Even though guidelines for clinical management of patients with low back pain (LBP) encourage health care practitioners to advise patients to remain active and return to work, most practitioners feel that work factors can cause or aggravate LBP and often recommend a 'short break from work' to allow healing.

According to a new study published in the December issue of PAIN, practitioners believe that there are some aspects of work that are harmful to patients' recovery and feel that their role in returning patients to work is limited.

Lead author Professor Tamar Pincus, PhD explains:

"Low back pain is consistently among the top most costly health problems. Back pain has been identified as the second main cause of absenteeism in the UK.

Our findings suggest that, despite guidelines that encourage maintaining people at work during episodes of back pain, many clinicians hold a range of beliefs that contradict this advice, and these beliefs can influence their clinical decisions and behaviors."

In a new study, researchers from the Department of Psychology at the Royal Holloway University of London decided to evaluate work-related behaviors and beliefs in terms of lower back pain in the UK. They surveyed the three professions who most commonly treat LBP after GPs, i.e. osteopaths, physiotherapists (physical therapists), and chiropractors, to measure factors, such as the frequency in which the practitioners visited a patient's workplace including prescribing exercises the patients could incorporate in their work routine, recommended a break from work for recovery and provided sick leave certificates.

The researchers included the Attitudes to Back Pain Scale for Musculoskeletal Practitioners in their study, to examine the connection between general beliefs about back pain and work-related behaviors, for example, whether practitioner's limited the number of treatment sessions for low back pain, as well as beliefs that increasing mobility should be a goal of treatment.

They also assessed practitioners' beliefs regarding the benefits compared with the risk of work to general health and particularly in terms of back pain; the need for patients to take a short break to recover from LBP; the work-related roles of musculoskeletal practitioners, and how the practitioners' perceived employers' willingness to help patients with LBP.

Their findings revealed that it was extremely common to advise patients to take absence from work, with 80% of respondents reporting they sometimes recommended work absence to LBP patients and 13% reporting that they do so often or always. Even though 70% of practitioners reported to have never visited the workplace to advise and prescribe ergonomic changes the findings nevertheless revealed that it was common practice with 83% of practitioners reporting they always or often prescribe exercises that can be incorporated into the work routine. Even though recommending a short break from work was common, less than 2% of the practitioners reported that they always or often prescribed sick leave certifications for LBP.

Interestingly, physiotherapists endorsed the benefits of work to help recovery from LBP more strongly compared with osteopaths or chiropractors. Whilst physiotherapists in the UK are employed by the National Health, osteopaths or chiropractors usually work in the private sector. The study also established that a significant number of physiotherapists did not agree with the belief that work can either cause or aggravate pain and that they tended to favor limiting the number of treatment sessions for LBP.

The researchers observed extremely low numbers of reports in which practitioners visited the workplace directly and contacted employers to collaborate with them in order to coordinate actions that support people suffering from LBP to stay at work.

Dr. Pincus states:

"Integrated care at work has shown promising results in earlier clinical trials. If return to work is beneficial to patients and is a primary goal for cost savings, bringing these practitioners on board and altering their perceptions of the individual-employer-clinician triad is important."

Written by Petra Rattue