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      Randomised controlled trial of integrated care to reduce disability from chronic low back pain in working and private life

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          Abstract

          Objective To evaluate the effectiveness of an integrated care programme, combining a patient directed and a workplace directed intervention, for patients with chronic low back pain.

          Design Population based randomised controlled trial.

          Setting Primary care (10 physiotherapy practices, one occupational health service, one occupational therapy practice) and secondary care (five hospitals).

          Participants 134 adults aged 18-65 sick listed for at least 12 weeks owing to low back pain.

          Intervention Patients were randomly assigned to usual care (n=68) or integrated care (n=66). Integrated care consisted of a workplace intervention based on participatory ergonomics, involving a supervisor, and a graded activity programme based on cognitive behavioural principles.

          Main outcome measures The primary outcome was the duration of time off work (work disability) due to low back pain until full sustainable return to work. Secondary outcome measures were intensity of pain and functional status.

          Results The median duration until sustainable return to work was 88 days in the integrated care group compared with 208 days in the usual care group (P=0.003). Integrated care was effective on return to work (hazard ratio 1.9, 95% confidence interval 1.2 to 2.8, P=0.004). After 12 months, patients in the integrated care group improved significantly more on functional status compared with patients in the usual care group (P=0.01). Improvement of pain between the groups did not differ significantly.

          Conclusion The integrated care programme substantially reduced disability due to chronic low back pain in private and working life.

          Trial registration Current Controlled Trials ISRCTN28478651.

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          Author and article information

          Contributors
          Role: researcher
          Role: professor
          Role: statistician
          Role: professor
          Role: senior researcher
          Journal
          BMJ
          bmj
          BMJ : British Medical Journal
          BMJ Publishing Group Ltd.
          0959-8138
          1468-5833
          2010
          2010
          16 March 2010
          : 340
          : c1035
          Affiliations
          [1 ]EMGO Institute for Health and Care Research, Department of Public and Occupational Health, VU University Medical Center, Amsterdam, Netherlands
          [2 ]EMGO Institute for Health and Care Research, Department of Epidemiology and Biostatistics
          [3 ]Dalla Lana School of Public Health, University of Toronto, Canada
          Author notes
          Correspondence to: J R Anema h.anema@ 123456vumc.nl
          Article
          laml656900
          10.1136/bmj.c1035
          2840223
          20234040
          48fdb967-6527-4cfe-aac3-29004b7378d8
          © Lambeek et al 2010

          This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: http://creativecommons.org/licenses/by-nc/2.0/ and http://creativecommons.org/licenses/by-nc/2.0/legalcode.

          History
          : 2 November 2009
          Categories
          Research
          Clinical trials (epidemiology)
          Other rehabilitative therapies
          General practice / family medicine
          Pain (neurology)
          Physiotherapy
          Sports and exercise medicine
          Occupational and environmental medicine

          Medicine
          Medicine

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