Use of Framingham Risk Score as a Clinical Tool for the Assessment of Fitness for Work

Results From a Cohort Study
Objective: The aim of this study is to validate the use of the Framingham Risk Score (FRS) as clinical tool to predict the risk of diagnosis of unsuitability for work in a cohort of Italian workers.
Methods: A cohort of workers has been observed from January 2006 to March 2014. FRS was calculated at each visit. Health surveillance diagnosis of unsuitability for work was selected as outcome.
Results: Two thousand eight hundred fifty seven workers were observed, 58.9% were men, mean age was 51.6 (±6.7), the mean FRS was 15.1% (±10.7%). Increased values of FRS at baseline were associated with increased rate of diagnosis of unsuitability for work (Hazard ratio [HR], 11.2, 95%CI, 3.3 to 37.8).
Conclusions: FRS is a strong predictor of diagnosis of unsuitability for work and should be used as a clinical tool for the assessment of fitness for work in health surveillance.

Source: Palladino, Raffaele; Caporale, Oreste; Nardone, Antonio; Fiorentino, Denise; Torre, Ida; Triassi, Maria. Journal of Occupational & Environmental Medicine: August 2016, Volume 58, Issue 8, p. 805-809.

Organizational justice and disability pension from all-causes, depression and musculoskeletal diseases

A Finnish cohort study of public sector employees
Work-related psychosocial factors that are measured once may not provide an accurate estimate of long-term exposure. Thus, we used repeated measures of organizational justice to evaluate its association with disability pension in a cohort of 24 895 Finnish public sector employees. High organizational justice was associated with lower risk of disability pension due to depression and musculoskeletal diseases.

Source: Juvani A, Oksanen T, Virtanen M, Elovainio M, Salo P, Pentti J, Kivimäki M, Vahtera J. Scand J Work Environ Health, 2016.

Screening instruments for predicting return to work in long-term sickness absence

BACKGROUND: Multiple somatic symptoms are common and may cause prolonged sickness absence (SA) and unsuccessful return to work (RTW). AIMS: To compare three instruments and their predictive and discriminative abilities regarding RTW. METHODS: A longitudinal cohort study of participants recruited from two municipal job centres, with at least 8 weeks of SA. The instruments used were the Symptom Check List of somatic distress (SCL-SOM) (score 0-48 points), the Bodily Distress Syndrome Questionnaire (BDSQ) (0-120 points) and the one-item self-rated health (SRH) (1-5 points). The instruments' predictive value was explored in a time-to-event analysis. Different cut-points were analysed to find the highest number of correctly classified RTW cases, identified in a register on public transfer payments. RESULTS: The study involved 305 subjects. The adjusted relative risk regarding prediction of RTW was 0.89 [95% confidence interval (CI) 0.83-0.95], 0.89 (95% CI 0.83-0.95) and 0.78 (95% CI 0.70-0.86) per 5-, 10- and 1-point increase in the SCL-SOM, BDSQ and SRH, respectively. After mutual adjustment for the three instruments, only the prediction of RTW from SRH remained statistically significant 0.81 (95% CI 0.72-0.92). The highest sensitivity (86%) was found by SRH at the cut-point.

Source: Momsen AH, Stapelfeldt CM, Nielsen CV, et al. Occupational Médicine, 2016.

Research review on rehabilitation and return to work

This review is part of a project of the European Agency for Safety and Health at Work (EU-OSHA), initiated by the European Parliament, on the safety and health of older workers. The objective of the review is to provide an up-to-date summary of knowledge regarding vocational rehabilitation and return-to-work systems, programmes and interventions and their different components.


Return to Work Survey 2016 - Australia

In 2012 a working group consisting of representatives of Australian and New Zealand workers' compensation authorities, unions and employer groups developed a survey instrument and sampling methodology to be used to measure return to work outcomes of injured workers receiving workers' compensation and to better understand the experience of those injured workers and the factors that may have an effect on their return to work. In June 2012 Safe Work Australia's Strategic Issues Group for Workers' Compensation agreed to the survey instrument and methodology developed by the working group and the Social Research Centre was contracted to run the survey. In 2014, Safe Work Australia agreed that the survey should be run biennially. This is the third time the revised Return to Work Survey has been run.


Effectiveness of very early workplace interventions to reduce sickness absence

A systematic review of the literature and meta-analysis
This systematic review identified a lack of evidence to support the effectiveness of "very early" (less than 15 days after the start of sickness absence) workplace intervention to reduce sick leave compared to usual care. Lack of consensus on definition of "very early/early" interventions, methodological design of studies, the extent, and timing of usual care provided and variable compliance between groups might explain the absence of demonstrated benefit.

Source: Vargas-Prada S, Demou E, Lalloo D, Avila-Palencia I, Sanati KA, Sampere M, Freer K, Serra C, Macdonald EB. Scand J Work Environ Health, 2016.

