2010-02-01 12:00 - Messages

A quantitative approach to measure occupational therapist–client interactions: a pilot study

Aims: The purpose of this pilot study was to assess the feasibility of a quantitative approach to study occupational therapist–client interactions. Role plays were videotaped in which 10 therapists met three client-actors. A questionnaire assessed the occupational therapists' and the patient-actors' opinion of the role-play experience. A modified version of the Roter Interaction Analysis System (RIAS), OT-RIAS, was used to analyse data. Major findings: Occupational therapists considered the role play experience to be “highly realistic” (mean score 5.4 on a 1–6 Likert scale). The actors' comfort role playing clients was also high (mean=4.0; range 1–5). Inter-coder reliability for the OT-RIAS was highly significant (r=0.919; p=0.000). The modified version of this system fits well in an occupational therapy context. Principal conclusion: The quantitative approach used in this study to explore the therapist–client relationship appears to be effective. The role plays and RIAS may be useful in research exploring correlation between the OT communication style and outcome measures such as client satisfaction or comprehension, or in order to assess and offer feedback in teaching communication skills programmes.

Source: http://informahealthcare.com/doi/abs/10.3109/11038120903147956

A Prospective Study of Return to Work Across Health Conditions: Perceived Work Attitude, Self-efficacy and Perceived Social Support

Abstract   Background The aim of the present study was to conduct subgroup-analyses in a prospective cohort of workers on long-term sickness absence to investigate whether associations between perceived work attitude, self-efficacy and perceived social support and time to RTW differ across different health conditions. Methods The study was based on a sample of 926 workers on sickness absence (6–12 weeks). The participants filled out a baseline questionnaire and were subsequently followed until the tenth month after listing sick. Perceived work attitude was measured with a Dutch language version of the Work Involvement Scale. Perceived social support was measured with a self-constructed standardized scale reflecting a person's perception of social support regarding RTW. Self-efficacy was measured with the standardised Dutch version of the General self-efficacy scale, assessing the subjects' expectations of their general capacities. The sample was divided into three subgroups: musculoskeletal health conditions, other physical health conditions and mental health conditions. Anova analyses and Cox proportional hazards regression analyses were used to identify differences in association between the three factors and the time to RTW between different subgroups. Results The associations between the perceived work attitude, self-efficacy and perceived social support and the time to RTW vary across different health condition subgroups, not only with regard to the strength of the association but also for the type of factor. In the multivariate model, hazard ratios (HRs) of 1.33 (95% CI 1.01–1.75) in the musculoskeletal subgroup, and 1.26 (95% CI 0.89–1.78) in the other physical subgroup were found in perceived work attitude. With regard to perceived social support HRs of 1.39 (95% CI 1.12–1.99) respectively 1.51 (1.05–2.17) in the same subgroups were found. Only self-efficacy remained in the multivariate model in all subgroups with HRs of 1.49 (95% CI 1.12–1.99) in the musculoskeletal subgroup, 1.53 (95% CI 1.07–2.18) in the other physical subgroup and 1.60 (1.07–2.40) in the mental subgroup. Conclusions The results of this study show that perceived work attitude, self-efficacy and perceived social support are relevant predictors with regard to the time to RTW in all types of health conditions, but that important differences are observed in type of factor and strengths of the relationships between physical and mental health conditions.

Source: http://www.springerlink.com/content/p555246qu57k2007/?p=7dfbda4d1df74456b58ffcb08313594d&pi=20

Coping self-efficacy as a mediator between catastrophizing and physical functioning: treatment target selection in an osteoarthritis sample

The purpose of this study was to assess the relative effects of coping self-efficacy and catastrophizing on physical functioning. Over a 9-month period, studying changes in self-efficacy as possible mediator between catastrophizing changes and physical functioning changes might provide evidence for the most promising treatment target. Data came from a randomized, longitudinal controlled trial comparing exercise, self-management and the two combined to treat 254 individuals with early knee osteoarthritis. A secondary analysis using a bootstrapped linear mixed-effects mediational model produced estimates of both the direct and indirect effects. Results indicated that self-efficacy partially mediated the effect between catastrophizing and physical functioning suggesting that self-efficacy was the more direct treatment target compared to catastrophizing. Treatments targeting both self-efficacy and catastrophizing may have greater impact on physical functioning compared to treatments that focus on only one.

