Management of low back pain by occupational health physicians - the belgian guidelines

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.