Abstract
BackgroundNeck and back pain are among the most common causes of prolonged disability, and development of interventions with effect on pain, disability and return to work is important. Reduction of fear avoidance might be one mechanism behind improvement after interventions. The aim of the present study was to evaluate changes in pain and disability at the 12-month follow-up of patients with neck and back pain treated with a work-focused intervention compared to patients treated with standard interventions, and the influence of improvement fear avoidance beliefs during the interventions on pain, disability and return to work at 12-month follow-up.Methods413 employed patients with back or neck pain referred to secondary care, and sick-listed between 4 weeks and 12 months, were randomized to a work-focused rehabilitation or control interventions. Follow-up was conducted 4 and 12 months after inclusion. The groups were compared (independent sample t-test) regarding differences in disability scores (Oswestry disability index/neck disability index) and pain (numeric rating scale) from baseline to 12-month follow-up. Changes in fear avoidance beliefs (FABQ) from baseline to 4 month follow-up were calculated, and the association between this change and return to work, pain and disability at 12 months were tested in stepwise multiple logistic regression models.ResultsPain and, disability scores decreased to in both the work-focused and control intervention to 12-month follow-up, and there were no significant differences between the groups. FABQ decreased similarly in both groups to 4 month follow-up. The logistic regression model revealed an association between a reduced FABQ work score at 4 months and return to work within one year (adjusted OR 3.60, 95% CI 1.19 to 10.88). Reduced FABQ physical activity score at 4 months was associated with decreased disability after 12 months (adjusted OR (3.65. 95% CI 1.43 to 9.28).ConclusionsShort work-focused rehabilitation had the same effect on pain and disability as control interventions. Reduction in FABQ-W score after treatment seems to be an important predictor for return to work in both groups.Trial registrationClinicaltrials.gov NCT00840697
Highlights
Neck and back pain are among the most common causes of prolonged disability, and development of interventions with effect on pain, disability and return to work is important
Six patients in the work-focused intervention and 2 patients in the control intervention were incorrectly randomised (Figure 1). 45 patients admitted with neck pain were included, and these were evenly distributed between the work-focused and control group
No significant differences were found in the baseline characteristics between the participants in the workfocused intervention and the control intervention (Table 2)
Summary
Neck and back pain are among the most common causes of prolonged disability, and development of interventions with effect on pain, disability and return to work is important. The aim of the present study was to evaluate changes in pain and disability at the 12-month follow-up of patients with neck and back pain treated with a work-focused intervention compared to patients treated with standard interventions, and the influence of improvement fear avoidance beliefs during the interventions on pain, disability and return to work at 12-month follow-up. Neck and back pain are among the most common causes of prolonged disability in “the global burden of disease study” [1,2], and development of effective rehabilitation strategies is of major importance. The control interventions used for comparison to work-focused programs ranged in intensity from usual care [12,16] and brief interventions [14], to multidisciplinary interventions sequentially following the work-focused interventions [10,11]
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