D. Penneau-Fontbonne

Active epidemiological surveillance of musculoskeletal disorders in a shoe factory.

Aims: (1) To evaluate an active method of surveillance of musculoskeletal disorders (MSDs). (2) To compare different criteria for deciding whether or not a work situation could be considered at high risk of MSDs in a large, modern shoe factory. Methods: A total of 253 blue collar workers were interviewed and examined by the same physician in 1996; 191 of them were re-examined in 1997. Risk factors of MSDs were assessed for each worker by standardised job site work analysis. Prevalence and incidence rates of carpal tunnel syndrome, rotator cuff syndrome, and tension neck syndrome were calculated for each of the nine main types of work situation. Different criteria used to assess situations with high risk of MSDs were compared. Results: On the basis of prevalence data, three types of work situation were detected to be at high risk of MSDs: cutting, sewing, and assembly preparation. The three types of work situations identified on the basis of incidence data (sewing preparation, mechanised assembling, and finishing) were different from those identified by prevalence data. At least one recognised risk factor for MSDs was identified for all groups of work situations. The ergonomic risk could be considered as serious for the four types of work situation having the highest ergonomic scores (sewing, assembly preparation, pasting, and cutting). Conclusion: The results of the health surveillance method depend largely on the definition of the criteria used to define the risk of MSDs. The criteria based on incidence data are more valid than those based on prevalence data. Health and risk factor surveillance must be combined to predict the risk of MSDs in the company. However, exposure assessment plays a greater role in determining the priorities for ergonomic intervention.

Multidisciplinary Intensive Functional Restoration Versus Outpatient Active Physiotherapy in Chronic Low Back Pain A Randomized Controlled Trial

Study Design. Randomized parallel group comparative trial with a 1-year follow-up period. Objective. To compare in a population of patients with chronic low back pain, the effectiveness of a functional restoration program (FRP), including intensive physical training and a multidisciplinary approach, with an outpatient active physiotherapy program at 1-year follow-up. Summary of Background Data. Controlled studies conducted in the United States and in Northern Europe showed a benefit of FRPs, especially on return to work. Randomized studies have compared these programs with standard care. A previously reported study presented the effectiveness at 6 months of both functional restoration and active physiotherapy, with a significantly greater reduction of sick-leave days for functional restoration. Methods. A total of 132 patients with low back pain were randomized to either FRP (68 patients) or active individual therapy (64 patients). One patient did not complete the FRP; 19 patients were lost to follow-up (4 in the FRP group and 15 in the active individual treatment group). The number of sick-leave days in 2 years before the program was similar in both groups (180 ± 135.1 days in active individual treatment vs. 185 ± 149.8 days in FRP, P = 0.847). Results. In both groups, at 1-year follow-up, intensity of pain, flexibility, trunk muscle endurance, Dallas daily activities and work and leisure scores, and number of sick-leave days were significantly improved compared with baseline. The number of sick-leave days was significantly lower in the FRP group. Conclusion. Both programs are efficient in reducing disability and sick-leave days. The FRP is significantly more effective in reducing sick-leave days. Further analysis is required to determine if this overweighs the difference in costs of both programs.

Return to work of 87 severely impaired low back pain patients two years after a program of intensive functional restoration

UNLABELLED Return to work is the main long-term objective of rehabilitation programs for patients with chronic low back pain (LBP). OBJECTIVES Evaluation of work status and number of sick leaves in 87 severely impaired LBP patients 2 years after a functional restoration program. PATIENTS AND METHODS Open prospective study. POPULATION 87 chronic LBP patients. INTERVENTION multidisciplinary functional restoration program. Ergonomic advice on the workplace was performed for 53 patients. OUTCOME work status and number of sick leaves due to LBP. RESULTS The characteristics of the 26 patients lost to follow-up did not differ significantly from the rest of the population before the program. In the 61 remaining patients, 48 (78%) were at work at 2 years, 43 full-time and 22 at the same job. Nineteen worked in a different environment. Sick leaves were reduced by 60% compared to the 2 years prior to the program: 128 days (+/-200 days) versus 329 days (+/-179 days); p<0.005. CONCLUSION Sick leaves remained significantly reduced and the number of workers who were at work significantly increased at 2 years after an intensive program.

