Journal of Occupational Rehabilitation最新文献

Background: Understanding the self-rated health of industrially disabled individuals is an important variable that significantly affects their quality of life, satisfaction, and return to work after an industrial accident. Since the health of people with industrial disabilities is affected by various environments and variables, interventions and policies that are suitable for their characteristics are needed.

Objectives: This study aimed to identify changes in self-rated health among industrially disabled individuals, distinguish between different latent classes, and verify predictive factors for each latent class.

Methods: Four time-point datasets from the 2018-2021 panel study of Korean workers' compensation insurance were used. Using the latent growth curve model, an overall trajectory of self-rated health of industrially disabled individuals was confirmed, and the number and characteristics of different trajectories were identified using the latent class growth model. Multinomial logistic regression analysis was used to identify the predictive factors for each class.

Results: Four classes of self-rated health trajectories were identified: low-decreasing (21.7%), moderate-increasing (15.7%), high-decreasing (56.1%), and low-stable (6.5%) classes. A multinomial logistic regression analysis revealed that significant determinants (age, capacity, type of industrial accident, grade of disability, mental activity, outdoor activity, and social relationships) were different for each latent class. Capacity level affected all potential class classifications.

Conclusions: To improve the self-rated health of industrially disabled individuals, it is necessary to develop an appropriate strategy that considers the characteristics of the latent class.

Purpose: To develop an index to assess capacity to work in relation to common mental disorders (CMDs) in the general working population and field test its psychometric properties.

Methods: Content analysis of three qualitative studies on people (n = 49) with their own experiences of working with CMD guided the items selected for the index. Face and content validity and test-retest reliability were performed. The index was field tested in two versions with 26 and 17 items, respectively, among health care professionals regarding internal reliability, component structure and concurrent validity.

Results: The final version of the Capacity to Work Index (C2WI; 17 items) was normally distributed in the field test with high internal reliability (Cronbach's alpha, 0.84). Missing responses were randomly distributed and nonspecific. Principal component analysis showed one clear component with negatively framed items. Concurrent validity showed high correlation with the WHO-5 Well-Being Scale (Pearson's r, 0.68), but lower correlation for the general health question (r, - 0.44), one item of the Work Ability Index (r, - 0.33), and the Stress of Conscience constructs (r, 0.44).

Conclusion: The C2WI showed promising psychometric qualities. Low and negative correlation with the item from Work Ability Index suggests that the C2WI measures additional dimensions, but further testing in larger and more diverse samples is required.

Purpose: Musculoskeletal disorders (MSDs) are common worldwide and gender differences exist in terms of prevalence and disability. MSDs are a leading cause of sick leave and physical work exposures. To assess the association between physical exposures assessed by the gender-specific CONSTANCES Job-Exposure Matrix (JEM) and musculoskeletal pain in six areas: neck pain, shoulder pain, elbow/arm pain, hand/wrist pain, low back pain, knee/leg pain; and to compare the results with those obtained using the non-gendered CONSTANCES JEM and with individual self-report exposures.

Methods: We included 48,736 male and 63,326 female workers from the CONSTANCES cohort (France). The association between 27 physical exposures and musculoskeletal self-reported pain in six body areas was assessed using logistic regression. We conducted the analysis with three types of exposures: (1) individual self-reported exposures; (2) gender-specific CONSTANCES JEM; (3) non-gendered CONSTANCES JEM, and adjusted for age and Body Mass Index (BMI). Analyses were stratified by gender.

Results: The associations to the gender-specific and non-gendered JEM were similar. The odds ratios using individual self-reported exposures were comparable to the JEM-based associations, with the exceptions of the exposures 'change tasks', 'rest eyes' and 'reach behind'. In some comparisons, there were differences in the direction and/or significance of effects between genders (regardless of whether the JEM used was gender-specific or not).

Conclusion: The gender-specific and non-gendered JEMs gave similar results, hence, developing physical work exposures JEMs that are gender-specific may not be essential. However, when predicting musculoskeletal pain, it seems relevant to stratify the analysis by gender.

Purpose: A comprehensive review of the literature on the time between the onset of symptoms and the first episode of care and its effects on important worker outcomes in compensated musculoskeletal conditions is currently lacking. This scoping review aimed to summarize the factors associated with time to service and describe outcomes in workers with workers' compensation accepted claims for musculoskeletal conditions.

Methods: We used the JBI guidelines for scoping reviews and reported following the PRISMA-ScR protocol. We included peer-reviewed articles published in English that measured the timing of health service initiation. We conducted searches in six databases, including Medline (Ovid), Embase (Ovid), PsycINFO, Cinahl Plus (EBSCOhost), Scopus, and the Web of Science. Peer-reviewed articles published up to November 01, 2022 were included. The evidence was summarized using a narrative synthesis.

