Lynn Shaw

Evidence-Based Guidelines for the Chiropractic Treatment of Adults With Neck Pain

OBJECTIVE The purpose of this study was to develop evidence-based treatment recommendations for the treatment of nonspecific (mechanical) neck pain in adults. METHODS Systematic literature searches of controlled clinical trials published through December 2011 relevant to chiropractic practice were conducted using the databases MEDLINE, EMBASE, EMCARE, Index to Chiropractic Literature, and the Cochrane Library. The number, quality, and consistency of findings were considered to assign an overall strength of evidence (strong, moderate, weak, or conflicting) and to formulate treatment recommendations. RESULTS Forty-one randomized controlled trials meeting the inclusion criteria and scoring a low risk of bias were used to develop 11 treatment recommendations. Strong recommendations were made for the treatment of chronic neck pain with manipulation, manual therapy, and exercise in combination with other modalities. Strong recommendations were also made for the treatment of chronic neck pain with stretching, strengthening, and endurance exercises alone. Moderate recommendations were made for the treatment of acute neck pain with manipulation and mobilization in combination with other modalities. Moderate recommendations were made for the treatment of chronic neck pain with mobilization as well as massage in combination with other therapies. A weak recommendation was made for the treatment of acute neck pain with exercise alone and the treatment of chronic neck pain with manipulation alone. Thoracic manipulation and trigger point therapy could not be recommended for the treatment of acute neck pain. Transcutaneous nerve stimulation, thoracic manipulation, laser, and traction could not be recommended for the treatment of chronic neck pain. CONCLUSIONS Interventions commonly used in chiropractic care improve outcomes for the treatment of acute and chronic neck pain. Increased benefit has been shown in several instances where a multimodal approach to neck pain has been used.

From margins to mainstream: what do we know about work integration for persons with brain injury, mental illness and intellectual disability?

Employment is a right of citizenship and a social determinant of health, but employment rates remain low for persons with disabilities. The purpose of this paper is to examine the principles and practices guiding work integration within the fields of intellectual disability (ID), brain injury, and mental illness and to identify best practices to support transitions to employment across these three groups. This integrative review drew upon an occupational perspective to analyze the current literature. Findings reveal that the need and benefits of working are recognized across disability groups but that philosophical perspectives guiding work integration differ. In the area of mental illness, recovery is seen as a process within which work plays an important role, in ID work is viewed as a planned outcome that is part of the developmental process, and in the field of brain injury, outcomes of employability and employment are emphasized. A common theme across the three disability groups is that in order to facilitate work integration, the person, the job and the work environment are important factors in need of examination. Evidence pointing to the effectiveness of the supported employment model is increasing across these three populations. A framework for guiding the development of further research and for promoting changes to support work integration is presented.

The Interprofessional Socialization and Valuing Scale: A tool for evaluating the shift toward collaborative care approaches in health care settings

BACKGROUND There is a need for tools by which to evaluate the beliefs, behaviors, and attitudes that underlie interprofessional socialization and collaborative practice in health care settings. METHOD This paper introduces the Interprofessional Socialization and Valuing Scale (ISVS), a 24-item self-report measure based on concepts in the interprofessional literature concerning shifts in beliefs, behaviors, and attitudes that underlie interprofessional socialization. The ISVS was designed to measure the degree to which transformative learning takes place, as evidenced by changed assumptions and worldviews, enhanced knowledge and skills concerning interprofessional collaborative teamwork, and shifts in values and identities. The scales of the ISVS were determined using principal components analysis. RESULTS The principal components analysis revealed three scales accounting for approximately 49% of the variance in responses: (a) Self-Perceived Ability to Work with Others, (b) Value in Working with Others, and (c) Comfort in Working with Others. These empirically derived scales showed good fit with the conceptual basis of the measure. CONCLUSION The ISVS provides insight into the abilities, values, and beliefs underlying socio-cultural aspects of collaborative and authentic interprofessional care in the workplace, and can be used to evaluate the impact of interprofessional education efforts, in house team training, and workshops.