Management of low back pain in primary care prior to multidisciplinary functional restoration: a retrospective study of 72 patients.

OBJECTIVE Chronic low back pain is a major socioeconomic health issue, due to the high direct (healthcare) and indirect (sick leave) costs. The aim of the present study was to describe the primary care management of low back pain patients prior to their inclusion in a multidisciplinary functional restoration network. METHODS A descriptive, retrospective, questionnaire-based survey of the general practitioners dealing with 72 low back pain patients. RESULTS Patients had been monitored by their general practitioner for an average of four years, with a mean frequency of eight appointments per year per patient. Ninety-three percent and 60% of the patients had been referred to a rheumatologist and a surgeon, respectively. Ninety-eight percent had had lumbar radiographies, 80% had undergone a computed tomography scan and 64% had undergone magnetic resonance imaging. The most commonly prescribed medications were anti-inflammatories and first- or second-line analgesics. Thirty percent had already received morphine analgesics and 50% had taken antidepressants. Thirty-two percent had undergone lumbar surgery. Physiotherapy was frequently reported and, indeed, 6% of patients had participated in over 100 sessions. Total sick leave averaged 8.25 months over the studys follow-up period. CONCLUSION The time interval before referral to a multidisciplinary care team is long and so GPs should be encouraged and helped to organize this process earlier. It is also essential to determine factors which predict progression to chronic LBP.

Silica-associated limited systemic sclerosis after occupational exposure to calcined diatomaceous earth

Silica-associated systemic sclerosis can occur in persons using calcined diatomaceous earth for filtration purpose. A limited systemic sclerosis was diagnosed in a 52-year-old male winegrower who had a combination of Raynauds phenomenon, oesophageal dysfunction, sclerodactyly and telangectasia. The anti-centromere antibodies titre was 1/5000. The patient was frequently exposed to high atmospheric concentrations of calcined diatomaceous earth when performing the filtration of wines. Calcined diatomaceous earth is almost pure crystalline silica under the cristobalite form. The diagnosis of silica-associated limited systemic sclerosis after exposure to calcined diatomaceous earth was made. The patients disease met the medical, administrative and occupational criteria given in the occupational diseases list 22 bis of the agriculture Social Security scheme and thence was presumed to be occupational in origin, without need to be proved. The diagnosis of occupational disease had been recognized by the compensation system of the agricultural health insurance.

La santé en réseau : l'expérience des médecins du travail du Maine-et-Loire, de la Sarthe, et de la Mayenne avec le réseau de maintien dans l'emploi de lombalgiques chroniques

Resume Objectifs Le but de cette etude etait d’apprecier les benefices d’un fonctionnement en reseau concernant la lombalgie chronique. Le reseau d’acteurs medicaux (medecins du travail, reeducateurs, psychotherapeutes), d’ergonomes du Maine-et-Loire, de la Sarthe et de la Mayenne, a ete mis en place des 1998 autour d’une consultation multidisciplinaire au CHU d’Angers dans le cadre d’un programme d’amelioration des conditions de travail des lombalgiques chroniques. Methodes L’etude a analyse des questionnaires sur l’impact et la satisfaction des lombalgiques adresses aux 108 salaries beneficiaires de l’action durant un an. L’impact du programme a egalement ete apprecie par questionnaires aupres des medecins du travail de ces salaries. Resultats Les salaries lombalgiques chroniques sont adresses par leur medecin du travail a la consultation multidisciplinaire. Les patients etaient porteurs d’une lombalgie chronique invalidante, en arret de travail a l’inclusion ou presentant des arrets repetes. Le succes du programme depend avant tout de la dynamique du reseau mis en place, du coordinateur, garant du fonctionnement, mais aussi de la qualite du message que le medecin du travail doit faire passer dans l’entreprise. A la croisee des disciplines, l’ergonomie a acquis une solide experience pratique de la multidisciplinarite dont elle a fait beneficier ses partenaires. Conclusion Travailler en reseau, c’est concourir a decloisonner le systeme medico-social et construire une approche communautaire de la sante dans sa dimension biopsychosociale.