2012-05-01 12:00 - Messages
Côté, Daniel (2012). Intercultural communication in health care: challenges and solutions in work rehabilitation practices and training: a comprehensive review. Disability & Rehabilitation (sous presse, disponible en ligne)
Purpose: The purpose of this comprehensive literature review it to explore cross-cultural issues in occupational rehabilitation and work disability prevention. Method: A literature review on cross-cultural issues was performed in medicine, health sciences, and social sciences databases (PubMed, Ingenta, Canadian Centre for Occupational Health and Safety, Ergonomics Abstract, Google Scholar, OSH Update and the Quebec Workers’ Compensation Board data base). A total of 27 documents published until 2010 in English or French were selected and analyzed. Results: Cross-cultural issues in occupational rehabilitation show that representations of pain, communication and therapist–patient relationship and intercultural competence could be presented as the major topics covered in the selected literature. As for the general topic of immigrant workers and OSH, barriers were identified revealing personal, relational, contextual and structural levels that put immigrant and minority workers in situation of vulnerability (ex. linguistic and cultural barriers, lack of knowledge of the system, precarious work or exposition to higher risk hazards, etc.). Cultural issues in occupational rehabilitation put less attention to work-related contextual factors but emphasized on attitude and pain behaviours, perceptions of illness and appropriate treatment, therapist–patient relationship and cultural competences among OT professionals. Conclusions: The growth of immigration in countries such as Canada poses a real challenge to the delivery of health care and rehabilitation services. Despite growing concerns in providing culturally appropriate heath cares, intervention models, tools and training tools are still lacking in occupational rehabilitation and disability management. Nevertheless, cultural competence seems to be a promising concept to be implemented in work rehabilitation and disability management.
Implications for Rehabilitation
- Cultural differences may result in diverging and conflicting representations of health, illness and therapy, and this may hinder the healing process or even cause its failure.
- Assessing health and illness representations (perception and definition of the problem and its solution) may help clinicians facilitate cross-personal communication and develop therapeutic alliance.
- Cultural competence in health care is multi-faceted (individual, organization, health policies) and is becoming an unavoidable aspect of developing culturally adapted interventions.
Verkerk, Karin (2012). Prognostic Factors for Recovery in Chronic Nonspecific Low Back Pain: A Systematic Review . Physical Therapy (sous presse, version électronique)
Background Few data are available on predictors for a favorable outcome in patients with chronic non-specific low back pain (CNLBP). Purpose To assess prognostic factors for pain intensity, disability, return to work, quality of life, or global perceived effect in patients with CNLBP at short-term (≤ 6 months) and long-term (> 6 months) follow-up. Data Sources Relevant studies evaluating the prognosis of CNLBP were searched in PubMed, Cinahl and Embase (through March 2010). Study Selection Articles were included for all types of study design; patients suffering from CNLBP (≥ 12 weeks duration); were older than 18 years; and the study is related to prognostic factors for recovery. Fourteen studies met the inclusion criteria. Data Extraction One author extracted the data and details of each study. Data Synthesis A qualitative analysis using ‘level of evidence' was performed for all included studies. Data was summarized in tables and critically appraised. Limitations The results of the studies reviewed were limited by their methodological weaknesses. Conclusion At short-term no association was found for the factors age and gender, with outcome pain intensity and disability; on the long-term, smoking had the same result. At long-term, pain intensity and fear of movement had no association with disability. On the short-term, conflicting evidence was found for the association between pain intensity or disability and the factor fear of movement. On the long-term, conflicting evidence was found for the factors age, gender and physical job demands. At long-term, conflicting evidence was found for the association between return to work and age, gender and activities of daily living. Limited evidence was there for lower pain intensity and physical job demands at baseline for a positive influence on return to work. No high-quality studies were found for the outcome quality of life and global perceived effect.
Steenstra, Ivan et coll. (2012). Factors affecting RTW following acute low-back pain. Institute for Work & Health (IWH)
Sommaire d'une recension des écrits sur les déterminants du retour au travail chez les personnes souffrant de lombalgies aigues.
Although most workers with acute low-back pain (i.e. pain for up to six weeks) return to work following a relatively straightforward path, anywhere from one-fifth to one-third go on to suffer chronic low-back pain (i.e. pain for longer than three months). This results in potentially lengthy absences from work.
This systematic review set out to find what factors affect the length of time it takes before returning to work. The aim was to identify which workers with acute low-back pain are at high risk of long-term absences and, therefore, in need of extra attention to help them recover and return to work more quickly.
The review found strong evidence that the following factors predict the likelihood and timing of return to work among workers with acute low-back pain:
- workers' recovery expectations
- interactions with health-care providers
- workers' self-reported pain and functional limitations
- presence of radiating pain
- work-related factors, including physical demands of the job, job satisfaction and the offer of modified work.
