Secondary prevention of work-related disability in nonspecific low back pain: does problem-solving therapy help? A randomized clinical trial

Clin J Pain. 2003 Mar-Apr;19(2):87-96. doi: 10.1097/00002508-200303000-00003.


Objectives: Given the individual and economic burden of chronic work disability in low back pain patients, there is a need for effective preventive interventions. The aim of the present study was to investigate whether problem-solving therapy had a supplemental value when added to behavioral graded activity, regarding days of sick leave and work status.

Design: Randomized controlled trial.

Patients and setting: Employees who were recently on sick leave as a result of nonspecific low back pain were referred to the rehabilitation center by general practitioner, occupational physician, or rehabilitation physician. Forty-five employees had been randomly assigned to the experimental treatment condition that included behavioral graded activity and problem-solving therapy (GAPS), and 39 employees had been randomly assigned to behavioral graded activity and group education (GAGE).

Outcome measures: Days of sick leave and work status. Data were retrieved from occupational health services.

Results: Data analyses showed that employees in the GAPS group had significantly fewer days of sick leave in the second half-year after the intervention. Moreover, work status was more favorable for employees in this condition, in that more employees had a 100% return-to-work and fewer patients ended up receiving disability pensions one year after the intervention. Sensitivity analyses confirmed these results.

Conclusions: The addition of problem-solving therapy to behavioral graded activity had supplemental value in employees with nonspecific low back pain.

Publication types

  • Clinical Trial
  • Comparative Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Behavior Therapy / methods*
  • Cognitive Behavioral Therapy / methods*
  • Combined Modality Therapy
  • Disability Evaluation*
  • Disease Management
  • Employment / statistics & numerical data
  • Female
  • Humans
  • Low Back Pain / classification
  • Low Back Pain / diagnosis
  • Low Back Pain / etiology
  • Low Back Pain / prevention & control*
  • Male
  • Occupational Diseases / complications
  • Occupational Diseases / prevention & control
  • Patient Education as Topic* / methods
  • Problem Solving
  • Reproducibility of Results
  • Sensitivity and Specificity
  • Sick Leave / statistics & numerical data
  • Treatment Outcome