Australasian Faculty of Occupational and Environmental Medicine
Recommendations from the Australasian Faculty of Occupational and Environmental Medicine on low back imaging, opioids, time off work and asbestos exposure. The Australasian Faculty of Occupational & Environmental Medicine (AFOEM) is a Faculty of the Royal Australasian College of Physicians (RACP) that connects and represents Occupational and Environmental Medicine Fellows and trainees in Australia and New Zealand.
Do not request low back X-rays or other forms of low back imaging as part of a routine preplacement medical examination.
The purpose of preplacement medical examinations should be to determine an individual’s ability to perform the job. However, such examinations are generally not recommended unless there is a reason for using them to assess some specific occupational risks. Even if a routine preplacement medical examination is justified, low back X-rays and other imaging are not useful preplacement tests to undertake because they have not been found to predict future injuries. These tests also result in unnecessary radiation exposure and age-related, asymptomatic, clinically unimportant findings may trigger further imaging evaluation and/or patient anxiety.
- Gibson ES, Martin RH, Terry CW. Incidence of low back pain and pre-placement x-ray screening. J Occup Med 1980; 22(8):515-9.
- Schaafsma FG, Mahmud N, Reneman MF, et al. Pre-employment examinations for preventing injury, disease and sick leave in workers. Cochrane Database Syst Rev 2016; 1: CD008881.
The College worked with the President and EVOLVE Lead Fellow of AFOEM to compile and refine a list of nine recommendations regarding low-value clinical practices in occupational and environmental medicine. This initial list served as the basis for an online survey. Based on survey responses, each of the nine recommendations was assigned a score and ranked accordingly. Based on the ranking of the initial nine, and the review of newly suggested items, these five low-value practices and interventions were chosen.
- 1 Do not request low back X-rays or other forms of low back imaging as part of a routine preplacement medical examination.
- 2 Do not order X-rays or other imaging for acute non-specific low back pain, unless there are red flags or other clinical reasons to suspect serious spinal pathology.
Do not prescribe opioids for the treatment of acute or chronic pain without assessing the patient’s clinical condition, potential side effects, alternative analgesic options, work status, and capacity to perform safety-critical activities such as driving a motor vehicle.
- 4 Do not certify a patient as totally unfit for work unless the work absence is clinically necessary and the patient is unfit for suitable alternative or restricted duties.
- 5 Do not repeat chest X-rays when screening asbestos-exposed workers unless clinically indicated.