Treatment of Early Intervention for Acute Low Back Pain Patients Utilizing a "Back-To-Work Transition" Component: A One-Year Prospective Study

This study built upon previous research by Gatchel et al. (2003) which utilized an algorithm developed by Gatchel et al. (1995), to identify what patients with ALBP were at high-risk for developing chronic pain and then implemented an interdisciplinary early intervention program in order to prevent the progression of ALBP to chronic low back pain (CLBP). The aforementioned authors were able to demonstrate the effectiveness of the early-intervention program as measured by decreases on a number of pain and disability-related measures as compared to "treatment as usual." In addition, they established the cost-effectiveness of such a program as compared to "treatment as usual" in terms of costs of medications, disability days, and healthcare utilization. The current study expanded upon the early-intervention program established by Gatchel et al. (2003) by adding a work transition component to better facilitate improved return-to-work and better work-related outcomes. In addition, the study set out to establish the effectiveness of the early-intervention and work transition component as well. After subjects were identified as being at high-risk for developing chronic pain, they were randomized into one of four treatment groups: early intervention (EI); early intervention with work transition (EI/W); work transition (NI/W); and non-intervention (NI), and followed-up for a period of 1-year. A limitation of the study was small sample size and resulting reductions A limitation of the study was small sample size and resulting reductions in statistical power. Despite this, the findings confirm prior studies that show early intervention with an acute pain population is important for achieving pain reduction, improved coping abilities, and return to work rates. Significant reductions in pain ratings were noted for the EI group from intake to 1-year. Overall, pain ratings for the EI, EI/W, and NI/W groups were observed to be comparable to one another and all were noted to be lower than NI group pain ratings at 1-year. In addition the EI, EI/W, and NI/W groups all demonstrated significant increases on a measure of coping that assesses an overall sense of control over physical well-being. Significant decreases and moderate decreases in functional disability were found for the EI group and EI/W group respectively from intake to 1-year. Results on a measure of obstacles to return-to-work indicated a moderately improved prognosis for return-to-work for the EI group at 1-year.