Return to work after sickness absence due to back disorders - A systematicreview on intervention strategies

Objectives: The aim was to review the literature with regard to the effecti veness of intervention programmes for the prevention of aggravation of back disorders or prolonged duration of sickness absence. Methods: A systematic search of the literature was performed using three groups of key words and inclusion/exclusion criteria. Effectiveness was evaluated using two measur es: the difference between intervention and referent groups in return to wo rk, and the fraction of sickness absence among referent groups that could b e prevented if these referents had undergone the same intervention (prevent able Fraction). Results: Twelve articles with quantitative information on t he effect of ergonomic interventions on return to work were included. In ei ght studies, introduction of a back-school programme was the preferred inte rvention, combining exercise and functional conditioning, and training in w orking methods and lifting techniques. III seven out of eight back-school s tudies, return to work was significantly better in the intervention group. Intervention after 60 days, in the subacute phase of back pain. showed the most promising results. In these studies the preventable fraction varied be tween -11% and 80%, largely depending on the stage and phase of back disord ers and the time of follow-up. The success of intervention also depended on the profile of the referents when left untampered. In all studies complian ce during the intervention was fairly good, but there was a lack of informa tion on sustainability of the intervention during the follow-up and on recu rrence of back complaints and consequent sickness absence. Conclusions: Few studies were performed to assess the outcome return to work after ergonomi c intervention. However, there is evidence that intervention in the subacut e phase of back pain is preferable. Future intervention studies should addr ess intervention sustainability and recurrence of sickness absence due to b ack pain over at least a 1-year follow-up period.