Novembre 2019

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 one year after injury, 41.0% of workers had at least one day of Gradual RTW. Serious injury severity, female gender, 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 and Environmental Medicine, 2019 Nov.

Obstacles to returning to work with chronic pain: in-depth interviews with people who are off work due to chronic pain and employers

Purpose The global burden of chronic pain is growing with implications for both an ageing workforce and employers. Many obstacles are faced by people with chronic pain in finding employment and returning to work after a period of absence. Few studies have explored obstacles to return-to-work (RTW) from workers' and employers' perspectives. Here we explore views of both people in pain and employers about challenges to returning to work of people who are off work with chronic pain. Methods We did individual semi-structured interviews with people who were off work (unemployed or off sick) with chronic pain recruited from National Health Service (NHS) pain services and employment services, and employers from small, medium, and large public or private sector organisations. We analysed data using the Framework method. Results We interviewed 15 people off work with chronic pain and 10 employers. Obstacles to RTW for people with chronic pain spanned psychological, pain related, financial and economic, educational, and work-related domains. Employers were concerned about potential attitudinal obstacles, absence, ability of people with chronic pain to fulfil the job requirements, and the implications for workplace relationships. Views on disclosure of the pain condition were conflicting with more than half employers wanting early full disclosure and two-thirds of people with chronic pain declaring they would not disclose for fear of not getting a job or losing a job. Both employers and people with chronic pain thought that lack of confidence was an important obstacle. Changes to the job or work conditions (e.g. making reasonable adjustments, phased return, working from home or redeployment) were seen by both groups as facilitators. People with chronic pain wanted help in preparing to RTW, education for managers about pain and supportive working relationships. Conclusions People with chronic pain and employers may think differently in terms of perceptions of obstacles to RTW. Views appeared disparate in relation to disclosure of pain and when this needs to occur. They appeared to have more in common regarding opinions about how to facilitate successful RTW. Increased understanding of both perspectives may be used to inform the development of improved RTW interventions.

Source: Grant M, Rees S, Underwood M, Froud R, BMC Musculoskeletal Disorders, Vol. 20 (1), 2019 Oct.

Effect of Partial Sick Leave on Sick Leave Duration in Employees with Musculoskeletal Disorders

Purpose This study determined if partial sick leave was associated with a shorter duration of sick leave due to musculoskeletal disorders (MSD) based on routinely collected health data in Dutch sick-listed employees. Furthermore, the effect of timing of partial sick leave on sick leave duration was determined. Methods This cohort study consisted of 771 employees with partial sick leave and 198 employees with full-time sick leave who participated in an occupational health check, and had sick leave due to MSD for minimally 4 weeks and were diagnosed by an occupational physician. Multivariable linear regression models were performed to determine the effects of partial sick leave (unadjusted and adjusted for confounders and MSD diagnosis) and Kaplan-Meier curves were presented for visualization of return to work for different timings of starting partial sick leave. Furthermore, linear regression analysis were done in subsets of employees with different minimal durations of sick leave to estimate the effects of timing of partial sick leave. Results Initial results suggest that partial sick leave was associated with longer sick leave duration, also when adjusted for confounders and sick leave diagnosis. Secondary results which accounted for the timing of partial sick leave suggest that partial sick leave had no effect on the duration of sick leave. Conclusions Partial sick leave does not influence MSD sick leave duration in this study when accounting for the timing of partial sick leave.

Source: Bosman LC, Twisk JWR, Geraedts AS, Heymans MW, Journal of Occupational Rehabilitation, 2019 Oct.

