Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

ACC 2024 Congress

Catch up on all the top stories and latest evidence in cardiology research with our ACC 2024 Congress hub page.
ADVANCED SEARCH
Log in
Top
BMC Musculoskeletal Disorders
Published in: BMC Musculoskeletal Disorders 1/2008

Open Access 01-12-2008 | Research article

Subacute and chronic, non-specific back and neck pain: cognitive-behavioural rehabilitation versus primary care. A randomized controlled trial

Authors: Odd Lindell, Sven-Erik Johansson, Lars-Erik Strender

Published in: BMC Musculoskeletal Disorders | Issue 1/2008

Login to get access

Abstract

Background

In the industrial world, non-specific back and neck pain (BNP) is the largest diagnostic group underlying sick-listing. For patients with subacute and chronic (= full-time sick-listed for 43 – 84 and 85 – 730 days, respectively) BNP, cognitive-behavioural rehabilitation was compared with primary care. The specific aim was to answer the question: within an 18-month follow-up, will the outcomes differ in respect of sick-listing and number of health-care visits?

Methods

After stratification by age (≤ 44/≥ 45 years) and subacute/chronic BNP, 125 Swedish primary-care patients were randomly allocated to cognitive-behavioural rehabilitation (rehabilitation group) or continued primary care (primary-care group). Outcome measures were Return-to-work share (percentage) and Return-to-work chance (hazard ratios) over 18 months, Net days (crude sick-listing days × degree), and the number of Visits (to physicians, physiotherapists etc.) over 18 months and the three component six-month periods. Descriptive statistics, Cox regression and mixed-linear models were used.

Results

All patients: Return-to-work share and Return-to-work chance were equivalent between the groups. Net days and Visits were equivalent over 18 months but decreased significantly more rapidly for the rehabilitation group over the six-month periods (p < .05). Subacute patients:Return-to-work share was equivalent. Return-to-work chance was significantly greater for the rehabilitation group (hazard ratio 3.5 [95%CI1.001 – 12.2]). Net days were equivalent over 18 months but decreased significantly more rapidly for the rehabilitation group over the six-month periods and there were 31 days fewer in the third period. Visits showed similar though non-significant differences and there were half as many in the third period. Chronic patients:Return-to-work share, Return-to-work chance and Net days were equivalent. Visits were equivalent over 18 months but tended to decrease more rapidly for the rehabilitation group and there were half as many in the third period (non-significant).

Conclusion

The results were equivalent over 18 months. However, there were indications that cognitive-behavioural rehabilitation in the longer run might be superior to primary care. For subacute BNP, it might be superior in terms of sick-listing and health-care visits; for chronic BNP, in terms of health-care visits only. More conclusive results concerning this possible long-term effect might require a longer follow-up.

