A1 Journal article (refereed)
Evaluation of training in guideline‐oriented biopsychosocial management of low back pain in occupational health services : Protocol of a cluster randomized trial (2021)

Karppinen, J., Simula, A. S., Holopainen, R., Lausmaa, M., Remes, J., Paukkunen, M., Ussing, K., Booth, N., Ryynänen, K., Koski, T., Abbott, A., Öberg, B., Linton, S. J., Smith, A., O'Sullivan, P., & Malmivaara, A. (2021). Evaluation of training in guideline‐oriented biopsychosocial management of low back pain in occupational health services : Protocol of a cluster randomized trial. Health Science Reports, 4(1), Article e251. https://doi.org/10.1002/hsr2.251

JYU authors or editors

Publication details

All authors or editors: Karppinen, Jaro; Simula, Anna Sofia; Holopainen, Riikka; Lausmaa, Mikko; Remes, Jouko; Paukkunen, Maija; Ussing, Kasper; Booth, Neill; Ryynänen, Katja; Koski, Tomi; et al.

Journal or series: Health Science Reports

ISSN: 2398-8835

eISSN: 2398-8835

Publication year: 2021

Volume: 4

Issue number: 1

Article number: e251

Publisher: John Wiley & Sons

Publication country: United States

Publication language: English

DOI: https://doi.org/10.1002/hsr2.251

Publication open access: Openly available

Publication channel open access: Open Access channel

Publication is parallel published (JYX): https://jyx.jyu.fi/handle/123456789/74566


To prevent low back pain (LBP) from developing into a prolonged disabling condition, clinical guidelines advocate early stage assessment, risk‐screening, and tailored interventions. Occupational health services recommend guideline‐oriented biopsychosocial screening and individualized assessment and management. However, it is not known whether training a limited number of health care professionals improves the management process. The primary objective of this study is to investigate whether training in the biopsychosocial practice model is effective in reducing disability. Furthermore, we aim to evaluate health‐economic impacts of the training intervention in comparison to usual medical care.

The occupational health service units will be allocated into a training or control arm in a two‐arm cluster randomized controlled design. The training of occupational physiotherapists and physicians will include the assessment of pain‐related psychosocial factors using the STarT Back Tool and the short version of the Örebro Musculoskeletal Pain Screening Questionnaire, the use of an evidence‐based patient education booklet as part of the management of LBP, and tailored individualized management of LBP according to risk stratification. The control units will receive no training. The study population will include patients aged 18–65 with nonspecific LBP. The primary outcome is a patient‐reported Oswestry Disability Index from baseline to 12 months. By estimating group differences over time, we aim to evaluate the effectiveness of the training intervention in comparison to usual medical care, and to undertake an economic evaluation using individual patients' health care records (participant‐level data) and the participating units' registries (cluster‐level data). In addition, through interviews and questionnaires, we will explore the health care professionals' conceptions of the adoption of, the barriers to, and the facilitators of the implementation of the practice model.

The evaluation of training in the guideline‐oriented biopsychosocial management of LBP in occupational health services is justified because LBP represents an enormous burden in terms of work disability.

Keywords: spinal diseases; chronic pain; psychosocial factors; preventive medicine; occupational health; physiotherapy; psychophysical physiotherapy

Free keywords: biopsychosocial approach; cluster randomized controlled study; implementation research; lowback pain; occupational health services; Örebro musculoskeletal pain screening questionnaire; risk stratification; STarT Back tool

Contributing organizations

Ministry reporting: Yes

Reporting Year: 2021

Preliminary JUFO rating: 1

Last updated on 2021-09-08 at 12:11