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Överskrift Does light mobilization treatment reduce long-term sick leave for low back pain?
Upplaga 2
Sidor 137-44
Överskrift Does light mobilization treatment reduce long-term sick leave for low back pain?
Beskrivning Background: Low back pain is one of the most frequent reasons for sick leave and disability pension. Early intervention with information, advice, reassurance, and encouragement to stay active may be a cost-effective method for returning patients quickly to normal activity. Material and methods: 451 patients sick listed 8-12 weeks for low back pain with or without radiating pain and age between 18-60 years were included. The patients were randomised into an intervention group (n=237) and a control group (n=220). The intervention group was examined at a spine clinic by a treatment team consisting of a physician (specialist in physical medicine and rehabilitation) and a physiotherapist. The patients were given time to express their concerns and explain how the back problem affected their life and daily activities. They were given practical advice in how to resume normal activity, and they were encouraged to stay active despite the pain. The control group was treated within the primary health care. All subjects filled out questionnaires. Data on sick leave, disability, and other social benefits were collected register data from the National Insurance Offices. Finally, the subjective health complaints scored by all the subjects in the study group at inclusion time were compared to reference values from a Norwegian normal population, consisting of 1240 adults. Results: The intervention program had significant effect in reducing sick leave. At 12 months 68.4% in the intervention group vs 56.4% in the control group had returned to work. Over the 3 years of observation, the intervention group had significantly fewer days of sickness compensation (average 125.7 d/person) than the control group (169.6 d/person). The difference was mainly caused by a more rapid return to work during the first year. The intervention had economic gains for the society. Net benefits accumulated over 3 years of treating the 237 patients in the intervention group amount to approximately NOK 6 049 649 ($ 828 719). At three months follow up the strongest modifying effect of the intervention on return to work was the perception of constant back strain when working, and beliefs about reduced ability to work. At 12 months, gastrointestinal complaints were the strongest modifier for the effect of the intervention. Compared to the normal reference population, the low back pain patients had significantly more subjective health complaints. Conclusion: Early intervention with examination, information, reassurance, and encouragement to engage in physical activity as normal as possible reduced sick leave for subacute low back pain and had economic gains for the society. There was no increased risk for reoccurrence of sick leave due to low back pain over the next 2 years in patients returning early. The intervention was short and simple and seemed to have a main effect on work absenteeism via interacting with concerns of being unable to work. Patients suffering from low back pain also have other complaints, and these comorbid conditions may influence the prognosis, in particular the trust and ability to return to work. The intervention may have its main effect via the perception and interpretation of the condition, and the concerns underlying the decision to return to work. Copyright © 2008 Elsevier B. V., Amsterdam. All Rights Reserved.
Källa Norsk Epidemiologi
Publicerad 2006
Författare Hagen EM


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