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Ruhle SA, Breitsohl H, Aboagye E, Baba V, Biron C, Correia Leal C, Dietz C, Ferreira AI, Gerich J, Johns G, Karanika-Murray M, Lohaus D, Løkke A, Lopes SL, Martinez LF, Miraglia M, Muschalla B, Poethke U, Sarwat N, Schade H, Steidelmüller C, Vinberg S, Whysall Z, Yang T. “To work, or not to work, that is the question” – Recent trends and avenues for research on presenteeism. EUROPEAN JOURNAL OF WORK AND ORGANIZATIONAL PSYCHOLOGY 2019. [DOI: 10.1080/1359432x.2019.1704734] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- S. A. Ruhle
- Faculty of Business Administration and Economics, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - H. Breitsohl
- Human Resources, Leadership, and Organization, University of Klagenfurt, Klagenfurt, Austria
| | - E. Aboagye
- Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden
| | - V. Baba
- DeGroote School of Business, McMaster University, Hamilton, Canada
| | - C. Biron
- Department of Management, Laval University, Québec, Canada
| | - C. Correia Leal
- Business Research Unit (BRU-IUL), Instituto Universitário de Lisboa (ISCTE-IUL), Lisbon, Portugal
| | - C. Dietz
- Faculty of Life Sciences, Leipzig University, Leipzig, Germany
| | - A. I. Ferreira
- Business Research Unit (BRU-IUL), Instituto Universitário de Lisboa (ISCTE-IUL), Lisbon, Portugal
| | - J. Gerich
- Institute for Sociology, Johannes Kepler Universitat Linz, Linz, Austria
| | - G. Johns
- John Molson School of Business, Concordia University, Montreal, Canada
- Sauder School of Business, University of British Columbia, Vancouver, Canada
| | | | - D. Lohaus
- Department of Business Psychology, University of Applied SciencesDarmstadt, Darmstadt, Germany
| | - A. Løkke
- Department of Management, Aarhus University, Aarhus, Denmark
| | - S. L. Lopes
- Business Research Unit (BRU-IUL), Instituto Universitário de Lisboa (ISCTE-IUL), Lisbon, Portugal
| | - L. F. Martinez
- Nova School of Business and Economics, Universidade Nova de Lisboa, Carcavelos, Portugal
| | - M. Miraglia
- University of Liverpool Management School, University of Liverpool, Liverpool, UK
| | - B. Muschalla
- Technische Universität Braunschweig, Braunschweig, Germany
| | - U. Poethke
- Center for Higher Education, TU Dortmund University, Dortmund, Germany
| | - N. Sarwat
- Institute of Management Sciences, Bahauddin Zakariya University, Multan, Pakistan
| | - H. Schade
- Department of Psychology, Chemnitz University of Technology, Chemnitz, Germany
| | - C. Steidelmüller
- Federal Institute for Occupational Safety and Health, Dortmund, Germany
| | - S. Vinberg
- Department of Health Sciences, Mid Sweden University, Sundsvall, Sweden
| | - Z. Whysall
- Nottingham Business School, Nottingham Trent University, Nottingham, UK
| | - T. Yang
- Faculty of Organization and Human Resource, Beijing Institute of Technology, Beijing, China
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Godycki-Cwirko M, Nocun M, Butler CC, Little P, Verheij T, Hood K, Fleten N, Kowalczyk A, Melbye H. Family Practitioners' Advice about Taking Time Off Work for Lower Respiratory Tract Infections: A Prospective Study in Twelve European Primary Care Networks. PLoS One 2016; 11:e0164779. [PMID: 27760225 PMCID: PMC5070783 DOI: 10.1371/journal.pone.0164779] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Accepted: 10/02/2016] [Indexed: 11/30/2022] Open
Abstract
Background Acute cough and lower respiratory tract infections (LRTIs) are one of the most important causes of lost working hours. Aim to explore variation and predictors in family practitioners (FPs) advice to patients with LRTIs about taking time off work in different European countries. Methods Prospective observational study in primary care networks in 12 countries, with multilevel mixed-effects binomial logistic regression. Results 324 FPs recruited 1616 employed adults who presented to primary care with LRTIs. The proportion of patients advised to take time off work varied from 7.6% in the Netherlands to 89.2% in Slovakia, and of these, 88.2% overall were advised to stay off work for seven days or less. None of Finnish or Dutch patients were advised to take more than 7 days off, in contrast to 35.5% of Polish and 27.0% of Slovak patients. The strongest predictors of FPs’ advice about time off work were: patient symptoms interfering with normal activities (OR 4.43; P<0.001), fever (2.49; P<0.001), patients feeling generally unwell (2.21; P<0.001), antibiotic prescribing (1.51; P = 0.025) and auscultation abnormality (1.50; P = 0.029). Advice to take time off was not associated with patient reported recovery. Conclusions There is large variation in FPs’ advice given to patients with LRTIs in Europe about taking time off work, which is not explained by differences in patients’ reported illness duration, but might be explained by differences in regulations around certification and sick pay. Evidence based guidance for advising patients about taking time off work for this common condition is needed.
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Affiliation(s)
- Maciek Godycki-Cwirko
- Centre for Family and Community Medicine, Division of Public Health, Medical University of Lodz, Lodz, Poland
| | - Marek Nocun
- Department of Toxicology and Carcinogenesis, Nofer Institute of Occupational Medicine, Lodz, Poland
- * E-mail:
| | - Christopher C. Butler
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Paul Little
- School of Medicine, University of Southampton, Southampton, United Kingdom
| | - Theo Verheij
- University Medical Center Utrecht, Julius Center for Health, Sciences and Primary Care, Utrecht, The Netherlands
| | - Kerenza Hood
- Centre for Trials Research, Cardiff University, Cardiff, United Kingdom
| | - Nils Fleten
- General Practice Research Unit, Department of Community Medicine, UiT the Arctic University of Norway, Tromsø, Norway
| | - Anna Kowalczyk
- Centre for Family and Community Medicine, Division of Public Health, Medical University of Lodz, Lodz, Poland
| | - Hasse Melbye
- General Practice Research Unit, Department of Community Medicine, UiT the Arctic University of Norway, Tromsø, Norway
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Billis E, McCarthy CJ, Gliatis J, Matzaroglou C, Oldham JA. Attitudes and diagnostic practice in low back pain: A qualitative study amongst Greek and British physiotherapists. World J Orthop 2016; 7:561-569. [PMID: 27672569 PMCID: PMC5027011 DOI: 10.5312/wjo.v7.i9.561] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2016] [Revised: 04/21/2016] [Accepted: 06/29/2016] [Indexed: 02/06/2023] Open
Abstract
AIM To explore current diagnostic practice and attitudes of Greek and United Kingdom physiotherapists (PTs) on assessing low back pain (LBP) patients.
