Workplace Social System and Sustained Return-to-Work: A Study of Supervisor and Co-worker Supportiveness and Injury Reaction

Objective: To examine the impact of the social workplace system on sustained return-to-work (SRTW). Methods: A random sample of workers' compensation claimants was recruited to complete a survey following claim acceptance (baseline), and 6 months later (time 2). SRTW, at baseline and time 2, was classified as those reporting being back at work for >28 days. Co-worker and supervisor support were assessed using five and seven items, respectively, and total scores were produced. A list of potential supervisory and co-worker reactions were presented to participants who were asked whether the reaction applied to them; response were coded as positive or non-positive. Demographic and injury characteristics, and work context factors were collected. Baseline and at time 2 multivariable models were conducted to examine the impact of supervisory and coworker support and injury reaction on SRTW. Results: 551 (baseline) and 403 (time 2) participants from the overall cohort met study eligibility criteria. At baseline, 59% of all participants indicated SRTW; 70% reported SRTW at time 2. Participants reported moderate support from their supervisor (mean = 8.5 ± 3.9; median = 8.2; range = 5–15) and co-workers (mean = 10.2 ± 4.5; median = 10.3; range = 5–25). Over half reported a positive supervisor (59%) or co-worker injury reaction (71%). Multivariable models found that a positive supervisor injury reaction was significantly associated with SRTW at baseline (OR 2.3; 95% CI 1.4–3.9) and time 2 (OR 1.6; 95% CI 1.1–2.3). Conclusions: Promoting supervisor positivity towards an injured worker is an important organizational work disability management strategy.

Source: Jetha, A., LaMontagne, A. D., Lilley, R., Hogg-Johnson, S., Sim, M. et Smith, P. (2018). Journal of occupational rehabilitation, 28(3), 486-494.

Sickness absence after carpal tunnel release

A systematic review of the literature
Objectives: The aim of this systematic review was to provide an overview of time to return to work (RTW) after carpal tunnel release (CTR), including return to different occupations and working patterns.
Methods: A systematic search from inception to 2016 was conducted using nine electronic databases, trial registries and grey literature repositories. Randomized controlled trials and observational studies reporting RTW times after CTR were included. Study risk of bias was assessed using Cochrane risk of bias assessment tools. Time to RTW was summarized using median and range.
Results: A total of 56 relevant studies were identified: 18 randomized controlled trials and 38 observational studies. Only 4 studies were rated as having a low risk of bias. Reported RTW times ranged from 4–168 days. Few studies reported occupational information. Among 6 studies, median time to return to non-manual work was 21 days (range 7–41), compared with 39 days for manual work (range 18–101). Median time to return to modified or full duties was 23 days (ranges 12–50 and 17–64, respectively), as reported by 3 studies. There was no common method of defining, collecting or reporting RTW data.
Conclusions: This review highlights wide variation in reported RTW times after CTR. Whilst occupational factors may play a role, these were poorly reported, and there is currently limited evidence to inform individual
patients of their expected duration of work absence after CTR. A standardized definition of RTW is needed, as well as an agreed method of collecting and reporting related data.

Source: Newington L., Stevens M., Warwick D., Adams J. et Walker-Bone K. (2018). Scand J Work Environ Health.

Interventions Developed with the Intervention Mapping Protocol in Work Disability Prevention

A Systematic Review of the Literature
Purposes Intervention mapping (IM) is a protocol for developing effective behavior change interventions. It has been used for 10 years to develop work disability prevention (WDP) interventions, but it is not known to what extent and with what success. The main objective of this study was to review the effectiveness of these interventions. Secondary objectives were to review their fidelity to the IM protocol, their theoretical frameworks and their content. Methods A search strategy was conducted in MEDLINE, Web of Science, PsycINFO, Pascal, Francis, and BDSP. All titles and abstracts were reviewed. A standardized extraction form was developed. All included studies were reviewed by two reviewers blinded to each other. Results Eight WDP interventions were identified aimed at return to work (RTW; n = 6) and self-management at work (n = 2). RTW interventions targeted workers with stress-related mental disorders (n = 1), low back pain (n = 1), musculoskeletal disorders (n = 1), cancer (n = 2) and gynecological surgery (n = 1). The fidelity to the IM protocol was weaker for the participatory planning group. Matrices of change, change methods, and applications were systematically reported. The main theoretical frameworks used were the attitude-social influence-self efficacy model (n = 4) and the theory of planned behavior (n = 2). Half of the interventions included a workplace component (n = 4). Two interventions were reported as effective, and one partially effective. Conclusion The IM protocol is used in WDP since 2007. The participative dimension appears underused. Few theoretical frameworks were used. Implications are to better consider the stakeholders involvement, and mobilize theoretical frameworks with greater attempts to intervene on the work environment.

Source: Fassier, J. B., Sarnin, P., Rouat, S., Péron, J., Kok, G., Letrilliart, L. et Lamort-Bouché, M. (2018). Journal of Occupational Rehabilitation.

