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Sormunen E, Mäenpää-Moilanen E, Ylisassi H, Turunen J, Remes J, Karppinen J, Martimo KP. Participatory Ergonomics Intervention to Prevent Work Disability Among Workers with Low Back Pain: A Randomized Clinical Trial in Workplace Setting. J Occup Rehabil 2022; 32:731-742. [PMID: 35384630 PMCID: PMC9668957 DOI: 10.1007/s10926-022-10036-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 03/16/2022] [Indexed: 06/14/2023]
Abstract
Purpose In order to support people with low back pain (LBP) to stay at work, work arrangements are regarded important. This study aimed to evaluate the effectiveness of a workplace intervention using a participatory approach on work disability of workers with ongoing or recurrent LBP. Methods A total of 107 workers with LBP, with duration of pain for at least two consecutive weeks or recurrent pain of any duration during the last year, were randomized either to the intervention (n = 51) or control group (n = 56). The intervention included arrangements at the workplace, along with individual guidance provided by an occupational physiotherapist (OPT). The randomized intervention study used standard counselling and guidance by an OPT without workplace intervention as a comparison. Surveys were completed at baseline, and 6 and 12 months after baseline. Results There were no statistically significant differences between the intervention and control groups on the primary outcome measure, i.e. self-assessed work ability. We found no between-group differences in perceived health, self-assessed work productivity, number of sickness absence days and severity of back pain. However, there were significant positive within-group changes in the intervention group in the intensity of LBP, perceived health and the number of sickness absence days due to LBP. Conclusion Workplace arrangements are feasible using participatory ergonomics, but more quantitative and qualitative research is needed on its utilization and effectiveness among workers with LBP.
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Affiliation(s)
- Erja Sormunen
- Finnish Institute of Occupational Health, P.O. Box 40, 00032, Työterveyslaitos, Helsinki, Finland.
| | - Eija Mäenpää-Moilanen
- Finnish Institute of Occupational Health, P.O. Box 40, 00032, Työterveyslaitos, Helsinki, Finland
| | - Hilkka Ylisassi
- Finnish Institute of Occupational Health, P.O. Box 40, 00032, Työterveyslaitos, Helsinki, Finland
| | - Jarno Turunen
- Finnish Institute of Occupational Health, P.O. Box 40, 00032, Työterveyslaitos, Helsinki, Finland
| | - Jouko Remes
- Finnish Institute of Occupational Health, P.O. Box 40, 00032, Työterveyslaitos, Helsinki, Finland
| | - Jaro Karppinen
- Finnish Institute of Occupational Health, P.O. Box 40, 00032, Työterveyslaitos, Helsinki, Finland
- Center for Life Course Health Research, Faculty of Medicine, University of Oulu, Oulu, Finland
- Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
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Uronen LA, Hartiala J, Martimo KP, Moen H, Teperi S, Salanterä S. Reply. Occup Med (Lond) 2020; 70:685-686. [DOI: 10.1093/occmed/kqaa143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Sormunen E, Ylisassi H, Mäenpää-Moilanen E, Remes J, Martimo KP. Co-operation in the prevention of work disability due to musculoskeletal disorders: A cross-sectional study among occupational health professionals in Finland. Work 2020; 67:697-708. [DOI: 10.3233/wor-203319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND: Occupational health service (OHS) providers and their client organizations are obligated to collaborate in promoting health and work ability. Little is known how this multiprofessional co-operation is implemented in relation to the prevention of musculoskeletal disorders (MSD). OBJECTIVE: The aim of this study was to investigate the working practices of co-operation among OHS professionals, and between the OHSs and workplaces. METHODS: In 2015 a web-based questionnaire was sent to 3900 OHS professionals in Finland. A total of 589 responded: 106 physicians, 322 nurses, 134 physiotherapists and 27 psychologists. RESULTS: The co-operation within OHS personnel was regarded to strengthen the processes to promote work ability of workers with MSD. Despite the positive expectations of co-operation, there is a problem of having enough time to put good ideas into practice. Four main possibilities to develop co-operation were identified: creating proactive working models with defined roles; increasing awareness of importance of early intervention models; implementing the principles of good OH practice; and adopting the knowledge of the latest information to promote work ability. CONCLUSIONS: Despite its recognized importance, co-operation both with OHS colleagues and with the workplaces was not always optimal. There is a need for defined roles and common proactive working models between each stakeholder for more effective co-operation.
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Affiliation(s)
- Erja Sormunen
- Finnish Institute of Occupational Health, Helsinki, Finland
| | | | | | - Jouko Remes
- Finnish Institute of Occupational Health, Helsinki, Finland
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Järnefelt H, Härmä M, Sallinen M, Virkkala J, Paajanen T, Martimo KP, Hublin C. Correction to: Cognitive behavioural therapy interventions for insomnia among shift workers: RCT in an occupational health setting. Int Arch Occup Environ Health 2020; 93:551. [PMID: 32125525 PMCID: PMC7260145 DOI: 10.1007/s00420-020-01527-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Heli Järnefelt
- Finnish Institute of Occupational Health (FIOH), Topeliuksenkatu 41 b, 00250, Helsinki, Finland.
- Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland.
