Early occupational intervention for people with low back pain in physically demanding jobs: A randomized clinical trial

Educational attainment, family background and the emergence of pain gradients in adulthood

Current studies have indicated that the number of individuals living with pain has risen in recent years, with nearly half of all adults in some countries living with some form of pain. Such trends have prompted researchers to explore differences in pain across different sociodemographic groups, with a dominant focus on educational attainment. However, much of the studies fail to consider the confounding role of early life characteristics, such as family background. Using data on over 400,000 individuals from the UK Biobank, we look at how educational attainment is associated with nine different domains of pain (headache, facial, neck, back, hip, knee, stomach, all over, and no pain). Ultimately, we find that compared to those with no educational credentials, education is associated with anywhere between a 0.1-15% change in the likelihood of reporting pain, depending on pain type and education level, with the greatest change occurring in those with the highest level. Yet, when accounting for family background characteristics in the form of sibling fixed effects, nearly all relationships between education and pain fell by either 50% or were eliminated. We ultimately conclude that failure to consider early life characteristics, such as family background characteristics may lead to inflated estimates of pain, and that future research should delve into early life exposures and their influence on pain in adulthood.

Promoting labour market inclusion of the chronically ill: a scoping review of Scandinavian countries' efforts

OBJECTIVES

This article is a scoping review of efforts in labour market inclusion of the chronically ill in the Scandinavian countries, a research area that has received much political as well as research attention in recent years. The aim of the review was to identify promising strategies and the need for further research.

METHODS

Six electronic databases were searched for literature published between 2015 and 2020. We included peer-reviewed articles that studied the effect of measures, aimed at the workplace or at the individual, that are intended to increase participation. Our search resulted in 2718 articles; our screening procedures resulted in 47 included articles.

RESULTS

Among the included studies, musculoskeletal problems (17 articles) and mental health problems (29 articles) were the most frequent chronic conditions. Multimodal occupational rehabilitation programmes directed towards the individual employee were the most frequent interventions (30 articles). Return to work (24 articles) and sickness absence (12 articles) were the most common outcomes. About half (25 articles) of the included studies reported a positive impact of the intervention on work inclusion of the chronically ill.

CONCLUSIONS

Our review found little evidence of how government programmes directed towards the supply side of the labour market succeed in including the chronically ill. Our review further indicated that multidisciplinary workplace interventions have a substantial effect. We also identified a significant lack of research on the effect of various governmental policies and programmes, including local health, work and welfare services, and limited coordination and cooperation between health and work services professions.

Occupational Physical Activity Was Associated With Disability Levels at 6-Month Follow-Up of Patients With Chronic Nonspecific Low Back Pain: A Prospective Cohort Study

BACKGROUND

Physical activity plays an important role in the prognosis of chronic low back pain (LBP); however, whether physical activity predicts pain intensity and disability remains unknown. This study investigated whether objective and subjective physical activity measures predict pain intensity and disability levels 6 months later in patients with chronic LBP.

METHODS

Patients with chronic LBP seeking care at 2 outpatient physiotherapy clinics were recruited. At baseline assessment, we collected anthropometric/sociodemographic data, duration of symptoms, pain intensity, disability, and physical activity (accelerometer and questionnaire). After 6 months, we reassessed pain and disability. Multivariable regression analyses were performed to investigate the association of physical activity measures with pain and disability at follow-up.

RESULTS

A total of 179 patients with chronic LBP were included. High occupational physical activity at baseline predicted disability at 6-month follow-up (B = 1.22; 95% confidence interval, 0.21 to 2.21) after controlling for age and baseline disability, meaning that for every 1-point increase in occupational physical activity, disability increased on average by 1.22 point. The remaining physical activity measures showed no association with pain intensity or disability at follow-up.

CONCLUSION

Higher perceived levels of occupational physical activity predicted higher disability levels at 6-month follow-up in patients with chronic LBP.

Multilevel, risk group-oriented strategies to decrease sickness absence in the public sector: evaluation of interventions in two regions in Sweden

Purpose

Sickness absence has been identified as needing to be addressed through multilevel interventions, but knowledge regarding optimal design and implementation of such interventions is scarce. The aim of this study was to evaluate the implementation and effects of a large-scale multilevel intervention in the public sector in Sweden.

