2010-03-01 12:00 - Messages

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CAB evidence on the ESA work capability assessment
Employment and support allowance (ESA) was introduced in October 2008 to replace the existing incapacity benefit (IB) for new claimants. It aims to give more help to those who might, with support, be able to work. Citizens Advice has been monitoring the impact of the new benefit, and this is our second report since its introduction. Limited capability, published in November 2009,
covered the administration of the benefit, and this report looks at the assessment process. Bureaux advisers have expressed grave concern at the number of people unexpectedly being found fit for work. This report therefore examines three key aspects of the ESA assessment process: who is being selected for the work capability assessment (WCA); its design and content; and how it is
carried out in practice.

Source : http://www.citizensadvice.org.uk/not_working

Development of the Reasonable Accommodation Factor Survey: Results and Implications

The purpose of this study was (a) to explore the latent factors in the Reasonable Accommodation Factor Survey (RAFS) instrument and (b) to compare scores on the latent factors of the RAFS by participant's role. Eight latent factors were identified through an exploratory factor analysis with orthogonal rotation. The reliability tests indicated satisfactory reliability scores on each of the eight latent factors of the RAFS. Comparison of scores by roles of stakeholders (employee, employer, and service provider) indicated statistically significant differences in scores on three latent factors: Employee Competence in Reasonable Accommodation, Workplace Impact, and Employee Work Record. Implications for practice and research are discussed.

Source: http://rcb.sagepub.com/cgi/content/abstract/53/3/153

Quality of life assessed with Short Form 36 – a comparison between two populations with long-term musculoskeletal pain disorders

To assess quality of life (QoL) in two groups of patients with long-term musculoskeletal pain with and without psychiatric co-morbidity and to compare them with a reference group of normative controls. The patients in both study groups were sick-listed full or part time for 3 months or more. Method.The patients were recruited from a company health service and consulting psychiatry. A generic QoL questionnaire, the SF-36, was used to assess QoL. Each group was compared with age- and gender-matched normative controls. Results.Both groups reported a pronounced impairment of QoL (p<0.001) compared with their age- and gender-matched populations. The greatest impairment was seen among the patients referred for psychiatric assessment (n=30). The patients in the company health service (n=42) reported significantly higher QoL with regard to the dimensions mental health (p<0.028), social functioning (p<0.034) and role emotional (p<0.040) compared with the patients referred for psychiatric assessment. Conclusion.Patients with long-term pain in the company health care and patients with psychiatric co-morbidity, sick-listed full or part-time reported severely impaired QoL with regard both to physical, social and mental dimensions. Psychiatric co-morbidity reported even more pronounced impairment of emotional, social and mental dimensions of QoL which might indicate dysfunctional coping strategies.

Source: http://informahealthcare.com/doi/abs/10.3109/09638281003734383

Cost-effectiveness of a participatory return-to-work intervention for temporary agency workers and unemployed workers sick-listed due to musculoskeletal disorders: design of a randomised controlled trial

Within the working population there is a vulnerable group: workers without an employment contract and workers with a flexible labour market arrangement, e.g. temporary agency workers. In most cases, when sick-listed, these workers have no workplace/employer to return to. Also, for these workers access to occupational health care is limited or even absent in many countries. For this vulnerable working population there is a need for tailor-made occupational health care, including the presence of an actual return-to-work perspective. Therefore, a participatory return-to-work program has been developed based on a successful return-to-work intervention for workers, sick-listed due to low back pain. The objective of this paper is to describe the design of a randomised controlled trial to study the (cost-)effectiveness of this newly developed participatory return-to-work program adapted for temporary agency workers and unemployed workers, sick-listed due to musculoskeletal disorders, compared to usual care. The design of this study is a randomised controlled trial with one year of follow-up. The study population consists of temporary agency workers and unemployed workers sick-listed between 2 and 8 weeks due to musculoskeletal disorders. The new return-to-work program is a stepwise program aimed at making a consensus-based return-to-work implementation plan with the possibility of a (therapeutic) workplace to return-to-work. Outcomes are measured at baseline, 3, 6, 9 and 12 months. The primary outcome measure is duration of the sickness benefit period after the first day of reporting sick. Secondary outcome measures are: time until first return-to-work, total number of days of sickness benefit during follow-up; functional status; intensity of musculoskeletal pain; pain coping; and attitude, social influence and self-efficacy determinants. Cost-benefit is evaluated from an insurer's perspective. A process evaluation is part of this study. For sick-listed workers without an employment contract there can be gained a lot by improving occupational health care, including return-to-work guidance, and by minimising the 'labour market handicap' by creating a return-to-work perspective. In addition, reduction of sickness absence and work disability, i.e. a reduction of disability claims, may result in substantial benefits for the Dutch Social Security System.

