Dr. Birgitte M. Blatter

1. Work related interventions improving return-to-work of workers with MSDs and some Dutch examples Dr. Birgitte M. Blatter

2. Work related interventions improving return-to-work of workers with MSDs and some Dutch examples Content • Work-related musculoskeletal disorders: Back to work report (Topic Centre Working Environment: Agency, HSL, TNO, Prevent, Eurogip, FIOH) • Examples from Netherlands: ongoing projects of • an insurance company • a rehabilitation center • an occupational health service Lighten the Load, workshop return-to-work

3. Work-related musculoskeletal disorders: Back to work report • Evaluate the effectiveness of interventions in the workplace • Scientific literature • Back pain / upper limb pain / lower limb pain • (Policy initiatives) Lighten the Load, workshop return-to-work

4. Work-related musculoskeletal disorders: Back to work report: Back pain • Modified work • Lumbar supports • Exercise therapy • Back schools • Behavioural treatment • Multidisciplinary approach • Acute /sub-acute / chronic back pain Lighten the Load, workshop return-to-work

5. ++ = high quality evidence + = moderate quality evidence Lighten the Load, workshop return-to-work

6. Work-related musculoskeletal disorders: Back to work report: Neck and upper limb pain • Technical / mechanical interventions • Psychosocial interventions • Exercise therapy • Multidisciplinary approach Lighten the Load, workshop return-to-work

7. ++ = high quality evidence + = moderate quality evidence +/- = limited evidence Lighten the Load, workshop return-to-work

8. Work-related musculoskeletal disorders: Back to work report: Lower limb pain • No literature • Non-occupational interventions • General population • Exercise therapy • Other (magnetic bracelets, thermotherapy, ultrasound) Lighten the Load, workshop return-to-work

9. ++ = high quality evidence + = moderate quality evidence - = no studies or inconclusive results Lighten the Load, workshop return-to-work

10. Work-related musculoskeletal disorders: Back to work report: Conclusions • Multidisciplinary approach seems promising (low back and neck and upper limb) • Scientific evidence limited regarding neck and upper limb pain and no evidence regarding lower limb pain • Evaluation of workplace interventions should probably adopt different criteria than evaluation of medical treatment • Policy makers and employers should not be discouraged from taking action because there is no 100% proof it works Lighten the Load, workshop return-to-work

11. Work-related musculoskeletal disorders: Examples from the Netherlands Examples from Netherlands: ongoing projects of • an insurance company that refers self employed persons with MSDs to physical training a • a rehabilitation center that developed a website • an occupational health service that started with implementing the Sherbrooke model (participative approach to implement work adaptations) Lighten the Load, workshop return-to-work

12. Work-related musculoskeletal disorders: Physical training for insurance company Fysioké project • Aim: evaluate the effectiveness of physical training in self-employed • Intervention: • tailor-made fitness training (cardiovascular, strengthening, relaxation) • cognitive behavioural component • training of work tasks (only in South) • Methods: randomized controlled trial, inclusion via claim evaluators at the insurance company, North and South Lighten the Load, workshop return-to-work

13. Work-related musculoskeletal disorders: Physical training for insurance company Results: Lighten the Load, workshop return-to-work

14. North 1,0 Physical training Usual care 0,8 Censored data Censored data 0,6 Cum Survival 0,4 P-value logrank test = 0,02 0,2 0,0 0 50 100 150 200 Total days of disability after 6 months Lighten the Load, workshop return-to-work

15. South 1,0 Physical training Usual care 0,8 Censored Censored 0,6 Cum Survival 0,4 P-value logrank test = 0,70 0,2 0,0 0 50 100 150 200 Total days of disability after 6 months Lighten the Load, workshop return-to-work

16. Work-related musculoskeletal disorders: rehabilitation center www.snelbeter.nl project • Aim: develop website for workers with neck and back pain and their OHPs and evaluate the effectiveness • Intervention = website • Checklists/questionnaires • Exercises • Diary • Information to reassure worker • Feedback to OHP • Methods: RCT, sickness absence, consultation with OHP, inclusion via 80 OHPs Lighten the Load, workshop return-to-work

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18. Work-related musculoskeletal disorders: rehabilitation center Results: • Inclusion period was extended drastically • Amount of OHPs was extended drastically • Only 23 cases and 23 controls (aim 64 and 64) • Project stopped ! • Process evaluation • Takes time during consultation / OHPs forget about study ? • System to include patients not user-friendly? • Satisfaction about website itself? • Few workers with sickness absence in a period that long Lighten the Load, workshop return-to-work

19. Work-related musculoskeletal disorders: occupational health service Implementation of participative work adaptations: • Back disorders (general policy) • Mental disorders (project basis) Lighten the Load, workshop return-to-work

20. Work-related musculoskeletal disorders: conclusions from the Netherlands • Legislation and regulations have changed • Responsibility for costs has shifted from government to employers • Three examples of how insurers, rehabilitation centers and occupational health services have anticipated on this situation Lighten the Load, workshop return-to-work