dr. birgitte m. blatter
DESCRIPTION
Work related interventions improving return-to-work of workers with MSDs and some Dutch examples. Dr. Birgitte M. Blatter. Work related interventions improving return-to-work of workers with MSDs and some Dutch examples. Content - PowerPoint PPT PresentationTRANSCRIPT
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
Lighten the Load, workshop return-to-work2
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