Length of Disability and Medical Costs in Low Back Pain

Do State Workers' Compensation Policies Make a Difference?
Objective: The aim of the study was to examine the impact of state workers' compensation (WC) policies regarding wage replacement and medical benefits on medical costs and length of disability (LOD) in workers with low back pain (LBP).
Methods: Retrospective cohort analysis of LBP claims from 49 states (n?=?59,360) filed between 2002 and 2008, extracted from a large WC administrative database.
Results: Longer retroactive periods and state WC laws allowing treating provider choice were associated with higher medical costs and longer LOD. Limiting the option to change providers and having a fee schedule were associated with longer LOD, except that allowing a one-time treating provider change was associated with lower medical costs and shorter LOD.
Conclusions: WC policies about wage replacement and medical treatment appear to be associated with WC LBP outcomes, and might represent opportunities to improve LOD and reduce medical costs in occupational LBP.

Source: Shraim, Mujahed; Cifuentes, Manuel; Willetts, Joanna L.; Marucci-Wellman, Helen R.; Pransky, Glenn. Journal of Occupational & Environmental Medicine: December 2015, Volume 57, Issue 12, p. 1275-1283.

Is Early Prescribing of Opioid and Psychotropic Medications Associated With Delayed Return to Work and Increased Final Workers’ Compensation Cost?

Objective: To explore the association between the initial 60 days of prescriptions for psychotropic medications and final workers' compensation claim outcomes.
Methods: A cohort of 11,394 claimants involved in lost time injuries between 1999 and 2002 were followed through December 31, 2009. Logistic regressions and Cox Proportional Hazard Models were used in the analysis.
Results: The initial 60 days of prescriptions for psychotropic medications were significantly associated with a final claim cost at least $100,000. Odds ratios were 1.88 for short-acting opioids, 2.14 for hypnotics, antianxiety agents, or antidepressants, and 3.91 for long-acting opioids, respectively. Significant associations were also found between decreased time lost from work and decreased claim closures during the study period.
Conclusions: Early prescription of opioids and other psychotropic drugs may be useful predictors of high claim costs and time lost from work.

Source: Tao, Xuguang (Grant), Lavin, Robert A.; Yuspeh, Larry; Weaver, Virginia M.; Bernacki, Edward J. Journal of Occupational & Environmental Medicine: December 2015, Volume 57, Issue 12, p. 1315-1318.

Work participation and health-related characteristics of sickness absence beneficiaries with multiple somatic symptoms

Objectives: The primary aim was to study whether high levels of multiple symptoms influenced sick-listed individuals' employment status or desire to return to work (RTW) and whether this was associated with social relations at work.
Study design: A cross-sectional study nested in a clinical trial.
Methods: In 2011–2012, 736 (34%) of 2172 sick-listed individuals completed a posted questionnaire and were included. Main outcome was self-reported employment status. The Symptom Check List (SCL-SOM)'s sum score (0–48) was categorized in high (>18) and low (≤18) levels. Previous employment, sick-listing, and use of health care were register-data. Multivariate logistic regression analyses with adjustments were performed.
Results: Beneficiarie with high SCL-SOM score (n = 218, 33%) reported poorer health, job satisfaction, a lower desire to RTW and more problems with supervisors. The risk of being unemployed was higher for this group than for those with a low score. Adjusting for general health reduced the association between symptoms and unemployment, whereas problems with social relations only affected it marginally.
Conclusions: Sick-listed individuals reporting high levels of symptoms were more often unemployed and less frequently desired to RTW than those with few symptoms. The association could not be explained by problems with social relations at work.

Source: Momsen AH, Nielsen CV, Nielsen MB, et al. Public Health, 2015.

Programme de prise de décision entre l'ergothérapeute et le travailleur ayant une incapacité due à un trouble musculosquelettique persistant

Les travailleurs et les autres acteurs qui prennent des décisions en matière d'interventions de retour au travail ont souvent des intérêts et des buts différents. Le processus de prise de décision partagée (PDP) est une approche centrée sur la personne qui permet d'agir sur les écarts entre les travailleurs et les autres acteurs par rapport au but et au plan d'action à mettre de l'avant. À notre connaissance, un programme de PDP n'avait jamais été spécifiquement contextualisé en réadaptation au travail.

