Function-centred Rehabilitation Increases Days at Work in Patients with Non-specific Non-acute Low Back Pain, a Randomized Controlled Trial

Purpose: This study in patients with non-acute non-specific low back pain (LBP) compares the effect of 3 weeks function centred (FCT) and pain centred treatment (PCT) on the number of days at work in the follow-up year.

Methods: Randomized controlled trial in 174 workers with LBP and 191 (SD 145) previous days off-work. Patients with positive predictive tests for non-return-to-work (Kool 2002) were excluded. FCT (4 hrs/day) emphasized activity in spite of pain and coping and consisted of work simulation, strength, endurance and cardiovascular training in groups. PCT (2.5 hrs/day) emphasized pain reduction and consisted of a mini back-school and individual therapy with passive and active mobilization, stretching and strength training. By means of regression analyses the influence of work-load, nationality, sex, and employment status on number of days at work and predictive factors for work days were estimated.

Results: The number of days at work was significantly larger in the FCT group (118±SD 134) than in the PCT group (74±SD 114, p=0.011). Treatment was more effective in patients who were younger or had a physical workload below 10kg, and independent of employment status and nationality. Predictive factors explaining 39% of the variance in work days were the maximum weight carried with the right arm, guarding as behavioural response during the assessment, pain intensity, Swiss nationality, the patients' belief about return to the previous work and work load (R=0.642, adjusted R squared=0.388).

Discussion: FCT is more effective than PCT to increase work days in patients with non-acute non-specific low back pain. Based on these results, we recommend that function centred rehabilitation should be applied instead of the still widely used pain centred treatment. Further research is needed to identify the essential elements of treatment and to develop cheaper outpatient programs. Management to reduce work related disability must be improved, probably emphasizing early intervention and job adaptation and involving legal and financial incentives for both workers and employers.

References:

Kool J, Oesch P, de Bie R. Predictive tests for non-return to work in patients with chronic low back pain. Eur Spine J 2002;11(5):258–66.

Kool J, Oesch P, Bachmann S, Knüsel O, De Bie R, Van Den Brandt P. Increasing days at work using function-centered rehabilitation in non-acute non-specific low back pain: a randomized controlled trial. APMR accepted 2005.