Effectiveness of fitness for work interventions for workers with low back pain: A systematic review

Abstract

Objectives Safety at work is important for workers with low back pain (LBP). This requires good job design that considers both worker capacities and work requirements, a concept called “Fitness for Work.” This systematic review aimed to evaluate the effects of fitness for work interventions on workers with LBP. Methods We searched PubMed, the Cochrane Library, and Scopus from 2000 through 2020, using relevant terms. Results We reviewed nine randomized controlled trials (RCTs) out of 3052 unique references. All studies were RCTs conducted in Western countries. Some RCTs reported positive findings that fitness for work interventions were effective for LBP in facilitating shorter return to work time and reducing short‐term sick leave. However, the results of the reviewed studies were inconsistent; therefore, there is insufficient evidence to draw firm conclusions about the effectiveness of fitness for work interventions. Furthermore, the interventions were not effective in reducing long‐term sick leave over a 24‐month period. There were consistent findings that fitness for work interventions were no more effective than control interventions on pain intensity, disability, and work ability of workers with LBP. Conclusions These results suggest that fitness for work interventions may be somewhat effective in facilitating return to work and preventing short‐term recurrence in workers with LBP. However, workers need to carefully manage their condition to prevent long‐term recurrence.

What is the volume, quality and characteristics of evidence relating to the effectiveness and cost‐effectiveness of multi‐disciplinary occupational health interventions aiming to improve work‐related outcomes for employed adults? An evidence and gap map of systematic reviews

“…Of the health conditions studied, 12 cast a wide net, seeking studies of participants with a wide range of conditions (Gensby et al, 2014 ; Hoefsmit et al, 2012 ; Lefever et al, 2018 ; NICE, 2019 ; Odeen et al, 2013 ; Schandelmaier et al, 2012 ; Tingulstad et al, 2022 ; Tompa et al, 2008 ; van Vilsteren et al, 2015 ; Venning et al, 2021 ; Vogel et al, 2017 ). Of those that were more focused, there were 11 reviews with a focus on workers with musculoskeletal conditions and/or chronic pain (Bernaers et al, 2022 ; Brewer et al, 2007 ; Carroll et al, 2010; Cochrane et al, 2017 ; Franche et al, 2005 ; Ishimaru et al, 2021 ; Neverdal, 2015 ; Oakman et al, 2016 ; Palmer et al, 2012 ; Schaafsma et al, 2013 ; van Geen et al, 2007 ), three that looked exclusively at mental health conditions (Gaillard et al, 2020 ; Mikkelsen & Rosholm, 2018 ; Nieuwenhuijsen et al, 2020 ), and one which included participants with musculoskeletal and/or mental health conditions (Cullen et al, 2018 ). There was almost no information provided about the industry or work sector in which the primary studies had been conducted, with only Brewer and colleagues mentioning some exclusions (Brewer et al, 2007 ).…”

“…Scores are provided for each item on the AMSTAR‐2 checklist, alongside an overall rating. Of the 30 systematic reviews, 10 were allocated a rating of ‘High’ quality (Gaillard et al, 2020 ; Gensby et al, 2014 ; Heathcote et al, 2019 ; NICE, 2019 ; Nieuwenhuijsen et al, 2020 ; Schaafsma et al, 2013 ; Schandelmaier et al, 2012 ; van Vilsteren et al, 2015 ; Verhoef et al, 2020 ; Vogel et al, 2017 ), four of ‘Moderate’ quality (Bernaers et al, 2022 ; Cochrane et al, 2017 ; Mikkelsen & Rosholm, 2018 ; Tingulstad et al, 2022 ), four of ‘Low’ quality (Cullen et al, 2018 ; Lefever et al, 2018 ; Odeen et al, 2013 ; Tompa et al, 2008 ) and 12 of ‘Critically Low’ quality (Axén et al, 2020 ; Brewer et al, 2007 ; Carroll et al, 2010; Franche et al, 2005 ; Hoefsmit et al, 2012 ; Ishimaru et al, 2021 ; Kojimahara et al, 2020 ; Neverdal, 2015 ; Oakman et al, 2016 ; Palmer et al, 2012 ; van Geen et al, 2007 ; Venning et al, 2021 ).…”

“…Critical items were numbers 2, 4, 9, 11 and 13. By far the most commonly failed item was item 2, with 11 of the 12 ‘Critically Low’ rated reviews not having a protocol (Axén et al, 2020 ; Brewer et al, 2007 ; Carroll et al, 2010 ; Franche et al, 2005 ; Neverdal, 2015 ; Oakman et al, 2016 ; Palmer et al, 2012 ; van Geen et al, 2007 ) (Hoefsmit et al, 2012 ; Ishimaru et al, 2021 ; Venning et al, 2021 ).…”

“…Across the 30 reviews, only three provided a justification for the study designs they chose to include (Gaillard et al, 2020 ; Gensby et al, 2014 ; Hoefsmit et al, 2012 ), only four reported funding sources in their included studies (Gaillard et al, 2020 ; NICE, 2019 ; Nieuwenhuijsen et al, 2020 ; Vogel et al, 2017 ). It is also notable that there was no evidence of duplicate study selection being performed in ten studies (Bernaers et al, 2022 ; Brewer et al, 2007 ; Carroll et al, 2010; Cullen et al, 2018 ; Hoefsmit et al, 2012 ; Kojimahara et al, 2020 ; Neverdal, 2015 ; Palmer et al, 2012 ; Tompa et al, 2008 ; van Geen et al, 2007 ), or data extraction ( n = 8 studies) (Axén et al, 2020 ; Bernaers et al, 2022 ; Hoefsmit et al, 2012 ; Ishimaru et al, 2021 ; Kojimahara et al, 2020 ; Neverdal, 2015 ; Oakman et al, 2016 ; van Geen et al, 2007 ).…”

Association Between Types of Chronic Disease and Receiving Workplace Accommodations

“…Most workplaces are unable to provide workers with low back pain with the full range of workplace accommodations they require. A review by Ishimaru et al 32 concluded that there were no fitness-for-work interventions with long-term positive effects for 6) 286 ( 7) Low back pain and other joint diseases 728 (11) 229 ( 9) 499 (12) Other diseases 809 ( 12) 355 ( 14) 454 (11) workers with low back pain. Third, because low back pain is susceptible to stigma, 33 if a worker with low back pain requests any additional workplace accommodations, the workplace may be less likely to provide them.…”