At a glance:
A review of 198 research articles on management and rehabilitation.
Rehabilitation: The process of helping a person back to their former abilities and
quality of life (or as close as possilble) after injury or a medical condition.
Lower back pain in the workplace found:
15 articles (10 studies) of high quality and relevant to the topic
The studies suggest the best intervention
Intervention: A treatment or management program. Interventions
combine several approaches. In this field approaches include training
in problem solving, adaptation of work duties, graded activity, an exercise
and stretching program and pain relief. for back pain is to advise an injured
to be active, and to return to modified work duties early.
If this advice was followed workers returned to work earlier, with
less pain and disability.
How It Was Done:
This was an extensive Review of studies in this area, evaluating
the effectiveness of workplace rehabilitation interventions for
lower back pain.
Five reviewers examined 1244 articles and selected 198 that were relevant
to the topic. Of these, 15 articles on 10 studies were of a high enough quality
to be included.
The Review focused on strategies for the management of work related
musculoskeletal
Musculoskeletal:
Involving the muscles and the skeleton.
This term includes the limbs, neck, shoulders and back.
It also refers to many different conditions that can affect the tendons,
and related structures.
Problems that were implemented in the workplace and involved secondary
prevention.
Secondary prevention:
Approaches undertaken early in a condition with the aim of preventing
worsening of problems that can arise from the condition.
Secondary preventions are approaches undertaken early in a condition
with the aim of preventing the worsening of symptoms and disability.
In the workplace these may include actions such as modifying work duties
to make them manageable for an injured worker, or structuring a gradual
return to work program.
Study Findings:
Clinical treatment involving light activity and early return to work with initial
adaptation of work tasks and hours reduces pain and disability.
The effectiveness of this clinical treatment was not increased by adding
workplace interventions.
Low back pain affects workers and their families and employers.
Although most (80%) people with low back pain recover in the first 3
months a small number remain affected for 6 months and some become
permanently disabled. Disability from back pain causes high costs to
health systems.
This review of relevant studies found the following:
Early Return to Work / Modified Work:
An intervention of immediate assessment, treatment and return to
modified work duties was provided to a group of nurses with back
problems, and the results compared to those who received usual care.
The results showed that the group with the workplace intervention had
less had time off from injury, lower pain, less disability, and increasing
ability to perform normal duties.
Occupational Interventions with Clinical Interventions:
A study examined return to work outcomes for people with back pain
who were treated with one of four approaches.
One group had traditional physical fitness rehabilitation (work hardening,
fitness program and alternate days at work with increased tasks), the
second group had an occupational intervention (evaluation and modification
of work environment and duties), the third group received both of these
interventions, and the fourth group did not receive either of the interventions.
The study found that the group that received both interventions returned
to work 2.4 times faster than the group that did not receive either intervention.
Ergonomic Interventions:
A major study examined the results of ergonomic ergonomic
Designing activities and the workplace in a way to minimize discomfort. i.e.
Adapting work tasks, hours, or workstation to accommodate people.
An ergonomic computer workstation allows the person to work in the
best position to relieve load on the muscles of the neck and arms.
interventions (adapting the workplace environment, work duties and
hours) for over 1600 workers in five countries who were off work.
This study showed that adaptation of job tasks and working hours was
effective in helping workers to return to work after 200 days off sick.
Adaptation of the work site was also found to improve the likelihood of
return to work.
Exercises and Workplace Visit:
Two articles indicated that light exercise at first, with gradually increasing
activity, were more effective in reducing days on sick leave, pain and
difficulty with daily activities than “usual' care. The interventions were
carried out in a clinic. The addition of a worksite visit and suggestion of
modified work environment and duties was not shown to increase the
effectiveness of the treatment.
Supervisor Involvement:
An educational program to train supervisors in return to work management
resulted in increased contact between supervisors and employees with an
injury, a more active approach to adapting the workplace for return to work
by supervisors, and increased confidence of employees in their supervisors.
