Substantial sick-leave costs savings due to a graded activity intervention for workers with non-specific sub-acute low back pain Pain response classification does not predict long-term outcome in patients with low back pain who are sick-listed. Economic Evaluation of a Multi-Stage Return to Work Program for Workers on Sick-Leave Due to Low Back Pain Long-term prognosis of acute low back pain in patients seen in general practice: a 1-year prospective follow-up study. Multidisciplinary Rehabilitation for Subacute Low Back Pain: Graded Activity or Workplace Intervention or Both?: A Randomized Controlled Trial Physical performance, pain, pain behavior and subjective disability in patients with subacute low back pain. Study protocol of cost-effectiveness and cost-utility of a biopsychosocial multidisciplinary intervention in the evolution of non-specific sub-acute low back pain in the working population: cluster randomised trial Potential Risk Factors of Persistent Low Back Pain Developing from Mild Low Back Pain in Urban Japanese Workers Prediction model for unsuccessful return to work after hospital-based intervention in low back pain patients Cost effectiveness of a multi-stage return to work program for workers on sick leave due to low back pain, design of a population based controlled trial [ISRCTN60233560] One-year prognosis in sick-listed low back pain patients with and without radiculopathy. Prognostic factors influencing pain and disability. Prognostic Factors for Duration of Sick Leave Due to Low-Back Pain in Dutch Health Care Professionals Stay@Work: Participatory Ergonomics to prevent low back and neck pain among workers: design of a randomised controlled trial to evaluate the (cost-)effectiveness Low back pain in general practice: cost-effectiveness of a minimal psychosocial intervention versus usual care
The objective of this study is to compare the costs and benefits of a grade d activity ( GA ) intervention to usual care ( UC ) for sick-listed workers with non-specific low back pain ( LBP ) . The study is a single-blind , r and omized controlled trial with 3-year follow-up . A total of 134 ( 126 men and 8 women ) predominantly blue-collar workers , sick-listed due to LBP were recruited and r and omly assigned to either GA ( N = 67 ; mean age 39 ± 9 years ) or to UC ( N = 67 ; mean age 37 ± 8 years ) . The main outcome measures were the costs of health care utilization during the first follow-up year and the costs of productivity loss during the second and the third follow-up year . At the end of the first follow-up year an average investment for the GA intervention of € 475 per worker , only € 83 more than health care utilization costs in UC group , yielded an average savings of at least € 999 ( 95 % CI : −1,073 ; 3,115 ) due to a reduction in productivity loss . The potential cumulative savings were an average of € 1,661 ( 95 % CI : −4,154 ; 6,913 ) per worker over a 3-year follow-up period . It may be concluded that the GA intervention for non-specific LBP is a cost-beneficial return-to-work intervention STUDY DESIGN Prospect i ve cohort study nested in a r and omized clinical trial . OBJECTIVE To investigate the prognostic value of pain response classification at initial physiotherapy examination in patients with low back pain ( LBP ) who are sick-listed . BACKGROUND Recurrent and chronic LBP accounts for a substantial proportion of all absence from work . In predicting outcome in patients with LBP , psychosocial factors are thought to play an important role , while findings from clinical examination seem to be of more limited value . Mechanical evaluation , using repeated end range spinal movements that result in specific pain responses , has been shown to be of some value . METHODS The study included 351 patients sick-listed because of LBP with or without sciatica . Prior to clinical examination , the patients completed a comprehensive question naire including questions on pain , function , and psychosocial factors . The physiotherapy examination included a st and ardized mechanical evaluation . Patients were classified into 3 groups according to their pain response : central ization , peripheralization , or no response . Outcomes were obtained by national register data , medical records , and a postal question naire at 1 year . RESULTS At 1-year follow-up , 65 % of the patients had returned to work . All pain response groups showed significant and clinical ly important improvements in both pain and disability . No significant differences were found between pain response groups in any outcome measure . Results remained unchanged after adjustment for potential confounders . CONCLUSION The prognostic value of pain response classification seems limited in patients sick-listed from work because of LBP Objective : To evaluate the cost-effectiveness and cost-utility of a return to work ( RTW ) program for workers on sick-leave due to low back pain ( LBP ) , comparing a workplace intervention implemented between 2 to 8 weeks of sick-leave with usual care , and a clinical intervention after 8 weeks of sick-leave with usual care . Design : Economic evaluation alongside a r and omised controlled trial ( RCT ) . Study population : Workers sick-listed for a period of 2 to 6 weeks due to LBP . Interventions : 1 . workplace assessment , work modifications and case management ) . 