Table 4

Occupational guidelines: recommendations regarding information and advice, return to work measures, and treatment

CountryInformation/adviceReturn to work measuresTreatment
Canada (Quebec)Reassure patient on benign nature of condition and on its compatibility with work.
 Counselling on posture and lifestyle.If symptoms have improved or do not cause functional restriction, return to work should be considered. 
 If after 3 months the worker has not resumed work a multidisciplinary team should be consulted (with assistance from the Worker’ compensation board), whose composition will depend on the underlying problem.Analgesics, NSAIDs. 
 Intense pain/spasm: bed rest for 2 days, prescription renewed if pain/spasm still intense.
 When no improvement: physiotherapeutic modalities including instruction and practice in proper posture and body mechanics at rest and during movement.
Australia (Victoria)Set up a treatment plan, which includes elements of medical treatment and procedures to facilitate the injured worker’s return to work. 
 Decisions and actions regarding the treatment plan should be fully discussed with the worker.A work place visit by the treating practitioner increases the understanding of the working environment and the available range of duties. Where possible, return workers to their normal duties. Where this is not possible, modify their normal tasks. Bring in occupational rehabilitation services when necessary.The purpose of treatment is to improve function, with a view to return to work. 
 Different treatment options are listed for short term (24 hours to 6 weeks after injury), medium term (6 to 12 weeks after injury) and long term complaints.
USAProvide assurance and education about back problems. 
 Recommend activity alterations to decrease symptoms.
 Encourage return to full activity.Review of work duties to decide whether modifications can be accomplished without employer notification and to determine whether modified duty is available. 
 Without co-morbidity or complicating factors (employment, legal issues): maintain patient at maximal levels of activity, including work activities; target for return to work with modified duty is 0–2 days; target for return to work without modified duty is 7–14 days.Temporary avoidance of activities that increase mechanical stress on spine. 
 Gradual return to normal activities. 
 Low stress aerobic exercise and conditioning exercises for trunk muscles after 2 weeks. 
 Discussion of surgical option in case of persistent and severe sciatica and clinical evidence of nerve root compression if symptoms persist after 1 month of conservative therapy.
New ZealandLBP usually self-limiting, serious back injuries are not common. 
 Pain does not mean that work and activity are harmful.
 Staying active and at work helps people recover better and more quickly. 
 Promote self-management and self-responsibility.Advice to modify or continue work. 
 Provide options for modified work tasks and a gradual return to work. 
 Get occupational advice if needed 
 Set return to work plan. 
 Contact between employer, case manager and treatment provider important.Advise to continue usual activities and work if appropriate. 
 Simple pain relief (paracetamol and anti-inflammatory medication). 
 Manipulation (only in first 4 to 6 weeks). 
 Eventual referral to specialist in case of “red flags”.
NetherlandsNon specific LBP and lumbosacral radical syndrome (light complaints): explanation about good prognosis; activity is not harmful. 
 Lumbosacral radicular syndrome (severe complaints): after treatment, the above mentioned advice.Non specific LBP and lumbosacral radical syndrome (light complaints): return to work within 2 weeks in absence of complications, adaptation of duties (hours or tasks) when necessary. 
 Lumbosacral radicular syndrome (severe complaints): advice on temporary work adaptation. 
 Specific LBP: look for acceptable work adaptation in consultation with employer.When no improvement within 2 weeks of work absence: eventual referral to graded activity programme (gradually increasing exercise programme). 
 When no improvement within 12 weeks of work absence: referral for multidisciplinary rehabilitation.
UKEmployers and workers must be aware that: 
 – LBP is common and frequently recurrent but acute attacks are usually brief and self-limiting. 
 – Physical demands at work are one factor influencing LBP but are often not the most important. 
 Case management needs to be directed at both physical and psychosocial factors 
 Expected recovery times have to be discussed, as is the importance of continuing ordinary activities as normally as possible despite pain. 
 Workers with LBP should receive the key information (The Back Book).Remain at work or return in early stage even if there is still some LBP. 
 Advice employers on the actions required, which may include maintaining sympathetic contact with the absent worker. 
 Consider temporary adaptation of the job or pattern of work. 
 Address the common misconception of the need to be pain free before return to work.
 Encourage the employer to establish a surveillance system to identify those off work with LBP for over 4 weeks so that appropriate action can be taken. 
 Advise employers on ways in which the physical demands of the job can be temporarily modified to facilitate return to work.Refer the worker who is having difficulty returning to normal occupational duties at 4–12 weeks to an active rehabilitation programme. 
 The rehabilitation programme should consist of education, reassurance and advice, exercise, and pain management according to behavioural principles; the programme should be embedded in an occupational setting and strongly directed towards return to work.