Octobre 2019

Recovering the capability to work among patients with chronic low Back pain after a four-week, multidisciplinary biopsychosocial rehabilitation program: 18-month follow-up study

Purpose Chronic low back pain (LBP) is a leading cause of disability worldwide. Biopsychosocial rehabilitation programs have been advocated for its management, especially since the widespread acceptance of the biopsychosocial model of chronic pain. Despite extensive evidence of its short-term benefits, few studies have reported on its long-term effect and more specifically on indirect outcomes such as return to work and quality of life (QoL). The present study evaluated the long-term effect of a multidisciplinary biopsychosocial rehabilitation (MBR) program for patients with chronic LBP, for which short- and intermediate-term efficacy had been established, with an emphasis on recovering work capability. Methods This prospective cohort study enrolled 201 patients on a four-week MBR program incorporating physical and occupational therapies and psychological counselling. Assessments occurred at program admission and discharge and at 6 and 18 months. Work capability, Oswestry Disability Index, Tampa Scale for Kinesiophobia, Core Outcome Measures Index (COMI), and Hospital Anxiety and Depression Scale were assessed. Multiple mixed models were used to detect changes in each outcome. Logistic regressions were calculated to identify predictors of recovery of work capability. Results Of the 201 patients who fulfilled the eligibility criteria, 160 (79.8%) attended the discharge assessment, 127 (63.2%) attended the 6-month follow-up, and 107 (53.3%) continued to the 18-month follow-up. Initially, 128 patients (71.5%) had been on sick leave. At 6 and 18 months, 72 (56.7%) and 84 (78.5%) participants had recovered their work capability, respectively. There were significant improvements in pain, disability, kinesiophobia, and anxiety and depression scores over time. Patients who recovered work capability showed significantly greater improvements in their total COMI score, general QoL, and disability, which were the best three predictors of recovering work capability. Conclusions This study extends previous results confirming the program's contribution to recovering work capability among chronic LBP patients.

Source: Ibrahim ME, Weber K, Courvoisier DS, Genevay S, BMC Musculoskeletal Disorders, Vol. 20 (1), 2019 Oct.

Recovering the capability to work among patients with chronic low Back pain after a four-week, multidisciplinary biopsychosocial rehabilitation program: 18-month follow-up study

Purpose Chronic low back pain (LBP) is a leading cause of disability worldwide. Biopsychosocial rehabilitation programs have been advocated for its management, especially since the widespread acceptance of the biopsychosocial model of chronic pain. Despite extensive evidence of its short-term benefits, few studies have reported on its long-term effect and more specifically on indirect outcomes such as return to work and quality of life (QoL). The present study evaluated the long-term effect of a multidisciplinary biopsychosocial rehabilitation (MBR) program for patients with chronic LBP, for which short- and intermediate-term efficacy had been established, with an emphasis on recovering work capability. Methods This prospective cohort study enrolled 201 patients on a four-week MBR program incorporating physical and occupational therapies and psychological counselling. Assessments occurred at program admission and discharge and at 6 and 18 months. Work capability, Oswestry Disability Index, Tampa Scale for Kinesiophobia, Core Outcome Measures Index (COMI), and Hospital Anxiety and Depression Scale were assessed. Multiple mixed models were used to detect changes in each outcome. Logistic regressions were calculated to identify predictors of recovery of work capability. Results Of the 201 patients who fulfilled the eligibility criteria, 160 (79.8%) attended the discharge assessment, 127 (63.2%) attended the 6-month follow-up, and 107 (53.3%) continued to the 18-month follow-up. Initially, 128 patients (71.5%) had been on sick leave. At 6 and 18 months, 72 (56.7%) and 84 (78.5%) participants had recovered their work capability, respectively. There were significant improvements in pain, disability, kinesiophobia, and anxiety and depression scores over time. Patients who recovered work capability showed significantly greater improvements in their total COMI score, general QoL, and disability, which were the best three predictors of recovering work capability. Conclusions This study extends previous results confirming the program's contribution to recovering work capability among chronic LBP patients.

Source: Ibrahim ME, Weber K, Courvoisier DS, Genevay S, BMC Musculoskeletal Disorders, Vol. 20 (1), 2019 Oct.

