A Participatory Return-to-Work Intervention for Temporary Agency Workers and Unemployed Workers Sick-Listed Due to Musculoskeletal Disorders: Results of a Randomized Controlled Trial

Introduction Within the labour force workers without an employment contract represent a vulnerable group. In most cases, when sick-listed, these workers have no workplace/employer to return to. Therefore, the aim of this study was to evaluate the effectiveness on return-to-work of a participatory return-to-work program compared to usual care for unemployed workers and temporary agency workers, sick-listed due to musculoskeletal disorders. Methods The workers, sick-listed for 2–8 weeks due to musculoskeletal disorders, were randomly allocated to the participatory return-to-work program (n = 79) or to usual care (n = 84). The new program is a stepwise procedure aimed at making a consensus-based return-to-work plan, with the possibility of a temporary (therapeutic) workplace. Outcomes were measured at baseline, 3, 6, 9 and 12 months. The primary outcome measure was time to sustainable first return-to-work. Secondary outcome measures were duration of sickness benefit, functional status, pain intensity, and perceived health. Results The median duration until sustainable first return-to-work was 161 days in the intervention group, compared to 299 days in the usual care group. The new return-to-work program resulted in a non-significant delay in RTW during the first 90 days, followed by a significant advantage in RTW rate after 90 days (hazard ratio of 2.24 [95% confidence interval 1.28–3.94] P = 0.005). No significant differences were found for the measured secondary outcomes. Conclusions The newly developed participatory return-to-work program seems to be a promising intervention to facilitate work resumption and reduce work disability among temporary agency workers and unemployed workers, sick-listed due to musculoskeletal disorders.     

Coordinated and Tailored Work Rehabilitation: A Randomized Controlled Trial with Economic Evaluation Undertaken with Workers on Sick Leave Due to Musculoskeletal Disorders

Introduction In Denmark, the magnitude and impact of work disability on the individual worker and society has prompted the development of a new “coordinated and tailored work rehabilitation” (CTWR) approach. The aim of this study was to compare the effects of CTWR with conventional case management (CCM) on return-to-work of workers on sick leave due to musculoskeletal disorders (MSDs). Methods The study was a randomized controlled trial with economic evaluation undertaken with workers on sick leave for 4–12 weeks due to MSDs. CTWR consists of a work disability screening by an interdisciplinary team followed by the collaborative development of a RTW plan. The primary outcome variable was registered cumulative sickness absence hours during 12 months follow-up. Secondary outcomes were work status as well as pain intensity and functional disability, measured at baseline, 3 and 12 months follow-up. The economic evaluation (intervention costs, productivity loss, and health care utilization costs) was based on administrative data derived from national registries. Results For the time intervals 0–6 months, 6–12 months, and the entire follow-up period, the number of sickness absence hours was significantly lower in the CTWR group as compared to the control group. The total costs saved in CTWR participants compared to controls were estimated at US $ 1,366 per person at 6 months follow-up and US $ 10,666 per person at 12 months follow-up. Conclusions Workers on sick leave for 4–12 weeks due to MSD who underwent “CTWR” by an interdisciplinary team had fewer sickness absence hours than controls. The economic evaluation showed that—in terms of productivity loss—CTWR seems to be cost saving for the society.     

Prognostic Factors for the Work Participation of Sick-Listed Unemployed and Temporary Agency Workers with Psychological Problems

