Lighten the Load, workshop return-to-workDr. Birgitte M. Blatter

Work related interventions improving return-to-work of workers with MSDs and some Dutch examples

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Work related interventions improving return-to-work of workers with MSDs and some Dutch examples

Content

• Work-related musculoskeletal disorders: Back to work report (Topic Centre Working Environment: Agency,

HSL, TNO, Prevent, Eurogip, FIOH)

• Examples from Netherlands: ongoing projects of• an insurance company

• a rehabilitation center

• an occupational health service

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Work-related musculoskeletal disorders: Back to work report

• Evaluate the effectiveness of interventions in the workplace

• Scientific literature

• Back pain / upper limb pain / lower limb pain

• (Policy initiatives)

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Work-related musculoskeletal disorders: Back to work report: Back pain

• Modified work

• Lumbar supports

• Exercise therapy

• Back schools

• Behavioural treatment

• Multidisciplinary approach

• Acute /sub-acute / chronic back pain

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Therapy Acute LBP(<4/6 wks)

Subacute LBP(4/6-12 wks)

Chronic LBP(>12 wks)

Modified work+reduction of time of work, if

embedded in good occupational management

+reduction of time of work, if

embedded in good occupational management

no studies /inconclusive

Lumbar supports +no effect

+no effect

+no effect

Exercise therapy in general

++no effect

+/-absenteeism

++slightly effective in pain

reduction and function improvement

Back schools no studies /inconclusive no studies /inconclusive +pain and functional status

Behavioural treatment no studies /inconclusive no studies /inconclusive ++moderate effect on pain,

small effect on functional status

Multidisciplinary rehabilitation

no studies /inconclusive +return to work, subjective

disability and functional status

++Intensive (>100 hrs) therapy

improves function and pain

++ = high quality evidence + = moderate quality evidence

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Work-related musculoskeletal disorders: Back to work report: Neck and upper limb pain

• Technical / mechanical interventions

• Psychosocial interventions

• Exercise therapy

• Multidisciplinary approach

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Therapy Neck and upper limb pain

Technical/mechanical +/- some might be effective

Psychosocial no studies /inconclusive

Exercise therapy +/-effective

Multidisciplinary treatment

+/- results on effectiveness are promising

++ = high quality evidence + = moderate quality evidence +/- = limited evidence

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Work-related musculoskeletal disorders: Back to work report: Lower limb pain

• No literature

• Non-occupational interventions

• General population

• Exercise therapy

• Other (magnetic bracelets, thermotherapy, ultrasound)

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Therapy Lower limb pain

Exercise++effect on clinical outcomes, less pain

Other no studies / inconclusive

++ = high quality evidence + = moderate quality evidence - = no studies or inconclusive results

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Work-related musculoskeletal disorders: Back to work report: Conclusions

• Multidisciplinary approach seems promising (low back and neck and upper limb)

• Scientific evidence limited regarding neck and upper limb pain and no evidence regarding lower limb pain

• Evaluation of workplace interventions should probably adopt different criteria than evaluation of medical treatment

• Policy makers and employers should not be discouraged from taking action because there is no 100% proof it works

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Work-related musculoskeletal disorders: Examples from the Netherlands

Examples from Netherlands: ongoing projects of

• an insurance company that refers self employed persons with MSDs to physical training a

• a rehabilitation center that developed a website

• an occupational health service that started with implementing the Sherbrooke model (participative approach to implement work adaptations)

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Work-related musculoskeletal disorders: Physical training for insurance company

Fysioké project

• Aim: evaluate the effectiveness of physical training in self-employed

• Intervention: • tailor-made fitness training (cardiovascular, strengthening,

relaxation)

• cognitive behavioural component

• training of work tasks (only in South)

• Methods: randomized controlled trial, inclusion via claim evaluators at the insurance company, North and South

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Work-related musculoskeletal disorders: Physical training for insurance company

Results:

Physical training (n=51 / n=75)

Usual care (n=49 / n=75)

P value(* < 0,05)

disability (days)1: median North 181 154 0.02 *

disability (days)1: median South 148 140 0.24

recovery of symptoms: % yes North 52 24 0.02 *

recovery of symptoms: % yes South 45 36 0.51

pain level T1-T0: mean North -1.4 0.3 0.01 *

pain level T1-T0: mean South -0.9 -0.1 0.09

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200150100500

Total days of disability after 6 months

1,0

0,8

0,6

0,4

0,2

0,0

Cu

m S

urv

ival Censored data

Censored data

Usual care

Physical training

North

P-value logrank test = 0,02

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200150100500

Total days of disability after 6 months

1,0

0,8

0,6

0,4

0,2

0,0

Cu

m S

urv

ival Censored

Censored

Usual care

Physical training

South

P-value logrank test = 0,70

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Work-related musculoskeletal disorders: rehabilitation center

www.snelbeter.nl project

• Aim: develop website for workers with neck and back pain and their OHPs and evaluate the effectiveness

• Intervention = website• Checklists/questionnaires

• Exercises

• Diary

• Information to reassure worker

• Feedback to OHP

• Methods: RCT, sickness absence, consultation with OHP, inclusion via 80 OHPs

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Work-related musculoskeletal disorders: rehabilitation center

Results:

• Inclusion period was extended drastically

• Amount of OHPs was extended drastically

• Only 23 cases and 23 controls (aim 64 and 64)

• Project stopped !

• Process evaluation• Takes time during consultation / OHPs forget about study ?

• System to include patients not user-friendly?

• Satisfaction about website itself?

• Few workers with sickness absence in a period that long

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Work-related musculoskeletal disorders: occupational health service

Implementation of participative work adaptations:

• Back disorders (general policy)

• Mental disorders (project basis)

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Work-related musculoskeletal disorders: conclusions from the Netherlands

• Legislation and regulations have changed

• Responsibility for costs has shifted from government to employers

• Three examples of how insurers, rehabilitation centers and occupational health services have anticipated on this situation