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Shanthanna H, Gilron I, Rajarathinam M, AlAmri R, Kamath S, Thabane L, Devereaux PJ, Bhandari M. Benefits and safety of gabapentinoids in chronic low back pain: A systematic review and meta-analysis of randomized controlled trials. PLoS Med 2017; 14:e1002369. [PMID: 28809936 PMCID: PMC5557428 DOI: 10.1371/journal.pmed.1002369] [Citation(s) in RCA: 92] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Accepted: 07/06/2017] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Chronic Low Back Pain (CLBP) is very common, with a lifetime prevalence between 51% and 80%. In majority, it is nonspecific in nature and multifactorial in etiology. Pregabalin (PG) and Gabapentin (GB) are gabapentinoids that have demonstrated benefit in neuropathic pain conditions. Despite no clear rationale, they are increasingly used for nonspecific CLBP. They necessitate prolonged use and are associated with adverse effects and increased cost. Recent guidelines from the National Health Service (NHS), England, expressed concerns on their off-label use, in addition to the risk of misuse. We aimed to assess the effectiveness and safety of gabapentinoids in adult CLBP patients. METHODS Electronic databases of MEDLINE, EMBASE, and Cochrane were searched from their inception until December 20th, 2016. We included randomized control trials reporting the use of gabapentinoids for the treatment of CLBP of >3 months duration, in adult patients. Study selection and data extraction was performed independently by paired reviewers. Outcomes were guided by Initiative on Methods, Measurement and Pain Assessment in Clinical Trials guidelines, with pain relief and safety as the primary outcomes. Meta-analyses were performed for outcomes reported in 3 or more studies. Outcomes were reported as mean differences (MDs) or risk ratios (RRs) with their corresponding 95% confidence intervals (CIs), and I2 in percentage representing the percentage variability in effect estimates that could be explained by heterogeneity. GRADE (Grading of Recommendations Assessment, Development, and Evaluation) was used to assess the quality of evidence. RESULTS Out of 1,385 citations, eight studies were included. Based on the interventions and comparators, studies were analyzed in 3 different groups. GB compared with placebo (3 studies, n = 185) showed minimal improvement of pain (MD = 0.22 units, 95% CI [-0.5 to 0.07] I2 = 0%; GRADE: very low). Three studies compared PG with other types of analgesic medication (n = 332) and showed greater improvement in the other analgesic group (MD = 0.42 units, 95% CI [0.20 to 0.64] I2 = 0; GRADE: very low). Studies using PG as an adjuvant (n = 423) were not pooled due to heterogeneity, but the largest of them showed no benefit of adding PG to tapentadol. There were no deaths or hospitalizations reported. Compared with placebo, the following adverse events were more commonly reported with GB: dizziness-(RR = 1.99, 95% CI [1.17 to 3.37], I2 = 49); fatigue (RR = 1.85, 95% CI [1.12 to 3.05], I2 = 0); difficulties with mentation (RR = 3.34, 95% CI [1.54 to 7.25], I2 = 0); and visual disturbances (RR = 5.72, 95% CI [1.94 to 16.91], I2 = 0). The number needed to harm with 95% CI for dizziness, fatigue, difficulties with mentation, and visual disturbances were 7 (4 to 30), 8 (4 to 44), 6 (4 to 15), and 6 (4 to 13) respectively. The GRADE evidence quality was noted to be very low for dizziness and fatigue, low for difficulties with mentation, and moderate for visual disturbances. Functional and emotional improvements were reported by few studies and showed no significant improvements. CONCLUSIONS AND RELEVANCE Existing evidence on the use of gabapentinoids in CLBP is limited and demonstrates significant risk of adverse effects without any demonstrated benefit. Given the lack of efficacy, risks, and costs associated, the use of gabapentinoids for CLBP merits caution. There is need for large high-quality trials to more definitively inform this issue. TRIAL REGISTRATION PROSPERO CRD42016034040.
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Affiliation(s)
- Harsha Shanthanna
- Department of Anesthesiology, St Joseph's Healthcare, McMaster University, Hamilton, Ontario, Canada.,Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Ian Gilron
- Departments of Anesthesiology & Perioperative Medicine and Biomedical & Molecular Sciences, Queen's University, Kingston, Ontario, Canada
| | - Manikandan Rajarathinam
- Department of Anesthesiology, St Joseph's Healthcare, McMaster University, Hamilton, Ontario, Canada
| | - Rizq AlAmri
- Department of Anesthesiology, St Joseph's Healthcare, McMaster University, Hamilton, Ontario, Canada
| | - Sriganesh Kamath
- Department of Anesthesiology, St Joseph's Healthcare, McMaster University, Hamilton, Ontario, Canada.,Department of Neuroanesthesia, National Institute of Mental Health and Neuro Sciences, Bangalore, India
| | - Lehana Thabane
- Department of Anesthesiology, St Joseph's Healthcare, McMaster University, Hamilton, Ontario, Canada.,Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada.,Biostatistics Unit, St Joseph's Healthcare, Hamilton, Ontario, Canada
| | - Philip J Devereaux
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada.,Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Mohit Bhandari
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada.,Department of Surgery, McMaster University, Hamilton, Ontario, Canada
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Improving the effectiveness of sickness benefit case management through a public-private partnership? A difference-in-difference analysis in eighteen Danish municipalities. BMC Public Health 2017; 17:329. [PMID: 28420369 PMCID: PMC5395754 DOI: 10.1186/s12889-017-4236-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Accepted: 04/06/2017] [Indexed: 11/16/2022] Open
Abstract
Background The aim of this study was to investigate whether a multidimensional public-private partnership intervention, focussing on improving the quality and efficiency of sickness benefit case management, reduced the sickness benefit duration and the duration until self-support. Methods We used a difference-in-difference (DID) design with six intervention municipalities and 12 matched control municipalities in Denmark. The study sample comprised 282,103 sickness benefit spells exceeding four weeks. The intervention group with 110,291 spells received the intervention, and the control group with 171,812 spells received ordinary sickness benefit case management. Using register data, we fitted Cox proportional hazard ratio models, estimating hazard ratios (HR) and confidence intervals (CI). Results We found no joint effect of the intervention on the sickness benefit duration (HR 1.02, CI 0.97–1.07) or the duration until self-support (HR 0.99, CI 0.96–1.02). The effect varied among the six municipalities, with sickness benefit HRs ranging from 0.96 (CI 0.93–1.00) to 1.13 (CI 1.08–1.18) and self-support HRs ranging from 0.91 (CI 0.82–1.00) to 1.11 (CI 1.06–1.17). Conclusions Compared to receiving ordinary sickness benefit management the intervention had on average no effect on the sickness benefit duration or duration until self-support. However, the effect varied considerably among the six municipalities possibly due to differences in the implementation or the complexity of the intervention. Electronic supplementary material The online version of this article (doi:10.1186/s12889-017-4236-5) contains supplementary material, which is available to authorized users.
