-
[show abstract]
[hide abstract]
ABSTRACT: The purpose of this prospective cohort study with 1-year follow-up was to determine prognostic factors for duration of sickness absence due to musculoskeletal disorders.
Workers were included when on sickness absence of 2 to 6 weeks due to musculoskeletal disorders. A self-administered questionnaire was used to collect personal and work-related factors, pain, functional disability, and general health perceptions. Statistical analysis was done with Cox proportional hazard regression with an interaction variable with time for every risk factor of interest. Univariate and multivariate analyses were performed on musculoskeletal disorders and, separately, for low back pain.
The main factors that were associated with longer sickness absence were older age, gender, perceived physical workload, and poorer general health for neck, shoulder and upper extremity disorders, and functional disability, sciatica, worker's own perception of the ability of return to work, and chronic complaints for low back pain. Workers with a high perceived physical work load returned to work increasingly slower over time than expected, whereas workers with a high functional disability returned to work increasingly faster over time.
High pain intensity is a major prognostic factor for duration of sickness absence, especially in low back pain. The different disease-specific risk profiles for prolonged sickness absence indicate that low back pain and upper extremity disorders need different approaches when applying intervention strategies with the aim of early return to work. The interaction of perceived physical workload with time suggests that perceived physical workload would increasingly hamper return to work and, hence, supports the need for workplace interventions among workers off work for prolonged periods.
Clinical Journal of Pain 03/2006; 22(2):212-21. · 2.81 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: This prospective cohort study quantified the reduced productivity of workers on full duty after sickness absence from a musculoskeletal disorder and determined the effect of health parameters such as perceived pain, functional disability, and general health on reduced productivity.
Workers were included who were returning to work from 2- to 6-week sickness absence due to a musculoskeletal disorder. Self-administered questionnaires at baseline, after return to work, and at a 12-month follow-up were used to collect information on productivity and health status. Logistic regression analyses evaluated the determinants of reduced productivity and determined the level of productivity loss shortly after return to work.
Reduced productivity was prevalent for 60% of the workers after they returned to work, and for 40% still at the 12-month follow-up. The initial musculoskeletal disorder caused 75% of the productivity loss shortly after return to work and 60% at the follow-up. Among those with productivity loss, the median loss for an 8-hour workday was 1.6 hours shortly after return to work and also at the follow-up. Worse physical health, more functional disability, and poorer relations with the supervisor were associated with productivity loss shortly after return to work, whereas recurrent sick leave was the greatest predictor of productivity loss at the follow-up.
Reduced productivity was common among workers returning to full duty after sickness absence due to a musculoskeletal disorder. Productivity loss illustrates the importance of the timing of return to work, especially among workers with residual functional disability after return to work. Moreover, the supervisor should be engaged early in the return-to-work process to guarantee an early, sustainable, and productive return to work for the employee.
Scandinavian journal of work, environment & health 11/2005; 31(5):367-74. · 3.12 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Prospective cohort study with 1-year follow-up.
The purpose of this study is to describe the improvement in several health outcomes during sick leave resulting from musculoskeletal disorders and in the first months after return to work (RTW), and to evaluate the personal and work-related factors associated with these health outcomes, in order to provide some insight in the timing of RTW.
Although improvements in pain perception and functional disability appear to be associated with time of RTW, little is known about the required improvement enabling RTW, the additional health improvement after RTW, and whether the health status at the time of RTW is associated with the probability of a recurrence of sick leave.
Workers were included when on sickness absence between 2 to 6 weeks due to musculoskeletal disorders. Self-administered questionnaires at baseline, after RTW, and at 12-month follow-up were used to collect information on changes in symptom status, functional status, and general health.
All health outcomes were improved significantly at the time of RTW, whereas perceived pain, functional disability, and physical health also improved significantly in the first months after RTW. Previous sick leave 12 months before study entry was significantly associated with the level of functional disability and general health at time of RTW and also predictive for recurrence of sickness absence. Personal and work-related factors showed little, if any, association with health status at RTW and improvement thereafter.
Being fully recovered is not a stipulation for regaining work activities. We hypothesize that workers with musculoskeletal disorders may need additional medical guidance shortly after RTW, especially those with a history of sick leave.
