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

Physical Therapists' Expectations Regarding the Recovery of Work-Disabled Individuals Aged 55 and Over

PURPOSE

The aim of this study was to document physical therapy professionals' expectations regarding the recovery of work-disabled individuals aged 55 and over with a musculoskeletal disorder (MSD).

METHODS

Using a qualitative descriptive method, semi-structured interviews were conducted with a purposive sample of physical therapy professionals. The Think Aloud method was used with two fictional vignettes describing work-disabled women (a 57-year-old and a 37-year-old) to explore the participants' recovery expectations. The two vignettes were compared to highlight recovery expectations related specifically to ageing workers.

RESULTS

Twelve physical therapy professionals participated. Most reported more unfavourable expectations regarding the recovery of the worker aged 55 and over. Physical therapists indicated that higher anxiety-related symptoms, lower level of engagement, and the effect of ageing on general health lowered their recovery expectations. Also, perceptions of patient psychosocial risk factors were viewed as an important negative influence on recovery expectations. Early-career participants were more likely to perceive the older worker's characteristics as negatively influencing their recovery expectations compared with those of the younger worker.

CONCLUSION

Results indicate that physical therapists tend to report lower recovery expectations for these older workers. This study offers deeper insight into how patient age may influence clinicians' recovery expectations.

Using the Functional Comorbidity Index with administrative workers' compensation data: Utility, validity, and caveats

BACKGROUND

Chronic health conditions impact worker outcomes but are challenging to measure using administrative workers' compensation (WC) data. The Functional Comorbidity Index (FCI) was developed to predict functional outcomes in community-based adult populations, but has not been validated for WC settings. We assessed a WC-based FCI (additive index of 18 conditions) for identifying chronic conditions and predicting work outcomes.

METHODS

WC data were linked to a prospective survey in Ohio (N = 512) and Washington (N = 2,839). Workers were interviewed 6 weeks and 6 months after work-related injury. Observed prevalence and concordance were calculated; survey data provided the reference standard for WC data. Predictive validity and utility for control of confounding were assessed using 6-month work-related outcomes.

RESULTS

The WC-based FCI had high specificity but low sensitivity and was weakly associated with work-related outcomes. The survey-based FCI suggested more comorbidity in the Ohio sample (Ohio mean = 1.38; Washington mean = 1.14), whereas the WC-based FCI suggested more comorbidity in the Washington sample (Ohio mean = 0.10; Washington mean = 0.33). In the confounding assessment, adding the survey-based FCI to the base model moved the state effect estimates slightly toward null (<1% change). However, substituting the WC-based FCI moved the estimate away from null (8.95% change).

CONCLUSIONS

The WC-based FCI may be useful for identifying specific subsets of workers with chronic conditions, but less useful for chronic condition prevalence. Using the WC-based FCI cross-state appeared to introduce substantial confounding. We strongly advise caution-including state-specific analyses with a reliable reference standard-before using a WC-based FCI in studies involving multiple states.

Impact of persistent pain symptoms on work absence, health status and employment 18 months following disabling work-related injury or illness

OBJECTIVES

While most individuals physically injured at work will make a complete medical recovery, a portion of workers will experience persistent pain following their injury. This study estimated persistent pain prevalence and its association with health and return-to-work outcomes 18 months following the incidence of a disabling work-related injury.

METHODS

We studied 1131 workers disabled by a work-related injury who were recruited from a sampling frame of disability benefit claimants in Ontario, Canada. Work injuries and claim benefits characteristics from administrative data were linked with measures of work status, pain symptoms, and physical and mental health obtained from telephone interviews completed 18 months postinjury. Associations of persistent pain symptoms with health and employment outcomes 18 months postinjury were estimated using multinomial and linear regression.

RESULTS

Roughly 30% of participants reported no pain symptoms in the previous 4 weeks, 45% reported mild pain symptoms and 25% reported severe pain symptoms accompanied by substantial functional impairment. Workers with severe pain symptoms were more likely to not be currently working at 18 months (33%) vs those without pain symptoms (16%), and had poorer self-reported physical and mental health. Workers with severe pain symptoms had higher probabilities of benefit durations of 12-18 months (OR=9.35), higher lost-earnings costs (~47.7% higher) and higher healthcare expenditure costs at 18 months (~125.9% higher) compared with those with no pain symptoms.

