Week 10 readings Flashcards
What type of research does Cullin et al.s paper describe?
Systematic review of published medium-high quality studies from 1990-2015
List the elements in the 6 review steps developed by IWH.
- Question development
- Literature search
- Relevance screen
- Quality appraisal
- Data extraction
- Evidence synthesis
What is a key benefit of conducting a systematic literature review using the process developed by IWH?
A particular strength of this review is the unique process of stakeholder engagement adopted throughout the review process. Our stakeholders provided guidance to ensure the review question was relevant, the search terms were comprehensive and the targeted literature identified was up-to-date. But more importantly, stakeholders helped us examine the findings from this review to determine the best wording for our key messages to facilitate uptake and dissemination of these evidence-based approaches for OHS practitioners and other workplace parties.
Describe the following step in the systematic literature review process developed by IWH: question development
review team and stakeholders met to discuss the research question and proposed search terms; used review question and search terms from original review as the starting point
Describe the following step in the systematic literature review process developed by IWH: literature search
research team, in consultation with librarian, stakeholders, and content area experts, developed search terms. Searched multiple databases. Identified studies from own holdings and via contact with international content area experts
Describe the following step in the systematic literature review process developed by IWH: relevance screen
exclusion criteria: commentary/editorial; not about RTW or disability management/support; non-intervention studies or interventions that did not occur as part of a system, program, policy, or work practice change, intervention that were not workplace-based, study population included greater than 50% of any of the following excluded conditions: severe TBI, spinal cord injury, severe lower limb traumatic injuries including amputations, MSK disorders secondary to cancer, cancer-related pain or osteoporosis; and severe mental disorders (i.e. bipolar disorder, chronic severe depression or schizophrenia)
title and abstract of references were screened
Full text of articles were screened
Describe the following step in the systematic literature review process developed by IWH: quality appraisal
group multiple articles associated with single study, designating one as primary article; quality assessed using following criteria: design and objectives, level of recruitment, intervention characteristics, intervention intensity, outcomes, and analysis. Methodological quality scores for each study were based on a weighted sum score of the quality criteria
Quality ranking was used to group studies into 3 categories: high, medium and low
Quality appraisal measured: internal validity, external validity, and statistical validity
Describe the following step in the systematic literature review process developed by IWH: data extraction
used standardize forms; created summary tables sorted by intervention category and used for evidence synthesis
Describe the following step in the systematic literature review process developed by IWH: evidence synthesis
created intervention categories using the data summary tables. Then, summarized evidence for each intervention category.
Define: randomized control trial
randomized control trials: experimental study where participants are randomly assigned to either the intervention group (receiving the treatment) or the control group (receiving a placebo or standard care).
- Randomization reduces selection bias and ensures comparable groups.
- Controlled environment allows direct comparison between intervention and control.
- Considered the gold standard for establishing causality (cause-effect relationships).
Define: non-randomized control trial
similar to an RCT but lacks random assignment. Participants are assigned to groups based on predetermined criteria (e.g., patient preference or availability).
No randomization, which increases the risk of bias.
Still compares an intervention group with a control group.
Easier and often faster to conduct than RCTs but less rigorous.
Define: cohort studies
A cohort study is an observational study that follows a group of people (a cohort) over time to track how exposures (e.g., treatments, risk factors) affect outcomes.
No intervention—researchers observe natural differences.
Can be prospective (looking forward) or retrospective (looking back).
Useful for studying long-term effects and rare exposures.
What are health focused RTW interventions?
facilitate the delivery of health services to the injured worker either in the workplace or in settings linked to the workplace (e.g., visits to healthcare providers initiated by the employer/workplace). Specific health services intervention subcategories for which evidence synthesis was conducted include; graded activity/exercise, cognitive behavioural therapy, work hardening and multi-component health-focused interventions (which often included the above elements as well as: medical assessment, physical therapy, psychological therapy, occupational therapy).
What are service coordinated RTW interventions?
