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The job demands-resources (JD-R) model has hardly been studied in volunteer organizations and there is a scarcity of studies evaluating self-compassion as a personal resource within the JD-R model. The present study addresses these gaps in current knowledge, first by examining the applicability of the JD-R model in a crisis line volunteer organization. Second, self-compassion is examined, both in terms of its moderating role on the exhaustion process as well as its role on the motivation process. Structural equation modelling was used for the analyses. The influence on the organizational outcome ‘compassion towards others’ was examined using a multiple regression analysis. The results showed that the JD-R model has an acceptable fit on this sample and supports the central assumption that exhaustion and motivation are two independent but related processes. This study provides evidence that self-compassion is a valuable addition to the JD-R model, as it has an indirect effect on both processes, and increases the explained variance in compassion towards others by 7% through the exhaustion process and by 3% through the motivational process. These findings point to the importance of focusing on self-compassion in training and supervision in volunteer organizations.

Background Little is known about any differences between young people with chronic physical conditions who do and do not apply for disability benefits in young adulthood for providing insights for future policy and rehabilitation care. Objective We aimed to identify predictors during adolescence of receiving disability benefits in young adulthood and to compare recipients and non-recipients of benefits in social participation and psychosocial outcomes in young adulthood. Methods Follow-up study of 18 to 25 year olds with various chronic conditions who at adolescent age completed a web-based survey (n = 518; T0). The outcome was receiving disability benefits (yes or no). Associations with background characteristics, social participation, and impact of the chronic condition were explored with stepwise multivariate modelling, using T0 variables. Differences between recipients and non-recipients were explored using chi-square tests and t-tests. Results Receiving disability benefits in young adulthood was associated with greater extent of physical disability, receiving less special education, absenteeism at school/work, and low health-related quality of life during adolescence. In young adulthood, recipients of benefits reported higher perceived impact of the chronic condition on their school/work career and lower quality of life than non-recipients. Social participation varied across domains. Conclusion This study provides important insights into the characteristics of a vulnerable subgroup of young people with chronic physical conditions. Disability benefit recipients experienced more impact of their chronic condition and reported a lower health-related quality of life over time than non-recipients. Rehabilitation professionals are encouraged to use patient-reported outcomes to address the lived experiences and screen the need for psychosocial support of this vulnerable subgroup of young people with chronic physical conditions.

Aangezien de prevalentie van autisme hoger blijkt dan voorheen werd gedacht (circa 1%), moeten bedrijfsartsen geregeld clienten zien met autisme. Door middel van een enquete werd onderzocht in hoeverre bedrijfsartsen autisme (tijdig) herkennen en dan weten hoe verder te handelen. Bedrijfsartsen rapporteren voldoende vertrouwen te hebben in hun passieve algemene kennis ten aanzien van autisme en de diagnostische mogelijkheden, maar minder zeker te zijn over hun kennis van de therapeutische mogelijkheden. Er lijkt sprake van handelingsverlegenheid, aangezien de actieve praktische toepassing van de aanwezige kennis vooralsnog bescheiden van aard is.

BACKGROUND: Stigma and disclosure are important work-related issues for people living with HIV (PLWH). To gain better understanding and improve the position of PLWH in the labor market, further insight in these issues is needed. OBJECTIVE: This study reviews the scientific evidence related to work-related stigma and disclosure. METHODS: A sensitive literature search was performed in the databases of Medline, Embase, Cochrane Library, Cinahl and Psychinfo for articles published between 1996 and 2016. All studies on PLWH in western countries and investigating disclosure or stigma in relation to work were included. RESULTS: Of the 866 identified studies, 19 met the inclusion criteria: 4 addressed both disclosure and stigma (2 quantitative), 9 addressed only disclosure (4 quantitative) and 7 studies addressed only stigma (4 quantitative). CONCLUSION: This review provides a unique overview of the research on work-related disclosure and stigma, which will enable health care providers to support PWLH to make well-considered decisions. However, the available literature was heterogeneous and in most studies the topics of our interest were secondary outcomes and provided only basic insight.

