2010-07-01 12:00 - Messages

New Canadian guideline released on opioid use for chronic non-cancer pain

At Work, le bulletin trimestriel de l'Institute for Work and Health (IWH), annonce la parution récente d'un guide canadien sur l'utilisation des opiacés pour contrôler les douleurs au dos.  Il est question du mauvais usage des opiacés par les Canadiens et du traitement inadéquat de la douleur. Le guide complet peut être téléchargé à partir du site de l'IWH.

Source: http://www.iwh.on.ca/at-work/61/new-canadian-guidelne-released-on-opioid-use-for-chronic-non-cancer-pain

A systematic review on the effectiveness of physical and rehabilitation interventions for chronic non-specific low back pain

Low back pain (LBP) is a common and disabling disorder in western society. The management of LBP comprises a range of different intervention strategies including surgery, drug therapy, and non-medical interventions. The objective of the present study is to determine the effectiveness of physical and rehabilitation interventions (i.e. exercise therapy, back school, transcutaneous electrical nerve stimulation (TENS), low level laser therapy, education, massage, behavioural treatment, traction, multidisciplinary treatment, lumbar supports, and heat/cold therapy) for chronic LBP. The primary search was conducted in MEDLINE, EMBASE, CINAHL, CENTRAL, and PEDro up to 22 December 2008. Existing Cochrane reviews for the individual interventions were screened for studies fulfilling the inclusion criteria. The search strategy outlined by the Cochrane Back Review Groups (CBRG) was followed. The following were included for selection criteria: (1) randomized controlled trials, (2) adult (≥18 years) population with chronic (≥12 weeks) non-specific LBP, and (3) evaluation of at least one of the main clinically relevant outcome measures (pain, functional status, perceived recovery, or return to work). Two reviewers independently selected studies and extracted data on study characteristics, risk of bias, and outcomes at short, intermediate, and long-term follow-up. The GRADE approach was used to determine the quality of evidence. In total 83 randomized controlled trials met the inclusion criteria: exercise therapy (n = 37), back school (n = 5), TENS (n = 6), low level laser therapy (n = 3), behavioural treatment (n = 21), patient education (n = 1), traction (n = 1), and multidisciplinary treatment (n = 6). Compared to usual care, exercise therapy improved post-treatment pain intensity and disability, and long-term function. Behavioural treatment was found to be effective in reducing pain intensity at short-term follow-up compared to no treatment/waiting list controls. Finally, multidisciplinary treatment was found to reduce pain intensity and disability at short-term follow-up compared to no treatment/waiting list controls. Overall, the level of evidence was low. Evidence from randomized controlled trials demonstrates that there is low quality evidence for the effectiveness of exercise therapy compared to usual care, there is low evidence for the effectiveness of behavioural therapy compared to no treatment and there is moderate evidence for the effectiveness of a multidisciplinary treatment compared to no treatment and other active treatments at reducing pain at short-term in the treatment of chronic low back pain. Based on the heterogeneity of the populations, interventions, and comparison groups, we conclude that there are insufficient data to draw firm conclusion on the clinical effect of back schools, low-level laser therapy, patient education, massage, traction, superficial heat/cold, and lumbar supports for chronic LBP.

Source: http://www.springerlink.com/content/f3j2555002851087/

Difficulties with multitasking on return to work after TBI: A critical case study

Work performance research highlights that psychometric cognitive measures and cognitive component information processing measures are strong predictors of success in multitasking work environments [14]. People with a mild to moderate traumatic brain injury (TBI) returning to a job requiring multitasking, may have difficulty succeeding despite pre-morbid equivalent cognitive scores. A critical case study is presented to begin to determine what aspects of information processing contribute to difficulties in multitasking work performance, for people with a TBI. The Perceive Recall Plan and Perform (PRPP) System of Task Analysis: Workplace Interview (i.e. [email protected]) is used with the employer to obtain information processing scores. Results indicate substantial information processing deficits were perceived by the employer for the employee with a TBI. Future larger studies of people with a TBI who return to work that requires multitasking are needed to more clearly indicate: the level of multitasking they perform; what aspects of information processing hinder their work performance; the impact on performance of perceived cognitive load by the person with a TBI and the type and impact of support provided to improve their work performance.

