Marie-France Coutu

A critical review of gender issues in understanding prolonged disability related to musculoskeletal pain: how are they relevant to rehabilitation?

Purpose. The purpose of this critical review is to describe the available theoretical models for understanding the gender issues in prolonged work disability related to persistent musculoskeletal (MSK) pain. Method. A critical literature review was conducted in medicine, health sciences, and social sciences databases (MEDLINE, CINHAL, PsychINFO and SOCINDEX) using specific keywords. After screening titles and abstracts, followed by methodological quality assessment, a total of 55 references were retained for content analysis. Results. Gender issues in disability related to persistent MSK pain show that men and women may experience pain and rehabilitation process in different ways. Three main themes were exftracted and further described: (1) the experience of distrust; (2) the self-identity process; and (3) the domestic strain. Each of these themes has a specific and potentially different impact on men and women, and we report that experiential differences may strongly impact the rehabilitation process and outcomes such as return to work. Conclusions. This critical review provides insight into gender issues in the process of rehabilitation and outcomes such as return to work. We suggest that work and family considerations are the two most important issues in the rehabilitation process and that differences between men and women are likely to occur.

A review of best work-absence management and return-to-work practices for workers with musculoskeletal or common mental disorders

BACKGROUND Workplace absenteeism is still a curse for developed countries, and more systematic practices need to be adopted to address this issue. OBJECTIVE To review the literature on best practices for managing work absences related to musculoskeletal or common mental disorders. METHODS A review was conducted by performing a search in bibliographic databases and on work-disability research institute websites. Recommendations regarding work-absence management and return-to-work practices were extracted from all the retained documents and organized within a chronological framework. RESULTS In total, 17 documents were analyzed, leading to identification of common work-absence management and return-to-work practices, the importance of a worker support approach, and recommended roles and responsibilities for stakeholders. These practices were then integrated into a six-step process: (1) time off and recovery period; (2) initial contact with the worker; (3) evaluation of the worker and his job tasks; (4) development of a return-to-work plan with accommodations; (5) work resumption, and (6) follow-up of the return-to-work process. CONCLUSIONS Based on this review, we constructed a comprehensive work-absence management and return-to-work process designed to assist organizations. Our results indicate that such a process must be included within a broader policy of health promotion and job retention. Adaptations will be required for implementation in the workplace.

Representations: An Important Key to Understanding Workers’ Coping Behaviors During Rehabilitation and the Return-to-Work Process

IntroductionEvery year many workers are excluded from work because of a work disability attributable to a musculoskeletal disorder (MSD). Factors associated with the development and persistence of the work disability can be related to the worker, work environment, compensation policies, healthcare system and insurance system. Workers’ understanding/representations of their disability are associated with coping behaviors aimed at helping them adapt to or solve their health problem. A representation is a complex, organized entity incorporating thoughts, beliefs, and attitudes regarding a particular subject. Representations have been studied in anthropology, sociology and psychology since the 1960s, but often in a compartmentalized way. These representations provide an important key to understanding what motivates workers during rehabilitation and the return-to-work process. To build upon disciplinary knowledge and better understand workers’ efforts to cope with their persistent disability, this article therefore aims to pool the different knowledge available on the illness representation concept, from the fields of anthropology, sociology and psychology in order to gain a better understanding of its application in the MSD context.MethodsAn electronic literature search (French, English) from 1960 on was conducted in medical, paramedical and social science databases (MedLINE, PsychINFO, CINAHL, etc.) using predetermined key words. After screening abstracts based on a set of criteria, content analysis was performed on the 131 articles retained. Results: The theoretical models and approaches can be divided into three categories: (1) personal experience; (2) interactionist; and (3) sociocultural. The models found in sociology and anthropology are mainly descriptive and developed in a medical context, and only rarely in an occupational health context. However, these models could add elements to psychosocial models that are more dynamic and oriented toward understanding the reasons behind specific behaviors.ConclusionBridging the gap between these disciplines will help us achieve a new level of knowledge that will, by taking social interactions into account, enhance understanding of workers’ representations, and the behaviors they adopt to manage their MSD-related disability.

A Review of Assessment Tools of Illness Representations: Are These Adapted for a Work Disability Prevention Context?

