Prognostic factors for return to work after a first compensated episode of back pain

[Factors related to the one-month retention of 8507 employees declared medically unfit in Hauts-de-France companies between 2014 and 2018]

BACKGROUND

Given the low rate of retention in a company after an employee has been found unfit for the job, our aim was to determine the factors related to employees being kept by their company one month after being declared unfit for the job due to either a musculoskeletal disease (MSD) or a mental health disorder (MHD).

METHODS

This study was based on all employees declared unfit for the job by the occupational physicians in the "Unfitness" survey in the French "Hauts-de-France" region between 2014 and 2018. For each of the two groups of workers, factors related to the employees being kept by their company one month after being declared unfit for the job were studied by logistic regression.

RESULTS

Only 6.9% of the 5352 workers declared unfit for the job due to MSD were kept in their company whereas 3.6% of the 3155 workers declared unfit for the job due to MHD were kept in theirs. For the two groups of workers, the proportion of employees kept by their company decreased with female gender (OR=0.63 95%CI [0.47-0.84] for MSD and OR=0.50 [0.32-0.78] for MHD for female vs. male), long sick-leave (OR=0.26 [0.18-0.40] for MSD and OR=0.22 [0.11-0.45] for MHD for sick-leave>6 months vs. no sick leave), small size of the company (<50 employees) and working in the construction field or services sector (vs. industry or administration). Concerning the employees declared unfit due to MSD alone, the proportion of employees kept by their company decreased for seniors (>50 years old) and for those with low seniority (<5 years).

CONCLUSION

"Retention in a company" as a tool for "maintenance of employment" is a little-discussed subject, lending further credence to the current recommendations for reduction of inequalities in working conditions and vocational training of employees according to age and socio-occupational category, and also for reduction of inequalities in occupational pathways according to gender.

The Relationship Between Public Sector Employment and Population Health: Evidence From the 1980s and Its Contemporary Implications

This article explores the relationship between public sector employment and population health both theoretically and quantitatively. First, we build a theoretical framework to situate public employment in the literature that explores the link between politics and health. We argue that public employment, as an instrument of pro-redistributive policies in both the labor market and the welfare state, improves equality and ultimately health. Second, based on a cross-country dataset from the 1980s, and by applying regression analysis and outlier identification techniques, we find that population health measured by life expectancy improves with the size of public employment. The association is stronger for countries with lower income and for women. When policymakers contemplate downsizing state enterprises and government functions, they should consider the health effect of public employment.

Predictors of return to work with and without restrictions in public workers

Background

Sick leaves are important events for both the worker and the employer. Many factors are related with sick leaves and depending on the factors the worker could perform a successful return to work. In this sense, the objective of this study is to identify those factors associated with return to work after sick leaves in a group of public workers in Brazil.

Methods

A case-control study of return to work after sick leaves in a university campus from 2010 to 2015. Logistic regression models were adjusted for two different response variables: return to work with and without restrictions. A digital database was created and completed with data from manual sources.

Results

A computerised database has been created, based on manual records, which has allowed us to identify labour and non-labour factors associated with the return to work after a sick leave and the possible functional readaptation, with or without restrictions, in public workers. Age at the beginning of the process, number of sick leaves, those of more than 16 days, average duration (total time of sick leaves / number of medical records), and mid-level healthcare positions were associated with return to work without restrictions. In the model of return to work with restrictions, the age of hiring by the university, the number of sick leaves, those of more than 16 days, and mid-level healthcare positions, both rural work and operational positions, were associated to the response variable.

Conclusions

This study has allowed us to identify the factors associated with the return to work after a period of sick leave in a large group of public workers. However, more research is needed on the mental disorders that cause sick leaves, their evaluation and the handling of these situations.

Lag times in the work disability process: Differences across diagnoses in the length of disability following work-related injury

BACKGROUND

The amount of time between key points in the work disability and workers' compensation process, referred to as lag times, has been shown to relate to work disability outcomes but little research has examined how this finding may differ based on the diagnosis associated with the cause of work disability.

OBJECTIVE

To examine whether relationships between lag times in the work disability process and disability duration vary by diagnosis in a sample of workers' compensation claims.

METHODS

Using workers' compensation claims, Analysis of Covariance was used to estimate differences in disability duration across three lag times (days from the date of injury to: reporting the injury, seeking medical care, and starting lost work time paid by the workers' compensation insurer) and injury diagnosis groups (Work-related Musculoskeletal Disorders (WRMSD) and fractures).

RESULTS

WRMSD tended to have longer lag times than fractures, whereas disability duration tended to be longer for fractures than WRMSD. Overall, shorter lag times were associated with shorter disability duration, but the relationships varied across diagnosis groups, and greater variation in disability duration was observed for WRMSD compared to fractures.

CONCLUSIONS

The findings suggest the importance of responding to work-related injuries by reporting the injury, receiving medical care, and taking time off of work if necessary, in a timely fashion.

Road casualties in work-related and private contexts: occupational medical impact. Results from the ESPARR cohort

BACKGROUND

Road accidents may impact victims' physical and/or mental health and socio-occupational life, notably including return to work.

OBJECTIVES

To assess whether the occupational medical consequences sustained by subjects injured in road accidents occurring in a work-related context differ from those associated with private accidents.

METHODS

778 adults who were in work or occupational training at the time of their accident were included. Two groups were distinguished: 354 (45.5%) injured in road accidents occurring in a work-related context (commuting or on duty) and 424 (54.5%) injured in a private accident. The groups were compared on medical and occupational factors assessed on prospective follow-up at 6 months and 1 and 3 years. Multivariate analysis explored for factors associated at 6 months and 1 year with sick leave following the accident and duration of sick leave.

RESULTS

There were no significant differences between groups for demographic data apart from a slightly higher injury severity in private accidents (32.5% of private accidents with MAIS3+(Maximum Abbreviated Injury Scale greater or equal to 3) vs. 23.7% for work-related accidents, p = 0.007). Victims of work-related accidents were more often on sick leave (OR = 1.8; 95% CI, 1.1-2.9). Although the length of sick leave is higher for work-related accidents that for private accidents, multivariate analysis showed that the injury severity and the post-traumatic stress disorder (PTSD) are significant factors to explain the time to return to work. There were no significant differences according to occupational impact during follow-up, notably including sick-leave duration, number of victims returning to work within 3 years and number of victims out of work due to incapacity.

CONCLUSIONS

In the ESPARR (follow-up study of a road-accident population in the Rhône administrative county: Etude de Suivi d'une Population d'Accidentés de la Route dans le Rhône) cohort, the fact that a road accident occurred in a work-related context did not affect the occupational consequences.

