Pain Education and Virtual Reality Improves Pain, Pain-related Fear of Movement, and Trunk Kinematics in Individuals with Persistent Low Back Pain.

OBJECTIVES: To evaluate the effect of combining pain education and virtual reality exposure therapy using a cognitive behavioural therapy-informed approach (VR-CBT) on pain intensity, fear of movement, and trunk movement, in individuals with persistent low back pain. METHODS: Thirty-seven participants were recruited in a single cohort repeated measures study, attending three sessions one week apart. The VR-CBT intervention included standardised pain education (Session 1), and virtual reality exposure therapy (Session 2) incorporating gameplay with mixed reality video capture and reflective feedback of performance. Outcome measures (Pain intensity, pain-related fear of movement (Tampa Scale of Kinesiophobia), and trunk kinematics during functional movements (maximum amplitude, peak velocity) were collected at baseline (Session1), and one week following education (Session 2) and virtual reality exposure therapy (Session 3). One-way repeated measures ANOVAs evaluated change in outcomes from baseline to completion. Post-hoc contrasts evaluated effect sizes for the education and virtual reality components of VR-CBT. RESULTS: Thirty-four participants completed all sessions. Significant (P<0.001) reductions were observed in Mean(SD) pain (baseline 5.9(1.5); completion 4.3(2.1)) and fear of movement (baseline 42.6(6.4); completion 34.3(7.4)). Large effect sizes (Cohen's d) were observed for education (pain intensity 0.85; fear of movement 1.28) while the addition of virtual reality exposure therapy demonstrated very small insignificant effect sizes, (pain intensity 0.10; fear of movement 0.18). Peak trunk velocity, but not amplitude, increased significantly (P<0.05) across trunk movement tasks. DISCUSSION: A VR-CBT intervention improved pain, pain-related fear of movement, and trunk kinematics. Further research should explore increased VR-CBT dosage and mechanisms underlying improvement.

Pilot implementation and evaluation of the Sit-Stand e-Guide: an e-training program on the use of sit-stand workstations.

The 'Sit-Stand e-Guide' e-training program, designed to promote appropriate use of sit-stand workstations (SSWs), was evaluated for usability, acceptability and impact on various outcomes among SSW users. Participants from a large municipal organisation (25% male; mean age 45 [SD = 10.6] years) completed questionnaires pre-training (T0, n = 57), immediately post-training (T1, n = 50), and four weeks (T2, n = 46: primary endpoint) and twelve months later (T3, n = 30). High usability, acceptability and usefulness scores were reported at T1. Median [IQR] knowledge (4.4/5 [0.9]) and confidence (4.6/5 [1.0]) significantly increased at T1 compared to baseline (2.8 [1.2]; 3.3 [1.4]) and maintained at T2 and T3. At T2, mean [SD] sitting time (5.3 [1.2] h/workday) and low back discomfort (2.4 [2.3]) significantly decreased compared to baseline (6.1 [1.3] h; 3.4 [2.5] discomfort), SSW usage increased (1.4 [1.4]-2.8 [1.7] transitions), with no significant changes in work performance. Some behavioural changes were sustained at T3. The Sit-Stand e-Guide was acceptable and effective; evaluation across diverse workplaces and workers is now needed.

This study evaluated a novel, evidence-based e-training program to support the appropriate use of sit-stand workstations. The Sit-Stand e-Guide showed high usability, acceptability and effectiveness in enhancing workers' knowledge and awareness of sedentary behaviour and the use of their sit-stand workstation. It also improved sit/stand behaviour and low back discomfort. However, for long-term benefits, yearly refresher training is recommended.

Effectiveness of Interventions on Work Outcomes After Road Traffic Crash-Related Musculoskeletal Injuries: A Systematic Review and Meta-analysis.

