Pratiques des milieux de travail pour assurer un retour en emploi sain et durable

Au Québec, la Loi sur les accidents du travail et des maladies professionnelles (LATMP) établit que tout travailleur ayant subi une lésion professionnelle qui porte atteinte à son intégrité physique ou psychique a droit à la réadaptation que requiert son état en vue de sa réinsertion sociale et professionnelle. La LATMP prévoit aussi un droit de retour au travail lorsque le travailleur redevient capable d’exercer son métier. Les organisations et les travailleurs sont donc directement concernés par la mise en place de solutions de retour au travail (RaT) adéquates, durables et efficaces. Alors que la littérature récente nous renseigne abondamment sur les principes d’intervention basés sur les données probantes permettant un RaT sain et durable (pratiques exemplaires), les pratiques des milieux de travail à cet égard auprès des travailleurs ayant subi un trouble musculosquelettique (TMS) ont été, à ce jour, peu étudiées. Globalement, la présente étude vise à évaluer les écarts éventuels entre les pratiques exemplaires de RaT, basées sur des données probantes, et les pratiques actuelles des milieux de travail pour, par la suite, proposer des pistes d’amélioration. Plus précisément, les objectifs spécifiques suivants ont été définis : 1) Identifier les pratiques exemplaires de RaT durable et de prévention de l’incapacité prolongée des travailleurs ayant subi un TMS; 2) Décrire les pratiques actuelles de RaT dans quelques organisations québécoises et déterminer les éléments contextuels facilitant leur mise en place; 3) Explorer les écarts entre les pratiques exemplaires recommandées en recherche et les pratiques actuelles des milieux de travail pour ensuite envisager des façons d’améliorer le transfert entre la théorie et la pratique.

Source: http://www.irsst.qc.ca/publications-et-outils/publication/i/100950/n/pratiques-milieux-travail-retour-emploi-sain-durable

Barriers to and facilitators of return to work after sick leave in workers with common mental disorders

Perspectives of workers, mental health professionals, occupational health professionals, general physicians and managers
Common mental disorders (CMDs), such as anxiety, stress and depression, are among the leading causes of disability worldwide and have a major impact in terms of lost productivity and sickness absence. Returning to work is a complex process in which different stakeholders may be involved and have to co-operate.
This report discusses the return-to-work process of workers on sick leave with CMDs, and the barriers and facilitators from a multi-stakeholder perspective, ie workers, managers, mental health professionals, occupational health professionals and general physicians. This research was undertaken by Tilburg University.

Source: https://www.iosh.co.uk/~/media/Documents/Books%20and%20resources/Tilburg%20full%20report%20final.pdf?la=en

Work, organisational practices, and margin of manoeuver during work reintegration

BACKGROUND: Many individuals of working age experience cardiovascular disease and are disabled from work as a result. The majority of research in cardiac work disability has focused on individual biological and psychological factors influencing work disability despite evidence of the importance of social context in work disability. In this article, the focus is on work and organisational features influencing the leeway (margin of manoeuvre) workers are afforded during work reintegration.
METHODS: A qualitative method was used. A large auto manufacturing plant was selected owing to work, organisational, and worker characteristics. Workplace context was assessed through site visits and meetings with stakeholders including occupational health, human resources and union personnel and a review of collective agreement provisions relating to seniority, benefits and accommodation. Worker experience was assessed using a series of in-depth interviews with workers (n = 12) returning to work at the plant following disabling cardiac illness. Data was analysed using qualitative content analysis.
RESULTS: Workers demonstrated variable levels of adjustment to the workplace that could be related to production expectations and work design. Policies and practices around electronic rate monitoring, seniority and accommodation, and disability management practices affected the buffer available to workers to adjust to the workplace.
CONCLUSIONS: Work qualities and organisational resources establish a margin of manoeuver for work reintegration efforts. Practitioners need to inform themselves of the constraints on work accommodation imposed by work organisation and collective agreements. Organisations and labour need to reconsider policies and practices that creates unequal accommodation conditions for disabled workers. Implications for rehabilitation Margin of manoeuvre offers a framework for evaluating and structuring work reintegration programmes. Assessing initial conditions for productivity expectations, context and ways and means to support work reintegration can be integrated with worker perceptions of work ability and possibilities for adaptation to structure and then monitor work reintegration programmes. Margin of manoeuvre can be used to evaluate sustainability of work at the end of rehabilitation. Cause-based workers' compensation schemes, collective agreement provisions, and organisational approaches to non-compensable disability create two tiers of disabled workers and make certain workers more vulnerable to occupational disability.

