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Title: Function-centred rehabilitation increases work days in patients with non-acute non-specific low back pain: one-year results from a randomised controlled trial.

Authors and affiliation: Jan Kool1, MSc, Stefan Bachmann, MD1, Peter Oesch, MSc1, Otto Knuesel, MD1, Rob de Bie, PhD2, Piet van den Brandt, PhD2

1 Department of Rheumatology, Rehabilitation Centre Valens, Valens, Switzerland
2 Department of Epidemiology, Maastricht University, Maastricht, the Netherlands

Email address: j.kool@klinik-valens.ch

Introduction: Days lost from work are responsible for the major costs related to low back pain. Multidisciplinary rehabilitation is effective compared with usual care. It is unknown whether function centred treatment (FCT), developed for foreign workers in Switzerland with limited knowledge of the national language, is superior to pain centred treatment (PCT).

Objective: To compare the effect of FCT and PCT on the number of work days during the follow-up year, to perform a subgroup analysis based on pre-treatment assessments and to determine predictive factors based on measurements after treatment.

Methods: Randomised controlled trial. FCT, 4 hrs/day, 3 weeks, emphasised activity in spite of pain and coping and consisted of work simulation, strength, endurance and cardiovascular training in groups. PCT, 2.5 hrs/day, 3 weeks, emphasised pain reduction and consisted of a mini back-school and individual therapy with passive and active mobilisation, stretching and strength training. Analysis was by intention-to-treat. Predictive factors for work days were determined with stepwise regression.

Results: We considered 260 patients, 174 were included. During the follow-up year, the FCT group had more work days (118±134) than the PCT group (74±114, ES=.35, p=0.011). The effect was larger in patients performing light work and independent of nationality, sex, and unemployment. Predictive factors were the lifting capacity, pain behaviour, pain intensity, unemployment, nationality, the patients’ belief about return to the previous work and work load.

Conclusion: FCT is more effective than PCT for increasing work days.