DÉCEMBRE 2017

Identifying return-to-work trajectories using sequence analysis in a cohort of workers with work-related musculoskeletal disorders

Purpose This study aimed to identify return-to-work (RTW) trajectories among workers with work-related musculoskeletal disorders (MSD) and examine the associations between different MSD and these RTW trajectories. Methods We used administrative workers' compensation data to identify accepted MSD lost-time claims with an injury date between 2010-2012 in British Columbia, Canada. Cox regression analyses were used to investigate differences in time to RTW between MSD. Validated day-to-day calendar measures of four RTW states (sickness absence, modified RTW, RTW, and non-RTW) were grouped into RTW trajectories spanning a one-year period using sequence analysis. RTW trajectories were clustered using decision rules that identified a shared trajectory structure. Poisson regression with robust standard errors was used to estimate relative risk ratios (RR) with 95% confidence intervals (CI) between MSD and RTW trajectory clusters. Results In a cohort of 81 062 claims, 2132 unique RTW trajectories were identified and clustered into nine RTW trajectory clusters. Half of the workers sustainably returned to work within one month. Workers with back strains were most likely to have trajectories characterized by early sustained RTW, while workers with fractures or dislocations were more likely to have prolonged sickness absence trajectories (RR 4.9-9.9) or non-RTW trajectories (RR 1.4-7.6). Conclusions This is the first study that has characterized different types of RTW trajectories of workers with MSD using sequence analysis. The application of sequence analysis and the identification of RTW trajectories yielded a number of key insights not found using conventional cox regression analysis.

Source: McLeod C, Reiff E, Maas E, Bültmann U, Scandinavian Journal of WorkEnvironment & Health, 2017 Dec.

Intensive spa and exercise therapy program for returning to work for low back pain patients: a randomized controlled trial

Purpose We aimed to determine whether a 5-day intensive inpatient spa and exercise therapy and educational program is more effective than usual care in improving the rate of returning to work at 1 year for patients with subacute and chronic low back pain (LBP) on sick leave for 4 to 24 weeks. We conducted a 12-month randomized controlled trial. LBP patients were assigned to 5-day spa (2 hr/day), exercise (30 min/day) and education (45 min/day) or to usual care. The primary outcome was the percentage of patients returning to work at 1 year after randomization. Secondary outcomes were pain, disability and health-related quality of life at 1 year and number of sick leave days from 6 to 12 months. The projected recruitment was not achieved. Only 88/700 (12.6%) patients planned were enrolled: 45 in the spa therapy group and 43 in the usual care group. At 1 year, returning to work was 56.3% versus 41.9% (OR 1.69 [95% CI 0.60-4.73], p = 0.32) respectively. There was no significant difference for any of the secondary outcomes. However, our study lacked power.

Source: Nguyen C, Boutron I, Rein C, Baron G, Sanchez K, Palazzo C, Dupeyron A, Tessier JM, Coudeyre E, Eschalier B, Forestier R, Roques-Latrille CF, Attal Y, Lefèvre-Colau MM, Rannou F, Poiraudeau S, Scientific Reports, Vol. 7 (1), 2017 Dec.

A pilot study of the individual placement and support model for patients with chronic pain

Purpose Individual Placement and Support (IPS) is an evidence-based work rehabilitation model with well-documented effects for people with mental illness. The model has, however, never been tested out for people with chronic pain. This pilot study aimed to investigate chronic pain patients' experiences with the IPS job support model. Methods We recruited eight consecutive patients referred for various chronic pain conditions at a hospital outpatient pain clinic. They were offered IPS job support as an integrated part of their interdisciplinary pain rehabilitation. The patients' experiences were investigated through semi-structured interviews 3 months after inclusion in the study. Results The participants reported mostly positive experiences with IPS. One participant dropped out of the study after deterioration of symptoms, while the remaining participants were satisfied with the intervention. Particular helpful aspects of the IPS intervention were the follow-up from the employment specialist, focus on competitive employment, focus on work despite pain complaints, reframing work into something positive, administrative support, and practice in writing applications. No participants reported adverse experiences from the IPS intervention. Within a 12-months time frame, 3 of the 8 participants gained competitive employment. Conclusions This is the first report of the IPS model of supported employment applied in an outpatient setting for chronic pain patients. The results suggest that IPS can be successfully integrated with interdisciplinary pain rehabilitation, and warrants large-scale testing in a randomized controlled trial.

Source: Rødevand L, Ljosaa TM, Granan LP, Knutzen T, Jacobsen HB, Reme SE,  BMC Musculoskeletal Disorders, Vol. 18, p.1-10, 2017 Dec.

