[Adaptation of a questionnaire measuring representations related to work disability]. / Adaptation d'un questionnaire visant à mesurer les représentations liées à l'incapacité de travail.

BACKGROUND: Health, illness and treatment representations have been described as key factors for return to work. The Revised Illness Perception Questionnaire (IPQ-R) is a quantitative tool available to assess these factors. However, an adaptation is necessary before its use with workers on prolonged work disability presenting musculoskeletal disorders (MSD). METHODS: Two distinct phases were carried out, firstly, by adapting the IPQ-R for a population of workers in prolonged work disability related to an MSD and, secondly, by conducting a pre-test on the adapted questionnaire to assess item clarity. PHASE 1: The Technique for Research of Information by the Animation of a Group of Experts (TRIAGE) was selected to proceed with the adaptation. TRIAGE is an inductive and structured method aiming at the attainment of group consensus. Consensus was obtained in two steps: for the individual production, each expert had to judge the pertinence of the questioned elements and suggested new elements if needed; for the group production, all suggestions submitted were sorted according to TRIAGE systematic procedure, in order to retain the most pertinent ones by group consensus. Analysis was done simultaneously to data collection, by the attainment of group consensus. The group of experts consisted of six clinicians and two researchers. For the clinicians, selection criteria consisted of: being an occupational therapist or a psychologist and working for at least 2 years in a vocational rehabilitation setting for workers in prolonged work disability; for the researchers, being affiliated to a university and to have pursued a least one research project regarding prolonged work disability following MSD and development/validation of assessment tools. As a result of the adaptation process eight items were excluded because they were not considered pertinent by the experts. The label "illness" was changed for "current health condition" and 26 new items have been added to the questionnaire to better account for the work disability. The adapted questionnaire appears to present good content validity. PHASE 2: The assessment tool was then pre-tested using a widely known method for trans-cultural adaptation of questionnaires. This method adds a 7-point scale following each item in order to assess item clarity. When the questionnaire is filled, questions are asked to the respondent about items with low rating (4 or less on 7) in order to identify potential ambiguities. Inclusion criteria for the respondents consisted of: being between 18 and 64 of age, having more than 3 months of absence from work related to an MSD and being admitted in a rehabilitation program. Workers absent from work for more than a year, unable to understand and/or read French, suffering from an MSD related to a specific pathology, or presenting major psychiatric problems as indicated in their medical record were excluded. Nine workers were recruited using convenience sampling. Average clarity rating was above 4 for each item, suggesting that the adapted questionnaire was clear. Characteristics of participants seem to be representative of the target population. CONCLUSION: A questionnaire was adapted in order to better assess the representations of workers in a situation of work disability following an MSD. The rigorous process used in this study ensures the quality of the adaptation, but a validation study must be conducted before the implementation of the questionnaire in clinic and research.

Work reintegration and cardiovascular disease: medical and rehabilitation influences.

INTRODUCTION: Research into work reintegration following cardiovascular disease onset is limited in its clinical and individual focus. There is no research examining worker experience in context during the return to work process. METHODS: Qualitative case study method informed by applied ethnography. Worker experience was assessed through longitudinal in-depth interviews with 12 workers returning to work following disabling cardiac illness. Workplace context (Canadian auto manufacturing plant) was assessed through site visits and meetings with stakeholders including occupational health personnel. Data was analyzed using constant comparison and progressive coding. RESULTS: Twelve men (43-63 years) participated in the study. Results revealed that unyielding production demands and performance monitoring pushed worker capacities and caused "insidious stress". Medical reassurance was important in the workers' decisions to return to work and stay on the job but medical restrictions were viewed as having limited relevance owing to limited understanding of work demands. Medical sanction was important for transient absence from the workplace as well as permanent disability. Cardiac rehabilitation programs were beneficial for lifestyle modification and building exercise capacity, but had limited benefit on work reintegration. Occupational health provided monitoring and support during work reintegration. CONCLUSIONS: Medical reassurance can be an important influence on worker representations of disease threat. Medical advice as it pertained to work activities was less valued as it lacked considerations of work conditions. Cardiac rehabilitation lacked intensity and relevance to work demands. Occupational health was reassuring for workers and played an important role in developing return to work plans.

'I'm cured but....': perceptions of illness following treatment.

The current qualitative research studied representations of illness posttreatment from a heart transplant group, a panic disorder group, and a tic disorder group. All three groups were preoccupied with perceptions about the impact of the illness, perception of self and the perception of how others view the ill person. The heart transplant group seem to adopt an active style of coping compared to the panic disorder group who presented a more passive, anticipatory mode of coping, and the tic group who were preoccupied with control over the perceptions of others. This qualitative information could help optimize adaptation strategies.

