Brief intervention as effective as multidisciplinary for lower back pain
MedWire News: A brief intervention for increasing return to work (RTW) rates and improving health in sick-listed employees with lower back pain (LBP) is as effective as hospital-based multidisciplinary interventions, suggest study findings.
"Previous studies in sick-listed employees with LBP have indicated efficacy of both brief and more comprehensive multidisciplinary interventions," say Chris Jensen (University of Aarhus, Denmark) and co-authors.
However, such studies have not shown which elements are instrumental in furthering RTW and improving health, or which intervention is most effective.
The researchers therefore compared 1-year RTW rates, pain, disability, and physical and mental health among 344 sick-listed (3-16 weeks) employees with LBP assigned to receive a hospital-based multidisciplinary intervention or a brief intervention.
Patients assigned to receive the brief intervention received clinical examinations and treatment advice offered by a rehabilitation physician and physiotherapist. The multidisciplinary intervention was supplemented with the expertise of a team and patients were assigned to a case manager who drew up a rehabilitation plan.
The median duration from first to last contact between the clinic and the patient in the multidisciplinary group was 18 weeks on average. In the brief intervention group, patients were seen only once or twice with an interval of about 2 weeks.
In total, 54% and 32% of patients were diagnosed with non-specific LBP and radiculopathy, respectively.
Analysis of social transfer payments revealed that RTW (first 4-week period during which the patient received no funds) occurred in 71% and 76% of patients assigned to receive the multidisciplinary and brief interventions, respectively. Median time to RTW was 14 and 18 weeks in the brief and multidisciplinary intervention groups, respectively.
Pain, disability, most Short Form (SF)-36 subscales, and fear avoidance were not significantly different for the two groups at one year. The SF-36 mental health subscale score was found to be significantly higher (by 5 units) in the multidisciplinary intervention group than in the brief intervention group, although the researchers say this is most likely a chance finding.
"The multidisciplinary intervention demanded more resources, but no final conclusion can be drawn regarding the cost-effectiveness until health economic analyses have been performed," write the authors in the journal Spine.
MedWire (www.medwire-news.md) is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2011
By Ingrid Grasmo