Showing papers in "Journal of Occupational Rehabilitation in 2006"
TL;DR: There is a great need for additional high quality trials before any conclusions on effectiveness of bio-behavioural interventions for reduction of neck and upper limb problems and return to work after these symptoms can be made.
Abstract: Work related neck and upper limb symptoms have a multi-factorial origin Possible risk factors are of a physical, psychosocial or personal origin These factors can reinforce each other and their influence can also be mediated by cultural or societal factors Initially, most research on neck and upper limb symptoms focused on work-related physical exposure Nowadays, psychosocial work characteristics are recognized as important risk factors Various models have been developed to offer frameworks for possible pathways, but their empirical support is still not conclusive In part I of this paper an overview is presented of the results of recent epidemiological studies on work related psychosocial and personal risk factors for neck and upper limb symptoms In addition, the interplay between these factors and the possible intermediate role of an individuals work style in this process is explored In contrast to previous reviews, it is now possible to base the conclusions on the effect of work related psychosocial factors on neck and upper limb symptoms on quite a few longitudinal studies These studies show that high work demands or little control at work are often related to these symptoms However, this relationship is neither very strong nor very specific Perceived stress is studied in not as many studies but more consistently related to neck and upper limb symptoms This also applies to general distress or other pain (co-morbidity) Job dissatisfaction does not contribute to neck and upper limb symptoms Too little research on personal characteristics is available to draw any conclusions It is plausible that behavioural aspects, such as work style, are of importance in the etiology of work related upper limb symptoms However, studies concerning these factors are promising but too scarce to draw conclusions Future studies should address these behavioural aspects In part II, the recent studies on the effectiveness of preventive measures for work related neck and upper limb problems are discussed Few randomised or non randomised controlled trials have been carried out to evaluate the effectiveness of individual or organisational interventions to improve work related psychosocial factors Very few have reported on the preventive effect for work related neck and upper limb symptoms Therefore, there is a great need for additional high quality trials before any conclusions on effectiveness of bio-behavioural interventions for reduction of neck and upper limb problems and return to work after these symptoms can be made From the low back pain intervention research can be learned that interventions should best be targeted to both the worker and the organisation and that interventions will only be successful when all stakeholders are involved
483 citations
TL;DR: Few high quality studies were found that examined the effects of interventions in the office on musculoskeletal or visual health and a mixed level of evidence was observed for the general question.
Abstract: Background: The literature examining the effects of workstation, eyewear and behavioral interventions on musculoskeletal and visual symptoms among computer users is large and heterogeneous. Methods: A systematic review of the literature used a best evidence synthesis approach to address the general question “Do office interventions among computer users have an effect on musculoskeletal or visual health?” This was followed by an evaluation of specific interventions. Results: The initial search identified 7313 articles which were reduced to 31 studies based on content and quality. Overall, a mixed level of evidence was observed for the general question. Moderate evidence was observed for: (1) no effect of workstation adjustment, (2) no effect of rest breaks and exercise and (3) positive effect of alternative pointing devices. For all other interventions mixed or insufficient evidence of effect was observed. Conclusion: Few high quality studies were found that examined the effects of interventions in the office on musculoskeletal or visual health.
236 citations
TL;DR: The epidemiological evidence examining associations between upper extremity musculoskeletal symptoms and disorders and keyboard use intensity and computer user posture was explored and it appears that the most consistent finding was the association observed between hours keying and hand/arm outcomes.
Abstract: Background: In this review, the epidemiological evidence examining associations between upper extremity musculoskeletal symptoms and disorders and keyboard use intensity (hours of computer use-per day or per-week) and computer user posture was explored. Methods: An OVID Medline® literature search was conducted to identify papers published in the peer-reviewed medical literature between 1966 and November, 2005. A total of 558 citations were found and reviewed. Those papers in which associations between musculoskeletal outcomes and (1) posture (ascertained by a study investigator) or (2) computer use, in units of hours-per-day, hours-per-week, or as a percent of work-time, were included in the review. Results: Thirty-nine epidemiological studies examining associations between computer use and MSD outcomes were identified. While the observational epidemiological literature was heterogeneous, some trends did emerge. It appears that the most consistent finding was the association observed between hours keying and hand/arm outcomes. Associations between some postural effects and musculoskeletal outcomes may also be inferred from the literature. In particular, placing the keyboard below the elbow, limiting head rotation, and resting the arms appears to result in reduced risk of neck/shoulder outcomes. Minimizing ulnar deviation and keyboard thickness appears to result in reduced risk of hand/arm outcomes. Conclusions: Several methodological limitations, including non-representative samples, imprecise or biased measures of exposure and health outcome, incomplete control of confounding, and reversal of cause and effect, may contribute to the heterogeneity of observed results. Suggestions are made for improving the validity of future investigations.
189 citations
TL;DR: No core set of predictors exists for sickness absence in general and further research and use of acore set of measurements and uniform definitions are needed to predict sickness absence and return to work in patients with CLBP.
