Torill H. Tveito

Managing pain in the workplace: a focus group study of challenges, strategies and what matters most to workers with low back pain

Purpose. Most working adults with low back pain (LBP) continue to work despite pain, but few studies have assessed self-management strategies in this at-work population. The purpose of this study was to identify workplace challenges and self-management strategies reported by workers remaining at work despite recurrent or persistent LBP, to be used as a framework for the development of a workplace group intervention to prevent back disability. Method. Workers with LBP (n = 38) participated in five focus groups, and audio recordings of sessions were analysed to assemble lists of common challenges and coping strategies. A separate analysis provided a general categorisation of major themes. Results. Workplace pain challenges fell within four domains: activity interference, negative self-perceptions, interpersonal challenges and inflexibility of work. Self-management strategies consisted of modifying work activities and routines, reducing pain symptoms, using cognitive strategies and communicating pain effectively. Theme extraction identified six predominant themes: knowing your work setting, talking about pain, being prepared for a bad day, thoughts and emotions, keeping moving and finding leeway. Conclusions. To retain workers with LBP, this qualitative investigation suggests future intervention efforts should focus on worker communication and cognitions related to pain, pacing of work and employer efforts to provide leeway for altered job routines.

Systematic review of active workplace interventions to reduce sickness absence

Background The workplace is used as a setting for interventions to prevent and reduce sickness absence, regardless of the specific medical conditions and diagnoses. Aims To give an overview of the general effectiveness of active workplace interventions aimed at preventing and reducing sickness absence. Methods We systematically searched PubMed, Embase, Psych-info, and ISI web of knowledge on 27 December 2011. Inclusion criteria were (i) participants over 18 years old with an active role in the intervention, (ii) intervention done partly or fully at the workplace or at the initiative of the workplace and (iii) sickness absence reported. Two reviewers independently screened articles, extracted data and assessed risk of bias. A narrative synthesis was used. Results We identified 2036 articles of which, 93 were assessed in full text. Seventeen articles were included (2 with low and 15 with medium risk of bias), with a total of 24 comparisons. Five interventions from four articles significantly reduced sickness absence. We found moderate evidence that graded activity reduced sickness absence and limited evidence that the Sheerbrooke model (a comprehensive multidisciplinary intervention) and cognitive behavioural therapy (CBT) reduced sickness absence. There was moderate evidence that workplace education and physical exercise did not reduce sickness absence. For other interventions, the evidence was insufficient to draw conclusions. Conclusions The review found limited evidence that active workplace interventions were not generally effective in reducing sickness absence, but there was moderate evidence of effect for graded activity and limited evidence for the effectiveness of the Sheerbrooke model and CBT.

Psychosocial stress and multi-site musculoskeletal pain: A cross-sectional survey of patient care workers

The aim of this study was to assess the relationship between psychosocial factors at work and multi-site musculoskeletal pain among patient care workers. In a survey of 1,572 workers from two hospitals, occupational psychosocial factors and health outcomes of workers with single and multi-site pain were evaluated using items from the Job Content Questionnaire that was designed to measure psychological demands, decision latitude, and social support. An adapted Nordic Questionnaire provided data on the musculoskeletal pain outcome. Covariates included body mass index, age, gender, and occupation. The analyses revealed statistically significant associations between psychosocial demands and multi-site musculoskeletal pain among patient care associates, nurses, and administrative personnel, both men and women. Supervisor support played a significant role for nurses and women. These results remained statistically significant after adjusting for covariates. These results highlight the associations between workplace psychosocial strain and multi-site musculoskeletal pain, setting the stage for future longitudinal explorations.

Does the presence of psychosocial yellow flags alter patient-provider communication for work-related, acute low back pain?

Objective: To determine whether patterns of patient-provider communication might vary depending on psychosocial risk factors for back disability. Methods: Working adults (N = 97; 64% men; median age = 38 years) with work-related low back pain completed a risk factor questionnaire and then agreed to have provider visits audiotaped. Verbal exchanges were divided into utterances and coded for content, then compared among low-, medium-, and high-risk patients. Results: Among high-risk patients only, providers asked more biomedical questions, patients provided more biomedical information, and providers used more language to engage patients and facilitate communication. There were no group differences in psychosocial exchanges. Conclusions: Clinicians may recognize the need for more detailed assessment of patients with multiple psychosocial factors, but increases in communication are focused on medical explanations and therapeutic regimen, not on lifestyle and psychosocial factors.

Subjective health complaints and health related quality of life in a population of health care workers

The aim of this study was to assess whether Subjective Health Complaints (SHC), demands and coping are associated with health-related quality of life in a population of health care workers. One hundred and nineteen employees in two nursing homes for the elderly filled in a questionnaire on health, exercise, psychological factors, and work conditions. Main outcome measures were SHC and quality of life measured by SF-36. High level of SHC was associated to low health-related quality of life. Low coping and high demands were related to low scores (low quality of life), and high coping and low demands to high scores on mental health. Pseudoneurological complaints (e.g. tiredness, sadness), high demands and low coping were associated with low mental health. The expected negative association between SHC and health-related quality of life was found. There was a positive association between coping and quality of life.

Worker assessments of organizational practices and psychosocial work environment are associated with musculoskeletal injuries in hospital patient care workers

BACKGROUND Hospital patient care (PC) workers have high rates of workplace injuries, particularly musculoskeletal injuries. Despite a wide spectrum of documented health hazards, little is known about the association between psychosocial factors at work and OSHA-recordable musculoskeletal injuries. METHODS PC-workers (n = 1,572, 79%) completed surveys assessing a number of organizational, psychosocial and psychological variables. Associations between the survey responses and injury records were tested using bivariate and multivariate analyses. RESULTS A 5% of the PC-workers had at least one OSHA-recordable musculoskeletal injury over the year, and the injuries were significantly associated with: organizational factors (lower people-oriented culture), psychosocial factors (lower supervisor support), and structural factors (job title: being a patient care assistant). CONCLUSIONS The results show support for a multifactorial understanding of musculoskeletal injuries in hospital PC-workers. An increased focus on the various dimensions associated with injury reports, particularly the organizational and psychosocial factors, could contribute to more efficient interventions and programs.

