Topical Seminar 1

Topical Seminar 1:
Putting conceptual frameworks to use to improve work disability intervention

Session chair(s): Fergal O'Hagan

Schedule Details

Monday September 29
10:45 - 12:15 Morning Concurrent Sessions (M O1 - M O12 and Seminar 1)
Topic: Clinical interventions
Room C

Seminar Objectives

Background

Research provides valuable insights into influences on work disability processes but often fails to develop tangibly into useful products to support knowledge translation and improve work reintegration. Our research group has examined the role of injury representations on work disability. This has lead to the development of an online tool to assess injury representations and provide structured feedback to clinicians that can be used in the rehabilitation process. The tool also supports program evaluation and research.

Objective

Following this thematic session participants will be able to:

  1. Explain the value of a representations framework in work reintegration research and practice;
  2. Describe how a program of research on illness representations lead to the development of a clinical support tool for MSD disability; and
  3. Explain the critical features that enabled the implementation of theoretical and empirical findings in developing and deploying the tool.

Methods

We will achieve these objectives by:

  1. Providing an up to date theoretical summary of representations identifying why the representations framework is superior to other models.
  2. Presenting empirical findings relating representations to work reintegration, focusing on work from our group but also drawing on work from other researchers.
  3. Presenting information on the development, deployment and utility of the Illness Perceptions Questionnaire-R adapted to work disability.

Our thematic session proposal adds value by:

  1. Providing a substantive overview of injury representations and self-regulation and a tool for assessing representations; and
  2. Describing a case study of the process involved in taking a conceptual perspective on adaptation to disabling injury and putting it to work for workers and clinicians. This fits well with the theme of the conference “Implementing Work Disability Prevention Knowledge.”

Agenda

Time Topic/activity
0000 What can be learned from the literature on social representations to understand workers’ motivation during work rehabilitation?
0020 Questions and Discussion
0025 What does research say about the role of representations in work rehabilitation?
0045 Questions and Discussion
0050 Facilitating the evaluation of work disability representations in practice settings
0115 Questions and Discussion

Presentation 1: What can be learned from the literature on social representations to understand workers’ motivation during work rehabilitation?

Presented by: Marie-France Coutu

Authors

Durand MJ1

  1. CAPRIT and School of Rehabilitation, Université de Sherbrooke, Longueuil, Québec, Canada

Abstract

Background

According to a previous systematic review, illness representations have an important role on work participation. A representation is a complex, organised entity including information, opinions, attitudes and beliefs on a particular subject. Studied in anthropology, sociology and psychology since the sixties, representations are often evaluated in a compartmentalized way. Objective: 1) to document existing models and conceptual frameworks on representations, 2) to establish a transdisciplinary link among findings and 3) to document the theoretical applicability in work rehabilitation for MSD.

Methods

A narrative interpretative approach was used. An electronic literature search (French, English) from 1960 to 2005, was first performed, and updated in 2014 in medical, paramedical and social science databases (MedLINE, PsychINFO, CINAHL, etc.) with predetermined key words. After screening titles, and abstract based on a set of criteria, content analysis was performed on retained articles. The inclusion criteria were as follows: (1) concerned with persistent pain of musculoskeletal origin; or (2) concerned with a theoretical or methodological model related to illness representation; and (3) contribute a new, or substantial, understanding of the main models used to interpret and analyze data. A manual search was also done of lists of references, appropriate journals and symposium proceedings.

Results

The theoretical models and approaches can be divided into three categories: (1) personal experience; (2) interactionist; and (3) sociocultural. The models found in sociology and anthropology are mainly descriptive and developed in a medical context, and only rarely in an occupational health context. However, these models could add elements to psychosocial models that are more dynamic and oriented toward understanding the reasons behind specific behaviors.

Conclusions

Bridging the gap between these disciplines will help us achieve a new level of knowledge that will, by taking social constructions into account, enhance understanding of workers’ representations, and the behaviors they adopt to manage their MSD-related disability.

