Back to work – evaluation of a multidisciplinary rehabilitation programme with emphasis on musculoskeletal disorders. A two-year follow-up

Return to work after vocational rehabilitation for sick-listed workers with long-term back, neck and shoulder problems: A follow-up study of factors involved

BACKGROUND

Absence from work due to musculoskeletal disorders is a significant problem from a number of perspectives, and there is a great need to identify factors that facilitate return to work (RTW).

OBJECTIVE

To identify factors related to RTW after vocational rehabilitation for sick-listed workers with long-term back, neck and/or shoulder problems, and to compare the results with those from a previous literature review based on studies from 1980 to 2000.

METHODS

A literature review based on studies published 2001-2014 in PubMed, CINAHL, EMBASE, ERIC and the Cochrane Library.

RESULTS

Major risk factors for not returning to work are: higher age, factors related to pain such as higher levels of pain and pain related fear, avoidance of activity, high distress and depression. Facilitating factors for RTW are: lower functional disability, gaining control over one's own condition, believing in RTW and work-related factors such as occupational training, and having a job coach or an RTW coordinator. Compared with the results from the previous review, the present review shows less of a focus on sociodemographic factors and more on psychological factors. Both studies highlight risk factors such as older age, higher levels of pain, depression and less internal locus of control.

CONCLUSION

Psychosocial and work-related factors are important and should be included in interventions for the RTW of people with long-term back, neck and/or shoulder problems.

Improved life satisfaction and pain reduction: follow-up of a 5-week multidisciplinary long-term pain rehabilitation programme

BACKGROUND

Multidisciplinary rehabilitation programmes can improve physical functioning and help patients with long-term pain back to work. Little is known, however, of the extent to which such rehabilitation also affects life satisfaction, pain severity, and disability. We wanted to evaluate if a 5-week rehabilitation programme for patients with long-term pain improves life satisfaction and decreases pain severity and disability.

METHODS

The subjects were 164 patients aged 18-65 years from a pain rehabilitation clinic. Most of them were referred from primary care units. One group of repeated tests was used. Participants were asked to fill out the LiSat-11 checklist and parts of the Multidimensional Pain Inventory (MPI), including pain severity, at admission, at discharge, and 1 year after the rehabilitation programme.

RESULTS

Satisfaction with life as a whole, and six of ten LiSat-11 domains improved during the follow-up, though none reached the levels for the general population. MPI subscales pain severity, pain interference, life control, and affective distress improved, whereas no change was observed for general activity. Patients older than 38 years decreased more in MPI affective distress than younger patients. Gender, pain severity, and work status before the programme did not significantly influence the outcome.

CONCLUSIONS

The results indicate that multidisciplinary rehabilitation improves life satisfaction, reduces pain severity, and reduces negative psychological, social, and behavioural effects of pain. These outcome variables relate to domains known to be of interest for patients and should therefore be considered for evaluation of rehabilitation programmes for long-term pain.

Physical functioning after occupational rehabilitation and returning to work among employees with chronic musculoskeletal pain and comorbid depressive symptoms

Background

The aim of this investigation was to assess whether measures of physical functioning after multidisciplinary rehabilitation are associated with return to work among individuals with chronic musculoskeletal pain conditions and comorbid depressive symptoms.

Methods

Included were 92 employees with chronic musculoskeletal disorders who had participated in a 57- week multidisciplinary rehabilitation program. Their ages ranged from 25–59 years. The Hospital Anxiety and Depression Scale was used to assess depressive symptoms. Different aspects of physical functioning (muscle strength, mobility, endurance capacity, and balance) were measured with single-item visual analog scales, and physical fitness was measured with the validated COOP/WONCA charts. Being on “active work strategies,” such as receiving rehabilitation benefit/vocational rehabilitation or being reported partly or completely fit, was defined as “on their way into/in work”. Cross-sectional associations were measured using logistic regression models, estimating odds ratio with 95% confidence intervals.

Results

There were no differences between the “on their way into/in work” group (n=70) and the “on their way out/out of work” group (n=22) regarding age, sex, or levels of anxiety or pain. Surprisingly, regression analyses showed that those with higher levels of physical functioning had significantly lower odds of returning to work.

Conclusion

The findings of an inverse relationship between self-reported physical function and returning to work in this sample illustrate that the return-to-work process among employees with chronic musculoskeletal pain and comorbid depressive symptoms is multifactorial and influenced by factors other than physical functioning at the individual level. Further research, especially longitudinal studies, is needed to assess the occupational trajectories among employees with chronic musculoskeletal pain and comorbid depressive symptoms after participation in a multidisciplinary rehabilitation program.

An early intervention programme had no detectable influence on the health status of people with musculoskeletal injuries following road traffic crashes: comparative study

OBJECTIVE

To compare the health status of people with minor injuries from road traffic crashes that are exposed to an early, active intervention programme (intervention group) with those receiving usual care (control group) over a 12 month period.

