Association between co-morbidities and labour force participation amongst persons with back problems

Patient and Staff Insights on Digital Care Pathways for Patients With Low Back Pain in the Emergency Department: A Qualitative Study

BACKGROUND

Back pain is a huge global problem. For some people, the pain is so severe that they feel the need to present to an emergency department (ED). Our aim was to explore patient and staff perspectives for the development of a digital care pathway (DCP) for people with back pain who have presented to ED, including acceptability, barriers and facilitators.

METHODS

We used a descriptive phenomenology approach using semi-structured interviews with patient and staff participants at a tertiary hospital. Interviews were transcribed and data codes were developed using inductive thematic analysis. Themes were discussed between researchers until consensus was achieved.

RESULTS

A total of 16 interviews were carried out, half of which involved patient participants. We identified three major themes: (i) expectations and experiences of staff and patients with low back pain in ED; (ii) a digital care pathway can empower patients and support clinicians in providing care; and (iii) acceptability, barriers, facilitators and recommendations of engaging with a DCP to track the trajectory of back pain. Each theme was further categorised into subthemes.

CONCLUSION

Introducing a DCP was perceived as acceptable and beneficial by patients and staff. Both groups were aware of the potential participant burden if surveys were too long. Introducing a DCP could be a valuable adjunct to current management care models, providing a standardised source of education with the potential for individualised tracking and monitoring. The design and development of a DCP will need to consider reported facilitators and address perceived barriers for engagement.

PATIENT OR PUBLIC CONTRIBUTION

This project sought insights from patients and staff about a digital care pathway. This forms the first step of patient and consumer consultation before implementing a digital care pathway. All consumers were offered the opportunity to review their responses and our interpretation.

Everyday Lives of Middle-Aged Persons with Multimorbidity: A Mixed Methods Systematic Review

The healthcare burden of patients with multimorbidity may negatively affect their family lives, leisure time and professional activities. This mixed methods systematic review synthesizes studies to assess how multimorbidity affects the everyday lives of middle-aged persons, and identifies skills and resources that may help them overcome that burden. Two independent reviewers screened title/abstracts/full texts in seven databases, extracted data and used the Mixed Methods Appraisal Tool (MMAT) to assess risk of bias (RoB). We synthesized findings from 44 studies (49,519 patients) narratively and, where possible, quantitatively. Over half the studies provided insufficient information to assess representativeness or response bias. Two studies assessed global functioning, 15 examined physical functioning, 18 psychosocial functioning and 28 work functioning. Nineteen studies explored skills and resources that help people cope with multimorbidity. Middle-aged persons with multimorbidity have greater impairment in global, physical and psychosocial functioning, as well as lower employment rates and work productivity, than those without. Certain skills and resources help them cope with their everyday lives. To provide holistic and dynamic health care plans that meet the needs of middle-aged persons, health professionals need greater understanding of the experience of coping with multimorbidity and the associated healthcare burden.

Chronic Diseases and Labor Force Participation Among Presenile and Senile Chinese

Background: The incidence of chronic diseases has increased dramatically due to rapid aging and lifestyle changes of China in recent decades. The population aged more than 45 years is an important participant in the labor force market, and the health status directly affects their labor force participation decision. This study aims to explore the relationship between chronic diseases and the labor force participation among the elderly Chinese population aged more than 45 years.

Method: We employ a multivariate probit (MVP) model to construct five structural equations for an analysis. The advantage of this model is that it can deal with the endogeneity of chronic diseases.

Results: Firstly, compared with the elderly, younger people are more likely to participate in the labor force market; the influence of chronic diseases is the largest for presenile women in the decision-making of labor force participation; the impact of psychological problems on labor force participation cannot be ignored, especially for men aged more than 45 years. In addition, sociodemographic factors such as geographical location and marital status also have direct effects on the probability of labor force participation while the impact of both family wealth and family number is much smaller. Finally, unhealthy lifestyles through chronic diseases have negative and indirect marginal effects on labor force participation.

