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Huang YH, Sears JM, He Y, Courtney TK, Rega E, Kelly A. The utility of a safety climate scale among workers with a work-related permanent impairment who have returned to work. Work 2022; 73:927-936. [DOI: 10.3233/wor-205285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND: Safety climate (SC) is a robust leading indicator of occupational safety outcomes. There is, however, limited research on SC among workers who have returned to work with a work-related permanent impairment. OBJECTIVE: This study examined three propositions: (1) a two-level model of SC (group-level and organization-level SC) will provide the best fit to the data; (2) antecedent factors such as safety training, job demands, supervisor and coworker support, and decision latitude will predict SC; and (3) previously reported associations between SC and outcomes such as reinjury, work-family conflict, job performance, and job security will be observed. METHOD: A representative cross-sectional survey gathered information about experiences during the first year of work reintegration. About one year after claim closure, 599 interviews with workers were conducted (53.8% response rate). Confirmatory factor analyses were conducted to test the factor structure of the SC construct. Further, researchers used correlation analyses to examine the criterion-related validity. RESULTS: Consistent with general worker populations, our findings suggest the following: (1) the two-factor structure of SC outperformed the single-factor structure in our population of workers with a permanent impairment; (2) correlations demonstrate that workplace safety training, decision latitude, supervisor support, coworker support, and job demands could predict SC; and (3) SC may positively impact reinjury risk, work-family conflict, and may increase job performance and job security. CONCLUSIONS: Our study validated a two-factor SC scale among workers with a history of disabling workplace injury or permanent impairment who have returned to work. Practical applications of this scale will equip organizations with the necessary data to improve working conditions for this population.
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Affiliation(s)
- Yueng-Hsiang Huang
- Oregon Institute of Occupational Health Sciences, Oregon Health and Science University, Portland, OR, USA
| | - Jeanne M. Sears
- Department of Health Systems and Population Health, University of Washington, Seattle, WA, USA
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA, USA
- Harborview Injury Prevention and Research Center, Seattle, WA, USA
- Institute for Work and Health, Toronto, ON, Canada
| | - Yimin He
- Oregon Institute of Occupational Health Sciences, Oregon Health and Science University, Portland, OR, USA
- Department of Psychology, University of Nebraska at Omaha, Omaha, NE, USA
| | - Theodore K. Courtney
- Oregon Institute of Occupational Health Sciences, Oregon Health and Science University, Portland, OR, USA
- TKC Consulting LLC, Charlton, MA, USA
- Environmental and Occupational Medicine and Epidemiology Program, Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Elisa Rega
- Oregon Institute of Occupational Health Sciences, Oregon Health and Science University, Portland, OR, USA
| | - Anna Kelly
- Oregon Institute of Occupational Health Sciences, Oregon Health and Science University, Portland, OR, USA
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Sears JM, Schulman BA, Fulton-Kehoe D, Hogg-Johnson S. Workforce Reintegration After Work-Related Permanent Impairment: A Look at the First Year After Workers' Compensation Claim Closure. JOURNAL OF OCCUPATIONAL REHABILITATION 2021; 31:219-231. [PMID: 32651725 PMCID: PMC7796860 DOI: 10.1007/s10926-020-09912-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Purpose The purpose of this study was to descriptively quantify experiences of injured workers with permanent impairment during their first year of work reintegration. Methods A representative survey was conducted to characterize health, disability, pain, employment, reinjury, and economic outcomes for 598 workers with permanent impairment who had returned to work during the year after workers' compensation claim closure. Survey responses were summarized by degree of whole body impairment (< 10% vs. ≥ 10%). Results Injured workers who had returned to work reported that permanent impairment made it difficult to get a job (47%) and to keep their job (58%). A year after claim closure, 66% reported moderate to very severe pain; 40% reported pain interference with work. About 13% reported new work injuries; over half thought permanent impairment increased their reinjury risk. Asked to compare current to pre-injury work status, workers with a higher degree of impairment more frequently reported working fewer hours (OR 1.60; 95% CI 1.06, 2.42), earning less (OR 1.56; 95% CI 1.04, 2.36), and being at higher risk of losing their current job due to their impairment (OR 1.66; 95% CI 1.01, 2.71). Conclusions Injured workers with permanent impairment face long-term challenges related to health limitations, chronic pain, work reintegration, and economic impacts. Workers with a higher degree of impairment more frequently reported several economic and job security challenges. Developing workplace and workers' compensation-based interventions that reduce return-to-work interruption and reinjury for workers with permanent impairment should be prioritized as an important public health and societal goal.
