Managing work participation for people with rheumatic and musculoskeletal diseases.

Improving work participation for individuals with rheumatic and musculoskeletal diseases (RMDs), has gained increasing interest over the last 10 years. New approaches are based upon increasing adoption of a biopsychosocial approach to improving work participation, incorporating evidence that health professionals within multidisciplinary teams have a key and critical role. In particular, interaction between health professionals and employers, and rehabilitation services that are linked to the workplace are key elements for improving work participation for people with RMDs. This review outlines recent research that underpins approaches for health professionals to develop their role in improving work participation for people with RMDs based on recent research; it outlines how to measure work-related outcomes in clinical practice, models of work participation, and approaches for health professionals to improve work participation outcomes. The potential for developing the role of health professionals in future years is also outlined.

Avaliação de incapacidade e funcionalidade de trabalhadoras com LER/DORT: uso da CIF em checklist / Disability and functioning assessment of women with RSI/WRMSDs: the use of the ICF checklist

Introdução: As abordagens compreensivas utilizando o modelo do checklist da Classificação Internacional de Funcionalidade, Incapacidade e Saúde (CIF) vêm sendo utilizadas para dar visibilidade às demandas em situações de saúde específicas. Objetivo: Avaliar a incapacidade e funcionalidade relacionadas à atividade/participação e a fatores ambientais apresentadas por trabalhadoras com lesões por esforço repetitivo/distúrbios osteomusculares relacionados ao trabalho (LER/DORT) por meio da associação entre suas narrativas, os códigos da CIF e o do checklist LER/DORT criado por profissionais. Métodos: Foi realizado um estudo qualitativo com 15 trabalhadoras com diagnóstico de LER/DORT que responderam a uma entrevista em profundidade. A avaliação da incapacidade e funcionalidade deu-se pela ligação entre os códigos da CIF identificados nas entrevistas e os que constavam do checklist. Resultados: Cinquenta e três dos 60 códigos da CIF presentes no checklist para LER/DORT foram identificados nas entrevistas. Acerca da atividade/participação, foram reconhecidos 26 códigos, e dos fatores ambientais, foram identificados 27 códigos. Conclusões: Esses resultados apontam que o checklist LER/DORT é um importante instrumento cujo uso pode facilitar a identificação dos aspectos clínicos e sociais vivenciados pelos trabalhadores no seu processo de reabilitação e retorno ao trabalho. Os achados deste estudo reforçam a importância da ampliação da aplicação do checklis tem trabalhadores e trabalhadoras com LER/DORT em processo de reabilitação para que alcancemos outros níveis de sua validação

Background: Comprehensive approaches using the International Classification of Functioning, Disability and Health (ICF) Checklist have been adopted to give more visibility to demands related to specific health situations. Objective: To analyze the incapacity and functioning associated with activity/participation and environmental factors of female workers with repetitive strain injury/work-related musculoskeletal disorders (RSI/WRMSDs) using workers' narratives, ICF codes and the RSI/WRMSDs Checklist developed as a part of the present research project. Methods: A qualitative analysis of in-depth interviews with 15 female workers diagnosed with RSI/WRMSDs was completed. Functioning and disability were assessed by linking ICF codes identified in the participants' narratives to those included in the RSI/WRMSDs Checklist. Results: Fifty-three of 60 ICF codes included in the RSI/WRMSDs Checklist were detected in the participants' narratives. Related to activity/participation, 26 codes were identified and 27 related to environmental factors. Conclusion: These results highlight the significance of the RSI/WMSDs Checklist to detect clinical and social problems experienced by workers during the rehabilitation and return-to-work process. They also reinforce the relevance of expanding the application of the checklist to male and female workers with RSI/WRMSDs undergoing rehabilitation to attain other levels of validation.

Disability and functioning assessment of women with RSI/WRMSDs: the use of the ICF checklist.

BACKGROUND: Comprehensive approaches using the International Classification of Functioning, Disability and Health (ICF) Checklist have been adopted to give more visibility to demands related to specific health situations. OBJECTIVE: To analyze the incapacity and functioning associated with activity/participation and environmental factors of female workers with repetitive strain injury/work-related musculoskeletal disorders (RSI/WRMSDs) using workers' narratives, ICF codes and the RSI/WRMSDs Checklist developed as a part of the present research project. METHODS: A qualitative analysis of in-depth interviews with 15 female workers diagnosed with RSI/WRMSDs was completed. Functioning and disability were assessed by linking ICF codes identified in the participants' narratives to those included in the RSI/WRMSDs Checklist. RESULTS: Fifty-three of 60 ICF codes included in the RSI/WRMSDs Checklist were detected in the participants' narratives. Related to activity/participation, 26 codes were identified and 27 related to environmental factors. CONCLUSION: These results highlight the significance of the RSI/WMSDs Checklist to detect clinical and social problems experienced by workers during the rehabilitation and return-to-work process. They also reinforce the relevance of expanding the application of the checklist to male and female workers with RSI/WRMSDs undergoing rehabilitation to attain other levels of validation.

