Rehabilitation and return to work after cancer: Literature review

As treatments have improved, there are more and more people surviving cancer in Europe. While most cancer survivors return to work after treatment, many face long-term symptoms and impairments that can make it difficult for them to do so.
This report provides an overview of the relevant scientific literature, conducted to collect information on existing initiatives, policies and practices on rehabilitation and return to work after cancer and gather examples of successful interventions.


Joint association of multimorbidity and work ability with risk of long-term sickness absence

A prospective cohort study with register follow-up
Objectives: The aim of this study was to determine the joint association of multimorbidity and work ability with the risk of long-term sickness absence (LTSA) in the general working population.
Methods: Cox regression analysis censoring for competing events (statutory retirement, early retirement, disability pension, immigration, or death) was performed to estimate the joint association of chronic diseases and work ability in relation to physical and mental demands of the job with the prospective risk for LTSA (defined as ≥6 consecutive weeks during 2-year follow-up) among 10 427 wage earners from the general working population (2010 Danish Work Environment Cohort Study). Control variables were age, gender, psychosocial work environment, smoking, leisure physical activity, body mass index, job group, and previous LTSA.
Results: Of the 10 427 respondents, 56.8% had experienced ≥1 chronic disease at baseline. The fully adjusted model showed an association between number of chronic diseases and risk of LTSA. This association was stronger among employees with poor work ability (either physical or mental). Compared to employees with no diseases and good physical work ability, the risk estimate for LTSA was 1.95 [95% confidence interval (95% CI) 1.50–2.52] for employees with ≥3 chronic diseases and good physical work ability, whereas it was 3.60 (95% CI 2.50–5.19) for those with ≥3 chronic diseases and poor physical work ability. Overall, the joint association of chronic disease and work ability with LTSA appears to be additive.
Conclusions: Poor work ability combined with ≥1 chronic diseases is associated with high risk of long-term sickness absence in the general working population. Initiatives to improve or maintain work ability should be highly prioritized to secure sustainable employability among workers with ≥1 chronic diseases.p>

Source: Sundstrup, E., Jakobsen, M. D., Mortensen, O. S., & Andersen, L. L. (2017). Scandinavian Journal of Work, Environment & Health.

Troubles musculosquelettiques

Revue réaliste sur les bases théoriques des programmes de réadaptation incluant le milieu de travail
Une revue réaliste portant sur un ensemble de programmes de réadaptation au travail incluant une intervention en milieu de travail a été réalisée. Selon cette méthode, les programmes se caractérisent par trois éléments principaux : le contexte (C), qui représente les caractéristiques des conditions dans lesquelles les programmes sont mis en place et les composantes de ces derniers; les mécanismes (M), qui décrivent ce qui fait en sorte qu'un programme parvient à atteindre ses résultats; et les résultats (O, pour outcomes), soit les effets prévus et imprévus d'un programme, résultant de l'interaction de différents mécanismes, dans différents contextes.


Effectiveness of Occupational Therapy Interventions for Adults With Musculoskeletal Conditions of the Forearm, Wrist, and Hand

A Systematic Review
Occupational therapy practitioners are key health care providers for people with musculoskeletal disorders of the distal upper extremity. It is imperative that practitioners understand the most effective and efficient means for remediating impairments and supporting clients in progressing to independence in purposeful occupations. This systematic review provides an update to a previous review by summarizing articles published between 2006 and July 2014 related to the focused question, What is the evidence for the effect of occupational therapy interventions on functional outcomes for adults with musculoskeletal disorders of the forearm, wrist, and hand? A total of 59 articles were reviewed. Evidence for interventions was synthesized by condition within bone, joint, and general hand disorders; peripheral nerve disorders; and tendon disorders. The strongest evidence supports postsurgical early active motion protocols and splinting for various conditions. Very few studies have examined occupation-based interventions. Implications for occupational therapy practice and research are provided.

Source: Roll, S. C., & Hardison, M. E. (2017). American Journal of Occupational Therapy, 71(1).

