Cognitive-behavioural treatment for workers with chronic spinal pain: a matched and controlled cohort study in Sweden.

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Abstract
An ambulatory multimodal cognitive-behavioural treatment programme (MMCBT) for Swedish workers with chronic spinal pain was formally evaluated. The design was a matched cohort study with three repeated measures done in two groups of 35 referred patients (one exposed to MMCBT and controls exposed to usual care). The MMCBT package includes standardised modules of physical treatment, cognitive-behavioural treatment, education of worker patients, and education of subjects' supervisors. The primary outcome variables assessed were absenteeism, disability, pain, and depression. Because of a change in Swedish sick leave compensation laws affecting records of absence during the study period, absenteeism could not be reliably measured among controls. The trend, however, suggested a reduction of absenteeism among the subjects in the MMCBT cohort. The findings for disability, pain, and depression all showed clinically important and significant beneficial changes (ANOVA for repeated measures: disability p = 0.05; pain p = 0.001; depression p = 0.01). The direction of the improvements and the size of effect were coherent and clinically plausible. The benefits were only among the women in the study. These comprised 74% of each group. Further research on larger sample sizes and in cohorts more representative of the whole country are needed to confirm these encouraging findings and to explore how the benefits might be extended to men.