Biomedical subjects
Publications and source records attributed to Eva Schonstein.
Systematic reviews have been described by leaders in the field of evidence-based practice as the most powerful and useful evidence available to guide practice. This paper gives a description and analysis of systematic reviews currently included in the Cochrane Database for Systematic Reviews which have been identified by newly formed Cochrane Occupational Health Field as having an occupational health focus.
Returning the disabled worker to maximum productivity is a shared responsibility between the treating health practitioners and employers, with the insurer as an overseer of the injury management plan. Allied health professionals have responded to the need for standardized tools to assess work capacity by developing Functional Capacity Evaluations (FCEs). Literature exists outlining the limitations of FCEs in injury management systems; however, little is known about their uses and perceived usefulness. Questionnaires were posted to managers and therapists of accredited rehabilitation providers. The questionnaires consisted of both open and closed format questions. The response rate for the managers' questionnaire was 53%, while the therapists' questionnaire was 27%. The majority of rehabilitation providers use an assessment of their Own Design. Eight commercial FCEs were identified as being used. The majority of therapists use only one type of FCE. Therapists rated FCEs highly on their flexibility with Own Design assessment rated as significantly more flexible than the most frequently used commercial FCEs. From the data collected, it appears that cost is the main factor influencing choice of assessment. Level of evidence supporting capabilities of particular assessments does not appear to influence use. It seems that, despite there being poor research evidence to support the use of many brands of FCEs, they are still commonly used by rehabilitation providers. To achieve optimal use of FCEs, further research is required on the types of adaptations therapists make to commercial assessments and properties of Own Design assessments, including reliability and validity studies.
OBJECTIVE: To determine the effect on time lost from work of physical conditioning programs for workers with back and neck pain. DATA SOURCES Randomized trials were located by searching MEDLINE, EMBASE, CINAHL, PsycINFO, the Cochrane Controlled Trial Register, and PEDro. REVIEW METHODS: Two reviewers independently extracted data and assessed trial quality. Where data could be pooled, meta-analysis was performed. Based on cost considerations, we nominated a mean saving of 10 sick days per year or a number needed to treat to return 1 person to work of 10 as the smallest treatment effects that would be clinically worthwhile. RESULTS: Nineteen trials in 21 publications yielded 23 contrasts relevant to this review. These trials provide evidence that physical conditioning programs that included a cognitive-behavioral approach could produce a clinically worthwhile reduction in the number of sick days taken at 12 months (average of 45 days; 95% confidence interval 3-88) when compared to general practitioner care or advice for workers with chronic back pain. There was little evidence of an effect on time lost from work of specific exercise programs that did not include a cognitive-behavioral component. CONCLUSION: Physical conditioning programs that incorporate a cognitive-behavioral approach reduce the number of sick days for workers with chronic back pain when compared to usual care.
We retrospectively analysed 219 consecutive treatment plans submitted to a large New South Wales workers' compensation insurer for workers coded by the insurer as suffering from back pain. The purpose was to (i) describe the quality of goals of treatment provided to insurers by physiotherapists for workers with back pain using guidelines provided by the WorkCover Authority of New South Wales (WorkCover); (ii) compare the physiotherapists' prognoses against prognoses indicated in clinical practice guidelines; and (iii) make recommendations about the communication system between physiotherapists and insurers. The back pain of most treated workers was classified as acute and the majority of physiotherapists estimated that treatment would be of short duration, which is concordant with current treatment guidelines. However, most physiotherapists did not provide precise, measurable or time-specific treatment goals, despite this being emphasised by WorkCover. We propose ways of improving communication practices between physiotherapists and insurers.
This paper reviews the current status of functional capacity evaluations in the assessment of workers with low back pain. Conceptual and practical difficulties are discussed and a new model that we call Work Capacity Evaluation (WCE) is proposed. Specific reference is made to the role of the medical practitioner in the process of injury management.