The Relationship of the Amount of Physical Therapy to Time Lost From Work and Costs in the Workers’ Compensation System

Physical therapy (PT) is perceived as a cost driver in the US workers' compensation system. We conducted a 5-year (2013 to 2017) retrospective analysis utilizing 192,197 claims from a large Texas based workers' compensation insurance company to describe the relationship between the amount of physical therapy delivered and workers' compensation costs and lost-time. Closed, indemnity claims with 15 or more PT visits were six times more likely (95% confidence interval [CI]: 5.50, 86.58) to result in high medical costs (>$7000, excluding PT costs) and were four times more likely (95% CI: 3.77, 4.42) to result in more than or equal to 6 months of lost-time, when controlling for confounders. When the number of PT visits more than or equal to 15 visits for a lost time claim, this level of PT exceeds all other predictors (opioid use, comorbidities, legal involvement, surgery, etc) of medical cost and extended time out from work.

Source: Leung, N., Tao, X. G. et Bernacki, E. J. (2019). Journal of Occupational and Environmental Medicine, 61(8), 635-640.

Breast cancer specialists' perspective on their role in their patients' return to work: A qualitative study

Objectives: This study aimed to explore the views of breast cancer (BC) specialists as to their role in the returnto-work (RTW) process of their BC patients.
Methods: A qualitative study using semi-structured interviews was conducted in a sample of 20 BC specialists selected according to age, gender, medical specialty (medical oncology, radiation oncology, gynecological
surgery), and healthcare organization (regional cancer center, university or private hospital). All interviews were audiotaped and transcribed for qualitative thematic content analysis.
Results: BC specialists had heterogeneous representations and practices regarding their role in their patients' RTW process, ranging from non-involvement to frequent discussion. Most BC specialists had concerns regarding the “right time and right way” to address patient's RTW. They hardly mentioned workplace and job factors as potential barriers but rather stressed motivation. The main reported barriers to involvement in the RTW process were lack of time, lack of knowledge, lack of skills, and a professional attitude exclusively focused on cancer care issues.
Conclusion: While our study showed varying representations and practices among BC specialists, participants consistently identified barriers in supporting BC survivors' RTW. The results will guide the development of an intervention to facilitate the role of BC specialists in the RTW process as part of a multicomponent intervention to facilitate BC survivors' RTW.

Source: Lamort-Bouché M, Péron J, Broc G, Kochan A, Jordan C, Letrilliart L, Fervers B, Fassier J-B, FASTRACS study group. Scandinavian Journal of Work, Environment & Health.

Le retour à l'emploi diminue-t-il avec l'âge ?

Le cas des travailleurs âgés en Grande-Bretagne
L'objectif d'accroître le taux d'emploi des seniors soulève la question de leur retour à l'emploi en cas de chômage. À partir des données issues des enquêtes emploi anglaises, ce Connaissance de l'emploi tente de déterminer si le faible taux de réemploi des seniors est dû à leur âge.
Les résultats montrent que la variable d'âge est effectivement un facteur important dans le retour à l'emploi des seniors si bien que les chances de retrouver un emploi diminuent à mesure que les travailleurs vieillissent. Ceci peut être en partie attribuable à des différences de comportement des entreprises en fonction de l'âge des candidats à l'embauche. Une simulation de la durée passée au chômage, basée sur l'âge, soutient le rôle clé de ce facteur dans l'écart de durée de chômage entre les seniors et le reste de la population active.


The effectiveness of vocational rehabilitation on work participation

A propensity score matched analysis using nationwide register data
Objective: Research on the effectiveness of vocational rehabilitation has focused on small and selected groups, lacked proper controls, or not captured dynamic changes in work participation. Using rich nationwide data on vocational rehabilitees and matched controls, long-term changes in work participation before and after vocational rehabilitation were examined to assess its effectiveness. Methods: Representative Finnish register data were used to examine 3199 recently employed individuals aged 30-55 years with histories of musculoskeletal- and mental-related work disability starting vocational rehabilitation in 2008-2010 (intervention group), and 3199 propensity score matched non-rehabilitees (control group). Sociodemographic and work-related factors and detailed 3-year work disability and other labor market history were used for matching. Generalized estimation equations were used to examine differences in the proportion of time spent at work between periods before and after rehabilitation among the intervention and control group and the difference in these differences (DID). Results: Vocational rehabilitation resulted in gains in work participation, the total 1-, 2-, and 3-year DID being 11.8 [95% confidence interval (CI) 10.0-13.7], 8.9 (95% CI 7.6-10.2), and 7.2 (95% CI 6.1-8.3) percentage points, respectively. Contrary to this overall pattern, larger DID was observed over the long term for those whose rehabilitation lasted >10 months. The DID was lowest among women with musculoskeletal diseases. Conclusions :Vocational rehabilitation after musculoskeletal- or mental-related work disability showed modest effectiveness on work participation. To promote sustained work participation after shorter rehabilitation (likely comprising workplace interventions) and faster work resumption after longer rehabilitation (likely comprising training), enhanced and complementary interventions should be considered.