METHODS Three focus groups were undertaken, followed by a structured questionnaire-type survey comprising 23 health professionals and a random stratified sample of 150 PTs, respectively. Twenty-nine themes relating to LBP diagnostic practice emerged. These were then given to 30 British PTs assessing their level of agreement with their Greek counterparts. Analysis was performed by percentage agreements and χ2 tests.
RESULTS The survey was divided into three subsections; PTs’ attitudes on LBP assessment, patients’ attitudes and diagnostic/healthcare issues, each constituting 14, 7 and 8 statements, respectively. Over half of the statements fell within the 30%-80% agreement between Greece and United Kingdom whereas, 5 statements reported low (< 10%) and 8 statements demonstrated high (> 90%) PT percentage agreement. Similarities across British and Greek PTs were detected in history taking methods and in the way PTs feel patients perceive physiotherapy practice whereas, re-assessment was undertaken less frequently in Greece. Diagnosis according to 91% of the Greek PTs is considered a “privilege” which is exclusive for doctors in Greece (only 17% British PTs agreed) and is accompanied with a great overuse of medical investigations. Forty percent of Greek PTs (compared to 0% of British) consider themselves as “executers”, being unable to interfere with treatment plan, possibly implying lack of autonomy.
CONCLUSION Although similarities on history taking methods and on patients’ attitudes were detected across both groups, gross differences were found in re-assessment procedures and diagnostic issues between Greek and British physiotherapists, highlighting differences in service delivery and professional autonomy.
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Abstract
The aim of this study is to present a complete scoring system for subjective health complaints (SHC) as they are experienced by the lay population. The scoring system records the complaints, and does not map attributions or medical diagnoses. In all, 1,219 subjects (323 men, 896 women) from various occupations were tested with a scoring system, the SHC inventory, previously referred to as the Ursin Health Inventory (UHI). The SHC consists of 29 questions concerning severity and duration of subjective somatic and psychological complaints. The SHC inventory yields scores on single items and a total number of health complaints categorized into five factors: musculoskeletal pain (α=0.74), pseudoneurology (α=0.73), gastrointestinal problems (α=0.62), allergy (α=0.58) and flu (α=0.67). The SHC inventory is a systematic, easy, and reliable way to score subjective health complaints. The prevalence of these complaints is high, and should be considered before conclusions are reached about new diseases and new attributions of environmental hazards.
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Affiliation(s)
- Hege R. Eriksen
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway,
| | - Camilla Ihlebæk
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway
| | - Holger Ursin
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway
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Abstract
Aims : As subjective health complaints are one of the major reasons for short- and long-term sickness absence it is important to know the prevalence of these conditions in the general population. Methods : In this cross-sectional study, 1,240 individuals (aged 15-84 years) from the normal population in Norway answered the Subjective Health Complaint (SHC) inventory in spring 1996. Results : The prevalence of reporting subjective health complaints was high: 80% reported musculoskeletal complaints, 65% reported ``pseudoneurological' ' complaints (tiredness, depression, dizziness), 60% gastrointestinal complaints, 34% allergic complaints, and 54% flu-like complaints. The prevalence of substantial complaints was low: 13% reported musculoskeletal complaints, 5% reported "pseudoneurological' 'complaints, 4% gastrointestinal complaints, 2% allergic complaints, and 18% flu-like complaints. Women had higher prevalence of musculoskeletal, ``pseudoneurological' ' , and allergic complaints compared with men, and reported more substantial complaints on all subscales. Individuals older than 50 years were less likely to report headache, tiredness, eczema, and fl u-like complaints compared with individuals younger than 30 years. However, they had higher risk of arm pain, shoulder pain, palpitations, and several gastrointestinal and allergic complaints. The intensity of musculoskeletal, gastrointestinal, and allergic complaints was signifi cantly higher in the oldest age group. Conclusions: Subjective health complaints are very common in the normal population; there are gender and age differences in both prevalence and degree of complaints. The intensity of subjective health complaints forms a continuum, and there are no obvious cut-off point to indicate what are ``normal' ' complaints and what is illness.
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Affiliation(s)
- Camilla Ihlebæk
- Department of Biological and Medical Psychology, University of Bergen, Norway
| | - Hege R. Eriksen
- Department of Biological and Medical Psychology, University of Bergen, Norway
| | - Holger Ursin
- Department of Biological and Medical Psychology, University of Bergen, Norway
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Maeland S, Magnussen LH, Eriksen HR, Werner EL, Helle-Valle A, Hensing G. Correspondence in Stakeholder Assessment of Health, Work Capacity and Sick Leave in Workers with Comorbid Subjective Health Complaints? A Video Vignette Study. JOURNAL OF OCCUPATIONAL REHABILITATION 2016; 26:340-349. [PMID: 26615412 PMCID: PMC4967420 DOI: 10.1007/s10926-015-9618-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Purpose The purpose of this study is to test if there is correspondence in stakeholders' assessments of health, work capacity and sickness certification in four workers with comorbid subjective health complaints based on video vignettes. Methods A cross sectional survey among stakeholders (N = 514) in Norway in 2009/2010. Logistic regression and multinomial logistic regression was used to obtain the estimated probability of stakeholders choosing 100 % sick leave, partial sick leave or work and the estimation of odds ratio of stakeholder assessment compared to the other stakeholders for the individual worker. Results The supervisors were less likely to assess poor health and reduced work capacity, and more likely to suggest partial sick leave and full time work compared to the GPs for worker 1. The public was less likely to assess comorbidity and reduced work capacity, and 6 and 12 times more likely to suggest partial sick leave and full time work compared to the GPs for worker 1. Stakeholders generally agreed in their assessments of workers 2 and 3. The public was more likely to assess poor health, comorbidity and reduced work capacity, and the supervisors more likely to assess comorbidity and reduced work capacity, compared to the GPs for worker 4. Compared to the GPs, all other stakeholders were less likely to suggest full time work for this worker. Conclusions Our results seem to suggest that stakeholders have divergent assessments of complaints, health, work capacity, and sickness certification in workers with comorbid subjective health complaints.
