Function-Centered Rehabilitation Increases Work Days in Patients With Nonacute Nonspecific Low Back Pain: 1-Year Results From a Randomized Controlled Trial

Kool J, Bachmann S, Oesch P, Knuesel O, Ambergen T, de Bie R, van den Brandt P. Function-centered rehabilitation increases work days in patients with nonacute nonspecific low back pain: 1-year results from a randomized controlled trial.

Objective

To compare the effect of function-centered treatment (FCT) and pain-centered treatment (PCT) on the number of work days, permanent disability, and the unemployment rate.

Design

Randomized controlled trial.

Setting

Inpatient rehabilitation center.

Participants

Patients (N=174; 79% male; mean age, 42y) with previous sick leave of 6 weeks or more.

Interventions

FCT (4h/d for 3wk) emphasized activity despite pain by using work simulation, strength, endurance, and cardiovascular training. PCT (2.5h/d for 3wk) emphasized pain reduction and included passive and active mobilization, stretching, strength training, and a 4-hour mini back school with education and exercise. Analysis was by intention to treat.

Main Outcome Measures

Work days, return to work, rate of patients receiving financial compensation for permanent disability, and unemployment rate. Effect sizes (Cohen d) were defined as small (0.2–0.5), moderate (0.5–0.8), and large (>0.8).

Results

After 1 year, the FCT group had significantly more work days (mean, 118; median, 39.5; interquartile range [IQR], 0−198) than the PCT group (mean, 74; median, 0; IQR, 0−160; Mann-Whitney U test, P=.011). The odds ratio of returning to work in the FCT group relative to the PCT group was 2.1 (95% confidence interval, 1.1−3.9). The differences in unemployment rates and in the numbers of patients receiving compensation for permanent disability were not significant.

Conclusions

FCT is more effective than PCT for increasing work days.