Subgroup analyses on return to work in sick-listed employees with low back pain in a randomised trial comparing brief and multidisciplinary intervention

Abstract

BackgroundMultidisciplinary intervention is recommended for rehabilitation of employees sick-listed for 4-12 weeks due to low back pain (LBP). However, comparison of a brief and a multidisciplinary intervention in a randomised comparative trial of sick-listed employees showed similar return to work (RTW) rates in the two groups. The aim of the present study was to identify subgroups, primarily defined by work-related baseline factors that would benefit more from the multidisciplinary intervention than from the brief intervention.MethodsA total of 351 employees sick-listed for 3-16 weeks due to LBP were recruited from their general practitioners. They received a brief or a multidisciplinary intervention. Both interventions comprised clinical examination and advice by a rehabilitation doctor and a physiotherapist. The multidisciplinary intervention also comprised assignment of a case manager, who made a rehabilitation plan in collaboration with the patient and a multidisciplinary team. Using data from a national database, we defined RTW as no sickness compensation benefit disbursement for four consecutive weeks within the first year after the intervention. At the first interview in the clinic, it was ensured that sick leave was primarily due to low back problems.Questionnaires were used to obtain data on health, disability, demographic and workplace-related factors. Cox hazard regression analyses were used with RTW as outcome measure and hazard rate ratios (HRR = HRmultidisciplinary/HRbrief) were adjusted for demographic and health-related variables. An interaction term consisting of a baseline variable*intervention group was added to the multivariable regression model to analyse whether the effects of the interventions were moderated by the baseline factor. Subsequently, a new study was performed that included 120 patients who followed the same protocol. This group was analyzed in the same way to verify the findings from the original study group.ResultsThe multidisciplinary intervention group ensured a quicker RTW than the brief intervention group in a subgroup with low job satisfaction, notably when claimants were excluded. The opposite effect was seen in the subgroup with high job satisfaction. When claimants were excluded, the effect was also in favour of the multidisciplinary intervention in subgroups characterised by no influence on work planning and groups at risk of losing their job. Inversely, the effect was in favour of the brief intervention in the subgroups who were able to influence the planning of their work and who had no risk of losing their job due to current sick leave. Interaction analysis of the data in the new study displayed similar or even more pronounced differences between subgroups in relation to intervention type.ConclusionsMultidisciplinary intervention seemed more effective than brief intervention in subgroups of patients with low job satisfaction, no influence on work planning and feeling at risk of losing their jobs due to their sick leave as compared with subgroups not fulfilling the...

Do Patients With Chronic Low Back Pain Benefit From Early Intervention Regarding Absence From Work?

“…28,29 However, the ultimate intensity of multidisciplinary treatment remains under discussion. 8,19,28 One recent study reported 20 that both brief and multidisciplinary treatments were effective, although in different subgroups. In those without work-related yellow flags, 4 the brief intervention was sufficient, while approximately one-third of the group showed better outcomes as a result of participating in multidisciplinary treatment.…”

Incapacité de travail prolongée. Revue des facteurs de risque professionnels et des stratégies d’intervention

“…Ainsi Stapelfeldt et al [39] ont étudié l'efficacité de ces interventions sur le retour au travail en analysant des sous-groupes de travailleurs aux caractéristiques psychosociales différentes. Leur analyse montre que les interventions multidisciplinaires sont surtout profitables aux populations présentant un faible niveau de satisfaction professionnelle, avec des travailleurs souffrant d'exclusion, ayant peu de prise sur la planification de leur travail et évoquant des craintes de perte de leur emploi.…”

Knowledge translation from continuing education to physiotherapy practice in classifying patients with low back pain

“…[1][2][3][4][5][6][7][8] In many countries, early LBP management is emphasized when training physiotherapists (PTs) for direct access, including Great Britain, the Netherlands, Norway, Finland, the USA, Canada, and Australia. Results of surveys for early PT management of patients with LBP have been positive, from the patient's point of view, as well as with respect to the costs associated with return to work.…”