Trial registration

NCT00488735.
Appendix
Available only for authorised users
Literature
1.
Hansson T, Jensen I: Sickness absence due to back and neck disorders. Sickness absence – causes, consequences, and physicians' sickness-certification practice. Scand J Public Health. Edited by: Alexanderson K, Norlund A. 2004, 32 (Suppl 63): 109-151.
2.
Nachemson A: Introduction. Neck and back pain. The scientific evidence of causes, diagnosis, and treatment. Edited by: Nachemson A, Jonson E. 2000, Philadelphia: Lippincott, Williams & Williams, 1-12.
3.
Norlund A, Waddell G: Cost of back pain in some OECD Countries. Neck and back pain. The scientific evidence of causes, diagnosis, and treatment. Edited by: Nachemson A, Jonson E. 2000, Philadelphia: Lippincott, Williams & Williams, 421-425.
4.
Waddell G, Watson PJ: Rehabilitation. Back Pain Revolution. Edited by: Waddell G. 2004, Edinburgh: Churchill Livingstone, 371-399. 2
5.
Wasiak R, Young AE, Roessler RT, McPherson KM, van Poppel MN, Anema JR: Measuring return to work. J Occup Rehabil. 2007, 17: 766-781. 10.1007/s10926-007-9101-4.CrossRefPubMed
6.
Hazard RG, Fenwick JW, Kalisch SM, Redmond J, Reeves V, Reid S, Frymoyer JW: Functional restoration with behavioural support. A one-year prospective study of patients with chronic low-back pain. Spine. 1989, 14: 157-161. 10.1097/00007632-198902000-00003.CrossRefPubMed
7.
Hlobil H, Staal JB, Twisk J, Köke A, Ariëns G, Smid T, van Mechelen W: The effects of a graded activity intervention for low back pain in occupational health on sick leave, functional status and pain: 12-month results of a randomized controlled trial. J Occup Rehabil. 2005, 15: 569-580. 10.1007/s10926-005-8035-y.CrossRefPubMed
8.
Anema JR, Steenstra IA, Bongers PM, de Vet HC, Knol DL, Loisel P, van Mechelen W: Multidisciplinary rehabilitation for subacute low back pain: graded activity or workplace intervention or both? A randomized controlled trial. Spine. 2007, 32: 291-298. 10.1097/01.brs.0000253604.90039.ad.CrossRefPubMed
9.
Linton SJ, Nordin E: A 5-year follow-up evaluation of the health and economic consequences of an early cognitive behavioral intervention for back pain: a randomized, controlled trial. Spine. 2006, 31: 853-858. 10.1097/01.brs.0000209258.42037.02.CrossRefPubMed
10.
Linton SJ, Ryberg M: A cognitive-behavioral group intervention as prevention for persistent neck and back pain in a non-patient population: a randomized controlled trial. Pain. 2001, 90: 83-90. 10.1016/S0304-3959(00)00390-0.CrossRefPubMed
11.
Waddell G: The biopsychosocial model. Back Pain Revolution. Edited by: Waddell G. 2004, Edinburgh: Churchill Livingstone, 265-282. 2
12.
Waddell G, van Tulder M: Clinical guidelines. Back Pain Revolution. Edited by: Waddell G. 2004, Edinburgh: Churchill Livingstone, 283-322. 2
13.
Karjalainen K, Malmivaara A, van Tulder M, Roine R, Jauhiainen M, Hurri H, Koes B: Multidisciplinary biopsychosocial rehabilitation for neck and shoulder pain among working age adults. Cochrane Database Syst Rev. 2003, CD002194-2
14.
Lindström I, Öhlund C, Eek C, Wallin L, Peterson LE, Fordyce WE, Nachemson A: The effect of graded activity on patients with sub-acute low back pain: a randomized prospective clinical study with an operant-conditioning behavioral approach. Phys Ther. 1992, 72: 279-293.PubMed
15.
Loisel P, Lemaire J, Poitras S, Durand MJ, Champagne F, Stock S, Diallo B, Tremblay C: Cost-benefit and cost-effectiveness analysis of a disability prevention model for back pain management: a six year follow up study. Occup Environ Med. 2002, 59: 807-815. 10.1136/oem.59.12.807.CrossRefPubMedPubMedCentral
16.