Juillet et Août 2019

Adaptation of a Guide to Equip Employers to Manage the Gradual Return to Work of Individuals with a Musculoskeletal Disorder

Purpose The gradual return to work (GRTW) of injured workers poses numerous challenges for workplaces. The aim of this study was to provide employers with an adapted tool to support them in managing GRTWs following a musculoskeletal disorder (MSD), by adapting the Guide for estimation of margin of manoeuvre (Durand et al. in 7th international scientific conference on prevention of work-related musculoskeletal disorders, 2010) and then evaluating the acceptability of the adapted version. Methods A mixed methods design was used. Content experts were surveyed about the content and form of a first version of the adapted tool. Proposed modifications were then discussed in a group meeting until consensus was reached on the changes to be made. The acceptability of the new version was determined by conducting semi-structured interviews of potential users. A thematic analysis of the verbatim transcript was performed. Results Nine experts reached a consensus on 20 modifications, which yielded a tool comprising an instruction guide and a planning worksheet. The eight companies consulted found the tool acceptable, useful, and pertinent, but also identified a few changes to be made. Conclusions The use of original methods made it possible to adapt the content of the tool while taking evidence-based data and user needs into account, all of which contributed to its acceptance. The tool will support employers and standardize management of GRTWs following MSD-related sick leaves. Possible avenues for future research emerged from this study: evaluate the acceptability of new formats and a transdiagnostic version of the tool, and consult workers.

Source: Bouffard J, Durand MJ, Coutu MF, Journal of Occupational Rehabilitation, Vol. 29(3), p.625-635, 2019 Sep.

Use of cognitive behavioural therapy with usual physical therapy intervention for individuals who are unemployed secondary to chronic low back pain: A case series

Purpose Low back pain (LBP) is a leading cause of work absence and may influence the development of fear-avoidance behaviours. The purpose of this case series was to examine the use of cognitive behavioural therapy (CBT) with physical therapy (PT) for the treatment of fear-avoidance behaviours in patients with chronic LBP who are disabled or in a period of work absence. Methods Four patients with high-irritability chronic LBP who were considered as being on work absence or disability were treated in outpatient PT clinics. The intervention consisted of fundamental CBT concepts utilized in combination with a traditional PT intervention.Results Patients were treated until the achievement of functional goals and normalized movement patterns. Pain, disability and function were measured via a numerical pain rating scale, the Oswestry Disability Index and Focus on Therapeutic Outcomes. All patients achieved the minimally clinically important difference for these measures. Fear-avoidance behaviours decreased, as observed by an average 15-point change in Fear-Avoidance Behaviour Questionnaire (Physical Activity) outcomes. Patients on work absence returned to work. Conclusions This case series describes the use of CBT in combination with a traditional PT intervention for the treatment of high-irritability, fear-avoidant individuals who are on disability or in a period of work absence. The results indicated that CBT may be a useful and feasible adjunct to PT and may positively influence a return to work. Further studies are needed to determine effectiveness, including randomized controlled trials.

Source: Walston Z, Niles P, Spiker L, Yake D, Musculoskeletal Care, 2019 Aug.

Avril 2019

Return to Work After Interdisciplinary Pain Rehabilitation: One- And Two-Year Follow-Up Study Based On The Swedish Quality Registry For Pain Rehabilitation

Purpose To investigate: (i) changes in sick-leave benefits from 1 year prior to multimodal rehabilitation to 1 and 2 years after rehabilitation; (ii) sex differences in sick leave; and (iii) the impact of policy changes on sick leave. MethodsAll patients undergoing multimodal rehabilitation registered in a national pain database for 2007--11 (n = 7,297) were linked to the Swedish Social Insurance Agency database. Sick leave was analysed in 3-month periods: T0: 1 year before rehabilitation; T1: before start; T2: 1 year after; and T3: 2 years after rehabilitation. Four sick-leave benefit categories were constructed: no sick leave, part-time sick leave, full-time sick leave, and full-time permanent sick leave. The individual change in sick-leave category at each time-period was analysed. ResultsSick-leave benefits increased from T0 to T1 (p <0.001) and decreased from T1 to T3 (p < 0.001). Reductions were significant for both men and women from T1 to T3, but men had less sick-leave benefits at T2 and T3. Positive changes in sick-leave benefits at T2 and T3 were found both prior to and after policy changes, with less sick-leave benefits after policy changes at all time-points. ConclusionsMultimodal rehabilitation may positively influence sick-leave benefits for patients with chronic pain, regardless of their sick-leave situation, sex or policy changes.

