One-Year Follow-Up in Employees Sick-Listed Because of Low Back Pain: Randomized Clinical Trial Comparing Multidisciplinary and Brief Intervention Subgroup analyses on return to work in sick-listed employees with low back pain in a randomised trial comparing brief and multidisciplinary intervention Stay@Work: Participatory Ergonomics to prevent low back and neck pain among workers: design of a randomised controlled trial to evaluate the (cost-)effectiveness A Prospective Study of the Effectiveness of Early Intervention with High-risk Back-injured Workers—A Pilot Study Effectiveness of an at-work exercise program in the prevention and management of neck and low back complaints in nursery school teachers. A multifaceted workplace intervention for low back pain in nurses' aides: a pragmatic stepped wedge cluster randomised controlled trial Multidisciplinary Rehabilitation for Subacute Low Back Pain: Graded Activity or Workplace Intervention or Both?: A Randomized Controlled Trial Reducing sedentary behaviour to decrease chronic low back pain: the stand back randomised trial Effect of a multidisciplinary program for the prevention of low back pain in hospital employees: a randomized controlled trial. Effectiveness of a Back Pain Prevention Program: A Cluster Randomized Controlled Trial in an Occupational Setting Process evaluation of a participatory ergonomics programme to prevent low back pain and neck pain among workers Prediction model for unsuccessful return to work after hospital-based intervention in low back pain patients The economic evaluation of a participatory ergonomics programme to prevent low back and neck pain. In a controlled trial training general practitioners and occupational physicians to collaborate did not influence sickleave of patients with low back pain. Improving the care for people with acute low-back pain by allied health professionals (the ALIGN trial): A cluster randomised trial protocol Participatory ergonomics as a return-to-work intervention: a future challenge? Economic Evaluation of a Multi-Stage Return to Work Program for Workers on Sick-Leave Due to Low Back Pain
Study Design . R and omized clinical trial comparing two interventions in employees sick-listed 3 to 16 weeks because of low back pain ( LBP ) . Objective . To compare 1-year return to work ( RTW ) , pain , disability and physical and mental health dimensions in subjects offered a hospital-based multidisciplinary intervention or a brief intervention .  Summary of Background Data . Previous studies in sick-listed employees with LBP have indicated efficacy of both brief and more comprehensive multidisciplinary interventions . However , it remains unknown , which is the more effective , and which elements are instrumental in furthering RTW , and improving health . Methods . The brief intervention comprised clinical examination and advice offered by a rehabilitation physician and a physiotherapist . In the multidisciplinary intervention , this intervention was supplemented with the expertise of a team and the assignment of a case manager who drew up a rehabilitation plan in collaboration with the patient and the multidisciplinary team . One-year RTW was estimated by data from a comprehensive national data base of social transfer payments . Question naires were used to obtain baseline and 1-year data on Rol and Morris disability score , LBP Rating Scale , SF36 , and fear-avoidance . Results . A total of 351 patients were included and r and omized and 344 ( 98 % ) patients participated in all the consultations according to the study protocol . RTW was achieved by 125 ( 71.0 % ) participants in the multidisciplinary and 133 ( 76.0 % ) participants in the brief intervention group . The hazard ratio was 0.84 after adjustment for sex , age , smoking , compensation cl aims , disability score , and diagnosis ( 95 % confidence interval [ CI ] : 0.65–1.08,P = 0.18 ) . Multiple linear regression analysis displayed no differences in secondary outcomes , except for the mental health score ( SF36 ) , which was a little higher in the multidisciplinary intervention group than in the brief intervention group . Conclusion . Hospital-based multidisciplinary intervention may be no better than brief intervention to increase RTW and improve health in sick-listed employees with low back pain Background Multidisciplinary intervention is recommended for rehabilitation of employees sick-listed for 4 - 12 weeks due to low back pain ( LBP ) . However , comparison of a brief and a multidisciplinary intervention in a r and omised comparative trial of sick-listed employees showed similar return to work ( RTW ) rates in the two groups . The aim of the present study was to identify subgroups , primarily defined by work-related baseline factors that would benefit more from the multidisciplinary intervention than from the brief intervention . Methods A total of 351 employees sick-listed for 3 - 16 weeks due to LBP were recruited from their general practitioners . They received a brief or a multidisciplinary intervention . Both interventions comprised clinical examination and advice by a rehabilitation doctor and a