Predictors of return-to-work in patients with chronic musculoskeletal pain: A randomized clinical trial

Purpose To assess the predictive effect of a multidisciplinary intervention programme, pain, work-related factors and health, including anxiety/depression and beliefs, on return-to-work for patients sick-listed due to musculoskeletal pain. Design A randomized clinical study. Methods A total of 284 patients were randomized to either a multidisciplinary intervention programme (n = 141) or to a less resource-demanding brief intervention (n = 143). Work participation was estimated monthly from register data for 12 months. Return-to-work was defined as increased work participation in 3 consecutive months. Results In the adjusted model, return-to-work by 3 months was associated with a multidisciplinary intervention programme (odds ratio (OR) = 2.7, 95% confidence interval (95% CI) = 1.1-6.9), the factor "belief that work was cause of the pain" (OR = 2.2, 95% CI = 1.1-4.3), anxiety and depression (OR = 0.5, 95% CI = 0.2-0.98), and by an interaction between the multidisciplinary intervention and perceived support at work (OR = 0.3, 95% CI = 0.1-0.9). At 12 months, only duration of sick leave was associated with return-to-work (OR = 0.6, 95% CI = 0.5-0.8). Conclusions Multidisciplinary intervention may hasten return-to-work and benefit those who perceive low support at work, but at 12 months only duration of sick leave at baseline was associated with return-to-work.

Source: Brendbekken R, Vaktskjold A, Harris A, Tangen T, Journal of Rehabilitation Medicine, 2017 Dec.

NOVEMBRE 2017

Early interventions to promote work participation in people with regional musculoskeletal pain: a systematic review and meta-analysis

Purpose To determine the effectiveness of early multidisciplinary interventions in promoting work participation and reducing work absence in adults with regional musculoskeletal pain. Methods Seven databases (CENTRAL, CINAHL, EMBASE, MEDLINE, Scopus, OT Seeker, PEDro; 1990 to December 2016) were searched for eligible studies. Trials were included if they reported on work-based outcomes for participants experiencing difficulties at work or ⩽ three month's sick leave. Interventions had to include two or more elements of the biopsychosocial model delivered as a coordinated programme. Quality was assessed using the GRADE criteria. Results were analysed by hazard ratios for return to work data; continuous outcomes were analysed as standardised mean difference with 95% confidence intervals. Results A total of 20 randomized controlled trials, with 16,319 participants were included; the interventions were grouped according to their main components for meta-analyses. At 12-months follow-up, moderate quality evidence suggests that programmes involving a stepped care approach (four studies) were more effective than the comparisons in promoting return to work (hazard ratio (HR) 1.29 (95% confidence interval (CI) 1.03 to 1.61), p = 0.03), whereas case management (two studies) was not (HR 0.92 (95% CI 0.69 to 1.24), p = 0.59). Analyses suggested limited effectiveness in reducing sickness absences, in pain reduction or functional improvement across the intervention categories. Conclusions There is uncertainty as to the effectiveness of early multicomponent interventions owing to the clinical heterogeneity and varying health and social insurance systems across the trials.

Source: Cochrane A, Higgins NM, FitzGerald O, Gallagher P, Ashton J, Corcoran O, Desmond D, Clinical Rehabilitation, Vol. 31 (11), p.1466-1481, 2017 Nov.

SEPTEMBRE 2017

Experiences of participating in return-to-work group programmes for people with musculoskeletal disorders: A focus group study

Purpose The present study aimed to explore the experiences of individuals with musculoskeletal disorders (MSDs) who had participated in return-to-work group programmes (RTW-GPs) and to assess whether the programmes had had an impact on their work disability. Methods Three focus group interviews and one individual interview were conducted involving 17 women (mean age=47) with MSDs who had completed RTW-GPs. All interviews were audio-recorded, transcribed verbatim and analysed using thematic analyses. Results Participant experiences were categorised into three main themes: changed way of thinking, the importance of being able to work, and a changed lifestyle. The respondents said that participation in the RTW-GPs had enabled them to shift their focus from problems to opportunities. They had become more aware of strategies to enhance their energy levels and continue working. Several participants had reduced their work hours to achieve a better balance between work and daily life. Many participants had also changed their lifestyle habits, which had led to weight reduction, more energy and less pain. Conclusions The study participants had attained a heightened awareness of what they could do to continue working. Many participants had introduced changes in their daily lives, with consequences for employment, social life and lifestyle. The findings suggest that RTW-GPs can help people with MSDs to remain in employment and prevent absenteeism.

Source: Hamnes B, Rønningen A, Skarbø Å, Musculoskeletal Care, Vol. 15 (3), p. 272-280, 2017 Sep.