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Vogel N, Schandelmaier S, Zumbrunn T, Ebrahim S, de Boer WEL, Busse JW, Kunz R. Return-to-work coordination programmes for improving return to work in workers on sick leave. Cochrane Database Syst Rev 2017; 3:CD011618. [PMID: 28358173 PMCID: PMC6464073 DOI: 10.1002/14651858.cd011618.pub2] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND To limit long-term sick leave and associated consequences, insurers, healthcare providers and employers provide programmes to facilitate disabled people's return to work. These programmes include a variety of coordinated and individualised interventions. Despite the increasing popularity of such programmes, their benefits remain uncertain. We conducted a systematic review to determine the long-term effectiveness of return-to-work coordination programmes compared to usual practice in workers at risk for long-term disability. OBJECTIVES To assess the effects of return-to-work coordination programmes versus usual practice for workers on sick leave or disability. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL; 2016, Issue 11), MEDLINE, Embase, CINAHL and PsycINFO up to 1 November 2016. SELECTION CRITERIA We included randomised controlled trials (RCTs) that enrolled workers absent from work for at least four weeks and randomly assigned them to return-to-work coordination programmes or usual practice. DATA COLLECTION AND ANALYSIS Two review authors independently screened titles, abstracts and full-text articles for study eligibility; extracted data; and assessed risk of bias from eligible trials. We contacted authors for additional data where required. We conducted random-effects meta-analyses and used the GRADE approach to rate the quality of the evidence. MAIN RESULTS We identified 14 studies from nine countries that enrolled 12,568 workers. Eleven studies focused on musculoskeletal problems, two on mental health and one on both. Most studies (11 of 14) followed workers 12 months or longer. Risk of bias was low in 10 and high in 4 studies, but findings were not sensitive to their exclusion.We found no benefits for return-to-work coordination programmes on return-to-work outcomes.For short-term follow-up of six months, we found no effect on time to return to work (hazard ratio (HR) 1.32, 95% confidence interval (CI) 0.93 to 1.88, low-quality evidence), cumulative sickness absence (mean difference (MD) -16.18 work days per year, 95% CI -32.42 to 0.06, moderate-quality evidence), the proportion of participants at work at end of the follow-up (risk ratio (RR) 1.06, 95% CI 0.86 to 1.30, low-quality evidence) or on the proportion of participants who had ever returned to work, that is, regardless of whether they had remained at work until last follow-up (RR 0.87, 95% CI 0.63 to 1.19, very low-quality evidence).For long-term follow-up of 12 months, we found no effect on time to return to work (HR 1.25, 95% CI 0.95 to 1.66, low-quality evidence), cumulative sickness absence (MD -14.84 work days per year, 95% CI -38.56 to 8.88, low-quality evidence), the proportion of participants at work at end of the follow-up (RR 1.06, 95% CI 0.99 to 1.15, low-quality evidence) or on the proportion of participants who had ever returned to work (RR 1.03, 95% CI 0.97 to 1.09, moderate-quality evidence).For very long-term follow-up of longer than 12 months, we found no effect on time to return to work (HR 0.93, 95% CI 0.74 to 1.17, low-quality evidence), cumulative sickness absence (MD 7.00 work days per year, 95% CI -15.17 to 29.17, moderate-quality evidence), the proportion of participants at work at end of the follow-up (RR 0.94, 95% CI 0.82 to 1.07, low-quality evidence) or on the proportion of participants who had ever returned to work (RR 0.95, 95% CI 0.88 to 1.02, low-quality evidence).We found only small benefits for return-to-work coordination programmes on patient-reported outcomes. All differences were below the minimal clinically important difference (MID). AUTHORS' CONCLUSIONS Offering return-to-work coordination programmes for workers on sick leave for at least four weeks results in no benefits when compared to usual practice. We found no significant differences for the outcomes time to return to work, cumulative sickness absence, the proportion of participants at work at end of the follow-up or the proportion of participants who had ever returned to work at short-term, long-term or very long-term follow-up. For patient-reported outcomes, we found only marginal effects below the MID. The quality of the evidence ranged from very low to moderate across all outcomes.
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Affiliation(s)
- Nicole Vogel
- EbIM Evidence‐based Insurance MedicineDepartment Clinical ResearchUniversity of Basel HospitalSpitalstrasse 8+12BaselSwitzerland4031
- Hirslanden Klinik BirshofLeonardoReinacherstrasse 28MünchensteinSwitzerland4142
| | - Stefan Schandelmaier
- McMaster UniversityDepartment of Health Research Methods, Evidence, and Impact1280 Main Street WestHamiltonONCanadaL8S4L8
- University of BaselBasel Institute for Clinical Epidemiology and Biostatistics, Department of Clinical ResearchSpitalstrasse 12BaselSwitzerland4031
| | - Thomas Zumbrunn
- University of Basel HospitalClinical Trial UnitSchanzenstrasse 55BaselSwitzerland4031
| | | | - Wout EL de Boer
- EbIM Evidence‐based Insurance MedicineDepartment Clinical ResearchUniversity of Basel HospitalSpitalstrasse 8+12BaselSwitzerland4031
| | - Jason W Busse
- McMaster UniversityDepartment of Anesthesia1280 Main Street West, Rm. 2C12HamiltonONCanadaL8S 4K1
| | - Regina Kunz
- EbIM Evidence‐based Insurance MedicineDepartment Clinical ResearchUniversity of Basel HospitalSpitalstrasse 8+12BaselSwitzerland4031
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Cochrane A, Higgins NM, FitzGerald O, Gallagher P, Ashton J, Corcoran O, Desmond D. Early interventions to promote work participation in people with regional musculoskeletal pain: a systematic review and meta-analysis. Clin Rehabil 2017; 31:1466-1481. [DOI: 10.1177/0269215517699976] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives: To determine the effectiveness of early multidisciplinary interventions in promoting work participation and reducing work absence in adults with regional musculoskeletal pain. Data sources: Seven databases (CENTRAL, CINAHL, EMBASE, MEDLINE, Scopus, OT Seeker, PEDro; 1990 to December 2016) were searched for eligible studies. Review methods: Trials were included if they reported on work-based outcomes for participants experiencing difficulties at work or ≤ three months’ sick leave. Interventions had to include two or more elements of the biopsychosocial model delivered as a coordinated programme. Quality was assessed using the GRADE criteria. Results were analysed by hazard ratios for return to work data; continuous outcomes were analysed as standardised mean difference with 95% confidence intervals. Results: A total of 20 randomized controlled trials, with 16,319 participants were included; the interventions were grouped according to their main components for meta-analyses. At 12-months follow-up, moderate quality evidence suggests that programmes involving a stepped care approach (four studies) were more effective than the comparisons in promoting return to work (hazard ratio (HR) 1.29 (95% confidence interval (CI) 1.03 to 1.61), p = 0.03), whereas case management (two studies) was not (HR 0.92 (95% CI 0.69 to 1.24), p = 0.59). Analyses suggested limited effectiveness in reducing sickness absences, in pain reduction or functional improvement across the intervention categories. Conclusion: There is uncertainty as to the effectiveness of early multicomponent interventions owing to the clinical heterogeneity and varying health and social insurance systems across the trials.
