University of Oulu

Rantonen, J., Karppinen, J., Vehtari, A., Luoto, S., Viikari-Juntura, E., Hupli, M., Malmivaara, A., Taimela, S. (2018) Effectiveness of three interventions for secondary prevention of low back pain in the occupational health setting - a randomised controlled trial with a natural course control. BMC Public Health, 18 (1), 598. doi:10.1186/s12889-018-5476-8

Effectiveness of three interventions for secondary prevention of low back pain in the occupational health setting : a randomised controlled trial with a natural course control

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Author: Rantonen, J.1,2,3; Karppinen, J.4,5; Vehtari, A.6;
Organizations: 1University of Helsinki, Doctoral School in Health Sciences
2Lappeenranta University of Technology
3Department of Occupational Medicine, South Karelia Social and Health Care District
4Medical Research Center Oulu, University of Oulu and Oulu University Hospital
5Finnish Institute of Occupational Health
6Helsinki Institute for Information Technology HIIT, Department of Computer Science, Aalto University
7Department of Physical Medicine and Rehabilitation, South Karelia Social and Health Care District
8National Institute for Health and Welfare, Centre for Health and Social Economics
9Evalua International
10Department of Orthopedics and Traumatology, Helsinki University Hospital and University of Helsinki
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 0.9 MB)
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Language: English
Published: Springer Nature, 2018
Publish Date: 2018-08-09


Background: We assessed the effectiveness of three interventions that were aimed to reduce non-acute low back pain (LBP) related symptoms in the occupational health setting.

Methods: Based on a survey (n = 2480; response rate 71%) on LBP, we selected a cohort of 193 employees who reported moderate LBP (Visual Analogue Scale VAS > 34 mm) and fulfilled at least one of the following criteria during the past 12 months: sciatica, recurrence of LBP ≥ 2 times, LBP ≥ 2 weeks, or previous sickness absence. A random sample was extracted from the cohort as a control group (Control, n = 50), representing the natural course of LBP. The remaining 143 employees were invited to participate in a randomised controlled trial (RCT) of three 1:1:1 allocated parallel intervention arms: multidisciplinary rehabilitation (Rehab, n = 43); progressive exercises (Physio, n = 43) and self-care advice (Advice, n = 40). Seventeen employees declined participation in the intervention. The primary outcome measures were physical impairment (PHI), LBP intensity (Visual Analogue Scale), health related quality of life (QoL), and accumulated sickness absence days. We imputed missing values with multiple imputation procedure. We assessed all comparisons between the intervention groups and the Control group by analysing questionnaire outcomes at 2 years with ANOVA and sickness absence at 4 years by using negative binomial model with a logarithmic link function.

Results: Mean differences between the Rehab and Control groups were − 3 [95% CI -5 to − 1] for PHI, − 13 [− 24 to − 1] for pain intensity, and 0.06 [0.00 to 0.12] for QoL. Mean differences between the Physio and Control groups were − 3 [95% CI -5 to − 1] for PHI, − 13 [− 29 to 2] for pain intensity, and 0.07 [0.01 to 0.13] for QoL. The main effects sizes were from 0.4 to 0.6. The interventions were not effective in reducing sickness absence.

Conclusions: Rehab and Physio interventions improved health related quality of life, decreased low back pain and physical impairment in non-acute, moderate LBP, but we found no differences between the Advice and Control group results. No effectiveness on sickness absence was observed.

Trial registration: Number NCT00908102

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Series: BMC public health
ISSN: 1471-2458
ISSN-E: 1471-2458
ISSN-L: 1471-2458
Volume: 18
Issue: 1
Article number: 598
DOI: 10.1186/s12889-018-5476-8
Type of Publication: A1 Journal article – refereed
Field of Science: 3141 Health care science
3142 Public health care science, environmental and occupational health
Funding: The Finnish Work Environment Fund funded this study (grant number 114047 / J Rantonen).
Copyright information: © The Author(s). 2018. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (, which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated.