Development and validation of a work-related risk score for upper-extremity musculoskeletal disorders in a French working population.

OBJECTIVES: The aim was to develop an easy-to-use risk score based on occupational factors and to validate its performance to identify workers either having (diagnostic setting) or developing (prognostic setting) upper-extremity musculoskeletal disorders (UEMSD). METHODS: This study relied on data from the Cosali prospective cohort conducted in a French working population. Diagnostic status for six UEMSD at inclusion and at follow-up was assessed by a standardized clinical examination. Data on occupational factors were collected through a self-administered questionnaire completed before the clinical examination at inclusion. The risk score was derived from a prediction model developed on data of 2,468 workers included in 2002-2003, and the validation sample is composed of 1,051 workers included later in 2004-2005. The prognostic performance of the risk score was assessed in workers without UEMSD at baseline. RESULTS: A total of 13% and 12% of workers had a UEMSD at inclusion in the development and validation sample. The developed risk score includes physical, organizational and psychosocial factors at work. In the validation sample, this score had acceptable performance for identifying workers having or not UEMSD at baseline (AUC: 0.60 [95% CI 0.57 to 0.63]), in particular the negative predictive value was high (89%-90%). The baseline risk score showed similar performance for predicting incident UEMSD at follow-up examination. CONCLUSION: This score can be useful as a first-line risk assessment tool, especially for excluding the low-risk work situations from further intervention by an ergonomist. Further validation studies are needed to determine its performance among various working populations.

Influence of low back pain characteristics on the healthcare procedures prescribed by general practitioners for adult patients: ancillary analysis of the French ECOGEN study.

BACKGROUND: Non-specific low back pain is a frequent reason for consultation, yet little is known about how general practitioners manage it in France. OBJECTIVES: To describe the healthcare procedures general practitioners prescribe for low back pain in France. MATERIALS AND METHODS: This is an ancillary analysis of an observational, cross-sectional study (ECOGEN) conducted between November 2011 and April 2012 among 128 general practitioners. Adults younger than 65 years consulting for low back pain were included. Patient and general practitioner characteristics, consultation results (diagnosis) and healthcare procedures were collected and coded using the International Classification in Primary Care. Analyses focused on the initial or follow-up consultation, adjusting on age, gender, and socio-occupational category. RESULTS AND DISCUSSION: Out of 11510 consultations, 845 (7.3%) were for low back pain. Of these, 776 (79.5%) resulted in a clinical examination, 634 (73.4%) in medication prescription, and 203 (23.9%) were prescribed sick leave, but imaging and specialist referral were rare. Imaging was more frequent with radiating pain (adjusted odds ratio (aOR) = 1.61; 95% CI [1.07, 2.42]), as were specialist referrals (OR = 2.92; 95% CI [1.40, 6.09]) and sick leave prescription (aOR = 1.52; 95% CI [1.10, 2.09]), but physiotherapist referral was less frequent (aOR = 0.55; 95% CI [0.38, 0.82]). Clinical examinations (aOR = 2.75; 95% CI [1.98, 3.80]), imaging (aOR = 1.61; 95% CI [1.02, 2.31]) and medication prescriptions (aOR = 2.34; 95% CI [1.65, 3.30]) were more common in initial consultations, but specialist referral (aOR = 0.16; 95% CI [0.05, 0.47]) or sick leave prescription (aOR = 0.68; 95% CI [0.48, 0.97]) were rarer. CONCLUSION: Low back pain characteristics could influence healthcare procedures more markedly than patient or general practitioner characteristics.

Upper-extremity musculoskeletal disorders: how many cases can be prevented? Estimates from the COSALI cohort.

Objective This study aimed to estimate the proportion and number of incident upper-extremity musculoskeletal disorders (UEMSD) cases attributable to occupational risk factors in a working population. Methods Between 2002-2005, occupational physicians randomly selected 3710 workers, aged 20-59, from the Pays de la Loire (PdL) region. All participants underwent a standardized clinical examination. Between 2007-2010, 1611 workers were re-examined. This study included 1246 workers who were free of six main clinically diagnosed UEMSD at baseline but were diagnosed with at least one of these UEMSD at follow-up [59% of men, mean age: 38 (standard deviation 8.6) years]. Relative risks and population-attributable fractions (PAF) were calculated using Cox multivariable models with equal follow-up time and robust variance. The total number of incident UEMSD in the PdL region was estimated after adjustment of the sample weights using 2007 census data. The estimated number of potentially avoidable UEMSD was calculated by multiplying PAF by the total number of incident UEMSD in PdL. Results At follow-up, 139 new cases of UEMSD (11% of the study sample) were diagnosed. This represented an estimated 129 320 incident cases in the PdL in 2007. Following adjustment for personal factors, 26 381 (20.4% of all incident UEMSD) were attributable to high physical exertion, 16 682 (12.9%) to low social support, and 8535 (6.6%) to working with arms above shoulder level. Conclusions A large number and important proportion of incident UEMSD may be preventable by reducing work exposures to physical exertion and working with arms above shoulder level as well as improving social support from co-workers/supervisors.

