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See detailLe rôle du Fonds des Maladies Professionnelles en faveur de la réadaptation des patients lombalgiques
Poot, Olivier; Strauss, Patrick; Mairiaux, Philippe ULg

in Revue Médicale de Bruxelles (2009), 30(4), 326-329

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See detailManagement of low back pain by occupational health physicians - the belgian guidelines
Mairiaux, Philippe ULg; Mazina, D. ULg

in Proceedings ICOH 2009 (2009, March)

Introduction With the support of the Belgian Health Care Knowledge Centre (KCE), a systematic review of the EBM literature concerning the management of low back pain (LBP) patients in the occupational ... [more ▼]

Introduction With the support of the Belgian Health Care Knowledge Centre (KCE), a systematic review of the EBM literature concerning the management of low back pain (LBP) patients in the occupational health (OH) context has been undertaken in order to issue good practices recommendations for occupational physicians (OP). Methods The guidelines development proceeded in three steps. First, an electronic search was performed to retrieve relevant guidelines and systematic reviews (SR) from 8 international databases. The identified guidelines were appraised using the AGREE method, while SR’s were appraised using the Cochrane Collaboration grid: 7 guidelines and 27 SR’s were selected. A draft of the intended Belgian guidelines was then validated by a group of Belgian OH experts. In a third step, the guidelines were adapted in a more practical format, thanks to a working group involving OP’s coming from 12 OH services and medical advisors (MA) from the sickness funds. Results Two documents have been published with the support of the Belgian Ministry of Labor. The guidelines document (50 p) summarizes the scientific evidence according to the OP main missions : background information to be given to employers and employees, evidence-based prevention policies to promote in the enterprises. As regard the health surveillance of workers, the guidelines consider three situations: periodic health surveillance, spontaneous examinations at the worker request, and return to work examinations after long duration sick leaves. Secondly, a management guide (19 p) is intended for employers and trade unions representatives. Discussion From a health care policy point of view, this study highlighted the major roles of the occupational physician and of the sickness funds medical adviser and stressed the need to better define those roles if decision makers want to tackle the low back pain problem and the economic consequences of the related sick leave. [less ▲]

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See detailImpact of participatory risk assessment approaches on occupational health professional's attitudes and practices
Mairiaux, Philippe ULg; Mazina, D. ULg; Roussel, Sandrine et al

Poster (2009, March)

Introduction In the last 10 years with the support of the Belgian Federal Public Service (FPS) for Employment and Labour and the European Social Fund, prevention advisors (PA) and occupational health ... [more ▼]

Introduction In the last 10 years with the support of the Belgian Federal Public Service (FPS) for Employment and Labour and the European Social Fund, prevention advisors (PA) and occupational health physicians (OP) have been invited to use new methods for risk assessment involving workers’ participation, namely the Sobane strategy, or the Risk/Toxtrainer methodology. This study aimed at evaluating these methods actual use among PA’s and OP’s, and its impact on representations and risk management practices. Methods A national postal survey was conducted in 2007 among a random sample (n=3340) of all professionals registered as PA (>6000) or OP (about 1000) by the FPS. The questionnaire explored those professionals’ familiarity with 12 different risk assessments methods, the nature of their interventions in enterprises, their representations about participation and collected demographic information. Results A total of 859 completed surveys (response rate: 25.7 %) could be analyzed. Among the methods studied, the Kinney-Wiruth accident risk analysis is the most familiar (54% regular users + 19% trained ones). The participatory methods are familiar (users + trained) to respectively 46 % (Sobane) and 11% (Risktrainer) of the respondents. When analyzing practices in enterprises, the professionals familiar with one of the participatory approaches are more often than the other professionals suggesting the use of participation in risk management to colleagues (84 vs 67.5% ; p<0.000) or to the employer (84 vs 73.5% ; p<0.000). Those professionals not familiar with the participatory approaches agree more often with the following statements: “PA role is more to inform than to listen” (p=0.005), “Participatory processes are raising unrealistic expectations among the staff” (p=0.002). Discussion This study shows that participatory risk assessment methods are gaining ground in Belgian enterprises. It also highlights the significant influence that information and training in those methods have had on risk management practices and the professionals’ representations. [less ▲]

