¹Linköping University, Linköping, Sweden
²University of Oulu, Oulu, Finland
³Univ Angers, CHU Angers, Univ Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail)-UMR_S 1085, SFR ICAT, Angers, France
⁴University of Jyväskylä, Jyväskylä, Finland
⁵Tampere University, Tampere, Finland

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Introduction: Low back pain (LBP) is one of the leading causes of work disability worldwide (Hartvigsen et al., Lancet, 2018) and one of the most common reasons for absence from work in Finland (Pekkala et al., BMC Public Health, 2017).

We investigated the effects of a brief training intervention for professionals in occupational health services (OHS) over one-year follow-up on multiprofessional resource utilization and associated costs of biopsychosocial (BPS) management of patients with LBP compared to usual care among all participants and those in work disability-based risk groups.

Methods: OHS utilization and LBP-related sick leave data were collected from electronic patient records, comparing 232 patients in the intervention arm and 80 control-arm patients, stratified for work disability risk based on the Örebro Musculoskeletal Pain Screening Questionnaire. We estimated costs using linear mixed models by multiplying unit costs (in euros) by each type of OHS resource use (visits to physicians, physiotherapists, nurses, use of imaging) and the number of sick leave days. Estimated mean cost differences with confidence intervals (CI) were reported using bootstrapping to deal with skewed cost data.

Results: The median numbers (and interquartile ranges) of visits to physicians and physiotherapists in the intervention versus control arms were 1 (0–3) and 2 (1–4) versus 2 (1–3) and 1 (0–2), respectively. Multiprofessional physiotherapist-driven care was significantly more common in the intervention arm versus the control arm (90% vs 64%, respectively).

The intervention arm accrued (€, 95% CI) lower physician costs (€-43, €-82– -3, P=0.034) and higher physiotherapist costs (€55, €26–84, P<0.001) compared to the control arm. There was no significant difference in average total costs between the arms (€-1908, €-6734–2919).

In the low- and medium-risk groups of work disability, physiotherapist costs were higher in the intervention than control arm, but no significant differences were observed between the arms in the total resource utilization or sickness absence costs. Notably, costs for high-risk patients were considerably higher than for those at low risk: more than five times higher in the BPS care arm (€1,196 vs. €222) and as much as twelve times higher in the usual care arm (€2,801 vs. €232).

Discussion: Developing the division of work among OHS professionals may help optimize resource allocation and costs. This cost analysis with promising results suggests that a brief training intervention seems feasible in inducing shift toward multiprofessional physiotherapist-driven care based on disability risk. The results highlight the importance of early risk assessment with targeted treatment particularly for those patients at greatest risk of losing work capacity. Long-term outcomes need to be monitored to further evaluate cost-effectiveness.

Conclusion: Brief BPS training may support a shift in OHS resource use from solely physician-driven care to multiprofessional, physiotherapist-driven management of LBP across different work disability risk groups, without a substantial increase in total costs.