Conclusions: This article proves that chronic diseases have a negative impact on the labor force participation for Chinese aged more than 45 years. The public should give more tolerance and opportunities to these groups. The population aged more than 45 years are more vulnerable and face more psychological problems, which will lead to a decline in labor force participation. Psychological health counseling and services are urgently needed. As the urban areas enjoy more social welfare, Chinese welfare policy needs to be tilted toward the rural elderly. For individuals, maintaining healthy lifestyles can help you stay away from chronic diseases and stay in the labor force market.

[Multidomain approach in chronic non-specific back pain patient's treatment]

The concept of chronic nonspecific back pain (CNBP) as a pathology of the spine (osteochondrosis, spondylosis, intervertebral disc herniation, facet syndrome) is extremely outdated and has not justified itself, first of all, from the therapeutic view point. Numerous studies, including meta-analyzes and systematic reviews, have convincingly shown the ineffectiveness of the methods of CNBP treatment, aimed only at solving the problems of the spine itself and / or surrounding tissues. A substantial amount of special imaging studies have proven the dissociation between morphological vertebral changes and the clinical picture of pain. CNBP is the overall result of the interaction of numerous factors in the spine tissues (changes in the discs, joints, ligaments, fascia, muscles) and factors beyond the spine. The latter include, first of all, psychological and social factors, cognitive functions, the quality of night sleep, the level of physical activity, concomitant diseases (comorbidity). In each patient, the interaction of these factors determines the development of specific pathophysiological mechanisms of pain and, as a result, an individual clinical picture of pain (phenotype). Understanding these processes will allow for the reconsideration of the approach of searching for an anatomical pain source as the main pathogenetic factor; recognizing the multifocal generation of chronic pain as the result of a complex interaction of biological, psychological and social factors; the development of new principles and therapy algorithms. The authors propose to introduce into practice a multidomain screening approach for evaluating patients with CNBP, which would take into account the phenotype of pain, factors affecting its perception, and allow personalized treatment for each patient based on the biopsychosocial approach.

Chronic diseases and multimorbidity among unemployed and employed persons in the Netherlands: a register-based cross-sectional study

OBJECTIVES

The first objective of this study was to describe the age-specific prevalence of chronic diseases and multimorbidity among unemployed and employed persons. The second objective was to examine associations of employment status and sociodemographic characteristics with chronic diseases and multimorbidity.

DESIGN

Data linkage of cross-sectional nationwide registries on employment status, medication use and sociodemographic characteristics in 2016 was applied.

SETTING

Register-based data covering residents in the Netherlands.

PARTICIPANTS

5 074 227 persons aged 18-65 years were selected with information on employment status, medication use and sociodemographic characteristics.

OUTCOME MEASURES

Multiple logistic regression analysis and descriptive statistics were performed to examine associations of employment and sociodemographic characteristics with the prevalence of chronic diseases and multimorbidity. The age-specific prevalence of six common chronic diseases was described, and Venn diagrams were applied for multimorbidity among unemployed and employed persons.

RESULTS

Unemployed persons had a higher prevalence of psychological disorders (18.3% vs 5.4%), cardiovascular diseases (20.1% vs 8.9%), inflammatory diseases (24.5% vs 15.8%) and respiratory diseases (11.7% vs 6.5%) than employed persons. Unemployed persons were more likely to have one (OR 1.30 (1.29-1.31)), two (OR 1.74 (1.73-1.76)) and at least three chronic diseases (OR 2.59 (2.56-2.61)) than employed persons. Among unemployed persons, psychological disorders and inflammatory conditions increased with age but declined from middle age onwards, whereas a slight increase was observed among employed persons. Older persons, women, lower educated persons and migrants were more likely to have chronic diseases.

