Table 1 - uploaded by Chris J Main
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Objective:
To develop a consensus plan for research and practice to encourage routine clinician screening of occupational factors associated with long-term back disability.
Methods:
A 3-day conference workshop including 21 leading researchers and clinicians (the "Decade of the Flags Working Group") was held to review the scientific evidence conc...
Contexts in source publication
Context 1
... recent years, this system has been refined in scope and concept [25], and workplace factors that were previ- ously included as yellow flags now occupy two separate categories: ''black flags'', actual workplace conditions that can affect disability; and ''blue flags'', individual percep- tions about work, whether accurate or inaccurate, that can affect disability. As shown in Table 1, blue flags have been conceptualized as worker perceptions of a stressful, un- supportive, unfulfilling, or highly demanding work environment. Black flags include both employer and insurance system characteristics (Category I) as well as objective measures of physical demands and job charac- teristics (Category II). ...
Context 2
... there are increasing numbers of prospective cohort studies of back pain prognosis, only a few researcher groups have attempted to translate prognostic findings into clinical screening tools. In addition to the Yellow Flags method described in Table 1, a number of other questionnaires, interview guides, and assessment procedures have been developed to assess prognostic fac- tors in back disability, including occupational factors. Rather than provide an exhaustive review of these mea- sures, we have chosen six that provide a representative sampling of other approaches. ...
Citations
... Enabling skilled and able workers to remain at work and prevent unnecessary disability addresses an important societal problem and helps to support perceptions of fairness and inclusiveness in the workplace setting (Chumo et al., 2023). Workplace characteristics are frequently cited as predictive factors in studies of return-to-work, stay-at-work, and other work disability outcomes (Kristman et al., 2016;Shaw et al., 2009), but most of the focus has been on job stress and physical demands, not measures of organizational support. ...
Background/Purpose
One-third of US workers report chronic health conditions that can limit their ability to work, sometimes leading to extended sickness absence, job loss, or premature retirement. The purpose of this study was to evaluate whether selected organizational factors were associated with fatigue and turnover intent among workers with chronic health conditions.
Method
Workers with chronic physical health conditions (N = 119) volunteered for a worksite group intervention program and completed a pre-intervention survey including the Work Limitations Questionnaire, Areas of Worklife Survey, Job Leeway Scale, the Occupational Fatigue Exhaustion Recovery scale, and a measure of turnover intention. We evaluated whether perceptions of organizational support (control, fairness, community, and leeway) were associated with fatigue and intention to leave.
Results
Workers reported a median of 3 chronic conditions with moderate levels of work-related fatigue, and 30% were considering a job change. All four organizational support factors were negatively correlated with fatigue and turnover intention. In multiple regression analyses controlling for severity of work limitations, fatigue was uniquely explained by fairness and leeway, while turnover intention was uniquely explained by fairness. There was a statistically significant age interaction showing greater benefits of leeway to prevent turnover among younger workers.
Conclusions and Implications
Organizations that implement policies and practices that provide greater control, fairness, sense of community, and health-related leeway may reduce worker fatigue and turnover among workers with chronic health conditions.
Trial registration
Clinicaltrials.gov; NCT01978392 (issued November 6, 2013).
... Evidence is accumulating that the prognosis and course of back pain are affected by a range of physical, psychological, and social dimensions [10][11][12][13]. Recent systematic reviews indicate that so-called blue flags (i.e., perceptions of work-related factors) influence disability of individuals with back pain [14,15]. For example, Chou et al. indicated in a systematic review that high physical job demands and less work satisfaction predict disabling back pain one year after onset [11]. ...
