Under-reporting of work-related musculoskeletal disorders in the Veterans Administration

PURPOSE: Work-related musculoskeletal disorders following patient contact represent a major concern for health care workers. Unfortunately, research and prevention have been hampered by difficulties ascertaining true prevalence rates owing to under-reporting of these injuries. The purpose of this study is to determine the predictors for under-reporting work-related musculoskeletal injuries and their reasons. DESIGN/METHODOLOGY/APPROACH: Multivariate analysis using data obtained in a survey of Veterans Administration employees in the USA was used to determine underreporting patterns among registered nurses, licensed practical nurses and nursing assistants. Focus groups among health care workers were conducted at one of the largest Veterans Administration hospitals to determine reasons for under-reporting. FINDINGS: A significant number of workers reported work-related musculoskeletal pain, which was not reported as an injury but required rescheduling work such as changing shifts and taking sick leave to recuperate. The findings indicate that older health care workers and those with longer service were less likely to report as were those working in the evening and night shifts. Hispanic workers and personnel who had repetitive injuries were prone to under-reporting, as were workers in places that lack proper equipment to move and handle patients. Reasons for under-reporting include the time involved, peer pressure not to report and frustration with workers' compensation procedures. ORIGINALITY/VALUE: This study provides insights into under-reporting musculoskeletal injuries in a major US government organization. The research indicates that current reporting procedures appear to be overtly cumbersome in time and effort. More flexible work assignments are needed to cover staff shortfalls owing to injuries. Health education on the detrimental long-term effects of ergonomic injuries and the need for prompt attention to injuries should prove useful in improving rates of reporting.     

Can favorable psychosocial work conditions and high work dedication protect against the occurrence of work-related musculoskeletal disorders?

OBJECTIVES: This study investigated whether work dedication and job resources are longitudinally related to work-related musculoskeletal disorders and whether job resources buffer the impact of job demands on these disorders? METHODS: Data were used from a longitudinal three-phase study (2004, 2005, 2006) on health at work among a sample of Dutch workers. The first survey was sent in 2004 by e-mail to 3100 members of an existing panel. For the analyses, 1522 participants were included with full longitudinal data. The analyses were performed using an autoregressive model with generalized estimating equations. RESULTS: The job-resource quality of communication was found to predict the risk of work-related musculoskeletal disorders over time. This effect was not mediated by work dedication. A high quality of communication was also found to buffer the negative effects of a high physical workload on the risk of work-related musculoskeletal disorders. Furthermore, a low level of social support by colleagues was found to buffer the negative effect of a medium physical workload on work-related musculoskeletal disorders. CONCLUSIONS: This study shows that job resources are not only important for promoting work dedication, but may also moderate the negative impact of high job demands on the risk of work-related musculoskeletal disorders. With respect to social support, the question is raised of whether this can also work negatively. The results of this study imply that, besides avoiding or reducing risks to health in the workplace and lowering job demands, strengthening job resources may additionally buffer harmful effects of job demands on musculoskeletal health.     

Chronic symptoms in construction workers treated for musculoskeletal injuries.

BACKGROUND: Soft tissue musculoskeletal injuries make up a high proportion of all work-related injuries in construction. Data from Workers' Compensation claims indicate that strains and sprains are the leading compensable injury for construction workers. This study describes the consequences of soft tissue musculoskeletal injuries for construction workers, and assesses the persistence of symptoms after an injury and the impact of that injury on return to work. METHODS: Through an Emergency Department surveillance system [Hunting et al., 1994a], we recorded 176 construction worker visits, from 5/01/93 through 2/28/95, for strains, sprains, joint injury or pain, tendinitis, dislocations, hernias, or other musculoskeletal injuries excluding fractures. Telephone interviews were conducted several months after workers had visited the emergency room for a musculoskeletal injury. RESULTS: Seventy individuals were interviewed about the long-term impacts of 72 incidents that had resulted in work-related musculoskeletal injuries. For 46 (62%) of the 74 diagnoses, problems continued beyond two months. The likelihood of problems continuing more than two months varied considerably by body location of injury. Hispanic workers and older workers were more likely to have continuing symptoms. Eleven of the 45 construction workers with symptoms persisting longer than two months were not employed at the time of the interview. Only 11 of the 45 workers with ongoing symptoms told us that modifications had been made to their jobs to accommodate their symptoms. About one-quarter of these 45 subjects reported substantial effects on home or work life. CONCLUSIONS: Acute musculoskeletal injuries in construction workers frequently result in chronic symptoms, and those with chronic symptoms report substantial effects of the injury on their quality of life. Job accommodations were made in a minority of these injuries. These findings point to the need for heightened efforts for injury prevention in this industry.     

