The Work Disability Prevention CIHR Strategic Training Program: Program Performance After 5 Years of Implementation

Introduction The Work Disability Prevention (WDP) Canadian Institutes of Health Research (CIHR) Strategic Training Program was developed in 2001 and is a unique program in the world. The main objective of this program is to help future researchers develop transdisciplinary knowledge, skills and attitudes regarding WDP. The purpose of this paper is to present a descriptive portrait of the program's performance over the past 5 years, as well as the trainees' and alumni's perspectives on the WDP CIHR Training Program. Methods Data on the program's performance were collected from documents in the program records. The trainees' opinions on the WDP training program were obtained through focus groups and telephone interviews. The data collected were compiled and divided into themes to summarize the qualitative findings pertaining to each question. Results From 2003 to 2007, five successive summer sessions have been offered, involving 44 high-caliber applicants from nine countries, 34 mentors and collaborators, 29 guest speakers and 15 stakeholders. Overall, trainees appreciated the networking, the opportunity to interact with people from different disciplines and countries, the openness, and the international perspective and uniqueness of the program. The least appreciated aspects concerned mainly the e-learning course, evaluations and information on optional courses. The coordination and logistics were judged appropriate and several topics were suggested to improve the program quality. Conclusion In general, the program implementation went well, with good participation from mentors, speakers and stakeholders; the program was appreciated by the trainees and alumni. This paper underscores the importance of the international perspective, the transdisciplinarity and the scientific networking established through the progra

La transformation de la réadaptation au travail d’une perspective parcellaire à une perspective systémique

Les troubles musculo-squelettiques associés au travail sont extrêmement courants. Habituellement, ce problème de santé est de courte durée. Cependant, dans un petit nombre de cas, il génère des coûts sociaux importants et affecte la productivité des entreprises. Les évidences actuelles démontrent que les causes de l’incapacité ne sont pas uniquement reliées aux caractéristiques de l’individu blessé, mais proviennent aussi de l’environnement du travailleur : le milieu de travail, le système de compensation et même le système de prise en charge médical. Une revue des études portant sur les interventions qui ont eu un effet positif sur le retour au travail supporte d’une part, l’utilisation du milieu de travail naturel comme contexte de réentraînement et d’autre part, renforce la nécessité de l’implication des différents partenaires dans le processus. Cet article décrira la structure d’un programme d’intervention basée sur les plus récentes évidences scientifiques. L’implantation de ce programme demande des changements profonds dans les rôles des partenaires impliqués mais apparaît prometteuse à long terme pour éviter l’incapacité prolongée chez les travailleurs.Musculoskeletal disorders are an extremely common short-term but recurring health problem that, in a small number of cases, generates major societal costs and affects the productivity of companies. Recent evidence has shown that the causes of disability are not only related to the patient’s characteristics, but also originate from the worker’s environment : the workplace, the compensation system, and even the healthcare delivery system. A review of studies on interventions that had a positive effect on returning to work supports, on the one hand, the use of the natural workplace as a context for retraining, and on the other, the need for the involvement of the different partners in the process. This article describes the structure of an intervention program based on the most recent scientific evidence. The implementation of this program requires major changes in the roles of the stakeholders but seems promising over the long term for avoiding prolonged disability in workers.Los tratornos musculoesqueléticos asociados al trabajo son muy frecuentes. Normalmente, ese problema de salud es de corta duración. Sin embargo, en pocos casos, genera costos sociales importantes y afecta la productividad de las empresas. Las tendencias actuales demuestran que las causas de la incapacidad no solamente están vinculadas con las características del individuo herido, sino también con el medio ambiente del trabajador : el lugar de trabajo, el sistema de compensación e incluso el sistema de cuidado médico. Una revista de los estudios tratando de las intervenciones que han tenido un efecto positivo sobre la vuelta al trabajo, soporta por una parte, la utilización del ambiente de trabajo natural como contexto de reintegración y por otra parte, reforza la necesidad de la implicación de los diferentes socios en el proceso. Este artículo describe la estructura de un programa de intervención basado en las evidencias científicas más recientes. La implantación de este programa requiere cambios profundos en los papeles de los socios implicados pero aparece prometedora a largo plazo para evitar la incapacidad prolongada con los trabajadores

Twenty-five years with the biopsychosocial model of low back pain-is it time to celebrate?:A report from the twelfth international forum for primary care research on low back pain

