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Consultez les résultats de notre veille scientifique de décembre 2022!

Incapacité et retour au travail

Purpose Certifying long-term sick leave and coordinating complex rehabilitation programs are essential activities of social insurance doctors. These doctors have a role in preventing the decreased work capacity of employees that may lead to leaving the labour market and the transition of these employees to other social insurance benefits, such as a work disability pension. Objective: Analysis of long-term sick leaves (over 183 days) to identify risk factors and population groups with low potential for work capacity rehabilitation. Method We conducted a cross-sectional study between September 2019 and September 2020. The information was collected from the National Institute of Medical Assessment and Work Capacity Rehabilitation Bucharest registers and the EXPMED application. The data were statistically analysed using PSPP software. Results The highest rehabilitation percentage was achieved in cases of traumatic injuries (73.17%), followed by musculoskeletal diseases (70.06%). We noticed lower recovery in cases of nervous system diseases (50.56%) and cardiovascular diseases (44.23%). In the group that summed up the other pathologies, the recovery percentage was 58.37%. People who regained their work capacity were significantly younger (mean age 47.87 y +/- 8.93) than those who turned to other forms of social benefits, such as a disability pension or an old-age pension (mean age 53.16 y +/- 8.43). Conclusion Most of the subjects (72%) regained their work capacity and did not need a disability pension. We identified the sociodemographic and morbidity characteristics of people on long-term sick leave along with target groups requiring intensive intervention measures.

© Oancea C; Capraru RS; Stanescu AMA; Gherman DM.  BMC Public Health. 22(1):2249, 2022 Dec 02.

Purpose Research has long documented the low cost and effectiveness of most workplace accommodations to enable qualified people with disabilities to seek, secure, and maintain employment. Methods RETAIN Kentucky's return to work and stay at work intervention involves focused training for participants on requesting needed accommodations from their employers. Results In this article, we describe the win-win approach to reasonable accommodations, which serves as the basis for helping Kentuckians with disabilities identify and request on-the-job supports to aid in their efforts to remain in the workforce. Conclusions Workers with disabilities are more likely to stay in the workforce and continue making valuable contributions to the national and global economies if they have effective accommodations and other employment supports available to them.

© Rumrill PD; Rumrill SP; Wickert K; Sheppard-Jones K; Baumunk M; Roessler RT.  Work.  2022 Nov 28.

Trouble musculosquelettique

Purpose To describe how managers of employees on sick-leave, due to chronic pain conditions, experience participating in a three-party meeting using the Demand and Ability Protocol (DAP) in the return-to-work process. Methods This study is based on individual semi-structured interviews with 17 managers of employees with chronic pain. Interviews were conducted after participating in a three-party meeting including the employee, manager, and a representative from the rehabilitation team. The data were analyzed using thematic analysis with an inductive approach. Results Two main themes were identified - "to converse with a clear structure and setup" and "to be involved in the employee's rehabilitation." The first theme describe experiences from the conversation, and the second theme reflected the managers' insights when being involved in the employee's rehabilitation. The themes comprise 11 sub-themes describing how the DAP conversation and the manager's involvement in the rehabilitation may influence the manager, the manager-employee relationship, and the organization. Conclusions This study show, from a manager's perspective, how having a dialogue with a clear structure and an active involvement in the employee's rehabilitation may be beneficial for the manager-employee relationship. Insights from participating in the DAP may also be beneficial for the organization. A structured dialogue between the employee, employer, and rehabilitation supports the return to work (RTW) process. A structured dialogue and collaboration may strengthen the relationship between the manager and employee. An active engagement of managers in the employees RTW process is beneficial for the manager-employee relationship, and for the organisation. Healthcare professionals should collaborate with the workplace to promote participation of managers.

© Aili K; Svartengren M; Danielsson K; Johansson E; Hellman T. Disability & Rehabilitation. 1-10, 2022 Dec 01.