Prevalence of musculoskeletal disorders in nursing professionals

A cross-sectional study estimated the prevalence of work-related musculoskeletal disorders among nursing assistants in Salvador, Bahia. Three hundred and eight workers, randomly selected, answered a questionnaire applied by trained interviewers during working hours. The majority of respondents worked the day shift and did not usually work overtime. About 34% reported having another regular job. Average time in the formal or informal labor market was 19 years. There was high occupational exposure to repetitive hand movements, standing posture, walking, inadequate postures of the trunk and manual handling of loads. The prevalence of work-related musculoskeletal disorders in at least one body segment was 83.4%.The most affected body segments were: low back (53.9%), legs (51.9%), neck (36.4%), upper back (35.7%) and shoulders (33.8%). There was high prevalence of work-related musculoskeletal disorders in the studied population, which points out to the need for improvements in the working conditions of those professionals.     

Why most workers with occupational repetitive trauma do not file for workers' compensation

Despite the availability of no fault insurance for wage replacement and medical care costs, the majority of workers diagnosed with an occupational disease do not apply for workers' compensation. The objective of the study was to determine the reasons why workers diagnosed with work-related musculoskeletal disease did not apply for workers' compensation benefits. A cross-sectional study of 1598 individuals diagnosed with neck, upper extremity, and low back work-related musculoskeletal disease from April to June 1996 was performed. All individuals were interviewed over the telephone using a standardized questionnaire. The questionnaire included questions about the precipitating event; demographics; health limitations; mood; pain level; and attitudes toward their health care provider, fellow workers, management, work environment, and filing for workers' compensation. Whenever possible, standardized questions from previous surveys were used. The interviewed individuals with work-related musculoskeletal disease were reported by health care practitioners as required by the state of Michigan's occupational disease reporting law. Workers reported during 12 weeks in the spring of 1996 by a Michigan health care professional as having a neck, back, or upper extremity musculoskeletal disorder were eligible to participate. Among the 2703 reports received, 490 individuals could not be reached, 22 did not speak English, 12 had died or were too incapacitated by other medical conditions, and 581 refused. We interviewed 59% of all eligible workers and 73% of all workers who were reachable and capable of responding in English. Only 25% of workers diagnosed with musculoskeletal disease filed a workers' compensation claim. The factors significantly associated with filing a claim were (1) increased length of employment (> 21 years: odds ratio [OR], 3.01, 95% confidence interval [CI], 1.31 to 6.90); 11 to 20 years: OR, 2.34, 95% CI, 1.01 to 5.47; 6 to 10 years: OR, 1.76, 95% CI, 0.73 to 4.25; 1 to 5 years: OR, 2.36, 95% CI, 1.03 to 5.42; < 1 year: OR, 1.00; (2) lower annual income (< $40,000: OR, 1.75, 95% CI, 1.06 to 2.88 vs > or = $80,000: OR, 1.00); (3) workers' dissatisfaction with coworkers (OR, 1.76, 95% CI, 1.01 to 3.06); (4) physician restrictions on activity (OR, 2.16, 95% CI, 1.55 to 3.00); (5) type of physician providing treatment (specialist, including surgeon or orthopedist: OR, 3.63, 95% CI, 2.37 to 5.55); physical and occupational therapist: OR, 2.15, 95% CI, 1.35 to 3.43); family practitioner: OR, 1.33, 95% CI = 0.89 to 2.01; company physician: OR = 1.00); (6) off work > or = 7 days (OR, 14.85, 95% CI, 10.57 to 20.85); (7) decreased current health status (OR, 0.82, 95% CI, 0.70 to 0.96); and (8) increased severity of illness (OR, 1.24, 95% CI, 1.06 to 20.88). This study showed that only 25% of workers with a work-related musculoskeletal condition filed for workers' compensation and refutes the common perception that an individual with a work-related problem is likely to file a workers' compensation claim. The strongest predictors of who would file were those factors associated with the severity of the condition. Other factors were increasing length of employment, lower annual income, and worker dissatisfaction with coworkers. Our study population consisted mainly of unionized autoworkers, and our findings may not be generalizable to the total workforce.     

