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

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
BMC Public Health
Published in: BMC Public Health 1/2018

Open Access 01-12-2018 | Research article

Effectiveness of three interventions for secondary prevention of low back pain in the occupational health setting - a randomised controlled trial with a natural course control

Authors: J. Rantonen, J. Karppinen, A. Vehtari, S. Luoto, E. Viikari-Juntura, M. Hupli, A. Malmivaara, S. Taimela

Published in: BMC Public Health | Issue 1/2018

Login to get access

Abstract

Background

We assessed the effectiveness of three interventions that were aimed to reduce non-acute low back pain (LBP) related symptoms in the occupational health setting.

Methods

Based on a survey (n = 2480; response rate 71%) on LBP, we selected a cohort of 193 employees who reported moderate LBP (Visual Analogue Scale VAS > 34 mm) and fulfilled at least one of the following criteria during the past 12 months: sciatica, recurrence of LBP ≥ 2 times, LBP ≥ 2 weeks, or previous sickness absence. A random sample was extracted from the cohort as a control group (Control, n = 50), representing the natural course of LBP. The remaining 143 employees were invited to participate in a randomised controlled trial (RCT) of three 1:1:1 allocated parallel intervention arms: multidisciplinary rehabilitation (Rehab, n = 43); progressive exercises (Physio, n = 43) and self-care advice (Advice, n = 40). Seventeen employees declined participation in the intervention. The primary outcome measures were physical impairment (PHI), LBP intensity (Visual Analogue Scale), health related quality of life (QoL), and accumulated sickness absence days. We imputed missing values with multiple imputation procedure. We assessed all comparisons between the intervention groups and the Control group by analysing questionnaire outcomes at 2 years with ANOVA and sickness absence at 4 years by using negative binomial model with a logarithmic link function.

Results

Mean differences between the Rehab and Control groups were − 3 [95% CI -5 to − 1] for PHI, − 13 [− 24 to − 1] for pain intensity, and 0.06 [0.00 to 0.12] for QoL. Mean differences between the Physio and Control groups were − 3 [95% CI -5 to − 1] for PHI, − 13 [− 29 to 2] for pain intensity, and 0.07 [0.01 to 0.13] for QoL. The main effects sizes were from 0.4 to 0.6. The interventions were not effective in reducing sickness absence.

Conclusions

Rehab and Physio interventions improved health related quality of life, decreased low back pain and physical impairment in non-acute, moderate LBP, but we found no differences between the Advice and Control group results. No effectiveness on sickness absence was observed.

