Specific Work-Focused Programs Do Not Substantially Alter Return to Work Rate in Patients with Chronic Neck and Back Pain as Compared to Standard Treatments

Neck and lower back pain are among the most prominent disorders that lead to time away from work as well as disability. Studies and models have already been developed focusing on the return-to-work (RTW) process. Multidisciplinary treatment for back pain has been a long standing tradition. In Norway, a recent randomized trial was performed that sought to look at utilizing workplace focused rehabilitation in specialized care versus traditional multidisciplinary treatments with the aim to see if there would be a reduction in the number of days needed before a sustainable RTW among sick-listed patients with chronic neck and low back pain. RTW was defined as the first five-week period after assignment that the patient did not receive sickness benefits, a work assessment allowance pension or a disability pension from the Norwegian Labour and Welfare administration.

The design was a multicenter trial in which sick-listed patients whom were referred to neck and back clinics in Norway were included and followed for one year. Each of the participants were allocated to either the work-focused or control interventions. All patients received a standard clinical examination with imaging evaluated and findings discussed with the patients. Emphasis was placed on removing fear-avoidance beliefs, restoring activity levels and enhancing self-care and coping. Rehabilitation for both groups included sessions of physiotherapy and overall interaction of a multidisciplinary healthcare team. Patients allocated to the work-focused intervention, additionally, had emphasis placed on RTW process. This process included individual appointments with a caseworker in which a RTW schedule was created. The caseworker also assisted members of the work-focused groups with setting up meetings with the employers and helped contact municipal social services if sick-leave compensation was an issue.

Results of the study demonstrated that there was no statistical significant differences found in RTW rate of work-focused group as compared to control intervention group. The median time before RTW was 161 days for the work-focused group and 158 days for the control group. The analyses did demonstrate that 70 per cent of participants in the work-focused group and 75 per cent of participants in the control group returned to work within the first year after inclusion.