2010-06-01 12:00 - Messages

Sociodemographic, clinical, and work characteristics associated with return-to-work outcomes following surgery for work-related knee injury

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.

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

Reasons of drop-out from rehabilitation in patients of Turkish and Moroccan origin with chronic low back pain in The Netherlands: A qualitative study

Objective: To explore which factors led to drop-out in patients of Turkish and Moroccan origin with chronic non-specific low back pain who participated in a rehabilitation programme. Subjects: Patients of Turkish or Moroccan origin with chronic non-specific low back pain (n = 23) from 2 rehabilitation centres and 4 rehabilitation departments of general hospitals in the Netherlands. Methods: In-depth semi-structured interviews were conducted with patients of Turkish and Moroccan origin (n = 23), rehabilitation physicians (n = 8) and rehabilitation therapists (n = 2). Interviews were transcribed or summarized and subsequently coded and analysed according to themes. Results: Most patients dropped out due to expectations of a specific medical diagnosis and pain relief as the main aims of rehabilitation treatment. Other reasons for drop-out detected in the interviews were: lack of acknowledgement of the patient's complaints, lack of trust in the rehabilitation physician, contradicting views to those of the physician from the patients' country of origin with regard to the cause and treatment of pain, and communication problems. Conclusion: The major reason for drop-out was patients having different expectations, from those of their health providers, of the aim of treatment, as a result of a different view of the origin and treatment of low back pain.

Source: http://jrm.medicaljournals.se/article/abstract/10.2340/16501977-0536

A qualitative study of perpetuating factors for long term sick leave and promoting factors for return to work: chronic work disabled patients in their own words

Chronic work disability generates high financial costs for society and causes personal suffering to patients and their families; however, crucial knowledge about the factors associated with long-term sick leave is still missing. This study provides insight, from the perspective of chronic work disabled patients, into the perpetuating factors for long-term sick leave and promoting factors for return to work.
Patients and methodsFive focus group interviews were conducted with 27 patients with different disorders who had been on long-term sickness absence (18 months or more). Qualitative data analysis was performed using a conceptual framework to identify barriers and enablers for return to work.
Results: Four main themes of important perpetuating factors for long-term sick leave were identified: health-related obstacles, personal obstacles, social obstacles, and work-related obstacles. Four main themes of important promo­ting factors for return to work were identified: favourable working conditions, positive personal characteristics of the employee, the influence of the social environment, and the influence of the personal economic situation.
Conclusion: Besides sickness, several non-medical factors are recognized barriers for return to work. Factors such as illness perceptions and self-efficacy expectations are reported to be promoting factors for return to work.

Source: http://jrm.medicaljournals.se/article/abstract/10.2340/16501977-0544

Whole body vibration compared to conventional physiotherapy in patients with gonarthrosis: a protocol for a randomized, controlled study

Osteoarthritis (OA) is the most common degenerative arthropathy. Load-bearing joints such as knee and hip are more often affected than spine or hands. The prevalence of gonarthrosis is generally higher than that of coxarthrosis. Because no cure for OA exists, the main emphasis of therapy is analgesic treatment through either mobility or medication. Non-pharmacologic treatment is the first step, followed by the addition of analgesic medication, and ultimately by surgery. The goal of non-pharmacologic and non-invasive therapy is to improve neuromuscular function, which in turn both prevents formation of and delays progression of OA. A modification of conventional physiotherapy, whole body vibration has been successfully employed for several years. Since its introduction, this therapy is in wide use at our facility not only for gonarthrosis, but also coxarthrosis and other diseases leading to muscular imbalance. Methods: This study is a randomized, therapy-controlled trial in a primary care setting at a university hospital. Patients presenting to our outpatient clinic with initial symptoms of gonarthrosis will be assessed against inclusion and exclusion criteria. After patient consent, 6 weeks of treatment will ensue. During the six weeks of treatment, patients will receive one of two treatments, conventional physiotherapy or whole-body-vibration exercises of one hour three times a week. Follow-up examinations will be performed immediately after treatment and after another 6 and 20 weeks, for a total study duration of 6 months. 20 patients will be included in each therapy group. Outcome measurements will include objective analysis of motion and ambulation as well as examinations of balance and isokinetic force. The Western Ontario and McMaster Universities Arthritis Index and SF-12 scores, the patients' overall status, and clinical examinations of the affected joint will be carried out. Discussion: As new physiotherapy techniques develop for the treatment of OA, it is important to investigate the effectiveness of competing strategies. With this study, not only patient-based scores, but also objective assessments will be used to quantify patient-derived benefits of therapy.

