Disability and return to work after a multidisciplinary intervention for (sub)acute low back pain: A systematic review.

OBJECTIVE: This systematic review aimed to examine pain, functional status and return to work after a multidisciplinary intervention, with or without additional workplace intervention, for (sub)acute low back pain among adults. DATA SOURCES: A comprehensive search was completed (November 2022) in six electronic databases (Embase, MEDLINE, Web of Science, Cochrane, CENTRAL and Scopus) and in the reference list of all identified studies. REVIEW METHODS: The search results were screened against predefined eligibility criteria by two independent researchers. Included articles were systematic reviews or randomized controlled trials examining the effect of a multidisciplinary intervention, with or without workplace intervention, in working adults with (sub)acute low back pain. Relevant information was summarized and clustered, and the methodological quality and certainty of evidence were assessed respectively using the RoB 2-tool, the ROBIS tool and the GRADE criteria. RESULTS: The search resulted in a total of 3020 articles. After the screening process, 12 studies remained (11 randomized controlled trials and 1 systematic review), which studied overall 2751 patients, with a follow-up period of at least 12 months. CONCLUSIONS: A multidisciplinary intervention is favorable compared to usual care for pain intensity and functional status but this is less clear for return to work. Comparable work-related effects were found when comparing a multidisciplinary intervention with a less extensive intervention, whereas uncertainties exist regarding outcomes of pain intensity and functional status. Furthermore, adding a workplace intervention to usual care and subdividing patients based on work-related characteristics seems beneficial for return to work.

Searching for consensus among physicians involved in the management of sick-listed workers in the Belgian health care sector: a qualitative study among practitioners and stakeholders.

BACKGROUND: In Belgium, the management of sick leave involves general practitioners (GPs), occupational health physicians (OPs) and social insurance physicians (SIPs). A dysfunctional relationship among these physicians can impede a patient's ability to return to work. The objective of this study was to identify ways to improve these physicians' mutual collaboration. METHODS: Two consensus techniques were successively performed among the three professional groups. Eight nominal groups (NGs) gathered 74 field practitioners, and a two-round Delphi process involved 32 stakeholders. RESULTS: From the results, it appears that two areas (reciprocal knowledge and evolution of the legal and regulatory framework) are objects of consensus among the three medical group that were surveyed. Information transfer, particularly electronic transfer, was stressed as an important way to improve. The consensual proposals regarding interdisciplinary collaboration indicate specific and practical changes to be implemented when professionals are managing workers who are on sick leave. The collaboration process appeared to be currently more problematic, but the participants correctly identified the need for common training. CONCLUSIONS: The three physician groups all agree regarding several inter-physician collaboration proposals. The study also revealed a latent conflict situation among the analysed professionals that can arise from a lack of mutual recognition. Practical changes or improvements must be included in an extended framework that involves the different determinants of interdisciplinary collaboration that are shown by theoretical models. Collaboration is a product of the actions and behaviours of various partners, which requires reciprocal knowledge and trust; collaboration also implies political and economic structures that are led by public health authorities.

Return to Work after a Work Accident: Is Coordination between the Occupational Physician and the Insurance Physician Possible? / Retour à l'emploi après un accident de travail : une coordination entre médecin du travail et médecin-conseil d'assurance est-elle possible ?

Occupational physicians and insurance physicians each have their own roles in managing the consequences of work accidents and their interaction is pivotal in the administrative and clinical process of return to work. We wanted to analyse the barriers and facilitators of this collaboration in Belgium.A qualitative study was conducted based on individual interviews of a sample of insurance physicians and occupational physicians working in French-speaking Belgium. This sample was selected to represent all insurance companies and most prevention and protection services operating on the territory. The interview scheme was designed to explore the various dimensions of the RDIC model (Resource Dependence Institutional Collaboration) of collaboration between professionals.This study highlighted certain obstacles to collaboration, related to the mutual perception of the 2 professions, ignorance of the other profession's work context, lack of independent resources blocking the willingness to cooperate (sufficient time, fees). Some facilitating factors were also identified : occupational physicians' willingness to cooperate, a positive attitude towards the ability to cooperate, as well as proposals for immediate improvement of some factors. Collaboration between these 2 professions has rarely been studied and the results of the present study provide tracks for improvement that can be applied in the short or medium term to enable those two categories of physicians to be better organized and more efficient in managing disability consequences of work accidents.

