Conference Agenda

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Session Overview
Location: Room 97
Date: Wednesday, 05/Jun/2019
11:30am - 1:00pmWork and lifestyle factors
Session Chair: Douglas Paul Gross
Session Chair: Eva Ladekjær Larsen
Room 97 
 

Current Practices And Perceived Implementation Barriers For Working With Alcohol Prevention In Occupational Health Services: The WIRUS OHS Study

Mikkel Magnus Thørrisen1, Jens Christoffer Skogen2,3,4, Ingvild Kjeken1,5, Irene Jensen6, Randi Wågø Aas1,4,7

1OsloMet - Oslo Metropolitan University, Oslo, Norway; 2Norwegian Institute of Public Health, Bergen, Norway; 3Stavanger University Hospital, Stavanger, Norway; 4University of Stavanger, Stavanger, Norway; 5Diakonhjemmet Hospital, Oslo, Norway; 6Karolinska Institutet, Stockholm, Sweden; 7Presenter - Making Sense of Science, Stavanger, Norway

Background: The workplace may be a serviceable arena for targeting employees' alcohol problems, especially due to its impact on presenteeism and sick leave. However, little is known about the role occupational health services (OHS) play in targeting this public health problem.

Objectives: The aims of this study were to explore current practices of such preventive efforts in a sample of OHS professionals, investigate whether perceived implementation barriers are associated with such preventive efforts, and explore whether barriers display differential associations across different risk groups.

Methods: In a cross-sectional design, survey data were collected from 295 OHS professionals in Norway. Reported alcohol-preventive efforts were analysed by means of descriptive statistics and one-way analysis of variance (ANOVA). Associations between alcohol-preventive efforts and implementation barriers were explored by applying multiple hierarchical regression analyses.

Results: The OHS' were most focused on targeting problem drinkers or heavy drinkers (tertiary prevention), and more seldom working with those at risk (secondary prevention). Yet overall, alcohol-preventive efforts were quite limited. Barriers concerning the competence among OHS' and their resources were associated with alcohol-preventive efforts across all different risk groups, but barriers concerning employers and employees were not.

Conclusion: This study revealed that to increase the implementation of workplace primary preventive interventions targeting alcohol problems, presenteeism and sick leave, it is necessary to facilitate training of OHS professionals as well as ensuring sufficient time and resources for addressing this important public health challenge.



Is Alcohol Consumption Among Employees A Risk Factor For Presenteeism? A Systematic Review

Mikkel Magnus Thørrisen1, Tore Bonsaksen1,2, Neda S. Hashemi3, Ingvild Kjeken1,4, Randi Wågø Aas1,3,5

1OsloMet - Oslo Metropolitan University, Oslo, Norway; 2VID Specialized University, Sandnes, Norway; 3University of Stavanger, Stavanger, Norway; 4Diakonhjemmet Hospital, Oslo, Norway; 5Presenter - Making Sense of Science, Stavanger, Norway

Background: Alcohol consumption is a major risk factor for disease, disability and mortality, as well as being associated with sickness absence. Presenteeism (reduced on-the-job productivity) is an important, but under-researched topic.

Objective: The aim of this review was to explore whether evidence in the research literature supports employees' alcohol consumption to be a risk factor for presenteeism in the workplace.

Methods: Primary observational studies, published 1990 or later in English or a Scandinavian language, were included. Tested associations in the included data were quality assessed and analyzed descriptively with frequency tables and cross tabulations. Associations' measurements were categorized by means of content analysis. 26 articles, containing 132 tested associations, were included in the review.

Results: The vast majority of the tested associations (77 %) indicated a positive relationship between alcohol consumption and presenteeism (i.e., higher consumption associated with higher presenteeism), and positive associations were considerably more likely than negative to be statistically significant (OR = 14.00, p <.001). Alcohol measurements based on hangovers and composite instruments were overrepresented among significant positive associations of moderate or high quality. However, negative associations (19 %) were, compared to positive, less likely to be of low quality (OR = 0.22, p <.01). Overall, the majority of tested associations were characterized by low quality.

Implications: Workplace interventions aimed at improving productivity could benefit from including an emphasis on alcohol consumption.

Conclusion: Evidence suggests alcohol consumption to be associated with presenteeism. However, due to the lack of longitudinal designs and low research quality, existing evidence may still be characterized as inconclusive regarding whether alcohol constitutes a risk factor for presenteeism. More robust and less heterogeneous research is needed.



How Much or How Often? Alcohol Consumption, Sickness Presenteeism, and impaired Daily Activities

Randi W. Aas1,2,3, Mikkel M. Thørrisen2, Hildegunn Sagvaag1, Aleksandra Servic1

1University of Stavanger, Norway; 2Oslo Metropoletan University, Oslo, Norway; 3Presenter - Making Sense of Science, Stavanger, Norway

Background: Harmful alcohol consumption constitutes a global public health issue. Studies conducted in developed countries have identified between 10 and 35% of employees as risky drinkers. Employees' alcohol consumption may influence their activity performance across domains, including the occupational and domestic spheres. Studies have found high levels of alcohol use to be associated with sickness presenteeism, i.e., reduced on-the-job productivity as well as impaired daily activities. Drinking frequency and drinking intensity (episodic heavy drinking or binge drinking) may have dissimilar effects on activity performance.

Aim: The aim of this study was to explore and compare the influence of two aspects of alcohol consumption (drinking frequency, i.e., “how often” and drinking intensity, i.e. “how much”) on sickness presenteeism and impaired daily activities.

Methods: Cross-sectional data from 3278 Norwegian employees were collected. Drinking frequency and intensity were measured with items from the Alcohol Use Disorders Identification Test (AUDIT), developed by the WHO. Frequency was measured by asking to rate how often they had consumed alcohol during the last year. Intensity was measured by asking how often during the last year they had had binge drinking episodes, i.e., six or more alcohol units on a single occasion. The two activity performance items were taken from the Work Productivity and Activity Impairment questionnaire (WPAI).

Results: Results showed that drinking intensity (how much) displayed significant associations with both sickness presenteeism and impaired daily activities. Drinking frequency (how often) did display a significant association with impaired daily activities, but to a lesser degree than drinking intensity.

Conclusion: Frequent drinking over time is a risk factor for long-term health complications. However, high-frequency drinking would not necessarily produce short-term impairments comparable to binge drinking episodes (how much each time).The study found also that drinking intensity displayed a stronger association with impaired daily activities than with sickness presenteeism.



Employee Perspectives Of A Workplace Health Programme

Charlotte Brøgger Bond, Karen Søgaard, Lotte Nygaard Andersen

University of Southern Denmark, Denmark

Background:Risk of long-term sick leave increases with high physical occupational load while it decreases with high leisure time physical activity. Sønderborg Municipality in the Southern Region of Denmark has since 2008 offered a workplace health programme including various initiatives to promote a healthy lifestyle for employees. Elected health- and safety representatives are expected to act as health ambassadors and promote the health programme at the workplace. The aim of this study wasto understand how a workplace health programme is received and used by the employees.

Methodology: A comparative case study design was used with two different workplaces within the municipality serving as cases. Observations and interviews were done among employees from all layers of the workplaces and was analysed using Malteruds systematic text condensation.