Source: http://iospress.metapress.com/content/852p0v296747jr40/?p=659a28cab0b24307bb9f4975a17caefc&pi=8

Work Related Factors and Sick Leave After Rehabilitation in Burnout Patients: Experiences from the REST-Project

Introduction The aim of this study was to investigate the impact of psychosocial working conditions and coping strategies at work on change in sick leave level for patients on long-term sick leave due to burnout. Methods A cohort sample of patients (n = 117) on long-term sick leave due to burnout was analyzed. The patients answered a questionnaire at baseline and sick leave information was collected from the Swedish Social Insurance Agency at baseline and at follow-up 2 years later. Two groups were formed depending on whether the patients had “improved” and reduced their sick leave level (56%) or if the sick leave level was “unchanged” (44%) at follow-up. The association between change in sick leave and predictors measuring psychosocial working conditions and coping strategies at work were analyzed using logistic regression. Results The predictor, low control at work, was associated with unchanged sick leave at follow-up. When background characteristics were taken into account, usage of covert coping towards supervisors and covert coping towards workmates, respectively, also predicted unchanged sick leave level. High overcommitment was of borderline significance and associated with a reduced sick leave level at follow-up. Conclusions Patients with burnout who have experienced low control at work and used covert coping towards supervisors and/or workmates have a higher risk of not reducing their sick leave after rehabilitation. The workplace may contribute to a reduction of sick leave lengths with a more flexible work environment and improvement in communication strategies for employees and supervisors.

Source: http://www.springerlink.com/content/3415776qg2864820/

A Typology of Sick-Listed Claimants to Improve Communication Skills for Social Insurance Physicians during Medical Disability Assessment Interviews

Introduction Role play with standardised simulated patients is often included in communication training. However, regarding physician-patient encounters in medical disability assessment interviews it is unclear what should be included in the scenarios for actors. The first objective of this study was to determine which types of medical disability claimants can be distinguished based on behavioural determinants. The second objective was to determine if these types of claimants differed in their perception of communication behaviour and their satisfaction with the communication with physicians. Methods Questionnaire data were collected from 56 Dutch claimants for 13 behavioural determinants before their assessment interview, and for 12 behavioural and satisfaction variables afterwards. For the first objective cluster analyses were performed and for the second objective linear regression analyses were performed. Results The results showed that three types of claimants could be distinguished: insecure support-seeking claimants, confident claimants, and socially isolated claimants. Overall, claimants were positive about the communication with the physician: insecure support-seeking claimants were satisfied and confident claimants were highly satisfied, but socially isolated claimants were unsatisfied. Conclusion Scenarios for standardised simulated patients should include different types of claimants. In training, special attention should be given to communication with socially isolated claimants.

Source: http://www.springerlink.com/content/844v632537224415/

The Predictive Validity of Job-Specific Functional Capacity Evaluation on the Employment Status of Patients With Nonspecific Low Back Pain

Objectives: To examine the predictive validity of a job-specific functional capacity evaluation (FCE) on the employment status of patients with nonspecific low back pain (LBP). Methods: Seven hundred and thirteen patients with nonspecific LBP received job-specific FCE. Based on their performance, return-to-work recommendations were given. Three months after evaluation, all patients were contacted by telephone to find out their employment status to examine the predictive validity of each FCE-based rating. Results: The correct prediction of employment status from an FCE pass rating was 79.8%; fail rating because of not meeting all the criteria of FCE tasks was 61.7%; and fail rating because of failing all FCE tasks was 68.4%. Conclusions: Job-specific FCE shows a high level of predictive validity that could be used to evaluate the employment status of patients with nonspecific chronic LBP.

