2012-03-01 12:00 - Messages

Pain coping in injured workers with chronic pain

What's unique about workers?
Purpose: Pain caused by a work injury is a complex phenomenon comprising multiple factors, e.g. age, gender, prior health status, occupation, job demands, and severity of injury. Little research has focused on injured workers with chronic pain. This study investigates injured workers' pain coping. Methods: A descriptive cross-sectional study design was used to measure coping strategies of injured workers in a work rehabilitation program. Differences in coping strategies by demographics, injury-related variables, pain, disability, and depression were measured. Results: n = 479. The coping strategy with the highest mean score was "coping self statements" (Mean = 19.4, SD = 7.6), followed by "praying/hoping" (Mean = 18.2, SD = 9.7), and "catastrophizing" (Mean = 17.5, SD = 8.0). Statistical differences for coping strategies were noted between gender, marital status, depression levels, self-perceived disability levels, and pain (p < 0.01 for all). Conclusions: This study provided relevant information about how injured workers cope with pain. In conditions in which there may be a perceived lack of control (high pain intensity, high self-perceived disability, and high self rated depression), there were significantly higher amounts of both "catastrophizing" and "praying and hoping". Therefore, workers with high pain and high self-perceived disability are more likely catastrophize their pain, leading to poor recovery outcomes.

Source : Phillips LA, Carroll LJ, Voaklander DC, Gross DP, Beach JR. Disabil. Rehabil. 2012.
http://dx.doi.org/10.3109/09638288.2012.662261

Rehabilitation Interventions for Pain and Disability in Osteoarthritis...

Iversen, Maura Daly (2012). Rehabilitation Interventions for Pain and Disability in Osteoarthritis: A review of interventions including exercise, manual techniques, and assistive devices. Orthopaedic Nursing 31(8): 103-108.

OVERVIEW: Osteoarthritis (OA) results in progressive destruction of articular cartilage and bone at the joint margins, leading to impairments extending far beyond the synovial joint. Rehabilitation interventions that target specific impairments and activity restrictions can help restore independence and promote healthy living. Such interventions include exercise, physical modalities (ice, heat, ultrasonography), manual techniques (mobilization and manipulation), and assistive devices. The predominance of evidence on the effects of rehabilitation interventions for knee and hip OA suggest that they afford modest pain relief, reduced disability, and improved function. Research is needed to identify the modes of exercise and the effective doses for relief of symptoms and functional limitations.

Source: http://journals.lww.com/orthopaedicnursing/Abstract/2012/03000/Rehabilitation_Interventions_for_Pain_and.9.aspx 

Medical Interpretation for Immigrant Workers

Forst, Linda et coll. (2012). Medical Interpretation for Immigrant Workers. New Solutions: A Journal of Environment and Occupational Health Policy, 22(1): 37-50.

Foreign-born workers have high rates of occupational mortality and morbidity, despite downward trends for the U.S. workforce overall. They have limited access to health care services. Medical interpreters (MIs) facilitate care of acutely injured, low-English-proficiency (LEP) patients, including those sustaining occupational injuries. Our goal was to assess the potential for MIs to serve as advocates of LEP patients injured at work and to deliver preventive messages. We conducted interviews and a focus group of MIs regarding their attitudes toward foreign-born workers, knowledge of occupational health, and perceived roles. They were familiar with occupational injuries and sympathetic toward foreign-born workers, and they described their roles as conduits, cultural brokers, and advocates for hospitals, providers, and patients. More detailed and representative data would require a larger investigation. However, the time-sensitive nature of policy-making at this point mandates that occupational health stakeholders participate in the national dialogue on standards, training, and licensure for MIs to promote improved access and quality of health care for LEP patients who have been injured at work.

Source: http://baywood.metapress.com/app/home/contribution.asp?referrer=parent&backto=issue,4,9;journal,2,57;linkingpublicationresults,1:300327,1

Transitions between sickness absence, work, unemployment, and disability in Denmark 2004-2008

Pedersen, J. et coll. (2012). Transitions between sickness absence, work, unemployment, and disability in Denmark 2004-2008. Scandinavian Journal of Work, Environment, and Health (sous presse).