2 . physiotherapy based on operant behavioural principles . 3 . usual care : provided by an occupational physician . Outcomes : The primary outcome was return to work ( RTW ) . Other outcomes were pain intensity , functional status , quality of life and general health . The economic evaluation was conducted from a societal perspective . Outcomes were assessed at baseline ( after 2–6 weeks on sick-leave ) , and 12 weeks , 26 weeks , and 52 weeks after the first day of sick-leave . Results : The workplace intervention group returned to work 30.0 days ( 95 % CI=[3.1 , 51.3 ] ) earlier on average than the usual care group at slightly higher direct costs ( ratio of 1 day : € 19 ) . Workers in the clinical intervention group that had received usual care in the first 8 weeks returned to work 21.3 days ( 95 % CI= [ −74.1 , 29.2 ] ) later on average . The group that had received the workplace intervention in the first 8 weeks and the clinical intervention after 8 weeks returned to work 50.9 days ( 95 % CI=[−89.4 , −2.7 ] ) later on average . A workplace intervention was more effective than usual care in RTW at slightly higher costs and was equally effective as usual care at equal costs on other outcomes . A clinical intervention was less effective than usual care and associated with higher costs . Conclusion : The workplace intervention results in a safe and faster RTW than usual care at reasonable costs for workers on sick-leave for two to six weeks due to LBP OBJECTIVES We aim ed to examine the prognosis of acute low back pain ( LBP ) in patients in general practice and to identify prognostic factors associated with the long-term prognosis based on information immediately available to the GP . METHOD We conducted a prospect i ve cohort study in general practice in Denmark . The patients were those aged 18 - 60 years consulting their GP due to an episode of LBP lasting less than 2 weeks . The GPs collected data regarding 34 exposure variables , including their global assessment of the likelihood of chronic LBP . Outcome variables were collected from the patients after 1 , 6 and 12 months . The outcome measures were days on sick leave , and functional or complete recovery from LBP . RESULTS In total , 503 ( 96 % ) patients were followed during the whole study period . Fifty per cent of the patients on sick leave returned to work within 8 days ; after 1 year , only 2 % remained on sick leave . At the 1-year follow-up , 45 % of the patients continued to complain of LBP . Logistic regression analyses showed that the factors most significantly associated with poor long-term LBP outcome were ( i ) severity of LBP at inclusion , ( ii ) assessment s by the GP of susceptibility to develop chronic LBP and ( iii ) a history of LBP having caused previous sick leave . CONCLUSIONS LBP in general practice has a good prognosis with regard to sick leave , but a high proportion of patients continue to complain of LBP . We were not able to identify objective measures that strongly predict the prognosis of the individual LBP patient . The overall assessment by the GPs seems to be the most important predictor associated with the long-term outcome Study design . Population -based r and omized controlled trial . Objective . To assess the effectiveness of workplace intervention and grade d 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 r and omized 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 r and omized for grade d activity  ( n = 55 ) or usual care ( n = 57 ) . Grade d 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 ) .  Grade d 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 . Grade d activity or combined intervention is not advised The aim of this paper was to study the physical performance , pain , pain behavior and disability in patients with subacute low back pain ( LBP ) . The patients were blue-collar workers and had been sick-listed for 8 weeks due to subacute low back pain . A total of 103 patients were r and omized , 51 of them to the intervention group and the other to a control group .  