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Carmina D, Benfenati V, Simonelli C, Rotolo A, Cardano P, Grovale N, Mangoni di S Stefano L, de Santo T, Zamboni R, Palermo V, Muccini M, De Seta F. Innovative solutions for disease management. Bioelectron Med 2023; 9:28. [PMID: 38053220 DOI: 10.1186/s42234-023-00131-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 11/06/2023] [Indexed: 12/07/2023] Open
Abstract
The increasing prevalence of chronic diseases is a driver for emerging big data technologies for healthcare including digital platforms for data collection, systems for active patient engagement and education, therapy specific predictive models, optimized patient pathway models. Powerful bioelectronic medicine tools for data collection, analysis and visualization allow for joint processing of large volumes of heterogeneous data, which in turn can produce new insights about patient outcomes and alternative interpretations of clinical patterns that can lead to implementation of optimized clinical decisions and clinical patient pathway by healthcare professionals.With this perspective, we identify innovative solutions for disease management and evaluate their impact on patients, payers and society, by analyzing their impact in terms of clinical outcomes (effectiveness, safety, and quality of life) and economic outcomes (cost-effectiveness, savings, and productivity).As a result, we propose a new approach based on the main pillars of innovation in the disease management area, i.e. progressive patient care models, patient-centric approaches, bioelectronics for precise medicine, and lean management that, combined with an increase in appropriate private-public-citizen-partnership, leads towards Patient-Centric Healthcare.
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Affiliation(s)
- Dafni Carmina
- Medtronic Clinical & Regulatory Solutions - Study & Scientific Solutions, Via Aurelia 866, Roma, 00165, Italy.
| | - Valentina Benfenati
- Consiglio Nazionale delle Ricerche, Istituto per la Sintesi Organica e Fotoreattività, via Gobetti 101, Bologna, 40129, Italy.
| | - Claudia Simonelli
- Medtronic Clinical & Regulatory Solutions - Study & Scientific Solutions, Via Aurelia 866, Roma, 00165, Italy
| | - Alessia Rotolo
- Consiglio Nazionale delle Ricerche, Istituto per lo Studio dei Materiali Nanostrutturati, via Gobetti 101, Bologna, 40129, Italy
| | - Paola Cardano
- Medtronic Clinical & Regulatory Solutions - Study & Scientific Solutions, Via Aurelia 866, Roma, 00165, Italy
| | - Nicoletta Grovale
- Medtronic Clinical & Regulatory Solutions - Study & Scientific Solutions, Via Aurelia 866, Roma, 00165, Italy
| | | | - Tiziana de Santo
- Medtronic Clinical & Regulatory Solutions - Study & Scientific Solutions, Via Aurelia 866, Roma, 00165, Italy
| | - Roberto Zamboni
- Consiglio Nazionale delle Ricerche, Istituto per la Sintesi Organica e Fotoreattività, via Gobetti 101, Bologna, 40129, Italy
| | - Vincenzo Palermo
- Consiglio Nazionale delle Ricerche, Istituto per la Sintesi Organica e Fotoreattività, via Gobetti 101, Bologna, 40129, Italy
| | - Michele Muccini
- Consiglio Nazionale delle Ricerche, Istituto per lo Studio dei Materiali Nanostrutturati, via Gobetti 101, Bologna, 40129, Italy
- Mister Smart Innovation S, via Gobetti 101, Bologna, 40129, Italy
| | - Francesco De Seta
- Medtronic Clinical & Regulatory Solutions - Study & Scientific Solutions, Via Aurelia 866, Roma, 00165, Italy
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Durand MJ, Sylvain C, Paquette MA. Return to Work for People with Common Mental Disorders: Insights into the Implementation of a Collaborative Program in a Specialized Mental Health Hospital. JOURNAL OF OCCUPATIONAL REHABILITATION 2023; 33:362-374. [PMID: 36329284 DOI: 10.1007/s10926-022-10079-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/14/2022] [Indexed: 05/12/2023]
Abstract
Purpose Common mental disorders (CMDs) are a major cause of sick leave. Return-to-work (RTW) interventions providing mechanisms that support the participation and collaboration of the different stakeholders appear promising in these circumstances. The Therapeutic Return-to-Work (TRW) Program offers such mechanisms designed to enable affected workers to fully reintegrate into their jobs on a sustainable basis. This study evaluated the feasibility of implementing this program for workers with CMDs, within a specialized mental health hospital. Methods The study was conducted using a multiple case design and three main data sources: (1) the worker's medical file, (2) the log completed by the clinicians, and (3) individual interviews with stakeholders. Data were analyzed using a qualitative approach. Results Twelve workers between 32 and 60 years old, mostly women with complex mental health profiles working in large enterprises, participated in this study. Three main observations were made regarding the TRW Program implementation: (1) eight cases were characterized by complete or virtually complete implementation; (2) no explanatory factor could be identified for the different implementation levels; (3) eight cases achieved RTW success (RTW to the original job or another job), which appears partially attributable to the high level of program implementation. Conclusions: The TRW Program seems highly promising for supporting the return to work of workers with CMDs. However, studies identifying the factors likely to influence the implementation process in different health service contexts and specifying the scope and nature of the program's actual impact on RTW outcomes should be conducted before larger-scale implementation takes place.
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Affiliation(s)
- Marie-José Durand
- Centre d'action en prévention et réadaptation des incapacités au travail (CAPRIT), Université de Sherbrooke, 150 Place Charles-Le Moyne, Suite 200, Longueuil, QC, J4K 0A8, Canada.
- Centre de recherche Charles-Le Moyne (CRCLM), Université de Sherbrooke, 150 Place Charles-Le Moyne, Suite 200, Longueuil, QC, J4K 0A8, Canada.
- School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, 150 Place Charles-Le Moyne, Suite 200, Longueuil, QC, J4K 0A8, Canada.
| | - Chantal Sylvain
- Centre d'action en prévention et réadaptation des incapacités au travail (CAPRIT), Université de Sherbrooke, 150 Place Charles-Le Moyne, Suite 200, Longueuil, QC, J4K 0A8, Canada
- Centre de recherche Charles-Le Moyne (CRCLM), Université de Sherbrooke, 150 Place Charles-Le Moyne, Suite 200, Longueuil, QC, J4K 0A8, Canada
- School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, 150 Place Charles-Le Moyne, Suite 200, Longueuil, QC, J4K 0A8, Canada
| | - Marie-Andrée Paquette
- Centre d'action en prévention et réadaptation des incapacités au travail (CAPRIT), Université de Sherbrooke, 150 Place Charles-Le Moyne, Suite 200, Longueuil, QC, J4K 0A8, Canada
- Centre de recherche Charles-Le Moyne (CRCLM), Université de Sherbrooke, 150 Place Charles-Le Moyne, Suite 200, Longueuil, QC, J4K 0A8, Canada
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Anema JR, Fassier JB. Pr. Patrick Loisel (1943-2022): A Pioneer, a Visionary Man, and Founding Father of Work Disability Prevention Research Field and Community. JOURNAL OF OCCUPATIONAL REHABILITATION 2023; 33:1-3. [PMID: 36897485 DOI: 10.1007/s10926-023-10106-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Affiliation(s)
- Johannes R Anema
- Department of Public and Occupational Health, Amsterdam UMC, Amsterdam, The Netherlands.
- Amsterdam Public Health Research Institute, Societal Participation and Health, Amsterdam, The Netherlands.
| | - Jean-Baptiste Fassier
- Umrestte UMR T9405, Université Claude Bernard Lyon 1, Université de Lyon, Lyon, France
- Occupational Health and Medicine Department, Hospices Civils de Lyon, Lyon, France
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Effects of an early multidisciplinary intervention on sickness absence in patients with persistent low back pain—a randomized controlled trial. BMC Musculoskelet Disord 2022; 23:854. [PMID: 36088313 PMCID: PMC9463744 DOI: 10.1186/s12891-022-05807-7] [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: 04/18/2022] [Accepted: 09/02/2022] [Indexed: 11/20/2022] Open
Abstract
Background Multidisciplinary rehabilitation is recommended to reduce sickness absence and disability in patients with subacute or chronic low back pain (LBP). This study aimed to investigate whether a 12-week coordinated work oriented multidisciplinary rehabilitation intervention was effective on return to work and number of days off work during one-year follow-up when compared to usual care. Methods This study is a randomized controlled trial comparing the effectiveness of a 12-week multidisciplinary vocational rehabilitation program in addition to usual treatment. 770 patients with LBP, who were sick-listed, or at risk of being sick-listed were included in the study. The primary outcome was number of days off work due to LBP. The secondary outcomes were disability, health-related quality of life, pain, psychological distress and fear avoidance behavior. Data were collected at baseline, at the end of treatment, and at 6- and 12-months follow-up. Analyses were carried out according to the “intention-to-treat” principles. Results A significant decrease in the number of patients who were on sick-leave was found in both groups at the end of treatment and at 6- and 12-months follow-up. Additionally, disability, pain, health related quality of life, psychological distress, and fear avoidance beliefs improved in both groups. No statistically significant differences were found between the groups on any of the outcomes. Conclusions The coordinated multidisciplinary intervention had no additional effect on sickness absence, disability, pain, or health related quality of life as compared with that of usual care. Trial registration This study was retrospectively registered in ClinicalTrials.gov (registration ID: NCT01690234). The study was approved by The Danish Regional Ethics Committee (file no: H-C-2008–112) as well as registered at and approved by the Danish Data Protection Agency.
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Main CJ, Shaw WS, Nicholas MK, Linton SJ. System-level efforts to address pain-related workplace challenges. Pain 2022; 163:1425-1431. [PMID: 35195550 PMCID: PMC9341230 DOI: 10.1097/j.pain.0000000000002548] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 11/01/2021] [Accepted: 11/08/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Chris J. Main
- Primary Care and Health Sciences, Keele University, Keele, Staffordshire, United Kingdom
| | - William S. Shaw
- Department of Medicine, University of Connecticut School of Medicine, Farmington, CT, United States
| | - Michael K. Nicholas
- Pain Management Research Institute, University of Sydney, Sydney, New South Wales, Australia
| | - Steven J. Linton
- Department of Law, Psychology, and Social Work, Orebro University, Orebro, Sweden
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Brandicourt P, Luby N, Djidjeli I, Cheng I, De Barros A, Brauge D, Roux FE. Clinical long-term consequences of thoraco-lumbar spine fracture and osteosynthesis. Orthop Traumatol Surg Res 2021; 107:102941. [PMID: 33895384 DOI: 10.1016/j.otsr.2021.102941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 11/17/2020] [Accepted: 01/12/2021] [Indexed: 02/03/2023]
Abstract
OBJECT Although traumatic spine fractures can be treated by osteosynthesis, their long-term clinical, social, and familial consequences are less known. The aim of this study was to assess these global consequences to a very long-term (at least more than 12 years after the fracture). METHODS Two groups, one composed of 30 patients operated for a thoracolumbar fracture by posterior fixation and one with 30 controls (who never had a spinal fracture) matched for age, sex, job and time of follow-up were studied. Patients and control subjects had to answer to 3 questionnaires: one about clinical, familial, and socio-professional changes, and 2 back pain (Dallas and Eifel) scales. RESULTS The mean patient follow-up was 14.5 years (from 12 to 18 years, sd 2.3) - control subjects, 15 years. The majority (56%) of the fractures occurred at T12/L1 level. At last follow-up, the chronic low back pain concerned 20 (66,7%) patients versus 11 (36.7%) control subjects (p=0.03); more patients (13 patients - 43.3%) consumed analgesics than control (5 persons - 16.6%) subjects (p=0.04). A large majority (13 patients, 57%) had sick leaves that exceeded 6 months. The loss of wage due to traumatism or chronic low back pain was also significant (p=0.002) between patients and matched controls over the period. At follow-up, the mean Eifel score for the whole patients' cohort was significaty superior compared to control group (4.7 [sd 3.75] vs. 2.6 [sd 4.2], p=0.008). Dallas score was superior in the patient's group for the daily, work-leisure activities and sociability aspect (p<0.05). CONCLUSION Chronic back pain, long sick leaves, changes in professional and familial life, the very long-term postoperative outcome of patients could be more difficult than expected in a majority of patients operated for thoracolumbar fracture. In order to facilitate the back to work and reduce these long-term consequences, we propose that guidelines about job resume in traumatic spinal fractures should be established along with early occupational medicine consultations. LEVEL OF EVIDENCE III; retrospective case control study.
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Affiliation(s)
- Pierre Brandicourt
- Pôle Neuroscience (Neurochirurgie), Centre Hospitalier Universitaire de Toulouse, Toulouse, France; Centre hospitalo-universitaires de Toulouse, Université de Toulouse, UPS, Toulouse, France.
| | - Nicolas Luby
- Centre hospitalo-universitaires de Toulouse, Université de Toulouse, UPS, Toulouse, France; Pôle Santé-Société, Réadaptation, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Imène Djidjeli
- Pôle Neuroscience (Neurochirurgie), Centre Hospitalier Universitaire de Toulouse, Toulouse, France; Centre hospitalo-universitaires de Toulouse, Université de Toulouse, UPS, Toulouse, France
| | - Ing Cheng
- Pôle Neuroscience (Neurochirurgie), Centre Hospitalier Universitaire de Toulouse, Toulouse, France; Centre hospitalo-universitaires de Toulouse, Université de Toulouse, UPS, Toulouse, France
| | - Amaury De Barros
- Pôle Neuroscience (Neurochirurgie), Centre Hospitalier Universitaire de Toulouse, Toulouse, France; Centre hospitalo-universitaires de Toulouse, Université de Toulouse, UPS, Toulouse, France
| | - David Brauge
- Pôle Neuroscience (Neurochirurgie), Centre Hospitalier Universitaire de Toulouse, Toulouse, France; Centre hospitalo-universitaires de Toulouse, Université de Toulouse, UPS, Toulouse, France
| | - Franck-Emmanuel Roux
- Pôle Neuroscience (Neurochirurgie), Centre Hospitalier Universitaire de Toulouse, Toulouse, France; Centre hospitalo-universitaires de Toulouse, Université de Toulouse, UPS, Toulouse, France; Centre de Recherche Cerveau et Cognition (CNRS; CerCo), Centre Hospitalier Universitaire de Toulouse, Toulouse, France
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Effects of COVID-19 lockdown on low back pain intensity in chronic low back pain patients: results of the multicenter CONFI-LOMB study. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2021; 31:159-166. [PMID: 34605990 PMCID: PMC8488322 DOI: 10.1007/s00586-021-07007-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 08/19/2021] [Accepted: 09/21/2021] [Indexed: 01/09/2023]
Abstract
Purpose The COVID-19 pandemic and the extended lockdown are associated with numerous changes in behavior and lifestyles. The objective was to assess the impact of the first lockdown on LBP course among chronic LBP patients. Methods Descriptive and analytical, cross-sectional, multicenter study, conducted by questionnaire from mid-May to end of June 2020 among patients treated for chronic LBP in 6 French and 1 Swiss center. Collected data concerned changes in LBP intensity during lockdown, lockdown experience, physical activity (PA) practice and sedentary lifestyle prior and during lockdown, recourse to care, consumption of psychoactive substances for LBP, and professional activity and its conditions during lockdown. Results 360 participants (58.6% women, 52.1 ± 13.4 years) were included of which 65% were active (63% keep on working of which 54% teleworked). LBP got worse in 41.1%, mean VAS went from 49.5 ± 21.6 before to 53.5 ± 22.4 during lockdown (p < 0.001) and needed increase of treatment by 29% but very few people increased their consumption psychoactive substances for analgesia. Half of participants had well-experienced lockdown. Findings revealed a significant decrease in PA and increase of sedentary during lockdown (p < 0.0001). Good experience of lockdown was associated with LBP improvement (OR = 0.6 [0.3–0.9]) and decrease of PA with LBP worsening (OR = 1.9 [1.1–3.2]). Teleworking was also associated with LBP worsening. Gender, age, or BMI did not influence LBP course. Conclusion These findings indicate that chronic LBP people suffered from increase in self-perceived LBP during lockdown and help to better understand the factors associated with their condition. Supplementary Information The online version contains supplementary material available at 10.1007/s00586-021-07007-8.
