Dr. Maurits van Tulder talks in a quiet but direct way. Yet the Dutch scientist, who is a leading expert in low-back pain research, speaks loud and clear about the current state of research in low-back pain. Along with Institute Senior Scientist Dr. Claire Bombardier, van Tulder is coordinating editor of the Cochrane Back Review Group (see below).
Van Tulder recently talked with At Work about the important work that the Cochrane Back Review Group conducts and how it has influenced the international occupational health community.
What have been some of the Back Review Group’s recent successes?
Recently, the Back Review Group’s research evidence around treatment and management of low-back pain was the basis for several clinical guidelines, including the European Agency for Safety and Health at Work’s back to work report, the American College of Physicians and the American Pain Society guidelines on the management of low-back pain, and European guidelines on low-back pain management. These are important accomplishments because guidelines help practitioners and patients to make informed decisions about appropriate health-care treatments.
The European Agency’s report can be downloaded here: http://osha.europa.eu/publications/reports/7807300
The American guidelines can be viewed here: www.annals.org/cgi/content/full/147/7/478
The European guidelines can be viewed here: www.backpaineurope.org
What challenges do review groups, such as the Back Review Group, face?
The most important challenge is keeping up-to-date with the number of published studies. The structure of a systematic review is to search and select relevant studies, which in itself is not an easy thing to do. It may take up to one year to conduct the initial review and, by the time the review is complete, other studies may have been published that could impact it.
Plus, the Cochrane Back Review Group is an international initiative so there could be language issues around communicating among the researchers and volunteer readers, for example.
What are the differences between how the North American labour market and how the European labour market view low-back pain?
Worldwide, low-back pain is a huge social and economic problem. I think the main difference is in the interpretation of low-back pain itself. In North America, low-back pain is mainly called an “injury” and it has to be claimed as a work-related disorder for a worker to receive health-care treatment and compensation. In Europe, low-back pain is classified as a health-care problem which doesn’t need to be attributed to work exposures. For example, if I have low-back pain in the Netherlands, my company reimburses me for my health-care costs and work absenteeism costs – there is usually no claim.
There is a vast amount of research related to the treatment of low-back pain and some research on prevention efforts. Why haven’t we seen a greater drop in the prevalence or in workers’ compensation claims?
The impact of anything we do in health care is limited to the impact of policy decisions. We have made progress on the treatment side, but it’s only with policy decisions that we will see any real decreases in rates or claims. For example, about 10 years ago, there was a drop in the prevalence of low-back pain in the Netherlands because there was a change in the social security system. The new policy is if a worker is off for more than one year due to low-back pain, the worker would begin to receive a disability pension. We saw a drop in prevalence after this policy was initiated.
If you could make a global recommendation in how clinicians treat patients with low-back pain, what would it be?
For acute low-back pain, I would recommend that clinicians provide patients reassurance and advise them to stay as active as possible – there is no need to over-treat patients. For chronic low-back pain, I would suggest clinicians help assist patients to change their lifestyle to a more active one.