2009-09-01 12:00 - Messages

Index international et dictionnaire de la réadaptation et de l'intégration sociale (IIDRIS)

L'Index international et dictionnaire de la réadaptation et de l'intégration sociale vise à fournir au domaine scientifique de la réadaptation son premier index international multilingue et son premier dictionnaire trilingue. Le tout sera réalisé par le Laboratoire d'informatique et de terminologie de la réadaptation et de l'intégration sociale (LITRIS) de l'Institut de réadaptation en déficience physique de Québec (IRDPQ), le Laboratoire d'informatique médicale (L.I.M.) de la Faculté de médecine de l'Université de Rennes-1 et une équipe multidisciplinaire nationale et internationale répartie en divers comités. Il s'agit d'une refonte du Dictionnaire de la réadaptation (2 000 entrées) et du Service international scientifique de réadaptation et de l'intégration sociale (SISRAI-4 000 entrées) qui ont été élaborés au LITRIS. L'IIDRIS a plus de 18 000 entrées, plus de 6 000 en français, anglais et espagnol; il représente la base de la description de notre domaine, de même que la base d'un système d'information complet pour la réadaptation avec un accès universel sur l'autoroute de l'information. Ce projet est essentiel pour la recherche, pour le travail en équipe multidisciplinaire, pour l'éducation et pour l'objectivation de la connaissance scientifique en réadaptation, de même que pour les personnes qui forment la clientèle de la réadaptation.

Source: http://www.med.univ-rennes1.fr/iidris/

Work stress and work ability: cross-sectional findings from the German sociomedical panel of employees

Maintenance of work ability and restoration of reduced work ability by prevention and rehabilitation are major aims of disability management. To achieve these aims, decision-makers and health care providers need evidence of the determinants of restricted work ability. The aim of this article was to analyse the cross-sectional association between work stress and work ability in a population drawn from a random sample of employees. A total of 1463 working men and women aged 30-59 years from the baseline survey of the German SPE were included in the analyses. Work stress was defined in terms of the demand-control model and the effort-reward (ER) imbalance model. Work ability was assessed by the Work Ability Index (WAI). We used multiple imputations to account for missing data and calculated logistic regression models to estimate associations between the two work stress models and restrictions of work ability. Approximately one third (32.0%) of the respondents reported restrictions of work ability (WAI <37) indicating a need of interventions to improve and to restore work ability. High job strain was experienced by about one third (34.2%) of the participants and 12.7% of the respondents reported an ER ratio > 1 indicating an ER imbalance. Restrictions of work ability were explained independently by high job strain due to high demand and low control (OR = 4.66; 95% CI = [2.93, 7.42]) and by effort-reward imbalance (OR = 2.88; 95% CI = [1.95, 4.25]). Work stress is associated with restrictions of work ability, but longitudinal analyses are required to confirm a causal relation.

Source: http://www.informaworld.com/smpp/content~content=a911800092~db=all~jumptype=rss

Coping with chronic pain: Current advances and practical information for clinicians
Transferring knowledge and evidence from the pain psychology literature to all types of practitioners is one small but important step towards reducing the economic and personal cost of injuries. Through early identi?cation of at-risk clients, it may be possible to prevent chronic pain from developing. Pain is a perception which is affected by physical, psychological and social factors, yet many health care professionals are only beginning to consider the relative contributions of each of these elements. It is essential that clinicians understanding how a client's pain coping strategies impact progress and functional outcomes. For clients endorsing maladaptive methods of coping, one step is to refer the client to a psychologist; however, understanding of key underlying principles can also inform any type of treatment. All care providers involved with the client should discourage maladaptive strategies where appropriate and encouraging adaptive ones. Of equal importance is knowing whether or not the client is ready to adapt to change. Clinician knowledge of coping strategies and readiness may also help reduce the likelihood of clients withdrawing from treatment in frustration. The end result will hopefully be less disability and improved functioning of clients experiencing chronic pain.