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Klevanger NE, Fimland MS, Rise MB. Aligning stakeholders' understandings of the return-to-work process: a qualitative study on workplace meetings in inpatient multimodal occupational rehabilitation. Int J Qual Stud Health Well-being 2021; 16:1946927. [PMID: 34278973 PMCID: PMC8291062 DOI: 10.1080/17482631.2021.1946927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Purpose: Although it is believed that involving the workplace and stakeholders in return-to-work interventions is beneficial, Norwegian occupational rehabilitation programmes rarely do. During 2015–2016, Hysnes Rehabilitation Centre provided inpatient multimodal occupational rehabilitation, including workplace meetings with employees, supervisors, and rehabilitation therapists. This study aims to explore the meetings´ content and stakeholders´ experiences.Methods: This was a multiple case study including non-participant observation of workplace meetings and interviews with participantsResults: Essential features of meetings included revealing and aligning the employee’s and supervisor’s understandings. Three components seemed instrumental in developing shared understandings leading to appropriate adjustments: 1) disclosing causes of absence, 2) validating difficulties, attitudes, and efforts, and 3) delimiting responsibility. Therapists played a vital role in addressing these components, supporting employees, and ensuring planning of appropriate solutions.Conclusion: Developing shared understandings by addressing and aligning illness- and return-to-work representations appears important for return-to-work interventions. Although pivotal to developing appropriate adjustments, disclosure depends upon supervisors’ display of understanding and should not be encouraged without knowledge of the employee´s work situation. How supervisors relate to employees and implement adjustments may be as important as the types of adjustments. The therapist’s support and validation of employees in vulnerable situations also seem valuable.Trial registration: The trial is registered at clinicaltrials.gov (NCT02541890), 4 September 2015. https://clinicaltrials.gov/ct2/show/NCT02541890.
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Affiliation(s)
- Nina Elisabeth Klevanger
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Marius Steiro Fimland
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway.,Unicare Helsefort Rehabilitation Centre, Rissa, Norway.,Department of Physical Medicine and Rehabilitation, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Marit By Rise
- Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
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Monticone M, Ambrosini E, Portoghese I, Rocca B. Multidisciplinary program based on early management of psychological factors reduces disability of patients with subacute low back pain. Results of a randomised controlled study with one year follow-up. Eur J Phys Rehabil Med 2021; 57:959-967. [PMID: 33947827 DOI: 10.23736/s1973-9087.21.06696-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Multidisciplinary rehabilitation induces disability improvement, pain reduction and favours return-to-work in patients with subacute low back pain (LBP). Current research advises additional high-quality trials. AIM To test the effect of a multidisciplinary rehabilitative programme incorporating cognitivebehavioural interventions compared to general physiotherapy alone to treat subacute LBP, and to appraise its long-term extent. DESIGN Randomised parallel-group superiority-controlled trial. SETTING Outpatient rehabilitation hospital. POPULATION 150 patients with subacute LBP. METHODS Patients were assigned randomly to a 10-week individual-based multimodal programme of task-oriented exercises integrated with cognitive-behavioural therapy (experimental group, 75 patients) or individual-based general physiotherapy (control group, 75 patients). Before treatment, 10 weeks later (post-treatment), and 12 months after treatment, the staff administered the Oswestry Disability Index (ODI, primary outcome), a pain intensity numerical rating scale (NRS), the Tampa Scale for Kinesiophobia (TSK), the Pain Beliefs and Perception Inventory (PBAPI), the Hospital and Anxiety Depression Score (HADS) and the Coping Strategies Questionnaire-revised (CSQ-R). Linear mixed model analysis for repeated measures was carried out for each outcome measure. RESULTS Significant group (p<0.001), time (p=0.002), and time-by-group interaction (p<0.001) effects were found for ODI, with a between-group difference (standard error) after training of 11.5 (1.0) and at follow-up of 15.7 (0.9), in favour of the experimental group. A significant interaction effect (p<0.001) was found for all secondary outcome measures, with significantly greater improvements in the experimental group, after rehabilitation and at follow-up. CONCLUSIONS The multidisciplinary intervention was superior to general physiotherapy in reducing disability, pain, psychological factors and coping strategies of patients with subacute LBP. The effects were reinforced after one year. CLINICAL REHABILITATION IMPACT Treatment of subacute LBP requires cognitive modifications closely linked to physical performances in order to achieve mental adjustments and guarantee cognitive-behavioural and motor lasting changes.
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Affiliation(s)
- Marco Monticone
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy - .,Neurorehabilitation Unit, Department Neuroscience and Rehabilitation, G. Brotzu Hospital, Cagliari, Italy -
| | - Emilia Ambrosini
- Neuroengineering and Medical Robotics Laboratory, Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Igor Portoghese
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Barbara Rocca
- Physical Medicine and Rehabilitation Unit, Scientific Institute of Lissone, Clinical and Scientific Institutes Maugeri, Institute of Care and Research, Lissone, Monza Brianza, Italy
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Ali F, Gabbay M, Baillie N. NICE public health guidance update. J Public Health (Oxf) 2021; 43:e100-e102. [PMID: 32735011 PMCID: PMC7454735 DOI: 10.1093/pubmed/fdaa112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 06/11/2020] [Accepted: 06/22/2020] [Indexed: 11/13/2022] Open
Abstract
This article highlights recent guidance from the National Institute for Health and Care Excellence (NICE). It highlights the organization's response to the COVID-19 pandemic and then provides a spotlight on workplace health in the context of long-term sickness absence and capability to work. It discusses some of the actions that need to be taken by a range of stakeholders in order to implement NICE guidance in this area and aid employees in ensuring good workplace health. The NICE guidance on workplace health, discussed in this article, predates the current pandemic. Comment is made specifically on fitness for work assessments, where the COVID-19 pandemic has posed a range of unique clinical challenges.
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Affiliation(s)
| | - Mark Gabbay
- University of Liverpool, Liverpool L69 3BX, UK
| | - Nick Baillie
- Leadership and Engagement, NICE, London SW1A 2BU, UK
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Langagergaard V, Jensen OK, Nielsen CV, Jensen C, Labriola M, Sørensen VN, Pedersen P. The comparative effects of brief or multidisciplinary intervention on return to work at 1 year in employees on sick leave due to low back pain: A randomized controlled trial. Clin Rehabil 2021; 35:1290-1304. [PMID: 33843296 DOI: 10.1177/02692155211005387] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To compare return to work (RTW) rates among patients with low back pain (LBP) and different job relations randomized to brief or multidisciplinary intervention. DESIGN A randomized controlled trial with 1-year follow-up. SETTING Silkeborg Regional Hospital, Denmark. SUBJECTS Four hundred seventy-six participants were divided into two groups concerning job relations: strong (influence on job and no fear of losing it) or weak (no influence on job and/or fear of losing it), and afterwards randomized to brief or multidisciplinary intervention. INTERVENTIONS Brief intervention included examination and advice by a rheumatologist and a physiotherapist. Multidisciplinary intervention included brief intervention plus coaching by a case manager making a plan for RTW with the patient. MAIN MEASURES Primary outcome was 1-year RTW rate. Secondary outcomes included pain intensity (LBP rating scale), disability (Roland Morris disability scale), and psychological measures (Common Mental Disorder Questionnaire, Major Depression Inventory, and EQ-5D-3L). RESULTS Mean (SD) age was 43.1 (9.8) years. Among 272 participants with strong job relations, RTW was achieved for 104/137 (76%) receiving brief intervention compared to 89/135 (66%) receiving multidisciplinary intervention, hazard ratio 0.73 (CI: 0.55-0.96). Corresponding results for 204 participants with weak job relations were 69/102 (68%) in both interventions, hazard ratio 1.07 (CI: 0.77-1.49). For patients with strong job relations, depressive symptoms and quality of life were more improved after brief intervention. CONCLUSION Brief intervention resulted in higher RTW rates than multidisciplinary intervention for employees with strong job relations. There were no differences in RTW rates between interventions for employees with weak job relations.
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Affiliation(s)
- Vivian Langagergaard
- Diagnostic Center, University Research Clinic for Innovative Patient Pathways, Silkeborg Regional Hospital, Silkeborg, Denmark.,Department of Clinical Social Medicine and Rehabilitation, Gødstrup Hospital, Herning, Denmark
| | - Ole Kudsk Jensen
- Diagnostic Center, University Research Clinic for Innovative Patient Pathways, Silkeborg Regional Hospital, Silkeborg, Denmark
| | - Claus Vinther Nielsen
- Department of Clinical Social Medicine and Rehabilitation, Gødstrup Hospital, Herning, Denmark.,Section of Clinical Social Medicine and Rehabilitation, Department of Public Health, Aarhus University, Aarhus, Denmark.,DEFACTUM, Central Denmark Region, Aarhus, Denmark
| | - Chris Jensen
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway.,National Advisory Unit on Occupational Rehabilitation, Rauland, Norway
| | | | - Vibeke Neergaard Sørensen
- Diagnostic Center, University Research Clinic for Innovative Patient Pathways, Silkeborg Regional Hospital, Silkeborg, Denmark
| | - Pernille Pedersen
- Section of Clinical Social Medicine and Rehabilitation, Department of Public Health, Aarhus University, Aarhus, Denmark.,DEFACTUM, Central Denmark Region, Aarhus, Denmark
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Marois E, Durand MJ, Coutu MF. Logic models for the Therapeutic Return-to-Work Program as adapted for common mental disorders: A guide for health professionals. Work 2020; 67:345-358. [PMID: 33044215 DOI: 10.3233/wor-203284] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Workplace interventions are recommended for workers with common mental disorders, but knowledge of their action mechanisms and operationalization remains limited. The Therapeutic Return-to-Work Program, developed for workers with musculoskeletal disorders, is recommended for common mental disorders. OBJECTIVE Our objective was to adapt this program's logic models to common mental disorders. METHODS A program logic analysis was conducted using a literature review and a two-phase group consensus method. We submitted a preliminary adapted version of the program's logic models and two questionnaires to health professional experts who participated in two group sessions, ultimately to produce the final version of the models. RESULTS We consulted 86 publications. The health professional experts (N = 7) had overall mean agreement scores of respectively 4.10/5 and 3.89/5 for questions on the program's theoretical and operational models. The final version of the logic models adapted for common mental disorders included four specific and 15 intermediate objectives, three main components, one optional component, four key processes, and 44 tasks. CONCLUSION The adapted logic models for the Therapeutic Return-to-Work Program show the relevance of the original objectives and components for common mental disorders. The next step will involve evaluating its feasibility with other stakeholders (insurers, employers, unions, workers).
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Affiliation(s)
- Elyse Marois
- Université de Sherbrooke, Health Sciences Program -Faculty of Medicine and Health Sciences, Sherbrooke, Quebec, Canada.,Center for Action in Work Disability Prevention and Rehabilitation (CAPRIT) affiliated with the Charles-Le Moyne - Saguenay-Lac-Saint-Jean Research Center on Health Innovations (CR-CSIS), Quebec, Canada
| | - Marie-José Durand
- Center for Action in Work Disability Prevention and Rehabilitation (CAPRIT) affiliated with the Charles-Le Moyne - Saguenay-Lac-Saint-Jean Research Center on Health Innovations (CR-CSIS), Quebec, Canada.,Université de Sherbrooke -School of Rehabilitation, Longueuil, Quebec, Canada
| | - Marie-France Coutu
- Center for Action in Work Disability Prevention and Rehabilitation (CAPRIT) affiliated with the Charles-Le Moyne - Saguenay-Lac-Saint-Jean Research Center on Health Innovations (CR-CSIS), Quebec, Canada.,Université de Sherbrooke -School of Rehabilitation, Longueuil, Quebec, Canada
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13
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Froud R, Grant M, Burton K, Foss J, Ellard DR, Seers K, Smith D, Barillec M, Patel S, Haywood K, Underwood M. Development and feasibility of an intervention featuring individual supported work placements to aid return to work for unemployed people living with chronic pain. Pilot Feasibility Stud 2020; 6:49. [PMID: 32337065 PMCID: PMC7175501 DOI: 10.1186/s40814-020-00581-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 03/10/2020] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Working in good jobs is associated with good health. High unemployment rates are reported in those disabled with musculoskeletal pain. Supported employment interventions work well for helping people with mental health difficulties to gain and retain employment. With adaptation, these may be useful for people with chronic pain. We aimed to develop and explore the feasibility of delivering such an adapted intervention. METHODS We developed an intervention and recruited unemployed people with chronic pain from NHS pain clinics and employment services. We trained case managers to assess participants and match them to six-week work placements in the Midlands and provide ongoing support to them and their managers. Participants attended a two-day work preparation session prior to placement. Outcome measures included quality of life at baseline, six- weeks, 14-weeks, and six-months, and return to work at 14-weeks and six-months. We held focus groups or interviews with stakeholders to examine acceptability and experiences of the intervention. RESULTS We developed an intervention consisting of work preparation sessions, work experience placements, and individualised employment support. We enrolled 31 people; 27 attended work preparation sessions, and 15 attended placements. Four of our participants started jobs during the study period. We are aware of two others starting jobs shortly after cessation of follow-up. We experienced challenges to recruitment in one area where we had many and diverse placement opportunities and good recruitment in another area where we had a smaller range of placement opportunities. All stakeholders found the intervention acceptable, and it was valued by those given a placement. While there was some disappointment among those not placed, this group still valued the work preparation sessions. CONCLUSIONS The developed intervention was acceptable to participants and partners. Trialling the developed intervention could be feasible with attention to three main processes. To ensure advanced availability of a sufficiently wide range of work placements in each area, multiple partners would be needed. Multiple recruitment sites and focus on employment services will yield better recruitment rates than reliance on NHS pain clinics. Maintaining an adequate follow-up response rate will likely require additional approaches with more than the usual effort.
