• J Bogefeldt, Marie I Grunnesjö, K Svärdsudd, and S Blomberg.
• Uppsala University, Department of Public Health and Caring Sciences, Family Medicine Section, Uppsala, Sweden. johan.bogefeldt@pubcare.uu.se
• Clin Rehabil. 2008 Jun 1;22(6):529-41.

ObjectiveTo evaluate if a comprehensive manual therapy programme reduces sick leave due low back pain and facilitates return to work more than the conventional optimized activating care.DesignA randomized controlled trial over a 10-week period with a two-year follow-up.SettingPrimary health care and Visby Hospital, Municipality of Gotland, Sweden.SubjectsOne hundred and sixty patients (70 women, 90 men, ages 20-55 years) with acute or subacute low back pain with or without pain radiation into the legs.InterventionsStandardized optimized activating care (n = 71) versus a comprehensive pragmatic manual therapy programme including specific corticosteroid injections (n = 89).Main MeasuresSick leave measured as net sick leave volume, point prevalence and return to work.ResultsAfter 10 weeks, significantly more manual therapy patients than reference patients had returned to work (hazards ratio 1.62, 95% confidence interval (CI) 1.006-2.60, P<0.05), and among those on sick leave at baseline, significantly fewer were still on sick leave (8/58 versus 13/40, ratio 0.35, 95% CI 0.13-0.97, P<0.05). For all other measures there were inconclusive differences in favour of the manual therapy group. No significant differences remained after two years.ConclusionsThe manual therapy programme used in this study decreased sick leave and increased return to work more than the standardized optimized activating care only up to 10 weeks but not up to two years.

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