Journal of Occupational Rehabilitation

, Volume 16, Issue 4, pp 557–578

Economic Evaluation of a Multi-Stage Return to Work Program for Workers on Sick-Leave Due to Low Back Pain

  • Ivan A. Steenstra
  • Johannes R. Anema
  • Maurits W. van Tulder
  • Paulien M. Bongers
  • Henrica C. W. de Vet
  • Willem van Mechelen
Original Paper

Abstract

Objective: To evaluate the cost-effectiveness and cost-utility of a return to work (RTW) program for workers on sick-leave due to low back pain (LBP), comparing a workplace intervention implemented between 2 to 8 weeks of sick-leave with usual care, and a clinical intervention after 8 weeks of sick-leave with usual care. Design: Economic evaluation alongside a randomised controlled trial (RCT). Study population: Workers sick-listed for a period of 2 to 6 weeks due to LBP. Interventions: 1. workplace assessment, work modifications and case management). 2. physiotherapy based on operant behavioural principles. 3. usual care: provided by an occupational physician. Outcomes: The primary outcome was return to work (RTW). Other outcomes were pain intensity, functional status, quality of life and general health. The economic evaluation was conducted from a societal perspective. Outcomes were assessed at baseline (after 2–6 weeks on sick-leave), and 12 weeks, 26 weeks, and 52 weeks after the first day of sick-leave. Results: The workplace intervention group returned to work 30.0 days (95% CI=[3.1, 51.3]) earlier on average than the usual care group at slightly higher direct costs (ratio of 1 day: €19). Workers in the clinical intervention group that had received usual care in the first 8 weeks returned to work 21.3 days (95% CI= [−74.1, 29.2]) later on average. The group that had received the workplace intervention in the first 8 weeks and the clinical intervention after 8 weeks returned to work 50.9 days (95% CI=[−89.4, −2.7]) later on average. A workplace intervention was more effective than usual care in RTW at slightly higher costs and was equally effective as usual care at equal costs on other outcomes. A clinical intervention was less effective than usual care and associated with higher costs. Conclusion: The workplace intervention results in a safe and faster RTW than usual care at reasonable costs for workers on sick-leave for two to six weeks due to LBP.

Keywords

Low back pain Operant behavioural Participative Ergonomics Return to work Randomized Controlled Trial Cost-effectiveness Occupational health 

