Occupational Health Program Doesn't Improve Outcomes of Low Back Pain

For workers with back pain, management by a physician specializing in occupational medicine doesn't necessarily enhance recovery or shorten the time to return to work, suggests a study in the September 1 issue of the journal Spine.

Dr. Jos H. Verbeek and colleagues of the University of Amsterdam evaluated an early occupational health management program in 120 workers on sick leave for low back pain. One group of workers received early evaluation and management by an occupational medicine physician, specially trained in guidelines for the management of low back pain. Workers in the other group of workers were managed by their supervisors, as usual.

Surprisingly, management by the occupational physician did not significantly improve back pain outcomes. Median time off work was somewhat shorter for workers managed by the occupational physician: 51 days, compared with 62 days for workers managed by their supervisors.

Patients managed by the occupational physician actually had a higher rate of recurrent back pain--about 50 percent, compared with 25 percent for patients managed by supervisors. Most other back pain outcomes were similar between groups.

Several factors might have diluted the effects of the occupational health management program, the researchers suggest. Workers managed by supervisors were free to see the occupational physician if they chose; nearly one-fourth did so within the first 3 months after their injury.

In addition, more than one-third of workers assigned to see the occupational physician did not do so until after more than one month of sick leave. Furthermore, the participating occupational physicians did not always follow the guidelines for back pain management, which focus on early evaluation and encouragement of activity. Supervisors participating in the study were advised to stay in touch with the injured workers, permit them to return to work gradually, and refer them to their primary care doctor if necessary.

Back pain is a very frequent and costly occupational health problem. Finding ways of reducing sick leave and disability among workers with back injuries is one of the main challenges facing occupational physicians today.

However, at least as implemented in this study, management by an occupational physician did not reduce time off work or improve other outcomes in workers on sick leave for back pain. Workers who were simply managed by their supervisors recovered just as well as those managed by occupational physicians, and were less likely to have recurrent back injuries. Future studies should clarify the role of occupational physicians in managing workers with back pain, including active management of return to work after prolonged absences--longer than one month.