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Incapacité et retour au travail

Purpose This article provides a state-of-the-art review of issues and factors associated with the sustainable return to work (S-RTW) of ethnocultural minority workers experiencing disability situations attributable to one of four major causes: musculoskeletal disorders, common mental disorders, other chronic diseases or cancer. Methods Using an interpretive description method, an integrative review was conducted of the literature on ethnocultural factors influencing S-RTW issues and factors associated with these four major work-disability causes. An initial review of the 2006-2016 literature was subsequently updated for November 2016-May 2021. To explore and contextualize the results, four focus groups were held with RTW stakeholders representing workplaces, insurers, the healthcare system and workers. Qualitative thematic analysis was performed. Results A total of 56 articles were analyzed and 35 stakeholders participated in four focus groups. Two main findings emerged. First, belonging to an ethnocultural minority group appears associated with cumulative risk factors that may contribute to vulnerability situations and compound the complexity of S-RTW. Second, cultural differences with respect to the prevailing host-country culture may generate communication and trust issues, and conflicts in values and representations, in turn possibly hindering the establishment of positive relationships among all stakeholders and the ability to meet workers' needs. Being a woman in these groups and/or having a lower level of integration into the host country's culture also appear associated with greater S-RTW challenges. Conclusions Based on our findings, we recommend several possible strategies, such as the cultural humility model, for preventing differences from exacerbating the already significant vulnerability situation of some ethnocultural minority workers.

© Coutu MF, Durand MJ, Cote D, Tremblay D, Sylvain C; Gouin MM, Bilodeau K, Nastasia I, Paquette MA.  Journal of Occupational Rehabilitation.  2022 May 26

Purpose This article is a scoping review of efforts in labour market inclusion of the chronically ill in the Scandinavian countries, a research area that has received much political as well as research attention in recent years. The aim of the review was to identify promising strategies and the need for further research. Methods Six electronic databases were searched for literature published between 2015 and 2020. We included peer-reviewed articles that studied the effect of measures, aimed at the workplace or at the individual, that are intended to increase participation. Our search resulted in 2718 articles; our screening procedures resulted in 47 included articles. Results Among the included studies, musculoskeletal problems (17 articles) and mental health problems (29 articles) were the most frequent chronic conditions. Multimodal occupational rehabilitation programmes directed towards the individual employee were the most frequent interventions (30 articles). Return to work (24 articles) and sickness absence (12 articles) were the most common outcomes. About half (25 articles) of the included studies reported a positive impact of the intervention on work inclusion of the chronically ill. Conclusions Our review found little evidence of how government programmes directed towards the supply side of the labour market succeed in including the chronically ill. Our review further indicated that multidisciplinary workplace interventions have a substantial effect. We also identified a significant lack of research on the effect of various governmental policies and programmes, including local health, work and welfare services, and limited coordination and cooperation between health and work services professions.

©   Rydland HT; Bentsen HL; Ervik R; GrOnning K; Islam K; Kjerstad E; Skogedal.  Scandinavian Journal of Public Health, 2022 May 10.

Purpose This article focuses on the risk that work disability policies lock people into work disability rather than promote durable health and return to work. We outline the concept of a work disability trap as a heuristic device to explore this policy paradox inherent in the design of most social insurance systems. Methods This is a conceptual paper drawing on examples from existing research. Results We identify three manifestations of the disability trap: not overcoming disability; underperforming; and returning to work prematurely. The causes of these manifestations are identified as structural rather than based on malingering clients, while negative consequences are identified both on client and system levels. Conclusion We emphasize the need for systems built on trust and reasonable expectations, and the need for providing rehabilitation support independently of economic compensation. Universal basic income is introduced as a potential tool to ameliorate some of the consequences of the disability trap.Implications for rehabilitation Compensation systems focusing too prominently on early return to work may have counter-productive effects on rehabilitation.Overly suspicious assessment systems nurture a view of people as malingerers. Rehabilitation professionals need to be attentive to system-generated effects which may prevent overcoming work disability.

©   Stahl C; De Wispelaere J; MacEachen E. Disability & Rehabilitation. 1-7, 2022 May 16.

