Case Management of Injured Workers for Return-to-work / 中国康复理论与实践

@#Objective To explore the case management model of return to work injured workers. Methods A retrospective cohort wasformed with 523 injured workers in rehabilitation centre. The social demographic information, medical data and intervention process wereextracted from the medical records. A Cox Regression Model was used to examine the effect of case management on work processes and otherrelevant factors affecting RTW. Results 275 cases (82.1%) out of the 335 subjects successfully returned to work after median absence durationof 36.0 days. Computer training prompted RTW outcomes (P<0.01), while disability adjustment activity showed an opposite effect(P<0.05). It showed that education level, family attitude to RTW and level of injury were significantly associated with outcomes of RTW.Conclusion Specific skills reconstruction and training would is one of the most important components of the case management interventionprogram on RTW. Although disability adjustment did not specifically benefit RTW, it might help in improving workers' general health status,and it should not be ignored in any case.

Prevalência de lombalgia em trabalhadores submetidos ao programa de Reabilitação Profissional do Instituto Nacional do Seguro Social (INSS), São Luís, MA / Prevalence of low back pain among employees undergoing the Occupational Rehabilitation Program at Instituto Nacional do Seguro Social (INSS), São Luís, MA

O presente estudo avalia a prevalência de lombalgia na população de trabalhadores inseridos no Programa de Reabilitação Profissional do Instituto Nacional do Seguro Social (INSS), na cidade de São Luís/MA. Este programa apresenta como funções básicas a avaliação do potencial laborativo e a definição da real capacidade de retorno ao trabalho dos segurados atendendo aproximadamente 400 pessoas por mês. Através dos registros em prontuários, foi realizado um estudo de corte transversal retrospectivo em que foram separados 264 prontuários, válidos de 1995 a 2009, de trabalhadores afastados do trabalho e ainda com vínculo empregatício. Aqueles apresentados como desempregados foram excluídos do trabalho. Dessa amostra, selecionou-se somente os trabalhadores com diagnóstico de lombalgia, totalizando 88 prontuários, em que foram encontrados 83 casos do sexo masculino (94,3%), média de idade de 41 anos, variando de 24 a 53 anos. A prevalência de lombalgia foi de 33,3% em relação aos diagnósticos encontrados na amostra inicial. Observou-se que em sua maioria, a amostra era composta por trabalhadores casados, com baixa escolaridade, do sexo masculino, em idade produtiva e afastados do trabalho há mais de um ano, associada à realização de atividades profissionais às quais exigem postura estática, movimentos repetitivos e carregamento de peso.

The present study evaluates the prevalence of low back pain in a population of employees participating in the Occupational Rehabilitation Program at the Instituto Nacional do Seguro Social (INSS) in the city of São Luis, located in the state of Maranhão, Brazil. The basic functions of this program are the evaluation of labor potential and the definition of the real capacity to return to work of employees, and it serves approximately 400 people per month. Through the records in the medical registers, a retrospective cross-sectional study was carried out with 264 records, from 1995 to 2009, of employees off work and of employees still working. Those shown as unemployed were excluded from this study. From this sample, only employees with low back pain were selected, totaling 88 records, in which 83 male cases (94.3%) were found with an average age of 41 years, ranging from 24 to 53. The prevalence of low back pain was 33.3% compared to the medical registers found in the initial sample. Of those in the sample, it was noticed that most were married, with little schooling, male, at a productive age, and had been off work for more than a year. They had occupations that required static posture, repetitive motion, and strenuous physical activity.

Facilitadores e barreiras para o retorno ao trabalho: a experiência de trabalhadores atendidos em um Centro de Referência em Saúde do Trabalhador SP, Brasil / Facilitating factors and barriers for returning to work the experience of workers treated at a Workers Health Reference Center in São Paulo, Brazil

