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Rehabilitation of Injured Workers with Chronic Pain: A Stage of Change Phenomenon

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Abstract

Objective This study was designed to explore the stages of change involved in return to work (RTW) for a group of workers who had been suffering from chronic pain. Method The participants were 67 (mean age = 42.67) injured workers who participated in a six-week RTW program. Assessments of the participants on various measures were conducted before and during the program, and at the end of the follow-up period (3 months post-program). Results The overall RTW rate of the participants was 65.7%. Most importantly, the participants’ RTW outcomes were found to be significantly predicted by their readiness for RTW (action) at the baseline. In the third week, their RTW was significantly predicted by their confidence in returning to work and their readiness for RTW (action). By the sixth week, their RTW outcomes were predicted by their readiness for RTW (pre-contemplation). Conclusion The results enable us to better understand the stage-of-change factors that might influence injured workers’ resumption of a productive work role and the rehabilitation process of RTW.

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References

  1. McGovern P, Kochevar L, Lohman W, Zaidman B, Gerberich SG, Nyman JA, Findorff-Dennis M. The cost of work-related physical assaults in Minnesota. Health Serv Res 2000;35(3):663–86.

    PubMed  CAS  Google Scholar 

  2. Waehrer G, Leigh JP, Cassady D, Miller TR. Costs of occupational injury and illness across states. J Occup Environ Med 2004;46(10):1084–95.

    Article  PubMed  Google Scholar 

  3. Ryden LA, Molgaard CA, Bobbitt SL. Benefits of a back care and light duty health promotion program in a hospital setting. J Commun Health 1988;13(4):222–30.

    Article  CAS  Google Scholar 

  4. Schulte PA. Characterizing the burden of occupational injury and disease. J Occup Environ Med 2005;47(6):607–22.

    Article  PubMed  Google Scholar 

  5. Baril R, Clarke J, Friesen M, Stock S, Cole D. Management of return-to-work programs for workers with musculoskeletal disorders: a qualitative study in three Canadian provinces. Soc Sci Med 2003;57(11):2101–14.

    Article  PubMed  CAS  Google Scholar 

  6. Isernhagen SJ. The comprehensive guide to work injury management. Gaithersburg, MD: Aspen Publishers; 1995. p. 543–56.

    Google Scholar 

  7. Chan CCH. Introduction to process of occupational rehabilitation. In: Chan CCH, Hui KYL, Lo EKS, Lo SY, Kwok TWW, editors. Cumulative trauma at work. Hong Kong: Hong Kong Workers’ Health Centre; 2001. p. 41–54.

    Google Scholar 

  8. Li EJQ, Li-Tsang CWP, Lam CS, Hui KYL, Chan CCH. The effect of a “training on work readiness” program for workers with musculoskeletal injuries: a randomized control trial (RCT) study. J Occup Rehabil 2006;16:529–41.

    Article  PubMed  Google Scholar 

  9. Rachel EH, Nancy JP, Els RN. A RTW program for injured workers: a reassignment model. Work 1999;12:123–31.

    Google Scholar 

  10. Saha A, Kulkarni P, Chaudhuri R, Saiyed H. Occupational injuries: is job security a factor? Ind J Med Sci 2005;59(9):375–81.

    Article  Google Scholar 

  11. Crook J, Moldofsky H. The probability of recovery and RTW from work disability as a function of time. Qual Life Res 1994;3(1):s97–109.

    Article  PubMed  Google Scholar 

  12. Van der Guizen AM, Bouter LM, Nijhuis FJN. Prediction of return-to-work of low back pain patients sicklisted for 3–4 months. Pain 2000;87:285–94.

    Article  Google Scholar 

  13. Bruyns CNP, Jaquet JB, Schreuders TAR, Kalmijn S, Kuypers PDL, Hovius SER. Predictors for RTW in patients with median and ulnar nerve injuries. J Hand Surgery 2003;28(1):28–34.

