Back pain management in Dutch occupational health care

Dit proefschrift gaat over een gezamenlijk project van TNO Arbeid en de afdeling Sociale Geneeskunde van het VU medisch centrum. Lage rugklachten zijn een groot probleem in de Westerse samenleving. Zij kunnen ziekteverzuim en arbeidsongeschiktheid veroorzaken en als gevolg daarvan grote kosten met zich meebrengen. Bedrijfsartsen adviseren vaak werkaanpassingen en oefenprogramma's om de werkhervatting van werknemers met lage rugklachten te bevorderen, maar er is weinig wetenschappelijk bewijs dat dit effectief is. Dit proefschrift besteedt, naar analogie van Canadees onderzoek, aandacht aan de effectiviteit van een methode voor werkaanpassing met actieve betrokkenheid van werknemer èn werkgever en de effectiviteit van een fysiotherapeutisch oefenprogramma. De methode voor werkaanpassing blijkt werkhervatting te bespoedigen, hetgeen zowel gezondheidkundige als economische winst oplevert. Het fysiotherapeutische oefenprogramma blijkt in dit onderzoek geen meerwaarde te hebben. Verder is in dit proefschrift gekeken naar de oorzaken van een vertraging in de terugkeer naar werk

An exploratory subgroup analysis in a randomized control trial on the effectiveness of workplace interventions in low back pain patients on sick leave

Sixth International Scientific Conference on Prevention of Work-Related Musculosketal Disorders (PREMUS) Boston, USA, 27-30 august 2007

Comparing current definitions of return to work: A measurement approach

Introduction Return-to-work (RTW) status is an often used outcome in work and health research. In low back pain, work is regarded as a normal activity a worker should return to in order to fully recover. Comparing outcomes across studies and even jurisdictions using different definitions of RTW can be challenging for readers in general and when performing a systematic review in particular. In this study, the measurement properties of previously defined RTW outcomes were examined with data from two studies from two countries. Methods Data on RTW in low back pain (LBP) from the Canadian Early Claimant Cohort (ECC); a workers' compensation based study, and the Dutch Amsterdam Sherbrooke Evaluation (ASE) study were analyzed. Correlations between outcomes, differences in predictive validity when using different outcomes and construct validity when comparing outcomes to a functional status outcome were analyzed. Results In the ECC all definitions were highly correlated and performed similarly in predictive validity. When compared to functional status, RTW definitions in the ECC study performed fair to good on all time points. In the ASE study all definitions were highly correlated and performed similarly in predictive validity. The RTW definitions, however, failed to compare or compared poorly with functional status. Only one definition compared fairly on one time point. Conclusions Differently defined outcomes are highly correlated, give similar results in prediction, but seem to differ in construct validity when compared to functional status depending on societal context or possibly birth cohort. Comparison of studies using different RTW definitions appears valid as long as RTW status is not considered as a measure of functional status. © Springer Science+Business Media, LLC 2012

Multidisciplinary rehabilitation for subacute low back pain : graded activity or workplace intervention or both? : a randomized controlled trial

To assess the effectiveness of workplace intervention and graded activity, separately and combined, for multidisciplinary rehabilitation of low back pain (LBP). Summary of Background Data. Effective components for multidisciplinary rehabilitation of LBP are not yet established. Methods: Participants sick-listed 2 to 6 weeks due to nonspecific LBP were randomized to workplace intervention (n = 96) or usual care (n = 100). Workplace intervention consisted of workplace assessment, work modifications, and case management involving all stakeholders. Participants still sick-listed at 8 weeks were randomized for graded activity (n = 55) or usual care (n = 57). Graded activity comprised biweekly 1-hour exercise sessions based on operant-conditioning principles. Outcomes were lasting return to work, pain intensity and functional status, assessed at baseline, and at 12, 26, and 52 weeks after the start of sick leave. Results: Time until return to work for workers with workplace intervention was 77 versus 104 days (median) for workers without this intervention (P = 0.02). Workplace intervention was effective on return to work (hazard ratio = 1.7; 95% CI, 1.2-2.3; P = 0.002). Graded activity had a negative effect on return to work (hazard ratio = 0.4; 95% CI, 0.3-0.6; P < 0.001) and functional status. Combined intervention had no effect. Conclusion: Workplace intervention is advised for multidisciplinary rehabilitation of subacute LBP. Graded activity or combined intervention is not advised

What works best for whom? An exploratory, subgroup analysis in a randomized, controlled trial on the effectiveness of a workplace intervention in low back pain patients on return to work

). A modifying effect of gender, heavy work, and pain score and functional status on the effectiveness of this intervention was not found. CONCLUSION: The findings from these exploratory analyses should be tested in future RCTs. This workplace intervention seems very suitable for return to work of older workers and workers with previous sick leave. Gender, perceived heavy work, and baseline scores in pain and functional status should not be a basis for assignment to this interventio