Supporting return to work through appropriate certification: a systematic approach for Australian primary care

Primary Care Physicians' Learning Needs in Returning Ill or Injured Workers to Work. A Scoping Review

Primary care physicians are uniquely positioned to assist ill and injured workers to stay-at-work or to return-to-work. Purpose The purpose of this scoping review is to identify primary care physicians' learning needs in returning ill or injured workers to work and to identify gaps to guide future research. Methods We used established methodologies developed by Arksey and O'Malley, Cochrane and adapted by the Systematic Review Program at the Institute for Work & Health. We used Distiller SR©, an online systematic review software to screen for relevance and perform data extraction. We followed the PRISMA for Scoping Reviews checklist for reporting. Results We screened 2106 titles and abstracts, 375 full-text papers for relevance and included 44 studies for qualitative synthesis. The first learning need was related to administrative tasks. These included (1) appropriate record-keeping, (2) time management to review occupational information, (3) communication skills to provide clear, sufficient and relevant factual information, (4) coordination of services between different stakeholders, and (5) collaboration within teams and between different professions. The second learning need was related to attitudes and beliefs and included intrinsic biases, self-confidence, role clarity and culture of blaming the patient. The third learning need was related to specific knowledge and included work capacity assessments and needs for sick leave, environmental exposures, disclosure of information, prognosis of certain conditions and care to certain groups such as adolescents and pregnant workers. The fourth learning need was related to awareness of services and tools. Conclusions There are many opportunities to improve medical education for physicians in training or in continuing medical education to improve care for workers with an illness or injury that affect their work.

Lumbar spinal fusion surgery outcomes in a cohort of injured workers in the Victorian workers' compensation system

BACKGROUND

Lumbar spinal fusion (LSF) outcomes for workers' compensation patients are worse than for the general population. The objectives were to examine the long-term work capacity, opioid prescription and mental health outcomes of injured workers who have undergone LSF surgery in Victoria, Australia, and to identify demographic and pre- and post-operative characteristics associated with these outcomes.

METHODS

Retrospective study of 874 injured workers receiving elective LSF from 2008 to 2016 in the Victorian workers' compensation system. WorkSafe Victoria's claims data were used to infer outcomes for recovery. Association of demographics, pre-surgery and surgery variables with outcomes were modelled using multivariate multinomial logistic regression analyses.

RESULTS

Twenty-four months after LSF surgery, 282 (32.3%) of the 874 injured workers had substantial work capacity, 388 (44.4%) were prescribed opioids, and 330 (37.8%) were receiving mental health treatment. Opioid prescription and limited work capacity before surgery were independent strong predictors of opioid prescription, reduced work capacity and mental health treatment 24 months after LSF. Pre-operative mental health treatment was associated with the use of mental health treatment at 24 months. Other predictors for poor outcomes included a greater than 12-month duration from injury to surgery, LSF re-operation and common law or impairment benefit lodgement before surgery.

CONCLUSION

An association between pre-operative factors and post-operative outcomes after LSF in a Victorian workers' compensation population was identified, suggesting that pre-operative status may influence outcomes and should be considered in LSF decisions. The high opioid use indicates that opioid management before and after surgery needs urgent review.

The Impact of Musculoskeletal Injuries Sustained in Road Traffic Crashes on Work-Related Outcomes: A Systematic Review

Musculoskeletal injuries occur frequently after road traffic crashes (RTCs), and the effect on work participation is not fully understood. The primary aim of this review was to determine the impact of sustaining a musculoskeletal injury during an RTC on the rate of return to work (RTW), sick leave, and other work outcomes. The secondary aim was to determine factors associated with these work-related outcomes. An electronic search of relevant databases to identify observational studies related to work and employment, RTC, and musculoskeletal injuries was conducted. Where possible, outcome data were pooled by follow-up period to answer the primary aim. Fifty-three studies were included in this review, of which 28 were included in meta-analyses. The pooled rate of RTW was 70% at 1 month, 67% at 3 months, 76% at 6 months, 83% at 12 months, and 70% at 24 months. Twenty-seven percent of participants took some sick leave by one month follow-up, 13% by 3 months, 23% by 6 months, 36% by 12 months, and 22% by 24 months. Most of the factors identified as associated with work outcomes were health-related, with some evidence also for sociodemographic factors. While 70% of people with RTC-related musculoskeletal injury RTW shortly after accident, many still have not RTW two years later.

