Return to Work Self-Efficacy (RTWSE-19) Assessment for Patients with Acute Work-Related Low Back Pain

Nurse practitioners (NPs) often see patients with occupational back pain. Research indicates that hesitation to return to work (RTW) is largely due to perceptions of being unable to resume job tasks or meet expectations. This pilot study evaluates whether the Return-to-Work Self-Efficacy–19 (RTWSE-19) questionnaire, which has been used for injuries at other anatomical sites, is appropriate for lower back pain. The RTWSE-19 was administered to 30 patients who presented with a complaint of an acute work-related back pain; however, it was found to be nonpredictive of RTW, suggesting that NPs should identify other tools to assess their patients’ ability to RTW.     

Piloting an email-based resource package for job seekers with multiple sclerosis

Purpose: Media-based rehabilitation provides a powerful opportunity to examine vocational behaviors in the disability sector. However, this research is preliminary at best. This paper reports pilot data. Method: Eighteen adults with multiple sclerosis (MS) accessed an email-delivered, resource-based package, Work and MS. Pre- and post-access vocational self-efficacy and identity (Job-Procurement Self Efficacy Scale, My Vocational Situation Scale- primary outcomes), life orientation and depressed mood (Life Orientation Test – revised and Patient Health Questionnaire-9 – secondary outcomes) were assessed. Pre- and post-change scores were examined with Wilcoxon signed ranks tests and Hedges g effect sizes with associated 95% confidence intervals. Reliable change analyses were additionally calculated to determine the clinical significance of individual change scores. Results: Significant and positive effects were reported for vocational self-efficacy, identity, and optimism. Reliable change scores in one or more of these key outcomes were reported by 30% of the sample. Satisfaction with the content and delivery of the email-based intervention was also noted. Conclusions: Preliminary evidence suggests that Work and MS can help to promote vocational goals, interests and strengths among job seekers with a disability by providing a set of tools, information and linkages relating to vocational pursuits and career development. Replication with a randomized control design is indicated.

• Implications for Rehabilitation

• Research indicates a high unemployment rate among working-age adults with MS.

• A combination of disease-specific, psychological, programmatic and societal variables contribute to employment instability in this group.

• This pilot study demonstrates that an e-mail-based resource package, Work and MS, provides an innovative and feasible option for promoting consumer engagement with vocational services and, potentially, improving vocational outcomes.

• Work and MS has potential applicability to other disability groups.

     

Workplace Disability Management: International Trends and Perspectives

The social and economic costs of injury and disability in the workplace has had an adverse impact on employers and societies throughout the world. International trends in worksite disability management policies and practices, as surveyed by the International Labor Organization, are explored. The impact of formal training for Disability Management Coordinators is discussed, as relates to reductions in unnecessary lost time and workplace disability costs. A disability management audit system is summarized, as a strategic planning process for developing return-to-work programs for workers with disabilities.     

Recurrence of sickness absence episodes certified by general practitioners in the UK

Background: Compared to other areas of sickness certification, recurrence of certified sickness absence has been relatively under-researched.

Objectives: This study aims to report the extent and patterns of recurrence and to identify factors associated with higher rates of recurrence.

Methods: Sickness certification (‘fit note’) data were collected from 68 general practices in eight regions of the UK for 12 months.

Results: Twenty percent of 31,453 patients in the study had a recurrent certified sickness episode, with over half of these having the second episode in the same diagnostic category as their first. Mental health problems accounted for over a half of all days certified in same-diagnosis recurrent episodes. Male gender, residing in an area of social deprivation, a longer episode of initial certified sickness absence, not having return to work (‘may be fit’) advice in the first episode, having a mental disorder or musculoskeletal (particularly back) problem were all independently associated with a higher incidence of recurrence.

Conclusion: Differential risk of recurrence needs to be considered when designing return-to-work interventions. Evaluation of effectiveness of interventions (particularly for sickness absentees with mental health problems) has to consider the sustainability of employment after a return to work.     

Work ability and return-to-work in cancer patients

The extent to which self-assessed work ability collected during treatment can predict return-to-work in cancer patients is unknown. In this prospective study, we consecutively included employed cancer patients who underwent treatment with curative intent at 6 months following the first day of sick leave. Work ability data (scores 0-10), clinical and sociodemographic data were collected at 6 months, while return-to-work was measured at 6, 12 and 18 months. Most of the 195 patients had been diagnosed with breast cancer (26%), cancer of the female genitals (22%) or genitourological cancer (22%). Mean current work ability scores improved significantly over time from 4.6 at 6 months to 6.3 and 6.7 at 12 and 18 months, respectively. Patients with haematological cancers and those who received chemotherapy showed the lowest work ability scores, while patients with cancer of urogenital tract or with gastrointestinal cancer had the highest scores. Work ability at 6 months strongly predicted return-to-work at 18 months, after correction for the influence of age and treatment (hazard ratio=1.37, CI 1.27-1.48). We conclude that self-assessed work ability is an important factor in the return-to-work process of cancer patients independent of age and clinical factors.     

