Lay participation in health care decision making has attracted increasing interest in Canada, with numerous provincial government reports advocating this initiative. Interest stems from a number of factors. Among them is a growing recognition that patient preferences ought to be incorporated into decision making that involves individual treatment choices. Another factor is the desire to increase public accountability for decisions on the allocation of health care resources, in order to make providers more accountable to the communities they serve. There is, however, still considerable confusion over what lay participation really means. In addition, little consideration has been given to whether and how lay participation can lead to better decision making and the criteria by which it should be judged. This article presents a framework based on decision-making domains, role perspectives, and levels of participation and is intended as an initial step toward providing greater conceptual clarity regarding the key dimensions and goals of lay participation in health care decision making.

This is the second of two papers that systematically review available scientific evidence on the causes of disability from occupational low back pain, and the effectiveness of interventions to prevent it after its onset (secondary prevention). This paper reviews the national history of how back pain and the risk factors for its extension into chronic disability, followed by a critical summary of intervention studies attempting to reduce the duration of this disability, and to evaluate the results.

This is the first of two papers that systematically review available scientific evidence on the causes of disability from occupational low back pain, and the effectiveness of interventions to prevent it-before disability begins (primary prevention-Part I) and after its onset (secondary prevention-Part II). This first paper reviews the risk factors for the onset of pain and associated disability followed by a critical summary of intervention studies attempting to achieve prevention and to evaluate the results.

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