PROGRAMS TO IMPROVE OCCUPATIONAL HEALTH AND REDUCE WORK ABSENTEEISM
Background.
Back ailments are the leading cause of work
absenteeism in industrialized countries. It is estimated that
the labor costs alone derived specifically from low back pain
in a European country amounts to 1.5% of its Gross Domestic
Product each year.
Traditional management of occupational low back pain has
failed. Formerly, it was mistakenly believed that back ailments
were essentially due to over-exertions of the musculature
or to the existence of structural disorders in the spine,
such as scoliosis or disc hernias. On that basis, the recommended
treatments were bed rest to reduce the muscle over-load and
surgery to correct the structural disorders.
Despite the fact that for years this was the traditional
view, it was never supported by any quality scientific study.
In fact, available scientific evidence shows that the identification
of the cause for pain was wrong, that bed rest is counterproductive
and that back surgery is useful in less than 1% of the patients
and has high failure rates when performed in cases for which
it is not strictly indicated. It is likely that these measures
adopted to solve the problem contributed to aggravate it and
explain the increase in the frequency of occupational low
back pain and the costs it generates.
In fact, despite the continual investment in ergonomics and
the advances in surgical techniques, the costs derived from
occupational low back pain increase more rapidly than all
other causes for sick leave. In the past 20 years, for example,
the costs from occupational low back pain have increased 300%
in the United Kingdom when costs from all other causes for
sick leave have increased only 50%.
In recent years, measures for improving workers' health have
been taken that reduce the economic impact of occupational
back pain. Currently, there is growing scientific evidence
that shows their efficacy, both from the point of view of
health as from the occupational and economic points of view.
While their application requires overcoming prejudices and
drastically modifying traditional management, change is inevitable
because common practice has been shown to be as harmful from
the point of view of health as it is unsustainable from the
economic point of view.
The currently available scientific evidence shows that occupational
back pains have a multifactor origin, in which psychosocial
aspects have as much influence as biomechanical ones. The
first have greater influence in the risk of the appearance
and persistence of pain and the latter in disability and absenteeism.
For this reason, in order to improve occupational health and
reduce absenteeism due to low back pain, it is necessary to
adopt multidisciplinary measures which include not only medical
aspects but also organizational, educational and psychosocial
ones as well.
Objective.
To define and apply a program aimed at improving
occupational health and reducing absenteeism due to back problems,
which includes those measures which have been scientifically
shown to be effective.
Description.
To be more effective, instead of imposing
these measures, they should be agreed upon by all of the parties
involved, including the workers, their representatives, the
company, the company doctors and health care professionals.
Given that the current situation harms the worker's health,
frustrates his or her doctors, and taxes the company's economy,
this consensus is viable and is attainable when it is promoted
and coordinated by a scientific and health-centered entity
which, as it is not-for-profit and does not constitute an
interested party, maintains good relations with all of the
agents involved, is completely impartial and is not engaged
in any of the possible conflicts among them.
Although some of the measures that should be included are
not viable in certain settings, a complete program consists
of:
-
Actions to be taken the company and with its managers,
aimed at:
-
Identifying and eliminating the mechanical and psychosocial
factors that increase the risk of back ailments and
that are avoidable.
-
Adopting the organizational measures that have been
shown to be effective in reducing the risk of the
appearance and persistence of back disorders.
-
Monitor absenteeism due to back ailments in order
to study the factors not previously detected which
could imply a greater risk of suffering them and identify
early on those patients in whom pain lasts for more
than 4 weeks, since they should be the object of special
treatment and handling so as to prevent the ailment
from becoming chronic.
-
Health education programs for workers which include:
-
Postural hygiene to teach workers to carry out their
daily activities, including those on the job, so as
to create the least load possible on the back.
-
Ergonomics, encouraging the proper use of the available
ergonomic devices.
-
Exercise, insisting on its usefulness in reducing
the risk of unspecified low back pain and explaining
the proper norms to follow when exercising.
-
The attitude to adopt should pain appear in order
to avoid the risk of it becoming chronic and causing
functional disability.
-
Actions with the labor unions, to collaborate in the
application of the actions directed at the companies and
their workers.
-
Actions with the company doctors to ensure their continuing
medical training, based on scientific evidence that is
up-to-date, especially in:
-
The identification and control of factors exposing
a worker to a greater risk of unspecified low back
pain or impeding his or her recovery.
-
Occupational management of back pains that is optimal
for the worker's health.
-
The behavior to follow in order to properly identify
and manage the cases of low back pain which, on lasting
4 weeks, have a high risk of becoming chronic.
-
Actions with the workers' health care physicians in order
to:
-
Ensure their fluid communication with the company
doctors, especially geared to collaboration in cases
of sick leave due to low back pain that lasts 4 weeks.
-
Train them in evidence-based medical management of
back ailments.
-
Encourage mechanisms of continuing medical training
that permit an evidence-based clinical practice in
the care of patients with unspecified low back pain.
The Foundation acts as the program consultant and also executes
some of the educational and medical actions that comprise
it. Usually, it works in coordination with a work accident
mutual insurance company or with the company's labor consultants
in order to unite efforts, prevent delays, and ensure the
greatest efficiency of the available resources.
Along with the Kovacs Foundation, the following
have participated in this project.
Companies in different sectors and mutual insurance for work
accidents. The programs are co-funded by the Foundation and
these entities.
Status and results.
In 1996, the Foundation began to apply several
of the measures that make up the complete program in different
settings in order to assess their effect and viability.
Although the implantation of this kind of program is relatively
recent, there are already reliable studies on the outcome
of some of the measures that comprise it, reflecting a notable
reduction in the yearly incidence of occupational absenteeism
due to back ailments and a high degree of satisfaction on
the part of the workers.
In view of these results, it has decided to integrate the
different measures into a single global program and to accord
its application with the companies and agents involved in
improving occupational health and reducing absenteeism.
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