Return to work programs

Rehabilitation programs designed for workers with CLBP and other musculoskeletal conditions can be effective at reducing work absenteeism. These successful programs share several key components including intensive physical training. The training for these workers, who are typically either off work or in modified duties, is oriented to specific work tasks. In addition, there exists a significant cognitive-behavioral therapy (CBT) component. CBT involves attempting to change the CLBP patient's cognitions and behaviors consistent with the biopsychosocial model of Waddell.2 In this model, the pain and secondary disability are influenced not only by the structure(s) in the back, but also the culture in which the patient experiences the pain. Therefore, the individual's beliefs, attitudes as well as psychological distress will play into how much illness behavior they display. Modifying maladaptive beliefs and attitudes, and addressing distress, changes behavior and thus disability. So called "work hardening'' programs have support in the literature20, 21 [II] and can be cost-effective.

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