Trial registration

Number NCT00908102 Clinicaltrials.gov
Literature
1.
Balagué F, Mannion AF, Pellisé F, Cedraschi C. Non-specific low back pain. Lancet. 2012;379(9814):482–91.CrossRefPubMed
2.
Stanton TR, Latimer J, Maher CG, Hancock MJ. How do we define the condition ‘recurrent low back pain’? A systematic review. Eur Spine J. 2010;19(4):533–9.CrossRefPubMed
3.
Hoy D, Brooks P, Blyth F, Buchbinder R. The epidemiology of low back pain. Best Pract Res Clin Rheumatol. 2010;24(6):769–81.CrossRefPubMed
4.
Hoy D, March L, Brooks P, Woolf A, Blyth F, Vos T, Buchbinder R. Measuring the global burden of low back pain. Best Pract Res Clin Rheumatol. 2010;24(2):155–65.CrossRefPubMed
5.
Burton AK, Balague F, Cardon G, Eriksen HR, Henrotin Y, Lahad A, Leclerc A, Muller G, van der Beek AJ. Chapter 2. European guidelines for prevention in low back pain : November 2004. Eur Spine J. 2006;15 Suppl 2:S136–68.CrossRefPubMed
6.
Hoy D, March L, Brooks P, Blyth F, Woolf A, Bain C, Williams G, Smith E, Vos T, Barendregt J, et al. The global burden of low back pain: estimates from the global burden of disease 2010 study. Ann Rheum Dis. 2014;73(6):968–74.CrossRefPubMed
7.
Steenstra IA, Anema JR, van Tulder MW, Bongers PM, de Vet HC, van Mechelen W. Economic evaluation of a multi-stage return to work program for workers on sick-leave due to low back pain. J Occup Rehabil. 2006;16(4):557–78.CrossRefPubMed
8.
Choi KLB, Verbeek JH, Tam WW, Jiang JYY. Exercises for prevention of recurrences of low-back pain. Cochrane Database Syst Rev. 2011;(2).
9.
Schaafsma FG, Anema JR, van der Beek AJ. Back pain: prevention and management in the workplace. Best Pract Res Clin Rheumatol. 2015;29(3):483–94.CrossRefPubMed
10.
Mairiaux P, Loomis D. Randomised trials on secondary prevention of low back pain in occupational settings. Occup Environ Med. 2012;69(1):1–2.CrossRefPubMed
11.
Steffens D, Maher CG, Pereira LM, et al. Prevention of low back pain: a systematic review and meta-analysis. JAMA Intern Med. 2016;176(2):199–208.CrossRefPubMed
12.
Staal JB, Hlobil H, Twisk JW, Smid T, Koke AJ, van Mechelen W. Graded activity for low back pain in occupational health care: a randomized, controlled trial. Ann Intern Med. 2004;140(2):77–84.CrossRefPubMed
13.
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 (Phila Pa 1976). 2007;32(3):291–8.CrossRef
14.
Loisel P, Abenhaim L, Durand P, Esdaile JM, Suissa S, Gosselin L, Simard R, Turcotte J, Lemaire J. A population-based, randomized clinical trial on back pain management. Spine (Phila Pa 1976). 1997;22(24):2911–8.CrossRef
15.
Hlobil H, Uegaki K, Staal JB, de Bruyne MC, Smid T, van Mechelen W. Substantial sick-leave costs savings due to a graded activity intervention for workers with non-specific sub-acute low back pain. Eur Spine J. 2007;16(7):919–24.CrossRefPubMed
16.
Lambeek LC, van Mechelen W, Knol DL, Loisel P, Anema JR. Randomised controlled trial of integrated care to reduce disability from chronic low back pain in working and private life. BMJ. 2010;340:c1035.CrossRefPubMedPubMedCentral
17.
18.
Kamper SJ, Apeldoorn AT, Chiarotto A, Smeets RJ, Ostelo RW, Guzman J, van Tulder MW. Multidisciplinary biopsychosocial rehabilitation for chronic low back pain: Cochrane systematic review and meta-analysis. BMJ. 2015;350:h444.
19.
Karjalainen K, Malmivaara A, van Tulder M, Roine R, Jauhiainen M, Hurri H, Koes B. Multidisciplinary biopsychosocial rehabilitation for subacute low back pain among working age adults. Cochrane Database Syst Rev. 2008(3):CD002193.
20.
Suni J, Rinne M, Natri A, Statistisian MP, Parkkari J, Alaranta H. Control of the lumbar neutral zone decreases low back pain and improves self-evaluated work ability: a 12-month randomized controlled study. Spine (Phila Pa 1976). 2006;31(18):E611–20.CrossRef
21.
Rantonen J, Luoto S, Vehtari A, Hupli M, Karppinen J, Malmivaara A, Taimela S. The effectiveness of two active interventions compared to self-care advice in employees with non-acute low back symptoms: a randomised, controlled trial with a 4-year follow-up in the occupational health setting. Occup Environ Med. 2012;69(1):12–20.CrossRefPubMed
22.
Rantonen J, Vehtari A, Karppinen J, Luoto S, Viikari-Juntura E, Hupli M, Malmivaara A, Taimela S. Face-to-face information combined with a booklet versus a booklet alone for treatment of mild low-back pain: a randomized controlled trial. Scand J Work Environ Health. 2014;40(2):156–66.CrossRefPubMed
23.
