Evaluation of effective return-to-work treatment programs for sick-listed patients with non-specific musculoskeletal complaints: a systematic review

Objective: This systematic review seeks to gain insight into the effectiveness of return-to-work treatment programs among sick-listed patients with non-specific musculoskeletal complaints. The focus here lies on the composition of effective treatment programs, itemized for regional non-specific musculoskeletal complaints. Methods: A systematic literature search was performed and methodological quality criteria were applied. Results: Eighteen high quality articles were selected, which reported on a combined total of 22 treatment programs, including a total of 3,579 participants. Of these 22 treatments programs, seven experimental treatments (32%) resulted in faster return to work compared to the control treatment. None of the studies reviewed reported negative findings. What appeared to be essential to effective treatment was knowledge conditioning, psychological, physical and work conditioning, possibly supplemented with relaxation exercises. Most of the high quality studies (64%) reported on a low back pain population. Conclusion: The findings were inconsistent regarding the effectiveness of treatment programs in enabling sick-listed patients with non-specific musculoskeletal disorders to return to work. Except for low back pain, none of the studies explicitly itemized the effects of treatment programs on return to work by regional musculoskeletal disorders, such as upper extremity musculoskeletal disorders.     

Management of return-to-work programs for workers with musculoskeletal disorders: a qualitative study in three Canadian provinces

In this qualitative research project, researchers in three Canadian provinces explored the perceptions of many different actors involved in return-to-work (RTW) programs for injured workers, studying their views on successful RTW strategies and barriers to/facilitators of the RTW process, then analyzing the underlying dynamics driving their different experiences. Each research team recruited actors in a variety of different workplaces and key informants in the RTW system, and used a combination of in-depth, semi-structured interviews and focus groups to collect data, which were coded using an open coding system. Analysis took a social constructionist perspective. The roles and mandates of the different groups of actors (injured workers; other workplace actors; actors outside the workplace), while sometimes complementary, could also differ, leading to tension and conflict. Characteristics of injured workers described as influencing RTW success included personal and sociodemographic factors, beliefs and attitudes, and motivation. Human resources managers and health care professionals tended to attribute workers' motivation to their individual characteristics, whereas injured workers, worker representatives and health and safety managers described workplace culture and the degree to which workers' well-being was considered as having a strong influence on workers' motivation. Some supervisors experienced role conflict when responsible for both production quotas and RTW programs, but difficulties were alleviated by innovations such as consideration of RTW program responsibilities in the determination of production quotas and in performance evaluations. RTW program success seemed related to labor-management relations and top management commitment to Health and Safety. Non-workplace issues included confusion stemming from the compensation system itself, communication difficulties with some treating physicians, and role conflict on the part of physicians wishing to advocate for patients whose problems were non-compensable. Several common themes emerged from the experiences related by the wide range of actors including the importance of trust, respect, communication and labor relations in the failure or success of RTW programs for injured workers.     

Health status,work limitations,and return-to-work trajectories in injured workers with musculoskeletal disorders

BACKGROUND: The purpose of this study was to describe the health status and work limitations in injured workers with musculoskeletal disorders at 1 month post-injury, stratified by return-to-work status, and to document their return-to-work trajectories 6 months post-injury. METHODS: A sample of 632 workers with a back or upper extremity musculoskeletal disorder, who filed a Workplace Safety and Insurance Board lost-time claim injury, participated in this prospective study. Participants were assessed at baseline (1 month post-injury) and at 6 months follow-up. RESULTS: One month post-injury, poor physical health, high levels of depressive symptoms and high work limitations are prevalent in workers, including in those with a sustained first return to work. Workers with a sustained first return to work report a better health status and fewer work limitations than those who experienced a recurrence of work absence or who never returned to work. Six months post-injury, the rate of recurrence of work absence in the trajectories of injured workers who have made at least one return to work attempt is high (38%), including the rate for workers with an initial sustained first return to work (27%). CONCLUSIONS: There are return-to-work status specific health outcomes in injured workers. A sustained first return to work is not equivalent to a complete recovery from musculoskeletal disorders.     

