204 lines
6.8 KiB
YAML
204 lines
6.8 KiB
YAML
abstract: 'Background Occupational medicine seeks to reduce sick leave; however,
|
|
|
|
evidence for an add-on effect to usual care is sparse. The objective of
|
|
|
|
the GOBACK trial was to test whether people with low back pain (LBP) in
|
|
|
|
physically demanding jobs and at risk of sick leave gain additional
|
|
|
|
benefit from a 3-month complex intervention that involves occupational
|
|
|
|
medicine consultations, a work-related evaluation and workplace
|
|
|
|
intervention plan, an optional workplace visit, and a physical activity
|
|
|
|
program, over a single hospital consultation and an MRI. Methods and
|
|
|
|
findings We enrolled people from the capital region of Denmark to an
|
|
|
|
open-label, parallel-group randomized controlled trial with a
|
|
|
|
superiority design from March 2014 through December 2015. In a hospital
|
|
|
|
setting 305 participants (99 women) with LBP and in physically demanding
|
|
|
|
jobs were randomized to occupational intervention (n = 153) or no
|
|
|
|
additional intervention (control group; n = 152) added to a single
|
|
|
|
hospital consultation giving a thorough explanation of the pain (i.e.,
|
|
|
|
clinical examination and MRI) and instructions to stay active and
|
|
|
|
continue working. Primary outcome was accumulated sick leave days due to
|
|
|
|
LBP during 6 months. Secondary outcomes were changes in neuropathic pain
|
|
|
|
(painDETECT questionnaire {[}PDQ]), pain 0-10 numerical rating scale
|
|
|
|
(NRS), Fear-Avoidance Beliefs Questionnaire (FABQ), Roland-Morris
|
|
|
|
Disability Questionnaire (RMDQ), Short Form Health Survey (SF-36) for
|
|
|
|
physical and mental health-related quality of life (HRQoL), and
|
|
|
|
self-assessed ability to continue working (range 0-10). An
|
|
|
|
intention-to-treat analysis of sick leave at 6 months showed no
|
|
|
|
significant difference between groups (mean difference in days
|
|
|
|
suggestively in favor of no additional intervention: 3.50 {[}95\% CI
|
|
|
|
-5.08 to 12.07], P = 0.42). Both groups showed significant improvements
|
|
|
|
in average pain score (NRS), disability (RMDQ), fear-avoidance beliefs
|
|
|
|
about physical activities and work (FABQ), and physical HRQoL (SF-36
|
|
|
|
physical component summary); there were no significant differences
|
|
|
|
between the groups in any secondary outcome. There was no statistically
|
|
|
|
significant improvement in neuropathic pain (PDQ score), mental HRQoL
|
|
|
|
(SF-36 mental component summary), and self-assessed ability to stay in
|
|
|
|
job. Four participants could not complete the MRI or the intervention
|
|
|
|
due to a claustrophobic attack or accentuated back pain. Workplace
|
|
|
|
visits may be an important element in the occupational intervention,
|
|
|
|
although not always needed. A per-protocol analysis that included the 40
|
|
|
|
participants in the intervention arm who received a workplace visit as
|
|
|
|
part of the additional occupational intervention did not show an add-on
|
|
|
|
benefit in terms of sick leave (available cases after 6 months, mean
|
|
|
|
difference: -0.43 days {[}95\% CI -12.8 to 11.94], P = 0.945). The main
|
|
|
|
limitations were the small number of sick leave days taken and that the
|
|
|
|
comprehensive use of MRI may limit generalization of the findings to
|
|
|
|
other settings, for example, general practice. Conclusions When given a
|
|
|
|
single hospital consultation and MRI, people in physically demanding
|
|
|
|
jobs at risk of sick leave due to LBP did not benefit from a complex
|
|
|
|
additional occupational intervention. Occupational interventions aimed
|
|
|
|
at limiting biopsychological obstacles (e.g., fear-avoidance beliefs and
|
|
|
|
behaviors), barriers in the workplace, and system barriers seem
|
|
|
|
essential to reduce sick leave in patients with LBP. This study
|
|
|
|
indicates that these obstacles and barriers may be addressed by thorough
|
|
|
|
usual care.'
|
|
affiliation: 'Hansen, BB (Corresponding Author), Copenhagen Univ Hosp, Parker Inst,
|
|
Bispebjerg, Denmark.
|
|
|
|
Hansen, BB (Corresponding Author), Copenhagen Univ Hosp, Parker Inst, Frederiksberg,
|
|
Denmark.
|
|
|
|
Hansen, BB (Corresponding Author), Copenhagen Univ Hosp, Dept Occupat \& Environm
|
|
Med, Bispebjerg, Denmark.
|
|
|
|
Hansen, BB (Corresponding Author), Copenhagen Univ Hosp, Dept Occupat \& Environm
|
|
Med, Frederiksberg, Denmark.