Source: Leinonen, T., Viikari-Juntura, E., Husgafvel-Pursiainen, K., Juvonen-Posti, P., Laaksonen, M. et Solovieva, S. (2019). Scandinavian Journal of Work, Environment & Health.

Work Disability Management Communication Bottlenecks Within Large and Complex Public Service Organizations: A Sociotechnical Systems Study

Purpose Within large and complex organizations work disability (WD) communication bottlenecks emerge and contribute to avoidable disability days. Our study utilized soft systems methods to better understand communication problems in WD management. Methods Semi-structured interviews were conducted with disability case managers (n = 10), frontline supervisors (n = 15) and human resource/labor relations specialists (n = 5) within three public service organizations. Interview questions asked about organizational WD system structure and communication practices. Thematic analysis was conducted to examine system structure and emergent communication bottlenecks. Results WD communication took place across a number of internal and external stakeholders. Communication bottlenecks tended to concentrate within WD case manager and frontline supervisor activities. Inconsistent communication across organizations, challenges interacting with external stakeholders, mental health disability information exchange, lack of WD communication experience and previous worker performance represented communication bottlenecks that contributed to avoidable disability days. Conclusions To strengthen communication practices, systems-focused responses towards organizational WD management are required.

Source : Jetha, A., Yanar, B., Lay, A.M. et al. Journal of Occupational Rehabilitation (2019).

Physical capacity, occupational physical demands, and relative physical strain of older employees in construction and healthcare

Purpose To assess age-related differences in physical capacity, occupational physical demands, and relative physical strain at a group level, and the balance between capacity and demands at an individual level, for construction and healthcare workers. Methods Shoulder strength, back strength, and aerobic capacity were assessed among construction (n = 62) and healthcare workers (n = 64). During a full working day, accelerometers estimated upper-arm elevation, trunk flexion, and occupational physical activity as indicators of occupational physical demands. Simultaneously, normalised surface electromyography (%sEMGmax) of the upper trapezius and erector spinae muscles, and normalised electrocardiography (percentage heart rate reserve (%HRR)) estimated relative physical strain. Differences between younger (≤ 44 years) and older (≥ 45 years) workers, as well as the moderating effect of age on the associations between capacity and demands, were analysed per sector. Results Compared to younger workers, older workers had similar strength and lower aerobic capacity; older construction workers had similar demands while older healthcare workers had higher demands. Compared to younger workers, older employees had unfavourable muscle activity patterns; %HRR had a tendency to be lower for older construction workers and higher for older healthcare workers. Among construction workers, age moderated the associations between shoulder strength and arm elevation (p = 0.021), and between aerobic capacity and occupational physical activity (p = 0.040). Age did not moderate these associations among healthcare workers. Conclusions In both sectors, the level of occupational physical demands and the higher relative physical strain in older employees require addressing to promote sustainable work participation among an aging population.

Source : Merkus, S.L., Lunde, LK., Koch, M. et al. International Archives of Occupational and Environmental Health (2019) 92: 295.



Interventions ergonomiques pour prévenir les troubles musculo-squelettiques des membres supérieurs et du cou liés au travail chez les employés de bureau

Les troubles musculo‐squelettiques (TMS) des membres supérieurs et du cou liés au travail sont l'un des troubles professionnels les plus courants au monde. Des études ont montré que le pourcentage d'employés de bureau souffrant de TMS varie de 20 à 60 pour cent. Les coûts directs et indirects des TMS des membres supérieurs liés au travail sont élevés en Europe, en Australie et aux États‐Unis. Bien que les interventions ergonomiques soient susceptibles de réduire le risque que les employés de bureau développent des TMS des membres supérieurs et du cou liés à leur travail, les données probantes manquent de clarté. Il s'agit d'une mise à jour d'une revue Cochrane dont la dernière version a été publiée en 2012.

Source :

A systematic review and meta-analysis of return to work after mild Traumatic brain injury

Objective: To perform a systematic review and meta-analysis of return to work (RTW) times for adult patients with mild traumatic brain injury (mTBI).
Methods: Six databases and six trials registries were searched. Inclusion: studies reporting RTW, > 30 patients, adults, with mTBI. Exclusion: final measurement RTW < 30 days after injury, first measurement > 1 year.
Results: Of 978 records, 14 eligible studies were identified. Two included patients exclusively in paid employment pre-injury; four included paid employment, students, homemakers or other activities; seven included pre-injury occupational status described but unclear; one included patients whose pre-injury occupational status not described. Three reported average RTW, 12 reported proportions of patients RTW at pre-specified time-points (1 both). Average RTW times varied from 13 to 93 days. At 1 month the proportion of patients RTW (three pooled studies) was 0.56 (95% CI 0.30–0.79), at 6 months (six studies) 0.83 (0.74–0.89), at 12 months (seven studies) 0.89 (0.83–0.93).
Conclusion: More than half of patients with mTBI have returned to work by 1 month after injury, and more than 80% by 6 months. Most studies had poor internal validity. Reporting of outcomes in mTBI is variable, and this accounted for some of the heterogeneity found in this review.

