The importance, measurement and practical implications of worker's expectations for return to work

PURPOSE: Workers' own expectations for return to work consistently predict work status. To advance the understanding of the relationship between RTW expectations and outcomes, we reviewed existing measures to determine those which we felt were the most likely to capture the construct.
METHOD: A comprehensive search of the work-disability rehabilitation literature was undertaken. The review of the measures was conducted in three steps: first, a review of terminology; second, an examination of whether a time reference was included; third, an evaluation of ease of comprehension, and applicability across contexts.
RESULTS: A total of 42 different measures were identified. One of the most striking findings was the inconsistency in terminology. Measures were also limited by not including a time reference. Problems were also identified with regards to ease of understanding, utility of response options, and applicability in a wide variety of research and applied settings.
CONCLUSIONS: Most previously used measures contain elements that potentially limit utility. However, it would seem that further development can overcome these, resulting in a tool that provides risk prediction information, and an opportunity to start a conversation to help identify problems that might negatively impact a worker's movement through the RTW process and the outcomes achieved. Implications for Rehabilitation Return to work is an integral part of workplace injury management. The capture of RTW expectations affords a way to identify the potential for less than optimal RTW processes and outcomes. A mismatch between an injured worker's expectations and what other stakeholders might expect suggests that efforts could be made to determine what is causing the injured worker's concerns. Once underling issues are identified, work can be put into resolving these so that the worker's return to the workplace is not impeded.

Source: Young AE, Besen E, Choi Y. Disabil. Rehabil, 2014.

Screening manual and office workers for risk of long-term sickness absence

Cut-off points for the Work Ability Index
Objectives : The aim of this study was to investigate the Work Ability Index (WAI) as a tool to screen for risk of different durations of long-term sickness absence (LTSA) among manual and office workers.
Methods : The prospective study comprised a cohort of 3049 (1710 manual and 1339 office) workers participating in occupational health surveys between 2010–2012. The survey date was set as baseline and incident LTSA episodes of different duration (>14, >28, >42, >60, and >90 days) were retrieved from an occupational health register in the year following the survey. Baseline WAI scores were associated with LTSA episodes occurring (no/yes) during one-year follow-up by logistic regression analysis in a random sample (N=1000) of the cohort. Predictions of LTSA risk were then validated among the workers not included in the random sample.
Results : The odds of LTSA episodes at follow-up decreased with increasing baseline WAI scores (ie, better work ability). The WAI accurately predicted the risk of future LTSA episodes >28, >42, >60 days, but over-predicted the risk of LTSA episodes >14 and >90 days. The WAI discriminated between workers at high and low risk of LTSA episodes of all durations. Office workers had higher WAI scores than manual workers. Consequently, false-negative rates were higher among office workers and false-positive rates were higher among manual workers at each WAI cut-off point.
Conclusion : The WAI could be used to screen both manual and office workers for risk of LTSA episodes lasting >28, >42, >60 days. WAI cut-off points depend on the objectives of screening and may differ for manual and office workers.

Source: Schouten LS, Joling C, van der Gulden JWJ, Heymans MW, Bültmann U, Roelen CAM. Scand J Work Environ Health, 2014.

Compensation benefits in a population-based cohort of men and women on long-term disability after musculoskeletal injuries

Costs, course, predictors
OBJECTIVES: The aim of this study is to assess costs, duration and predictors of prolonged compensation benefits by gender in a population characterised by long-term compensation benefits for traumatic or non-traumatic musculoskeletal injuries (MSIs).
METHODS: This study examined 3 years of data from a register-based provincial cohort including all new allowed long-term claims (≥3 months of wage replacement benefits) related to neck/shoulder/back/trunk/upper-limb MSIs in Quebec, Canada, from 2001 to 2003 (13 073 men and 9032 women). Main outcomes were compensation duration and costs. Analyses were carried out separately for men and women to investigate gender differences. An extended Cox model with Heaviside functions of time was used to account for covariates with time-varying effects.
RESULTS: Male workers experienced a longer compensation benefit duration and higher median costs. At the end of follow-up, 3 years postinjury, 12.3% of men and 7.3% of women were still receiving compensation benefits. Effects of certain predictors (e.g., income, injury site or industry) differed markedly between men and women. Age and claim history had time-varying effects in the men's and women's models, respectively.
CONCLUSIONS: Knowing costs, duration and predictors of long-term compensation claims by gender can help employers, decision makers and rehabilitation specialists to identify at-risk workers and industries to engage them in early intervention and prevention programmes. Tailoring parts of long-term disability prevention and management efforts to men's and women's specific needs, barriers and vulnerable subgroups, could reduce time on benefits among both male and female long-term claimants.

