2013-04-01 12:00 - Messages

The `Ability' Paradigm in Vocational Rehabilitation: Challenges in an Ontario Injured Worker Retraining Program

Introduction In recent years, a focus on workers' ability, rather than impairment, has guided disability management services. However, a challenge with the notion of `ability' is identification of the border between ability and inability. This article considers this gray zone of disability management in the case of a workers' compensation vocational retraining program for injured workers in Ontario. Methods In-depth interviews and focus groups were conducted with a purposive sample of 71 participants who were directly involved with the vocational retraining process. Workers in the program had on average incurred injury 3 years earlier. Procedural and legal documents were also analyzed. Principles of grounded theory and discourse analysis guided the data gathering and analysis. Results A program focus on worker abilities did not allow for consideration of unresolved medical problems. Concepts such as maximum medical rehabilitation distracted attention from workers' ongoing chronic and unstable health situations, and incentive levers to employers directed some of the least capable workers into the program. As well, communication pathways for discussing health problems were limited by rules and provider reluctance to reveal problems. Therefore, workers completing the program were deemed `employable', while ongoing and problematic health conditions preventing employment remained relatively uncharted and invisible. Conclusions This study reinforces how the shift in disability management paradigm to a focus on ability and return to work requires consideration of environmental conditions, including policies and programs and implementation. A focus on the environment in which worker ability can be enacted might be as important as a focus on improving individual worker characteristics.
Keywords: Workers' compensation; Vocational rehabilitation; Injured workers; Qualitative; Vocational retraining; Program implementation

MacEachen, E.; Kosny, A.; Ferrier, S.; Lippel, K.; Neilson, C.; Franche, R.; Pugliese, D. The `Ability' Paradigm in Vocational Rehabilitation: Challenges in an Ontario Injured Worker Retraining Program. Journal of Occupational Rehabilitation, Vol. 22, no 1, March 2012 , p. 105-117(13). http://dx.doi.org/10.1007/s10926-011-9329-x



Short-term goal attainment of in-patient rehabilitation in Germany and long-term risk of early retirement in patients with musculoskeletal diseases: results from a prospective 5-year follow-up study

Purpose: Occupational consequences of musculoskeletal disorders (MSDs) are consistently found in epidemiological studies. The aim of this study was to evaluate the prognostic value of various short-term rehabilitation outcome parameters on early retirement in Germany. Method: In a prospective multi-centre cohort study of self-rated patient status, physician chosen therapy goals and attainment were measured by means of standardized questionnaires at the beginning and end of medical rehabilitation. Information with regard to disability was collected by self-report over a 5-year follow-up period. Results: We included 1268 MSD patients aged 45-57 who underwent a 3-week, multidisciplinary, in-patient rehabilitation programme in 10 rehabilitation centres in Southern Germany between January and December 2001. During follow-up (mean duration: 3.9 years) 117 (9%) patients received a disability pension. After adjustment for sex, age and patient outcomes, risk for early retirement was significantly increased for patients with only partial success with respect for the therapy goals pain reduction (HR 1.95), improvement in spine motility (HR 1.6) and improvement of muscle strength (HR 2.3). Patients who did not have the therapy goal were at the same risk as patients with full goal achievement. Conclusions: Clinicians' rating of short-term therapy outcome might be of prognostic relevance of MSD patients' long-term employment status.

Source : Authors: Neuner, Ralf1; Braig, Stefanie1; Weyermann, Maria; Kaluscha, Rainer; Krischak, Gert. Disability and Rehabilitation, Volume 35, Number 8, April 2013 , pp. 656-661(6). http://dx.doi.org/10.3109/09638288.2012.703756


Validity and Reliability of the Fear-Avoidance Beliefs Questionnaire (FABQ) in Workers with Upper Extremity Injuries

