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Patrick Loisel

Publications and source records attributed to Patrick Loisel.

At least 19 recordsLinked to original sources
PubMed2005

The values underlying team decision-making in work rehabilitation for musculoskeletal disorders.

PURPOSE: This paper presents the results of a qualitative study on the values underlying the decision-making process of an interdisciplinary team working in a work rehabilitation facility of a Québec teaching hospital. METHODS: In order to document the values underlying the decision-making process, a single case observational study was conducted. Interdisciplinary team weekly discussions on ongoing cases of 22 workers absent from work due to musculoskeletal disorders were videotaped. All discourses were transcribed and analyzed following an inductive and iterative approach. The values identified were validated by feedback from team members. RESULTS: Ten common decision values emerged from the data: (1) team unity and credibility, (2) collaboration with stakeholders, (3) worker's internal motivation, (4) worker's adherence to the program, (5) worker's reactivation, (6) single message, (7) reassurance, (8) graded intervention, (9) pain management and (10) return to work as a therapy. The analysis of these values led to the design of a model describing interrelations between them. CONCLUSIONS: This study throws light on some mechanisms underlying the decisions made by the team and determining its action. This improves understanding of the actions taken by an interdisciplinary team in work rehabilitation and may facilitate knowledge transfer in the training of other teams.

Decision Making↗
PubMed2005

Training the next generation of researchers in work disability prevention: the Canadian Work Disability Prevention CIHR Strategic Training Program.

INTRODUCTION: There is a need to create, disseminate, and implement new knowledge in the work disability prevention (WDP) field. Training programs attracting high-quality applicants and taking into account the complexity of this emerging field are urgently needed. METHODS: An advanced training program, funded by the Canadian Institutes of Health Research (CIHR), was developed by 24 mentors affiliated with nine different universities. The main objective of this program is to develop transdisciplinary knowledge, skills, and attitudes regarding WDP. This program has been developed for PhD students or post-doctoral fellows already registered full-time in a Canadian or recognized foreign university whose main interest is WDP, regardless of the health problem. RESULTS: Since its implementation, the program received two successive cohorts of 10 students. They were registered in 13 universities in five countries and trained in nine different disciplines. CONCLUSIONS AND SIGNIFICANCES: Appropriate WDP research may save major societal costs attributable to prolonged work disability. The proposed training program will contribute to developing tomorrow's research workforce.

Attitude of Health Personnel↗
PubMed2005

Improving return to work research.

BACKGROUND: Despite considerable multidisciplinary research on return to work (RTW), there has been only modest progress in implementation of study results, and little change in overall rates of work disability in developed countries. METHODS: Thirty RTW researchers, representing over 20 institutions, assembled to review the current state of the art in RTW research, to identify promising areas for further development, and to provide direction for future investigations. RESULTS AND CONCLUSION: Six major themes were selected as priority areas: early risk prediction; psychosocial, behavioral and cognitive interventions; physical treatments; the challenge of implementing evidence in the workplace context; effective methods to engage multiple stakeholders; and identification of outcomes that are relevant to both RTW stakeholders and different phases of the RTW process. Understanding and preventing delayed RTW will require application of new concepts and study designs, better measures of determinants and outcomes, and more translational research. Greater stakeholder involvement and commitment, and methods to address the unique challenges of each situation are required.

Humans↗
PubMed2005

Prevention of work disability due to musculoskeletal disorders: the challenge of implementing evidence.

BACKGROUND: The process of returning disabled workers to work presents numerous challenges. In spite of the growing evidence regarding work disability prevention, little uptake of this evidence has been observed. One reason for limited dissemination of evidence is the complexity of the problem, as it is subject to multiple legal, administrative, social, political, and cultural challenges. PURPOSE AND METHODS: A literature review and collection of experts' opinion is presented, on the current evidence for work disability prevention, and barriers to evidence implementation. Recommendations are presented for enhancing implementation of research results. CONCLUSION: The current evidence regarding work disability prevention shows that some clinical interventions (advice to return to modified work and graded activity programs) and some non-clinical interventions (at a service and policy/community level but not at a practice level) are effective in reducing work absenteeism. Implementation of evidence in work disability is a major challenge because intervention recommendations are often imprecise and not yet practical for immediate use, many barriers exist, and many stakeholders are involved. Future studies should involve all relevant stakeholders and aim at developing new strategies that are effective, efficient, and have a potential for successful implementation. These studies should be based upon a clearer conceptualization of the broader context and inter-relationships that determine return to work outcomes.

