2010-09-01 12:00 - Messages
Introduction Office workers share several behavioural patterns: they work seated without moving for long times, they use only a few specific muscles of their arms, wrists and hands, and they keep an overall poor body posture. These working patterns generate musculoskeletal disorders, and produce discomfort or pain. Implementation of a work fitness program is thus a low-cost strategy to reduce/prevent body pain derived from work. The aim of this study was to test the benefits of a workplace fitness program, specifically applied to an administrative department of a Portuguese enterprise. Recall that this type of primary prevention level of musculoskeletal disorders has been seldom applied in Portugal, so this research effort materialized an important contribution to overcome such a gap. Methods The participants in this study were office workers (n = 29 in the study group, and n = 21 in the control group)—who consistently had reported pain mostly on their back side (neck, posterior back, and dorsal and lumbar zones), wrists and posterior legs. The workplace fitness program consisted of three sessions per week during an 8-month period, with 15 min per session; emphasis was on stretching exercises for the body regions most affected by workers' pain perception. Each participant was requested to point out the injured region, as well as the intensity of pain felt, by using a visual analogue scale. Statistical analyses of the perceived pain data from control and study groups resort to non-parametric hypothesis tests. Results There was a strong evidence that the workplace fitness program applied was effective in reducing workers' pain perception for their posterior back, dorsal and lumbar zones, and for their right wrist (P < 0.05). Conclusions These results generated are rather promising, so they may efficiently serve as an example for other enterprises in that country—while raising awareness on the important issue of quality of life at the workplace.
Dossier spécial dans From Research to Reality, Fall 2010
Work. For most people, it is part and parcel of a healthy way of life. At its most basic level, work provides the income we need to survive. But work can also fulfi ll higher level needs by providing a sense of accomplishment and purpose, physical and mental stimulation, societal involvement, and social support. When an injury or illness leads to prolonged
work loss, the fi nancial, emotional, and social costs to the disabled individual can be devastating.
Source : http://www.libertymutualgroup.com/omapps/ContentServer?c=cms_document&pagename=LMGResearchInstitute%2Fcms_document%2FShowDoc&cid=1239998613235
Objective: The objective of this paper is to propose a three-step procedure that can be used in the selection of functional tests from any full Functional Capacity Evaluation (FCE) method in order to assess efficiently physical work-ability in workers with musculoskeletal complaints (MSC) and related functional limitations. Methods: Recently, some authors have considered the selection of functional tests specific to particular jobs from within a full FCE method. In the present study, based on existing literature and on their own expertise on FCE methods, the authors develop in an analogous manner a conceptual framework for selecting functional tests specific to particular MSCs from within a full FCE method. Results: The first step is to establish the worker's medical condition and to assign it to one or more defined MSC categories (upper extremity, back, lower extremity). The second step is to identify activities that are restricted by the medical condition (e.g., lifting and bending for MSC of the back). The third and final step is to select functional tests from a full FCE tests battery to permit measurement of the restricted activities identified in Step 2, striving to avoid redundancy by selecting a limited number of tests for each activity under investigation. Conclusions: The proposed three-step procedure is a new approach to enhance the efficiency and practicality of FCEs.
Objective: To examine the psychometric properties of the Neck Disability Index, Patient-Specific Functional Scale, and the Numeric Pain Rating Scale in a cohort of patients with cervical radiculopathy. Design: A single-group repeated-measures design. Patients (n = 165) presenting to physical therapy with cervical radiculopathy completed the Neck Disability Index, Patient-Specific Functional Scale, and Numeric Pain Rating Scale at the baseline examination and at a follow-up. At the time of follow-up, all patients also completed the Global Rating of Change, which was used to dichotomize patients as improved or stable. Baseline and follow-up scores were used to determine the test-retest reliability, construct validity, and minimal levels of detectable and clinically important change for the Neck Disability Index, Patient-Specific Functional Scale, and Numeric Pain Rating Scale. Results: Both the Neck Disability Index and Numeric Pain Rating Scale exhibited fair test-retest reliability, whereas the Patient-Specific Functional Scale exhibited poor reliability in patients with cervical radiculopathy. All three outcome measures showed adequate responsiveness in this patient population. The minimal detectable change was 13.4 for the Neck Disability Index, 3.3 for the Patient-Specific Functional Scale, and 4.1 for the Numeric Pain Rating Scale. The threshold for the minimal clinically important difference was 8.5 for the Neck Disability Index and 2.2 for both the Patient-Specific Functional Scale and Numeric Pain Rating Scale. Conclusions: In light of the varied distribution of symptoms in patients with cervical radiculopathy, future studies should investigate the psychometric properties of other neck-related disability measures in this patient population.
