Work-related Pain Research Articles

Exploring the Influence of Clinical and Classroom Training on Advocacy for Safe Patient Handling Practices Among Student Physical Therapists

BACKGROUND AND PURPOSEOver the last 20 years in the USA, concerns regarding safe patient handling (SPH) have received increased attention among health professionals performing patient handling tasks.1,2 Olkowski and Stolfi3 recently surveyed 192 acute care physical therapists (PTs) and found that 91.1% of those who responded to the survey are trained to use SPH equipment and practices and have positive perceptions regarding SPH. SPH can be defined as the judicious use of assistive technology (eg, electro-mechanical equipment and lift-assist devices), ergonomic principles, and other resources (eg, lift teams) to maximize patient and caregiver safety for patient handling tasks such as lifts, transfers, and repositioning.1 In contrast, traditional nontherapeutic patient handling tasks for lifts and transfers have been performed manually by health care providers with a foremost emphasis on use of sound body mechanics. A recent systematic review of occupational musculoskeletal injuries in the health care environment found that patient handling was the most common occupational factor in the cause of work-related injuries among PTs and nursing practitioners. Lifting and transfer of patients was the largest reported occupational cause of practitioner injuries.4 Campo and colleagues5 found a 1-year incidence rate of work-related musculoskeletal disorders (WMSDs) of 20.7% among PTs in the US and noted that many of these injuries were due to patient handling tasks. Darragh and colleagues6 surveyed 1,158 occupational therapists (OTs) and PTs in Wisconsin and found that patient transfers and lifts were associated with 58% of all injuries reported.Using a phenomenological approach to explore the meaning of work-related pain in PTs and OTs, Campo and Darragh7 noted that all therapists were concerned about their potential clinical longevity due to work-related pain. Such injuries may also occur during physical therapist education, as Nyland and Grimmer8 found that physiotherapy students' risk of low back pain increased progressively with the year of study. WMSDs have serious consequences to clinicians, employers, and the health care system as a whole. As many as 1 in 6 PTs have reportedly changed professions as a result of a WMSD injury.9 In addition, employers and insurance companies are left to deal with significant direct and indirect costs due to work-related injuries that totaled $194 billion in 2007.'° Worker's compensation covers less than 25% of these costs, leaving the burden shared through all members of society and contributing significantly to the cost of health care.10Use of assistive technology and biomechanically sound lifting and transfer techniques, principles of SPH practice, have been shown to reduce both the rate of injury and the economic burden associated with lifting injuries.11'14 Although SPH techniques are often taught in health professions classrooms, a discrepancy between education and clinical practice appears to persist.15'18 Students found clinical settings were not frequently supportive of SPH techniques.16'21 For example, Green19 asked nursing students to reflect on their performance of SPH practices throughout their clinical experiences and found that allowing students to develop a heightened sense of awareness through reflection on action enabled them to establish personal attitudes and the subsequent assertiveness to utilize SPH techniques. This type of reinforcement early in the education process is vital to protect students, as evidence shows that WMSDs are most frequent and significant within a PTs initial 4-5 years of work.22'24Perhaps a dynamic, multi-disciplinary approach to promoting a safer work environment for health care workers could be most effective in changing SPH attitudes. Geiger25 examined the combined efforts of Israeli ergonomists and direct health care providers with regard to a safe patient handling and movement program spearheaded by physical therapists. Short-term outcomes included improved hospital-wide awareness of ergonomics, patient safety equipment, and a need for additional safety equipment. …

Work-related musculoskeletal disorders among dental professionals in Saudi Arabia

