Development of a Work Disability Prevention Management System Standard for Employers
1Institute for Work & Health, Canada; 2Conestoga College
Work disability is multifaceted in nature and addressing it requires a coordinated effort by the injured/ill worker, employer, insurer, and service providers, amongst others. In previous work, emphasis has been given to the need for a coordinator function in disability management. This is indeed important, but still treats it as a side bar issue. To truly take a proactive approach, it needs to be integrated into the broader management system of organizations, much like health & safety and quality. A management systems approach would make work disability prevention the responsibility of all managers, indeed everyone, much like joint management systems for health & safety. Ideally, it would also be built on the principles of continuous improvement.
We make the case for the need for a work disability prevention management system standard, and the importance of dovetailing it with existing management system standards. It needs to be sympathetic to the jurisdictional setting, specifically the structure of supports and the legal context, if it is to be truly national or international in scope. It also needs to be comprehensive and universal in terms of health issues and workforce characteristics, addressing both physical and mental health issues, regardless of cause. Ideally, it would include standards on recruitment and retention, given that that the principles of accommodation are the same.
Currently there is no standard for work disability prevention management systems anywhere in the world, but an initiative is underway to develop the first of its kind in Canada through Canada’s national standard body. We describe the initiative and efforts to ensure a balanced, multi-stakeholder process. The consensus-based standard development process draws on best evidence from the literature and field. We conclude with a description of plans to develop and evaluation resources for uptake in different sectors and organizational contexts.
A Descriptive Portrait of Mental Disorders Among Workers on Prolonged Work Disability for Musculoskeletal Disorders
1Universite de Sherbrooke, Canada; 2Trent University; 3Institut de recherche Robert-Sauvé en santé et en sécurité du travail
Mental health issues are common among workers experiencing prolonged disability owing to a musculoskeletal disorder. Few studies have conducted an assessment that takes the work disability situation into account. The aim of this study was to establish a portrait of the mental disorders experienced by disabled workers with a standardized measure while considering the work disability situation.
We conducted a descriptive study with a convenience sample of 79 workers (39 men and 40 women) with a work-related musculoskeletal disorder causing absence from their regular work for more than three months. A trained evaluator (supervised by two expert psychologists, one on anxiety disorders and one on work disability) conducted the assessment at the beginning and ending work rehabilitation, with the Anxiety Disorder Interview Schedule IV. Adjustment disorder and workplace phobia (as described by Muschalla), were also assessed. Interrater agreement was assessed. Descriptive analyses were performed.
Levels of severity disorders were categorized by primary and comorbid diagnoses as well as subclinical (scores of 3/8). A primary diagnosis was found in 67% (n = 49) of participants and subclinical diagnosis in another 7% (n = 5). The most prevalent primary diagnoses were adjustment disorder (n = 27; 37%), workplace phobia (n = 5; 7%) and major depression (n = 5; 7%). These emerged from the current work disability situation. Most participants experienced anxiety about various subjects, but these primarily related to the work disability situation. Thus, real generalized anxiety was only found in 5 participants (7%). In 62% of participants, a comorbid diagnosis was made, with panic disorder being the most prevalent. Diagnoses did not significantly change over the work rehabilitation period.
Using assessments that do not take into account the work disability situation may lead to misdiagnoses, and thus may lead to intervention that is not well adapted.
Return to Work from a System-based and Workplace-based Perspective: A Resource Guide
1Institute for Work & Health, Canada; 2Team Arbejdsliv Aps, Denmark; 3Ontario Shores for Mental Health Sciences, Canada
Introduction: While work injury rates have declined in most high-income countries, equivalent improvements have not been seen in return-to-work (RTW) rates. For example, older workers take longer to RTW than younger workers and are more likely to ‘relapse’ into a period away from work following an initial RTW. As a result, our team set out to create an evidence-informed practical guide to support RTW and recovery for musculoskeletal, pain-related and mental health conditions based on the findings from systematic reviews on system-based and workplace-based strategies and a qualitative review on the same topic.
Methods: The team combined research evidence summarized from recent systematic reviews on RTW from systems and workplace perspectives. Throughout the process of completing the reviews the team consulted with Occupational Health & Safety (OHS) and Disability Manager (DM) stakeholders from across Canada on design and content. Specifically, we worked with stakeholders in framing of the project, contextualizing main messages from the reviews and in guide format and layout.
Results: Selected messages from the reviews include: that in most cases, interventions were multi-faceted and included multiple intervention components and similarly from the qualitative review; concepts fall into the three strata (i) Personal dimensions; (ii) Socio-relational, and (iii) Structural dimensions of the RTW process. The key messages from the reviews with stakeholder input/direction have resulted in a practical and innovative guide for OHS practitioners on the best DM strategies to support RTW and recovery for injured or ill workers and to reduce the extensive burden associated with work disability.