This study assessed whether persons with spinal cord injuries who had been successfully rehabilitated into employment following receipt of rehabilitation services had better quality of life and subjective well-being than the unsuccessfully rehabilitated who did not obtain employment following receipt of rehabilitation services. Persons who were successfully rehabilitated had a significantly higher overall quality of life and health and higher quality of life in their physical health, psychological health, social relationships, and environmental domains than the unsuccessfully rehabilitated. The successfully rehabilitated also had higher psychological, financial, and physical well-being than the unsuccessfully rehabilitated. Rehabilitation counselors can use quality of life and subjective well-being measures to provide more focused interventions during rehabilitation and as an outcome measure in addition to employment upon completion of rehabilitation services.
The WorkHab Functional Capacity Evaluation (FCE) is one of many FCEs currently available and is widely used in the Australian workplace injury management and occupational rehabilitation arena. This study investigated the test–retest reliability of manual handling tasks within the WorkHab FCE in healthy adults. Method.A convenience sample of 25 healthy subjects, consisting of 19 women and 6 men with a mean age of 29 years (SD: 12.0) participated in this study. Two FCE sessions were held a week apart and subjects completed a floor to bench, bench to shoulder and bench to bench lift. Analysis of the outcomes of the FCE included descriptive analysis, intra-class correlations (ICC), kappa, percentage agreement and 95% limits of agreement where appropriate. Results.The ICCs for the three lifts show an excellent reliability (0.90–0.92), and a moderate reliability for the manual handling score (0.74). Further analysis of the components of the manual handling score found the percentage agreement was high for all components ranging from 72 to 92%; however, the kappa scores suggested poor to moderate reliability (range: −0.06 to 0.52). Internal consistency of the manual handling score was good (Cronbach's Alpha=0.92) indicating this is a reliable scale. Conclusions.The ratings for the lifting components identified substantial levels of test–retest reliability for the lifting components of the WorkHab FCE in healthy adults.
Breaking the Barriers: Sweden
Sickness and disability is a key economic policy concern for many OECD countries. Medical conditions, or problems labelled as such by societies and policy systems, are proving an increasing obstacle to raising labour force participation and keeping public expenditure under control. More and more people of working age rely on sickness and disability benefits as their main source of income, and the employment rates of those reporting disabling conditions are low. This report is an assessment of the Swedish reforms, which aim to lower inactivity and increase participation, against the background of recent trends and policy responses in other OECD countries. It looks at what Sweden is currently doing and what more it could do to transform its sickness and disability schemes from passive benefits to active support systems that promote work.
Source : http://www.oecd-ilibrary.org/social-issues-migration-health/sickness-disability-and-work-breaking-the-barriers-sweden_9789264090606-en
Surmonter les obstacles : Canada
Comment peut-on améliorer l’état moyen de santé de la population alors que de nombreux travailleurs quittent encore le marché du travail de façon permanente en raison de problèmes de santé ou d’incapacités, et qu’ils dépendent des prestations d’aide pour survivre ?
Dans le même temps, de plus en plus d’adultes en âge de travailler mais affectés d’un handicap sont exclus de la population active. C’est une tragédie à la fois sociale et
économique qui frappe pratiquement l’ensemble des pays de l’OCDE, dont le Canada ; et c’est aussi un paradoxe qui mérite explication.
Le présent rapport qui fait partie de la série Maladie, invalidité et travail propose une évaluation de la situation au Canada. Il explore quelques-unes des raisons expliquant ce paradoxe au Canada et la spécificité de sa politique qui implique plusieurs acteurs publics et privés ainsi que différents niveaux de gouvernement pour réduire l’inactivité et augmenter la participation. Il propose une liste de recommandations politiques pour s’attaquer aux disparités actuelles et prévisibles.
