FEATURE
assessment to identify what the employee is physically capable of doing. The results are then used to tailor workplace adjustments and provide physiotherapy to keep employees affected by physical problems healthy and working for as long as possible.
Increasingly, however, health professionals are moving to a position that says that psychology – people’s attitudes to themselves and to their health – plays a significant role in conditions like chronic back pain. This isn’t only an anatomical or physiological problem. Physiotherapy and surgery aren’t necessarily going to be enough.
GPs have tended to use a ‘red flag’ system with MSDs, where they will examine patients to rule out potential physical causes of back pain, such as inflammation, infection, disc problems, trauma and cancer. Now, some GPs are starting to also use a ‘yellow flag’ system to explore whether there might a different sort of underlying problem, such as a psychological issue.
The yellow flag approach is one beginning to be made available to employers through what’s become known as the Orebro Musculoskeletal Pain questionnaire (named after the town in Sweden where the tool was developed). The original questionnaire covers five relevant areas: function, pain, psychological, fear-avoidance and miscellaneous. Questions explore individual attitudes and feelings about levels of pain experienced recently, its effect on their ability to work, experiences of anxiety or depression and any impact on sleeping.
Research into the questionnaire has shown it to be effective in predicting future issues including which employees are most likely to be absent long-term and whose back pain issue is likely to become chronic and affect their ability to work.
In other words, this kind of ‘biopsychosocial’ approach picks up on negative attitudes, fears and concerns that exacerbate and encourage the experience of chronic pain. It may be an existing psychological problem, anxiety, depression or the tendency to have an exaggerated sense of, or
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response to, pain; or there might be issues relating to the heavy demands of work or problems with the work environment itself.
Using data from the Orebro questionnaire is a basis for referring employees to other forms of support that tackle the underlying root causes – often through Cognitive Behavioural Therapy, which has been shown to be effective in encouraging more positive attitudes and therefore a better ability to cope with the types of pain associated with MSDs. Staff are able to get back to work more quickly, and there’s the platform for better health and coping in the long-term.
One research study looked at the impact of a number of programmes offering a combination of physical therapy along with psychological therapy (counselling or Cognitive Behavioural Therapy). The progress of chronic back pain sufferers was tracked over at least a year, showing that including a psychological element of treatment was more likely to lead to a better recovery than exercise alone.
There’s also good evidence from a programme undertaken in New South Wales in Australia under its Work Cover initiative, which saw successful results in terms of helping speed up recovery times and help more people back to work. Orebro is now being used by Bluecrest Wellness in the UK as part of a standard health screening process, where organisations are providing screens across whole staff populations.
The scale of the back pain issue for employees and employers means new thinking and approaches are needed. Getting the work environment and facilities right is an important basis, it ticks the box and demonstrates a commitment to support, but clearly doesn’t totally solve the problem. The more we can break out of the standard routines of treatment and understand the whole picture, the closer we’ll come to helping people stay in work, avoiding what can become a vicious circle of physical and mental illness.
www.bluecrestwellness.com
“GETTING THE WORK ENVIRONMENT AND FACILITIES RIGHT IS AN IMPORTANT BASIS, BUT CLEARLY DOESN’T TOTALLY SOLVE THE PROBLEM.”
www.tomorrowshs.com
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