A case of mistaken identity? The role of injury representations in chronic musculoskeletal pain.

PURPOSE: To explore how patients construe bodily injury, examine how injury representations change over the course of a rehabilitation program and how injury representations influence adaptation and recovery trajectories. METHODS: A case study method was used with qualitative interviews as the primary data source. Qualitative semi-structured interviews were conducted three times over the course of a 12-week intensive interdisciplinary occupational rehabilitation program with one interview 1 month following discharge. To capture changes in rehabilitation trajectories, data analysis employed a narrative approach informed by Bury (progression, regression, and stability) and Frank's (chaos, restitution, and quest) approaches. RESULTS: Sixteen patients (10 men and 6 women) were disabled as a result of persistent pain and impairment from a variety of work injuries participated. Progression/restitution narratives were characterized by the transformation of bone and nerve problems to include soft tissue elements. These participants expanded their scope of injury representations and appraisal to include neurobiological aspects of chronic pain and dimensions of psychosocial well-being, and linked diagnostic representations to self-management strategies in a functional manner. CONCLUSION: Body representations of injury morphology and pain mechanisms are important objects of fear and acceptance for injury recovery. Active strategies that encourage a "hands on" understanding of diagnosis may prove most effective in treating persistent pain. IMPLICATIONS FOR REHABILITATION: Patient representations of pain and body injury are windows into the personal experience of individuals with chronic musculoskeletal pain. When patients enter programs, practitioners need to assess what the patient believes is wrong with their body and what will be helpful in rectifying the problem. Based on their initial assessment, practitioners need to direct education and activity toward shifting patient beliefs to include elements of soft tissue and a broader scope of pain sensitization and psychological impact. Activity-based intervention is essential for creating coherence between injury and pain representations and coping action. During rehabilitation, practitioners need to monitor patient beliefs about their injury. Shifting beliefs are signs that the patient is adopting a more adaptive cognitive stance toward their injury. Lack of movement indicates that the message is not getting through and the approach needs to be modified. When working with patients to transform beliefs, a collaborative approach might be best to increase trust and reduce reactance.

Measurement properties of a new quality of life measure for patients with work disability associated with musculoskeletal pain.

INTRODUCTION: The Quality of Life Systemic Inventory (QLSI) measures patients' goal attainment based on the system control theory. It quantifies the perceived impact of the disorder and the gap between the present and aspired states. PURPOSE: To evaluate concurrent validity and responsiveness of the QLSI among workers on sick leave due to musculoskeletal disorders (MSDs). METHODS: Participants (10 women; 29 men) were recruited at a work rehabilitation centre and had more than 4 weeks of absence from work due to MSDs compensated by the Workers' Compensation Board. Concurrent validity and external responsiveness were based on baseline and post-treatment measures of external criteria. Criteria and related instruments were the following: perception of disability (Roland-Morris Disability Questionnaire); health-related quality of life (SF-12); stress (Psychological Stress Measure) and distress (Psychological Distress Index). RESULTS: Regression analyses revealed significant correlations between QLSI scores and the Psychological Distress Index (r2 = .11 to .19 and .66; p < .001), with either the SF-12 mental component scale (r2 = .18 and .11; p < .01) or the Roland-Morris Disability Questionnaire (r2 = .04 and .10; p < .05). All measures showed highly significant change over time. CONCLUSION: Results support the concurrent validity and responsiveness of the QLSI, with an MSD population. SIGNIFICANCE: This instrument could serve in future research as an outcome measurement instrument in the evaluation of more long-term effects of rehabilitation programs.

The impact of cholesterol lowering on patients' mood.

This study compared mood changes in 212 patients treated for hypercholesterolemia, as a function of their level of adherence to dietary recommendations. Assessments of mood (anxiety, depression, and hostility), measured by the Profile of Mood States, were obtained at baseline and 3-, 6-, and 12-month follow-up. Adherence to diet was categorized as low, medium, or high based on the Food Record Rating. Repeated-measures ANOVAs showed a significant decrease over time for anxiety, total cholesterol (TC), and low-density lipoproteins (LDL). A multiple regression was performed to determine if reductions in TC or LDL were associated with the anxiety decrease. The model for anxiety change was highly significant and included gender, baseline anxiety, number of stressful events, psychological stress, baseline level of adherence to diet, gender x adherence interaction, and change in TC x adherence interaction. In conclusion, cholesterol lowering did not negatively affect patients' moods. However, those who adhered poorly but nonetheless showed stable or reduced TC exhibited a greater decrease in anxiety.