2010-01-01 12:00 - Messages

Interactive effects of catastrophizing and suppression on responses to acute pain: a test of an appraisal × emotion regulation model

We examined whether people who tend to catastrophize about pain and who also attempt to regulate negative thoughts and feelings through suppression may represent a distinct subgroup of individuals highly susceptible to pain and distress. Ninety-seven healthy normal participants underwent a 4-min ischemic pain task followed by a 2-min recovery period. Self-reported pain and distress was recorded during the task and every 20 s during recovery. Participants completed the Pain Catastrophizing Scale and the White Bear Suppression Inventory. Repeated measures multiple regression analysis (using General Linear Model procedures) revealed significant 3-way interactions such that participants scoring high on the rumination and/or helplessness subscales of the Pain Catastrophizing Scale and who scored high on the predisposition to suppress unwanted thoughts and feelings reported the greatest pain and distress during recovery. Results suggest that pain catastrophizers who attempt to regulate their substantial pain intensity and distress with maladaptive emotion regulation strategies, such as suppression, may be especially prone to experience prolonged recovery from episodes of acute pain. Thus, emotion regulation factors may represent critical variables needed to understand the full impact of catastrophic appraisals on long-term adjustment to pain.

Source: http://www.springerlink.com/content/cx3h928657348561/

Minimizing the effect of TBI-related physical sequelae on vocational return

This article evaluated the common physical sequelae that affect return to work (RTW) after traumatic brain injury (TBI). We performed a Medline search and evaluation of current TBI rehabilitation texts. The information presented is a combination of published literature and clinical guidelines. The limitations faced by many patients with TBI can best be overcome through clever job search, job redesign, and community linkages with business and industry that are willing to partner in helping the patient with TBI regain employment. The physician plays a key role in communicating suggestions to the vocational specialist. The comorbidities described represent challenges to successful RTW. These problems are recurrent, long-term, and clearly affect job procurement, nature of job, level of required support, and likelihood of job retention. Conversely, these challenges should not be viewed as impenetrable obstacles. With appropriate supports such as compensatory strategies, job coaching, assistive technology, medical management, and job restructuring, successful RTW is viable option. Physicians must focus on employment outcomes in real jobs and not settle for volunteer work, sheltered work, or assessment and planning. Individuals should be placed in real work for real pay. Through close collaboration between the survivor of TBI, the physician, the vocational specialist, and community resources, successful employment for survivors of TBI is possible and must be prescribed a high value.

Source: http://www.rehab.research.va.gov/jour/09/46/6/pdf/mcnamee.pdf

Common Health Problems, Yellow Flags and Functioning in a Community Setting

Common health problems such as pain, depression and fatigue have a high impact on daily life, work and healthcare utilization. This study aimed to investigate the prevalence of these complaints in a UK community setting and to establish whether psychosocial risk factors, or ‘yellow flags', moderate their impact on daily life and work. Methods 580 women and 420 men participated in a cross-sectional survey in the UK in 2007. 467 (57.2%) of the 816 working age adults in this sample reported complaints over the last month and were included in the moderator multivariate analysis. Results Women and the not employed group reported a higher number and greater extent (frequency × severity) of complaints. Statistically significant models emerged for interference with daily life (...) were associated with time off work. Extent of complaints and number of yellow flags were independently associated with interference with daily life (...). No moderating effect of yellow flags was found. Conclusions Common health problems and yellow flags can be briefly and simply assessed. A broader approach is needed in managing these complaints in community and work contexts, moving beyond reducing complaint severity. Interventions need to acknowledge and address people's beliefs and affective responses to complaints, as well as wider socio-economic issues.

