Effect of peer-based low back pain information and reassurance at the workplace on sick leave: a cluster randomized trial

[Does patient communication influence kinesiophobia? A systematic review]

The aim of the present systematic review was to determine the effect of communication in the health care setting on kinesiophobia. To this end, a literature search was conducted in seven databases between November 2022 and February 2023. The review was carried out following the PRISMA statement and for the analysis of methodological quality we used: PEDro Scale, Van Tulder criteria and risk of bias analysis of the Cochrane Collaboration. A total of 13 articles were included with a mean methodological quality of 7.1 out of 10. Significant results were obtained for at least one variable (kinesiophobia, disability or level of physical activity) in 12 articles. There is strong evidence that communication can influence a subject's kinesiophobia. This influence is most likely to be in a negative or disabling sense, but it can also act in a positive sense by decreasing it.

What do people believe to be the cause of low back pain? A scoping review

OBJECTIVE

To explore how causal beliefs regarding non-specific low back pain (LBP) have been quantitatively investigated.

METHODS

A scoping review based on the guidelines by the JBI (former Joanna Briggs Institute) was conducted. We searched Medline, Embase, Psychinfo, and CINAHL for relevant studies and included peer-reviewed original articles that measured causal beliefs about non-specific LBP among adults and reported results separate from other belief domains.

RESULTS

A total of 81 studies were included, of which 62 (77%) had cross sectional designs, 11 (14%) were cohort studies, 3 (4%) randomized controlled trials, 4 (5%) non-randomized controlled trials, and 1 (1%) case control. Only 15 studies explicitly mentioned cause, triggers, or etiology in the study aim. We identified the use of 6 questionnaires from which a measure of causal beliefs could be obtained. The most frequently used questionnaire was the Illness Perception Questionnaire which was used in 8 of the included studies. The studies covered 308 unique causal belief items which we categorized into 15 categories, the most frequently investigated being causal beliefs related to "structural injury or impairment", which was investigated in 45 (56%) of the studies. The second and third most prevalent categories were related to "lifting and bending" (26 studies [32%]) and "mental or psychological" (24 studies [30%]).

CONCLUSION

There is a large variation in how causal beliefs are measured and a lack of studies designed to investigate causal beliefs, and of studies determining a longitudinal association between such beliefs and patient outcomes. This scoping review identified an evidence gap and can inspire future research in this field.

Comparing the new interdisciplinary Health in work intervention to conventional monodisciplinary welfare interventions at Norwegian workplaces: Protocol for a pragmatic cluster-randomized trial (Preprint)

Background

Musculoskeletal and mental health complaints are the dominant diagnostic categories in long-term sick leave and disability pensions in Norway. Continuing to work despite health complaints is often beneficial, and a good work environment can improve work inclusion for people affected. In 2001, the Norwegian Labour and Welfare Administration began to offer inclusive work measures to improve the psychosocial work environment and work inclusion of people with health complaints. In 2018, the Norwegian Labour and Welfare Administration and specialist health services started offering the new collaborative Health in work program. Its workplace intervention presents health and welfare information that may improve employees’ coping ability regarding common health complaints. It encourages understanding of coworkers’ health complaints and appropriate work adjustments to increase work participation.

Objective

This protocol presents an ongoing, 2-arm, pragmatic cluster-randomized trial. Its aim is to compare the effect of monodisciplinary inclusive work measures (treatment as usual) and interdisciplinary Health in work in terms of changes in overall sickness absence, health care use, health-related quality of life, and costs. The secondary objectives are to compare changes in individual sickness absence, psychosocial work environment, job and life satisfaction, health, and health anxiety at both the individual and group levels.

Methods

Data will be collected from national registers, trial-specific registrations, and questionnaires. Effects will be explored using difference-in-difference analysis and regression modeling. Multilevel analysis will visualize any cluster effects using intraclass correlation coefficients.

Results

Inclusion was completed in July 2021 with 97 workplaces and 1383 individual consents. Data collection will be completed with the last questionnaires to be sent out in July 2023.

Conclusions

This trial will contribute to filling knowledge gaps regarding the effectiveness and costs of workplace interventions, thereby benefiting health and welfare services, political decision makers, and the public and business sectors. The findings will be disseminated in reports, peer-reviewed journals, and conferences.

Trial Registration

ClinicalTrials.gov NCT04000035; https://clinicaltrials.gov/ct2/show/NCT04000035

International Registered Report Identifier (IRRID)

DERR1-10.2196/36166

Clinical Guidance to Optimize Work Participation After Injury or Illness: The Role of Physical Therapists

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.

