2009-05-01 12:00 - Messages
Demand for rehabilitation services is expected to increase due to factors such as an aging population, workforce pressures, rise in chronic and complex multi-system disorders, advances in technology, and changes in interprofessional health service delivery models. However,health human resource (HHR) strategies for Canadian rehabilitation professionals are lagging behind other professional groups such as physicians and nurses. The objectives of this study were: 1) to identify recruitment and retention strategies of rehabilitation professionals including occupational therapists, physical therapists and speech language pathologists from the literature; and 2) to investigate both the importance and feasibility of the identified strategies using expert panels amongst HHR and education experts. Methods: A review of the literature was conducted to identify recruitment and retention strategies for rehabilitation professionals. Two expert panels, one on Recruitment and Retention and the other on Education were convened to determine the importance and feasibility of the identified strategies. A modified-delphi process was used to gain consensus and to rate the identified strategies along these two dimensions. Results: A total of 34 strategies were identified by the Recruitment and Retention and Education expert panels as being important and feasible for the development of a HHR plan for recruitment and retention of rehabilitation professionals. Seven were categorized under the Quality of Worklife and Work Environment theme, another seven in Financial Incentives and Marketing, two in Workload and Skill Mix, thirteen in Professional Development and five in Education and Training. Based on the results from the expert panels, the three major areas of focus for HHR planning in the rehabilitation sector should include strategies addressing Quality of Worklife and Work Environment
The cost effectiveness of work-oriented rehabilitation for persons on long-term sick leave needs to be assessed. This prospective observational study presents a follow-up seven years after rehabilitation using two different evidence-based work-oriented regimens. Individuals on sick leave for neck and back pain were referred to two rehabilitation programmes in Sweden. The first programme was a relatively low-intensity programme based on orthopaedic manual therapy and exercise programme (OMTP). The second programme was a full-time multidisciplinary programme (MDP). The primary outcome was sickness absence seven years after intervention. Cost effectiveness was calculated on the basis of loss of production due to sickness absence. The results show that participants referred to MDP and with less than 60 sick days before rehabilitation have reduced sickness absence after intervention as compared to matched controls. This corresponds to a cost reduction of about 94,494 EUR per referred individual. Further, the results indicate that participants of the OMTP who have more than 60 sick days before rehabilitation have a statistically significant increased risk of disability pension. This means increased cost in terms of loss of production of 44,593 EUR per referred individual. The results of this study show that MPD but not OMTP achieves the goal of working life-oriented rehabilitation. A direct comparison between the rehabilitation programmes strengthened the assumption that long-term sickness absence prior to rehabilitation is associated with more days on sick leave after rehabilitation. This analysis also indicated the importance of participants' pain self-efficacy beliefs and recovery beliefs on rehabilitation outcome.
Rehabilitation is a problem-solving process focused on activities and aiming to optimize social participation. Until recently, studies have rarely considered adverse effects arising from rehabilitation. Consideration of adverse effects is ethically necessary; one should not act in a way that may cause net harm. Several types of adverse effect exist. Societal adverse effects arise when resources are used that deliver less benefit than an alternative use of the same resource; this applies in all health care systems, albeit more apparently in those providing moreor- less universal coverage. Patient adverse effects may be transient or permanent, and may be inevitable, or arise by change, or arise predictably in a proportion of people. All are discussed in this Editorial. One significant potential adverse event is stressed: the maintenance of the patient in the sick role and, associated with this, maintenance of unattainable expectations. There is minimal evidence available concerning the actual frequency and severity of adverse events. Two recommendations arise. First, systematic recording of adverse outcomes should become routine, with the goal of improving service quality. Second, rehabilitation services should always focus on helping patients to find satisfying, sustainable activities and roles to replace the role of being a patient.
Return to work (RTW) in patients with hand disorders and hand injuries is determined by several determinants not directly related to the physical situation. Besides biomedical determinants, work-related and psychosocial determinants may influence RTW as well. This study is conducted to investigate the influence of these potential determinants on RTW in patients with hand disorders and hand injuries. Methods Included 91 patients who were operatively treated for a hand disorder or a hand injury, and who were employed prior to surgery. Patients answered several questionnaires on the aforementioned categories. Potential determinants significantly related to RTW in a univariate analysis were entered in a logistic regression for the total group and the acutely injured patients separately. Results Pain, accident location, job independence and symptoms of post-traumatic stress disorder (PTSD) were univariately associated with RTW. Pain was a determinant for late RTW in the total group and accident location and symptoms of PTSD in the acutely injured group. Conclusion Pain, accident location and symptoms of PTSD were most important in resuming work in hand injured patients or in patients with a hand disorder. These findings may indicate that attention should be paid to the treatment of pain, and to the development of symptoms of PTSD during rehabilitation. It may be necessary to make extra efforts aimed at RTW in patients who sustained their injury on the job.
Employment - Hand injuries - Hand disorders - Posttraumatic stress disorder - Pain - Accident location
Report by the Industrial Injuries Advisory Council in accordance with Section 171 of the Social Security Administration Act 1992 considering prescription for osteoarthritis of the knee in coal miners. This review considers the case for prescription for osteoarthritis of the knee in miners from wear and tear or meniscal injuries outwith accidental events. Our inquiry follows a representation from an ex-Council member highlighting research evidence of an increased risk of the disease in miners. During the course of the review, the Council undertook its own literature search, made a call for evidence, and consulted with experts in the field and representatives from the coal mining industry.
We investigate the returns to promotions and separations from firms using Portuguese linked employer-employee data. More than 90% of the total variation in wages can be explained by observed and unobserved characteristics of workers and firms. Taken together, worker and firm unobserved effects explain more than half of the variation of wages for all types of job mobility. Our results suggest that promoted workers are high wage workers in high wage firms. Movers are inherently lower wage workers, in lower wage firms. However, on average, workers that find a new job within one year enter firms that pay higher wages. This is not true for workers that take more than a year to find a new job.
To identify the risk factors for noncompletion of a functional restoration program for patients with chronic disabling occupational musculoskeletal disorders. Prospective cohort study. Consecutive patients undergoing functional restoration treatment in a regional rehabilitation referral center. A sample of 3052 consecutive patients, classified as either completers (n=2367) or noncompleters (n=685), who entered a functional restoration program. The measures used included medical evaluations, demographic data, Diagnostic and Statistical Manual of Mental Disorders psychiatric diagnoses, the Minnesota Multiphasic Personality Inventory, and validated questionnaires evaluating pain, depression, and occupational factors. The findings revealed that patients who did not complete the program had a longer duration of total disability between injury and admission to treatment (completers=20mo vs noncompleters=13mo; P<.001). Furthermore, patients who were opioid-dependent were 1.5 times more likely to drop out of rehabilitation, and patients diagnosed with a socially problematic Cluster B Personality Disorder were 1.6 times more likely to drop out. Although some risk factors associated with program noncompletion may be addressed in treatment, socially maladaptive personality disorders, long-neglected disability, and chronic opioid dependence are the major barriers to successful treatment completion. The patients identified with personality disorders may display resistance to treatment and may be difficult for the treatment staff to deal with. Early recognition of these treatment-resistant personality characteristics in the functional restoration process may assist the treatment team in developing more effective strategies to help this dysfunctional group.
This guide has been produced by the Health and Safety Authority (HSA) using guidance and expertise from the National Disability Authority (NDA). It aims to assist employers to provide a healthy and safe workplace for employees with disabilities.