Are workplace health promotion/wellness programs effective at improving presenteeism (on the job productivity) in workers? a systematic review and best evidence synthesis of the literature

Background: Presenteeism is highly prevalent and costly to employers. It is defined as being present at work but limited in some aspect of job performance by a health problem. Workplace health promotion (WHP) is a common strategy used to enhance on-the-job productivity. Objectives: The primary objective is to determine if WHP programs are effective in improving presenteeism. Secondary objectives include identifying the types of risk factors and health issues affecting workers who work despite health problems, and to identify characteristics of the programs successful at improving presenteeism. Study Design: Systematic search and best-evidence synthesis of the scientific literature.Data Synthesis: The scientifically admissible studies consisted of 5 (36%) randomized controlled trials (RCTs), 5 (36%) cluster RCTs, 1 (7%) interrupted time series, 1 (7%) crossover design, 1 (7%) pre-post study, and 1 (7%) quasi-experimental study. Risk factors contributing to presenteeism include being overweight, poor diet, lack of physical exercise, high stress, and poor relations with coworkers and management. Contributing health conditions include arthritis, musculoskeletal disorders, allergies, chronic pain, and depression and anxiety. There is preliminary evidence of a positive effect of some WHP programs. Successful programs offer organizational leadership, health risk screening, individually tailored programs, incentives, and a supportive workplace culture.Conclusions: The presenteeism literature is young, heterogeneous, and inconsistent, limiting the ability to draw firm conclusions. Nonetheless, the available evidence suggests that presenteeism is an important issue for employers and society. Better quality research is needed in this area. Future research would benefit from standard presenteeism metrics, studies conducted across a broad range of workplace settings and employee populations, and better reporting of studies in line with current scientific standards. Key Words: Presenteeism; Health and productivity management; Workplace health promotion; Primary prevention; Systematic review

Incidence and prognosis of post-traumatic headache in adults

Post-traumatic headache (PTH) is a common debilitating symptom after mild traumatic brain injury (MTBI) or concussion from motor vehicle collisions (MVC), falls, sports concussions and other trauma. It is also a common whiplash-associated disorder (WAD). PTH is one of the most poorly understood headache disorders in terms of its burden, pathophysiology, and prognosis. The primary objective of my thesis was to investigate the incidence and prognosis of PTH. To achieve this, I conducted a systematic review, and developed two prediction models by analyzing data from a population-based, incidence cohort study on traffic injuries from Saskatchewan, Canada. Finally, I used data from an insurance cohort of Swedish incident traffic injuries to validate my prediction models. My systematic review revealed sparse literature on the incidence and prognosis of PTH. The incidence of PTH varied across studies because the methods and populations studied were very different. The review suggested that pre-existing headache, younger age, and post-traumatic stress disorder (PTSD) are associated with delayed recovery from PTH. From my analysis of the Saskatchewan cohort, I found that the incidence of PTH is highest among young females, with an annual incidence of 734 per 100,000 (95% CI 731.5â 736.6) in 1999. I developed two separate prediction models for PTH and the nonrecovery from all injuries six months after a MVC. The models are based on patient and clinical characteristics that are routinely collected during an initial clinical encounter. Some common predictors between the models included older age, poorer current health, and lower recovery expectations. The predictive abilities were similar for both models (c-statistic: 0.73). The models were externally validated in a population of traffic-injured adults from Sweden. This thesis provides the first evidence synthesis on the incidence and prognosis of PTH. It also presents the first sex-, age-, and sex-age-stratified estimates of population-based incidence rates of PTH following MVC and proposes prediction models for recovery at six months in adults with PTH. This information advances the field of PTH by indicating important gaps in the literature, and providing recommendations for improving the prediction of outcomes for adults who present with PTH within 30 days of a traffic collision.Ph.D.2019-12-19 00:00:0