Development of a workplace intervention for sick-listed employees with stress-related mental disorders: Intervention Mapping as a useful tool

Background  

To date, mental health problems and mental workload have been increasingly related to long-term sick leave and disability. However, there is, as yet, no structured protocol available for the identification and application of an intervention for stress-related mental health problems at the workplace. This paper describes the structured development, implementation and planning for the evaluation of a return-to-work intervention for sick-listed employees with stress-related mental disorders (SMDs). The intervention is based on an existing successful return-to-work intervention for sick-listed employees with low back pain.     

Using intervention mapping as a participatory strategy: development of a cervical cancer screening intervention for Hispanic women

Cervical cancer is preventable with treatment of precancerous lesions and treatable at early stages. Hispanics have higher rates of cervical cancer and lower rates of screening. Ayndando a las Mujeres con Informaccion, Guia, y Amor para su Salud (AMIGAS) is an intervention to increase cervical cancer screening in U.S. women of Mexican origin. AMIGAS was developed with the participation of the community using intervention mapping (IM). Following the IM process, the authors completed a needs assessment, development of program objectives, selection of intervention methods and strategies, and program design. A benefit of IM is its linkage with community-based participatory research as it includes engagement of community members to identify and refine priority areas. The success of this strategy suggests it a useful tool for other populations. The resulting intervention program is currently being tested for efficacy and cost-effectiveness in three sites: El Paso, Texas; Houston, Texas; and Yakima, Washington.     

Prevalence of musculoskeletal disorders,ergonomics risk assessment and implementation of participatory ergonomics program for pistachio farm workers

Background and objectives: Pistachio farmers are exposed to a variety of risk factors for musculoskeletal disorders (MSDs). However, no study has been conducted to investigate MSDs in pistachio workers. Therefore, in the present study, besides investigating the prevalence of MSDs and their ergonomic risk factors, the participatory ergonomics (PE) method is used to provide an intervention program to reduce MSDs in this population in harvesting and processing pistachio. Methods: The present study was conducted in two phases. In the first phase 138 workers participated. The prevalence of MSDs was assessed with Nordic Musculoskeletal Questionnaire and the ergonomic risk factors was identified with ManTRA method. In the second phase PE was used to perform ergonomic interventions for reducing MSDs and the effect of the intervention was investigated. Sixty-four workers participated in the second phase (32 in the case group and 32 in the control group). Results: The highest prevalence of MSDs was in shoulders (63.7%), followed by the lower back (63%) and wrists/hands (52.1%). The comparison showed that after implementing the PE intervention program, the prevalence of MSDs in the intervention group was not significantly different from that in the control group. However, in the reassessment by the ManTRA method for five tasks that were identified as high risk in the first phase, a decrease in ManTRA final score was observed for all the five tasks. Conclusions: MSDs were prevalent in all body regions of workers. After implementing PE interventions exposure to ergonomic risk factors decreased. Key words: Agriculture, musculoskeletal disorders, participatory ergonomics, working posture, pistachio, farmer     

A pattern recognition approach to the development of a classification system for upper-limb musculoskeletal disorders of workers

OBJECTIVES: Workers' musculoskeletal disorders are often pain-based and elude specific diagnoses; yet diagnosis or classification is the cornerstone to researching and managing these disorders. Clinicians are skilled in pattern recognition and use it in their daily practice. The purpose of this study was to use the clinical reasoning of experienced clinicians to recognize patterns of signs and symptoms and thus create a classification system. METHODS: Two hundred and forty-two workers consented to a standardized physical assessment and to completing a questionnaire. Each physical assessment finding was dichotomized (normal versus abnormal), and the results were graphically displayed on body diagrams. At two different workshops, groups of experienced researchers or clinicians were led through an exercise of pattern recognition (clustering and naming of clusters) to arrive at a classification system. Interobserver reliability was assessed (8 observers, 40 workers), and the classification system was revised to improve reliability. RESULTS: The initial classification system had good face validity but low interobserver reliability (kappa <0.3). Revisions were made that resulted in a proposed triaxial classification system. The signs and symptoms axes quantified the areas in the involved upper limbs. The proposed third axis described the likelihood of a specific clinical diagnosis being made and the degree of certainty. The interobserver reliability improved to approximately 0.70. CONCLUSIONS: This triaxial classification system for musculoskeletal disorders is based on clinically observable findings. Further testing and application in other populations is required. This classification system could be useful for both clinicians and epidemiologists.     