Purpose The Demand and Ability Protocol (DAP) is used in three-party meetings involving an employee, an employer, and a representative from the rehabilitation team. The aim of this study is to investigate the inclusion of an intervention using the DAP in an interdisciplinary pain rehabilitation programme (IPRP) compared to usual care. Methods This non-randomised controlled trial included patients assigned to an IPRP in Sweden. The intervention group received a DAP intervention targeting their work situation in addition to the usual care provided by the IPRP. The control group received IPRP only. Outcome measures were collected from the Swedish Quality Registry for Pain Rehabilitation. Results Results demonstrated improvements in both groups regarding self-reported anxiety, depression and EQ5D. Sleep was improved in the intervention group but not in the control group. No statistical differences in outcomes were observed between the groups. Conclusion In conclusion, adding the DAP intervention to IPRP seemed to have the potential to improve sleep among the patients, which may indicate an overall improvement regarding health outcomes from a longer perspective. The results were less clear, however, regarding the work-related outcomes of sickness absence and workability.

© Aili K; Hellman T; Svartengren M; Danielsson K. International Journal of Environmental Research & Public Health 19(24), 2022 Dec 10.

Purpose Conditions affecting the elbow, forearm, wrist, and hand can cause debilitating pain and loss of function in the working population. While there is knowledge about intervention options for this region of the body, there is limited research on systematically identifying the predictors of return to work in this population. Methods A systematic literature review identified all English-language studies that assess predictors of return to work for people with elbow, wrist, and hand conditions from 2009 to 2021 using PRISMA guidelines. Studies that examined exclusively shoulder injuries, randomized control trials, non-human studies, case studies, case reports, case series, and narrative reviews were excluded. Participants of included studies must have a health-related condition of the fingers, wrist, forearm, and elbow that is preventing work participation and must be 16 years and older. Included studies must be observational, longitudinal, and include a return to work outcome. Results Nineteen out of 170 studies were included. Average time away from work varied between seven to 304 days. Positive predictors of early return to work include: demographics, type of injury, type of treatment, work status, physical factors, psychological factors, use of self-reported outcome measures, and self-reported pain. Conclusion Five clinician recommendations were developed based on the findings of our systematic review. Clinicians should consider the type of work, use of outcome measures, psychological factors, hospitalization, and salary. These recommendations are intended to influence the behavior of clinicians when determining prognosis for return to work of people with elbow, wrist, and hand conditions.

© Bousfield K; Cheon JY; Harley S; Lampiris-Tremba A; Loseby J; Bianchi N; Barnes A; Escorpizo R.  Journal of Occupational Rehabilitation. 32(3):380-413, 2022 09.

Purpose The burden of osteoarthritis (OA) has increased steadily due to an aging population, increasing life expectancy, obesity and lifestyle factors. Total hip replacement has become one of the most prevalent and successful operations globally and it is projected that demand will continue to grow as the incidence of OA continues to increase. Patients undergoing the operation expect much-improved function and pain relief but also increasingly need to return to work postoperatively, especially given the growing demand for the procedure and the encouragement of older people to continue working by most governments in the developed world. Results This review provides an overview of function and employment outcomes after hip arthroplasty. Despite the generally good success rate, some patients do not attain good functional outcomes and it is important that we develop ways to identify these patients preoperatively. We describe the effect of demographic, clinical and other factors on functional outcomes, as well as trajectories of physical function and pain recovery beyond the first few weeks after total hip replacement. Regarding employment outcomes, many people in work preoperatively are likely to resume to work after recovery; however, patients feel that they lack guidance from clinicians about returning to work postoperatively. Conclusion Our review encompasses factors associated with return to work, timing of return to work, and potential temporary or permanent limitations that people might experience at work depending on type of employment.

©  Zaballa E; Dennison E; Walker-Bone K. Maturitas. 167:8-16, 2023 01.