Conséquences de la survenue du cancer sur les parcours professionnels

Une analyse sur données médico-administratives
Ce rapport étudie les effets à court et moyen termes de la survenue d'un cancer sur l'emploi et l'activité. Il utilise la base de données Hygie, produite par l'Irdes à partir des données administratives de la Caisse nationale de l'Assurance maladie et de la Caisse nationale d'assurance vieillesse. Hygie permet de reconstituer la carrière de l'individu ainsi que les événements de santé.
Une première partie exploite la dimension rétrospective liée à la carrière et confirme l'effet pénalisant du cancer sur l'activité et l'augmentation des arrêts maladie. Les résultats d'un modèle de double différence avec appariement exact montrent la persistance des effets de la maladie sur l'éloignement du marché du travail, la probabilité d'être employé au moins un trimestre dans l'année diminuant jusqu'à un horizon de cinq ans. Nous mesurons également l'effet des douze cancers les plus prévalents dans la base Hygie et de maladies chroniques ayant un impact potentiel sur le marché du travail. Les effets les plus marqués sont relatifs au cancer du poumon et des bronches, à la schizophrénie et au VIH. Les maladies chroniques autres que le cancer ont des effets nettement plus atténués probablement parce que leurs traitements au long cours améliorent la qualité de vie.


Return to Work in Employees on Sick Leave due to Neck or Shoulder Pain

A Randomized Clinical Trial Comparing Multidisciplinary and Brief Intervention with One-Year Register-Based Follow-Up
Purpose: The aim of this study was to evaluate the effect of a multidisciplinary intervention (MDI) compared to a brief intervention (BI) with respect to return to work (RTW), pain and disability in workers on sick leave because of neck or shoulder pain. Methods: 168 study participants with sickness absence for 4–16 weeks due to neck or shoulder pain were enrolled in a hospital-based clinical study and randomized to either MDI or BI. The primary outcome was RTW obtained by a national registry on public transfer payments. Secondary outcomes were self-reported pain and disability levels. One-year follow-up RTW rates were estimated by Cox proportional hazard regression adjusted for gender, age, sick leave prior to inclusion, part-time sick leave and clinical diagnosis. Secondary outcomes were analysed using logistic and linear regression analysis for pain and disability, respectively. Results: In the MDI group, 50 participants (59%) experienced four or more continuous weeks of RTW while 48 (58%) returned to work in the BI group during the 1 year of follow-up. Results showed a statistically non significant tendency towards a lower rate of RTW in the MDI group than in the BI group (adjusted HR = 0.84, 95% CI 0.54, 1.31). There were no statistically significant differences in secondary outcomes between the MDI and BI groups. Conclusion: The brief and the multidisciplinary interventions performed equally with respect to both primary and secondary outcomes. The added focus on RTW in the multidisciplinary group did not improve RTW rates in this group.

Source: Moll, L. T., Jensen, O. K., Schiøttz-Christensen, B., Stapelfeldt, C. M., Christiansen, D. H., Nielsen, C. V. et Labriola, M. (2018). Journal of occupational rehabilitation, 28,(2), 346-356.

Common Psychosocial Factors Predicting Return to Work After Common Mental Disorders, Cardiovascular Diseases, and Cancers

A Review of Reviews Supporting a Cross-Disease Approach
Purpose: This systematic review aimed at identifying the common psychosocial factors that facilitate or hinder the return to work (RTW) after a sick leave due to common mental disorders (CMDs), cardiovascular diseases (CVDs), or cancers (CAs). Methods: We conducted a review of reviews searching 13 databases from 1994 to 2016 for peer-reviewed, quantitative, cohort studies investigating factors influencing RTW after a CMD, CVD, or CA. Then, for each disease we identified additional cohort studies published after the date of the latest review included. Data were extracted following a three steps best-evidence synthesis method: the extraction of results about each predictor from studies within each single review and in the additional papers; the synthesis of results across the reviews and additional papers investigating the same disease; and the synthesis of results across the diseases. Results: The search strategy identified 1029 unique records from which 27 reviews and 75 additional studies underwent comprehensive review. 14 reviews and 32 additional cohort studies met eligibility criteria. Specific predictors of RTW with different levels of evidence are provided for each disease. We found four common facilitators of RTW (job control, work ability, perceived good health and high socioeconomic status), and six barriers of RTW (job strain, anxiety, depression, comorbidity, older age and low education). Conclusion: This is the first review to systematically analyze commonalities in RTW after CMDs, CVDs, or CAs. The common factors identified indicate that the RTW process presents many similarities across various diseases, thus supporting the validity of a cross-disease approach.

Source: Gragnano, A., Negrini, A., Miglioretti, M. et Corbière, M. (2018). Journal of occupational rehabilitation, 28(2), 215-231.

