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. 2004 Apr;61(4):289–294. doi: 10.1136/oem.2002.006460

The effectiveness of ergonomic interventions on return-to-work after low back pain; a prospective two year cohort study in six countries on low back pain patients sicklisted for 3–4 months

J Anema 1, B Cuelenaere 1, A J van der Beek 1, D Knol 1, H C W de Vet 1, W van Mechelen 1
PMCID: PMC1740746  PMID: 15031385

Abstract

Aims: To study occurrence and effectiveness of ergonomic interventions on return-to-work applied for workers with low back pain (LBP).

Methods: A multinational cohort of 1631 workers fully sicklisted 3–4 months due to LBP (ICD-9 codes 721, 722, 724) was recruited from sickness benefit claimants databases in Denmark, Germany, Israel, Sweden, the Netherlands, and the United States. Medical, ergonomic, and other interventions, working status, and return-to-work were measured using questionnaires and interviews at three months, one and two years after the start of sickleave. Main outcome measure was time to return-to-work. Cox's proportional hazards model was used to calculate hazard ratios regarding the time to return-to-work, adjusted for prognostic factors.

Results: Ergonomic interventions varied considerably in occurrence between the national cohorts: 23.4% (mean) of the participants reported adaptation of the workplace, ranging from 15.0% to 30.5%. Adaptation of job tasks and adaptation of working hours was applied for 44.8% (range 41.0–59.2%) and 46.0% (range 19.9–62.9%) of the participants, respectively. Adaptation of the workplace was effective on return-to-work rate with an adjusted hazard ratio (HR) of 1.47 (95% CI 1.25 to 1.72; p < 0.0001). Adaptation of job tasks and adaptation of working hours were effective on return-to-work after a period of more than 200 days of sickleave with an adjusted HR of 1.78 (95% CI 1.42 to 2.23; p < 0.0001) and 1.41 (95% CI 1.13 to 1.76; p = 0.002), respectively.

Conclusions: Results suggest that ergonomic interventions are effective on return-to-work of workers long term sicklisted due to LBP.