physiotherapist . The multidisciplinary intervention also comprised assignment of a case manager , who made a rehabilitation plan in collaboration with the patient and a multidisciplinary team . Using data from a national data base , we defined RTW as no sickness compensation benefit disbursement for four consecutive weeks within the first year after the intervention . At the first interview in the clinic , it was ensured that sick leave was primarily due to low back problems . Question naires were used to obtain data on health , disability , demographic and workplace-related factors . Cox hazard regression analyses were used with RTW as outcome measure and hazard rate ratios ( HRR = HRmultidisciplinary/HRbrief ) were adjusted for demographic and health-related variables . An interaction term consisting of a baseline variable*intervention group was added to the multivariable regression model to analyse whether the effects of the interventions were moderated by the baseline factor . Subsequently , a new study was performed that included 120 patients who followed the same protocol . This group was analyzed in the same way to verify the findings from the original study group . Results The multidisciplinary intervention group ensured a quicker RTW than the brief intervention group in a subgroup with low job satisfaction , notably when cl aim ants were excluded . The opposite effect was seen in the subgroup with high job satisfaction . When cl aim ants were excluded , the effect was also in favour of the multidisciplinary intervention in subgroups characterised by no influence on work planning and groups at risk of losing their job . Inversely , the effect was in favour of the brief intervention in the subgroups who were able to influence the planning of their work and who had no risk of losing their job due to current sick leave . Interaction analysis of the data in the new study displayed similar or even more pronounced differences between subgroups in relation to intervention type . Conclusions Multidisciplinary intervention seemed more  effective than brief intervention in subgroups of patients with low job satisfaction , no influence on work planning and feeling at risk of losing their jobs due to their sick leave as compared with subgroups not fulfilling these criteria Background Low back pain ( LBP ) and neck pain ( NP ) are a major public health problem with considerable costs for individuals , companies and society . Therefore , prevention is imperative . The Stay@Work study investigates the (cost-)effectiveness of Participatory Ergonomics ( PE ) to prevent LBP and NP among workers . Methods In a r and omised controlled trial ( RCT ) , a total of 5,759 workers working at 36 departments of four companies is expected to participate in the study at baseline . The departments consisting of about 150 workers are pre-stratified and r and omised . The control departments receive usual practice and the intervention departments receive PE . Within each intervention department a working group is formed including eight workers , a representative of the management , and an occupational health and safety coordinator . During a one day meeting , the working group follows the steps of PE in which the most important risk factors for LBP and NP , and the most adequate ergonomic measures are identified on the basis of group consensus . The implementation of ergonomic measures at the department is performed by the working group . To improve the implementation process , so-called ' ergocoaches ' are trained . The primary outcome measure is an episode of LBP and NP . Secondary outcome measures are actual use of ergonomic measures , physical workload , psychosocial workload , intensity of pain , general health status , sick leave , and work productivity . The cost-effectiveness analysis is performed from the societal and company perspective . Outcome measures are assessed using question naires at baseline and after 6 and 12 months . Data on the primary outcome as well as on intensity of pain , sick leave , work productivity , and health care costs are collected every 3 months . Discussion Prevention of LBP and NP is beneficial for workers , employers , and society . If the intervention is proven (cost-)effective , the intervention can have a major impact on LBP and NP prevention and , thereby , on work disability prevention . Results are expected in 2010.Trial registration IS RCT Introduction It was postulated that workers , at the sub-acute stage after injury , respond differently to clinical and occupational interventions offered in a workers ’ compensation environment . Individual worker risk of disability , it was further believed , would influence the effectiveness of early intervention . The objective of the current pilot study was to evaluate return to work ( RTW ) outcomes following proactive , combined clinical , occupational and case management-based interdisciplinary early intervention , provided in a workers ’ compensation environment 4–10 weeks of onset of back pain , to workers with medium and high risk for disability . Methods The project was a controlled study comparing