What makes men and women with musculoskeletal complaints decide they are too sick to work?

Health-related quality of life in young people: the importance of education

Background

The concept of health-related quality of life and education integrates the bio-psychosocial perspective of health and the multidimensional potentialities of education for wellbeing. This present work is especially relevant to young people because understanding the interaction between health and education can facilitate the design of preventive policies. The research examines the way in which the educational level of young people from an urban district in the city of Zaragoza (Casablanca) has an influence on their health-related quality of life (HRQOL).

Methods

A cross sectional survey was undertaken in the Casablanca district of Zaragoza (Spain). Participants were not randomly selected; their numbers reflected the areas where they lived with respect to age and sex distribution. It comprised 122 boys and 122 girls, aged between16 and 29, living in the neighbourhood are: Viñedo Viejo, Las Nieves and Fuentes Claras. These three residence zones are markedly different in terms of socioeconomic composition. The questionnaire included the following information: socioeconomic characteristics (sex, age, educational level, employment status, residence zone), an assessment of health (health problems, diagnosis and medication in the last 2 weeks) and HRQOL (WHOQOL-BREF dimensions: mental health; physical health; social relations; and environment). ANOVA and four regression models were used to assess the role, direction and intensity of educational level on HRQOL.

Results

The results show that the higher the level of education, the better the level of HRQOL. The biggest impact of education was on the mental health dimension, but this influence was modulated by sex and residence zone. The value of the interaction of education and residence zone was more significant than educational level alone. HRQOL of girls is more sensitive to education, being a student and residence zone than the HRQOL of boys.

Conclusions

The dimensions of HRQOL are influenced by educational level. The influence is greatest among girls and the youngest members of the poorest area of the district. Public authorities should contemplate the development of an equitable education system from the beginning of the life cycle as a public health strategy.

Factors Related to Presenteeism among South Korean Workers Exposed to Workplace Psychological Adverse Social Behavior

Presenteeism negatively affects both individuals and society. This study identified factors of presenteeism among workers in South Korea, especially in relation to exposure to adverse social behaviors. Here, an adverse social behavior refers to any forms of workplace violence or intimidation. This study used the data from 23,164 full-time salaried employees, who participated in the fifth Korean Working Conditions Survey. This study attempted to predict presenteeism based on the exposure to adverse social behaviors and working conditions using logistic regression. Presenteeism was reported in 15.9% of the sample. Presenteeism was significantly higher among workers with the following characteristics: females, aged 40 years or older; middle school graduates; over 40 working hours a week; shift workers; no job-related safety information received; exposure to adverse social behavior and discrimination; and those with a high demand for quantitative work, low job autonomy, high emotional demands, and high job stress. The workers exposed to adverse social behavior showed a higher prevalence of presenteeism (41.2%), and low job autonomy was the most significant predictor of presenteeism. The findings of this study suggest that allowing enough autonomy in job-related roles may help alleviate presenteeism among those who have experienced adverse social behavior at work.

Sickness presenteeism at work: prevalence, costs and management

INTRODUCTION

Presenteeism is defined as continuing to attend work during illness. As a growing health concern, awareness of the factors that encourage presenteeism and the risks of this behaviour is needed.

SOURCES OF DATA

A narrative review of research obtained via several databases, including Medline and Psycinfo, was conducted.

AREAS OF AGREEMENT

A range of contextual and individual factors is associated with presenteeism. Workers in some sectors, such as healthcare, appear to be at greater risk. Presenteeism may facilitate rehabilitation and recovery but it can exacerbate existing health problems and increase the risk of subsequent illness and absence as well as impair workability.

AREAS OF CONTROVERSY

The incidence of sickness presenteeism is rising, alongside reductions in absenteeism. The growing awareness of the costs of presenteeism, especially in safety-critical environments, suggests that it should be considered a risk-taking behaviour and carefully measured and managed.

GROWING POINTS AND AREAS FOR DEVELOPING RESEARCH

Measuring presenteeism as well as absenteeism will provide more accurate information about employee health. Raising awareness of the risks of working while sick and the economic, moral, cultural and social pressures on employees to do so appears crucial. Systemic interventions to manage presenteeism based on research evidence are required.