Attitude to Health↗
PubMed2005

Workplace-based return-to-work interventions: optimizing the role of stakeholders in implementation and research.

INTRODUCTION: The challenges of engaging and involving stakeholders in return-to-work (RTW) intervention and research have not been well documented. METHODS: This article contrasts the diverse paradigms of workers, employers, insurers, labor representatives, and healthcare providers when implementing and studying workplace-based RTW interventions. RESULTS: Analysis of RTW stakeholder interests suggests that friction is inevitable; however, it is possible to encourage stakeholders to tolerate paradigm dissonance while engaging in collaborative problem solving to meet common goals. We review how specific aspects of RTW interventions can be instrumental in resolving conflicts arising from differing paradigms: calibration of stakeholders' involvement, the role of supervisors and of insurance case managers, and procedural aspects of RTW interventions. The role of the researcher in engaging stakeholders, and ethical aspects associated with that process are discussed. CONCLUSIONS: Recommendations for future research include developing methods for engaging stakeholders, determining the optimal level and timing of stakeholder involvement, expanding RTW research to more diverse work settings, and developing RTW interventions reflecting all stakeholders' interests.

Community Participation↗
PubMed2005

Interorganizational collaboration in occupational rehabilitation: perceptions of an interdisciplinary rehabilitation team.

INTRODUCTION: Various obstacles to and facilitators of collaboration between an interdisciplinary work rehabilitation team and the stakeholders (workers, insurers, physicians, and employers) exist, but are not well characterized. METHODS: An observational study was conducted, using videotapes of interdisciplinary team discussions of ongoing cases involving 22 workers absent from work due to musculoskeletal disorders. The actions taken and strategies adopted by the team in an effort to overcome the obstacles to collaboration were studied. RESULTS: Various factors influence collaboration between the rehabilitation team and the stakeholders. In general, stakeholder endorsement of the team's therapeutic principles and confidence in their approach emerged as particularly important factors. Diverse strategies, most often, education and awareness-raising, were used by the team to foster collaboration among the parties. CONCLUSIONS: This study provides greater insight into the factors affecting collaboration among a rehabilitation team, an injured worker and other stakeholders. The results may improve understanding of the actions taken by rehabilitation teams and help to optimize their practices.

Decision Making↗
PubMed2004

Treatment of lateral epicondylitis: where is the evidence?

Lateral epicondylitis is the most commonly diagnosed elbow condition and affects about 1-3% of the population at large. It produces a heavy burden of workdays lost and residual impairments. Although many treatment modalities are used, few of them rest on scientific evidence and none has been proven more effective than the others. This paucity of evidence on treatments for lateral epicondylitis may stem from several sources, including the possible self-limiting nature of the condition, the lack of pathophysiological data, the methodological shortcomings of available studies, and the existence of numerous factors influencing the outcome.

Evidence-Based Medicine↗
PubMed2004

The interrater reliability of a functional capacity evaluation: the physical work performance evaluation.

The purpose was to evaluate the interrater reliability of the Dynamic Strength, Position Tolerance, and Mobility tasks of the Physical Work Performance Evaluation (PWPE), a Functional Capacity Evaluation often used with workers disabled due to back pain. For each worker's evaluation, two raters were preselected among five trained raters. One of the raters administered the PWPE while the other functioned as a silent rater. A convenience sample of 40 workers disabled due to back pain and referred to an occupational rehabilitation center was used. In general, the reliability was "substantial" (0.61 < or = kappa < or = 0.80) to "almost perfect" (0.81 < or = kappa < or = 1.00) for most of the 21 tasks and three sections of the PWPE evaluated with the exception of three tasks in the Mobility section (ladder climbing (kappa = 0.47), repetitive trunk rotation--standing (kappa = 0.54), and repetitive trunk rotation--sitting (kappa = 0.37)) task and the Mobility section itself (kappa = 0.54). Several reasons could explain the lower agreement on the observation of the physical signs associated with these tasks. Since these tasks involve rotation movements or complex neuromuscular integration, it seemed difficult for the raters to define what are the normal physical signs and when physical signs of maximal functional capacity are present. The criteria for establishing the presence of the physical signs in the PWPE should be improved.

