The probability of recovery and return to work from work disability as a function of time

This paper describes a prospective longitudinal cohort study of musculoskeletal soft tissue pain impairment following a work related injury. It focuses on specific, univariate prognostic factors indicated in previous research studies that might affect the likelihood that injured workers will return to work or remain on work disability at any point in time. These factors include gender, age, return to work attempts and site of injury. Life table analysis was used to model the probability of work disability. The results showed that different disability and return to work patterns emerged for males and females. Males were more likely to return to work; however, females had a higher probability than males of remaining at work once they returned to work. Older workers had the highest probability of being off work any given number of days after injury; were less likely to return to work, and if they did, had a higher probability of becoming disabled again. Efforts to return early to work contributed to a decrease in overall work disability. Workers with low back injuries had a greater likelihood of recurrence compared to injuries at other body sites.     

The Impact of Psychological Symptoms on Return to Work in Workers After Occupational Injury

Introduction This study aimed to investigate the impact of psychological symptoms on return to work (RTW) in workers after occupational injuries. Methods Our study candidates were injured workers who were hospitalized for 3 days or longer and received hospitalization benefits from the Labor Insurance. A self-reported questionnaire including Brief Symptom Rating Scale (BSRS-50) and RTW was sent to workers at 12 weeks after injury. At 1 year, all participants were contacted again to determine whether or not they had RTW. Results A total of 2001 workers completed the questionnaire (response rate 45.5 %) at 12 weeks after injury, among them, 1,149 had returned to work. Among the 852 who were unable to return to work at 12 weeks after injury, 225 reportedly returned to work by 1 year. A proportional hazards regression indicated that after adjusting for all possible risk factors, higher scores in BSRS-50 and BSRS-5 at 12 weeks after injury were significant risk factors for not return to work (NRTW) at 1 year after injury. Other risk factors were gender, education level, length of hospitalization, affected physical appearance, and injury type. Among 10 psycho-physiological symptoms of BSRS-50, a proportional hazards regression indicated that high score in phobic-anxiety scale was a risk factor for NRTW. Conclusions After considering all other factors, psychological symptoms further predicted poorer probability of returning to work after occupational injury, and phobic-anxiety was the most significant symptom predicting poor RTW. Development of preventive measures among injured workers according to the risk factors identified in this study is warranted.     

Upper extremity disorders in the workplace: Costs and outcomes beyond the first return to work

BACKGROUND: Cumulative trauma disorders of the upper extremities (CTD) have become increasingly important in workers' compensation caseloads over the last two decades. Relative to occupational back pain, CTD have been much less studied. METHODS: We analyzed post-injury employment patterns and return-to-work probabilities for a sample of Ontario workers with CTD, for up to five years after injury. Results for workers with CTD are compared to results for workers with back injuries or fractures. RESULTS: Most workers with CTD return to work at least once, but a first return does not necessarily mark the end of work disability. Among workers absent at least once, 26% with CTD report a second injury-related absence, compared to 18% with back pain and 12% with fractures. After five years, focusing on first returns underestimates work-loss days associated with CTD by 32%. CONCLUSIONS: A substantial proportion of workers with CTD or work-related back pain experience injury-related absences after their first return to work. Focusing on the first return to work is misleading for both injury groups, but even more so for CTD, as they appear to be even more susceptible to multiple spells of work absence.     

Well being, work environment and work accidents

We examine factors that influence accident proneness among employees. We agree that the determinants of accident proneness include organizational, emotional and personal factors. Using logistic regression we estimated three models, and their predictability for accident proneness among sample of 200 injured workers interviewed upon entering hospital emergency wards in Israel. Work injuries were not contingent on age, religion, nor education. The effects of gender were strong but non-significant. Subcontracted and higher-paid workers are more likely to get repeat injuries. Prior injury experience sensitized employees to stronger perceptions of risk associated with unsafe practices. Large family households, ameliorates stress feelings and lessens the likelihood of accident proneness while poor housing conditions have the opposite effect. The full model demonstrates considerable prediction of injuries when focusing on type of employment, personal income level, being involved in dangerous jobs, emotional distress and a poor housing environment. The model contains most of the significant results of interest and provides a high level of predictability for work injuries.     

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.     

