19 research outputs found
Comprehensive approach to reintegration of disability benefit recipients with multiple problems (CARm) into the labour market:results of a randomized controlled trial
PURPOSE: Although most clients on work disability benefits face multiple problems, most traditional interventions for (re)integration focus on a single problem. The aim of this study was to evaluate the "Comprehensive Approach to Reintegrate clients with multiple problems" (CARm), which provides a strategy for labour experts to build a relationship with each client in order to support clients in their needs and mobilize their social networks.METHODS: This study is a stratified, two-armed, non-blinded randomized controlled trial (RCT), with a 12-month follow-up period. Outcome measures were: having paid work, level of functioning, general health, quality of life, and social support.RESULTS: We included a total of 207 clients in our study; 97 in the intervention group and 110 in the care as usual (CAU) group. The clients' mean age was 35.4 years (SD 12.8), 53.1% were female, and 179 (86.5%) reported multiple problems. We found the CARm intervention to have no significant effects superior to those of the CAU group on all outcomes.CONCLUSION: As we found no superior effect of the CARm intervention compared to CAU, we cannot recommend widespread adoption of CARm. A process evaluation will give more insight into possible implementation failure of the intervention.IMPLICATIONS FOR REHABILITATIONMost traditional interventions for (re)integration into the labour market are problem-centred, i.e., focusing on a single problem, and have limited effectiveness in persons with multiple problems.A strength-based intervention may be suitable for vocational rehabilitation and disability settings, since it contains many elements (e.g., being strength-based, focused on clients' wishes and goals, and involving activation of the social environment) also likely to improve chances of re-employment of persons with multiple problems.In this study a strength-based intervention did not show a superior effect on paid employment and functioning within one year follow-up compared to care as usual in people with multiple problems on a work disability benefit.</p
Content Validation of a Practice-Based Work Capacity Assessment Instrument Using ICF Core Sets
PURPOSE: A shift from providing long-term disability benefits to promoting work reintegration of people with remaining work capacity in many countries requires new instruments for work capacity assessments. Recently, a practice-based instrument addressing biopsychosocial aspects of functioning, the Social Medical Work Capacity instrument (SMWC), was developed. Our aim was to examine the content validity of the SMWC using ICF core sets. METHODS: First, we conducted a systematic search to identify relevant ICF core sets for the working age population. Second the content of these core sets were mapped to assess the relevance and comprehensiveness of the SMWC. Next, we compared the content of the SMWC with the ICF-core sets. RESULTS: Two work-related core sets and 31 disease-specific core sets were identified. The SMWC and the two work-related core sets overlap on 47 categories. Compared to the work-related core sets, the Body Functions and Activities and Participation are well represented in the new instrument, while the component Environmental factors is under-represented. Compared to the disease-specific core sets, items related to the social and domestic environmental factors are under-represented, while the SMWC included work-related factors complementary to the ICF. CONCLUSION: The SMWC content seems relevant, but could be more comprehensive for the purpose of individual work capacity assessments. To improve assessing relevant biopsychosocial aspects, it is recommended to extend the instrument by adding personal and environmental (work- and social-related) factors as well as a more tailored use of the SMWC for assessing work capacity of persons with specific diseases or underlying illness. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s10926-020-09918-7) contains supplementary material, which is available to authorized users
Improving mental health of student and novice nurses to prevent dropout:A systematic review
Aims: To provide: (a) an overview of interventions aimed at improving mental health of student or novice nurses; and (b) an evaluation of their effectiveness on dropout-related outcomes. Design: Systematic review. Data sources: Research papers published between January 1971–February 2019 were identified from the following databases: Embase, Medline, PsycInfo, CINAHL, ERIC, the Cochrane Library, Web of Science, and Google Scholar. Review methods: We followed the procedures recommended by the Editorial Board of the Cochrane Collaboration Back Review Group. We included peer-reviewed articles with a quantitative research design, examining interventions aimed at improving mental health of student and novice nurses and their effect on dropout-related outcomes. The large variation in studies prohibited statistical pooling and a synthesis without meta-analysis of studies was performed. Results: We identified 21 studies with three areas of focus: managing stress or stressors (N = 4); facilitating the transition to nursing practice (N = 14); and a combined approach (N = 3). Five studies showed a statistically significant effect on dropout-related outcomes. The overall risk of bias was high. Conclusion: A wide range of interventions are available, but the evidence for their effectiveness is limited. There is a need for high-quality studies in this field, preferably with a randomized controlled design
Dyadic interventions for community-dwelling people with dementia and their family caregivers: a systematic review.