Source: http://iospress.metapress.com/content/e57442j525223t78/

Older workers: An exploration of the benefits, barriers and adaptations for older people in the workforce

 The continuation of older people in the paid workforce is regarded as beneficial for both the economy and older workers. While there have been attempts to encourage older people to continue working, little is understood about older workers' perspectives. This qualitative study explored the lived experiences and perceptions of paid workers aged 60 years and older with the aim of understanding why older people continue to work and the barriers and facilitators they encounter. Sixteen older Australians (eight males and eight females, mean age 67 years) who participated in paid employment for at least 12 hours per month were interviewed. Thematic analysis elicited themes of benefits of work, problems encountered at work and the ways in which older people respond to these challenges. Financial considerations, the desire to contribute and the absence of competing interests were reasons given for continuing involvement in work. Older workers identified stress, lack of support, physical demands and overemphasis on qualifications as barriers to their participation. Maintaining a healthy lifestyle, having a passion for work, and education were factors that participants identified as supporting continued work. These findings enhance the understanding of the experiences of older workers and may have implications for encouraging workforce participation of older people.

Source: http://iospress.metapress.com/content/925k2346g4675x05/

Predicting Return to Work in Employees Sick-Listed Due to Minor Mental Disorders

Objective To investigate which factors predict return to work (RTW) after 3 and 6 months in employees sick-listed due to minor mental disorders. Methods Seventy GPs recruited 194 subjects at the start of sick leave due to minor mental disorders. At baseline (T0), 3 and 6 months later (T1 and T2, respectively), subjects received a questionnaire and were interviewed by telephone. Using multivariate logistic regression analyses, we developed three prediction models to predict RTW at T1 and T2. Results The RTW rates were 38% after 3 months (T1) and 61% after 6 months (T2). The main negative predictors of RTW at T1 were: (a) a duration of the problems of more than 3 months before sick leave; and (b) somatisation. The main negative predictors of RTW at T2 were: (a) a duration of the problems of more than 3 months before sick leave; (b) more than 3 weeks of sick leave before inclusion in the study; and (c) anxiety. The main negative predictors of RTW at T2 for those who had not resumed work at T1 were: (a) more than 3 weeks of sick leave before inclusion in the study; and (b) depression at T1. The predictive power of the models was moderate with AUC-values between 0.695 and 0.763. Conclusions The main predictors of RTW were associated with the severity of the problems. A long duration of the problems before the occurrence of sick leave and a long duration of sick leave before seeking help predict a relatively small probability to RTW within 3–6 months. High baseline somatisation and anxiety, and high depression after 3 months make the prospect even worse. Since these predictors are readily assessable with just a few questions and a symptom questionnaire, this opens the opportunity to select high-risk employees for a targeted intervention to prevent long-term absenteeism.

Source: http://www.springerlink.com/content/r1017k61w7562272/

Can Cross Country Differences in Return-to-Work After Chronic Occupational Back Pain be Explained? An Exploratory Analysis on Disability Policies in a Six Country Cohort Study

Introduction There are substantial differences in the number of disability benefits for occupational low back pain (LBP) among countries. There are also large cross country differences in disability policies. According to the Organization for Economic Cooperation and Development (OECD) there are two principal policy approaches: countries which have an emphasis on a compensation policy approach or countries with an emphasis on an reintegration policy approach. The International Social Security Association initiated this study to explain differences in return-to-work (RTW) among claimants with long term sick leave due to LBP between countries with a special focus on the effect of different disability policies. Methods A multinational cohort of 2,825 compensation claimants off work for 3–4 months due to LBP was recruited in Denmark, Germany, Israel, the Netherlands, Sweden, and the United States. Relevant predictors and interventions were measured at 3 months, one and 2 years after the start of sick leave. The main outcome measure was duration until sustainable RTW (i.e. working after 2 years). Multivariate analyses were conducted to explain differences in sustainable RTW between countries and to explore the effect of different disability policies. Results Medical and work interventions varied considerably between countries. Sustainable RTW ranged from 22% in the German cohort up to 62% in the Dutch cohort after 2 years of follow-up. Work interventions and job characteristics contributed most to these differences. Patient health, medical interventions and patient characteristics were less important. In addition, cross-country differences in eligibility criteria for entitlement to long-term and/or partial disability benefits contributed to the observed differences in sustainable RTW rates: less strict criteria are more effective. The model including various compensation policy variables explained 48% of the variance. Conclusions Large cross-country differences in sustainable RTW after chronic LBP are mainly explained by cross-country differences in applied work interventions. Differences in eligibility criteria for long term disability benefits contributed also to the differences in RTW. This study supports OECD policy recommendations: Individual packages of work interventions and flexible (partial) disability benefits adapted to the individual needs and capacities are important for preventing work disability due to LBP.