Conclusions: This new guide will become a companion to IWH’s “The 7 Principles for Successful Return-to-Work”. We expect this new evidence and innovative guide to have substantial impact in helping to meet the needs of OHS stakeholders responsible for implementing effective DM & RTW support interventions.
Developing a Culturally Relevant Workplace Mental Health E-health Application with the Canadian Indigenous Population
1Department of Health Sciences, Lakehead University, Ontario, Canada; 2EPID@Work Research Institute, Lakehead University, Ontario, Canada; 3Division of Human Sciences, Northern Ontario School of Medicine, Ontario, Canada; 4Institute for Work & Health, Ontario, Canada; 5Nokiiwin Tribal Council, Ontario, Canada
Introduction: Workplace stress stemming from lateral violence in the workplace is problematic for Indigenous workers. Unlike workplace bullying, lateral violence differs due to the root cause. Canadian Indigenous people are abusing their own people in similar ways to how they have been abused. It is a cycle of abuse and its roots lie in factors of colonisation, oppression, intergenerational trauma and the ongoing experiences of racism and discrimination. Information on mental health and mental health resources within Indigenous workplaces is lacking. Therefore, our objective was to develop an e-health intervention for Indigenous mental health in the workplace.
Methods: We participated in a Canadian Institutes of Health Research “Work Stress and Wellbeing Hackathon” to achieve our objective. The Hackathon was a two and a half day event where participants work with an e-health team to devise a solution to their problem. The event was collaborative and involved multiple perspectives in the development of the e-mental health solution. In addition to the principal investigator and knowledge user, the team included an individual with lived experience and technical expertise, including designers and programmers.
Results: At the end of the Hackathon we had developed a prototype of a working e-mental health application based on the medicine wheel and Indigenous cultural teachings. We also developed a relationship with an e-health company, Cossette Health, who is turning the prototype into a viable working e-health application. We will present the prototype at the conference.
Conclusion: Future goals of the project will be to evaluate the effectiveness of the completed e-mental health application, in the communities affiliated with the Nokiiwin Tribal Council, with respect to improving access to relevant mental health information and reducing workplace lateral violence.
Psychological Distress And The Effect On Health And Occupational Outcomes Of Intensive Group Based Cognitive Therapy In Patients With Newly Diagnosed Ischemic Heart Disease
Bispebjerg and Frederiksberg Hospitals, Denmark
Thirty percent of patients with newly diagnosed ischemic heart disease present with psychological distress, anxiety and depression after revascularization. Psychological distress is associated with increased morbidity and mortality, reduced quality of life and return to work. Intervention for psychological distress in patients with ischemic heart disease is emphasized in European guidelines, but useful treatment methods are lacking.
To develop a cost-effective model for intensive group based cognitive therapy on psychological distress in patients with newly diagnosed ischemic heart disease.
Single-center, prospective, randomized clinical trial in patients with newly diagnosed ischemic heart disease and concomitant significant score of psychological distress using the Hospital Anxiety and Depression Score (HADS) (HADS A/D ≥8 or HADS>15). 128 patients will be randomized to either intervention or control group. All patients are offered usual cardiac rehabilitation, and in addition, the intervention group is offered standardized group based cognitive therapy, consisting of 5 sessions (each 1.5 h) performed by trained cardiac rehabilitation nurses. Assessment of effect will focus on return to work, HADS-score, adherence to cardiac rehabilitation, health-related quality of life measured by HeartQoL, adherence to life style interventions, and cardiovascular readmissions.
100 patients havebeen screened. 49 patients have been included.
If adding a short, intensive group based cognitive therapy improves short and long term outcomes for newly revascularized patients with ischemic heart disease and concomitant psychological distress, it will have positive effects on the prognosis and efficiency of the cardiac rehabilitation program.
Policy, Practice and Programmatic Approaches to Healthcare in Five Work Disability Management Systems
1Partnership for Work, Health and Safety, University of British Columbia; 2Centre for Health Services and Policy Research, University of British Columbia; 3Institute for Work and Health
A primary component of effective work disability management is the provision of timely and appropriate healthcare. In Canada, workers’ compensation boards (WCBs) operate as parallel payers in the healthcare system alongside publicly-funded plans delivered by provincial governments. In response to rising wait times and costs in provincial plans, WCBs have taken more active roles in managing healthcare to decrease medical service delays and avoid delayed return-to-work. This research examines the different approaches to healthcare across WCBs in five Canadian jurisdictions.