Source: Lederer V, Rivard M. Occup. Environ. Med. 2014.

Multidisciplinary biopsychosocial rehabilitation for chronic low back pain

Low back pain (LBP) is responsible for considerable personal suffering worldwide. Those with persistent disabling symptoms also contribute to substantial costs to society via healthcare expenditure and reduced work productivity. While there are many treatment options, none are universally endorsed. The idea that chronic LBP is a condition best understood with reference to an interaction of physical, psychological and social influences, the 'biopsychosocial model', has received increasing acceptance. This has led to the development of multidisciplinary biopsychosocial rehabilitation (MBR) programs that target factors from the different domains, administered by healthcare professionals from different backgrounds.

Source: Kamper SJ, Apeldoorn AT, Chiarotto A, Smeets RJ, Ostelo RWJG, Guzman J, van Tulder MW. Multidisciplinary biopsychosocial rehabilitation for chronic low back pain. Cochrane Database of Systematic Reviews 2014, Issue 9. Art. No.: CD000963.

Prévention de l'incapacité prolongée chez les travailleurs indemnisés pour troubles musculo-squelettiques

Une revue systématique de la littérature - Mise à jour 2008-2013
La présente mise à jour confirme et renforce les tendances déjà observées dans la revue de la littérature précédemment citée et couvrant la période 2000-2007 : l'intérêt pour le dépistage des travailleurs à risque d'incapacité prolongée, l'intérêt pour les points de vue de différents acteurs intervenant dans le processus de prévention, l'intérêt pour le développement et la validation des outils d'évaluation et d'intervention. Même si les recherches dans le domaine de la prévention de l'incapacité prolongée sont encore peu nombreuses, des progrès importants ont été réalisés, entre autres, sur le dépistage précoce des travailleurs à risque d'incapacité prolongée. En effet, bien que les études concernant les facteurs qui influencent l'incapacité soient peu nombreuses, il semble qu'un consensus s'installe en ce qui concerne l'importance d'identifier précocement les travailleurs à risque d'incapacité prolongée, en vue d'intervenir de façon ciblée sur les aspects propices au rétablissement des capacités des travailleurs et à leur retour au travail sain et durable. L'analyse transversale des différents sujets d'intérêt des articles a permis d'identifier six stratégies favorables à la prévention de l'incapacité prolongée : la détection précoce des travailleurs à risque d'incapacité prolongée, l'intervention ciblée pour les travailleurs à risque d'incapacité prolongée ou l'intervention multimodale pour les cas complexes, l'implication active du travailleur dans son propre plan de réadaptation et de retour au travail, l'intervention centrée sur le milieu de travail et sur l'activité de travail du travailleur, la prise en compte des conditions et du contexte d'implantation et la collaboration centralisée entre les différents acteurs pour réussir un retour au travail durable.


Evaluation of Functional Restoration Outcomes for Chronic Disabling Occupational Cervical Disorders

Objective: To systematically evaluate the effectiveness of an interdisciplinary functional restoration program (FRP) for treating chronic cervical disorders.
Methods: Consecutive chronic occupational lumbar disorder patients (n = 898) and chronic occupational cervical disorder patients (n = 215) were admitted to an FRP from 2001 to 2011. Patients were compared on demographics, work-related and psychosocial factors, and socioeconomic outcomes 1 year after discharge.
Results: Compared with lumbar patients, cervical patients were more likely to be female, have preadmission surgery, perform white-collar work, and have a longer time between injury and treatment admission. Cervical patients were similar to lumbar patients on most psychosocial self-report outcome measures. In addition, both groups exhibited high work return and work retention rates 1 year after FRP discharge.
Conclusions: An FRP seems to be equally efficacious for treating both chronic occupational cervical and lumbar disorders.

Source: Hartzell, Meredith M.; Mayer, Tom G.; Asih, Sali; Neblett, Randy; Gatchel, Robert J. Journal of Occupational & Environmental Medicine: September 2014, Volume 56, Issue 9, p 959–964.

Bilan des connaissances sur les facteurs de risque de l’arthrose du genou et sur les outils d’évaluation et les interventions en matière de soins et services

L'arthrose est une maladie chronique caractérisée par une dégénérescence progressive du cartilage et de l'os sous-chondral, entraînant de la douleur, des limitations fonctionnelles et des incapacités à long terme. Les articulations portantes sont particulièrement vulnérables au développement de la maladie, mais l'arthrose du genou (AG) est plus susceptible de causer des incapacités fonctionnelles. Bien que la maladie soit principalement présente chez les personnes âgées de plus de 65 ans, l'Agence de santé publique du Canada estime que la prévalence de l'AG chez les personnes âgées de 55 à 64 ans sera de 66 % en 2026. Cet accroissement anticipé de la prévalence est fort préoccupant sachant que l'arthrose compte parmi les maladies chroniques les plus importantes en matière d'utilisation des services de santé. Les impacts négatifs de l'AG sur les plans sociaux et économiques sont multiples. Ces données soulignent l'importance de proposer une prise en charge plus efficiente de l'AG tout au long du continuum de soins et services (prévention-traitement-réadaptation).


