Faculty of Medicine, Department of Clinical Sciences Lund, Orthopedics, Lund University, Lund, Sweden.
Blekinge Centre of Competence, Region Blekinge, Karlskrona, Sweden.
Scand J Prim Health Care. 2020 Mar;38(1):92-100. doi: 10.1080/02813432.2020.1717081. Epub 2020 Jan 30.
To study the long-term effects of a workplace intervention in addition to structured physiotherapy regarding self-reported measures in patients with acute/subacute neck and/or back pain. WorkUp - a cluster-randomised controlled trial in 32 primary care centers in Sweden, from January 2013 through December 2014 (ClinicalTrials.gov ID: NCT02609750). Structured physiotherapy with the workplace dialogue 'Convergence Dialogue Meeting' (CDM), conducted by the treating physiotherapist as an add-on. Reference group received structured physiotherapy. Adults, 18-67 years (mean 43.7, standard deviation (SD) 12.2), 65.3% women with acute/subacute neck and/or back pain who had worked ≥4 weeks past year, considered at risk of sick leave or were on short-term sick leave (≤60 days) were included ( = 352). Self-reported function, functional rating index (FRI), health-related quality of life (EQ-5D-3L) and work ability (Work Ability Score, WAS) at 12 months follow-up. The mean differences in outcomes between intervention and reference group were; -0.76 (95% confidence interval (CI): -2.39, 0.88; FRI), 0.02 (95% CI: -0.04, 0.08; EQ-5D-3L) and -0.05 (95% CI: -0.63, 0.53; WAS). From baseline to 12 months, the intervention group improved function from 46.5 (SD 19.7) to 10.5 (SD 7.3) on FRI; health-related quality of life from 0.53 (SD 0.29) to 0.74 (SD 0.20) on EQ-5D and work ability from 5.7 (SD 2.6) to 7.6 (SD 2.1) on WAS. Despite a clinically relevant improvement over time, there were no significant differences in improvement between groups, thus we conclude that CDM had no effect on self-reported measures in this study.Key pointsIn earlier analysis of the primary outcome (work ability measured by absenteeism) in this trial, a positive effect was found when the workplace intervention 'Convergence Dialogue Meeting' (CDM) was added to structured physiotherapy for patients with neck or back pain.By contrast, in this new analysis of secondary outcomes (self-reported function, health and perceived work ability), there was no added effect of CDM above structured physiotherapy alone, although patients in both the intervention and reference group improved over time.The addition of CDM to physiotherapy is therefore justified by its specific effect on behavior (work absence) rather than any effect on clinical outcomes.
除了结构物理疗法外，研究工作场所干预对急性/亚急性颈痛和/或背痛患者自我报告测量结果的长期影响。WorkUp - 2013 年 1 月至 2014 年 12 月在瑞典 32 个初级保健中心进行的一项群组随机对照试验（临床试验.gov 标识符：NCT02609750）。结构物理疗法外加治疗物理治疗师进行的工作场所对话“趋同对话会议”（CDM）。对照组接受结构物理疗法。18-67 岁（平均 43.7，标准差 12.2）、65.3%为女性的急性/亚急性颈痛和/或背痛患者，过去一年至少工作 4 周，被认为有请病假风险或正在短期请病假（≤60 天）（n=352）。12 个月随访时自我报告的功能、功能评定指数（FRI）、健康相关生活质量（EQ-5D-3L）和工作能力（工作能力评分，WAS）。干预组和对照组在结局方面的平均差异为：-0.76（95%置信区间（CI）：-2.39，0.88；FRI）、0.02（95% CI：-0.04，0.08；EQ-5D-3L）和-0.05（95% CI：-0.63，0.53；WAS）。从基线到 12 个月，干预组 FRI 的功能从 46.5（SD 19.7）改善到 10.5（SD 7.3）；EQ-5D 的健康相关生活质量从 0.53（SD 0.29）改善到 0.74（SD 0.20）；WAS 的工作能力从 5.7（SD 2.6）改善到 7.6（SD 2.1）。尽管随着时间的推移，功能得到了明显的改善，但两组之间的改善没有显著差异，因此我们得出结论，在这项研究中，CDM 对自我报告的测量结果没有影响。关键点：在这项试验的主要结局（缺勤率衡量的工作能力）的早期分析中，当为颈痛或背痛患者添加工作场所干预措施“趋同对话会议”（CDM）时，结构物理疗法的效果为阳性。相比之下，在对次要结局（自我报告的功能、健康和感知工作能力）的这项新分析中，CDM 对结构物理疗法单独治疗的效果没有增加，尽管干预组和对照组的患者随着时间的推移都有所改善。因此，CDM 对物理治疗的补充是合理的，因为它对行为（缺勤）有特定的影响，而不是对临床结果有任何影响。
