Effectiveness of postsurgical rehabilitation following lumbar disc herniation surgery: A systematic review.

Introduction: The effectiveness of post-surgical rehabilitation following lumbar disc herniation (LDH) surgery is unclear. Research question: To investigate the effectiveness and safety of rehabilitation interventions initiated within three months post-surgery for adults treated surgically for LDH. Material and methods: This systematic review searched seven databases from inception to November 2023. Independent reviewers screened studies, assessed and extracted data, and rated the certainty of the evidence using the GRADE approach. Results: This systematic review retrieved 20,531 citations and included 25 randomized controlled trials. The high certainty evidence suggests that adding Pilates exercise to routine care and cognitive behavioral therapy may improve function immediately post-intervention (1 RCT), and that adding whole-body magnetic therapy to exercise, pharmacological and aquatic therapy may reduce low back pain intensity (1 RCT) immediately post-intervention. Compared to placebo, pregabalin did not reduce low back pain or leg pain intensity (1 RCT) (moderate to high certainty evidence). We found no differences between: 1) behavioral graded activity vs. physiotherapy (1 RCT); 2) exercise and education vs. neck massage or watchful waiting (1 RCT); 3) exercise, education, and in-hospital usual care vs. in-hospital usual care (1 RCT); 4) functional or staged exercise vs. usual post-surgical care including exercise (2 RCTs); and 5) supervised exercise with education vs. education (1 RCT). No studies assessed adverse events. Discussion and conclusion: Evidence on effective and safe post-surgical rehabilitation interventions is sparse. This review identified two interventions with potential short-term benefits (Pilates exercises, whole-body magnetic therapy) but safety is unclear, and one with an iatrogenic effect (pregabalin).

Workplace inclusion: A scoping review of the qualitative literature.

BACKGROUND: An inclusive workplace culture supports and values the individual and collective work processes of workers from diverse backgrounds. The reality or perception of inclusion or exclusion at work can influence the social functioning, health, and well-being of workers. However, we lack knowledge about the concepts relevant to inclusion at the workplace. Furthermore, research is needed to better understand the drivers and obstacles to workplace inclusion to better promote participation in working life. OBJECTIVE: This scoping review of the qualitative literature identifies the barriers to and facilitators of workplace inclusion. METHODS: Systematic searches of five databases were conducted from 2000 to January 2020. Pairs of reviewers independently screened and reviewed all citations and full-text articles. We used Arksey and O'Malley's scoping review framework which advances through five stages. Barriers and facilitators of workplace inclusion were categorized relative to a multi-layered conceptualization of workplace inclusion and grouped by theme. Studies were described and thematic results totaled and communicated with evidence tables and conceptual maps. RESULTS: Thirty-nine qualitative studies met our inclusion criteria. All five domains of the multi-layered framework were represented by the reported shared experiences of study participants. Organizational level factors, especially attitudinal barriers were the most reported barriers to workplace inclusion. Facilitators of workplace inclusion focused on employer level factors and most often cited the role of inclusive leadership and support. CONCLUSION: Workplace inclusion requires consideration of societal, organizational, employer, and interpersonal level factors in addition to individual worker characteristics.

Challenges with providing gender-sensitive care: exploring experiences within pediatric rehabilitation hospital.

PURPOSE: The purpose of this study was to explore the perceived challenges with providing a gender-sensitive care approach among pediatric rehabilitation care providers. METHODS: Using a qualitative needs assessment design and a purposive sampling strategy, we recruited clinicians from a Canadian pediatric rehabilitation hospital. We conducted interviews with 23 pediatric rehabilitation healthcare providers (19 women, 3 men, 1 transgender man) from a range of disciplines. Three coders performed a thematic analysis of the transcripts. RESULTS: Our analysis revealed the following themes regarding the perceived challenges in providing a gender-sensitive care approach: (1) a lack of training and experience; (2) gender differences and stereotypes; (3) binary documentation and potential for misgendering; (4) the complexity of gender identity; and (5) the gender of the clinician. CONCLUSIONS: Pediatric rehabilitation care providers face many challenges in offering a gender-sensitive care approach and need further training and systemic support.Implications for rehabilitationAwareness of the challenges in providing gender-sensitive care could be an important first step in helping to address inequities.Systemic and interpersonal barriers may impede the provision of gender-sensitive care among rehabilitation providers.Clinicians need more training and support in how to provide gender-sensitive care.

