The following factors were found to have consistent , but limited , support as regards their influence on the risk for sick leave due to back and neck disorders : ( a ) heavy physical workload , bent or twisted working position , and low work satisfaction increases the risk for short-term and long-term sick leave ; ( b ) specific back diagnoses and previous sick leave due to back disorders increases the risk for short-term and long-term sick leave ; ( c ) female gender , smoking , exposure to vibration , and deficient social support were not found to significantly increase the risk for short-term and long-term sick leave ; ( d ) self-reported pain and functional impairments were associated with a high risk for long-term sick leave ; ( e ) longer employment periods reduced the risk for short-term sick leave ; ( f ) perceived dem and s at work did not influence short-term sick leave ; ( g ) female gender and higher age increases the risk for disability pension
Coordination of Primary Health Care for Back Pain: A Randomized Controlled Trial
Study Design . A r and omized controlled trial comparing usual care with a program for the coordination of primary health care ( CORE ) for the treatment of subacute low-back pain patients . Objectives . To measure the effectiveness of the CORE program  as a mean for implementing clinical practice guidelines for low-back pain in an urban community . Summary of Background Data . Clinical practice guidelines have been developed for primary care physicians and patients on the clinical management of low-back pain . The implementation of the guidelines in a large community is difficult with the multiplicity of medical and nonmedical back care providers and products . The CORE program was design ed to make the guidelines fit in this complex environment . Methods . One hundred ten workers compensated for low-back pain for 4 to 8 weeks in metropolitan Montreal were r and omized in two groups : usual care ( N=56 ) and the CORE program ( N=54 ) . Coordination of primary health care was performed by two primary care physicians and a nurse in liaison with the treating physicians , and included a complete examination , recommendations for the clinical management , and support to carry out the recommendations . All workers were followed for 6 months . Back pain and functional status were assessed at baseline , 3 months , and 6 months . Results . In the 6-month follow-up , the CORE group returned to work 6.6 days ( st and ard error = 8.9 ) quicker than the control group , a difference that was not statistically significant . However , the CORE group showed a sustained improvement in pain and functional status with two-fold differences at the end of the 6 months of follow-up . This represented nine points on the Oswestry scale ( P = 0.02 ) and 12 points on the Quebec Back Pain Disability Scale ( P = 0.01 ) . The CORE group also used three times less specialized imaging tests of the spine at 3 months ( P < 0.01 ) and exercised twice as much at 6 months ( P < 0.05 ) than the controls . Conclusions . The therapeutic results for workers with low-back pain could be improved by implementing the clinical practice guidelines with primary care physicians in a large community , without delaying the return to work . The CORE intervention for back pain patients ishighly relevant to primary care practice . It is simple in its application , flexible to accommo date physicians ’ and patients ’ preferences in health care , and it is effective on patients ’ clinical outcome
The following factors were found to have consistent , but limited , support as regards their influence on the risk for sick leave due to back and neck disorders : ( a ) heavy physical workload , bent or twisted working position , and low work satisfaction increases the risk for short-term and long-term sick leave ; ( b ) specific back diagnoses and previous sick leave due to back disorders increases the risk for short-term and long-term sick leave ; ( c ) female gender , smoking , exposure to vibration , and deficient social support were not found to significantly increase the risk for short-term and long-term sick leave ; ( d ) self-reported pain and functional impairments were associated with a high risk for long-term sick leave ; ( e ) longer employment periods reduced the risk for short-term sick leave ; ( f ) perceived dem and s at work did not influence short-term sick leave ; ( g ) female gender and higher age increases the risk for disability pension