Designing a workplace return-to-work program for occupational low back pain: an intervention mapping approach.
BACKGROUND
Despite over 2 decades of research, the ability to prevent work-related low back pain (LBP) and disability remains elusive. Recent research suggests that interventions that are focused at the workplace and incorporate the principals of participatory ergonomics and return-to-work (RTW) coordination can improve RTW and reduce disability following a work-related back injury. Workplace interventions or programs to improve RTW are difficult to design and implement given the various individuals and environments involved, each with their own unique circumstances. Intervention mapping provides a framework for designing and implementing complex interventions or programs. The objective of this study is to design a best evidence RTW program for occupational LBP tailored to the Ontario setting using an intervention mapping approach.


METHODS
We used a qualitative synthesis based on the intervention mapping methodology. Best evidence from systematic reviews, practice guidelines and key articles on the prognosis and management of LBP and improving RTW was combined with theoretical models for managing LBP and changing behaviour. This was then systematically operationalized into a RTW program using consensus among experts and stakeholders. The RTW Program was further refined following feedback from nine focus groups with various stakeholders.


RESULTS
A detailed five step RTW program was developed. The key features of the program include; having trained personnel coordinate the RTW process, identifying and ranking barriers and solutions to RTW from the perspective of all important stakeholders, mediating practical solutions at the workplace and, empowering the injured worker in RTW decision-making.


CONCLUSIONS
Intervention mapping provided a useful framework to develop a comprehensive RTW program tailored to the Ontario setting.
Ammendolia
Carlo
C
Centre for Research Expertise in Improved Disability Outcomes, University Health Network, Toronto, Canada. cammendo@uhnresearch.ca
Cassidy
David
D
Steensta
Ivan
I
Soklaridis
Sophie
S
Boyle
Eleanor
E
Eng
Stephanie
S
Howard
Hamer
H
Bhupinder
Bains
B
Côté
Pierre
P
D000041:Absenteeism; D001521:Behavior Therapy / Q000379:methods; D004779:Environment Design / Q000592:standards*; D006804:Ergonomics / Q000379:methods; D055317:Evidence-Based Practice / Q000379:methods; D005104:Expert Testimony; D005246:Feedback; D017144:Focus Groups / Q000379:methods; D006801:Humans; D017116:Low Back Pain / Q000453:epidemiology / Q000517:prevention & control* / Q000534:rehabilitation*; D009784:Occupational Diseases / Q000453:epidemiology / Q000517:prevention & control* / Q000534:rehabilitation*; D009864:Ontario / Q000453:epidemiology; D017410:Practice Guidelines as Topic / Q000592:standards; D017132:Workplace / Q000592:standards*