Introduction Fear Avoidance Beliefs (FAB) have been associated with increased pain, dysfunction and difficulty returning to work in Upper Extremity (UE) injures. The FABQ is used to assess FAB, but its measurement properties have not been established in UE. The purpose of this study is to evaluate the reliability and validity of the FABQ to screen UE compensated injured workers for FAB. Methods Consenting workers attending a specialty clinic completed a modified FABQ, QuickDASH (Disability), SPADI Pain Score and von Korff Chronic Pain Grade (Pain), SF-36v2 (General Health), and Work Instability Scale (Job Instability). A sub-sample of workers (n = 48) completed the FABQ 2 weeks later for test-retest reliability. Results 187 workers; 54.0% male; mean age 45.2 (sd 9.68); 56% were currently working. Mean subscale scores (FABQ-Work [FABQ-W]/FABQ-Physical Activity [FABQ-PA]) were 35/42 and 20/24. Ceiling effects (23%/38%) existed in both subscales. Cronbach's alphas were 0.75/0.78. Test-retest analysis (ICC(2,1)) was lower than desired (0.52/0.59). Construct validation was supported by a moderate correlation between FABQ-W/FABQ-PA and QuickDASH Work Module (0.51/0.42) and WIS (0.46/0.38) in those currently working. Low correlations were found between the subscales measures of pain (SPADI: 0.24/0.23; Chronic Pain Grade: 0.25/0.25), and SF-36 MCS (−0.25/−0.30). Conclusions Although FAB is an important concept to measure in compensated UE injured workers, the FABQ had limitations in this population as there was a high ceiling effect, and lower than desired reliability for individual discrimination. A priori hypotheses around construct validity were rejected for 16/22 concepts tested.
Keywords: Measurement; Reliability and validity; Fear avoidance; Workers' compensation

Source : Inrig, Taucha; Amey, Bev; Borthwick, Cheryl; Beaton, Dorcas. Validity and Reliability of the Fear-Avoidance Beliefs Questionnaire (FABQ) in Workers with Upper Extremity Injuries. Journal of Occupational Rehabilitation, vol. 22, no 1, March 2012 , p. 59-70(12). http://dx.doi.org/10.1007/s10926-011-9323-3



Injured Workers' Construction of Expectations of Return to Work with Sub-Acute Back Pain: The Role of Perceived Uncertainty

Introduction: Little is known about the formation of expectations of return to work (RTW) from the perspective of injured workers with back injuries. This modified grounded theory study uses a biopsychosocial approach that considers the workers' complex social circumstances, to unpack the multidimensional construct of expectations of RTW from the injured worker's perspective. Method: Initial semi-structured interviews were conducted with 18 individuals with sub-acute back pain, who were off work between 3 and 6 months. Follow-up interviews were conducted with 7 participants for the purposes of member checking. The interview data was coded, compared and analyzed over the course of data collection, until saturation was reached. Results: Data analysis revealed that expectations of return-to-work are constructed based on perceived uncertainty which subsumes five inter-related categories (1) perceived lack of control over the return-to-work process, (2) perceived lack of recognition by others of the impact of the injury, (3) perceived inability to perform the pre-injury job, (4) fear of re-injury, and (5) perceived need for workplace accommodations. Expectations, once formed, were influenced by the worker's experience of coping with perceived uncertainty. Conclusion: Perceived uncertainty plays a key role in injured workers' formation of expectations of return-to-work. Implications are discussed regarding how this perceived uncertainty plays a role in the development of (re)injury prevention and rehabilitation programs. The importance of further research on perceived uncertainty is presented, along with potential future research considerations.

Source: Stewart, Alison; Polak, Emily; Young, Richard; Schultz, Izabela. Journal of Occupational Rehabilitation, Vol. 22, no 1, March 2012 , p. 1-14(14). http://dx.doi.org/10.1007/s10926-011-9312-6



Predicting Return to Work in Workers with All-Cause Sickness Absence Greater than 4 Weeks: A Prospective Cohort Study

