Models of care for the management of persistent musculoskeletal pain and/or depression

Musculoskeletal pain can occur following damage to the muscles, ligaments, tendons, and bones. The three main causes of musculoskeletal pain are unusual or repetitive strain on the system, trauma to a specific area from a fall, sprain or blow, and certain musculoskeletal diseases.1 Many Australians experience musculoskeletal pain, however for a few, this becomes chronic or persistent. 2 Persistent musculoskeletal pain is often associated with depression and anxiety.3 Persistent musculoskeletal pain is a major cause of disability in older age and a major cause of work absence in the working age population. Low back pain is the most common type of persistent musculoskeletal pain.

Source: http://www.iscrr.com.au/__data/assets/pdf_file/0004/1007950/Horizon-Scanning-Brief-July-2017-Models-of-Care-Musculoskeletal-Pain-Depression.pdf

Return to work after mild-to-moderate stroke: work satisfaction and predictive factors

A large proportion of stroke patients are unable to return to work (RTW), although figures vary greatly. A total of 121 mild-to-moderate stroke patients, who had a paid job at the time of their stroke were included (a) to quantify RTW and work satisfaction one-year post-stroke (using the Utrecht Scale for Evaluation of Rehabilitation-Participation) and (b) to determine factors predicting RTW post-stroke, based on stroke-related, personal and neuropsychological variables. Half of the patients were not in work (28%) or were working less (22%) than pre-stroke. Ninety percent of those in fulltime employment post-stroke were satisfied with their occupational situation, against 36% of the unemployed participants. In regards to factors predicting RTW, global cognitive functioning (r = .19, Montreal Cognitive Assessment) and depressive symptoms (r = −.16, Hospital Anxiety and Depression Scale) at two months post-stroke onset were associated with return to work within one year. Only global cognitive functioning was an independent predictor of RTW (11.3% variance, p = .013). Although the explained variance was not that high, neuropsychological factors probably play a pivotal role in returning to work and should be taken into account during rehabilitation after mild and moderate stroke.

Source: van der Kemp, J., Kruithof, W. J., Nijboer, T. C., van Bennekom, C. A., van Heugten, C., & Visser-Meily, J. M. (2017). Neuropsychological Rehabilitation, 1-16.
http://dx.doi.org/10.1080/09602011.2017.1313746

Return to work after work-related stress

A randomized controlled trial of a work-focused cognitive behavioral intervention
In this randomized controlled trial (RCT) study, a work-focused cognitive behavioral therapy (CBT) treatment combined with an optional workplace intervention was associated with faster lasting return to work compared to a control group that received clinical assessment among patients on sick leave due to work-related stress. The intervention group returned to work four weeks faster, which could have substantial financial impact on both the employee and related societal costs.

Source: Dalgaard, V. L., Aschbacher, K., Andersen, J. H., Glasscock, D. J., Willert, M. V., Carstensen, O., & Biering, K. (2017). Scandinavian Journal of Work, Environment & Health.
http://dx.doi.org/10.5271/sjweh.3655

Length of sickness absence and sustained return-to-work in mental disorders and musculoskeletal diseases

A cohort study of public sector employees
This study adds to the scientific evidence on the length of sickness absence until sustained return to work (SRTW) in depression, anxiety disorders, intervertebral disc disorders, and back pain among Finnish public sector employees. Timescales are provided for returning to work in different occupational groups also taking into consideration the persistence of the health problem and comorbid conditions.

Source: Kausto, J., Pentti, J., Oksanen, T., Virta, L. J., Virtanen, M., Kivimäki, M., & Vahtera, J. (2017). Scandinavian Journal of Work, Environment & Health.
http://dx.doi.org/10.5271/sjweh.3643

