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BACKGROUND Living and working with chronic pain requires persons to alter lifestyles and have the knowledge as well as support to manage unforeseen challenges. Knowledge for persons living with pain who want to participate in meaningful paid and unpaid work is not easily accessible. While there is literature on chronic pain management, work transitions and return to work, less emphasis has been placed on the complexity of living and working with chronic pain. The Creating a Way Forward Project was envisioned to address this gap and to identify the informational needs of workers with pain, health/helping professionals (workers' advisors, return to work specialists, legal representatives), and stakeholders. The overarching aim of the project was to use evidence and experiential knowledge to inform the development of a foundation for educational guides and toolkits to support workers with pain to achieve their outcomes for remaining at work. METHODS Phase one of the project involved a scoping review of chronic pain and work. Phase two involved stakeholder consultations, a focus group and knowledge integration of the literature and experiential insights. Knowledge synthesis drew on a Template Analysis of multiple sources of data. RESULTS Knowledge domains and key components were identified for persons with pain and for the health/helping professions. CONCLUSION These domains reflect a foundation for knowledge in practical training and the development of curriculum for education in self-management program and in inter professional health profession education. These knowledge domains provide a basis for future research in integrated approaches and knowledge use toward improving transitions for persons living with chronic pain who want to participate in productive paid and unpaid work. Ongoing research in knowledge domains that health providers and persons with pain need will expand the potential for improving health outcomes in living with and managing pain.

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

BACKGROUND Parents who care for young children with chronic conditions are knowledge users. Their efforts, time, and energy to source, consider and monitor information add to the 'invisible' work of parents in making decisions about care, school transitions, and interventions. Little is known or understood about the work of parents as knowledge users. OBJECTIVE To understand the knowledge use patterns and how these patterns may be monitored in parents caring for their young children with cerebral palsy (CP). METHODS An embedded case study methodology was used. In-depth qualitative interviews and visual mapping were employed to collect and analyze data based on the experiences of three mothers of young children with CP. RESULTS Knowledge use in parents caring for their young children with CP is multi-factorial, complex and temporal. Findings resulted in a provisional model elaborating on the ways knowledge is used by parents and how it may be monitored. CONCLUSIONS The visual mapping of pathways and actions of parents as end users makes the processes of knowledge use more visible and open to be valued as well as appreciated by others. The provisional model has implications for knowledge mobilization as a strategy in childhood rehabilitation and the facilitation of knowledge use in the lives of families with children with chronic health conditions.

Background: The marginalisation of youth with disabilities from employment opportunities is evident from literature in as far as they form part of the larger groups ‘people with disabilities’ and ‘youth’. A focused view of programmes that assist youth with disabilities into employment has not been presented, despite the worldwide crisis of youth unemployment.Aim: This review aimed to identify evidence on work transition programmes that are effective in assisting people with disabilities into open labour market (competitive) employment, as well as to highlight gaps in knowledge to inform future research on this topic.Methods: Literature and policy on programmes that support such transitions were considered, firstly from a global perspective and then with a view from developing countries. The SALSA (Search, Appraisal, Synthesis and Analysis) framework was used to source and analyse information from a diverse set of documents. Various online databases were searched for research papers published between 1990 and 2016, and websites were searched for reports pertaining to this topic.Results: Ninety-nine documents were selected to inform the review, out of an identified 259 scientific journal articles, policy documents, acts, organisational reports and book chapters.Conclusion: A synthesis of findings was presented in a narrative that reflects the themes of youth with disabilities and employment in the world, work transition endeavours in the developing world and a specific focus on this group in South Africa. The review revealed a gap in knowledge and evidence pertaining to youth with disabilities and employment, highlighting these as research foci, and emphasising the need for youth-focused research that generates knowledge about disability and transitions into the labour force.

Drawing on data from a larger study, the aim of this paper is to illuminate how the everyday doings of women with disabilities are coordinated to and shaped by organizational processes and social context, particularly as these relate to the potential of being labelled disabled.An institutional ethnography was conducted with seven Austrian women diagnosed with rheumatoid arthritis (RA). Interviews and participant observations were conducted, and texts about the historical development of disability policies were identified. Data analysis included grouping similar doings of participants together to subsequently explore links between what the women did and how their doings are shaped by disability policies and the social context.The women, who participated in this study, spent time and effort to keep the disease invisible, resist disability and negotiate a disability pass. By drawing upon the historical development of Austrian disability policies, the interpretation reveals how this development infiltrates into participants' lives and shapes their everyday doing.This study furthers understanding of how broader policies and practices, shaped over historical time, infiltrate into the daily lives of women with disabilities. It illustrates how full participation may not necessarily be a lived reality for people with disabilities at this point in Austria. Implications for Rehabilitation Maximising full participation for people with rheumatoid arthritis is important. This requires focusing not only on the bodily health of people with rheumatoid arthritis but also on their interaction with the social, cultural and political context in their daily lives. This requires also understanding how knowledge about disability is passed on from previous generations.