Proportion of upper extremity musculoskeletal disorders attributable to personal and occupational factors: results from the French Pays de la Loire study.

BACKGROUND: Upper extremity musculoskeletal disorders (UEMSD) are one of the most common and costly occupational health problems. We aimed to assess the population-attributable fraction (PAF) of personal and occupational risk factors associated with incident UEMSD in a working population. METHODS: From 2002 to 2005, a random sample of 3710 workers from the Pays de la Loire region in France, aged 20-59 were included by occupational physicians (OPs). Between 2007 and 2010, 1611 workers were re-examined by their OPs. Subjects free from UEMSD at baseline were included in this study (1275 workers, mean age: 38.2 years). Cox regression models with equal follow-up time and robust variance estimates were used to estimate age-adjusted and multivariable-adjusted relative risks (RRs) and their 95% confidence intervals (CIs). Based on multivariable models, PAF associated with each factor included in the models was estimated. RESULTS: During the follow-up period, 143 (11%) cases of UEMSD were diagnosed. PAFs for factors associated with the incident UEMSD risk were 30% (7 to 51) for high physical exertion (RPE Borg scale ≥12), 12% (- 0.2 to 24) for low social support, 7% (- 3 to 17) for working with arms above shoulder level (≥2 h/day), 20% (12 to 28) for age group ≥45, 13% (3 to 22) for the age group 35-44, and 12% (0.3 to 24) for female gender. CONCLUSIONS: Our study suggests that an important fraction of UEMSD can be attributed to occupational exposures after the contributions of personal and other work-related factors are considered. In terms of public health, our findings are in agreement with the ergonomic literature postulating that a high proportion of UEMSD are preventable through modifying workplace risk factors. Such information is useful to help public health practitioners and policy makers implement programs of prevention of UEMSD in the working population.

[Exposure to occupational biomechanical risk factors: The impact of the 2017 reform]. / L'exposition professionnelle aux facteurs de risque biomécaniques : impact de l'ordonnance de 2017.

OBJECTIVE: We aimed to assess the number, the prevalence and the socio-occupational characteristics of the employees who were allowed to benefit from prevention measures due to their exposure to occupational biomechanical factors before and after the modification, by the reform (order n° 2017-1389), of the law dealing with occupational health and safety preventive measures. METHODS: This study was based on the French national survey on occupational exposures (Sumer 2010). Almost 48,000 employees, representative of the French population, were included. Exposure to the four biomechanical factors, initially included in the law and associated with a minimum exposure threshold, were assessed during the employee's interview by the occupational physician. RESULTS: Before the reform, 31.2% of men and 23.6% of women were likely to benefit from measures of prevention due to their exposure to occupational biomechanical factors. Following the reform, 11,6% of men and 13,7% of women employees are still able to benefit from these occupational preventive measures, leading to an overall decrease of 3.3 million of beneficiaries. CONCLUSIONS: Although musculoskeletal disorders (MSD) remain the first cause of recognition as an occupational disease, the exclusion, by the reform, of three biomechanical occupational risk factors of MSDs from the preventives measures in occupational health and safety risk assessment will substantially decrease the number of employees exposed to biomechanical factors that could benefit from these preventive and compensatory occupational measures.

Theoretical impact of workplace-based primary prevention of lumbar disc surgery in a French region: A pilot study.

