Risk assessment for prolonged sickness absence due to musculoskeletal disorders: protocol for a prospective cohort study

Level of diagnostic agreement in musculoskeletal shoulder diagnosis between remote and face-to-face consultations: A retrospective service evaluation

Background and Aims

To determine the level of diagnostic agreement between remote and face-to-face consultation in assessing shoulder complaints.

Methods

A retrospective service evaluation with three groups of patient data; those assessed only face-to-face (group 1), remotely then face-to-face (group 2), remotely only (group 3). Patient data were extracted from 6 secondary care shoulder Advanced Physiotherapy Practitioner's (APPs) records, covering six sites. Three-hundred-and-fifty-nine sets of patient data were included in the final evaluation. The main outcome measure was the percentage of agreement between diagnosis at initial and follow-up consultation, when assessed by APPs across the three groups. A Pearson χ 2 test was used to assess the relationship between the method of consultation and the level of diagnostic agreement. Diagnoses were categorized as either the same, similar, or different by an independent APP. Secondary outcome measures investigated whether age or the length of time between appointments had any effect in determining the level of diagnostic concordance.

Results

There was exact agreement of 77.05% and 85.52% for groups 1 and 3, respectively, compared with 34.93% for patient data in group 2. Similar clinical impressions across both initial and follow-up were seen 16.39% of the time in group 1, 7.24% of the time in group 3, and 36.99% in group 2. Lastly, the percentage of times a diagnosis was changed between initial and review appointments occurred in only 6.56% of group 1 contacts, 7.24% of group 3 contacts, but 28.08% of the time in group 2.

Conclusion

There was a large mismatch in the diagnosis of musculoskeletal shoulder complaints, when patients are initially assessed remotely and then followed-up in-person. This has implications for the future provision of shoulder assessment in physiotherapy.

Modifiable prognostic factors of high societal costs among people on sick leave due to musculoskeletal disorders: findings from an occupational cohort study

OBJECTIVES

The objective was to identify modifiable prognostic factors of high societal costs among people on sick leave due to musculoskeletal disorders, and to identify modifiable prognostic factors of high costs related to separately healthcare utilisation and productivity loss.

DESIGN

A prospective cohort study with a 1-year follow-up.

PARTICIPANTS AND SETTING

A total of 549 participants (aged 18-67 years) on sick leave (≥ 4 weeks) due to musculoskeletal disorders in Norway were included.

OUTCOME MEASURES AND METHOD

The primary outcome was societal costs aggregated for 1 year of follow-up and dichotomised as high or low, defined by the top 25th percentile. Secondary outcomes were high costs related to separately healthcare utilisation and productivity loss aggregated for 1 year of follow-up. Healthcare utilisation was collected from public records and included primary, secondary and tertiary healthcare use. Productivity loss was collected from public records and included absenteeism, work assessment allowance and disability pension. Nine modifiable prognostic factors were selected based on previous literature. Univariable and multivariable binary logistic regression analyses were performed to identify associations (crude and adjusted for selected covariates) between each modifiable prognostic factor and having high costs.

RESULTS

Adjusted for selected covariates, six modifiable prognostic factors associated with high societal costs were identified: pain severity, disability, self-perceived health, sleep quality, return to work expectation and long-lasting disorder expectation. Depressive symptoms, work satisfaction and health literacy showed no prognostic value. More or less similar results were observed when high costs were related to separately healthcare utilisation and productivity loss.

CONCLUSION

Factors identified in this study are potential target areas for interventions which could reduce high societal costs among people on sick leave due to musculoskeletal disorders. However, future research aimed at replicating these findings is warranted.

TRIAL REGISTRATION NUMBER

NCT04196634, 12 December 2019.

The validity and reliability of the Turkish version of the 12-item Örebro musculoskeletal screening questionnaire (ÖMSQ-12-TR)

PURPOSE

The 12-item Örebro Musculoskeletal Screening Questionnaire (ÖMSQ-12) is a multidimensional questionnaire assessing general musculoskeletal problems. This study aimed to investigate its construct validity and reliability.

MATERIALS AND METHODS

Confirmatory factor analysis (CFA) was performed for construct validity. The Tampa Scale for Kinesiophobia (TSK) and the SF-12 and Pain Numerical Rating Scale (P-NRS) were used for convergent validity. Reliability (ICC), internal consistency (Cronbach's alpha), reproducibility, and known-group validity were assessed. The cut-off value was measured.

RESULTS

A total of n = 378 individuals (aged 35.7 ± 12.4 years, female = 73.3%) with a musculoskeletal problem participated in the study. P-NRS score of the individuals was 5. Results showed that a 3-factor model did fit well under CFA (χ2/df = 2.76 ≤ 3). The questionnaire had good reliability (ICC = 0.865) and internal consistency (α = 0.810). There were no floor or ceiling effects (<%15). Total ÖMSQ-12-TR scores had a correlation with the TSK, SF-12 and P-NRS (r = 0.303-0.609). The AUC for the risk of absenteeism from work was obtained as 0.738 (p < 0.001). The risk of absenteeism was high in individuals with an ÖMSQ-12-TR score of ≥57.5.