Source: O'Hagan, F. (2017). Disability and Rehabilitation, 1-10.
https://doi.org/10.1080/09638288.2017.1383520

How do line managers experience and handle the return to work of employees on sick leave due to work-related stress?

A one-year follow-up study
PURPOSE: To examine how line managers experience and manage the return to work process of employees on sick leave due to work-related stress and to identify supportive and inhibiting factors.
MATERIALS AND METHODS: Semi-structured interviews with 15 line managers who have had employees on sick leave due to work-related stress. The grounded theory approach was employed.
RESULTS: Even though managers may accept the overall concept of work-related stress, they focus on personality and individual circumstances when an employee is sick-listed due to work-related stress. The lack of a common understanding of stress creates room for this focus. Line managers experience cross-pressure, discrepancies between strategic and human-relationship perspectives and a lack of organizational support in the return to work process.
CONCLUSION: Organizations should aim to provide support for line managers. Research-based knowledge and guidelines on work-related stress and return to work process are essential, as is the involvement of coworkers. A commonly accepted definition of stress and a systematic risk assessment is also important. Cross-pressure on line managers should be minimized and room for adequate preventive actions should be provided as such an approach could support both the return to work process and the implementation of important interventions in the work environment. Implication for rehabilitation Organizations should aim to provide support for line managers handling the return to work process. Cross-pressure on line managers should be minimized and adequate preventive actions should be provided in relation to the return to work process. Research-based knowledge and guidelines on work-related stress and return to work are essential. A common and formal definition of stress should be emphasized in the workplace.

Source: Ladegaard, Y., Skakon, J., Elrond, A. F., & Netterstrøm, B. (2017). Disability and Rehabilitation, 1-9.
http://dx.doi.org/10.1080/09638288.2017.1370733

Cadre de référence sur le soutien et la réintégration au travail

Vers une approche axée sur la collaboration
Le cadre de référence sur le soutien et la réintégration au travail est destiné à l'ensemble des établissements du réseau de la santé et des services sociaux. Il s'adresse d'abord à la haute direction, particulièrement à la Direction des ressources humaines, des communications et des affaires juridiques, qui est responsable du service de la gestion de la présence au travail. Il s'adresse ensuite à l'ensemble du personnel d'encadrement et des employés des établissements, qui ont tous un rôle à jouer dans le soutien et la réintégration au travail des employés en invalidité.

Source: http://publications.msss.gouv.qc.ca/msss/document-001946/

Legislative change enabling use of early part-time sick leave enhanced return to work and work participation in Finland

Part-time sick leave is used in many countries to enhance return to work, however its effectiveness – especially at the early stage of work disability – is not known. This quasi-experiment utilizing propensity
score matching shows that part-time sick leave, started during the first 12 weeks of work disability, enhances return to work and increases work participation over a 2-year period.

Source: Viikari-Juntura E, Virta LJ, Kausto J, Autti-Rämö I, Martimo K-P, Laaksonen M, Leinonen T, Husgafvel-Pursiainen K, Burdorf A, Solovieva S. (2017). Scand J Work Environ Health.
http://dx.doi.org/10.5271/sjweh.3664

Models of care for the management of persistent musculoskeletal pain and/or depression

Musculoskeletal pain can occur following damage to the muscles, ligaments, tendons, and bones. The three main causes of musculoskeletal pain are unusual or repetitive strain on the system, trauma to a specific area from a fall, sprain or blow, and certain musculoskeletal diseases.1 Many Australians experience musculoskeletal pain, however for a few, this becomes chronic or persistent. 2 Persistent musculoskeletal pain is often associated with depression and anxiety.3 Persistent musculoskeletal pain is a major cause of disability in older age and a major cause of work absence in the working age population. Low back pain is the most common type of persistent musculoskeletal pain.