Source: http://journals.lww.com/joem/Abstract/2010/07000/The_Predictive_Validity_of_Job_Specific_Functional.9.aspx

What Stops Us From Healing the Healers: a Survey of Help-Seeking Behaviour, Stigmatisation and Depression Within the Medical Profession

Doctors are poor at help-seeking, particularly for mental ill health; attitudes of colleagues reflecting stigmatisation may be important factors influencing decisions to seek support. Aims: This article focuses on doctors' attitudes to depression rather than mental illness in general. It seeks to determine the extent to which doctors perceive depression is stigmatised within the medical profession and whether the level of perceived stigma affects patterns of help-seeking behaviour. Method: A postal survey was sent to 1488 General Practitioners and 152 psychiatrists in Devon and Cornwall. Questions assessed stigmatising attitudes to depression; help-seeking behaviour and barriers to help-seeking. Prevalence of self-reported depression and time off work was measured. Results: The response rate was 76.6%. Doctors perceived that many of their profession hold stigmatising views of depression. Some 46.2% of respondents reported that they had suffered an episode of depression. Help-seeking was significantly reduced in those with a history of depression. Barriers to help-seeking were reported as letting colleagues down (73.1%), confidentiality (53.4%), letting patients down (51.9%) and career progression (15.7%). Gender and a history of depression significantly affected help-seeking behaviour and perceived stigmatisation. Higher levels of perceived stigma increased concerns about help-seeking and reduced help-seeking from own GP or colleagues. Conclusion: Stigma associated with depression in doctors is endemic in the medical profession and the level of perceived stigma is related to reduced help-seeking behaviour. Efforts need to be made by the profession to reduce the stigma anticipated by those who become depressed, to enable appropriate help-seeking and support.

Source: http://isp.sagepub.com/content/56/4/359.abstract?rss=1

A systematic review of early prognostic factors for return to work following acute orthopaedic trauma

Acute orthopaedic trauma is a major contributor to the global burden of disease. This study aims to synthesise and summarise current knowledge concerning prognostic factors for return to work and duration of work disability following acute orthopaedic trauma. Methods: A systematic review of prognostic studies was performed. The Medline, Embase, PsychINFO, CINAHL and AMED electronic databases were searched for studies between 1985 and May 2009. Included studies were longitudinal, reported results with multivariate statistical analyses appropriate to prognostic studies, comprised persons employed at the time of the injury, included prognostic factors measured proximal to the injury and focused on upper and lower extremity injuries. Results: Searches yielded 980 studies of which 15 met the inclusion criteria and were rated for methodological quality. Analysis focused on the 14 factors considered in more than one study. There was limited evidence for the role of any factor as a predictor of return to work. There is strong evidence for level of education and blue collar work and moderate evidence for self-efficacy, injury severity and compensation as prognostic factors for the duration of work disability. Significant methodological issues were encountered in the course of the review that limited interpretation of the evidence and the conclusions that could be drawn from the findings. Conclusion: People who have sustained acute orthopaedic trauma regardless of severity experience difficulties in returning to work. Due to the lack of factors considered in more than one cohort, the results of this review are inconclusive. The review highlights the need for more prospective studies that are methodologically rigorous, have larger sample sizes and considers a comprehensive range of factors.

Source: http://www.injuryjournal.com/article/PIIS0020138310002573/abstract?rss=yes

Maintaining a balance: a focus group study on living and coping with chronic whiplash-associated disorder

There is little qualitative insight into how persons with chronic whiplash-associated disorder cope on a day-to-day basis. This study seeks to identify the symptoms persons with whiplash-associated disorder describe as dominating and explore their self-initiated coping strategies. Methods: Qualitative study using focus groups interviews. Fourteen Norwegian men and women with whiplash-associated disorder (I or II) were recruited to participate in two focus groups. Data were analyzed according to a phenomenological approach, and discussed within the model of Cognitive Activation Theory of Stress (CATS). Results: Participants reported neck and head pain, sensory hypersensitivity, and cognitive dysfunction following their whiplash injury. Based on the intensity of symptoms, participants divided everyday life into good and bad periods. In good periods the symptoms were perceived as manageable. In bad periods the symptoms intensified and took control of the individual. Participants expressed a constant notion of trying to balance their three main coping strategies; rest, exercise, and social withdrawal. In good periods participants experienced coping by expecting good results from the strategies they used. In bad periods they experienced no or negative relationships between their behavioral strategies and their complaints. Conclusions: Neck and head pain, sensory hypersensitivity, and cognitive dysfunctions were reported as participants' main complaints. A constant notion of balancing between their three main coping strategies; rest, exercise, and social withdrawal, was described.