BACKGROUND: Musculoskeletal injuries are common after road traffic crash (RTC) and can lead to poor work-related outcomes. This review evaluated the impact of interventions on work-related (e.g. sick leave), health, and functional outcomes in individuals with a RTC-related musculoskeletal injury, and explored what factors were associated with work-related outcomes. METHODS: Searches of seven databases were conducted up until 9/03/2023. Eligible interventions included adults with RTC-related musculoskeletal injuries, a comparison group, and a work-related outcome, and were in English. Meta-analyses were conducted using RevMan and meta-regressions in Stata. RESULTS: Studies (n = 27) were predominantly conducted in countries with third-party liability schemes (n = 26), by physiotherapists (n = 17), and in participants with whiplash injuries (94%). Pooled effects in favour of the intervention group were seen overall (SMD = - 0.14, 95% CI: - 0.29, 0.00), for time to return to work (- 17.84 days, 95% CI: - 24.94, - 10.74), likelihood of returning to full duties vs. partial duties (RR = 1.17, 95% CI: 1.01, 1.36), decreased pain intensity (- 6.17 units, 95% CI: - 11.96, - 0.39, 100-point scale), and neck disability (- 1.77 units, 95% CI: - 3.24, - 0.30, 50-point scale). DISCUSSION: Interventions after RTC can reduce time to return to work and increase the likelihood of returning to normal duties, but the results for these outcomes were based on a small number of studies with low-quality evidence. Further research is needed to evaluate a broader range of interventions, musculoskeletal injury types, and to include better quality work-related outcomes.

Work-related interventions are not commonly included in physiotherapy management of lower limb osteoarthritis: A cross-sectional survey of Australian Physiotherapists.

BACKGROUND: Lower limb osteoarthritis (OA) is a leading cause of disability and can affect an individual's ability to work. OBJECTIVES: To explore Australian physiotherapists' use of work-related interventions in managing patients with lower limb OA, and identify current management practices. METHODS: Physiotherapists with at least two years of experience treating patients with lower limb OA were invited to complete an online survey to understand how physiotherapists manage patients with lower limb OA, specifically regarding interventions related to work. RESULTS: A total of 132 physiotherapists completed the survey. In free text responses, only 1.5% and 2.3% of physiotherapists nominated work-related items in their key components of treatment or educational topics discussed with patients with lower limb OA, respectively. From a range of work-related activities presented, over half of physiotherapists indicated they regularly/always provided education about the benefits of remaining in work (63.5%) and advice on managing symptoms at work (57.4%). Less than 10% of physiotherapists regularly/always used a validated scale to identify barriers for work (9.6%), discussed absences from work (9.6%), conducted a workplace assessment (4.4%), and discussed submitting workers' compensation claims (2.6%). Exercise and patient education were the most frequently nominated physiotherapy treatments in free text (96.2% and 86.3%, respectively) and fixed response (99.2% and 93.9%, respectively) questions. CONCLUSION: Many physiotherapists do not address work-related activities in their management of patients with lower limb OA. In light of work-related challenges commonly experienced by individuals with lower limb OA, this is an important aspect of management of this condition.

Wellbeing After Finalization of a Workers' Compensation Claim: A Systematic Scoping Review.

OBJECTIVE: A workers' compensation claim may have significant negative impacts on an injured worker's wellbeing. Wellbeing provides a good global measure of potential effects of a claim on an individual, and is important for contemporary economic modelling. The purpose of this study was to synthesize knowledge about the wellbeing of injured workers after the finalization of a workers' compensation claim and identify gaps in the current literature. METHODS: A systematic scoping review was conducted. RESULTS: 71 full-text articles were screened for inclusion, with 32 articles eligible for this review. None of the included articles evaluated overall wellbeing. Included articles did evaluate a variety of constructs inherent in wellbeing. Injured workers were generally disadvantaged in some manner following claim finalization. The literature recommends a focus on reducing negative impacts on injured workers after finalization of a compensation claim, with a need for regulatory bodies to review policy in this area. CONCLUSION: There appears to be potential for ongoing burden for individuals, employers, and society after finalization of a workers' compensation claim. A gap in knowledge exists regarding the specific evaluation of wellbeing of injured workers following finalization of a workers' compensation claim.

Implementation of the "clinical framework for the delivery of health services" by treating healthcare professionals: perspectives of regulators and insurers.