Adolescent↗
PubMed2004

The cross-cultural adaptation of the Work Role Functioning Questionnaire in Canadian French.

The Work Role Functioning Questionnaire (WRFQ) is a new work disability measurement tool assessing the perceived impact of a health problem on the worker's ability to perform his job. The objective of this study was to make the cross-cultural adaptation of the WRFQ for the French Canadian population. The methodology was composed of five steps: forward translation, synthesis of the translations, back translation, revision by an expert committee and test of the pre-final version. The psychometric properties of the translated version were evaluated by administering the questionnaire to forty workers with a musculoskeletal disorder (MSD). Results indicated good content validity and internal consistency (Cronbach alpha > 0.80 for each scale). Construct validity was tested and confirmed through three hypotheses: (1) subjects with MSD scored higher for the Physical, Work Scheduling and Output demands scales than for the Mental and Social demands scales, (2) subjects having back pain had lower scores than subjects having pain at other body sites and (3) subjects with an MSD had lower scores than healthy workers working full time. This study confirmed that the process used for the adaptation of the Canadian French version of the WRFQ was successful and that this version had good psychometric properties.

Adult↗
PubMed2003

Muscle recovery from a short fatigue test and consequence on the reliability of EMG indices of fatigue.

The purpose of the present study was to evaluate if rest intervals of 10 or 15 min allow the back muscles to recover completely, from an electromyographic (EMG) point of view, after performing a fatiguing contraction. Twelve healthy males stood in a dynamometer with the trunk in a vertical position and performed three trunk extension fatiguing trials (30 s contractions sustained at 75% of the maximal voluntary contraction) separated successively by a 15 min (between trial 1 and 2) and a 10 min (between trial 2 and 3) rest period. The EMG signals from four pairs of back muscles were collected at 2,048 Hz with active surface electrodes. Different EMG indices computed from the temporal and frequency domains of the EMG signal were considered to evaluate muscular fatigue and recovery from trial 1 to trial 2 and from trial 2 to trial 3. No significant differences (one-way ANOVAs between the three trials, alpha=0.05) were obtained for the different EMG indices computed. The percentage of variance explained by the inter-trial effect was none in most cases, corroborating that no systematic error was present between the trials and suggesting that complete muscle recovery was allowed with 10 or 15 min rest periods. These results support the use of rest periods of 10 to 15 min between multiple fatigue tests, at least for back muscles and for high intensity short duration fatigue tasks as the one used in the present study.

Adult↗
PubMed2003

Back strength cannot be predicted accurately from anthropometric measures in subjects with and without chronic low back pain.

OBJECTIVES: (1) To develop a multiple regression equation using anthropometric measurements to predict back strength and (2) to estimate the effect of practice on the back strength results and back strength predictions. DESIGN: Comparative study with repeated measures performed on three days. BACKGROUND: The assessment of back muscle relative endurance (% maximal strength) requires the measurement of maximal back strength which is problematic with low back pain patients. METHODS: The back strength (L5/S1 static extension moment), age and 26 anthropometric parameters were obtained from 83 male volunteers [42 healthy subjects and 41 chronic low back pain patients] aged between 20 and 60 years. A subsample of 20 healthy subjects and 20 patients were assessed through three days of testing to evaluate the variations of back strength with practice. RESULTS: The final regression model (n=42 healthy subjects) explained 39% of the variance in back strength. Back strength increased with practice (Day1<Day2 & 3) for both healthy and patients groups. However, the error of prediction of back strength derived from the regression model showed a significant improvement with practice for the patients only. CONCLUSIONS: Back strength cannot be predicted from simple anthropometric measures without important errors. The decrease of the error of prediction obtained for the patient group is indicative of a decreasing influence of psychological factors that are independent of motor learning because the effect of motor learning would have occurred on both groups if present. RELEVANCE: The prediction of back strength would be useful to determine (1) the relative force level of a given exercise or (2) the preinjury back strength. Unfortunately, anthropometric measurements are not enough good predictors of back strength.

Adult↗
PubMed2003

Surface electromyography assessment of back muscle intrinsic properties.