Results: Out of the 3502 studies identified, 31 were included. Eight studies reported the factors associated with time to service. Male workers, availability of return to work programmes, physically demanding occupations, and greater injury severity were associated with a shorter time to service, whereas female workers, a high number of employees in the workplace, and having legal representation were associated with a longer time to service. The relationship between time service and worker outcomes was observed in 25 studies, with early access to physical therapy and biopsychosocial interventions indicating favourable outcomes. Conversely, early opioids, and MRI in the absence of severe underlying conditions were associated with a longer duration of disability, higher claim costs, and increased healthcare utilization.

Conclusion: Existing evidence suggests that the time to service for individuals with compensated musculoskeletal conditions was found to be associated with several characteristics. The relationship between time to service and worker outcomes was consistently indicated in the majority of the studies. This review highlights the need to consider patient-centred treatments and develop strategies to decrease early services with negative effects and increase access to early services with better outcomes.

Purpose: The purpose of this study was to explore the perspectives of self-employed workers with a physically demanding job on work participation.

Methods: We interviewed self-employed workers with a physically demanding job, using semi-structured interviews, which were audio recorded. The main topic addressed was the workers' health in relation with their work participation, work demands, and preventive measures. The interviews were transcribed verbatim and coded by three team members of the research team in several steps. We used the consolidated criteria for reporting qualitative research (COREQ) checklist to report our findings.

Results: We interviewed 18 self-employed workers: 83% male, 49 years (SD 7), self-employed for 18 years (SD 9) and the majority (n = 14) worked in the construction sector. Thematic analysis revealed facilitators and barriers for work participation across three main themes: personal factors, work factors, and healthcare. Personal factors compassed sub-themes such as health and financial consequences. Work factors included sub-themes related to work demands and adaptations and healthcare encompassed sub-themes associated with work-related care and medication.

Conclusion: To our knowledge, this is the first qualitative study that investigated the perspectives of self-employed workers in physically demanding jobs regarding work participation. While most facilitators and barriers were consistent with those described in the literature for employees, certain factors, such as financial consequences of ceasing work, emerged important factors for work participation among self-employed workers.

Purpose: Firefighters perform dangerous and physically demanding work, increasing their risk of musculoskeletal injuries that can lead to work absences. Return-to-work procedures can help firefighters return-to-work sooner and safely. The purpose of this study was to explore what firefighters understand about return-to-work procedures in their workplaces, and what firefighters believe the facilitators and barriers to return-to-work are.

Methods: Thirty-eight Canadian career firefighters were recruited for semi-structured interviews. Qualitative descriptive methods were used to analyze the transcripts. Two researchers performed the inductive coding and thematic analysis.

Results: Five themes were identified: 1. Variation in the return-to-work process knowledge among firefighters based on their experiences; 2. Accessible medical resources and treatments to support injury recovery; 3. Light duties must be meaningful and suitable; 4. Pressures to return-to-work too soon may lead to negative consequences; and 5. Heavy physical demands of firefighting may become a barrier for return-to-work. 'Factors affecting RTW depended on personal experiences and context' was the overarching theme identified, as many reported facilitators for return-to-work were also reported as barriers in different contexts. There was a variation in the experiences and understanding of return-to-work.

Conclusion: There is a lack of knowledge of the return-to-work processes. Firefighters require access to clear return-to-work policies and procedures and treatments that are targeted to firefighting duties to support recovery from injuries and regain physical abilities after an injury. Firefighters must be able to perform all essential duties before returning to firefighting work, as returning to work too soon can lead to further injury.

Purpose: Enhancing workplace communication and support processes to enable individuals living with disabilities to sustain employment and return to work is a priority for workers, employers, and community stakeholders. The objective of this study was to evaluate a new resource that addresses support challenges, the Job Demands and Accommodation Planning Tool (JDAPT), and assess its use, relevance, and outcomes over a nine-month follow-up period.

Methods: Workers with physical and mental health/cognitive conditions causing limitations at work were recruited using purposive sampling. Online surveys were administered at baseline (prior to using the JDAPT), and at three and nine months post-baseline. Information was collected on demographics (e.g., age, gender) and work characteristics (e.g., job sector, organization size). Outcomes included assessing JDAPT use and relevance, and changes in self-efficacy, work productivity difficulties, employment concerns, difficulties with job demands, and absenteeism.

Results: Baseline participants were 269 workers (66% women; mean age 41 years) of whom 188 (69.9%) completed all three waves of data collection. Many workers reported using JDAPT strategies at and outside of work, and held positive perceptions of the tool's usability, relevance, and helpfulness. There were significant improvements (Time 1-2; Time 1-3) in self-efficacy, perceived work productivity, and absenteeism with moderate to large effect sizes in self-efficacy and productivity (0.46 to 0.78). Findings were consistent across gender, age, health condition, and work context variables.