Source: http://www.irsst.qc.ca/publications-et-outils/publication/i/100853/

Nordic approaches to disability prevention

Different approaches to disability prevention, including work modifications, work schedule redesign and national legislative changes were the topics at the Disability prevention seminar, held in Helsinki, Finland, by the Finnish Institute of Occupational Health (FIOH) on November 26.

Source: http://www.ttl.fi/en/news/Pages/Nordic_approach_to_disability_prevention_presentations.aspx

Chronic low back pain among French healthcare workers and prognostic factors of return to work (RTW)

A non-randomized controlled trial
Background: Many factors influence the return to work of workers with chronic low back pain (CLBP). They have been said to vary according to socio-professional group. This study first aimed to compare prognostic factors influencing the return to work of CLBP healthcare workers (HCWs) and other workers (non-HCWs) after rehabilitation coupled with an occupational intervention. The second objective was to improve the evolution of indicators such as clinical examination, psychosocial impact and pain impact.
Methods: Between 2007 and 2012, a cohort of 217 CLBP workers (54.8 %-women; mean age = 41.3 ± 9.5 years, 118 non-HCWs; 99 HCWs mainly from the public sector) was included in an ambulatory rehabilitation program (standard physiotherapy or intensive network physiotherapy) coupled with an occupational intervention. Workers completed a questionnaire and had a clinical examination at baseline and after 24 months' follow up. Physical, social and occupational data was collected at the same time. Statistical analyses were performed to evaluate prognostic factors for return to work and compare the two worker populations.
Results: There was no difference between groups for the rate of OP (occupational physician) intervention or type of physiotherapy. 77.3 % of workers returned to work after 2 years following inclusion. To be an HCW (OR 0.1; 95 % CI [0.03–0.34]), to have less than 112 sick- leave days (OR 1.00; 95 % CI [0.93–1.00]), a small fingertip-floor distance (OR 0.96; 95 % CI [0.93–0.99]), a low anxiety/depression score (OR 0.97; 95 % CI [0.95–1.00]), a low impact of CLBP on daily life (OR 0.96; 95 % CI [0.93–1.00]), and on quality of life (OR 0.98; 95 % CI [0.95–1.00]) at baseline were statistically associated with return to work after 2 years of follow up. Only the profession (workplace) was statistically associated with return to work after 2 years of follow up using multivariate analysis.
Conclusion: To our knowledge, this is the first cohort study concerning predictive factors of RTW among CLBP workers after 2 years of follow up. Interventions in the work environment did not seem to predict job retention significantly. But only 50 % of the employees in both groups (HCW and non-HCW) had one intervention at their workplace after 2 years. This study underlined the fact that the type of physiotherapy with a well-trained physiotherapist used to take care of CLBP could not impact on the RTW forecast. To develop these initial results, it might be interesting to study the comparison between private and public sectors and to randomize the physiotherapeutic intervention.

Source: Cougot, B., Petit, A., Paget, C., Roedlich, C., Fleury-Bahi, G., Fouquet, M. et al. (2015). Journal of Occupational Medicine and Toxicology. 10: 40. http://dx.doi.org/10.1186/s12995-015-0082-5

