Conséquences des troubles musculo-squelettiques sur l’itinéraire professionnel, résultats d’une enquête nationale

Objectif: Utiliser les données d'une enquête nationale pour décrire les conséquences sur l'itinéraire professionnel des troubles musculo-squelettiques (TMS), que ceux-ci soient ou non d'origine professionnelle, avec un intérêt spécifique pour certaines conséquences : retrait définitif du marché du travail, inaptitude, rente pour maladie professionnelle.
Matériel et méthodes: La population d'étude est constituée des 11 646 sujets de l'enquête santé et itinéraire professionnel (SIP), âgés de 30 à 74 ans, qui avaient occupé au moins un emploi dans leur vie. Les sujets ayant souffert de TMS dans leur vie, et pour lesquels la conséquence a été un retrait définitif du travail, ont été comparés à deux autres groupes, TMS sans conséquence sur l'histoire professionnelle, et absence de TMS, par des modèles multinomiaux. Les autres conséquences des TMS sur l'itinéraire professionnel ont fait l'objet d'analyses descriptives.
Résultats: Parmi les sujets classés « TMS avec conséquence sur l'itinéraire professionnel » c'est le retrait définitif du marché du travail qui est la conséquence la plus fréquente, pour les hommes comme pour les femmes, et ce risque est lié au niveau d'études. Un pourcentage élevé des sujets mis en inaptitude suite à un TMS se retrouve licencié ou hors du marché du travail (18/27 pour les hommes, 32/48 pour les femmes). Peu de sujets dans le groupe « TMS avec conséquence » bénéficient d'une rente pour maladies professionnelle (3 % des hommes, 1 % des femmes), et dans ce groupe être bénéficiaire de l'allocation adulte handicapé (AAH) est plus fréquent pour les femmes que pour les hommes.
Conclusions: Ces résultats amènent à s'interroger sur ce qui devrait être mis en œuvre pour que des personnes souffrant de TMS (ou d'autres problèmes de santé) puissent continuer à travailler. Il serait aussi utile de comprendre quels sont les processus de décision qui sous-tendent les associations observées.

Source: Leclerc, A., Chastang, J. F., Pascal, P., Plouvier, S., & Mediouni, Z. (2015). Archives des Maladies Professionnelles et de l'Environnement.
http://dx.doi.org/10.1016/j.admp.2014.10.009

Stability of Employment Over the First 3 Years Following Traumatic Brain Injury

Objective: To examine the stability of employment between 1 and 3 years following traumatic brain injury (TBI) and to identify the variables associated with continued employment throughout this time span.
Participants: This study included 236 individuals with predominantly moderate to very severe TBI, who had received rehabilitation in the context of a no-fault accident compensation system. Participants were eligible for the current study if they were employed before injury and reported their employment status at 1, 2, and 3 years following their injury as part of a longitudinal head injury outcome study.
Results: Only 44% of participants remained employed at each of the 3 years following TBI. There was also substantial transition into and out of employment across the 3 years. Significantly greater instability in employment was reported by individuals who were machinery operators or laborers before injury, had a longer duration of posttraumatic amnesia, reported more cognitive difficulties, and were less mobile 1 year following their injury.
Conclusion: A number of important factors determine the likelihood of achieving stability in employment following TBI. Findings from the current study support the continued need to identify ways in which physical as well as cognitive changes contribute to employment following TBI. Further examination is needed to identify possible compensatory strategies or job modifications to maximize the likelihood of job retention.

Source: Ponsford, Jennie L.; Spitz, Gershon. Journal of Head Trauma Rehabilitation: May/June 2015, Volume 30, Issue 3, p. E1–E11.
http://dx.doi.org/10.1097/HTR.0000000000000033

