La réduction de facteurs de risque de chronicité et le retour au travail

L’objectif de cette recherche était d’examiner le degré avec lequel la réduction des facteurs de risques psychosociaux était associée au retour au travail. Cette recherche a été effectuée dans le contexte d’un programme de réadaptation pour les travailleurs ayant subi une blessure au dos. Les participants étaient 116 (68 hommes, 48 femmes) clients de la Commission des accidents du travail de la Nouvelle-Écosse ayant demandé une indemnisation pour accident de travail. Les participants étaient orientés vers une intervention cognitivo-comportementale, donc le but était de réduire les obstacles psychologiques au progrès en réadaptation. Les facteurs psychologiques ciblés par le programme étaient les pensées catastrophiques, la crainte du mouvement, les croyances concernant l’incapacité et la dépression. Dans cet échantillon, 56 % des participants ont retourné au travail dans les quatre semaines suivant la fin du traitement. Des analyses de variance à mesures répétées ont révélé des diminutions significatives dans la douleur, la dépression, les pensées catastrophiques, les croyances concernant l’incapacité, et la peur du mouvement. Des analyses univariées ont indiqué que la réduction de tous les facteurs de risque était associée à une plus haute probabilité de retour au travail. Une analyse de régression logistique a révélé que la durée d’absence du travail et la réduction des pensées catastrophiques ont contribué uniquement à la prédiction du retour au travail. Les résultats de cette étude offrent des preuves préliminaires selon lesquelles les interventions qui visent spécifiquement à réduire les facteurs de risques psychosociaux reliés à la chronicité ont un impact positif sur la probabilité de retour au travail.The purpose of the present study was to examine the degree to which psychosocial risk factor reduction was associated with the return to work. This study was carried out in the context of a rehabilitation program for workers who had suffered a back injury. The participants were 116 Nova Scotia WCB claimants (68 men, 48 women) who had made a claim for an industrial accident. The participants were oriented towards a cognitive behavioral intervention whose purpose was to reduce psychological obstacles to rehabilitation. The psychosocial risk factors targeted by the program included pain catastrophizing, fear of movement, beliefs about disability, and depression. In this sample, 56 % of the participants returned to work within four weeks of treatment termination. Pre- to post-treatment comparisons revealed significant reductions in pain, depression, catastrophizing, perceived disability, and fear of movement. Univariate analyses revealed that reductions in all risk factors were associated with a higher probability of a return to work. Logistic regression revealed that only the duration of work disability and the reduction in pain catastrophizing contributed solely to the prediction of a return to work. The results of the present study provide preliminary evidence that the reduction of psychosocial risk factors related to chronicity may have a positive impact on the probability of returning to work.El objetivo de esta investigación era de examinar hasta qué punto se asocia la reducción de factores de riesgos psicosociales con la vuelta al trabajo. Se ha efectuado esta investigación en el contexto de un programa de rehabilitación para trabajadores que han sufrido de una herida en la espalda. Los participantes eran 116 (68 hombres y 48 mujeres) clientes de la Comisión de los accidentes en el trabajo de Nueva Escocia que habían pedido una indemnización por accidente laboral. Los participantes eran orientados hacia una intervención cognitivo-conductual cuya finalidad era de reducir los obstáculos psicológicos a su rehabilitación. Los factores psicológicos focalizados en este programa eran los pensamientos catastróficos, el miedo del movimiento, las creencias a propósito de la invalidez y la depresión. En estea muestra, 56 % de los participantes volvieron al trabajo en las quatro semanas siguiente el fín del tratamiento. Análisis de varianza con mediciones repetidas han revelado diminuciones significativas del dolor, la depresión, la catastrofización, las creencias a propósito de la invalidez y el miedo del movimiento. Análisis univariados indicaron que la reducción de todos los factores de riesgos se relacionan con una probabilidad más grande de la vuelta al trabajo. Análisis de regresión logísticos han revelado que la duración de ausencia al trabajo y la reducción de la catastrofización han contribuido solamente a la predicción de la vuelta al trabajo. Los resultados de este estudio demuestran mediante pruebas preliminarias que la reducción de los factores de riesgos psicosociales vinculados a la cronicidad tienen un impacto positivo sobre la probabilidad de la vuelta al trabajo