Purpose Optimizing return to work after knee arthroplasty is becoming more important because of the growing incidence of KA among workers and poor return to work outcomes. The purpose of this study is to investigate the feasibility of Back At work After Surgery (BAAS): an integrated clinical pathway for return to work after knee arthroplasty. Method Working patients who received unicompartmental knee arthroplasty (UKA) or total knee arthroplasty (TKA) between January 2021 and November 2021, younger than 65 years and motivated to return to work were eligible to participate. Feasibility was investigated on five domains: reach, dose delivered, dose received, fidelity and patients' attitudes. These outcomes were obtained by a patient-reported questionnaire and an interview with the occupational case manager and medical case manager. Results Of the eligible 29 patients, eleven were willing to participate (response rate 38%; due to travel distance to and from the hospital). The dose delivered was between 91 and 100%, except information given about return to work from the orthopedic surgeon which was 18%. The dose received was 100%. For fidelity, case managers reported nine shortcomings for which five solutions were mentioned. In terms of patients' attitude, all patients were satisfied and one patient mentioned an improvement. In terms of reach, participation was low: only 29%. Conclusions The BAAS clinical pathway seems feasible based on dose delivered, dose received, fidelity and patient attitudes. The next step is to assess the effectiveness of the BAAS clinical pathway for return to work.

© Strijbos DO; van der Sluis G; Boymans TAEJ; de Groot S; Klomp S; Kooijman CM; Reneman MF; Kuijer PPFM.  Musculoskeletal Care. 20(4):950-959, 2022 Dec.

Purpose This systematic review aimed to examine pain, functional status and return to work after a multidisciplinary intervention, with or without additional workplace intervention, for (sub)acute low back pain among adults. Methods A comprehensive search was completed (November 2022) in six electronic databases (Embase, MEDLINE, Web of Science, Cochrane, CENTRAL and Scopus) and in the reference list of all identified studies.The search results were screened against predefined eligibility criteria by two independent researchers. Included articles were systematic reviews or randomized controlled trials examining the effect of a multidisciplinary intervention, with or without workplace intervention, in working adults with (sub)acute low back pain. Relevant information was summarized and clustered, and the methodological quality and certainty of evidence were assessed respectively using the RoB 2-tool, the ROBIS tool and the GRADE criteria. Results The search resulted in a total of 3020 articles. After the screening process, 12 studies remained (11 randomized controlled trials and 1 systematic review), which studied overall 2751 patients, with a follow-up period of at least 12 months. Conclusions A multidisciplinary intervention is favorable compared to usual care for pain intensity and functional status but this is less clear for return to work. Comparable work-related effects were found when comparing a multidisciplinary intervention with a less extensive intervention, whereas uncertainties exist regarding outcomes of pain intensity and functional status. Furthermore, adding a workplace intervention to usual care and subdividing patients based on work-related characteristics seems beneficial for return to work.

©   Bernaers L; Cnockaert E; Braeckman L; Mairiaux P; Willems TM. Clinical Rehabilitation. 2692155221146447, 2022 Dec 26.

Purpose Little is known about ability to work after unicompartmental knee replacement (UKR) and total knee replacement (TKR), especially in physically-demanding occupations. This study described rates of return-to-work (RTW) and ability to sustain work by job after arthroplasty. Method Participants from The Clinical Outcomes in Arthroplasty Study (COASt) aged 18-65 were eligible if they underwent UKR or TKR and had at least 5 years' follow-up post-operation. We posted a survey asking about pre-operative occupation, post-operative occupations and associated physical demands, and whether they had quit a job post-surgery due to difficulties with the operated knee (knee-related job loss (KRJL)). We fitted Cox Proportional Hazard Models to investigate the role of demanding physical activities on KRJL. Results 251 people (143 UKR, 108 TKR) returned a questionnaire, of whom 101 UKR and 57 TKR worked post-operatively. Rates of RTW were highest amongst those in managerial and professional or technical roles, whichever operation they received. RTW was poorest amongst those in elementary occupations. In associate professional/technical occupations, RTW rates were better amongst UKR recipients. Amongst participants who returned to work, 17 reported KRJL (8.5% UKR and 16.7% TKR). Respondents were more likely to have KRJL if their job involved carrying/lifting ≥10 kg (HR:4.81, 95%CI 1.55-14.93) or climbing >30 flights of stairs (HR:4.03, 95%CI 1.36-11.98). Conclusions Knee arthroplasty recipients working pre-operatively mostly RTW. RTW may be more difficult after TKR than UKR. Jobs which involve lifting and climbing stairs may be particularly challenging. Surgeons offering knee arthroplasty should counsel patients about workability as well as risk of revision.