Factors Associated With Success in an Occupational Rehabilitation Program for Work-Related Musculoskeletal Disorders

Work-related musculoskeletal disorders are a significant burden; however, no consensus has been reached on how to maximize occupational rehabilitation programs for people with these disorders, and the impact of simulating work tasks as a mode of intervention has not been well examined. In this retrospective cohort study, the authors used logistic regression to identify client and program factors predicting success for 95 clients in a general occupational rehabilitation program and 71 clients in a comprehensive occupational rehabilitation program. The final predictive model for general rehabilitation included gender, number of sessions completed, and performance of work simulation activities. Maximum hours per session was the only significant predictor of success in the comprehensive rehabilitation program. This study identifies new factors associated with success in occupational rehabilitation, specifically highlighting the importance of intensity (i.e., session length and number of sessions) of therapy and occupation-based activities for this population.

Source: Hardison, M. E., & Roll, S. C. (2017). American Journal of Occupational Therapy, 71(1).

An Intervention Bundle to Facilitate Return to Work for Burn-Injured Workers

Report From a Burn Model System Investigation
Rates of return to work (RTW) after burn injury vary. A 2012 systematic review of the burn literature reported that nearly 28% of all adult burn survivors never return to any form of employment. These authors called for interventions designed to assist survivors' ability to function in an employed capacity. In 2010, our burn center outpatient clinic instituted an intervention aimed to return injured workers to employment within 90 days of their insurance claims. The interventions include patient/family education focused on recovery rather than disability, employer contact and education by the vocational rehabilitation (VR) counselor, physician recommendations for work accommodations, provision of employee status letters, and Activity Prescription Forms (APFs). The purpose of this study is to report on the effectiveness of these interventions. Following institutional review board (IRB) approval, medical records of adults with occupation-related burn injuries and receiving care at a single regional burn center from June 2010 to July 2015 were reviewed. Data on patient and injury characteristics and outpatient VR services provided were collected. The primary outcome of interest was the percentage of patients who RTW; 338 individuals met study entry criteria. The VR counselor evaluated all patients. All patients received an employer letter(s) and APF documentation. Workplace accommodations were provided to more than 30% of patients. RTW rate was 93%, with an average of 24 days from injury to RTW. In an intervention bundle involving the patient, employer, Workers' compensation, and the burn clinic staff, injured workers achieved a high rate of RTW. Although we cannot correlate individual bundle components to outcome, we postulate that the combination of employer/employee/insurer engagement and flexibility contributed to the success of this program.

Source: Carrougher, G. J., Brych, S. B., Pham, T. N., Mandell, S. P., & Gibran, N. S. (2017). Journal of Burn Care & Research, 38(1), e70-e78.

The role of health-care providers in the workers' compensation system and the return-to-work process

International research has generated strong evidence that health-care providers have a key role in the return-to-work (RTW) process. However, pressure on consultation time, administrative challenges and limited knowledge about a patient's workplace can thwart meaningful engagement. This multi-jurisdictional, two-year study focused on health-care providers' experiences within the workers' compensation system and their role in the RTW process.


Development and validation of a prediction model for long-term sickness absence based on occupational health survey variables

PURPOSE: The purpose of this study is to develop and validate a prediction model for identifying employees at increased risk of long-term sickness absence (LTSA), by using variables commonly measured in occupational health surveys. MATERIALS AND METHODS: Based on the literature, 15 predictor variables were retrieved from the DAnish National working Environment Survey (DANES) and included in a model predicting incident LTSA (>/=4 consecutive weeks) during 1-year follow-up in a sample of 4000 DANES participants. The 15-predictor model was reduced by backward stepwise statistical techniques and then validated in a sample of 2524 DANES participants, not included in the development sample. Identification of employees at increased LTSA risk was investigated by receiver operating characteristic (ROC) analysis; the area-under-the-ROC-curve (AUC) reflected discrimination between employees with and without LTSA during follow-up. RESULTS: The 15-predictor model was reduced to a 9-predictor model including age, gender, education, self-rated health, mental health, prior LTSA, work ability, emotional job demands, and recognition by the management. Discrimination by the 9-predictor model was significant (AUC = 0.68; 95% CI 0.61-0.76), but not practically useful. CONCLUSIONS: A prediction model based on occupational health survey variables identified employees with an increased LTSA risk, but should be further developed into a practically useful tool to predict the risk of LTSA in the general working population.

