Multidisciplinary rehabilitation for subacute low back pain: Graded activity or workplace intervention or both? A randomized controlled trial

被引:170
作者
Anema, Johannes R.
Steenstra, Ivan A.
Bongers, Paulien M.
de Vet, Henrica C. W.
Knol, Dirk L.
Loisel, Patrick
van Mechelen, Willem
机构
[1] Free Univ Amsterdam, Med Ctr, Dept Publ & Occupat Hlth, NL-1081 BT Amsterdam, Netherlands
[2] Free Univ Amsterdam, Med Ctr, Inst Res Extramural Med, NL-1081 BT Amsterdam, Netherlands
[3] Free Univ Amsterdam, Med Ctr, TNO, Bodywork,Res Ctr Phys Activ Work & Hlth, NL-1081 BT Amsterdam, Netherlands
关键词
return to work; low back pain; effectiveness; graded activity; workplace intervention;
D O I
10.1097/01.brs.0000253604.90039.ad
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Study design. Population-based randomized controlled trial. Objective. To assess the effectiveness of workplace intervention and graded activity, separately and combined, for multidisciplinary rehabilitation of low back pain ( LBP). Summary of Background Data. Effective components for multidisciplinary rehabilitation of LBP are not yet established. Methods. Participants sick-listed 2 to 6 weeks due to nonspecific LBP were randomized to workplace intervention ( n = 96) or usual care ( n = 100). Workplace intervention consisted of workplace assessment, work modifications, and case management involving all stakeholders. Participants still sick-listed at 8 weeks were randomized for graded activity ( n = 55) or usual care ( n = 57). Graded activity comprised biweekly 1-hour exercise sessions based on operant-conditioning principles. Outcomes were lasting return to work, pain intensity and functional status, assessed at baseline, and at 12, 26, and 52 weeks after the start of sick leave. Results. Time until return to work for workers with workplace intervention was 77 versus 104 days ( median) for workers without this intervention ( P = 0.02). Workplace intervention was effective on return to work ( hazard ratio = 1.7; 95% CI, 1.2 - 2.3; P = 0.002). Graded activity had a negative effect on return to work ( hazard ratio = 0.4; 95% CI, 0.3 - 0.6; P < 0.001) and functional status. Combined intervention had no effect. Conclusion. Workplace intervention is advised for multidisciplinary rehabilitation of subacute LBP. Graded activity or combined intervention is not advised.
引用
收藏
页码:291 / 298
页数:8
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