The purpose of this study was to assess (1) the reliability and (2) the sensitivity to low back pain status and gender of different EMG indices developed for the assessment of back muscle weakness, muscle fiber composition and fatigability. Healthy subjects (men and women) and chronic low back pain patients (men only) performed, in a static dynamometer, maximal and submaximal static trunk extension tasks (short and long duration) to assess weakness, fiber composition and fatigue. Surface EMG signals were recorded from four (bilateral) pairs of back muscles and three pairs of abdominal muscles. To assess reliability of the different EMG parameters, 40 male volunteers (20 controls and 20 chronic low back pain patients) were assessed on three occasions. Reliable EMG indices were achieved for both healthy and chronic low back pain subjects when specific measurement strategies were applied. The EMG parameters used to quantify weakness and fiber composition were insensitive to low back status and gender. The EMG fatigue parameters did not detect differences between genders but unexpectedly, healthy men showed higher fatigability than back pain patients. This result was attributed to the smaller absolute load that was attributed to the patients, a load that was defined relative to their maximal strength, a problematic measure with this population. An attempt was made to predict maximal back strength from anthropometric measurements but this prediction was prone to errors. The main difficulties and some potential solutions related to the assessment of back muscle intrinsic properties were discussed.

Abdominal Wall↗
PubMed2003

Constructing the program impact theory for an evidence-based work rehabilitation program for workers with low back pain.

PURPOSE: Several low back pain work rehabilitation programs have been developed and evaluated for their outcomes. Unfortunately, the program impact theory for these programs is not described, and consequently, the exact mechanisms of action by which these programs intend to increase the probability of return to work remain unknown. This lack of knowledge jeopardizes the implementation of effective programs by health professionals and managers. The objective of this paper is to present the results of an exploratory study aimed at building the program impact theory for the PREVICAP work rehabilitation program. METHODS: The program impact theory was develop by conducting: unpublished documents and scientific literature analyses, individual and group discussions with multiple stakeholders and observation of program reality by reviewing the files of workers who completed the program. RESULTS: The PREVICAP program's impact theory was elaborated based on an ecological approach to work rehabilitation. Program goals and objectives were defined for the three dimensions of the model: the worker, the work environment and the interaction between the worker and his work environment. Two program action mechanisms were defined and describe how the program was intended to achieve its expected outcomes. CONCLUSIONS: This study made explicit the PREVICAP program impact theory and can help rehabilitation practitioners to address work disability according to an ecological model.

Canada↗
PubMed2002

Discriminative and predictive validity assessment of the quebec task force classification.

STUDY DESIGN: A prospective cohort study of workers with low back pain who had been absent from work for more than 4 weeks was conducted. OBJECTIVE: To assess the discriminative and predictive validity of the Quebec Task Force Classification for workers during the subacute phase of disability from back pain. SUMMARY OF BACKGROUND DATA: The Quebec Task Force Classification was designed for clinical decision making, prognosis establishment, quality of care evaluation, and scientific research in low back pain. METHODS: For this study, 104 workers absent from work because of back pain were classified according to the first four categories of the Quebec Task Force Classification 4 weeks after their first day of work absence. They then were randomized into four treatment groups: standard care (control), clinical-rehabilitation intervention, occupational intervention, and the Sherbrooke model (a combination of the clinical-rehabilitation and occupational interventions). Functional status, pain level, and work status were assessed at baseline and after 1 year. Duration of full compensation and back-related costs were calculated over a mean follow-up period of 6.5 years. The discriminative validity of the Quebec Task Force Classification was evaluated using Kendall tau correlation coefficients. Predictive validity was evaluated using logistic regression analyses. Age, gender, comorbidities, body mass index, and treatment group were considered as potential confounders. RESULTS: Significant but low correlation coefficients were found between Quebec Task Force Classification categories and functional status scores at baseline. Subjects classified as having distal radiating pain (categories 3 and 4) at baseline were more likely to have a lower functional status, higher pain level, and no return to regular work at the 1-year follow-up evaluation. They also were more likely to accumulate more days of full compensation and to cost more after a mean follow-up period of 6.5 years. CONCLUSION: The Quebec Task Force Classification demonstrated good predictive ability by discriminating between subjects with and those without distal radiating pain.

Adult↗
PubMed2002

A biomechanical comparison of lifting techniques between subjects with and without chronic low back pain during freestyle lifting and lowering tasks.