The Association Between Time Taken to Report, Lodge, and Start Wage Replacement and Return-to-Work Outcomes

OBJECTIVE

The aim of the study was to determine if prolonged times taken to notify, file, adjudicate, and start wage replacement for workers' compensation claims are associated with poorer return-to-work (RTW) outcomes.

METHODS

Using 71,607 claims lodged 2007 to 2012, logistic regression determined associations between time to claim filing, adjudication, and payment and (1) socio-demographic/economic, occupational, and injury-related factors; and (2) 52 weeks of wage replacement (WR).

RESULTS

Prolonged times for all processing steps were associated with increased odds of reaching 52 weeks of WR. Prolonged times in more than one step increased the odds of a long-term claim. Being female was the only variable consistently associated with each prolonged processing time.

CONCLUSIONS

The predictive ability of prolonged times in claim lodgement and processing and compensation payments demonstrate that shorter claims management and adjudication times could improve RTW outcomes.

Lag Times in Reporting Injuries, Receiving Medical Care, and Missing Work: Associations With the Length of Work Disability in Occupational Back Injuries

The aim of this study is to examine the associations between lag times following occupational low back injury and the length of work disability.

Management of Acute Lumbar Injuries in the Workplace

Occupational acute lumbar injuries are a common injury. One intervention that is unique to occupational health is the determination of the amount of physical activity that an injured worker can perform without increasing the risk of further injury. Clinical recommendations suggest that workers continue to stay active; however, it is still the clinician's responsibility to determine the level of activity. The level of work activity is determined on a case-to-case basis and is done by evaluating the physical capacity of an injured worker and the job description. Current evidence-based guidelines suggest that staying active may actually reduce pain levels. The purpose of this evidence-based literature review is to outline the proper assessment and management of workers who have sustained a work-related low back injury. The related literature has been reviewed as well as red flags for more severe neurological conditions that require more in-depth evaluation. Determining the safe level of activity and guided return to work have been discussed.

Evaluation of functional restoration outcomes for chronic disabling occupational cervical disorders

OBJECTIVE

To systematically evaluate the effectiveness of an interdisciplinary functional restoration program (FRP) for treating chronic cervical disorders.

METHODS

Consecutive chronic occupational lumbar disorder patients (n = 898) and chronic occupational cervical disorder patients (n = 215) were admitted to an FRP from 2001 to 2011. Patients were compared on demographics, work-related and psychosocial factors, and socioeconomic outcomes 1 year after discharge.

RESULTS

Compared with lumbar patients, cervical patients were more likely to be female, have preadmission surgery, perform white-collar work, and have a longer time between injury and treatment admission. Cervical patients were similar to lumbar patients on most psychosocial self-report outcome measures. In addition, both groups exhibited high work return and work retention rates 1 year after FRP discharge.

CONCLUSIONS

An FRP seems to be equally efficacious for treating both chronic occupational cervical and lumbar disorders.

Associations with duration of compensation following whiplash sustained in a motor vehicle crash

CONTEXT

Continued exposure to compensation systems has been reported as deleterious to the health of participants. Understanding the associations with time to claim closure could allow for targeted interventions aimed at minimising the time participants are exposed to the compensation system.

STUDY OBJECTIVE

To identify the associations of extended time receiving compensation benefits with the aim of developing a prognostic model that predicts time to claim closure.

STUDY DESIGN

Prospective cohort study in people with whiplash associated disorder.

OUTCOME MEASURES

Time to claim closure, in a privately underwritten fault based third party traffic crash insurance scheme in New South Wales, Australia.

METHOD

Cox proportional hazard regression modelling.

RESULTS

Of the 246 participants, 25% remained in the compensation system longer than 24 months with 15% remaining longer than three years. Higher initial disability (Functional Rating Index≥25 at baseline) (HRR: 95% CI, 1.916: 1.324-2.774, p<0.001); and lower initial mental health as measured by SF-36 Mental Component Score (HRR: 95% CI, 0.973: 0.960-0.987, p<0.001) were significantly and independently associated with an increased time-to-claim closure. Shorter time to claim closure was associated with having no legal involvement (HRR: 95% CI, 1.911: 1.169-3.123, p=0.009); and, not having a prior claim for compensation (HRR: 95% CI, 1.523: 1.062-2.198, p=0.022).

CONCLUSIONS

Health and insurance related factors are independently associated with time to claim closure. Both factors need to be considered by insurers in their assessment of complexity of claims. Interventions aimed at minimising the impact of these factors could reduce claimants' exposure to the compensation system. In turn insurers can potentially reduce claims duration and cost, while improving the health outcomes of claimants.

The effects of individual, occupational, and supportive factors on successful return to work using a structural equation model

OBJECTIVES

We aimed to ascertain the relationship between several factors and successful return to work using a structural equation model.

METHODS

We used original data from the Panel Study of Worker's Compensation Insurance, and defined four latent variables as occupational, individual, supportive, and successful return to work. Each latent variable was defined by its observed variables, including age, workplace size, and quality of the medical services. A theoretical model in which all latent variables had a relationship was suggested. After examining the model, we modified some pathways that were not significant or did not fit, and selected a final structural equation model that had the highest goodness of fit.

RESULTS

All three latent variables (occupational, individual, and supportive) showed statistically significant relationships with successful return to work. The occupational and supportive factors had relationships with each other, but there was no relationship between individual and the other factors. Nearly all observed variables had significance with their latent variables. The correlation coefficients from the latent variables to successful return to work were statistically significant and the indices for goodness of fit were satisfactory. In particular, four observed variables-handicap level, duration of convalescence, working duration, and support from the company-showed construct validities with high correlation coefficients.

CONCLUSIONS

All factors that we examined are related to successful return to work. We should focus on the supportive factor the most because its variables are modifiable to promote a return to work by those injured in their workplace.

Does the economy affect functional restoration outcomes for patients with chronic disabling occupational musculoskeletal disorders?

PURPOSE

To determine how the economy affects psychosocial and socioeconomic treatment outcomes in a cohort of chronic disabling occupational musculoskeletal disorder (CDOMD) patients who completed a functional restoration program (FRP).

METHODS

A cohort of 969 CDOMD patients with active workers' compensation claims completed an FRP (a medically-supervised, quantitatively-directed exercise progression program, with multi-modal disability management). A good economy (GE) group (n = 532) was released to work during a low unemployment period (2005-2007), and a poor economy (PE) group (n = 437) was released during a higher unemployment period (2008-2010). Patients were evaluated upon admission for demographic and psychosocial variables, and were reassessed at discharge. Socioeconomic outcomes, including work return and work retention 1 year post-discharge, were collected.

