Multidisciplinary care can reduce sick leave for low back pain patients without increasing costs
According to research, in treating working-age patients with low back pain, resources can be more effectively allocated to physiotherapist-led care rather than relying solely on the traditional physician-led model. This new approach considers the patient's physical, psychological, and social factors, as well as the risk of work disability, and appears to reduce sickness absence without incurring additional costs.
Research conducted by Maija Paukkunen, a physiotherapist and researcher at the University of Oulu, was awarded Best Spine Research of the Year by the Finnish Spine Research Society on 4 April 2025.
In her intervention study, Paukkunen compared the effects and costs of a biopsychosocial assessment and treatment model—known as BPS care—with conventional treatment within occupational health services. The results showed that over the course of one year, the number of doctor visits decreased in the BPS group, while visits to occupational physiotherapists increased. At the same time, sickness absence days were reduced: 65% of patients in the intervention group took no sick leave due to back pain, compared to 50% in the usual care group. Despite patients in the BPS group receiving more rehabilitative guidance, overall costs did not rise.
“The findings show that the role of physiotherapists in back pain care can be enhanced, which is particularly important at a time when physician shortages and cost pressures are challenging the healthcare system,” Paukkunen notes.
Significant cost differences were observed based on the patient's risk of work disability. Among high-risk patients, BPS care proved markedly more cost-effective than conventional care: their median cost was €1,196 under the BPS model, compared to €2,801 with standard care. As expected, costs for high-risk patients were considerably higher than for those at low risk: more than five times higher with BPS care (€1,196 vs. €222) and as much as twelve times higher under conventional care (€2,801 vs. €232).
“These results highlight the importance of early risk assessment and targeting treatment particularly for patients at greatest risk of losing work capacity,” Paukkunen summarises.
Maija Paukkunen is a researcher at the University of Oulu and is also pursuing a PhD in implementation research at Linköping University in Sweden. She is an editor for the Finnish Medical Society Duodecim’s Current Care Guidelines (Käypä hoito), Vice Chair of the Finnish Association of Occupational Health Physiotherapists, and a board member of the Finnish Musculoskeletal Association TULE ry.
The study was carried out at six occupational health service providers in Finland between 2017 and 2021, involving 312 working-age patients with low back pain. The impact was assessed using patient registry data and national cost estimates.
The study has been published in the Scandinavian Journal of Work, Environment and Health, one of the leading journals in the field of occupational health.
Article: Paukkunen M, Karppinen J, Öberg B, Ala-Mursula L, Heikkala E, Ryynänen K, Holopainen R, Booth S, Booth N, & Abbott A. Cost analysis comparing guideline-oriented biopsychosocial management to usual care for low-back pain: a cluster-randomized trial in occupational health primary care. Scandinavian Journal of Work Environment and Health, 2025.