The article will describe factors of influence on return to work RTW and evidence-based interventions that enhance return to work (RTW) after sick leave due to common mental health disorders (CMD). First the concepts of both RTW and CMD are outlined. Second, the sense of urgency for effective RTW interventions for workers with CMD is briefly described. Third, a variety of predictors of RTW are presented with respect to the disorder, personal factors, and environmental factors. Lastly, a brief description of usual care and an overview of effective RTW interventions will be provided. A final paragraph will provide some conclusions as to which measures at what level appear to be effective in return to work after sick leave due to mental health disorders.
Randomized Controlled Trial
Background: Rheumatoid arthritis (RA) is chronic systematic disease that affects people during the most productive period of their lives. Web-based health interventions have been effective in many studies; however, there is little evidence and few studies showing the effectiveness of online social support and especially gamification on patients' behavioral and health outcomes.
Objective: The aim of this study was to look into the effects of a Web-based intervention that included online social support features and gamification on physical activity, health care utilization, medication overuse, empowerment, and RA knowledge of RA patients. The effect of gamification on website use was also investigated.
Methods: We conducted a 5-arm parallel randomized controlled trial for RA patients in Ticino (Italian-speaking part of Switzerland). A total of 157 patients were recruited through brochures left with physicians and were randomly allocated to 1 of 4 experimental conditions with different types of access to online social support and gamification features and a control group that had no access to the website. Data were collected at 3 time points through questionnaires at baseline, posttest 2 months later, and at follow-up after another 2 months. Primary outcomes were physical activity, health care utilization, and medication overuse; secondary outcomes included empowerment and RA knowledge. All outcomes were self-reported. Intention-to-treat analysis was followed and multilevel linear mixed models were used to study the change of outcomes over time.
Results: The best-fit multilevel models (growth curve models) that described the change in the primary outcomes over the course of the intervention included time and empowerment as time-variant predictors. The growth curve analyses of experimental conditions were compared to the control group. Physical activity increased over time for patients having access to social support sections plus gaming (unstandardized beta coefficient [B]=3.39, P=.02). Health care utilization showed a significant decrease for patients accessing social support features (B=–0.41, P=.01) and patients accessing both social support features and gaming (B=–0.33, P=.03). Patients who had access to either social support sections or the gaming experience of the website gained more empowerment (B=2.59, P=.03; B=2.29, P=.05; respectively). Patients who were offered a gamified experience used the website more often than the ones without gaming (t 91=–2.41, P=.02; U=812, P=.02).
Conclusions: The Web-based intervention had a positive impact (more desirable outcomes) on intervention groups compared to the control group. Social support sections on the website decreased health care utilization and medication overuse and increased empowerment. Gamification alone or with social support increased physical activity and empowerment and decreased health care utilization. This study provides evidence demonstrating the potential positive effect of gamification and online social support on health and behavioral outcomes.
Source: Ahmed Allam, Zlatina Kostova, Kent Nakamoto and Peter Johannes Schulz. J Med Internet Res. 2015 Jan; 17(1).
Results of a two-year follow-up study
Purpose: Mental health problems (MHPs) are increasingly common as reasons for long-term sickness absence. However, the knowledge of how to promote a stable return to work (RTW) after sickness absence due to MHPs is limited. The purpose of this study was to assess the effects of a multidisciplinary, coordinated and tailored RTW-intervention in terms of stability of RTW, cumulative sickness absence and labour market status after 2 years among sickness absence compensation beneficiaries with MHPs. Methods: In a quasi-randomised, controlled trial, we followed recipients of the intervention (n = 88) and of conventional case management (n = 80) for 2 years to compare their risk of recurrent sickness absence and unemployment after RTW, their cumulative sickness absence and their labour market status after 2 years. Results: We found no statistically significant intervention effect in terms of the risk of recurrent sickness absence or unemployment. Intervention recipients had more cumulated sickness absence in year one (mean difference = 58 days; p < 0.01) and year two (mean difference = 36 days; p = 0.03), and fewer were self-supported at the end of follow-up (52% versus 69%; p = 0.02). Conclusion: The intervention showed no benefits in terms of improved stability of RTW, reduced sickness absence or improved labour market status after 2 years when compared to conventional case management.
