ARTICLES

 

Return-to-work (RTW) of patients after Lumbar Surgery

 

 

Herculene van Staden^I; René Kemp^II; Susan Beukes^III

^IB OT, M OT (Vocational Rehabilitation). Occupational Therapist in Vocational Rehabilitation and Medico-Legal Private Practice
^IIB OT, M OT. Lecturer - Division of Occupational Therapy, Department of Inter-disciplinary Sciences, Faculty of Health Sciences, University of Stellenbosch
^IIIB OT, M OT. Head, Senior Lecturer - Division of Occupational Therapy, Department of Inter-disciplinary Sciences, Faculty of Health Sciences, University of Stellenbosch

Correspondence

 

 

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ABSTRACT

BRACKGROUND: Return to work (RTW) after lumbar surgery due to a work-related injury poses a challenge internationally. Work hardening is used as an intervention for acute and chronic lower back pain (CLBP), but it is not necessarily used in post-operative treatments. Method: The RTW rate of an experimental group (Group A) of unskilled labourers was compared with that of a control group (Group B) of unskilled labourers. Group A received multidisciplinary intervention, including a work hardening programme with ergonomic adaptations, while Group B received only physiotherapy after surgery as a multidisciplinary team was not available. A RTW questionnaire was used as an outcome measure for both groups. During the multidisciplinary intervention, the improvement of pain and functionality of patients from Group A were also evaluated from the pre-operative state to 24 weeks post-operatively with the Visual Analogue Scale (VAS) and the Oswestry Disability Index (ODI) as additional outcome measures. Results: There was a positive tendency to successful RTW after work hardening for Group A, but no statistical significance between Groups A and B. The improvement of pain and functionality in Group A was highly significant from time of surgery to six months post-operatively. Conclusion: Work hardening was found to have a positive tendency towards ensuring RTW for work-injured patients after lumbar surgery, with a highly significant effect on pain and functionality.

Key words: Work hardening; work-injured patients; lumbar surgery; return to work (RTW); multidisciplinary approach

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References

1. Jordan KD, Mayer TG, Gatchel RJ. Should extended disability be an exclusion criterion for tertiary rehabilitation? Spine, 1998; 23(19): 2110-2117.         [ Links ]

2. Soeker MS, Wegner L, Pretorius B. I'm going back to work: back injured clients' perceptions and experiences of their worker roles. Work, 2008:161-170. DOI: 1051-9815/08.         [ Links ]

3. Guo H-R. Working hours spent on repeated activities and prevalence of back pain. Occup Environ Med, 2002; 59: 680-688. Available from: www.occenvmed.com.         [ Links ]

4. Macdonald E, Haslock I. Spinal Disorders. In: Cox RAF with Edwards FC and Palmer K, editors. Fitness for work: The medical aspects. 3rd ed. New York: Oxford University Press Inc, 2000.         [ Links ]

5. Martin BI, Deyo RA, Mirza SK, Turner JA, Comstock BA, Hollingworth W, Sullivan SD. Expenditures and health status among adults with back and neck problems. JAMA, 2008; 299(6): 656-664.         [ Links ]

6. Louw QA, Morris LD, Grimmer-Somers K. The prevalence of low back pain in Africa: a systematic review. BMC Musculoskeletal Disorders, 2007;8:105. Available from: http://www.biomedicalcentral.com/1471-2474/8/105.         [ Links ]

7. Van Vuuren B, Zinzen E, Van Heerden HJ, Becker PJ, Meeusen R. Work and family support systems and the prevalence of lower back problems in a South African steel industry. J Occup Rehabil, 2007; 17: 409-42I. DOI: I0.I007/sI0926-007-9092-I.         [ Links ]

8. Fairbank J, Frost H, Wilson-Macdonald J, Yu L-M, Barker K, Collins R. Randomised controlled trial to compare surgical stabilisation of the lumbar spine with an intensive rehabilitation programme for patients with chronic low back pain: the MRC spine stabilisation trial. BMJ, 2005 May 28; 330(7502): 1239-1245. DOI:I0.1136/bmj.38441.620417.BFF        [ Links ]

9. McGregor AH, Dicken B, Jamrozik K. (2006). National audit of post-operative management in spinal surgery [Internet].         [ Links ] [cited 2008 Sep 8]. BMC Musculoskeletal Disorders, 2006 May 3I; 7: 47-52. Available from: http://www.biomedcentral.com/I47I-2474-7-47.