Burton AK, Waddell G, Tillotson KM, Summerton N. Information and advice to patients with back pain can have a positive effect. A randomized controlled trial of a novel educational booklet in primary care. Spine. 1999;24(23):2484–91.CrossRefPubMed
24.
WHO. International statistical classification of diseases and related health problems (ICD-10). In: 10th revision. Geneva: World Health Organization; 2003.
25.
Stratford PW, Binkley JM. Measurement properties of the RM-18. A modified version of the Roland- Morris disability scale. Spine. 1997;22(20):2416–21.CrossRefPubMed
26.
Jordan K, Dunn KM, Lewis M, Croft P. A minimal clinically important difference was derived for the Roland-Morris disability questionnaire for low back pain. J Clin Epidemiol. 2006;59(1):45–52.CrossRefPubMed
27.
Million R, Hall W, Nilsen KH, Baker RD, Jayson MI. Assessment of the progress of the back-pain patient 1981 Volvo award in clinical science. Spine. 1982;7(3):204–12.CrossRefPubMed
28.
Hawker GA, Mian S, Kendzerska T, French M. Measures of adult pain: visual analog scale for pain (VAS pain), numeric rating scale for pain (NRS pain), McGill pain questionnaire (MPQ), short-form McGill pain questionnaire (SF-MPQ), chronic pain grade scale (CPGS), short Form-36 bodily pain scale (SF-36 BPS), and measure of intermittent and constant osteoarthritis pain (ICOAP). Arthritis Care Res (Hoboken). 2011;63(Suppl 11):S240–52.CrossRef
29.
Sintonen H. The 15D instrument of health-related quality of life: properties and applications. Ann Med. 2001;33(5):328–36.CrossRefPubMed
30.
Niemisto L, Rissanen P, Sarna S, Lahtinen-Suopanki T, Lindgren KA, Hurri H. Cost-effectiveness of combined manipulation, stabilizing exercises, and physician consultation compared to physician consultation alone for chronic low back pain: a prospective randomized trial with 2-year follow-up. Spine (Phila Pa 1976). 2005;30(10):1109–15.CrossRef
31.
Fairbank JC, Couper J, Davies JB, O'Brien JP. The Oswestry low back pain disability questionnaire. Physiotherapy. 1980;66(8):271–3.PubMed
32.
Roland M, Fairbank J. The Roland-Morris disability questionnaire and the Oswestry disability questionnaire. Spine. 2000;25(24):3115–24.CrossRefPubMed
33.
Waddell G, Newton M, Henderson I, Somerville D, Main CJ. A fear-avoidance beliefs questionnaire (FABQ) and the role of fear-avoidance beliefs in chronic low back pain and disability. Pain. 1993;52(2):157–68.CrossRefPubMed
34.
Wertli MM, Rasmussen-Barr E, Held U, Weiser S, Bachmann LM, Brunner F. Fear-avoidance beliefs—a moderator of treatment efficacy in patients with low back pain: a systematic review. Spine J. 2014;14(11):2658–78.CrossRefPubMed
35.
Wertli MM, Rasmussen-Barr E, Weiser S, Bachmann LM, Brunner F. The role of fear avoidance beliefs as a prognostic factor for outcome in patients with nonspecific low back pain: a systematic review. Spine J. 2014;14(5):816–836.e814.CrossRefPubMed
36.
Burton A, Billingham LJ, Bryan S. Cost-effectiveness in clinical trials: using multiple imputation to deal with incomplete cost data. Clin Trials. 2007;4(2):154–61.CrossRefPubMed
37.
Ellis PD. The essential guide to effect sizes: statistical power, meta-analysis, and the interpretation of research results. New York: Cambridge University Press; 2010.
38.
Marmot M, Feeney A, Shipley M, North F, Syme SL. Sickness absence as a measure of health status and functioning: from the UK Whitehall II study. J Epidemiol Community Health. 1995;49(2):124–30.CrossRefPubMedPubMedCentral
39.
Kivimaki M, Head J, Ferrie JE, Shipley MJ, Vahtera J, Marmot MG. Sickness absence as a global measure of health: evidence from mortality in the Whitehall II prospective cohort study. BMJ. 2003;327(7411):364.CrossRefPubMedPubMedCentral
40.
Thorsen ST, Friborg C, Lundstrøm B, Kausto J, Örnelius K, Sundell T, Kalstø Å, Thune O, Gross B-O, Petersen H, et al. Sickness absence in the Nordic countries. Copenhagen: Nordic Social Statistical Committee; 2015.
41.
Spratt M, Carpenter J, Sterne JAC, Carlin JB, Heron J, Henderson J, Tilling K. Strategies for multiple imputation in longitudinal studies. Am J Epidemiol. 2010;172(4):478–87.CrossRefPubMed
42.
Sterne JAC, White IR, Carlin JB, Spratt M, Royston P, Kenward MG, Wood AM, Carpenter JR. Multiple imputation for missing data in epidemiological and clinical research: potential and pitfalls. The BMJ. 2009;338:b2393.CrossRefPubMedPubMedCentral
43.
Lamb SE, Hansen Z, Lall R, Castelnuovo E, Withers EJ, Nichols V, Potter R, Underwood MR. Group cognitive behavioural treatment for low-back pain in primary care: a randomised controlled trial and cost-effectiveness analysis. Lancet. 2010;375(9718):916–23.CrossRefPubMed