RESULTS

Some significant differences in psychosocial self-report data were found, but most of the effect sizes were small, so caution should be made when interpreting the data. Compared to the PE group, the GE group reported more depressive symptoms and disability at admission, but demonstrated a larger decrease in depressive symptoms and disability and increase in self-reported quality of life at discharge. The PE group had lower rates of work return and retention 1-year after discharge, even after controlling for other factors such as length of disability and admission work status.

CONCLUSIONS

CDOMD patients who completed an FRP in a PE year were less likely to return to, or retain, work 1-year after discharge, demonstrating that a PE can be an additional barrier to post-discharge work outcomes. A difference in State unemployment rates of <3% (7 vs. 5%) had a disproportionate effect on patients' failure to return to (19 vs. 6%) or retain (28 vs. 15%) work.

Clinical examination findings as prognostic factors in low back pain: a systematic review of the literature

Background

There is a strong tradition of performing a clinical examination of low back pain (LBP) patients and this is generally recommended in guidelines. However, establishing a pathoanatomic diagnosis does not seem possible in most LBP patients and clinical tests may potentially be more relevant as prognostic factors. The aim of this review of the literature was to systematically assess the association between low-tech clinical tests commonly used in adult patients with acute, recurrent or chronic LBP and short- and long-term outcome.

Methods

MEDLINE, Embase, and MANTIS were searched from inception to June 2012. Prospective clinical studies of adult patients with LBP with or without leg pain and/or signs of nerve root involvement or spinal stenosis, receiving non-surgical or no treatment, which investigated the association between low-tech clinical tests and outcome were included. Study selection, data extraction and appraisal of study quality were performed independently by two reviewers.

Results

A total of 5,332 citations were retrieved and screened for eligibility, 342 articles were assessed as full text and 49 met the inclusion criteria. Due to clinical and statistical heterogeneity, qualitative synthesis rather than meta-analysis was performed. Associations between clinical tests and outcomes were often inconsistent between studies. In more than one third of the tests, there was no evidence of the tests being associated with outcome. Only two clinical tests demonstrated a consistent association with at least one of the outcomes: centralization and non-organic signs.

Conclusions

For most clinical tests in LBP there is not consistent evidence for an association with outcome. Centralization and non-organic signs are exceptions from that. None of the other clinical tests have been investigated in confirmatory studies and study quality is generally low. There is a need for hypothesis testing studies designed specifically to investigate the prognostic value of the clinical tests, and a need for standardization of the performance and interpretation of tests.

Electronic supplementary material

The online version of this article (doi:10.1186/s12998-015-0054-y) contains supplementary material, which is available to authorized users.

Absence from work and return to work in people with back pain: a systematic review and meta-analysis

Background

A considerable proportion of work absence is attributed to back pain, however prospective studies in working populations with back pain are variable in setting and design, and a quantitative summary of current evidence is lacking.

Objective

To investigate the extent to which differences in setting, country, sampling procedures and methods for data collection are responsible for variation in estimates of work absence and return to work.

Methods

Systematic searches of seven bibliographic databases. Inclusion criteria were: adults in paid employment, with back pain, work absence or return to work during follow-up had been reported. Random effects meta-analysis and meta-regression analysis was carried out to provide summary estimates of work absence and return to work rates.

Results

45 studies were identified for inclusion in the review; 34 were included in the meta-analysis. The pooled estimate for the occurrence of work absence in workers with back pain was 15.5% (95% CI 9.8% to 23.6%, n=17 studies, I² 98.1%) in studies with follow-up periods of ≤6 months. The pooled estimate for the proportion of people with back pain returning to work was 68.2% (95% CI 54.8% to 79.1%, n=13, I² 99.2%), 85.6% (95% CI 78.2% to 90.7%, n=13, I² 98.7%) and 93.3% (95% CI 84.0% to 94.7%, n=10, I² 99%), at 1 month, 1–6 months and ≥6 months, respectively. Differences in setting, risk of participation bias and method of assessing work absence explained some of the heterogeneity.

Conclusions

Pooled estimates suggest high return to work rates, with wide variation in estimates of return to work only partly explained by a priori defined study-level variables. The estimated 32% not back at work at 1 month are at a crucial point for intervention to prevent long term work absence.

Prediction model for unsuccessful return to work after hospital-based intervention in low back pain patients

Background

Many studies on low back pain (LBP) have identified prognostic factors, but prediction models for use in secondary health care are not available. The purpose of this cohort study, based on a randomised clinical study, was to identify risk factors for unsuccessful return to work (U-RTW) in sick-listed LBP patients with or without radiculopathy and to validate a prediction model for U-RTW.

Methods

325 sick-listed LBP patients with or without radiculopathy were included in an intervention study and followed for one year. Afterwards, 117 other LBP patients were recruited similarly, included in a validation study and also followed for one year. All patients were subjected to identical procedures and interventions and received a brief intervention by the same rehabilitation doctor and physiotherapist. Half of them received case manager guidance within a multidisciplinary setting. At baseline, they completed a questionnaire and went through a clinical low-back examination. Sciatica was investigated by magnetic resonance imaging (MRI). U-RTW was registered in a national database both initially and at 1-year.

Results

Neither initial U-RTW (24.0%) nor one-year U-RTW (38.2%) were statistically significantly different in the two intervention groups nor in patients with and without radiculopathy. Multivariate logistic regression analysis identified two clinical and five psychosocial baseline predictors for one-year U-RTW (primary outcome). The clinical predictors included pain score (back+leg pain) and side-flexion. The five psychosocial predictors included ‘bodily distress’ ‘low expectations of RTW’, ‘blaming the work for pain’, ‘no home ownership’ and ‘drinking alcohol less than once/month’. These predictors were not statistically significantly different in patients with and without radiculopathy, and they also predicted initial U-RTW (secondary outcome). Obesity and older age were only supplementary predictors in patients with radiculopathy. A prediction model was established and tested in the validation study group. The model predicted one-year U-RWT in patients with intermediate and high risk, but only partially in patients with low risk. The model predicted all three risk categories in initial U-RTW.

Conclusions

A prediction model combining baseline clinical and psychosocial risk factors predicted patients with low, intermediate and high risk for unsuccessful return to work, both initially and at 1-year.

Self perceptions as predictors for return to work 2 years after rehabilitation in orthopedic trauma inpatients

PURPOSE

This study aimed to identify self-perception variables which may predict return to work (RTW) in orthopedic trauma patients 2 years after rehabilitation.