CONCLUSIONS

Persistent pain symptom prevalence 18 months postinjury is high among workers disabled by a work-related injury and associated with substantial functional impairment and longer wage replacement benefit duration.

A Literature Review of Productivity Loss Associated with Hypertension in the United States

A literature review of peer-reviewed articles published 2000-2019 was conducted to determine the types and extent of hypertension-associated productivity loss among adults in the United States. All monetary outcomes were standardized to 2019 $ by using the Employment Cost Index. Twenty-seven articles met the inclusion criteria. Nearly half of the articles (12 articles) presented monetary outcomes of productivity loss. Absenteeism (14 articles) and presenteeism (8 articles) were most frequently assessed. Annual absenteeism was estimated to cost more than $11 billion, nationally controlling for sociodemographic characteristics. The annual additional costs per person were estimated at $63 for short-term disability, $72-$330 for absenteeism, and $53-$156 for presenteeism, controlling for participant characteristics; and may be as high as $2362 for absenteeism and presenteeism when considered in combination. The annual additional time loss per person was estimated as 1.3 days for absenteeism, controlling for common hypertension comorbidities, including stroke and diabetes; and 15.6 days for work and home productivity loss combined, controlling for sociodemographic characteristics. The loss from absenteeism alone might be more than 20% of the total medical expenditure of hypertension. Although the differences in estimation methods and study populations make it challenging to synthesize the costs across the studies, this review provides detailed information on the various types of productivity loss. In addition, the ways in which methods could be standardized for future research are discussed. Accounting for the costs from productivity loss can help public health officials, health insurers, employers, and researchers better understand the economic burden of hypertension.

A Retrospective Cohort Analysis of the Impact of Osteoarthritis on Disability Leave, Workers' Compensation Claims, and Healthcare Payments

OBJECTIVES

Examine short-term disability (STD) and workers' compensation (WC) associated leave and wage replacements, and overall direct healthcare payments, among employees with osteoarthritis (OA) versus other chronically painful conditions; quantifying the impact of opioid use.

METHODS

Analysis of employees with more than or equal to two STD or WC claims for OA or pre-specified chronically painful conditions (control) in the IBM MarketScan Research Databases (2014 to 2017).

RESULTS

The OA cohort (n = 144,355) had an estimated +1.2 STD days, +$152 STD payments, and +$1410 healthcare payments relative to the control cohort (n = 392,639; P < 0.001). WC days/payments were similar. Differences were partially driven by an association between opioid use, increased STD days/payments, and healthcare payments observed in pooled cohorts (P < 0.001).

CONCLUSIONS

OA is associated with high STD days/payments and healthcare payments. Opioid use significantly contributes to these and this should be considered when choosing treatment.

Insights into the Sustainable Return to Work of Aging Workers with a Work Disability: An Interpretative Description Study

Purpose A sustainable return to work (S-RTW) following prolonged work disability poses particular challenges as workers age. This article provides a synthesis of the factors and issues involved in a S-RTW process for aging workers following such a disability. Methods Using interpretive description methods, a critical review was conducted of the literature specifying return-to-work factors and issues for aging workers with regard to four major causes of work disability (musculoskeletal disorders, common mental disorders, cancer or other chronic diseases). The initial review concerned the 2000-2016 literature, and was subsequently updated for November 2016-December 2018. To further explore and contextualise the results of this literature review, four focus groups were held with stakeholders, representing the workplace, insurance, and healthcare systems and workers. Qualitative thematic analysis was performed. Results Fifty-five articles were reviewed and 35 stakeholders participated in the focus groups. Returning to work and staying at work appear to be particularly challenging for aging workers, who face notable issues and stigma concerning their ability to meet work demands, as well as their mobilisation and engagement in these processes. Such findings echo in many ways the main assertions of the literature on aging at work, except those regarding the transformation of capacities with aging, which is not mentioned in relation to workers with a work disability. The influence of healthcare and compensation systems on the S-RTW of aging work-disabled workers has also received little attention to date. Conclusions The results underscore that aging workers with a disability are frequently vulnerable in terms of their health or their jobs. Intersectoral efforts are needed to remedy this situation to keep them at work.

Disability and sex/gender intersections in unmet workplace support needs: Findings from a large Canadian survey of workers

INTRODUCTION

Individual attributes including disability and sex/gender have the potential to intersect and determine the likelihood of unmet workplace support needs. Our study compares unmet workplace support needs between workers with and without a disability, and according to disability type and sex/gender differences.