Source: http://www.biomedcentral.com/1471-2474/11/60

The Epidemiology, Etiology, Diagnosis, and Treatment of Osteoarthritis of the Knee

Osteoarthritis is the most common joint disease of adults worldwide. Its incidence rises with age. Both intrinsic and extrinsic risk factors promote its development. In men aged 60 to 64, the right knee is more commonly affected; in women, the right and left knees are affected with nearly equal frequency.
Methods: The PubMed, Medline, Embase and Cochrane Library data-bases were selectively searched for current studies (up to September 2009; case reports excluded) on the epidemiology, etiology, diagnosis, staging, and treatment of osteoarthritis of the knee. The search terms were “gonarthrosis,” “prevention,” “conservative treatment,” “joint preservation,” “physical activity,” “arthroscopy,” “osteotomy,” “braces,” “orthoses,” and “osteoarthritis knee joint.”
Results and Conclusion: Osteoarthritis is not yet a curable disease, and its pathogenesis remains unclear. The best treatment for osteoarthritis of the knee is prevention. The goal of therapy is to alleviate clinical manifestations. The therapeutic spectrum ranges from physiotherapy and orthopedic aids to pharmacotherapy and surgery.

Source: http://www.aerzteblatt.de/int/article.asp?src=heft&id=68000

Evaluation of evidence within occupational therapy in stroke rehabilitation

Evidence-based practice creates practice that integrates research-driven evidence with clinical expertise and patients' preferences in clinical decision-making. Aim: The aim of this study was to investigate and evaluate the quality and applicability of scientific research in occupational therapy intervention related to the use of everyday life occupations and client-centred practice within stroke rehabilitation. Design: Systematic searches of research studies published in English during 2000–2007 in peer-reviewed journals were undertaken. Thirty-nine articles and one Cochrane review were appraised and the quality evaluated using an evidence taxonomy and an evidence hierarchy. Results: Evidence arose providing support for a client-centred approach, entailing outcome related to better ability to recall goals, the patients feeling more involved and able to manage more everyday life occupations after rehabilitation. There is also considerable evidence for the use of everyday life occupations in occupational therapy. Occupational therapy was evaluated as an important aspect of stroke rehabilitation improving outcomes in everyday life occupations including activities of daily living (ADL) and participation. Discussion: As research of relevance for the profession to a large extent includes qualitative research it gives rise to reflection on including more tools than the evidence hierarchy while evaluating evidence within occupational therapy.

Source: http://informahealthcare.com/doi/abs/10.3109/11038120903563785

The integration of bio-medicine and culturally based alternative medicine: implications for health care providers and patients

Complementary and alternative medicine (CAM) are therapies used along with or in place of bio-medicine. Many forms of CAM originate in culture, referred to as culturally based alternative medicines. Usage of CAM is high with large numbers of patients using CAM for mental health, pain and musculoskeletal problems. Their desire for holistic care may be the impetus for this interest, as alternative care practitioners spend more time analyzing illness symptoms. These factors along with the global migration of immigrants accustomed to traditional medicine but now immersed in biomedical health care systems, has created potential for misunderstanding. Drug interactions for some forms of CAM taken with bio-medicine can occur. Insufficient scientific studies about CAM has reduced acceptance and educational opportunities to learn about CAM are limited. Ideas for policy and research are forming.

