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Occupational health guidelines for the management of low back pain: an international comparison
  1. J B Staal1,
  2. H Hlobil1,
  3. M W van Tulder2,
  4. G Waddell3,
  5. A K Burton4,
  6. B W Koes5,
  7. W van Mechelen1
  1. 1Department of Social Medicine, VU University Medical Centre, Amsterdam, Netherlands
  2. 2Institute for Research in Extramural Medicine, VU University Medical Centre Amsterdam, van der Boechorststraat 7, 1081 BT Amsterdam, Netherlands
  3. 3Glasgow Nuffield Hospital, 25 Beaconsfield Road, Glasgow G12 0PJ, UK
  4. 4Spinal Research Unit, University of Huddersfield, 30 Queen Street, Huddersfield HD1 2SP, UK
  5. 5Department of General Practice, Erasmus University Rotterdam, PO Box 1738, 3000 DR Rotterdam, Netherlands
  1. Correspondence to:
 Prof. W van Mechelen, Department of Social Medicine, Institute for Research in Extramural Medicine, VU University Medical Center, 1081 BT Amsterdam, Netherlands; 


Background: The enormous socioeconomic burden of low back pain emphasises the need for effective management of this problem, especially in an occupational context. To address this, occupational guidelines have been issued in various countries.

Aims: To compare available international guidelines dealing with the management of low back pain in an occupational health care setting.

Methods: The guidelines were compared regarding generally accepted quality criteria using the AGREE instrument, and also summarised regarding the guideline committee, the presentation, the target group, and assessment and management recommendations (that is, advice, return to work strategy, and treatment).

Results and Conclusions: The results show that the quality criteria were variously met by the guidelines. Common flaws concerned the absence of proper external reviewing in the development process, lack of attention to organisational barriers and cost implications, and lack of information on the extent to which editors and developers were independent. There was general agreement on numerous issues fundamental to occupational health management of back pain. The assessment recommendations consisted of diagnostic triage, screening for “red flags” and neurological problems, and the identification of potential psychosocial and workplace barriers for recovery. The guidelines also agreed on advice that low back pain is a self limiting condition and, importantly, that remaining at work or an early (gradual) return to work, if necessary with modified duties, should be encouraged and supported.

  • low back pain
  • occupational health
  • guidelines
  • LBP, low back pain
  • RCT, randomised controlled trial
  • RTW, return to work

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