Prediction of occupational disability from psychological and neuropsychological evidence in forensic context

Injured worker participation in assessment during the acute phase of workers compensation rehabilitation: a scoping review

PURPOSE

Rates of return to work (RTW) are declining in the Australian workers compensation system alongside significant economic and social costs, disputes, and secondary psychological injury. Non-medical assessment of workplace injuries now considers psychosocial and workplace factors, and worker participation in the assessment process is limited. This scoping review examines studies regarding non-medical assessment during the acute phase of rehabilitation in terms of costs, disputes, secondary psychological injury, and worker participation.

METHOD

An electronic and manual search of relevant articles across four databases was conducted using PRISMA guidelines, followed by quality assessment.

RESULTS

Of the 1,630 studies retrieved, 12 met the inclusion criteria with most focused on assessment for risk of obstructed or delayed RTW.

CONCLUSIONS

Non-medical assessment in the acute stage of rehabilitation identifies risk for delayed or complicated RTW, overlooking potential for the process of assessment to contribute to disputes and development of secondary psychological injury. Doubt around the capacity of workers to participate objectively in assessment persists. These are aspects of assessment worthy of further exploration for their impact on RTW outcomes.

Low Back Pain (LBP), work and absenteeism

BACKGROUND

Occupational physical demands are commonly assumed the cause of work-related Low Back Pain (LBP) and absenteeism.

OBJECTIVES

To analyse relationships between LBP at work, physical demands and absenteeism.

METHODS

Workers filled out a questionnaire on socio-demographic and work-related factors, general health, LBP (number of episodes in a 12-month period, pain severity and intensity), and occupational hazards related with physical demands.

RESULTS

735 workers completed the questionnaire (male n = 359). A high proportion of workers n = 507 (69%), from different occupational backgrounds, reported at least one LBP episode in the previous 12-month period. The highest ratio of subjects with more than 6 episodes of LBP per year was found among public services employees (31.8%) and the lowest ratio among administrative workers (10.3%). The highest ratio of workers (39%) were classified as sedentary workers, 34% of workers having a low or moderate level of physical demands in their work, and 27% reported high levels of physical demands in their work. There was a 4 % absenteeism rate in a 12-month period, which was significantly higher in the group with physically demanding work. Those subjects with higher physical requirements at work have increased odds of having more than 3 episodes of LBP during the previous year (p < 0.05) in comparison with subjects with more sedentary jobs and those with low or moderate physical demands. High intensity work, compared to sedentary work, is associated with an increased probability of being absent of work because of LBP in a previous 12-month period (OR = 3.12; CI 1.23-7.89; p = 0.016).

CONCLUSIONS

Our findings suggest there is an association between highly physically demanding jobs, LBP and absenteeism. These results may contribute to the improvement of LBP assessment and prevention programs in Occupational Health Services.

Psychological Intervention in Traumatic Brain Injury Patients

Objective

To provide a brief and comprehensive summary of recent research regarding psychological interventions for patients surviving a traumatic brain injury.

Methods

A bibliographical search was performed in PubMed, Cochrane Library, PsycNET, Scopus, ResearchGate, and Google Scholar online databases. Analysis included distribution by year of publication, age stage of participants (paediatric, adult), location of the research team, study design, type of intervention, and main outcome variables.

Results

The initial search eliciting 1541 citations was reduced to 62 relevant papers. Most publications had adult samples (88.7%). The United States outstands as the country with more research (58.1%); Latin America countries provided no results. Cognitive behavioural therapy (CBT) was the most widely used approach for treatment of (sub)clinical mental disturbances (41.9%). Neuropsychological interventions were scarce (4.8%). Outcome measures included psychiatric disorders (e.g., posttraumatic stress disorder (PTSD), depression, and anxiety) (37.1%), postconcussive symptoms (16.1%), cognitive and functional deficits (48.1%), and social and psychological dimensions (62.9%).

Conclusions

CBT outstands as the preferred therapeutic approach for treating behavioural and emotional disturbances. Also, other related therapies such as dialectical behaviour, mindfulness, and acceptance and commitment therapies have been proposed, and probably in the years to come, more literature regarding their effectiveness will be available. On the other hand, evidence showed that interventions from the field of neuropsychology are minimal if compared with its contribution to assessment. Future research should be aimed at performing studies on more diverse populations (e.g., nonmilitary communities and paediatric and Latin American populations) and at controlling designs to examine the therapeutic efficacy of psychotherapeutic and neurocognitive rehabilitation interventions and compare amelioration by injury severity, age of patients, and clinical profile, in the hopes of creating better guidelines for practitioners.

Psychiatric/Psychological Injury and Law: Introduction

This special issue on psychiatric/psychological injury and law covers major developments in the field, and illustrates the complexities for mental health professionals in dealing with psychiatric/psychological injuries in court. The articles vary in the range of topics covered, and include ones on posttraumatic stress disorder, other trauma reactions, dissociation, disability, pain, and traumatic brain injury, in particular but also new areas, such as the effects of early penile injury. Work in the area of psychiatric/psychological injury and law needs to be scientifically-informed, comprehensive, and impartial, and the series of articles to follow will help workers in the area meet this standard.