Experiences of patient-led chronic pain peer support groups after pain management programmes: A qualitative study

OBJECTIVE

A qualitative study of patients' experiences and the impacts of peer support groups that patients maintained after UK NHS group pain management programmes (PMPs).

DESIGN

Long-term impacts of group PMPs remain unclear, with indications that positive effects can fade. We evaluated a model of continued peer support, co-produced by patients and clinicians, to maintain the therapeutic impact of PMP groups. A protocol was implemented that encouraged patients to continue to meet in their established PMP group for patient-led peer support (without clinical input) after PMPs finished. Peer support aimed to consolidate self-management, and advance social life recovery. We examined the impacts that groups had on attendees, and why some dropped out.

METHODS

Semi-structured interviews with 38 patients and 7 clinicians, analysed thematically.

RESULTS

Friendship bonds and mutual understandings of effective ways of coping with pain encouraged participants to maintain recovery following PMPs. After PMP professional involvement has ended, these meetings enabled patients to develop greater agency from the shared sense of helping bring about new achievements or averting setbacks. Peer support extended the understanding of what is possible when living with pain. However, continuing meetings were not right for all. Reasons for not attending included lack of connection with peers.

CONCLUSIONS

Co-produced peer support groups after PMPs can be a low-cost, effective social intervention, providing emotional, practical and social benefits, with improved self-management skills, stronger social connections and some reduced use of health services. Project resources for developing peer support meetings after PMPs are freely available online.

Development of the workplace inclusion questionnaire (WIQ)

Aims:

To develop a questionnaire to examine attitudes among employees and managers to include people with various health problems into their work group, and to test the questionnaire in one relevant population within the labour market.

Methods:

A questionnaire was developed through a process involving discussions in a scientific forum and pilot testing with group discussions. The final questionnaire, which was tested in a survey study of managers and employees in 33 Norwegian kindergartens (N=485), contained 10 short case stories followed by questions concerning workplace inclusion. The case stories described individuals with musculoskeletal and mental disorders, as well as individuals with potentially stigmatising behavioural history and lifestyle, and control cases. Risk ratios with 95% confidence intervals (CIs) were used to compare the case stories. Cases with high risk ratios had an increased risk of not being included compared to a control case.

Results:

Attitudes for workplace inclusion varied between the different case stories. Cases portraying mental illness had the highest risk ratios, indicating that employees and managers are less likely to include people with mental illness than people with musculoskeletal illness. Furthermore, unspecific or chronic illness had higher risk ratios than specific and acute illness. The most important barriers also varied between case stories.

Conclusions:

The workplace inclusion questionnaire fulfills the need for a quantitative measure of attitudes to include individuals with various health problems into the workplace. Comparison of risk ratios showed clear differences between case stories, indicating that the workplace inclusion questionnaire is a valuable tool to measure the variance in workplace inclusion.

A scoping review to ascertain the parameters for an evidence synthesis of psychological interventions to improve work and wellbeing outcomes among employees with chronic pain

Background: Psychological interventions have mixed effects on improving employee outcomes, partly due to significant variability across studies and a lack of focus on mechanisms of action. This scoping review reports on the parameters of these interventions and examines intervention content to bring clarity to this heterogeneous topic area and direct future systematic review work.

Method: Six databases were searched (Cinahl, Cochrane, Embase, Medline, PsychINFO and Web of Science) from April 2010 to August 2020, and a grey literature search was undertaken. Screening was undertaken independently by two authors. The results summarised country, participant and employment characteristics, psychological interventions and work, health and wellbeing outcomes. 10% of the papers were analysed to determine the feasibility of coding intervention descriptions for theory and behaviour change technique (BCT) components.

Results: Database searches yielded 9341 titles, of which 91 studies were included. Most studies were conducted in Europe (78%) and included males and females (95%) ranging in age from 31-56.6 years although other demographic, and employment information was lacking. Musculoskeletal pain was common (87%). Psychological interventions commonly included cognitive behavioural therapy (30%) and education (28%). Most studies employed a randomised control trial design (64%). Over half contained a control group (54%). Interventions were delivered in mostly healthcare settings (72%) by health professionals. Multiple outcomes were often reported, many of which involved measuring sickness absence and return-to-work (62%) and pain and general health (53%). Within the feasibility analysis, most papers met the minimum criteria of containing one paragraph of intervention description, but none explicitly mentioned theory or BCTs.

Conclusion: Psychological interventions for employees with chronic pain vary in their nature and implementation. We have shown scoping reviews can be used to assess the feasibility of applying tools from health psychology to identify the content of these interventions in future systematic review work to improve intervention development.

Should musicians play in pain?