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Affiliation(s)
- Andy Cochrane
- Department of Psychology, Maynooth University, Maynooth, Ireland
| | - Niamh M Higgins
- Department of Psychology, Maynooth University, Maynooth, Ireland
| | - Oliver FitzGerald
- School of Medicine and Medical Sciences, University College Dublin, Dublin, Ireland
| | - Pamela Gallagher
- School of Nursing and Human Sciences, Dublin City University, Dublin, Ireland
| | | | - Oriel Corcoran
- Rheumatology Services, Waterford Regional Hospital, Waterford, Ireland
| | - Deirdre Desmond
- Department of Psychology, Maynooth University, Maynooth, Ireland
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Holm A, Høgelund J, Gørtz M, Rasmussen KS, Houlberg HSB. Employment effects of active labor market programs for sick-listed workers. JOURNAL OF HEALTH ECONOMICS 2017; 52:33-44. [PMID: 28182999 DOI: 10.1016/j.jhealeco.2017.01.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Revised: 01/23/2017] [Accepted: 01/24/2017] [Indexed: 06/06/2023]
Abstract
We use register data of 88,948 sick-listed workers in Denmark over the period 2008-2011 to investigate the effect of active labor market programs on the duration until returning to non-subsidized employment and the duration of this employment. To identify causal treatment effects, we exploit over-time variation in the use of active labor market programs in 98 job centers and time-to- event. We find that ordinary education and subsidized job training have significant positive employment effects. Subsidized job training has a large, positive effect on the transition into employment but no effect on the subsequent employment duration. In contrast, ordinary education has a positive effect on employment duration but no effect on the transition into employment. The latter effect is the result of two opposing effects, a large positive effect of having completed education and a large negative lock-in effect, with low re-employment chances during program participation.
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Affiliation(s)
- Anders Holm
- Department of Sociology, Western University, London, Ontario, N6A 5C2, Canada; Department of Economics, Western University, London, Ontario, N6A 5C2, Canada.
| | - Jan Høgelund
- The Danish Working Environment Authority, Landskronagade 33, DK-2100 Copenhagen Ø, Denmark
| | - Mette Gørtz
- University of Copenhagen, Department of Economics, Øster Farimagsgade 5, DK-1353 Copenhagen K, Denmark
| | - Kristin Storck Rasmussen
- Marselisborg - Development, Competence, Knowledge, Robert Jacobsens vej 76A, DK-2300 Copenhagen S, Denmark
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Soteriades ES. A workplace modified duty program for employees in an oncology center. Work 2017; 56:157-164. [PMID: 28128788 DOI: 10.3233/wor-162478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Workplace modified duty programs may provide reasonable accommodations to employees who have partial temporary job disability and could work on duty accommodations until they fully recover. However, little is known about the implementation barriers and effectiveness of such programs. OBJECTIVE This study is aimed at evaluating the implementation of a modified duty program for employees in an oncology center. METHODS A modified duty program for employees working at the Bank of Cyprus Oncology Center, a non profit organization with 200 employees located in the Republic of Cyprus was evaluated based on the health records of the occupational medicine department. RESULTS Employees' participation in the program was 3%. A total of 12 employees participated (6 each year). The participants were all women and the mean participation period was 21.6 days (range 10 - 65 days). The two most frequent reasons for a modified duty assignment were pregnancy and back pain. Employees were assigned either on limited duties or on a combination of limited duties and reduced work hours. Employees reported being very satisfied with their participation based on a follow-up narrative oral assessment. CONCLUSION The small participation rate does not allow for advanced statistical analyses. Further studies from larger organizations are urgently needed to evaluate the effectiveness of modified duty programs. The development of a legal framework for such modified duty programs in Cyprus as well as internationally may promote their implementation in order to facilitate the effective management of temporary partial job disability for the benefit of both employees and businesses.
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Affiliation(s)
- Elpidoforos S Soteriades
- Department of Occupational and Environmental Medicine, Cyprus Institute of Biomedical Sciences (CIBS), Nicosia, Cyprus.,Department of Occupational Health, Bank of Cyprus Oncology Center, Nicosia, Cyprus.,Department of Environmental Health, Harvard T.H. Chan School of Public Health, Environmental and Occupational Medicine and Epidemiology (EOME), Boston, MA, USA
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Williams-Whitt K, Bültmann U, Amick B, Munir F, Tveito TH, Anema JR. Workplace Interventions to Prevent Disability from Both the Scientific and Practice Perspectives: A Comparison of Scientific Literature, Grey Literature and Stakeholder Observations. JOURNAL OF OCCUPATIONAL REHABILITATION 2016; 26:417-433. [PMID: 27614465 PMCID: PMC5104758 DOI: 10.1007/s10926-016-9664-z] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Purpose The significant individual and societal burden of work disability could be reduced if supportive workplace strategies could be added to evidence-based clinical treatment and rehabilitation to improve return-to-work (RTW) and other disability outcomes. The goal of this article is to summarize existing research on workplace interventions to prevent disability, relate these to employer disability management practices, and recommend future research priorities. Methods The authors participated in a year-long collaboration that ultimately led to an invited 3-day conference, Improving Research of Employer Practices to Prevent Disability, held October 14-16, 2015, in Hopkinton, Massachusetts, USA. The collaboration included a topical review of the literature, group conference calls to identify key areas and challenges, drafting of initial documents, review of industry publications, and a conference presentation that included feedback from peer researchers and a question/answer session with an expert panel with direct employer experience. Results Evidence from randomized trials and other research designs has shown general support for job modification, RTW coordination, and organizational support, but evidence is still lacking for interventions at a more granular level. Grey literature reports focused mainly on job re-design and work organization. Panel feedback focused on organizational readiness and the beliefs and values of senior managers as critical factors in facilitating changes to disability management practices. While the scientific literature is focused on facilitating improved coping and reducing discomforts for individual workers, the employer-directed grey literature is focused on making group-level changes to policies and procedures. Conclusions Future research might better target employer practices by tying interventions to positive workplace influences and determinants, by developing more participatory interventions and research designs, and by designing interventions that address factors of organizational change.