© Zaballa E; Ntani G; Harris EC; Arden NK; Cooper C; Walker-Bone K, The Knee, 2022 Dec 13; Vol. 40, pp. 245-255.

Santé mentale

Purpose Sick leave caused by common mental health disorders (CMD) is becoming more prevalent. For most people, work is essential for good mental and physical health. It is necessary to provide treatments that facilitate return to work (RTW) and a reduction of symptoms. A qualitative study can contribute to an understanding of what makes an intervention successful. The aim of this study was to investigate how individuals who are on sick leave because of CMD perceive and handle their symptoms and their work, after completing metacognitive therapy and work-focused interventions. Methods Semi-structured interviews were conducted with 23 participants after they had completed therapy. Thematic analysis was used to analyse the data. Results Through both therapy and the process of RTW, the participants had gained increased awareness and understanding of their mental health problems and the relationship between those problems and work. Together with the sense that they were in charge of their own process of RTW, this helped to improve their self-confidence. An important part of the process was the change to new strategies and the rejection of older maladaptive ones, in relation to both mental health and work. Being open about their mental illness in the workplace could lead to support but also to the opposite, and therefore not an option for everyone. After treatment, most had returned to work and gained a more positive outlook on the future, but some had less confidence in their ability to deal with future symptoms and workplace issues. Conclusions Achieving improved self-confidence and adopting new strategies, which enabled them to change how they related to their mental problems and how they addressed their problems at work, seemed to have increased their self-efficacy. Active involvement in therapy and at work was also important, both for the process and as a way of increasing self-efficacy. This gave them renewed belief in themselves and in their ability to handle their work at present and in the future. Despite this being a manualized treatment, the participants' experience was that it was adapted to each individual, something they regarded as important.

© Bjorndal MT; Giaever F; Aschim BM; Gjengedal RGH; Lending HD; Bull-Hansen B; Hannisdal M; Hjemdal O. BMC Public Health. 22(1):2231, 2022 Nov 30.

Purpose Considering worker's perspective, the purpose of this study was twofold: (1) to document the meaning of the experience of recognition in the return to work (RTW) process of work after a sick leave due to a common mental disorder (CMD) and (2) to investigate the phenomenon of recognition for workers in the process of RTW after a sick leave due to a CMD, by evaluating the presence or absence of marks of recognition from salient RTW stakeholders stemming from different systems. Methods The Relational Caring Inquiry phenomenological method was used to explore the meaning of recognition during the return-to-work process and marks of recognition in a group of 20 workers who returned to their employment after a sick leave due to a CMD. In depth individual interviews were conducted with each participant. Results The definition of recognition that emerged from workers experiencing the RTW process is related to the behaviours and attitudes of various stakeholders, stemming from the work, health, insurance and social systems that allow them to feel appreciated, valued and respected, throughout the RTW process. Recognition was most often described as showing support, trust, respect for recovery and pace, and providing positive feedback. Conclusion The findings from this study could serve as guidelines in organizations regarding the RTW process, and in particular clarifying the roles and actions that different stakeholders could take in the workplace to stimulate expressions of meaningful recognition.

© Corbiere M; Charette-Dussault E; Lariviere N. Journal of Occupational Rehabilitation.  2022 Dec 03.

Purpose To discuss the impact of depression on work and how depression-related sick leave duration could be a potential indicator and outcome for measuring functionality in depression. Methods Our review was based on a literature search and expert opinion that emerged during a virtual meeting of European psychiatrists that was convened to discuss this topic. Results Current evidence demonstrates that depression-related sick leave duration is influenced by multiple disease-, patient- and work-related factors, together with societal attitudes towards depression and socioeconomic conditions. A wide variety of pharmacological and non-pharmacological treatments and work-based interventions are effective in reducing depression-related sick leave duration and/or facilitating return to work. Recent real-world evidence showed that patients treated with antidepressant monotherapy appear to recover their working life faster than those receiving combination therapy. Although depression-related sick leave duration was found to correlate with severity of depressive symptoms, it cannot be used alone as a viable marker for disease severity. Conclusions Given its multifactorial nature, depression-related sick leave duration is not on its own a viable outcome measure of depression severity but could be used as a secondary outcome alongside more formal severity measures and may also represent a useful measure of functionality in depression.

