A Review of Self-Management Support for (Work-Related) Musculoskeletal Pain Disorders

Fig. 22.1

A theoretically informed plan to introduce SMS into vocational rehabilitation for those with chronic compensated musculoskeletal disorders

The next step would be for the VR to assess the motivation for self-management. The PSOCQ (Kerns et al., 1997) or the MPRCQ2 (Nielson et al., 2008), both based on the TTM of behaviour change, could be used by the VR practitioner to periodically assess the readiness to accept responsibility for injury management. Those identified with score profiles indicative of very little or no perceived responsibility for self-management, and who are at the precontemplation stage for self-management, are unlikely to be open (as yet) to the principles of SMS. This group of individuals is likely to need more time to get their symptoms/health under control before undertaking such an intervention. A ‘stepped-care approach’ should be offered to this group that firstly addresses potential barriers through VR and/or treats underlying psychosocial issues (see Fig. 22.1). The ultimate aim of Step 1 is to enable the worker with a MSD to reach the contemplation stage, as per the MRPSM model (Jensen et al., 2003). The ideal time to introduce SM education is once individuals have formed the ‘good intention’ to RTW (i.e. those who have reached the contemplation stage and are ready to consider accepting responsibility for the management of their condition). By targeting only those people with chronic MSDs with higher levels of perceived responsibility for the management of their condition and pain control, and who are at the stage of contemplating self-management, the authors hypothesise that improvements in SM programme attendance, completion (as has been found by Tkachuk et al., 2012) and subsequent functional outcomes would be achieved. In order to further maximise the SMS engagement by these individuals, the specific characteristics of the SMS programme itself should be considered carefully. The programme should also be available in a mode of delivery that is convenient for the majority of the target population (Damush et al., 2002; Swerissen et al., 2006). Preliminary focus groups (see Fig. 22.1) with the target population would allow a well-informed decision to be made as to the ideal mode of delivery (e.g. multimodal, web-based interactive). However, it should be one that involves at least some exposure to group sessions, as evidence suggests that this is the most effective mode of delivery in terms of outcomes for those with chronic conditions. Providing content that is currently unavailable in generic SMS programmes (e.g. managing RTW and navigating the workers’ compensation system) and relevant problem-solving skills would also improve the ‘action self-efficacy’ for the injured worker around these specific issues. Notwithstanding VR provider and compensation barriers, should the plan be introduced for workers with a chronic compensated MSD, the authors hypothesise that the addition of SMS to VR will contribute to improving the rate and sustainability of RTW.

Concluding Remarks

Given the evidence of the substantial influence of individuals’ beliefs about their own abilities to effect behavioural change with regard to chronic condition management and also the influence of self-perceptions of health status on work disability, it is not surprising that self-management is on the agenda as part of the future for health reform in developed nations. SMS aims to empower patients to develop skills and techniques to enhance self-care and management of their chronic conditions. There is growing concern that the evidence base to support vocational rehabilitation interventions is still weak. We know that people with compensated conditions have slower recoveries than people with similar conditions who are not receiving compensation and that people in compensation systems feel disempowered. Theoretically, self-management should assist. We are currently on the cusp of determining whether this sort of approach is viable and effective with this particularly complex group. We have learned that there are many barriers—some that can potentially be overcome and others that we need to be aware of and work with. There are also still other questions. One is WHEN is the best time to introduce SMS? Is it best to introduce to those who are currently working with a MSD (prevention of disability/maintenance approach; e.g. Shaw et al., 2012), or is it post-onset for those who have been identified as having chronic MSDs and, if so, when during their injury recovery process? We also need to consider the potential modifying effects of patient group characteristics on RTW outcomes, from the individual level up to the societal level. Indeed, the literature has reported influences at the individual level (such as worker characteristics, characteristics of the condition, exposure to medical treatments and/or occupational rehabilitation programmes, level of education and health literacy, duration of job tenure, age), as well as at the job level (i.e. various work characteristics), organisational level (i.e. employer characteristics) and society level (Krause, Frank, Dasinger, Sullivan, & Sinclair, 2001). These cannot just be ignored. The other major consideration is that SMS needs an infrastructure; it needs to be tied to a system already in operation. Is SMS best offered within primary care, occupational rehabilitation or the workplace? The engagement of, and endorsement by, compensation systems, insurance providers, rehabilitation and healthcare professionals or workplaces will require more information on benefits in terms of client outcomes and cost-effectiveness.

Appendix: Literature Review Methodology

The form of the review on self-management interventions for chronic conditions and musculoskeletal disorders (MSDs) within this chapter is narrative. Individual qualitative and quantitative research studies as well as systematic reviews and other reviews of relevance were considered. Four major databases (Ovid Medline, AMED, PsycINFO, Cochrane) were searched for relevant peer-reviewed literature published in the last 10 years. Publications prior to this period were included in the review if the work was considered seminal in terms of its contribution to the self-management knowledge base within the context of interest. The following terms were used as keywords and linked using Boolean operators: self-care, self-management, chronic disease, chronic illness, patient education as topic, patient-centred care, health behaviour, low back pain and musculoskeletal disorders. As the focus of the review was on persons of working age, the limits applied included English language and adults aged 15–64 years. Relevant grey literature and references from key authors in the field were also consulted. We did not formally assess the methodological quality of included studies. The identified peer-reviewed studies were then examined for intervention components that are tightly conceptually linked with self-management and the involvement of chronic conditions, especially MSDs, and excluded otherwise.

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