Shortages in the nursing profession are increasing. It is, therefore, imperative to understand why novice nurses are leaving the profession. This qualitative study explores Dutch novice nurses’ motives for leaving the profession. Individual semi-structured interviews were held with seventeen former novice nurses who had decided to leave nursing within two years after graduation. Data was collected and analysed following the principles of Thematic Analysis, leading to six themes; 1) Lack of challenge; ambitious to progress further in management or research roles. 2) Lack of passion; no feeling of passion for patient care. 3) Lack of perceived competence; not feeling “up to the challenge”. 4) Lack of job satisfaction due to heavy workload; work-life imbalance and inability to deliver high-quality care. 5) Lack of work capacity due to non-work-related health conditions; unmet requirements for job or work environment adjustment. 6) Lack of feeling of belonging; suffering from a negative attitude of colleagues to one another. To prevent novice nurse professional turnover, measures such as capacity building, supervisor support and a tailored personal development plan could be taken. To make novice nurses feel safe and reassured, support from colleagues and supervisors is important. Such measures require thoughtful implementation and evaluation.

door middel van een pilotstudie evalueren van de haalbaarheid en toepasbaarheid van een nieuwe interventie, waarin revalidatie en re-integratie gecombineerd worden, om de arbeidsparticipatie te verbeteren van jongvolwassenen met lichamelijke beperkingen. Methode: twaalf jongvolwassenen (19-28 jaar) met een lichamelijke beperking hebben deelgenomen aan de interventie. In een pre-post interventie design zijn de haalbaarheid, waaronder realisatie en kosten van een geintegreerd aanbod, en toepasbaarheid, waaronder geschiktheid voor het bevorderen van de arbeidsparticipatie van jongvolwassenen met lichamelijke beperkingen, bestudeerd. De veranderingen in arbeidsparticipatie zijn geevalueerd met behulp van vragenlijsten en semi-gestructureerde interviews. Aanvullend is de arbeidsparticipatie na 2 en 3 jaar nagegaan. een interventie, waarbij jongvolwassenen een jaar worden ondersteund door een revalidatieteam en een jobcoach in een groepsprogramma en individuele begeleiding, is geimplementeerd in een revalidatiepolikliniek voor jongvolwassenen. De mediane kosten per deelnemer bedragen € 3128,- voor 1 jaar. Post-interventie en na 2 en 3 jaar follow-up was een groter deel van de deelnemers aan de pilotstudie werkzaam (67% post vs. 16% preinterventie; p

OBJECTIVE: To provide a systematic overview of self-management interventions (SMI) for young people with chronic conditions with respect to content, formats, theories, and evaluated outcomes. METHODS: Embase, Medline, PsycINFO, Web-of-Science, CINAHL, and Cochrane were searched. Reviews' reference lists were scrutinized. Selected studies were: Original research articles in English published between 2003 and March 2014; about the evaluation of SMI for 7 to 25-year-olds with somatic chronic conditions/physical disabilities; with clear outcomes and intervention descriptions. The classification of medical, role and emotion management served to review content. Formats, theories, and evaluated outcomes were summarized. RESULTS: 86 studies were reviewed. Most aimed at medical management and were unclear about theoretical bases. Although a variety of outcomes was evaluated and the distribution over self-management domains was quite unpredictable, outcomes conceptually related to specific content. A content-based framework for the evaluation of self-management interventions is presented. CONCLUSIONS AND PRACTICE IMPLICATIONS: SMI relate to self-management tasks and skill-building. Yet, conceptualizations of self-management support often remained unclear and content focuses predominantly on the medical domain, neglecting psycho-social challenges for chronically ill young people. Future evaluations should match outcomes/themes to content and characteristics. Our framework and overview of SMI characteristics and outcomes may assist clinicians in providing self-management support.

Background: It remains unclear to what extent patients recover from chronic non-specific low back pain (NSLBP). The objective of this study was to determine (1) the course of chronic NSLBP in tertiary care and (2) which factors predicted 5- and 12-month outcomes. Methods: This prospective study includes 1760 chronic NSLBP patients from a rehabilitation clinic (mean age 40.1 years, SD 10.6). After baseline measurement, patients followed a 2-month multidisciplinary therapy programme; evaluation took place at 2, 5 and 12 months post baseline. Recovery was defined as (1) relative recovery [30% improvement on the pain, visual analogue scale (VAS) compared with baseline] and (2) absolute recovery (VAS pain ≤ 10 mm). The multivariate logistic regression analysis included 23 baseline characteristics. Results: Patient-reported intensity of back pain decreased from 55.5 (SD 23.0) at baseline to 37.0 (SD 23.8), 35.3 (SD 26.1) and 32.3 (SD 26.9) at 2-, 5- and 12-month follow-up, respectively. Younger age, back pain at baseline, no psychological/physical dysfunction (Symptom Check List-90, item 9), and higher baseline scores on the physical component scale and mental component scale of quality of life (Short Form-36) were positively associated with recovery at 5 and 12 months. At 5-month follow-up, higher work participation at baseline was also a prognostic factor for both definitions of recovery. At 12-month follow-up, having co-morbidity was predictive for both definitions. Conclusion: The results of this study indicate that in chronic NSLBP patients, bio-psychosocial prognostic factors may be important for clinicians when predicting recovery in back pain intensity during a 1-year period.