Abstract: Objectives: To provide evidence of predictors for sickness absence in patients with non-specific chronic low back pain (CLBP), distinguishing predictors aimed at the decision to report sick (absence threshold) and decision to return to work (return to work threshold). Methods: Medical and psychological databases were searched, as well as citations from relevant reviews. In- and exclusion criteria were applied. Two reviewers assessed the methodological quality of the papers independently. Results: Many different predictors were studied, and few factors were studied more than once. Consistent evidence was found for own expectations of recovery only as predictor for the decision to return to work. Patients with higher expectations had less sickness absence at the moment of follow-up measurement. As expected, different predictors were found aiming at the absence threshold or the return to work threshold. Furthermore, predictors varied also with the measurement instruments used, timing of follow-up measurements, and definition of outcomes. Until now, too few studies are available to overcome several potential sources of heterogeneity. Conclusions: No core set of predictors exists for sickness absence in general. The characteristics of the study including the decision to report sick or to return to work determined the influence of several predictors on sickness absence in patients with CLBP. Further research and use of a core set of measurements and uniform definitions are needed to predict sickness absence and return to work in patients with CLBP.
144 citations
TL;DR: There is strong evidence that extracorporeal shock-wave therapy is not effective, moderate evidence that exercise combined with manual therapy is more effective than exercise alone, that ultrasound is noteffective, and that open and arthroscopic acromioplasty are equally effective on the long term.
Abstract: The goal of this systematic review is to evaluate the effectiveness of different treatments for impingement syndrome and rotator cuff tear on the improvement in functional limitations and concomitant duration of sick leave. A systematic search for clinical trials or controlled studies was conducted with the following text words: should*, rotator cuff, impingement, work, sick leave, disabilit*, function*. Nineteen articles were included in this review. For functional limitations, there is strong evidence that extracorporeal shock-wave therapy is not effective, moderate evidence that exercise combined with manual therapy is more effective than exercise alone, that ultrasound is not effective, and that open and arthroscopic acromioplasty are equally effective on the long term. For all other interventions there is only limited evidence. We found many studies using range of motion and pain as outcome measures but functional limitations were less often used as an outcome measure in this type of research. Duration of sick leave was seldom included as an outcome measure.
119 citations
TL;DR: Gaps between the epidemiological and intervention research of back disability prevention could be reduced by testing mediators of intervention effects or by stratifying outcomes according to pre-intervention risk factors.
Abstract: Objective: To assess, from the review literature, the extent to which effective strategies for reducing work absence after acute low back pain (LBP) match empirical risk factors. Methods: From 17 recent review articles (2000–2005), disability risk factors and interventions were cross-tabulated to assess levels of relative concordance. Results: Potentially modifiable risk factors included 23 variables describing 3 workplace and 3 personal domains. Effective interventions included 25 strategies that were personal (physical or behavioral), engineering, or administrative in nature. There was a strong risk factor concordance for workplace technical and organizational interventions, graded activity exposure, and cognitive restructuring of pain beliefs. There was less risk factor concordance for exercise, back education, and RTW coordination. Few interventions focused on relieving emotional distress or improving job dissatisfaction, two well-supported risk factors. Discussion: Gaps between the epidemiological and intervention research of back disability prevention could be reduced by testing mediators of intervention effects or by stratifying outcomes according to pre-intervention risk factors.
113 citations
TL;DR: Investigation of the association of a broad set of prognostic indicators related to characteristics of worker, job, low back pain and psychosocial issues on return to work lasting at least 4 weeks and minimally 1 day of first return toWork (first-RTW) found factors concerning the expectations and beliefs of the worker affected the RTW process.
Abstract: Background: Successful management of workers on sick leave due to low back pain depends on the identification by the occupational physician of modifiable prognostic factors in the early phase of sick-leave. The prognostic value of factors which influence the course of low back pain and return to work in occupational health care is unclear. Methods: Secondary data analysis in a cohort of 299 workers on sick leave between 3 and 6 weeks due to low back pain was applied. We investigated the association of a broad set of prognostic indicators related to characteristics of worker, job, low back pain and psychosocial issues on return to work lasting at least 4 weeks (lasting-RTW) and minimally 1 day of first return to work (first-RTW). Relationships were studied using Cox regression analysis and covered a follow-up period of 12 months. The explained variation of the models was also calculated. Results: The median time to return to work using lasting-RTW and first-RTW was 76 and 71 days respectively. In addition to individual analysis of potential predictive factors a backward selection procedure resulted in the following multivariable model: self-predicted timing of return to work, pain intensity, job satisfaction, social support, pain radiation, expectations of treatment succes of the occupational physician. Similar results were found for first-RTW. The explained variance of the multivariate model of lasting-RTW was 18%. Conclusions: Factors concerning the expectations and beliefs of the worker affected the RTW process. Knowledge of these factors by the occupational physician in the early phase of low back pain and sick-leave may contribute to solutions to promote return to work.
