Musculoskeletal disorders are among the most common types of work injury in industrialized countries and constitute a major economic burden on contemporary society. Moreover, workrelated musculoskeletal disorders (WRMSDs) are among the leading causes of significant human suffering, loss of productivity, and heavy financial costs to society. A large portion of this burden is associated with the number of workdays lost by a small percentage of workers being compensated for prolonged disability caused by musculoskeletal disorder.
In the work disability research field over the past two decades, numerous studies have described and evaluated different types of interventions found to be helpful in preventing disability in workers who have WRMSDs, with many of these interventions originating from the rehabilitation and RTW fields. More recently, several systematic literature reviews and metaanalyses have been published with the aim of enlightening the decision-making process by providing evidence-based data on the best interventions for preventing work disability. However, very little of the literature addresses the issue of preventing prolonged disability in workers compensated for WRMSDs. In addition, the controversial nature of the results evaluating the effectiveness of the different interventions, the incomplete description of the participants involved in the studies, and the absence of explanations concerning the implementation process and strategies of the different programs and interventions make their application dangerous in actual practice. The endless proliferation of concepts in the work disability field, the diversity of implementation contexts and interventions, and the multiple interests and points of view of the stakeholders involved in the intervention process compound the complexity of the challenges faced, not only by researchers but also by managers and practitioners, in preventing prolonged disability. Many questions persist, particularly regarding the strategies to be used to prevent prolonged disability and promote successful rehabilitation and sustainable return-to-work (RTW). Stakeholders still need comprehensive reviews that provide a synthesis of and details on interventions and their application context, especially from the perspective of preventing prolonged disability. The main objective of this literature review was therefore to provide an overview of the main topics and trends in contemporary work disability research and to identify potentially successful intervention modalities for preventing prolonged disability in workers compensated for WRMSDs.
A systematic electronic search of the literature was performed in ten scientific databases by a specialized librarian. The descriptors and key words searched in the databases pertained to five key concepts: 1) workplace absenteeism, 2) work-related musculoskeletal disorders, 3) work disability intervention, 4) rehabilitation and return-to-work intervention, and 5) compensation issues. After correcting the list of references obtained for duplications and misspellings and checking the references against the inclusion and exclusion criteria, 218 articles were selected for review: 186 articles reporting on one or more revelatory studies, 20 theoretical articles and 12 literature reviews. Descriptive quantitative analyses were performed on the 218 abstracts. In order to pinpoint the main topics and recent trends in research on intervention, the articles were
first described in terms of the country of the first author, publishing journal, and type and stage of WRMSDs discussed. Second, the articles reporting on one or more revelatory studies (186) were categorized on the basis of their main objective, stakeholder(s) involved in the study or interested by the study’s results, research perspective, and area of application. A grid constructed especially for these purposes was used to categorize the articles and compile the relevant information. Two reviewers, whose decisions were made by consensus, proceeded to define the main categories and classes to be included in the grid, to categorize the articles, and to extract the pertinent information for describing the topics and trends. A database was created for further reference. Finally, qualitative analyses were performed on the articles found by the reviewers to describe strategic components of intervention aimed at preventing prolonged disability (88 out of the 186 articles that reported on one or more revelatory studies), to identify these strategic components in the different programs, policies, strategies, and guidelines reported by the authors, to identify the main strategies aimed at preventing prolonged disability, and, further, to explain their usefulness to practitioners and stakeholders in their decision-making processes.
Five main topics were identified in the literature reviewed. The first major topic concerns the factors contributing to prolonged disability and a clear interest in developing modalities for screening people at risk of prolonged disability in order to provide them with appropriate interventions. A second major topic pertains to the evaluation of outcomes associated with different programs or combined interventions, either from the perspective of the successful component(s) or mix of interventions to be used to obtain better outcomes, or from the perspective of the best practices to be used by the concerned practitioners or stakeholders in order to achieve such results. Multidisciplinary, multimodal, or targeted intervention was often reported as being incorporated into the development of such programs. Based on the literature, psychosocial and ergonomic-related workplace factors appear to be the components most frequently associated with processes aimed at preventing prolonged disability in workers compensated for WRMSDs. A third topic of interest to researchers in the work disability field is the documentation and evaluation of the key actors’ practices in terms of their rehabilitation and RTW interventions. More specifically, we observed a clear interest in describing the role and responsibility of the different actors involved in the rehabilitation and RTW process. A fourth major topic concerns the compensation issue. The differences in outcomes associated with the different compensation systems in place, or between people with different compensation status, are the predominant issues explored. Finally, a fifth topic pertains to the different methodological issues related to the development, validation, and evaluation of tools useful in the work disability management process, specifically, in measuring the disability outcomes obtained in diverse populations according to the different types of interventions.
