OBJECTIVE:To identify trajectories of productivity loss and examine the relationship between the trajectories and work disability outcomes.
METHODS:Latent class growth analysis of productivity loss ...was estimated for the ages of 25 to 44 years in the Panel Study of Income Dynamics (N = 4960). Differences among the trajectories for work disability outcomes for the ages of 25 to 64 years were estimated using logistic regression and analysis of variance.
RESULTS:A five-group trajectory model was identified with a no-risk, low-risk, high-risk, early-onset increasing risk, and late-onset increasing risk group. The likelihood of ever experiencing permanent disability or receiving Social Security Disability Insurance between the ages of 25 and 64 years differed across the trajectories with the early-onset and high-risk groups having the greatest likelihood and the no-risk trajectory having the lowest likelihood of work disability.
CONCLUSIONS:Productivity loss trajectories are highly related to work disability outcomes.
Literature review.
To review the literature about the performance of physicians as mediators of temporary and permanent disability for patients with chronic musculoskeletal complaints. To assess ...specifically the nature and variance of recommendations from physicians, factors influencing physician performance, and efforts to influence physician behavior in this area.
While caring for patients with musculoskeletal injuries, physicians are often asked to recommend appropriate levels of activity and work. These recommendations have significant consequences for patients' general health, employment, and financial well-being.
Medical literature search.
Physician recommendations limiting activity and work after injury are highly variable, often reflecting their own pain attitudes and beliefs. Patients' desires strongly predict disability recommendations (i.e., physicians often acquiesce to patients' requests). Other influences include jurisdiction, employer, insurer, and medical system factors. The most successful efforts to influence physician recommendations have used mass communication to influence public attitudes, while reinforcing the current standard of practice for physicians.
Physician recommendations for work and activity have important health and financial implications. Systemic, multidimensional approaches are necessary to improve performance.
Background
Low back pain (LBP) is a common and in some cases disabling condition. Until recently, workers presenting with non-specific LBP have generally been regarded as a homogeneous population. If ...this population is not homogeneous, different interventions might be appropriate for different subgroups. We hypothesized that (1) Clusters of individuals could be identified based on risk factors, (2) These clusters would predict duration and recurrences 6 months post-injury.
Methods
The study focuses on the 442 LBP claimants in the Readiness for Return-to-Work Cohort Study. Claimants (
n
= 259) who had already returned to work, approximately 1 month post-injury were categorized as the low risk group. A latent class analysis was performed on 183 workers absent from work, categorized as the high risk group. Groups were classified based on: pain, disability, fear avoidance beliefs, physical demands, people-oriented culture and disability management practice at the workplace, and depressive symptoms.
Results
Three classes were identified; (1) workers with ‘workplace issues’, (2) workers with a ‘no workplace issues, but back pain’, and (3) workers having ‘multiple issues’ (the most negative values on every scale, notably depressive symptoms). Classes 2 and 3 had a similar rate of return to work, both worse than the rate of class 1. Return-to-work status and recurrences at 6 months were similar in all 3 groups.
Conclusion
This study largely confirms that several subgroups could be identified based on previously defined risk factors as suggested by an earlier theoretical model by Shaw et al. (J Occup Rehab 16(4):591–605, 2006). Different groups of workers might be identified and might benefit from different interventions.
Background
Returning to work following a job-related injury or illness can be a complex process, influenced by a range of interrelated personal, psychosocial, and organizational components. System ...dynamics modelling (SDM) takes a sociotechnical systems perspective to view return-to-work (RTW) as a system made up of multiple feedback relationships between influential components.
Design and Methods
To build the RTW SDM, a mixed-method approach will be used. The first stage, that has already been completed, involved creating a baseline model using key informant interviews. Second, in two manufacturing companies, stakeholder-based models will be developed through interviews and focus groups with senior management, frontline workers, and frontline supervisors. Participants will be asked about the RTW process in general and more targeted questions regarding influential components. Participants will also be led through a reference mode exercise where they will be asked to estimate the direction, shape and magnitude of relationships between influential components. Data will be entered into the software program Vensim that provides a platform for visualizing system-structure and simulating the effects of adapting components. Finally, preliminary model validity testing will be conducted to provide insights on model generalizability and sensitivity.
Expected Impact of the study for Public Health
The proposed methodology will create a SDM of the RTW process using feedback relationships of influential components. It will also provide an important simulation tool to understand system behaviour that underlies complex RTW cases, and examine anticipated and unanticipated consequences of disability management policies.
▪ : The present study was designed to evaluate the relative degree and type of emotional distress in high‐risk acute low back pain (ALBP) subjects (defined as less than 3 months since initial ...injury) vs. high‐risk chronic low back pain (CLBP) subjects (defined as greater than 3 months since initial injury). It is an extension of earlier findings that demonstrated the significant role that such emotional distress may play in the development of CLBP disability if not appropriately treated in the acute phase. This work stems from a conceptual three‐stage model, which characterizes the progression from acute to chronic pain. Several psychosocial measures were administered that included information allowing for the classification of subjects as high‐risk based upon an earlier developed screening algorithm. The ancova procedure in SPSS was used to compare groups, controlling for gender, ethnicity, and age. Results revealed that CLBP subjects had higher rates of certain measures of emotional distress and depression relative to ALBP subjects. These findings further support the importance of effectively managing emotional distress factors early, when treating musculoskeletal disorders such as low back pain. ▪
Low back pain: a call for action Buchbinder, Rachelle; van Tulder, Maurits; Öberg, Birgitta ...