Source: http://www.springerlink.com/content/m8r47088g49g8h2t/

Factors Associated with Work Participation and Work Functioning in Depressed Workers: A Systematic Review

Background Depression is associated with negative work outcomes such as reduced work participation (WP) (e.g., sick leave duration, work status) and work functioning (WF) (e.g., loss of productivity, work limitations). For the development of evidence-based interventions to improve these work outcomes, factors predicting WP and WF have to be identified. Methods This paper presents a systematic literature review of studies identifying factors associated with WP and WF of currently depressed workers. Results A total of 30 studies were found that addressed factors associated with WP (N = 19) or WF (N = 11). For both outcomes, studies reported most often on the relationship with disorder-related factors, whereas personal factors and work-related factors were less frequently addressed. For WP, the following relationships were supported: strong evidence was found for the association between a long duration of the depressive episode and work disability. Moderate evidence was found for the associations between more severe types of depressive disorder, presence of co-morbid mental or physical disorders, older age, a history of previous sick leave, and work disability. For WF, severe depressive symptoms were associated with work limitations, and clinical improvement was related to work productivity (moderate evidence). Due to the cross-sectional nature of about half of the studies, only few true prospective associations could be identified. Conclusion Our study identifies gaps in knowledge regarding factors predictive of WP and WF in depressed workers and can be used for the design of future research and evidence-based interventions. We recommend undertaking more longitudinal studies to identify modifiable factors predictive of WP and WF, especially work-related and personal factors.

Source: http://www.springerlink.com/content/y82767285226004k/

The Friction Model – a dynamic model of functioning, disability and contextual factors and its conceptual and practical applicability

Purpose.To develop a model of the dynamics of functioning, disability and contextual factors which harmonises with the International Classification of Functioning, Disability and Health (ICF). Method.Model parts based on ICF were identified and a model drawing from engineering concepts was developed. The conceptual and practical applicability of the model was discussed. Results.The so called Friction Model was created, which incorporates the ICF entities capacity, performance, environmental factors, health condition, body functions and structures, and personal factors. Friction describes the interaction between a person and his or her environment. The coefficient of friction is defined as the ratio between capacity and performance. Conclusion.Carrying conceptual strengths and limitations, the Friction Model appears to offer opportunities for practical applications, including ICF-based alternatives to health–economic analyses. Harmonising with the ICF model and terminology, the model uses friction to describe the interaction between a person and the environment. The coefficient of friction can be used as a simple measure of how facilitating an environment is. The applicability is not limited to functioning of people with impairments.

Source: http://informahealthcare.com/doi/abs/10.3109/09638280903531220

Emploi et invalidité

Éviter l'impasse
Les maladies chroniques et l'invalidité sont des facteurs essentiels de chômage et d'exclusion du monde professionnel. Lorsqu'on leur parle de «personnes handicapées», la plupart des gens pensent aux invalides de naissance ou aux personnes qui le sont devenues à la suite d'une maladie ou d'un accident. Toutefois, pour le marché du travail, ces termes désignent des personnes qui avaient un travail mais qui bénéficient à présent d'allocations d'invalidité pour leur longue absence du marché de l'emploi. Les personnes invalides ne sont plus en relation avec leur employeur et demandent à bénéficier d'une allocation d'invalidité temporaire ou permanente. Pour la plupart de ces personnes leur invalidité est apparue au cours de leur vie professionnelle.

Source : http://www.eurofound.europa.eu/publications/htmlfiles/ef091092_fr.htm

Physical conditioning program for improving work outcomes in workers with back pain
The main goal of physical conditioning programs, sometimes called work conditioning, work hardening or functional restoration/exercise programs, is to return injured or disabled workers to work or improve the work status for workers performing modified duties. Such programs either simulate or duplicate work, functional tasks, or both, in a safe, supervised environment. These tasks are structured and progressively graded to increase psychological, physical and emotional tolerance and improve endurance and work feasibility. In such environments, injured workers learn appropriate job performance skills in addition to improving their physical condition, through an exercise program aimed at increasing strength, endurance, flexibility, and cardiovascular fitness. Work hardening programs are individualized, work-oriented activities that involve clients in simulated or actual work tasks. Work conditioning is a program with an emphasis on physical conditioning that addresses the issues of strength, endurance, flexibility, motor control, and cardiopulmonary function. Functional restoration refers to any intervention aimed at restoring a reasonable functional level for daily living including work. Based on 23 included studies, we analysed eight comparisons of physical conditioning programs versus care as usual or other types of interventions, such as standard exercise therapy for different durations of back pain and follow-up times. We divided physical conditioning programs into a light or an intense program depending on its intensity and duration. Results showed that light physical conditioning program have no significant effect on sickness absence duration for workers with subacute or chronic back pain. We found conflicting results for intense physical conditioning programs for workers with subacute back pain. Further analysis suggested a positive effect on sick leave when the workplace was involved in the intervention. Physical conditioning programs probably have a small effect on return-to-work in workers with chronic back pain. We found conflicting results for intense physical conditioning programs compared to other exercise therapy in the first two years of sick leave. No difference in effect was found between a light or an intense physical conditioning program. We found that cognitive behavorial therapy probably has no value as an alternative, or in addition to physical conditioning programs.
Les bonnes pratiques des entreprises en matière de maintien et de retour en activité professionnelle des seniors en Nord - Pas de Calais