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Affiliation(s)
- Kelly Williams-Whitt
- University of Lethbridge, 4401 University Drive, Lethbridge, AB, T1K 3M4, Canada.
| | - Ute Bültmann
- University Medical Center Groningen, Community and Occupational Medicine, University of Groningen, Groningen, The Netherlands
| | - Benjamin Amick
- Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA
- Institute for Work and Health, Toronto, Canada
| | - Fehmidah Munir
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, Leicestershire, UK
| | - Torill H Tveito
- Uni Research Health, Bergen, Norway
- Department of Health Promotion, University College of Southeast Norway, Horten, Norway
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Addressing Work-Related Issues in Medical Rehabilitation: Revision of an Online Information Tool for Healthcare Professionals. Rehabil Res Pract 2016; 2016:7621690. [PMID: 27610246 PMCID: PMC5004025 DOI: 10.1155/2016/7621690] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Revised: 06/24/2016] [Accepted: 07/04/2016] [Indexed: 11/17/2022] Open
Abstract
Background. Medical rehabilitation increasingly considers occupational issues as determinants of health and work ability. Information on work-related rehabilitation concepts should therefore be made available to healthcare professionals. Objective. To revise a website providing healthcare professionals in medical rehabilitation facilities with information on work-related concepts in terms of updating existing information and including new topics, based on recommendations from implementation research. Method. The modification process included a questionnaire survey of medical rehabilitation centers (n = 28); two workshops with experts from rehabilitation centers, health payers, and research institutions (n = 14); the selection of new topics and revision of existing text modules based on expert consensus; and an update of good practice descriptions of work-related measures. Results. Health payers' requirements, workplace descriptions, and practical implementation aids were added as new topics. The database of good practice examples was extended to 63 descriptions. Information on introductory concepts was rewritten and supplemented by current data. Diagnostic tools were updated by including additional assessments. Conclusions. Recommendations from implementation research such as assessing user needs and including expert knowledge may serve as a useful starting point for the dissemination of information on work-related medical rehabilitation into practice. Web-based information tools such as the website presented here can be quickly adapted to current evidence and changes in medicolegal regulations.
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Cancelliere C, Donovan J, Stochkendahl MJ, Biscardi M, Ammendolia C, Myburgh C, Cassidy JD. Factors affecting return to work after injury or illness: best evidence synthesis of systematic reviews. Chiropr Man Therap 2016; 24:32. [PMID: 27610218 PMCID: PMC5015229 DOI: 10.1186/s12998-016-0113-z] [Citation(s) in RCA: 237] [Impact Index Per Article: 29.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Accepted: 07/07/2016] [Indexed: 01/23/2023] Open
Abstract
Background Work disability is a major personal, financial and public health burden. Predicting future work success is a major focus of research. Objectives To identify common prognostic factors for return-to-work across different health and injury conditions and to describe their association with return-to-work outcomes. Methods Medline, Embase, PsychINFO, Cinahl, and Cochrane Database of Systematic Reviews and the grey literature were searched from January 1, 2004 to September 1, 2013. Systematic reviews addressing return-to-work in various conditions and injuries were selected. Eligible studies were critically appraised using the Scottish Intercollegiate Guidelines Network criteria to identify low risk of bias reviews. Results Of the 36,193 titles screened and the 94 eligible studies reviewed, 56 systematic reviews were accepted as low risk of bias. Over half of these focused on musculoskeletal disorders, which were primarily spine related (e.g., neck and low back pain). The other half of studies assessed workers with mental health or cardiovascular conditions, stroke, cancer, multiple sclerosis or other non-specified health conditions. Many factors have been assessed, but few consistently across conditions. Common factors associated with positive return-to-work outcomes were higher education and socioeconomic status, higher self-efficacy and optimistic expectations for recovery and return-to-work, lower severity of the injury/illness, return-to-work coordination, and multidisciplinary interventions that include the workplace and stakeholders. Common factors associated with negative return-to-work outcomes were older age, being female, higher pain or disability, depression, higher physical work demands, previous sick leave and unemployment, and activity limitations. Conclusions Expectations of recovery and return-to-work, pain and disability levels, depression, workplace factors, and access to multidisciplinary resources are important modifiable factors in progressing return-to-work across health and injury conditions. Employers, healthcare providers and other stakeholders can use this information to facilitate return-to-work for injured/ill workers regardless of the specific injury or illness. Future studies should investigate novel interventions, and other factors that may be common across health conditions.