A document analysis of healthcare policies, programs and practices supporting return-to-work for work-related injuries was conducted. Documents were entered into NVivo v.11 and descriptively analyzed according to an a priori coding scheme capturing information about the organization and provision of services, financing, and physical and human resources.
Results suggest that the level of involvement in guiding healthcare varies across jurisdictions. All jurisdictions have created service-delivery arrangements with private providers outside the publicly-funded plans and instituted financial incentives for expedited diagnostic testing and surgeries. However, several WCBs actively guide the provision of healthcare through WCB-run clinics and structured recovery programs. For example, workers with muskoskeletal injuries in one jurisdiction are required to participate in programs offered by WCB-approved providers with prescribed treatment interventions and healing timelines. In contrast, other jurisdictions rely more on standard care provided through the publicly-funded plans, especially at the primary treatment level. The analysis also finds that expedited care, specialized clinics and recovery programs cluster in urban and semi-urban areas, with fewer services in rural areas.
This analysis highlights strategies WCBs have taken to address increased wait times and costs in publicly-funded plans and identify potential challenges in reaching rural workers. The findings indicate a need to examine the impact of these strategies on the efficiency and equity of healthcare provision in disability management systems.
The “Rite of Passage” of Breast Cancer Survivors Returning to Work: a Qualitative Longitudinal Study
1University of Montreal, Montreal, Canada; 2University of Sherbrooke, Longueuil, Canada; 3Charles-Le Moyne Hospital Research Centre, Longueuil, Canada
Background and objective: AlthoughCancer diagnosis causes a life-course disruption, returning to work remains a significant step despite the overall challenges related to survivorship. The aim of this study is to describe the return-to-work (RTW) pathway from the end of breast cancer (BC) treatments to RTW.
Method: Nine BC survivors were recruited in the province of Quebec (Canada). The participants were Francophones between 30 and 60 years old that received chemotherapy treatments and planned to RTW in the next six months. The qualitative interviews were performed at the end of cancer treatments (n=9), one month before RTW (n=9), and after RTW (n=5). A content analysis was performed according to an iterative process.
Results: The first six months after the end of treatment was identified as an "in-between" period for BC survivors. During that period, participants questioned their ability to return to a normal life due to the impact of side effects and a sense of withdrawal from healthcare services. A three-step pathway similar to a “rite of passage” process was observed. BC survivors first gained awareness of being on the fringe of the workplace and were awaiting to RTW. During that waiting period BC survivors were rebuilding a “normal routine” and taking actions by themselves in order to reincorporate their workplace. After the RTW, they needed to make adjustments to maintain a work routine.
Conclusion: Support for BC survivors resuming their active lives needs to be optimized. We suggest implementing interventions at one, three and six months after cancer treatment. At these moments, BC survivors require support on side effects management, RTW decision-making, and resources for reintegration of daily activities. Also, all stakeholders of the RTW pathway must be aware of the “in between” period and assist the BC survivors to build confidence during that “rite of passage” process.
What Facilitates or Prevents Successful Return-to-Work in the Construction Sector?
1Partnership for Work, Health and Safety, The University of British Columbia; 2Département de management et gestion des ressources humaines, École de gestion, Université de Sherbrooke; 3Institute for Work & Health
Successful return-to-work (RTW) after work injury for construction workers is challenging and may include additional barriers to RTW compared to other types of work. We undertook a qualitative study in four Canadian provinces to identify barriers and facilitators of RTW in construction.
We conducted four focus groups of policy directors in participating provinces and 62 interviews of workers’ compensation staff, health and safety representatives, construction employers and injured workers. Interviews were analyzed in QDA Miner using Template Analysis; a type of thematic analysis using both a priori and a posteriori codes. Codes and corresponding themes were reviewed by expert advisors.
Analysis of the interviews highlighted 110 codes, grouped in 7 themes and 29 sub-themes that broadly relate to social norms, government legislation, the social welfare system, worker characteristics, workplace environment, rehabilitation recovery process and nature of injury. Some codes identified, such as access to health care, were not unique to construction, however others such as challenges in retraining construction workers to work outside construction were.
Facilitators to successful RTW were legislation requiring accommodate of injured workers, access to expedited healthcare, a claims management approach predicated on worker-focussed care, a positive orientation towards RTW by employers and workplace interventions that emphasised early interaction and recovery at work. Barriers identified included healthcare providers with limited knowledge of construction duties, workers with few transferable skills, difficulties in providing modified work due to the nature of construction work and a lack of employer expertise to facilitate RTW. Some aspects, such as union involvement, were identified as both barriers and facilitators.
