Effectiveness of Occupational Therapy Interventions for Adults With Musculoskeletal Conditions of the Forearm, Wrist, and Hand

A Systematic Review
Occupational therapy practitioners are key health care providers for people with musculoskeletal disorders of the distal upper extremity. It is imperative that practitioners understand the most effective and efficient means for remediating impairments and supporting clients in progressing to independence in purposeful occupations. This systematic review provides an update to a previous review by summarizing articles published between 2006 and July 2014 related to the focused question, What is the evidence for the effect of occupational therapy interventions on functional outcomes for adults with musculoskeletal disorders of the forearm, wrist, and hand? A total of 59 articles were reviewed. Evidence for interventions was synthesized by condition within bone, joint, and general hand disorders; peripheral nerve disorders; and tendon disorders. The strongest evidence supports postsurgical early active motion protocols and splinting for various conditions. Very few studies have examined occupation-based interventions. Implications for occupational therapy practice and research are provided.

Source: Roll, S. C., & Hardison, M. E. (2017). American Journal of Occupational Therapy, 71(1).
https://dx.doi.org/10.5014%2Fajot.2017.023234

Factors Associated With Success in an Occupational Rehabilitation Program for Work-Related Musculoskeletal Disorders

Work-related musculoskeletal disorders are a significant burden; however, no consensus has been reached on how to maximize occupational rehabilitation programs for people with these disorders, and the impact of simulating work tasks as a mode of intervention has not been well examined. In this retrospective cohort study, the authors used logistic regression to identify client and program factors predicting success for 95 clients in a general occupational rehabilitation program and 71 clients in a comprehensive occupational rehabilitation program. The final predictive model for general rehabilitation included gender, number of sessions completed, and performance of work simulation activities. Maximum hours per session was the only significant predictor of success in the comprehensive rehabilitation program. This study identifies new factors associated with success in occupational rehabilitation, specifically highlighting the importance of intensity (i.e., session length and number of sessions) of therapy and occupation-based activities for this population.

Source: Hardison, M. E., & Roll, S. C. (2017). American Journal of Occupational Therapy, 71(1).
https://dx.doi.org/10.5014%2Fajot.2016.023200

An Intervention Bundle to Facilitate Return to Work for Burn-Injured Workers

Report From a Burn Model System Investigation
Rates of return to work (RTW) after burn injury vary. A 2012 systematic review of the burn literature reported that nearly 28% of all adult burn survivors never return to any form of employment. These authors called for interventions designed to assist survivors' ability to function in an employed capacity. In 2010, our burn center outpatient clinic instituted an intervention aimed to return injured workers to employment within 90 days of their insurance claims. The interventions include patient/family education focused on recovery rather than disability, employer contact and education by the vocational rehabilitation (VR) counselor, physician recommendations for work accommodations, provision of employee status letters, and Activity Prescription Forms (APFs). The purpose of this study is to report on the effectiveness of these interventions. Following institutional review board (IRB) approval, medical records of adults with occupation-related burn injuries and receiving care at a single regional burn center from June 2010 to July 2015 were reviewed. Data on patient and injury characteristics and outpatient VR services provided were collected. The primary outcome of interest was the percentage of patients who RTW; 338 individuals met study entry criteria. The VR counselor evaluated all patients. All patients received an employer letter(s) and APF documentation. Workplace accommodations were provided to more than 30% of patients. RTW rate was 93%, with an average of 24 days from injury to RTW. In an intervention bundle involving the patient, employer, Workers' compensation, and the burn clinic staff, injured workers achieved a high rate of RTW. Although we cannot correlate individual bundle components to outcome, we postulate that the combination of employer/employee/insurer engagement and flexibility contributed to the success of this program.

Source: Carrougher, G. J., Brych, S. B., Pham, T. N., Mandell, S. P., & Gibran, N. S. (2017). Journal of Burn Care & Research, 38(1), e70-e78.
http://dx.doi.org/10.1097/BCR.0000000000000410

The role of health-care providers in the workers' compensation system and the return-to-work process

International research has generated strong evidence that health-care providers have a key role in the return-to-work (RTW) process. However, pressure on consultation time, administrative challenges and limited knowledge about a patient's workplace can thwart meaningful engagement. This multi-jurisdictional, two-year study focused on health-care providers' experiences within the workers' compensation system and their role in the RTW process.

