Building a Common Language to Facilitate Discussion Among Stakeholders in Work Disability: A Consensus Group Approach

Journal of Occupational Rehabilitation - Work disability stakeholders may not share the same understanding and solutions among themselves or with researchers, causing misunderstandings and...     

Implementing the Work Disability Prevention Paradigm Among Therapists in Hong Kong: Facilitators and Barriers

Introduction This is a discussion paper to examine the issues surrounding management of work-related injuries by physiotherapists and occupational therapists in Hong Kong. Therapists working in public hospitals are faced with managing injured workers with limited resources and this frequently results in suboptimal outcomes. Methods In this paper, five experienced therapists critically reviewed the current practices in the physiotherapy and occupational therapy professions in Hong Kong, with regard to managing patients with work injuries. In many hospitals, therapists still practice with a disease-based model focusing on symptom relief and restoration of general physical function. We collated information about current programs initiated by physiotherapists and occupational therapists to provide more strategic intervention strategies for early screening of high-risk patients and adaptive biopsychosocial interventions targeting return-to-work outcomes. Clinical and system-level barriers and facilitators of a major paradigm shift towards work disability prevention are discussed. Conclusion Physiotherapists and occupational therapists need to develop more strategic collaborations and actively voice out the need for major systematic changes within the local healthcare system, in order to provide a more effective management approach in line with the concept of Work Disability Prevention.     

Training the Next Generation of Researchers in Work Disability Prevention: The Canadian Work Disability Prevention CIHR Strategic Training Program

INTRODUCTION: There is a need to create, disseminate, and implement new knowledge in the work disability prevention (WDP) field. Training programs attracting high-quality applicants and taking into account the complexity of this emerging field are urgently needed. METHODS: An advanced training program, funded by the Canadian Institutes of Health Research (CIHR), was developed by 24 mentors affiliated with nine different universities. The main objective of this program is to develop transdisciplinary knowledge, skills, and attitudes regarding WDP. This program has been developed for PhD students or post-doctoral fellows already registered full-time in a Canadian or recognized foreign university whose main interest is WDP, regardless of the health problem. RESULTS: Since its implementation, the program received two successive cohorts of 10 students. They were registered in 13 universities in five countries and trained in nine different disciplines. CONCLUSIONS AND SIGNIFICANCES: Appropriate WDP research may save major societal costs attributable to prolonged work disability. The proposed training program will contribute to developing tomorrow's research workforce.     

Inability to Work Fulltime,Prevalence and Associated Factors Among Applicants for Work Disability Benefit

Journal of Occupational Rehabilitation - Purpose Inability to work fulltime is an important outcome in the assessment of workers applying for a disability benefit. However, limited knowledge is...     

Cross-Jurisdiction Comparative Research in Work Disability Prevention: Introduction to the Special Series

Journal of Occupational Rehabilitation - The systems that societies construct to support work disability prevention can have powerful effects on both the experiences of people with work disability...     

Evaluation of a Workplace Disability Prevention Intervention in Canada: Examining Differing Perceptions of Stakeholders

Introduction Workplace disability prevention is important, but stakeholders can differ in their appreciation of such interventions. We present a responsive evaluation of a workplace disability prevention intervention in a Canadian healthcare organization. Three groups of stakeholders were included: designers of the intervention, deliverers, and workers. The aim was to examine the appreciation of this intervention by analyzing the discrepancies with respect to what these various stakeholders see as the causes of work disability, what the intervention should aim at to address this problem, and to what extent the intervention works in practice. Methods A qualitative research method was used, including data-triangulation: (a) documentary materials; (b) semi-structured interviews with the deliverers and workers (n = 14); (c) participatory observations of group meetings (n = 6); (d) member-checking meetings (n = 3); (e) focus-group meetings (n = 2). A grounded theory approach, including some ethnographic methodology, was used for the data-analysis. Results Stakeholders’ perceptions of causes for work disability differ, as do preferred strategies for prevention. Designers proposed work-directed measures to change the workplace and work organizations, and individual-directed measures to change workers’ behaviour. Deliverers targeted individual-directed measures, however, workers were mostly seeking work-directed measures. To assess how the intervention was working, designers sought a wide range of outcome measures. Deliverers focused on measurable outcomes targeted at reducing work time-loss. Workers perceived that this intervention offered short-term benefits yet fell short in ensuring sustainable return-to-work. Conclusion This study provides understanding of where discrepancies between stakeholders’ perceptions about interventions come from. Our findings have implications for workplace disability prevention intervention development, implementation and evaluation criteria.     

