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The Dutch multidisciplinary occupational health guideline to enhance work participation among low back pain and lumbosacral radicular syndrome patients
Luites JWH, Kuijer PPFM, Hulshof CTJ, Kok R, Langendam MW, Oosterhuis T, Anema JR, Lapre-Utama VP, Everaert CPJ, Wind H, Smeets RJEM, van Zaanen Y, Hoebink EA, Voogt L, de Hoop W, Boerman DH, Hoving JL [Netherlands Society of Occupational Medicine, Dutch Society of Insurance Medicine, Dutch Association of Medical Officers in Private Insurances, Netherlands Society of Physical and Rehabilitation Medicine, Dutch Association of Physiotherapists Working in Occupational Health and Ergonomics, Dutch Association for Patients With Back Problems, Dutch Association for Labour Experts, Netherlands Society for Neurology]
Journal of Occupational Rehabilitation 2022 Sep;32(3):337-352
practice guideline

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.

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