| | - Mikko Härmä
- Finnish Institute of Occupational Health (FIOH), Topeliuksenkatu 41 b, 00250, Helsinki, Finland
| | - Mikael Sallinen
- Finnish Institute of Occupational Health (FIOH), Topeliuksenkatu 41 b, 00250, Helsinki, Finland
- Department of Psychology, University of Jyväskylä, Jyväskylä, Finland
| | - Jussi Virkkala
- Finnish Institute of Occupational Health (FIOH), Topeliuksenkatu 41 b, 00250, Helsinki, Finland
- Department of Clinical Neurophysiology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Teemu Paajanen
- Finnish Institute of Occupational Health (FIOH), Topeliuksenkatu 41 b, 00250, Helsinki, Finland
| | - Kari-Pekka Martimo
- Finnish Institute of Occupational Health (FIOH), Topeliuksenkatu 41 b, 00250, Helsinki, Finland
| | - Christer Hublin
- Finnish Institute of Occupational Health (FIOH), Topeliuksenkatu 41 b, 00250, Helsinki, Finland
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Järnefelt H, Härmä M, Sallinen M, Virkkala J, Paajanen T, Martimo KP, Hublin C. Cognitive behavioural therapy interventions for insomnia among shift workers: RCT in an occupational health setting. Int Arch Occup Environ Health 2019; 93:535-550. [PMID: 31853633 PMCID: PMC7260280 DOI: 10.1007/s00420-019-01504-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 12/02/2019] [Indexed: 02/07/2023]
Abstract
Introduction The aim of the study was to compare the effectiveness of cognitive behavioural therapy interventions for insomnia (CBT-I) to that of a sleep hygiene intervention in a randomized controlled design among shift workers. We also studied whether the features of shift work disorder (SWD) affected the results. Methods A total of 83 shift workers with insomnia disorder were partially randomized into a group-based CBT-I, self-help CBT-I, or sleep hygiene control intervention. The outcomes were assessed before and after the interventions and at 6-month follow-up using questionnaires, a sleep diary, and actigraphy. Results Perceived severity of insomnia, sleep-related dysfunctional beliefs, burnout symptoms, restedness, recovery after a shift, and actigraphy-based total sleep time improved after the interventions, but we found no significant differences between the interventions. Mood symptoms improved only among the group-based CBT-I intervention participants. Non-SWD participants had more mental diseases and symptoms, used more sleep-promoting medication, and had pronounced insomnia severity and more dysfunctional beliefs than those with SWD. After the interventions, non-SWD participants showed more prominent improvements than those with SWD. Conclusions Our results showed no significant differences between the sleep improvements of the shift workers in the CBT-I interventions and of those in the sleep hygiene control intervention. Alleviation of mood symptoms seemed to be the main added value of the group-based CBT-I intervention compared to the control intervention. The clinical condition of the non-SWD participants was more severe and these participants benefitted more from the interventions than the SWD participants did. Trial registration ClinicalTrials.gov, NCT02523079.
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Affiliation(s)
- Heli Järnefelt
- Finnish Institute of Occupational Health (FIOH), Topeliuksenkatu 41 b, 00250, Helsinki, Finland. .,Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland.
| | - Mikko Härmä
- Finnish Institute of Occupational Health (FIOH), Topeliuksenkatu 41 b, 00250, Helsinki, Finland
| | - Mikael Sallinen
- Finnish Institute of Occupational Health (FIOH), Topeliuksenkatu 41 b, 00250, Helsinki, Finland.,Department of Psychology, University of Jyväskylä, Jyväskylä, Finland
| | - Jussi Virkkala
- Finnish Institute of Occupational Health (FIOH), Topeliuksenkatu 41 b, 00250, Helsinki, Finland.,Department of Clinical Neurophysiology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Teemu Paajanen
- Finnish Institute of Occupational Health (FIOH), Topeliuksenkatu 41 b, 00250, Helsinki, Finland
| | - Kari-Pekka Martimo
- Finnish Institute of Occupational Health (FIOH), Topeliuksenkatu 41 b, 00250, Helsinki, Finland
| | - Christer Hublin
- Finnish Institute of Occupational Health (FIOH), Topeliuksenkatu 41 b, 00250, Helsinki, Finland
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Horppu R, Martimo KP, MacEachen E, Lallukka T, Viikari-Juntura E. Application of the Theoretical Domains Framework and the Behaviour Change Wheel to Understand Physicians' Behaviors and Behavior Change in Using Temporary Work Modifications for Return to Work: A Qualitative Study. J Occup Rehabil 2018; 28:135-146. [PMID: 28391503 PMCID: PMC5820403 DOI: 10.1007/s10926-017-9706-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Purpose Applying the theoretical domains framework (TDF) and the Behaviour Change Wheel (BCW) to understand physicians' behaviors and behavior change in using temporary work modifications (TWMs) for return to work (RTW). Methods Interviews and focus group discussions were conducted with 15 occupational physicians (OPs). Responses were coded using the TDF and the BCW. Results Key behaviors related to applying TWMs were initiating the process with the employee, making recommendations to the workplace, and following up the process. OP behaviors were influenced by several factors related to personal capability and motivation, and opportunities provided by the physical and social environment. Capability comprised relevant knowledge and skills related to applying TWMs, remembering to initiate TWMS and monitor the process, and being accustomed to reflective practice. Opportunity comprised physical resources (e.g., time, predefined procedures, and availability of modified work at companies), and social pressure from stakeholders. Motivation comprised conceptions of a proper OP role, confidence to carry out TWMs, personal RTW-related goals, beliefs about the outcomes of one's actions, feedback received from earlier cases, and feelings related to applying TWMs. OPs' perceived means to target these identified factors were linked to the following BCW intervention functions: education, training, persuasion, environmental restructuring, and enablement. The results suggest that at least these functions should be considered when designing future interventions. Conclusions Our study illustrates how theoretical frameworks TDF and BCW can be utilized in a RTW context to understand which determinants of physicians' behavior need to be targeted, and how, to promote desired behaviors.
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Affiliation(s)
- Ritva Horppu
- Work Disability Prevention, Finnish Institute of Occupational Health, P.O. Box 40, 00251, Helsinki, Finland.
| | - K P Martimo
- Work Disability Prevention, Finnish Institute of Occupational Health, P.O. Box 40, 00251, Helsinki, Finland
| | - E MacEachen
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Canada
- Centre for Research on Work Disability Policy, Institute for Work & Health, Toronto, Canada
| | - T Lallukka
- Work Disability Prevention, Finnish Institute of Occupational Health, P.O. Box 40, 00251, Helsinki, Finland
| | - E Viikari-Juntura
- Work Disability Prevention, Finnish Institute of Occupational Health, P.O. Box 40, 00251, Helsinki, Finland
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Horppu R, Martimo KP, MacEachen E, Lallukka T, Viikari-Juntura E. Application of the Theoretical Domains Framework and the Behaviour Change Wheel to Understand Physicians' Behaviors and Behavior Change in Using Temporary Work Modifications for Return to Work: A Qualitative Study. J Occup Rehabil 2018; 28:135-146. [PMID: 28391503 DOI: 10.1007/s10926-017-9706-1/tables/4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Purpose Applying the theoretical domains framework (TDF) and the Behaviour Change Wheel (BCW) to understand physicians' behaviors and behavior change in using temporary work modifications (TWMs) for return to work (RTW). Methods Interviews and focus group discussions were conducted with 15 occupational physicians (OPs). Responses were coded using the TDF and the BCW. Results Key behaviors related to applying TWMs were initiating the process with the employee, making recommendations to the workplace, and following up the process. OP behaviors were influenced by several factors related to personal capability and motivation, and opportunities provided by the physical and social environment. Capability comprised relevant knowledge and skills related to applying TWMs, remembering to initiate TWMS and monitor the process, and being accustomed to reflective practice. Opportunity comprised physical resources (e.g., time, predefined procedures, and availability of modified work at companies), and social pressure from stakeholders. Motivation comprised conceptions of a proper OP role, confidence to carry out TWMs, personal RTW-related goals, beliefs about the outcomes of one's actions, feedback received from earlier cases, and feelings related to applying TWMs. OPs' perceived means to target these identified factors were linked to the following BCW intervention functions: education, training, persuasion, environmental restructuring, and enablement. The results suggest that at least these functions should be considered when designing future interventions. Conclusions Our study illustrates how theoretical frameworks TDF and BCW can be utilized in a RTW context to understand which determinants of physicians' behavior need to be targeted, and how, to promote desired behaviors.
