Professional Documents
Culture Documents
DOI: 10.1093/occmed/kqg109
Objective To assess the effect of controlled workplace interventions on low back pain (LBP)
through a review of controlled studies. The rising costs of employees with LBP have
resulted in an abundance of offers to society and organizations of interventions to
Because most of the adult population is employed, PsycINFO. The search strategy used for the other
worksite interventions enable contact with large parts databases was as close to the sensitive strategy as possible.
of this population [15]. In addition, musculoskeletal
problems are often believed to be work related [16]. Methodological quality assessment
Interventions carried out at the workplace will keep
employees on sick leave in contact with work and Two of the authors assessed the methodological quality of
colleagues, which is something believed to make return the studies independently, and later used a consensus
to work easier [17,18]. However, employees on sick leave method to reach agreement on scoring the articles, with
with LBP may not benefit from an intervention carried consultation of the third author if disagreement persisted.
out at the workplace unless they are specifically invited to Using the guidelines of van Tulder et al. [8], the
participate.The prognosis of acute LBP is very good if left methodological quality of the studies was assessed,
to its natural course [19]. After 6 weeks, 90% of cases and the studies were graded as high, medium or low
have recovered and are back at work [13,20,21]. The methodological quality. Blinding of providers and
prognosis deteriorates with the length of the sick leave. participants was not used as a criterion because of the
not have a control group, were not workplace inter- Sick leave
ventions or did not use any of the outcome measures.
The effect of educational interventions on sick leave due
The 24 preventive interventions were split into five
to LBP was reported in six studies [32–34,37,39,40]. Two
subcategories:
studies [32,40] reported a positive effect on sick leave in
· educational (10 interventions, 11 publications) the intervention group, but there was no significant
· back belts (fiveinterventions)
exercise (six difference between the intervention and control groups.
·· multidisciplinaryinterventions)
(two interventions)
One study [32] had a risk of selection bias and other
methodological weaknesses. The other study [40] was one
· pamphlet (one intervention) of the methodologically strongest studies in this group.
The rest of the studies did not report significant effects on
Back schools dominated the preventive interventions in sick leave. There is no evidence of effect on sick leave
the education subcategory. Back schools were introduced from educational interventions.
in Sweden in 1970, and the programme involved instruc-
tions in proper lifting techniques and body mechanics
Education no evidence of effect no evidence of effect limited evidence of no no evidence of effect yes
effect
Exercise limited evidence of effect limited evidence of effect limited evidence of effect no evidence of effect yes
Back belts no evidence of effect no evidence of effect limited evidence of no no evidence of effect yes
effect
Multidisciplinary limited evidence of no no evidence of effect no evidence of effect limited evidence of effect yes
interventions effect
Pamphlet no evidence of effect – – – yes
Treatment moderate evidence of no evidence of effect limited evidence of effect no evidence of effect yes
effect
6 OCCUPATIONAL MEDICINE
Educational interventions
[32] 140 municipality back school with education and exercise for medium cost-effectiveness related to
employees with a history of on-the-job back lost time cost and medical
injury, 2 h/day for 6 weeks for all the cost
participants in the back school; the control
group had no intervention
[33] 4000 postal service two 90 min sessions of body mechanics, medium incidence of LBP, days lost
lifting techniques, exercises and pain and costs (days lost,
management medical and replacements);
reports from 5.5 years
[34] 272 hospital theoretical instruction on how to handle medium episodes of LBP, injury rate,
patients and other loads lasting 6 days; 2 days number of days on sick
Exercise
[43] 142 hospital comparison of a callisthenics programme medium number of painful months,
twice a week for 3 months with five sessions strength and flexibility
(totalling 7.5 h) of back school with an
emphasize on exercise; the control group was
promised the most effective programme
[44] 60 geriatric hospital 20 min workout once or twice per week for medium back muscle strength,
13 months; designed to improve back muscle endurance, co-ordination,
strength, endurance and coordination; lost workdays, days with
non-intervention control complaints
[45] 469 municipal fire fighters mandatory flexibility exercises 30 min per day medium flexibility, costs related to
on every shift for 6 months; non-intervention medical care and lost time
control
[46] 282 home care personnel physical exercise, self-administered with medium neck, shoulder, and back
individual design of programme and five pain, physical exertion,
follow-ups on diary, and stress management, psychosocial factors
90 min weekly for 7 weeks; no intervention in
control group
T. H. TVEITO ET AL.: LOW BACK PAIN INTERVENTIONS AT THE WORKPLACE 7
Table 2. Continued
[47] 111 industry weekly exercise programme one hour per medium days with sick leave, LBP
week for 1.5 years during work hours;
committed to exercise on their own at least
once a week; non-intervention control
[48] 65 hospital comparison of two exercise programmes, medium/low pain and aerobic capacity
endurance and strength, 1 h twice a week for
15 weeks; waiting list control group.