What factors determine Belgian general practitioners' approaches to detecting and managing substance abuse? A qualitative study based on the I-Change Model.

BACKGROUND: General practitioners (GPs) are considered to play a major role in detecting and managing substance abuse. However, little is known about how or why they decide to manage it. This study investigated the factors that influence GP behaviours with regard to the abuse of alcohol, illegal drugs, hypnotics, and tranquilisers among working Belgians. METHODS: Twenty Belgian GPs were interviewed. De Vries' Integrated Change Model was used to guide the interviews and qualitative data analyses. RESULTS: GPs perceived higher levels of substance abuse in urban locations and among lower socioeconomic groups. Guidelines, if they existed, were primarily used in Flanders. Specific training was unevenly applied but considered useful. GPs who accepted abuse management cited strong interpersonal skills and available multidisciplinary networks as facilitators.GPs relied on their clinical common sense to detect abuse or initiate management. Specific patients' situations and their social, psychological, or professional dysfunctions were cited as cues to action.GPs were strongly influenced by their personal representations of abuse, which included the balance between their professional responsibilities toward their patients and the patients' responsibilities in managing their own health as well the GPs' abilities to cope with unsatisfying patient outcomes without reaching professional exhaustion. GPs perceived substance abuse along a continuum ranging from a chronic disease (whose management was part of their responsibility) to a moral failing of untrustworthy people. Alcohol and cannabis were more socially acceptable than other drugs. Personal experiences of emotional burdens (including those regarding substance abuse) increased feelings of empathy or rejection toward patients.Multidisciplinary practices and professional experiences were cited as important factors with regard to engaging GPs in substance abuse management. Time constraints and personal investments were cited as important barriers.Satisfaction with treatment was rare. CONCLUSIONS: Motivational factors, including subjective beliefs not supported by the literature, were central in deciding whether to manage cases of substance abuse. A lack of theoretical knowledge and training were secondary to personal attitudes and motivation. Personal development, emotional health, self-awareness, and self-care should be taught to and fostered among GPs to help them maintain a patient-centred focus. Health authorities should support collaborative care.

Work ability assessment in a worker population: comparison and determinants of Work Ability Index and Work Ability score.

BACKGROUND: Public authorities in European countries are paying increasing attention to the promotion of work ability throughout working life and the best method to monitor work ability in populations of workers is becoming a significant question. The present study aims to compare the assessment of work ability based on the use of the Work Ability Index (WAI), a 7-item questionnaire, with another one based on the use of WAI's first item, which consists in the worker's self-assessment of his/her current work ability level as opposed to his/her lifetime best, this single question being termed "Work Ability score" (WAS). METHODS: Using a database created by an occupational health service, the study intends to answer the following questions: could the assessment of work ability be based on a single-item measure and which are the variables significantly associated with self-reported work ability among those systematically recorded by the occupational physician during health examinations? A logistic regression model was used in order to estimate the probability of observing "poor" or "moderate" WAI levels depending on age, gender, body mass index, smoking status, position held, firm size and diseases reported by the worker in a population of workers aged 40 to 65 and examined between January 2006 and June 2010 (n=12389). RESULTS: The convergent validity between WAS and WAI was statistically significant (rs=0.63). In the multivariable model, age (p<0.001), reported diseases (OR=1.13, 95%CI [1.11-1.15]) and holding a position mostly characterized by physical activity (OR=1.67, 95%CI [1.49-1.87]) increased the probability of reporting moderate or poor work ability. A work position characterized by the predominance of mental activity (OR=0.71, 95%CI [0.61-0.84]) had a favourable impact on work ability. These relations were observed regardless of the work ability measurement tool used. CONCLUSION: The convergent validity and the similarity in results between WAI and WAS observed in a large population of employed workers should thus foster the use of WAS for systematic screening of work ability. Ageing, overweight, decline in health status, holding a mostly physical job and working in a large-sized firm increase the risk of presenting moderate or poor work ability.

