The role of job strain on return to work after carpal tunnel surgery

Injuries That Happen at Work Lead to More Opioid Prescriptions and Higher Opioid Costs

OBJECTIVES

This study aimed to compare opioid prescription incidence, supply days, and cost associated with occupational injury and other injury-caused conditions.

METHODS

We used Medical Expenditure Panel Survey (MEPS) data for 2010-2019. The MEPS provides information on medical conditions and associated medical encounters, treatments, and treatment costs, as well as demographic, education, health, working status, income, and insurance coverage information. We used descriptive statistics and logistic and 2-part regressions.

RESULTS

Controlling for covariates and compared with other injury-caused conditions, occupational injury-caused conditions resulted in 33% higher odds of opioid prescribing, 32.8 more opioid prescription supply days, and $134 higher average cost.

CONCLUSIONS

Occupational injuries were associated with higher opioid incidence and costs, and more opioid supply days. These findings point to the need to focus on making work safer and the role employers may play in supporting worker recovery from injury and opioid use disorders.

The top 50 most cited articles in carpal tunnel syndrome research: A bibliometrics study

BACKGROUND

Citation analysis was applied to identify the influential studies in the specific field. More and more literature related to carpal tunnel syndrome (CTS) have been published in recent years. To our knowledge, no one has performed a citation analysis of CTS. Thus, our study identified the top 50 influential articles pertaining to CTS and conduct an analysis of their characteristics.

METHODS

The Web of Science database was used to identify all the articles from 1900 to 2020. We obtained the top 50 articles ranked by citation times, and articles were included and excluded based on the relevance to CTS. Also, we collected the information about journal name, level of evidence, source country and institution, and research type for further analysis.

RESULTS

The top 50 articles were published between 1959 and 2012. The number of citations ranged from 151 to 1083. The citation density was between 3.23 and 40.27 per year. Muscle Nerve published most articles in CTS research, followed by Journal of Bone and Joint Surgery American Volume. The USA was the leading country, and all the top 5 institutions were from the USA. Katz JN with the highest h-index published most articles. Level III was the most common evidence level.

CONCLUSIONS

We identified the top 50 cited articles related to CTS. These influential articles might provide researchers with a comprehensive list of the major contribution related to CTS research.

The Influence of Illness Perception and Mental Health on Return to Work After Carpal Tunnel Release Surgery

PURPOSE

Although multiple factors influencing return to work after a carpal tunnel release (CTR) have been identified, little is known about the influence of psychological patient factors on return to work. Therefore, this study aimed to identify the psychological factors that play a role in the return to work after a CTR surgery.

METHODS

Patients who planned to undergo a CTR were asked to fill out the Brief Illness Perception Questionnaire and the Patient Health Questionnaire before surgery to measure their illness perceptions and mental health status, respectively. Return to work was defined as the time until returning to work for 50% of normal hours and was measured using a questionnaire at 6 weeks, 3 months, and 6 months. To identify associations between nonpsychological and psychological patient factors and the return to work after CTR surgery, a Cox proportional hazards model was constructed.

RESULTS

In total, 615 patients were included in our study. Six months after surgery, 91% of the patients returned to work. For the psychological patient factors, we found that increases of 1 point on the items of worrying about carpal tunnel syndrome and having faith preoperatively in a beneficial effect of the CTR surgery were associated with hazard ratios of 0.92 (95% confidence interval, 0.88-0.96) and 1.10 (95% confidence interval, 1.02-1.19), respectively, for returning to work in the first 6 months after surgery. An increase of 1 point on the depression subscale of the Patient Health Questionnaire was associated with a hazard ratio of 0.88 (95% confidence interval, 0.78-0.99) for returning to work in the first 6 months after surgery.

CONCLUSIONS

Our study showed that multiple psychological patient factors are associated with return to work after a CTR surgery. Addressing these psychological factors before surgery might be a low-cost intervention to improve return to work after the CTR surgery.

TYPE OF STUDY/LEVEL OF EVIDENCE

Prognostic II.

Impact of Patient-Surgeon Relationship on Patient's Return to Work

BACKGROUND

Upper-limb injuries and musculoskeletal disorders represent a major economic burden for both patients and society, largely due to limitations in returning to work. We hypothesized that a positive patient-surgeon relationship may facilitate patients' recovery and lead to a faster return to work.

METHODS

This longitudinal observational study comprised 219 patients, from 8 French hand trauma centers, who were 18 to 55 years of age and were on sick leave from work because of an injury or musculoskeletal disorder of the upper limb. In addition to instruments measuring patients' functional scores and quality of life, the quality of the patient-surgeon relationship was assessed at enrollment using a specific questionnaire (Q-PASREL [Quality of PAtient-Surgeon RELationship]). Six months after enrollment, the return-to-work status was assessed. Logistic and Cox regression models were developed to identify predictors of return to work (yes/no) and the time off from work in days.