La réinsertion professionnelle

Il peut s’avérer difficile pour les salariés victimes d’accidents ou de maladies – en lien ou non avec le travail – de revenir vers l’emploi. D’autant plus lorsque leur état de santé ne leur permet plus d’exercer un métier qui a souvent constitué l’essentiel de leur expérience professionnelle. De nombreuses initiatives locales ont permis pourtant un retour vers l’emploi, souvent au prix de changements conséquents, pour le salarié comme pour l’entreprise.

Source: Dossier thématique, Travail & Sécurité, n° 753, Septembre 2014.

After the storm: the social relations of return to work following electrical injury

In this study, we explored the experiences of 13 individuals who had suffered an electrical injury at work and had subsequently returned to work. In this article, we report on the social, institutional, and relational elements that workers perceived to influence return to work experiences and the provision of workplace accommodations. These elements included (a) worker resources, (b) job characteristics, (c) workplace setting, (d) injury elements, (e) workers' compensation context, and (f) supports and advocacy provided. We conclude that the availability and provision of supportive accommodations are influenced by a multiplicity of interrelated factors including the legitimacy of resulting impairments following electrical injury, institutional structures (e.g., compensation and health care systems), the social relations of work, and broader labor market and economic contexts. Those workers who were vulnerable because of factors such as employment circumstances or labor market conditions were often poorly supported when returning to work following electrical injury.

Source: Mansfield E, Stergiou-Kita M, Kirsh B, Colantonio A. Qual. Health Res. 2014

Work-injury absence and compensation among partnered and lone mothers and fathers

Background: The purpose of this study is to examine the risk of a work-injury absence and the likelihood of receiving compensation among partnered and lone mothers and fathers.
Methods: This study utilized data from an annual survey of Canadian residents. Logistic regression models examined the association between family status and the receipt of workers' compensation, and absences due to work-related injury or illnesses of 7 or more days.
Results: Being a lone mother was significantly associated with the risk of work-injury absence. Gender differences were observed for workers' compensation: mothers were half as likely as fathers to receive workers' compensation benefits, which may be attributed to differences in work experiences between men and women.
Conclusions: Findings may help in understanding whether some parental situations are more vulnerable than others and may contribute to identifying policies that could help workers sustain employment or return to work following an injury.

Source: Imelda S. Wong, Peter M. Smith, Cameron A. Mustard, Monique A. M. Gignac. American Journal of Industrial Medicine. Volume 57, Issue 8,  pages 960–969, August 2014.

Analyse d’un protocole d’intervention post-traumatique et de mesures de gestion associées au Centre jeunesse de Montréal-Institut universitaire

L'objectif général de la recherche est de documenter les services offerts aux travailleurs victimes d'événements à potentiel traumatique et de connaître l'efficacité de l'intervention réalisée par le CJM-IU. La Phase I, l'objet de ce rapport, vise à décrire l'intervention du CJM-IU en contexte réel d'application, à en dégager la théorie sous-jacente et à documenter les interventions alternatives présentes dans les autres Centres jeunesse du Québec. La phase II visera à évaluer l'impact de l'intervention sur les travailleurs victimes d'événements traumatiques et fera l'objet d'un projet subséquent.


Travailler après un cancer du sein

Enjeux, contraintes et perspectives
Le présent article s'intéresse aux conséquences du cancer du sein sur la réinsertion professionnelle de 21 femmes, âgées de moins de 40 ans lors du diagnostic et interrogées de 16 à 24 mois après. Si la volonté d'un réinvestissement dans une vie professionnelle fait l'unanimité, chacun de leurs parcours témoigne des profondes transformations des rapports à la vie professionnelle, induites par la maladie. Dans une analyse mettant en lumière les interactions entre la maladie et le travail dans ces récits de vie, se dessine en filigrane l'inscription des conceptions du cancer du sein et du travail dans nos sociétés, ainsi que leur articulation.

Source : C Tarantini, L Gallardo, P Peretti-Watel. Sociologie, vol. 5, n°2, 2014, p. 121-138.