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Affiliation(s)
- Ritva Horppu
- Work Disability Prevention, Finnish Institute of Occupational Health, P.O. Box 40, 00251, Helsinki, Finland.
| | - K P Martimo
- Work Disability Prevention, Finnish Institute of Occupational Health, P.O. Box 40, 00251, Helsinki, Finland
| | - E MacEachen
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Canada
- Centre for Research on Work Disability Policy, Institute for Work & Health, Toronto, Canada
| | - T Lallukka
- Work Disability Prevention, Finnish Institute of Occupational Health, P.O. Box 40, 00251, Helsinki, Finland
| | - E Viikari-Juntura
- Work Disability Prevention, Finnish Institute of Occupational Health, P.O. Box 40, 00251, Helsinki, Finland
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Halonen JI, Solovieva S, Virta LJ, Laaksonen M, Martimo KP, Hiljanen I, Lallukka T, Autti-Rämö I, Viikari-Juntura E. Sustained return to work and work participation after a new legislation obligating employers to notify prolonged sickness absence. Scand J Public Health 2018; 46:65-73. [PMID: 29471755 DOI: 10.1177/1403494817732445] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AIMS Return to work (RTW) after prolonged sickness absence benefits both the individual and society. However, the effectiveness of legislation aiming to improve RTW remains uncertain. We examined whether sustained RTW and work participation were different before and after a legislative change enacted in 2012 (i.e. an intervention) that obligated employers to give notice of prolonged sickness absence to occupational health services. METHODS Two random samples (2010 and 2013) of the Finnish working aged population (70%, ~2.6 million each) were drawn. Using survival analysis, we assessed sustained RTW (≥28 consecutive working days) during a two-month follow-up after a sickness absence minimum of 30 calendar days in the pre- and post-intervention period. We also identified pathways for RTW with cluster analysis and calculated relative gain in work participation in the total sample and by several population subgroups. RESULTS In the total sample, sustained RTW was 4% higher and the mean time to sustained RTW was 0.42 days shorter in the post- than in the pre-intervention period. The estimates were larger among women than men and among those with mental disorders compared with other diagnoses. Changes in the pathways for sustained RTW indicated a 4.9% relative gain in work participation in the total sample. The gain was larger among those who lived in areas of low unemployment rate (20.6%) or worked in the public sector (11.9%). CONCLUSIONS From 2010 to 2013, RTW and work participation increased among the employees with prolonged sickness absence, suggesting that the legislative change enhanced RTW. The change in work participation varied by population subgroup.
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Affiliation(s)
| | | | - Lauri J Virta
- 2 The Social Insurance Institution of Finland, Finland
| | | | | | - Ismo Hiljanen
- 2 The Social Insurance Institution of Finland, Finland
| | - Tea Lallukka
- 1 Finnish Institute of Occupational Health, Finland
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Viikari-Juntura E, Virta LJ, Kausto J, Autti-Rämö I, Martimo KP, Laaksonen M, Leinonen T, Husgafvel-Pursiainen K, Burdorf A, Solovieva S. Legislative change enabling use of early part-time sick leave enhanced return to work and work
participation in Finland. Scand J Work Environ Health 2017; 43:447-456. [DOI: 10.5271/sjweh.3664] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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10
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Horppu R, Martimo KP, Viikari-Juntura E, Lallukka T, MacEachen E. Occupational Physicians' Reasoning about Recommending Early Return to Work with Work Modifications. PLoS One 2016; 11:e0158588. [PMID: 27367908 PMCID: PMC4930161 DOI: 10.1371/journal.pone.0158588] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Accepted: 06/17/2016] [Indexed: 11/19/2022] Open
Abstract
Previous research indicates that work modifications can effectively enhance return to work (RTW) at an early stage of work disability. We aimed to examine how occupational physicians (OPs) reason about recommending early return to work (RTW) with work modifications. Pre-defined propositions regarding the use of work modifications in promoting early RTW were discussed in four focus groups with altogether 11 Finnish OPs. Discussions were audio recorded, and the transcribed data were analyzed using qualitative content analysis. Five different rationales for supporting early RTW were identified: to manage medical conditions, to enhance employee well-being, to help workplace stakeholders, to reduce costs to society, and to enhance OP’s own professional fulfillment. However, OPs identified situations and conditions in which early RTW may not be suitable. In addition, there were differences between the OPs in the interpretation of the rationales, suggesting variation in clinical practice. In conclusion, encouraging early RTW with work modifications was perceived by OPs as a meaningful task and, to a large extent, beneficial for employees and several stakeholders. However, this practice was not accepted without consideration to the RTW situation and context. If early RTW and work modifications are to be promoted, OPs should be offered education that addresses their views regarding this practice.
