Réadaptation au travail

Factors affecting RTW following acute low-back pain

Daniel Côté — Fri, 11 May 2012 12:00:00 GMT

Steenstra, Ivan et coll. (2012). Factors affecting RTW following acute low-back pain. Institute for Work & Health (IWH)

Sommaire d'une recension des écrits sur les déterminants du retour au travail chez les personnes souffrant de lombalgies aigues.

Although most workers with acute low-back pain (i.e. pain for up to six weeks) return to work following a relatively straightforward path, anywhere from one-fifth to one-third go on to suffer chronic low-back pain (i.e. pain for longer than three months). This results in potentially lengthy absences from work.

This systematic review set out to find what factors affect the length of time it takes before returning to work. The aim was to identify which workers with acute low-back pain are at high risk of long-term absences and, therefore, in need of extra attention to help them recover and return to work more quickly.

The review found strong evidence that the following factors predict the likelihood and timing of return to work among workers with acute low-back pain:

workers' recovery expectations
interactions with health-care providers
workers' self-reported pain and functional limitations
presence of radiating pain
work-related factors, including physical demands of the job, job satisfaction and the offer of modified work.

Source: http://www.iwh.on.ca/sbe/factors-affecting-rtw-following-acute-low-back-pain

Reexamining workers' compensation: A human rights perspective

Daniel Côté — Thu, 10 May 2012 18:38:00 GMT

Boden, Leslie I. (2012). Reexamining workers' compensation: A human rights perspective. American Journal of Industrial Medicine 55 (6): 483-486

Injured workers, particularly those with more severe injuries, have long experienced workers' compensation systems as stressful and demeaning, have found it difficult to obtain benefits, and, when able to obtain benefits, have found them inadequate. Moreover, the last two decades have seen a substantial erosion of the protections offered by workers' compensation. State after state has erected additional barriers to benefit receipt, making the workers' compensation experience even more difficult and degrading. These changes have been facilitated by a framing of the political debate focused on the free market paradigm, employer costs, and worker fraud and malingering. The articles in this special issue propose an alternate framework and analysis, a human rights approach, that values the dignity and economic security of injured workers and their families.

Source: http://dx.doi.org/10.1002/ajim.22054

The 'Ability' Paradigm in Vocational Rehabilitation

Maryse Gagnon — Mon, 07 May 2012 12:11:00 GMT

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.

Source : http://www.iwh.on.ca/biblio/the-ability-paradigm-in-vocational-rehabilitation-challenges-in-an-ontario-injured-worker

Making a successful return to work

Maryse Gagnon — Thu, 03 May 2012 15:46:00 GMT

The UK burden of injury multicentre longitudinal study
BACKGROUND: Injuries are common and make a significant contribution to sickness absence, but little is known about problems experienced by injured people on return to work (RTW). AIM: To quantify work problems on RTW and explore predictors of such problems. Design & setting: Multicentre longitudinal study in four UK hospitals. METHOD: Prospective study of injured participants aged 16-65 years who were employed or self-employed prior to the injury and had RTW at 1 or 4 months post injury. RESULTS: At 1 month, most (59%) had only made a partial RTW. By 4 months, 80% had fully RTW. Those who had partially RTW had problems related to physical tasks (work limited for median of 25% of time at 1 month, 18% at 4 months), time management (10% at 1 month, 20% at 4 months) and output demands (10% at 1 month, 15% at 4 months). Productivity losses were significantly greater among those with partial than full RTW at 1 month (median 3.3% versus 0.9%, P<0.001) and 4 months (median 4.6% versus 1.1% P = 0.03). Moderate/severe injuries (relative risk [RR] 1.93, 95% confidence interval [CI] = 1.35 to 2.77) and sports injuries (RR 1.73, 95% CI = 1.12 to 2.67) were associated with significantly greater productivity losses at 1 month while pre-existing long-term illnesses (RR 2.12, 95% CI = 1.38 to 3.27) and upper limb injuries (RR 1.64, 95% CI = 1.06 to 2.53) were at 4 months. CONCLUSION: Injuries impact on successful RTW for at least 4 months. Those who have only partially RTW experience the most problems and GPs should pay particular attention to identifying work problems in this group and ways of minimising such problems.

