Mai 2020

Vocational Rehabilitation with or without Work Module for Patients with Chronic Musculoskeletal Pain and Sick Leave from Work: Longitudinal Impact on Work Participation

Purpose To study the longitudinal relationship between interdisciplinary vocational rehabilitation (VR) with and without additional work module on work participation of patients with chronic musculoskeletal pain and sick leave from work. Methods Retrospective longitudinal data retrieved from care as usual in seven VR centers in the Netherlands was used. The VR program without work module consisted of multi-component healthcare (physical exercise, cognitive behavioral therapy, education, relaxation). The other program with additional work module (VR+) included case management and a workplace visit. Generalized estimating equations using binary logistic was applied. The dependent variable was work participation (achieved/not achieved) on discharge and 6-months follow-up. Independent variables were type of intervention, return to work expectation, sick leave duration, working status, job strain, and job dissatisfaction. Results Data from N = 470 patients were analyzed, of which 26% received VR and 74% VR+. Both programs increased work participation at 6-months follow-up (VR 86%, VR+ 87%). The crude model showed a significant longitudinal relationship between type of intervention and work participation in favor of VR+ (OR 1.8, p = 0.01). The final model showed a non-significant relationship on discharge (OR 1.3, p = 0.51) and a significant relationship on 6-months follow-up in favor of VR+ (OR 1.7, p = 0.04). RTW expectation was a significant confounder in the final model on discharge and 6-months follow up (OR 3.1, p = 0.00). Conclusions Both programs led to increased work participation. The addition of a work module to the VR program lead to a significant increase in odds of work participation at 6-months follow-up.

Source: Beemster TT, van Bennekom CAM, van Velzen JM, Frings-Dresen MHW, Reneman MF, Journal of occupational rehabilitation, 2020 May.

Motivational Interviewing and Return to Work for People with Musculoskeletal Disorders: A Systematic Mapping Review

Purpose There is limited knowledge about motivational interviewing (MI) for people on sick leave with musculoskeletal disorders. Hence, our objective was to investigate what research on MI as a method to facilitate return to work for individuals who are on sick leave due to musculoskeletal disorders exists, and what are the results of the research? Methods We systematically searched MEDLINE, PsycINFO, EMBASE, Cochrane Library, CINAHL, Web of Science, Sociological Abstracts, Epistemonikos, SveMed + and DARE & HTA (covering 1983 to August 2019). We also searched the MINT bulletin and relevant web pages. Eligibility criteria: empirical studies investigating MI and return to work for people with musculoskeletal disorders. Two authors independently screened the records, critically appraised the studies and charted the data using a data extraction form. Results The searches identified 1264 records of which two studies were included. One randomized controlled trial (RCT) found no effect of MI on return to work for disability pensioner with back pain (n = 89, high risk of bias), while a cluster RCT found that MI increased return to work for claimants with chronic musculoskeletal disorders (n = 728, low risk of bias). Conclusions This mapping review identified a huge gap in research on MI to increase return to work for individuals with musculoskeletal disorders.

Source: Aanesen F, Berg R, Løchting I, Tingulstad A, Eik H, Storheim K, Grotle M, Øiestad BE, Journal of occupational rehabilitation, 2020 Apr.

Février 2020

Return to work advice after total hip and knee replacement

Purpose Little is known about the information and advice on return to work received by patients undergoing total hip and knee replacement. Aims To investigate patients' views and experiences of work-related advice provided by clinicians, and how this might be improved. Methods Semi-structured interviews with patients who had undergone total hip and knee replacement, were working prior to surgery and intended to return to work. Data were analysed thematically. Results Forty-five patients from three UK regions were consented. Eight themes were identified including lack of information, lack of an individualized approach and accessibility and acceptability of information dissemination methods. Patients identified their information needs and who they felt was best placed to address them. Conclusions Patients receive little information and advice on return to work following total hip and knee replacement, although not all patients required this. However, more focus is needed on providing this, and patients should be screened to ensure resources are best targeted with interventions being tailored to the individual.

Source: Nouri F, Coole C, Baker P, Drummond A, Occupational Medicine, 2020 Feb.

