Upbeat approach helps with low-back pain

Communication is key in return-to-work

Good communication is the key to promote successful return-to-work among employees with low-back pain, says Denise Knoblauch, BSN, RN, COHN-S/CM, clinical case manager at OSF Saint Francis Medical Center in Peoria, IL.

To make sure the message and support remain consistent among patients, Saint Francis developed a low-back pain protocol, which is based on the low-back pain guidelines of the American College of Occupational and Environmental Medicine (ACOEM). The goal: Return to full duty within 28 days for at least 75% of the employees suffering from low-back pain.

To develop the protocol, Knoblauch and her colleagues began by bringing together a task force that included advanced practice nurses, case managers, and an exercise specialist. They conducted root cause analysis to better understand the hazards.

Through the safe patient handling program, Saint Francis is trying to eliminate some of the causes of injury, says Knoblauch. “We hired a consultant to help with education and follow-up,” she says. “They analyze patient handling injuries to see if they were preventable.”

They discovered that some injuries occurred when employees didn’t use the available equipment. For example, patient care techs would roll over an obese patient to change the linens without realizing that it was a high-risk task.

After an injury occurs, Knoblauch and her colleagues work hard to keep employees on track and to give them a positive framework for recovery. Coping skills begin with optimism, she says. The nurses are scripted to tell employees from the first visit, “Yes, you’re going to be hurting today, but in two days it’s going to get better,” she says.

The visit with an injured employee occurs within the first week — or within one or two days, if the employee is unable to work. A nurse provides information about the use of heat and cold, medications, stretching and movement, and physical therapy, if appropriate.

Nurses set positive expectations: “Remember by following these instructions you will be able to resolve back pain faster. We expect back strains to resolve within about 10 days.”

The second visit occurs at about 10 to 14 days post-injury, with an assessment of exercise, medication, therapy and work restrictions. (At either visit, radiographs may be necessary, based on the course of the injury.)

More encouragement is forthcoming: “We don’t want you to give up what you have gained. We really want to see this resolve for you within the next week.”

The third and four re-checks, at 20 to 21 and 27 to 28 days, nurses and case managers remind the employees to continue the lifestyle changes: “Remember, don’t give up your exercises and all the gains you’ve made with those. We see most back pains go back to regular duties within 28 days when they follow this plan. Keep doing everything you are doing.”

If recovery is delayed, they also assess for psychosocial factors that can add to pain and impairment. Injured employees who have a confounding diagnosis, such as infection, tumor, fracture or dislocation, do not follow this protocol.

“Our advance practice nurses are good communicators,” says Knoblauch, who notes that they also monitor patients to make sure they keep on schedule with their follow-up visits.