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Affiliation(s)
- Jeanne M Sears
- Department of Health Services, University of Washington, Box 357660, Seattle, WA, 98195, USA.
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA, USA.
- Harborview Injury Prevention and Research Center, Seattle, WA, USA.
- Institute for Work and Health, Toronto, ON, Canada.
| | - Beryl A Schulman
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA, USA
| | - Deborah Fulton-Kehoe
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA, USA
| | - Sheilah Hogg-Johnson
- Institute for Work and Health, Toronto, ON, Canada
- Canadian Memorial Chiropractic College, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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Ratinaud M, Chamoux A, Glace B, Coudeyre E. Job satisfaction evaluation in low back pain: A literature review and tools appraisal. Ann Phys Rehabil Med 2013; 56:465-81. [DOI: 10.1016/j.rehab.2013.06.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2012] [Revised: 06/15/2013] [Accepted: 06/29/2013] [Indexed: 10/26/2022]
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Watson PJ, Booker CK, Moores L, Main CJ. Returning the chronically unemployed with low back pain to employment. Eur J Pain 2012; 8:359-69. [PMID: 15207517 DOI: 10.1016/j.ejpain.2003.11.003] [Citation(s) in RCA: 82] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2003] [Accepted: 11/05/2003] [Indexed: 11/22/2022]
Abstract
Much of the research into return to work following rehabilitation for low back pain in the literature reflects work done in those employed. Unemployment is a consequence of chronic low back pain which has considerable health and economic consequences for the individual and society. This paper describes an occupationally orientated rehabilitation programme for long-term unemployed people (mean duration of unemployment 38.9 months). The aim of the project was to identify factors which predict return to work and progress towards employment. Eight six subjects underwent a pain management rehabilitation programme incorporating vocational focussing and advice, subjects were followed up at 6 months to determine work status. At follow-up 38.4% of subjects were employed and another 23% were in voluntary work, or education/training. There were no significant differences on presenting characteristics between those who returned to work and those who did not. Subjects were divided into those who made positive progress (work, education/training or voluntary work) and those who did not (remained unemployed, dropped out of the programme or lost to follow up). Those who failed to make positive progress were characterised by longer duration of unemployment and higher scores on somatic anxiety and depression. A predictive model was able to identify 80% of those who failed to make progress but prediction of those achieving a positive outcome was poor (44% correct prediction). The factors predicting return to work in unemployed people with low back pain differs from the employed, the need for employment skills training and a vocational focus to rehabilitation are highlighted.
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Affiliation(s)
- Paul J Watson
- Department of Anaesthesia, Pain Management and Critical Care, Leicester Medical School, University of Leicester, Leicester LE5 4PW, UK.
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Fishbain DA, Lewis JE, Cutler R, Cole B, Steele Rosomoff R, Rosomoff HL. Does smoking status affect multidisciplinary pain facility treatment outcome? PAIN MEDICINE 2009; 9:1081-90. [PMID: 19067831 DOI: 10.1111/j.1526-4637.2007.00306.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Smoking may be a major problem in chronic low back pain (LBP) patients. The goal of this study was to determine whether smoking status affected multidisciplinary pain facility treatment outcome. DESIGN As part of a grant study, chronic LBP patients identified themselves as either current smokers (N = 81) or current nonsmokers (N = 140), and were compared by chi-square for employment status at 1, 6, 12, and 24 months after multidisciplinary pain facility treatment. Smokers who were unemployed at each time interval were then compared with employed smokers for a large number of assessment scales and clinical variables of interest by chi-square or Student's t-test. The significant independent variables from these analyses were then utilized in a logistic regression to determine predictors for smoker nonemployment. SETTING Pain facility. RESULTS Current smokers were less likely to be employed at each follow-up time point. Pain levels over the previous 24 hours predicted employment status for current smokers at 1-, 12-, and 24-month follow-up, while worker compensation status predicted employment status at 6 months. CONCLUSIONS Current smoking status appears to be associated with poorer treatment outcome after multidisciplinary pain facility treatment. Return to work within smokers is predicted by pain and worker compensation status. Pain facilities should target current smokers with significant perceived pain for close treatment monitoring in an attempt to improve treatment outcome.