CONCLUSIONS

The ÖMSQ-12-TR is a valid and reliable questionnaire that can be used in determining the risk of absenteeism in musculoskeletal disorders and is convenient for online use.

CLINICAL TRIAL NUMBER

NCT04723615.

Identification and Characterisation of Trajectories of Sickness Absence Due to Musculoskeletal Pain: A 1-Year Population-based Study

Purpose This study aimed to identify trajectories of sickness absence in workers on sick leave due to musculoskeletal disorders and explore the association between these trajectories and established prognostic factors for sickness absence. Methods We conducted a prospective cohort study of 549 workers (56% women, aged 18-67 years) on sick leave due to musculoskeletal disorders in Norway in 2018-2019. Sickness absence data were collected from the Norwegian sick leave registry and prognostic factors via self-reported baseline questionnaires. We used group-based trajectory modelling to define the different trajectories of sickness absence spanning a 1-year period. Multivariable multinomial logistic regression was used to estimate odds ratios and 95% confidence intervals for prognostic factors associated with the identified trajectory groups. Results We identified six distinct trajectories of sickness absence over 1 year: 'fast decrease' (27% of the cohort): 'moderate decrease' (22%); 'slow decrease' (12%); 'u-shape' (7%); 'persistent moderate' (13%); and 'persistent high' (18%). Prognostic factors, such as previous sickness absence days, return-to-work expectancy, workability, multisite pain, and health scores, differentiated between the sickness absence trajectories (all P < 0.05). Negative return-to-work expectancy was associated with the three trajectory groups with the highest number of sickness absence days ('slow decrease', 'persistent moderate', and 'persistent high'). Conclusions This is the first study to explore the association of return-to-work expectancy with trajectories of sickness absence. Our findings highlight different patterns of sickness absence and the complex range of prognostic factors. These findings have implications for secondary and tertiary prevention strategies for work absence in workers with musculoskeletal disorders.

Stratifying workers on sick leave due to musculoskeletal pain: translation, cross-cultural adaptation and construct validity of the Norwegian Keele STarT MSK tool

OBJECTIVES

Stratified care using prognostic models to estimate the risk profiles of patients has been increasing. A refined version of the popular STarT Back tool, the Keele STarT MSK tool, is a newly developed model for matched treatment across a wide range of musculoskeletal pain presentations. The aim of this study was to translate and culturally adapt the Keele STarT MSK tool into Norwegian, examine its construct validity and assess the representativeness of the included sample.

METHODS

The Keele STarT MSK tool was formally translated into Norwegian following a multistep approach of forward and backward translation. A pre-final version was tested in 42 patients. Minor changes were implemented. To assess its construct validity, an online survey was conducted among workers aged 18-67 years who were on sick leave (>4 weeks) due to musculoskeletal disorders. Construct validity was evaluated in terms of convergent and discriminant validity using Pearson's correlation coefficient, and known-group validity by comparing risk subgroups as suggested by the COSMIN checklist. The representativeness of the sample was assessed by comparing demographic and sick leave information of participants to eligible non-participants (n=168,137).

RESULTS

A representative sample of 549 workers participated in the validity assessment; 74 participants (13.5%) were categorised as low risk, 314 (57.2%) as medium risk and 161 (29.3%) as high risk. The construct validity was found sufficient, with 90.9% and 75.0% of the pre-defined hypotheses confirmed for convergent and discriminant validity, and known-group validity, respectively. Floor or ceiling effects were not found.

CONCLUSIONS

The Keele STarT MSK tool was successfully translated into Norwegian. The construct validity of the tool was acceptable in a representative cohort of workers on sick leave as a result of musculoskeletal pain. However, the analyses raised concerns as to whether one of the questions captures the construct it is intended to measure.

Validity and reliability of the Norwegian version of the Musculoskeletal Health Questionnaire in people on sick leave

Background

The Musculoskeletal Health Questionnaire (MSK-HQ) is a recently developed generic questionnaire that consists of 14 items assessing health status in people with musculoskeletal disorders. The objective was to translate and cross-culturally adapt the MSK-HQ into Norwegian and to examine its construct validity and reliability in people on sick leave with musculoskeletal disorders.

Methods

A prospective cohort study was carried out in Norway on people between 18 and 67 years of age and sick leave due to a musculoskeletal disorder. The participants were recruited through the Norwegian Labour and Welfare Administration during November 2018–January 2019 and responded to the MSK-HQ at inclusion and after four weeks. Internal consistency was assessed by Cronbach’s alpha, and structural validity with a factor analysis. Construct validity was assessed by eight “a priori” defined hypotheses regarding correlations between the MSK-HQ and other reference scales. Correlations were analyzed by Spearman’s- or Pearson’s correlation coefficient and interpreted as high with values ≥ 0.50, moderate between 0.30–0.49, and low < 0.29. Reliability was tested with test–retest, standard error of measurement (SEM) and smallest detectable change (SDC).