Introduction Long-term sickness absence is a major public health and economic problem. Evidence is lacking for factors that are associated with return to work (RTW) in sick-listed workers. The aim of this study is to examine factors associated with the duration until full RTW in workers sick-listed due to any cause for at least 4 weeks. Methods In this cohort study, health-related, personal and job-related factors were measured at entry into the study. Workers were followed until 1 year after the start of sickness absence to determine the duration until full RTW. Cox proportional hazards regression analyses were used to calculate hazard ratios (HR). Results Data were collected from N = 730 workers. During the first year after the start of sickness absence, 71% of the workers had full RTW, 9.1% was censored because they resigned, and 19.9% did not have full RTW. High physical job demands (HR .562, CI .348-.908), contact with medical specialists (HR .691, CI .560-.854), high physical symptoms (HR .744, CI .583-.950), moderate to severe depressive symptoms (HR .748, CI .569-.984) and older age (HR .776, CI .628-.958) were associated with a longer duration until RTW in sick-listed workers. Conclusions Sick-listed workers with older age, moderate to severe depressive symptoms, high physical symptoms, high physical job demands and contact with medical specialists are at increased risk for a longer duration of sickness absence. OPs need to be aware of these factors to identify workers who will most likely benefit from an early intervention.
Keywords: Return to work; Long-term sickness absence; Prognostic factors

Source : Vlasveld, M.; Feltz-Cornelis, C.; Bültmann, U.; Beekman, A.; Mechelen, W.; Hoedeman, R.; Anema, J. Predicting Return to Work in Workers with All-Cause Sickness Absence Greater than 4 Weeks: A Prospective Cohort Study. .Journal of Occupational Rehabilitation, vol. 22, no 1, March 2012 , p. 118-126(9). http://dx.doi.org/10.1007/s10926-011-9326-0


Factors that Predict Return-to-work in Workers with PTSD

Posttraumatic stress disorder (PTSD) is a clinical condition that may develop following exposure to a traumatic event. PTSD can be triggered by traumatic workplace events including robbery, assault, or injury. Many workers who develop PTSD after a traumatic work event fail to return to work, and the factors that influence this transition are poorly understood. The purpose of this study was to identify barriers that impede return-to-work (RTW) in individuals who develop PTSD after experiencing a traumatic event in the workplace. The researchers were also interested in examining whether features of a work environment, or anger/blame towards the employer, could be used to predict RTW in individuals experiencing work-related PTSD.

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Studies reveal crucial role of co-workers in return-to-work process

Co-workers can play an important role after a work-related injury. They can provide details about the circumstances of an accident, offer emotional support to the injured worker and help with job tasks upon a co-worker's return to work (RTW). Working with an injured co-worker, however, can also strain work relationships and increase workload. The purpose of this study was to determine the role that co-workers play after a work-related injury and during the RTW process in the unionized, electrical construction sector. Methods We conducted two focus groups with injured electricians and union representatives. We also interviewed co-workers who had worked with someone who had been injured in the course of employment. We examined the role that co-workers can play after a work-related injury and some of the factors facilitating and hindering co-worker support. Results The structure of work in the electrical sector—a focus on cost-cutting and competition, job insecurity, perceptions of “different camps” among co-workers, little modified work and poor formal communication—can impede co-worker support and contribute to making injured workers' experiences difficult. Management can play an important role in setting an example for how injured workers are regarded and treated. Conclusions Future research should explore how workers can better be supported after a work-related injury and during the RTW process.

Source : http://www.cos-mag.com/human-resources/hr-stories/studies-reveal-crucial-role-of-co-workers-in-return-to-work-process.html

Agnieszka Kosny, Marni Lifshen, Diana Pugliese, Gary Majesky, Desre Kramer, Ivan Steenstra, Sophie Soklaridis, Christine Carrasco. Buddies in Bad Times? The Role of Co-workers After a Work-Related Injury. Journal of Occupational Rehabilitation, December 2012. http://dx.doi.org/10.1007/s10926-012-9411-z

Internal consistency and construct validity of the Revised Illness Perception Questionnaire adapted for work disability following a musculoskeletal disorder

