Prognostic factors for musculoskeletal sickness absence and return to work among welders and metal workers

OBJECTIVES: To analyse factors that determine the occurrence of sickness absence due to musculoskeletal problems and the time it takes to return to work. METHODS: A longitudinal study with two year follow up was conducted among 283 male welders and metal workers. The survey started with a standardised interview on the occurrence of musculoskeletal complaints. 61 (22%) workers were lost to follow up. Data on sickness absence among 222 workers during the follow up were collected from absence records and self reports. Regression analysis based on proportional hazards models was applied to identify risk factors for the occurrence and duration of sickness absence due to various musculoskeletal complaints. RESULTS: During the follow up 51% of the workers attributed at least one period of sickness absence to musculoskeletal complaints which accounted for 44% of all work days lost. A history of back pain was not associated with sickness absence for back pain, partly because subjects with back pain were more likely to be lost to follow up. Neck or shoulder pain and pain of the upper extremities contributed significantly to neck or shoulder absence (relative risk (RR) 3.35; 95% confidence interval (95% CI) 1.73 to 6.47) and to upper extremities absence (RR 2.29; 95% CI 1.17 to 4.46), respectively. Company and job title were also significant predictors for sickness absence due to these musculoskeletal complaints. Absence with musculoskeletal complaints was not associated with age, height, body mass index, smoking, and duration of employment. Return to work after neck or shoulder absence was worse among metal workers than welders (RR 2.12; 95% CI 1.08 to 4.17). Return to work after lower extremities absence was strongly influenced by visiting a physician (RR 11.31; 95% CI 2.94 to 43.46) and by musculoskeletal comorbidity (RR 2.81; 95% CI 1.18 to 6.73). CONCLUSIONS: Complaints of the neck or shoulder and upper extremities in the 12 months before the study were associated with sickness absence for these complaints during the follow up. Workers with absence due to pain from back, neck or shoulder, upper extremities, or lower extremities were at higher risk of subsequent sickness absence in the next year.

 

     

Factors influencing return to work following hospitalization for traumatic injury.

This paper describes the employment experience of 266 individuals one year after traumatic injury severe enough to require hospitalization. Of those working full-time prior to their injury, 56 per cent were employed full-time at one year; an additional 5 per cent were working part-time. Those sustaining a severe head or spinal cord injury were at highest risk of not returning to work (only 43 per cent and 21 per cent, respectively, had returned within the year). Low one-year employment rates (58 per cent) were also noted for individuals whose most severe injury was to one or more extremities. The extent and rate of return to work was examined in relation to selected socioeconomic and personal characteristics. Findings indicate that after controlling for type and severity of injury, personal income, and educational level of the injured person, as well as the identification of a strong social network as defined by the presence of one or more confidants, were important correlates of post-injury employment status.     

Medical fitness to return to work for disabled workers

Return to work for the disabled worker is one of the critical issues for both the person himself and his employer. The early return to work is a manifestation of social restoration for the disabled worker as well as an effective way to reduce social cost-related disabilities. Several studies on effectiveness of the formal return to work program have been reported. This program is one of the workplace disability management systems that promote the workplace accommodation for the disabled. The purpose of a medical assessment of fitness for return to work in this program is to make sure that an individual is fit to perform the task involved effectively and without risk to his own or to others' health and safety. Decision-making, the process of assessment of medical fitness, and the design for a return to work are discussed.     

Factors affecting first return to work following a compensable occupational back injury

