Heymans Martijn W, de Vet Henrica C W, Bongers Paulien M, Knol Dirk L, Koes Bart W, van Mechelen Willem
Body@Work, Research Center Physical Activity, Work and Health, TNO-VUmc, Amsterdam, The Netherlands.
Spine (Phila Pa 1976). 2006 May 1;31(10):1075-82. doi: 10.1097/01.brs.0000216443.46783.4d.
Randomized controlled trial.
To compare high- and low-intensity back schools with usual care in occupational health care.
The content and intensity of back schools vary widely and the methodologic quality of randomized controlled trials is generally weak. Until now, no back school has proven to be superior for workers sick-listed because of subacute nonspecific low back pain.
Workers (n = 299) sick-listed for a period of 3 to 6 weeks because of nonspecific low back pain were recruited by the occupational physician and randomly assigned to a high-intensity back school, a low-intensity back school, or care as usual. Outcome measures were days until return to work, total days of sick-leave, pain, functional status, kinesiophobia, and perceived recovery and were assessed at baseline and at 3 and 6 months of follow-up. Principal analyses were performed according to the intention-to-treat principle.
We randomly allocated 299 workers. Workers in the low-intensity back school returned to work faster compared with usual care and the high-intensity back school, with hazard ratios of 1.4 (P = 0.06) and 1.3 (P = 0.09), respectively. The comparison between high-intensity back school and usual care resulted in a hazard ratio of 1.0 (P = 0.83). The median number of sick-leave days was 68, 75, and 85 in the low-intensity back school, usual care, and high-intensity back school, respectively. Beneficial effects on functional status and kinesiophobia were found at 3 months in favor of the low-intensity back school. No substantial differences on pain and perceived recovery were found between groups.
The low-intensity back school was most effective in reducing work absence, functional disability, and kinesiophobia, and more workers in this group scored a higher perceived recovery during the 6-month follow-up.
随机对照试验。
在职业卫生保健中，比较高强度和低强度的背部康复训练与常规护理。
背部康复训练的内容和强度差异很大，随机对照试验的方法学质量普遍较差。到目前为止，对于因亚急性非特异性下背痛而被列入病假名单的工人，尚无背部康复训练被证明具有优越性。
职业医生招募了因非特异性下背痛而被列入病假名单3至6周的工人（n = 299），并将他们随机分配到高强度背部康复训练组、低强度背部康复训练组或常规护理组。结局指标包括返回工作岗位所需天数、病假总天数、疼痛、功能状态、运动恐惧以及自我感觉的恢复情况，并在基线以及随访的3个月和6个月时进行评估。主要分析按照意向性分析原则进行。
我们随机分配了299名工人。与常规护理组和高强度背部康复训练组相比，低强度背部康复训练组的工人返回工作岗位的速度更快，风险比分别为1.4（P = 0.06）和1.3（P = 0.09）。高强度背部康复训练组与常规护理组的比较结果显示风险比为1.0（P = 0.83）。低强度背部康复训练组、常规护理组和高强度背部康复训练组的病假天数中位数分别为68天、75天和85天。在3个月时发现低强度背部康复训练组对功能状态和运动恐惧有有益影响。各组之间在疼痛和自我感觉的恢复方面未发现实质性差异。
低强度背部康复训练在减少缺勤、功能障碍和运动恐惧方面最有效，并且在6个月的随访期间，该组中更多工人的自我感觉恢复情况更好。
