Effectiveness of work-related interventions for return to work in people on sick leave: a systematic review and meta-analysis of randomized controlled trials

Background: Long-term sick leave is a serious concern in developed countries and the cost of sickness absence and disability benefits cause major challenges for both the individual and society as a whole. Despite an increasing body of research reported by existing systematic reviews, there is uncertainty regarding the effect on return to work of workrelated interventions for workers with different diagnoses. The objective of this systematic review was to assess and summarize available research about the effects of work-related interventions for people on long-term sick leave and those at risk of long-term sick leave. Methods: We conducted a systematic review in accordance with international guidelines. Campbell Collabora‑ tion (Area: Social Welfare), Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, Embase, Epistemonikos, MEDLINE, PsycINFO, Scopus, and Sociological Abstracts were systematically searched in March 2021. Two authors independently screened the studies. We conducted risk of bias assessments and meta-anal‑ yses of the available evidence in randomized controlled trials (RCTs). The remaining comparisons were synthesized narratively. The certainty of evidence for each outcome was assessed. Results: We included 20 RCTs comprising 5753 participants at baseline from 4 different countries. The studies had generally low risk of bias. Our certainty in the effect estimates ranged from very low to moderate. Eight different interventions were identified. Meta-analysis revealed no statistically signifcant difference between multidisciplinary rehabilitation (MR) and usual care (US) (Risk Ratio [RR] 1.01; Confidence Interval [CI] 95% 0.70-1.48 at 12 months fol‑ low-up) and between MR and other active intervention (Risk Ratio [RR] 1.04; Confidence Interval [CI] 95% 0.86-1.25 at 12 months follow-up). Remaining intervention groups revealed marginal, or no effect compared to the control group. The results for the secondary outcomes (self-efficacy, symptom reduction, function, cost-effectiveness) showed varied and small effects in the intervention groups. Conclusion: Overall, the present data showed no conclusive evidence of which work-related intervention is most effective for return to work. However, a handful of potential interventions exist, that may contribute to a foundation for future research. Our findings support the need for adequately powered and methodologically strong studies

Effect of remote patient monitoring and resource utilisation in primary and specialist healthcare services: a systematic review

Source at https://www.fhi.no/.Velferdsteknologi, inkludert digital hjemmeoppfølging, er et viktig element i utviklingen av helse- og omsorgssektoren. Formålet med denne systematiske oversikten var å undersøke effekter av digital hjemmeoppfølging for voksne med ikke-smittsomme kroniske sykdommer mht. ressursbruk i primær- og spesialisthelsetjenesten. Digital hjemmeoppfølging i denne oversikten innebærer forhåndsavtalte helserelaterte målinger som gjøres av personen selv og som overføres til helsetjenesten ved hjelp av digitalt utstyr (f.eks. applikasjoner, nettbrett og telefon). Våre hovedfunn viser at digital hjemmeoppfølging gir trolig liten eller ingen forskjell i sykehusinnleggelser, liggedøgn på sykehus, besøk på poliklinikk og akuttmottak og bruk av fastlege sammenlignet med vanlig praksis etter 12 måneder. digital hjemmeoppfølging reduserer neppe timeforbruk på helsetjenester i hjemmet sammenlignet med vanlig praksis etter 12 måneder. effekten av digital hjemmeoppfølging på bruk av fastlege er svært usikker sammenlignet med oppfølging med papirbaserte dagbok-kort etter 12 måneder. Resultatene baserer seg kun på enkeltstudier og kunnskapsgrunnlaget er for mangelfullt til å kunne si sikkert om digital hjemmeoppfølging har noen effekt på ressursbruk i primær- og spesialisthelsetjenesten sammenlignet med vanlig praksis etter 12 måneder

Associations between health-related quality of life, physical function and fear of falling in older fallers receiving home care

Falls and injuries in older adults have significant consequences and costs, both personal and to society. Although having a high incidence of falls, high prevalence of fear of falling and a lower quality of life, older adults receiving home care are underrepresented in research on older fallers. The objective of this study is to determine the associations between health-related quality of life (HRQOL), fear of falling and physical function in older fallers receiving home care

A falls prevention programme to improve quality of life, physical function and falls efficacy in older people receiving home help services: study protocol for a randomised controlled trial

