Fostering shared decision making by occupational therapists and workers involved in accidents resulting in persistent musculoskeletal disorders: A study protocol

Background: From many empirical and theoretical points of view, the implementation of shared decision making (SDM) in work rehabilitation for pain due to a musculoskeletal disorder (MSD) is justified but typically the SDM model applies to a one on one encounter between a healthcare provider and a patient and not to an interdisciplinary team. Objectives: To adapt and implement an SDM program adapted to the realities of work rehabilitation for pain associated with a MSD. More specific objectives are to adapt an SDM program applicable to existing rehabilitation programs, and to evaluate the extent of implementation of the SDM program in four rehabilitation centres. Method: For objective one, we will use a mixed perspective combining a theory-based development program/intervention and a user-based perspective. The users are the occupational therapists (OTs) and clinical coordinators. The strategies for developing an SDM program will include consulting the scientific literature and group consensus with clinicians-experts. A sample of convenience of eight OTs, four clinical coordinators and four psychologists all of whom have been working full-time in MSD rehabilitation for more than two years will be recruited from four collaborating rehabilitation centres. For objective two, using the same criteria as for objective one, we will first train eight OTs in SDM. Second, using a descriptive design, the extent to which the SDM program has been implemented will be assessed through observations of the SDM process. The observation data will be triangulated with the dyadic working alliance questionnaire, and findings from a final individual interview with each OT. A total of five patients per trained OT will be recruited, for a total of 40 patients. Patients will be eligible if they have a work-related disability for more than 12 weeks due to musculoskeletal pain and plan to start their work rehabilitation programs. Discussion: This study will be the first evaluation of the program and it is expected that improvements will be made prior to a broader-scale implementation. The ultimate aim is to improve the quality of decision making, patients' quality of life, and reduce the duration of their work-related disability by improving the services offered during the rehabilitation process.Medicine, Faculty ofNon UBCReviewedFacult

Stratégies de retour au travail d’employés ayant fait l’expérience d’une dépression : perspectives des employeurs et des cadres des ressources humaines

La dépression majeure est l’une des premières causes d’incapacité au travail dans le monde et a de nombreuses conséquences tant sur l’employé concerné qu’auprès des acteurs du milieu de travail.Objectif Nous visons à documenter, selon la perspective des employeurs et des cadres des ressources humaines, les stratégies que ces acteurs préconisent dans leur organisation pour faciliter le retour au travail (RaT) d’employés en absence maladie due à une dépression.Méthode Deux cent dix-neuf employeurs et cadres de ressources humaines (n = 219) ont accepté de répondre à une entrevue semi-structurée téléphonique. La question abordée dans cet article était : « Selon vous, quelles sont les stratégies les plus efficaces pour aider un employé ayant reçu un diagnostic de dépression à retourner au travail ? » La codification du verbatim a été effectuée à partir d’études empiriques et de théories existantes.Résultats Trente-quatre (34) stratégies réparties sur six grands principes ont émergé : 1) Contact avec l’employé en absence maladie (10 stratégies) ; 2) Évaluation et planification du RaT sans précipitation (6) ; 3) Formation des gestionnaires et du collectif de travail à la problématique de la santé mentale au travail (4) ; 4) Concertation des acteurs clés du RaT (4) ; 5) RaT progressif avec aménagements (4) ; 6) Suivi de la santé de l’employé et de son travail (6).Conclusion Ces principes articulés autour de 34 stratégies du RaT vont au-delà d’un processus étapiste de nature chronologique. Articulés dans un programme de RaT, ils devront être testés afin d’évaluer leurs retombées dans les organisations, notamment sur la gestion de l’incapacité au travail.Major depression is one of the leading causes of work disability across the world. In Canada, the lifetime prevalence of depression varies from 10 to 12%. Depression impacts not only the employee who is often stigmatized and can lose his professional identity, but also has consequences on colleagues and supervisors in organizations. In the literature, four models are described from which employers and managers use in their organizations to make decisions regarding the work disability of employees on sick leave: biomedical, financial management, personnel management, and organizational development. These models can also be supported by economic, legal and ethical interests. Even though these models are essential to better understand the decision of employers and HR regarding work disability, information remains scarce regarding the concrete strategies used by these stakeholders to facilitate the return to work for employees on sick leave due to depression.Objectives the aim of this paper is to document, considering employers’ and human resources’ perspectives, the best strategies to put in place to facilitate the return to work of employees on sick leave due to depression.Method This study was part of a larger study carried out in Canada to assess factors influencing the return to work after a depression-related sick leave, taking into account the viewpoint of four types of stakeholders: employers/human resources, supervisors, unions and people diagnosed with depression. 219 employers (68.5%) and human resources directors (31.5%) from 82.6% organizations having more than 100 employees accepted to answer a telephone semi-structured interview. The question of interest in this study is: In your opinion, what are the best strategies to help an employee who has had a depression to return to work? Coding was influenced by empirical findings and theories related to psychosocial risk factors that the authors use in their respective disciplines as well as return to work principles/steps mentioned in the literature. The main objective was to keep all the strategies mentioned by participants, and analyzing them with major principles of return to work.Results 24 return to work strategies spread on six principles emerged: 1) Contact with the employee during his sick leave (10 strategies); 2) Evaluate and plan the return to work without precipitating it (6); 3) Training for managers and colleagues regarding mental health in the workplace (4); 4) Concertation between key return to work stakeholders (4); 5) Progressive return to work with work accommodations (4); 6) Health and work follow-up regarding the employee (6).Conclusion These six principles including 34 strategies are usually related to the timeframe process of the return to work, though they can be implemented sometimes in parallel. This possible overlap reinforces the idea to consider the return to work as sustainable in order to prevent potential relapses and improve the performance at work. Next steps will be to systematically implement these principles and strategies in organizations in order to evaluate their impact on return to work of employees on sick leave due to depression

Derivation of clinical prediction rules for identifying patients with non-acute low back pain who respond best to a lumbar stabilization exercise program at post-treatment and six-month follow-up.

