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St-Georges M, Hutting N, Hudon A. Competencies for Physiotherapists Working to Facilitate Rehabilitation, Work Participation and Return to Work for Workers with Musculoskeletal Disorders: A Scoping Review. JOURNAL OF OCCUPATIONAL REHABILITATION 2022; 32:637-651. [PMID: 35384629 DOI: 10.1007/s10926-022-10037-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/16/2022] [Indexed: 06/14/2023]
Abstract
Purpose The aim of this scoping review was to synthesize the literature addressing the competencies that physiotherapists in a clinical setting need to facilitate the rehabilitation, work participation, and return to work of workers with musculoskeletal disorders.Methods We conducted a scoping review in accordance with Arksey & O'Malley's five-step method. The following categories of keywords were used during searches in Embase, Medline and CINAHL in May 2020: (1) physiotherapy/physical therapy; (2) return to work, work participation or occupational health; and (3) education/professional competencies/guidelines. Two authors reviewed the full-text papers and agreed on the selection of articles for inclusion. The selected articles were then charted in an Excel grid and descriptively analyzed.Results Three main categories of competencies were identified: (1) Understanding and interacting with patients who are workers; (2) Planning rehabilitation with other stakeholders; and (3) Reaching out to the workplace. The fourth category named "Obstacles to the development of work-related competencies", regroups several obstacles that were identified as potentially impeding the development of work-related competencies by physiotherapists.Conclusion The findings of this scoping review inform physiotherapy clinicians, educators and regulators on the specific knowledge, skills, abilities, and attitudes that appear to play a role in facilitating the rehabilitation of workers with musculoskeletal disorders. We trust that this study will lead to new initiatives that will define, implement and evaluate the effectiveness of these competencies in practice, along with rekindling the discussions about the place of work rehabilitation in the physiotherapy profession.
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Affiliation(s)
- Mélodie St-Georges
- School of Rehabilitation, Faculty of Medicine, University of Montreal, C.P. 6128 Succ. Centre-ville, Montreal, Québec, H3C 3J7, Canada
| | - Nathan Hutting
- School of Organisation and Development, Research Group Occupation & Health, HAN University of Applied Sciences, PO Box 6960, 6503 GL, Nijmegen, The Netherlands
| | - Anne Hudon
- School of Rehabilitation, Faculty of Medicine, University of Montreal, C.P. 6128 Succ. Centre-ville, Montreal, Québec, H3C 3J7, Canada.
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Institut universitaire sur la réadaptation en déficience physique de Montréal (IURDPM), Centre intégré de services sociaux et de santé du Centre-Sud-de-l'Ile-de-Montréal (CIUSSS CSMTL), Montreal, Quebec, Canada.
- Centre de Recherche en Éthique (CRÉ), Montreal, Canada.
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Axén I, Sennehed CP, Eek F, Stigmar K. Can a workplace dialogue impact the perceived influence of neck and/or backpain on everyday activities and performance at work? A secondary analysis from the randomized controlled trial WorkUp. BMC Musculoskelet Disord 2022; 23:861. [PMID: 36104781 PMCID: PMC9476597 DOI: 10.1186/s12891-022-05812-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 09/08/2022] [Indexed: 11/13/2022] Open
Abstract
Background Neck- and back- pain are highly prevalent conditions in Sweden and world-wide. Such pain often has consequences on everyday activities, work- and personal life. One consequence is work absence and decreased productivity at work. Adding a workplace dialogue to structured physiotherapy was recently found to lead to increased workability, i.e., not being on sick leave during the 12th month of follow up. Aim The aim of the study was to explore the effect of a workplace dialogue intervention on secondary outcomes: perceived impact of neck and/or back pain on everyday activities and on performance at work, and total days of sick leave during 12 month follow up. A further aim was to examine associations between perceived influence of pain, and sick leave. Method Patients with neck and/or back pain in primary care in the south of Sweden were randomized into structured physiotherapy alone (n = 206) or with the addition of a workplace dialogue (n = 146). Data regarding the pain’s influence on everyday activities and on performance at work were collected using weekly text messages for 52 weeks. The pattern of change in perceived influence of neck and/or back pain on everyday activities and performance at work was compared between the groups with linear mixed models. Cross sectional correlations between perceived influence of neck and/or back pain on everyday activities and performance at work, and days of sick leave, during the preceding four weeks at months 3, 6, 9 and 12 were examined. Result We found no differences in change of perceived influence of neck and/or back pain on daily activities or perceived performance at work, or total days of sick leave during the 12 months of follow up between the groups with structured physiotherapy with or without a workplace dialogue. There was a weak to moderate positive correlation between days of sick leave and perceived influence of neck and/or back pain on everyday activities and performance at work (rho 0.28–0.47). Conclusion A workplace dialogue was not found to affect the perceived impact of neck and/or back pain on everyday activities and performance at work. Trial registration ClinicalTrials.gov ID: NCT02609750.
