Does the Length of Disability between Injury and Functional Restoration Program Entry Affect Treatment Outcomes for Patients with Chronic Disabling Occupational Musculoskeletal Disorders?

Dutch Dataset Vocational Rehabilitation for Chronic Musculoskeletal Pain: Baseline Patients' Characteristics and Program Eligibility

PURPOSE

Vocational rehabilitation (VR) is an intervention to improve return to work for patients with chronic musculoskeletal pain (CMP). However, a systematic overview of characteristics of referred patients or eligible for VR is lacking, which hinders comparability across studies. Objectives were (1) to describe characteristics of patients with CMP referred to and eligible for VR and (2) to identify factors that contribute to VR eligibility.

METHODS

This study used a multicenter, cross-sectional design. Data of self-reported questionnaires were obtained between 2013 and 2019 from care as usual of eight Dutch VR centers. Descriptive statistics were performed to describe sociodemographic, pain-related, and work-related characteristics. Logistic regression analysis was used to identify factors contributing to VR eligibility.

RESULTS

Data sets of n = 2970 referred patients were included. The mean age was 46 years and 60% were female. Low back (43%), neck (37%), and shoulder pain (34%) were most reported. 82% Worked in paid employment. The absenteeism rate was 85%, and 44% was partially absent. After multidisciplinary screening, 62.2% were eligible for VR. Persons most likely to be eligible for VR (OR < 1.20) were those having back or neck pain, whereas least eligible (OR < 0.80) were persons having pain in hand/fingers or pain in other regions, unemployed workers, and those referred by a 'other' medical specialists. All other factors contributed little or none to the model.

CONCLUSIONS

An extensive description of sociodemographic, pain-related, and work-related characteristics is presented for patients eligible for VR. Especially having back/neck pain and being an employee were associated with higher chance of eligibility for VR.

Recovery expectations can be assessed with single-item measures: findings of a systematic review and meta-analysis on the role of recovery expectations on return-to-work outcomes after musculoskeletal pain conditions

ABSTRACT

The objective of this systematic review is to quantify the association between recovery expectations and return-to-work outcomes in adults with musculoskeletal pain conditions. In addition, this review has the second objective to compare the predictive utility of single-item and multi-item recovery expectation scales on return-to-work outcomes. Relevant articles were selected from Embase, PsycINFO, PubMed, Cochrane, and manual searches. Studies that assessed recovery expectations as predictors of return-to-work outcomes in adults with musculoskeletal pain conditions were eligible. Data were extracted on study characteristics, recovery expectations, return-to-work outcomes, and the quantitative association between recovery expectations and return-to-work outcomes. Risk of bias was assessed using the Effective Public Health Practice Project. Odds ratios were pooled to examine the effects of recovery expectations on return-to-work outcomes. Chi-square analyses compared the predictive utility of single-item and multi-item recovery expectation scales on return-to-work outcomes. Thirty studies on a total of 28,741 individuals with musculoskeletal pain conditions were included in this review. The odds of being work disabled at follow-up were twice as high in individuals with low recovery expectations (OR = 2.06 [95% CI 1.20-2.92] P < 0.001). Analyses also revealed no significant differences in the predictive value of validated and nonvalidated single-item measures of recovery expectations on work disability (χ 2 = 1.68, P = 0.19). There is strong evidence that recovery expectations are associated with return-to-work outcomes. The results suggest that single-item measures of recovery expectations can validly be used to predict return-to-work outcomes in individuals with musculoskeletal pain conditions.

The Influence of Expectancies on Pain and Function Over Time After Total Knee Arthroplasty

OBJECTIVE

Expectancies have a well-documented influence on the experience of pain, responses to treatment, and postsurgical outcomes. In individuals with osteoarthritis, several studies have shown that expectations predict increased pain and disability after total knee replacement surgery. Despite the growing recognition of the importance of expectancies in clinical settings, few studies have examined the influence of expectancies throughout postsurgical recovery trajectories. The objective of the present study was to examine the role of presurgical expectancies on pain and function at 6-week, 6-month, and 1-year follow-ups after total knee arthroplasty.