Musculoskeletal symptoms, including pain, are often experienced by musicians at all levels. These symptoms may have a detrimental impact on musicians' personal and work lives, and may also impact upon the ensembles they work within. Providing musicians with appropriate, evidence-based advice regarding pain management is therefore paramount. In this review, we aim to improve the advice given to musicians regarding playing when in pain, by answering the question 'should musicians play in pain?'. This multidisciplinary narrative review draws upon contemporary pain science, including factors associated with poorer prognoses for those in pain, as well as the reported experiences of musicians with pain (including those who have taken time off from playing). Our current understanding of pain science provides further support for the potential for consequences related to avoiding activities due to pain. Pain is modulated by a number of neuro-immunological processes and is influenced by a range of psychosocial factors. Taking time off from playing might therefore not have any benefit. Importantly, one of the leading causes of a transition from acute to chronic pain is fear-avoidance behaviour (e.g. not playing when in pain); hence, encouraging such behaviour cannot be supported. Musicians who have taken time off from playing due to pain have experienced a range of consequences, including emotional and financial consequences. These experiences indicate that there are potential negative consequences related to taking time off from playing which need to be weighed against any benefits. We conclude that musicians should not necessarily be advised to take time off from playing to manage their pain, in keeping with current best practice for pain management. Instead, we recommend that musicians be educated on contemporary pain science and when to seek treatment from a health professional for individualised advice to reduce the burden of musicians' pain.

PALS: peer support for community dwelling older people with chronic low back pain: a feasibility and acceptability study

OBJECTIVES

(i) Examine the feasibility and acceptability of a peer support intervention (PALS) to facilitate self-management in community dwelling older adults with Chronic Low Back Pain (CLBP), and (ii) examine the feasibility of study methods in order to inform the design of a future randomised controlled trial.

DESIGN

Mixed methods feasibility and acceptability study.

SETTING

Community.

PARTICIPANTS

18 older adults (aged 65 to 79) with CLBP and 6 peer support volunteers (PSVs) aged 34 to 65.

INTERVENTION

Six sessions of 1 to 3hours duration, approximately 2 weeks apart, delivered in mutually convenient public places, or by telephone. Each session had a suggested topic and each participant and PSV had a PALS manual detailing aims and target outcomes for each session.

OUTCOME MEASURES

Recruitment, retention, integrity, acceptability and feasibility of the PALS intervention, feasibility of study processes, appropriateness and usefulness of outcome measures.

RESULTS

We recruited to target and retained 2/3 of participants. PALS was delivered as intended and acceptable to people with CLBP and PSVs. Most participants were satisfied with PALS and would recommend it to someone else with CLBP. Study processes worked well, but recruitment procedures need to be refined. Outcome measures were returned and were mostly complete, but further work on the most appropriate measures is required.

CONCLUSIONS

PALS was feasible to deliver and acceptable to the older people and PSVs who took part in this study. We identified amendments to PALS and the study processes that, once implemented, will allow the effectiveness of PALS to be tested in a large-scale study.

The Role of Peer Support in Managing Occupational Stress: A Qualitative Study of the Sustaining Resilience at Work Intervention

Background: Peer support at work may support psychological resilience by enhancing coping skills and providing social support. The current study aimed to examine how a workplace peer support program, "Sustaining Resilience at Work" (StRaW), may support employee mental health from the perspective of the trained peer supporter. Method: Nine individuals from various public and private organizations who had completed StRaW peer supporter training participated in semi-structured interviews to explore their views on the StRaW program. Data were analyzed using inductive thematic analysis. Findings: Three main themes emerged: the impact of workplace stressors on employee mental health, the impact of StRaW, and feedback on StRaW. The results suggested positive effects of StRaW training on practitioners' ability to support colleagues and maintain their own psychological well-being. Discussion/Application to Practice: Our results indicated that peer support programs in the workplace may improve employees' well-being and relationships between employees. As such, occupational health professionals should recommend that their organizations invest in these types of programs to improve organizational resilience. They should encourage employees they consider to be capable of supporting their colleagues to undergo this training as evidence suggests this is beneficial to the trained employees' own well-being, rather than making them feel burdened or under pressure. Occupational health professionals should also view such programs as useful ways of improving attitudes toward mental health within their organizations.