Cette étude a pour thème les bonnes pratiques des entreprises en matière de maintien et de retour en activité professionnelle des seniors. Les actions conduites dans 40 entreprises dont 10 en Nord Pas de Calais, ont été recensées, décrites qualifiées de manière en tirer des enseignements, lesquels sont à certaines conditions, généralisables et transposables à d'autres entreprises, dans une perspective d'allongement de la vie professionnelle.
Ce rapport présente les enseignements de l'étude nationale à la lueur des bonnes pratiques développées dans 10 entreprises de la région Nord-Pas de Calais.

Source : http://www.npdc.aract.fr/IMG/pdf/docaract9.pdf

La notion de handicap

Métaphore politique et point de ralliements des corporatismes
Il a déjà été amplement démontré que divers usages de la notion de handicap sont liés à des enjeux politiques, économiques, corporatistes.
Dans cet article fondé sur une analyse historique des usages de cette notion, nous montrons que leur évolution ne s'inscrit pas dans une démarche de connaissance mais dans une démarche normative orientée vers la recherche d'un consensus politique entre divers groupes de pression et diverses branches professionnelles.
Il en résulte que l'usage de cette notion dans une pratique scientifique ne peut être que déconseillé, sauf à en produire une définition opératoire fondée sur des distinctions non ambigües entre altérations organiques, dysfonctionnements et handicaps.
L'élaboration d'une structure conceptuelle opératoire et l'abandon de la quête compulsive d'un terme générique constituent aujourd'hui une tâche prioritaire et urgente. Elle conditionne la possibilité d'une analyse précise des relations entre les divers ordres de phénomènes concernés.

Source : http://www.revue-interactions.fr/revue/pagint/revue/article.php?cidarticle=71

La « Classification québécoise » dite « Processus de production du handicap » peut-elle contribuer à la production de connaissances et aider à la prise de décisions ?

Des travaux menés par le « Comité Québécois sur la Classification internationale des déficiences, incapacités et handicaps » parallèlement au processus de révision de l'I.C.I.D.H., ont conduit à la production d'une « classification » distincte de celle de l'O.M.S. La troisième version de cette « classification », dite « Processus de production du handicap », publiée en 1998 –considérée par ses promoteurs comme une version finale, achevée et validée – semble se situer en concurrence plutôt qu'en complémentarité de celle de l'O.M.S.
Intitulé « Classification », ce texte est en fait constitué de 5 documents distincts intitulés « nomenclature », dont aucun ne possède les propriétés formelles d'une classification.  L'expression « Processus de production du handicap » n'y renvoie pas à un ensemble délimité d'objets ou d'espèces susceptibles d'être classés mais constitue le nom propre d'un « modèle » qui se présente comme « modèle explicatif des causes et conséquences des maladies, traumatismes et autres atteintes à l'intégrité et au développement de la personne »
L'analyse de ces différentes nomenclatures montre que celles-ci n'ont pas été conçues en fonction d'un objectif général d'« explication » du « processus de production du handicap », autrement dit « processus de production de l'exclusion sociale » et qu'elles ne peuvent prétendre y contribuer de façon significative.  A contrario, l'objectif principal en fonction duquel ce document a été conçu semble être de fournir à des « experts » un moyen d'établir des « profils individuels » à partir de jugements portés sur des personnes, sur la nature et l'étendue de leurs « besoins », leur « appartenance à un groupe cible », leurs droits à « indemnisation ».

