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Consultez les résultats de notre veille scientifique de février 2024!

Incapacité et retour au travail

Purpose The aim of this study was to synthesize the findings of qualitative meta-syntheses (QMS) on return to work (RTW) of people with different chronic illnesses and to develop a generic RTW model that can provide advice on how to improve RTW interventions and strategies. Methods We conducted a systematic literature search in PubMed, Epistemonikos, CENTRAL, and PsycARTICLES to find relevant QMS, published in English or German between 2000 and 2021, and adapted the meta-ethnographic approach of Noblit and Hare to synthesize their findings. Results Nineteen QMS (five focusing on musculoskeletal disorders or chronic pain, four on acquired or traumatic brain injuries, four on cancer, two on mental disorders, one on spinal cord injury, and three on mixed samples) met our inclusion criteria for the meta-ethnographic synthesis. Through systematic comparison and reciprocal translation of the single QMS findings, we could identify a set of key cross-cutting themes/concepts, which formed the basis for four RTW principles and a generic RTW model. Conclusions RTW is a multifactorial and highly interactive multistakeholder process, embedded in an individual's life and working history, as well as in a determined social and societal context. It runs parallel and interdependently to the process of coping with the disease and realigning one's own identity, thus emphasizing the significance of RTW for the person. Besides symptoms and consequences of the disease, individual coping strategies, and RTW motivation, the course and success of RTW are strongly affected by the adaptability of the person's working environment and the social support in their private and working life. Thus, RTW is not only a problem of the individual, but also a matter of the social environment, especially the workplace, requiring a holistic, person-centered, and systemic approach, coordinated by a designated body, which considers the interests of all actors involved in the RTW process.

© Schwarz B; Banaschak H; Heyme R; von Kardorff E; Reims N; Streibelt M; Bethge M.  Rehabilitation. 63(1):39-50, 2024 Feb.

Purpose Despite the significant economic impact of occupational injuries on companies and society, studies focused on analyzing the determinants of workdays lost due to sick leave remain scarce and incomplete. This paper contributes to this issue by (a) analyzing the drivers of sick leave duration, distinguishing factors that explain the health recovery time from those that could lead workers to a voluntary extension of the absence period, and (b) formulating and empirically testing the effect of gender, citizenship, temporary work, job tenure, amount of disability benefit, and size of the injured worker's firm on the number of days the employee is off work after the injury. Methods Hypotheses are tested on a comprehensive dataset that includes all nonfatal occupational injuries causing sick leave that occurred in the manufacturing sector in Spain during 2015-2019, with more than 400,000 injuries. We conduct ordinary least squares and count data regression models in which the number of days off work is regressed on employees and work characteristics while accounting for a set of variables to control the injury's nature and severity. Results The results show that after considering the intrinsic characteristics of the injury and the severity of the worker's injuries, women, native workers, workers with more seniority, workers with higher salaries, and those working in larger companies have longer periods of sick leave. The results suggest that moral hazard considerations significantly impact the time to return to work after an occupational injury. Conclusions Based on the findings, several insights for company managers and public decision-makers are discussed. Specifically, interventions aimed at improving the organization of work and the working conditions of workers in manufacturing industries are highlighted, as well as the need to improve control and supervision mechanisms during the recovery process of injured workers.

© Arocena P; Garcia-Carrizosa LM. Journal of Safety Research. 86:311-317, 2023 09.

Purpose Due to the Belgian health insurance system's controlling nature, work-disabled claimants can feel forced to return to work (RTW), increasing their risk of relapse. RTW out of interest or importance is considered more sustainable. Such autonomous motivation for RTW can be promoted through 'motivational counselling', an integration of self-determination theory and motivational interviewing. To adopt this, health insurance practitioners need training, which can be designed through intervention mapping as an evidence-based planning tool. This paper reports on the development of a motivational counselling training for health insurance practitioners. Methods Intervention mapping's six steps guided the formulation of programme goals and learning outcomes, matching the context. We then identified change methods which were translated into practical components. Together with the health insurances' input, this resulted in a concrete training programme with an implementation and evaluation plan. Results The training was designed to increase practitioners' knowledge, skills, and beliefs relevant for learning motivational counselling, which also requires solution-focused strategies. Methods like guided practice were translated into built-in exercises, feedback, and information, which were implemented through an online training format of five sessions including one follow-up. Conclusion Reporting about training development increases understanding of its effectiveness and implementation, which will be evaluated via pre- and post-training data collection amongst practitioners. Future trainings can benefit from this by accounting for health insurances' organizational barriers or building on the training's evidence-based backbone whilst only requiring specific adaptations for other stakeholders and contexts. Further research should evaluate motivational counselling's impact on claimants' RTW trajectories.