BACKGROUND: Low back pain has a high economic burden in Germany due to back pain-related sick leave, disability pensions, and health care utilization. Work-related factors can predict disabling back pain. Job exposure matrices can be used to consider job demands and occupational characteristics in routine data analysis. OBJECTIVE: This longitudinal analysis tested whether rehabilitation utilization due to musculoskeletal disorders is associated with occupation-linked job exposures in employees with back pain. METHODS: Data from a German cohort study were used, including employees aged 45 to 59 years with self-reported back pain in the last three months. Individuals’ job titles were assessed in the baseline survey in 2017 and matched with parameters of aggregated job exposure indices. Administrative data from the German Pension Insurance were used to extract information on rehabilitation utilization. Proportional hazard models tested the associations. RESULTS: We considered data of 6,569 participants (mean age: 52.3 years; 57.7% women). During follow-up, with a maximum of 21 months, 296 individuals (4.5%) utilized medical rehabilitation due to musculoskeletal disorders. Adjusted analyses showed that high physical (HR = 2.87; 95% CI 1.74; 4.75) and overall (HR = 2.34; 95% CI 1.44; 3.80) job exposures were associated with a higher risk of rehabilitation utilization. CONCLUSION: Individuals with back pain working in occupations with high physical job exposures have a higher risk for rehabilitation utilization. To prevent work disability in individuals with back pain, occupational groups with high physical job exposures should be actively informed about tailored intervention options.
... Before setting off on the journey, it is important to revisit each of the potential obstacles and how they might be dealt with. The initial distinction between clinical and occupational factors 29,30 can lead to further distinctions between individual versus system factors. 31 In clinical practice, it is important to distinguish psychological factors (such as beliefs about pain, its impact on function, participation and well-being, expectations of outcome, and pain coping strategies) and social influences. ...
Psychologically informed practice (PiP) includes a special focus on psychosocial obstacles to recovery, but research trials have revealed significant difficulties in implementing PiP outside of research environments. Qualitative studies have identified problems of both competence and confidence in tackling the psychosocial aspects of care, with a tendency to prefer dealing with the more mechanical aspects of care. In PiP, the distinction between assessment and management is not clear-cut. Analysis of the problem is part of the intervention, and guided self-management begins with the initial detective work by the patient, who is encouraged to develop successful and relevant behavior change. This requires a different style and focus of communication that some clinicians find difficult to enact. In this Perspective, the PiP Consultation Roadmap is offered as a guide for clinical implementation to establish a therapeutic relationship, develop patient-centered communication, and guide effective pain self-management. These strategies are illustrated through the metaphor of the patient learning to drive, with the therapist as a driving instructor and the patient as a student driver. For convenience, the roadmap is depicted in 7 stages. Each stage represents aspects of the clinical consultation in a recommended order, although the roadmap should be viewed as a general guide with a degree of flexibility to accommodate individual differences and optimize PiP interventions. It is anticipated that the experienced PiP clinician will find it progressively easier to implement the roadmap as the building blocks and style of consultation become more familiar.
... The percentage of women and men working full-time was identical at 43% but more women had returned to part-time work (23 vs. 8%) and more men were unable to work (50 vs. 34%). Men had a higher frequency of meniscus/ligamentous injuries (39 vs. 28%) and women had a higher number of fractures (21 vs. 12%), but these differences were not statistically significant (p > 0. 05). ...
... The patient interview helps to identify patients' readiness and willingness for RTW, patients' perceptions of what they can and cannot do in a given job process, and yellow/blue flags indicating any psychological barriers to RTW [62,63]. ...
The current paper seeks to inform healthcare professionals on how adapting various components of return to work (RTW) programs that are already in use by other musculoskeletal rehabilitation settings can help optimize return to work process for patients with or without musculoskeletal manifestations, posthematopoietic cell transplantation. Since there is no universally agreed RTW structure for hematopoietic cell transplant patients, a narrative approach has been taken utilizing evidence from the existing musculoskeletal return to work assessment publications to help draw parallel for the hematopoietic cell transplant patients. Databases were searched including PUBMED, CINHAL, AMED, SCOPUS, and Cochrane using keywords RTW, functional restoration program, hematopoietic cell transplant, bone marrow transplant, stem cell transplant, and musculoskeletal functional assessment. The authors have managed to outline and propose a structured RTW assessment and monitoring program which can aid in getting patients back to employment by utilizing the functional capacity and job evaluation to help hematopoietic cell transplantation patients reintegrate socially. Patients undergoing hematopoietic cell transplant require additional support and a robust assessment system to allow safe RTW. The proposed model of RTW assessment can prove to be beneficial in helping patients return to work safely. Clinical Significance. To acknowledge the individuality in functional limitation is important in determining not only the rehab needs but also the RTW capabilities. The proposed RTW plan not only promotes an individualized approach to patients but also provides a structure for return to work assessments for hematopoietic cell transplantation patients, thus, eliminating the need for guess work by healthcare professionals. In line with the International Classification of Functioning, Disability, and Health (ICF) recommendations, a RTW assessment combined with a job evaluation helps healthcare professionals and stakeholders to understand the unique challenges and strengths of a patient and thereby design an individualized therapy approach.
