In the United Kingdom, a series of chiropractors, osteopaths, and physiotherapists were interviewed about their beliefs regarding return to work.

Work, they agreed, is generally beneficial.

However, if a particular worker had a back problem and did not want to take time off work, many treaters were of the opinion that this would have a negative impact on recovery. A lot of practitioners advised patients to take time off work to focus on improving their back problem.

The practitioners considered that their role was to treat the person's medical problem and provide advice about ergonomics, e.g. how a person should sit, stand.

However, they were reluctant to tackle a person’s beliefs. Psychosocial factors such as fear of pain, workplace problems and lack of support at home were also off limits.

The study indicates that while there may be a belief that work is beneficial, practitioners are often out of step in their return to work recommendations. Recommending time off work, even as a tool to improve back problems - with positive intentions to improve the condition - has not been shown to be helpful or improve outcomes. In fact, it is associated with a poorer prognosis.

The study indicates that a lot needs to be done to encourage health practitioners to treat the whole person, and understand that time off work is not likely to be helpful. It can, in fact, be counterproductive.

Authors

Pincus T. Woodcock A. Vogel S. .

Authors Full Name

Pincus, Tamar. Woodcock, Alison. Vogel, Steven. .

Institution

Department of Psychology, Royal Holloway, University of London, Egham, Surrey, TW20 0EX, UK. t.pincus@rhul.ac.uk

Title

Returning back pain patients to work: how private musculoskeletal practitioners outside the national health service perceive their role (an interview study).

Source

Journal of Occupational Rehabilitation. 20(3):322-30, 2010 Sep.

Abstract

BACKGROUND: Private musculoskeletal practitioners treat a large section of people with back pain, and could play an important role in returning and maintaining patients to work.

METHOD: We conducted a qualitative study to explore the self-perceived role of such practitioners in the UK. We interviewed 44 practitioners, including chiropractors, osteopaths and physiotherapists.

RESULTS: Thematic analysis of the interview transcripts indicated that return to work is a high priority for patients, many of whom are self-employed. Although in general work was perceived as beneficial to health, practitioners perceived work as a threat for some of their back pain patients. They perceived their role as giving ergonomic, postural and exercise based advice, but were more reluctant to address psychosocial problems related to back pain. A common view was that patients' reluctance to take a break from work impacted badly on their condition, and many practitioners advocated a short time off work duties to focus on rehabilitation. Contact with employers was very limited, and determined by the patients' request.

CONCLUSION: In summary, the study identifies several areas in which further education could expand the role of musculoskeletal practitioners and benefit their back pain patients. However, further study is required to determine whether these results are generalisable beyond the limits of this qualitative study UK based study.

PubMed Link: http://www.ncbi.nlm.nih.gov/pubmed/19921407