Results: Preliminary findings indicate that health- and safety representatives appointed as ambassadors for the health programme is problematic. The representatives do not feel confident because they lack proper training in the ambassador tasks. On the other hand employees and management in both workplaces emphasize that changing workplace culture in a more healthy direction will require employee driven processes. Decisions about health from the management alone may even have the opposite effect on some employees.

Conclusion:From an employee perspective Sønderborg Municipality’s health programme has implementation challenges because the health- and safety representatives are poorly prepared and empowered to cover all the complex aspects of the health ambassador job.



Does It Work? Introducing Work Focus Into a Lifestyle Intervention for Persons With Morbid Obesity

Wivi Andersen1, Anita Dyb Linge2,3, Chris Jensen1

1The Norwegian National Advisory Unit on Occupational Rehabilitation; 2Muritunet Rehabilitation Centre; 3Volda University College

Obesity is related to lower labor force participation, increased sickness absence and reduced productivity. This indicates that work rehabilitation may be important for persons with obesity. Despite this connection, work focus has not been a part of lifestyle interventions for persons with morbid obesity.

In our study, we wanted to examine whether introducing a work intervention in a lifestyle changing rehabilitation program affects the participants’ ability to work and their lifestyle. We also wanted to find out how the participants experienced their health, work ability and work capacity, quality of life, diet and self-efficacy before and during the intervention. We hypothesised that work focus would lead to higher work participation.

The study was designed as a randomized controlled study with an exploring prospective design. It included 178 participants, where 99 participants completed the whole intervention and formed the data-foundation. Of these, 20 were interviewed. The lifestyle group was randomized into two interventions, one with work intervention one without. The work intervention entailed lectures and individual guidance from a work consultant. Data material gathered at each stay consisting of forms, test (such as measurements of weight, BMI and aerobe capacity), journal and individual interviews. These were all collected at baseline, and at six and twelve months.

Results from this study was that there is only a small difference between the interventions regarding achieved work participation from the start to the end of the study. Most of the participants interpreted their intervention as a process of lifestyle change, rather than a process to improve their capacity to work.

However, the participants in the intervention with a work focus had in general better overall results, i.e. they had:

  • Bigger weight loss.
  • Higher work capacity (VO2 peak).
  • Greater belief on their ability to meet work demands.



The Relationship between Occupational Physical Activity and Need for Recovery: A cross sectional analysis from the DPhacto cohort

Matthew Leigh Stevens1,2, Patrick J Crowley1, David M Hallman3, Ole S Mortensen4, Clas-Håkan Nygård5, Andreas Holtermann1

1The National Research Center for the Working Environment, Denmark; 2The University of Sydney, Australia; 3University of Gävle, Sweden; 4University of Copenhagen, Denmark; 5University of Tampere, Finland

Introduction

Sustainable employment is one of the greatest problems facing modern economies. As an intermediate measure of sustainable employment, a person’s Need For Recovery (NFR) refers to the extent that the work task induces a need to recuperate from work induced effort, and has been linked to employee wellbeing, sickness absence and employee turnover. In this study we sought to determine the relationship between objectively measured Occupational Physical Activity (OPA) and NFR, as well as identify any moderating effect of age on this relationship.

Methods

This was a cross-sectional analysis of the DPhacto cohort. Physical activity data was collected on 840 white and blue-collar workers using tri-axial accelerometery worn on the thigh for several days. NFR was collected utilising a shortened version of the Danish NFR scale. Analysis was conducted in R utilising linear regression modelling of compositional data and compositional isotemporal substitution modelling.

Results

Preliminary results show a significant effect of the OPA composition on NFR (p<0.001). The effect of allocating 15 minutes of time to a particular activity (from all activities) was significant for sedentary behaviours (β=-0.018 ± 0.011), but not for standing (β=-0.011 ± 0.022), light physical activities (moving/slow walking; β=0.021 ± 0.041) or more vigorous activities (fast walking, running, cycling; β=0.030 ± 0.046)

Conclusions

Increasing sedentary behaviours seems to be associated with a decreased NFR. However, multivariate analyses investigating potential modifying effects of age still remain, and will be available for presentation at the conference.

 
4:00pm - 5:30pmPrevention and sustainable employment
Session Chair: Thomas Lund
Session Chair: Alex Collie
Room 97 
 

Job-rotation as a Tool to maintain Employability: The Interplay between Motivation, Qualification and Health

Susanne Bartel

Federal Association of Vocational Rehabilitation Centres, Germany

Facing the demographic changes in German society, innovative age and aging management concepts and prevention models are becoming increasingly important for employees, companies and the social security system. The decline in activity-related performance potentials, due to higher age, is often associated with health-stressing working conditions and the lack of opportunities to develop professionally and personally. Job-rotation between companies can counteract this process before health problems develop.

In the project “TerrA”, funded by the Federal Ministry of Education and Research (2016 to 2019), the possibilities and limitations of such a model is currently being tested in practice. Based on qualitative fieldwork (i.e. interviews with employees, participatory observation) and intense discussions with employers and stakeholders, specific consulting processes for employees and companies were developed and framework conditions described.

The results show that at the individual level, personal motivation, qualification and health play an essential role for such a preventive approach. At the same time, companies recognised the need for a long-term view of working-life biographies to prevent age-related mental and/or physical disabilities. Although the social insurance stakeholders have recognised the preventive potential of our model, they are currently unable to implement it, as legal frameworks only permit benefits if a health problem has already occurred.

Under what conditions can preventive job changes succeed? Where are the opportunities and limits of this preventive strategy in the context of securing employability? We draw the conclusion that for the implementation of preventive measures, a sensitisation for individual concepts of health and work is of great importance. At the same time, companies have a central responsibility to integrate anticipatory job analyses and qualification opportunities in human resources development concepts proactively. Finally, it became clear that financing possibilities for job qualification under a preventive perspective cannot be borne by the social security systems, yet.



Long-term Effects On Work Disability Of An Indicated Preventive Strategy Aimed At Preventing Future Long-term Sickness Absence

Sophie Heloïse Klasen, Ludovic G.P.M. van Amelsvoort, Nicole W.H. Jansen, IJmert Kant

Maastricht University, Netherlands, The

So far most general and selective preventive interventions have been proven rather ineffective in considerably reducing work disability risk. A preventive strategy, based on the principles of indicated prevention, that is, detecting high risk workers with a screening questionnaire and subsequent early intervention of these workers, was developed, aimed at preventing future long-term sickness absence. It is assumed that the reduction of long-term sickness also considerably reduces the work disability risk.

The aim of our study is to establish the efficacy of this preventive strategy on work disability risk and the long-term costs and effects. To assess the efficacy, data covering a prolonged follow up from two large Dutch RCTs on the effectiveness of the preventive strategy is collected. Trial I consisted of employees at high risk for long-term sickness absence receiving early consultation as compared to care as usual. Trial II compared the effect of a tailor made Problem Solving Therapy with elements of CBT at high risk for long-term sickness absence with mild depressive complaints to care as usual. Of the population (n=13,842) who filled in the screening questionnaire, (n=438) high risk employees were followed for six years.

