2011-09-01 12:00 - Messages

Publication d’un guide de pratique pour les ergothérapeutes

L'Institut de recherche Robert-Sauvé en santé et en sécurité du travail (IRSST) vient de publier un guide de pratique à l'intention des ergothérapeutes. Mis à la disposition des cliniciens, ce guide fournit les données scientifiques nécessaires pour éclairer leur décision en matière d'évaluation des capacités reliées au travail des personnes présentant une déficience physique. La pratique professionnelle est très variable, ce qui suscite un questionnement sur la qualité des services offerts aux personnes devant être évaluées et préoccupe l'Ordre des ergothérapeutes du Québec. Pour mieux soutenir les cliniciens, une équipe de chercheures a procédé à une revue systématique de la littérature et classé les données probantes pertinentes selon le niveau de preuve scientifique. Par la suite, elle a élaboré une première version d'un guide de pratique qui a été soumis à 24 ergothérapeutes experts. Cette consultation a permis de bonifier l'outil au regard de son format, de sa clarté et de la pertinence de chacune des recommandations. Ce guide devrait permettre de réduire le caractère variable de la pratique et d'améliorer la qualité des évaluations et des interventions en réadaptation au travail. « Les recommandations du guide seront utiles pour le clinicien et lui permettront de faire des choix éclairés en matière d'évaluation et de mieux étayer ses recommandations visant le rétablissement du travailleur accidenté et son retour en emploi , conclut Mme Sophie Roy, auteure principale du rapport qu'on peut consulter sur le Web :

Source: http://www.irsst.qc.ca/-communique-publication-d-un-guide-de-pratique-pour-les-ergotherapeutes.html

Motor performance in chronic low back pain: is there an influence of pain-related cognitions? A pilot study

Kusters, Dymphy et coll. (2011). Motor performance in chronic low back pain: is there an influence of pain-related cognitions? A pilot study. BMC Musculoskeletal Disorders 2011, 12:211. (article en libre accès)

Backgroundf: Chronic low back pain (CLBP) is often accompanied by an abnormal motor performance. However, it has not been clarified yet whether these deviations also occur during motor tasks not involving the back and whether the performance is influenced by pain and pain-related cognitions. Therefore, the aim of the present study is to get insight in the contribution of both pain experience and pain-related cognitions to general motor task performance in CLBP. Methods: 13 CLBP patients and 15 healthy subjects performed a hand-function task in three conditions: sitting, lying prone (lying) and lying prone without trunk support (provoking). The last condition was assumed to provoke pain-related cognitions, which was considered successful when a patients' pain expectancy on a numeric rating scale was at least 1 point higher than actual pain experienced. Subjects' performance was expressed in reaction time and movement time. Repeated measures analysis of variance was performed to detect main effect for group and condition. Special interest was given to group*condition interaction, since significant interaction would indicate that patients and healthy subjects performed differently throughout the three conditions. Results: Patients were slower throughout all conditions compared to healthy subjects. With respect to the provoking condition, patients showed deteriorated performance compared to lying while healthy subjects' performance remained equal between these two conditions. Further analysis of patients' data showed that provocation was successful in 54% of the patients. Especially this group showed deteriorated performance in the provoking condition. Conclusion: It can be concluded that CLBP patients in general have worse motor task performance compared to healthy subjects and that provoking pain-related cognitions further worsened performance.

Source: http://www.biomedcentral.com/1471-2474/12/211


Communication style: help or hindrance in facilitating return to work?

 Williams (2011). Communication style: help or hindrance in facilitating return to work? Occupational Medicine, 61 (6): 380-382.



