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Clinical Management of Occupational Low Back Pain in Australia: What is the Real Picture?

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Abstract

Introduction The aim of this study was to compare the clinical management of patients with occupational low back pain (LBP) presenting to secondary care practitioners in Australia with national and international practice guidelines. Methods A consecutive cohort of 401 patients with LBP following a work injury was assembled at the time of referral to secondary rehabilitation. A comprehensive assessment was performed to collect demographic, clinical and occupational data, which were analysed using descriptive statistics. Clinical and occupational management data were compared with evidence-based guidelines for the management of LBP. Results This study revealed that in this cohort presenting to secondary care, referral for guideline-based active treatment was delayed until, on average, 10 months post-injury; radiographic investigations had been ordered for almost every patient, including those presenting in the first three months of their injury; the prevalence of co-morbidities was high and there were signs that psychological distress was under-diagnosed. Conclusions This study reveals a lack of compliance with clinical guidelines for occupational back pain management in Australia.

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Acknowledgements

The author gratefully acknowledges Jennifer Hewitt and staff at Rehab One Physiotherapy Pty Ltd., Sydney, where data was collected for this study as well as Andrew Leaver (University of Sydney) and Professor Chris Maher (The George Institute for International Health and the University of Sydney) for helpful discussions about the manuscript.

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Authors and Affiliations

  1. Back Pain Research Group, Faculty of Health Sciences, University of Sydney, P.O. Box 170, Lidcombe, NSW, 1825, Australia

    Julia M. Hush

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  1. Julia M. Hush
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Correspondence to Julia M. Hush.

Appendix 1

Appendix 1

Estimation of Proportion of Population Sampled

The New South Wales Workers Compensation Statistical Bulletin 2004/05 [5] lists the number of workplace back injuries in NSW in 2002/03 = 10,827 and in 2003/04 = 10,540. Therefore the average number of workplace back injuries in NSW during the sampling period August 2002 to Feb 2004 = [(10,827 + 10,540)/2] * 1.5 = 16,024 cases.

The cohort in this study sampled those with a mean injury duration of 10 months. It has been estimated that 6% of workplace injuries are of duration greater than 6 months (but incur 34% of total costs) [5]. Therefore in the sampling period, there were approximately 16,024 * 0.06 = 961 cases of back injuries lasting more than 6 months in NSW. This study sampled 401 consecutive patients with a workplace back injury lasting, on average, longer than 26 weeks which is approximately 42% of the population with a persisting workplace back injury in NSW at that time.

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Hush, J.M. Clinical Management of Occupational Low Back Pain in Australia: What is the Real Picture?. J Occup Rehabil 18, 375–380 (2008). https://doi.org/10.1007/s10926-008-9149-9

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