Os trabalhadores acometidos por doenças ocupacionais têm vivenciado muitas dificuldades para retornar ao trabalho devido às limitações funcionais e aos obstáculos vivenciados junto às empresas, à previdência social e aos serviços de saúde. Restrição laboral e retorno ao trabalho são aspectos dos mais complexos nas políticas de atenção à saúde do trabalhador. Visando identificar os facilitadores e as barreiras para o retorno ao trabalho de trabalhadores com longo período de permanência e sem resolutividade no serviço, em 2008, realizou-se um estudo exploratório, de natureza empírica, com abordagem qualitativa, desenvolvido a partir de estudo documental de 10 prontuários de trabalhadores acompanhados em grupo pela terapia ocupacional de um Centro de Referência em Saúde do Trabalhador dacidade de São Paulo. A organização e a análise dos dados foram realizadas segundo os componentes da CIF. O uso da CIF favoreceu ampliar a visão das condições de saúde dos trabalhadores e compreender a influência de serviços, sistemas e políticas nas diferentes áreas. As principais barreiras ao retorno ao trabalho foram: ausência de adequados programas de reabilitação profissional e insuficiente comunicação entre os atores dos diferentes níveis administrativos e políticos. Os principais facilitadores foram as atitudes e os comportamentos individuais dos profissionais de saúde do CRST, que forneceram acolhimento e suporte.

After being affected by occupational diseases, workers face difficulties to return to work due to their functional limitations and obstacles presented by employers, social welfare and health services. Labor restrictions and return to work are complex aspects within workers health policies. The purpose of this qualitative exploratory study conducted in the second half of 2008 was to identify the facilitating factors and the barriers for returning to work of workers with long unsuccessful treatment. It was based on the documental analysis of 10 clinical records of participants in a occupational therapy group at a Workers Health Reference Center (CRST) in the city of São Paulo. Data were organized and analyzed according to ICF (InternationalClassification of Functioning, Disability, and Health) components. Working within ICF framework widened our views on workers health conditions and helped usunderstand the influence of services, systems, and policies in different areas. Mainbarriers for returning to work were the lack of adequate occupational rehabilitation programs and the miscommunication among actors at different administrative and political levels. The main facilitator was the individual attitude and the behavior of the CRST staff, providing holding and support to workers.

Reabilitação profissional no Brasil: elementos para a construção de uma política pública / Occupational rehabilitation in Brazil: elements for the development of public policy

Partindo de uma retrospectiva histórica da reabilitação profissional, o objetivo do presente ensaio é refletir sobre as possibilidades de se construir uma política pública, tendo como objetivo a real reinclusão social dos acidentados e adoecidos e não um mecanismo de desfecho burocrático para a redução de custos com benefícios previdenciários. Voltado para os trabalhadores com restrições decorrentes de acidentes traumáticos, o serviço de reabilitação profissional do Instituto Nacional de Seguro Social (INSS), existente até os anos 1990, mostrava-se insuficiente para promover a reinserção de trabalhadores com agravosde perfil epidêmico, particularmente Lesões por Esforços Repetitivos/Distúrbios Osteomusculares Relacionados ao Trabalho (LER/DORT). Nessa época, reflexo da política privatizante, promoveu-se um desmonte nessas estruturas dentro do INSS e a delegação da reinserção dos trabalhadores às empresas. A construçãode uma política pública de reabilitação profissional exige: a inserção da saúde do trabalhador nas políticas de desenvolvimento econômico; a desconstrução da cultura e da máquina previdenciária voltada prioritariamente para os custos; a real articulação da Saúde e da Previdência Social em projetos nacionais e locais; a inclusão do caráter distributivo nos planos de modernização; o monitoramento da trajetória dos trabalhadores; e a transparência institucional.

Starting from a historical review of occupational rehabilitation, this essay reflects on the possibilities of structuring a public policy towards a real social reinclusin of the injured and diseased workers, and not as a bureaucratic mechanism to reduce social security benefit costs. Aimed at workers with disabilities caused by traumatic accidents, the occupational rehabilitation department of the National Social Security Institute (INSS) in Brazil, which existed until the 1990s, proved to be inadequate to reintegrate workers with health problems of epidemic profile,particularly Repetitive Strain Injuries/Work-Related Musculoskeletal Disorders (RSI/WRMD). At that time, as a consequence of a privatizing policy, these structures within INSS were dismantled and companies had to assume the reintroduction of workers. The development of an occupational rehabilitation policy requires the inclusion of occupational health as a topic in economic development policies, the deconstruction of the current thought and system geared primarily by pension costs, the real articulation of Health and Social Welfare in national and local projects, the inclusion of a distributive quality in the modernization plans, the monitoring of workers trajectory, and institutional transparency.