Recordings of physical performance and complaints of LBP were done before and after treatment in the intervention group . The proportion of patients with no complaints of LBP was significantly greater in the intervention group than in the control group at the one-year follow-up . The patients who intra-individually improved their physical performance also intra-individually decreased their complaints of LBP . The intra-individual improvements were suggested to be important for the individual return to work Background Low back pain ( LBP ) , with high incidence and prevalence rate , is one of the most common reasons to consult the health system and is responsible for a significant amount of sick leave , leading to high health and social costs . The objective of the study is to assess the cost-effectiveness and cost-utility analysis of a multidisciplinary biopsychosocial educational group intervention ( MBEGI ) of non-specific sub-acute LBP in comparison with the usual care in the working population recruited in primary healthcare centres . Methods / design The study design is a cost-effectiveness and cost-utility analysis of a MBEGI in comparison with the usual care of non-specific sub-acute LBP . Measures on effectiveness and costs of both interventions will be obtained from a cluster r and omised controlled clinical trial carried out in 38 Catalan primary health care centres , enrolling 932 patients between 18 and 65 years old with a diagnosis of non-specific sub-acute LBP . Effectiveness measures are : pharmaceutical treatments , work sick leave ( % and duration in days ) , Rol and Morris disability , McGill pain intensity , Fear Avoidance Beliefs ( FAB ) and Golberg Question naires . Utility measures will be calculated from the SF-12 . The analysis will be performed from a social perspective . The temporal horizon is at 3 months ( change to chronic LBP ) and 12 months ( evaluate the outcomes at long term ) . Assessment of outcomes will be blinded and will follow the intention-to-treat principle . Discussion We hope to demonstrate the cost-effectiveness and cost-utility of MBEGI , see an improvement in the patients ' quality of life , achieve a reduction in the duration of episodes and the chronicity of non-specific low back pain , and be able to report a decrease in the social costs . If the intervention is cost-effectiveness and cost-utility , it could be applied to Primary Health Care Centres . Trial registration IS RCT N : IS RCT Study Design Two-year , prospect i ve cohort data from the Japan epidemiological research of occupation-related back pain study in urban setting s were used for this analysis . Objective To examine the association between aggravated low back pain and psychosocial factors among Japanese workers with mild low back pain . Summary of Background Data Although psychosocial factors are strongly indicated as yellow flags of low back pain ( LBP ) leading to disability , the association between aggravated LBP and psychosocial factors has not been well assessed in Japanese workers . Methods At baseline , 5,310 participants responded to a self-administered question naire including questions about individual characteristics , ergonomic work dem and s , and work-related psychosocial factors ( response rate : 86.5 % ) , with 3,811 respondents completing the 1-year follow-up question naire . The target outcome was aggravation of mild LBP into persistent LBP during the follow-up period . Incidence was calculated for the participants with mild LBP during the past year at baseline . Logistic regression was used to explore risk factors associated with persistent LBP . Results Of 1,675 participants who had mild LBP during the preceding year , 43 ( 2.6 % ) developed persistent LBP during the follow-up year . Multivariate analyses adjusted for individual factors and an ergonomic factor found statistically significant or almost significant associations of the following psychosocial factors with persistent LBP : interpersonal stress at work [ adjusted odds ratio ( OR ) : 1.96 and 95 % confidence interval ( 95%CI ) : 1.00–3.82 ] , job satisfaction ( OR : 2.34 , 95%CI : 1.21–4.54 ) , depression ( OR : 1.92 , 95%CI : 1.00–3.69 ) , somatic symptoms ( OR : 2.78 , 95%CI : 1.44–5.40 ) , support from supervisors ( OR : 2.01 , 95%CI : 1.05–3.85 ) , previous sick-leave due to LBP ( OR : 1.94 , 95%CI : 0.98–3.86 ) and family history of LBP with disability ( OR : 1.98 , 95%CI : 1.04–3.78 ) . Conclusions Psychosocial factors are important risk factors for persistent LBP in urban Japanese workers . It may be necessary to take psychosocial factors into account , along with physical work dem and s , to reduce LBP related disability Background Many studies on low back pain ( LBP ) have identified prognostic factors , but prediction models for use in secondary