Do occupational health assessments match guidelines for low back pain?

BACKGROUND: Audit is an important facet of clinical governance and good occupational health practice. There are well-established clinical guidelines for the management of low back pain. Occupational Health Guidelines for the Management of Low Back Pain at Work were launched by the Faculty of Occupational Medicine in March 2000, based on an extensive, systematic review of the scientific literature predominantly from occupational settings or concerning occupational outcomes. AIM: To determine whether documented National Health Service occupational health assessment of low back pain in the North West region of England conforms to the published guidelines. METHODS: A retrospective audit of case notes was conducted. Six performance indicators were derived from the Occupational Health Guidelines for the Management of Low Back Pain at Work in order to evaluate the performance by occupational physicians. Two hundred and seventy-seven case notes were identified from eight different occupational health departments. RESULTS: Low rates of compliance with national standards were observed for recording of some performance indicators, notably for the assessment and documentation of 'red' and 'yellow flags'. Our findings suggest that the quality of documentation of key information in the notes leaves significant room for improvement. CONCLUSIONS: For future audits, we recommend having two external auditors and seek to demonstrate a high degree of agreement between observers by conducting a reproducibility exercise. Future Faculty guidelines should emphasize documentation of the assessment and perhaps consider assessment tools to improve documentation.

Return to paid work after cancer: a British experience.

INTRODUCTION: The impact of cancer on people's working lives is an increasingly important concern, yet, little is known regarding return to work after cancer in England. The rate of cancer patients who returned to paid employment within 18 months of diagnosis, and explored associations with demographic, clinical and work perception in one English region was investigated. MATERIALS AND METHODS: A postal survey of all cancer patients registered in North West England from June 2002 through December 2002. Participants were between the ages 18-55 with a primary diagnosis of cancer, in paid employment at the time of diagnosis and being judged by their General Practitioners as suitable for return to work. RESULTS: Two hundred sixty-seven eligible patients returned a completed consent form and questionnaire, a response rate of 50%. The median age was 48 years. The majority of respondents (48%) were female with breast cancer, followed by colorectal (14%), prostate (9%) and lung cancers (6%). 82% of respondents returned to work. Treatment modality (absence of surgery) and the length of sick-leave were the only significant factors related to return to work (Odds Ratio 0.28 95% CI 0.08-0.94; Odds Ratio 1.68 95% CI .1.23-2.28). The median length of sickness absence was less than 6 months, longer in the most economically deprived quintile. One fifth of those who returned to work reported deterioration in job satisfaction and career prospects. CONCLUSIONS: While a high proportion of respondents managed to return to their place of work 20% were not able to do so. The duration of sick leave absence was associated with more difficulties in returning to work. Despite the fact that males were more likely than females to take no sick leave, they were more likely to take longer periods of absence when they did (18 months and over). In addition, the length of sick leave was greatest in the most economically deprived group, and in those survivors of cancer diagnosis and treatment who did not receive surgery.

The incidence of work-related illness in the UK health and social work sector: The Health and Occupation Reporting network 2002-2003.

BACKGROUND: In the United Kingdom, The Health and Occupation Reporting network (THOR) collects incidence data on work-related illness. THOR data show that the health and social work sector generates a high proportion of case reports. This study analyses the most recent data for the health and social work sector, from 2002 to 2003. METHODS: Cases returned to the Occupational Physicians Reporting Activity (OPRA) scheme and three other specialist schemes (Surveillance of Occupational Stress and Mental Illness, Musculoskeletal Occupational Surveillance Scheme and occupational skin surveillance) were analysed. Estimates of incidence rates for stress-related illness, musculoskeletal disorders and skin disease were calculated using two denominators. RESULTS: In this period, 23% (11,016/47,437) of all estimated cases in THOR were in health and social work sector employees. In OPRA, in the health and social work sector, annual average incidence rates per 100,000 calculated using Labour Force Survey (LFS) data as the denominator were 51.2 for mental illness, 35.9 for musculoskeletal disorders and 10.4 for skin disease; using McDonald's data as the denominator the corresponding rates were 119.5, 83.7 and 24.3. In the specialist THOR schemes, annual average incidence rates per 100,000 using LFS data as the denominator were 18.4 (mental illness), 6.1 (musculoskeletal disorders) and 15.3 (skin disease). CONCLUSIONS: Our results highlight the importance of collecting information on incident cases and denominators, to allow calculation of occupational disease rates. The higher incidence of mental illness (compared with musculoskeletal and skin disorders) in this employment sector merits further investigation.