Effectiveness of three interventions for secondary prevention of low back pain in the occupational health setting - a randomised controlled trial with a natural course control

Abstract

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

Qualification for prevention of musculoskeletal diseases. Low back pain example.

“…While determining whether a person is eligible for a prevention program one needs to decide whether such prevention is advisable as well as assess the functional condition of a patient in order to ascertain whether they should seek medical consultation and treatment [13]. When encountering symptoms that may have their source in the spine one may consider consulting with a neurosurgeon [14]. Currently Poland has no standardized and nationwide back pain prevention programs, and Supreme Audit Office has never produced any reports shedding light on prevention of musculoskeletal problems.…”

“…Back pain prevention comes into question when pain has been experienced recently or has been recurring, radiating to a lower extremity, or causing absenteeism [14]. In order to assess risk factors which, when established, should result in specialist treatment, one should conduct a detailed examination of pain intensity and complete a check for possible "red flags."…”

“…In the process of qualifying for back pain prevention one may use standardized questionnaires typically used to assess progress in treatment [5,6,7]. They provide, however, too much data difficult to interpret using only algorithms, and so usually one resorts to various forms of a questionnaire which, after initial analysis, allows to single out patients suffering from recurring back pain who could benefit from prevention programs [14]. At the same time, the questionnaire is designed in such a way as to separate patients who potentially need a detailed physiotherapeutic examination and, possibly, treatment.…”

Organisational Intervention on Absenteeism Among Workers: A Systematic Review

“…The studies that had showed insignificant findings can be summed up by the characteristics of participants, the designed intervention and the event occurred during conducting intervention. One study had included all types of workers that had sickness absence, however, the intervention only focused on improving back pain (Rantonen et al 2018). Furthermore, the intervention conducted on managers involved managers with most experienced in their work and the most senior, which had difficulties to change their behaviour in a short period of time (Stansfeld et al 2015).…”

“…Furthermore, the intervention conducted on managers involved managers with most experienced in their work and the most senior, which had difficulties to change their behaviour in a short period of time (Stansfeld et al 2015). The type of intervention also plays an important role as the intervention involving rehabilitation will only have the effect on sickness absence if the intervention is not less than three to four years (Rantonen et al 2018). Furthermore, intervention based on education alone will not give a significant impact on the change of behaviour without the elements of motivation for behaviour change (Stansfeld et al 2015).…”