What is the evidence for clinical practice?
Traumatic brain injury (TBI) typically affects young adults with potentially many years of working life ahead of them. For people who were in work prior to their injury, return to work (RTW) is a common goal. However, a systematic review of RTW rates for people with TBI who were in work prior to their injury found that approximately 41% were in work at one and two years post TBI.1 Since TBI is a leading cause of morbidity worldwide in young adults,2 this discrepancy between what people with TBI want and what they achieve is important. The question is does the research evidence inform clinicians how to help a person with TBI return to work?
Results of a randomized controlled trial
Objectives: The primary purpose of this randomized controlled trial (RCT) was to evaluate the efficacy of a guided internet-based recovery training for employees who suffer from both work-related strain and sleep problems (GET.ON Recovery). The recovery training consisted of six lessons, employing well-established methods from cognitive behavioral therapy for insomnia (CBT-I) such as sleep restriction, stimulus control, and hygiene interventions as well as techniques targeted at reducing rumination and promoting recreational activities.
Methods: In a two-arm RCT (N=128), the effects of GET.ON Recovery were compared to a waitlist-control condition (WLC) on the basis of intention-to-treat analyses. German teachers with clinical insomnia complaints (Insomnia Severity Index ≥15) and work-related rumination (Irritation Scale, cognitive irritation subscale ≥15) were included. The primary outcome measure was insomnia severity.
Results: Analyses of covariance (ANCOVA) revealed that, compared to the WLC, insomnia severity of the intervention group decreased significantly stronger (F=74.11, P<0.001) with a d=1.45 [95% confidence interval (95% CI) 1.06–1.84] The number needed to treat (NNT) was <2 for reliable change and NNT <4 for reduction in expert-rated diagnosis of primary insomnia.
Conclusion: The training significantly reduces sleep problems and fosters mental detachment from work and recreational behavior among adult stressed employees at post-test and 6-months follow up. Given the low threshold access this training could reach out to a large group of stressed employees when results are replicated in other studies.
Source: Thiart H, Lehr D, Ebert DD, Berking M, Riper H. Scand J Work Environ Health, 2015.
Depression is a major problem that affects about 300 million people globally. Symptoms of depression include the core symptoms of low mood or loss of interest coupled with other symptoms such as feelings of inadequacy and hopelessness or sleep problems. These symptoms usually impair functioning and therefore sickness absence is common in people with depression. We evaluated the effectiveness of interventions that can help depressed workers to resume work activities.
Source: Nieuwenhuijsen K, Faber B, Verbeek JH, Neumeyer-Gromen A, Hees HL, Verhoeven AC, van der Feltz-Cornelis CM, Bültmann U. Cochrane Database of Systematic Reviews 2014, Issue 12. Art. No.: CD006237.
PURPOSE: The incidence and prevalence of work-related musculoskeletal nursing injuries is a top concern for nurses. These injuries are thought to be a dynamic interplay of multiple factors. A literature review reveals a knowledge gap in understanding context-specific patterns of nursing injuries.
DESIGN: Using a cross-sectional descriptive research design, 58 rehabilitation nurses participated in this study.
METHODS: Anonymous paper surveys were sent to all rehabilitation nursing personnel on the unit.
FINDINGS: Six themes emerged: lack of time and help, patient acuity, ergonomics, body movement issues, knowledge deficit, and communication.
CONCLUSIONS: Nursing input is critical in understanding and reducing context-specific work-related musculoskeletal injuries. Further research that includes nursing voices is advocated. CLINICAL RELEVANCE: Rehabilitation nursing injuries appear to be a complex interaction of multiple determinants; therefore, multifaceted solutions using a quality improvement lens are recommended to improve the working conditions on the units.
Source: Bhimani R. Rehabilitation Nursing, 2014.
A focus group study about participants' expériences
Background: Our aim was to explore how individuals who had participated in a brief back and neck pain intervention perceived connections between the intervention and their subsequent coping. Methods: Three focus group discussions were conducted with a sample of ten employees aged 20–67 years, who had participated in a brief intervention for back and neck pain, perceived the intervention as helpful and had returned or remained at work subsequent to the intervention. Participants were invited to share stories of how the intervention had made a positive difference to their work situation and everyday life and helped them cope with their complaints. Systematic text condensation was used for analysis. Results: Analysis revealed several aspects of how the participants considered the intervention to be helpful. They emphasized the importance of having the information delivered in a comprehensible way, with the use of practical examples and images of the spine. Discussions revealed the significance of trusting the lecturers and perceiving them as experts. Understanding why they felt the pain and that it was not a sign of serious disease changed the participants' perception of how they could live with the complaints. They told stories of how they had exceeded their previous limits and dared to undertake activities they previously had avoided due to fear. Conclusions: Having confidence in the lecturers and seeing them as experts that delivered the information in a comprehensible way helped participants to cope with their pain and was seen as the most important aspects of the brief back and neck pain intervention.
Source: Ree E, Harris A, Indahl A, Tveito TH, Malterud K. Scand J Public Health, 2014.
PURPOSE: Workers' own expectations for return to work consistently predict work status. To advance the understanding of the relationship between RTW expectations and outcomes, we reviewed existing measures to determine those which we felt were the most likely to capture the construct.