44.
Jellema P, van der Roer N, van der Windt DA, van Tulder MW, van der Horst HE, Stalman WA, Bouter LM. Low back pain in general practice: cost-effectiveness of a minimal psychosocial intervention versus usual care. Eur Spine J. 2007;16(11):1812–21.CrossRefPubMedPubMedCentral
45.
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(11):718–25.CrossRefPubMedPubMedCentral
46.
Lamb SE, Lall R, Hansen Z, Castelnuovo E, Withers EJ, Nichols V, Griffiths F, Potter R, Szczepura A, Underwood M. A multicentred randomised controlled trial of a primary care-based cognitive behavioural programme for low back pain. The back skills training (BeST) trial. Health Technol Assess. 2010;14(41):1–253. iii-ivCrossRefPubMed
47.
Hay EM, Dunn KM, Hill JC, Lewis M, Mason EE, Konstantinou K, Sowden G, Somerville S, Vohora K, Whitehurst D, et al. A randomised clinical trial of subgrouping and targeted treatment for low back pain compared with best current care. The STarT back trial study protocol. BMC Musculoskelet Disord. 2008;9:58.CrossRefPubMedPubMedCentral
48.
Hill JC, Whitehurst DGT, Lewis M, Bryan S, Dunn KM, Foster NE, Konstantinou K, Main CJ, Mason E, Somerville S, et al. Comparison of stratified primary care management for low back pain with current best practice (STarT back): a randomised controlled trial. Lancet. 2011;378(9802):1560–71.CrossRefPubMedPubMedCentral
49.
Rantonen J, Karppinen J, Vehtari A, Luoto S, Viikari-Juntura E, Hupli M, Malmivaara A, Taimela S. Cost-effectiveness of providing patients with information on managing mild low-back symptoms in an occupational health setting. BMC Public Health. 2016;16(1):316.CrossRefPubMedPubMedCentral
50.
Liddle SD, Gracey JH, Baxter GD. Advice for the management of low back pain: a systematic review of randomised controlled trials. Man Ther. 2007;12(4):310–27.CrossRefPubMed
51.
Rolli Salathé C, Melloh M, Mannion AF, Tamcan Ö, Müller U, Boos N, Elfering A. Resources for preventing sickness absence due to low back pain. Occup Med. 2012;62(4):273–80.CrossRef
52.
van Oostrom SH, Driessen MT, de Vet HC, Franche RL, Schonstein E, Loisel P, van Mechelen W, Anema JR. Workplace interventions for preventing work disability. Cochrane Database Syst Rev. 2009;(2):CD006955.
53.
Haukka E. Musculoskeletal disorders and psychosocial factors at work. Effects of a participatory ergonomics intervention in a cluster randomized controlled trial. Helsinki: University of Helsinki; 2010.
54.
Driessen MT, Proper KI, van Tulder MW, Anema JR, Bongers PM, van der Beek AJ. The effectiveness of physical and organisational ergonomic interventions on low back pain and neck pain: a systematic review. Occup Environ Med. 2010;67(4):277–85.CrossRefPubMed
55.
Kaaria S, Luukkonen R, Riihimaki H, Kirjonen J, Leino-Arjas P. Persistence of low back pain reporting among a cohort of employees in a metal corporation: a study with 5-, 10-, and 28-year follow-ups. Pain. 2006;120(1–2):131–7.CrossRefPubMed
56.
Hall AM, Maher CG, Latimer J, Ferreira ML, Costa LO. The patient-specific functional scale is more responsive than the Roland Morris disability questionnaire when activity limitation is low. Eur Spine J. 2011;20(1):79–86.CrossRefPubMed
Metadata
Title
Effectiveness of three interventions for secondary prevention of low back pain in the occupational health setting - a randomised controlled trial with a natural course control
Authors
J. Rantonen
J. Karppinen
A. Vehtari
S. Luoto
E. Viikari-Juntura
M. Hupli
A. Malmivaara
S. Taimela
Publication date
01-12-2018
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2018
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/s12889-018-5476-8

Other articles of this Issue 1/2018

BMC Public Health 1/2018 Go to the issue

Research article

Subjective and objective assessment of sedentary behavior among college employees

Research article

A postpartum vaccination promotion intervention using motivational interviewing techniques improves short-term vaccine coverage: PromoVac study

Study protocol

Protocol for evaluating the impact of a national school policy on physical activity levels in Danish children and adolescents: the PHASAR study - a natural experiment

Research article

Liquor licences issued to Australian schools

Research article

The impact of a private sector living wage intervention on consumption and cardiovascular disease risk factors in a middle income country

Correction

Correction to: Factors associated with late presentation of cervical cancer cases at a district hospital: a retrospective study