Objective: Persons with brain injury experience a shift in their self identity that is underpinned by work loss and changes to their worker role. However, little is known on how to assist a worker with a brain injury re-establish their occupational identity. Thus, the objective of this article is to present the results of a scoping review undertaken to examine the literature on occupational identity and self identity after a brain injury. Methods: A scoping review was performed using the keywords traumatic, acquired brain injury, occupational, and self identity. Articles were narrowed through three phases which involved reviewing articles to ensure a thorough discussion of identity after a brain injury was included and to highlight the research questions. Results: In total 16 articles and 3 theses were included. No articles were retrieved on occupational identity after a brain injury. Fourteen articles discussed the loss of self identity experienced after a brain injury while three articles highlighted rehabilitation programs. Conclusions: Research indicates there are extensive changes to identity after a brain injury and this impacts returning to previous occupations. This knowledge can further our understanding of returning to occupations after a brain injury and the impact on occupational identity.

The world of work is transforming. Where work is performed, who performs work or has the right to work is changing. Along with these changes workers are experiencing shifts in the knowledge needed to work, the dissolving of contracted benefits, and the disappearance of traditional opportunities for work such as in manufacturing. Moreover, there are many influences that shape what workers can do, are expected to do, what they can expect from work and the types of work they can expect to do in the future. Some of these changes give rise to new meanings of work or what it means to be productive within a society or community. Currently, some of the factors shaping the world of work and its situated nature include global shifts in the economy, mandatory retirement changes, the growing number of immigrant or older or migrant workers, the offshoring of work from one country to another, and the discourses about future work possibilities (e.g. the demise of manufacturing in the western world, unemployment as a common phenomenon and the emergence and acceptance of service work or knowledge work as the norm). All of these are changing the occupational salience or valuing of goal directed activities within a community or society [1]. Shifts in occupational salience in work occupations can be changes in the jobs that are considered valued or meaningful or accessible to workers as well as aspects about the nature of working that create new meanings about participation in goal directed activities. For instance, in developed countries one of the most common problems is that global shifts in the economy and the discourse in the popular media about high rates of unemployment raise the expectation of unemployment not only for young people but, also for current workers across all employment sectors. We have even seen the emergence of disparaging or marginalizing lexicons used to describe workers such as discouraged workers [2], undocumented workers, alien workers or injured workers. Workers today can expect more periods of intermittent work disruption and disengagement as part of their employment trajectory due to the unpredictability of and unstable global economies. Unemployment is not new, however what is new is the anticipation of unemployment as an expected part of work life and the rise in the numbers of people from all employment sectors that will experience unemployment. The shift in the availability of work or lack of work has many important consequences for governments, employment insurance programs, labour organizations and for workers. For example, many workers have not previously approached employment with the view of considering and anticipating the need to plan for intermittent or prolonged periods of work disruption. In turn, more peoplewill likely use or rely on unemployment types of benefits during their working years. On the more positive side, workers today can also expect to experience

Objective: This article presents a review of the current literature on knowledge transfer in the use of technology, amongst children and adolescents. Participants: Researchers, teachers, children, adolescents, and related stakeholders are the targeted users of this paper. Methods: A scoping review and detailed analysis of the review based on ergonomic outcomes of comfort, safety and productivity. Results: The review revealed very few studies addressing the knowledge use and transfer with children or adolescents in this topic area. Current literature on knowledge transfer requires more rigorous evaluation, as well as use of explicit health, occupational and ergonomic outcomes. Conclusions: This paper concludes the need for a call for future research in the area of knowledge transfer to promote healthy and safe use of technology, in the population of children and adolescents.

Objectives: The purpose of this articleis to share the details, outcomes and deliverables from an international workshop on work transitions in London, Ontario, Canada. Participants: Researchers, graduate students, and community group members met to identity ways to advance the knowledge base of strategies to enhance work participation for those in the most disadvantaged groups within society. Methods: A participatory approach was used in this workshop with presentations by researchers and graduate students. This approach included dialogue and discussion with community members. In addition, small group dialogue and debate, world cafe discussions, written summaries of group discussion and reflection boards were used to bring new ideas to the discussion and to build upon what we know. Findings: Two research imperatives and six research recommendations were identified to advance global dialogue on work transitions and to advance the knowledge base. Occupational justice can be used to support future research directions in the study of work transitions. Conclusions: Moving forward requires a commitment of community of researchers, clinicians and stakeholders to address work disparities and implement solutions to promote participation in work.