Source: Bloom, B., Thomas, S., Ahrensberg, J. M., Weaver, R., Fowler, A., Bestwick, J., ... et Pearse, R. (2018). Brain injury.

Physiotherapy for injured workers in Canada: are insurers’ and clinics’ policies threatening good quality and equity of care?

Results of a qualitative study
In recent years, significant efforts have been made to improve the provision of care for compensated injured workers internationally. However, despite increasing efforts at implementing best practices in this field, some studies show that policies overseeing the organisation of care for injured workers can have perverse influences on healthcare providers' practices and can prevent workers from receiving the best care possible. The influence of these policies on physiotherapists' practices has yet to be investigated. Our objectives were thus to explore the influence of 1) workers' compensation boards' and 2) physiotherapy clinics' policies on the care physiotherapists provide to workers with musculoskeletal injuries in three large Canadian provinces.
The Interpretive Description framework, a qualitative methodological approach, guided this inquiry. Forty participants (30 physiotherapists and 10 leaders and administrators from physiotherapy professional groups and workers' compensation boards) were recruited in British Columbia, Ontario and Quebec to participate in an in-depth interview. Inductive analysis was conducted using constant comparative techniques.
Narratives from participants show that policies of workers' compensation boards and individual physiotherapy clinics have significant impacts on physiotherapists' clinical practices. Policies found at both levels often place physiotherapists in uncomfortable positions where they cannot always do what they believe to be best for their patients. Because of these policies, treatments provided to compensated injured workers markedly differ from those provided to other patients receiving physiotherapy care at the same clinic. Workers' compensation board policies such as reimbursement rates, end points for treatment and communication mechanisms, and clinic policies such as physiotherapists' remuneration schemes and restrictions on the choice of professionals had negative influences on care. Policies that were viewed as positive were board policies that recognize, promote and support physiotherapists' duties and clinics that provide organisational support for administrative tasks.
In Canada, workers' compensation play a significant role in financing physiotherapy care for people injured at work. Despite the best intentions in promoting evidence-based guidelines and procedures regarding rehabilitation care for injured workers, complex policy factors currently limit the application of these recommendations in practice. Research that targets these policies could contribute to significant changes in clinical settings.

Source: Hudon, A., Hunt, M. et Feldman, D. E. (2018). BMC Health Services Research, 18(1), 682.

Return to work after specialized rehabilitation

An explorative longitudinal study in a cohort of severely disabled persons with stroke in seven countries
Introduction: Stroke may impose disabilities with severe consequences for the individual, with physical, psychological, social, and work-related consequences. The objective with the current study was to investigate to what extent persons with stroke were able to return to work, to maintain their financial situation, and to describe the follow-up services and participation in social networks and recreational activities.
Methods: The design was a prospective, descriptive study of specialized stroke rehabilitation in nine rehabilitation centers in seven countries. Semistructured interviews, which focused on the return to work, the financial situation, follow-up services, the maintenance of recreational activities, and networks, were performed 6 and 12 months post discharge from rehabilitation.
Results: The working rate before the onset of stroke ranged from 27% to 86%. At 12 months post stroke, the return to work varied from 11% to 43%. Consequently, many reported a reduced financial situation from 10% to 70% at 6 months and from 10% to 80% at 12 months. Access to postrehabilitation follow-up services varied in the different countries from 24% to 100% at 6 months and from 21% to 100% at 12 months. Physical therapy was the most common follow-up services reported. Persons with stroke were less active in recreational activities and experienced reduced social networks. Associations between results from the semistructured interviews and related themes in LiSat-11 were small to moderate. The study shows that education, age, and disability are predictors for return to work. Differences between countries were observed in the extent of unemployment.
Conclusions: In this international multicentre study, return to work after severe stroke and specialized/comprehensive rehabilitation was possible, depending on the extent of the disability, age, and education. Altered financial situation, reduced social networks, and reduced satisfaction with life were common psychosocial situations for these patients.

Source: Langhammer, B., Sunnerhagen, K. S., Sällström, S., Becker, F. et Stanghelle, J. K. (2018). Brain and Behavior, 8(8).