METHODS

Workers with (n = 901) and without (n = 895) a disability were surveyed to examine their need and use of workplace supports including job accommodations, work modifications and health benefits. A multivariable logistic model was conducted to examine the relationship between disability status, disability type and sex/gender and unmet workplace support needs. The model included interaction terms between sex/gender × physical disability, sex/gender × nonphysical disability, and sex/gender × physical and nonphysical disability.

RESULTS

Among participants with a disability, 24% had a physical disability, 20% had a nonphysical disability (e.g., cognitive, mental/emotional or sensory disability) and 56% had both physical and nonphysical disability. Over half of the respondents were women (56%). Results from the multivariable model showed that nondisabled women were more likely to report unmet workplace support needs when compared to nondisabled men (odds ratio [OR] = 1.54, 95% confidence interval [CI], 1.13-2.10). Findings also showed an intersection between the number and type of disability and sex/gender; women with both a physical and nonphysical disability had the greatest likelihood of reporting unmet workplace support needs when compared to nondisabled men (OR = 2.73; 95% CI, 1.83-4.08).

CONCLUSIONS

Being a woman and having one or more disabilities can determine unmet workplace support needs. Strategies to address workplace support needs should consider the intersection between disability and sex/gender differences.

Depressive Symptoms and the Arthritis-Employment Interface: A Population-Level Study

OBJECTIVE

To examine the relationship between depressive symptoms, arthritis, and employment, and to determine whether this relationship differs across young, middle-age, and older working-age adults with arthritis.

METHODS

Data from the US National Health Interview Survey from 2013-2017 were analyzed. Analyses were restricted to adults with doctor-diagnosed arthritis of working age (ages 18-64 years) with complete data on depressive symptoms (n = 11,380). Covariates were sociodemographic information, health, and health system utilization variables. Employment prevalence was compared by self-reported depressive symptoms. We estimated percentages, as well as univariable and multivariable logistic regression models, to examine the relationship between depression and employment among young adults (ages 18-34 years), middle-age adults (ages 35-54 years), and older adults (ages 55-64 years).

RESULTS

Among all working-age US adults with arthritis, the prevalence of depressive symptoms was 13%. Those reporting depressive symptoms had a higher prevalence of fair/worse health (60%) and arthritis-attributable activity limitations (70%) compared to those not reporting depression (23% and 39%, respectively). Respondents with depressive symptoms reported significantly lower employment prevalence (30%) when compared to those not reporting depressive symptoms (66%) and lower multivariable-adjusted association with employment (prevalence ratio 0.88 [95% confidence interval (95% CI) 0.83-0.93]). Middle-age adults reporting depression were significantly less likely to be employed compared to their counterparts without depression (prevalence ratio 0.83 [95% CI 0.77-0.90]); similar but borderline statistically significant relationships were observed for both young adults (prevalence ratio 0.86 [95% CI 0.74-0.99]) and older adults (prevalence ratio 0.94 [95% CI 0.86-1.03]).

CONCLUSION

For adults with arthritis, depressive symptoms are associated with not participating in employment. Strategies to reduce arthritis-related work disability may be more effective if they simultaneously address mental health.

Examining the Likelihood of Experiencing Productivity Loss and Receiving Social Security Disability Income Following the Onset of Chronic Disease

OBJECTIVE

The aim of the study was to examine the likelihood of reporting productivity loss and receiving social security disability (SSD) income following a chronic health condition diagnosis using a longitudinal panel design.

METHODS

Using the Panel Study of Income Dynamics, logistic regression analyses were conducted to estimate the likelihood of reporting productivity loss or receiving SSD following the diagnosis of arthritis, cancer, psychological problems, or heart conditions. Respondents reporting a new diagnosis of a condition were matched with five similarly aged respondents not reporting a diagnosis.

RESULTS

For all conditions except cancer, the odds of reporting productivity loss and receiving SSD increased at both the wave where the condition was first reported and 2 years after for respondents reporting a condition compared with those not reporting a condition.

CONCLUSIONS

The onset of chronic disease increases the likelihood of experiencing productivity loss and receiving SSD.

Supporting Arthritis and Employment Across the Life Course: A Qualitative Study

OBJECTIVE

To examine the need for and availability and use of formal and informal workplace resources and to uncover differences across the life course in adults with arthritis.

