Cost-effectiveness of providing patients with information on managing mild low-back symptoms in an occupational health setting

Abstract

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.

Education as a strategy for managing occupational-related musculoskeletal pain: a scoping review

“…Of the 19 studies included, 10 studies were randomised controlled trials 25–34. Eight studies used a prospective design where educational management strategies were tested using one35–39 or two groups 40–42. One study43 used a mixed-methods design to assess the individual workers’ experience of the educational intervention.…”

“…The content of the educational set-up and content varied between the included studies where three themes for methods of delivery emerged: written material in a hard copy (eg, pamphlet or book),25 27 29 32–34 36 41 43 electronic delivery29 30 38 39 or a teacher–student setting (eg, lecture or face-to-face teaching/mentoring) 25 26 28 31 35 37 40 42. Some of these included studies employed a mixed approach where education was supplemented by a more active approach (see Potential influence of delivery method section and table 2).…”

“…Some studies lacked comparators35–39 and others focused on improving physiological parameters such as aerobic capacity28 31 and strength 26. In general, a map of the existing evidence indicates that an educational intervention may positively influence musculoskeletal pain in the workplace, especially when including factors such as absence from work26 29 33 40 41 and cost–benefits of staying at work despite pain 37 39 41. However, it needs to be acknowledged that favourable findings came from studies lacking a comparator 35–39.…”

“…In this regard, adding ergonomic advice or exercise was suggested to have additional benefits,25 33 although inconsistent findings were evident 27. For example, combining an educational booklet with face-to-face advice resulted in little or no additive effect on low back pain as assessed by pain levels, cost or absence from work 32 41. A face-to-face intervention, however, may ensure better retention of the educational information as compared with electronic delivery, such as through email 43…”

A classification-based approach to low back pain in primary care – protocol for a benchmarking controlled trial

“…Appropriate patient education can reduce pain and disability in the short term [26]. Even simple patient information has shown to be cost-effective and to produce savings in the costs of managing mild low back symptoms in occupational settings [27].…”