Spine 06/2005; 30(9):1086-92. · 2.08 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: To determine which individual and work-related factors are associated with performing modified work and to evaluate the influence of modified work on the duration of sick leave and health-related outcomes among employees with musculoskeletal complaints.
A prospective study with 12 months follow-up.
In this prospective study a total of 164 employees on sick leave for 2-6 weeks due to musculoskeletal complaints completed 2 questionnaires. At baseline we gathered information about individual characteristics, physical and psychosocial workload, and disease specific and general health. The follow-up questionnaire, sent to respondents who returned to their original job on full duty, collected information about having performed modified work, and disease-specific and general health.
Employees were less likely to perform modified work when their regular work was characterized by frequent lifting and their relationship with colleagues was less than good. Employees were more likely to return to modified work when they had a better mental health, had prolonged periods of standing in their regular job and had less skill discretion. Duration of sick leave was influenced by chronicity of complaints and disability, but not by modified work.
Modified work, as the only advice given by a occupational health physician, did not influence the total duration of sick leave nor the improvement in health during sick leave for employees on sick leave due to musculoskeletal complaints.
Journal of Rehabilitation Medicine 06/2005; 37(3):172-9. · 2.05 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: A cross-sectional study.
To measure interrelationships among pain, functional disability, general health, and overall quality of life for workers on sickness absence for 2 to 6 weeks due to musculoskeletal complaints, and to assess the impact of work-related and individual characteristics on these different health dimensions. The results of this study will contribute to a better understanding of the relationship between health and functional disability.
When choosing a patient-based outcome measure, different health dimensions must be considered. For musculoskeletal complaints, four health dimensions are important: pain, disability, general health, and overall quality of life. Improvement at one dimension does not necessarily correlate with better health on another dimension. Moreover, correlations between different dimensions may be influenced by individual and environmental factors. However, it is not known whether these factors influence different health dimensions differently.
A total of 218 workers on sickness absence for 2 to 6 weeks due to musculoskeletal complaints completed a questionnaire on four different health dimensions and work-related and environmental factors.
Moderate correlations (r < 0.50) among measures of pain, disability, general health, and quality of life were found. These health dimensions were not influenced by work-related physical and psychosocial workload, suggesting no impact of recall bias in studies for work-related musculoskeletal complaints. Self-perceived ability to return to work within 6 weeks explained 21% to 26% of the outcomes on pain and disability and contributed less to the generic measures of health.
Within a population of workers on sickness absence for 2 to 6 weeks, specific dimensions of pain and disability seem to be more appropriate measures of health than generic instruments of general health and quality of life.
Spine 10/2004; 29(19):2178-83. · 2.08 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: This study aimed at developing a model for determining the work-relatedness of low-back pain for a worker with low-back pain using both a personal exposure profile for well-established risk factors and the probability of low-back pain if the worker were unexposed to these factors.
After a systematic review of the literature, the pooled prevalence of low-back pain in an unexposed population and the pooled odds ratio (OR) for each risk factor was calculated in a meta-analysis using a random effect model. An unbiased risk estimate for each risk factor was obtained by correcting the pooled OR for confounding by other risk factors. The probability of low-back pain was calculated with a logistic regression model. The input was (i) the age-dependent prevalence when not exposed and (ii) the unbiased risk estimates per risk factor of low and high exposure. The etiologic fraction was calculated to determine the level of work-relatedness.
The pooled prevalence for low-back pain among unexposed subjects was 22%, 30%, and 34% for the <35-year, 35-to-45-year, and >45-year age categories, respectively. The pooled OR was 1.51 [95% confidence interval (95% CI) 1.31-1.74] for manual materials handling, 1.68 (95% CI 1.41-2.01) for frequent bending or twisting, 1.39 (95% CI 1.24-1.55) for whole-body vibration, and 1.30 (1.17-1.45) for job dissatisfaction. For high exposure to manual materials handling, frequent bending or twisting, and whole-body vibration, the pooled OR was 1.92, 1.93, and 1.63, respectively.