OBJECTIVES: Studies of labor market outcomes like sickness absence are usually restricted to a single outcome. This paper investigates the use of multi-state models for studying multiple transitions between sick-listing, work, unemployment, and disability pension by analyzing longitudinal register data. Every person sick-listed in Denmark during 2004 was followed until the spring of 2008. METHODS: A multi-state model was used to analyze transitions between four states: work, sickness absence, unemployment, and disability pension. The first three are possible recurrent states. The predictor variables include age group, gender, geographical region, chronic disease, temporary disease, self-employment sickness absence insurance, and pregnancy. The relative effects of previous transitions were also studied. RESULTS: Risk of transition from sickness absence to disability pension differs with age and geographical region. Those aged 20-29 years have an increased risk of transitioning from work to sickness absence and from sickness absence to unemployment. The self-employed have increased risk of transitioning from work to sickness absence. Those with chronic disease have increased risk of sickness absence, but also a greater probability of returning to work. Previous sickness absence increases the risk of transitioning from work to sickness absence, from sickness absence to unemployment, from work to unemployment, and from work to disability pension. CONCLUSIONS: The multi-state model is an effective way of analyzing register data and the transitions between sickness absence, work, unemployment, and disability pension. These methods can be used to develop better predictive models of sickness absence, return to work, unemployment, and disability.

Source: http://dx.doi.org/10.5271/sjweh.3293

How well do observed functional limitations explain the variance in Roland Morris scores in patients with chronic non-specific low back pain undergoing physiotherapy?

Caporaso, F. et coll.  How well do observed functional limitations explain the variance in Roland Morris scores in patients with chronic non-specific low back pain undergoing physiotherapy? European Spine Journal.

Self-rated activity limitations in patients with non-specific chronic low back pain (cLBP) do not correlate well with performance in traditional tests of impairment (e.g. back strength, ROM, etc.). Tests using more “functional activities” have therefore been recommended as alternative “objective” outcome measures. We examined the relationship between a battery of such tests and self-reported activity limitations, before and in response to physiotherapy, and the influence of psychological factors on the relationship. Methods : 37 patients with cLBP took part (45 ± 12 years; 23 female, 14 male); 32 completed 9 weeks’ physiotherapy. Before and after therapy, the patients completed the Roland Morris (RM) disability questionnaire and questionnaires to assess fear avoidance beliefs, catastrophising and psychological disturbance. They also performed eight simple functional tests (stair climb, prolonged flexion, stand to floor, lift test, sock test, roll-up test, pick-up test, fingertip-to-floor test). Results : Baseline RM scores were significantly (p < 0.05) correlated with all but one of the functional test scores (ranging from r = −0.34 (half-flexion) to 0.56 (pick-up test), and with a functional test index score for all tests together (r = 0.60, p < 0.0001). The correlation between the change-scores (after treatment) for RM and for the functional test index was 0.55 (p = 0.001). Psychological factors explained 7–23 % variance in RM scores (baseline, post-therapy, and change scores), beyond that which was explained by the functional tests. Effect sizes for patients with a self-rated “good global outcome” were 1.23 for RM and 0.75 for the functional test index; for those with a “poor outcome”, they were −0.08 and 0.23, respectively. Conclusion  : Moderately high correlations (for both absolute and change scores) were observed between the subjective and observed measures of activity limitation. This indicates that to some extent they are assessing the same underlying construct, but it also suggests that each is delivering a certain amount of unique information. Psychological factors explained some of the discrepancy between the two types of measure. Both were responsive to therapy, and their change scores reflected well the patients’ global outcome ratings. The two methods of assessing activity limitations should serve to complement one another in the assessment of treatment outcome.

Source:  http://dx.doi.org/10.1007/s00586-012-2255-6

Return to work and productive activities following a spinal cord injury

The role of income and insurance
Study design:We analyzed longitudinal data on secondary outcomes from participants in a telerehabilitation study.Objectives:To examine the factors affecting return to productive activities and employment and the time to these events following a spinal cord injury (SCI).Setting:A large southeastern rehabilitation hospital in the United States.Methods:We used hazard regression models to analyze data from newly injured people (n=111) participating in an educational intervention post discharge who were followed for up to 2 years. Outcomes were time to return to productive activities and employment.Results:Increasing age and being on Medicaid significantly decreased the likelihood of returning to productive activities (P<0.01), while being white (P<0.05) and having a higher median income (P<0.001) significantly increased this probability. The same factors, bar being on Medicaid, affected the return to employment. Whites returned to productive activities 2.5 times sooner than African Americans and employment twice as fast (P<0.001). Being in the 75th income percentile compared with the 25th shortened time to employment by 209 days.Conclusion:Findings here suggest that income and race affect the time to return to productivity and employment, while being on Medicaid also has a role in general post injury productivity.