Conclusions:
Back pain interfering with return to work is a common problem. This
review was conducted to evaluate the effectiveness of workplace rehabilitation
interventions for injured workers with low back pain. The study found advising
the injured worker to be active and supporting return to work in the workplace,
including modifying work duties, produces the best treatment outcomes.
Original Article, Authors & Publication Details:
R. M. Williams1, M. G. Westmorland1, C. A. Lin2, G. Schmuck3 and
M. Creen4 (2007). "A systematic review. Disability and Rehabilitation";
29(8): 607-24.
1. School of Rehabilitation Science, McMaster University, Hamilton, Ontario
2 CanChild Centre for Childhood Disability Research, School of Rehabilitation
Science, McMaster University, Hamilton, Ontario
3 Link With Work, Grand River Hospital, Kitchener, Ontario, and
4 Manulife Financial, Toronto, Ontario, Canada
Showing posts with label study into workcover. Show all posts
Showing posts with label study into workcover. Show all posts
Tuesday, 4 November 2008
Study: Factors that can affect a person's ability to return to work
Refers to psychological and social factors involved with injured workers
returning to work.
Examples of psychosocial factors that affect return to work area
include:
A personâl belief about how they will cope with their condition,
the attitude of the injured worker's family to their condition and return to work,
the employer's return to work policy and the influence of the WorkCover
system on a person. factors that can influence the self-assessment of function.
(Journal of Occupational Rehabilitation; 14(3):197-206Department of Psychiatry,
The University of Texas Southwestern Medical Center at Dallas, Dallas,
TexasBackground, Study Objectives, )
How It Was Done:
This paper's author suggests that many factors can influence the assessment
of a person's level of pain and their ability to function. Therefore, it is best to
approach assessment by taking into account this broad range of factors, rather
than using one simple measure.The aim of this paper is to better understand
the factors that can influence assessment of function and recovery. The paper
reviews some evidence from previous studies, and then recommends an
approach for assessing a person's ability to function after sustaining injury.
Study Findings:
The following factors can influence a persons beliefs and approach to recovery
and in turn can affect their return to work. Each factor needs to be understood
in order to be addressed. While this can be difficult it can make a significant
difference.Secondary loss issuesSecondary loss can be a barrier to recovery.
Some types of loss that can be caused as a secondary result of injury are:
Economic loss
Loss of relationships at work
Loss of social support networks
Social stigma of being disabled, or on workers compensation
Guilt about disability
Loss of recreational activities
Loss of respect from family and friends
The papers author indicates that these losses can have a cascade effect,
leading to significant emotional distress. This then complicates the physical
problem. Effective management of return to function acknowledges
secondary loss, and assists the patient to address these problems positively.
Secondary gain:
Secondary gain has been defined as "the interpersonal or social advantage
obtained by the patient as a consequence of illness". Secondary gain is a
normal facet of life. For example, a person with a headache may not have
to do the dishes, and someone with a cold may spend a day at home rather
than at work. It is a normal for people to experience secondary gain.
Secondary gain:
Any indirect gain that occurs as the result of an injury or illness.
For example, financial gain (in the form of compensation), not having to
work, sympathy or attention. in a modest way.However in some circumstances
the secondary gain becomes a significant issue, and can interfere with return to
function. Secondary gain can range from fulfilment of token needs and wishes
(such as to be taken care of, to change family dynamics or to get even when
blame is involved) to more material issues (such as financial gain, or avoiding
work while maintaining income).It is often said that financial compensation
encourages disability.
Disability:
A condition or function that leaves a person unable to do tasks that most
other people can do. If patients are paid to be sick, they may learn to continue
to seem to be sick, as using this behaviour brings them reward. It is often
expected that people will return to normal functioning when they are no
longer receiving compensation for their injury. However, when the financial
reward stops, the authors of this paper suggest that the behaviours often do
not change. People can continue to behave in a way that allows them to avoid
activity.The authors also go on to suggest that treating practitioners shouldn't
assume that patients with financial secondary gain issues cannot be treated
effectively.
