2009-12-01 12:00 - Messages

Can workers with chronic back pain shift from pain elimination to function restore at work?

Workers with chronic low back pain (LBP) mean a heavy human and social-economic burden. Their medical histories often include different treatments without attention to work-relatedness or communication with occupational health providers, leaving them passive and medicalized in (outpatient) health care. So we developed and implemented an innovative, patient-activating alternative: the multidisciplinary outpatient care (MOC) programme, including work(place) intervention and graded activity. It aims at function restore (instead of pain elimination), return to work (RTW) and coordinated communication. Objectives: To qualitatively explore how patients and health care providers perceive the programme effectiveness and which factors influence its implementation. Methods: In-depth, semi structured interview with patients and focus groups of health care providers are used, all recorded, transformed into verbatim transcript and analysed. Results: This qualitative study shows that although patients' expectations were low at the start of the program, and despite long LBP histories, including many different therapies, (primarily) directed at pain reduction, the MOC programme was successful in changing patients' goal setting from pain oriented towards function restore and RTW. The programme was therefore perceived as applicable and effective. Patient compliance was influenced by barriers – despair, supervisory and subordinate resistance at work, waiting period, medicalisation in health care – and facilitators: disciplinary motivation, protocolled communication, information supply, tailor-made exercises. For some patients the barriers were too high. Several improvement suggestions were given. Conclusions: This qualitative study shows that generally, patients and professionals perceived the multidisciplinary outpatient care programme as applicable and effective. After incorporating improvement suggestions this program seems promising for further, broader application and hypothesis testing. For those, negatively evaluating the programme, alternatives should be explored.

Source: http://iospress.metapress.com/content/864116871upu25q5/?p=f6b02b04b60b4ffab46419ac0c818d66&pi=1

'We got the whole story all at once': physiotherapists' use of key questions when meeting patients with long-standing pain

Long-standing musculoskeletal pain has many dimensions. Physiotherapy lacks a tested method of dialogue with which physiotherapists and patients can together explore pain in all its complexity. The present aim was to find out how physiotherapists experienced the influence of systematically prepared key questioning on their relation to, and understanding of, patients with long-standing pain. A group of six physiotherapists with long experience of pain rehabilitation used such questions in their encounters with their patients. Two periods of work with the questions were followed by discussions in which the physiotherapists shared their experience in a joint focus group. Verbatim transcripts of the discussions constitute the data of the study. A phenomenographic method was used for the analysis. The responses to the key questions gave the physiotherapists an insight into the patient as a person. The questions started a process of change in the patient, and changed the physiotherapist's relation to her or him. The patient expressed feelings and experience, and this also seemed to encourage a change in chosen coping strategies. This new content of the interaction challenged the physiotherapist's role, thus raising questions about her professional mandate.

Source: http://www3.interscience.wiley.com/journal/120173941/issue?CRETRY=1&SRETRY=0

Employment and return to work in head and neck cancer survivors

To investigate employment in working-age head and neck cancer (HNC) survivors before and after treatment in relation to sociodemographic and clinical factors, health related quality of life, and emotional distress. Patients younger than 65years at time of diagnosis and at least 2years after curative treatment for HNC were included. Exclusion criteria were cognitive dysfunction and no understanding of Dutch language. Primary outcome measures were employment status and return to work assessed by a study specific questionnaire. Secondary outcome measures were health related quality of life (EORTC QLQ-C30 and QLQ-H&N35) and emotional distress (Hospital Anxiety and Depression Scale (HADS)). Sociodemographic and disease and treatment related parameters, health related quality of life, and distress were compared to employment status. Eighty-five out of 113 included patients completed the questionnaires (response rate 75%). At time of diagnosis 32 patients were not working (38%), significantly associated with (higher) age and (lower) education level. Of the 53 patients who were employed at time of diagnosis, 44 patients returned to work (83%): 28 to the same work, 7 to adapted work and 9 to other work. Median time was 6months to return to work (range 0-24months) and 71% of the patient returned to work within 6months after treatment. Anxiety and oral dysfunction as xerostomia, trismus, sticky saliva, problems with teeth, and loss of appetite, problems with social eating and social contacts were significantly associated with employment after treatment. The majority of employed HNC survivors return to work within 6months after treatment. Oral dysfunction, loss of appetite, deteriorated social functioning, and high levels of anxiety are barriers for HNC survivors to return to work after treatment.

