Diane Berthelette

Disability Prevention: New Paradigm for the Management of Occupational Back Pain

Occupational back pain is a widespread self-limited but recurring disease that generates major societal costs and impairs workplace productivity. However, this societal impact is mostly accounted for by a small fraction of patients with back pain who have prolonged absence from work, i.e. prolonged disability.Evidence from research from the past 2 decades has progressively shown that most efforts to prevent or cure the disease have limited results, explaining the expanding number of disability cases from back pain. However, recent evidence has also shed light on the causes of disability that are not only due to the patients’s personal characteristics (physical and psychosocial), but also stem from the patients’s environment in the disability problem — the workplace, the compensation system and even the healthcare delivery system.In addition, successful intervention studies have used an approach to disability prevention through patient reassurance and interventions linked to the workplace, instead of using a medical model of back pain treatment. It is evident that the present disease treatment paradigm should be replaced by a disability prevention paradigm for patients with subacute or chronic back pain to avoid unnecessary evolution towards prolonged disability.We propose a disability prevention management model to encourage clinicians, employers, unions and insurers, as well as researchers in the field, to work within the perspective of the disability paradigm.

Early return to work of injured workers: multidimensional patterns of individual and organizational factors

Abstract The research reported here, part of a larger exploratory project about the factors that may play a role in the implementation of corporate return to work measures, characterized workers having suffered an occupational injury. These workers constitute the target population of a governmental policy designed to favour early return to work. The study population was composed of 13 728 cases of occupational injury. The characteristics of workers, characteristics of injuries and structural characteristics of companies in cases in which return to work measures were present were compared with these same characteristics in cases in which such measures were absent. Using correspondence and ascending hierarchical classification analyses, homogenous groups were identified. Bivariate analysis revealed that the following eight variables were associated with the presence of early return to work measures (i.e. the proportion of cases benefiting from early return to work measures was significantly higher than expected): nature of the injury (inflammation); site of injury (upper limbs and shoulder); CSST assessment category (=100%, i.e. large company); duration of absence (0–44 days and 183–365 days); gender (female); sector (rubber and plastics); relapse (present); and age (30–39 years). The presence or absence of return to work measures was a defining characteristic of five of the seven classes identified by multivariate analysis. The composition of these classes reflects the complex interaction between return to work measures on the one hand and the socio-demographic characteristics of workers, characteristics of injuries, and structural characteristics of companies on the other.

Evaluation of the implementation fidelity of an ergonomic training program designed to prevent back pain

The aim of this study was to evaluate the implementation fidelity of a multidimensional ergonomic program designed to prevent back pain injuries among healthcare personnel. The program, provided by peer trainers included training intended to modify patient handling and transfer behaviour, trainee follow-up, prevention activities aimed at work environment improvements and follow-up monitors training. Two hundred twenty-one peer trainers at 139 Quebec healthcare institutions participated in our study. Only 61.5% were involved in training; most of them taught safe patient handling, positioning, transfer, and preparation techniques, which are the cornerstones of the program; 72.7% were involved in prevention activities, 46.1% in follow-up activities, and 10.7% in follow-up monitors training. The study results should help organizations anticipate and prevent potential discrepancies between prescribed and implemented programs.

Knowledge transfer on complex social interventions in public health: a scoping study.

Objectives Scientific knowledge can help develop interventions that improve public health. The objectives of this review are (1) to describe the status of research on knowledge transfer strategies in the field of complex social interventions in public health and (2) to identify priorities for future research in this field. Method A scoping study is an exploratory study. After searching databases of bibliographic references and specialized periodicals, we summarized the relevant studies using a predetermined assessment framework. In-depth analysis focused on the following items: types of knowledge transfer strategies, fields of public health, types of publics, types of utilization, and types of research specifications. Results From the 1,374 references identified, we selected 26 studies. The strategies targeted mostly administrators of organizations and practitioners. The articles generally dealt with instrumental utilization and most often used qualitative methods. In general, the bias risk for the studies is high. Conclusion Researchers need to consider the methodological challenges in this field of research in order to improve assessment of more complex knowledge transfer strategies (when they exist), not just diffusion/dissemination strategies and conceptual and persuasive utilization.

