Return to work with chronic low back pain: using an evidence-based approach along with the occupational therapy framework

This paper will attempt to apply the occupational therapy framework [1] along with an evidence-based approach and an occupation-based intervention with a population of workers with chronic low back pain (CLBP) to help them return to work and maintain their work status. This paper will focus primarily on those clients with CLBP who still have a link to their employment but who do not perceive themselves as being capable to go back to their job despite conflicting opinions from other stakeholders (primary health care professionals, employer or insurer). They are being evaluated in occupational therapy shortly before return to work and followed until their optimal functional capacities are reached. This means that either all functional goals related to the actual physical demands of their job have been reached or that further treatment does not result in functional improvement.     

Factors contributing to work related low back pain among personal care workers in old age

This study aims to preliminary explore the work related and individual factors that contributed to the occurrence of low back pain (LBP) that affected work activities of Personal Care Workers (PCWs). A cross-sectional study was conducted to 36 PCWs in an old age home of Hong Kong. The study is divided into three parts: 1) a questionnaire to document the workload exposure factors and the musculoskeletal symptoms survey of the PCWs, 2) work posture evaluation; and 3) an evaluation of the physical fitness and lifting capacity of the PCWs. Univariate analyses were used to explore the risk factors associated with LBP that affected work activities. The results indicated that individual physical profile and lifting capacities did not contribute to occurrence of low back pain at work. For the work demand factors, the perceived physical demands in lifting and lowering heavy objects, awkward sustain neck and back postures, loading on the back, and perceived effort of cleaning task contributed to the occurrence of LBP. For the physical environment factors, thermal stress and improper ventilation were associated with the occurrence of LBP cases. For the individual factor, LBP cases were associated with workers' self perceived muscular effort, and perceived risk of mental illness in response to work requirements.     

The costs of job accommodations for employees with low back pain

Accommodations are interventions designed to reduce exposure to factors that limit the activities of an impaired individual. The process incurs costs due to job analysis, implementation and follow up. This theoretical paper expands a model of the ergonomic intervention process and provides data on costs of accommodating individuals with musculoskeletal disorders, particularly low back pain. Accommodations begin with evaluation and documentation of exposure to risk factors. The methods depend on the budget and clinical utility of the data. A full hazard analysis may require 1-hour managerial time plus 1-hour employee time per job. Studies by the Department of Labor and others indicate that at least a quarter of problem jobs could be addressed faster and for less than US dollars 500. Follow-up incurs variable employee and managerial time; an ergonomist may be required in 15% of cases. The benefit is expected mainly from reducing compensation costs. Universal solutions could increase the benefits.     

Outcome of an interdisciplinary pain management program in a rehabilitation clinic

The Chronic Pain Section at Reykjalundur has 33 beds for patients with various chronic pain problems. About 200 patients are treated annually. For 3 years, 158 patients were enrolled in a random study focusing on increasing the patients' functioning and eliminating analgesic drugs through an interdisciplinary rehabilitation program. Patients answered a questionnaire at admission, before discharge from the clinic and about one year after discharge. The follow-up was done with a mailed questionnaire. The focus was on the patients' functioning rather than absence of pain. The program's duration was 7 weeks. The first 2 weeks were utilized for evaluation, information and education (pain school). Pain relieving drugs were gradually withdrawn but anti-inflammatory drugs were used when indicated. Cognitive behavioral therapy was applied in an increasing number of cases over the 3 year period by specially trained nurses and a psychiatrist. Pain, anxiety and depression were self-evaluated on a numeric rating scale (NRS). About 50% of the patients had a history of pain for more than 5 years. Low back pain was the most common diagnosis (48.1%) and 28.5% had post-traumatic pain. A significant reduction in pain, anxiety and depression was found both at discharge (p < 0.0001) and at follow-up (p < 0.001). Before entering the program, only 18.4% of the patients were able to work whereas 48.1% returned to work after discharge and 59.2% were working at follow-up.     

Work rehabilitation for migrant workers with work injury--the magic of Chinese paper cutting

As China has gradually transformed from agricultural economy into industrial economy since 1978, occupational injuries and diseases become a serious social problem in China. For occupational rehabilitation professionals, helping workers with occupational injuries and diseases, return to work and re-integrate to community are the ultimate goals of occupational rehabilitation. This article reports a new indigenous initiative with cultural notions in occupational rehabilitation piloted by Guangdong Provincial Rehabilitation Center. Case studies reflected that by learning and practicing traditional Chinese paper cutting, workers with occupational injury and disease could regain their self confidence, identity their strengths, learn more vocational skills as well as to re-integrate into community.     

