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

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

Source: http://www.irsst.qc.ca/-publication-irsst-incapacite-prolonge-revue-litterature-r-841.html

Evaluation of Functional Restoration Outcomes for Chronic Disabling Occupational Cervical Disorders

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

Source: Hartzell, Meredith M.; Mayer, Tom G.; Asih, Sali; Neblett, Randy; Gatchel, Robert J. Journal of Occupational & Environmental Medicine: September 2014, Volume 56, Issue 9, p 959–964.
http://dx.doi.org/10.1097/JOM.0000000000000204

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

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

Source: http://www.irsst.qc.ca/-publication-irsst-arthrose-du-genou-r-832.html

La réinsertion professionnelle

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

Source: Dossier thématique, Travail & Sécurité, n° 753, Septembre 2014.
http://www.travail-et-securite.fr/ts/dossier.html

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

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

Source: Mansfield E, Stergiou-Kita M, Kirsh B, Colantonio A. Qual. Health Res. 2014
http://dx.doi.org/10.1177/1049732314545887

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

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

Source: Imelda S. Wong, Peter M. Smith, Cameron A. Mustard, Monique A. M. Gignac. American Journal of Industrial Medicine. Volume 57, Issue 8,  pages 960–969, August 2014.
http://dx.doi.org/10.1002/ajim.22351

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

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

Source: http://www.irsst.qc.ca/-publication-irsst-protocole-d-intervention-post-traumatique-r-819.html

Travailler après un cancer du sein

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

Source : C Tarantini, L Gallardo, P Peretti-Watel. Sociologie, vol. 5, n°2, 2014, p. 121-138.
http://dx.doi.org/10.3917/socio.052.0139

Recovery from mental conditions

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

Source: Lin KH, Shu-Chu Shiao J, Liao SC, Kuo CY, Leon Guo Y, Guo NW. Occup. Environ. Med. 2014; 71(Suppl 1): A72.
http://dx.doi.org/10.1136/oemed-2014-102362.224

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

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

Source: http://www.drees.sante.gouv.fr/IMG/pdf/er885.pdf

Exploring factors facilitating adults with spinal cord injury rejoining the workforce

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

Source: Wilbanks SR, Ivankova NV. Disabil. Rehabil. 2014.
http://dx.doi.org/10.3109/09638288.2014.938177

Systematic review of return to work after mild traumatic brain injury

Results of the International Collaboration on Mild Traumatic Brain Injury Prognosis
OBJECTIVE: To synthesize the best available evidence on return to work (RTW) after mild traumatic brain injury (MTBI). DATA SOURCES: MEDLINE and other databases were searched (2001-2012) with terms including "craniocerebral trauma" and "employment." Reference lists of eligible articles were also searched. STUDY SELECTION: Controlled trials and cohort and case-control studies were selected according to predefined criteria. Studies had to assess RTW or employment outcomes in at least 30 MTBI cases. DATA EXTRACTION: Eligible studies were critically appraised using a modification of the Scottish Intercollegiate Guidelines Network criteria. Two reviewers independently reviewed and extracted data from accepted studies into evidence tables. DATA SYNTHESIS: Evidence was synthesized qualitatively according to modified Scottish Intercollegiate Guidelines Network criteria and prioritized according to design as exploratory or confirmatory. After 77,914 records were screened, 299 articles were found eligible and reviewed; 101 (34%) of these with a low risk of bias were accepted as scientifically admissible, and 4 of these had RTW or employment outcomes. This evidence is preliminary and suggests that most workers RTW within 3 to 6 months after MTBI; MTBI is not a significant risk factor for long-term work disability; and predictors of delayed RTW include a lower level of education (<11y of formal education), nausea or vomiting on hospital admission, extracranial injuries, severe head/bodily pain early after injury, and limited job independence and decision-making latitude. CONCLUSIONS: Our findings are based on preliminary evidence with varied patient characteristics and MTBI definitions, thus limiting firm conclusions. More well-designed studies are required to understand RTW and sustained employment after MTBI in the longer term (≥2y post-MTBI).