Source : Kendrick D, Vinogradova Y, Coupland C, Christie N, Lyons RA, Towner E. Br. J. Gen. Pract. 2012; 62(595): 82-90.
http://dx.doi.org/10.3399/bjgp12X625139

Prognostic value of self-reported work ability and performance-based lifting tests for sustainable return to work among construction workers

Maryse Gagnon — Tue, 01 May 2012 17:09:00 GMT

Objective : This study aims to evaluate whether performance-based tests have additional prognostic value over self-reported work ability for sustainable return to work (RTW) in physically demanding work.
Methods : A one-year prospective cohort study was performed among 72 construction workers on sick leave for six weeks due to musculoskeletal disorders. The Work Ability Index (WAI) question regarding “current work ability” was used. Three dynamic lifting tests were used from a Functional Capacity Evaluation (FCE). Sustainable RTW was the number of days on sick leave until the first day of returning fully to work for a period of ≥4 weeks. Regression models were built to calculate the prognostic values.
Results : Self-reported work ability alone predicted sustainable RTW (R=0.31, R2=0.09, P=0.009). In combination with one lifting test, the explained variance (R2) increased to 0.16 (P=0.001).
Conclusion : Combining self-reported work ability and a lifting test nearly doubled the explained variance for sustainable RTW in physically demanding work, although the strength remained modest.

Source : Kuijer PPFM, Gouttebarge V, Wind H, van Duivenbooden C, Sluiter JK, Frings-Dresen MHW. Scand J Work Environ Health. 2012.
http://dx.doi.org/10.5271/sjweh.3302

Partner relationships and long-term sick leave among female workers: consequences and impact on dimensions of health and return to work

Daniel Côté — Fri, 27 Apr 2012 17:45:00 GMT

Dellve, Lotta et Tone Ahlborg (2012). Partner relationships and long-term sick leave among female workers: consequences and impact on dimensions of health and return to work. Scandinavian Journal of Caring Sciences.

Few efforts have been made to prospectively identify resources and obstacles outside work that may predict regained work ability and return to work when workers are on sick leave. This study investigates the association between partner relationships and sick leave. Our research questions were as follows: (i) What is the influence of sick leave, pain, stress and domestic strain on the quality of the dyadic partner relationship?, and (ii) What is the influence of the partner and social relationship on pain, stress, work ability, self-rated health and return to work? A cohort of female workers (n = 225) on long-term sick leave (>60 days), all in a partner relationship, at 6-month intervals completed a questionnaire based on the Quality of Dyadic Relationship (QDR) instrument, the Interview Schedule of Social Interaction (ISSI), the Work Ability Index (WAI) and the Copenhagen Psychosocial Questionnaire (COPSOQ). Univariate and multivariate analyses of baseline and prospective data were performed. The results showed that decreased partner relationship quality was related to having major responsibility for household work despite being on sick leave, having pain and having decreased social integration. Among younger individuals on sick leave, a reduction in the quality of the partner relationship was shown already at the first (6-month) follow-up, while among middle-aged women, such a reduction was seen only at the 12-month follow-up. No dimensions of partner relationship quality at baseline were related to dimensions of return to work, either as a resource or as an obstacle. Consequently, our results show that a good relationship does not keep the woman from returning to work. Having main responsibility for household work, which implies domestic strain while on sick leave, predicts lower partner relationship quality. The practical implications are that healthcare professionals treating women on sick leave should emphasize the importance of keeping a social network as well as making sufficient adjustments at home for the relationship quality to be safeguarded. Special attention should be given to the young woman on sick leave as being on sick leave seems to influence her partner relationship considerably.

Source: http://dx.doi.org/10.1111/j.1471-6712.2012.00985.x

Intervention Characteristics that Facilitate Return to Work After Sickness Absence: A Systematic Literature Review

Daniel Côté — Fri, 27 Apr 2012 17:29:00 GMT

Hoefsmit, Nicole, Houkes, Inge et Nijhuis, Frans J. N. (2012). Intervention Characteristics that Facilitate Return to Work After Sickness Absence: A Systematic Literature Review. Journal of Occupational Rehabilitatin.