112 citations
TL;DR: The workplace intervention results in a safe and faster RTW than usual care at reasonable costs for workers on sick-leave for two to six weeks due to LBP.
Abstract: Objective: To evaluate the cost-effectiveness and cost-utility of a return to work (RTW) program for workers on sick-leave due to low back pain (LBP), comparing a workplace intervention implemented between 2 to 8 weeks of sick-leave with usual care, and a clinical intervention after 8 weeks of sick-leave with usual care Design: Economic evaluation alongside a randomised controlled trial (RCT) Study population: Workers sick-listed for a period of 2 to 6 weeks due to LBP Interventions: 1 workplace assessment, work modifications and case management) 2 physiotherapy based on operant behavioural principles 3 usual care: provided by an occupational physician Outcomes: The primary outcome was return to work (RTW) Other outcomes were pain intensity, functional status, quality of life and general health The economic evaluation was conducted from a societal perspective Outcomes were assessed at baseline (after 2–6 weeks on sick-leave), and 12 weeks, 26 weeks, and 52 weeks after the first day of sick-leave Results: The workplace intervention group returned to work 300 days (95% CI=[31, 513]) earlier on average than the usual care group at slightly higher direct costs (ratio of 1 day: €19) Workers in the clinical intervention group that had received usual care in the first 8 weeks returned to work 213 days (95% CI= [−741, 292]) later on average The group that had received the workplace intervention in the first 8 weeks and the clinical intervention after 8 weeks returned to work 509 days (95% CI=[−894, −27]) later on average A workplace intervention was more effective than usual care in RTW at slightly higher costs and was equally effective as usual care at equal costs on other outcomes A clinical intervention was less effective than usual care and associated with higher costs Conclusion: The workplace intervention results in a safe and faster RTW than usual care at reasonable costs for workers on sick-leave for two to six weeks due to LBP
110 citations
TL;DR: Results support the further use of the PDQ as a standard treatment outcomes measure in this area of musculoskeletal disorders and demonstrate the ability of this simple and psychometrically-sound disability rating scale for systematic functional assessment in predicting treatment outcomes in patients with CDOMD.
Abstract: Objective: The Pain Disability Questionnaire (PDQ) is a new functional assessment instrument designed for evaluating chronic disabling musculoskeletal disorders. It is useful for assessing function/disability as affected by pain. This is the first study to assess the predictive validity of the PDQ in its relationship to 1-year post-treatment work- and health-related outcomes in a chronic disabling occupational musculoskeletal disorder (CDOMD) population. Design: A prospective cohort of CDOMD patients (n=150) completed a prescribed functional restoration rehabilitation program, with PDQ and other psychosocial measures evaluated before and immediately after treatment. A structured telephonic interview for objective work- and health-related outcomes took place 1-year following treatment. Results: Lower rates of work retention were associated with more severe pre-treatment PDQ scores. Higher post-treatment PDQ were associated with decreased return-to-work rates, decreased work retention and a greater percentage seeking health care from a new provider. In addition, PDQ scores were also associated with psychosocial measures such as depression and perceived pain intensity, as well as alternative measures of disability. Conclusions: Results demonstrated the ability of this simple and psychometrically-sound disability rating scale for systematic functional assessment in predicting treatment outcomes in patients with CDOMD. Results support the further use of the PDQ as a standard treatment outcomes measure in this area of musculoskeletal disorders.
105 citations
TL;DR: The lack of communication and agreement by Dutch GPs and OPs in medical diagnosis and management of employees long-term sick listed due to mental health problems are indicators of sub—optimal medical treatment and return-to-work strategies.
Abstract: Objectives: To describe medical management by the general practitioner (GP) and occupational physician (OP) of workers sick listed due to mental health problems, and to determine agreement in diagnosis, main cause of sickness absence and obstacles in return to work. Methods: A cohort of 555 employees being sick listed for 12 to 20 weeks due to mental health problems was recruited and followed for 1 year. These employees were interviewed about their mental health and contacts with GP, OP, other specialists and employer. In addition, the GP and/or the OP of 72 employees were interviewed about the medical diagnosis and management. Results: Most employees sick listed for 12–20 weeks visited their GP and OP. According to the employees most interventions applied by the GP were medical interventions, such as referral of employees and prescription of medical drugs. Working conditions were seldom discussed by the GP and work-related interventions were never applied. Most interventions applied by the OP were work-related interventions and/or contact with the employer. The OP more often talked about working conditions and conflicts. According to the employees, the communication between GP and OP only took place in 8% of the cases. Agreement in the diagnosis, main cause of sickness absence, and obstacles in return to work reported by the GPs and OPs of the same employee was poor. In addition, similarity in reported diagnosis by GP and/or OP and the employees’ scores on valid questionnaires on (mental) health was limited. Conclusions: The lack of communication and agreement by Dutch GPs and OPs in medical diagnosis and management of employees long-term sick listed due to mental health problems are indicators of sub—optimal medical treatment and return-to-work strategies.