Source: http://www.springerlink.com/content/h2nh3624700013p8/

Keywords  Compensation policy - Disability policy - Back pain - Medical intervention - Work intervention - Multinational cohort

Evaluation of the effectiveness and efficacy of iyengar yoga therapy on chronic low back pain

STUDY DESIGN: The effectiveness and efficacy of Iyengar yoga for chronic low back pain (CLBP) were assessed with intention-to-treat and per-protocol analysis. Ninety subjects were randomized to a yoga (n = 43) or control group (n = 47) receiving standard medical care. Participants were followed 6 months after completion of the intervention. OBJECTIVE: This study aimed to evaluate Iyengar yoga therapy on chronic low back pain. Yoga subjects were hypothesized to report greater reductions in functional disability, pain intensity, depression, and pain medication usage than controls. SUMMARY OF BACKGROUND DATA: CLBP is a musculoskeletal disorder with public health and economic impact. Pilot studies of yoga and back pain have reported significant changes in clinically important outcomes. METHODS: Subjects were recruited through self-referral and health professional referrals according to explicit inclusion/exclusion criteria. Yoga subjects participated in 24 weeks of biweekly yoga classes designed for CLBP. Outcomes were assessed at 12 (midway), 24 (immediately after), and 48 weeks (6-month follow-up) after the start of the intervention using the Oswestry Disability Questionnaire, a Visual Analog Scale, the Beck Depression Inventory, and a pain medication-usage questionnaire. RESULTS: Using intention-to-treat analysis with repeated measures ANOVA (group x time), significantly greater reductions in functional disability and pain intensity were observed in the yoga group when compared to the control group at 24 weeks. A significantly greater proportion of yoga subjects also reported clinical improvements at both 12 and 24 weeks. In addition, depression was significantly lower in yoga subjects. Furthermore, while a reduction in pain medication occurred, this was comparable in both groups. When results were analyzed using per-protocol analysis, improvements were observed for all outcomes in the yoga group, including agreater trend for reduced pain medication usage. Although slightly less than at 24 weeks, the yoga group had statistically significant reductions in functional disability, pain intensity, and depression compared to standard medical care 6-months postintervention. CONCLUSION: Yoga improves functional disability, pain intensity, and depression in adults with CLBP. There was also a clinically important trend for the yoga group to reduce their pain medication usage compared to the control group.

Source: http://www.ncbi.nlm.nih.gov/pubmed/19701112?ordinalpos=9&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum

The Influence of Employer Support on Employee Management of Chronic Health Conditions at Work

Introduction This study examined the relationship between employer support, self-efficacy and self-management of chronic illness at work. Method 772 employees reporting musculoskeletal pain (n = 230), arthritis and rheumatism (n = 132), asthma (n = 129), depression and anxiety (n = 121), heart disease (n = 80) and diabetes (n = 80) completed a questionnaire distributed across four large organizations. A modified version of the Self-Efficacy to Manage Symptoms Scale and the Self-Management Behaviors Scale were used. Support from line manager and occupational health were assessed. Results Structural equation modelling analyses revealed that line managers support was directly related to employees' self-management of symptoms and medication at work. All three self-efficacy measures (beliefs about the ability to make adjustments, take medication and manage symptoms at work) partially mediated the relationship between line manager support and the use of medication at work. Self-efficacy beliefs in taking medication and making work adjustments also partially mediated the relationship between line manager support and self-management of symptoms at work. In contrast, there were no direct relationship between occupational health support and two self-management behaviors. Self-efficacy beliefs about making adjustments at work fully mediated the relationship between support from occupational health and self-management behaviors. Conclusions Employer support in developing both symptom-related and work-related self-efficacy for medication adherence and symptom management is important for those working with a chronic illness.