BACKGROUND: Falls and fall-related injuries in older adults are associated with great burdens, both for the individuals, the health care system and the society. Previous research has shown evidence for the efficiency of exercise as falls prevention. An understudied group are older adults receiving home help services, and the effect of a falls prevention programme on health-related quality of life is unclear. The primary aim of this randomised controlled trial is to examine the effect of a falls prevention programme on quality of life, physical function and falls efficacy in older adults receiving home help services. A secondary aim is to explore the mediating factors between falls prevention and health-related quality of life. METHODS: The study is a single-blinded randomised controlled trial. Participants are older adults, aged 67 or older, receiving home help services, who are able to walk with or without walking aids, who have experienced at least one fall during the last 12 months and who have a Mini Mental State Examination of 23 or above. The intervention group receives a programme, based on the Otago Exercise Programme, lasting 12 weeks including home visits and motivational telephone calls. The control group receives usual care. The primary outcome is health-related quality of life (SF-36). Secondary outcomes are leg strength, balance, walking speed, walking habits, activities of daily living, nutritional status and falls efficacy. All measurements are performed at baseline, following intervention at 3 months and at 6 months' follow-up. Sample size, based on the primary outcome, is set to 150 participants randomised into the two arms, including an estimated 15-20% drop out. Participants are recruited from six municipalities in Norway. DISCUSSION: This trial will generate new knowledge on the effects of an exercise falls prevention programme among older fallers receiving home help services. This knowledge will be useful for clinicians, for health managers in the primary health care service and for policy makers

Falls prevention to improve health-related quality of life, physical function and falls self-efficacy in older adults receiving home care

Background: Falls and fall-related injuries in older adults are associated with great burdens for the individuals, the health care system and society. Although they have a high incidence of falls, a high prevalence of fear of falling and a lower level of health-related quality of life (HRQOL), older adults receiving home care are underrepresented in research on older fallers. Effective interventions to prevent falls and improve HRQOL, physical function and falls selfefficacy in this population is of importance to meet current and future public health challenges. Aims: The first aim of the thesis was to provide an in-depth background for the study with detailed information on the project procedures. The second aim was to describe the characteristics of the population of home care recipients, including their HRQOL, physical function and falls self-efficacy, and to determine the relationship between these factors. The third aim was to evaluate the short- and longer-term effects of a falls prevention exercise programme on HRQOL, physical function and falls self-efficacy. The final aim was to examine the agreement between the two general measures of HRQOL, SF-6D and EQ-5D, employed when evaluating interventions in home care recipients. Methods: This thesis consists of five papers in which three different designs are employed. The first paper is a study protocol for the randomised controlled trial (RCT). The second paper presents a study with a cross-sectional observational design. In the third and fourth papers, a single-blinded parallel-group RCT, including a follow-up at 3 months and 6 months is presented. The fifth paper reports on a longitudinal study on the same data. The participants in all studies were 155 older adults receiving home care from six municipality health care services in Eastern Norway. Inclusion criteria were being over 67, receiving home care, having experienced at least on fall during the last 12 months, being able to walk with or without a walking aid and being able to communicate in Norwegian. Exclusion criteria were medical contraindications to exercise, life expectancy below 1 year, a Mini-Mental State Examination (MMSE) score below 23 and currently participating in other falls prevention programmes or trials. The intervention group received an individual home-based falls prevention exercise programme based on the Otago Exercise Programme (OEP) lasting 12 weeks. The control group received usual care. Assessments were carried out at baseline, at the end of the intervention at 3 months and at a 6-month follow-up. The primary outcome, HRQOL, was measured using the Short-Form 36 Health Survey (SF-36). Physical function was measured using the Bergs Balance Scale (BBS), the 30-second sit-to-stand test (STS), the 4-metre walk test (4MWT), instrumental activities of daily living (IADL) and walking habits. Falls self-efficacy was measured using the Falls Efficacy Scale International (FES-I). Nutritional status was measured using the Mini-Nutritional Assessment (MNA). At baseline, MMSE scores, demographic information and background variables were collected. Information on adverse events and exercise adherence was collected at 3 and 6 months. Results: The sample of older home care recipients included in this project had poor HRQOL, physical function and falls self-efficacy compared to the general older population. Paper II shows that better HRQOL was associated with better physical function and falls self-efficacy, when adjusted for baseline values such as sex, education, living alone and number of falls. Paper III shows that the intervention group improved their physical HRQOL and balance in the short term following a falls prevention exercise intervention. Further analysis revealed that the effects were greater for those who managed to complete the programme as prescribed and showed a negative impact on mental HRQOL for those who did not manage to complete the programme as prescribed. Paper IV shows that the improvement in physical HRQOL was sustained at follow-up. Further analysis demonstrated that the intervention increased the probability of maintaining exercise post-intervention and that this exercise mediated the effect of the intervention on physical HRQOL. Paper V shows that older adults with a higher mean HRQOL and/or better physical function scored higher on EQ-5D, while those with lower mean HRQOL and/or poorer physical function scored higher on SF-6D. EQ-5D was more responsive to changes in physical function compared to SF-6D. Conclusions: Home care recipients are a frail group of older adults with poor HRQOL, physical function and falls-self efficacy. A falls prevention exercise programme can improve their HRQOL and physical function in the short term and can help sustain their HRQOL in the longer term. SF-6D and EQ-5D are applicable when evaluating interventions in home care, but EQ-5D seems more responsive to changes in physical function. More research on this group is needed, particularly in terms of developing interventions and evaluating the effects of falls prevention programmes on mental HRQOL and falls self-efficacy