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Affiliation(s)
- Ritva Horppu
- Prevention of Work Disability, Finnish Institute of Occupational Health, Helsinki, Finland
- * E-mail:
| | - Kari-Pekka Martimo
- Prevention of Work Disability, Finnish Institute of Occupational Health, Helsinki, Finland
| | - Eira Viikari-Juntura
- Prevention of Work Disability, Finnish Institute of Occupational Health, Helsinki, Finland
| | - Tea Lallukka
- Prevention of Work Disability, Finnish Institute of Occupational Health, Helsinki, Finland
| | - Ellen MacEachen
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Canada
- Centre for Research on Work Disability Policy, Institute for Work & Health, Toronto, Canada
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Haukka E, Martimo KP, Kivekäs T, Horppu R, Lallukka T, Solovieva S, Shiri R, Pehkonen I, Takala EP, MacEachen E, Viikari-Juntura E. Efficacy of temporary work modifications on disability related to musculoskeletal pain or depressive symptoms--study protocol for a controlled trial. BMJ Open 2015; 5:e008300. [PMID: 25986643 PMCID: PMC4442237 DOI: 10.1136/bmjopen-2015-008300] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Previous research suggests that work with a suitable workload may promote health and work retention in people with disability. This study will examine whether temporary work modifications at the early stage of work disability are effective in enhancing return to work (RTW) or staying at work among workers with musculoskeletal or depressive symptoms. METHODS AND ANALYSIS A single-centre controlled trial with modified stepped wedge design will be carried out in eight enterprises and their occupational health services (OHSs) in nine cities in Finland. Patients seeking medical advice due to musculoskeletal pain (≥4 on a scale from 0-10) or depressive symptoms (≥1 positive response to 2 screening questions) and fulfilling other inclusion criteria are eligible. The study involves an educational intervention among occupational physicians to enhance the initiation of work modifications. Primary outcomes are sustained RTW (≥4 weeks at work without a new sickness absence (SA)) and the total number of SA days during a 12-month follow-up. Secondary outcomes are intensity of musculoskeletal pain (scale 0-10), pain interference with work or sleep (scale 0-10) and severity of depressive symptoms (Patient Health Questionnaire, PHQ-9), inquired via online questionnaires at baseline and 3, 6, 9 and 12 months after recruitment. Information on SA days will be collected from the medical records of the OHSs over 12 months, before and after recruitment. The findings will give new information about the possibilities of training physicians to initiate work modifications and their effects on RTW in employees with work disability due to musculoskeletal pain or depressive symptoms. ETHICS AND DISSEMINATION The Coordinating Ethics Committee of Hospital District of Helsinki and Uusimaa has granted approval for this study. The results will be published in peer-reviewed journals. TRIAL REGISTRATION NUMBER ISRCTN74743666.
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Affiliation(s)
- Eija Haukka
- Health and Work Ability, OHS and Work Health, Finnish Institute of Occupational Health, Helsinki, Finland
- Disability Prevention Research Centre, Finnish Institute of Occupational Health, Helsinki, Finland
| | - Kari-Pekka Martimo
- Disability Prevention Research Centre, Finnish Institute of Occupational Health, Helsinki, Finland
- Client Services, Occupational Health Collaboration, Finnish Institute of Occupational Health, Helsinki, Finland
| | - Teija Kivekäs
- Disability Prevention Research Centre, Finnish Institute of Occupational Health, Helsinki, Finland
- Development of Work and Organizations, Mental Health and Cognition, Finnish Institute of Occupational Health, Helsinki, Finland
| | - Ritva Horppu
- Health and Work Ability, OHS and Work Health, Finnish Institute of Occupational Health, Helsinki, Finland
- Disability Prevention Research Centre, Finnish Institute of Occupational Health, Helsinki, Finland
| | - Tea Lallukka
- Health and Work Ability, OHS and Work Health, Finnish Institute of Occupational Health, Helsinki, Finland
- Disability Prevention Research Centre, Finnish Institute of Occupational Health, Helsinki, Finland
| | - Svetlana Solovieva
- Health and Work Ability, OHS and Work Health, Finnish Institute of Occupational Health, Helsinki, Finland
- Disability Prevention Research Centre, Finnish Institute of Occupational Health, Helsinki, Finland
| | - Rahman Shiri
- Health and Work Ability, OHS and Work Health, Finnish Institute of Occupational Health, Helsinki, Finland
- Disability Prevention Research Centre, Finnish Institute of Occupational Health, Helsinki, Finland
| | - Irmeli Pehkonen
- Health and Work Ability, OHS and Work Health, Finnish Institute of Occupational Health, Helsinki, Finland
- Disability Prevention Research Centre, Finnish Institute of Occupational Health, Helsinki, Finland
| | - Esa-Pekka Takala
- Health and Work Ability, OHS and Work Health, Finnish Institute of Occupational Health, Helsinki, Finland
- Disability Prevention Research Centre, Finnish Institute of Occupational Health, Helsinki, Finland
| | - Ellen MacEachen
- University of Waterloo, School of Public Health and Health Systems, Waterloo, Ontario, Canada
- University of Toronto, Dalla Lana School of Public Health, Toronto, Ontario, Canada
| | - Eira Viikari-Juntura
- Disability Prevention Research Centre, Finnish Institute of Occupational Health, Helsinki, Finland
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Verbeek JH, Martimo KP, Kuijer PPFM, Karppinen J, Viikari-Juntura E, Takala EP. Proper manual handling techniques to prevent low back pain, a Cochrane systematic review. ACTA ACUST UNITED AC 2014; 41 Suppl 1:2299-301. [PMID: 22317058 DOI: 10.3233/wor-2012-0455-2299] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Training and provision of assistive devices are considered major interventions to prevent and treat low back pain (LBP) among workers exposed to manual material handling (MMH). To establish the effectiveness of training and provision of assistive devices in preventing and treating LBP an update of a Cochrane literature review was performed to November 2010. Randomised controlled trials (RCTs) and cohort studies with a concurrent control group (CCTs) were included. Nine RCTs (20.101 employees) and nine CCTs (1280 employees) were included for prevention: six more than in the previous version. No study on treatment was found. None of the included RCTs and CCTs provided evidence that training and provision of assistive devices prevented LBP when compared to no intervention or another intervention.