A detailed set of themes reflecting multiple stakeholder and jurisdictional perspectives emerged that identified barriers and facilitators to RTW in construction. Findings from this study can support compensation and health care providers, employers and workers in achieving successful RTW in construction after work injury.
Absenteeism of outsourced workers: Analysis from the perspective of Occupational Health Nursing
State University of Rio de Janeiro, Brazil
Outsourcing is a process of hiring companies or people to perform activities of another company – secondary activities that are not directly linked to your production process. In this context, the outsourced worker is often placed in a poorly protected environment, which can lead to occupational risks, triggering a process of illness and distancing him from his work activity. In Brazil, there are several difficulties to study and to quantify absenteeism due to illnesses and to specify public and economic burden caused by absences from work. In this context, this study has the aim to map absenteeism of employees of a private outsourcing service company, in the state of Rio de Janeiro, Brazil. It is a census study, with quantitative approach, approved by the Ethical Research Committee. Between April 2017 and April 2018, 9,477 represent the medium population of workers (67.9% male), performing activities as cleaning, gardening, fire brigade, building maintenance, telephone attendant, among others. Absenteeism occurred because of health issues (71.4%), with medical appointment for removal, and spontaneous lack of work (28.6%), representing 23,348 missing days and $1,102,685.55 BLR (or $274,450,45 USD) of lost. Worker’s health is a field of knowledge of occupational health nursing through which work-related illnesses are identified and understood through studies, preventive actions, care and surveillance, aiming, in particular, to reduce occupational diseases and accidents at work. The recognition of this situation, by a Occupational Health Nurse and the Health Staffs team, allowed the proposal and implementation of actions and standards to prevent the recurrence of high absenteeism rates, as observed in the 13 months of this study.
Welcome back program - Santander Bank Brazil
Santander Bank, Brazil
Welcome Back is the internal rehabilitation program for the promotion and maintenance of Santander Bank’s employees’ health.
A multi-professional team receives and implements adjustments to the labor activities of those who do not present their total work capacity restored to which they had prior to their sickening, once their social security benefit has ended.
From 2014 until June 2018, the program has assisted 2,577 employees in over 15,000 consultations.
From all the participants in the program, 86% adhered to the consultations and to the rehabilitation plan, that lasted, in average, 5 months. There has been higher prevalence of mental disorders (40%), followed by musculoskeletal disorders (36%) and, a last, other clinical situations such as cancer, pregnancy and rheumatic disorders, which represented 24% of the cases. Age distribution concentrated mainly in the range from 31 to 50 years old, representing 66% of participants. From the totality of cases, 33% had been working in the company for 5 years or less, 29% from 6 to 10 years, 18% from 11 to 19 years and 20% for over 20 years.
The program was one of the responsible actions for the reduction of the percentage in payed leave of 44,5% between June 2014 and June 2018. Before Welcome Back’s implementation, 44% of the population on a leave presented a new leave within the next 6 months (2013-2014). From the program’s implementation on, of those who concluded the rehabilitation plan, 89% kept active, productive and effectively included in the 6 following months from discharge.
The program optimized the use of residual labor capacity of employees and promoted the reintegration of the individual to the productive and social environments.
It was demonstrated that the investment in health enhances trust in the employee and increases productivity, promotes the company and certifies the Simple, Personal and Fair culture.
"Meta-Synthesis Of Qualitative Research On The Association Between Leadership And Return-to-Work"
University of Stavanger, Norway
Sickness absence is a severe challenge in many countries. Norway has one of the highest absence rates among the OECD countries. Earlier studies have paid little consideration on supervisors’ influence on the return-to-work (RTW) process. Although, research has showed that supervisors’ involvement and behavior play a vital part on how long sick-listed employees are absent from work, and how rapid they return to work. Still, we do not know many of the underlying aspects that could explain this. The main purpose of this meta-ethnographic synthesis is to provide an up-to-date knowledge of the existing scientific qualitative literature regarding supervisors and employees own experiences and perceptions about supervisors’ follow-up of sick-listed employees. A meta-ethnographic synthesis was chosen as the design in this study, as it has been used earlier to describe different experiences and perspectives around a specific topic from relevant stakeholders. This methodology is one of the most well developed to review qualitative studied. This review was designed according to the method described by Noblit and Hare. A systematic database search of six databases was made between January and April 2018. The databases searched was Medline, CENTRAL, SveMed+, ISI Web of Science, Cinahl, and PsycInfo. The two key elements in the searches were leadership and Return-to-work. All included relevant titles and abstracts were reviewed by two independent reviewers, according to the inclusion criteria. One reviewer did the data extraction. One reviewer has made the analyzing model, and another reviewer put extracted data into the model. All the other reviewers will review all the articles to verify that all relevant data were included in the model. We found 2510 articles in our database searches, whereas 105 qualitative research articles met the inclusion criteria. The conclusions from this review is expected to be revealed in March 2019.
