Secondary prevention of low back pain in occupational health services : long-term effectiveness and cost-effectiveness of early interventions

Research output: ThesisDoctoral Thesis


Background: Four out of five people will experience low back pain (LBP) during their lives. Most LBP episodes pass within one to three months, but about one third reoccur within one year. One in ten people suffer from chronic LBP. Because LBP mainly affects the working-age population, it often leads to serious socio-economic consequences at the personal, employer and societal level. Therefore, it is the most common disabling condition on a global scale. To prevent LBP from developing into a recurrent, chronic and potentially disabling condition, risk-based assessment and targeted interventions should be carried out in the early stage. Hence, the main questions regarding the prevention of LBP and its consequences are: At whom should preventive actions be targeted, how and when? Aims: This thesis evaluates the effectiveness of early-stage interventions offered to employees who reported disabling pain and stiffness in their low back area but were still able to work. Methods: An employee survey, recruitment of participants and secondary preventive interventions were carried out in an occupational health (OH) setting. Employees were selected for the study cohort and later categorized into ‘mild’ and ‘moderate’ LBP subgroups according to their responses in the employee survey, based on pre-defined, low back specific criteria. After this, the study participants were allocated into two randomized controlled trials, either the patient information option or the active rehabilitation option. A random sample represented the natural course of LBP as a no-intervention control for both trials. The effectiveness of the interventions was evaluated on the basis of low-back -specific outcomes and sickness absence in comparison to the those of the controls. In addition, health care resource utilization was evaluated in the patient information group. Results: In both subgroups, a secondary preventive approach showed improvements in some low-back-specific outcomes and quality of life in comparison to controls. In the ‘mild’ subgroup, health care costs decreased at the societal level in both patient information arms and booklet information was cost-effective. Sickness absence also decreased. Although absolute improvements were minor, the effects were substantial with respect to the low baseline levels. Conclusions: Early interventions are recommended for pre-defined, symptom-based employee groups as a preventive management strategy for disabling LBP in OH settings.
Original languageEnglish
  • Taimela, Simo Pekka, Supervisor
  • Karppinen, Jaro, Supervisor, External person
Place of PublicationHelsinki
Print ISBNs978-951-51-5658-7
Electronic ISBNs978-951-51-5659-4
Publication statusPublished - 2019
MoE publication typeG5 Doctoral dissertation (article)

Fields of Science

  • Low Back Pain
  • +prevention & control
  • +rehabilitation
  • +therapy
  • Patient Education as Topic
  • +methods
  • Chronic Disease
  • Cost of Illness
  • Cost-Benefit Analysis
  • Health Care Costs
  • Occupational Health
  • Occupational Health Services
  • Quality of Life
  • Return to Work
  • Secondary Prevention
  • Self Care
  • Sick Leave
  • Treatment Outcome
  • Work
  • Work Capacity Evaluation
  • 3126 Surgery, anesthesiology, intensive care, radiology

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