Measuring the Impact of Organizational Behaviors on Work Disability Prevention and Management

Increased rates of work disability and its associated costs have prompted businesses to develop innovative approaches to managing the health and productivity of the work force. The paper 1) provides practitioners with the results of research that demonstrates the importance of employer organizational factors in preventing and resolving work disability, and 2) provides researchers with measures that can efficiently assess organizational factors and advance clinical research by incorporating contextual factors involved in occupational rehabilitation. Data from a series of studies in Michigan are reviewed and it is concluded that employer reports of organizational policies and practices (OPPs) are important in reducing the number of work-related disabilities and their consequences for the employee and for the company. We test the hypothesis that employee reports of OPPs are reliable and valid. To test the reliability and validity of an employee version of the same instrument, we used data from a prospective community-based study of 198 workers with carpal tunnel syndrome. Four OPPs were identified as important: people-oriented culture ( = .88), safety climate ( = .88), disability management policies and practices ( = .88), and ergonomic practices ( = .88). These four scales were shown to have strong test–retest reliabilities and predictive validity. It was concluded that the conceptual model guiding the research in Michigan was supported with research from another State, Maine, using an individual-level measure of OPPs.     

Prevention of Work Disability Due to Musculoskeletal Disorders: The Challenge of Implementing Evidence

Background: The process of returning disabled workers to work presents numerous challenges. In spite of the growing evidence regarding work disability prevention, little uptake of this evidence has been observed. One reason for limited dissemination of evidence is the complexity of the problem, as it is subject to multiple legal, administrative, social, political, and cultural challenges. Purpose and methods: A literature review and collection of experts' opinion is presented, on the current evidence for work disability prevention, and barriers to evidence implementation. Recommendations are presented for enhancing implementation of research results. Conclusion: The current evidence regarding work disability prevention shows that some clinical interventions (advice to return to modified work and graded activity programs) and some non-clinical interventions (at a service and policy/community level but not at a practice level) are effective in reducing work absenteeism. Implementation of evidence in work disability is a major challenge because intervention recommendations are often imprecise and not yet practical for immediate use, many barriers exist, and many stakeholders are involved. Future studies should involve all relevant stakeholders and aim at developing new strategies that are effective, efficient, and have a potential for successful implementation. These studies should be based upon a clearer conceptualization of the broader context and inter-relationships that determine return to work outcomes.     

Using Administrative Data to Assess the Risk of Permanent Work Disability: A Cohort Study

Journal of Occupational Rehabilitation - Purpose Unmet rehabilitation needs are common. We therefore developed a risk score using administrative data to assess the risk of permanent work...     

Self-Perceptions on the Impact of Diabetes Among Working Adults: Insights into Disability Prevention

Effective diabetes self-management requires persons to be active participants in their care to prevent poor function and maintain independence and employment. Persons' perceptions and understanding of the potential impact of the disease could influence their self-management practices and success. This study explores perceptions on the impact of diabetes on future independence and employment. Findings indicate that 34% of participants believed diabetes would affect their employment, and 57% believed it would impact their independence. Logistic regression analyses showed that participants who believed that diabetes would impact employment were more likely to be younger, Native Hawaiian, and in poor physical health and to have been diagnosed with diabetes for a longer period of time. Those concerned with future independence were more likely to be younger and in poor physical and mental health. Understanding the associations between individual characteristics and perceived future abilities may enable healthcare professionals to tailor health education, promotion, and maintenance interventions to the needs of specific sub-populations of diabetics.     

Secondary Prevention of Work Disability: Community-Based Psychosocial Intervention for Musculoskeletal Disorders

INTRODUCTION: One objective of the present research was to examine the degree to which psychological risk factors could be reduced through participation in a community-based psychosocial intervention for work-related musculoskeletal disorders. A second objective was to examine whether psychosocial risk reduction had an effect on the probability of return to work. METHODS: Participants were 215 Workers Compensation Board claimants with work-related musculoskeletal disorders who had been absent from work for an average of approximately 7 months (M = 28.8 weeks, range = 4-100 weeks) and were referred to a community-based multidisciplinary secondary prevention program in Nova Scotia, Canada. RESULTS: In the current sample, 63.7% of participants returned to work within 4 weeks of treatment termination. The percentage reductions in targeted risk factors from pretreatment to posttreatment were as follows: catastrophizing (32%), depression (26%), fear of movement/re-injury (11%), and perceived disability (26%). Logistic regression indicated that elevated pretreatment scores on fear of movement and re-injury (OR = 0.58, 95% CI = 0.35-0.95) and pain severity (OR = 0.64, 95% CI = 0.43-0.96) were associated with a lower probability of return to work. A second logistic regression addressing the relation between risk factor reduction and return to work revealed that only reductions in pain catastrophizing (OR = 0.17, 95% CI = 0.07-0.46) were significant predictors of return to work. CONCLUSIONS: The results of the present study provide further evidence that risk factor reduction can impact positively on short term return to work outcomes. SIGNIFICANCE: Outcomes of rehabilitation programs for work disability might be improved by incorporating interventions that specifically target catastrophic thinking. Community-based models of psychosocial intervention might represent a viable approach to the management of work disability associated with musculoskeletal disorders.     

