Kimberley Cullen

Workplace-based return-to-work interventions: a systematic review of the quantitative literature

Introduction: A systematic review was conducted to review the effectiveness of workplace-based return-to-work (RTW) interventions. Method: Seven databases were searched, in English and French, between January 1990 and December 2003 for peer-reviewed studies of RTW interventions provided at the workplace to workers with work disability associated with musculoskeletal or other pain-related conditions. Methodological quality appraisal and data extraction were conducted by pairs of reviewers. Results: Of a total of 4124 papers identified by the search, 10 studies were of sufficient quality to be included in the review. There was strong evidence that work disability duration is significantly reduced by work accommodation offers and contact between healthcare provider and workplace; and moderate evidence that it is reduced by interventions which include early contact with worker by workplace, ergonomic work site visits, and presence of a RTW coordinator. For these five intervention components, there was moderate evidence that they reduce costs associated with work disability duration. Evidence for sustainability of these effects was insufficient or limited. Evidence regarding the impact of supernumerary replacements was insufficient. Evidence levels regarding the impact of the intervention components on quality-of-life was insufficient or mixed. Conclusions: Our systematic review provides the evidence base supporting that workplace-based RTW interventions can reduce work disability duration and associated costs, however the evidence regarding their impact on quality-of-life outcomes was much weaker.

A systematic review of the effectiveness of occupational health and safety training

OBJECTIVES Training is regarded as an important component of occupational health and safety (OHS) programs. This paper primarily addresses whether OHS training has a beneficial effect on workers. The paper also examines whether higher engagement OHS training has a greater effect than lower engagement training. METHODS Ten bibliographic databases were searched for pre-post randomized trial studies published in journals between 1996 and November 2007. Training interventions were included if they were delivered to workers and were concerned with primary prevention of occupational illness or injury. The methodological quality of each relevant study was assessed and data was extracted. The impacts of OHS training in each study were summarized by calculating the standardized mean differences. The strength of the evidence on trainings effectiveness was assessed for (i) knowledge, (ii) attitudes and beliefs, (iIi) behaviors, and (iv) health using the US Centers for Disease Control and Preventions Guide to Community Preventive Services, a qualitative evidence synthesis method. RESULTS Twenty-two studies met the relevance criteria of the review. They involved a variety of study populations, occupational hazards, and types of training. Strong evidence was found for the effectiveness of training on worker OHS behaviors, but insufficient evidence was found of its effectiveness on health (ie, symptoms, injuries, illnesses). CONCLUSIONS The review team recommends that workplaces continue to deliver OHS training to employees because training positively affects worker practices. However, large impacts of training on health cannot be expected, based on research evidence.

Minimal change is sensitive, less specific to recovery: a diagnostic testing approach to interpretability

OBJECTIVE The pursuit of interpretability of longitudinal measures of patient outcome has led to several methods for defining minimal amounts of change or final states that are important. Little is known about the best method. The purpose of this study was to directly compare methods using diagnostic utility to evaluate their usefulness. STUDY DESIGN AND SETTING Secondary analysis of longitudinal cohort data of persons attending physiotherapy for shoulder pain. Disability of the arm, shoulder, and hand outcome fielded at baseline and 3 months. Published methods were used to define positive response in scores: minimal change, final state, and combined change and final state. Proportions described as improved were compared (Kappa) and diagnostic testing techniques used to evaluate the strengths of each. RESULTS Only moderate agreement was found between methods (Kappa=0.47). Minimal clinically important differences were most sensitive but not specific. Final states were less sensitive, more specific, and most accurate. Combinations were slightly less specific. CONCLUSION A new approach allowed us to evaluate the relative merits and risks of different approaches to interpreting longitudinal patient outcomes. Our study points to a combination of change greater than error and/or a final score within general population norms as being the most clinically sensible with strong diagnostic accuracy.

Effectiveness of Workplace Interventions in Return-to-Work for Musculoskeletal, Pain-Related and Mental Health Conditions: An Update of the Evidence and Messages for Practitioners