Source: http://www.biomedcentral.com/1471-2474/11/128

Prévention de la désinsertion professionnelle

L'expérience de 6 pays
Le thème de la prévention de la désinsertion professionnelle - et, en amont, du maintien dans l'emploi - est d'autant plus important, qu'avec l'allongement de la vie professionnelle, garder les salariés au travail et en bonne santé, va devenir une priorité. La nécessité d'agir dans ce domaine est soulignée dans une enquête réalisée en 2007 par le Crédoc. Les résultats de cette enquête montrent que trois ans après un accident, seulement la moitié des personnes concernées avaient repris un travail, alors que 85% d'entre elles avaient un emploi auparavant. Présentée sous forme de fiches, la note d'EUROGIP dresse un tableau de l'approche choisie par 6 pays qui ont déjà une expérience certaine en matière de prévention de la désinsertion professionnelle : l'Allemagne, la Suisse, le Danemark, les Pays-Bas, la Suède et le Québec.

Source : http://www.eurogip.fr/fr/publication-prevention-de-la-desinsertion-professionnelle-l-experience-de-6-pays.php?id=142

Knowledge brokering with injured workers: Perspectives of Injured Worker Groups and Health Care Professionals

The aim of this study is to understand the barriers and facilitators in brokering knowledge brokering knowledge to help injured workers make informed decisions about recovery and to support their transitions to return to work (RTW). Participants: Perceptions of 63 Injured Worker Groups (IWGs) and 43 Health Care Professionals (HCPs) in facilitating and brokering knowledge were examined. Methods: Critical theory and participatory action research approaches informed the development of a multi-stakeholder research team and the study design to support an exploration into knowledge exchange and transfer. Data was analyzed using a critical occupational perspective to reveal the source of barriers and to identify the facilitators of the knowledge exchange and transfer process. Results: Barriers in transferring knowledge included system barriers, a lack of information accessibility, and problems with variations in injured worker capacity and experience using information. IWG and HCP participants lacked expertise in knowledge transfer. Findings also revealed the interactive knowledge transfer processes that IWGs and HCPs use to help injured workers understand and use information. Conclusions: Change is required to improve knowledge exchange and transfer of information for and to persons with injuries and disabilities. Suggested changes include the development of a sustainable knowledge transfer community of practice, a best practice guide for knowledge brokers such as IWGs and HCPs, and a process for ongoing assessment and evaluation of injured worker information needs and preferences.

Source: http://iospress.metapress.com/content/1438861504q830x4/?p=71269c355add4625945ac87ff7f8bedb&pi=9

The Work Ratio – modeling the likelihood of return to work for workers with musculoskeletal disorders: A fuzzy logic approach

The world of musculoskeletal disorders (MSDs) is complicated and fuzzy. Fuzzy logic provides a precise framework for complex problems characterized by uncertainty, vagueness and imprecision. Although fuzzy logic would appear to be an ideal modeling language to help address the complexity of MSDs, little research has been done in this regard. The Work Ratio is a novel mathematical model that uses fuzzy logic to provide a numerical and linguistic valuation of the likelihood of return to work and remaining at work. It can be used for a worker with any MSD at any point in time. Basic mathematical concepts from set theory and fuzzy logic are reviewed. A case study is then used to illustrate the use of the Work Ratio. Its potential strengths and limitations are discussed. Further research of its use with a variety of MSDs, settings and multidisciplinary teams is needed to confirm its universal value.

Source: http://iospress.metapress.com/content/g160x217uh025r7h/?p=71269c355add4625945ac87ff7f8bedb&pi=8

Evidence and Practice in the Self-Management of Low Back Pain: Findings From an Australian Internet-based Survey

Low back pain (LBP) is common, but sufferers pursue a range of management options and only some seek professional advice. This study examines how Australian consumers report that they manage LBP, with emphasis on the extent to which their practices match clinical recommendations and guidelines. Methods: A self-reported cross-sectional online survey comprising 29 questions in English (see Supplemental Digital Content 1, http://links.lww.com/CJP/A13) was conducted in February 2009. The internet-based survey sample was matched with national population proportions; 1220 respondents were screened and 1001 met the inclusion criteria (age >18 y and having suffered from back pain in the previous 6 mo). Results: A total of 570 (57%) participants had experienced LBP, of whom half (307; 54%) sought healthcare advice. Although 126 (41%) respondents reported receiving advice to exercise or stretch, only 107 (19%) reported that their initial response was to follow this advice. One-third maintained normal activity levels and 15% took bed rest, mostly for less than 1 day. A large proportion of respondents were overweight or obese (391, 68%); only 8% were active currently undertaking a weight loss regime. Taking analgesic medication was the most common initial action to LBP (449, 78% respondents); paracetamol was the predominant choice. Under-dosing was evident among users of over-the-counter analgesics. Conclusions: The self-care choices that some people with LBP are making are not in line with the current evidence-based guidelines. This may lead to delayed recovery and the risk of medication-related problems. The provision of education about the nonpharmacologic management options for LBP, optimal information about appropriate medicines choices, and about medication contraindications is essential.