CONCLUSION

Large differences exist in the prevalence of chronic diseases and multimorbidity among unemployed and employed persons. The age-specific prevalence follows a different pattern among employed and unemployed persons, with a relatively high prevalence of psychological disorders and inflammatory conditions among middle-aged unemployed persons. Policy measures should focus more on promoting employment among unemployed persons with chronic diseases.

Self-reported long-term conditions of nurses and midwives across a northern Australian health service: A survey

BACKGROUND

Although nurses generally constitute the largest component of the health workforce there is no systematic collection of data about their health status. Similarly, little is known about how nurses manage any long-term condition they may have, which could contribute to their reducing hours of employment or leaving the workforce completely. Such information will become more important against the backdrop of a global shortage of nurses, and ageing of the nursing population.

OBJECTIVES

This study aimed to identify the types and impacts of reported long-term conditions, and strategies employed by nurses to manage their conditions.

DESIGN

A cross-sectional survey design was used.

SETTINGS

The setting was a large regional health service in North Queensland, Australia, comprising a tertiary referral hospital, two residential aged care facilities and several rural and remote hospitals and community health services.

PARTICIPANTS

All full-time, part-time and casual nurses and midwives employed within the health service were invited to participate; 665 (30.9%) completed surveys were returned.

METHODS

A paper-based questionnaire, comprising six sections, was individually addressed to all potential participants, together with reply-paid envelopes for returning completed questionnaires. The anonymous questionnaire took approximately 15 to 25min to complete, less time if the nurse reported no long-term conditions.

RESULTS

Three-fifths of respondents had at least one long-term condition. Respondents older than 50 years were statistically more likely to report having at least one long-term condition (χ(2)=5.64, p=0.018). Back pain, migraine and asthma were the most frequently reported individual conditions; more than one-quarter of respondents reported a condition relating to mental health and wellbeing. Respondents who reported more than one long-term condition compared to a single long-term condition were statistically more likely to have had more years of nursing experience (t=02.2, p=0.03). Nurses used a combination of varied personal and workplace strategies for many conditions; however personal strategies were most frequently used for all conditions.

CONCLUSIONS

This survey elicited information about reported long-term conditions, and strategies that nurses used to manage the condition they considered most important to them. We recommend that further investigation into how the full range of workplace strategies could be implemented to assist nurses to manage long-term conditions.

[Formalized consensus: clinical practice recommendations for the management of acute low back pain of the African patient]

La lombalgie aiguë est la pathologie rhumatismale la plus fréquente en Afrique. L’épidémiologie et la présentation clinique ne diffèrent pas de celles observées sur les autres continents. En revanche, les aspects psycho-sociaux, la disponibilité des traitements, l'accès aux soins et le poids culturel des médecines traditionnelles sont autant de spécificités qui ont conduit à la réalisation du 1er consensus d'experts en rhumatologie pour la prise en charge du patient africain. Destiné aux praticiens, ce travail collaboratif multinational a pour objectif de fournir 11 recommandations de pratiques cliniques simples, fondées sur les preuves, et adaptées aux conditions de l'exercice médical en Afrique. Leur ambition est d'améliorer la prise en charge de la lombalgie aigue par une évaluation initiale clinique pertinente, une diminution des examens radiologiques inutiles, une prescription médicamenteuse adéquate et l'abandon de procédures invasives inappropriées.

Multiple chronic conditions and labor force outcomes: A population study of U.S. adults

BACKGROUND

Although 1-in-5 adults have multiple (≥ 2) chronic conditions, limited attention has been given to the association between multiple chronic conditions and employment.

METHODS

Cross-sectional data (2011 National Health Interview Survey) and multivariate regression analyses were used to examine the association among multiple chronic conditions, employment, and labor force outcomes for U.S. adults aged 18-64 years, controlling for covariates.

