Research Review by Dr. Shawn Thistle©


Sept. 2003

Study Title:

Does early intervention with a light mobilization program reduce long-term sick leave for low back pain: A 3-year follow-up study


Hagen EM, Grasdal A, Eriksen HR

Publication Information:

Spine 2003; 28(20): 2309-2316.


Low back pain is a very common problem, and is a major cause for lost work time and decreased production. As such, it has a significant financial impact in most industrialized nations. This Norwegian study discusses the three year follow-up of an ongoing project.

Using a randomized, controlled trial design, the research group employed a very simple intervention for patients with subacute low back pain (defined here as between 8-12 weeks), to see if it had an effect on return-to-work status.

The intervention group (237 patients, average age ~ 40 years) received examination at a spine clinic, information about back pain, reassurance and encouragement to engage in normal physical activity as soon as possible. The control group (22 patients, average age ~ 40 years) filled in the same insurance paperwork as the intervention group, but were treated within the primary health care system.

The results at 12 months indicated that the intervention had a significant effect in reducing sick leave 68.4% of the intervention group remained OFF sick leave compared to only 56.4% of the control group. This translated into significant economic saving for society.

The intervention group were also less likely to use bed rest and more likely to use stretching and walking as coping strategies compared to the control group at 6 months. Interestingly, the three year follow-up revealed that the differences between the groups occurred only in the first year.

Conclusions & Practical Application:

This study provides further evidence that early "activation" of a patient through reassurance, clear explanations of back pain and encouragement to resume normal physical activities is beneficial for returning subacute low back pain patients to work. Chiropractors and other manual medicine practitioners should be aware of these strategies, and employ them when clinically indicated.

The fact that the positive effect on return-to-work status diminished after the first year suggests a need for more research to determine the most appropriate timing and follow-up schedules of such intervention strategies.