Prevention and Management of Occupational Related LBP

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Original Editors

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Search Strategy

• Databases Searched: CINAHL, PT Journal, JOSPT, Google Scholar,
  
• Key Terms: low back pain, prevention of LBP, prevention of low back pain, management of LBP, management of low back pain, management of occupational related LBP, occupational related low back pain, occupational related LBP, work related LBP, work related low back pain
  
• Dates Searched: April 6, 2011 to April 20, 2011
  

Definition/Description

IN PROGRESS: Back pain is second leading cause for all physician visits (Deyo, 1996) and occurs in approximately 80% of the population will experience it at some point in their lifetime (??? et al). Work-related low back pain (WRLBP) is a major cause of work absenteeism and accounts for a high proportion of occupational disability costs (Poitras et al.)

Workers' compensation claims account for 70% of all compensation costs.&nbsp; Suprisingly, this percentage only accounts for 7% of all LBP cases. Another important factor associated with WRLBP is the psychosocial element. In people with acute WRLBP, the individual opinion on whether or not they would return to work was most predictive of who would be off work for 4 weeks after the onset (Godges et al, 2008).  The greatest psychosocial predictor of prolonged work restrictions is the work subscale of the Fear-Avoidance Beliefs Questionnaire with a negative likelihood ratio (-LR) of 0.08 for scores less than 30 and positive<br />likelihood ratio (+LR) of 3.33 for scores greater than 34 (Fritz et al 2002). Acute pain is typically pain present in the first month whereas chronic pain usually presents longer than 3 months (Poitras et al).

Epidemiology /Etiology

According to Shaw et. al., back disability&nbsp;is highly associated with 7 variable:work that involves heavy physical demand, inability to modify work, stressful work demands, lack of workplace social support, job dissatisfaction, lack of work social support, job dissatisfaction, poor expectation of recovery and return to work, and the fear of reinjury. Heavy physical demands includes bending, lifting, pushing, or pulling heavy objects for a long period of time&nbsp;at work. Workers that have stressful jobs involving time pressure, productivity demand and&nbsp;the inability to control the speed of work could associated with a prolonged recovery.&nbsp; The lack of a workplace social support can be a result from an isolated work environment, unusual working hours, new place of employment, a recent departmental trasfer, past conflicts with coworkers or supervisors or difficulty developing social ties in the workplace.

Characteristics/Clinical Presentation

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Differential Diagnosis

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Examination

IN PROGRESS: According to Fritz et al., measurements of impairments, pain, disability and psychosocial measures should be assessed to determine the appropriate intervention. (Fritz, 2)

Physical Therapy Management (current best evidence)

The Treatment Based Classification system developed by Delitto and colleagues is used to classify those with LBP into either manipulation, stabilization, repeated exercise, or traction subgroups to better allow for homogenous subgroups based on impairments. (Fritz 2) Focusing on pain reduction, increasing range of motion, strength, reducing muscle tension, and educatining the worker are all treatment focuses that should be considered for appropriate management of the patient. (Poitras et al. 8)

Key Research

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Resources

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Clinical Bottom Line

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Recent Related Research (from Pubmed)

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References

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