2010-11-01 12:00 - Messages
Synthèse des résultats dans les pays de l'OCDE
Ce rapport, le dernier de la série de l'OCDE intitulée Maladie, invalidité et travail : surmonter les obstacles synthétise les conclusions du projet et étudie les facteurs qui peuvent expliquer ce paradoxe. Il met en lumière le rôle des institutions en place et des politiques mises en œuvre et conclut qu'il est essentiel pour les principaux acteurs – travailleurs, employeurs, médecins, organismes publics et prestataires de services – de rehausser les attentes et d'améliorer les incitations. À partir d'un examen des bonnes et mauvaises pratiques observées dans les pays de l'OCDE, le rapport suggère qu'une série de réformes de fond s'impose afin de promouvoir l'emploi des personnes atteintes de problèmes de santé.
Source : http://www.oecd-ilibrary.org/social-issues-migration-health/maladie-invalidite-et-travail-surmonter-les-obstacles_9789264088870-fr
Musculo Skeletal Disorders (MSDs) are the focus of considerable attention and research in occupational health, which is in part due to high prevalence rates and associated costs. In the United States, the total cost associated with MSDs increased from 81 billion in 1986 to215 billion in 2005 . Epidemiological studies have repeatedly shown associations between work-related psychosocial factors and MSDs, and the role of psychosocial factors and stress in these disorders has received increased attention. Several reviews have reported associations between MSDs and work-related psychosocial factors such as high workload/demands, high perceived stress levels, low social support, low job control, low job satisfaction and monotonous work. Several theories have been proposed to explain the apparent relationship between stress and MSDs in the workplace from a biological perspective. These include the biopsychosocial model of job stress, the hyperventilation theory, the migraine theory, the muscle spindle theory and the Cinderella hypothesis. Within the literature, a vast array of questionnaires have been developed in an attempt to measure the psychosocial factors that occur within the workplace. This article presents a discussion of existing knowledge of the psychosocial risk factors potentially linked to MSDs and potential pathways to injury. A discussion of evaluation approaches used to estimate psychosocial risk exposures in workplaces is also presented.
Background: Alongside work environment factors, interference between work and domestic life has been proposed as an important explanation for long-term sickness absence, particularly for women. The aim was to investigate the association between work-to-family interference, family-to-work interference and long-term sickness absence among women and men in different family- and work-related settings. Methods: The study population was a random sample of 2867 gainfully employed adults in Sweden aged 25–50. In 2004, telephone interview data were collected that included questions about family, work and health. The outcome measure was having at least one spell of long-term sickness absence (>14 days) in 2005 based on social insurance register data. Associations were analysed by logistic regression. Results: Work-to-family interference was more common than family-to-work interference and more often reported by women. The overall associations with long-term sickness absence were weak. However, after adjustment for age and self-reported health, work-to-family interference was associated with long-term sick leave among men with higher socioeconomic status (odds ratio 2.87; 95% CI 1.36–6.07), and there was also a tendency to association among women bearing the main responsibility for housework and family (1.59; 0.99–2.54). Conclusions: These findings suggest that work-to-family interference is associated with long-term sickness absence in the working population, but in a gender- and situation-specific manner. Hence, extensive work responsibilities for men, and probably extensive family responsibilities for women, could hamper the balance between work and family and increase the risk of long-term sick leave. Further studies are warranted within this area.