Bandura's theory states that ‘Perceived self-efficacy refers to beliefs in one's capabilities to organise and execute the courses of action required to produce given attainments. It is a useful concept that has attracted significant attention with regard to unemployed people but its application to return from sick leave has been little researched (...) It is known that the longer people who have chronic health problems are absent from work, the less likely they are to return (...) If being absent from work lowers self-efficacy and low self-efficacy is linked to inactivity and inability to take positive steps to return to work, occupational physicians should avoid lowering individual self-efficacy through the use of inappropriate language (...) Discussion of this issue has resulted in the word ‘barriers’ becoming one of the most commonly used words in the language around disability and impaired work capacity (...) Question is whether language can help or whether it hinders the return to work process. It certainly changes a specific issue into a general negative concern of uncertain influence and range (...) Alternative suggestions have included terms such as challenges or constraints (...) We recognize that ‘barrier’ is a term in widespread usage and appears in the UN Convention but we would argue that its inappropriate use can have negative consequences for individuals—usage needs to be managed so it is appropriate—and practitioners need to take care with their selection of words within the context of attendance management discussions, return to work interviews and organizational sickness absence policies. We believe there is appropriate usage within the social context in order to remove social barriers but that at an individual level the term should be avoided lest it inadvertently gives the message that work is a more distant possibility than it truly is.

Source: http://occmed.oxfordjournals.org/content/61/6/380.full

Factors Influencing Work Interference in Patients With Chronic Low Back Pain: A Residency Research Network of Texas (RRNeT) Study

Young, Richard A. et coll. (2011). Factors Influencing Work Interference in Patients With Chronic Low Back Pain: A Residency Research Network of Texas (RRNeT) Study. The Journal of the American Board of Family Medicine, 24 (5): 503-510. (article en libre accès)

Introduction: Chronic low back pain (CLBP) is a disabling and expensive condition commonly seen in family physicians' offices. A complete understanding of factors contributing to patients' return to work remains elusive. Objective: To describe patients with CLBP seen in family physicians' offices and to explore factors interfering with return to work. Subjects: Three hundred sixty outpatients with CLBP for more than 3 months. Setting: Ten participating family physicians' offices of the Residency Research Network of Texas. Primary Outcome: The effect of pain on work effect as measured by a Likert scale. Results: Patients were typically female (72%), overweight or obese (mean body mass index, 33.4), had pain for many years (mean, 13.6 years), and screened positive for recent depressive symptoms (83%). The majority of patients took at least some opioid medication for their pain (59%). Multivariate linear regression analysis found that the largest single contributor to effect on work was the subjects' score on the SF-36 physical function scale (β = –0.382). Other contributors included average daily pain (β = 0.189), the frequency of flare-ups of pain (β = 0.108), the effect of the painful flare-ups (β = 0.170), and current depressive symptoms (β = 0.131) (adjusted R2 for model = 0.535). Age, sex, race/ethnicity, total time the patient has had CLBP, other comorbidities (including a diagnosis of depression), disability status, use of opioids, history of intimate partner violence, social support, and procedures attempted were not predictive. Discussion: Future studies attempting to demonstrate the effectiveness of interventions in CLBP should measure depressive symptoms and the magnitude and effect of painful flare-ups, not just the overall pain score. The majority of CLBP patients seen in these practices take opioids for their pain. Screening and treating for depression may be reasonable for some patients, though evidence of its effectiveness is lacking.

Source: http://www.jabfm.org/cgi/content/abstract/24/5/503

Relation Between Perceived Health and Sick Leave in Employees With a Chronic Illness

Boot, Cécile R. L. (2011). Relation Between Perceived Health and Sick Leave in Employees With a Chronic Illness. Journal of Occupational Rehabilitation, 21 (2): 211-219. (article en libre accès)

Introduction: To improve work participation in individuals with a chronic illness, insight into the role of work-related factors in the association between health and sick leave is needed. The aim of this study was to gain insight into the contribution of work limitations, work characteristics, and work adjustments to the association between health and sick leave in employees with a chronic illness. Methods: All employees with a chronic illness, between 15 and 65 years of age (n = 7,748) were selected from The Netherlands Working Conditions Survey. The survey included questions about perceived health, working conditions, and sick leave. Block-wise multivariate linear regression analyses were performed and, in different blocks, limitations at work, work characteristics, and work adjustments were added to the model of perceived health status. Changes in regression coefficient (B) (%) were calculated for the total group and for sub-groups per chronic illness. Results: When work limitations were added to the model, the B between health and sick leave decreased by 18% (5.0 to 4.1). Adding work characteristics did not decrease the association between health and sick leave, but the B between work limitations and sick leave decreased by 14%, (5.3 to 4.5). When work adjustments were added to the model, the Bs between sick leave and work limitations and work characteristics changed from 4.5 to 3.4 for work limitations and from 2.1 to 1.9 for temporary contract and from −0.8 to −1.0 for supervisor support. Conclusions: The association between health and sick leave was explained by limitations at work, work characteristics, and work adjustments. Paying more attention to work limitations, characteristics and adjustments offers opportunities to reduce the negative consequences of chronic illness.