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Affiliation(s)
- Silje Maeland
- Uni Research Health, Postbox 7810, 5020, Bergen, Norway.
- Department of Occupational Therapy, Physiotherapy and Radiography, Bergen University College, Bergen, Norway.
| | - Liv Heide Magnussen
- Department of Occupational Therapy, Physiotherapy and Radiography, Bergen University College, Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Hege R Eriksen
- Uni Research Health, Postbox 7810, 5020, Bergen, Norway
- Hemil, Research Centre for Health Promotion, University of Bergen, Bergen, Norway
| | - Erik L Werner
- Research Unit for General Practice, Uni Research Health, Bergen, Norway
- Department of General Practice, University of Oslo, Oslo, Norway
| | - Anna Helle-Valle
- GAMUT - Grieg Academy Music Therapy Research Centre, University of Bergen/Uni Research Health, Bergen, Norway
| | - Gunnel Hensing
- Section of Social Medicine and Epidemiology, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
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Yang SY, Bogosian A, Moss-Morris R, McCracken LM. Healthcare professionals’ perceptions of psychological treatment for chronic pain in Singapore: challenges, barriers, and the way forward. Disabil Rehabil 2015; 38:1643-51. [DOI: 10.3109/09638288.2015.1107635] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Letrilliart L, Barrau A. Difficulties with the sickness certification process in general practice and possible solutions: A systematic review. Eur J Gen Pract 2012. [DOI: 10.3109/13814788.2012.727795] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Godycki-Cwirko M, Nocun M, Butler CC, Muras M, Fleten N, Melbye H. Sickness certification for patients with acute cough/LRTI in primary care in Poland and Norway. Scand J Prim Health Care 2011; 29:13-8. [PMID: 21189105 PMCID: PMC3347931 DOI: 10.3109/02813432.2010.544898] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To compare the frequency and duration of sickness certificates issued by GPs to Polish and Norwegian working adults with acute cough/lower respiratory tract infection (LRTI). DESIGN Cross-sectional observational study with clinicians from nine primary care centres in Poland and 11 primary care centres in Norway. GPs filled out a case report form for all patients, including information on antibiotic prescribing, sickness certification, and advice to stay off work. SETTING Primary care research networks in Poland and Norway. SUBJECTS Working adults with a new or worsening cough or clinical presentation suggestive of LRTI. MAIN OUTCOME MEASURES Issuing sickness certificates and advising patients to stay off work. RESULTS GPs recorded similar symptoms and signs in patients in the two countries. Antibiotics were prescribed more often in Polish than in Norwegian patients (70.4% vs. 27.1%, p < 0.0001). About half of the patients received a formal sickness certificate (50.5% in Norway and 52.0% in Poland). The proportion of patients advised to stay off work was significantly higher in the Polish sample compared with the Norwegian sample (75.2% vs. 56.1%, p = 0.002). Norwegian GPs less often issued sick certificates for more than seven days (5.6% vs. 36.9%, p < 0.0001). CONCLUSION The overall proportion of sickness certification for acute cough/LRTI was similar in Norwegian and Polish patients. However, in the Polish sample, GPs more often advised patients to take time off work without issuing a sick note. When sickness certificates were issued, duration of longer than seven days was more common in Polish than in Norwegian patients.
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Affiliation(s)
- Maciek Godycki-Cwirko
- Department of Family and Community Medicine, Medical University of Lodz, Kopcinskiego 20, Lodz,Poland.
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Abstract
BACKGROUND The Department for Work and Pensions (DWP) has designed a trial medical statement. AIM To compare fitness for work assessment outcomes and written advice across current and trial medical statements. To examine the use of and suggestions to improve the trial medical statement. DESIGN OF STUDY Comparative study with a two-way mixed design using questionnaire-based vignettes presenting GPs with three hypothetical sick leave cases (back pain, depression, combined back pain and depression) and medical statements (current or trial). The questionnaire also gathered GP views of using the trial Med 3. SETTING Nine primary care organisations (PCOs) in England, Scotland, and Wales. METHOD Five hundred and eighty-three GPs employed in PCOs in summer 2008 were randomised to receive a current or trial Med 3 postal questionnaire. GPs assessed vignette patients' fitness for work using the questionnaire medical statements. RESULTS GPs using the trial Med 3 were less likely to advise refraining from work and more likely to provide written fitness for work advice compared to GPs using the current Med 3 form. Date sections of the trial Med 3 were used inconsistently, and a return to work date was unclear. GPs wanted further clarification of the implications of assessing a case as 'fit for some work' and its relationship to employers' willingness to follow GP advice about work. CONCLUSION The study indicates a revised form may reduce the number of patients advised to refrain from work and increase the provision of written fitness for work information.
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Wynne-Jones G, Mallen CD, Main CJ, Dunn KM. What do GPs feel about sickness certification? A systematic search and narrative review. Scand J Prim Health Care 2010; 28:67-75. [PMID: 20334576 PMCID: PMC3442320 DOI: 10.3109/02813431003696189] [Citation(s) in RCA: 82] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract Objective. To identify GPs' attitudes towards sickness certification. Design. Systematic search and narrative review identifying themes around attitudes towards sickness certification. Results. Eighteen papers were identified for inclusion in the review; these included qualitative, quantitative, and systematic reviews. The papers were predominantly from Scandinavia and the UK. Three themes were identified from the literature: conflict, role responsibility, and barriers to good practice. Conflict was predominantly centred on conflict between GP and patients regarding the need for a certificate, but there was also conflict between all stakeholders. Role responsibility focused on the multiple roles GPs had to fulfil, and barriers to good practice were identified both within and outside the healthcare system. Conclusion. Any potential for changing the certification system needs to focus on reducing the potential for conflict, clarification of the roles of all stakeholders, and improving access to specialist occupational health and rehabilitation services.
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Affiliation(s)
- Gwenllian Wynne-Jones
- Arthritis Research Campaign National Primary Care Centre, Primary Care Sciences, Keele University, UK.
