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The effectiveness of two active interventions compared to self-care advice in employees with non-acute low back symptoms: a randomised, controlled trial with a 4-year follow-up in the occupational health setting
  1. J Rantonen1,
  2. S Luoto2,
  3. A Vehtari3,
  4. M Hupli2,
  5. J Karppinen4,
  6. A Malmivaara5,
  7. S Taimela6,7
  1. 1Finnish Institute of Occupational Health, Lappeenranta, Finland
  2. 2Department of Physical Medicine and Rehabilitation, South Karelian Central Hospital, South Karelian District of Social and Health Services, Lappeenranta, Finland
  3. 3Department of Biomedical Engineering and Computational Science, Aalto University, Espoo, Finland
  4. 4Department of Physical Medicine and Rehabilitation, University of Oulu, Oulu, Finland
  5. 5National Institute for Health and Welfare, Centre for Health and Social Economics, Helsinki, Finland
  6. 6Evalua International, Espoo, Finland
  7. 7Department of Public Health, University of Helsinki, Helsinki, Finland
  1. Correspondence to Dr J Rantonen, Finnish Institute of Occupational Health (FIOH) Lappeenranta, Laserkatu 6, 53850 Lappeenranta, Finland; jarmo.rantonen{at}



Objective Evaluate the effectiveness of two active interventions, aimed at secondary prevention of low back pain (LBP), in occupational health.


Methods We performed a survey of LBP (n=2480; response rate 71%) and randomized 143 employees (66% males, 45 years) with LBP over 34 mm on VAS into Rehabilitation (n=43), Exercise (n=43) or self-care (n=40) groups. Primary outcomes were LBP, physical impairment (PI) and health-related quality of life (HRQoL) for two years and sickness absence (SA) days during four years (LBP specific, total).


Results Compared to self-care, exercise reduced LBP at 12 months (mean difference (MD) −12 mm; 95% CI −21 to −2) and improved HRQoL at 12 and 24 months (0.03; 0.00 to 0.05), but did not reduce PI. The MDs of SA days in four years were −17 (−70 to 35, total) and −15 (−47 to 13, LBP specific). Exercise reduced the probability of LBP specific SA during the third and fourth year. Compared to self-care, Rehabilitation reduced LBP at 3 months (−10 mm; −19 to −1) and 6 months (−10 mm; −20 to − 1), but was not effective in HRQoL or PI. The MDs of SA days in four years were −41 (−93 to 8; total) and 5 (−30 to 47; LBP specific). Rehabilitation reduced the probability of total SA during first and second year and amount of total SA days in the fourth year.


Conclusions Among employees with relatively mild LBP, both interventions reduced pain, but the effects on SA and PI were minor. Exercise improved HRQoL. The effect sizes were rather small.

Trial registration

Trial registration Number NCT00908102.

  • low back pain
  • secondary prevention
  • occupational health
  • randomised controlled trial
  • comparative effectiveness research
  • sick leave
  • intervention studies
  • occupational health practice
  • back disorders
  • intervention studies
  • longitudinal studies
  • sickness absence

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  • Funding Centenary Foundation of Kymi Corporation, Yrjo Jahnsson Foundation, Juho Vainio Foundation and Finnish Cultural Foundation funded the research at the beginning of this study. The authors' work is independent of the funders.

  • Competing interests JR, SL, JK, AV and AM have no competing interests to declare. During physical medicine unit (PMU) interventions, MH was the head physician of the PMU. ST is the Medical Director of DBC International.

  • Ethics approval The South Karelian Central Hospital Research Ethics Board approved this study (record number (Dnr) A18/01).

  • Provenance and peer review Not commissioned; externally peer reviewed.

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