OBJECTIVES--The aim was to combat occurrence of chronic occupational back pain. METHODS--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. RESULTS--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. CONCLUSION--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.
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