Introduction
Methods
Evidence Search in Literature
Grading of Evidence
Formulating Guideline Recommendations
Layout Guideline
External Independent Review
Guideline Authorisation
Results
Recommendations for the Intake
Recommendations for Daily Functioning
Recommendations for Prevention
Risk factors | LBP [18] | |
---|---|---|
Work-related Physical | Flexed posture (> 45–60° trunk for > 5% of the time) Lifting (> 25 kg or repetitive 3–25 kg) Whole-body vibrations (driving 10-14 h p/w) Bending forward and backward (often) Pulling (> 25 kg), kneeling (> 15 min), standing (> 30 min/h) Working with hands above shoulders (> 15 min) | Lifting and bending of the trunk Heavy physically demanding work or manual laborer (> 2 h p/d) Working in kneeling or squatting position (> 1u p/d) Working with the trunk forward flexed (> 2 h/d) Bending and twisting of trunk Whole-body vibrations (driving > 2 h 1 × p/w) Lifting and carrying Working with hands above shoulders (> 1 h p/d) |
Work-related Psychosocial | Highly monotonous work Low job security Low social support from coworkers and supervisor High job strain Low supervisor support High job demands Low job control | No factors found in literature |
Personal Physical | No factors found in literature | No factors found in literature |
Personal Psychosocial | Depression, mental distress- being stressed, nervous or tense Dissatisfaction with life Psychosomatic factors | No factors found in literature |
Personal Lifestyle | Obesity (BMI > 30) Smoking | Smoking Overweight (BMI 25–29.9) and obesity (BMI > 30) |
Risk groups | Age (< 45 year) in women Previous episode(s) of low back pain | Age (> 60 year) Height (> 1.80 m) Previous episode(s) of low back pain |
Recommendations for Work Participation
1) Information and Advice in Case of Complaints Without Sick Leave
Prognostic factors | Negative effect | Positive effect | ||
---|---|---|---|---|
LBP [12] | LRS [24] | LBP [12] | LRS [24] | |
Work-related Physical | High physical job demands | Higher physical demands1 | Lower physical demands | No factors found in literature |
Work-related Psychosocial | No factors found in literature | No factors found in literature | No factors found in literature | No factors found in literature |
Personal Physical | High pain intensity Small increase of functionality High physical demands in daily live | No factors found in literature | Low pain intensity Better general health status Good cardiovascular fitness (FCE) Improved trunk flexibility after training Less functional limitations | Lower pain intensity2 Negative SLR-test2 Less disability by LRS2 Higher physical function2 |
Personal Psychosocial | Low recovery expectations Pain catastrophising Inadequate coping Fear avoidance Low cognitive appraisal | More fear avoidance1 | No factors found in literature | Less fear avoidance2 |
Risk Groups | Male sex Higher age | Older age1 | Higher socio economic status (SES) | Younger age1,2 |
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Advice about the positive effect of an active approach on pain and functioning.Based on expert opinion [15], OH professionals should advise from the thought of the notion of positive health, by explaining people that active strategies are associated with reduced disability. OH professionals should provide workers with information on the nature of LBP and LRS, like back anatomy, biomechanical principals and pain mechanism, and encourage them to continue with normal activities, based on moderate to very-low quality evidence [25].
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Advice to keep working as much as possible, despite pain.Explain that participation in work supports recovery including reduction of pain and limitations. Pain is no reason to limit physical activity [28].
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Advice to reduce workload caused by work-related risk factors and prognostic factors.OH professionals should facilitate work participation by advising specific interventions to reduce present work-related risk factors and prognostic factors [7], such as eliminating manual lifting when lifting is a risk factor or explaining the positive effect of being active in case of fear avoidance behavior.
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Advice to keep working as much as possible, if necessary, through temporary modification of workload, first in intensity, or else in tasks or duration.
Based on moderate quality evidence [29] and expert opinion, OH professionals should advice to enable work participation through (short-term) modification of work environments such as adaptation of the level of intensity of the physical demands, or else in tasks or duration of the physical demands.
