Journal of Occupational Rehabilitation

, Volume 20, Issue 2, pp 256–263 | Cite as

Early Intervention Options for Acute Low Back Pain Patients: A Randomized Clinical Trial with One-Year Follow-Up Outcomes

  • Travis Whitfill
  • Robbie Haggard
  • Samuel M. Bierner
  • Glenn Pransky
  • Robert G. Hassett
  • Robert J. Gatchel
Article

Abstract

Introduction In an earlier study, Gatchel et al. (J Occup Rehabil 13:1–9, 2003) demonstrated that participants at high risk for developing chronic low back pain disability (CLBPD), who received a biopsychosocial early intervention treatment program, displayed significantly more symptom improvement, as well as cost savings, relative to participants receiving standard care. The purpose of the present study was to expand on these results by examining whether the addition of a work-transition component would further strengthen the effectiveness of this early intervention treatment. Methods Using an existing algorithm, participants were identified as being high-risk (HR) or low-risk (LR) for developing CLBPD. HR participants were then randomly assigned to one of three groups: early intervention (EI); early intervention with work transition (EI/WT); or standard care (SC). Participants provided information regarding pain, disability, work status, and psychosocial functioning at baseline, periodically during treatment, and again 1 year following completion of treatment. Results At 1-year follow-up, no significant differences were found between the EI and EI/WT groups in terms of occupational status, self-reports of pain and disability, coping ability or psychosocial functioning. However, significant differences in all these outcomes were found comparing these groups to standard care. Conclusion The addition of a work transition component to an early intervention program for the treatment of ALBP did not significantly contribute to improved work outcomes. However, results further support the effectiveness of early intervention for high-risk ALBP patients.