Low back pain (LBP) remains one of the most common and incapacitating health conditions worldwide. Clinical guidelines recommend exercise programs after the acute phase, but clinical effects are modest when assessed at a population level. Research needs to determine who is likely to benefit from specific exercise interventions, based on clinical presentation. This study aimed to derive clinical prediction rules (CPRs) for treatment success, using a lumbar stabilization exercise program (LSEP), at the end of treatment and at six-month follow-up. The eight-week LSEP, including clinical sessions and home exercises, was completed by 110 participants with non-acute LBP, with 100 retained at the six-month follow-up. Physical (lumbar segmental instability, motor control impairments, posture and range of motion, trunk muscle endurance and physical performance tests) and psychological (related to fear-avoidance and home-exercise adherence) measures were collected at a baseline clinical exam. Multivariate logistic regression models were used to predict clinical success, as defined by ≥50% decrease in the Oswestry Disability Index. CPRs were derived for success at program completion (T8) and six-month follow-up (T34), negotiating between predictive ability and clinical usability. The chosen CPRs contained four (T8) and three (T34) clinical tests, all theoretically related to spinal instability, making these CPRs specific to the treatment provided (LSEP). The chosen CPRs provided a positive likelihood ratio of 17.9 (T8) and 8.2 (T34), when two or more tests were positive. When applying these CPRs, the probability of treatment success rose from 49% to 96% at T8 and from 53% to 92% at T34. These results support the further development of these CPRs by proceeding to the validation stage

Évaluation de l’usage des inhibiteurs du SGLT2 au Centre intégré universitaire de santé et de services sociaux de l’Estrie-Centre hospitalier universitaire de Sherbrooke

Objectif : Décrire les caractéristiques des patients diabétiques de type 2 qui utilisent un inhibiteur du cotransporteur sodium-glucose de type 2 (iSGLT2) et les comparer à celles des non-utilisateurs de cette classe d’antidiabétiques. Méthode : Étude rétrospective dans laquelle les données ont été collectées à partir des dossiers médicaux des patients diabétiques de type 2 adultes, admis à l’urgence ou hospitalisés au Centre intégré universitaire de santé et de services sociaux de l’Estrie-Centre hospitalier universitaire de Sherbrooke entre le 1er janvier 2015 et le 17 août 2018. Les utilisateurs d’un iSGLT2 ont été pairés (ratio 1:1) aux non-utilisateurs selon la même date d’admission et le même nombre de classes d’agents antidiabétiques. Résultats : Les caractéristiques de 439 utilisateurs d’un iSGLT2 ont été comparées à celles d’un même nombre de sujets diabétiques de type 2, non utilisateurs. Les utilisateurs d’un iSGLT2 avaient un plus jeune âge (62,9 vs 69,4 ans), moins d’hypertension (38,3 % vs 46,0 %) et une meilleure fonction rénale (débit de filtration glomérulaire 84,7 mL/min/1,73 m2 vs 73,4 mL/min/1,73 m2) que les non-utilisateurs. La canagliflozine était l’iSGLT2 le plus souvent prescrit (55,4 %), et la majorité des sujets avaient au moins trois classes d’antidiabétiques. Conclusion : L’usage des iSGLT2 par des patients plus jeunes, ayant moins d’hypertension et d’insuffisance rénale, pourrait refléter l’instauration plus récente de ces médicaments dans l’arsenal thérapeutique du diabète. Avec la publication croissante de données montrant des bénéfices de protection cardiovasculaire et rénale, ces agents sont susceptibles d’être davantage prescrits en présence de comorbidités. Abstract Objective: To describe the characteristics of type 2 diabetic patients who use a sodium-glucose cotransporter 2 inhibitor (SGLT2i) and to compare them with those non-users of this class of antidiabetics. Method: A retrospective study in which data were collected from the medical records of adult type 2 diabetic patients admitted to the emergency department or hospitalized at the Centre intégré universitaire de santé et de services sociaux de l’Estrie - Centre hospitalier universitaire de Sherbrooke between January 1, 2015 and August 17, 2018. The SGLT2i users were matched (1:1 ratio) to non-users according to the same date of admission and the same number of classes of antidiabetics. Results: The characteristics of 439 SGLT2i users were compared with those of the same number of non-user type 2 diabetic patients. The SGLT2i users were younger (62.9 vs. 69.4 years), had less hypertension (38.3% vs. 46.0%) and better renal function (GFR 84.7 ml/min/1.73 m2 vs. 73.4 ml/min/1.73 m2) than the non-users. Canagliflozin was the most frequently prescribed SGLT2i (55.4%), and most of the patients were using at least three classes of antidiabetics. Conclusion: The use of SGLT2i by younger patients with less hypertension and renal impairment may reflect the more recent introduction of these drugs into the therapeutic arsenal for diabetes. With more and more data being published showing cardiovascular and renal protective benefits, these agents are likely to be prescribed more often in the presence of comorbidities