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Watson J, Shin R, Zurakowski D, Ring D. A survey regarding physician recommendations regarding return to work. J Hand Surg Am 2009; 34:1111-8.e2. [PMID: 19481359 DOI: 10.1016/j.jhsa.2009.02.030] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2008] [Revised: 02/21/2009] [Accepted: 02/25/2009] [Indexed: 02/02/2023]
Abstract
PURPOSE Returning patients to work may be influenced by subjective factors and physician bias. The purpose of this study was to determine whether factors such as complaints of pain and patient motivation influence physicians' recommendations regarding return to work or activity. METHODS One hundred twenty-five members of the American Society for Surgery of the Hand completed an online survey describing a 25-year-old patient with surgically treated diaphyseal fractures of the radius and ulna. Physicians were asked whether the patient could be returned to work in 4 distinct scenarios varying with occupation, time since injury, radiographic union, patient motivation, and pain. RESULTS Logistic regression analysis demonstrated that all 5 predictor variables were highly significant predictors of return to work. Pain and diminished motivation were associated with a significantly lower probability of return to work. CONCLUSIONS Although in the scenario depicted, objective factors such as radiographic union and job demands are the major determinants of physician clearance to return to work, physicians are also influenced by patient motivation and complaints of pain.
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Fullen BM, Baxter GD, O'Donovan BGG, Doody C, Daly LE, Hurley DA. Factors impacting on doctors' management of acute low back pain: a systematic review. Eur J Pain 2008; 13:908-14. [PMID: 19110456 DOI: 10.1016/j.ejpain.2008.11.013] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2008] [Revised: 11/02/2008] [Accepted: 11/11/2008] [Indexed: 12/12/2022]
Abstract
The aim of this review was to determine the factors that impact on doctors' management of patients with acute low back pain. A methodological assessment of databases (Medline, EMBASE, Psychinfo, BIOSIS, CINAHL, and the Cochrane Central Register of Controlled Trials) identified papers which were screened for inclusion criteria by two independent reviewers. Data were extracted from accepted papers, and the internal validity and strength of the evidence were determined using valid and reliable scales. The search generated a total of 28 papers [quantitative (n=27), qualitative (n=1) methodologies]. Themes were identified from the accepted papers: education (n=18), knowledge of clinical guidelines and impact on management (n=7), and doctors' demographics (n=4). There was consistent evidence that doctors did not adhere to clinical guidelines when performing a spinal assessment. There was inconsistent evidence that education increased adherence with acute LBP guideline recommendations in terms of referral rates to physiotherapy, for investigations, to secondary care and for maintaining patients at work. Strategies to address the factors impacting on doctors' management of acute LBP are required; these would lead to improvement in patient outcomes and reduce healthcare costs.
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Affiliation(s)
- Brona M Fullen
- School of Physiotherapy and Performance Science, University College Dublin, Ireland.
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Fullen BM, Baxter GD, O'Donovan BGG, Doody C, Daly L, Hurley DA. Doctors' attitudes and beliefs regarding acute low back pain management: A systematic review. Pain 2008; 136:388-396. [PMID: 18395982 DOI: 10.1016/j.pain.2008.01.003] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2007] [Revised: 12/21/2007] [Accepted: 01/04/2008] [Indexed: 01/22/2023]
Abstract
The aim of this systematic review was to determine the attitudes and beliefs of doctors to acute low back pain, and the factors that influence these. The review comprised three phases: a methodological assessment of databases (Medline, EMBASE, Psychinfo, BIOSIS, CINAHL, and the Cochrane Central Register of Controlled Trials) identified potential papers; these were screened for inclusion criteria by two independent reviewers, the extraction of data and the rating of internal validity and strength of the evidence, using valid and reliable scales from accepted papers. Themes were then identified from the accepted literature. The search generated a total of 15 papers of both qualitative (n=3) and quantitative (n=12) methodologies. Themes that emerged included doctors' attitudes and beliefs, and four factors that influenced attitudes and beliefs: doctors' specialty, demographic factors, personal beliefs and education. There was consistent evidence that doctors' specialty impacted their attitudes and beliefs: lack of consensus regarding the natural history of LBP, around treatment options, and issues regarding work. There was inconsistent evidence that demographic factors (age) and level of education impacted doctors' attitudes and beliefs. Strategies to address/ modify these attitudes and beliefs are required, as in some cases they are at odds with guideline recommendations. Long term, these changes in these areas have the potential to maximise patient-care, and reduce costs to health services.
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Affiliation(s)
- B M Fullen
- UCD School of Physiotherapy and Performance Science, Health Sciences Centre, University College Dublin, Dublin, Ireland Centre for Physiotherapy Research, School of Physiotherapy, University of Otago, New Zealand Department of General Practice, NUI Galway, Ireland UCD School of Public Health and Population Science, Dublin, Ireland
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15
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Rehabilitation and Therapy Research Society Third Annual Conference: Collaborative research … making it a reality. PHYSICAL THERAPY REVIEWS 2008. [DOI: 10.1179/174328813x13789827565624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Norrmén G, Svärdsudd K, Andersson DKG. How primary health care physicians make sick listing decisions: the impact of medical factors and functioning. BMC FAMILY PRACTICE 2008; 9:3. [PMID: 18208594 PMCID: PMC2266928 DOI: 10.1186/1471-2296-9-3] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/02/2007] [Accepted: 01/21/2008] [Indexed: 11/10/2022]
Abstract
BACKGROUND The decision to issue sickness certification in Sweden for a patient should be based on the physician's assessment of the reduction of the patient's work capacity due to a disease or injury, not on psychosocial factors, in spite of the fact that they are known as risk factors for sickness absence. The aim of this study was to investigate the influence of medical factors and functioning on sick listing probability. METHODS Four hundred and seventy-four patient-physician consultations, where sick listing could be an option, in general practice in Orebro county, central Sweden, were documented using physician and patient questionnaires. Information sought was the physicians' assessments of causes and consequences of the patients' complaints, potential to recover, diagnoses and prescriptions on sick leave, and the patients' view of their family and work situation and functioning as well as data on the patients' former and present health situation. The outcome measure was whether or not a sickness certificate was issued. Multivariate analyses were performed. RESULTS Complaints entirely or mainly somatic as assessed by the physician decreased the risk of sick listing, and complaints resulting in severe limitation of occupational work capacity, as assessed by the patient as well as the physician, increased the risk of sick listing, as did appointments for locomotor complaints. The results for patients with infectious diseases or musculoskeletal diseases were partly similar to those for all diseases. CONCLUSION The strongest predictors for sickness certification were patient's and GP's assessment of reduced work capacity, with a striking concordance between physician and patient on this assessment. When patient's complaints were judged to be non-somatic the risk of sickness certification was enhanced.
