1. Dr. Birgitte M. Blatter Work related interventions improving return-to-work of workers with MSDs and some Dutch examples

2. Lighten the Load, workshop return-to-work2 Work related interventions improving return-to-work of workers with MSDs and some Dutch examples Content Work-related musculoskeletal disorders: Back to work report (Topic Centre Working Environment: Agency, HSL, TNO, Prevent, Eurogip, FIOH) Examples from Netherlands: ongoing projects of an insurance company a rehabilitation center an occupational health service

3. Lighten the Load, workshop return-to-work3 Work-related musculoskeletal disorders: Back to work report Evaluate the effectiveness of interventions in the workplace Scientific literature Back pain / upper limb pain / lower limb pain (Policy initiatives)

4. Lighten the Load, workshop return-to-work4 Work-related musculoskeletal disorders: Back to work report: Back pain Modified work Lumbar supports Exercise therapy Back schools Behavioural treatment Multidisciplinary approach Acute /sub-acute / chronic back pain

5. Lighten the Load, workshop return-to-work5 TherapyAcute LBP (<4/6 wks) Subacute LBP (4/6-12 wks) Chronic LBP (>12 wks) Modified work + reduction of time of work, if embedded in good occupational management + reduction of time of work, if embedded in good occupational management no studies /inconclusive Lumbar supports+ no effect + no effect + no effect Exercise therapy in general ++ no effect +/- absenteeism ++ slightly effective in pain reduction and function improvement Back schoolsno studies /inconclusive + pain and functional status Behavioural treatmentno studies /inconclusive ++ moderate effect on pain, small effect on functional status Multidisciplinary rehabilitation no studies /inconclusive+ return to work, subjective disability and functional status ++ Intensive (>100 hrs) therapy improves function and pain ++= high quality evidence + = moderate quality evidence

6. Lighten the Load, workshop return-to-work6 Work-related musculoskeletal disorders: Back to work report: Neck and upper limb pain Technical / mechanical interventions Psychosocial interventions Exercise therapy Multidisciplinary approach

7. Lighten the Load, workshop return-to-work7 TherapyNeck and upper limb pain Technical/mechanical+/- some might be effective Psychosocialno studies /inconclusive Exercise therapy+/- effective Multidisciplinary treatment +/- results on effectiveness are promising ++= high quality evidence + = moderate quality evidence +/- = limited evidence

8. Lighten the Load, workshop return-to-work8 Work-related musculoskeletal disorders: Back to work report: Lower limb pain No literature Non-occupational interventions General population Exercise therapy Other (magnetic bracelets, thermotherapy, ultrasound)

9. Lighten the Load, workshop return-to-work9 TherapyLower limb pain Exercise ++ effect on clinical outcomes, less pain Otherno studies / inconclusive ++= high quality evidence + = moderate quality evidence - = no studies or inconclusive results

10. Lighten the Load, workshop return-to-work10 Work-related musculoskeletal disorders: Back to work report: Conclusions Multidisciplinary approach seems promising (low back and neck and upper limb) Scientific evidence limited regarding neck and upper limb pain and no evidence regarding lower limb pain Evaluation of workplace interventions should probably adopt different criteria than evaluation of medical treatment Policy makers and employers should not be discouraged from taking action because there is no 100% proof it works

11. Lighten the Load, workshop return-to-work11 Work-related musculoskeletal disorders: Examples from the Netherlands Examples from Netherlands: ongoing projects of an insurance company that refers self employed persons with MSDs to physical training a a rehabilitation center that developed a website an occupational health service that started with implementing the Sherbrooke model (participative approach to implement work adaptations)

12. Lighten the Load, workshop return-to-work12 Work-related musculoskeletal disorders: Physical training for insurance company Fysioké project Aim: evaluate the effectiveness of physical training in self- employed Intervention: tailor-made fitness training (cardiovascular, strengthening, relaxation) cognitive behavioural component training of work tasks (only in South) Methods: randomized controlled trial, inclusion via claim evaluators at the insurance company, North and South

13. Lighten the Load, workshop return-to-work13 Work-related musculoskeletal disorders: Physical training for insurance company Results: Physical training (n=51 / n=75) Usual care (n=49 / n=75) P value (* < 0,05) disability (days) 1 : median North1811540.02 * disability (days) 1 : median South1481400.24 recovery of symptoms: % yes North52240.02 * recovery of symptoms: % yes South45360.51 pain level T1-T0: mean North-1.40.30.01 * pain level T1-T0: mean South-0.9-0.10.09

14. Lighten the Load, workshop return-to-work14 200150100500 Total days of disability after 6 months 1,0 0,8 0,6 0,4 0,2 0,0 Cum Survival Censored data Usual care Physical training North P-value logrank test = 0,02

15. Lighten the Load, workshop return-to-work15 200150100500 Total days of disability after 6 months 1,0 0,8 0,6 0,4 0,2 0,0 Cum Survival Censored Usual care Physical training South P-value logrank test = 0,70

16. Lighten the Load, workshop return-to-work16 Work-related musculoskeletal disorders: rehabilitation center www.snelbeter.nlwww.snelbeter.nl project Aim: develop website for workers with neck and back pain and their OHPs and evaluate the effectiveness Intervention = website Checklists/questionnaires Exercises Diary Information to reassure worker Feedback to OHP Methods: RCT, sickness absence, consultation with OHP, inclusion via 80 OHPs

17. Lighten the Load, workshop return-to-work17

18. Lighten the Load, workshop return-to-work18 Work-related musculoskeletal disorders: rehabilitation center Results: Inclusion period was extended drastically Amount of OHPs was extended drastically Only 23 cases and 23 controls (aim 64 and 64) Project stopped ! Process evaluation Takes time during consultation / OHPs forget about study ? System to include patients not user-friendly? Satisfaction about website itself? Few workers with sickness absence in a period that long

19. Lighten the Load, workshop return-to-work19 Work-related musculoskeletal disorders: occupational health service Implementation of participative work adaptations: Back disorders (general policy) Mental disorders (project basis)

20. Lighten the Load, workshop return-to-work20 Work-related musculoskeletal disorders: conclusions from the Netherlands Legislation and regulations have changed Responsibility for costs has shifted from government to employers Three examples of how insurers, rehabilitation centers and occupational health services have anticipated on this situation