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Public >> Systematic Reviews \ Meta-Analysis

A critical review of gender issues in understanding prolonged disability related to musculoskeletal pain: how are they relevant to rehabilitation?
Author(s): Cote,D.; Coutu,M. F.
Journal: Disability and rehabilitation
Publication Year: 2010 Volume: 32 Issue: 2 Pages: 87-102
PMID: 21495273
PURPOSE: The purpose of this critical review is to describe the available theoretical models for understanding the gender issues in prolonged work disability related to persistent musculoskeletal (MSK) pain. METHOD: A critical literature review was conducted in medicine, health sciences, and social sciences databases (MEDLINE, CINHAL, PsychINFO and SOCINDEX) using specific keywords. After screening titles and abstracts, followed by methodological quality assessment, a total of 55 references were retained for content analysis. RESULTS: Gender issues in disability related to persistent MSK pain show that men and women may experience pain and rehabilitation process in different ways. Three main themes were exftracted and further described: (1) the experience of distrust; (2) the self-identity process; and (3) the domestic strain. Each of these themes has a specific and potentially different impact on men and women, and we report that experiential differences may strongly impact the rehabilitation process and outcomes such as return to work. CONCLUSIONS: This critical review provides insight into gender issues in the process of rehabilitation and outcomes such as return to work. We suggest that work and family considerations are the two most important issues in the rehabilitation process and that differences between men and women are likely to occur.
Public Key Messages
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Scientific Key Messages
  • The experience of distrust was an important gender issue in prolonged work disability related to musculoskeletal pain. Self-identity was also an important issue, associated with social roles, functions and culturally defined expectations. Domestic strain was observed to be a significant, and possibly determinant, issue influencing the rehabilitation process. Distrust, self-identity, and domestic strain are important considerations for return to work and should be assessed in the context of gender.
  • Gender role identification and expectation, and the level to which these are anchored in the representation of self or its reconstruction, may strongly impact the rehabilitation process and outcomes, such as return to work.
  • In considering return to work, a broader range of personal experiences must be considered along with work status and work conditions to enable us to gain a more complete understanding of the factors that impact the rehabilitation process.
Scientific Rating:
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Research Strengths
    Although gender is a common factor investigated in studies associated with return to work, this study provides a summary of different factors typically associated with gender (sociocultural/psychosocial factors) that may play a role in successful return to work. Researchers conducted a broad search strategy and good quality assessment matrix.
Research Weakness
    It would be helpful if the researchers clearly defined the level of evidence supporting claims made. The synthesis does not appear to incorporate quality weighting.
    These results are exploratory. Gender roles and identification may have an impact on successful return to work and maybe relevant to explore in future research. Women may be more at risk of catastrophizing than men.
Employer Characteristics:
    Not Available
Applicability to Small Employer:
    Possibly applicable
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