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See detailImpact of participatory risk assessment approaches on occupational health professional's attitutdes and practices Proceedings ICOH 2009
Mairiaux, Philippe ULg; Mazina, D. ULg; Roussel, Sandrine et al

Poster (2009, March)

In the last 10 years with the support of the Belgian Federal Public Service (FPS) for Employment and Labour and the European Social Fund, prevention advisors (PA) and occupational health physicians (OP ... [more ▼]

In the last 10 years with the support of the Belgian Federal Public Service (FPS) for Employment and Labour and the European Social Fund, prevention advisors (PA) and occupational health physicians (OP) have been invited to use new methods for risk assessment involving workers’ participation, namely the Sobane strategy, or the Risk/Toxtrainer methodology. This study aimed at evaluating these methods actual use among PA’s and OP’s, and its impact on representations and risk management practices. Methods A national postal survey was conducted in 2007 among a random sample (n=3340) of all professionals registered as PA (>6000) or OP (about 1000) by the FPS. The questionnaire explored those professionals’ familiarity with 12 different risk assessments methods, the nature of their interventions in enterprises, their representations about participation and collected demographic information. Results A total of 859 completed surveys (response rate: 25.7 %) could be analyzed. Among the methods studied, the Kinney-Wiruth accident risk analysis is the most familiar (54% regular users + 19% trained ones). The participatory methods are familiar (users + trained) to respectively 46 % (Sobane) and 11% (Risktrainer) of the respondents. When analyzing practices in enterprises, the professionals familiar with one of the participatory approaches are more often than the other professionals suggesting the use of participation in risk management to colleagues (84 vs 67.5% ; p<0.000) or to the employer (84 vs 73.5% ; p<0.000). Those professionals not familiar with the participatory approaches agree more often with the following statements: “PA role is more to inform than to listen” (p=0.005), “Participatory processes are raising unrealistic expectations among the staff” (p=0.002). Discussion This study shows that participatory risk assessment methods are gaining ground in Belgian enterprises. It also highlights the significant influence that information and training in those methods have had on risk management practices and the professionals’ representations. [less ▲]

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See detailPhysical characteristics of the back are not predictive of low back pain in healthy workers : a prospective study
Van Nieuwenhuyse, An; Crombez, Geert; Burdorf, Alex et al

in BMC Musculoskeletal Disorders (2009), 10(2), 1-9

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See detailLombalgie au travail - Un guide pour l'employeur et les partenaires sociaux
Mairiaux, Philippe ULg; Mazina, D. ULg

Book published by Service Public Fédéral Emploi, Travail et Concertation Sociale (2008)

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See detailOfficine et Prévention
Mairiaux, Philippe ULg

Article for general public (2008)

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See detailManutentions manuelles - Guide pour évaluer et prévenir les risques
Mairiaux, Philippe ULg; Demaret, J.-Ph.; Masset, D. et al

Book published by SPF Emploi, Travail et Concertation sociale (2008)

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See detailLes absences de longues durées pour lombalgie au sein du personnel soignant dans le secteur hospitalier
Vidick, Sarah ULg; Mairiaux, Philippe ULg

in Santé Publique : Revue Multidisciplinaire pour la Recherche et l'Action (2008), (Suppl. N° 3), 29-37

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See detailPromotion de la santé en milieu de travail : modèles et pratiques
Muller, Michel; Mairiaux, Philippe ULg

in Santé Publique : Revue Multidisciplinaire pour la Recherche et l'Action (2008), (Suppl. N° 3), 161-169

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See detailDeterminants of long duration sickness absence after an occupational back injury in the Belgian working population
Mairiaux, Philippe ULg; Mazina, D. ULg

Poster (2007, August)

Aims Occupational low-back injuries are a major cause not only of lost time but also of job loss and early retirement for health reasons. To promote the employability of an aging workforce, a better ... [more ▼]