INTRODUÇÃO: As abordagens compreensivas utilizando o modelo do checklist da Classificação Internacional de Funcionalidade, Incapacidade e Saúde (CIF) vêm sendo utilizadas para dar visibilidade às demandas em situações de saúde específicas. OBJETIVO: Avaliar a incapacidade e funcionalidade relacionadas à atividade/participação e a fatores ambientais apresentadas por trabalhadoras com lesões por esforço repetitivo/distúrbios osteomusculares relacionados ao trabalho (LER/DORT) por meio da associação entre suas narrativas, os códigos da CIF e o do checklist LER/DORT criado por profissionais. MÉTODOS: Foi realizado um estudo qualitativo com 15 trabalhadoras com diagnóstico de LER/DORT que responderam a uma entrevista em profundidade. A avaliação da incapacidade e funcionalidade deu-se pela ligação entre os códigos da CIF identificados nas entrevistas e os que constavam do checklist. RESULTADOS: Cinquenta e três dos 60 códigos da CIF presentes no checklist para LER/DORT foram identificados nas entrevistas. Acerca da atividade/participação, foram reconhecidos 26 códigos, e dos fatores ambientais, foram identificados 27 códigos. CONCLUSÕES: Esses resultados apontam que o checklist LER/DORT é um importante instrumento cujo uso pode facilitar a identificação dos aspectos clínicos e sociais vivenciados pelos trabalhadores no seu processo de reabilitação e retorno ao trabalho. Os achados deste estudo reforçam a importância da ampliação da aplicação do checklis tem trabalhadores e trabalhadoras com ­LER/­DORT em processo de reabilitação para que alcancemos outros níveis de sua validação.

Barriers to and facilitators for implementing an office ergonomics programme in a South African research organisation.

The focus of this study was on the possibility of implementing an office ergonomics programme as part of a broader workplace health initiative at a South African research organisation. We explored the perspectives of actors in the workplace regarding organisational barriers and facilitators to implementing ergonomic interventions. This qualitative study presents the perspectives of three workplace actor groups: operational managers (n = 4); health and safety representatives (n = 9); and office employees (n = 4) who were involved in a previous ergonomic assessments that proposed several corrective and preventive actions. Eight factors emerged as either barriers or as simultaneous barriers and facilitators to the implementation of proposed ergonomic interventions. These are: organisational culture; information and specialist support; funding; support from operational managers; attitude towards changes; general organisational awareness; individual knowledge of ergonomics; and support from colleagues. This study is one of the first in South Africa to investigate the perspectives of workplace actors in an office setting with regard to factors that influence implementation of ergonomics initiatives to reduce work-related musculoskeletal disorders.

Modelo lógico de um programa de retorno ao trabalho: instrumento orientador para prevenir a incapacidade / Logical model of a return to work program: guiding tool to prevent disability

Resumo Introdução: organizar e avaliar Programas de Retorno ao Trabalho (PRT) de indivíduos afastados por incapacidade, decorrente de lesões sofridas no ambiente laboral, é de grande importância para o Sistema Único de Saúde (SUS). Objetivo: construir o Modelo Lógico do PRT desenvolvido pelo Centro Estadual de Referência em Saúde do Trabalhador da Bahia (Cesat/Bahia) como uma das etapas iniciais do processo de avaliação da sua implantação. Método: estudo de caso único, integrado e retrospectivo, visando a elaboração de Modelo Lógico baseado em roteiro formulado pelo Instituto de Pesquisa Econômica Aplicada (Ipea) para avaliação de programas. Resultados: o Modelo Lógico final do PRT-Cesat/Bahia foi construído em três dimensões operacionais -indivíduo (trabalhador), ambiente de trabalho e atores sociais -, permitindo que a equipe coordenadora refletisse sobre as várias etapas do processo e sobre o impacto e a utilidade do programa para a população. Conclusão: o Modelo Lógico possibilita aos profissionais de saúde, pesquisadores, trabalhadores e demais atores sociais debater o conteúdo, princípios, recursos e teorias para implantação, replicação e avaliação de PRT.

Abstract Introduction: it is of great importance for the Brazilian Unified Health System (SUS) to organize and evaluate Return to Work programs for workers in disability leave due to injuries suffered in the work environment. Objective: to construct the Logical Model of the Return to Work program developed by the Bahia State Worker's Health Reference Center (Cesat/Bahia) as one of the initial stages for the evaluation of its implantation process. Method: a single, integrated and retrospective case study, aiming at elaborating a Logical Model based on a script formulated by the Institute for Applied Economic Research (Ipea). Results: the Cesat/Bahia Logical Model of Return to Work program was constructed in three operational dimensions - individual (worker), work environment and social actors -, allowing the coordinating team to reflect on its process stages as well as on the program impact and utility for the population. Conclusion: the Logical Model enables health professionals, researchers, workers and other social actors to discuss the content, principles, resources and theories for the implementation, propagation and evaluation of the Return to Work program.