It has been shown that a preventive strategy is able to reduce future long-term sickness absence over a period of one year from 31 to 18 days in the first trial (Kant et al., 2008) and from 50 to 27 days in the second trial (Lexis et al., 2011) which indicates a large potential to also reduce work disability risk. Since the analysis is currently ongoing the results will be presented at first at the conference. When this strategy is proven to be effective on the long-term, this strategy is promising for a reduction in work disability and broader implementation will be needed.



Barriers And Facilitators Of A Preventive Strategy To Prevent Future Long-term Sickness Absence And Work Disability. A Qualitative Study Among Employees And Employers.

Sophie H. Klasen, Ludovic G.P.M. van Amelsvoort, Inge Houkes, Nicole W.H. Jansen, IJmert Kant

Maastricht University, Netherlands, The

Objective: The prevention of work disability remains challenging. This research focuses on a preventive strategy which is proven effective in reducing sickness absence in the long-term. Thus, apparent also work disability risk. The strategy consists of a screening in which workers at high risk are identified, and subsequent early intervention by labor professionals. The implementation of this strategy appeared to be difficult though. The aim of this study is to identify and understand barriers and facilitators associated with the implementation of this preventive strategy as experienced by primary stakeholders (employees and employers) whether or not familiar with this strategy.

Methods:Semi-structured interviews were conducted with 9 employers and 11 employees. We used purposive sampling to obtain the perspectives of stakeholders with varying age, gender and degree of familiarity with the strategy. All interviews were transcribed and analyzed thematically.

Results: Employees generally expect positive outcomes of the preventive strategy, but report that an atmosphere of trust in the organization is important for serious employee participation and effectiveness.When asked about the preventive strategy, employees not depending on familiarity primarily talked about the screening questionnaire, neglecting the early intervention by the labor professionals. Employers were overall positive but those unfamiliar primarily talked about the screening questionnaire. As regards background and risk factors of sickness absence, employees and part of the employers focused on physical health and lifestyle, thereby neglecting mental health. Several misperceptions seem to exist about sickness absence and the preventive strategy which may inhibit implementation.

Conclusions: The basis, content and expected outcomes of the preventive strategy were not clear to employees. Misconception were also noticeable for the unfamiliar employers and to a lesser degree for the familiar employers. Better communication about risk factors of sickness absence and the preventive strategy itself, are needed for successful implementation of the strategy.



Employees With Long-term Health Conditions - A Diary Study Of Workplace Self-management Behaviour, Support Needs And Work Factors.

Sally Elizabeth Hemming

Loughborough University, United Kingdom

The prevalence of long-term health conditions is increasing and working people affected by conditions, are required to self-manage their health at work. Health condition management is increasingly popular in workplace health promotion, yet little is known about workplace self-management activity or support needs and how these vary over time. The self-management activities and experiences of people affected by conditions were explored using a workplace diary and journal, to gain a temporal and real time perspective. A fixed schedule 10-week longitudinal diary study was designed collecting quantitative and qualitative self-reported data. The FlexMR platform was used for an online diary and journal. Participants, recruited via a survey study, were asked to complete the diary on six occasions at two-week intervals. Diaries have been shown to be useful in examining health behaviours, assessing temporal changes. They have also been shown to be useful in exploring illness behaviours and for tracking self-management activities. The diary was made up of four tasks incorporating 17 questions in total. Participants were asked about their health condition status, self-management activities, workplace support needs and work engagement. An optional online journal function was also available for people to record in the moment activities and thoughts. One hundred and twenty-one participants were invited to take part in the diary study, 57 completed a diary entry with 18 participating fully. An understanding of long-term self-management behaviours of people affected by health conditions can potentially help employers provide workplace support to the benefit of working people. Study results identifying people’s typical workplace self-management and support needs, and the extent to which they vary over time will be presented. Furthermore, free text and online journal sections will be thematically analysed and presented.



Working With Disabilities – A Matter Of Time? First Results From The PROMI Project

Jana Felicitas Bauer, Susanne Groth, Mathilde Niehaus

University of Cologne, Germany

Background

Time is money in the world of work, therefore the person that is most productive in a given time frame is often considered to be the best employee. This view of „good employees“ can pose a fundamental challenge to people with disabilites who usually have to deal with disability-related time expenditure. Due to disability-related time expenditure, the time budget that can be spent on actual work tasks may be reduced or the time needed to complete a given work task may be extended. This may in turn make it difficult to keep up with the above mentioned ideal of productivity – especially when working conditions are not flexible in terms of scheduling. The aim of the present study is therefore to explore different kinds of disability-related time expenditure that are relevant to working life.

Methods

The sample consists of participants of the project „PROMI – promoting inclusive doctoral studies“. N = 30 PhD students with disabilities that work part-time as research assistants at german universities were surveyed via an accessible online questionnaire.

First Results

Nearly all of the participants report some kind of work-relevant disability-related time expenditure. About 73% have to keep frequent medical or therapeutical appointments, over 65% indicate that they are involved in time-consuming bureaucratic issues e.g. connected to the application for disability benefits, 50% state that they need more brakes than others to be able to work efficiently, moreover especially the visually and hearing impaired report that they need more time than others to complete work tasks.

Conclusions

The first results indicate that disability-related time expenditure is a manifold and relevant topic that needs further examination. A goal of future research should be to identify working conditions that reduce the challenge of balancing disability- and work-related time demands.



The Effectiveness Of Interventions To Promote Sustainable Employability: A Systematic Review

Emmelie Hazelzet1, Eleonora Picco2, Inge Houkes1, Hans Bosma1, Angelique de Rijk1

1Maastricht University, Netherlands, The; 2University of Milano, Italy

Objective: Despite growing interest in sustainable employability (SE), studies on the effectiveness of interventions specifically developed to promote employee SE are scarce. Based on the definition by Van der Klink and colleagues, researchers and practitioners distinguish three SE components: 1) health; 2) productivity and 3) a long-term perspective. The aim of this review is to (1) summarize the evidence for the effectiveness of SE interventions used by employers; and (2) to examine which of the three SE components are addressed by these interventions.

Methods: A systematic search was performed for articles published in the Cinahl (Ebsco), EconLit (Ebsco), Embase, PsycInfo (Ebsco), Pubmed and Web of Science databases between January 1997 and June 2018. We established inclusion criteria which were applied manually in the selection of studies. The adapted Quality Assessment Tool for Quantitative Studies developed by the Effective Public Health Practice Project (EPHPP) was used to assess methodological quality. Data extraction was based on type of intervention, target group and the three SE components.

Results: Seven out of 25 potentially relevant articles were included in the review. The methodological quality of these seven studies ranged from weak to moderate. The overall effectiveness of the SE interventions was mixed (i.e., small positive effects of subcomponents of the interventions or no effectiveness). Preliminary findings showed that the health focus and productivity focus are more or less covered by the interventions, whereas the long-term perspective of SE is often lacking.

Conclusions: No firm conclusions regarding the effectiveness of SE interventions can be drawn. This can partly be explained by the relatively low quality of the studies included, but may also by the type of interventions used by employers to enhance their employees’ SE. More attention for high quality studies and effective SE interventions provided by the employer seems necessary.