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Affiliation(s)
- Gunilla Norrmén
- Uppsala University, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology Section, S-75185 Uppsala, Sweden.
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Arrelöv B, Alexanderson K, Hagberg J, Löfgren A, Nilsson G, Ponzer S. Dealing with sickness certification - a survey of problems and strategies among general practitioners and orthopaedic surgeons. BMC Public Health 2007; 7:273. [PMID: 17910746 PMCID: PMC2089078 DOI: 10.1186/1471-2458-7-273] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2007] [Accepted: 10/02/2007] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In order to get sickness benefit a sick-listed person need a medical certificate issued by a physician; in Sweden after one week of self-certification. Physicians experience sick-listing tasks as problematic and conflicts may arise when patients regard themselves unable to work due to complaints that are hard to objectively verify for the physician. Most GPs and orthopaedic surgeons (OS) deal regularly with sick-listing issues in their daily practice. The aim of this study was to explore perceived problems and coping strategies related to tasks of sickness certification among general practitioners (GP) and orthopaedic surgeons (OS). METHODS A cross-sectional study about sickness certification in two Swedish counties, with 673 participating GPs and 149 OSs, who answered a comprehensive questionnaire. Frequencies together with crude and adjusted (gender and working years) Odds ratios were calculated. RESULTS A majority of the GPs and OSs experienced problems in sickness certification every week. To assess the patient's work ability, to handle situations when they and the patient had different opinions about the need for sickness absence, and to issue prolongation certificates when the previous was issued by another physician were reported as problematic by a majority in both groups. Both GPs and OSs prolonged sickness certifications due to waiting times in health care or at Social Insurance Office (SIO). To handle experienced problems they used different strategies; OSs issued sickness certificates without personal appointment more often than the GPs, who on the other hand reported having contact with SIO more often than the OSs. A higher rate of GPs experienced support from management and had a common strategy for handling sickness certification at the clinic than the OSs. CONCLUSION Most GPs and OSs handled sickness certification weekly and reported a variety of problems in relation to this task, generally GPs to a higher extent, and they used different coping strategies to handle the problems.
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Affiliation(s)
- Britt Arrelöv
- Department of Development in Health and Medical Services, FORUM, Box 175 33 Stockholm, Sweden
| | - Kristina Alexanderson
- Section of Personal Injury Prevention, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Jan Hagberg
- Section of Personal Injury Prevention, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Anna Löfgren
- Section of Personal Injury Prevention, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Gunnar Nilsson
- Department of Family medicine, Karolinska Institutet, Stockholm, Sweden
| | - Sari Ponzer
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
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Rainville J, Pransky G, Indahl A, Mayer EK. The physician as disability advisor for patients with musculoskeletal complaints. Spine (Phila Pa 1976) 2005; 30:2579-84. [PMID: 16284598 DOI: 10.1097/01.brs.0000186589.69382.1d] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Literature review. OBJECTIVES To review the literature about the performance of physicians as mediators of temporary and permanent disability for patients with chronic musculoskeletal complaints. To assess specifically the nature and variance of recommendations from physicians, factors influencing physician performance, and efforts to influence physician behavior in this area. SUMMARY OF BACKGROUND DATA While caring for patients with musculoskeletal injuries, physicians are often asked to recommend appropriate levels of activity and work. These recommendations have significant consequences for patients' general health, employment, and financial well-being. METHODS Medical literature search. RESULTS Physician recommendations limiting activity and work after injury are highly variable, often reflecting their own pain attitudes and beliefs. Patients' desires strongly predict disability recommendations (i.e., physicians often acquiesce to patients' requests). Other influences include jurisdiction, employer, insurer, and medical system factors. The most successful efforts to influence physician recommendations have used mass communication to influence public attitudes, while reinforcing the current standard of practice for physicians. CONCLUSIONS Physician recommendations for work and activity have important health and financial implications. Systemic, multidimensional approaches are necessary to improve performance.
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Affiliation(s)
- James Rainville
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts, USA.
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Söderberg E, Alexanderson K. Gatekeepers in sickness insurance: a systematic review of the literature on practices of social insurance officers. HEALTH & SOCIAL CARE IN THE COMMUNITY 2005; 13:211-23. [PMID: 15819742 DOI: 10.1111/j.1365-2524.2005.00551.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Decisions concerning entitlement to sickness benefits have a substantial impact on the lives of individuals and on society. In most countries, such decisions are made by staff of private or public insurance organisations. The work performed by these professionals is debated, hence more knowledge is needed on this subject. The aim of the present study was to review scientific studies of the practices of social insurance officers (SIOs) published in English, Danish, Norwegian and Swedish. Studies were searched for in literature databases, in reference lists, and through personal contacts. Analyses were made of type of study, areas investigated, research questions, theories used, and the results. Sixteen studies were included. SIOs and several other actors are responsible for applying measures to minimise sick-leave and promote return to work (RTW). The studies focusing on coordination of such measures revealed that SIOs felt unsure about how to handle their contacts with clients and other actors. One study indicated that the SIOs, partly due to lack of time, accepted the recommendations of physicians instead of making their own judgments about granting sickness benefits. While all SIOs must make decisions concerning entitlement to sickness benefits on a daily basis, few of the reviewed studies scrutinised the actual granting of sickness compensation. The studies were also deficient in that they investigated the decision latitude of the SIOs from a very limited perspective, mainly on an individual level and often primarily in relation to colleagues and/or clients rather than to the laws and regulations of the sickness insurance. The concepts and framework in this area of research need to be developed to facilitate elucidation of the interaction between different actors in local spheres, professionals in different disciplines, and between welfare staff and individual citizens.
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Affiliation(s)
- Elsy Söderberg
- Division of Social Medicine and Public Health Science, Department of Health and Society, Linköping University, Linköping, Sweden.
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20
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Wahlström R, Alexanderson K. Swedish Council on Technology Assessment in Health Care (SBU). Chapter 11. Physicians' sick-listing practices. Scand J Public Health 2005; 63:222-55. [PMID: 15513660 DOI: 10.1080/14034950410021916] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Physicians' sick-listing practices have been studied to a very limited extent. There is limited scientific evidence that physicians perceive sick-listing duties to be difficult and problematic, regarding both the medical and the insurance-related aspects. There is limited scientific evidence also that quality is often deficient in the sickness certificates issued by physicians. This may affect case management at the local insurance office. There is insufficient scientific evidence to explain the differences in physicians' sick-listing patterns. The effects on patients are also insufficiently studied.
