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The Multidisciplinary Approach to Occupational Low Back Pain and Disability

University of Vermont College of Medicine, Burlington.

Chronic disability generates most of the growing costs of occupational low back injuries. When back problems persist for more than a few months, traditional diagnostic and therapeutic approaches are rarely curative. Beyond the challenges of physical impairment, disabling back pain is commonly complicated by psychosocial issues, including depression, fear of reinjury, family discord, and vocational dissatisfaction. The biopsychosocial complexity of chronic disability often demands integrated care from physicians, physical and occupational therapists, psychologists, and vocational counselors. In the past decade, the care of back-injured workers has shifted emphasis from symptom palliation toward functional restoration. This evolution has been possible, in part, through improved quantification of physical capacities. Repeated objective measurements of function guide rehabilitation and recommendations for return to work and other activities. Published results of function-oriented multidisciplinary care depend on the outcome variables reported and the particular socioeconomic setting.