10. Puolakka K, Ylinen J, Neva MH, Kautiainen H, Häkkinen A. Risk factors for back pain-related loss of working time after surgery for lumbar disc herniation: a 5-year follow-up study. Eur. Spine J, 2008; I7: 386-392. DOI: I0.I007/s00586-007-0552-2.         [ Links ]

11. National Institute of Occupation Safety and Health. Musculoskeletal disorders and Workplace Factors: A Critical review of Epidemiologic Evidence for Work-Related Musculoskeletal Disorder of the Neck, Upper Extremity, and Low Back [Internet].         [ Links ] 2005. [cited 2008 Sep 8] Publication No. 97-I4I. Available from http://www.cdc.gov/niosh/pubreference/ouputid2295.htm.

12. Levy HI. Low back pain: history and physical examination. In: Kaplan-sky BD, editor. Occupational low back pain: aggressive nonsurgical care. Boca Raton (Fl): CRC Press LLC; 2000: 3-22.         [ Links ]

13. Hoogendoorn WE, Van Poppel MNM, Bongers PM, Koes BW, Bouter LM. Systematic review of psychosocial factors at work and private life as risk factors for back pain [Internet]. Spine, 2000; 25(I6): 2II4-2I25.

14. Pincus T, Burton AK, Vogel S, Field AFP A systematic review of psychological factors as predictors of chronicity/disability in prospective cohorts of low back pain [Internet].         [ Links ] Spine, 2002; 27(5): E109-E120.

15. Fisher GS, Emerson L, Firpo C, Ptak J, Wonn J, Bartolacci G. Chronic pain and occupation: An exploration of the lived experience [Internet].         [ Links ] Am J Occup Ther, 2007; 6I(3): 290-302.

16. Gatchel RJ, Ricard MD, Choksi DN, Mayank J, Howard K. The comprehensive muscular activity profile (CMAP): Its high sensitivity, specificity and overall classification rate for detecting submaximal effort on functional capacity testing. J Occup Rehabil, 2009; 19: 49-55. DOI: I0.I007/sI0926-008-9I56-x.         [ Links ]

17. Waddell G. The back pain revolution. Churchill Livingstone. I998.         [ Links ]

18. Shaw WS, Van der Windt DA, Main CJ, Loisel P Linton SJ and the "Decade of the Flags" Working Group. Early patient screening and intervention to address individual-level occupational factors ("blue flags") in back disability. J Occup Rehabil, 2009; I9: 64-80. DOI: I0.I007/sI0926-008-9I59-7.         [ Links ]

19. Booysen F le R. Vocational rehabilitation for high-risk groups: determinants of occupational injury and Disease in South Africa. SAJOT, 2003; 33(3): 5-8.         [ Links ]

20. Huang GD, Feuerstein M. Identifying work organization targets for a work-related musculoskeletal symptom prevention program. J Occup. Rehabil, 2004; I4(I): I3-30.         [ Links ]

21. Karjalainen KA, Malmivaara A, van Tulder MW, Roine R Jauhiainen M, Hurri H, Koes BW. Multidisciplinary biopsychosocial rehabilitation for subacute low-back pain among working age adults. Cochrane Database of Systematic Reviews, 2003, Issue 2. Art. No.: CD002I93. DOI: I0.I002/I465I858.CD002I93.         [ Links ]

22. Loisel P, Gosselin L, Durand P, Lemaire J, Poitras S, Abenhaim L. Implementation of a participatory ergonomics program in the rehabilitation of workers suffering from subacute back pain. Appl Ergon, 200I; 32: 53-60. Pii: S0003-6870(00)00038-7.         [ Links ]