Comparing the Relationship Between Age and Length of Disability Across Common Chronic Conditions

Objective: The aim of this study was to compare the association between age and disability length across common chronic conditions.
Methods: Analysis of 39,915 nonwork-related disability claims with a diagnosis of arthritis, diabetes, hypertension, coronary artery disease, depression, low back pain, chronic pulmonary disease, or cancer. Ordinary least squares regression models examined age-length of disability association across chronic conditions.
Results: Arthritis (76.6 days), depression (63.2 days), and cancer (64.9 days) were associated with longest mean disability lengths; hypertension was related to shortest disability lengths (41.5 days). Across chronic conditions, older age was significantly associated with longer work disability. The age–length of disability association was most significant for chronic pulmonary disease and cancer. The relationship between age and length of work disability was linear among most chronic conditions.
Conclusions: Work disability prevention strategies should consider both employee age and chronic condition diagnosis.

Source: Jetha, Arif; Besen, Elyssa; Smith, Peter M. Journal of Occupational & Environmental Medicine: May 2016, Volume 58, Issue 5, p. 485-491.

Effectiveness of Occupation- and Activity-Based Interventions to Improve Everyday Activities and Social Participation for People With Traumatic Brain Injury

A Systematic Review
This systematic review presents research on the effectiveness of occupation- and activity-based interventions to improve everyday activities and areas of occupation and social participation for people with traumatic brain injury (TBI). Nineteen studies identified through a comprehensive database search were reviewed and synthesized into five themes: (1) multidisciplinary and interdisciplinary treatment approaches, (2) community-based rehabilitation programs, (3) treatment approaches using client-centered goals and relevant contexts, (4) social skills training and peer mentoring interventions, and (5) community mobility interventions. Evidence supports the use of multidisciplinary and interdisciplinary approaches across a variety of settings, with no single treatment approach or setting clearly superior to another. The specific contributions of occupational therapy practitioners and the nature of occupational therapy interventions have not been well studied, making it difficult to determine the extent to which occupation- and activity-based interventions provided by occupational therapy practitioners improve occupational performance and social participation after TBI.

Source: Janet M. Powell; Timothy J. Rich; Elizabeth K. Wise. American Journal of Occupational Therapy, April 2016, Vol. 70.

Cross-cultural adaptation and validation of the Danish version of the 19-item return-to-work self-efficacy (RTWSE-19) questionnaire

A Danish version of the 19-item return-to-work self-efficacy (RTWSE-19) questionnaire was developed. The performance of a questionnaire may differ between populations and in various cultures. In order to use the RTWSE-19 in a Danish context, translation was necessary, and cross-cultural and conceptual adaptation needed to preserve the original purpose of the instrument.

Source: Hedeager Momsen A-M, Rosbjerg R, Stapelfeldt CM, Lund T, Jensen C, Johansen T, Nielsen CV, Labriola M. Scand J Work Environ Health, 2016.

Manual therapy for tension-type headache related to quality of work life and work presenteeism

Secondary analysis of a randomized controlled trial
OBJECTIVE: The objective of this research is to evaluate the efficacy of manual therapy for tension-type headache (TTH) in restoring workers quality of work life, and how work presenteeism affects this relation. DESIGN: This study is a secondary analysis of a factorial, randomized clinical trial on manual therapy interventions. Altogether, 80 patients (85% women) with TTH and without current symptoms of any other concomitant disease participated. INTERVENTIONS: An experienced therapist delivered the treatment: myofascial inhibitory technique (IT), articulatory technique (AT), combined technique (IT and AT), and control group (no treatment). RESULTS: In general, all treatments as compared to our control group had a large effect (f>/=.69) in the improvement of participants' quality of work life. Work presenteeism interacted with TTH treatment type's efficacy on participant's quality of work life. The inhibitory technique lead to higher reports of quality of work life than other treatment options only for participants with very low frequency of work presenteeism. In turn, TTH articulatory treatment techniques resulted in higher reports of quality of work life for a high to very high work presenteeism frequency. CONCLUSION: Articulatory manipulation technique is the more efficient treatment to improve quality of work life when the frequency of work presenteeism is high. Implications for future research and practice are discussed.

Source: Monzani L, Espi-Lopez GV, Zurriaga R, et al. Complementary Therapies in Médicine, 2016; 25: 86-91.

Relationship Between Opioid Prescribing Patterns and Claim Duration and Cost

Objective: The aim of this study was to assess the relationship between timing and duration of opioid prescriptions, disability duration, and claims costs for work-related injuries.
Method: A retrospective cohort study using lost time compensation claimant data to examine the relationship between opioid prescription patterns and claim duration and cost. Logistic regression adjusted for sex, marital status, initial reserve, attorney involvement, and spinal surgeries.
Results: Odds ratios for claim cost at least $100,000 and duration at least 3 years were not statistically different between groups prescribed opioids less than 30 days and those not prescribed opioids. Claims with short-acting opioids continued after 180 days; the odds ratios for claim cost at least $100,000 and duration at least 3 years were 6.21 (95% confidence interval 5.30 to 7.28) and 3.32 (95% confidence interval 2.94 to 3.74).
Conclusion: Claim cost and lost time are related to when and how long opioids are prescribed for work-related injuries.