Source: http://ped.sagepub.com/cgi/content/abstract/16/4/65

Retention, reintegration and rehabilitation of workers who have suffered chronic diseases

A new site provides guidance for the retention, reintegration and rehabilitation of workers who have suffered chronic diseases, and how to retain these workers in the work process. The site is an outcome of a pan-European project on the topic and addresses very diverse risks from cancer, musculoskeletal disorders to multiple sclerosis and infectious diseases such as hepatitis and AIDS. The project was supported by the European Social Fund.
The documentary tool kit provides information as well as recommendations for the use of OSH and other prevention actors, such as ergonomists, OSH practitioners safety engineers and social workers, who are confronted with concrete cases in enterprises.

Source : http://osha.europa.eu/en/news/FR-Chronical-diseases

Site Emploi et maladies chroniques évolutives : http://www.maladie-chronique-travail.eu/

The Epidemiology, Etiology, Diagnosis, and Treatment of Osteoarthritis of the Knee

incidence rises with age. Both intrinsic and extrinsic risk factors promote its development. In men aged 60 to 64, the right knee is more commonly affected; in women, the right and left knees are affected with nearly equal frequency.
Methods: The PubMed, Medline, Embase and Cochrane Library data-bases were selectively searched for current studies (up to September 2009; case reports excluded) on the epidemiology, etiology, diagnosis, staging, and treatment of osteoarthritis of the knee. The search terms were “gonarthrosis,” “prevention,” “conservative treatment,” “joint preservation,” “physical activity,” “arthroscopy,” “osteotomy,” “braces,” “orthoses,” and “osteoarthritis knee joint.”
Results and Conclusion: Osteoarthritis is not yet a curable disease, and its pathogenesis remains unclear. The best treatment for osteoarthritis of the knee is prevention. The goal of therapy is to alleviate clinical manifestations. The therapeutic spectrum ranges from physiotherapy and orthopedic aids to pharmacotherapy and surgery.

Source: http://www.aerzteblatt.de/int/article.asp?id=68000

A Biopsychosocial Perspective on the Management of Work-Related Musculoskeletal Disorders

This article provides an overview of current literature about workplace-related musculoskeletal disorders from a biopsychosocial perspective. The authors conclude that disability management and early intervention efforts can only be meaningful within the context of targeted interventions, including mechanisms for psychosocial screening. In addition, they suggest that return to work should be considered an integral, rather than superficial, contribution to the rehabilitative process.

Source: http://www.aaohnjournal.com/showAbst.asp?thing=62185

Relationship between competency in activities, injury severity, and post-concussion symptoms after traumatic brain injury

Objective: To determine to what extent injury severity and post-concussion symptoms after 3 months predict ability in activities 12 months after traumatic brain injury (TBI) and assess the frequency of problems in daily activities. Methods: A one-year cohort of 63 persons with mild to severe TBI was assessed on admission, after three and 12 months. Injury severity was assessed using the Glasgow Coma Scale, Abbreviated Injury Scale for the head and Injury Severity Score. Post-concussion symptoms were reported using the Rivermead Post Concussion Symptoms Questionnaire after three months. The Patient Competency Rating Scale (PCRS), a self-rating scale of ability in activities, was applied 12 months post-injury. The PCRS consists of the domains interpersonal/emotional and cognitive competency, and instrumental ADL. Multiple backward regression models were performed with the three subscales of PCRS as dependent variables. Results: Activity problems at 12 months were related to perceived cognitive and interpersonal/emotional competency. Post-concussion symptoms reported at three-month follow-up were main predictors of cognitive and interpersonal/emotional competency at 12 months. Injury severity predicted only cognitive competency. Conclusion: Symptoms evolving after the trauma seem to be the strongest predictor of perceived ability in activities in this population. This underlines the need for follow-up after TBI to identify persons at risk of developing long-term activity limitations.

