The physiotherapist's role in the management of stress-related work absence in vocational rehabilitation

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Introduction

Explain purpose of wiki, (final year students, background and context, justify relevance)

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Learning Outcomes

Aims

The aims of this wiki are:

1)To present a learning resource for Scottish final year physiotherapy students and newly qualified graduates which aims to develop their evidence-informed knowledge and understanding of vocational rehabilitation.

2)To present a learning resource for Scottish final year physiotherapy students and newly qualified graduates which aims to develop evidence-informed knowledge and understanding of vocational rehabilitation for stress-related work absence and promote in-depth exploration of the physiotherapist’s role in this area.

Learning Outcomes

Through completion of this wiki you will be able to:

1)Synthesise the main principles of vocational rehabilitation and critically analyse its role in achieving an optimum vocational outcome.

2)Explain the impact of stress and stress-related work absence on the individual.

3)Critically evaluate the role of the physiotherapist in the management of stress-related sickness absence/work loss in stress and how this relates to vocational rehabilitation settings.

4)Critically reflect on the challenges facing the physiotherapist in vocational rehabilitation.

Stress

Definition

There are numerous definitions of stress but no generally established scientific definition, (Waddell & Burton 2006). However, the Health and Safety Executive (2012) define stress as the negative response an individual exhibits when excessive pressure or demands are placed on them. 

Prevalence

Among the leading contributors to disease and disability burden globally are mental health problems making 10.5% of the worldwide disease burden. In the United Kingdom, mental health problems are the single largest source of disability accounting for 23% of total disease burden, (Kings Fund 2012).

About 1/4 of the general population will experience some kind of mental health problem in the course of a year. That is 1 in 4 British adults experiencing at least one mental disorder in any one year with women more likely to be treated than, 29% compared with 17%.
Common mental health problems peak in mid age with 20-25% of people in the age group 45-54 years having a neurotic disorder and then falling as people age with only 9.4% of people aged 70-74 years having a neurotic disorder compared with 16.4% of the general population.

About a third of the working population will have some mental symptoms at any one time in their lives that is 1 in 3 British adults in the working age population will experiencing some kind of mental health problem. Of this 1 in 6 in the working age population will experience depression, anxiety or problems related to stress.

In 2013 the Labour Force Survey found that 131 million days were lost due to absence either as a result of sickness or injury. Mental health problems such as stress/anxiety/depression, musculoskeletal disorders and minor illnesses contributed to this number with 15 million, 31 million and 27 million, respectively.

According to the CIPD’s 2015 annual absent report:
- The main causes of short term absence (≥ 4 weeks) were minor illness, musculoskeletal disorders and stress. With musculoskeletal           disorders more prevalent in manual workers and stress more prevalent in non-manual works.
- The main causes of long term absence (≤ 4 weeks) were acute medical conditions, stress, mental ill health and musculoskeletal disorders.
- The median annual absence cost per employee across all organizations was £554. This cost varied in the different individual organizations,    ranging from between £400 - £914, and with the highest costs being in the public services.

According to the Labour Force Survey in 2013/14:
- The total number of cases of work-related stress, depression or anxiety was 487 000 cases (39%) out of a total of 1 241 000 cases for all     work-related illnesses
- There was an estimated prevalence of 221 000 male and 266 000 female cases of work-related stress and an estimated incidence of 115     000 male and 128 000 female cases
- The total number of working days lost due to work-related stress, depression or anxiety was 11.3 million, an average of 23 days per case     of stress, depression or anxiety
- Of the 11.3 million lost days, male workers accounted for approximately 5.4 million of those days while female worker accounted for             approximately 5.9 million days
- The age 45-54 years had the highest incidence rate for all genders

Summary of findings from both mental health and stress statistics:
- Age group most affected is 45-54
- Gender most affected is women.
- Prevalence of stress higher in non-manual workers

Although not a medical condition in itself, stress that is left unmanaged has been associated with stress-related mental and physical health problems such as anxiety, depression, cardiovascular disease and musculoskeletal pain, (CIPD 2011).

Impact

Although there is a collective opinion that mental health problems are caused by work the relationship between the two is complex. While there is strong evidence that work is good for both mental and physical health, there is also evidence that mental well-being can be adversely affected by work.

Work-related stress may occur when individuals are faced with work demands or pressures they cannot cope with or have very little control over. The Health and Safety Executive defines stress as the negative response an individual exhibits when excessive pressure or demands are placed on them. Job stress is one of the top 10 work-related health problems and has increasingly been associated with the occurrence of mental health problems, cardiovascular disease and musculoskeletal disorder, (Waddell and Burton 2006; Habibi, Dehghan and Hassanzadeh 2014).

