Skip to main content
SpringerLink
Log in

Economic Evaluation of a Multi-Stage Return to Work Program for Workers on Sick-Leave Due to Low Back Pain

  • Original Paper
  • Published:
Journal of Occupational Rehabilitation Aims and scope Submit manuscript

Abstract

Objective: To evaluate the cost-effectiveness and cost-utility of a return to work (RTW) program for workers on sick-leave due to low back pain (LBP), comparing a workplace intervention implemented between 2 to 8 weeks of sick-leave with usual care, and a clinical intervention after 8 weeks of sick-leave with usual care. Design: Economic evaluation alongside a randomised controlled trial (RCT). Study population: Workers sick-listed for a period of 2 to 6 weeks due to LBP. Interventions: 1. workplace assessment, work modifications and case management). 2. physiotherapy based on operant behavioural principles. 3. usual care: provided by an occupational physician. Outcomes: The primary outcome was return to work (RTW). Other outcomes were pain intensity, functional status, quality of life and general health. The economic evaluation was conducted from a societal perspective. Outcomes were assessed at baseline (after 2–6 weeks on sick-leave), and 12 weeks, 26 weeks, and 52 weeks after the first day of sick-leave. Results: The workplace intervention group returned to work 30.0 days (95% CI=[3.1, 51.3]) earlier on average than the usual care group at slightly higher direct costs (ratio of 1 day: €19). Workers in the clinical intervention group that had received usual care in the first 8 weeks returned to work 21.3 days (95% CI= [−74.1, 29.2]) later on average. The group that had received the workplace intervention in the first 8 weeks and the clinical intervention after 8 weeks returned to work 50.9 days (95% CI=[−89.4, −2.7]) later on average. A workplace intervention was more effective than usual care in RTW at slightly higher costs and was equally effective as usual care at equal costs on other outcomes. A clinical intervention was less effective than usual care and associated with higher costs. Conclusion: The workplace intervention results in a safe and faster RTW than usual care at reasonable costs for workers on sick-leave for two to six weeks due to LBP.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Frymoyer JW, Cats-Baril WL. An overview of the incidences and costs of low back pain. Orthop Clin North Am 1991;22(2):263–71.

    CAS  PubMed  Google Scholar 

  2. Maniadakis N, Gray A. The economic burden of back pain in the UK. Pain 2000;84(1):95–103.

    Article  CAS  PubMed  Google Scholar 

  3. van Tulder MW, Koes BW, Bouter LM. A cost-of-illness study of back pain in the Netherlands. Pain 1995;62(2):233–40.

    Article  CAS  PubMed  Google Scholar 

  4. Hutubessy RC, van Tulder MW, Vondeling H, Bouter LM. Indirect costs of back pain in the netherlands: a comparison of the human capital method with the friction cost method. Pain 1999;80(1–2):201–7.

    Article  CAS  PubMed  Google Scholar 

  5. Lee P. The economic impact of musculoskeletal disorders. Qual Life Res 1994;3(Suppl 1):85–91.

    Article  Google Scholar 

  6. Abenhaim L, Suissa S. Importance and economic burden of occupational back pain: a Study of 2,500 Cases Representative of Quebec. J Occup Med 1987;29(8):670–4.

    CAS  PubMed  Google Scholar 

  7. Hlobil H, Staal JB, Spoelstra M, Ariens GA, Smid T, van Mechelen W. Effectiveness of a return-to-work intervention for subacute low-back pain. Scand J Work Environ Health 2005;31(4):249–57.

    PubMed  Google Scholar 

  8. Loisel P. Intervention for return to work–what is really effective? Scand J Work Environ Health 2005;31(4):245–7.

    PubMed  Google Scholar 

  9. Scientific Approach to the Assessment and Management of Activity-Related Spinal Disorders. A Monograph for Clinicians. Report of the Quebec Task Force on Spinal Disorders. Spine 1987;12(7 Suppl):1–59.

    Google Scholar 

  10. Leino PI, Berg MA, Puska P. Is Back Pain Increasing? Results from national surveys in finland during 1978/9-1992. Scand J Rheumatol 1994;23(5):269–76.