L'effet des arrêts maladie sur les trajectoires professionnelles

À la fin des années 2000, les taux d'emploi des personnes ayant des incapacités en France étaient de 46 % contre 72 % pour les personnes sans incapacités. Si l'on sait évaluer, pour l'Assurance maladie, le coût de l'indemnisation de l'incapacité temporaire de travail pour maladie (6,7 milliards d'euros soit 3,7 % des dépenses de santé en 2012), on ignore encore largement les effets de ces arrêts de travail sur les parcours professionnels.
Cette étude analyse l'effet des arrêts maladie – qui constituent une mesure de l'incapacité temporaire de travail – sur la dynamique des trajectoires professionnelles. Elle mobilise des données administratives de carrière et de dépenses de santé des salariés affiliés au Régime général (panel Hygie 2005-2008). Une typologie est mise en oeuvre pour caractériser les transitions entre cinq états (emploi sans arrêt, emploi avec peu d'arrêts, emploi avec arrêts longs, chômage et inactivité). Le recours à un modèle multinomial dynamique à effets fixes permet d'estimer l'effet des épisodes d'arrêt maladie sur le chômage et l'inactivité d'une année à l'autre en distinguant la dépendance d'état de l'hétérogénéité inobservée.
Nous observons des trajectoires plus durablement dégradées (vers le chômage et l'inactivité notamment) pour les personnes ayant des arrêts de travail, en particulier lorsque ceux-ci sont dus à des longs épisodes de maladie. Cet effet est comparable pour les hommes et les femmes ; le risque plus élevé d'inactivité après des arrêts longs chez les femmes s'expliquant principalement par l'hétérogénéité inobservée. Si les arrêts courts peuvent a priori s'interpréter comme un marqueur de sécurité de l'emploi, une fois l'hétérogénéité inobservée prise en compte, ils constituent également un facteur de risque pour les salariés dès lors que leur durée cumulée dépasse 30 jours. Les salariés semblent d'ailleurs intégrer ces risques de pénalités en limitant leur recours aux arrêts à la suite d'épisodes de chômage ou d'inactivité.

Source: Barnay, T.; Favrot, J.; Pollak, C. Économie et statistique, n°475-476, 2015, p. 135-156.
http://www.insee.fr/fr/ffc/docs_ffc/ES475H.pdf

Les enjeux organisationnels de la reprise du travail de salariés après une longue absence

Cette étude s'appuie sur une intervention ergonomique réalisée à la demande d'un établissement bancaire à la suite de difficultés rencontrées par des agents au moment du retour au travail après une longue absence. De nombreux travaux ont été menés au sujet des reprises de travail à la suite d'un problème de santé, mais ceux-ci ne constituent qu'une partie de ces situations. L'objectif de notre étude porte sur les situations de reprise du travail quelle que soit l'origine de l'absence dont il s'agira d'abord de montrer la diversité. Notre propos est basé sur l'analyse de 16 cas de reprise du travail après une absence de plus de trois mois.
Nous avons choisi de considérer la reprise de travail comme une « trajectoire » débutant avant le moment de l'absence et se poursuivant après le retour au travail du salarié. Nous avons relevé trois grandes catégories d'absence et de processus de retour. Nous avons pu ainsi élargir les possibilités d'action tout au long de ce processus pour faciliter le retour au travail. Nous avons mis l'accent sur la gestion organisationnelle de la reprise de travail qui devrait impliquer quelques acteurs-clés : le médecin du travail, l'encadrement de proximité, le référent Ressources humaines et les représentants du personnel.

Source: Célia Quériaud, Bernard Dugué et Johann Petit. Pistes, 17-1, Printemps 2015.
http://pistes.revues.org/4469

Predictors of permanent work disability among =50-year-old patients undergoing percutaneous coronary intervention

Objectives: This study aimed to describe the incidence and periprocedural predictors of permanent work disability (PWD) pension among patients ≤50 years old who underwent percutaneous coronary intervention (PCI).
Methods: Patient records of 910 consecutive patients undergoing PCI at four Finnish hospitals in 2002–2012 were reviewed for baseline and procedural data and late adverse events. Data on permanent work disability (PWD) pension allocation were acquired from the Finnish Centre for Pensions, which governs the statutory pension security in Finland.
Results: Mean follow-up was 41 [standard deviation (SD) 31] months. Altogether 103/910 (11.3%) of patients were on PWD by the end of follow-up, 60 (58.3%) for cardiac diagnoses (cumulative freedom from PWD 81% at 7 years). Independent predictors of PWD were post procedural stroke [hazard ratio (HR) 4.7, 95% confidence interval (95% CI) 1.8–11.9], post procedural myocardial infarction (MI) (HR 3.3, 95% CI 1.8–6.0), diabetes (HR 2.0, 95% CI 1.1–3.7), discharge diuretics (HR 3.5, 95% CI 2.1–5.9), and increasing age (HR 1.2, 95% CI 1.1–1.3). Predictors of PWD for cardiac diagnoses were post procedural stroke and MI, discharge diuretics, and use of calcium-channel blockers, diabetes and older age.
Conclusions: Patients ≤50 years old undergoing PCI are at a high risk for subsequent permanent disability for cardiac diagnoses. This finding underscores the need for reinforcing adherence to secondary prevention by cardiac rehabilitation and early collaboration with occupational health care professionals.