Introduction Among the working population, unemployed and temporary agency workers are a particularly vulnerable group, at risk for sickness absence due to psychological problems. Knowledge of prognostic factors for work participation could help identify sick-listed workers with a high-risk for work disability and provide input for sickness absence counseling. The purpose of this study was to identify prognostic factors for the work participation of medium- and long-term sick-listed unemployed and temporary agency workers with psychological problems. Methods A cohort of 932 sick-listed unemployed and temporary agency workers with psychological problems was followed for one and a half years. Data collection was conducted at three time-frames: 10?months, 18?months and 27?months after reporting sick. Univariate and multiple logistic regression analyses were performed. Results Perceived health, full return-to-work (RTW) expectations, age and work status at 18?months were strong prognostic factors for work participation at subsequent time-frames in the univariate analyses. Multiple logistic regression revealed that full RTW expectation was a prognostic factor for future work participation in both the medium- and long-term, whereas moderate-to-good perceived health was a prognostic factor for work participation in the medium-term. Being under 45?years of age and having a positive work status at 18?months were prognostic factors for work participation in the long-term. Conclusions Workers?? self-appraisal of health, age and work status were strong prognostic factors for the future work participation of sick-listed unemployed and temporary agency workers with psychological problems. These findings could help occupational and insurance physicians identify high-risk sick-listed workers for sickness absence counseling.     

Process Evaluation of a Participatory Supportive Return to Work Program for Workers Without a Permanent Employment Contract,Sick-Listed Due to a Common Mental Disorder

Purpose This study aimed to perform a process evaluation of a participatory supportive return to work program for workers without a (permanent) employment contract, sick-listed due to a common mental disorder. The program consisted of a participatory approach, integrated care and direct placement in a competitive job. Our main questions were: were these components realized in practice and in accordance with the protocol? The evaluation took place alongside a randomized controlled trial. Methods The study population consisted of workers who filed a sickness benefit claim at the Dutch Social Security Agency, professionals of this agency and of vocational rehabilitation agencies. We focused on sick-listed workers and professionals who had actually participated in the intervention. Data was collected mainly by questionnaires. Results Only 36 out of 94 intervention group participants started with the program. In half of these cases application of integrated care was reported. Most other steps in the program were completed. However, fidelity to the protocol was low to reasonable. Much delay was observed in the execution of the program and only two sick-listed workers were placed in a competitive job. Still, satisfaction with the participatory approach was good. Conclusions Despite the positive evaluation of the participatory approach, the full program was executed less successfully compared to similar programs evaluated in earlier studies. This will probably affect the outcomes of our trial. Findings from this study will help to interpret these outcomes. Nevertheless, more knowledge is needed about experiences of stakeholders who participated in the program. Trial Registration NTR3563.     

Effect Evaluation of a Self-Management Program for Dutch Workers with a Chronic Somatic Disease: A Randomized Controlled Trial

Purpose The objective of this study is to investigate the effect of a Self-Management Program for workers with a chronic disease. This program is based on the Chronic Disease Self-Management Program of Stanford University, modified for workers with a chronic somatic disease. Methods In a randomized controlled trial, the effectiveness of a Self-Management Program was evaluated. Participants were randomly assigned to the experimental group (n = 57) and the control group (n = 47). The experimental group received an intervention, the control group received care as usual. Primary outcome measures were self-efficacy at work and the attitude towards self-management at work. Secondary outcomes were the SF-12 health survey questionnaire, job satisfaction and intention to change job. The results were measured at baseline, after the intervention and 8 months after the intervention. Results The attitude towards self-management at work (enjoyment) improved after 8 months for the intervention group (p = 0.030). No other outcome variable differed significantly. As an interaction effect, it was found that low educated workers developed a better physical health quality (SF-12) in the intervention group compared with the control group. The attitude towards self-management at work (importance) improved in the intervention group for older and female workers and the attitude toward enjoying self-management at work improved for female workers only. Conclusion The results show that low educated workers, older workers and women benefit significantly more from the training than higher educated workers, younger workers and men.     