The capability set for work

Development and validation of a new questionnaire
Objectives: The aim of this study was to develop a questionnaire to measure work capabilities based on Amartya Sen's capability approach and evaluate its validity.
Methods: The development of the questionnaire was based on a combination of qualitative and quantitative methods: interviews, literature study, and an expert meeting. Additionally, in a survey, the validity was evaluated by means of hypotheses testing (using correlations and regression analyses).
Results: The questionnaire consists of a set of seven capability aspects for work. For each aspect, it is determined whether it is part of a worker's capability set, ie, when the aspect is considered valuable, is enabled in work, and is realized. The capability set was significantly correlated with work role functioning-flexibility demands (-0,187), work ability (-0.304), work performance (-0.282), worked hours (-0.073), sickness absence (yes/no) (0.098), and sickness absence days (0.105). The capability set and the overall capability item are significantly associated with all work outcomes (P<0.010).
Conclusions: The new capability set for work questionnaire appears to be a valid instrument to measure work capabilities. The questionnaire is unique because the items include the valued aspects of work and incorporate whether a worker is able to achieve what (s)he values in his/her work. The questionnaire can be used to evaluate the capability set of workers in organizations to identify aspects that need to be addressed in interventions.

Source: Abma FI, Brouwer S, de Vries HJ, Arends I, Robroek SJW, Cuijpers MPJ, van der Wilt GJ, Bültmann U, van der Klink JJL. Scand J Work Environ Health, 2015.

Entry into vocational rehabilitation program following work-related hand injury: potential candidates

OBJECTIVES: This case-control study aimed to investigate the predictors of return to work (RTW) following work-related major forearm, wrist or hand injury at the preparation stage of return to work. MATERIAL AND METHODS: A total of 80 clients were recruited and divided into 2 groups depending on their readiness of RTW. The groups were compared with each other with regard to their demographics, compensation status, hand injury severity, health perception, and time off work (TOW) using correlation coefficient. Predictors of RTW were measured by logistic regression analysis.
RESULTS: There were no significant differences in demographics and the severity of hand injury between 2 groups. Self-perceived physical functioning (p = 0.04), vitality (p = 0.01), mental health (p = 0.03) and TOW (p = 0.001) were significantly different between Action group and Preparation group. With binary logistic regression analysis, self-perceived vitality (odds ratio (OR) = 1.041) and TOW (OR = 0.996) were shown to be strongly predictive of RTW at the preparation stage of return to work. CONCLUSIONS: This study has shown that shorter TOW and better self-perceived vitality could predict early readiness for RTW after major work-related forearm, wrist or hand injury.

Source: Chen YH, Hsu CY, Lien SH, Yu SJ, Chang JM, Su SW, Chao YH. Int. J. Occup. Med. Environ. Health, 2016; 29 (1) : p. 101-111.

Economic Evaluation of a New Organizational RTW Intervention to Improve Cooperation Between Sick-Listed Employees and Their Supervisors: A Field Study

A Field Study
Objective: The purpose of this study is to assess the cost-effectiveness, -utility, and -benefit of a new organizational return-to-work intervention to improve COoperation between Sick-listed employees and their Supervisors (COSS).
Methods: A field study with 6 months follow-up comparing COSS with common practice randomized participants aged 18 to 60, working at least 12?hours/week and absent for at least 2 weeks. Outcomes were initial return-to-work, quality-adjusted life years, and productivity gains.
Results: After 6 months, COSS generated less costs when compared with common practice. Participants in the COSS group returned to work earlier, improvement in quality-adjusted life years were uncertain. Net benefits of COSS versus common practice yielded a productivity gain of €395.89.
Conclusions: Implementing COSS for sick-listed employees has potentials to reduce costs and improve productivity, and potentially quality of life. Longitudinal research might detect whether COSS also has the potential reaching sustainable return-to-work.

Source: Noben, Cindy; Hoefsmit, Nicole; Evers, Silvia; de Rijk, Angelique; Houkes, Inge; Nijhuis, Frans. Journal of Occupational & Environmental Medicine: November 2015, Volume 57, Issue 11, p. 1170-1177.

Understanding the Probability of a Disability Resulting From Work-Related Injuries

Objectives: To assess the conditions under which the measured risk of a workplace injury resulting in a disability changes.
Methods: Multivariate regression analysis and administrative claims data build an understanding of the factors that underlie the probability that a workplace injury results in a disability (disability probability).
Results: First, jointly examining injury incidence rates and disability probabilities challenges some conclusions suggested by examining the two separately. Second, some characteristics identified as risk factors for disability when studied in isolation are not risk factors. Third, risk factors are qualitatively consistent across groups of workers but quantitatively different.
Conclusions: Policymakers might draw incorrect conclusions about the risk of a workplace injury becoming a disability unless the research provides a joint assessment of incidence rates and disability probabilities and a comprehensive analysis of risk factors across worker groups.