OBJECTIVE This feature article on knowledge transfer presents principles and strategies to support the development of short communiques to end-users. PARTICIPANTS Formal and informal knowledge brokers are the targeted users of the strategies. METHODS Research studies and conceptual literature in knowledge transfer informed the development of brief-Knowledge Transfer (b-KT) principles. Principles are explained and a sample of how they informed the development of KIT-Tip Sheets is offered to promote ways to use principles in knowledge dissemination. RESULTS b-KT principles can be used as a framework to guide the development of short communiques by knowledge brokers in work practice but also in the health, social and rehabilitation domains. In addition, these principles promote the participation of end-users in the development of knowledge transfer. CONCLUSIONS Formal evaluation is needed on the use of these principles in achieving the uptake and use of knowledge by end-users.

When selected, accepted and used appropriately, low vision assistive technology devices (ATDs) have the potential to facilitate the performance of occupations that lead to posi tive outcomes. Objective: This paper identifies some low vision ATDs currently used and explores their relative importance for the performance of daily occupation from participants' perspectives. Participants: 17 adults (M = 56 years old, SD = 15.8) with low vision we0re recruited through a purposeful sampling strategy. Methods: Through one-on-one semi-structured telephone interviews, ATD usage data, ranking of perceived importance of ATDs and verbal data were collected from the participants. Results: A total of 124 devices were identified by the participants of w hich 104 (83.9%) were used and 20 (16.1%), mostly adaptive computer technologies, were not. 22 (21%) mainstream aids to daily living were identified (large monitor, larg e screen TV, DVD player) and they ranked high in terms of perceived importance by the participants for daily activities. Verbal fe edback from participants supplemented this finding. Conclusion: Concepts related to usage and ranking of importance of ATDs for daily occupations are multi-faceted and complex (e.g. combination of devices used, multiple equal rankings, etc.). The authors suggested future research opportuniti es to examine these concepts through qualitative means.

Background: There is a need for tools by which to evaluate the beliefs, behaviors, and attitudes that underlie interprofessional socialization and collaborative practice in health care settings. Method: This paper introduces the Interprofessional Socialization and Valuing Scale (ISVS), a 24-item self-report measure based on concepts in the interprofessional literature concerning shifts in beliefs, behaviors, and attitudes that underlie interprofessional socialization. The ISVS was designed to measure the degree to which transformative learning takes place, as evidenced by changed assumptions and worldviews, enhanced knowledge and skills concerning interprofessional collaborative teamwork, and shifts in values and identities. The scales of the ISVS were determined using principal components analysis. Results: The principal components analysis revealed three scales accounting for approximately 49% of the variance in responses: (a) Self-Perceived Ability to Work with Others, (b) Value in Working with Others, and (c) Comfort in Working with Others. These empirically derived scales showed good fit with the conceptual basis of the measure. Conclusion: The ISVS provides insight into the abilities, values, and beliefs underlying socio-cultural aspects of collaborative and authentic interprofessional care in the workplace, and can be used to evaluate the impact of interprofessional education efforts, in house team training, and workshops.

Objectives: A historical review of the editorial board and the founding editor of WORK: A Journal of Prevention, Assessment and Rehabilitation was conducted to examine the understanding of the editorship and contributions of this team to the knowledge in WORK. Participants: The team of four authors worked together to identify an approach to evaluate the contributions and impact of WORK's editorial board (EB) on the journal's scholarship. The editor-in-chief (EIC) and editorial board members were participants in this evaluation. Methods: Informative and formative evaluations were used to investigate how knowledge was shaped through the development of an epistemic community of scholars in the field of work. Metrics of the EB composition and participation in the journal as well as surveys and interviews with the board and the editor-in-chief were analyzed. Results: The EB represents an international community of scholars with a common interest in work and who contribute academically both within WORK and beyond. The epistemic community that has evolved through the editorial board represents a pluralistic perspective on work that is needed to inform practice, and knowledge. Conclusion: Future directions to continue to advance knowledge through WORK's editorial board and EIC are elaborated.

Background: Historically the supports available to help injured workers transition back to pre-injury jobs focused primarily on the medical treatment of the injury and modifications in the workplace. However, for many injured workers, with chronic disabilities, the need for support extends to learning to live with newly exposed disabilities, managing changes within family and social life as well as meeting new expectations in claims and health management. Supports that many injured workers require to resume employment are not adequately addressed. Objective: A critical social perspective was used to engage a partnership with injured worker group members in the design, implementation and evaluation of injured worker needs to promote social change. This paper reflects a program of research established in partnership with the Canadian Injured Worker Alliance to develop and examine a conceptual framework of supports for use in meeting the transitional needs of injured workers with chronic disabilities. Occupational and educational perspectives were used to develop a conceptual framework comprised of 8 dimensions of support. Method: A regional needs assessment using multi-methods, including surveys, interviews and focus groups, was conducted in British Columbia (BC). Priorities of three stakeholder groups were mapped to the 8 dimensions of support. This conceptual framework was also tested nationally to evaluate the distribution of supports that exist and identify further needs for support to help injured workers manage multiple transitions. Findings: Access to the range of supports that injured workers need in transitioning to and from work is inconsistent and inequitable across Canada. Conclusion: Collaborative approaches and a broader spectrum of resources and supports are needed to help injured workers and their families in resuming meaningful participation in daily, social and productive occupations. Language: en