Identification of obstacles for chronic pain patients to return to work: evaluation of a questionnaire

The Obstacles to Return-to-Work Questionnaire (ORQ) was developed and evaluated. A total of 154 patients with chronic musculoskeletal pain and prolonged work disability participated in the study. Factor analyses reduced the ORQ to 55 items grouped into 9 subscales. The subscales were named Depression, Pain intensity, Difficulties at work return, Physical workload and harmfulness, Social support at work, Worry due to sick leave, Work satisfaction, Family situation and support, and Perceived prognosis of work return. The subscales showed satisfactory reliability. In order to determine predictive validity a discriminant analysis was conducted with sick leave 9 months after assessment as the outcome. This analysis indicated that the scales Perceived prognosis of work return, Social support at work, Physical workload and harmfulness, Depression, and Pain intensity could significantly predict sick leave and correctly classified 79% of the patients. The Multidimensional Pain Inventory and the Disability Rating Index could also significantly predict sick leave in this sample and correctly classified as many patients as the ORQ. However, these questionnaires do not include any work-oriented items and they had a lower specificity than the ORQ. This study suggests that patients' perceptions and beliefs about work and returning to work may be a significant hindrance for actual recovery.     

Management and Employee Agreement on Reports of Organizational Policies and Practices Important in Return to Work Following Carpal Tunnel Surgery

This studys purpose was to assess the agreement between management and employee ratings of organizational policies and practices (OPP) involved in the return to work process following carpal tunnel surgery. As a part of the prospective community-based Maine Carpal Tunnel II Study, 65 manager and employee pairs completed a questionnaire tapping four OPP dimensions: people oriented culture, safety climate, ergonomic practices, and disability management. It was hypothesized that managers and employees would agree on their assessment of the four OPPs and a composite organizational support index. Agreement was assessed using Lins concordance correlation coefficient. Employee and manager ratings were similar for the organizational support index (rho_c = 0.14, p = 0.08), and people oriented culture (rho_c = 0.25, p = 0.01) but not the other three OPPs. In larger companies (> 450 employees), ratings were also similar for safety climate (rho_c = 0.24, p = 0.09), disability management (rho_c = 0.22, p = 0.07) and ergonomic practices (rho_c = 0.35, p = 0.02). In unionized companies there was agreement for safety climate (rho = 0.44, p = 0.02), disability management (rho_c = 0.41, p = 0.01) and ergonomic practices (rho_c = 0.40, p = 0.06). These preliminary results suggest employees can report on certain OPPs and that an employee questionnaire can be used to assess organizational support. Given recent evidence that employee ratings of OPPs are predictive of injury/illness incidence, work disability and return-to-work outcomes, further research is needed to confirm these findings.     

What do referred patients with upper extremity musculoskeletal disorders expect of a multidisciplinary treatment and what is the perceived value?

Purpose. To describe reasons for not starting and to determine expectations and perceived value of multidisciplinary treatment among referred patients, sick-listed due to upper extremity musculoskeletal disorders

Method. Twenty-six randomly chosen referred patients who did not start the treatment were interviewed by telephone to identify their reasons for not starting and 24 randomly chosen patients who participated in the treatment were interviewed face-to-face to explore their expectations and experiences of multidisciplinary treatment.

Results. Reasons for not starting the treatment are mainly intrinsic to the treatment. The most important reason was that the treatment was thought to be too psychological in nature. Most treated patients had no prior expectations but saw it as a last resort for their complaints. The psychological (cognitive-behavioural) component was perceived as the most useful part that acquired the ability to cope with their complaints and developed an increased self-awareness. Most treated patients are satisfied, although some said the treatment did not meet their expectations, because their complaints had not disappeared.

Conclusion. The most important reason for not starting the treatment was the assumption that the treatment is too psychological in nature, while in treated patients the psychological sessions were perceived as most useful treatment component.     

Development and Validation of a Short-Form Functional Capacity Evaluation for Use in Claimants with Low Back Disorders

Objectives: Functional Capacity Evaluations (FCE) are used for making return-to-work decisions, yet FCE's modest predictive ability is currently outweighed by the administrative burden of testing. We attempted to develop a short-form FCE while maintaining comparable predictive ability. Methods: Three databases previously created for evaluating FCE predictive validity were used. Subjects were compensation claimants with low back disorders. FCE measures included items in the Isernhagen Work Systems’ FCE. Days until benefit suspension served as an indicator of return-to-work. Analysis included Cox regression. Results: Three items, floor-to-waist lift, crouching, and standing, were maintained in the short-form FCE. The short-form FCE was found to predict comparably to the entire FCE protocol in two validation cohorts (R ² difference<3%). Subjects meeting job demands on all three items consistently experienced faster benefit suspension. Conclusion: A short-form FCE for determining future work status in claimants with low back disorders was developed. A substantially abbreviated FCE may offer an efficient alternative.