104 citations
TL;DR: Focusing on the first return to work is misleading for both injury groups, but even more so for CTD, as they appear to be even more susceptible to multiple spells of work absence.
Abstract: Background: Cumulative trauma disorders of the upper extremities (CTD) have become increasingly important in workers' compensation caseloads over the last two decades. Relative to occupational back pain, CTD have been much less studied. Methods: We analyzed post-injury employment patterns and return-to-work probabilities for a sample of Ontario workers with CTD, for up to five years after injury. Results for workers with CTD are compared to results for workers with back injuries or fractures. Results: Most workers with CTD return to work at least once, but a first return does not necessarily mark the end of work disability. Among workers absent at least once, 26% with CTD report a second injury-related absence, compared to 18% with back pain and 12% with fractures. After five years, focusing on first returns underestimates work-loss days associated with CTD by 32%. Conclusions: A substantial proportion of workers with CTD or work-related back pain experience injury-related absences after their first return to work. Focusing on the first return to work is misleading for both injury groups, but even more so for CTD, as they appear to be even more susceptible to multiple spells of work absence.
TL;DR: Offering traditional rehabilitation measures to a person with a negative prediction of his/her RTW, could be a waste of resources if done ahead of improving self-confidence and view of what is possible.
Abstract: Study Design: Prospective cohort study with 18-month follow-up. Objective: To investigate if long-term sick listed persons’ own predictions of their future return to work (RTW) have an impact on their RTW when controlling for other established factors. Method: Postal questionnaires at baseline were sent to persons who had been on sick leave for more than 90 days, and were employed in five municipalities and four county councils in Sweden. A follow-up regarding their RTW was performed 18 months later. Results: After 18 months 135 out of 508 persons (27%) had returned to work, full or part-time. In a multivariate logistic regression, the sick listed persons’ own prediction of their RTW proved to be highly significant (OR=8.28, 95% CI: 3.31–20.69). Only six out of 132 persons with a negative view of their RTW did return to wok. Other predictive factors that were found for RTW were: being on sick leave for a period of less than 1 year (OR=2.09, 95% CI: 1.19–3.67), having less pain than persons in the quartile with most pain (OR=2.65, 95% CI: 1.21–5.81), perceiving that one was welcome back to work (OR=1.98, 95% CI: 1.10–3.58), and being under 55 years of age (OR=2.37, 95% CI: 1.07–5.23 for age between 45 and 54 years and the same trend for age below 45 years OR=1.85, 95% CI: 0.82–4.20). Conclusion: Persons with a positive prediction should get help to realise their potential for RTW. Offering traditional rehabilitation measures to a person with a negative prediction of his/her RTW, could be a waste of resources if done ahead of improving self-confidence and view of what is possible. The problems in this group might decrease or be easier to handle if decisions about the future are taken within a year.
TL;DR: This pilot study demonstrated the feasibility of the approach used, however level of adherence to eduactional leaflet was not associated with an improvement in return to work in cancer survivors.
Abstract: Background: For employed cancer survivors, returning to work and maintaining employment is an important aspect of their quality of life. We developed an intervention aimed at enhancing this by means of (a) providing the patient with an educational leaflet on return to work and (b) enhancing communication between attending and occupational physicians. The purpose of this study is to test the feasibility of this intervention and to examine the relation of patient adherence to the advice of the leaflet and return to work. Methods: A patient series of 35 employed cancer survivors was used to evaluate the intervention. Survivors completed a baseline questionnaire prior to their treatment. Survivors and occupational physicians were interviewed by telephone eight weeks following all curative treatment. Our measure of feasibility included satisfaction of survivors with the intervention, adherence to the advice, time to return to work, satisfaction of occupational physicians with the intervention, and perceived influence on their rehabilitation efforts. Results: Interviews of 26 survivors and 24 occupational physicians, revealed that those groups perceived the leaflet as useful (i.e., 7 on a 0–10 scale. Also seven out of ten suggestions in the leaflet was adhered to and half of the occupational physicians perceived the guidance they provided was helpful. However there was no effect of level of adherence on actual return to work. Conclusion: This pilot study demonstrated the feasibility of the approach used. However level of adherence to eduactional leaflet was not associated with an improvement in return to work in cancer survivors.
TL;DR: In order to maximize return to work potential, the content, structure and duration of rehabilitation programs requires modification as a function of the injured workers level of the depression severity.
