Making Sense of Conflicting Data on Work Exposures and Their Relationship to the Development of Knee Osteoarthritis: Findings from a Systematic Review.
1Institute for Work & Health, Toronto ON, Canada; 2School of Human Kinetics & Recreation, Memorial University of Newfoundland, St. John's NL, Canada; 3Dalla Lana School of Public Health, University of Toronto, Toronto ON, Canada; 4Toronto Western Research Institute, Toronto ON, Canada.
Objective: Knee osteoarthritis (OA) is a leading cause of disability worldwide. A recent systematic review of the literature identified inconsistent findings across studies regarding the relationship between similar occupational activities (i.e., kneeling, squatting and knee bending) and the development of knee OA. Using sensitivity analyses, we sought to explain these inconsistencies to better inform work disability prevention decision making and to identify future knowledge needs.
Methods: Using the findings from a recent systematic review, we employed sensitivity analyses to examine similarities and differences in study findings related to sex/gender, job activity measurement (e.g., how knee activities were measured), work exposures and dose response information (e.g., duration, frequency of knee activities), early or late OA diagnosis, study designs, and methodological quality.
Results: Twenty studies provided data on the relationship between kneeling, squatting and/or knee bending job activities and the development of knee OA. Overall findings were often inconsistent across studies. For example, across men and women, strong or moderate evidence emerged for knee OA when combining kneeling, squatting and bending activities. Yet, there was no effect when squatting and kneeling were examined individually. Sensitivity analyses help explain the findings and highlight the need for attention to measurement, including whether compartmentalizing or differentiating among knee bending tasks accurately reflects real-world work conditions; the frequency and duration of knee bending; and whether knee bending occurs in conjunction with lifting heavy loads.
Conclusions: Sensitivity analyses provide insight into inconsistent findings in the relationship between specific job activities and the development of knee OA. These findings inform work disability prevention efforts and highlight additional research gaps, especially in measurement of work activities, the consideration of sex and/or gender differences and dose response relationships for the development of knee OA.
Promoting Resilience for Workers on Prolonged Work Disability: Developing a transdiagnostic intervention
Université de Sherbrooke, Canada
Purpose: Growing evidence supports the importance of resilience in the rehabilitation of client’s with musculoskeletal disorders (MSD) or common mental disorders (CMD). Yet, there is a lack of operationalized intervention on resilience in work rehabilitation. This study aims to develop a transdiagnostic intervention promoting resilience in prolonged work disability, and to explore its acceptability with workers.
Methods: A multimethod design was used. First, a scoping review on resilience and associated factors for (1) MSD and (2) CMD was conducted. Data was synthesized into common themes to form a preliminary version of the intervention logic model. Second, 10 expert clinicians in work rehabilitation with knowledge on resilience completed an online survey including questions and proposed changes on the clarity, applicability, relevance and exhaustiveness of the preliminary version. Third, the same experts participated in a group consensus to adapt the intervention logic model. Fourth, we interviewed workers who completed a work rehabilitation program on the prospective acceptability of the adapted version of the intervention. Thematic analysis of the verbatim was performed.
Results: 14 studies in MSD and 9 in CMD were reviewed. 11 common resilience factors were found for both MSD and CMD. Based on these results the preliminary intervention logic model was developed and included: 4 specific and 9 intermediate objectives, 5 activities and 44 tasks. Expert clinicians indicated in the survey 15/29 questions needing consensus. 41 proposed changes yielded a consensus on 15 modifications on the clarity, pertinence, and exhaustiveness of the intervention. Six workers (3 MDS; 3 CMD) had positive attitudes toward the intervention, found it useful and coherent with their values.
Conclusion: A systematic method was used to develop and operationalize an intervention logic model based on literature, expert clinicians and users; thus proposing a novel resilience intervention in work rehabilitation.
Two Systematic Reviews on Economic Evaluations of Interventions Aimed at Preventing Work-Related Musculoskeletal Disorders and Common Mental Disorders
1Université du Québec à Montréal, Canada; 2Université de Bourgogne
Background: The literature is quite scarce on cost-benefit results of preventive interventions in occupational and health safety. We performed two systematic reviews on the prevention of work-related musculoskeletal disorders (WMSD) and common mental disorders (CMD). We had two objectives: (1) to analyze the cost-benefit results, (2) to explore factors related to the implementation process of these interventions (obstacles and levers) in order to identify whether economic results may be due to a successful or unsuccessful implementation. Methods: Systematic review. Studies were searched in eight electronic databases and in reference lists of included studies. Companion papers were identified through backward and forward citation tracking. A quality assessment tool was developed following guidelines available in the literature. An integration of quantitative economic results and qualitative implementation data was conducted following an explanatory sequential design. Results: Regarding WMSD, out of 189 records, nine studies met selection criteria. Out of nine included studies, grouped into four types of interventions, seven yielded positive economic results, one produced a negative result and one mixed results (negative cost-effectiveness and positive net benefit). However, the level of evidence was limited for the four types of interventions. Results regarding CMD are under process. Among the included studies on WMSD, negative and mixed economic results were observed when the dose delivered and received by participants was low, when the support from top and/or middle management was limited either due to limited participation of supervisors or a lack of financial resources and when adequacy of intervention to workers’ needs was low. In studies on WMSD where economic results were positive, implementation data showed strong support from supervisors and a high rate of employee participation. Conclusion: Economic evaluation should include information on the implementation process in order to permit the interpretation of economic results.