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Oswald W, Ummels I, Raaijmakers T, Baart P, Staal JB, Bieleman HJ, Nijhuis-van der Sanden MWG, Heerkens YF, Hutting N. Therapists' experiences and needs with regard to providing work-focused care: a focus group study. BMC Musculoskelet Disord 2021; 22:923. [PMID: 34727896 PMCID: PMC8565033 DOI: 10.1186/s12891-021-04806-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 10/20/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Musculoskeletal disorders (MSDs) can create a temporary or permanent disability that reduce a person's ability to work. Physiotherapists (PTs), occupational therapists (OTs) and exercise therapists (ETs) are often involved in the early management of MSDs. There is a need for additional insights into therapists' experiences, barriers and needs to work-focused care. Moreover, there is no evidence on how OTs and ETs address work participation. Therefore, the aim of this qualitative study was 1) to investigate how generalist PTs, OTs and ETs provide work-focused healthcare and 2) to obtain insight into their perceived barriers and needs that affect their ability to address occupational factors. METHODS An exploratory qualitative study using three focus groups. Generalist PTs, OTs and ETs were eligible to participate if they treated working patients with MSDs. A semi-structured interview guide with open-ended questions was developed. Two moderators facilitated each focus group using the interview guide, and all the groups were audio recorded. Data were analysed using inductive thematic analysis. RESULTS Sixteen therapists (mean age 44 years, range 25-59) participated in this study. Participants were aware of the importance of taking occupational factors into account. Whether they address occupational factors is largely dependent on the patient's request for help. However, ETs and OTs consider it normal to ask about occupational factors during the diagnostic process, while PTs often address this in later consultations. Almost all participants were unaware of the existence of PTs, OTs or ETs who are specialised in occupational health. Moreover, almost all participants struggled with when to refer a patient to other (occupational) healthcare professionals. This study identified several needs of therapists. These included knowledge about laws and legislation and skills for identifying and addressing work-related or work-relevant complaints. CONCLUSIONS Participants in this qualitative study were aware of the importance of taking occupational factors into account. However, how PTs, OTs and ETs address work participation and the extent to which they do so can be improved. There was a lack of knowledge about and cooperation with occupational health professionals, including PTs, OTs or ETs specialised in occupational health.
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Affiliation(s)
- Wiebke Oswald
- School of Organisation and Development, HAN University of Applied Sciences, Research Group Occupation & Health, P.O. Box 6960, 6503 GL, Nijmegen, The Netherlands
- School for Allied Health, HAN University of Applied Sciences, Physical Therapy, Nijmegen, The Netherlands
| | - Inez Ummels
- School of Organisation and Development, HAN University of Applied Sciences, Research Group Occupation & Health, P.O. Box 6960, 6503 GL, Nijmegen, The Netherlands
| | | | - Paul Baart
- Centre Work Health, Amersfoort, The Netherlands
| | - J Bart Staal
- School for Allied Health, HAN University of Applied Sciences, Key Factors in Physiotherapy and Allied Health Research Group, Nijmegen, the Netherlands
- Radboud Institute for Health Sciences, Radboud University Medical Centre, IQ Healthcare, Nijmegen, the Netherlands
| | - Hendrik J Bieleman
- Saxion University of Applied Sciences, Research Group Health and Physical Activity, Enschede, The Netherlands
| | | | - Yvonne F Heerkens
- School of Organisation and Development, HAN University of Applied Sciences, Research Group Occupation & Health, P.O. Box 6960, 6503 GL, Nijmegen, The Netherlands
| | - Nathan Hutting
- School of Organisation and Development, HAN University of Applied Sciences, Research Group Occupation & Health, P.O. Box 6960, 6503 GL, Nijmegen, The Netherlands.