Gender, Cultural Influences, and Coping with Musculoskeletal Pain at Work: The Experience of Malaysian Female Office Workers

Purpose Workers with musculoskeletal pain (MSP) often continue to work despite their condition. Understanding the factors that enable them to remain at work provides insights into the development of appropriate workplace accommodations. This qualitative study aims to explore the strategies utilised by female Malaysian office workers with MSP to maintain productive employment. Methods A qualitative approach using thematic analysis was used. Individual semi-structured interviews were conducted with 13 female Malaysian office workers with MSP. Initial codes were identified and refined through iterative discussion to further develop the emerging codes and modify the coding framework. A further stage of coding was undertaken to eliminate redundant codes and establish analytic connections between distinct themes. Results Two major themes were identified: managing the demands of work and maintaining employment with persistent musculoskeletal pain. Participants reported developing strategies to assist them to remain at work, but most focused on individually initiated adaptations or peer support, rather than systemic changes to work systems or practices. A combination of the patriarchal and hierarchical cultural occupational context emerged as a critical factor in the finding of individual or peer based adaptations rather than organizational accommodations. Conclusions It is recommended that supervisors be educated in the benefits of maintaining and retaining employees with MSP, and encouraged to challenge cultural norms and develop appropriate flexible workplace accommodations through consultation and negotiation with these workers.

Decision-making in job attendance within health care--a qualitative study

BACKGROUND

Musculoskeletal complaints are considered a major cause of sickness absence, particularly in areas such as the health sector. However, little is known about the personal decision-making process for self-certified sickness absence.

AIMS

To explore female health care workers' thoughts and experiences about work attendance when experiencing musculoskeletal symptoms.

METHODS

A qualitative study using individual, semi-structured, in-depth interviews with eight female health care workers was performed. Questions were related to factors influencing the decision to attend work and decision-making when facing the dilemma of attending work when experiencing musculoskeletal symptoms. The data were analysed according to the systematic text condensation.

RESULTS

Subjects reported a high threshold before calling in sick. Self-certified sickness absence was not a strategy for coping with musculoskeletal symptoms as participants chose to be physically active and work part-time rather than taking sickness absence. Making decisions about attending work fostered conflicting norms, as women faced a dilemma between feeling guilt towards colleagues and patients and taking care of their own health.

CONCLUSIONS

The findings highlight the complexity of managing work when experiencing musculoskeletal symptoms, and the dilemmas faced by those affected. The importance of work environment factors and the fact that some women feel compelled to work part-time in order to prioritize their own health require further consideration.

What Challenges Manual Workers' Ability to Cope with Back Pain at Work, and What Influences Their Decision to Call in Sick?

INTRODUCTION

Although back pain (BP) is a very common cause for sickness absence, most people stay at work during BP episodes. Existing knowledge on the factors influencing the decision to stay at work despite pain is limited. The aim of this study was to explore challenges for coping with BP at work and decisive factors for work attendance among workers with high physical work demands.

METHODS

Three focus groups (n = 20) were conducted using an explorative inductive method. Participants were public-employed manual workers with high physical work demands. All had personal BP experience. Thematic analysis was used for interpretation. Results were matched with the Flags system framework to guide future recommendations.

RESULTS

Workers with BP were challenged by poor physical work conditions and a lack of supervisor support/trust (i.e. lack of adjustment latitude). Organization of workers into teams created close co-worker relationships, which positively affected BP coping. Workers responded to BP by applying helpful individual adjustments to reduce or prevent pain. Traditional ergonomics was considered inconvenient, but nonetheless ideal. When pain was not decisive, the decision to call in sick was mainly governed by workplace factors (i.e. sick absence policies, job strain, and close co-workers relationships) and to a less degree by personal factors.

CONCLUSION

Factors influencing BP coping at work and the decision to report sick was mainly governed by factors concerning general working conditions. Creating a flexible and inclusive working environment guided by the senior management and overall work environment regulations seems favourable.