Source : Phillips VL, Hunsaker AE, Florence CS. Spinal Cord. 2012.
 http://dx.doi.org/10.1038/sc.2012.22

Predictors of employment among cancer survivors after medical rehabilitation

A prospective study
Objectives This study aimed to (i) investigate cancer survivor's employment status one year after the completion of a medical rehabilitation program and (ii) identify demographic, cancer, and psychosocial, treatment-, and work-related predictors of return to work (RTW) and time until RTW.
Methods A total of 1520 eligible patients were consecutively recruited on average 11 months post diagnosis and assessed at the beginning (t0) (N=1148) and end of rehabilitation (t1) (N=1060) and 12 months after rehabilitation (t2) (N=750). Participants completed validated measures assessing functional impairments, pain, anxiety, depression, quality of life, social support, and work-related characteristics including work ability, sick leave absence, job requirements, work satisfaction, self-perceived employer accommodation, and perceived job loss. Physicians estimated the degree of cancer-entity-specific functional impairment.
Results In a mean time of six weeks after rehabilitation, 568 patients (76%) had returned to work. The multivariate hierarchical logistic regression analysis indicated that baseline RTW intention [odds ratio (OR) 6.22, 95% confidence interval (95% CI) 1.98–19.51], perceived employer accommodation (OR 1.93, 95% CI 0.33–0.99), high job requirements (OR=1.84, 95% CI 1.02–3.30), cancer recurrence or progression (OR=0.27, 95% CI 0.12 – 0.63), baseline sick leave absence (OR=0.26, 95% CI 0.09–0.77), and problematic social interactions (OR=0.58, 95% CI 0.33–0.99) emerged as significant predictors for RTW. The explained variance of the total model was Nagelkerke's R²=0.59 (P<0.001).
Conclusion Our findings emphasize the high relevance of motivational factors. Occupational motivation and skepticism towards returning to work should be carefully assessed at the planning of the rehabilitation program.

Source : Mehnert A, Koch U. Scand J Work Environ Health. 2012.
http://dx.doi.org/10.5271/sjweh.3291

Trajectories and predictors of return to work after traumatic limb injury

A 2-year follow-up study
Objectives: This study aims to explore the trajectories of return to work (RTW) and examine the predictors of different trajectories among workers following traumatic limb injury.
Methods: A total of 804 participants were recruited during hospital admission for a 2-year prospective study. The RTW outcome was repeatedly assessed at 1, 3, 6, 12, 18, and 24 months after the injury. A group-based trajectory model (GBTM) was employed to identify trajectories of RTW among the participants. Comparisons of group characteristics of different trajectories were performed based on a multinomial logistic regression.
Results: GBTM identified three distinct trajectories of RTW: (i) fast RTW consisted of workers with early and stable RTW status from the first month after the injury; (ii) average RTW consisted of workers who achieved and remained at a stable RTW status within 6 months; and (iii) slow RTW consisted of workers who had slow and unsustainable RTW status within the 2-year follow-up period. The estimated proportions were 21.5%, 50.7%, and 27.8%, respectively. Workers with slow and unsustainable RTW after injury were found to be older, married, less educated, employed as repair personnel/operators/laborers, seriously injured, and depressed; they were also found to feel more disturbance in daily life, have lower self-efficacy, and believe they experience a poorer quality of life.
Conclusion: Following traumatic limb injury, individual workers showed three distinct RTW trajectories, each of which was associated with different categories of biopsychosocial factors. An understanding of how different factors contribute to increasing the likelihood of RTW for injured workers in each trajectory group should aid policy-making in worker-oriented vocational rehabilitation programs.

Source : Hou W-H, Sheu C-F, Liang H-W, Hsieh C-L, Lee Y, Chuang H-Y, Cheng Y-T. Trajectories and predictors of return to work after traumatic limb injury – a 2-year follow-up study. Scand J Work Environ Health. 2012.
http://dx.doi.org/10.5271/sjweh.3287

Measuring Workplace Social Support for Workers with Disability

Lysaght, Rosemary et coll. (2012). Measuring Workplace Social Support for Workers with Disability. Journal of Occupational Rehabilitation.