Étude des qualités psychométriques de l’Outil d’identification de la situation de handicap au travail (OISHT) utilisé auprès de travailleurs ayant un trouble musculosquelettique ou un trouble mental courant

L'outil d'identification de la situation de handicap au travail (OISHT) consiste en une entrevue structurée qui a été développée pour aider les cliniciens à identifier de façon systématique les facteurs liés à l'incapacité au travail. L'OISHT est un des rares outils disponibles en réadaptation pour la clientèle en phase chronique d'incapacité au travail. Il tient compte de l'influence de différents systèmes (personnel, santé, travail, indemnisation) et a été élaboré pour les deux principales problématiques de santé associées à l'incapacité au travail, soit les troubles musculosquelettiques (TMS) et les troubles mentaux courants (TMC).
L'objectif de cette étude visait la validation de l'OISHT auprès de personnes absentes du travail, en raison de TMS ou de TMC. Plus précisément, il s'agissait de décrire les qualités psychométriques suivantes de l'OISHT : 1) la validité de construit, 2) la cohérence interne, 3) la fidélité interjuges et 4) la validité convergente.


Workplace Social System and Sustained Return-to-Work: A Study of Supervisor and Co-worker Supportiveness and Injury Reaction

Objective: To examine the impact of the social workplace system on sustained return-to-work (SRTW). Methods: A random sample of workers' compensation claimants was recruited to complete a survey following claim acceptance (baseline), and 6 months later (time 2). SRTW, at baseline and time 2, was classified as those reporting being back at work for >28 days. Co-worker and supervisor support were assessed using five and seven items, respectively, and total scores were produced. A list of potential supervisory and co-worker reactions were presented to participants who were asked whether the reaction applied to them; response were coded as positive or non-positive. Demographic and injury characteristics, and work context factors were collected. Baseline and at time 2 multivariable models were conducted to examine the impact of supervisory and coworker support and injury reaction on SRTW. Results: 551 (baseline) and 403 (time 2) participants from the overall cohort met study eligibility criteria. At baseline, 59% of all participants indicated SRTW; 70% reported SRTW at time 2. Participants reported moderate support from their supervisor (mean = 8.5 ± 3.9; median = 8.2; range = 5–15) and co-workers (mean = 10.2 ± 4.5; median = 10.3; range = 5–25). Over half reported a positive supervisor (59%) or co-worker injury reaction (71%). Multivariable models found that a positive supervisor injury reaction was significantly associated with SRTW at baseline (OR 2.3; 95% CI 1.4–3.9) and time 2 (OR 1.6; 95% CI 1.1–2.3). Conclusions: Promoting supervisor positivity towards an injured worker is an important organizational work disability management strategy.

Source: Jetha, A., LaMontagne, A. D., Lilley, R., Hogg-Johnson, S., Sim, M. et Smith, P. (2018). Journal of Occupational Rehabilitation, 28(3), 486-494.

Sickness absence after carpal tunnel release

A systematic review of the literature
Objectives: The aim of this systematic review was to provide an overview of time to return to work (RTW) after carpal tunnel release (CTR), including return to different occupations and working patterns.
Methods: A systematic search from inception to 2016 was conducted using nine electronic databases, trial registries and grey literature repositories. Randomized controlled trials and observational studies reporting RTW times after CTR were included. Study risk of bias was assessed using Cochrane risk of bias assessment tools. Time to RTW was summarized using median and range.
Results: A total of 56 relevant studies were identified: 18 randomized controlled trials and 38 observational studies. Only 4 studies were rated as having a low risk of bias. Reported RTW times ranged from 4–168 days. Few studies reported occupational information. Among 6 studies, median time to return to non-manual work was 21 days (range 7–41), compared with 39 days for manual work (range 18–101). Median time to return to modified or full duties was 23 days (ranges 12–50 and 17–64, respectively), as reported by 3 studies. There was no common method of defining, collecting or reporting RTW data.
Conclusions: This review highlights wide variation in reported RTW times after CTR. Whilst occupational factors may play a role, these were poorly reported, and there is currently limited evidence to inform individual
patients of their expected duration of work absence after CTR. A standardized definition of RTW is needed, as well as an agreed method of collecting and reporting related data.

Source: Newington L., Stevens M., Warwick D., Adams J. et Walker-Bone K. (2018). Scand J Work Environ Health.

