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      One Year Effects of a Workplace Integrated Care Intervention for Workers with Rheumatoid Arthritis: Results of a Randomized Controlled Trial

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          Abstract

          Purpose To evaluate the effectiveness of a workplace integrated care intervention on at-work productivity loss in workers with rheumatoid arthritis (RA) compared to usual care. Methods In this randomized controlled trial, 150 workers with RA were randomized into either the intervention or control group. The intervention group received an integrated care and participatory workplace intervention. Outcome measures were the Work Limitations Questionnaire, Work Instability Scale for RA, pain, fatigue and quality of life (RAND 36). Participants filled out a questionnaire at baseline, and after 6 and 12 months. We performed linear mixed models to analyse the outcomes. Results Participants were on average 50 years of age, and mostly female. After 12 months, no significant intervention effect was found on at-work productivity loss. We also found no significant intervention effects on any of the secondary outcomes. Conclusions We did not find evidence for the effectiveness of our workplace integrated care intervention after 12 months of follow up. Future studies should focus on investigating the intervention in groups of workers with severe limitations in work functioning, and an unstable work situation.

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          Most cited references 32

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          Long term sickness absence.

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            The Stanford Health Assessment Questionnaire: a review of its history, issues, progress, and documentation.

             Bonnie Bruce,  J Fries (2002)
            Over the last 2 decades, assessment of patient health status has undergone a dramatic paradigm shift, evolving from a predominant reliance on biochemical and physical measurements to an emphasis upon health outcomes based on the patient's personal appreciation of their illness. The Health Assessment Questionnaire (HAQ), published in 1980, was among the first instruments based on patient centered dimensions. The HAQ was designed to represent a model of patient oriented outcome assessment and has played a major role in diverse areas such as prediction of successful aging, inversion of the therapeutic pyramid in rheumatoid arthritis (RA), quantification of nonsteroidal antiinflammatory drug gastropathy, development of risk factor models for osteoarthrosis, and examination of mortality risks in RA. The HAQ has established itself as a valuable, effective, and sensitive tool for measurement of health status. It has increased the credibility and use of validated self-report measurement techniques as a quantifiable set of hard data endpoints and has contributed to a new appreciation of outcome assessment. We review the development, content, and dissemination of the HAQ and provide reference sources for its uses, translations, and validations. We discuss contemporary issues regarding outcome assessment instruments relative to the HAQ's identity and utility. These include: (1) the issue of labeling instruments as generic versus disease-specific; (2) floor and ceiling effects in scales such as "disability"; (3) distances between values on scales; and (4) the continuing introduction of new measurement instruments and their potential effects.
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              Randomised controlled trial of integrated care to reduce disability from chronic low back pain in working and private life

              Objective To evaluate the effectiveness of an integrated care programme, combining a patient directed and a workplace directed intervention, for patients with chronic low back pain. Design Population based randomised controlled trial. Setting Primary care (10 physiotherapy practices, one occupational health service, one occupational therapy practice) and secondary care (five hospitals). Participants 134 adults aged 18-65 sick listed for at least 12 weeks owing to low back pain. Intervention Patients were randomly assigned to usual care (n=68) or integrated care (n=66). Integrated care consisted of a workplace intervention based on participatory ergonomics, involving a supervisor, and a graded activity programme based on cognitive behavioural principles. Main outcome measures The primary outcome was the duration of time off work (work disability) due to low back pain until full sustainable return to work. Secondary outcome measures were intensity of pain and functional status. Results The median duration until sustainable return to work was 88 days in the integrated care group compared with 208 days in the usual care group (P=0.003). Integrated care was effective on return to work (hazard ratio 1.9, 95% confidence interval 1.2 to 2.8, P=0.004). After 12 months, patients in the integrated care group improved significantly more on functional status compared with patients in the usual care group (P=0.01). Improvement of pain between the groups did not differ significantly. Conclusion The integrated care programme substantially reduced disability due to chronic low back pain in private and working life. Trial registration Current Controlled Trials ISRCTN28478651.
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                Author and article information

                Contributors
                +31 20 444 9680 , crl.boot@vumc.nl
                Journal
                J Occup Rehabil
                J Occup Rehabil
                Journal of Occupational Rehabilitation
                Springer US (New York )
                1053-0487
                1573-3688
                7 April 2016
                7 April 2016
                2017
                : 27
                : 1
                : 128-136
                Affiliations
                [1 ]ISNI 0000 0004 0435 165X, GRID grid.16872.3a, Department of Public and Occupational Health, EMGO Institute for Health and Care Research, , VU University Medical Center, ; Room BS7-C573, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands
                [2 ]ISNI 0000 0004 0435 165X, GRID grid.16872.3a, Body@Work, Research Center on Physical Activity, Work, and Health, , TNO-VU University Medical Center, ; Amsterdam, The Netherlands
                [3 ]ISNI 0000 0004 1754 9227, GRID grid.12380.38, Department of Health Sciences Section Methodology and Applied Biostatistics, , VU University, ; Amsterdam, The Netherlands
                [4 ]TNO Work, Health and Care, Leiden, The Netherlands
                [5 ]ISNI 0000 0004 0435 165X, GRID grid.16872.3a, Department of Rheumatology, , VU University Medical Center, ; Amsterdam, The Netherlands
                [6 ]Jan van Breemen Research Institute | Reade, Amsterdam, The Netherlands
                [7 ]ISNI 0000 0004 0435 165X, GRID grid.16872.3a, Research Center for Insurance Medicine, , AMC-UMCG-UWV-VU University Medical Center, ; Amsterdam, The Netherlands
                Article
                9639
                10.1007/s10926-016-9639-0
                5306224
                27056549
                © The Author(s) 2016

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/501100003779, Instituut Gak;
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                © Springer Science+Business Media New York 2017

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