Fitness for duty considerations in disabling occupational low-back pain

Individuals who develop a work or non-work-related medical condition in the course of employment generally recover and return to full-duty status. There are, however, a small number who develop chronic diseases, delayed recovery syndromes or other similar disabling conditions. These difficult situations raise the question of whether the individual continues to be a qualified employee for the job he/she was hired to perform. Workers who develop stationary medical conditions with residual impairment, functional limitations, chronic pain syndromes or permanent medical restrictions represent significant medical, legal and ethical challenges for the treating or evaluating physician as well as the employer. Occupational low-back pain (OLBP) is not only one of the most commonly encountered of these type of conditions in the industrial setting, but also represents a significant disability challenge when material handling activities are considered essential functions of the job. This paper presents an appropriate medical, legal and ethical approach to identifying workers with OLBP risk and assisting the employer in either matching them to essential functions of jobs they may be qualified to hold or moving them into an appropriate disability pathway.