Study design The Oswestry Disability Index (ODI) has become one of the principal condition-specific outcome measures used in the management of spinal disorders. This review is based on publications using the ODI identified from the authors' personal databases, the Science Citation Index, and hand searches of Spine and current textbooks of spinal disorders. Objectives To review the versions of this instrument, document methods by which it has been validated, collate data from scores found in normal and back pain populations, provide curves for power calculations in studies using the ODI, and maintain the ODI as a gold standard outcome measure. Summary of background data It has now been 20 years since its original publication. More than 200 citations exist in the Science Citation Index. The authors have a large correspondence file relating to the ODI, that is cited in most of the large textbooks related to spinal disorders. Methods All the published versions of the questionnaire were identified. A systematic review of this literature was made. The various reports of validation were collated and related to a version. Results Four versions of the ODI are available in English and nine in other languages. Some published versions contain misprints, and many omit the scoring system. At least 114 studies contain usable data. These data provide both validation and standards for other users and indicate the power of the instrument for detecting change in sample populations. Conclusions The ODI remains a valid and vigorous measure and has been a worthwhile outcome measure. The process of using the ODI is reviewed and should be the subject of further research. The receiver operating characteristics should be explored in a population with higher self-report disabilities. The behavior of the instrument is incompletely understood, particularly in sensitivity to real change.

https://womenshealthapta.org/wp-content/uploads/2013/12/oswestry-fairbanks.pdf

The Oswestry Disability Index.

Non-specific low back pain

Condition-specific health status measures are commonly used as outcome measures in clinical trials and to assess patient progress in routine clinical practice. The expert panel that met to discuss this special issue of Spine recommended that, when possible, a condition-specific measure for back pain should be chosen from two widely used measures, the Roland–Morris Disability Questionnaire (RDQ) or the Oswestry Disability Index (ODI). These two measures have been used in a wide variety of situations over many years, and each is available in a number of languages. In this article, the authors describe these two instruments and provide evidence of their validity and reliability and some comparative results obtained with the use of the two questionnaires. The instruments themselves are included in the appendixes. When used in the forms reproduced in the appendixes, no permission is required from the authors or from Spine. Other back pain–specific health status measures are described by Kopec elsewhere in this edition of Spine.

The Roland-Morris Disability Questionnaire and the Oswestry Disability Questionnaire.

Introduction: A systematic review was conducted to review the effectiveness of workplace-based return-to-work (RTW) interventions. Method: Seven databases were searched, in English and French, between January 1990 and December 2003 for peer-reviewed studies of RTW interventions provided at the workplace to workers with work disability associated with musculoskeletal or other pain-related conditions. Methodological quality appraisal and data extraction were conducted by pairs of reviewers. Results: Of a total of 4124 papers identified by the search, 10 studies were of sufficient quality to be included in the review. There was strong evidence that work disability duration is significantly reduced by work accommodation offers and contact between healthcare provider and workplace; and moderate evidence that it is reduced by interventions which include early contact with worker by workplace, ergonomic work site visits, and presence of a RTW coordinator. For these five intervention components, there was moderate evidence that they reduce costs associated with work disability duration. Evidence for sustainability of these effects was insufficient or limited. Evidence regarding the impact of supernumerary replacements was insufficient. Evidence levels regarding the impact of the intervention components on quality-of-life was insufficient or mixed. Conclusions: Our systematic review provides the evidence base supporting that workplace-based RTW interventions can reduce work disability duration and associated costs, however the evidence regarding their impact on quality-of-life outcomes was much weaker.

Workplace-Based Return-to-Work Interventions: A Systematic Review of the Quantitative Literature

