To the Editor.
—The article by Mayer et al1 presents the impressive results of their program in returning to work 87% of the patients with chronic low back pain whom they treated. A recent review2 of the literature in this field estimated from other studies that overall no more than 15% of such patients ever return to work. I wish to make two comments on this study. The first is on the classification of groups used and the second is on the implications of this research for our understanding of the nature of disabling low back pain.Current research seems to require contemporaneous comparison groups, though the outcome data in this study are so extraordinary that this does not seem necessary. For "controls"—the researchers appropriately avoided this term—they used a comparison group whose medical insurance did not entitle them to the rehabilitation program studied. A second comparison group
Ruane TJ. Restoration of Function in Industrial Low Back Injury. JAMA. 1988;259(8):1181. doi:10.1001/jama.1988.03720080017016