    Article  Google Scholar 

  14. Kerr MS, Frank JW, Shannon HS, Norman RW, Wells RP, Neumann WP, Bombardier C. Biomechanical and psychosocial risk factors for low-back pain at work. Am J Public Health 2001;91(7):1069–75.

    Article  PubMed  CAS  Google Scholar 

  15. Schultz IZ, Crook J, Meloche GR, Berkowitz J, Milner R, Zuberbier OA, Meloche W. Psychosocial factors predictive of occupational low back disability: towards development of a return-to-work model. Pain 2004;107(1–2):77–85.

    Article  PubMed  CAS  Google Scholar 

  16. Shaw L, Segal R, Polatajko H, Harburn K. Understanding RTW behaviours: promoting the importance of individual perceptions in the study of RTW. Disabil Rehabil 2002;24(4):185–95.

    Article  PubMed  Google Scholar 

  17. Watson PJ, Booker CK, Moores L, Main CJ. Returning the chronically unemployed with low back pain to employment. Eur J Pain 2004;8(4):359–69.

    Article  PubMed  Google Scholar 

  18. Von Korff M, Miglioretti DL. A prognostic approach to defining chronic pain. Pain 2005;117(3):304–13.

    Article  Google Scholar 

  19. Cole DC, Mondloch MV, Hogg-Johnson S. Early Claimant Cohort Prognostic Modelling Group. Listening to injured workers: how recovery expectations predict outcomes: a prospective study. Can Med Assoc J 2002;166(6):749–54.

    Google Scholar 

  20. Kopec JA, Sayre EC, Esdaile JM. Predictors of back pain in a general population cohort. Spine 2004;29(1):70–7.

    Article  PubMed  Google Scholar 

  21. Linton SJ, Buer N, Vlaeyen J, Hellsing A. Are fear-avoidance beliefs related to the inception of an episode of back pain? A prospective study. Psychol Health 2000;14:1051–9.

    Google Scholar 

  22. White CL, LeFort SM, Amsel R, Jeans ME. Predictors of the development of chronic pain. Res Nursing Health 1997;20(4):309–18.

    Article  CAS  Google Scholar 

  23. Kerns RD, Rosenberg R, Otis JD. Self-appraised problem solving and pain-relevant social support as predictors of the experience of chronic pain. Ann Behav Med 2002;24(2):100–5.

    Article  PubMed  Google Scholar 

  24. Krause N, Dasinger LK, Deegan LJ, Rudolph L, Brand RJ. Psychosocial job factors and return-to-work after compensated low back injury: a disability phase-specific analysis. Am J Ind Med 2001;40:374–92.

    Article  PubMed  CAS  Google Scholar 

  25. Williams RA, Pruitt SD, Doctor JN, Epping-Jordan JE, Wahlgren DR, Grand I, Patterson TL, Webster JS, Slater JA, Atkinson JH. The contribution of job satisfaction to the transition from acute to chronic low back pain. Arch Phys Med Rehabil 1998;79(4):366–74.

    Article  PubMed  CAS  Google Scholar 

  26. Kames LD, Rapkin AJ, Naliboff BD, Afifi S, Ferrer-Brechner T. Effectiveness of an interdisciplinary pain management program for the treatment of chronic pelvic pain. Pain 1990;41(1):41–6.

    Article  PubMed  CAS  Google Scholar 

  27. Prochaska JO, Diclemente CC, Norcross JC. In search of how people change: applications to addictive behaviors. Am Psychol 1992;47:1102–14.

    Article  PubMed  CAS  Google Scholar 

  28. Share D, McCrady B, Epstein E. Stage of change and decisional balance for women seeking alcohol treatment. Addict Behav 2004;29(3):525–35.

    Article  PubMed  Google Scholar 

  29. Dijkstra A. The validity of the stages of change model in the adoption of the self-management approach in chronic pain. Clin J Pain 2005;21(1):27–37.

    Article  PubMed  Google Scholar 

  30. Glenn B, Burns J. Pain self-management in the process and outcome of multidisciplinary treatment of chronic pain: evaluation of a stages of change model. J Behav Med 2003;26(5):417–33.