 
Date: Thursday, 06/Jun/2019
10:30am - 12:00pmMusculoskeletal disorders
Session Chair: Andreas Holtermann
Session Chair: Marion Lamort-Bouché
Room 97 
 

Evaluating the Costs and Benefits of Gradually Returning to Work after a Work-Related Musculoskeletal Disorder

Esther T Maas, Mieke Koehoorn, Christopher B McLeod

University of British Columbia, Canada

Musculoskeletal disorders (MSDs) are the most prevalent chronic condition in Canada, and are an increasing cause of work disability in an aging workforce. Gradually returning to work (GRTW) after injury, by increasing the workload and limiting or modifying work tasks, is assumed to improve health and labour market outcomes and reduce work disability after injury. The aim of this study is to identify effective and cost-beneficial use of GRTW for workers with MSDs, and reduce work disability duration.

Population-based data using accepted lost-time claims from the workers’ compensation system in the Canadian province of British Columbia were extracted for the period 2010-2016 (N=121,891). Within one year after injury, 40% of workers had at least one day of GRTW. Of all workers who had GRTW, 59% were male, 44% had back sprains or strains, and the average age was 41 years. Evaluating the costs and benefits using the claims data is challenging as GRTW is strongly associated with injury severity. In order to address this limitation, the workers’ compensation data is being linked to health services data, and prescription data. Combined claims and health-related data is used to match injured workers with and without GRTW on demographic and work-related characteristics, injury severity, health status, and health services intensity to evaluate the independent effects of GRTW.

This is the first study using data from three population-based health data sources for a comprehensive investigation of a workplace intervention aimed to reduce work disability over a longitudinal time period and within the Canadian context. Also, using this data for the purpose of evaluating the costs and benefits of GRTW is unique but will generate evidence to inform GRTW practices that are not currently standardized/regulated in the jurisdiction in order to limit the health and economic impact of work-related MSDs in an aging workforce.



The independent Association Between Number Of Pain Sites And Return To Work. An Explanatory, Prospective Cohort Study

Jesper Stejnicher Drongstrup Jensen1, Lotte Nygaard Andersen1, Mette Jensen Stochkendahl1,2

1Department of Sports Science and Clinical Biomechanics University of Southern Denmark, Denmark; 2Nordic Institute of Chiropractic and Clinical Biomechanics, Odense, Denmark

Purpose

Persons with musculoskeletal pain often suffer from pain in multiple locations. Multi-site pain has been shown to influence work ability and sickness absence, but the influence of number of pain sites (NPS) on return to work has yet to be clarified. The aim of this study was to measure the independent association between number of pain sites (NPS) and return to work (RTW) in adults absent from work due to musculoskeletal pain in the upper body (MSP).

Method

We conducted a phase 2 explanatory prognosis investigation of 122 citizens absent from work for less than nine weeks due to MSP. Participants were recruited from Sønderborg Municipality (public compensation agent) for an 11-month, two-arm RCT on physical activity. No between-group differences were seen in the RCT, and the groups were combined to form the cohort. The exposure was self-reported NPS at baseline based on a modified Nordic Musculoskeletal Questionnaire. The outcome was working status as registered by The Department of Financial Security in Sønderborg Municipality at 11-month follow-up. The independent association between NPS and RTW when adjusted for confounders relating to both outcome and exposure was evaluated using logistic regression analysis.

Results

At baseline, the mean NPS was 4.3 (2.36 SD). At 11 months, 71 (58.2%) had returned to work. A significant association was found between NPS and RTW in both the unadjusted model OR=1.31 [95% CI=1.11-1.55] and adjusted model OR=1.22 [95% CI=1.01-1.47] when adjusted for gender, age, body mass index ≥25, educational level, physical and mental health.

Conclusion

NPS was found to be an independent predictor of RTW in citizens absent from work due to MSP. The results from this study highlight the importance of assessing NPS when assisting persons with MSP in the RTW process.



What Have We Learnt From Qualitative Studies Regarding Patient Recovery In Musculoskeletal Research?

Corrie Myburgh1, Eleanor Boyle1, Ellie Pinsker2, Amanda Normandeau3, Maria Hondras4, Stacie Salsbury5, Dorcas Beaton2

1University of Southern Denmark, Denmark; 2Dalla Lana School of Public Health, University of Toronto, Toronto, Canada; 3Private research contractor; 4University of Kansas Medical Center; 5Palmer Center for Chiropractic Research, Palmer College of Chiropractic

Background: The relationship betweendisease-related recovery outcomes and the lived experiences of patients recovering from chronic musculoskeletal (MSK) disorders is poorly described in the literature. Methodologically, the complicated multifactorial nature of how individuals recover appears amenable to qualitative investigation. However, it is currently unclear whether these studies can be integrated into a unified framework from which to inform evidence-based practice, and stimulate hypothesis generation and testing. In this investigation, we evaluated and synthesized qualitative research focused on recovery in the MSK healthcare context. Methods: We conducted a systematic review of primary empirical literature, excluding investigations that did not integrate results into a conceptualization of recovery. Studies were evaluated for quality and potential to guide practice and policy using an existing hierarchy of evidence-for-practiceframework. Computer Assisted Qualitative Software facilitated thematic analysis across investigations. This study was registered prospectively via PROSPERO (ref no: 52476). Results: Thirteen studies (7 anatomic site specific and 6 regional/mixed MSK complaints) were included for full review. Hierarchical categorization revealed the majority of studies provided descriptive or conceptual frameworks for recovery, with 5 adjudged relevant for guiding policy and practice. Five themes emerged across studies: ‘the construct of recovery’, ‘pain in recovery’, ‘the process of recovery’, ‘adapting to a new individual norm’ and ’interaction with the health care system’. At least three distinct recovery phases were observed: resolution, adjustment/adaptation, and redefinition. Conclusions: Individuals’ perceptions of recovery are shaped and re-shaped internally by personal adaptation, rather than externally modified during treatment. Not recognising and reacting to shifts in the process, may render the recovery trajectory static and delay the individual’s return to health. Due to the complexity and spatiotemporal variability of recovery, the validity of single-item recovery outcome measures is questionable. Rather, outcome measures should be tailored to capture the spectrum of the recovery process.



GLA:D® Back: Perceived Work Ability in Primary Care Patients with Back Pain Relates to Intensity, Perceptions of Pain and Self-efficacy, but not to Age or Symptom Duration

Alice Kongsted1,2, Per Kjaer1,3, Inge Ris1, Jan Hartvigsen1,2

1Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Denmark, Odense, Denmark; 2Nordic Institute of Chiropractic and Clinical Biomechanics, Odense, Denmark; 3Department of Applied Health Science, University College Lillebaelt, Odense, Denmark

Background: Back pain is the leading cause of disability globally, and responsible for 20% of days with sick leave and 6% of Danish disability pensions. Still, most people consulting primary care for back pain are not absent from work. Therefore, it is important to address who are at risk of work disability and how this might be prevented. However, work ability is sparsely investigated in primary care populations with back pain, and there is little evidence to inform what determines perceptions of work ability, when experiencing back pain.

Objective: This study investigated to what extent self-perceived work ability is affected across age-groups of primary care patients with back pain, and if self-perceived work ability is associated with back pain characteristics, illness perceptions and pain self-efficacy.