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Selected References

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  1. Anema J. R., Van Der Giezen A. M., Buijs P. C., Van Mechelen W. Ineffective disability management by doctors is an obstacle for return-to-work: a cohort study on low back pain patients sicklisted for 3-4 months. Occup Environ Med. 2002 Nov;59(11):729–733. doi: 10.1136/oem.59.11.729. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Beissner K. L., Saunders R. L., McManis B. G. Factors related to successful work hardening outcomes. Phys Ther. 1996 Nov;76(11):1188–1201. doi: 10.1093/ptj/76.11.1188. [DOI] [PubMed] [Google Scholar]
  3. Elders L. A., van der Beek A. J., Burdorf A. Return to work after sickness absence due to back disorders--a systematic review on intervention strategies. Int Arch Occup Environ Health. 2000 Jul;73(5):339–348. doi: 10.1007/s004200000127. [DOI] [PubMed] [Google Scholar]
  4. Fleten N., Johnsen R., Ostrem B. S. Sykmeldte tror tiltak på arbeidsplassen kan redusere sykefravaer. Tidsskr Nor Laegeforen. 1999 Oct 20;119(25):3730–3734. [PubMed] [Google Scholar]
  5. Frank J. W., Brooker A. S., DeMaio S. E., Kerr M. S., Maetzel A., Shannon H. S., Sullivan T. J., Norman R. W., Wells R. P. Disability resulting from occupational low back pain. Part II: What do we know about secondary prevention? A review of the scientific evidence on prevention after disability begins. Spine (Phila Pa 1976) 1996 Dec 15;21(24):2918–2929. doi: 10.1097/00007632-199612150-00025. [DOI] [PubMed] [Google Scholar]
  6. Frymoyer J. W. Predicting disability from low back pain. Clin Orthop Relat Res. 1992 Jun;(279):101–109. [PubMed] [Google Scholar]
  7. Gallagher R. M., Rauh V., Haugh L. D., Milhous R., Callas P. W., Langelier R., McClallen J. M., Frymoyer J. Determinants of return-to-work among low back pain patients. Pain. 1989 Oct;39(1):55–67. doi: 10.1016/0304-3959(89)90175-9. [DOI] [PubMed] [Google Scholar]
  8. Haldorsen E. M., Kronholm K., Skouen J. S., Ursin H. Multimodal cognitive behavioral treatment of patients sicklisted for musculoskeletal pain: a randomized controlled study. Scand J Rheumatol. 1998;27(1):16–25. doi: 10.1080/030097498441128. [DOI] [PubMed] [Google Scholar]
  9. Hansson T. H., Hansson E. K. The effects of common medical interventions on pain, back function, and work resumption in patients with chronic low back pain: A prospective 2-year cohort study in six countries. Spine (Phila Pa 1976) 2000 Dec 1;25(23):3055–3064. doi: 10.1097/00007632-200012010-00013. [DOI] [PubMed] [Google Scholar]
  10. Hazard R. G., Haugh L. D., Reid S., Preble J. B., MacDonald L. Early prediction of chronic disability after occupational low back injury. Spine (Phila Pa 1976) 1996 Apr 15;21(8):945–951. doi: 10.1097/00007632-199604150-00008. [DOI] [PubMed] [Google Scholar]
  11. Hoogendoorn W. E., Bongers P. M., de Vet H. C. W., Ariëns G. A. M., van Mechelen W., Bouter L. M. High physical work load and low job satisfaction increase the risk of sickness absence due to low back pain: results of a prospective cohort study. Occup Environ Med. 2002 May;59(5):323–328. doi: 10.1136/oem.59.5.323. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Infante-Rivard C., Lortie M. Prognostic factors for return to work after a first compensated episode of back pain. Occup Environ Med. 1996 Jul;53(7):488–494. doi: 10.1136/oem.53.7.488. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Loisel P., Abenhaim L., Durand P., Esdaile J. M., Suissa S., Gosselin L., Simard R., Turcotte J., Lemaire J. A population-based, randomized clinical trial on back pain management. Spine (Phila Pa 1976) 1997 Dec 15;22(24):2911–2918. doi: 10.1097/00007632-199712150-00014. [DOI] [PubMed] [Google Scholar]
  14. Rossignol M., Abenhaim L., Séguin P., Neveu A., Collet J. P., Ducruet T., Shapiro S. Coordination of primary health care for back pain. A randomized controlled trial. Spine (Phila Pa 1976) 2000 Jan 15;25(2):251–259. doi: 10.1097/00007632-200001150-00018. [DOI] [PubMed] [Google Scholar]
  15. Shaw W. S., Pransky G., Fitzgerald T. E. Early prognosis for low back disability: intervention strategies for health care providers. Disabil Rehabil. 2001 Dec 15;23(18):815–828. doi: 10.1080/09638280110066280. [DOI] [PubMed] [Google Scholar]
  16. Staal J. Bart, Hlobil Hynek, van Tulder Maurits W., Köke Albère J. A., Smid Tjabe, van Mechelen Willem. Return-to-work interventions for low back pain: a descriptive review of contents and concepts of working mechanisms. Sports Med. 2002;32(4):251–267. doi: 10.2165/00007256-200232040-00004. [DOI] [PubMed] [Google Scholar]
  17. Teasell R. W., Bombardier C. Employment-related factors in chronic pain and chronic pain disability. Clin J Pain. 2001 Dec;17(4 Suppl):S39–S45. doi: 10.1097/00002508-200112001-00010. [DOI] [PubMed] [Google Scholar]
  18. van der Giezen A. M., Bouter L. M., Nijhuis F. J. Prediction of return-to-work of low back pain patients sicklisted for 3-4 months. Pain. 2000 Sep;87(3):285–294. doi: 10.1016/S0304-3959(00)00292-X. [DOI] [PubMed] [Google Scholar]
  19. van der Weide W. E., Verbeek J. H., Sallé H. J., van Dijk F. J. Prognostic factors for chronic disability from acute low-back pain in occupational health care. Scand J Work Environ Health. 1999 Feb;25(1):50–56. doi: 10.5271/sjweh.383. [DOI] [PubMed] [Google Scholar]

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