Source: Rivano Fischer M, Persson E, B. Stalnacke BM, Schult ML, Löfgren M, Journal of Rehabilitation Medicine, Vol. 51(4), p.281-289, 2019.

Mars 2019

Workplace-Based Rehabilitation of Upper Limb Conditions: A Systematic Review

Purpose The objective of this systematic review was to identify, collate and analyse the current available evidence on the effectiveness of workplace-based rehabilitative interventions in workers with upper limb conditions on work performance, pain, absenteeism, productivity and other outcomes. Methods We searched Medline, Cochrane Library, Scopus, Web of Science, Academic Search Premier, Africa-Wide Information, CINAHL, OTSeeker and PEDro with search terms in four broad areas: upper limb, intervention, workplace and clinical trial (no date limits). Studies including neck pain only or musculoskeletal pain in other areas were not included. Results Initial search located 1071 articles, of which 80 were full text reviewed. Twenty-eight articles were included, reporting on various outcomes relating to a total of seventeen studies. Nine studies were of high methodological quality, seven of medium quality, and one of low quality. Studies were sorted into intervention categories: Ergonomic controls (n = 3), ergonomic training and workstation adjustments (n = 4), exercise and resistance training (n = 6), clinic-based versus workplace-based work hardening (n = 1), nurse case manager training (n = 1), physiotherapy versus Feldenkrais (n = 1), and ambulant myofeedback training (n = 1). The largest body of evidence supported workplace exercise programs, with positive effects for ergonomic training and workstation adjustments, and mixed effects for ergonomic controls. Ambulant myofeedback training had no effect. The remaining three categories had positive effects in the single study on each intervention. Conclusions While there is substantial evidence for workplace exercise programs, other workplace-based interventions require further high quality research.

Source: Hoosain M, Klerk S, Burger M, Journal of Occupational Rehabilitation, Vol. 29 (1), p.175-193, 2019 Mar.

Février 2019

Psychological and work-related outcomes after inpatient multidisciplinary rehabilitation of chronic low back pain: a prospective randomized controlled trial

Purpose This study investigated the long-term effects (12 months post-rehabilitation) of a standard inpatient multidisciplinary rehabilitation program for patients with chronic low back pain (CLBP), in which a control group (CG) received pain competence training and an intervention group (IG) received combined pain competence and depression prevention training. Methods In this prospective control group study with cluster-block randomization, a total of n = 583 patients were included into per protocol analyses. To examine the effects of rehabilitation on depressive symptoms, pain self-efficacy, and work ability, patients were stratified in repeated-measures analyses of variance by treatment condition (IG vs. CG), level of depressive symptoms (low vs. high), and time of assessment (pre, post, 6, and 12 months after rehabilitation). The impact of each treatment on pain-related days of sick leave (DSL; dichotomized into ≤ vs. > 2 weeks) was determined separately by conducting non-parametric analyses. Multiple imputations (n = 1225) confirmed the results. Effects were interpreted if clinical significance was given. Results Only patients with high levels of depressive symptoms showed long-term improvements in depressive symptoms and self-efficacy. Long-term improvements in work ability index and mental work ability item were restricted to the IG. Furthermore, long-term effects on pain-related DSL were ascertained by per protocol and multiple imputation analyses only for the IG. Conclusions Patients with high levels of depressive symptoms showed improvements in depressive symptoms and self-efficacy, supporting the psychological effectiveness of both interventions. However, the beneficial long-term effects of rehabilitation on work ability and pain-related DSL among the IG support implementation of combined pain competence and depression prevention training.