Method: Patients aged 18-75 enrolled in a primary care education and exercise intervention for persistent back pain, GLA:D® Back, scored their work ability 0-10 (10 = ‘as when best’), and completed The Arthritis Self-Efficacy Scale modified for back pain and the Illness Perceptions Questionnaire as part of a pre-treatment questionnaire. Associations between work ability and other factors were tested using linear mixed effect models.

Preliminary Results: From 220 patients (20% aged >60), 9% were on sick leave when enrolled. People absent and not absent from work reported mean self-perceived work ability 4.4 (SD=2.0) and 7.2 (SD=1.7) respectively. Perceived work ability was unrelated to age and duration of back pain, but associated with back pain intensity, illness perceptions and self-efficacy.

Conclusions: Back pain patients reported reduced work ability also when not absent from work. This was associated with perceptions of pain as threatening, high pain intensity, and low self-efficacy. The interplay between these factors with work absenteeism needs further investigations.

Patient enrolment is ongoing and we expect to present results from 500 participants at WDPC-2019.



Sleep-Work-Activity Profiles (SWAP) and Low Back Pain: A Compositional Latent Profile Analysis

Nidhi Gupta1, David Hallman2, Dorothea Dumuid3, Charlotte Lund Rasmussen1,4, Marie Birk Jørgensen5, Andreas Holtermann1,6

1National Research Centre for the Working Environment, Copenhagen, Denmark; 2Centre for Musculoskeletal Research, Department of Occupational and Public Health Sciences, University of Gävle, Gävle, Sweden; 3Alliance for Research in Exercise, Nutrition and Activity (ARENA), School of Health Sciences, University of South Australia, Adelaide, South Australia, Australia; 4Department of Public Health, Section of Social Medicine, University of Copenhagen, Copenhagen, Denmark; 5Department of Forensic Science, University of Copenhagen, Copenhagen, Denmark; 6Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark

Introduction

A current pain prevention approach is to promote daily physical activity or reduce prolonged sedentary time. Another preventive approach could be to facilitate a balance between all activities and postures at work, leisure, and sleep. The aim of the study is to identify profiles indicating various balances between activities and postures at work, leisure and sleep, termed sleep-work-activity profiles (SWAP) and to investigate their association with low back pain (LBP) in a working population.

Methods

Eight-hundred-and-seven workers self-reported LBP intensity and worn thigh-based accelerometer to determine the daily time-use composition of sedentary behaviors, standing still and light (LIPA) and moderate to vigorous physical activity (MVPA) at work and leisure and bedtime, that were isometrically log-transformed (ilr). The SWAP profiles were determined using latent profile analysis on ilr data. Multiple linear regression was used to determine the association between profiles and LBP.

Results

Four SWAP were determined—Chimpanzees (n=226), Lions (n=179), Ants (n=244), Koalas (n=158). Compared to Chimpanzees that were moderately active at work [mean in minutes; (sedentary=197, standing still=147, LIPA=60, MVPA=57)] and highly active at leisure (sedentary=306, standing still=121, LIPA=62, MVPA=52, bedtime=440), (a) Lions were more active at work, more sedentary at leisure and had more bedtime, (b) Ants were more active at work and leisure, and had similar bedtime; (c) Koalas were more sedentary at work and leisure and had more bedtime. Compared to Chimpanzees, Lions had significantly lower LBP (B=-0.76, P=0.02), while Ants and Koalas were not significantly different.

Conclusion

The SWAP are associated with LBP. Future studies should investigate if this approach of obtaining a balance between various activities and postures at work and leisure and sleep is better than only increasing physical activity or reducing sedentary time, for understanding, preventing, and reducing LBP.



Beyond Symptom Resolution: Insurance Case Manager’s Thoughts on What can be Used to Predict Recovery

Maurizio A. Trippolini1,2,3, Amanda E. Young3,4, Glenn Pransky5, Nieke A. Elbers6, Keri Lockwood7, Ian D. Cameron7

1Bern University of Applied Sciences, Deptartment of Health, Bern, Switzerland; 2Massachusetts General Hospital (MGH) Institute for Health Professions, PhD program in Rehabilitation Sciences, Charlestown, Boston, USA; 3Center for Disability Research, Liberty Mutual Research Institute for Safety, Hopkinton, MA, USA; 4Young Normandeau & Co., Hopkinton, MA, USA; 5Department of Quantitative Health sciences, University of Massachusetts Medical School, Worcester, MA, USA; 6Netherlands Institute for the Study of Crime and Law enforcement. Faculty of Law, VU University Amsterdam, Amsterdam, The Netherlands; 7John Walsh Centre for Rehabilitation Research, Kolling Institute, University of Sydney, St Leonards, NSW Australia

Purpose: Insurance company case managers (CMs) play a critical role in the rehabilitation process of people with musculoskeletal disorders after minor motor vehicle crash injuries (MSD-MV) due to their interaction with multiple stakeholders over the course of the condition, and role in approving various services. This study aimed to identify factors that CMs perceive as predictive of recovery in people with MSD-MV.

Materials and Methods: To explore the perspectives of CMs in Australia (n=20) and the USA (n=20), semi-structured interviews explored factors that CMs thought provided an early indication of likely recovery outcomes in people with a MSD-MV injury. A framework analysis was applied.

Results: CMs demonstrated a broad, detailed understanding of biopsychosocial and contextual issues influencing recovery. They emphasized affect and motivation, style of communication, role of lawyers, family and friends, cultural and geographic variation. The overarching themes perceived as having a major influence on recovery outcomes were general health, pain processing and response, work situation, and compensation entitlement.

Conclusions: CMs broad and detailed perceptions about recovery may provide additional, valuable perspectives for professionals

 
1:00pm - 2:30pmPrevention
Session Chair: Martin Lindhardt Nielsen
Session Chair: Mette Jensen Stochkendahl
Room 97 
 

Making Sense of Conflicting Data on Work Exposures and Their Relationship to the Development of Knee Osteoarthritis: Findings from a Systematic Review.

Kim Cullen1,2, Monique Gignac1,3,4, Emma Irvin1, Dwayne Van Eerd1

1Institute for Work & Health, Toronto ON, Canada; 2School of Human Kinetics & Recreation, Memorial University of Newfoundland, St. John's NL, Canada; 3Dalla Lana School of Public Health, University of Toronto, Toronto ON, Canada; 4Toronto Western Research Institute, Toronto ON, Canada.

Objective: Knee osteoarthritis (OA) is a leading cause of disability worldwide. A recent systematic review of the literature identified inconsistent findings across studies regarding the relationship between similar occupational activities (i.e., kneeling, squatting and knee bending) and the development of knee OA. Using sensitivity analyses, we sought to explain these inconsistencies to better inform work disability prevention decision making and to identify future knowledge needs.

Methods: Using the findings from a recent systematic review, we employed sensitivity analyses to examine similarities and differences in study findings related to sex/gender, job activity measurement (e.g., how knee activities were measured), work exposures and dose response information (e.g., duration, frequency of knee activities), early or late OA diagnosis, study designs, and methodological quality.

Results: Twenty studies provided data on the relationship between kneeling, squatting and/or knee bending job activities and the development of knee OA. Overall findings were often inconsistent across studies. For example, across men and women, strong or moderate evidence emerged for knee OA when combining kneeling, squatting and bending activities. Yet, there was no effect when squatting and kneeling were examined individually. Sensitivity analyses help explain the findings and highlight the need for attention to measurement, including whether compartmentalizing or differentiating among knee bending tasks accurately reflects real-world work conditions; the frequency and duration of knee bending; and whether knee bending occurs in conjunction with lifting heavy loads.