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Clinical Guidance to Optimize Work Participation After Injury or Illness: The Role of Physical Therapists. J Orthop Sports Phys Ther 2021; 51:CPG1-CPG102. [PMID: 34338006 DOI: 10.2519/jospt.2021.0303] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Work rehabilitation refers to the process of assisting workers to remain at work or return to work (RTW) in a safe and productive manner, while limiting the negative impact of restricted work, unemployment, and work disability. The primary purpose of this clinical practice guideline (CPG) is to systematically review available scientific evidence and provide a set of evidence-based recommendations for effective physical therapy evaluation, treatment, and management of individuals experiencing limitations in the ability to participate in work following injury or illness. J Orthop Sports Phys Ther 2021;51(8):CPG1-CPG102. doi:10.2519/jospt.2021.0303.
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Burgess R, Hall J, Bishop A, Lewis M, Hill J. Costing Methodology and Key Drivers of Health Care Costs Within Economic Analyses in Musculoskeletal Community and Primary Care Services: A Systematic Review of the Literature. J Prim Care Community Health 2021; 11:2150132719899763. [PMID: 31941391 PMCID: PMC6966248 DOI: 10.1177/2150132719899763] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Identifying variation in musculoskeletal service costs
requires the use of specific standardized metrics. There has been a large focus
on costing, efficiency, and standardized metrics within the acute
musculoskeletal setting, but far less attention in primary care and community
settings. Objectives: To (a) assess the quality of
costing methods used within musculoskeletal economic analyses based primarily in
primary and community settings and (b) identify which cost
variables are the key drivers of musculoskeletal health care costs within these
settings. Methods: Medline, AMED, EMBASE, CINAHL, HMIC, BNI, and
HBE electronic databases were searched for eligible studies. Two reviewers
independently extracted data and assessed quality of costing methods using an
established checklist. Results: Twenty-two studies met the review
inclusion criteria. The majority of studies demonstrated moderate- to
high-quality costing methods. Costing issues included studies failing to fully
justify the economic perspective, and not distinguishing between short- and
long-run costs. Highest unit costs were hospital admissions, outpatient visits,
and imaging. Highest mean utilization were the following: general practitioner
(GP) visits, outpatient visits, and physiotherapy visits. Highest mean costs per
patient were GP visits, outpatient visits, and physiotherapy visits.
Conclusion: This review identified a number of key resource use
variables that are driving musculoskeletal health care costs in the
community/primary care setting. High utilization of these resources (rather than
high unit cost) appears to be the predominant factor increasing mean health care
costs. There is, however, need for greater detail with capturing these key cost
drivers, to further improve the accuracy of costing information.