Source: Cancelliere C, Kristman VL, Cassidy JD, Hincapié CA, Côté P, Boyle E, Carroll LJ, Stålnacke BM, Nygren-de Boussard C, Borg J. Arch. Phys. Med. Rehabil. 2014; 95(3S): S201-S209.
http://dx.doi.org/10.1016/j.apmr.2013.10.010

Assessing work ability

A cross-sectional study of interrater agreement between disability claimants, treating physicians, and medical experts
Objectives It is unclear to what extent assessments of work ability differ between disability claimants, their treating physicians, and multidisciplinary medical expert teams.
Methods We compared assessments of work ability for consecutive disability claimants referred to a multidisciplinary assessment center in Switzerland over a 4-year period. Assessments were made for the last job (LJ) prior to claiming a disability benefit and an alternative job (AJ) thought to suit the claimant's physical and mental abilities. Mean differences (MD) in percentage work ability between assessments from claimants, physicians, and experts were then estimated in a linear regression model.
Results The 3562 claims made during the study period were mostly due to musculoskeletal and depressive disorders. Assessments differed little between claimants and physicians [LJ MD 1.3% (95% confidence interval [95% CI] 0.5–2.2%); AJ MD 11% (95% CI 10–12%)]. Experts on average assessed a claimant's work ability higher than either the claimant or physician, particularly in the AJ [MD between expert and claimant 57% (95% CI 56–58%) and between expert and physician 46% (95% CI 45–48%)].
Conclusions Assessments of work ability differed substantially between experts in multidisciplinary medical teams and both claimants and their treating physicians. A careful evaluation of the disability assessment process is needed in an effort to reduce disagreement between expert teams and treating physicians and so improve acceptance of the process.

Source: Dell-Kuster S, Lauper S, Koehler J, Zwimpfer J, Altermatt B, Zwimpfer T, Zwimpfer L, Young J, Bucher HC, Nordmann AJ, Scand J Work Environ Health, 2014.
http://dx.doi.org/10.5271/sjweh.3440

Estimating the Net Benefit of a Specialized Return-to-Work Program for Workers on Short-Term Disability Related to a Mental Disorder

An Example Exploring Investment in Collaborative Care
Objective: This article estimates the net benefit for a company incorporating a collaborative care model into its return-to-work program for workers on short-term disability related to a mental disorder.
Methods: Employing a simple decision model, the net benefit and uncertainty were explored.
Results: The breakeven point occurs when the average short-term disability episode is reduced by at least 7 days. In addition, 85% of the time, benefits could outweigh costs.
Conclusions: Model results and sensitivity analyses indicate that organizational benefits can be greater than the costs of incorporating a collaborative care model into a return-to-work program for workers on short-term disability related to a mental disorder. The results also demonstrate how the probability of a program's effectiveness and the magnitude of its effectiveness are key factors that determine whether the benefits of a program outweigh its costs.

Source: Dewa, Carolyn S. Hoch, Jeffrey S. Journal of Occupational & Environmental Medicine: June 2014 - Volume 56 - Issue 6 - p 628–631.
http://dx.doi.org/10.1097/JOM.0000000000000157

Functional and occupational characteristics predictive of a return to work within 18 months after stroke in Japan

Implications for rehabilitation
Objective: This study examined clinical, functional, and occupational factors associated with return to work within 18 months after stroke, specifically focusing on the impact of higher cortical dysfunction on return to work in the chronic phase. Methods: This prospective cohort study in 21 hospitals specializing in clinical and occupational health recruited consecutive working-age inpatients receiving acute care for their first stroke (n = 351). A unified database was used to extract patient information from hospital records at the time of admission, discharge, and follow-up at 18 months post-stroke. Cox proportional hazard regression analysis was conducted to determine clinical, functional, and occupational factors influencing return to work within 18 months. Results: Of 351 registered stroke patients (280 males, 71 females, mean age ± SD, 55.3 ± 7.2 years) who met inclusion criteria, 250 responded to the follow-up survey and 101 were lost to follow-up. Half (51 %) succeeded in returning to work during the 18-month follow-up after stroke onset. After adjusting for age, gender, and Barthel index at initial rehabilitation, the following factors were identified as significant predictors of a return to work: white-collar versus blue-collar occupation (hazard ratio (HR) 1.5; 95 % confidence interval (CI) 1.1-2.2), no aphasia (HR 3.0; 95 % CI 1.5-5.9), no attention dysfunction (HR 2.0; 95 % CI 1.0-4.0), and walking ability (HR 3.1; 95 % CI 1.3-7.1).Conclusions: This study indicated the importance of tailored rehabilitation to alleviate the impact of higher cortical dysfunction and to support return to work by stroke survivors.

Source: Tanaka H; Toyonaga T; Hashimoto H, International Archives Of Occupational And Environmental Health, 2014 May; Vol. 87 (4), p. 445-453.
http://dx.doi.org/10.1007/s00420-013-0883-8

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