Patients With Low Back Pain Benefit From Advice To Stay Active
The researchers Marc Du Bois, MD, and Peter Donceel, PhD, from the Katholieke Universiteit Leuven in Belgium, stated: "Combined counseling and disability evaluation by a medical advisor results in a higher return to work rate due to a lower sick leave recurrence as compared to disability evaluation alone."
The team recruited 506 workers, mainly blue-collar workers, who were on medical leave due to lower back pain, and all of whom were routinely evaluated by a medical advisor as part of the Belgian national health and disability insurance plan.
The team randomly split the workers into two groups. One group received the standard disability evaluation only, whilst the other workers also received information and counseling for lower back pain according to the best medical practices currently available. These included avoiding bed rest and staying active, and continuing with normal daily activities as much as possible coupled with reassurance that the pain was likely to subside with time. Workers with more serious conditions like sciatica were not included in the study.
The findings revealed that those in the counseling group had a higher chance of eventually coming off disability and return to work, with only 4% of workers who did not return after one year compared with 8% of those who only received the standard disability evaluation. This difference was mainly due to less repeated episodes of medical leave amongst those in the counseling group (38%) compared with 60% in the evaluation-only group. The team observed no considerable difference in the total amount of sick days or in the percentage of those who ultimately required surgery (10 to 12%).
Nonspecific low back pain, i.e. back pain that is not caused by any specific abnormality is very common and also a very costly medical condition, and although the condition is usually "self-limiting" and improves over time, many patients suffer from prolonged periods of pain that lead to numerous treatments and prolonged disability. In Belgium alone, lower back pain is responsible for one-fourth of all workers on lifetime disability.
Recovery can be delayed and even hindered through long absences from work and being sedentary, with psychosocial factors also playing a role in the risk that the pain becomes a chronic problem. According to earlier research, offering reassurance of the pain improving and advising workers to remain as active as possible has demonstrated to decrease time off work.
The researchers conclude that patient information and counseling together with a routine evaluation for lower back pain can raise the number of patients who return to their work place, decreasing the number of people who claim disability and sick leave. A "rehabilitation-oriented approach" appears to be beneficial in decreasing the rate of recurrent sick leave, and doubling the chances of returning to work in subsequent months.
Both Du Bois and Donceel believe that this kind of counseling could help to prevent that low back pain becomes a chronic, disabling condition in many patients, and highlight that routine information and counseling need to be given "very early", i.e. within 6 weeks after the patient goes on medical leave, "before any side effects of being sick-listed have settled."
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Du Bois, Marc MD; Donceel, Peter MD, PhD
Spine, August 2012, doi: 10.1097/BRS.0b013e31824e4ada
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