Table 3

Occupational guidelines: recommendations regarding assessment of LBP

CountryPatient populationDiagnostic classificationExaminationx ray examinationPsychosocial factorsWorkplace factors
Canada (Quebec)Subjects (workers) with activity related spinal disorders11 categories ranging from LBP without radiation to chronic pain syndrome and “other diagnoses”. 
 Further classification of duration (<7 days, 7 days–7 weeks, >7 weeks) and working status (working or idle); idle means absent from work, unemployed or inactive.0–4 weeks absence from work: history and complete physical examination (including neurological examination); in case of serious disease further investigation. 
 4–7 weeks absence from work: re-evaluation, radiograph and sedimentation rate. 
 Not working after 6 weeks: referral to musculoskeletal specialist. 
 After 3 months of absence from work: consultation of multidisciplinary teamIf signs suggest a specific or serious disease.Identification of chronic pain syndrome, psychosocial factors tend to complicate the clinical problem after 3 months from the onset of a spinal disorder.0–4 weeks absence from work: identify work factors that may have caused the problem. 
 4–7 weeks absence from work: assessment of occupational skills (to assist in returning to work).
Australia (Victoria)Workers with compensable LBPBack pain (non specific). 
 Back strain (till 8 weeks after injury). 
 Back pain with specific diagnosis.History. 
 Physical examination: inspection, palpation and movements; 
 signs of nerve root tension and irritation (SLR etc.); 
 sign of impairment of nerve conduction (neurological examination); 
 functional signs to assess possible psychological involvement (over-reaction, pain on simulated force, superficial or non-anatomical tenderness, regional weakness or sensory loss, SLR discrepancy); 
 examination of sacroiliac jointsLBP with no radicular elements: at 4 to 6 weeks after onset to show individuals with spondylolysthesis or degenerative diseases. 
 Findings must be related to clinical presentation. 
 LBP with radicular symptoms (back and leg pain with abnormal unilateral signs): at onset of complaintsPsychosocial history: circumstances or difficulties at home and in the workplace, employment history, previous workers compensation episodes. 
 After 2 and 6 weeks of absence from work: psychosocial assessment, 
 Assessment of depression, consider psychological or psychiatric referral.Work history: duties, perceived difficulties in returning to work, relationships at work. 
 After 2 and 6 weeks of absence from work: determine need for vocational assessment.
USAWorkers with <3 months activity intolerance due to LBP and/or back related leg symptoms related to occupational injury or exposurePotentially serious low back disorders (red flags).
 Degenerative disorders. 
 Non-specific disorders.Medical history. 
 Physical examination: general observation, regional examination of the low back, neurological screening, testing for lumbosacral nerve root tension.When symptoms do not improve over 4 weeks, or in cases of red flags.Not mentioned.Perceived work relatedness of limitations, information on specific job duties.
New ZealandWorkers with acute LBPAcute (LBP <3 months)
 Chronic (LBP >3 months). 
 Red flags: potentially serious conditions. 
 Yellow flags: potential psychosocial obstacles to recovery.History 
 Screening for red and yellow flags.Only in cases of “red flags” or when the symptoms do not reduce in intensity after 4 weeks.Screening for yellow flags.Identify difficult tasks (heavy work, lots of lifting and forceful movements, bending and twisting, a lot of driving). 
 Investigate accidents or injuries.
NetherlandsWorkers who are absent from work because of LBPNon-specific LBP. 
 Radicular syndrome.
 Specific LBP.Medical history. 
 Physical examination: flexion, extension, lateral bending and rotation of lower back. 
 In case of radiation: SLR test, strength, reflexes, sensibility.Only in cases of “specific” LBPDiagnosis of inadequate pain or illness behaviour, somatic fixation, kinesiophobia.Identify risk factors (twisting, bending forward and sideward, frequency of lifting, asymmetric load). 
 Eventually assistance of occupational health nurse or occupational hygienist for workplace investigation. 
 Review psychosocial load of work.
UKWorkers presenting with LPB, and those having difficulty returning to duties at 4–12 weeksSimple back pain. 
 Nerve root pain. 
 Red flags for possible serious spinal pathology.Screen for serious spinal diseases and nerve root problems. 
 Clinical, disability and occupational history.x ray examinations and scans not indicated for the occupational health management of the worker with LBP.Consider psychosocial “yellow flags”; guidance provided.Occupational history: concentrate on impact of symptoms on work, and any obstacles to recovery and return to work.