There is strong, internationally confirmed evidence for the short-term effectiveness of multimodal interdisciplinary specific treatment programs for chronic back pain. However, the verification of long-term sustainability of achieved effects is missing so far. For long-term improvement of pain and functional ability high intervention intensity or high volume seems to be necessary (> 100 therapy hours). Especially in chronic back pain rehabilitation, purposefully refined aftercare treatments offer the possibility to intensify positive effects or to increase their sustainability. However, quality assured goal-conscious specific aftercare programs for the rehabilitation of chronic back pain are absent. Methods. This study aims to examine the efficacy of a specially developed bio-psycho-social chronic back pain specific aftercare intervention (RUCKGEWINN) in comparison to the current usual aftercare (IRENA) and a control group that is given an educational booklet addressing pain-conditioned functional ability and back pain episodes. Overall rehabilitation effects as well as predictors for compliance to the aftercare programs are analysed. Therefore, a multicenter prospective 3-armed randomised controlled trial is conducted. 456 participants will be consecutively enrolled in inpatient and outpatient rehabilitation and assigned to either one of the three study arms. Outcomes are measured before and after rehabilitation. Aftercare programs are assessed at ten month follow up after dismissal form rehabilitation. Discussion. Special methodological and logistic challenges are to be mastered in this trial, which accrue from the interconnection of aftercare interventions to their residential district and the fact that the proportion of patients who take part in aftercare programs is low. The usability of the aftercare program is based on the transference into the routine care and is also reinforced by developed manuals with structured contents, media and material for organisation assistance as well as training manuals for therapists in the aftercare. Trial Registration number: NCT01070849
Aim: Changes in the mental health field have created new job expectations of occupational therapists (OTs). The present research investigated differences in general self-efficacy (GSE) and work-related self-efficacy (WRSE) between occupational therapists (OTs) working in psychiatric hospitals and OTs working in community-based mental health services. Method: Thirty-four OTs working in psychiatric hospitals and 30 OTs working in community-based settings (n = 60) completed the General Self Efficacy Scale (GSE) and the WRSE in Mental Health Occupational Therapy Scale (WSMOT). Results: The two groups showed no differences in total WRSE score. Both evinced high self-efficacy in direct intervention activities, and low self-efficacy in managing and counseling. Conclusion: Results enlighten an overall high WRSE, which indicates successful adaptation of OTs to changing roles and tasks in mental health, similar to studies in other countries. However, it reveals discrepancies between job demands and self-efficacy of OTs that should be addressed at educational and managerial levels.
The Cochrane Collaboration has become the premier source worldwide of high-quality systematic reviews in health care. Cochrane's importance has even been compared to that of the Human Genome Project (Naylor, 1995). The Cochrane Collaboration's focus on health care applies in many ways to disability and rehabilitation, particularly in the health and function domain. The purpose of this FOCUS Technical Brief is to provide a brief overview of The Cochrane Collaboration and to highlight entities and resources of the Collaboration that can assist disability and rehabilitation researchers and knowledge users in their knowledge translation (KT) efforts.
Objective: To investigate the predictive validity of fear avoidance beliefs as assessed by the Work Subscale (FABQ-W) of the Fear Avoidance Beliefs Questionnaire in a sample of 117 patients with a work-related musculoskeletal disorder, and identify two FABQ-W cut off points that identified participants as high or low risk of non return to work, following an interdisciplinary rehabilitation program. Methods: A retrospective analysis of patient data collected in conjunction with the Victorian Workcover Authority "Sprains and Strains" program. Sequential logistic regression analysis was used to construct a model of prediction from the baseline variables of age, disability (using the Pain Disability Index), gender and FABQ-W scores. Receiver Operator Characteristic (ROC) curves were used to identify FABQ-W cut off points that best predicted the return to work outcome. Results: Age and initial FABQ-W scores significantly improved the predictive capabilities of the model, but gender and disability did not. The model explained between 13.1% and 18.2% of the variability in the RTW outcome. ROC curves showed maximum sensitivity was 100% for a score of ? 27.5, with a score of > 39.5 identified as having optimum specificity (81.9%).Conclusion: Individuals with low FABQ-W scores are likely to return to work, however those with high scores will not necessarily have a poor outcome. This study supports the limited utility of the FABQ-W score for screening for risk of a poor return to work outcome in patients with a work related musculoskeletal disorder.
Objective To determine the impact of ill health on exit from paid employment in Europe among older workers.
Methods Participants of the Survey on Health and Ageing in Europe (SHARE) in 11 European countries in 2004 and 2006 were selected when 50–63 years old and in paid employment at baseline (n=4611). Data were collected on self-rated health, chronic diseases, mobility limitations, obesity, smoking, alcohol use, physical activity and work characteristics. Participants were classified into employed, retired, unemployed and disabled at the end of the 2-year follow-up. Multinomial logistic regression was used to estimate the effect of different measures of ill health on exit from paid employment.
Results During the 2-year follow-up, 17% of employed workers left paid employment, mainly because of early retirement. Controlling for individual and work related characteristics, poor self-perceived health was strongly associated with exit from paid employment due to retirement, unemployment or disability (ORs from 1.32 to 4.24). Adjustment for working conditions and lifestyle reduced the significant associations between ill health and exit from paid employment by 0–18.7%. Low education, obesity, low job control and effort–reward imbalance were associated with measures of ill health, but also risk factors for exit from paid employment after adjustment for ill health.
Conclusion Poor self-perceived health was strongly associated with exit from paid employment among European workers aged 50–63 years. This study suggests that the influence of ill health on exit from paid employment could be lessened by measures targeting obesity, problematic alcohol use, job control and effort–reward balance.