Workers' perception of chemical risks: a focus group study.

Workers' perceptions with respect to health and safety at work are rarely taken into account when considering the development of prevention programs. The aim of this study was to explore workers' perceptions of chemical risks at the workplace, in order to investigate the prerequisites for a workplace health program. A qualitative study was conducted involving seven focus groups of 5-10 participants (blue-collar workers) each. All groups were homogeneous in terms of sex, work status, language, and company membership. Results showed that several factors have an important influence on workers' perception of chemical risks. Workers assess risks by means of both sensory and empirical diagnosis and are concerned about the long-term health consequences. They perceive the threat of chemical risks as high. Despite this, they are resigned to accepting the risks. Existing formal sources of information are rarely consulted because they are judged to be difficult to understand and not user friendly. Instead, workers tend to obtain information from informal sources. Communication problems with and lack of trust in prevention advisers and hierarchy are frequently mentioned. Workers feel that their specific knowledge of their working conditions and their proposals for practical, cost-effective solutions to improve health and safety at the workplace are insufficiently taken into account. The use of focus groups yielded a useful insight into workers' perceptions of chemical risks. Our findings suggest that training programs for prevention advisers should include topics such as understanding of workers' perceptions, usefulness of a participatory approach, and communication and education skills.

Physical characteristics of the back are not predictive of low back pain in healthy workers: a prospective study.

BACKGROUND: In the working population, back disorders are an important reason for sick leave and permanent work inability. In the context of fitting the job to the worker, one of the primary tasks of the occupational health physician is to evaluate the balance between work-related and individual variables. Since this evaluation of work capacity often consists of a physical examination of the back, the objective of this study was to investigate whether a physical examination of the low back, which is routinely performed in occupational medicine, predicts the development of low back pain (LBP). METHODS: This study is part of the Belgian Low Back Cohort (BelCoBack) Study, a prospective study to identify risk factors for the development of low back disorders in occupational settings. The study population for this paper were 692 young healthcare or distribution workers (mean age of 26 years) with no or limited back antecedents in the year before inclusion. At baseline, these workers underwent a standardised physical examination of the low back. One year later, they completed a questionnaire on the occurrence of LBP and some of its characteristics. To study the respective role of predictors at baseline on the occurrence of LBP, we opted for Cox regression with a constant risk period. Analyses were performed separately for workers without any back antecedents in the year before inclusion ('asymptomatic' workers) and for workers with limited back antecedents in the year before inclusion ('mildly symptomatic' workers). RESULTS: In the group of 'asymptomatic' workers, obese workers showed a more than twofold-increased risk on the development of LBP as compared to non-obese colleagues (RR 2.57, 95%CI: 1.09 - 6.09). In the group of 'mildly symptomatic' workers, the self-reports of pain before the examination turned out to be most predictive (RR 3.89, 95%CI: 1.20 - 12.64). CONCLUSION: This study showed that, in a population of young workers wh no or limited antecedents of LBP at baseline, physical examinations, as routinely assessed in occupational medicine, are not useful to predict workers at risk for the development of back disorders one year later.

[Workplace health promotion: models and practice]. / Promotion de la santé en milieu de travail: modèles et pratiques.

Acknowledging the synergies between occupational health and safety and health promotion, this paper aims to analyze the interactions between these two fields and their possible integration. It looks at the different health promotion concepts used in occupational health: creation of health-promoting settings, participation and community action, education and development of personal skills, re-orientating public policies, and inter-sectoral collaboration. Four models of action are defined and their characteristics are explored: occupational health and safety; use of health promotion principles, strategies and techniques for occupational health and safety management; general health education actions at the workplace, and integrated approaches (or settings-based ecological approaches).

