Een werkplekinterventie, graded activity of beide bij subacute rugpijn ter preventie van langdurig ziekteverzuim? Een gerandomiseerd gecontroleerd onderzoek

INTRODUCTION: Recommendations concerning the use of clinical and workplace interventions for the occupational reintegration of people with low back pain can only been made on the basis of high-quality, randomized controlled trials. There are few such studies of these interventions. OBJECTIVE: To evaluate/study the effectiveness of a workplace intervention and graded activity for occupational low back pain (LBP). METHODS: A population-based randomized controlled trial involving 196 employees on sick leave for 2 to 6 weeks due to non-specific LBP was performed in collaboration with 13 Dutch Occupational Health Services between October 2000 and October 2003. Participants were randomized to the workplace intervention (n = 96) or usual care (n = 100). The workplace intervention consisted of a workplace assessment, work modifications, and case management. Participants who were still on sick leave at 8 weeks were randomized to receive graded activity (n = 55) or usual care (n = 57). Graded activity is an exercise programme based on cognitive-behavioural principles. The primary outcome was the duration of sick leave. Secondary outcomes were functional status and pain, as assessed before randomization, before the first intervention, and at 12, 26, and 52 weeks after first day of sick leave. RESULTS: The median time to full return-to-work was 77 days for employees receiving the workplace intervention and 104 days for employees receiving usual care (p = 0.018). Thus the workplace intervention speeded up the return to work (HR 1.7; p = 0.003). In contrast, graded activity delayed the return to work (HR 0.4; p < 0.001). A combination of both interventions had no effect on the duration of sick leave. The workplace intervention had a non-significant positive effect on functional limitations and pain, whereas graded activity had a significant negative effect on functional limitations and a non-significant negative effect on pain. CONCLUSION: A workplace intervention should be recommended for the occupational reintegration of employees with LBP. Implications for Dutch healthcare and possible mechanisms of action are discussed.