2009-06-01 12:00 - Messages

Multidisciplinary rehabilitation for fibromyalgia and musculoskeletal pain in working age adults

Non-malignant musculoskeletal pain is an increasing problem in western countries. Fibromyalgia syndrome is an increasing recognised
chronic musculoskeletal disorder. The objective of this systematic review was to determine the effectiveness of multidisciplinary rehabilitation for fibromyalgia and
widespread musculoskeletal pain among working age adults.


Douleur chronique : comment la dépister et la prendre en charge?

La Haute Autorité de santé vient de publier des recommandations sur la prise en charge du syndrome douloureux chronique, suite à la demande formulée par la Société Française d'Etude et de Traitement de la Douleur (SFTED). Celles-ci visent principalement à atteindre plusieurs objectifs : identifier les patients souffrant de douleur chronique, définir son évaluation clinique, et préciser le parcours du patient en amont et en aval des structures spécialisées.


Designing a workplace return-to-work program for occupational low back pain: an intervention mapping approach

Despite over 2 decades of research, the ability to prevent work-related low back pain (LBP) and disability remains elusive. Recent research suggests that interventions that are focused at the workplace and incorporate the principals of participatory ergonomics and return-to-work (RTW) coordination can improve RTW and reduce disability following a work-related back injury. Workplace interventions or programs to improve RTW are difficult to design and implement given the various individuals and environments involved, each with their own unique circumstances. Intervention mapping provides a framework for designing and implementing complex interventions or programs. The objective of this study is to design a best evidence RTW program for occupational LBP tailored to the Ontario setting using an intervention mapping approach. We used a qualitative synthesis based on the intervention mapping methodology. Best evidence from systematic reviews, practice guidelines and key articles on the prognosis and management of LBP and improving RTW was combined with theoretical models for managing LBP and changing behaviour. This was then systematically operationalized into a RTW program using consensus among experts and stakeholders. The RTW Program was further refined following feedback from nine focus groups with various stakeholders. A detailed five step RTW program was developed. The key features of the program include; having trained personnel coordinate the RTW process, identifying and ranking barriers and solutions to RTW from the perspective of all important stakeholders, mediating practical solutions at the workplace and, empowering the injured worker in RTW decision-making. Intervention mapping provided a useful framework to develop a comprehensive RTW program tailored to the Ontario setting.


Does participation in interdisciplinary work rehabilitation programme influence return to work obstacles and predictive factors?
Musculoskeletal disorders evolve into long-term work disabilities in ∼10% of work-injury cases. From a prevention perspective, screening for predictive factors and obstacles associated with long-term work disability appear to offer a promising avenue for work rehabilitation. However, knowledge of the factors at play during the chronic phase remains limited. This study aims to explore the presence of a relationship between the predictive factors and obstacles identified at the time of admission to an interdisciplinary work rehabilitation programme and return to work upon completion of the programme, in individuals with a long-term work disability. A descriptive correlational study involving 222 individuals assessed using the Work Disability Diagnostic Interview and who participated in the PREacuteVICAP work rehabilitation programme. The general model accurately predicts the work status of 77% of the participants. Seven to nine factors were found to be associated with return to work in each model produced (3). Those factors were mainly psychosocial and work-related in nature and differ according to gender. Unexpectedly, certain obstacles observed at the time of admission to the programme appear to have a protective effect and thus promote participants' return to work. The results obtained support the hypothesis that screening for predictive factors and obstacles at the time of admission of a work rehabilitation programme for individuals with a long-term work disability allows for more effective intervention regarding these factors, and in all likelihood, promotes return to work.


Rehabilitation - A short guide to the evidence

172 million working days were lost due to sickness absence last year. 34 million of these were due to an injury or illness caused by work.

For most people who become ill or are injured, their main priority is to get their health back as soon as possible. Usually a person will get better by themselves, but often the person will need help and support in recovering. If they have been off work for a long time they may also need help in regaining their confidence in getting back to work.