[Long-term absenteeism due to lower back pain: the case of health care professionals in the hospital sector]. / Les absences de longue durée pour lombalgie au sein du personnel soignant dans le secteur hospitalier.

Following the launch and implementation of a national program for the prevention of chronic low back pain for nursing staff in hospitals in Belgium, two studies were conducted to precisely assess the incidence of long-term sick leave (28 days or more) among this category of workers in this regard. The first was centred on the administrative level and was carried out through a questionnaire survey in 2005 among the 650 members of the nursing staff at the university hospital in Liege. A second study was carried out involving 4 large hospitals: 3 in the French-speaking region of Belgium, and one in the Dutch-speaking region. The workers' medical files were screened to identify those who had undergone a "return to work (RTW) examination" between Jan 1st 2003 and Dec 31st 2004. The medical diagnosis at the origin of the sick leave was searched in order to assess the number of low back pain induced sick leaves among nurses. In the first survey, 1.95% of nursing staff have reported a work absence of 28 days or more due to low back pain over a 12 months period. The second study, based on the prolonged sick leaves registered in the nurses' medical files, showed that the prevalence of a 28 days or more sick leave due to back pain varied between 5.1 and 7.6 work absences per year and per 1000 nurses at work. These prevalence figures indicate that in each health care institution the target group for the prevention programme intended for nursing staff would rarely exceed 10 people per year; this may have important implications for the actual implementation of this programme.

Perceptions and types of support coming from families caring for patients suffering from advanced illness in Kinshasa, Democratic Republic of Congo.

BACKGROUND: Perceptions of families who take care of patients suffering from advanced illness are rarely considered in Kinshasa medical practices; nevertheless, these families are the main actors involved in such care. The objective of this present study was to illustrate, in a Congolese context, the perceptions of families on the care of patients suffering from advanced illness, and to identify the possible aids provided by healthcare facilities. METHODS: A qualitative study was performed among focus groups in six hospitals in Kinshasa. Each group included eight members. RESULTS: We gathered factors that could negatively influence the care of a patient suffering from advanced disease. Such factors included: scarcity of and inaccessibility to painkillers, economic resilience, poor quality treatment, lack of psychological counselling, seeking alternative solutions and poor communication between caregivers and patients. In contrast, the study also showed that relatives caring for these patients often receive support from the wider family and from cult members. CONCLUSIONS: This study focuses on the miscommunication between healthcare workers and patients, poor management in advanced illness as well as a lack of psychological support from caregivers. The findings can serve as basis for further research in palliative care.

Chronic illness needing palliative care in Kinshasa hospitals, Democratic Republic of the Congo (DRC).

BACKGROUND: Chronic illnesses are a major public health problem in low-income countries. In the Democratic Republic of the Congo (DRC), few data are available, especially in palliative care. In this context, the present study aimed at describing the patterns of diseases in Kinshasa hospitals as well as risk factors associated with patients' evolving status and length of hospital stay. METHODS: A prospective study was conducted in ten hospitals of Kinshasa, over a 1-year period. A total of 2699 patients with a chronic condition (non-communicable diseases (NCD) and/or AIDS) were consecutively enrolled in the study between January and December, 2013. RESULTS: Out of 2699 patients studied, 36.9% were suffering from cardiovascular diseases, 29.7% from comorbidity and 17.5% from AIDS. 27.5% of patients died while hospitalized, and 67.4% were lost to follow-up. The risk factors independently associated with death in hospitals were AIDS (adjusted OR = 2.2) and age over 65 years old (adjusted OR = 1.7). Peri-urban and rural areas were significantly associated with a mean adjusted hospital stay longer than 3 days. The length of stay (LOS) was shorter for women and patients living in urban areas. Patients survived for a median of 10 days (range 7-20 days). CONCLUSIONS: This study reveals the high proportion of patients suffering from advanced chronic diseases, including cardiovascular diseases, AIDS and comorbidity. It demonstrates the need for palliative care (PC) in medical practices in Kinshasa, the capital of the Democratic Republic of the Congo.

French good practice guidelines for management of the risk of low back pain among workers exposed to manual material handling: Hierarchical strategy of risk assessment of work situations.