Which Factors Influence The Participation Of Blue Collar Workers In Worksite Health Promotion Programs Within The Construction and Transport & Logistics Sector.
1HAN University of Applied Sciences, Netherlands, The; 2Open University, Heerlen, the Netherlands; 3Norwegian University of Science and Technology (NTNU), Trondheim, Norway.
Transport and construction workers are highly at risk of developing overweight and obesity. A recent study has shown that 73% of the transport and logistic workers is overweight. Overweight and obesity are related to a decrease of work ability of the individual. There is until now little insight into the factors that influence the participation of blue-collar workers in WHPP’s and which factors influence the implementation of WHPP’s. The main goal of the current project is to evaluate the implementation and effect of two WHPP's in the sector Construction and Transport & Logistic sector in order to fine tune the implementation strategy and improve the health and vitality & work-ability of blue-collar workers.
A randomized research design will be used with 12 months follow-up. The research population will consist of blue collar workers within the Construction and Transport and Logistic sector. This project uses the RE-AIM model framework, for the systematic evaluation of the implementation of WHPP’s combined with the validated framework of Steckler & Linnan (2002) for the evaluation of interventions. The data will be collected through questionnaires and interviews. The data will be analyzed at three different actor levels (macro-level: organization and management; meso-level: implementer; micro-level: participant).
The results of the baseline and T1 data will be presented at the conference as well as the results of the qualitative analysis which gives insight in which personal and organization factors affect the participation of blue-collar workers in WHPP’s within the Construction and Transport & logistics sector and the motivation of blue-collar workers to change their lifestyle behavior.
Psychological Distress In Australian Workers' Compensation Claimants
Monash University, Australia
Background: Qualitative studies of workers' compensation (WC) claimants have identified that claims processes can contribute to the onset or exacerbation of mental health conditions and psychological distress. There is limited quantitative research on this topic in cause-based systems of WC such as those in Australia. Psychological distress may slow recovery from injury and return to work.
Objective: To determine the prevalence of psychological distress among Australian WC claimants and identify factors associated with distress.
Method: Telephone based quantitative survey of 4,719 Australians with accepted WC claims, conducted up to two years post claim acceptance. Psychological distress was measured using the six question version of the Kessler scale. Worker, employer and claim related factors were assessd for their assocation with severe and moderate distress using multivariate ordinal logistic regression.
Results: Severe psychological distress was reported in 617 (13.1%) workers and a further 1259 (27.7%) had moderate distress. Rates were higher in workers with WC claims for mental health conditions (26.7% severe; 34.1% moderate distress) but otherwise equivalent between workers with physical conditions. Factors significantly associated with psychological distress included age less than 50 years, current pain, concerns about employer reactions to the WC claim, perceived lack of justice in the claim process, financial stress, poor self-rated health and not having returned to work at time of interview.
Conclusion: More than 40% of Australian WC claimants report moderate or severe psychological distress in the two year period after claim onset. A range of worker, claim and employer factors are associated with distress. Some are evident early in the claim process and modifiable. Combined with previously reported impacts of psychological distress on return to work and claim duration, the high prevalence suggests that screening workers for psychological distress should be routine in Australian WC systems.
The impact of depression on ill-health retirement and its moderating factors: Analysis form the Korean Longitudinal Study of Aging (2006-2014)
The Catholic University of Korea. College of Medicine, Korea, Republic of (South Korea)
Objective: To investigate the effect of depressive symptoms on IHR (ill-health retirement).
Methods: Data were collected from the Korean Longitudinal Study of Ageing which conducted biennially from 2006 to 2014. IHR were defined as those who retired due to their health problems. The short-form Center for Epidemiological Studies-Depression scale served as outcome measure for definition of depressive symptoms. Hazard ratios of IHR were estimated by Cox regression.
Results: We observed that depressive symptoms significantly increased risk of IHR during 8-year follow-up period. Compared to those without depressive symptoms, depressed worker had 1.27-fold elevated risk for IHR. Subgroup analysis showed that the association between depressive symptoms and IHR is greater in the elders, women, and lower income group than the others.
Conclusion: Depressive symptoms independently predicted IHR. Moreover, age, sex, and socioeconomic status modified these effects.