PURPOSE: To understand the current utilisation of the clinical framework for delivery of health services to manage compensable musculoskeletal injuries from the perspectives of insurer case managers and clinical panel members. MATERIALS AND METHODS: Using a qualitative descriptive approach, 15 semi-structured interviews were conducted with members of key organisations including WorkSafe Victoria and Transport Accident Commission Victoria. All interviews were recorded and transcribed verbatim and analysed using thematic analysis. RESULTS: Four over-arching themes were identified: (i) current use of the framework and principles is suboptimal leading to several problems including lack of evidence-based treatment by clinicians; (ii) barriers to optimal use of the framework include lack of adequate training of healthcare professionals on the framework principles and financial aspects of the compensation system; (iii) utilisation of the framework could be improved with training from peak associations, insurers, and regulating bodies; and (iv) optimal use of the framework will result in better health and work outcomes. CONCLUSIONS: The current use of the framework and its principles is suboptimal but can be improved by addressing the identified barriers.IMPLICATIONS FOR REHABILITATIONRehabilitation of compensable musculoskeletal injuries is often complex.Implementing the "Clinical Framework for Delivery of Health Services" can lead to provision of time and cost effective, evidence-based rehabilitation for compensable injuries, ultimately improving patient outcomes.Clinicians can enhance the implementation of the framework principles by integrating evidence-based practice and recommendations from clinical practice guidelines in treatment of compensable musculoskeletal injuries.Implementation of the framework principles may be enhanced by reviewing the compensation funding model to allow the healthcare practitioners adequate time and remuneration to adopt the framework principles when treating persons with compensable injuries.

Co-design and development of the sit-stand e-guide: An e-training program for the optimal use of sit-stand workstations.

This paper describes the co-design and development process of an evidence-informed e-training program (Sit-Stand e-Guide) to support the safe and optimal use of sit-stand workstations from ergonomics and behavioural change perspectives. Using an instructional system design process, supported by a participatory design approach, data was collected through three workshops with workplace consumers (staff [n = 5] and managers [n = 5]), and subject matter experts (n = 5). Content and learning activities were developed based on behaviour change principles and optimal pedagogy. Key topics identified for the e-training were sedentary behaviour and health; workstation set-up; and strategies for behaviour change. Learning activities (scenarios and reflection) to enhance knowledge retention and skills implementation and an interactive one-page guide on completion were included in the e-training. The relevance and usefulness of the training prototype were reviewed through one-to-one think-aloud sessions with the workshop consumers (n = 5) and external health and safety professionals (n = 5) receiving positive feedback. The Sit-Stand e-Guide is readily available for workplace implementation and evaluation. This paper serves as a practical guide for future training development.

Experiences of Working with Lower Limb Osteoarthritis: A Qualitative Study.

PURPOSE: Pain and disability associated with lower limb osteoarthritis (OA) may contribute to difficulties at work. This study aimed to understand the perspectives of workers with lower limb OA on difficulties, concerns, and coping strategies used at work. METHODS: Twenty-two individuals with lower limb OA who were working in paid employment participated in semi-structured interviews. Data were qualitatively analyzed using an inductive thematic approach. Codes were identified and refined through review of interview transcripts and discussion with the research team. RESULTS: Six themes were identified in relation to experiences working with lower limb OA. Themes were as follows: weight-bearing physical demands are challenging; lower limb OA can affect work performance; emotional consequences of pain; concerns about work in the future; positive experiences of supportive colleagues and managers; and minimal effects on sedentary work. Three themes were identified relating to strategies to manage at work: adjustments at work help manage pain and avoid exacerbations; regular strategies to manage pain; and healthcare professionals are consulted, but usually not specifically for work. CONCLUSIONS: Workers with lower limb OA experience physical and emotional difficulties at work that can impact work performance. Workers are concerned about longevity and job security and use a range of strategies to manage symptoms and remain at work. Employers, employees, and healthcare professionals may need to work together to create workplace accommodations to help workers with lower limb OA confidently remain in work.

Work-related outcomes in individuals with and without lower limb osteoarthritis: an online survey.

OBJECTIVE: While osteoarthritis (OA) affects people who are still participating in the workforce, there is limited data about the impact of OA on work. The aim of this study was to compare work participation in individuals with and without lower limb OA. METHODS: This cross-sectional study included workers with (n = 124) and without (n = 106) lower limb OA. Work participation was assessed as work status (full/part time work), work ability (Work Ability Index (WAI)), absenteeism and presenteeism (World Health Organization's Health and Work Performance Questionnaire (WHO-HPQ)), and perceived difficulties meeting work demands (Work Role Functioning Questionnaire (WRFQ)). The data were analyzed using an analysis of covariance with age, body mass index and physical job demands included as covariates. RESULTS: Work ability was poorer (p < 0.001) and loss of work performance (p < 0.001) was higher among workers with OA than healthy controls. There was no statistical difference in absenteeism or overall ability to meet work demands between participants with and without lower limb OA. However, workers with lower limb OA had more difficulty with work scheduling demands (p = 0.05) and physical demands (p = 0.003) than healthy workers. CONCLUSION: Lower limb OA was associated with poorer work ability, loss of work performance and difficulty in meeting physical and work scheduling demands. Health professionals and employers should consider these challenges when managing individuals with lower limb OA and supporting them to remain in the workforce.

