[Supporting the return to work following sick leave for a depressive disorder: why and how?] / Soutenir le retour au travail après un arrêt de travail en raison d'un trouble dépressif : pourquoi et comment faire en soins primaires ?

Depressive disorders have become one of the main causes of sick leave in recent years. For the individuals concerned, the risk of long-term work disability is very real and generates considerable human and social costs, not to mention financial costs. Despite its importance, the issue of the return to work is rarely presented to primary care professionals, among others, as a priority to be factored into their clinical interventions. The latter thus have very few guidelines to help them choose the best intervention for promoting a timely return to work and may even question the relevance of such an objective.The purpose of this article is therefore to propose a set of reference points for primary care professionals by answering the following question: why and how should the return to work be supported following sick leave for a depressive disorder? The first part of the article provides an overview of current knowledge that supports the relevance of early intervention to the prevention of long-term work disability. The second part proposes a number of promising interventions for achieving this objective and feasible for primary care professionals. These proposals are based on recent research work by our team.

Evaluation of the implementation fidelity of an ergonomic training program designed to prevent back pain.

The aim of this study was to evaluate the implementation fidelity of a multidimensional ergonomic program designed to prevent back pain injuries among healthcare personnel. The program, provided by peer trainers included training intended to modify patient handling and transfer behaviour, trainee follow-up, prevention activities aimed at work environment improvements and follow-up monitors training. Two hundred twenty-one peer trainers at 139 Quebec healthcare institutions participated in our study. Only 61.5% were involved in training; most of them taught safe patient handling, positioning, transfer, and preparation techniques, which are the cornerstones of the program; 72.7% were involved in prevention activities, 46.1% in follow-up activities, and 10.7% in follow-up monitors training. The study results should help organizations anticipate and prevent potential discrepancies between prescribed and implemented programs.

Psychological predictors of pain expression and activity intolerance in chronic pain patients.

Recent research suggests that communicative and protective pain behaviors represent functionally distinct subsystems of behavior associated with pain. The present research examined whether components of pain experience such as pain severity, catastrophizing and fear of pain were differentially associated with communicative and protective pain behaviors. It was predicted that pain severity would be associated with decreased physical tolerance and heightened expression of pain behavior. It was also predicted that pain catastrophizing would be preferentially associated with communicative pain behaviors, and fear of pain would be preferentially associated with protective pain behaviors and decreased physical tolerance. To test these predictions, work-disabled patients with musculoskeletal pain conditions (N=72) were filmed as they participated in a simulated occupational lifting task. Multiple regressions revealed that pain severity was uniquely associated with decreased physical tolerance and increased expression of protective pain behaviors. Pain catastrophizing was uniquely associated with the expression of both communicative and protective pain behaviors. Fear of pain was associated with physical tolerance and protective pain behaviors but not when controlling for pain severity. This study provides additional evidence for the functional distinctiveness of different types of pain expression and provides preliminary evidence for the functional distinctiveness of pain expression and activity intolerance. Discussion addresses the processes by which psychological factors might influence the display of different types of pain behaviors. Discussion also addresses how different types of interventions might be required to specifically target the sensory and behavioral dimensions of the pain system.