2011-06-01 12:00 - Messages
Glâssel, Andrea et al. (2011). Vocational Rehabilitation From the Client’s Perspective Using the International Classification of Functioning, Disability and Health (ICF) as a Reference. Journal of Occupational Rehabilitation, 21(2): 167-178. (Accès limité)
Introduction A mixed-methods (qualitative-quantitative), multicenter study was conducted using a focus group design to explore the lived experiences of persons in vocational rehabilitation (VR) with regard to functioning and contextual factors using six open-ended questions related to the ICF components. The results were classified by using the International Classification of Functioning, Disability and Health (ICF) as a frame of reference. Methods The meaningful concepts within the transcribed data were identified and linked to ICF categories according to established linking rules. Results The seven focus groups with 26 participants yielded a total of 4,813 relevant concepts which were linked to a total of 160 different second-level ICF categories. From the client perspective, the ICF components (a) body functions, (b) activities and participation and (c) environmental factors were equally represented, while (d) body structures appeared less frequently. Out of the total number of concepts, 864 concepts (18%) were assigned to the ICF component personal factors which is not yet classified but could indicate important aspects of resource management and strategy development of patients in VR. Conclusion Therefore, VR of patients must not be limited to anatomical and pathophysiologic changes, but should also consider a more comprehensive view which includes client’s demands, strategies and resources in daily life and the context around the individual and social circumstances of their work situation.
Stedman, Amanda, and Thomas, Yvonne (2011) Reflecting on our effectiveness: occupational therapy interventions with Indigenous clients. Australian Occupational Therapy Journal, 58 (1). pp. 43-49.
Background: The health and social inequity experienced by the Indigenous population of Australia has resulted in the establishment of a national priority to close the gap in health outcomes. The occupational therapy profession is being urged to ensure the cultural appropriateness of practice interventions for Indigenous people. Although the importance of practice modification has been recognised by the occupational therapy profession, minimal research has been conducted in relation to older Aboriginal and Torres Strait Islander populations. Method: The aim of this study was to explore occupational therapists' views of their effectiveness when practising with Indigenous clients. The qualitative study utilises in-depth interviews with occupational therapists working in a regional centre of North Queensland to explore their views of effectiveness when modifying interventions for Indigenous clients. Results: Inductive thematic analysis of the descriptive data generated four themes. The first theme provides insights into participants' views of effectiveness when providing interventions to Indigenous clients. The remaining themes identify specific modification as (i) awareness of culture and respect for the individual, (ii) developing different expectations and (iii) ensuring equality of outcomes. Conclusion: The study supports the importance of modifying practice to provide culturally safe occupational therapy to Indigenous clients. The importance of adopting a client-centred approach in modifying interventions is also highlighted. Self-reflection by the therapist regarding their occupational therapy practice with Indigenous clients is strongly suggested. In response, a self-reflection tool has been developed from the findings of the study.
Cheng, A. S., Loisel, P., Feuerstein, M. (2011). Return-to-Work Activities in a Chinese Cultural Context. Journal of Occupational Rehabilitation, 21 (supplement 1): 44-54. (Accès limité)
Introduction Several studies have been conducted in the West showing that return to work (RTW) coordination is a key element to facilitate RTW of injured workers and to prevent work disabilities. However, no study has been carried out to investigate the scope of RTW activities in China. The purpose of this study was to explore the views of key RTW stakeholders on necessary activities for RTW coordination. Methods A cross-sectional survey was conducted in Guangdong province of China. A three-tiered approach including focus group discussions and panel reviews was used to collect RTW activities, analyze the content validity, and classify domains. Descriptive statistics and intra-class correlation (ICC) were used to describe the importance of RTW activities and the degree of agreement on the classification of different domains. A Kruskal–Wallis test with subsequent post-hoc analysis using multiple Mann–Whitney U tests was carried out to check for any differences in the domains of different RTW activities among RTW stakeholders. Results The domains of RTW activities in China were similar to those in the West and included workplace assessment and mediation, social problem solving, role and liability clarification, and medical advice. Good agreement (ICC: 0.729–0.844) on the classification of RTW activities into different domains was found. The domains of the RTW activities of healthcare providers differed from those of employers (P = 0.002) and injured workers (P = 0.001). However, there was no significant difference between employers and injured workers. Conclusions This study indicated that differences among stakeholders were observed in terms of areas of relative priority. There is a clear need for research and training in China to establish a nation-wide terminology for RTW coordination, facilitate cross-provincial studies and work toward a more integrated system addressing the diverse perspectives of stakeholders involved in the RTW process.