conventional workers ’ compensation case management with integrated , interdisciplinary and multimodal early intervention ( hereinafter referred to as “ EI ” ) . At baseline , risk status was determined by a vali date d Risk for Disability Question naire by Carragee et al. ( Spine 5(1):24–35 , 2005 ) . Seventeen workers at high risk of protracted disability and 20 workers at moderate risk of disability received conventional case management , and 17 workers assessed at high risk of protracted disability and 18 workers at moderate risk of disability received the Early Intervention . Results At 3 months post back pain onset , no statistically significant differences were identified in RTW outcomes between conventional case management and the Early Intervention . However , by 6 months post back pain onset , workers at high risk of work disability who received the Early Intervention were significantly more likely to RTW than high risk workers who received conventional case management . In contrast , moderate risk workers continued to exhibit no statistically significant differences in RTW outcomes . Conclusion Multimodal Early Intervention in the workers ’ compensation case management context is likely effective for workers with sub-acute back pain who are at high risk of occupational disability . The comprehensive Early Intervention is , however , likely redundant for workers who are not at high risk for disability and should not be applied indiscriminately . Further studies are required to determine longer-term Early Intervention outcomes , and to replicate the findings using a r and omized control design . Also , with a larger sample size , it will be possible to determine predictors of occupational outcomes The aim of the study was to determine the effectiveness of an extension-oriented exercise program in the prevention and management of low back/neck pain in nursery school teachers . A Cluster R and omized Controlled Trial was utilized . Seventy-one nursery school teachers working in nine school buildings were r and omly divided into two groups , with each school as a unit of r and omization . All the teachers in both groups received an ergonomic brochure ; teachers in the experimental group also received an extension-oriented exercise program , conducted by a physical therapist . Data were collected at baseline and at a two-month follow-up . The primary outcome measure recorded was the level of disability ( Rol and Morris Disability Question naire and Oswestry Disability Index ) , while secondary outcome measure included the evaluation of cervical and lumbar physical discomfort ( Visual Analogue Scale ) . At follow-up , a significant improvement was registered in the experimental group as compared to the control group for all the outcomes evaluated . In conclusion an extension-oriented exercise program may be a useful strategy to prevent low back and neck complaints and to reduce consequent LBP functional disability among nursery school teachers Abstract This study established the effectiveness of a workplace multifaceted intervention consisting of participatory ergonomics , physical training , and cognitive – behavioural training ( CBT ) for  low back pain ( LBP ) . Between November 2012 and May 2014 , we conducted a pragmatic stepped wedge cluster r and omised controlled trial with 594 workers from eldercare workplaces ( nursing homes and home care ) r and omised to 4 successive time periods , 3 months apart . The intervention lasted 12 weeks and consisted of 19 sessions in total ( physical training [ 12 sessions ] , CBT [ 2 sessions ] , and participatory ergonomics [ 5 sessions ] ) . Low back pain was the outcome and was measured as days , intensity ( worst pain on a 0 - 10 numeric rank scale ) , and bothersomeness ( days ) by monthly text messages . Linear mixed models were used to estimate the intervention effect . Analyses were performed according to intention to treat , including all eligible r and omised participants , and were adjusted for baseline values of the outcome . The linear mixed models yielded significant effects on LBP days of −0.8 ( 95 % confidence interval [ CI ] , −1.19 to −0.38 ) , LBP intensity of −0.4 ( 95 % CI , −0.60 to −0.26 ) , and bothersomeness days of −0.5 ( 95 % CI , −0.85 to −0.13 ) after the intervention compared with the control group . This study shows that a multifaceted intervention consisting of participatory ergonomics , physical training , and CBT can reduce LBP among workers in eldercare . Thus , multifaceted interventions may be relevant for improving LBP in a working population Study design . Population -based r and omized controlled trial . Objective . To assess the effectiveness of workplace intervention and grade d activity , separately and combined , for multidisciplinary rehabilitation of low back pain ( LBP ) . Summary of Background Data . Effective components for multidisciplinary rehabilitation of LBP are not yet established . Methods . Participants sick-listed 2 to 6 weeks due to nonspecific LBP were r and omized to workplace intervention ( n = 96 ) or usual care ( n = 100 ) .  