Prevalence of musculoskeletal symptoms and associated factors among metal industry workers in Canoas--RS

Workers health is a field of community health that has opened spaces for identifying and preventing work-related diseases, especially musculoskeletal disorders in view of their extent and magnitude. We conducted thus a cross-sectional study in the biggest metal industry in the city of Canoas--RS, aimed at identifying the musculoskeletal symptoms of a group of metal industry workers and the association of these symptoms with socio-demographic and occupational variables. Two questionnaires were employed for gathering data: the first one was used to collect information on demographic and occupational variables and individual life habits and the second for identifying the prevalence of musculoskeletal symptoms (Nordic Musculoskeletal Questionnaire). Results showed that 75.2 % of the workers had related some kind of musculoskeletal symptom during the last 12 months, 53.3% during the last 7 days and 38.5% had already taken a time off due to this problem. There was also an association between the musculoskeletal symptom and the variables sex, age, occupation and educational level. We conclude that there is a high prevalence of work-related musculoskeletal disorders among workers, calling for preventive actions and health promotion in the work environment.     

The association of socioeconomic status and psychosocial and physical workplace factors with musculoskeletal injury in hospital workers

BACKGROUND: The combined effect of socioeconomic, organizational, psychosocial, and physical factors on work-related musculoskeletal disorders (WRMSDs) were studied in a heterogeneous, socioeconomically diverse sample (cases and their matched referents) of hospital workers. METHODS: Cases were defined by a new acute or cumulative work-related musculoskeletal injury; referents were matched by job group, shift length, or at random. Information was obtained through telephone interviews and on-site ergonomics observation. Questionnaire items included sociodemographic variables, lost work time, work effectiveness, health status, pain/disability, and psychosocial working conditions using Effort Reward Imbalance (ERI) and Demand-Control (DC) models. Two multivariate models were tested: Model 1 included occupation as a predictor; Model 2 included education-income as a predictor. RESULTS: Cases reported greater pain, disability, lost time, and decreased work effectiveness than the referents. Model 1 was statistically significant for neck/upper extremity injury (Chi-square = 19.3, P = 0.01), back/lower extremity injury (Chi-square = 14.0, P = 0.05), and all injuries combined (Chi-square = 25.4, P = 0.001). "Other Clinical" occupations (34% mental health workers) had the highest risk of injury (OR 4.5: 95%CI, 1.7-12.1) for all injuries. The ERI ratio was a significant predictor for neck and upper extremity (OR 1.5: 95%CI, 1.1-1.9) and all injuries (OR 1.3; 95%CI, 1.04-1.5), per SD change in score. CONCLUSIONS: In this study, the risk of WRMSDs was more strongly influenced by specific psychosocial and physical job-related exposures than by broad socioeconomic factors such as education and income.     

The fiscal impact of informal caregiving to home care recipients in Canada: How the intensity of care influences costs and benefits to government

The objective of this study was to estimate the annual costs and consequences of unpaid caregiving by Canadians from a government perspective. We estimated these costs both at the individual and population levels for caregivers aged 45 and older. We conducted a cost-benefit analysis where we considered the costs of unpaid caregiving to be potential losses in income tax revenues and changes in social assistance payments and the potential benefit of reduced paid care expenditures. Our costing methods were based on multivariate analyses using the 2007 General Social Survey, a cross-sectional survey of 23,404 individuals. We determined the differential probability of employment, wages, and hours worked by caregivers of varying intensity versus non-caregivers. We also used multivariate analysis to determine how receiving different intensities of unpaid care impacted both the probability of receiving paid care and the weekly hours of paid care received. At the lowest intensities of caregiving, there was a net benefit to government from caregiving, at both the individual and population levels. At the population level, the net benefit to government was estimated to be $4.4 billion for caregivers providing less than five hours of weekly care. At the highest intensity of caregiving, there was a net cost to government of $641 million. Our overall findings were robust to a number of changes applied in our sensitivity analysis. We found that the factor with the greatest impact on cost was the probability of labour force participation. As the biggest cost driver appears to be the higher likelihood of intense caregivers dropping out of the labour force, government policies that enable intense caregivers to balance caregiving with employment may help to mitigate these losses.     

