2011-01-01 12:00 - Messages

Return to work following disabling occupational injury – facilitators of employment continuation

Return to work following occupational injury is an important rehabilitation milestone; however, it does not mark the end of the return-to-work process. Following a return to the workplace, workers can experience difficulties that compromise their rehabilitation gains. Although there has been investigation of factors related to a return to the workplace, little attention has been paid to understanding what facilitates continued return-to-work success as this paper aims to do. Methods This study used data gathered during one-on-one telephone interviews with 146 people who experienced a work-related injury that resulted in their being unable to return to their pre-injury job, but who returned to work following an extended period of absence and the receipt of vocational services. Results Numerous return-to-work facilitators were reported, including features of the workers' environmental and personal contexts, as well as body function, activities, and participation. Influences that stood out included a perception that the work was appropriate, supportive workplace relationships, and a sense of satisfaction/achievement associated with being at work. Conclusions The findings support the contention that initiatives aimed at improving return-to-work outcomes can go beyond the removal of barriers to include interventions to circumvent difficulties before they are encountered. Together with providing ideas for interventions, the study's findings offer an insight into research and theoretical development that might be undertaken to further the understanding of the return-to-work process and the factors that impact upon it.

Source: http://www.sjweh.fi/show_abstract.php?abstract_id=2986

The Association Between Chronic Low Back Pain and Sleep: A Systematic Review

Objectives: Chronic low back pain (CLBP) adversely affects many quality of life components, and is reported to impair sleep. The aim of this review was to determine the association between CLBP and sleep. Methods: This review comprised 3 phases: an electronic database search (PubMed, Cinahl Plus, EMBASE, PsychInfo, Pedro, and Cochrane Library) identified potential articles; these were screened for inclusion criteria by 2 independent reviewers; extraction of data from accepted articles; and rating of internal validity by 2 independent reviewers and strength of the evidence using valid and reliable scales. Results: The search generated 17 articles that fulfilled the inclusion criteria (quantitative n=14 and qualitative n=3). CLBP was found to relate to several dimensions of sleep including: sleep disturbance and duration (n=15), sleep affecting day-time function (n=5), sleep quality (n=4), sleep satisfaction and distress (n=4), sleep efficiency (n=4), ability to fall asleep (n=3), and activity during sleep (n=3). Consistent evidence found that CLBP was associated with greater sleep disturbance; reduced sleep duration and sleep quality; increased time taken to fall asleep; poor day-time function; and greater sleep dissatisfaction and distress. Inconsistent evidence was found that sleep efficiency and activity were adversely associated with CLBP. Discussion: Many dimensions of sleep are adversely associated with CLBP. Management strategies for CLBP need to address these to maximize quality of life in this patient cohort.

Source: http://journals.lww.com/clinicalpain/Abstract/2011/02000/The_Association_Between_Chronic_Low_Back_Pain_and.12.aspx

Clinical Investigation of Pain-related Fear and Pain Catastrophizing for Patients With Low Back Pain

Objective: To investigate select psychometric properties of fear-avoidance model measures commonly used to assess pain-related fear and catastrophizing in clinical studies of low back pain. Methods: A convenience sample was recruited from patients (n=80) seeking outpatient physical therapy for low back pain. All patients completed self-report questionnaires for pain-related fear [Fear-avoidance Beliefs Questionnaire-physical activity (FABQ-PA), FABQ-work scale (W), and Tampa Scale for Kinesiophobia -11] and pain catastrophizing (PCS) at initial evaluation session. Patients also completed clinical measures for pain intensity (numerical rating scale) and self-report of disability (Oswestry Disability Index) at the initial evaluation session. Construct redundancy of the fear-avoidance questionnaires was assessed by factor analysis for individual items and Pearson correlation for total questionnaire scores. Concurrent validity was investigated with multiple regression models for pain intensity and disability. Results: Item analysis indicated all PCS and FABQ-W items loaded on 2 separate factors. The FABQ-PA and Tampa Scale for Kinesiophobia-11 loaded together on a third factor. As expected, all of the fear-avoidance questionnaires were significantly correlated with each other to varying degrees (rs ranged from 0.28 to 0.55, P<0.05 for all). In the multiple regression models only the FABQ-PA and PCS contributed unique variance to pain intensity and disability measures. Further analysis indicated the PCS mediated the relationship of the FABQ-PA by weakening its association with pain intensity and disability. Discussion: These analyses suggest clinical assessment of the Fear-Avoidance Model of Musculoskeletal Pain likely captures 3 factors including PCS, beliefs about work, and beliefs about physical activity. The FABQ-PA and PCS can be recommended for clinical use because of their unique associations with pain intensity and disability. The FABQ-W may only be appropriate for those interested in assessing work specific beliefs.