RESULTS

Overall, 74% of the patients who returned to work within 6 months after enrollment had a high or medium-high Q-PASREL score, whereas 64% of the patients who were still on sick leave had a low or medium-low Q-PASREL score. The odds of patients with a low or medium-low Q-PASREL score returning to work were, respectively, 95% and 71% lower than the odds of patients with a high score doing so, with a percent difference of 56% (95% confidence interval [CI] = 40% to 71%) for low versus high (odds ratio [OR] = 0.05 [95% CI = 0.02 to 0.13]) and 25% (95% CI = 6% to 44%) for medium-low versus high (OR = 0.29 [95% CI = 0.11 to 0.76]). All Q-PASREL items and scores were significantly associated with return to work.

CONCLUSIONS

Patients with a lower Q-PASREL score and more severe disability were less likely to return to work within 6 months and had a longer time off from work. Efforts to improve the quality of patient-surgeon relationships may minimize the duration of sick leaves and accelerate patient recovery.

LEVEL OF EVIDENCE

Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.

The Work Role Functioning Questionnaire v2.0 Showed Consistent Factor Structure Across Six Working Samples

Objective The Work Role Functioning Questionnaire v2.0 (WRFQ) is an outcome measure linking a persons' health to the ability to meet work demands in the twenty-first century. We aimed to examine the construct validity of the WRFQ in a heterogeneous set of working samples in the Netherlands with mixed clinical conditions and job types to evaluate the comparability of the scale structure. Methods Confirmatory factor and multi-group analyses were conducted in six cross-sectional working samples (total N = 2433) to evaluate and compare a five-factor model structure of the WRFQ (work scheduling demands, output demands, physical demands, mental and social demands, and flexibility demands). Model fit indices were calculated based on RMSEA ≤ 0.08 and CFI ≥ 0.95. After fitting the five-factor model, the multidimensional structure of the instrument was evaluated across samples using a second order factor model. Results The factor structure was robust across samples and a multi-group model had adequate fit (RMSEA = 0.63, CFI = 0.972). In sample specific analyses, minor modifications were necessary in three samples (final RMSEA 0.055-0.080, final CFI between 0.955 and 0.989). Applying the previous first order specifications, a second order factor model had adequate fit in all samples. Conclusion A five-factor model of the WRFQ showed consistent structural validity across samples. A second order factor model showed adequate fit, but the second order factor loadings varied across samples. Therefore subscale scores are recommended to compare across different clinical and working samples.

Sickness absence after carpal tunnel release: a systematic review of the literature

Objectives The aim of this systematic review was to provide an overview of time to return to work (RTW) after carpal tunnel release (CTR), including return to different occupations and working patterns. Methods A systematic search from inception to 2016 was conducted using nine electronic databases, trial registries and grey literature repositories. Randomized controlled trials and observational studies reporting RTW times after CTR were included. Study risk of bias was assessed using Cochrane risk of bias assessment tools. Time to RTW was summarized using median and range. Results A total of 56 relevant studies were identified: 18 randomized controlled trials and 38 observational studies. Only 4 studies were rated as having a low risk of bias. Reported RTW times ranged from 4-168 days. Few studies reported occupational information. Among 6 studies, median time to return to non-manual work was 21 days (range 7-41), compared with 39 days for manual work (range 18-101). Median time to return to modified or full duties was 23 days (ranges 12-50 and 17-64, respectively), as reported by 3 studies. There was no common method of defining, collecting or reporting RTW data. Conclusions This review highlights wide variation in reported RTW times after CTR. Whilst occupational factors may play a role, these were poorly reported, and there is currently limited evidence to inform individual patients of their expected duration of work absence after CTR. A standardized definition of RTW is needed, as well as an agreed method of collecting and reporting related data.

The First Six Years of Building and Implementing a Return-to-Work Service for Patients with Acquired Brain Injury. The Rapid-Return-to-Work-Cohort-Study

Background and objective Despite large activity worldwide in building and implementing new return-to-work (RTW) services, few studies have focused on how such implementation processes develop. The aim of this study was to examine the development in patient and service characteristics the first six years of implementing a RTW service for persons with acquired brain injury (ABI). Methods The study was designed as a cohort study (n=189). Data were collected by questionnaires, filled out by the service providers. The material was divided into, and analyzed with, two implementation phases. Non-parametrical statistical methods and hierarchical regression analyses were applied on the material. Results The number of patients increased significantly, and the patient group became more homogeneous. Both the duration of the service, and the number of consultations and group session days were significantly reduced. Conclusion The patient group became more homogenous, but also significantly larger during the first six years of building the RTW service. At the same time, the duration of the service decreased. This study therefore questions if there is a lack of consensus on the intensity of work rehabilitation for this group.