Work ability in rheumatoid arthritis patients

A register study on the prospective risk of exclusion and probability of returning to work
Objectives: The aim was to study work ability in patients with RA compared with the general population by investigating the rates and risks of long-term sickness absence, unemployment and disability pension, and the chance of returning to work and the changes in these risks over time (1994-2011). Methods: This was a cohort study with up to 17 years of follow-up (mean 6.95 years/person) including 6677 RA patients of working age (identified in the nationwide DANBIO registry) and 56 955 matched controls from the general population. A multi-state model was used to analyse all shifts between the work-related states (long-term sickness absence, unemployment and disability pension, as well as the chance of returning to work) and calculate hazard rates (HRs). Analyses were stratified by disease duration and controlled for socio-demographic factors, physical job exposure and somatic and psychiatric co-morbidities. Results: RA patients had increased risk of long-term sickness absence (e.g. early RA: HR = 4.00, 95% CI: 3.64, 4.30) and disability pension (e.g. established RA: HR = 2.75, 95% CI: 2.54, 2.98) relative to controls. From 1994-99 to 2006-11, a decrease in the effect of established RA was observed [long-term sickness absence: from HR = 2.25 (95% CI: 1.99, 2.54) to 1.63 (95% CI: 1.51, 1.75); and disability pension: from HR = 3.49 (95% CI: 2.83, 4.32) to 2.40 (95% CI: 2.15, 2.69)]. RA patients had a lower chance of returning to work from long-term sickness absence or unemployment (HR = 0.60, HR=0.80), and this did not change over time. Conclusion: RA patients remain at high risk for long-term sickness absence and disability pension, despite a positive development between 1996-99 and 2006-11. Returning to work after sick leave or unemployment remains a challenge for RA patients.

Source: Hansen, S. M., Hetland, M. L., Pedersen, J., Østergaard, M., Rubak, T. S., & Bjorner, J. B. (2017). Rheumatology.
https://doi.org/10.1093/rheumatology/kex064

Relations interculturelles - Comprendre le processus de réadaptation et de retour au travail

Dans le domaine de la santé et de la sécurité du travail (SST), les barrières linguistiques et culturelles sont souvent décrites comme des facteurs de vulnérabilité des travailleurs. Il est rapporté que de telles barrières ont déjà été ou sont encore à l'origine d'erreurs diagnostiques ou de mauvaises évaluations cliniques, compliquant ainsi le processus de réadaptation et de retour au travail. La problématique de la réadaptation et du retour au travail dans le contexte de la rencontre interculturelle est pourtant peu documentée à l'échelle internationale. Il devient impératif de connaître l'expérience et la perspective de chacun des acteurs et de cibler des besoins et des problèmes spécifiques sur lesquels il faudra concentrer les efforts de recherche et de développement. L'objectif général de cette étude vise à déterminer les stratégies mises de l'avant par les différents acteurs pour faciliter le processus de réadaptation et de retour au travail des travailleurs dans le contexte de la rencontre interculturelle. Elle vise à décrire l'expérience et la perspective de chaque partie concernée (travailleurs, cliniciens, conseillers en réadaptation, milieux de travail) pour mieux faire ressortir les contraintes, les obstacles, les facilitateurs et les besoins spécifiques.

Source: http://www.irsst.qc.ca/publications-et-outils/publication/i/100929/n/relations-interculturelles-readaptation-retour-travail

Long-Term Outcomes of Multidisciplinary Rehabilitation for Chronic Musculoskeletal Pain