DESIGN

Prospective comparative study using sequential cohorts.

SUBJECTS

People presenting to hospital emergency departments with mild to moderate musculoskeletal injuries following road traffic crashes.

MAIN OUTCOME MEASURES

Physical Component Score (PCS) and Mental Component Score (MCS) of the Short Form 36 (SF-36) health status measure; Hospital Anxiety and Depression Scale (HADS) and the Functional Rating Index (FRI) recorded immediately post-crash, at 6 months and at 12 months after injury.

RESULTS

There were 95 participants allocated to the control group and 98 allocated to the intervention group. Participants were enrolled at a mean of 9.3 days following the crash. There were no significant differences in baseline health measures between the groups. Apart from a small improvement in anxiety for the intervention group, there were no significant differences in health status between the groups. Twenty percent of participants in the intervention group received treatment from external healthcare providers that was inconsistent with the recommendations of the intervention programme.

CONCLUSIONS

The intervention programme failed to result in a clinically significant improvement in health outcomes compared with usual care. There is some evidence to suggest that the intervention had some psychological benefits, as evidenced by the small improvement in anxiety levels. Limited adherence, frequent use of co-interventions, or other factors (such as intervention content or intensity) may have reduced its effect.

Back to work: evaluation of a multidisciplinary rehabilitation program with emphasis on mental symptoms; A two-year follow up

Background

The aim of this investigation was to analyze temporal changes in anxiety, depression, and stress in patients with musculoskeletal pain for a period of up to 2 years after a multidisciplinary rehabilitation program, in relation to sick-listing (registered with The Swedish Social Insurance Agency [Forsakringskassan] for sickness benefit).

Methods

Ten persons with full-time sick leave (absence from work for medical reasons) (group 1) and 49 with part-time or no sick leave (group 2) at the end of the 2-year study period participated. It was shown in a previous study that group 1 had higher pain rating and higher subjective physical disability than group 2, with little or no improvement during and after rehabilitation. In the present study, all participants were evaluated with the Hospital Anxiety and Depression scale and a self-rated stress test.

Results

Participants with full-time sick leave during the study period (group 1) showed improved stress levels but no change in anxiety and depression levels. Anxiety, depression, and stress changed more favorably in participants with part-time or no sick leave than in those with full-time sick leave.

Conclusion

The results of this study indicate that investigation and appropriate treatment of psychological symptoms, including anxiety and depression, are important in multidisciplinary rehabilitation of patients with musculoskeletal disorders.

The association of compensation on longer term health status for people with musculoskeletal injuries following road traffic crashes: emergency department inception cohort study

OBJECTIVE

To compare the health status of people claiming compensation for injuries sustained in road traffic crashes (RTC), with people who do not claim compensation.

DESIGN

Prospective cohort study.

SETTING

Australian Capital Territory, Australia and a fault based common law compensation scheme.

SUBJECTS

People presenting to the emergency department with mild to moderate musculoskeletal injury following RTC.

MAIN OUTCOME MEASURES

Physical Component Score (PCS) and Mental Component Score (MCS) of the Short Form 36 (SF-36) health status measure, Hospital Anxiety and Depression Scale (HADS) and the Functional Rating Index (FRI). These measures are recorded immediately post crash, at 6 and 12 months post crash.

RESULTS

95 people participated in the study and were enrolled a mean of 8.6 (median 8) days following the crash. 86% were followed up to 12 months after injury. Mean age was 37 years, 61% were female and 91% were employed at the time of their injury.33%ultimately claimed compensation, and 25% engaged a lawyer. There were no major differences in baseline personal characteristics or injury related factors between the groups. As expected, involvement as a passenger and in multiple vehicle crashes, were more frequent in the group claiming compensation. Over the duration of the study claiming compensation was associated with lower SF-36 PCS (5.5 (95%CI 8.6 to 2.4), p = 0.001), greater HADS-Anxiety (1.7 (95%CI 0.2–3.3), p = 0.048), and worse FRI (11.2 (95%CI 3.9–18.5), p = 0.003). There was a highly significant improvement in health status between baseline and 6 months after injury, but no further significant change between 6 and 12 months after injury. There was no difference in rate of improvement between the groups. Claiming compensation and psychological factors were independent predictors of worse health status at 12 months.

CONCLUSION

In this study the group claiming compensation had overall worse health status following mild to moderate musculoskeletal injuries over the course of the study. There was no difference in rate of improvement between the groups. However, it is not possible to determine whether this negative effect was due to claiming compensation itself or the presence of other unmeasured factors.

Effect of yoga on quality of life of CLBP patients: A randomized control study

CONTEXT

In two of the earlier Randomized Control Trials on yoga for chronic lower back pain (CLBP), 12 to 16 weeks of intervention were found effective in reducing pain and disability.

AIM

To study the efficacy of a residential short term intensive yoga program on quality of life in CLBP.