在落实辐射防护三原则中医院预防科的职责

目的 探讨预防科如何贯彻和落实辐射防护三原则。方法 就我们在实际工作中的做法与三原则联系起来。结果 贯彻和落实辐射防护三原则是预防科的责任。结论 限制照射剂量、预防事故和减轻事故后果,预防科责无旁贷。     

农村留守居民艾滋病防治知识的宣传效果评价

目的 评价对农村留守居民进行艾滋病防治知识宣传的效果,为开展有针对性的宣传提供依据.方法 采用分阶段抽样,抽取四川省4县的农村留守居民,统一对各县(市、区)的调查骨干(由疾病预防控制中心专业人员)进行培训后,调查人员深入农村居民家中,进行问卷调查.在开展艾滋病防治知识宣传的1～2月后,再对同一对象进行调查.结果 基线调查2 096人,宣传后共调查1 974人,艾滋病防治知识宣传前后农村留守居民的艾滋病知晓比例分别为86.88％和99.85％,艾滋病危害知晓率分别为77.4％和97.4％,艾滋病防治知识总知晓率分别为40.5％和77.6％,艾滋病防治知识分题知晓率和艾滋病检测信息知晓率分别32.6％和86.7％),向在外亲人宣传艾滋病比例分别为24.1％和79.9％,其差异均有统计学意义(P＜0.01).结论 对农村留守居民艾滋病防治知识的宣传效果较显著,今后开展农村艾滋病健康教育活动要有针对性,要进一步增加农村留守居民对艾滋病危害及各种防治知识的全面了解,并能主动向在外务工家人宣传艾滋病,形成稳定、高效的农村艾滋病健康教育宣传体系.     

Prevention and Management of Work Disability in Asia Pacific: Challenges and Opportunities

Introduction: The economic growth in Asia Pacific brings with it challenges and opportunities in many areas of work and health. As economies grow and work demands increase so do accidents, injures and work disability. Methods: Burns, chemical exposures, and construction related injuries are often catastrophic in severity and lead to work disability, major acute medical and subsequent rehabilitation efforts. In addition to these acute injuries, musculoskeletal and chronic illnesses are also sources of work disability. Results: Industrial injuries and health problems are often explained and managed based on the classic unidimensional hazard prevention model. In contrast, work disability is a multi-factorial problem and requires more complex conceptualizations than an exposure outcome model. The economic impact of disability, limitations of the widely used impairment based disability determination method, lack of adherence to wide scale implementation of evidence based clinical approaches, the need for meaningful stakeholder involvement and the potential of a multivariable view of work disability, in all aspects of work disability prevention, management and policy are discussed in the context of Asia Pacific economic growth. Conclusions: With ideal alignment of diverse goals and incentives along with consideration of past efforts in disability prevention and management, new models, processes and policies can be created as commerce in these countries continues to grow.     

Dissonance-based Interventions for the Prevention of Eating Disorders: Using Persuasion Principles to Promote Health

The limited efficacy of prior eating disorder (ED) prevention programs led to the development of dissonance-based interventions (DBIs) that utilize dissonance-based persuasion principles from social psychology. Although DBIs have been used to change other attitudes and behaviors, only recently have they been applied to ED prevention. This article reviews the theoretical rationale and empirical support for this type of prevention program. Relative to assessment-only controls, DBIs have produced greater reductions in ED risk factors, ED symptoms, future risk for onset of threshold or subthreshold EDs, future risk for obesity onset, and mental health utilization, with some effects persisting through 3-year follow-up. DBIs have also produced significantly stronger effects than alternative interventions for many of these outcomes, though these effects typically fade more quickly. A meta-analysis indicated that the average effects for DBIs were significantly stronger than those for non-DBI ED prevention programs that have been evaluated. DBIs have produced effects when delivered to high-risk samples and unselected samples, as well as in efficacy and effectiveness trials conducted by six independent labs, suggesting that the effects are robust and that DBIs should be considered for the prevention of other problems, such as smoking, substance abuse, HIV, and diabetes care.     