Workplace intervention consisted of workplace assessment , work modifications , and case management involving all stakeholders . Participants still sick-listed at 8 weeks were r and omized for grade d activity  ( n = 55 ) or usual care ( n = 57 ) . Grade d activity comprised biweekly 1-hour exercise sessions based on operant-conditioning principles . Outcomes were lasting return to work , pain intensity and functional status , assessed at baseline , and at 12 , 26 , and 52 weeks after the start of sick leave . Results . Time until return to work for workers with workplace intervention was 77 versus 104 days ( median ) for workers without this intervention ( P = 0.02 ) . Workplace intervention was effective on return to work ( hazard ratio = 1.7 ; 95 % CI , 1.2–2.3 ; P = 0.002 ) .  Grade d activity had a negative effect on return to work ( hazard ratio = 0.4 ; 95 % CI , 0.3–0.6 ; P < 0.001 ) and functional status . Combined intervention had no effect . Conclusion . Workplace intervention is advised for multidisciplinary rehabilitation of subacute LBP . Grade d activity or combined intervention is not advised Objective The St and Back study evaluated the feasibility and effects of a multicomponent intervention targeting reduced prolonged sitting and pain self-management in desk workers with chronic low back pain ( LBP ) . Methods This r and omised controlled trial recruited 27 individuals with chronic LBP , Oswestry Disability Index ( ODI ) > 10 % and desk jobs ( sitting ≥20 hours/week ) . Participants were r and omised within strata of ODI ( > 10%–<20 % , ≥20 % ) to receive bimonthly behavioural counselling ( in-person and telephone ) , a sit-st and desk attachment , a wrist-worn activity-prompting device and cognitive behavioural therapy for LBP self-management or control . Self-reported work sitting time , visual analogue scales ( VAS ) for LBP and the ODI were assessed by monthly , online question naires and compared across intervention groups using linear mixed models . Results Baseline mean ( SD ) age was 52 ( 11 ) years , 78 % were women , and ODI was 24.1 (10.5)% . Across the 6-month follow-up in models adjusted for baseline value , work sitting time was 1.5 hour/day ( P<0.001 ) lower comparing intervention to controls . Also across follow-up , ODI was on average 8 points lower in intervention versus control ( P=0.001 ) . At 6 months , the relative decrease in ODI from baseline was 50 % in intervention and 14 % in control ( P=0.042 ) . LBP from VAS was not significantly reduced in intervention versus control , though small-to-moderate effect sizes favouring the intervention were observed ( Cohen ’s d ranged from 0.22 to 0.42 ) . Conclusion An intervention coupling behavioural counselling targeting reduced sedentary behaviour and pain self-management is a translatable treatment strategy that shows promise for treating chronic LBP in desk-bound employees . Trial registration number NCT0224687 ; Pre- results BACKGROUND Hospital workers with physically dem and ing jobs are at risk for developing recurrent LBP . There is a lack of studies evaluating multidisciplinary prevention of  low back pain ( LBP ) in hospital workers . OBJECTIVE This r and omized controlled trial evaluates the effect of a multidisciplinary prevention program , focusing on a client-centred approach , on hospital workers at risk for developing LBP . METHODS Caregiving hospital workers were allocated to an experimental ( 12-week lasting multidisciplinary prevention program ) or control group ( no intervention ) . They were evaluated prior to the intervention and after a 6 months follow-up period . Primary outcome measures included incidence of LBP , work absenteeism and general health . Secondary outcomes included daily physical activity , job satisfaction and coping strategies . RESULTS A significant improvement was seen for passive coping after 6 months follow-up , but no significant differences were observed between groups in primary or other secondary outcome measures ( p > 0.05 ) . CONCLUSIONS A multidisciplinary prevention program fitting into a bio-psychosocial context may not have been intensive enough to promote a change in daily habitudes , and had no effect on work absenteeism , incidence of LBP or general health . Further research should determine whether prevention of LBP is possible in caregiving personnel Study Design . A cluster r and omized controlled trial and economic evaluation with a 12-month follow-up and with work department as the unit of r and omization . Objective . To evaluate the effectiveness of a prevention program for  low back pain ( LBP ) in an occupational setting with an economic evaluation . Summary of Background Data . LBP accounts for high economic costs in Western societies . Little is known on the effectiveness and related costs and savings of prevention programs for LBP . Methods . The study population consisted of workers in physically dem and ing jobs from 9 large companies located throughout The Netherl and s. In each company , 2 comparable work units were r and omly allocated , result ing in 18 clusters with 258 workers assigned to the intervention group and 231 workers to the control group . Results . Results in our study did not show significant differences in effects or costs savings of the program . Indirect costs related to work absence and productivity losses accounted for the majority ( 84 % ) of total costs due to LBP . Conclusions . This study provides no evidence for the adoption of this worksite prevention program for LBP Background Both low back pain ( LBP ) and neck pain ( NP ) are major occupational health problems . In the workplace , participatory ergonomics ( PE ) is frequently used on musculoskeletal disorders . However , evidence on the effectiveness of PE to prevent LBP and NP obtained from r and omised controlled trials ( RCTs ) is scarce . This study evaluates the process of the Stay@Work participatory ergonomics programme , including the perceived implementation of the prioritised ergonomic measures . Methods This cluster- RCT was conducted at the departments of four Dutch companies ( a railway transportation company , an airline company , a steel company , and a university including its university medical hospital ) . Directly after the r and omisation outcome , intervention departments formed a working group that followed the steps of PE during a six-hour working group meeting . Guided by an ergonomist , working groups identified and prioritised risk factors for LBP and NP , and composed and prioritised ergonomic measures . Within three months after the meeting , working groups had to implement the prioritised ergonomic measures at their department . Data on various process components ( recruitment , reach , fidelity , satisfaction , and implementation components , i.e. , dose delivered and dose received ) were collected and analysed on two levels : department ( i.e. , working group members from intervention departments ) and participant ( i.e. , workers from intervention departments ) . Results A total of 19 intervention departments ( n = 10 with mental workloads , n = 1 with a light physical workload , n = 4 departments with physical and mental workloads , and n = 4 with heavy physical workloads ) were recruited for participation , and the reach among working group members who participated was high ( 87 % ) . Fidelity and satisfaction towards the PE programme rated by the working group members was good ( 7.3 or higher ) . The same was found for the Stay@Work ergocoach training ( 7.5 or higher ) . In total , 66 ergonomic measures were prioritised by the working groups . Altogether , 34 % of all prioritised ergonomic measures were perceived as implemented ( dose delivered ) , while the workers at the intervention departments perceived 26 % as implemented ( dose received ) . Conclusions PE can be a successful method to develop and to prioritise ergonomic measures to prevent LBP and NP . Despite the positive rating of the PE programme the implementation of the prioritised ergonomic measures was lower than expected . Trial registration Current Controlled Trials IS RCT Background Many studies on low back pain ( LBP ) have identified prognostic factors , but prediction models for use in secondary health care are not available . The purpose of this cohort study , based on a r and omised clinical study , was to identify risk factors for unsuccessful return to work ( U-RTW ) in sick-listed LBP patients with or without radiculopathy and to vali date a prediction model for U-RTW . Methods 325 sick-listed LBP patients with or without radiculopathy were included in an intervention study and followed for one year . Afterwards , 117 other LBP patients were recruited similarly , included in a validation study and also followed for one year . All patients were subjected to identical procedures and interventions and received a brief intervention by the same rehabilitation doctor and physiotherapist . Half of them received case manager guidance within a multidisciplinary setting . At baseline , they completed a question naire and went through a clinical low-back examination . Sciatica was investigated by magnetic resonance imaging ( MRI ) . U-RTW was registered in a national data base both initially and at 1-year . Results Neither initial U-RTW ( 24.0 % ) nor one-year U-RTW ( 38.2 % ) were statistically significantly different in the two intervention groups nor in patients with and without radiculopathy . Multivariate logistic regression analysis identified two clinical and five psychosocial baseline predictors for one-year U-RTW ( primary outcome ) . The clinical predictors included pain score ( back+leg pain ) and side-flexion . The five psychosocial predictors included ‘ bodily distress ’ ‘ low expectations of RTW ’ , ‘ blaming the work for pain ’ , ‘ no home ownership ’ and ‘ drinking alcohol less than once/month ’ . These predictors were not statistically significantly different in patients with and without radiculopathy , and they also predicted initial U-RTW ( secondary outcome ) . Obesity and older age were only supplementary predictors in patients with radiculopathy . A prediction model was established and tested in the validation study group . The model predicted one-year U-RWT in patients with intermediate and high risk , but only partially in