Source: Roelen, C., Thorsen, S., Heymans, M., Twisk, J., Bültmann, U., & Bjørner, J. (2016). Disability and Rehabilitation, 1-8.

Costs and Work Loss Burden of Diagnosed Opioid Abuse Among Employees on Workers Compensation or Short-term Disability

Objective: To compare 12-month healthcare costs between employees with versus without diagnosed opioid abuse within 12 months after an injury-related workers' compensation (WC) or short-term disability (STD) claim.
Methods: Retrospective study using 2003 to 2014 US insurance claims linked to administrative data on WC/STD claims. Multivariable models compared healthcare costs between employees with versus without diagnosed opioid abuse.
Results: Study included 107,975 opioid-treated employees with an injury-related WC or STD claim. Mean number of opioid prescription fills and adjusted total healthcare costs were substantially greater in employees with diagnosed opioid abuse versus without (WC: 13.4 vs. 4.5, P?<?0.001; $18,073 vs. $8470, P?<?0.001; STD: 13.7 vs. 4.5, P?<?0.001; $25,693 vs. $14,939, P?<?0.001).
Conclusion: Opioids are commonly prescribed to employees with injury-related WC/STD claims. Employers may benefit from proactively addressing the issue of opioid abuse in these populations.

Source: Johnston, S. S., Alexander, A. H., Masters, E. T., Mardekian, J., Semel, D., Malangone-Monaco, E., ... & Sadosky, A. (2016). Journal of Occupational and Environmental Medicine, 58(11), 1087-1097.

Effects of a randomized controlled intervention trial on return to work and health care utilization after long-term sickness absence

BACKGROUND: The aim of the RCT study was to investigate if the effect of a multidisciplinary intervention on return to work (RTW) and health care utilization differed by participants' self-reported health status at baseline, defined by a) level of somatic symptoms, b) health anxiety and c) self-reported general health. METHODS: A total of 443 individuals were randomized to the intervention (n = 301) or the control group (n = 142) and responded to a questionnaire measuring health status at baseline. Participants were followed in registries measuring RTW and health care utilization. Relative risk (RR) and odds ratio (OR) were used as measures of associations. Results were adjusted for gender, age, educational level, work ability and previous sick leave. RESULTS: Among all responders we found no effect of the intervention on RTW. Among participants with low health anxiety, the one-year probability of RTW was lower in the intervention than in the control group (RR = 0.79 95 % CI 0.68-0.93), but for those with high health anxiety there was no difference between the groups (RR = 1.15 95 % CI 0.84-1.57). Neither general health nor somatic symptoms modified the effect of the intervention on RTW. The intervention had no effect on health care utilization. CONCLUSIONS: The multidisciplinary intervention did not facilitate RTW or decrease health care utilization compared to ordinary case management in subgroups with multiple somatic symptoms, health anxiety or low self-rated health. However, the intervention resulted in a reduced chance of RTW among participants with low health anxiety levels.

Source: Momsen, A. M. H., Stapelfeldt, C. M., Nielsen, C. V., Nielsen, M. B. D., Aust, B., Rugulies, R., & Jensen, C. (2016). BMC Public Health, 16(1), 1149.

Engaging Employers to Prevent Disability

The Journal is honored to be publishing this special issue and grateful to all of the very talented contributors involved. The papers in this issue of the Journal provide not only a state-of-the-art review of employer factors and interventions but also provide information about research design challenges and recommendations that will be useful for anyone planning research in this domain. Practitioners will also appreciate the efforts to include information from the “grey literature” and to highlight issues of employer decision-making and implementation. All of the papers have been published as “Open Access” and can be accessed freely on the SpringerLink website. We trust that you will find this work helpful in your efforts to improve the understanding, prevention, and management of work disability.