Effect of Reassuring Information About Musculoskeletal and Mental Health Complaints at the Workplace: A Cluster Randomized Trial of the atWork Intervention

Purpose The purpose of this study was to investigate the possible difference between the Modified atWork intervention (MAW) and the Original atWork intervention (OAW) on sick leave and other health related outcomes. atWork is a group intervention using the workplace as an arena for distribution of evidence-based knowledge about musculoskeletal and mental health complaints. Methods A cluster randomized controlled trial with 93 kindergartens, comprising a total of 1011 employees, was conducted. Kindergartens were stratified by county and size and randomly allocated to MAW (45 clusters, 324 respondents) or OAW (48 clusters, 313 respondents). The randomization and intervention allocation processes were concealed. There was no blinding to group allocation. Primary outcome was register data on sick leave at cluster level. Secondary outcomes were health complaints, job satisfaction, social support, coping, and beliefs about musculoskeletal and mental health complaints, measured at the individual level. Results The MAW group reduced sick leave by 5.7% during the intervention year, while the OAW group had a 7.5% increase. Overall, the changes were not statistically significant, and no difference was detected between groups, based on 45 and 47 kindergartens. Compared to the OAW group, the MAW group had a smaller reduction for two of the statements concerning faulty beliefs about back pain, but believed less in the hereditary nature of depression. Conclusions The MAW did not have a different effect on sick leave at cluster level compared to the OAW. Trial registration https://Clinicaltrials.gov/ : NCT02396797. Registered March 23th, 2015.

Young adults at risk of early work disability: who are they?

BACKGROUND

Young adults that are not in education, training or employment represent a problem across European countries. While some are cases of temporary transitions or short-term inactivity, others represent a more vulnerable group at risk of early work disability. Early exclusion from the labor market represents long lives exposed to detrimental effects of unemployment on health and well-being, and constitutes an economic burden for society. There is need for more knowledge about young adults who are at risk of early work disability but have not yet reached the point of more permanent exclusion. This study aims to investigate social and health-related problems in a Norwegian sample of young adults at risk of early work disability, and their self-perceived causes of illness.

METHODS

Baseline data from participants in the SEED-trial (N = 96), a randomized controlled trial comparing individual placement and support to traditional vocational rehabilitation in young adults at risk of early work disability, were analyzed. Background, health behaviors, adverse social experiences, disability level, physical and mental health, social support, coping, and self-perceived causal attributions of illness were measured. Gender differences were analyzed using chi-square and t-tests.

RESULTS

Mean age was 24, and 68% were men. One third reported reading and writing difficulties, and 40% had less than high-school education. The majority had experienced bullying (66%) or violence (39%), and 53% reported hazardous alcohol use. Psychological distress was the most prevalent health problem (52%), and women generally had more physical and mental health problems than men. Self-perceived causal attributions of illness were mainly related to relational problems, followed by health behaviors, heredity/genetics, and external environmental factors.

CONCLUSIONS

The study provides a deeper insight into a vulnerable group with substantial challenges related to adverse social experiences, psychological distress, and alcohol use, who emphasized relational problems as the main causal factor for their illness. Findings suggest a need for broader focus on psychological and social factors in vocational rehabilitation efforts targeting young adults at risk of early work disability. Furthermore, gender-specific approaches may be warranted and should be followed up in future studies.

TRIAL REGISTRATION

Clinicaltrials.gov: NCT02375074 . Retrospectively registered December 3rd 2014.

Prevention of post-concussion-like symptoms in patients presenting at the emergency room, early single eye movement desensitization, and reprocessing intervention versus usual care: study protocol for a two-center randomized controlled trial

Background

Recent data suggest that 10–20% of injury patients will suffer for several months after the event from diverse symptoms, generally referred to as post-concussion-like symptoms (PCLS), which will lead to a decline in quality of life. A preliminary randomized control trial suggested that this condition may be induced by the stress experienced during the event or emergency room (ER) stay and can be prevented in up to 75% of patients with a single, early, short eye movement desensitization and reprocessing (EMDR) psychotherapeutic session delivered in the ER.

The protocol of the SOFTER 3 study was designed to compare the impact on 3-month PCLS of early EMDR intervention and usual care in patients presenting at the ER. Secondary outcomes included 3-month post-traumatic stress disorder, 12-month PCLS, self-reported stress at the ER, self-assessed recovery expectation at discharge and 3 months, and self-reported chronic pain at discharge and 3 months.

Methods

This is a two-group, open-label, multicenter, comparative, randomized controlled trial with 3- and 12-month phone follow-up for reports of persisting symptoms (PCLS and post-traumatic stress disorder). Those eligible for inclusion were adults (≥18 years old) presenting at the ER departments of the University Hospital of Bordeaux and University Hospital of Lyon, assessed as being at high risk of PCLS using a three-item scoring rule. The intervention groups were a (1) EMDR Recent Traumatic Episode Protocol intervention performed by a trained psychologist during ER stay or (2) usual care. The number of patients to be enrolled in each group was 223 to evidence a 15% decrease in PCLS prevalence in the EMDR group.