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Affiliation(s)
- Robert Froud
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Gibbet Hill Road, Coventry, CV4 7AL UK
- Institute of Health Sciences, Kristiania University College, Prinsens Gate 7-9, 0152 Oslo, Norway
| | - Mary Grant
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Gibbet Hill Road, Coventry, CV4 7AL UK
| | - Kim Burton
- Centre for Applied Research in Health, School of Human & Health Sciences, The University of Huddersfield, Queensgate, Huddersfield, HD1 3DH UK
| | - Jonathan Foss
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Gibbet Hill Road, Coventry, CV4 7AL UK
| | - David R. Ellard
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Gibbet Hill Road, Coventry, CV4 7AL UK
| | - Kate Seers
- Warwick Research in Nursing, Division of Health Sciences, Warwick Medical School, University of Warwick, Gibbet Hill Road, Coventry, CV4 7AL UK
| | - Deb Smith
- University/User Teaching and Research Action Partnership, University of Warwick, Coventry, UK
| | - Mariana Barillec
- Serco UK & Europe; Employment, Skills and Enterprise, Trigate Business Centre, 210-222 Hagley Road West, Birmingham, B68 0NP UK
| | - Shilpa Patel
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Gibbet Hill Road, Coventry, CV4 7AL UK
| | - Kirstie Haywood
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Gibbet Hill Road, Coventry, CV4 7AL UK
| | - Martin Underwood
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Gibbet Hill Road, Coventry, CV4 7AL UK
- University Hospitals of Coventry and Warwickshire, Clifford Bridge Road, Coventry, CV2 2DX UK
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14
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Wilkie R, Bjork M, Costa-Black KM, Parker M, Pransky G. Managing work participation for people with rheumatic and musculoskeletal diseases. Best Pract Res Clin Rheumatol 2020; 34:101517. [PMID: 32321677 DOI: 10.1016/j.berh.2020.101517] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Improving work participation for individuals with rheumatic and musculoskeletal diseases (RMDs), has gained increasing interest over the last 10 years. New approaches are based upon increasing adoption of a biopsychosocial approach to improving work participation, incorporating evidence that health professionals within multidisciplinary teams have a key and critical role. In particular, interaction between health professionals and employers, and rehabilitation services that are linked to the workplace are key elements for improving work participation for people with RMDs. This review outlines recent research that underpins approaches for health professionals to develop their role in improving work participation for people with RMDs based on recent research; it outlines how to measure work-related outcomes in clinical practice, models of work participation, and approaches for health professionals to improve work participation outcomes. The potential for developing the role of health professionals in future years is also outlined.
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Affiliation(s)
- Ross Wilkie
- Versus Arthritis Primary Care Centre, School of Primary, Community and Social Care, Keele University, Keele, Staffordshire, ST5 5BG, United Kingdom; MRC Versus Arthritis Centre for Musculoskeletal Health and Work, University of Southampton, UK.
| | - Mathilda Bjork
- Unit of Occupational Therapy, Department of Health, Medicine and Caring Sciences, Faculty of Health Sciences, Linköping University, Department of Rheumatology, Heart and Medicine Center, Region Östergötland, Sweden.
| | - Katia M Costa-Black
- The British Standards Institution, Environmental Health and Safety Services and Solutions, Hillsboro, OR, USA; Graduate Program in Ergonomics and Biomechanics, School of Medicine, New York University, New York, NY, USA.
| | - Marty Parker
- Versus Arthritis Primary Care Centre, School of Primary, Community and Social Care, Keele University, Keele, Staffordshire, ST5 5BG, United Kingdom.
| | - Glenn Pransky
- Dept. of Quantitative Health Sciences, Univ of Massachusetts Medical School, Worcester, MA, USA.
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15
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Parry SP, Coenen P, Shrestha N, O'Sullivan PB, Maher CG, Straker LM. Workplace interventions for increasing standing or walking for decreasing musculoskeletal symptoms in sedentary workers. Cochrane Database Syst Rev 2019; 2019:CD012487. [PMID: 31742666 PMCID: PMC6953379 DOI: 10.1002/14651858.cd012487.pub2] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND The prevalence of musculoskeletal symptoms among sedentary workers is high. Interventions that promote occupational standing or walking have been found to reduce occupational sedentary time, but it is unclear whether these interventions ameliorate musculoskeletal symptoms in sedentary workers. OBJECTIVES To investigate the effectiveness of workplace interventions to increase standing or walking for decreasing musculoskeletal symptoms in sedentary workers. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, OSH UPDATE, PEDro, ClinicalTrials.gov, and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) search portal up to January 2019. We also screened reference lists of primary studies and contacted experts to identify additional studies. SELECTION CRITERIA We included randomised controlled trials (RCTs), cluster-randomised controlled trials (cluster-RCTs), quasi RCTs, and controlled before-and-after (CBA) studies of interventions to reduce or break up workplace sitting by encouraging standing or walking in the workplace among workers with musculoskeletal symptoms. The primary outcome was self-reported intensity or presence of musculoskeletal symptoms by body region and the impact of musculoskeletal symptoms such as pain-related disability. We considered work performance and productivity, sickness absenteeism, and adverse events such as venous disorders or perinatal complications as secondary outcomes. DATA COLLECTION AND ANALYSIS Two review authors independently screened titles, abstracts, and full-text articles for study eligibility. These review authors independently extracted data and assessed risk of bias. We contacted study authors to request additional data when required. We used GRADE considerations to assess the quality of evidence provided by studies that contributed to the meta-analyses. MAIN RESULTS We found ten studies including three RCTs, five cluster RCTs, and two CBA studies with a total of 955 participants, all from high-income countries. Interventions targeted changes to the physical work environment such as provision of sit-stand or treadmill workstations (four studies), an activity tracker (two studies) for use in individual approaches, and multi-component interventions (five studies). We did not find any studies that specifically targeted only the organisational level components. Two studies assessed pain-related disability. Physical work environment There was no significant difference in the intensity of low back symptoms (standardised mean difference (SMD) -0.35, 95% confidence interval (CI) -0.80 to 0.10; 2 RCTs; low-quality evidence) nor in the intensity of upper back symptoms (SMD -0.48, 95% CI -.096 to 0.00; 2 RCTs; low-quality evidence) in the short term (less than six months) for interventions using sit-stand workstations compared to no intervention. No studies examined discomfort outcomes at medium (six to less than 12 months) or long term (12 months and more). No significant reduction in pain-related disability was noted when a sit-stand workstation was used compared to when no intervention was provided in the medium term (mean difference (MD) -0.4, 95% CI -2.70 to 1.90; 1 RCT; low-quality evidence). Individual approach There was no significant difference in the intensity or presence of low back symptoms (SMD -0.05, 95% CI -0.87 to 0.77; 2 RCTs; low-quality evidence), upper back symptoms (SMD -0.04, 95% CI -0.92 to 0.84; 2 RCTs; low-quality evidence), neck symptoms (SMD -0.05, 95% CI -0.68 to 0.78; 2 RCTs; low-quality evidence), shoulder symptoms (SMD -0.14, 95% CI -0.63 to 0.90; 2 RCTs; low-quality evidence), or elbow/wrist and hand symptoms (SMD -0.30, 95% CI -0.63 to 0.90; 2 RCTs; low-quality evidence) for interventions involving an activity tracker compared to an alternative intervention or no intervention in the short term. No studies provided outcomes at medium term, and only one study examined outcomes at long term. Organisational level No studies evaluated the effects of interventions solely targeted at the organisational level. Multi-component approach There was no significant difference in the proportion of participants reporting low back symptoms (risk ratio (RR) 0.93, 95% CI 0.69 to 1.27; 3 RCTs; low-quality evidence), neck symptoms (RR 1.00, 95% CI 0.76 to 1.32; 3 RCTs; low-quality evidence), shoulder symptoms (RR 0.83, 95% CI 0.12 to 5.80; 2 RCTs; very low-quality evidence), and upper back symptoms (RR 0.88, 95% CI 0.76 to 1.32; 3 RCTs; low-quality evidence) for interventions using a multi-component approach compared to no intervention in the short term. Only one RCT examined outcomes at medium term and found no significant difference in low back symptoms (MD -0.40, 95% CI -1.95 to 1.15; 1 RCT; low-quality evidence), upper back symptoms (MD -0.70, 95% CI -2.12 to 0.72; low-quality evidence), and leg symptoms (MD -0.80, 95% CI -2.49 to 0.89; low-quality evidence). There was no significant difference in the proportion of participants reporting low back symptoms (RR 0.89, 95% CI 0.57 to 1.40; 2 RCTs; low-quality evidence), neck symptoms (RR 0.67, 95% CI 0.41 to 1.08; two RCTs; low-quality evidence), and upper back symptoms (RR 0.52, 95% CI 0.08 to 3.29; 2 RCTs; low-quality evidence) for interventions using a multi-component approach compared to no intervention in the long term. There was a statistically significant reduction in pain-related disability following a multi-component intervention compared to no intervention in the medium term (MD -8.80, 95% CI -17.46 to -0.14; 1 RCT; low-quality evidence). AUTHORS' CONCLUSIONS Currently available limited evidence does not show that interventions to increase standing or walking in the workplace reduced musculoskeletal symptoms among sedentary workers at short-, medium-, or long-term follow up. The quality of evidence is low or very low, largely due to study design and small sample sizes. Although the results of this review are not statistically significant, some interventions targeting the physical work environment are suggestive of an intervention effect. Therefore, in the future, larger cluster-RCTs recruiting participants with baseline musculoskeletal symptoms and long-term outcomes are needed to determine whether interventions to increase standing or walking can reduce musculoskeletal symptoms among sedentary workers and can be sustained over time.
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Affiliation(s)
- Sharon P Parry
- Curtin UniversitySchool of Physiotherapy and Exercise ScienceKent StreetBentleyPerthWest AustraliaAustralia6102
| | - Pieter Coenen
- Curtin UniversitySchool of Physiotherapy and Exercise ScienceKent StreetBentleyPerthWest AustraliaAustralia6102
- VU University Medical CenterDepartment of Public and Occupational Health, EMGO Institute for Health and Care Researchvan der Boechorststraat 7AmsterdamNetherlands1081BT
| | - Nipun Shrestha
- Victoria UniversityInstitute for Health and Sport (IHES)MelbourneVictoriaAustralia
| | - Peter B O'Sullivan
- Curtin UniversitySchool of Physiotherapy and Exercise ScienceKent StreetBentleyPerthWest AustraliaAustralia6102
| | - Christopher G Maher
- University of SydneySydney School of Public HealthLevel 10 North, King George V Building, Missenden Road, CamperdownSydneyNSWAustralia2050
| | - Leon M Straker
- Curtin UniversitySchool of Physiotherapy and Exercise ScienceKent StreetBentleyPerthWest AustraliaAustralia6102
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16
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Ibrahim ME, Weber K, Courvoisier DS, Genevay S. Recovering the capability to work among patients with chronic low Back pain after a four-week, multidisciplinary biopsychosocial rehabilitation program: 18-month follow-up study. BMC Musculoskelet Disord 2019; 20:439. [PMID: 31597562 PMCID: PMC6785904 DOI: 10.1186/s12891-019-2831-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 09/12/2019] [Indexed: 12/28/2022] Open
Abstract
Background Chronic low back pain (LBP) is a leading cause of disability worldwide. Biopsychosocial rehabilitation programs have been advocated for its management, especially since the widespread acceptance of the biopsychosocial model of chronic pain. Despite extensive evidence of its short-term benefits, few studies have reported on its long-term effect and more specifically on indirect outcomes such as return to work and quality of life (QoL). The present study evaluated the long-term effect of a multidisciplinary biopsychosocial rehabilitation (MBR) program for patients with chronic LBP, for which short- and intermediate-term efficacy had been established, with an emphasis on recovering work capability. Methods This prospective cohort study enrolled 201 patients on a four-week MBR program incorporating physical and occupational therapies and psychological counselling. Assessments occurred at program admission and discharge and at 6 and 18 months. Work capability, Oswestry Disability Index, Tampa Scale for Kinesiophobia, Core Outcome Measures Index (COMI), and Hospital Anxiety and Depression Scale were assessed. Multiple mixed models were used to detect changes in each outcome. Logistic regressions were calculated to identify predictors of recovery of work capability. Results Of the 201 patients who fulfilled the eligibility criteria, 160 (79.8%) attended the discharge assessment, 127 (63.2%) attended the 6-month follow-up, and 107 (53.3%) continued to the 18-month follow-up. Initially, 128 patients (71.5%) had been on sick leave. At 6 and 18 months, 72 (56.7%) and 84 (78.5%) participants had recovered their work capability, respectively. There were significant improvements in pain, disability, kinesiophobia, and anxiety and depression scores over time. Patients who recovered work capability showed significantly greater improvements in their total COMI score, general QoL, and disability, which were the best three predictors of recovering work capability. Conclusions This study extends previous results confirming the program’s contribution to recovering work capability among chronic LBP patients.
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Affiliation(s)
- Maha E Ibrahim
- Division of Rheumatology, University Hospitals of Geneva, Beau Séjour Hospital, CH-1205, 14, Geneva, Switzerland. .,Department of Physical Medicine, Rheumatology and Rehabilitation, Suez Canal University, Ismailia, Egypt.
| | - Kerstin Weber
- Medical Direction, University Hospitals of Geneva, Geneva, Switzerland
| | - Delphine S Courvoisier
- Division of Rheumatology, University Hospitals of Geneva, Beau Séjour Hospital, CH-1205, 14, Geneva, Switzerland.,Quality of Care Service, University Hospitals of Geneva, Geneva, Switzerland.,Department of General Internal Medicine, Rehabilitation and Geriatrics, University of Geneva, Geneva, Switzerland
| | - Stéphane Genevay
- Division of Rheumatology, University Hospitals of Geneva, Beau Séjour Hospital, CH-1205, 14, Geneva, Switzerland
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17
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Schofield K, Ryan AD, Dauner KN. Comparing disability and return to work outcomes between alternative and traditional workers' compensation programs. Am J Ind Med 2019; 62:755-765. [PMID: 31298426 DOI: 10.1002/ajim.23017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 05/31/2019] [Accepted: 05/31/2019] [Indexed: 11/08/2022]
Abstract
BACKGROUND The Union Construction Workers' Compensation Program (UCWCP) was developed in 1996 as an alternative workers' compensation arrangement. The program includes use of a preapproved medical and rehabilitation network and alternative dispute resolution (ADR), and prioritizes a quick and safe return-to-work. The aim of this study is to determine if differences in recovery-related outcomes exist between UCWCP and the statutory workers' compensation system (SWCS). METHODS Claims data from 2003 to 2016 were classified as processed through UCWCP or SWCS. Outcomes included: temporary total disability (TTD), vocational rehabilitation (VR), claim duration and costs, and permanent partial disability (PPD). The relative risk of incurring TTD, VR, and PPD in UCWCP vs SWCS was calculated using log-binomial regression. Linear regression examined the relationship between programs and continuous outcomes including costs and duration. Estimates were adjusted for age, sex, wage, and severity. RESULTS The UCWCP processed 15.8% of claims; higher percentages of UCWCP claimants were older and earned higher wages. Results point to positive findings of decreased TTD incidence and cost, lower risk of TTD extending over time, higher likelihood of VR participation, and less attorney involvement and stipulation agreements associated with UCWCP membership. Differences were more apparent in workers who suffered permanent physical impairment. CONCLUSION Findings suggest that the defining programmatic elements of the UCWCP, including its medical provider and rehabilitation network and access to ADR, have been successful in their aims. Claims with increased severity exhibited more pronounced differences vs SWCS, potentially due, in part, to greater use of programmatic elements.