BACKGROUND: Manual material handling remains a major cause of occupational accidents and diseases in various sectors and occupations. OBJECTIVE: This paper summarizes the main recommendations of the good practice guidelines of the French Society of Occupational Medicine for the risk assessment for back disorders in workers exposed to manual handling of loads. METHODS: The guidelines were written by a multidisciplinary working group of 24 experts, according to the Clinical Practice Guidelines method proposed by French National Health Authority, and reviewed by a multidisciplinary peer review committee of 50 experts. Recommendations were based on a large systematic review of the international literature carried out from 1990 to March 2012 and classified (Grade A, B, C or expert consensus) according to their level of evidence. RESULTS: The main recommendations are a three-level hierarchical method of risk assessment based on participatory ergonomics and suggested assessment tools that can be used routinely by professionals of occupational health, workers themselves and their supervisors. CONCLUSION: These French guidelines are intended for professionals of occupational health in charge of the prevention of low back disorders. The recommended methods are applicable to other countries than France.

Occupational Stress among Textile Workers in the Democratic Republic of Congo.

CONTEXT: In the Democratic Republic of Congo (DRC), scientific studies on occupational health are scarce. The present study aims at estimating the level of occupational stress, as well as associated factors, in a textile company. METHODS: We performed a cross-sectional survey among textile workers in DRC. Data (N = 192 subjects) were collected through a self-questionnaire validated for the assessment of stress (Karasek and Siegrist's scale); supplemented by a medical examination. Frequencies and odds ratios (ORs) were estimated for descriptive analyses. Adjusted ORs were calculated through a logistic regression model to investigate associations between socio-demographic and organisational variables and stress. RESULTS: Our study highlighted a high level of stress among individuals: 28% of them were suffering from stress, according to Karasek, and 22%, when applying Siegrist's model. A 14%-isostrain was calculated when considering all workers. A statistically significant association was observed between stress and age, seniority and perceived non-adaptation to work, considering both approaches. Furthermore, when job strain was determined according to Karasek, it was related to the worker status, the poor perception of organisation and alcohol consumption, while stress estimated by applying Siegrist's model showed an association with education level and the occurrence of cardiac symptoms. CONCLUSION: The present study provides of stress among individuals through both models. Several socio-professional factors are associated with stress, which determines populations at risk. The results revealed that both stress models offer complementary information, thus increasing the probability to model workers' health more exactly and to make recommendations on prevention and management.

French good practice guidelines for medical and occupational surveillance of the low back pain risk among workers exposed to manual handling of loads.

Several clinical practice guidelines related to the assessment and management of low back pain (LBP) have been published with varied scopes and methods. This paper summarises the first French occupational guidelines for management of work-related LBP (October 2013). There main originality is to treat all the three stages of primary, secondary and tertiary prevention of work-related LBP. The guidelines were written by a multidisciplinary working group of 24 experts, according to the Clinical Practice Guidelines method proposed by French National Health Authority, and reviewed by a multidisciplinary peer review committee of 50 experts. Recommendations were based on a large systematic review of the literature carried out from 1990 to 2012 and rated as strong (Level A), moderate (B), limited (C) or based on expert consensus (D) according to their level of evidence. It is recommended to deliver reassuring and consistent information concerning LBP prognosis (Level B); to perform a clinical examination looking for medical signs of severity related to LBP (Level A), encourage continuation or resumption of physical activity (Level A), identify any changes in working conditions and evaluate the occupational impact of LBP (Level D). In case of persistent/recurrent LBP, assess prognostic factors likely to influence progression to chronic LBP, prolonged disability and delayed return to work (Level A). In case of prolonged/repeated sick leave, evaluate the pain, functional disability and their impact and main risk factors for prolonged work disability (Level A), promote return to work measures and inter professional coordination (Level D). These good practice guidelines are primarily intended for professionals of occupational health but also for treating physicians and paramedical personnel participating in the management of LBP, workers and employers.

