IRSST - Institut de recherche Robert-Sauvé en santé et en sécurité du travail

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Preliminary Evaluation of an Approach to Rehabilitation Aimed at Promoting Return-to-Work in Individuals with Co-morbid Musculoskeletal Pain and Depression

Summary

Many individuals who have sustained injuries in the workplace will experience symptoms of pain as well as symptoms of depression. The combination of pain and depressive symptoms can have a negative impact on recovery. The presence of depressive symptoms can interfere with an individuals’ ability to engage in many important activities of daily living, including occupational activities. Studies have shown that injured workers with depressive symptoms will be absent from work twice as long as injured workers without depression. Interventions that have been used to treat pain and disability in injured workers are much less effective when the injured worker is also experiencing symptoms of depression. Many clinicians and researchers have called for the development and evaluation of treatments specifically designed to meet the needs of injured workers who are experiencing symptoms of pain and depression

The present study was designed to evaluate the feasibility and impact of an intervention specifically designed to meet the needs of injured workers experiencing symptoms of pain and depression. The intervention that was evaluated in this study is referred to as the ‘Progressive Goal Attainment Program’ (PGAP). The intervention contains a wide range of techniques designed to increase activity involvement, improve mood, and assist the injured worker in returning to work. In this intervention, the injured worker meets with a specially trained rehabilitation professional for one hour each week, for a maximum of 10 weeks.

In order to recruit participants for this study, advertisements were placed in newspapers, on the radio and in rehabilitation clinics in the greater Montreal region. A total of 57 injured workers (43 men, 14 women) experiencing symptoms of pain and depression volunteered to participate in the study. The majority of participants successfully completed the intervention. Only 9 participants (17%) discontinued the intervention prematurely either due to lack of interest, medical complications or geographical distance.

The average age of participants was 41 years of age. The majority of participants were married or living common-law and had completed at least 12 years of schooling. On average, participants had been absent from work for approximately 6 months when they enrolled in the study.

Participation in PGAP led to many positive changes. At the end of the intervention, participants were more optimistic about their situation and their health condition, and they were less worried about engaging in physical activities. Participants also reported that their pain had decreased and their mood had improved. Participants reported that the intervention program had improved their quality of life and the majority of participants indicated that they were either ‘very’ or ‘extremely’ satisfied with the treatment they received.

When contacted 6 months after the end of treatment, 58% of participants indicated that they had returned to work. In the absence of a control group, it is not possible to make confident statements about the degree to which return to work outcomes were influenced by the intervention. Epidemiological studies suggest that, for individuals who have been work-disabled for 3 months, approximately 40% will return to work; for individuals who have been workdisabled for 6 months, only 25% will return to work, Return to work rates are even lower in injured workers who also suffer depression. Considering that the mean duration of work disability in the current sample was 6 months, the observed return to work rates would be considered a positive outcome.

Although the outcome of the study would be considered positive, some degree of caution must be exercised in the interpretation of the findings. Given the modest sample size, it was not possible to control for all extraneous factors (e.g., concurrent treatment, previous treatment history, employment sector) that might have influenced the probability of returning to work. It is also important to note that the participants in the intervention were volunteers. It is possible that people who volunteer for research studies might be especially motivated to improve and return to work. This might not be true of all injured workers.

Implementation challenges must also be considered. The skills that are required to deliver the intervention are not taught in the clinical training programs of rehabilitation professionals. The clinicians that provided services for this study received specialized training to acquire the skills necessary to deliver the intervention. Attempting to make this specialized training available to rehabilitation professionals across the province would be challenging and costly.

One possible avenue to consider would be to evaluate the effectiveness of a tele-health version of the intervention. By using a tele-health model of service delivery, only a small number of rehabilitation professionals would need to be trained. A tele-health model of service delivery would also increase access to services for injured workers who live in rural or remote communities. Also important is that a tele-health model of service delivery would be associated with lower costs than services provided through rehabilitation clinics.

In conclusion, the results of this study suggest that PGAP can contribute to clinical improvement and return to work in injured workers with symptoms of pain and depression. The majority of participants indicated they were satisfied with the treatment they received and that their quality of life had improved. Greater accessibility of interventions such as the one tested in this study could improve the recovery outcomes of injured workers experiencing symptoms of pain and depression. The results of the study warrant consideration of testing the effectiveness of PGAP within a controlled clinical trial.