Implementation of Early Intervention Protocol in Australia for 'High Risk' Injured Workers is Associated with Fewer Lost Work Days Over 2 Years Than Usual (Stepped) Care

Purpose To evaluate whether a protocol for early intervention addressing the psychosocial risk factors for delayed return to work in workers with soft tissue injuries would achieve better long-term outcomes than usual (stepped) care. Methods The study used a controlled, non-randomised prospective design to compare two case management approaches. For the intervention condition, workers screened within 1–3 weeks of injury as being at high risk of delayed returned to work by the Örebro Musculoskeletal Pain Screening Questionnaire—short version (ÖMPSQ-SF) were offered psychological assessment and a comprehensive protocol to address the identified obstacles for return to work. Similarly identified injured workers in the control condition were managed under usual (stepped) care arrangements. Results At 2-year follow-up, the mean lost work days for the Intervention group was less than half that of the usual care group, their claim costs were 30% lower, as was the growth trajectory of their costs after 11 months. Conclusions The findings supported the hypothesis that brief psychological risk factor screening, combined with a protocol for active collaboration between key stakeholders to address identified psychological and workplace factors for delayed return to work, can achieve better return on investment than usual (stepped) care.

Source: Nicholas MK, Costa DS, Linton SJ, Main CJ, Shaw WS, Pearce G, Gleeson M, Pinto RZ, Blyth FM, McAuley JH, Smeets RJEM, McGarity A, Journal of Occupational Rehabilitation, Vol. 30(1), p.93-104, 2020 Mar.

Descriptive Epidemiology of Gradual Return to Work for Workers With a Work-Acquired Musculoskeletal Disorder in British Columbia, Canada

Purpose This study investigates the injury, socio-demographic, workplace, and temporal characteristics related with gradual return to work (RTW) among workers with a work-acquired musculoskeletal disorder in British Columbia, Canada, Methods Accepted workers' compensation lost-time claims were extracted between 2010 and 2015 (n = 141,490). A multivariable logistic regression model was used to analyze the determinants of Gradual RTW. Results Within 1 year after injury, 41.0% of workers had at least 1 day of Gradual RTW. Serious injury severity, female sex, increasing age, wage, and firm size, longer sickness absence, and recent previous claims increased the proportion of workers being provided with Gradual RTW. Conclusions Consideration of injury, socio-demographic, workplace, and temporal variability in the provision of Gradual RTW can identify inequalities in the provision and increase effective use of Gradual RTW for workers with musculoskeletal disorders.

Source: Maas ET, Koehoorn M, McLeod CB, Journal of Occupational & Environmental Medicine, Vol. 62 (2), p.113-123, Feb 2020. 

Pain rehabilitation during adolescence; work in adulthood? A long-term follow-up study to explore the facilitators and barriers for work

Purpose Adolescents with chronic musculoskeletal pain face different impairments in daily life. After an inpatient pain rehabilitation program adolescents function better on several domains. The aim of this study is to explore the long-term work participation of adults who followed inpatient pain rehabilitation during adolescence because of chronic musculoskeletal pain and to identify potential facilitators and barriers regarding work in later life. Methods A mixed methods study with standardized questionnaires and semi-structured interviews. The questionnaires measured pain, disability, work status and quality and quantity of the work. The interviews contained questions about work participation. Potential participants were all patients who received an inpatient pain rehabilitation program 15-20 years ago. Analyses were performed by thematic analysis. Using the Sherbrooke model as guidance, themes were classified in four systems: healthcare, workplace, legislative/insurance and personal system. Results Fourteen patients consented to participate (12 females). 71% Of them have paid work. The mean self-reported quality of the work delivered is 9.6 (Standard Deviation=0.5). 18 Facilitators and 12 barriers regarding work participation later on in life were mentioned. The inpatient pain rehabilitation program is the most frequently mentioned facilitator (n=5), while the personal system and coping related factors are the most frequently mentioned barriers (n=5). Conclusions Ten out of 14 participants are currently working, most of them despite experiencing pain. Several factors based on the four systems of the Sherbrooke model contribute as facilitators or barriers regarding current work participation. Pain rehabilitation is mostly regarded as a facilitator for work participation later on in life.

Source : Achten D, de Blécourt ACE, Westendorp T, Herweijer H, Reneman MF, Pain Practice: the Official Journal of World Institute of Pain, 2020 Feb.