Concepts of rehabilitation for the management of low back pain.

UnumProvident Centre for Psychosocial and Disability Research, University of Cardiff, Wales, UK.
Bailli&egrave re s Best Practice and Research in Clinical Rheumatology (Impact Factor: 3.06). 09/2005; 19(4):655-70. DOI: 10.1016/j.berh.2005.03.008
Source: PubMed

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: The purpose of this study was to test the reliability and validity of the Korean version of the fear of daily activities questionnaire (FDAQ) for low back pain patients. Seventy-three subjects with low back pain were participated in this study. The subjects completed ten standardized self-administered questionnaires that measure fear of specific daily activities. The reliability of the acquired data was determined by the intra-class correlation coefficient (ICC) and the Cronbach's for internal consistency. Constructive validity was analyzed by factor analysis, and concurrent validity was acquired from comparison FDAQ scores to the visual analogue scale (VAS) and Oswestry disability index (ODI) scores. The test-retest reliability of the Korean version of the FDAQ showed good ICC (2,1)= 0.96 (95%CI and Cronbach's alpha value was 0.93. Factor analysis suggested two factors solution consisting of spinal loading and spinal movement/posture, it explained 76.1% of the total variance. The concurrent validity was moderately related with pain and disability. Therefore, the Korean version of the FDAQ is a useful method for measuring the fear of daily activities of patients with low back pain.
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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.
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