[Purpose] Musculoskeletal disorders are common causes of work-related disability in different professions involving the frequent practice of lifting, stooping, twisting, prolonged sitting, or standing. The dental profession is one such profession. Our aim was to determine the prevalence of work-related musculoskeletal disorders among dental professionals in Saudi Arabia, the factors associated with them, and their consequences and to propose preventive measures for them. [Subjects and Methods] A self-administered online questionnaire was sent to 225 members of the Saudi Dental Association. It included questions on demographic and professional characteristics, general medical history, and history of work-related musculoskeletal disorders before and after joining the dental profession. [Results] The questionnaire was completed by 65% of the respondents. Among them 85% reported that they had developed some pain due to work after joining the dental profession, and 42% reported that they were suffering pain at the time of the survey. Besides lower back, shoulder, and neck regions, the hands, upper back, and other regions like the elbows, buttocks, thighs, leg, and feet were areas in which they pain. [Conclusion] The prevalence of work-related musculoskeletal disorders among dental professionals in Saudi Arabia is high, affecting their daily activities, sometimes even forcing them to change their work setting. Age, gender, specialty of work, work setting, number of contact hours with patients, etc., were all found to be related to their work-related pain. We need to emphasize the role of ergonomics, counseling, proper techniques of patient handling, etc., during the training of dental professionals so that they can work efficiently.

The Effects of High-Frequency Transcutaneous Electrical Nerve Stimulation for Dental Professionals with Work-Related Musculoskeletal Disorders: A Single-Blind Randomized Placebo-Controlled Trial

Work-related musculoskeletal symptom disorders (WMSDs) have a significant issue for dental professionals. This study investigated the effects of high-frequency transcutaneous electrical nerve stimulation (TENS) on work-related pain, fatigue, and the active range of motion in dental professionals. Among recruited 47 dental professionals with WMSDs, 24 subjects received high-frequency TENS (the TENS group), while 23 subjects received placebo stimulation (the placebo group). TENS was applied to the muscle trigger points of the levator scapulae and upper trapezius, while placebo-TENS was administered without electrical stimulation during 60 min. Pain and fatigue at rest and during movement were assessed using the visual analog scale (VAS), pain pressure threshold (PPT), and active range of motion (AROM) of horizontal head rotation at six time points: prelabor, postlabor, post-TENS, and at 1 h, 3 h, and 1 day after TENS application. Both groups showed significantly increased pain and fatigue and decreased PPT and AROM after completing a work task. The TENS group showed significantly greater improvements in VAS score, fatigue, PPT, and AROM at post-TENS and at 1 h and 3 h after application (all P < 0.05) as compared to the placebo group. A single session high-frequency TENS may immediately reduce symptoms related to WMSDs in dental professionals.

Musculoskeletal complaints among physiotherapy and occupational therapy rehabilitation professionals in Bangladesh.

Physiotherapy and occupational therapy professionals are at high risk of developing occupational musculoskeletal injuries globally. Musculoskeletal pain is the most common problem. To determine the extent of discomfort that physiotherapy and occupational therapy health professionals report while working at a physical rehabilitation centre. Physiotherapy and occupational therapy professionals which include both graduate and diploma physiotherapists and occupational therapists as well as physiotherapy and occupational therapy assistants. A self administered questionnaire (survey) was conducted on a convenient sample of 101 physiotherapy and occupational therapy personnel. The mean age of the 101 participants was 27.8 (± 4.5) years and most of the participants (62%) had less than 5 years of work experience. Ninety-five percent of the participants complained of work related pain. Most of the participants reported pain in the lower back (n=84) followed by upper back (n=71) and neck (n=66). Significant associations were found for pain in ankles/feet with age (p=0.05) and pain in neck with gender (p=0.01). Physiotherapy and occupational therapy professionals suffer from pain in relation to the work they do as therapists which may be due to non-practice of appropriate body mechanics. Mechanism to assess level of practice during dealing with patients may be introduced to enable corrective measures. Incentives should be considered for appropriate practice.

Evaluation of Musculoskeletal Disorders in Dentists and Application of DMAIC Technique to Improve the Ergonomics at Dental Clinics and Meta-Analysis of Literature.

