Audit in Occupational Health: 8

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Back pain consultations

Since "back pain" and "psychiatric or psychological problems" are important problems facing employees and hence occupational health professionals, stop and think how you assess and manage these problems. Then produce a check list, as a self assessment exercise, of the points you feel are important in a good consultation of a worker with these problems. Then proceed.

You may not agree with the relative importance of all the points listed in these pages or you may have some additional ones of your own. Good! You now have a starting point for debate - read the relevant literature, meet with your colleagues, discuss these issues in general and in relation to individual consultation (including randomly selected ones). Scroll down...
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

Points to consider include:
 

History

• Onset - Timing
• Symptomatic description
• Precipitant
• Aggravating factors/movements and limits of tolerance of activity
• Relevant past history (first/recurrent/chronic)

Examination

• Distribution of pain
• Local back signs
• Lumbar spinal flexion
• Neurological features

Diagnosis and Conclusions
 

• Anatomical / Pathological / Aetiological
• Statement of objective functional impairment
• Disproportionate behaviour/psychological overlay

Advice/Action

• Activity
• Advice on fitness for work
• Physiotherapy
• Workplace assessment
• Occupational rehabilitation/ adjustment


Note: It is essential to pursue a criterion based audit, as far as the available scientific evidence will allow.
 
 

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Raymond Agius © Copyright 1995-2007


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NOW.... Now consider carefully - perhaps in your workplace there are problems with stress, or respiratory or cutaneous sensitisation. How would you audit your clinical assessment of these cases? Once you have written your thoughts, then you may proceed to the next page.
 

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