A return to work program for injured workers: a reassignment model

The current workers' compensation system does not encourage permanently restricted workers who are disabled due to work related injuries to return to work. Workers are often labeled permanently disabled and are released from their positions with their employers. However, according to the Americans with Disabilities Act of 1990, these individuals may be qualified to return to productive employment. This paper will describe a Reassignment Model for occupational therapy supported by the rehabilitation frame of reference. This Model presents reassignment to a vacant position as a reasonable accommodation to return injured workers to productive employment. A case study will illustrate the successful implementation of the model. The potential benefits of using this Model will be described for clients, society, employers, and the occupational therapy profession.     

A comprehensive work injury prevention program with clerical and office workers: Phase II

Sixteen full-time clerical and office workers participated in this prospective parallel-randomized trial. Intervention consisted of four hours of individualized training through a multi-faceted injury prevention program. In Phase I, musculoskeletal symptoms, stress, and energy levels were measured before and after intervention. Differences between Group A (intervention) and Group B (control) were described; pre to post differences between members within each group were also described. In Phase II, there were a greater number of statistically and clinically relevant differences within Group A at week 16 (eleven weeks following intervention) than at week five (immediately post-intervention). The eyes, neck, shoulder, elbow-forearm, and wrist-hand were impacted most positively by intervention, however, the frequency and intensity of headaches increased. Stress and energy level differences were minimal. Group B workers received intervention during weeks 18-21. Differences in average measures from pre to immediately post-intervention were greater within Group B than Group A. Both groups reported fewer sick days during the month of intervention than during pre and post-intervention months.     

A comprehensive work injury prevention program with clerical and office workers: phase I

The risk for the development of musculoskeletal disorders and associated conditions in clerical and office workers is well documented. The majority of work injury prevention programs for this population were single-faceted (education, workstation redesign, or task modification) and yielded both positive and negative findings. This pilot study was conducted with 16 full-time clerical and office workers at a small private college. In a randomized control trial, the intervention group received four hours of individualized training through a multi-faceted injury prevention program. Between group differences in musculoskeletal symptom frequency and intensity and perceived stress and energy levels existed, although were statistically insignificant. There was a statistically significant decrease in Lower Back ache/pain from pre to post measures for the intervention group.     

Work injury rehabilitation and the tendency to return to work of workers with injuries in Mainland China

This paper aims to describe the current situation of the work injury rehabilitation system in China with its drawbacks, especially relating to the employment services for workers with injuries and bringing up the topic of the need for more work to attempt to construct a modern work injury occupational rehabilitation system: perfecting the administration mechanism of policy, establishing an occupational rehabilitation pattern with Chinese characteristics, establishing the socialization service network as the core of occupational rehabilitation and establishing a practical professional team and academic communication platform. These creative thoughts may shed light on the development of the work injury rehabilitation system as well as the return to work for workers with injuries in China.     

Risk factors for attrition from an evidence-based parenting program: Findings from the Netherlands

Parent management training programs for the treatment of childhood conduct problems are increasingly being transported from their country of origin to international settings. Family interactions, however, may be influenced by different cultural expectations and children's mental health problems may be addressed within different systems. Demonstrating reductions in symptoms within the new population is insufficient to support the wide-scale transport of a treatment model. Implementation outcomes such as the rates of treatment retention and factors related to treatment attrition must also be considered. We explored predictors of attrition in families from the Netherlands referred to the evidence-based parenting program Parent–Child Interaction Therapy (PCIT). Participants included 40 children with conduct problems (2–7 years; 68% boys) and their caregivers. Attrition (40%) was somewhat lower than findings with similar community samples in the US. Significant predictors of attrition were child age and maternal levels of internalizing symptoms. Low parental demandingness and high child compliance before start of treatment were related to early attrition within twelve treatment sessions. Meeting the needs of families at risk for attrition is an important goal for parent management training programs within and outside the US if families in need of services are to benefit from them.     