Source: http://informahealthcare.com/doi/abs/10.3109/11038120903171295

British pain clinic practitioners' recognition and use of the bio-psychosocial pain management model for patients when physical interventions are ineffective or inappropriate: results of a qualitative study

Background: To explore how chronic musculoskeletal pain is managed in multidisciplinary pain clinics for patients for whom physical interventions are inappropriate or ineffective. Methods: A qualitative study was undertaken using semi-structured interviews with twenty five members of the pain management team drawn from seven pain clinics and one pain management unit located across the UK. Results: All clinics reported using a multidisciplinary bio-psychosocial model. However the chronic pain management strategy actually focussed on psychological approaches in preference to physical approaches. These approaches were utilised by all practitioners irrespective of their discipline. Consideration of social elements such as access to social support networks to support patients in managing their chronic pain was conspicuously absent from the approaches used. Conclusions: Pain clinic practitioners readily embraced cognitive/behavioural based management strategies but relatively little consideration to the impact social factors played in managing chronic pain was reported. Consequently multidisciplinary pain clinics espousing a bio-psychosocial model of pain management may not be achieving their maximum potential.

Source: http://www.biomedcentral.com/1471-2474/11/51

International Encyclopedia of Rehabilitation

The International Encyclopedia of Rehabilitation is a collaborative effort from the Center for International Rehabilitation Research Information and Exchange (CIRRIE), at the University at Buffalo, SUNY, and the Laboratoire d'informatique et de terminologie de la réadaptation et de l'intégation sociale (LITRIS), from the Institut de réadaptation en déficience physique de Québec (IRDPQ). On its completion, the encyclopedia will include four hundred articles on rehabilitation and disability topics identified through terms found in the CIRRIE and REHABDATA Thesauri, the World Health Organization's International Classification of Functioning, Disability and Health (ICF) and the International Index and Dictionary of Rehabilitation and Social Integration (IIDRIS). Links among the encyclopedia, CIRRIE and REHABDATA databases, the dictionary and other databases will create an integrated information system and a comprehensive synthesis of the field of rehabilitation in a free, accessible, online, multilingual encyclopedia in English, French, and Spanish.

Source: http://cirrie.buffalo.edu/encyclopedia/index.php

Randomised controlled trial of integrated care to reduce disability from chronic low back pain in working and private life

Objective To evaluate the effectiveness of an integrated care programme, combining a patient directed and a workplace directed intervention, for patients with chronic low back pain. Design Population based randomised controlled trial. Setting Primary care (10 physiotherapy practices, one occupational health service, one occupational therapy practice) and secondary care (five hospitals). Participants 134 adults aged 18-65 sick listed for at least 12 weeks owing to low back pain. Intervention Patients were randomly assigned to usual care (n=68) or integrated care (n=66). Integrated care consisted of a workplace intervention based on participatory ergonomics, involving a supervisor, and a graded activity programme based on cognitive behavioural principles. Main outcome measures The primary outcome was the duration of time off work (work disability) due to low back pain until full sustainable return to work. Secondary outcome measures were intensity of pain and functional status. Results The median duration until sustainable return to work was 88 days in the integrated care group compared with 208 days in the usual care group (P=0.003). Integrated care was effective on return to work (hazard ratio 1.9, 95% confidence interval 1.2 to 2.8, P=0.004). After 12 months, patients in the integrated care group improved significantly more on functional status compared with patients in the usual care group (P=0.01). Improvement of pain between the groups did not differ significantly. Conclusion The integrated care programme substantially reduced disability due to chronic low back pain in private and working life.