Workplace Practices for Preventing Prolonged Disability in Workers with Musculoskeletal Disorders
1Institut de recherche Robert-Sauvé en santé et en securité du travail, Canada; 2École de réadaptation, Université de Sherbrooke, Longueuil, Québec, CANADA
Return to work (RTW) is a complex process, involving many actors and implying several essential activities. The objective of this presentation is to compare, between four companies in Québec, the actual policies, procedures and practices in regard to RTW of employees suffering of with work-related musculoskeletal disabilities (WRMDs) and identify the main organisational conditions related to the similarities and differences observed.
A multiple case study (n = 4) was conducted in two sectors of activity: health care and manufacturing. The case was defined as all the RTW management procedures and practices of a specific organisation. Multiple sources of data included written procedures and semi-structured interviews with key actors. Between 5 and 17 key actors involved in the RTW process (i.e. human resources counsellor, manager, supervisor, union representative, and workers absent from their regular work during more than 3 months and now working since more than 6 months) were interviewed by organisation. Actions performed by essential activity, by phase and group of actors, and perceived facilitators and barriers were described. Analyses were done in order to highlight and explain differences and similarities between organisations.
Similarities exist in terms of procedures, involvement of actors and actions completed. However, we also noted many differences, specifically in terms of the various modalities of application of policies and procedures, as well as in terms of the different RTW inter organisational conditions.
The consideration of the differences and/or similarities among the organisations, and the conditions facilitating or not the RTW among the distinct workplaces, contribute to a better understanding of the practical contexts’ realities and of their implications in the application of RTW policies, procedures and practices in the workplaces.
How Satisfied Are Knee And Hip Osteoarthritis Patients With Exercise-Based Therapy As Treatment For Pain And Performance Of Activities Of Daily Life, Sports & Leisure Time And Work?
1Amsterdam UMC, University of Amsterdam, Coronel Institute of Occupational Health, Amsterdam Public Health research institute, Amsterdam, The Netherlands; 2Amphia Hospital, Department of Orthopaedic Surgery, Foundation FORCE (Foundation for Orthopaedic Research Care and Education), Breda, The Netherlands; 3Amsterdam UMC, University of Amsterdam, Department of Orthopaedic Surgery, Amsterdam Movement Sciences, Amsterdam, The Netherlands; 4Amsterdam UMC, University of Amsterdam, Academic Center for Evidence-Based Sports Medicine (ACES) Amsterdam, The Netherlands; 5Leiden University Medical Center, Department of Biomedical Data Sciences, Leiden, The Netherlands; 6ICONE Orthopedie & Sportletsels, Schijndel, The Netherlands
Worldwide, the number of working knee and hip osteoarthritis patients is increasing rapidly. The ultimate treatment is joint arthroplasty for these patients. The Dutch Orthopaedic Association strongly supports that joint arthroplasty is only performed after adequate, stepwise conservative treatment. This is advocated in their Choosing Wisely Initiative. Exercise-based therapy is a cornerstone in this stepped-care strategy. However, no recent data are available describing whether these patients scheduled for surgery indeed received exercise-based therapy. Furthermore, satisfaction with the effect of non-operative treatments on pain and participation in daily life, work and sports activities has not been described.
A cross-sectional study was performed among end stage knee and hip osteoarthritis patients in five hospitals in the Netherlands in 2017. Using a questionnaire, all patients were asked which joint preserving treatments, like exercise-based therapy, they had received. In addition, satisfaction with the exercise-based therapy for pain and performance of activities in daily life, sports & leisure time and work was rated on a scale from 1 (very dissatisfied) to 10 (very satisfied).
One hundred seventy-six patients completed the survey. The mean age was 66 (SD 8) years, 57% was female and the median BMI was 29 kg/m2 [IQR 25-33]. A majority (61%) received exercise-based therapy. The median satisfaction scores for the effect of exercise-based therapy on pain and activities of daily life were 6 [IQR 4-7]. These median scores were 5 for both sport & leisure time and work activities [IQR 2-6].
In 2017, a majority of Dutch knee and hip osteoarthritis patients received exercise-based therapy. In general, patients were satisfied with the effect on pain and activities of daily life but unsatisfied with the effect on sport & leisure time and work activities. Future studies should try to enhance the effectiveness of exercise-based therapy especially for sport & leisure time and work.
Healthcare Utilization for Workers with Musculoskeletal Disorders in British Columbia, Canada
University of British Columbia, Canada
Musculoskeletal disorders (MSDs) are the second most common cause of disability worldwide, and account for the highest disability costs in Canada. This study presents the first comprehensive picture of healthcare utilization and costs related to workers’ compensation claims, for a cohort of workers with MSDs in British Columbia, Canada.