METHOD: A comprehensive search of the work-disability rehabilitation literature was undertaken. The review of the measures was conducted in three steps: first, a review of terminology; second, an examination of whether a time reference was included; third, an evaluation of ease of comprehension, and applicability across contexts.
RESULTS: A total of 42 different measures were identified. One of the most striking findings was the inconsistency in terminology. Measures were also limited by not including a time reference. Problems were also identified with regards to ease of understanding, utility of response options, and applicability in a wide variety of research and applied settings.
CONCLUSIONS: Most previously used measures contain elements that potentially limit utility. However, it would seem that further development can overcome these, resulting in a tool that provides risk prediction information, and an opportunity to start a conversation to help identify problems that might negatively impact a worker's movement through the RTW process and the outcomes achieved. Implications for Rehabilitation Return to work is an integral part of workplace injury management. The capture of RTW expectations affords a way to identify the potential for less than optimal RTW processes and outcomes. A mismatch between an injured worker's expectations and what other stakeholders might expect suggests that efforts could be made to determine what is causing the injured worker's concerns. Once underling issues are identified, work can be put into resolving these so that the worker's return to the workplace is not impeded.
Source: Young AE, Besen E, Choi Y. Disabil. Rehabil, 2014.
Cut-off points for the Work Ability Index
Objectives : The aim of this study was to investigate the Work Ability Index (WAI) as a tool to screen for risk of different durations of long-term sickness absence (LTSA) among manual and office workers.
Methods : The prospective study comprised a cohort of 3049 (1710 manual and 1339 office) workers participating in occupational health surveys between 2010–2012. The survey date was set as baseline and incident LTSA episodes of different duration (>14, >28, >42, >60, and >90 days) were retrieved from an occupational health register in the year following the survey. Baseline WAI scores were associated with LTSA episodes occurring (no/yes) during one-year follow-up by logistic regression analysis in a random sample (N=1000) of the cohort. Predictions of LTSA risk were then validated among the workers not included in the random sample.
Results : The odds of LTSA episodes at follow-up decreased with increasing baseline WAI scores (ie, better work ability). The WAI accurately predicted the risk of future LTSA episodes >28, >42, >60 days, but over-predicted the risk of LTSA episodes >14 and >90 days. The WAI discriminated between workers at high and low risk of LTSA episodes of all durations. Office workers had higher WAI scores than manual workers. Consequently, false-negative rates were higher among office workers and false-positive rates were higher among manual workers at each WAI cut-off point.
Conclusion : The WAI could be used to screen both manual and office workers for risk of LTSA episodes lasting >28, >42, >60 days. WAI cut-off points depend on the objectives of screening and may differ for manual and office workers.
Source: Schouten LS, Joling C, van der Gulden JWJ, Heymans MW, Bültmann U, Roelen CAM. Scand J Work Environ Health, 2014.
Costs, course, predictors
OBJECTIVES: The aim of this study is to assess costs, duration and predictors of prolonged compensation benefits by gender in a population characterised by long-term compensation benefits for traumatic or non-traumatic musculoskeletal injuries (MSIs).
METHODS: This study examined 3 years of data from a register-based provincial cohort including all new allowed long-term claims (≥3 months of wage replacement benefits) related to neck/shoulder/back/trunk/upper-limb MSIs in Quebec, Canada, from 2001 to 2003 (13 073 men and 9032 women). Main outcomes were compensation duration and costs. Analyses were carried out separately for men and women to investigate gender differences. An extended Cox model with Heaviside functions of time was used to account for covariates with time-varying effects.
RESULTS: Male workers experienced a longer compensation benefit duration and higher median costs. At the end of follow-up, 3 years postinjury, 12.3% of men and 7.3% of women were still receiving compensation benefits. Effects of certain predictors (e.g., income, injury site or industry) differed markedly between men and women. Age and claim history had time-varying effects in the men's and women's models, respectively.
CONCLUSIONS: Knowing costs, duration and predictors of long-term compensation claims by gender can help employers, decision makers and rehabilitation specialists to identify at-risk workers and industries to engage them in early intervention and prevention programmes. Tailoring parts of long-term disability prevention and management efforts to men's and women's specific needs, barriers and vulnerable subgroups, could reduce time on benefits among both male and female long-term claimants.
Source: Lederer V, Rivard M. Occup. Environ. Med. 2014.
Low back pain (LBP) is responsible for considerable personal suffering worldwide. Those with persistent disabling symptoms also contribute to substantial costs to society via healthcare expenditure and reduced work productivity. While there are many treatment options, none are universally endorsed. The idea that chronic LBP is a condition best understood with reference to an interaction of physical, psychological and social influences, the 'biopsychosocial model', has received increasing acceptance. This has led to the development of multidisciplinary biopsychosocial rehabilitation (MBR) programs that target factors from the different domains, administered by healthcare professionals from different backgrounds.
Source: Kamper SJ, Apeldoorn AT, Chiarotto A, Smeets RJ, Ostelo RWJG, Guzman J, van Tulder MW. Multidisciplinary biopsychosocial rehabilitation for chronic low back pain. Cochrane Database of Systematic Reviews 2014, Issue 9. Art. No.: CD000963.
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.
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.
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).
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.
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
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.
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