The prevention of occupational low back pain disability: evidence-based reviews point in a new direction.

The findings of recent extensive evidence-based reviews of the literature on occupational low back pain disability (OLBPD) are examined. There is strong evidence that variables other than biomedical or biomechanical factors have more impact on OLBPD. Nevertheless, the multitude of interacting physical, psychological, social, occupational, financial, and legal variables has confounded, and is likely to continue to confound, efforts to develop simple checklists to predict disability. In contrast, a shift toward conceptualizing and differentially treating OLBP according to its duration postinjury provides a promising new direction. Increasing evidence points to the subacute stage postinjury (4-12 weeks) as a critical period in preventing disability. In limited studies to date, interventions implemented in the subacute stage that address maladaptive cognitions and behavior and focus on return to work have demonstrated reductions in lost work time and disability. Collaborative approaches that combine the proactive efforts of the physician, rehabilitation professionals, and the workplace hold the most promise for future prevention of OLBPD.