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Affiliation(s)
- Roanna Burgess
- Keele University, Keele, Staffordshire, UK.,Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
| | - James Hall
- Keele University, Keele, Staffordshire, UK.,University of Birmingham, Birmingham, UK
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Hutting N, Boucaut R, Gross DP, Heerkens YF, Johnston V, Skamagki G, Stigmar K. Work-Focused Health Care: The Role of Physical Therapists. Phys Ther 2020; 100:2231-2236. [PMID: 32929495 DOI: 10.1093/ptj/pzaa166] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 07/23/2020] [Accepted: 08/21/2020] [Indexed: 01/21/2023]
Affiliation(s)
- Nathan Hutting
- School of Organisation and Development, Research Group Occupation and Health, HAN University of Applied Sciences, PO Box 6960, 6503 GL Nijmegen, the Netherlands
| | - Rose Boucaut
- Allied Health & Human Performance, University of South Australia, Adelaide, Australia
| | - Douglas P Gross
- Department of Physical Therapy, University of Alberta, Edmonton, Alberta, Canada
| | - Yvonne F Heerkens
- School of Organisation and Development, Research Group Occupation and Health, HAN University of Applied Sciences
| | - Venerina Johnston
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Glykeria Skamagki
- School of Health, Physiotherapy, Coventry University, Coventry, United Kingdom
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Larsson M, Nordeman L, Holmgren K, Grimby-Ekman A, Hensing G, Björkelund C, Bergman S, Ekhammar A, Dottori M, Bernhardsson S. Prevention of sickness absence through early identification and rehabilitation of at-risk patients with musculoskeletal pain (PREVSAM): a randomised controlled trial protocol. BMC Musculoskelet Disord 2020; 21:790. [PMID: 33248457 PMCID: PMC7700707 DOI: 10.1186/s12891-020-03790-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 11/11/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Musculoskeletal pain is globally a leading cause of physical disability. Many musculoskeletal-related pain conditions, such as low back pain, often resolve spontaneously. In some individuals, pain may recur or persist, leading to ong-term physical disability, reduced work capacity, and sickness absence. Early identification of individuals in which this may occur, is essential for preventing or reducing the risk of developing persistent musculoskeletal pain and long-term sickness absence. The aim of the trial described in this protocol is to evaluate effects of an early intervention, the PREVSAM model, on the prevention of sickness absence and development of persistent pain in at-risk patients with musculoskeletal pain. METHODS Eligible participants are adults who seek health care for musculoskeletal pain and who are at risk of developing persistent pain, physical disability, and sickness absence. Participants may be recruited from primary care rehabilitation centres or primary care healthcare centres in Region Västra Götaland. Participants will be randomised to treatment according to the PREVSAM model (intervention group) or treatment as usual (control group). The PREVSAM model comprises an interdisciplinary, person-centred rehabilitation programme, including coordinated measures within primary health care, and may include collaboration with participants' employers. The primary outcome sickness absence is operationalised as the number and proportion of individuals who remain in full- or part-time work, the number of gross and net days of sickness absence during the intervention and follow-up period, and time to first sickness absence spell. Secondary outcomes are patient-reported short-term sickness absence, work ability, pain, self-efficacy, health-related quality of life, risk for sickness absence, anxiety and depression symptoms and physical disability at 1 and 3 months after inclusion (short-term follow-up), and at 6 and 12 months (long-term follow-up). A cost-effectiveness analysis is planned and drug consumption will be investigated. DISCUSSION The study is expected to provide new knowledge on the effectiveness of a comprehensive rehabilitation model that incorporates early identification of patients with musculoskeletal pain at risk for development of sickness absence and persistent pain. The study findings may contribute to more effective rehabilitation processes of this large patient population, and potentially reduce sickness absence and costs. TRIAL REGISTRATION ClinicalTrials.gov Protocol ID: NCT03913325 , Registered April 12, 2019. Version 2, 10 July 2020. Version 2 changes: Clarifications regarding trial aim and inclusion process.
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Affiliation(s)
- Meh Larsson
- Department of Education, Research and Development Primary Health Care, Region Västra Götaland, Gothenburg, Sweden. .,Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.