Evaluation of ergonomic training programs

Seven evaluative studies of ergonomic training programs are synthesized in this article. The training programs were offered to production workers, foremen and occupational health and safety professionals. The main objective of the programs was to provide the participants with conceptual and methodological aids that could help them to improve their working conditions. Most of the programs included theoretical grounding as well as some applications of the acquired knowledge to real working conditions. Most studies in this area focus on the evaluation of program results. Their authors attempt to verify whether or not the programs produced expected outcomes. Post-test and pre-test/post-test designs were the most frequently used research designs. In general, data was collected using questionnaires administered to the individuals participating in the training programs. Study results show that ergonomic training programs contribute to improve working conditions. Further research is needed in order to elaborate an exhaustive theoretical framework dealing with the relationship between programs process and outcomes. Emphasis should be put on the control of biases that could jeopardize the internal and external validity of study results.

Economic evaluations of ergonomic interventions preventing work-related musculoskeletal disorders: a systematic review of organizational-level interventions

BackgroundWork-related musculoskeletal disorders (WMSD) represent a major public health problem and economic burden to employers, workers and health insurance systems. This systematic review had two objectives: (1) to analyze the cost-benefit results of organizational-level ergonomic workplace-based interventions aimed at preventing WMSD, (2) to explore factors related to the implementation process of these interventions (obstacles and facilitating factors) in order to identify whether economic results may be due to a successful or unsuccessful implementation.MethodsSystematic review. Studies were searched in eight electronic databases and in reference lists of included studies. Companion papers were identified through backward and forward citation tracking. A quality assessment tool was developed following guidelines available in the literature. An integration of quantitative economic results and qualitative implementation data was conducted following an explanatory sequential design.ResultsOut of 189 records, nine studies met selection criteria and were included in our review. Out of nine included studies, grouped into four types of interventions, seven yielded positive economic results, one produced a negative result and one mixed results (negative cost-effectiveness and positive net benefit). However, the level of evidence was limited for the four types of interventions given the quality and the limited number of studies identified. Our review shows that among the nine included studies, negative and mixed economic results were observed when the dose delivered and received by participants was low, when the support from top and/or middle management was limited either due to limited participation of supervisors in training sessions or a lack of financial resources and when adequacy of intervention to workers’ needs was low. In studies where economic results were positive, implementation data showed strong support from supervisors and a high rate of employee participation.ConclusionStudies investigating the determinants of financial outcomes of prevention related to implementation process are very seldom. We recommend that in future research economic evaluation should include information on the implementation process in order to permit the interpretation of economic results and enhance the generalizability of results. This is also necessary for knowledge transfer and utilization of research results for prevention-oriented decision-making in occupational health and safety.

Validation of the programme impact theory for a work rehabilitation programme.

OBJECTIVE The Therapeutic Return to Work (TRW) is a comprehensive rehabilitation process that is centralised in the workplace and consists of a workers progressive return to his or her regular work. A programme impact theory for the TRW and three mechanism hypotheses were developed [12]. The objective of this study was to validate the mechanism hypotheses. participants: Construction workers who received compensation for low back pain. METHODS A multiple-case study was carried out. Data on the programme activities were collected on a repeated basis using validated measurement instruments and semi-structured interviews of the 20 participants and the clinicians responsible for them. Analyses were carried out using the pattern matching technique. RESULTS The results supported two of the three hypotheses proposed in the impact theory, specifically, that the development of competent work behaviours is a key factor in promoting return to work and appears to be associated with a reduction in work environment constraints, an improvement in work capacities and the presence of concerted action. CONCLUSION This study revealed that rehabilitation interventions carried out in the workplace and involving workers with low back pain are both complex and embedded in the social environment, and that the actions taken must be coordinated in collaboration with various stakeholders.

Evaluation of the Outcomes of an Occupational Health and Safety Training Program

We are evaluating the outcomes of an occupational health and safety training program provided by a Quebec union whose objective is to increase members ability to participate in injury prevention through union action. In a previous exploratory study we identified the 32 themes of the OHS training program and the learning outcomes pertaining to each of these themes. We used a pretest posttest control group design in order to evaluate the programs outcomes. Questionnaires were distributed to intervention (n=40) and control groups (n=47) whose respective response rates were 100% and 89.4%. We used logistic regression in order to measure the respective effects of OHS program exposure and of the pretest results on the posttest results. In addition, we controlled for the potential confounding effects of the following variables: length of experience as a union delegate or as a member of occupational health and safety committee, previous exposure to an OHS training program, and presence in the delegates firm of other workers previously exposed to the OHS training program under study. We report on one of the themes of the OHS training program that we identified: the legal right for a worker to refuse to execute a dangerous working activity. The results show that the training on that theme produced most of its expected outcomes.