Job demands and decision control predicted return to work: the rapid-RTW cohort study

Background

In order to help workers with long-term sickness absence return to work (RTW), it is important to understand factors that either impede or facilitate employee’s reintegration into the labour force. The aim of this study was therefore to examine the impact of psychological work characteristics on time-to first RTW in sick listed employees in Norway.

Methods

The study was designed as a cohort study of 543 employees participating in 50 different RTW programmes. The Job Content Questionnaire (JCQ) was used to gather information on the psychological work conditions. The participants were followed for up to 18 months after they started treatment in the RTW programme. Survival analyses were used to investigate the association between psychological work conditions and time-to first RTW.

Results

Having high psychological job demands (HR = .654; 95% CI: .513–.832) and low decision control (HR = 1.297; 95% CI: 1.010–1.666) were both independent predictors of delayed RTW. Employees in low-strain jobs (low demands/high control) (HR = 1.811; 95% CI: 1.287–2.549) and passive jobs (low demands/low control) (HR = 1.599; 95% CI: 1.107–2.309), returned to work earlier compared to employees in high-strain jobs (high demands/low control). No difference was found for active jobs (high demands/high control).

Conclusion

This study revealed that high psychological demands, low control, and being in a high strain job reduced the probability of early RTW in sick listed employees. RTW programmes should therefore increase the focus on these issues.

Long-term symptomatic, functional, and work outcomes of carpal tunnel syndrome among construction workers

BACKGROUND

The long-term outcomes of carpal tunnel syndrome (CTS) including symptoms, functional status, work disability, and economic impact are unknown.

METHODS

We conducted a retrospective study of 234 active construction workers with medical claims for CTS and 249 workers without CTS claims; non-cases were matched on age, trade, and insurance eligibility. We conducted telephone interviews with cases and non-cases and collected administrative data on work hours.

RESULTS

Compared to non-cases, CTS cases were more likely to report recurrent hand symptoms, decreased work productivity/quality, decreased performance of physical work demands, and greater functional limitations. Surgical cases showed larger improvements on multiple outcomes than non-surgical cases. Minimal differences in paid work hours were seen between cases and non-cases in the years preceding and following CTS claims.

CONCLUSIONS

Persistent symptoms and functional impairments were present several years after CTS diagnosis. Long-term functional limitations shown by this and other studies indicate the need for improved prevention and treatment.

Carpal tunnel syndrome and work

Carpal tunnel syndrome (CTS) is the most common peripheral nerve entrapment syndrome, and it frequently presents in working-aged adults. Its mild form causes 'nuisance' symptoms including dysaesthesia and nocturnal waking. At its most severe, CTS can significantly impair motor function and weaken pinch grip. This review discusses the anatomy of the carpal tunnel and the clinical presentation of the syndrome as well as the classification and diagnosis of the condition. CTS has a profile of well-established risk factors including individual factors and predisposing co-morbidities, which are briefly discussed. There is a growing body of evidence for an association between CTS and various occupational factors, which is also explored. Management of CTS, conservative and surgical, is described. Finally, the issue of safe return to work post carpal tunnel release surgery and the lack of evidence-based guidelines are discussed.

Sickness absence from work among persons with new physician-diagnosed carpal tunnel syndrome: a population-based matched-cohort study

Background

Carpal tunnel syndrome is common among employed persons. Data on sickness absence from work in relation to carpal tunnel syndrome have been usually based on self-report and derived from clinical or occupational populations. We aimed to determine sickness absence among persons with physician-diagnosed carpal tunnel syndrome as compared to the general population.

Methods

In Skåne region in Sweden we identified all subjects, aged 17–57 years, with new physician-made diagnosis of carpal tunnel syndrome during 5 years (2004–2008). For each subject we randomly sampled, from the general population, 4 matched reference subjects without carpal tunnel syndrome; the two cohorts comprised 5456 and 21,667 subjects, respectively (73% women; mean age 43 years). We retrieved social insurance register data on all sickness absence periods longer than 2 weeks from 12 months before to 24 months after diagnosis. Of those with carpal tunnel syndrome 2111 women (53%) and 710 men (48%) underwent surgery within 24 months of diagnosis. We compared all-cause sickness absence and analyzed sickness absence in conjunction with diagnosis and surgery.