1. Introduction
For patients with blood cancers, participation in activities of daily living and returning to work (RTW) have been considered among the main goals of patients posthematopoietic cell transplantation (HCT) and rehabilitation programs [1, 2]. However, RTW process is complex and dependent on many factors including patients’ physical and psychological health and functional capacity [3]. HCT patients can suffer from long-term life changing manifestations, both physical and mental, which can have a great impact on patients’ functional performance [4]. Manifestations that may impact functional capacity can include fasciitis, neuropathy, bone necrosis, contractures, muscle weakness, fatigue, and reduced cognitive ability [5]. Developing a universal and adaptable return to work (RTW) framework for post-HCT patients is an evolving process with a lack of consensus among healthcare professionals around the globe. Furthermore, post-HCT, acute graft versus host disease (aGVHD), and chronic graft versus host disease (cGVHD) patients can be classified as at greater risk of reduced function, disability, and poor health as per the International Classification of Functioning, Disability, and Health (ICF) Framework, a unified and standard framework for the description of health and health-related issues developed by the World Health Organization (WHO) [6–8]. In the ICF framework, post-HCT patients can face challenges resulting from HCT and posttransplant aGVHD or cGVHD. These are summarized in Table 1, which highlights the ICF classification and common deficits, impairments, and functional limitations experienced by HCT patients.
ICF components
Subcomponent
Description in the context of HCT patients
Functioning and disability
Body structure and function: refers to the anatomical and physiological function of the human body (i.e., motor function, cognition, and emotion) [82–89]
Musculoskeletal, neurologic, and cardiopulmonary manifestations, GVHD and skin involvement including maculopapular rash and pruritic, and in the more severe forms, erythrodermic (stage III), and bullae formation (stage IV), avascular necrosis of the bone, infections, neurological (critical illness myopathy/neuropathy) complications, steroid myopathy as a side-effect of GVHD treatment, chemotherapy-induced cognitive dysfunction, and significant fatigue
Activities and participation: refers to the person’s level of task execution (i.e., communication, mobility, interpersonal interactions, self-care, and learning) [5, 90–92]
Diminished activities of daily life, reduced functional capacity, and altered speech.
Contextual factors
Environmental factors: the social and physical factors in the person’s life which facilitate or hinder the function (i.e., family, work, government agencies, laws, and cultural beliefs) [93–98]
Support from the employer, healthcare providers, and caregivers.
Personal factors: the characteristics which is unique to the person (i.e., race, gender, age, educational level, and coping styles. Personal factors are not specifically coded in the ICF because of the wide variability among cultures)
Age, depression, anxiety, social withdrawal, and poor quality of life.
... Alcuni fattori sul posto di lavoro sono anche predittivi di maggiori difficoltà. Includono le richieste di lavoro fisico, la capacità di modificare il lavoro, lo stress sul lavoro, supporto o disfunzionalità sociale sul posto di lavoro, la soddisfazione sul lavoro, l'aspettativa di riprendere il lavoro e la paura di un nuovo infortunio [26]. Se molti di questi fattori sono presenti, allora un intervento aggiuntivo sotto forma di coordinamento di rientro al lavoro, consulenza, educazione alla gestione del dolore o esposizione graduale all'attività, può essere utile per alleviare queste preoccupazioni [27,28]. ...