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Affiliation(s)
- Carol Cancelliere
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario Canada ; Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario Canada
| | - James Donovan
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario Canada
| | | | | | - Carlo Ammendolia
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario Canada ; Department of Surgery, Faculty of Medicine, University of Toronto, Toronto, Ontario Canada
| | - Corrie Myburgh
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230 Odense M, Denmark
| | - J David Cassidy
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario Canada ; Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario Canada ; Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230 Odense M, Denmark ; Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario Canada
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Scholz SM, Andermatt P, Tobler BL, Spinnler D. Work Incapacity and Treatment Costs After Severe Accidents: Standard Versus Intensive Case Management in a 6-Year Randomized Controlled Trial. JOURNAL OF OCCUPATIONAL REHABILITATION 2016; 26:319-31. [PMID: 26687330 PMCID: PMC4967427 DOI: 10.1007/s10926-015-9615-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Purpose Case management is widely accepted as an effective method to support medical rehabilitation and vocational reintegration of accident victims with musculoskeletal injuries. This study investigates whether more intensive case management improves outcomes such as work incapacity and treatment costs for severely injured patients. Methods 8,050 patients were randomly allocated either to standard case management (SCM, administered by claims specialists) or intensive case management (ICM, administered by case managers). These study groups differ mainly by caseload, which was approximately 100 cases in SCM and 35 in ICM. The setting is equivalent to a prospective randomized controlled trial. A 6-year follow-up period was chosen in order to encompass both short-term insurance benefits and permanent disability costs. All data were extracted from administrative insurance databases. Results Average work incapacity over the 6-year follow-up, including contributions from daily allowances and permanent losses from disability, was slightly but insignificantly higher under ICM than under SCM (21.6 vs. 21.3 % of pre-accident work capacity). Remaining work incapacity after 6 years of follow-up showed no difference between ICM and SCM (8.9 vs. 8.8 % of pre-accident work incapacity). Treatment costs were 43,500 Swiss Francs (CHF) in ICM compared to 39,800 in SCM (+9.4 %, p = 0.01). The number of care providers involved in ICM was 10.5 compared to 10.0 in ICM (+5.0 %, p < 0.001). Conclusions Contrary to expectations, ICM did not reduce work incapacity as compared to SCM, but did increase healthcare consumption and treatment costs. It is concluded that the intensity of case management alone is not sufficient to improve rehabilitation and vocational reintegration of accident victims.
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Affiliation(s)
- Stefan M Scholz
- Suva (Swiss National Accident Insurance Fund), Lucerne, Switzerland.
| | - Peter Andermatt
- Suva (Swiss National Accident Insurance Fund), Lucerne, Switzerland
| | - Benno L Tobler
- Suva (Swiss National Accident Insurance Fund), Lucerne, Switzerland
| | - Dieter Spinnler
- Suva (Swiss National Accident Insurance Fund), Lucerne, Switzerland
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Small S, de Boer C, Swab M. Perceived barriers to and facilitators of labor market engagement for individuals with chronic physical illness in their experience with disability policy: a systematic review of qualitative evidence protocol. ACTA ACUST UNITED AC 2016; 13:59-69. [PMID: 26767816 DOI: 10.11124/jbisrir-2015-2493] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Accepted: 10/20/2015] [Indexed: 10/31/2022]
Affiliation(s)
- Sanda Small
- School of Nursing.,Memorial University of Newfoundland, Canada
| | | | - Michelle Swab
- Health Sciences Librarian, Memorial University of Newfoundland, Canada
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van Vilsteren M, van Oostrom SH, de Vet HCW, Franche R, Boot CRL, Anema JR. Workplace interventions to prevent work disability in workers on sick leave. Cochrane Database Syst Rev 2015; 2015:CD006955. [PMID: 26436959 PMCID: PMC9297123 DOI: 10.1002/14651858.cd006955.pub3] [Citation(s) in RCA: 131] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Work disability has serious consequences for individuals as well as society. It is possible to facilitate resumption of work by reducing barriers to return to work (RTW) and promoting collaboration with key stakeholders. This review was first published in 2009 and has now been updated to include studies published up to February 2015. OBJECTIVES To determine the effectiveness of workplace interventions in preventing work disability among sick-listed workers, when compared to usual care or clinical interventions. SEARCH METHODS We searched the Cochrane Work Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, and PsycINFO databases on 2 February 2015. SELECTION CRITERIA We included randomised controlled trials (RCTs) of workplace interventions that aimed to improve RTW for disabled workers. We only included studies where RTW or conversely sickness absence was reported as a continuous outcome. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data and assessed risk of bias of the studies. We performed meta-analysis where possible, and we assessed the quality of evidence according to GRADE criteria. We used standard methodological procedures expected by Cochrane. MAIN RESULTS We included 14 RCTs with 1897 workers. Eight studies included workers with musculoskeletal disorders, five workers with mental health problems, and one workers with cancer. We judged six studies to have low risk of bias for the outcome sickness absence.Workplace interventions significantly improved time until first RTW compared to usual care, moderate-quality evidence (hazard ratio (HR) 1.55, 95% confidence interval (CI) 1.20 to 2.01). Workplace interventions did not considerably reduce time to lasting RTW compared to usual care, very low-quality evidence (HR 1.07, 95% CI 0.72 to 1.57). The effect on cumulative duration of sickness absence showed a mean difference of -33.33 (95% CI -49.54 to -17.12), favouring the workplace intervention, high-quality evidence. One study assessed recurrences of sick leave, and favoured usual care, moderate-quality evidence (HR 0.42, 95% CI 0.21 to 0.82). Overall, the effectiveness of workplace interventions on work disability showed varying results.In subgroup analyses, we found that workplace interventions reduced time to first and lasting RTW among workers with musculoskeletal disorders more than usual care (HR 1.44, 95% CI 1.15 to 1.82 and HR 1.77, 95% CI 1.37 to 2.29, respectively; both moderate-quality evidence). In studies of workers with musculoskeletal disorders, pain also improved (standardised mean difference (SMD) -0.26, 95% CI -0.47 to -0.06), as well as functional status (SMD -0.33, 95% CI -0.58 to -0.08). In studies of workers with mental health problems, there was a significant improvement in time until first RTW (HR 2.64, 95% CI 1.41 to 4.95), but no considerable reduction in lasting RTW (HR 0.79, 95% CI 0.54 to 1.17). One study of workers with cancer did not find a considerable reduction in lasting RTW (HR 0.88, 95% CI 0.53 to 1.47).In another subgroup analysis, we did not find evidence that offering a workplace intervention in combination with a cognitive behavioural intervention (HR 1.93, 95% CI 1.27 to 2.93) is considerably more effective than offering a workplace intervention alone (HR 1.35, 95% CI 1.01 to 1.82, test for subgroup differences P = 0.17).Workplace interventions did not considerably reduce time until first RTW compared with a clinical intervention in workers with mental health problems in one study (HR 2.65, 95% CI 1.42 to 4.95, very low-quality evidence). AUTHORS' CONCLUSIONS We found moderate-quality evidence that workplace interventions reduce time to first RTW, high-quality evidence that workplace interventions reduce cumulative duration of sickness absence, very low-quality evidence that workplace interventions reduce time to lasting RTW, and moderate-quality evidence that workplace interventions increase recurrences of sick leave. Overall, the effectiveness of workplace interventions on work disability showed varying results. Workplace interventions reduce time to RTW and improve pain and functional status in workers with musculoskeletal disorders. We found no evidence of a considerable effect of workplace interventions on time to RTW in workers with mental health problems or cancer.We found moderate-quality evidence to support workplace interventions for workers with musculoskeletal disorders. The quality of the evidence on the effectiveness of workplace interventions for workers with mental health problems and cancer is low, and results do not show an effect of workplace interventions for these workers. Future research should expand the range of health conditions evaluated with high-quality studies.