Purpose This systematic review aims to synthesise existing evidence on doctors' personal, social and organisational needs when returning to clinical work after an absence. Methods Design: Systematic review using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Data sources: AMED, BNI, CINAHL, EMBASE, EMCARE, HMIC, Medline, PsycINFO and PubMed were searched up to 4 June 2020. Non-database searches included references and citations of identified articles and pages 1-10 of Google and Google Scholar. Eligibility criteria: Included studies presented quantitative or qualitative data collected from doctors returning to work, with findings relating to personal, social or organisational needs. Data extraction and synthesis: Data were extracted using a piloted template. Risk of bias assessment used the Medical Education Research Study Quality Instrument or Critical Appraisal Skills Programme Qualitative Checklist. Data were not suitable for meta-analyses and underwent narrative synthesis due to varied study designs and mixed methods. Results Twenty-four included studies (14 quantitative, 10 qualitative) presented data from 92 692 doctors in the UK (n=13), US (n=4), Norway (n=3), Japan (n=2), Spain (n=1), Canada (n=1). All studies identified personal needs, categorised as work-life balance, emotional regulation, self-perception and identity, and engagement with return process. Seventeen studies highlighted social needs relating to professional culture, personal and professional relationships, and illness stigma. Organisational needs found in 22 studies were flexibility and job control, work design, Occupational Health services and organisational culture. Emerging resources and recommendations were highlighted. Variable quality and high risk of biases in data collection and analysis suggest cautious interpretation. Conclusion This review posits a foundational framework of returning doctors' needs, requiring further developed through methodologically robust studies that assess the impact of length and reason for absence, before developing and evaluating tailored interventions. Organisations, training programmes and professional bodies should refine support for returning doctors based on evidence.

©   Attoe C; Matei R; Thompson L; Teoh K; Cross S; Cox T. BMJ Open. 12(5):e053798, 2022 May 31.

Purpose This article, the first in the Return-to-Work (RTW) Corner series, summarizes a comprehensive RTW and Stay-at-Work (SAW) program in Kentucky, which is funded by the United States Department of Labor. Methods The program, Retaining Employment and Talent After Injury/Illness Network: Kentucky (RETAIN Kentucky), focuses on RTW and SAW strategies, depending upon participants' employment status at the time of enrollment in the project. RETAIN Kentucky services are implemented by RTW Coordinators (RTWCs) who help people with non-work-related injuries and illnesses continue in the workforce. The first Phase of RETAIN Kentucky, which lasted for nearly 3 years, is now informing the Phase 2 intervention, which began in October 2021 and will enroll participants for 30 months. Results In this article, we outline the employment retention problem that RETAIN Kentucky addresses, describe the key features and services of the program, summarize our findings so far, and present future directions for Phase 2.

© Rumrill P; Sheppard-Jones K; Collett JW; McCurry S. Work. 72(1):3-8, 2022.

Purpose Motivation may predict return to work (RTW), yet the measurement of motivation needs more scientific evidence. We adopt a dimensional approach, based on the self-determination theory (SDT), distinguishing between amotivation, controlled and autonomous motivation. We seek to explore the presence of these dimensions in sick-disabled patients, and are interested in associations with quality of life, depression, patient's predictions of RTW, and health care provider estimations of patient's motivation. Methods A cross-sectional study in 336 patients was conducted. Motivation was assessed using the Motivation at Work Scale (MAWS) and examined in relation to patient outcomes, patient's prediction of RTW, and health care provider estimations of patients' motivation. A cluster analysis was performed, and differential associations between motivational profiles were explored. Results Cluster analysis revealed four profiles. Highly controlled profiles were most prevalent, reported poorer mental quality of life, and expected a longer time before RTW, regardless of the level of autonomous motivation. Interestingly, the health care provider's estimation was not related to controlled motivation. Conclusions Our results show that SDT may help to differentiate people with a work disability regarding their motivation to RTW. Most notably, the devastating consequences of controlled motivation are discussed, and clinical implications are provided. Implications for Rehabilitation Assessing the different dimensions of motivation in the context of RTW will be a significant advance as the self-report measures appear to be viable tools. Controlled motivation, which indicates that people are motivated to RTW but only because they "have to", has negative consequences yet a high prevalence and should therefore be addressed by the practitioner. Practitioners should keep in mind that employees are motivated by several motives at the same time, with some being more beneficial than others. Controlled motivation can be converted into autonomous (i.e., good quality) motivation by supporting autonomy of the patient, by supporting their relationships with colleagues, managers, and health care providers and by supporting their feeling of competence in the RTW process.

© Vanovenberghe C; Van den Broeck A; Lauwerier E; Goorts K; Du Bois M. Disability & Rehabilitation. 44(10):2053-2062, 2022 May.

Trouble musculosquelettique

Purpose This study aims to paint a picture of the factors that influence the process of rehabilitation, return, and stay at work, for aging workers who have suffered an occupational injury. Methods Based on a descriptive interpretative research design, the authors conducted interviews with 23 participants (i.e., aging workers, workers' representatives, employers, insurers, and rehabilitation professionals) to gather their perspectives. Qualitative data was analyzed through thematic analysis. Results Fifteen factors related to the worker, health system, workplace, or compensation system were identified. These factors prevail during rehabilitation, return to work, stay at work, or the entire process. Conclusions This study contributes to the advancement of knowledge regarding three main ideas: (1) the importance of not placing the responsibility on the worker in this complex process, (2) the key role of the compensation system, and (3) the necessity of transforming work to reduce ageism.