Source: http://www.bmj.com/cgi/content/abstract/340/mar16_1/c1035?maxtoshow=&hits=10&RESULTFORMAT=&fulltext=Lambeek&searchid=1&FIRSTINDEX=0&sortspec=date&resourcetype=HWCIT

Correlates of Upper Extremity Disability in Medical Transcriptionists

Objective To investigate the association between disability and personal/lifestyle, medical, and psychosocial risk factors for upper extremity musculoskeletal symptoms and disorders (UEMSDs) in medical transcriptionists. Methods A web-based survey involving the Disabilities of the Arm, Shoulder and Hand (DASH), Perceived Stress Scale (PSS) and Overall Job Satisfaction (OJS) questionnaires of all medical transcriptionists working at a large healthcare facility. Results Responses were received from 80% (251 of 314) possible participants. Mean DASH, PSS, and OJS scores for those working at their current position for at least 1 year were 8.5 ± 10.1, 14.3 ± 6.7 and 5.3 ± 0.9. Personal/lifestyle factors including age (P < 0.001), lower educational level (P = 0.014), current or previous smoking (P = 0.012), and limited exercise (P = 0.013); medical conditions including diabetes mellitus (P = 0.015), carpal tunnel syndrome (P < 0.001), prior treatment for upper extremity symptoms (P < 0.001); prior workstation evaluation (P < 0.001) and psychosocial factors of perceived stress (P < 0.001), are associated with increased DASH scores. In these workers, multivariate analysis suggests that medical conditions (finger or other upper extremity symptoms requiring treatment or workstation evaluation; and diabetes mellitus) have a larger effect on the DASH than personal/lifestyle or psychosocial factors (age; previous or current smoking; and perceived stress). Conclusions Prior upper extremity musculoskeletal symptoms requiring treatment or ergonomic assessment, high perceived stress and a history of smoking are associated with self-reported disability. Diabetics have significantly higher levels of upper extremity disability than non-diabetics. Prospective studies are needed to see if interventions addressing these factors will prevent future work disability.

Source: http://www.springerlink.com/content/90090v6k7j8l7466/

Resilience in the face of coping with a severe physical injury

A study of trajectories of adjustment in a rehabilitation setting
Objective: Despite the popularity of the concept of resilience, little research has been conducted on populations in physical rehabilitation settings. Our purpose was to identify three trajectories of psychological adjustment to an acquired severe physical injury characterized by resilience, recovery, or distress in a longitudinal design. Participants: Eighty inpatients with a severe injury at a rehabilitation hospital. The participants had spinal cord injury or multiple traumas. Design: Classification into the three trajectories was based on symptoms of psychological distress (posttraumatic stress disorder, depression, anxiety, and negative affect) and participants’ level of positive affect at admission to and discharge from the rehabilitation hospital. Results: The most common trajectory was the resilience trajectory (54%), followed by the recovery trajectory (25%) and the distress trajectory (21%). The most interesting differences between the trajectories were the result of optimism, affect, social support, and pain. Trait negative and positive affect predicted classification into the trajectories. Conclusions: An adaptation pattern characterized by resilience was found to be the most common response to an acquired severe injury, and trait affect predicts the outcome pattern. Interventions based on resilience are discussed.

Source : http://psycnet.apa.org/journals/rep/55/1/12/

Long-term return to work after a functional restoration program for chronic low-back pain patients: a prospective study

Low-back pain is a major health and socio economic problem. Functional restoration programs (FRP) have been developed to promote the socio-professional reintegration of patients with important work absenteeism. The aim of this study was to determine the long-term effectiveness of FRP in a group of 105 chronic low-back pain patients and to determine the predictive factors of return to work. One hundred-and-five chronic LBP patients with over 1 month of work absenteeism were included in a FRP. Pain, professional status, quality of life, functional disability, psychological impact, and fear and avoidance beliefs were evaluated at baseline, after 1 year and at the end of follow-up. Main effectiveness criterion was return to work. Fifty-five percent of the patients returned to work after mean follow-up time of 3.5 years, compared with 9% of the patients at work at baseline. Quality of life, functional disability, psychological factors, and fear and avoidance beliefs were all significantly improved. Three predictive factors were found: younger age at the onset of low-back pain, practice of sports, and shorter duration of sick leave at baseline. FRP show positive results in terms of return to work for chronic LBP patients with prolonged work absenteeism. Efforts should be made to propose such programs at an earlier stage of the disease.