Work-related musculoskeletal disorders in Norway's offshore petroleum industry

BACKGROUND: Since 1992, physicians have reported work-related diseases among workers in Norway's offshore petroleum industry to the Petroleum Safety Authority, as required by law. AIMS: To analyse the number of reported work-related musculoskeletal disorders and risk factors (occupation and reported exposure) from 1992 to 2003. METHODS: Data from the Petroleum Safety Authority's registry of work-related diseases were analysed. RESULTS: During the 12 years, 3131 new work-related musculoskeletal disorders were reported and this was the category of work-related disease most frequently reported (47%). The number of work-related musculoskeletal disorders varied substantially from year to year. Disorders of the upper limb accounted for 53% and back disorders for 20% of all work-related musculoskeletal disorders. Lower limb disorders accounted for 16%, of which knee disorders dominated (12% of all cases). The dominant occupational categories were maintenance work (40%) and catering (21%). Frequently reported types of exposure were high physical workload, repetitive work and walking on hard surfaces/climbing stairs and ladders. CONCLUSION: Strategies for preventing musculoskeletal disorders should be carried out to reduce the burden of high physical workload and repetitive work, especially in maintenance work and catering. Further research is recommended on the association between walking on hard surfaces/climbing stairs and ladders and knee disorders. Reporting routines need to be improved to monitor trends over time and to assess the effects of interventions.     

A prospective study of psychosocial risk factors and absence due to musculoskeletal disorders--implications for occupational screening

OBJECTIVES: There is considerable evidence documenting the association between psychosocial risk factors and work disability due to musculoskeletal disorders, and this has prompted suggestions that psychosocial screening should be administered in the workplace in order to identify individuals at risk of prolonged absence. However, the predictive value of psychosocial risk factors on return-to-work is largely unknown. The present study aimed to explore the predictive relationship between psychosocial risk factors and absence due to musculoskeletal disorders of the lower back and upper limbs. METHODS: A prospective study of 4637 workers from a large, multi-site company in the UK was conducted in which a wide range of established questionnaires were used to collect baseline psychosocial data. Respondents were then followed over the ensuing 15 months, and absence due to musculoskeletal disorders was recorded. RESULTS: 219 workers took absence due to musculoskeletal disorders. Detrimental cut-off scores (risks) on the psychosocial instruments were established, and it was found that work-related psychosocial risk factors predicted the likelihood of a future spell of absence (odds ratios ranging between 1.6 and 3.2), but not the duration of that absence. CONCLUSIONS: Although work-related psychosocial factors were associated with the occurrence of absence due to musculoskeletal disorders, these findings do not lend support to the use of routine occupational psychosocial screening in order to predict prolonged absence.     

Empowerment as a way to prevent work-related health conditions in slaughterhouse workers

The objective of the review was to emphasize the need for educational efforts aiming at the empowerment of slaughterhouse workers based on their major work-related conditions. Slaughterhouse work involves stressful and tiring tasks. These workers suffer from serious occupational injuries and health problems including musculoskeletal disorders, zoonoses, skin conditions and injuries related to animals and sharp instruments. Slaughterhouse workers are generally low-skill staff, have no control over their job tasks and may not be aware of the determinants affecting their health. While working for the Brazilian Ministry of Agriculture, veterinarians are greatly responsible for the work routine in slaughterhouses and are aware of health risks involved in these workers' jobs. Besides focusing their activities on food safety, veterinarians should take an active role in educating slaughterhouse workers for their empowerment.     