Abstract: Introduction: The present study examined the recovery trajectories of a group of mildly depressed and moderately-severely depressed injured workers enrolled in a 10-week community-based rehabilitation program. Methods: A sample of 168 individuals (75 women, 93 men) with a disabling musculoskeletal pain condition participated in the research. On the basis of BDI-II (1) scores at pre-treatment assessment, patients were classified as either mildly (BDI-II = 9‐16; N = 68) or moderately-severely depressed (BDI-II >16; N: 100). Results: Both groups showed significant reductions in depression, but individuals in the (initially) moderately-severely depressed group were more likely to score in the depressed range of the BDI-II at post-treatment than individuals who were initially mildly depressed. For the mildly depressed group, early treatment reductions in pain catastrophizing, and perceived disability predicted improvement in depression scores. For the moderately-severely depressed group, none of the early treatment changes predicted improvement in depression; only late treatment reductions in pain catastrophizing and fear of movement/re-injury predicted improvement in depression. Chi-square analysis revealed that patients who were no longer depressed at post-treatment had the highest probability of returning to work (91%), followed by (post-treatment) mildly depressed patients (60%), and finally (post-treatment) moderately-severely depressed patients (26%), χ 2 = 38.9, p < 0.001. Conclusion: In order to maximize return to work potential, the content, structure and duration of rehabilitation programs requires modification as a function of the injured workers level of the depression severity.
Journal Article•
TL;DR: For both men and women the likelihood to RTW increased with increasing number of opportunities to adjust, and the study indicates that work organisation is important for RTW.
Abstract: Return to work and adjustment latitude among employees on long-term sickness absence : Journal of Occupational Rehabilitation
TL;DR: There is a need for economic expertise in the multidisciplinary research teams evaluating workplace-based occupational health and safety interventions, and more than half of these studies considered only the consequences in monetary terms, rather than both the costs and consequences associated with the intervention.
Abstract: Background: We review economic analyses in studies of workplace-based occupational health and safety interventions in order to report on evidence of their financial merits and assess the quality of application of economic evaluation methodologies. The focus of the review is interventions applicable to an office setting. Materials and Methods: We draw on several systematic reviews to identify studies that consider both the costs and consequences of an intervention, or simply the consequences in monetary terms. Results: In total, we identified 23 studies which we included in our final synthesis. More than half of these studies considered only the consequences in monetary terms, rather than both the costs and consequences associated with the intervention. Conclusions: In reviewing the studies, we identified a number of methodological shortcomings which we discuss in detail. A key message from our review is that there is a need for economic expertise in the multidisciplinary research teams evaluating workplace-based occupational health and safety interventions.
TL;DR: In this article, the authors studied whether return to work after long-term sickness absence is affected by adjustment latitude i.e. opportunities to adjust one's work to one's state of health by e.g. choosing among work tasks and deciding about work pace and working hours.
Abstract: Introduction: The aim was to study whether return to work (RTW) after long-term sickness absence is affected by adjustment latitude i.e. opportunities to adjust one's work to one's state of health by e.g. choosing among work tasks and deciding about work pace and working hours. We also studied whether the effect of adjustment latitude differed between those returning full-time and those returning part-time. Methods: Differences between men and women were also studied. A questionnaire was sent to 5,590 salaried employees who had been on sick leave for at least 90 days in 2000. The year after, 2001, they received a questionnaire which included questions about work status, working conditions, adjustment latitude and health. Results: The questionnaire was returned from 3056 persons. Among women 32% were fully back to work, 34% were partly back and 34% were still on sick leave. Comparable figures for men were 33%, 32% and 36%. Conclusion: For both men and women the likelihood to RTW increased with increasing number of opportunities to adjust. Adjustment latitude increased returning to part-time as well as full-time work. The study indicates that work organisation is important for RTW.
TL;DR: CTS has both work-related and personal risk factors and the diagnosis is best established using a combination of history, symptom distribution and confirmation using the relative latency of median sensory testing using normative data.
Abstract: Objectives: Carpal tunnel syndrome (CTS) is common in the industrial setting but there are still some advocates who argue that CTS is not a work related problem. There are also controversies about the proper way to establish the diagnosis and whether screening for CTS in the industrial setting is warranted. Methods: A comprehensive literature review. Results: The literature does demonstrate that the prevalence of CTS in the industrial setting is significantly higher than in the general population. Numerous epidemiologic studies have identified independent risk factors, which include repetitiveness of work, forceful exertions, mechanical stress, posture, and vibration as well as several personal co-factors. The strength of these associations are discussed. The diagnostic criteria for establishing work-related CTS are discussed as well as the effectiveness of various screening methods that are commonly used in the workplace. The sensitivity and specificity of nerve conduction studies to establish or confirm the diagnosis of CTS is presented along with normative data for the industrial worker. Conclusions: CTS has both work-related and personal risk factors. The diagnosis is best established using a combination of history, symptom distribution and confirmation using the relative latency of median sensory testing using normative data. Screening for CTS in the industrial setting has questionable benefit.
TL;DR: The present results revealed that the psychometric properties of WSSCO were quite adequate and can provide a potentially useful tool for research on job stress in correctional officers.
