Jeff Snodgrass; Effective Occupational Therapy Interventions in the Rehabilitation of Individuals With Work-Related Low Back Injuries and Illnesses: A Systematic Review. Am J Occup Ther 2011;65(1):37-43. doi: 10.5014/ajot.2011.09187.
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© 2016 American Occupational Therapy Association
A systematic review of the literature related to effective occupational therapy interventions in rehabilitation of individuals with work-related low back injuries and illnesses was carried out as part of the Evidence-Based Literature Review Project of the American Occupational Therapy Association. This review evaluated research on a broad range of occupational therapy–related intervention procedures and approaches. Findings from the review indicate that the evidence is insufficient to support or refute the effectiveness of exercise therapy and other conservative treatments for subacute and chronic low back injuries. The research reviewed strongly suggests that for interventions to be effective, occupational therapy practitioners should use a holistic, client-centered approach. The research supports the need for occupational therapy practitioners to consider multiple strategies for addressing clients’ needs. Specifically, interventions for individuals with low back injuries and illnesses should incorporate a biopsychosocial, client-centered approach that includes actively involving the client in the rehabilitation process at the beginning of the intervention process and addressing the client’s psychosocial needs in addition to his or her physical impairments. The implications for occupational therapy practice, research, and education are also discussed.
Therapist-directed and -supervised therapeutic exercises targeting the individual client’s symptoms (stretching, range of motion, flexibility, endurance, and strengthening)
Client education (proper body mechanics, back education)
Graded functional activity (work reconditioning, on-site interventions, graduated return to work)
Environmental modifications (work site visit, ergonomic modifications)
Cognitive–behavioral strategies (positive reinforcement, progressive relaxation, biofeedback)
Physical agent modalities (superficial heat, transcutaneous electrical nerve stimulation) as preparatory or adjunctive interventions.
Analyze and compare costs and quality of services for clients participating in return-to-work programs with those attending traditional occupational therapy services.
Design and implement outcome studies to measure the effectiveness of occupational therapy services for clients with work-related injuries.
Analyze the impact of on-site (employer-based) occupational therapy services on the rate of return to work and prevention of work-related MSDs relative to costs and injury rates.
Compare outcomes of implementing an on-site occupational therapy–based ergonomics program by analyzing incidence and prevalence of MSDs, workers’ compensation cost, and employee productivity before, during, and after implementation.
Analyze cost-effectiveness of preemployment postoffer screenings (used to determine whether an applicant is suitable for a job before employment or an offer of employment) related to preventing injuries and reducing absenteeism and turnover.
Compare and contrast work hardening and conditioning and functional capacity evaluation models (AOTA, 2006).
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