Source: http://www.iscrr.com.au/__data/assets/pdf_file/0004/1007950/Horizon-Scanning-Brief-July-2017-Models-of-Care-Musculoskeletal-Pain-Depression.pdf

Return to work after mild-to-moderate stroke: work satisfaction and predictive factors

A large proportion of stroke patients are unable to return to work (RTW), although figures vary greatly. A total of 121 mild-to-moderate stroke patients, who had a paid job at the time of their stroke were included (a) to quantify RTW and work satisfaction one-year post-stroke (using the Utrecht Scale for Evaluation of Rehabilitation-Participation) and (b) to determine factors predicting RTW post-stroke, based on stroke-related, personal and neuropsychological variables. Half of the patients were not in work (28%) or were working less (22%) than pre-stroke. Ninety percent of those in fulltime employment post-stroke were satisfied with their occupational situation, against 36% of the unemployed participants. In regards to factors predicting RTW, global cognitive functioning (r = .19, Montreal Cognitive Assessment) and depressive symptoms (r = −.16, Hospital Anxiety and Depression Scale) at two months post-stroke onset were associated with return to work within one year. Only global cognitive functioning was an independent predictor of RTW (11.3% variance, p = .013). Although the explained variance was not that high, neuropsychological factors probably play a pivotal role in returning to work and should be taken into account during rehabilitation after mild and moderate stroke.

Source: van der Kemp, J., Kruithof, W. J., Nijboer, T. C., van Bennekom, C. A., van Heugten, C., & Visser-Meily, J. M. (2017). Neuropsychological Rehabilitation, 1-16.
http://dx.doi.org/10.1080/09602011.2017.1313746

Return to work after work-related stress

A randomized controlled trial of a work-focused cognitive behavioral intervention
In this randomized controlled trial (RCT) study, a work-focused cognitive behavioral therapy (CBT) treatment combined with an optional workplace intervention was associated with faster lasting return to work compared to a control group that received clinical assessment among patients on sick leave due to work-related stress. The intervention group returned to work four weeks faster, which could have substantial financial impact on both the employee and related societal costs.

Source: Dalgaard, V. L., Aschbacher, K., Andersen, J. H., Glasscock, D. J., Willert, M. V., Carstensen, O., & Biering, K. (2017). Scandinavian Journal of Work, Environment & Health.
http://dx.doi.org/10.5271/sjweh.3655

Length of sickness absence and sustained return-to-work in mental disorders and musculoskeletal diseases

A cohort study of public sector employees
This study adds to the scientific evidence on the length of sickness absence until sustained return to work (SRTW) in depression, anxiety disorders, intervertebral disc disorders, and back pain among Finnish public sector employees. Timescales are provided for returning to work in different occupational groups also taking into consideration the persistence of the health problem and comorbid conditions.

Source: Kausto, J., Pentti, J., Oksanen, T., Virta, L. J., Virtanen, M., Kivimäki, M., & Vahtera, J. (2017). Scandinavian Journal of Work, Environment & Health.
http://dx.doi.org/10.5271/sjweh.3643