Interventions Developed with the Intervention Mapping Protocol in Work Disability Prevention

A Systematic Review of the Literature
Purposes Intervention mapping (IM) is a protocol for developing effective behavior change interventions. It has been used for 10 years to develop work disability prevention (WDP) interventions, but it is not known to what extent and with what success. The main objective of this study was to review the effectiveness of these interventions. Secondary objectives were to review their fidelity to the IM protocol, their theoretical frameworks and their content. Methods A search strategy was conducted in MEDLINE, Web of Science, PsycINFO, Pascal, Francis, and BDSP. All titles and abstracts were reviewed. A standardized extraction form was developed. All included studies were reviewed by two reviewers blinded to each other. Results Eight WDP interventions were identified aimed at return to work (RTW; n = 6) and self-management at work (n = 2). RTW interventions targeted workers with stress-related mental disorders (n = 1), low back pain (n = 1), musculoskeletal disorders (n = 1), cancer (n = 2) and gynecological surgery (n = 1). The fidelity to the IM protocol was weaker for the participatory planning group. Matrices of change, change methods, and applications were systematically reported. The main theoretical frameworks used were the attitude-social influence-self efficacy model (n = 4) and the theory of planned behavior (n = 2). Half of the interventions included a workplace component (n = 4). Two interventions were reported as effective, and one partially effective. Conclusion The IM protocol is used in WDP since 2007. The participative dimension appears underused. Few theoretical frameworks were used. Implications are to better consider the stakeholders involvement, and mobilize theoretical frameworks with greater attempts to intervene on the work environment.

Source: Fassier, J. B., Sarnin, P., Rouat, S., Péron, J., Kok, G., Letrilliart, L. et Lamort-Bouché, M. (2018). Journal of Occupational Rehabilitation.

Conséquences de la survenue du cancer sur les parcours professionnels

Une analyse sur données médico-administratives
Ce rapport étudie les effets à court et moyen termes de la survenue d'un cancer sur l'emploi et l'activité. Il utilise la base de données Hygie, produite par l'Irdes à partir des données administratives de la Caisse nationale de l'Assurance maladie et de la Caisse nationale d'assurance vieillesse. Hygie permet de reconstituer la carrière de l'individu ainsi que les événements de santé.
Une première partie exploite la dimension rétrospective liée à la carrière et confirme l'effet pénalisant du cancer sur l'activité et l'augmentation des arrêts maladie. Les résultats d'un modèle de double différence avec appariement exact montrent la persistance des effets de la maladie sur l'éloignement du marché du travail, la probabilité d'être employé au moins un trimestre dans l'année diminuant jusqu'à un horizon de cinq ans. Nous mesurons également l'effet des douze cancers les plus prévalents dans la base Hygie et de maladies chroniques ayant un impact potentiel sur le marché du travail. Les effets les plus marqués sont relatifs au cancer du poumon et des bronches, à la schizophrénie et au VIH. Les maladies chroniques autres que le cancer ont des effets nettement plus atténués probablement parce que leurs traitements au long cours améliorent la qualité de vie.


Return to Work in Employees on Sick Leave due to Neck or Shoulder Pain

A Randomized Clinical Trial Comparing Multidisciplinary and Brief Intervention with One-Year Register-Based Follow-Up
Purpose: The aim of this study was to evaluate the effect of a multidisciplinary intervention (MDI) compared to a brief intervention (BI) with respect to return to work (RTW), pain and disability in workers on sick leave because of neck or shoulder pain. Methods: 168 study participants with sickness absence for 4–16 weeks due to neck or shoulder pain were enrolled in a hospital-based clinical study and randomized to either MDI or BI. The primary outcome was RTW obtained by a national registry on public transfer payments. Secondary outcomes were self-reported pain and disability levels. One-year follow-up RTW rates were estimated by Cox proportional hazard regression adjusted for gender, age, sick leave prior to inclusion, part-time sick leave and clinical diagnosis. Secondary outcomes were analysed using logistic and linear regression analysis for pain and disability, respectively. Results: In the MDI group, 50 participants (59%) experienced four or more continuous weeks of RTW while 48 (58%) returned to work in the BI group during the 1 year of follow-up. Results showed a statistically non significant tendency towards a lower rate of RTW in the MDI group than in the BI group (adjusted HR = 0.84, 95% CI 0.54, 1.31). There were no statistically significant differences in secondary outcomes between the MDI and BI groups. Conclusion: The brief and the multidisciplinary interventions performed equally with respect to both primary and secondary outcomes. The added focus on RTW in the multidisciplinary group did not improve RTW rates in this group.

Source: Moll, L. T., Jensen, O. K., Schiøttz-Christensen, B., Stapelfeldt, C. M., Christiansen, D. H., Nielsen, C. V. et Labriola, M. (2018). Journal of occupational rehabilitation, 28,(2), 346-356.

