OBJECTIVE:

To compare the effect of function-centered treatment (FCT) and pain-centered treatment (PCT) on the number of work days, permanent disability, and the unemployment rate.

DESIGN:

Randomized controlled trial.

SETTING:

Inpatient rehabilitation center.

PARTICIPANTS:

Patients (N=174; 79% male; mean age, 42 y) with previous sick leave of 6 weeks or more.

INTERVENTIONS:

FCT (4 h/d for 3 wk) emphasized activity despite pain by using work simulation, strength, endurance, and cardiovascular training. PCT (2.5h/d for 3 wk) emphasized pain reduction and included passive and active mobilization, stretching, strength training, and a 4-hour mini back school with education and exercise. Analysis was by intention to treat.

MAIN OUTCOME MEASURES:

Work days, return to work, rate of patients receiving financial compensation for permanent disability, and unemployment rate. Effect sizes (Cohen d) were defined as small (0.2-0.5), moderate (0.5-0.8), and large (>0.8).

RESULTS:

After 1 year, the FCT group had significantly more work days (mean, 118; median, 39.5; interquartile range [IQR], 0-198) than the PCT group (mean, 74; median, 0; IQR, 0-160; Mann-Whitney U test, P=.011). The odds ratio of returning to work in the FCT group relative to the PCT group was 2.1 (95% confidence interval, 1.1-3.9). The differences in unemployment rates and in the numbers of patients receiving compensation for permanent disability were not significant.

CONCLUSIONS:

FCT is more effective than PCT for increasing work days.