Research review on rehabilitation and return to work

This review is part of a project of the European Agency for Safety and Health at Work (EU-OSHA), initiated by the European Parliament, on the safety and health of older workers. The objective of the review is to provide an up-to-date summary of knowledge regarding vocational rehabilitation and return-to-work systems, programmes and interventions and their different components.


Return to Work Survey 2016 - Australia

In 2012 a working group consisting of representatives of Australian and New Zealand workers' compensation authorities, unions and employer groups developed a survey instrument and sampling methodology to be used to measure return to work outcomes of injured workers receiving workers' compensation and to better understand the experience of those injured workers and the factors that may have an effect on their return to work. In June 2012 Safe Work Australia's Strategic Issues Group for Workers' Compensation agreed to the survey instrument and methodology developed by the working group and the Social Research Centre was contracted to run the survey. In 2014, Safe Work Australia agreed that the survey should be run biennially. This is the third time the revised Return to Work Survey has been run.


Effectiveness of very early workplace interventions to reduce sickness absence

A systematic review of the literature and meta-analysis
This systematic review identified a lack of evidence to support the effectiveness of "very early" (less than 15 days after the start of sickness absence) workplace intervention to reduce sick leave compared to usual care. Lack of consensus on definition of "very early/early" interventions, methodological design of studies, the extent, and timing of usual care provided and variable compliance between groups might explain the absence of demonstrated benefit.

Source: Vargas-Prada S, Demou E, Lalloo D, Avila-Palencia I, Sanati KA, Sampere M, Freer K, Serra C, Macdonald EB. Scand J Work Environ Health, 2016.

Comparing the Relationship Between Age and Length of Disability Across Common Chronic Conditions

Objective: The aim of this study was to compare the association between age and disability length across common chronic conditions.
Methods: Analysis of 39,915 nonwork-related disability claims with a diagnosis of arthritis, diabetes, hypertension, coronary artery disease, depression, low back pain, chronic pulmonary disease, or cancer. Ordinary least squares regression models examined age-length of disability association across chronic conditions.
Results: Arthritis (76.6 days), depression (63.2 days), and cancer (64.9 days) were associated with longest mean disability lengths; hypertension was related to shortest disability lengths (41.5 days). Across chronic conditions, older age was significantly associated with longer work disability. The age–length of disability association was most significant for chronic pulmonary disease and cancer. The relationship between age and length of work disability was linear among most chronic conditions.
Conclusions: Work disability prevention strategies should consider both employee age and chronic condition diagnosis.

Source: Jetha, Arif; Besen, Elyssa; Smith, Peter M. Journal of Occupational & Environmental Medicine: May 2016, Volume 58, Issue 5, p. 485-491.

Effectiveness of Occupation- and Activity-Based Interventions to Improve Everyday Activities and Social Participation for People With Traumatic Brain Injury

A Systematic Review
This systematic review presents research on the effectiveness of occupation- and activity-based interventions to improve everyday activities and areas of occupation and social participation for people with traumatic brain injury (TBI). Nineteen studies identified through a comprehensive database search were reviewed and synthesized into five themes: (1) multidisciplinary and interdisciplinary treatment approaches, (2) community-based rehabilitation programs, (3) treatment approaches using client-centered goals and relevant contexts, (4) social skills training and peer mentoring interventions, and (5) community mobility interventions. Evidence supports the use of multidisciplinary and interdisciplinary approaches across a variety of settings, with no single treatment approach or setting clearly superior to another. The specific contributions of occupational therapy practitioners and the nature of occupational therapy interventions have not been well studied, making it difficult to determine the extent to which occupation- and activity-based interventions provided by occupational therapy practitioners improve occupational performance and social participation after TBI.

Source: Janet M. Powell; Timothy J. Rich; Elizabeth K. Wise. American Journal of Occupational Therapy, April 2016, Vol. 70.

Cross-cultural adaptation and validation of the Danish version of the 19-item return-to-work self-efficacy (RTWSE-19) questionnaire

A Danish version of the 19-item return-to-work self-efficacy (RTWSE-19) questionnaire was developed. The performance of a questionnaire may differ between populations and in various cultures. In order to use the RTWSE-19 in a Danish context, translation was necessary, and cross-cultural and conceptual adaptation needed to preserve the original purpose of the instrument.

Source: Hedeager Momsen A-M, Rosbjerg R, Stapelfeldt CM, Lund T, Jensen C, Johansen T, Nielsen CV, Labriola M. Scand J Work Environ Health, 2016.