Source: http://www.springerlink.com/content/d74m216675p347ku/

Patients' views on responsibility for the management of musculoskeletal disorders - A qualitative study

Musculoskeletal disorders are very common and almost inevitable in an individual's lifetime. Enabling self-management and allowing the individual to take responsibility for care is stated as desired in the management of these disorders, but this may be asking more than people can generally manage. A willingness among people to take responsibility for musculoskeletal disorders and not place responsibility out of their hands or on employers but to be shared with medical professionals has been shown. The aim of the present study was to describe how people with musculoskeletal disorders think and reason regarding responsibility for prevention, treatment and management of the disorder. Individual interviews with a strategic sample of 20 individuals with musculoskeletal disorders were performed. The interviews were tape-recorded, transcribed verbatim and analysed according to qualitative content analysis. From the interviews an overarching theme was identified: own responsibility needs to be met. The analysis revealed six interrelated categories: Taking on responsibility, Ambiguity about responsibility, Collaborating responsibility, Complying with recommendations, Disclaiming responsibility, and Responsibility irrelevant. These categories described different thoughts and reasoning regarding the responsibility for managing musculoskeletal disorders. Generally the responsibility for prevention of musculoskeletal disorders was described to lie primarily on society/authorities as they have knowledge of what to prevent and how to prevent it. When musculoskeletal disorders have occurred, health care should provide fast accessibility, diagnosis, prognosis and support for recovery. For long-term management, the individuals described themselves to be responsible for making the most out of life despite disorders. No matter what the expressions of responsibility for musculoskeletal disorders are, own responsibility needs to be met by society, health care, employers and family in an appropriate way, with as much or as little of the "right type" of support needed, based on the individual's expectations.

Source: http://www.biomedcentral.com/1471-2474/10/103/abstract

Reducing MSD hazards in the workplace: A guide to successful participatory ergonomics programs

In participatory ergonomics (PE) programs, workers, supervisors and other workplace parties jointly identify and address work-related hazards. PE can help reduce low-back injuries and other musculoskeletal disorders (MSDs), resulting in fewer workers' compensation claims and lost days from work. This booklet, based on a systematic review by IWH researchers, outlines six key steps that have been shown to contribute to the success of a PE program.

Source: http://www.iwh.on.ca/pe-guide

Occupational burnout as a predictor of disability pension: a population-based cohort study

Objectives: The aim of this study was to investigate whether burnout predicts new disability pension at population level during a follow-up of approximately 4 years. The diagnosis for which the disability pension was granted was also examined in relation to the level of burnout. Methods: We used a population-based cohort sample (n = 3125) of 30–60-year-old employees from an epidemiological health study, the Health 2000 Study, gathered during 2000–2001 in Finland. The data collection comprised an interview, a clinical health examination including a standardised mental health interview, and a questionnaire including the Maslach Burnout Inventory-General Survey. Disability pensions and their causes until December 2004 were extracted from national pension records. The association between burnout and new disability pension was analysed with logistic regression models adjusted for sociodemographic factors and health at baseline. Results: Altogether 113 persons were granted a new disability pension during the follow-up: 22% of those with severe burnout, 6% of those with mild burnout, and 2% of those with no burnout at baseline. After sociodemographic factors and health were adjusted for, each one-point increase in the overall burnout sum score was related to 49% increase in the odds for a future disability pension. A disability pension was most often granted on the basis of mental and behavioural disorders and diseases of the musculoskeletal system among those with burnout. After adjustments, exhaustion dimension among men and cynicism dimension among a combined group of men and women predicted new disability pensions. Conclusion: Burnout predicts permanent work disability and could therefore be used as a risk marker of chronic health-related work stress. To prevent early exit from work life, working conditions and employee burnout should be regularly assessed with the help of occupational health services.

Source: http://oem.bmj.com/cgi/content/abstract/66/5/284

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