patients with low risk . The model predicted all three risk categories in initial U-RTW . Conclusions A prediction model combining baseline clinical and psychosocial risk factors predicted patients with low , intermediate and high risk for unsuccessful return to work , both initially and at 1-year This study was an economic evaluation conducted alongside a cluster r and omised controlled trial with a follow-up of 12 months . The aim was to evaluate the cost-effectiveness and cost-benefit of the Stay@Work Participatory Ergonomics programme ( PE ) compared to a control group ( no PE ) . In total , 37 departments ( n=3047 workers ) were r and omised into either the intervention ( PE ) or control group ( no PE ) . During a meeting , working groups followed the steps of PE , and composed and prioritized ergonomic measures aim ed to prevent low back pain ( LBP ) and neck pain ( NP ) . Working groups had to implement the ergonomic measures within three months in their department . Cost data included those directly related to LBP and NP . Cost-effectiveness analyses ( CEA ) and cost-benefit analyses ( CBA ) were performed . After 12 months , health care costs and costs of productivity losses were higher in the intervention group than in the control group ( the mean total cost difference was $ /euro$127 ; 95 % CI $ /euro$-164 - $ /euro$418 ) . From a societal perspective , the CEA showed that PE was not cost-effective compared to control for LBP and NP prevalence , work performance , and sick leave . The CBA from a company perspective showed a monetary loss of $ /euro$78 per worker . The PE programme was neither cost-effective nor cost-beneficial on any of the effect measures OBJECTIVE The objective of this study was to determine the effectiveness of a training to increase collaboration between general practitioners and occupational health physicians in the treatment of patients with low back pain ( LBP ) because more collaboration might improve a patient 's recovery and shorten sick leave . METHODS In a controlled trial , the intervention in one region was compared with usual care in a control region . Participating physicians enrolled patients with LBP on sick leave for 3 - 12 weeks . Patients filled out three question naires : at inclusion , at 3 months , and at 6 months . Information on sick leave was gathered from occupational health services . All analyses were performed on an intention-to-treat basis . RESULTS Fifty-six patients with LBP were enrolled in each region . There was little collaboration between physicians during the project . Patients in the intervention region returned to work significantly later ( P=.005 ) but were significantly more satisfied with their occupational health physician ( P=.01 ) . No differences were found between the intervention and control patients for pain , disability , quality of life , and medical consumption . CONCLUSION Our study does not show a positive effect of the training to increase collaboration between general practitioners and occupational health physicians . The training may not have improved collaboration enough to influence the prognosis of LBP Background Variability between clinical practice guideline recommendations and actual clinical practice exists in many areas of health care . A 2004 systematic review examining the effectiveness of guideline implementation interventions concluded there was a lack of evidence to support decisions about effective interventions to promote the uptake of guidelines . Further , the review recommended the use of theory in the development of implementation interventions . A clinical practice guideline for the management of acute low-back pain has been developed in Australia ( 2003 ) . Acute low-back pain is a common condition , has a high burden , and there is some indication of an evidence - practice gap in the allied health setting . This provides an opportunity to develop and test a theory-based implementation intervention which , if effective , may provide benefits for patients with this condition . Aims This study aims to estimate the effectiveness of a theory-based intervention  to increase allied health practitioners ' ( physiotherapists and chiropractors in Victoria , Australia ) compliance with a clinical practice guideline for acute non-specific low back pain ( LBP ) , compared with providing practitioners with a printed copy of the guideline . Specifically , our primary objectives are to establish if the intervention is effective in reducing the percentage of acute non-specific LBP patients who are either referred for or receive an x-ray  , and improving mean level of disability for patients three months post-onset of acute LBP . Methods The design of the study is a cluster r and omised trial . Restricted r and omisation was used to r and omise 210 practice s ( clusters ) to an intervention or control group . Practitioners in the control group received a printed copy of the guideline . Practitioners in the intervention group received a theory-based intervention developed to address prospect ively identified barriers to practitioner compliance with the guideline . The intervention primarily consisted of an educational symposium .  