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Mini-Intervention for Subacute Low Back Pain: A Randomized Controlled Trial.
Karjalainen, Kaija MD; Malmivaara, Antti MD, PhD; Pohjolainen, Timo MD, PhD; Hurri, Heikki MD, PhD; Mutanen, Pertti MSc; Rissanen, Pekka PhD; Pahkajarvi, Helena RPT; Levon, Heikki MD; Karpoff, Hanna RN; Roine, Risto MD, PhD
[Miscellaneous Article] Spine. 28(6):533-540, March 15, 2003.

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Study Design. Randomized controlled trial.

Objectives. To investigate the effectiveness and costs of a mini-intervention, provided in addition to the usual care, and the incremental effect of a work site visit for patients with subacute disabling low back pain.

Summary of Background Data. There is lack of data on cost-effectiveness of brief interventions for patients with prolonged low back pain.

Methods. A total of 164 patients with subacute low back pain were randomized to a mini-intervention group (A), a work site visit group (B), or a usual care group (C). Groups A (n = 56) and B (n = 51) underwent one assessment by a physician plus a physiotherapist. Group B received a work site visit in addition. Group C served as controls (n = 57) and was treated in municipal primary health care. All patients received a leaflet on back pain. Pain, disability, specific and generic health-related quality of life, satisfaction with care, days on sick leave, and use and costs of health care consumption were measured at 3-, 6-, and 12-month follow-ups.

Results. During follow-up, fewer subjects had daily pain in Groups A and B than in Group C (Group A vs. Group C, P = 0.002; Group B vs. Group C, P = 0.030). In Group A, pain was less bothersome (Group A vs. Group C, P = 0.032) and interfered less with daily life (Group A vs. Group C, P = 0.040) than among controls. Average days on sick leave were 19 in Group A, 28 in Group B, and 41 in Group C (Group A vs. Group C, P = 0.019). Treatment satisfaction was better in the intervention groups than among the controls, and costs were lowest in the mini-intervention group.

Conclusions. Mini-intervention reduced daily back pain symptoms and sickness absence, improved adaptation to pain and patient satisfaction among patients with subacute low back pain, without increasing health care costs. A work site visit did not increase effectiveness.