© Volz HP; Bartecku E; Bartova L; Bessa J; De Berardis D; Dragasek J; Kozhuharov H; Ladea M; Lazary J; Roca M; Usov G; Wichniak A; Godman B; Kasper S. International Journal of Psychiatry in Clinical Practice. 26(4):406-416, 2022 Nov.

Purpose We attempted to score data extracted from written medical records containing assessment results using natural language processing, and to clarify the relationship between duration of sick leave and the use of emotional words among return-to-work (RTW) program users on sick leave due to mental health problems. Method Participants were users of an RTW program. We extracted textual data from their electronic medical records, and gave all words a score based on the following two considerations: positivity score (the degree of positive emotion a word has) and emotion score with respect to seven emotions (sadness, anxiety, anger, disgust, trust, surprise, and joy), with the score for each emotion measured for each word. We analyzed relationships between duration of sick leave and each score. Results Forty-two users participated. The results showed that high positive scores (β = −0.42, p < 0.00) and high sadness scores (β = −0.60, p < 0.00) were related to a shorter duration of sick leave, and high anger score (β = 0.52, p < 0.00) was related to a longer duration of sick leave. Conclusion Professional assessments based on occupational therapy and natural language processing of medical records may predict the appropriate timing of RTW.

© Kutsuna I; Hoshino A; Morisugi A; Mori Y; Shirato A; Takeda M; Isaji H; Suwa M. British Journal of Occupational Therapy, Dec2022; 85(12): 993-1001.


Purpose Studies found that women with breast cancer struggle with significant physical and mental challenges that affect their participation in daily living, social and work activities. Although women express their need for rehabilitation, in Israel there has been scant research on the nature of these needs. Objective: To examine the implications of breast cancer for Israeli women in terms of their quality of life, body function, activities and participation in all facets of life, including work. Methods The sample was composed of women diagnosed with breast cancer. The data were collected through: (a) an online electronic survey assessing cancer-related quality of life (QoL), function and disability, fatigue and sensory-motor functions, (n = 201) followed by (b) face-to-face interviews and assessments (n= 20), and a healthy control group (n = 61). Results Women with breast cancer reported significantly lower QoL compared to the healthy control group. They reported higher levels of disability in areas such as, cognition, mobility, upper extremity, as well as overall difficulties in self-care, doing routine household activities and return to work. Roughly one-third of the women did not return to work. Interestingly, our sample did not perceive a decline in terms of their social support or networks, the women stated that family and social support were major enabling factors. Conclusion The results show that breast cancer has short and long-term functional effects on most facets of these women’s life. The women’s social support system served as an enabling factor. Many women expressed their frustration at the lack of rehabilitation services for their condition and needs in Israel.

© Langer D; Tendler S; Bar-Haim Erez A. Work. Dec2022, p1-13.

Accident vasculaire cérébral (AVC)