Validation of the Readiness for Return-To-Work Scale in outpatient occupational rehabilitation in Canada

Purpose: To examine construct and concurrent validity of the Readiness for Return-To-Work (RRTW) Scale with injured workers participating in an outpatient occupational rehabilitation program. Methods: Lost-time claimants (n = 389) with sub-acute or chronic musculoskeletal disorders completed the RRTW Scale on their first day of their occupational rehabilitation program. Statistical analysis included exploratory and confirmatory factor analyses of the readiness items, reliability analyses, and correlation with related scales and questionnaires. Results: For claimants in the non-job attached/not working group (n = 165), three factors were found (1) Contemplation (2) Prepared for Action-Self-evaluative and (3) Prepared for Action-Behavioural. The precontemplation stage was not identified within this sample of injured workers. For claimants who were job attached/working group in some capacity (n = 224), two factors were identified (1) Uncertain Maintenance and (2) Proactive Maintenance. Expected relationships and statistically significant differences were found among the identified Return-To-Work (RTW) readiness factors and related constructs of pain, physical and mental health and RTW expectations. Conclusion: Construct and concurrent validity of the RRTW Scale were supported in this study. The results of this study indicate the construct of readiness for RTW can vary by disability duration and occupational category. Physical health appears to be a significant barrier to RRTW for the job attached/working group while mental health significantly compromises RRTW with the non-job attached/not working group.

Source: Park, J., Roberts, M. R., Esmail, S., Rayani, F., Norris, C. M. et Gross, D. P. (2018). Journal of occupational rehabilitation, 28(2), 332-345.

Rehabilitation and return to work after cancer - Instruments and practices

Being diagnosed with cancer has immediate and long-lasting effects, even after the completion of treatment.
This project explores the occupational safety and health challenges that employers and employees face when workers return to work after a diagnosis of cancer. The report provides national examples of successful instruments and practices that help prevent long-term sickness absence and unemployment.


How Can Supervisors Contribute to the Return to Work of Employees Who have Experienced Depression?

Background: In Western countries, work disability due to depression is a widespread problem that generates enormous costs. Objective: The goal of this study was to determine the types and prevalence of supervisor contributions during the different phases of the return-to-work (RTW) process (before and during the sick-leave absence, and during the RTW preparations) of employees diagnosed with depression. Moreover, we sought to determine which contributions actually facilitate employees' RTW, and to identify the work accommodations most frequently implemented by supervisors at the actual time of their employee's RTW. Methods: Telephone interviews were conducted in Québec (Canada) with 74 supervisors working with employees who were already back at work or still on sick leave due to depression. A sub-sample of 46 supervisors who had already taken measures to facilitate their employees' RTW was questioned about the work accommodations implemented. Results: Most of the supervisors got along well with their employees before their sick leave and 72% stayed in contact with them during their leave. Nearly 90% of the supervisors encouraged their employees to focus primarily on their recovery before their RTW, but 43% pressured their employees to RTW as soon as possible. Cox regression analyses performed for the entire sample revealed that “the supervisors' intention to take measures to facilitate their employees' RTW” was the only significant predictor of the RTW at the time of the interview. The Kaplan–Meier survival curve showed that 50% of the employees were expected to RTW within the first 8 months of absence. Four of the most frequently implemented work accommodations were actions directly involving the supervisor (i.e. providing assistance, feedback, recognition, and emotional support to the employee). Conclusions: This study shed light on the less explored point of view of the supervisor involved in the RTW process of employees post-depression. It highlighted the most frequent and effective supervisor contributions to the process. These results can be used to develop concrete action plans for training supervisors to contribute to the sustainable RTW of employees on sick leave due to depression.

Source: Negrini, A., Corbière, M., Lecomte, T., Coutu, M. F., Nieuwenhuijsen, K., St-Arnaud, L., ... et Berbiche, D. (2018). Journal of occupational rehabilitation, 28(2), 279-288.

Quels sont les facilitateurs du maintien en emploi en santé des travailleurs seniors dans un milieu d’éducation au Québec?

