2010-02-01 12:00 - Messages
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
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
Background: Assessment of efforts to promote return-to-work (RTW) includes all efforts (vocational and non-vocational) designed to improve the work ability of the sick-listed employee and increase the chance to return to work. Aim of the study was to investigate whether in 13 European countries these RTW efforts are assessed and to compare the procedures by means of six criteria. METHODS: Data were gathered in the taxonomy project of the European Union of Medicine in Assurance and Social Security and by means of an additional questionnaire. RESULTS: In seven countries RTW efforts are subject of the assessment in relation to the application for disability benefits. Description of RTW efforts is a prerequisite in five countries. Guidelines on the assessment of RTW efforts are only available in the Netherlands and no countries report the use of the ICF model. Based on the results of the additional questionnaire, the assessor is a social scientist or a physician. The information used to assess RTW efforts differs, from a report on the RTW process to medical information. A negative outcome of the assessment leads to delay of the application for disability benefits or to application for rehabilitation subsidy. Conclusion: RTW efforts are assessed in half of the participating European countries. When compared, the characteristics of the assessment of RTW efforts in the participating European countries show both similarities and differences. This study may facilitate the gathering and exchange of knowledge and experience between countries on the assessment of RTW efforts.
Source: http://eurpub.oxfordjournals.org/cgi/content/abstract/ckp244
OBJECTIVE: To determine factors associated with return to work following acute non-life-threatening orthopaedic trauma. DESIGN: Prospective cohort study. PARTICIPANTS: One hundred and sixty-eight participants were recruited and followed for 6 months. The study achieved 89% participant follow-up. METHODS: Baseline data were obtained by survey and medical record review. Participants were further surveyed at 2 weeks, 3 and 6 months post-injury. Logistic regression was used to examine the association between potential predictors and first return to work by these 3 time-points. RESULTS: Sixty-eight percent of participants returned to work within 6 months. Those who sustained isolated upper extremity injuries were more likely to return to work early. Significant positive determinants of return to work included a strong belief in recovery, the presence of an isolated injury, education to university level and self-employment. Determinants associated with non-return to work included the receipt of compensation, older age, pain attitudes and blue-collar work. The primary reason given for return to work was financial security. CONCLUSION: Demographic, injury, occupation and psychosocial factors were significant predictors of return to work. The relative importance of factors at different time-points suggests that return to work is a multifactorial process that involves the complex interaction of many factors in a time-dependent manner.
Source: http://jrm.medicaljournals.se/article/abstract/10.2340/16501977-0495
The interdependence of labor market conditions and the demand for health care has been addressed by several theoretical and empirical analyses. We contribute to the debate by empirically examining the eff ect of a decrease in self-perceived job security on health care utilization. That is, employees at risk of losing their job might postpone or even try not to use non-acute rehab measures in order to reduce their
individual risk of being laid off by avoiding absenteeism and signaling good health. We use individual-level data from the German Socioeconomic Panel for the years 2003, 2004, and 2006. The identifi cation strategy rests on an instrumental variable approach where the county unemployment rate and its relative change compared to the previous year serve as instruments for the employees' self-assessed risk of losing their jobs. Contrary to the hypothesis, we have evidence for job insecurity increasing the demand for medical rehab. This fi nding is robust to various model variants.
Source : http://www.rwi-essen.de/pls/portal30/docs/FOLDER/PUBLIKATIONEN/RUHRECPAP/REP162/REP_10_162.PDF
STUDY DESIGN: Prospective randomized and observational cohorts. OBJECTIVE: To compare outcomes of patients with and without workers' compensation who had surgical and nonoperative treatment for a lumbar intervertebral disc herniation (IDH). SUMMARY OF BACKGROUND DATA: Few studies have examined the association between worker's compensation and outcomes of surgical and nonoperative treatment. METHODS: Patients with at least 6 weeks of sciatica and a lumbar IDH were enrolled in either a randomized trial or observational cohort at 13 US spine centers. Patients were categorized as workers' compensation or nonworkers' compensation based on baseline disability compensation and work status. Treatment was usual nonoperative care or surgical discectomy. Outcomes included pain, functional impairment, satisfaction and work/disability status at 6 weeks, 3, 6, 12, and 24 months. RESULTS: Combining randomized and observational cohorts, 113 patients with workers' compensation and 811 patients without were followed for 2 years. There were significant improvements in pain, function, and satisfaction with both surgical and nonoperative treatment in both groups. In the nonworkers' compensation group, there was a clinically and statistically significant advantage for surgery at 3 months that remained significant at 2 years. However, in the workers' compensation group, the benefit of surgery diminished with time; at 2 years no significant advantage was seen for surgery in any outcome (treatment difference for SF-36 bodily pain [-5.9; 95% CI: -16.7-4.9] and physical function [5.0; 95% CI: -4.9-15]). Surgical treatment was not associated with better work or disability outcomes in either group. CONCLUSION: Patients with a lumbar IDH improved substantially with both surgical and nonoperative treatment. However, there was no added benefit associated with surgical treatment for patients with workers' compensation at 2 years while those in the nonworkers' compensation group had significantly greater improvement with surgical treatment.
Source : http://www.ncbi.nlm.nih.gov/pubmed?term=%22Spine%22%5BJour%5D+AND+2010%5Bpdat%5D+AND+Atlas%5Bauthor%5D
Effets et limites de l'obligation d'accommodement raisonnable en droit québécois
La prestation de travail de l'employé est l'essence même du contrat de travail. Ce principe est consacré à l'article 2085 du Code civil du Québec qui édicte que le contrat de travail est « celui par lequel une personne, le salarié, s'oblige pour un temps limité et moyennant rémunération, à effectuer un travail sous la direction et le contrôle d'une autre personne, l'employeur ». Traditionnellement, ce lien de subordination du salarié à l'égard de l'employeur justifiait celui-ci d'imposer ses exigences tant en ce qui concerne l'exercice des tâches que les conditions de travail. Le salarié incapable d'accomplir les tâches pour lesquelles il avait été embauché ou encore de respecter les conditions de travail auxquelles il était assujetti, dans la mesure où celles-ci n'allaient pas à l'encontre des règles d'ordre public, s'exposait au congédiement.
Or, l'obligation d'accommodement, telle que définie par les tribunaux canadiens et québécois, a complètement bouleversé le cadre d'analyse en cette matière. Suivant cette obligation, l'employeur doit adapter ses règles d'emploi afin de tenir compte des employés incapables de respecter les exigences du poste, voire d'accomplir leur prestation de travail, pour des motifs protégés par les lois sur les droits de la personne. Le syndicat, qui jouit au Québec du monopole de représentation à l'égard des salariés qui font partie du groupe (« unité d'accréditation ») pour lequel il a été accrédité, doit lui aussi composer avec cette nouvelle obligation et participer à la recherche d'un compromis raisonnable.
Source : http://www.pistes.uqam.ca/v12n1/articles/v12n1a1.htm
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