OBJECTIVE:To investigate the clinical course of, and prognostic factors for, work-participation in patients with chronic non-specific low back pain.METHODS:A total of 1,608 patients with chronic non-specific low back pain received a multidisciplinary therapy and were evaluated at baseline and 2-, 5- and 12-month follow-ups. Recovery was defined as absolute recovery if the patient worked 90% of his contract hours at follow-up. Potential factors were identified using multivariable logistic regression analysis.RESULTS:Patients reported a mean increase in work-participation from 38% at baseline to 82% after 12 months. Prognostic factors for ≥ 90% work-participation at 5 months were being married (odds ratio (OR) 1.72 (95% confidence interval (95% CI) 1.12-2.65)), male (OR 1.99 (95% CI 1.24-3.20)), a higher score on disability (OR 1.00 (95% CI 0.997-1.02)) and physical component scale (Short-Form 36 (SF-36)) (OR 1.05 (95% CI 1.02-1.07)), previous rehabilitation (OR 1.85 (95% CI 1.14-2.98)), not receiving sickness benefits (OR 0.52 (95% CI 0.24-1.10)) and more work-participation (OR 4.86 (95% CI 2.35-10.04)). More work-participation (OR 5.22 (95% CI 3.47-7.85)) and male sex (OR 1.79 (95% CI 1.25-2.55)) were also prognostic factors at 12-month follow-up.CONCLUSION:At 12 months 52% of patients reported ≥ 90% work-participation. The strongest prognostic factor was more work-participation at baseline for the recovery of chronic non-specific low back pain

The objective of this study was to develop a multidisciplinary guideline that supports the care and vocational rehabilitation of HIV-infected people with employment-related problems. The guideline was developed according to the "evidence-based guideline development" method developed by the Dutch Institute for Health Care Improvement. This method consists of the following steps: forming a multidisciplinary core group and an expert panel, formulating key questions, searching and appraising the available literature, formulating considerations and recommendations, peer reviewing the draft guideline, and authorizing the final guideline. All relevant professional associations were represented in the core group that was assembled to develop the guideline, i.e., HIV doctors, HIV nurses, general practitioners, occupational health physicians, psychologists, social workers, occupational health nurses, vocational experts, and insurance physicians. Five key questions for the guideline were formulated with the following themes: determinants of employment, disclosure and stigma, self-management, interventions, and the organization of care. In the literature review on these topics, 45 studies met the inclusion criteria. The methodological quality of the included articles was poor. Factors such as patient preferences and medical/ethical issues were considered. The recommendations in the guideline are a weighting of the scientific evidence and the considerations of the core group. The guideline, as well as its summary for daily practice, clarifies the most important barriers and facilitators to people with HIV either staying at work or returning to work, and it constitutes a clinical, easy-to-use guideline for health-care providers and how they can support people with HIV who want to work.

OBJECTIVE: To document the development of work participation in young adults with cerebral palsy who are transitioning into adulthood, examine associated characteristics, and investigate work limitations and barriers among employed persons. DESIGN: Observational longitudinal cohort study. SUBJECTS: Seventy-four young adults with cerebral palsy of average intelligence, aged 16–20 years at baseline. METHODS: Work participation in 3 categories (employed, unemployed, studying) was assessed at baseline, 2-year and 4-year follow-ups using structured interviews. At 4-year follow-up, associations of work participation with demographic and clinical characteristics were examined using multinomial logistic regression. Work limitations and barriers among employed persons were evaluated using questionnaires. RESULTS: From age range 16–20 years to age range 20–24 years the proportions of subjects who were employed and unemployed increased from 12% to 49% and 3% to 17%, respectively; the proportion who were students decreased from 85% to 34%. In the age range 20–24 years, the employment rate of young adults with cerebral palsy was lower and the unemployment rate higher, than that of the general population. A lower level of gross motor function and younger age were associated with unemployment. Employed persons experienced few work limitations; 28% experienced situational or health barriers. CONCLUSION: Young adults with cerebral palsy and average intelligence are at risk of experiencing unfavourable developments in work participation. Rehabilitation services should offer support to prevent unemployment and occupational disability.