Patients aged 18 years or older who visit a participating practitioner for acute non-specific LBP of less than three months duration over a two-week data collection period , three months post the intervention symposia , are eligible for inclusion . Sample size calculations are based on recruiting between 15 to 40 patients per practice . Outcome assessors will be blinded to group allocation . Trial registration Australian New Zeal and Clinical Trials Registry ACTRN12609001022257 ( date registered 25th November 2009 BACKGROUND Participatory ergonomics ( PE ) are often applied for prevention of low back pain ( LBP ) . In this pilot- study , a PE-program is applied to the disability management of workers sick listed due to LBP . METHODS The process , implementation , satisfaction , and barriers for implementation concerning the PE-program were analyzed quantitatively and qualitatively for 35 workers sick listed 2 - 6 weeks due to LBP and their ergonomists . RESULTS Two-hundred- and -seventy ergonomic solutions were proposed to the employer . They were targeted more at work design and organization of work ( 58.9 % ) than at workplace and equipment design ( 38.9 % ) . They were planned mostly on a short-term basis ( 74.8 % ) . Almost half ( 48.9 % ) of the solutions for work adjustment were completely or partially implemented within 3 months after the first day of absenteeism . Most workers were satisfied about the  PE-program  ( median score 7.8 on a 10-point scale ) and reported a stimulating effect on return-to-work ( 66.7 % ) . Main obstacles to implementation were technical or organizational difficulties ( 50.0 % ) and physical disabilities of the worker ( 44.8 % ) . CONCLUSIONS This study suggests that compliance , acceptance , and satisfaction related to the PE-program were good for all participants . Almost half of the proposed solutions were implemented Objective : To evaluate the cost-effectiveness and cost-utility of a return to work ( RTW ) program for workers on sick-leave due to low back pain ( LBP ) , comparing a workplace intervention implemented between 2 to 8 weeks of sick-leave with usual care , and a clinical intervention after 8 weeks of sick-leave with usual care . Design : Economic evaluation alongside a r and omised controlled trial ( RCT ) . Study population : Workers sick-listed for a period of 2 to 6 weeks due to LBP . Interventions : 1 . workplace assessment , work modifications and case management ) . 2 . physiotherapy based on operant behavioural principles . 3 . usual care : provided by an occupational physician . Outcomes : The primary outcome was return to work ( RTW ) . Other outcomes were pain intensity , functional status , quality of life and general health . The economic evaluation was conducted from a societal perspective . Outcomes were assessed at baseline ( after 2–6 weeks on sick-leave ) , and 12 weeks , 26 weeks , and 52 weeks after the first day of sick-leave . Results : The workplace intervention group returned to work 30.0 days ( 95 % CI=[3.1 , 51.3 ] ) earlier on average than the usual care group at slightly higher direct costs ( ratio of 1 day : € 19 ) . Workers in the clinical intervention group that had received usual care in the first 8 weeks returned to work 21.3 days ( 95 % CI= [ −74.1 , 29.2 ] ) later on average . The group that had received the workplace intervention in the first 8 weeks and the clinical intervention after 8 weeks returned to work 50.9 days ( 95 % CI=[−89.4 , −2.7 ] ) later on average . A workplace intervention was more effective than usual care in RTW at slightly higher costs and was equally effective as usual care at equal costs on other outcomes . A clinical intervention was less effective than usual care and associated with higher costs . Conclusion : The workplace intervention results in a safe and faster RTW than usual care at reasonable costs for workers on sick-leave for two to six weeks due to LBP
The key features of the program include ; having trained personnel coordinate the RTW process , identifying and ranking barriers and solutions to RTW from the perspective of all important stakeholders , mediating practical solutions at the workplace and , empowering the injured worker in RTW decision-making .
Background Despite over 2 decades of research , the ability to prevent  work-related low back pain ( LBP ) and disability  remains elusive .
Recent research suggests that interventions that are focused at the workplace and incorporate the principals of participatory ergonomics and return-to-work ( RTW ) coordination can improve RTW and reduce disability following a work-related back injury .
Workplace interventions or programs to improve RTW  are difficult to design and implement given the various individuals and environments involved , each with their own unique circumstances .
Intervention mapping provides a framework for design ing and implementing complex interventions or programs .
The objective of this study is to design a best evidence RTW program for occupational LBP tailored to the Ontario setting using an intervention mapping approach .