Loisel P, Durand P, Abenhaim L, Gosselin L, Simard R, Turcotte J, Esdaile J M
Department of Surgery (Division of Orthopaedics), Université de Sherbrooke, Quebec, Canada.
Occup Environ Med. 1994 Sep;51(9):597-602. doi: 10.1136/oem.51.9.597.
The aim was to combat occurrence of chronic occupational back pain.
A multidisciplinary model to manage back pain that includes both clinical and ergonomic approaches has been developed. Early detection, early clinical and ergonomic evaluations, and early active treatment make up the cornerstone of management. Detection of cases starts after four weeks of absence from work. An ergonomic intervention is implemented at six weeks. A medical specialist is involved at eight weeks. If return to work is not possible after 12 weeks, a functional recovery therapy followed by a therapeutic return to work is implemented. A multidisciplinary team decides if return to original or modified work is possible or if vocational rehabilitation is necessary. This model has been implemented by the investigators in the Sherbrooke (Quebec, Canada) area, and is presently being evaluated through a randomised trial in 31 industrial settlements (about 20,000 workers). A cluster randomisation of industries and workers will allow separate testing of ergonomic and clinical interventions.
One year after implementation, 31 of 35 of the eligible industrial sites participated in the study and 79 of 88 of the eligible workers affected by recent back pain had agreed to participate. Ergonomic and clinical interventions have been implemented as planned. Only three workers dropped out. Hence this global clinical and ergonomic management programme has been shown to be feasible in a general population.
A global management programme of back pain joining ergonomic and clinical intervention with a multidisciplinary approach has not been tested yet. Linking these two strategies in a same multidisciplinary team represents a systemic approach to this multifactorial ailment. During the first year of this trial we did not find any conflict between these two interventions from the employer's or worker's point of view.
旨在对抗慢性职业性背痛的发生。
已开发出一种管理背痛的多学科模式，该模式包括临床和人体工程学方法。早期检测、早期临床和人体工程学评估以及早期积极治疗构成了管理的基石。病例检测在缺勤四周后开始。在六周时实施人体工程学干预。八周时由医学专家介入。如果12周后仍无法重返工作岗位，则实施功能恢复治疗，随后进行治疗性重返工作。一个多学科团队决定是否有可能重返原工作岗位或调整后的工作岗位，或者是否需要职业康复。该模式已由研究人员在加拿大魁北克省舍布鲁克地区实施，目前正在31个工业住区（约20,000名工人）通过一项随机试验进行评估。对企业和工人进行整群随机分组将允许分别测试人体工程学和临床干预措施。
实施一年后，35个符合条件的工业场所中有31个参与了研究，88名近期受背痛影响的符合条件的工人中有79人同意参与。人体工程学和临床干预已按计划实施。只有三名工人退出。因此，这一全球临床和人体工程学管理方案在普通人群中已被证明是可行的。
将人体工程学和临床干预与多学科方法相结合的背痛全球管理方案尚未经过测试。在同一个多学科团队中将这两种策略联系起来代表了针对这种多因素疾病的一种系统方法。在该试验的第一年里，从雇主或工人的角度来看，我们没有发现这两种干预措施之间存在任何冲突。