Boden, Leslie I. (2012). Reexamining workers' compensation: A human rights perspective. American Journal of Industrial Medicine 55 (6): 483-486
Injured workers, particularly those with more severe injuries, have long experienced workers' compensation systems as stressful and demeaning, have found it difficult to obtain benefits, and, when able to obtain benefits, have found them inadequate. Moreover, the last two decades have seen a substantial erosion of the protections offered by workers' compensation. State after state has erected additional barriers to benefit receipt, making the workers' compensation experience even more difficult and degrading. These changes have been facilitated by a framing of the political debate focused on the free market paradigm, employer costs, and worker fraud and malingering. The articles in this special issue propose an alternate framework and analysis, a human rights approach, that values the dignity and economic security of injured workers and their families.
Challenges in an Ontario Injured Worker Retraining Program
Introduction : In recent years, a focus on workers' ability, rather than impairment, has guided disability management services. However, a challenge with the notion of 'ability' is identification of the border between ability and inability. This article considers this gray zone of disability management in the case of a workers' compensation vocational retraining program for injured workers in Ontario.
Methods : In-depth interviews and focus groups were conducted with a purposive sample of 71 participants who were directly involved with the vocational retraining process. Workers in the program had on average incurred injury 3 years earlier. Procedural and legal documents were also analyzed. Principles of grounded theory and discourse analysis guided the data gathering and analysis.
Results : A program focus on worker abilities did not allow for consideration of unresolved medical problems. Concepts such as maximum medical rehabilitation distracted attention from workers' ongoing chronic and unstable health situations, and incentive levers to employers directed some of the least capable workers into the program. As well, communication pathways for discussing health problems were limited by rules and provider reluctance to reveal problems. Therefore, workers completing the program were deemed 'employable', while ongoing and problematic health conditions preventing employment remained relatively uncharted and invisible.
Conclusions : This study reinforces how the shift in disability management paradigm to a focus on ability and return to work requires consideration of environmental conditions, including policies and programs and implementation. A focus on the environment in which worker ability can be enacted might be as important as a focus on improving individual worker characteristics.
Source : http://www.iwh.on.ca/biblio/the-ability-paradigm-in-vocational-rehabilitation-challenges-in-an-ontario-injured-worker
The UK burden of injury multicentre longitudinal study
BACKGROUND: Injuries are common and make a significant contribution to sickness absence, but little is known about problems experienced by injured people on return to work (RTW). AIM: To quantify work problems on RTW and explore predictors of such problems. Design & setting: Multicentre longitudinal study in four UK hospitals. METHOD: Prospective study of injured participants aged 16-65 years who were employed or self-employed prior to the injury and had RTW at 1 or 4 months post injury. RESULTS: At 1 month, most (59%) had only made a partial RTW. By 4 months, 80% had fully RTW. Those who had partially RTW had problems related to physical tasks (work limited for median of 25% of time at 1 month, 18% at 4 months), time management (10% at 1 month, 20% at 4 months) and output demands (10% at 1 month, 15% at 4 months). Productivity losses were significantly greater among those with partial than full RTW at 1 month (median 3.3% versus 0.9%, P<0.001) and 4 months (median 4.6% versus 1.1% P = 0.03). Moderate/severe injuries (relative risk [RR] 1.93, 95% confidence interval [CI] = 1.35 to 2.77) and sports injuries (RR 1.73, 95% CI = 1.12 to 2.67) were associated with significantly greater productivity losses at 1 month while pre-existing long-term illnesses (RR 2.12, 95% CI = 1.38 to 3.27) and upper limb injuries (RR 1.64, 95% CI = 1.06 to 2.53) were at 4 months. CONCLUSION: Injuries impact on successful RTW for at least 4 months. Those who have only partially RTW experience the most problems and GPs should pay particular attention to identifying work problems in this group and ways of minimising such problems.
Source : Kendrick D, Vinogradova Y, Coupland C, Christie N, Lyons RA, Towner E. Br. J. Gen. Pract. 2012; 62(595): 82-90.
Objective : This study aims to evaluate whether performance-based tests have additional prognostic value over self-reported work ability for sustainable return to work (RTW) in physically demanding work.
Methods : A one-year prospective cohort study was performed among 72 construction workers on sick leave for six weeks due to musculoskeletal disorders. The Work Ability Index (WAI) question regarding “current work ability” was used. Three dynamic lifting tests were used from a Functional Capacity Evaluation (FCE). Sustainable RTW was the number of days on sick leave until the first day of returning fully to work for a period of ≥4 weeks. Regression models were built to calculate the prognostic values.
Results : Self-reported work ability alone predicted sustainable RTW (R=0.31, R2=0.09, P=0.009). In combination with one lifting test, the explained variance (R2) increased to 0.16 (P=0.001).
Conclusion : Combining self-reported work ability and a lifting test nearly doubled the explained variance for sustainable RTW in physically demanding work, although the strength remained modest.
Source : Kuijer PPFM, Gouttebarge V, Wind H, van Duivenbooden C, Sluiter JK, Frings-Dresen MHW. Scand J Work Environ Health. 2012.