Renée-Louise Franche

Cardiac rehabilitation II: referral and participation

Cardiovascular disease (CVD) is the leading cause of death and disability for women and men. Substantial health risks continue following ischemic coronary events (ICEs), but secondary prevention efforts, including cardiac rehabilitation (CR), have beneficial effects on both early and late mortality and morbidity. This prospective study examined the relationship among psychosocial factors and CR referral and participation patterns in 906 (586 men, 320 women) patients from the coronary intensive care unit (CICU) over the course of six months. Only 30% of participants were referred to CR programs, with significantly fewer women being referred. A logistic regression analysis was used to determine whether depression, anxiety, self-efficacy, or social support predicted CR participation six months following an ICE, while controlling for sociodemographic factors. Results show that higher family income, greater anxiety symptomatology, and higher self-efficacy were significantly predictive of CR participation at six months. Implications for womens recovery from an ICE are discussed.

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.

Readiness for return to work following injury or illness: conceptualizing the interpersonal impact of health care, workplace, and insurance factors.

Return to work after injury or illness is a behavior influenced by physical, psychological, and social factors. Disability research lacks a conceptual framework for combining these factors in the study of the return-to-work process. Two extant theoretical models withinthe social context are considered as they apply to the behavior of returning to work: 1) the Readiness for Change Model originating from the field of health promotion and addressing the issue of motivation for behavior change, and 2) the Phase Model of Disability developed for the epidemiological study of occupational disability addressing the developmental and temporal aspects of disability. A new Readiness for Return-to-Work Model is proposed focusing on the interpersonal context of the work-disabled employee. Employee interactions with the workplace, the health care, and insurance systems are considered as they impact the three defining dimensions of change—decisional balance, self-efficacy, and change processes. The evidence for their impact on return-to-work is examined within the framework of the Phase Model of Disability, which puts forth the phase-specificity of symptoms, risks, and interventions for disability. The Readiness for Return-to-Work Model has the potential to account for individual variation in optimal stage-specific timing of interventions based on an individuals readiness for return-to-work. The model therefore complements the Phase Model of Disability by allowing for an individual-level staging of the disability and recovery process within the broader group-level-derived framework of occupational disability phases. This link between the two models needs to be empirically tested in future research.

Disability prevention and communication among workers, physicians, employers, and insurers—current models and opportunities for improvement

Purpose: To review prevailing models of disability management and prevention with respect to communication, and to suggest alternative approaches. Method: Review of selected articles. Results: Effective disability management and return to work strategies have been the focus of an increasing number of intervention programmes and associated research studies, spanning a variety of worker populations and provider and business perspectives. Although primary and secondary disability prevention approaches have addressed theoretical basis, methods and costs, few identify communication as a key factor influencing disability outcomes. Four prevailing models of disability management and prevention (medical model, physical rehabilitation model, job-match model, and managed care model) are identified. The medical model emphasizes the physicians role to define functional limitations and job restrictions. In the physical rehabilitation model, rehabilitation professionals communicate the importance of exercise and muscle reconditioning for resuming normal work activities. The job-match model relies on the ability of employers to accurately communicate physical job requirements. The managed care model focuses on dissemination of acceptable standards for medical treatment and duration of work absence, and interventions by case managers when these standards are exceeded. Despite contrary evidence for many health impairments, these models share a common assumption that medical disability outcomes are highly predictable and unaffected by either individual or contextual factors. As a result, communication is often authoritative and unidirectional, with workers and employers in a passive role. Conclusion: Improvements in communication may be responsible for successes across a variety of new interventions. Communication-based interventions may further improve disability outcomes, reduce adversarial relationships, and prove cost-effective; however, controlled trials are needed.

Cardiac rehabilitation I: review of psychosocial factors

Cardiovascular disease (CVD) is the leading cause of death and disability for women and men. There are gender differences in recovery from coronary events, which may be due physiological, sociodemographic, or psychosocial factors. Cardiac rehabilitation programs have beneficial effects on coronary recovery. The following presents a review of the literature from MedLine (1997-2001) and PsychInfo (1984-2001) on gender differences in participation in cardiac rehabilitation programs, with a focus on depression, anxiety, self-efficacy and social support. A critical analysis of gaps in the literature as well as areas for future research are presented.

Examining the relationship between work-family spillover and sleep quality.

The present study examined the relationship between work-family spillover, job characteristics, and sleep quality in a sample of health care workers (N = 168) recruited from 3 Canadian hospitals. A multiple regression analysis revealed that positive family-to-work spillover is associated with better sleep quality, after controlling for age, physical health, depressive symptomatology, work situation, and number of children. These findings are discussed within a theoretical framework drawing on the concepts of effort and recovery.