    Article  PubMed  Google Scholar 

  31. Habib S, Morrissey SA, Helmes E. Readiness to adopt a self-management approach to pain: evaluation of the pain stages of change model in a non-pain-clinic sample. Pain 2003;104(1–2):283–90.

    Article  PubMed  Google Scholar 

  32. Morley S, Shapiro D, Biggs J. Developing a treatment manual for attention management in chronic pain. Cogn Behav Ther 2004;33(1):1–11.

    Article  PubMed  Google Scholar 

  33. Hong Kong Census and Statistics Department. Hong Kong. http://www.info.gov.hk/censtatd/eng/hkstat/concepts_methods/cm_labour_index.html, http://www.info.gov.hk/censtatd/eng/interest/ghs/ghs_index.html. Retrieved October 2, 2004.

  34. Lee GK, Chan CC, Hui-Chan CWY. Work profile and functional capacity of formwork carpenters at construction sites. Disabil Rehabil 2001;23(1):9–14.

    Article  PubMed  CAS  Google Scholar 

  35. Bellace JV, Healy D, Besser MP, Byron T, Hohman L. Validity of the Dexter Evaluation System’s Jamar dynamometer attachment for assessment of hand grip strength in a normal population. J Hand Ther 2000;13(1):46–51.

    PubMed  CAS  Google Scholar 

  36. Chan HHK, Li-Tsang CWP, Chan C, Lam CS, Lo-Hui KYL, Bard C. Validation of Lam Assessment of Employment Readiness (C-LASER) for Chinese injured workers. J Occup Rehabil 2006;16:697–705.

    Article  PubMed  Google Scholar 

  37. Shek DTL. Reliability and factorial structure of the Chinese Version of the State-Trait Anxiety Inventory. J Psychopathol Behav Assess 1988;10(4):303–17.

    Article  Google Scholar 

  38. Ping CLTW, Keung SCF, Yee PLW. Functional assessment of repetitive strain injuries: two case studies. J Hand Ther 1996;9(4):394–8.

    PubMed  CAS  Google Scholar 

  39. Ware JE, Snow KK, Kosinski M, Gandek B. SF-36 health survey: manual and interpretation guide. Boston, MA: Nimrod Press; 1993.

    Google Scholar 

  40. Lam CS. A conceptual model for service delivery to people who are unemployed. Unpublished manuscript, Illinois Institute of Technology; 1997.

  41. Barrett T, Browne D, Lamers M, Steding E. Reliability and validity testing of VALPAR 19. Proceedings of the 19th National Conference of the Australian Association of Occupational Therapists. Perth, WA: AAOT 1997;2:179–83.

  42. Lee GKL. Work profile and functional capacity of formwork carpenters in Hong Kong. Unpublished doctoral dissertation. Hong Kong: The Hong Kong Polytechnic University; 1998.

  43. Innes E, Straker L. Validity of work-related assessments. Work 1999;13(2):1025–152.

    Google Scholar 

  44. Fuh JL, Wang SJ, Lu SR, Juang KD, Lee SJ. Psychometric evaluation of a Chinese (Taiwanese) version of the SF-36 health survey amongst middle-aged women from a rural community. Qual Life Res 2000;9:675–83.

    Article  PubMed  CAS  Google Scholar 

  45. Lam CLK, Gandek B, Ren XS, Chan MS. Tests of scaling assumptions and construct validity of the Chinese (HK) version of the SF-36 health survey. J Clin Epidemiol 1998;51(11):1139–47.

    Article  PubMed  CAS  Google Scholar 

  46. Li L, Wang HM, Shen Y. Chinese SF36 Health Survey: translation, cultural adaptation, validation, and normalization. J Epidemiol Commun Health 2003;57(4):259–63.

    Article  CAS  Google Scholar 

  47. Ren XS, Amick B, Zhou L, Gandek B. Translation and psychometric evaluation of a Chinese version of the SF-36 health survey in the United States. J Clin Epidemiol 1998;51(11):1129–38.

