Clinical Science (41)

Abstract

Does early intervention with a light mobilization program reduce long‐term sick leave for low back pain? (Central Hospital in Hedmark, Ottestad, Norway) Spine 2000;25:1973–1976.This randomized, controlled clinical trial investigated the effect of a light mobilization program on the duration of sick leave for patients with subacute low back pain. Early intervention with information, diagnostics, and light mobilization may be a cost‐effective method for returning patients quickly to normal activity. In this experiment, patients were referred to a low back pain clinic and given a simple and systematic program as an outpatient treatment. Patients sick‐listed 8 to 12 weeks (N = 457) for low back pain were randomized into two groups: an intervention group (n = 237) and a control group (n = 220). The intervention group was examined at a spine clinic and given information and advice to stay active. The control group was not examined at the clinic, but was treated with conventional primary health care. At 12‐month follow‐up assessment, 68.4% in the intervention group had returned to full‐duty work, as compared with 56.4% in the control group. Conclude that early intervention with examination, information, and recommendations to stay active showed significant effects in reducing sick leave for patients with low back pain. Comment by Susan Anderson, MD.This is a randomized controlled clinical trial to compare patients that have been sick listed for more than 8 weeks in Norway. Comparison was between a control group that received conventional primary health care and an intervention group that was examined at a spine clinic, given information, and advised to stay active. The authors wanted to examine if an early intervention with information, diagnostics, and light mobilization may be a cost‐effective method for returning patients quickly to normal activity. This study involved 457 patients that were sick listed 8 to 12 weeks for low back pain. The inclusion criteria for the study was based on 1) 8 to 12 weeks being “sick‐listed,” 2) age (18 to 60 years), and 3) diagnosis that included back pain, low back pain, leg and thigh pain, back pain without sciatica, and sciatica. Exclusion criteria included pregnancy, recent low back trauma, cauda equina symptoms, cancer, osteoporosis, rheumatic low back disease, and ongoing low back treatment. The intervention used was modification of Indahl's light mobilization program where the patient was referred to a spine clinic, answered standard questionnaires, and was interviewed and examined by a treatment team consisting of a physician and a physiotherapist. Any somatic findings during the examination were explained to the patient and information was given about their importance. All radiographs were shown and explained. The idea was to educate the patient and dedramatize their problems. The patient was assured of a good prognosis and informed of the importance of remaining active to avoid development of muscle dysfunction. The physiotherapist individually advises the patient on how to train and stretch at home. They were also advised on how to manage the back pain and resume normal activity. The patients in the control group were not examined at the clinic, but were treated with primary health care, which included at least one visit to a general practitioner. The patients were reassessed at 3 months, 6 months, and 12 months. The assessment was to determine if the patient had returned to full duty work. At each of the assessments, the intervention group had a higher percentage of patients that had returned to full duty work. At the 12‐month follow‐up, 68.4% in the intervention group had returned to full duty work as compared with 56.4% in a controlled group.This study demonstrates that a consultation with thorough examination, information, reassurance, and encouragement shows a significant effect in reducing sick leave for patients with low back pain as compared to the conventional health care guidelines used by general practitioners that tend to recommend bed rest, caution, and reduced activities. The authors suggest that information and fear reduction when offered systematically may reduce the fear of “doing something wrong” to the back. This may then prevent unnecessary activity and long sick leave.