Study Design: An integrated review of current knowledge about the biopsychosocial model of back pain for understanding etiology, prognosis, and interventions, as presented at the plenary sessions of the XII International Forum on LBP Research in Primary Care (Denmark; October 17–19, 2012). Objective: To evaluate the utility of the model in reference to rising rates of back pain-related disability, by identifying (a) the most promising avenues for future research in biological, psychological, and social approaches, (b) promising combinations of all 3 approaches, and (c) obstacles to effective implementation of biopsychosocial-based research and clinical practice. Summary of Background Data: The biopsychosocial model of back pain has become a dominant model in the conceptualization of the etiology and prognosis of back pain, and has led to the development and testing of many interventions. Despite this back pain remains a leading source of disability worldwide. Methods: The review is a synthesis based on the plenary sessions and discussions at the XII International Forum on LBP Research in Primary Care. The presentations included evidence-based reviews of the current state of knowledge in each of the 3 areas (biological, psychological, and social), identification of obstacles to effective implementation and missed opportunities, and identification of the most promising paths for future research. Results: Although there is good evidence for the role of biological, psychological, and social factors in the etiology and prognosis of back pain, synthesis of the 3 in research and clinical practice has been suboptimal. Conclusion: The utility of the biopsychosocial framework cannot be fully assessed until we truly adopt and apply it in research and clinical practice

Randomised controlled trial of integrated care to reduce disability from chronic low back pain in working and private life

Objective To evaluate the effectiveness of an integrated care programme, combining a patient directed and a workplace directed intervention, for patients with chronic low back pain

Trajectoires des travailleurs recevant un programme de retour au travail : étude exploratoire des discussions d’une équipe interdisciplinaire

Sujet : Cette étude exploratoire a pour objectif de décrire différents types de trajectoires de travailleurs présentant des troubles musculo-squelettiques pendant un programme de réadaptation. Les trajectoires sont tracées à partir des visions d’une équipe interdisciplinaire.Méthode : Le devis de recherche est une méthode de cas unique où l’unité d’analyse principale est une équipe interdisciplinaire. Cette équipe a discuté de la progression de 18 travailleurs, durant un programme de réadaptation. Les analyses des discussions ont été inspirées par la phénoménologie. Toutes les discussions de l’équipe ont été enregistrées et retranscrites. L’analyse de contenu a été effectuée par deux chercheurs. Résultats : Quatre types de trajectoires ont émergé : 1) trajectoires de retour au travail sans obstacle ; 2) trajectoires de retour au travail avec obstacles ; 3) trajectoires de non-retour au travail avec épisodes de progression et 4) trajectoires de non-retour au travail sans progression. Trois facteurs clefs ont émergé de ces analyses comme déterminant au processus de retour au travail : 1) la complaisance des travailleurs face au programme de réadaptation, 2) les différentes façons dont le travailleur aborde et vit la première exposition au travail et 3) la collaboration avec les différents partenaires. Les résultats de cette étude suggèrent aussi que l’absence de message unique entre les professionnels de la santé face au travailleur peut entraîner de la confusion et devenir un frein à la reprise des activités.Conclusions : Les résultats soulignent encore une fois la complexité pour les cliniciens de la prise en charge en réadaptation au travail de travailleurs en phase chronique. Cette intervention doit agir à la fois sur le travailleur et également sur les interactions entre les travailleurs et les différents partenaires concernés. Aussi, cette étude souligne le processus non linéaire de la réadaptation au travail pour des individus présentant des incapacités prolongées d’origine musculo-squelettique, tel que décrit par une équipe interdisciplinaire.Purpose : Based on the viewpoint of an interdisciplinary team, this exploratory study aimed to identify different types of trajectories followed by workers with musculoskeletal disorders and the factors contributing to them.Methods : The research design used a single-case study in which the main unit of analysis was an interdisciplinary work team. This team discussed eighteen workers’ progression during a work rehabilitation programme. Analytical methods were based on phenomenology. All team discussions were audiotaped and transcribed, and two researchers completed the content analysis.Results : Four types of trajectories emerged : (1) return-to-work trajectories without obstacles ; (2) return-to-work trajectories with obstacles ; (3) non-return-to-work trajectories with episodes of progression ; and (4) non-return-to-work trajectories without progression. Moreover, three outlines emerged from the data analysis : (1) the worker’s compliance with the programme ; (2) the way the worker coped with exposure to work ; and (3) stakeholder collaboration. The results of this study also suggested that the absence of a single consistent message among participating health professionals could create confusion for workers and pose a major impediment to the resumption of their activities.Conclusion : The results underscore, for clinicians, the complexity in managing this type of chronic work rehabilitation population, related to both the worker and the worker’s interactions with the stakeholders. Also, this study casts light on the non-linear work rehabilitation processes of individuals with prolonged disabilities of musculoskeletal origin, as described by an interdisciplinary team.Tema : Este estudio exploratorio se propone identificar diferentes tipos de trayectorias de trabajadores que presentan lesiones músculo-esqueléticas en el marco de un programa de readaptación. Las trayectorias se definen a partir de las visiones de un equipo interdisciplinar.Método : El método utilizado, llamado « devis de investigación » es un método basado en el estudio de casos y en el cual la unidad de análisis principal es un equipo interdisciplinar. En este caso, el equipo ha intercambiado opiniones acerca de la progresión de dieciocho trabajadores durante un programa de readaptación. El análisis de los intercambios ha seguido un enfoque fenomenológico. Todas las discusiones del equipo han sido grabadas y desgrabadas posteriormente. El análisis del contenido ha sido efectuado por dos investigadores.Resultados : Cuatro tipos de trayectorias han emergido : 1) trayectorias de reinsecion laboral sin obstaculos ; 2) Trayectorias de reinserción laboral con obstáculos ; 3) trayectorias sin reinserción laboral y con episodios de progresión ; y 4) trayectorias sin reinserción laboral y sin progresión. Tres factores clave han emergido de estos análisis en tanto determinates del proceso de reinserción laboral : 1) el hecho de que los trabajadores respeten el programa de readaptación, 2) las diferentes formas en las que el trabajador aborda y vive su primera exposición al trabajo, 3) la colaboracion con los diferentes compañeros de trabajo. Los resultados de este estudio sugieren tambien que la ausencia de unidad en los mensajes enviados por los profesionales de la salud al trabajador puede generar confusión y transformarse en un freno en el proceso de retorno a la actividad.Conclusiones : Los resultados obtenidos resaltan una vez más la complejidad que significa, desde un enfoque clínico, el hacerce cargo de la readaptación del trabajador en fase crónica. Esta intervención debe actuar a la vez sobre el trabajador y sobre las interacciones entre los trabajadores y las diferentes personas implicadas. Asimismo, este estudio subraya la no linealidad de la readaptación laboral para los individuos que presentan incapacidades prolongadas de origen musculoesquelético, tal como lo describe un equipo interdisciplinar