Common Psychosocial Factors Predicting Return to Work After Common Mental Disorders, Cardiovascular Diseases, and Cancers

A Review of Reviews Supporting a Cross-Disease Approach
Purpose: This systematic review aimed at identifying the common psychosocial factors that facilitate or hinder the return to work (RTW) after a sick leave due to common mental disorders (CMDs), cardiovascular diseases (CVDs), or cancers (CAs). Methods: We conducted a review of reviews searching 13 databases from 1994 to 2016 for peer-reviewed, quantitative, cohort studies investigating factors influencing RTW after a CMD, CVD, or CA. Then, for each disease we identified additional cohort studies published after the date of the latest review included. Data were extracted following a three steps best-evidence synthesis method: the extraction of results about each predictor from studies within each single review and in the additional papers; the synthesis of results across the reviews and additional papers investigating the same disease; and the synthesis of results across the diseases. Results: The search strategy identified 1029 unique records from which 27 reviews and 75 additional studies underwent comprehensive review. 14 reviews and 32 additional cohort studies met eligibility criteria. Specific predictors of RTW with different levels of evidence are provided for each disease. We found four common facilitators of RTW (job control, work ability, perceived good health and high socioeconomic status), and six barriers of RTW (job strain, anxiety, depression, comorbidity, older age and low education). Conclusion: This is the first review to systematically analyze commonalities in RTW after CMDs, CVDs, or CAs. The common factors identified indicate that the RTW process presents many similarities across various diseases, thus supporting the validity of a cross-disease approach.

Source: Gragnano, A., Negrini, A., Miglioretti, M. et Corbière, M. (2018). Journal of occupational rehabilitation, 28(2), 215-231.

Validation of the Readiness for Return-To-Work Scale in outpatient occupational rehabilitation in Canada

Purpose: To examine construct and concurrent validity of the Readiness for Return-To-Work (RRTW) Scale with injured workers participating in an outpatient occupational rehabilitation program. Methods: Lost-time claimants (n = 389) with sub-acute or chronic musculoskeletal disorders completed the RRTW Scale on their first day of their occupational rehabilitation program. Statistical analysis included exploratory and confirmatory factor analyses of the readiness items, reliability analyses, and correlation with related scales and questionnaires. Results: For claimants in the non-job attached/not working group (n = 165), three factors were found (1) Contemplation (2) Prepared for Action-Self-evaluative and (3) Prepared for Action-Behavioural. The precontemplation stage was not identified within this sample of injured workers. For claimants who were job attached/working group in some capacity (n = 224), two factors were identified (1) Uncertain Maintenance and (2) Proactive Maintenance. Expected relationships and statistically significant differences were found among the identified Return-To-Work (RTW) readiness factors and related constructs of pain, physical and mental health and RTW expectations. Conclusion: Construct and concurrent validity of the RRTW Scale were supported in this study. The results of this study indicate the construct of readiness for RTW can vary by disability duration and occupational category. Physical health appears to be a significant barrier to RRTW for the job attached/working group while mental health significantly compromises RRTW with the non-job attached/not working group.

Source: Park, J., Roberts, M. R., Esmail, S., Rayani, F., Norris, C. M. et Gross, D. P. (2018). Journal of occupational rehabilitation, 28(2), 332-345.

Rehabilitation and return to work after cancer - Instruments and practices

Being diagnosed with cancer has immediate and long-lasting effects, even after the completion of treatment.
This project explores the occupational safety and health challenges that employers and employees face when workers return to work after a diagnosis of cancer. The report provides national examples of successful instruments and practices that help prevent long-term sickness absence and unemployment.


How Can Supervisors Contribute to the Return to Work of Employees Who have Experienced Depression?

Background: In Western countries, work disability due to depression is a widespread problem that generates enormous costs. Objective: The goal of this study was to determine the types and prevalence of supervisor contributions during the different phases of the return-to-work (RTW) process (before and during the sick-leave absence, and during the RTW preparations) of employees diagnosed with depression. Moreover, we sought to determine which contributions actually facilitate employees' RTW, and to identify the work accommodations most frequently implemented by supervisors at the actual time of their employee's RTW. Methods: Telephone interviews were conducted in Québec (Canada) with 74 supervisors working with employees who were already back at work or still on sick leave due to depression. A sub-sample of 46 supervisors who had already taken measures to facilitate their employees' RTW was questioned about the work accommodations implemented. Results: Most of the supervisors got along well with their employees before their sick leave and 72% stayed in contact with them during their leave. Nearly 90% of the supervisors encouraged their employees to focus primarily on their recovery before their RTW, but 43% pressured their employees to RTW as soon as possible. Cox regression analyses performed for the entire sample revealed that “the supervisors' intention to take measures to facilitate their employees' RTW” was the only significant predictor of the RTW at the time of the interview. The Kaplan–Meier survival curve showed that 50% of the employees were expected to RTW within the first 8 months of absence. Four of the most frequently implemented work accommodations were actions directly involving the supervisor (i.e. providing assistance, feedback, recognition, and emotional support to the employee). Conclusions: This study shed light on the less explored point of view of the supervisor involved in the RTW process of employees post-depression. It highlighted the most frequent and effective supervisor contributions to the process. These results can be used to develop concrete action plans for training supervisors to contribute to the sustainable RTW of employees on sick leave due to depression.