Discussion

In 2012, the year of the last national survey in France, 10.6 million people attended the ER, some of whom did so several times since 18 million visits were recorded in the same year. The SOFTER 3 study therefore addresses a major public health challenge.

Trial registration

Clinical Trials. NCT03400813. Registered 17 January 2018 – retrospectively registered.

Electronic supplementary material

The online version of this article (10.1186/s13063-018-2902-2) contains supplementary material, which is available to authorized users.

Workplace inclusion of employees with back pain and mental health problems: A focus group study about employees' experiences

Aim: To explore how employees experience workplace inclusion of their colleagues or themselves when having back pain or mental health problems. Methods: Three focus group interviews with a sample of 16 kindergarten employees were conducted. Systematic Text Condensation was used for analysis. Results: The participants emphasized that it was easier to include colleagues whose health problems were specific, especially when they were open about having problems and expressed their needs for accommodation clearly. Discussions revealed difficulties of acceptance and accommodating colleagues with longstanding health problems, when the burden on the other staff members was heavy, and if it had negative consequences for the kindergarten children. Some of the participants had experienced health problems themselves, which was also described as challenging. Having health problems at work often induced feelings of guilt, being a burden to their colleagues, and experiencing a disparity between the ideals and the realities of inclusion practices. Conclusions: Workplace inclusion of employees is difficult when their health problems are unspecific, longstanding, and lead to negative consequences for children or colleagues. System level efforts are necessary to reduce negative stereotypes about employees with health problems and facilitate inclusion practices.

Group-based healthy lifestyle workplace interventions for shift workers: a systematic review

Objective

Shift work is a risk factor for many chronic diseases and has been associated with unhealthy lifestyle behaviors. Workplaces have great potential for promoting and supporting behavior change. We conducted a systematic review of group-based lifestyle workplace interventions for shift workers to (i) identify adaptations and intervention components that accommodate shift working and (ii) assess their impact on weight, physical activity, sedentary behavior and healthy eating.

Methods

A systematic search was conducted in Scopus, Web of Knowledge, EBSCO and Ovid databases. Using pre-established criteria, independent pairs of researchers conducted the study selection, quality appraisal and data extraction.

Results

In total, 22 studies on group-based workplace interventions for shift workers were included. Many demonstrated organizational level adaptations, such as flexible delivery times and paying employees’ time for their involvement. Delivery locations near the workplace and management support were other key features. Common intervention components included competitive group activities, individualized goal setting, self-monitoring and feedback, staff involvement in intervention delivery, and incentives. There was moderate evidence for effectiveness on weight and physical activity outcomes, but insufficient evidence for healthy eating outcomes. No interventions focusing on sedentary behavior among shift workers were found.

Conclusion

Current evidence demonstrates that group-based workplace interventions can be effective for supporting shift workers to lose weight and increase physical activity, while further research is needed to change healthy eating and sedentary behaviors. Our findings offer decision support on organizational-level adaptations and intervention components that are important to make interventions that promote healthy lifestyles more accessible to shift workers.

Emergency room intervention to prevent post concussion-like symptoms and post-traumatic stress disorder. A pilot randomized controlled study of a brief eye movement desensitization and reprocessing intervention versus reassurance or usual care

Up to 20% of patients presenting at an emergency room (ER) after a stressful event will for several months suffer from very diverse long-lasting symptoms and a potentially significant decline in quality of life, often described as post concussion-like symptoms (PCLS). The objectives of our randomized open-label single-center study were to assess the feasibility of psychologist-led interventions in the context of the ER and to compare the effect of eye movement desensitization and reprocessing (EMDR) with reassurance and usual care. Conducted in the ER of Bordeaux University Hospital, the study included patients with a high risk of PCLS randomized in three groups: a 15-min reassurance session, a 60-min session of EMDR, and usual care. Main outcomes were the proportion of interventions that could be carried out and the prevalence of PCSL and post-traumatic stress disorder (PTSD) three months after the ER visit. One hundred and thirty patients with a high risk of PCLS were randomized. No logistic problem or patient refusal was observed. In the EMDR, reassurance and control groups, proportions of patients with PCLS at three months were 18%, 37% and 65% and those with PTSD were 3%, 16% and 19% respectively. The risk ratio for PCLS adjusted for the type of event (injury, non-injury) for the comparison between EMDR and control was 0.36 [95% CI 0.20-0.66]. This is the first randomized controlled trial that shows that a short EMDR intervention is feasible and potentially effective in the context of the ER. The study was registered at ClinicalTrials.gov (NCT03194386).

