2011-08-01 12:00 - Messages

Fear-Avoidance Beliefs, Catastrophizing, and Distress: A Longitudinal Subgroup Analysis on Patients With Musculoskeletal Pain

Westman, Anders E. et al. (2011). Fear-Avoidance Beliefs, Catastrophizing, and Distress: A Longitudinal Subgroup Analysis on Patients With Musculoskeletal Pain. Clinical Journal of Pain, 27 (7) : 567–577.

Purpose: The aim of the present study was to describe fear-avoidance beliefs, catastrophizing, and emotional distress among musculoskeletal pain patients in primary healthcare and to explore the relationship of psychological risk profiles for pain, function, and sick leave from baseline through 1-year and 3-year follow-ups. Methods: Ratings from 110 musculoskeletal pain patients were collected and cluster analysis was used to identify subgroups with similar patterns on fear-avoidance beliefs, catastrophizing, and emotional distress. The clusters were examined cross-sectionally and prospectively on sick leave, function, and pain. Results: Five distinct profiles were found: “low scores cluster,” “high score cluster,” “fear-avoidance beliefs and catastrophizing cluster,” “distress only cluster,” and “medium catastrophizing cluster.” The “low scores cluster” and “distress only cluster” had the most favorable scores on outcome variables. The analysis of common developmental pathways showed considerable stability over time. Reorganization of clusters in a psychological “high risk cluster” and a “low risk cluster” showed significant differences at 1-year and 3-year follow-ups in functional ability as well as in decreased sick leave. There were no significant differences between the groups on average pain ratings at the 2 measure points. Conclusions: Distinct profiles of catastrophizing, fear-avoidance beliefs, and emotional distress were extracted and meaningfully related to future sick leave and dysfunction outcomes. The structures of the profiles were essentially stable and became more accentuated across a 3-year period. The results underscore the need to address psychological aspects as fear-avoidance beliefs, catastrophizing, and emotional distress in the management of patients with musculoskeletal pain and may open the path for a better tailored treatment approach for this patient group.

Source: http://journals.lww.com/clinicalpain/Abstract/2011/09000/Fear_Avoidance_Beliefs,_Catastrophizing,_and.2.aspx

Swedish rehabilitation professionals' perspectives on work ability assessments in a changing sickness insurance system

Stååhl, Christian et al. (2011). Swedish rehabilitation professionals' perspectives on work ability assessments in a changing sickness insurance system. Disability & Rehabilitation, 33 (15-16): 1373-1382.

Purpose. Changes in the Swedish sickness insurance system shifts focus from return-to-work to labour market reintegration. This article analyses Swedish rehabilitation professionals' perspectives on how the changed regulations affect practice, with a special focus on work ability assessments. Methods. Two groups of representatives ((n == 15)) from organizations involved in rehabilitation and return-to-work met at seven occations. The groups worked with a tutor with a problem-based approach to discuss how their practice is influenced by the changed regulations. The material was analysed inductively using qualitative content analysis. Results. The new regulations require developed cooperation among insurance, health care, employers and occupational health care; however, these demands are not met in practice. In work ability assessments, several flaws regarding competence and cooperation are identified. An increasing number of people previously assessed as work disabled are required to participate in labour market reintegration, which puts demands on professionals to engage in motivational activities, although this is perceived as hopeless due to the group's lack of employability. Conclusions. The possibility for employers to sidestep their responsibility has increased with changed regulations. The overall lack of cooperation between relevant actors and the lack of relevant competence undermine the ambitions of activation and reintegration in the reform.

Source: http://www.ingentaconnect.com/content/apl/tids/2011/00000033/f0020015/art00010

The quest for greater flexibility: Creative innovations for workers with arthritis

Arthritis is a leading cause of disability among adults, and it often affects them in the prime of their career. How it’s approached in the workplace can make all the difference, according to a new study by an adjunct scientist at the Institute for Work & Health. An accessible and supportive workplace is the litmus test as to whether a person with arthritis can continue working. This is the implication of a study led by Institute for Work & Health (IWH) Adjunct Scientist Dr. Monique Gignac, which explored the sometimes mercurial combination of arthritis and work. Gignac and her team, including IWH Scientist Dr. Dorcas Beaton and Research Associate Ken Tang, completed a four-year study examining workplace activity limitations related to arthritis and their relationship to job modification and outcomes. The researchers concluded that employers—who may be unaware of the problem—can do things to help. “Policies like flex time can have a huge impact,” says Gignac, an associate professor at the University of Toronto. Disability related to arthritis has been linked to work loss and lost productivity. However, health factors don’t tell the whole story. They combine with other factors, such as the environment, interpersonal issues, including workplace support, and psychological factors like job stress, to predict a variety of work outcomes—absenteeism, reduced hours and job changes, for example. People with arthritis highlight a number of difficulties working. These relate to managing symptoms; worries about remaining employed; decisions about whether to disclose one’s condition; balancing work, health and family; and difficulties with the pace of work. Many employers are unaware that workers are having such difficulties. That’s because those with arthritis sometimes hesitate to tell others about their chronic condition for fear of looking sick, being seen as a poor worker or having limitations placed on their positions.