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Affiliation(s)
- Myrthe van Vilsteren
- VU University Medical CenterDepartment of Public and Occupational Health, EMGO Institute for Health and Care ResearchPO Box 7057AmsterdamNetherlands1007 MB
| | - Sandra H van Oostrom
- National Institute for Public Health and the EnvironmentCentre for Nutrition, Prevention and Health ServicesBilthovenNetherlands
| | - Henrica CW de Vet
- VU University Medical CenterDepartment of Epidemiology and Biostatistics, EMGO Institute for Health and Care ResearchPO Box 7057AmsterdamNetherlands1007 MB
| | | | - Cécile RL Boot
- EMGO Institute for Health and Care Research, VU University Medical CenterDepartment of Public and Occupational HealthAmsterdamNetherlands
| | - Johannes R Anema
- VU University Medical CenterDepartment of Public and Occupational Health, EMGO Institute for Health and Care ResearchPO Box 7057AmsterdamNetherlands1007 MB
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Petit A, Rozenberg S, Fassier JB, Rousseau S, Mairiaux P, Roquelaure Y. Pre-return-to-work medical consultation for low back pain workers. Good practice recommendations based on systematic review and expert consensus. Ann Phys Rehabil Med 2015; 58:298-304. [PMID: 26372310 DOI: 10.1016/j.rehab.2015.08.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Revised: 08/11/2015] [Accepted: 08/11/2015] [Indexed: 11/29/2022]
Affiliation(s)
- A Petit
- Laboratoire d'ergonomie et d'épidémiologie en santé et travail (LEEST), LUNAM, faculté de médecine d'Angers, université d'Angers, Angers, France; Centre de consultations de pathologie professionnelle, laboratoire d'épidémiologie et d'étude en santé au travail, CHU d'Angers, 4, rue Larrey, 49933 Angers cedex 9, France.
| | - S Rozenberg
- Service de rhumatologie, hôpital Pitié-Salpêtrière, Paris, France
| | - J B Fassier
- Service de médecine et santé au travail, hospices civils de Lyon, UMRESTTE, université Claude-Bernard Lyon 1, Lyon, France
| | - S Rousseau
- Médecine et santé au travail, comité interentreprises d'hygiène du Loiret, Orléans, France
| | - P Mairiaux
- Service de santé au travail et éducation pour la santé, université de Liège, Liège, Belgium
| | - Y Roquelaure
- Laboratoire d'ergonomie et d'épidémiologie en santé et travail (LEEST), LUNAM, faculté de médecine d'Angers, université d'Angers, Angers, France; Centre de consultations de pathologie professionnelle, laboratoire d'épidémiologie et d'étude en santé au travail, CHU d'Angers, 4, rue Larrey, 49933 Angers cedex 9, France
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Laaksonen M, Gould R. Return to Work After Temporary Disability Pension in Finland. JOURNAL OF OCCUPATIONAL REHABILITATION 2015; 25:471-480. [PMID: 25385200 DOI: 10.1007/s10926-014-9554-1] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
PURPOSE When it is possible that the employee's work ability can be restored through treatment or rehabilitation, disability pension in Finland is granted for a fixed period. We examined which factors are associated with return to work (RTW) after such temporary disability pension. METHODS The study included all Finnish residents whose temporary disability pension from the earnings-related pension system started in 2008 (N = 10,269). Competing risks regression analysis was applied to examine register-based determinants for RTW after temporary disability pension due to mental disorders, musculoskeletal diseases, other diseases, and injury over a 4-year follow-up period. RESULTS The overall cumulative incidence of RTW was 25%. RTW was more probable after temporary disability pension due to injury and musculoskeletal diseases and less probable after temporary disability pension due to mental disorders. Younger age and higher education increased RTW but differences between genders, private and public sector employees, and occupational classes were relatively small. The probability of RTW was higher among those who were employed before their temporary disability pension (subhazard ratio in multivariate analysis 2.41 (95% CI 2.13-2.72) and among the 9% who participated in vocational rehabilitation during their pension [SHR 2.10 (95% CI 1.90-2.31)]. With some exceptions, the results were fairly similar for all diagnostic causes of temporary disability pension. CONCLUSION Return to work after temporary disability pension was relatively uncommon. Nevertheless, in all diagnostic groups RTW continued for the whole follow-up period. The low educated and those not employed before temporary disability pension need more support in their RTW. The strong association between vocational rehabilitation and RTW suggests that increasing rehabilitation among those with impaired work ability may promote RTW.
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Affiliation(s)
- Mikko Laaksonen
- Finnish Centre for Pensions, 00065, Eläketurvakeskus, Finland,
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Busse JW, Ebrahim S, Heels-Ansdell D, Wang L, Couban R, Walter SD. Association of worker characteristics and early reimbursement for physical therapy, chiropractic and opioid prescriptions with workers' compensation claim duration, for cases of acute low back pain: an observational cohort study. BMJ Open 2015; 5:e007836. [PMID: 26310398 PMCID: PMC4554906 DOI: 10.1136/bmjopen-2015-007836] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVE To assess the association between early reimbursement for physiotherapy, chiropractic and opioid prescriptions for acute low back pain (LBP) with disability claim duration. DESIGN Observational cohort study. SETTING AND PARTICIPANTS From a random sample of 6665 claims for acute, uncomplicated LBP approved by the Ontario Workplace Safety and Insurance Board (WSIB) in 2005, we analysed 1442 who remained on full benefits at 4 weeks after claim approval. PRIMARY OUTCOME MEASURE Our primary outcome was WSIB claim duration. RESULTS We had complete data for all but 3 variables, which had <15% missing data, and we included missing data as a category for these factors. Our time-to-event analysis was adjusted for demographic, workplace and treatment factors, but not injury severity, although we attempted to include a sample with very similar, less-severe injuries. Regarding significant factors and treatment variables in our adjusted analysis, older age (eg, HR for age ≥ 55 vs <25=0.52; 99% CI 0.36 to 0.74) and WSIB reimbursement for opioid prescription in the first 4 weeks of a claim (HR=0.68; 99% CI 0.53 to 0.88) were associated with longer claim duration. Higher predisability income was associated with longer claim duration, but only among persistent claims (eg, HR for active claims at 1 year with a predisability income >$920 vs ≤$480/week=0.34; 99% CI 0.17 to 0.68). Missing data for union membership (HR=1.27; 99% CI 1.01 to 1.59), and working for an employer with a return-to-work programme were associated with fewer days on claim (HR=1.78; 99% CI 1.45 to 2.18). Neither reimbursement for physiotherapy (HR=1.01; 99% CI 0.86 to 1.19) nor chiropractic care (HR for active claims at 60 days=1.15; 99% CI 0.94 to 1.41) within the first 4 weeks was associated with claim duration. Our meta-analysis of 3 studies (n=51,069 workers) confirmed a strong association between early opioid use and prolonged claim duration (HR=0.57, 95% CI 0.48 to 0.69; low certainty evidence). CONCLUSIONS Our analysis found that early WSIB reimbursement for physiotherapy or chiropractic care, in claimants fully off work for more than 4 weeks, was not associated with claim duration, and that early reimbursement for opioids predicted prolonged claim duration. Well-designed randomised controlled trials are needed to verify our findings and establish causality between these variables and claim duration.