Source: http://journals.lww.com/clinicalpain/pages/articleviewer.aspx?year=2010&issue=07000&article=00010&type=abstract

A qualitative study of perpetuating factors for long term sick leave and promoting factors for return to work: chronic work disabled patients in their own words

Chronic work disability generates high financial costs for society and causes personal suffering to patients and their families; however, crucial knowledge about the factors associated with long-term sick leave is still missing. This study provides insight, from the perspective of chronic work disabled patients, into the perpetuating factors for long-term sick leave and promoting factors for return to work. Patients and methodsFive focus group interviews were conducted with 27 patients with different disorders who had been on long-term sickness absence (18 months or more). Qualitative data analysis was performed using a conceptual framework to identify barriers and enablers for return to work. RESULTS: Four main themes of important perpetuating factors for long-term sick leave were identified: health-related obstacles, personal obstacles, social obstacles, and work-related obstacles. Four main themes of important promo-ting factors for return to work were identified: favourable working conditions, positive personal characteristics of the employee, the influence of the social environment, and the influence of the personal economic situation. CONCLUSION: Besides sickness, several non-medical factors are recognized barriers for return to work. Factors such as illness perceptions and self-efficacy expectations are reported to be promoting factors for return to work.

Source: http://jrm.medicaljournals.se/article/pdf/10.2340/16501977-0544

The personal and workplace factors relevant to work readiness evaluation following acquired brain injury: Occupational therapists’ perceptions

This study examined the personal and workplace/environmental factors perceived most relevant to work readiness evaluations following acquired brain injury. Research design: Using a qualitative secondary analysis design ‘indicators of success' and ‘risks of failure', identified as relevant in a primary study of occupational therapists' evaluation practices, were explored further. Method: Data collected in the primary study, e.g. interviews, practice surveys, evaluation protocols, were re-analysed. Surveys and protocols were used to define participant and practice context characteristics. Interviews were coded, by three investigators, using a constructivist grounded theory approach. Results: Four themes emerged describing relevant personal client attributes: (1) motivation; (2) physical and functional independence; (3) cognitive abilities; and (4) use of compensatory strategies and feedback. Four themes emerged describing relevant workplace factors: (1) workplace demands; (2) employer risks and burden; (3) risks associated with information sharing; and (4) financial implications associated with return to work. Conclusions: Findings suggest that work readiness needs to be viewed as both a client and a workplace issue. Findings are translated into questions for rehabilitation professionals to guide evaluations of work readiness. Recommendations for future research include investigating how professionals weigh factors in their decision-making and exploring strategies relevant from a workplace perspective.

Source: http://informahealthcare.com/doi/abs/10.3109/02699052.2010.491495

Wii-habilitation: Is there a role in trauma?

Rehabilitation forms an essential component of the therapeutic continuum in multiply injured patients. Effective rehabilitation programmes assist patients in optimising their level of physical, psychological and social function, while also reducing the length of patient stay, re-admission rates and use of primary care resources. A recent report from the National Audit Office on trauma care within the UK highlighted rehabilitation as an area of trauma patient care that frequently fell short of the standards expected. The current decline in the economy is likely to impact upon the financial resources available to address these concerns particularly recognising the high dependency on human resources. As a result, those involved in the rehabilitation of injured patients will need to develop new, innovative, cost-effective strategies to improve the current rehabilitation programmes available. These programmes need to intervene early and provide task-orientated training along with high repetition intensity. Such programmes not only test patient motivation, but also frequently demand a high degree of therapist supervision. Efforts logically should therefore focus on designing interventions that engage and motivate patients and encourage increased therapist-independent patient rehabilitation. Virtual reality (VR) offers a possible solution. VR is a technology that allows the user to directly interact with a computer-simulated environment. This technology, developed initially for military training, has now become widely available through video games. The potential for VR interfaces to create an environment that encourages high repetition intensity has been exploited by numerous vocational training programmes, such as laparoscopic surgical skill training. It is now conceivable that computer-based rehabilitation programmes could be developed using current, widely available, affordable virtual reality platforms, such as the Nintendo® Wii. This review aims to discuss the use of modern computer technology in patient rehabilitation and how this may be applied to trauma patients.