Source: Martin MH, Nielsen MB, Pedersen J, et al. Disability and Rehabilitation, 2015.
A systematic review
OBJECTIVE: To explore the association between psychiatric disorders as a comorbidity and return-to-work (RTW) in individuals with acquired brain injury (ABI).
METHODS: A systematic review was performed. The search strategy (2002-2012) contained terms related to ABI, psychiatric comorbidity and keywords adapted to the outcome measure RTW. Selection and review were performed by two authors independently. In the case of uncertainty, a third author was consulted to reach consensus on inclusion or exclusion. The methodological quality of included studies was determined and evidence was classified.
RESULTS: Seven studies were included. Strong evidence was found for a negative association between psychiatric disorders as a comorbidity (like depression, anxiety and post-traumatic stress disorder) and RTW of patients with ABI. Patients with a previous history of psychiatric disorders were at considerably higher risk for a new episode and lower RTW rates following ABI.
CONCLUSION and implications: Psychiatric disorders as a comorbidity after ABI are strong negatively associated with RTW. The heightened frequency of psychiatric disorders as a comorbidity after ABI and more important their amenability to treatment implicates that more attention should be paid to diagnosing and treating psychiatric disorders as a comorbidity in patients with ABI in order to further improve re-integration in work.
Source: Garrelfs SF, Donker-Cools BH, Wind H, Frings-Dresen MH. Brain Inj, 2015: 1-8.
A four-year evaluation of the impact on absenteeism
Objectives In May 2008, the National Health Service (NHS) Lanarkshire (NHSL) implemented a unique telephone-based sickness absence management service entitled “EASY” (Early Access to Support for You). The EASY service supplements existing absence policies and enables telephone communication between the absentee, their line manager, and the EASY service from the first day of absence and referral to occupational health services at day ten. The aim of this study was to determine if the EASY service was effective between May 2008 and May 2012 in reducing sickness absence in NHSL compared to normal occupational healthcare in NHS Scotland and is, as such, a cost-saving intervention.
Methods This study included time-series analysis of health board sickness absence data and analyses of the EASY service database (survival analyses and Cox's proportional hazards model).
Results The EASY service was effective in reducing sickness absence by 21% in NHSL, whereas the nonspecific tightening of the sickness absence policies across the rest of Scottish NHS health boards reduced sickness absence by approximately 9%. The richness of the EASY database gave detailed information on absentees by cause, duration, job family, and reporting compliance. The mean duration of musculoskeletal absences was significantly shorter in years 2, 3, and 4 compared to year 1. Those absentees contacted by phone on the first day of absence were more likely to return to work than those contacted on subsequent days. The EASY service improves economic efficiency; the value of the hours saved from the reduced sickness absence exceeds the cost of operating the service.
Conclusion The study highlights the importance of an early telephone-based intervention for sickness absence management.
Source: Brown J, Mackay D, Demou E, Craig J, Frank J, Macdonald EB. Scand J Work Environ Health, 2015.
What is the evidence for clinical practice?
Traumatic brain injury (TBI) typically affects young adults with potentially many years of working life ahead of them. For people who were in work prior to their injury, return to work (RTW) is a common goal. However, a systematic review of RTW rates for people with TBI who were in work prior to their injury found that approximately 41% were in work at one and two years post TBI.1 Since TBI is a leading cause of morbidity worldwide in young adults,2 this discrepancy between what people with TBI want and what they achieve is important. The question is does the research evidence inform clinicians how to help a person with TBI return to work?
Results of a randomized controlled trial
Objectives: The primary purpose of this randomized controlled trial (RCT) was to evaluate the efficacy of a guided internet-based recovery training for employees who suffer from both work-related strain and sleep problems (GET.ON Recovery). The recovery training consisted of six lessons, employing well-established methods from cognitive behavioral therapy for insomnia (CBT-I) such as sleep restriction, stimulus control, and hygiene interventions as well as techniques targeted at reducing rumination and promoting recreational activities.