Results

Mean number of all-cause sickness absence days per each 30-day period from 12 months before to 24 months after diagnosis was significantly higher in the carpal tunnel syndrome than in the reference cohort. A new sickness absence period longer than 2 weeks in conjunction with diagnosis was recorded in 12% of the women (n = 492) and 11% of the men (n = 170) and with surgery in 53% (n = 1121) and 58% (n = 408) of the surgically treated, respectively; median duration in conjunction with surgery was 35 days (IQR 27–45) for women and 41 days (IQR 28–50) for men.

Conclusions

Persons with physician-diagnosed carpal tunnel syndrome have substantially more sickness absence from work than age and sex-matched persons from the general population from1 year before to 2 years after diagnosis. Gender differences were small.

Facilitadores e barreiras de retorno ao trabalho de trabalhadores acometidos por LER/DORT

INTRODUÇÃO: As Lesões por Esforços Repetitivos/Distúrbios Osteomusculares Relacionados ao Trabalho (LER/DORT) causam afastamento do trabalho de uma grande parcela de trabalhadores. OBJETIVO: Entender e sistematizar de que forma os fatores relacionados ao retorno ao trabalho (RT) de trabalhadores acometidos por LER/DORT são descritos na literatura como facilitadores ou barreiras. MÉTODOS: Revisão crítica de literatura do período de janeiro de 2005 a outubro de 2010 disponível nas bases Lilacs, MedLine e SciELO. As informações foram sistematizadas em três categorias de fatores que influenciam o RT e como facilitadores ou barreiras - de ordem pessoal, de ordem organizacional e relacionadas às características dos serviços, sistemas e políticas. RESULTADOS: Dos 633 artigos inicialmente levantados, 21 atenderam aos critérios de inclusão. Fatores identificados como mais relevantes: de ordem pessoal - dor, fatores psicossociais, afastamento do trabalho; organizacionais - modificações nos postos de trabalho, demanda psicológica do trabalho, apoio organizacional, apoio de colegas e da chefia; relacionados aos serviços, sistemas e políticas - programa de retorno ao trabalho, tempo de afastamento e serviços de apoio. CONCLUSÃO: O estudo evidenciou que o RT é um processo complexo, que demanda políticas intersetoriais, cooperação técnica e pactuação de metas entre os atores envolvidos no processo.

Perceived mastery of work among shift workers in the Norwegian offshore petroleum industry

This study investigated associations between individual and work-related factors and perceived mastery of work among offshore shift workers. 2,406 employees of a Norwegian petroleum company were invited to participate. A web-based survey was used and 1336 completed questionnaires were returned (56%). Mastery of work was assessed using QPS Nordic Mastery Scale and the results were compared with a sample from the QPS Nordic study. Individual factors adjusted for were age, gender, marital status and personality. The following work-related factors were included: demands, control, support, night work and shift work home interference. Female offshore shift workers reported higher levels of perceived mastery of work compared with women in the comparison sample. The following variables were independently associated with perceived mastery of work: female gender (β=0.10, p=0.008), decisional demands (β=0.13, p<0.001), control (β=0.05, p=0.009), social support (β=0.07, p<0.001), shift-work locus of control (β=0.04, p=0.005) and neuroticism (β=-0.29, p<0.001). Post hoc analyses showed no sex differences in perceived mastery in two separate work positions on the platforms. Work-related variables and personality explained 55% and 45% respectively of the total variance (R(2)=0.22) explained by the final model. Female petroleum offshore workers reported somewhat higher levels of mastery of work than their male colleagues, however, this may be due to different work positions. Work-related factors accounted for about half of the explained variance and decisional demands, control and support remained statistically significant after controlling for personality.

Massage therapy as an effective treatment for carpal tunnel syndrome

Carpal tunnel syndrome is a common peripheral entrapment that causes neuralgia in the median nerve distribution of the hand. The primary aim of this study was to evaluate the efficacy of massage therapy as a treatment for carpal tunnel syndrome. Within this process, the locations of trigger-points that refer neuropathy to the hand were identified. The creation of massage pressure tables provides a means of treatment reproducibility. Twenty-one participants received 30 min of massage, twice a week, for six weeks. Carpal tunnel questionnaires, the Phalen, Tinel, and two-point discrimination tests provided outcome assessment. The results demonstrated significant (p < 0.001) change in symptom severity and functional status from two weeks. Based on this study, the combination of massage and trigger-point therapy is a viable treatment option for carpal tunnel syndrome and offers a new treatment approach.