Source: http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6TB6-4XWMGVC-3&_user=4494765&_coverDate=12%2F09%2F2009&_rdoc=4&_fmt=high&_orig=browse&_srch=doc-info(%23toc%235134%239999%23999999999%2399999%23FLA%23display%23Articles)&_cdi=5134&_sort=d&_docanchor=&_ct=16&_acct=C000063264&_version=1&_urlVersion=0&_userid=4494765&md5=6b72b5c429149706a2ec42455436b3b0

Does graded return-to-work improve sick-listed workers' chance of returning to regular working hours?

Using Danish register and survey data, we examine the effect of a national graded return-to-work program on the probability of sick-listed workers returning to regular working hours. During program participation, the sick-listed worker works fewer hours and receives the normal hourly wage for the hours worked and sickness benefit for the hours off work. When the worker's health improves, working hours are increased until the sick-listed worker is able to work regular hours. Taking account of unobserved differences between program participants and non-participants, we find that participation in the program significantly increases the probability of returning to regular working hours.

Source: http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6V8K-4XR5MY1-1&_user=4494765&_coverDate=11%2F18%2F2009&_rdoc=11&_fmt=high&_orig=browse&_srch=doc-info(%23toc%235873%239999%23999999999%2399999%23FLA%23display%23Articles)&_cdi=5873&_sort=d&_docanchor=&_ct=21&_acct=C000063264&_version=1&_urlVersion=0&_userid=4494765&md5=33aa52e2eec6b8176d75819112a58005

The role of communication and support in return to work following cancer-related absence

Many cancer survivors experience difficulties returning to work. However, there have been relatively few attempts to understand why problems with employer support and work adjustment occur. This paper aims to extend previous work in two ways: first, through exploring the way in which communication and support at work effect cancer survivors on their return to work and during the post-return period; and second, by drawing on a research sample working in the United Kingdom. Methods: In all, 26 cancer survivors took part in a semi-structured telephone interview. Interviews were transcribed and analysed using thematic analysis. Results: The analysis revealed three key findings. First, the central role of communication and support from (and between) occupational health, line managers, and colleagues was highlighted. Second, two discrete processes or periods of return to work were identified: the experience of return to work during the initial period of return and the experiences of post-return to work. Third, during the post-return period, the importance of the delayed impact of cancer on the ability to work, the lack of follow-up and monitoring, and the wear-off effect of empathy and support were highlighted as contributing to return-to-work difficulties. Conclusions: This qualitative study highlights the importance of communication within the workplace with regard to the return-to-work process and the need to provide better support and guidance to cancer survivors, line managers and colleagues. Research is required in delineating how employers without occupational health or human resources support manage the return-to-work process.