RESULTS

Among U.S. adults aged 18-64 years (unweighted, n = 25,458), having multiple chronic conditions reduced employment probability by 11-29%. Some individual chronic conditions decreased employment probability. Among employed adults (unweighted, n = 16,096), having multiple chronic conditions increased the average number of work days missed due to injury/illness in the past year by 3-9 days.

CONCLUSIONS

Multiple chronic conditions are a barrier to employment and increase the number of work days missed, placing affected individuals at a financial disadvantage. Researchers interested in examining consequences of multiple chronic conditions should give consideration to labor force outcomes.

Back problems, comorbidities, and their association with wealth

BACKGROUND CONTEXT

Studies assessing the economic burden of back problems have given little consideration to the presence of comorbidities.

PURPOSE

To assess the difference in the value of wealth held by Australians who have back problems and varying numbers of chronic comorbidities.

STUDY DESIGN

A cross-sectional study.

PATIENT SAMPLE

Individuals aged 45 to 64 years in 2009: 4,388 with no chronic health conditions, 1,405 with back problems, and 3,018 with other health conditions.

OUTCOME MEASURE

Total wealth (cash, shares, superannuation, investment property, and owner occupied home).

METHODS

Using a microsimulation model (Health&WealthMOD), logistic regression models were used to assess the odds of having any wealth. Linear regression models were used to assess the difference in the value of this wealth.

RESULTS

Those with back problems and two comorbidities had 0.16 (95% confidence interval [CI]: 0.06-0.42) times the odds and those with back problems and three or more comorbidities had 0.20 (95% CI: 0.11-0.38) times the odds of having accumulated some wealth than those with no chronic health conditions. Those with back problems and three or more comorbidities had a median value of total wealth of around $150,000, whereas those with back problems only and back problems and one comorbidity had a median value of total wealth of around $250,500. There was no significant difference in the amount of wealth accumulated by those with back problems and at least one comorbidity and those with other health conditions and the same number of comorbidities. However, those with only one health condition (excluding back problems) had 65% more wealth than those with back problems only (95% CI: 5.1-161.2).

CONCLUSIONS

This study highlights the importance of considering multiple morbidities when discussing the relationship between back problems and economic circumstances.

The association of chronic neck pain, low back pain, and migraine with absenteeism due to health problems in Spanish workers

STUDY DESIGN

Cross-sectional.

OBJECTIVE

To examine whether 3 types of chronic pain are associated with absenteeism and with the number of days absent from work in the general population of Spain.

SUMMARY OF BACKGROUND DATA

Chronic pain has been associated with absenteeism, but most of the evidence is based on unadjusted analyses and on specific professional categories.

METHODS

A cross-sectional analysis was performed on the basis of data of 8283 Spanish workers. Chronic pain was ascertained from self-reported information on frequent symptoms of pain in the low back and neck and/or migraine in the last 12 months. Absenteeism was defined as missing at least 1 day from work because of health problems. Multivariate regression models were adjusted for the main confounders.

RESULTS

Health-related absenteeism was reported by 27.8% of subjects. The prevalence of chronic pain was reported to be 12.3% in the neck, 14.1% in the low back, and 10.3% migraine. In adjusted analyses, absenteeism was associated with chronic neck pain (odds ratio: 1.20; 95% confidence interval [CI], 1.02-1.40), low back pain (odds ratio: 1.22; 95% CI, 1.06-1.42), and migraine (odds ratio: 1.22; 95% CI, 1.04-1.44). These associations were strongest in younger (18-34 yr) rather than in older workers. Furthermore, those who reported frequent pain in the neck and low back were 44% more likely to be absent for more than 30 days in the past year than those who did not report these symptoms.

CONCLUSION

Spanish workers with chronic pain were more likely to be absent from work and to stay absent from work for longer. These associations are independent of sociodemographic characteristics, occupation, lifestyle, health status, and analgesics use.

LEVEL OF EVIDENCE

N/A.

