Article

PURPOSE: To document in workers having a work disability due to a musculoskeletal
disorder (MSD), the presence and variation over time of their intolerance of
uncertainty and its maintenance factors as defined in Dugas et al.'s generalized
anxiety disorder (GAD) model, i.e. worries, negative problem orientation, beliefs
about the usefulness of worrying, cognitive avoidance and their consequences on
depressive symptoms. METHODS: An observational, prospective repeated-measures
design was retained. Thirty-nine workers with an MSD having caused a work absence
of over three months and who were beginning a work rehabilitation program were
recruited and evaluated at four moments (beginning of rehabilitation program,
first hours of work exposure, 50% of regular working hours and end of
rehabilitation program). Validated self-report questionnaires measuring
intolerance of uncertainty and its maintenance factors were administered.
Finally, the Worry and Anxiety Questionnaire measured the presence and intensity
of GAD symptoms as defined in the DSM-IV-TR. RESULTS: Fifty percent of the
workers initially exhibited GAD symptoms. Concerning the variation over time,
improvements were noted in all GAD-related factors during the program,
particularly with the first hours of work exposure. At the end of rehabilitation,
only 21% of the participants still met GAD diagnostic criteria. CONCLUSION:
Workers with an MSD causing a work disability averaging one year in length and
enrolled in a work rehabilitation program exhibited a high level of anxiety at
the beginning of the work rehabilitation program. Workers perceived a usefulness
in worrying and presented some intolerance of uncertainty and some cognitive
avoidance strategies. According to Dugas et al.'s GAD model, the intensity of the
symptoms associated with GAD development and maintenance factors was, however,
not typical of a GAD. IMPLICATION FOR REHABILITATION: A reconceptualization of
the problem in terms of reducing the work disability rather than reducing pain
may constitute a promising avenue to reduce anxiety symptoms. Future studies
should look at the specific impact of work exposure, not only on pain symptoms
but also on worries. The high level of anxiety and the reported worries by
workers stresses the importance of studying the hypothesis of a workplace phobia
in order to improve clinical practice guidelines.

Langue : ANGLAIS