Affiliations: [a] TNO Work&Employment, Hoofddorp, The Netherlands | [b] Body@Work, Research Center Physical Activity, Work and Health, TNO-VU-University Medical Center, Amsterdam, The Netherlands | [c] Department of Public and Occupational Health, VU University Medical Center, Amsterdam, The Netherlands | [d] Institute for Research in Extramural Medicine, VU University Medical Center, Amsterdam, The Netherlands | [e] Research Center for Insurance Medicine, AMC-UWV-VUmc, Amsterdam, The Netherlands
Correspondence:
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Address for correspondence: P.C. Buijs, TNO Work&Employment, Pb 718, 2350 AS Hoofddorp, The Netherlands. Tel.: +31 23 5549488; Fax: +31 23 554 9304; E-mail: peter.buijs@tno.nl
Abstract: Introduction:Workers with chronic low back pain (LBP) mean a heavy human and social-economic burden. Their medical histories often include different treatments without attention to work-relatedness or communication with occupational health providers, leaving them passive and medicalized in (outpatient) health care. So we developed and implemented an innovative, patient-activating alternative: the multidisciplinary outpatient care (MOC) programme, including work(place) intervention and graded activity. It aims at function restore (instead of pain elimination), return to work (RTW) and coordinated communication. Objectives:To qualitatively explore how patients and health care providers perceive the programme effectiveness and which factors influence its implementation. Methods:In-depth, semi structured interview with patients and focus groups of health care providers are used, all recorded, transformed into verbatim transcript and analysed. Results:This qualitative study shows that although patients’ expectations were low at the start of the program, and despite long LBP histories, including many different therapies, (primarily) directed at pain reduction, the MOC programme was successful in changing patients’ goal setting from pain oriented towards function restore and RTW. The programme was therefore perceived as applicable and effective. Patient compliance was influenced by barriers – despair, supervisory and subordinate resistance at work, waiting period, medicalisation in health care – and facilitators: disciplinary motivation, protocolled communication, information supply, tailor-made exercises. For some patients the barriers were too high. Several improvement suggestions were given. Conclusions:This qualitative study shows that generally, patients and professionals perceived the multidisciplinary outpatient care programme as applicable and effective. After incorporating improvement suggestions this program seems promising for further, broader application and hypothesis testing. For those, negatively evaluating the programme, alternatives should be explored.
Keywords: Qualitative research, return to work, low back pain
