title: From evidence to community practice in work rehabilitation: the Quebec experience.
abstract: BACKGROUND
  The causes of prolonged disability due to back pain are multiply determined, involving medical, social, and environmental factors. Possible solutions to the problem of prolonged back pain disability have emerged from recent research but few efforts have been made to transfer evidence-based programs to large community settings.
  
  
  OBJECTIVE
  This article describes three phases of the process of transfer of evidence from rehabilitation research to community practice in the province of Quebec.
  
  
  RESULTS
  Phase A: Based on literature review and expert knowledge, the Sherbrooke model was developed and assessed through a population-based, randomized clinical trial. Results at 1-year follow-up showed quicker return to regular work and improvement of quality of life; the 6-year follow-up showed the cost-effectiveness of the method. Phase B: Based on the Sherbrooke model experience and recent evidence, a new program addressing the disability paradigm was developed and implemented in the province of Quebec (Canada). Results at 1- and 3-year follow-ups showed that only 24% of workers were not working owing to their musculoskeletal disorder. The program is presently being tested through a population-based, randomized clinical trial in a population of construction workers. Phase C: To implement the program at a provincial level, a network for management, research and education in work rehabilitation was developed. An external assessment is presently planned to evaluate return to work and economic outcomes and quality of implementation of the program in various settings.
authors.affiliation: Department of Surgery, Division of Orthopedics, Sherbrooke University, Charles LeMoyne Hospital, 1111 St-Charles Street West, Suite 101, Longueuil, Quebec J4K 5G4, Canada. Patrick.Loisel@USherbrooke.ca
authors.forename: Patrick
authors.initials: P
authors.lastname: Loisel
authors.forename: Marie-José
authors.initials: MJ
authors.lastname: Durand
authors.forename: Binta
authors.initials: B
authors.lastname: Diallo
authors.forename: Brigitte
authors.initials: B
authors.lastname: Vachon
authors.forename: Nicole
authors.initials: N
authors.lastname: Charpentier
authors.forename: Josée
authors.initials: J
authors.lastname: Labelle
mesh_terms: D000328:Adult; D001416:Back Pain / Q000145:classification / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology / Q000534:rehabilitation; D002985:Clinical Protocols; D002986:Clinical Trials as Topic; D015331:Cohort Studies; D003153:Community Health Services / Q000379:methods*; D004185:Disability Evaluation; D004651:Employment / Q000706:statistics & numerical data; D019317:Evidence-Based Medicine / Q000379:methods*; D005260:Female; D006304:Health Status; D006305:Health Status Indicators; D006801:Humans; D008297:Male; D009140:Musculoskeletal Diseases / Q000150:complications / Q000453:epidemiology / Q000534:rehabilitation; D009784:Occupational Diseases / Q000150:complications / Q000453:epidemiology* / Q000534:rehabilitation*; D009788:Occupational Therapy / Q000379:methods*; D010348:Patient Care Team / Q000458:organization & administration; D011792:Quebec / Q000453:epidemiology