某电解铝厂作业工人慢性肌肉骨骼损伤调查分析

目的 探讨慢性肌肉骨骼损伤与电解铝厂工人职业病的相关性。 方法 选取某电解铝厂100名电解铝工人和100名行政管理工作人员分别设为观察组和对照组,分析比较两组人员慢性肌肉骨骼损伤的检出率。 结果 观察组肌肉骨骼损伤检出率(54.00%)高于对照组(14.00%),差异有统计学意义(P<0.01)。腰背部疼痛检出率最高,观察组肩部、腕部和腰背部肌肉骨骼损伤检出率均高于对照组,差异有统计学意义(P<0.05)。检出率随着工龄的增加而增加(P<0.01),采用固定站立操作姿势工作的人员肌肉骨骼损伤检出率高于采用"自由站立"和"坐姿"操作姿势工作的人员(P<0.008)。 结论 保持同一姿势进行长时间作业是导致电解铝厂工人肌肉骨骼损伤的首要原因,应采取相应的措施对病情的发生和发展进行控制。     

Workers' compensation reform in New York State: A proposal to address medical,ergonomic, and psychological factors associated with work disability

This paper presents testimony before the New York State Assembly Joint Hearings on Workers' Compensation. The testimony first establishes the background of the speaker in relation to the problems in the workers' compensation system. A brief summary of the problem including the increased prevalence of work-related musculoskeletal disorders and their contribution to work disability, the rising costs of insurance premiums, indemnity, and medical costs, and the percentage of payroll that workers' compensation costs consume in New York State is then presented. A review of problems injured workers and health care providers face is also considered. Following this, two proposals that represent a compromise position in relation to business and labor concerns are presented. The first relates to the implementation of state mandated prevention programs to reduce the risk of injury/illness and associated disability in areas accounting for the majority of the workers' compensation injuries/illnesses—low back and upper extremity disorders. It is proposed that individual employers receive incentives in the form of premium savings based upon actual program outcomes. The second proposal relates to the establishment of mutually agreed upon standards of health care for low back and upper extremity disorders similar to what currently exists in Minnesota. The potential benefits of these plans are discussed in relation to increasing costs and human suffering associated with work-related injuries/illness and disability. This paper is presented as an example of an approach to advocacy that health care providers can take to contribute to reform in the workers' compensation systems of their own states.     

Trends in research and prevention policies for work-related musculoskeletal disorders at the European Agency for Safety and Health at Work (EU-OSHA)]

The European Agency for Safety and Health at Work (EU-OSHA) has been working on matters related to occupational health problems in 15 European Union (EU) member states. EU-OSHA established 10 topic centers on work and health research in 1998. One of the topic centers is assigned for research and information on work-related musculoskeletal disorders. The present report is written because such activities of EU-OSHA are scarcely known in Japan. Work-related musculoskeletal disorders have become a very serious problem in EU member states, i.e., 30% of workers complain of backache, and 17% complain of muscular pains in their arms and legs. The affected workers not only suffer at work but also in their home life. The economic costs of all work-related ill health range from 2.6 to 3.8% of the gross national product, and work-related musculoskeletal disorders constitute 40-50% of this. Therefore EU member states consider that prevention of work-related musculoskeletal disorders in itself is an extremely good economic policy. EU-OSHA published "Work-related neck and upper limb musculoskeletal disorders" in 1999, and "Research on work-related low back disorders" in 2000. These publications suggest various preventive methods which can be introduced in practice at work. One of the most remarkable things in EU-OSHA's activities for work-related musculoskeletal disorders is that EU-OSHA has been trying hard to introduce the results of its research into real policies for EU member states by several means, i.e., held a seminar participated in by policy makers, representatives of trade unions, and researchers from EU member states, and sent seminar resolutions to politicians who are responsible for employment and social affairs. Finally the resolution has been adopted in a new social affairs policy by the EU parliament and will be put into force during 2002. Work-related musculoskeletal disorders will remain one of the most serious occupational problems in EU member states, and EU-OSHA will continue to pay close attention to it.     

Underreporting of non-fatal work-related injuries in Brazil

OBJECTIVE: The implementation of work-related injury prevention policies has been hindered by underreporting of incidents among formal workers, and substantial underreporting among informal workforce. This study aimed at estimating the underreporting of work-related injury in a median-sized city. METHODS: A random survey was carried out among residences in the urban area of Brazil. Residents were interviewed about the occurrence of work-related injury to people aged more than nine years in the last 90 days. All incidents reported were double checked in the National Social Security Institute (INSS) records. RESULTS: There were 9,626 residences visited. It was estimated 79.5% (CI 95%: 78.8%-80.3%) of underreporting of work-related injury. CONCLUSIONS: Work-related injury reporting is poor in the study location and this may be occurring in other cities. Data suggest the need to build up information systems on Brazilian workers' health. It should incorporate methods, materials and human recourses necessary to recognize, store, analyze, and spread information to support injury prevention policies and promote workers' health programs.     

