Does light mobilization treatment reduce long-term sick leave for low back pain? / Kan råd om fysisk aktivitet redusere sykefraværet for pasienter med ryggplager?

Sammendrag

Background: Low back pain is one of the most frequent reasons for sick leave and disability pension. Early intervention with information, advice, reassurance, and encouragement to stay active may be a cost-effective method for returning patients quickly to normal activity.
Material and methods: 457 patients sick listed 8-12 weeks for low back pain with or without radiating pain and age between 18-60 years were included. The patients were randomised into an intervention group (n=237) and a control group (n=220). The intervention group was examined at a spine clinic by a treatment team consisting of a physician (specialist in physical medicine and rehabilitation) and a physiotherapist. The patients were given time to express their concerns and explain how the back problem affected their life and daily activities. They were given practical advice in how to resume normal activity, and they were encouraged to stay active despite the pain. The control group was treated within the primary health care. All subjects filled out questionnaires. Data on sick leave, disability, and other social benefits were collected register data from the National Insurance Offices. Finally, the subjective health complaints scored by all the subjects in the study group at inclusion time were compared to reference values from a Norwegian normal population, consisting of 1240 adults.
Results: The intervention program had significant effect in reducing sick leave. At 12 months 68.4% in the intervention group vs 56.4% in the control group had returned to work. Over the 3 years of observation, the intervention group had significantly fewer days of sickness compensation (average 125.7 d/person) than the control group (169.6 d/person). The difference was mainly caused by a more rapid return to work during the first year. The intervention had economic gains for the society. Net benefits accumulated over 3 years of treating the 237 patients in the intervention group amount to approximately NOK 6 049 649 ($ 828 719). At three months follow up the strongest modifying effect of the intervention on return to work was the perception of constant back strain when working, and beliefs about reduced ability to work. At 12 months,gastrointestinal complaints were the strongest modifier for the effect of the intervention. Compared to the normal reference population, the low back pain patients had significantly more subjective health complaints.
Conclusion: Early intervention with examination, information, reassurance, and encouragement to engage in physical activity as normal as possible reduced sick leave for subacute low back pain and had economic gains for the society. There was no increased risk for reoccurrence of sick leave due to low back pain over the next 2 years in patients returning early. The intervention was short and simple and seemed to have a main effect on work absenteeism via interacting with concerns of being unable to work. Patients suffering from low back pain also have other complaints, and these comorbid conditions may influence the prognosis,
in particular the trust and ability to return to work. The intervention may have its main effect via the perception and interpretation of the condition, and the concerns underlying the decision to return to work.

Bakgrunn: Ryggsmerter er en av de hyppigste årsaker til sykmelding og uføretrygd. Behandlingstiltak rettet mot å redusere utvikling av kroniske plager og langvarig sykmelding vil derfor kunne være kostnadseffektive.
Materiale og metode: 457 pasienter sykmeldt 8-12 uker for ryggsmerter med eller uten utstrålende smerter og alder 18-60 år ble inkludert og randomisert til en intervensjonsgruppe (n=237) og en kontrollgruppe (n=220). Pasientene i intervensjonsgruppen ble undersøkt på en ryggpoliklinikk. De fikk informasjon om årsak til plagene, råd og veiledning om mestring av plagene og hvordan de kunne gjenoppta normal aktivitet, og de ble oppmuntret til å være i mest mulig normal fysisk aktivitet selv om ryggen var vond. Kontrollgruppen fikk vanlig behandling i primærhelsetjenesten.
Resultater: Pasientene som ble behandlet på ryggpoliklinikken kom fortere tilbake i jobb enn de pasientene som fikk vanlig behandling i primærhelsetjenesten. Etter et år var 68% friskmeldt i ryggpoliklinikkgruppen og 56% friskmeldt i primærhelsetjenestegruppen. Den raskere tilbakekomst til jobb det første året medførte ikke økt risiko for resykmelding de påfølgende to år og ga samfunnsøkonomiske besparelser. De som hadde best nytte av behandlingen på ryggpoliklinikken, var de som trodde at deres arbeidsevne var betydelig redusert, hadde konstant belastning på ryggen mer enn halve arbeidstiden, og trodde at årsak til ryggplagene ikke hadde sammenheng med tilfeldigheter. Studien viser også at ryggpasienter har flere subjektive helseplager enn normalbefolkningen.
Fortolkning: Den tidlige intervensjonen på ryggpoliklinikken medførte mindre sykefravær, og resultater fra analysene kan tyde på at denne behandlingen reduserte pasientenes frykt og engstelse for smertene og endret tro og forventninger om hvilken betydning jobben hadde som årsak til plagene.