Musculoskeletal disorders (MSD) result in discomfort, pain and illness that can result in disruption or impairment of dental practice. A cross-sectional study consisting of 60 dentists was carried out to determine musculoskeletal work related pain in major cities of Northern India. The study was planned in two phases. In the first phase, the subjects were given questionnaire related to the musculoskeletal pain happened over the last twelve months. In the second phase of study, improvement was carried out by recommending the subjects to implement ergonomics at their workplace. After three months subjects were again approached and given questionnaire about the musculoskeletal disorders. DMAIC (define, measure, analyse, improve and control) methodology of six sigma strategy was used to access the MSDs. Chi-square test was used for the analysis and a p-value of less than or equal to 0.05 was considered statistically significant. The overall prevalence of musculoskeletal problems in the present study was found to be 68.3%. After three months only 23 respondents applied ergonomics at their work place, prevalence of pain was reduced in neck from 47.8% to 21.7% out of total 23 respondents, shoulder pain 39.1% to 17.3%, pain in elbows from 26% to 21.7%, as well as in other locomotor organs. The p-value was significant with p <0.05. MSD represents a major occupational health issue for dentists in India as well as worldwide and result revealed necessitates the need of workshops to create awareness of ergonomics as effective measures for reducing MSD among dentists.

Work Injuries Among Therapists In Physical Rehabilitation

Background: Physical therapists in rehabilitation settings often perform heavy lifting, repetitive forceful tasks and endure long periods of static or awkward postures. These work conditions put therapists at increased risk of work-related injuries (WRIs). Methods: A cross-sectional survey was conducted among physical therapists (PTs) and physical therapist assistants (PTAs) at 14 randomly selected rehabilitation facilities to determine the prevalence and severity of work-related injuries in physical rehabilitation. Results: A majority of respondents reported their most severe pain or discomfort within the last year affected their back, lasted 24 hours to 1 week, occurred once every 2-6 months, and was rated as moderate on the 0 to 10 pain scale. The 1-year prevalence of WRIs among PTs and PTAs working in physical rehabilitation was 32%. Sixty percent (60%) of those reporting pain/discomfort had mechanical patient lifts available within their work area. Less than half reported using mechanical patient lifts before or during/after their work-related pain. Conclusion: More than 65% of rehabilitation PTs and PTAs experienced work-related pain due to therapeutic activities including patient handling and movement. It is critical to understand therapists’ technology usage barriers, redesign technology to meet end-user needs, and develop technology-based best practices that promote both worker safety and patient outcomes.

Work-related outcomes in randomised placebo-controlled pain trials: a systematic review and meta-analysis.

BackgroundChronic painful conditions have an important influence on the ability to work. Work-related outcomes, however, are not commonly reported in publications on trials investigating the treatment of chronic painful conditions. We aim to provide an overview of the reporting of work-related outcomes in such trials and investigate the relationship between work-related outcomes and pain outcomes.MethodsWe conducted a systematic literature search in PubMed with the aim of identifying randomised placebo-controlled clinical trials investigating treatments for chronic painful conditions or rheumatic diseases that also reported on work-related outcomes. Methodological study quality was assessed with the Oxford Quality Scale (OQS). Meta-analyses were conducted for the outcomes of interference with work and number of patients with at least 30% reduction in pain intensity (30% pain responders). The correlation between work-related and pain outcomes was investigated with regression analyses.ResultsWe included 31 publications reporting on 27 datasets from randomised placebo-controlled trials (with a total of 11,434 study participants) conducted in chronic painful or rheumatic diseases and reporting on work-related outcomes. These 31 publications make up only about 0.2% of all publications on randomised placebo-controlled trials in such conditions. The methodological quality of the included studies was high; only nine studies scored less than four (out of a maximum five) points on the OQS. Sixteen different work-related outcomes were reported on in the studies. Of 25 studies testing for the statistical significance of changes in work-related outcomes over the course of the trials, 14 (56%) reported a significant improvement; the others reported non-significant changes. Eight studies reported data on both interference with work and 30% pain responders: meta-analyses demonstrated similar, statistically significant improvements in both these outcomes with active therapy compared to placebo and regression analysis showed that these outcomes were correlated.ConclusionsDespite the importance of pain as a reason for decreased ability to work, work-related outcomes are reported in substantially less than 1% of publications on placebo-controlled trials in chronic painful and rheumatic diseases. Work-related outcomes and pain responder outcomes are closely related.