Source: http://www3.interscience.wiley.com/journal/123212376/abstract

Many cancer survivors experience difficulties returning to work. However, there have been relatively few attempts to understand why problems with employer support and work adjustment occur. This paper aims to extend previous work in two ways: first, through exploring the way in which communication and support at work effect cancer survivors on their return to work and during the post-return period; and second, by drawing on a research sample working in the United Kingdom.
Methods: In all, 26 cancer survivors took part in a semi-structured telephone interview. Interviews were transcribed and analysed using thematic analysis.
Results: The analysis revealed three key findings. First, the central role of communication and support from (and between) occupational health, line managers, and colleagues was highlighted. Second, two discrete processes or periods of return to work were identified: the experience of return to work during the initial period of return and the experiences of post-return to work. Third, during the post-return period, the importance of the delayed impact of cancer on the ability to work, the lack of follow-up and monitoring, and the wear-off effect of empathy and support were highlighted as contributing to return-to-work difficulties.
Conclusions: This qualitative study highlights the importance of communication within the workplace with regard to the return-to-work process and the need to provide better support and guidance to cancer survivors, line managers and colleagues. Research is required in delineating how employers without occupational health or human resources support manage the return-to-work process.
Many cancer survivors experience difficulties returning to work. However, there have been relatively few attempts to understand why problems with employer support and work adjustment occur. This paper aims to extend previous work in two ways: first, through exploring the way in which communication and support at work effect cancer survivors on their return to work and during the post-return period; and second, by drawing on a research sample working in the United Kingdom.
Methods: In all, 26 cancer survivors took part in a semi-structured telephone interview. Interviews were transcribed and analysed using thematic analysis.
Results: The analysis revealed three key findings. First, the central role of communication and support from (and between) occupational health, line managers, and colleagues was highlighted. Second, two discrete processes or periods of return to work were identified: the experience of return to work during the initial period of return and the experiences of post-return to work. Third, during the post-return period, the importance of the delayed impact of cancer on the ability to work, the lack of follow-up and monitoring, and the wear-off effect of empathy and support were highlighted as contributing to return-to-work difficulties.
Conclusions: This qualitative study highlights the importance of communication within the workplace with regard to the return-to-work process and the need to provide better support and guidance to cancer survivors, line managers and colleagues. Research is required in delineating how employers without occupational health or human resources support manage the return-to-work process.
Many cancer survivors experience difficulties returning to work. However, there have been relatively few attempts to understand why problems with employer support and work adjustment occur. This paper aims to extend previous work in two ways: first, through exploring the way in which communication and support at work effect cancer survivors on their return to work and during the post-return period; and second, by drawing on a research sample working in the United Kingdom.
Methods: In all, 26 cancer survivors took part in a semi-structured telephone interview. Interviews were transcribed and analysed using thematic analysis.
Results: The analysis revealed three key findings. First, the central role of communication and support from (and between) occupational health, line managers, and colleagues was highlighted. Second, two discrete processes or periods of return to work were identified: the experience of return to work during the initial period of return and the experiences of post-return to work. Third, during the post-return period, the importance of the delayed impact of cancer on the ability to work, the lack of follow-up and monitoring, and the wear-off effect of empathy and support were highlighted as contributing to return-to-work difficulties.
Conclusions: This qualitative study highlights the importance of communication within the workplace with regard to the return-to-work process and the need to provide better support and guidance to cancer survivors, line managers and colleagues. Research is required in delineating how employers without occupational health or human resources support manage the return-to-work process.
Objective: Many cancer survivors experience difficulties returning to work. However, there have been relatively few attempts to understand why problems with employer support and work adjustment occur. This paper aims to extend previous work in two ways: first, through exploring the way in which communication and support at work effect cancer survivors on their return to work and during the post-return period; and second, by drawing on a research sample working in the United Kingdom.
Methods: In all, 26 cancer survivors took part in a semi-structured telephone interview. Interviews were transcribed and analysed using thematic analysis.
Results: The analysis revealed three key findings. First, the central role of communication and support from (and between) occupational health, line managers, and colleagues was highlighted. Second, two discrete processes or periods of return to work were identified: the experience of return to work during the initial period of return and the experiences of post-return to work. Third, during the post-return period, the importance of the delayed impact of cancer on the ability to work, the lack of follow-up and monitoring, and the wear-off effect of empathy and support were highlighted as contributing to return-to-work difficulties.
Conclusions: This qualitative study highlights the importance of communication within the workplace with regard to the return-to-work process and the need to provide better support and guidance to cancer survivors, line managers and colleagues. Research is required in delineating how employers without occupational health or human resources support manage the return-to-work process. Copyright © 2009 John Wiley & Sons, Ltd.
Effectiveness of a Targeted Occupational Health Intervention in Workers with High Risk of Sickness Absence: Baseline Characteristics and Adherence as Effect Modifying Factors in a Randomized Controlled Trial

In a recently published randomized controlled trial (RCT), a targeted occupational health (OH) intervention was found effective in an intention-to-treat analysis in controlling sickness absence among workers with high risk of sickness absence, compared to usual care. We performed an exploratory subgroup analysis in order to detect possible effect modifiers and mediators. Methods Age, gender, working status, severity of physical impairment, depression score, self-rated working ability, co-morbidity, and sickness absence characteristics in the previous 12 months were identified as potential effect modifiers (n = 382). We conducted regression analyses with the potential effect modifiers and a mediator (treatment attendance as intended) as explanatory variables. The difference of sickness absence days during the previous year and the follow-up year was the dependent variable. Results The intervention was especially effective in the subgroups of workers who were certain that they will not be able to continue working in their current job due to health-related reasons (−74 days; 95% CI −105 to −43), had co-morbidities (−22.5 days; 95% CI −35.5 to −9.5), or severe physical impairment at work (−17.5 days; 95% CI −28.5 to −6.5). A modifying effect of age, gender, working status, depressive symptoms, or prior sickness absence on the effectiveness of this OH intervention was not found. Conclusions This targeted OH intervention seems especially suitable for workers who consider that they are no longer able to continue working due to health reasons and have high level of physical impairment or co-morbidities. The findings from these exploratory analyses should be tested in future RCTs.