© Lecours A; Laliberte M; Lord MM; Leonard G; Ruel J. Journal of Occupational Rehabilitation.  2022 May 23.

Purpose There is strong evidence that social support is an important determinant of return to work (RTW). Little is known about the role of social support in RTW after total hip or knee arthroplasty (THA/TKA). Objective was to examine the influence of preoperative and postoperative perceived social support on RTW status 6 months postoperatively. Methods Design: A prospective multicentre cohort study was conducted. Setting: Orthopaedic departments of four Dutch medical centres; a tertiary university hospital, two large teaching hospitals and a general hospital. Participants: Patients planned to undergo THA/TKA, aged 18-63 and employed preoperatively were included. Main outcome and measures: Questionnaires were filled out preoperatively and 3 and 6 months postoperatively and included questions to assess patients' perceived social support targeting three sources of social support: from home (friends, family), from work (coworkers, supervisors) and from healthcare (occupational physician, general practitioner, other caregivers). Control variables included age, gender, education, type of arthroplasty and comorbidities. RTW was defined as having fully returned to work 6 months postoperatively. Univariate and multivariate logistic regression analyses were conducted. Results Enrolled were 190 patients (n=77 THA, n=113 TKA, median age was 56 years, 56% women). The majority returned to work (64%). Preoperatively, social support from the occupational physician was associated with RTW (OR 2.53, 95% CI 1.15 to 5.54). Postoperatively, social support from the occupational physician (OR 3.04, 95% CI 1.43 to 6.47) and the supervisor (OR 2.56, 95% CI 1.08 to 6.06) was associated with RTW. Conclusions This study underscores the importance of work-related social support originating from the occupational physician and supervisor in facilitating RTW after primary THA/TKA, both preoperatively and postoperatively. Further research is needed to confirm our results and to understand the facilitating role of social support in RTW, as arthroplasty is being performed on a younger population for whom work participation is critical.

© Kamp T; Stevens M; Van Beveren J; Rijk PC; Brouwer R; Bulstra S; Brouwer S. BMJ Open. 12(5):e059225, 2022 May 27.

Purpose To explore how patients who participate in an interdisciplinary pain rehabilitation program (IPRP) experience a three-party meeting based on the Demand and Ability Protocol (DAP) to assist in return to work (RTW). The DAP is a employee and his/her immediate manager under the guidance of medical staff with knowledge of the patient's work requirements and his/her current functional ability. Methods Data included 18 semi structured individual interviews with persons having chronic pain, who participated in a DAP-dialogue during their IPRP. Thematic analysis was used to analyze the data. Results Four themes were identified: A structured dialogue facilitated new insights; the dialogue enabled employer participation; the facilitator enabled experiences of feeling safe during the dialogue; and the dialogue created a link between rehabilitation and work. Conclusions The DAP dialogue was experienced as a supportive measure for RTW where the employer naturally participated in IPRP. The structure of the dialogue supported concrete planning for workplace adaptations. Furthermore, the dialogue enabled a connection between rehabilitation and the activity of work in everyday life. The results reinforce the importance of including efforts close to the workplace in IPRP in order to facilitate rehabilitation outcomes related to RTW. Implications for rehabilitation: A structured collaboration and dialogue between the employee, employer, and rehabilitation supports the RTW process. Collaboration between stakeholders is important and should be intertwined in IPRP to jointly facilitate the employee's RTW. Clarifying the work demands provides motivation for the RTW process. Healthcare professionals should collaborate with the workplace to promote employer participation.

©   Johansson E; Svartengren M; Danielsson K; Hellman T. Disability & Rehabilitation. 1-8, 2022 Jun 10.

Purpose For many workers suffering from chronic low back pain (CLBP), the main challenge after a disabling episode is not returning to work in itself, but rather sustaining this reinstatement. The goal of this study was to identify key elements that should be included in a self-management (SM) program in order to facilitate a sustainable return to work for patients suffering from LBP. Methods We conducted a mapping review to examine the current evidence surrounding this issue in four databases (CINAHL, PudMed, Scopus, Cochrane Library). Key content elements of SM programs, as well as facilitators/barriers associated with sustainable RTW were extracted and analysed. Results Only three studies that met our eligibility criteria. Results from these studies suggest that, in the context of RTW, the two most valuable components of an SM program are educational materials and strategies specifically tailored to the work context. Conclusions Among this admittedly scarce evidence, we were able to identify valuable elements that should be included in SM programs in order to promote a sustainable RTW. Additional studies assessing the effectiveness of both current SM programs and programs developed based on our recommendations will be called for to further support our results.

