Qualitative Evidence from Studies of Interventions Aimed at Return to Work and Staying at Work for Persons with Chronic Musculoskeletal Pain

Chronic musculoskeletal pain is a significant burden for employees, employers, and society. However, more knowledge is needed about which interventions reduce sick leave. Interventions were defined as the act or an instance of intervening, provided by different stakeholders. This review synthesizes the experiences of patients, employers, and health professionals concerning the interventions that influence returning to work and staying at work for persons with chronic musculoskeletal pain. A literature search was performed using several combinations of key terms. Overall, 18 qualitative studies published between 2002 and 2018 were included. Qualitative analysis assessed how much confidence could be placed in each review finding. Moderate evidence was found for factors improving the return to work process such as collaboration between stakeholders, including the persons with chronic musculoskeletal pain and support from all involved actors in the process. Moderate evidence was found for self-management strategies and workplace adjustments needed to facilitate more persons to returning to work and staying at work despite pain. This review provides stakeholders, employers, and health professionals’ information that could be used to develop and implement interventions to increase the possibilities for persons with chronic musculoskeletal pain returning to work or staying at work

A logic model for a self-management program designed to help workers with persistent and disabling low back pain stay at work

BACKGROUND: Workers with persistent disabling low back pain (LBP) often encounter difficulty staying at work. Self-management (SM) programs can offer interesting avenues to help workers stay at work. OBJECTIVE: To establish the plausibility of a logic model operationalizing a SM program designed to help workers with persistent disabling LBP stay at work. METHODS: We used a qualitative design. A preliminary version of the logic model was developed based on the literature and McLaughlin et al.’s framework for logic models. Clinicians in work rehabilitation completed an online survey on the plausibility of the logic model and proposed modifications, which were discussed in a focus group. Thematic analyses were performed. RESULTS: Participants (n = 11) found the model plausible, contingent upon a few modifications. They raised the importance of making more explicit the margin of maneuver or “job leeway” for a worker who is trying to stay at work and suggested emphasizing a capability approach. Enhancing the workers’ perceived self-efficacy and communication skills were deemed essential tasks of the model. CONCLUSION: A plausible logic model for a SM program designed for workers with disabling LBP stay at work was developed. The next step will be to assess its acceptability with potential users.

Prognostic Factors for Staying at Work for Partially Sick-Listed Workers with Subjective Health Complaints: A Prospective Cohort Study.

Examination of prognostic factors for staying at work for long-term sick-listed workers with subjective health complaints (SHC) who partially work in a paid job, and to evaluate whether these factors are comparable with those of workers with other disorders. We used data of 86 partially sick-listed workers with SHC (57 females, 29 males, mean age 47.1 years) and 433 with other disorders (227 females, 206 males, mean age 50.9 years), from an existing prospective cohort study consisting of 2593 workers aged 18–65 years and registered as sick-listed with different health complaints or disorders for at least 84 weeks in the database of the Dutch Social Security Institute. We performed univariable logistic regression analyses (p ≤ 0.157) for all independent variables with the dependent variable staying at work for the workers with SHC. We then performed multivariable logistic regression analyses with forward selection (p ≤ 0.157) and combined the remaining factors in a final, multivariable model (p ≤ 0.05), which we also used for logistic regression analysis in the workers with other disorders. The following factors were significant prognostic factors for staying at work for workers with SHC: full work disability benefits (odds ratio (OR) 0.07, 95% confidence interval (95% CI) 0.01–0.64), good mental health (OR 1.08, 95% CI 1.02–1.14), positive expectations for staying at work (OR 6.49, 95% CI 2.00–21.09), previous absenteeism for the same health complaint (OR 0.31, 95% CI 0.10–0.96) and good coping strategies (OR 1.13, 95% CI 1.04–1.23). For workers with other disorders, full work disability benefits, good mental health and positive expectations for staying at work were also prognostic factors for staying at work. Individual and policy factors seem to be important for staying at work of sick-listed workers with SHC and those with other disorders alike, but several biopsychosocial factors are particularly important for workers with SHC.

Predicting the evolution of neck pain episodes in routine clinical practice

Background The objective of this study was to develop models for predicting the evolution of a neck pain (NP) episode. Methods Three thousand two hundred twenty-five acute and chronic patients seeking care for NP, were recruited consecutively in 47 health care centers. Data on 37 variables were gathered, including gender, age, employment status, duration of pain, intensity of NP and pain referred down to the arm (AP), disability, history of neck surgery, diagnostic procedures undertaken, imaging findings, clinical diagnosis, and treatments used. Three separate multivariable logistic regression models were developed for predicting a clinically relevant improvement in NP, AP and disability at 3 months. Results Three thousand one (93.5%%) patients attended follow-up. For all the models calibration was good. The area under the ROC curve was ≥0.717 for pain and 0.664 for disability. Factors associated with a better prognosis were: a) For all the outcomes: pain being acute (vs. chronic) and having received neuro-reflexotherapy. b) For NP: nonspecific pain (vs. pain caused by disc herniation or spinal stenosis), no signs of disc degeneration on imaging, staying at work, and being female. c) For AP: nonspecific NP and no signs of disc degeneration on imaging. d) For disability: staying at work and no signs of facet joint degeneration on imaging. Conclusions A prospective registry can be used for developing valid predictive models to quantify the odds that a given patient with NP will experience a clinically relevant improvement.

Illness narratives in the workplace

Why is there so little research on illness narratives in the workplace albeit the significant role of labour in society, the considerable increase of illnesses at work and high rates of sick-leave and early retirement? The importance of reconstructing illness narratives in the workplace for prevention, timely support, coping and staying at work is emphasized. It will further be shown how illness narratives are embedded in narrations on working conditions and return to work experiences. The mixed-method study focused on return to work trajectories of participants of vocational retraining. On this basis, this chapter discusses strategies of successful and failed arrangements in the workplace.

COMMONLY UTILIZED PHYSIOTHERAPY TREATMENT APPROACHES IN THE MANAGEMENT OF SUB-ACUTE SCIATICA: A PILOT STUDY USING THE DELPHI PROCESS

There is limited evidence for the utilization of physiotherapy in the management of sub-acute sciatica. The aim of this pilot study was to explore the Delphi method to attempt to reach consensus on physiotherapeutic approaches to the management of sub-acute sciatica amongst a panel of clinicians experienced in this field. The panel included senior physiotherapists (n = 10) working within an outpatient setting at a specialized orthopedic trust. Iteration 1 consisted of the open-ended question "List the treatment approaches/techniques/modalities you employ when treating a patient with sub-acute sciatica and provide justifications". Themes reaching 70% consensus progressed to the second iteration which followed up with the question "Please indicate how frequently you would employ the following treatments in the management of sub-acute sciatica" using a 5-point likert scale ranging from 1 (never) to 5 (always). The mean score was calculated for each treatment and those themes achieving a mean of 3.5 or greater progressed to iteration 3 "Please rank in order of preference which of the following treatments you would employ in the treatment of sub-acute sciatica". The response rate at iteration 3 was 60%. This pilot study achieved consensus on five treatment approaches to be employed in the management of sub-acute sciatica. In order of preference these treatments were advice (regarding staying active, staying at work, reassurance, analgesia), advice (time scale of recovery, natural course of sciatica, self-limiting condition, hurt does not equal harm), lumbar joint mobilizations (rotations, PA's, ilial mobs [distractions], transverse glides), direction specific stretches and nerve mobilizations. This pilot study provides preliminary evidence of commonly used treatment approaches for sub acute sciatica amongst physiotherapists.