Role models in a preventive program for hand eczema among healthcare workers: a qualitative exploration of their main tasks and associated barriers and facilitators

Background

Role models often play a role when implementing guidelines in healthcare. However, little is known about how role models perform their respective roles, or about which factors may hamper or enhance their functioning. The aim of the present study was therefore to investigate how role models perform there role as a part of a multifaceted implementation strategy on the prevention of hand eczema, and to identify barriers and facilitators for the performing of their role.

Methods

The role models were selected to become a role model and received a role model training. All role models worked at a hospital. In total, 19 role models, were interviewed. A topic list was used focussing on how the role models performed their role and what they experienced to be facilitators and barriers for their role. After coding the interviews, the codes were divided into themes.

Results

This study shows that the main tasks perceived by the role models were to raise awareness, to transfer information, to interact with colleagues about hand eczema, to provide material, and to perform coordinating tasks. Barriers and facilitators were whether the role suited the participant, affinity with the topic, and risk perception.

Conclusions

Most role models performed only the tasks they learned during their training. They mentioned a wide range of barriers and facilitators for the performing of their role. To enhance the functioning of the role models, a suggestion would be to select role models by taking into account prior coaching experience.

Trial registration

Trial registration number: NTR2812

[Translation, cultural adaptation, validity and reliability of the shoulder rating questionnaire for use in Brazil]

OBJECTIVE

To translate and culturally adapt the Shoulder Rating Questionnaire (SRQ) to the Brazilian Portuguese language, and to determine its validity, reliability and sensitivity to change in patients with functional impairment of the shoulder.

METHODS

After translation and back-translation of the original version by four independent translators, the instrument was reviewed by a committee of experts and subsequently applied to eight patients with shoulder injury (target audience) to produce the Portuguese version. Then, this version was applied to 102 patients selected from four reference centers for functional treatment of the shoulder, who had a variety of clinical diagnoses, educational levels, socioeconomic, and cultural backgrounds. The evaluation was performed twice with an interval of four weeks between each application.

RESULTS

The Brazilian version of SRQ was equivalent in terms of semantics and showed good levels of reliability (Cronbach's Alpha=0.89 and ICC=0.83). The reproducibility was high (Spearman Correlation Coefficient=0.82) and validity of the items that ranged from 0.54 to 0.99 was considered excellent. The Cohen's d and T test for repeated measures showed that the instrument is able to monitor and track improvements in shoulder function.

CONCLUSION

Psychometric criteria were found, which justify the applicability of the Brazilian version of SRQ in individuals with shoulder functional impairments.

Physical and psychosocial risk factors for musculoskeletal disorders in Brazilian and Italian nurses

As part of the international CUPID investigation, we compared physical and psychosocial risk factors for musculoskeletal disorders among nurses in Brazil and Italy. Using questionnaires, we collected information on musculoskeletal disorders and potential risk factors from 751 nurses employed in public hospitals. By fitting countryspecific multiple logistic regression models, we investigated the association of stressful physical activities and psychosocial characteristics with site-specific and multisite pain, and associated sickness absence. We found no clear relationship between low back pain and occupational lifting, but neck and shoulder pain were more common among nurses who reported prolonged work with the arms in an elevated position. After adjustment for potential confounding variables, pain in the low back, neck and shoulder, multisite pain, and sickness absence were all associated with somatizing tendency in both countries. Our findings support a role of somatizing tendency in predisposition to musculoskeletal disorders, acting as an important mediator of the individual response to triggering exposures, such as workload.

Bridging the gap between the economic evaluation literature and daily practice in occupational health: a qualitative study among decision-makers in the healthcare sector

Background

Continued improvements in occupational health can only be ensured if decisions regarding the implementation and continuation of occupational health and safety interventions (OHS interventions) are based on the best available evidence. To ensure that this is the case, scientific evidence should meet the needs of decision-makers. As a first step in bridging the gap between the economic evaluation literature and daily practice in occupational health, this study aimed to provide insight into the occupational health decision-making process and information needs of decision-makers.