© Tousignant-Laflamme Y; Longtin C; Coutu MF; Gaudreault N; Kairy D; Nastasia I; Leonard G. European Journal of Physiotherapy. Jun2022, Vol. 24 Issue 3, p164-173.

Purpose To examine the impact of pre-existing anxiety and depression disorders on return to work (RTW) using a phase-based approach. Methods Accepted lost-time workers' compensation claims for upper limb or spine strain or sprain from 2009 to 2013 were extracted for workers in the Canadian province of British Columbia (n = 78,186). Pre-existing anxiety and depression disorders were identified using health claims data. Probability of RTW following a first or second work lost-time episode was analyzed using Prentice, Williams and Peterson models for recurrent events (common hazards ratios (cHR)). Probability of a first lost-time recurrence was analyzed using Cox models (HR). All models included two years of follow up and were stratified by gender. Results For men, anxiety alone (cHR = 0.90, 95% CI: 0.85 to 0.94) or comorbid with depression (cHR = 0.95, 95% CI: 0.92 to 0.99) was significantly associated with a lower probability of RTW, and comorbid anxiety and depression with a higher probability of recurrence (HR = 1.29, 95% CI: 1.13 to 1.48). In women, comorbid anxiety and depression was significantly associated with a lower probability of RTW (cHR = 0.96, 95% CI: 0.93 to 0.99) and a higher probability of recurrence (HR = 1.15, 95% CI: 1.04 to 1.28); and anxiety alone with a higher probability of recurrence (HR = 1.25, 95% CI: 1.09 to 1.43). There was little evidence that depression alone was associated with RTW or recurrence. Conclusions Workers with a pre-existing anxiety disorder may require additional supports both during lost-time and after initial RTW.

©   Jones AM; Koehoorn M; Bultmann U; McLeod CB. Journal of Occupational Rehabilitation.  2022 Jun 06.

Santé mentale

Purpose Depression highly impairs function and reduces quality of life. Therefore, both symptomatic and functional recovery are important treatment goals. Depression consists of several cognitive, somatic, and affective symptom factors that differently affect function. However, it is unclear whether changes in these domains predict return to work (RTW) after treatment. Methods Data were collected during treatment from patients on full or partial sick leave reporting depression symptoms (N = 300) at an out-patient clinic. Information on work status was assessed pre- and post-treatment and at 6 months follow-up. Multiple logistic regression was used to investigate if residualized changes in symptom factors predicted full RTW, controlling for gender, education level, and age. Results Changes (as symptom improvement) in the cognitive, somatic, and affective factor scores each significantly predicted full RTW post-treatment and at follow-up for patients on full and partial sick leave, even after controlling for gender, education level, and age. The change in the somatic factor explained the largest proportion of variance for full work post-treatment in patients on full sick-leave, while change in the cognitive factor explained most unique variance for patients on graded sick leave. Discussion The sample consisted of a majority of women with a relatively high level of education. This study should be replicated in more heterogeneous samples. Conclusion Changes in depression symptom domains are significant predictors for RTW work post-treatment. The change in the somatic factor explained the largest proportion of variance in patients on full sick leave and thus may particularly influence RTW after treatment.

© Gjengedal RGH, Osnes K, Reme SE, Lagerveld SE, Johnson SU, Lending HD, Sandin K, Bjorndal MT, Hjemdal O. Journal of Affective Disorders. 308:520-527, 2022 Jul 01.

Purpose The objective of this scoping review was to provide an overview of existing health questionnaires utilised by health care providers and affiliated researchers. It reviewed their effectiveness and suitability to detect mental distress endured by injured workers engaged in the return to work process. Methods A scoping review methodology was conducted using the Arksey and O'Malley framework which examined peer-reviewed articles published between 2000 and March 2020 comprising health questionnaires. Database searches included Medline, CINAHL, EMBASE and PsycINFO combining specific MeSH terms and key words. Results The full search identified 3168 articles. Following full screening a total of 164 articles reviewed the use of health questionnaires and specific criteria to determine their suitability. Most of the health questionnaires reviewed were used as screening measures for identifying both work and non-work-related psychological hazards. However, they were found to be limited in their application when considering all potential predictors of delayed return to work such as poor or stressful interactions with stakeholders, financial stress and the injured workers experience of the RTW process. Conclusion Earlier identification of mental distress using an optimal MHSQ followed by appropriate intervention will reduce the risk of psychological injury becoming cumulative on a physical workplace injury. Without such complications, early return to work can be achieved with significant cost saving to the economy.

© Bohatko-Naismith J; McCormack L; Weerasekara I; James D; Marley J. Work. 72(1):75-90, 2022.