Source: (2016). Journal of Occupational Rehabilitation, 26(4).

Managerial abuse and the process of absence among mental health staff

Managers' abuse of subordinates is a common form of unethical behaviour in workplaces. When exposed to such abuse, employees may go absent from work. We propose two possible explanations for employee absence in response to managerial abuse: a sociological explanation based on perceptions of organizational justice and a psychological explanation based on psychological strain. Both are tested using data from a sample of 1472 mental health workers. The occurrence, duration and frequency of absence are investigated using a hurdle model. Managerial abuse is found to be associated with the occurrence of absence through both perceptions of organizational justice and psychological strain. Distributive justice and depression are especially significant in explaining the relationship between abuse and absence. Once absent, duration of absence is not further affected by managerial abuse but is still linked to depression and distributive justice, whereas frequency of absence is linked to bullying and depression.

Source: Wood, S., Niven, K., & Braeken, J. (2016). Work, Employment & Society.

Chronic Condition Combinations and Productivity Loss Among Employed Nonelderly Adults (18 to 64 Years)

Objective: We examined the relationship between specific chronic condition combinations and productivity loss measured by missed work days among nonelderly employed adults with at least two physical chronic conditions of arthritis, diabetes mellitus, heart disease, and hypertension.
Methods: We analyzed data from the Medical Expenditure Panel Survey for the years 2004 to 2012.
Results: Adults with arthritis/diabetes/heart disease had the highest average missed work days (14.42). In the adjusted model, compared with adults with arthritis/hypertension, adults with diabetes/heart disease and arthritis/heart disease/hypertension had significantly higher missed work days, while adults with diabetes/hypertension had significantly lower missed work days.
Conclusion: Specific chronic condition combinations have a high burden of disease in terms of productivity loss. Workplace health programs that address multiple health conditions at the same time should be implemented to reduce missed work days.

Source: Meraya, A. M., & Sambamoorthi, U. (2016). Journal of Occupational & Environmental Medicine, 58(10), 974-978.

Effectiveness of multifaceted implementation strategies for the implementation of back and neck pain guidelines in health care

A systematic review
For the optimal use of clinical guidelines in daily practice, mere distribution of guidelines and materials is not enough, and active implementation is needed. This review investigated the effectiveness of multifaceted implementation strategies compared to minimal, single, or no implementation strategy for the implementation of non-specific low back and/or neck pain guidelines in health care.

Source: Suman, A., Dikkers, M. F., Schaafsma, F. G., van Tulder, M. W., & Anema, J. R. (2016). Implementation Science, 11(1), 126.

Online assessment of patients’ work disability representations to promote evidence based practice in rehabilitation setting

The Revised Illness Perception Questionnaire adapted for Work Disability (IPQR-WD) is an adaptation of Illness Perception Questionnaire-Revised: the most used and most comprehensive tool for measuring illness perceptions. Evaluating representations is crucial, since it is a main determinant of return to work in cases of persistent pain due to musculoskeletal disorders.
This study aim at facilitating systematic assessment of work disability representations by assessing the usability of the Web platform and the usefulness of automatic interpretation of the results.

Source: Coutu, M. F., Albert, V., & Labrecque, M. E. (2016). Annals of Physical and Rehabilitation Medicine, 59, e147.