Review of musculoskeletal injuries and prevention in the endoscopy practitioner.

Practitioners of endoscopy often experience musculoskeletal pain and injury (most often in the back, neck, shoulders, hands, wrists, and thumbs) that are associated with the minute and repetitive strain that is placed on these areas during endoscopic procedures. This review of the current documentation of endoscopy-related pain and injuries among practitioners finds that such problems are widespread and specific in kind as well as strongly correlated with high procedure volume and procedure duration. Research on the nature and impact of cumulative trauma and overuse syndromes in other professions such as dentistry, pianists, production labor, and athletics is brought to bear on the work of the endoscopist. A more thorough understanding of the nature and prevalence of work-related pain and injury sustained by endoscopists should inform further development of ergonomic practices and equipment design. This article reviews current recommendations for ergonomic design in the endoscopy procedure space and finds that reported compliance with those recommendations is quite low. Strategies for the management of the risk of musculoskeletal injuries related to the practice of endoscopy include compliance with currently recommended ergonomic practices, education of trainees in ergonomic technique when practicing endoscopy, and research toward the modification and development of more ergonomic endoscopes and procedure spaces.

Ergonomics of Office Seating and Postures

Objective: This research focuses on the working environment of office workers and aims to propose an ideal seating posture and chair design. Background: Generally, office workers having to seat in a fixed posture for long periods of time tend to suffer from an increased rate of musculoskeletal disorders. Method: The measurement and survey of 123 office workers on their working conditions and literature survey will lead to a suggestion of an ideal seating posture and workstation design theory. Results: Work environment satisfaction appeared low for chair and desks. Workrelated pain over the last year was experienced among 47.2% of the respondents in shoulder (34.2%), neck (30.9%). Observation of working posture revealed that only 27.6% of workers utilize backrest during work. Conclusion: Office work embodies many situations where risks of musculoskeletal disorders may be high. Thus, the seated workplace must be set up to allow proper seating posture for workers. Application: The results of this study can be applied as baseline data for preventing musculoskeletal disorders of office workers.

Oxygenation and Hemodynamics Do Not Underlie Early Muscle Fatigue for Patients with Work-Related Muscle Pain

Patients suffering from work-related muscle pain (WRMP) fatigue earlier during exercise than healthy controls. Inadequate oxygen consumption and/or inadequate blood supply can influence the ability of the muscles to withstand fatigue. However, it remains unknown if oxygenation and hemodynamics are associated with early fatigue in muscles of WRMP patients. In the present study we applied near-infrared spectroscopy (NIRS) on the extensor carpi radialis (ECR) and trapezius (TD) muscles of patients with WRMP (n = 18) and healthy controls (n = 17). Our objective was to determine if there were group differences in endurance times for a low-level contraction of 15% maximal voluntary contraction (MVC) – sustained for 12–13 min, and to see if these differences were associated with differences in muscle oxygenation and hemodynamics. At baseline, oxygen saturation (StO2%) was similar between groups for the ECR, but StO2% was significantly lower for TD for the WRMP patients (76%) compared to controls (85%) (P<0.01). Also, baseline ECR blood flow was similar in the two groups. For both muscles there were a larger number of patients, compared to controls, that did not maintain the 15% MVC for the allotted time. Consequently, the endurance times were significantly shorter for the WRMP patients than controls (medians, ECR: 347 s vs. 582 s; TD: 430 s vs. 723 s respectively). Responses in StO2% during the contractions were not significantly different between groups for either muscle, i.e. no apparent difference in oxygen consumption. Overall, we interpret our findings to indicate that the early fatigue for our WRMP patients was not associated with muscle oxygenation and hemodynamics.