OBJECTIVE: To evaluate if chronic low back pain patients perform manual material handling tasks differently from control subjects. DESIGN: Comparative study using a repeated measures design. BACKGROUND: No study evaluated the lifting technique of back pain patients relative to control subjects during free style lifting and lowering tasks. Previous findings suggest that lowering would be more hazardous than lifting to the low back. It would be interesting to evaluate if chronic low back pain patients behave differently than controls when lifting and lowering. METHODS: Thirty-three male subjects (18 controls, 15 suffering from non-specific chronic low back pain) participated. A 12-kg box was lifted (freestyle) from the floor to the hips (1) in front (symmetric task) or (2) to a shelf located at 90 degree on the right (asymmetric task) and was lowered back to the floor. A 3D biomechanical analysis involving the assessment of L5/S1 loading, posture of segments, inertial parameters, and EMG was performed. RESULTS: There was no difference between the groups for postural (trunk and lower limb angles), inertial (trunk velocity and acceleration), and L5/S1 loading (moments and compression) variables. The patients showed abnormally low left lumbar erector spinae (symmetric task, lowering) or high left thoracic erector spinae (all tasks) EMG activation. Significant Group x Action (lifting vs. lowering) interactions were also observed for some inertial and L5/S1 loading variables suggesting that the biomechanical differences detected between lifting and lowering may have a differential influence on the technique used by back pain patients and control subjects. CONCLUSIONS: The gross lifting technique of back pain patients was unaltered relative to controls but the activation of paraspinal muscles differed, suggesting that a more detailed biomechanical analysis, such as the use of EMG driven models, might be required to reveal lumbar impairments during lifting. RELEVANCE: To evaluate if chronic low back pain patients use naturally different lifting techniques to prevent pain exacerbation and damaged lumbar tissue overloading.

Adult↗
PubMed2002

Helping clinicians in work disability prevention: the work disability diagnosis interview.

Recent evidence has demonstrated that disability from musculoskeletal disorders is a multifactorial problem that is not only due to workers' characteristics but also closely related to environmental factors, such as the workplace, the health care system, the compensation system, and the interactions among all stakeholders regarding the disability problem. The Work Disability Diagnosis Interview (WoDDI) was developed following a systematic method in order to help clinicians detect possible disability prognostic factors in subacute or chronic musculoskeletal pain patients. A structured literature review, followed by expert input and a second round of revisions after 4-year's usage led to the current version. The WoDDI is composed of open-ended questions on physical, psychosocial, occupational, and administrative factors, collated into an interview form used at the first encounter with the disabled worker. It enables clinicians to develop a rehabilitation plan and focus on disability resolution in patients absent from work due to a musculoskeletal disorder. Initial application demonstrated a high prevalence of sociodemographic, work-related, and psychosocial factors that may contribute to prolonged work absence.

Absenteeism↗
PubMed2002

Electromyographic assessment of back muscle weakness and muscle composition: reliability and validity issues.

OBJECTIVE: To assess the reliability and construct validity of various electromyographic indices developed to assess back muscle weakness and muscle fiber composition. DESIGN: A prospective study with repeated measures performed on 3 days along with comparisons of groups presenting different back strength and/or back muscle fiber composition. SETTING: A biomechanics laboratory within a rehabilitation center. PARTICIPANTS: Forty male volunteers (20 healthy, 20 with chronic low back pain) were assessed on 3 different days to assess reliability and to make group comparisons. Thirteen healthy women were also assessed once to obtain a third group with known lower strength and different back muscle fiber composition. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Surface electromyography was recorded for 4 pairs of homologous back muscles while the subjects performed, on a dynamometer, static trunk extension efforts. Electromyographic parameters were computed to assess muscle weakness and muscle fiber composition. The reliability of the data collected across the 3 sessions and comparisons between groups were determined. RESULTS: Electromyographic parameters generally showed good to excellent reliability, but were insensitive to differences in back muscle strength and did not appear to be related to muscle composition. Some trends were observed in the electromyographic parameters across the force levels, but the large interindividual variability impeded statistical comparisons. CONCLUSIONS: The assessment of muscle weakness and muscle fiber composition through electromyographic analysis does not appear feasible, at least on an individual basis, for the muscles of the back.

Adult↗