Low back pain (LBP) is a common health issue that affects individuals worldwide, and it is a major cause of disability, morbidity, and lost productivity in the workplace. To address this issue, the first Dutch multidisciplinary practice guideline for occupational health professionals was developed to enhance work participation and prevent LBP and lumbosacral radicular syndrome (LRS). The guideline was developed by a multidisciplinary working group consisting of healthcare professionals, a patient representative, and researchers. The recommendations were based on a systematic review of the evidence and rated with the GRADE framework and the Evidence to Decision (EtD) framework.

The Dutch Multidisciplinary Guidelines are based on evidence-based medicine and provide a structured approach to diagnosing and treating low back pain and lumbosacral radicular syndrome. The guidelines are divided into three main sections: diagnosis, treatment, and follow-up.

• The diagnosis section of the guidelines outlines the steps for diagnosing low back pain and lumbosacral radicular syndrome. It begins with a thorough history and physical examination, followed by imaging studies such as X-rays, CT scans, and MRI scans. The guidelines also recommend laboratory tests, such as blood tests, to rule out other conditions.
• The treatment section of the guidelines outlines the various treatment options for low back pain and lumbosacral radicular syndrome. These include non-surgical treatments such as physical therapy, medications, and lifestyle modifications. The guidelines also recommend surgical treatments, such as lumbar decompression or fusion, when appropriate.
• Finally, the follow-up section of the guidelines outlines the steps for monitoring the patient’s progress and adjusting the treatment plan as needed. This includes regular follow-up visits with the patient’s healthcare provider, as well as periodic imaging studies and laboratory tests.

The guideline covers four areas, including risk factors, prevention, prognostic factors, and interventions. The working group recommends that an inventory of risk factors should be considered, and an assessment of prognostic factors is advised. To prevent LBP and LRS, physical exercises and education are advised. The working group also recommends the application of evidence-based practical guidelines, such as “lifting” and “whole body vibration.”

To enhance work participation, a stepped-care approach is recommended. This approach starts with the advice to stay active, which is facilitated by informing the worker, reducing workload, providing an action plan, and time-contingent increase of work participation for a defined amount of hours and tasks. If work participation has not improved within 6 weeks, additional treatments should be considered based on the present risk and prognostic factors. The additional treatments include (1) physiotherapy or exercise therapy, (2) an intensive workplace-oriented program, or (3) cognitive-behavioral therapy. After 12 weeks, multi-disciplinary (occupational) rehabilitation therapy needs to be considered.

The guideline is based on a comprehensive review of the evidence, and the recommendations are rated with the GRADE framework, which provides a transparent and systematic approach to evaluating the quality of evidence. The working group used the EtD framework to formulate recommendations, which takes into account the certainty of the evidence, the balance between benefits and harms, patient preferences, and resource implications.

The guideline emphasizes the importance of a multidisciplinary approach to managing LBP and LRS, involving occupational health professionals, general practitioners, physiotherapists, exercise therapists, and mental health professionals. The guideline also highlights the importance of patient-centered care, which involves understanding the patient’s preferences, values, and goals, and involving them in decision-making.

In conclusion, the Dutch multidisciplinary practice guideline for occupational health professionals is a comprehensive and evidence-based approach to enhancing work participation and preventing LBP and LRS. The guideline provides practical recommendations for identifying risk factors, preventing LBP and LRS, assessing prognostic factors, and managing LBP and LRS using a stepped-care approach. The guideline emphasizes the importance of a multidisciplinary and patient-centered approach to managing LBP and LRS. The implementation of the guideline may improve the quality of care for patients with LBP and LRS and reduce the burden of disability and lost productivity in the workplace.

Reference: Luites JWH, Kuijer PPFM, Hulshof CTJ, Kok R, Langendam MW, Oosterhuis T, Anema JR, Lapré-Utama VP, Everaert CPJ, Wind H, Smeets RJEM, van Zaanen Y, Hoebink EA, Voogt L, de Hoop W, Boerman DH, Hoving JL. The Dutch Multidisciplinary Occupational Health Guideline to Enhance Work Participation Among Low Back Pain and Lumbosacral Radicular Syndrome Patients. J Occup Rehabil. 2022 Sep;32(3):337-352. doi: 10.1007/s10926-021-09993-4. Epub 2021 Jul 27. PMID: 34313903; PMCID: PMC9576671.