Occupational guidelines: recommendations regarding assessment of LBP
| Country | Patient population | Diagnostic classification | Examination | x ray examination | Psychosocial factors | Workplace factors |
|---|---|---|---|---|---|---|
| Canada (Quebec) | Subjects (workers) with activity related spinal disorders | 11 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 team | If 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 LBP | Back 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 joints | LBP 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 complaints | Psychosocial 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. |
| USA | Workers with <3 months activity intolerance due to LBP and/or back related leg symptoms related to occupational injury or exposure | Potentially 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 Zealand | Workers with acute LBP | Acute (LBP <3 months) Recurrent. 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. |
| Netherlands | Workers who are absent from work because of LBP | Non-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” LBP | Diagnosis 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. |
| UK | Workers presenting with LPB, and those having difficulty returning to duties at 4–12 weeks | Simple 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. |