Methods: In a two-arm RCT (N=128), the effects of GET.ON Recovery were compared to a waitlist-control condition (WLC) on the basis of intention-to-treat analyses. German teachers with clinical insomnia complaints (Insomnia Severity Index ≥15) and work-related rumination (Irritation Scale, cognitive irritation subscale ≥15) were included. The primary outcome measure was insomnia severity.
Results: Analyses of covariance (ANCOVA) revealed that, compared to the WLC, insomnia severity of the intervention group decreased significantly stronger (F=74.11, P<0.001) with a d=1.45 [95% confidence interval (95% CI) 1.06–1.84] The number needed to treat (NNT) was <2 for reliable change and NNT <4 for reduction in expert-rated diagnosis of primary insomnia.
Conclusion: The training significantly reduces sleep problems and fosters mental detachment from work and recreational behavior among adult stressed employees at post-test and 6-months follow up. Given the low threshold access this training could reach out to a large group of stressed employees when results are replicated in other studies.
Source: Thiart H, Lehr D, Ebert DD, Berking M, Riper H. Scand J Work Environ Health, 2015.
Depression is a major problem that affects about 300 million people globally. Symptoms of depression include the core symptoms of low mood or loss of interest coupled with other symptoms such as feelings of inadequacy and hopelessness or sleep problems. These symptoms usually impair functioning and therefore sickness absence is common in people with depression. We evaluated the effectiveness of interventions that can help depressed workers to resume work activities.
Source: Nieuwenhuijsen K, Faber B, Verbeek JH, Neumeyer-Gromen A, Hees HL, Verhoeven AC, van der Feltz-Cornelis CM, Bültmann U. Cochrane Database of Systematic Reviews 2014, Issue 12. Art. No.: CD006237.
PURPOSE: The incidence and prevalence of work-related musculoskeletal nursing injuries is a top concern for nurses. These injuries are thought to be a dynamic interplay of multiple factors. A literature review reveals a knowledge gap in understanding context-specific patterns of nursing injuries.
DESIGN: Using a cross-sectional descriptive research design, 58 rehabilitation nurses participated in this study.
METHODS: Anonymous paper surveys were sent to all rehabilitation nursing personnel on the unit.
FINDINGS: Six themes emerged: lack of time and help, patient acuity, ergonomics, body movement issues, knowledge deficit, and communication.
CONCLUSIONS: Nursing input is critical in understanding and reducing context-specific work-related musculoskeletal injuries. Further research that includes nursing voices is advocated. CLINICAL RELEVANCE: Rehabilitation nursing injuries appear to be a complex interaction of multiple determinants; therefore, multifaceted solutions using a quality improvement lens are recommended to improve the working conditions on the units.
Source: Bhimani R. Rehabilitation Nursing, 2014.
A focus group study about participants' expériences
Background: Our aim was to explore how individuals who had participated in a brief back and neck pain intervention perceived connections between the intervention and their subsequent coping. Methods: Three focus group discussions were conducted with a sample of ten employees aged 20–67 years, who had participated in a brief intervention for back and neck pain, perceived the intervention as helpful and had returned or remained at work subsequent to the intervention. Participants were invited to share stories of how the intervention had made a positive difference to their work situation and everyday life and helped them cope with their complaints. Systematic text condensation was used for analysis. Results: Analysis revealed several aspects of how the participants considered the intervention to be helpful. They emphasized the importance of having the information delivered in a comprehensible way, with the use of practical examples and images of the spine. Discussions revealed the significance of trusting the lecturers and perceiving them as experts. Understanding why they felt the pain and that it was not a sign of serious disease changed the participants' perception of how they could live with the complaints. They told stories of how they had exceeded their previous limits and dared to undertake activities they previously had avoided due to fear. Conclusions: Having confidence in the lecturers and seeing them as experts that delivered the information in a comprehensible way helped participants to cope with their pain and was seen as the most important aspects of the brief back and neck pain intervention.
Source: Ree E, Harris A, Indahl A, Tveito TH, Malterud K. Scand J Public Health, 2014.
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.
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.
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.
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.
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.
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