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Affiliation(s)
- Rolf Wahlström
- Institute for Public Health, Karolinska Institute, Stockholm, Sweden.
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21
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Ferrari R, Russell AS. Survey of general practitioner, family physician, and chiropractor's beliefs regarding the management of acute whiplash patients. Spine (Phila Pa 1976) 2004; 29:2173-7. [PMID: 15454712 DOI: 10.1097/01.brs.0000141184.86744.37] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Questionnaire Survey. OBJECTIVE The purpose of this study was to survey the whiplash management beliefs for practicing general practitioners, family physicians, and chiropractors. SUMMARY OF BACKGROUND DATA Many treatments are prescribed by general practitioners, family physicians, and chiropractors for acute whiplash, but to date no survey of management beliefs for acute whiplash has been reported. METHODS A total of 483 physicians and 123 chiropractors in the urban setting of Edmonton, Alberta, Canada were asked to participate by completing a questionnaire with 24 items designed to assess management beliefs regarding acute whiplash. RESULTS A total of 362 physicians (75%) and 88 chiropractors (72%) completed the survey. Only 1% of physicians and none of the chiropractors believed that whiplash patients should be prescribed bed rest until almost all their pain goes away. As well, only 1% of physicians and none of the chiropractors believed that patients with acute whiplash should not return to work until almost all their pain goes away. More than 89% of physicians and 76% of chiropractors believed that encouragement of maintaining normal activities, even if they hurt, is important in the recovery from whiplash. Also, 91% of physicians and 84% of chiropractors agreed that exercise therapy was effective in acute whiplash patients. Physicians are more likely to have negative feelings about treating patients who have whiplash, were more likely to believe there was nothing physically wrong with many patients with chronic whiplash, and agree that nonsteroidal anti-inflammatory drugs and muscle relaxants are effective in acute whiplash. Chiropractors are more likely to agree that traction, transcutaneous electrical nerve stimulation, manipulation, massage, and acupuncture are effective in acute whiplash. CONCLUSIONS Physicians and chiropractors generally hold beliefs that are consistent with the current evidence regarding the most helpful approaches to acute whiplash, although chiropractors were more likely to be supportive of passive therapy methods.
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Affiliation(s)
- Robert Ferrari
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
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22
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Hussey S, Hoddinott P, Wilson P, Dowell J, Barbour R. Sickness certification system in the United Kingdom: qualitative study of views of general practitioners in Scotland. BMJ 2004; 328:88. [PMID: 14691065 PMCID: PMC314050 DOI: 10.1136/bmj.37949.656389.ee] [Citation(s) in RCA: 142] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/11/2003] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To explore how general practitioners operate the sickness certification system, their views on the system, and suggestions for change. DESIGN Qualitative focus group study consisting of 11 focus groups with 67 participants. SETTING General practitioners in practices in Glasgow, Tayside, and Highland regions, Scotland. SAMPLE Purposive sample of general practitioners, with further theoretical sampling of key informant general practitioners to examine emerging themes. RESULTS General practitioners believed that the sickness certification system failed to address complex, chronic, or doubtful cases. They seemed to develop various operational strategies for its implementation. There appeared to be important deliberate misuse of the system by general practitioners, possibly related to conflicts about roles and incongruities in the system. The doctor-patient relationship was perceived to conflict with the current role of general practitioners in sickness certification. When making decisions about certification, the general practitioners considered a wide variety of factors. They experienced contradictory demands from other system stakeholders and felt blamed for failing to make impossible reconciliations. They clearly identified the difficulties of operating the system when there was no continuity of patient care. Many wished either to relinquish their gatekeeper role or to continue only with major changes. CONCLUSIONS Policy makers need to recognise and accommodate the range and complexity of factors that influence the behaviour of general practitioners operating as gatekeepers to the sickness certification system, before making changes. Such changes are otherwise unlikely to result in improvement. Models other than the primary care gatekeeper model should be considered.
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Affiliation(s)
- Susan Hussey
- Research and Development Office NHS Highland, The Greenhouse, Beechwood Business Park North, Inverness IV2 3ED.
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23
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Arrelöv B, Borgquist L, Ljungberg D, Svärdsudd K. The influence of change of legislation concerning sickness absence on physicians' performance as certifiers. A population-based study. Health Policy 2003; 63:259-68. [PMID: 12595125 DOI: 10.1016/s0168-8510(02)00081-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
In Sweden, a change of the legislation for sickness absence became effective on 1st October, 1995. The purpose of the change was to reduce costs for sickness absence by exclusion of non-medical criteria for sick-listing, more part-time sick-listing and faster rehabilitation. This study was conducted in order to describe and analyse certification practice of various physician categories, before and after the change in legislation. Thirty-one thousand seven hundred and thirty certificates for sickness absence, collected by the local offices of the National Social Insurance Board in eight Swedish counties, fulfilled the inclusion criteria. The number of certificates decreased temporarily. The number of certified net days, i.e. crude days multiplied by degree, tended to increase and there was no shift from full to partial sick-listing during the period. There were small changes regarding case mix, i.e. patient characteristics, and sick-listing physician category. The results were almost unchanged when these small changes were taken into account. General practitioners issued significantly shorter periods of sick-leave than the other categories both years. The goals of the legislative change were thus not met. The result of the study indicates that other factors than the legislation may be more important for physicians' practice.
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Affiliation(s)
- Britt Arrelöv
- Department of Public Health and Caring Sciences, Clinical Epidemiology and Family Medicine Sections, Uppsala University, Uppsala Science Park,751 85, Uppsala, Sweden.
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Abstract
A variety of subjective illnesses with few or no objective findings have appeared at regular intervals as epidemics in our society under different labels. There are few or no objective findings that might explain the "disease" or the complaints go beyond what is regarded as "reasonable" by the physician. Muscle pain and other types of subjective health complaints are among the most frequent reason for encounters with general practitioners, and one of the major causes for sickness absence. The prevalence of subjective health complaints is very high, with at least 75% of the population reporting one or more subjective health complaints the past 30 days. From a statistical point of view, it is "normal" to have complaints. It is when they become intolerable that assistance is required. The difficult thing is that this threshold is individual and subjective. The psychiatric definitions of these complaints, therefore, refer only to the tip of an iceberg.
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Affiliation(s)
- Hege R Eriksen
- Department of Biological and Medical Psychology, University of Bergen, Norway.