Motivational Interviewing for Workers with Disabling Musculoskeletal Disorders: Results of a Cluster Randomized Control Trial

Purpose Although functional restoration programs appear effective in assisting injured workers to return-to-work (RTW) after a work related musculoskeletal (MSK) disorder, the addition of Motivational Interviewing (MI) to these programs may result in higher RTW. Methods We conducted a cluster randomized controlled trial with claimants attending an occupational rehabilitation facility from November 17, 2014 to June 30, 2015. Six clinicians provided MI in addition to the standard functional restoration program and formed an intervention group. Six clinicians continued to provide the standard functional restoration program based on graded activity, therapeutic exercise, and workplace accommodations. Independent t tests and chi square analysis were used to compare groups. Multivariable logistic regression was used to obtain the odds ratio of claimants’ confirmed RTW status at time of program discharge. Results 728 workers’ compensation claimants with MSK disorders were entered into 1 of 12 therapist clusters (MI group?=?367, control group?=?361). Claimants were predominantly employed (72.7%), males (63.2%), with moderate levels of pain and disability (mean pain VAS?=?5.0/10 and mean Pain Disability Index?=?48/70). Claimants were stratified based on job attachment status. The proportion of successful RTW at program discharge was 12.1% higher for unemployed workers in the intervention group (intervention group 21.6 vs. 9.5% in control, p?=?0.03) and 3.0% higher for job attached workers compared to the control group (intervention group 97.1 vs. 94.1% in control, p?=?0.10). Adherence to MI was mixed, but RTW was significantly higher among MI-adherent clinicians. The odds ratio for unemployed claimants was 2.64 (0.69–10.14) and 2.50 (0.68–9.14) for employed claimants after adjusting for age, sex, pain intensity, perceived disability, and therapist cluster. Conclusion MI in addition to routine functional restoration is more effective than routine functional restoration program alone in improving RTW among workers with disabling MSK disorders.     

Evaluation of a PDA-based Dietary Assessment and Intervention Program: A Randomized Controlled Trial

Objective: To evaluate the capability of DietMatePro, a PDA-based dietary assessment program, to monitor dietary intake and to improve adherence to a dietary regimen.

Design: Randomized controlled trial.

Subjects. Overweight and obese (Body Mass Index (BMI) 25–40) participants without dietary restrictions.

Intervention: Participants (n = 174) were randomized to record usual dietary intake using either DietMatePro or a paper food diary for one week to compare concordance with 24-hr recall. At the week 1 visit, participants were individually counseled to follow the diet recommendations of the Ornish Prevention Diet for three weeks and continue monitoring food intake using the assigned method to estimate adherence to the intervention by monitoring condition.

Outcome Measures: Spearman correlations between week 1 24-hr recall and the assigned recording method were compared to assess validity. Mean pre-post changes in intake measured by 24-hr recall were compared according to monitoring condition to measure adherence to the Ornish diet.

Results: Correlations of energy and nutrient values reported on the food label ranged from 0.41 to 0.71 for the DietMatePro condition versus 0.63 to 0.83 for the paper-based diary. Diet adherence was higher among DietMatePro (43%) compared to the paper diary (28%) group (p = 0.039).

Conclusions/Applications: DietMatePro does not appear to produce more valid data than paper-based approaches. DietMatePro may improve adherence to dietary regimens compared to paper-based methods.     

A Participatory Workplace Intervention for Employees With Distress and Lost Time: A Feasibility Evaluation Within a Randomized Controlled Trial

Introduction Little is known about feasibility and acceptability of return to work (RTW) interventions for mental health problems. RTW for mental health problems is more complicated than for musculoskeletal problems due to stigmatization at the workplace. A participatory workplace intervention was developed in which an employee and supervisor identify and prioritize obstacles and solutions for RTW guided by a RTW coordinator. This paper is a feasibility study of this innovative intervention for employees with distress. The aims of this study were to describe the reach and extent of implementation of the workplace intervention, the satisfaction and expectations of all stakeholders, and the intention to use the workplace intervention in the future. Methods Eligible for this study were employees who had been on sick leave from regular work for 2–8 weeks with distress. Data were collected from the employees, their supervisors, RTW coordinators, and occupational physicians by means of standardized matrices and questionnaires at baseline and 3 months follow-up. Reach, implementation, satisfaction, expectations, and maintenance regarding the workplace intervention were described. Results Of the 56 employees with distress eligible to receive the workplace intervention, 40 employees, their supervisors and RTW coordinators actually participated in the intervention. They identified 151 obstacles for RTW mostly related to job design, communication, mental workload and person-related stress factors. The 281 consensus-based solutions identified were mostly related to job design, communication and training. Of those solutions, 72% was realized at the evaluation with the employee and supervisor. Overall, employees, supervisors and occupational health professionals were satisfied with the workplace intervention and occupational health professionals rated it with a 7.1. Time-investment was the only barrier for implementation reported by the occupational health professionals. Conclusions The results of this study indicate a high feasibility for a broad implementation of a participatory workplace intervention for employees with distress and lost time, and their supervisors.     