Source: Journal of Occupational & Environmental Medicine: November 2015, Volume 57, Issue 11, p. 1236-1243.

Replication of a Prospective Randomized Controlled Trial of Resource Facilitation to Improve Return to Work and School after Brain Injury

OBJECTIVE: To determine the extent to which previous findings on the effectiveness of resource facilitation to impact return to work and school could be replicated.
DESIGN: Randomized controlled trial. SETTING: Outpatient rehabilitation clinic. PARTICIPANTS: Forty-four outpatients with acquired brain injury. INTERVENTION: Fifteen months of resource facilitation services. MAIN OUTCOME MEASURES: A revised version of the Vocational Independence Scale and the Participation Index of the Mayo-Portland Adaptability Inventory-4.
RESULTS: Participants randomized to the resource facilitation group demonstrated significant advantage in terms of rate and timing of return to productive community-based work relative to control participants. When examining only return to competitive work (and not return to school), 69% of the resource facilitation group was able to return as compared to 50% of the control participants. Analyses of measures of participation in household and community activities revealed that both groups improved significantly over the 15 month study period, but no significant advantage for either group was demonstrated.
CONCLUSIONS: This study replicates the positive impact of resource facilitation in improving productive community-based activity, including competitive employment and volunteering in the community.

Source: Trexler LE, Parrott DR, Malec JF. Arch. Phys. Med. Rehabil. 2015.

Work-related rehabilitation aftercare for patients with musculoskeletal disorders

Results of a randomized-controlled multicenter trial
There is evidence that rehabilitation with a multidisciplinary focus on work-related demands effectively improves work ability and quickens return to work in patients with musculoskeletal disorders. There could be benefits to the transfer of work-related components into rehabilitation aftercare. We examined the effectiveness of an intensified work-related rehabilitation aftercare program compared with standard intensified rehabilitation aftercare in Germany on work ability. We randomly assigned 307 patients with musculoskeletal disorders from 11 rehabilitation centers to an aftercare program with work-related functional capacity training, work-related psychosocial groups, social counseling, relaxation training and exercise therapy (intervention group), or the usual aftercare program consisting of only exercise therapy (control group). The 6-month follow-up questionnaire was completed by 78.5% of patients. There was no statistically relevant between-group difference in follow-up primary (work ability) and secondary outcomes (e.g. health-related quality of life, sick leave duration). Significant improvements were observed within both the intervention and the control groups. Severely disabled participants in the intervention group had better physical functioning and shorter sick leave duration after 6 months compared with severely disabled patients in the control group. A partial replacement of standard exercise therapy by a more work-related therapy does not seem to improve work ability superiorly. Improved aftercare treatment may require a focus on employer participation and involvement within the actual work environment.

Source: Knapp, Sebastian; Briest, Juliane; Bethge, Matthias. International Journal of Rehabilitation Research, September 2015, Volume 38, Issue 3, p. 226-232.