Source : http://www.revue-interactions.fr/revue/pagint/revue/article.php?cidarticle=70

Determinants of return to work after long-term sickness absence in six Danish municipalities

BACKGROUND: Different follow-up times and methods in return to work (RTW) research make it difficult to compare results between studies, and not all intervention effects and determinants may be constant over time. AIMS: This study aimed to describe the RTW process of a population of long-term sickness-absent workers over a 3-year period in terms of the effect of selected determinants over time. METHODS: A total of 7780 sickness-absent persons were registered by social workers in six different municipalities and were followed up for 2 to 3 years. Estimates from multiple logistic regression analyses conducted for every 4 weeks were plotted against time to identify changes in the effects of selected determinants. RESULTS: After 1.5 years, 55.2% of the population had returned to work and this level was maintained through the remaining follow-up period. All the included potential determinants were found to be significantly related to RTW at 1 and 3 years. The effects of sex, ethnicity, and income were found to be nearly constant over time. The effects of municipality, diagnosis, and age changed markedly over time and mostly during the first year. CONCLUSIONS: RTW increased during the first 1.5 years after which a steady level was maintained. The effect of diagnosis, age, and municipality changed markedly over time.

Source (from PubMed): http://www.ncbi.nlm.nih.gov/pubmed/20056786?itool=Email.EmailReport.Pubmed_ReportSelector.Pubmed_RVDocSum&ordinalpos=1

Toward a Climate for Work Resumption: The Nonmedical Determinants of Return to Work

Objective: People who have been on long-term absence from work because of ill health usually have reduced chances to resume work again. Nevertheless, little is known about its causal factors. The aim of this study is to present and test an empirical model to predict return to work of employees who are long-term absent for physical- or mental ill health reasons. Method: A longitudinal study has been performed with a sample of long-term absents in five European countries (N = 1460). Results: Health improvement is necessary but it alone not sufficient as precondition for return to work. Psychological factors (ie, self-efficacy, depression) and organizational factors have the highest impact. Conclusions: A climate for work resumption and its implications for personnel management practices to reduce/prevent workers to remain in absence leave when the medical symptoms have disappeared are discussed.

Source: http://journals.lww.com/joem/Abstract/publishahead/Toward_a_Climate_for_Work_Resumption__The.99865.aspx

Job-Related Osteoarthritis of the Knee, Foot, Hand, and Cervical Spine

Objectives: To assess the influence of occupational exposures on risk of site-specific radiographic osteoarthritis (OA) of the knee, hand, foot, and cervical spine. Methods: Using a cross-sectional design, data collected from men and women aged 40 years and older participating in the Clearwater Osteoarthritis Study were analyzed (n = 3436). Subjects' occupational exposures were queried using the study intake form, including stair climbing, standing on a rigid surface, squatting, and jolting. Physical examinations including radiographs of the knee, hand, foot, and cervical spine were conducted. The Kellgren and Lawrence ordinal scale was used to determine evidence of radiographic OA. Results: Both the unadjusted and adjusted odds ratios (ORs) for men and women indicated that age and body mass index were associated with OA. There were no other significant odds ratios for the cervical spine. Among men, there were significant associations with knee OA for stair climbing and jolting of the legs and with foot OA with stair climbing. Among women, there was a significant association between standing on a rigid surface and knee OA. For hand OA in women, there was a significant association for jolting of the hands. Conclusions: Although the association with stair climbing was found in other investigations for knee OA, it was also associated with foot OA in this study. In addition, the jolting feature was seen in only one other study for men (knees) and novel for women (hands).