Applying theories to better understand socio-political challenges in implementing evidence-based work disability prevention strategies.

PURPOSE: This article explores and applies theories for analyzing socio-political aspects of implementation of work disability prevention (WDP) strategies. METHOD: For the analysis, theories from political science are explained and discussed in relation to case examples from three jurisdictions (Sweden, Brazil and Québec). RESULTS: Implementation of WDP strategies may be studied through a conceptual framework that targets: (1) the institutional system in which policy-makers and other stakeholders reside; (2) the ambiguity and conflicts regarding what to do and how to do it; (3) the bounded rationality, path dependency and social systems of different stakeholders; and (4) coalitions formed by different stakeholders and power relations between them. In the case examples, the design of social insurance systems, the access to and infrastructure of healthcare systems, labor market policies, employers' level of responsibility, the regulatory environment, and the general knowledge of WDP issues among stakeholders played different roles in the implementation of policies based on scientific evidence. CONCLUSIONS: Future research may involve participatory approaches focusing on building coalitions and communities of practice with policy-makers and stakeholders, in order to build trust, facilitate cooperation, and to better promote evidence utilization. Implications for Rehabilitation Implementation of work disability prevention policies are subject to contextual influences from the socio-political setting and from relationships between stakeholders Stakeholders involved in implementing strategies are bound to act based on their interests and previous courses of action To promote research uptake on the policy level, stakeholders and researchers need to engage in collaboration and translational activities Political stakeholders at the government and community levels need to be more directly involved as partners in the production and utilization of evidence.

The practical application of theory and research for preventing work disability: a new paradigm for occupational rehabilitation services in China?

INTRODUCTION: Theoretical frameworks for preventing work disability have evolved over the last decade and various experimental models have been tested in occupational rehabilitation settings. The successful application and uptake of the most recent research evidence in rehabilitation practices depend on a complex interplay of the decisions of multi-stakeholders, including their perceptions of the evidence, a proper regulatory framework for injury prevention, compensation and disability management; as well as the cultural and socioeconomic factors unique to each country (social context). This paper summarizes the scope of the work disability prevention field and describes the contextual barriers and support mechanisms for implementing evidence-based practices for disability prevention in China's national rehabilitation system. METHODS: Expert opinions and relevant publications in the field were reasoned around key constructs of a translational model used to identify potential barriers and support platforms for research uptake in China. RESULTS: A crucial component of experimental models for disability prevention is to promote well-coordinated return to work actions centred in the workplace. Potential barriers and support mechanisms for implementing this and other evidence-based recommendations in China are described. CONCLUSIONS: The complexity of implementing a system-wide disability prevention model in a country as large and diverse as China is well-recognized. Improved efforts are thus required for international knowledge-sharing that can empower greater research utilization of effective disability prevention methods in China. The development of well-connected communities of practice might be a helpful strategy for enhancing stakeholders' perceptions, attitudes and collaborative efforts towards locally relevant and cultural sensitive solutions to work disability.

Back pain and work.

Low back pain is a leading cause of work disability and constitutes a significant socioeconomic burden worldwide. In an attempt to stem the serious consequences of long-term disability, a new approach for back pain in primary care is being disseminated. It mainly focusses on identifying the relationship between pain/disability and work, recognising important workplace and psychosocial issues, providing patients reassuring messages about activity, facilitating the return to work process and engaging other resources as needed. This article examines current expert opinion and available evidence on work issues for effective back pain management. In general, return to work, if safe, is beneficial for recovery and well-being. Some cases might require physicians to actively communicate with employers, claims managers and others in order to achieve safe and sustained return to work, while in most instances, simple efforts to identify and discuss work issues directly with the patient can lead to better work outcomes.

Interdisciplinary team discussion on work environment issues related to low back disability: a multiple case study.

From both a social and cost-benefit perspective, disability prevention and associated management strategies for assisting employees with back pain are only successful if they address critical return-to-work (RTW) determining factors present in the workplace, including ergonomic factors. Despite our current knowledge of the importance of an integrated team approach targeting these factors, questions remain regarding the conceptual framework adopted by contemporary rehabilitation teams as it relates to work-oriented interventions to accommodate employees back to work. The purpose of this study was to explore and describe the work environment issues discussed by an interdisciplinary team engaged in the work rehabilitation process of low back disability cases. A qualitative content analysis was conducted for 10 sample cases that underwent a rehabilitation program in Quebec (Canada). Drawing on the results of these analyses, a framework representing a synopsis of practitioners' involvement in the person-environment dynamic is presented and discussed. This study makes a unique contribution to the understanding of the 'real-life' content of an interdisciplinary activity in disability management, thus, helping rehabilitation practitioners to build knowledge on the practical application of a cross-disciplinary framework to address work environment issues during the RTW process of those patients sick-listed due to back pain.