2010-10-01 12:00 - Messages
Objective: To examine possible predictors of lost workdays among nurses and nurses' aides who sought treatment for work-related back pain. Participants: Nursing staff employed at a tertiary care medical center over a 13-year time period (1994 through 2006). Methods: We used existing data from clinic surveys administered to nursing personnel during their initial treatment visit to the hospital's occupational health clinic. Predictors of losing ? 7 and ? 8 workdays was examined. Results: 589 of 708 (83%) nursing personnel with complaints of work-related back pain completed the survey, with 31% resulting in lost workdays. Experiencing sudden onset of pain (RR:1.9; 95% CI: 1.1, 3.1), a combination of severe pain with numbness and tingling in the back/legs (RR: 7.4; 95% CI: 2.9, 18.6), severe pain only (RR: 4.4; 95% CI: 1.8, 11.1), numbness and tingling in the back/legs only (RR: 3.5; 95% CI: 1.0, 12.2), and working < 5 years at the hospital (RR: 2.3; 95% CI: 1.2, 4.7) were predictive of losing ? 8 workdays. Job title, work demands, work conflicts, and most psychosocial factors were not predictive. Conclusions: Severe pain, neurologic symptoms and sudden onset of pain were predictive of delayed return-to-work; however, these symptoms alone should not be considered indicators of poor outcomes given that most workers who reported these symptoms returned to work in less than 8~days. Among these health care workers, lost workdays appear to be related to more severe pathology rather than workplace characteristics.
The Lam Assessment on Stages of Employment Readiness (LASER) was developed to assess welfare recipients' employment readiness. The LASER consists of 14 items corresponding to Prochaska's stages of change model (Prochaska, DiClemente and Norcross, 1992). A sample of 149 welfare recipients from a work training program participated in the study. The Confirmatory Factor Analysis (CFA) supported the three factors structure corresponding to Prochaska's Pre-Contemplation, Contemplation, and Action stages. A cluster analysis classified the sample into three groups according to their LASER scores. A six months follow-up on employment outcomes showed that those who were in Pre-contemplation stage had the poorest employment outcome (25%), those who were in the Action stage had the best outcome (56%) and those in the Contemplation stage were in between (38%). Implications for work rehabilitation and treatment matching were discussed.
Patients frequently ask NPs to write work restrictions, even if it is not in their best interest. This article helps providers construct valid work restrictions and addresses specific tasks and issues to keep the patient and coworkers safe when returning to work.
Objective To test whether return to work as a binary (yes/no) outcome that includes all persons who returned to work regardless of mode of return reflects a composite or a homogeneous outcome in a cohort of workers who have sustained acute orthopaedic trauma resulting in hospitalisation. Methods Prospective cohort study. One hundred and sixty-eight participants were recruited and followed for 6 months. The study achieved 89% follow-up. Baseline data were obtained at study recruitment and participants were further surveyed by phone at three timepoints during the study. Polytomous logistic regression was used to simultaneously examine the association between potential predictors and different modes of first return to work (RTW). A test of the equality of the ORs associated with the independent predictor variables was also undertaken. Results Of the 152 participants with full follow-up, 46 (30%) returned first to full duties, 58 (38%) returned first to modified work and 48 (32%) did not return to work during the study period. Significant determinants of the two modes of return to work were different. A test of the equality of ORs indicated that the relative ORs for the difference in the slope coefficients for five of the 10 independent factors in the two polytomous logistic regression sub-models corresponding to each mode of return to work were statistically significant. This raises the likelihood that first RTW reflects a composite rather than a homogeneous outcome. Conclusion The study provides evidence that RTW may reflect a composite outcome when it includes different modes of first RTW. The identified predictive factors appear to exert different mechanisms of action depending on the mode of RTW. The findings suggest that the different modes of RTW may need to be considered independently. The results of the study have potentially important implications for research and insurance practice.
Many foreign patients attending our pain clinic are unable to understand one of the four Swiss national languages and are also unable to speak English. Therefore, communication with these patients can be very difficult or even impossible. Consequently, diagnosis and treatment may also prove difficult. Recognizing that language barriers can have deleterious effects, the use of an interpreter is at times the only way to communicate, however, the financial responsibility becomes that of the health care provider. Many foreign patients attending our pain clinic are unable to understand one of the four Swiss national languages and are also unable to speak English. Therefore, communication with these patients can be very difficult or even impossible. Consequently, diagnosis and treatment may also prove difficult. Recognizing that language barriers can have deleterious effects, the use of an interpreter is at times the only way to communicate, however, the financial responsibility becomes that of the health care provider. Many foreign patients attending our pain clinic are unable to understand one of the four Swiss national languages and are also unable to speak English. Therefore, communication with these patients can be very difficult or even impossible. Consequently, diagnosis and treatment may also prove difficult. Recognizing that language barriers can have deleterious effects, the use of an interpreter is at times the only way to communicate, however, the financial responsibility becomes that of the health care provider. Methods: The aim of this paper was to study the aspects of communication with immigrants and to discuss the effect of language difficulties on the organizational structure of a pain clinic. In our analysis, we prospectively included all patients attending our pain clinic between January 1st and December 31st, 2006 and 2008. The mother tongue, rather than the nationality, of the patients and their ability to communicate was registered. Results: In 2006, the communication of 92% of the patients was “good” or “very good”. Communication was extremely difficult or impossible in 6% to 7%. No statistically significant difference was found between the number of consultations per patient per mother tongue, irrespective of the patient's ability to communicate. Additionally, the consultation times were significantly shorter in patients with a poor ability to communicate. Discussion: In 6% to 7% of our pain patients, communication was impossible or extremely difficult. Language barriers can be problematic in all cultures and consultation situations. The average consultation length may be associated with better outcomes in chronic pain patients.