Evaluation of a participatory ergonomic intervention aimed at improving musculoskeletal health

BACKGROUND: Participatory ergonomic (PE) interventions have been increasingly utilized to deal with work-related musculoskeletal disorders (WMSD). METHODS: Using a longitudinal quasi-experimental design, a PE process was launched at one depot of a large courier company, with a nearby depot serving as a control. Evaluations focused on 122 employees across the two depots who participated in both pre- and post-questionnaires. An evaluation framework assessed the process of implementation, changes in risk factors, and changes in musculoskeletal health outcomes. Partial and multiple regressions explored the relationships in the evaluation framework. RESULTS: Changes in work organizational factors had a consistent impact upon changes in health outcomes. Greater participation in the process was associated with increased levels of job influence and communication (P = 0.0059 and P = 0.0940 respectively). Improvements in communication levels were associated with reduced pain intensity and improved work role function (WRF) (P = 0.0077 and P = 0.0248 respectively). Lower levels of pain post-intervention were related to greater WRF (P = 0.0493). CONCLUSIONS: A PE approach can improve risk factors related to WMSD, and meaningful worker participation in the process is an important aspect for the success of such interventions.     

Rehabilitation of home care workers: supportive factors and obstacles prior to disability pension due to musculoskeletal disorders

The aim of this study was to retrospectively explore the prevalence of rehabilitation actions, supportive factors, and obstacles for rehabilitation among home care workers with musculoskeletal disorders, especially focusing on aspects related to occupational rehabilitation. All home care workers in Sweden whose disability pension was approved in 1997 and 1998 because of a musculoskeletal disorder, were selected (n = 373). Data, covering aspects of the rehabilitation process and conditions in working life 5 and 15 years prior to their disability pension, were collected from a questionnaire. The majority considered that the disorder leading to a disability pension was caused by their work, but only one-third of them had their occupational disorder formally approved. Only one-third of the study group received occupational rehabilitation. However, an approved occupational disorder was related to higher prevalence of occupational rehabilitation. In the age group 60–65, few home care workers received rehabilitation. The majority perceived good support from their supervisor and working team, but no support with regard to lowering physical demands. Modification and reduction of physical demands might improve both sustained work ability in home care work and the outcome of the rehabilitation.     

Effectiveness of participatory training for prevention of musculoskeletal disorders: a randomized controlled trial

Purpose

Health and safety training program has been applied to prevent work-related musculoskeletal disorders (MSDs) in workplace. We evaluated the effectiveness of participatory training and didactic training programs on MSD prevention among frontline workers in Shenzhen, China.

Methods

The authors randomly assigned 918 workers from intervention factories to receive participatory training (intervention group), and 907 workers from intervention factories and 1,654 workers from control factories to receive didactic training (control_1 group, control_2 group, respectively) from June 1, 2008 to November 30, 2009. Participants were asked to report experience of ache, pain or discomfort in 10 body parts at baseline and 1 year after training. Data were analyzed to compare the MSD prevalence 1 year before and 1 year after training in different groups from 2009 to 2010.

Results

The follow-up rate was 61 % (2,120/3,479) at 1 year after training. In the year after training, there were no statistically significant changes in the proportion of workers who reported MSD in any body part. MSD prevalence rates in the intervention group reduced from 16.8 to 9.9 % for lower extremities (χ² = 13.102, p < 0.001) and from 12.9 to 8.3 % (χ² = 9.433, p = 0.002) for wrist and finger at 1 year after training. However, the rates did not change significantly for upper back, lower back, neck, shoulder and elbow in the intervention group and for all 10 body parts in two control groups.

Conclusions

Overall, the training programs did not seem to prevent the occurrence of MSD among frontline workers. However, participatory training might be effective to reduce MSD in the lower extremities and wrist and finger.     