References

  1. 1.
    Frymoyer JW, Cats-Baril WL. An overview of the incidences and costs of low back pain. Orthop Clin North Am 1991;22(2):263–71.PubMedGoogle Scholar
  2. 2.
    Maniadakis N, Gray A. The economic burden of back pain in the UK. Pain 2000;84(1):95–103.CrossRefPubMedGoogle Scholar
  3. 3.
    van Tulder MW, Koes BW, Bouter LM. A cost-of-illness study of back pain in the Netherlands. Pain 1995;62(2):233–40.CrossRefPubMedGoogle Scholar
  4. 4.
    Hutubessy RC, van Tulder MW, Vondeling H, Bouter LM. Indirect costs of back pain in the netherlands: a comparison of the human capital method with the friction cost method. Pain 1999;80(1–2):201–7.CrossRefPubMedGoogle Scholar
  5. 5.
    Lee P. The economic impact of musculoskeletal disorders. Qual Life Res 1994;3(Suppl 1):85–91.CrossRefGoogle Scholar
  6. 6.
    Abenhaim L, Suissa S. Importance and economic burden of occupational back pain: a Study of 2,500 Cases Representative of Quebec. J Occup Med 1987;29(8):670–4.PubMedGoogle Scholar
  7. 7.
    Hlobil H, Staal JB, Spoelstra M, Ariens GA, Smid T, van Mechelen W. Effectiveness of a return-to-work intervention for subacute low-back pain. Scand J Work Environ Health 2005;31(4):249–57.PubMedGoogle Scholar
  8. 8.
    Loisel P. Intervention for return to work–what is really effective? Scand J Work Environ Health 2005;31(4):245–7.PubMedGoogle Scholar
  9. 9.
    Scientific Approach to the Assessment and Management of Activity-Related Spinal Disorders. A Monograph for Clinicians. Report of the Quebec Task Force on Spinal Disorders. Spine 1987;12(7 Suppl):1–59.Google Scholar
  10. 10.
    Leino PI, Berg MA, Puska P. Is Back Pain Increasing? Results from national surveys in finland during 1978/9-1992. Scand J Rheumatol 1994;23(5):269–76.PubMedGoogle Scholar
  11. 11.
    Loisel P, Lemaire J, Poitras S, Durand MJ, Champagne F, Stock S, Diallo B, Tremblay C. Cost-Benefit and Cost-Effectiveness analysis of a disability prevention model for back pain management: a Six Year Follow Up Study. Occup Environ Med 2002;59(12):807–15.CrossRefPubMedGoogle Scholar
  12. 12.
    BMC Musculoskeletal Disorders. Vol. 4, 2003.Google Scholar
  13. 13.
    Aulman P, Bakker-Rens RM, Dielemans SF, Mulder A, Verbeek JHAM. Dutch occupational guideline on low back pain (in Dutch:Handelen van de bedrijfsarts bij werknemers met lage rugklachten). Eindhoven: NVAB; 1999.Google Scholar
  14. 14.
    Steenstra IA, Koopman FS, Knol DL, Kat E, Bongers PM, de Vet HC, van Mechelen W. Prognostic factors for duration of sick leave due to low-back pain in dutch health care professionals. J Occup Rehabil 2005;15(4):591–605.CrossRefPubMedGoogle Scholar
  15. 15.
    Pocock SJ. Clinical trials, a practical approach. London: John Wiley & Sons Ltd.; 1987.Google Scholar
  16. 16.
    Loisel P, Durand P, Abenhaim L, Gosselin L, Simard R, Turcotte J, Esdaile JM. Management of occupational back pain: the Sherbrooke Model. Results of a pilot and feasibility study. Occup Environ Med 1994;51(9):597–602.PubMedCrossRefGoogle Scholar
  17. 17.
    Loisel P, Abenhaim L, Durand P, Esdaile JM, Suissa S, Gosselin L, Simard R, Turcotte J, Lemaire J. A population-based, randomized clinical trial on back pain management. Spine 1997;22(24):2911–8.CrossRefPubMedGoogle Scholar
  18. 18.
    Staal JB, Hlobil H, Twisk JW, Smid T, Koke AJ, van Mechelen W. Graded activity for low back pain in occupational health care: a Randomized, controlled trial. Ann Intern Med 2004;140(2):77–84.PubMedGoogle Scholar
  19. 19.
    Fordyce WE. Behavioral methods for chroninc pain and illness. St. Louis: Mosby; 1976.Google Scholar
  20. 20.
    Lindstrom I, Ohlund C, Eek C, Wallin L, Peterson LE, Fordyce WE, Nachemson AL. The effect of graded activity on patients with subacute low back pain: a randomized prospective clinical study with an operant-conditioning behavioral approach. Phys Ther 1992;72(4):279–90.PubMedGoogle Scholar