[Socioeconomic position and duration of disability benefit due to work-related musculoskeletal disorders]

This study estimated the effect of socioeconomic position on the duration of disability benefits due to musculoskeletal disorders affecting the neck and/or upper limbs. A cohort study including 563 insured workers from the city of Salvador, Bahia, Brazil, registered in the General Social Security System and who received temporary disability benefits due to musculoskeletal disorders affecting the neck and/or upper limbs, was performed in 2008 using data from the National Social Security Institute. The results show that among union member workers with high psychosocial demands at work, those with low socioeconomic status are almost twice as likely to receive benefit for a shorter period of time compared to those with a higher socioeconomic position (RR = 1.89; 95%CI: 1.25-2.87). These results reveal an inequitable situation or unnecessary use of insurance for workers with a higher socioeconomic position. Future research aimed at elucidating the differences in the use of benefits are needed so that social insurance system managers may take the appropriate steps to resolve this issue.

Ergonomic practices within patient care units are associated with musculoskeletal pain and limitations

BACKGROUND

With the high prevalence of musculoskeletal disorders (MSDs) for patient care unit workers, prevention efforts through ergonomic practices within units may be related to symptoms associated with typical work-related MSDs.

METHODS

We completed a cross-sectional survey of patient care workers (n = 1,572) in two large academic hospitals in order to evaluate relationships between self-reported musculoskeletal pain, work interference due to this pain, and limitations during activities of daily living (functional limitations) and with ergonomic practices and other organizational policy and practices metrics within the unit. Bivariate and multiple logistic regression analyses tested the significance of these associations.

RESULTS

Prevalence of self-reported musculoskeletal symptoms in the past 3 months was 74% with 53% reporting pain in the low back. 32.8% reported that this pain interfered with their work duties and 17.7% reported functional limitations in the prior week. Decreased ergonomic practices were significantly associated with reporting pain in four body areas (low back, neck/shoulder, arms, and lower extremity) in the previous 3 months, interference with work caused by this pain, symptom severity, and limitations in completing activities of daily living in the past week. Except for low back pain and work interference, these associations remained significant when psychosocial covariates such as psychological demands were included in multiple logistic regressions.

CONCLUSIONS

Ergonomic practices appear to be associated with many of the musculoskeletal symptoms denoting their importance for prevention efforts in acute health care settings.

Factors affecting return to work after carpal tunnel syndrome surgery in a large French cohort

OBJECTIVE

To evaluate occupational outcomes after surgical release of the median nerve in carpal tunnel syndrome (CTS).

DESIGN

Retrospective study 12 to 24 months after surgery.

SETTING

Hand centers (N=3) in 2 different areas.

PARTICIPANTS

Patients who had undergone surgical release of the median nerve in 2002 to 2003.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURE

Duration of sick leave after surgery and associated factors were analyzed by using bivariate (log rank) and multivariate analyses of survival (Cox model).

RESULTS

Questionnaires mailed in 2004 regarding medical condition (history and surgery), employment (occupational category codes in 1 digit), and compensation were returned (N=1248; 62%), with 253 men and 682 women stating they were employed at the time of surgery (N=935). Most were working at the time of the study (n=851; 91.0%). Median duration of sick leave before returning to work was 60 days. The main factors associated with adverse occupational outcome (long duration of sick leave) were simultaneous intervention for another upper-extremity musculoskeletal disorder, belief (by the patient) in an occupational cause, and "blue-collar worker" occupational category (the strongest determinant).

CONCLUSION

This study emphasizes the multifactorial nature of the occupational outcome of CTS after surgery, including occupational category. The probability of return to work for each risk factor provides a fair description of prognosis for physicians and patients.

The effect of recalled previous work environment on return to work after a rehabilitation program including vocational aspects for trauma patients

INTRODUCTION

The aim of the present study was to assess the association between remembered previous work place environment and return to work (RTW) after hospitalisation in a rehabilitation hospital.

METHODS

A cohort of 291 orthopedic trauma patients discharged from hospital between 15 December 2004 and 31 December 2005 was included in a study addressing quality of life and work-related questions. Remembered previous work environment was measured by Karasek's 31-item Job Content Questionnaire (JCQ), given to the patients during hospitalisation. Post-hospitalisation work status was assessed 3 months, 1, and 2 years after discharge, using a questionnaire sent to the ex-patients. Logistic regression models were used to test the role of four JCQ variables on RTW at each time point while controlling for relevant confounders.

RESULTS

Subjects perceiving a higher physical demand were less likely to return to work 1 year after hospital discharge. Social support at work was positively associated with RTW at all time points. A high job strain appeared to be positively associated with RTW 1 year after rehabilitation, with limitations due to large confidence intervals.

CONCLUSIONS

Perceptions of previous work environment may influence the probability of RTW. In a rehabilitation setting, efforts should be made to assess those perceptions and, if needed, interventions to modify them should be applied.