Social Media and Total Joint Arthroplasty: An Analysis of Patient Utilization on Instagram

Purpose The purpose of this study was to analyze the nature of shared content of total joint arthroplasty patients on Instagram. Specifically, we evaluated social media posts for: (1) perspective and timing; (2) tone; (3) focus (activities of daily living [ADLs], rehabilitation, return-to-work); and (4) the comparison between hip and knee arthroplasties. Methods A search of the public Instagram domain was performed over a 6-month period. Total hip and knee arthroplasties (THA and TKA) were selected for the analysis using the following terms: "#totalhipreplacement," "#totalkneereplacement," and associated terms. 1287 individual public posts of human subjects were shared during the period. A categorical scoring system was utilized for media format (photo or video), time (preoperative, perioperative, or postoperative) period, tone (positive or negative), return-to-work, ADLs, rehabilitation, surgical site, radiograph image, satisfaction, and dissatisfaction. Results Ninety-one percent of the posts were shared during the postoperative period. Ninety-three percent of posts had a positive tone. Thirty-four percent of posts focused on both ADLs and 33.8% on rehabilitation. TKA patients shared more about their surgical site (14.5% vs 3.3%, P < .001) and rehabilitation (58.9% vs 8.8%, P < .001) than THA patients, whereas THA patients shared more about ADLs than TKA patients (60.5% vs 7.6%, P < .001). Conclusions When sharing their experience on Instagram, arthroplasty patients did so with a positive tone, starting a week after surgery. TKA posts focused more on rehabilitation and wound healing than THA patients, whereas THA patients shared more posts on ADLs. The analysis of social media posts provides insight into what matters to patients after total joint arthroplasty.

Source: Prem N.Navarro R, M. Haeberle S, S.Chughtai H, Flynn M, E.Mont M, Michael A, Journal of Arthroplasty, Vol. 32(9), p.2694-2700, 2017 Sep.

AOÛT 2017

Activity levels and return to work following total knee arthroplasty in patients under 65 years of age

Purpose Little is known about employment following total knee arthroplasty (TKA). This study aims to identify factors which predict return to work following TKA in patients of working age in the United Kingdom.Methods We prospectively assessed 289 patients (289 TKAs) aged ≤ 65 years who underwent TKA between 2010 and 2013. There were 148 women. The following were recorded pre-operatively: age, gender, body mass index, social deprivation, comorbidities, indication for surgery, work status and nature of employment, activity level as assessed by the University of California, Los Angeles (UCLA) activity score and Oxford Knee Score (OKS). The intention of patients to return to work or to retire was not assessed pre-operatively. At a mean of 3.4 years (2 to 4) post-operatively, the return to work status, OKS, the EuroQol-5 dimensions (EQ-5D) score, UCLA activity score and Work, Osteoarthritis and joint-Replacement (WORQ) score were obtained. Univariate and multivariate analyses were performed. Results Of 261 patients (90%) who were working before TKA, 105 (40%) returned to any job, including 89 (34%) who returned to the same job at a mean of 13.5 weeks (2 to 104) post-operatively. A total of 108 (41%) retired following TKA and 18 remained on welfare. Patients not working before the operation did not return to work. Median UCLA scores improved in 125 patients (58%) from 4 (mild activity) to 6 (moderate activity) (p < 0.001). Significant (p < 0.05) factors which were predictive of return to any work included age, heavy or moderate manual work, better post-operative UCLA, OKS and EQ-5D general health scores. Significant predictive factors of return to the same work included age, heavy or moderate manual work and post-operative OKS. Multivariate analysis confirmed heavy or moderate manual work and age to independently predict a return to either any or the same work. All patients aged < 50 years who were working pre-operatively returned to any work as did 60% of those aged between 50 and 54 years, 50% of those aged between 55 and 59 years and 24% those aged between 60 and 65 years. Conclusions If working pre-operatively, patients aged < 50 years invariably returned to work following TKA, but only half of those aged between 50 to 60 years returned. High post-operative activity levels and patient reported outcome measures do not predict return to work following TKA.

Source: Scott CEH, Turnbull GS, MacDonald D, Breusch SJ, The Bone & Joint Journal, Vol. 99-B (8), p. 1037-1046, 2017 Aug.

Work ability is influenced by kinesiophobia among patients with persistent pain

Purpose The purpose of this study was to investigate how kinesiophobia fluctuates in patients over a four weeks multimodal rehabilitation program and to study the relationship between work ability and kinesiophobia. Methods The study included 112 patients (94 women, 18 men). Measurements were made before, directly after, 2 months after, and 12 months after the program. The level of work ability was rated by the patients on a scale from 0% to 100%, and kinesiophobia was measured by the Swedish version of the Tampa Scale for Kinesiophobia (TSK-SV). Kinesiophobia decreased between the start of the multimodal rehabilitation program and the follow-up periods. Results Work ability increased over time, but not between baseline and the 2-month follow-up. Decreases in the TSK-SV score between baseline and the 2-month follow-up were related to the increased probability of improved work ability at the 12-month follow-up. Conclusions In conclusion, a decrease in kinesiophobia seems to be related to increased work ability of patients participating in a 4-week multimodal rehabilitation program.