|
|
|
|
Hansen, Bjarke Brandt; Bliddal, Henning; Christensen, Robin; Kristensen, Lars Erik,
|
|
Copenhagen Univ Hosp, Parker Inst, Bispebjerg, Denmark.
|
|
|
|
Hansen, Bjarke Brandt; Bliddal, Henning; Christensen, Robin; Kristensen, Lars Erik,
|
|
Copenhagen Univ Hosp, Parker Inst, Frederiksberg, Denmark.
|
|
|
|
Hansen, Bjarke Brandt; Begtrup, Luise Moelenberg; Andreasen, Ditte Lundsgaard; Flachs,
|
|
Esben Meulengracht; Kryger, Ann Isabel, Copenhagen Univ Hosp, Dept Occupat \& Environm
|
|
Med, Bispebjerg, Denmark.
|
|
|
|
Hansen, Bjarke Brandt; Begtrup, Luise Moelenberg; Andreasen, Ditte Lundsgaard; Flachs,
|
|
Esben Meulengracht; Kryger, Ann Isabel, Copenhagen Univ Hosp, Dept Occupat \& Environm
|
|
Med, Frederiksberg, Denmark.
|
|
|
|
Kirkeskov, Lilli, Copenhagen Univ Hosp, Ctr Social Med, Bispebjerg, Denmark.
|
|
|
|
Kirkeskov, Lilli, Copenhagen Univ Hosp, Ctr Social Med, Frederiksberg, Denmark.
|
|
|
|
Boesen, Mikael, Copenhagen Univ Hosp, Dept Radiol, Bispebjerg, Denmark.
|
|
|
|
Boesen, Mikael, Copenhagen Univ Hosp, Dept Radiol, Frederiksberg, Denmark.
|
|
|
|
Christensen, Robin, Univ Southern Denmark, Odense Univ Hosp, Dept Clin Res, Res
|
|
Unit Rheumatol, Odense, Denmark.'
|
|
article-number: e1002898
|
|
author: Hansen, Bjarke Brandt and Kirkeskov, Lilli and Begtrup, Luise Moelenberg and
|
|
Boesen, Mikael and Bliddal, Henning and Christensen, Robin and Andreasen, Ditte
|
|
Lundsgaard and Kristensen, Lars Erik and Flachs, Esben Meulengracht and Kryger,
|
|
Ann Isabel
|
|
author-email: dr.bjarke@gmail.com
|
|
author_list:
|
|
- family: Hansen
|
|
given: Bjarke Brandt
|
|
- family: Kirkeskov
|
|
given: Lilli
|
|
- family: Begtrup
|
|
given: Luise Moelenberg
|
|
- family: Boesen
|
|
given: Mikael
|
|
- family: Bliddal
|
|
given: Henning
|
|
- family: Christensen
|
|
given: Robin
|
|
- family: Andreasen
|
|
given: Ditte Lundsgaard
|
|
- family: Kristensen
|
|
given: Lars Erik
|
|
- family: Flachs
|
|
given: Esben Meulengracht
|
|
- family: Kryger
|
|
given: Ann Isabel
|
|
da: '2023-09-28'
|
|
doi: 10.1371/journal.pmed.1002898
|
|
eissn: 1549-1676
|
|
files: []
|
|
issn: 1549-1277
|
|
journal: PLOS MEDICINE
|
|
keywords-plus: 'HEALTH-CARE; SICK-LEAVE; QUESTIONNAIRE; WORKPLACE; MANAGEMENT; WORKERS;
|
|
|
|
RETURN; RATES'
|
|
language: English
|
|
month: AUG
|
|
number: '8'
|
|
number-of-cited-references: '33'
|
|
orcid-numbers: 'Bliddal, Henning/0000-0002-7951-1668
|
|
|
|
Boesen, Mikael/0000-0002-8774-6563
|
|
|
|
Christensen, Robin/0000-0002-6600-0631
|
|
|
|
Hansen, Bjarke Brandt/0000-0002-4440-1960
|
|
|
|
Flachs, Esben Meulengracht/0000-0002-2252-8426'
|
|
papis_id: 0c7b316434483e8885b6c193555a90e0
|
|
ref: Hansen2019earlyoccupational
|
|
researcherid-numbers: 'Kristensen, Lars Erik/AAZ-2615-2020
|
|
|
|
'
|
|
times-cited: '9'
|
|
title: 'Early occupational intervention for people with low back pain in physically
|
|
demanding jobs: A randomized clinical trial'
|
|
type: Article
|
|
unique-id: WOS:000489050500023
|
|
usage-count-last-180-days: '1'
|
|
usage-count-since-2013: '4'
|
|
volume: '16'
|
|
web-of-science-categories: Medicine, General \& Internal
|
|
year: '2019'
|