Factors in Client–Clinician Interaction That Influence Hearing Aid Adoption

The influence of client–clinician interactions has not been emphasized in hearing health care, despite the extensive evidence of the impact of the provider–patient interaction on health outcomes. The purpose of this study was to identify factors in the client–clinician interaction that may influence hearing aid adoption. Thirteen adults who had received a hearing aid recommendation within the previous 3 months and 10 audiologists participated in a study to generate, sort, and rate the importance of factors in client–clinician interaction that may influence the hearing aid purchase decision. A concept mapping approach was used to define meaningful clusters of factors. Quantitative analysis and qualitative interpretation of the statements resulted in eight concepts. The concepts in order of their importance are (a) Ensuring client comfort, (b) Understanding and meeting client needs, (c) Client-centered traits and actions, (d) Acknowledging client as an individual, (e) Imposing undue pressure and discomfort, (f) Conveying device information by clinician, (g) Supporting choices and shared decision making, and (h) Factors in client readiness. Two overarching themes of client-centered interaction and client empowerment were identified. Results highlight the influence of the client–clinician interaction in hearing aid adoption and suggest the possibility of improving hearing aid adoption by empowering clients through a client-centered interaction.

Ergonomic interventions for office workers with musculoskeletal disorders: A systematic review

INTRODUCTION Ergonomic interventions designed for office and computer work have become widely available and heavily marketed but there is little evidence to support their use with workers who already have a musculoskeletal disorder (MSD). The purpose of any ergonomic intervention can be to improve worker comfort, safety and/or productivity. The ergonomic research in secondary prevention typically focuses outcomes on improved worker comfort but less if any emphasis has been put on productivity and safety. The purpose of this study was to determine the level and quality of evidence supporting ergonomic interventions to improve the comfort, safety and/or productivity of office workers with symptoms of MSDs. METHOD A search of the ergonomic intervention literature based on MSDs of four body areas (low back, upper limb, eye and neck) was employed. The studies underwent two levels of analysis for inclusion in a best-evidence synthesis approach, which included a priori evaluation of specific interventions relative to outcomes of comfort, safety and/or productivity. RESULTS Twenty-seven out of 202 articles were synthesized based on relevance, quality and significant results. Only 8 articles were determined high quality and no strong levels of evidence were identified. Levels of evidence for specific ergonomic interventions ranged from insufficient to moderate. Generally outcomes were focused mostly on improved comfort of workers. CONCLUSIONS There is still limited quality research that addresses ergonomic interventions designed for secondary prevention. Further high quality studies are needed to support evidence-based ergonomic interventions in practice. For all stakeholders to fully evaluate the usefulness of the ergonomic intervention studies need to attend to outcomes not only of worker comfort but also to productivity and safety.

Exploring hearing aid use in older women through narratives

Abstract This study explored experiences surrounding hearing aid use and non-use in older women with hearing loss. A narrative approach was used to gain an in-depth understanding of the meaning and contextual issues that impact upon the adaptation process of older adults and their transitions in using hearing devices. Four women over the age of sixty who were identified as being consistent hearing aid users took part in three face-to-face interviews. 43 biographic-narrative-interview guiding framework was used to gather data in this study. Data were analyzed both holistically and thematically from a phenomenological perspective to identify the meaning and essence of the participants’ experiences. The results revealed an overarching theme of meaningful participation in life situations and events that were linked to purposeful use and non-use of hearing aids. Barriers and facilitators related to participation, which in turn affect hearing aid use and acceptance, were uncovered. The results of this study have implications for audiologic research, and practice. Sumario Este estudio exploró las experiencias alrededor del uso o no uso de auxiliares auditivos por ancianas con pérdidas auditivas. Se usaron las narraciones como enfoque, para lograr la comprensión exhaustiva del significado y de los aspectos contextuales que impactan el proceso de adaptación de los adultos mayores y su transición en el uso de instrumentos auditivos. Tomaron parte en tres entrevistas cara-a-cara, cuatro mujeres mayores de sesenta años, identificadas como usuarias consistentes de auxiliares auditivos. Se usó el marco guía de 43 de entrevistas biográficas-narrativas para obtener los datos de este estudio. Estos datos fueron analizados tanto holística como temáticamente, desde una perspectiva fenomenológica para identificar el significado y la esencia de las experiencias de las participantes. Los resultados revelaron un tema enarcado de participación significativa en situaciones de vida y eventos ligados al uso propositivo o al no uso de auxiliares auditivos. Las barreras y los facilitadores relacionados con la participación, que afectan en sus momentos el uso y la aceptación del auxiliar auditivo, no fueron cubiertos. Los resultados de este estudio tienen implicaciones para la investigación y la práctica audiológica.