Introduction In many Western countries, a vast amount of interventions exist that aim to facilitate return to work (RTW) after sickness absence. These interventions are usually focused on specific target populations such as employees with low back pain, stress-related complaints or adjustment disorders. The aim of the present study is to detect and identify characteristics of RTW interventions that generally facilitate return to work (i.e. in multiple target populations and across interventions). This type of knowledge is highly relevant to policy makers and health practitioners who want to deliver evidence based care that supports the employee's health and participation in labour. Methods We performed a keyword search (systematic literature review) in seven databases (period: 1994–2010). In total, 23 articles were included and assessed for their methodological quality. The characteristics of the interventions were evaluated as well. Results Early interventions, initiated in the first 6 weeks of the RTW process were scarce. These were effective to support RTW though. Multidisciplinary interventions appeared effective to support RTW in multiple target groups (e.g. back pain and adjustment disorders). Time contingent interventions in which activities followed a pre-defined schedule were effective in all physical complaints studied in this review. Activating interventions such as gradual RTW were effective in physical complaints. They have not been studied for people with psychological complaints. Conclusions Early- and multidisciplinary intervention and time-contingent-, activating interventions appear most effective to support RTW.

Source: http://dx.doi.org/10.1007/s10926-012-9359-z

Health-related effects of early part-time sick leave due to musculoskeletal disorders

Maryse Gagnon — Fri, 27 Apr 2012 13:52:00 GMT

A randomized controlled trial
Objective : Previously we reported that early part-time sick leave enhances return to work (RTW) among employees with musculoskeletal disorders (MSD). This paper assesses the health-related effects of this intervention.
Methods : Patients aged 18–60 years who were unable to perform their regular work due to MSD were randomized to part- or full-time sick leave groups. In the former, workload was reduced by halving working time. Using validated questionnaires, we assessed pain intensity and interference with work and sleep, region-specific disability due to MSD, self-rated general health, health-related quality of life (measured via EuroQol), productivity loss, depression, and sleep disturbance at baseline, 1, 3, 8, 12, and 52 weeks. We analyzed the repeated measures data (171–356 observations) with the generalized estimating equation approach.
Results : The intervention (part-time sick leave) and control (full-time sick leave) groups did not differ with regard to pain intensity, pain interference with work and sleep, region-specific disability, productivity loss, depression, or sleep disturbance. The intervention group reported better self-rated general health (adjusted P=0.07) and health-related quality of life (adjusted P=0.02) than the control group. In subgroup analyses, the intervention was more effective among the patients whose current problem began occurring <6 weeks before baseline and those with ≤30% productivity loss at baseline.
Conclusions : Our findings showed that part-time sick leave did not exacerbate pain-related symptoms and functional disability, but improved self-rated general health and health-related quality of life in the early stage of work disability due to MSD.

Source : Shiri R, Kausto J, Martimo K-P, Kaila-Kangas L, Takala E-P, Viikari-Juntura E. Scand J Work Environ Health. 2012.
http://dx.doi.org/10.5271/sjweh.3301

Association of Returning to Work With Better Health in Working-Aged Adults

Maryse Gagnon — Fri, 20 Apr 2012 13:44:00 GMT

A Systematic Review
Objectives. We systematically reviewed the literature on the impact of returning to work on health among working-aged adults.
Methods. We searched 6 electronic databases in 2005. We selected longitudinal studies that documented a transition from unemployment to employment and included a comparison group. Two reviewers independently appraised the retrieved literature for potential relevance and methodological quality.
Results. Eighteen studies met our inclusion criteria, including 1 randomized controlled trial. Fifteen studies revealed a beneficial effect of returning to work on health, either demonstrating a significant improvement in health after reemployment or a significant decline in health attributed to continued unemployment. We also found evidence for health selection, suggesting that poor health interferes with people's ability to go back to work. Some evidence suggested that earlier reemployment may be associated with better health.
Conclusions. Beneficial health effects of returning to work have been documented in a variety of populations, times, and settings. Return-to-work programs may improve not only financial situations but also health.