A comparison of self-perceived physical and psycho-social worker profiles of people with direct work injury, chronic low back pain, and cumulative trauma

This study investigated the psycho-social factors among injured workers and the influence of their psycho-social profile on the readiness of return to work. Sixty-four subjects with injuries on the upper limbs or lower limbs, low back pain, or cumulative trauma disorder were recruited. The workers' profiles (self-perceived physical health, mental health, and work readiness) together with the impact and types of work injury on the workers' perceived wellness were measured. The regression model of work readiness was constructed to develop a theoretical background for predicting work readiness based on different factors. The results showed that injured workers with chronic injury such as low back pain or cumulative trauma had poorer self-perception of physical health and psycho-social/mental health compared to those with direct trauma. The regression analysis further affirmed that self-perceived pain and physical functioning were significant factors influencing the readiness for returning to work. Workers with low back pain were found to have lower motivation for returning to work. Other factors such as the non-verbal intelligence of the injured workers, their anxiety level, and the support they received from family members were found to have some indirect impact on their ability to return to work, but this was not statistically proven.     

Participatory ergonomic intervention for prevention of low back pain: assembly line redesign case

This paper gives an overview of a participatory ergonomic intervention aimed at reducing low back pain cases in the dispatch department of a catalogue and e-commerce retail company. Based on the findings of the ergonomic analysis and design committee, the company's own employees redesigned the assembly line's layout. As a result of these changes two job tasks that involved manual material handling of boxes, identified by the revised NIOSH equation as posing an increased risk for lifting-related low back pain, were totally eliminated, and the employees responsible for moving boxes from the end of the assembly line to pallets on the ground were given more control over their jobs, and these jobs were also enriched with a new, less heavy task. These results demonstrate that participatory ergonomic interventions are a viable and effective strategy to reduce the exposure to work-related physical and psychosocial risk factors for low back pain.     

Examining the need for cultural adaptations to an evidence-based parent training program targeting the prevention of child maltreatment

Evidence-based behavioral parent training programs (BPTs) have been recommended as a primary prevention strategy for child maltreatment, and use of BPTs is increasing. As these programs are implemented in new contexts and among new populations, the cultural relevance of these programs and need for adaptations or modifications must be considered. The purpose of this study was to assess the types of cultural adaptations that are being made to a widely implemented BPT, SafeCare, by providers working with families involved in the child welfare system, and to explore the need for more systematic adaptations. Eleven SafeCare providers, from six states, participated in individual, semi-structured interviews. Overall, the providers did not recommend systematic adaptations of the model for specific ethnic groups. However, they provided general and specific information regarding SafeCare components that require adaptation on a case-by-case basis, which is likely to be applicable to many BPTs. More research is needed to develop clear guidance about when and how to assess the need for cultural adaptations and how to institute adaptations that improve rather than weaken evidence-based programs. By sharing data and experiences, purveyors can contribute to the body of knowledge about adaptation.     

Interdisciplinary staff perceptions of an occupational therapy return to work program for people living with AIDS

The purpose of this qualitative study was to identify the perception of interdisciplinary staff members regarding the impact of a model work and independent living oriented program for residents in supportive living facilities. This study used focus groups and individual interviews to collect these perceptions. Staff members identified four areas of impact: utilization of a holistic and process-oriented approach, an ability to identify and work with the strengths of clients, emphasis on the learning of practical skills, and creating an intersection for all aspects of services. These findings point to the fact that staff members found the value that occupational therapy has to offer their overall programming by improving participation of clients with HIV in learning practical skills for use in their daily lives and in developing work related skills.     

Evaluation of a personal device in reducing the risk of low back disorders during stooped work

Adoption of the stooped posture in the workplace is widespread throughout the world in agriculture, construction, and mining. This type of posture has been established as a risk factor for developing low back disorders (LBDs). The purpose of this study is to evaluate a personal weight transfer device as a possible intervention to reduce the load on the lumbar spine, thereby reducing the risk of developing LBDs. Eighteen healthy subjects performed stooped posture tasks in a laboratory study designed to simulate harvesting of low-growing crops. Results showed that when wearing the device in the static stooped posture, biceps femoris activity was reduced by 17%, lumbar flexion was reduced by 12%, ankle plantar-flexion increased by 5%, and the lumbar erector spinae of those subjects who did not experience flexion-relaxation of the erector spinae was reduced by 26%. Hip and knee flexion were not significantly altered. Therefore, the device may be beneficial for those with existing LBDs, and who use the stooped posture routinely.