Studies have shown that even in the presence of unresolved financial gain
claims, treatment outcomes can be positive. One of the risks of focusing on
secondary gain is that it deters the treater from appropriate treatment,
may result in poorer outcomes.It is recommended that the treating
practitioner
Treating practitioner:
A health professional that treats patients. In return to work this may
include doctors, physiotherapists, chiropractors, osteopaths, psychologists,
masseurs, etc. take into account the persons situation and any barriers to
recovery, and focus on improving their level of function. The focus should not
be on freeing the patient from pain, but rather on supporting active
rehabilitation.
Management of this situation includes:
Defining a medical endpoint:
Arranging a treatment plan in communication with all parties, with the
aim to return to as normal a life as possible. This may involve family
members, other health care providers, claims managers, and employers.
The team should:
Establish trust and rapport with one another
Plan the return to work
Address any financial issues, including secondary gain, and provide the
person with an understanding of the financial implications
Set goals, including the injured person in this process
After trust has been established, educate the patient about their
reasonable expectation for recovery.
Emotional distress:
Changes in a person's mood often accompany pain and in turn this
affects function. Studies have indicated that 40 to 50% of all chronic
pain patients experienced some form of depression.
Continuing a long time or recurring frequently pain patients:
Experience some form of depression, Anxiety is also common.
People who are fearful of pain avoid activity that they think may cause pain.
They often experience more distress and secondary loss.
Secondary loss:
Any indirect loss that occurs as the result of an injury or illness.
For example, loss of social contact with work friends, loss of status,
financial loss from reduced income. issues. The fear of pain prompts
avoidance behaviour and retreat from normal daily activities. In turn
this leads to increased social isolation, inability to return to function and
prolonged disability.Anger is also becoming recognised as an emotional
state that can affect function. Anger may be directed at persisting
symptoms, unsuccessful treatment, a person blamed for the injury, the
workplace where the injury has occurred, the workers' compensation
system, any delay in management, or family, or colleagues who may be
unsympathetic. Anger that is not expressed is associated with increased
intensity of pain and perceived interference with activities of daily living.
People who are angry seem to be less motivated to respond to assessment
or treatment.
Other factors the author notes influence a persons level of distress are:
Uncertainty about:
How they should manage the condition
The likely outcome (how long the condition will take to improve and
whether the condition is likely to leave them with long-term problems)
The best treatment
Feelings of being misunderstood
Lack of understanding about their entitlement, such as delays in being paid,
difficulties in sorting out the level of pay, etc.Symptom magnification. It is
rare that a patient is consciously faking functional disability. Symptoms
may be exaggerated consciously, or unconsciously, as a way of expressing
the person's illness.
Compliance and resistance issues:
Fear and trust can be major issues for some people, and can interfere with
their willingness, or motivation to participate in a rehabilitation
Rehabilitation :
The process of helping a person back to their former abilities and quality of
life (or as close as possilble) after injury or a medical condition. program.
These issues need to be dealt with in a supportive and educational manner.
It may take some time to develop a level of trust that supports a collaborative
working relationship to overcome these barriers.
Patient Comprehension:
Practitioners tend to assume that patients understand discussions and any
reading material. However, some information needs to be presented a
number of times, or in different ways for patients to fully grasp its meaning.
It is important that the treating practitioner recognise when a patient does
fully understand the information and advice given about their condition.
Iatrogenic effect :
An unwanted negative health effect that occurs as a result of treatment.
E.g. side effects of medication, the problems that can occur from a person
being told to rest, a complication from surgery. An iatrogenic effect it is an
unwanted effect inadvertently introduced by a health care professional, or
treatment. For example, after being advised to rest to relieve pain a person
may continue to rest for longer than necessary. In turn this can change the
person's behaviour, or beliefs in response to their condition and alter their
routine. It is important that treating practitioners understand this issue,
so that appropriate advice is given.
Conclusions:
This study notes that there are many factors that influence a patient's
return to function and their assessment of their own ability and recovery.
