Multidisciplinary outpatient care program for patients with chronic low back pain: design of a randomized controlled trial and cost-effectiveness study ISRCTN28478651Reportar como inadecuado

Multidisciplinary outpatient care program for patients with chronic low back pain: design of a randomized controlled trial and cost-effectiveness study ISRCTN28478651 - Descarga este documento en PDF. Documentación en PDF para descargar gratis. Disponible también para leer online.

BMC Public Health

, 7:254

First Online: 20 September 2007Received: 16 May 2007Accepted: 20 September 2007DOI: 10.1186-1471-2458-7-254

Cite this article as: Lambeek, L.C., Anema, J.R., van Royen, B.J. et al. BMC Public Health 2007 7: 254. doi:10.1186-1471-2458-7-254


BackgroundChronic low back pain LBP is a major public and occupational health problem, which is associated with very high costs. Although medical costs for chronic LBP are high, most costs are related to productivity losses due to sick leave. In general, the prognosis for return to work RTW is good but a minority of patients will be absent long-term from work. Research shows that work related problems are associated with an increase in seeking medical care and sick leave. Usual medical care of patients is however, not specifically aimed at RTW.

The objective is to present the design of a randomized controlled trial, i.e. the BRIDGE-study, evaluating the effectiveness in improving RTW and cost-effectiveness of a multidisciplinary outpatient care program situated in both primary and outpatient care setting compared with usual clinical medical care for patients with chronic LBP.

Methods-DesignThe design is a randomized controlled trial with an economic evaluation alongside. The study population consists of patients with chronic LBP who are completely or partially sick listed and visit an outpatient clinic of one of the participating hospitals in Amsterdam the Netherlands. Two interventions will be compared. 1. a multidisciplinary outpatient care program consisting of a workplace intervention based on participatory ergonomics, and a graded activity program using cognitive behavioural principles. 2. usual care provided by the medical specialist, the occupational physician, the patient-s general practitioner and allied health professionals. The primary outcome measure is sick leave duration until full RTW. Sick leave duration is measured monthly by self-report during one year. Data on sick leave during one-year follow-up are also requested form the employers. Secondary outcome measures are pain intensity, functional status, pain coping, patient satisfaction and quality of life. Outcome measures are assessed before randomization and 3, 6, and 12 months later. All statistical analysis will be performed according to the intension-to-treat principle.

DiscussionUsual care of primary and outpatient health services isn-t directly aimed at RTW, therefor it is desirable to look for care which is aimed at RTW. Research shows that several occupational interventions in primary care are aimed at RTW. They have shown a significant reduction of sick leave for employee with LBP. If a comparable reduction of sick leave duration of patients with chronic LBP of who attend an outpatient clinic can be achieved, such reductions will be obviously substantial for the Netherlands and will have a considerable impact.

Trial registrationISRCTN28478651

AbbreviationsGAgraded activity

GPgeneral practitioner

HRhazard ratio

LBPlow back pain

MOCmultidisciplinary outpatient care

OPoccupational physician

Par-QPhysical Activities Readiness Questionnaire

PCIPain Coping Inventory scale

RCQ-24Roland – Morris Disability-24 Questionnaire

RCTrandomized controlled trial

RTWreturn to work

UCusual clinical medical care

VASVisual Analogue Scale.

Electronic supplementary materialThe online version of this article doi:10.1186-1471-2458-7-254 contains supplementary material, which is available to authorized users.

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Autor: Ludeke C Lambeek - Johannes R Anema - Barend J van Royen - Peter C Buijs - Paul I Wuisman - Maurits W van Tulder - Wil


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