Source : Sergio Rueda, Lori Chambers, Mike Wilson, Cameron Mustard, Sean B. Rourke, Ahmed Bayoumi, Janet Raboud, John Lavis. American Journal of Public Health: March 2012, Vol. 102, No. 3: 541–556.
http://dx.doi.org/10.2105/AJPH.2011.300401

Maladies chroniques et accidents

Maryse Gagnon — Fri, 13 Apr 2012 18:53:00 GMT

Une évaluation de leur impact
Cet article traite de l'impact des maladies chroniques et des accidents sur les performances individuelles sur le marché du travail. Nous utilisons l'enquête Santé Itinéraires Professionnels (SIP) réalisée en France en 2006-2007 et mettons en oeuvre la méthode du score de propension de manière à évaluer l'impact des maladies chroniques et des accidents sur la participation aux marchés de travail et les revenus. Nous constatons que les maladies chroniques tout comme les accidents ont un effet négatif sur la carrière et les revenus. Concernant les femmes, les accidents ont un impact plus important sur les revenus et salaires.

Source : http://www.cee-recherche.fr/fr/doctrav/155-maladies-chroniques-accidents-evaluation-impact-parcours-professionnel-revenus.pdf

Predictors for suicidal ideation after occupational injury

Maryse Gagnon — Thu, 05 Apr 2012 18:12:00 GMT

Risk of suicide has been associated with trauma and negative life events in several studies. Our aim was to investigate the prevalence and risk factors of suicidal ideation, and the population attributable risk among workers after occupational injuries. We investigated workers who had been hospitalized for ?3days after occupational injuries between February 1 and August 31, 2009. A self-reported questionnaire including demographic data, injury condition, and the question of suicidal ideation was sent to 4498 workers at 3months after their occupational injury. A total of 2001 workers (45.5%) completed the questionnaires and were included in final analysis. The prevalence of reporting suicidal ideation was 8.3%. After mutual adjustment, significant risk factors for suicidal ideation higher than "serious" in a self-rated severity scale (adjusted odds ratio, aOR=2.31; adjusted population attributable risk, aPAR=34.7%), total hospital stay for 8days or longer (OR=1.98; aPAR=20.5%), intracranial injury (OR=2.30; aPAR=10.2%), and marriage status of being divorced/separated/widowed (OR=2.70; aPAR=10.0%). Three months after occupational injury, a significant proportion of workers suffered from suicidal ideation. Significant predictors of suicidal ideation after occupational injury included broken marriage, intracranial injury, injury severity, and total hospital stay. Identification of high risk subjects for early intervention is warranted.

Source : Kuo CY, Liao SC, Lin KH, Wu CL, Lee MB, Guo NW, Guo YL. Psychiatry Res. 2012.
http://dx.doi.org/10.1016/j.psychres.2012.02.011

The joint association of sleep duration and insomnia symptoms with disability retirement

Maryse Gagnon — Tue, 03 Apr 2012 11:59:00 GMT

A longitudinal, register-linked study
Objective : The aim of this study was to examine the joint association of sleep duration and insomnia symptoms with subsequent disability retirement.
Methods : Baseline survey data were collected in 2000–2002 from 40–60-year-old employees of the City of Helsinki, all working at baseline. Baseline data were linked with disability retirement data until the end of 2010, obtained from the Finnish Centre for Pensions registers (N=6042). Sleep duration and self-reported insomnia symptoms (difficulties in initiating and maintaining sleep and non-restorative sleep) were derived from the baseline surveys. All-cause disability retirement (N=561) and the most prevalent diagnostic groups – musculoskeletal diseases (43%) and mental disorders (26%) – were examined. Cox regression analysis was used to yield hazard ratios (HR) with 95% confidence intervals (CI).
Results : A joint association of sleep duration and insomnia symptoms with disability retirement was found, implying a higher risk for those with frequent insomnia symptoms. HR for all-cause disability retirement ranged among those with frequent symptoms from 2.02 (95% CI 1.53–2.68, sleeping 7 hours) to 3.92 (95% CI 2.57–5.97, sleeping ≤5 hours). Adjusting for sociodemographic, work-related factors and health attenuated the associations, which nevertheless remained. The associations were similar for the two diagnostic groups, although stronger for those with mental disorders.
Conclusion : Frequent insomnia symptoms dominate the joint association of sleep duration and insomnia symptoms with subsequent disability retirement. Examining exclusively sleep duration would provide an incomplete understanding of the consequences of poor sleep.