There are many opportunities for health professionals to enhance their roles as advocates for individuals returning to work and advocates for change to policies and practices. Overall, it is important for advocates to be aware of the multiple stakeholders involved in the return to work process and to adopt a multipronged approach that considers the immediate needs of individual workers as well as the long term needs to create more inclusive and accommodating workplace environments. In addition, health care professionals are well positioned to advance the needs of disabled workers and to offer solutions for future legislative reforms for the benefit of all citizens. We are all encouraged to continue taking up this challenge.
Objective: Occupational therapists (OTs) engage in continuing education to integrate best available knowledge and skills into their practice. However, many barriers influence the degree to which they are currently able to integrate research evidence into their clinical decision making process. The specific objectives were to explore the clinical decision-making processes they used, and to describe the empowerment process they developed to become evidence-based practitioners. Participants: Eight OTs, who had attended a four-day workshop on evidence-based work rehabilitation, were recruited to participate to a reflective practice group. Methods: A collaborative research methodology was used. The group was convened for 12 meetings and held during a 15-month period. The data collected was analyzed using the grounded theory method. Results: The results revealed the different decision-making modes used by OTs: defensive, repressed, cautious, autonomous intuitive and autonomous thoughtful. These modes influenced utilization of evidence and determined the stances taken toward practice change. Reflective learning facilitated their utilization of an evidence-based practice model through a three-level empowerment process: deliberateness, client-centeredness and system mindedness. Conclusions: During the course of this study, participants learned to become evidence-based practitioners. This process had an impact on how they viewed their clients, their practice and the work rehabilitation system.
titre complet: Sickness absence, social relations, and self-esteem: A qualitative study of the importance of relationships with family, workmates, and friends among persons initially long-term sickness absent due to back diagnoses
Objective: The aim of the present study was to explore and analyze accounts of social interactions and relationships with family, workmates, and friends supplied by persons with experience of sickness absence due to back, neck, or shoulder diagnoses. The focus was on experiences that seemed to involve positive and negative self-evaluative aspects, and therefore may be important to the self-conception and self-esteem of the absentee, and possibly to return to work. Participants: The interviewees were women and men between 25 to 34 years of age who had been sickness certified due to back, neck, or shoulder diagnosis. Methods: A descriptive and explorative method was used to analyze data from five focus-group interviews. Results: The importance of being supported and encouraged by family members, and the importance of feeling needed at work as well as being part of a social context were aspects stressed by the respondents. Conclusions: Our results indicate that these interactions and relations are important to the absentees' self-esteem, and that this should be taken into account when discussing rehabilitation efforts.
Objective: To investigate the impact of employment characteristics on the occurrence of long-term sickness absence taking socioeconomic covariates into account. Methods: A longitudinal analysis was conducted for 62,745 employees aged 18 to 64 during 1990–1999. A nonlinear random-effects model was used. In particular, the missing data patterns and their relationship with sickness absence were studied. Results: Strong relationship of socioeconomic background with occurrence of long-term sickness absence (≥3 days) was found. The missing data patterns significantly predicted sickness absence for female employees. In subsequent analysis, the discontinuous employment history with high occurrence of short-term sickness absence (<3 days) appeared to be strongly linked to long-term sickness absence in young women. Conclusions: An investigation of missing values and short-term sickness absence as predictors for long-term sickness absence uncovered that young women with irregular employment history constituted high-risk employees.
Objective: To propose an incidence definition of back injury for epidemiologic studies using health care contacts. Methods: Medical services, hospitalizations, and workers' compensation data were linked for a longitudinal database of health care contacts among a cohort of heavy-industry workers for trajectory, group-based analysis. Results: During follow-up, 25.8% of workers had no health care contacts for back injury. Among workers with at least one contact, four trajectories were identified: one with a high probability of back injury during follow-up and three with episodic trajectories of increasing and decreasing probability of back injury. Conclusions: Workers with no back injury history could be followed for incidence in cohort studies or as controls in case-control designs. Episodic groups could be followed for new episodes, providing they were free of health care contacts for back injury for at least 3 years.
titre complet: Impact of Burnout and Psychosocial Work Characteristics on Future Long-Term Sickness Absence. Prospective Results of the Danish PUMA Study Among Human Service Workers.
Objectives: The objective of this study was to examine if burnout and psychosocial factors predicted long-term sickness absence (>2 weeks) at work unit level. Methods: Data were collected prospectively at 82-work units in human services (PUMA cohort, PUMA: Danish acronym for Burnout, Motivation and Job satisfaction) followed up during the proceeding 18 months regarding onset of long-term sickness absence. Questionnaire data regarding burnout and psychosocial factors were aggregated at work unit level. We used Poisson regression models with psychosocial factors and burnout as predictors of long-term sickness absence for more than 18 months based on data from a national absence register. Results: Long-term sickness absence was predicted by psychosocial factors and by burnout at work unit level. Conclusion: To reduce sickness absence, organizations within human services should improve the psychosocial work environment, and equally important, the organizations should be attentive to employees with symptoms of burnout.