[The evidence-based occupational health paradigm in managing back pain: identifying the problem and evaluation of the decision].
BACKGROUND
Occupational health professionals must rely on the best available evidence in support of the appropriateness of diagnostic tests and preventive or clinical interventions. This study aims at comparing the decisions made in respect of health care personnel with the decisions made on the basis of the evidence and evaluating the effectiveness of these decisions.


METHODS
Five female nurses with back problems exposed to health risk mostly associated with patient handling and movement were considered. The diagnostic results and the interventions following the decisions made in 2002 were evaluated and compared with the medical data during the years 2004-2005. To assess health changes occurring after the intervention, an indicator of impact was used. During 2006 the health problems were reviewed by means of the multi-step evidence-based occupational health paradigm: starting from identification of the problem and search for evidence (with a new and validated search string and the database Medline) followed by evaluation of performance. Professional performance was assessed by comparing the medical decisions made in 2002 with the decision supported by the evidence.


RESULTS
All the medical decisions were in agreement with the decisions inferred from scientific evidence. Furthermore, all subjects showed an improvement in both perceived and objective health conditions after the intervention, together with increased acceptability of working conditions.


CONCLUSIONS
Given that no gold standard exists and that guidelines for the management of back pain need to be assessed for their effectiveness, this study shows that the occupational health professional should be aware of the availability of up-to-date scientific evidence which can provide appropriate solutions to the commonly encountered problems. This perspective will be a challenge for professionals aware of the need to adopt practices related to the concept of quality in occupational health care.
Franco
G
G
Cattedra e Scuola di Specializzazione di Medicina del lavoro dell'Università di Modena e Reggio Emilia, Azienda Ospedaliero-Universitaria, Modena. franco@unimo.it
Minerva
Maddalena
M
Grandi
Pamela
P
Franchi
A
A
D000328:Adult; D019090:Case Management; D003657:Decision Making; D004650:Employee Performance Appraisal; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000150:complications / Q000175:diagnosis / Q000628:therapy; D017116:Low Back Pain / Q000209:etiology / Q000628:therapy*; D008159:Lumbar Vertebrae; D008962:Models, Theoretical; D009729:Nursing; D009784:Occupational Diseases / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D009787:Occupational Medicine / Q000379:methods*; D010353:Patient Education as Topic; D026741:Physical Therapy Modalities; D013128:Spinal Osteophytosis / Q000150:complications / Q000175:diagnosis / Q000628:therapy; D013168:Spondylolisthesis / Q000150:complications / Q000175:diagnosis / Q000628:therapy; D016896:Treatment Outcome