Work ability in rheumatoid arthritis patients

A register study on the prospective risk of exclusion and probability of returning to work
Objectives: The aim was to study work ability in patients with RA compared with the general population by investigating the rates and risks of long-term sickness absence, unemployment and disability pension, and the chance of returning to work and the changes in these risks over time (1994-2011). Methods: This was a cohort study with up to 17 years of follow-up (mean 6.95 years/person) including 6677 RA patients of working age (identified in the nationwide DANBIO registry) and 56 955 matched controls from the general population. A multi-state model was used to analyse all shifts between the work-related states (long-term sickness absence, unemployment and disability pension, as well as the chance of returning to work) and calculate hazard rates (HRs). Analyses were stratified by disease duration and controlled for socio-demographic factors, physical job exposure and somatic and psychiatric co-morbidities. Results: RA patients had increased risk of long-term sickness absence (e.g. early RA: HR = 4.00, 95% CI: 3.64, 4.30) and disability pension (e.g. established RA: HR = 2.75, 95% CI: 2.54, 2.98) relative to controls. From 1994-99 to 2006-11, a decrease in the effect of established RA was observed [long-term sickness absence: from HR = 2.25 (95% CI: 1.99, 2.54) to 1.63 (95% CI: 1.51, 1.75); and disability pension: from HR = 3.49 (95% CI: 2.83, 4.32) to 2.40 (95% CI: 2.15, 2.69)]. RA patients had a lower chance of returning to work from long-term sickness absence or unemployment (HR = 0.60, HR=0.80), and this did not change over time. Conclusion: RA patients remain at high risk for long-term sickness absence and disability pension, despite a positive development between 1996-99 and 2006-11. Returning to work after sick leave or unemployment remains a challenge for RA patients.

Source: Hansen, S. M., Hetland, M. L., Pedersen, J., Østergaard, M., Rubak, T. S., & Bjorner, J. B. (2017). Rheumatology.
https://doi.org/10.1093/rheumatology/kex064

Relations interculturelles - Comprendre le processus de réadaptation et de retour au travail

Dans le domaine de la santé et de la sécurité du travail (SST), les barrières linguistiques et culturelles sont souvent décrites comme des facteurs de vulnérabilité des travailleurs. Il est rapporté que de telles barrières ont déjà été ou sont encore à l'origine d'erreurs diagnostiques ou de mauvaises évaluations cliniques, compliquant ainsi le processus de réadaptation et de retour au travail. La problématique de la réadaptation et du retour au travail dans le contexte de la rencontre interculturelle est pourtant peu documentée à l'échelle internationale. Il devient impératif de connaître l'expérience et la perspective de chacun des acteurs et de cibler des besoins et des problèmes spécifiques sur lesquels il faudra concentrer les efforts de recherche et de développement. L'objectif général de cette étude vise à déterminer les stratégies mises de l'avant par les différents acteurs pour faciliter le processus de réadaptation et de retour au travail des travailleurs dans le contexte de la rencontre interculturelle. Elle vise à décrire l'expérience et la perspective de chaque partie concernée (travailleurs, cliniciens, conseillers en réadaptation, milieux de travail) pour mieux faire ressortir les contraintes, les obstacles, les facilitateurs et les besoins spécifiques.

Source: http://www.irsst.qc.ca/publications-et-outils/publication/i/100929/n/relations-interculturelles-readaptation-retour-travail

Long-Term Outcomes of Multidisciplinary Rehabilitation for Chronic Musculoskeletal Pain

Objectives: Evidence for the effectiveness of multidisciplinary rehabilitation for chronic musculoskeletal pain (CMP) has been reported but its outcomes in the longer term and in mixed groups of chronic pain patients are largely unknown. The aim of the present study was to describe the two-year outcomes of a 15-week multidisciplinary pain rehabilitation programme in patients with mixed CMP in terms of pain, activities, participation and healthcare usage.
Methods: Data were recorded routinely at admission, discharge, and at three, 12 and 24 months' follow-up for all consecutive patients with CMP referred to a rehabilitation programme over a 21-month period. The 15-week multidisciplinary rehabilitation programme consisted of cognitive behavioural therapy and exercise, as well as individual and group sessions with additional treatment modalities. Assessments included the Pain Disability Index (PDI), the Pain Catastrophizing Scale (PCS), the Multidimensional Pain Inventory (MPI) and numerical scales for pain and fatigue. Moreover, the RAND-36-Item Health Survey (‘RAND-36') and questions on healthcare usage and work status were administered at admission, and at 12 and/or 24 months. Paired t-tests, Wilcoxon signed-rank tests, McNemar tests and mixed-model analyses were used to analyse changes over time.
Results: A total of 165 patients were included initially [mean age 44.1 (standard deviation 12.9) years], 143 of whom (87%) were women, with data from 125 (76%) and 120 (73%) patients being available at 12 and 24 months' follow-up, respectively. All outcomes showed statistically significant improvements between admission and discharge, and at three, 12 and 24 months' follow-up (p < 0.05). At 24 months, the median number of different healthcare providers visited in the previous year had decreased significantly compared with that at admission [from a median of 4 (range 1–13) to a median of 2 (range 0–9)], and within the group of patients working at admission (50%), the proportion of those working 25 hours or more per week had increased significantly from 16% to 48%.
Conclusions: Improvements in pain and functioning seen directly after a 15-week multidisciplinary treatment programme for patients with CMP were maintained, health care usage decreased and the number of working hours among working patients increased at 24 months' follow-up. Future studies are needed to examine if additional interventions after discharge can enhance further the favourable results.