Déterminants cliniques et neuromécaniques du développement de l'incapacité lombaire chez les travailleurs

Au-delà de la simple lésion, les blessures, dysfonctions et pathologies musculosquelettiques entraînent aussi, sur le plan individuel, des conséquences psychologiques importantes. Sur le plan sociétal, la gestion de ce type d'affections entraîne d'importants coûts socio-économiques. La société occidentale qui a vu, au cours des dernières décennies, une augmentation de la disponibilité des services et de l'accessibilité aux soins de santé, a aussi parallèlement connu une explosion du nombre de consultations pour les affections musculosquelettiques. Parmi ce type d'affections, l'une d'entre elles semble s'être démarquée par sa prévalence et son incidence élevées, sa complexité et les dépenses importantes qui y sont associées. Les douleurs lombaires constituent désormais le second motif de consultation médicale, et la principale blessure d'ordre musculosquelettique. De fait, dans les sociétés industrialisées, la prévalence à vie des lombalgies varie entre 70 % et 85 %, tandis que la prévalence annualisée oscille entre 15 % et 45 %. Considérant cette réalité et son impact important au sein des populations actives de travailleurs, l'équipe a tenté, par l'entremise d'une étude de cohorte longitudinale, de déterminer les facteurs cliniques, psychologiques et physiques qui expliquent l'apparition et le développement de l'incapacité associée aux affections qui présentent un historique de douleurs lombaires. L'objectif principal de l'étude consistait à déterminer si la douleur initiale, les facteurs psychologiques qui lui sont associés, les capacités motrices en présence de douleur et les mécanismes de modulation de la douleur jouent un rôle dans l'évolution des incapacités fonctionnelles et l'absentéisme associés à la lombalgie chez un groupe de travailleurs ayant connu au moins un récent épisode significatif de lombalgies.


Return to work after vocational rehabilitation for sick-listed workers with long-term back, neck and shoulder problems

A follow-up study of factors involved
BACKGROUND: Absence from work due to musculoskeletal disorders is a significant problem from a number of perspectives, and there is a great need to identify factors that facilitate return to work (RTW).
OBJECTIVE: To identify factors related to RTW after vocational rehabilitation for sick-listed workers with long-term back, neck and/or shoulder problems, and to compare the results with those from a previous literature review based on studies from 1980 to 2000.
METHODS: A literature review based on studies published 2001–2014 in PubMed, CINAHL, EMBASE, ERIC and the Cochrane Library.
RESULTS: Major risk factors for not returning to work are: higher age, factors related to pain such as higher levels of pain and pain related fear, avoidance of activity, high distress and depression. Facilitating factors for RTW are: lower functional disability, gaining control over one's own condition, believing in RTW and work-related factors such as occupational training, and having a job coach or an RTW coordinator. Compared with the results from the previous review, the present review shows less of a focus on sociodemographic factors and more on psychological factors. Both studies highlight risk factors such as older age, higher levels of pain, depression and less internal locus of control.
CONCLUSION: Psychosocial and work-related factors are important and should be included in interventions for the RTW of people with long-term back, neck and/or shoulder problems.

Source: Rinaldo, U., & Selander, J. (2016). Work, 1-17.

Pratiques des grandes organisations au Québec en regard de la coordination du retour au travail

L'objectif général de cette étude consistait à décrire les pratiques des personnes impliquées dans la coordination du retour au travail dans de grandes organisations privées et publiques au Québec. Le premier objectif spécifique était de décrire les personnes impliquées dans la coordination du retour au travail, ainsi que les organisations pour lesquelles elles travaillent. Le deuxième objectif spécifique était de décrire les tâches et activités réalisées par ces personnes, identifier les acteurs avec lesquels elles sont appelées à collaborer, ainsi qu'établir les qualités et aptitudes requises pour effectuer la coordination du retour au travail. Enfin, le troisième objectif spécifique était d'explorer les leviers et les obstacles à l'accomplissement des tâches et activités, de même que ceux associés au retour au travail.


Travailleurs avec déchirure de la coiffe des rotateurs et asymptomatiques

Corrélation entre des paramètres morphoanthropométriques et d'imagerie diagnostique et la fonction de l'épaule
L'objectif général du présent projet est de faire des analyses de corrélation entre différents paramètres d'imagerie diagnostique, morphologiques, posturaux et de pseudo-cinématique et la fonction de l'épaule chez deux groupes de travailleurs avec et sans rupture de la coiffe pour tenter d'établir les déterminants de la fonction de l'épaule.