  21. 21.
    Staal JB, Hlobil H, van Tulder MW, Waddell G, Koes BW, van Mechelen W. Occupational health guidelines for the management of low back pain: an International Comparison. Occup Environ Med 2003;60(9):618–26.CrossRefPubMedGoogle Scholar
  22. 22.
    Aulman P, Bakker-Rens RM, Dielemans SF, Mulder A, Verbeek JHAM. Dutch occupational guideline on low back pain (in Dutch:Handelen van de bedrijfsarts bij werknemers met lage rugklachten). Eindhoven: NVAB; 1999.Google Scholar
  23. 23.
    de Jong AM, Vink P. Participatory ergonomics applied in installation work. Appl Ergon 2002;33(5):439–48.CrossRefPubMedGoogle Scholar
  24. 24.
    Anema JR, Steenstra IA, Urlings IJM, Bongers PM, de Vroome EMM, van Mechelen W. Participatory ergonomics as a return-to-work intervention; a future challenge? implementation of a participatory ergonomics program for the disability management of workers sicklisted due to low back pain. Am J Ind Med 2003; 1–9.Google Scholar
  25. 25.
    Loisel P, Gosselin L, Durand P, Lemaire J, Poitras S, Abenhaim L. Implementation of a participatory ergonomics program in the rehabilitation of workers suffering from subacute back pain. Appl Ergon 2001;32(1):53–60.CrossRefPubMedGoogle Scholar
  26. 26.
    Anema JR, Buijs PC, van Putten DJ. Samenwerking Van Huisarts En Bedrijfsarts: Een Leidraad Voor De Praktijk (Cooperation Between General Practitioner and Occuaptional Practitioner: a Guideline for Practise). Medisch Contact 2001;56(20):790–3.Google Scholar
  27. 27.
    Staal JB, Hlobil H, Twisk JWR, Smid T, van Mechelen W. The effects of graded activity for low back pain in occupational health on absence from work, functional status and pain. Ann Intern Med 2003.Google Scholar
  28. 28.
    Roland M, Morris R. A study of the natural history of back pain. Part I: Development of a reliable and sensitive measure of disability in low-back pain. Spine 1983;8(2):141–4.CrossRefPubMedGoogle Scholar
  29. 29.
    Gommans IHB, Koes BW, van Tulder MW. Validiteit En Responsiviteit Nederlandstalige Roland Disability Questionnaire. Vragenlijst Naar Functionele Status Bij Patiënten Met Lage Rugpijn. Ned Tijdschr voor Fysiotherapie 1997;2(107):28–33.Google Scholar
  30. 30.
    Carlsson AM. Assessment of chronic pain. I. aspects of the reliability and validity of the visual analogue scale. Pain 1983;16(1):87–101.CrossRefPubMedGoogle Scholar
  31. 31.
    Roach KE, Brown MD, Dunigan KM, Kusek CL, Walas M. Test-retest reliability of patient reports of low back pain. J Orthop Sports Phys Ther 1997;26(5):253–9.PubMedGoogle Scholar
  32. 32.
    Dolan P. Modeling Valuations for EuroQol Health States. Med Care 1997;35(11):1095–8.CrossRefPubMedGoogle Scholar
  33. 33.
    Brooks R. EuroQol: the current state of play. Health Policy 1996;37(1):53–72.CrossRefPubMedGoogle Scholar
  34. 34.
    Brouwer WB, Koopmanschap MA, Rutten FF. Patient and informal caregiver time in cost-effectiveness analysis. A response to the recommendations of the Washington panel. Int J Technol Assess Health Care 1998;14(3):505–13.PubMedCrossRefGoogle Scholar
  35. 35.
    Oostenbrink JB, Koopmanschap MA, Rutten FF. Standardisation of costs: the dutch manual for costing in economic evaluations. Pharmacoeconomics 2002;20(7):443–54.CrossRefPubMedGoogle Scholar
  36. 36.
    Karasek R. Job content instrument users guide: revision 1.1. 1985.Google Scholar
  37. 37.
    Karasek R, Brisson C, Kawakami N, Houtman I, Bongers PM, Amick B. The job content questionnaire (JCQ): an instrument for internationally comparative assessments of psychosocial job characteristics. J Occup Health Psychol 1998;3(4):322–55.CrossRefPubMedGoogle Scholar
  38. 38.
    Janssen N, Van Den Heuvel WP, Beurskens AJ, Nijhuis FJ, Schroer CA, van Eijk JT. The demand-control-support model as a predictor of return to work. Int J Rehabil Res 2003;26(1):1–9.CrossRefPubMedGoogle Scholar