Purpose To assess the feasibility and acceptability of conducting a trial of the clinical effectiveness and cost-effectiveness of a new case-management intervention to facilitate the return to work of health care workers, on sick leave, having a common mental disorder (CMD). Methods A mixed methods feasibility study. Results Systematic review examined 40 articles and 2 guidelines. Forty-nine National Health Service Occupational Health (OH) providers completed a usual care survey. We trained six OH nurses as case managers and established six recruitment sites. Forty-two out of 1938 staff on sick leave with a CMD were screened for eligibility, and 24 participants were recruited. Out of them, 94% were female. Eleven participants received the intervention and 13 received usual care. Engagement with most intervention components was excellent. Return-to-work self-efficacy improved more in the intervention group than in the usual care group. Qualitative feedback showed the intervention was acceptable. Conclusions The intervention was acceptable, feasible and low cost to deliver, but it was not considered feasible to recommend a large-scale effectiveness trial unless an effective method could be devised to improve the early OH referral of staff sick with CMD. Alternatively, the intervention could be trialled as a new stand-alone OH intervention initiated at the time of usual OH referral.

©   Parsons V; Juszczyk D; Gilworth G; Ntani G; Henderson M; Smedley J;  McCrone P; Hatch SL; Shannon R; Coggon D; Molokhia M; Griffiths A; Walker-Bone K; Madan I. Journal of Public Health. 2022 May 30.

Purpose Health professions are ranked among the most stressful occupations and have a much higher likelihood of absenteeism from work. Methods In this paper, we present findings from four health professional case studies in our Healthy Professional Worker partnership, involving surveys with 1860 respondents and 163 interviews with nurses, physicians, midwives, and dentists conducted between December 2020 and April 2021. Results We found that the pathway from mental health experiences through to the decision to take a leave of absence and return to work differed between the health professions and that both gender and leadership matter greatly. Conclusions There is a need to de-stigmatize mental health issues and encourage greater awareness and support from supervisors and colleagues. Leadership can play an important role in mitigating mental health issues, and as such investment in both leadership training and mentorship are important first steps in acting upon our research findings.

©   Bourgeault IL; Atanackovic J; McMillan K; Akuamoah-Boateng H; Simkin S. Healthcare Management Forum. 8404704221092953, 2022 Jun 09.

Purpose Mental illnesses are among the most common diseases worldwide. Cases of inability to work caused by mental illness are frequent and the related economic burden is immense. A successful reintegration into their work environment of those patients who were on sick leave due to a mental illness is an important prognostic factor for the further course of the disease and helps reducing financial consequences. It was the aim of the present review to give an overview of the status quo of return-to-work interventions in the international literature. Results Main themes of interventions addressing return to work of persons with mental illnesses are the provision of psychotherapeutic support with or without combining these approaches with work directed interventions. Personal contact of employees, mental healthcare staff and supervisors may be helpful with regard to facilitating return to work. Discussion Current return to work interventions are mostly elaborate, extensive and expensive without convincing results regarding work related outcome parameters. A variety of reasons might be responsible for this finding, including heterogeneity of outcomes, a poor definition of return-to-work-interventions and the complexity of the issue (involving multiple stakeholders).

©  Hamann J; Lang A; Riedl L; Brieger P. Current Opinion in Psychiatry.  2022 Jun 09

Purpose Identify ethical issues that arise in the coordination of return-to-work (RTW) among employees on sick leave due to common mental disorders (CMDs). Methods 41 semi-structured individual interviews and one focus group interview with stakeholders (n = 46) involved in RTW: employees on sick leave due to CMDs, coordinators and physicians at primary health care centres, managers, representatives of the Swedish social insurance agency and occupational health services. A six-step thematic analysis focused on the ethical values and norms related to autonomy, privacy, resources and organization, and professional values. Results Five themes were identified: (1) autonomous decision-making versus the risk of taking over, (2) employee rights versus restrictions to self-determination, (3) respect for employee privacy versus stakeholders' interests, (4) risk of unequal inclusion due to insufficient organizational structure and resources, (5) risk of unequal support due to unclear professional roles and responsibilities. Conclusion The main ethical issues are the risks of unequal access to and unequal support for the coordination of RTW. For the fair and equal provision of coordination, it is necessary to be transparent on how to prioritize the coordination of RTW for different patient groups, provide clarity about the coordinator's professional role, and facilitate ongoing boundary work between stakeholders. Implications for rehabilitation: Unfair and arbitrary criteria for inclusion to the coordination of RTW implicate risks of unequal access for the employee on sick leave due to CMDs.Unclear professional roles and responsibilities among stakeholders in the coordination of RTW implicate risks of unequal support for the employee on sick leave due to CMDs.Coordination of RTW should be transparently prioritized on policy and organisational levels to secure fair and equal inclusion. The coordinator's professional role should be clearly defined to facilitate boundary work between stakeholders and improve the competence around the coordination of RTW.

©   Holmlund L; Sandman L; Hellman T; Kwak L; Bjork Bramberg E. Disability & Rehabilitation. 1-10, 2022 Jun 08.

