Physical conditioning programs for improving work outcomes in workers with back pain

Schaafsma F, Schonstein E, Whelan KM, Ulvestad E, Kenny DT, Verbeek JH

Summary

Physical conditioning program for improving work outcomes in workers with back pain

The main goal of physical conditioning programs, sometimes called work conditioning, work hardening or functional restoration/exercise programs, is to return injured or disabled workers to work or improve the work status for workers performing modified duties. Such programs either simulate or duplicate work, functional tasks, or both, in a safe, supervised environment. These tasks are structured and progressively graded to increase psychological, physical and emotional tolerance and improve endurance and work feasibility. In such environments, injured workers learn appropriate job performance skills in addition to improving their physical condition, through an exercise program aimed at increasing strength, endurance, flexibility, and cardiovascular fitness. Work hardening programs are individualized, work-oriented activities that involve clients in simulated or actual work tasks. Work conditioning is a program with an emphasis on physical conditioning that addresses the issues of strength, endurance, flexibility, motor control, and cardiopulmonary function. Functional restoration refers to any intervention aimed at restoring a reasonable functional level for daily living including work.

Based on 23 included studies, we analysed eight comparisons of physical conditioning programs versus care as usual or other types of interventions, such as standard exercise therapy for different durations of back pain and follow-up times. We divided physical conditioning programs into a light or an intense program depending on its intensity and duration. Results showed that light physical conditioning program have no significant effect on sickness absence duration for workers with subacute or chronic back pain. We found conflicting results for intense physical conditioning programs for workers with subacute back pain. Further analysis suggested a positive effect on sick leave when the workplace was involved in the intervention. Physical conditioning programs probably have a small effect on return-to-work in workers with chronic back pain. We found conflicting results for intense physical conditioning programs compared to other exercise therapy in the first two years of sick leave. No difference in effect was found between a light or an intense physical conditioning program. We found that cognitive behavorial therapy probably has no value as an alternative, or in addition to physical conditioning programs.