Acknowledging and dealing with secondary loss and secondary gain issues,
emotional distress, and the potential for treatment to cause unwanted effects
is needed to accurately assess function. These issues can be complex, but the
authors indicate that they can be effectively addressed with adequate time,
& communication and the development of trust.
Original Article, Authors & Publication Details:
R. J. Gatchel1 (2004).
Psychosocial factors that can influence the self-assessment of function.
J Occup Rehabil. 2004 Sep;14(3):197-206. Review.
PMID: 15156778 [PubMed - indexed for MEDLINE]
returning to work.
Examples of psychosocial factors that affect return to work area
include:
A personâl belief about how they will cope with their condition,
the attitude of the injured worker's family to their condition and return to work,
the employer's return to work policy and the influence of the WorkCover
system on a person. factors that can influence the self-assessment of function.
(Journal of Occupational Rehabilitation; 14(3):197-206Department of Psychiatry,
The University of Texas Southwestern Medical Center at Dallas, Dallas,
TexasBackground, Study Objectives, )
How It Was Done:
This paper's author suggests that many factors can influence the assessment
of a person's level of pain and their ability to function. Therefore, it is best to
approach assessment by taking into account this broad range of factors, rather
than using one simple measure.The aim of this paper is to better understand
the factors that can influence assessment of function and recovery. The paper
reviews some evidence from previous studies, and then recommends an
approach for assessing a person's ability to function after sustaining injury.
Study Findings:
The following factors can influence a persons beliefs and approach to recovery
and in turn can affect their return to work. Each factor needs to be understood
in order to be addressed. While this can be difficult it can make a significant
difference.Secondary loss issuesSecondary loss can be a barrier to recovery.
Some types of loss that can be caused as a secondary result of injury are:
Economic loss
Loss of relationships at work
Loss of social support networks
Social stigma of being disabled, or on workers compensation
Guilt about disability
Loss of recreational activities
Loss of respect from family and friends
The papers author indicates that these losses can have a cascade effect,
leading to significant emotional distress. This then complicates the physical
problem. Effective management of return to function acknowledges
secondary loss, and assists the patient to address these problems positively.
Secondary gain:
Secondary gain has been defined as "the interpersonal or social advantage
obtained by the patient as a consequence of illness". Secondary gain is a
normal facet of life. For example, a person with a headache may not have
to do the dishes, and someone with a cold may spend a day at home rather
than at work. It is a normal for people to experience secondary gain.
Secondary gain:
Any indirect gain that occurs as the result of an injury or illness.
For example, financial gain (in the form of compensation), not having to
work, sympathy or attention. in a modest way.However in some circumstances
the secondary gain becomes a significant issue, and can interfere with return to
function. Secondary gain can range from fulfilment of token needs and wishes
(such as to be taken care of, to change family dynamics or to get even when
blame is involved) to more material issues (such as financial gain, or avoiding
work while maintaining income).It is often said that financial compensation
encourages disability.
Disability:
A condition or function that leaves a person unable to do tasks that most
other people can do. If patients are paid to be sick, they may learn to continue
to seem to be sick, as using this behaviour brings them reward. It is often
expected that people will return to normal functioning when they are no
longer receiving compensation for their injury. However, when the financial
reward stops, the authors of this paper suggest that the behaviours often do
not change. People can continue to behave in a way that allows them to avoid
activity.The authors also go on to suggest that treating practitioners shouldn't
assume that patients with financial secondary gain issues cannot be treated
effectively.
Studies have shown that even in the presence of unresolved financial gain
claims, treatment outcomes can be positive. One of the risks of focusing on
secondary gain is that it deters the treater from appropriate treatment,
may result in poorer outcomes.It is recommended that the treating
practitioner
Treating practitioner:
A health professional that treats patients. In return to work this may
include doctors, physiotherapists, chiropractors, osteopaths, psychologists,
masseurs, etc. take into account the persons situation and any barriers to
recovery, and focus on improving their level of function. The focus should not
be on freeing the patient from pain, but rather on supporting active
rehabilitation.
