A POPULATION-BASED, RANDOMIZED CLINICAL-TRIAL ON BACK PAIN MANAGEMENT

Study Design. Population-based randomized clinical trial. Objectives. To develop and test a model of management of subacute back pain, to pr event prolonged disability. Summary of Background Data. The present ma nagement of back pain seems inadequate, and development of innovative models has been urged. Methods. A model for the treatment of subacute work-related back pain has been developed and evaluated in a populatio n-based randomized clinical trial. Workers (n = 130) from eligible wor kplaces in the Sherbrooke area (N = 31), who had been absent from work for more than 4 weeks for back pain, were randomized, based on their workplace, in one of four treatment groups: usual care, clinical inter vention, occupational intervention, and full intervention (a combinati on of the last two). The duration of absence from regular work and fro m any work was evaluated using survival analysis. Functional status an d pain were compared at study entry and after 1 year of follow-up. Res ults. The full intervention group returned to regular work 2.41 times faster than the usual care intervention group (95% confidence interval 1.19-4.89; P = 0.01). The specific effect of the occupational interve ntion accounted for the most important part of this result, with a rat e ratio of return to regular work of 1.91 (95% confidence interval = 1 .18-3.10; P < 0.01). Pain and disability scales demonstrated either a statistically significant reduction or a trend toward reduction in the three intervention groups, compared with the trend in the usual care intervention group. Conclusions. Close association of occupational int ervention with clinical care is of primary importance in impeding prog ression toward chronicity of low back pain.