Actively Leaving Low Back Pain Behind
Studies have shown that it's better for people with low back pain to stay active. In Norway, there's a program to help workers do this. It's called "active sick leave." Active sick leave allows workers to get back on the job sooner. Work activities are reduced or changed to accommodate low back pain. Employers get money to hire full-time help in the meantime, so the work is sure to get done. This sounds like a win-win situation. But for some reason, not many people are using it.

Active sick leave requires the cooperation of doctors, employers, patients, and the insurance administration that pays for it. These authors felt that active sick leave wasn't being used because of lack of information and poor communication between these parties. The authors came up with two intervention strategies to try to increase the use of active sick leave, thereby decreasing total number of days off work.

The first strategy included extra reminders to doctors about active sick leave and the importance of keeping active during back pain. More information about active sick leave was given to patients, employers, and the local insurance administration. In addition, a standard agreement was set up between employers and employees to make it easier to get the ball rolling for active sick leave.

The second strategy was more aggressive. In addition to the above, doctors were offered continuing education workshops on low back pain and active sick leave. Also, occupational therapists were hired to help doctors and patients use active sick leave.

Did either of these strategies make a difference for over six thousand patients studied? Active sick leave was used a lot more when the aggressive intervention was in place. With the added resources of occupational therapists and continuing education workshops, 18 percent of eligible patients used active sick leave. Otherwise, only 12 percent of patients used active sick leave. Early results suggest that the aggressive intervention led patients to start active sick leave sooner. These patients also took fewer days off work.

What part of the intervention made a difference? Not the continuing education workshops for doctors, which were poorly attended. The personal follow-up of patients by occupational therapists got more patients to use active sick leave. In fact, the personal attention of therapists was so important that active sick leave dropped off once the therapists' work ended. In general, changes in use of active sick leave came mostly from patients, not from doctors.

This study suggests that health programs are more widely used when patients are personally encouraged to use them. More research is needed to see whether early return to work reduces sick leave, prevents disability, and improves patients' quality of life.
Inger B. Scheel, DC, MOH, et al. A Call for Action: A Randomized Controlled Trial of Two Strategies to Implement Active Sick Leave for Patients With Low Back Pain. In Spine. March 15, 2002. Vol. 27. No. 6. Pp. 561-566.