Results

A total of 549 patients, mean age (SD) 48.6 (10.7), 309 women (56.3%), were included. The mean (SD) MSK-HQ sum scores (min–max 3–56) were 27.7 (8.2). Internal consistency was 0.86 and a three-factor structure was determined by factor analysis. Construct validity was supported by the confirmation of all hypotheses; high correlation with HRQOL, psychosocial risk profile, and self-perceived health; moderate correlation with physical activity, self-perceived work ability, and work presenteeism; and low correlation with the number of sick days. The test–retest reliability was good with an intraclass correlation coefficient of 0.83 (95% CI, 0.74–0.89), SEM was 2.3 and SDC 6.5.

Conclusions

The Norwegian version of the MSK-HQ demonstrated high internal consistency, a three-factor structure, good construct validity and good test–retest reliability when used among people on sick leave due to musculoskeletal disorders.

Comparison of self-reported and public registered absenteeism among people on long-term sick leave due to musculoskeletal disorders: criterion validity of the iMTA Productivity Cost Questionnaire

OBJECTIVE

To evaluate criterion validity of the iMTA Productivity Cost Questionnaire (iPCQ) by comparing iPCQ-reported occurrence and duration of long-term absenteeism (> 4 weeks) with public registry data collected from the Norwegian Labour and Welfare Administration (NAV) among people on sick leave due to musculoskeletal disorders.

METHOD

Baseline data from a cohort study was used, in which people on sick leave for at least 4 weeks due to musculoskeletal disorders were recruited electronically through the NAV website. To compare the occurrence of long-term absenteeism overall agreement between the two methods was measured by percentages. To compare the duration (number of days with absenteeism) and adjusted duration (number of days with complete absenteeism) of long-term absenteeism we conducted intraclass correlation coefficient (ICC) two-way random average agreement, descriptive statistic and Wilcoxon signed-rank test.

RESULTS

In total, 144 participants with a median age (range) of 49 (24-67) were included. The overall agreement on the occurrence of long-term absenteeism was 100%. The ICC value was 0.97 and 0.86 for duration and adjusted duration of long-term absenteeism, respectively. The median difference_{(iPCQ-registry)} between the two methods was 0 and 17 days for long-term absenteeism duration and adjusted duration, respectively. A significant difference between the two methods was observed (Wilcoxon signed-rank test, p < 0.001) with regards to adjusted duration of long-term absenteeism.

CONCLUSION

The iPCQ showed good agreement with public registry data regarding the occurrence and duration of long-term absenteeism among people with musculoskeletal disorders on long-term sick-leave in Norway. However, the iPCQ does not cover part-time sick-leave and thereby potentially overestimate the total amount of long-term absenteeism.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier no. NCT04196634.

Study protocol for a randomized controlled trial of the effectiveness of adding motivational interviewing or stratified vocational advice intervention to usual case management on return to work for people with musculoskeletal disorders. The MI-NAV study

Background

Little research exists on the effectiveness of motivational interviewing (MI) on return to work (RTW) in workers on long term sick leave. The objectives of this study protocol is to describe a randomized controlled trial (RCT) with the objectives to compare the effectiveness and cost-effectiveness of usual case management alone with usual case management plus MI or usual case management plus stratified vocational advice intervention (SVAI), on RTW among people on sick leave due to musculoskeletal (MSK) disorders.

Methods

A multi-arm RCT with economic evaluation will be conducted in Norway with recruitment of 450 participants aged 18–67 years on 50–100% sick leave for > 7 weeks due to MSK disorders. Participants will be randomized to either usual case management by the Norwegian Labour and Welfare Administration (NAV) alone, usual case management by NAV plus MI, or usual case management by NAV plus SVAI. Trained caseworkers in NAV will give two MI sessions, and physiotherapists will give 1–4 SVAI sessions depending upon risk of long-term sick leave. The primary outcome is the number of sick leave days from randomization to 6 months follow-up. Secondary outcomes are number of sick leave days at 12 months follow-up, time until sustainable RTW (≥4 weeks of at least 50% of their usual working hours) at 12 months, proportions of participants receiving sick leave benefits during 12 months of follow-up, and MSK symptoms influencing health at 12 months. Cost-utility evaluated by the EuroQoL 5D-5L and cost-benefit analyses will be performed. Fidelity of the interventions will be assessed through audio-recordings of approximately 10% of the intervention sessions.

Discussion

The results from this RCT will inform stakeholders involved in supporting RTW due to MSK disorders such as staff within NAV and primary health care.

Trial registration

ClinicalTrials.gov ID: NCT03871712 registered March 12th 2020.