Presentation 2: Illness representations and work rehabilitation

Presented by: Fergal O'Hagan

Authors

Coutu MF1,2

  1. Trent University, Peterborough
  2. CAPRIT and School of Rehabilitation, Université de Sherbrooke, Longueuil, Québec, Canada

Abstract

Background

Patients are “common-sense scientists” who develop personal representations of health problems that lead to decisions about coping response and ultimately appraisal of the effectiveness of actions. Representations are also part of the patients recovery, reflecting their cognitive and emotional adaptation to an injury or illness. Our particular interest lies in how representations develop, transform and influence worker adaptation to illness and injury. Our overarching goal is to understand the complex self-regulatory system involved in response to disabling injury and illness.

Methods

Data synthesis of two qualitative research projects focusing on illness representations and work reintegration. Longitudinal interviews were conducted with 16 workers with chronic work-related MSK disability and 12 workers returning to work following disabling cardiovascular disease events. Themes were developed through constant comparative methods. Results were integrated with extant literature.

Results

The following themes developed from the data: 1. Health and illness are appraised for their functional consequences. 2. Symptoms like pain are appraised for their threat value. Pain can be reinterpreted leading to better rehabilitation participation and return to work. 3. The body is an important object of interpretation. Body representations enable and constrain adaptive response like exercise and work. 3. Expanding the scope of the disability problem to include social isolation and lack of purpose also expands range of coping response available to deal with the problem. 4. Illness uncertainty is anxiety provoking, diminishes personal control and leads to withdrawal from work and rehabilitation activities. 5. Personal construal of illness and injury is dynamic and influenced positively and negatively by a range of personal and social stimuli.

Conclusions

Representations provide a valuable window into the experience and perspectives of workers with disabling health conditions. Representations facilitate shared understanding and worker motivation to rehabilitate and provide a leading indicator of progress in rehabilitation. Workers’ representations should evaluated as part of evidence-based practice in work disability management.

Presentation 3: Facilitating the evaluation of work disability representations in practice settings

Presented by: Marie-France Coutu

Authors

Coutu MF1,2, Durand MJ2, O’Hagan F1, Labrecque ME3

  1. Trent University, Peterborough, Canada
  2. Université de Sherbrooke, Longueuil
  3. Université du Québec à Montréal, Montréal

Abstract

Background

Illness representations provide a valuable framework for integrating worker understandings of injury and their consequences into therapeutic intervention. No evaluation tools presently exist. We adapted of the the Revised Illness Perception Questionnaire has been developed to assess representations of workers on sick leave due to musculoskeletal disorders (MSDs). Objective: A two-phase project aimed at: 1) validating the internal consistency and construct validity of the adapted questionnaire (IPQR-WD); 2) performing an English translation and implementing the questionnaire online with intervention support feedback for clinicians.

Methods

Phase 1) A cross-sectional study was conducted (Dec 2010 to June 2011) in Montreal region, Canada. Participants (n=41 males and females, French speaking) were between 3 months and a year of absence from work due to MSDs and recruited from work rehabilitation programs. We administered the IPQR-WD and the following related measures for the construct validity: Pain Catastrophizing Scale, Tampa Scale for Kinesiophobia, Pain Beliefs and Perceptions Inventory, Pain Disability Index, Psychiatric Symptoms Index, Self-Efficacy for Return to Work Scale, Implicit Models of Illness Questionnaire and a Visual Analog Scale for pain intensity. Phase 2) a double back translation was performed and item clarity was assessed (varying from 1 to 7 absolutely clear) with anglophones (May-Dec 2013). The questionnaire is now online. Usability and utility is currently being assessed with 15 workers and their clinicians.

Results

1) Cronbach’s alphas showed good to excellent internal consistency for each dimension (0.61 to 0.88), lowest score being associated to the Cyclical Timeline scale which contains only 4 items. Multiple regression analyses with each dimension of the IPQR-WD and variables found to be significantly associated in a preliminary correlation matrix explained a good proportion of the variance (r2 from 0.40 to 0.74) for each dimension, except for Cyclical timeline, which correlations became non-significant after adjusting for gender, age and length of sick leave. 2) All translated items were rated on an average as 6 - 7/7 (very clear). Preliminary results show that the online version is usable and clinically useful.

Conclusions

A simple, easily administered questionnaire can assess representations related to work disability and may facilitate their systematic evaluation in research and in the clinic.