Implementation of the Danish return-to-work program

Process evaluation of a trial in 21 Danish municipalities
Objectives: The aim of this study was to evaluate the implementation of the Danish national return-to-work (RTW) program in 21 Danish municipalities.
Methods: We conducted a structured process evaluation on (i) reach and recruitment, (ii) fidelity, (iii) dose-delivered, (iv) dose-received, and (v) context by formulating 29 implementation criteria and analyzing qualitative and quantitative data from administrative records, interviews, field notes, and questionnaires.
Results: All municipalities integrated the basic features of the RTW program into the existing framework of the sickness benefit management system to an acceptable degree, ie, establishment of RTW teams, participation of RTW team members in the training courses, and following the general procedures of the program. However, the level of implementation varied considerably between the municipalities, particularly with respect to fidelity (defined as implementation consistent with the principles of the interdisciplinary RTW process). Five municipalities had high and eight had low fidelity scores. Similar large differences were found with regard to dose-delivered, particularly in the quality of cooperation with beneficiaries, employers, and general practitioners. Only 50% of the first consultations with the RTW coordinator were conducted in time. Among participants who were employed when their sickness absence period started, only 9% had at least one meeting with their workplace.
Conclusion: It was feasible to implement the basic features of the Danish RTW program, however, large variations existed between municipalities. Establishment of well-functioning interdisciplinary RTW teams might require more time and resources, while ensuring early assessment and more frequent cooperation with employers might need more general adjustments in the Danish sickness benefit system.

Source: Aust B, Nielsen MBD, Grundtvig G, Buchardt HL, Ferm L, Andersen I, Lund TL, Jelle MOC, Andersen MF, Hansen JV, Tverborgvik T, Helverskov T, Bjorner JB, Rugulies R, Ørbæk P, Winzor G, Bültmann U, Poulsen OM. Scand J Work Environ Health, 2015. 

L’évaluation clinique, les traitements et le retour en emploi de travailleurs souffrant d’atteintes de la coiffe des rotateurs

Bilan des connaissances
Les atteintes musculosquelettiques de l'épaule constituent une problématique importante au sein de la population générale, et particulièrement chez les travailleurs. Ce type d'atteintes affecte le statut fonctionnel de l'épaule et la qualité de vie des personnes et peut entrainer, chez les travailleurs, des problématiques d'absentéisme ou des pertes de productivité. Les travailleurs effectuant des tâches avec les bras au-dessus des épaules ou des tâches répétitives présentent un risque plus important de développer une lésion à l'épaule, particulièrement une atteinte de la coiffe des rotateurs (CR). Pour la période 2005-2007, les coûts totaux générés annuellement par les lésions aux épaules acceptées par la Commission de la santé et de la sécurité du travail (CSST), incluant les coûts humains et ceux associés aux pertes de productivité, se chiffraient à 393 204 738$.
Devant l'importance de cette problématique, un vaste bilan des connaissances a été effectué sur plusieurs aspects liés aux atteintes de la CR. L'objectif principal de ce bilan des connaissances était de synthétiser les données probantes et de formuler des recommandations concernant les outils diagnostiques et d'évaluation clinique, les interventions thérapeutiques ainsi que les interventions en milieu de travail pour les travailleurs souffrant d'une atteinte de la CR. Des revues systématiques ou des méta-analyses de la littérature pertinente ont été effectuées pour chacun de ces thèmes. Plusieurs acteurs du réseau ont contribué à dresser ce bilan, soit des chercheurs, des collaborateurs et des cliniciens.

Source: http://www.irsst.qc.ca/publications-et-outils/publication/i/100837/n/traitements-retour-emploi-travailleurs-souffrant-coiffe-rotateurs

Leaving Some Behind: What Happens When Workers Get Sick

In a given year, six percent of Canadian workers will experience a personal health issue that will require them to adjust their work status. This can include being away from work for an extended period of time, changing from full- to part-time work, or leaving the labour market entirely.
Interrupting work is costly for everyone. In 2010, Canadian governments and insurance carriers provided $29 billion in direct income support to individuals dealing with a personal illness or disability. The loss of productivity to employers, the demand for care and the decline in consumption among households when employment earnings cannot fully be replaced are also significant dimensions of a health episode.
As our workforce ages and episodic and chronic health conditions become more prevalent, it is important that Canada have a robust and integrated system to support workers and employers when someone becomes sick. In June 2015, the IRPP convened a special round table with experts, stakeholders and practitioners to discuss these issues. Building on the round table discussion, Tyler Meredith and Colin Chia examine how Canada is doing, and the policy options governments should consider to strengthen the system.

Source: http://irpp.org/research-studies/report-2015-09-03/

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