Improving Assessment of Work Related Mental Health Function Using the Work Disability Functional Assessment Battery (WD-FAB)

Purpose To improve the mental health component of the Work Disability Functional Assessment Battery (WD-FAB), developed for the US Social Security Administration’s (SSA) disability determination process. Specifically our goal was to expand the WD-FAB scales of mood & emotions, resilience, social interactions, and behavioral control to improve the depth and breadth of the current scales and expand the content coverage to include aspects of cognition & communication function. Methods Data were collected from a random, stratified sample of 1695 claimants applying for the SSA work disability benefits, and a general population sample of 2025 working age adults. 169 new items were developed to replenish the WD-FAB scales and analyzed using factor analysis and item response theory (IRT) analysis to construct unidimensional scales. We conducted computer adaptive test (CAT) simulations to examine the psychometric properties of the WD-FAB. Results Analyses supported the inclusion of four mental health subdomains: Cognition & Communication (68 items), Self-Regulation (34 items), Resilience & Sociability (29 items) and Mood & Emotions (34 items). All scales yielded acceptable psychometric properties. Conclusions IRT methods were effective in expanding the WD-FAB to assess mental health function. The WD-FAB has the potential to enhance work disability assessment both within the context of the SSA disability programs as well as other clinical and vocational rehabilitation settings.     

通江县农村居民艾滋病防治入户宣传效果评价

目的 分析农村居民艾滋病知识入户宣传效果,为制定艾滋病防治宣传策略提供依据.方法 对通江县农村居民开展艾滋病知识面对面宣传,并发放宣传资料.在宣传前后,对农村居民进行抽样调查.结果 接受入户宣传的农村居民共56 252户,154 391人.入户宣传后,农村居民听说过艾滋病的比例、艾滋病知识知晓率、免费检测机构的知晓率和对外出打工的亲人宣传率分别由86.50％、28.00％、15.75％和13.25％上升到99.75％、62.25％、71.25％和61.00％,差异有统计学意义(x2分别为54.84、94.75、250.66和195.36,P均＜0.01).结论 入户宣传对提高农村居民艾滋病相关知识效果显著.     

Knowledge and Willingness to Provide Research Biospecimens Among Foreign-Born Latinos Using Safety-Net Clinics

Latinos tend to be under-represented in cancer research and in bio-repositories. We conducted a Spanish-language, interviewer-administered cross-sectional survey of 331 foreign-born Latinos from Central and South America attending safety-net clinics in order to describe factors associated with knowledge about and intention to provide bio-specimens for research purposes. We used logistic regression and multiple imputation methods to evaluate associations between socio-cultural measures, medical trust, demographics, as well as knowledge about and intentions to provide bio-specimens. Almost half (47 %) of respondents knew what bio-specimens were, and 67 % said that they would provide a specimen after being given information about what this involved; this increased to 72 % among those with prior knowledge. Controlling for covariates, Latinos with a high school education and above were more likely to know what a bio-specimen was and to say they would provide bio-specimens than were those with lower levels of education [adjusted OR (aOR) 2.85, 95 % CI 1.37–5.96; and 3.49, 95 % CI 1.41–8.63, p ≤ 0.01, respectively]. Those with greater social integration were more likely to know about bio-specimens than those with less integration (aOR 2.54, 95 % CI 1.45–4.46, p = 0.001). Higher endorsement of family values was independently associated with intent to give bio-specimens (aOR 1.11, 95 % CI 1.02–1.20, p = 0.017 per five-point increase in “familism” score). Medical mistrust was not related to intentions to provide specimens. Our results suggest that interventions to increase willingness to provide bio-specimens could leverage trusted clinics or social networks and should consider individuals’ education and socio-cultural perspectives.     

公众脑卒中防治知识水平调查及健康教育对策

目的调查了解东莞地区公众对脑卒中防治知识的认知状况 ,提出健康教育对策。方法 2 0 0 1年 3～ 6月以随机分层原则多次分别按行业向广东省东莞市城区及郊区 17岁以上居住人口发放问卷 ,共 2 5 0 0份。问卷分 5部分 :脑卒中的一般知识、预防知识、识别知识、处理知识及获取脑卒中防治知识途径。全卷共 35个正式问题和 5个分层项目问题。结果回收有效问卷 2 32 0份。全卷问题回答正确率平均为 4 9.8% ,以识别知识一项最低 ;各类知识水平男性均优于女性 ,中老年组优于青年组 ,职业中各类公务员、自由职业者、工人、农民、学生依次递减 ;文化程度中高等、中等、低等亦依次递减 ;患过脑卒中者优于未患者 ;总分 <6 0 %占 4 6 .2 % ,以识别知识和处理知识最差。结论目前东莞地区公众脑卒中防治知识水平较低 ,尤其是识别知识和处理知识。提示当地公众脑卒中健康教育亟需广泛开展。据情提出适当的健康教育对策     