Population-based data using accepted workers’ compensation claims for MSDs from WorkSafeBC (the workers’ compensation system of British Columbia) were extracted for the period 2010-2016. Two researchers independently coded and reconciled differences in 10,244 healthcare service codes, and categorized those based on healthcare provider and service type. This allowed us to compare the main healthcare utilization and cost drivers for work-related MSD claims in British Columbia.
Preliminary results show that in total 175,077 injured workers had 377,668 claims related to work-acquired MSDs between 2010 and 2016 (approximately two claims per worker on average). These claims were associated with 7,417,101 healthcare payment transactions (approximately 20 payments per claim). The largest proportion of payments were for physician services (49%). Of these, 42% were general practitioner services, 24% specialists’ services, and 34% did not have physician specialty recorded. The second most common were payments to other qualified healthcare providers (17%), of which the majority were for physiotherapy services. Rehabilitation programs and prescription drugs comprised 10% and 9% of payments respectively. The remaining 15% of payments were miscellaneous or other costs (e.g. travel costs).
This study presents the first categorization of healthcare claim costs related to MSDs in British Columbia. This categorization of healthcare utilization will inform future research that will evaluate health services use and resulting cost drivers of healthcare for injured worker groups. Understanding these costs can inform policy makers to make better allocative decisions in the distribution of limited resources.
Work Environment Obstacles Influencing the Return to Work of Aging Workers on sick-leave due to Common Mental Disorders
Université de Sherbrooke, Canada
Objective: Currently, very few studies have examined the factors from the work environment (WE) which impede the return to work of aging workers on sick-leave due to a common mental disorder (CMD). This study aims to fill these gaps through the following two objectives: (1) characterize the main WE obstacles of workers aged 50 and over (W50+) on sick-leave due to a CMD, and 2) explore among stakeholders their understanding of the main obstacles hindering the return to work of these workers.
Methods: This study uses an exploratory sequential mixed method design. The first phase (quantitative) will use a secondary analysis of a database comprising a sample of 44 W50+ and admitted to a rehabilitation program. Descriptive analyses will be performed. The second phase (qualitative) will use interviews with two types of participants: supervisors and human resources managers in a large organization. Inclusion criteria for the supervisors are: (1) having a minimal experience of one year in staff management, and (2) having minimally supervised one return to work of a W50+ in the last two years. A sample size of 8-12 supervisors is aimed. Inclusion criteria for the human resources managers are: (1) having thorough knowledge on the policies and procedures surrounding disability management, and (2) having a minimal experience of one year. A sample size of 3-6 human resources managers is aimed. An interview guide will be developed which will take account of the quantitative results obtained during the first phase. Thematic content analysis will be done.
Conclusion: This research is currently underway. Results will allow a better understanding of WE factors most likely to impede the return to work of workers aged 50 and over with CMD. Furthermore, the point of view of key stakeholders on the WE obstacles will be explored.
Validation Of A Triage Instrument To Assess Risk Of Long-Term Sickness Absence
1University of Leuven, Centre for Environment and Health, Kapucijnenvoer 35/5, 3000 Leuven, Belgium.; 2Idewe, External Service for Prevention and Protection at Work, Interleuvenlaan 58, 3001 Heverlee, Belgium; 3Université de Liège, Médecine du Travail et environnementale, Département des Sciences de la Santé publique, Avenue Hippocrate 13, 4000 Liège, Belgium; 4SPMT-ARISTA, External Service for Prevention and Protection at Work, Rue Royale 196, 1000 Brussels, Belgium.
Given the scarce means and as most employees will return to work spontaneously, resources for return to work projects should be mainly dedicated to the high-risk group for long-term sickness absence. In this project, a questionnaire was developed to predict the risk of long-term sickness absence in the early stage of a sickness period. We aim to measure the predicitive validity of the screening instrument.
Between 11/09/2017 and 22/10/2017, the screening instrument, containing sixty-one items, was sent to every patient after 6 weeks of sickness absence. The risk for long-term sickness absence was related to work-related, function-related, work-life-interference related and person-related factors. We measured the time until return to work for all patients, to be able to evaluate the predictive validity of our screening instrument.
The questionnaire developed aims to support physicians to assess the risk of long-term sickness absence in employees, for whom an earlier start of return-to work support becomes possible. We aim to guide more employees successfully and sustainably back to work.
