Occupational Medicine Practice Guidelines, 2nd Edition: Evaluation and Management of Common Health Problems and Functional Recovery in Workers, 2008 Revision

Abstract

The American College of Occupational and Environmental Medicine (ACOEM) first published its Occupational Medicine Practice Guidelines (ACOEM Practice Guidelines or Guidelines) in 1997 to identify effective treatment strategies for injured workers. The ACOEM Practice Guidelines are evidence-based guidelines that focus on returning acutely injured employees to work within 90 days of injury. Given the rising societal expectations for quality of care in addition to the increasing utilization of standardized medical guidelines by state workers’ compensation systems across the nation, ACOEM has committed itself to updating individual chapters on a 3-year rotating basis. This version of the second edition of the Guidelines includes revisions to the chapters on Elbow Disorders, Low Back Disorders, and Chronic Pain. ACOEM also performs an annual review of the literature to identify recently published studies that would significantly impact clinical practice and necessitate earlier revisions to the book to ensure their recommendations remain state-of-the-art. The textbook is divided into two major sections. Section one reviews the foundations of occupational medicine practice and includes chapters on prevention, initial assessment and documentation, initial treatment strategies, causation and work-relatedness, disability prevention, chronic pain, and independent medical examinations. The chronic pain guidelines are noteworthy in that they include a detailed review of more than 20 medications commonly used to treat patients with chronic pain, recommendations regarding the use of appliances and alternative therapies, and efficacy outcomes regarding various injection therapies. Although expertly written and informative, it is unclear why several chapters in this section of the book fail to include in-text citations for material that corresponds to the reference list at the end of the chapter. The second section of the Guidelines focuses on disorders with the chapters organized by body part, e.g. neck and upper back, lower back, shoulder, elbow and other physical disorders. This section also includes a chapter on stressrelated disorders. Most of the chapters follow the same general format in terms of content, i.e. general approach and basic principles, initial assessment, medical history, physical examination, special studies and diagnostic considerations, work-relatedness, initial care, activity modification, work activities, follow-up visits, medications and surgical considerations, referral to other healthcare professionals, rehabilitation, algorithms, and references. This format allows for easy access of desired information. The ACOEM Practice Guidelines are well written and organized, but not without its short-comings and controversies. It is interesting that the Guidelines are marketed as an authoritative evidence-based document; however, close scrutiny of the book’s analytic methodology suggests that the final product is ultimately that of a consensus document. Not unexpectedly, the ACOEM Practice Guidelines have been scrutinized by several professional organizations. A joint position statement published by the American Academy of Pain Medicine, American Society of Interventional Pain Physicians, International Spine Intervention Society, Neuromodulation Therapy Access Coalition, and North American Neuromodulation cited several serious flaws in the ACOEM Practice Guidelines such as limited expert review of pain-related tests, therapies and interventions, incomplete and outdated evidence, inconsistencies in the application of ACOEM’s evidence-ranking B. A. Barron (&) Division of Occupational and Environmental Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA e-mail: bruce_barron@urmc.rochester.edu