Health and rehabilitation providers are adopting empowering approaches to increase consumer involvement in the service process. This practice trend has evolved in response to the emergence and adoption of consumer-driven models in health care. However, the processes of enabling opportunities for consumers to participate as partners in rehabilitation are difficult and complex. The purpose of this study was to develop a theoretical understanding of the strategies, actions, and interactions between consumers and providers that supported consumer involvement in vocational rehabilitation processes. Data from a grounded theory study involving in-depth interviews with a sample of seven consumers and seven providers were analyzed using the constant comparative approach and Glaser's analysis criteria. A conceptual model of how consumer participation is enacted emerged. Consumer and provider interactions focused on optimizing environments to support consumer partnering and self-direction through establishing shared expectations, advancing consumer potential in practice, and persistently pursuing goals in the community. Opportunities to enhance consumer participation in the social context, practice settings, and the community are elaborated.

The variations in return to work outcomes for ill or injured persons experiencing health leaves are complex. However, it is important to comprehend these variations in order to develop evidenced-based practice in work rehabilitation. Currently, a plethora of studies exist in the literature that have attempted to explain the variations in work outcomes. A 20-year review of the literature on work outcomes has revealed several limitations in using this knowledge in occupational therapy. The study of return to work outcomes is, for the most part, atheoretical and the knowledge base is fragmented and disorganized. In addition, the literature does not reflect a consistent understanding of the multidimensional nature of either work disability or the facilitators for return to work. In this paper, the Occupational Competence Model is presented as a framework for filling this gap. This model is used here to organize and synthesize the factors previously studied on work outcomes to foster an understanding of this literature from an occupational therapy perspective and the future study of work outcomes and work rehabilitation.

The purpose of this paper is to demonstrate and discuss how individuals' subjective perceptions of personal and environmental issues influence return to work behaviour.A qualitative design utilizing in-depth interviews and maximum variation sampling of 11 individuals who either returned to work or withdrew from work after a health leave was conducted. Experiences elicited were analysed using the constant comparative method followed by a member check with participants to confirm findings and interpretations.Findings underscored the importance of two key constructs in understanding return to work from the individual's perspective: the personal meaning of disability and return to work relevancy. Throughout the experience of getting better and returning to work participants reflected upon the impact of personal and external factors that contributed to their work disability, sought clarity of their performance capacities and examined the importance of work and the consequences of work disability within their life circumstances.Insights into an individual's perceptions of their impairment and the personal relevance of work can promote a better understanding of return to work behaviour. Integrating individual perceptions is essential to advancing a multidimensional approach in return to work research.

Background Despite widespread availability of assistive technology and the role of occupational therapists and audiologists in workplace health, little is known about how these groups influence the health of workers with hearing loss. Objective Based on a previously conducted study, this paper explores the need for networking and community of practice theory to promote knowledge sharing and use between occupational therapists, audiologists, educators, regulators, workers, and employers. Methods Five occupational therapists and five audiologists participated in in-depth interviews. Grounded theory was used to investigate the processes that hinder or support these professionals in addressing the accommodation needs of and workplace accessibility for workers with hearing loss. Results Constraints to addressing the needs of workers with hearing loss included: lack of knowledge about professional practice processes, lack of networking, lack of knowledge on current research, and lack of knowledge on the realm of expertise of audiologists by occupational therapists and of occupational therapists by audiologists. Conclusions Innovations in workplace practice in hearing loss require engagement of occupational therapists, audiologists, and employers in knowledge transfer, networking, and learning. This column introduces two theories that may guide the use and development of evidence, knowledge, and expertise toward innovations in hearing work practice.

This special issue was envisioned to provide international perspectives on research and viewpoints on work rehabilitation relevant to the work participation of persons with hearing loss. Papers in this special issue engaged the voices of persons with hearing loss who are active in creating awareness about the work potential of persons with hearing loss as well as advocating for systemic change, use of technology and the reduction of hearing stigma (Kooser from the US, Hannan from Canada, and Nealon from Australia). Consistent with WORK’s aim to support scholarship of graduate students we invited graduate students to submit papers and have a systematic review by Gussenhoven et al. that includes students and researchers from the Netherlands. Three research papers (Jennings, et al., Stam et al., Cheesman et al.) explore hearing and work in this issue. We (the three guest editors) drew on the current knowledge from the articles in this special issue to develop a ‘Pay it Forward’ knowledge transfer document on Tips for Work Rehabilitation Professionals and service providers in enabling hearing solutions at work. This issue begins with two Sounding Board articles. Nealon shares viewpoints relevant to hearing, rehabilitation and policy from Australia. Kooser calls for a renewed focus on comprehensive approaches to address