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Affiliation(s)
- David A Fishbain
- Department of Psychiatry, Miller School of Medicine at University of Miami, Florida 33136, USA.
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Wasiak R, Young AE, Roessler RT, McPherson KM, van Poppel MNM, Anema JR. Measuring return to work. JOURNAL OF OCCUPATIONAL REHABILITATION 2007; 17:766-81. [PMID: 17929149 DOI: 10.1007/s10926-007-9101-4] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2007] [Accepted: 08/17/2007] [Indexed: 05/15/2023]
Abstract
BACKGROUND It is argued that one of the factors limiting the understanding of return to work (RTW) following work disability is the use of measurement tools that do not capture a complete picture of workers' RTW experiences. To facilitate the investigation of RTW, the current authors proposed a developmental conceptualization of RTW, which argues for an expanded awareness that encompasses four phases: off work, work reintegration, work maintenance and advancement. This paper reports on work undertaken with the aim of operationalizing the conceptualization. METHODS A review of the RTW and related literature, with databases searched including PubMed, EconLit, and PsycInfo. We began by extracting details of RTW instruments used by previous researchers. We then interpreted these within the context of the phases of RTW. Using the International Classification of Functioning, Disability, and Health (ICF) to inform our thinking and coding structure, we conceptualized phase-based RTW outcomes and categorized them as 'tasks and actions', 'contextual' or 'process driven'. Iteratively, we reviewed existing instruments for their use as measures of RTW. Where gaps in instrumentation were found, the wider vocational and career assessment literature was searched for instruments that could be adapted for use in RTW research. RESULTS Results indicate that, although numerous research instruments have been used to assess RTW, within the scientific literature some important dimensions of RTW lack instrumentation. In particular, we found that outcomes such as goal setting, motivation, expectation, job seeking, work maintenance, and career advancement require operationalization. Amongst the outcomes had been operationalized, we found considerable variation in conceptual development and application. CONCLUSIONS The lack of consistency and comprehensiveness of RTW measurement is one of the factors compromising the advancement of the field of RTW research. It is suggested that a more complete and psychometrically sound array of research instruments, grounded within a commonly adopted paradigm, would further the understanding of RTW and the factors affecting it.
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Affiliation(s)
- Radoslaw Wasiak
- Liberty Mutual Research Institute for Safety, Center for Disability Research, Hopkinton, MA, USA.
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Schult ML, Ekholm J. Agreement of a work-capacity assessment with the World Health Organisation International Classification of Functioning, Disability and Health pain sets and back-to-work predictors. Int J Rehabil Res 2007; 29:183-93. [PMID: 16900038 DOI: 10.1097/01.mrr.0000210057.06989.12] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The degree of agreement between a clinical multi-professional work-capacity assessment and the Comprehensive World Health Organisation International Classification of Functioning, Disability and Health (ICF) Core Sets for chronic pain and risk factors for no return to work was investigated. A review of data records and interviews with team members included measures of body function/structure, activities/participation and environmental factors. Predictors for return to work were reviewed. The team used eight different methods for data collection. Of the 29 categories concerning environmental factors, two were excluded; the methods used were more unstructured, e.g. interviews. The agreement with the 41 predictors of work resumption was high. The clinical work-capacity assessment agreed largely with the Comprehensive ICF Core Sets for the components body function, body structure, activities and participation. Nine categories out of 69 were not included. The clinical work-capacity assessment agreed largely with the Comprehensive ICF Core Sets for chronic pain conditions and with 40 predictors of work resumption. Clinically speaking, however, the current work-capacity assessment lacks on-the-job site evaluations and this most certainly affects reliability. The same is true for ICF, although the structure lacks proper coding for relevant factors found at work.