Le pourcentage de travailleurs seniors âgés de 45 ans et plus augmente sans cesse sur le marché du travail au Québec. Dans le secteur de l'éducation, une large portion de la main-d'œuvre est âgée de 45 ans et plus (41 %) et un tiers du personnel aura quitté son poste entre 2009 et 2018 (Grenier, 2009). Des statistiques récentes montrent aussi que les lésions tant de nature physique que psychologique des travailleurs québécois du secteur de l'éducation sont souvent associées à une perte de temps indemnisée par la Commission des normes, de l'équité, de la santé et de la sécurité du travail (CNESST). Ces lésions touchent davantage des travailleurs seniors qui occupent diverses fonctions (p. ex., enseignants, personnel administratif) (Busque, 2012). L'objectif général de cette étude est d'identifier les déterminants du maintien en emploi en santé des travailleurs seniors âgés de 45 ans et plus œuvrant dans une commission scolaire (CS) québécoise.
Cette étude a permis de mieux comprendre comment les conditions de travail caractérisées par la présence de facteurs psychosociaux favorisent la santé psychologique des travailleurs seniors et les encouragent à rester en emploi à la CS plutôt que de décider à prendre une retraite hâtive. Les résultats de la Phase 1 ont mis en évidence que les travailleurs en fin de carrière montrent de plus hauts niveaux de stresseurs ressentis au travail et d'amotivation comparativement à ceux qui se trouvent dans l'étape intermédiaire de leur carrière. Pour les travailleurs retraités, l'autonomie et la flexibilité des horaires contribuaient à leur satisfaction au travail et à leur motivation introjectée. Ces aspects positifs de la santé psychologique au travail, à leur tour, ont déterminé leur choix de se maintenir en emploi à la CS, et ce, jusqu'à leur retraite régulière. Comparativement au groupe qui a opté pour une retraite hâtive avec des pénalités financières, celui des travailleurs qui ont choisi une retraite régulière se caractérise par des niveaux plus élevés de satisfaction au travail et de satisfaction envers l'établissement.


Psychosocial work environment and mental health-related long-term sickness absence among nurses

Purpose: We investigated which job demands and job resources were predictive of mental health-related long-term sickness absence (LTSA) in nurses.
Methods: The data of 2059 nurses were obtained from the Norwegian survey of Shift work, Sleep and Health. Job demands (psychological demands, role conflict, and harassment at the workplace) and job resources (social support at work, role clarity, and fair leadership) were measured at baseline and linked to mental health-related LTSA during 2-year follow-up. Cox regression models estimated hazard ratios (HR) and related 95% confidence intervals (CI). The c-statistic was used to investigate the discriminative ability of the Cox regression models.
Results: A total of 1533 (75%) nurses were included in the analyses; 103 (7%) of them had mental health-related LTSA during 2-year follow-up. Harassment (HR = 1.07; 95% CI 1.01–1.17) and social support (HR = 0.92; 95% CI 0.87–0.98) were associated with mental health-related LTSA. However, the Cox regression model did not discriminate between nurses with and without mental health-related LTSA (c = 0.59; 95% CI 0.53–0.65).
Conclusions: Harassment was positively and social support at the workplace was negatively related to mental health-related LTSA, but both failed to discriminate between nurses with and without mental health-related LTSA during 2-year follow-up.

Source: Roelen, C. A., van Hoffen, M. F., Waage, S., Schaufeli, W. B., Twisk, J. W., Bjorvatn, B., ... et Pallesen, S. (2018). International archives of occupational and environmental health, 91(2), 195-203.

Prediction of long-term absence due to sickness in employees

Development and validation of a multifactorial risk score in two cohort studies
Objectives: This study aimed to develop and validate a risk prediction model for long-term sickness absence.
Methods: Survey responses on work- and lifestyle-related questions from 65 775 public-sector employees were linked to sickness absence records to develop a prediction score for medically-certified sickness absence lasting >9 days and ≥90 days. The score was externally validated using data from an independent population-based cohort of 13 527 employees. For both sickness absence outcomes, a full model including 46 candidate predictors was reduced to a parsimonious model using least-absolute-shrinkage-and-selection-operator (LASSO) regression. Predictive performance of the model was evaluated using C-index and calibration plots.
Results: Variance explained in ≥90-day sickness absence by the full model was 12.5%. In the parsimonious model, the predictors included self-rated health (linear and quadratic term), depression, sex, age (linear and quadratic), socioeconomic position, previous sickness absences, number of chronic diseases, smoking, shift work, working night shift, and quadratic terms for body mass index and Jenkins sleep scale. The discriminative ability of the score was good (C-index 0.74 in internal and 0.73 in external validation). Calibration plots confirmed high correspondence between the predicted and observed risk. In >9-day sickness absence, the full model explained 15.2% of the variance explained, but the C-index of the parsimonious model was poor (<0.65).
Conclusions: Individuals' risk of a long-term sickness absence that lasts ≥90 days can be estimated using a brief risk score. The predictive performance of this score is comparable to those for established multifactorial risk algorithms for cardiovascular disease, such as the Framingham risk score.

Source: Airaksinen, J., Jokela, M., Virtanen, M., Oksanen, T., Koskenvuo, M., Pentti, J., ... et Kivimäki, M. (2018). Scandinavian journal of work, environment & health.