Nature and incidence of self-reported adolescent work injury in minnesota

Most studies of adolescent work-related injury that have been published to date have been confined to administratively collected data available through state or national departments of labor and industry and/or occupational safety and health administrations. These data do not contain information on the severity or the sequelae of injuries. In addition, estimates of incidence may be biased due to inadequate data on the nature, amount, and seasonal variability of work done by adolescent workers. The present study is a cross-sectional survey of work and work injuries of 3,051 10th through 12th grade students from 39 high schools throughout Minnesota. Injury was defined as an event which caused any of the following: loss of consciousness, seeking medical care, and/or restricting normal activities for at least 1 day. The average hours of work per week during the summer and during the school year were 30 (95% Confidence Interval [CI] = 27,33) and 16 (95% CI = 15, 17), respectively. There was no difference in hours worked between ethnic minorities and white students. The rate of reportable injuries was 12 per 100,000 hr worked (95% CI = 7, 18) for rural and 13 per 100,000 hr worked (95% CI = 7, 28) for urban females, 16 (95% CI = 9, 22) per 100,000 hr for urban males, and 20 (95% CI = 12, 28) per 100,000 hr for rural males. Ongoing medical problems were reported by 26% of the injured workers. Previous estimates of work-related injury to adolescents may have been low. More study is required to clearly define the incidence of injury and risk factors for these injuries.     

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.     

Antecedents of work disability absence among young people: a prospective study

PURPOSE: This study examined the relative contribution of individual factors, job characteristics, and temporal factors to the likelihood of lost days of work due to a work-related disability or illness among Canadians 16 to 24 years old. METHODS: Using a prospective Canadian survey with up to 6 years of follow-up, the job-based analyses included 45,125 job episodes generated from a representative sample of young workers. A hazard model on work disability absence included the following predictors: age, gender, physical demands of the job (manual, nonmanual, and mixed), hours worked, highest education achieved, multiple concurrent job, job tenure, school activity, and living in a rural or urban area. RESULTS: The overall 1-week work disability absence rate was 0.78 per 1000 person-months. In the multivariate model, young workers holding manual jobs were 2.65 times more likely to have a work disability absence compared with young workers with nonmanual jobs. Also, those with less than a high school education were almost 3 times more likely to have a work disability absence. Other demographic factors such as gender were not independently associated with work disability absences. CONCLUSIONS: This prospective study finds that job characteristics are the predominant risk factors for work disability absences for young workers. Young workers with less education appear to be particularly vulnerable, possibly because of inadequate job skills or particularly dangerous job tasks.     

Risk factors for back injury in 31,076 retail merchandise store workers.

Risk factors for work-associated strain or sprain back injuries were investigated in a cohort of 31,076 material handlers from 260 retail merchandise stores in the United States. The workers studied were those with significant material-handling responsibilities--daily lifting and movement of merchandise. Workers in jobs with the greatest physical work requirements had an injury rate of 3.64 per 100 person-years versus 1.82 in workers with lesser work requirements. The unadjusted injury rate for males was 3.67 per 100 person-years compared with 2.34 per 100 person-years for females, but the excess for males was confounded by higher physical work requirements for men in the stocker/receiver job category. The injury rate ratio for short versus long duration of employment was 3.53 (95% confidence interval: 2.90, 4.30); for medium versus long duration of employment, it was 1.38 (95% confidence interval: 1.18, 1.62). The elevated rate ratios were maintained when the data were stratified by subsets with different rates of turnover. The results suggest that workers with the greatest physical work requirements and those with the shortest duration of employment are at the highest risk of back injuries. However, selection forces causing worker turnover within this cohort of active workers are not well characterized and have the potential to bias the measures for time-related factors such as duration of employment.     

Geographic variation in work injuries: a multilevel analysis of individual-level data and area-level factors within Canada

PurposeThis study sought to examine provincial variation in work injuries and to assess whether contextual factors are associated with geographic variation in work injuries.MethodsIndividual-level data from the 2003 and 2005 Canadian Community Health Survey was obtained for a representative sample of 89,541 Canadians aged 15 to 75 years old who reported working in the past 12 months. A multilevel regression model was conducted to identify geographic variation and contextual factors associated with the likelihood of reporting a medically attended work injury, while adjusting for demographic and work variables.ResultsProvincial differences in work injuries were observed, even after controlling for other risk factors. Workers in western provinces such as Saskatchewan (adjusted odds ratio [AOR], 1.30; 95% confidence interval [CI], 1.09–1.55), Alberta (AOR, 1.31; 95% CI, 1.13–1.51), and British Columbia (AOR, 1.46; 95% CI, 1.26–1.71) had a higher risk of work injuries compared with Ontario workers. Indicators of area-level material and social deprivation were not associated with work injury risk.ConclusionsProvincial differences in work injuries suggest that broader factors acting as determinants of work injuries are operating across workplaces at a provincial level. Future research needs to identify the provincial determinants and whether similar large area–level factors are driving work injuries in other countries.     

