At a glance:
A review of 198 research articles on management and rehabilitation.
Rehabilitation: The process of helping a person back to their former abilities and
quality of life (or as close as possilble) after injury or a medical condition.
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
Intervention: A treatment or management program. Interventions
combine several approaches. In this field approaches include training
in problem solving, adaptation of work duties, graded activity, an exercise
and stretching program and pain relief. for back pain is to advise an injured
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.
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
Musculoskeletal:
Involving the muscles and the skeleton.
This term includes the limbs, neck, shoulders and back.
It also refers to many different conditions that can affect the tendons,
and related structures.
Problems that were implemented in the workplace and involved secondary
prevention.
Secondary prevention:
Approaches undertaken early in a condition with the aim of preventing
worsening of problems that can arise from the condition.
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
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 ergonomic
Designing activities and the workplace in a way to minimize discomfort. i.e.
Adapting work tasks, hours, or workstation to accommodate people.
An ergonomic computer workstation allows the person to work in the
best position to relieve load on the muscles of the neck and arms.
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.
Original Article, Authors & Publication Details:
R. M. Williams1, M. G. Westmorland1, C. A. Lin2, G. Schmuck3 and
M. Creen4 (2007). "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
4 Manulife Financial, Toronto, Ontario, Canada
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