leaves. Exploratory analysis revealed no differences at subgroup-levels either.Conclusions Face-to-face patient information by an OH nurse in addition to a booklet was not more eff...
BackgroundEvidence shows that low back specific patient information is effective in sub-acute low back pain (LBP), but effectiveness and cost-effectiveness (CE) of information in early phase symptoms is not clear. We assessed effectiveness and CE of patient information in mild LBP in the occupational health (OH) setting in a quasi-experimental study.MethodsA cohort of employees (N = 312, aged <57) with non-specific, mild LBP (Visual Analogue Scale between 10–34 mm) was selected from the respondents of an employee survey (N = 2480; response rate 71 %). A random sample, representing the natural course of LBP (NC, N = 83; no intervention), was extracted as a control group. Remaining employees were invited (181 included, 47 declined, one excluded) into a randomised controlled study with two 1:1 allocated parallel intervention arms (“Booklet”, N = 92; “Combined”, N = 89). All participants received the “Back Book” patient information booklet and the Combined also an individual verbal review of the booklet. Physical impairment (PHI), LBP, health care (HC) utilisation, and all-cause sickness absence (SA) were assessed at two years. CE of the interventions on SA days was analysed by using direct HC costs in one year, two years from baseline. Multiple imputation was used for missing values.ResultsCompared to NC, the Booklet reduced HC costs by 196€ and SA by 3.5 days per year. In 81 % of the bootstrapped cases the Booklet was both cost saving and effective on SA. Compared to NC, in the Combined arm, the figures were 107€, 0.4 days, and 54 %, respectively. PHI decreased in both interventions.ConclusionsBooklet information alone was cost-effective in comparison to natural course of mild LBP. Combined information reduced HC costs. Both interventions reduced physical impairment. Mere booklet information is beneficial for employees who report mild LBP in the OH setting, and is also cost saving for the health care system.Trial registrationClinicalTrials.gov NCT00908102Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-016-2974-4) contains supplementary material, which is available to authorized users.
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