Source : http://www.iwh.on.ca/at-work/65/the-quest-for-greater-flexibility

Gignac, M. A. M., Cao, X., Tang, K. and Beaton, D. E. (2011), Examination of arthritis-related work place activity limitations and intermittent disability over four-and-a-half years and its relationship to job modifications and outcomes. Arthritis Care & Research, 63: 953–962. doi: 10.1002/acr.20456

 

Pain Catastrophizing and Pain-related Emotions: Influence of Age and Type of Pain

Ruscheweyh, Ruth et al. (2011). Pain Catastrophizing and Pain-related Emotions: Influence of Age and Type of Pain. Clinical Journal of Pain, 27 (7): 578–586.

Objectives: One of the most important determinants of the individual pain experience is pain catastrophizing, reflecting an excessively negative cognitive and emotional orientation toward pain. Its assessment by standard questionnaires, which ask participants to reflect on idiosyncratic past painful experiences, is important. It is currently not known whether different types of pain differently shape pain catastrophizing. Furthermore, as the regulation of emotions changes during the life span, age may affect pain catastrophizing, as well. Methods: In this study, 134 healthy participants, differentiated into 2 age groups (20 to 40 y and 50 to 70 y), completed the Pain Catastrophizing Scale with reference to their past experiences with 3 common types of day-to-day pain (headache, back pain, dental pain). Results: On average, the different types of pain shared one-third of the variance in pain catastrophizing. Pain-type-specific catastrophizing scores were more strongly related to ratings of sensory and emotional pain characteristics than standard catastrophizing scores. In younger adults, pain catastrophizing was preferentially associated with emotional responses to pain whereas in older adults, it was preferentially associated with pain intensity ratings. Discussion: This study indicates that for day-to-day pain, catastrophizing significantly depends on pain type. The results suggest the use of pain-type-specific instructions for catastrophizing questionnaires because it may lead to better prediction of clinically relevant pain characteristics, such as pain intensity. Furthermore, pain catastrophizing seems to change during the life span, with a higher engagement of emotional versus sensory pain processing in younger compared with older adults.

Source: http://journals.lww.com/clinicalpain/Abstract/2011/09000/Pain_Catastrophizing_and_Pain_related_Emotions_.3.aspx

A prospective cohort study on severe pain as a risk factor for long-term sickness absence in blue- and white-collar workers

Andersen, Lars Louis et al. (2011). A prospective cohort study on severe pain as a risk factor for long-term sickness absence in blue- and white-collar workers. Occuputional and Environmental Medicine, 68:590-592.

 

Source: http://oem.bmj.com/content/68/8/590.abstract

Objective To estimate the impact of pain in different body regions on future long-term sickness absence (LTSA) among blue- and white-collar workers. Method Prospective cohort study in a representative sample of 5603 employees (the Danish Work Environment Cohort Study) interviewed in 2000, and followed in 2001–2002 in a national sickness absence register. Cox regression analysis was performed to assess the risk estimates of mutually adjusted severe pain in the neck/shoulder, low back, hand/wrist and knees for onset of LTSA, defined as receiving sickness absence compensation for at least 3 consecutive weeks. Age, gender, body mass index, smoking and diagnosed disease were controlled for. Results In 2000 the prevalence among blue- and white-collar workers, respectively, of severe pain was 33% and 29% (neck/shoulder), 33% and 25% (low back), 16% and 11% (hand/wrists), and 16% and 12% (knees). During 2001–2002, the prevalence of LTSA among blue- and white-collar workers was 18% and 12%, respectively. Hand/wrist pain (HR 1.49, 95% CI 1.23 to 1.81) and low back pain (HR 1.30, 95% CI 1.11 to 1.53) were significant risk factors among the total cohort. Neck/shoulder pain was a significant risk factor among white-collar workers only (HR 1.35, 95% CI 1.21 to 1.85). Knee pain was not a significant risk factor. Conclusion While hand/wrist pain and low back pain are general risk factors for LTSA, neck/shoulder pain is a specific risk factor among white-collar workers. This study suggests the potential for preventing future LTSA through interventions to manage or reduce musculoskeletal pain.

Prognostic Factors of Long Term Disability Due to Mental Disorders: A Systematic Review
Adaptations to pain rehabilitation programmes for non-native patients with chronic pain
Maurits Sloots, Jos H. M. Dekker, Edien A. C. Bartels, Jan Henricus Geertzen, Joost Dekker
Disability and Rehabilitation Jan 2011, Vol. 33, No. 15-16: 1324–1329.



Read More: http://informahealthcare.com/toc/dre/33/15-16
Adaptations to pain rehabilitation programmes for non-native patients with chronic pain
Maurits Sloots, Jos H. M. Dekker, Edien A. C. Bartels, Jan Henricus Geertzen, Joost Dekker
Disability and Rehabilitation Jan 2011, Vol. 33, No. 15-16: 1324–1329.