Stage of chronicity and treatment response in patients with musculoskeletal injuries and concurrent symptoms of depression

Abstract The present study examined the relation between stage of chronicity and treatment response in patients with work-related musculoskeletal conditions and concurrent depressive symptoms. Also of interest was the role of reductions in pain severity, catastrophic thinking and fear of movement/re-injury as mediators of the relation between chronicity and treatment response. A sample of 80 individuals (38 women, 42 men) with a disabling musculoskeletal pain condition and concurrent depressive symptoms participated in the research. Individuals with work absence of less than 6 months (range 12-26 weeks) were classified as early chronic (N = 40), and individuals with work absence greater than 6 months (range 27-52 weeks) were classified as chronic. Both groups were matched on sex, age (±2 years) and severity of depressive symptoms. All participants were enrolled in a 10-week community-based disability management intervention. The early chronic group showed significantly greater reduction in depressive symptoms, and pain symptoms, than the chronic group. Regression analyses revealed that pain reduction, but not catastrophic thinking or fear of movement/ re-injury, mediated the relation between chronicity and improvement in depressive symptoms. The results highlight the importance of early detection and treatment of depressive symptoms, given that treatment response decreases over time. The results also suggest that reductions in depressive symptoms might be a precondition to the effective reduction of pain symptoms in this population. Discussion addresses the factors that might contribute to treatment resistance as the period of disability extends over time.

Walk well:a randomised controlled trial of a walking intervention for adults with intellectual disabilities: study protocol

Background - Walking interventions have been shown to have a positive impact on physical activity (PA) levels, health and wellbeing for adult and older adult populations. There has been very little work carried out to explore the effectiveness of walking interventions for adults with intellectual disabilities. This paper will provide details of the Walk Well intervention, designed for adults with intellectual disabilities, and a randomised controlled trial (RCT) to test its effectiveness. Methods/design - This study will adopt a RCT design, with participants allocated to the walking intervention group or a waiting list control group. The intervention consists of three PA consultations (baseline, six weeks and 12 weeks) and an individualised 12 week walking programme. A range of measures will be completed by participants at baseline, post intervention (three months from baseline) and at follow up (three months post intervention and six months from baseline). All outcome measures will be collected by a researcher who will be blinded to the study groups. The primary outcome will be steps walked per day, measured using accelerometers. Secondary outcome measures will include time spent in PA per day (across various intensity levels), time spent in sedentary behaviour per day, quality of life, self-efficacy and anthropometric measures to monitor weight change. Discussion - Since there are currently no published RCTs of walking interventions for adults with intellectual disabilities, this RCT will examine if a walking intervention can successfully increase PA, health and wellbeing of adults with intellectual disabilities

Psychosocial factors related to return to work following rehabilitation of whiplash injuries

Abstract Introduction The present study examined the effects of pain chronicity on the responsiveness of psychosocial variables to intervention for whiplash injuries. Methods Participants (N = 75) were work disabled patients with a diagnosis of Whiplash Grade II and were clients in a 10-week community-based, psychosocial intervention aimed at facilitating return to work. Individuals were classified as subacute (4-12 weeks; N = 25), early chronic (3-6 months; N = 25), and chronic (6-18 months; N = 25). Patients in the three groups were matched on sex (13 men, 12 women) and age (±2 years). Patients completed measures of pain severity, self-reported disability, pain catastrophizing and fear of movement at pre-treatment, mid-treatment and post-treatment. Results Return to work rates were 80, 72 and 32% for the subacute, early chronic and chronic groups, respectively. Individuals in the chronic group, compared to individuals in the subacute or early chronic groups, had significantly more elevated pre-treatment scores on measures of pain catastrophizing, F(2, 74) = 9.6, P < .001, and fear of movement, F(2, 74) = 3.4, P < .05. The magnitude of treatment-related reductions i