Source: http://www.springerlink.com/content/nw36g21154186823/

Expanding the Concept of Acculturation in Mexican American Rehabilitation Psychology Research and Practice

Objective This study examined the association between return-to-work (RTW) outcomes and sociodemographic, clinical, and work characteristics among a cohort of injured workers who underwent knee surgery between 2001–2005 in British Columbia, Canada. Methods Workers’ compensation databases were used to identify the retrospective cohort and abstract the study variables. Multinomial logistic regression provided odds ratios (OR) and 95% confidence intervals (95% CI) for the association between RTW (unspecified, partial, full, or non-RTW) and the independent variables. Results Data was abstracted for 1394 injured workers. Compared to men, women were more likely to have partial RTW (OR 2.55, 95% CI 1.53–4.23) and non-RTW (OR 2.61, 95% CI 1.35–5.03) than full RTW; low income earners were more likely than high income earners to have partial RTW (OR 3.05, 95% CI 1.86–4.99) and non-RTW (OR 4.07, 95% CI 2.19–7.57). Moreover, workers in trade, primary resource, and processing/manufacturing occupations were more likely than those in management occupations to have non-RTW than full RTW by the end of follow-up (OR 2.97, 95% CI 1.32–6.68; OR 9.31, 95% CI 3.41–25.41, and OR 2.71, 95% CI 1.07–6.5, respectively). Surgical and clinical factors were not associated with RTW outcomes. Conclusions Using population-based data, our study found a link between sociodemographic and work characteristics and the type of RTW outcome following knee surgery for a work-related injury. Women and lower income earners tended not to have full RTW, after controlling for covariates. Workers in physically demanding occupations also tended not to have full RTW, suggesting that factors beyond clinical and surgical characteristics influence disability outcomes. RTW programs need to take into consideration these broader determinants of worker health.

Source: http://www.sjweh.fi/show_abstract.php?abstract_id=2901

An exploratory study of the rehabilitation process of people with stress-related disorders

The aim was to describe how former clients with stress-related disorders and rehabilitation team members experience the rehabilitation process, and to describe how experiences from the rehabilitation have been integrated into the former clients' everyday lives. A qualitative grounded theory approach was used. The sample consisted of seven team members working at a vocational rehabilitation clinic and eight former clients who were interviewed. The participants were involved in four different rehabilitation programmes, all of which used cognitive approaches. In addition, two of the programmes offered activities in a therapeutic garden. The result highlighted experiences that might have contributed to changes in the former clients' self-image, development of conscious strategies for handling stressful situations, and changes in values attached to everyday occupations. In addition, two different modes of integrating experiences from rehabilitation into the former clients' everyday lives were identified: changing approaches to handling stressful situations in everyday life and changing occupational repertoire in everyday life. Important implications might be that activities which promote relaxation and enjoyment should be included in the rehabilitation of people with stress-related disorders since experiences from these activities seemed to facilitate occupational balance in everyday life.

Source: http://informahealthcare.com/doi/abs/10.3109/11038120902956878

10 fiches action pour l'emploi des seniors

Maintien et retour en activité professionnelle des seniors
Ce guide pour l'action est composé de 10 fiches. Il permet de définir la politique de maintien en activité des seniors dans votre entreprise (fiches 1, 2 et 10). Il décrit des actions mises en oeuvre par des entreprises pour recruter et maintenir en emploi des seniors. Ces démarches s'organisent autour de trois grands leviers d'action : préserver la santé (fiches 3 et 4), développer les compétences (fiches 5, 6 et 7), et favoriser l'engagement au travail (fiches 8 et 9).

Source : http://www.priorite-seniors.fr/articles/lire/75-guide-pour-l-action-seniors.html

Employment maintenance and the factors that impact it after vocational rehabilitation and return to work

To determine post-return-to-work disability and functioning amongst occupationally injured workers and to test the extent to which demographic and other variables relate to employment maintenance. In addition, the project sought to document what workers believe determined their work continuation. Method.Semi-structured in-depth interviews were conducted to inquire about participant's (N=150) post-vocational rehabilitation return-to-work experiences. Results were interpreted using the health and health-related domains from the International Classification of Functioning, Disability and Health. Results.Although most participants were working at the time of interview, almost all were experiencing functional- or activity-based restrictions. Factors differentiating those employed from those not, were largely contextual and included relationships with supervisors, economic climate, and working conditions. Conclusions.The findings stress the importance of considering environmental strains when planning return to work and indicate ways to assist workers to achieve return-to-work success.