Source: http://www.iwh.on.ca/system/files/documents/role_of_health-care_providers_in_return_to_work_final_report_2016.pdf

Development and validation of a prediction model for long-term sickness absence based on occupational health survey variables

PURPOSE: The purpose of this study is to develop and validate a prediction model for identifying employees at increased risk of long-term sickness absence (LTSA), by using variables commonly measured in occupational health surveys. MATERIALS AND METHODS: Based on the literature, 15 predictor variables were retrieved from the DAnish National working Environment Survey (DANES) and included in a model predicting incident LTSA (>/=4 consecutive weeks) during 1-year follow-up in a sample of 4000 DANES participants. The 15-predictor model was reduced by backward stepwise statistical techniques and then validated in a sample of 2524 DANES participants, not included in the development sample. Identification of employees at increased LTSA risk was investigated by receiver operating characteristic (ROC) analysis; the area-under-the-ROC-curve (AUC) reflected discrimination between employees with and without LTSA during follow-up. RESULTS: The 15-predictor model was reduced to a 9-predictor model including age, gender, education, self-rated health, mental health, prior LTSA, work ability, emotional job demands, and recognition by the management. Discrimination by the 9-predictor model was significant (AUC = 0.68; 95% CI 0.61-0.76), but not practically useful. CONCLUSIONS: A prediction model based on occupational health survey variables identified employees with an increased LTSA risk, but should be further developed into a practically useful tool to predict the risk of LTSA in the general working population.

Source: Roelen, C., Thorsen, S., Heymans, M., Twisk, J., Bültmann, U., & Bjørner, J. (2016). Disability and Rehabilitation, 1-8.
http://dx.doi.org/10.1080/09638288.2016.1247471

Costs and Work Loss Burden of Diagnosed Opioid Abuse Among Employees on Workers Compensation or Short-term Disability

Objective: To compare 12-month healthcare costs between employees with versus without diagnosed opioid abuse within 12 months after an injury-related workers' compensation (WC) or short-term disability (STD) claim.
Methods: Retrospective study using 2003 to 2014 US insurance claims linked to administrative data on WC/STD claims. Multivariable models compared healthcare costs between employees with versus without diagnosed opioid abuse.
Results: Study included 107,975 opioid-treated employees with an injury-related WC or STD claim. Mean number of opioid prescription fills and adjusted total healthcare costs were substantially greater in employees with diagnosed opioid abuse versus without (WC: 13.4 vs. 4.5, P?<?0.001; $18,073 vs. $8470, P?<?0.001; STD: 13.7 vs. 4.5, P?<?0.001; $25,693 vs. $14,939, P?<?0.001).
Conclusion: Opioids are commonly prescribed to employees with injury-related WC/STD claims. Employers may benefit from proactively addressing the issue of opioid abuse in these populations.

Source: Johnston, S. S., Alexander, A. H., Masters, E. T., Mardekian, J., Semel, D., Malangone-Monaco, E., ... & Sadosky, A. (2016). Journal of Occupational and Environmental Medicine, 58(11), 1087-1097.
http://dx.doi.org/10.1097/JOM.0000000000000865

Effects of a randomized controlled intervention trial on return to work and health care utilization after long-term sickness absence

BACKGROUND: The aim of the RCT study was to investigate if the effect of a multidisciplinary intervention on return to work (RTW) and health care utilization differed by participants' self-reported health status at baseline, defined by a) level of somatic symptoms, b) health anxiety and c) self-reported general health. METHODS: A total of 443 individuals were randomized to the intervention (n = 301) or the control group (n = 142) and responded to a questionnaire measuring health status at baseline. Participants were followed in registries measuring RTW and health care utilization. Relative risk (RR) and odds ratio (OR) were used as measures of associations. Results were adjusted for gender, age, educational level, work ability and previous sick leave. RESULTS: Among all responders we found no effect of the intervention on RTW. Among participants with low health anxiety, the one-year probability of RTW was lower in the intervention than in the control group (RR = 0.79 95 % CI 0.68-0.93), but for those with high health anxiety there was no difference between the groups (RR = 1.15 95 % CI 0.84-1.57). Neither general health nor somatic symptoms modified the effect of the intervention on RTW. The intervention had no effect on health care utilization. CONCLUSIONS: The multidisciplinary intervention did not facilitate RTW or decrease health care utilization compared to ordinary case management in subgroups with multiple somatic symptoms, health anxiety or low self-rated health. However, the intervention resulted in a reduced chance of RTW among participants with low health anxiety levels.