Évaluation de différents protocoles de gestion d’incident et de soutien aux employés après un incident grave

L'industrie ferroviaire canadienne fait régulièrement face à des incidents critiques (IC) associés à des collisions avec des personnes ou des véhicules. Ces incidents peuvent occasionner des blessures graves, ou des décès, parmi les victimes, mais aussi des problèmes de santé mentale chez les ingénieurs et conducteurs opérant les locomotives. Chaque année, environ 20 personnes décèdent lors de collisions avec un train au Québec et une centaine au Canada. À ces incidents mortels s'ajoute un nombre inconnu d'incidents lors desquels des personnes ont été blessées ou des dégâts matériels ont été constatés. La plupart des ingénieurs et conducteurs de train seront exposés au moins une fois dans leur carrière à ce type d'évènement. Ils sont à la fois témoins, victimes, parties prenantes et souvent premiers répondants lorsqu'un tel incident critique se produit.
Quelques études se sont intéressées aux protocoles de gestion d'IC et de soutien (PGICS) offerts par les employeurs et leurs recommandations visaient souvent à mettre de l'avant des pratiques visant à réduire l'impact potentiel des IC sur les employés et à accélérer le retour au travail. Par contre, ces protocoles, même s'ils sont fondés sur des études des conséquences des IC et des besoins des employés, n'ont pas encore fait l'objet d'évaluations empiriques. De telles évaluations sont nécessaires pour déterminer les éléments importants qui génèrent des effets positifs sur la récupération des employés et pour promouvoir les recommandations fondées sur des connaissances scientifiques.
Ce projet vise à évaluer les PGICS déjà en place au Canada dans l'industrie ferroviaire et leurs effets sur les trajectoires de récupération des employés victimes d'un incident critique et de proposer les pratiques clés pour en réduire les effets négatifs.


Effets psychologiques et biomécaniques immédiats de deux catégories de ceintures lombaires chez des travailleurs en santé et des travailleurs avec maux de dos

Bien que les ceintures lombaires (CL) soient inefficaces pour prévenir un premier épisode de lombalgie, l'avancement des connaissances soutient leur utilisation chez les travailleurs souffrant déjà de ce mal. Dans la perspective où un retour au travail tardif risque de nuire à la condition de santé des travailleurs, l'option du port de la CL peut potentiellement être avantageuse, car elle pourrait permettre, lors du retour progressif au travail, d'apporter un soutien psychologique afin de rassurer le patient. Cela pourrait donc représenter un outil additionnel, parmi les moyens entrepris pour intervenir sur les facteurs psychosociaux reliés à l'individu et son environnement de travail, pour faciliter ce retour au travail et également pour aider le travailleur à se maintenir au travail. Cependant, il importe aussi que la CL apporte un support biomécanique en matière de stabilité mécanique de la colonne vertébrale lombaire afin de rehausser la sécurité du travailleur. Deux catégories de ceintures souples permettent un niveau suffisant de confort pour être utilisées en milieu de travail, soit les ceintures (1) extensibles (élastiques) ou CL-E; (2) non extensibles ou CL-NE. La présente étude a pour but de comparer ces deux catégories de CL en ce qui a trait aux soutiens psychologique et biomécanique qu'elles prodiguent, cela autant chez des sujets en santé que chez des sujets avec maux de dos (lombalgies). À titre exploratoire, il devenait aussi pertinent de vérifier si différents sous-groupes de sujets lombalgiques, déterminés en fonction d'hypothèses biomécanique (instabilité lombaire) ou psychologique (peurs du mouvement ou de la douleur), présenteraient des effets biomécaniques différents.  Dans la perspective de l'évaluation de l'effet du port d'une CL dans un éventuel essai clinique, il était nécessaire d'évaluer, aussi à titre exploratoire, certaines variables associées à l'adoption à ce type d'intervention.


Identifying return-to-work trajectories using sequence analysis in a cohort of workers with work-related musculoskeletal disorders

Objectives: This study aimed to identify return-to-work (RTW) trajectories among workers with work-related musculoskeletal disorders (MSD) and examine the associations between different MSD and these RTW trajectories.
Methods: We used administrative workers' compensation data to identify accepted MSD lost-time claims with an injury date between 2010–2012 in British Columbia, Canada. Cox regression analyses were used to investigate differences in time to RTW between MSD. Validated day-to-day calendar measures of four RTW states (sickness absence, modified RTW, RTW, and non-RTW) were grouped into RTW trajectories spanning a one-year period using sequence analysis. RTW trajectories were clustered using decision rules that identified a shared trajectory structure. Poisson regression with robust standard errors was used to estimate relative risk ratios (RR) with 95% confidence intervals (CI) between MSD and RTW trajectory clusters.
Results: In a cohort of 81 062 claims, 2132 unique RTW trajectories were identified and clustered into nine RTW trajectory clusters. Half of the workers sustainably returned to work within one month. Workers with back
strains were most likely to have trajectories characterized by early sustained RTW, while workers with fractures or dislocations were more likely to have prolonged sickness absence trajectories (RR 4.9–9.9) or non-RTW trajectories (RR 1.4–7.6).
Conclusion: This is the first study that has characterized different types of RTW trajectories of workers with MSD using sequence analysis. The application of sequence analysis and the identification of RTW trajectories
yielded a number of key insights not found using conventional cox regression analysis.

Source: McLeod C., Reiff E., Maas E., Bültmann U. (2017). Scand J Work Environ Health.