The effect of lower limb osteoarthritis on work-related outcomes: a systematic review and meta-analysis.

PURPOSE: Lower limb osteoarthritis (OA) is a prevalent condition that has a profound impact on an individual's life in several domains, including occupational activities. The objective of this study was to systematically describe and compare work-related outcomes (e.g., employment status, absenteeism, and productivity loss) in individuals with and without lower limb OA. MATERIALS AND METHODS: Five databases were searched until 17 June 2023. Studies were eligible for inclusion if they compared work-related outcomes between individuals with lower limb OA and healthy controls (e.g., people without OA or the general population). RESULTS: Seven studies met the inclusion criteria of which two were included in a meta-analysis. Meta-analysis revealed that individuals with OA were less frequently in paid employment than control individuals (odds ratio: 0.25; 95% confidence intervals: 0.12, 0.53). Evidence from single studies indicated greater absenteeism and presenteeism and poorer functional capacity in people with lower limb OA compared to controls. CONCLUSIONS: This systematic review suggests that individuals with lower limb OA have poorer work-related outcomes than those without OA. Low study numbers and lack of consistency in the way work outcomes are defined and measured make accurate quantification of the impact of OA on work challenging.Prospero: registration number: CRD42020178820.

Individuals with lower limb osteoarthritis (OA) are less frequently in paid employment and experience greater absenteeism and presenteeism and poorer functional capacity than people without OA.For holistic management of lower limb OA, healthcare providers should have conversations about any difficulties experienced at work and include outcome measures related to work.Clinicians should work with individuals with lower limb OA and employers to develop interventions to maximize work participation.

Tools to assess employment readiness for colorectal cancer survivors: A scoping review.

BACKGROUND: The ability to return to work and remain at work is an important recovery milestone after a cancer diagnosis. With the projected number of colorectal cancer patients of working age likely to increase, it is important to identify when a person is ready to resume work. There are many employment-related tools available to help people return to work after injury or illness; however, it is unknown which may be suitable for a person with colorectal cancer. AIM: To identify tools related to employment readiness in colorectal cancer survivors and to chart the relevant factors of employment assessed by these tools. METHOD: Literature searches were performed in PubMed, CINAHL, Embase and Medline, the Cochrane library and PsycINFO using search terms around cancer, survivorship and employment to identify all peer-reviewed articles published in English up to June 2022. RESULTS: Thirty-five studies used a total of 77 tools focused on assessing employment issues experienced by people with cancer in general. Four tools were used with colorectal cancer survivors. None considered all relevant employment-related factors for colorectal cancer survivors. CONCLUSION: Tools used to identify return-to-work and remain-at-work were not specific to colorectal cancer. There are a range of existing tools that collate some, but not all, of the domains and outcome criteria required to meet the employment needs of colorectal cancer survivors. To optimize work outcomes for the working colorectal cancer population, a specified tool is warranted.

Clinically Relevant Decreases in Neck/Shoulder Pain Among Office Workers Are Associated With Strength Training Adherence and Exercise Compliance: Explorative Analyses From a Randomized Controlled Trial.

OBJECTIVE: The objectives of this study were to quantify training adherence and exercise compliance during a workplace-based strength training intervention delivered to office workers over a 12-week period and to analyze the association with clinically relevant pain reductions. METHODS: A subsample of 269 participants completed a training diary from which measures of training adherence and exercise compliance (training volume, load, and progression) were calculated. The intervention consisted of 5 specific exercises targeting the neck/shoulder area (neck, shoulders, and upper back). The associations of training adherence, quitting time, and measures of exercise compliance with 3-month pain intensity (on a scale from 0 to 9) were analyzed for the whole sample, pain cases (reporting pain of ≥3 at baseline), participants attaining/not attaining clinically relevant pain reductions (≥30%), and participants meeting/not meeting per-protocol training adherence of ≥70%. RESULTS: Participants reported reduced pain in the neck/shoulder area after 12 weeks of specific strength training, especially women and pain cases, with the caveat that attaining clinically relevant pain reductions depended on the levels of training adherence and exercise compliance attained. Over the 12-week intervention, 30% of the participants were absent for a minimum of 2 consecutive weeks (quitting time), with the median quitting time at approximately weeks 6 to 8. With a threshold of 70% training adherence, a total training volume of approximately 11,000 kg (only in women) and progressions of 1 to 2 times baseline values were shown to be significant for clinically relevant pain reductions. CONCLUSION: Strength training produced clinically relevant reductions in neck/shoulder pain when appropriate levels of training adherence and exercise compliance were attained. This finding was particularly evident for women and pain cases. We advocate for the inclusion of both training adherence and exercise compliance measures in future studies. To optimize intervention benefits, motivational activities after 6 weeks are needed to avoid participants quitting. IMPACT: These data can be used to design and prescribe clinically relevant rehabilitation pain programs and interventions.