DESIGN AND PARTICIPANTS

Data were collected from patients scheduled for total knee arthroplasty 1 week before surgery and then at 6 weeks, 6 months, and 1 year after surgery. Correlational and multivariable regression analyses examined the influence of expectancies on patients' perceptions of pain reduction and functional improvement at each time point. Analyses controlled for age, sex, body mass index, presurgical pain intensity and function, pain catastrophizing, anxiety, and depression.

RESULTS

Results revealed that expectancies significantly predicted pain reduction and functional improvement at 1-year follow-up. However, expectancies did not predict outcomes at the 6-week and 6-month follow-ups. Catastrophizing and depressive symptoms emerged as short-term predictors of postsurgical functional limitations at 6-week and 6-month follow-ups, respectively.

CONCLUSIONS

The results suggest that targeting high levels of catastrophizing and depressive symptoms could optimize short-term recovery after total knee arthroplasty. However, the results demonstrate that targeting presurgical negative expectancies could prevent prolonged recovery trajectories, characterized by pain and loss of function up to 1 year after total knee arthroplasty.

Outlining the Invisible: Experiences and Perspectives Regarding Concussion Recovery, Return-to-Work, and Resource Gaps

Appropriate supports and accommodations are necessary to ensure full concussion recovery and return-to-work (RTW). This research investigated barriers and facilitators to concussion recovery and RTW, and resource gaps reported by adults with concussion (‘workers’) and workplace and healthcare professionals (‘workplaces’). Semi-structured interviews and focus groups were conducted with workers (n = 31) and workplaces (n = 16) across British Columbia. Data were analyzed using inductive content analysis. Facilitators to workers’ concussion recovery and RTW included treatment, social support, and workplace and lifestyle modifications. To address barriers, both groups recommended: (a) widespread concussion and RTW education and training (b) standardized concussion recovery guidelines; (c) changing attitudes toward concussion; (d) mental health supports; and (e) increasing awareness that every concussion is unique. Findings can inform best practice for concussion recovery and RTW among professionals in workplaces, healthcare, occupational health and safety, and workers’ compensation boards.

Health screening questionnaires used in the management of mental distress acquired during an injured worker’s return to work: A scoping review

BACKGROUND: Mental distress is often endured by injured workers participating in the rehabilitation or return to work process following a physical injury. Delays in detecting the onset and treating mental distress can lead to a diverse range of cognitive and behavioural changes that may precipitate psychological distress such as anxiety, depression, and posttraumatic stress. OBJECTIVE: 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.

Assessing the Functional Status of Patients with Chronic Pain-Cross Cultural Adaptation and Psychometric Properties of the Serbian Version of the Pain Disability Questionnaire

The Pain Disability Questionnaire (PDQ) has established itself as a leading patient-reported outcome measure for assessing both mental and physical components of pain-related disability. The current study aimed to translate the PDQ into Serbian and validate its psychometric properties. Following a standard translation process, a total of 554 chronic pain patients (average age 55.37 ± 12.72 years; 375 (67.5%) females) completed the PDQ-Serb, Oswestry Disability Index (ODI), Short Form-36 (SF-36), pain intensity rating and a six-minute walk test (6MWT). Responsiveness was examined in a subsample of 141 patients who completed an inpatient rehabilitation program. The internal consistency of the PDQ-Serb was excellent (Cronbach α = 0.92) and test-retest reliability was favorable (ICC = 0.87). Factor analyses found a bifactor model to be the best fit (CFI = 0.97: TLI = 0.96: RMSEA = 0.05; SRMR = 0.03). Statistically significant Pearson’s coefficient correlations (p < 0.001) were found between the PDQ-Serb and ODI (r = 0.786), SF-36 Physical Components summary (r = −0.659), SF-36 Mental Components summary (r = −0.493), pain intensity rating (r = 0.572), and 6MWT (r = −0.571). Significant post-treatment improvements following inpatient rehabilitation were found with the PDQ-Serb (p < 0.001; effect size 0.431) and other clinical variables (p < 0.001; effect sizes from 0.367 to 0.536). The PDQ-Serb was shown to be a reliable and valid self-report instrument for the evaluation of pain-related disability.

