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Occupational Health (OH) professionals at the primary care oriented OH service handle chronic morbidities like hypertension and diabetes. Besides individual suffering, low back pain (LBP) account for major work loss among employees. We evaluated the effectiveness of two active interventions aimed at secondary prevention of LBP in the OH setting.
Methods
After a LBP specific survey (n=2480; response rate 71%), we randomized 143 employees (66% males, 45 years) with LBP over 34 mm on Visual Analogue Scale into Rehabilitation (n=43), Exercise (n=43) or Self-care (n=40) groups in this pragmatic trial. Primary outcomes were LBP, physical impairment (PI) and health-related quality of life (HRQoL) for two years and sickness absence (SA) days during four years (LBP specific, total).
Results
Compared to Self-care, Exercise reduced LBP at 12 months (mean difference (MD) -12 mm; 95% CI -21 – -2) but not PI. Exercise improved HRQoL at 12 and 24 months (0.03; 0.00 – 0.05). The MDs of SA days in four years were -17 (-70 – 35, total) and -15 (-47 – 13, LBP specific). Exercise reduced the probability of LBP specific SA during the third and fourth year. Compared to Self-care, Rehabilitation reduced LBP at 3 months (-10 mm; -19 – -1) and 6 months (-10 mm; -20 – - 1), but was not effective in HRQoL or PI. The MDs of SA days in four years were -41 (-93 – 8; total) and 5 (-30 – 47; LBP specific). Rehabilitation reduced the probability of total SA during first and second year and the amount of total SA days in the fourth year.
Discussion
Among non-sick-listed employees with moderate LBP, active interventions reduced pain and sickness absence with no effect on physical impairment. Exercise improved health related quality of life. LBP specific interventions aiming at secondary prevention of LBP and work loss seem feasible.