Multidisciplinary Rehabilitation for Subacute Low Back Pain: Graded Activity or Workplace Intervention or Both?

TLDR

The study aimed to evaluate the effectiveness of workplace intervention, graded activity, and their combination in multidisciplinary rehabilitation of subacute low back pain among sick‑listed workers. The trial randomized workers to a workplace intervention involving assessment, work modifications, and stakeholder case management, or to graded activity consisting of biweekly 1‑hour exercise sessions based on operant‑conditioning principles, with outcomes measured at baseline and 12, 26, and 52 weeks. Workplace intervention accelerated return to work (median 77 vs 104 days, HR 1.7, P = 0.002), whereas graded activity delayed return to work (HR 0.4, P < 0.001) and worsened functional status; the combined intervention had no benefit, leading the authors to recommend workplace intervention alone for subacute low back pain rehabilitation.

Abstract

Population-based randomized controlled trial.To assess the effectiveness of workplace intervention and graded activity, separately and combined, for multidisciplinary rehabilitation of low back pain (LBP).Effective components for multidisciplinary rehabilitation of LBP are not yet established.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.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.Workplace intervention is advised for multidisciplinary rehabilitation of subacute LBP. Graded activity or combined intervention is not advised.