Patient engagement in rehabilitation therapy: physical and occupational therapist impressions

The study is performed to examine the impressions of physical and occupational therapists on therapeutic engagement among their patients. Engagement in this context was defined as a patient's deliberate effort to work toward recovery by participating fully in their rehabilitation therapies. Using a survey approach, physical and occupational therapists (N = 199) from across the United States were asked about issues they have encountered in their daily practise that have acted as either barriers or facilitators of patient engagement. Fear of pain, depressed mood and cognitive issues were rated as the most frequently encountered barriers impacting patient engagement. Making therapy tasks meaningful and explicitly related to personal goals of the patient was the most commonly reported practise for enhancing therapeutic engagement. The knowledge of therapists gained from day-to-day experience with patients in rehabilitation can be of use to other rehabilitation professionals in treating patients who are difficult to engage in the rehabilitation process.



Prognostic Factors for Intervention Effect on Neck/Shoulder Symptom Intensity and Disability among Female Computer Workers

It has been suggested that treatments may be more effective when they are matched to patient characteristics. This study aimed at investigating potential prognostic factors for clinically relevant improvement in symptom intensity and symptom-related disability among employees with symptoms in the neck/shoulder area, receiving either ergonomics counseling or such counseling in combination with myofeedback training. A randomized controlled study was performed among female computer users aged 45 or older (n = 36). A clinical examination and a questionnaire survey were performed before inclusion in the study. Symptom intensity and disability was assessed using questionnaires before the start of the interventions (baseline) and at follow-ups directly after the end of the interventions (T0) and after 3 (T3) and 6 (T6) months. Logistic regression analyses were performed in order to assess prognostic factors for clinically relevant improvement in symptom intensity and disability. Improvement in symptom intensity was consistently predicted by symptom intensity at baseline. Diagnosis and stress-induced lack of muscular rest were prognostic factors for improvement in symptom intensity at short term follow-up. Baseline disability and passive coping consistently served as prognostic factors for outcome in disability. Few substantial differences were found between the interventions in terms of prognostic factors. Conclusions Myofeedback training in combination with ergonomics counseling seem to be an especially beneficial tool for secondary prevention among employees with moderate levels of symptom intensity and symptom-related disability, who respond to work-related stress by increased/sustained muscle activation, and who tend to employ passive coping to deal with their neck/shoulder symptoms.


Handicap et travail

Les situations de handicap mettent le monde du travail face à des enjeux importants : trouver des solutions profitables aussi bien aux entreprises qu'aux personnes handicapées, qu'il s'agisse de maintien dans l'emploi, d'insertion ou de réinsertion professionnelle. Ce dossier présente les principales notions à connaître : dispositif réglementaire élaboré « pour l'égalité des droits et des chances, la participation et la citoyenneté des personnes handicapées », structures pouvant aider les entreprises et les salariés dans leurs actions, liens avec la démarche de prévention des risques professionnels.


Returning to work after stroke: a review

This review focuses on the experiences and rehabilitation needs of working age, higher functioning stroke survivors in relation to their 'return to work'. It grew out of the poststroke experience of one of the authors and her realization of the inadequacy of services to facilitate return to work and optimal recovery from stroke. The authors' aim is to present a practice-oriented review that can provide information for future practice and research. Returning to work and sustaining employment are considered key aspects of rehabilitation and recovery by younger stroke survivors. From a psychosocial perspective, successful return to work can enhance recovery and life satisfaction by consolidating self-esteem, confidence and social identity. However, even higher functioning stroke survivors with minimal or no obvious physical disability may experience workplace challenges relating to their neurological condition. Appropriate rehabilitation would include specific preparation for return to work, education within the workplace to facilitate return to work, participation by the stroke survivor in all aspects of the management of their return to work, and an ongoing role for a stroke educator/workplace advocate. In conclusion, further research is required in this area to support stroke survivors in returning to and maintaining employment to achieve their poststroke potential. Thirteen recommendations arising from the existing literature and the lived experience of one of the authors are presented at the end of the review.


Le projet de l'OCDE sur "Maladie, Invalidité et Travail "

Les politiques en faveur des personnes handicapées sont devenues déterminantes dans la plupart des pays de l'OCDE. Les problèmes médicaux liés à l'invalidité augmentent et causent de plus en plus de problèmes non seulement aux personnes mais aussi sur le marché du travail et pour les politiques sociales. De plus en plus de personnes tirent l'essentiel de ses ressources de prestations d'invalidité ou de maladie et les taux d'emploi des personnes handicapées sont faibles.