Keywords

Early intervention Low back pain Biopsychosocial Chronicity Treatment High risk 

References

  1. 1.
    Gatchel RJ, et al. Treatment- and cost-effectiveness of early intervention for acute low-back pain patients: a one-year prospective study. J Occup Rehabil. 2003;13(1):1–9.CrossRefPubMedGoogle Scholar
  2. 2.
    Andersson GB. The epidemiology of spinal disorders. In: Frymoyer JW, editor. The adult spine: principles and practice. Philadelphia: Lippencott-Raven; 1997. p. 93–133.Google Scholar
  3. 3.
    Picavet HS, Schouten JS, Smit HA. Prevalences and consequences of low back pain problems in the Netherlands, working vs non-working population, the MORGEN-study. Public Health. 1999;113:73–7.CrossRefPubMedGoogle Scholar
  4. 4.
    Kelsey JL. Epidemiology and impact of low-back pain. Spine. 1980;5(2):133–42.CrossRefPubMedGoogle Scholar
  5. 5.
    Von Korff M, et al. Chronic spinal pain and physical-mental comorbidity in the United States: results from the national comorbidity survey replication. Pain. 2005;113(3):331–9.CrossRefGoogle Scholar
  6. 6.
    Von Korff M, Saunders K. The course of back pain in primary care. Spine. 1996;21(24):2833–7.CrossRefGoogle Scholar
  7. 7.
    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
  8. 8.
    Mayer TG, Gatchel RJ. Functional restoration for spinal disorders: the sports medicine approach. Philadelphia: Lea & Febiger; 1988.Google Scholar
  9. 9.
    National Center for Health Statistics. Health, 2005. With chartbook on trends in the health of Americans. Maryland: Hyattsville; 2005.Google Scholar
  10. 10.
    Straus BN. Chronic benign pain syndromes: the cost of intervention. Spine. 2003;27:2614–9.CrossRefGoogle Scholar
  11. 11.
    De Lissovoy G, et al. Cost-effectiveness of long-term intrathecal morphine therapy for pain associated with failed back surgery syndrome. Clin Ther. 1997;19(1):96–112. discussion 84-5.CrossRefPubMedGoogle Scholar
  12. 12.
    National Research Council. Musculoskeletal disorders the workplace: low back, upper extremities. Washington, D.C.: National Academy Press; 2001.Google Scholar
  13. 13.
    Linton SJ, editor. New avenues for the prevention of chronic musculoskeletal pain and disability. Amsterdam: Elsevier; 2002.Google Scholar
  14. 14.
    Gatchel RJ, Polatin P, Mayer T. The dominant role of psychosocial risk factors in the development of chronic low back pain disability. Spine. 1995;20(24):2702–9.CrossRefPubMedGoogle Scholar
  15. 15.
    Gatchel RJ, Polatin PB, Kinney RK. Predicting outcome of chronic back pain using clinical predictors of psychopathology: a prospective analysis. Health Psychol. 1995;14(5):415–20.CrossRefPubMedGoogle Scholar
  16. 16.
    Linton SJ, Bradley LA. Strategies for the prevention of chronic pain. In: Gatchel RJ, Turk DC, editors. Psychological approaches to pain management: a practitioner’s handbook. New York: Guilford Publications, Inc; 1996.Google Scholar
  17. 17.
    van Der Giezen AM, Bouter LM, Nijhuis FJN. Prediction of return-to-work of low back pain patients sick listed for 3–4 months. Pain. 2000;87:285–94.CrossRefPubMedGoogle Scholar
  18. 18.
    Teasell RW, Bombardier C. Employment-related factors in chronic pain and chronic pain disability. Clin J Pain. 2001;December 2001 supplement:S39–S45.Google Scholar
  19. 19.
    McLellan RK, Pransky G, Shaw WS. Disability management training for supervisors: A pilot inventory program. J Occup Rehabil. 2001;11:33–42.Google Scholar
  20. 20.
    Marhold C, Linton SJ, Melin L. Identification of obstacles for chronic pain patients to return to work: evaluation of a questionnaire. J Occup Rehabil. 2002;12:65–76.CrossRefPubMedGoogle Scholar
  21. 21.
    Koopman C, et al. Stanford presenteeism scale: health status and employee productivity. J Occup Environ Med. 2002;44(1):14–20.CrossRefPubMedGoogle Scholar
  22. 22.
    Million S, et al. Assessment of the progress of the back-pain patient. 1981 Volvo Award in Clinical Science. Spine. 1982;7:204–12.CrossRefPubMedGoogle Scholar
  23. 23.
    Dworkin SF, LeResche L. Research diagnostic criteria for temporomandibular disorders. J Craniomandib Disord. 1992;6:301–55.PubMedGoogle Scholar
  24. 24.
    Ware JE, et al. SF-36 health survey: manual and interpretation guide. Boston: The Health Institute, New England Medical Center; 1993.Google Scholar
  25. 25.
    SPSS. SPSS for windows. Chicago: SPSS Inc.; 2008.Google Scholar
  26. 26.
    Siddiqui O, Ali MW. A comparison of the random-effects pattern mixture model with last-observation-carried-forward (LOCF) analysis in longitudinal clinical trials with dropouts. J Biopharm Stat. 1998;8(4):545–63.CrossRefPubMedGoogle Scholar
  27. 27.
    Ostelo RW, et al. Interpreting change scores for pain and functional status in low back pain: towards international consensus regarding minimal important change. Spine. 2008;33(1):90–4.CrossRefPubMedGoogle Scholar
  28. 28.
    Jensen IB, et al. A 3-year follow-up of a multidisciplinary rehabilitation programme for back and neck pain. Pain. 2005;115(3):273–83.CrossRefPubMedGoogle Scholar
  29. 29.
    Loisel P, et al. A population-based, randomized clinicl trial on back pain management. Spine. 1997;22:2911–8.CrossRefPubMedGoogle Scholar
  30. 30.
    Côté P, et al. Patterns of sick-leave and health outcomes in injured workers with back pain. Eur Spine J. 2008;17(4):484–93.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • Travis Whitfill
    • 1
  • Robbie Haggard
    • 2
  • Samuel M. Bierner
    • 3
  • Glenn Pransky
    • 4
  • Robert G. Hassett
    • 5
  • Robert J. Gatchel
    • 2
  1. 1.Division of Clinical PsychologyThe University of Texas Southwestern Medical Center at DallasDallasUSA
  2. 2.Department of Psychology, College of ScienceThe University of Texas at ArlingtonArlingtonUSA
  3. 3.Department of Physical Medicine & RehabilitationThe University of Texas Southwestern Medical Center at DallasDallasUSA
  4. 4.Liberty Mutual Research CenterHopkintonUSA
  5. 5.VP Medical OperationsConcentra Health ServicesAddisonUSA

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