Patellofemoral pain: consensus statement from the 3rd International Patellofemoral Pain Research Retreat held in Vancouver, September 2013

Patellofemoral pain (PFP) is often seen in physically active individuals and may account for 25–40% of all knee problems seen in a sports injury clinic.1 ,2 Patellofemoral-related problems occur more...

Work-related risk factors for low back pain in firefighters. Is exercise helpful?

The aim of this study was to research the correlation between work-related physical risk factors and LBP pain and to examine the contribution of exercise among firefighters. In this study, a questionnaire survey was carried out among fully paid firefighters in Greece. Statistical analyses used were frequencies, Chi-square test and binary logistic regression. The study population consisted of 3,451 fully paid firefighters. Among the responders of the research, 30 % (n = 1,037) were reported to have LBP. There was a significant association between ‘job position’, ‘work time’ (years in current position), ‘weight lifting’, ‘exercise’, ‘age’, smoking, ‘gender’ and LBP (p < 0.05). The odds ratios (OR) of LBP were significantly greater: (a) in rescuers than in drivers, in comparison to officer firefighters; (b) in women than in men; (c) those who worked ‘more than 5 years’ than those working ‘between 1 and 5 years’; (d) those who do exercise ‘1–5 h per week’ than those doing exercise ‘more than 5 h/week’, in comparison to those who do ‘no exercise’, and those who lift more than 25 kg than those whose weight lifting is over 10 kg. In conclusion, improvements in job techniques and special exercise programs can contribute to the reduction of LBP symptoms in the future.

Prevalence and risk factors for work-related shoulder pain among informal garment workers in the northeast of Thailand

This cross-sectional study investigated the prevalence of work-related shoulder pain (SP) and risk factors associated with SP among 446 informal garment workers, mainly in small or home businesses in the northeast of Thailand. Data were collected by face-to-face interviews using a structured questionnaire and a survey form about the working environment. Risk factors for SP were indicated by multiple logistic regression analysis. The six month-prevalence of SP was 46.9%. The significant risk factors for SP included worked less than 10 years (ORadj = 1.5), no change of working posture each hour (ORadj = 2.0) and inappropriate seat width (ORadj = 3.0). It is concluded that the prevalence of SP is high in Thai garment workers and that work posture and workstation are contributing risk factors. In order to help reduce or prevent SP in this occupational group, it is proposed that ergonomics education and redesign of seats at workstations should be routinely implemented.

Effects of self stretching on pain and musculoskeletal symptom of bus drivers.

[Purpose] The aim of this study was to evaluate the musculoskeletal symptoms, pain and risk of postures as well as the effects of stretching exercise on the work-related symptoms and pain of bus drivers. [Subjects and Methods] Eighty-one drivers were randomly recruited from a bus corporation for this study. Information about pain levels, painful regions, and general characteristics of subjects was obtained using the symptom research form (KOSHA Code H-30-2003). The level of pain was assessed on a scale of numeric rating scale (NRS) which is divided by 10. Ergonomic posture assessment was conducted using the rapid upper limb assessment (RULA). Self-stretching exercise was performed for 4 weeks by the bus drivers who suffered from neck and shoulder pain. [Results] Musculoskeletal symptoms were present in the order of shoulder, neck, lower back and lower extremities. Compared with other jobs, the final score, and the action level of bus drivers were very high, showing 57.6% of action levels 3 and 4. A statistically significant decrease of pain was shown after the self-stretching intervention. There was also a significant decrease of musculoskeletal symptoms in the neck and shoulders after the self-stretching exercise. [Conclusion] Performing stretching for musculoskeletal symptoms had a positive influence on the symptoms and reduced pain.

Pain, Work-related Characteristics, and Psychosocial Factors among Computer Workers at a University Center.