Source: http://journals.lww.com/joem/Abstract/publishahead/Job_Related_Osteoarthritis_of_the_Knee,_Foot,.99859.aspx

Bio-psychosocial determinants of time lost from work following non life threatening acute orthopaedic trauma

Background: To determine factors predicting the duration of time away from work following acute orthopaedic non life threatening trauma. Methods: Prospective cohort study conducted at four hospitals in Victoria, Australia. The cohort comprised 168 patients aged 18-64 years who were working prior to the injury and sustained a range of acute unintentional orthopaedic injuries resulting in hospitalization Baseline data was obtained by survey and medical record review. Multivariate Cox proportional hazards regression analysis was used to examine the association between potential predictors and the duration of time away from work during the six month study. The study achieved 89% follow-up. Results: Of the 168 participants recruited to the study, 68% returned to work during the six month study. Multivariate Cox proportional hazards regression analysis identified that blue collar work, negative pain attitudes with respect to work, high initial pain intensity, injury severity, older age, initial need for surgery, the presence of co-morbid health conditions at study entry and an orthopaedic injury to more than one region were associated with extended duration away from work following the injury. Participants in receipt of compensation who reported high social functioning at two weeks were 2.58 times more likely to have returned to work than similar participants reporting low social functioning. When only those who had returned to work were considered, the participant reported reason for return to work " to fill the day" was a significant predictor of earlier RTW [RR 2.41 (95% C.I 1.35-4.30)] whereas "financial security" and "because they felt able to" did not achieve significance. Conclusions: Many injury-related and psycho social factors affect the duration of time away from work following orthopaedic injury. Some of these are potentially modifiable and may be amenable to intervention. Further consideration of the reasons provided by participants for returning to work may provide important opportunities for social marketing approaches designed to alleviate the financial and social burden associated with work disability.

Source: http://www.biomedcentral.com/1471-2474/11/6/abstract

Controlled 3-year follow-up of a multidisciplinary pain rehabilitation program in primary health care

Purpose. The high prevalence of musculoskeletal pain generates significant costs for primary health care and the whole of society. The development of appropriate interventions is therefore necessary. The aim of this effectiveness study was to assess the long-term effects of a primary health care multidisciplinary rehabilitation program in Sweden. Methods. An experimental group comprising 89 patients from two primary health care units received individualised treatment interventions after a multidisciplinary investigation. A control group of 69 patients with the same inclusion criteria from four other primary health care units were treated according to routine. All participants completed questionnaires measuring pain, sick leave, quality of life, health care utilisation, drug consumption and psychosocial factors at baseline and at 3-year follow-up. Results. After 3 years, utilisation of primary health care was significantly lower in the experimental group and work capacity was slightly but not significantly higher. The control group showed a trend of having a higher risk of high consumption after 3 years compared to the intervention group. There was no significant difference between the two groups concerning remaining variables such as function, catastrophising and pain. Conclusion. Both groups demonstrated considerable improvement over the course of 3 years. The experimental group had lower health care utilisation and a reduced risk of using large amounts of medication at the 3-year follow-up, indicating that compared with participants in the control group they were coping in a better way with pain.

Source: http://informahealthcare.com/doi/abs/10.3109/09638280903095924

A community-based exercise and education scheme for stroke survivors: a randomized controlled trial and economic evaluation

Objective: The evaluation of a community-based exercise and education scheme for stroke survivors. Design: A single blind parallel group randomized controlled trial. Setting: Leisure and community centres in the south-west of England. Subjects: Stroke survivors (median (IQR) time post stroke 10.3 (5.4—17.1) months). 243 participants were randomized to standard care (124) or the intervention (119). Intervention: Exercise and education schemes held twice weekly for eight weeks, facilitated by volunteers and qualified exercise instructors (supported by a physiotherapist), each with nine participants plus carers or family members. Method: Participants were assessed by a blinded independent assessor at two weeks before the start of the scheme, nine weeks and six months. One-year follow-up was by postal assessment. Main measures: Primary outcomes: Subjective Index of Physical and Social Outcome (SIPSO); Frenchay Activities Index; Rivermead Mobility Index. NHS, social care and personal costs. Secondary outcomes included WHOQoL-Bref. Analysis: Intention-to-treat basis, using non-parametric analysis to investigate change from baseline. Economic costs were compared in a cost-consequences analysis. Results: There were significant between-group changes in SIPSO physical at nine weeks (median (95% confidence interval (CI)), 1 (0, 2): P = 0.022) and at one year (0 (—1, 2): P = 0.024). (WHOQol-Bref psychological (6.2 (—0.1, 9.1): P = 0.011) at six months. Mean cost per patient was higher in the intervention group. The difference, excluding inpatient care, was £296 (95% CI: —£321 to £913). Conclusion: The community scheme for stroke survivors was a low-cost intervention successful in improving physical integration, maintained at one year, when compared with standard care.