Factors associated with return to work in patients with long-term disabilities due to neurological and neuropsychiatric disorders

The current study explores factors predicting return to work in a sample of patients with neurological and neuropsychiatric disorders who have attended a prevocational readiness and social skills training programme many years after trauma. Participants were community-dwelling adults with long-term disabilities (N = 67). Results of univariate analyses followed by multivariate logistic regression analysis revealed that both pre-injury (prior) and post-injury (current) factors influenced the likelihood of employment in our sample: prior employment, current employment readiness, current cognitive competence (particularly memory and executive functioning) and emotional adjustment. Our findings demonstrate that both pre-trauma and current factors interact in predicting return to work not only for individuals with traumatic brain injury (TBI), but also for a broader group of patients with long-term disabilities due to a variety of neurological and neuropsychiatric conditions. Thus, our findings provide preliminary support for ongoing long-term management of individuals with long-term disabilities and warrant close attention of future investigators to potential benefits of cognitive remediation, psychotherapy and vocational rehabilitation in terms of maintenance of initial gains and increased probability of return to work many years after trauma.

Source: Mitrushina, M., & Tomaszewski, R. (2017). Neuropsychological rehabilitation, 1-19.

Les pratiques d’orientation en direction des personnes malades chroniques

Accompagnement collectif et individuel dans le cadre d'une recherche-action
Cet article présente les pratiques d'orientation individuelles et collectives mises en œuvre auprès de personnes malades chroniques, dans le cadre d'une recherche-action portant sur les freins et les leviers de leur retour à l'emploi. Après avoir exposé nos ancrages théoriques et les choix méthodologiques effectués, nous décrirons comment des pratiques collectives au sein d'un dispositif d'échanges et des pratiques individuelles se complètent pour permettre aux sujets de revenir sur leur parcours, de trouver dans le regard des autres un point d'appui à la mise en œuvre des stratégies individuelles et mettre à jour de nouvelles potentialités. La dynamique de groupe joue un rôle important dans la construction du projet en tant que support à la transition professionnelle. L'entretien individuel se centre sur la narration des activités, afin de réactualiser la perception de soi et l'éprouvé des capacités. Lorsque la maladie conduit à un réaménagement du parcours de vie, des capacités et des désirs, la construction de projets peut s'appuyer sur l'expérience des activités déployées depuis l'irruption de la maladie : celles-ci sont l'occasion de confronter désirs et possibles.

Source: Joëlle Mezza. (2017). Perspectives interdisciplinaires sur le travail et la santé, 19-2.

Modulation du gain auditif central dans une perspective de réadaptation des travailleurs souffrant d’acouphènes

L'objectif de l'étude 1 était de démontrer l'existence du gain auditif central et de le localiser fonctionnellement. Deux groupes d'adultes ayant une audition normale ont porté des bouchons ou des générateurs de bruit pendant une semaine. Ils ont fait l'objet de tests avant et après la privation (bouchons) ou la stimulation (générateurs de bruit) sur une batterie d'évaluation de l'audition contenant des mesures allant de la cochlée jusqu'au cortex auditif. Les résultats démontrent que le système auditif module effectivement sa réponse en fonction des conditions acoustiques (privation ou stimulation, quoique plus modestement sur cette dernière), et que cette modulation s'effectue non pas au niveau périphérique (c'est-à-dire dans la cochlée), mais au sein du cortex auditif, soit au niveau le plus élevé du système auditif. En effet, aucun changement n'est observé en deçà de ce niveau. Ainsi la présence d'une modulation du gain auditif dont l'origine est purement centrale est appuyée par nos données.
L'objectif de l'étude 2 était d'examiner si ce gain auditif central peut être modulé chez des adultes ayant des acouphènes. En effet, chez cette population, il a été proposé que le mécanisme de gain auditif central serait inadapté (c'est-à-dire trop important), et qu'il serait responsable de l'acouphène et de l'hyperacousie, laquelle se définit comme une hypersensibilité auditive. En effet, ce modèle propose que l'acouphène reflèterait une hyperactivité neurale spontanée alors que l'hyperacousie reflèterait une hyperactivité évoquée par les sons externes. En bref, le gain central auditif serait altéré de façon chronique chez les gens avec acouphènes et hyperacousie et constituerait le mécanisme pathophysiologique principal de ces troubles auditifs. Si c'est le cas, un retour à la normale des mécanismes d'adaptation du gain devrait se refléter par une diminution de la sensibilité observable dans les jugements de sonie de même qu'une diminution de l'intensité de l'acouphène. Dans l'étude 2, des participants souffrant d'acouphènes sans perte ou avec perte auditive ont porté des générateurs de bruit pendant trois semaines. Des mesures auditives et psychométriques ont été prises en préintervention, après une semaine de port de générateurs, après trois semaines, de même qu'un mois après la fin de l'intervention.


