The annual Health and Wellbeing at Work conference took place in Birmingham in March this year. Anne Byrne presented a College of Occupational Therapists’ sponsored presentation on “Functional Limitation of Back Pain and the Impact on Return to Work”, focusing on factors pertaining to the functional outcome of rehabilitation.
Low back pain (LBP) is characterised by a range of signs and symptoms, ranging from subjective findings such as pain and stiffness, to objective findings relating to decreased range of movement and psychological distress. Research indicates that 90% of LBP is non-specific and 28% of the population will experience a significantly disabling episode of LBP in their lifetime. In the majority of cases, rapid resolution is expected within four weeks and full recovery by six weeks. The question remains as to why some individuals fail to recover and experience persisting symptoms.
Causes of LBP range from heavy and light lifting, to materials manipulation and computer use such as keyboarding. Occupations with the highest prevalence include health care professionals, skilled trades, service sector, construction and agriculture. LBP accounted for 2.8 million days lost in Great Britain in 2014.
Research has shown that psychological stress and fear avoidance beliefs correlate better with measures of functional limitation than clinical severity and clinically relevant pain. It appears that psychosocial factors, such as anxiety, lack of understanding and fear, impact on an individual’s functional outcome following an onset of LBP. Identifying and addressing these obstacles are key to facilitating recovery and participation.
Although traditional clinical evaluation methods can be helpful, the focus is often only on the physical impairment and performance components are not assessed. A biopsychosocial approach is put as an alternative method, making use of the core set for LBP as outlined by the International Classification of Function. A robust FCE should incorporate the assessment of both physical and psychological function, making use of multiple methods and triangulation of findings.
A multidimensional task analysis profile (MTAP) is then used to compare the client’s objective report to the subjective work capacity, and thereby matching capacity to demands.
Part of the FCE would be to identify obstacles (physical, psychological and social) that can delay RTW. This could include the claimant’s attitude and beliefs regarding his or her own condition and return to work. Social obstacles can also hinder the RTW process, e.g. loss of contact with employer, lack of modified duties and poor social support. The evaluator should pay attention to language used, so as not to feed into fear avoidance beliefs and catastrophic thinking patterns.
In focusing on capacity and the claimant’s strengths rather than limitations, the occupational therapist is opening the door of possibility and instilling hope. The focus should be on using a pro-active method of identifying appropriate interventions than can assist the claimant in returning to independence in activities of daily living and work.
An FCE is an effective method of identifying barriers and maximising participation. Early identification of obstacles is crucial in order to plan the way forward.