Finding the Optimal Treatment for Workers with Low Back Pain

For the past 10 years, research in the area of low back pain has taken a different direction. Instead of studying large groups of heterogenous (all different) people, the approach now is to find subgroups of low back pain patients who are most likely to respond to treatment. Sometimes the focus is on treatment in general. In other studies, the response of a subgroup to a specific treatment idea is investigated.

In this study, researchers from Canada and The Netherlands teamed up to detect possible patient factors that might affect response to treatment. The workers studied were all employed in physically demanding jobs. They had been off work on sick leave for eight weeks. Previous studies have already shown that age, gender, and poor function are predictive of longer use of sick leave.

The question in this study was whether or not these same factors would change how workers responded to a workplace intervention. The intervention was an unspecified graded activity. The authors just stated that modified and ergonomic work was provided. The goal was to successfully return the worker to his or her job after an episode of low back pain. The workers were divided into two groups. One group received usual care. The second group participated in the workplace intervention.

Data collected on each participant included number of weeks on sick leave, pain level, function, and time to return-to-work. Function was measured using specific tests such as the Roland Morris Disability Scale and the Dutch Musculoskeletal Questionnaire.

Analysis of the data showed that older adults (44 years old or older) were more likely to benefit from the intervention and return-to-work sooner than younger adults. Anyone who had a previous history of taking sick leave for their low back pain was also more likely to get better and return-to-work sooner.

Another way to look at the results of this study is to say that there are certain subgroups of low back pain patients who seem to respond to this particular intervention. The workplace intervention is a good idea for older workers and for those who have already used sick leave before. Selecting workers for this type of program to get them back on-the-job shouldn’t be based on their gender (male versus female), how much pain they are in, their level of function, or even whether or not their job involves heavy labor.

The bottom-line of this study was to find ways to return workers to their jobs faster after being off work for low back pain. Providing the right treatment to the right group of patients is the current goal of studies like this one.

Understanding why certain patient characteristics affect how well a particular treatment works may be helpful. In the case of these two modifiers (age and previous sick leave), no clear explanation was obvious. The authors suggest it's possible that older adults who have been off work before for low back pain realize the need to make changes in order to prevent future episodes. And maybe those workers who took sick leave just needed a more practical way to deal with their back pain.

The future of back pain research will continue to focus on finding the best way to get patients back on their feet and back to work as quickly as possible. Looking for subgroups and modifiers of treatment within those subgroups could be a very good way to choose the right treatment for each person.

Ivan A. Steenstra, PhD, et al. What Works Best for Whom? Trial on the Effectiveness of a Workplace Intervention in Low Back Pain Patients on Return to Work. In Spine. May 20, 2009. Vol. 34. No. 12. Pp. 1243-1249.

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