University of Oulu

Karppinen, J, Simula, AS, Holopainen, R, et al. Evaluation of training in guideline-oriented biopsychosocial management of low back pain in occupational health services: Protocol of a cluster randomized trial. Health Sci Rep. 2021; 4:e251.

Evaluation of training in guideline-oriented biopsychosocial management of low back pain in occupational health services : protocol of a cluster randomized trial

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Author: Karppinen, Jaro1,2; Simula, Anna Sofia1,3; Holopainen, Riikka4;
Organizations: 1Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
2Finnish Institute of Occupational Health, Oulu, Finland
3Department of General Medicine, The South Savo Social and Health Care Authority, Mikkeli, Finland
4Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
5Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine, Unit of Physiotherapy, Linköping University, Linköping, Sweden
6Spine and Mind Fysio, Odense, Denmark
7Spine Center of Southern Denmark, Lillebaelt Hospital, Middelfart, Denmark
8Faculty of Social Sciences (Health Sciences), Tampere University, Tampere, Finland
9Mehiläinen Corporation, Oulu, Finland
10Työterveys Virta Oy, Oulu, Finland
11Department of Law, Psychology, and Social Work, Center for Health and Medical Psychology, Örebro University, Örebro, Sweden
12School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia
13Body Logic Physiotherapy, Perth, Western Australia, Australia
14Centre for Health and Social Economics, Finnish Institute for Health and Welfare, Helsinki, Finland
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 1 MB)
Persistent link:
Language: English
Published: John Wiley & Sons, 2021
Publish Date: 2021-06-11


Background: To prevent low back pain (LBP) from developing into a prolonged disabling condition, clinical guidelines advocate early stage assessment, risk-screening, and tailored interventions. Occupational health services recommend guideline-oriented biopsychosocial screening and individualized assessment and management. However, it is not known whether training a limited number of health care professionals improves the management process. The primary objective of this study is to investigate whether training in the biopsychosocial practice model is effective in reducing disability. Furthermore, we aim to evaluate health-economic impacts of the training intervention in comparison to usual medical care.

Methods: The occupational health service units will be allocated into a training or control arm in a two-arm cluster randomized controlled design. The training of occupational physiotherapists and physicians will include the assessment of pain-related psychosocial factors using the STarT Back Tool and the short version of the Örebro Musculoskeletal Pain Screening Questionnaire, the use of an evidence-based patient education booklet as part of the management of LBP, and tailored individualized management of LBP according to risk stratification. The control units will receive no training. The study population will include patients aged 18–65 with nonspecific LBP. The primary outcome is a patient-reported Oswestry Disability Index from baseline to 12 months. By estimating group differences over time, we aim to evaluate the effectiveness of the training intervention in comparison to usual medical care, and to undertake an economic evaluation using individual patients’ health care records (participant-level data) and the participating units’ registries (cluster-level data). In addition, through interviews and questionnaires, we will explore the health care professionals’ conceptions of the adoption of, the barriers to, and the facilitators of the implementation of the practice model.

Discussion: The evaluation of training in the guideline-oriented biopsychosocial management of LBP in occupational health services is justified because LBP represents an enormous burden in terms of work disability.

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Series: Health science reports
ISSN: 2398-8835
ISSN-E: 2398-8835
ISSN-L: 2398-8835
Volume: 4
Issue: 1
Article number: e251
DOI: 10.1002/hsr2.251
Type of Publication: A1 Journal article – refereed
Field of Science: 3142 Public health care science, environmental and occupational health
Funding: The study wass funded by the Finnish Work Environment Fund (#117139/2017); the Finnish Institute of Occupational Health; the Rokua Health and Rehabilitation Foundation; the Finnish Cultural Foundation; and the University of Oulu, Oulu, Finland. Bodies of the Finnish Work Environment Fund and the Finnish Institute of Occupational Health peer-reviewed the study as part of the funding application. The funders did not influence the study design, data collection, data analysis, decision to publish, or preparation of the manuscript.
Copyright information: © 2021 The Authors. Health Science Reports published by Wiley Periodicals LLC. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made