Can group-based reassuring information alter low back pain behavior? A cluster-randomized controlled trial

Abstract

BackgroundLow back pain (LBP) is common in the population and multifactorial in nature, often involving negative consequences. Reassuring information to improve coping is recommended for reducing the negative consequences of LBP. Adding a simple non-threatening explanation for the pain (temporary muscular dysfunction) has been successful at altering beliefs and behavior when delivered with other intervention elements. This study investigates the isolated effect of this specific information on future occupational behavior outcomes when delivered to the workforce.DesignA cluster-randomized controlled trial.MethodsPublically employed workers (n = 505) from 11 Danish municipality centers were randomized at center-level (cluster) to either intervention (two 1-hour group-based talks at the workplace) or control. The talks provided reassuring information together with a simple non-threatening explanation for LBP—the ‘functional-disturbance’-model. Data collections took place monthly over a 1-year period using text message tracking (SMS). Primary outcomes were self-reported days of cutting down usual activities and work participation. Secondary outcomes were self-reported back beliefs, work ability, number of healthcare visits, bothersomeness, restricted activity, use of pain medication, and sadness/depression.ResultsThere was no between-group difference in the development of LBP during follow-up. Cumulative logistic regression analyses showed no between-group difference on days of cutting down activities, but increased odds for more days of work participation in the intervention group (OR = 1.83 95% CI: 1.08–3.12). Furthermore, the intervention group was more likely to report: higher work ability, reduced visits to healthcare professionals, lower bothersomeness, lower levels of sadness/depression, and positive back beliefs.ConclusionReassuring information involving a simple non-threatening explanation for LBP significantly increased the odds for days of work participation and higher work ability among workers who went on to experience LBP during the 12-month follow-up. Our results confirm the potential for public-health education for LBP, and add to the discussion of simple versus multidisciplinary interventions.

Can beliefs about musculoskeletal pain and work be changed at the national level? Prospective evaluation of the Danish national Job & Body campaign

“…A prospective study in a factory setting showed that distribution of an educational psychosocial pamphlet improved beliefs about pain control and consequences of low-back pain (21). A recent randomized controlled trial (RCT) among public-sector employees found reduced sickness absence due to low-back pain -in spite of unchanged low-back pain intensity -from group-based reassuring information and a non-threatening explanation for low-back pain to alter beliefs about back pain and activity (22). Hence, beliefs related to musculoskeletal pain, movement and work are modifiable and can lead to altered sickness behavior (22).…”

“…A recent randomized controlled trial (RCT) among public-sector employees found reduced sickness absence due to low-back pain -in spite of unchanged low-back pain intensity -from group-based reassuring information and a non-threatening explanation for low-back pain to alter beliefs about back pain and activity (22). Hence, beliefs related to musculoskeletal pain, movement and work are modifiable and can lead to altered sickness behavior (22). However, the translation from research to practice -especially when going from a workplace study to the society level -can be challenging.…”

Fear Avoidance Beliefs and Risk of Long-Term Sickness Absence: Prospective Cohort Study among Workers with Musculoskeletal Pain

“…Further, Godges et al [ 21 ] found that education and pain management counselling, physical activity, and exercise can reduce the number sick days in people with high fear avoidance beliefs and acute low back pain compared with standard physical therapy [ 21 ]. In addition, Frederiksen et al [ 22 ] recently found in a cluster-randomized controlled trial that reassuring information delivered in a nonthreatening manner, about low back pain significantly, increased the odds for work participation and work ability among workers who experienced low back pain in a 12-month period [ 22 ]. These findings fit well with the biopsychosocial model first proposed by Engel [ 3 ] explaining the interconnected influence of biomedical, psychological, and social aspects of behavior in pain [ 3 , 23 ].…”

Education as a strategy for managing occupational-related musculoskeletal pain: a scoping review

“…Furthermore, communicating education about work-related pain and individualised advice could be essential for the management of persistent MSK pain 16–18. In fact, communication of non-threatening information about MSK pain may reduce absenteeism 19 20. However, an overview of educational material for employees for the self-management of WMSK pain and implementation strategies for pain management within the workplace is lacking.…”