Barriers for Early Return-to-Work of Workers with Musculoskeletal Disorders According to Occupational Health Physicians and Human Resource Managers

Recent studies have indicated positive effects of modified work for workers with musculosceletal complaints. The question remains how effectively modified work can be implemented in companies. This study describes barriers for introducing modified work for workers on sickness absence due to musculoskeletal complaints. Modified work was defined as gradually increasing the physical demands at work until the worker is ready for full duty in his regular job. In order to describe barriers in implementation of modified work, a model based on health education was used, consisting of six successive stages. A questionnaire derived from this model was sent to human resource managers of different companies and their occupational health physicians. The internal consistency was estimated with the Cronbach's alpha. The results showed a large number of barriers for modified work. According to 52% of the company management and 54% of the occupational health physicians evident barriers were found due to lack of knowledge on modified work and negative attitudes of the employees. Both companies and physicians reported a barrier in the possibilities to change the work tasks (45-54%) or the organization of the work (45-38%). About 62% of the companies reported barriers due to a mismatch between the education of the sick worker and the specific requirements of modified work. Despite the assumed positive effects of modified work, the implementation process is hampered by a large number of barriers. A maximum effort from all parties involved is required for a successful rehabilitation process.     

The Effect of a Job Placement and Support Program for Workers with Musculoskeletal Injuries: A Randomized Control Trial (RCT) Study

Background This is a randomized clinical trial (RCT) to investigate the efficacy of a job placement and support program designed for workers with musculoskeletal injuries and having difficulties in resuming the work role. The program was planned to help injured workers to successfully return to work (RTW) by overcoming the difficulties and problems during the process of job seeking and sustaining a job using a case management approach. Methodology A total of 66 injured workers were recruited and randomly assigned into the job placement and support group (PS group) or the self-placement group (SP group). A three-week job placement and support program was given to subjects in the PS group while subjects in the control group (SP group) were only given advice on job placement at a workers' health center. The PS program was comprised of an individual interview, vocational counseling, job preparation training, and assisted placement using the case management approach. The Chinese Lam Assessment of Stages of Employment Readiness (C-LASER), the Chinese State Trait and Anxiety Inventory (C-STAI), and the SF-36 were the outcome measures for the two groups before and after the training program to observe the changes in subjects' work readiness status, emotional status and their health related quality of life pre- and post-training program. The rate of return to work was measured for both groups of subjects after the training program. Results The results indicated that the rate of success in RTW (73%) was significantly higher in the job placement (PS) group than that of the self-placement (SP) group (51.6%) with P < 0.05. Significant differences were also found in C-STAI (P < 0.05), SF-36 (P < 0.05) and C-LASER scores on action (P < 0.05) between the two groups. Conclusion The job placement (PS) program appeared to have enhanced the employability of injured workers. Workers who participated in the program also showed higher levels of work readiness and emotional status in coping with their work injuries.     

Streamlined Prevention and Early Intervention for Pediatric Anxiety Disorders: A Randomized Controlled Trial

Prevention Science - There is a need to optimize the fit between psychosocial interventions with known efficacy and the demands of real-word service delivery settings. However, adaptation of...     

