Evaluating relapse prophylaxis in addition to interdisciplinary multimodal pain therapy for back pain: a randomised controlled trial.
OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2025;13(22):21 J Rehabil Med . 2025 Aug 20:57:jrm42088.What this means for my practice?
Clinicians should remember that adding a structured 12-month relapse prophylaxis programme to a 4-week interdisciplinary multimodal back pain therapy improved functional capacity but did not significantly reduce days of incapacity to work over one year. In practice, these findings imply that long-term follow-up and self-management support may enhance functional outcomes, but additional or differently structured strategies may be required to meaningfully impact work absence. Key limitations include the wide variability and skewed distribution of sick-leave data, modest effect sizes, lower-than-planned participation in relapse prophylaxis, and reliance on self-report for secondary outcomes, all of which may have diluted the observable impact on work incapacity.
Resumen del estudio
Two hundred ninety-seven employed patients with dorsopathies (ICD-10 M40–M54) and recent back pain–related work incapacity were randomized to receive either 4 weeks of outpatient interdisciplinary multimodal pain therapy (IMPT) plus a 12-month relapse prophylaxis programme (intervention; n = 150) or the same multimodal pain therapy alone (control; n = 147). The IMPT comprised team-based medical, physiotherapy, psychological, and educational components delivered in standard or complex formats, while relapse prophylaxis offered low-, medium-, or high-intensity follow-up with combinations of telephone consultations, booster sessions, and optional monthly medical training therapy. The primary outcome was the number of days of incapacity to work over the 12 months after IMPT, obtained from health insurance claims. Secondary outcomes were functional capacity (Hannover Functional Ability Questionnaire, HFAQ) and health-related quality of life (EQ-5D-5L index and EQ VAS), assessed at baseline (T0), after IMPT (4 weeks, T1), and after 12 months (T2). Outcomes were thus evaluated over 12 months, with an intermediate assessment at 4 weeks. Overall, the results of the study revealed no statistically significant reduction in sick-leave days with relapse prophylaxis, but the intervention group showed significantly greater and sustained gains in functional capacity and modest, non-significant trends toward better health-related quality of life. These findings suggest that adding relapse prophylaxis may enhance self-reported function but, as implemented, does not clearly translate into fewer days off work within one year.
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