Integrated care can cut chronic back pain work disability by 4 months

A programme of integrated care, directed at both the patient and the workplace, can help people with chronic low back pain return to work, on average, four months earlier than those receiving usual care, finds a study published in the British Medical Journal today.

Back pain is a common problem in Western societies. Although the chance of returning to work is generally good, up to a quarter of patients with low back pain remain absent from work in the long term, causing 75% of the costs due to sickness leave and disability.

So researchers based in The Netherlands and Canada set out to evaluate the effectiveness of an integrated care programme in 134 patients with chronic low back pain. All patients were aged between 18 and 65 years and had been absent from work due to low back pain for almost half a year on average.

Patients were randomly assigned to either usual care or integrated care. Integrated care consisted of adjustments to the workplace and a graded exercise programme to teach patients how to move safely while increasing activity levels. The main aim of the programme was to restore occupational functioning and to achieve lasting return to work for patients in their own job or similar work.

The usual care group received normal pain treatment with usually little or no workplace involvement.

Patients completed questionnaires at the start of the study and after three, six, nine and 12 months. Sickness absence data were collected every month.

Over the 12-month study period, patients who received integrated care returned to sustainable work after an average of 88 days compared with 208 days for patients receiving usual care, an average reduction of 120 days.

After 12 months patients in the integrated care group also improved significantly more on functional status compared to patients in the usual care group. No statistically significant differences in pain improvement were found between the two groups.

The integrated care programme substantially reduced disability due to chronic low back pain in both working and private life, say the authors. This promising integrated care approach, directed to both the patient and the work environment, could have a great impact on the individual burden of low back pain, they conclude.