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Affiliation(s)
- Jos H Verbeek
- Finnish Institute of Occupational Health, PO Box 310 70701 Kuopio, Finland
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Shiri R, Kausto J, Martimo KP, Kaila-Kangas L, Takala EP, Viikari-Juntura E. Health-related effects of early part-time sick leave due to musculoskeletal disorders: a randomized controlled trial. Scand J Work Environ Health 2013; 39:37-45. [DOI: 10.5271/sjweh.3301] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
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14
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Viikari-Juntura E, Kausto J, Shiri R, Kaila-Kangas L, Takala EP, Karppinen J, Miranda H, Luukkonen R, Martimo KP. Return to work after early part-time sick leave due to musculoskeletal disorders: a randomized controlled trial. Scand J Work Environ Health 2011; 38:134-43. [PMID: 22033811 DOI: 10.5271/sjweh.3258] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVES The purpose of this study was to assess the effects of early part-time sick leave on return to work (RTW) and sickness absence among patients with musculoskeletal disorders. METHODS A randomized controlled trial was conducted in six occupational health units of medium- and large-size enterprises. Patients aged 18-60 years with musculoskeletal disorders (N=63) unable to perform their regular work were randomly allocated to part- or full-time sick leave. In the former group, workload was reduced by restricting work time by about a half. Remaining work tasks were modified when necessary, as specified in a "fit note" from the physician. The main outcomes were time to return to regular work activities and sickness absence during 12-month follow-up. RESULTS Time to RTW sustained for ≥4 weeks was shorter in the intervention group (median 12 versus 20 days, P=0.10). Hazard ratio of RTW adjusted for age was 1.60 [95% confidence interval (95% CI) 0.98-2.63] and 1.76 (95% CI 1.21-2.56) after further adjustment for pain interference with sleep and previous sickness absence at baseline. Total sickness absence during the 12-month follow-up was about 20% lower in the intervention than the control group. Compliance with the intervention was high with no discontinuations of part-time sick leave due to musculoskeletal reasons. CONCLUSIONS Early part-time sick leave may provide a faster and more sustainable return to regular duties than full-time sick leave among patients with musculoskeletal disorders. This is the first study to show that work participation can be safely increased with early part-time sick leave.
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Affiliation(s)
- Eira Viikari-Juntura
- Finnish Institute of Occupational Health, Topeliuksenkatu 41a A, 00250 Helsinki, Finland.
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Verbeek J, Martimo KP, Karppinen J, Kuijer PP, Takala EP, Viikari-Juntura E. Manual material handling advice and assistive devices for preventing and treating back pain in workers: a Cochrane Systematic Review. Occup Environ Med 2011; 69:79-80. [PMID: 21849341 DOI: 10.1136/oemed-2011-100214] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- J Verbeek
- Finnish Institute of Occupational Health, Cochrane Occupational Safety and Health Review Group, PO Box 310, 70701 Kuopio, Finland.
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Verbeek JH, Martimo KP, Karppinen J, Kuijer PPF, Viikari-Juntura E, Takala EP. Manual material handling advice and assistive devices for preventing and treating back pain in workers. Cochrane Database Syst Rev 2011:CD005958. [PMID: 21678349 DOI: 10.1002/14651858.cd005958.pub3] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Training and the provision of assistive devices are considered major interventions to prevent back pain and its related disability among workers exposed to manual material handling (MMH). OBJECTIVES To determine the effectiveness of MMH advice and training and the provision of assistive devices in preventing and treating back pain. SEARCH STRATEGY We searched CENTRAL (The Cochrane Library 2011, issue 1), MEDLINE, EMBASE, CINAHL, Nioshtic, CISdoc, Science Citation Index, and PsychLIT to February 2011. SELECTION CRITERIA We included randomised controlled trials (RCT) and cohort studies with a concurrent control group that were aimed at changing human behaviour in MMH and measured back pain, back pain-related disability or sickness absence. DATA COLLECTION AND ANALYSIS Two authors independently extracted the data and assessed the risk of bias using the criteria recommended by the Cochrane Back Review Group for RCTs and MINORS for the cohort studies.We based the results and conclusions on the analysis of RCTs only. We compared these with the results from cohort studies. MAIN RESULTS We included nine RCTs (20,101 employees) and nine cohort studies (1280 employees) on the prevention of back pain in this updated review. Studies compared training to no intervention (4), professional education (2), a video (3), use of a back belt (3) or exercise (2). Other studies compared training plus lifting aids to no intervention (3) and to training only (1). The intensity of training ranged from a single educational session to very extensive personal biofeedback.Six RCTs had a high risk of bias.None of the included studies showed evidence of a preventive effect of training on back pain.There was moderate quality evidence from seven RCTs (19,317 employees) that those who received training reported levels of back pain similar to those who received no intervention, with an odds ratio of 1.17 (95% confidence intervals (CI) 0.68 to 2.02) or minor advice (video), with a relative risk of 0.93 (95% CI 0.69 to 1.25). Confidence intervals around the effect estimates were still wide due to the adjustment for the design effect of clustered studies.The results of the cohort studies were similar to those of the randomised studies. AUTHORS' CONCLUSIONS There is moderate quality evidence that MMH advice and training with or without assistive devices does not prevent back pain or back pain-related disability when compared to no intervention or alternative interventions. There is no evidence available from RCTs for the effectiveness of MMH advice and training or MMH assistive devices for treating back pain. More high quality studies could further reduce the remaining uncertainty.
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Affiliation(s)
- Jos H Verbeek
- Occupational Safety and Health Review Group, Finnish Institute of Occupational Health, PO Box 310, Kuopio, Finland, 70101
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Shiri R, Martimo KP, Miranda H, Ketola R, Kaila-Kangas L, Liira H, Karppinen J, Viikari-Juntura E. The effect of workplace intervention on pain and sickness absence caused by upper-extremity musculoskeletal disorders. Scand J Work Environ Health 2011; 37:120-8. [PMID: 21218270 DOI: 10.5271/sjweh.3141] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES The aim of this study was to assess the effect of an ergonomic intervention on pain and sickness absence caused by upper-extremity musculoskeletal disorders. METHODS In this randomized controlled study, subjects aged 18-60 years (N=177) seeking medical advice due to upper-extremity symptoms were included if their symptoms, or the exacerbation of symptoms, had started <30 days prior to the medical consultation and immediate sick leave was not required. Workplace ergonomic improvements were made in the intervention group. Data on symptoms and sickness absences were gathered during one-year follow-up. RESULTS Pain intensity, pain interference with work, leisure time, or sleep did not differ between the intervention and control group during the one-year follow-up. During the first three months of follow-up, the percentage of employees with sickness absence due to upper-extremity or other musculoskeletal disorders did not differ between the intervention (N=89) and control (N=84) group, but the total number of sickness absence days in the intervention group was about half of that in the control group (mean 6.2 versus 9.8 days for upper-extremity disorder and 6.0 versus 11.5 days for upper-extremity and other musculoskeletal disorders combined). During 4-12 months of follow-up, the percentage of employees with sickness absence due to upper-extremity disorder (10.1% versus 16.7%, P=0.20) or upper-extremity and other musculoskeletal disorders combined (20.2% versus 32.1%, P=0.07) was lower in the intervention than the control group. CONCLUSIONS Our findings suggest that an early ergonomic intervention reduces sickness absence due to upper-extremity or other musculoskeletal disorders.