Comparing severity of impairment for different permanent upper extremity musculoskeletal injuries

The labor market impact of upper extremity musculoskeletal injuries that result in permanent disability was estimated using data from the State of California. Administrative data on disability evaluations and resulting ratings was matched to data on the earnings of over 7000 injured workers. Using these data, labor market experience pre- and postinjury was tracked. Each injured worker was matched to a set of control workers who worked at the same firm, had the same tenure at the firm, and earned the same income at the time of injury. By comparing the injured and uninjured workers, lost earnings and the impact of injury on return to work was estimated. Evidence of considerable lost earnings resulting from injury was found. The results are compared to disability ratings that are used to set compensation under California's workers' compensation program. The disability rating was also found to predict poorly differences across upper extremity injuries in losses. In particular, those with shoulder injuries have larger losses than those with elbow or wrist injuries, despite receiving the same disability ratings.     

A study of factors influencing return to work after wrist or ankle fractures

BACKGROUND: Factors associated with time to return to work are poorly understood for occupational injuries, other than those to the back. METHODS: Anonymized data on claims for work-related wrist or ankle fracture between 1/1/1998 and 12/31/2002 were identified in administrative data held by the Workers Compensation Board in Alberta, Canada. Bivariate and Cox regression analyses were used to identify factors associated with return to work. RESULTS: Increased duration of temporary disability (TD) was associated with older age, female gender, work in construction and construction trade services, smaller company size, higher industry claim rates, a fall/jump from a height, ankle fracture, and greater medical aid costs in the 30 days following injury (used as a proxy for severity). CONCLUSIONS: Factors associated with longer time off work were largely consistent with those reported following back injury. Median time to return to work was longer following ankle than wrist fracture. Although Workers' Compensation Board (WCB) administrative data provided information that could be used to identify factors affecting return to work, better information on injury severity would considerably enhance their research potential.     

Paths of reentry: employment experiences of injured workers

BACKGROUND: An injury at work can result in a change in jobs or employers, unemployment, or withdrawal from the labor force. Substantial life changes can occur, often mediated by the initial attempt to return to employment. METHODS: This study uses ethnographic interviews of 204 workers injured in Florida. RESULTS: The study describes three paths to reemployment taken by the injured workers. The "welcome back" path provides workers with a sense of being valued by their preinjury employers. This positive effect remains, even for those who are unable to continue working because of limitations imposed by their injuries. Other paths cause workers to feel undervalued, as discarded or damaged goods, and generate hostility and resentment. Females in all groups are less likely to be currently working. White males were more likely than other groups to be employed in skilled jobs and are also the most likely to return to light-duty jobs and to remain in their preinjury jobs over time. CONCLUSIONS: Half of the workers in this study experience employer indifference or hostility in response to their attempts to return to work after an occupational back injury. After injury, there are both commonalities and meaningful disparities in post-injury experiences of White, Black, and Hispanic male and female workers.     

Urban-rural differences in work disability after an occupational injury

OBJECTIVES: In comparison with their urban counterparts, people living in rural areas have been found to experience higher rates of morbidity and mortality and have inferior health outcomes after illnesses and injuries. The current study sought to determine if this trend extends to work-disability outcomes after work-related injuries. METHODS: This study was a retrospective cohort study using data on workers' compensation claims. Rurality was defined at the postal-code level on the basis of United States 2000 census data. Work disability was measured using the number of full days a person was off work in the 2 years following an injury. Regression analyses were used to test the association between rurality and the duration of work disability after a work-related bone fracture. RESULTS: The claimants with higher rurality experienced less work disability than those with lower rurality. This relationship remained after control for the impact of age, gender, part of body injured, occupation, and industry. CONCLUSIONS: Rurality was found to be related to work disability. However, rather than being associated with more time off after an injury, as could be expected on the basis of past findings, increased rurality was found to be associated with less time off work. The findings suggest that features of rural environments, cultures, and behavioral patterns may facilitate return to work.     

