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Randomised controlled trial of integrated care to reduce disability from chronic low back pain in working and private life
Open accessAbstract
OBJECTIVE: To evaluate the effectiveness of an integrated care programme, combining a patient directed and a workplace directed intervention, for patients with chronic low back pain. DESIGN: Population based randomised controlled trial. SETTING: Primary care (10 physiotherapy practices, one occupational health service, one occupational therapy practice) and secondary care (five hospitals). PARTICIPANTS: 134 adults aged 18-65 sick listed for at least 12 weeks owing to low back pain. INTERVENTION: Patients were randomly assigned to usual care (n=68) or integrated care (n=66). Integrated care consisted of a workplace intervention based on participatory ergonomics, involving a supervisor, and a graded activity programme based on cognitive behavioural principles. MAIN OUTCOME MEASURES: The primary outcome was the duration of time off work (work disability) due to low back pain until full sustainable return to work. Secondary outcome measures were intensity of pain and functional status. RESULTS: The median duration until sustainable return to work was 88 days in the integrated care group compared with 208 days in the usual care group (P=0.003). Integrated care was effective on return to work (hazard ratio 1.9, 95% confidence interval 1.2 to 2.8, P=0.004). After 12 months, patients in the integrated care group improved significantly more on functional status compared with patients in the usual care group (P=0.01). Improvement of pain between the groups did not differ significantly. CONCLUSION: The integrated care programme substantially reduced disability due to chronic low back pain in private and working life. Trial registration Current Controlled Trials ISRCTN28478651.
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“Most occupational rehabilitation programs described in the scientific literature use some sort of cognitive behavioral therapy approach [6, 11].”
From Effects of Inpatient Multicomponent Occupational Rehabilitation versus Less Comprehensive Outpatient Rehabilitation on Somatic and Mental Health: Secondary Outcomes of a Randomized Clinical Trial. (2017) · cites this paper as [6]
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“In contrast, Lambeek et al. [6] and Loisel et al. [7] reported that multidisciplinary occupational rehabilitation led to increased return to work and reduced disability, but with little effect on pain.”
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Self-citation
Metadata
- Authors
- Lambeek, L. C., van Mechelen, W., Knol, D. L., Loisel, P., & Anema, J. R.
- Affiliations
- Amsterdam Public Health (NL)
- University of Toronto (CA)
- Corresponding author
- Anema, J. R
- ORCID
- Anema, J. R
- Venue
- BMJ
- Publisher
- BMJ
- Published
- 2010-03-16
- Volume
- 340
- Issue
- mar16 1
- Pages
- c1035-c1035
- ISSN
- 0007-1447 (ISSN-L)
- 0959-8138
- 1468-5833
- PMC
- PMC2840223
- OpenAlex
- W2028702370
- Cited by
- 293
- References
- 38
- Citations by year
- 2026: 11 · 2025: 9 · 2024: 10 · 2023: 14 · 2022: 13 · 2021: 15 · 2020: 13 · 2019: 17 · 2018: 17 · 2017: 19 · 2016: 22 · 2015: 28 · 2014: 16 · 2013: 22 · 2012: 27
- FWCI
- 21.00
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- cc-by-nc
- Locations
- BMJ (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- Amsterdam UMC (VU Amsterdam) - Institutional Repository (publishedVersion)
- VU Research Portal (publishedVersion, other-oa)
- HighWire Press Open Archive (submittedVersion)
- Pure Amsterdam UMC (submittedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- Funders
- ZonMw
- Vrije Universiteit Amsterdam
- Instituut Gak
- Canadian Institutes of Health Research (FRN53909)
- Topics
- Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Musculoskeletal pain and rehabilitation
- Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Medical Practices and Rehabilitation
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Workplace Health and Well-being
- Keywords
- chronic low back pain, integrated care, return to work, sick leave, work disability, participatory ergonomics, workplace interventions, cognitive behavioral therapy, functional status, pain intensity, occupational health
- MeSH terms
- Adolescent, Adult, Aged, Chronic Disease, Female, Persons with Disabilities, Disabled Persons, Hospitalization, Humans, Male, Middle Aged, Occupational Health Services, Occupational Therapy, Patient Compliance, Surveys and Questionnaires, Rehabilitation, Vocational, Program Evaluation, Treatment Outcome, Low Back Pain, Delivery of Health Care, Integrated, Physical Therapy Modalities, Young Adult
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