Indicated Prevention Interventions in the Workplace for Depressive Symptoms: A Systematic Review and Meta-analysis
University of Ottawa, Institute of Mental Health Research
Background: Depressive symptoms are highly prevalent and cause substantive morbidities and loss of functioning among employees. Depression may be prevented at its early stages. However, there is a paucity of information regarding indicated preventive interventions for depression among employees. The objective of this review is to examine the effectiveness of indicated interventions for the reduction of depressive symptoms in the workplace.
Methods: A systematic review and meta-analysis of articles published between January 2000 and September 2017 was conducted using major electronic databases including PubMed/MEDLINE, PsycINFO, EMBASE, SOCINDEX, and ABI/ProQuest. Studies were selected based on a set of predefined inclusion criteria. Primary outcome measures were depressive symptomatology, and the nature of the interventions was indicated prevention. Studies were pooled based on the intervention type and the effect size was measured using the standardized mean difference.
Results: A computer and hand search of the literature yielded 4,462 papers, from which 16 trials were identified to be suitable for meta-analysis. Eight of 16 studies reported significant effects for workplace preventive interventions targeting depressive symptoms in which six were cognitive behavioral therapy (CBT) based interventions and two were non–CBT-based interventions. Small to medium effect sizes were found for both CBT- and non–CBT-based interventions (standardized mean difference = –0.44, 95% CI= –0.61, –0.26, I2=62.1% and standardized mean difference= –0.32, 95% CI= –0.59, –0.06, I2=58%, respectively).
Conclusions: This review demonstrates that indicated interventions can significantly reduce the level of depressive symptoms among workers. The implementation of evidence-based workplace interventions should consequently be considered to prevent the development of depressive symptoms among employees.
Cross-Country Comparison Model For Work Disability Prevention
Maastricht University, Netherlands, The
Background: Work disability research is in need for a model for comparing legislation and other social context factors across countries. The model should support systematic interpretation of research outcomes, their transferability and inform on country specific implementation requirements. The large cross-country differences in labour participation of persons with chronic diseases is one of the important issues. Our aims were (1) to develop a generic model for cross-country comparison in relation to work disability prevention and (2) to validate this model regarding labour participation of persons with chronic diseases.
Method: New institutional theory (NIT) was used to develop a generic model. Empirical evidence for the relation between model concepts and labour participation of persons with chronic diseases was searched for by a scoping review of the literature.
Results: The Cross-Country Comparison model for Work Disability Prevention (CCC-model for WDP) consists of five concepts representing a country’s social context: (1) regulative institutions (legislation); (2) normative institutions (norms and values of professionals and lay persons involved); (3) WDP organizations and professions; (4) cultural-cognitive institutions (cultural beliefs); (5) labour market characteristics. Relations with labour participation of persons with chronic diseases were found for specific variables within each concept: (1) welfare state type, employment protection and anti-discrimination legislation; (2) norms regarding work, sick role, professional role and gender role; (3) WDP organizations and professionals; (4) hierarchy and individualism; (5) informal employment, contract and job type.
Conclusion: The CCC-model for WDP is a generic model consisting of five main concepts. The model was validated for interpreting cross-country differences in labour participation of persons with chronic diseases. The model can guide systematic interpretation of empirical findings in relation to WDP across countries, and inform on policy changes and intervention development in line with a country’s social context.
Process And Content Of The French Guidelines For Work Disability Prevention
1UMRESTTE UMR T9405, Université Claude Bernard Lyon 1, France; 2Occupational health and medicine department, Hospices Civils de Lyon, France; 3Centre de consultations de pathologie professionnelle du CHU d’Angers, Angers, France / INSERM, U1085, IRSET, Equipe ESTER , Université d'Angers; 4Institut de Santé au Travail du Nord de la France, Lille, France; 5Haute Autorité de Santé, Paris, France; 6Cellule d'Urgence Médico-Psychologique CUMP 69, Hospices Civils de Lyon, France; 7Centre de consultations de pathologie professionnelle du CHU-Hôpitaux de Rouen, CISMeF-TIBS-LITIS EA 4108, Université de Rouen; 8Centre de consultations de pathologie professionnelle du CHU de Lille, CRDP EA 4487, Université Lille
Due to the rising trend in the number of disabled workers, work disability prevention (WDP) has been identified as an objective of the national health policy in France. The French Society of Occupational Medicine and the French National Authority for Health (HAS) commissioned guidelines for WDP.
It was chosen to focus on the most disabling conditions, including musculoskeletal disorders, cancer, common mental health disorders, neurological and cardiovascular diseases. A bibliographic search was performed in Medline, Central, Lissa, Scisearch, Cairn and Eficatt from 2007 to 2018. References were reviewed by title and abstract (n=1393) and full text (n=286), before inclusion in the evidence base (n=157). Existing guidelines, meta-analysis and literature reviews were considered in priority. Recommendations were formulated, reviewed and modified by a multidisciplinary task force of 25 experts. Each recommendation was then rated by a reading group of 82 stakeholders. Final version was elaborated by multidisciplinary working group consensus based on HAS method.
General recommendations pertain to the WDP missions of occupational health (OH) services, compliance with the regulatory framework, coordination of actors, and analysis of the factors influencing occupational prognosis. Most recommendations applied whatever the medical conditions. Specific recommendations were formulated in some disabling conditions where appropriate. It is recommended that OH professionals formulate a return-to-work (RTW) plan for the management of workers on sick leave beyond 3 months, including a shared analysis of the situation, a list of barriers and facilitators, and the solutions to be implemented and evaluated. A catalogue is provided including key measures to facilitate RTW and job retention. Similar recommendations are developed for workers who are still at work with health problems.
These are the first French recommendations for WDP. Improving OH practices will require the active dissemination of these recommendations with tools and incentives to facilitate their use.