Purpose Common mental disorders (CMD) are major causes of sick leave and have huge negative impacts on psychosocial well-being and to overall society. The return to work (RTW) process involves various welfare sectors, but often lack collaboration across these sectors and may cause uneven RTW processes. This study reports from an intervention aimed to increase collaboration between the mental health care system (MHCS) and the social insurance sector (SIS). The intervention consisted of two phases: (a) a development phase building on a participatory approach and (b) an implementation phase. Interprofessional meetings, evaluation workshops and joint consultations with workers from SIS and MHCS, and patients, comprised the key components of the intervention. The study explores how the collaborative process is experienced during the implementation phase with a focus on how collaboration maintains and challenges professional identities. Methods A qualitative design was employed consisting of individual interviews (n20), focus group discussions (4), and observations of interactions between Patients with CMDs, case managers from SIS, and professionals working in MHCS. Results Patients with CMDs felt supported and did not feel pushed to RTW prematurely. SIS and MHCS professionals reported that they were not sufficiently prepared and it was not clear who was responsible for which tasks. MHCS professionals experienced that their professional identities were in conflict with the aim of the intervention whereas SIS professionals found that the intervention improved their poor reputation. Conclusions The results suggest that a higher level of participation in the intervention design and implementation process can improve a clear and transparent role distribution between professionals in MHCS and SIS. Implications for rehabilitation: Collaboration across sectors is key to successful Return-to-work after sickness-related absence. Professional identities are challenged in collaborative interventions as different agendas are at play. Collaboration is most likely to be successful when engaging involved professions to decide goals and methods which are compatible with local work procedures.

© Ladekjaer Larsen E; Jensen JM; Pedersen KMH. Disability & Rehabilitation. 44(11):2317-2324, 2022 Jun.

Purpose Sickness absence and rehabilitation processes can be challenging for an individual. At a time of generally reduced capacity, the individual must comprehend and navigate through several options. The aim of this study was to investigate the prerequisites for support, knowledge and information related to decision making experienced by people on sickness absence due to common mental disorders. Methods A qualitative explorative approach was used. Face-to-face interviews took place with 11 sick-listed individuals with common mental disorders. Patients were recruited from different sources in the western part of Sweden, such as primary health care centres, patient organizations and via social media. Data analysis was performed using manifest content analysis, meaning that the analysis was kept close to the original text, and on a low level of interpretation and abstraction. Results The analysis revealed three themes that described experiences of decision making during the sick leave and rehabilitation process: Ambiguous roles challenge possibilities for moving on; Uncertain knowledge base weakens self-management; and Perceived barriers and enablers for ending sick leave. Conclusions Our findings suggest that alternatives need to be found that address sickness absence and rehabilitation processes from a complex perspective. Collaboration between stakeholders as well as shared decision making should be considered when the time for return to work is discussed with sick-listed individuals. Other factors in the context of the individual must also be considered. Current knowledge on strategies to improve health/well-being while being in the sick leave process need to be elaborated, communicated and adapted to each individuals' unique situation, including clarifying rights, obligations and opportunities during the sick-leave process.

© Andersson C; Jakobsson A; Priebe G; Elf M; Fornazar R; Hensing G. BMC Public Health. 22(1):1189, 2022 Jun 14.

Cancer

Purpose Promoting the return to work of breast cancer survivors is of major interest to patients, healthcare and occupational health professionals, companies, governments, and researchers worldwide. We previously conducted a French consensus study resulting in a model describing the multifactorial process of the return to work of breast cancer survivors (the REWORK-BC model). Other work has identified the transtheoretical model as a relevant theoretical framework for interventions to promote the return to work of cancer survivors. In this opinion paper, we provide a theoretically-based clinical framework describing how to support breast cancer survivors at each stage of the return-to-work process. Results This clinical framework considers several essential aspects of supportive care for breast cancer survivors returning to work, such as: (i) helping the patient actively self-manage, by considering her to be the main decision-maker; (ii) respecting and adapting to the patient's choice of professional project; (iii) respecting the temporality of the patient's choices; (iv) proposing tailored interventions; (v) implementing simple tools to promote the return to work, shared representation between the patient and a multidisciplinary team, and improvement of working conditions and the knowledge of health and occupational professionals, and managers or employers; and (vi) maintaining certain flexibility aimed at proposing, but never imposing, changes in practices. Conclusions This clinical framework, specific to breast cancer survivors, could be extrapolated to other tumor types, offering a practical guide for healthcare and occupational health professionals to better understand the return-to-work process of cancer survivors. This clinical framework aims to be a usable tool for any hospital or cancer care center wishing to implement a patient-centered intervention that promotes returning to work, regardless of the country.