Purpose The objective of this systematic review was to synthesize evidence on the effectiveness of workplace-based return-to-work (RTW) interventions and work disability management (DM) interventions that assist workers with musculoskeletal (MSK) and pain-related conditions and mental health (MH) conditions with RTW. Methods We followed a systematic review process developed by the Institute for Work & Health and an adapted best evidence synthesis that ranked evidence as strong, moderate, limited, or insufficient. Results Seven electronic databases were searched from January 1990 until April 2015, yielding 8898 non-duplicate references. Evidence from 36 medium and high quality studies were synthesized on 12 different intervention categories across three broad domains: health-focused, service coordination, and work modification interventions. There was strong evidence that duration away from work from both MSK or pain-related conditions and MH conditions were significantly reduced by multi-domain interventions encompassing at least two of the three domains. There was moderate evidence that these multi-domain interventions had a positive impact on cost outcomes. There was strong evidence that cognitive behavioural therapy interventions that do not also include workplace modifications or service coordination components are not effective in helping workers with MH conditions in RTW. Evidence for the effectiveness of other single-domain interventions was mixed, with some studies reporting positive effects and others reporting no effects on lost time and work functioning. Conclusions While there is substantial research literature focused on RTW, there are only a small number of quality workplace-based RTW intervention studies that involve workers with MSK or pain-related conditions and MH conditions. We recommend implementing multi-domain interventions (i.e. with healthcare provision, service coordination, and work accommodation components) to help reduce lost time for MSK or pain-related conditions and MH conditions. Practitioners should also consider implementing these programs to help improve work functioning and reduce costs associated with work disability.

Workplace organizational policies and practices in Ontario educational facilities.

Background: Workplace organizational policies and practices (OPPs) play a pivotal role in managing injury and disability. This study identifies the workplace OPPs in Ontario’s education sector. Methods: OPPs were examined using a cross-sectional survey with 157 participants. The relationship among the type of school, workplace OPPs and injury and disability outcomes were investigated. Results: Mean subscale scores (potential range 1–5) varied from 3.1 (SD, 1.0) to 4.2 (SD, 0.6) for all schools. Private schools scored lowest on measures of disability prevention, disability management, and corporate culture. Ergonomic practices and return to work initiatives were achieved less frequently than other OPPs for all schools. Higher scores on safety diligence were associated with lower injury and disability incidence (proportion of variance explained ranged from 10 to 23%). Higher scores on people-oriented culture were associated with lower disability incidence and duration (proportion of variance explained ranged from 7 to 20%). Conclusions: Public schools engage more often in workplace OPPs than private schools. Improved achievements on safety diligence and people-oriented culture practices predict reduced injury and disability outcomes.

A systematic review of interventions to promote work participation in older workers

PURPOSE The objective of this systematic review was to synthesize evidence on the effectiveness of interventions aimed at promoting work participation in older workers. METHODS We followed a systematic review process developed by the Institute for Work & Health and a best evidence synthesis that ranked evidence as strong, moderate, limited, or insufficient. RESULTS Seven electronic databases were searched from inception to March 2014. Evidence from 14 studies were synthesized in 4 different intervention categories: multi-component, exercise, medication and other interventions. There was moderate evidence that work participation was improved by multi-component interventions encompassing at least two of three components (health service delivery, coordination of services, and work modifications). There was not enough evidence to recommend the other interventions. CONCLUSIONS Although there is a vast body of research on work participation of older workers, there are only a few high quality intervention studies aimed at improving work participation in this population. We recommend that multi-component interventions could be considered for implementation by practitioners to help improve work participation in older workers. PRACTICAL APPLICATIONS With a moderate level of evidence, multi-component interventions could be considered for use in practice if practitioners deem it suitable for their setting. There is not enough evidence to recommend exercise interventions, pharmaceutical interventions, different types of surgeries, patient education or work accommodation alone to improve work participation. However, the lack of evidence should not be considered, as absence of effect and practitioners should continue to be creative in developing solutions.

545 Workplace practices and policies to support workers with depression

Introduction The burden associated with the effects of depression in the workplace is extensive. Workers with depression lose more health-related productive time, have higher rates of absenteeism and short-term disability, and experience higher rates of job turnover than those without depression. Our objective is to synthesise evidence from the scientific literature, practice evidence (workplace policies and practices), and experiences from OHS stakeholders. Methods Our study sample is OHS stakeholders: workers, managers, and consultants in workplaces from our contact database (approximately 700 OHS contacts across Canada willing to be contacted for research). Data collection includes a web-based survey, focus groups (ongoing), and interviews (ongoing) with stakeholder representatives from multiple sectors. We are collecting information about workplace practices and policies to prevent productivity losses, promote stay-at-work, and support return-to-work for workers with depression. The synthesis is a two stage process: first synthesising practice evidence gathered from stakeholders and then combining that with evidence from the scientific literature. Results Preliminary results (n=400, 73% workers, 27% managers/consultants) reveal a willingness among participants to share their experiences with depression and work. Workers report practices related to non-judgemental listening and external supports were most helpful to them. Managers/consultants suggest non-judgemental listening and employee assistance programs were most helpful. However, workers often feel workplace support is lacking and report non-supportive supervisors as a key barrier to receiving needed support. Managers indicate a lack of training and knowledge about depression are the main barriers to providing support to workers. Workers did not feel providing information was helpful whereas managers often did. Conclusion Preliminary results reveal the importance of non-judgemental listening as a workplace support for depression. However, responses reveal workers and managers do not have similar experiences of workplace support. Synthesising practice and scientific evidence will help guide policies and practices to support workers with depression.