Manual therapy for tension-type headache related to quality of work life and work presenteeism

Secondary analysis of a randomized controlled trial
OBJECTIVE: The objective of this research is to evaluate the efficacy of manual therapy for tension-type headache (TTH) in restoring workers quality of work life, and how work presenteeism affects this relation. DESIGN: This study is a secondary analysis of a factorial, randomized clinical trial on manual therapy interventions. Altogether, 80 patients (85% women) with TTH and without current symptoms of any other concomitant disease participated. INTERVENTIONS: An experienced therapist delivered the treatment: myofascial inhibitory technique (IT), articulatory technique (AT), combined technique (IT and AT), and control group (no treatment). RESULTS: In general, all treatments as compared to our control group had a large effect (f>/=.69) in the improvement of participants' quality of work life. Work presenteeism interacted with TTH treatment type's efficacy on participant's quality of work life. The inhibitory technique lead to higher reports of quality of work life than other treatment options only for participants with very low frequency of work presenteeism. In turn, TTH articulatory treatment techniques resulted in higher reports of quality of work life for a high to very high work presenteeism frequency. CONCLUSION: Articulatory manipulation technique is the more efficient treatment to improve quality of work life when the frequency of work presenteeism is high. Implications for future research and practice are discussed.

Source: Monzani L, Espi-Lopez GV, Zurriaga R, et al. Complementary Therapies in Médicine, 2016; 25: 86-91.

Relationship Between Opioid Prescribing Patterns and Claim Duration and Cost

Objective: The aim of this study was to assess the relationship between timing and duration of opioid prescriptions, disability duration, and claims costs for work-related injuries.
Method: A retrospective cohort study using lost time compensation claimant data to examine the relationship between opioid prescription patterns and claim duration and cost. Logistic regression adjusted for sex, marital status, initial reserve, attorney involvement, and spinal surgeries.
Results: Odds ratios for claim cost at least $100,000 and duration at least 3 years were not statistically different between groups prescribed opioids less than 30 days and those not prescribed opioids. Claims with short-acting opioids continued after 180 days; the odds ratios for claim cost at least $100,000 and duration at least 3 years were 6.21 (95% confidence interval 5.30 to 7.28) and 3.32 (95% confidence interval 2.94 to 3.74).
Conclusion: Claim cost and lost time are related to when and how long opioids are prescribed for work-related injuries.

Source: Lavin, Robert A. MD, MS; Tao, Xuguang (Grant) MD, PhD; Yuspeh, Larry BA; Kalia, Nimisha MD, MPH, MBA; Bernacki, Edward J. MD, MPH. Journal of Occupational & Environmental Medicine: March 2016, Volume 58, Issue 3, p. e90-e93.

Effects of graded return-to-work

A propensity-score-matched analysis
Objectives: Graded work exposure is deemed to have a therapeutic effect. In Germany, graded return-to-work (GRTW) is therefore frequently used following a rehabilitation program if workers are still unable to perform full job duties. The aim of the analyses was to determine long-term effects on disability pension and regular employment.
Methods: Analyses were performed with longitudinal administrative data. Patients aged 18–60 years who attended an orthopedic, cardiac, oncological, or psychosomatic rehabilitation between January and June 2007 were eligible to participate in a GRTW scheme. The effects of GRTW were analyzed by a propensity-score-matched comparison of patients with and without GRTW. Outcomes were disability pension rates, regular income, and the duration of receiving welfare benefits due to sickness absence and unemployment up to the end of 2009.
Results: The propensity-score-matched sample comprised 1875 patients on GRTW and 1875 matched controls not undergoing GRTW. The probability of a disability pension was decreased by about 40% among GRTW patients [5.4% versus 8.6%; hazard rate ratio (HR) 0.62, 95% confidence interval (95% CI) 0.49–0.80]. The three-year income (2007–2009) was EUR12 920 higher (95% CI EUR10 054–15 786) in the GRTW group. The duration of receiving welfare benefits due to sickness absence and unemployment was significantly reduced.
Conclusions: Graded work exposure supports labor participation and reduces the risk of permanent work disability.

Source: Bethge M. Scand J Work Environ Health, 2016.

Facteurs prédictifs d'une restriction d'aptitude ou d'une inaptitude au poste de travail antérieur en visite de reprise

Élaboration d'un score
L'objectif est d'étudier les facteurs liés à la décision d'aptitude du médecin du travail lors de la visite de reprise d'un salarié après un arrêt de travail pour maladie. Une enquête descriptive multicentrique transversale a été réalisée auprès de 402 salariés suivis par des services de santé au travail (SST) de l'agglomération stéphanoise. La reprise du travail au poste antérieur est significativement liée à certains facteurs professionnels et médicaux. Un score prédictif d'un avis d'aptitude autre que " apte " a été construit en renseignant quatre variables explicatives de l'avis d'aptitude identifiées dans l'analyse multivariée. Ce score pourrait être utilisé pour identifier en amont les situations difficiles de reprise du travail, de manière à mieux anticiper la mise en place des procédures de maintien dans l'emploi.


Rehabilitation and return to work

An analysis of EU and Member State systems and programmes
Against the backdrop of the ageing workforce, this report gives an overview of the approaches taken to rehabilitation and return to work throughout Europe. It analyses the factors that influence whether rehabilitation and return-to-work systems are developed and implemented in countries, and it goes on to identify particular success factors of these systems in Europe. It concludes by discussing the policy-relevant findings, and identifying areas where additional research is required to bridge the current knowledge gaps.