METHODS

A prospective cohort investigated 1,207 orthopedic trauma inpatients, hospitalised in rehabilitation, clinics at admission, discharge, and 2 years after discharge. Information on potential predictors was obtained from self administered questionnaires. Multiple logistic regression models were applied.

RESULTS

In the final model, a higher likelihood of RTW was predicted by: better general health and lower pain at admission; health and pain improvements during hospitalisation; lower impact of event (IES-R) avoidance behaviour score; higher IES-R hyperarousal score, higher SF-36 mental score and low perceived severity of the injury.

CONCLUSION

RTW is not only predicted by perceived health, pain and severity of the accident at the beginning of a rehabilitation program, but also by the changes in pain and health perceptions observed during hospitalisation.

Determinants of sickness absence duration after an occupational back injury in the Belgian population

BACKGROUND

This study aimed at assessing factors associated to the duration of sickness absence after a back injury in the Belgian working population, with a special emphasis on cultural factors.

METHODS

The data were retrieved from the Belgian Fund for Work Accidents database over a 3-year period (2001-2003). The population source involved all Belgian workers under a job contract in the private sector registered as compensated cases for an accident that occurred at the workplace (n = 558,276). From that database, all back injury cases involving a complete data set and registered during the first 6 months of each year (n = 11,262) were selected and eight factors (gender, age, seniority in the current job, job category, accident regional location, enterprise size, sector of activity, and accident circumstances) were analyzed in relation to the outcome variable, sick leave duration recorded as ordered time intervals between 0 and 183-366 days.

RESULTS

Sick leave duration was strongly associated in a multivariate model to age (≥40 years: OR = 2.18), blue-collar job (1.55), work in building industry (1.32), and enterprise size (>100: 0.85), and to a less extent to seniority (>10y: 0.88), and circumstance of accident (falls: 1.26). Injuries occurring in the French-speaking part of the country were associated to a longer sick leave (1.07; P = 0.034).

CONCLUSIONS

This study shows that besides well-known risk factors, subtle cultural language-linked factors and/or regional differences in economic climate may significantly influence the length of disability period after a back injury.

Twenty years of multidisciplinary research and practice: the Journal of Occupational Rehabilitation then and now

BACKGROUND

Early research of work disability in the 1980s showed a complexity of factors influencing pain and health-related functional limitation at work; hence, multidisciplinary perspectives were necessary to understand the complex interplay between biomechanical, organizational, social, and psychological factors impacting work disability. To address this need, the Journal of Occupational Rehabilitation was founded in 1991 with the goal of providing a scientific, yet practical forum for presenting multidisciplinary research and practice in work disability. Now, the 20-year collection of articles in the Journal reflects important trends and directions in the field of occupational rehabilitation.

METHODS

We conducted a retrospective summary of the past 20 years of the Journal of Occupational Rehabilitation, including its inaugural goals and intent, rates of submission and acceptance, trends in the types of articles published, study topics, global distribution of authors, and future directions.

RESULTS

The original goal of providing a multidisciplinary scientific and practical forum has been met, but current trends reflect a maturing scientific evidence base, with less representation of employer-based case studies and practical innovations. There has been a dramatic increase in the international representation of studies, authors, and peer reviewers outside of the US. Also, published studies now address work disability for a larger number of health concerns.

CONCLUSIONS

Contributions to the Journal continue to reflect a multidisciplinary perspective, but the Journal has seen significant changes with respect to international representation, the expanding study of non-musculoskeletal sources of work disability, and the maturing scientific evidence base in the field of occupational rehabilitation. Future volumes of the Journal will likely reflect continuing changes in the global economy, workforce fitness, and job demands.

Influence of efforts of employer and employee on return-to-work process and outcomes

BACKGROUND

Research on disability and RTW outcome has led to significant advances in understanding these outcomes, however, limited studies focus on measuring the RTW process. After a prolonged period of sickness absence, the assessment of the RTW process by investigating RTW Effort Sufficiency (RTW-ES) is essential. However, little is known about factors influencing RTW-ES. Also, the correspondence in factors determining RTW-ES and RTW is unknown. The purpose of this study was to investigate 1) the strength and relevance of factors related to RTW-ES and RTW (no/partial RTW), and 2) the comparability of factors associated with RTW-ES and with RTW.

METHODS

During 4 months, all assessments of RTW-ES and RTW (no/partial RTW) among employees applying for disability benefits after 2 years of sickness absence, performed by labor experts at 3 Dutch Social Insurance Institute locations, were investigated by means of a questionnaire.

RESULTS

Questionnaires concerning 415 cases were available. Using multiple logistic regression analysis, the only factor related to RTW-ES is a good employer-employee relationship. Factors related to RTW (no/partial RTW) were found to be high education, no previous periods of complete disability and a good employer-employee relationship.

CONCLUSIONS

Different factors are relevant to RTW-ES and RTW, but the employer-employee relationship is relevant for both. Considering the importance of the assessment of RTW-ES after a prolonged period of sickness absence among employees who are not fully disabled, this knowledge is essential for the assessment of RTW-ES and the RTW process itself.

Low back pain predict sickness absence among power plant workers

Background:

Low back pain (LBP) remains the predominant occupational health problem in most industrialized countries and low-income countries. Both work characteristics and individual factors have been identified as risk factors. More knowledge about the predictors of sickness absence from LBP in the industry will be valuable in determining strategies for prevention.

Objectives:

The aim of this longitudinal study was to investigate whether individual, work-related physical risk factors were involved in the occurrence of LBP sickness absence.

Methods:

A follow-up study was conducted among 489 workers, aged 18–65 years, at Kosovo Energetic Corporation in Kosovo. This cross-sectional study used a self-administered questionnaire to collect data on individual and work-related risk factors and the occurrence of LBP sickness absence. Logistic regression models were used to determine associations between risk factors and the occurrence of sickness absence due to LBP.

Results:

Individual factors did not influence sickness absence, whereas work-related physical factors showed strong associations with sickness absence. The main risk factors for sickness absence due to LBP among production workers were extreme trunk flexion (OR = 1.71, 95% CI = 1.05–2.78) as well as very extreme trunk flexion (OR = 6.04, 95% CI = 1.12–32.49) and exposure to whole-body vibration (OR = 1.75, 95% CI = 1.04–2.95).

Conclusion:

Reducing sickness absence from LBP among power plant workers requires focusing on the working conditions of blue-collar workers and risk factors for LBP. Increasing social support in the work environment may have effects in reducing sickness absence from LBP.

