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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
Objective: To explore the association between the initial 60 days of prescriptions for psychotropic medications and final workers' compensation claim outcomes.
Methods: A cohort of 11,394 claimants involved in lost time injuries between 1999 and 2002 were followed through December 31, 2009. Logistic regressions and Cox Proportional Hazard Models were used in the analysis.
Results: The initial 60 days of prescriptions for psychotropic medications were significantly associated with a final claim cost at least $100,000. Odds ratios were 1.88 for short-acting opioids, 2.14 for hypnotics, antianxiety agents, or antidepressants, and 3.91 for long-acting opioids, respectively. Significant associations were also found between decreased time lost from work and decreased claim closures during the study period.
Conclusions: Early prescription of opioids and other psychotropic drugs may be useful predictors of high claim costs and time lost from work.
Source: Tao, Xuguang (Grant), Lavin, Robert A.; Yuspeh, Larry; Weaver, Virginia M.; Bernacki, Edward J. Journal of Occupational & Environmental Medicine: December 2015, Volume 57, Issue 12, p. 1315-1318.
Objectives: The primary aim was to study whether high levels of multiple symptoms influenced sick-listed individuals' employment status or desire to return to work (RTW) and whether this was associated with social relations at work.
Study design: A cross-sectional study nested in a clinical trial.
Methods: In 2011–2012, 736 (34%) of 2172 sick-listed individuals completed a posted questionnaire and were included. Main outcome was self-reported employment status. The Symptom Check List (SCL-SOM)'s sum score (0–48) was categorized in high (>18) and low (≤18) levels. Previous employment, sick-listing, and use of health care were register-data. Multivariate logistic regression analyses with adjustments were performed.
Results: Beneficiarie with high SCL-SOM score (n = 218, 33%) reported poorer health, job satisfaction, a lower desire to RTW and more problems with supervisors. The risk of being unemployed was higher for this group than for those with a low score. Adjusting for general health reduced the association between symptoms and unemployment, whereas problems with social relations only affected it marginally.
Conclusions: Sick-listed individuals reporting high levels of symptoms were more often unemployed and less frequently desired to RTW than those with few symptoms. The association could not be explained by problems with social relations at work.
Source: Momsen AH, Nielsen CV, Nielsen MB, et al. Public Health, 2015.
Les travailleurs et les autres acteurs qui prennent des décisions en matière d'interventions de retour au travail ont souvent des intérêts et des buts différents. Le processus de prise de décision partagée (PDP) est une approche centrée sur la personne qui permet d'agir sur les écarts entre les travailleurs et les autres acteurs par rapport au but et au plan d'action à mettre de l'avant. À notre connaissance, un programme de PDP n'avait jamais été spécifiquement contextualisé en réadaptation au travail.
Different approaches to disability prevention, including work modifications, work schedule redesign and national legislative changes were the topics at the Disability prevention seminar, held in Helsinki, Finland, by the Finnish Institute of Occupational Health (FIOH) on November 26.
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