Conclusions: The JDAPT can enhance support provision and provide greater transparency and consistency to workplace disability practices, which is critical to creating more inclusive and accessible employment opportunities.

Purpose: The aim was to evaluate the effectiveness of a problem-solving intervention with workplace involvement (PSI-WPI) added to care as usual (CAU) in reducing sickness absence days among employees with common mental disorders compared to CAU alone in Swedish primary health care on a monthly basis over 18-months follow-up.

Methods: We conducted a cluster-randomised controlled trial including 197 employees blinded to allocation (85 PSI-WPI and 112 CAU). As sickness absence data was skewed and over-dispersed, generalised estimating equations was used to enable a comparison between the intervention and control group for each month of the follow-up period.

Results: The median number of sickness absence days over the 18-month follow-up was 78 days, inter-quartile range (IQR) 18-196 for employees receiving PSI-WPI and 64 days, IQR 18-161 for employees receiving CAU. The time x group generalised estimating equations analysis showed no statistically significant difference in sickness absence days per month.

Conclusion: The addition of a PSI-WPI to CAU was not more effective in reducing sickness absence days. This may be explained by the primary health care context, lack of specialisation in occupational health and the Swedish social insurance system with specific time limits.

Trial registration: The trial was registered at ClinicalTrials.gov, identifier: NCT03346395 on January 12th, 2018.

Purpose: To evaluate the cost-effectiveness of a multifaceted workplace intervention to reduce musculoskeletal pain (MSP) in nursing staff.

Methods: The study was a 1-year cluster-randomized controlled trial. The intervention combined participatory ergonomics, health promotion, and case management. The control group received usual care. Societal and health system perspectives were used. Costs included direct health and indirect costs. The effects were MSP and quality-adjusted life years (QALYs). MSP was measured using the Standardized Nordic Questionnaire at baseline and 6- and 12-month follow-up. QALYs were measured using the EuroQol-5D-3L at 6- and 12-month follow-up. Incremental costs and QALYs were modelled using generalized linear models. MSP was analysed through generalized logistic models. Incremental cost-effectiveness ratios (ICERs) were calculated, and cost-effectiveness planes and acceptability curves were constructed.

Results: Total mean costs per person were €614 and €216 for the intervention and control group, respectively, with a societal perspective. The intervention mean cost was €38/person. From the societal perspective, the ICER showed that overall additional €68 (€9 from a health system perspective) were required to achieve 1-extra-percentage-point reduction of MSP. ICERs were €34 from the societal and €4 from the health system perspectives for neck, shoulders and upper back pain; €53 and €7 for low back; €179 and €23 for hands; €39 and €5 for legs; €115 and €14 for the knees; €36 and €5 for feet For MSP in the elbows. For participants with pain in the elbow, and for QALYs, the ICER showed that the intervention group was dominated by the control group.

Conclusion: This intervention was not cost-effective in terms of QALYs. However, in terms of MSP, with a willingness to pay of €100, the probability of the intervention being cost-effective was around 90%. Further studies incorporating our recommendations are needed to confirm these findings.

Study registration: ISRCTN15780649, retrospectively registered.

Purpose: Low-back pain (LBP) is a prevalent condition among healthcare workers, negatively affecting well-being and work ability. Research has identified fear-avoidance beliefs, i.e., the belief that physical activities worsen or prolong pain, as a key psychological factor in LBP. Given the physical demands of healthcare work, understanding the link between fear-avoidance and LBP is crucial for effective prevention and management strategies. This study investigated the prospective association between fear-avoidance beliefs and risk of increased LBP intensity and duration in hospital workers.

Methods: Fear-avoidance beliefs and LBP were assessed in 1933 healthcare workers from 389 departments at 19 hospitals at baseline and 1-year follow-up. Associations between baseline work-related fear-avoidance beliefs (FABW) and LBP intensity and duration at follow-up were analyzed using cumulative logistic regression, adjusting for various factors including age, sex, baseline LBP, education, seniority, patient transfers, psychosocial work environment, and lifestyle.

Results: Moderate and high FABW was associated with higher odds of increased pain intensity (OR: 1.37 [95% CI 1.09-1.73] and 1.85 [95% CI 1.18-2.88], respectively) and prolonged pain duration (OR: 1.37 [95% CI 1.05-1.78] and 2.27 [95% CI 1.50-3.44], respectively). A sensitivity analysis including only female nurses showed similar results, with the high FABW group having significantly higher odds of increased pain intensity (OR 2.95, 95% CI 1.84-4.72) and duration (OR 2.64, 95% CI 1.55-4.49).

Conclusions: Fear-avoidance beliefs increase the risk of LBP intensity and duration among healthcare workers, emphasizing the need for interventions dealing with psychological aspects of LBP.