Frederiksen Pernille, Indahl Aage, Andersen Lars L, Burton Kim, Hertzum-Larsen Rasmus, Bendix Tom
Copenhagen Center for Back Research (COPE BACK), Centre for Rheumatology and Spine Diseases, Glostrup, Denmark.
Metropolitan University College, Copenhagen, Denmark.
PLoS One. 2017 Mar 27;12(3):e0172003. doi: 10.1371/journal.pone.0172003. eCollection 2017.
Low back pain (LBP) is common in the population and multifactorial in nature, often involving negative consequences. Reassuring information to improve coping is recommended for reducing the negative consequences of LBP. Adding a simple non-threatening explanation for the pain (temporary muscular dysfunction) has been successful at altering beliefs and behavior when delivered with other intervention elements. This study investigates the isolated effect of this specific information on future occupational behavior outcomes when delivered to the workforce.
A cluster-randomized controlled trial.
Publically employed workers (n = 505) from 11 Danish municipality centers were randomized at center-level (cluster) to either intervention (two 1-hour group-based talks at the workplace) or control. The talks provided reassuring information together with a simple non-threatening explanation for LBP-the 'functional-disturbance'-model. Data collections took place monthly over a 1-year period using text message tracking (SMS). Primary outcomes were self-reported days of cutting down usual activities and work participation. Secondary outcomes were self-reported back beliefs, work ability, number of healthcare visits, bothersomeness, restricted activity, use of pain medication, and sadness/depression.
There was no between-group difference in the development of LBP during follow-up. Cumulative logistic regression analyses showed no between-group difference on days of cutting down activities, but increased odds for more days of work participation in the intervention group (OR = 1.83 95% CI: 1.08-3.12). Furthermore, the intervention group was more likely to report: higher work ability, reduced visits to healthcare professionals, lower bothersomeness, lower levels of sadness/depression, and positive back beliefs.
Reassuring information involving a simple non-threatening explanation for LBP significantly increased the odds for days of work participation and higher work ability among workers who went on to experience LBP during the 12-month follow-up. Our results confirm the potential for public-health education for LBP, and add to the discussion of simple versus multidisciplinary interventions.
下背痛（LBP）在人群中很常见，其本质具有多因素性，常涉及负面后果。建议提供安慰性信息以改善应对方式，从而减少LBP的负面后果。当与其他干预要素一起提供时，为疼痛添加一个简单的无威胁性解释（暂时性肌肉功能障碍）已成功改变了信念和行为。本研究调查了向劳动力群体提供这一特定信息对未来职业行为结果的单独影响。
一项整群随机对照试验。
来自丹麦11个市政中心的受雇公共部门工作人员（n = 505）在中心层面（整群）被随机分为干预组（在工作场所进行两次为时1小时的小组讲座）或对照组。讲座提供了安慰性信息以及对LBP的简单无威胁性解释——“功能障碍”模型。在1年期间每月通过短信追踪（SMS）进行数据收集。主要结局是自我报告的减少日常活动天数和工作参与情况。次要结局是自我报告的背部信念、工作能力、医疗就诊次数、困扰程度、活动受限情况、止痛药使用情况以及悲伤/抑郁情绪。
随访期间LBP的发展在组间无差异。累积逻辑回归分析显示，在减少活动天数方面组间无差异，但干预组工作参与天数更多的几率增加（OR = 1.83，95%CI：1.08 - 3.12）。此外，干预组更有可能报告：更高的工作能力、减少就医、更低的困扰程度、更低的悲伤/抑郁水平以及积极的背部信念。
包含对LBP简单无威胁性解释的安慰性信息显著增加了在12个月随访期间经历LBP的工人的工作参与天数几率和更高的工作能力。我们的结果证实了LBP公共健康教育的潜力，并为简单干预与多学科干预的讨论增添了内容。