Willert, Morten Vejs et al. (2011). Effects of a stress management intervention on absenteeism and return to work – results from a randomized wait-list controlled trial. Scandinavian Journal of Work Environment and Health, 37(3): 186-195. (Accès limité)
Objectives High levels of work-related stress are associated with increased absenteeism from work and reduced work ability. In this study, we investigated the effects of a stress management intervention on absenteeism and return to work. Methods We randomized 102 participants into either the intervention or wait-list control (WLC) group. The intervention group received the intervention in weeks 1–16 from baseline, and the WLC group received the intervention in weeks 17–32. Self-reported data on absenteeism (number of days full- or part-time absent from work within the previous three months) were obtained at 16, 32, and 48 weeks follow-up. Register-based data on long-term absence from work were drawn from the Danish public transfer payments (DREAM) database from baseline and 48 weeks onwards. The DREAM database contains weekly information on long-term sickness absence compensation. The threshold to enter DREAM is sick leave for two consecutive weeks. Results At follow-up in week 16, self-reported absenteeism in the intervention group [median 11 days (range 3–25)] was lower (P=0.02) than in the WLC group [median 45 days (range 19–60)], corresponding to a 29% [95% confidence interval (95% CI) 5–52] reduction. On register-based data (cumulated weeks in DREAM, weeks 1–16), the intervention group median [6 weeks (range 0–11)] was lower than that of the WLC group [median 12 weeks (range 8–16)], though not significantly (P=0.06), corresponding to a 21% (95% CI 0–42) reduction. For return to work, a hazard ratio of 1.58 (95% CI 0.89–2.81) favoring the intervention group was found (P=0.12). Conclusions The intervention reduces self-reported absenteeism from work. A similar trend was found from register-based records. No conclusive evidence was found for return to work.
Durand, Marie-José et al. (2011). Relationship between the margin of manoeuvre and the return to work after a long-term absence due to a musculoskeletal disorder: an exploratory study. Disability & Rehabilitation, 33(13-14): 1245-1252. (Accès limité)
Purpose. The application of the margin of manoeuvre (MM) concept in work rehabilitation is new. It allows for variations in both health status and work demands, and the interaction between the two, to be taken into account. The objective of this exploratory study was to document the relationship between the presence of an MM in the workplace and the return to work (RTW), after a long-term absence. Methods. This study use
Leresche, L. (2011). Defining Gender Disparities in Pain Management. Clinical Orthopaedics and Related Research, 469(7): 1871-1877. (Accès limité)
Background: Prevalence rates of most musculoskeletal pain conditions are higher among women than men. Reasons for these prevalence disparities likely include sex differences in basic pain mechanisms and gender differences in psychosocial factors. Questions/purposes: The purposes of this review were to (1) identify reasons for differences in pain prevalence between men and women, (2) assess whether musculoskeletal pain conditions are differently treated in men and women, and (3) identify reasons for sex/gender disparities in pain treatment. Methods : A MEDLINE search was conducted using the terms “pain” or “musculoskeletal pain” and “gender differences” or “sex differences” with “health care,” “health services,” and “physician, attitude.” Articles judged relevant were selected for inclusion. Where Are We Now? Higher pain prevalence in women is consistently observed but not well understood. The relative contributions of sex differences in pain mechanisms and gender differences in psychosocial factors (eg, coping, social roles) to explaining differences in prevalence are not yet clear. Gender disparities in the amount of healthcare use for pain may be partially explained by the experience of higher-intensity pain in women. Pain intensity also seems to be a major factor influencing treatment, especially the prescription of medications for acute pain. However, clinicians’ gender stereotypes, as well as the clinician’s own gender, appear to influence diagnostic and treatment decisions for more persistent pain problems. Where Do We Need To Go? The ultimate goal is optimal pain control for each individual, with gender being one difference between individuals. How Do We Get There? Further research is needed to address all three major purposes, with particular attention to whether gender-specific pain treatment may sometimes be warranted.
