The contribution of ergonomics to the rehabilitation of back pain patients

Participatory ergonomics as a return-to-work intervention: a future challenge?

BACKGROUND

Participatory ergonomics (PE) are often applied for prevention of low back pain (LBP). In this pilot-study, a PE-program is applied to the disability management of workers sick listed due to LBP.

METHODS

The process, implementation, satisfaction, and barriers for implementation concerning the PE-program were analyzed quantitatively and qualitatively for 35 workers sick listed 2-6 weeks due to LBP and their ergonomists.

RESULTS

Two-hundred-and-seventy ergonomic solutions were proposed to the employer. They were targeted more at work design and organization of work (58.9%) than at workplace and equipment design (38.9%). They were planned mostly on a short-term basis (74.8%). Almost half (48.9%) of the solutions for work adjustment were completely or partially implemented within 3 months after the first day of absenteeism. Most workers were satisfied about the PE-program (median score 7.8 on a 10-point scale) and reported a stimulating effect on return-to-work (66.7%). Main obstacles to implementation were technical or organizational difficulties (50.0%) and physical disabilities of the worker (44.8%).

CONCLUSIONS

This study suggests that compliance, acceptance, and satisfaction related to the PE-program were good for all participants. Almost half of the proposed solutions were implemented.

Early occupational health management of patients with back pain: a randomized controlled trial

STUDY DESIGN

A randomized controlled trial in occupational health practice was conducted.

OBJECTIVE

To study the efficacy of early management of workers with low back pain by occupational physicians, as compared with management by the supervisor only.

SUMMARY OF BACKGROUND DATA

Health care and university workers with back pain and on sick leave for less than 1 month were included in the study.

METHODS

Patients with low back pain for at least 10 days on sick leave were randomly assigned to early management by the occupational physician (n = 61) or to a reference group with management by the worker's supervisor during the first 3 months of sick leave (n = 59). The patients were observed for 1 year and compared in terms of time until return to work, pain intensity, functional disability, and general health perception. The occupational physicians were provided with management guidelines.

RESULTS

No significant differences were found after 3 and 12 months of follow-up evaluation in terms of time until return to work (hazard ratio, 1.3; 95% CI, 0.90-1.90) or in terms of other health outcomes. Recurrences, however, occurred more frequently in the intervention group, but the total duration of sick leave in 1 year did not differ between the groups.

CONCLUSIONS

The findings do not show a significant positive effect of an early intervention by occupational physicians on workers with low back pain. This might reflect the early phase of disability or the low intensity of the intervention resulting from overestimation of the physicians' compliance with the guidelines.

Development and evaluation of a quality assessment instrument for occupational physicians

OBJECTIVES

To develop and apply a method for assessing the quality of the process of occupational health care for individual patients.

METHODS

The scientific literature was studied to develop a method to assess the quality of the process of occupational rehabilitation for workers with low back pain. The method was applied to health care and university workers with low back pain who were rehabilitated by their occupational physicians.

RESULTS

Assessment of quality of care is regarded as a four step approach. Firstly, guidelines should be developed and implemented. Secondly, indicators for quality and criteria to demarcate good and deviant quality were derived from the guidelines. Thirdly, a method for data collection was chosen. Finally, quality was scored. For occupational rehabilitation, there was some deviance from the guidelines for most cases, especially in continuity of care with a deviant rate of 47%. Other indicators deviated from 1.4%-17.4%. Occupational physicians agreed on the relevance of the indicators and criteria, but for three indicators they evaluated the criteria as too rigid. They did not agree with their own performance scores in 66% of the deviant cases.

CONCLUSION

Assessing the quality of the process of occupational health care with this method is an asset to present methods, but more specific criteria are needed for a more sensitive assessment.

Isodynamic evaluation of trunk muscles and low-back pain among workers in a steel factory

A cross-sectional study was conducted to explore the relationship between dynamic parameters of trunk muscle strength and the occurrence of low-back pain (LBP). Isodynamic strength measurements were performed among 31 male maintenance workers with spells of low-back pain in the past 12 months and 28 maintenance workers without a history of low-back pain. In general, workers with low-back pain showed a lower trunk muscle performance than the workers without low-back pain. Only the measures of torque during lateral movement differed significantly between both groups. Regression analysis revealed the importance of the nature of low-back pain for trunk muscle strength. Most parameters of trunk muscle strength were significantly decreased among workers with chronic low-back pain of a rather severe nature, showing reductions from 18% to 50%. None of the work-related risk factors for low-back pain contributed significantly to the prediction of trunk strength measures. The study suggests that isodynamic evaluation of trunk muscle strength may assist in determining objective measures for the severity of low-back pain rather than in evaluating a subject's capability of successfully coping with a specific work load.