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25
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Strand LI, Ljunggren AE, Haldorsen EM, Espehaug B. The impact of physical function and pain on work status at 1-year follow-up in patients with back pain. Spine (Phila Pa 1976) 2001; 26:800-8. [PMID: 11295903 DOI: 10.1097/00007632-200104010-00022] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A randomized, controlled trial. OBJECTIVE To examine the impact of physical function and pain on work status in patients who are long-term sick-listed because of back pain. SUMMARY OF BACKGROUND DATA Sickness benefit is granted to a person who is incapable of working because of reduced functioning. Improved physical function and decrease of pain may be important in considering return to work. METHODS Physical performance (five activities), disability, and pain (self-reported questionnaires) were assessed at baseline and at the 1-year follow-up evaluation in 117 patients randomized to an intervention group (n = 81) and a control group (n = 36). RESULTS At the 1-year follow-up evaluation, 50% had returned to work. Statistically significant improvements were demonstrated from baseline to follow-up evaluation in returners to work: in the intervention group on all tests and in the control group on all except two performance tests. Improvement measures discriminated between returners and nonreturners to work in the intervention group on all physical tests and a pain test and in the control group on three physical tests and a pain test. In the intervention group, odds ratios for not having returned to work were high when test measures at follow-up indicated markedly impaired physical function and high pain; in the control group, this appeared in high pain. CONCLUSIONS Return to work was related to physical function and pain. More importance seemed to be attributed to physical performance in the intervention group than in the controls as a basis for returning patients to work.
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Affiliation(s)
- L I Strand
- Section of Physiotherapy Science, Faculty of Medicine, University of Bergen, Norway.
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Rainville J, Carlson N, Polatin P, Gatchel RJ, Indahl A. Exploration of physicians' recommendations for activities in chronic low back pain. Spine (Phila Pa 1976) 2000; 25:2210-20. [PMID: 10973405 DOI: 10.1097/00007632-200009010-00012] [Citation(s) in RCA: 134] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A mailed survey of 142 practicing physicians (63 orthopedic spine surgeons and 79 family physicians) inquiring about their expertise and experience with chronic low back pain, their pain attitudes and beliefs, and recommendations about the appropriate level of function for chronic back pain patients. OBJECTIVES To explore physicians' recommendations for activity and work for patients with chronic low back pain and to determine factors that might influence these recommendations. SUMMARY OF BACKGROUND DATA Physicians continuously are asked to recommend the appropriate level of activities and work for patients with chronic low back pain. Although these recommendations can have a significant impact on patients' lives, little is known about the factors that shape recommendations. METHODS Mailed surveys included questions inquiring about the physicians' demographics, training, and experience in low back pain, the Health Care Providers' Pain and Impairment Relationship Scale, and three vignettes of work-disabled, chronic low back pain patients. After each vignette, physicians rated their perceptions of severity of symptoms and pathology and recommendations for work and daily activities through five graded responses. Three mailings were done within 4 weeks to maximize the response rate. The association of each variable with work and activity recommendations was statistically explored. To assess the influence of clinical expertise on recommendations, the responses of orthopedic spine surgeons were compared with those of family physicians. Test-retest reliability was assessed with a second mailing of the questionnaire to all initial responders. RESULTS Sixty-five percent of the orthopedic surgeons and 52% of the family physicians responded to the survey. Thirty-nine percent of the initial responders completed the reliability survey. The survey instrument demonstrated modest reliability, with identical recommendations for activities and work occurring 57% of the time. In general, a wide range of activities and work was recommended, with most physicians recommending avoidance of painful activities or greater restrictions. Orthopedic spine surgeons were slightly less restrictive in their activity recommendations compared with family physicians. Most physicians demonstrated some consistency in their pattern of recommendations when compared with their colleagues. Physicians' pain attitudes and belief influenced their recommendations, as did their perception of the severity of the patients' clinical symptoms. CONCLUSIONS Physicians' recommendations for activity and work to patients with chronic back pain vary widely and frequently are restrictive. These recommendations reflect personal attitudes of the physicians as well as factors related to the patients' clinical symptoms.
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Affiliation(s)
- J Rainville
- Spine Center at New England Baptist Bone and Joint Institute, Boston, MA 02120, USA
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27
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Predictors for outcome of a multi-modal cognitive behavioural treatment program for low back pain patients-a 12-month follow-up study. Eur J Pain 2000; 2:293-307. [PMID: 10700325 DOI: 10.1016/s1090-3801(98)90028-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Low back pain patients (n=142) on sick leave for at least 8 weeks were given a multi-modal cognitive behavioural treatment program (MMCBT) that lasted for 4 weeks. Before treatment, all patients were tested with a comprehensive test battery. The outcome at 12-month follow-up was predictable from the pretest, but only when combining medical and psychological data. Patients who returned to work (Returners, 50%) in the MMCBT group were characterised by less pain, more psychological strength, were evaluated by the physiotherapist as having a good prognosis for return to work, and were less educated. Patients who did not return to work (Non-returners) in the MMCBT group felt tense and unfit, felt hopelessness concerning the future, were less physically active, thought their complaints would worsen if they continued working, and reported fewer difficulties driving a car. Returners to work (58%) in the randomised control group (n=81), who received ordinary physical therapy, were characterised by high levels of energy, less subjective health complaints, less exhaustion for a condition test, and did not work in positions giving a constant load on the back. There was no significant differences between number of patients who had returned to work in the MMCBT and the control group. Non-returners in the control group lacked energy, trained less regularly, worked in occupations that gave an almost constant load on the back, and did not expect to be back to work in the course of a couple of weeks. It seems to be important to develop further diagnostic tools to identify those who might benefit from extensive or specific treatments. Copyright 1998 European Federation of Chapters of the International Association for the Study of Pain.