Occupational back injuries produced $27 billion in direct and indirect costs in 1988. Predictors of prolonged disability have generally been identified in selected clinical populations, but there have been few population-based studies using statewide registries from workers' compensation systems. This study uses a 1986 cohort of 8,628 Michigan workers with compensable back injuries followed to March 1, 1990. Cox proportional hazards analyses with nine categorical covariates identified factors predicting missed worktime for the first disability episode following the injury. The model distinguished factors affecting the acute (≤ 8 weeks) and chronic disability periods (> 8 weeks). The first disability episode following injury contains 69.6% of the missed worktime observed through follow-up. In the acute phase, which contributes 15.2% of first episode missed worktime, gender, age, number of dependents, industry (construction), occupation, and type of accident predict continued work disability. Marital status, weekly wage compensation rate, and establishment size do not. Beyond 8 weeks, age, establishment size and, to a lesser degree, wage compensation rate predict duration of work disability. Graphs show the predicted disability course for injured workers with specific covariate patterns. Future efforts to reduce missed worktime may require modifications in current clinical practice by patient age group and the development of new strategies to encourage small and medium-size employers to find ways to return their injured employees to work sooner. Recent federal statutes covering disabled workers will only partially correct the strong effect of employer establishment size. © 1996 Wiley-Liss, Inc.     

汽车制造工人职业性肌肉骨骼疾患与工作组织因素的相关性研究

目的调查汽车制造工人职业性肌肉骨骼疾患(WMSDs)发生情况及其工作组织影响因素。方法采用流行病学横断面调查方法,选用经修订的《肌肉骨骼疾患调查问卷》和中文版《工作付出-回报失衡(ERI)量表问卷》,对某汽车制造厂554名工人近1年内肌肉骨骼疾患患病与工作组织以及社会心理情况进行调查。结果该厂工人WMSDs发生率为661%;不同部位的发生率为114%～395%,其中前四位的依次为颈部(395%)、下背部(348%)、肩部(347%)和踝/足部(339%)。控制潜在混杂因素后发现,休息时间充足(OR=043)、自主选择工作间休息(OR=047)和与同事轮流完成工作(OR=058)是下背部WMSDs的保护因素;每天工作时长(加班)(OR=265)和工作涉及寒冷/凉风或气温变化(OR=177)是下背部WMSDs的危险因素;工间休息时间充足(OR=039)和休息次数(OR=05)是踝/足部WMSDs的保护因素;人员短缺(OR=159)和工作每天重复(OR=287)是肩部WMSDs的危险因素。结论汽车制造工人WMSDs的发生率较高,工作组织因素可能对工人WMSDs产生一定的影响。     

Differences between younger and older workers in the need for recovery after work

Objective The aim of this study was to test the hypothesis whether ageing workers have a higher need for recovery than younger workers. Methods 1100 subjects (84.3% participation rate) employed in the public sector participated in a cross-sectional questionnaire study. The subjects were divided into two age groups: older workers (≥45 years) and younger workers (<45 years). The dependent outcome variable was assessed by “The Need for Recovery Scale” questionnaire. A need for recovery score higher than 45 was defined as a high need for recovery. A standardized questionnaire was used to assess psychosocial and physical work strain. Other occupational factors were included: part-time or full-time work, shift work and more than one employment. The following personal and social life and family related factors were also considered: gender, presence of chronic disease, degree of ability to cope with stress, number of children at home, taking care of disabled or elderly people, degree of satisfaction on family and social relationships. Stepwise multiple logistic regression analysis was used to examine the presence of a high need for recovery in older workers. Results The mean recovery score was significantly higher in the group of the older workers (40.9) as compared to the younger workers (33.6) (P < 0.005). In the final multivariate logistic regression model the older age group had a significantly higher risk for the presence of a high need for recovery versus the younger group (OR 1.56, 95%CI 1.15–2.11). Gender, presence of musculoskeletal disorder, work pressure, monotonous work, social support from superiors, full time work and unsatisfactory social contacts were also significantly associated with the need for recovery. Conclusion The hypothesis that ageing workers have a higher need for recovery than younger workers was confirmed.     