The Allied Health Professions Health and Work Report and the fit note: Perspectives of patients and stakeholders

Introduction

Although the role of occupational therapists in the provision of vocational support is established, there has been little research into their role in issuing Allied Health Professions Health and Work Reports or their potential to complete fit notes.

Method

Employed patients ( n = 14) and stakeholders ( n = 12) took part in semi-structured telephone interviews and were questioned about occupational therapy-run vocational clinics, experiences of the Allied Health Professions Health and Work Reports and their views of occupational therapists completing fit notes.

Results

Most interviewees saw the Allied Health Professions Health and Work Report as a valuable tool in affecting return to work and even employers with access to in-house occupational health predominantly found it useful in corroborating recommendations. There was consensus, amongst patients and stakeholders, that completion of the fit note by the occupational therapist could reduce the burden on the general practitioner, and potentially provide more in-depth advice via the ‘may be fit’ option. However, stakeholders strongly believed that the profile of the Allied Health Professions Health and Work Report needed to be raised nationally.

Conclusion

The potential value of Allied Health Professions Health and Work Reports in primary care is recognised. However, in order to maximise this, its profile and utility needs to be raised nationally as a matter of urgency. There was also support for occupational therapists completing fit notes.

Comparing face-to-face with online training for occupational therapists in advising on fitness for work: Protocol for the CREATE study

Introduction

Occupational therapists play a key role in advising on fitness for work; however, there is a concern that they lack knowledge and confidence in using the Allied Health Professions health and work report (formerly the Allied Health Professions advisory fitness for work report), developed in the United Kingdom. Comparing a reusable learning object with face-to-face training for occupational therapists in advising on fitness for work (CREATE) compares face-to-face training with online training for occupational therapists in completing the Allied Health Professions health and work report.

Method

A mixed methods study. Phase 1, occupational therapists will co-design an online training resource. A standardised face-to-face group-based training session will also be developed based on the same content. Phase 2, a feasibility study will be conducted. Thirty occupational therapists will either attend face-to-face group training or access the online resource. Data on self-reported knowledge and confidence in using the Allied Health Professions health and work report will be collected at baseline, 1 week and 8 weeks post-training. Feedback on the training will be collected by interview and, for the online resource, using an online tool.

Results

Quantitative results will be predominantly analysed descriptively. If appropriate, between-group responses will be compared using the Mann–Whitney test. Qualitative findings will be analysed thematically.

Conclusion

CREATE will have made a significant contribution to the debate around appropriate training methods in advising on fitness for work.

People with low back pain perceive needs for non-biomedical services in workplace, financial, social and household domains: a systematic review

QUESTION

What needs of non-biomedical services are perceived by people with low back pain?

DESIGN

Systematic review of qualitative and quantitative studies examining perceived needs of non-biomedical services for low back pain, identified through searching of MEDLINE, EMBASE, CINAHL and PsycINFO (1990 to 2016).

PARTICIPANTS

Adults with low back pain of any duration.

DATA EXTRACTION AND ANALYSIS

Descriptive data regarding study design and methodology were extracted. The preferences, expectations and satisfaction with non-biomedical services reported by people with low back pain were identified and categorised within areas of perceived need.

RESULTS

Twenty studies (19 qualitative and one quantitative) involving 522 unique participants (total pool of 590) were included in this systematic review. Four areas emerged. Workplace: people with low back pain experience pressure to return to work despite difficulties with the demands of their occupation. They want their employers to be informed about low back pain and they desire workplace accommodations. Financial: people with low back pain want financial support, but have concerns about the inefficiencies of compensation systems and the stigma associated with financial remuneration. Social: people with low back pain report feeling disconnected from social networks and want back-specific social support. Household: people with low back pain report difficulties with household duties; however, there are few data regarding their need for auxiliary devices and domestic help.

CONCLUSION

People with low back pain identified work place, financial and social pressures, and difficulties with household duties as areas of need beyond their healthcare requirements that affect their ability to comply with management of their condition. Consideration of such needs may inform physiotherapists, the wider health system, social networks and the workplace to provide more relevant and effective services. [Chou L, Cicuttini FM, Urquhart DM, Anthony SN, Sullivan K, Seneviwickrama M, Briggs AM, Wluka AE (2018) People with low back pain perceive needs for non-biomedical services in workplace, financial, social and household domains: a systematic review. Journal of Physiotherapy 64: 74-83].