Risk factors for low back pain in active military personnel: a systematic review.

PURPOSE: Low back pain (LBP) is prevalent in military personnel. We aimed to systematically review the literature regarding risk factors for first-time LBP during military service among active duty military personnel. METHODS: We searched six electronic databases (inception-April 2020) for randomised controlled trials, cohort studies, and case-control studies published in English in peer-reviewed journals. Eligible studies were independently critically appraised by paired reviewers and a descriptive synthesis was conducted. RESULTS: We screened 1981 records, reviewed 118 full-text articles, and synthesised data from eight acceptable quality cohort studies. Studies assessed physical (n = 4), sociodemographic (n = 2), and/or occupational factors (n = 5) associated with LBP. Two studies reported prior LBP was associated with a greater than twofold increased risk of LBP compared to those without prior LBP. Other factors consistently associated with LBP included previous musculoskeletal injury (n = 2), less time spent on physical training (n = 2), female sex (n = 2), and lower rank (n = 2). Factors associated with LBP from single studies included marital status, lower education level, blast injury, job duties, and service type. We found inconsistent associations for performance on physical fitness tests, age, and occupation type. Psychological risk factors were not assessed in any included studies. CONCLUSION: In active duty personnel, prior history of LBP, previous musculoskeletal injury, less time in physical training, female sex, and lower rank were consistent risk factors for LBP. This information is relevant for researchers, active duty military personnel, and other decision makers. Future studies should explore causal relationships for LBP in this population. PROSPERO registration number: CRD42018084549.

The global summit on the efficacy and effectiveness of spinal manipulative therapy for the prevention and treatment of non-musculoskeletal disorders: a systematic review of the literature.

BACKGROUND: A small proportion of chiropractors, osteopaths, and other manual medicine providers use spinal manipulative therapy (SMT) to manage non-musculoskeletal disorders. However, the efficacy and effectiveness of these interventions to prevent or treat non-musculoskeletal disorders remain controversial. OBJECTIVES: We convened a Global Summit of international scientists to conduct a systematic review of the literature to determine the efficacy and effectiveness of SMT for the primary, secondary and tertiary prevention of non-musculoskeletal disorders. GLOBAL SUMMIT: The Global Summit took place on September 14-15, 2019 in Toronto, Canada. It was attended by 50 researchers from 8 countries and 28 observers from 18 chiropractic organizations. At the summit, participants critically appraised the literature and synthesized the evidence. SYSTEMATIC REVIEW OF THE LITERATURE: We searched MEDLINE, Embase, the Cochrane Central Register of Controlled Trials, the Cumulative Index to Nursing and Allied Health, and the Index to Chiropractic Literature from inception to May 15, 2019 using subject headings specific to each database and free text words relevant to manipulation/manual therapy, effectiveness, prevention, treatment, and non-musculoskeletal disorders. Eligible for review were randomized controlled trials published in English. The methodological quality of eligible studies was assessed independently by reviewers using the Scottish Intercollegiate Guidelines Network (SIGN) criteria for randomized controlled trials. We synthesized the evidence from articles with high or acceptable methodological quality according to the Synthesis without Meta-Analysis (SWiM) Guideline. The final risk of bias and evidence tables were reviewed by researchers who attended the Global Summit and 75% (38/50) had to approve the content to reach consensus. RESULTS: We retrieved 4997 citations, removed 1123 duplicates and screened 3874 citations. Of those, the eligibility of 32 articles was evaluated at the Global Summit and 16 articles were included in our systematic review. Our synthesis included six randomized controlled trials with acceptable or high methodological quality (reported in seven articles). These trials investigated the efficacy or effectiveness of SMT for the management of infantile colic, childhood asthma, hypertension, primary dysmenorrhea, and migraine. None of the trials evaluated the effectiveness of SMT in preventing the occurrence of non-musculoskeletal disorders. Consensus was reached on the content of all risk of bias and evidence tables. All randomized controlled trials with high or acceptable quality found that SMT was not superior to sham interventions for the treatment of these non-musculoskeletal disorders. Six of 50 participants (12%) in the Global Summit did not approve the final report. CONCLUSION: Our systematic review included six randomized clinical trials (534 participants) of acceptable or high quality investigating the efficacy or effectiveness of SMT for the treatment of non-musculoskeletal disorders. We found no evidence of an effect of SMT for the management of non-musculoskeletal disorders including infantile colic, childhood asthma, hypertension, primary dysmenorrhea, and migraine. This finding challenges the validity of the theory that treating spinal dysfunctions with SMT has a physiological effect on organs and their function. Governments, payers, regulators, educators, and clinicians should consider this evidence when developing policies about the use and reimbursement of SMT for non-musculoskeletal disorders.