Individuals with chronic low back pain have greater difficulty in engaging in positive lifestyle behaviours than those without back pain: An assessment of health literacy

Briggs, Andrew M. et al. (2011). Individuals with chronic low back pain have greater difficulty in engaging in positive lifestyle behaviours than those without back pain: An assessment of health literacy. BMC Musculoskeletal Disorders, 12: 161.

Background. Despite the large volume of research dedicated to understanding chronic low back pain (CLBP), patient outcomes remain modest while healthcare costs continue to rise, creating a major public health burden. Health literacy - the ability to seek, understand and utilise health information - has been identified as an important factor in the course of other chronic conditions and may be important in the aetiology of CLBP. Many of the currently available health literacy measurement tools are limited since they measure narrow aspects of health literacy. The Health Literacy Measurement Scale (HeLMS) was developed recently to measure broader elements of health literacy. The aim of this study was to measure broad elements of health literacy among individuals with CLBP and without LBP using the HeLMS. Methods. Thirty-six community-dwelling adults with CLBP and 44 with no history of LBP responded to the HeLMS. Individuals were recruited as part of a larger community-based spinal health study in Western Australia. Scores for the eight domains of the HeLMS as well as individual item responses were compared between the groups. Results. HeLMS scores were similar between individuals with and without CLBP for seven of the eight health literacy domains (p>0.05). However, compared to individuals with no history of LBP, those with CLBP had a significantly lower score in the domain 'Patient attitudes towards their health' (mean difference [95% CI]: 0.46 [0.11-0.82]) and significantly lower scores for each of the individual items within this domain (p<0.05). Moderate effect sizes ranged from d=0.47-0.65. Conclusions. Although no differences were identified in HeLMS scores between the groups for seven of the health literacy domains, adults with CLBP reported greater difficulty in engaging in general positive health behaviours. This aspect of health literacy suggests that self-management support initiatives may benefit individuals with CLBP. 

Source: http://www.biomedcentral.com/1471-2474/12/161/abstract

Exploring the return-to-work process for workers partially returned to work and partially on long-term sick leave due to common mental disorders: a qualitative study

Noordik, E. et coll. (2011). Exploring the return-to-work process for workers partially returned to work and partially on long-term sick leave due to common mental disorders: a qualitative study. Disability & Rehabilitation, 33 (17-18): 1625-1635.

Purpose.We conducted a qualitative study into the return-to-work process of workers partially on sick leave due to common mental disorders. Our objectives were to describe the barriers to a full return to work, solutions, communicating to the working environment and the aim of a full return to work, all as perceived by the workers. Method.Workers who had partially returned to work and were partially on long-term sick leave due to a stress-related, anxiety or depressive disorder were eligible for this study. Fourteen workers were interviewed and the interviews were transcribed verbatim and coded. Results.The perceived main barriers were: inability to set limits, recognise exhaustion and to control cognitions and behaviour such as perfectionism. A general pattern in the process was that all workers perceived barriers to a full return to work; most workers were able to mention solutions; all workers aimed for a full return to work, and after some time all workers were met with sufficient understanding and social support from their supervisor and health care professional. However, hardly any worker intended to implement or utilise the solutions at the workplace, except the structural adaptations of the work demands. Conclusions.The pattern we found suggests a critical intention–behaviour gap between solutions and intentions for a full return to work and its implementation at work. This implies that we should develop new interventions that focus on helping workers and their environment to bridge this gap.

Source: http://informahealthcare.com/doi/abs/10.3109/09638288.2010.541547

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