Programa de reabilitação profissional para trabalhadores com incapacidades por LER/DORT: relato de experiência do Cerest-Piracicaba, SP / Rehabilitation program for of workers with RSI/WRMD at Cerest-Piracicaba, São Paulo, Brazil

Este artigo relata a experiência do projeto-piloto em reabilitação profissionalpara adoecidos de LER/DORT em andamento no Centro de Referência em Saúde do Trabalhador de Piracicaba (Cerest-Piracicaba) desde 2007, a partir da reconstituição do seu modelo assistencial e de vigilância em Saúde do Trabalhador, por meio da caracterização de seus aspectos constitutivos fundamentais e da lógica da intervenção. As várias fases da programação desenvolvidas pela equipe interdisciplinar, os métodos empregados e os fundamentos teóricos que norteiam o equacionamento entre a situação-problema e a consecução dos objetivos pretendidos são descritos. Os resultados quantitativos e qualitativos obtidos até o momento são analisados à luz dos elementos estratégicos facilitadores,bem como das relações de interesse que atuam como impedimentospara a participação no programa e para o retorno ao trabalho dos trabalhadores reabilitados. As lições aprendidas e algumas propostas que poderiam contribuir para a eficiência de uma política pública de reabilitação profissional concluem o presente estudo.

Starting from a historical review of occupational rehabilitation, this essay reflects on the possibilities of structuring a public policy towards a real social reinclusin of the injured and diseased workers, and not as a bureaucratic mechanism to reduce social security benefit costs. Aimed at workers with disabilities caused by traumatic accidents, the occupational rehabilitation department of the National Social Security Institute (INSS) in Brazil, which existed until the 1990s, proved to be inadequate to reintegrate workers with health problems of epidemic profile, particularly Repetitive Strain Injuries/Work-Related Musculoskeletal Disorders(RSI/WRMD). At that time, as a consequence of a privatizing policy, these structures within INSS were dismantled and companies had to assume the reintroduction of workers. The development of an occupational rehabilitation policy requires the inclusion of occupational health as a topic in economic development policies, the deconstruction of the current thought and system geared primarily by pension costs, the real articulation of Health and Social Welfare in national and local projects, the inclusion of a distributive quality in the modernization plans, the monitoring of workers? trajectory, and institutional transparency.

Contributors of Return to Work for a Cohort of Spinal Cord Injured Workers / 中国康复理论与实践

@#Objective To explore the rate of return to work among a cohort of spinal cord injury (SCI) who were at least 18 months post injury and some psychosocial factors contributing to return to work. MethodsA convenient sampling method was adopted and total 161 subjects were involved. The demographic characteristic and psychosocial variable were collected by 6 self-reported questionnaires: World Health Organization Disability Assessment Schedule Ⅱ, Acceptance of Disability Scale, Rosenberg Self-Esteem Scale, Center for Epidemiologic Studies Short Depression Scale, Generalized Self-Efficacy Scale and Multidimensional Scale of Perceived Social Support. Self-administered, telephone and face-to-face interview were the manners to capture data. ResultsThe return to work rate is 31%. The result generated from Logistic regression showed that the type of SCI (paraplegia or quadriplegia) （OR=4.397）, acceptance of disability (OR=0.979), disability assessment level (OR=0.948), and the impact of belief to activities of daily living (OR=0.681) were the contributors for successful return to work. ConclusionFor those who suffering from SCI after 18 months, both psychosocial adjustment factors and physical functioning may have the great impacts for the outcomes of return to work rather than that of external factors, such as social supports.

Action Research on Occupational Rehabilitation and Community Re-integration of Migrant Injured Worker / 中国康复理论与实践

@#Objective To discuss with the principles and methods of whole rehabilitation plan including occupational rehabilitation and community re-integration for injured workers.MethodsAfter following up on 371 injured workers, 14 intensive investigation and follow-up injured workers' cases were taken out as samples and studied according to some elements including gender and family role, degree of physical disability, rehabilitation process, compensation for work injury. The status of occupational rehabilitation and community re-integration and affected factors were also analyzed.ResultsThe factors affecting injured workers' occupational rehabilitation and community re-integration included the degree of physical disability, gender and family role, compensation for work injury, work injury rehabilitation policy and the model of work injury rehabilitation service management by multi-professional group.ConclusionThe whole injury rehabilitation plan should be considered the needs of injury worker basic medical treatment, occupational rehabilitation and community re-integration, the appropriate support and guidance should be provided and the model of one stage and intensive investigation work injury rehabilitation service management should be established early.