Background: In this review, we study the effects of dyadic psychosocial interventions focused on community-dwelling people with dementia and their family caregivers, and the relationship of the effects with intervention components of programs. Methods: A search from January 2005 to January 2012 led to 613 hits, which we reviewed against our inclusion criteria. We added studies from 1992 to 2005 reviewed by Smits et al. (Smits, C. H. M., De Lange, J., Droes, R.-M., Meiland, F., Vernooij-Dassen, M. and Pot, A. M. (2007). Effects of combined intervention programs for people with dementia living at home and their caregivers: a systematic review. International Journal of Geriatric Psychiatry, 22, 1181-1193). We assessed the methodological quality of 41 programs with the Cochrane criteria and two items of the Oxford Centre of Evidence-based Medicine guidelines. Results: Studies of moderate to high quality concerning 20 different dyadic psychosocial programs for people with dementia and caregivers were included. Nineteen of these programs show significant effects on the patient with dementia, the caregiver, or both. Due to differences in the programs and the studies, this study does not provide an unequivocal answer about which programs are most effective. Programs with intervention components that actively train one or more specific functional domains for the person with dementia and/or the caregiver seem to have a beneficial impact on that domain, although there are exceptions. Reasons can be found in the program itself, the implementation of the program, and the study design. Conclusions: Dyadic psychosocial programs are effective, but the outcomes for the person with dementia and the caregiver vary. More attention is needed for matching the targeted functional domains, intervention components, and delivery characteristics of a program with the needs of the person with dementia and the family caregiver. Copyright © International Psychogeriatric Association 2013
Prevalence, types, and combinations of multiple problems among recipients of work disability benefits
Purpose: For persons on disability benefits who are facing multiple problems, active labour market policies seem less successful. Besides health problems, these people perceive personal, social, and environmental problems. Since very little is known about these “non-medical” problems our aim was to explore the prevalence of clients experiencing multiple problems, the types and number of perceived problems, combinations of perceived problems, and associated characteristics in a group of work disability benefit recipients. Methods: We performed a cross-sectional study, using self-reported data on perceived problems and socio-demographics, and register data from the Dutch Social Security Institute on diagnosed diseases and employment status. A convenient group of labour experts recruited eligible clients on work disability benefit. Results: Of the 207 persons on work disability benefit, 87% perceived having multiple problems. Most reported problems were related to physical (76%) or mental (76%) health. Health problems most frequently occurred together with a mismatch in education, financial problems, or care for family members. Clients with lower education experienced significantly more problems than clients with an intermediate or high educational level. Conclusions: Clients with multiple problems face severe and intertwined problems in different domains of life, and need tailored multi-actor work disability management.Implications for rehabilitation Clients with multiple problems face severe and intertwined problems in different domains of life; therefore, interventions tailored to deal with needs related to specific problems might be more effective than traditional programs. Interventions should match experienced barriers, and involve multi-actor work disability management with all the challenges of mutual cooperation. For persons with multiple problems a focus on pure medical barriers is too narrow, because personal, social, and environmental factors might also obstruct participation in work
Exploring the concept inability to work fulltime in the context of work disability assessments: a qualitative study
Abstract Background In many countries inability to work fulltime is recognized as an important concept in work disability assessments. However, consensus is lacking regarding the concept and how it should be assessed. This study seeks to conceptualize and operationalize the concept of inability to work fulltime, and includes perspectives of both patients and physicians. Research questions involve identifying: 1. key elements, 2. measurable indicators, and 3. valid methods for assessing indicators of inability to work fulltime. Methods We used a qualitative study with a thematic content analysis design to conceptualize inability to work fulltime, based on nineteen semi-structured interviews conducted among insurance and occupational health physicians, and representatives of patient organizations. Results