Source: Volker, G., Vree, F., Wolterbeek, R., Gestel, M., Smeets, R., Köke, A., & Vlieland, T. V. (2017). Musculoskeletal care, 15(1), 59-68.
http://dx.doi.org/10.1002/msc.1141

Effectiveness of Workplace Interventions in Return-to-Work for Musculoskeletal, Pain-Related and Mental Health Conditions

An Update of the Evidence and Messages for Practitioners
Purpose: The objective of this systematic review was to synthesize evidence on the effectiveness of workplace-based return-to-work (RTW) interventions and work disability management (DM) interventions that assist workers with musculoskeletal (MSK) and pain-related conditions and mental health (MH) conditions with RTW. Methods: We followed a systematic review process developed by the Institute for Work & Health and an adapted best evidence synthesis that ranked evidence as strong, moderate, limited, or insufficient. Results: Seven electronic databases were searched from January 1990 until April 2015, yielding 8898 non-duplicate references. Evidence from 36 medium and high quality studies were synthesized on 12 different intervention categories across three broad domains: health-focused, service coordination, and work modification interventions. There was strong evidence that duration away from work from both MSK or pain-related conditions and MH conditions were significantly reduced by multi-domain interventions encompassing at least two of the three domains. There was moderate evidence that these multi-domain interventions had a positive impact on cost outcomes. There was strong evidence that cognitive behavioural therapy interventions that do not also include workplace modifications or service coordination components are not effective in helping workers with MH conditions in RTW. Evidence for the effectiveness of other single-domain interventions was mixed, with some studies reporting positive effects and others reporting no effects on lost time and work functioning. Conclusions: While there is substantial research literature focused on RTW, there are only a small number of quality workplace-based RTW intervention studies that involve workers with MSK or pain-related conditions and MH conditions. We recommend implementing multi-domain interventions (i.e. with healthcare provision, service coordination, and work accommodation components) to help reduce lost time for MSK or pain-related conditions and MH conditions. Practitioners should also consider implementing these programs to help improve work functioning and reduce costs associated with work disability.

Source: Cullen, K.L., Irvin, E., Collie, A. et al. (2017). J Occup Rehabil.
http://dx.doi.org/10.1007/s10926-016-9690-x

Return to Work in Patients with Chronic Musculoskeletal Pain: Multidisciplinary Intervention Versus Brief Intervention

A Randomized Clinical Trial
Objective: This randomized clinical trial was performed to compare the effect of a new multidisciplinary intervention (MI) programme to a brief intervention (BI) programme on return to work (RTW), fully and partly, at a 12-month and 24-month follow-up in patients on long-term sick leave due to musculoskeletal pain. Methods: Patients (n = 284, mean age 41.3 years, 53.9 % women) who were sick-listed with musculoskeletal pain and referred to a specialist clinic in physical rehabilitation were randomized to MI (n = 141) or BI (n = 143). The MI included the use of a visual educational tool, which facilitated patient-therapist communication and self-management. The MI also applied one more profession, more therapist time and a comprehensive focus on the psychosocial factors, particularly the working conditions, compared to a BI. The main features of the latter are a thorough medical, educational examination, a brief cognitive assessment based on the non-injury model, and a recommendation to return to normal activity as soon as possible. Results: The number of patients with full-time RTW developed similarly in the two groups. The patients receiving MI had a higher probability to partly RTW during the first 7  months of the follow-up compared to the BI-group. Conclusions: There were no differences between the groups on full-time RTW during the 24 months. However, the results indicate that MI hastens the return to work process in long-term sick leave through the increased use of partial sick leave.