中老年职工肌肉骨骼功能与工作能力的关系

为了探索肌肉骨骼功能测定在评价工作能力方面的作用，在成都地区对８８名不同职业的中老年职工（４０～６０岁）进行肌肉骨骼功能测定和工作能力指数（ＷＡＩ）测量。结果显示，肌肉骨骼功能指标中，力量指标的平均水平男性显著高于女性，而柔韧性指标女性高于男性。从劳动类型来看，肌肉骨骼功能男性以体力劳动者平均水平最低，女性则以体脑混合型最低。肌肉骨骼功能与工作能力之间存在着密切的相关关系。提示肌肉骨骼功能的测定对评价职工工作能力可能是一组有价值的指标。     

The relationship between upper extremity musculoskeletal symptoms attributed to work and risk factors in office workers

Purpose  

Office workers are exposed to various individual, work-related and psychosocial factors during work that have been associated with the development of musculoskeletal symptoms. There is an increasing in evidence that suggests that musculoskeletal symptoms in the upper extremity are very common among office workers. The aim of this study was to examine the effects of individual, work-related physical and psychosocial factors on the prevalence of shoulder, elbow and wrist/hand symptoms attributed to work in office workers.     

Occupational physician's role regarding return to work of workers with acquired disability

Occupational physicians are expected to play important roles in helping workers with an acquired disability return to work. However, the key elements to develop a successful program to help these workers return to work are still unclear. In this study, we searched the literature referring to occupational physicians' role in the return-to-work process of the workers with acquired disability. Many of these studies mentioned the following; occupational physicians should start co-operating with the treating physician right after the appearance of the disability and exchange medical and occupational health information with each other. When a disabled worker wishes to return to work, the occupational physician in charge should carefully evaluate his/her work ability, and fitness for the work. We also performed a hearing survey at 15 diverse institutions and organizations that are generally aimed at promoting employment, social welfare and medical service for disabled persons located in at least a 5 million population prefecture in Japan. Among them, the Local Occupational Center for the Disabled functions as the practical gateway for employment, and the Health and Welfare Center is the principal window for the social welfare of the disabled. However, their services are sometimes limited to only those who have become jobless and not for those returning to their original work. We considered that occupational physicians should also communicate positively with the organizations to promote successful returning of the workers with acquired disability to their former work.     

Early discharge and return to work following myocardial infarction

Individuals who have experienced a myocardial infarction (MI) account for the largest component of all hospitalization costs and foregone earnings due to cardiac disease. Early return to full employment and premorbid activity level should be the focus of cost-effective rehabilitative programs. Yet the economic benefits of vocational rehabilitation have not been directly researched. Therefore, issues of import regarding activity after MI include the timing of ambulation, discharge and return to work.Studies of early mobilization and discharge are contrasted in terms of methodology and outcome. These cite economic, social and psychological advantages, yet these factors are examined in isolation of other variables. A review of the literature reveals that there is a reluctance by many health professionals to institute such practices based in part on the dilemma surrounding selection of specific indicators and risk factors. Yet analysis reveals that the contention surrounding these exclusion criteria is perhaps unfounded, as the variance is less than is commonly assumed.Recurrent themes likewise emerge regarding the multiplicity of variables associated with the timing of resumption of employment, which is considered to be the most precise index of recovery following an MI. Of these, only early intense rehabilitation, directed at attitudinal and behavioural change, is amenable to modification by health professionals. Related research endeavours have examined employment following aortocoronary bypass surgery, risk factors in the work environment and work stressors which occur following MI. Controversy arises regarding the correlation of age and personality factors with return to work. Discrepancies in research findings are attributed to the diverse approaches to data collection, obstacles encountered in measuring psychological states, lack of operational definitions, differences in degree of rehabilitation and length of follow-up and the absence of controlled trials. Clearly, experimental research focusing on the job-related economic and human cost impact of specific rehabilitation programs must be conducted.Three strategies are identified which should facilitate return to premorbid levels of activity, including (1) the definition, development and integration of roles of diverse professionals within the interdisciplinary health care team, (2) the early detection and modification of psychological problems, physical disability and inappropriate occupations which would prevent MI patients from returning to their former occupations and (3) prompt follow-up and comprehensive structured rehabilitation programs which incorporate education, exercise and emotional support at the individual, family and community level.This analytical survey supports the principle of early mobilization, discharge and return to employment or premorbid state, yet operational definitions and deadlines are only in the infancy stage. Multidisciplinary experimental efforts must be directed toward the detection of significant variables and generalizable rehabilitation mechanisms. The process of programs requires testing as do the emotional, physical and health outcomes.     

