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Physical Exercise Interventions to Improve Disability and Return to Work in Low Back Pain: Current Insights and Opportunities for Improvement

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Abstract

Introduction: There is a body of literature that indicates that physical exercise interventions, with a primary focus on improvement of functioning instead of pain relief, might be effective to stimulate return to work and improve function in workers who are absent from work due to low back pain (LBP). Successful application and implementation of these interventions however, depends on multiple factors that need to be addressed carefully in clinical practice as well as research. Methods: Descriptive literature review, to identify an overview of current knowledge with respect to the safety, content- and context-related aspects of physical exercise interventions, issues relating to timing, the influence of treatment confidence and patient expectations, and the process of changing provider and employer behavior. Results: Physical exercises are not associated with an increased risk for recurrences. The effects of interventions may vary depending on content-related factors (i.e., type of exercises, dosage, frequency, skills of the healthcare providers, etc.) and contextual factors (i.e., treatment setting, compensation system, etc.). Treatment confidence and patients' expectations also significantly influence outcomes of physical exercise interventions. Timing is also important; interventions targeting return to work, applied during the acute phase of work absenteeism, compete with a high rate of spontaneous recovery and may therefore be inefficient. Conclusions: Despite numerous studies, more quantitative and qualitative investigations are needed to further clarify the requirements for a successful application and implementation of physical exercise interventions for disabled workers with low back pain.

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Authors and Affiliations

  1. Department of Epidemiology, Maastricht University, 6200 MD, PO Box 616, Maastricht, The Netherlands

    J. Bart Staal PT, PhD

  2. Department of Physical Medicine and Rehabilitation, Harvard Medical School, New England Baptist Hospital, Boston, Massachusetts

    James Rainville

  3. Division of Physical Therapy, University of Utah, Salt Lake City, Utah

    Julie Fritz

  4. Department of Public and Occupational Health, EMGO Institute and Body@Work TNO Vumc VU University Medical Center, Amsterdam, The Netherlands

    Willem van Mechelen

  5. Center for Disability Research, Liberty Mutual Research Institute for Safety, Hopkinton, Massachusetts

    Glenn Pransky

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  1. J. Bart Staal PT, PhD
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Correspondence to J. Bart Staal PT, PhD.

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Staal, J.B., Rainville, J., Fritz, J. et al. Physical Exercise Interventions to Improve Disability and Return to Work in Low Back Pain: Current Insights and Opportunities for Improvement. J Occup Rehabil 15, 491–505 (2005). https://doi.org/10.1007/s10926-005-8030-3

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