Source: Brendbekken, R., Eriksen, H. R., Grasdal, A., Harris, A., Hagen, E. M., & Tangen, T. (20176). Journal of occupational rehabilitation, 27(1), 82-91.
https://dx.doi.org/10.1007%2Fs10926-016-9634-5

Effectiveness of Workplace Interventions in Return-to-Work for Musculoskeletal, Pain-Related and Mental Health Conditions

An Update of the Evidence and Messages for Practitioners
Purpose: The objective of this systematic review was to synthesize evidence on the effectiveness of workplace-based return-to-work (RTW) interventions and work disability management (DM) interventions that assist workers with musculoskeletal (MSK) and pain-related conditions and mental health (MH) conditions with RTW. Methods: We followed a systematic review process developed by the Institute for Work & Health and an adapted best evidence synthesis that ranked evidence as strong, moderate, limited, or insufficient. Results: Seven electronic databases were searched from January 1990 until April 2015, yielding 8898 non-duplicate references. Evidence from 36 medium and high quality studies were synthesized on 12 different intervention categories across three broad domains: health-focused, service coordination, and work modification interventions. There was strong evidence that duration away from work from both MSK or pain-related conditions and MH conditions were significantly reduced by multi-domain interventions encompassing at least two of the three domains. There was moderate evidence that these multi-domain interventions had a positive impact on cost outcomes. There was strong evidence that cognitive behavioural therapy interventions that do not also include workplace modifications or service coordination components are not effective in helping workers with MH conditions in RTW. Evidence for the effectiveness of other single-domain interventions was mixed, with some studies reporting positive effects and others reporting no effects on lost time and work functioning. Conclusions: While there is substantial research literature focused on RTW, there are only a small number of quality workplace-based RTW intervention studies that involve workers with MSK or pain-related conditions and MH conditions. We recommend implementing multi-domain interventions (i.e. with healthcare provision, service coordination, and work accommodation components) to help reduce lost time for MSK or pain-related conditions and MH conditions. Practitioners should also consider implementing these programs to help improve work functioning and reduce costs associated with work disability.

Source: Cullen, K.L., Irvin, E., Collie, A. et al. (2017). J Occup Rehabil.
http://dx.doi.org/10.1007/s10926-016-9690-x

Return to work after cancer

There is an increasing amount of information available for line managers, human resources and occupational health professionals on helping individuals with cancer stay in work.
However, until this research, there had been a lack of evidence on specific health and safety issues and effective approaches to risk assessment and risk management for occupational safety and health (OSH) professionals, and others, to support those undergoing treatment or returning to work after cancer.
The research addresses this evidence gap by:
- seeking to understand the health and safety implications of returning to work after cancer and cancer treatment
- identifying what employers can do to facilitate return to work and what is good practice in dealing with health and safety issues

Source: http://www.iosh.co.uk/Books-and-resources/Return-to-work-after-Cancer.aspx

Effectiveness of Occupational Therapy Interventions for Lower-Extremity Musculoskeletal Disorders

A Systematic Review
Lower-extremity (LE) musculoskeletal disorders (MSDs) can have a major impact on the ability to carry out daily activities. The effectiveness of interventions must be examined to enable occupational therapy practitioners to deliver the most appropriate services. This systematic review examined the literature published between 1995 and July 2014 that investigated the effectiveness of occupational therapy interventions for LE MSDs. Forty-three articles met the criteria and were reviewed. Occupational therapy interventions varied on the basis of population subgroup: hip fracture, LE joint replacement, LE amputation or limb loss, and nonsurgical osteoarthritis and pain. The results indicate an overall strong role for occupational therapy in treating clients with LE MSDs. Activity pacing is an effective intervention for nonsurgical LE MSDs, and multidisciplinary rehabilitation is effective for LE joint replacement and amputation. Further research on specific occupational therapy interventions in this important area is needed.

