Injured worker participation in assessment during the acute phase of workers compensation rehabilitation: a scoping review

PURPOSE

Rates of return to work (RTW) are declining in the Australian workers compensation system alongside significant economic and social costs, disputes, and secondary psychological injury. Non-medical assessment of workplace injuries now considers psychosocial and workplace factors, and worker participation in the assessment process is limited. This scoping review examines studies regarding non-medical assessment during the acute phase of rehabilitation in terms of costs, disputes, secondary psychological injury, and worker participation.

METHOD

An electronic and manual search of relevant articles across four databases was conducted using PRISMA guidelines, followed by quality assessment.

RESULTS

Of the 1,630 studies retrieved, 12 met the inclusion criteria with most focused on assessment for risk of obstructed or delayed RTW.

CONCLUSIONS

Non-medical assessment in the acute stage of rehabilitation identifies risk for delayed or complicated RTW, overlooking potential for the process of assessment to contribute to disputes and development of secondary psychological injury. Doubt around the capacity of workers to participate objectively in assessment persists. These are aspects of assessment worthy of further exploration for their impact on RTW outcomes.

Systemic barriers to reporting work injuries and illnesses in contexts of language barriers

BACKGROUND

Workers who experience language barriers are at increased risk of work-related injuries and illnesses and face difficulties reporting these health problems to their employer and workers' compensation. In the existing occupational health and safety literature, however, such challenges are often framed in individual-level terms. We identify systemic barriers to reporting among injured workers who experience language barriers within the varying contexts of Ontario and Quebec, Canada.

METHODS

This study merges data from two qualitative studies that investigated experiences with workers' compensation and return-to-work, respectively, for injured workers who experience language barriers. We conducted semi-structured interviews with 39 workers and 70 stakeholders in Ontario and Quebec. Audio recordings were transcribed and coded using NVivo software. The data was analysed thematically and iteratively.

RESULTS

Almost all workers (34/39) had filed a claim, though most had initially delayed reporting their injuries or illnesses to their employer or to workers' compensation. Workers faced several obstacles to reporting, including confusion surrounding the cause and severity of injuries and illnesses; lack of information, misinformation, and disinformation about workers' compensation; difficulties accessing and interacting with care providers; fear and insecurity linked to precarity; claim suppression by employers; negative perceptions of, and experiences with, workers' compensation; and lack of supports. Language barriers amplified each of these difficulties, resulting in significant negative impacts in economic, health, and claim areas.

CONCLUSION

Improving the linguistic and cultural competence of organizations and their representatives is insufficient to address under-reporting among workers who experience language barriers. Efforts to improve timely reporting must tackle the policies and practices that motivate and enable under-reporting for workers, physicians, and employers.

Developing guidelines to support injured workers who live and work with chronic pain

BACKGROUND

Living and working with chronic pain requires persons to alter lifestyles and have the knowledge as well as support to manage unforeseen challenges. Knowledge for persons living with pain who want to participate in meaningful paid and unpaid work is not easily accessible. While there is literature on chronic pain management, work transitions and return to work, less emphasis has been placed on the complexity of living and working with chronic pain. The Creating a Way Forward Project was envisioned to address this gap and to identify the informational needs of workers with pain, health/helping professionals (workers' advisors, return to work specialists, legal representatives), and stakeholders. The overarching aim of the project was to use evidence and experiential knowledge to inform the development of a foundation for educational guides and toolkits to support workers with pain to achieve their outcomes for remaining at work.

METHODS

Phase one of the project involved a scoping review of chronic pain and work. Phase two involved stakeholder consultations, a focus group and knowledge integration of the literature and experiential insights. Knowledge synthesis drew on a Template Analysis of multiple sources of data.

RESULTS

Knowledge domains and key components were identified for persons with pain and for the health/helping professions.

CONCLUSION

These domains reflect a foundation for knowledge in practical training and the development of curriculum for education in self-management program and in inter professional health profession education. These knowledge domains provide a basis for future research in integrated approaches and knowledge use toward improving transitions for persons living with chronic pain who want to participate in productive paid and unpaid work. Ongoing research in knowledge domains that health providers and persons with pain need will expand the potential for improving health outcomes in living with and managing pain.