Lydell, Marie et al. (2011). Thoughts and feelings of future working life as a predictor of return to work: a combined qualitative and quantitative study of sick-listed persons with musculoskeletal disorders. Disability & Rehabilitation, 33(13-14) : 1262-1271. (Accès limité)
Purpose. The main aim of this study was to describe the thoughts and feelings of future working life related to return to work (RTW) in sick-listed persons due to musculoskeletal disorders (MSD). Further aim was to compare these descriptions with the person's actual working situation 1, 5 and 10 years after a rehabilitation period. Methods. This study consisted of two parts. The first part had an explorative design, and qualitative content analysis was chosen in order to analyse the response to an open question regarding future working life answered before, persons sick-listed due to MSD (n = 320), took part in a rehabilitation programme 10 years ago. The second part had a prospective design and quantitative analysis was used to compare the results of the qualitative analysis with RTW and the working situation 1, 5 and 10 years after baseline. Results. Three categories emerged from the data with a total of nine subcategories. In the categories Motivation and optimism and Limitations to overcome, there were significantly more persons who had RTW 1 year after baseline when compared with the category Hindrance and hesitation. There were also some significant differences between the subcategories. Conclusions. The question, regarding thoughts and feelings of future working life, may be a simple screening method to predict RTW in persons sick-listed with MSD. This will guide the rehabilitation team to adjust the rehabilitation to each person's needs and facilitating RTW.
Fan, Z. Joyce et al. (2011). Responsiveness of the QuickDASH and SF-12 in Workers with Neck or Upper Extremity Musculoskeletal Disorders: One-Year Follow-Up. Journal of Occupational Rehabilitation, 21(2): 234-243. (Accès limité)
Introduction Questionnaires that measure functional status such as the Disability of the Arm, Shoulder and Hand (QuickDASH) and the Medical Outcomes Study 12-item Short-Form Health Survey (SF-12) can quantify the impact of health on performance. Little is known about whether these questionnaires can be used as a tool for measuring disabilities among workers. We compare the responsiveness of these two functional status questionnaires to changes in clinical outcomes of neck or upper extremity musculoskeletal disorders (UEMSD) among active workers in a longitudinal study. Methods We evaluated the effect size (ES) and standardized response means (SRM) of the QuickDASH and the SF-12 for 148 workers who were divided into four subgroups based on the diagnosis status change between baseline and 1-year visit. Results The ES and SRM for QuickDASH scores were 0.6/0.6 for the 50 subjects who became incident symptomatic neck or UEMSD cases, 1.3/1.0 for the 18 subjects who became incident clinical cases of neck or UEMSD, −1.0/−1.1 for the 46 subjects who recovered from having neck or UEMSD symptoms, and −1.1/−1.1 for the 34 subjects who recovered from being neck or UEMSD clinical cases. The correspondent ES/SRM for the QuickDASH work module were 0.4/0.3, 0.7/0.5, −0.6/−0.4, and −1.0/−0.8, respectively. The correspondent ES/SRM for the physical component scores of SF-12 (PCS12) for the four subgroups were 0.2/0.2, −0.9/−0.6, 0.3/0.2, and 0.3/0.3, respectively. Conclusions The QuickDASH scores were responsive to changes among active workers who were neck or UEMSD symptomatic or clinical case. PCS12 scores were sufficient only for use in clinical case status change.
Wååhlin-Norgren, Charlotte et al. (2011). Is an expert diagnosis enough for assessment of sick leave for employees with musculoskeletal and mental disorders?. Disability & Rehabilitation, 33(13-14): 1147-1156. (accès limité)
Purpose. The aim of this study is to determine differences in self-reported work ability, work conditions, health and function between ICD-10 groups with musculoskeletal disorders (MSD), mental disorders (MDs) and MSD ++ MD and to determine which variables are associated with sick leave. Method. A cross-sectional study of 210 employees was conducted at an occupational health service unit. Physiotherapists and physicians classified the employees' health problems according to ICD-10 and the employees answered a questionnaire with questions on demographic variables, health, functioning, work ability and work conditions. Results. Forty-four per cent of the employees had MSD, 22%% had MD and 34%% had a MSD ++ MD. The group on sick leave had worse results for all health and work measures. Belonging to the MD group, belonging to the MSD ++ MD group, having poor work ability and functioning were associated with being on sick leave. The value for the model explaining being on sick leave was 0.63 (Nagelkerke R2). Conclusions. Having a diagnosis of MD based on a professional opinion and having poor work ability and functioning based on self-reports are associated with being on sick leave. The results suggest that self-reported data could be used to complement the expert-based diagnosis.