Purpose Finding and keeping employment is difficult for people with HIV. To improve supportive care for people with HIV and employment-related problems, a multidisciplinary guideline was developed in the Netherlands in 2010/2011. To identify the employment-related concerns of people with HIV and to formulate the key questions for the guideline, we conducted a qualitative study. The results of this study are described in this article. Methods This study was performed in three HIV-treatment centers in the Netherlands. In total 18 participants participated in three focus-group interviews and nine participants were interviewed individually. The data were transcribed ad verbatim and were analyzed according to the principle of constant comparison. Results Our findings indicate that people with HIV in the Netherlands face many work-related concerns. The themes which emerged from this study were disclosure, stigma and discrimination, knowledge about HIV, physical and psychological factors, working conditions, absenteeism, reintegration, and dismissal and counselling. Conclusions This study provides insight into employment-related concerns for people with HIV living in a Western country. It formed the basis for the key questions which were addressed in a multidisciplinary, evidence-based guideline "HIV and work". Finally, it gives leads for further scientific research and opportunities for improving the vocational guidance of people with HIV.

The aim of the study was to evaluate the feasibility of a new intervention to improve work participation of young adults with physical disabilities, addressing (1) implementation and costs and (2) preliminary effectiveness.Twelve young adults with physical disabilities (six males, six females; age 19-28 y, median age 21 y 6 mo) participated in a 1-year multidisciplinary vocational rehabilitation intervention. In a pre-post intervention design, we assessed implementation and costs as well as preliminary effectiveness in terms of employment and occupational performance using questionnaires and interviews. We tested pre-post differences with the McNemar test for proportions and the Wilcoxon signed-rank test for scores on occupational performance; p-values less than 0.05 were considered statistically significant. Additionally, we assessed work participation at follow-up after 2 years and 3 years.The intervention was implemented in an outpatient rehabilitation clinic for young adults. The median cost per participant for 1 year was €3128, which is an equivalent to the cost of 72 contact hours per participant. Post intervention, and at 2 years and 3 years follow-up, a significantly higher proportion of participants were employed (8/12 post vs 2/12 pre-intervention; p0.05), with the ratio of those in paid to unpaid employment being 4:4, 5:3, and 7:1 respectively. Participants showed improved occupational performance in work, self-care, and leisure.Feasibility and preliminary effectiveness of the intervention are promising. Employed participants seemed to have achieved suitable and continuous employment.

To examine the intelligibility and psychometric properties of the modified Dutch language version of the Work Limitations Questionnaire (WLQ) (WLQ-mdlv).Employed patients with a physical chronic condition completed the WLQ-mdlv, the Work Ability Index, and the 36-item short form health survey. Intelligibility, internal consistency, test-retest reliability, and external construct validity of the WLQ-mdlv were assessed.In 125 patients, the WLQ-mdlv showed improved intelligibility for a Dutch population. With Cronbach α coefficients more than .80, squared weighted κ of 0.63 or more (individual items), intraclass correlation coefficients of 0.83 or more (WLQ scales), a minimal detectable change of four points (WLQ index), and negative correlations with the Work Ability Index and related 36-item short form health survey scales reliability and external construct validity of the WLQ-mdlv were confirmed.The WLQ-mdlv is an intelligible, reliable, and valid instrument for evaluating work limitations in employees with a chronic condition in the Netherlands.

Objectives: To evaluate the differences in predictors of nonrecovery between patients with a specific diagnosis at arm, neck, and/or shoulder, vs. patients with a nonspecific diagnosis in general practice at 6 months after the first consultation. Study Design and Setting: New consulters with nontraumatic arm, neck, or shoulder complaints entered the cohort. Patient, complaint, and physical, psychosocial, and work characteristics were evaluated as possible predictors. Logistic regression analyses were conducted for the specific and nonspecific groups separately. Results: At 6 months, 38% (n = 298) of the specific-group members and 49% (n = 249) of the nonspecific-group members reported nonrecovery. Univariately, similar variables were related in both groups, although their strength sometimes differed. Multivariately, duration of complaints was predictive of nonrecovery in both groups. Other predictors in the specific group were as follows: more somatization, low social support, older age, high body mass index, and unemployment. In the nonspecific group, the predictors were as follows: musculoskeletal comorbidity, recurrent complaint, poor perceived general health, multiple-region complaints, and high level of kinesiophobia. Conclusion: At 6 months, nonrecovery was reported more frequently in the group of patients with a nonspecific diagnosis. The predictive value of psychosocial factors on nonrecovery is at least of equal importance in patients with a specific diagnosis compared with patients with a nonspecific diagnosis. (C) 2010 Elsevier Inc. All rights reserved.

