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Randomised trials on secondary prevention of low back pain in occupational settings
  1. Philippe Mairiaux1,
  2. Dana Loomis2
  1. 1Occupational Health and Health Education, University of Liège, Liège, Belgium
  2. 2Department of Epidemiology, University of Nebraska, Nebraska, Omaha, USA
  1. Correspondence to Professor Philippe Mairiaux, Occupational Health and Health Education, University of Liège, STES, Sart Tilman B23, Belgium; ph.mairiaux{at}ulg.ac.be

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In most industrialised countries, the institutions managing the healthcare system are increasingly concerned by rising trends in disability and work loss due to low back pain (LBP). From a public health perspective, a health problem such as LBP, that affects 30%–45% of the adult population annually, would certainly demand primary prevention programs. Although such programs have proven helpful for other prevalent conditions such as cardiovascular diseases, they have not yet been shown to be effective for LBP in spite of a quarter of a century of effort and scientific trials.1 2 While these negative results are not a compelling reason to abandon well-designed multidimensional prevention programs, they do provide public health authorities and medical professionals with a strong incentive to focus preventive efforts on LBP prognostic factors through secondary prevention strategies.

The possible benefits to be gained from secondary prevention have long drawn interest from health professionals and researchers. Since the 1990s innovative rehabilitation programs for workers sicklisted due to LBP have been developed, notably the so-called Sherbrooke model which aims at an early return to work through integration of the workplace in the treatment program.3 Solid evidence is now available to show that this type of workplace-based intervention is more effective than usual healthcare interventions for reducing sick leave and preventing work disability among workers with musculoskeletal disorders.4

However, the effectiveness of a workplace component in these interventions raises many …

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