Determinants of Sickness Absence and Return to Work Among Employees with Common Mental Disorders

A Scoping Review
Purpose: To present an overview of the existing evidence on prognostic factors of (recurrent) sickness absence (SA) and return to work (RTW) among workers with a common mental disorder (CMD). This scoping review provides information about determinants for SA and RTW, which could be used to develop better interventions aimed at the prevention of SA and promotion of RTW among workers with a CMD.
Methods: Relevant articles were identified in PubMed, Embase, PsycINFO, PSYNDEX, and SINGLE up to October 2016. In order to be included, studies should provide insight into prognostic factors of SA or RTW of workers with a CMD. We classified all factors according to the domains of the International Classification of Functioning, Disability and Health.
Results: Our searches identified 2447 possible relevant articles, of which 71 were included for data extraction. There is consistent evidence in ≥3 studies that previous episodes of CMD, higher symptom severity, previous absenteeism, co-morbidity, high job demands, low job control, high job strain, female gender, lower educational level, smoking behavior, and low perceived general health are predictors of SA in people with CMDs. Earlier RTW is consistently predicted by lower symptom severity, having no previous absenteeism, younger age, and positive expectations concerning sick-leave duration or RTW.
Conclusions: The amount of research on determinants for SA and RTW in workers with CMD has increased dramatically in recent years, although most studies are from the Netherlands and Scandinavia. There are some research gaps identified in this scoping review that need further attention in primary and secondary studies. Based on the summary of the evidence, we provide guidance for policy, practice and research.

Source: de Vries, H., Fishta, A., Weikert, B., Sanchez, A. R., & Wegewitz, U. (2017). Journal of Occupational Rehabilitation.

Le retour au travail des immigrants victimes de lésions professionnelles

Les embûches de la rencontre interculturelle et la précarité du lien d'emploi
Cet article rapporte une partie des résultats d'une étude exploratoire sur le processus de réadaptation et de retour au travail en contexte de relations interculturelles. Cette étude avait deux objectifs : identifier les stratégies mises de l'avant par les différents acteurs pour faciliter le processus de réadaptation et de retour au travail des travailleurs immigrants et décrire les contraintes, les obstacles et les aides au processus selon la perspective des différents acteurs. Des entrevues semi-dirigées ont ainsi été menées auprès de 47 répondants : cliniciens, agents d'indemnisation et conseillers en réadaptation de la CNESST, employeurs et travailleurs immigrants victimes d'une lésion reconnue et indemnisée. Au-delà des barrières linguistiques et culturelles, deux facteurs nuisent au retour en emploi des travailleurs immigrants : d'une part, la précarité du lien d'emploi freine leurs efforts et mine leur volonté de consolider leur état de santé et, d'autre part, la menace ou la perte réelle du lien d'emploi amène une rupture symbolique dans leur processus d'intégration. Cette rupture est importante pour ceux qui sont surqualifiés pour leur poste, surtout si leur emploi est un passage obligé pour acquérir une expérience de travail au Canada et viser ensuite un emploi à la hauteur de leurs compétences. Le processus de réadaptation peut soit se transformer en un « parcours déshonorant », soit fournir une occasion d'améliorer sa situation sur un marché du travail discriminant. Adapter les programmes à la réalité de ces travailleurs immigrants est possible, mais pose un dilemme moral et éthique : comment motiver les travailleurs à se rétablir tout en explorant un autre créneau d'emploi si leur lien d'emploi risque d'être rompu, alors que les règles relatives au droit de retour au travail prévoient la réintégration de l'emploi prélésionnel ou tout autre poste jugé équivalent ?

Source: Côté, D., Gravel, S., Dubé, J., Gratton, D., & White, B. (2017). Comprendre le processus de réadaptation et de retour au travail. Alterstice, 7(1), 21-38.

Return to work: A comparison of psychological and physical injury claims

The report examines the similarities and differences between psychological and physical claims. Two main areas are considered: RTW by potential influencing factors, and employees responses and experiences.


Pratiques des milieux de travail pour assurer un retour en emploi sain et durable

Au Québec, la Loi sur les accidents du travail et des maladies professionnelles (LATMP) établit que tout travailleur ayant subi une lésion professionnelle qui porte atteinte à son intégrité physique ou psychique a droit à la réadaptation que requiert son état en vue de sa réinsertion sociale et professionnelle. La LATMP prévoit aussi un droit de retour au travail lorsque le travailleur redevient capable d’exercer son métier. Les organisations et les travailleurs sont donc directement concernés par la mise en place de solutions de retour au travail (RaT) adéquates, durables et efficaces. Alors que la littérature récente nous renseigne abondamment sur les principes d’intervention basés sur les données probantes permettant un RaT sain et durable (pratiques exemplaires), les pratiques des milieux de travail à cet égard auprès des travailleurs ayant subi un trouble musculosquelettique (TMS) ont été, à ce jour, peu étudiées. Globalement, la présente étude vise à évaluer les écarts éventuels entre les pratiques exemplaires de RaT, basées sur des données probantes, et les pratiques actuelles des milieux de travail pour, par la suite, proposer des pistes d’amélioration. Plus précisément, les objectifs spécifiques suivants ont été définis : 1) Identifier les pratiques exemplaires de RaT durable et de prévention de l’incapacité prolongée des travailleurs ayant subi un TMS; 2) Décrire les pratiques actuelles de RaT dans quelques organisations québécoises et déterminer les éléments contextuels facilitant leur mise en place; 3) Explorer les écarts entre les pratiques exemplaires recommandées en recherche et les pratiques actuelles des milieux de travail pour ensuite envisager des façons d’améliorer le transfert entre la théorie et la pratique.