Objectives: Evidence for the effectiveness of multidisciplinary rehabilitation for chronic musculoskeletal pain (CMP) has been reported but its outcomes in the longer term and in mixed groups of chronic pain patients are largely unknown. The aim of the present study was to describe the two-year outcomes of a 15-week multidisciplinary pain rehabilitation programme in patients with mixed CMP in terms of pain, activities, participation and healthcare usage.
Methods: Data were recorded routinely at admission, discharge, and at three, 12 and 24 months' follow-up for all consecutive patients with CMP referred to a rehabilitation programme over a 21-month period. The 15-week multidisciplinary rehabilitation programme consisted of cognitive behavioural therapy and exercise, as well as individual and group sessions with additional treatment modalities. Assessments included the Pain Disability Index (PDI), the Pain Catastrophizing Scale (PCS), the Multidimensional Pain Inventory (MPI) and numerical scales for pain and fatigue. Moreover, the RAND-36-Item Health Survey (‘RAND-36') and questions on healthcare usage and work status were administered at admission, and at 12 and/or 24 months. Paired t-tests, Wilcoxon signed-rank tests, McNemar tests and mixed-model analyses were used to analyse changes over time.
Results: A total of 165 patients were included initially [mean age 44.1 (standard deviation 12.9) years], 143 of whom (87%) were women, with data from 125 (76%) and 120 (73%) patients being available at 12 and 24 months' follow-up, respectively. All outcomes showed statistically significant improvements between admission and discharge, and at three, 12 and 24 months' follow-up (p < 0.05). At 24 months, the median number of different healthcare providers visited in the previous year had decreased significantly compared with that at admission [from a median of 4 (range 1–13) to a median of 2 (range 0–9)], and within the group of patients working at admission (50%), the proportion of those working 25 hours or more per week had increased significantly from 16% to 48%.
Conclusions: Improvements in pain and functioning seen directly after a 15-week multidisciplinary treatment programme for patients with CMP were maintained, health care usage decreased and the number of working hours among working patients increased at 24 months' follow-up. Future studies are needed to examine if additional interventions after discharge can enhance further the favourable results.

Source: Volker, G., Vree, F., Wolterbeek, R., Gestel, M., Smeets, R., Köke, A., & Vlieland, T. V. (2017). Musculoskeletal care, 15(1), 59-68.
http://dx.doi.org/10.1002/msc.1141

Effectiveness of Workplace Interventions in Return-to-Work for Musculoskeletal, Pain-Related and Mental Health Conditions

An Update of the Evidence and Messages for Practitioners
Purpose: The objective of this systematic review was to synthesize evidence on the effectiveness of workplace-based return-to-work (RTW) interventions and work disability management (DM) interventions that assist workers with musculoskeletal (MSK) and pain-related conditions and mental health (MH) conditions with RTW. Methods: We followed a systematic review process developed by the Institute for Work & Health and an adapted best evidence synthesis that ranked evidence as strong, moderate, limited, or insufficient. Results: Seven electronic databases were searched from January 1990 until April 2015, yielding 8898 non-duplicate references. Evidence from 36 medium and high quality studies were synthesized on 12 different intervention categories across three broad domains: health-focused, service coordination, and work modification interventions. There was strong evidence that duration away from work from both MSK or pain-related conditions and MH conditions were significantly reduced by multi-domain interventions encompassing at least two of the three domains. There was moderate evidence that these multi-domain interventions had a positive impact on cost outcomes. There was strong evidence that cognitive behavioural therapy interventions that do not also include workplace modifications or service coordination components are not effective in helping workers with MH conditions in RTW. Evidence for the effectiveness of other single-domain interventions was mixed, with some studies reporting positive effects and others reporting no effects on lost time and work functioning. Conclusions: While there is substantial research literature focused on RTW, there are only a small number of quality workplace-based RTW intervention studies that involve workers with MSK or pain-related conditions and MH conditions. We recommend implementing multi-domain interventions (i.e. with healthcare provision, service coordination, and work accommodation components) to help reduce lost time for MSK or pain-related conditions and MH conditions. Practitioners should also consider implementing these programs to help improve work functioning and reduce costs associated with work disability.

Source: Cullen, K.L., Irvin, E., Collie, A. et al. (2017). J Occup Rehabil.
http://dx.doi.org/10.1007/s10926-016-9690-x

Return to Work in Patients with Chronic Musculoskeletal Pain: Multidisciplinary Intervention Versus Brief Intervention