Methods

An exploratory qualitative study was conducted with a purposeful sample of occupational health decision-makers in the Ontario healthcare sector. Eighteen in-depth interviews were conducted to explore the process by which occupational health decisions are made and the importance given to the financial implications of OHS interventions. Twenty-five structured telephone interviews were conducted to explore the sources of information used during the decision-making process, and decision-makers’ knowledge on economic evaluation methods. In-depth interview data were analyzed according to the constant comparative method. For the structured telephone interviews, summary statistics were prepared.

Results

The occupational health decision-making process generally consists of three stages: initiation stage, establishing the need for an intervention; pre-implementation stage, developing an intervention and its business case in order to receive senior management approval; and implementation and evaluation stage, implementing and evaluating an intervention. During this process, information on the financial implications of OHS interventions was found to be of great importance, especially the employer’s costs and benefits. However, scientific evidence was rarely consulted, sound ex-post program evaluations were hardly ever performed, and there seemed to be a need to advance the economic evaluation skill set of decision-makers.

Conclusions

Financial information is particularly important at the front end of implementation decisions, and can be a key deciding factor of whether to go forward with a new OHS intervention. In addition, it appears that current practice in occupational health in the healthcare sector is not solidly grounded in evidence-based decision-making and strategies should be developed to improve this.

Sickness absence, marginality, and medically unexplained physical symptoms: a focus-group study of patients' experiences

PURPOSE

Medically unexplained physical symptoms (MUPS) form a major cause of sickness absence. The purpose of this study was to explore factors which may influence further marginalization among patients with MUPS on long-term sickness absence.

METHODS

Two focus-group discussions were conducted with a purposive sample of 12 participants, six men and six women, aged 24-59 years. Their average duration of sickness absence was 10.5 months. Participants were invited to share stories about experiences from the process leading to the ongoing sickness absence, with a focus on the causes being medically unexplained. Systematic text condensation was applied for analysis. Inspired by theories of marginalization and coping, the authors searched for knowledge of how patients' positive resources can be mobilized to counteract processes of marginality.

RESULTS

Analysis revealed how invisible symptoms and lack of objective findings were perceived as an additional burden to the sickness absence itself. Factors that could counteract further marginalization were a supportive social network, positive coping strategies such as keeping to the daily schedule and physical activity, and positive attention and confidence from professionals.

CONCLUSIONS

Confidence from both personal and professional contacts is crucial. GPs have an important and appreciated role in this aspect.

Validation of the Simple Shoulder Test in a Portuguese-Brazilian population. Is the latent variable structure and validation of the Simple Shoulder Test Stable across cultures?

BACKGROUND

The validation of widely used scales facilitates the comparison across international patient samples. The objective of this study was to translate, culturally adapt and validate the Simple Shoulder Test into Brazilian Portuguese. Also we test the stability of factor analysis across different cultures.

OBJECTIVE

The objective of this study was to translate, culturally adapt and validate the Simple Shoulder Test into Brazilian Portuguese. Also we test the stability of factor analysis across different cultures.

METHODS

The Simple Shoulder Test was translated from English into Brazilian Portuguese, translated back into English, and evaluated for accuracy by an expert committee. It was then administered to 100 patients with shoulder conditions. Psychometric properties were analyzed including factor analysis, internal reliability, test-retest reliability at seven days, and construct validity in relation to the Short Form 36 health survey (SF-36).

RESULTS

Factor analysis demonstrated a three factor solution. Cronbach's alpha was 0.82. Test-retest reliability index as measured by intra-class correlation coefficient (ICC) was 0.84. Associations were observed in the hypothesized direction with all subscales of SF-36 questionnaire.

CONCLUSION

The Simple Shoulder Test translation and cultural adaptation to Brazilian-Portuguese demonstrated adequate factor structure, internal reliability, and validity, ultimately allowing for its use in the comparison with international patient samples.

Attending work or not when sick - what makes the decision? A qualitative study among car mechanics

Background

High prevalence of sickness absence in countries with generous welfare schemes has generated debates on mechanisms that may influence workers’ decisions about calling in sick for work. Little is known about the themes at stake during the decision-making process for reaching the choice of absence or attendance when feeling ill. The aim of the study was to examine decisions of absence versus attendance among car mechanics when feeling ill.