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Affiliation(s)
- Rahman Shiri
- Centre of Expertise for Health and Work Ability, Finnish Institute of Occupational Health, FIN-00250, Helsinki, Finland.
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Kusnetsov J, Neuvonen LK, Korpio T, Uldum SA, Mentula S, Putus T, Tran Minh NN, Martimo KP. Two Legionnaires' disease cases associated with industrial waste water treatment plants: a case report. BMC Infect Dis 2010; 10:343. [PMID: 21126333 PMCID: PMC3014939 DOI: 10.1186/1471-2334-10-343] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2010] [Accepted: 12/02/2010] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Finnish and Swedish waste water systems used by the forest industry were found to be exceptionally heavily contaminated with legionellae in 2005. CASE PRESENTATION We report two cases of severe pneumonia in employees working at two separate mills in Finland in 2006. Legionella serological and urinary antigen tests were used to diagnose Legionnaires' disease in the symptomatic employees, who had worked at, or close to, waste water treatment plants. Since the findings indicated a Legionella infection, the waste water and home water systems were studied in more detail. The antibody response and Legionella urinary antigen finding of Case A indicated that the infection had been caused by Legionella pneumophila serogroup 1. Case A had been exposed to legionellae while installing a pump into a post-clarification basin at the waste water treatment plant of mill A. Both the water and sludge in the basin contained high concentrations of Legionella pneumophila serogroup 1, in addition to serogroups 3 and 13. Case B was working 200 meters downwind from a waste water treatment plant, which had an active sludge basin and cooling towers. The antibody response indicated that his disease was due to Legionella pneumophila serogroup 2. The cooling tower was the only site at the waste water treatment plant yielding that serogroup, though water in the active sludge basin yielded abundant growth of Legionella pneumophila serogroup 5 and Legionella rubrilucens. Both workers recovered from the disease. CONCLUSION These are the first reported cases of Legionnaires' disease in Finland associated with industrial waste water systems.
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Affiliation(s)
- Jaana Kusnetsov
- National Institute for Health and Welfare (THL), Water and Health Unit, P.O.Box 95, FI-70701 Kuopio, Finland
| | | | | | | | - Silja Mentula
- National Institute for Health and Welfare, Bacteriology Unit, Helsinki, Finland
| | | | - Nhu Nguyen Tran Minh
- National Institute for Health and Welfare, Epidemiologic Surveillance and Response Unit, Helsinki, Finland
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Martimo KP, Shiri R, Miranda H, Ketola R, Varonen H, Viikari-Juntura E. Effectiveness of an ergonomic intervention on the productivity of workers with upper-extremity disorders – a randomized controlled trial. Scand J Work Environ Health 2009; 36:25-33. [DOI: 10.5271/sjweh.2880] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Martimo KP, Shiri R, Miranda H, Ketola R, Varonen H, Viikari-Juntura E. Self-reported productivity loss among workers with upper extremity disorders. Scand J Work Environ Health 2009; 35:301-8. [PMID: 19471843 DOI: 10.5271/sjweh.1333] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE Upper extremity disorders (UED) are prevalent in working populations. This study investigates the prevalence, magnitude, and associated factors of on-the-job productivity loss among workers with UED. METHODS Workers with incipient upper extremity symptoms were invited to participate in our study after the disorder was verified by a physician and no immediate sick leave was required. Of the 177 eligible patients, 168 (95%) were included in the study. They were asked to describe their symptoms, personal characteristics, and work-related factors. Self-assessed productivity measured the impact of UED on the achieved work output. RESULTS Of the 168 participants, 56% reported a productivity loss; the average reduction thereof was 34%. Productivity loss was associated with pain intensity [odds ratio (OR) for the third tertile 2.8, 95% confidence interval (95% CI) 1.2-6.5], pain interference with work (OR for the third tertile 5.7, 95% CI 2.2-14.3) and fear-avoidance beliefs (OR 2.8, 95% CI 0.9-8.9). Pain interference with sleep was associated with productivity loss only among those aged 46 years or older, whereas high job strain showed an association with productivity loss only among workers aged 20-45 years. In the younger group, productivity loss was more associated with a combination of any two of the following three factors than the presence of only one: pain intensity, job strain, and physical loads at work. CONCLUSIONS UED cause substantial loss of productivity at work. The most important associated factors are related to pain and its impact on work and sleep, but also to psychological aspects of pain and work. Our findings suggest that the factors associated with productivity loss differ in younger and older workers.
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Affiliation(s)
- Kari-Pekka Martimo
- Finnish Institute of Occupational Health, Topeliuksenkatu, Helsinki, Finland.
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Kausto J, Miranda H, Martimo KP, Viikari-Juntura E. Partial sick leave--review of its use, effects and feasibility in the Nordic countries. Scand J Work Environ Health 2008; 34:239-49. [PMID: 18815712 DOI: 10.5271/sjweh.1266] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Partial sick leave and partial sickness benefits are currently available in Sweden, Norway, Denmark, and Finland. The literature was reviewed to determine their use, describe their recipients, find evidence of their effects, and explore attitudes towards and experiences with their use. Eight databases were searched. National sickness absence statistics and other relevant sources were also reviewed. Of the sickness benefits, partial benefits accounted for approximately one-fifth in Norway, less than 10% in Denmark, and over a third in Sweden. In Finland, partial sick leave was seldom used during the first year (2007) of benefit availability. Few peer-reviewed studies on its effects were identified, and scientific evidence was scarce. Its acceptance was good in all four countries. Most of the recipients were women and over 45 years of age. Studies of its feasibility seem congruent in reporting hindrances due to inflexible work arrangements and poor collaboration between actors. More research and more rigorous study designs are needed to determine whether partial sick leave is feasible and beneficial in keeping those with reduced work ability in worklife.
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Affiliation(s)
- Johanna Kausto
- Finnish Institute of Occupational Health, Topeliuksenkatu 41 a A, Helsinki, Finland.