Source: http://www.springerlink.com/content/un632164q448u685/?p=3198b054c5e7426d8dfd0b655f0ab0d2&pi=0

Occupational Safety and Health Interventions to Reduce Musculoskeletal Symptoms in the Health Care Sector
Introduction Health care work is dangerous and multiple interventions have been tested to reduce the occupational hazards. Methods A systematic review of the literature used a best evidence synthesis approach to address the general question “Do occupational safety and health interventions in health care settings have an effect on musculoskeletal health status?” This was followed by an evaluation of the effectiveness of specific interventions. Results The initial search identified 8,465 articles, for the period 1980–2006, which were reduced to 16 studies based on content and quality. A moderate level of evidence was observed for the general question. Moderate evidence was observed for: (1) exercise interventions and (2) multi-component patient handling interventions. An updated search for the period 2006–2009 added three studies and a moderate level of evidence now indicates: (1) patient handling training alone and (2) cognitive behavior training alone have no effect on musculoskeletal health. Few high quality studies were found that examined the effects of interventions in health care settings on musculoskeletal health. Conclusions The findings here echo previous systematic reviews supporting exercise as providing positive health benefits and training alone as not being effective. Given the moderate level of evidence, exercise interventions and multi-component patient handling interventions (MCPHI) were recommended as practices to consider. A multi-component intervention includes a policy that defines an organizational commitment to reducing injuries associated with patient handling, purchase of appropriate lift or transfer equipment to reduce biomechanical hazards and a broad-based ergonomics training program that includes safe patient handling and/or equipment usage. The review demonstrates MCPHI can be evaluated if the term multi-component is clearly defined and consistently applied.
Young adults' experience of stroke: a qualitative review of the literature

Stroke is a life-threatening event that has a devastating impact on young adults and their families. The author conducted a systematic review of the qualitative literature to explore the experience of stroke from the perspective of young adults. Four primary research 'papers' were analyzed using the Qualitative Assessment and Review Instrument; 60 findings were extracted from the papers and merged into 13 categories, from which three synthesized findings were developed - disorientation, disrupted sense of self, and roles and relationships. Many of the effects of stroke are 'invisible' but have significant impact on social participation, including the ability to return to work and to enjoy an active social life. Young adults feel the same and yet different following stroke, which may have a profound effect on relationships. Effective communication between patients, families and health professionals is crucial to all aspects of recovery.

Source: http://www.internurse.com/cgi-bin/go.pl/library/abstract.html?uid=46787

A Short-Form Functional Capacity Evaluation Predicts Time to Recovery but Not Sustained Return-to-Work

Objectives To evaluate the ability of a short-form FCE to predict future timely and sustained return-to-work. Methods A prospective cohort study was conducted using data collected during a cluster RCT. Subject performance on the items in the short-form FCE was compared to administrative recovery outcomes from a workers’ compensation database. Outcomes included days to claim closure, days to time loss benefit suspension and future recurrence (defined as re-opening a closed claim, restarting benefits, or filing a new claim for injury to the same body region). Analysis included multivariable Cox and logistic regression using a risk factor modeling strategy. Potential confounders included age, sex, injury duration, and job attachment status, among others. Results The sample included 147 compensation claimants with a variety of musculoskeletal injuries. Subjects who demonstrated job demand levels on all FCE items were more likely to have their claims closed (adjusted Hazard Ratio 5.52 (95% Confidence Interval 3.42–8.89), and benefits suspended (adjusted Hazard Ratio 5.45 (95% Confidence Interval 2.73–10.85) over the follow-up year. The proportion of variance explained by the FCE ranged from 18 to 27%. FCE performance was not significantly associated with future recurrence. Conclusion A short-form FCE appears to provide useful information for predicting time to recovery as measured through administrative outcomes, but not injury recurrence. The short-form FCE may be an efficient option for clinicians using FCE in the management of injured workers.

Source: http://www.springerlink.com/content/58204h6742643722/

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