Qualitative Meta-Synthesis: Reflections on the Utility and Challenges in Occupational Therapy

Background. A qualitative meta-synthesis is an approach to synthesizing relevant findings from across qualitative studies on a particular topic using methods consistent with qualitative research. Purpose. Using examples of recently completed qualitative meta-synthesis projects, the purpose of this paper is to present the meta-synthesis approach; highlight the key steps, processes, and issues involved; and demonstrate its potential to advance knowledge about occupation and occupation-based practice. Key Issues. The qualitative meta-synthesis approach allows us to take stock of the current state of knowledge in a given area in order to ensure that we have explored the phenomenon from different perspectives and to begin to push the field forward by allowing us to develop deeper insights and understandings. Implications. Despite certain limitations and challenges associated with the approach, qualitative meta-syntheses can provide new knowledge through critical analysis and interpretation to inform client, practitioner, and policy audiences.

A Systematic Review of Multidisciplinary Outcomes in the Management of Chronic Low Back Pain

OBJECTIVE Previous research has provided an inconsistent message as to the effectiveness of multidisciplinary programs to improve employment outcomes in clients with Chronic Low Back Pain (CLBP). The primary aims of this review were to: 1) update the evidence for the multidisciplinary treatment of CLBP to improve employment outcomes 2) assess what knowledge supports occupational therapy as contributing to a multidisciplinary approach in the treatment of CLBP. PARTICIPANTS Working-age adults experiencing CLBP who took part in controlled trials evaluating multidisciplinary programs between July 1998 and July 2009. METHODS Updated guidelines provided by the Cochrane Collaboration Back Review Group (BRG) were used to perform a systematic review to identify, appraise, and synthesize research evidence relevant to our research questions. RESULTS Twelve unique articles were found, after a database search and citation tracking, only two of which were high quality. Our findings suggest that there is still conflicting evidence for the effectiveness of multidisciplinary programs to improve employment outcomes in CLBP. CONCLUSIONS The results are discussed with reference to current methodological limitations found in the literature. Furthermore, occupational therapists were found to be underutilized in the included studies and future multidisciplinary programs should take advantage of the wide range of skills that occupational therapists can contribute in this practice area.

Chronic pain in episodic illness and its influence on work occupations: A scoping review

OBJECTIVES The aim of this review was to understand and synthesize the realm of knowledge on intermittent work capacity (IWC) about strategies to support work sustainability. Specifically, this review focused on literature that examined productive work with individuals who have chronic pain due to Fibromyalgia, Breast Cancer, Multiple Sclerosis, and Human Immunodeficiency Virus. METHODS A scoping review of research conducted across 10 databases. Nature of the knowledge base on return to work barriers and strategies and future recommended strategies needed to support persons with IWC in maintaining work participation were charted and thematically analyzed and organized into micro, meso and macro categories. RESULTS Majority of the knowledge base reflects factors impeding and facilitating employment or re-employment at the micro level. At the micro level, self advocacy was a strategy that persons with IWC used to maintain employment and navigate stigmatizing work environments to meet their needs. At the meso level education and knowledge sharing with employers to increase awareness was underscored; at the macro level introduction of new policies was recommended. CONCLUSIONS These findings suggest the need for future greater examination of the dialectical relationships across micro, meso and macro level strategies to overcome work disparities for persons with IWC.

Using occupational science to study occupational transitions in the realm of work: From micro to macro levels

For the past five years, Drs. Shaw and Laliberte Rudman have explored occupational science concepts related to occupational transitions and their impact on health, well-being and productivity. For instance, Dr. Shaw has expanded her research on return to work to include and address system barriers to support persons with disabilities in resuming meaningful social and work participation. Dr. Laliberte Rudman has developed a program of research focused on the contemporary re-shaping of retirement, examining this macrolevel transformation in the work-retirement transition through analysis of policy and media discourse. In addition, drawing on narratives of middle-aged and older individuals, she is examining how the work-retirement transition is understood and negotiated in relation to broader macro level transformations. This special issue of the journal of WORK is part of our journey in networking with other researchers around the globe who share a common interest in investigating transitions into, within, and out of productive work occupations. Our initial call for papers was unique in that we asked for contributions addressing occupational transitions relevant to the realm of work