Documents van Tulder, Maurits W. 6 results

"Background
Since the introduction of the Swedish back school in 1969, back schools have frequently been used for treating patients with low-back pain (LBP). However, the content of back schools has changed and appears to vary widely today.


Objectives
To assess the effectiveness of back schools for patients with non-specific LBP.


Search strategy
We searched the MEDLINE and EMBASE databases and the Cochrane Central Register of Controlled Trials to May 2003 for relevant trials reported in English, Dutch, French or German. We also screened references from relevant reviews and included trials. The literature search has now been updated to November 2004. No additional trials were identified.


Selection criteria
Randomized controlled trials (RCTs) that reported on any type of back school for non-specific LBP were included.


Data collection and analysis
Four reviewer authors, blinded to authors, institution and journal, independently extracted the data and assessed the quality of the trials. We set the high quality level, a priori, at a trial meeting six or more of 11 internal validity criteria. As data were clinically and statistically too heterogeneous to perform a meta-analysis, we used a qualitative review (best evidence synthesis) to summarize the results. The evidence was classified into four levels (strong, moderate, limited or no evidence), taking into account the methodological quality of the studies. We also evaluated the clinical relevance of the studies.


Main results
Nineteen RCTs (3584 patients) were included in this updated review. Overall, the methodological quality was low, with only six trials considered to be high quality. It was not possible to perform relevant subgroup analyses for LBP with radiation versus LBP without radiation. The results indicate that there is moderate evidence suggesting that back schools have better short and intermediate-term effects on pain and functional status than other treatments for patients with recurrent and chronic LBP. There is moderate evidence suggesting that back schools for chronic LBP in an occupational setting, are more effective than other treatments and placebo or waiting list controls on pain, functional status and return to work during short and intermediate-term follow-up. In general, the clinical relevance of the studies was rated as insufficient.


Authors' conclusions
There is moderate evidence suggesting that back schools, in an occupational setting, reduce pain, and improve function and return-to-work status, in the short and intermediate-term, compared to exercises, manipulation, myofascial therapy, advice, placebo or waiting list controls, for patients with chronic and recurrent LBP. However, future trials should improve methodological quality and clinical relevance and evaluate the cost-effectiveness of back schools.


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Plain language summary

Back schools for non-specific low-back pain
There is moderate evidence suggesting that back schools are more effective for pain and function than other conservative treatments if the patients with chronic low-back pain (LBP) are from the general public, primary or secondary care. There is conflicting evidence whether back schools are more effective than placebo or waiting list controls for pain, function and return-to-work.

There is moderate evidence suggesting that back schools, in an occupational setting, reduce pain, and improve function and return-to-work status, in the short and intermediate-term, compared to exercises, manipulation, myofascial therapy or advice, placebo or waiting list controls, for patients with chronic LBP."

"Background: The enormous socioeconomic burden of low back pain emphasises the need for effective management of this problem, especially in an occupational context. To address this, occupational guidelines have been issued in various countries.

Aims: To compare available international guidelines dealing with the management of low back pain in an occupational health care setting. Methods: The guidelines were compared regarding generally accepted quality criteria using the AGREE instrument, and also summarised regarding the guideline committee, the presentation, the target group, and assessment and management recommendations (that is, advice, return to work strategy, and treatment).

Results and Conclusions: The results show that the quality criteria were variously met by the guidelines. Common flaws concerned the absence of proper external reviewing in the development process, lack of attention to organisational barriers and cost implications, and lack of information on the extent to which editors and developers were independent. There was general agreement on numerous issues fundamental to occupational health management of back pain. The assessment recommendations consisted of diagnostic triage, screening for "red flags" and neurological problems, and the identification of potential psychosocial and workplace barriers for recovery. The guidelines also agreed on advice that low back pain is a self limiting condition and, importantly, that remaining at work or an early (gradual) return to work, if necessary with modified duties, should be encouraged and supported."

Various conservative treatment options for repetitive strain injury are widely used, despite questionable evidence of their effectiveness. This systematic review evaluates the effectiveness of these treatment options for relieving symptoms of repetitive strain injury and improving activities of daily living. Searches in Medline and Embase, with additional reference checking resulted in 15 eligible trials for this review. Methodological quality was assessed, and data-extraction was performed. With the use of a "best-evidence synthesis", no strong evidence was found for the effectiveness of any of the treatment options. There is limited evidence that multidisciplinary rehabilitation, ergonomic intervention measures, exercises, and spinal manipulation combined with soft tissue therapy are effective in providing symptom relief or improving activities of daily living. There is conflicting evidence for the effectiveness of behavioral therapy. In conclusion, little is known about the effectiveness of conservative treatment options for repetitive strain injury. To establish strong evidence, more high-quality trials are needed.

"This study identified occupations with a marked impact on sick leaves due to respiratory disease.Respiratory disease accounted for 4.4% of the total number of sick leaves. The incidence of long-term ({>=90 days) sick leaves due to respiratory disease was 3 times higher in occupations with a high incidence than in those with a low incidence. There was a high correlation (r=0.80) between the incidence of long-term sick leave due to respiratory disease and sick leave due to all other conditions; this finding suggests that market and selection factors may play an important role in determining the overall risk for sick leave in various occupations. The proportion of sick leaves due to long-term respiratory disease out of all long-term disease was compared between occupations. Agricultural workers had a 46% higher proportion of long-term respiratory disease than metal workers. Industrial workers, food industry workers, and painters were also occupations with an increased risk. These findings could not be explained by differences in age or smoking habits.Major differences were found among manual and service occupations regarding long-term sick leave due to respiratory disease. Several occupations, in which exposure to respiratory sensitizers and irritants are known to occur, were among those in which workers had an increased risk for long-term respiratory disease. ..."