health care are not available . The purpose of this cohort study , based on a r and omised clinical study , was to identify risk factors for unsuccessful return to work ( U-RTW ) in sick-listed LBP patients with or without radiculopathy and to vali date a prediction model for U-RTW . Methods 325 sick-listed LBP patients with or without radiculopathy were included in an intervention study and followed for one year . Afterwards , 117 other LBP patients were recruited similarly , included in a validation study and also followed for one year . All patients were subjected to identical procedures and interventions and received a brief intervention by the same rehabilitation doctor and physiotherapist . Half of them received case manager guidance within a multidisciplinary setting . At baseline , they completed a question naire and went through a clinical low-back examination . Sciatica was investigated by magnetic resonance imaging ( MRI ) . U-RTW was registered in a national data base both initially and at 1-year . Results Neither initial U-RTW ( 24.0 % ) nor one-year U-RTW ( 38.2 % ) were statistically significantly different in the two intervention groups nor in patients with and without radiculopathy . Multivariate logistic regression analysis identified two clinical and five psychosocial baseline predictors for one-year U-RTW ( primary outcome ) . The clinical predictors included pain score ( back+leg pain ) and side-flexion . The five psychosocial predictors included ‘ bodily distress ’ ‘ low expectations of RTW ’ , ‘ blaming the work for pain ’ , ‘ no home ownership ’ and ‘ drinking alcohol less than once/month ’ . These predictors were not statistically significantly different in patients with and without radiculopathy , and they also predicted initial U-RTW ( secondary outcome ) . Obesity and older age were only supplementary predictors in patients with radiculopathy . A prediction model was established and tested in the validation study group . The model predicted one-year U-RWT in patients with intermediate and high risk , but only partially in patients with low risk . The model predicted all three risk categories in initial U-RTW . Conclusions A prediction model combining baseline clinical and psychosocial risk factors predicted patients with low , intermediate and high risk for unsuccessful return to work , both initially and at 1-year Background To describe the design of a population based r and omized controlled trial ( RCT ) , including a cost-effectiveness analysis , comparing participative ergonomics interventions between 2–8 weeks of sick leave and Grade d Activity after 8 weeks of sick leave with usual care , in occupational back pain management . Methods Design : An RCT and cost-effectiveness evaluation in employees sick-listed for a period of 2 to 6 weeks due to low back pain . Interventions used are 1 . Communication between general practitioner and occupational physician plus Participative Ergonomics protocol performed by an ergonomist . 2 . Grade d Activity based on cognitive behavioural principles by a physiotherapist . 3 . Usual care , provided by an occupational physician according to the Dutch guidelines for the occupational health management of workers with low back pain . The primary outcome measure is return to work . Secondary outcome measures are pain intensity , functional status and general improvement . Intermediate variables are kinesiophobia and pain coping . The cost-effectiveness analysis includes the direct and indirect costs due to low back pain . The outcome measures are assessed before r and omization ( after 2–6 weeks on sick leave ) and 12 weeks , 26 weeks and 52 weeks after first day of sick leave . Discussion The combination of these interventions has been subject of earlier research in Canada . The results of the current RCT will : 1 . crossvali date the Canadian findings in an different sociocultural environment ; 2 . add to the cost-effectiveness on treatment options for workers in the sub acute phase of low back pain . Results might lead to alterations of existing (inter)national guidelines BACKGROUND CONTEXT Previous research has documented various psychosocial risk factors with influence on outcome in low back pain ( LBP ) patients , but the value of clinical predictors has been less well documented . PURPOSE To identify clinical and psychosocial risk factors at baseline influencing disability and pain at 1 year in LBP patients sick-listed 3 to 16 weeks , and to look for differences between nonspecific LBP and radiculopathy . STUDY DESIGN Cohort study with 1-year follow-up based on a r and omized clinical trial . OUTCOME MEASURES Disability and change of disability , pain and change in pain at 1 year . METHODS In a r and omized