Application of community-based participatory research principles: preventing work-related musculoskeletal disorders among female Korean-Chinese migrant workers in Korea

The primary purpose of this study was to describe the intervention development process using the National Occupational Research Agenda (NORA) research framework. The intervention was then implemented to prevent work-related musculoskeletal disorders among female Korean-Chinese migrant workers living in Korea. The secondary purpose was to determine how community-based participatory research (CBPR) principles could be applied to the intervention development process. A literature review, a focus group of the target population, key informant interviews, and community committee meetings with the researchers were conducted. Several CBPR principles, including developing community resources and promoting an equitable partnership between the researchers and the migrant community, ensured the appropriateness of the stretching intervention program for the ethnic migrant group, promoting program participation. It is suggested that occupational health nurses consider the CBPR approach in program development for underserved migrant workers.     

某电厂工人职业性肌肉骨骼疾患研究

目的 探讨某电厂工人肌肉骨骼疾患(MSD)情况,研究性别、年龄、工龄与MSD的关系.方法 采用北欧Nordic MSD调查表对某电厂788名工人进行MSD的问卷调查,取其中从事人事及财务管理等轻体力劳动人员234名为对照组,其余554人为观察组.根据各因素的不同进行分析.结果 观察组MSD依次以腰部、颈部、肩部和背部为主,年患病率分别为61.0％、54.0％、46.0％和37.0％,均高于对照组(P＜0.05);观察组女性颈部、肩部和背部年患病率要高于男性,腰部年患病率低于男性(P＜0.05);MSD年患病率存在部分工龄和性别差异.结论 工龄和性别是MSD患病率影响因素之一,应采取积极合理的工效学手段进行干预和预防.     

Effectiveness of a return-to-work intervention for subacute low-back pain

The effectiveness of return-to-work intervention for subacute low-back pain on work absenteeism, pain severity, and functional status was examined by means of a systematic review of randomized controlled trials. Publications in English that met the selection criteria were identified in a computer-aided search and assessed for methodological quality. A best-evidence synthesis was performed instead of statistical data pooling, because of the heterogeneity of the interventions and study populations. Five of nine studies comparing return-to-work intervention with usual care were identified as methodologically high-quality studies. Strong evidence was found for the effectiveness of return to work intervention on the return-to-work rate after 6 months and for the effectiveness of return-to-work intervention on the reduction of days of absence from work after > or = 12 months. It can be concluded that return-to-work interventions are equal or more effective regarding absence from work due to subacute low-back pain than usual care is.     

Cost-effectiveness of a workplace intervention for sick-listed employees with common mental disorders: design of a randomized controlled trial

Background  

Considering the high costs of sick leave and the consequences of sick leave for employees, an early return-to-work of employees with mental disorders is very important. Therefore, a workplace intervention is developed based on a successful return-to-work intervention for employees with low back pain. The objective of this paper is to present the design of a randomized controlled trial evaluating the cost-effectiveness of the workplace intervention compared with usual care for sick-listed employees with common mental disorders.     

Effects of ergonomic intervention on work-related upper extremity musculoskeletal disorders among computer workers: a randomized controlled trial

Purpose

The aim of the study was to determine effects of ergonomic intervention on work-related upper extremity musculoskeletal disorders (WUEMSDs) among computer workers.

Methods

Four hundred computer workers answered a questionnaire on work-related upper extremity musculoskeletal symptoms (WUEMSS). Ninety-four subjects with WUEMSS using computers at least 3 h a day participated in a prospective, randomized controlled 6-month intervention. Body posture and workstation layouts were assessed by the Ergonomic Questionnaire. We used the Visual Analogue Scale to assess the intensity of WUEMSS. The Upper Extremity Function Scale was used to evaluate functional limitations at the neck and upper extremities. Health-related quality of life was assessed with the Short Form-36. After baseline assessment, those in the intervention group participated in a multicomponent ergonomic intervention program including a comprehensive ergonomic training consisting of two interactive sessions, an ergonomic training brochure, and workplace visits with workstation adjustments. Follow-up assessment was conducted after 6 months.