Source: http://cre.sagepub.com/cgi/content/abstract/24/1/3?etoc

Meeting stroke survivors’ perceived needs: a qualitative study of a community-based exercise and education scheme

Objective: A qualitative study using a phenomenological approach, to explore stroke survivors’ needs and their perceptions of whether a community stroke scheme met these needs. Methods: Semi-structured in-depth interviews of 12 stroke survivors, purposively selected from participants attending a new community stroke scheme. Interpretative phenomenological analysis of interviews by two researchers independently. Results: Participants attending the community stroke scheme sought to reconstruct their lives in the aftermath of their stroke. To enable this they needed internal resources of confidence and sense of purpose to ‘create their social self’, and external resources of ‘responsive services’ and an ‘informal support network’, to provide direction and encouragement. Participants felt the community stroke scheme met some of these needs through exercise, goal setting and peer group interaction, which included social support and knowledge acquisition. Conclusion: Stroke survivors need a variety of internal and external resources so that they can rebuild their lives positively post stroke. A stroke-specific community scheme, based on exercise, life-centred goal setting, peer support and knowledge acquisition, is an external resource that can help with meeting some of the stroke survivor’s needs.

Source: http://cre.sagepub.com/cgi/content/abstract/24/1/16?etoc

Long-term adjustment to work-related low back pain: associations with socio-demographics, claim processes, and post-settlement adjustment

OBJECTIVE: Predict long-term adjustment (pain intensity, pain-related catastrophizing, and pain-related disability) from socio-demographic, claim process, and post-settlement adjustment variables in a cohort of 374 Workers' Compensation low back claimants. METHODS: Age- and gender-matched subsamples of African Americans and Caucasians were randomly selected for long-term follow-up (6 years post-settlement) from a larger, existing cohort of Workers' Compensation low back claimants in Missouri. Computer-assisted telephone interviews were used to assess pain, catastrophizing, and disability. Path analysis and logistic regression analysis were used to predict long-term adjustment from socio-demographic variables (race, gender, age, and socioeconomic status), Workers' Compensation claim process variables (surgery, diagnosis, claim duration, treatment costs, settlement awards, and disability rating), and adjustment at baseline. RESULTS: Poorer long-term adjustment (higher levels of pain, catastrophizing, and pain-related disability) was significantly predicted by relatively poorer adjustment at baseline, lower socioeconomic status, and African American race. African American race associations were also mediated through lower socioeconomic status. Higher levels of occupational disability, as measured by long-term rates of unemployment and social security disability, were also predicted by African American race (in addition to age and claim process factors). CONCLUSION: Long-term adjustment to low back pain in this cohort of Workers' Compensation claimants was stable, relative to short-term adjustment soon after settlement. Long-term adjustment was worse for people of lower socioeconomic status, particularly for economically disadvantaged African Americans, suggesting the possibility of race- and class-based disparities in the Workers' Compensation system.

Source: http://www3.interscience.wiley.com/journal/123191944/abstract

The Economic Impact of a Disability Prevention Program

We evaluated the effect of an employer- and clinic-based intervention on indemnity, medical, and workers compensation costs. The intervention was designed to improve communication and coordination of employer and physician efforts to help employees with work-related injuries to return-to-work. The research design was a quasi-experimental comparison of expenditures in treatment and control employers and clinics, controlling for differences in baseline expenditures and other characteristics of the subjects. We estimated that the employer and clinic interventions produced combined savings of $490 per employee per year (21% of total health expenditures). Ninety-four percent of savings came from reduced medical expenditure. Our findings suggest that relative modest efforts at coordinating appropriate medical care with employer accommodation that allow early reintegration of injured workers back into the workforce could result in substantial reductions of medical expenditures.

Source: http://journals.lww.com/joem/Abstract/publishahead/The_Economic_Impact_of_a_Disability_Prevention.99861.aspx

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