Background Chronic low back pain is a major cause of disability and work loss. Functional restoration programs (FRPs) are effective multidisciplinary programs in terms of return to work. However, the effectiveness of such programs appears greater if work interruption is semi-recent (<6 months) .
Objectives To explore FRP access in France, with a specific focus on duration of the work interruption before inclusion in the FRPs, and the determinants of a late/delayed access.
Methods A census of FRPs centers in France was made in 2011. In centers agreeing to participate, a cross sectional study with prospective inclusion of all patients starting the FRPs was conducted over a period of three months. For each patient, socio-professional data, pain characteristics, socio-professional and psychological aspects were collected. Late/delayed access to the FRP was defined as a work interruption of more than 6 months before the FRP (ie sick leave or permanent disability). Factors associated with late access were analyzed by univariate and multivariate logistic regression analysis.
Results Of the 62 FRPs centers identified, 21 (35%) participated: 185 patients were included (mean age 43 years, 61% men), pain VAS (0-100) was 45.8 (±23.2 SD)). Only 66% of patients had consulted a rheumatologist, with an average time between pain onset and consultation of 7.4 months. 54% of patients had consulted a surgeon. In 120 (65%) patients on sick leave or work disability, the average duration of work interruption was 9.4 (±7.4) months, 62% were off for more than 6 months. In the univariate analysis, factors associated with late/delayed access were low income, low education level, low perceived support of the occupational physician and hierarchical support at work (table 1). In multivariate analysis, hierarchical support (Karasek Score) was associated with late access (OR=0.85 (0.72 to 1.0), p=0.049).
Conclusions Access of low back pain patients to FRP centers is often delayed. Factors associated with this delay in our study were mainly work-related factors. Therefore it seems necessary to strengthen cooperation between the health care teams and occupational medicine health professionals.
Bontoux L, et al. Prospective study of the outcome at one year of patients with chronic low back pain in a program of intensive functional restoration and ergonomic intervention. Factors predicting their return to work. Ann Readapt Med Phys 2004;47(8):563-72.
Disclosure of Interest None declared
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