© Porro B; Campone M; Moreau P; Roquelaure Y. International Journal of Environmental Research & Public Health. 19(9), 2022 Apr 22

Purpose This study aimed to understand Canadian cancer survivors' experiences during the return-to-work (RTW) process. Methods A prospective qualitative longitudinal design was employed using the principles of phenomenological inquiry. Cancer survivors took part in three in-depth interviews: at the end of treatment, and 3 and 9 months after the first interview. Transcripts were analyzed using constant comparative analysis, guided by the Cancer and Work model. Results A total of 38 in-depth interviews were conducted with 13 participants. The resultant themes were: (1) supports received or desired to enable RTW; (2) others' limited understanding of the long-term impacts of a cancer diagnosis and its treatment; (3) worries and self-doubts about returning to work; and (4) changing perspectives on life and work after cancer. Conclusions Cancer patients returning to work after treatment often experience challenges throughout the process, including varying levels of support from others and a range of ongoing effects and motivation to RTW. There is a clear gap in terms of the professional supports available to these individuals. Future research should focus on investigating how to improve both quality and accessibility of supports in a way that is personalized to the individual.

© Urquhart R; Scruton S; Kendell C. Current Oncology. 29(5):3013-3025, 2022 Apr 23.

Purpose The aim of this paper was to critically appraise the evidence produced between 2008–2017 on several key stages of the return to work process against the key stakeholders identified in the articles included. Methods A systematic search was done on four databases to identify relevant papers. Papers were selected based on pre-defined selection criteria. A qualitative evidence synthesis was performed on the articles included. Results A total of 57 articles were included in the analysis. Using the secondary thematic analysis, this study identified three categories of articles relative to the stakeholders included: articles focusing on patients’ experience (n = 41); articles dealing with multiple stakeholders, including patients (n = 12); and articles drawing on stakeholders other than patients ( = 4). The analysis also revealed five key stages of the return to work process which follow a sequential order and provide a comprehensive image of the process. Conclusions More research is required on how employers view and can facilitate the return to work process after cancer. New forms of support must be planned and delivered by health professionals for patients who return on the labour market. The five stages model proposed in this study can help employers and policymakers to plan and deliver tailored legislation and guidance for RTW facilitation. All stakeholders must be further trained to embrace the idea that return to work is a complex process which continues long after the survivor returns to work.

© Popa, AE. Work. Jun2022, p1-12.

Purpose As a result of the cancer diagnosis and the mostly multimodal, stressful therapy, psychological distress is a common symptom in breast cancer patients. Methods As part of this prospective study, 1400 patients who were admitted to the hospital for oncological rehabilitation were screened for distress and somatic, therapy-induced secondary disorders. Results Mean distress in the screened population was 5.6 ± 2.56 (range 0-10). In 942 cases (67.3%) a significant distress score (≥ 5) was detected and in 587 cases (41.9%) very high levels of distress (≥ 7) was observed. Psychological distress significantly correlated with younger age, presence of triple negative breast cancer (TNBC), tumor recurrence and metastasis, and inability to work. Treatment-induced side effects such as lymphedema, CIPN or extensive tumor resection (mastectomy) showed a (not significant) trend for higher distress. Conclusion The high incidence of distress underscores the importance of psycho-oncological therapy offers and the great importance of occupational measures during oncological rehabilitation such as the importance of a successful return to work for a better quality of life in breast cancer patients.

© Hass HG; Seywald M; Wöckel A; Muco B; Tanriverdi M; Stepien J. Archives of Gynecology & Obstetrics. Jun2022, p1-7

Purpose Breast cancer survivors can be at high risk of having work-related problems. Previous studies suggest that GPs could discuss work participation with cancer patients and provide guidance. The aim this study is to explore the experiences and expectations of breast cancer survivors with their GPs' role regarding guidance on work participation and return to work. Methods A qualitative study with Dutch female breast cancer survivors was held in the Netherlands. Four focus groups with 25 participants were conducted and audio-taped. Transcripts were analysed using thematic analysis. Results Breast cancer survivors reported a wide range of experiences with guidance from their GPs regarding work participation. Patients who contacted their GPs with work-related issues felt listened to during the consultation. Some patients experienced very limited or no guidance, while others were intensively guided by their GPs. The guidance was provided in the form of counseling, psychosocial support, and referral to other health care professionals. When cancer patients experienced problems with reintegration in work, they expected GPs to have a supportive and referring role in work participation guidance. Conclusion In returning to work, breast cancer survivors expect their GPs to play a supportive role, especially when they encounter difficulties in reintegrating. However, their actual experience of guidance received from their GPs varied, from none received at all, to intensive support provided.

