Successful return to work of individuals with chronic pain according to health care providers: a meta-synthesis

Abstract

Abstract:Introduction: Chronic pain is a persistent disease that causes personal and social economic problems when individuals are unable to return to work. Objective: This meta-synthesis investigated the perspectives of health professionals on the best mechanisms (triggering change) and approaches to support people with chronic pain on return to work. Method: Peer-reviewed articles published until October 2017 were searched in databases such as PsycINFO, EMBASE, CINAHL and Pubmed. The search was based on three concepts: "chronic pain", "return to work" and "therapist". Six articles were analyzed. Meta-ethnography was used to synthesize data extracted from qualitative studies. Results: Five second-order interpretations were revealed: social interactions contribute to rehabilitation and can interrupt the return to work; inadequate coordination and excessive bureaucracy complicates the return to work; communication between worker and other stakeholders is critical for return to work; health professionals are not clear about their roles; the congruence between health professionals and the workers'perspectives and goals on return to work impacts the treatment and its outcomes. A posterior analysis produced two third-order syntheses: 1. the need for assertive communication to lay the groundwork for best practices; and 2. inadequate coordination in the current system complicates return to work in cases of chronic pain. Conclusion: Stakeholders and health professionals need to understand their roles and responsibilities to consistently set goals and action plans for return to work. Keywords: Chronic Pain, Return to Work, Health Personnel.Retorno bem-sucedido ao trabalho para indivíduos com dor crônica, segundo os profissionais de saúde: uma metassíntese Resumo: Introdução: Dor crônica é doença persistente que causa problemas econômicos, pessoais e sociais, quando indivíduos não conseguem voltar ao trabalho. Objetivo: Esta metassíntese investigou as perspectivas dos profissionais de saúde acerca dos melhores mecanismos (desencadeantes da mudança) e abordagens para apoiar trabalhadores com dor crônica, no retorno ao trabalho. Método: Artigos revisados por pares foram pesquisados em bases de dados, como PsycINFO, EMBASE, CINAHL e Pubmed, publicados até outubro de 2017. As buscas empregaram três conceitos: "dor crônica", "retorno ao trabalho" e "terapeuta". Foram analisados seis artigos. Metaetnografia foi utilizada para sintetizar os dados extraídos de estudos qualitativos. Resultados: Foram reveladas cinco interpretações de segunda ordem: 1. as interações sociais contribuem para a reabilitação e podem interromper o retorno ao trabalho; 2. a coordenação inadequada e a burocracia excessiva complicam o retorno Successful return to work of individuals with chronic pain according to health care providers: a meta-synthesis

Qualitative Evidence from Studies of Interventions Aimed at Return to Work and Staying at Work for Persons with Chronic Musculoskeletal Pain

“…In our study, the lack of collaboration between the persons with CMSP and different stakeholders and among stakeholders negatively influenced the process. Furthermore, communication and transfer of information/knowledge between stakeholders were emphasized as improving the process and would be valuable for creating standards of practice to improve the process of RTW, which are findings also confirmed by Magalhães [ 7 ]. Collaboration between different actors must consider complex relationships and social hierarchies when trying to improve these inter-professional relationships.…”

“…Franche et al [ 10 ] reported strong evidence that contact between health care providers and the workplace significantly reduces the duration of work disability. Furthermore, Magalhães [ 7 ] emphasized that an excessive bureaucracy in the different organizations complicate RTW, and a successful RTW requires a dynamic interdisciplinary team.…”

“…Health professionals’ perspectives on approaches to support people with CMSP to RTW showed that RTW processes are delayed due to the way the system (all involved actors in a RTW process) is organized—i.e., a rigid system caused by a lack of coordination and collaboration is a barrier to RTW interventions and ultimately RTW [ 7 ]. Congruence between stakeholders and patient perspectives in sharing decisions on plans and goals for RTW can lead to better treatment and ultimately better outcomes.…”

“…Congruence between stakeholders and patient perspectives in sharing decisions on plans and goals for RTW can lead to better treatment and ultimately better outcomes. All stakeholders need to understand their roles and responsibilities in the RTW process, and communication and coordination among stakeholders is of the greatest importance [ 7 ].…”

Development of a Digital Support Application With Evidence-Based Content for Sustainable Return to Work for Persons With Chronic Pain and Their Employers: User-Centered Agile Design Approach

“…In addition, the employers reported lacking knowledge on how to support their employees’ RTW and requested more knowledge about how chronic pain might affect work status and the needs and challenges their employees with chronic pain might experience [ 7 ]. For a successful RTW, employers need to effectively collaborate, communicate, and negotiate with their employees, all interactions that require good listening skills [ 8 , 9 ]. In general, barriers to RTW for persons with chronic pain include lack of workplace support, lack of relationships with supervisors and coworkers, and inability to find the right fit between a person’s physical abilities and job tasks [ 10 , 11 ].…”