Source: Gunn J, Kiviniemi T, Biancari F, Kajander O, Mäkikallio T, Eskola M, Ilveskoski E, Korpilahti K, Wistbacka J-O, Anttila V, Heikkinen J, Airaksinen J. Scand J Work Environ Health, 2015.
http://dx.doi.org/10.5271/sjweh.3508

Gender Influences on Return to Work Following Mild Traumatic Brain Injury

OBJECTIVE: To examine the influence of gender on the return to work experience of workers who had sustained a work-related mild traumatic brain injury (wrMTBI) DESIGN: Qualitative study using in-depth telephone interviews SETTING: Community living adults in Ontario, Canada PARTICIPANTS: Purposive sampling was used to recruit participants. Eligibility criteria were mild/moderate TBI diagnosis based on multidisciplinary assessment and workplace injury. Six males and six females with mild TBI participated INTERVENTIONS AND MAIN OUTCOME MEASURE(S): N/A RESULTS: Our findings suggest that gender impacts return to work experiences in multiple ways. Occupational and breadwinner roles were significant for both men and women following wrMTBI. Female participants in this study were more proactive than men in seeking and requesting medical and rehabilitation services; however, the workplace culture may contribute to whether and how health issues are discussed. Among our participants, those who worked in supportive, nurturing (e.g., "feminine") workplaces reported more positive return to work (RTW) experiences than participants employed in traditionally "masculine" work environments. For all participants, employer and co-worker relations were critical elements in RTW outcomes CONCLUSION: The application of a gender analysis in this preliminary exploratory study revealed that gender is implicated in the return to work process on many levels for men and women alike. Further examination of the work reintegration processes that takes gender into account is necessary for the development of successful policy and practice for return to work following wrMTBI.

Source: Stergiou-Kita M, Mansfield E, Sokoloff S, Colantonio A. Arch. Phys. Med. Rehabil., 2015.
http://dx.doi.org/10.1016/j.apmr.2015.04.008

The Effect of Occupation-based Cognitive Rehabilitation for Traumatic Brain Injury

A Meta-analysis of Randomized Controlled Trials
Traumatic brain injury (TBI) is the leading cause of death and disability among people younger than 35 years in the United States. Cognitive difficulty is a common consequence of TBI. To address cognitive deficits of patients with TBI, various cognitive rehabilitation approaches have been used for the clinical setting. The purpose of this study was to investigate the overall effect of occupation-based cognitive rehabilitation on patients' improvement in cognitive performance components, activity of daily living (ADL) performance, and values, beliefs and spirituality functions of patients with TBI. The papers used in this study were retrieved from the Cochrane Database, EBSCO (CINAHL), PsycINFO, PubMed and Web of Science published between 1997 and 2014. The keywords for searching were cognitive, rehabilitation, occupation, memory, attention, problem-solving, executive function, ADL, values, beliefs, spirituality, randomized controlled trials and TBI. For the meta-analysis, we examined 60 effect sizes from nine studies that are related to the occupation-based cognitive rehabilitation on persons with TBI. In persons with TBI, overall mental functions, ADL, and values, beliefs and spirituality were significantly improved in the groups that received occupation-based cognitive rehabilitation compared with comparison groups (mean d = 0.19, p < .05). Evidence from the present meta-analytic study suggests that occupation-based cognitive rehabilitation would be beneficial for individuals with TBI for improving daily functioning and positively be able to affect their psychosocial functions. Collecting many outcome measures in studies with relatively few participants and the final data are less reliable than the whole instrument itself. Future research should evaluate the effectiveness of specific occupation-based cognitive rehabilitations programmes in order to improve consistency among rehabilitation providers.

Source: Park HY, Maitra K, Martinez KM. Occup. Ther. Int. 2015.
http://dx.doi.org/10.1002/oti.1389

La survenue du cancer: effets de court et moyen termes sur l’emploi, le chômage et les arrêts maladie