OBJECTIVE We wanted to evaluate associations between diagnosis and characteristics of the patient, complaint, and general practitioner (GP), as well as 6 common management decisions, in patients with nontraumatic arm, neck, and shoulder complaints at the time of the first consultation with their physician. METHODS We undertook an observational cohort study set in 21 Dutch general practices, including 682 patients with nontraumatic complaints of arm, neck, and shoulder. The outcome measure was application (yes/no) of a specific management option: watchful waiting, additional diagnostic tests, prescription of medication, corticosteroid injection, referral for physiotherapy, and referral for medical specialist care. RESULTS Separate multilevel analyses showed that overall, the diagnostic category, having long duration of complaints, and reporting many functional limitations were most frequently associated with the choice of a management option. For watchful waiting, only complaint variables played a role (long duration of complaints, high complaint severity, many functional limitations, recurrent complaint). All these variables were negatively associated with watchful waiting. When opting for 1 of the 5 other management options, several physician characteristics played a role as well. Less clinical experience was associated with additional diagnostic tests and referral to a medical specialist. GPs working in a solo practice more frequently referred to a medical specialist. GPs working in a rural area more frequently referred for physiotherapy. Female GPs prescribed medication less frequently. Physicians with special interest in musculoskeletal complaints gave corticosteroid injections more frequently. CONCLUSIONS Diagnostic category, long duration of complaints, and high functional limitations were key variables in management decisions with these complaints. In addition, several physician characteristics played a role as well.

Arm, neck and/or shoulder complaints are common in western societies. In the Netherlands, general practice guidelines are issued on shoulder pain and epicondylitis only. Little is known about actual management of the total range of diagnoses. The objectives of the study are: to determine management in patients consulting the GP with a new episode of non-traumatic arm neck and shoulder complaints up to 6 months after the first consultation. To evaluate differences in management between patients with specific diagnoses versus non-specific diagnoses and between specific diagnostic groups. In a prospective cohort study in general practice. We recruited 682 eligible patients. Data on diagnosis, management, patient- and complaint-characteristics were collected. Co-occurrence of treatment options was presented in scaled rectangles. After 6 months, additional diagnostic tests had been performed in 18% of the patients, mainly radiographic examination (14%). Further, 49% had been referred for physiotherapy and 12% to the medical specialist. Patients with specific diagnoses were more frequently referred for specialist treatment, and patients with non-specific diagnoses for physiotherapy. Corticosteroid injections (17%) were mainly applied specific diagnoses (e.g. impingement syndrome, frozen shoulder, carpal tunnel and M. Quervain). Frequencies of prescribed medication (51%) did not differ between specific and non-specific diagnoses. In 19% of the patients no referral, prescribed analgesics or injection was applied. Braces (4%) were mainly prescribed in epicondylitis. Overall, management most frequently consisted of prescribed analgesics and referral for physiotherapy. Specific and non-specific diagnostic subgroups differed in the frequency corticosteroid injections were applied, and referrals to physiotherapy and to a medical specialist.

Multidisciplinaire consensus over terminologie en indeling van klachten van het bewegingsapparaat in de arm-, nek- en schouderregio is een eerste vereiste om te komen tot accurate en betekenisvolle communicatie tussen professionals in de gezondheidszorg. Bovendien zal consensus en het gebruik ervan het vergelijken van resultaten van wetenschappelijk onderzoek makkelijker maken. Klachten van het bewegingsapparaat in de arm-, nek- en schouderregio vormen een veel voorkomend gezondheidsprobleem. Overal ter wereld worden mensen geconfronteerd met de problematiek die deze klachten met zich meebrengt. Prevalentiecijfers van deze klachten, die in wetenschappelijke literatuur gevonden worden, lopen nogal uiteen; 2–41% van de mensen geeft aan in het voorafgaande jaar klachten van arm, nek en/of schouder te hebben gehad en 2–53% van de mensen blijkt klachten te hebben op het moment van meten. 1 Een van de hoofdoorzaken voor deze

