Change in pain, disability and influence of fear-avoidance in a work-focused intervention on neck and back pain: a randomized controlled trial
Open accessAbstract
BACKGROUND: Neck and back pain are among the most common causes of prolonged disability, and development of interventions with effect on pain, disability and return to work is important. Reduction of fear avoidance might be one mechanism behind improvement after interventions. The aim of the present study was to evaluate changes in pain and disability at the 12-month follow-up of patients with neck and back pain treated with a work-focused intervention compared to patients treated with standard interventions, and the influence of improvement fear avoidance beliefs during the interventions on pain, disability and return to work at 12-month follow-up. METHODS: 413 employed patients with back or neck pain referred to secondary care, and sick-listed between 4 weeks and 12 months, were randomized to a work-focused rehabilitation or control interventions. Follow-up was conducted 4 and 12 months after inclusion. The groups were compared (independent sample t-test) regarding differences in disability scores (Oswestry disability index/neck disability index) and pain (numeric rating scale) from baseline to 12-month follow-up. Changes in fear avoidance beliefs (FABQ) from baseline to 4 month follow-up were calculated, and the association between this change and return to work, pain and disability at 12 months were tested in stepwise multiple logistic regression models. RESULTS: Pain and, disability scores decreased to in both the work-focused and control intervention to 12-month follow-up, and there were no significant differences between the groups. FABQ decreased similarly in both groups to 4 month follow-up. The logistic regression model revealed an association between a reduced FABQ work score at 4 months and return to work within one year (adjusted OR 3.60, 95% CI 1.19 to 10.88). Reduced FABQ physical activity score at 4 months was associated with decreased disability after 12 months (adjusted OR (3.65. 95% CI 1.43 to 9.28). CONCLUSIONS: Short work-focused rehabilitation had the same effect on pain and disability as control interventions. Reduction in FABQ-W score after treatment seems to be an important predictor for return to work in both groups. TRIAL REGISTRATION: Clinicaltrials.gov NCT00840697.
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The finding of no substantial difference on somatic and mental health outcomes between the two rehabilitation programs is in line with some earlier studies on individuals with musculoskeletal complaints and mental health disorders.
“No substantial difference on somatic and mental health outcomes between the two rehabilitation programs is in line with some earlier studies on individuals with musculoskeletal complaints [5, 32] and mental health disorders [9].”
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- Authors
- Marchand, G. H., Myhre, K., Leivseth, G., Sandvik, L., Lau, B., Bautz-Holter, E., & Røe, C.
- Affiliations
- Norwegian University of Science and Technology (NO)
- Oslo University Hospital (NO)
- National Institute of Occupational Health (NO)
- Corresponding author
- Marchand, Gunn Hege
- Venue
- BMC Musculoskeletal Disorders
- Published
- 2015-04-21
- Volume
- 16
- Issue
- 1
- Pages
- 94-94
- ISSN
- 1471-2474 (ISSN-L)
- PMC
- PMC4410457
- OpenAlex
- W2061918260
- Cited by
- 41
- References
- 64
- Citations by year
- 2025: 2 · 2024: 6 · 2023: 2 · 2021: 4 · 2020: 8 · 2019: 3 · 2018: 6 · 2017: 4 · 2016: 4 · 2015: 1
- FWCI
- 3.61
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- BMC Musculoskeletal Disorders (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- BIBSYS Brage (BIBSYS (Norway)) (submittedVersion)
- NORA - Norwegian Open Research Archives (submittedVersion, other-oa)
- NORA - Norwegian Open Research Archives (submittedVersion, cc-by)
- Funders
- Norges Forskningsråd
- 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
- neck pain, back pain, fear-avoidance beliefs, return to work, disability, pain, sick leave, Oswestry Disability Index, Neck Disability Index, Fear-Avoidance Beliefs Questionnaire
- MeSH terms
- Adult, Avoidance Learning, Back Pain, Disability Evaluation, Fear, Female, Disabled Persons, Persons with Disabilities, Humans, Male, Middle Aged, Occupational Health, Neck Pain
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