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Intervention Review

Physical conditioning programs for improving work outcomes in workers with back pain

  1. Frederieke Schaafsma1,*,
  2. Eva Schonstein1,
  3. Karyn M Whelan2,
  4. Eirik Ulvestad3,
  5. Dianna Theadora Kenny4,
  6. Jos H Verbeek5

Editorial Group: Cochrane Back Group

Published Online: 20 JAN 2010

Assessed as up-to-date: 26 DEC 2008

DOI: 10.1002/14651858.CD001822.pub2


How to Cite

Schaafsma F, Schonstein E, Whelan KM, Ulvestad E, Kenny DT, Verbeek JH. Physical conditioning programs for improving work outcomes in workers with back pain. Cochrane Database of Systematic Reviews 2010, Issue 1. Art. No.: CD001822. DOI: 10.1002/14651858.CD001822.pub2.

Author Information

  1. 1

    The University of Sydney, Faculty of Health Sciences, Lidcombe, NSW, Australia

  2. 2

    The University of Sydney, Discipline of Physiotherapy, Faculty of Health Sciences, Lidcombe, NSW, Australia

  3. 3

    University of Sydney, Faculty of Health Sciences, Lidcombe, NSW, Australia

  4. 4

    University of Sydney, Behavioural and Social Sciences in Health, Faculty of Health Sciences, Lidcombe, NSW, Australia

  5. 5

    Finnish Institute of Occupational Health, Occupational Safety and Health Review Group, Kuopio, Finland

*Frederieke Schaafsma, Faculty of Health Sciences, The University of Sydney, Cumberland Campus C42, PO Box 170, Lidcombe, NSW, 1825, Australia. f.g.schaafsma@gmail.com.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 20 JAN 2010

SEARCH

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. Résumé

Background

Physical conditioning programs aim to improve work status for workers on sick leave. This is an update of a Cochrane Review (Work conditioning, work hardening and functional restoration for workers with back and neck pain) first published in 2003.

Objectives

To compare the effectiveness of physical conditioning programs in reducing time lost from work for workers with back pain.

Search methods

We searched the following databases to June/July 2008: CENTRAL (The Cochrane Library 2008, issue 3), MEDLINE from 1966, EMBASE from 1980, CINAHL from 1982, PsycINFO from 1967, and PEDro.

Selection criteria

Randomized controlled trials (RCTs) and cluster RCTs that studied workers with work disability related to back pain and who were included in physical conditioning programs.

Data collection and analysis

Two review authors independently extracted data and assessed risk of bias.

Main results

Thirty-seven references, reporting on 23 RCTs (3676 workers) were included, 13 of which had a low risk of bias. In 14 studies, physical conditioning programs were compared to usual care. In workers with acute back pain, there was no effect on sickness absence. For workers with subacute back pain, we found conflicting results, but subgroup analysis showed a positive effect of interventions with workplace involvement. In workers with chronic back pain, pooled results of five studies showed a small effect on sickness absence at long-term follow-up (SMD: -0.18 (95% CI: -0.37 to 0.00)). In workers with chronic back pain, physical conditioning programs were compared to other exercise programs in six studies, with conflicting results. The addition of cognitive behavioural therapy to physical conditioning programs was not more effective than the physical conditioning alone.

Authors' conclusions

The effectiveness of physical conditioning programs in reducing sick leave when compared to usual care or other exercises in workers with back pain remains uncertain. In workers with acute back pain, these programs probably have no effect on sick leave, but there may be a positive effect on sick leave for workers with subacute and chronic back pain. Workplace involvement might improve the outcome. Better understanding of the mechanism behind physical conditioning programs and return-to-work is needed to be able to develop more effective interventions.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. Résumé

Physical conditioning program for improving work outcomes in workers with back pain

The main goal of physical conditioning programs, sometimes called work conditioning, work hardening or functional restoration/exercise programs, is to return injured or disabled workers to work or improve the work status for workers performing modified duties. Such programs either simulate or duplicate work, functional tasks, or both, in a safe, supervised environment. These tasks are structured and progressively graded to increase psychological, physical and emotional tolerance and improve endurance and work feasibility. In such environments, injured workers learn appropriate job performance skills in addition to improving their physical condition, through an exercise program aimed at increasing strength, endurance, flexibility, and cardiovascular fitness. Work hardening programs are individualized, work-oriented activities that involve clients in simulated or actual work tasks. Work conditioning is a program with an emphasis on physical conditioning that addresses the issues of strength, endurance, flexibility, motor control, and cardiopulmonary function. Functional restoration refers to any intervention aimed at restoring a reasonable functional level for daily living, including work.