Sex Differences in Factors Associated with General Life Satisfaction among Occupationally Injured Workers in Korea: A Panel Analysis of the 2013-2017 Panel Study of Worker's Compensation Insurance

The majority of previous occupational studies focused on factors affecting life satisfaction among occupationally injured workers have been based on a cross-sectional design, not a sex-aggregated model. This study aimed to identify sex differences in factors related to life satisfaction among workers who experienced work-related injuries using nationally representative panel data from South Korea. Data from the first to fifth (2013-2017) waves of the Panel Study of Worker's Compensation Insurance were analyzed. Of 1514 respondents, those who participated in all five survey waves were included in the final study population. To assess the factors associated with general life satisfaction of the occupationally injured workers, a panel data analysis was conducted using generalized estimating equations. The impacts of education level, return to work, self-rated health, task performance, self-esteem, and self-efficacy were significant in both sexes. On the other hand, the influence of age, marital status, personal labor income, and National Basic Livelihood Act recipient status significantly varied by sex. There were sex differences in factors related to general life satisfaction among occupationally injured workers, highlighting the need for sex-specific intervention programs. Employers, healthcare providers, and other stakeholders need to pay attention to vulnerable groups and investigate the most appropriate financial support.

Mapping first-line health care providers' roles, practices, and impacts on care for workers with compensable musculoskeletal disorders in four jurisdictions: A critical interpretive synthesis

BACKGROUND

First-line health care providers are the primary access point for workers' benefits. However, little is known about their impact on quality of care and return-to-work. Our objective was to critically compare literature on the practices of first-line providers for workers with musculoskeletal injuries in Ontario and Quebec (Canada), Washington State (United States), and Victoria (Australia).

METHODS

A critical interpretive synthesis of peer-reviewed scientific literature was conducted. The search across six databases yielded 59 relevant publications that were critically appraised.

RESULTS

Three themes emerged: 1) how policies about first-line health care providers' modulate worker access to care, 2) how these providers' roles, practices, and training shape disability management, and 3) how the quality of care and disability outcomes are evaluated.

CONCLUSIONS

First-line health care providers have a critical influence on workers' trajectories of care. A focus on their role while taking the complexity of the context into account will help orient future policy changes.

Single-Session Attention Bias Modification Training in Victims of Work-Related Accidents

Individuals who experienced traumatic work-related accidents frequently show cognitive deficits and biased processing of trauma-relevant information, which, in turn, could increase the risk of further accidents. The attention bias modification training (ABMT) is designed to reduce hypervigilance toward and enhance attentional disengagement from threat stimuli. The aim of the present study was to assess whether it is possible to implicitly reduce the attentional bias toward trauma-related stimuli through a single session of ABMT in individuals who experienced a traumatic occupational accident. Nineteen individuals who had experienced a traumatic work-related accident and 11 workers who never experienced a work accident (control group) underwent a preliminary assessment of cognitive performance (executive functions and sustained attention) and an evaluation of the attentional bias toward accident-related pictures by means of a dot-probe task. The results showed that injured workers performed more poorly than controls in tasks of executive functions and concentration abilities. Also, injured workers showed an attentional bias toward trauma reminders (i.e., faster reaction times to probes replacing trauma-related pictures). Injured workers were then randomly allocated to a single-session of ABMT (N = 10) or to an Attention Control Condition (ACC; N = 9). After the training, the dot-probe task was administered again to assess changes in the attentional bias toward trauma-relevant pictures. Injured workers who underwent the ABMT, but not those who underwent the ACC, showed a significant reduction of the attentional bias from pre- to post-training. Overall, these results support previous findings reporting an association between traumatic occupational accidents and cognitive dysfunctions. More importantly, these preliminary findings add to a growing body of evidence suggesting the effectiveness of a short ABMT in reducing the attentional bias after a traumatic workplace accident.

Employee experience of workplace supervisor contact and support during long-term sickness absence

PURPOSE

Workplace support is an important factor in promoting successful return to work. The purpose of this article is to examine relationships between supervisor contact, perceived workplace support and demographic variables among employees on long-term sickness absence.