    CAS  PubMed  Google Scholar 

  11. Loisel P, Lemaire J, Poitras S, Durand MJ, Champagne F, Stock S, Diallo B, Tremblay C. Cost-Benefit and Cost-Effectiveness analysis of a disability prevention model for back pain management: a Six Year Follow Up Study. Occup Environ Med 2002;59(12):807–15.

    Article  CAS  PubMed  Google Scholar 

  12. BMC Musculoskeletal Disorders. Vol. 4, 2003.

  13. Aulman P, Bakker-Rens RM, Dielemans SF, Mulder A, Verbeek JHAM. Dutch occupational guideline on low back pain (in Dutch:Handelen van de bedrijfsarts bij werknemers met lage rugklachten). Eindhoven: NVAB; 1999.

  14. Steenstra IA, Koopman FS, Knol DL, Kat E, Bongers PM, de Vet HC, van Mechelen W. Prognostic factors for duration of sick leave due to low-back pain in dutch health care professionals. J Occup Rehabil 2005;15(4):591–605.

    Article  PubMed  Google Scholar 

  15. Pocock SJ. Clinical trials, a practical approach. London: John Wiley & Sons Ltd.; 1987.

    Google Scholar 

  16. Loisel P, Durand P, Abenhaim L, Gosselin L, Simard R, Turcotte J, Esdaile JM. Management of occupational back pain: the Sherbrooke Model. Results of a pilot and feasibility study. Occup Environ Med 1994;51(9):597–602.

    Article  CAS  PubMed  Google Scholar 

  17. Loisel P, Abenhaim L, Durand P, Esdaile JM, Suissa S, Gosselin L, Simard R, Turcotte J, Lemaire J. A population-based, randomized clinical trial on back pain management. Spine 1997;22(24):2911–8.

    Article  CAS  PubMed  Google Scholar 

  18. Staal JB, Hlobil H, Twisk JW, Smid T, Koke AJ, van Mechelen W. Graded activity for low back pain in occupational health care: a Randomized, controlled trial. Ann Intern Med 2004;140(2):77–84.

    PubMed  Google Scholar 

  19. Fordyce WE. Behavioral methods for chroninc pain and illness. St. Louis: Mosby; 1976.

    Google Scholar 

  20. Lindstrom I, Ohlund C, Eek C, Wallin L, Peterson LE, Fordyce WE, Nachemson AL. The effect of graded activity on patients with subacute low back pain: a randomized prospective clinical study with an operant-conditioning behavioral approach. Phys Ther 1992;72(4):279–90.

    CAS  PubMed  Google Scholar 

  21. Staal JB, Hlobil H, van Tulder MW, Waddell G, Koes BW, van Mechelen W. Occupational health guidelines for the management of low back pain: an International Comparison. Occup Environ Med 2003;60(9):618–26.

    Article  CAS  PubMed  Google Scholar 

  22. Aulman P, Bakker-Rens RM, Dielemans SF, Mulder A, Verbeek JHAM. Dutch occupational guideline on low back pain (in Dutch:Handelen van de bedrijfsarts bij werknemers met lage rugklachten). Eindhoven: NVAB; 1999.

  23. de Jong AM, Vink P. Participatory ergonomics applied in installation work. Appl Ergon 2002;33(5):439–48.

    Article  PubMed  Google Scholar 

  24. Anema JR, Steenstra IA, Urlings IJM, Bongers PM, de Vroome EMM, van Mechelen W. Participatory ergonomics as a return-to-work intervention; a future challenge? implementation of a participatory ergonomics program for the disability management of workers sicklisted due to low back pain. Am J Ind Med 2003; 1–9.

  25. Loisel P, Gosselin L, Durand P, Lemaire J, Poitras S, Abenhaim L. Implementation of a participatory ergonomics program in the rehabilitation of workers suffering from subacute back pain. Appl Ergon 2001;32(1):53–60.

    Article  CAS  PubMed  Google Scholar 

  26. Anema JR, Buijs PC, van Putten DJ. Samenwerking Van Huisarts En Bedrijfsarts: Een Leidraad Voor De Praktijk (Cooperation Between General Practitioner and Occuaptional Practitioner: a Guideline for Practise). Medisch Contact 2001;56(20):790–3.

