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