Table 2.
Characteristics of the low back pain (LBP) rehabilitation studies (published in 1997–2022 in Finland, the Netherlands, Canada and Denmark) including active workplace involvement and occupational health (OH) or case managers in the intervention
| Study | Study population and design | Total sample/subgroup sample number | Randomization/allocation | Intervention | Control group | Outcome and follow-up | Potential confounders* |
|---|---|---|---|---|---|---|---|
| Finland, 2003 [21] | patients were recruited from 36 primary health care centres in the Helsinki metropolitan area (RCT) | total N = 164 subgroups:
|
|
Worksite visit group consisted of mini-intervention and worksite visit. The FIOH physiotherapist visited the patient's worksite. The patient's work supervisor and OH of the company joined the session (86% of cases employers attended). The aim of the visit was to ensure practical instructions of appropriate ergonomics at work with the cooperation of OH and employer. In mini-intervention, patient had appointments with physiatrist and physiotherapist and continued with graded activity and light mobilisation program. | Usual care group: patients in the usual care group were not examined but did receive an informative leaflet about back pain (as did all other study patients). They were treated by their GPs in public primary health care, including specialist consultations and physiotherapy, if assessed necessary by the GP. Patients could also have visited private doctors if they paid the costs of the visits themselves. | sick leaves resulting from back pain (1 year) | LBP for >4 weeks but <3 months age (M (range)):
gender: females
blue-collar workers:
losses during follow-up: 1 in usual care group (total <1%) |
| The Netherlands, 2010 [22] | outpatient clinic patients of the participating hospitals in Amsterdam (RCT) | total N = 134 subgroups:
|
|
The integrated care consisted of a workplace intervention based on participatory ergonomics and a graded activity programme. The intervention was provided by a team consisting of a care manager, clinical occupational physician, GP, a medical specialist, an occupational therapist, and a graded activity therapist. Care coordinators were occupational physicians trained for the task. Every patient had an appointment with care coordinator at the start. In the workplace intervention OT visited a workplace and discussed between patient and supervisor finding feasible solutions for RTW. | Usual care was passive observation of the health care usage. Healthcare use of all the patients was monitored during the 12 months of follow-up. In most cases usual care consisted of treatment by a physiotherapist (N = 42) or manual therapist (N = 20). Only a few patients visited their occupational physician (N = 16) or general practitioner (N = 10). Compared to the integrated care, patients in the usual care group received more diagnostic tests, used more analgesics and had more consultations for manual therapy, Cesar therapy, medical specialist, and psychological care. |
|
LBP lasting >12 weeks and patients being on sick leave (also partial sick leave) age (M±SD ):
gender: females
radiculopathy: not evaluated physical work:
losses during follow-up:
|
| Canada, 1997 [15] | patients were recruited from workplaces (which had >175 employees) in the Sherbrooke are (Canada, Quebec) (RCT) | total N = 104 subgroups:
|
|
Sherbrooke model is a 3-step rehabilitation program combining occupational intervention and clinical intervention. Occupational arm included only the occupational intervention. In the first step on sixth week of absence occupational doctor examines the worker and physiotherapist visits the worksite. Afterwards the meeting was held with the worker and the employer to find sustainable solutions for return to work. Second step was clinical intervention which included back pain specialist appointment after 8 weeks of absence from work. If needed, third step began after 12 weeks consisting of multidisciplinary intervention with functional restoration and cognitive-behavioural therapy. | At the start of the study, every study group (including standard care group) got an educational video of back pain and employers got a questionnaire. The physicians in standard care group had no limitations compared with their usual work. The physicians did not get advice about return to work as other groups had. | HR (1 year) | LBP and absence from regular work for >4 weeks age (M±SD) years:
gender: females
|
| Denmark, 2011 [23], 2012 [24], 2018 [25] | patients from 9 municipalities in Denmark Region were referred to The Spine Centre by their GP (RCT) | [23, 24] total N = 351 subgroups:
[25]: total N = 464 second study population (N = 120) was included to the previous subgroups:
|
all studies:
|
In addition to the BI described next, RTW plan was performed by a case manager and the treatment continued with the same rheumatologist and physiotherapist, along with a specialist in clinical social medicine and a social worker. The first visit for the case manager was taken place few days after the allocation to treatment groups. Follow-up visits were scheduled if needed. The multidisciplinary team had regular meetings. The case manager and a participant made a rehabilitation plan together. If suitable, the case manager assisted at a meeting at the workplace or contacted the employer by phone. Later, if RTW was deemed unrealistic, a plan for vocational rehabilitation was made (e.g., in some cases participants started other jobs supported by the social system). | Before allocation to treatment groups, all study patients had a similar clinical examination in the beginning, which was carried out by a rheumatologist and a physiotherapist (double blinded before the allocation). Relevant examinations and imaging were scheduled. In the visits patients with nonspecific LBP were informed about exercise being the best treatment. Patients with sciatica were informed about the good spontaneous prognosis and beneficial exercises for the pain. All study participants had a second visit to the physiotherapist after 2 weeks. The BI group participants were informed to book appointments with their GP, if they needed continuation for sick leave or needed advice for RTW. | HR (RTW to regular work) (1, 2 years)
employment status “cumulative weeks at work” (1, 2, 3, 4 and 5 years) |
[23, 24]: LBP and sick listed 3–16 weeks
age (M±SD):
gender: females
physical work: not evaluated radiculopathy:
losses during follow-up:
[25]: gender: females 58.3% age (M±SD):
radiculopathy: not evaluated losses during follow-up: 0 |
| Denmark, 2021 [26], 2022 [27] | patients from 9 municipalities in Denmark Region were referred to The Spine Centre by their GP (RCT) | total N = 476 new study group subgroups:
|
all studies:
|
Multidisciplinary intervention was similar as in the previous Danish study. As in the earlier study the case manager arranged a meeting in workplace with an employer or called the employer by phone. Both interventions happened only if they were approved by the participant. | Brief intervention was similar as in the previous Danish study. Rheumatologist does all the relevant tests and imaging for the diagnosis. Similar fear avoidance advises were given for all participants. | HR (RTW) in weak and strong job relation groups (1, 2 years) | LBP and partial or full sick leave for 4–12 weeks
age (M±SD):
gender, females:
physical work: not evaluated radiculopathy:
losses during follow-up: 0 (RTW was analysed for every participant) |
Bl - brief intervention; f IOH - Finnish Institute of Occupational Health; GP - general practitioner; HR - hazard ratio per protocol; IBP - low back pain; MOI - multidisciplinary intervention; OH - occupational health; OT - occupational therapist; RCT - randomized controlled trial; RTW - return to work.
Low back pain, age, gender, sciatica, losses during follow-up.