Read More: http://informahealthcare.com/toc/dre/33/15-16
Cornelius, L. R. et al. (2011). Prognostic Factors of Long Term Disability Due to Mental Disorders: A Systematic Review. Journal of Occupational Rehabilitation, 21 (2): 259-274. (article en libre accès)
Introduction In the past few decades, mental health problems have increasingly contributed to sickness absence and long-term disability. However, little is known about prognostic factors of return to work (RTW) and disability of persons already on sick leave due to mental health problems. Understanding these factors may help to develop effective prevention and intervention strategies to shorten the duration of disability and facilitate RTW. Method We reviewed systematically current scientific evidence about prognostic factors for mental health related long term disability, RTW and symptom recovery. Searching PubMed, PsycINFO, Embase, Cinahl and Business Source Premier, we selected articles with a publication date from January 1990 to March 2009, describing longitudinal cohort studies with a follow-up period of at least 1 year. Participants were persons on sick leave or receiving disability benefit at baseline. We assessed the methodological quality of included studies using an established criteria list. Consistent findings in at least two high quality studies were defined as strong evidence and positive findings in one high quality study were defined as limited evidence. Results Out of 796 studies, we included seven articles, all of high methodological quality describing a range of prognostic factors, according to the ICF-model categorized as health-related, personal and external factors. We found strong evidence that older age (>50 years) is associated with continuing disability and longer time to RTW. There is limited evidence for the association of other personal factors (gender, education, history of previous sickness absence, negative recovery expectation, socio-economic status), health related (stress-related and shoulder/back pain, depression/anxiety disorder) and external i.e., job-related factors (unemployment, quality and continuity of occupational care, supervisor behavior) with disability and RTW. We found limited evidence for the association of personal/external factors (education, sole breadwinner, partial/full RTW, changing work tasks) with symptom recovery. Conclusion This systematic review identifies a number of prognostic factors, some more or less consistent with findings in related literature (mental health factors, age, history of previous sickness absence, negative recovery expectation, socio-economic status, unemployment, quality and continuity of occupational care), while other prognostic factors (gender, level of education, sole breadwinner, supervisor support) conflict with existing evidence. There is still great need for research on modifiable prognostic factors of continuing disability and RTW among benefit claimants with mental health problems. Recommendations are made as to directions and methodological quality of further research, i.e., prognostic cohort studies.
A Typology of Sick-Listed Claimants to Improve Communication Skills for Social Insurance Physicians during Medical Disability Assessment Interviews

Van Rijssen, H. J. et al. (2011). A Typology of Sick-Listed Claimants to Improve Communication Skills for Social Insurance Physicians during Medical Disability Assessment Interviews. Journal of Occupational Rehabilitation, 21 (1): 66-75.

Introduction Role play with standardised simulated patients is often included in communication training. However, regarding physician-patient encounters in medical disability assessment interviews it is unclear what should be included in the scenarios for actors. The first objective of this study was to determine which types of medical disability claimants can be distinguished based on behavioural determinants. The second objective was to determine if these types of claimants differed in their perception of communication behaviour and their satisfaction with the communication with physicians. Methods Questionnaire data were collected from 56 Dutch claimants for 13 behavioural determinants before their assessment interview, and for 12 behavioural and satisfaction variables afterwards. For the first objective cluster analyses were performed and for the second objective linear regression analyses were performed. Results The results showed that three types of claimants could be distinguished: insecure support-seeking claimants, confident claimants, and socially isolated claimants. Overall, claimants were positive about the communication with the physician: insecure support-seeking claimants were satisfied and confident claimants were highly satisfied, but socially isolated claimants were unsatisfied. Conclusion Scenarios for standardised simulated patients should include different types of claimants. In training, special attention should be given to communication with socially isolated claimants.

Source: http://www.springerlink.com/content/844v632537224415/

Factors associated with working status among workers assessed at a specialized worker's compensation board psychological trauma program

Hensel, Jennifer M. et al. (2011). Factors associated with working status among workers assessed at a specialized worker's compensation board psychological trauma program. American Journal of Industrial Medicine, 54 (7): 552-559.

Psychological morbidity following trauma occurring in the workplace can impact return to work but few studies have investigated this. Methods: This study was a secondary analysis of administrative data from a specialized workers' compensation board psychological trauma program in Toronto, Canada. Unadjusted and adjusted logistic regression analyses were used to examine factors associated with working status at the time of assessment for workers referred within 1 year of traumatic event. Results: Having a disrupted marriage (OR = 3.06, 95% CI 1.14–8.20), sustaining a permanently impairing physical injury (OR = 2.76, 95% CI 1.01–7.55) and the presence of secondary psychiatric diagnoses (OR = 2.55, 95% CI 1.34–4.83) were significantly associated with not working at the time of assessment. When the analyses were subset to workers without permanently impairing physical injuries, only the presence of additional psychiatric diagnoses was significantly associated with not working (OR = 3.81, 95% CI 1.48–9.83). Conclusions: Return to work after trauma can be a complicated and difficult to treat problem. Social supports, physical rehabilitation and treatment of complex mental health problems likely play a crucial role in improving outcomes.

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