    Google Scholar 

  27. Staal JB, Hlobil H, Twisk JWR, Smid T, van Mechelen W. The effects of graded activity for low back pain in occupational health on absence from work, functional status and pain. Ann Intern Med 2003.

  28. Roland M, Morris R. A study of the natural history of back pain. Part I: Development of a reliable and sensitive measure of disability in low-back pain. Spine 1983;8(2):141–4.

    Article  CAS  PubMed  Google Scholar 

  29. Gommans IHB, Koes BW, van Tulder MW. Validiteit En Responsiviteit Nederlandstalige Roland Disability Questionnaire. Vragenlijst Naar Functionele Status Bij Patiënten Met Lage Rugpijn. Ned Tijdschr voor Fysiotherapie 1997;2(107):28–33.

    Google Scholar 

  30. Carlsson AM. Assessment of chronic pain. I. aspects of the reliability and validity of the visual analogue scale. Pain 1983;16(1):87–101.

    Article  CAS  PubMed  Google Scholar 

  31. Roach KE, Brown MD, Dunigan KM, Kusek CL, Walas M. Test-retest reliability of patient reports of low back pain. J Orthop Sports Phys Ther 1997;26(5):253–9.

    CAS  PubMed  Google Scholar 

  32. Dolan P. Modeling Valuations for EuroQol Health States. Med Care 1997;35(11):1095–8.

    Article  CAS  PubMed  Google Scholar 

  33. Brooks R. EuroQol: the current state of play. Health Policy 1996;37(1):53–72.

    Article  CAS  PubMed  Google Scholar 

  34. Brouwer WB, Koopmanschap MA, Rutten FF. Patient and informal caregiver time in cost-effectiveness analysis. A response to the recommendations of the Washington panel. Int J Technol Assess Health Care 1998;14(3):505–13.

    Article  CAS  PubMed  Google Scholar 

  35. Oostenbrink JB, Koopmanschap MA, Rutten FF. Standardisation of costs: the dutch manual for costing in economic evaluations. Pharmacoeconomics 2002;20(7):443–54.

    Article  PubMed  Google Scholar 

  36. Karasek R. Job content instrument users guide: revision 1.1. 1985.

  37. Karasek R, Brisson C, Kawakami N, Houtman I, Bongers PM, Amick B. The job content questionnaire (JCQ): an instrument for internationally comparative assessments of psychosocial job characteristics. J Occup Health Psychol 1998;3(4):322–55.

    Article  CAS  PubMed  Google Scholar 

  38. Janssen N, Van Den Heuvel WP, Beurskens AJ, Nijhuis FJ, Schroer CA, van Eijk JT. The demand-control-support model as a predictor of return to work. Int J Rehabil Res 2003;26(1):1–9.

    Article  CAS  PubMed  Google Scholar 

  39. Hildebrandt VH, Bongers PM, van Dijk FJ, Kemper HC, Dul J. Dutch Musculoskeletal Questionnaire: Description and Basic Qualities. Ergonomics 2001;44(12):1038–55.

    Article  CAS  PubMed  Google Scholar 

  40. Efron B, Tibshirani RJ. An introduction to the bootstrap. New York, London: CHapman & Hall; 1993.

    Google Scholar 

  41. Drummond MF, O’Brien B, Stoddart GL, Torrance GW. Methods for the Economic Evaluation of Health Care Programmes, 2nd edn. Oxford, New York: Oxford University Press; 1997.

  42. van Hout BA, Al MJ, Gordon GS, Rutten FF. Costs, effects and C/E-Ratios alongside a clinical trial. Health Econ 1994;3(5):309–19.

    CAS  PubMed  Google Scholar 

  43. Korthals-de Bos I, Van Tulder M, van Dieten H, Bouter L. Economic evaluations and randomized trials in spinal disorders: Principles and Methods. Spine 2004;29(4):442–8.

    Article  PubMed  Google Scholar 

  44. Steenstra IA, Anema H, Bongers PM, de Vet HC, Knol DL, Mechelen WV. The effectiveness of graded activity for low back pain in occupational healthcare. Occup Environ Med 2006.