Brouwer, Sandra et al. (2011). Return-to-Work Self-Efficacy: Development and Validation of a Scale in Claimants with Musculoskeletal Disorders. Journal of Occupational Rehabilitation, 21(2): 244-258. (Article en libre accès)
Introduction We report on the development and validation of a 10-item scale assessing self-efficacy within the return-to-work context, the Return-to-Work Self-Efficacy (RTWSE) scale. Methods Lost-time claimants completed a telephone survey 1 month (n = 632) and 6 months (n = 446) after a work-related musculoskeletal injury. Exploratory (Varimax and Promax rotation) and confirmatory factor analyses of self-efficacy items were conducted with two separate subsamples at both time points. Construct validity was examined by comparing scale measurements and theoretically derived constructs, and the phase specificity of RTWSE was studied by examining changes in strength of relationships between the RTWSE Subscales and the other constructs at both time measures. Results Factor analyses supported three underlying factors: (1) Obtaining help from supervisor, (2) Coping with pain (3) Obtaining help from co-workers. Internal consistency (alpha) for the three subscales ranged from 0.66 to 0.93. The total variance explained was 68% at 1-month follow-up and 76% at 6-month follow-up. Confirmatory factor analyses had satisfactory fit indices to confirm the initial model. With regard to construct validity: relationships of RTWSE with depressive symptoms, fear-avoidance, pain, and general health, were generally in the hypothesized direction. However, the hypothesis that less advanced stages of change on the Readiness for RTW scale would be associated with lower RTWSE could not be completely confirmed: on all RTWSE subscales, RTWSE decreased significantly for a subset of participants who started working again. Moreover, only Pain RTWSE was significantly associated with RTW status and duration of work disability. With regard to the phase specificity, the strength of association between RTWSE and other constructs was stronger at 6 months post-injury compared to 1 month post-injury. Conclusions A final 10-item version of the RTWSE has adequate internal consistency and validity to assess the confidence of injured workers to obtain help from supervisor and co-workers and to cope with pain. With regard to phase specificity, stronger associations between RTWSE and other constructs at 6-month follow-up suggest that the association between these psychological constructs consolidates over time after the disruptive event of the injury.
Monsivais, Diane B. (2011). Promoting Culturally Competent Chronic Pain Management Using the Clinically Relevant Continuum Model. Nursing Clinics of North America, 46(2): 163-169.
This article reviews the culture of biomedicine and current practices in pain management education, which often merge to create a hostile environment for effective chronic pain care. Areas of cultural tensions in chronic pain frequently involve the struggle to achieve credibility regarding one's complaints of pain (or being believed that the pain is real) and complying with pain medication protocols. The clinically relevant continuum model is presented as a framework allowing providers to approach care from an evidence-based, culturally appropriate (patient centered) perspective that takes into account the highest level of evidence available, provider expertise, and patient preferences and values.
Horsley, Robyn (2011). Factors that affect the occurrence and chronicity of occupation-related musculoskeletal disorders. Best Practice & Research Clinical Rheumatology, 25(1): 103-115. (Accès limité)
The components that affect the occurrence and chronicity of musculoskeletal disease are multifactorial. The return to work process and prevention of future chronic disability commences at the time of the initial assessment. The clinician can identify, at an early stage, patients with negative expectations of return to work and adopt a care plan oriented to functional adaptation. Medical and psychosocial treatment plans taking account of coping preferences, beliefs and practices are more likely to help prevent chronic disability. Other factors that can influence the long-term disability rate include medically discretionary or unnecessary time off work and litigation itself. Workplace factors can result in unnecessary absenteeism and poorly managed presenteeism.
Tengland, Per-Anders (2011). The Concept of Work Ability. Journal of Occupational Rehabilitation, 21(2): 275-285.