The Kawa model: The power of culturally responsive occupational therapy
The Kawa (Japanese for river) model, developed by Japanese and Canadian rehabilitation professionals, presents an important and novel alternative to contemporary 'Western' models of rehabilitation. Rather than focussing primarily on the individual client, the Kawa model focusses on 'contexts' that shape and influence the realities and challenges of peoples' day-to-day lives. The first substantial model of rehabilitation practice developed outside of the West illuminates the transactional quality of human-environment dynamics and the importance of inter-relations of self and others through the metaphor of a river's flow. The model's reflection of Eastern thought and views of nature presents a useful point of comparison to familiar rational and mechanical explanations of occupation and well-being. In this article, the rationale for an alternative model in rehabilitation is presented, followed by an explanation of the structure and concepts of the Kawa model. Implications for culturally responsive practice as well as the model's significance to the advancement of culturally safe rehabilitation worldwide are discussed.


Towards a comprehensive approach for managing transitions of older workers with hearing loss

Demographic and legislative trends suggest that many older workers may remain at work past the traditional retirement age. This extended work trajectory poses new challenges and opportunities for workers with acquired hearing loss as they age. Workplaces require a new approach to enable transitions of older workers with hearing loss to remain safe and productive. A review of the literature on older workers, those with hearing loss, and strategies used to accommodate them suggests that individualized and piecemeal approaches are predominant. While universal design represents a fresh ideology that may help create more accessible and usable products and environments, its application to improve workplaces for older workers with hearing loss is limited. This paper proposes that occupational science be integrated with knowledge in hearing sciences, accessibility, and usability to assist with the transitions faced by older workers with hearing loss. A more comprehensive approach including the following three key components will be posited to examine the nexus of aging, hearing loss and work: (1) the use of an occupational perspective, along with concepts in hearing sciences to examine hearing demands and improve hearing access; (2) the use of contextual processes to promote physical and social change, and (3) the inclusion of Universal Design for Hearing (UDH) considerations as stakeholders develop more hearing friendly workplaces.


Evaluating the support needs of injured workers in managing occupational transitions after injury

Background: Historically the supports available to help injured workers transition back to pre-injury jobs focused primarily on the medical treatment of the injury and modifications in the workplace. However, for many injured workers, with chronic disabilities, the need for support extends to learning to live with newly exposed disabilities, managing changes within family and social life as well as meeting new expectations in claims and health management. Supports that many injured workers require to resume employment are not adequately addressed. Objective: A critical social perspective was used to engage a partnership with injured worker group members in the design, implementation and evaluation of injured worker needs to promote social change. This paper reflects a program of research established in partnership with the Canadian Injured Worker Alliance to develop and examine a conceptual framework of supports for use in meeting the transitional needs of injured workers with chronic disabilities. Occupational and educational perspectives were used to develop a conceptual framework comprised of 8 dimensions of support. Method: A regional needs assessment using multi-methods, including surveys, interviews and focus groups, was conducted in British Columbia (BC). Priorities of three stakeholder groups were mapped to the 8 dimensions of support. This conceptual framework was also tested nationally to evaluate the distribution of supports that exist and identify further needs for support to help injured workers manage multiple transitions. Findings: Access to the range of supports that injured workers need in transitioning to and from work is inconsistent and inequitable across Canada. Conclusion: Collaborative approaches and a broader spectrum of resources and supports are needed to help injured workers and their families in resuming meaningful participation in daily, social and productive occupations. 


Perceptions of possibilities of returning to work with chronic musculoskeletal disorders

Chronic musculoskeletal disorders (MSD) are the most common cause of work disability in the western world. Return to work (RTW) with chronic MSD is a complex process dependent on individual and social factors, including individual perceptions of the process. No studies have addressed RTW in the Slovenian context of high job protection legislation. This study was aimed at understanding how Slovenian employees with MSD made sense of their experiences with work and life before and after the occurrence of MSD, giving meaning to their perceptions of the possibility to return to work. Data were collected through narrative interviews with six Slovenian employees with chronic MSD and analyzed with a paradigmatic approach. The participants described their experiences in a narrative of a transition from a life of stability and fulfillment to a life of suspense about their future. The work environment as well as health and disability systems were experienced as the most decisive in the development of those perceptions. The participants linked those experiences, more than the MSD itself, to their feelings of hope, doubt and fear about their possibilities of returning to work. The study shows how narratives about life and work can give meaning to individual perceptions of RTW process in a specific social and work context.


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