Brain sensitization to external and internal stimuli

Sensitization is defined as a non-associative learning process occurring when repeated administrations of a stimulus result in a progressive amplification of a response (Shettleworth, 2010). The purpose of this review paper is to discuss whether brain sensitization is helpful in common health problems in man. The paper reviews data on brain sensitization covering increased behavioral, physiological, cognitive, and emotional responses in man and animals. The paper concludes that brain sensitization may be a helpful concept to understand subjective and "unexplained" health complaints (nonspecific muscle pain, mood changes, fatigue, and gastrointestinal complaints), and, therefore, relevant for evidence based treatment and prevention of these common health problems.

The indirect economic impacts of co-morbidities on people with depression

It is known that people with depression often have other co-morbid conditions; however this is rarely acknowledged in studies that access the economic impacts of depression. This paper aims to quantify the association between co-morbid health conditions and labour force status and economic circumstances of people with depression. This study undertakes cross-sectional analysis using a dataset that is representative of the 45-64 year old Australian population with depression. The probability of being out of the labour force increases with increasing number of co-morbidities, and the amount of weekly income received by people with depression decreased with increasing numbers of co-morbidities. Those with depression and three or more co-morbidities were 4.31 times more likely to be out of the labour force (95% CI: 1.74-10.68), and received a weekly private income 88% lower (95% CI: -94%, -75%) than people with depression alone. It is important to consider the co-morbid conditions an individual has when assessing the impact of depression on labour force participation and economic circumstances.

Premature retirement due to ill health and income poverty: a cross-sectional study of older workers

OBJECTIVES

To assess the income-poverty status of Australians who were aged between 45 and 64 years and were out of the labour force due to ill health.

DESIGN

A cross-sectional study using a microsimulation model of the 2009 Australian population (Health&WealthMOD).

SETTING

2009 Australian population.

PARTICIPANTS

9198 people aged between 45 and 64 years surveyed for the 2003 Survey of Disability, Ageing and Carers.

PRIMARY OUTCOME MEASURES

50% of the median equivalised income-unit-income poverty line.

RESULTS

It was found that individuals who had retired early due to other reasons were significantly less likely to be in income poverty than those retired due to ill health (OR 0.43 95% CI 0.33 to 0.51), and there was no significant difference in the likelihood of being in income poverty between these individuals and those unemployed. Being in the same family as someone who is retired due to illness also significantly increases an individual's chance of being in income poverty.

CONCLUSIONS

It can be seen that being retired due to illness impacts both the individual and their family.

Chronic back problems and labor force participation in a national population survey: impact of comorbid arthritis

Background

Back problems and arthritis are common chronic conditions, while having back problems is a frequent reason for lost work time. The objective of this study was to investigate employment status amongst individuals who report having both back problems and arthritis, compared to having either condition alone.

Methods

We analyzed data from the 2007/2008 Canadian Community Health Survey (ages 25–64, n = 79,719). Respondents who reported neither having worked in the past 12 months nor the past week were coded as not currently employed. Those reported being permanently unable to work were considered to be out of the labor force. Log-Poisson regressions, adjusting for socio-demographic and lifestyle factors, were used to estimate risks for being not currently employed or being out of the labor force for 5 mutually exclusive groups of chronic conditions: arthritis and back problems, back problems, arthritis, any other chronic conditions, and no chronic conditions.

Results

12.7% of respondents reported being not currently employed and 2.9% being out of the labor force. 5.8% of respondents reported both arthritis and back problems, while 16.1% reported back problems and 7.3% arthritis. The back problems and arthritis group had the highest risk of not being currently employed. The risk was higher for men (PR = 1.90; 95% CI = 1.58, 2.29) than for women (PR = 1.31; 95% CI = 1.18, 1.46). Risks of being permanently unable to work were also the greatest for those with comorbid back problems and arthritis.

Conclusions

There is a need for a reappraisal of back problems as a cause of work disability to account for the possibility of co-occurring arthritis.