Source: Dorsey, J., & Bradshaw, M. (2017). American Journal of Occupational Therapy, 71(1).
http://dx.doi.org/10.5014/ajot.2017.023028

Rehabilitation and return to work after cancer: Literature review

As treatments have improved, there are more and more people surviving cancer in Europe. While most cancer survivors return to work after treatment, many face long-term symptoms and impairments that can make it difficult for them to do so.
This report provides an overview of the relevant scientific literature, conducted to collect information on existing initiatives, policies and practices on rehabilitation and return to work after cancer and gather examples of successful interventions.

Source: https://osha.europa.eu/en/tools-and-publications/publications/rehabilitation-and-return-work-after-cancer-literature-review/view

Joint association of multimorbidity and work ability with risk of long-term sickness absence

A prospective cohort study with register follow-up
Objectives: The aim of this study was to determine the joint association of multimorbidity and work ability with the risk of long-term sickness absence (LTSA) in the general working population.
Methods: Cox regression analysis censoring for competing events (statutory retirement, early retirement, disability pension, immigration, or death) was performed to estimate the joint association of chronic diseases and work ability in relation to physical and mental demands of the job with the prospective risk for LTSA (defined as ≥6 consecutive weeks during 2-year follow-up) among 10 427 wage earners from the general working population (2010 Danish Work Environment Cohort Study). Control variables were age, gender, psychosocial work environment, smoking, leisure physical activity, body mass index, job group, and previous LTSA.
Results: Of the 10 427 respondents, 56.8% had experienced ≥1 chronic disease at baseline. The fully adjusted model showed an association between number of chronic diseases and risk of LTSA. This association was stronger among employees with poor work ability (either physical or mental). Compared to employees with no diseases and good physical work ability, the risk estimate for LTSA was 1.95 [95% confidence interval (95% CI) 1.50–2.52] for employees with ≥3 chronic diseases and good physical work ability, whereas it was 3.60 (95% CI 2.50–5.19) for those with ≥3 chronic diseases and poor physical work ability. Overall, the joint association of chronic disease and work ability with LTSA appears to be additive.
Conclusions: Poor work ability combined with ≥1 chronic diseases is associated with high risk of long-term sickness absence in the general working population. Initiatives to improve or maintain work ability should be highly prioritized to secure sustainable employability among workers with ≥1 chronic diseases.p>

Source: Sundstrup, E., Jakobsen, M. D., Mortensen, O. S., & Andersen, L. L. (2017). Scandinavian Journal of Work, Environment & Health.
http://dx.doi.org/10.5271/sjweh.3620

Troubles musculosquelettiques

Revue réaliste sur les bases théoriques des programmes de réadaptation incluant le milieu de travail
Une revue réaliste portant sur un ensemble de programmes de réadaptation au travail incluant une intervention en milieu de travail a été réalisée. Selon cette méthode, les programmes se caractérisent par trois éléments principaux : le contexte (C), qui représente les caractéristiques des conditions dans lesquelles les programmes sont mis en place et les composantes de ces derniers; les mécanismes (M), qui décrivent ce qui fait en sorte qu'un programme parvient à atteindre ses résultats; et les résultats (O, pour outcomes), soit les effets prévus et imprévus d'un programme, résultant de l'interaction de différents mécanismes, dans différents contextes.

Source: http://www.irsst.qc.ca/publications-et-outils/publication/i/100905/n/troubles-musculosquelettiques-bases-programmes-readaptation

Effectiveness of Occupational Therapy Interventions for Adults With Musculoskeletal Conditions of the Forearm, Wrist, and Hand

A Systematic Review
Occupational therapy practitioners are key health care providers for people with musculoskeletal disorders of the distal upper extremity. It is imperative that practitioners understand the most effective and efficient means for remediating impairments and supporting clients in progressing to independence in purposeful occupations. This systematic review provides an update to a previous review by summarizing articles published between 2006 and July 2014 related to the focused question, What is the evidence for the effect of occupational therapy interventions on functional outcomes for adults with musculoskeletal disorders of the forearm, wrist, and hand? A total of 59 articles were reviewed. Evidence for interventions was synthesized by condition within bone, joint, and general hand disorders; peripheral nerve disorders; and tendon disorders. The strongest evidence supports postsurgical early active motion protocols and splinting for various conditions. Very few studies have examined occupation-based interventions. Implications for occupational therapy practice and research are provided.