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Affiliation(s)
- Katherine Schofield
- Department of Mechanical and Industrial EngineeringUniversity of Minnesota Duluth Duluth Minnesota
| | - Andrew D. Ryan
- Department of Environmental Health SciencesUniversity of Minnesota Minneapolis Minnesota
| | - Kim N. Dauner
- Department of Economics and Health Care ManagementUniversity of Minnesota Duluth Duluth Minnesota
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18
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Boyle E, Cassidy JD, Côté P. Determining the reliability and convergent validity of a return-to-work status questionnaire. Work 2019; 63:69-80. [PMID: 31127746 DOI: 10.3233/wor-192909] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND In occupational rehabilitation programs, return-to-work is a key outcome measure; however, the studies either used different definitions for return-to-work or do not provide their definition. In order to provide a solution to this issue, we developed a self-report return-to-work measure. OBJECTIVE We investigated the reliability and validity of a self-report return-to-work questionnaire in a cohort of workers with a work-related injury. METHODS Two research assistants independently administered the baseline questionnaires and a follow-up questionnaire. The questionnaires contained work-related questions (e.g., currently working, if duties changed) that were used to create a four-category work status measure. Pain-related and a recovery questions were also asked. We obtained loss of earnings data from the compensation board. The short-term reliability and convergent validity were assessed. RESULTS We recruited 75 workers, and 57 completed the test-re-test baseline questionnaire, and 51 completed the follow-up. The mean age was 45.4 years and 57% were female. The participants had a mixture of musculoskeletal injuries. Most were in the acute stage, but 17% of the participants were injured for more than a year. The short-term reliability of current working status had a kappa value of 0.90. Participants who were not working had higher levels of pain-related disability than those who were working. The kappa value for the agreement between self-reported working status and administrative data on receiving any loss of earnings payment was around 0.65. CONCLUSIONS Our study provides evidence of reliability and validity for a new return-to-work measure.
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Affiliation(s)
- Eleanor Boyle
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.,Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - J David Cassidy
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.,Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Pierre Côté
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.,Faculty of Health Sciences, University of Ontario Institute of Technology (UOIT), Oshawa, Canada.,UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, Oshawa, Canada
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19
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Aasdahl L, Fimland MS. Is there really a "golden hour" for work disability interventions? A narrative review. Disabil Rehabil 2019; 42:586-593. [PMID: 30602340 DOI: 10.1080/09638288.2018.1503735] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The subacute phase of low back pain has been termed as the "golden hour" to intervene to prevent work disability. This notion is based on the literature up to 2001 and is limited to back pain. In this narrative review, we examined whether the current literature indicate an optimal time for return to work (RTW) interventions. We considered randomized controlled trials published from 1997 to April 2018 assessing effects of occupational rehabilitation interventions for musculoskeletal complaints (15 included), mental health disorders (9 included) or a combination of the two (1 included). We examined participants' sick leave duration at inclusion and the interventions' effects on RTW. Most studies reporting an effect on RTW included participants with musculoskeletal complaints in the subacute phase, supporting that this phase could be a beneficial time to start RTW-interventions. However, recent studies suggest that RTW-interventions also can be effective for workers with longer sick leave durations. Our interpretation is that there might not be a limited time window or "golden hour" for work disability interventions, but rather a question about what type of intervention is right at what time and for whom. However, more research is needed. Particularly, we need more high-quality studies on the effects of RTW-interventions for sick listed individuals with mental health disorders.Implications for rehabilitationThe subacute phase of low back pain has been termed the "golden hour" for work disability prevention.Recent evidence suggests there is a wider time-window for effective interventions, both for musculoskeletal- and common mental disorders.A stepped-care approach, starting with simpler low-cost interventions (e.g., brief reassuring interventions), before considering more comprehensive interventions (e.g., multimodal rehabilitation), could facilitate return to work and avoid excessive treatment.
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Affiliation(s)
- Lene Aasdahl
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway.,Unicare Helsefort Rehabilitation Centre, Rissa, Norway
| | - Marius Steiro Fimland
- Unicare Helsefort Rehabilitation Centre, Rissa, Norway.,Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
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20
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Doki S, Harano S, Shinada K, Ohyama A, Kojimahara N. [Return-to-work support programs for workers on sick leave: a systematic review and meta-analysis]. SANGYŌ EISEIGAKU ZASSHI = JOURNAL OF OCCUPATIONAL HEALTH 2018; 60:169-179. [PMID: 30369589 DOI: 10.1539/sangyoeisei.2018-008-a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES We are responsible for answering the research question, "Does a return-to-work program improve the returning outcome?" This is one of the six research questions in the evidence-based "Return-to-work Guidance in Occupational Health 2017" developed by the Kanto branch of the Japanese Society of Occupational Health. This study aimed to integrate the effectiveness of the return-to-work program to improve the state of sick-listed employees suffering from cardiovascular disease, cancer, and musculoskeletal and mental health problems. METHODS Three different databases, PubMed, Cochrane Library, and Ichushi-Web were searched. Based on the results of a systematic review, the guidance developing group created the draft of the recommendations with evidence to decision framework and used a poll to determine the recommendations. We integrated the evidence from a systematic review and meta-analysis at the disease level. This study protocol was registered with PROSPERO (the registration number is: CRD42016048937). RESULTS A total of five articles on musculoskeletal diseases and six on mental health problems were retrieved. No articles in the cardiovascular and cancer areas matched the eligibility criteria. When workers suffered from musculoskeletal disorders, the rehabilitation group statistically returned to work earlier than the usual care group did [HR 1.58 (95% CI 1.26-1.97), -40.71days (95% CI -60.69--20.72) ]. In the mental health problems group, the psychological intervention program group had statistically less days of sick leaves as compared to that in the usual care group [-18.64 days (95% CI -27.98--9.30) ]. CONCLUSIONS It might be suggested that work environment management, work management, tackling psychological problems, cognitive behavioral approach, and several meetings with supervisors and occupational health staff, in addition to a direct focus on backache contributed to the early return-to-work of workers suffering from musculoskeletal disease. Regarding mental health problems, interviews with a psychological approach and consultations with psychologists and psychiatrists might be effective in reducing the days of sick leaves. However, because these methods were investigated in Europe, we need to be careful when introducing these practises in Japan due to the differences in the occupational health support systems. Further, high quality evidence level studies are needed in Japan.
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Affiliation(s)
| | | | - Kayoko Shinada
- Department of Oral Health Promotion, Graduate School, Tokyo Medical and Dental University
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21
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Huysmans E, Goudman L, Van Belleghem G, De Jaeger M, Moens M, Nijs J, Ickmans K, Buyl R, Vanroelen C, Putman K. Re: Return to work following surgery for lumbarradiculopathy-is there a need for postoperative rehabilitation? Spine J 2018; 18:2376-2377. [PMID: 30240878 DOI: 10.1016/j.spinee.2018.09.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 09/12/2018] [Accepted: 09/13/2018] [Indexed: 02/03/2023]
Affiliation(s)
- Eva Huysmans
- I-CHER, Interuniversity Center for Health Economics Research, Belgium; Pain in Motion International Research Group, www.paininmotion.be; Department of Public Health (GEWE), Faculty ofMedicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium; Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy (KIMA), Vrije Universiteit Brussel, Brussels, Belgium; Department of Physical Medicine and Physiotherapy, Universitair Ziekenhuis Brussel, Brussels, Belgium.
| | - Lisa Goudman
- Pain in Motion International Research Group, www.paininmotion.be; Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy (KIMA), Vrije Universiteit Brussel, Brussels, Belgium; Department of Neurosurgery, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Griet Van Belleghem
- I-CHER, Interuniversity Center for Health Economics Research, Belgium; Department of Public Health (GEWE), Faculty ofMedicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Mats De Jaeger
- Department of Neurosurgery, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Maarten Moens
- Department of Neurosurgery, Universitair Ziekenhuis Brussel, Brussels, Belgium; Center for Neurosciences, Faculty of Medicine & Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium; Department of Manual Therapy (MANU), Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Jo Nijs
- Pain in Motion International Research Group, www.paininmotion.be; Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy (KIMA), Vrije Universiteit Brussel, Brussels, Belgium; Department of Physical Medicine and Physiotherapy, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Kelly Ickmans
- Pain in Motion International Research Group, www.paininmotion.be; Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy (KIMA), Vrije Universiteit Brussel, Brussels, Belgium; Department of Physical Medicine and Physiotherapy, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Ronald Buyl
- Department of Public Health (GEWE), Faculty ofMedicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium; Department of Biostatistics and Medical Informatics, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Christophe Vanroelen
- Interface Demography, Vrije Universiteit Brussel, Brussels, Belgium; Health Inequalities Research Group (GREDS),Universitat Pompeu Fabra, Barcelona, Spain
| | - Koen Putman
- I-CHER, Interuniversity Center for Health Economics Research, Belgium; Department of Public Health (GEWE), Faculty ofMedicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium
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22
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Kojimahara N, Fukumoto M, Yoshikawa E, Shinada K, Tsuiki H. [Development process of Evidence-based "Return-to-work Guidance in Occupational Health 2017"]. SANGYŌ EISEIGAKU ZASSHI = JOURNAL OF OCCUPATIONAL HEALTH 2018; 60:103-111. [PMID: 29877207 DOI: 10.1539/sangyoeisei.2017-030-b] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE "Return-to-work Guidance in Occupational Health 2017 (RTW Guidance 2017) " is the first occupational health guide in Japan that evaluates the quality of evidence and offers recommendations based on results of the systematic review of randomized controlled trials. Details of the systematic review of each review question (RQs) will be described separately. This article presents an overview of the method and process of developing the "RTW Guidance 2017." MATERIALS AND METHODS The guidance was developed following the previously-published "Method for developing evidence based occupational health guidance," which included the composition of a highly-transparent guidance developing group as well as the recruitment and selection of RQs. Using the Cochrane Library, PubMed, and Ichushi-Web, a literature search for the six RQs was conducted in January 2016 by partly modifying the search terms of the existing systematic review. Articles were selected according to the inclusion criteria, and the quality of evidence was evaluated using the GRADE approach. Meta-analysis was conducted for RQ2 and RQ4, and a qualitative systematic review was conducted for RQ5, RQ6, and cost-effectiveness. Recommendations were subsequently made after a thorough consideration for feasibility in Japan by examining the costs and available resources. RESULTS Based on a comprehensive literature search, eleven RQ2, four RQ4, one RQ5, and three RQ6 were selected. Support program for returning to work, such as "Re-work" for those who are temporarily not working due to musculoskeletal disorders or mental health disorder, was recommended based on moderate evidence (RQ2). For RQ4, the collaboration between occupational health practice and clinical practice was weakly recommended based on low evidence. For RQ5 that evaluated the usefulness of social support, intervention by the manager/co-worker was proposed as a "best practice statement" without indicating it as a recommendation. Work accommodation was weakly recommended based on low evidence in RQ6. DISCUSSION AND CONCLUSION From the result of systematic reviews, it was recommended for workers on sick leave more than four weeks regardless of sick leave and sickness absence that interventions during leave would improve work-related outcomes, such as earlier reinstatement. Although there is limited evidence regarding occupational health in Japan, it is important for many occupational health professionals to learn the method of developing guidance and to identify issues for future studies with priority in Japan.
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Affiliation(s)
- Noriko Kojimahara
- Tokyo Women's Medical University.,Committee of Developing RTW Guidance in Occupational Health, the Japan Society for Occupational, Kanto Branch
| | - Masakatsu Fukumoto
- Social Welfare Corporation Nagaoka Welfare Society Metropolitan Division Health Care Facility for Elderly Shimbashi-Bara-no-sono.,Committee of Developing RTW Guidance in Occupational Health, the Japan Society for Occupational, Kanto Branch
| | - Etsuko Yoshikawa
- Japan Red Cross College of Nursing.,Committee of Developing RTW Guidance in Occupational Health, the Japan Society for Occupational, Kanto Branch
| | - Kayoko Shinada
- Tokyo Medical and Dental University.,Committee of Developing RTW Guidance in Occupational Health, the Japan Society for Occupational, Kanto Branch
| | - Hirokazu Tsuiki
- a-ru Limited Liability Company.,Committee of Developing RTW Guidance in Occupational Health, the Japan Society for Occupational, Kanto Branch
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23
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Grobler SH, Mostert K, Becker P. The impact of a change in work posture from seated to stand-up on work-related musculoskeletal disorders among sewing-machine operators. Am J Ind Med 2018; 61:699-711. [PMID: 29876956 DOI: 10.1002/ajim.22865] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2018] [Indexed: 01/24/2023]
Abstract
BACKGROUND Work-related postural change could lead to improved musculoskeletal health. METHOD(S) In a quantitative, retrospective, longitudinal study, data of work-related musculoskeletal disorders of 123 sewing-machine operators were captured for 4.5 years, and analysed using Poisson regression. RESULTS Stand-up work posture (SUWP) reduced the incidence for spinal disorders (SD) to 0.29 fold the incidence for sitting work posture (SWP) (P < 0.001). Morbid obesity had significantly increased (P = 0.04) incidence of upper limb disorders (ULD), 3.35 times that of normal body mass index (BMI) (regardless of work posture). SUWP was associated with increased IRR (1.49) for lower limb disorders (LLD). LLDs were associated with obesity (overweight (IRR = 2.58; P = 0.08), obese (IRR = 2.45; P = 0.09), and morbidly obese (IRR = 6.24; P = 0.001)). CONCLUSIONS The protective benefit of the SUWP was statistically significant for SD incidence. Owing to high mean BMI, SUWP had a negative impact on the incidence of LLDs for the first 2 months.
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Affiliation(s)
- Susan H Grobler
- Physiotherapy Private Practice, Pretoria, South Africa
- Department of Physiotherapy, University of Pretoria, Pretoria, South Africa
| | - Karien Mostert
- Department of Physiotherapy, University of Pretoria, Pretoria, South Africa
| | - Piet Becker
- Research Office, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
- Biostatistics Unit, South African Medical Research Council, Pretoria, South Africa
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24
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Moll LT, Jensen OK, Schiøttz-Christensen B, Stapelfeldt CM, Christiansen DH, Nielsen CV, Labriola M. Return to Work in Employees on Sick Leave due to Neck or Shoulder Pain: A Randomized Clinical Trial Comparing Multidisciplinary and Brief Intervention with One-Year Register-Based Follow-Up. JOURNAL OF OCCUPATIONAL REHABILITATION 2018; 28:346-356. [PMID: 28836120 PMCID: PMC5978826 DOI: 10.1007/s10926-017-9727-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Purpose The aim of this study was to evaluate the effect of a multidisciplinary intervention (MDI) compared to a brief intervention (BI) with respect to return to work (RTW), pain and disability in workers on sick leave because of neck or shoulder pain. Methods 168 study participants with sickness absence for 4-16 weeks due to neck or shoulder pain were enrolled in a hospital-based clinical study and randomized to either MDI or BI. The primary outcome was RTW obtained by a national registry on public transfer payments. Secondary outcomes were self-reported pain and disability levels. One-year follow-up RTW rates were estimated by Cox proportional hazard regression adjusted for gender, age, sick leave prior to inclusion, part-time sick leave and clinical diagnosis. Secondary outcomes were analysed using logistic and linear regression analysis for pain and disability, respectively. Results In the MDI group, 50 participants (59%) experienced four or more continuous weeks of RTW while 48 (58%) returned to work in the BI group during the 1 year of follow-up. Results showed a statistically non significant tendency towards a lower rate of RTW in the MDI group than in the BI group (adjusted HR = 0.84, 95% CI 0.54, 1.31). There were no statistically significant differences in secondary outcomes between the MDI and BI groups. Conclusion The brief and the multidisciplinary interventions performed equally with respect to both primary and secondary outcomes. The added focus on RTW in the multidisciplinary group did not improve RTW rates in this group.
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Affiliation(s)
- Line Thorndal Moll
- DEFACTUM, Central Denmark Region, P.P. Oerums Gade 11, bygn. 1B, 8000, Aarhus C, Denmark.
- Section of Clinical Social Medicine and Rehabilitation, Department of Public Health, Aarhus University, P.P. Oerums Gade 9-11, bygn. 1B, 8000, Aarhus C, Denmark.