Barriers and enablers to returning to work from long-term sickness absence: Part I-A quantitative perspective

BACKGROUND

Long-term sickness absence (LTSA) in the United Kingdom labor market has become a major health issue in recent years. In contrast to short-term sickness absence, rates for LTSA have been on the increase. This paper, part 1 of a two-part paper, identifies individual domain barriers to returning to work (RTW) from LTSA across the work disability timeline in the UK labor market.

METHODS

This is a retrospective cohort study of 6,246 workers from an occupationally diverse Police Force within the UK using a large administrative database. A series of chi-squared analyses were conducted to analyze the between and within group associations. Next, multiple logistic regression analyses using the Enter method were performed to develop a predictive model for RTW and Absence Phase.

RESULTS

Findings substantiated the presence of individual domain barriers to RTW and predictors of RTW outcome and established the absence phase specificity of a number of risk factors of prolonged work disability. In particular, injury/illness especially mental ill health (MIH), physical job demands, sex, and number of episodes of LTSA are significant individual domain barriers to RTW and represent important risk factors for prolonged work disability.

CONCLUSIONS

Duration of work disability is associated with medical diagnosis, especially MIH, physical job demands, sex, and number of LTSA episodes. Findings also support the importance of using the outcome measure of absence phase of risk factors in addition to RTW outcome.

The impact of psychiatric comorbidity on the return to work in patients undergoing herniated disc surgery

INTRODUCTION

This study examines (1) return to work (RTW) and ability to work (ATW) rates, and the association with (2) psychiatric comorbidity and (3) socio-demographic, illness-related, vocational and rehabilitation-related characteristics in herniated disc surgery patients.

METHODS

In this longitudinal observational study 305 consecutive patients took part in face-to-face interviews during hospital stay. 277 patients also participated in a 3-month follow-up survey via telephone (drop-out rate 9%). Psychiatric comorbidity was assessed with the Composite International Diagnostic Interview (CIDI-DIA-X). Calculations were conducted via Chi-Square tests, independent T-tests and binary logistic regression analyses.

RESULTS

40.1% of the herniated disc patients in this study were able to RTW, 44.4% had regained their ATW 3 months after surgery. Psychiatric comorbidity appeared to be an important risk factor for RTW and ATW. Other risk factors were lower educational qualification, unemployment status, a lower subjective prognosis of gainful employment, a higher number of herniated discs in medical history, cervical disc surgery, and the existence of other chronic diseases, a longer hospital stay and higher pain intensity. Patients who did not RTW, or did not regain their ATW participated more often in inpatient rehabilitation.

CONCLUSIONS

Identifying a high risk group for RTW and ATW at an early age is of utmost importance for the purpose of improving rehabilitation effects and to make a return to the work place easier. Specific interventions, such as social-medical counselling, pain therapy and management, as well as the assistance of mental health professionals during hospital and rehabilitation treatment are recommended for this risk group.

Relationship of early magnetic resonance imaging for work-related acute low back pain with disability and medical utilization outcomes

OBJECTIVE

To examine early magnetic resonance imaging (MRI) utilization for workers compensation cases with acute, disabling low back pain and further, to examine low or high propensity to undergo early MRI with disability duration, medical costs, and surgery.

METHODS

Two-year follow-up of 3264 cases. Cox regression and generalized linear models were used to examine the association between both early MRI (first 30 days postonset) and propensity of belonging to the early MRI group (estimated by demographic and severity indicators) with outcomes.

RESULTS

A total of 21.7% cases had early MRI. After controlling for covariates, cases that had early MRI and simultaneously had a low propensity to undergo early MRI were more likely to have worse outcomes.

CONCLUSIONS

The majority of cases had no early MRI indications. Results suggest that iatrogenic effects of early MRI are worse disability and increased medical costs and surgery, unrelated to severity.

Validation of a risk factor-based intervention strategy model using data from the readiness for return to work cohort study

BACKGROUND

Low back pain (LBP) is a common and in some cases disabling condition. Until recently, workers presenting with non-specific LBP have generally been regarded as a homogeneous population. If this population is not homogeneous, different interventions might be appropriate for different subgroups. We hypothesized that (1) Clusters of individuals could be identified based on risk factors, (2) These clusters would predict duration and recurrences 6 months post-injury.

METHODS

The study focuses on the 442 LBP claimants in the Readiness for Return-to-Work Cohort Study. Claimants (n = 259) who had already returned to work, approximately 1 month post-injury were categorized as the low risk group. A latent class analysis was performed on 183 workers absent from work, categorized as the high risk group. Groups were classified based on: pain, disability, fear avoidance beliefs, physical demands, people-oriented culture and disability management practice at the workplace, and depressive symptoms.

RESULTS

Three classes were identified; (1) workers with 'workplace issues', (2) workers with a 'no workplace issues, but back pain', and (3) workers having 'multiple issues' (the most negative values on every scale, notably depressive symptoms). Classes 2 and 3 had a similar rate of return to work, both worse than the rate of class 1. Return-to-work status and recurrences at 6 months were similar in all 3 groups.

CONCLUSION

This study largely confirms that several subgroups could be identified based on previously defined risk factors as suggested by an earlier theoretical model by Shaw et al. (J Occup Rehab 16(4):591-605, 2006). Different groups of workers might be identified and might benefit from different interventions.

Predictors of delayed return to work after back injury: A case-control analysis of union carpenters in Washington State

METHODS

Union administrative records identified 20,642 union carpenters who worked in Washington State from 1989 to 2003. The Department of Labor and Industries provided records of workers' compensation claims and associated medical care. Work-related back claims (n = 4,241) were identified by ANSI codes (back, trunk, or neck/back) or ICD-9 codes relevant to medical care consistent with a back injury. Cases (n = 738) were defined as back injury claims with >90 days of paid lost time; controls (n = 699) resulted in return to work within 30 days. Logistic regression models estimated odds ratios and 95% confidence intervals (OR, 95% CI) of delayed return to work (DRTW).

RESULTS

Thirty percent of case claims and 8% of control claims were identified by an ICD-9 code. DRTW after back injury was associated with being female (2.7, 95% CI: 1.3-5.5), age 30-44 (1.2, 95% CI: 0.9-1.7) and age over 45 (1.6, 95% CI: 1.1-2.3), four or more years union experience (1.4, 95% CI: 1.1-1.8), previous paid time loss back claim (1.8, 95% CI: 1.3-2.5), and >or=30-day delay to medical care (3.6, 95% CI: 2.1, 6.1). Evidence of more acute trauma was also associated with DRTW.