Source: http://www.springerlink.com/content/h50545747141l715/

Health Psychology: A Cultural Approach

Although employee wellness programs have materialized as an important workplace strategy to optimize employee health and productivity during the last decade, the success of these programs have been dependent on a number of variables. Many programs have placed increasing emphasis on employee emotional well being. As a result health psychology has become an essential component of most corporate wellness programs because it speaks to the potential impact of thought, behavior, and emotions on employee health, illness, and productivity. Cultural diversity is another factor influencing the outcomes of worksite wellness programs. Given the potential impact of health psychology and cultural diversity on the outcomes of employee health and wellness programs in industry today, the publication of Health Psychology: A Cultural Approach, 2nd Edition could not have been more timely. The author's goals for this second edition were to study health and illness from a psychological and cultural perspective and to introduce concepts and practices pertinent to the field of health psychology. (...) The author emphasized the importance and potential impact of an individual's culture, i.e. ethnicity, race, age, gender, religion, and family, on health and illness behavior. It is likely that application of the more comprehensive biopsychocultural model rather than more circumscribed biopsyhcosocial model of health will yield better outcomes and greater returns on investment as it relates to employee health and wellness programs.

Source: http://www.springerlink.com/content/p352440263356216/fulltext.pdf

Patients' experience of groups in outpatient mental health services and its significance for daily occupations

The prevalence of mental health problems such as depression and anxiety in the Swedish population is increasing and individuals' daily occupations are seriously affected. Occupational therapy groups have long been used in mental health services. Now, with the increase in the number of outpatients and the current principle of patients' participation there is a need for further knowledge of this group of patients' perspective on the method. The aim of this study was thus to explore how outpatients in mental health services experience treatment in occupational therapy groups and what significance the treatment has for daily occupations. The focus group method was used. Four groups, with a total of 14 participants, were formed and met on one occasion. A number of factors for positive change in occupational therapy groups were found, i.e. “timing”, “belonging”, “involvement”, “challenge”, “meaningful occupation”, and “balanced focus on disease”. The participants' active use of the treatment and the transfer of experiences and knowledge from treatment to daily life were important for success. The abilities “to manage” and “to dare” developed in occupational therapy groups helped participants in the process of making changes in daily occupations. The findings show how a traditional method in occupational therapy in mental health services can be used to meet current needs and principles.

Source: http://informahealthcare.com/doi/abs/10.1080/11038120802512433

Perceptions of illness and their impact on sickness absence

A patient's perception of their illness can influence their coping ability, compliance with treatment and functional recovery. Psychological interventions to address negative beliefs may facilitate an earlier return to work. Aims To compare perceptions of illness, fitness to return to work and time to return to work among employees with those of their occupational physicians (OPs). Methods A cross-sectional study of employees off sick for >2 weeks, with the return to work date ascertained at 3 months. Employees and their OPs completed similar questionnaires that included the Brief Illness Perception Questionnaire. Results Of total, 84 employees (76% response rate) and nine OPs participated. Employees reported a greater impact on their life (P < 0.01), a longer duration of illness (P < 0.01), more symptoms (P < 0.01), more concern about their illness (P < 0.01), more emotional impact of their illness (P < 0.01) and that their illness was more serious (P < 0.01) than did the OPs. They attributed their illness to work more often than their OPs (P < 0.05) and predicted more accurately when they would be fit to return to work (P < 0.01). Employees who returned to work believed that their illness was shorter lasting (P < 0.01), more treatable (P < 0.01), more controllable (P < 0.05), less serious (P < 0.01), had less emotional impact (P < 0.01), perceived fewer symptoms (P < 0.05) and had less concern (P < 0.05) than those who failed to return to work. Conclusions Employees had more negative perceptions about their illness than OPs. Positive perceptions were associated with an earlier return to work. Unhelpful negative beliefs about illness need to be addressed by OPs.

Source: http://occmed.oxfordjournals.org/cgi/content/abstract/59/8/550

Understanding how traumatic re-enactment impacts the workplace: Assisting clients' successful return to work

This research explores the observation that people who have had traumatic life experiences may connect with work in an unhealthy way, impacting their ability to return to work successfully. Purpose: This research aims to understand how past traumatic experiences influence career choice and workplace behaviour and, given this understanding, consider how occupational therapists can facilitate change towards a successful return to work. Methods: Semi-structured interviews were used to gather information from twenty-five clients experiencing depression, anxiety or post-traumatic stress disorder. Clients were followed for six months following their planned return to work date. Findings: Participants identified re-enacting unhealthy past experiences at work through: focusing on the needs of others, seeking acceptance and avoidance. Healthy change was created through engaging in coping strategies and partnering with the occupational therapist and workplace stakeholders on return to work planning. Implications: To facilitate a successful return to work, clients must become aware of how their traumatic histories play a role in their current career choices and workplace behavior. With this awareness, occupational therapists and clients may work together towards creating healthy change in the present.

Source: http://iospress.metapress.com/content/k6754q8m25615748/

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