- Spine Centre, Diagnostic Centre, Silkeborg Regional Hospital, Falkevej 1-3, 8600, Silkeborg, Denmark.
| | - Ole Kudsk Jensen
- Spine Centre, Diagnostic Centre, Silkeborg Regional Hospital, Falkevej 1-3, 8600, Silkeborg, Denmark
| | - Berit Schiøttz-Christensen
- Spine Centre of Southern Denmark, Hospital Lillebaelt Middelfart and Institute of Regional Health Research, University of Southern Denmark, Oestre Hougvej 55, 5500, Middelfart, Denmark
| | - Christina Malmose Stapelfeldt
- DEFACTUM, Central Denmark Region, P.P. Oerums Gade 11, bygn. 1B, 8000, Aarhus C, Denmark
- Section of Clinical Social Medicine and Rehabilitation, Department of Public Health, Aarhus University, P.P. Oerums Gade 9-11, bygn. 1B, 8000, Aarhus C, Denmark
| | - David Høyrup Christiansen
- Department of Occupational Medicine, University Research Clinic, Regional Hospital West Jutland, Gl. Landevej 61, 7400, Herning, Denmark
| | - Claus Vinther Nielsen
- DEFACTUM, Central Denmark Region, P.P. Oerums Gade 11, bygn. 1B, 8000, Aarhus C, Denmark
- Section of Clinical Social Medicine and Rehabilitation, Department of Public Health, Aarhus University, P.P. Oerums Gade 9-11, bygn. 1B, 8000, Aarhus C, Denmark
| | - Merete Labriola
- DEFACTUM, Central Denmark Region, P.P. Oerums Gade 11, bygn. 1B, 8000, Aarhus C, Denmark
- Section of Clinical Social Medicine and Rehabilitation, Department of Public Health, Aarhus University, P.P. Oerums Gade 9-11, bygn. 1B, 8000, Aarhus C, Denmark
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25
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Rantonen J, Karppinen J, Vehtari A, Luoto S, Viikari-Juntura E, Hupli M, Malmivaara A, Taimela S. Effectiveness of three interventions for secondary prevention of low back pain in the occupational health setting - a randomised controlled trial with a natural course control. BMC Public Health 2018; 18:598. [PMID: 29739371 PMCID: PMC5941604 DOI: 10.1186/s12889-018-5476-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2017] [Accepted: 04/17/2018] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND We assessed the effectiveness of three interventions that were aimed to reduce non-acute low back pain (LBP) related symptoms in the occupational health setting. METHODS Based on a survey (n = 2480; response rate 71%) on LBP, we selected a cohort of 193 employees who reported moderate LBP (Visual Analogue Scale VAS > 34 mm) and fulfilled at least one of the following criteria during the past 12 months: sciatica, recurrence of LBP ≥ 2 times, LBP ≥ 2 weeks, or previous sickness absence. A random sample was extracted from the cohort as a control group (Control, n = 50), representing the natural course of LBP. The remaining 143 employees were invited to participate in a randomised controlled trial (RCT) of three 1:1:1 allocated parallel intervention arms: multidisciplinary rehabilitation (Rehab, n = 43); progressive exercises (Physio, n = 43) and self-care advice (Advice, n = 40). Seventeen employees declined participation in the intervention. The primary outcome measures were physical impairment (PHI), LBP intensity (Visual Analogue Scale), health related quality of life (QoL), and accumulated sickness absence days. We imputed missing values with multiple imputation procedure. We assessed all comparisons between the intervention groups and the Control group by analysing questionnaire outcomes at 2 years with ANOVA and sickness absence at 4 years by using negative binomial model with a logarithmic link function. RESULTS Mean differences between the Rehab and Control groups were - 3 [95% CI -5 to - 1] for PHI, - 13 [- 24 to - 1] for pain intensity, and 0.06 [0.00 to 0.12] for QoL. Mean differences between the Physio and Control groups were - 3 [95% CI -5 to - 1] for PHI, - 13 [- 29 to 2] for pain intensity, and 0.07 [0.01 to 0.13] for QoL. The main effects sizes were from 0.4 to 0.6. The interventions were not effective in reducing sickness absence. CONCLUSIONS Rehab and Physio interventions improved health related quality of life, decreased low back pain and physical impairment in non-acute, moderate LBP, but we found no differences between the Advice and Control group results. No effectiveness on sickness absence was observed. TRIAL REGISTRATION Number NCT00908102 Clinicaltrials.gov.
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Affiliation(s)
- J. Rantonen
- University of Helsinki, Doctoral School in Health Sciences, Helsinki, Finland
- Lappeenranta University of Technology, Lappeenranta, Finland
- Department of Occupational Medicine, South Karelia Social and Health Care District, Lappeenranta, Finland
| | - J. Karppinen
- Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
- Finnish Institute of Occupational Health, Oulu, Finland
| | - A. Vehtari
- Helsinki Institute for Information Technology HIIT, Department of Computer Science, Aalto University, Espoo, Finland
| | - S. Luoto
- Department of Physical Medicine and Rehabilitation, South Karelia Social and Health Care District, Lappeenranta, Finland
| | | | - M. Hupli
- Department of Physical Medicine and Rehabilitation, South Karelia Social and Health Care District, Lappeenranta, Finland
| | - A. Malmivaara
- National Institute for Health and Welfare, Centre for Health and Social Economics, Helsinki, Finland
| | - S. Taimela
- Evalua International, Espoo, Finland
- Department of Orthopedics and Traumatology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
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26
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Streibelt M, Bethge M. Prognostic accuracy of the SIMBO regarding future return-to-work problems in patients with mental and musculoskeletal disorders. Disabil Rehabil 2018; 41:1571-1577. [PMID: 29566559 DOI: 10.1080/09638288.2018.1432703] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
PURPOSE A screening instrument (0-100 points) to predict return-to-work (RTW) problems was developed. We tested the predictive validity in patients with mental diseases (MD) and musculoskeletal diseases (MSD). MATERIALS AND METHODS A prospective multicenter study with questionnaires at admission and 3 months after rehabilitation was conducted. Patients with MD and MSD were included. The outcome was occurrence of RTW problems during the follow-up. Receiver operating characteristic analyses were performed. Sensitivity, specificity, and predictive values were calculated for each disease group using the threshold of 27 points. RESULTS There were 401 patients with MD (n = 250) and MSD (n = 151) included in the study, and 31.8% and 46.4% reported RTW problems during the follow-up, respectively. The area under curve was 0.885 (0.838-0.920) and 0.899 (0.841-0.943). The sensitivity rates were 87.1% and 87.5% and the specificity rates were 79.9% and 88.4% for MD and MSD, respectively. The post-test probability of experiencing RTW problems was 78.9% for MD and 77.8% for MSD. Analyses including only employed patients showed similar results. CONCLUSIONS The screening predicts short-term RTW problems after rehabilitation in patients with mental or MSD regardless of employment. The threshold of 27 points was confirmed as reasonable, but alternatives in the range of 20-30 points can also be recommended. Implications for Rehabilitation The SIMBO is a short and economic screening predicting future problems during the return to work (RTW) in patients with mental or musculoskeletal diseases. The SIMBO can be recommended to detect the initial RTW chance at the beginning of the rehabilitation process. This paper implied that there are mainly generic factors predicting the success of an RTW. Based on this it is possible to use one screening for different disease groups.
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Affiliation(s)
- Marco Streibelt
- a Department of Rehabilitation , German Federal Pension Insurance , Berlin , Germany
| | - Matthias Bethge
- b Institute of Social Medicine and Epidemiology, University of Lübeck , Lübeck , Germany
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27
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Aasdahl L, Pape K, Vasseljen O, Johnsen R, Gismervik S, Halsteinli V, Fleten N, Nielsen CV, Fimland MS. Effect of Inpatient Multicomponent Occupational Rehabilitation Versus Less Comprehensive Outpatient Rehabilitation on Sickness Absence in Persons with Musculoskeletal- or Mental Health Disorders: A Randomized Clinical Trial. JOURNAL OF OCCUPATIONAL REHABILITATION 2018; 28:170-179. [PMID: 28401441 PMCID: PMC5820389 DOI: 10.1007/s10926-017-9708-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Purpose To assess effects of an inpatient multicomponent occupational rehabilitation program compared to less comprehensive outpatient rehabilitation on sickness absence in persons with musculoskeletal- or mental health disorders. Methods Randomized clinical trial with parallel groups. Participants were individuals 18-60 years old on sick-leave for 2-12 months with a sick-leave diagnosis within the musculoskeletal, psychological or general and unspecified chapters of ICPC-2, identified in a national register. The inpatient program (4 + 4 days) consisted of Acceptance and Commitment Therapy (ACT), physical training and work-related problem-solving including creating a return to work plan and a workplace visit if considered relevant. The outpatient program consisted primarily of ACT (6 sessions during 6 weeks). Both programs were group based. Primary outcome was cumulated number of sickness absence days at 6 and 12 months follow-up. Secondary outcome was time until sustainable return to work. Results 168 individuals were randomized to the inpatient program (n = 92) or the outpatient program (n = 76). We found no statistically significant difference between the programs in median number of sickness absence days at 6 and 12 months follow-up. In the outpatient program 57% of the participants achieved sustainable return to work (median time 7 months), in the inpatient program 49% (log rank, p = 0.167). The hazard ratio for sustainable return to work was 0.74 (95% CI 0.48-1.32, p = 0.165), in favor of the outpatient program. Conclusions This study provided no support that the more comprehensive 4 + 4 days inpatient multicomponent occupational rehabilitation program reduced sickness absence compared to the outpatient rehabilitation program.
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Affiliation(s)
- Lene Aasdahl
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, NTNU, Trondheim, Norway.
- Department of Physical Medicine and Rehabilitation, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.
| | - Kristine Pape
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, NTNU, Trondheim, Norway
| | - Ottar Vasseljen
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, NTNU, Trondheim, Norway
| | - Roar Johnsen
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, NTNU, Trondheim, Norway
| | - Sigmund Gismervik
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, NTNU, Trondheim, Norway
- Department of Physical Medicine and Rehabilitation, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Vidar Halsteinli
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, NTNU, Trondheim, Norway
- Regional Center for health care improvement, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Nils Fleten
- Department of Community Medicine, UiT The Artic University of Norway, Tromsø, Norway
| | | | - Marius Steiro Fimland
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, NTNU, Trondheim, Norway
- Department of Physical Medicine and Rehabilitation, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
- Hysnes Rehabilitation Center, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
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28
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Cullen KL, Irvin E, Collie A, Clay F, Gensby U, Jennings PA, Hogg-Johnson S, Kristman V, Laberge M, McKenzie D, Newnam S, Palagyi A, Ruseckaite R, Sheppard DM, Shourie S, Steenstra I, Van Eerd D, Amick BC. Effectiveness of Workplace Interventions in Return-to-Work for Musculoskeletal, Pain-Related and Mental Health Conditions: An Update of the Evidence and Messages for Practitioners. JOURNAL OF OCCUPATIONAL REHABILITATION 2018; 28:1-15. [PMID: 28224415 PMCID: PMC5820404 DOI: 10.1007/s10926-016-9690-x] [Citation(s) in RCA: 227] [Impact Index Per Article: 37.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Purpose The objective of this systematic review was to synthesize evidence on the effectiveness of workplace-based return-to-work (RTW) interventions and work disability management (DM) interventions that assist workers with musculoskeletal (MSK) and pain-related conditions and mental health (MH) conditions with RTW. Methods We followed a systematic review process developed by the Institute for Work & Health and an adapted best evidence synthesis that ranked evidence as strong, moderate, limited, or insufficient. Results Seven electronic databases were searched from January 1990 until April 2015, yielding 8898 non-duplicate references. Evidence from 36 medium and high quality studies were synthesized on 12 different intervention categories across three broad domains: health-focused, service coordination, and work modification interventions. There was strong evidence that duration away from work from both MSK or pain-related conditions and MH conditions were significantly reduced by multi-domain interventions encompassing at least two of the three domains. There was moderate evidence that these multi-domain interventions had a positive impact on cost outcomes. There was strong evidence that cognitive behavioural therapy interventions that do not also include workplace modifications or service coordination components are not effective in helping workers with MH conditions in RTW. Evidence for the effectiveness of other single-domain interventions was mixed, with some studies reporting positive effects and others reporting no effects on lost time and work functioning. Conclusions While there is substantial research literature focused on RTW, there are only a small number of quality workplace-based RTW intervention studies that involve workers with MSK or pain-related conditions and MH conditions. We recommend implementing multi-domain interventions (i.e. with healthcare provision, service coordination, and work accommodation components) to help reduce lost time for MSK or pain-related conditions and MH conditions. Practitioners should also consider implementing these programs to help improve work functioning and reduce costs associated with work disability.
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Affiliation(s)
- K L Cullen
- Institute for Work & Health, 481 University Ave, Toronto, ON, M5G 2E9, Canada.
| | - E Irvin
- Institute for Work & Health, 481 University Ave, Toronto, ON, M5G 2E9, Canada
| | - A Collie
- Institute for Safety Compensation and Recovery Research, Monash University, Melbourne, VIC, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - F Clay
- Institute for Safety Compensation and Recovery Research, Monash University, Melbourne, VIC, Australia
| | - U Gensby
- National Centre for Occupational Rehabilitation, Rauland, Norway
- Team WorkingLife ApS, Copenhagen, Denmark
| | - P A Jennings
- Department of Community Emergency Health and Paramedic Practice, Monash University, Melbourne, VIC, Australia
| | - S Hogg-Johnson
- Institute for Work & Health, 481 University Ave, Toronto, ON, M5G 2E9, Canada
| | - V Kristman
- Institute for Work & Health, 481 University Ave, Toronto, ON, M5G 2E9, Canada
- Lakehead University, Thunder Bay, ON, Canada
| | - M Laberge
- University of Montreal and CHU Ste-Justine Research Centre, Montreal, QC, Canada
| | - D McKenzie
- Institute for Safety Compensation and Recovery Research, Monash University, Melbourne, VIC, Australia
| | - S Newnam
- Accident Research Centre, Monash University, Melbourne, VIC, Australia
| | - A Palagyi
- Institute for Safety Compensation and Recovery Research, Monash University, Melbourne, VIC, Australia
| | - R Ruseckaite
- Institute for Safety Compensation and Recovery Research, Monash University, Melbourne, VIC, Australia
| | - D M Sheppard
- Accident Research Centre, Monash University, Melbourne, VIC, Australia
| | - S Shourie
- Accident Research Centre, Monash University, Melbourne, VIC, Australia
| | - I Steenstra
- Institute for Work & Health, 481 University Ave, Toronto, ON, M5G 2E9, Canada
- Ted Rogers School of Management, Ryerson University, Toronto, ON, Canada
| | - D Van Eerd
- Institute for Work & Health, 481 University Ave, Toronto, ON, M5G 2E9, Canada
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada
| | - B C Amick
- Institute for Work & Health, 481 University Ave, Toronto, ON, M5G 2E9, Canada
- Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA
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29
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Rise MB, Skagseth M, Klevanger NE, Aasdahl L, Borchgrevink P, Jensen C, Tenggren H, Halsteinli V, Jacobsen TN, Løland SB, Johnsen R, Fimland MS. Design of a study evaluating the effects, health economics, and stakeholder perspectives of a multi-component occupational rehabilitation program with an added workplace intervention - a study protocol. BMC Public Health 2018; 18:219. [PMID: 29402253 PMCID: PMC5800096 DOI: 10.1186/s12889-018-5130-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Accepted: 01/30/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Recent research has suggested that interventions at the workplace might be the most potent ingredient in return to work interventions, but few studies have investigated the different effects of workplace interventions as part of occupational rehabilitation programs. The comprehensive design described in this article includes effect (on return to work and health outcomes), and health economic evaluations of a workplace intervention added to a multicomponent rehabilitation program. Qualitative and mixed method studies will investigate sick-listed persons', rehabilitation therapists' and employers' perspectives on the usability and outcomes of the rehabilitation program and the workplace intervention. The program and intervention are provided to patients with musculoskeletal, psychological or general and unspecified diagnoses. The program is multi-component and includes Acceptance and Commitment Therapy, physical exercise, patient education and creating a plan for increased work participation. METHODS Persons who are employed, aged from 18 to 60 years, with a current sick leave status of 50% or more and a diagnosis within the musculoskeletal, psychological or general and unspecified chapters of International Classification of Primary Care-2 (ICPC-2) will be recruited to a researcher-blinded parallel-group randomized controlled trial. All participants take part in an in-patient occupational rehabilitation program, while the intervention group also takes part in an intervention at the workplace. The effect and economic evaluation will investigate the effect of the added workplace intervention. The primary outcome measures will be time until full sustainable return to work and total number of sickness absence days in the 12 months after inclusion. Health economic evaluations will investigate the cost-effectiveness and cost-utility. Qualitative studies will investigate rehabilitation therapists' experiences with working towards return to work within an ACT-approach and stakeholders' experiences with the workplace intervention. A mixed methods study will combine quantitative and qualitative findings on the participants' expectations and motivation for return to work. DISCUSSION The outline of this comprehensive study could represent an important addition to the standard designs of return to work evaluation. The mixed methods design, with qualitative approaches as well as a rigorous randomized controlled trial, might prove useful to shed light on contextual factors. TRIAL REGISTRATION ClinicalTrials.gov : NCT02541890 . September 4, 2015.