CONCLUSIONS

Use of ICD-9 codes identified claims with multiple injuries that would otherwise not be captured by ANSI codes alone. Though carpenters of younger age and inexperience were at increased risk for a paid lost time back injury claim, older carpenters and more experienced workers, once injured, were more likely to have DRTW as were those who experienced acute events.

Does participation in interdisciplinary work rehabilitation programme influence return to work obstacles and predictive factors?

PURPOSE

Musculoskeletal disorders evolve into long-term work disabilities in--10% of work-injury cases. From a prevention perspective, screening for predictive factors and obstacles associated with long-term work disability appear to offer a promising avenue for work rehabilitation. However, knowledge of the factors at play during the chronic phase remains limited. This study aims to explore the presence of a relationship between the predictive factors and obstacles identified at the time of admission to an interdisciplinary work rehabilitation programme and return to work upon completion of the programme, in individuals with a long-term work disability.

METHOD

A descriptive correlational study involving 222 individuals assessed using the Work Disability Diagnostic Interview and who participated in the PREVICAP work rehabilitation programme.

RESULTS

The general model accurately predicts the work status of 77% of the participants. Seven to nine factors were found to be associated with return to work in each model produced (3). Those factors were mainly psychosocial and work-related in nature and differ according to gender. Unexpectedly, certain obstacles observed at the time of admission to the programme appear to have a protective effect and thus promote participants' return to work.

CONCLUSION

The results obtained support the hypothesis that screening for predictive factors and obstacles at the time of admission of a work rehabilitation programme for individuals with a long-term work disability allows for more effective intervention regarding these factors, and in all likelihood, promotes return to work.

Administrative delays and chronic disability in patients with acute occupational low back injury

OBJECTIVES

This study assessed whether an organizational factor, delays to claim acceptance or administrative delays, had an influence on outcomes for individuals with acute back injuries in the workers' compensation system.

METHODS

Multivariate logistic regression was used to test whether individuals who experienced administrative delays were more likely to develop chronic disability than those who did not experience delays.

RESULTS

Beyond the first 2 weeks, each interval of administrative delay was associated with increased odds of developing chronic disability. Injury severity, physician experience and weeks to medical treatment were additionally very strong predictors for the development of chronic disability.

CONCLUSIONS

Insurers, employers, and policy makers can significantly reduce chronic disability if controls are adopted to reduce administrative and treatment delays and to direct workers to experienced clinicians.

Estimating investment worthiness of an ergonomic intervention for preventing low back pain from a firm's perspective

A mathematical model was developed for estimating the net present value (NPV) of the cash flow resulting from an investment in an intervention to prevent occupational low back pain (LBP). It combines biomechanics, epidemiology, and finance to give an integrated tool for a firm to use to estimate the investment worthiness of an intervention based on a biomechanical analysis of working postures and hand loads. The model can be used by an ergonomist to estimate the investment worthiness of a proposed intervention. The analysis would begin with a biomechanical evaluation of the current job design and post-intervention job. Economic factors such as hourly labor cost, overhead, workers' compensation costs of LBP claims, and discount rate are combined with the biomechanical analysis to estimate the investment worthiness of the proposed intervention. While this model is limited to low back pain, the simulation framework could be applied to other musculoskeletal disorders. The model uses Monte Carlo simulation to compute the statistical distribution of NPV, and it uses a discrete event simulation paradigm based on four states: (1) working and no history of lost time due to LBP, (2) working and history of lost time due to LBP, (3) lost time due to LBP, and (4) leave job. Probabilities of transitions are based on an extensive review of the epidemiologic review of the low back pain literature. An example is presented.

ISSLS prize winner: early predictors of chronic work disability: a prospective, population-based study of workers with back injuries

STUDY DESIGN

Prospective population-based cohort study.

OBJECTIVE

To identify early predictors of chronic work disability after work-related back injury.

SUMMARY OF BACKGROUND DATA

Identification of early predictors of prolonged disability after back injury could increase understanding concerning the development of chronic, disabling pain, and aid in secondary prevention. Few studies have examined predictors across multiple domains in a large, population-based sample.

METHODS

Workers (N = 1885) were interviewed 3 weeks (average) after submitting a lost work-time claim for a back injury. Sociodemographic, employment-related, pain and function, clinical, health care, administrative/legal, health behavior, and psychological domain variables were assessed via worker interviews, medical records, and administrative databases. Logistic regression analyses identified early predictors of work disability compensation 1 year after claim submission.

RESULTS

Significant baseline predictors of 1-year work disability in the final multidomain model were injury severity (rated from medical records), specialty of the first health care provider seen for the injury (obtained from administrative data), and worker-reported physical disability (Roland-Morris disability questionnaire), number of pain sites, "very hectic" job, no offer of a job accommodation (e.g., light duty), and previous injury involving a month or more off work. The model showed excellent ability to discriminate between workers who were/were not disabled at 1 year (area under the receiver operating characteristic curve = 0.88, 95% CI = 0.86-0.90).

CONCLUSION

Among workers with new lost work-time back injury claims, risk factors for chronic disability include radiculopathy, substantial functional disability, and to a lesser extent, more widespread pain and previous injury with extended time off work. The roles of employers and health care providers also seem important, supporting the need to incorporate factors external to the worker in models of the development of chronic disability and in disability prevention efforts.

Risk factors for sickness absence due to low back pain and prognostic factors for return to work in a cohort of shipyard workers

The purpose of this study was to determine risk factors for the occurrence of sickness absence due to low back pain (LBP) and to evaluate prognostic factors for return to work. A longitudinal study with 1-year follow-up was conducted among 853 shipyard workers. The cohort was drawn around January 2004 among employees in the shipyard industry. Baseline information was obtained by questionnaire on physical and psychosocial work load, need for recovery, perceived general health, musculoskeletal complaints, sickness absence, and health care use during the past year. During the 1-year follow-up for each subject medical certifications were retrieved for information on the frequency and duration of spells of sickness absence and associated diagnoses. Cox regression analyses were conducted on occurrence and on duration of sickness absence with hazard ratios (HR) with 95% confidence interval (95% CI) as measure of association. During the 1-year follow-up period, 14% of the population was on sick leave at least once with LBP while recurrence reached 41%. The main risk factors for sickness absence were previous absence due to a health problem other than LBP (HR 3.07; 95%CI 1.66–5.68) or previous sickness absence due to LBP (HR 6.52; 95%CI 3.16–13.46). Care seeking for LBP and lower educational level also hold significant influences (HR 2.41; 95%CI 1.45–4.01 and HR 2.46; 95%CI 1.19–5.07, respectively). Living with others, night shift and supervising duties were associated with less absenteeism due to LBP. Workers with a history of herniated disc had a significantly decreased rate of returning to work, whereas those who suffered from hand-wrist complaints and LBP returned to work faster. Prior sick leave due to LBP partly captured the effects of work-related physical and psychosocial factors on occurrence of sick leave. Our study showed that individual and job characteristics (living alone, night shift, lower education, sick leave, or care seeking during the last 12 months) influenced the decision to take sick leave due to LBP. An increased awareness of those frequently on sick leave and additional management after return to work may have a beneficial effect on the sickness absence pattern.