Training peers to support older people with chronic low back pain following physiotherapy discharge: a feasibility study

OBJECTIVE

To determine the feasibility and acceptability of a training programme for peer volunteers to support older adults with chronic low back pain (CLBP) following discharge from physiotherapy.

DESIGN

Feasibility study.

SETTING

Community-based.

PARTICIPANTS

17 adults (4 male, 13 female) with CLBP or experience of supporting someone with CLBP enrolled and 12 (2 male, 10 female) completed the volunteer training.

INTERVENTION

Volunteers took part in a face-to-face or blended delivery peer support training programme based on the Mental Health Foundation's "Principles into Practice" and adapted for CLBP by the study team.

MAIN OUTCOME MEASURES

Recruitment/retention rates; demographics; time & resources used to deliver training; training evaluation (questionnaire); knowledge questionnaire, and self-efficacy questionnaire.

RESULTS

17 participants enrolled on the training programme (11 face-to-face, 6 blended delivery). 12 (71%) completed the training (73% face-to-face, 67% blended delivery). The training was positively evaluated. All but two participants passed the knowledge quiz at the end of the training, and the majority of self-efficacy scores (90%) were high.

CONCLUSIONS

It is feasible to develop, implement and evaluate a peer support training programme for the facilitation of CLBP self-management in older adults following discharge from physiotherapy. Blended delivery of training may facilitate the recruitment of greater numbers of peer support volunteers in future studies. Supported self-management of CLBP pain is widely recommended but can be difficult to achieve. Peer support might be a promising method of facilitating CLBP self-management without additional burden to health services, and should be further evaluated in a larger study.

Work and Mental Complaints: Are Response Outcome Expectancies More Important Than Work Conditions and Number of Subjective Health Complaints?

Purpose Investigate the relative effect of response outcome expectancies, work conditions, and number of subjective health complaints (SHC) on anxiety and depression in Norwegian employees. Learned response outcome expectancies are important contributors to health. Individual differences in the expectancy to cope with workplace and general life demands may be important for how work conditions influence health. Method A survey was conducted among 1746 municipal employees (mean age 44.1, SD = 11.5, 81.5 % female), as part of a randomized controlled trial. This cross-sectional study used baseline data. Multiple logistic regression analysis was performed. Outcome variables were anxiety and depression; response outcome expectancies, work conditions, and number of SHC were independent variables. Results A high number of SHC was a significant factor in explaining anxiety (OR 1.26), depression (OR 1.22) and comorbid anxiety and depression (OR 1.31). A high degree of no and/or negative response outcome expectancies was a significant factor in explaining depression (OR 1.19) and comorbid anxiety and depression (OR 1.28). The variance accounted for in the full models was 14 % for anxiety, 23 % for depression, and 41 % for comorbid anxiety and depression. Conclusion A high number of SHC, and a high degree of no and/or negative response outcome expectancies were associated with anxiety and depression. The strongest association was found for number of SHC. However, previous studies indicate that it may not be possible to prevent the occurrence of SHC. We suggest that workplace interventions targeting anxiety and depression could focus on influencing and altering employees' response outcome expectancies.

Return-to-work coordination programmes for improving return to work in workers on sick leave

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.

Can group-based reassuring information alter low back pain behavior? A cluster-randomized controlled trial

BACKGROUND

Low back pain (LBP) is common in the population and multifactorial in nature, often involving negative consequences. Reassuring information to improve coping is recommended for reducing the negative consequences of LBP. Adding a simple non-threatening explanation for the pain (temporary muscular dysfunction) has been successful at altering beliefs and behavior when delivered with other intervention elements. This study investigates the isolated effect of this specific information on future occupational behavior outcomes when delivered to the workforce.

DESIGN

A cluster-randomized controlled trial.

METHODS

Publically employed workers (n = 505) from 11 Danish municipality centers were randomized at center-level (cluster) to either intervention (two 1-hour group-based talks at the workplace) or control. The talks provided reassuring information together with a simple non-threatening explanation for LBP-the 'functional-disturbance'-model. Data collections took place monthly over a 1-year period using text message tracking (SMS). Primary outcomes were self-reported days of cutting down usual activities and work participation. Secondary outcomes were self-reported back beliefs, work ability, number of healthcare visits, bothersomeness, restricted activity, use of pain medication, and sadness/depression.

RESULTS

There was no between-group difference in the development of LBP during follow-up. Cumulative logistic regression analyses showed no between-group difference on days of cutting down activities, but increased odds for more days of work participation in the intervention group (OR = 1.83 95% CI: 1.08-3.12). Furthermore, the intervention group was more likely to report: higher work ability, reduced visits to healthcare professionals, lower bothersomeness, lower levels of sadness/depression, and positive back beliefs.