METHODS

Focus groups and interviews were conducted with young (aged 18-34 years; n = 7), middle-aged (35-54 years; n = 13), and older adults (≥55 years; n = 25) with a diagnosis of inflammatory arthritis, osteoarthritis, or other rheumatic disease. Participants were asked about their employment experiences, formal and informal workplace resource needs, and availability and use of workplace resources. Differences based on chronological, functional, psychosocial, organizational, and lifespan dimensions of age were examined. A modified grounded theory approach was used to inductively analyze the data.

RESULTS

Young, middle-aged, and older adult participants required similar workplace resources. Across all participants, scheduling modifications tended to be the most needed workplace resource. In contrast, the perceived availability and use of formal workplace resources differed among participants. Young adult participants and those who were newer to their jobs reported that workplace resources were less available and utilized. Middle-aged and older adults reported greater availability of workplace resources. Scheduling accommodations and at-work modifications were the workplace resources that were used most by middle-aged and older adults, respectively.

CONCLUSION

Similar workplace resources could meet the employment needs of individuals with arthritis across the life course. Attention should be paid to young adults and those who are new to their jobs, because they may perceive more barriers to accessing formal workplace resources and be susceptible to work disability.

Effect of a community-based participatory health literacy program on health behaviors and health empowerment among community-dwelling older adults: A quasi-experimental study

This study evaluated the effect of a community-based participatory health literacy program aimed at improving the health behaviors and health empowerment for older adults. A two-group pretest and posttest quasi-experimental design with surveys conducted at baseline (T₁), immediately after the intervention (T₂), and 6 months after the intervention (T₃). The intervention group (n = 94) attended a 12-week health literacy program; while the comparison group (n = 78) did not. The results demonstrated that intervention group had significantly better health behavior practices for weight control (OR = 3.71, 95% CI = 1.59-8.64), regular exercise (OR = 15.26, 95% CI = 1.92-121.13), and health information navigation (OR = 2.61, 95% CI = 1.16-5.84). Health empowerment was significantly higher in the intervention group than the comparison group (p < 0.01).This study suggests that integrating community-based participatory design is effective in improving some health behaviors and health empowerment in older adults over a short period.

The Participation of People with Disabilities in the Workplace Across the Employment Cycle: Employer Concerns and Research Evidence

Despite legislation on diversity in the workplace, people with disabilities still do not experience the same access to work opportunities as do their counterparts without disabilities. Many employers have been shown to harbor sincere yet ill-founded views about the work-related abilities of people with disabilities; these negative views are often a result of interrelated concerns that permeate the entire employment cycle. In this paper, we provide evidence-based responses to 11 specific concerns that employers have about people with disabilities, from pre-employment and entry experiences to the final dissolution of the employment relationship. At each stage of the employment cycle, we summarize and evaluate the relevant empirical evidence and provide recommendations for organizations committed to creating more effective, equitable, and inclusive workplaces for all individuals. We also suggest avenues for future research.

Forced expiratory volume in one second: A novel predictor of work disability in subjects with suspected obstructive sleep apnea

Whether the association of work disability with obstructive sleep apnea (OSA) is mainly due to the disease, i.e. the number and frequency of apneas-hypoapneas, or to coexisting factors independent from the disease, is not well-established. In this study, we aim to evaluate work ability in a group of subjects undergoing OSA workup and to identify the major contributors of impaired work ability. In a cross-sectional study, we enrolled 146 consecutive subjects who have been working for the last five years and referred to the sleep disorders outpatients' clinic of the University-Hospital of Ferrara, Italy, with suspected OSA. After completing an interview in which the Work Ability Index (WAI) and the Epworth Sleepiness Scale (ESS) questionnaires were administered to assess work ability and excessive daytime sleepiness, respectively, subjects underwent overnight polysomnography for OSA diagnosing and spirometry. Of the 146 subjects, 140 (96%) completed the tests and questionnaires and, of these, 66 exhibited work disability (WAI < 37). OSA was diagnosed (apnea-hypopnea index ≥ 5) in 45 (68%) of the 66 subjects. After controlling for confounders, a lower level of forced expiratory volume at 1 second (FEV1), [odds ratio 0.97 (95% CI 0.95-1.00)], older age [1.09 (95% CI 1.03-1.15)], excessive daytime sleepiness [3.16 (95% CI 1.20-8.34)] and a worse quality of life [0.96 (95% CI 0.94-1.00)], but not OSA [1.04 (95% CI 0.41-2.62)], were associated with work disability. Patients with a higher number of diseases, in which OSA was not included, and a lower quality of life had an increased probability of absenteeism in the previous 12 months. In subjects with suspected OSA, FEV1 can be an important predictor of work disability.

