記住我
educate and consider referral to active rehab including cognitive behavioral therapy, in presence of belief that pain and activity are harmful
○educate and consider pain clinic referral, in presence of ‘sickness behaviors’ (like extended rest)
○assess for psychopathology and treat, in presence of low or negative moods, social withdrawal
○educate, in presence of treatment beliefs not fitting best practice
○connect with stakeholders and case manage, in presence of problems with claim and compensation
○follow-up regularly and refer if recovering slowly, in presence of history of back pain, time-off, other claims
○engage case management through disability carrier, in presence of problems at work, poor job satisfaction
○follow-up regularly and refer if recovering slowly, in presence of heavy work, unsociable hours (shifts)
○educate patient and family, in presence of overprotective family or lack of support
not providedThere is insufficient evidence to recommend for or against modified work duties for facilitating return to work1 RCTDenmark (42Stochkendahl MJ Kjaer P Hartvigsen J Kongsted A Aaboe J Andersen M Andersen MØ Fournier G Højgaard B Jensen MB Jensen LD Karbo T Kirkeskov L Melbye M Morsel-Carlsen L Nordsteen J Palsson TS Rasti Z Silbye PF Steiness MZ Tarp S Vaagholt M. National clinical guidelines for non-surgical treatment of patients with recent onset low back pain or lumbar radiculopathy.)Individual patient education should be offered specifically to patients who are worried about their LBP, show signs of fear-avoidance or passive behavior, and only in those patients who are motivated, are able to change their level of self-efficacy, and be based on a patient-centered dialogueexpert opinionEurope (3Airaksinen O Brox JI Cedraschi C Hildebrandt J Klaber-Moffett J Kovacs F Mannion AF Reis S Staal JB Ursin H Zanoli G. On behalf of the COST B13 Working Group on Guidelines for Chronic Low Back Pain. Chapter 4. European guidelines for the management of chronic nonspecific low back pain.,4Becker A Niehus W Breen A Breen A Gil del Real MT Hutchinson A Koes B Laerum E Malmivaara A On behalf of the COST B13 Working Group on Guidelines for the Management of Acute Low Back Pain in Primary Care. Chapter 3 European guidelines for the management of acute nonspecific low back pain in primary care.)Manage psychosocial factors appropriatelyexpert opinionIdentification of yellow flags should lead to appropriate cognitive and behavioral management. However, there is no evidence on the effectiveness of psychosocial assessment or intervention in acute LBPlevel AFrance (1Agence Nationale d'Accréditation et d'Évaluation en Santébasis psychosomatic care
○regular screening for chronification factors
○initiation and coordination of further psychotherapeutic care, if necessary
○possibly social counseling with respect to disability and compensation, or initiation of such counseling
○possibly suggestion of measures for occupational reintegration and/or retraining
-patients with symptom-maintaining or symptom-reinforcing comorbidities (such as anxiety and depression):-patients with continued inability to work:○screening for workplace-related risk factors
○contact with company physician and, if necessary, with employer or pension insurance company
○consider and, if necessary, initiate measures to support occupational reintegration
not providedItaly (27Negrini S Giovannoni S Minozzi S Barneschi G Bonaiuti D Bussotti A D'Arienzo M Di Lorenzo N Mannoni A Mattioli S Modena V Padua L Serafini F Violante FS Diagnostic therapeutic flow-charts for low back pain patients: The Italian clinical guidelines.)In patients at high risk of chronicity, the main aim of treatment is early, specific intervention on bio-psycho-social risk factors of chronicitylevel AMultidisciplinary approach is not recommended in case of low-disability and if (i) complex treatment is difficult because of cognitive, psychological or motivational factors, and/or (ii) patient does not believe a solution is possiblelevel CMalaysia (15Hussein MMA Singh D Mansor M Kamil OIM Choy CY Cardosa MS Hasnan N Vijayan R. The Malaysian low back pain management guidelines.)If the patient does not improve within 4-6 weeks, yellow flags should be addressednot providedIdentify and address specifically the patient's worries and anxiety about health matters that they suspect is related to their back pain.multiple studiesRefer to a pain specialist if yellow flags still persist and activity has not returned to normal after 3 monthsmultiple studiesIdentification of yellow flags leads to (i) decision whether more detailed assessment is needed, (ii) identification of factors that can be addressed by specific interventions, and (iii) secondary prevention of chronic back painnot providedNetherlands (48Van Tulder MW Custers JWH Bie RA Hammelburg R Hulshof CTJ Kolnaar BGM Kuijpers T Ostelo RWJG van Royen BJ Sluiter A. Ketenzorgrichtlijn Aspecifieke Lage Rugklachten.)Cognitive behavioral therapy is recommended in presence of cognitive behavioral problemsnot providedIdentification of yellow flags should lead to appropriate cognitive and behavioral managementnot providedIf needed, the health care professional should refer the patient to a primary care psychologist for diagnostics or treatment (if no improvement in 2-3 weeks and presence of any psychosocial risk factor for chronicity)not providedPatient in sick leave because of LBP and their supervisor should be advised to perform a workplace assessment to analyze any barriers for return to work and if so, apply necessary adaptations in work(place)level B (moderate evidence)New Zealand (28New Zealand acute low back pain guideProvide a positive expectation that the individual will return to work and normal activity, aid if the problem persists beyond 2-4 weeks, provide a reality-based warning of what is going to be the likely outcome
○Be directive in scheduling regular reviews of progress
○Keep the individual active and at work if at all possible, even for a small part of the day. Consider reasonable requests for selected duties and modifications to the workplace. After 4-6 weeks, if there has been little improvement, review vocational options, job satisfaction, any barriers to return to work, including psychosocial distress
○Acknowledge difficulties with activities of daily living, but avoid making the assumption that these indicate all activity or any work must be avoided
○Help to maintain positive cooperation between the individual, an employer, the compensation system, and health professionals, and encourage collaboration wherever possible
○Make a concerted effort to communicate that having more time off work will reduce the likelihood of a successful return to work
○Be alert for the presence of individual beliefs that he or she should stay off work until treatment has provided a ‘total cure’
○Promote self-management and self-responsibility, and encourage the development of self-efficacy to return to work
○Be prepared to ask for a second opinion, especially if it may help clarify that further diagnostics are unnecessary
○Avoid confusing the report of symptoms with the presence of emotional distress
○Avoid suggesting (even inadvertently) that the person from a regular job may be able to work at home, or in their own business because it will be under their own control
○Encourage people to recognize, from the earliest point, that pain can be controlled and managed so that a normal, active or working life can be maintained
○If barriers to return to work are identified and the problem is too complex to manage, referral to a multidisciplinary team as described in the New Zealand Acute Low Back Pain Guide is recommended
not providedProvide your patient, and their employer, with advice on monitoring and managing work activities that cause painnot providedIf the physical demands of the patient's job are high, workplace modifications may be needed. You may be able to advise the employer on how to seek specialist occupational health advice about this.not providedPhilippine (33Philippine Academy of Rehabilitation Medicine (PARM)
留言 (0)