The Lancet (British edition),
06/2018, Volume:
391, Issue:
10137
Journal Article
Peer reviewed
Open access
Low back pain is the leading worldwide cause of years lost to disability and its burden is growing alongside the increasing and ageing population.1 Because these population shifts are more rapid in ...low-income and middle-income countries, where adequate resources to address the problem might not exist, the effects will probably be more extreme in these regions. Most low back pain is unrelated to specific identifiable spinal abnormalities, and our Viewpoint, the third paper in this Lancet Series,2,3 is a call for action on this global problem of low back pain.
Purpose
This study examined the impact of a Safe Resident Handling Program (SRHP) on length of disability and re-injury, following work-related injuries of nursing home workers. Resident ...handling-related injuries and back injuries were of particular interest.
Methods
A large national nursing home corporation introduced a SRHP followed by three years of training for 136 centers. Lost-time workers’ compensation claims (3 years pre-SRHP and 6 years post-SRHP) were evaluated. For each claim, length of first episode of disability and recurrence of disabling injury were evaluated over time. Differences were assessed using Chi square analyses and a generalized linear model, and “avoided” costs were projected.
Results
The SRHP had no impact on length of disability, but did appear to significantly reduce the rate of recurrence among resident handling-related injuries. As indemnity and medical costs were three times higher for claimants with recurrent disabling injuries, the SRHP resulted in significant “avoided” costs due to “avoided” recurrence.
Conclusions
In addition to reducing overall injury rates, SRHPs appear to improve long-term return-to-work success by reducing the rate of recurrent disabling injuries resulting in work disability. In this study, the impact was sustained over years, even after a formal training and implementation program ended. Since back pain is inherently a recurrent condition, results suggest that SRHPs help workers remain at work and return-to-work.
Rationale and objectives Low back pain (LBP) is a common condition with frequent health care visits and work disability. Quality improvement efforts in primary care focused on guidelines adherence, ...provider selection and education, and feedback on appropriateness of care. Such efforts can only succeed if a health care provider is in charge of care over a substantial period. This study was conducted to provide insights about actual patterns of provider involvement in LBP care and implications for quality evaluation.
Methods Established primary care patients with occupational LBP and health care covered by a workers’ compensation insurer were selected. Primary care physician (PCP) involvement was examined relative to overall health care utilization. Four methods of classifying PCP involvement were used to assess the association between PCP involvement and health care and work disability outcomes over a 2‐year follow‐up period.
Results Primary care physician was rarely the sole provider during episodes of occupational LBP. PCP was the initial non‐emergency room provider in 55% of cases, and was the most prevalent provider during at least one episode of care in 45% of cases. Different methods of classification led to different conclusions about the association between PCP involvement and work disability or number of health care visits. Multiple providers were involved throughout the clinical course of the small number of cases that accounted for most of the health care visits and work disability; in these cases, the role of PCP in care was difficult to determine.
Conclusions Administrative data alone are adequate for provider comparisons only in relatively simple cases. Provider comparisons based on initial treating provider likely overstate the importance of early care, particularly in more complex cases. For LBP, quality improvement models based on PCP‐directed interventions or reinforcing guideline adherence may not impact outcomes. A patient‐centred model may be necessary to achieve outcome improvements.
The 19-item return-to-work self-efficacy (RTWSE-19) scale is a new self-report measure intended to assess workers' beliefs of their current ability to resume normal job responsibilities following ...pain onset. The aim of this study was to evaluate the factor structure, internal consistency, and predictive and concurrent validity of RTWSE-19 among workers with acute low-back pain.
Patients (N=399, 59% male, mean age 37 years) consulting for acute, work-related low-back pain completed an original 28-item version of the new scale along with concurrent measures of pain, functional limitation, activity avoidance, workplace physical demands, and pain catastrophizing. The assessment was repeated at visit 2, and work limitations and duration of sickness absence were assessed by questionnaire at 3-month follow-up. Exploratory factor analysis (principal component analysis with varimax rotation) was used to assess content validity of the scale, and scores were compared to concurrent pain measures and with disability outcomes at 3 months.
The full response range (1-10) was utilized on all 28 items, and there were no ceiling or floor effects. Mean item scores ranged from 4.9 ("reducing physical workload") to 8.3 ("describing injury to supervisor"). The exploratory factor analysis supported three underlying factors (eigenvalue >1.0): (i) meeting job demands; (ii) modifying job tasks; and (iii) communicating needs to others. Internal consistency (alpha) for the three scales were 0.98, 0.92, and 0.81 respectively. At visit 2, self-efficacy scores improved for "meeting job demands" and "modifying job tasks", but not for "communicating needs to others". After controlling for pain and functional limitation, both sickness absence and persistent work limitations were predicted by self-efficacy assessed at visit 2 (P<0.05), but self-efficacy assessed at visit 1 did not predict sickness absence.
The RTWSE-19 is a new measure with adequate reliability and validity to measure the confidence of workers to meet job demands, modify job tasks, and communicate needs to co-workers and supervisors. When assessed 1-2 weeks after pain onset, the scale is predictive of disability outcomes.
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