Can demographic and anthropometric characteristics predict clinical improvement in patients with chronic non-specific low back pain?

OBJECTIVE

To identify potential prognostic factors that may predict clinical improvement of patients treated with different physical therapy interventions in the short-term.

METHODS

This is a prospective cohort study. A total of 616 patients with chronic non-specific low back pain treated with interventions commonly used by physical therapists were included. These patients were selected from five randomized controlled trials. Multivariate linear regression models were used to verify if sociodemographic characteristics (age, gender, and marital status), anthropometric variables (height, body mass, and body mass index), or duration of low back pain, pain intensity at baseline, and disability at baseline could be associated with clinical outcomes of pain intensity and disability four weeks after baseline.

RESULTS

The predictive variables for pain intensity were age (β=0.01 points, 95% CI=0.00 to 0.03, p=0.03) and pain intensity at baseline (β=0.23 points, 95% CI=0.13 to 0.33, p=0.00), with an explained variability of 4.6%. Similarly, the predictive variables for disability after four weeks were age (β=0.03 points, 95% CI=0.00 to 0.06, p=0.01) and disability at baseline (β=0.71 points, 95% CI=0.65 to 0.78, p=0.00), with an explained variability of 42.1%.

CONCLUSION

Only age, pain at baseline and disability at baseline influenced the pain intensity and disability after four weeks of treatment. The beta coefficient for age was statistically significant, but the magnitude of this association was very small and not clinically important.

Predictors of Depression and Musculoskeletal Disorder Related Work Disability Among Young, Middle-Aged, and Aging Employees

OBJECTIVE

The aim of this study was to investigate the level and predictors of work disability in different age groups.

METHODS

We followed young (18 to 34 years), middle-aged (35 to 50 years), and aging (>50 years) employees (n = 70,417) for 7 years (2005 to 2011) for all-cause and cause-specific work disability (sickness absence and disability pension). Using negative binomial regression, we obtained both relative risk estimates and absolute rates, that is, days of work disability per person-year.

RESULTS

The greatest relative difference in all-cause, and specifically depression-related work disability, was between young women and young men, and between employees with low versus high levels of education. Aging employees with a low education and chronic somatic disease had the highest levels of musculoskeletal disorder related work disability.

CONCLUSIONS

The predictors of work disability vary by age and diagnosis. These results help target age-specific measures for the prevention of permanent work disability.

Does Social Support Moderate the Association Among Major Depression, Generalized Anxiety Disorder, and Functional Disability in Adults With Diabetes?

BACKGROUND

Diabetes requires complex self-management routines to prevent the development of functional disability. Relative to people without diabetes, those with diabetes are more likely to have comorbid major depressive disorder (MDD) and generalized anxiety disorder (GAD), which also increase the likelihood of functional disability. Social support is associated with positive health outcomes in people with comorbid diabetes and mental disorders and may serve as a buffer against functional disability, though this possibility has yet to be examined.

OBJECTIVES

This study examined whether social support moderates the association between MDD or GAD and functional disability in adults with diabetes. Adults with MDD or GAD were expected to report greater disability than those without MDD or GAD. This association was expected to be stronger in people reporting lower social support relative to those reporting higher social support.

METHODS

Data came from the cross-sectional 2012 Canadian Community Health Survey-Mental Health (n = 1764). Diabetes status, social support, and functional disability were assessed via self-report; past-year MDD and GAD were assessed with structured diagnostic interviews.

RESULTS

Linear regression analyses, conducted separately for MDD and GAD, indicated main effects of past-year MDD and GAD, such that those with a mental disorder reported greater functional disability than those without a mental disorder. Social support did not moderate the associations between either MDD and functional disability or GAD and functional disability.

CONCLUSIONS

In this nationally representative population study, both MDD and GAD predicted greater functional disability in adults with diabetes. Social support, however, did not moderate these associations.

Temporarily Disabled Workers Account For A Disproportionate Share Of Health Care Payments

About one in four employees in a cohort of 408,000 US workers took a temporary leave of absence from work because of illness or injury in the period 2008-12. They accounted for nearly 60 percent (about $6.5 billion) of total worker health care and disability payments. This finding underscores the importance of workplace care management, lifestyle management, and health and safety efforts to prevent disability leaves.