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Function-centered rehabilitation increases work days in patients with nonacute nonspecific low back pain: 1-year results from a randomized controlled trial
Kool J, Bachmann S, Oesch P, Knuesel O, Ambergen T, de Bie R, van den Brandt P
Archives of Physical Medicine and Rehabilitation 2007 Sep;88(9):1089-1094
clinical trial
8/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: Yes; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: Yes; Adequate follow-up: Yes; Intention-to-treat analysis: Yes; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

OBJECTIVE: To compare the effect of function-centered treatment (FCT) and pain-centered treatment (PCT) on the number of work days, permanent disability, and the unemployment rate. DESIGN: Randomized controlled trial. SETTING: Inpatient rehabilitation center. PARTICIPANTS: Patients (N = 174; 79% male; mean age 42 y) with previous sick leave of 6 weeks or more. INTERVENTIONS: FCT (4 h/d for 3 wk) emphasized activity despite pain by using work simulation, strength, endurance, and cardiovascular training. PCT (2.5h/d for 3 wk) emphasized pain reduction and included passive and active mobilization, stretching, strength training, and a 4-hour mini back school with education and exercise. Analysis was by intention to treat. MAIN OUTCOME MEASURES: Work days, return to work, rate of patients receiving financial compensation for permanent disability, and unemployment rate. Effect sizes (Cohen d) were defined as small (0.2 to 0.5), moderate (0.5 to 0.8), and large (> 0.8). RESULTS: After 1 year, the FCT group had significantly more work days (mean 118; median 39.5; interquartile range (IQR) 0 to 198) than the PCT group (mean 74; median 0; IQR 0 to 160; Mann-Whitney U test, p = 0.011). The odds ratio of returning to work in the FCT group relative to the PCT group was 2.1 (95% confidence interval 1.1 to 3.9). The differences in unemployment rates and in the numbers of patients receiving compensation for permanent disability were not significant. CONCLUSIONS: FCT is more effective than PCT for increasing work days.

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