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Affiliation(s)
- Marit B Rise
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway. .,Department of Mental Health, Norwegian University of Science and Technology, 7491, Trondheim, Norway.
| | - Martin Skagseth
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
| | - Nina E Klevanger
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
| | - Lene Aasdahl
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Physical Medicine and Rehabilitation, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Petter Borchgrevink
- Hysnes Rehabilitation Center, Trondheim University Hospital, Trondheim, Norway.,Department of Circulation and Medical Imaging, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Chris Jensen
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway.,National Centre for Occupational Rehabilitation, Rauland, Norway
| | - Hanne Tenggren
- Hysnes Rehabilitation Center, Trondheim University Hospital, Trondheim, Norway
| | - Vidar Halsteinli
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
| | - Trym N Jacobsen
- Department of Physical Medicine and Rehabilitation, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway.,Hysnes Rehabilitation Center, Trondheim University Hospital, Trondheim, Norway
| | - Svein B Løland
- Hysnes Rehabilitation Center, Trondheim University Hospital, Trondheim, Norway
| | - Roar Johnsen
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
| | - Marius S Fimland
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway.,Hysnes Rehabilitation Center, Trondheim University Hospital, Trondheim, Norway
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Pedersen P, Nielsen CV, Andersen MH, Langagergaard V, Boes A, Jensen OK, Jensen C, Labriola M. Comparing multidisciplinary and brief intervention in employees with different job relations on sick leave due to low back pain: protocol of a randomised controlled trial. BMC Public Health 2017; 17:959. [PMID: 29246257 PMCID: PMC5732442 DOI: 10.1186/s12889-017-4975-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Accepted: 12/05/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Low back pain (LBP) is a common problem that affects the lives of many individuals and is a frequent cause of sickness absence. To help this group of individuals resume work, several interventions have been studied. However, not all individuals may profit from the same intervention and the effect of a given intervention on return to work (RTW) may depend on their work situation. The aim of this study is to evaluate whether employees on sick leave due to LBP and with poor job relations will benefit more from a multidisciplinary intervention, while patients with strong job relations will benefit more from a brief intervention. METHODS The study is designed as a randomised controlled trial with up to five years of follow-up comparing brief intervention with brief intervention plus multidisciplinary intervention. Employees, aged 18-60 years, are included in the study from March 2011 to August 2016 if they have been on sick leave for 4-12 weeks due to LBP with or without radiculopathy. They are divided into two groups, a group with poor job relations and a group with strong job relations based on their answers in the baseline questionnaire. Each group is randomised 1:1 to receive the brief intervention or brief intervention plus multidisciplinary intervention. The brief intervention comprises a clinical examination and advice offered by a rheumatologist and a physiotherapist, whereas the supplementary multidisciplinary intervention comprises the assignment of a case manager who draws up a rehabilitation plan in collaboration with the participant and the multidisciplinary team. The primary outcome is duration of sickness absence measured by register data. Secondary outcomes include sustainable RTW and questionnaire-based measures of functional capacity. Outcomes will be assessed at one, two and five years of follow-up. DISCUSSION This trial will evaluate the effect of brief and multidisciplinary intervention on RTW and functional capacity among employees on sick leave due to LBP with poor or strong job relations. This will indicate whether work-related characteristics should be considered when providing treatment of LBP patients in the health care sector. TRIAL REGISTRATION Current Controlled Trials ISRCTN14136384 . Registered 4 August 2015.
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Affiliation(s)
| | - Claus Vinther Nielsen
- Section of Clinical Social Medicine and Rehabilitation, Department of Public Health, Aarhus University, P.P. Oerums Gade 11, 1B, Silkeborg, 8600, Aarhus, Denmark.,DEFACTUM, Central Denmark Region, Aarhus, Denmark
| | | | - Vivian Langagergaard
- Spine Center, Diagnostic Center, Silkeborg Regional Hospital, Silkeborg, Denmark.,Department of Clinical Social Medicine & Rehabilitation, The Regional Hospital West Jutland, Aarhus, Denmark
| | - Anders Boes
- Spine Center, Diagnostic Center, Silkeborg Regional Hospital, Silkeborg, Denmark
| | - Ole Kudsk Jensen
- Spine Center, Diagnostic Center, Silkeborg Regional Hospital, Silkeborg, Denmark
| | - Chris Jensen
- Department of Public Health and General Practice, Norwegian University of Science and Technology, NTNU, Trondheim, Norway.,National Advisory Unit on Occupational Rehabilitation, Rauland, Norway
| | - Merete Labriola
- Section of Clinical Social Medicine and Rehabilitation, Department of Public Health, Aarhus University, P.P. Oerums Gade 11, 1B, Silkeborg, 8600, Aarhus, Denmark.,DEFACTUM, Central Denmark Region, Aarhus, Denmark
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Gouin MM, Coutu MF, Durand MJ. Return-to-work success despite conflicts: an exploration of decision-making during a work rehabilitation program. Disabil Rehabil 2017; 41:523-533. [DOI: 10.1080/09638288.2017.1400592] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Marie-Michelle Gouin
- Department of Management and Human Resource Management, Management school, Université de Sherbrooke, Longueuil, Canada
| | - Marie-France Coutu
- Centre for Work Disability Prevention and Rehabilitation (CAPRIT), Charles-Le Moyne Hospital Research Centre affiliated with Université de Sherbrooke, Longueuil, Canada
| | - Marie-José Durand
- Centre for Work Disability Prevention and Rehabilitation (CAPRIT), Charles-Le Moyne Hospital Research Centre affiliated with Université de Sherbrooke, Longueuil, Canada
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Amick BC, Lee H, Hogg-Johnson S, Katz JN, Brouwer S, Franche RL, Bültmann U. How Do Organizational Policies and Practices Affect Return to Work and Work Role Functioning Following a Musculoskeletal Injury? JOURNAL OF OCCUPATIONAL REHABILITATION 2017; 27:393-404. [PMID: 27654622 DOI: 10.1007/s10926-016-9668-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Purpose Organizational-level policies and practices that promote safety leadership and practices, disability management and ergonomic policies and practices are considered key contextual determinants of return to work. Our objective was to examine the role of worker-reported organizational policies and practices (OPPs) in return to work (RTW) and work role functioning (WRF) and the mediating role of pain self-efficacy and work accommodation. Methods A worker cohort (n = 577) in Ontario, Canada was followed at 1, 6 and 12 months post injury. Both RTW (yes/no) and WRF (WLQ-16) status (3 levels) were measured. OPPs were measured (high vs. low) at 1 month post-injury. Pain self-efficacy (PSE) and work accommodation (WA) were included in mediation analyses. Results OPPs predicted RTW at 6 months (adjusted OR 1.77; 95 % CI 1.07-2.93) and 12 months (adjusted OR 2.07; 95 % CI 1.18-3.62). OPPs predicted WRF at 6 months, but only the transition from working with limitations to working without limitations (adjusted OR 3.21; 95 % CI 1.92-5.39). At 12 months, OPPs predicted both the transition from not working to working with and without limitations and from not working or working with limitations to working without limitations (adjusted OR 2.13; 95 % CI 1.37-3.30). Offers of WA mediated the relationship between OPPs and both RTW and WRF at 6 months follow-up. PSE mediated the relationship between OPPs and RTW and WRF at 6 months. At 12 months neither mediated the relationship. Conclusions The findings support worker-reported OPPs as key determinants of both RTW and WRF. These results point to the importance of WA and PSE in both RTW and WRF at 6 months.
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Affiliation(s)
- Benjamin C Amick
- Institute for Work and Health, Toronto, ON, Canada.
- Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th St., AHC-5-453, Miami, FL, 33199, USA.
| | - Hyunmi Lee
- Institute for Work and Health, Toronto, ON, Canada
| | - Sheilah Hogg-Johnson
- Institute for Work and Health, Toronto, ON, Canada
- Dalla Lana School of Public Health, Toronto, ON, Canada
| | | | - Sandra Brouwer
- Community and Occupational Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Renée-Louise Franche
- Institute for Work and Health, Toronto, ON, Canada
- WorkSafeBC, Vancouver, BC, Canada
| | - Ute Bültmann
- Community and Occupational Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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33
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Aasdahl L, Pape K, Vasseljen O, Johnsen R, Gismervik S, Jensen C, Fimland MS. Effects of Inpatient Multicomponent Occupational Rehabilitation versus Less Comprehensive Outpatient Rehabilitation on Somatic and Mental Health: Secondary Outcomes of a Randomized Clinical Trial. JOURNAL OF OCCUPATIONAL REHABILITATION 2017; 27:456-466. [PMID: 27815771 PMCID: PMC5591353 DOI: 10.1007/s10926-016-9679-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Purpose To evaluate effects on somatic and mental health of a multicomponent inpatient occupational rehabilitation program compared to a less comprehensive outpatient program in individuals on sick leave for musculoskeletal complaints or mental health disorders. Methods A randomized clinical trial with parallel groups. Participants were individuals on sick-leave for 2-12 months with a sick-leave diagnosis within the musculoskeletal, psychological or general and unspecified chapters of ICPC-2. Potential participants were identified in the Social Security System Registry. The multicomponent inpatient program (4 + 4 days) consisted of Acceptance and Commitment Therapy, physical training and work-related problem-solving including creating a return to work plan and a workplace visit if considered relevant. The comparative outpatient program consisted primarily of ACT (6 sessions during 6 weeks). Self-reported health-related quality of life, subjective health complaints, pain and anxiety and depression symptoms were assessed up to 12 months after the program. Results 168 individuals were randomized to the multicomponent inpatient program (n = 92) or the outpatient program (n = 76). Linear mixed models showed no statistically significant differences between the programs, except for slightly more reduced pain after the outpatient program. Conclusions This study presents no support that a 4 + 4 days multicomponent inpatient rehabilitation program is superior to a less comprehensive outpatient program, in improving health outcomes.
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Affiliation(s)
- Lene Aasdahl
- Department of Public Health and General Practice, Faculty of Medicine, NTNU, Norwegian University of Science and Technology, Trondheim, Norway.
| | - Kristine Pape
- Department of Public Health and General Practice, Faculty of Medicine, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
| | - Ottar Vasseljen
- Department of Public Health and General Practice, Faculty of Medicine, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
| | - Roar Johnsen
- Department of Public Health and General Practice, Faculty of Medicine, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
| | - Sigmund Gismervik
- Department of Public Health and General Practice, Faculty of Medicine, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Physical Medicine and Rehabilitation, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Chris Jensen
- Department of Public Health and General Practice, Faculty of Medicine, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
- National Center for Occupational Rehabilitation, Rauland, Norway
| | - Marius Steiro Fimland
- Department of Public Health and General Practice, Faculty of Medicine, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
- Hysnes Rehabilitation Center, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
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Hara KW, Borchgrevink PC, Jacobsen HB, Fimland MS, Rise MB, Gismervik S, Woodhouse A. Transdiagnostic group-based occupational rehabilitation for participants with chronic pain, chronic fatigue and common mental disorders. A feasibility study. Disabil Rehabil 2017; 40:2516-2526. [DOI: 10.1080/09638288.2017.1339298] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Karen Walseth Hara
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
- Norwegian Advisory Unit on Complex Symptom Disorders, St. University Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Petter Christian Borchgrevink
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
- Norwegian Advisory Unit on Complex Symptom Disorders, St. University Hospital, Trondheim University Hospital, Trondheim, Norway
- Hysnes Rehabilitation Center, St. University Hospital, Trondheim, Norway
| | - Henrik Børsting Jacobsen
- Norwegian Advisory Unit on Complex Symptom Disorders, St. University Hospital, Trondheim University Hospital, Trondheim, Norway
- Hysnes Rehabilitation Center, St. University Hospital, Trondheim, Norway
| | - Marius Steiro Fimland
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
- Hysnes Rehabilitation Center, St. University Hospital, Trondheim, Norway
| | - Marit By Rise
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Mental Health, Faculty of Medicine and Health Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Sigmund Gismervik
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Physical Medicine and Rehabilitation, St. University Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Astrid Woodhouse
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
- Norwegian Advisory Unit on Complex Symptom Disorders, St. University Hospital, Trondheim University Hospital, Trondheim, Norway
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Marin TJ, Van Eerd D, Irvin E, Couban R, Koes BW, Malmivaara A, van Tulder MW, Kamper SJ. Multidisciplinary biopsychosocial rehabilitation for subacute low back pain. Cochrane Database Syst Rev 2017; 6:CD002193. [PMID: 28656659 PMCID: PMC6481490 DOI: 10.1002/14651858.cd002193.pub2] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Low back pain (LBP) is associated with enormous personal and societal burdens, especially when it reaches the chronic stage of the disorder (pain for a duration of more than three months). Indeed, individuals who reach the chronic stage tend to show a more persistent course, and they account for the majority of social and economic costs. As a result, there is increasing emphasis on the importance of intervening at the early stages of LBP.According to the biopsychosocial model, LBP is a condition best understood with reference to an interaction of physical, psychological, and social influences. This has led to the development of multidisciplinary biopsychosocial rehabilitation (MBR) programs that target factors from the different domains, administered by healthcare professionals from different backgrounds.This review is an update of a Cochrane Review on MBR for subacute LBP, which was published in 2003. It is part of a series of reviews on MBR for musculoskeletal pain published by the Cochrane Back and Neck Group and the Cochrane Musculoskeletal Group. OBJECTIVES To examine the effectiveness of MBR for subacute LBP (pain for a duration of six to 12 weeks) among adults, with a focus on pain, back-specific disability, and work status. SEARCH METHODS We searched for relevant trials in any language by a computer-aided search of CENTRAL, MEDLINE, Embase, CINAHL, PsycINFO and two trials registers. Our search is current to 13 July 2016. SELECTION CRITERIA We included randomised controlled trials (RCTs) of adults with subacute LBP. We included studies that investigated a MBR program compared to any type of control intervention. We defined MBR as an intervention that included a physical component (e.g. pharmacological, physical therapy) in combination with either a psychological, social, or occupational component (or any combination of these). We also required involvement of healthcare professionals from at least two different clinical backgrounds with appropriate training to deliver the component for which they were responsible. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. In particular, the data extraction and 'risk of bias' assessment were conducted by two people, independently. We used the Cochrane tool to assess risk of bias and the GRADE approach to assess the overall quality of the evidence for each outcome. MAIN RESULTS We included a total of nine RCTs (981 participants) in this review. Five studies were conducted in Europe and four in North America. Sample sizes ranged from 33 to 351. The mean age across trials ranged between 32.0 and 43.7 years.All included studies were judged as having high risk of performance bias and high risk of detection bias due to lack of blinding, and four of the nine studies suffered from at least one additional source of possible bias.In MBR compared to usual care for subacute LBP, individuals receiving MBR had less pain (four studies with 336 participants; SMD -0.46, 95% CI -0.70 to -0.21, moderate-quality of evidence due to risk of bias) and less disability (three studies with 240 participants; SMD -0.44, 95% CI -0.87 to -0.01, low-quality of evidence due to risk of bias and inconsistency), as well as increased likelihood of return-to-work (three studies with 170 participants; OR 3.19, 95% CI 1.46 to 6.98, very low-quality of evidence due to serious risk of bias and imprecision) and fewer sick leave days (two studies with 210 participants; SMD -0.38 95% CI -0.66 to -0.10, low-quality of evidence due to risk of bias and imprecision) at 12-month follow-up. The effect sizes for pain and disability were low in terms of clinical meaningfulness, whereas effects for work-related outcomes were in the moderate range.However, when comparing MBR to other treatments (i.e. brief intervention with features from a light mobilization program and a graded activity program, functional restoration, brief clinical intervention including education and advice on exercise, and psychological counselling), we found no differences between the groups in terms of pain (two studies with 336 participants; SMD -0.14, 95% CI -0.36 to 0.07, low-quality evidence due to imprecision and risk of bias), functional disability (two studies with 345 participants; SMD -0.03, 95% CI -0.24 to 0.18, low-quality evidence due to imprecision and risk of bias), and time away from work (two studies with 158 participants; SMD -0.25 95% CI -0.98 to 0.47, very low-quality evidence due to serious imprecision, inconsistency and risk of bias). Return-to-work was not reported in any of the studies.Although we looked for adverse events in both comparisons, none of the included studies reported this outcome. AUTHORS' CONCLUSIONS On average, people with subacute LBP who receive MBR will do better than if they receive usual care, but it is not clear whether they do better than people who receive some other type of treatment. However, the available research provides mainly low to very low-quality evidence, thus additional high-quality trials are needed before we can describe the value of MBP for clinical practice.