A Randomized Clinical Trial
Objective: This randomized clinical trial was performed to compare the effect of a new multidisciplinary intervention (MI) programme to a brief intervention (BI) programme on return to work (RTW), fully and partly, at a 12-month and 24-month follow-up in patients on long-term sick leave due to musculoskeletal pain. Methods: Patients (n = 284, mean age 41.3 years, 53.9 % women) who were sick-listed with musculoskeletal pain and referred to a specialist clinic in physical rehabilitation were randomized to MI (n = 141) or BI (n = 143). The MI included the use of a visual educational tool, which facilitated patient-therapist communication and self-management. The MI also applied one more profession, more therapist time and a comprehensive focus on the psychosocial factors, particularly the working conditions, compared to a BI. The main features of the latter are a thorough medical, educational examination, a brief cognitive assessment based on the non-injury model, and a recommendation to return to normal activity as soon as possible. Results: The number of patients with full-time RTW developed similarly in the two groups. The patients receiving MI had a higher probability to partly RTW during the first 7  months of the follow-up compared to the BI-group. Conclusions: There were no differences between the groups on full-time RTW during the 24 months. However, the results indicate that MI hastens the return to work process in long-term sick leave through the increased use of partial sick leave.

Source: Brendbekken, R., Eriksen, H. R., Grasdal, A., Harris, A., Hagen, E. M., & Tangen, T. (20176). Journal of occupational rehabilitation, 27(1), 82-91.
https://dx.doi.org/10.1007%2Fs10926-016-9634-5

Effectiveness of Workplace Interventions in Return-to-Work for Musculoskeletal, Pain-Related and Mental Health Conditions

An Update of the Evidence and Messages for Practitioners
Purpose: The objective of this systematic review was to synthesize evidence on the effectiveness of workplace-based return-to-work (RTW) interventions and work disability management (DM) interventions that assist workers with musculoskeletal (MSK) and pain-related conditions and mental health (MH) conditions with RTW. Methods: We followed a systematic review process developed by the Institute for Work & Health and an adapted best evidence synthesis that ranked evidence as strong, moderate, limited, or insufficient. Results: Seven electronic databases were searched from January 1990 until April 2015, yielding 8898 non-duplicate references. Evidence from 36 medium and high quality studies were synthesized on 12 different intervention categories across three broad domains: health-focused, service coordination, and work modification interventions. There was strong evidence that duration away from work from both MSK or pain-related conditions and MH conditions were significantly reduced by multi-domain interventions encompassing at least two of the three domains. There was moderate evidence that these multi-domain interventions had a positive impact on cost outcomes. There was strong evidence that cognitive behavioural therapy interventions that do not also include workplace modifications or service coordination components are not effective in helping workers with MH conditions in RTW. Evidence for the effectiveness of other single-domain interventions was mixed, with some studies reporting positive effects and others reporting no effects on lost time and work functioning. Conclusions: While there is substantial research literature focused on RTW, there are only a small number of quality workplace-based RTW intervention studies that involve workers with MSK or pain-related conditions and MH conditions. We recommend implementing multi-domain interventions (i.e. with healthcare provision, service coordination, and work accommodation components) to help reduce lost time for MSK or pain-related conditions and MH conditions. Practitioners should also consider implementing these programs to help improve work functioning and reduce costs associated with work disability.

Source: Cullen, K.L., Irvin, E., Collie, A. et al. (2017). J Occup Rehabil.
http://dx.doi.org/10.1007/s10926-016-9690-x

Return to work after cancer

There is an increasing amount of information available for line managers, human resources and occupational health professionals on helping individuals with cancer stay in work.
However, until this research, there had been a lack of evidence on specific health and safety issues and effective approaches to risk assessment and risk management for occupational safety and health (OSH) professionals, and others, to support those undergoing treatment or returning to work after cancer.
The research addresses this evidence gap by:
- seeking to understand the health and safety implications of returning to work after cancer and cancer treatment
- identifying what employers can do to facilitate return to work and what is good practice in dealing with health and safety issues

Source: http://www.iosh.co.uk/Books-and-resources/Return-to-work-after-Cancer.aspx

Effectiveness of Occupational Therapy Interventions for Lower-Extremity Musculoskeletal Disorders

A Systematic Review
Lower-extremity (LE) musculoskeletal disorders (MSDs) can have a major impact on the ability to carry out daily activities. The effectiveness of interventions must be examined to enable occupational therapy practitioners to deliver the most appropriate services. This systematic review examined the literature published between 1995 and July 2014 that investigated the effectiveness of occupational therapy interventions for LE MSDs. Forty-three articles met the criteria and were reviewed. Occupational therapy interventions varied on the basis of population subgroup: hip fracture, LE joint replacement, LE amputation or limb loss, and nonsurgical osteoarthritis and pain. The results indicate an overall strong role for occupational therapy in treating clients with LE MSDs. Activity pacing is an effective intervention for nonsurgical LE MSDs, and multidisciplinary rehabilitation is effective for LE joint replacement and amputation. Further research on specific occupational therapy interventions in this important area is needed.