Introduction The concept of “work ability” is central for many sciences, especially for those related to working life and to rehabilitation. It is one of the important concepts in legislation regulating sickness insurance. How the concept is defined therefore has important normative implications. The concept is, however, often not sufficiently well defined. Aim and Method The objective of this paper is to clarify, through conceptual analysis, what the concept can and should mean, and to propose a useful definition for scientific and practical work. Results Several of the defining characteristics found in the literature are critically scrutinized and discussed, namely health, basic standard competence, occupational competence, occupational virtues, and motivation. These characteristics are related to the work tasks and the work environment. One conclusion is that we need two definitions of work ability, one for specific jobs that require special training or education, and one for jobs that most people can manage given a short period of practice. Having work ability, in the first sense, means having the occupational competence, the health required for the competence, and the occupational virtues that are required for managing the work tasks, assuming that the tasks are reasonable and that the work environment is acceptable. In the second sense, having work ability is having the health, the basic standard competence and the relevant occupational virtues required for managing some kind of job, assuming that the work tasks are reasonable and that the work environment is acceptable. Conclusion These definitions give us tools for understanding and discussing the complex, holistic and dynamic aspects of work ability, and they can lay the foundations for the creation of instruments for evaluating work ability, as well as help formulate strategies for rehabilitation.
James, Carol et al. (2011). The Return-To-Work Coordinator Role: Qualitative Insights for Nursing. Journal of Occupational Rehabilitation, 21(2): 220-227. (Accès limité)
Introduction Few studies have examined the role of RTW Coordination from the perspective of RTW Coordinator's. Furthermore there is little health specific literature on returning injured nurses to work despite the critical workforce shortages of these professionals. The study aimed to examine barriers and facilitators identified by the RTW Coordinator to returning injured nurses to work and influences on specific health sector or geographic location. The study sought to gain insights into the professional backgrounds and everyday work practices of RTW Coordinators. Method Five focus groups were conducted in metropolitan and rural areas of NSW, Australia. Twenty-five RTW Coordinators from 14 different organisations participated in the study. The focus groups included participants representing different health sectors (aged, disability, public and private hospital and community health). Results The data analysis identified information pertaining to the qualifications and backgrounds of RTW Coordinators; the role of RTW Coordinators' within organisational structures; a range of technical knowledge and personal qualities for RTW Coordination and important elements of the case management style used to facilitate RTW. Conclusions The findings identified a wide range of professional backgrounds that RTW Coordinators bring to the role and the impact of organisational structures on the ability to effectively undertake RTW responsibilities. The study found that interpersonal skills of RTW Coordinators may be more important to facilitate RTW than a healthcare background. A collaborative case management style was also highlighted and the difficulties associated with juggling conflicts of interest, multiple organisational roles and the emotional impact of the work.
Maiwald, K. et al. (2011). Evaluation of a Workplace Disability Prevention Intervention in Canada: Examining Differing Perceptions of Stakeholders. Journal of Occupational Rehabilitation 21(2) : 179-189. (Article en libre accès)
Introduction Workplace disability prevention is important, but stakeholders can differ in their appreciation of such interventions. We present a responsive evaluation of a workplace disability prevention intervention in a Canadian healthcare organization. Three groups of stakeholders were included: designers of the intervention, deliverers, and workers. The aim was to examine the appreciation of this intervention by analyzing the discrepancies with respect to what these various stakeholders see as the causes of work disability, what the intervention should aim at to address this problem, and to what extent the intervention works in practice. Methods A qualitative research method was used, including data-triangulation: (a) documentary materials; (b) semi-structured interviews with the deliverers and workers (n = 14); (c) participatory observations of group meetings (n = 6); (d) member-checking meetings (n = 3); (e) focus-group meetings (n = 2). A grounded theory approach, including some ethnographic methodology, was used for the data-analysis. Results Stakeholders' perceptions of causes for work disability differ, as do preferred strategies for prevention. Designers proposed work-directed measures to change the workplace and work organizations, and individual-directed measures to change workers' behaviour. Deliverers targeted individual-directed measures, however, workers were mostly seeking work-directed measures. To assess how the intervention was working, designers sought a wide range of outcome measures. Deliverers focused on measurable outcomes targeted at reducing work time-loss. Workers perceived that this intervention offered short-term benefits yet fell short in ensuring sustainable return-to-work. Conclusion This study provides understanding of where discrepancies between stakeholders' perceptions about interventions come from. Our findings have implications for workplace disability prevention intervention development, implementation and evaluation criteria.
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