Source: http://www.injuryjournal.com/article/PIIS0020138310002160/abstract?rss=yes

Correlation of Return to Work Outcomes and Hand Impairment Measures Among Workers with Traumatic Hand Injury

Introduction Hand impairment is a common and serious occupational injury among workers because it can affect the outcome to return to work (RTW) and even cause permanent dysfunction. The hand measures can directly describe the primary hand function and limitation. This study investigated the correlation of RTW and the overall hand impairment measures in the workers with traumatic hand injury. Methods Ninety-six subjects with occupational hand injury were recruited in this study to answer the RTW questionnaire and received the hand evaluation and motion analysis for their affected hands. RTW outcomes assessed whether the subjects successfully returned to work, either from a job change or salary reduction, and the length of the time it took for them to return to work (TRTW). The hand impairment measures included the hand impairment ratio, total active motion loss, motion area loss, grasp power loss, lateral-pinch power loss, and palmar-pinch power loss. Results A stepwise regression indicated that grasp power loss was a significant predictor for the length of TRTW. The motion area loss was firstly adopted to show statistically significance with RTW outcomes. Besides, the hand impairment ratio was also found to have mild positive correlation with TRTW significantly. Conclusions This study presented the subtle correlation of RTW outcomes and hand impairment measures. Both the strength loss and the motion area loss of the hand showed the significant correlation with RTW outcomes. The findings can point to some practical focuses in occupational rehabilitation for the workers with hand trauma.

Source: http://www.springerlink.com/content/w52513341r348860/

Does self-management for return to work increase the effectiveness of vocational rehabilitation for chronic compensated musculoskeletal disorders?

Titre complet: Does self-management for return to work increase the effectiveness of vocational rehabilitation for chronic compensated musculoskeletal disorders? - Protocol for a randomised controlled trial

Musculoskeletal disorders are common and costly disorders to workers compensation and motor accident insurance systems and are a leading contributor to the burden of ill-health. In Australia, vocational rehabilitation is provided to workers to assist them to stay in, or return to work. Self-management training may be an innovative addition to improve health and employment outcomes from vocational rehabilitation. Methods: The research plan contains mixed methodology consisting of a single blind randomised controlled trial, an economic evaluation and qualitative research. Participants (n=366) are volunteers with compensated musculoskeletal disorders of 3 months to 3 years in duration who were working at the time of the injury/onset of the chronic disorder. The trial tests the effectiveness of usual vocational rehabilitation plus the Chronic Disease Self-Management Program (CDSMP) to which two additional and newly-developed modules have been added, against vocational rehabilitation alone (control). The modules added to the CDSMP focus on how to navigate through compensation systems and manage the return to work process, and aim to be relevant to those in a vocational rehabilitation setting. The primary outcome is readiness for return-to-work which will be evaluated using the Readiness for Return-to-Work scale. Secondary outcomes include health efficacy (heiQTM questionnaire, general health status (SF-12v2(R) Health Survey) and return-to-work status. Measures will be taken at baseline, immediately post-intervention and at 6 and 12 months post-intervention by an independent assessor. An economic evaluation will compare the costs and outcomes between the intervention and control groups in terms of a cost-effectiveness and partial cost-benefit or cost analysis. The impact of the self-management return to work intervention will also be evaluated qualitatively, in terms of its acceptability to stakeholders. Discussion: This article describes the protocol for a single blind randomized controlled trial with a one year follow-up. The results will provide evidence for the addition or not of self-management training within vocational rehabilitation for chronic compensated musculoskeletal disorders.

Source: http://www.biomedcentral.com/1471-2474/11/115

Migration and occupational health: Shining a light on the problem

 

Global migration has dramatically increased over the past decade and is at an all-time high, approaching 200 million persons per year. Demographics and economic interdependence suggest that immigration will continue for the near future at record high levels. METHODS: A review of the few studies that have investigated occupational injury and illness rates among immigrant populations. RESULTS: Existing data indicate that higher rates of fatal and non-fatal injuries are common compared to native populations. This increase is in part due to immigrants working in higher risk occupations (e.g., agriculture, construction), but occupational morbidity and mortality is higher among immigrants than native-born workers within occupational categories. CONCLUSIONS: Research is needed to identify the causes of increased risk among immigrants and to provide direction to effective public health interventions. Research methods must be adapted to different epidemiologic characteristics of immigrant populations, including lack of standard sampling frames, different language and culture from the dominant culture, and precarious work status.

Source: http://www3.interscience.wiley.com/journal/123304901/abstract

 

Return-to-work/Stay-at-work Interventions for Workers with Mental Health Conditions

Best Practices
OHSAH and a core group of stakeholders have developed a consensus and evidence-based Return-to-work (RTW) and Stay-at-work (SAW) Best Practices, adapted to the needs of healthcare workers in British Columbia. These recommendations focus on workplace interventions aimed at assisting workers with common mental health conditions return to work and/or stay at work.

Source : http://www.ohsah.bc.ca/media/392-PF-RTW.SAW.pdf 

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