  45. Anema JR, Steenstra IA, Bongers PM, de Vet HCW, Knol DL, Loisel P, van Mechelen W. Multidisciplinary rehabilitation for sub acute low back pain: Graded Activity or Workplace Intervention or Both? A Randomized Controlled Trial. Spine 2006.

  46. Brouwer WB, van Exel NJ, Koopmanschap MA, Rutten FF. Productivity costs before and after absence from work: as important as common? Health Policy 2002;61(2):173–87.

    Article  CAS  PubMed  Google Scholar 

  47. Korthals-de Bos I, Smidt N, van Tulder MW, Rutten-van Molken MP, Ader HJ, Van Der Windt DA, Assendelft WJ, Bouter LM. Cost effectiveness of interventions for lateral epicondylitis: results from a randomised controlled trial in primary care. Pharmacoeconomics 2004;22(3):185–95.

    Google Scholar 

  48. Korthals-de Bos IB, Hoving JL, van Tulder MW, Rutten-van Molken MP, Ader HJ, de Vet HC, Koes BW, Vondeling H, Bouter LM. Cost effectiveness of physiotherapy, manual therapy, and general practitioner care for neck pain: economic evaluation alongside a randomised controlled trial. BMJ 2003;326(7395):911.

    Article  PubMed  Google Scholar 

  49. Loisel P, Lemaire J, Poitras S, Durand MJ, Champagne F, Stock S, Diallo B, Tremblay C. Cost-benefit and cost-effectiveness analysis of a disability prevention model for back pain management: a six year follow up study. Occup Environ Med 2002;59(12):807–15.

    Article  CAS  PubMed  Google Scholar 

  50. Roland M, Torgerson, DJ. Understanding controlled trials: what are pragmatic trials? BMJ 1998;316(7127):285.

    CAS  PubMed  Google Scholar 

  51. Aulman P, Bakker-Rens RM, Dielemans SF, Mulder A, Verbeek JHAM. Het handelen van de bedrijfsarts bij lage rug klachten (Occupational management of workers with back pain). Eindhoven: NVAB; 1999.

Download references

Acknowledgements

We would like to thank all professionals at the OHSs for their cooperation in this study, Fieke Koopman for her excellent work in data collection and processing and Ernest de Vroome from TNO Work and Employment for building the syntax to calculate all sick leave outcomes.

Author information

Authors and Affiliations

  1. Institute for Research in Extramural Medicine, VU University Medical Center, Amsterdam, The Netherlands

    Ivan A. Steenstra, Johannes R. Anema, Maurits W. van Tulder, Paulien M. Bongers, Henrica C. W. de Vet & Willem van Mechelen

  2. Department of Public and Occupational Health, VU University Medical Center, Amsterdam, The Netherlands

    Ivan A. Steenstra, Johannes R. Anema & Willem van Mechelen

  3. TNO Work and Employment, P.O. Box 718, 2130 AS, Hoofddorp, The Netherlands

    Ivan A. Steenstra, Johannes R. Anema & Paulien M. Bongers

  4. Body@Work, Research Center Physical Activity, Work and Health, TNO-VU, Amsterdam, The Netherlands

    Ivan A. Steenstra, Johannes R. Anema, Paulien M. Bongers & Willem van Mechelen

  5. Institute for Health Sciences, VU University, Amsterdam, The Netherlands

    Maurits W. van Tulder

  6. Institute for Work and Health, Toronto, ON, Canada

    Ivan A. Steenstra

Authors
  1. Ivan A. Steenstra
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Johannes R. Anema
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Maurits W. van Tulder
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Paulien M. Bongers
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Henrica C. W. de Vet
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Willem van Mechelen
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Willem van Mechelen.

Additional information

This study is granted by: The Netherlands Organisation for Health Research and Development (ZonMw), Dutch Ministries of Health, Welfare and Sports and, of Social Affairs. international Standard Randomised Controlled Trial Number: 60233560.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Steenstra, I.A., Anema, J.R., van Tulder, M.W. et al. Economic Evaluation of a Multi-Stage Return to Work Program for Workers on Sick-Leave Due to Low Back Pain. J Occup Rehabil 16, 557–578 (2006). https://doi.org/10.1007/s10926-006-9053-0

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10926-006-9053-0

Keywords

Search

Navigation