© Sarfo MC; van Asselt KM; Frings-Dresen MH; de Jong F; van Dijk N; de Boer AGEM, BMC primary care, 2022 Jun 17; Vol. 23 (1), pp. 152

Accident vasculaire cérébral (AVC)

Purpose Return to work is a key rehabilitation goal for people with cardiovascular disease (CVD) because employment matters to individuals and societies. However, people recovering from CVD often struggle with returning to work and maintaining employment. To identify people in need of vocational counselling, we examined the probability of feeling under pressure to return to work following CVD. Methods We conducted a combined survey- and register-based study in   randomly selected, population-based cohort of 10,000 people diagnosed with atrial fibrillation, heart failure, heart valve disease, or ischaemic heart disease in 2018. The questionnaire covered return-to-work items, and we reported the probabilities of feeling under pressure to return to work with 95% confidence intervals (CIs) in categories defined by sex, age, and CVD diagnosis. Results The survey response rate was 51.1%. In this study, we included 842 respondents (79.7% men) aged 32-85 years, who had returned to work following a sick leave. Overall, 249 (29.7%) had felt pressure to return to work. The probability of feeling under pressure to return to work ranged from 18.3% (95% CI: 13.1-24.6) among men aged > 55 years with atrial fibrillation to 51.7% (95% CI: 32.5-70.6) among women aged <= 55 years with atrial fibrillation. In addition, 66.0% of all respondents had not been offered vocational rehabilitation, and 48.6% of those who reported a need for vocational counselling had unmet needs. Survey responses also indicated that many respondents had returned to work before feeling mentally and physically ready. Conclusion A substantial proportion of people with cardiovascular disease feel under pressure to return to work, and this pressure is associated with age, sex, and diagnosis. The results show that vocational rehabilitation must be improved and emphasize the importance of ensuring that cardiac rehabilitation programmes include all core rehabilitation components.

© Bernt Jorgensen SM; Johnsen NF; Gerds TA; Brondum S; Maribo T; Gislason G; Kristiansen M. BMC Public Health. 22(1):1059, 2022 May 27

Traumatisme crânien cérébral léger (TCCL)

Purpose Return to work (RTW) might be delayed in patients with complicated mild traumatic brain injury (MTBI), i.e., MTBI patients with associated traumatic intracranial lesions. However, the effect of different types of lesions on RTW has not studied before. We investigated whether traumatic intracranial lesions detected by CT and MRI are associated with return to work and post-concussion symptoms in patients with MTBI. Methods We prospectively followed up 113 adult patients with MTBI that underwent a brain MRI within 3-17 days after injury. Return to work was assessed with one-day accuracy up to one year after injury. Rivermead Post-Concussion Symptoms Questionnaire (RPQ) and Glasgow Outcome Scale Extended (GOS-E) were conducted one month after injury. A Kaplan-Meier log-rank analysis was performed to analyze the differences in RTW. Results Full RTW-% one year after injury was 98%. There were 38 patients with complicated MTBI, who had delayed median RTW compared to uncomplicated MTBI group (17 vs. 6 days), and more post-concussion symptoms (median RPQ 12.0 vs. 6.5). Further, RTW was more delayed in patients with multiple types of traumatic intracranial lesions visible in MRI (31 days, n = 19) and when lesions were detected in the primary CT (31 days, n = 24). There were no significant differences in GOS-E. Conclusions The imaging results that were most clearly associated with delayed RTW were positive primary CT and multiple types of lesions in MRI. RTW-% of patients with MTBI was excellent and a single intracranial lesion does not seem to be a predictive factor of disability to work.

© Huovinen A; Marinkovic I; Isokuortti H; Korvenoja A; Maki K; Nybo T; Raj R; Melkas S. Acta Neurochirurgica. 2022 May 31.

Purpose MTBI Practice Guidelines recommend screening for psychological symptoms. Optimal timing of screening is not established. In this 10-year matched cohort study of workers' compensation cases, early mental health intervention, defined as treatment within three months of injury, was associated with lower health care costs and shorter durations of disability. Objective: To examine the impact of timing of mental health interventions in workers' compensation claims for mild traumatic brain injury (MTBI). Methods A 10-year matched retrospective cohort study of MTBI claims. Cases who started treatment within 3 months of the date of injury were hard matched to cases who started treatment more than 3 months after the date of injury. Outcomes were incremental cost difference and loss of earnings benefit duration 1 year after first intervention. Results Seventeen percent (17%) of patients received mental health interventions. The early mental health intervention group had lower mean costs (incremental difference$1580 [95% CI: $5718 to $2085]) and shorter durations of disability (off loss of earnings) (59.2% versus 46.6%, NS). Sensitivity and stratified analyses demonstrated the same trend. Conclusions Early mental health interventions for MTBI patients may lead to reduced health care costs and shorter durations of disability.

© Nanwa N; Wong V; Thompson AMS. Journal of Occupational & Environmental Medicine. Jun2022, p458-464.