The model is the first that estimates the probability of work-relatedness for low-back pain for a given worker with low-back pain seen by a general practitioner or an occupational health physician.
Scandinavian journal of work, environment & health 01/2004; 29(6):431-40. · 3.12 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The purpose of this review is to present more insight into the effects of primary interventions on both mechanical exposure and musculoskeletal health and to determine whether these outcomes are good performance indicators of such interventions.
The literature was scrutinised for relevant references. Primary prevention was defined as any activity aimed at preventing the occurrence of musculoskeletal disorders in occupational populations. Primary outcome measures were mechanical exposure, musculoskeletal health, and sick leave due to musculoskeletal disorders. The impact of interventions was assessed by calculating the reduction in mechanical exposure and the preventable fraction (PF) of the musculoskeletal complaints. After selection, 40 studies were included for further analysis.
In general, of the 40 included studies, 29 (73%) found a reduction in musculoskeletal symptoms (PF range 0.10-0.95). Eighteen out of 29 studies (62%) reported a statistically significant reduction in musculoskeletal disorders. In 12 of the 40 studies (30%) changes in both mechanical exposure and musculoskeletal health were used as performance indicators for the intervention. Of these studies nine (67%) showed a reduction in both mechanical exposure (range 14%-87% reduction) and musculoskeletal disorders or sick leave due to musculoskeletal disorders (PF range 0.15-0.92). From these nine it was seen that a reduction of at least 14% in mechanical exposure resulted in a concomitant reduction in musculoskeletal health.
More quantitative information is needed to describe the relationship between mechanical exposure and musculoskeletal health as presented in the model. In this case it is recommended that in primary intervention studies not only changes in health outcomes be measured but also changes in mechanical exposure along the pathway of the intervention. In this way a better insight will be gained about the dose-response relationships between exposure to physical-load risk factors and work-related musculoskeletal disorders (WRMSD). More insight into these relationships will eventually lead to more efficient implementations of primary intervention strategies.
Archiv für Gewerbepathologie und Gewerbehygiene 11/2002; 75(8):549-61. · 1.89 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The authors conducted a study to compare the efficacies of three nonsurgical treatment strategies in patients with sciatica. Their hypothesis was that bed rest, physiotherapy, and continuation of activities of daily living (ADLs) (control treatment) are each of equivalent efficacy.
This randomized controlled trial was designed for comparison of bed rest, physiotherapy, and continuation of ADLs. The setting was an outpatient clinic. General practitioners were asked to refer patients for treatment as soon as possible. The authors enrolled 250 patients (< 60 years of age) with sciatica of less than 1-month's duration and who had not yet been treated with bed rest or physiotherapy. Primary outcome measures were radicular pain (based on a visual analog pain scale [VAPS]) and hampered ADLs (Quebec Disability Scale [QDS]). Secondary outcome measures were the rates of treatment-related failure and surgical treatment. Measures were assessed at baseline and during follow up at 1, 2, and 6 months. Mean differences in VAPS and QDS scores between bed rest and control treatment were 2.5 (95% confidence interval [CI] -6.4 to 11.4) and -4.8 (95% CI -10.6 to 0.9) at 1 month and 0.9 (95% CI -8.7 to 10.4) and -2.7 (95% CI -9.9 to 4.4) at 2 months, respectively. The respective differences between physiotherapy and control treatment were 0.8 (95% CI -8.2 to 9.8) and -0.5 (95% CI -6.3 to 5.3) at 1 month and -0.3 (95% CI -9.4 to 10) and 0.0 (95% CI -7.2 to 7.3) at 2 months. The respective odds ratios for treatment failure and surgical treatment of bed rest compared with control treatment were 1.6 (95% CI 0.8-3.5) and 1.5 (95% CI 0.7-3.6) at 6 months. When physiotherapy was compared with control treatment, these ratios were 1.5 (95% CI 0.7-3.2) and 1.2 (95% CI 0.5-2.9) at 6 months, respectively.
Bed rest and physiotherapy are not more effective in acute sciatica than continuation of ADLs.
Journal of Neurosurgery 01/2002; 96(1 Suppl):45-9. · 2.96 Impact Factor