Conclusions: Sensitivity analyses provide insight into inconsistent findings in the relationship between specific job activities and the development of knee OA. These findings inform work disability prevention efforts and highlight additional research gaps, especially in measurement of work activities, the consideration of sex and/or gender differences and dose response relationships for the development of knee OA.



Promoting Resilience for Workers on Prolonged Work Disability: Developing a transdiagnostic intervention

Eve Dulude, Marie-José Durand, Marie-France Coutu

Université de Sherbrooke, Canada

Purpose: Growing evidence supports the importance of resilience in the rehabilitation of client’s with musculoskeletal disorders (MSD) or common mental disorders (CMD). Yet, there is a lack of operationalized intervention on resilience in work rehabilitation. This study aims to develop a transdiagnostic intervention promoting resilience in prolonged work disability, and to explore its acceptability with workers.

Methods: A multimethod design was used. First, a scoping review on resilience and associated factors for (1) MSD and (2) CMD was conducted. Data was synthesized into common themes to form a preliminary version of the intervention logic model. Second, 10 expert clinicians in work rehabilitation with knowledge on resilience completed an online survey including questions and proposed changes on the clarity, applicability, relevance and exhaustiveness of the preliminary version. Third, the same experts participated in a group consensus to adapt the intervention logic model. Fourth, we interviewed workers who completed a work rehabilitation program on the prospective acceptability of the adapted version of the intervention. Thematic analysis of the verbatim was performed.

Results: 14 studies in MSD and 9 in CMD were reviewed. 11 common resilience factors were found for both MSD and CMD. Based on these results the preliminary intervention logic model was developed and included: 4 specific and 9 intermediate objectives, 5 activities and 44 tasks. Expert clinicians indicated in the survey 15/29 questions needing consensus. 41 proposed changes yielded a consensus on 15 modifications on the clarity, pertinence, and exhaustiveness of the intervention. Six workers (3 MDS; 3 CMD) had positive attitudes toward the intervention, found it useful and coherent with their values.

Conclusion: A systematic method was used to develop and operationalize an intervention logic model based on literature, expert clinicians and users; thus proposing a novel resilience intervention in work rehabilitation.



Two Systematic Reviews on Economic Evaluations of Interventions Aimed at Preventing Work-Related Musculoskeletal Disorders and Common Mental Disorders

Hélène Sultan-Taïeb1, Aurélie Gaillard2

1Université du Québec à Montréal, Canada; 2Université de Bourgogne

Background: The literature is quite scarce on cost-benefit results of preventive interventions in occupational and health safety. We performed two systematic reviews on the prevention of work-related musculoskeletal disorders (WMSD) and common mental disorders (CMD). We had two objectives: (1) to analyze the cost-benefit results, (2) to explore factors related to the implementation process of these interventions (obstacles and levers) in order to identify whether economic results may be due to a successful or unsuccessful implementation. Methods: Systematic review. Studies were searched in eight electronic databases and in reference lists of included studies. Companion papers were identified through backward and forward citation tracking. A quality assessment tool was developed following guidelines available in the literature. An integration of quantitative economic results and qualitative implementation data was conducted following an explanatory sequential design. Results: Regarding WMSD, out of 189 records, nine studies met selection criteria. Out of nine included studies, grouped into four types of interventions, seven yielded positive economic results, one produced a negative result and one mixed results (negative cost-effectiveness and positive net benefit). However, the level of evidence was limited for the four types of interventions. Results regarding CMD are under process. Among the included studies on WMSD, negative and mixed economic results were observed when the dose delivered and received by participants was low, when the support from top and/or middle management was limited either due to limited participation of supervisors or a lack of financial resources and when adequacy of intervention to workers’ needs was low. In studies on WMSD where economic results were positive, implementation data showed strong support from supervisors and a high rate of employee participation. Conclusion: Economic evaluation should include information on the implementation process in order to permit the interpretation of economic results.



Indicated Prevention Interventions in the Workplace for Depressive Symptoms: A Systematic Review and Meta-analysis

Yeshambel Tesfa Nigatu, JinaLi Wang

University of Ottawa, Institute of Mental Health Research

Background: Depressive symptoms are highly prevalent and cause substantive morbidities and loss of functioning among employees. Depression may be prevented at its early stages. However, there is a paucity of information regarding indicated preventive interventions for depression among employees. The objective of this review is to examine the effectiveness of indicated interventions for the reduction of depressive symptoms in the workplace.

Methods: A systematic review and meta-analysis of articles published between January 2000 and September 2017 was conducted using major electronic databases including PubMed/MEDLINE, PsycINFO, EMBASE, SOCINDEX, and ABI/ProQuest. Studies were selected based on a set of predefined inclusion criteria. Primary outcome measures were depressive symptomatology, and the nature of the interventions was indicated prevention. Studies were pooled based on the intervention type and the effect size was measured using the standardized mean difference.

Results: A computer and hand search of the literature yielded 4,462 papers, from which 16 trials were identified to be suitable for meta-analysis. Eight of 16 studies reported significant effects for workplace preventive interventions targeting depressive symptoms in which six were cognitive behavioral therapy (CBT) based interventions and two were non–CBT-based interventions. Small to medium effect sizes were found for both CBT- and non–CBT-based interventions (standardized mean difference = –0.44, 95% CI= –0.61, –0.26, I2=62.1% and standardized mean difference= –0.32, 95% CI= –0.59, –0.06, I2=58%, respectively).

Conclusions: This review demonstrates that indicated interventions can significantly reduce the level of depressive symptoms among workers. The implementation of evidence-based workplace interventions should consequently be considered to prevent the development of depressive symptoms among employees.



Cross-Country Comparison Model For Work Disability Prevention

Angelique De Rijk, Inge Houkes

Maastricht University, Netherlands, The

Background: Work disability research is in need for a model for comparing legislation and other social context factors across countries. The model should support systematic interpretation of research outcomes, their transferability and inform on country specific implementation requirements. The large cross-country differences in labour participation of persons with chronic diseases is one of the important issues. Our aims were (1) to develop a generic model for cross-country comparison in relation to work disability prevention and (2) to validate this model regarding labour participation of persons with chronic diseases.

Method: New institutional theory (NIT) was used to develop a generic model. Empirical evidence for the relation between model concepts and labour participation of persons with chronic diseases was searched for by a scoping review of the literature.

Results: The Cross-Country Comparison model for Work Disability Prevention (CCC-model for WDP) consists of five concepts representing a country’s social context: (1) regulative institutions (legislation); (2) normative institutions (norms and values of professionals and lay persons involved); (3) WDP organizations and professions; (4) cultural-cognitive institutions (cultural beliefs); (5) labour market characteristics. Relations with labour participation of persons with chronic diseases were found for specific variables within each concept: (1) welfare state type, employment protection and anti-discrimination legislation; (2) norms regarding work, sick role, professional role and gender role; (3) WDP organizations and professionals; (4) hierarchy and individualism; (5) informal employment, contract and job type.