Source: Momsen, A. M. H., Stapelfeldt, C. M., Nielsen, C. V., Nielsen, M. B. D., Aust, B., Rugulies, R., & Jensen, C. (2016). BMC Public Health, 16(1), 1149.
http://dx.doi.org/10.1186/s12889-016-3812-4

Engaging Employers to Prevent Disability

The Journal is honored to be publishing this special issue and grateful to all of the very talented contributors involved. The papers in this issue of the Journal provide not only a state-of-the-art review of employer factors and interventions but also provide information about research design challenges and recommendations that will be useful for anyone planning research in this domain. Practitioners will also appreciate the efforts to include information from the “grey literature” and to highlight issues of employer decision-making and implementation. All of the papers have been published as “Open Access” and can be accessed freely on the SpringerLink website. We trust that you will find this work helpful in your efforts to improve the understanding, prevention, and management of work disability.

Source: (2016). Journal of Occupational Rehabilitation, 26(4).
http://link.springer.com/journal/10926/26/4

Managerial abuse and the process of absence among mental health staff

Managers' abuse of subordinates is a common form of unethical behaviour in workplaces. When exposed to such abuse, employees may go absent from work. We propose two possible explanations for employee absence in response to managerial abuse: a sociological explanation based on perceptions of organizational justice and a psychological explanation based on psychological strain. Both are tested using data from a sample of 1472 mental health workers. The occurrence, duration and frequency of absence are investigated using a hurdle model. Managerial abuse is found to be associated with the occurrence of absence through both perceptions of organizational justice and psychological strain. Distributive justice and depression are especially significant in explaining the relationship between abuse and absence. Once absent, duration of absence is not further affected by managerial abuse but is still linked to depression and distributive justice, whereas frequency of absence is linked to bullying and depression.

Source: Wood, S., Niven, K., & Braeken, J. (2016). Work, Employment & Society.
http://dx.doi.org/10.1177/0950017015613755

Chronic Condition Combinations and Productivity Loss Among Employed Nonelderly Adults (18 to 64 Years)

Objective: We examined the relationship between specific chronic condition combinations and productivity loss measured by missed work days among nonelderly employed adults with at least two physical chronic conditions of arthritis, diabetes mellitus, heart disease, and hypertension.
Methods: We analyzed data from the Medical Expenditure Panel Survey for the years 2004 to 2012.
Results: Adults with arthritis/diabetes/heart disease had the highest average missed work days (14.42). In the adjusted model, compared with adults with arthritis/hypertension, adults with diabetes/heart disease and arthritis/heart disease/hypertension had significantly higher missed work days, while adults with diabetes/hypertension had significantly lower missed work days.
Conclusion: Specific chronic condition combinations have a high burden of disease in terms of productivity loss. Workplace health programs that address multiple health conditions at the same time should be implemented to reduce missed work days.

Source: Meraya, A. M., & Sambamoorthi, U. (2016). Journal of Occupational & Environmental Medicine, 58(10), 974-978.
http://dx.doi.org/10.1097/JOM.0000000000000839

Effectiveness of multifaceted implementation strategies for the implementation of back and neck pain guidelines in health care

A systematic review
For the optimal use of clinical guidelines in daily practice, mere distribution of guidelines and materials is not enough, and active implementation is needed. This review investigated the effectiveness of multifaceted implementation strategies compared to minimal, single, or no implementation strategy for the implementation of non-specific low back and/or neck pain guidelines in health care.

Source: Suman, A., Dikkers, M. F., Schaafsma, F. G., van Tulder, M. W., & Anema, J. R. (2016). Implementation Science, 11(1), 126.
https://dx.doi.org/10.1186%2Fs13012-016-0482-7

Online assessment of patients’ work disability representations to promote evidence based practice in rehabilitation setting

The Revised Illness Perception Questionnaire adapted for Work Disability (IPQR-WD) is an adaptation of Illness Perception Questionnaire-Revised: the most used and most comprehensive tool for measuring illness perceptions. Evaluating representations is crucial, since it is a main determinant of return to work in cases of persistent pain due to musculoskeletal disorders.
This study aim at facilitating systematic assessment of work disability representations by assessing the usability of the Web platform and the usefulness of automatic interpretation of the results.