MATERIALS AND METHODS

About 80 patients with CLBP (females 37) registered for a week long treatment at SVYASA Holistic Health Centre in Bengaluru, India. They were randomized into two groups (40 each). The yoga group practiced a specific module for CLBP comprising of asanas (physical postures), pranayama (breathing practices), meditation and lectures on yoga philosophy. The control group practiced physical therapy exercises for back pain. Perceived stress scale (PSS) was used to measure baseline stress levels. Outcome measures were WHOQOL Bref for quality of life and straight leg raising test (SLR) using a Goniometer.

RESULTS

There were significant negative correlations (Pearson's, P<0.005, r>0.30) between baseline PSS with all four domains and the total score of WHOQOLBref. All the four domains' WHOQOLBref improved in the yoga group (repeated measures ANOVA P=0.001) with significant group*time interaction (P<0.05) and differences between groups (P<0.01). SLR increased in both groups (P=0.001) with higher increase in yoga (31.1 % right, 28.4 % left) than control (18.7% right, 21.5 % left) group with significant group*time interaction (SLR right leg P=0.044).

CONCLUSION

In CLBP, a negative correlation exists between stress and quality of life. Yoga increases quality of life and spinal flexibility better than physical therapy exercises.

Reliability and Validation Properties of the Malaysian Language Version of the Occupational Self Assessment Version 2.2 for Injured Workers with Musculoskeletal Disorders

Introduction:

It has been difficult for occupational therapists in Asia to use occupational therapy assessments, such as the Occupational Self Assessment (OSA) version 2.2, that are not validated in the local language. This study aimed to produce and assess the psychometric properties of a Malaysian version of the 21-item OSA.

Method:

The translation process involved the forward and back translation from the original English version into the Malaysian version, followed by field tests conducted with a small group of occupational therapists and workers to confirm the translation's equivalence and appropriateness. A total of 35 Malaysian injured workers with musculoskeletal disorders who were not involved in a return to work programme were assessed using the Malaysian version of the OSA. Twenty-three were reassessed 7–14 days later to determine test-retest reliability.

Results:

The Malaysian version of the OSA showed acceptable reliability (internal consistency, corrected item correlation and test-retest reliability) and validity (convergent and discriminant validity).

Conclusion:

The results suggest that the OSA is reliable and valid in assessing occupational functioning for injured Asian workers with musculoskeletal disorders.

Patient perspectives of Condition Management Programmes as a route to better health, well-being and employability

BACKGROUND

Condition Management Programmes (CMPs), delivered through primary care settings, have been identified as possible vehicles to facilitate return to work for individuals with chronic health problems. There is little research, however, which examines how such programmes are received by patients.

OBJECTIVE

To explore patients' experiences of CMPs in terms of health, well-being and employability.

METHODS

Four focus groups and nine semi-structured interviews were conducted in order to capture patients' (n = 25) perceptions and experiences regarding participation in one of five different CMPs: Cardiac Rehabilitation, Counselling, Lower Back Pain Services, Smoking Cessation and a GP Exercise Referral Programme.

RESULTS

Experiences of the CMPs were generally positive. Respondents reported improved health behaviours (specifically better diets and increased exercise), positive psychosocial outcomes (including increased self-esteem, confidence and social support) and in some cases, return to work. However, concerns were expressed about the shortness of interventions and their accessibility.

CONCLUSIONS

Although condition management appears to have been well received by participants, the findings also illustrate that there is no 'one size fits all' template for CMPs. Rather, interventions should be adapted to take account of the dynamics of specific conditions, the context in which the intervention is based and the characteristics of the individuals involved.

Percepção de servidores municipais frente ao diagnóstico de distúrbio osteomuscular relacionado ao trabalho

As doenças osteomusculares relacionadas ao trabalho (DORT) são distúrbios do aparelho locomotor de etiologia ligada à atividade laboral que vêm apresentando incidência crescente em todo o mundo. Este estudo teve o objetivo de descrever a forma como servidores municipais de Fortaleza, CE, vivenciam as DORT. O estudo qualitativo foi realizado em uma clínica de fisioterapia em 2004. Os informantes foram nove servidores (com idades entre 40 e 57 anos) em atendimento fisioterápico na clínica - agentes administrativos, professores e um técnico. Os dados foram coletados por meio da observação participante e de entrevista semi-estruturada. Da análise emergiram as categorias temáticas "reações frente ao diagnóstico e tratamento" e "vivência da doença nas relações interpessoais". Os resultados permitiram inferir o impacto do diagnóstico da DORT no cotidiano do trabalhador: a limitação funcional leva à frustração e indignação; o não-reconhecimento pelos colegas gera a percepção de rejeição ou exclusão social. A reação de negação inicial, que leva o trabalhador a evitar a procura de atendimento especializado, é importante pela subnotificação gerada, que provoca limitação nas medidas de prevenção e controle das DORT.