These interventions were designed to better coordinate the delivery of, and access to, services to assist RTW within and involving the workplace. Coordination involves attempts to improve communication within the workplace or between the workplace and the healthcare providers. Examples are development of RTW plans, case management and education and training.
What are work modification RTW interventions?
These interventions alter the organization of work or introduce modified working conditions. Examples are: workplace accommodations such as provision of modified duties, modified working hours, supernumerary replacements, ergonomic adjustments or other worksite adjustments.
What are multi domain RTW interventions?
These interventions had multiple intervention components and included at least two of the three above intervention domains [e.g., interventions that involved graded activity in the workplace (health-focused domain) in addition to modified working conditions (work modification domain)].
Describe some of the RTW outcome measures from lost time
measures approximating the amount of time spent away from the workplace, or the rate of RTW amongst a group over a given time period. These include outcomes such as days from injury until first return to work, total duration of sick leave over a given time period, work status (working/not working) at a point in time, and recurrences of sick leave/work absence. These measures may be self-reported or collected from organisational or system records
Describe some of the RTW outcome measures from work functioning
measures assessing the workers function in the workplace and health-related lost productivity. These include outcomes such as the self-rated work limitations questionnaire and estimates of productive working hours
Describe some of the RTW outcome measures from cost
measures assessing the workers function in the workplace and health-related lost productivity. These include outcomes such as the self-rated work limitations questionnaire and estimates of productive working hours
Summarize the main conclusions of this study with regards to interventions for RTW.
There was strong evidence that duration away from work from both MSK or pain-related conditions and MH conditions were significantly reduced by multi-domain interventions encompassing at least two of the three domains. There was moderate evidence that these multi-domain interventions had a positive impact on cost outcomes. There was strong evidence that cognitive behavioural therapy interventions that do not also include workplace modifications or service coordination components are not effective in helping workers with MH conditions in RTW. Evidence for the effectiveness of other single-domain interventions was mixed, with some studies reporting positive effects and others reporting no effects on lost time and work functioning
The primary finding is strong evidence that multiple domain interventions are effective in improving RTW outcomes in workers with MSK, pain-related or MH conditions. In contrast, most single domain focused interventions have mixed or limited evidence to support their effectiveness. This result is aligned with one of the dominant theoretical paradigms in the work disability and return to work literature, the Sherbrooke model [93]. This model proposes that multi-disciplinary and multi-factorial interventions that seek to address an array of individual and societal factors that influence RTW are likely to be effective.
How is Collin et al.’s work significantly different from RTW intervention studies in the past?
Combining newer studies with those from the original review [7] resulted in stronger evidence levels across a greater number of intervention categories. In addition, we were able to synthesize new evidence on intervention strategies to manage mental health conditions in the workplace, which has emerged as an important area of concern for employers since the original review was published.
Our review identified that in most cases interventions were multi-faceted and included multiple intervention components, often operating across multiple domains (health focus, service coordination and work modification). This approach is different to the previous review [7], which sought to evaluate the effectiveness of discrete intervention components; leading to a different interpretation of the literature.
How do the effectiveness of interventions for physical MSD differ from mental health problems according to this study?
Activity programs and work accommodations had a moderate level of evidence for positive effect in reducing lost time associated with work disability.
Cognitive behavioural therapy programs focused on work relevant solutions for mental health conditions had a strong level of evidence for a positive effect on both reducing lost time and costs associated with work disability
Describe 3 different challenges in conducting research on the effectiveness of RTW programs.
In conducting a systematic review, may be limited in number of studies that you pull as many articles discussing interventions are of low methodological quality; Although interventions may actually be effective, there is insufficient evidence to support recommending them
Research requires the endorsement and cooperation of several stakeholders with competing interests (employers, insurers, labour unions, provider networks, compensation authorities, etc.). Lots of red tape to even do a study
Many RTW program studies suffer from attrition bias. There is an uneven amount of attrition in the control vs intervention groups and a substantial amount of subjects lost in follow-up. Thus, study validity is largely impacted