A Randomized Controlled Trial of a Community-Based Nutrition Education Program for Low-Income Parents

ObjectiveAssess effectiveness of the Expanded Food and Nutrition Education Program on nutrition behaviors post-education and longitudinally.DesignSwitching replications randomized experimental design. Participants randomly assigned to immediate education (IE) or delayed education (DE). Participants in IE received intervention the first 8 weeks, and those in DE the second 8 weeks, with no intervention during alternate periods. Data were collected in 3 repeated measures.ParticipantsParents (n = 168 randomized; n = 134 completed) of children in 2 Head Start and 6 low-income schools.InterventionEight weekly workshops, based on Eating Right is Basic-Enhanced adapted to incorporate dialogue approach with experiential learning.Main Outcome MeasuresTen-item self-reported behavior checklist on nutrition, food resource management, food safety, and food security; responses on a 5-point scale reporting frequency of behavior.AnalysisChi-square, analysis of variance, and multiple regression.ResultsGroups were demographically similar. Both groups reported improved behaviors pre- to post-education (P < .05). There was no significant difference between groups at Time 1 (T1) or DE control period (T1 vs T2). Changed IE behavior was retained T2 to T3. A multiple regression model of overall change, controlling for T1 score and educator, showed significant improvement (n = 134, β = 5.72, P < .001).Conclusions and ImplicationsPositive outcomes were supported by this experimental study in a usual program context, with reported behavior changes retained at least 2 months.     

Return-to-Work Self-Efficacy: Development and Validation of a Scale in Claimants with Musculoskeletal Disorders

Introduction We report on the development and validation of a 10-item scale assessing self-efficacy within the return-to-work context, the Return-to-Work Self-Efficacy (RTWSE) scale. Methods Lost-time claimants completed a telephone survey 1 month (n = 632) and 6 months (n = 446) after a work-related musculoskeletal injury. Exploratory (Varimax and Promax rotation) and confirmatory factor analyses of self-efficacy items were conducted with two separate subsamples at both time points. Construct validity was examined by comparing scale measurements and theoretically derived constructs, and the phase specificity of RTWSE was studied by examining changes in strength of relationships between the RTWSE Subscales and the other constructs at both time measures. Results Factor analyses supported three underlying factors: (1) Obtaining help from supervisor, (2) Coping with pain (3) Obtaining help from co-workers. Internal consistency (alpha) for the three subscales ranged from 0.66 to 0.93. The total variance explained was 68% at 1-month follow-up and 76% at 6-month follow-up. Confirmatory factor analyses had satisfactory fit indices to confirm the initial model. With regard to construct validity: relationships of RTWSE with depressive symptoms, fear-avoidance, pain, and general health, were generally in the hypothesized direction. However, the hypothesis that less advanced stages of change on the Readiness for RTW scale would be associated with lower RTWSE could not be completely confirmed: on all RTWSE subscales, RTWSE decreased significantly for a subset of participants who started working again. Moreover, only Pain RTWSE was significantly associated with RTW status and duration of work disability. With regard to the phase specificity, the strength of association between RTWSE and other constructs was stronger at 6 months post-injury compared to 1 month post-injury. Conclusions A final 10-item version of the RTWSE has adequate internal consistency and validity to assess the confidence of injured workers to obtain help from supervisor and co-workers and to cope with pain. With regard to phase specificity, stronger associations between RTWSE and other constructs at 6-month follow-up suggest that the association between these psychological constructs consolidates over time after the disruptive event of the injury.     

Evaluation of a Parent Education Program Emphasizing Responsive Parenting and Mindfulness: An Inclusive Randomized Controlled Trial

Child & Youth Care Forum - Recent studies indicate that parent education programs that include content to enhance parents’ mental states may prove efficacious in improving parenting...     