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Affiliation(s)
- Teresa J Marin
- York UniversityDepartment of Psychology209 Behavioural Sciences Building4700 Keele StreetTorontoONCanadaM3J 1P3
| | - Dwayne Van Eerd
- Institute for Work & Health481 University Avenue, Suite 800TorontoONCanadaM5G 2E9
| | - Emma Irvin
- Institute for Work & Health481 University Avenue, Suite 800TorontoONCanadaM5G 2E9
| | - Rachel Couban
- McMaster UniversityDepartment of Anesthesiology1280 Main Street WestHamiltonONCanadaL8S 4K1
| | - Bart W Koes
- Erasmus Medical CenterDepartment of General PracticePO Box 2040RotterdamNetherlands3000 CA
| | - Antti Malmivaara
- National Institute for Health and Welfare (THL)Centre for Health and Social Economics (CHESS)PO Box 30Mannerheimintie 166HelsinkiFinlandFI‐00271
| | - Maurits W van Tulder
- VU University AmsterdamDepartment of Health Sciences, Faculty of Earth and Life SciencesPO Box 7057Room U454AmsterdamNetherlands1007 MB
| | - Steven J Kamper
- The George Institute for Global HealthMusculoskeletal DivisionPO Box M201Missenden Road, CamperdownSydneyNSWAustralia2050
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Cochrane A, Higgins NM, FitzGerald O, Gallagher P, Ashton J, Corcoran O, Desmond D. Early interventions to promote work participation in people with regional musculoskeletal pain: a systematic review and meta-analysis. Clin Rehabil 2017; 31:1466-1481. [DOI: 10.1177/0269215517699976] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives: To determine the effectiveness of early multidisciplinary interventions in promoting work participation and reducing work absence in adults with regional musculoskeletal pain. Data sources: Seven databases (CENTRAL, CINAHL, EMBASE, MEDLINE, Scopus, OT Seeker, PEDro; 1990 to December 2016) were searched for eligible studies. Review methods: Trials were included if they reported on work-based outcomes for participants experiencing difficulties at work or ≤ three months’ sick leave. Interventions had to include two or more elements of the biopsychosocial model delivered as a coordinated programme. Quality was assessed using the GRADE criteria. Results were analysed by hazard ratios for return to work data; continuous outcomes were analysed as standardised mean difference with 95% confidence intervals. Results: A total of 20 randomized controlled trials, with 16,319 participants were included; the interventions were grouped according to their main components for meta-analyses. At 12-months follow-up, moderate quality evidence suggests that programmes involving a stepped care approach (four studies) were more effective than the comparisons in promoting return to work (hazard ratio (HR) 1.29 (95% confidence interval (CI) 1.03 to 1.61), p = 0.03), whereas case management (two studies) was not (HR 0.92 (95% CI 0.69 to 1.24), p = 0.59). Analyses suggested limited effectiveness in reducing sickness absences, in pain reduction or functional improvement across the intervention categories. Conclusion: There is uncertainty as to the effectiveness of early multicomponent interventions owing to the clinical heterogeneity and varying health and social insurance systems across the trials.
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Affiliation(s)
- Andy Cochrane
- Department of Psychology, Maynooth University, Maynooth, Ireland
| | - Niamh M Higgins
- Department of Psychology, Maynooth University, Maynooth, Ireland
| | - Oliver FitzGerald
- School of Medicine and Medical Sciences, University College Dublin, Dublin, Ireland
| | - Pamela Gallagher
- School of Nursing and Human Sciences, Dublin City University, Dublin, Ireland
| | | | - Oriel Corcoran
- Rheumatology Services, Waterford Regional Hospital, Waterford, Ireland
| | - Deirdre Desmond
- Department of Psychology, Maynooth University, Maynooth, Ireland
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Brendbekken R, Eriksen HR, Grasdal A, Harris A, Hagen EM, Tangen T. Return to Work in Patients with Chronic Musculoskeletal Pain: Multidisciplinary Intervention Versus Brief Intervention: A Randomized Clinical Trial. JOURNAL OF OCCUPATIONAL REHABILITATION 2017; 27:82-91. [PMID: 26910406 PMCID: PMC5306180 DOI: 10.1007/s10926-016-9634-5] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
OBJECTIVE This randomized clinical trial was performed to compare the effect of a new multidisciplinary intervention (MI) programme to a brief intervention (BI) programme on return to work (RTW), fully and partly, at a 12-month and 24-month follow-up in patients on long-term sick leave due to musculoskeletal pain. METHODS Patients (n = 284, mean age 41.3 years, 53.9 % women) who were sick-listed with musculoskeletal pain and referred to a specialist clinic in physical rehabilitation were randomized to MI (n = 141) or BI (n = 143). The MI included the use of a visual educational tool, which facilitated patient-therapist communication and self-management. The MI also applied one more profession, more therapist time and a comprehensive focus on the psychosocial factors, particularly the working conditions, compared to a BI. The main features of the latter are a thorough medical, educational examination, a brief cognitive assessment based on the non-injury model, and a recommendation to return to normal activity as soon as possible. RESULTS The number of patients with full-time RTW developed similarly in the two groups. The patients receiving MI had a higher probability to partly RTW during the first 7 months of the follow-up compared to the BI-group. CONCLUSIONS There were no differences between the groups on full-time RTW during the 24 months. However, the results indicate that MI hastens the return to work process in long-term sick leave through the increased use of partial sick leave. TRIAL REGISTRATION http://www.clinicaltrials.gov with the registration number NCT01346423.
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Affiliation(s)
- Randi Brendbekken
- Department of Physical Medicine and Rehabilitation, Innlandet Hospital Trust, Ottestad, Norway.
| | - Hege R Eriksen
- Department of Sport and Physical Activity, Bergen University College, Uni Research Health, Bergen, Norway
| | - Astrid Grasdal
- Department of Economics, University of Bergen, Bergen, Norway
| | - Anette Harris
- Department of Psychosocial Science, Faculty of Psychology, University of Bergen, Bergen, Norway
| | - Eli M Hagen
- Department of Physical Medicine and Rehabilitation, Innlandet Hospital Trust, Ottestad, Norway
| | - Tone Tangen
- Department of Clinical Medicine, Haukeland University Hospital, University of Bergen, Bergen, Norway
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Donovan M, Khan A, Johnston V. The Effect of a Workplace-Based Early Intervention Program on Work-Related Musculoskeletal Compensation Outcomes at a Poultry Meat Processing Plant. JOURNAL OF OCCUPATIONAL REHABILITATION 2017; 27:24-34. [PMID: 26880190 DOI: 10.1007/s10926-016-9628-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
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.
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Affiliation(s)
- Michael Donovan
- Division of Physiotherapy, The University of Queensland, Brisbane, QLD, 4072, Australia.
| | - Asaduzzaman Khan
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, 4072, Australia
| | - Venerina Johnston
- Division of Physiotherapy, The University of Queensland, Brisbane, QLD, 4072, Australia
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Ståhl C, Costa-Black K, Loisel P. Applying theories to better understand socio-political challenges in implementing evidence-based work disability prevention strategies. Disabil Rehabil 2017; 40:952-959. [DOI: 10.1080/09638288.2016.1277399] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Christian Ståhl
- Department of Medical and Health Sciences, Division of Community Medicine, Linköping University, Linköping, Sweden
- HELIX Competence Centre, Linköping University, Linköping, Sweden
| | - Katia Costa-Black
- School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, Pretoria, Republic of South Africa
| | - Patrick Loisel
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Canadian Memorial Chiropractic College, Toronto, Canada
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Williams-Whitt K, Bültmann U, Amick B, Munir F, Tveito TH, Anema JR. Workplace Interventions to Prevent Disability from Both the Scientific and Practice Perspectives: A Comparison of Scientific Literature, Grey Literature and Stakeholder Observations. JOURNAL OF OCCUPATIONAL REHABILITATION 2016; 26:417-433. [PMID: 27614465 PMCID: PMC5104758 DOI: 10.1007/s10926-016-9664-z] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Purpose The significant individual and societal burden of work disability could be reduced if supportive workplace strategies could be added to evidence-based clinical treatment and rehabilitation to improve return-to-work (RTW) and other disability outcomes. The goal of this article is to summarize existing research on workplace interventions to prevent disability, relate these to employer disability management practices, and recommend future research priorities. Methods The authors participated in a year-long collaboration that ultimately led to an invited 3-day conference, Improving Research of Employer Practices to Prevent Disability, held October 14-16, 2015, in Hopkinton, Massachusetts, USA. The collaboration included a topical review of the literature, group conference calls to identify key areas and challenges, drafting of initial documents, review of industry publications, and a conference presentation that included feedback from peer researchers and a question/answer session with an expert panel with direct employer experience. Results Evidence from randomized trials and other research designs has shown general support for job modification, RTW coordination, and organizational support, but evidence is still lacking for interventions at a more granular level. Grey literature reports focused mainly on job re-design and work organization. Panel feedback focused on organizational readiness and the beliefs and values of senior managers as critical factors in facilitating changes to disability management practices. While the scientific literature is focused on facilitating improved coping and reducing discomforts for individual workers, the employer-directed grey literature is focused on making group-level changes to policies and procedures. Conclusions Future research might better target employer practices by tying interventions to positive workplace influences and determinants, by developing more participatory interventions and research designs, and by designing interventions that address factors of organizational change.
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Affiliation(s)
- Kelly Williams-Whitt
- University of Lethbridge, 4401 University Drive, Lethbridge, AB, T1K 3M4, Canada.
| | - Ute Bültmann
- University Medical Center Groningen, Community and Occupational Medicine, University of Groningen, Groningen, The Netherlands
| | - Benjamin Amick
- Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA
- Institute for Work and Health, Toronto, Canada
| | - Fehmidah Munir
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, Leicestershire, UK
| | - Torill H Tveito
- Uni Research Health, Bergen, Norway
- Department of Health Promotion, University College of Southeast Norway, Horten, Norway
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41
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Abstract
The scientific evidence on the causes for sick leave attributed to back and neck disorders was reviewed. Categories were established for acute, recurring, and chronic problems based on the duration of the sick leave period. Forty-eight articles were found to be relevant, whereof two were of high quality and 26 were of medium or low quality. Quality was assessed exclusively in relation to the aim of this systematic review. The results reveal limited published research on causes for sick leave from back and neck disorders. The generalisability of the findings is also limited since most of the subjects were men and employees in manufacturing industries. Women, white-collar workers, employees in the public sector (care, social services, schools, etc) were underrepresented in the studies. Hence, these groups and areas should be studied further to verify conclusions and enhance knowledge about the causes for sick leave from back and neck disorders. The following factors were found to have consistent, but limited, support as regards their influence on the risk for sick leave due to back and neck disorders: (a) heavy physical workload, bent or twisted working position, and low work satisfaction increases the risk for short-term and long-term sick leave; (b) specific back diagnoses and previous sick leave due to back disorders increases the risk for short-term and long-term sick leave; (c) female gender, smoking, exposure to vibration, and deficient social support were not found to significantly increase the risk for short-term and long-term sick leave; (d) self-reported pain and functional impairments were associated with a high risk for long-term sick leave; (e) longer employment periods reduced the risk for short-term sick leave; (f) perceived demands at work did not influence short-term sick leave; (g) female gender and higher age increases the risk for disability pension.
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Affiliation(s)
- Tommy Hansson
- Medical Faculty, Sahlgrenska Academy, Göteborg University, Göteborg, Sweden.
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42
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Snook SH. The Role of Ergonomics in Reducing Low Back Pain and Disability in the Workplace. ACTA ACUST UNITED AC 2016. [DOI: 10.1177/154193120504901416] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Low back pain is a common problem, an expensive problem, and a recurring problem. In this paper, the problem is defined, the available evidence is reviewed, and three types of interventions are discussed. The interventions are job design, changing personal behavior and beliefs, and secondary intervention to reduce the disability. Ergonomics plays an important role in each of the interventions. Although low back pain cannot be completely prevented, the evidence indicates that it can be reduced and managed with considerable success.
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Affiliation(s)
- Stover H. Snook
- Department of Environmental Health Harvard School of Public Health Boston, Massachusetts
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43
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Abstract
Occupational therapists can play a major role in the work rehabilitation process through the assessment and rehabilitation of clients for a return to work (Gibson and Strong 2003). The challenge facing the occupational therapist is identifying if the client's current functional abilities are a suitable match for the demands of the job. Ideally, the occupational therapist should assess the demands of the job that the client is required to perform as well as completing an assessment of the client's work abilities. The purpose of this opinion piece is to highlight to occupational therapists the importance of job analysis in all specialties within vocational rehabilitation and to illustrate the process used by the occupational therapists in the Occupational Health and Safety Advisory Service.
