PHYSICAL THERAPY & REHAB
Predictors identified for non-return to work in patients with low back pain .
This report has been verified
by one or more authors of the
original publication.
OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2013;1(1):26 BMC Musculoskelet Disord. 2009 Nov 13;10:139.246 patients suffering from low back pain, who have been sick listed for 8-12 weeks, were randomized to receive a brief intervention program alone or a brief intervention in combination with physical exercise. The objective of this trial was to identify predictors for not returning to work (i.e. secondary analysis). At 3, 12 and 24 months, there were no differences in return to work between participants in each group. As such, both arms were pooled for analysis of predictors of not returning to work. Significant predictors included pain intensity while resting and during activity, negative expectations for return to work, perceived reduced ability to walk long distances, and having prior treatment from a physiotherapist before the trial.
Was the allocation sequence adequately generated?
Was allocation adequately concealed?
Blinding Treatment Providers: Was knowledge of the allocated interventions adequately prevented?
Blinding Outcome Assessors: Was knowledge of the allocated interventions adequately prevented?
Blinding Patients: Was knowledge of the allocated interventions adequately prevented?
Was loss to follow-up (missing outcome data) infrequent?
Are reports of the study free of suggestion of selective outcome reporting?
Were outcomes objective, patient-important and assessed in a manner to limit bias (ie. duplicate assessors, Independent assessors)?
Was the sample size sufficiently large to assure a balance of prognosis and sufficiently large number of outcome events?
Was investigator expertise/experience with both treatment and control techniques likely the same (ie.were criteria for surgeon participation/expertise provided)?
Oui = 1
Incertain = 0,5
Non pertinent = 0
Non = 0
L'évaluation des critères de rapport permet d'évaluer la transparence avec laquelle les auteurs rapportent les caractéristiques méthodologiques et les caractéristiques de l'essai dans la publication. L'évaluation est divisée en cinq catégories qui sont présentées ci-dessous.
1/4
Randomization
1/4
Outcome Measurements
2/4
Inclusion / Exclusion
4/4
Therapy Description
3/4
Statistics
Detsky AS, Naylor CD, O'Rourke K, McGeer AJ, L'Abbé KA. J Clin Epidemiol. 1992;45:255-65
L'indice de fragilité est un outil qui aide à l'interprétation des résultats significatifs, en fournissant une mesure de la force d'un résultat. L'indice de fragilité représente le nombre d'événements consécutifs qui doivent être ajoutés à un résultat dichotomique pour que le résultat ne soit plus significatif. Un petit nombre représente un résultat plus faible et un grand nombre un résultat plus fort.
Pourquoi cette étude était-elle nécessaire maintenant ?
Low back pain is one of the most common causes for loss of work and is a large economic burden. Brief intervention (BI) programs, consisting of consultations and a short follow up, have been demonstrated to significantly reduce sick leave; however, a large proportion of patients still do not return to work. This study identified predictors of non-return to work in patients who participated in a BI program alone or in combination with exercise.
Quelle était la principale question de recherche ?
What predictors for not returning to work are present in patients suffering from sub-acute low back pain undergoing a brief intervention program or a brief intervention program in combination with physical exercise?
- No significant differences in return to work were observed between group 1 and group 2 at 3, 12, or 24 months
- Both groups were combined for regression analysis of predictors for non-return to work
- At 3 months, pain intensity while resting (OR= 5.6 95%CI= 1.7-19.0), perception of constant back strain while working (OR= 4.1; 95% CI= 1.5-11.5), negative expectations of return to work (OR=4.2; 95% CI= 1.7-10.2), and physical therapy prior to study participation (OR=3.3; 95% CI=1.3-8.3) predicted non-return to work
- At 12 months, perceived reduced ability to walk far due to complaints (OR= 2.6; 95% CI= 1.3-5.4), pain during activities (OR=2.4;95% CI= 1.1-5.1), and physical therapy prior to participation in the trial (OR 2.1; 95% CI=1.1-4.3) predicted non-return to work at 12 months
- At 24 months, age below 41 years was the only predictor of non-return to work (OR= 2.9; 95% CI= 1.4-6.0)
De quoi dois-je me souvenir en priorité ?
The addition of an exercise program to a brief intervention provided no significant improvements in patient return to work. Pooled regression analysis identified a number of predictors for non-return to work at different follow-up points. These included the pain intensity at rest, perception of constant back strain negative expectations of return to work, pain during activities, perceived reduced ability to walk, and age less than 41, and previous treatment by a physiotherapist.
Comment cela affectera-t-il les soins prodigués à mes patients ?
Return to work for patients suffering from sub-acute low back pain is dependent on a number of individual and cognitive factors, including negative expectations and perceptions of pain and disability. Previous physiotherapy treatment was also identified as a novel predictor for non return to work, an unexpected finding that deserves further investigation.
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