Relationships between work-related factors and musculoskeletal health with current and future work ability among male workers

Purpose

The purpose was to increase job-specific knowledge about individual and work-related factors and their relationship with current and future work ability (WA). We studied cross-sectional relationships between mental demands, physical exertion during work, grip strength, musculoskeletal pain in the upper extremities and WA and the relationships between these variables and WA 11 years later.

Methods

We used a dataset of a prospective cohort study (1997–2008) among employees of an engineering plant (n?=?157). The cohort was surveyed by means of tests and written questions on work demands, musculoskeletal health, WA score (WAS; 0–10), and mental and physical WA. Spearman correlation coefficients and logistic regression analysis were used.

Results

Among manual workers, we found weak correlations between grip strength and current and future physical WA. We did not find predictors for future poor WA among the manual workers. Among the office workers, we found that musculoskeletal pain was moderately and negatively related to current WAS and physical WA. More handgrip strength related to better future WAS and physical WA. Musculoskeletal pain (OR 1.67 p?<?0.01) and lower handgrip strength (OR 0.91 p?<?0.05) predicted future poor WA among office workers.

Conclusions

Our results showed cross-sectional and longitudinal relationships between musculoskeletal health and work ability depending on occupation. However, the present implies that predicting work ability in the far future based on health surveillance data is rather difficult. Testing the musculoskeletal system (grip strength) and asking workers’ about their musculoskeletal health seems relevant when monitoring work ability.

     

Pre- and postoperative factors associated with return to work following surgery for lumbar spinal stenosis

Low back disorders are an increasingly common and costly health problem in Western countries. It has been recommended that the return to work of patients should be the most important outcome measure of medical care. The aim of this study was to compare women's and men's working capacity after lumbar spinal stenosis (LSS) operations and to identify the factors related to it. The subjects of this study were 185 women (mean age 54 years, mean follow-up time 4.2 years) and 254 men (mean age 52 years, mean follow-up time 4.3 years). After the operation, 37% of the women and 41% of the men returned to work. None of the patients who had retired before the operation returned to work afterward. The variables that predicted postoperative ability to work for women were: being fit to work at the time of operation, age <50 years at the time of operation, and duration of LSS symptoms <2 years. For men, these variables were: being fit to work at the time of operation, age <50 years at the time of operation, no prior surgery, and the extent of the surgical procedure equal to or less than 1 laminectomy. Women's and men's working capacity do not differ after LSS operation. If the aim is to maximize working capacity, then, when an LSS operation is indicated, it should be performed without delay. In LSS patients who are >50 years old and on sick leave, it is unrealistic to expect that they will return to work. Therefore, after such an extensive surgical procedure, re-education of patients for lighter job could improve the chances of these patients returning to work. © 1996 Wiley-Liss, Inc.     

Can we enhance the ability to return to work among workers with stress-related disorders?

Background  

Stress-related disorders are widespread and responsible for high societal costs e.g. sick leave payment and reduced productivity. The aim of this study was to evaluate the effect of an intervention program on return to work or labour market.     

Multilevel analysis of individual and contextual factors as predictors of return to work

OBJECTIVE: The objective of this study was to examine if individual and contextual levels of work environment factors predict return to work (RTW). METHODS: Baseline data from 52 workplaces was linked to a national absence register. Four hundred twenty-eight persons with more than 2 weeks of sickness absence during a 2-year period were identified. Follow up was 1 year to examine three RTW outcomes. Multilevel logistic and Poisson regression models were used. RESULTS: At the individual level, significant associations were found between one psychosocial and four physical factors and RTW within 4 weeks. Two physical factors predicted RTW within 1 year. Two psychosocial and two physical factors significantly prolonged duration of sickness absence. No significant contextual level risk factors were found. CONCLUSION: At the individual level, both the psychosocial and physical work environment factors are important independent predictors of RTW.