Back belts
[49] 60 nursing and intervention group was to wear belts at work medium back injuries and pain
environmental for the 3 months study period; controls did
services not wear belts
Multidisciplinary interventions
[18] 66 hospital 8 h per day for 5 weeks of physical therapy, high pain, anxiety, depression,
exercise, ergonomics, behaviour therapy and usual subjective health
prevention of pain and reinjury; waiting-list complaints and pain-related
control group with priority sick leave
[55] 205 county back injury prevention programme including medium cost related to medical
(inter- education, training, physical fitness activities claims and sick leave,
vention and ergonomics lasting 1 year; adjusted for the costs of the
group) non-intervention control programme; prevalence of
back pain
Pamphlet
[56] 571 light industry pamphlet encouraging active coping, activity medium knowledge and attitude,
and early return to work after LBP sick leave
distributed in intervention company; control
company had neutral pamphlet; attitude and
knowledge measured
Table 2. Continued
[61] not given mine new mine with treatment plan for acute back medium costs related to claims and
pain including staff education, early number of claims due to
treatment and emphasis on early return to back pain; days lost; reports
work; control mine in adjacent town from 6 years
[62] 1645 hospital same intervention as [57] medium sick leave, incidence of LBP
(inter- and cost related to lost time
vention and medical expenses
wards:
250)
Educational interventions
[32] N U P P high
[33] U N U P high
[34] N P NR N high
[35] N N P N high
[36] N U P N high
[37] N P N N high
[38] U U U N high
[39] N P U P high
[40] N P NR P high
[41] N N N N high
[42] N N P P high
Exercise
[43] U P N P high
[44] U P N N high
[45] N P U P high
[46] U N P N high
[47] U N N N high
[48] N N U N high
Back belts
[49] U P NR P medium
[50] U P NR U medium
[51] N U NR N high
[52] P P NR N high
[53] P/U P P N high
Multidisciplinary interventions
[18] U U U P medium
[55] N P NR N high
Pamphlet
[56] N NR NR P high
P, positive score; U, unclear score/not reported; N, negative score; NR, not relevant for the study.
T. H. TVEITO ET AL.: LOW BACK PAIN INTERVENTIONS AT THE WORKPLACE 9
Sick leave Three studies tested effect of back belts on new episodes
of LBP [49,51,52]. Two studies did not find significant
Two studies assessed the effect of exercise on sick leave effects [49,52], one study reported an effect, but had a
[44,47] and both showed important significant effects. low methodological score [51]. There is limited evidence
However, there was risk of selection bias and low scores that back belts have no effect on new episodes of LBP.
on internal validity. There is limited evidence for a
positive effect from exercise on sick leave.
Pain
Costs One study assessed effect on level of pain and found no
significant difference between the groups [49]. There is
Two studies assessed the effect of exercise interventions
no evidence of effect of back belts on level of pain.
on costs [44,45]. Both showed substantial economic
savings, but had methodological weaknesses. There is
limited evidence that exercise has a positive effect on Multidisciplinary interventions
costs. Two studies were multidisciplinary interventions [18,55]
(see Tables 2 and 3). In a methodologically strong study,
Episodes of LBP Linton et al. [18] found no significant difference between
Three of the studies reported an effect of exercise on new the groups on sick leave, but demonstrated a clinically
episodes of LBP [43,44,47]. All studies demonstrated important positive effect on level of pain. Shi [55]
important significant effects between the groups, but had reported positive effects on costs and new episodes of
risk of bias. There is limited evidence that exercise has a LBP. There is limited evidence that multidisciplinary
positive effect on new episodes of LBP. interventions have no effect on sick leave, no evidence for
effect on costs or new episodes of LBP, and limited
Pain evidence of effect on level of pain.
Interventions to treat employees with LBP evidence of effect on new episodes of LBP, and no
evidence of effect on costs and level of pain.
Four interventions aiming to treat employees with LBP
Educational interventions showed limited evidence of
were reported in six different publications [57–62] (see
no effect on new episodes of LBP and no evidence of
Tables 2 and 3). The two publications by Loisel et al.
effect on sick leave, costs and level of pain. Back belts
[59,60] were reports from the same intervention, as were
showed limited evidence of no effect on new episodes
the publications by Cooper et al. [57] and Yassi et al. [62].
of LBP and no evidence of effect on sick leave, costs
and level of pain. There was no evidence of effect of a
Sick leave
pamphlet on sick leave.
Four studies reported effects on sick leave from inter- Some of the evidence scores were based on evidence
ventions to treat LBP [58,59,61,62]. One intervention from only one or two studies. However, many studies
did not report significant effects [58]. The study by Loisel assessing the outcome of LBP interventions by sick leave,
et al. [59] had a high methodological score. There is costs, new episodes, and level of LBP, were not included
moderate evidence that interventions to treat employees in this review because of the inclusion criterion that the
There is strong evidence that traditional education does not prevent the perspective in this study is interventions carried out in a work
LBP; back schools may be effective in occupational settings place setting
There is contradictory evidence that physical exercise may prevent exercise, multidisciplinary and treatment interventions at the
LBP; exercise may be effective for chronic LBP patients workplace have documented effect on LBP
There is strong evidence that back belts are not effective for LBP educational interventions, lumbar supports and distribution of a LBP
Multidisciplinary interventions addressing beliefs and attitudes seem pamphlet at the work place have no documented effect on LBP
to be effective for LBP
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