Directions for advancing the study of work transitions in the 21st century.

OBJECTIVES: The purpose of this article is to share the details, outcomes and deliverables from an international workshop on work transitions in London, Ontario, Canada. PARTICIPANTS: Researchers, graduate students, and community group members met to identity ways to advance the knowledge base of strategies to enhance work participation for those in the most disadvantaged groups within society. METHODS: A participatory approach was used in this workshop with presentations by researchers and graduate students. This approach included dialogue and discussion with community members. In addition, small group dialogue and debate, world cafe discussions, written summaries of group discussion and reflection boards were used to bring new ideas to the discussion and to build upon what we know. FINDINGS: Two research imperatives and six research recommendations were identified to advance global dialogue on work transitions and to advance the knowledge base. Occupational justice can be used to support future research directions in the study of work transitions. CONCLUSIONS: Moving forward requires a commitment of community of researchers, clinicians and stakeholders to address work disparities and implement solutions to promote participation in work.

Using multiple stakeholders to define a successful return to work: a concept mapping approach.

OBJECTIVE: Currently no standard or universal outcome measure for return to work (RTW) programs exists making the evaluation and comparison of such programs difficult. RTW outcomes are often measured using nominal scales based on administrative data but these fail to take the perspectives of workers and other stakeholders into consideration. In order to gain that perspective this study was conducted to identify what outcomes are of interest and importance to RTW stakeholders. RTW stakeholders identified indicators of successful RTW in order to develop a conceptual framework of successful RTW. PARTICIPANTS: A total of 24 RTW stakeholders participated, representing both RTW consumers and providers from Southwestern Ontario. METHOD: This study used a mixed-method integrated form of concept mapping, which qualitatively generates and interprets data, and quantitatively analyzes data using multidimensional scaling and hierarchical cluster analysis. RESULTS: Participants generated 48 statements, which were subsequently clustered into the following six concepts; worker performance, worker job satisfaction, human rights, worker well-being, seamless RTW process through collaborative communication, and satisfaction of stakeholders other than workers. CONCLUSIONS: The results reflect the perspectives of stakeholders and suggest that RTW outcome measures are needed that not only evaluate all aspects of the worker's life, but the RTW process as well. Aside from confirming the inadequacy of nominal, administrative type outcomes, these findings imply that the actual RTW process is intimately tied to outcome. Implications and relevance are discussed for planning RTW programs and towards developing a RTW outcome tool.

Ergonomic interventions for office workers with musculoskeletal disorders: a systematic review.

INTRODUCTION: Ergonomic interventions designed for office and computer work have become widely available and heavily marketed but there is little evidence to support their use with workers who already have a musculoskeletal disorder (MSD). The purpose of any ergonomic intervention can be to improve worker comfort, safety and/or productivity. The ergonomic research in secondary prevention typically focuses outcomes on improved worker comfort but less if any emphasis has been put on productivity and safety. The purpose of this study was to determine the level and quality of evidence supporting ergonomic interventions to improve the comfort, safety and/or productivity of office workers with symptoms of MSDs. METHOD: A search of the ergonomic intervention literature based on MSDs of four body areas (low back, upper limb, eye and neck) was employed. The studies underwent two levels of analysis for inclusion in a best-evidence synthesis approach, which included a priori evaluation of specific interventions relative to outcomes of comfort, safety and/or productivity. RESULTS: Twenty-seven out of 202 articles were synthesized based on relevance, quality and significant results. Only 8 articles were determined high quality and no strong levels of evidence were identified. Levels of evidence for specific ergonomic interventions ranged from insufficient to moderate. Generally outcomes were focused mostly on improved comfort of workers. CONCLUSIONS: There is still limited quality research that addresses ergonomic interventions designed for secondary prevention. Further high quality studies are needed to support evidence-based ergonomic interventions in practice. For all stakeholders to fully evaluate the usefulness of the ergonomic intervention studies need to attend to outcomes not only of worker comfort but also to productivity and safety.