Cervical and axioscapular muscle stiffness measured with shear wave elastography: A comparison between different levels of work-related neck disability.

Assessing muscle mechanical properties in terms of stiffness may provide important insights into mechanisms underlying work-related neck pain. This study compared stiffness of cervical and axioscapular muscles between 92 participants (sonographers) with no (n = 31), mild (n = 43) or moderate/severe (n = 18) neck disability. It was hypothesized that participants with more severe neck pain and disability would present with altered distribution of stiffness in cervical and axioscapular muscles than those with no disability. Using shear wave elastography, the shear modulus (kPa) of five cervical and six axioscapular muscles or muscle segments were measured in a relaxed seated upright or side-lying position. Muscle activity was measured simultaneously using surface electromyography during the elastography measurements and scapular depression was measured using a measurement tape and inclinometer before the elastography measurements to evaluate their potential confounding influences on shear modulus. Increased shear modulus was found in deeper than superficial cervical muscles and more cranial than caudal axioscapular muscles. However, no differences in shear modulus of the cervical or axioscapular muscles were found between sonographers with varying levels of disability. This study suggests no alterations in stiffness of cervical and axioscapular muscles were associated with work-related neck pain and disability.

Exploring the perspectives of key stakeholders in returning to work after minor to serious road traffic injuries: a qualitative study.

PURPOSE: This qualitative study conducted in Queensland, Australia aimed to explore various stakeholders' perspectives on (1) the barriers and facilitators of Return to Work (RTW) for injured persons following minor to serious Road Traffic Injuries (RTI) in a fault-based scheme, and to investigate the changes needed to better support RTW following RTI. METHODS: The study was performed using the Interpretive Description methodological approach. Data were collected during interviews (n = 17), one focus group (n = 4), and an open-ended survey (n = 10) with five categories of stakeholders: treating health providers, workplace representatives, legal representatives, rehabilitation advisors, and insurers. Participants were eligible to participate if they had at least one year of employment history in their respective profession in Queensland, Australia, and were experienced in assisting the RTW of people with RTI. Thematic analysis was used to analyse the data. RESULTS: Seven themes were extracted reflecting the barriers and facilitators of RTW along with stakeholders' recommendations to address these barriers. These themes were: (1) knowledge is power; (2) stakeholder expertise; (3) early and appropriate treatment matters; (4) insurers could do better; (5) necessity of employers' support; (6) fix the disjointed system; (7) importance of individual factors pre- and post- injury. The main barriers identified were stakeholders' insufficient communication and knowledge on RTW process following RTI. CONCLUSIONS: Individual and system barriers identified in this study suggest that RTW after RTI occurs in a complex system requiring the commitment of all stakeholders. This is particularly important for managing knowledge-related barriers by provision of high quality and easily accessible information about the RTW process, disability schemes, and the nature of RTI.

A Multi-component Intervention (NEXpro) Reduces Neck Pain-Related Work Productivity Loss: A Randomized Controlled Trial Among Swiss Office Workers.