It is believed that the pathogenesis of physical disease is influenced by stress. Stress results in the production of adverse affective states which have a direct impact on the biological processes and behavioural patterns that predispose an individual to the risk of disease.

Stress can elicit the same responses that the body would produce if it were under physical danger. The body goes into ‘flight or fight’ mode triggering stress hormones adrenaline, noradrenaline and cortisol which in turn cause accelerated breathing, increased heartrate and dilation of blood vessels leading to increased blood pressure. In small amounts these responses are not harmful however when exposed to them for prolonged periods degenerative changes can occur within the body. Prolonged exposure to increased heart rate, blood pressure and stress hormones consequently lead to hypertension, arrhythmias, myocardinal infarctions, or stroke, (Torpy et al 2007). Furthermore, adrenaline can cause muscles to automatically contract and tense up in a biological response to stress as a means to protect the body from further harm. Prolonged exposure to muscle tension and muscle overuse causes the muscles to fatigue, tighten or degenerate consequently increasing the risks of developing musculoskeletal disorders, (Lundberg 2002).

Stress can cause psychological changes that result in numerous adverse effects on an individual such as reduced competency, diminished initiative, reduced thought flexibility, loss of accountability and reduced concern for both work colleagues and the organization as a whole. Additionally stress alters an individual’s physical state. The changes that occur in muscular structures can cause pain and discomfort resulting in an individual finding it difficult to sit at an office desk the whole day or concentrate on work tasks due to lack of comfortability. If stress is not managed immediately the physical and psychological effects of it that consequently lead to mental and physical changes can stop an individual from working at optimum capacity, (Ongori and Agolla 2008).

The conservation of an individual’s physical and mental health depends on their ability to adequately satisfy the demands they are confronted with. The greater an individual’s ability and control are over the exposed demands the more effective the response produced will be. Conversely, when an individual is exposed to demands found to predominate their current knowledge and abilities they exhibit reduced capacity to work and perform their job adequately causing them to produce responses that are not effective, (Negeliskii and Lautert 2011).

A major contributor to an organizations profit and its existence is the amount of productivity delivered by employees. It is well established that excessive stress is detrimental to both an individual’s mental and physical well-being as well as productivity. With knowledge of this it can be recognised that stress is therefore a serious concern for organizations. Mental and physical changes can significantly influence an individual’s ability to work effectively which as a consequence can lead to increased absentee rates, increased turnover, sickness absence and work-related accidents. All of which negatively impact on an organization by decreasing its probability of success in competitive markets through reductions in overall productivity and service quality as well as increased expenditure on recruitment and selection costs as a result of turnover effects, (Ongori and Agolla 2008; Ekundayo 2014). Additionally, these factors cost the national economy an astounding amount of money annually through sickness absence which results in sick pay, staff turnover and lost productivity. Furthermore, social welfare systems endure the costs of medical care and potential compensations in salary, (Park 2007; Hauke et al 2011).

Vocational Rehabilitation

The government policy ‘What Works, For Whom and When’ (2008) describes vocational rehabilitation as helping people with health problems stay at, return to and remain in work and this is unanimously the widespread definition. The Vocational Rehabilitation Association (2013) describes vocational rehab as any process which supports people with functional, physical, psychological, developmental, cognitive or emotional impairments to overcome obstacles to accessing, maintaining, or returning to work or another useful occupation. Vocational rehabilitation can be described as an idea or an approach, as much as it can an intervention (Connolly, 2011).

An effective vocational rehabilitation service should adopt a multi disciplinary approach, involving both healthcare professionals and employers. Vocational rehabilitation can also be practiced in a variety of settings. Primary healthcare settings can have a positive effect on occupational outcomes, either helping people with mild to moderate conditions return to work promptly or continue to offer treatment, education and help devise a return to work plan for a person who requires further assistance. Workplace interventions can also be highly beneficial. Many organisations have developed sickness absence and disability management programmes which efficiently cuts costs and enables return to work or the possibility of adapted working. More structured vocational rehabilitation programmes can also be followed for those with more severe cases. Vocational rehabilitation programmes can help to improve work outcomes for those in the early stages of claiming incapacity benefits. Incapacity benefit comes after a period of statutory sick pay and generally does not start until week 29 of sickness absence. However, many people are not employed at the time they start receiving benefits and they can often be faced with many barriers when trying to return to work. A person is likely to remain on benefits long term once they have been claiming for 1-2 years, meaning it is vital for vocational rehabilitation to play a part early on (Waddell et al 2008).

For many people these days, work is their key determinant of self worth, family income and esteem, as well as identity within the community and social fulfilment (Black 2008). Carol Black’s ‘Working for a healthier tomorrow’ review looking at the health of our working population suggests that the average UK employee is absent from work due to sickness for six days each year. Although these figures vary between workplaces, it is thought that these absences equate to an annual cost of around £598 per employer. Therefore, the estimated cost to the UK economy as a result of employee absence is around £100 billion annually- which is greater than the NHS annual budget (NICE 2009).

