Sick leave reductions from a comprehensive manual therapy programme for low back pain: the Gotland Low Back Pain Study

Objective: To 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. Design: A randomized controlled trial over a 10-week period with a two-year follow-up. Setting: Primary health care and Visby Hospital, Municipality of Gotland, Sweden. Subjects: One 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. Interventions: Standardized optimized activating care (n = 71) versus a comprehensive pragmatic manual therapy programme including specific corticosteroid injections (n = 89). Main measures: Sick leave measured as net sick leave volume, point prevalence and return to work. Results: After 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