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Sixth International Scientific Conference on Prevention of Work-Related Musculosketal Disorders (PREMUS) Boston, USA, 27-30 august 2007.

To assess the effectiveness of workplace intervention and graded activity, separately and combined, for multidisciplinary rehabilitation of low back pain (LBP). Summary of Background Data. Effective components for multidisciplinary rehabilitation of LBP are not yet established. Methods: Participants sick-listed 2 to 6 weeks due to nonspecific LBP were randomized to workplace intervention (n = 96) or usual care (n = 100). Workplace intervention consisted of workplace assessment, work modifications, and case management involving all stakeholders. Participants still sick-listed at 8 weeks were randomized for graded activity (n = 55) or usual care (n = 57). Graded activity comprised biweekly 1-hour exercise sessions based on operant-conditioning principles. Outcomes were lasting return to work, pain intensity and functional status, assessed at baseline, and at 12, 26, and 52 weeks after the start of sick leave. Results: Time until return to work for workers with workplace intervention was 77 versus 104 days (median) for workers without this intervention (P = 0.02). Workplace intervention was effective on return to work (hazard ratio = 1.7; 95% CI, 1.2-2.3; P = 0.002). Graded activity had a negative effect on return to work (hazard ratio = 0.4; 95% CI, 0.3-0.6; P < 0.001) and functional status. Combined intervention had no effect. Conclusion: Workplace intervention is advised for multidisciplinary rehabilitation of subacute LBP. Graded activity or combined intervention is not advised.

Objective: To evaluate the cost-effectiveness and cost-utility of a return to work (RTW) program for workers on sick-leave due to low back pain (LBP), comparing a workplace intervention implemented between 2 to 8 weeks of sick-leave with usual care, and a clinical intervention after 8 weeks of sick-leave with usual care. Design: Economic evaluation alongside a randomised controlled trial (RCT). Study population: Workers sick-listed for a period of 2 to 6 weeks due to LBP. Interventions: 1. workplace assessment, work modifications and case management). 2. physiotherapy based on operant behavioural principles. 3. usual care: provided by an occupational physician. Outcomes: The primary outcome was return to work (RTW). Other outcomes were pain intensity, functional status, quality of life and general health. The economic evaluation was conducted from a societal perspective. Outcomes were assessed at baseline (after 2-6 weeks on sick-leave), and 12 weeks, 26 weeks, and 52 weeks after the first day of sick-leave. Results: The workplace intervention group returned to work 30.0 days (95% CI=[3.1, 51.3]) earlier on average than the usual care group at slightly higher direct costs (ratio of 1 day: €19). Workers in the clinical intervention group that had received usual care in the first 8 weeks returned to work 21.3 days (95% CI= [-74.1, 29.2]) later on average. The group that had received the workplace intervention in the first 8 weeks and the clinical intervention after 8 weeks returned to work 50.9 days (95% CI=[-89.4, -2.7]) later on average. A workplace intervention was more effective than usual care in RTW at slightly higher costs and was equally effective as usual care at equal costs on other outcomes. A clinical intervention was less effective than usual care and associated with higher costs. Conclusion: The workplace intervention results in a safe and faster RTW than usual care at reasonable costs for workers on sick-leave for two to six weeks due to LBP. © 2006 Springer Science+Business Media, LLC.

Dit proefschrift gaat over een gezamenlijk project van TNO Arbeid en de afdeling Sociale Geneeskunde van het VU medisch centrum. Lage rugklachten zijn een groot probleem in de Westerse samenleving. Zij kunnen ziekteverzuim en arbeidsongeschiktheid veroorzaken en als gevolg daarvan grote kosten met zich meebrengen. Bedrijfsartsen adviseren vaak werkaanpassingen en oefenprogramma's om de werkhervatting van werknemers met lage rugklachten te bevorderen, maar er is weinig wetenschappelijk bewijs dat dit effectief is. Dit proefschrift besteedt, naar analogie van Canadees onderzoek, aandacht aan de effectiviteit van een methode voor werkaanpassing met actieve betrokkenheid van werknemer èn werkgever en de effectiviteit van een fysiotherapeutisch oefenprogramma. De methode voor werkaanpassing blijkt werkhervatting te bespoedigen, hetgeen zowel gezondheidkundige als economische winst oplevert. Het fysiotherapeutische oefenprogramma blijkt in dit onderzoek geen meerwaarde te hebben. Verder is in dit proefschrift gekeken naar de oorzaken van een vertraging in de terugkeer naar werk.