Source : http://www.oecd-ilibrary.org/fr/social-issues-migration-health/maladie-invalidite-et-travail-surmonter-les-obstacles_9789264090439-fr
Purpose.To describe experiences and perceptions of work ability and how it can be assessed among Swedish physicians. Method.We interviewed eight men and six women in the fields of general practice, occupational health, rehabilitation and orthopaedic surgery. Qualitative content analysis was applied to the data. Results.The approach striving to support the patient in mutual confidence was what primarily affected how work ability was understood and how it could be assessed. Two main categories, with sub categories were settled: familiar but vague, with subcategories conflicting expectations and relations and consensus within speciality and the second main category relying on intuition and examinations, with sub categories life as a whole, reasonableness, progression plan, external obstacles and need for knowledge and collaboration. Conclusions.We found that physicians mainly rely on what patients were telling about their work situation when assessing work ability. But it was not clear if they should consider the patient's whole life situation, motivation and wishes. Protecting the physician–patient relationship was seen as important as well as the need for teamwork assessments and increased work place knowledge.
Purpose.The aim of this study was to establish the relationship between known cognitive factors and levels of pain and disability in patients with idiopathic chronic neck pain. Method.Ninety-four patients referred for physiotherapy because of chronic neck pain completed measures of pain, disability, catastrophising, pain-related fear, pain vigilance and awareness and self-efficacy beliefs. Hierarchical multiple regression analyses were then performed to establish whether the cognitive factors were significant determinants of levels of pain and disability. Results.The cognitive measures were significantly related to levels of pain and disability, explaining 23% of the variance in pain intensity and 30% of the variance in disability. Specifically, greater catastrophising (β=0.37, p<0.05) and lower pain vigilance and awareness (β=−0.32, p<0.05) were associated with greater pain intensity. Moreover, greater catastrophising (β=0.26, p<0.05) and lower functional self-efficacy beliefs (β=−0.34, p<0.001) were significantly associated with greater levels of disability. Conclusions.Cognitive factors were strongly related to levels of pain and disability in patients with chronic neck pain. In view of this, targeting the modification of these cognitive factors should be an integral part of therapy when treating patients with idiopathic chronic neck pain.
Background Shoulder complaints are common in primary care and have an unfavourable long term prognosis. Our objective was to evaluate the clinical effectiveness of manipulative therapy of the cervicothoracic spine and the adjacent ribs in addition to usual medical care (UMC) by the general practitioner in the treatment of shoulder complaints. Methods This economic evaluation was conducted alongside a randomized trial in primary care. Included were 150 patients with shoulder complaints and a dysfunction of the cervicothoracic spine and adjacent ribs. Patients were treated with UMC (NSAID's, corticosteroid injection or referral to physical therapy) and were allocated at random (yes/no) to manipulative therapy (manipulation and mobilization). Patient perceived recovery, severity of main complaint, shoulder pain, disability and general health were outcome measures. Data about direct and indirect costs were collected by means of a cost diary. Results Manipulative therapy as add-on to UMC accelerated recovery on all outcome measures included. At 26 weeks after randomization, both groups reported similar recovery rates (41% vs. 38%), but the difference between groups in improvement of severity of the main complaint, shoulder pain and disability sustained. Compared to the UMC group the total costs were higher in the manipulative group (1167 euro vs. 555 euro). This is explained mainly by the costs of the manipulative therapy itself and the higher costs due sick leave from work. The cost effectiveness ratio showed that additional manipulative treatment is more costly but also more effective than UMC alone. The cost-effectiveness acceptability curve shows that a 50%-probability of recovery with AMT within 6 months after initiation of treatment is achieved at 2876 euro. Conclusion Manipulative therapy in addition to UMC accelerates recovery and is more effective than UMC alone on the long term, but is associated with higher costs. International Standard Randomized Controlled Trial Number Register: ISRCTN11216
Osteoarthritis (OA) is the most common joint disorder in the United States. Symptomatic knee OA occurs in 10% men and 13% in women aged 60 years or older. The number of people affected with symptomatic OA is likely to increase due to the aging of the population and the obesity epidemic. OA has a multifactorial etiology, and can be considered the product of an interplay between systemic and local factors. Old age, female gender, overweight and obesity, knee injury, repetitive use of joints, bone density, muscle weakness, and joint laxity all play roles in the development of joint OA, particularly in the weight-bearing joints. Modifying these factors may reduce the risk of OA and prevent subsequent pain and disability.