© Rymenans I; Van den Broeck A; Vanovenberghe C; Du Bois M; Lauwerier E, Journal of occupational rehabilitation, 2024 Feb 26.

Trouble musculosquelettique

Purpose The aim was to evaluate if rehabilitation procedures including occupational health (OH) and workplace participation increase return to work (RTW) rates among patients with subacute and chronic low back pain (LBP). Methods A systematic review of randomized controlled trials was conducted using the PubMed and Cochrane databases. Main outcomes were RTW and days of sick leave. Interventions needed to be multidisciplinary including both OH and active workplace involvement in rehabilitation. Results Out of 1073 potentially eligible references, 8 met the inclusion criteria. Three studies had OH and 5 case managers involved in rehabilitation. Rehabilitation involving both OH and workplace improved RTW and decreased the number of sick leave days among LBP patients. Having case managers involved had no effect in RTW. In order to improve RTW, workplace visits and work ability meetings (WAMs) between OH and workplace are essential components in the rehabilitation process among patients with chronic LBP. Conclusion Based on the study results, the authors suggest utilizing these co-operative interventions with workplaces in OH. High quality research investigating only the effect of WAMs in OH setting is needed in future.

© Kokkonen V; Lamminpaa A; Reijula K; Russo F; Iavicoli S; Denaro V; Kuoppala J. International Journal of Occupational Medicine & Environmental Health. 2024 Jan 25.

Santé mentale

Purpose Incorporating multiple perspectives and contexts in knowledge mobilisation for return-to-work after sick leave due to common mental disorders can promote interprofessional and organisational strategies for facilitating the return-to-work process. This study aimed to explore the facilitators of and barriers to return-to-work after common mental disorders. This exploration considered the perspectives of employees and managers and the realms of work and private life. Methods A qualitative approach was used with data from 27 semi-structured telephone interviews. The strategic sample consisted of employees who returned to work after sick leave due to common mental disorders (n = 17) and managers responsible for their return-to-work process (n = 10). Thematic analysis conducted in a six-step process was used to generate themes in the interview data. Results The analysis generated three main themes with subthemes, illustrating experiences of barriers to and facilitators of return-to-work positioned in the employees' private and work contexts: (1) Getting along: managing personal difficulties in everyday life; (2) Belonging: experiencing social connectedness and support in work and private life; and (3) Organisational support: fostering a supportive work environment. The results contribute to a comprehensive understanding of the return-to-work process, including the challenges individuals face at work and in private life. Conclusions The study suggests that return-to-work after sick leave due to CMDs is a dynamic and ongoing process embedded in social, organisational, and societal environments. The results highlight avenues for an interprofessional approach and organisational learning to support employees and managers, including space for the employee to recover during the workday.

© Holmlund L; Ljungberg HT; Bultmann U; Bramberg EB. BMC Public Health. 24(1):372, 2024 Feb 05.

Purpose This study aims to explore ethical challenges potentially arising from a problem-solving intervention with workplace involvement (PSI-WPI) in primary health care (with first-line manager involvement) for employees on sickness absence due to common mental disorders. Methods A qualitative design guided by the theoretical framework for systematic identification of ethical aspects of healthcare technologies. Semi-structured interviews were performed with coordinators (n = 6), employees (n = 13), and first-line managers (n = 8). Reflexive thematic analysis was used to analyse and interpret themes. Results A main theme was identified "the workplace and healthcare hold different organizational value logics" and four sub-themes: "the PSI-WPI challenged the organizational goals and values of the workplace and healthcare", "the PSI-WPI challenged organizational values on fairness", "the PSI-WPI challenged the professional roles of first-line managers and rehabilitation coordinators" and "the PSI-WPI introduced a need for the employee to juggle the employee and patient roles". Conclusion Different organizational value logics, values, and goals can introduce ethical challenges. We advise clarifying stakeholders' roles and preparing employees and managers for the return to work process by providing sufficient information. The ethical challenges and suggested measures to minimize them, should be considered when planning return to work interventions that involve several stakeholders.

© Karlsson I; Sandman L; Axen I; Kwak L; Sernbo E; Bjork Bramberg E. International Journal of Qualitative Studies on Health and Well-being. 19(1):2308674, 2024 Dec.

