Advice to stay active promotes recovery in patients with low back pain

For workers on medical leave because of low back pain, giving advice to stay active increases the chances of returning to work, reports a study in the August 1 issue of Spine. The journal is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health.

"Combined counseling and disability evaluation by a medical advisor results in a higher return to work rate due to a lower sick leave recurrence as compared to disability evaluation alone," according to the study by Marc Du Bois, MD, and Peter Donceel, PhD, of Katholieke Universiteit Leuven, Belgium.

Advice to Stay Active Promotes Recovery

The study included 506 workers—mainly blue collar workers—on sick leave because of low back pain. All were undergoing routine evaluation by a medical advisor as part of the Belgian national health and disability insurance plan.

In addition to disability evaluation, half of the workers were randomly assigned to receive information and advice regarding low back pain. Consistent with best current medical practice, counseling included:
•Reassurance that back pain was likely to resolve with time.
•Recommendation to avoid bed rest.
•Advice to stay active and continue with daily normal activities, as much as possible.

The rest of the workers received the standard disability evaluation only. Workers with "red flags" signaling possibly more serious conditions—for example, sciatica—were excluded from the study.

Workers who received information and advice were more likely to eventually go off disability and return to work. By one year, only four percent of workers in the counseling group had not returned to work, compared to eight percent of those receiving disability evaluation only.

The difference mainly resulted from a lower rate of repeated episodes of medical leave among workers assigned to information and advice: 38 percent, compared to 60 percent with evaluation only. There was no significant difference in the total time on sick leave or in the percentage of patients who eventually underwent surgery (ten to twelve percent).

Nonspecific low back pain—unrelated to any specific abnormality—is a very common and costly medical problem. Even though low back pain is usually a "self-limiting" condition that improves over time, many patients have prolonged pain leading to many treatments and prolonged disability. In Belgium, low back pain accounts for one-fourth of all workers on lifetime disability.

Prolonged absence from work and avoidance of activity can delay and even hinder recovery; psychosocial factors affect the risk of back pain becoming a chronic problem. In previous studies, strategies offering reassurance that pain will get better and advice to stay as active have been shown to reduce missed work time.

The new study suggests that including this information and advice as part of routine evaluation for low back pain can increase the percentage of patients returning to work—and getting off of disability and sick leave. This "rehabilitation-oriented approach" seems to improve outcomes by reducing the rate of recurrent sick leave, doubling the chances of return to work in the subsequent months.

Drs Du Bois and Donceel believe that this type of counseling could help prevent low back pain from becoming a chronic, disabling condition for many patients. They emphasize that routine information and advice needs to be provided "very early"—within six weeks after the patient goes on medical leave—"before any side effects of being sick-listed have settled."