Work-related carpal tunnel syndrome in Washington State workers' compensation: utilization of surgery and the duration of lost work

BACKGROUND

Work-related carpal tunnel syndrome (CTS) is a leading cause of lengthy disability.

METHODS

This population-based retrospective cohort study used Washington State workers' compensation claims for CTS to characterize associations between utilization of CTS surgery and duration of lost work. The sample included all claims (n = 8,224) filed during 1990-1994 (followed through 2000) and receiving lost-work compensation.

RESULTS

Sixty-four percent of studied workers had CTS surgery. Among workers with >1 month of lost work, the total duration was much shorter when workers had surgery, versus those who did not (median 4.3 and 6.2 months, respectively; P < 0.001); there was no difference when disability extended >6 months. When workers had surgery, disability was less likely to end before 6 months if non-CTS conditions were present, surgery occurred >3 months after claim filing, or employment was in an industry with high incidence of CTS; disability was more likely to end if the diagnosing provider and operating surgeon had higher CTS claims volume. Physical and rehabilitation medicine services were associated with lower probability of returning to work, with or without surgery.

CONCLUSIONS

There is a need to scrutinize the role of surgery and physical-rehabilitation medicine modalities in the management of CTS covered by workers' compensation. The findings suggest disability can be minimized by establishing the CTS diagnosis as early as possible and, if surgery is appropriate, conducting surgery without substantial delay and maximizing post-operative efforts to facilitate return to work. Use of surgery >6 months after filing should be considered with great caution.

Margin of manoeuvre indicators in the workplace during the rehabilitation process: a qualitative analysis

INTRODUCTION

The task of evaluating workers' capacity to return to their pre-injury employment or other jobs continues to pose a daily challenge for clinicians. In this study, a concept frequently used in the field of ergonomics, the margin of manoeuvre (MM), was applied during the rehabilitation process. The study identified the indicators of the MM taken into account during the return to work of workers with musculoskeletal disorders.

METHODS

This study used a multiple-case design. A case was defined as a dyad comprising a worker admitted to a work rehabilitation program and the clinician who was managing the return-to-work process. The results were then validated with investigators and expert ergonomists, through group interviews. Content analyses were performed using the conceptual framework for the work activity model adapted from Vézina and the procedures recommended by Miles and Huberman.

RESULTS

A total of 11 workers, five clinicians, two experts and two investigators participated in this study. The interview analysis process resulted in a more detailed definition of the MM and the identification of 50 indicators. The indicators were classified according to six dimensions: (1) work context; (2) employer's requirements and expectations; (3) means and tools; (4) worker's personal parameters; (5) work activity; and (6) impacts of the work situation.

CONCLUSIONS

The more specific indicators identified in this study will allow for more systematic observation of the MM. Subsequent studies will seek to link each indicator described in the model with a specific method of observation.

Predictors of return to work ten months after primary breast cancer surgery

BACKGROUND

The most common female cancer in Western countries is breast cancer and women diagnosed with this disease are often under 65 years old. With increasing prevalence of survivors it is important to shed light on problems facing these women after diagnosis and treatment. The aim of this study was to assess factors predicting return to work (RTW) in women with early-stage breast cancer.

MATERIAL AND METHODS

A cohort of 102 women aged 18-64 with early-stage breast cancer who had undergone curative primary surgery with or without systemic adjuvant therapy were followed for 10 months using data from questionnaires and medical files.

RESULTS

Ten months after primary surgery, 59% of the women had returned to work while 41% were sick-listed part-time or full-time. After adjusting for age, health status, life satisfaction, vocational situation, and irradiation to the breast/chest wall and regional nodes, a multivariate logistic regression revealed the following factors as being negatively associated with RTW: a high-demand job (OR=0.1, 95% CI 0.0-0.8), axillary node dissection (OR=0.1, 95% CI 0.0-0.6), and treatment with chemotherapy (OR=0.1, 95% CI 0.0-0.7).

DISCUSSION

Treatment factors and high demands at work play an important role in RTW for women with early-stage breast cancer.

Impact of compensation on work outcome of carpal tunnel syndrome

BACKGROUND

Work-related carpal tunnel syndrome (CTS) is a complex and costly condition. There is some evidence that the employment outcome may be worse in cases of CTS where the condition is being considered for compensation.

AIM

To examine whether workers' compensation status is an important determinant of outcome of CTS.

METHODS

Cases, with a Workers' Compensation Board (WCB) claim, and referents, in work but without a WCB claim, were identified from the practice of a single specialist physician. Data on history prior to and at the time of diagnosis, and events since diagnosis, were collected from clinical records and by a telephone-administered questionnaire. Prior events, severity, treatment and outcome associated with a WCB claim were assessed by logistic regression.