Abstract: Introduction: This study aimed at examining the psychometric properties of Work Stress Scale for Correctional Officers (WSSCO). Methods: One hundred nineteen correctional officers (109 males and 10 females) employed in Turkey participated in this study. In addition to WSSCO, Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Beck Hopelessness Scale (BHS), and Multidimensional Scale of Perceived Social Support (MSPSS) were administered to the participants. Results: The internal consistencies and the item-total correlations were acceptable both for the whole scale and for its subscales; namely, “work overload,” “role conflict and role ambiguity,” “inadequacies in physical conditions of prison,” “threat perception,” and “general problems.” Test–retest reliability coefficient was 0.77 for total scale, and test-retest reliability coefficients ranged between 0.68 and 0.78 for the subscales. The total scale and most of the subscales were positively correlated with depression, anxiety, and hopelessness, and negatively correlated with perceived social support. Furthermore, all subscales significantly differentiated high depressive symptomatology group from the low depressive symptomatology group. Conclusions: The present results revealed that the psychometric properties of WSSCO were quite adequate. The scale can provide a potentially useful tool for research on job stress in correctional officers.
TL;DR: This study lends support to the HCP playing an active role early in the RTW process, one that includes direct contact with the workplace and proactive communication with the patient.
Abstract: Problem: One of the key players in the return-to-work (RTW) and work accommodation process is the healthcare provider (HCP). This study examines the association between RTW approximately one month post injury and early, proactive HCP communication with the patient and workplace. Methods: In this cross-sectional study 187 Ontario workers completed a telephone survey 17–43 days post injury. All had accepted or pending lost-time claims for back, neck or upper extremity occupational musculoskeletal injuries. Logistic regression was used to analyze the effects of three self-reported items “your HCP told you the date you could RTW,” “your HCP advised you on how to prevent re-injury or recurrence,” “your HCP made contact with your workplace” on self-reported RTW. Fourteen potential confounders were also tested in the model including sex, age, income, education, occupational classification, worksite size, co-morbidity, psycho-physical work demands, pain, job satisfaction, depression, and time from injury to interview. Results: The HCP giving a patient a RTW date (adjusted OR=3.33, 95% CI=1.62–6.87) and giving a patient guidance on how to prevent recurrence and re-injury (adjusted OR=2.71, 95% CI=1.24–5.95) were positively associated with an early RTW. Contact by the HCP with the workplace was associated with RTW, however, this association became weaker upon adjusting for confounding variables (crude OR=2.11, 95% C1=1.09–4.09; adjusted OR=1.72, 95% CI=0.83–3.58). Interpretation: Our study lends support to the HCP playing an active role early in the RTW process, one that includes direct contact with the workplace and proactive communication with the patient.
TL;DR: This study supported the neuromatrix theory of pain for patients with CLBP, as cognitive-evaluative factor contributed to pain perception, and cognitive- evaluative and sensory-discriminative factors uniquely contributed to an action program in response to chronic pain.
Abstract: Introduction: Quantitative sensory testing has demonstrated a promising link between experimentally determined pain sensitivity and clinical pain. However, previous studies of quantitative sensory testing have not routinely considered the important influence of psychological factors on clinical pain. This study investigated whether measures of thermal pain sensitivity (temporal summation, first pulse response, and tolerance) contributed to clinical pain reports for patients with chronic low back pain, after controlling for depression or fear-avoidance beliefs about work. Method: Consecutive patients (n=27) with chronic low back pain were recruited from an interdisciplinary pain rehabilitation program in Jacksonville, FL. Patients completed validated self-report questionnaires for depression, fear-avoidance beliefs, clinical pain intensity, and clinical pain related disability. Patients also underwent quantitative sensory testing from previously described protocols to determine thermal pain sensitivity (temporal summation, first pulse response, and tolerance). Hierarchical regression models investigated the contribution of depression and thermal pain sensitivity to clinical pain intensity, and fear-avoidance beliefs and thermal pain sensitivity to clinical pain related disability. Results: None of the measures of thermal pain sensitivity contributed to clinical pain intensity after controlling for depression. Temporal summation of evoked thermal pain significantly contributed to clinical pain disability after controlling for fear-avoidance beliefs about work. Conclusion: Measures of thermal pain sensitivity did not contribute to pain intensity, after controlling for depression. Fear-avoidance beliefs about work and temporal summation of evoked thermal pain significantly influenced pain related disability. These factors should be considered as potential outcome predictors for patients with work-related low back pain. Signifance: This study supported the neuromatrix theory of pain for patients with CLBP, as cognitive-evaluative factor contributed to pain perception, and cognitive-evaluative and sensory-discriminative factors uniquely contributed to an action program in response to chronic pain. Future research will determine if a predictive model consisting of fear-avoidance beliefs and temporal summation of evoked thermal pain has predictive validity for determining clinical outcome in rehabilitation or vocational settings.
TL;DR: The pattern of visits for WMSDs suggests that workers visit general practitioners as part of an ongoing pattern of symptoms, resulting in frequent utilization of health services prior to work disability that is also reflected in health care contacts after return-to-work.