Age related differences in work injuries and permanent impairment: a comparison of workers' compensation claims among adolescents,young adults,and adults

Aims: To investigate the severity of work injuries across age groups.

Methods: Workers' compensation records were used to examine work related injuries among adolescents (15–19 years old), young adults (20–24 years old), and adults (25+ years old) between 1993 and 2000. The incidence of compensated injuries was calculated for each age group and compared by gender, industry, and type of injury. The presence and degree of permanent impairment in each age group was also examined.

Results: For males, adolescents and young adults had higher claim rates than adults. For females, adults had the highest claim rates and young adults the lowest. Rates of permanent impairment indicated that age was positively associated with severity of injury.

Conclusions: Indicators of health consequences, in particular presence of permanent impairment, provide preliminary evidence that compensated work injuries sustained by youth are not as serious as injuries sustained by adults. Nevertheless, there was evidence that some young workers sustain injuries that have long term consequences. Documenting the consequences of the injuries that young workers sustain has implications for secondary prevention efforts and health services policy.

     

Workplace injury or “part of the job”?: Towards a gendered understanding of injuries and complaints among young workers

Epidemiological studies have found that teenage workers have higher occupational injury rates than adult workers, and that young males are a particularly high-risk subgroup. However, there have been few studies to date that have explored qualitatively young workers' everyday understandings and experiences of occupational health risks. Based on focus groups conducted with Canadian urban and suburban teenagers aged 16-18 years, this paper explores young workers' understandings and experiences of occupational health risks, and their gendered nature. The respondents were employed in a diverse range of jobs. The findings suggest that young workers experience a number of minor injuries and physical complaints related to their work. These injuries were typically seen as "part of the job" because they happened frequently and were of low severity. Also, the experience of these injuries as "part of the job" was informed by the young workers' perceived lack of control to improve or alter the conditions of their work. Furthermore, young workers' complaints and concerns were systematically discounted and this happened in a gendered fashion. Whereas the females emphasized how their complaints were actively disregarded by their superiors, males (and some females in male-dominated work settings) described how they stifled their complaints in order to appear mature among their (older) co-workers. Comparisons with qualitative studies of adult workers suggest that accepting some risks and injuries as "part of the job" is not peculiar to young workers. The implications of these findings for improving workplace safety for young workers are discussed.     

Getting back to work after injury: the UK Burden of Injury multicentre longitudinal study

ABSTRACT: BACKGROUND: Injuries to working age adults are common and place a considerable burden on health services accounting for more than 10% of GP sick notes and 14% of those claiming benefits because they are unable to work in the UK. General practitioners (GPs) currently assess fitness to work and provide care and referral to other services to facilitate return to work (RTW). Recent UK recommendations suggest replacing GP sickness certification with independent assessments of fitness to work after four weeks sick leave. The impact of a wide range of injuries on RTW and subsequent need for independent fitness to work assessments has not been well studied in the UK. The aim of this study was to quantify RTW and factors predicting RTW following a wide range of injuries. METHODS: We used a multicentre longitudinal study, set in four acute NHS Trusts in the UK which recruited emergency department (ED) attenders and hospital admissions for injury and included those aged 16-65years that were employed or self-employed before the injury. Participants were followed up by postal questionnaire at 1, 4 and 12 months post injury to measure health status (EQ-5D), recovery, use of health and social services, time off work in the preceding month and work problems amongst those who had RTW. Multivariable Poisson regression with a robust variance estimator was used to estimate relative risks for factors associated with RTW. RESULTS: One month after injury 35% of ED attenders had fully RTW. The self employed were more likely (RR 1.70, 95% CI 1.17 to 2.47 compared with employed) and the moderate/severely injured less likely to RTW (RR 0.48, 95% CI 0.32 to 0.72 compared with minor injuries). At four months, 83% of ED attenders had RTW and self employment and injury severity remained significant predictors of RTW (self employment RR 1.15, 95% CI 1.03 to 1.30; moderate/severe injury RR 0.79, 95% CI 0.68 to 0.92). At four months 57% of hospital admissions had RTW. Men were more likely than women to RTW (RR 1.94, 95% CI 1.34 to 2.82), whilst those injured at work (RR 0.49, 95% CI 0.27 to 0.87 compared with at home) and those living in deprived areas (most deprived tertile RR 0.59, 95% CI 0.40 to 0.85 and middle tertile RR 0.61, 95% CI 0.40 to 0.93) were less likely to RTW. Health status was significantly poorer at one and four months after injury than before the injury and was significantly poorer amongst those that had not RTW compared to those that had. Problems with pain control, undertaking usual activities, mobility and anxiety and depression were common and persisted in a considerable proportion of participants up to four months post injury. CONCLUSIONS: Injuries have a large impact on time off work, including amongst those whose injuries did not warrant hospital admission. The majority of injured people would require an in-depth fitness for work assessment if recent UK recommendations are implemented. Many people will have on-going pain, mobility problems, anxiety and depression at the point of assessment and it is important that patients are encouraged to use primary care services to address these problems. A range of factors may be useful for identifying those at risk of a slower recovery and a delayed RTW so that appropriate interventions can be provided to this group.     