RESULTS

Interviews were successfully completed for 46 cases and 50 referents. In the model adjusted only for age and gender, claimants had a worse outcome in terms of changing job or stopping work with time loss from work due to CTS [odds ratio (OR) 5.1, 95% confidence interval (CI) 1.9-13.3]. The OR was much influenced by the inclusion of treatment in the model (OR = 9.6, 95% CI 1.6-58.6) with WCB cases more likely to have surgical and physiotherapy treatments. Cases with a WCB claim cost more to treat and reported greater loss in income than those not seeking compensation.

CONCLUSIONS

Although these data are limited, the results are suggestive of poorer outcome among WCB claimants despite greater use of treatment and comparable severity of disease.

Early return to work following open carpal tunnel decompression in lamb freezing workers

Carpal tunnel syndrome is common at the largest lamb processing plant in the world, especially in new lamb boners. The purpose of this study was to establish the incidence and whether expeditious return to work following open carpal tunnel decompression was possible. Two hundred patients with a neurophysiologically confirmed diagnosis underwent surgery between 2002 and 2006. One hundred and eighty-seven patients were assessed retrospectively and 13 prospectively. The incidence in new lamb boners was 10% in their first season. On average, workers commenced rehabilitation at 11 days post-operatively and full duties at 29 days post-operatively with minimal further time off taken. Ninety percent returned to their previous role. By 8 weeks in the prospective group visual analogue pain scores had improved from 8.75 to 2.0 (P<0.01) and Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) scores had improved from 140 points to 68 (P<0.01). Grip/pinch testing, static two-point discrimination scores and complication rates were comparable with previous studies. This study provides good evidence that coordinated, early rehabilitation and return to work is effective in a high-demand population.

Health, psychosocial factors and retirement intentions among Finnish physicians

BACKGROUND

Early retirement among physicians is a worldwide problem and all efforts to try to minimize it are of importance.

AIMS

To investigate whether characteristics of work, organization factors and health factors might be associated with retirement intentions among physicians.

METHODS

Cross-sectional survey data from the Finnish Health Care Professional Study was used. A random sample of Finnish physicians included 682 women and 701 men aged 45-65 years. A three-level retirement intention score was constructed based on responses to two questions asking about (i) willingness to continue working or retiring and (ii) pension-applying considerations. Health indicators used were self-rated health, work ability and sickness absence during the past 12 months. Karasek's job control and Colquitt's organizational justice were measured. Ordinal logistic regression models were used to analyse the data.

RESULTS

Self-reports of poor health [odds ratio (OR) 2.17, 95% CI 1.84-2.56], low work ability (OR 2.18, 95% CI 1.12-1.46), taking sickness absence (OR 1.28, 95% CI 1.12-1.46), low job control (OR 1.71, 95% CI 1.50-1.95) and organizational injustice (OR 1.27, 95% CI 1.17-1.39) all independently increased the likelihood of retirement intentions. Low job control strengthened the associations of poor health and low work ability with retirement intentions. In addition, organizational injustice strengthened the associations of poor health and sickness absences with retirement intentions.

CONCLUSION

Low job control and organizational injustice may intensify the effect of poor health on retirement intentions. Promoting control opportunities and organizational justice might help to decrease early retirement among physicians.

Work organization and drinking: an epidemiological comparison of two psychosocial work exposure models

OBJECTIVES

To examine the relationship between two alternative psychosocial work exposure measurement frameworks (i.e., job alienation and job stress) and three drinking behaviours (frequent, heavy and drinking and work).

METHODS

A cross-sectional survey was conducted among 3,099 US drinking workers. Job stress conditions were assessed according to the Karasek's job strain model. Alienating job conditions were assessed with measures based on Kohn and Schooler's occupational self-direction concept. Multivariate logistic regression controlling for a wide range of known covariates was used.

RESULTS

High strain work showed no associations, while workers in passive jobs had an increased likelihood of heavy (OR = 1.29; 95%CI: 1.02-1.64) and lower likelihood of frequent drinking (OR = 0.71; 95%CI: 0.52-0.97). Unexpectedly, low complexity combined with low constraint related to more frequent drinking (OR = 1.60; 95%CI: 1.22-2.10). No associations with drinking at work were observed.

CONCLUSION

Our findings suggest an association between different work environment features and drinking behaviours. Our findings highlight the value of exploring the hypothesized passive pathway of the job strain model together with other theoretical perspectives, such as alienating job conditions.