CONCLUSION

Reassuring information involving a simple non-threatening explanation for LBP significantly increased the odds for days of work participation and higher work ability among workers who went on to experience LBP during the 12-month follow-up. Our results confirm the potential for public-health education for LBP, and add to the discussion of simple versus multidisciplinary interventions.

The Effect of a Workplace-Based Early Intervention Program on Work-Related Musculoskeletal Compensation Outcomes at a Poultry Meat Processing Plant

Introduction The aim of this study is to determine whether a workplace-based early intervention injury prevention program reduces work-related musculoskeletal compensation outcomes in poultry meat processing workers. Methods A poultry meatworks in Queensland, Australia implemented an onsite early intervention which included immediate reporting and triage, reassurance, multidisciplinary participatory consultation, workplace modifica tion and onsite physiotherapy. Secondary pre-post analyses of the meatworks' compensation data over 4 years were performed, with the intervention commencing 2 years into the study period. Outcome measures included rate of claims, costs per claim and work days absent at an individual claim level. Where possible, similar analyses were performed on data for Queensland's poultry meat processing industry (excluding the meatworks used in this study). Results At the intervention meatworks, in the post intervention period an 18 % reduction in claims per 1 million working hours (p = 0.017) was observed. Generalized linear modelling revealed a significant reduction in average costs per claim of $831 (OR 0.74; 95 % CI 0.59-0.93; p = 0.009). Median days absent was reduced by 37 % (p = 0.024). For the poultry meat processing industry over the same period, generalized linear modelling revealed no significant change in average costs per claim (OR 1.02; 95 % CI 0.76-1.36; p = 0.91). Median days absent was unchanged (p = 0.93). Conclusion The introduction of an onsite, workplace-based early intervention injury prevention program demonstrated positive effects on compensation outcomes for work-related musculoskeletal disorders in poultry meat processing workers. Prospective studies are needed to confirm the findings of the present study.

Protocol for the atWork trial: a randomised controlled trial of a workplace intervention targeting subjective health complaints

Background

Subjective health complaints, such as musculoskeletal and mental health complaints, have a high prevalence in the general population, and account for a large proportion of sick leave in Norway. It may be difficult to prevent the occurrence of subjective health complaints, but it may be possible to influence employees’ perception and management of these complaints, which in turn may have impact on sick leave and return to work after sick leave. Long term sick leave has many negative health and social consequences, and it is important to gain knowledge about effective interventions to prevent and reduce long term sick leave.

Methods/Design

This study is a cluster randomised controlled trial to evaluate the effect of the modified atWork intervention, targeting non-specific musculoskeletal complaints and mental health complaints. This intervention will be compared to the original atWork intervention targeting only non-specific musculoskeletal complaints. Kindergartens in Norway are invited to participate in the study and will be randomly assigned to one of the two interventions. Estimated sample size is 100 kindergartens, with a total of approximately 1100 employees. Primary outcome is sick leave at unit level, measured using register data from the Norwegian Labour and Welfare Administration. One kindergarten equals one unit, regardless of number of employees. Secondary outcomes will be measured at the individual level and include coping, health, job satisfaction, social support, and workplace inclusion, collected through questionnaires distributed at baseline and at 12 months follow up. All employees in the included kindergartens are eligible for participating in the survey.

Discussion

The effect evaluation of the modified atWork intervention is a large and comprehensive project, providing evidence-based information on prevention of long-term sick leave, which may be of considerable benefit both from a societal, organisational, and individual perspective.

Trial registration

Clinicaltrials.gov: NCT02396797. Registered March 23th, 2015.

Reduction in sick leave by a workplace educational low back pain intervention: A cluster randomized controlled trial

Aims: The aim of this study was to investigate whether a workplace educational low back pain intervention had an effect on sick leave at the individual level and to identify possible predictors of the effect of intervention. Methods: Work units in two municipalities were cluster randomized to (a) educational meetings and peer support (45 units), (b) educational meetings, peer support and access to an outpatient clinic if needed (48 units) or (c) a control group (42 units). Both intervention groups attended educational meetings with information about back pain based on a non-injury model. A peer adviser was selected from among their colleagues. The outcome was days of sick leave at the individual level at 3, 6, 9 and 12 months, adjusting for previous sick leave at the unit level. As a result of similar effects on sick leave, the two intervention groups were merged (n=646) and compared with the control group (n=211). The predictors were different levels of belief in back pain myths, pain-related fear, helplessness/hopelessness and low back pain. Results: The intervention group had significantly less days of sick leave at the three month (4.9 days, p=0.001) and six month (4.4 days, p=0.016) follow ups compared with the control group. At three months, a low level of pain-related fear was the only predictor for the intervention effect (8.0 less days of sick leave, p<0.001). Conclusions: A workplace educational back pain intervention had an effect on sick leave for up to six months. A low score on pain-related fear was a predictor of the intervention effect.