Purpose Neck pain is common among office workers and leads to work productivity loss. This study aimed to investigate the effect of a multi-component intervention on neck pain-related work productivity loss among Swiss office workers. Methods Office workers, aged 18-65 years, and without serious neck-related health problems were recruited from two organisations for our stepped-wedge cluster randomized controlled trial. The 12-week multi-component intervention included neck exercises, health-promotion information, and workplace ergonomics. The primary outcome of neck pain-related work productivity loss was measured using the Work Productivity and Activity Impairment Questionnaire and expressed as percentages of working time. In addition, we reported the weekly monetary value of neck pain-related work productivity loss. Data was analysed on an intention-to-treat basis using a generalized linear mixed-effects model. Results Data from 120 participants were analysed with 517 observations. At baseline, the mean age was 43.7 years (SD 9.8 years), 71.7% of participants were female (N = 86), about 80% (N = 95) reported mild to moderate neck pain, and neck pain-related work productivity loss was 12% of working time (absenteeism: 1.2%, presenteeism: 10.8%). We found an effect of our multi-component intervention on neck pain-related work productivity loss, with a marginal predicted mean reduction of 2.8 percentage points (b = -0.27; 95% CI: -0.54 to -0.001, p = 0.049). Weekly saved costs were Swiss Francs 27.40 per participant. Conclusions: Our study provides evidence for the effectiveness of a multi-component intervention to reduce neck pain-related work productivity loss with implications for employers, employees, and policy makers.Trial Registration ClinicalTrials.gov, NCT04169646. Registered 15 November 2019-Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT04169646 .

Using framework analysis to understand multiple stakeholders' views of vocational rehabilitation following acquired brain injury.

PURPOSE: To explore how vocational rehabilitation (VR) is currently delivered for individuals with acquired brain injury (ABI) across multiple stakeholder groups and identify areas for improvement in service delivery using the Consolidated Framework for Implementation Research (CFIR). METHODS: Seven focus groups were conducted with rehabilitation clinicians; outreach providers, insurers/regulators, VR providers and disability employment service providers (n = 44) experienced in VR of individuals with ABI. All groups were audio-recorded and transcribed verbatim. Data analysis was guided by the CFIR constructs. RESULTS: All stakeholder groups believed they offered quality VR interventions given available resources and legislation, but many clients fell through the 'cracks'. Themes that were identified included: a) number and complexity of systems supporting VR; b) fractured communication across systems, c) lack of knowledge by both stakeholders and clients in navigating systems, d) lack of expertise in supporting the vocational needs of clients with ABI and e) perceived limited awareness of ABI by employers. CONCLUSION: Stakeholders and clients need support to navigate Australia's complex VR pathways. Limited specialist ABI clinicians, VR providers and disability employment services were identified as barriers for effective VR. Domains of the CFIR were appropriate for organising and understanding how VR is delivered.

"No Man's Land": the experiences of persons injured in a road traffic crash wanting to return to work in Queensland, Australia.

PURPOSE: This study aimed to explore individuals' experiences of return to work (RTW) following minor to serious road traffic injury (RTI) in Queensland, Australia; seek their recommendations if any, on how to provide support for RTW after RTI; and identify the strategies and resources used to return and remain at work after their RTI. METHODS: The interpretive description methodological approach was used. Semi-structured interviews were conducted with eligible participants (n = 18) aged 18-65 y who had experienced a minor to serious RTI at least 6 months earlier. Thematic analysis was used to analyse the data. RESULTS: Five themes emerged: (1) physical and mental consequences of RTI negatively impact RTW; (2) money matters; (3) RTW support makes a difference; (4) feeling alone and confused in the RTW process; and (5) several strategies and resources helped with return/stay at work after RTI. Regular contact and cooperation with employers and insurers, job modifications, and using social media to obtain information and social support were helpful RTW strategies. Participants recommended timely and appropriate medical care, financial assistance, and educational support. CONCLUSIONS: Policy changes to reduce financial stress, increase employer support, and improve injured individuals' knowledge following a RTI are recommended in jurisdictions operating a fault-based scheme.IMPLICATIONS FOR REHABILITATIONThis study identified several factors that can influence return to work (RTW) following minor to serious road traffic injuries (RTIs) in a jurisdiction operating a fault-based compensation scheme.Legislative changes that provide financial assistance to all injured people regardless of their fault-status could reduce financial stress arising from reduced work ability following a road traffic injury.Increasing employer' awareness of the importance of return to work for those with road traffic injuries and reimbursement for possible expenses of providing RTW support for these individuals could increase employability of injured people following RTI.Improving injured individuals' knowledge about return-to-work processes after a road traffic injury could accelerate recovery and return to work.

Characteristics and Effectiveness of Postoperative Rehabilitation Strategies in Ankle Fractures: A Systematic Review.