[Purpose] Complaint of pain is common in computer workers, encouraging the investigation of pain-related workplace factors. This study investigated the relationship among work-related characteristics, psychosocial factors, and pain among computer workers from a university center. [Subjects and Methods] Fifteen subjects (median age, 32.0 years; interquartile range, 26.8–34.5 years) were subjected to measurement of bioelectrical impedance; photogrammetry; workplace measurements; and pain complaint, quality of life, and motivation questionnaires. [Results] The low back was the most prevalent region of complaint (76.9%). The number of body regions for which subjects complained of pain was greater in the no rest breaks group, which also presented higher prevalences of neck (62.5%) and low back (100%) pain. There were also observed associations between neck complaint and quality of life; neck complaint and head protrusion; wrist complaint and shoulder angle; and use of a chair back and thoracic pain. [Conclusion] Complaint of pain was associated with no short rest breaks, no use of a chair back, poor quality of life, high head protrusion, and shoulder angle while using the mouse of a computer.

Perceptions of risk from workers in high risk industries with work related musculoskeletal disorders

Work-related musculoskeletal disorders (WMSDs) remain a major occupational health problem, despite decades of research, outreach, and intervention. The aim of this study is to promote early identification and prevention of WMSDs by developing education and outreach materials grounded in interview data collected from workers that have recently filed for workers compensation (WC) for WMSDs. We conducted semi-structured telephone interviews with WC claimants (n=66) from high risk industries identified through the use of a Prevention Index (PI) in Washington state with WMSDs of the back, shoulder, hand/wrist, or knee. Perceptions regarding the degree of exposure to WMSD risk factors, the social construction of pain, and the potential to implement injury-prevention measures varied widely. Many workers dismissed their injuries as the result of "fluke" or "freak" occurrences and framed their exposure to risk factors for WMSDs as either inevitable or "just part of the job." Workers in high-risk industries for WMSDs described their work conditions in ways that suggested: (1) a lack of awareness of the potential for developing a WMSD, (2) a view of work-related pain as normal, and/or (3) a pattern of self-blame for WMSD onset. A paradigm that either asserts the inevitability of WMSDs or dismisses potential control measures presents both a significant barrier to injury prevention efforts as well as a major opportunity for future occupational health research.

Translating Laboratory Research of BIOCERAMIC Material, Application on Computer Mouse and Bracelet, to Ameliorate Computer Work-Related Musculoskeletal Disorders

We investigated the effects of a room temperature-emitting far infrared ray ceramic material (BIOCERAMIC) on computer work-related pain and coldness. Thirty-two computer users reporting complaints in upper extremities and shoulders were assigned to play 30-cycles of specially-designed computer game. Each subject was provided with a normal and BIOCERAMIC-made mouse for the game on two different days. When using BIOCERAMIC mouse for the computer game, the most significant improvements among the upper extremity complaints were for wrist, finger, forearm, and partially shoulder soreness. Greater differences in surface temperatures of mouse and hand in BIOCERAMIC group were seen. The most significant difference occurred when using both the BIOCERAMIC cover and bracelet were found to reduce pain sensations. It was concluded that pain intensity and disability were significantly reduced after using BIOCERAMIC mouse for the game. The effect remained during follow-up when using BIOCERAMIC mouse cover and bracelet during their usual computer work.

A Pilot Study on Work-Related Neck-Shoulder Pain among Sewing Machine Operators

Prevalence of neck-shoulder pain among sewing machine operators is well known. It may be due to the nature and incorrect posture used by sewing machine operators while performing sewing work. However, up till now there is no empirical evidence that can be used to relate the risk factors that would results towards the development of neck and shoulder pain among sewing machine operators. The main objective of this study is to identify and investigate the risk factors that result in neck and shoulder pain among Malaysian sewing machine operators. Twenty female sewing machine operators took part in answering a survey questionnaire to investigate the prevalence of neck and shoulder pain among sewing machine operators. The survey questionnaire was divided into five sections: socio-demographic, work background, workload information, physical exposures and physical musculoskeletal symptoms experienced by workers. Having done that, sewing machine operators who have been screened with neck and/or shoulder pain was evaluated with Rapid Upper Limb Assessment (RULA) to determine the level of workplace risk factors. Subjects without neck and/or shoulder pain were excluded. Results of the study shows that all sewing operators were expose to risk of prolonged sitting, repetitive task and working at high speed. Ninety five percent of sewing machine operators had experienced neck and/or shoulder pain and 80% of them were exposed to high work risk factors that require them to undergo further investigation. Shoulder pain was found to be strongly correlated with high work risk factor among sewing machine operators (p&lt;0.05). In conclusion, occurrence of shoulder pain among sewing operators is due to posture and nature of sewing work.