Sickness absence and mental health

Evidence from a nationally representative longitudinal Survey
Objectives Previous studies have consistently reported evidence of large significant associations between measures of psychological health and sickness absence. Some of this association, however, may be confounded by relevant covariates that have not been controlled. By using data with repeated observations from the same individuals, this study aimed to quantify the bias due to unobserved characteristics that are time invariant.
Methods Longitudinal data from the Household, Income, and Labour Dynamics in Australia (HILDA) Survey were used to estimate negative binomial regression models of the number of annual paid sickness absence days. Observations spanning the period 2005–2012, and covering all employed persons aged 15–64 years, were used (56 348 observations from 13 622 individuals).
Results Significant associations between the number of paid sickness absence days taken each year and scores on the mental health subscale of the SF-36 (MHI-5) were found. Inclusion of correlated random effects (which effectively control for unobserved person-specific factors that do not vary over time), however, resulted in a marked decline in the magnitude of this association. For persons with severe depressive symptoms (MHI-5 ≤52), the estimated incidence rate ratios were in the range 1.13–1.14 for men and 1.10–1.12 for women.
Conclusions Poor mental health is a risk factor affecting work attendance, but the magnitude of this effect, at least in a country where the rate of sickness absence is relatively low, is modest.

Source: Wooden M, Bubonya M, Cobb-Clark D. Scand J Work Environ Health, 2016.

Lag Times in Reporting Injuries, Receiving Medical Care, and Missing Work

Associations With the Length of Work Disability in Occupational Back Injuries
Objective: The aim of this study is to examine the associations between lag times following occupational low back injury and the length of work disability.
Methods: In a retrospective cohort study using workers' compensation claims, random effects Tobit models were used to explore how disability length relates to three lag times: the number of days from the date of injury to reporting the injury, the number of days from the date of injury to medical care, and the number of days from the date of injury to initiating work disability.
Results: In general, shorter lag times for each of the different lags were related to shorter lengths of disability.
Conclusions: Decreasing the length of the lag times in reporting injuries, receiving medical care, and missing work may help to decrease the length of work disability for workers after low back injury.

Source: Besen, Elyssa; Harrell, Mason; Pransky, Glenn. Journal of Occupational & Environmental Medicine: January 2016, Volume 58, Issue 1, p. 53-60.

Workplace social capital and risk of long-term sickness absence

Are associations modified by occupational grade?
BACKGROUND: Workplace social capital (WSC) is an emerging topic among both work environment professionals and researchers. We examined (i) whether high WSC protected against risk of long-term sickness absence (LTSA) in a random sample of the Danish workforce during a 1-year follow-up and (ii) whether the association of WSC with sickness absence was modified by occupational grade. METHODS: We measured WSC by self-report in a cohort of 3075 employees and linked responses to a national register of sickness absence. We calculated hazard ratios (HRs) and 95% confidence intervals (CIs) of onset of LTSA (>/=21 days), adjusted for covariates. We stratified analyses by occupational grade and examined if there was an interaction effect of WSC and occupational grade. RESULTS: A one standard deviation higher WSC score predicted a reduced risk of sickness absence after adjustment for sociodemographic variables, prevalent health problems and health behaviours (HR = 0.85, 95% CI = 0.74-0.99). The HR was attenuated and lost statistical significance after further adjustment for occupational grade (HR = 0.90, 95% CI = 0.78-1.04). When stratified by occupational grade, high WSC predicted a decreased risk of sickness absence among higher grade workers (HR = 0.61, 95% CI = 0.44-0.84) but not among lower grade workers (HR = 0.98, 95% CI = 0.83-1.15). The interaction effect of WSC and occupational grade was statistically significant (HR = 0.97, 95% CI = 0.95-0.99). CONCLUSION: High WSC might reduce risk of LTSA. However, the protective effect appears to be limited to workers of higher occupational grade.

Source: Rugulies R, Hasle P, Pejtersen JH, et al. European Journal of Public Health, 2016. 

Length of Disability and Medical Costs in Low Back Pain

Do State Workers' Compensation Policies Make a Difference?
Objective: The aim of the study was to examine the impact of state workers' compensation (WC) policies regarding wage replacement and medical benefits on medical costs and length of disability (LOD) in workers with low back pain (LBP).
Methods: Retrospective cohort analysis of LBP claims from 49 states (n?=?59,360) filed between 2002 and 2008, extracted from a large WC administrative database.
Results: Longer retroactive periods and state WC laws allowing treating provider choice were associated with higher medical costs and longer LOD. Limiting the option to change providers and having a fee schedule were associated with longer LOD, except that allowing a one-time treating provider change was associated with lower medical costs and shorter LOD.
Conclusions: WC policies about wage replacement and medical treatment appear to be associated with WC LBP outcomes, and might represent opportunities to improve LOD and reduce medical costs in occupational LBP.

Source: Shraim, Mujahed; Cifuentes, Manuel; Willetts, Joanna L.; Marucci-Wellman, Helen R.; Pransky, Glenn. Journal of Occupational & Environmental Medicine: December 2015, Volume 57, Issue 12, p. 1275-1283.

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