OBJECTIVES: To explore the characteristics and to report on the effectiveness of postoperative rehabilitation strategies for people with an ankle fracture. DATA SOURCES: PubMed, Cochrane Library, EMBASE, Web of Science, and CINAHL were searched to identify studies published from January 2010 to November 2021. STUDY SELECTION: Studies that described or evaluated postoperative rehabilitation strategies for surgically repaired ankle fractures were included. DATA EXTRACTION: Data on postoperative rehabilitation were extracted in accordance with the Template for Intervention Description and Replication guide. Quality was assessed using the National Heart, Lung, and Blood Institute's Study Quality Assessment Tools. DATA SYNTHESIS: Meta-analysis was planned to look at the effectiveness of postoperative rehabilitation strategies. Forty studies described postoperative rehabilitation strategies without evaluating effectiveness, whereas 15 studies focused on evaluating effectiveness. Because of the large variety in postoperative strategies and outcomes, narrative synthesis was deemed most suitable to answer our aims. Characteristics of postoperative rehabilitation strategies varied widely and were poorly described in a way that could not be replicated. Most of the studies (48%) used a late weight-bearing approach, although definitions and details around weight-bearing were unclear. CONCLUSIONS: Late weight-bearing has been the most common postoperative approach reported in the past 10 years. The variety of definitions around weight-bearing and the lack of details of rehabilitation regimens limit replication and affect current clinical practice. The authors propose to adopt consistent definitions and terminology around postoperative practices such as weight-bearing to improve evidence for effectiveness and ultimately patient outcomes. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

How distracting is chronic pain? The impact of chronic pain on driving behaviour and hazard perception.

In road safety research, few studies have examined driving behaviour in chronic pain cohorts. The aim of this study was to investigate driving behaviour among drivers experiencing chronic pain. We compared individuals with chronic pain with age-gender matched healthy controls. Participants completed: (i) an anonymous online survey that included participant demographics, transport characteristics, self-reported driving behaviour, and pain characteristics (ii) a response-time hazard perception test and a verbal-response hazard prediction test for drivers, and (iii) a driving diary in which participants recorded their driving over two weeks. The results showed that participants with chronic pain were not significantly worse than controls for hazard perception and prediction test scores, self-reported attention-related errors, driving errors, driving violations, and involuntary distraction. Drivers with chronic pain did report significantly more driving lapses but this effect became non-significant when variables confounded with chronic pain, such as fatigue, were adjusted for. We also found that participants who reported particularly high levels of chronic pain performed worse in the hazard prediction test compared to the control group (and this effect could not be accounted for by other variables associated with chronic pain). In addition, participants with chronic pain reported significantly higher driving workload (mental demand, physical demand, effort, and frustration) compared with controls. The findings of this study provide new insights into driving behaviour in individuals with chronic pain and recommendations for future research in terms of driving assessment and self-regulation strategies are provided.

Evaluation of an exercise and ergonomics intervention for the prevention of neck pain in office workers: exploratory analysis of a cluster randomised trial.

OBJECTIVES: To determine the impact of a 12-week ergonomic/exercise programme compared with an ergonomic/health education programme on the development of neck pain in office workers over 12 months. METHODS: This cluster-randomised trial prospectively recruited office workers from public and private organisations. Only non-neck pain cases at baseline were included (n=484). All participants received an ergonomic workstation review then randomly allocated to receive a neck/shoulder progressive exercise programme (20 min, 3 ×/week; intervention group) or health education sessions (60 min, 1 ×/week; active control) for 12 weeks. Generalised estimating equations evaluated group differences in the point prevalence of neck pain cases (defined as those with a neck pain score of ≥3 on a 0 (no pain) to 9 (worst pain) scale) over time (3, 6, 9 and 12 months) with cumulative incidence of neck pain cases evaluated descriptively. RESULTS: While no significant group × time interaction was evident, the 12-month point prevalence of neck pain cases in the intervention group (10%) was half that of the active control group (20%) (adjusted OR 0.46, 95% CI 0.21 to 1.01, p=0.05). Lower cumulative incidence of neck pain cases was observed in the intervention (17%) compared with active control group (30%) over the 12 months. CONCLUSIONS: A combined ergonomics and exercise intervention may have more benefits in preventing neck pain cases in office workers than an ergonomic and health education intervention. Group differences were modest and should be interpreted with caution when considering strategies for primary prevention of neck pain in the office worker population. TRIAL REGISTRATION: ACTRN12612001154897.