Body@Work

The BRIDGE study: Development and (cost) effectiveness evaluation of integrated care for patient with chronic occupational back pain

PERIOD
March 2005-December 2009

FINANCE
VUmc, TNO, CVZ, SIG en ZonMw.
 

RESEARCHERS
L.C. Lambeek ^{1, 2, 3}
dr. J. R. Anema ^{1, 2, 3}
dr. B. van Royen ⁴
Prof. dr. M.W. van Tulder ^{1, 5}
Prof. dr. W. van Mechelen ^{1, 2, 3}
 

1 Institute for Research in Extramural Medicine, VU University Medical Center, Amsterdam, The Netherlands
2 Department of Social Medicine VU University Medical Center, Amsterdam, The Netherlands
3 Body@Work, Research Center Physical Activity, Work and Health, TNO-VU, Amsterdam, The Netherlands
4 Department of Orthopaedic Surgery, VU University Medical Center, Amsterdam, The Netherlands
5 Institute for Health Sciences, Faculty of Earth & Life Sciences, Vrije Universiteit, Amsterdam, the Netherlands

OBJECTIVES
Low back pain (LBP) is a major public health problem and very costly. Most of the costs related to LBP are due to sick leave and disability of a relatively small group of workers with long-term sick leave absence. Usual care of primary and outpatient health services isn’t directly aimed at return to work (RTW). Research shows that several occupational interventions in primary care are aimed at RTW and have shown a significant reduction of sick leave for employee with LBP.
Because usual care is not directly aimed at RTW, we developed an integrated care program, combining patient-directed and workplace-directed interventions given by a multidisciplinary team.
The aims of the BRIGDE study are to evaluate the (cost) effectiveness and its feasibility of the integrated care program for patients with chronic LBP.

METHODS
Patients with sick leave due to chronic LBP visiting outpatient clinics (orthopedics, neurology etc.) of five hospitals in the area of Amsterdam (The Netherlands) were included (n=134). They were randomized to integrated care (n= 66) or usual care (n=68). Integrated care is a care system that consists of a workplace intervention, directed at both the worker and the supervisor, and a graded activity program focusing on the pain behavior of the patient. It is applied by a team consisting of a medical specialist, a clinical occupational physician, an occupational therapist and a physical therapist. The clinical occupational physician is the case-manager for the integrated care, and has an intermediate role between primary and outpatient care.
Outcome measures are: duration of sick leave due to LBP until full sustainable RTW (> 4 weeks) measured monthly, pain intensity, functional status, direct and indirect costs assessed by questionnaire before randomization and 3,6 and 12 months later. The evaluation of the implementation was done by questionnaire, semi structured interviews with patients and focus groups with the members of the multidisciplinary team.

RESULTS
Results on the (cost) effectiveness and feasibility are available at the end of 2009.

Ludeke Lambeek

For more information
Email l.lambeek@vumc.nl
Tel +31 20 4448265