Disclosure and workplace accommodations for people with autism: a systematic review.

PURPOSE: The objective of this systematic review was to describe the prevalence and processes of disability disclosure for persons with autism spectrum disorder. METHODS: Systematic searches of seven international databases revealed 26 studies meeting our inclusion criteria. We analyzed these studies with respect to participant demographics, methodology, results and quality of the evidence. RESULTS: Among the 26 studies, 7006 participants (aged 13-75, mean 28.1 years) were represented across seven countries. Our findings showed that rates of disclosure and receiving workplace accommodations varied considerably. Benefits of disclosing in the workplace included greater acceptance and inclusion, receiving accommodations, and increasing awareness about autism. Limitations of disclosing to employers involved experiencing stigma and discrimination. Factors affecting decisions to disclose included age at diagnosis, social demands of the job, and workplace policies. Types of accommodations that were received or desired included adjustments to the job interview process, schedules (i.e., flexibility, working from home), job content or working conditions, environment (i.e., lighting, quiet space); support with communication and social skills; and disability awareness training for their workplace colleagues. CONCLUSIONS: Our findings highlight that disclosing a condition of autism in the workplace and requesting accommodations is complex. More research is needed to explore processes of disclosing and accommodation and how these processes vary by autism sub-type, gender, and industry type.Implications for rehabilitationClinicians and vocational Counselors should support people with autism to advocate for their needs in the workplace, including the potential benefits of disclosing their conditions so they can access accommodations that allow them to keep healthy and productive in workplace.Clinicians should recognize that people with autism spectrum disorder may have different workplace accommodation needs than those with other types of disabilities, in particular support with social and communication skills.Clinicians should aid people with autism to access resources and supports that are available to them to access workplace accommodations.

Measures of Workplace Inclusion: A Systematic Review Using the COSMIN Methodology.

Purpose To systematically assess the measurement properties and the quality of the evidence for measures of inclusion or exclusion at work. Methods Comprehensive searches of five electronic databases were conducted up to February 2019. Eligible studies aimed to develop a measure of workplace inclusion or exclusion or assessed at least one measurement property. Pairs of reviewers independently screened articles and assessed risk of bias. Methodological quality was appraised with the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist. A best-evidence synthesis approach guided the analysis. For each measurement property, evidence quality was rated as high, moderate, low, or very low and results were classified as sufficient, insufficient, or inconsistent. Results The titles and abstracts of 14,380 articles were screened, with 151 full-text articles reviewed for eligibility. Of these, 27 studies were identified, 10 of which were measure development studies. Included measures were the Workplace Ostracism Scale, Ostracism Interventionary Behaviour Scale, Workplace Culture Survey, Workplace Exclusion Scale, Perceived Group Inclusion Scale, Organizational Cultural Intelligence Scale, Inclusion-Exclusion Scale, Climate for Inclusion Scale, Workplace Social Inclusion Scale and the Inclusion-Diversity Scale. Most workplace inclusion instruments were not examined for some form of validity or reliability and evidence for responsiveness was absent. The quality of the evidence for content validity was low for 30% of studies and very low for 70% of studies. Conclusion Future research should focus on comprehensive evaluations of the psychometric properties of existing measures, with an emphasis on content validity, measurement error, reliability and responsiveness.

The chiropractic workforce: a global review.