To examine sleep disturbances as a predictor of cause-specific work disability and delayed return to work.
Prospective observational cohort study linking survey data on sleep disturbances with records of work disability (≥ 90 days sickness absence, disability pension, or death) obtained from national registers.
Public sector employees in Finland.
56,732 participants (mean age 44.4 years, 80% female), who were at work and free of work disability at the study inception.
Measurements and Results:
During a mean follow-up of 3.3 years, incident diagnosis-specific work disability was observed in 4,028 (7%) employees. Of those, 2,347 (60%) returned to work. Sleep disturbances 5-7 nights per week predicted work disability due to mental disorders (hazard ratio [HR] 1.6, 95% confidence interval [CI] 1.3-1.9) and diseases of the circulatory system (HR = 1.6, 95% CI 1.2-2.1), musculoskeletal system (HR = 1.6, 95% CI 1.4-1.8) and nervous system (HR = 1.5, 95% CI 1.0-2.2), and injuries and poisonings (HR = 1.6, 95% CI 1.2-2.1) after controlling for baseline age, sex, socioeconomic status, night/shift work, health behaviors (e.g., smoking, exercise), diagnosed somatic diseases, use of pain killers, depression, and anxiety. In addition, sleep disturbances prior to disability were associated with higher likelihood of not returning to work after work disability from musculoskeletal diseases (HR = 1.2, 95% CI 1.1-1.7) and, in men, after work disability due to mental disorders (HR = 4.4, 95% CI 1.7-11.1).
Sleep disturbances are associated with increased risk for subsequent disabling mental disorders and various physical illnesses. They also predict the outcome of work disability due to musculoskeletal disorders.
The impact of scientific findings on medical, psychological, and legal concepts has led to the adoption of laws and regulations that do not easily fit into the established legal categories of medical law or mental health law. Instead, this convergence of forces has resulted in laws and regulations mandating biopsychosocial treatment guidelines, where both medical and psychological cares are integrated within the framework of a single paradigm. Laws and regulations of this type have been adopted by a number of US states and Canadian provinces, and could be considered to represent a new category, for which we offer the term “biopsychosocial law.” Biopsychosocial laws currently pertain to medical treatment guidelines for workers' compensation, a medical treatment system noted for high costs, high levels of litigation, and psychological involvement. There are a number of examples of biopsychosocial laws, but the most noteworthy are based on guidelines developed by the Colorado Division of Workers' Compensation, the American College of Occupational and Environmental Medicine, the Work Loss Data Institute, and The Reed Group. These guidelines differ significantly with regard to features, conditions covered, and strength of evidence basis. However, all of these guideline systems were developed with the intent of providing good care while controlling costs, are evidence based, integrate the practice of medicine and psychology, and are legally mandated in certain jurisdictions. Taken together, these guidelines represent a growing convergence of scientific evidence, professional society positions, payor policies, and legal regulations. These forces are propelling a broad societal shift away from Cartesian assumptions that the body and mind are separate, and toward a biopsychosocial paradigm for the treatment of injury and illness.
Rehabilitation clinicians routinely make judgments about the capacity of individuals to return to work following whiplash injury, which can have serious implications for individuals' continued access to salary indemnity benefits. The present study examined the validity and determinants of these judgments. During a standardized rehabilitation intervention, data regarding demographic factors, crash characteristics, pain severity, range of motion, pain-related psychological functioning, as well as change in the latter three factors over the course of treatment were collected for 104 whiplash-injured individuals (73 women, 31 men). Upon completion of the intervention, clinicians rated the number of hours each individual was capable of working per day. Follow-up data regarding the actual number of hours worked were collected 1 year later. Hierarchical regression analyses revealed that clinicians' judgments added significant unique variance to the return to work prediction beyond other predictive factors, and that clinicians were particularly influenced by patients' pain severity and treatment-related change in pain severity in making these judgments. Although clinicians were significantly able to predict return to work, the limited variance accounted for by their judgments (12%) warrants caution in the use of these judgments in decisions related to access to services or indemnity. Factors predictive of clinician judgment and actual return to work are compared, and recommendations to enhance the utility of these judgments are made.
