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Background  In the industrial world, non-specific back and neck pain (BNP) is the largest diagnostic group underlying sick-listing. For patients with subacute and chronic (= full-time sick-listed for 43 – 84 and 85 – 730 days, respectively) BNP, cognitive-behavioural rehabilitation was compared with primary care. The specific aim was to answer the question: within an 18-month follow-up, will the outcomes differ in respect of sick-listing and number of health-care visits?    Methods  After stratification by age (≤ 44/≥ 45 years) and subacute/chronic BNP, 125 Swedish primary-care patients were randomly allocated to cognitive-behavioural rehabilitation (rehabilitation group) or continued primary care (primary-care group). Outcome measures were  Return-to-work share  (percentage) and  Return-to-work chance  (hazard ratios) over 18 months,  Net days  (crude sick-listing days × degree), and the number of  Visits  (to physicians, physiotherapists etc.) over 18 months and the three component six-month periods. Descriptive statistics, Cox regression and mixed-linear models were used.    Results   All patients:  Return-to-work share  and  Return-to-work chance  were equivalent between the groups.  Net days  and  Visits  were equivalent over 18 months but decreased significantly more rapidly for the rehabilitation group over the six-month periods ( p  < .05). Subacute patients:   Return-to-work share  was equivalent.  Return-to-work chance  was significantly greater for the rehabilitation group (hazard ratio 3.5 [95%CI1.001 – 12.2]).  Net days  were equivalent over 18 months but decreased significantly more rapidly for the rehabilitation group over the six-month periods and there were 31 days fewer in the third period.  Visits  showed similar though non-significant differences and there were half as many in the third period. Chronic patients:   Return-to-work share, Return-to-work chance  and  Net days  were equivalent.  Visits  were equivalent over 18 months but tended to decrease more rapidly for the rehabilitation group and there were half as many in the third period (non-significant).    Conclusion  The results were equivalent over 18 months. However, there were indications that cognitive-behavioural rehabilitation in the longer run might be superior to primary care. For subacute BNP, it might be superior in terms of sick-listing and health-care visits; for chronic BNP, in terms of health-care visits only. More conclusive results concerning this possible long-term effect might require a longer follow-up.    Trial registration  NCT00488735.

Subacute and chronic, non-specific back and neck pain: cognitive-behavioural rehabilitation versus primary care. A randomized controlled trial