The #Tamojunto Drug Prevention Program in Brazilian Schools: a Randomized Controlled Trial

A randomized controlled trial was conducted in 2014 with 7th and 8th grade students from 72 public schools in 6 Brazilian cities. This trial aimed to evaluate the effects of an adapted European school-based drug prevention program Unplugged, called #Tamojunto in Brazil, which was implemented by the Ministry of Health as part of public policy. The experimental group (n = 3340) attended 12 classes in the #Tamojunto program, and the control group (n = 3318) did not receive a school prevention program. Baseline data were collected prior to program implementation, and follow-up data were collected 9 months later, allowing a matching of 4213 adolescents in both waves. The substances examined were alcohol, tobacco, marijuana, inhalants, cocaine, and crack. Multilevel analyses were used to evaluate the changes in consumption of each drug between time points and between groups. The intervention and control groups had similar baseline characteristics. The mean age of the adolescents was 12.5 ± 0.7 years, and 51.3% were female. The program seemed to increase alcohol use initiation (first alcohol use); students in the experimental group had a 30% increased risk of initiating alcohol use during the 9-month follow-up (aRR = 1.30, 95% confidence interval (95%CI) 1.13–1.49, p < 0.001) compared to the control group. The opposite was found for the first inhalant use: the risk of using inhalants for the first time after baseline was lower in the experimental group (aRR = 0.78, 95%CI 0.63–0.96, p = 0.021) than the control group. The results of the #Tamojunto program suggest that the content and lessons regarding alcohol may enhance curiosity about its use among adolescents. We suggest a re-evaluation of the expansion of the #Tamojunto program in schools while analyzing why the program’s effects were inconsistent with those of previous European studies.     

Annals Journal Club: Vitamin D Supplementation for Nonspecific Musculoskeletal Pain in Non-Western Immigrants: A Randomized Controlled Trial

PURPOSE

Many non-Western immigrants report musculoskeletal pains that are hard to treat. We studied the effect of high-dose vitamin D₃ on nonspecific persistent musculoskeletal complaints in vitamin D–deficient non-Western immigrants and assessed correlation of pain patterns with benefit.

METHODS

We conducted a semi-crossover randomized controlled trial between February 2008 and February 2010 in primary care in 84 non-Western immigrants visiting their general practitioner for nonspecific musculoskeletal pain. At baseline, patients were randomized to placebo or vitamin D (150,000 IU vitamin D₃ orally); at week 6, patients in the original vitamin D group were randomized a second time to receive vitamin D (again) or to switch to placebo, whereas patients in the original placebo group were all switched to vitamin D. The main outcome was self-assessed change in pain after the first 6 weeks.

RESULTS

Patients in the vitamin D group were significantly more likely than their counterparts in the placebo group to report pain relief 6 weeks after treatment (34.9% vs 19.5%, P = .04). The former were also more likely to report an improved ability to walk stairs (21.0% vs 8.4%, P = .008). Pain pattern was not correlated with the success of treatment. In a nonsignificant trend, patients receiving vitamin D over 12 weeks were more likely to have an improvement than patients receiving it over 6 weeks.

CONCLUSIONS

There is a small positive effect 6 weeks after high-dose vitamin D₃ on persistent nonspecific musculoskeletal pain. Future research should focus on longer follow-up, higher supplementation doses, and mental health.Key words: vitamin D, vitamin deficiency, immigrants, musculoskeletal pain, pain, supplementation, primary care, practice-based research     

Helping Youth Immediately Following War Exposure: A Randomized Controlled Trial of a School-Based Intervention Program

This study evaluates a school-based primary prevention intervention designed to promote adolescents’ coping in the immediate aftermath of war exposure in Operation Cast Lead. Participants were 179 adolescents from two demographically similar schools in Ashkelon in south Israel. The intervention incorporated two previously proven resilience factors—mobilization of support and self-efficacy. In a repeated measures design, the study assessed pre- to post-test changes in intervention (n = 94) and control (n = 85) conditions among adolescents exposed to high or low political life events (PLE). Findings showed significant pre-test differences in self-efficacy and psychological symptoms between participants with low and high PLE. For both PLE groups, the intervention strengthened support mobilization and self-efficacy and reduced psychological distress and emotional symptoms. Findings reinforce the importance of offering appropriate evidence-based interventions for school staff to restore security and well-being to adolescents in a crisis context immediately following war. Despite the apparent return to a school routine after war, school staff should be aware of the risk to youth for development of psychological symptoms and disorders, and the need for preventative intervention.