Purpose Based on current scientific evidence and best practice, the first Dutch multidisciplinary practice guideline for occupational health professionals was developed to stimulate prevention and enhance work participation in patients with low back pain (LBP) and lumbosacral radicular syndrome (LRS). Methods A multidisciplinary working group with health care professionals, a patient representative and researchers developed the recommendations after systematic review of evidence about (1) Risk factors, (2) Prevention, (3) Prognostic factors and (4) Interventions. Certainty of the evidence was rated with GRADE and the Evidence to Decision (EtD) framework was used to formulate recommendations. High or moderate certainty resulted in a recommendation “to advise”, low to very low in a recommendation “to consider”, unless other factors in the framework decided differently. Results An inventory of risk factors should be considered and an assessment of prognostic factors is advised. For prevention, physical exercises and education are advised, besides application of the evidence-based practical guidelines “lifting” and “whole body vibration”. The stepped-care approach to enhance work participation starts with the advice to stay active, facilitated by informing the worker, reducing workload, an action plan and a time-contingent increase of work participation for a defined amount of hours and tasks. If work participation has not improved within 6 weeks, additional treatments should be considered based on the present risk and prognostic factors: (1) physiotherapy or exercise therapy; (2) an intensive workplace-oriented program; or (3) cognitive behavioural therapy. After 12 weeks, multi-disciplinary (occupational) rehabilitation therapy need to be considered. Conclusions Based on systematic reviews and expert consensus, the good practice recommendations in this guideline focus on enhancing work participation among workers with LBP and LRS using a stepped-care approach to complement existing guidelines focusing on recovery and daily functioning.
BackgroundA hallmark feature of multidisciplinary team care is patient-centeredness; every aspect of patient's health status is systematically evaluated and the treatment goals and plans for interventions are jointly set, evaluated, attuned.1 But the perceptions and values of patients and health care professionals (HCPs) about the role and degree of active involvement of patients in team care has received little attention.ObjectivesTo explore patients' and HCPs views on the meaning and role of patient participation in team care, and to explore the experiences of patient membership in team conference.MethodsThis study was conducted before and after the introduction of patients in team conference. To explore the views about patient participation semi-structured face-to-face interviews were held with 10 patients with rheumatic diseases eligible for or participating in multidisciplinary treatment and 12 HCPs. After the introduction of patients' membership in the team conference, telephone interviews with 8 patients and a focus group (n=5) with HCPs were held. The interviews and the focus group were audiotaped and described verbatim. Thematic content analysis of the interviews were performed by two researchers independently and discussed until consensus was reached. Similarly, data of the telephone interviews and focus group were analysed and identified topics were discussed by a rheumatology nurse and a researcher.ResultsParticipants described patient participation in terms of an active participatory behaviour of the patient (e.g. willingness to change, motivation, asking questions, expressing their own opinions, treatment adherence), an open respectful dialogue between patients and HCPs based on trust and equality, and (shared) responsibility of treatment. Participants indicated that patients' involvement in team care varied, from passive receiver to meaningful exchange between patients and HCPs. Opportunities for improvement were identified: improving information about the treatment, facilitating patient involvement in goal-setting, planning and evaluation of treatment, and stimulating patient's responsibility of care. After the introduction of patients in team conference, the evaluation of patient membership revealed that although some patients felt tense the atmosphere felt safe and they experienced a honest, transparent and respectful interaction between themselves and HCPs. Patients felt they were taken seriously and that their needs were taken into account, the treatment goals were set in mutual agreement and the resulting therapeutic interventions were clear and satisfactorily. HCPs valued patient's membership in team conference, although they needed to get used to it. HCPs experienced an open, honest and truthful team dialogue and a truly shared treatment plan leading to more patient commitment to treatment. The limited time, prior to team conference, to formulate a draft treatment plan to be discussed during the team conference, was seen as a disadvantage, especially in complex cases.ConclusionsPatients and ...
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