Incidence densities in primary care are often based on disease or region-specific code registration (e.g. 'epicondylitis', 'shoulder symptom') according to the International Classification of Primary Care (ICPC). Few estimates are available on arm, neck and shoulder complaints. Unknown, is the proportion missed due to registration with a non-region-specific code (e.g. 'muscle pain'). Therefore, we estimated the incidence in non-traumatic arm, neck and shoulder complaints in the age-group 18-64 years, and determined the contribution of non-specific codes to the total figure. In this prospective registration study, 21 general practitioners (GPs) from 13 Dutch general practices classified and registered patient's symptoms and diagnoses according to ICPC at each consultation during 12 consecutive months. Incidence densities were calculated. The incidence density was 97.4/1000 person-years (95% CI: 91.2-103.7). This results in 147 (95% CI: 138-157) incident cases/year for an average-sized GP-practicc (2350 patients). Main contributors were: shoulder (L92, L08) and neck complaints (L01, L83). Of all incident consultations, 23% were registered with non-region-specific codes, mainly 'other musculoskeletal disease' (L99). Non-traumatic complaints of arm. neck and shoulder are frequently consulted for in Dutch primary care. When estimating morbidity in primary care, based on diagnostic codes, one should be aware of possible underestimation of morbidity and corresponding workload, when excluding codes not specific for that region or disease. (C) 2007 Elsevier Ltd. All rights reserved.

Purpose For some disorders, such as radial tunnel syndrome (RTS), no randomized controlled trials and controlled clinical trials are available. To gain insight into the effectiveness of conservative and surgical interventions for treating RTS, we systematically reviewed all available observational studies on treatment of RTS. Although the validity of case series is inferior to that of controlled trials, the case series might provide valuable data about the efficacy of treatment options. Methods A literature search and additional reference checking resulted in 21 eligible case series for this review. Based on previous checklists, we constructed a new quality assessment and rating system to analyze the included case series. The methodological quality was assessed, and data extraction was performed. Studies with less than 50% of the maximum points on the methodological quality assessment were considered inadequate and were excluded from the analysis. To summarize the results according to the rating system for the strength of the scientific evidence for these case series, we introduced 4 levels: (1) tendency, (2) slight tendency, (3) conflicting tendency, and (4) no tendency. Results After the methodological quality assessment, 6 articles were included in the final analysis. They all reported on surgical treatment. Conclusions There is a tendency that surgical decompression of the radial tunnel might be effective in patients with RTS. The effectiveness of conservative treatments for RTS is unknown because, for most treatments, no studies were available. Additional high-quality controlled studies are needed to assess the level of conclusive evidence for surgical treatment and also to evaluate conservative treatments for RTS. For this, we recommend a multicenter, randomized clinical trial. Due to the lack of a clear protocol for diagnosing RTS, a reliable and valid diagnostic tool should be developed. Type of study/level of evidence Therapeutic IV.

Klachten aan het bewegingsapparaat zijn een belangrijke oorzaak van arbeidsverzuim. Werknemers met verzuim vanwege deze klachten kunnen behandeld worden door zowel een orthopedisch chirurg als een bedrijfsarts.

For the posterior interosseus nerve syndrome (PINS), no randomised controlled trials or controlled clinical trials about the effectiveness of interventions are available; only case series can be found. Although the validity of case series is inferior to controlled trials, they may provide valuable data about the efficacy of treatment options. Therefore, we systematically reviewed all available observational studies on treatment of PINS. A literature search and additional reference checking was done. On the basis of previous checklists, we constructed a quality assessment and rating system to analyse the included case series. Studies with less than 50% of the maximum points on the methodological quality assessment were excluded from the analysis. The results are summarised according to a rating system for the strength of the scientific evidence. Six eligible case series for this review were found. After the data extraction and methodological quality assessment, two higher quality studies that evaluated the effectiveness of surgical decompression of the PIN were included in the final analysis. There is a tendency for the effectiveness of surgical decompression of the PIN in patients with PINS. The effectiveness of a conservative treatment for PINS is unknown because no higher quality studies are available. Additional high-quality controlled studies are needed to assess the level of 'conclusive evidence' for surgical treatment. There is also a need for high-quality controlled trials into the effectiveness of conservative treatments for PINS.

The goal of this systematic review is to evaluate the effectiveness of different treatments for impingement syndrome and rotator cuff tear on the improvement in functional limitations and concomitant duration of sick leave. A systematic search for clinical trials or controlled studies was conducted with the following text words: should*, rotator cuff, impingement, work, sick leave, disabilit*, function*. Nineteen articles were included in this review. For functional limitations, there is strong evidence that extracorporeal shock-wave therapy is not effective, moderate evidence that exercise combined with manual therapy is more effective than exercise alone, that ultrasound is not effective, and that open and arthroscopic acromioplasty are equally effective on the long term. For all other interventions there is only limited evidence. We found many studies using range of motion and pain as outcome measures but functional limitations were less often used as an outcome measure in this type of research. Duration of sick leave was seldom included as an outcome measure.