BACKGROUND: Lumbar disc-related disorders are a main cause of work-related osteo-articular morbidity. Lumbar disc surgery (LDS) has been chosen as sentinel event for the epidemiological surveillance of these disorders since LDS can be identified in the medical databases from public and private hospitals. OBJECTIVE: To assess the theoretical impact of workplace-based primary interventions designed to reduce exposure to personal and/or work-related risk factors for LDS. METHODS: Cases of LDS were assessed using hospital discharge records for persons aged 20-64 in 2007-8 in the French Pays de la Loire region. We estimated the number of work-related cases of LDS (WR-LDS) in high-risk industry sectors. Three theoretical scenarios of workplace-based primary prevention have been simulated: a mono-component work-centered intervention reducing the incidence of WR-LDS by 10%, and two multicomponent global interventions reducing the incidence of all cases of LDS by 5% and 10% by targeting personal and occupational risk factors. RESULTS: Four high-risk sectors were identified, amounting to 277 [216-352] cases, of which 98 [37-175] were WR-LDS: construction and information & communication for men; wholesale & retail trade and accommodation & food service activities for women. AFE was limited for each industry sector, 30%, 50%, 33% and 55%, respectively. CONCLUSIONS: Prevention scenarios combining actions on personal and occupational risk factors would be the most effective, compared to prevention focused only on occupational risk factors. Implementing actions of promotion of health at work would be necessary in addition of actions on occupational risks.

Functional incapacity related to rotator cuff syndrome in workers. Is it influenced by social characteristics and medical management?

STUDY DESIGN: Survey. INTRODUCTION: Rotator cuff syndrome (RCS) is one of the most common musculoskeletal disorders reported in workers. The functional incapacity related to RCS may vary according to the sociodemographic context and to the medical management. PURPOSE OF THE STUDY: The purpose of this is to analyze the RCS-related functional incapacity assessed by the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaires in workers according to their sociodemographic characteristics and the use of care. METHODS: A cross-sectional study was carried out on a French sample of workers diagnosed with RCS. The DASH and DASH-work scores were studied according to the sociodemographic factors, musculoskeletal symptoms, and RCS medical management during the preceding 12 months. RESULTS: Two hundred seven workers who suffered from RCS filled out the questionnaire of which 80% were still working. The DASH score was significantly higher in women (24.0 vs 17.4; P < .01; effect size (d) = 0.39), in patients over the age of 50 years (23.6 vs 11.3; P < .005) and in case of another upper limb musculoskeletal disorder (P < .0001; d ≥ 0.4). The DASH and DASH-work scores were significantly higher in case of use of care for RCS (P < .005; d > 0.6). DISCUSSION: The demographic factors and the RCS medical management influenced the overall incapacity assessed by the DASH questionnaire. Work incapacity was more especially related to the use of care for RCS. CONCLUSION: The sociodemographic and medical parameters added to other established predictors could help guide clinicians in managing their patients.

Multiple Exposures and Coexposures to Occupational Hazards Among Agricultural Workers: A Systematic Review of Observational Studies.

BACKGROUND: Workers may be exposed to various types of occupational hazards at the same time, potentially increasing the risk of adverse health outcomes. The aim of this review was to analyze the effects of multiple occupational exposures and coexposures to chemical, biomechanical, and physical hazards on adverse health outcomes among agricultural workers. METHODS: Articles published in English between 1990 and 2015 were identified using five popular databases and two complementary sources. The quality of the included publications was assessed using the methodology developed by the Effective Public Health Practice Project assessment tool for quantitative studies. RESULTS: Fifteen articles were included in the review. Multiple chemical exposures were significantly associated with an increased risk of respiratory diseases, cancer, and DNA and cytogenetic damage. Multiple physical exposures seemed to increase the risk of hearing loss, whereas coexposures to physical and biomechanical hazards were associated with an increased risk of musculoskeletal disorders among agricultural workers. CONCLUSION: Few studies have explored the impact of multiple occupational exposures on the health of agricultural workers. A very limited number of studies have investigated the effect of coexposures among biomechanical, physical, and chemical hazards on occupational health, which indicates a need for further research in this area.

Use of Multiple Data Sources for Surveillance of Work-Related Chronic Low-Back Pain and Disc-Related Sciatica in a French Region.

Objectives: To compare the data of the French workers' compensation system (WCS) and three surveillance networks, and to determine the possibility of identifying the industry sectors most in need of programs for prevention of low-back pain (LBP). Methods: This study compared four databases and two types of indicators in a west central region of France: • surveillance of musculoskeletal symptoms in the working population [LBP and disc-related sciatica (DRS) indicators; Cosali study] • surveillance of uncompensated work-related diseases (LBP and DRS indicators) • surveillance of lumbar disc surgery (LDS) in the general population (DRS indicator) • French WCS (disc herniation with radiculopathy caused by vibration or handling of materials; DRS indicator) People aged 20-59 were studied. The prevention index (PI) was used to rank industry sectors according to the number of cases and the prevalence/incidence rate. Results: Construction and manufacturing were the first sectors in terms of PI for men in all databases and indicators. Moreover, transport and agriculture were not consistently highlighted. For women, manufacturing was the leading sector (except for the LDS study: health sector), followed by the health sector. Specific epidemiologic surveillance networks (LDS and Cosali studies) provided ranking of the greatest number of sectors out of the 17 classified. For DRS indicators, the LDS study classified 13 sectors for both genders, and for LBP indicators, the Cosali study ranked 8 and 7 sectors in men and women, respectively. Conclusions: The results showed the complementarity of the four surveillance programs. A multi-component surveillance system allowed detection of industry sectors most in need of prevention programs.