PURPOSE. To examine the effectiveness of a multidisciplinary rehabilitation programme for patients with chronic low back pain in Hong Kong, and to identify factors associated with work resumption. METHODS. 57 men and 8 women aged 20 to 56 (mean, 39) years who had a more than 3-month history of low back pain and were unresponsive to more than 6 months of conventional treatment participated in a 14-week multidisciplinary rehabilitation programme involving physical conditioning, work conditioning, and work readiness. Training protocols entailed flexibility and endurance training, hydrotherapy, weight lifting, and work stimulation. Patients were assessed at baseline (week 1), week 7, week 14, and month 6 with regard to the intensity of low back pain, self-perceived disability, range of lumbar motion, isoinertial performance of the trunk muscles, and depression level. Patient demographics that influenced work resumption were identified using a prediction model. Patients who did and did not return to work were compared. RESULTS. Of the 54 patients who completed all follow-up assessments, 28 returned to work and 26 did not. The latter was significantly older (37 vs. 42 years, p=0.038) and absent from work longer (11 vs. 22 months, p=0.029) than the former. The rehabilitation programme helped patients regain physical function and the ability to work. Patients who returned to work showed greater improvement in self-perceived disability and physical function. CONCLUSION. This rehabilitation programme facilitated regain of physical functioning and the ability to return to work. The pre-programme employment status, duration of absence from work, and patient age were the most important predictors for work resumption.
Associations with sick leave, symptoms, and health – a prospective study of women on long-term sick leave
Objectives : This study investigated the association between the work ability index (WAI) and the single-item question on work ability among women working in human service organizations (HSO) currently on long-term sick leave. It also examined the association between the WAI and the single-item question in relation to sick leave, symptoms, and health. Predictive values of the WAI, the changed WAI, the single-item question, and the changed single-item question were investigated for degree of sick leave, symptoms, and health.
Methods : This cohort study comprised 324 HSO female workers on long-term (>60 days) sick leave, with follow-ups at 6 and 12 months. Participants responded to questionnaires. Data on work ability, sick leave, health, and symptoms were analyzed with regard to associations and predictability. Spearman correlation and mixed-model analysis were performed for repeated measurements over time.
Results : The study showed a very strong association between the WAI and the single-item question among all participants. Both the WAI and the single-item question showed similar patterns of associations with sick leave, health, and symptoms. The predictive value for the degree of sick leave and health-related quality of life (HRQoL) was strong for both the WAI and the single-item question, and slightly less strong for vitality, neck pain, both self-rated general and mental health, and behavioral and current stress.
Conclusion : This study suggests that the single-item question on work ability could be used as a simple indicator for assessing the status and progress of work ability among women on long-term sick leave.
Source : http://www.sjweh.fi/download.php?abstract_id=2917&file_nro=1
The psychosocial risk factors of depression, anxiety, anger/ hostility, and social isolation have a significant effect on cardiac disease comparable with other highly publicized risk factors. This study assesses the validity of the Psychosocial Risk Factor Survey (PRFS) to conveniently assess all of these primary risk factors in cardiac patients at once. METHODS: Two samples totaling 364 cardiac patients were administered the PRFS and various widely accepted independent-comparison tests measuring depression, anxiety, anger/hostility, social isolation, and emotional guardedness. The researchers also performed a principal components analysis, calculated PRFS intrascale consistency reliabilities, and examined the PRFS Emotional Guardedness scale to determine whether it measures patient tendencies to underreport risk factors. RESULTS: Concurrent validity correlations between the PRFS scales and their associated independent-comparison measures were statistically significant and substantial. The principal components analysis indicated that the Depression and Anxiety scale items loaded on a single factor whereas the Anger/Hostility, Social Isolation, and Emotional Guardedness scale items loaded as expected on their target factors. The scales evidenced sufficient levels of internal consistency, with the exception of the Emotional Guardedness scale. Finally, a scaled range of symptom severity for each measured construct was established. CONCLUSION: This analysis suggests that the PRFS has concurrent validity for assessing the primary psychosocial risk factors of depression, anxiety, anger/hostility, and social isolation in cardiac patients. This tool is a valid, convenient, and efficient measure of the prominent psychosocial risk factors and includes a scale that may help discern underreporting of risk factors.