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Affiliation(s)
- Jason W Busse
- The Michael G. DeGroote Institute for Pain Research and Care, McMaster University, Hamilton, Ontario, Canada
- Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - Shanil Ebrahim
- Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, Stanford Prevention Research Center, Stanford University, Stanford, California, USA
- Department of Anaesthesia & Pain Medicine,The Hospital for Sick Children, Toronto, Canada
| | - Diane Heels-Ansdell
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - Li Wang
- Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada
| | - Rachel Couban
- Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada
| | - Stephen D Walter
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
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Andersen LN, Juul-Kristensen B, Sørensen TL, Herborg LG, Roessler KK, Søgaard K. Efficacy of Tailored Physical Activity or Chronic Pain Self-Management Programme on return to work for sick-listed citizens: A 3-month randomised controlled trial. Scand J Public Health 2015; 43:694-703. [PMID: 26113171 DOI: 10.1177/1403494815591687] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/24/2015] [Indexed: 11/16/2022]
Abstract
OBJECTIVES The aim was to evaluate the efficacy of 'Tailored Physical Activity' (TPA) and a 'Chronic Pain Self-management Programme' (CPSMP) compared with a reference group (REF) on return to work after 3 months as sick-listed citizens with pain related to the back or the upper body. METHODS Using a randomised controlled trial design all participants (n= 141) received health guidance for 1.5 hours and were randomised to TPA, CPSMP or REF. Characteristics of participants were collected from a questionnaire. The primary endpoint was proportion of participants returned to work as registered by the municipality and the co-primary endpoint was duration of the sickness absence period. Secondary outcomes consisted of pain, body mass index, aerobic capacity, grip strength, work ability and kinesiophobia. The trial was conducted in Sonderborg Municipality from March 2011 to October 2013. RESULTS TPA was more effective on return to work than REF, while CPSMP only tended to be more effective than REF, and the primary outcome was the only between-groups significant difference. TPA participants also reached a highly significant reduction in pain from baseline to follow-up with no similar effect seen in CPSMP or REF. In contrast, no benefit of TPA and CPSMP was evident regarding work ability, kinesiophobia or physical capacity after 3 months of follow-up. CONCLUSIONS The results suggest that TPA is a promising intervention to facilitate return to work and reduce pain among sick-listed citizens with pain related to the back or upper body compared to REF.
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Affiliation(s)
- Lotte Nygaard Andersen
- Department of Sports Science and Clinical Biomechanics, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark 2Department of Psychology, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Birgit Juul-Kristensen
- Department of Sports Science and Clinical Biomechanics, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark Institute of Occupational Therapy, Physiotherapy and Radiography, Bergen University College, Bergen, Norway
| | - Thomas Lund Sørensen
- Medical Department, Hospital of Southern Jutland, Region of Southern Denmark, Denmark
| | - Lene Gram Herborg
- Senior Citizen and Health Department, Social and Health Affairs, Municipality of Sonderborg, Denmark
| | - Kirsten Kaya Roessler
- 2Department of Psychology, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Karen Søgaard
- Department of Sports Science and Clinical Biomechanics, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
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Schaafsma FG, Anema JR, van der Beek AJ. Back pain: Prevention and management in the workplace. Best Pract Res Clin Rheumatol 2015; 29:483-94. [PMID: 26612243 DOI: 10.1016/j.berh.2015.04.028] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Despite all the efforts in studying work-related risk factors for low back pain (LBP), interventions targeting these risk factors to prevent LBP have no proven cost-effectiveness. Even with adequate implementation strategies for these interventions on group level, these did not result in the reduction of incident LBP. Physical exercise, however, does have a primary preventive effect on LBP. For secondary prevention, it seems that there are more opportunities to cost-effectively intervene in reducing the risk of long-term sickness absence due to LBP. Starting at the earliest moment possible with proper assessment of risk factors for long-term sickness absence related to the individual, the underlying mechanisms of the LBP, and also factors related to the workplace by a well-trained clinician, may increase the potential of effective return to work (RTW) management. More research on how to overcome barriers in the uptake of these effective interventions in relation to policy-specific environments, and with regard to proper financing of RTW management is necessary.
