Research Plus: October/November 2008

Manual handling Cochrane review

The latest OH Cochrane review finds that neither training workers about ‘correct’ material handling techniques, nor providing them with assistive devices are, by themselves, effective in preventing back pain or pain-related disability. Six randomised controlled trials (RCTs) and five cohort studies were identified up to summer 2005. Two of the RCTs and all five cohort studies were considered as ‘high-quality’ evidence. There was moderate evidence that advice and training are no more effective at preventing back pain or pain-related disability than either no intervention or minor advice; limited evidence that advice and training are no more effective than physical exercise or back belt use in preventing back pain; and limited evidence that advice plus assistive devices are no more effective than advice alone, or no intervention, in preventing back pain or pain-related disability.

Cochrane Database of Systematic Reviews 2007; 3: CD005958

Stress and burnout

A systematic review of research on stress and burnout in healthcare workers found evidence that stress management interventions can lead to better health outcomes; however, the evidence came from just one trial. Of papers published between 1987 and 2005, 14 randomised controlled trials, three cluster-randomised trials, and two crossover trials met inclusion criteria. Thirteen trials investigated ‘person-directed’ interventions, such as cognitive-behavioural training, relaxation training, and therapeutic massage. Other interventions included problem-solving, psychological training and changes in work organisation. Evidence from one trial suggests that interventions with cognitive elements do better than those with behavioural features.

Scandinavian Journal of Work Environment and Health 2008; 34(3): 169–178

Raynaud’s phenomenon

Raynaud’s phenomenon (RP) is a common symptom of hand–arm vibration symptom (HAVS) and is generally diagnosed by a subjective assessment of the employee’s symptom history – the sporadic appearance of symptoms makes direct observation by the physician unlikely. But a presenting history of RP in workers seeking compensation for HAVS may not be accurate. Thirty-six workers referred for independent medical examination (having previously been diagnosed with RP or white finger disease, and/or with symptoms such as blanching, whiteness or pale fingers) were asked to document their symptoms using a disposable camera. Nearly half (43%) of the individuals were unable to support a diagnosis of RP with photographic evidence.

Occupational Medicine 2008; 58(6): 431–435

Pre-placement assessments

An audit of 2,973 pre-placement health assessments carried out over 12 months at an NHS trust revealed that that no-one had been declared entirely unfit for work in the NHS, though 45 people (1.5%) were ‘fit with comments’. Musculoskeletal (33%), psychiatric (22%), endocrine (11%) and dermatological (9%) disorders were the most common health reasons given in the ‘fit with comments’ category. Work restrictions were advised in 15 (0.5%) cases (five of these because of latex allergy) and OH follow-up in 12 (0.4%). Anticipated future sickness absence was recorded in just seven cases (0.2%). The total cost of carrying out pre-placement assessments over the 12 months was £13,502.

Occupational Medicine 2007; online first: doi: 10.1093/occmed/kqn098

Alexander technique for low back pain

A randomised controlled trial on patients with chronic back pain suggests that exercise in combination with lessons in Alexander technique offer effective relief from back pain, with the improvements sustainable after one year. Massage was beneficial in the short term, but the effects were not maintained after three months. The trial involved 579 patients with chronic or recurrent back pain recruited from 64 general practices in England. Patients received either normal care (control), six sessions of therapeutic massage, or six or 24 lessons in Alexander technique; each group subdivided into those with or without exercise prescription. Impact was measured using disability and quality-of-life questionnaire scores. Six one-to-one lessons in Alexander technique followed by exercise was almost as beneficial as 24 lessons in Alexander technique alone.

British Medical Journal 2008; 337;a884, doi: 10.1136/bmj.a884

Cooperative case management

Lack of cooperation between key players has been cited as a common barrier to the success of multidisciplinary vocational rehabilitation (VR) programmes. A matched-control study with a six-year follow-up was used to test the effectiveness of a structured multidisciplinary VR programme set up to support municipal workers in Stockholm, Sweden. Case management planning meetings, involving HR, OH, social insurance, the employee and (if requested) the union representative, were held every two weeks and detailed rehabilitation plans drawn up. Crucially, the emphasis was on cooperation, with team members understanding each other’s roles and developing joint responsibility for finding solutions. Sickness absence was significantly lower in the intervention group (p = 0.003) and the average economic benefit of the intervention was estimated at €36,600 per person over the six-year period.

Journal of Rehabilitation Medicine 2008; 40(8); 628–636

Breast cancer return to work

The key factor determining return to work in early-stage breast cancer patients is the type of treatment received. In a study carried out at an OH service in the Netherlands, 72 patients were monitored for two years after diagnosis and their return to work analysed according to treatment type and cancer-related symptoms. All but four of the patients had returned to work after two years, with 35% still absent after one year (mean absence duration 11.4 months). Full and partial return to work was longer in patients who underwent chemotherapy or multimodal treatment (radiotherapy and chemotherapy). Cancer-related symptoms had little effect on the time taken to return to normal hours, though shoulder-function impairment – a common complication after axillary lymph node dissection – delayed partial return to work.

Journal of Occupational Rehabilitation 2008; 18: 267–272

Fear avoidance is major obstacle

Interventions aimed at rehabilitating long-term sickness absentees should focus on overcoming fears of returning to work and on illness perceptions of subjective health complaints. The prospective cohort study was carried out on 135 individuals on long-term sick leave (mean 10.5 months). Most had complex, non-specific subjective health complaints. They were given a four-week inpatient vocational rehabilitation course, with six one-hour sessions five days a week. Sixty per cent had returned to work after three months, and 70% after 12 months. Fear-avoidance beliefs about work were the most important risk factors for not returning, both at three and 12 months. Subjective health complaints were significant at three months.

Journal of Rehabilitation Medicine; 40

Successful vocational rehabilitation

Successful vocational rehabilitation requires a combination of work-focused healthcare and accommodating workplaces, an evidence review of more than 450 papers concludes. Most people with common health problems will return to work uneventfully, but those off work for more than about six weeks will require additional help and support; long-term absentees require interventions that address the major psychosocial obstacles to return to work. Common health problems should be prioritised owing to the sheer numbers of people affected.

Vocational Rehabilitation: What works, for whom, and when? ISBN 9780117038615, 307 pages. London: The Stationery Office, 2008