MATERIALS AND METHOD

Data were collected from 204 public employees at a municipality in Sweden who had been on long term sickness absence (60 days or more) using a 23 question survey instrument that collected information on demographic variables, supervisor contact and perceived workplace support.

RESULTS

Most injured employees (97%) reported having contact with their supervisors during their sickness absence, with a majority (56%) reporting high levels of support, including early (58.6%) and multiple (70.7%) contacts. Most were pleased with amount of contact (68.9%) and the majority had discussed workplace accommodations (68.1%). Employees who self-initiated contact, felt the amount of contact was appropriate, had a personal meeting with their supervisors and discussed workplace adjustments reported experiencing higher levels of support from supervisors.

CONCLUSIONS

Employees on long-term sickness absence appreciate contact from their supervisors and this is associated with perceived workplace support. However, the amount and employee experience of this contact is important. It needs to be perceived by employees as supportive, which includes a focus on strategies (e.g., work adjustment) to facilitate a return to work. Supervisor training is required in this area to support the return to work process. Implications for Rehabilitation Contact and support from workplace supervisors is important to workers on long-term sickness absence. Employees appreciate frequent contact from supervisors during long-terms sickness absence. Employees appreciate a personal meeting with supervisors and the opportunity to discuss issues related to return to work such as work adjustment. Employers should provide training to supervisors on how to communicate and assist employees on long-term sickness absence.

Outcomes and prognostic variables of radiofrequency zygapophyseal joint neurotomy in Utah workers' compensation patients

Purpose

The prevalence of radiofrequency zygapophyseal joint neurotomy (RFN) has increased substantially across the past decade. Limited research exists that has examined pre-procedure predictors of RFN outcomes, particularly within workers’ compensation populations. The purpose of this study was to determine if pre-procedure biopsychosocial variables are predictive of outcomes in a cohort of compensated Utah patients who have undergone RFN.

Patients and methods

This was a retrospective cohort study consisting of a review of pre-procedure medical records and a telephone outcome survey. The sample consisted of 101 compensated workers from Utah who had undergone RFN. Fifty-six patients (55%) responded to the outcome survey. Patients were an average of 46 months post-neurotomy at the time of follow-up. Outcome measures included patient satisfaction, disability status, Roland–Morris Disability Questionnaire, Stauffer–Coventry Index, and Short-Form Health Survey-36 (v.2). Statistical techniques utilized included frequencies, mean comparisons, and logistic and multiple regressions.

Results

Forty percent of patients were totally disabled at the time of follow-up. Lawyer involvement, older age, and a positive history of depression were predictors of poor outcomes in logistic and multiple regression equations.

Conclusion

Presurgical biopsychosocial variables were predictive of multidimensional patient outcomes, and a high rate of total disability was observed. Additional research on the effectiveness of RFN for workers’ compensation patients is recommended.

Adding Genetic Testing to Evidence-Based Guidelines to Determine the Safest and Most Effective Chronic Pain Treatment for Injured Workers

Published guidelines for treating injured workers include the need for personalized treatment to manage chronic pain symptoms and increase functional status. However, they often fail to clarify how to objectively personalize these treatments. Further, certain patients need analgesic relief beyond the short term. In these cases, it is not sufficient or reasonable to utilize the typical broad protocol-based justifications for reduction of opioids and other medications in a haphazard manner based purely on poor response, without attempting to elucidate possible pharmacogenetic reasons for this. These guidelines acknowledge the problem of substance abuse and set forth methods for treatment and prevention. Although it has been established in the scientific community that an individual's experience of pain and likelihood for addiction both have genetic components, genetic testing is not routinely included as part of the overall treatment plan for injured workers with chronic pain. Because decisions in cases of workplace injury should be based on scientific evidence, genetic testing results can add some objective information to the existing subjective and objective clinical data; help ascertain the efficacy and potential for toxicity of treatment; and therefore provide more information for accurate clinical decisions. We propose the addition of genetic testing to consensus guidelines for treating injured workers in order to improve patients' functional status, increase productivity, improve safety of prescribing, decrease the likelihood of substance abuse, and save on overall healthcare costs.

