Evaluating the Costs and Benefits of Gradually Returning to Work after a Work-Related Musculoskeletal Disorder
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
1Department of Sports Science and Clinical Biomechanics University of Southern Denmark, Denmark; 2Nordic Institute of Chiropractic and Clinical Biomechanics, Odense, Denmark
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).
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.
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.
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?
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
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
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
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.
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.
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.
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
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