Source: http://informahealthcare.com/doi/abs/10.3109/09638281003611029

Factors contributing to work-ability for injured workers: literature review and comparison with available measures

Despite a range of factors being proposed in research literature to be key to ‘work-ability’, agreed definitions and boundaries of this concept are lacking. This review sought to identify and clarify key factors thought to contribute to individual work-ability, then compare these against existing measures of work-ability for people with injury. Method.A literature search was undertaken based on principles of systematic review. MEDLINE, AMED, Scopus and Web of Science databases were searched. All potentially relevant articles were obtained and, if they met inclusion criteria, evaluated for quality. The search was expanded and repeated to identify currently available measures of work-ability for people with injury. These measures were then compared against components from the first search. Results.Thirty-four articles were obtained from the first search, and 23 provided information about factors that contribute to work-ability. Six broad categories were identified: physical, psychological, cognitive, social/behavioural, workplace factors, and factors outside the workplace. The follow-up search identified 10 measures. No one measure captured all six identified categories. Conclusions.Components contributing to work-ability go beyond the ability to perform particular work tasks. Measures intended to be used to inform vocational rehabilitation arguably need to consider all these factors to maximise likelihood of a sustainable return to work.

Source: http://informahealthcare.com/doi/abs/10.3109/09638281003653302

Musculoskeletal pain and treatment choice: an exploration of illness perceptions and choices of conventional or complementary therapies

This study explored experiences of receiving treatment for musculoskeletal pain (MSKP), particularly choices of complementary and alternative medicine (CAM) and/or conventional treatment, using the illness perception dimension of Leventhal's Self-Regulatory Model as the underpinning model within the broader biopsychosocial framework of the International Classification of Functioning, Disability and Health. Method.A mixed-method study was conducted involving 17 people with MSKP. Data were collected in semi-structured interviews, using a phased approach that included the Brief Illness Perception Questionnaire and open-ended questions about experiences of managing and seeking treatment for MSKP. Questionnaire data were analysed descriptively; interview data were transcribed verbatim and analysed using the principles of Interpretative Phenomenological Analysis. Results.Analysis points to health professionals and participants as gatekeepers to treatment, with gatekeeping based on matters of power, searching for solutions, and managing day to day. The themes Role of the Gatekeeper, Swing of the Interminable Pendulum, and Solution of Soldiering On are discussed in relation to literature about health beliefs and choices of CAM or conventional treatments. Conclusions.Future research could include mixed-method designs to further explore issues of knowledge, beliefs, and control that feed into the role of gatekeepers to treatment, as well as comparing CAM choices between public and privately-funded healthcare.

Source: http://informahealthcare.com/doi/abs/10.3109/09638281003649896

Return to work: The predictive value of the Worker Role Interview (WRI) over two years

Worker Role Interview (WRI) is an assessment tool designed to identify psychosocial and environmental factors which influence a person's ability to return to work. The purpose of this study was to investigate if the Worker Role Interview (WRI) can predict return to work over a period of two years. Fifty three long-term sick-listed people were interviewed and rated with the WRI. Differences in ratings and the ability of WRI to correctly predict whether these people would fall into the working or non-working groups at 6, 12 and 24 month follow-ups were tested by Mann--Whitney test and logistic regression respectively. Eight of 17 items in WRI were rated differently between the groups at one or more of the follow-ups. The regression models based on the WRI ratings had an overall correct prediction rate ranging from 81% to 96%. 'Expectation of job success' which concerns the person's belief in abilities in relation to return to work emerged as an important predictive factor for return to work in all statistical analyses. The WRI assessment contains items that could predict return to work. This implies that the WRI could be a useful tool in vocational rehabilitation for identifying individual rehabilitation needs.

Source: http://iospress.metapress.com/content/86pnt57l51355173/?p=e5c771a26a7a482a88dad2217f2f529a&pi=6

Experiences of professionals participating in inter-organisational cooperation aimed at promoting clients' return to work

In Sweden, the activities initiated to promote return to work (RTW) are performed in parallel by four different public organisations: the health services, the social services, the employment and the social insurance authorities. The aim was to gain deeper understanding on the experiences of professionals involved in cooperative projects aimed at promoting RTW among unemployed sickness benefit recipients. Qualitative analyses were performed of transcribed data from interviews of professionals participating in cooperative projects. First, the analysis identified that the daily collaboration on the same cases enabled development of good relationships and cooperative competence, which improved the contact with clients. Second, the cooperative projects made it possible to include only clients perceived motivated for RTW measures. Third, the closer and more frequent interaction with clients proved to be constructive in that it facilitated recognition and mobilisation of strengths and abilities. Fourth, the differences in rules and regulations between the social insurance and the unemployment insurance standards were often perceived to induce problems, for example, on how to assess the work capacity of clients. The assessments of work capacity represent important and complex tasks that professionals must perform without having access to either scientific knowledge or consensus agreement on which to base their decisions.