The prognostic value of depressive symptoms, fear-avoidance, and self-efficacy for duration of lost-time benefits in workers with musculoskeletal disorders

Background: The psychological factors of depressive symptoms, fear-avoidance, and self-efficacy are deemed to be important in the work disability process. However, the prognostic value of these factors for time on benefit is not well understood. Aims: To analyse the prognostic value of psychological factors for the number of days on total compensation benefit over a 12 month period. Methods: In a longitudinal study of 187 workers receiving total compensation benefits due to musculoskeletal disorders, the prognostic value of psychological factors measured 4–5 weeks post-injury for duration on total compensation benefit over 12 months was analysed. Cox proportional hazard regression analyses were conducted. Special emphasis was given to variable selection and to the analysis of confounding effects of potential prognostic variables. Results: The final model indicated that increased depressive symptoms and poorer physical health significantly increase the number of days on total benefit. Confounders included in the final model were pain and fear of income loss. In the final model the impact of fear-avoidance ceased to be significant when work related variables were included in the fully adjusted model. This illustrates that interrelationships between variables must be taken into account when building multivariate prognostic models. The addition of work related variables to the model did not result in any major changes in the adjusted model, which suggests that when measured 4–5 weeks post-injury, psychological and physical health factors are strong predictors of time on benefits, while work conditions are less important. Conclusion: Results suggest that the presence of depressive symptoms and poor physical health in workers on benefit due to musculoskeletal disorders increases the number of days on total compensation benefits significantly, when controlling for confounding variables.

The impact of early workplace-based return-to-work strategies on work absence duration : A 6-month longitudinal study following an occupational musculoskeletal injury

Objectives: To examine, using administrative and self-reported data, the relationship between early return-to-work (RTW) strategies and work absence duration. Methods: Using a cohort of 632 claimants with work-related musculoskeletal injuries, Cox proportional hazard analyses were performed with RTW strategies measured 1 month after injury as predictors. Outcomes were 6-month self-reported work absence duration and time receiving wage replacement benefits from an administrative database. Results: Work accommodation offer and acceptance and advice from health care provider (HCP) to the workplace on re-injury prevention were significant predictors of shorter work absence duration indexed by both self-report and administrative data. Receiving an ergonomic visit was a significant predictor of shorter duration receiving benefits only. Conclusions: Analyses using administrative and self-reported indices of work absence generally converged. Work accommodation and targeted HCP communication with the workplace are critical for effective early RTW interventions.

Workplace-Based Work Disability Prevention Interventions for Workers with Common Mental Health Conditions: A Review of the Literature

Introduction To summarize evidence on workplace-based work disability prevention (WDP) interventions in workers with common mental health conditions (CMHCs). Primary outcomes of interest were work absence duration and work functioning; secondary outcomes were quality of life, and economic costs. Methods We conducted a systematic literature search in 5 electronic databases (MEDLINE, EMBASE, CINAHL, PsychINFO, Web of Science) for studies published from 2007 to 2009. Two reviewers screened for studies: (1) Targeting workers with CMHCs absent from, or struggling at, work; (2) evaluating workplace-based WDP interventions; (3) assessing our primary outcome(s); and (4) with controlled trials. Quality assessment (using 29 criteria) was performed by two reviewers. Results Our search yielded 671 abstracts: 8 eligible studies and of sufficient quality. We identified three main intervention elements: (a) Facilitation of access to clinical treatment; (b) Workplace-based high-intensity psychological intervention; and (c) Facilitation of navigation through the disability management system. Moderate evidence was found that facilitation of treatment improved work functioning, quality of life and economic outcomes, with limited evidence for work absence duration. Moderate evidence was found that psychological interventions, primarily cognitive-behavioral therapy, improved work functioning, quality of life, and economic outcomes. Moderate evidence indicated that facilitation of navigation through the disability management system improved work absence duration. Conclusions Workplace-based interventions could improve work disability outcomes for workers with CMHCs. Facilitation of access to clinical treatment, and workplace-based high-intensity psychological intervention were most effective in improving work functioning and quality of life, and in reducing costs.

Psychologic and obstetric predictors of couples' grief during pregnancy after miscarriage or perinatal death.

Objective To determine if the psychologic constructs of self-criticism and marital adjustment, considered jointly with obstetric and demographic factors, are significant predictors of grief during a pregnancy after a miscarriage or perinatal death. Methods Participants included 60 pregnant women with previous miscarriages or perinatal deaths, and 50 of their partners. Participants completed a package of psychometric instruments between the tenth and 19th week of gestation. Predictors of grief (active grief, difficulty coping, despair) included (1) psychologic factors: marital adjustment and self-criticism; (2) demographic factors: age and number of living children; and (3) obstetric factors: gestational age at time of loss, number of losses, and time between loss and subsequent conception. Results Stepwise regression analyses were conducted for each grief component for women and men. For women, active grief was significantly associated with high self-criticism and later losses (R2 = 0.31). Later losses and longer time between loss and conception were significantly associated with difficulty coping (R2 = 0.55) and despair (R2 = 0.44). In men, active grief was associated with high self-criticism and later losses (R2 = 0.28), difficulty coping (R2 = 0.18), and despair (R2 = 0.25) with high self-criticism. A trend was found for poor marital adjustment to be associated with higher levels of difficulty coping and despair in men. Conclusion High levels of self-criticism and later gestational age at time of loss are predictors of increased grief during a pregnancy after a miscarriage or perinatal death. Increased time between loss and subsequent conception is also predictive of increased grief for women. For men, low levels of marital adjustment are predictive of increased grief. These results may be helpful in counselling couples considering pregnancy after a loss.