La réduction des inégalités face à la maladie est un des attendus majeurs du troisième Plan cancer 2014-2019 qui préconise de « diminuer l'impact du cancer sur la
vie personnelle » afi n d'éviter la « double peine » (maladie et exclusion du marché du travail). Dans ce contexte, nous évaluons l'impact de un à cinq ans d'un primo-enregistrement en Affection de longue durée (ALD) caractérisant le cancer sur la situation professionnelle et la durée passée en emploi, maladie et chômage de salariés du secteur privé. Nous utilisons la base de données administratives Hygie, recensant la carrière professionnelle et les épisodes de maladie d'un échantillon de salariés affi liés au Régime général de la Sécurité sociale. L'évaluation de l'impact de la survenue du cancer s'appuie sur une méthode de double différence avec appariement exact pour comparer les salariés malades aux salariés sans aucune ALD. La première année après le diagnostic correspond au temps des traitements caractérisé par une augmentation du nombre de trimestres d'arrêts de travail pour maladie de 1,7 pour les femmes et de 1,2 pour les hommes. L'âge joue également un rôle sur les absences liées à la maladie. Par ailleurs, l'employabilité des travailleurs atteints du cancer diminue avec le temps. La proportion de femmes et d'hommes employés au moins un trimestre, baisse respectivement de 8 et 7 points de pourcentage dans l'année suivant la survenue du cancer et jusqu'à treize points de pourcentage cinq ans plus tard. Cette distance à l'emploi se renforce lorsque les salariés malades sont plus âgés. L'effet de la maladie à cinq ans est respectivement de 15 et 19 points de pourcentage pour les hommes de plus de 51 ans et pour les femmes de plus de 48 ans. Ces différences de genre et d'âge peuvent traduire des différences de localisation et de sévérité des cancers, d'une part, de séquelles des cancers et de difficultés de réinsertion sur le marché du travail plus importantes avec l'avancée en âge, d'autre part.

Source: http://www.irdes.fr/recherche/documents-de-travail/065-la-survenue-du-cancer-effets-de-court-et-moyen-termes-sur-emploi-chomage-arrets-maladie.pdf

Barriers and facilitators for implementation of a return-to-work intervention for sickness absence beneficiaries with mental health problems

Results from three Danish municipalities
AIMS: Evidence for the effectiveness of return-to-work (RTW) interventions aimed at sickness absence beneficiaries with mental health problems (MHPs) is still relatively sparse and mostly inconclusive. This may in part reflect the varying settings and inconsistent implementations associated with the interventions. The aim of this paper is to identify barriers and facilitators for the implementation of a coordinated and tailored RTW-intervention implemented at three different sites. METHODS: We used qualitative and quantitative data to assess the implementation according to process evaluation guidelines. Data sources were individual and group interviews, observations, national registers, and documents used in the intervention. RESULTS: The quality of the implementation varied greatly across the three settings. Barriers included lack of skills to assess MHPs according to the inclusion criteria, different interpretations of sickness absence legislation among stakeholders, competing rehabilitation alternatives, and lack of managerial support for the intervention. An important facilitator was the motivation and availability of resources to solve disagreements through extensive communication. CONCLUSIONS: The different settings presented various barriers and facilitators, which resulted in different versions of the intervention. A higher degree of user involvement in the design and development phase is likely to improve the implementation quality of future interventions.

Source: Martin MH, Moefelt L, Nielsen MB, et al. Scandinavian Journal of Public Health, 2015.
http://dx.doi.org/10.1177/1403494814568484

Quel est l’impact du système d’indemnisation maladie sur la durée des arrêts de travail pour maladie ?

En France, les indemnités journalières versées à un salarié en cas d'absence au travail pour maladie sont fi nancées par un système à trois étages. Le premier étage
est constitué des indemnités journalières versées par l'Assurance maladie. Le deuxième étage dépend des dispositions de la convention collective dont le salarié relève. Le troisième étage, facultatif pour les employeurs, est négocié au niveau de chaque entreprise, et permet de bénéfi cier d'indemnité en sus des obligations des accords de branche. Ce troisième étage n'est pas abordé ici. Le deuxième étage offre des prestations qui peuvent aller bien au-delà de la prestation minimale obligatoire, avec de grandes disparités selon la convention collective et la catégorie dont relève le salarié.

Source: http://www.irdes.fr/recherche/documents-de-travail/066-quel-est-l-impact-du-systeme-d-indemnisation-maladie-sur-la-duree-des-arrets-de-travail-pour-maladie.pdf

Development and validation of a clinical prediction rule of the return-to-work status of injured employees in Minnesota

