The Dutch Multidisciplinary Occupational Health Guideline to Enhance Work Participation Among Low Back Pain and Lumbosacral Radicular Syndrome Patients

Abstract

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.

Occupational recovery of Dutch workers with low back pain

“…LBP diagnoses were coded by OPs using the Classification system for Occupational and Social insurance physicians (CAS), which is based on the International Classification of Diseases (ICD-10) [ 17 ]. These codes were categorized into four diagnosis groups in line with a new policy for LBP management that was introduced by the occupational health service in 2020, which is based on the new guideline LBP and LRS published by the Dutch Association of Occupational Medicine [ 18 ]. Table 1 shows an overview of CAS codes and categories that were used.…”

Changing concepts in approaches to occupational low back pain

“…If prognostic factors are present or in case of a high-risk profile on the SBST, interventions should be considered to eliminate or reduce factors hindering work participation and to support beneficial factors 22 ) . The use of SBST is recommended in the world’s first multidisciplinary occupational health guideline focused on effective interventions for work participation 23 ) . If SBST has a high-risk profile, a mechanism needs to be established to share both the results and effective intervention methods with the clinicians and occupational health staff.…”

“…Since it has already become clear that nociplastic pain with central sensitization is common in musculoskeletal disorders, such as LBP and osteoarthritis 25 ) , there is a need to recognize nociplastic pain and develop solutions for it in the field of occupational health. Candidate solutions or intervention packages may include approaches to fear-avoidance and pain behavior 23 ) ; exercise with a time-contingent approach 23 ) ; approaches to depression 4 ) and sleep 26 ) , which are mutually causal to LBP; and rehabilitation that also utilizes the mechanism of exercise-induced hypoalgesia. The WHO is developing disease-specific, priority evidence-based interventions, including those for LBP, and a package of interventions for rehabilitation that deliver them safely and effectively.…”

“…All stakeholders in occupational health need to know that the only evidence-based intervention recommended for both recurrence prevention and chronic LBP relief is exercise. Needless to say, “staying active” is recommended for nonspecific LBP, even if it is acute, to the extent that performing work can be preferred over rest 23 , 27 ) .…”

“…As the way of working is changing due to the pandemic, it is desirable to establish an individualized population approach based on the rational and strategic assessment of LBP, which is a common disease with the highest disability impact and is frequently recurrent, to help workers improve their self-management 33 ) and self-efficacy, maintain constant work participation 23 ) and moderate physical activity, and improve productivity. This requires further interdisciplinary and international collaborations.…”