L. Shawa, M.B. Jenningsb and S.E. Kramerc,d School of Occupational Therapy, Faculty of Health Sciences, The University of Western Ontario, London, ON, Canada National Centre of Audiology, Faculty of Health Sciences, Western University, London, ON, Canada VU University Medical Center, Department of ENT/Audiology, Amsterdam, the Netherlands EMGO+ Institute for Health and Care Research, Amsterdam, the Netherlands

Objectives The aim of this review was to understand and synthesize the realm of knowledge on intermittent work capacity (IWC) about strategies to support work sustainability. Specifically, this review focused on literature that examined productive work with individuals who have chronic pain due to Fibromyalgia, Breast Cancer, Multiple Sclerosis, and Human Immunodeficiency Virus. Methods A scoping review of research conducted across 10 databases. Nature of the knowledge base on return to work barriers and strategies and future recommended strategies needed to support persons with IWC in maintaining work participation were charted and thematically analyzed and organized into micro, meso and macro categories. Results Majority of the knowledge base reflects factors impeding and facilitating employment or re-employment at the micro level. At the micro level, self advocacy was a strategy that persons with IWC used to maintain employment and navigate stigmatizing work environments to meet their needs. At the meso level education and knowledge sharing with employers to increase awareness was underscored; at the macro level introduction of new policies was recommended. Conclusions These findings suggest the need for future greater examination of the dialectical relationships across micro, meso and macro level strategies to overcome work disparities for persons with IWC.

Objective This review sought to synthesize existing evidence on work capacity assessments and to identify the knowledge supporting their use in return to work practice and future research. Methods A scoping review was conducted identifying studies examining assessments used in return to work. Studies published before 1986 and studies not written in English were excluded. A five point relevancy criteria was used to establish the fit of articles with the research question. Articles were thematically analyzed into components of the PEO Model, proposed future research, and areas of vested interest. Results Forty four articles met the criteria for inclusion. For over twenty five years, work capacity assessment literature has remained focused on the individual's physical work performance capacities. Gaps were identified in the lack of qualitative research and incorporation of person, occupation, and environmental dimensions in evaluation of work capacity. Future research recommendations emphasize the need for knowledge generation on work modification and investigation of psychosocial factors that impact work capacity and return to work yet only minimal progression is evident in these areas in the literature reviewed. Conclusion The limited consideration of the occupation and environmental dimensions in returning to work and the global interest in work capacity assessment highlight the need for the development of contextually based assessment tools. Assessment needs to move toward the incorporation of environmental and occupational aspects in addition to the person dimension in a culturally transcendent manner.

This special issue has two exciting sections. The first has an international focus on advancing knowledge and research on work transitions into the 21 century. The second is a special issue on European Perspectives on work-related education practice and research. The first section of the journal issue is dedicated to the documentation of the outcomes from an international workshop held on work transitions in the summer of 2009 that was titled Work Transitions in the 21 Century: Advancing Occupational Justice. Four research papers and a summary article on the workshop are included.

Objective: Currently no standard or universal outcome measure for return to work (RTW) programs exists making the evaluation and comparison of such programs difficult. RTW outcomes are often measured using nominal scales based on administrative data but these fail to take the perspectives of workers and other stakeholders into consideration. In order to gain that perspective this study was conducted to identify what outcomes are of interest and importance to RTW stakeholders. RTW stakeholders identified indicators of successful RTW in order to develop a conceptual framework of successful RTW. Participants: A total of 24 RTW stakeholders participated, representing both RTW consumers and providers from Southwestern Ontario. Method: This study used a mixed-method integrated form of concept mapping, which qualitatively generates and interprets data, and quantitatively analyzes data using multidimensional scaling and hierarchical cluster analysis. Results: Participants generated 48 statements, which were subsequently clustered into the following six concepts; worker perfor- mance, worker job satisfaction, human rights, worker well-being, seamless RTW process through collaborative communication, and satisfaction of stakeholders other than workers. Conclusions: The results reflect the perspectives of stakeholders and suggest that RTW outcome measures are needed that not only evaluate all aspects of the worker's life, but the RTW process as well. Aside from confirming the inadequacy of nominal, administrative type outcomes, these findings imply that the actual RTW process is intimately tied to outcome. Implications and relevance are discussed for planning RTW programs and towards developing a RTW outcome tool.