Source: Åkerström ML, Grimby-Ekman A, Lundberg M, Physiotherapy Theory & Practice, Vol. 33 (8,) 634-643, 2017 Aug.

JUILLET 2017

Factors associated with return to work among people on work absence due to long-term neck or back pain: a narrative systematic review

Purpose The purpose of this narrative systematic review was to summarise prognostic factors for return to work (RTW) among people with long-term neck/shoulder or back pain.Methods: A systematic literature search was performed through three databases (Medline, CINAHL and PsycINFO) for studies published until February 2016. Only observational studies of people on work absence (≥2 weeks) due to neck/shoulder or back pain were included. The methodological quality of the included studies was assessed using guidelines for assessing quality in prognostic studies on the basis of Framework of Potential Biases. Factors found in the included studies were grouped into categories based on similarities and then labelled according to the aspects covered by the factors in the category.Results: Nine longitudinal prospective cohort studies and one retrospective study fulfilled the inclusion criteria. From these, five categories of factors were extracted. Our findings indicate that recovery beliefs, health-related factors and work capacity are important for RTW among people with long-term neck or back pain. We did not find support for workplace factors and behaviour being predictive of RTW.Conclusions: Our findings suggest that recovery beliefs, perceived health and work capacity may be important targets of intervention for people with long-term neck or back pain. However, more high-quality prospective studies are needed to confirm the results and improve our understanding of what is needed to facilitate RTW in this population.

Source: Rashid M, Kristofferzon ML, Nilsson A, Heiden M, BMJ Open, Vol. 7 (6), 2017 July.

The Association Between Rurality And Return To Work For Workers' Compensation Claimants With Work-Related Musculoskeletal Injuries: An Analysis Of Workers Who Failed To Return To Work Within Typical Healing Time Frames

Purpose The objectives of this study have been to: 1) describe and compare urban and rural injured worker populations in Alberta, Canada; 2) identify return-to-work outcomes in urban and rural populations; 3) examine the relationship between geographic location of residence and recovery from work-related musculoskeletal injury; and 4) investigate if this relationship is attenuated after controlling for other known risk factors. Methods This study was a secondary analysis utilizing data of a population of musculoskeletal injury claimants who underwent clinical/RTW (return to work) assessment between December 2009 and January 2011 collected by the Workers' Compensation Board of Alberta. Descriptive statistics were computed for 32 variables and used for comparing urban and rural workers. The logistic regression analysis was performed to test the association between geographic location of residence and likelihood of return-to-work. Results Data on 7843 claimants was included, 70.1% of them being urban and 29.9% - rural. Rural claimants tended to have spent less time in formal education, have a blue-collar job, have no modified work available, have a diagnosed comorbidity, and not been enrolled in a specialized rehabilitation program. They were 1.43 (1.12-1.84) times the odds more likely than urban claimants to be continuing to receive full disability benefits 90 days after their RTW assessment, and 1.68 (1.06-2.67) times the odds as likely to report a recurrence of receiving disability benefits. Conclusions Rural residence was associated with prolonged work disability, even after controlling for age, job type, education level, health utilization and other potential confounders. Further research is required to explore why injured workers in rural settings experience prolonged reception of disability benefits and have greater rates of recurrence of receiving disability benefits.

Source: Lavoie CA, Voaklander D, Beach JR, Gross DP, International Journal of Occupational Medicine & Environmental Health, Vol. 30 (5), 715-729, 2017 July.

Work remains meaningful despite time out of the workplace and chronic pain

Purpose Although work has been found to be meaningful and a source of motivation to return to work in certain disabled populations, it was unclear if this was also true for people experiencing a long period of unemployment and job loss due to a musculoskeletal injury. Therefore, the aim of this phenomenological study was to explore the meaning of work for those with chronic work disability due to a musculoskeletal injury. Methods The data from 27 interviews, conducted with 9 participants, was analyzed using the Empirical Phenomenological Psychological method. Results Work remained central to the lives of the participants and aligned with previous valued work outcomes and goals regardless of the amount of time away from work. These findings point to the importance of recognizing the ongoing centrality of work for those with chronic work disability and the importance of tapping into work values and beliefs to provide workers with the motivation needed to get past physical and systemic barriers to return to work. Conclusions This study shows that a shift in focus back to meaning not only has benefits for people with chronic work disability, but for occupational therapists in their ability to make a unique and effective contribution to the field of work disability. Implications for rehabilitation The chronic work disabled population remains one of the most challenging to return to work. Reflection on the meaning of work provides motivation needed for clients to overcome barriers to work including chronic pain. Exploring meaning is not difficult or time consuming in vocational rehabilitation.

Source: Saunders S, Nedelec B, MacEachen E, Disability and Rehabilitation, 1-8, 2017 July.