Subacute and chronic, non-specific back and neck pain: cognitive-behavioural rehabilitation versus primary care. A randomized controlled trial
Open accessAbstract
BACKGROUND: In the industrial world, non-specific back and neck pain (BNP) is the largest diagnostic group underlying sick-listing. For patients with subacute and chronic (= full-time sick-listed for 43 - 84 and 85 - 730 days, respectively) BNP, cognitive-behavioural rehabilitation was compared with primary care. The specific aim was to answer the question: within an 18-month follow-up, will the outcomes differ in respect of sick-listing and number of health-care visits? METHODS: After stratification by age (< or = 44/> or = 45 years) and subacute/chronic BNP, 125 Swedish primary-care patients were randomly allocated to cognitive-behavioural rehabilitation (rehabilitation group) or continued primary care (primary-care group). Outcome measures were Return-to-work share (percentage) and Return-to-work chance (hazard ratios) over 18 months, Net days (crude sick-listing days x degree), and the number of Visits (to physicians, physiotherapists etc.) over 18 months and the three component six-month periods. Descriptive statistics, Cox regression and mixed-linear models were used. RESULTS: All patients: Return-to-work share and Return-to-work chance were equivalent between the groups. Net days and Visits were equivalent over 18 months but decreased significantly more rapidly for the rehabilitation group over the six-month periods (p < .05). Subacute patients: Return-to-work share was equivalent. Return-to-work chance was significantly greater for the rehabilitation group (hazard ratio 3.5 [95%CI1.001 - 12.2]). Net days were equivalent over 18 months but decreased significantly more rapidly for the rehabilitation group over the six-month periods and there were 31 days fewer in the third period. Visits showed similar though non-significant differences and there were half as many in the third period. Chronic patients: Return-to-work share, Return-to-work chance and Net days were equivalent. Visits were equivalent over 18 months but tended to decrease more rapidly for the rehabilitation group and there were half as many in the third period (non-significant). CONCLUSION: The results were equivalent over 18 months. However, there were indications that cognitive-behavioural rehabilitation in the longer run might be superior to primary care. For subacute BNP, it might be superior in terms of sick-listing and health-care visits; for chronic BNP, in terms of health-care visits only. More conclusive results concerning this possible long-term effect might require a longer follow-up.
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For Lindell 2008, blinding of outcome assessment was judged high risk because assessors were not blind to treatment condition, except for the sick-listing outcome.
“High risk Assessors not blind to treatment condition, except for sick-listing outcome”
From Psychological therapies for the management of chronic pain (excluding headache) in adults (2020) · cites this paper as Lindell 2008
For Lindell 2008, random sequence generation was judged low risk because a computerised block randomisation procedure was used.
“Low risk Computerised block randomisation procedure”
From Psychological therapies for the management of chronic pain (excluding headache) in adults (2020) · cites this paper as Lindell 2008
For Lindell 2008, allocation concealment was judged low risk because randomisation was generated by an independent statistician and placed in opaque envelopes.
“Low risk Randomisation generated by independent statistician; in opaque envelopes”
From Psychological therapies for the management of chronic pain (excluding headache) in adults (2020) · cites this paper as Lindell 2008
For Lindell 2008, selective reporting was judged unclear risk because the trial protocol was not published.
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The Methods > Analyses and statistics passage mentions a per-protocol analysis, not a published trial protocol. Searches for a trial protocol and selective reporting found no passage stating whether a protocol was published or assessing the risk of selective reporting; the cited trial therefore does not verify the citing authors’ judgment. Page numbers are unavailable in our copy. (LLM, conf=0.70)
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- Authors
- Lindell, O., Johansson, S.-E., & Strender, L.-E.
- Affiliations
- Karolinska Institutet (SE)
- Corresponding author
- Lindell, Odd
- ORCID
- Johansson, Sven-Erik
- Venue
- BMC Musculoskeletal Disorders
- Published
- 2008-12
- Volume
- 9
- Issue
- 1
- Pages
- 172-172
- ISSN
- 1471-2474 (ISSN-L)
- PMC
- PMC2649916
- OpenAlex
- W2087457633
- Cited by
- 28
- References
- 45
- Citations by year
- 2024: 1 · 2023: 2 · 2022: 2 · 2020: 1 · 2019: 1 · 2018: 3 · 2016: 1 · 2015: 3 · 2014: 2 · 2013: 1 · 2012: 5
- FWCI
- 1.41
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- BMC Musculoskeletal Disorders (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- Pfizer
- Vårdalstiftelsen
- Stockholms Läns Landsting
- Socialdepartementet
- 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
- non-specific back pain, non-specific neck pain, subacute low back pain, chronic low back pain, primary care, sick-listing, return to work, medical visits, sick leave, physiotherapy, occupational health services, Swedish National Board of Health and Welfare
- MeSH terms
- Acute Disease, Adult, Back Pain, Chronic Disease, Female, Follow-Up Studies, Humans, Male, Middle Aged, Pain Measurement, Primary Health Care, Cognitive Behavioral Therapy, Treatment Outcome, Neck Pain
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