UNLABELLED The literature relevant to the treatment of Whiplash-Associated Disorders (WAD) is extensive and heterogeneous. METHODS A Participatory Action Research (PAR) approach was used to engage a chiropractic community of practice and stakeholders in a systematic review to address a general question: 'Does chiropractic management of WAD clients have an effect on improving health status?' A systematic review of the empirical studies relevant to WAD interventions was conducted followed by a review of the evidence. RESULTS The initial search identified 1,155 articles. Ninety-two of the articles were retrieved, and 27 articles consistent with specific criteria of WAD intervention were analyzed in-depth. The best evidence supporting the chiropractic management of clients with WAD is reported. Further review identified ways to overcome gaps needed to inform clinical practice and culminated in the development of a proposed care model: the WAD-Plus Model. CONCLUSIONS There is a baseline of evidence that suggests chiropractic care improves cervical range of motion (cROM) and pain in the management of WAD. However, the level of this evidence relevant to clinical practice remains low or draws on clinical consensus at this time. The WAD-Plus Model has implications for use by chiropractors and interdisciplinary professionals in the assessment and management of acute, subacute and chronic pain due to WAD. Furthermore, the WAD-Plus Model can be used in the future study of interventions and outcomes to advance evidence-based care in the management of WAD.

Introduction Ergonomic interventions designed for office and computer work have become widely available and heavily marketed but there is little evidence to support their use with workers who already have a musculoskeletal disorder (MSD). The purpose of any ergonomic intervention can be to improve worker comfort, safety and/or productivity. The ergonomic research in secondary prevention typically focuses outcomes on improved worker comfort but less if any emphasis has been put on productivity and safety. The purpose of this study was to determine the level and quality of evidence supporting ergonomic interventions to improve the comfort, safety and/or productivity of office workers with symptoms of MSDs. Method A search of the ergonomic intervention literature based on MSDs of four body areas (low back, upper limb, eye and neck) was employed. The studies underwent two levels of analysis for inclusion in a best-evidence synthesis approach, which included a priori evaluation of specific interventions relative to outcomes of comfort, safety and/or productivity. Results Twenty-seven out of 202 articles were synthesized based on relevance, quality and significant results. Only 8 articles were determined high quality and no strong levels of evidence were identified. Levels of evidence for specific ergonomic interventions ranged from insufficient to moderate. Generally outcomes were focused mostly on improved comfort of workers. Conclusions There is still limited quality research that addresses ergonomic interventions designed for secondary prevention. Further high quality studies are needed to support evidence-based ergonomic interventions in practice. For all stakeholders to fully evaluate the usefulness of the ergonomic intervention studies need to attend to outcomes not only of worker comfort but also to productivity and safety.

Objective: Chronic pain such as arthritis has a significant impact on occupational performance in the workplace that contributes to decreased productivity, reduced rates of employment, personal and societal economic costs. In commemoration of the 20th anniversary of WORK, a scoping review was conducted to understand the knowledge base on chronic pain. The purpose of this was to examine and describe WORK's contribution to the literature relevant for rehabilitation professionals such as occupational therapists to improve work related outcomes for persons experiencing chronic pain. Method: The method employed the use of historical, citation and dimension analyses of assessment and intervention articles. Results: Of the 30 articles identified in WORK, the historical analysis of their scope indicated an international representation of authors and a greater emphasis on quantitative study designs. The citation analysis revealed that the articles in WORK drew heavily on medical literature to inform their studies. The dimensional analysis of the assessment and intervention articles applied an occupational lens of self-care, productivity and leisure, to draw upon the Occupational Competence Model and identified that the majority of papers focused on 2 or more dimensions of the person, environment and occupation. Conclusions: WORK has contributed to the knowledge base of assessment and intervention approaches that inform work rehabilitation strategies for individuals with chronic pain. To advance its knowledge base for the rehabilitation and management of chronic pain, WORK is encouraged to include more prevention and multidimensional interventions articles, as well as articles that contain multidimensional assessment tools that address both clinical and outcome assessments of chronic pain. Additionally internal dialogue should be encouraged within WORK so that new authors build on previous submissions and increase the impact and quality of research on chronic pain as it pertains to work.

Introduction: The aim of this review was to gain an understanding of the first 20 years of contributions to WORK within the assessment domain and to reflect on the perspectives underscoring this knowledge base. Method: A narrative review of assessment articles using the WORK ARTicle database was conducted. Assessment articles were searched using issues from 1990 to 2009. Descriptive data was analyzed to examine historical trends of the specific types and dimensions of articles, the regional location of the contributions, and the methodological accordance. A reflective process was used by an editorial board member of WORK to inductively interpret perspectives and contextual issues that underpinned the evolution of the assessment domain in WORK. Results: Over half of N = 108 of the articles on assessment in WORK focused on establishing or reporting reliability and validity of assessments used in clinical practice or evaluation research. The majority of the assessment articles were predominantly focused on the person. Contributions of articles were from 5 regions: North America, Europe, Australia, Asia and Africa. Conclusions: Assessment articles in WORK have contributed to the development of evidence to support assessment of the worker. These articles represent a knowledge base that emphasizes evidence-based assessments to evaluate what a person can and cannot do to participate in work. Efforts are needed to expand knowledge generation in assessment to include more evaluations on the workplace and occupation dimensions, and that also considers the worker in context.