Using linked federal and state data to study the adequacy of workers' compensation benefits

Background

We combined federal and state administrative data to study the long-term earnings losses associated with occupational injuries and assess the adequacy of workers’ compensation benefits.

Methods

We linked state data on workers’ compensation claims from New Mexico for claimants injured from 1994-2000 to federal earnings records from 1987-2007. We estimated earnings losses up to 10 years after injury and computed the fraction of losses replaced by benefits.

Results

Workers with lost-time injuries lost an average of 15% of their earnings over the 10 years after injury. On average, workers’ compensation income benefits replaced 16% of these losses. Men and women had similar losses and replacement rates. Workers with minor injuries had lower losses but also had lower replacement rates.

Conclusion

Earnings losses after an injury are highly persistent, even for comparatively minor injuries. Income benefits replace a smaller fraction of those losses than previously believed.

Early predictors of occupational back reinjury: results from a prospective study of workers in Washington State

STUDY DESIGN

Prospective population-based cohort study.

OBJECTIVE

To identify early predictors of self-reported occupational back reinjury within 1 year after work-related back injury.

SUMMARY OF BACKGROUND DATA

Back injuries are the costliest and most prevalent disabling occupational injuries in the United States. A substantial proportion of workers with back injuries have reinjuries after returning to work, yet there are few studies of risk factors for occupational back reinjuries.

METHODS

We aimed to identify the incidence and early (in the claim) predictors of self-reported back reinjury by approximately 1 year after the index injury among Washington State workers with new work disability claims for back injuries. The Washington Workers' Compensation Disability Risk Identification Study Cohort provided a large, population-based sample with information on variables in 7 domains: sociodemographic, employment-related, pain and function, clinical status, health care, health behavior, and psychological. We conducted telephone interviews with workers 3 weeks and 1 year after submission of a time-loss claim for the injury. We first identified predictors (P < 0.10) of self-reported reinjury within 1 year in bivariate analyses. Those variables were then included in a multivariate logistic regression model predicting occupational back reinjury.

RESULTS

A total of 290 (25.8%) of 1123 (70.0% response rate) workers who completed the 1-year follow-up interview and had returned to work reported having reinjured their back at work. Baseline variables significantly associated with reinjury (P < 0.05) in the multivariate model included male sex, constant whole-body vibration at work, previous similar injury, 4 or more previous claims of any type, possessing health insurance, and high fear-avoidance scores. Baseline obesity was associated with reduced odds of reinjury. No other employment-related or psychological variables were significant.

CONCLUSION

One-fourth of the workers who received work disability compensation for a back injury self-reported reinjury after returning to work. Baseline variables in multiple domains predicted occupational back reinjury. Increased knowledge of early risk factors for reinjury may help to lead to interventions, such as efforts to reduce fear avoidance and graded activity to promote recovery, effective in lowering the risk of reinjury.

Mental health status of Ontario injured workers with permanent impairments

OBJECTIVE

Each year, approximately 31,000 Canadian injured worker claimants are certified to have permanent impairments associated with the initial workplace incident. Permanent impairments are characterized by ongoing pain, and limitations in physical function and activity participation--all predisposing factors to mental health problems. Here we examine the post-accident mental health status of a sample of Ontario injured workers with permanent impairments.

METHODS

We analyze data from a cross-sectional telephone survey of 494 injured workers. Mental health status is examined using nine dichotomous diagnostic, symptomatic and functional mental health indicators identified by survey respondents as non-present, or having pre- or post-injury onset, and the CES-D. We describe the relationship of these indicators and work injury, demographic and socio-economic factors.

RESULTS

Post-injury onset mental health problems are elevated compared to pre-injury onset in seven of nine indicators. Diagnosed depression, medication abuse, inability to concentrate, and sleep problems are elevated compared to general Canadian population prevalence. Diagnosed depression is elevated compared to populations with pain and chronic health conditions. Higher education and pre-injury income are associated with lower depressive symptoms. Men and older individuals are less likely to report a diagnosis of depression. Older individuals are less likely to report concentration problems.

CONCLUSION

These data paint a troubling mental health picture among injured workers with permanent impairments. Implications for return-to-work and income recovery, health service access and rehabilitation within and outside the compensation system are discussed.