Theoretical impact of simulated workplace-based primary prevention of carpal tunnel syndrome in a French region.

BACKGROUND: Carpal tunnel syndrome (CTS) is the most common nerve entrapment neuropathy in the working-age population. The reduction of CTS incidence in the workforce is a priority for policy makers due to the human, social and economic costs. To assess the theoretical impact of workplace-based primary interventions designed to reduce exposure to personal and/or work-related risk factors for CTS. METHODS: Surgical CTS were assessed using regional hospital discharge records for persons aged 20-59 in 2009. Using work-related attributable fractions (AFEs), we estimated the number of work-related CTS (WR-CTS) in high-risk jobs. We simulated three theoretical scenarios of workplace-based primary prevention for jobs at risk: a mono-component work-centered intervention reducing the incidence of WR-CTS arbitrarily by 10% (10%-WI), and multicomponent global interventions reducing the incidence of all surgical CTS by 5% and 10% by targeting personal and work risk factors. RESULTS: A limited proportion of CTS were work-related in the region's population. WR-CTS were concentrated in nine jobs at high risk of CTS, amounting to 1603 [1137-2212] CTS, of which 906 [450-1522] were WR-CTS. The 10%-WI, 5%-GI and 10%-GI hypothetically prevented 90 [46-153], 81 [58-111] and 159 [114-223] CTS, respectively. The 10%-GI had the greatest impact regardless of the job. The impact of the 10%-WI interventions was high only in jobs at highest risk and AFEs (e.g. food industry jobs). The 10%-WI and 5%-GI had a similar impact for moderate-risk jobs (e.g. healthcare jobs). CONCLUSION: The impact of simulated workplace-based interventions suggests that prevention efforts to reduce exposure to work-related risk factors should focus on high-risk jobs. Reducing CTS rates will also require integrated strategies to reduce personal risk factors, particularly in jobs with low levels of work-related risk of CTS.

Risk factors for episodic neck pain in workers: a 5-year prospective study of a general working population.

PURPOSE: Development of neck pain (NP) in workers has a multifactorial etiology and depends on both individual and workplace factors. The aim of this study was to investigate risk factors for episodic NP in a large diverse sample of active workers. METHODS: A prospective study based on the surveillance program implemented by the French Public Health Agency in the Loire Valley region. Between 2002 and 2005, 3710 workers were included. Between 2007 and 2010, 2332 workers responded to a follow-up questionnaire which assessed: (1) musculoskeletal symptoms (Nordic questionnaire) and (2) individual and work-related risk factors. Associations between episodic NP in 2007 (i.e., free subjects at baseline and who suffered at least 8 days during the preceding 12 months) and individual and work-related risk factors at baseline were studied using logistic regression modeling, stratified by sex. RESULTS: Among the 1510 workers (914 men, 596 women) still active at follow-up, 10.4% (8.4-12.4) of men and 14.6% (11.8-17.4) of women declared episodic NP. Among men, work pace dependence of guests or permanent hierarchical controls were risk factors of NP [OR = 1.8 (1.1-2.8) and OR = 2.1 (1.3-3.3), respectively]. Among women, the combination of sustained/repeated arm abduction with high physical perceived exertion was the strongest risk factor for NP [OR = 3.5 (1.7-7.2)]; age and paced work were also predictors for NP in women. CONCLUSIONS: NP results from complex relationships between individual and work-related variables. High physical workload, awkward postures, and poor organizational environment together with age differently predicted episodic NP according to the sex.

[Occupational disorders epidemiology]. / Épidémiologie des maladies professionnelles

Occupational disorders epidemiology. The aim of this narrative review was to give some basics of occupational disorders epidemiology, compensated or not, and focusing on complementarity between data sources available in France.

Épidémiologie des maladies professionnelles. L'objectif de cette mise au point est de donner quelques repères sur l'épidémiologie des maladies liées au travail et des maladies professionnelles, en insistant sur les sources possibles de données disponibles en France et leur complémentarité.

