2012-09-01 12:00 - Messages

Évolution comparée de la douleur et du statut de travail à la suite d’un programme de réadaptation pour des travailleurs ayant des troubles musculo-squelettiques

Les troubles musculo-squelettiques (TMS) touchent chaque année plus de 45 000 travailleurs québécois dans tous les secteurs d’activité. Dans un modèle de représentation biopsychosocial des TMS, la question des croyances des principaux acteurs sociaux à propos de l’incapacité et la douleur est fondamentale pour le processus de réadaptation. Plusieurs intervenants de la santé, employeur ou assureur, croient que l’employé ne doit pas se présenter au travail avant d’être
complètement rétabli de sa blessure. Paradoxalement, d’autres croient qu’il n’existerait qu’un rapport ténu entre l’absence au travail et la douleur. Le but de cette étude était de mieux comprendre l’association de l’évolution de l’intensité de la douleur perçue par la personne ayant un TMS avec son statut du travail et la réintégration de ses activités habituelles. Les questions spécifiques étaient : (1) Quels sont les profils d’évolution de l’intensité de la douleur chez les travailleurs souffrant de TMS? (2) Quelles sont les différences entre les profils d’évolution de l’intensité de la douleur lorsque l’on considère les variables sociodémographiques (âge, sexe, pathologie, nombre de semaines d’absence du travail), le statut du travail et la réintégration des activités habituelles?

Source : http://www.irsst.qc.ca/media/documents/PubIRSST/R-744.pdf


The development of the model of occupational self efficacy: An occupational therapy practice model to facilitate returning to work after a brain injury

Objective: The purpose of this article is to describe the methodology used in order to develop the Model of Occupational Self Efficacy: An occupational therapy practice model to facilitate returning to work after a brain injury. Participants: Nine males and one female participated in the study. Methods: Face to face, semi structured individual interviews were conducted and data were analyzed using a qualitative approach to explicate patterns and themes. The study was conducted in two phases, namely, Phase one described the lived experience of individuals with brain injury who had returned to work and Phase two described the development of the model by means of theory generation methodology. Results: Four themes emerged that reflected the lived experiences for people returning to work after a brain injury. (1) A sense of loss of former self; (2) Uncertainty about the future; (3) The road to acceptance and believing in yourself; and (4) Participation in occupation enables growth. The above themes contributed to the central concept called Occupational Self Efficacy that resulted in the development of the occupational therapy practice model. Conclusions: The findings of the study suggest that theory generation methodology is adequate for the conceptual development of an occupational therapy practice model.

Source : Soeker MS. The development of the model of occupational self efficacy: An occupational therapy practice model to facilitate returning to work after a brain injury . Work 2012; ePub. http://dx.doi.org/10.3233/WOR-2012-1412

Biopsychosocial determinants of work outcomes of workers with occupational injuries receiving compensation

Objectives: The evolution of musculoskeletal disorders and the adjustment to its consequences is a complex, multidimensional process determined by biopsychosocial factors. Despite the plethora of research in this field, little consensus has emerged about its main risk factors. The aims of the present study are to investigate the capacity of biopsychosocial variables to predict active involvement in a return to work process. Participants: A sample (N=62) of workers with mostly chronic occupational injuries receiving compensation benefits from the CSST [Quebec Workers' Compensation Board] was recruited. Methods: Questionnaires were administered at baseline and subjects were followed prospectively and assessed again after 2 and 8 months. Results: The variables under investigation were: age, gender, duration of symptoms, pain severity, disability, work importance, work support, work satisfaction, recovery expectations, depression, anxiety, global distress severity index, post-traumatic symptoms and readiness to change. After multivariate analysis, we found gender, work recovery expectations and importance of work to be predictive of work outcomes at 2 months. After 8 months, age, medical consolidation, trauma symptoms, work support and importance of work were predictive of work outcomes. Conclusion: The results show the importance of addressing chronic work disability in research and rehabilitation from a multidimensional perspective although psychosocial variables were the most significant predictors in this study.

