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ARTICLE #16: A REVIEW OF WORKPLACE REHABILITATION APPROACHES FOR BACK PAIN

At a glance:
A review of 198 research articles on management and rehabilitation of lower back pain in the workplace found:

• 15 articles (10 studies) of high quality and relevant to the topic
• The studies suggest the best intervention for back pain is to advise an injured worker to be active, and to return to modified work duties early.
• If this advice was followed workers returned to work earlier, with less pain and disability.

Employee
This review looked at many pieces of research to find the most effective approach to the rehabilitation of low back pain in the workplace.

The review found that the most effective way to manage low back pain is for health care professionals to advise light activity and an early return to work with some changes in work tasks initially.

Try to encourage discussion between your doctor, your employer and yourself on this subject. Work with your employer in a partnership to facilitate your return to work.

Employer
This review shows that clinical treatment involving light activity and early return to work, with some initial adaptation of work tasks and hours, reduces pain and disability and results in an earlier return to normal work duties.

Some initial adaptation of workplace tasks and working hours is important to reduce pain and suffering and lost work days.

Initiatives in the workplace have a major impact on outcomes for people with back pain.

Treater
This systematic review light activity and early return to work, with some initial adaptation of work tasks and hours, reduces pain and disability and results in an earlier return to normal work duties and hours.

Insurer
Clinical intervention involving early return to work with some work task adaptation and flexible hours, along with light exercise and activity, increased return to work rates. It is worth encouraging the employer to understand the major role they can play in assisting the employee get back to work.

Original Article, Authors & Publication Details:
R. M. Williams1, M. G. Westmorland1, C. A. Lin2, G. Schmuck3 and M. Creen4 (2007).

Effectiveness of workplace rehabilitation interventions in the treatment of work-related low back pain: A systematic review.
Disability and Rehabilitation; 29(8): 607-24.

1 School of Rehabilitation Science, McMaster University, Hamilton, Ontario
2 CanChild Centre for Childhood Disability Research, School of Rehabilitation Science, McMaster University, Hamilton, Ontario
3 Link With Work, Grand River Hospital, Kitchener, Ontario, and 4Manulife Financial, Toronto, Ontario, Canada

Background, Study Objectives, How It Was Done:
This was an extensive Review of studies in this area, evaluating the effectiveness of workplace rehabilitation interventions for lower back pain.

Five reviewers examined 1244 articles and selected 198 that were relevant to the topic. Of these, 15 articles on 10 studies were of a high enough quality to be included.

The Review focused on strategies for the management of work related musculoskeletal problems that were implemented in the workplace and involved secondary prevention. Secondary preventions are approaches undertaken early in a condition with the aim of preventing the worsening of symptoms and disability. In the workplace these may include actions such as modifying work duties to make them manageable for an injured worker, or structuring a gradual return to work program.

Study Findings:

• Clinical treatment involving light activity and early return to work with initial adaptation of work tasks and hours reduces pain and disability.
• The effectiveness of this clinical treatment was not increased by adding workplace interventions.

Low back pain affects workers and their families and employers. Although most (80%) people with low back pain recover in the first 3 months a small number remain affected for 6 months and some become permanently disabled. Disability from back pain causes high costs to health systems.

This review of relevant studies found the following:

Early Return to Work / Modified Work:

An intervention of immediate assessment, treatment and return to modified work duties was provided to a group of nurses with back problems, and the results compared to those who received usual care. The results showed that the group with the workplace intervention had less had time off from injury, lower pain, less disability, and increasing physical ability to perform normal duties.

Occupational Interventions with Clinical Interventions:

A study examined return to work outcomes for people with back pain who were treated with one of four approaches.

One group had traditional physical fitness rehabilitation (work hardening, fitness program and alternate days at work with increased tasks), the second group had an occupational intervention (evaluation and modification of work environment and duties), the third group received both of these interventions, and the fourth group did not receive either of the interventions.

The study found that the group that received both interventions returned to work 2.4 times faster than the group that did not receive either intervention.

Ergonomic Interventions:

A major study examined the results of ergonomic interventions (adapting the workplace environment, work duties and hours) for over 1600 workers in five countries who were off work.

This study showed that adaptation of job tasks and working hours was effective in helping workers to return to work after 200 days off sick. Adaptation of the work site was also found to improve the likelihood of return to work.

Exercises and Workplace Visit:

Two articles indicated that light exercise at first, with gradually increasing activity, were more effective in reducing days on sick leave, pain and difficulty with daily activities than “usual' care. The interventions were carried out in a clinic. The addition of a worksite visit and suggestion of modified work environment and duties was not shown to increase the effectiveness of the treatment.

Supervisor Involvement:

An educational program to train supervisors in return to work management resulted in increased contact between supervisors and employees with an injury, a more active approach to adapting the workplace for return to work by supervisors, and increased confidence of employees in their supervisors.

Conclusions:
Back pain interfering with return to work is a common problem. This review was conducted to evaluate the effectiveness of workplace rehabilitation interventions for injured workers with low back pain. The study found advising the injured worker to be active and supporting return to work in the workplace, including modifying work duties, produces the best treatment outcomes.

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