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Objective Evaluate the effectiveness of two active interventions, aimed at secondary prevention of low back pain (LBP), in occupational health. Methods We performed a survey of LBP (n¼2480; response rate 71%) and randomized 143 employees (66% males, 45 years) with LBP over 34 mm on VAS into Rehabilitation (n¼43), Exercise (n¼43) or self-care (n¼40) groups. Primary outcomes were LBP, physical impairment (PI) and health-related quality of life (HRQoL) for two years and sickness absence (SA) days during four years (LBP specific, total). Results Compared to self-care, exercise reduced LBP at 12 months (mean difference (MD) À12 mm; 95% CI À21 to À2) and improved HRQoL at 12 and 24 months (0.03; 0.00 to 0.05), but did not reduce PI. The MDs of SA days in four years were À17 (À70 to 35, total) and À15 (À47 to 13, LBP specific). Exercise reduced the probability of LBP specific SA during the third and fourth year. Compared to self-care, Rehabilitation reduced LBP at 3 months (À10 mm; À19 to À1) and 6 months (À10 mm; À20 to À 1), but was not effective in HRQoL or PI. The MDs of SA days in four years were À41 (À93 to 8; total) and 5 (À30 to 47; LBP specific). Rehabilitation reduced the probability of total SA during first and second year and amount of total SA days in the fourth year. Conclusions Among employees with relatively mild LBP, both interventions reduced pain, but the effects on SA and PI were minor. Exercise improved HRQoL. The effect sizes were rather small. Trial registration Number ClinicalTrials.gov NCT00908102.

The Finnish translation of the SBST is linguistically accurate and has been adapted to the Finnish-speaking population. It showed to be a valid and reliable instrument and comparable with the original English version. Therefore, it may be used in clinical work with Finnish LBP patients.