OBJECTIVE: Previous research has provided an inconsistent message as to the effectiveness of multidisciplinary programs to improve employment outcomes in clients with Chronic Low Back Pain (CLBP). The primary aims of this review were to: 1) update the evidence for the multidisciplinary treatment of CLBP to improve employment outcomes 2) assess what knowledge supports occupational therapy as contributing to a multidisciplinary approach in the treatment of CLBP. PARTICIPANTS: Working-age adults experiencing CLBP who took part in controlled trials evaluating multidisciplinary programs between July 1998 and July 2009. METHODS: Updated guidelines provided by the Cochrane Collaboration Back Review Group (BRG) were used to perform a systematic review to identify, appraise, and synthesize research evidence relevant to our research questions. RESULTS: Twelve unique articles were found, after a database search and citation tracking, only two of which were high quality. Our findings suggest that there is still conflicting evidence for the effectiveness of multidisciplinary programs to improve employment outcomes in CLBP. CONCLUSIONS: The results are discussed with reference to current methodological limitations found in the literature. Furthermore, occupational therapists were found to be underutilized in the included studies and future multidisciplinary programs should take advantage of the wide range of skills that occupational therapists can contribute in this practice area.

For older workers with acquired hearing loss, this loss as well as the changing nature of work and the workforce, may lead to difficulties and disadvantages in obtaining and maintaining employment. Currently there are very few instruments that can assist workplaces, employers and workers to prepare for older workers with hearing loss or with the evaluation of auditory perception demands of work, especially those relevant to communication, and safety sensitive workplaces that require high levels of communication. This paper introduces key theoretical considerations that informed the development of a new framework, The Audiologic Ergonomic (AE) Framework to guide audiologists, work rehabilitation professionals and workers in developing tools to support the identification and evaluation of auditory perception demands in the workplace, the challenges to communication and the subsequent productivity and safety in the performance of work duties by older workers with hearing loss. The theoretical concepts underpinning this framework are discussed along with next steps in developing tools such as the Canadian Hearing Demands Tool (C-HearD Tool) in advancing approaches to evaluate auditory perception and communication demands in the workplace.

OBJECTIVE: The aim of this study is to understand the barriers and facilitators in brokering knowledge brokering knowledge to help injured workers make informed decisions about recovery and to support their transitions to return to work (RTW). PARTICIPANTS: Perceptions of 63 Injured Worker Groups (IWGs) and 43 Health Care Professionals (HCPs) in facilitating and brokering knowledge were examined. METHODS: Critical theory and participatory action research approaches informed the development of a multi-stakeholder research team and the study design to support an exploration into knowledge exchange and transfer. Data was analyzed using a critical occupational perspective to reveal the source of barriers and to identify the facilitators of the knowledge exchange and transfer process. RESULTS: Barriers in transferring knowledge included system barriers, a lack of information accessibility, and problems with variations in injured worker capacity and experience using information. IWG and HCP participants lacked expertise in knowledge transfer. Findings also revealed the interactive knowledge transfer processes that IWGs and HCPs use to help injured workers understand and use information. CONCLUSIONS: Change is required to improve knowledge exchange and transfer of information for and to persons with injuries and disabilities. Suggested changes include the development of a sustainable knowledge transfer community of practice, a best practice guide for knowledge brokers such as IWGs and HCPs, and a process for ongoing assessment and evaluation of injured worker information needs and preferences.

Purpose: This study aimed to gain knowledge about environmental factors (EFs) that impact work and social life participation of people with multiple sclerosis (MS) in Austria and Switzerland to extend the knowledge of participation and to identify key areas for measuring participation. Method: A three-round Delphi study was conducted defining patients as experts. In the 1st round, qualitative data was gathered through questionnaires, analyzed with content analysis, and factors were assigned to EFs as classified in the ICF. In the 2nd and 3rd round, experts judged EFs according to its relevance to obtain consensus (cut-off 75%). Categories were ranked on a scale from mostly important to important. Results: One hundred and twelve Austrian and 109 Swiss experts were recruited. The content analysis revealed 768 EFs. The study resulted in a list of 176 consensus factors for Austria and 177 Switzerland. Five categories revealed to be highly important, 12 moderately important, 6 fairly important, and 10 important. Conclusions: This study indicates that participation in work or social life is influenced by physical, social, attitudinal, and policy factors. Consensus factors afford insights into areas for consideration in the development of participation outcome measurements and support a comprehensive and inclusive rehabilitation approach.