Aims Occupational low-back injuries are a major cause not only of lost time but also of job loss and early retirement for health reasons. To promote the employability of an aging workforce, a better understanding of the prognostic factors for a long duration sick leave after such injuries is needed. The Belgian national database of work accidents was used to investigate these factors. Methods The data were retrieved from the Belgian Fund for Work Accidents (FAT) database over a three-year period (2001-2003). The population source involved all the workers under a job contract in the private sector recorded during that period as compensated cases for an accident that occurred at the workplace (n=558.276); 6,6% of those cases had the back as “location of injury”. Taking into account the calendar year system for counting time on benefits, the analysis was restricted to the 18936 workers who had reported a back injury during the first 6 months of each year. Eight factors (gender, age, region, professional category, size of enterprise, seniority, sector of activity and accident circumstances) were analyzed in relation with the duration of sick leave as attributed by the insurance company. For each factor, the relative prevalence of cases with more than 92 days of work absence (outcome variable) was compared using the Pearson’s 2 in the bivariate analysis. In the multivariate analysis, a Stepwise Logistic Regression was performed to obtain the final model. Results The proportion of back injured workers with more than 92 lost days was 6.8 % (CI 95%: 6.4-7.1). In the bivariate analysis, all the 8 factors under study, gender and seniority excepted, were correlated with sick leave duration. After adjustment for confounding factors, the final model involved 5 factors statistically associated to a long duration sick leave: age (older than 40 years : OR=1.45(1.25-1.68)); geographical location of company (Wallonia: OR=1.70(1.47-1.98); Brussels: OR=1.61(1.29-2.02)); professional category (blue collar: OR=1.71 (1.32-2.20)); circumstance of accident (falls : OR=1.26 (1.03-1.52); overexertion: OR=0.75(0.64-0.89)); and sector of activity (building industry: OR=1.47(1.22-1.78)). Discussion and conclusions This study showed that in the Belgian working population, 6.8 % of the compensated back injuries can be considered as chronic back pain cases. This figure is however likely to underestimate the actual incidence of the problem as the FAT statistics showed that 21.7% of the back injury claims were rejected by the insurers. The proportion of back injured workers with a long sick leave (chronic low back pain) is clearly related to the worker age, blue-collar status, accident precipitating cause, and some high-risk activities; these observations are in line with the literature. The observed regional differences in incidence could not be explained by a differential distribution of high risk sectors in the country; they are probably to be ascribed to cultural and social factors but these could not be studied on the basis of the variables recorded in the FAT database. In conclusion, this study shows that considerable prevention efforts have to be focused on some categories of workers with back injury, who are at risk for a long sickness absence leading to chronic low back pain. References 1. Nielens H., Van Zundert J., Mairiaux P., Gailly J., Van Den Hecke N., Mazina D., Camberlin C., Bartholomeeussen S., De Gauquier K., Paulus D., Ramaekers D. Chronic Low Back Pain. Good Clinical Practice (GCP). Bruxelles: Centre fédéral d'expertise des soins de santé (KCE); 2006. KCE reports 48B (D/2006/10.273/64). 2. Crook J, Milner R, Schultz IZ et al. Determinants of occupational disability following a low back injury: a critical review of the literature. [Review] [68 refs]. Journal of Occupational Rehabilitation.12:277-95, 2002. [less ▲]

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See detailA nation-wide project for early rehabilitation of low back pain workers : an implementation study
Mairiaux, Philippe ULg; CREYTENS, Guido; DELARUELLE, Dirk et al

in Book of Abstracts: Sixth International Scientific Conference on Prevention of Work-related musculoskeletal disorders. PREMUS 2007 (2007, August)

Aims Based on a new policy for managing work-related diseases, the Belgian government has launched, starting March 1st 2005, an evidence-based program to promote an early return to work and to prevent ... [more ▼]