Source: Hampel P, Köpnick A, Roch S, BMC Psychology, Vol. 7 (1), 2019 Feb.

Janvier 2019

Factors influencing return to work after hip and knee arthroplasty

Purpose A substantial proportion of patients undergoing lower limb arthroplasty are of working age. This study aims to identify when patients return to work (RTW) and if they return to normal hours and duties, and to identify which factors influence postoperative RTW. The hypothesis is that there is no difference in time of RTW between the different types of surgery, and no difference in time of RTW based on the physical demands of the job.Methods Consecutive patients aged < 65 years who had undergone unilateral primary total hip arthroplasty (THA), total knee arthroplasty (TKA), or medial unicompartmental knee arthroplasty (UKA) from 2015 to 2017 were sent a questionnaire. Quantitative questions explored timing and nature of RTW, and qualitative questions explored factors influencing timing of RTW. Results There were 116 patients (64 male, 52 female) with an average age of 56 years. Thirty-one patients were self-employed and 85 were employees. Of these patients, 58 had undergone THA, 31 had undergone TKA, and 27 had undergone UKA. One hundred and six (91%) patients returned to work. Patients returned to work after (mean) 6.4 weeks (THA), 7.7 weeks (TKA), and 5.9 weeks (UKA). Time of RTW was not significantly influenced by type of surgery (p = 0.18) (ns). There was a non-significant correlation between physical demands of the work versus time of RTW (p = 0.28) (ns). There was a significantly earlier time of RTW if flexible working conditions were resumed (p = 0.003). Active recovery, motivation, necessity and job flexibility enabled RTW. The physical effects of surgery, medical restrictions and work factors impeded RTW. Conclusions The time of RTW was not significantly influenced by the type of operation or by the physical demands of the job. Patients returned to work 5.9-7.7 weeks after hip/knee arthroplasty. Rehabilitation, desire, and necessity promoted RTW. Pain, fatigue and medical restrictions impeded RTW.

Source: McGonagle L, Convery-Chan L, DeCruz P, Haebich S, Fick DP, Khan RJK, Journal of Orthopaedics and Traumatology: Official Journal of the Italian Society of Orthopaedics and Traumatology, Vol. 20 (1), 2019 Jan.

Adaptation of a Guide to Equip Employers to Manage the Gradual Return to Work of Individuals with a Musculoskeletal Disorder

Purpose The gradual return to work (GRTW) of injured workers poses numerous challenges for workplaces. The aim of this study was to provide employers with an adapted tool to support them in managing GRTWs following a musculoskeletal disorder (MSD), by adapting the Guide for estimation of margin of manoeuvre (Durand et al. in 7th international scientific conference on prevention of work-related musculoskeletal disorders, 2010) and then evaluating the acceptability of the adapted version. Methods A mixed methods design was used. Content experts were surveyed about the content and form of a first version of the adapted tool. Proposed modifications were then discussed in a group meeting until consensus was reached on the changes to be made. The acceptability of the new version was determined by conducting semi-structured interviews of potential users. A thematic analysis of the verbatim transcript was performed. Results Nine experts reached a consensus on 20 modifications, which yielded a tool comprising an instruction guide and a planning worksheet. The eight companies consulted found the tool acceptable, useful, and pertinent, but also identified a few changes to be made. Conclusions The use of original methods made it possible to adapt the content of the tool while taking evidence-based data and user needs into account, all of which contributed to its acceptance. The tool will support employers and standardize management of GRTWs following MSD-related sick leaves. Possible avenues for future research emerged from this study: evaluate the acceptability of new formats and a transdiagnostic version of the tool, and consult workers.

Source: Bouffard J, Durand MJ, Coutu MF, Journal of Occupational Rehabilitation, 2019 Jan.