Source: Coutu, M. F., Albert, V., & Labrecque, M. E. (2016). Annals of Physical and Rehabilitation Medicine, 59, e147.
http://dx.doi.org/10.1016/j.rehab.2016.07.328

Déterminants cliniques et neuromécaniques du développement de l'incapacité lombaire chez les travailleurs

Au-delà de la simple lésion, les blessures, dysfonctions et pathologies musculosquelettiques entraînent aussi, sur le plan individuel, des conséquences psychologiques importantes. Sur le plan sociétal, la gestion de ce type d'affections entraîne d'importants coûts socio-économiques. La société occidentale qui a vu, au cours des dernières décennies, une augmentation de la disponibilité des services et de l'accessibilité aux soins de santé, a aussi parallèlement connu une explosion du nombre de consultations pour les affections musculosquelettiques. Parmi ce type d'affections, l'une d'entre elles semble s'être démarquée par sa prévalence et son incidence élevées, sa complexité et les dépenses importantes qui y sont associées. Les douleurs lombaires constituent désormais le second motif de consultation médicale, et la principale blessure d'ordre musculosquelettique. De fait, dans les sociétés industrialisées, la prévalence à vie des lombalgies varie entre 70 % et 85 %, tandis que la prévalence annualisée oscille entre 15 % et 45 %. Considérant cette réalité et son impact important au sein des populations actives de travailleurs, l'équipe a tenté, par l'entremise d'une étude de cohorte longitudinale, de déterminer les facteurs cliniques, psychologiques et physiques qui expliquent l'apparition et le développement de l'incapacité associée aux affections qui présentent un historique de douleurs lombaires. L'objectif principal de l'étude consistait à déterminer si la douleur initiale, les facteurs psychologiques qui lui sont associés, les capacités motrices en présence de douleur et les mécanismes de modulation de la douleur jouent un rôle dans l'évolution des incapacités fonctionnelles et l'absentéisme associés à la lombalgie chez un groupe de travailleurs ayant connu au moins un récent épisode significatif de lombalgies.

Source: http://www.irsst.qc.ca/publications-et-outils/publication/i/100898/n/determinants-cliniques-neuromecaniques-incapacite-lombaire

Return to work after vocational rehabilitation for sick-listed workers with long-term back, neck and shoulder problems

A follow-up study of factors involved
BACKGROUND: Absence from work due to musculoskeletal disorders is a significant problem from a number of perspectives, and there is a great need to identify factors that facilitate return to work (RTW).
OBJECTIVE: To identify factors related to RTW after vocational rehabilitation for sick-listed workers with long-term back, neck and/or shoulder problems, and to compare the results with those from a previous literature review based on studies from 1980 to 2000.
METHODS: A literature review based on studies published 2001–2014 in PubMed, CINAHL, EMBASE, ERIC and the Cochrane Library.
RESULTS: Major risk factors for not returning to work are: higher age, factors related to pain such as higher levels of pain and pain related fear, avoidance of activity, high distress and depression. Facilitating factors for RTW are: lower functional disability, gaining control over one's own condition, believing in RTW and work-related factors such as occupational training, and having a job coach or an RTW coordinator. Compared with the results from the previous review, the present review shows less of a focus on sociodemographic factors and more on psychological factors. Both studies highlight risk factors such as older age, higher levels of pain, depression and less internal locus of control.
CONCLUSION: Psychosocial and work-related factors are important and should be included in interventions for the RTW of people with long-term back, neck and/or shoulder problems.

Source: Rinaldo, U., & Selander, J. (2016). Work, 1-17.
http://dx.doi.org/10.3233/WOR-16238710.3233/WOR-162387

Pratiques des grandes organisations au Québec en regard de la coordination du retour au travail

L'objectif général de cette étude consistait à décrire les pratiques des personnes impliquées dans la coordination du retour au travail dans de grandes organisations privées et publiques au Québec. Le premier objectif spécifique était de décrire les personnes impliquées dans la coordination du retour au travail, ainsi que les organisations pour lesquelles elles travaillent. Le deuxième objectif spécifique était de décrire les tâches et activités réalisées par ces personnes, identifier les acteurs avec lesquels elles sont appelées à collaborer, ainsi qu'établir les qualités et aptitudes requises pour effectuer la coordination du retour au travail. Enfin, le troisième objectif spécifique était d'explorer les leviers et les obstacles à l'accomplissement des tâches et activités, de même que ceux associés au retour au travail.

Source: http://www.irsst.qc.ca/publications-et-outils/publication/i/100900/n/pratiques-des-grandes-organisations-au-quebec-en-regard-de-la-coordination-du-retour-au-travail

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