The effectiveness of additional oral advice compared to self-care information booklet alone in early phase occupational low back trouble: A 4-year follow-up of a randomised controlled trial

Introduction
Primary care oriented occupational health (OH) deliver patient information concerning chronic morbidities like hypertension and diabetes. Low back pain (LBP) is a common health problem among employees. We aimed to determine the effectiveness of oral information compared to “Back Book” booklet alone for employees of early onset low back (LB) symptoms in a randomised controlled trial.

Methods
A cohort of 312 subjects (66% males, mean age 45 y) with prolonged or recurrent but mild LB pain (VAS between 10-34 mm) was included in this pragmatic trial on the basis of an employee survey in a forestry company (n=2480; response rate 71%). Subjects were randomised into two groups (BB and BB+A), both receiving the “Back Book” from an OH nurse. BB+A group received also oral information. Primary outcomes were LBP, physical impairment (RM, Roland Morris Disability Questionnaire) and quality of life (QoL) over a two-year follow-up and accumulated sickness absence (SA) days in 4 years.

Results
A decrease of LBP, physical impairment and sick leave occurred in both groups during the follow-up. Still, oral advice was not more effective than the booklet alone in RM at 3 or 24 months (BBA vs. BB, mean difference 0 [95% CI -1 – 1]), LBP or QoL. There was no difference between the treatment arms in the mean of SA days in 4 years (BBA vs. BB, mean difference 1 day [95% CI -25 – 27].

Discussion
Among non-sick-listed employees suffering from early phase LB symptoms, oral advice was not more effective on pain, physical impairment, quality of life or sickness absence than the Back Book information alone. However, it seems feasible to screen subjects with early phase LB symptoms and deliver simple patient information in primary care oriented occupational health services.