Background: The world is faced with a chronic shortage of health workers, and the World Health Organization (WHO) has estimated a global shortage of 7.2 million health workers resulting in large gaps in service provision for people with disability. The magnitude of the unmet needs, especially within musculoskeletal conditions, is not well established as global data on health work resources are scarce. Methods: We conducted an international, cross-sectional survey of all 193 United Nation member countries and seven dependencies to describe the global chiropractic workforce in terms of the availability (numbers and where they are practising), quality (education and licensing), accessibility (entry and reimbursement), and acceptability (scope of practice and legal rights). An electronic survey was issued to contact persons of constituent member associations of the World Federation of Chiropractic (WFC). In addition, data were collected from government websites, personal communication and internet searches. Data were analysed using descriptive statistics. Worldwide density maps of the distribution of numbers of chiropractors and providers of chiropractic education were graphically presented. Results: Information was available from 90 countries in which at least one chiropractor was present. The total number of chiropractors worldwide was 103,469. The number of chiropractors per country ranged from 1 to 77,000 (median = 10; IQR = [4-113]). Chiropractic education was offered in 48 institutions in 19 countries. Direct access to chiropractic services was available in 81 (90%) countries, and services were partially or fully covered by government and/or private health schemes in 46 (51.1%) countries. The practice of chiropractic was legally recognized in 68 (75.6%) of the 90 countries. It was explicitly illegal in 12 (13.3%) countries. Conclusion: We have provided information about the global chiropractic workforce. The profession is represented in 90 countries, but the distribution of chiropractors and chiropractic educational institutions, and governing legislations and regulations largely favour high-income countries. There is a large under-representation in low- and middle-income countries in terms of provision of services, education and legislative and regulatory frameworks, and the available data from these countries are limited.

Is neck pain associated with worse health-related quality of life 6 months later? A population-based cohort study.

BACKGROUND CONTEXT: Current evidence suggests that neck pain is negatively associated with health-related quality of life (HRQoL). However, these studies are cross-sectional and do not inform the association between neck pain and future HRQoL. PURPOSE: The purpose of this study was to investigate the association between increasing grades of neck pain severity and HRQoL 6 months later. In addition, this longitudinal study examines the crude association between the course of neck pain and HRQoL. STUDY DESIGN: This is a population-based cohort study. PATIENT SAMPLE: Eleven hundred randomly sampled Saskatchewan adults were included. OUTCOME MEASURES: Outcome measures were the mental component summary (MCS) and physical component summary (PCS) of the Short-Form-36 (SF-36) questionnaire. METHODS: We formed a cohort of 1,100 randomly sampled Saskatchewan adults in September 1995. We used the Chronic Pain Questionnaire to measure neck pain and its related disability. The SF-36 questionnaire was used to measure physical and mental HRQoL 6 months later. Multivariable linear regression was used to measure the association between graded neck pain and HRQoL while controlling for confounding. Analysis of variance and t tests were used to measure the crude association among four possible courses of neck pain and HRQoL at 6 months. The neck pain trajectories over 6 months were no or mild neck pain, improving neck pain, worsening neck pain, and persistent neck pain. Finally, analysis of variance was used to examine changes in baseline to 6-month PCS and MCS scores among the four neck pain trajectory groups. RESULTS: The 6-month follow-up rate was 74.9%. We found an exposure-response relationship between neck pain and physical HRQoL after adjusting for age, education, arthritis, low back pain, and depressive symptomatology. Compared with participants without neck pain at baseline, those with mild (ß=-1.53, 95% confidence interval [CI]=-2.83, -0.24), intense (ß=-3.60, 95% CI=-5.76, -1.44), or disabling (ß=-8.55, 95% CI=-11.68, -5.42) neck pain had worse physical HRQoL 6 months later. We did not find an association between neck pain and mental HRQoL. A worsening course of neck pain and persistent neck pain were associated with worse physical HRQoL. CONCLUSIONS: We found that neck pain was negatively associated with physical but not mental HRQoL. Our analysis suggests that neck pain may be a contributor of future poor physical HRQoL in the population. Raising awareness of the possible future impact of neck pain on physical HRQoL is important for health-care providers and policy makers with respect to the management of neck pain in populations.