Abstract: Introduction: The purpose of this study was to investigate if work-related musculoskeletal disorders (WMSDs) are associated with increased health care use, over and above workers’ compensation health care benefits, in the period prior to and following a workers’ compensation claim indicating gradual progression and declining function associated with musculoskeletal morbidity. Methods: This study employed secondary analysis of employment data, workers’ compensation claim data and provincial (universal) medical services data for a cohort of health care workers; and investigated rates of medical care contacts among injured workers with a WMSD claim (n=549) compared to a matched group of non-claim workers. Predictors of health care contacts were estimated using general linear regression. Results: WMSD injured workers had significantly higher rates of health care contacts associated with a claim compared to non-injured workers, over and above workers compensation health care benefits. In the final multi-variable model, a WMSD claim among injured workers was associated with an estimated 69% (95% CI, 1.50, 1.91) increase in health care use for the 12-month period immediately after the injury date compared to non injured workers. Conclusion: The pattern of visits for WMSDs suggests that workers visit general practitioners as part of an ongoing pattern of symptoms, resulting in frequent utilization of health services prior to work disability that is also reflected in health care contacts after return-to-work.
TL;DR: The TWR program appeared to improve injured workers’ motivation and employment readiness.
Abstract: Background: This is a clinical randomized trail (RCT) to investigate the effects of a three-week training program on work readiness designed for musculoskeletal injured workers with long-term sick leave who had difficulties resuming their work role. The program was planned to help injured workers overcome the psychological and psychosocial problems and to facilitate their Work Readiness on Return to Work (RTW) based on the Employment readiness model. Methodology: A total of 64 injured workers were recruited and randomly assigned into the training (T) and control (C) groups. Observations were blinded between service providers and evaluators. A three-week intensive training on work readiness program was given to the T group while subjects in the C group were given advice on job placement by social workers in a community work health center. The training program was comprised of individual vocational counseling and group therapy using cognitive behavioral approach to alleviate symptoms of stress, pain and anxiety. The Chinese Lam Assessment of Stages of Employment Readiness (C-LASER), the Chinese State Trait and Anxiety Inventory (C-STAI) and the Short form of Health Survey (SF-36) were used to evaluate all subjects’ psychological health status and behavioral changes on job readiness before and after the intervention. Results: Subjects in the T group showed significant improvement in their work readiness (p < 0.05), level of anxiety (p < 0.05) and their self perception of health status measured by SF-36 (p < 0.02) when compared with subjects in the C group. Control of chronic pain, negative motivation, and anxiety level were some of the key behavioral changes found from the study. Conclusion: The TWR program appeared to improve injured workers’ motivation and employment readiness. Further study on the employment outcomes of subjects is recommended.
TL;DR: Findings indicate that CBT has a useful role in the rehabilitation of people on worker's compensation who are seeking employment.
Abstract: Introduction: The aim of this study was to determine whether cognitive behavioural therapy (CBT) would enhance employment outcomes in worker's compensation clients who were seeking employment. Methods: Participants were randomly assigned to a standard job search assistance group that met for 4 hours/week for four weeks, or to a group that received standard job search assistance for 4 hours/week for the first two weeks and CBT for 4 hours/week for the next two weeks. Depression, Anxiety and Stress scores were measured prior to and on completion of the intervention, and employment outcomes were assessed at four- and ten-week follow-up. Results: Affective states decreased and employment was found more rapidly after CBT than after standard job search assistance. Conclusion: These findings indicate that CBT has a useful role in the rehabilitation of people on worker's compensation who are seeking employment.
TL;DR: It is suggested that a feedback device promotes the adoption of beneficial postures, which may be effective in preventing VDT-work-related neck and upper-limb disorders.
Abstract: Introduction: This study was designed to identify the effects of feedback from a proximity-sensing chair on head, shoulder, and trunk postures when working at a visual display terminal (VDT). Methods: Twenty healthy adults were asked to perform VDT work, and their forward head, forward shoulder, and trunk flexion angles were analyzed using a 3-D motion analysis system. The statistical significance of differences between without and with an auditory feedback device was tested by paired t-tests, with the significance cutoff set at α=0.05. Results: The forward head, forward shoulder, and trunk flexion angles significantly decreased during VDT work when using the proximity sensor with auditory feedback. Conclusion: We suggest that a feedback device promotes the adoption of beneficial postures, which may be effective in preventing VDT-work-related neck and upper-limb disorders.
TL;DR: Considerable opportunities exist to expand the range of integrative interventions, particularly at the organizational and system levels, and incorporate a combination of knowledge transfer and exchange with intervention evaluation.