Conclusion: The CCC-model for WDP is a generic model consisting of five main concepts. The model was validated for interpreting cross-country differences in labour participation of persons with chronic diseases. The model can guide systematic interpretation of empirical findings in relation to WDP across countries, and inform on policy changes and intervention development in line with a country’s social context.



Process And Content Of The French Guidelines For Work Disability Prevention

Jean-Baptiste Fassier1,2, Audrey Petit3, Camille Baumann4, Karine Petitprez5, Ludivine Nohalès6, Laetitia Rollin7, Sophie Fantoni8

1UMRESTTE UMR T9405, Université Claude Bernard Lyon 1, France; 2Occupational health and medicine department, Hospices Civils de Lyon, France; 3Centre de consultations de pathologie professionnelle du CHU d’Angers, Angers, France / INSERM, U1085, IRSET, Equipe ESTER , Université d'Angers; 4Institut de Santé au Travail du Nord de la France, Lille, France; 5Haute Autorité de Santé, Paris, France; 6Cellule d'Urgence Médico-Psychologique CUMP 69, Hospices Civils de Lyon, France; 7Centre de consultations de pathologie professionnelle du CHU-Hôpitaux de Rouen, CISMeF-TIBS-LITIS EA 4108, Université de Rouen; 8Centre de consultations de pathologie professionnelle du CHU de Lille, CRDP EA 4487, Université Lille

Context

Due to the rising trend in the number of disabled workers, work disability prevention (WDP) has been identified as an objective of the national health policy in France. The French Society of Occupational Medicine and the French National Authority for Health (HAS) commissioned guidelines for WDP.

Methods

It was chosen to focus on the most disabling conditions, including musculoskeletal disorders, cancer, common mental health disorders, neurological and cardiovascular diseases. A bibliographic search was performed in Medline, Central, Lissa, Scisearch, Cairn and Eficatt from 2007 to 2018. References were reviewed by title and abstract (n=1393) and full text (n=286), before inclusion in the evidence base (n=157). Existing guidelines, meta-analysis and literature reviews were considered in priority. Recommendations were formulated, reviewed and modified by a multidisciplinary task force of 25 experts. Each recommendation was then rated by a reading group of 82 stakeholders. Final version was elaborated by multidisciplinary working group consensus based on HAS method.

Results

General recommendations pertain to the WDP missions of occupational health (OH) services, compliance with the regulatory framework, coordination of actors, and analysis of the factors influencing occupational prognosis. Most recommendations applied whatever the medical conditions. Specific recommendations were formulated in some disabling conditions where appropriate. It is recommended that OH professionals formulate a return-to-work (RTW) plan for the management of workers on sick leave beyond 3 months, including a shared analysis of the situation, a list of barriers and facilitators, and the solutions to be implemented and evaluated. A catalogue is provided including key measures to facilitate RTW and job retention. Similar recommendations are developed for workers who are still at work with health problems.

Conclusion

These are the first French recommendations for WDP. Improving OH practices will require the active dissemination of these recommendations with tools and incentives to facilitate their use.

 
Date: Friday, 07/Jun/2019
11:00am - 12:30pmPrecarious workers and vulnarable groups
Session Chair: Ellen MacEachen
Session Chair: Astrid Velasquez Sanchez
Room 97 
 

Work-related mental disorders in the workplace and in the Workers Compensation System

Yun Ladegaard, Janne Skakon, Bo Netterstrøm

University of Copenhagen, Denmark

Background Challenges in the psychosocial work environment are key issues in the current labour market. Psychosocial risks, such as work-related stress and workplace violence, are widely recognized as major challenges to occupational health and safety. Current study focuses on work-related mental disorders such as stress-related disorders, depression and PTSD. How are these work-related mental disorders handled at the workplace respectively in the Workers’ Compensation System?

Methods The project applied a variety of methodological approaches, thus data consisted of expert and stakeholder interviews (N=23) and patient interviews (N=23), analyzing interview data from a grounded theory approach, respectively questionnaire responses from employees with workers compensation claims of mental disorders (N=436), analyzing data with Chi2 tests.

Results From the employee perspective, a workers compensation claim of a mental disorder, was most often submitted with the aim of initiating prevention in the work environment, to spare colleagues of similar negative experiences and demands. However employees often reported that both the workplace and Workers’ Compensation System took an isolated approach at the individual. Changes in the work environment and workplace inspections were rarely detected by the employee. Managers were frequently experienced negatively by the employee while health-and-safety or union representatives were often experienced as uninvolved. Further, many employees received inadequate information from the Workers’ Compensation System and found compensation schemes difficult to fill out. Workers’ compensation claims could be an obstacle for RTW.

Conclusions Strengthened interactions between the legislative/insurance and workplace systems are needed to enable information about psychosocial hazards to be used systematically to prevent work-related mental disorders. Workers’ compensation claims might be a valuable source in this matter. Employees with work-related mental disorders should not be advised against filing compensation claims solely in concern for their health, but there are room for improvement in the Workers’ Compensation System



Work Motivation And Employment Outcomes In People With Severe Mental Illness

Miljana Vukadin1, Frederieke G. Schaafsma1, Sandra J. Vlaar1, Jooske T. Van Busschbach2, Peter M. Van de Ven1, Harry W.C. Michon3, Johannes R. Anema1

1Amsterdam UMC, Vrije Universiteit Amsterdam, Netherlands, The; 2University of Groningen, University Medical Center Groningen; 3Trimbos Institute, The Netherlands Institute of Mental Health and Addiction

Purpose: To explore associations between self-reported work motivation and employment outcomes in people with severe mental illness (SMI), who expressed a wish to work and were enrolled in Individual Placement and Support (IPS) or a traditional vocational rehabilitation (TVR) program, and to assess whether associations between work motivation and employment outcomes differ between the two programs.

Methods: Data of 151 study participants, collected from a randomised controlled trial with a 30-month follow-up period, were used for a secondary data analysis. Cox regression and multiple linear regression analyses were performed to analyse the association between work motivation and time until job obtainment and job duration.

Results: No direct association was found between work motivation at baseline and time until job obtainment (HR = 1.37, 95% CI 0.48-3.32, p = 0.48) and (log-transformed) job duration (B = -0.99, 95% CI -2.59-0.61, p = 0.22, R-squared = 0.05). These associations did not differ between IPS and TVR. However, corrected for program, age modified the association between work motivation and time until job obtainment (p = 0.01): in younger people (17-33 years) higher work motivation was associated with shorter time until job obtainment (HR = 3.50, 95% CI 1.12 - 10.93, p = 0.03), whereas no such association was found in older people (HR = 0.29, 95% CI 0.06-1.38, p = 0.12).

Conclusions: Results suggest that work motivation is an ambiguous factor with regard to employment outcomes in people with SMI. Assessing work motivation, however, could be relevant for younger people who are enrolled in a vocational rehabilitation program.