Coping with chronic pain: current advances and practical information for clinicians.

Transferring knowledge and evidence from the pain psychology literature to all types of practitioners is one small but important step towards reducing the economic and personal cost of injuries. Through early identification of at-risk clients, it may be possible to prevent chronic pain from developing. Pain is a perception which is affected by physical, psychological and social factors, yet many health care professionals are only beginning to consider the relative contributions of each of these elements. It is essential that clinicians understanding of how a client's pain coping strategies impact progress and functional outcomes. For clients endorsing maladaptive methods of coping, one step is to refer the client to a psychologist; however, understanding of key underlying principles can also inform any type of treatment. All care providers involved with the client should discourage maladaptive strategies where appropriate and encouraging adaptive ones. Of equal importance is knowing whether or not the client is ready to adapt to change. Clinician knowledge of coping strategies and readiness may also help reduce the likelihood of clients withdrawing from treatment in frustration. The end result will hopefully be less disability and improved functioning of clients experiencing chronic pain.

Using the ICF as a conceptual framework to guide ergonomic intervention in occupational rehabilitation.

Traditional treatment of work-related musculoskeletal disorders focuses on the body functions and body structures aspects of the injury, with little or no attention paid to ergonomics as a form of treatment. The use of ergonomics in preventing disability in injured workers is a relatively new area of study. There are a number of factors that may contribute to the lack of emphasis on ergonomic interventions in the prevention of disability following musculoskeletal injury. For instance, a review of the knowledge base suggests that there is a lack of a formal conceptualization or standardized approach to ergonomics in the return to work process. In part, this lack of consistency may be due to the varied disciplinary backgrounds of ergonomists, leading individuals to view ergonomics from a specific perspective, rather than utilizing a transdisciplinary approach. The purpose of this paper is to introduce a new practice model of occupational rehabilitation ergonomics. The model draws upon the International Classification of Functioning, Disability, and Health (ICF) and merges this with basic ergonomic and rehabilitation principles.

Validating the potential of the International Classification of Functioning, Disability and Health to identify barriers to and facilitators of consumer participation.

BACKGROUND: Occupational therapists need tools to identify barriers and facilitators to participation in societal roles. PURPOSE: The purpose of this study was to examine the potential of the International Classification of Functioning, Disability and Health (ICF) two-level classification for use in occupational therapy. METHODS: A secondary analysis of an existing dataset was conducted to identify participation barriers and facilitators that mapped to the ICF and those that did not. RESULTS: A broad range of factors was captured across the components of the ICF. Findings also revealed enabling and disabling factors that were not evident in the ICF. PRACTICE IMPLICATIONS: The ICF can support the identification of a broad range of external barriers and facilitators relevant to participation and of interest to occupational therapy. However, therapists must use other strategies to gain a comprehensive understanding of the nature, extent and consequences of barriers and facilitators that may exist in a given

A comparison of the International Classification of Functioning, Disability, and Health to the disability tax credit.

BACKGROUND: The Disability Tax Credit (DTC) Certification is an assessment tool used to provide Canadians with disability tax relief The International Classification of Functioning, Disability and Health (ICF) provides a universal framework for defining disability. PURPOSE: The purpose of this study was to evaluate the DTC and familiarize occupational therapists with the process of mapping measures to the ICF classification system. METHOD: Concepts within the DTC were identified and mapped to appropriate ICF codes (Cieza et al., 2005). RESULTS: The DTC was linked to 45 unique ICF codes (16 Body Functions, 19 Activities and Participation, and 8 Environmental Factors). IMPLICATIONS: The DTC encompasses various domains of the ICF; however, there is no consideration of Personal Factors, Body Structures, and key aspects of Activities and Participation. Refining the DTC to address these aspects will provide an opportunity for fair and just determinations for those who experience disability.