Relationship between early opioid prescribing for acute occupational low back pain and disability duration, medical costs, subsequent surgery and late opioid use

STUDY DESIGN

Retrospective cohort study of workers' compensation (WC) claims with acute disabling low back pain (LBP).

OBJECTIVE

To examine the association between early opioid use for acute LBP and outcomes: disability duration, medical costs, "late opioid" use (> or = 5 prescriptions from 30 to 730 days), and surgery in a 2-year period following LBP onset.

SUMMARY OF BACKGROUND DATA

Opioid analgesics have become more accepted for acute pain management. However, treatment guidelines recommend limited opioid use for acute LBP management. Little is known about the long-term impact on outcomes of opioid use for acute LBP.

METHODS

The sample consisted of 8443 claimants from a large WC database with new-onset, disabling LBP that occurred between January 1, 2002 and December 31, 2003. Based on morphine equivalent amount (MEA) in milligrams received in the first 15 days ("early opioids"), claimants were divided into 5 groups (0, 1-140, 141-225, 226-450, 450+). The associations between early opioids and outcomes were evaluated using multivariate linear and logistic regression models. Covariates included age, gender, job tenure, and low back injury severity. Injury severity was classified using ICD-9 codes.

RESULTS

Twenty-one percent of claimants received at least 1 early opioid prescription. After controlling for the covariates, mean disability duration, mean medical costs, and risk of surgery and late opioid use increased monotonically with increasing MEA. Those who received more than 450 mg MEA were, on average, disabled 69 days longer than those who received no early opioids (95% confidence interval [CI], 49.2-88.9). Compared with the lowest MEA group (0 mg opioid), the risk for surgery was 3 times greater (95% CI, 2.4-4.0) and the risk of receiving late opioids was 6 times greater (95% CI, 4.9-7.7) in the highest MEA group. Low back injury severity was a strong predictor of all the outcomes.

CONCLUSION

Given the negative association between receipt of early opioids for acute LBP and outcomes, it is suggested that the use of opioids for the management of acute LBP may be counterproductive to recovery.

Return to work among sickness-absent Danish employees: prospective results from the Danish Work Environment Cohort Study/National Register on Social Transfer Payments

This study investigates the determinants within socio-demography, health behaviour, employer characteristics, and psychosocial and physical work environment for return to work. In 2000, a total of 5357 employees were interviewed regarding age, gender, family status, education, health behaviour, employer characteristics and work environment. They were followed in a national register for 18 months in order to identify subjects with 2 weeks or more of sickness absence. They were followed for an additional 12 months in order to establish associations between baseline measurements and time to first return to work. A total of 930 (17.4%) employees experienced sickness absence in the 18 months after baseline. During the 12-month follow-up, 856 (92.0%) returned to work, the mean absence period being 6.6 weeks. Prolonged time to first return to work was associated with female gender, increased age, no post-school education, being employed by a public employer, working at a workplace with 20 or more employees, high emotional demands in work, high job insecurity and sedentary work. There were no associations between health behaviour variables and return to work. The study indicates a potential for promoting return to work through interventions targeting emotional job demands, job insecurity and decreasing the risks associated with sedentary work.

Prognostic Factors of Long-Term Disability in a Workers?? Compensation System

OBJECTIVE

We identified predictive factors of long-term disability in new workers' compensation claims to guide secondary prevention research and target interventions for high-risk claims.

METHODS

Workers with 4 or more days of work disability resulting from workplace injuries were followed for approximately 6 years in a population-based retrospective inception cohort study of 81,077 workers.

RESULTS

Predictors of long-term disability included delay between injury and first medical treatment, older age, construction industry, logging occupation, longer time from medical treatment to claim filing, back injury, smaller firm size, female gender, higher unemployment rate, and having dependents. We used logistic and quantile regression to investigate predictors of disability. These models produced consistent information regarding predictors.

CONCLUSION

These factors can be used to identify jobs or workers at increased risk for long-term disability that warrant prevention intervention.

Predicting the long term course of low back pain and its consequences for sickness absence and associated work disability

BACKGROUND

Low back pain is characterised by a dynamic pattern of episodes and recovery but little is known about the long term course of back pain due to lack of cohort studies with sufficiently long follow up periods.

METHODS

A cohort of 523 workers in nursing homes and homes for the elderly was followed for two years. Physical load was measured by observations at the workplace. Psychosocial factors at work, individual characteristics, and low back pain were determined by questionnaire once a year. The effect of work load on low back pain and the transition of low back pain into sickness absence was calculated with logistic regression analysis. A Markov model was used to construct a hypothetical cohort of workers with follow up of 40 years (40 cycles of 1 year) with transitional probabilities between no complaints, low back pain, and sickness due to low back pain. Permanent disability was used as end state of health.

RESULTS

The transitional probability from no complaints to low back pain varied between p = 0.25 and p = 0.29, from low back pain to sickness absence between p = 0.09 and p = 0.25, and recurrence of sickness absence varied between p = 0.27 and p = 0.50, depending on the level of physical load. During a 40 year career, total sickness absence due to low back pain was approximately 140 weeks (6.6%) among workers with high physical load and about 30 weeks (1.4%) among those with low physical load.

CONCLUSION

The Markov approach illustrated the potential impact of physical load on (permanent) disability due to low back pain among workers with exposure to physical load. These consequences may go unnoticed in cohort studies with follow up periods of a few years.