| | - L Nordeman
- Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.,Department of Education, Research and Development Primary Health Care, Region Västra Götaland, Borås, Sweden
| | - K Holmgren
- Unit of Occupational Therapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - A Grimby-Ekman
- School of Public Health and Community Medicine, Institute of Medicine, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - G Hensing
- School of Public Health and Community Medicine, Institute of Medicine, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - C Björkelund
- Primary Care, School of Public Health and Community Medicine, Institute of Medicine, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - S Bergman
- Primary Care, School of Public Health and Community Medicine, Institute of Medicine, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - A Ekhammar
- Department of Education, Research and Development Primary Health Care, Region Västra Götaland, Gothenburg, Sweden.,Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - M Dottori
- Department of Education, Research and Development Primary Health Care, Region Västra Götaland, Gothenburg, Sweden
| | - S Bernhardsson
- Department of Education, Research and Development Primary Health Care, Region Västra Götaland, Gothenburg, Sweden.,Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
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Forsbrand MH, Turkiewicz A, Petersson IF, Sennehed CP, Stigmar K. Long-term effects on function, health-related quality of life and work ability after structured physiotherapy including a workplace intervention. A secondary analysis of a randomised controlled trial (WorkUp) in primary care for patients with neck and/or back pain. Scand J Prim Health Care 2020; 38:92-100. [PMID: 32000558 PMCID: PMC7054906 DOI: 10.1080/02813432.2020.1717081] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Objective: To study the long-term effects of a workplace intervention in addition to structured physiotherapy regarding self-reported measures in patients with acute/subacute neck and/or back pain.Design: WorkUp - a cluster-randomised controlled trial in 32 primary care centers in Sweden, from January 2013 through December 2014 (ClinicalTrials.gov ID: NCT02609750).Intervention: Structured physiotherapy with the workplace dialogue 'Convergence Dialogue Meeting' (CDM), conducted by the treating physiotherapist as an add-on. Reference group received structured physiotherapy.Subjects: Adults, 18-67 years (mean 43.7, standard deviation (SD) 12.2), 65.3% women with acute/subacute neck and/or back pain who had worked ≥4 weeks past year, considered at risk of sick leave or were on short-term sick leave (≤60 days) were included (n = 352).Outcome measures: Self-reported function, functional rating index (FRI), health-related quality of life (EQ-5D-3L) and work ability (Work Ability Score, WAS) at 12 months follow-up.Results: The mean differences in outcomes between intervention and reference group were; -0.76 (95% confidence interval (CI): -2.39, 0.88; FRI), 0.02 (95% CI: -0.04, 0.08; EQ-5D-3L) and -0.05 (95% CI: -0.63, 0.53; WAS). From baseline to 12 months, the intervention group improved function from 46.5 (SD 19.7) to 10.5 (SD 7.3) on FRI; health-related quality of life from 0.53 (SD 0.29) to 0.74 (SD 0.20) on EQ-5D and work ability from 5.7 (SD 2.6) to 7.6 (SD 2.1) on WAS.Conclusion: Despite a clinically relevant improvement over time, there were no significant differences in improvement between groups, thus we conclude that CDM had no effect on self-reported measures in this study.Key pointsIn earlier analysis of the primary outcome (work ability measured by absenteeism) in this trial, a positive effect was found when the workplace intervention 'Convergence Dialogue Meeting' (CDM) was added to structured physiotherapy for patients with neck or back pain.By contrast, in this new analysis of secondary outcomes (self-reported function, health and perceived work ability), there was no added effect of CDM above structured physiotherapy alone, although patients in both the intervention and reference group improved over time.The addition of CDM to physiotherapy is therefore justified by its specific effect on behavior (work absence) rather than any effect on clinical outcomes.
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Affiliation(s)
- Malin H Forsbrand
- Faculty of Medicine, Department of Clinical Sciences Lund, Orthopedics, Lund University, Lund, Sweden
- Blekinge Centre of Competence, Region Blekinge, Karlskrona, Sweden
| | - Aleksandra Turkiewicz
- Clinical Epidemiology Unit, Orthopedics, Clinical Sciences, Lund, Lund University, Lund, Sweden
| | - Ingemar F Petersson
- Faculty of Medicine, Department of Clinical Sciences Lund, Orthopedics, Lund University, Lund, Sweden
- Skåne University Hospital, Lund, Sweden
| | - Charlotte Post Sennehed
- Faculty of Medicine, Department of Clinical Sciences Lund, Orthopedics, Lund University, Lund, Sweden
- Department of Research and Development, Region Kronoberg, Växjö, Sweden
| | - Kjerstin Stigmar
- Skåne University Hospital, Lund, Sweden
- Department of Health Sciences, Physiotherapy, Lund University, Lund, Sweden
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