Study design: A systematic review of the literature to inform the development of occupational health guidelines for the management of low back pain at work. Objectives: To evaluate the evidence from occupational health settings or concerning occupational outcomes. Summary of background: Clinical guidelines for the management of low back pain (LBP) provide only limited guidance on the occupational aspects. Thus the Faculty of Occupational Medicine requested this review in order that a multi-disciplinary working group could develop the first evidence-based UK guidelines for management of LBP at work. Methods: A systematic literature search was followed by rating of the strength of the evidence plus a narrative review, by agreement between two experienced and independently-minded reviewers. There was no attempt at blinded double review or quality scoring. The final version followed peer-review by four international experts. Results: More than 2000 titles were considered. 34 systematic reviews, 28 narrative reviews, 52 additional scientific studies, 22 less rigorous scientific studies and 17 previous guidelines were identified and included. The evidence statements (rated for strength) were presented under headings that reflect a logical sequence of occupational health situations (Background, Pre-placement assessment, Prevention, Assessment of the worker presenting with back pain, Management principles for the worker presenting with back pain, Management of the worker having difficulty returning to normal occupational duties at 4–12 weeks). Some important areas were given additional narrative evidence-linked discussion (High risk patients/physically demanding jobs, Return to work with back pain, Rehabilitation programmes). Thirty six evidence-linked statements were developed to inform the guidelines group. The strongest evidence suggests that: generally the physical demands at work have only a modest influence on the incidence of LBP or permanent spinal damage; a history of LBP is not a reason to deny employment; preventive strategies based on the injury model do not reduce LBP or work loss; individual and work-related psychosocial factors play an important role in persisting symptoms and work loss; the management approach should be ‘active’ (including early work return); the combination of clinical, rehabilitation and organisational interventions designed to assist work return is more effective than single elements. However, further research is needed to identify the optimal roles of all stakeholders (clinicians, employers and workers) in case management. Conclusions: This review consolidates the emerging focus on active management of LBP at work, and indicates that approaches addressing obstacles to recovery will provide greater benefits than attempts at primary prevention. The outcome of the review has resulted in what we believe are the first truly evidence-linked occupational health guidelines for back pain in the world (www.facoccmed.ac.uk).

Occupational health guidelines for the management of low back pain at work – evidence review

STUDY DESIGN Population-based randomized clinical trial. OBJECTIVES To develop and test a model of management of subacute back pain, to prevent prolonged disability. SUMMARY OF BACKGROUND DATA The present management of back pain seems inadequate, and development of innovative models has been urged. METHODS A model for the treatment of subacute work-related back pain has been developed and evaluated in a population-based randomized clinical trial. Workers (n = 130) from eligible workplaces in the Sherbrooke area (N = 31), who had been absent from work for more than 4 weeks for back pain, were randomized, based on their workplace, in one of four treatment groups: usual care, clinical intervention, occupational intervention, and full intervention (a combination of the last two). The duration of absence from regular work and from any work was evaluated using survival analysis. Functional status and pain were compared at study entry and after 1 year of follow-up. RESULTS The full intervention group returned to regular work 2.41 times faster than the usual care intervention group (95% confidence interval 1.19-4.89; P < 0.01). The specific effect of the occupational intervention accounted for the most important part of this result, with a rate ratio of return to regular work of 1.91 (95% confidence interval = 1.18-3.10; P < 0.01). Pain and disability scales demonstrated either a statistically significant reduction or a trend toward reduction in the three intervention groups, compared with the trend in the usual care intervention group. CONCLUSIONS Close association of occupational intervention with clinical care is of primary importance in impeding progression toward chronicity of low back pain.

A population-based, randomized clinical trial on back pain management

Implementation of a participatory ergonomics program in the rehabilitation of workers suffering from subacute back pain.

OBJECTIVES--The aim was to combat occurrence of chronic occupational back pain. METHODS--A multidisciplinary model to manage back pain that includes both clinical and ergonomic approaches has been developed. Early detection, early clinical and ergonomic evaluations, and early active treatment make up the cornerstone of management. Detection of cases starts after four weeks of absence from work. An ergonomic intervention is implemented at six weeks. A medical specialist is involved at eight weeks. If return to work is not possible after 12 weeks, a functional recovery therapy followed by a therapeutic return to work is implemented. A multidisciplinary team decides if return to original or modified work is possible or if vocational rehabilitation is necessary. This model has been implemented by the investigators in the Sherbrooke (Quebec, Canada) area, and is presently being evaluated through a randomised trial in 31 industrial settlements (about 20,000 workers). A cluster randomisation of industries and workers will allow separate testing of ergonomic and clinical interventions. RESULTS--One year after implementation, 31 of 35 of the eligible industrial sites participated in the study and 79 of 88 of the eligible workers affected by recent back pain had agreed to participate. Ergonomic and clinical interventions have been implemented as planned. Only three workers dropped out. Hence this global clinical and ergonomic management programme has been shown to be feasible in a general population. CONCLUSION--A global management programme of back pain joining ergonomic and clinical intervention with a multidisciplinary approach has not been tested yet. Linking these two strategies in a same multidisciplinary team represents a systemic approach to this multifactorial ailment. During the first year of this trial we did not find any conflict between these two interventions from the employer's or worker's point of view.

https://oem.bmj.com/content/oemed/51/9/597.full.pdf

Lise Gosselin

Papers

A population-based, randomized clinical trial on back pain management

Implementation of a participatory ergonomics program in the rehabilitation of workers suffering from subacute back pain.

Management of occupational back pain: the Sherbrooke model. Results of a pilot and feasibility study.