Het instrument is de enige beschikbare evidence-based methode voor de beoordeling van de arbeidsgerelateerdheid van aspecifieke lage-rugklachten.

Objective: The objective of this study was to determine the effectiveness of a training to increase collaboration between general practitioners and occupational health physicians in the treatment of patients with low back pain (LBP) because more collaboration might improve a patient’s recovery and shorten sick leave. Methods: In a controlled trial, the intervention in one region was compared with usual care in a control region. Participating physicians enrolled patients with LBP on sick leave for 3–12 weeks. Patients filled out three questionnaires: at inclusion, at 3 months, and at 6 months. Information on sick leave was gathered from occupational health services. All analyses were performed on an intention-to-treat basis. Results: Fifty-six patients with LBP were enrolled in each region. There was little collaboration between physicians during the project. Patients in the intervention region returned to work significantly later (P .005) but were significantly more satisfied with their occupational health physician (P .01). No differences were found between the intervention and control patients for pain, disability, quality of life, and medical consumption. Conclusion: Our study does not show a positive effect of the training to increase collaboration between general practitioners and occupational health physicians. The training may not have improved collaboration enough to influence the prognosis of LBP. 2005

Objective: To investigate the incidence and prevalence of shoulder complaints in the general population.Method: A systematic review of the literature was conducted. Medline, Embase, and Cinahl were searched for relevant studies.Results: Eighteen studies on prevalence and one study on incidence met the inclusion criteria. Incidence figures of 0.9–2.5% were found for different age groups. Prevalence figures differed from 6.9 to 26% for point prevalence, 18.6–31% for 1‐month prevalence, 4.7–46.7% for 1‐year prevalence and 6.7–66.7% for lifetime prevalence. Prevalence rates decreased when the case definition was restricted, in terms of duration of pain or the presence of limited movements, and increased when the location for pain was enlarged.Conclusion: The reported prevalence figures on shoulder complaints diverged strongly. Health professionals and policymakers who estimate the amount of medical care needed and related costs should be aware of the variations in prevalence rate and the underlying reasons fo...

Objectives This study aimed at developing a model for determining the work-relatedness of low-back pain for a worker with low-back pain using both a personal exposure profile for well-established risk factors and the probability of low-back pain if the worker were unexposed to these factors. Methods After a systematic review of the literature, the pooled prevalence of low-back pain in an unexposed population and the pooled odds ratio (OR) for each risk factor was calculated in a meta-analysis using a random effect model. An unbiased risk estimate for each risk factor was obtained by correcting the pooled OR for confounding by other risk factors. The probability of low-back pain was calculated with a logistic regression model. The input was (i) the age-dependent prevalence when not exposed and (ii) the unbiased risk estimates per risk factor of low and high exposure. The etiologic fraction was calculated to determine the level of work-relatedness. Results The pooled prevalence for low-back pain among unexposed subjects was 22%, 30%, and 34% for the＜35-year, 35-to-45-year, and ＞45-year age categories, respectively. The pooled OR was 1.51 [95% confidence interval (95% CI) 1.31-1.74] for manual materials handling, 1.68 (95% CI 1.41-2.01) for frequent bending or twisting, 1.39 (95% CI 1.24-1.55) for whole-body vibration, and 1.30 (1.17-1.45) for job dissatisfaction. For high exposure to manual materials handling, frequent bending or twisting, and whole-body vibration, the pooled OR was 1.92, 1.93, and 1.63, respectively. Conclusions The model is the first that estimates the probability of work-relatedness for low-back pain for a given worker with low-back pain seen by a general practitioner or an occupational health physician.

Objective: To investigate the relationship between work and quality of life (QOL) in patients with rheumatoid arthritis (RA) and ankylosing spondylitis (AS) aged 16-59. Methods: 1056 patients with RA and 658 with AS were included in the study. Data were obtained by postal questionnaire, which included severa generic and disease related QOL instruments. Separate dimensions and physical and mental summary scores from the SF-36 were compared. Stepwise multiple regression was performed to study the relationship between work and physical and mental health related QOL, including disease related factors, coping, and fatigue. Results: Physical health related QOL was reported to be worse, and mental health related QOL better, in RA than in AS in people of working age. No differences between RA and AS were found in somatic pain, physical role functioning, social functioning, emotional role functioning, vitality, or general health perception; nor were there any significant differences in fatigue and behavioural coping styles. Work was positively associated with physical health related QOL in both groups and, after disease characteristics, was the most important determinant. No association was found with mental health related QOL. Conclusions: Although physical health related QOL was worse in patients with RA, the impact on several dimensions of health related QOL in patients with RA and AS of working age under rheumatologica care was comparable. Patients with RA and AS experienced similar limitations in physical role functioning, including work. Work is an important independent external determinant of physical health related QOL, but not of mental health related QOL.