Aims Based on a new policy for managing work-related diseases, the Belgian government has launched, starting March 1st 2005, an evidence-based program to promote an early return to work and to prevent chronic low back pain (LBP). Target workers belong to the health care sector and must be off work due to LBP for at least 4 weeks and maximum 3 months. Considering the challenge in applying an innovative program on such a large scale, its implementation was carefully monitored by a task force created within the Fund for Occupational Diseases (FOD) and various process and impact evaluations carried out to identify barriers to its possible extension to other categories of workers. Methods The program can be defined as a “return to work” (RTW) program and involves a multidisciplinary back rehabilitation program available through more than 40 rehabilitation centres across the country, and an ergonomics intervention in the health care institutions to be carried out by the OH prevention service. Financial incentives are allowed to both the patient and the employer to stimulate participation. For every worker included in the project, data are systematically retrieved both by the rehabilitation centre and the prevention service using standardized forms. Questions arising from the various stakeholders (workers, trade unions, employers, general practitioners, OH physicians) about the program are systematically recorded by the task force. In addition, a phone survey has been conducted among the first 83 participants (out of 91 accepted applications) to know the managing path followed by each worker, and to identify the strengths and weaknesses of the designed program. Results One year after its official launch, the program was found to have reached 5.1% to 14.6% of the target population depending on the estimation basis chosen. Only 18.5% of the participants had seen or read the information leaflet edited by the FOD in the two national languages (in 20.000 exemplars). The main access criterion (>= 4 weeks sick leave), even supported by a solid scientific evidence, has been considered too severe by many stakeholders; the possibility to access the program during a relapse of a pain episode was not properly understood. Arising from wrong beliefs about back pain and its treatment, some patients but also their treating physicians were not keen to participate to such an active program. Entering the program also implied a visit by the OH physician during the sick leave, a new procedure still rarely used in the enterprises. Some employers worried about the program becoming a stimulus for extending the sick leave period instead of shortening it, but the collected data did not support this assumption. Potential concurrence between health professionals had also a negative influence in some areas. Regarding its content, the program was consistently applied in its medical component, well formalized within the Belgian health care system, but much less in its ergonomics component that was highly dependent on each institution own dynamic for prevention. As regard the program impact at short term, 98% of the participants did return to work and for 79% of them well before the end of the rehabilitation treatment in the centre; subjective improvements were recorded in 85% to 91% of the workers depending on the variable considered. Discussion and conclusions Informing about 90.000 workers in hundreds of health care institutions was a challenge and would have needed an ambitious media campaign. The project being completely innovative in the Belgian context, it implies deep changes in the traditional interactions between different health professionals and it requests altering very common beliefs about back pain. Such beliefs or behaviours cannot be changed in a few months! More fundamentally this project shows that there is long way to go before implementing with success at a national scale, interventions originally developed and tested in well controlled conditions and in a selected number of settings: return to work research has yet to evolve from establishing efficacy to proving effectiveness. References See FOD web site : www.fmp-fbz.fgov.be (“prevention dos” or “rugpreventie”) [less ▲]

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See detailThe Belgian guidelines for management of low back pain in occupational health
Mairiaux, Philippe ULg; Mazina, D. ULg

Poster (2007)

Aims As part of the promotion of a national strategy for the prevention and the management of acute and chronic low back pain (CLBP), the Belgian Health Care Knowledge Centre (KCE) funded a systematic ... [more ▼]