Methods

Interviews with 263 male car mechanics from 19 companies were used for the study, analysed by systematic text condensation and presented as descriptions and quotations of experiences and opinions.

Results

Three major themes were at stake during the decision-making process: 1) Experienced degree of illness, focusing on the present health condition and indicators of whether you are fit for work or not; 2) daily life habits, where attending work was a daily routine, often learned from childhood; 3) the importance of the job, with focus on the importance of work, colleagues, customers and work environment.

Conclusions

The car mechanics expressed a strong will to attend work in spite of illness. Knowledge about attitudes and dilemmas in reaching the decision regarding sickness absence or sickness attendance is useful in the prevention of sickness absence.

Staying at work with chronic nonspecific musculoskeletal pain: a qualitative study of workers' experiences

BACKGROUND

Many people with chronic nonspecific musculoskeletal pain (CMP) have decreased work ability. The majority, however, stays at work despite their pain. Knowledge about workers who stay at work despite chronic pain is limited, narrowing our views on work participation. The aim of this study was to explore why people with CMP stay at work despite pain (motivators) and how they manage to maintain working (success factors).

METHODS

A semi-structured interview was conducted among 21 subjects who stay at work despite CMP. Participants were included through purposeful sampling. Interviews were audio-recorded, transcribed verbatim, and imported into computer software Atlas.ti. Data was analyzed by means of thematic analysis. The interviews consisted of open questions such as: "Why are you working with pain?" or "How do you manage working while having pain?"

RESULTS

A total of 16 motivators and 52 success factors emerged in the interviews. Motivators were categorized into four themes: work as value, work as therapy, work as income generator, and work as responsibility. Success factors were categorized into five themes: personal characteristics, adjustment latitude, coping with pain, use of healthcare services, and pain beliefs.

CONCLUSIONS

Personal characteristics, well-developed self-management skills, and motivation to work may be considered to be important success factors and prerequisites for staying at work, resulting in behaviors promoting staying at work such as: raising adjustment latitude, changing pain-coping strategies, organizing modifications and conditions at work, finding access to healthcare services, and asking for support. Motivators and success factors for staying at work may be used for interventions in rehabilitation and occupational medicine, to prevent absenteeism, or to promote a sustainable return to work. This qualitative study has evoked new hypotheses about staying at work; quantitative studies on staying at work are needed to obtain further evidence.

Go to work or report sick? A focus group study on decisions of sickness presence among offshore catering section workers

Background

To identify and explore the factors promoting sickness presenteeism among offshore catering section workers.

Methods

Twenty men and women, working in the offshore catering section onboard three offshore oil and gas production platforms on the Norwegian Continental Shelf, participated in three focus groups. Data from the focus groups were analysed according to a phenomenological approach, and supported by theories on presenteeism.

Results

The results show that the decision to attend work despite illness, first and foremost, was based on the severity of the health complaint. Other factors identified were; the individual's location once the health complaint occurred, job satisfaction, the norms of the team, and experiences of how company policies on sickness absenteeism were implemented by the catering section leaders.

Conclusions

Offshore working conditions may promote sickness presenteeism. The factors promoting sickness presenteeism onboard the platforms reflected experiences of a healthy work environment.

Gender differences in disability after sickness absence with musculoskeletal disorders: five-year prospective study of 37,942 women and 26,307 men

Background

Gender differences in the prevalence and occupational consequences of musculoskeletal disorders (MSDs) are consistently found in epidemiological studies. The study investigated whether gender differences also exist with respect to chronicity, measured as the rate of transition from sickness absence into permanent disability pension (DP).

Methods

Prospective national cohort study in Norway including all cases with a spell of sickness absence > eight weeks during 1997 certified with a MSD, 37,942 women and 26,307 men. The cohort was followed-up for five years with chronicity measured as granting of DP as the endpoint. The effect of gender was estimated in the full sample adjusting for sociodemographic factors and diagnostic distribution. Gender specific analyses were performed with the same explanatory variables. Finally, the gender difference was estimated for nine diagnostic subgroups.

