Development of a return to work tool for primary care providers for patients with low back pain: A pilot study

CONTEXT: Low back pain (LBP) is a common cause of disability in adults and primary care physicians (PCPs) are commonly the first medical practitioners to assess these patients. Despite this, PCPs often feel unprepared to make return to work (RTW) recommendations. AIMS: The purpose of our project was to develop RTW guidelines for patients with LBP in the form of an accessible and adaptable electronic medical records (EMR) integrated tool. SETTINGS AND DESIGN: All licensed physicians and physician extenders who see patients over the age of 18 years, presenting with acute LBP who are currently employed were eligible for participation. PCPs were randomized with and without the RTW guidelines and charts were reviewed to assess if PCPs made RTW recommendations. SUBJECTS AND METHODS: RTW guidelines were developed using the Oswestry LBP Disability Questionnaire and the Official Disability Guidelines and integrated into the EMR. STATISTICAL ANALYSIS USED: A Chi-square analysis was used to compare physicians in the interventional and control groups. RESULTS: Forty-four PCPs were randomized into the intervention group and 37 into the control group. In the intervention group, 301 patient encounters met the inclusion criteria for acute LBP. Of these, RTW recommendations were used in 7.3% encounters. Comparatively, there were 256 cases of LBP in the control group and RTW recommendations were offered in 1.6% of encounters (P < 0.001). CONCLUSION: This study showed that PCPs with access to the RTW guidelines in an EMR-integrated tool were significantly more likely to make such recommendations.