Are there any correlations between social and hand functions in patients with carpal tunnel release surgery postoperatively?

BACKGROUND

Carpal tunnel syndrome is one of the most common and disabling work injuries in North America. Patients with carpal tunnel syndrome are often associated with substantial productivity loss and cost both at work and at home. Several studies have examined the relationship of social supports as a predictor of returning to work following carpal tunnel release surgery (CTRS). However, no studies published to date have examined the relationship between social support and the ability to perform activities of daily living after having CTRS.

OBJECTIVE

To examine whether a correlation exists between the degree of social support and hand function in terms of the ability to perform activities of daily living in patients who have had CTRS.

METHODS

Patients in the present cross-sectional study were evaluated with two standardized questionnaires at least two months postoperatively following CTRS. The questionnaires consisted of the Multidimensional Scale of Perceived Social Support, which evaluated social support, and QuickDASH, which evaluated hand function. A correlation analysis was then performed to identify any relationships between the two questionnaires.

RESULTS

In a sample of 20 patients, correlation analyses revealed that perceived social support was significantly associated with hand function scores postoperatively (r=-0.73, P<0.01). In addition, a statistically significant relationship existed between social support and the preoperative self-rating pain scores (r=-0.51, P<0.05). These results indicate that there is a strong association between the degree of social support and the ability to perform hand activities of daily living following CTRS.

Early predictors of chronic work disability associated with carpal tunnel syndrome: a longitudinal workers' compensation cohort study

BACKGROUND

The study objectives were to identify early predictors of chronic work disability associated with carpal tunnel syndrome (CTS) and to test the hypothesis that variables from each of several domains (sociodemographic, clinical, work-related, and psychosocial) would add unique predictive information.

METHODS

Washington State workers were interviewed 18 days (median) after submitting a new workers' compensation claim for CTS. Baseline predictors of chronic work disability (> or =180 days of work disability compensation in the year after claim submission) were examined for workers who had at least 1 day of disability compensation (N = 899).

RESULTS

Baseline demographic variables, symptom severity, functional limitations, lack of job accommodation, job physical demands, job psychosocial conditions, and worker psychosocial characteristics predicted chronic disability bivariately. Each domain of variables added significantly to the prediction of chronic disability. The final multivariable model had fair ability to discriminate individuals with versus without chronic disability (cross-validated area under the ROC curve = 0.76).

CONCLUSIONS

Sociodemographic, clinical, work-related, and worker psychosocial factors early in a claim contribute unique information to the prediction of subsequent work disability associated with CTS.

Epidemiology of work related neck and upper limb problems: psychosocial and personal risk factors (part I) and effective interventions from a bio behavioural perspective (part II)

Work related neck and upper limb symptoms have a multi-factorial origin. Possible risk factors are of a physical, psychosocial or personal origin. These factors can reinforce each other and their influence can also be mediated by cultural or societal factors. Initially, most research on neck and upper limb symptoms focused on work-related physical exposure. Nowadays, psychosocial work characteristics are recognized as important risk factors. Various models have been developed to offer frameworks for possible pathways, but their empirical support is still not conclusive. In part I of this paper an overview is presented of the results of recent epidemiological studies on work related psychosocial and personal risk factors for neck and upper limb symptoms. In addition, the interplay between these factors and the possible intermediate role of an individuals work style in this process is explored. In contrast to previous reviews, it is now possible to base the conclusions on the effect of work related psychosocial factors on neck and upper limb symptoms on quite a few longitudinal studies. These studies show that high work demands or little control at work are often related to these symptoms. However, this relationship is neither very strong nor very specific. Perceived stress is studied in not as many studies but more consistently related to neck and upper limb symptoms. This also applies to general distress or other pain (co-morbidity). Job dissatisfaction does not contribute to neck and upper limb symptoms. Too little research on personal characteristics is available to draw any conclusions. It is plausible that behavioural aspects, such as work style, are of importance in the etiology of work related upper limb symptoms. However, studies concerning these factors are promising but too scarce to draw conclusions. Future studies should address these behavioural aspects. In part II, the recent studies on the effectiveness of preventive measures for work related neck and upper limb problems are discussed. Few randomised or non randomised controlled trials have been carried out to evaluate the effectiveness of individual or organisational interventions to improve work related psychosocial factors. Very few have reported on the preventive effect for work related neck and upper limb symptoms. Therefore, there is a great need for additional high quality trials before any conclusions on effectiveness of bio-behavioural interventions for reduction of neck and upper limb problems and return to work after these symptoms can be made. From the low back pain intervention research can be learned that interventions should best be targeted to both the worker and the organisation and that interventions will only be successful when all stakeholders are involved.