Based on 23 included studies, we analysed eight comparisons of physical conditioning programs versus care as usual or other types of interventions, such as standard exercise therapy for different durations of back pain and follow-up times. We divided physical conditioning programs into a light or an intense program depending on its intensity and duration. Results showed that light physical conditioning programs have no significant effect on sickness absence duration for workers with subacute or chronic back pain. We found conflicting results for intense physical conditioning programs for workers with subacute back pain. Further analysis suggested a positive effect on sick leave when the workplace was involved in the intervention. Physical conditioning programs probably have a small effect on return-to-work for workers with chronic back pain. We found conflicting results for intense physical conditioning programs compared to other exercise therapy in the first two years of sick leave. No difference in effect was found between a light or an intense physical conditioning program. We found that cognitive behavourial therapy probably has no value as an alternative therapy, or in addition to physical conditioning programs.

 

Résumé

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. Résumé

Contexte

Les programmes de réadaptation physique visent à améliorer la capacité de travail des travailleurs en congé de maladie. Le présent texte est une mise à jour d’un article publié en 2003 dans la Revue Cochrane (réadaptation au travail, endurcissement au travail et restauration fonctionnelle pour les travailleurs ayant une rachialgie ou une cervicalgie.

Objectif

Comparer l’efficience des programmes de réadaptation physique dans la réduction des absences au travail chez les travailleurs souffrant de maux de dos.

Stratégie de recherche

Nous avons cherché dans les bases de données suivantes jusqu’en juin/juillet 2008 : CENTRAL (The Cochrane Library 2008, numéro 3), MEDLINE à partir de 1966, EMBASE à partir de 1980, CINAHL à partir de 1982, PsycINFO à partir de 1967 et PEDro.

Critères de sélection

Les essais contrôlés randomisés (ECR) et ECR en grappe (cluster RCTs) qui ont étudié les travailleurs ayant des incapacités au travail liées aux maux de dos et qui ont été inclus dans des programmes de réadaptation physique.

Collecte de données et analyse

Deux auteurs ont indépendamment extrait les données et évalué les risques de biais.

Principaux résultats

Ont été retenus, trente-sept articles portant sur 23 ECR (3676 travailleurs), dont 13 avaient un faible risque de biais. Dans 14 études, des programmes de réadaptation physique ont été comparés aux soins habituels. Chez les travailleurs souffrant de maux de dos aigus, ces programmes n’avaient pas d’effet sur les absences pour cause de maladie. Pour les travailleurs souffrant de maux de dos subaigus, on trouve des résultats incohérents, mais des analyses par sous-groupes ont montré un effet positif des interventions dont une composante est réalisée en milieu de travail. Chez les travailleurs souffrant de maux de dos chroniques, les résultats agrégés de cinq études ont montré un faible effet sur l’absence pour cause de maladie dans un suivi à long terme, soit une différence moyenne standardisée ou DMS de -0,18 (IC 95 % : -0,37 à 0,00). Chez ces mêmes travailleurs, les programmes de réadaptation physique ont été comparés à d’autres types de programmes d’exercices dans six études, avec des résultats incohérents. L’ajout de la thérapie cognitivo-comportementale n’ajoutait rien par rapport à la réadaptation physique seule.

Conclusions des auteurs

L’efficience des programmes de réadaptation physique demeure incertaine dans la réduction des absences pour maladie lorsqu’ils sont comparés aux soins habituels ou à d’autres exercices chez les travailleurs ayant des maux de dos. Chez les travailleurs souffrant de maux de dos aigus, ces programmes n’ont probablement aucun effet sur les absences pour maladie, mais peuvent avoir un effet positif sur les absences dans les cas de douleur subaigüe et chronique. Les programmes avec une composante réalisée en milieu de travail peuvent améliorer les résultats. Dans le but de développer des interventions plus efficaces, une meilleure compréhension du mécanisme derrière les programmes de réadaptation physique et de retour au travail s’avère nécessaire.

Traduction

La traduction française de cet examen Cochrane a été financée par le groupe Cochrane sur les maux de dos et a été effectuée par Arlette Missiha et Bernard Soucy.