Source : Haaramo P, Rahkonen O, Lahelma E, Lallukka T. Scand J Work Environ Health. 2012.
http://dx.doi.org/10.5271/sjweh.3269

Pain coping in injured workers with chronic pain

Maryse Gagnon — Fri, 30 Mar 2012 13:32:00 GMT

What's unique about workers?
Purpose: Pain caused by a work injury is a complex phenomenon comprising multiple factors, e.g. age, gender, prior health status, occupation, job demands, and severity of injury. Little research has focused on injured workers with chronic pain. This study investigates injured workers' pain coping. Methods: A descriptive cross-sectional study design was used to measure coping strategies of injured workers in a work rehabilitation program. Differences in coping strategies by demographics, injury-related variables, pain, disability, and depression were measured. Results: n = 479. The coping strategy with the highest mean score was "coping self statements" (Mean = 19.4, SD = 7.6), followed by "praying/hoping" (Mean = 18.2, SD = 9.7), and "catastrophizing" (Mean = 17.5, SD = 8.0). Statistical differences for coping strategies were noted between gender, marital status, depression levels, self-perceived disability levels, and pain (p < 0.01 for all). Conclusions: This study provided relevant information about how injured workers cope with pain. In conditions in which there may be a perceived lack of control (high pain intensity, high self-perceived disability, and high self rated depression), there were significantly higher amounts of both "catastrophizing" and "praying and hoping". Therefore, workers with high pain and high self-perceived disability are more likely catastrophize their pain, leading to poor recovery outcomes.

Source : Phillips LA, Carroll LJ, Voaklander DC, Gross DP, Beach JR. Disabil. Rehabil. 2012.
http://dx.doi.org/10.3109/09638288.2012.662261

Rehabilitation Interventions for Pain and Disability in Osteoarthritis...

Daniel Côté — Wed, 28 Mar 2012 11:00:00 GMT

Iversen, Maura Daly (2012). Rehabilitation Interventions for Pain and Disability in Osteoarthritis: A review of interventions including exercise, manual techniques, and assistive devices. Orthopaedic Nursing 31(8): 103-108.

OVERVIEW: Osteoarthritis (OA) results in progressive destruction of articular cartilage and bone at the joint margins, leading to impairments extending far beyond the synovial joint. Rehabilitation interventions that target specific impairments and activity restrictions can help restore independence and promote healthy living. Such interventions include exercise, physical modalities (ice, heat, ultrasonography), manual techniques (mobilization and manipulation), and assistive devices. The predominance of evidence on the effects of rehabilitation interventions for knee and hip OA suggest that they afford modest pain relief, reduced disability, and improved function. Research is needed to identify the modes of exercise and the effective doses for relief of symptoms and functional limitations.

Source: http://journals.lww.com/orthopaedicnursing/Abstract/2012/03000/Rehabilitation_Interventions_for_Pain_and.9.aspx

Medical Interpretation for Immigrant Workers

Daniel Côté — Tue, 27 Mar 2012 11:00:00 GMT

Forst, Linda et coll. (2012). Medical Interpretation for Immigrant Workers. New Solutions: A Journal of Environment and Occupational Health Policy, 22(1): 37-50.

Foreign-born workers have high rates of occupational mortality and morbidity, despite downward trends for the U.S. workforce overall. They have limited access to health care services. Medical interpreters (MIs) facilitate care of acutely injured, low-English-proficiency (LEP) patients, including those sustaining occupational injuries. Our goal was to assess the potential for MIs to serve as advocates of LEP patients injured at work and to deliver preventive messages. We conducted interviews and a focus group of MIs regarding their attitudes toward foreign-born workers, knowledge of occupational health, and perceived roles. They were familiar with occupational injuries and sympathetic toward foreign-born workers, and they described their roles as conduits, cultural brokers, and advocates for hospitals, providers, and patients. More detailed and representative data would require a larger investigation. However, the time-sensitive nature of policy-making at this point mandates that occupational health stakeholders participate in the national dialogue on standards, training, and licensure for MIs to promote improved access and quality of health care for LEP patients who have been injured at work.

Source: http://baywood.metapress.com/app/home/contribution.asp?referrer=parent&backto=issue,4,9;journal,2,57;linkingpublicationresults,1:300327,1