BACKGROUND: The aim of this case study was to explore transitions of an injured worker suffering from multiple chemical sensitivity (MCS), and his lived experiences in learning to function in everyday life with this injury. To date, little research exists about the transitions of a worker to an injured worker beyond the focus of strategies in returning to work and rehabilitation. METHODS: The injured worker's perspective was captured through the use of metaphors in understanding the transition processes of participating in daily life without work. Metaphors were used to facilitate this injured worker's expression of deep thoughts and feelings, and to allow for different and abstract ways of thinking about disability and illness. FINDINGS: Metaphors were identified within several transitions involved in the process of going from a worker to an injured worker functioning in daily life. CONCLUSIONS: The findings from this case study can be shared with others as a means of increasing the awareness of the experiences in managing daily life when living with MCS. In addition, insights from this injured worker's case could act as a venue for distributing knowledge about chemical injuries to health care professionals to broaden their views of this injury and its treatment.

Demographic and legislative trends suggest that many older workers may remain at work past the traditional retirement age. This extended work trajectory poses new challenges and opportunities for workers with acquired hearing loss as they age. Workplaces require a new approach to enable transitions of older workers with hearing loss to remain safe and productive. A review of the literature on older workers, those with hearing loss, and strategies used to accommodate them suggests that individualized and piecemeal approaches are predominant. While universal design represents a fresh ideology that may help create more accessible and usable products and environments, its application to improve workplaces for older workers with hearing loss is limited. This paper proposes that occupational science be integrated with knowledge in hearing sciences, accessibility, and usability to assist with the transitions faced by older workers with hearing loss. A more comprehensive approach including the following three key components will be posited to examine the nexus of aging, hearing loss and work: (1) the use of an occupational perspective, along with concepts in hearing sciences to examine hearing demands and improve hearing access; (2) the use of contextual processes to promote physical and social change, and (3) the inclusion of Universal Design for Hearing (UDH) considerations as stakeholders develop more hearing friendly workplaces.

Employment is a right of citizenship and a social determinant of health, but employment rates remain low for persons with disabilities. The purpose of this paper is to examine the principles and practices guiding work integration within the fields of intellectual disability (ID), brain injury, and mental illness and to identify best practices to support transitions to employment across these three groups. This integrative review drew upon an occupational perspective to analyze the current literature. Findings reveal that the need and benefits of working are recognized across disability groups but that philosophical perspectives guiding work integration differ. In the area of mental illness, recovery is seen as a process within which work plays an important role, in ID work is viewed as a planned outcome that is part of the developmental process, and in the field of brain injury, outcomes of employability and employment are emphasized. A common theme across the three disability groups is that in order to facilitate work integration, the person, the job and the work environment are important factors in need of examination. Evidence pointing to the effectiveness of the supported employment model is increasing across these three populations. A framework for guiding the development of further research and for promoting changes to support work integration is presented.

Welcome to the first columnon KnowledgeTransfer: Making Information Work! My name is Lynn Shaw, I am an occupational scientist, researcher, an associate professor in the School of Occupational Therapy at the University of Western Ontario, and I am an editorial board member of WORK. I have developed a passion for KT through my research in chronic pain and work injuries, my involvement in leading and partnering in KT initiatives in occupational therapy as an educational influential occupational therapist in a work practice network in Ontario and in other professions such as chiropractic and audiology. This column is designed to provide readers with knowledge (evidence, theory and practical knowledge) for use in enhancing knowledge brokering and networking in work related practice, in education, in research, in the community and in the workplace. For this column, a broad definition of knowledge transfer is adopted, knowledge transfer includes the exchanging and sharing of research, policy and procedural knowledge between and among a realm of knowledge producers, knowledge brokers and end users [1,2]. For instance, people from all sectors and institutions are key stakeholders in knowledge exchange andmay include but not limited to the following researchers, health professionals, career counsellors, ergonomic specialists, vocational providers, human resource specialists, workplaces, educators, employers, workers, persons with work injuries, family members, students, insurers, health and safety professionals and regulators etc. The types of knowledge transferred and exchanged in work practice can include, research, procedural information, workplace safety information, health information, career information or other information that has the main aim of enabling workers, and their families, students, health and vocational professionals, workplace parties, educators or recruiters, and trainers to consider the relevance and value of new information to make informative decisions. Use of knowledge can where the word that was facilitate adaptation, accommodation, work style redesign, positive change in behaviours or procedures or policies to prevent injuries, promote health and productivity at work and by workplaces, and assist others to advance vocational pursuits or careers. Mediums for knowledge exchange and transfer are also broadly considered in this column and will include dialogic, group or collective approaches and interactions, as well as use of network approaches, the internet, written text, social media, artistic, photo novella or symbolic expressions, etc. This column will also promote the use of theory to inform different strategies and approaches for effective KT that are sensitive to one-on-one, group or organizational specific needs and preferences. Given that the readers of this journal are international, this column is also designed to advance knowledge transfer that underscores cultural ways of knowing and disseminating informationwithin different contexts relevant to work around the world.