In recente studies is bij werknemers die verzuimen vanwege klachten aan het bewegingsapparaat, een positief effect gesignaleerd van werkhervatting door middel van aangepast werk. De vraag is of deze aanpassing van arbeidsomstandigheden ook gerealiseerd kan worden binnen bedrijven waarin met name fysiek belastende arbeid wordt verricht. In dit artikel worden de resultaten weergegeven van een studie naar belemmerende factoren voor vroege werkhervatting door middel van aangepast werk. Een bestaand model gericht op gedragsverandering is voor de huidige studie gespecificeerd, waarbij in zes verschillende stadia het proces rond invoering van aangepast werk wordt weergegeven. Vanuit het model is een vragenlijst samengesteld die is uitgezet onder bedrijven en bedrijfsartsen die te maken hebben met fysiek belastend werk en waarin belemmerende factoren voor aangepast werk worden geinventariseerd. De onderdelen van de vragenlijst corresponderen met de zes stadia van het model. De uitkomsten van het vragenlijstonderzoek laten zien dat door bedrijven en bedrijfsartsen een groot aantal belemmeringen ervaren wordt in het realiseren van vroegtijdige werkhervatting door middel van aangepast werk. Belemmeringen ontstaan volgens bedrijven onder andere door de onbekendheid met de effecten van aangepast werk en de negatieve houding van de verzuimende werknemer. In 52% van de bedrijven maakt dit de implementatie van aangepast werk moeilijk. De beschikbaarheid van aangepaste taken of de organisatie die nodig is om aangepast werk te kunnen realiseren, geven in 45% van de bedrijven belemmeringen. Beperkingen in de opleiding van de werknemer scoren het hoogst en is voor 62% van de bedrijven een barriere voor vroege werkhervatting door middel van aangepast werk. Ondanks positief veronderstelde effecten verloopt de implementatie van vroege werkhervatting door aangepast werk met veel belemmeringen en wordt van alle betrokkenen een grote creativiteit verwacht om de verzuimende werknemer met klachten aan het bewegingsapparaat vroegtijdig te laten terugkeren naar de werkplek. Op de belemmerende factoren gerichte interventies kunnen de toepassing van werkhervatting via aangepast werk bevorderen.

Objective - To assess separate and combined effects of work factors and behavioural coping in relation to withdrawal from the labour force among patients with rheumatoid arthritis (RA). Methods - A cross sectional study was conducted in a Dutch nationwide random sample of 720 patients with RA. Information about work factors and behavioural coping was collected by a self-administered postal questionnaire. A broad variety of work factors and coping styles were evaluated separately and in combination using multivariate logistic regression analyses, controlling for sociodemographic and disease related variables. Attributable and preventable fractions were calculated from the combined analyses to assess the relative importance of the contributing factors. Results - Additional job training, equal career opportunities, letting the disease influence the choice of the current job position, and informing colleagues about having the disease were negatively associated with withdrawal from the labour force. The most relevant factor in terms of decreasing the risk was adjusting job demands which accounted for 63% of the patients still in the labour force. Decreasing activities and diverting attention in order to cope with pain, and pacing in order to cope with limitations were the coping styles which were positively associated with withdrawal from the labour force. The most relevant factor in terms of increasing the risk of withdrawal was pacing which accounted for 67% of the withdrawals. Conclusion - Work factors are potentially important modifiable risk factors for withdrawal from the labour force in patients with RA. Behavioural coping is also relevant.

Onlangs heeft de NVAB met enkele andere beroepsorganisaties het initiatief genomen voor een multidisciplinaire richtlijn ‘Vermindering van tilbelasting om rugklachten te voorkomen’. Eind 2012 heeft de NVAB de richtlijn geautoriseerd en kort daarna online gepubliceerd. Kuijer et al. vatten in dit artikel de belangrijkste conclusies en aanbevelingen samen. Daarmee geeft het artikel een compact en helder overzicht en stroomschema voor het stappenplan. Voor diegenen die in de praktijk betrokken zijn bij de preventie van rugklachten, verdient het zeker aanbeveling om de volledige richtlijn en het achtergronddocument te lezen, die beide ook heel helder zijn geschreven.