• Silje E Reme, Torill H Tveito, Anette Harris, Stein Atle Lie, Astrid Grasdal, Aage Indahl, Jens Ivar Brox, Tone Tangen, Eli Molde Hagen, Sigmund Gismervik, Arit Ødegård, Livar Fryland, Egil A Fors, Trudie Chalder, and Hege R Eriksen.
• *Uni Research Health, Bergen, Norway†Department of Health Promotion and Development, University of Bergen, Bergen, Norway‡Department of Economics, University of Bergen, Bergen, Norway§Department of Psychiatry, Haukeland University Hospital, Bergen, Norway¶National Institute of Nutrition and Seafood Research (NIFES), Bergen, Norway||Oslo University Hospital, Oslo, Norway**Department of Physical Medicine and Rehabilitation, St Olav University Hospital, Trondheim, Norway††Department of Psychological Medicine, King's College London, London, UK‡‡The Department of Public Health and General Practice, Norwegian University of Science and Technology, Trondheim, Norway§§Department of Physical Medicine and Rehabilitation, Innlandet Hospital Trust, Ottestad, Norway¶¶Department of Research and Development, Clinic Physical Medicine and Rehabilitation, Vestfold Hospital Trust, T⊘nsberg, Norway||||National Competence Centre for Complex Disorders, St Olav's Hospital, Trondheim, Norway***Unicare, Friskvernklinikken, Asker, Norway||||||Department of of Clinical Dentistry, University of Bergen, Bergen, Norway****Department of Psychology, Faculty of Social Sciences, University of Oslo, Oslo,††††Department of Sport and Physical Activity, Bergen University College, Bergen, Norway‡‡‡‡Department of Health Promotion, University College of Southeast Norway, Oslo, Norway.
• Spine. 2016 Oct 15; 41 (20): 1557-1564.

Study DesignA randomized controlled trial.ObjectiveThe aim of this study was to evaluate whether a tailored and manualized cognitive behavior therapy (CBT) or nutritional supplements of seal oil and soy oil had any additional benefits over a brief cognitive intervention (BI) on return to work (RTW).Summary Of Background DataBrief intervention programs are clinically beneficial and cost-effective for patients with low back pain (LBP). CBT is recommended for LBP, but evidence on RTW is lacking. Seal oil has previously been shown to have a possible effect on muscle pain, but no randomized controlled trials have so far been carried out in LBP patients.MethodsFour hundred thirteen adults aged 18 to 60 years were included. Participants were sick-listed 2 to 10 months due to LBP. Main outcome was objectively ascertained work participation at 12-month follow-up. Participants were randomly assigned to BI (n = 100), BI and CBT (n = 103), BI and seal oil (n = 105), or BI and soy oil (n = 105). BI is a two-session cognitive, clinical examination program followed by two booster sessions, while the CBT program is a tailored, individual, seven-session manual-based treatment.ResultsAt 12-month follow-up, 60% of the participants in the BI group, 50% in the BI and CBT group, 51% in the BI and seal oil group, and 53% in the BI and soy oil group showed reduced sick leave from baseline, and had either partly or fully RTW. The differences between the groups were not statistically significant (χ = 2.54, P = 0.47). There were no significant differences between the treatment groups at any of the other follow-up assessments either, except for a significantly lower sick leave rate in the BI group than the other groups during the first 3 months of follow-up (χ = 9.50, P = 0.02).ConclusionCBT and seal oil had no additional benefits over a brief cognitive intervention on sick leave. The brief cognitive intervention alone was superior in facilitating a fast RTW.Level Of Evidence2.

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