Determinants of "return to work in good health" among workers with back pain who consult in primary care settings: a 2-year prospective study

Many factors have been linked to return to work after a back pain episode, but our understanding of this phenomenon is limited and cross-sectional dichotomous indices of return to work are not valid measures of this construct. To describe the course of "return to work in good health" (RWGH--a composite index of back pain outcome) among workers who consulted in primary care settings for back pain and identify its determinants, a 2-year prospective study was conducted. Subjects (n = 1,007, 68.4%) were workers who consulted in primary care settings of the Quebec City area for a nonspecific back pain. They completed five telephone interviews over 2 years (follow-up = 86%). Analyses linking baseline variables with 2-year outcome were conducted with polytomous logistic regression. The proportion of "success" in RWGH increased from 18% at 6 weeks to 57% at 2 years. In women, persistent pain, pain radiating to extremities, increasing job seniority, not having a unionized job, feeling that the physician did listen carefully and increasing fear-avoidance beliefs towards work and activity were determinants of "failure" in RWGH. In men, decreasing age, cigarette smoking, poor self-reported health status, pain in the thoracic area, previous back surgeries, a non-compensated injury, high pain levels, belief that job is below qualifications, likelihood of losing job, job status, satisfaction with health services and fear-avoidance beliefs towards work were all significant. RWGH among workers with back pain receives multiple influences, especially among men. In both genders, however, fear-avoidance beliefs about work are associated with failure and high self-efficacy is associated with success.

Prospective study of physical and psychosocial risk factors for sickness absence

AIM

To investigate the associations between psychosocial and physical work environment exposures and sickness absence from work taking into account health, health behaviour and employer characteristics known to affect sickness absence.

METHODS

In 1995, a random sample of 5574 employees aged 18-64 years were interviewed. In 2000, 3792 of those still employed supplied data on days absent from work the year preceding the date of follow-up. Associations between risk factors at baseline and sickness absence at follow-up were studied. Logistic regression analyses were performed.

RESULTS

Sickness absence was associated with working with arms lifted/hands twisted, extreme bending/stooping of the back/neck, repetitive monotonous work, low skill discretion, low decision authority, obesity, current and former smoking, poor self-rated health, female gender, increasing age and public employer. The aetiological fraction attributable to differences in work environment exposures was calculated to be 40%.

CONCLUSION

The study suggests a potential for reducing sickness absence through multifactorial interventions towards smoking, obesity, physical and psychosocial work environment exposures. The study showed that differences in work environment exposures account for 40% of the cases of high sickness absence.

Time dependent factors affecting the duration of work disability after compensated low-back pain in South Korea

The purpose of this study was to investigate the time dependent effects among factors affecting duration of work disability after compensated low-back pain. A postal survey involving 238 compensated workers at 39 companies was performed between January 5, 2004, and March 23, 2004. Cox proportional hazard regression analysis was used to model the effect of demographic, work-related, and injury factors affecting the duration of work disability. The variables that significantly affected the duration of work disability were age, company size, compensation benefit, pain radiation, and diagnosis. In addition, company size and pain radiation showed statistically significant time dependent effect. Consequently, this study found that there were time dependent factors affecting the duration of work disability. A phase-specific analysis would be useful to make policy for the prevention of long-term disability after back injury.

Return to work and adjustment latitude among employees on long-term sickness absence

INTRODUCTION

The aim was to study whether return to work (RTW) after long-term sickness absence is affected by adjustment latitude i.e. opportunities to adjust one's work to one's state of health by e.g. choosing among work tasks and deciding about work pace and working hours. We also studied whether the effect of adjustment latitude differed between those returning full-time and those returning part-time.

METHODS

Differences between men and women were also studied. A questionnaire was sent to 5,590 salaried employees who had been on sick leave for at least 90 days in 2000. The year after, 2001, they received a questionnaire which included questions about work status, working conditions, adjustment latitude and health.

RESULTS

The questionnaire was returned from 3056 persons. Among women 32% were fully back to work, 34% were partly back and 34% were still on sick leave. Comparable figures for men were 33%, 32% and 36%.

CONCLUSION

For both men and women the likelihood to RTW increased with increasing number of opportunities to adjust. Adjustment latitude increased returning to part-time as well as full-time work. The study indicates that work organisation is important for RTW.

Case management interviews and the return to work of disabled employees

This study measures the effect of case management interview (CMI) on 1,000 long-term sick-listed employees' probability of returning to work. In contrast to previous studies, we use instrumental variables to correct for selection effects in CMI. Using a competing hazard rate model, we find that CMI increases the probability of returning to work for the pre-sick leave employer, but has no effect on the probability of resuming work for a new employer. We argue that CMI either motivates the sick-listed employees to resume work or adjusts for asymmetric information between the employee and the pre-sick leave employer.

Length of disability prognosis in acute occupational low back pain: development and testing of a practical approach

STUDY DESIGN

Retrospective cohort study.

OBJECTIVES

Practical evaluation of a rapid prognostic screening method to predict length of disability after acute occupational low back pain (OLBP).

SUMMARY OF BACKGROUND DATA

Few studies have evaluated the prognostic value of administrative data and selected clinical variables in typical practice settings.

METHODS

Nurse case manager (NCM) input for 16 variables and 7 administrative data variables were collected for 494 OLBP cases with at least 30 days of disability. Length of disability (LOD) was ascertained by individual indemnity payment analysis. Cases were censored after accumulating 365 days of temporary total disability or if they received a lump sum settlement. Prognostic variables were evaluated by Cox proportional hazards modeling.

RESULTS

In a multivariate model, prolonged LOD was associated with older age, shorter job tenure, female gender, presence of language barriers, comorbidity, prior work absence, delayed referral, attorney involvement nonsupportive of return to work (RTW), and low RTW motivation. Although only 12% of overall variance in LOD was explained by the model, high-risk and low-risk terciles were readily distinguished.

CONCLUSIONS

In a typical setting, data collection and risk prediction by nurses or case managers are feasible and provide specific information that can be used to identify who should receive intervention, as well as some guidance on factors that should be addressed.

A study of factors influencing return to work after wrist or ankle fractures

BACKGROUND

Factors associated with time to return to work are poorly understood for occupational injuries, other than those to the back.

METHODS

Anonymized data on claims for work-related wrist or ankle fracture between 1/1/1998 and 12/31/2002 were identified in administrative data held by the Workers Compensation Board in Alberta, Canada. Bivariate and Cox regression analyses were used to identify factors associated with return to work.

RESULTS

Increased duration of temporary disability (TD) was associated with older age, female gender, work in construction and construction trade services, smaller company size, higher industry claim rates, a fall/jump from a height, ankle fracture, and greater medical aid costs in the 30 days following injury (used as a proxy for severity).

CONCLUSIONS

Factors associated with longer time off work were largely consistent with those reported following back injury. Median time to return to work was longer following ankle than wrist fracture. Although Workers' Compensation Board (WCB) administrative data provided information that could be used to identify factors affecting return to work, better information on injury severity would considerably enhance their research potential.