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.     

Training the Next Generation of Researchers in Work Disability Prevention: The Canadian Work Disability Prevention CIHR Strategic Training Program

INTRODUCTION: There is a need to create, disseminate, and implement new knowledge in the work disability prevention (WDP) field. Training programs attracting high-quality applicants and taking into account the complexity of this emerging field are urgently needed. METHODS: An advanced training program, funded by the Canadian Institutes of Health Research (CIHR), was developed by 24 mentors affiliated with nine different universities. The main objective of this program is to develop transdisciplinary knowledge, skills, and attitudes regarding WDP. This program has been developed for PhD students or post-doctoral fellows already registered full-time in a Canadian or recognized foreign university whose main interest is WDP, regardless of the health problem. RESULTS: Since its implementation, the program received two successive cohorts of 10 students. They were registered in 13 universities in five countries and trained in nine different disciplines. CONCLUSIONS AND SIGNIFICANCES: Appropriate WDP research may save major societal costs attributable to prolonged work disability. The proposed training program will contribute to developing tomorrow's research workforce.     

The impact of perinatal loss on adjustment to subsequent pregnancy.

The current study compared the emotional adjustment of pregnant couples with and without a history of perinatal loss. Thirty-one pregnant women with a history of perinatal loss and 31 pregnant women with an unremarkable reproductive history were assessed between their 10th and 24th week of gestation. Partners were also recruited. Twenty-eight men were in the loss group and 23 men in the comparison group. Couples with a history of loss reported significantly more depressive symptomatology and pregnancy-specific anxiety than couples in the comparison group. Women reported more depressive symptomatology than men. Regression analyses revealed that for the group with a previous loss, depressive symptomatology was significantly associated with self-criticism, interpersonal dependency and number of previous losses. For the comparison group, depressive symptomatology was significantly associated dyadic adjustment. Pregnancy-specific anxiety of women with a previous loss was associated with their belief that their behavior affects fetal health; for women in the comparison group, pregnancy-specific anxiety was associated with the belief that health professionals' behavior affects fetal health. Implications for practice of health care professionals are discussed. The importance of early intervention to reduce distress is highlighted by the finding that alterations in mood are apparent in the early stages of pregnancy for both women and men who have experienced a previous perinatal loss. While carefully reducing personal responsibility for fetal health in women with a previous loss may reduce their pregnancy-specific anxiety, women with an unremarkable obstetrical history may benefit from an approach diminishing their perception of the power that medical staff has on fetal health.     

Workplace-based work disability prevention interventions for workers with common mental health conditions: a review of the literature

Introduction To summarize evidence on workplace-based work disability prevention (WDP) interventions in workers with common mental health conditions (CMHCs). Primary outcomes of interest were work absence duration and work functioning; secondary outcomes were quality of life, and economic costs. Methods We conducted a systematic literature search in 5 electronic databases (MEDLINE, EMBASE, CINAHL, PsychINFO, Web of Science) for studies published from 2007 to 2009. Two reviewers screened for studies: (1) Targeting workers with CMHCs absent from, or struggling at, work; (2) evaluating workplace-based WDP interventions; (3) assessing our primary outcome(s); and (4) with controlled trials. Quality assessment (using 29 criteria) was performed by two reviewers. Results Our search yielded 671 abstracts: 8 eligible studies and of sufficient quality. We identified three main intervention elements: (a) Facilitation of access to clinical treatment; (b) Workplace-based high-intensity psychological intervention; and (c) Facilitation of navigation through the disability management system. Moderate evidence was found that facilitation of treatment improved work functioning, quality of life and economic outcomes, with limited evidence for work absence duration. Moderate evidence was found that psychological interventions, primarily cognitive-behavioral therapy, improved work functioning, quality of life, and economic outcomes. Moderate evidence indicated that facilitation of navigation through the disability management system improved work absence duration. Conclusions Workplace-based interventions could improve work disability outcomes for workers with CMHCs. Facilitation of access to clinical treatment, and workplace-based high-intensity psychological intervention were most effective in improving work functioning and quality of life, and in reducing costs.     

The prognostic value of depressive symptoms, fear-avoidance, and self-efficacy for duration of lost-time benefits in workers with musculoskeletal disorders

Background

The psychological factors of depressive symptoms, fear‐avoidance, and self‐efficacy are deemed to be important in the work disability process. However, the prognostic value of these factors for time on benefit is not well understood.