2) Information and Advice in Case of Sick Leave
Intervention1 | Comparison1 | State LBP2 | Outcome3 | FU4 | Systematic review | No st5 | Studies | N6 | Effect | Effect Size7 | Lower limit 95% CI | Upper limit 95% CI | Limitations8 | GRADE9 |
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Physical exercise | Unknown | Unknown | Work disability | LT | Oesch 2010 | 8 | Hagen 2000 Karjalainen 2003 Lindström 1992 Niemistö 2003 Skouen 2002 Staal 2005 Steenstra 2006 Torstensen 1998 | 1992 | OR | 0.66 | 0.48 | 0.92 | Inconsistency | Low |
IPCP | CaU | Chronic | Time to RTW | ST (3 m) | Schaafsma 2013 | 1 | Bendix 1996 | 74 | OR | 0.16 | 0.05 | 0.49 | Very serious risk of bias Imprecision | Very low |
IPCP | CaU | Chronic | Time to RTW | LT (12 m) | Schaafsma 2013 | 5 | Mitchell 1994 Bendix 1996 Corey 1996 Jensen 2001 Skouen 2002 | 1039 | SMD | − 0.23$ | -0.42 | -0.03 | Serious risk of bias | Moderate |
IPCP + CaU | CaU | Chronic | Time to RTW | LT (12 m) | Schaafsma 2013 | 1 | Lambeek 2010 | 134 | SMD | − 4.42 | -5.06 | -3.79 | Imprecision | Low |
IPCP + CaU | CaU | Subacute | Time to RTW | VLT (> 24 m) | Schaafsma 2013 | 2 | Staal 2004 Lindstrom 1992 | 237 | SMD | − 0.39 | -0.76 | -0.02 | Imprecision | Moderate |
IPCP | ET | Chronic | Time to RTW | VLT (> 24 m) | Schaafsma 2013 | 1 | Bendix 1997 | 52 | SMD | − 0.62 | -1.21 | -0.04 | Very serious risk of bias Imprecision | Very low |
RTWI | CaU | Subacute | RTW | IT (6 m) | Hlobil 2005 | 6 | Hagen 2000 Staal 2004 Rossignol 2000 Indahl 1998 Lindström 1992 Loisel 1997 | 1773 | Significant positive effect | Serious risk of bias | Moderate | |||
RTWI | CaU | Chronic | Days of sick leave | LT (12 m) | Hlobil 2005 | 3 | Gatchel 2003 Hagen 2000 Staal 2004 | 715 | Significant positive effect | High | ||||
RTWI | CaU | Chronic | Days of sick leave | VLT (24 m) | Hlobil 2005 | 1 | Lindström 1992 | 103 | Significant positive effect | Serious risk of bias Imprecision | Low | |||
RTWI | CaU | Chronic | Days of sick leave | VVLT (36 m) | Hlobil 2005 | 1 | Hagen 2000 | 457 | Significant positive effect | High | ||||
WPI | CaU | Chronic | First sick leave period | LT (12 m) | Van Vlisteren 2015 | 2 | Lambeek 2010 Anema 2007 | 330 | HR | 1.77 | 1.37 | 2.29 | Imprecision | Moderate |
CI | No | Acute* | RTW < 3 m | VLT (24 m) | RCT** | 1 | Nicholas 2019 | 109 | OR | 0.26 | 0.07 | 0.98 | Indirectness Imprecision | Low |
MBR | CaU | Chronic | RTW | LT (12 m) | Marin 2017 | 3 | Bultmann 2009 Loisel 1997 Whitfill 2010 | 170 | OR | 3.19 | 1.46 | 6.98 | Very serious risk of bias Imprecision | Very low |
MBR | CaU | Chronic | Sick leave days | LT (12 m) | Marin 2017 | 2 | Karjalainen 2003 Schiltenwolf 2006 | 210 | SMD | − 0.38 | − 0.66 | − 0.10 | Serious risk of bias Imprecision | Low |
MBR | PT | Chronic | Proportion working | IT (3-12 m) | Kamper 2014 | 3 | Bendix 1996/1998 Henchoz 2010 Jousset 2004 | 221 | OR | 2.14 | 1.12 | 4.10 | Serious risk of bias Imprecision | Low |
MBR | PT | Chronic | Proportion working | LT (≥ 12 m) | Kamper 2014 | 8 | Alaranta 1994 Bendix 1996/1998 Bendix 2000 Henchoz 2010 Kapaa 2006 Kool 2007 Roche 2007/2011 Streibelt 2009 | 1006 | OR | 1.87 | 1.39 | 2.53 | Serious risk of bias | Moderate |
MBR | ACG | Chronic | Proportion working | IT (3-12 m) | Hoffman 2007 | 3 | Bendix 1998 Christensen 2003 Brox 2003 | 245 | ESD | 0.36 | 0.06 | 0.65 | Imprecision | Moderate |
MBR | ACG | Chronic | Proportion working | LT (≥ 12 m) | Hoffman 2007 | 4 | Alaranta 1994 Bendix 1998 Christensen 2003 Corey 1996 | 609 | ESD | 0.53 | 0.19 | 0.86 | Inconsistency | Moderate |