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: 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.
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ABSTRACT: Occupational health and safety issues and objectives: The inability of workers with psychological health problems to remain at work is a matter of growing social concern. It is therefore important to develop a systematic approach for identifying the determinants of occupational disability in order to target valid instruments in wide use and thereby allow them to be compared in different contexts. The general objective of this project was to develop a systematic approach for identifying the determinants of the inability of workers with psychological problems to maintain an active working life.
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ABSTRACT: La difficulté à se maintenir au travail en raison d’un problème de santé psychologique constitue une préoccupation sociale grandissante.Les auteurs ont voulu développer une approche systématique pour identifier les déterminants de l’incapacité à maintenir une vie professionnelle active chez le travailleur ayant des difficultés psychologiques. Pour ce faire, ils ont élaboré et effectué une première validation de deux outils à l’intention des milieux de travail:un dispositif d’enquête permettant d’identifier les déterminants, la prévalence et la distribution de la détresse psychologique et du présentéisme et un outil ergonomique pour décrire et évaluer la charge de travail et ses déterminants dans l’activité de travail.Cette étude innove en proposant des outils pré-testés, qui interrogent le travail prescrit et réel des employés en termes de difficultés ressenties, tout en tenant compte de la charge de travail ressentie par eux.