23. Elders LAM, Van der Beek AJ, Burdorf A. Return to work after sickness absence due to back disorders - a systematic review on intervention strategies. Int Arch Occup Environ Health, 2000; 73: 339-348.         [ Links ]

24. Franche R-L, Cullen K, Clarke J, Irvin E, Sinclair S, Frank J and The Institute for Work & Health (IWH) Workplace-Based RTW Intervention Literature Review Research Team. Workplace-based return-to-work interventions: a systematic review of the quantitative literature. J Occup Rehabil, 2005; I5(4): 607-63I. DOI: 10.I007/ s10926-005-8038-8.         [ Links ]

25. Guzman J, Esmail R, Karjalainen K, Malmivaara A, Irvin E, Bombardier C. Multidisciplinary rehabilitation for chronic low back pain: systematic review [Internet].         [ Links ] [cited 2008 Jun 14]. BMJ, 200I; 322: 1511-1516. Available from: http://www.bmj.com.

26. Brox JI, Reikeras O, Nygaard O, Sorensen R, Indahl A, Holm I, et al. Lumbar instrumented fusion compared with cognitive intervention and exercises in patients with chronic back pain after previous surgery for disc herniation: A prospective randomized controlled study. Pain, 2006; I22: I45-255. DOI:10.1016/j.pain.2006.01.027.         [ Links ]

27. Melloh M, Röder C, Elfering A, Theis J-C, Müller U, Staub LP et al. Differences across health care systems in outcome and cost-utility of surgical and conservative treatment of chronic low back pain: a study protocol [Internet].         [ Links ] [cited 2008 Jun I4]. BMC Musculoskeletal Disorders, 2008;9:81-90. PubMed PMID: 18534034. Available from: http://www.biomedcentral.com/1471-2474/9/81.

28. Ostelo RWJG, De Vet HCW, Waddell G, Kerckhoffs MR, Leffers P Van Tulder MW. Rehabilitation following first-time lumbar disc surgery: a systematic review within the framework of the Cochrane Collaboration [Internet].         [ Links ] [cited 2008 Jul 30]. Spine, 2003; 28(3): 209-218. Available from: http://ovidsp.tx.ovid.com.ez.sun.ac.za/spb/ovidweb.cgi.

29. Mirza SK, Deyo RA. Systematic review of randomized trials comparing lumbar fusion surgery to nonoperative care for treatment of chronic back pain. Spine, 2007; 32(7): 816- 823.         [ Links ]

30. Johnson LS, Archer-Heese G, Caron-Powles DL, Dowson TM. Work hardening: outdated fad or effective intervention? Work, 2001; 16(3): 235-243.         [ Links ]

31. Kornblau BL. Work hardening. In: Tollison CD, Kriegel ML, editors. Interdisciplinary rehabilitation of low back pain. Baltimore: Williams & Wilkins, 1989: 277-290.         [ Links ]

32. Li EJQ, Li-Tsang CWP Lam CS, Hui KYL, Chan CCH. The effect of a "training on work readiness" program for workers with musculoskeletal injuries: a randomized control trial (RCT) study. J Occup Rehabil, 2006; 16: 529-541. DOI: 10.1007/s10926-006-9034-3.         [ Links ]

33. Matheson LN, Ogden LD, Violette K, Schultz K. Work hardening: Occupational therapy in industrial rehabilitation. Am J Occup Ther, 1985; 39(5): 3l4-32l.         [ Links ]

34. Taylor ME. Return to work following back surgery: A review. Am J Ind Med, 1989; 16(1): 79-88. DOI: 10.100z/ajim.4700160109.         [ Links ]

35. Cole K, Kruger M, Bates D, Steil G, Zbreski M. Physical demand levels in individuals completing a sports performance-based work conditioning/hardening program after lumbar fusion. The Spine J, 2009; 9: 39-46. DOI: 10.1016/j.spinee.2008.07.007.         [ Links ]