Source : Laisné F, Lecomte C, Corbière M. Biopsychosocial determinants of work outcomes of workers with occupational injuries receiving compensation: A prospective study . Work 2012; ePub. http://dx.doi.org/10.3233/WOR-2012-1378


Return-to-work program for workers on sick leave due to common mental disorders

In case of long-term sick leave, gradually increasing workload appears to be an effective component of work-directed interventions to reduce sick leave due to common mental disorders (CMD). We developed an exposure-based return-to-work (RTW-E) intervention and evaluated the effect on time-to-full return to work (RTW) among workers who were on sick leave due to CMD in comparison to those treated with care-as-usual (CAU). CAU is guideline-directed and consists of problem-solving strategies and graded activities. The median time-to-full RTW differed significantly between groups [hazard ratio (HR) 0.55; 95% confidence interval (95% CI) 0.33–0.89]. The workers receiving RTW-E (209 days; 95% CI 62–256) had a prolonged time-to-full RTW compared to workers receiving CAU (153 days; 95% CI 128–178).

Conclusions Workers on sick leave due to CMD treated with RTW-E showed a prolonged time-to-full RTW compared to those treated with CAU. We recommend that OP do not apply RTW-E but continue counseling workers on sick leave due to CMD according to CAU.

Source : Noordik E, van der Klink JJ, Geskus RB, de Boer MR, van Dijk FJH, Nieuwenhuijsen K. Effectiveness of an exposure-based return-to-work program for workers on sick leave due to common mental disorders: a cluster-randomized controlled trial Scand J Work Environ Health. http://dx.doi.org/doi:10.5271/sjweh.3320


Mental ill-health and second claims for work-related injury

Background There is some evidence that mental ill-health (MIH) is associated with injury at work, but data are sparse. Aims To examine, within a cohort of workers with a first workers' compensation claim, whether those with a history of MIH had a higher than expected number of second claims. Methods All Workers' Compensation Board (WCB) records from January 1995 to December 2004 were linked to administrative health records, and a physician diagnosis of MIH in the 48 months prior to the first WCB claim extracted. The first and second (if any) claim for each worker were identified and time to second claim calculated. Survival time to second claim was estimated by Cox regression with history of MIH as a covariate. Results Results were available for 389 903 WCB first claimants. Of these 53% of men and 38% of women had a second claim, with a mean time between claims of 768 days (men) and 785 days (women). Those with a history of MIH were somewhat more likely to make a second claim and, in the survival analysis, to make this claim sooner. Type of injury at first claim did not appear to modify this effect. Conclusions Workers with a recent history of MIH at the time of making a first WCB claim for a work injury are at greater risk of a second injury, leading to a new claim. Strategies to get workers back to work after the first injury/claim should include management of MIH to reduce the risk of further injury.

Source : Cherry N, Burstyn I, Beach J. Mental ill-health and second claims for work-related injury. Occup. Med. 2012; 62(6): 462-465.

Return to work after a serious hand injury

Objectives: This paper explores factors important for return to work (RTW) in people who have sustained a serious hand injury. Participants: Forty people aged 19-64, with a severe or major hand injury were recruited consecutively during 2005-2007. Methods: A self-administered and study specific questionnaire, including demographic data and standardised questionnaires for function, disability, daily occupations, health, quality of life, sense of coherence and several open questions was sent out by mail twelve months after injury. Open questions regarding RTW were also included. Results: The results showed that 27 people had returned to work within twelve months and 13 had not. Factors related to RTW and general work motivations were divided into individual factors, and factors related to the work environment and rehabilitation. The most prominent differences between the groups were individual factors, such as higher perceived disability, reduced hand function, and dissatisfaction with daily occupations resulting in a lower physical quality of life. The no RTW group had also more ward days (inpatient care) and lower sense of coherence. Conclusions: These findings support the idea that the RTW process can be more dependent on the person's own ability and motivation than on the severity of the hand injury. Suggestions for intervention and further studies are presented in the discussion.

Source : Ramel E, Rosberg HE, Dahlin LB, Cederlund RI. Return to work after a serious hand injury. Work 2012; ePub. http://dx.doi.org/10.3233/WOR-2012-1373

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