The authors examined whether early employer response to workplace injury affects injured workers' subsequent attitudes and mental health. At 1 month and 6 months postinjury, telephone surveys were conducted with 344 workers from Ontario, Canada, who had experienced a musculoskeletal lost-time workplace injury. One-month reports of initial supervisor reaction to the injury and the use of workplace-based return-to-work strategies (early contact with worker, ergonomic assessment, presence of designated coordinator, accommodation offer) were hypothesized to predict reports of fairness, affective commitment, and depressive symptoms measured at 6 months postinjury. Structural equation modeling supported a model wherein fairness perceptions fully mediated the relationship between early responses and injured workers' attitudes and mental health. Early contact and supervisor reactions were significant predictors of fairness perceptions. The implications for early employer response are discussed.
Background. Shoulder pain is a common complaint in primary health care and has an unfavourable outcome in many patients. The objectives were to identify predictors for pain and disability (SPADI) and work status in patients with subacromial shoulder pain. Methods. Secondary analyses of data from a randomized clinical controlled trial were performed. Outcome measures were the absolute values of the combined Shoulder Pain and Disability Index (SPADI) and work status 1 year after treatment with supervised exercises (SE) or radial extracorporeal shockwave therapy (rESWT). Predictors of outcome were investigated using multiple linear regression (SPADI) and logistic regression (work status). Results. 104 patients were included. Low education (≤ 12 years), previous shoulder pain, and a high baseline SPADI score predicted poor results with these variables explaining 29.9% of the variance in SPADI score at 1 year. Low education and poor self-reported health status predicted a work status of "not working": Odds Ratio, OR = 4.3(95% CI (1.3 to 14.9)), p = 0.02 for education, and OR = 1.06 (95% CI (1.0 to 1.1)), p = 0.001 for self-reported health status, respectively. Adjustments for age, gender, and treatment group were performed, but did not change the results. Conclusion. Education was the most consistent predictor of pain and disability, and work status at 1 year follow-up. Also, baseline SPADI score, previous shoulder pain and self-reported health status predicted outcome.
Low back pain (LBP) is the most common and expensive musculoskeletal (MSK) disorder in industrialized countries. There is evidence that personal and occupational psychosocial variables play a more important role than spinal pathology or the physical demands of the job. However, it is unclear which psychosocial variables are most important. The objective of this study is to understand which psychosocial variables are deemed most important to various workplace stakeholders involved in the process of returning a worker with LBP to work. Nine focus groups were convened with injured workers, small and large employers, unions, health and safety associations, physicians and non-physician clinicians, return to work coordinators and compensation board representatives in Ontario, Canada. A qualitative grounded theory approach was applied to explore, from their perspectives, important psychosocial factors that prevent the promotion of early and safe return to work (RTW) for individuals with LBP. While the study began by asking questions related to the various psychosocial factors and their association to LBP and RTW, it took an interesting turn. The majority of study participants described how psychosocial factors were the product of larger systemic/organizational issues. Rather than focusing solely on individual psychosocial factors, respondents described how the context of a much larger system, and the complex interplay between the many different components of that system, contributes directly or indirectly to the treatment of LBP and RTW. It is the interrelationships between these systems that determine the process of returning an injured worker with LBP back to work. Although it is important to understand how psychosocial factors affect RTW, organizational structures within our social context seem to play a role in shaping how all stakeholders see and emotionally respond to LBP and RTW, as well as the degree to which they can envision taking action on them. We need to consider moving beyond a psychosocial conceptualization of LBP and RTW into a sociopolitical and economic conceptualization. This reconceptualization provides insight into the “upstream factors” associated with LBP and RTW.
Purpose.Most working adults with low back pain (LBP) continue to work despite pain, but few studies have assessed self-management strategies in this at-work population. The purpose of this study was to identify workplace challenges and self-management strategies reported by workers remaining at work despite recurrent or persistent LBP, to be used as a framework for the development of a workplace group intervention to prevent back disability. Method.Workers with LBP (n=38) participated in five focus groups, and audio recordings of sessions were analysed to assemble lists of common challenges and coping strategies. A separate analysis provided a general categorisation of major themes. Results.Workplace pain challenges fell within four domains: activity interference, negative self-perceptions, interpersonal challenges and inflexibility of work. Self-management strategies consisted of modifying work activities and routines, reducing pain symptoms, using cognitive strategies and communicating pain effectively. Theme extraction identified six predominant themes: knowing your work setting, talking about pain, being prepared for a bad day, thoughts and emotions, keeping moving and finding leeway. Conclusions.To retain workers with LBP, this qualitative investigation suggests future intervention efforts should focus on worker communication and cognitions related to pain, pacing of work and employer efforts to provide leeway for altered job routines.
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