Associations Between Alcohol Use and Sick leave: A Systematic Review
1Department of Public Health, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway; 2Department of Occupational Therapy, Oslo Metropolitan University, Oslo, Norway; 3Norwegian Institute of Public Health; 4Presenter- Making Sense of Science, Stavanger, Norway
Background: Alcohol is a prevalent psychoactive substance, and a major risk factor for disease, disability, and mortality. Risky alcohol use has been identified as a causal agent in more than 200 disease and injury conditions. Excessive or prolonged alcohol consumption might lead to injuries and accidents, but also to sickness absence, sickness presenteeism, and behavioral changes. Sick leave is a substantial indicator of impairment, and this systematic review provides an updated summary of the existing scientific literature on the association between alcohol consumption and sick leave (both short-term and long-term). In addition, we aim to describe the differences and similarities of how alcohol and sick leave are operationalized across studies. At last, the review will indicate recommendations for future research on alcohol use and sick leave.
Methodology: The systematic review is planned according to the Cochrane Handbook. The literature search has been executed in the following databases: Medline, Embase, Cinahl, PsychInfo, Amed, and ISI Web of Science. Studies from 1980 and up to 2018 in English or Scandinavian languages were included. After extracting the data on tested associations in included studies, these underwent a quality assessment. Because the associations are as the unit of interest, quality assessment is on each association test rather than each study. We hope to perform a meta-analysis in the next phase, if this is not possible, a narrative analysis will be performed.
Results: 57 studies met the inclusion criteria and constituted the included studies. All of these studies contain association tests between alcohol consumption and sick leave. The article is in the data extraction and analysis phase and will be finalized in February 2019.
Tracing The Change. What Are The Effective Components Of Workplace E-health Interventions? – A Systematic Review
1University of Stavanger, Stavanger, Norway; 2OsloMet – Oslo Metropolitan University, Oslo, Norway
Investing in health and participation of employees has many positive outcomes for both organizations and society. According to previous research, by reducing sick leave and sickness presenteeism there is a potential for improving the long-term health of employees. Workplace interventions based on online content or including a computer-mediated component have gained popularity since the 1990s. Such E-health interventions are aiming to improve employee’ health and lifestyle choices, as well as promote a safe and early return to work. Although effectiveness of e-health interventions has been investigated to some extent, it is still unclear how these interventions work and which components (i.e. active ingrediences) or which design and interfaces contribute to their effectiveness. The aim of this systematic review is to reveal which components, design, and interfaces contribute to effectiveness of e-health workplace interventions.
We are searching for literature in the following databases: MEDLINE, PubMed, Embase, Cinahl, PsycInfo and SveMed+. Empirical papers published between 1990 and 2018 in English and Scandinavian languages, concerning adults in working age (18 to 67 years) as well as all sectors, branches and job types will be included. This review follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Overall quality of the evidence for primary outcomes will be assessed by using the GRADE and risk of bias approaches from Cochrane Collaboration. We will further use the behavior change technique taxonomy (BCT-taxonomy) to map behavior change in e-health programs.
Our search strategy revealed 2409 records. We are now in the inclusion/exclusion process, where two independent reviewers are screening the studies according to the inclusion criteria
This systematic review is still in the process. Completion of the results for presentation in Odense is expected in the Spring 2019.
Key Words: e-health, workplace interventions, systematic review, health promotion and organizational health
Implementing Best Practices With Employers and a Union: Setting a New Milestone for Research
1Université de Sherbrooke, Canada; 2Université du Québec en Outaouais, Canada
Implementing best practices in the workplace is complex and embedded within a multi-party and multi-factorial context. This study explores factors hindering and facilitating adaptation of work disability management best practices in real practice settings using a collaborative framework.
The research team, union and human resources (HR) directors of employers of organisations in the education sector decided on a participatory action-research approach. The Community-Based Participatory Research framework (CBPR) guides the project. An adaptation of the validated CBPR questionnaire is completed prospectively at three times during the project. Individual interviews are held at the end of participation, using results from the questionnaire to more deeply explore the results of the collaboration between parties. The questionnaire includes three theory-driven dimensions: 1) capacity of parties to collaborate, 2) goodness-of-fit between participants, and 3) operations supporting collaboration and the deliverable product.
A total of four organisations in the education sector affiliated with the same union are participating, with an equal number of HR and union representatives. The participants include the HR director, disability managers, and a direct supervisor (HR departments), and the president, the union director, and delegates (unions). The following activities were agreed upon to structure the adaptation of work disability practices for each organisation: 1) audit of current practices; 2) presenting the gaps found between best practices and current practices of each organisation; 3) establishing a consensus on practices needing adaptation and 4) adapting best practices to each organisation. Steps 2 to 3 are conducted using bipartite group meetings. So far, two organisations have completed the process and one is at step 4. Preliminary results highlight factors in all three dimensions impacting the adaptation of practices.
A new milestone is being set in the aim of implementing best practices in work disability prevention.