Vocational Rehabilitation with or without Work Module for Patients with Chronic Musculoskeletal Pain and Sick Leave from Work: Longitudinal Impact on Work Participation

Purpose To study the longitudinal relationship between interdisciplinary vocational rehabilitation (VR) with and without additional work module on work participation of patients with chronic musculoskeletal pain and sick leave from work. Methods Retrospective longitudinal data retrieved from care as usual in seven VR centers in the Netherlands was used. The VR program without work module consisted of multi-component healthcare (physical exercise, cognitive behavioral therapy, education, relaxation). The other program with additional work module (VR+) included case management and a workplace visit. Generalized estimating equations using binary logistic was applied. The dependent variable was work participation (achieved/not achieved) on discharge and 6-months follow-up. Independent variables were type of intervention, return to work expectation, sick leave duration, working status, job strain, and job dissatisfaction. Results Data from N = 470 patients were analyzed, of which 26% received VR and 74% VR+. Both programs increased work participation at 6-months follow-up (VR 86%, VR+ 87%). The crude model showed a significant longitudinal relationship between type of intervention and work participation in favor of VR+ (OR 1.8, p = 0.01). The final model showed a non-significant relationship on discharge (OR 1.3, p = 0.51) and a significant relationship on 6-months follow-up in favor of VR+ (OR 1.7, p = 0.04). RTW expectation was a significant confounder in the final model on discharge and 6-months follow up (OR 3.1, p = 0.00). Conclusions Both programs led to increased work participation. The addition of a work module to the VR program lead to a significant increase in odds of work participation at 6-months follow-up.

A scoping review to ascertain the parameters for an evidence synthesis of psychological interventions to improve work and wellbeing outcomes among employees with chronic pain

Background: Psychological interventions have mixed effects on improving employee outcomes, partly due to significant variability across studies and a lack of focus on mechanisms of action. This scoping review reports on the parameters of these interventions and examines intervention content to bring clarity to this heterogeneous topic area and direct future systematic review work.

Method: Six databases were searched (Cinahl, Cochrane, Embase, Medline, PsychINFO and Web of Science) from April 2010 to August 2020, and a grey literature search was undertaken. Screening was undertaken independently by two authors. The results summarised country, participant and employment characteristics, psychological interventions and work, health and wellbeing outcomes. 10% of the papers were analysed to determine the feasibility of coding intervention descriptions for theory and behaviour change technique (BCT) components.

Results: Database searches yielded 9341 titles, of which 91 studies were included. Most studies were conducted in Europe (78%) and included males and females (95%) ranging in age from 31-56.6 years although other demographic, and employment information was lacking. Musculoskeletal pain was common (87%). Psychological interventions commonly included cognitive behavioural therapy (30%) and education (28%). Most studies employed a randomised control trial design (64%). Over half contained a control group (54%). Interventions were delivered in mostly healthcare settings (72%) by health professionals. Multiple outcomes were often reported, many of which involved measuring sickness absence and return-to-work (62%) and pain and general health (53%). Within the feasibility analysis, most papers met the minimum criteria of containing one paragraph of intervention description, but none explicitly mentioned theory or BCTs.

Conclusion: Psychological interventions for employees with chronic pain vary in their nature and implementation. We have shown scoping reviews can be used to assess the feasibility of applying tools from health psychology to identify the content of these interventions in future systematic review work to improve intervention development.

The self-assessment INTERMED predicts healthcare and social costs of orthopaedic trauma patients with persistent impairments

Objective:

To use the self-assessment INTERMED questionnaire to determine the relationship between biopsychosocial complexity and healthcare and social costs of patients after orthopaedic trauma.

Design:

Secondary prospective analysis based on the validation study cohort of the self-assessment INTERMED questionnaire.

Setting:

Inpatients orthopaedic rehabilitation with vocational aspects.

Subjects:

In total, 136 patients with chronic pain and impairments were included in this study: mean (SD) age, 42.6 (10.7) years; 116 men, with moderate pain intensity (51/100); suffering from upper (n = 55), lower-limb (n = 51) or spine (n = 30) pain after orthopaedic trauma; with minor or moderate injury severity (severe injury for 25).