Socially Constructed Hierarchies of Impairments: The Case of Australian and Irish Workers’ Access to Compensation for Injuries

Objectives: Socially constructed hierarchies of impairment complicate the general disadvantage experienced by workers with disabilities. Workers with a range of abilities categorized as a “disability” are likely to experience less favourable treatment at work and have their rights to work discounted by laws and institutions, as compared to workers without disabilities. Value judgments in workplace culture and local law mean that the extent of disadvantage experienced by workers with disabilities additionally will depend upon the type of impairment they have. Rather than focusing upon the extent and severity of the impairment and how society turns an impairment into a recognized disability, this article aims to critically analyse the social hierarchy of physical versus mental impairment. Methods: Using legal doctrinal research methods, this paper analysis how Australian and Irish workers’ compensation and negligence laws regard workers with mental injuries and impairments as less deserving of compensation and protection than like workers who have physical and sensory injuries or impairments. Results: This research finds that workers who acquire and manifest mental injuries and impairments at work are less able to obtain compensation and protection than workers who have developed physical and sensory injuries of equal or lesser severity. Organizational cultures and governmental laws and policies that treat workers less favourably because they have mental injuries and impairments perpetuates unfair and artificial hierarchies of disability attributes. Conclusions: We conclude that these “sanist” attitudes undermine equal access to compensation for workplace injury as prohibited by the United Nations Convention on the Rights of Persons with Disabilities.     

Personal factors and working conditions as predictors of work injuries among industrial workers

The purpose of this study was to determine the personal factors and working conditions that predict work injuries among industrial workers. To fulfill this aim, a case control study was conducted including 2003 industrial workers who sustained a work injury and an equal number of controls. All were subjected to an interview questionnaire to collect relevant information. Moreover, records were reviewed to obtain the medical history of enrolled workers. Data revealed that workers in the index and control groups are comparable in respect to their sociodemographic characteristics. The multivariate logistic regression analysis pointed out that safety training significantly reduces the risk of work accidents among industrial workers. On the other hand, work accidents are more likely to occur in the main working shift. Moreover, workers who suffer from chronic health problems calling for surgical treatment, as well as those who reported family problems, are more likely to experience work accidents. These workers should receive considerable attention to reduce the extent of work injuries. More importantly, safety-training programs are mandatory for accident prevention in industrial settings.     

Factors associated with return‐to‐work and health outcomes among survivors of road crashes in Victoria

Objective: To explore the relationships between injury, disability, work role and return‐to‐work outcomes following admission to hospital as a consequence of injury sustained in a road crash. Design and setting: Prospective cohort study of patients admitted to an adult trauma centre and two metropolitan teaching hospitals in Victoria, Australia. Participants were interviewed in hospital, 2.5 and eight months post‐discharge. Participants: Participants were 60 employed and healthy adults aged 18 to 59 years admitted to hospital in the period February 2004 to March 2005. Results: Despite differences in health between the lower extremity fracture and non‐fracture groups eight months post‐crash the proportions having returned to work was approximately 90%. Of those returning to work, 44% did so in a different role. After adjustment for baseline parameters, lower extremity injuries were associated with a slower rate of return to work (HR: 0.31; 95%CI: 0.16–0.58) as was holding a manual occupation (HR: 0.16; 95%CI: 0.09–0.57). There were marked differences in physical health between and within the injury groups at both follow‐up periods. Conclusions: These results demonstrate that both injury type and severity and the nature of ones occupation have a considerable influence on the rate and pattern of return to work following injury. Further, persisting disability has a direct influence on the likelihood of returning to work. The implications of these findings and the types of data required to measure outcome post‐injury are discussed.