Intended for healthcare professionals

CCBYNC Open access

Randomised controlled trial of integrated care to reduce disability from chronic low back pain in working and private life

BMJ 2010; 340 doi: (Published 17 March 2010) Cite this as: BMJ 2010;340:c1035
  1. Ludeke C Lambeek, researcher1,
  2. Willem van Mechelen, professor1,
  3. Dirk L Knol, statistician2,
  4. Patrick Loisel, professor3,
  5. Johannes R Anema, senior researcher1
  1. 1EMGO Institute for Health and Care Research, Department of Public and Occupational Health, VU University Medical Center, Amsterdam, Netherlands
  2. 2EMGO Institute for Health and Care Research, Department of Epidemiology and Biostatistics
  3. 3Dalla Lana School of Public Health, University of Toronto, Canada
  1. Correspondence to: J R Anema h.anema{at}
  • Accepted 2 November 2009


Objective To evaluate the effectiveness of an integrated care programme, combining a patient directed and a workplace directed intervention, for patients with chronic low back pain.

Design Population based randomised controlled trial.

Setting Primary care (10 physiotherapy practices, one occupational health service, one occupational therapy practice) and secondary care (five hospitals).

Participants 134 adults aged 18-65 sick listed for at least 12 weeks owing to low back pain.

Intervention Patients were randomly assigned to usual care (n=68) or integrated care (n=66). Integrated care consisted of a workplace intervention based on participatory ergonomics, involving a supervisor, and a graded activity programme based on cognitive behavioural principles.

Main outcome measures The primary outcome was the duration of time off work (work disability) due to low back pain until full sustainable return to work. Secondary outcome measures were intensity of pain and functional status.

Results The median duration until sustainable return to work was 88 days in the integrated care group compared with 208 days in the usual care group (P=0.003). Integrated care was effective on return to work (hazard ratio 1.9, 95% confidence interval 1.2 to 2.8, P=0.004). After 12 months, patients in the integrated care group improved significantly more on functional status compared with patients in the usual care group (P=0.01). Improvement of pain between the groups did not differ significantly.

Conclusion The integrated care programme substantially reduced disability due to chronic low back pain in private and working life.

Trial registration Current Controlled Trials ISRCTN28478651.


  • We thank the clinical occupational physicians, occupational therapists, and physiotherapists for administering the intervention, the occupational physicians for providing data, the medical specialists for supporting this research project, and Sjennie Daelmans for her help with recruiting patients and data entry.

  • Contributors: LCL and JRA were responsible for the general coordination of the study, implemented the integrated care programme. LCL collected the data. WvM is guarantor. All authors designed the study, helped write the manuscript, and read and approved the final version of the manuscript.

  • Funding: This study was supported by VU University Medical Center, TNO Work & Employment, Dutch Health Insurance Executive Council, Stichting Instituut GAK, and the Netherlands Organisation for Health Research and Development. This research was carried out within the framework of the Work Disability Prevention Canadian Institutes of Health Research strategic training programme, which supported LCL (grant FRN: 53909). The authors were independent of the funders and the funders had no role in the project.

  • Competing interests: None declared.

  • Ethical approval: This study was approved by the medical ethics committees of the participating hospitals (VU University Medical Centre, Slotervaart Hospital, Amstelland Hospital, Onze Lieve Vrouwe Gasthuis, based in Amsterdam, and Spaarne Hospital based in Hoofddorp).

  • Data sharing: Details of the integrated care protocol are in the web extra.

  • Accepted 2 November 2009

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: and

View Full Text