The Approach Taken to Substance Abuse by Occupational Physicians: A Qualitative Study on Influencing Factors.

OBJECTIVE: Aiming to enhance occupational physicians' (OPs) practice when dealing with employee substance abuse, this study analyzes the experiences of OPs to gain insight into the factors influencing their behavior. METHODS: Semi-structured interviews were conducted and analyzed using Interpretative Phenomenological Analysis. RESULTS: OPs act differently depending on the type of drug. Their approach was mainly determined by contextual factors and by their attitudes and skills. Many OPs want to invest in health promotion. Barriers such as lack of time and focus on periodic examinations often hamper both adequate prevention and the management of workers with substance abuse. CONCLUSIONS: The approach to substance abuse by OPs could be supported by initiatives both at the individual and the collective level. A facilitating work context seems to be particularly important in their commitment to alcohol- and drug-related issues at work.

Characteristics of adolescent attempts to manage overweight.

This study evaluates the actions taken by obese adolescents in an attempt to lose weight in relation to changes in weight. Particular emphasis is put on the context surrounding the management process. Thirty one obese adolescents aged 14-18 participated in this study. The adolescents answered a written questionnaire, took a body-size dissatisfaction test and were interviewed. Their family physicians were interviewed by telephone. Quantitative data concerned changes in weight and body-size dissatisfaction scores. Qualitative analysis included cases analyses and building up of synthesis variables. Loss of weight is linked with continuity of management attempts as well as with medical follow-up. The most frequent management attempt is diet. Self-image is correlated with weight. The exclusive emphasis put on diet is discussed in relation to the importance of more psychosocial factors such as self-image, denial and attraction to discontinuity. Some recommendations for the management of overweight adolescents are then outlined.

Pain-related fear predicts disability, but not pain severity: a path analytic approach of the fear-avoidance model.

Two studies are reported that tested the fear-avoidance (FA) model using path analytic techniques. In study 1, 429 employees with back pain at baseline and back pain at 18 months follow-up completed questionnaires assessing sociodemographic information, pain severity, negative affect, pain-related fear, and disability. Results indicated that pain severity at baseline predicted pain-related fear and disability at follow-up, and that pain-related fear is rather a consequence than an antecedent of pain severity. Results further revealed that the disposition to experience negative affect has a low impact upon pain severity and disability, and is best viewed as a precursor of pain-related fear. Study 2 included 238 employees without back pain at baseline, but who developed back pain at 1 year follow-up. A similar model as in study 1 was tested. Overall, results are in line with those of study 1. Results are discussed in terms of theoretical relevance and clinical implications.

Validation of a self-administered questionnaire for assessing exposure to back pain mechanical risk factors.

OBJECTIVE: To validate a self-administered questionnaire assessing exposure to mechanical risk factors, developed for a cohort study aiming at assessing the influence of physical and psycho-social factors on the incidence of low back pain (LBP). METHODS: The study first involved a criterion validity test. A sample of the cohort workers (n=152) was observed at the workplace during four 30 min periods randomly distributed along the shift. At the end of the work shift, the questionnaire was filled in both by the worker and the observer. Agreements were tested between self-reports and observations, and between self-reports and observer opinion. Secondly, a comparison of exposure-effect relationships based on self-reports to those based on observations was carried out on the whole study cohort (n=716). Both sets of Relative Risks of being an incident case (LBP lasting at least 7 consecutive days in the follow-up year) were tested for heterogeneity. RESULTS: Self-reports agreement levels were better with observer opinion than with observational data and were higher for answers at a dichotomous level. Vehicle driving, manual handling without estimation of weight and frequencies, or trunk bending without rotation showed a fair to good agreement with the external criteria. Limits in the validation procedure did not allow validating the sitting and standing durations. As regards the health outcome comparison, questionnaire and observations led to homogeneous Relative Risks for the variables tested. CONCLUSIONS: Results show that self-reports provide a limited accuracy to assess actual frequencies and durations of work activities. Using a questionnaire, classifying the workers into exposure categories is rather relative, but questionnaire and observations seem similar in their relationships to outcome.