Introduction to the Special Section: Sustainability of Work with Chronic Health Conditions

Background The increasing prevalence of older workers and chronic health conditions represents a growing occupational health concern. More research is needed to understand risk factors, apply and adapt theories, and test workplace-focused interventions that might prevent work disability and disengagement among chronically ill workers. Methods A 2-h roundtable symposium involving 28 participants was held at an international conference (Second Scientific Conference on Work Disability Prevention & Integration, Groningen, The Netherlands) in October 2012. In that symposium, small groups of participants were invited to discuss theoretical, methodological, and implementation considerations for studying workplace function and well-being among workers with chronic health conditions. As a follow-up to the symposium, the organizers invited authors to submit original articles to a Special Section of the Journal of Occupational Rehabilitation for peer review and publication. Results Results of the symposium reflected the need to address social, not just physical, aspects of the workplace, to include both individual-level and organizational interventions, and to integrate employer perspectives and operational models. Contributions to the Special Issue focus on outcome measurement, symptom self-management at work, job accommodations, prognostic factors for disability escalation, and the perceived needs of affected workers. Conclusions The content of the Special Section reflects an evolving body of research that continues to grapple with basic issues around choice of outcome measures, level of intervention, and the optimal ways to meet the needs of workers with chronic health conditions, including supporting efforts to manage symptoms and function at work. Future research should focus on integrating organizational and individual-level interventions.

Cognitive Interventions and Nutritional Supplements (The CINS Trial): A Randomized Controlled, Multicenter Trial Comparing a Brief Intervention with Additional Cognitive Behavioral Therapy, Seal Oil, and Soy Oil for Sick-Listed Low Back Pain Patients

Study Design. A randomized controlled trial. Objective. The aim of this study was to evaluate whether a tailored and manualized cognitive behavior therapy (CBT) or nutritional supplements of seal oil and soy oil had any additional benefits over a brief cognitive intervention (BI) on return to work (RTW). Summary of Background Data. Brief intervention programs are clinically beneficial and cost-effective for patients with low back pain (LBP). CBT is recommended for LBP, but evidence on RTW is lacking. Seal oil has previously been shown to have a possible effect on muscle pain, but no randomized controlled trials have so far been carried out in LBP patients. Methods. Four hundred thirteen adults aged 18 to 60 years were included. Participants were sick-listed 2 to 10 months due to LBP. Main outcome was objectively ascertained work participation at 12-month follow-up. Participants were randomly assigned to BI (n = 100), BI and CBT (n = 103), BI and seal oil (n = 105), or BI and soy oil (n = 105). BI is a two-session cognitive, clinical examination program followed by two booster sessions, while the CBT program is a tailored, individual, seven-session manual-based treatment. Results. At 12-month follow-up, 60% of the participants in the BI group, 50% in the BI and CBT group, 51% in the BI and seal oil group, and 53% in the BI and soy oil group showed reduced sick leave from baseline, and had either partly or fully RTW. The differences between the groups were not statistically significant (&khgr;2 = 2.54, P = 0.47). There were no significant differences between the treatment groups at any of the other follow-up assessments either, except for a significantly lower sick leave rate in the BI group than the other groups during the first 3 months of follow-up (&khgr;2 = 9.50, P = 0.02). Conclusion. CBT and seal oil had no additional benefits over a brief cognitive intervention on sick leave. The brief cognitive intervention alone was superior in facilitating a fast RTW. Level of Evidence: 2

Effect of a Brief Cognitive Training Programme in Patients with Long-lasting Back Pain Evaluated as Unfit for Surgery

The aim of the study was to evaluate the effect of cognitive intervention (information and physical exercise), on patients with long-lasting back pain referred for surgical evaluation at an orthopaedic hospital, but evaluated as unfit for surgery. One hundred and fifty-two patients were randomized to a five days intervention or control. The intervention had no significant effects on pain. At three-month follow-up, the patients in the intervention group used significantly more active strategies to cope with the back pain compared to the control group. This effect seemed to increase over time, being more pronounced at one-year follow-up evaluation.

How can a brief intervention contribute to coping with back pain? A focus group study about participants’ experiences:

Background: Our aim was to explore how individuals who had participated in a brief back and neck pain intervention perceived connections between the intervention and their subsequent coping. Methods: Three focus group discussions were conducted with a sample of ten employees aged 20–67 years, who had participated in a brief intervention for back and neck pain, perceived the intervention as helpful and had returned or remained at work subsequent to the intervention. Participants were invited to share stories of how the intervention had made a positive difference to their work situation and everyday life and helped them cope with their complaints. Systematic text condensation was used for analysis. Results: Analysis revealed several aspects of how the participants considered the intervention to be helpful. They emphasized the importance of having the information delivered in a comprehensible way, with the use of practical examples and images of the spine. Discussions revealed the significance of trusting the lecturers and perceiving them as experts. Understanding why they felt the pain and that it was not a sign of serious disease changed the participants’ perception of how they could live with the complaints. They told stories of how they had exceeded their previous limits and dared to undertake activities they previously had avoided due to fear. Conclusions: Having confidence in the lecturers and seeing them as experts that delivered the information in a comprehensible way helped participants to cope with their pain and was seen as the most important aspects of the brief back and neck pain intervention.