Health care utilization of workers' compensation claimants associated with mild traumatic brain injury: a historical population-based cohort study of workers injured in 1997-1998.

OBJECTIVE: To compare the health care use of workers with an injury before and after making a workers' compensation claim for mild traumatic brain injury (MTBI). DESIGN: Cohort study of workers with an MTBI who received workers' compensation benefits. SETTING: Workers' compensation system in Ontario, Canada. PARTICIPANTS: Workers (N=728) who made an incident claim involving MTBI to the Ontario Workplace Safety and Insurance Board between 1997 and 1998. We linked workers' compensation and Ontario Health Insurance Plan files and collected all health care services accrued during the year before and 2 years after the claim was initiated. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: We report our results as a 7-day simple moving average of health care services per 1000 claimants per day. We stratified our analysis by age, sex, the preclaim level of health care utilization, diagnostic category, and health care specialty. RESULTS: Over the 2 years, 728 claims related to MTBI were filed by workers with an injury. The majority of the claims (65.8%) were filed by men, and 28.3% were filed by those aged between 25 and 34 years. The cumulative rate of health care utilization was stable (mean=67.6 visits/1000 claimants per day; 95% confidence interval [CI], 65.0-70.2) throughout the year before claim initiation. Health care utilization peaked during the first 4 weeks following the initiation of the claim (mean=274.3 visits/1000 claimants per day; 95% CI, 172.2-376.4) and remained on average 182% higher than that at baseline throughout the 5th to 12th week postclaim. Two years after the initiation of the claim, utilization remained 9.5% higher than the preclaim level. The increase was more pronounced (125% higher) for workers with less than the median preclaim utilization level. CONCLUSIONS: Making a workers' compensation claim involving MTBI is associated with a long-term increase in health care use.

The association between workers' compensation claims involving neck pain and future health care utilization: a population-based cohort study.

PURPOSE: To describe the health care utilization of injured workers who made a workers' compensation claim for neck pain. METHODS: We conducted a cohort study of injured workers who made an incident claim involving neck pain to the Ontario Workplace Safety and Insurance Board between 1997 and 1998. We linked their workers' compensation and Ontario Health Insurance Plan files to collect all health care services accrued during the year prior to and 2 years after the claim was initiated. We report the 7 day simple moving average of health care services per 1,000 claimants per day. We stratified our analysis by age, sex, the pre-claim level of health care utilization, diagnostic category and health care specialty. RESULTS: 58.1 % of claimants were males and 35.1 % were between the ages of 35 and 44 years. The cumulative rate of health care utilization was stable (mean = 60.80 services/1,000 claimants/day; 95 % CI: 59.7-62.0) throughout the year prior to the claim. However, it peaked during the first 4 days following the onset of the claim (mean = 473.3 services/1,000 claimants/day) and remained on average 311 % higher than baseline during the first month post-claim. On average in our sample, the health care utilization remained 11 % higher in the second year after the claim compared to the pre-claim level. This sustained increase was attributable to 6 % of claimants. CONCLUSIONS: We report a long-term increase in the average number of health care services utilized by injured workers who make a workers' compensation claim involving neck pain. This increase was attributable to a minority of claimants. The health reasons for this increase deserve further investigation.

The course of work absenteeism involving neck pain: a cohort study of Ontario lost-time claimants.

STUDY DESIGN: Cohort study. OBJECTIVE: To describe the course of lost-time claims involving neck pain in workers compensated by the Ontario Workplace Safety and Insurance Board (WSIB). SUMMARY OF BACKGROUND DATA: The prevalence of neck pain in workers varies from 27.1% to 47.8%. Very little is known about the course of work absenteeism related to neck pain. METHODS: Our cohort included 5761 injured workers with an incident lost-time claim to the WSIB in 1997 and 1998. Claimants were followed for 2 years. We measured the cumulative time on lost-time benefits using the Kaplan-Meier method and described the number and duration of episodes on benefits. RESULTS: The median cumulative time-on-benefits for the cohort was 13 days (95% CI: 13-14). The cumulative time on benefits was shorter for men than women and for younger than older workers. 14.2% of claimants experienced multiple episodes of work absenteeism during the 2 years after the initial claim. The median time on benefits for claimants with a single episode was 11 days (95% CI: 10-11). The median length of the first episode on benefits was longer for claimants with multiple episodes (19-22 days) compared with those with a single episode (11 days). Age was positively associated with longer time-on-benefits in claimants with a single episode of work absenteeism. CONCLUSION: Most injured workers who make a workers' compensation claim that involves neck pain do not make a second claim in the subsequent 2 years. However, an important minority (14.2%) experience multiple episodes of work absenteeism and these workers accrue 40.4% of all lost-time days. Recurrent claims involving neck pain represent a significant burden of disability in Ontario.

