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A nation-wide project for early rehabilitation of low back pain workers : an implementation study
Mairiaux, Philippe; CREYTENS, Guido; DELARUELLE, Dirk et al.
2007In Book of Abstracts: Sixth International Scientific Conference on Prevention of Work-related musculoskeletal disorders. PREMUS 2007
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Keywords :
Return to work; Low back pain; Disability
Abstract :
[en] Aims Based on a new policy for managing work-related diseases, the Belgian government has launched, starting March 1st 2005, an evidence-based program to promote an early return to work and to prevent chronic low back pain (LBP). Target workers belong to the health care sector and must be off work due to LBP for at least 4 weeks and maximum 3 months. Considering the challenge in applying an innovative program on such a large scale, its implementation was carefully monitored by a task force created within the Fund for Occupational Diseases (FOD) and various process and impact evaluations carried out to identify barriers to its possible extension to other categories of workers. Methods The program can be defined as a “return to work” (RTW) program and involves a multidisciplinary back rehabilitation program available through more than 40 rehabilitation centres across the country, and an ergonomics intervention in the health care institutions to be carried out by the OH prevention service. Financial incentives are allowed to both the patient and the employer to stimulate participation. For every worker included in the project, data are systematically retrieved both by the rehabilitation centre and the prevention service using standardized forms. Questions arising from the various stakeholders (workers, trade unions, employers, general practitioners, OH physicians) about the program are systematically recorded by the task force. In addition, a phone survey has been conducted among the first 83 participants (out of 91 accepted applications) to know the managing path followed by each worker, and to identify the strengths and weaknesses of the designed program. Results One year after its official launch, the program was found to have reached 5.1% to 14.6% of the target population depending on the estimation basis chosen. Only 18.5% of the participants had seen or read the information leaflet edited by the FOD in the two national languages (in 20.000 exemplars). The main access criterion (>= 4 weeks sick leave), even supported by a solid scientific evidence, has been considered too severe by many stakeholders; the possibility to access the program during a relapse of a pain episode was not properly understood. Arising from wrong beliefs about back pain and its treatment, some patients but also their treating physicians were not keen to participate to such an active program. Entering the program also implied a visit by the OH physician during the sick leave, a new procedure still rarely used in the enterprises. Some employers worried about the program becoming a stimulus for extending the sick leave period instead of shortening it, but the collected data did not support this assumption. Potential concurrence between health professionals had also a negative influence in some areas. Regarding its content, the program was consistently applied in its medical component, well formalized within the Belgian health care system, but much less in its ergonomics component that was highly dependent on each institution own dynamic for prevention. As regard the program impact at short term, 98% of the participants did return to work and for 79% of them well before the end of the rehabilitation treatment in the centre; subjective improvements were recorded in 85% to 91% of the workers depending on the variable considered. Discussion and conclusions Informing about 90.000 workers in hundreds of health care institutions was a challenge and would have needed an ambitious media campaign. The project being completely innovative in the Belgian context, it implies deep changes in the traditional interactions between different health professionals and it requests altering very common beliefs about back pain. Such beliefs or behaviours cannot be changed in a few months! More fundamentally this project shows that there is long way to go before implementing with success at a national scale, interventions originally developed and tested in well controlled conditions and in a selected number of settings: return to work research has yet to evolve from establishing efficacy to proving effectiveness. References See FOD web site : www.fmp-fbz.fgov.be (“prevention dos” or “rugpreventie”)
Disciplines :
Public health, health care sciences & services
Author, co-author :
Mairiaux, Philippe  ;  Université de Liège - ULiège > Département des sciences de la santé publique > Santé au travail et éducation pour la santé (STES)
CREYTENS, Guido;  Fonds des Maladies Professionnelles
DELARUELLE, Dirk;  Fonds des Maladies Professionnelles
Poot, Olivier;  Fonds des Maladies professionnelles
Strauss, Patrick;  FMP-FBZ
Language :
English
Title :
A nation-wide project for early rehabilitation of low back pain workers : an implementation study
Publication date :
August 2007
Event name :
PREMUS 2007 : Sixth International Scientific conference on Prevention of Work-related musculoskeletal disorders
Event organizer :
PREMUS 2007
Event place :
BOSTON, United States
Event date :
du 27 au 30 août 2007
Audience :
International
Main work title :
Book of Abstracts: Sixth International Scientific Conference on Prevention of Work-related musculoskeletal disorders. PREMUS 2007
Peer reviewed :
Peer reviewed
Funders :
FMP-FBZ
Available on ORBi :
since 15 February 2011

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