PURPOSE: Vocational rehabilitation services can be a valuable resource to injured employees at risk for sustaining permanent disability. The aim of this study was to develop and validate a predictive model of return-to-work (RTW) status at workers' compensation claim closure that may assist rehabilitation counselors tasked with determining how to allocate such services.
METHODS: A cross-sectional, retrospective study was conducted using data obtained from 15,372 workers' compensation claims in Minnesota's administrative claims database. The association between a set of 15 predictor variables representing medical and contextual factors and the RTW status as of claim closure of the accessible population was assessed using backward stepwise logistic regression. The most parsimonious set of variables that reliably predicted the outcome was selected as the optimal RTW model. This model was then internally validated via a split-dataset approach.
RESULTS: Risk factors for failure to RTW by claim closure include the following: (1) attorney involvement; (2) higher level of permanent impairment (PI); (3) shorter job tenure; (4) lower pre-injury average weekly wage (AWW); (5) injury affecting the head and neck or the back; and (6) lower level of educational attainment. The optimal RTW model included four main effects (attorney involvement; severity of PI; age; job tenure) and three first-order interaction effects (pre-injury AWW × pre-injury industry; attorney involvement × severity of PI; attorney involvement × job tenure). When applied to the full dataset, the overall classification rate was 74.7 %.
CONCLUSIONS: This study's optimal RTW model offers further support for evaluating disability from a biopsychosocial perspective. Given the model's performance, it may be of value to those assessing rehabilitation potential within Minnesota's, and possibly other, workers' compensation system(s).

Source: Hankins AB, Reid CA. J. Occup. Rehabil, 2015.
http://dx.doi.org/10.1007/s10926-015-9568-3

Physical capacity and risk for long-term sickness absence

A prospective cohort study among 8664 female health care workers
OBJECTIVE: To assess the prospective associations between self-reported physical capacity and risk of long-term sickness absence among female health care workers. METHODS: Female health care workers answered a questionnaire about physical capacity and were followed in a national register of sickness absence lasting for two or more consecutive weeks during 1-year follow-up. Using Cox regression hazard ratio analyses adjusted for age, smoking, body mass index, physical workload, job seniority, psychosocial work conditions, and previous sickness absence, we modeled risk estimates for sickness absence from low and medium physical capacity. RESULTS: Low and medium aerobic fitness, low muscle strength, low flexibility, and low overall physical capacity significantly increased the risk for sickness absence with 20% to 34% compared with health care workers with high capacity. CONCLUSIONS: Low physical capacity increases the risk of long-term sickness absence among female health care workers.

Source: Rasmussen, Charlotte Diana Nørregaard; Andersen, Lars Louis; Clausen, Thomas; Strøyer, Jesper; Jørgensen, Marie Birk; Holtermann, Andreas. Journal of Occupational & Environmental Medicine, 2015.
http://dx.doi.org/10.1097/JOM.0000000000000395

Results of a feasibility study: barriers and facilitators in implementing the Sherbrooke model in France

Objectives: Return-to-work interventions associated with the workplace environment are often more effective than conventional care. The Sherbrooke model is an integrated intervention that has proved successful in preventing work disability due to low-back pain. Implementation, however, runs up against many obstacles, and failure has been reported in many countries. The present study sought to identify barriers to and facilitators of the implementation of the Sherbrooke model within the French health system.
Methods: A multiple case study with nested levels of analysis was performed in two regions of France. A conceptual framework was designed and refined to identify barriers and facilitators at the individual, organizational and contextual levels. Qualitative data were collected via semi-structured interview (N=22), focus groups (N=7), and observation and from the gray literature. Participants (N=61) belonged to three fields: healthcare, social insurance, and the workplace.
Results: Numerous barriers and facilitators were identified in each field and at each level, some specific and others common to workers in all fields. Individual and organizational barriers comprised lack of time and resources, discordant professional values, and perceived risk. Legal barriers comprised medical confidentiality, legal complexity, and priority given to primary prevention. Individual-level facilitators comprised needs and perceived benefits. Some organizations had concordant values and practices. Legal facilitators comprised possibilities of collaboration and gradual return to work.
Conclusion: The present feasibility analysis of implementing the Sherbrooke model revealed numerous barriers and facilitators suggesting a new implementation strategy be drawn up if failure is to be avoided.

Source: Fassier J-B, Durand M-J, Caillard J-F, Roquelaure Y, Loisel P. 2015. Scand J Work Environ Health
http://dx.doi.org/10.5271/sjweh.3489

Return to Work after sick leave due to mental health problems

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.

Source: http://oshwiki.eu/wiki/Return_to_Work_after_sick_leave_due_to_mental_health_problems

The Effect of Social Support Features and Gamification on a Web-Based Intervention for Rheumatoid Arthritis Patients

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).
http://dx.doi.org/10.2196%2Fjmir.3510

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