A Systematic Review and Meta-Analysis of Observational Studies Identifies the Prevalence of Workplace Violence Among Physicians

Amin Yazdani5, Behdin Nowrouzi-Kia1, Emily Chai2, Koyo Usuba1, Behnam Nowrouzi-Kia3, Jennifer Casole4

1Laurentian University, Canada; 2University of Toronto, Canada; 3McMaster University, Canada; 4Loretto College, Canada; 5Conestoga College and the University of Waterloo

Objectives: The objective of this systematic review was to identify the types of workplace violence (WPV) present in the work environment of doctors. Moreover, a meta-analysis was completed to estimate the prevalence of WPV among doctors.
Methods: Primary papers on workplace violence in medicine were identified through a literature search in four health databases (Ovid Medline, Embase, PsychoINFO and CINAHL). The study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for the mapping and identification of records. To assess the studies included in our review, we used the Critical Appraisal Skills Programme cohort review checklist. All analyses were performed in R 3.4.3 and “metafor” package was used for the meta-analysis of proportions. The risk of bias was examined using the Cochrane Collaboration ‘risk of bias’ assessment tool across six domains.
Results: Thirteen articles were reviewed from a total of 2,154. Our systematic review outlined factors of physician WPV as following: (1) remote healthcare areas, (2) understaffed shifts, (3) mental/emotional stress of patients/visitors, (4) insufficient security, (5) cultural differences, and (5) lacking preventative measures.
Conclusions: The impact of WPV on healthcare institutions is profound and far-reaching. Thus, steps must be taken to promote an organizational culture where there are measures to protect and promote the well-being of doctors. Our recommendations are to encourage policy amendments that may begin to alleviate the negative impacts of WPV against physicians.



The Brainwork Intervention for Precarious Workers with Psychological Problems: Effect on Sickness Absence

Selwin S. Audhoe1, Karen Nieuwenhuijsen2, Jan L. Hoving2, Monique H.W. Frings-Dresen2

1Research Center for Insurance Medicine; 2Amsterdam UMC, University of Amsterdam, The Netherlands

Background Precarious workers are unemployed and temporary agency workers and workers with an expired fixed-term contract. Once these workers are on sick leave due to psychological problems, they are at high risk for prolonged work disability. The Brainwork intervention offers them a customized program attuned to their psychological and psychosocial problems. The components of the intervention, provided by vocational rehabilitation agencies and mental health institutions/professionals, can include an exercise program, vocational training, gym membership, and psychological interventions. The protocol further commended short lead times, ensuring timely telephone and face-to-face contacts of workers with professionals.

Objective The aim of this study was to assess the effect of the Brainwork intervention, compared to usual care, on sick leave over a 12-month follow-up.

Methods In a controlled clinical trial, using a quasi-randomization procedure, we compared the Brainwork Intervention (n = 164) to usual care (n = 156). The primary outcome was duration of sick leave, differences between the groups were tested using Cox regression analysis. Protocol adherence (Brainwork Intervention) was considered sufficient when at least three of the five protocol steps were followed within the pre-specified timeframe.

Results At six months, the Brainwork Intervention resulted in a non-significant reduction of the duration of sick leave compared to usual care (171 days versus 185 days; HR = 1.34; 95% CI 0.91−1.97; p = 0.14). Protocol adherence was low, 10% of the workers received the program according to the pre-specified timeline and 32% did not receive the intervention at all.

ConclusionsThe Brainwork Intervention, as implemented, did not result in a significant reduction of the duration of sick leave compared to usual care at six months, the 12-months follow up data will be analyzed by the end of 2018.



Indicators of Opioid Misuse Among Workers' Compensation Claimants

Sheilah Hogg-Johnson1, Nancy Carnide2, Hyunmi Lee2, Andrea Furlan3, Pierre Cote4, Mieke Koehoorn5

1Institute for Work & Health, Canadian Memorial Chiropractic College, University of Toronto; 2Institute for Work & Health; 3Institute for Work & Health, Toronto Rehabilitation Institute, University of Toronto; 4University of Ontario Institute of Technology, Canadian Memorial Chiropractic College; 5University of British Columber

Background & Objectives: Several studies have reported an association between opioid use and prolonged work disability among workers’ compensation (WC) claimants. Other potential risks associated with opioids include addiction and overdose. Our objective was to derive indicators of potential opioid misuse among WC claimants using a population-based network of prescription dispensing records.

Methods: Historical cohort of WorkSafeBC low back pain (LBP) claimants 1998 to 2009 with 1+ opioid prescriptions in the year following injury. Data were provided by Population Data BC. Prescription records for opioids dispensed within one year of injury included dispense date, drug identification number, drug strength, quantity, and days supply. Indicators of potential opioid misuse included: average daily morphine equivalent dose > 120 mg/day and TROUP misuse score (range 0-16) combining indicators of days supply, # of prescribers and # of pharmacies (Sullivan et al Pain 2010;150(2):332-339).

Results: Of 97,124 LBP claimants, 37,695 (39%) had 1+ opioid prescription in year after injury. Average daily MED > 120 mg/day was observed for 311 (0.8%). The TROUP misuse score was categorized as: no misuse (scores 0-1), possible misuse (scores 2-4) and probable misuse (score 5-16) with 35,053 (93.1%), 2096 (5.6%) and 490 (1.3%) claimants respectively. There were 542 (1.7%) claimants with 5+ opioid prescribers within a six-month window and 212 (0.7%) using 5+ pharmacies within a 28-day window. The proportion of probable misuse was steady year to year, but possible misuse increased from 4.9% in 1998 to 6.7% in 2009.

Conclusions: A small proportion of claimants displayed dispensing patterns suggestive of misuse. There are limitations to indicators based on dispensing patterns as it is difficult to obtain valid estimates of addiction. Nevertheless, indicators of misuse derived from administrative data may have some value as a screening tool. Based on this study, it appears that prevalence of misuse is low.



How Likely Are Icelandic Employers To Hire Individuals With Decreased Workability And Does Attitude Affect This Decision?

Jonina Waagfjord

VIRK Vocational Rehabilitation Fund, Iceland

Background: It has been well established that work is beneficial for people´s health and well-being. As the workforce ages, dealing with disability will become more of an issue than it is today, and employers play a crucial role in hiring, managing and retaining these employees.

Objective: The aim of this study is to examine how likely employers, participating in an ongoing return-to-work (RTW)-project with VIRK Vocational Rehabilitation Fund, are to hire individuals with decreased workability and if attitude affects the decision. The study is part of a larger study conducted by the Icelandic Ministry of Welfare in cooperation with VIRK, examining Icelandic employer´s perceived barriers and enablers to employment of individuals with decreased workability. The results will support preparation of a new governmental policy aiming to improve labour market participation of individuals with decreased workability.

Method: Cross-sectional survey using an electronically administered questionnaire. 589 (45% response rate) employers participated with 57% of them randomly sampled and 43% a convenience sample of employers associated with VIRK VR and the Directorate of Labour.

Results: Employers with prior experience of hiring were significantly more likely to hire again within the next two years and increased numbers of hiring, and size of the company, increased this probability. This was also true for companies connected with VIRK VR and they were also significantly more likely to have a RTW-plan, to stay in contact with and to accommodate returning employees (i.e. changing worktime and work duties, adjusting work environment, reposition to another job). These employers also demonstrated significantly more positive attitudes in relation to absenteeism, job flexibility and invited more diversity.

Conclusion: Results emphasise the importance of formal education to and interaction with employers, by special employment counsellors employed in the RTW-project, resulting in more positive attitude and increased willingness to hire individuals with decreased workability.