Lumbar surgery in work-related chronic low back pain: can a continuum of care enhance outcomes?

Background contextSystematic reviews of lumbar fusion outcomes in purely workers' compensation (WC) patient populations have indicated mixed results for efficacy. Recent studies on lumbar fusions in the WC setting have reported return-to-work rates of 26% to 36%, reoperation rates of 22% to 27%, and high rates of persistent opioid use 2 years after surgery. Other types of lumbar surgery in WC populations are also acknowledged to have poorer outcomes than in non-WC. The possibility of improving outcomes by employing a biopsychosocial model with a continuum of care, including postoperative functional restoration in this “at risk” population, has been suggested as a possible solution. PurposeTo compare objective socioeconomic and patient-reported outcomes for WC patients with different lumbar surgeries followed by functional restoration, relative to matched comparison patients without surgery. Study design/settingA prospective cohort study of chronic disabling occupational lumbar disorder (CDOLD) patients with WC claims treated in an interdisciplinary functional restoration program. Patient sampleA consecutive cohort of 564 patients with prerehabilitation surgery completed a functional restoration and was divided into groups based on surgery type: lumbar fusion (F group, N=331) and nonfusion lumbar spine surgery (NF group, N=233). An unoperated comparison group was matched for length of disability (U group, N=349). Outcome measuresValidated patient-reported measures of pain, disability, and depression were administered pre- and postrehabilitation. Socioeconomic outcomes were collected via a structured 1-year “after” interview. MethodsAll patients completed an intensive, medically supervised functional restoration program combining quantitatively directed exercise progression with a multimodal disability management approach. The writing of this article was supported in part by National Institutes of Health Grant 1K05-MH-71892; no conflicts of interest are noted among the authors. ResultsThe F group had a longer length of disability compared with the NF and U groups (M=31.6, 21.7, and 25.9 months, respectively, p<.001). There were relatively few statistically significant differences for any socioeconomically relevant outcome among groups, with virtually identical postrehabilitation return-to-work (F=81%, NF=84%, U=85%, p=.409). The groups differed significantly after surgery on diagnosis of major depressive disorder and opioid dependence disorder as well as patient-reported depressive symptoms and pain intensity prerehabilitation. However, no significant differences in patient-reported outcomes were found postrehabilitation. Prerehabilitation opioid dependence disorder significantly predicted lower rates of work return and work retention as well as higher rates of treatment-seeking behavior. Higher levels of prerehabilitation perceived disability and depressive symptoms were significant risk factors for poorer work return and retention outcomes. ConclusionsLumbar surgery in the WC system (particularly lumbar fusion) have the potential achieve positive outcomes that are comparable to CDOLD patients treated nonoperatively. This study suggests that surgeons have the opportunity to improve lumbar surgery outcomes in the WC system, even for complex fusion CDOLD patients with multiple prior operations, if they control postoperative opioid dependence and prevent an excessive length of disability. Through early referral of patients (who fail to respond to usual postoperative care) to interdisciplinary rehabilitation, the surgeon determining this continuum of care may accelerate recovery and achieve socioeconomic outcomes of relevance to the patient and WC jurisdiction through the combination of surgery and postoperative rehabilitation.

OP0122-PARE Pauseboogie - campaign to raise awareness of the DANISH rheumatism association

BackgroundThe Danish Rheumatism Association wants to fight the myths, that rheumatic diseases only concerns the elderly and that there is nothing to do about it anyway. We wanted to reach...