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When Getting Back Patients Back to Work, Function Comes before Pain
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Posted on: 11/30/1999
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Causes and effective treatments for back pain are often elusive. Much medical research focuses on back pain because the condition affects so many people. It also has a significant and costly effect in the work world. It is one of the major reasons people are out of work on disability status. But so far, medical research hasn't uncovered any crystal clear truths about diagnosing or treating back pain.
This study, done in Norway, added a bit of information to the search for efficient ways of treating back pain. Researchers measured pain levels and physical performance in 117 patients who were on long-term sick leave because of back pain. The patients were divided into two groups. The intervention group was made up of 81 patients who took part in a specific rehabilitation program. The program was four weeks long, and patients had six-hour sessions, five days a week. Patients received physical therapy, education, adaptations to their workplaces, and assistance in making lifestyle or behavior changes. Little emphasis was placed on pain.
Meanwhile, the 36 patients in the control group arranged their own health care. About 75% received standard medical care, 32% reported using alternative treatments, and five patients didn't seek any treatment.
Disability status, scores on the physical tests, and pain levels were compared in both groups from the beginning of the study and again one year later. At the one-year follow-up, half of all the patients in both groups had returned to work. They showed improvements over the year in the physical tests and in pain levels. Patients in the intervention group who had not returned to work tended to have high pain levels and difficulty doing the physical tests. However, the researchers note that performance in the common "fingertip-to-floor" test--bending over to touch your toes--didn't seem to be related to patients' ability to return to work.
In the control group, the results were not quite as clear. Those who didn't return to work tended to have higher pain levels. But on the physical tests, they scored about the same as others in their group who had gone back to work.
Because the control group was so small and so little is known about the care they received, it is hard to draw clear conclusions from this study. However, the results do suggest that an intense, comprehensive rehabilitation program that emphasizes activity instead of pain may help providers more objectively sort out which patients can return to work after debilitating back pain.
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References:
Liv I. Strand, MSc, et al. The Impact of Physical Function and Pain on Work Status at 1-Year Follow-up in Patients With Back Pain. In Spine. April 1, 2001. Vol. 26. No. 7. Pp. 800-808.
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