Results

In the intervention group, body posture (p < 0.001) and workstation layout (p = 0.002) improved over 6 months; furthermore, intensity (p < 0.001), duration (p < 0.001), and frequency (p = 0.009) of WUEMSS decreased significantly in the intervention group compared with the control group. Additionally, the functional status (p = 0.001), and physical (p < 0.001), and mental (p = 0.035) health-related quality of life improved significantly compared with the controls. There was no improvement of work day loss due to WUEMSS (p > 0.05).

Conclusions

Ergonomic intervention programs may be effective in reducing ergonomic risk factors among computer workers and consequently in the secondary prevention of WUEMSDs.     

Clinical assessment of musculoskeletal disorders in workers exposed to hand-arm vibration

OBJECTIVES: To describe the clinical assessment of musculoskeletal disorders among vibration-exposed workers and to review the experimental and epidemiological studies of the effects of vibration on the musculoskeletal system of the upper limbs. METHODS: A total of 212 references in English was found in Pub Med for the years 1980-2000 that dealt with clinical assessment. Many of these references were reviews and few were original research dealing with test performance in diagnostic procedures. RESULTS: The reported effects on bone are osteoporosis and cysts in the hands. Experiments have shown injuries to muscle cells in animals and additional physiological loading of muscles in humans by vibration. Low-frequency vibration exposure of high magnitude was associated with osteoarthrosis in the elbow, wrist and acromioclavicular joint and symptoms in the elbow and shoulder. Impacts, jerks and blows with high-energy transfer to the hands at low frequency might have the potential to result in musculoskeletal disorders considering the general model for injuries. Furthermore, the observed associations with vibration exposure and musculoskeletal disorders might result from the strong dynamic and static joint loading and the repetitive hand-arm motions required in tasks where hand-held machines are used. The clinical assessment of musculoskeletal disorders in workers exposed to hand-arm vibration consists of the clinical and exposure history and evaluation of the physical and laboratory findings. Since most patients with musculoskeletal disorders who are exposed to vibration are also exposed to other ergonomic stressors, accommodation of the injured worker has to take the whole work system into account (task, technology, environment and organisation). CONCLUSIONS: The scientific evidence that vibration per se is a risk factor for musculoskeletal disorders is still weak although there is strong evidence that job tasks with vibrating machines are associated with musculoskeletal disorders. The clinical assessment of musculoskeletal disorders in exposed patients imposes special requirements.     

Socioeconomic position and duration of disability benefit due to work-related musculoskeletal disorders

This study estimated the effect of socioeconomic position on the duration of disability benefits due to musculoskeletal disorders affecting the neck and/or upper limbs. A cohort study including 563 insured workers from the city of Salvador, Bahia, Brazil, registered in the General Social Security System and who received temporary disability benefits due to musculoskeletal disorders affecting the neck and/or upper limbs, was performed in 2008 using data from the National Social Security Institute. The results show that among union member workers with high psychosocial demands at work, those with low socioeconomic status are almost twice as likely to receive benefit for a shorter period of time compared to those with a higher socioeconomic position (RR = 1.89; 95%CI: 1.25-2.87). These results reveal an inequitable situation or unnecessary use of insurance for workers with a higher socioeconomic position. Future research aimed at elucidating the differences in the use of benefits are needed so that social insurance system managers may take the appropriate steps to resolve this issue.     

Classification systems for upper-limb musculoskeletal disorders in workers: a review of the literature

OBJECTIVE: The purpose of this study was to provide a review of the available classification systems and to describe the similarities and differences in the structure of these systems. METHODS: Classification systems of upper limb musculoskeletal disorders (MSDs) were located via electronic database searches and researchers' files. The classification systems were compared on the disorders they described and on the criteria presented for each disorder. RESULTS: Twenty-seven classification systems were found after title, abstract, or full article review of 1671 articles. The systems differed in the disorders they included, the labels used to identify the disorders, and the criteria used to describe the disorders. CONCLUSION: Twenty-seven classification systems were found that described disorders of the muscle, tendon, or nerve that may be caused or aggravated by work. No two systems were the same.