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Affiliation(s)
- Marie-Louise Schult
- Department of Public Health Sciences, Division of Rehabilitation Medicine, Karolinska Institutet, Stockholm, Sweden.
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Polypharmacy Treatment Approaches to the Psychiatric and Somatic Comorbidities Found in Patients with Chronic Pain. Am J Phys Med Rehabil 2005. [DOI: 10.1097/01.phm.0000154904.83278.32] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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van Duijn M, Lötters F, Burdorf A. Interrelationships between pain, disability, general health, and quality of life and associations with work-related and individual factors: a study among workers on sickness absence for 2 to 6 weeks for musculoskeletal complaints. Spine (Phila Pa 1976) 2004; 29:2178-83. [PMID: 15454713 DOI: 10.1097/01.brs.0000141181.90222.de] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A cross-sectional study. OBJECTIVES To measure interrelationships among pain, functional disability, general health, and overall quality of life for workers on sickness absence for 2 to 6 weeks due to musculoskeletal complaints, and to assess the impact of work-related and individual characteristics on these different health dimensions. The results of this study will contribute to a better understanding of the relationship between health and functional disability. SUMMARY OF BACKGROUND DATA When choosing a patient-based outcome measure, different health dimensions must be considered. For musculoskeletal complaints, four health dimensions are important: pain, disability, general health, and overall quality of life. Improvement at one dimension does not necessarily correlate with better health on another dimension. Moreover, correlations between different dimensions may be influenced by individual and environmental factors. However, it is not known whether these factors influence different health dimensions differently. METHODS A total of 218 workers on sickness absence for 2 to 6 weeks due to musculoskeletal complaints completed a questionnaire on four different health dimensions and work-related and environmental factors. RESULTS Moderate correlations (r < 0.50) among measures of pain, disability, general health, and quality of life were found. These health dimensions were not influenced by work-related physical and psychosocial workload, suggesting no impact of recall bias in studies for work-related musculoskeletal complaints. Self-perceived ability to return to work within 6 weeks explained 21% to 26% of the outcomes on pain and disability and contributed less to the generic measures of health. CONCLUSION Within a population of workers on sickness absence for 2 to 6 weeks, specific dimensions of pain and disability seem to be more appropriate measures of health than generic instruments of general health and quality of life.
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Affiliation(s)
- Miranda van Duijn
- Department of Public Health, University Medical Center Rotterdam, Rotterdam, The Netherlands
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Abstract
Patients with chronic pain frequently experience a complex and convoluted journey through the health care system that often is unrewarding for all involved. As job satisfaction and financial security diminish during our economic recession, the impact of the disability epidemic becomes more profound. There often is no direct correlation between objective impairment and a patient's request for disability status. Injured workers maintained on workers' compensation may have an increased risk for developing chronic pain syndromes unresponsive to conventional treatments. These patients may have significant financial, psychosocial, and environmental reinforcement for maintenance of their disability and little incentive to return to work. Excessive pain behavior may lead to unnecessary diagnostic testing or invasive procedures and result in iatrogenic complications and prolonged disability. Patients with chronic pain syndrome who have not had psychosocial treatment may not be at maximum medical improvement. The purpose of this paper is to help the readership identify types of psychiatric, psychologic, and psychosocial issues that can coexist in patients with chronic pain who are applying for disability, and to help treating physicians avoid contributing to iatrogenic pain and disability by performing needless and potentially harmful procedures on patients who may be better served with an emphasis on psychiatric or psychologic care.
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Affiliation(s)
- Gerald M Aronoff
- Department of Pain Medicine, Presbyterian Orthopedic Hospital, 1901 Randolph Road, Charlotte, NC 28207, USA.
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Fishbain DA. Risk factors for back pain incidence in industry: a prospective study. Pain 2000; 84:111. [PMID: 10681240 DOI: 10.1016/s0304-3959(99)00220-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- David A Fishbain
- Professor of Psychiatry, Neurological Surgery & Anesthesiology, University of Miami School of Medicine, University of Miami Comprehensive Pain and Rehabilitation Center, 600 Alton Rd, Miami Beach, FL 33139, USA
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