Effectiveness of workplace rehabilitation interventions in the treatment of work-related low back pain: a systematic review.

PURPOSE: A systematic review was conducted to evaluate the effectiveness of workplace rehabilitation interventions for injured workers with low back pain (LBP). METHOD: MEDLINE, CINAHL (Cumulative Index to Nursing and Allied Health Literature), EMBASE, and AMED (Allied and Complementary Medicine) were searched from 1982 to 2005 for peer-reviewed studies of rehabilitation interventions that were provided at the workplace to workers with musculoskeletal work-related LBP. Methodological quality appraisal and data extraction were conducted by five reviewers. RESULTS: Of a total of 1,224 articles that were identified by the search, 15 articles, consisting of 10 studies, were of sufficient quality to be included in the review. The best evidence was that clinical interventions with occupational interventions as well as early return to work/modified work interventions were effective in returning workers to work faster, reducing pain and disability, and decreasing the rate of back injuries. Ergonomic interventions also were found to be effective workplace interventions. CONCLUSION: The need for further research in this area is necessary to reduce the burden of back pain on employees and their families, employers, and the health care system.

Employers and policy makers can make a difference to the employment of persons with disabilities.

PURPOSE: The purpose of this article is to discuss what employers and policy makers can do to promote employment success for persons with disabilities. A study carried out in Rehabilitation Science at McMaster University, Ontario, Canada identified a number of themes, definitions of success and recommendations for change. METHOD: This article is a descriptive review of the study outcomes as well as a discussion of how the literature contributes to the position that employers and policy makers can do more to ensure that persons with disabilities achieve success in paid employment. RESULTS: The author proposes strategies that employers and policy makers can use that have been recommended both in the study and other more recent documents. CONCLUSIONS: Despite attempts to move the employment agenda for persons with disabilities forward, the results in both North America and Europe appear to be dismally low. There is evidence to suggest that employer activity in this regard is still minimal and that policy makers are not working together to ensure that there are opportunities for this population to succeed. Professionals working in this field need to be more actively involved with both employers and policy makers in order for the environment to change in a significant way.

Disability management in a sample of Australian self-insured companies.

PURPOSE: Disability management (DM) is a term developed in North America and refers to the prevention and management of injury and illness in the workplace. The purpose of this paper is to report findings of an Australian study that examined whether self-insured employers in that country have implemented integrated DM programmes. Key principles underpinning such programmes are explored to identify the extent to which Australian employers have adopted them. METHOD: Data was collected from 29 self-insured Australian companies in three Australian States using a structured interview format with additional open-ended questions. RESULTS: It was found that companies have in place, to varying degrees, some of the key elements of disability management programmes. However, these elements were often not well integrated in a comprehensive disability management approach. The focus on workplace-based, early intervention in the area of return to work for injured employees was particularly strong, but there was little evidence of formal labour-management committee structures responsible for implementing DM programmes. CONCLUSIONS: If the concept of DM is relevant to the Australian environment then this study would suggest that self-insured companies need to undertake further work to develop integrated approaches to preventing and managing disability in the workplace. Several limitations of this study are highlighted and it is concluded that further work in this area is needed.

The elements of a positive workplace environment: implications for persons with disabilities.

A group of researchers from humanities, business, geography and rehabilitation science at McMaster University carried out a qualitative research study involving persons with disabilities in a south-western Ontario community. The study examined how persons with disabilities defined positive work environments both in paid work and volunteer activity. The study used a framework of organizational factors, social factors; social supports outside the workplace and individual characteristics. The study found that participants stressed the importance of positive attitudes, respect, understanding, communication and education as key components.

What prevents people with disabilities from obtaining employment? An examination of Canadian data from a national and regional perspective.

People with disabilities who are able to be employed have historically had to struggle with a number of barriers related to workplace activities. In recent years, more data has become available regarding employment in general and for people with disabilities in particular. As major stakeholder groups (people with disabilities, service provider agencies, funders and employers) move to a more integrated and equitable approach, it is essential that data related to employment for people with disabilities not be esoteric but utilitarian. This article will review a Canadian regional study that is being used to help shape vocational services for people with disabilities and will compare the findings to the Canadian national scene.

Occupational cumulative trauma disorders of the upper extremity.

The umbrella term cumulative trauma disorders (CTDs) (also known as repetitive strain injuries, overuse syndromes, and repetitive motion disorders) covers a number of similar conditions arising from overuse of the joints or soft tissues of the upper extremity. Occupational CTDs have become a common problem in the workplace. These disorders are costly to the employer, the worker, and society in terms of time lost from work and resulting disability. Within the past decade, occupational therapists and physical therapists specializing in rehabilitation of work-related musculoskeletal injuries have seen an increase in the incidence of CTDs of the upper extremity in the workplace. Therapists are called upon not just to treat these injured workers, but also to help them regain a functional level for work reentry and to educate them to prevent reinjury. This article reviews the literature on the epidemiology, etiology, pathophysiology, and management of upper-extremity occupational CTDs. Because the ultimate goal of the workplace is to maintain the health and safety of the employee, an educational approach to hand, wrist, elbow, and shoulder use is essential to prevent, decrease, or eliminate the risk of occupational CTDs of the upper extremity.

The structured oral self-directed learning evaluation: one method of evaluating the clinical reasoning skills of occupational therapy and physiotherapy students.

The Structured Oral Self-directed Learning Examination (SOSLE) is used to evaluate the clinical reasoning skills of occupational therapy (OT) and physiotherapy (PT) students. It is an oral examination which evaluates a student's problem-solving ability, self-directed learning skills, knowledge level and self-assessment ability. The three parts of the examination are conducted over a 24-hour period. Validation of this instrument was carried out in two groups of OT and PT undergraduate students over two consecutive years (Year 1--n = 20) (Year 2--n = 18). Inter-rater reliability correlations varied from 0.61 to 0.78 the first year to 0.85 to 0.99 in the second year. The results obtained from the SOSLE were also compared to written and tutorial marks obtained in the same course. Pearson Correlation Coefficients (PCC) among mean SOSLE and two written paper scores ranged from 0.0-0.05 (Year 1) to 0.0-0.1 (Year 2). The PCC among the mean SOSLE and tutorial performance scores were 0.57 (Year 1) and 0.0 (Year 2). The results show that good agreement between raters can be reached using this evaluation method. However, the poor correlations between the SOSLE and the other methods of evaluation may show that different skills are being evaluated. Further validity testing needs to be carried out to confirm that this tool is measuring process oriented skills.