Cancer

Purpose Breast cancer (BC) is the most frequently diagnosed cancer among women. Approximately 40% of BC survivors are diagnosed during the peak years of their professional career. Women face numerous obstacles when returning to work (RTW) after BC. Their decision-making process and self-efficacy to overcome these barriers may undergo alterations. The objective of this study was to validate the Return-to-work Obstacles and Self-Efficacy Scale (ROSES) for BC survivors, with a focus on three psychometric properties: construct validity, test-retest reliability, and predictive validity. Methods This prospective study consists of three phases: Phase 1 (baseline, during sick leave) was conducted to evaluate construct validity, Phase 2 (2 weeks later) assessed test-retest reliability, and Phase 3 (6-month follow-up, RTW or not) aimed to evaluate predictive validity. A total of 153 BC survivors participated in Phase 1 of the study, where they completed the 10 dimensions of the ROSES (e.g., fear of relapse, cognitive difficulties). Confirmatory factor analyses (CFA), Pearson correlations, and Cox regressions were performed, with respect to each phase. Results The mean duration for RTW with the same employer was 62.7 weeks. CFAs confirmed the ROSES structure, which had previously been established for other health conditions, showing satisfactory coefficients. Significant Pearson correlation coefficients were observed between the ROSES dimensions from Phase 1 to Phase 2, ranging from 0.66 to 0.88. When considering various confounding variables, chemotherapy treatment and cognitive difficulties (ROSES dimension) emerged as the only significant predictors of RTW. Conclusion These findings support the utilization of the ROSES in clinical and research settings for BC survivors to improve their successful RTW. After an initial screening using the ROSES, occupational health professionals can further conduct a focused and thorough evaluation of specific dimensions, such as cognitive difficulties. Additional research and information are required to assist BC survivors in dealing with cognitive impairments induced by chemotherapy when they return to work.

© Corbiere M; Rabouin D; Negrini A; Mazaniello-Chezol M; Sideris L; Prady C; Lachance JP.  Journal of Occupational Rehabilitation.  2024 Feb 04.

Accident vasculaire cérébral (AVC)

Purpose To describe long-term effects on activity, participation, and quality of life (i) at different post-injury starting time points of attention training and (ii) of two different types of rehabilitation with attention training in patients after stroke or traumatic brain injury; and to describe their functioning level. Methods Design: 2 years after rehabilitation intervention, comparisons were made in one cohort receiving attention training subacute (< 4 months) or post-acute (4-12 months) and in one cohort with two different training methods, a process-based and an activity-based method respectively. Patients: 100 patients were recruited from our earlier RCT study. They had mild to moderate stroke or traumatic brain injury with relatively limited symptomatology, and all had moderate to severe attention impairment. Data collection: A questionnaire-based interview: EuroQol 5 dimensions, Occupational Gaps Questionnaire, Work Ability Index, self-assessed work status, self-reported employment conditions, sick leave, and experienced cognitive limitations in work performance. Results An advantage for patients receiving subacute attention training regarding daily activities, work ability and returning to work. Conclusion The results indicate that subacute rehabilitation with attention training (< 4 months) is preferable compared to post-acute intervention (4-12 months). There were only minor differences between the training methods.

© Markovic G; Bartfai A; Schult ML; Ekholm J. Journal of Rehabilitation Medicine. 56:jrm5308, 2024 Jan 12.

Traumatisme crânien cérébral léger (TCCL)

Purpose To describe long-term effects on activity, participation, and quality of life (i) at different post-injury starting time points of attention training and (ii) of two different types of rehabilitation with attention training in patients after stroke or traumatic brain injury; and to describe their functioning level. Methods Design: 2 years after rehabilitation intervention, comparisons were made in one cohort receiving attention training subacute (< 4 months) or post-acute (4-12 months) and in one cohort with two different training methods, a process-based and an activity-based method respectively. Patients: 100 patients were recruited from our earlier RCT study. They had mild to moderate stroke or traumatic brain injury with relatively limited symptomatology, and all had moderate to severe attention impairment. Data collection: A questionnaire-based interview: EuroQol 5 dimensions, Occupational Gaps Questionnaire, Work Ability Index, self-assessed work status, self-reported employment conditions, sick leave, and experienced cognitive limitations in work performance. Results An advantage for patients receiving subacute attention training regarding daily activities, work ability and returning to work. Conclusion The results indicate that subacute rehabilitation with attention training (< 4 months) is preferable compared to post-acute intervention (4-12 months). There were only minor differences between the training methods.

© Markovic G; Bartfai A; Schult ML; Ekholm J. Journal of Rehabilitation Medicine. 56:jrm5308, 2024 Jan 12.