Aims

To analyse the prognostic value of psychological factors for the number of days on total compensation benefit over a 12 month period.

Methods

In a longitudinal study of 187 workers receiving total compensation benefits due to musculoskeletal disorders, the prognostic value of psychological factors measured 4–5 weeks post‐injury for duration on total compensation benefit over 12 months was analysed. Cox proportional hazard regression analyses were conducted. Special emphasis was given to variable selection and to the analysis of confounding effects of potential prognostic variables.

Results

The final model indicated that increased depressive symptoms and poorer physical health significantly increase the number of days on total benefit. Confounders included in the final model were pain and fear of income loss. In the final model the impact of fear‐avoidance ceased to be significant when work related variables were included in the fully adjusted model. This illustrates that interrelationships between variables must be taken into account when building multivariate prognostic models. The addition of work related variables to the model did not result in any major changes in the adjusted model, which suggests that when measured 4–5 weeks post‐injury, psychological and physical health factors are strong predictors of time on benefits, while work conditions are less important.

Conclusion

Results suggest that the presence of depressive symptoms and poor physical health in workers on benefit due to musculoskeletal disorders increases the number of days on total compensation benefits significantly, when controlling for confounding variables.     

Health-promoting behaviors through pregnancy, maternity leave, and return to work: effects of role spillover and other correlates

Women's health-promoting behavior changes and their correlates across the transition to motherhood and return to work are insufficiently understood. The purpose of this study was to describe and compare women's health-promoting behaviors, particularly physical activity (PA), across these transitions. A prospective, observational design was employed to assess 243 female healthcare workers from 3 sites with regard to health-promoting behaviors, and their demographic (e.g., age, parity) and psychosocial (i.e., work-family role spillover) correlates. Forty-two participants were recruited while pregnant and re-assessed during maternity leave and upon return to work, and compared to 201 non-pregnant participants. No significant changes in health-promoting behaviors were observed from pregnancy through the postpartum. Pregnant participants reported better nutrition than comparison participants (p=.001), and were more likely to check their pulse when exercising (p=.004). During pregnancy, health-promoting behaviors were related to parental status, with first-time mothers engaging in more positive behaviors. Correlates of PA during maternity leave and return to work included family income and exercise history. Positive family-to-work spillover was significantly greater among pregnant women than among comparison participants (p<.001), and positive work-to-family spillover was related to greater PA upon return to work (p<.01). This study reveals little variability in health-promoting behaviors from the prenatal to the postpartum period. Both demographic and psychosocial factors have effects on health-promoting behaviors, and we must look to these correlates to promote increased PA.     

Factors Associated with Work Participation and Work Functioning in Depressed Workers: A Systematic Review

Background Depression is associated with negative work outcomes such as reduced work participation (WP) (e.g., sick leave duration, work status) and work functioning (WF) (e.g., loss of productivity, work limitations). For the development of evidence-based interventions to improve these work outcomes, factors predicting WP and WF have to be identified. Methods This paper presents a systematic literature review of studies identifying factors associated with WP and WF of currently depressed workers. Results A total of 30 studies were found that addressed factors associated with WP (N = 19) or WF (N = 11). For both outcomes, studies reported most often on the relationship with disorder-related factors, whereas personal factors and work-related factors were less frequently addressed. For WP, the following relationships were supported: strong evidence was found for the association between a long duration of the depressive episode and work disability. Moderate evidence was found for the associations between more severe types of depressive disorder, presence of co-morbid mental or physical disorders, older age, a history of previous sick leave, and work disability. For WF, severe depressive symptoms were associated with work limitations, and clinical improvement was related to work productivity (moderate evidence). Due to the cross-sectional nature of about half of the studies, only few true prospective associations could be identified. Conclusion Our study identifies gaps in knowledge regarding factors predictive of WP and WF in depressed workers and can be used for the design of future research and evidence-based interventions. We recommend undertaking more longitudinal studies to identify modifiable factors predictive of WP and WF, especially work-related and personal factors.     

Examining the relationship between work-family spillover and sleep quality

The present study examined the relationship between work-family spillover, job characteristics, and sleep quality in a sample of health care workers (N = 168) recruited from 3 Canadian hospitals. A multiple regression analysis revealed that positive family-to-work spillover is associated with better sleep quality, after controlling for age, physical health, depressive symptomatology, work situation, and number of children. These findings are discussed within a theoretical framework drawing on the concepts of effort and recovery.