Time trends in incidence and prevalence of carpal tunnel syndrome over eight years according to multiple data sources: Pays de la Loire study.

Objective The aim of this study was to describe time trends of incidence/prevalence of carpal tunnel syndrome (CTS), one of the most common musculoskeletal disorders, in a French region over an 8-year period. Methods Three independent data sources were analyzed for the population of the Pays de la Loire region aged 20-59 between 2004 and 2011: hospital discharge records for "surgically treated CTS" (SURG-CTS), the social insurance data on "CTS compensated for as an occupational disease" (OD-CTS), and the regional surveillance program of "work-related diseases" (WRD-CTS). Case counts were analyzed using negative binomial regression models and cubic spline curves with year as the main covariate. Results The annual incidence rates of SURG-CTS decreased from 3.35 to 2.98 per 1000 person-years over the 8-year period, with an overall declining trend [-2.00%, 95% confidence interval (95% CI) -3.07- -0.91%), P<0.001]. The annual incidence rate of OD-CTS per 1000 person-years decreased (from 1.52 to 1.01) between 2004 and 2007 and increased after 2007 (from 1.45 to 2.34), with an overall gain of 54% during the study period. The prevalence rate of WRD-CTS decreased from 5.04 (95% CI 3.90-6.13) to 3.08 (95% CI 2.11-4.06) per 1000 employed person-years, with a non-significant trend between 2004 and 2011. Conclusion The study showed declining rates of SURG-CTS and WRD-CTS in the population of working age between 2004 and 2011, contrasting with increasing rate of OD-CTS after 2007. More research and surveillance data are needed to assess whether and to what extent the declining rates of CTS are actually attributable to improvement in working conditions and/or to non-occupational factors.

Forms of work organization and associations with shoulder disorders: Results from a French working population.

The aim of this study was to identify forms of work organization in a French region and to study associations with the occurrence of symptomatic and clinically diagnosed shoulder disorders in workers. Workers were randomly included in this cross-sectional study from 2002 to 2005. Sixteen organizational variables were assessed by a self-administered questionnaire: i.e. shift work, job rotation, repetitiveness of tasks, paced work/automatic rate, work pace dependent on quantified targets, permanent controls or surveillance, colleagues' work and customer demand, and eight variables measuring decision latitude. Five forms of work organization were identified using hierarchical cluster analysis (HCA) of variables and HCA of workers: low decision latitude with pace constraints, medium decision latitude with pace constraints, low decision latitude with low pace constraints, high decision latitude with pace constraints and high decision latitude with low pace constraints. There were significant associations between forms of work organization and symptomatic and clinically-diagnosed shoulder disorders.

An epidemiological surveillance network of lumbar disc surgery to help prevention of and compensation for low back pain.

BACKGROUND: In the context of the establishment of a new surveillance system, the aim was to assess the proportion of cases of lumbar disc surgery (LDS) attributable to work according to occupation category and industry sector. METHODS: The sociodemographic and socioeconomic data of 3150 inpatients living in a French region discharged in 2007-2008 from spine centers of the region following LDS were compared with those of the regional population. Occupational history was gathered using a mailed questionnaire. The attributable fraction of risk for exposed individuals (AFE) and population attributable fraction of risk (PAF) were calculated in relation to occupations and industries. RESULTS: Three occupational subcategories presented an AFE >50% for men (police and armed forces, unskilled agricultural and skilled craft blue-collar workers). There were eight subcategories for women, including material handlers and related equipment workers, and skilled industrial and unskilled agricultural blue-collar workers. The PAF for men was highest for construction and for women it was highest for wholesale and retail trades. CONCLUSION: The AFE and PAF are valuable for public policy. Although PAF could be used to help public health policy makers to implement preventive measures, the AFE could assist expert tribunals who take decisions about compensation for occupational diseases.

Biomechanical constraints remain major risk factors for low back pain. Results from a prospective cohort study in French male employees.