Recovery from mental conditions

Is it different between TBI/non-TBI
OBJECTIVES: This study aimed to determine the rates of psychological symptoms among those with traumatic brain injury (TBI) and with non-TBI at 3 months and 12 months after occupational injury and to examine the change in psychological status over time.
METHOD: Our study candidates were injured workers in Taiwan who were hospitalised for 3 days or longer and received hospitalisation benefits from the Labour Insurance. A self-reported questionnaire including Brief Symptom Rating Scale (BSRS-50) and Post-traumatic Symptom Checklist (PTSC) was sent to workers at 3 months and 12 months.
RESULTS: Among 853 injured workers who completed the questionnaire at 3 and 12 months, regarding to the severity of BSRS score, 7.8% of those with TBI had recovered at 12 months, comparing with 8.1% in those with non-TBI. On the other hand, approximately11.6% of those with TBI had recovered from post-traumatic stress symptoms at 12 months, comparing with 9.7% among those with non-TBI. Injured workers with TBI had lower rate of recovery from psychological symptoms, comparing with non-TBI.
CONCLUSIONS: A significant proportion of victims with TBI and non-TBI suffered psychological symptoms after injury. The identification and treatment of psychological symptoms are important for optimal adaptation after traumatic injury.

Source: Lin KH, Shu-Chu Shiao J, Liao SC, Kuo CY, Leon Guo Y, Guo NW. Occup. Environ. Med. 2014; 71(Suppl 1): A72.

Troubles mentaux : quelles conséquences sur le maintien dans l'emploi ?

Environ 12 % des femmes et 6 % des hommes âgés de 30 à 55 ans, qui travaillent en 2006, déclarent souffrir au moins d'un trouble mental (trouble anxieux généralisé ou épisode dépressif caractérisé). Parmi ces personnes, plus de 20 % invoquent une limitation d'activité, environ 45 % indiquent souffrir d'une maladie chronique et près de la moitié se considèrent en mauvaise santé.
Ces données statistiques sont issues de l'enquête Santé et itinéraire professionnel (SIP), réalisée conjointement par la DREES et la DARES, en 2006 et 2010.
Les personnes déclarant souffrir de troubles mentaux ont sensiblement moins de chances de garder une activité professionnelle que celles qui n'en ont pas signalé. En effet, 86 % des femmes et 82 % des hommes porteurs de ces troubles ont conservé une activité professionnelle en 2010, contre respectivement 92 % et 93 % des personnes n'en déclarant pas.
Les troubles anxieux généralisés affectent la trajectoire professionnelle des hommes, mais pas celle des femmes. Ce sont les limitations d'activité déclarées qui augmentent le plus le risque de ne pas garder son emploi.
Le rôle propre de la santé mentale (en regard des poids respectifs de l'état de santé général et des comportements à risque) reste, cependant, à apprécier, car les caractéristiques individuelles et professionnelles ont traditionnellement une incidence sur le maintien dans l'emploi.
Ainsi, parmi les variables socio-économiques, l'âge au-delà de 50 ans, la présence d'enfants et le travail à temps partiel (chez les femmes), le niveau de diplôme ainsi que la profession et la catégorie socioprofessionnelle (chez les hommes) ont un effet significatif sur la capacité des personnes à conserver un emploi.


Exploring factors facilitating adults with spinal cord injury rejoining the workforce

A pilot study
BACKGROUND: Return-to-work (RTW) rates after spinal cord injury (SCI) in the USA are very low and are continuing to decline. Previous research has attempted to identify factors facilitating RTW; however, the phenomenon of RTW involves many personal factors and predicting RTW success remains difficult.
PURPOSE: The purpose of this pilot study was to explore the factors facilitating adults with SCI rejoining the workforce in an urban area in order to identify items that may be emphasized in the rehabilitation process.
METHODS: The study was completed using qualitative methods. Four adults who had acquired a traumatic SCI in adulthood and were currently employed participated. Their experiences in RTW after injury were collected via semi-structured interviews and photography of assistive devices.
RESULTS: The most common facilitating factor was motivation, with family and rehabilitation professionals serving as extrinsic motivators. Other facilitators were resources and perceived benefits.
CONCLUSIONS: Motivation and resources were important facilitators, including rehabilitation professional's personal influence and therapies, and resource assistance from state agencies. The results indicate that practitioners can play an important role in influencing RTW, and resources from state agencies are helpful when individuals know how to access and utilize them. Implications for Rehabilitation Assistive technology supports successful return to work after SCI. Motivation strongly influences return to work after SCI and can be influenced by rehabilitation professionals, family and community members. Patients should be well informed about how to access assistance programs such as vocational rehabilitation.

Source: Wilbanks SR, Ivankova NV. Disabil. Rehabil. 2014.

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