Source: Lavin, Robert A. MD, MS; Tao, Xuguang (Grant) MD, PhD; Yuspeh, Larry BA; Kalia, Nimisha MD, MPH, MBA; Bernacki, Edward J. MD, MPH. Journal of Occupational & Environmental Medicine: March 2016, Volume 58, Issue 3, p. e90-e93.

Effects of graded return-to-work

A propensity-score-matched analysis
Objectives: Graded work exposure is deemed to have a therapeutic effect. In Germany, graded return-to-work (GRTW) is therefore frequently used following a rehabilitation program if workers are still unable to perform full job duties. The aim of the analyses was to determine long-term effects on disability pension and regular employment.
Methods: Analyses were performed with longitudinal administrative data. Patients aged 18–60 years who attended an orthopedic, cardiac, oncological, or psychosomatic rehabilitation between January and June 2007 were eligible to participate in a GRTW scheme. The effects of GRTW were analyzed by a propensity-score-matched comparison of patients with and without GRTW. Outcomes were disability pension rates, regular income, and the duration of receiving welfare benefits due to sickness absence and unemployment up to the end of 2009.
Results: The propensity-score-matched sample comprised 1875 patients on GRTW and 1875 matched controls not undergoing GRTW. The probability of a disability pension was decreased by about 40% among GRTW patients [5.4% versus 8.6%; hazard rate ratio (HR) 0.62, 95% confidence interval (95% CI) 0.49–0.80]. The three-year income (2007–2009) was EUR12 920 higher (95% CI EUR10 054–15 786) in the GRTW group. The duration of receiving welfare benefits due to sickness absence and unemployment was significantly reduced.
Conclusions: Graded work exposure supports labor participation and reduces the risk of permanent work disability.

Source: Bethge M. Scand J Work Environ Health, 2016.

Facteurs prédictifs d'une restriction d'aptitude ou d'une inaptitude au poste de travail antérieur en visite de reprise

Élaboration d'un score
L'objectif est d'étudier les facteurs liés à la décision d'aptitude du médecin du travail lors de la visite de reprise d'un salarié après un arrêt de travail pour maladie. Une enquête descriptive multicentrique transversale a été réalisée auprès de 402 salariés suivis par des services de santé au travail (SST) de l'agglomération stéphanoise. La reprise du travail au poste antérieur est significativement liée à certains facteurs professionnels et médicaux. Un score prédictif d'un avis d'aptitude autre que " apte " a été construit en renseignant quatre variables explicatives de l'avis d'aptitude identifiées dans l'analyse multivariée. Ce score pourrait être utilisé pour identifier en amont les situations difficiles de reprise du travail, de manière à mieux anticiper la mise en place des procédures de maintien dans l'emploi.


Rehabilitation and return to work

An analysis of EU and Member State systems and programmes
Against the backdrop of the ageing workforce, this report gives an overview of the approaches taken to rehabilitation and return to work throughout Europe. It analyses the factors that influence whether rehabilitation and return-to-work systems are developed and implemented in countries, and it goes on to identify particular success factors of these systems in Europe. It concludes by discussing the policy-relevant findings, and identifying areas where additional research is required to bridge the current knowledge gaps.


Sickness absence and mental health

Evidence from a nationally representative longitudinal Survey
Objectives Previous studies have consistently reported evidence of large significant associations between measures of psychological health and sickness absence. Some of this association, however, may be confounded by relevant covariates that have not been controlled. By using data with repeated observations from the same individuals, this study aimed to quantify the bias due to unobserved characteristics that are time invariant.
Methods Longitudinal data from the Household, Income, and Labour Dynamics in Australia (HILDA) Survey were used to estimate negative binomial regression models of the number of annual paid sickness absence days. Observations spanning the period 2005–2012, and covering all employed persons aged 15–64 years, were used (56 348 observations from 13 622 individuals).
Results Significant associations between the number of paid sickness absence days taken each year and scores on the mental health subscale of the SF-36 (MHI-5) were found. Inclusion of correlated random effects (which effectively control for unobserved person-specific factors that do not vary over time), however, resulted in a marked decline in the magnitude of this association. For persons with severe depressive symptoms (MHI-5 ≤52), the estimated incidence rate ratios were in the range 1.13–1.14 for men and 1.10–1.12 for women.
Conclusions Poor mental health is a risk factor affecting work attendance, but the magnitude of this effect, at least in a country where the rate of sickness absence is relatively low, is modest.

Source: Wooden M, Bubonya M, Cobb-Clark D. Scand J Work Environ Health, 2016.

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