BACKGROUND CONTEXT: Low back pain (LBP) is a major public health problem, with a considerable impact on workers. PURPOSE: To model the risk of LBP in the male general working population. STUDY DESIGN/SETTING: Repeated cross-sectional surveys in a wide occupational setting. PATIENT SAMPLE: A random sample of 2,161 men working in various occupations in a French region participated in a first survey in 2002, and 1,313 of these (60.8%) participated in a second survey in 2007. OUTCOME MEASURE: The self-reported prevalence of LBP during the previous week in the second survey. METHODS: Twenty-one biomechanical, organizational, psychosocial, and individual factors were assessed in the first survey. The association between these potential risk factors and the prevalence of later LBP (in the second survey) was studied, using multistep logistic regression models. RESULTS: Three hundred ninety-four men reported LBP in the second survey (prevalence 30.0%). The final multivariate model highlighted four risk factors: frequent bending (odds ratio [OR], 1.45, 95% confidence interval [CI], 1.07-1.97 for bending forward only; and OR, 2.13, 95% CI, 1.52-3.00 for bending both forward and sideways), driving industrial vehicles (OR, 1.35; 95% CI, 1.00-1.81), working more hours than officially planned (OR, 1.38; 95% CI, 1.05-1.81), and reported low support from supervisors (OR, 1.35; 95% CI, 1.02-1.79). CONCLUSIONS: These results emphasize that biomechanical factors remain worth considering, even when psychosocial factors are taken into account, and provide a significant contribution to preventive strategies.

Incidence and risk factors for thoracic spine pain in the working population: the French Pays de la Loire study.

OBJECTIVE: To examine the incidence and risk factors for incident thoracic spine pain (TSP) in workers representative of a French region's working population. METHODS: In this prospective study, 3,710 workers were assessed in 2002-2005, and 2,332 (62.9%) of them were reassessed in 2007-2010. TSP was assessed by a self-administered Nordic questionnaire at baseline and at followup. At baseline, all participants completed a self-administered questionnaire on personal factors and work exposure. A total of 1,886 subjects (1,124 men and 762 women) without TSP at baseline were eligible for analysis. Associations between incident TSP and risk factors at baseline were analyzed by multivariate logistic regression. RESULTS: The incidence rate of TSP was 5.2 (95% confidence interval [95% CI] 3.9-6.6) per 100 men and 10.0 (95% CI 7.8-12.1) per 100 women. TSP was often associated with low back pain and neck pain. TSP in men was associated with age (odds ratios [ORs] ranging from 2.6 [95% CI 0.95-7.1] at 30-39 years to 6.0 [95% CI 2.1-17.3] at ≥50 years), being tall (OR 2.2 [95% CI 1.2-3.9]), frequent/sustained trunk bending (OR 3.0 [95% CI 1.5-6.1]), lack of recovery period or change in the task (OR 2.0 [95% CI 1.2-3.6]), and driving vehicles (OR 2.8 [95% CI 1.4-5.5]). Being overweight or obese was associated with lower risk (OR 0.5 [95% CI 0.3-0.96]). TSP in women was associated with high perceived physical workload (OR 1.9 [95% CI 1.1-3.3]), after adjustment for confounding variables. CONCLUSION: The risk model of TSP combined personal and work-related organizational and physical factors. Trunk bending appeared to be a strong independent predictor of TSP in this working population.

Multidisciplinary intensive functional restoration versus outpatient active physiotherapy in chronic low back pain: a randomized controlled trial.

STUDY DESIGN: Randomized parallel group comparative trial with a 1-year follow-up period. OBJECTIVE: To compare in a population of patients with chronic low back pain, the effectiveness of a functional restoration program (FRP), including intensive physical training and a multidisciplinary approach, with an outpatient active physiotherapy program at 1-year follow-up. SUMMARY OF BACKGROUND DATA: Controlled studies conducted in the United States and in Northern Europe showed a benefit of FRPs, especially on return to work. Randomized studies have compared these programs with standard care. A previously reported study presented the effectiveness at 6 months of both functional restoration and active physiotherapy, with a significantly greater reduction of sick-leave days for functional restoration. METHODS: A total of 132 patients with low back pain were randomized to either FRP (68 patients) or active individual therapy (64 patients). One patient did not complete the FRP; 19 patients were lost to follow-up (4 in the FRP group and 15 in the active individual treatment group). The number of sick-leave days in 2 years before the program was similar in both groups (180 ± 135.1 days in active individual treatment vs. 185 ± 149.8 days in FRP, P = 0.847). RESULTS: In both groups, at 1-year follow-up, intensity of pain, flexibility, trunk muscle endurance, Dallas daily activities and work and leisure scores, and number of sick-leave days were significantly improved compared with baseline. The number of sick-leave days was significantly lower in the FRP group. CONCLUSION: Both programs are efficient in reducing disability and sick-leave days. The FRP is significantly more effective in reducing sick-leave days. Further analysis is required to determine if this overweighs the difference in costs of both programs.