Source: Roll, S. C., & Hardison, M. E. (2017). American Journal of Occupational Therapy, 71(1).
https://dx.doi.org/10.5014%2Fajot.2017.023234

Factors Associated With Success in an Occupational Rehabilitation Program for Work-Related Musculoskeletal Disorders

Work-related musculoskeletal disorders are a significant burden; however, no consensus has been reached on how to maximize occupational rehabilitation programs for people with these disorders, and the impact of simulating work tasks as a mode of intervention has not been well examined. In this retrospective cohort study, the authors used logistic regression to identify client and program factors predicting success for 95 clients in a general occupational rehabilitation program and 71 clients in a comprehensive occupational rehabilitation program. The final predictive model for general rehabilitation included gender, number of sessions completed, and performance of work simulation activities. Maximum hours per session was the only significant predictor of success in the comprehensive rehabilitation program. This study identifies new factors associated with success in occupational rehabilitation, specifically highlighting the importance of intensity (i.e., session length and number of sessions) of therapy and occupation-based activities for this population.

Source: Hardison, M. E., & Roll, S. C. (2017). American Journal of Occupational Therapy, 71(1).
https://dx.doi.org/10.5014%2Fajot.2016.023200

An Intervention Bundle to Facilitate Return to Work for Burn-Injured Workers

Report From a Burn Model System Investigation
Rates of return to work (RTW) after burn injury vary. A 2012 systematic review of the burn literature reported that nearly 28% of all adult burn survivors never return to any form of employment. These authors called for interventions designed to assist survivors' ability to function in an employed capacity. In 2010, our burn center outpatient clinic instituted an intervention aimed to return injured workers to employment within 90 days of their insurance claims. The interventions include patient/family education focused on recovery rather than disability, employer contact and education by the vocational rehabilitation (VR) counselor, physician recommendations for work accommodations, provision of employee status letters, and Activity Prescription Forms (APFs). The purpose of this study is to report on the effectiveness of these interventions. Following institutional review board (IRB) approval, medical records of adults with occupation-related burn injuries and receiving care at a single regional burn center from June 2010 to July 2015 were reviewed. Data on patient and injury characteristics and outpatient VR services provided were collected. The primary outcome of interest was the percentage of patients who RTW; 338 individuals met study entry criteria. The VR counselor evaluated all patients. All patients received an employer letter(s) and APF documentation. Workplace accommodations were provided to more than 30% of patients. RTW rate was 93%, with an average of 24 days from injury to RTW. In an intervention bundle involving the patient, employer, Workers' compensation, and the burn clinic staff, injured workers achieved a high rate of RTW. Although we cannot correlate individual bundle components to outcome, we postulate that the combination of employer/employee/insurer engagement and flexibility contributed to the success of this program.

Source: Carrougher, G. J., Brych, S. B., Pham, T. N., Mandell, S. P., & Gibran, N. S. (2017). Journal of Burn Care & Research, 38(1), e70-e78.
http://dx.doi.org/10.1097/BCR.0000000000000410

The role of health-care providers in the workers' compensation system and the return-to-work process

International research has generated strong evidence that health-care providers have a key role in the return-to-work (RTW) process. However, pressure on consultation time, administrative challenges and limited knowledge about a patient's workplace can thwart meaningful engagement. This multi-jurisdictional, two-year study focused on health-care providers' experiences within the workers' compensation system and their role in the RTW process.

Source: http://www.iwh.on.ca/system/files/documents/role_of_health-care_providers_in_return_to_work_final_report_2016.pdf

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