Musculoskeletal disorders and comorbid depression: implications for practice

Background:  The physical demands of work have a substantial impact on the incidence of work-related musculoskeletal disorders. Depression is often associated with work-related injuries and may influence a person's success or otherwise return to work. There is pressure for occupational rehabilitation providers to produce good return-to-work outcomes in a timely and financially responsible manner. The aim was to examine current evidence for any added impact of depression on return-to-work prospects among people with work-related musculoskeletal disorders.
Methods:  A review of the literature was conducted to determine the extent to which depression comorbid with musculoskeletal disorders affected labour force participation and the outcomes obtained in occupational rehabilitation.
Results:  Australian population level data show that people of working age with depression comorbid with musculoskeletal disorders have extensive labour force disadvantage and reduced return-to-work outcomes when participating in occupational rehabilitation.
Conclusions:  Although more research is needed, there is already sufficient evidence to support the introduction of systems and practices to detect and integrate treatment for comorbid depression in order to prevent occupational rehabilitation failure.     

Medical costs and sources of payment for work-related injuries among Hispanic construction workers

OBJECTIVE: To assess medical costs of occupational injuries and sources of payment among Hispanic and non-Hispanic construction workers. METHODS: More than 7000 construction workers, including 1833 Hispanic workers were examined using the Medical Expenditure Panel Survey, 1996 to 2002. Univariate and multivariate analyses were conducted using SUDAAN. RESULTS: Annually, work-related injuries in construction cost $1.36 billion (2002 dollars), with 46% paid by workers' compensation. Compared with non-Hispanic workers, Hispanic workers were 53% more likely to have medical conditions resulting from work-related injuries, but 48% less likely to receive payment for medical costs from workers' compensation (P < 0.05). CONCLUSIONS: This study suggests an urgent need to reform the current workers' compensation system to reduce the burden shifted to injured workers and society. Such reforms should include easier access and more assistance for Hispanic and other immigrant workers.     

Work-related pain and injury and barriers to workers' compensation among Las Vegas hotel room cleaners

OBJECTIVES: We examined the prevalence of work-related pain and injury and explored barriers to and experiences of reporting among workers. METHODS: We surveyed 941 unionized hotel room cleaners about work-related pain, injury, disability, and reporting. RESULTS: During the past 12 months, 75% of workers in our study experienced work-related pain, and 31% reported it to management; 20% filed claims for workers' compensation as a result of work-related injury, and 35% of their claims were denied. Barriers to reporting injury included "It would be too much trouble" (43%), "I was afraid" (26%), and "I didn't know how" (18%). An estimated 69% of medical costs were shifted from employers to workers. CONCLUSIONS: The reasons for underreporting and the extent of claim denial warrant further investigation. Implications for worker health and the precise quantification of shifting costs to workers also should be addressed.     

Modified work: prevalence and characteristics in a sample of workers with soft-tissue injuries

Modified-work programs are designed to facilitate the return to work for employees with a work-related injury. Although extensive published literature exists that describes and evaluates "ideal" programs, to date there is a paucity of data describing practice. To address this pertinent issue, we administered a survey to a large sample of 1833 workers with soft-tissue injuries in Ontario, Canada, and asked them detailed questions about modified work and employer contact. Our results reveal that most workers (66%) were contacted by someone from their workplace to check on how they were doing. However, only a minority (36%) were offered arrangements by their employer to help them return to work after developing a work-related soft-tissue injury. Most arrangements that were offered to injured workers consisted of such temporary modifications as reduced hours (24%), flexible work hours (25%), or a lighter job (57%) rather than more permanent changes to the way that work is conducted, such as changes to the work layout or equipment (8%). Merely being contacted by the workplace to check on how the worker was doing was not associated with reduced compensation benefit duration. Workplace offers of arrangements to help the worker return to work were associated with reduced compensation benefit duration but were not statistically associated with workers' pain grade.