Occupational health guidelines for the management of low back pain: an international comparison.
BACKGROUND
The enormous socioeconomic burden of low back pain emphasises the need for effective management of this problem, especially in an occupational context. To address this, occupational guidelines have been issued in various countries.


OBJECTIVE
To compare available international guidelines dealing with the management of low back pain in an occupational health care setting.


METHODS
The guidelines were compared regarding generally accepted quality criteria using the AGREE instrument, and also summarised regarding the guideline committee, the presentation, the target group, and assessment and management recommendations (that is, advice, return to work strategy, and treatment).


RESULTS
and


CONCLUSIONS
The results show that the quality criteria were variously met by the guidelines. Common flaws concerned the absence of proper external reviewing in the development process, lack of attention to organisational barriers and cost implications, and lack of information on the extent to which editors and developers were independent. There was general agreement on numerous issues fundamental to occupational health management of back pain. The assessment recommendations consisted of diagnostic triage, screening for "red flags" and neurological problems, and the identification of potential psychosocial and workplace barriers for recovery. The guidelines also agreed on advice that low back pain is a self limiting condition and, importantly, that remaining at work or an early (gradual) return to work, if necessary with modified duties, should be encouraged and supported.
Staal
J B
JB
Department of Social Medicine, VU University Medical Centre, 1081 BT Amsterdam, Netherlands.
Hlobil
H
H
van Tulder
M W
MW
Waddell
G
G
Burton
A K
AK
Koes
B W
BW
van Mechelen
W
W
D004185:Disability Evaluation; D006801:Humans; D017116:Low Back Pain / Q000534:rehabilitation / Q000628:therapy*; D016272:Occupational Health; D017410:Practice Guidelines as Topic / Q000592:standards; D012959:Socioeconomic Factors