Haldorsen EM, Grasdal AL, Skouen JS, Risa AE, Kronholm K, Ursin H: Is there a right treatment for a particular patient group? Comparison of ordinary treatment, light multidisciplinary treatment, and extensive multidisciplinary treatment for long-term sick-listed employees with musculoskeletal pain. Pain. 2002, 95: 49-63. 10.1016/S0304-3959(01)00374-8.CrossRefPubMed
17.
Indahl A, Haldorsen EH, Holm S, Reikeras O, Ursin H: Five-year follow-up study of a controlled clinical trial using light mobilization and an informative approach to low back pain. Spine. 1998, 23: 2625-2630. 10.1097/00007632-199812010-00018.CrossRefPubMed
18.
Steenstra IA, Anema JR, Bongers PM, de Vet HC, Knol DL, van Mechelen W: The effectiveness of graded activity for low back pain in occupational healthcare. Occup Environ Med. 2006, 63: 718-725. 10.1136/oem.2005.021675.CrossRefPubMedPubMedCentral
19.
Jensen IB, Bergstrom G, Ljungquist T, Bodin L: A 3-year follow-up of a multidisciplinary rehabilitation programme for back and neck pain. Pain. 2005, 115: 273-283.CrossRefPubMed
20.
Ostelo RW, van Tulder MW, Vlaeyen JW, Linton SJ, Morley SJ, Assendelft WJ: Behavioural treatment for chronic low-back pain. Cochrane Database Syst Rev. 2005
21.
Turk DC, Rudy TE: Neglected topics in the treatment of chronic pain patients: Relapse, noncompliance, and adherence enhancement. Pain. 1991, 44: 5-28. 10.1016/0304-3959(91)90142-K.CrossRefPubMed
22.
Marklund S: Risk- och friskfaktorer. Sjukskrivning och rehabilitering i Sverige. [In Swedish; English summary: Sickness Absenteeism and Vocational Rehabilitation in Sweden]. 1997, RFV redovisar, 6-
23.
Jensen IB, Bodin L, Ljungquist T, Bergström G, Nygren Å: Assessing the needs of patients in pain: a matter of opinion?. Spine. 2000, 25: 2816-2823. 10.1097/00007632-200011010-00015.CrossRefPubMed
24.
25.
Grunnesjö MI, Bogefeldt JP, Svärdsudd KF, Blomberg SI: A randomized controlled clinical trial of stay-active care versus manual therapy in addition to stay-active care: functional variables and pain. J Manipulative Physiol Ther. 2004, 27: 431-441. 10.1016/j.jmpt.2004.06.001.CrossRefPubMed
26.
27.
28.
Arrelöv B, Borgquist L, Ljungberg D, Svärdsudd K: The influence of change of legislation concerning sickness absence on physicians' performance as certifiers. A population-based study. Health Policy. 2003, 63: 259-268. 10.1016/S0168-8510(02)00081-7.CrossRefPubMed
29.
Altman DG: Comparing groups – continuous data. Practical statistics for medical research. 1991, London: Chapman & Hall, 179-228. 1
30.
Altman DG: Comparing groups – categorical data. Practical statistics for medical research. 1991, London: Chapman & Hall, 229-276. 1
31.
Kelly PJ, Lim LL: Survival analysis for recurrent event data: an application to childhood infectious diseases. Statist Med. 2000, 19: 13-33. 10.1002/(SICI)1097-0258(20000115)19:1<13::AID-SIM279>3.0.CO;2-5.CrossRef
32.
Brown H, Prescott R: Applied mixed models in medicine. 2001, Edinburgh: John Wiley & Sons LTD, 199-259.
33.
Begg C, Cho M, Eastwood S, Horton R, Moher D, Olkin I, Pitkin R, Rennie D, Schulz KF, Simel D, Stroup DF: Improving the quality of reporting of randomized controlled trials. The CONSORT statement. JAMA. 1996, 276: 637-639. 10.1001/jama.276.8.637.CrossRefPubMed
34.
van Tulder MW, Assendelft WJ, Willem JJ, Koes BW, Bouter LM: Method guidelines for systematic reviews in the Cochrane Collaboration Back Review Group for Spinal Disorders. Spine. 1997, 22: 2323-2330. 10.1097/00007632-199710150-00001.CrossRefPubMed
35.
Waddell G: Low back pain: a twentieth century health care enigma. Spine. 1996, 21: 2820-2825. 10.1097/00007632-199612150-00002.CrossRefPubMed
36.
Mayer TG, Barnes D, Nichols G, Kishino ND, Coval K, Piel B, Hoshino D, Gatchel RJ: Progressive isoinertial lifting evaluation. II. A comparison with isokinetic lifting in a disabled chronic low-back pain industrial population. Spine. 1988, 13: 998-1002. 10.1097/00007632-198809000-00006.CrossRefPubMed
