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01.12.2015 | Research article | Ausgabe 1/2015 Open Access

BMC Musculoskeletal Disorders 1/2015

Change in pain, disability and influence of fear-avoidance in a work-focused intervention on neck and back pain: a randomized controlled trial

Zeitschrift:
BMC Musculoskeletal Disorders > Ausgabe 1/2015
Autoren:
Gunn Hege Marchand, Kjersti Myhre, Gunnar Leivseth, Leiv Sandvik, Bjørn Lau, Erik Bautz-Holter, Cecilie Røe
Wichtige Hinweise

Competing interests

The authors declare that they have no competing interests.

Authors’ contributions

GHM participated in the design and coordination of the study, data acquisition, statistical analysis and interpretation of data, and drafting of the manuscript. KM participated in the design and coordination of the study, data acquisition, and critical revision of the manuscript. GL participated in the design of the study, analysis and interpretation of data, and critical revision of the manuscript. LS participated in the statistical analysis and interpretation of data, and critical revision of the manuscript. BL participated in the design of the study, analysis and interpretation of data, and critical revision of the manuscript. EBH participated in the design and conception of the study, interpretation of data, and critical revision of the manuscript. CR participated in the conception, design and coordination of the study, analysis and interpretation of data, and critical revision of the manuscript. All authors read and approved the manuscript.

Abstract

Background

Neck and back pain are among the most common causes of prolonged disability, and development of interventions with effect on pain, disability and return to work is important. Reduction of fear avoidance might be one mechanism behind improvement after interventions. The aim of the present study was to evaluate changes in pain and disability at the 12-month follow-up of patients with neck and back pain treated with a work-focused intervention compared to patients treated with standard interventions, and the influence of improvement fear avoidance beliefs during the interventions on pain, disability and return to work at 12-month follow-up.

Methods

413 employed patients with back or neck pain referred to secondary care, and sick-listed between 4 weeks and 12 months, were randomized to a work-focused rehabilitation or control interventions. Follow-up was conducted 4 and 12 months after inclusion. The groups were compared (independent sample t-test) regarding differences in disability scores (Oswestry disability index/neck disability index) and pain (numeric rating scale) from baseline to 12-month follow-up. Changes in fear avoidance beliefs (FABQ) from baseline to 4 month follow-up were calculated, and the association between this change and return to work, pain and disability at 12 months were tested in stepwise multiple logistic regression models.

Results

Pain and, disability scores decreased to in both the work-focused and control intervention to 12-month follow-up, and there were no significant differences between the groups. FABQ decreased similarly in both groups to 4 month follow-up. The logistic regression model revealed an association between a reduced FABQ work score at 4 months and return to work within one year (adjusted OR 3.60, 95% CI 1.19 to 10.88). Reduced FABQ physical activity score at 4 months was associated with decreased disability after 12 months (adjusted OR (3.65. 95% CI 1.43 to 9.28).

Conclusions

Short work-focused rehabilitation had the same effect on pain and disability as control interventions. Reduction in FABQ-W score after treatment seems to be an important predictor for return to work in both groups.

Trial registration

Clinicaltrials.gov NCT00840697
Literatur
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