A qualitative study exploring physical therapists’ views on the Otago Exercise Programme for fall prevention: a stepping stone to “age in place” and to give faith in the future

Background: One of the most effective interventions to prevent falls is exercise. A commonly used program that prevents falls is the Otago Exercise Programme (OEP). Despite this, user-based knowledge of its applicability in real-world settings for older adults who are dependent on formal care in their homes is lacking. Purposes: To explore how physical therapists (PTs) experience the applicability of the OEP in clinical practice for home-dwelling older adults who are dependent on formal home care and to determine their beliefs regarding the benefits of the OEP for living longer at home. Methods: Semi-structured interviews were conducted with 17 physical therapists. Data were analyzed using qualitative thematic analysis. Results: The OEP was described by PTs to be applicable in clinical practice. Their experience was that the OEP seemed to be meaningful and to have a strong relationship with everyday activities. The OEP improved physical function, mood, self-efficacy, and participation in social activities in older adults, as well as provided faith in the future. Conclusion: The OEP is suitable for use in a primary care setting, and according to the perceptions of physical therapists, the OEP contributes to older adults’ capability to live longer at home

The tensions between micro-, meso- and macro-levels: physiotherapists’ views of their role towards fall prevention in the community – a qualitative study

Background: Falls are a global public health concern. Physiotherapists are a key resource in this context, but there is sparse knowledge about how they perceive their role in the primary care setting. Therefore, the purpose of the present study is to explore physical therapists’ (PTs) view of how they experience and perceive their role working with fall prevention in a community care setting. Methods: Semi-structured interviews were conducted with 17 physiotherapists. Data were analysed using a qualitative thematic analysis. Results: The analysis resulted in a core theme and three subthemes. The core theme was ‘capability to cope with the tensions between the micro-, meso- and macro-levels in fall, prevention’, which indicated the importance of an evolving multifaceted, evidence based and innovative physiotherapy role. A key factor for this role is to take an integrative biopsychosocial approach based on how biological and psychosocial factors are uniquely related in fall prevention. The three themes were as follows: 1) always moving and changing: the competent explorative knowledge-hungry clinician’s multifaceted role; 2) multiprofessional – but in the end alone; 3) reaching out – from the bottom to the top. Success in the role of physiotherapists in fall prevention depends on the empowering leadership and working culture, as well as on the time and multifaceted professional competence of the clinicians. Conclusion: Our findings indicate that the PTs’ role reflects their abilities to change and improve their professional work in accordance with evidence based knowledge. To ensure good quality the PTs focused on the special needs of the patients, evidence-based fall prevention, interdisciplinary team work, good clinical competences, good skills in communication, and interpersonal relations. Attention should be placed on the importance of biopsychosocial perspective framing in the actual clinical and political context. The PTs saw the need for working at the micro-, meso- and macro-levels to succeed in the work of fall prevention

Associations between health-related quality of life, physical function and fear of falling in older fallers receiving home care

Falls and injuries in older adults have significant consequences and costs, both personal and to society. Although having a high incidence of falls, high prevalence of fear of falling and a lower quality of life, older adults receiving home care are underrepresented in research on older fallers. The objective of this study is to determine the associations between health-related quality of life (HRQOL), fear of falling and physical function in older fallers receiving home care