932 Work exposures and their relationship to the development of osteoarthritis: a systematic review

Introduction Osteoarthritis (OA) ranks among the top ten causes of disability worldwide. Of increasing interest are occupational factors that contribute to the development of OA or aggravate its trajectory. This systematic review synthesised evidence for the relationship between work exposures and the development of OA to inform work disability prevention messaging and decision making and to identify future knowledge needs. Methods We implemented the systematic review process developed by the Institute for Work and Health and an adapted best evidence synthesis. Four electronic databases were searched from inception until May 2015. Articles that described the impact of work on OA were included in the review and examined knees, hips, spine, wrist, hands, or fingers, shoulder, ankle, foot, or toes, neck, elbow. Result The search yielded 3379 non-duplicate references with 67 studies meeting our inclusion criteria. Study designs included cross-sectional surveys (n=22), case-control studies (n=22), prospective cohorts (n=14), and retrospective cohorts (n=9). 96% of studies measured OA using reliable and valid measures. Measurement of work exposures was more variable with 33% (n=28) of studies not well described and 18% (n=12) using instruments with questionable or unknown reliability and validity. There was strong or moderate evidence of an increased risk for developing OA in hips or knees for several occupational tasks (e.g., lifting/load bearing activities, full body vibration, kneeling/bending/squatting) and for not having an increased risk of OA for walking, sitting, driving, climbing. Dose response data were highly variable and could not be synthesised for recommendations. Discussion This systematic review highlights that strong evidence exists for occupational risks and the development of OA in some joints, like knees and hips. However, data on complex job tasks (e.g., bending and lifting simultaneously) and dose response information are lacking. This is essential information going forward for prevention and early intervention efforts.

603 Workplace practices and policies to prevent msd: developing an implementation guide

Introduction Musculoskeletal disorders (MSD) continue to be a major burden for workplaces and workers as well as insurance and health systems. Evidence-based approaches are desired but research-to-practice gaps remain. One reason for gaps is the necessary research of sufficient quality is often not available. However evidence-based practice considers both scientific evidence as well as practitioner expertise. Our objective is to synthesise evidence from the scientific literature, practice evidence (policies and practices), and experiences from stakeholders. Methods Scientific evidence from recently published reviews, including a recent review our team completed, will be synthesised. Evidence from practitioners’ expertise and worker experiences are being collected using a web-based survey, focus groups, and interviews with representatives from various stakeholder groups from multiple sectors. We are using the Public Health Agency of Canada’s best practices portal to structure data collection of workplace practices and policies. We are synthesising the evidence gathered from stakeholders with that from recently published systematic reviews. Result Recent systematic review results revealed 61 high and medium studies addressing MSD. The studies described 30 different intervention categories. There was strong evidence that resistance training has a positive effect and moderate evidence that stretching, using a feedback mouse, and workstation forearm supports have positive effects. However the level of evidence was too low to make recommendations for many other interventions. The survey and interview/focus groups to collect practice-based evidence are ongoing. Discussion The presentation will focus on current policies and practices described by our practitioner and workplace audiences as compared to the scientific evidence. The discussion will outline the synthesis of evidence and co-creation (with OHS stakeholders) of a practical guide to help workplaces develop and implement effective practices and policies to prevent MSD and help workers with MSD return to work safely.

547 Systematic review evidence in one minute or less

Introduction Getting research evidence to knowledge users is a challenge. The Institute for Work and Health (IWH) initiated a systematic review program in 2004 to synthesise scientific literature on prevention of workplace injuries and disability. IWH systematic review products include 2–3 page lay summaries (called Sharing Best Evidence). The lay summaries are popular but are considered long by some knowledge users. Our objective was to produce and post short videos that summarise key findings of systematic reviews in one minute or less. Methods Video shorts are created by a multi-disciplinary team including a researcher, a video producer and a communications expert. The video shorts are based on high quality research (e.g. systematic review findings). Key messages are created in consultation with stakeholders. The production process begins with a storyboard (frame-by-frame outline). Development requires careful attention to style, pacing, tone, clarity, visual interest and audience appeal. Videos are tested with members of the target audience before being posted. Video shorts typically take about four weeks to complete. Results Two, 1 min videos were developed by IWH made to reach busy stakeholders with evidence they need in their work. The first video, posted since October 2016, is popular receiving over 1100 hits to date. Length: Videos are kept as short as possible, less than one minute. Format: No voice-overs are used. Simple graphics, images, text and short video clips are used, with instrumental background music. Content: Key messages from research findings are delivered in brief snippets of text. Conclusion Our videos are designed to serve two purposes: provide viewers with key evidence they can use, and link the viewer to the IWH website where they can read more information. Consultations with stakeholders on the key messages are important. One-minute research video shorts are an effective means of disseminating key research findings.