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22
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Martimo KP, Kaila-Kangas L, Kausto J, Takala EP, Ketola R, Riihimäki H, Luukkonen R, Karppinen J, Miranda H, Viikari-Juntura E. Effectiveness of early part-time sick leave in musculoskeletal disorders. BMC Musculoskelet Disord 2008; 9:23. [PMID: 18294405 PMCID: PMC2267790 DOI: 10.1186/1471-2474-9-23] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2008] [Accepted: 02/25/2008] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The importance of staying active instead of bed rest has been acknowledged in the management of musculoskeletal disorders (MSDs). This emphasizes the potential benefits of adjusting work to fit the employee's remaining work ability. Despite part-time sick leave being an official option in many countries, its effectiveness has not been studied yet. We have designed a randomized controlled study to assess the health effects of early part-time sick leave compared to conventional full-day sick leave. Our hypothesis is that if work time is temporarily reduced and work load adjusted at the early stages of disability, employees with MSDs will have less disability days and faster return to regular work duties than employees on a conventional sick leave. METHODS/DESIGN The study population will consist of 600 employees, who seek medical advice from an occupational physician due to musculoskeletal pain. The inclusion requires that they have not been on a sick leave for longer than 14 days prior to the visit. Based on the physician's judgement, the severity of the symptoms must indicate a need for conventional sick leave, but the employee is considered to be able to work part-time without any additional risk. Half of the employees are randomly allocated to part-time sick leave group and their work time is reduced by 40-60%, whereas in the control group work load is totally eliminated with conventional sick leave. The main outcomes are the number of days from the initial visit to return to regular work activities, and the total number of sick leave days during 12 and 24 months of follow-up. The costs and benefits as well as the feasibility of early part-time sick leave will also be evaluated. CONCLUSION This is the first randomised trial to our knowledge on the effectiveness of early part-time sick leave compared to conventional full-time sick leave in the management of MSDs. The data collection continues until 2011, but preliminary results on the feasibility of part-time sick leave will be available already in 2008. The increased knowledge will assist in better decision making process regarding the management of disability related to MSDs. TRIAL REGISTRATION International Standard Randomised Controlled Trial Number Register, register number ISRCTN30911719.
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Affiliation(s)
- Kari-Pekka Martimo
- Team of Musculoskeletal Disorders, Centre of Expertise of Health and Work Ability, Finnish Institute of Occupational Health, Topeliuksenkatu 41 a A, 00250 Helsinki, Finland.
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Martimo KP, Verbeek J, Karppinen J, Furlan AD, Takala EP, Kuijer PPFM, Jauhiainen M, Viikari-Juntura E. Effect of training and lifting equipment for preventing back pain in lifting and handling: systematic review. BMJ 2008; 336:429-31. [PMID: 18244957 PMCID: PMC2249682 DOI: 10.1136/bmj.39463.418380.be] [Citation(s) in RCA: 100] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To determine whether advice and training on working techniques and lifting equipment prevent back pain in jobs that involve heavy lifting. DATA SOURCES Medline, Embase, CENTRAL, Cochrane Back Group's specialised register, CINAHL, Nioshtic, CISdoc, Science Citation Index, and PsychLIT were searched up to September-November 2005. REVIEW METHODS The primary search focused on randomised controlled trials and the secondary search on cohort studies with a concurrent control group. Interventions aimed to modify techniques for lifting and handling heavy objects or patients and including measurements for back pain, consequent disability, or sick leave as the main outcome were considered for the review. Two authors independently assessed eligibility of the studies and methodological quality of those included. For data synthesis, we summarised the results of studies comparing similar interventions. We used odds ratios and effect sizes to combine the results in a meta-analysis. Finally, we compared the conclusions of the primary and secondary analyses. RESULTS Six randomised trials and five cohort studies met the inclusion criteria. Two randomised trials and all cohort studies were labelled as high quality. Eight studies looked at lifting and moving patients, and three studies were conducted among baggage handlers or postal workers. Those in control groups received no intervention or minimal training, physical exercise, or use of back belts. None of the comparisons in randomised trials (17,720 participants) yielded significant differences. In the secondary analysis, none of the cohort studies (772 participants) had significant results, which supports the results of the randomised trials. CONCLUSIONS There is no evidence to support use of advice or training in working techniques with or without lifting equipment for preventing back pain or consequent disability. The findings challenge current widespread practice of advising workers on correct lifting technique.
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Affiliation(s)
- Kari-Pekka Martimo
- Musculoskeletal Disorders Group, Centre of Expertise for Health and Work Ability, Finnish Institute of Occupational Health, Helsinki, Finland.
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Martimo KP, Verbeek J, Karppinen J, Furlan AD, Kuijer PPFM, Viikari-Juntura E, Takala EP, Jauhiainen M. Manual material handling advice and assistive devices for preventing and treating back pain in workers. Cochrane Database Syst Rev 2007:CD005958. [PMID: 17636814 DOI: 10.1002/14651858.cd005958.pub2] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Training and assistive devices are considered major interventions to prevent back pain among workers exposed to manual material handling (MMH). OBJECTIVES To determine the effectiveness of MMH advice and training and the provision of assistive devices in preventing and treating back pain. SEARCH STRATEGY We searched MEDLINE to November 2005, EMBASE to August 2005, and CENTRAL, the Back Group's Trials Register, CINAHL, Nioshtic, CISdoc, Science Citation Index, and PsychLIT to September 2005. SELECTION CRITERIA We included randomized controlled trials (RCT) and cohort studies with a concurrent control group, aimed at changing human behaviour in MMH and measuring back pain, back pain-related disability or sickness absence. DATA COLLECTION AND ANALYSIS Two authors independently extracted the data and assessed the methodological quality using the criteria recommended by the Back Review Group for RCTs and MINORS for the cohort studies. One author of an original study supplied additional data for the review. The results and conclusions are based on the primary analysis of RCTs. We conducted a secondary analysis with cohort studies. We compared and contrasted the conclusions from the primary and secondary analyses. MAIN RESULTS We included six RCTs (17,720 employees) and five cohort studies (772 employees). All studies focused on prevention of back pain. Two RCTs and all cohort studies met the majority of the quality criteria and were labeled high quality. We summarized the strength of the evidence with a qualitative analysis since the lack of data precluded a statistical analysis. There is moderate evidence that MMH advice and training are no more effective at preventing back pain or back pain-related disability than no intervention (four studies) or minor advice (one study). There is limited evidence that MMH advice and training are no more effective than physical exercise or back belt use in preventing back pain (three studies), and that MMH advice plus assistive devices are not more effective than MMH advice alone (one study) or no intervention (one study) in preventing back pain or related disability. The results of the cohort studies were similar to the randomised studies. AUTHORS' CONCLUSIONS There is limited to moderate evidence that MMH advice and training with or without assistive devices do not prevent back pain, back pain-related disability or reduce sick leave when compared to no intervention or alternative interventions. There is no evidence available for the effectiveness of MMH advice and training or MMH assistive devices for treating back pain.
