Addressing Occupational Factors in the Management of Low Back Pain: Implications for Physical Therapist Practice

Abstract

There is mounting evidence that occupational factors influence the extent of sickness absence following an episode of low back pain, but there have been limited efforts to integrate the identification and management of occupational factors into the routine practice of physical therapists. Systematic reviews suggest that a client's report of heavy physical demands, inability to modify job tasks, work stress, lack of organizational support, job dissatisfaction, poor expectations for resuming usual work, and fear of reinjury are indications of significant barriers to returning to work. Recommended strategies for evaluating and addressing occupational factors are explored with respect to the physical therapist's role in client assessment, development of activity and lifestyle recommendations, therapeutic exercise, communication with other providers, and summary reports. Primary recommendations include: (1) administration of self-report questionnaires to assess a client's perspective of physical job demands, (2) client-centered interviewing to highlight individual return-to-work concerns, (3) early discussions with clients about possible job modifications, and (4) incorporation of clients' workplace concerns in progress reports and summaries. These strategies may improve low back pain outcomes by encouraging effective communication with key stakeholders and by developing clients' ability to resolve obstacles to returning to work.

A Predictive Model of Occupational and Lifestyle Risk Factors and Pain Management Strategies for Participants in a Wellness Program Diagnosed with Chronic Low Back Pain

“…This is consistent with previous researches which have systematically examined the relationship between occupational and lifestyle risk factors and potential effects associated with CLBP [27,28,67]. However, many of the risk factor relationships shown by the OR in this study have not been widely reported as associated with CLBP in the literature, such as self-care at home [25].…”

“…Most diagnosed pain can be managed by physical therapy (laser therapy, lumbar support thermotherapy, etc.) [28,91,92], exercise/physical activity therapy (aerobic exercise and yoga [31,93]), and manual therapy (massage) [94]) [95]. In order to help employees understand back pain, employees should be educated on the pre-symptoms of bodily pain.…”

“…According to Waddell [16], CLBP is not only a physical problem, but also depends on a person's attitude [12], beliefs [25], and psychological distress [19,26]. Thus, there is a need for robust models to manage the chronic disorder and disability [20,27], including a better understanding of the contribution of occupational and lifestyle risk factors [28].…”

“…Contributors to CLBP are psychological activities [33], neurophysiological factors [34], and fear of pain [35]. Although psychological risk factors have been used to predict CLBP [8], there is no clear understanding of whether certain psychological risk factors contribute to CLBP and how to use these risk factors in physical therapies [28]. Workplace interventions can aid in prevention through physical approaches [36,37] such as physical activity [38], exercise [39], lumbar support [40], and education and training approaches [41].…”

Recovery From Depressive Symptoms Over the Course of Physical Therapy: A Prospective Cohort Study of Individuals With Work-Related Orthopaedic Injuries and Symptoms of Depression

“…Several factors that were not addressed in this study might have influenced patients' recovery. For instance, integrating work-related barriers (ie, blue flags 49,57 ) into our analysis might have yielded different results. Also, our findings may not be generalized to patients who are workdisabled but not receiving financial compensation.…”