Socioeconomic Inequality in Disability Among Adults: A Multicountry Study Using the World Health Survey

Objectives. We compared national prevalence and wealth-related inequality in disability across a large number of countries from all income groups.Methods. Data on 218 737 respondents participating in the World Health Survey 2002–2004 were analyzed. A composite disability score (0–100) identified respondents who experienced significant disability in physical, mental, and social functioning irrespective of their underlying health condition. Disabled persons had disability composite scores above 40. Wealth was evaluated using an index of economic status in households based on ownership of selected assets. Socioeconomic inequalities were measured using the slope index of inequality and the relative index of inequality.Results. Median age-standardized disability prevalence was higher in the low- and lower middle-income countries. In all the study countries, disability was more prevalent in the poorest than in the richest wealth quintiles. Pro-rich inequality was statistically significant in 43 of 49 countries, with disability prevalence higher among populations with lower wealth. Median relative inequality was higher in the high- and upper middle-income countries.Conclusions. Integrating equity components into the monitoring of disability trends would help ensure that interventions reach and benefit populations with greatest need.The World Health Organization (WHO) estimates that there are more than 1 billion people in the world living with some form of disability, of whom nearly 200 million have considerable difficulties in functioning.1 Almost everyone will experience disability at some time in their lives. Those who live longer will endure increasing difficulties in everyday physical and mental functioning.1 The United Nations Convention on the Rights of Persons with Disabilities2 identified disability as an international priority area for concerted action.Reported disability prevalence rates are lower in low- and lower middle-income countries than in upper middle- and high-income countries.1 However, this may reflect different approaches to measuring and defining disability within and between individual countries and also different age distributions in the countries.3–5 Surveys conducted in developing countries tend to focus on impairments. In developed countries, the focus is often on broader areas of participation and the need for services.1 There is clearly a need to improve comparability between countries and studies, but in order to do this it is necessary to achieve consistency in definition and measurement.The term disability is often used to refer to difficulties undertaking everyday tasks. Specific functional characterizations related to the activities of daily living are beneficial for many purposes (e.g., assessing eligibility for specific benefits or interventions). However, as a construct, disability spans many health conditions encompassing capacity limitations in physical, mental, and social functioning.6 Disability is increasingly becoming a major public health issue, but before effective policy responses can be formulated, it is necessary to achieve clarification and agreement on definition and measurement.7Consistent with the WHO and World Bank World Report on Disability,1 we applied the International Classification of Functioning, Disability and Health (ICF)8 framework. Disability included limitations in functioning that result from interactions between the individual’s health condition (e.g., diseases, injuries, and disorders) and environmental factors. We focused on measuring decrements in functioning that could be experienced by individuals in their body functions or capacities to carry out a set of activities not necessarily linked to their underlying health condition.9Many authors have referred to specific domains of disability, aspects of functional status (e.g., mobility, blindness, or deafness), or specific population subgroups (e.g., institutionalized populations or older age groups) in the disability literature. In this study, disability refers to any decrement in functioning in a chosen set of domains, irrespective of health condition. Individuals with arthritis, heart disease, diabetes, or depression could experience decrements in functioning, as well as those who are deaf, blind, or paralyzed.Persons with disability experience worse socioeconomic outcomes than persons without disability. Disability correlates with disadvantage, but causation is multidirectional.1 Disability can lead to socioeconomic disadvantage and vice versa. There is country-level evidence of correlation between disability and various indicators of socioeconomic status (SES) such as education, income, and housing.10–12 Given the rapid aging of the world’s populations, extending knowledge of the social and economic determinants of disability is timely. Developing policies and interventions to target the determinants of these inequalities requires urgent policy attention at national and international levels. Building upon the World Report on Disability,1 we examined how disability prevalence is distributed within country-specific adult populations in accordance with a standardized wealth index of SES.Most previous studies were conducted in higher income countries.13–16 This work advances international understanding of socioeconomic inequality in disability because the analysis covered household survey data collected from a large number of countries at varying income levels.Although the World Report on Disability1 used the ICF definition, the Report did not detail how disability prevalence was distributed within country-specific adult populations in accordance with SES. We aimed to measure and compare national prevalence and wealth-related inequality in disability among adults, aged 18 years and older, across a large number of countries from all income groups using a comparable data set and measurement method.