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45
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Kraaijeveld RA, Schaafsma FG, Ketelaar SM, Boot CRL, Bültmann U, Anema JR. Implementation of the participatory approach for supervisors to prevent sick leave: a process evaluation. Int Arch Occup Environ Health 2016; 89:847-56. [PMID: 26970753 PMCID: PMC4871914 DOI: 10.1007/s00420-016-1118-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Accepted: 01/25/2016] [Indexed: 11/29/2022]
Abstract
Purpose To perform a process evaluation of a multifaceted strategy to implement the participatory approach for supervisors to prevent sick leave in three organisations. Methods The implementation strategy incorporated a working group meeting with stakeholder representatives, supervisor training, and optional supervisor coaching. Context, recruitment, reach, dose delivered, dose received, fidelity, and satisfaction with the strategy were assessed at organisational and supervisor level using questionnaires and registration forms. Results At least 4 out of 6 stakeholders were represented in the working group meetings, and 11 % (n = 116) of supervisors could be reached. The working group meetings and supervisor training were delivered and received as planned and were well appreciated within all three organisations. Three supervisors made use of coaching. At 6-month follow-up, 11 out of 41 supervisors (27 %) indicated that they had applied the participatory approach at least one time. Conclusion The implementation strategy was largely carried out as intended. However, reach of both supervisors and department managers should be improved. Future studies should consider targeting employees with the strategy.
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Affiliation(s)
- R A Kraaijeveld
- Department of Public and Occupational Health, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - F G Schaafsma
- Department of Public and Occupational Health, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands. .,Research Center for Insurance Medicine, Collaboration Between AMC-UMCG-UWV-VUmc, Amsterdam, The Netherlands.
| | - S M Ketelaar
- Department of Public and Occupational Health, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - C R L Boot
- Department of Public and Occupational Health, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.,Body@Work, Research Center Physical Activity, Work and Health, TNO-VU University Medical Center, Amsterdam, The Netherlands
| | - U Bültmann
- Department of Health Sciences, Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - J R Anema
- Department of Public and Occupational Health, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.,Research Center for Insurance Medicine, Collaboration Between AMC-UMCG-UWV-VUmc, Amsterdam, The Netherlands
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46
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Self-Reported Poor Work Ability--An Indicator of Need for Rehabilitation? A Cross-Sectional Study of a Sample of German Employees. Am J Phys Med Rehabil 2016; 94:958-66. [PMID: 25888659 DOI: 10.1097/phm.0000000000000281] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The purpose of this study was to assess associations of self-reported work ability as measured by the Work Ability Index (WAI) with modifiable behavioral and occupational health risks, health service utilization, and intended rehabilitation and pension requests. DESIGN This is a cross-sectional study of a random sample of German employees aged 40-54 yrs on sickness benefits in 2012 (trial registration: DRKS00004824). RESULTS In total, 1312 male and 1502 female employees were included in the analyses. Low WAI scores (i.e., <37 points) were associated with a higher prevalence of occupational and behavioral health risks; a higher likelihood of frequent visits to general, somatic, and psychologic specialists as well as hospital stays; and four to six times higher risks of intended rehabilitation and pension requests. A two-item version of the WAI was as strongly associated with intended rehabilitation and pension requests as the total score. CONCLUSIONS This study indicates that the WAI is a sensitive screening tool to identify workers on sick leave with a probable need for rehabilitation. The WAI could support the assessment of need for rehabilitation by occupational health services in return-to-work strategies, which include the opportunity to access multiprofessional rehabilitation.
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Rise MB, Gismervik SØ, Johnsen R, Fimland MS. Sick-listed persons' experiences with taking part in an in-patient occupational rehabilitation program based on Acceptance and Commitment Therapy: a qualitative focus group interview study. BMC Health Serv Res 2015; 15:526. [PMID: 26613944 PMCID: PMC4662815 DOI: 10.1186/s12913-015-1190-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Accepted: 11/18/2015] [Indexed: 11/24/2022] Open
Abstract
Background Occupational medicine has shifted emphasis from disease treatment to disability rehabilitation and management. Hence, newly developed occupational rehabilitation programs are often generic and multicomponent, aiming to influence the sick-listed persons’ perception on return to work, and thereby support the return to work process. The aim of this study was to explore sick-listed persons’ experiences with taking part in an in-patient occupational rehabilitation program based on Acceptance and Commitment Therapy. Methods Twenty-nine adults on sickness benefit or work assessment allowance due to musculoskeletal and/or common mental health disorders participated in this study. They were interviewed in focus groups at the beginning and at the end of a 3.5 week inpatient group-based occupational rehabilitation program in Central Norway. Key elements in the program were Acceptance and Commitment Therapy (ACT), physical exercise and creating a work-participation plan. The program was mainly group-based including participants with different diagnoses. Data was analyzed according to a phenomenological approach. Results At the start of the program most participants expressed frustration regarding being sick-listed, external anticipations as well as hindrances towards returning to work, and described hope that the program would provide them with the skills and techniques necessary to cope with health problems and being able to return to work. At the end of the program the participants described that they had embarked upon a long process of increased awareness. This process encompassed four areas; an increased awareness of what was important in life, realizing the strain from external expectations and demands, a need to balance different aspects of life, and return to work as part of a long and complex process. Conclusions The occupational rehabilitation program induced a perceived meaningful reorientation encompassing several aspects of life. However, the return to work process was described as diffuse and uncertain for most participants. The providers of occupational rehabilitation program should balance this reorientation with specific steps towards return to work. Effect studies and long-term qualitative studies evaluating how this affects long-term work- and health outcomes are underway.
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Affiliation(s)
- Marit B Rise
- Department of Public Health and General Practice, Norwegian University of Science and Technology, Trondheim, Norway.
| | - Sigmund Ø Gismervik
- Department of Public Health and General Practice, Norwegian University of Science and Technology, Trondheim, Norway. .,Department of Physical Medicine and Rehabilitation, St. Olav's University Hospital, Trondheim, Norway.
| | - Roar Johnsen
- Department of Public Health and General Practice, Norwegian University of Science and Technology, Trondheim, Norway.
| | - Marius S Fimland
- Department of Public Health and General Practice, Norwegian University of Science and Technology, Trondheim, Norway. .,Hysnes Rehabilitation Center, St. Olav's University Hospital, Trondheim, Norway.
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48
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Ramond-Roquin A, Bouton C, Bègue C, Petit A, Roquelaure Y, Huez JF. Psychosocial Risk Factors, Interventions, and Comorbidity in Patients with Non-Specific Low Back Pain in Primary Care: Need for Comprehensive and Patient-Centered Care. Front Med (Lausanne) 2015; 2:73. [PMID: 26501062 PMCID: PMC4597113 DOI: 10.3389/fmed.2015.00073] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Accepted: 09/22/2015] [Indexed: 12/19/2022] Open
Abstract
Non-specific low back pain (LBP) affects many people and has major socio-economic consequences. Traditional therapeutic strategies, mainly focused on biomechanical factors, have had moderate and short-term impact. Certain psychosocial factors have been linked to poor prognosis of LBP and they are increasingly considered as promising targets for management of LBP. Primary health care providers (HCPs) are involved in most of the management of people with LBP and they are skilled in providing comprehensive care, including consideration of psychosocial dimensions. This review aims to discuss three pieces of recent research focusing on psychosocial issues in LBP patients in primary care. In the first systematic review, the patients' or HCPs' overall judgment about the likely evolution of LBP was the factor most strongly linked to poor outcome, with predictive validity similar to that of multidimensional scales. This result may be explained by the implicit aggregation of many prognostic factors underlying this judgment and suggests the relevance of considering the patients from biopsychosocial and longitudinal points of view. The second review showed that most of the interventions targeting psychosocial factors in LBP in primary care have to date focused on the cognitive-behavioral factors, resulting in little impact. It is unlikely that any intervention focusing on a single factor would ever fit the needs of most patients; interventions targeting determinants from several fields (mainly psychosocial, biomechanical, and occupational) may be more relevant. Should multiple stakeholders be involved in such interventions, enhanced interprofessional collaboration would be critical to ensure the delivery of coordinated care. Finally, in the third study, the prevalence of psychosocial comorbidity in chronic LBP patients was not found to be significantly higher than in other patients consulting in primary care. Rather than specifically screening for psychosocial conditions, this suggests taking into account any potential comorbidity in patients with chronic LBP, as in other patients. All these results support the adoption of a more comprehensive and patient-centered approach when dealing with patients with LBP in primary care. As this condition is illustrative of many situations encountered in primary care, the strategies proposed here may benefit most patients consulting in this setting.
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Affiliation(s)
- Aline Ramond-Roquin
- Department of General Practice, University of Angers, L’Université Nantes Angers Le Mans, Angers, France
- Laboratory of Ergonomics and Epidemiology in Occupational Health, University of Angers, L’Université Nantes Angers Le Mans, Angers, France
| | - Céline Bouton
- Laboratory of Ergonomics and Epidemiology in Occupational Health, University of Angers, L’Université Nantes Angers Le Mans, Angers, France
- Department of General Practice, University of Nantes, L’Université Nantes Angers Le Mans, Nantes, France
| | - Cyril Bègue
- Department of General Practice, University of Angers, L’Université Nantes Angers Le Mans, Angers, France
- Laboratory of Ergonomics and Epidemiology in Occupational Health, University of Angers, L’Université Nantes Angers Le Mans, Angers, France
| | - Audrey Petit
- Laboratory of Ergonomics and Epidemiology in Occupational Health, University of Angers, L’Université Nantes Angers Le Mans, Angers, France
- Department of Occupational Health, University Hospital of Angers, Angers, France
| | - Yves Roquelaure
- Laboratory of Ergonomics and Epidemiology in Occupational Health, University of Angers, L’Université Nantes Angers Le Mans, Angers, France
- Department of Occupational Health, University Hospital of Angers, Angers, France
| | - Jean-François Huez
- Department of General Practice, University of Angers, L’Université Nantes Angers Le Mans, Angers, France
- Laboratory of Ergonomics and Epidemiology in Occupational Health, University of Angers, L’Université Nantes Angers Le Mans, Angers, France
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van Vilsteren M, van Oostrom SH, de Vet HCW, Franche R, Boot CRL, Anema JR. Workplace interventions to prevent work disability in workers on sick leave. Cochrane Database Syst Rev 2015; 2015:CD006955. [PMID: 26436959 PMCID: PMC9297123 DOI: 10.1002/14651858.cd006955.pub3] [Citation(s) in RCA: 126] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Work disability has serious consequences for individuals as well as society. It is possible to facilitate resumption of work by reducing barriers to return to work (RTW) and promoting collaboration with key stakeholders. This review was first published in 2009 and has now been updated to include studies published up to February 2015. OBJECTIVES To determine the effectiveness of workplace interventions in preventing work disability among sick-listed workers, when compared to usual care or clinical interventions. SEARCH METHODS We searched the Cochrane Work Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, and PsycINFO databases on 2 February 2015. SELECTION CRITERIA We included randomised controlled trials (RCTs) of workplace interventions that aimed to improve RTW for disabled workers. We only included studies where RTW or conversely sickness absence was reported as a continuous outcome. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data and assessed risk of bias of the studies. We performed meta-analysis where possible, and we assessed the quality of evidence according to GRADE criteria. We used standard methodological procedures expected by Cochrane. MAIN RESULTS We included 14 RCTs with 1897 workers. Eight studies included workers with musculoskeletal disorders, five workers with mental health problems, and one workers with cancer. We judged six studies to have low risk of bias for the outcome sickness absence.Workplace interventions significantly improved time until first RTW compared to usual care, moderate-quality evidence (hazard ratio (HR) 1.55, 95% confidence interval (CI) 1.20 to 2.01). Workplace interventions did not considerably reduce time to lasting RTW compared to usual care, very low-quality evidence (HR 1.07, 95% CI 0.72 to 1.57). The effect on cumulative duration of sickness absence showed a mean difference of -33.33 (95% CI -49.54 to -17.12), favouring the workplace intervention, high-quality evidence. One study assessed recurrences of sick leave, and favoured usual care, moderate-quality evidence (HR 0.42, 95% CI 0.21 to 0.82). Overall, the effectiveness of workplace interventions on work disability showed varying results.In subgroup analyses, we found that workplace interventions reduced time to first and lasting RTW among workers with musculoskeletal disorders more than usual care (HR 1.44, 95% CI 1.15 to 1.82 and HR 1.77, 95% CI 1.37 to 2.29, respectively; both moderate-quality evidence). In studies of workers with musculoskeletal disorders, pain also improved (standardised mean difference (SMD) -0.26, 95% CI -0.47 to -0.06), as well as functional status (SMD -0.33, 95% CI -0.58 to -0.08). In studies of workers with mental health problems, there was a significant improvement in time until first RTW (HR 2.64, 95% CI 1.41 to 4.95), but no considerable reduction in lasting RTW (HR 0.79, 95% CI 0.54 to 1.17). One study of workers with cancer did not find a considerable reduction in lasting RTW (HR 0.88, 95% CI 0.53 to 1.47).In another subgroup analysis, we did not find evidence that offering a workplace intervention in combination with a cognitive behavioural intervention (HR 1.93, 95% CI 1.27 to 2.93) is considerably more effective than offering a workplace intervention alone (HR 1.35, 95% CI 1.01 to 1.82, test for subgroup differences P = 0.17).Workplace interventions did not considerably reduce time until first RTW compared with a clinical intervention in workers with mental health problems in one study (HR 2.65, 95% CI 1.42 to 4.95, very low-quality evidence). AUTHORS' CONCLUSIONS We found moderate-quality evidence that workplace interventions reduce time to first RTW, high-quality evidence that workplace interventions reduce cumulative duration of sickness absence, very low-quality evidence that workplace interventions reduce time to lasting RTW, and moderate-quality evidence that workplace interventions increase recurrences of sick leave. Overall, the effectiveness of workplace interventions on work disability showed varying results. Workplace interventions reduce time to RTW and improve pain and functional status in workers with musculoskeletal disorders. We found no evidence of a considerable effect of workplace interventions on time to RTW in workers with mental health problems or cancer.We found moderate-quality evidence to support workplace interventions for workers with musculoskeletal disorders. The quality of the evidence on the effectiveness of workplace interventions for workers with mental health problems and cancer is low, and results do not show an effect of workplace interventions for these workers. Future research should expand the range of health conditions evaluated with high-quality studies.
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Affiliation(s)
- Myrthe van Vilsteren
- VU University Medical CenterDepartment of Public and Occupational Health, EMGO Institute for Health and Care ResearchPO Box 7057AmsterdamNetherlands1007 MB
| | - Sandra H van Oostrom
- National Institute for Public Health and the EnvironmentCentre for Nutrition, Prevention and Health ServicesBilthovenNetherlands
| | - Henrica CW de Vet
- VU University Medical CenterDepartment of Epidemiology and Biostatistics, EMGO Institute for Health and Care ResearchPO Box 7057AmsterdamNetherlands1007 MB
| | | | - Cécile RL Boot
- EMGO Institute for Health and Care Research, VU University Medical CenterDepartment of Public and Occupational HealthAmsterdamNetherlands
| | - Johannes R Anema
- VU University Medical CenterDepartment of Public and Occupational Health, EMGO Institute for Health and Care ResearchPO Box 7057AmsterdamNetherlands1007 MB
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50
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Somville P, Mairiaux P. Incapacité de travail prolongée. Revue des facteurs de risque professionnels et des stratégies d’intervention. ARCH MAL PROF ENVIRO 2015. [DOI: 10.1016/j.admp.2015.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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