University of Oulu

Ryynänen K, Oura P, Simula A-S, Holopainen R, Paukkunen M, Lausmaa M, Remes J, Booth N, Malmivaara A, Karppinen J. Effectiveness of training in guideline-oriented biopsychosocial management of low-back pain in occupational health services – a cluster randomized controlled trial. Scand J Work Environ Health. 2021;47(5):367–376. doi:10.5271/sjweh.3959

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

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Author: Ryynänen, Katja1,2; Oura, Petteri1; Simula, Anna-Sofia1,3;
Organizations: 1Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
2Institute of Health Sciences, Center for Life Course Health Research, Medical Faculty, University of 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
5Faculty of Medical and Health Sciences, University of Linköping, Linköping, Sweden
6Finnish Institute of Occupational Health, Oulu, Finland
7Faculty of Social Sciences (Health Sciences), Tampere University, Tampere, Finland
8Centre for Health and Social Economics, Finnish Institute for Health and Welfare, Helsinki, Finland
9Rehabilitation Services of South Karelia Social and Health Care District, Lappeenranta, Finland
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 0.6 MB)
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Language: English
Published: Nordic Association of Occupational Safety and Health, 2021
Publish Date: 2021-10-15


Objective: This study aimed to investigate the effectiveness of brief training in the guideline-oriented biopsychosocial management of low-back pain (LBP) in occupational health services using a cluster-randomized design. A small sample of physiotherapists and physicians from the intervention units (N=12) were given three- to seven-day training focusing on the biopsychosocial management of LBP, while professionals in the control units (N=15) received no such training.

Methods: Eligible patients with LBP, with or without radicular pain, aged 18–65, were invited to participate. A web-based questionnaire was sent to all recruited patients at baseline, three months and one year. The primary outcome measure was disability (Oswestry Disability Index, ODI) over one year. Between-group differences were analyzed using linear and generalized linear mixed models adjusted for baseline-response delay as well as variables showing between-group imbalance at baseline.

Results: The final study sample comprised 234 and 81 patients in the intervention and control groups, respectively at baseline, and 137 and 47 patients, respectively, at one year. At baseline, the mean duration of pain was longer in the intervention group (P=0.017), and pain-related fear concerning physical activity was lower (P=0.012). We observed no significant difference between the groups’ primary outcome measure (adjusted one-year mean difference in the ODI: 2.3; 95% confidence interval -1.0–5.7; P=0.175) or most secondary outcomes.

Conclusions: Brief training in guideline-oriented biopsychosocial management of LBP for occupational health professionals did not appear to be effective in reducing patients’ symptom over one-year follow-up compared to treatment as usual.

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Series: Scandinavian journal of work, environment & health
ISSN: 0355-3140
ISSN-E: 1795-990X
ISSN-L: 0355-3140
Volume: 47
Issue: 5
Pages: 367 - 376
DOI: 10.5271/sjweh.3959
Type of Publication: A1 Journal article – refereed
Field of Science: 3142 Public health care science, environmental and occupational health
Funding: The study was funded by: The Finnish Work Environment Fund; the Finnish Institute of Occupational Health; the Rokua Health and Rehabilitation 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 Author(s). This work is licensed under a Creative Commons Attribution 4.0 International License.