Validation du questionnaire Obstacles au Retour au Travail Et Sentiment d’Efficacité pour les Surmonter (ORTESES) auprès de travailleurs avec un trouble mental courant ou un trouble musculosquelettique

L'objectif de cette étude prospective visait la validation de l'outil intitulé « Obstacles au Retour au Travail Et Sentiment d'Efficacité pour les Surmonter » (ORTESES) auprès d'employés en processus de RAT suite à un trouble mental courant (TMC) ou un trouble musculosquelettique (TMS). Plus précisément, il s'agissait de valider les propriétés psychométriques relatives à l'ORTESES : (1) validité de contenu, (2) validité apparente, (3) validité de construit, (4) stabilité temporelle (fidélité) et (5) validité prédictive.


Développement préliminaire d’une règle de prédiction clinique pour dépister les patients ayant une lombalgie non aiguë répondant favorablement à un programme d’exercice de stabilisation lombaire

Les exercices physiques permettent de réduire la douleur et les incapacités chez les gens souffrant d'une lombalgie non aiguë (> 3-4 semaines), mais ces effets sont relativement limités. Pour rehausser l'efficacité de ce type d'intervention, nous devons déterminer pour quels patients chaque modalité d'exercice est la plus efficace (arrimage patient/intervention) et pour quelles raisons (mécanismes sous-jacents). Dans la présente recherche, nous nous intéressons aux exercices de stabilisation lombaire, une modalité active d'exercice gagnant en crédibilité et en popularité. Trois objectifs spécifiques ont été poursuivis : (1) initier le développement de règles de prédiction clinique (RPC) de succès et d'échec pour dépister, lors de l'examen clinique, les patients qui répondront bien ou pas du tout à ces exercices; (2) étudier les mécanismes (d'origines neuromusculaire et psychologique) mis en action par ces exercices à l'aide de mesures plus spécifiques permettant de décrire les effets du traitement; (3) évaluer la fidélité test-retest de moyenne durée (8 semaines) des mesures neuromusculaires chez des sujets sains.


Ill Health–Related Job Loss

A One-Year Follow-Up of 54 026 Employees
Introduction: The diagnoses of workers being unfit to work may be a relevant health indicator. Therefore, the aim of this study was to analyze the one-year incidence of an unfit to work diagnosis.
Method: This one-year prospective study included all workers undergoing annual work medical examination from occupational health services in Troyes, France.
Results: Twenty-one occupational physicians followed 54,026 employees. The all-cause incidence of being unfit to return to work was 0.772%. The two main causes of being unfit to work were musculoskeletal disorders (61%) and psychopathologies (24%). The relative risk (RR) of being unfit to work, independent of the cause, was higher when employees were aged over 50 years (RR?=?2.51), and female (RR?=?1.51).
Conclusions: Prospective results from occupational physicians' medical records may provide significant and cost-effective directions to prioritize actions and target health promotion in the workplace.

Source: Dutheil, Frédéric; Naughton, Geraldine; Sindyga, Patricia; Lesage, François-Xavier. Journal of Occupational & Environmental Medicine: September 2016, volume 58, Issue 9, p. 918-923.

Measurement Properties of the Quebec Back Pain Disability Scale in Patients With Nonspecific Low Back Pain

Systematic Review
Background: The Quebec Back Pain Disability Scale (QBPDS) has been translated into different languages, and several studies on its measurement properties have been done.
Purpose: The purpose of this review was to critically appraise and compare the measurement properties, when possible, of all language versions of the QBPDS by systematically reviewing the methodological quality and results of the available studies.
Method: Bibliographic databases (PubMed, Embase, CINAHL, and PsycINFO) were searched for articles with the key words “Quebec,” “back,” “pain,” and “disability” in combination with a methodological search filter for finding studies on measurement properties concerning the development or evaluation of the measurement properties of the QBPDS in patients with nonspecific low back pain. Assessment of the methodological quality was carried out by the reviewers using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist for both the original language version of the QBPDS in English and French and all translated versions. The results of the measurement properties were rated based on criteria proposed by Terwee et al.
Results: The search strategy resulted in identification of 1,436 publications, and 27 articles were included in the systematic review. There was limited-to-moderate evidence of good reliability, validity, and responsiveness of the QBPDS for the different language versions, but for no language version was evidence available for all measurement properties.
Conclusion: For research and clinical practice, caution is advised when using the QBPDS to measure disability in patients with nonspecific low back pain. Strong evidence is lacking on all measurement properties for each language version of the QBPDS.