Four recent trends emerge in the literature reviewed. First, authors frequently point out phenomena associated with prolonged disability, yet they rarely focus on the prevention of these phenomena. Second, they appear to regard the taking into account of the different stakeholders’ points of view as a key feature in preventing prolonged disability. Third, descriptive studies in the field show researchers’ interest in better understanding the process of implementation (role of the different actors, role of the contextual factors, barriers and facilitators) of the different interventions (programs, policies, strategies, etc.). A final trend observed is that of factoring workers into the equation in order to raise the different stakeholders’ awareness of the economic, social, and personal consequences of the workers’ disability. Indeed, some studies appear to suggest that workers’ perceptions of the work disability phenomenon and its related issues constitute a powerful force in interventions aimed at improving their chances of moving away from disabled status towards employed status or shifting from a disempowered to an empowered perception of themselves.
Although the studies reviewed differ in their methodologies, objectives, areas of application, and research perspectives, and although they portray the different stakeholders and practitioners involved as having different views and concerns, they concur in identifying the same key strategies as potentially successful in preventing prolonged disability in workers compensated for WRMSDs. First, early screening of injured workers at risk of prolonged disability and the concentration of efforts on them through targeted intervention appears to be an effective way to prevent prolonged disability. Second, different types of interventions or combinations of interventions included in a given program appear to be beneficial in terms of helping prevent prolonged disability and promoting RTW. Multidisciplinary and multimodal programs are frequently associated with positive outcomes such as workers’ leaving the sickness benefits scheme and getting compensation claimants back to work, and with having a positive impact on the following: sick-leave status, recurrence rates, work disability status, cost-effectiveness, socioeconomic impacts, pain intensity, disability, depression and cumulative physical capability, and physical performance. Moreover, early targeted intervention for people who have been screened for psychosocial and ergonomic risk factors appears to be central to preventing prolonged disability and promoting sustainable safe RTW. Third, the actors’ practices have a significant impact on the implementation of these interventions. Physicians and other healthcare providers, case manager nurses or insurance representatives, and workplace actors all play an important role in the process of preventing prolonged disability through their actions and interactions with the workers. Other key elements of the different actors’ practices, including providing early access to appropriate advice, keeping workers at work, or returning them to work as quickly as possible, and the employer and compensation board representatives staying in touch with the individual and the physicians during the work absence also appear to be important, as reported by various authors. Continually providing practitioners with updated guidelines and directives for improving their practices appears to have, at least theoretically, a beneficial impact in terms of helping prevent prolonged disability. Providing them with knowledge about the different outcomes associated with diverse conditions of application could improve their ability to adapt their practices to a specific implementation context. Fourth, improving collaboration and communication among the key stakeholders and actors could enhance the coordination of actions aimed at preventing prolonged disability. Indeed, the coordination of key stakeholders’ actions appears essential to increasing the effectiveness of early multidisciplinary interventions aimed at preventing prolonged disability. Fifth, providing adequate information to the injured workers, but also to the multiple actors and stakeholders involved in the rehabilitation and RTW process, and making them aware of the human and social consequences of prolonged disability also appear to be critical to the sustainable RTW of injured workers compensated for WRMSDs.
The findings of this literature review inform stakeholders and practitioners in the field of work disability intervention of the main topics and current trends in research on intervention aimed at the successful rehabilitation and sustainable RTW of workers compensated for WRMSDs. In addition, by identifying potentially successful strategies for preventing prolonged work disability, the review provides stakeholders and practitioners with some possible avenues for action. Finally, the review highlights some further insights essential to the development of intervention programs that have the capacity to reach many employees and promote positive outcomes for all workers, especially those who need it most.
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Strategies for Preventing Prolonged Disability in Workers Compensated for Work Related Musculoskeletal Disorders – A Systematic and Comprehensive Literature ReviewNastasia, Iuliana; Tcaciuc, Rodica; Coutu, Marie-France
Studies and Research Projects / Report R-719, Montréal, IRSST, 2011, 146 pages.