Introduction Social support in the workplace has been has been demonstrated to serve as a contributor to a worker’s ability to manage work demands and to manage stress. Research in the area of disability management indicates that interpersonal factors play an important role in the success of return-to-work interventions. The role of workplace support has received limited attention in rehabilitation, despite the salience of support to the disability management process. Prior to this study, there existed no validated quantitative measure of social support for workers who re-enter the workplace following injury or disability. Methods A support measure prototype, the Support for Workers with Disability Scale, was tested with 152 workers in accommodated work situations. Four validation tools were used to assess criterion validity. Factor analysis was used to validate the content structure and reduce the total number of response items. Additional analysis was conducted to determine the ability of the measure to discriminate between groups, and to provide insight into how social support operates in workplaces. Results Based on analysis, a reduced measure consisting of 41 items and measuring supervisor, co-worker, and non-work supports was created. Secondary analysis disclosed information concerning the nature of supports in the workplace. Higher levels of support were identified for workers with fewer work role limitations and for those with one versus multiple injury claims. Conclusions This tool provides a validated outcome measure for research examining the social aspects of workplace disability. It can also serve as a quality management tool for human resource professionals engaged in continuous improvement of disability management programs.

Source: http://dx.doi.org/10.1007/s10926-012-9357-1

Breast cancer survivors' views of factors that influence the return-to-work process

A qualitative study
OBJECTIVES: Accumulating evidence suggests that most employed breast cancer survivors are able to return to work but often experience difficulties in the process. The objective of this study was to identify: (i) factors experienced as barriers to and facilitators of the return-to-work (RTW) process, (ii) which factors were important during initial and post RTW, and (iii) possible solutions to RTW problems.
METHODS: Twelve breast cancer survivors participated in semi-structured interviews. Interviews were thematically analyzed using MAXQDA, software for qualitative data analysis. We used the World Health Organization's International Classification of Functioning, Disability and Health as a conceptual framework.
RESULTS: Participants experienced many barriers to and facilitators of RTW. In line with previous studies, we found that work environmental factors, such as support from a supervisor, importance of work, and physical or psychological side-effects (such as fatigability), influenced RTW. In addition, we found that barriers included temperament and personality functions, "job lock", and societal attitudes, while facilitators comprised taking care of one's health, skills/coping, and support from family and healthcare professionals. During the initial RTW phase, physical or psychological side-effects hampered work resumption, while during the post RTW phase, a lack of understanding from the work environment was problematic. Participants mentioned that guidance from healthcare professionals and information for supervisors and colleagues should be improved.
CONCLUSIONS: To enhance RTW among breast cancer survivors, interventions should focus on barriers and facilitators for individuals at different time points in the RTW process. Better guidance from healthcare professionals and information for supervisors and colleagues could also enhance the process.

Source: Tamminga SJ, de Boer AGEM, Verbeek JHAM, Frings-Dresen MHW. Breast cancer survivors' views of factors that influence the return-to-work process - a qualitative study. Scand J Work Environ Health. 2012;38(2):144-154.
http://www.sjweh.fi/show_abstract.php?abstract_id=3199

Return to work after early part-time sick leave due to musculoskeletal disorders

A randomized controlled trial
OBJECTIVES: The purpose of this study was to assess the effects of early part-time sick leave on return to work (RTW) and sickness absence among patients with musculoskeletal disorders. Methods A randomized controlled trial was conducted in six occupational health units of medium- and large-size enterprises. Patients aged 18-60 years with musculoskeletal disorders (N=63) unable to perform their regular work were randomly allocated to part- or full-time sick leave. In the former group, workload was reduced by restricting work time by about a half. Remaining work tasks were modified when necessary, as specified in a "fit note" from the physician. The main outcomes were time to return to regular work activities and sickness absence during 12-month follow-up.
RESULTS: Time to return to work sustained for ≥4 weeks was shorter in the intervention group (median 12 versus 20 days, P=0.10). Hazard ratio of RTW adjusted for age was 1.60 [95% confidence interval (95% CI) 0.98-2.63] and 1.76 (95% CI 1.21-2.56) after further adjustment for pain interference with sleep and previous sickness absence at baseline. Total sickness absence during the 12-month follow-up was about 20% lower in the intervention than the control group. Compliance with the intervention was high with no discontinuations of part-time sick leave due to musculoskeletal reasons.
CONCLUSIONS: Early part-time sick leave may provide a faster and more sustainable return to regular duties than full-time sick leave among patients with musculoskeletal disorders. This is the first study to show that work participation can be safely increased with early part-time sick leave.

Source : Viikari-Juntura E, Kausto J, Shiri R, Kaila-Kangas L, Takala EP, Karppinen J, Miranda H, Luukkonen R, Martimo KP. Return to work after early part-time sick leave due to musculoskeletal disorders: a randomized controlled trial. Scand J Work Environ Health. 2012;38(2):134-143. 
http://www.sjweh.fi/show_abstract.php?abstract_id=3258

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