Results

The crude rate of DP was 22% for women and 18% for men. After adjusting for all sociodemographic variables, a slightly higher female risk of DP remained. However, additional adjustment for diagnostic distribution removed the gender difference completely. Having children and working full time decreased the DP risk for both genders, whereas low socioeconomic status increased the risk similarly. There was a different age effect as more women obtained a DP below the age of 50. Increased female risk of chronicity remained for myalgia/fibromyalgia, back disorders and "other/unspecified" after relevant adjustments, whereas men with neck disorders were at higher risk of chronicity.

Conclusions

Women with MSDs had a moderately increased risk of chronicity compared to men, when including MSDs with a traumatic background. Possible explanations are lower income, a higher proportion belonging to diagnostic subgroups with poor prognosis, and a younger age of chronicity among women. When all sociodemographic and diagnostic variables were adjusted for, no gender difference remained, except for some diagnostic subgroups.

What concerns workers with low back pain? Findings of a qualitative study of patients referred for rehabilitation

INTRODUCTION

Health and workplace strategies to address work loss and sickness absence due to low back pain are urgently required. A better understanding of the experiences of those struggling to stay at work with back pain may help clinicians and employers with their treatment and management approaches.

METHODS

A qualitative approach using thematic analysis was used. Individual semi-structured interviews were conducted with a convenience sample of 25 low back pain patients who had been referred for multidisciplinary back pain rehabilitation. All were in employment and concerned about their ability to work due to low back pain. Initial codes were identified and refined through constant comparison of the transcribed interview scripts as data collection proceeded. Themes were finally identified and analysed by repeated study of the scripts and discussion with the research team.

FINDINGS

Five main themes were identified: justifying back pain at work; concern about future ability to retain work; coping with flare-ups; reluctance to use medication; concern about sickness records.

CONCLUSIONS

In this study, workers with low back pain remained uncertain of how best to manage their condition in the workplace despite previous healthcare interventions and they were also concerned about the impact back pain might have on their job security and future work capacity. They were concerned about how back pain was viewed by their employers and co-workers and felt the need to justify their condition with a medical diagnosis and evidence. Clinicians and employers may need to address these issues in order to enable people to continue to work more confidently with back pain.

Expectations, perceptions, and physiotherapy predict prolonged sick leave in subacute low back pain

BACKGROUND

Brief intervention programs for subacute low back pain (LBP) result in significant reduction of sick leave compared to treatment as usual. Although effective, a substantial proportion of the patients do not return to work. This study investigates predictors of return to work in LBP patients participating in a randomized controlled trial comparing a brief intervention program (BI) with BI and physical exercise.

METHODS

Predictors for not returning to work was examined in 246 patients sick listed 8-12 weeks for low back pain. The patients had participated in a randomized controlled trial, with BI (n = 122) and BI + physical exercise (n = 124). There were no significant differences between the two intervention groups on return to work. The groups were therefore merged in the analyses of predictors. Multiple logistic regression analysis was used to identify predictors for non return to work at 3, 12, and 24 months of follow-up.

RESULTS

At 3 months of follow-up, the strongest predictors for not returning to work were pain intensity while resting (OR = 5.6; CI = 1.7-19), the perception of constant back strain when working (OR = 4.1; CI = 1.5-12), negative expectations for return to work (OR = 4.2; CI = 1.7-10), and having been to a physiotherapist prior to participation in the trial (OR = 3.3; CI = 1.3-8.3). At 12 months, perceived reduced ability to walk far due to the complaints (OR = 2.6; CI = 1.3-5.4), pain during activities (OR = 2.4; CI = 1.1-5.1), and having been to a physiotherapist prior to participation in the trial (OR = 2.1; CI = 1.1-4.3) were the strongest predictors for non return to work. At 24 months age below 41 years (OR = 2.9; CI = 1.4-6.0) was the only significant predictor for non return to work.

CONCLUSION

It appears that return to work is highly dependant on individual and cognitive factors. Patients not returning to work after the interventions were characterized by negative expectations, perceptions about pain and disability, and previous physiotherapy treatment. This is the first study reporting that previous treatment by physiotherapists is a risk factor for long-term sick leave. This has not been reported before and is an interesting finding that deserves more scrutiny.