Introduction: Musculoskeletal disorders are among the main causes of short- and long-term disability. Aim: Identify the methods for assessing multidimensional components of illness representations. Methods: An electronic literature search (French, English) from 1980 to the present was conducted in medical, paramedical and social science databases using predetermined key words. After screening titles and abstracts based on a specific set of criteria, sixty-four articles were reviewed. Results: Qualitative approaches for assessing illness representation were found mainly in the fields of anthropology and sociology and were based on the explanatory models of illness. The interviews reviewed were: the Short Explanatory Model Interview, the Explanatory Model of Illness Catalogue and the McGill Illness Narrative Interview. Quantitative approaches were found in the health psychology field and used the following self-administered questionnaires: the Survey of Pain Attitudes, the Pain Beliefs and Perceptions Inventory, the Pain Beliefs Questionnaire, the Fear-Avoidance Beliefs Questionnaire, the Implicit Model of Illness Questionnaire, the Illness Perception Questionnaire, including its derivatives, and the Illness Cognition Questionnaire. Conclusion: This review shows the actual use and existence of multiple interviews and questionnaires in assessing multidimensional illness representations. All have been used and/or tested in a medical context but none have been tested in a work disability context. Further research will be needed to determine their suitability for use in a work disability context.

Moving SDM forward in Canada: milestones, public involvement, and barriers that remain

Canadas approach to shared decision making (SDM) is as disparate as its healthcare system; a conglomerate of 14 public plans at various administrative levels. SDM initiatives are taking place in different pockets of the country and are in different stages of development. The most advanced provincial initiative is occurring in Saskatchewan, where in 2010 the provincial government prepare to introduce patient decision aids into certain surgical specialties. With regard to decision support tools for patients, perhaps the most active entity is the Patient Decision Aids Research Group in Ottawa, Ontario. This group maintains a public inventory of decision aids ranked according to International Patient Decision Aid Standards and has developed the generic Ottawa Personal Decision Guide, as well as a toolkit for integrating decision aids in clinical practice. All of these tools are publicly available free of charge. Professional interest in SDM in Canada is not yet widespread, but Canadas principal health research funding agency is sponsoring several important SDM projects. Researchers from institutions across the country are promoting SDM through continuing professional development programs and other interventions in fields as varied as primary care, dietary medicine and workplace rehabilitation. Still, the future of SDM in Canada remains uncertain. Canadas provincially based structure obliges promoters to work with each province separately, and the recent growth of private healthcare risks dissipating efforts to implement SDM.

Topics and trends in research on non-clinical interventions aimed at preventing prolonged work disability in workers compensated for work-related musculoskeletal disorders (WRMSDs): a systematic, comprehensive literature review.

Abstract Purpose: This study sought to provide an overview of the main topics and trends in contemporary research on successful non-clinical interventions for preventing prolonged work disability in workers compensated for work-related musculoskeletal disorders (WRMSDs). Methods: A systematic electronic search (English and French) was performed in ten scientific databases using keywords and descriptors. After screening the identified titles and abstracts using specific sets of criteria, categorical and thematic analyses were performed on the retained articles. Results: Five main topics appear to dominate the research: (1) risk factors and determinants; (2) effectiveness of interventions (programmes, specific components, strategies and policies); (3) viewpoints, experiences and perceptions of specific actors involved in the intervention process; (4) compensation issues; and (5) measurement issues. A currently widespread trend is early screening to identify risks factors for appropriate intervention and multidisciplinary, multimodal approaches. Morover, workplace-related psychosocial and ergonomic factors are considered vital to the success and sustainability of return-to-work (RTW) interventions. Finally, involving workplace actors, and more specifically, affected workers, in the RTW process appears to be a powerful force in improving the chances of moving workers away from disabled status. Conclusions: The findings of this literature review provide with information about the main topics and trends in research on rehabilitation interventions, revealing some successful modalities of intervention aimed at preventing prolonged work disability. Implications for Rehabilitation Successful intervention for preventing prolonged work disability in workers compensated for WRMSDs address workplace issues: physical and psychosocial demands at work, ability of the workers to fill these demands, work organization and support of the worker, and worker’ beliefs and attitudes related to work. Successful intervention promotes collaboration, coordination between all actors and stakeholders involved in the process of rehabilitation. Strategies able to mobilize the employees, employers, insurers and health care providers are still needed to be implemented.

Further validation of the BDI-II among people with chronic pain originating from musculoskeletal disorders.