37.
Lindell O, Eriksson L, Strender LE: The reliability of a 10-test package for patients with prolonged back and neck pain: Could an examiner without formal medical education be used without loss of quality? A methodological study. BMC Musculoskel Disord. 2007, 8: 31-10.1186/1471-2474-8-31.CrossRef
38.
Englund L, Svärdsudd K: Sick-listing habits among general practitioners in a Swedish county. Scand J Prim Health Care. 2000, 18: 81-86. 10.1080/028134300750018954.CrossRefPubMed
39.
40.
41.
42.
Linton SJ, Boersma K, Jansson M, Svard L, Botvalde M: The effects of cognitive-behavioral and physical therapy preventive interventions on pain-related sick leave: a randomized controlled trial. Clin J Pain. 2005, 21: 109-119. 10.1097/00002508-200503000-00001.CrossRefPubMed
43.
Schonstein E, Kenny DT, Keating J, Koes BW: Work conditioning, work hardening and functional restoration for workers with back and neck pain. Cochrane Database Syst Rev. 2003
44.
Heymans MW, de Vet HC, Bongers PM, Knol DL, Koes BW, van Mechelen W: The effectiveness of high-intensity versus low-intensity back schools in an occupational setting: a pragmatic randomized controlled trial. Spine. 2006, 31: 1075-1082. 10.1097/01.brs.0000216443.46783.4d.CrossRefPubMed
45.
Staal JB, Hlobil H, Köke AJ, Twisk JW, Smid T, van Mechelen W: Graded activity for workers with low back pain: who benefits most and how does it work?. Arthritis Rheum. 2008, 59: 642-649. 10.1002/art.23570.CrossRefPubMed
46.
Linton SJ: Utility of cognitive-behavioral psychological treatments. Neck and back pain. The scientific evidence of causes, diagnosis, and treatment. Edited by: Nachemson A, Jonson E. 2000, Philadelphia: Lippincott, Williams & Williams, 361-381.
47.
Goosens M, Evers S: Cost-effectiveness of treatment for neck and low back pain. Neck and back pain. The scientific evidence of causes, diagnosis, and treatment. Edited by: Nachemson A, Jonson E. 2000, Philadelphia: Lippincott, Williams & Williams, 399-419.
48.
Wewers ME, Lowe NK: A critical review of visual analogue scales in the measurement of clinical phenomena. Res Nurs Health. 1990, 13: 227-236. 10.1002/nur.4770130405.CrossRefPubMed
49.
Hansson E, Hansson T, Jonsson R: Predictors for work ability and disability in men and women with low-back or neck problems. Eur Spine J. 2006, 15: 780-793. 10.1007/s00586-004-0863-5.CrossRefPubMed
Metadata
Title
Subacute and chronic, non-specific back and neck pain: cognitive-behavioural rehabilitation versus primary care. A randomized controlled trial
Authors
Odd Lindell
Sven-Erik Johansson
Lars-Erik Strender
Publication date
01-12-2008
Publisher
BioMed Central
Published in
BMC Musculoskeletal Disorders / Issue 1/2008
Electronic ISSN: 1471-2474
DOI
https://doi.org/10.1186/1471-2474-9-172

Other articles of this Issue 1/2008

BMC Musculoskeletal Disorders 1/2008 Go to the issue

Study protocol

Individual and occupational risk factors for knee osteoarthritis – Study protocol of a case control study

Research article

Hydrodilatation, corticosteroids and adhesive capsulitis: A randomized controlled trial

Research article

Perioperative celecoxib administration for pain management after total knee arthroplasty – A randomized, controlled study

Research article

Extracorporeal shock waves down-regulate the expression of interleukin-10 and tumor necrosis factor-alpha in osteoarthritic chondrocytes

Research article

Agreement between a self-administered questionnaire on musculoskeletal disorders of the neck-shoulder region and a physical examination

Research article

The effect on the extracellular matrix of the deep fascia in response to leg lengthening