Abstract: Background: When applied to workplace interventions, integrative may be seen in various ways, requiring elucidation. Methods: Identification of primary studies through systematic reviews, limited bibliographic literature searches, the Cochrane Occupational Health Field database on intervention studies, and authors’ files. Focus was 2000 on. Categorization according to the Cochrane classes and lenses on integrative. Synthesis as narrative review. Results: Examples of each lens on integrative were uncovered: biomechanical and psychosocial, multiple component, primary and secondary prevention, organizational, and system. Each contributed different understanding to the potential impacts on different knowledge, exposure, behavior, health and administrative outcomes. Conclusions: Considerable opportunities exist to expand the range of integrative interventions, particularly at the organizational and system levels, and incorporate a combination of knowledge transfer and exchange with intervention evaluation.
TL;DR: The results suggest that the occupational rehabilitation needs of people with MSD comorbid with depression or anxiety may currently be underestimated.
Abstract: Aim: Musculoskeletal disorders (MSD) are a leading cause of work-related disability. This investigation explored the impact of MSD comorbid with depression and anxiety disorders, on labor force activity. Methods: The Australian Bureau of Statistics provided confidentialized data files collected from a household sample of 37,580 people. MSD, affective, and anxiety disorders were identified and employment restrictions were assessed at four levels of severity. Results: Anxiety and depression of six months duration was present in 12.1% of people with MSD. Comorbidity magnified the negative impacts of single conditions on labor force activity. Most at risk were people with back problems and comorbid depression, people with arthritis or other MSD and comorbid anxiety, males with MSD and comorbid depression, and females with MSD and comorbid anxiety. Conclusions: The results suggest that the occupational rehabilitation needs of people with MSD comorbid with depression or anxiety may currently be underestimated.
TL;DR: A short-form FCE for determining future work status in claimants with low back disorders was developed and was found to predict comparably to the entire FCE protocol in two validation cohorts (R2 difference<3%).
Abstract: Objectives: Functional Capacity Evaluations (FCE) are used for making return-to-work decisions, yet FCE's modest predictive ability is currently outweighed by the administrative burden of testing. We attempted to develop a short-form FCE while maintaining comparable predictive ability. Methods: Three databases previously created for evaluating FCE predictive validity were used. Subjects were compensation claimants with low back disorders. FCE measures included items in the Isernhagen Work Systems’ FCE. Days until benefit suspension served as an indicator of return-to-work. Analysis included Cox regression. Results: Three items, floor-to-waist lift, crouching, and standing, were maintained in the short-form FCE. The short-form FCE was found to predict comparably to the entire FCE protocol in two validation cohorts (R
2 difference<3%). Subjects meeting job demands on all three items consistently experienced faster benefit suspension. Conclusion: A short-form FCE for determining future work status in claimants with low back disorders was developed. A substantially abbreviated FCE may offer an efficient alternative.
TL;DR: It can be concluded that the PILE and the WWS cannot be used interchangeably and psychosocial variables cannot explain the differences between both tests.
Abstract: The Progressive Isoinertial Lifting Evaluation (PILE) and the lifting test of the WorkWell Systems Functional Capacity Evaluation (WWS) are well known as lifting performance tests. The objective of this study was to study whether the PILE and the WWS can be used interchangeably in patients with Chronic Low Back Pain (CLBP) and to explore whether psychosocial variables can explain possible differences. Methods: 53 Patients (32 men and 21 women) with CLBP were tested twice in a counter balanced design. Pearson Correlation Coefficient of r > 0.75 and non-significant differences on two-tailed t tests were considered as good comparability. Results: Pearson Correlation Coefficient was 0.75 (p < 0.01). Lifting performance on the WWS was a mean of 6.0 kg higher compared to the PILE (p < 0.01). The difference between the PILE and the WWS was unrelated to psychological variables. Conclusion: It can be concluded that the PILE and the WWS cannot be used interchangeably. Psychosocial variables cannot explain the differences between both tests.
TL;DR: The Australian experience suggests that as a consequence of the combination of lesser industrial bargaining power, lower wages and differing forms of injury and disease women often receive less than men in compensation payments, struggle to obtain equity in the dispute resolution process and experience greater difficulties in returning to work following injury or disease.
Abstract: Introduction: Gender differences is a question of major importance within workers’ compensation given the increased role of women in the workforce over the past several decades. This article reviews literature relating to women's experiences following work injury. Methods: An Australian study is used as background to exploring the broad issue of the question of gender equity in workers’ compensation. In doing so it takes account of historical, legal and medical issues. Results: Women's experience in the workers’ compensation system is different to that of men due to a range of factors. It is heavily influenced by the industrial environment in which they work. Women are paid less than men in many instances and work in gender-segregated circumstances, which often reduces their industrial bargaining power. Women also suffer different forms of injury and disease to men because of the different nature of their work. Conclusion: The Australian experience suggests that as a consequence of the combination of lesser industrial bargaining power, lower wages and differing forms of injury and disease women often receive less than men in compensation payments, struggle to obtain equity in the dispute resolution process and experience greater difficulties in returning to work following injury or disease.