Source: http://journals.lww.com/clinicalpain/Abstract/2011/02000/Clinical_Investigation_of_Pain_related_Fear_and.3.aspx

Effect of a multidisciplinary stress treatment programme on the return to work rate for persons with work-related stress. A non-randomized controlled study from a stress clinic

(Article disponible en libre accès)

In recent years an increasing number of patients have been referred to the medical sector with stress symptoms. Moreover, these conditions imply increased sickness absence. This indicates a need for treatment programmes in general medical practice. The aim of this study was to test the effect of a multidisciplinary stress treatment programme on the return to work (RTW) rate in persons with work-related stress and establish predictive factors for this outcome. Methods: During a two-year period 63 out of 73 referrals to the Stress Clinic (a section of a Clinic of Occupational Medicine) completed a stress treatment programme consisted of the following: 1) Identification of relevant stressors. 2. Changing the coping strategies of the participants. 3. Evaluating/changes in participant workload and tasks. 4. Relaxation techniques. 5. Physical exercise. 6. Psychiatric evaluation when indicated by depression test score. On average each patient attended six one-hour sessions over the course of four months. A group of 34 employees referred to the Clinic of Occupational Medicine by their general practitioners served as a control group. Each participant had a one-hour consultation at baseline and after four months. A specialist in occupational medicine carried out all sessions. Return To Work (RTW), defined as having a job and not being on sick leave at the census, was used as outcome measure four months after baseline, and after one and two years. Results: The level of sick leave in the stress treatment group dropped from 52% to 16% during the first four months of follow-up and remained stable. In the control group, the reduction in sick leave was significantly smaller, ranging from 48% at baseline to 27% after four months and 24% after one year. No statistically significant difference between the two groups was observed after one and two years. Age below 50 years and being a manager increased the odds ratio for RTW after one and two years, while gender and depression had no predictive value. Conclusions: The stress treatment programme showed a significant effect on the return to work rate. The stress treatment programme seems feasible for general practitioners.

Source: http://www.biomedcentral.com/1471-2458/10/658

Functional multidisciplinary rehabilitation versus outpatient physiotherapy for non-specific low back pain: randomised controlled trial

INTRODUCTION: In recent decades the treatment of non-specific low back pain has turned to active modalities, some of which were based on cognitive-behavioural principles. Non-randomised studies clearly favour functional multidisciplinary rehabilitation over outpatient physiotherapy. However, systematic reviews and meta-analysis provide contradictory evidence regarding the effects on return to work and functional status. The aim of the present randomised study was to compare long-term functional and work status after 3-week functional multidisciplinary rehabilitation or 18 supervised outpatient physiotherapy sessions. METHODS: 109 patients with non-specific low back pain were randomised to either a 3-week functional multidisciplinary rehabilitation programme, including physical and ergonomic training, psychological pain management, back school and information, or 18 sessions of active outpatient physiotherapy over 9 weeks. Primary outcomes were functional disability (Oswestry) and work status. Secondary outcomes were lifting capacity (Spinal Function Sort and PILE test), lumbar range-of-motion (modified-modified Schöber and fingertip-to-floor tests), trunk muscle endurance (Shirado and Biering-Sörensen tests) and aerobic capacity (modified Bruce test). RESULTS: Oswestry disability index was improved to a significantly greater extent after functional multidisciplinary rehabilitation compared to outpatient physiotherapy at follow-up of 9 weeks (P = 0.012), 9 months (P = 0.023) and 12 months (P = 0.011). Work status was significantly improved after functional multidisciplinary rehabilitation only (P = 0.012), resulting in a significant difference compared to outpatient physiotherapy at 12 months’ follow-up (P = 0.012). Secondary outcome results were more contrasted. CONCLUSIONS: Functional multidisciplinary rehabilitation was better than outpatient physiotherapy in improving functional and work status. From an economic point of view, these results should be backed up by a cost-effectiveness study.

Source: http://www.smw.ch/content/smw-2010-13133/

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