The association between prevalent neck pain and health-related quality of life: a cross-sectional analysis.

The aim of this study was to examine the association between grades of neck pain severity and health-related quality of life (HRQoL), using a population-based, cross-sectional mailed survey. The literature suggests that physical and mental HRQoL is worse for individuals with neck pain compared to those without neck pain. However, the strength of the association varies across studies. Discrepancies in study results may be attributed to the use of different definitions and measures of neck pain and differences in the selection of covariates used as control variables in the analyses. The Saskatchewan Health and Back Pain Survey was mailed to 2,184 randomly selected Saskatchewan adults of whom 1,131 returned the questionnaire. Neck pain was measured with the Chronic Pain Questionnaire and categorized into four increasing grades of severity. We measured HRQoL with the SF-36 Health Survey and computed the physical and mental component summary scores. We built separate multiple linear regression models to examine the association between grades of neck pain and physical and mental summary scores while controlling for sociodemographic, general health and comorbidity covariates. Our crude analysis suggests that a gradient exists between the severity of neck pain and HRQoL. Compared to individuals without neck pain, those with Grades III-IV neck pain have significantly lower physical (mean difference = -13.9/100; 95% CI = -16.4, -11.3) and mental (mean difference = -10.8/100; 95% CI = -13.6, -8.1) HRQoL. Controlling for covariates greatly reduced the strength of association between neck pain and physical HRQoL and accounted for the observed association between neck pain and mental HRQoL. In the comorbidity model, the strength of association between Grades III-IV neck pain and PCS decreased by more than 50% (mean difference = -4.5/100; 95% CI = -6.9, -2.0). In the final PCS model, Grades III-IV neck pain coefficients changed only slightly from the comorbidity model (mean difference = -4.4/100; 95% CI = -6.9, -1.9). This suggests that comorbid conditions account for most of the association between neck pain and PCS score. It was concluded that prevalent neck pain is weakly associated with physical HRQoL, and that it is not associated with mental HRQoL. Our cross-sectional analysis suggests that most of the observed association between prevalent neck pain and HRQoL is attributable to comorbidities.

Prevalence of lost-time claims for mild traumatic brain injury in the working population: improving estimates using workers compensation databases.

PRIMARY OBJECTIVE: To test the usefulness of a method to improve the measurement of prevalent mild traumatic brain injury (MTBI) among injured workers with a workers compensation claim. METHODS: Database codes were selected to identify MTBI cases in the Ontario workers compensation lost-time claims database. A random sample of 210 claims was selected, classified as MTBI or not, and used to calculate proportions with MTBI among code groups. The annual prevalence of MTBI in 1997 and 1998 was calculated by weighting the numerators with the appropriate proportions of MTBI within each code group. RESULTS: Four code groups were created: the head region, cranial region, concussion code group and the brain region. The proportion of MTBI in each group was 29%, 19%, 92% and 32%, respectively. The 1997 prevalence depended on the codes used, from 39/10,000 (95% confidence interval (CI): 35-44) for a weighted version of the 'concussion' code to 58/10,000 (95% CI: 50-65) for inclusion of all identified MTBI codes. CONCLUSIONS: Restricting the enumeration of MTBI to specific 'concussion' codes can lead to under-estimation of the prevalence of MTBI in epidemiological studies using workers compensation data. Approximately six out of every 1000 lost-time claims are associated with MTBI. Given lost-time estimates of disability under-estimate the prevalence of this mild injury, MTBI, is an important workplace injury.