Healthcare understandably plays a vital role in Vocational rehabilitation, but ultimately, it is not effective without working closely alongside employers (Waddell et al 2008). There is strong supporting evidence that a proactive workplace approach to sickness and modified working is not only most effective but is also an effective cost saving method for the company, especially in larger enterprises.

Employers can have a key role in facilitating an employee’s early return to work following a sickness absence by having early, regular and sensitive contact during their leave, although around 40% or organisations have no sick leave management policy at all (Black 2008). This report also discusses the stigmas associated with absence from work due to disability and ill health, and states how this can also be a contributing factor in delaying a persons return to work. This is especially apparent in employees suffering from mental health conditions as organisations often fail to recognise their capabilities. There is significant evidence to suggest that the longer a person is absent from work due to ill health, the harder it is for them to make an effective return.

Although employment rates for those suffering from a disability or long term health condition are increasing, with employment rates in Britain being high when compared to most countries, 7% of the working population are still seeking incapacity benefits, while another 3% are off work sick at one given time (Black 2008).

Physiotherapists Role in Vocational Rehabilitation

Which settings are they involved in

What conditions/problems do they help deal with What interventions do they use to help these problems

Look specifically into stress management

Link into PT and stress: managment and return to work

Physiotherapists play an important role in rehabilitation. As reported by the Chartered Society of Physiotherapist (CSP 2015) physiotherapists aim to get patients back to their best possible level of function and well being. Physiotherapist’s main goals for patients is to get them back to their regular lifestyle which may include activities in the home, activities for leisure or work. This expands beyond patients that suffer from MSK (musculoskeletal) conditions and it is shown that physiotherapists are increasingly aiding in the recovery of patients who suffer from mental health conditions. (www.sept.nhs.uk) A physiotherapist role in the recovery and rehabilitation of patients suffering from a mental illness merge the treatment of psychological and physical conditions into one. As WHO (The World Health organization) defines health as ‘Physical, mental, and social well-being, not merely the absence of disease and infirmity’. Thus highlighting the importance of a combined treatment approach within Physiotherapy.

Challenges to Vocational Rehabilitation

- barriors

- communication

- teamwork

early intervention

gap between reserch and practice- we can all add to

managment oposition

lack of resources, policy support, networks like other organisations

work hand in hand with employers and pts

Internal barriors

Managers beliefs

Barriors to returning to work in stress

Specific to PT_________________________________________________________

- barriors to PT in stress; pts communication style changing when stressed

Physiotherapist Role in Managing stress through VR

- Consolodate all evidence

 

== With this wiki the aim is to look more in depth at the treatment and intervention provided by physiotherapists to manage stress, primarily in patients who are out of work due to a multitude of ailments whether that be physical, mental or psychosocial.
What is stress in the work place?
MedNet.com (2015) defines stress as a physical, mental or external factor that causes physical or physiological strain on the individual. Another definition, looking more specifically at work stress, states that it is a hostile reaction individuals have to too much pressure or strain on them in the work place. As stress is becoming a worldwide issue it is important to acknowledging the effects of stress on individuals in and out of the workplace. It is suggested that a considerable percentage of people out of work will develop a mental disorder due to the stress of unemployment, likewise, patients can equally develop a mental disorder and be subject to mental distress within the workplace. (Audhoe. 2009) this it is important as developing physiotherapists that we are aware of the effect Benefits of exercise for the treatment of stress within the work place.
There is significant evidence to show the benefits of exercise in general and there has been recent increases in the application of prescribed exercise. A systematic review (Lawlor 2001) highlights the benefits of exercise on improving the symptoms of those suffering from depression such as self-worth, self-image and self-efficacy. With the increase of prescribed exercise there is also an increased awareness of stress affecting employees in the work place (B, Long 2007). therefore there is an emphasis on creating effective work based exercise programmes aimed at helping people suffering from stress manage their symptoms more effectively.

Physiotherapist’s management of stress.
With stress management there are key stages that implemented to ensure effective treatment. The initial stage should be highly focused on the education of the individual ( Meichenbaum 1985) it is suggested that a heavily structured programme is created and agreed on between employer and employee.
There is limited evidence to suggest a precise physiotherapy management for patients suffering from stress. (Waddel, 2008) this can be contributed to the increase in stress cases yet the still unclarified definition of stress and its manifestations. However there is still great evidence to support the need for an MDT approach when implementing vocational rehabilitation, especially within the work place and out in the community. ( C. Gobelet et al 2009)

==

Conclusion

- - Linking diagram; consolodating eveything

References

References will automatically be added here, see adding references tutorial.