  39. 39.
    Hildebrandt VH, Bongers PM, van Dijk FJ, Kemper HC, Dul J. Dutch Musculoskeletal Questionnaire: Description and Basic Qualities. Ergonomics 2001;44(12):1038–55.CrossRefPubMedGoogle Scholar
  40. 40.
    Efron B, Tibshirani RJ. An introduction to the bootstrap. New York, London: CHapman & Hall; 1993.Google Scholar
  41. 41.
    Drummond MF, O’Brien B, Stoddart GL, Torrance GW. Methods for the Economic Evaluation of Health Care Programmes, 2nd edn. Oxford, New York: Oxford University Press; 1997.Google Scholar
  42. 42.
    van Hout BA, Al MJ, Gordon GS, Rutten FF. Costs, effects and C/E-Ratios alongside a clinical trial. Health Econ 1994;3(5):309–19.PubMedGoogle Scholar
  43. 43.
    Korthals-de Bos I, Van Tulder M, van Dieten H, Bouter L. Economic evaluations and randomized trials in spinal disorders: Principles and Methods. Spine 2004;29(4):442–8.CrossRefPubMedGoogle Scholar
  44. 44.
    Steenstra IA, Anema H, Bongers PM, de Vet HC, Knol DL, Mechelen WV. The effectiveness of graded activity for low back pain in occupational healthcare. Occup Environ Med 2006.Google Scholar
  45. 45.
    Anema JR, Steenstra IA, Bongers PM, de Vet HCW, Knol DL, Loisel P, van Mechelen W. Multidisciplinary rehabilitation for sub acute low back pain: Graded Activity or Workplace Intervention or Both? A Randomized Controlled Trial. Spine 2006.Google Scholar
  46. 46.
    Brouwer WB, van Exel NJ, Koopmanschap MA, Rutten FF. Productivity costs before and after absence from work: as important as common? Health Policy 2002;61(2):173–87.CrossRefPubMedGoogle Scholar
  47. 47.
    Korthals-de Bos I, Smidt N, van Tulder MW, Rutten-van Molken MP, Ader HJ, Van Der Windt DA, Assendelft WJ, Bouter LM. Cost effectiveness of interventions for lateral epicondylitis: results from a randomised controlled trial in primary care. Pharmacoeconomics 2004;22(3):185–95.Google Scholar
  48. 48.
    Korthals-de Bos IB, Hoving JL, van Tulder MW, Rutten-van Molken MP, Ader HJ, de Vet HC, Koes BW, Vondeling H, Bouter LM. Cost effectiveness of physiotherapy, manual therapy, and general practitioner care for neck pain: economic evaluation alongside a randomised controlled trial. BMJ 2003;326(7395):911.CrossRefPubMedGoogle Scholar
  49. 49.
    Loisel P, Lemaire J, Poitras S, Durand MJ, Champagne F, Stock S, Diallo B, Tremblay C. Cost-benefit and cost-effectiveness analysis of a disability prevention model for back pain management: a six year follow up study. Occup Environ Med 2002;59(12):807–15.CrossRefPubMedGoogle Scholar
  50. 50.
    Roland M, Torgerson, DJ. Understanding controlled trials: what are pragmatic trials? BMJ 1998;316(7127):285.PubMedGoogle Scholar
  51. 51.
    Aulman P, Bakker-Rens RM, Dielemans SF, Mulder A, Verbeek JHAM. Het handelen van de bedrijfsarts bij lage rug klachten (Occupational management of workers with back pain). Eindhoven: NVAB; 1999.Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2006

Authors and Affiliations

  • Ivan A. Steenstra
    • 1
    • 2
    • 3
    • 4
    • 6
  • Johannes R. Anema
    • 1
    • 2
    • 3
    • 4
  • Maurits W. van Tulder
    • 1
    • 5
  • Paulien M. Bongers
    • 1
    • 3
    • 4
  • Henrica C. W. de Vet
    • 1
  • Willem van Mechelen
    • 1
    • 2
    • 4
  1. 1.Institute for Research in Extramural MedicineVU University Medical CenterAmsterdamThe Netherlands
  2. 2.Department of Public and Occupational HealthVU University Medical CenterAmsterdamThe Netherlands
  3. 3.TNO Work and EmploymentHoofddorpThe Netherlands
  4. 4.Body@WorkResearch Center Physical Activity, Work and Health, TNO-VUAmsterdamThe Netherlands
  5. 5.Institute for Health SciencesVU UniversityAmsterdamThe Netherlands
  6. 6.Institute for Work and HealthTorontoCanada

Personalised recommendations