Enhancing the vocational outcomes of people with chronic disabilities caused by a musculoskeletal condition: development and evaluation of content of self-management training modules.

BACKGROUND: No self-management interventions have been developed to empower those chronically disabled by a musculoskeletal condition to find and/or remain at work. OBJECTIVE: Developand evaluate the content of two self-management training modules to improve vocational outcomes for those with chronic musculoskeletal disorders. METHODS: Stanford University's Chronic Disease Self-Management Program provided the framework for the new modules. Focus groups with the eightpersons with workdisabilities and concept-mapping sessions with the 12 experienced vocational rehabilitation professionals were conducted to identify factors and themes contributing to workers remaining/returning to work post-injury. Five experienced self-management trainers reviewed the modules for consistency with self-management principles. RESULTS: Two new self-management modules: 'Navigating the System' and 'Managing a Return to Work' were developed.The persons with work disabilitiesgenerated four themes: accepting and coping with injury; skills to manage pain and life; positive working relationships and, re-inventing self, whereas the rehabilitation professionals identified three themes:communication and support of others; the injured worker's abilities and resources, and knowledge and education. CONCLUSIONS: Anintervention developed to enhance self-management skills and facilitate positive vocational outcomes of those seeking to return to work post-injury was confirmed as relevant by persons with work disabilities, rehabilitation professionals and self-management trainers.

Cost-analysis of gym-based versus home-based cardiac rehabilitation programs.

A cost-analysis of an existing gym-based program was compared with a proposed home-based program for delivering cardiac rehabilitation services in West Moreton, Queensland. Cost and baseline data were collected on 95 cardiac rehabilitation patients living in Ipswich and West Moreton. Cost data included costs to the program funders and patients. The average cost per patient rehabilitated was $1,933 in the gym-based program and $1,169 in the home-based program. Adopting the lower cost home-based program would allow the services to be provided to many more patients. The relevance of home-based rehabilitation programs for rural patients facing barriers accessing traditional hospital- or gym-based programs is significant.