Source: Negrini, A., Corbière, M., Lecomte, T., Coutu, M. F., Nieuwenhuijsen, K., St-Arnaud, L., ... et Berbiche, D. (2018). Journal of occupational rehabilitation, 28(2), 279-288.

Quels sont les facilitateurs du maintien en emploi en santé des travailleurs seniors dans un milieu d’éducation au Québec?

Le pourcentage de travailleurs seniors âgés de 45 ans et plus augmente sans cesse sur le marché du travail au Québec. Dans le secteur de l'éducation, une large portion de la main-d'œuvre est âgée de 45 ans et plus (41 %) et un tiers du personnel aura quitté son poste entre 2009 et 2018 (Grenier, 2009). Des statistiques récentes montrent aussi que les lésions tant de nature physique que psychologique des travailleurs québécois du secteur de l'éducation sont souvent associées à une perte de temps indemnisée par la Commission des normes, de l'équité, de la santé et de la sécurité du travail (CNESST). Ces lésions touchent davantage des travailleurs seniors qui occupent diverses fonctions (p. ex., enseignants, personnel administratif) (Busque, 2012). L'objectif général de cette étude est d'identifier les déterminants du maintien en emploi en santé des travailleurs seniors âgés de 45 ans et plus œuvrant dans une commission scolaire (CS) québécoise.
Cette étude a permis de mieux comprendre comment les conditions de travail caractérisées par la présence de facteurs psychosociaux favorisent la santé psychologique des travailleurs seniors et les encouragent à rester en emploi à la CS plutôt que de décider à prendre une retraite hâtive. Les résultats de la Phase 1 ont mis en évidence que les travailleurs en fin de carrière montrent de plus hauts niveaux de stresseurs ressentis au travail et d'amotivation comparativement à ceux qui se trouvent dans l'étape intermédiaire de leur carrière. Pour les travailleurs retraités, l'autonomie et la flexibilité des horaires contribuaient à leur satisfaction au travail et à leur motivation introjectée. Ces aspects positifs de la santé psychologique au travail, à leur tour, ont déterminé leur choix de se maintenir en emploi à la CS, et ce, jusqu'à leur retraite régulière. Comparativement au groupe qui a opté pour une retraite hâtive avec des pénalités financières, celui des travailleurs qui ont choisi une retraite régulière se caractérise par des niveaux plus élevés de satisfaction au travail et de satisfaction envers l'établissement.


Psychosocial work environment and mental health-related long-term sickness absence among nurses

Purpose: We investigated which job demands and job resources were predictive of mental health-related long-term sickness absence (LTSA) in nurses.
Methods: The data of 2059 nurses were obtained from the Norwegian survey of Shift work, Sleep and Health. Job demands (psychological demands, role conflict, and harassment at the workplace) and job resources (social support at work, role clarity, and fair leadership) were measured at baseline and linked to mental health-related LTSA during 2-year follow-up. Cox regression models estimated hazard ratios (HR) and related 95% confidence intervals (CI). The c-statistic was used to investigate the discriminative ability of the Cox regression models.
Results: A total of 1533 (75%) nurses were included in the analyses; 103 (7%) of them had mental health-related LTSA during 2-year follow-up. Harassment (HR = 1.07; 95% CI 1.01–1.17) and social support (HR = 0.92; 95% CI 0.87–0.98) were associated with mental health-related LTSA. However, the Cox regression model did not discriminate between nurses with and without mental health-related LTSA (c = 0.59; 95% CI 0.53–0.65).
Conclusions: Harassment was positively and social support at the workplace was negatively related to mental health-related LTSA, but both failed to discriminate between nurses with and without mental health-related LTSA during 2-year follow-up.

Source: Roelen, C. A., van Hoffen, M. F., Waage, S., Schaufeli, W. B., Twisk, J. W., Bjorvatn, B., ... et Pallesen, S. (2018). International archives of occupational and environmental health, 91(2), 195-203.

Prediction of long-term absence due to sickness in employees

Development and validation of a multifactorial risk score in two cohort studies
Objectives: This study aimed to develop and validate a risk prediction model for long-term sickness absence.
Methods: Survey responses on work- and lifestyle-related questions from 65 775 public-sector employees were linked to sickness absence records to develop a prediction score for medically-certified sickness absence lasting >9 days and ≥90 days. The score was externally validated using data from an independent population-based cohort of 13 527 employees. For both sickness absence outcomes, a full model including 46 candidate predictors was reduced to a parsimonious model using least-absolute-shrinkage-and-selection-operator (LASSO) regression. Predictive performance of the model was evaluated using C-index and calibration plots.
Results: Variance explained in ≥90-day sickness absence by the full model was 12.5%. In the parsimonious model, the predictors included self-rated health (linear and quadratic term), depression, sex, age (linear and quadratic), socioeconomic position, previous sickness absences, number of chronic diseases, smoking, shift work, working night shift, and quadratic terms for body mass index and Jenkins sleep scale. The discriminative ability of the score was good (C-index 0.74 in internal and 0.73 in external validation). Calibration plots confirmed high correspondence between the predicted and observed risk. In >9-day sickness absence, the full model explained 15.2% of the variance explained, but the C-index of the parsimonious model was poor (<0.65).
Conclusions: Individuals' risk of a long-term sickness absence that lasts ≥90 days can be estimated using a brief risk score. The predictive performance of this score is comparable to those for established multifactorial risk algorithms for cardiovascular disease, such as the Framingham risk score.

