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Abstract :
[en] Aims
As part of the promotion of a national strategy for the prevention and the management of acute and chronic low back pain (CLBP), the Belgian Health Care Knowledge Centre (KCE) funded a systematic review of the EBM literature concerning the management of LBP patients in the occupational health (OH) context. Taking account differences in regulations and practices within the health care system between EU countries1,2, this review aimed at issuing good practices recommendations applicable to the Belgian situation to prevent the transition from acute to chronic back pain and to avoid long duration absences from work.
Methods
The guidelines have been developed in three steps. First, an electronic search was performed for relevant guidelines and systematic reviews (SR) on the following databases: EMBASE, Medline, Cochrane Controlled Trials Register, NHS guidelines Finder, National Guidelines Clearing House, New Zealand Guidelines Group Search and Pedro database. The search strategy combined 3 groups of terms: low back pain, occupational medicine and the type of reference (practice guideline or SR). The identified guidelines were appraised using the AGREE method, while SR’s were appraised using the Cochrane Collaboration grid. In a second phase, the draft guidelines were submitted to a group of OH academics from the main Belgian universities. The revised version of the guidelines was then published in English in the KCE report 3. In a third step currently under way, the guidelines are adapted in a more practical format for facilitating their daily use by OH practitioners. This involves a working group of OH practitioners coming from 12 external prevention services and several large company OH services. The document will also be discussed with representatives of other health professionals (GP’s and medical advisors of the sickness funds).
Results
Scientific evidence from the 7 selected guidelines and from the 27 SR’s was organized according to the main missions of the occupational physician (OP) and medical adviser (MA). Which background information should be given to employers and employees when the OP is playing an adviser role? What evidence-based prevention policies (primary and secondary) should he/she promote in the enterprises? For the third mission of the OP, health surveillance of workers, the document considers three situations: periodic health surveillance, spontaneous examinations at the worker request, and return to work (RTW) examinations for workers absent for 28 days or more. The main conclusions are summarized in 4 tables under the format of key-points, each of those mentioning the quality of the evidence (using the Guyatt classification).
Discussion and conclusions
The key message for prevention of CLBP is the need for staying active and minimizing the time out of work. Evidence of high quality is in favor of a multidisciplinary approach using conservative treatments. One challenge is to avoid hospitalizations and especially surgery in CLBP patients. Those recommendations are relevant for all care settings, including the occupational environment. From a health care policy point of view, the project highlighted the major roles of the occupational physician and of the medical adviser and stressed the need to better define those roles if decision makers want to tackle the low back pain problem and the economic consequences of the related sick leave.
References
1. Dutch Association of Occupational Medicine (NVAB). Management of low back workers by the occupational physician. Approved guidelines ; April 1999.
2. RCM-FOM. Occupational health guidelines for management of low back pain at work: Evidence Review and Recommendations. London, 2000.
3. Nielens H., Van Zundert J., Mairiaux P., Gailly J., Van Den Hecke N., Mazina D., Camberlin C., Bartholomeeussen S., De Gauquier K., Paulus D., Ramaekers D. Chronic Low Back Pain. Good Clinical Practice (GCP). Brussels: Belgian Health Care Knowledge Centre (KCE); 2006. KCE reports 48B (D/2006/10.273/64).