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Affiliation(s)
- Frederieke G Schaafsma
- Department of Public and Occupational Health, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands; Research Centre for Insurance Medicine, Collaboration Between AMC-UMCG-UWV-VUmc, Amsterdam, The Netherlands.
| | - Johannes R Anema
- Department of Public and Occupational Health, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands; Research Centre for Insurance Medicine, Collaboration Between AMC-UMCG-UWV-VUmc, Amsterdam, The Netherlands
| | - Allard J van der Beek
- Department of Public and Occupational Health, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands; Research Centre for Insurance Medicine, Collaboration Between AMC-UMCG-UWV-VUmc, Amsterdam, The Netherlands; Body@Work, Research Center Physical Activity, Work and Health, TNO-VU University Medical Center, Amsterdam, The Netherlands
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68
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Return to work coordination programmes for improving return to work in workers on sick leave. Cochrane Database Syst Rev 2015. [DOI: 10.1002/14651858.cd011618] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Nielsen MBD, Vinsløv Hansen J, Aust B, Tverborgvik T, Thomsen BL, Bue Bjorner J, Steen Mortensen O, Rugulies R, Winzor G, Ørbæk P, Helverskov T, Kristensen N, Melchior Poulsen O. A multisite randomized controlled trial on time to self-support among sickness absence beneficiaries. The Danish national return-to-work programme. Eur J Public Health 2014; 25:96-102. [PMID: 24577065 DOI: 10.1093/eurpub/cku016] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND In 2010, the Danish Government launched the Danish national return-to-work (RTW) programme to reduce sickness absence and promote labour market attainment. Multidisciplinary teams delivered the RTW programme, which comprised a coordinated, tailored and multidisciplinary effort (CTM) for sickness absence beneficiaries at high risk for exclusion from the labour market. The aim of this article was to evaluate the effectiveness of the RTW programme on self-support. METHODS Beneficiaries from three municipalities (denoted M1, M2 and M3) participated in a randomized controlled trial. We randomly assigned beneficiaries to CTM (M1: n = 598; M2: n = 459; M3: n = 331) or to ordinary sickness absence management (OSM) (M1: n = 393; M2: n = 324; M3: n = 95). We used the Cox proportional hazards model to estimate hazard ratios (HR) comparing rates of becoming self-supporting between beneficiaries receiving CTM and OSM. RESULTS In M2, beneficiaries from employment receiving CTM became self-supporting faster compared with beneficiaries receiving OSM (HR = 1.32, 95% CI: 1.08-1.61). In M3, beneficiaries receiving CTM became self-supporting slower than beneficiaries receiving OSM (HR = 0.72, 95% CI: 0.54-0.95). In M1, we found no difference between the two groups (HR = 0.99, 95% CI: 0.84-1.17). CONCLUSION The effect of the CTM programme on return to self-support differed substantially across the three participating municipalities. Thus, generalizing the study results to other Danish municipalities is not warranted. TRIAL REGISTRATION ISRCTN43004323.
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Affiliation(s)
- Maj Britt D Nielsen
- 1 The National Research Centre for the Working Environment, Copenhagen, Denmark 2 Oxford Research, Copenhagen, Denmark
| | | | - Birgit Aust
- 1 The National Research Centre for the Working Environment, Copenhagen, Denmark
| | - Torill Tverborgvik
- 1 The National Research Centre for the Working Environment, Copenhagen, Denmark 3 Department for Occupational Medicine and Epidemiology, National Institute of Occupational Health, Oslo, Norway
| | - Birthe L Thomsen
- 1 The National Research Centre for the Working Environment, Copenhagen, Denmark
| | - Jakob Bue Bjorner
- 1 The National Research Centre for the Working Environment, Copenhagen, Denmark 4 Department of Public Health, University of Copenhagen, Copenhagen, Denmark 5 QualityMetric, Lincoln, RI, USA
| | - Ole Steen Mortensen
- 1 The National Research Centre for the Working Environment, Copenhagen, Denmark 6 Department of Occupational Medicine, Køge Hospital, Køge, Denmark
| | - Reiner Rugulies
- 1 The National Research Centre for the Working Environment, Copenhagen, Denmark 4 Department of Public Health, University of Copenhagen, Copenhagen, Denmark 7 Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Glen Winzor
- 1 The National Research Centre for the Working Environment, Copenhagen, Denmark
| | - Palle Ørbæk
- 1 The National Research Centre for the Working Environment, Copenhagen, Denmark 8 Danish Working Environment Authority, Copenhagen, Denmark
| | - Trine Helverskov
- 1 The National Research Centre for the Working Environment, Copenhagen, Denmark
| | - Nicolai Kristensen
- 9 KORA, Danish Institute for Local and Regional Governmental Research, Copenhagen, Denmark
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Nastasia I, Coutu MF, Tcaciuc R. Topics and trends in research on non-clinical interventions aimed at preventing prolonged work disability in workers compensated for work-related musculoskeletal disorders (WRMSDs): a systematic, comprehensive literature review. Disabil Rehabil 2014; 36:1841-56. [PMID: 24472007 DOI: 10.3109/09638288.2014.882418] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE This study sought to provide an overview of the main topics and trends in contemporary research on successful non-clinical interventions for preventing prolonged work disability in workers compensated for work-related musculoskeletal disorders (WRMSDs). METHODS A systematic electronic search (English and French) was performed in ten scientific databases using keywords and descriptors. After screening the identified titles and abstracts using specific sets of criteria, categorical and thematic analyses were performed on the retained articles. RESULTS Five main topics appear to dominate the research: (1) risk factors and determinants; (2) effectiveness of interventions (programmes, specific components, strategies and policies); (3) viewpoints, experiences and perceptions of specific actors involved in the intervention process; (4) compensation issues; and (5) measurement issues. A currently widespread trend is early screening to identify risks factors for appropriate intervention and multidisciplinary, multimodal approaches. Morover, workplace-related psychosocial and ergonomic factors are considered vital to the success and sustainability of return-to-work (RTW) interventions. Finally, involving workplace actors, and more specifically, affected workers, in the RTW process appears to be a powerful force in improving the chances of moving workers away from disabled status. CONCLUSIONS The findings of this literature review provide with information about the main topics and trends in research on rehabilitation interventions, revealing some successful modalities of intervention aimed at preventing prolonged work disability. IMPLICATIONS FOR REHABILITATION Successful intervention for preventing prolonged work disability in workers compensated for WRMSDs address workplace issues: physical and psychosocial demands at work, ability of the workers to fill these demands, work organization and support of the worker, and worker' beliefs and attitudes related to work. Successful intervention promotes collaboration, coordination between all actors and stakeholders involved in the process of rehabilitation. Strategies able to mobilize the employees, employers, insurers and health care providers are still needed to be implemented.
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Affiliation(s)
- Iuliana Nastasia
- Institut de recherche Robert-Sauvé en santé et en sécurité du travail (IRSST) , Montreal, Quebec , Canada and
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Shaw WS, Campbell P, Nelson CC, Main CJ, Linton SJ. Effects of workplace, family and cultural influences on low back pain: What opportunities exist to address social factors in general consultations? Best Pract Res Clin Rheumatol 2013; 27:637-48. [DOI: 10.1016/j.berh.2013.09.012] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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