Research approaches to networked employment services: A systematic review

Interdisciplinary pain rehabilitation programs (IPRPs) help people with chronic pain improve their health and manage their work; however, the way IPRPs address sick leave could be improved. Although work interventions can be a part of IPRP, it is not well known how and to what extent.This study explores the frequency of work interventions and the characteristics of patients who participate in work interventions as part of IPRP at specialist pain rehabilitation departments in Sweden. In addition, this study explores the association between participation in work interventions and change in patients' self-rated work ability after IPRP.Data from the Swedish quality registry for pain rehabilitation (SQRP), which includes 3809 patients between 2016 and 2018, were analysed with descriptive statistics and regression analyses.The results indicate a high participation rate in work interventions (90%). Some differences were evident concerning characteristics of patients who participated in different work interventions. The return-to-work (RTW) plan, the most frequently used work intervention, had the strongest association with change in self-rated work ability after IPRP. However, the effect sizes were small, and the initial score best explained the change. Furthermore, there were differences between employed and unemployed patients and employment had a positive association with change in self-rated work ability.More research is needed to understand IPRP's mechanisms and work interventions to support patients with chronic pain, reduce sick leave, and manage work. Employment status needs to be considered and interventions should be tailored to match the individual needs. 

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Work Interventions Within Interdisciplinary Pain Rehabilitation Programs (IPRP) – Frequency, Patient Characteristics, and Association with Self-Rated Work Ability

Resume La lombalgie est un probleme majeur de sante publique dans les pays occidentaux. Le caractere benin de la lombalgie contraste regulierement avec son retentissement sur la qualite de vie du fait de son caractere volontiers recidivant et de sa potentielle evolution vers la chronicite, stade auquel elle s’accompagne regulierement d’une restriction de participation sociale et professionnelle. La pratique d’une activite physique (AP) reguliere et d’exercices physiques (EP) est essentielle pour la prise en charge de la lombalgie et la prevention des recidives. L’AP est ainsi recommandee a tous les stades de la lombalgie. Or, la douleur, les croyances erronees et les comportements inappropries vis-a-vis de la douleur font regulierement obstacles a la pratique d’une AP. Selon le modele biopsychosocial, la lombalgie chronique est liee a un ensemble de facteurs qui rendent sa prise en charge complexe. Ce constat a conduit a la mise en place de programmes multidisciplinaires de reentrainement a l’effort comprenant une prise en charge des composantes physique, psycho-comportementale et socioprofessionnelle de la lombalgie chronique. La composante reeducative des programmes comprend classiquement des exercices de renforcement musculaire et d’etirement, des activites aerobies et de stabilisation rachidienne. Les autres aspects de la prise en charge incluent l’amelioration des parametres psychosociaux et comportementaux via notamment les therapies cognitives et comportementales et l’education therapeutique du patient. Enfin, la plupart des programmes proposent egalement une evaluation et un accompagnement socioprofessionnel en vue d’ameliorer le retour au travail ou le maintien en emploi. L’approche multidisciplinaire de la prise en charge de la lombalgie chronique a montre son efficacite, notamment en termes d’incapacite fonctionnelle et d’intensite de la douleur alors que les effets concernant l’absenteisme et le retour au travail sont plus heterogenes. Favoriser les comportements actifs et l’autonomie des patients au decours de la prise en charge supervisee, sur le long terme, est un enjeu crucial. Cela necessite donc, d’une part, de prendre en compte la preference du patient pour le choix de l’AP et des EP, mais egalement de mettre l’accent sur les strategies motivationnelles.

Activité physique et réentraînement à l’effort chez les patients lombalgiques

Non-specific low back pain is a frequent reason for consultation, yet little is known about how general practitioners manage it in France.To describe the healthcare procedures general practitioners prescribe for low back pain in France.This is an ancillary analysis of an observational, cross-sectional study (ECOGEN) conducted between November 2011 and April 2012 among 128 general practitioners. Adults younger than 65 years consulting for low back pain were included. Patient and general practitioner characteristics, consultation results (diagnosis) and healthcare procedures were collected and coded using the International Classification in Primary Care. Analyses focused on the initial or follow-up consultation, adjusting on age, gender, and socio-occupational category.Out of 11510 consultations, 845 (7.3%) were for low back pain. Of these, 776 (79.5%) resulted in a clinical examination, 634 (73.4%) in medication prescription, and 203 (23.9%) were prescribed sick leave, but imaging and specialist referral were rare. Imaging was more frequent with radiating pain (adjusted odds ratio (aOR) = 1.61; 95% CI [1.07, 2.42]), as were specialist referrals (OR = 2.92; 95% CI [1.40, 6.09]) and sick leave prescription (aOR = 1.52; 95% CI [1.10, 2.09]), but physiotherapist referral was less frequent (aOR = 0.55; 95% CI [0.38, 0.82]). Clinical examinations (aOR = 2.75; 95% CI [1.98, 3.80]), imaging (aOR = 1.61; 95% CI [1.02, 2.31]) and medication prescriptions (aOR = 2.34; 95% CI [1.65, 3.30]) were more common in initial consultations, but specialist referral (aOR = 0.16; 95% CI [0.05, 0.47]) or sick leave prescription (aOR = 0.68; 95% CI [0.48, 0.97]) were rarer.Low back pain characteristics could influence healthcare procedures more markedly than patient or general practitioner characteristics. 

Influence of low back pain characteristics on the healthcare procedures prescribed by general practitioners for adult patients: ancillary analysis of the French ECOGEN study

The objective of this study was to assess the workplace information collected and shared between professionals of the centers and occupational health professionals during functional restoration programs intended to chronic low back pain patients. A descriptive study carried out by a questionnaire sent to the French rehabilitation centers offering a functional restoration program. Data collection focused on the kinds of professionals involved in programs, professionals who approach work issues, work analysis, social and occupational information collected, existence of a specific work rehabilitation program, frequency of and methods for sharing information with occupational health professionals. Occupational information was mostly collected at inclusion during an individual interview by the rehabilitation physicians, social workers, and occupational therapists. Workplace environment was the most poorly discussed aspect. A minority of centers adapted their programs regarding these information. Information sharing with occupational physicians was mostly through the patient and was influenced by the presence of an ergonomist or of an occupational physician in the team. The study found poor interest about work environment and that the cooperation between practitioners in disability management remains limited. The various practitioners' cultures and interests may be a brake on cooperation and exchange of information.

Eliane Michon

Papers

Return to work after rehabilitation in chronic low back pain workers. Does the interprofessional collaboration work