A 5-Year Follow-Up Evaluation of the Health and Economic Consequences of an Early Cognitive Behavioral Intervention for Back Pain: A Randomized, Controlled Trial

In Brief Study Design. A 5-year follow-up of a randomized, controlled trial. Objective. To evaluate the long-term health and economic consequences of a cognitive behavioral intervention. Summary of Background Data. Linton and Andersson (Spine 2000;25:2825–31) provide 1 of only a few studies on the preventive effects of a cognitive behavioral intervention. The present study is a 5-year follow-up. Methods. In the original study, 213 participants were randomized to the cognitive-behavioral group intervention or to usual care plus information on self-care (information comparison group). Of participants, 97% completed a follow-up questionnaire 5 years after the intervention, and supplemental records were obtained from the National Insurance Authority. Results. The cognitive behavioral group had significantly less pain, was more active, enjoyed better quality of life, and had better general health relative to the information comparison group. There was no difference on health care use. The risk of long-term sick leave was 3 times higher in the information comparison group. The cognitive behavioral group had significantly less lost productivity costs and a lower total cost/y/person (16,514 Swedish kronor) compared to the information comparison group (45,990 Swedish kronor). Conclusions. A cognitive-behavioral group intervention produces long-term health and economic benefits. Usual medical care might be improved considerably by implementing these psychologic methods. A 5-year follow-up of a randomized trial shows that an early cognitive behavioral intervention was superior to treatment as usual plus self-help information for pain, function, and quality of life. Furthermore, an economic evaluation showed a 3-fold advantage for the psychologic intervention.