Bridging the Gap Between Rehabilitation and Return to Work: A Qualitative Evaluation of a Workplace Intervention for Low Back Pain.

Background: Low back pain (LBP) can lead to disability and sick leave, impacting work participation and overall health. Given the complex and multifactorial nature of LBP, Belgium's Federal Agency for Occupational Risks (FEDRIS) promotes a secondary prevention strategy for LBP among workers engaged in ergonomically demanding tasks. This strategy includes multidisciplinary-based rehabilitation and an optional workplace intervention (WPI), initiated upon employer request. The WPI component consists of a half-day ergonomic risk analysis at the workplace conducted by an external occupational health service. This paper is one of two parallel qualitative studies that explored the experiences and perspectives of employees and healthcare professionals (HCPs) on the secondary prevention program. The current study focuses on the optional WPI, aiming to identify its strengths, challenges, and potential solutions.

Methods: Between April 2022 and April 2023, six multicenter semistructured focus groups were held with 15 employees (2015-2019 program participants) and 24 HCPs (including external ergonomists) recruited from 11 Belgian rehabilitation centers and hospitals. Sessions were organized as employee-only, HCP-only, or mixed groups. All the interviews were anonymized, transcribed verbatim, and analyzed inductively via thematic analysis, with validation through data triangulation, intercoder checks, and participant feedback.

Results: The analysis reveals strengths, challenges, and solutions associated with the WPI before, during, and after implementation. Before the intervention, some HCPs recognized the WPIs' benefits, but limited awareness, employer hesitancy, practicality concerns, and job security fears presumably contributed to low application rates. The proposed solutions include proactive communication, streamlined processes, and enhanced employer engagement. During implementation, strengths included improved employee engagement and interdisciplinary collaboration, but challenges related to limited integration and timing affected effectiveness. Early ergonomic assessments and better communication are suggested. After the intervention, inconsistent feedback hindered sustainability, highlighting the need for systematic follow-up and stronger organizational commitment.

Conclusions: The WPI provides some tangible benefits for sustainable return to work in Belgium's secondary prevention strategy for LBP, yet a few gaps remain. Low employer awareness, application hesitancy, and inconsistent follow-up hinder effective implementation. Equally, interdisciplinary collaboration and proactive ergonomic assessments are considered strengths of the WPI. Involving all key stakeholders emerges as critical for addressing practical concerns and ensuring ongoing support. Future refinements should prioritize streamlined processes, early-stage interventions, and consistent feedback.