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Affiliation(s)
- K P Martimo
- Finnish Institute of Occupational Health, Topeliuksenkatu 41 a A, Helsinki, Finland, 00250.
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25
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Abstract
BACKGROUND Symptoms and health problems caused or aggravated by work are common. In order to study perceived work ability and associated factors, including those related to work, a closer analysis was undertaken in an occupational health setting. AIMS This study aimed to analyse self-assessed work ability and its determinants in employees seeking medical advice, with special emphasis on work-related factors. METHODS During 723 illness-related visits to occupational physicians, questionnaires covering personal data, main health problems, their work relatedness, duration and effect on work ability were completed by the employee and physician. Factors associated with self-assessed work ability were studied in a multinomial logistic regression model. RESULTS The majority of employees considered themselves as being able or partially able to work despite the health problem. Independent predictors of impaired work ability were mental or musculoskeletal disorders, self-assessed work relatedness of the disease, older age, blue-collar work and short duration of the symptoms. If the patient was convinced about the benefits of work-related interventions, the risk for disability was significantly reduced. CONCLUSIONS Special attention should be paid to the recognition and modification of potential work-related causes of disability. In addition, patients with partial work ability should be encouraged to stay at work instead of taking sick leave. For effective disability management, accommodated work and other evidence-based interventions are needed at the workplace.
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Affiliation(s)
- Kari-Pekka Martimo
- Centre of Expertise for Health and Work Ability, Finnish Institute of Occupational Health, Topeliuksenkatu 41 a A, FI-00250 Helsinki, Finland.
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Martimo KP. Audit matrix for evaluating Finnish occupational health units. Scand J Work Environ Health 1998; 24:439-43. [PMID: 9869317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023] Open
Abstract
OBJECTIVES The aim of this article is to describe how an audit matrix for occupational health units was formulated, what the preliminary results tell about its applicability, and how the matrix can help to implement the principles of "good practice in occupational health services". METHODS Twelve areas eligible for auditing were selected for the matrix. According to the recently issued principles of good practice, the principles of total quality management and continuous quality improvement, each area was divided into descriptions of 4 quality levels, the lowest being given 0 points and the highest 5-6 points. The maximum total score was 72 points. RESULTS Of the 30 external audits, no unit had less than 18 points. Nine units had 19-36 points, 17 units had 37-54 points, and 4 units had over 54 points. "Maintenance of work ability" received the highest mean of the given points (4.1), followed by "curative care"(4.0) and "multidisciplinarity"(3.9). The lowest means were for "planning of activities" (3.1), "customer orientation"(3.2), and "quality improvement"(3.2). CONCLUSIONS The audit matrix proved to be a practical method for auditing occupational health units, revealing both the most common flaws and strengths in the quality of Finnish occupational health services. Because the matrix has been accepted well by occupational health professionals and it manages to classify the units, it is probably a useful instrument for evaluating the performance of occupational health units and promoting good practice.
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Affiliation(s)
- K P Martimo
- Research and Development Centre for Occupational Health Services, Finnish Institute of Occupational Health, Helsinki.
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Martimo KP, Antti-Poika M, Leino T, Rossi K. Ethical issues among Finnish occupational physicians and nurses. Occup Med (Lond) 1998; 48:375-80. [PMID: 10024733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023] Open
Abstract
A postal survey was conducted among 200 Finnish occupational physicians and nurses on their ethical values and problems. Both groups considered 'expertise' and 'confidentiality' as the most important core values of occupational health services (OHS) corresponding with newly published national ethical guidelines for occupational physicians and nurses in Finland. Nearly all respondents had encountered ethically problematic situations in their work, but ethical problems with gene testing in the near future were not considered likely to occur. Only 41% of the nurses and 36% of the physicians had received some training in the ethics of OHS, and 76% of all respondents never used available ethical guidelines. According to the results, even if ethics play a vital role in OHS, the ability to critically evaluate one's own performance seems quite limited. This creates a need for further training and more practicable national guidelines.
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Affiliation(s)
- K P Martimo
- Research and Development Centre for Occupational Health Services, Finnish Institute of Occupational Health, Helsinki, Finland.
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Abstract
Ninhydrin is a laboratory chemical used as a reagent in the detection of free amino and carboxyl groups in proteins and peptides. We present the case of a laboratory technician who developed symptoms of rhinitis when handling papers immersed in a solution containing ninhydrin. Prick tests for ninhydrin and ninhydrin RAST were positive. The inhalation provocation test in an exposure chamber gave an immediate nasal response. A positive prick test to ninhydrin, an elevated level of specific IgE antibodies to ninhydrin, and the RAST inhibition test confirmed an IgE-mediated type I allergic reaction. We are not aware of any other report of ninhydrin as a cause of IgE-mediated allergy.
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Affiliation(s)
- M Hytönen
- Finnish Institute of Occupational Health, Helsinki, Finland
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Hirvonen J, Huttunen P, Martimo KP, Puurunen J. Combined ulcerogenic effect of ethanol and acetylsalicylic acid on the gastric mucosa of the rat. Z Rechtsmed 1983; 90:239-46. [PMID: 6637151 DOI: 10.1007/bf02116198] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
The effect on rat gastric mucosa of ethanol and acetylsalicylic acid given at two doses singly or in combination were studied by administering the drugs into the stomach. 40% ethanol alone caused many ulcerations after 5 h, and the effect was even more marked with simultaneous administration of acetylsalicylic acid (ASA). 10% ethanol and 50 mg ASA/kg b. wt. were tolerated well. The mucosal lesions consisted of coagulation necrosis and hemorrhages, with a disappearance of histamine and serotonin from the mucosal mast cells in and around the lesion.
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