The Effects of Cognitive-Behavioral and Physical Therapy Preventive Interventions on Pain-Related Sick Leave: A Randomized Controlled Trial
Abstract
OBJECTIVE: Recent recommendations suggest that reassuring patients with an acute bout of low back pain and encouraging a return to normal activities may be helpful in preventing the development of chronic disability. There is also a question as to whether psychologic or physical therapy interventions actually add anything to such reassurance and advice in terms of preventing chronicity. This study aimed to ascertain the preventive effects on future sick leave and health-care utilization of adding on a cognitive-behavioral group intervention or a cognitive-behavioral group intervention and preventive physical therapy (focused on activity and exercise) relative to a minimal treatment group (examination, reassurance, and activity advice). SUBJECTS: A total of 185 patients seeking care for nonspecific back or neck pain who were employed and at risk for developing long-term disability volunteered to participate in the study. Of these 185, 158 (85%) completed the pre- and 1-year follow-up assessments. RESULTS: Significant differences were observed on the key outcome variables of future health-care utilization and work absenteeism. For health-care utilization, the cognitive-behavioral intervention group and preventive physical therapy group had significantly fewer healthcare visits than did the Minimal Treatment Group. For work absenteeism, the cognitive-behavioral intervention group and cognitive-behavioral intervention and preventive physical therapy group had fewer days during the 12-month follow-up than did the Minimal Treatment Group. The risk for developing long-term sick disability leave was more than five-fold higher in the Minimal Group as compared with the other 2 groups. However, there was no difference between the cognitive-behavioral intervention group and cognitive-behavioral intervention and preventive physical therapy group on sick leave. CONCLUSION: Taken as a whole, this study shows that adding cognitive-behavioral intervention and cognitive-behavioral intervention and preventive physical therapy can enhance the prevention of long-term disability. There was no substantial difference in the results between the cognitive-behavioral intervention group and cognitive-behavioral intervention and preventive physical therapy group.
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Studies have noted that ACT and PT reduce pain behaviors such as less sick leave and medical visits, whereas CBT prevents taking more sick leave and medical visits in the future.
“Studies have noted that ACT [36, 37] and PT [38] reduce pain behaviors such as less sick leave and medical visits whereas CBT prevents from taking more sick leave and medical visits in the future [39].”
From Effectiveness of a multidisciplinary rehabilitation program in real-world patients with chronic back pain: A pilot cohort data analysis (2021) · cites this paper as [39]
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- Authors
- Linton, S. J., Boersma, K., Jansson, M., Sv??rd, L., & Botvalde, M.
- Affiliations
- Örebro University Hospital (SE)
- Örebro University (SE)
- Corresponding author
- Linton, Steven J.
- Boersma, Katja
- Venue
- The Clinical Journal of Pain
- Published
- 2005-03
- Volume
- 21
- Issue
- 2
- Pages
- 109-119
- ISSN
- 0749-8047 (ISSN-L)
- OpenAlex
- W2023196035
- Cited by
- 196
- References
- 44
- Citations by year
- 2026: 3 · 2025: 2 · 2023: 8 · 2022: 1 · 2021: 6 · 2020: 5 · 2019: 7 · 2018: 9 · 2017: 6 · 2016: 6 · 2015: 9 · 2014: 12 · 2013: 14 · 2012: 14
- FWCI
- 10.39
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Clinical Journal of Pain (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
- Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Medical Practices and Rehabilitation
- Health Sciences › Health Professions › General Health Professions › Workplace Health and Well-being
- Keywords
- low back pain, neck pain, cognitive-behavioral intervention, sick leave, absenteeism, health care utilization, exercise therapy, return to work
- MeSH terms
- Back Pain, Combined Modality Therapy, Disability Evaluation, Employment, Female, Humans, Male, Middle Aged, Prognosis, Risk Factors, Sweden, Cognitive Behavioral Therapy, Treatment Outcome, Outcome Assessment, Health Care, Risk Assessment, Sick Leave, Neck Pain, Physical Therapy Specialty
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