Source: Dorsey, J., & Bradshaw, M. (2017). American Journal of Occupational Therapy, 71(1).
http://dx.doi.org/10.5014/ajot.2017.023028

Rehabilitation and return to work after cancer: Literature review

As treatments have improved, there are more and more people surviving cancer in Europe. While most cancer survivors return to work after treatment, many face long-term symptoms and impairments that can make it difficult for them to do so.
This report provides an overview of the relevant scientific literature, conducted to collect information on existing initiatives, policies and practices on rehabilitation and return to work after cancer and gather examples of successful interventions.

Source: https://osha.europa.eu/en/tools-and-publications/publications/rehabilitation-and-return-work-after-cancer-literature-review/view

Joint association of multimorbidity and work ability with risk of long-term sickness absence

A prospective cohort study with register follow-up
Objectives: The aim of this study was to determine the joint association of multimorbidity and work ability with the risk of long-term sickness absence (LTSA) in the general working population.
Methods: Cox regression analysis censoring for competing events (statutory retirement, early retirement, disability pension, immigration, or death) was performed to estimate the joint association of chronic diseases and work ability in relation to physical and mental demands of the job with the prospective risk for LTSA (defined as ≥6 consecutive weeks during 2-year follow-up) among 10 427 wage earners from the general working population (2010 Danish Work Environment Cohort Study). Control variables were age, gender, psychosocial work environment, smoking, leisure physical activity, body mass index, job group, and previous LTSA.
Results: Of the 10 427 respondents, 56.8% had experienced ≥1 chronic disease at baseline. The fully adjusted model showed an association between number of chronic diseases and risk of LTSA. This association was stronger among employees with poor work ability (either physical or mental). Compared to employees with no diseases and good physical work ability, the risk estimate for LTSA was 1.95 [95% confidence interval (95% CI) 1.50–2.52] for employees with ≥3 chronic diseases and good physical work ability, whereas it was 3.60 (95% CI 2.50–5.19) for those with ≥3 chronic diseases and poor physical work ability. Overall, the joint association of chronic disease and work ability with LTSA appears to be additive.
Conclusions: Poor work ability combined with ≥1 chronic diseases is associated with high risk of long-term sickness absence in the general working population. Initiatives to improve or maintain work ability should be highly prioritized to secure sustainable employability among workers with ≥1 chronic diseases.p>

Source: Sundstrup, E., Jakobsen, M. D., Mortensen, O. S., & Andersen, L. L. (2017). Scandinavian Journal of Work, Environment & Health.
http://dx.doi.org/10.5271/sjweh.3620

Troubles musculosquelettiques

Revue réaliste sur les bases théoriques des programmes de réadaptation incluant le milieu de travail
Une revue réaliste portant sur un ensemble de programmes de réadaptation au travail incluant une intervention en milieu de travail a été réalisée. Selon cette méthode, les programmes se caractérisent par trois éléments principaux : le contexte (C), qui représente les caractéristiques des conditions dans lesquelles les programmes sont mis en place et les composantes de ces derniers; les mécanismes (M), qui décrivent ce qui fait en sorte qu'un programme parvient à atteindre ses résultats; et les résultats (O, pour outcomes), soit les effets prévus et imprévus d'un programme, résultant de l'interaction de différents mécanismes, dans différents contextes.

Source: http://www.irsst.qc.ca/publications-et-outils/publication/i/100905/n/troubles-musculosquelettiques-bases-programmes-readaptation

Plus de Messages Page suivante »

Abonnement courriel

Messages récents

Catégories

Méthodes et types d’études

Mots-Clés (Tags)

Blogoliste

Archives