Management of this situation includes:
Defining a medical endpoint:
Arranging a treatment plan in communication with all parties, with the
aim to return to as normal a life as possible. This may involve family
members, other health care providers, claims managers, and employers.
The team should:
Establish trust and rapport with one another
Plan the return to work
Address any financial issues, including secondary gain, and provide the
person with an understanding of the financial implications
Set goals, including the injured person in this process
After trust has been established, educate the patient about their
reasonable expectation for recovery.
Emotional distress:
Changes in a person's mood often accompany pain and in turn this
affects function. Studies have indicated that 40 to 50% of all chronic
pain patients experienced some form of depression.
Continuing a long time or recurring frequently pain patients:
Experience some form of depression, Anxiety is also common.
People who are fearful of pain avoid activity that they think may cause pain.
They often experience more distress and secondary loss.
Secondary loss:
Any indirect loss that occurs as the result of an injury or illness.
For example, loss of social contact with work friends, loss of status,
financial loss from reduced income. issues. The fear of pain prompts
avoidance behaviour and retreat from normal daily activities. In turn
this leads to increased social isolation, inability to return to function and
prolonged disability.Anger is also becoming recognised as an emotional
state that can affect function. Anger may be directed at persisting
symptoms, unsuccessful treatment, a person blamed for the injury, the
workplace where the injury has occurred, the workers' compensation
system, any delay in management, or family, or colleagues who may be
unsympathetic. Anger that is not expressed is associated with increased
intensity of pain and perceived interference with activities of daily living.
People who are angry seem to be less motivated to respond to assessment
or treatment.
Other factors the author notes influence a persons level of distress are:
Uncertainty about:
How they should manage the condition
The likely outcome (how long the condition will take to improve and
whether the condition is likely to leave them with long-term problems)
The best treatment
Feelings of being misunderstood
Lack of understanding about their entitlement, such as delays in being paid,
difficulties in sorting out the level of pay, etc.Symptom magnification. It is
rare that a patient is consciously faking functional disability. Symptoms
may be exaggerated consciously, or unconsciously, as a way of expressing
the person's illness.
Compliance and resistance issues:
Fear and trust can be major issues for some people, and can interfere with
their willingness, or motivation to participate in a rehabilitation
Rehabilitation :
The process of helping a person back to their former abilities and quality of
life (or as close as possilble) after injury or a medical condition. program.
These issues need to be dealt with in a supportive and educational manner.
It may take some time to develop a level of trust that supports a collaborative
working relationship to overcome these barriers.
Patient Comprehension:
Practitioners tend to assume that patients understand discussions and any
reading material. However, some information needs to be presented a
number of times, or in different ways for patients to fully grasp its meaning.
It is important that the treating practitioner recognise when a patient does
fully understand the information and advice given about their condition.
Iatrogenic effect :
An unwanted negative health effect that occurs as a result of treatment.
E.g. side effects of medication, the problems that can occur from a person
being told to rest, a complication from surgery. An iatrogenic effect it is an
unwanted effect inadvertently introduced by a health care professional, or
treatment. For example, after being advised to rest to relieve pain a person
may continue to rest for longer than necessary. In turn this can change the
person's behaviour, or beliefs in response to their condition and alter their
routine. It is important that treating practitioners understand this issue,
so that appropriate advice is given.
Conclusions:
This study notes that there are many factors that influence a patient's
return to function and their assessment of their own ability and recovery.
Acknowledging and dealing with secondary loss and secondary gain issues,
emotional distress, and the potential for treatment to cause unwanted effects
is needed to accurately assess function. These issues can be complex, but the
authors indicate that they can be effectively addressed with adequate time,
& communication and the development of trust.
Original Article, Authors & Publication Details:
R. J. Gatchel1 (2004).
Psychosocial factors that can influence the self-assessment of function.
J Occup Rehabil. 2004 Sep;14(3):197-206. Review.
PMID: 15156778 [PubMed - indexed for MEDLINE]
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