    Article  PubMed  CAS  Google Scholar 

  48. Vowles KE, Gross RT. Work-related beliefs about injury and physical capability for work in individuals with chronic pain. Pain 2003;101(3):291–8.

    Article  PubMed  Google Scholar 

  49. Blackwell TL, Leierer SJ, Haupt S, Kampitsis A. Predictors of vocational rehabilitation return-to-work outcomes in workers’ compensation. Rehabil Counseling Bull 2002;46(2):108–14.

    Google Scholar 

  50. Feuerstein M, Callan-Harris S, Hickey P, Dyer D, Armbruster W, Carosella AM. Multidisciplinary rehabilitation of chronic work-related upper extremity disorders: long-term effects. J Occup Med 1993;35(4):396–403.

    PubMed  CAS  Google Scholar 

  51. DiClemente CC, Prochaska JO, Fairhurst SK, Velicer WF, Velasquez MM, Rossi JS. The process of smoking cessation: an analysis of precontemplation, contemplation, and preparation stages of change. J Consult Clin Psychol 1991;59(2):295–304.

    Article  PubMed  CAS  Google Scholar 

  52. Marhold C, Linton SJ, Melin L. A cognitive-behavioral return-to-work program: effects on pain patients with a history of long-term versus short-term sick leave. Pain 2001;91(1–2):155–63.

    Article  PubMed  CAS  Google Scholar 

  53. Pfingsten M, Hildebrandt J, Leibing E, Franz C, Saur P. Effectiveness of a multimodal treatment program for chronic low-back pain. Pain 1997;73(1):77–85.

    Article  PubMed  CAS  Google Scholar 

  54. Hankin HA, Killian CB. Prediction of functional outcomes in patients with chronic pain. Work 2004;22(2):125–30.

    PubMed  Google Scholar 

  55. Hernandez-Avila CA, Burleson JA, Kranzler HR. Stage of change as a predictor of abstinence among alcohol-dependent subjects in pharmacotherapy trials. Subst Abuse 1998;19(2):81–91.

    Article  Google Scholar 

  56. Fitzgerald S, Becker D, Celentano D, Swank R, Brinker J. RTW after percutaneous transluminal coronary angioplasty. Am J Cardiol 1989;68:1108–12.

    Article  Google Scholar 

  57. Sandstrom J, Esbjornsson E. Return to work after rehabilitation. The significance of the patient’s own prediction. Scand J Rehabil Med 1986;18(1):29–33.

    PubMed  CAS  Google Scholar 

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Acknowledgments

The authors thank Mr. Henky Chan and Dr. Jiaqi Li for their help with the data collection. We would also like to thank all the participants, without whose support the study would not have been possible. This study was supported by a joint research grant provided by The Hong Kong Polytechnic University and The Hong Kong Workers’ Health Centre.

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Authors and Affiliations

  1. Functional Assessment and Work Rehabilitation, Guangdong Provincial Work Rehabilitation Centre, Guangzhou, China

    Yan-wen Xu

  2. Ergonomics and Human Performance Laboratory, Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong, China

    Chetwyn C. H. Chan

  3. Institute of Psychology, Illinois Institute of Technology, Illinois, USA

    Chow S. Lam

  4. Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, China

    Cecilia W. P. Li-Tsang

  5. Health Centre, Hong Kong, China

    Karen Y. L. Lo-Hui

  6. Department of Psychology, University of Texas at Arlington, Arlington, USA

    Robert J. Gatchel

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  1. Yan-wen Xu
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  2. Chetwyn C. H. Chan
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  3. Chow S. Lam
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  4. Cecilia W. P. Li-Tsang
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Correspondence to Chetwyn C. H. Chan.

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Xu, Yw., Chan, C.C.H., Lam, C.S. et al. Rehabilitation of Injured Workers with Chronic Pain: A Stage of Change Phenomenon. J Occup Rehabil 17, 727–742 (2007). https://doi.org/10.1007/s10926-007-9105-0

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  • DOI: https://doi.org/10.1007/s10926-007-9105-0

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