To assess internal consistency and construct validity of the French version of the Revised Illness Perception Questionnaire adapted for Work Disability (IPQR-WD). Method: A cross sectional study was conducted in rehabilitation centers and private clinics in the Montreal region of Canada, involving 43 men and women, French speaking, absent from work between 3 months and a year due to musculoskeletal disorders. The 9 dimension IPQR-WD and the following eight-related instruments for construct validity were administered: Tampa Scale for Kinesiophobia (TSK), Pain Catastrophizing Scale (PCS), Psychological Distress Index (PDI-14), Pain Disability Index (PDI), Self-Efficacy for Return to Work Scale (SERWS), Pain Beliefs and Perceptions Inventory (PBPI), Implicit Models of Illness Questionnaire (IMIQ) and a Visual Analog Scale for pain intensity (VAS). Results: Calculations of Cronbach's α (from 0.58 to 0.87) revealed satisfactory internal consistency of the IPQR-WD dimensions. Multiple regression analyses were performed with each IPQR-WD dimension and significant independent variables. Final models explained a good proportion of the variance (adjusted r2 = 0.33-0.70) for each dimension, except for the Cyclical timeline dimension for which associations became non-significant after adjusting for gender, age and length of sick leave. The SERWS and the VAS were not significantly associated to any of the IPQR-WD dimensions. Conclusions: Moderate to strong correlations were found with six-related instruments which support the multidimensional nature of the IPQR-WD and its unique contribution as one simple questionnaire that can assess representations related to work disability. Certain unhelpful beliefs related to the worker's own understanding (i.e. representation) of his/her current health condition may lead to behaviours that are poorly adapted to reducing the work disability following a musculoskeletal disorder.
The Revised Illness Perception Questionnaire adapted for Work Disability (IPQR-WD) is the only questionnaire available in French that can specifically assess the worker's representation following a musculoskeletal disorder. The use of this questionnaire will facilitate a systematic evaluation of the worker's representation according to a biopsychosocial approach, which may contribute to a clinical practice based on the latest scientific evidences available in the work disability field.

Source : Albert, Valérie; Coutu, Marie-France; Durand, Marie-José. Disability and Rehabilitation, Volume 35, Number 7, April 2013 , pp. 557-565. http://dx.doi.org/10.3109/09638288.2012.702849



How policy on employee involvement in work reintegration can yield its opposite: employee experiences in a Canadian setting

Canada has a long tradition of involving employee representatives in developing work reintegration policies and expects this to positively affect employee involvement to improve work reintegration success. The purpose of this study was to examine employee involvement in reintegration in a Canadian province as experienced by employees. Method: Fourteen semi-structured interviews were held with employees in a healthcare organization. The interview topic list was based on a review of local reintegration policy documents and literature. Interviews were transcribed verbatim and analysed using ethnographic methodology. Results Employees do not feel in control of their reintegration trajectory. In the phase of reporting sickness absence, they wrestle with a lack of understanding on how to report in sick. In the phase of reintegration planning and coordination, they hesitate to get involved in the organization of reintegration. In the phase of reintegration plan execution, employees encounter unfulfilled expectations on interventions. Conclusion: Employee involvement in the organization of reintegration makes them responsible for the development of reintegration trajectories. However, they consider themselves often incapable of completing this in practice. Moreover, employees experience that their contribution can boomerang on them. It is not that employees are not able to think along or decide on their reintegration trajectory but rather they are expected to do so at times when they cannot oversee their illness and/or recovery trajectory. Settings out reintegration procedures that are inflexible in practice do not recognize that employee involvement in work reintegration trajectories can develop over time. The disability management professional has a central role in organizing and supporting employee involvement in work reintegration, however, the employees do not experience this is indeed happening.

Source: Maiwald, Karin; Meershoek, Agnes; de Rijk, Angelique; Nijhuis, Frans. How policy on employee involvement in work reintegration can yield its opposite: employee experiences in a Canadian setting .Disability and Rehabilitation, vol. 35, no 7, 2013 , pp. 527-537. http://dx.doi.org/10.3109/09638288.2012.704123

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