ObjectiveOne criticism of the BDI-II for assessing depressive symptoms in people experiencing chronic pain has been the potential overlap between the physical or psychological origins of some of the symptoms. Furthermore, previous studies have reported both two-factor and three-factor solutions, so that the factor solution of the instrument in this population remains unclear. The main objective of the present study was to validate the BDI-II with a chronic pain population experiencing musculoskeletal disorders. Three specific objectives were: (1) to modify the BDI-II for people with musculoskeletal disorders by adding sub-questions to better identify the perceived cause of the depressive symptoms, (2) to assess the validity and reliability of this modified version of the BDI-II, and (3) to explore the perceptions of the causes/origins of symptoms reported on the BDI-II. Results of the confirmatory factor analysis supported the presence of three dimensions within the BDI- : Cognitive, Affective and Somatic. MethodsA total of 206 participants experiencing chronic pain answered a modified version of the BDI-II, the CES-D and a sociodemographic questionnaire. ResultsResults confirmed the three-dimensional factorial structure of the BDI for this population. Overall, participants experienced higher levels of somatic symptoms compared to symptoms belonging to other dimensions. The percentages of answers to the sub-questions were also similarly distributed between “pain”, and “pain and state of mind”, regardless of the dimension. DiscussionThe importance of assessing somatic symptoms of depression in pain patients and of thoroughly examining the underlying perceived cause of symptoms, regardless of the dimension, are discussed.

Level of distress among workers undergoing work rehabilitation for musculoskeletal disorders.

IntroductionMany studies have documented the high distress rates and their correlates among individuals experiencing persistent pain due to a musculoskeletal disorder (MSD). However, few have adopted a biopsychosocial perspective to understand this issue.ObjectiveThe first objective of this study was to examine workers’ distress levels before they start work rehabilitation and to compare it to those in a healthy population. The second objective was to assess the correlations between distress and biopsychosocial factors.MethodsThe participants were 228 workers on sick leave due to persistent pain from an MSD and who were referred to an interdisciplinary work rehabilitation program.ResultsThe workers had very high distress levels compared to normative data. Also, the results of a multiple regression showed that duration of absence, high occupational stress, perception of disability, and fear of movement and (re)injury were significantly associated with distress.ConclusionsThese results highlight the importance of considering distress not only as a predictor of work disability, but as an independent outcome measure. This shift of paradigm could provide a more comprehensive approach in the understanding of workers’ disability.

Evaluation of the fear-avoidance model with health care workers experiencing acute/subacute pain.

Summary The fear‐avoidance model required adjustments for people experiencing acute/subacute pain where fear avoidance beliefs and depressive symptoms were influenced simultaneously rather than sequentially. ABSTRACT Studies in the literature do not show clear evidence supporting the relationship between pain and depressive symptoms in individuals experiencing acute/subacute pain compared to those experiencing chronic pain. However, more information is needed about which variables act as mediators in the pain‐depression relationship in people having acute/subacute pain, before pain becomes chronic. Our objectives were to test the suitability of the fear‐avoidance model in a sample of 110 health care workers experiencing acute/subacute pain using path analyses, to improve the model as needed, and to examine a model involving both pain catastrophizing and pain self‐efficacy with work status as a final outcome. Overall, the results indicated that adjustments to the fear‐avoidance model were required for people experiencing acute/subacute pain, in which fear‐avoidance beliefs and depressive symptoms were concurrent rather than sequential. The catastrophizing concept was most closely associated with depressive symptoms, while pain self‐efficacy was directly associated with fear‐avoidance beliefs and indirectly to work outcomes. Assessing and modifying pain self‐efficacy in acute/subacute pain patients is important for interventions aiming to decrease fear‐avoidance and improve work outcomes.

Clinician-patient agreement about the work disability problem of patients having persistent pain: why it matters.

Background Studies from different fields documenting the differences between clinicians’ and workers’ representations have not elucidated where the differences exist or how they can be resolved. Purpose To define and describe scenarios depicting the differences between clinical judgment, workers’ representations about their disability and clinicians’ interpretations of these representations. Methods A multiple case-study design was used. Semi-structured prospective interviews were conducted at four points in time, with five clinicians managing 12 cases of workers having persistent pain and participating in an evidence-based work rehabilitation program. Results Four scenarios depicting differences in representations were found, but not all the differences necessarily had a negative impact on the program outcomes. For the clinicians, clear identification of the problem was important to allow for the use of concrete, pragmatic strategies. For the workers, congruence between the proposed strategy and their representations was crucial. Conclusion During rehabilitation, the objectives must be acceptable to both parties or the proposed strategy must, at least, make sense to the patient.