36. Young AE, Roessler RT, Wasiak R, McPherson KM, Van Poppel MNM, Anema JR. A developmental conceptualization of return to work. J Occup Rehabil, 2005; l5(4): 557-568.         [ Links ]

37. Stein F Cutler SK. Clinical research in Occupational Therapy. 4th ed. Canada: Singular, 2000.         [ Links ]

38. Babbie E, Mouton J. The practice of social research. South Africa: Oxford University Press, 2001.         [ Links ]

39. Manchikanti L, Pampati V. Research designs in interventional pain management: Is randomization superior, desirable or essential? Pain Physician, 2002; 5(3): 275-284.         [ Links ]

40. Fairbank JCT, Pynsent PB. The Oswestry Disability Index. Spine, 2000; 25(22): 2940-2953.         [ Links ]

41. Fisher K, Johnson M. Validation of the Oswestry low back pain disability questionnaire, its sensitivity as a measure of change following treatment and its relationship with other aspects of the chronic pain experience. Physiother Theory Pract, l997; I3: 67-68.         [ Links ]

42. McDowell I, Newell C. Measuring health: a guide to rating scales and questionnaires. 2nd ed. New York: Oxford University Press, 1996.         [ Links ]

43. Zanoli G, Strömqvist B, Jönsson B. VisuaL analog scales for interpretation of back and leg pain intensity in patients operated for degenerative lumbar spine disorders. Spine, 2001; 26(21): 2375-2380.         [ Links ]

44. Woodward CA, Chambers LW. Guide to questionnaire construction and question writing. The Canadian Public Health Association, Ontario, 1980.         [ Links ]

45. Marhold C, Linton SJ, Melin L. Identification of obstacles for chronic pain patients to return-to-work: evaluation of a questionnaire. J Occup Rehabil, 2002; 12(2): 65-75.         [ Links ]

46. Schonstein E, Kenny DT, Keating JL, Koes BW. Work conditioning, work hardening and functional restoration for workers with back and neck pain. Cochrane Database of Systematic reviews, 2003, Issue 3. Art. No.: CD00I822. DOI: 10.1002/ 14651858. CD00I822.         [ Links ]

47. Matheson LN. Physical demand characteristics of work. 1993. Available from: http://ssl4.westserver.net/epicrehab/FreeResources/PDC.pdf.         [ Links ]

48. Chou R, Baisden J, Carragee EJ, Resnick DK, Shaffer WO, Loeser JD. Surgery for low back pain: A review of the evidence for an American pain society clinical practice guideline. Spine, 2009; 34(10): 1094-1109.         [ Links ]

49. Ostelo RWJG, Costa LOP, Maher CG, De Vet HCW, Van Tulder MW. Rehabilitation after lumbar disc surgery: An updated Cochrane review. Spine, 2009; 34(17): 1839-1848.         [ Links ]

50. Robertson PA, Jackson SA. Prospective assessment of outcomes improvement following fusion for low back pain. J Spinal Disord Tech, 2004; 17(3): 183-188.         [ Links ]

51. National Academy of Sciences, Committee on Occupational Classification and Analysis. Dictionary of occupational titles (dot): Part l - current population survey, April 1971, augmented with dot characteristics, and Part ll - fourth edition dictionary of dot scores for 1970 census categories [Computer file].         [ Links ] Washington, DC: US Dept. of Commerce, Bureau of the Census [producer], 197?. Ann Arbor, MI: Inter-university Consortium for Political and Social Research [distributor], 1981. Available from: http://www.occupationalinfo.org/.

52. Van Vuuren BJ, Becker PJ, Van Heerden HJ, Zinzen E, Meeusen R. Lower back problems and occupational risk factors in a South African steel industry. Am J Ind Med, 2005; 47: 451-457.         [ Links ]

53. Grandjean, E. Fitting the task to the Man. 4th ed. London: Taylor & Francis Ltd. 1988.         [ Links ]

 

 

Correspondence:
Herculene van Staden
herculene@paarlrehab.co.za