Aims As part of the promotion of a national strategy for the prevention and the management of acute and chronic low back pain (CLBP), the Belgian Health Care Knowledge Centre (KCE) funded a systematic review of the EBM literature concerning the management of LBP patients in the occupational health (OH) context. Taking account differences in regulations and practices within the health care system between EU countries1,2, this review aimed at issuing good practices recommendations applicable to the Belgian situation to prevent the transition from acute to chronic back pain and to avoid long duration absences from work. Methods The guidelines have been developed in three steps. First, an electronic search was performed for relevant guidelines and systematic reviews (SR) on the following databases: EMBASE, Medline, Cochrane Controlled Trials Register, NHS guidelines Finder, National Guidelines Clearing House, New Zealand Guidelines Group Search and Pedro database. The search strategy combined 3 groups of terms: low back pain, occupational medicine and the type of reference (practice guideline or SR). The identified guidelines were appraised using the AGREE method, while SR’s were appraised using the Cochrane Collaboration grid. In a second phase, the draft guidelines were submitted to a group of OH academics from the main Belgian universities. The revised version of the guidelines was then published in English in the KCE report 3. In a third step currently under way, the guidelines are adapted in a more practical format for facilitating their daily use by OH practitioners. This involves a working group of OH practitioners coming from 12 external prevention services and several large company OH services. The document will also be discussed with representatives of other health professionals (GP’s and medical advisors of the sickness funds). Results Scientific evidence from the 7 selected guidelines and from the 27 SR’s was organized according to the main missions of the occupational physician (OP) and medical adviser (MA). Which background information should be given to employers and employees when the OP is playing an adviser role? What evidence-based prevention policies (primary and secondary) should he/she promote in the enterprises? For the third mission of the OP, health surveillance of workers, the document considers three situations: periodic health surveillance, spontaneous examinations at the worker request, and return to work (RTW) examinations for workers absent for 28 days or more. The main conclusions are summarized in 4 tables under the format of key-points, each of those mentioning the quality of the evidence (using the Guyatt classification). Discussion and conclusions The key message for prevention of CLBP is the need for staying active and minimizing the time out of work. Evidence of high quality is in favor of a multidisciplinary approach using conservative treatments. One challenge is to avoid hospitalizations and especially surgery in CLBP patients. Those recommendations are relevant for all care settings, including the occupational environment. From a health care policy point of view, the project highlighted the major roles of the occupational physician and of the medical adviser and stressed the need to better define those roles if decision makers want to tackle the low back pain problem and the economic consequences of the related sick leave. References 1. Dutch Association of Occupational Medicine (NVAB). Management of low back workers by the occupational physician. Approved guidelines ; April 1999. 2. RCM-FOM. Occupational health guidelines for management of low back pain at work: Evidence Review and Recommendations. London, 2000. 3. Nielens H., Van Zundert J., Mairiaux P., Gailly J., Van Den Hecke N., Mazina D., Camberlin C., Bartholomeeussen S., De Gauquier K., Paulus D., Ramaekers D. Chronic Low Back Pain. Good Clinical Practice (GCP). Brussels: Belgian Health Care Knowledge Centre (KCE); 2006. KCE reports 48B (D/2006/10.273/64). [less ▲]

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See detailChronic low back pain. Good clinical practice (GCP)
Nielens, H.; Van Zundert, J.; Mairiaux, Philippe ULg et al

Report (2006)

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See detailA nation-wide pilot project for early rehabilitation of low back pain workers
Mairiaux, Philippe ULg; DELARUELLE D.; STRAUSS, Patrick

in IEA 2006 Proccedings (2006, July)

As a result of both a political and a scientific thinking, the Belgian Fund for Occupational Diseases (FOD) has launched, starting March 1st 2005, a pilot project for the nursing staff in the health care ... [more ▼]

As a result of both a political and a scientific thinking, the Belgian Fund for Occupational Diseases (FOD) has launched, starting March 1st 2005, a pilot project for the nursing staff in the health care sector in order to prevent the transition of low back pain (LBP) to chronicity through a program promoting an early return to work. Target workers are those being off work due to LBP for at least 4 weeks and maximum 3 months. The program involves a standardised multidisciplinary back rehabilitation program on the one hand, and on the other hand an ergonomics intervention in the health care institution. Depending on the context, the workplace intervention may involve an ergonomic analysis with the participation of the sicklisted worker, a larger group-based ergonomics redesign, or temporary change in the worker duty or work time in order to facilitate his/her return to work. The employer gets a financial incentive from the FOD when he agrees to such an intervention. Due to a lack of communication among the target population, this pilot project has had a slow start; the presentation gives a qualitative overview of the first 100 cases having entered the program. [less ▲]

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See detailErgonomic guidelines for low back pain prevention in child care.
Somville, Pierre ULg; Mairiaux, Philippe ULg

in PROCEEDINGS IEA 2006 (2006, July)

Detailed reference viewed: 27 (2 ULg)