Source: http://iospress.metapress.com/content/p04nr458x250g762/?p=c39781eeee2a4fb7925b6c2c590c06a0&pi=4

Transforming the meaning of pain: An important step for the return to work

Previous studies have found illness representations to be associated with the degree to which patients adopt health behaviours. Surprisingly, pain representations, especially those in a work rehabilitation context, have rarely been explored. Objective: To conduct a thorough investigation of the pain representations held by workers who were on sick leave due to persistent musculoskeletal pain during the process of an intensive work rehabilitation program. Methods: Qualitative semi-structured interviews were conducted with 16 participants (male, female), three times during the program and one month after discharge. Data analysis was based on a narrative approach. Results: Throughout the process, pain representation was an indicator of the type of action the participants were ready to take to control the immediate or possible consequences of their pain. Using the context of a work rehabilitation trajectory we identified the differential impact of reconstruction or status quo in pain representations that eventually led to a return to work, or not. Discussion: This study highlights the importance of identifying and acknowledging workers' pain representations in facilitating their return to work.

Source: http://iospress.metapress.com/content/k660736203p84626/?p=fa34a57e756148b8b51bbd5f2e9e1fd1&pi=11

Determinants of Return to Work After Occupational Injury

The promotion of return to work (RTW) following occupational injury benefits injured workers, their families, enterprises and the society. The identification of the potential determinants would be helpful in improving RTW rate and minimizing the duration of absenteeism following injury. Objectives The aim of the study was to identify the potential determinants of RTW following work-related injury. Methods A historical cohort of workers with occupational injury in a state-owned locomotive vehicles company in central China was followed up on the outcomes of RTW. Demographic, employment and medical information was retrieved from the company archival documents; and post-injury information was interviewed by structured questionnaires. Univariate analysis and Cox Regression Model were used to examine the associations between potential determinants and outcomes of RTW. Results Three hundred of the 323 cases (92.9%) eventually returned to work after the median absence of 43 days. Factors from socio-demographic, clinical, economic, and psychological domains affected RTW in the univariate analyses. The multivariate analysis indicated that age, injury severity, injury locus, injury nature, pain in the injury locus, self-report health status and pre-injury monthly salary were significant determinants of RTW. Conclusions There were multidimensional factors affecting RTW after occupational injury. Proper clinical treatment and rehabilitation, as well as economic and social support to facilitate workers’ RTW would be the priorities upon intervention. Future studies should be conducted in larger representative samples to confirm the findings and to develop a multidisciplinary intervention strategy towards promoting RTW.

Source:

Employment maintenance and the factors that impact it after vocational rehabilitation and return to work

To determine post-return-to-work disability and functioning amongst occupationally injured workers and to test the extent to which demographic and other variables relate to employment maintenance. In addition, the project sought to document what workers believe determined their work continuation. Method.Semi-structured in-depth interviews were conducted to inquire about participant's (N=150) post-vocational rehabilitation return-to-work experiences. Results were interpreted using the health and health-related domains from the International Classification of Functioning, Disability and Health. Results.Although most participants were working at the time of interview, almost all were experiencing functional- or activity-based restrictions. Factors differentiating those employed from those not, were largely contextual and included relationships with supervisors, economic climate, and working conditions. Conclusions.The findings stress the importance of considering environmental strains when planning return to work and indicate ways to assist workers to achieve return-to-work success.

Source: http://www.informaworld.com/smpp/title~db=all~content=g769521346

The COPE LBP trial: Cognitive Patient Education for Low Back Pain - a cluster randomized controlled trial in primary care

Non-specific low back pain (LBP) is usually self-limiting within 4-6 weeks. Longstanding pain and disability are not predictable from clinical signs or pathoanatomical findings. Pain cognition and physical performance have been shown to improve patients with chronic LBP following neurophysiological education. The primary aim of this study is to evaluate whether a specific cognitive based education programme for patients with LBP in primary care is more effective than normal care in terms of increased function. The secondary aims of the study are to evaluate whether this intervention also results in earlier return to work, decreased pain, increased patient satisfaction, increased quality-of-life, and cost utility. Cluster randomised controlled trial with 20 general practitioners and 20 physiotherapists in primary care as the unit of randomisation. Each practitioner will recruit up to 10 patients, aged 20 to 55 years, with non-specific sub-acute/chronic LBP of more than four weeks but less than 1 year's duration. Practitioners in the intervention arm will provide cognitive patient education intervention in up to four weekly sessions, each lasting 30 minutes. Practitioners in the control arm will provide normal treatment, but have to make four appointments for the patients. Patients, outcome assessors, and study statistician will be blinded to group allocation. We present the rationale and design of an ongoing RCT study that potentially offers an easily implemented treatment strategy for LBP patients in primary care. The results will be available in 2012. Trial registration: ISRCTN ref no CCT-NAPN-18665 (registered 170409)

Source: http://www.biomedcentral.com/1471-2474/11/33/abstract

Plus de Messages Page suivante »

Abonnement courriel

Messages récents

Catégories

Méthodes et types d’études

Mots-Clés (Tags)

Blogoliste

Archives