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28
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Marriott A, Newman NM, Gracovetsky SA, Richards MP, Asselin S. Improving the evaluation of benign low back pain. Spine (Phila Pa 1976) 1999; 24:952-60. [PMID: 10332784 DOI: 10.1097/00007632-199905150-00005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A prospective, blind study was conducted to investigate the factors underlying the decisions of expert clinicians in diagnosis of acute, benign low back pain, compared with results obtained with an automated physical examination by machine. From the results, a strategy to significantly improve clinical diagnosis in cases of discordance was determined. OBJECTIVES To identify factors in the clinical assessment of low back pain that indicate when independent diagnostic testing would be useful. SUMMARY OF BACKGROUND DATA The clinical evaluation of low back pain is often dominated by subjective reports of pain. Published medical literature has underscored several inherent weaknesses of the clinical examination, and concerns have been raised about its effectiveness for assessing patients with low back pain. Thus, it has been proposed that objective measures to complement the clinician's examination would be beneficial in the formulation of dependable diagnoses. METHODS Randomly designated subjects, who in describing their conditions were objective or role playing, were assessed by clinicians and a machine for diagnosis of low back pain assessment versus normal backs. Each subject's pain assessment was compared with a gold standard that was established by experts in low back pain. Components of the clinical examination were analyzed to assess which were the most informative in making a reliable diagnosis. The information content of the machine assessment was also analyzed and a strategy to complement the clinical diagnosis with the machine diagnosis determined. RESULTS Discordance among the various components of the clinical examination was a strong indicator of when the efficacy of the clinical examination dropped below a random level of decision making. When there was discordance, incorporating the functional evaluation by machine into the clinical diagnosis improved the performance of the clinician. Notably, in nonobjective subjects, the accuracy of diagnosis was enhanced by as much as 69%. CONCLUSIONS It is possible to improve the accuracy of clinical diagnosis by incorporating a functional evaluation by machine when there is discordance between physical examination findings and reported pain.
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Affiliation(s)
- A Marriott
- Spinex Medical Technologies, Inc., Montréal, Québec, Canada
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29
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Gracovetsky SA, Newman NM, Richards MP, Asselin S, Lanzo VF, Marriott A. Evaluation of clinician and machine performance in the assessment of low back pain. Spine (Phila Pa 1976) 1998; 23:568-75. [PMID: 9530788 DOI: 10.1097/00007632-199803010-00009] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
STUDY DESIGN A prospective blind study to test and compare the performance of clinicians (evaluators) with that of an automated machine (the Spinoscope) in conducting an examination on randomly designated simulators/dissimulators and honest subjects to assess acute benign low back pain. OBJECTIVES To test the impact of reported pain and history on the clinical examination and to compare the ability of clinicians and the machine to recognize normal findings in a controlled group of subjects with and without benign low back pain. BACKGROUND The literature raises serious questions regarding the efficacy of the clinical examination for patients with low back pain. METHODS A "gold standard" (clinical examination by experts in low back pain) was established against which the clinical examination by the evaluators and the machine assessment (incorporating weight-lifting ability) of honest subjects and simulators/dissimulators were compared using the receiver operating characteristic technique. The selection of subjects was performed according to strict inclusion and exclusion criteria. RESULTS The evaluators were more accurate with the honest subjects, the machine more accurate with the simulators/dissimulators, and, for the entire population tested, the they were equivalent in accuracy (71% vs. 72% concordance). Results from the machine's expert system and from clinician readers of the machine data compared favorably. The machine's concordance with the gold standard increased with increasing loads lifted by the subject. CONCLUSION By relying primarily on the subject's self-presentation, often to the exclusion of objective findings, the clinician may err in evaluating low back function when the patient does not report his or her true condition. The additional functional analysis provided by the machine offers the clinician objective, pertinent information to complement the findings from the clinical examination.
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30
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Feeney A, North F, Head J, Canner R, Marmot M. Socioeconomic and sex differentials in reason for sickness absence from the Whitehall II Study. Occup Environ Med 1998; 55:91-8. [PMID: 9614392 PMCID: PMC1757555 DOI: 10.1136/oem.55.2.91] [Citation(s) in RCA: 116] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES Large socioeconomic differences exist in disease and mortality. This paper describes the distribution of specific medical reasons for sickness absence by grade of employment in the Whitehall II study and validates the medical reason by comparison with general practitioners' records. METHODS Analysis of sickness absence data on 5620 male and female civil servants aged 35-55 years. Data have been collected from 12 of the 20 London based civil service departments participating in the Whitehall II study, where medical reason for absence was available. Rates and distributions of reasons for absence for short spells (< or = 7 days) and long spells (> 7 days) were analysed. RESULTS Respiratory disorders and gastroenteritis accounted for over half of all spells of absence, with headache and migraine, musculoskeletal disorders, injury, and neurosis accounting for a further 20%-30% of absences. There was an inverse association with employment grade, the lower the grade the higher the rate of absence for both short spells (< or = 7 days) and long spells (> 7 days). In general, women had higher rates of absence than men. Comparison of reason for very long spells of absence (> 21 days) showed moderate agreement between civil service and general practitioner. CONCLUSION There is a lack of national comprehensive data on sickness absence and medical reason for absence, in particular for women and for spells of different duration. Data from the Whitehall II study show large employment grade and sex differences in the distribution of medical reasons for absence that are similar to socioeconomic differences in morbidity documented in other studies. Possible explanations include the subjective nature of illness and disease; the work/family interface; and the influence of the absence culture. Longer term follow up will provide information on whether sickness absence relates to serious morbidity and mortality.
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Affiliation(s)
- A Feeney
- Department of Epidemiology and Public Health, University College London, UK
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31
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Aasland OG, Olff M, Falkum E, Schweder T, Ursin H. Health complaints and job stress in Norwegian physicians: the use of an overlapping questionnaire design. Soc Sci Med 1997; 45:1615-29. [PMID: 9428082 DOI: 10.1016/s0277-9536(97)00093-2] [Citation(s) in RCA: 77] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
An extensive research program has been undertaken in Norway on physician health, sickness, working conditions and quality of life. Data are collected from cross-sectional and longitudinal prospective and retrospective surveys, qualitative studies, and vital statistics. This paper presents findings on subjectively experienced health problems, emotional distress, experienced job stress and job satisfaction, based on an extensive cross-sectional postal questionnaire study in 1993. An overlapping questionnaire design was used to allow many relationships to be estimated without exhausting the recipients. 9266 active physicians were included, which comprises close to the total Norwegian physician work-force minus a representative sample of 2100, used for other studies. The primary questionnaire was returned by 6652 (71.8%), the great majority of which also returned three secondary questionnaires. The results indicate that health complaints were significantly more frequent in female physicians and decreased with age. Low job satisfaction, high job stress, and emotional distress were all found to be significant predictors of subjective health complaints, as measured by the Ursin Health Inventory.
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Affiliation(s)
- O G Aasland
- Research Institute, Norwegian Medical Association, Oslo, Norway
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