Exercise treatments for chronic low back pain: a network meta-analysis

Objectives: This is a protocol for a Cochrane Review (intervention). The objectives are as follows:. The objectives of this systematic review, conducted using a collaborative review model, are to:. Assess the effectiveness of exercise treatment (overall) in adults with chronic non-specific low back pain on important individual health outcomes: pain, functional limitations, health-related quality of life, depression, and adverse effects versus comparison treatments: (a) placebo, sham, or attention control, (b) no trial treatment (including waiting lists, control groups described as having no treatment provided, usual/normal care not controlled by the trial available to all treatment groups, or when the exercise and comparison groups receive the same co-interventions, allowing the effect of exercise treatment to be isolated), and (c) other conservative treatments (eight categories). Estimate the treatment effects and associated uncertainty for comparisons of different specific types of exercise treatment in adults with chronic non-specific low back pain to each other, and to each comparison treatment, using direct and indirect evidence with network meta-analysis. Estimate the treatment effects and associated uncertainty for comparisons of treatments composed of different exercise type categories, design, delivery, dose, and additional treatment components, and their combinations, using direct and indirect evidence with component network meta-analysis

Response to Lawrence DJ: 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

In summary, the statements made by Lawrence about our methodology are incorrect and ill informed. While we thank Lawrence for his interest in our work, his statements about our methodology are in our opinion misconstrued and hence not appropriate.Medicine, Faculty ofNon UBCPopulation and Public Health (SPPH), School ofReviewedFacultyResearche

Correction to: 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

An amendment to this paper has been published and can be accessed via the original article.Medicine, Faculty ofNon UBCPopulation and Public Health (SPPH), School ofReviewedFacult

Response to Lawrence DJ: 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

Thank you for the opportunity to respond to the Letter to the Editor by Dana J. Lawrence. In his letter, Lawrence states that the results of our systematic review may be due to bias. However, he does not adequately substantiate his claims

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

Aspiration Versus Stent‐Retriever as First‐Line Endovascular Therapy Technique for Primary Medium and Distal Intracranial Occlusions: A Propensity‐Score Matched Multicenter Analysis

Background For acute proximal intracranial artery occlusions, contact aspiration may be more effective than stent‐retriever for first‐line reperfusion therapy. Due to the lack of data regarding medium vessel occlusion thrombectomy, we evaluated outcomes according to first‐line technique in a large, multicenter registry. Methods Imaging, procedural, and clinical outcomes of patients with acute proximal medium vessel occlusions (M2, A1, or P1) or distal medium vessel occlusions (M3, A2, P2, or further) treated at 37 sites in 10 countries were analyzed according to first‐line endovascular technique (stent‐retriever versus aspiration). Multivariable logistic regression and propensity‐score matching were used to estimate the odds of the primary outcome, expanded Thrombolysis in Cerebral Infarction score of 2b–3 (“successful recanalization”), as well as secondary outcomes (first‐pass effect, expanded Thrombolysis in Cerebral Infarction 2c‐3, intracerebral hemorrhage, and 90‐day modified Rankin scale, 90‐day mortality) between treatment groups. Results Of the 440 included patients (44.5% stent‐retriever versus 55.5% aspiration), those treated with stent‐retriever had lower baseline Alberta Stroke Program Early Computed Tomography Scale scores (median 8 versus 9; P<0.01), higher National Institutes of Health Stroke Scale scores (median 13 versus 11; P=0.02), and nonsignificantly fewer medium‐distal occlusions (M3, A2, P2, or other: 17.4% versus 23.8%; P=0.10). Use of a stent‐retriever was associated with 15% lower odds of successful recanalization (odds ratio [OR], 0.85; [95% CI 0.74–0.98]; P=0.02), but this was not significant after multivariable adjustment in the total cohort (adjusted OR, 0.88; [95% CI 0.72–1.09]; P=0.24), or in the propensity‐score matched cohort (n=105 in each group) (adjusted OR, 0.94; [95% CI 0.75–1.18]; P=0.60). There was no significant association between technique and secondary outcomes in the propensity‐score matched adjusted models. Conclusion In this large, diverse, multinational medium vessel occlusion cohort, we found no significant difference in imaging or clinical outcomes with aspiration versus stent‐retriever thrombectomy