Methods

The overall effect of the intervention was assessed using mixed-effect models. Sickness absence data (before, and 6 or 12 months after the intervention) for 90 intervention groups and 378 reference groups was retrieved from administrative personnel systems from the two participating regional councils. The implementation processes were evaluated using qualitative content analysis of qualitative interviews conducted at two timepoints.

Results

The results show that the vast majority of implemented measures were on an individual level and the integration of the intervention differed between the two regions. The reception and perception of the intervention activities seem to have been influenced by the implementation process, and how well the interventions were communicated and integrated, both regarding the integration of the different interventions and their integration into the discrete context and existing routines. No short-term overall effects on sickness absence were found.

Conclusions

The results point to the many challenges in implementing complex interventions, especially where organizational measures are involved—including adequate participation by, and communication between, the involved actors, as well as sufficient resources. The results indicate potential learning effects regarding the awareness of organizational factors in sick leave, after implementing and integrating multilevel strategies.

Interventions to Promote Work-Focused Care by Healthcare Providers for Individuals with Musculoskeletal Conditions a Scoping Review

PURPOSE

Building on an emerging body of evidence, this scoping review aimed to provide an overview of current interventions to promote work-focused care by healthcare providers for individuals with musculoskeletal conditions and to identify current knowledge gaps for future research.

METHODS

Literature searches were performed in Pubmed, CINAHL, EMBASE, and PsycInfo using Medical Subject Heading terms and text words relating to musculoskeletal conditions, interventions to promote work-focused care and work-related outcomes. Articles involving any interventions with elements of work-focused care delivered by healthcare providers to manage musculoskeletal conditions were reviewed for suitability and inclusion.

RESULTS

A total of 22 articles (18 intervention trials) were identified. Most studies were multidisciplinary interventions incorporating one or more elements of work-focused care including: work-related assessment to identify barriers to working, vocational advice/coaching or education to address barriers to working, involvement of the workplace stakeholders, restoration of fitness for work and regular communication with multidisciplinary team members. Most studies (61 %) concluded that their interventions achieved the desired work-related outcomes although firm conclusions could not be made regarding the effectiveness of a particular component, content or strategy of work-focused care itself because of the variability in the type and number of elements and outcomes used.

CONCLUSIONS

There is good evidence demonstrating the potential for healthcare providers to improve work outcomes for those with musculoskeletal conditions. Additional training is required to increase confidence in this area of practice. Accepting that work-focused care is important, however, does not diminish the challenge it presents.

The Effects of Workplace Interventions on Low Back Pain in Workers: A Systematic Review and Meta-Analysis

This systematic review and meta-analysis aimed to analyze the effects of workplace interventions (WI) on clinical outcomes related to low back pain (LBP) in a worker population, and to assess socio-economic parameters as participants on sick leave, days of sick leave, and return to work following WI. A systematic literature search was performed to select randomized clinical trials that investigated the effectiveness of WI on return to work, sick leave, and working capacity of workers affected by nonspecific LBP. Fourteen articles were included in the review and meta-analysis. The meta-analysis showed improvements in pain (p = 0.004), disability (p = 0.0008), fear-avoidance for psychical activity (p = 0.004), and quality of life (p = 0.001 for physical scale and p = 0.03 for mental scale) for patients who underwent WI compared to controls. Moreover, the pain reduction following WI was statistically significant in the healthcare workers’ group (p = 0.005), but not in the other workers’ group. The participants on sick leave and the number of days of sick leave decreased in the WI group without statistical significance (p = 0.85 and p = 0.10, respectively). Finally, LBP recurrence was significantly reduced in the WI group (p = 0.006). WI led to a significant improvement of clinical outcomes in a workers’ population affected by LBP.

Early Occupational Intervention for People with Low Back Pain in Physically Demanding Jobs: 1-year Follow-up Results of the Randomized Controlled GOBACK Trial

STUDY DESIGN

Randomized controlled trial with 1-year follow up.