Cross-cultural adaptation of the Work Disability Diagnosis Interview (WoDDI) for the Brazilian context

The Work Disability Diagnosis Interview (WoDDI) is a structured interview guide developed by the University of Sherbrooke, Canada to help clinicians detect the most important work-related disability predictors and to identify one or more causes of prolonged absenteeism. This methodological study aims for the cross-cultural adaptation of the WoDDI for the Brazilian context. The method followed international guidelines for studies of this kind, including the following steps: initial translation, synthesis of translations, back translation, evaluation by an expert committee and testing of the penultimate version. These steps allowed obtaining conceptual, semantic, idiomatic, experiential and operational equivalences, in addition to content validity. The results showed that the translated WoDDI is adapted to the Brazilian context and can be used after training.Work Disability Prevention Canadian Institutes of Health Research (CIHR) [FRN: 53909]Work Disability Prevention Canadian Institutes of Health Research (CIHR

An integrated care program to prevent work disability due to chronic low back pain: a process evaluation within a randomized controlled trial

<p>Abstract</p> <p>Background</p> <p>In the past decade, a considerable amount of research has been carried out to evaluate the effectiveness of innovative low back pain (LBP) interventions. Although some interventions proved to be effective, they are not always applied in daily practice. To successfully implement an innovative program it is important to identify barriers and facilitators in order to change practice routine. Because usual care is not directly aimed at return to work (RTW), we evaluated an integrated care program, combining a patient-directed and a workplace-directed intervention provided by a multidisciplinary team, including a clinical occupational physician to reduce occupational disability in chronic LBP patients. The aims of this study were to describe the feasibility of the implementation of the integrated care program, to assess the satisfaction and expectations of the involved stakeholders and to describe the needs for improvement of the program.</p> <p>Methods</p> <p>Eligible for this study were patients who had been on sick leave due to chronic LBP. Data were collected from the patients, their supervisors and the involved health care professionals, by means of questionnaires and structured charts, during 3-month follow-up. Implementation, satisfaction and expectations were investigated.</p> <p>Results</p> <p>Of the 40 patients who were eligible to participate in the integrated care program, 37 patients, their supervisors and the health care professionals actually participated in the intervention. Adherence to the integrated care program was in accordance with the protocol, and the patients, their supervisors and the health care professionals were (very) satisfied with the program. The role of the clinical occupational physician was of additional value in the RTW process. Time-investment was the only barrier for implementation reported by the multidisciplinary team.</p> <p>Conclusion</p> <p>The implementation of this program will not be influenced by any flaws in its application that are related to the program itself, or to the adherence of patients with chronic LBP and their health care professionals.</p> <p>This program is promising in terms of feasibility, satisfaction and compliance of the patients, their supervisors and the health care professionals. Before implementation on a wider scale, the communication and the information technology of the program should be improved.</p> <p>Trials Registration</p> <p>[ISRCTN28478651]</p