Source: Speksnijder, C. M., Koppenaal, T., Knottnerus, J. A., Spigt, M., Staal, J. B., & Terwee, C. B. (2016). Physical Therapy, 2016.

Web-Based Interventions for Chronic Back Pain: A Systematic Review

Background: Chronic low back pain is one of the most common presenting complaints to a physician's office. Treatment is often challenging and recovery depends on various factors, often resulting in significant investments of time and resources.
Objective: The aim of this review is to determine which Web-based interventions aimed at chronic low back pain are of benefit to patients.
Methods: Randomized controlled trials (RCTs) studying Web-based interventions directed at adults with chronic low back pain were included. Retrospective studies, narrative reviews, nonrandomized trials, and observational studies were excluded. Electronic databases and bibliographies were searched.
Results: In total, nine unique RCTs were identified (total participants=1796). The number of patients randomized in each trial ranged from 51 to 580. Four trials studied online cognitive behavioral therapy (CBT) and five trials studied other Web-based interventions with interactive features. Empowerment/control was improved in six studies. Use of CBT was associated with reduced catastrophization among patients. Mixed results were reported with regards to reduction in pain levels and disability, although some studies showed promise in reducing disability in the short term. One study that measured health care utilization reported reduced utilization with the use of moderated email discussion.
Conclusions: Limited data are available regarding effective Web-based interventions to improve outcomes for patients with chronic low back pain. Nine RCTs with small sample sizes were identified in this review. Online CBT appears to show some promise in terms of reducing catastrophization and improving patient attitudes. Further research in this area with larger-scale studies focusing on appropriate outcomes appears to be a priority.

Source: Shashank Garg, Divya Garg, Tanvir C Turin, M Faruq U Chowdhury. J Med Internet Res, 2016; 18 (7), p. e139.

Factors associated with return to work in men and women with work-related traumatic brain injury

Background: Symptoms that persist subsequent to a work-related traumatic brain injury (wrTBI) influence the ability to return to work (RTW) and indicate areas of functional disability, as classified in the International Classification of Functioning, Disability and Health (ICF) framework.
Objective: The purpose of this study was to describe the relationship between RTW status and ICF framework domains in men and women with a wrTBI.
Methods: A retrospective chart review of 209 consecutive workers with TBI (mild TBI: 71.8%; mean age: 40.2 ± 11.1, men: 71.3%) was conducted. Workers were assessed during the chronic post-injury phase, at the neurology service of a large rehabilitation hospital in Ontario, Canada in 2003. Frequency distributions were calculated and chi-square tests performed.
Results: At the point of assessment, 78.0% of workers were in receipt of disability benefits, while the remainder had returned to work on a full- or part-time basis. Significant differences were observed in the Body Functions and Structures domain of the ICF model, specifically clinical diagnoses of depression, anxiety, pain disorders; self-perceived cognitive disturbance, and certain psychosocial factors (p < 0.05), between workers who had returned to work and those who had not. When stratified according to sex, these associations remained significant only in men.
Conclusions: The factors outlined above should be subject to further TBI research, as indicators for RTW. The lack of significant findings in women warrants further exploration of variables within the physical and social environmental domains of the ICF.

Source: Chen Xiong, Tickalyn Martin, Aneesha Sravanapudi, Angela Colantonio, Tatyana Mollayeva. Disability and Health Journal, Volume 9, Issue 3, July 2016, p. 439-448.

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