Source: Airaksinen, J., Jokela, M., Virtanen, M., Oksanen, T., Koskenvuo, M., Pentti, J., ... et Kivimäki, M. (2018). Scandinavian journal of work, environment & health.

Évaluation de différents protocoles de gestion d’incident et de soutien aux employés après un incident grave

L'industrie ferroviaire canadienne fait régulièrement face à des incidents critiques (IC) associés à des collisions avec des personnes ou des véhicules. Ces incidents peuvent occasionner des blessures graves, ou des décès, parmi les victimes, mais aussi des problèmes de santé mentale chez les ingénieurs et conducteurs opérant les locomotives. Chaque année, environ 20 personnes décèdent lors de collisions avec un train au Québec et une centaine au Canada. À ces incidents mortels s'ajoute un nombre inconnu d'incidents lors desquels des personnes ont été blessées ou des dégâts matériels ont été constatés. La plupart des ingénieurs et conducteurs de train seront exposés au moins une fois dans leur carrière à ce type d'évènement. Ils sont à la fois témoins, victimes, parties prenantes et souvent premiers répondants lorsqu'un tel incident critique se produit.
Quelques études se sont intéressées aux protocoles de gestion d'IC et de soutien (PGICS) offerts par les employeurs et leurs recommandations visaient souvent à mettre de l'avant des pratiques visant à réduire l'impact potentiel des IC sur les employés et à accélérer le retour au travail. Par contre, ces protocoles, même s'ils sont fondés sur des études des conséquences des IC et des besoins des employés, n'ont pas encore fait l'objet d'évaluations empiriques. De telles évaluations sont nécessaires pour déterminer les éléments importants qui génèrent des effets positifs sur la récupération des employés et pour promouvoir les recommandations fondées sur des connaissances scientifiques.
Ce projet vise à évaluer les PGICS déjà en place au Canada dans l'industrie ferroviaire et leurs effets sur les trajectoires de récupération des employés victimes d'un incident critique et de proposer les pratiques clés pour en réduire les effets négatifs.


Effets psychologiques et biomécaniques immédiats de deux catégories de ceintures lombaires chez des travailleurs en santé et des travailleurs avec maux de dos

Bien que les ceintures lombaires (CL) soient inefficaces pour prévenir un premier épisode de lombalgie, l'avancement des connaissances soutient leur utilisation chez les travailleurs souffrant déjà de ce mal. Dans la perspective où un retour au travail tardif risque de nuire à la condition de santé des travailleurs, l'option du port de la CL peut potentiellement être avantageuse, car elle pourrait permettre, lors du retour progressif au travail, d'apporter un soutien psychologique afin de rassurer le patient. Cela pourrait donc représenter un outil additionnel, parmi les moyens entrepris pour intervenir sur les facteurs psychosociaux reliés à l'individu et son environnement de travail, pour faciliter ce retour au travail et également pour aider le travailleur à se maintenir au travail. Cependant, il importe aussi que la CL apporte un support biomécanique en matière de stabilité mécanique de la colonne vertébrale lombaire afin de rehausser la sécurité du travailleur. Deux catégories de ceintures souples permettent un niveau suffisant de confort pour être utilisées en milieu de travail, soit les ceintures (1) extensibles (élastiques) ou CL-E; (2) non extensibles ou CL-NE. La présente étude a pour but de comparer ces deux catégories de CL en ce qui a trait aux soutiens psychologique et biomécanique qu'elles prodiguent, cela autant chez des sujets en santé que chez des sujets avec maux de dos (lombalgies). À titre exploratoire, il devenait aussi pertinent de vérifier si différents sous-groupes de sujets lombalgiques, déterminés en fonction d'hypothèses biomécanique (instabilité lombaire) ou psychologique (peurs du mouvement ou de la douleur), présenteraient des effets biomécaniques différents.  Dans la perspective de l'évaluation de l'effet du port d'une CL dans un éventuel essai clinique, il était nécessaire d'évaluer, aussi à titre exploratoire, certaines variables associées à l'adoption à ce type d'intervention.


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