Barriers to and facilitators of return to work after sick leave in workers with common mental disorders

Perspectives of workers, mental health professionals, occupational health professionals, general physicians and managers
Common mental disorders (CMDs), such as anxiety, stress and depression, are among the leading causes of disability worldwide and have a major impact in terms of lost productivity and sickness absence. Returning to work is a complex process in which different stakeholders may be involved and have to co-operate.
This report discusses the return-to-work process of workers on sick leave with CMDs, and the barriers and facilitators from a multi-stakeholder perspective, ie workers, managers, mental health professionals, occupational health professionals and general physicians. This research was undertaken by Tilburg University.


Work, organisational practices, and margin of manoeuver during work reintegration

BACKGROUND: Many individuals of working age experience cardiovascular disease and are disabled from work as a result. The majority of research in cardiac work disability has focused on individual biological and psychological factors influencing work disability despite evidence of the importance of social context in work disability. In this article, the focus is on work and organisational features influencing the leeway (margin of manoeuvre) workers are afforded during work reintegration.
METHODS: A qualitative method was used. A large auto manufacturing plant was selected owing to work, organisational, and worker characteristics. Workplace context was assessed through site visits and meetings with stakeholders including occupational health, human resources and union personnel and a review of collective agreement provisions relating to seniority, benefits and accommodation. Worker experience was assessed using a series of in-depth interviews with workers (n = 12) returning to work at the plant following disabling cardiac illness. Data was analysed using qualitative content analysis.
RESULTS: Workers demonstrated variable levels of adjustment to the workplace that could be related to production expectations and work design. Policies and practices around electronic rate monitoring, seniority and accommodation, and disability management practices affected the buffer available to workers to adjust to the workplace.
CONCLUSIONS: Work qualities and organisational resources establish a margin of manoeuver for work reintegration efforts. Practitioners need to inform themselves of the constraints on work accommodation imposed by work organisation and collective agreements. Organisations and labour need to reconsider policies and practices that creates unequal accommodation conditions for disabled workers. Implications for rehabilitation Margin of manoeuvre offers a framework for evaluating and structuring work reintegration programmes. Assessing initial conditions for productivity expectations, context and ways and means to support work reintegration can be integrated with worker perceptions of work ability and possibilities for adaptation to structure and then monitor work reintegration programmes. Margin of manoeuvre can be used to evaluate sustainability of work at the end of rehabilitation. Cause-based workers' compensation schemes, collective agreement provisions, and organisational approaches to non-compensable disability create two tiers of disabled workers and make certain workers more vulnerable to occupational disability.

Source: O'Hagan, F. (2017). Disability and Rehabilitation, 1-10.

How do line managers experience and handle the return to work of employees on sick leave due to work-related stress?

A one-year follow-up study
PURPOSE: To examine how line managers experience and manage the return to work process of employees on sick leave due to work-related stress and to identify supportive and inhibiting factors.
MATERIALS AND METHODS: Semi-structured interviews with 15 line managers who have had employees on sick leave due to work-related stress. The grounded theory approach was employed.
RESULTS: Even though managers may accept the overall concept of work-related stress, they focus on personality and individual circumstances when an employee is sick-listed due to work-related stress. The lack of a common understanding of stress creates room for this focus. Line managers experience cross-pressure, discrepancies between strategic and human-relationship perspectives and a lack of organizational support in the return to work process.
CONCLUSION: Organizations should aim to provide support for line managers. Research-based knowledge and guidelines on work-related stress and return to work process are essential, as is the involvement of coworkers. A commonly accepted definition of stress and a systematic risk assessment is also important. Cross-pressure on line managers should be minimized and room for adequate preventive actions should be provided as such an approach could support both the return to work process and the implementation of important interventions in the work environment. Implication for rehabilitation Organizations should aim to provide support for line managers handling the return to work process. Cross-pressure on line managers should be minimized and adequate preventive actions should be provided in relation to the return to work process. Research-based knowledge and guidelines on work-related stress and return to work are essential. A common and formal definition of stress should be emphasized in the workplace.

Source: Ladegaard, Y., Skakon, J., Elrond, A. F., & Netterstrøm, B. (2017). Disability and Rehabilitation, 1-9.

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