Concepts of rehabilitation for the management of low back pain.
ABSTRACT This chapter develops rehabilitation principles for the clinical and occupational management of non-specific low back pain (LBP). Rehabilitation has traditionally been a secondary intervention, which focused on permanent impairment, but this is inappropriate for LBP. Most patients with LBP do not have any irremediable impairment and long-term incapacity is not inevitable: given the right care, support and opportunity, most should be able to return to work. Rehabilitation should then address obstacles to recovery and barriers to (return to) work. Rehabilitation should not be a separate, second stage after 'treatment' is complete: rehabilitation principles should be integral to clinical and occupational management. It should be possible to reduce sickness absence and long-term incapacity due to LBP by at least 30-50%, but this will require a fundamental shift in management culture.
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ABSTRACT: Stochastic resonance whole-body vibration training (SR-WBV) was tested to reduce work-related musculoskeletal complaints. Participants were 54 white-collar employees of a Swiss organization. The controlled crossover design comprised two groups each given 4 weeks of exercise and no training during a second 4-week period. Outcome was daily musculoskeletal well-being, musculoskeletal pain, and surefootedness. In addition, participants performed a behavioral test on body balance prior to when SR-WBV started and after 4 weeks of SR-WBV. Across the 4-week training period, musculoskeletal well-being and surefootedness were significantly increased (p < 0.05), whereas musculoskeletal pain was significantly reduced only in those who reported low back pain during the last 4 weeks prior to the study (p < 0.05). Body balance was significantly increased by SR-WBV (p < 0.05). SR-WBV seems to be an efficient option in primary prevention of musculoskeletal complaints and falls at work.Safety and health at work. 09/2013; 4(3):149-155.
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ABSTRACT: Aims: To investigate whether there are associations between the professional assessment of a patient's main clinical problem and the patient's self-reported health among patients with musculoskeletal disorders and/or mental disorders. To investigate differences in self-reported health and work-related measures in patients who were recommended clinical versus work-related interventions. Method: A cross-sectional study, including a convenience sample of 210 patients, visiting occupational health service. Patients answered a questionnaire on demographic variables, dimensions of health, functioning, work ability and working conditions. Patients’ main clinical problem and type of intervention was classified by physiotherapists. Activity limitations were identified using the Patient-Specific Functional Scale. Findings: The main clinical problems were: medical/organic problems (39%), psychosocial problems (46%) and physical work-related problems (15%). The psychosocial group reported more problems in mental functioning and the medical/organic group had worse physical functioning. There were significant differences for the main clinical problem, educational level, work ability, social interaction skills and mobility in patients who were recommended clinical versus work-related interventions. Conclusions: There are associations between the professional biopsychosocial classification and the patient's self-reported health and functioning. Clinical reasoning may be improved by including systematic biopsychosocial assessment of specific health and working conditions, and activity limitations according to Patient-Specific Functional Scale.Advances in Physiotherapy 12/2012; 14(4):155-165.
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ABSTRACT: A randomized controlled trial (RCT) was designed testing the effect of an interdisci-plinary return-to-work program fulfilling given local conditions and scientific criteria of an RCT. This program consisted of a work hardening program and workplace intervention. Timely and successful recruitment are key factors. The health care and insurance system in Switzerland make recruitment of sub-acute back pain (BP) patients only achievable with collaboration of large companies. Explicit case definition and incidence of cases for this recruitment are not well researched. In a pilot study, 104 absence patterns due to BP were analyzed from a retail company with 7400 employees. Concurrent occurrence of neck/shoulder and low BP was dominant. No clear cut-off point for prolonged absences was noted. This led to a case definition which included two locations for BP, minimum of 20 days of cumulative absence and no planned return-to-work within 10 days. 0.45% of employees would have fulfilled the case definition and indicated willingness for participation. 0.5% of employees from a second company would have met our criteria. Recruitment was successfully tested in these two companies (14 patients in 1 month). As a conclusion, to achieve our inclusion goal (240 subjects), col-laboration with companies representing at least 27'000 workers must be set up. Recruitment through companies is feasible. Labor market and company struc-ture are continuously changing and influence motivation to participate in our RCT, thus demanding an accurate randomization procedure and continual adaptation of study procedures to labor market trends. RTCs are designed on paper but executed in the field.