Inability to work fulltime is conceptualized as a complex concept which is strongly individually determined and variable due to time and underlying disease. Key dimensions of inability to work fulltime included besides the disease itself, also personal factors like psychological and lifestyle factors, as well as environmental factors related to the work situation and social context. Fatigue, cognitive impairments, and restrictions in functioning in- and outside work were reported as important measurable indicators. A combined use of self-assessment, assessment interviews, and testing, and assessment in the actual (work) setting was identified for assessing these indicators. Conclusion Taking into account the complex and variable nature of inability to work fulltime, we found it advisable to use multiple methods and multiple time points for the assessment. Results of this study provide starting points for further research on the operationalization of inability to work fulltime in a work disability context
Nonsteroidal anti-inflammatory drugs for low back pain - An updated Cochrane review
Study Design. A systematic review of randomized controlled trials. Objectives. To assess the effects of nonsteroidal anti-inflammatory drugs (NSAIDs) and COX-2 inhibitors in the treatment of nonspecific low back pain and to assess which type of NSAID is most effective. Summary of Background Data. NSAIDs are the most frequently prescribed medications worldwide and are widely used for patients with low back pain. Selective COX-2 inhibitors are currently available and used for patients with low back pain. Methods. We searched the MEDLINE and EMBASE databases and the Cochrane Central Register of Controlled Trials up to and including June 2007 if reported in English, Dutch, or German. We also screened references given in relevant reviews and identified trials. Randomized trials and double-blind controlled trials of NSAIDs in nonspecific low back pain with or without sciatica were included. Results. In total, 65 trials (total number of patients = 11,237) were included in this review. Twenty-eight trials (42%) were considered high quality. Statistically significant effects were found in favor of NSAIDs compared with placebo, but at the cost of statistically significant more side effects. There is moderate evidence that NSAIDs are not more effective than paracetamol for acute low back pain, but paracetamol had fewer side effects. There is moderate evidence that NSAIDs are not more effective than other drugs for acute low back pain. There is strong evidence that various types of NSAIDs, including COX-2 NSAIDs, are equally effective for acute low back pain. COX-2 NSAIDs had statistically significantly fewer side effects than traditional NSAIDs. Conclusion. The evidence from the 65 trials included in this review suggests that NSAIDs are effective for short-term symptomatic relief in patients with acute and chronic low back pain without sciatica. However, effect sizes are small. Furthermore, there does not seem to be a specific type of NSAID, which is clearly more effective than others. The selective COX-2 inhibitors showed fewer side effects compared with traditional NSAIDs in the randomized controlled trials included in this review. However, recent studies have shown that COX-2 inhibitors are associated with increased cardiovascular risks in specific patient population
Non-steroidal anti-inflammatory drugs for chronic low back pain
Background: Chronic back pain is an important health problem. Non-steroidal anti-inflammatory drugs (NSAIDs) are widely used to treat people with low back pain, especially people with acute back pain. Short term NSAID use is also recommended for pain relief in people with chronic back pain. Two types of NSAIDs are available and used to treat back pain: non-selective NSAIDs and selective COX-2 NSAIDs. In 2008, a Cochrane review identified a small but significant effect from NSAIDs compared to placebo in people with chronic back pain. This is an update of the Cochrane review published in 2008 and focuses on people with chronic low back pain. Objectives: To determine if NSAIDs are more efficacious than various comparison treatments for non-specific chronic low back pain and if so, which type of NSAID is most efficacious. Search methods: We searched CENTRAL, MEDLINE, EMBASE, PubMed and two clinical trials registry databases up to 24 June 2015 for randomized controlled trials (RCTs) published in English, German or Dutch. We also screened references cited in relevant reviews. Selection criteria: We included RCTs (double-blind and single-blind) of NSAIDs used to treat people with chronic low back pain. Data collection and analysis: Two review authors independently screened trials for inclusion in this Cochrane review according to the inclusion criteria. One review author extracted the data, and a second review author checked the data. Two review authors independently evaluated the risk of bias of all included trials. If data were clinically homogeneous, we perform