OBJECTIVE

The aim of this study was to assess whether people with low back pain (LBP) and self-reported physically demanding jobs, benefit from an occupational medicine intervention, in addition to a single hospital consultation and a magnetic resonance imaging, at 1 year of follow-up. Secondly, to examine whether the positive health effects, found in both groups at 6 months, persist at 1-year follow-up.

SUMMARY OF BACKGROUND DATA

The prevalence of LBP is high in the working population, resulting in a substantial social and economic burden. Although there are many guidelines available on the management of LBP, including multidisciplinary biopsychosocial rehabilitation, they provide limited guidance on the occupational medicine aspects.

METHODS

As reported previously, 305 participants with LBP and self-reported physically demanding jobs were enrolled in the randomized controlled study and randomly allocated to clinical care with additional occupational medicine intervention or clinical care alone. Data were collected at baseline, 6 months, and 1 year. Outcomes included in the present 1-year follow-up study are changes in neuropathic pain (painDETECT questionnaire), severity of pain (0-10 numerical rating scale), disability (Roland Morris Disability Questionnaire), fear-avoidance beliefs (FABQ), physical, and mental quality of life (short-form 36).

RESULTS

The study showed no effect of an occupational intervention on neuropathic pain, fear-avoidance beliefs, physical and mental quality of life nor disability measured after 1 year. The positive effects found at 6 months in both groups, remained at 1-year follow-up.

CONCLUSION

The results suggest that a thorough clinical consultation, with focus on explaining the cause of pain and instructions to stay active, can promote long-lasting physical and mental health in individuals with LBP. Therefore, additional occupational interventions could focus on altering occupational obstacles on a structural level.Level of Evidence: 2.

Effectiveness of fitness for work interventions for workers with low back pain: A systematic review

OBJECTIVES

Safety at work is important for workers with low back pain (LBP). This requires good job design that considers both worker capacities and work requirements, a concept called "Fitness for Work." This systematic review aimed to evaluate the effects of fitness for work interventions on workers with LBP.

METHODS

We searched PubMed, the Cochrane Library, and Scopus from 2000 through 2020, using relevant terms.

RESULTS

We reviewed nine randomized controlled trials (RCTs) out of 3052 unique references. All studies were RCTs conducted in Western countries. Some RCTs reported positive findings that fitness for work interventions were effective for LBP in facilitating shorter return to work time and reducing short-term sick leave. However, the results of the reviewed studies were inconsistent; therefore, there is insufficient evidence to draw firm conclusions about the effectiveness of fitness for work interventions. Furthermore, the interventions were not effective in reducing long-term sick leave over a 24-month period. There were consistent findings that fitness for work interventions were no more effective than control interventions on pain intensity, disability, and work ability of workers with LBP.

CONCLUSIONS

These results suggest that fitness for work interventions may be somewhat effective in facilitating return to work and preventing short-term recurrence in workers with LBP. However, workers need to carefully manage their condition to prevent long-term recurrence.

Relationship between impaired work function and coping behaviors in workers with low back pain

OBJECTIVES

The aim of the present study was to clarify the relationship between work functional impairment levels and three coping behaviors of workers with low back pain, which were about seeking medical attention, taking over-the-counter drugs, and taking self-care.

METHODS

We conducted a cross-sectional study on 14 Japanese companies in 2016. Work function impairment was measured using the Work Functioning Impairment Scale. Logistic regression analyses were conducted for the three coping behaviors and odds ratios (ORs) calculated for work functional impairment levels.

RESULTS

We analyzed 2232 subjects; 226 were women and 790 worked on production lines. 688 workers had sought medical attention, 436 had taken over-the-counter medication, and 1225 had engaged in self-care. Those seeking medical attention were associated with severe work function impairment compared with no work function impairment (adjusted OR = 2.84, 95% confidence interval: 1.82-4.45, p < .001). We observed a trend for the association between over-the-counter drug use with high levels of work function impairment (adjusted OR: 1.19 for low, 1.35 for moderate, 1.65 for severe). There was no apparent relationship between self-care and the degree of work functional impairment.

CONCLUSION

In workers with low back pain, severe work functional impairment may promote medical attention and over-the-counter medication use, but it would not encourage self-care, such as stretching or exercise. Therefore, workplaces need to provide special support to help them take care of themselves. Therefore, it is desirable to provide good support for self-care in the workplace.