Source: http://www.biomedcentral.com/1471-2474/11/158

Functional capacity evaluations for the prevention of occupational re-injuries in injured workers

Functional capacity evaluation (FCE) is a method to assess physical capacity to perform certain tasks. It is believed that FCE can prevent re-injury if injured workers are assessed before they return to work and get proper recommendations on how to perform work tasks.
We found no studies that compared workers given FCE to workers given no intervention to evaluate the effectiveness in preventing re-injury of FCE. We found one RCT involving 372 injured workers that compared a short version of the FCE to an extensive version in which more bodily functions were tested. The short-form FCE produced a 43% reduction in physical assessment time. However, there was no difference between the two forms of FCE in terms of prevention of recurrence of occupational injuries. We therefore concluded that there is no evidence for or against the effectiveness of the length of the FCE in ensuring that those who do return will not suffer an injury relapse.

Source : http://mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD007290/frame.html

Neck Pain Evidence Summary

This evidence summary is designed for health-care professionals who treat patients with neck pain, ranging from mild pain to whiplash. The summary presents helpful and unhelpful treatments as well as guidance on assessing patients. The Institute for Work & Health (IWH) created this summary to share the evidence synthesis completed by The Bone and Joint Task Force on Neck Pain. IWH worked in concert with the Canadian Memorial Chiropractic College, the Ontario Chiropractic Association and some members of the Executive Committee of the 2000-2010 Bone and Joint Task Force on Neck Pain and Its Associated Disorders to prepare this summary.

Source: http://www.iwh.on.ca/neck-pain-evidence-summary

Influence of Health and Work on Early Retirement

Objective: The influence of health and work on early retirement and incentives for longer working were determined. Methods: A systematic review was conducted of longitudinal studies on factors for nondisability early retirement. Besides, seven focus group interviews (n = 32) were conducted about reasons for planning retirement early and incentives to stay longer in work among workers with poor and excellent work ability. Results: Eight longitudinal studies showed that important factors for early retirement were poor health, being single, high physical work demands, high work pressure, low job satisfaction, and lack of physical activity in leisure time. In addition, focus group participants reported shift work, social support, and appreciative leadership style also as factors. Conclusions: Poor health and poor work circumstances are important factors in decisions to retire early. Social support and appreciative leadership style may be buffers in this process.

Source: http://journals.lww.com/joem/Abstract/2010/06000/Influence_of_Health_and_Work_on_Early_Retirement.2.aspx

Comparing Alternative Methods of Targeting Potential High-Cost Individuals for Chronic Condition Management

Objective: To compare the performance of predictive models based on health care claims, health risk assessment (HRA), or both in prospectively identifying high-cost individuals with chronic conditions. Methods: Participants included 8056 employees who completed an HRA and were enrolled in a health plan for at least 6 months during the 36-month study period. Two-stage multivariate regression identified predictors of claims cost in four age-by-gender groups. Results: All models predicted costs effectively, but the combined model performed better (R2 = 0.198 to 0.309) than either the claims-based (R2 = 0.168 to 0.263) or HRA-based model (R2 = 0.125 to 0.205). Conclusion: An HRA-based predictive model appears to be a reasonable alternative to claims-based predictive models for identifying individuals for chronic condition management outreach. Where practical, a combined model offers advantages of both approaches and meaningfully increases accuracy.

Source: http://journals.lww.com/joem/Abstract/2010/06000/Comparing_Alternative_Methods_of_Targeting.10.aspx

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