Purpose The purposes of this study were to (i) describe the lived experiences of participating in a Singaporean vocational rehabilitation (VR) program among individuals with stroke and spinal cord injury and (ii) identify salient features of the program that facilitated their return-to-work process. Methods This was a qualitative phenomenological study. Participants were invited to complete an interview about their return-to-work process after acquiring a disability vis-à-vis their participation in a local VR program. The qualitative data were analyzed inductively. Results Twenty-four middle-aged participants with a stroke or spinal cord injury completed the interviews. The participants’ experiences with the local VR program were largely positive. Several key features of the VR program were identified. These were: (i) providing a multi-disciplinary and individualized program; (ii) building positive collaborations between service providers and participants; and (iii) supporting personal growth among participants. Conclusions The Singaporean VR program demonstrated internationally recommended best practices. These best practices were beneficial for the participants’ return-to-work process, as reflected by their positive feedback about the program. Our study emphasizes the need for comprehensive and evidence-based VR programs to meet the complex needs of individuals with disabilities who want to return to work. Implications for rehabilitation Multi- or inter-disciplinary care services are needed in vocational rehabilitation (VR) programs to support the complex return-to-work process of clients. VR programs should have the capacity to provide client-centered care as their clients may experience diverse, yet unique challenges during their return-to-work process VR service providers play a crucial role in engaging and motivating their clients throughout the program to achieve their return-to-work goals VR service providers should address concurrent or future concerns that could impact on their clients’ ability to return to or remain at work. Multi- or inter-disciplinary care services are needed in vocational rehabilitation (VR) programs to support the complex return-to-work process of clients.VR programs should have the capacity to provide client-centered care as their clients may experience diverse, yet unique challenges during their return-to-work processVR service providers play a crucial role in engaging and motivating their clients throughout the program to achieve their return-to-work goalsVR service providers should address concurrent or future concerns that could impact on their clients’ ability to return to or remain at work.

© Mohamad NBZ; Ng YS; Asano M. Disability & Rehabilitation. Dec2022, p1-11.

Traumatisme crânien cérébral léger (TCCL)

Purpose While a vast amount of research focuses on unmodifiable and individual factors that may impact return to work (RTW) for patients with traumatic brain injury (TBI), less knowledge exists of the relationship between specific workplace factors and work retention. Objective: Identify types of accommodation in the workplace that influence the RTW process for employees with TBI and the challenges associated with them. Methods A multiple case study consisting of 38 cases and 109 interviews of employees with TBI and their managers conducted between 2017 and 2020 at two time points. Results Accommodation of both the organizational and psychosocial work environment influences RTW for employees with TBI. Social support and supportive management may have positive and negative effects. RTW is often not a linear process. Over time, maintaining and developing customized accommodation in the work organization is challenging. Conclusions Uncertainty about accommodation in RTW for employees with TBI is closely linked to lack of knowledge in the workplace of how to handle complex and nonlinear RTW processes. Work-oriented rehabilitation should to a greater extent provide managers with relevant information and support to develop the person-environment fit over time.

© Spjelkavik O; Enehaug H; Klethagen P; Howe EI; Fure SCR; Terjesen HCA; Lovstad M; Andelic N. Work. 2022 Nov 25.

Purpose Acquired brain injury (ABI) is a complex injury which impacts engagement with worker roles. Return to work (RTW) rates for individuals with brain injury are low and those who do RTW often report job instability. Vocational rehabilitation (VR) can improve RTW rates and job stability; however, service provision is varied, and no gold standard has been identified.  Methods A systematic scoping review of the literature was completed to explore research activity in VR for individuals with ABI to address the following three questions: what models have been identified to underpin VR in ABI? What clinical processes have been identified to guide provision of VR in ABI? What components of VR have been described and/or recommended in the ABI literature? Results The number of included articles was 57. From these articles, 16 models, nine process steps, eight components, and four service delivery components were identified that were utilised in provision of ABI VR. Implications for practice are discussed. Conclusions Key processes and components of ABI VR have been identified across a range of models and apply to clients at all phases post-injury. Findings may be used to inform service provision across a range of time points and support clinicians in their delivery of VR to adults with brain injury. Implications for Rehabilitation: People with acquired brain injury (ABI), even severe injury, can be successful with return to work (RTW) when provided appropriate supports.A wide range of models, interventions, and service components have been identified in the literature which can be used to guide clinical and policy development in ABI vocational rehabilitation. Vocational rehabilitation for individuals with brain injury involves a complex interaction of factors, and consideration should be paid to not only the person and their abilities but also job demands and the environment (physical, social, cultural). Vocational rehabilitation services should be accessible and timed to maximise chances of a successful RTW, provided by a coordinated interdisciplinary team and should involve active stakeholder engagement.

© Murray A; Watter K; McLennan V; Vogler J; Nielsen M; Jeffery S; Ehlers S; Kennedy A. Disability & Rehabilitation. 44(24):7641-7654, 2022 Dec.