clinical study evaluating multidisciplinary versus brief intervention , 325 patients were followed for 1 year . At baseline , they completed a question naire and went through a clinical low back examination , including measure of forward flexion and side flexion as well as tender point examination , a method to estimate diffuse tenderness . Furthermore , degenerative changes on plain X-rays of the lumbar spine were quantified , and sciatica was investigated by magnetic resonance imaging . RESULTS Radiculopathy was verified by magnetic resonance imaging in 111 ( 34 % ) patients . At 1 year , questions of disability in daily life activities and pain were answered by 60 % and 67 % , respectively . The intensity of back+leg pain and disability was closely correlated . Statistically significant predictors for both disability and back+leg pain at 1 year were intensity of back+leg pain , worrying and health anxiety , many tender points , and little or moderate exercise in leisure time . Two additional risk factors were identified in patients with radiculopathy : older age and " drinking alcohol less than once per month . " Furthermore , disability at 1 year was associated with initial disability and compensation cl aim , and back+leg pain at 1 year was associated with fear avoidance about physical activity and the duration of pain . Change in disability was more closely associated with return to work than change in pain . Disc degeneration was not associated with disability or pain at 1 year . General health was not statistically significantly associated with outcome when adjusted for back+leg pain , disability , and worrying and health anxiety . CONCLUSIONS Disability and pain at 1 year were associated with baseline disability and pain , diffuse tenderness , worrying and health anxiety , compensation cl aim , fear avoidance , and baseline exercise habits . Only in patients with verified nerve root affection , older age , and restrained alcohol seemed to play a role . The multivariate models were insufficient in predicting disability and pain , partly because disability and pain were also strongly associated with return to work Background : Information on prognostic factors for duration of sick leave  due to low-back pain ( LBP ) is growing . In this prospect i ve cohort study prognostic factors for duration of sick leave and course of disability were identified in a very early stage of sick leave due to LBP in an occupational health care setting . Methods : A total of 615 workers calling in sick from work due to LBP at an occupational health service ( OHS ) of one institution completed a question naire . Duration of follow-up was 26 weeks . Prognostic factors were identified by means of Cox regression analysis and multiple linear regression analysis , and explained variance was calculated . Results : Median time to first return to work ( RTW ) was 5 days ( Inter Quartile Range ( IQR ) = 2–12 ) . Median time to lasting return to work ( LRTW ) was 6 days ( IQR = 3–13 ) . The final model for delayed RTW included self-reported  expected duration of sick-leave  , treatment by GP or specialist , care-seeking , diminished mobility , and the interaction between care-seeking and diminished mobility . The final model for LRTW included : self-reported expected duration of sick-leave  ,  treatment by GP or specialist  , care-seeking , the interaction between the self-reported  expected duration of sick-leave and seeking care at OHS , complaints due to job stress , diminished mobility , and the interactions between expected duration of more then 10 days and seeking OP care and diminished mobility . Median total days on sick leave ( TDSL ) was 6 days ( IQR = 3–13 days ) . The final model for TDSL included : age , expected duration of sick leave , treatment by GP or medical specialist , seeking OP care , complaints due to physical load , and diminished mobility . Explained variance ( R2 ) of these models ranged from 30 to 35 % . Conclusions : Poor prognosis for duration of sick leave can be identified by means of a simple question naire administered on the first day of sick leave . Workers at high risk for longer duration of sick leave ( all outcomes ) expected to stay off work longer , were already being treated by a MD , sought OP care , and had diminished mobility . In case of delayed LRTW workers reported job stress as a possible cause of sick leave . Interactions were found in both RTW and LRTW between care-seeking and diminished mobility and in LRTW between expected duration of sick leave and seeking OP care . Older age increased TDSL with borderline significance Background Low back pain ( LBP ) and neck pain ( NP ) are a major public health problem with considerable costs for individuals , companies and society . Therefore , prevention is imperative . The Stay@Work study investigates the (cost-)effectiveness of Participatory Ergonomics ( PE ) to prevent LBP and NP among workers . Methods In a r and omised controlled trial ( RCT ) , a total of 5,759 workers working at 36 departments of four companies is expected to participate in the study at baseline . The departments consisting of about 150 workers are pre-stratified and r and omised . The control departments receive usual practice and the intervention departments receive PE . Within each intervention department a working group is formed including eight workers , a representative of the management , and an occupational health and safety coordinator . During a one day meeting , the working group follows the steps of PE in which the most important risk factors for LBP and NP , and the most adequate ergonomic measures are identified on the basis of group consensus . The implementation of ergonomic measures at the department is performed by the working group . To improve the implementation process , so-called ' ergocoaches ' are trained . The primary outcome measure is an episode of LBP and NP . Secondary outcome measures are actual use of ergonomic measures , physical workload , psychosocial workload , intensity of pain , general health status , sick leave , and work productivity . The cost-effectiveness analysis is performed from the societal and company perspective . Outcome measures are assessed using question naires at baseline and after 6 and 12 months . Data on the primary outcome as well as on intensity of pain , sick leave , work productivity , and health care costs are collected every 3 months . Discussion Prevention of LBP and NP is beneficial for workers , employers , and society . If the intervention is proven (cost-)effective , the intervention can have a major impact on LBP and NP prevention and , thereby , on work disability prevention . Results are expected in 2010.Trial registration IS RCT An intervention that can prevent low back pain ( LBP ) becoming chronic , may not only prevent great discomfort for patients , but also save substantial costs for the society . Psychosocial factors appear to be of importance in the transition of acute to chronic LBP . The aim of this study was to compare the cost-effectiveness of an intervention aim ed at psychosocial factors to usual care in patients with (sub)acute LBP . The study design was an economic evaluation alongside a cluster-r and omized controlled trial , conducted from a societal perspective with a follow-up of 1 year . Sixty general practitioners in 41 general practice s recruited 314 patients with non-specific LBP of less than 12 weeks ’ duration . General practitioners in the minimal intervention strategy ( MIS ) group explored and discussed psychosocial prognostic factors . Usual care ( UC ) was not protocol ized . Clinical outcomes were functional disability ( Rol and –Morris Disability Question naire ) , perceived recovery and health-related quality of life ( EuroQol ) . Cost data consisted of direct and indirect costs and were measured by patient cost diaries and general practitioner registration forms . Complete cost data were available for 80 % of the patients . Differences in clinical outcomes between both the groups were small and not statistically significant . Differences in cost data were in favor of MIS . However , the complete case analysis and the sensitivity analyses with imputed cost data were inconsistent with regard to the statistical significance of this difference in cost data . This study presents conflicting points of view regarding the cost-effectiveness of MIS . We conclude that ( Dutch ) general practitioners , as yet , should not replace their usual care by this new intervention
Specific LBP , higher disability levels , older age , female gender , more social dysfunction and more social isolation , heavier work , and receiving higher compensation were identified as predictors for a longer duration of sick leave .
A history of LBP , job satisfaction , educational level , marital status , number of dependants , smoking , working more than 8 hour shifts , occupation , and size of industry or company do not influence duration of sick leave due to LBP .
Many different constructs were measured to identify psychosocial predictors of long term sick leave , which made it impossible to determine the role of these factors
BACKGROUND The percentages of patients with acute low back pain ( LBP ) that go on to a chronic state varies between studies from 2 % to 34 % .
In some of these cases low back pain leads to great costs .
AIMS To evaluate the evidence for prognostic factors for return to work among workers sick listed with acute LBP .