Exploring peer-mentoring for community dwelling older adults with chronic low back pain: a qualitative study

OBJECTIVES

To explore the perceptions of patients, physiotherapists, and potential peer mentors on the topic of peer-mentoring for self-management of chronic low back pain following discharge from physiotherapy.

DESIGN

Exploratory, qualitative study.

PARTICIPANTS

Twelve patients, 11 potential peer mentors and 13 physiotherapists recruited from physiotherapy departments and community locations in one health board area of the UK.

INTERVENTIONS

Semi-structured interviews and focus groups.

MAIN OUTCOME MEASURES

Participants' perceptions of the usefulness and appropriateness of peer-mentoring following discharge from physiotherapy. Data were processed and analysed using the framework method.

RESULTS

Four key themes were identified: (i) self-management strategies, (ii) barriers to self-management and peer-mentoring, (iii) vision of peer-mentoring, and (iv) the voice of experience. Peer-mentoring may be beneficial for some older adults with chronic low back pain. Barriers to peer-mentoring were identified, and many solutions for overcoming them. No single format was identified as superior; participants emphasised the need for any intervention to be flexible and individualised. Important aspects to consider in developing a peer-mentoring intervention are recruitment and training of peer mentors and monitoring the mentor-mentee relationship.

CONCLUSIONS

This study has generated important knowledge that is being used to design and test a peer-mentoring intervention on a group of older people with chronic low back pain and volunteer peer mentors. If successful, peer-mentoring could provide a cost effective method of facilitating longer-term self-management of a significant health condition in older people.

How can a brief intervention contribute to coping with back pain? A focus group study about participants’ experiences

Background: Our aim was to explore how individuals who had participated in a brief back and neck pain intervention perceived connections between the intervention and their subsequent coping. Methods: Three focus group discussions were conducted with a sample of ten employees aged 20–67 years, who had participated in a brief intervention for back and neck pain, perceived the intervention as helpful and had returned or remained at work subsequent to the intervention. Participants were invited to share stories of how the intervention had made a positive difference to their work situation and everyday life and helped them cope with their complaints. Systematic text condensation was used for analysis. Results: Analysis revealed several aspects of how the participants considered the intervention to be helpful. They emphasized the importance of having the information delivered in a comprehensible way, with the use of practical examples and images of the spine. Discussions revealed the significance of trusting the lecturers and perceiving them as experts. Understanding why they felt the pain and that it was not a sign of serious disease changed the participants’ perception of how they could live with the complaints. They told stories of how they had exceeded their previous limits and dared to undertake activities they previously had avoided due to fear. Conclusions: Having confidence in the lecturers and seeing them as experts that delivered the information in a comprehensible way helped participants to cope with their pain and was seen as the most important aspects of the brief back and neck pain intervention.

Introduction to the special section: sustainability of work with chronic health conditions

BACKGROUND

The increasing prevalence of older workers and chronic health conditions represents a growing occupational health concern. More research is needed to understand risk factors, apply and adapt theories, and test workplace-focused interventions that might prevent work disability and disengagement among chronically ill workers.

METHODS

A 2-h roundtable symposium involving 28 participants was held at an international conference (Second Scientific Conference on Work Disability Prevention & Integration, Groningen, The Netherlands) in October 2012. In that symposium, small groups of participants were invited to discuss theoretical, methodological, and implementation considerations for studying workplace function and well-being among workers with chronic health conditions. As a follow-up to the symposium, the organizers invited authors to submit original articles to a Special Section of the Journal of Occupational Rehabilitation for peer review and publication.

RESULTS

Results of the symposium reflected the need to address social, not just physical, aspects of the workplace, to include both individual-level and organizational interventions, and to integrate employer perspectives and operational models. Contributions to the Special Issue focus on outcome measurement, symptom self-management at work, job accommodations, prognostic factors for disability escalation, and the perceived needs of affected workers.

CONCLUSIONS

The content of the Special Section reflects an evolving body of research that continues to grapple with basic issues around choice of outcome measures, level of intervention, and the optimal ways to meet the needs of workers with chronic health conditions, including supporting efforts to manage symptoms and function at work. Future research should focus on integrating organizational and individual-level interventions.