Main measures:

Biopsychosocial complexity, assessed with the self-assessment INTERMED questionnaire, and other confounding variables collected prospectively during rehabilitation. Outcome measures (healthcare costs, loss of wage costs and time for fitness-to-work) were collected through insurance files after case settlements. Linear multiple regression models adjusted for age, gender, pain, trauma severity, education and employment contract were performed to measure the influence of biopsychosocial complexity on the three outcome variables.

Results:

High-cost patients were older (+3.6 years) and more anxious (9.0 vs 7.3 points at HADS-A), came later to rehabilitation (+105 days), and showed higher biopsychosocial complexity (+3.2 points). After adjustment, biopsychosocial complexity was significantly associated with healthcare (ß = 0.02; P = 0.003; exp^ß = 1.02) and social costs (ß = 0.03; P = 0.006, exp^ß = 1.03) and duration before fitness-to-work (ß = 0.04; P < 0.001, exp^ß = 1.04).

Conclusion:

Biopsychosocial complexity assessed with the self-assessment INTERMED questionnaire is associated with higher healthcare and social costs.

A Systematic Review on the Research Progress and Evolving Trends of Occupational Health and Safety Management: A Bibliometric Analysis of Mapping Knowledge Domains

Background: Effective occupational health and safety management (OHSM) is important to employee health, enterprise sustainability, and social stability. However, scientific research into OHSM lags behind practice, and contextualizing OHSM research from the perspective of its historical evolution is urgently required.

Methods: The mapping of knowledge domains, based on bibliometric analysis, was adopted to classify 4,852 journal articles related to OHSM listed in the core database of Web of Science and published between 1900 and 2018.

Results and Conclusions: Risk assessment/management at the organizational level were found to have always been research hotspots, and the relationship between safety culture/atmosphere, sickness absence, and safety performance, among other factors, have become core research topics in the field in recent years. Research at the individual level has gradually evolved from an early focus on physiological problems such as work-related musculoskeletal disorders and low back pain, further toward issues such as occupational stress, mental health, and quality of life. In addition, the results of clustering analysis based on high-frequency keywords indicated six aspects of OHSM: OHSM mode and method; OHSM systems and standards; OHS risk assessment and management; OHSM and safety culture; mental health and quality of life; and specific disease management. Future development trends in OHSM research are described providing theoretical and practical reference for further study.

Predictive Value of the Fear-Avoidance Model on Functional Capacity Evaluation

Purpose Measuring the predictive value of the Fear-Avoidance Model (FAM) on lifting tasks in Functional Capacity Evaluation (FCE), and on reasons for stopping the evaluation (safe maximal effort, versus self-limited). Methods A monocentric prospective study was conducted on 298 consecutive inpatients. Components of the FAM were analyzed using the Cumulative Psychosocial Factor Index (CPFI: kinesiophobia, catastrophizing, depressive mood) and perceived disability (Hand/Spinal Function Sort: HFS/SFS). Floor-to-waist, waist-to-overhead and dominant-hand lifting tests were measured according to the FCE guidelines. Maximal safe performance was judged by certified FCE assessors. Analyses were conducted with linear multiple regression models. Results The CPFI was significantly associated with the 3 FCE lifting tests: floor-to-waist (ß = - 1.12; p = 0.039), waist-to-overhead (ß = - 0.88; p = 0.011), and dominant-handed lifting (ß = - 1.21; p = 0.027). Higher perceived disability was also related to lower performances: floor-to-waist (ß = 0.09; p < 0.001), waist-to-overhead (ß = 0.04; p < 0.001), and dominant-handed lifting (ß = 0.06; p < 0.001). The CPFI was not related to performances of patients with self-limited effort despite higher psychological scores, while a relationship was found for patients who achieved a safe maximal performance. Higher perceived disability was related to performances in both situations. Conclusions FAM components should be taken into account when interpreting maximal physical performance in FCE. This study also suggests that factors other than pain-related fears may influence patients with self-limited effort.