Lombalgia nei luoghi di lavoro Introduzione Il mal di schiena è un problema comune tra gli adulti che lavorano. Più di 1 lavoratore su 4 riferisce un mal di schiena in corso [1]. Alcuni episodi di mal di schiena possono essere accelerati da esigenze di lavoro fisico, ma episodi di dolore, sia legati al lavoro che non, possono contribuire ad assenze dal lavoro e alcuni lavoratori potrebbero riscontrare problemi nel continuare o nel riprendere le normali attività lavorative. Seb-bene la maggior parte del dolore alla schiena non sia grave dal punto di vista medico, l'esperienza del dolore può contrastare fino ad autolimitare le attività quotidiane, e il dolore alla schiena può portare a dif-ficoltà e interruzioni dell'attività professionale. Questa scheda riassume le evidenze sul problema del mal di schiena sul posto di lavoro. Prevalenza e andamento Sia gli episodi acuti di mal di schiena che quelli cronici primari (> 6 mesi) sono comuni tra gli adulti in età la-vorativa, sia maschi che femmine. Questionari tra gli addetti alla movimentazione manuale dei materiali sug-geriscono una prevalenza, nel corso di un anno, del 25% di dolore alla schiena che dura più di 7 giorni, del 14% per il dolore alla schiena e che richiede cure mediche e del 10% per il dolore alla schiena che richiede un allontanamento dal lavoro [2]. Dopo un episodio acuto di mal di schiena, la maggior parte degli individui è in grado di tornare alla normale funzionalità entro parecchie settimane, ma in circa il 10% dei casi, il mal di schiena acuto può diventare un problema più cronico, che dura più di 6 mesi [3]. Dopo un episodio iniziale di mal di schiena, episodi ricorrenti di mal di schiena sono comuni, con stime di recidiva fino a due terzi entro 12 mesi dalla guarigione dal mal di schiena [4]. In caso di mal di schiena cronico primario, ai lavoratori possono essere offerti diagnosi più approfindite, trattamenti terapeutici o palliativi, coordinamento del datore di lavoro o servizi di riabilitazione professionale. Il trattamento bio-psicosociale per il mal di schiena cronico subacuto o primario è generalmente considerato l'approccio più efficace per migliorare la funzionalità e prevenire la di-sabilità lavorativa a lungo termine [5, 6]. Fattori di rischio sul posto di lavoro Alcuni tipi di esigenze di lavoro fisico aumentano il rischio di insorgenza del mal di schiena, ma il dolore alla schiena può essere sperimentato in tutti i settori e le professioni. Le attività lavorative fisiche associate all'insorgenza del mal di schiena includono posture scomode, improvvisa impossibilità a svolgere le proprie mansioni di lavoro, affaticamento, sollevamento di carichi pesanti, lavoro all'aperto, movimenti delle mani e frequenti piegamenti e torsioni [7-11]. Le richieste psicologiche che aumentano il rischio di mal di schiena sono lo scarso supporto del supervisore, il lavoro monotono stressante, il lavoro a ritmi rapidi, l'insicurezza 1
... B. Katastrophisieren, Schon-und Angstvermeidungsverhalten, beharrliche Achtsamkeit u. Ä.) und psychischen Störungen wie Depressionen, Angststörungen und posttraumatischen Belastungsstörungen zusammenhängen [3,[15][16][17][18][19]. ...
Zusammenfassung
Hintergrund Eine Mehrzahl der Rückenschmerzpatienten leidet unter unspezifischen Schmerzen im unteren Rücken, die nicht auf eine bestimmte Ursache zurückzuführen sind, zwei Drittel davon unter rezidivierenden Beschwerden. Um die Wahrscheinlichkeit von wiederkehrenden und anhaltenden Schmerzen zu reduzieren, werden immer häufiger Testungen zur Ermittlung des aktuellen Funktionsstatus angewendet. Die vorliegende Literaturstudie untersucht die Evidenz von funktionellen Tests bei unspezifischen Rückenschmerzen und deren Aussagekraft bezogen auf den Return-to-Activity(RTA)-Status. Speziell zielt die Analyse auf Aktivitätsempfehlungen sowie die Einschätzung des Rezidiv- und Chronifizierungsrisikos ab.
Methoden PubMed-basierte Literaturrecherche. Narrative Übersichtsarbeit aus Arbeiten der letzten zehn Jahre.
Ergebnisse Insgesamt wurden 12 Studien in die Analyse eingeschlossen. Es konnten 33 Tests identifiziert werden, zu denen positive Aussagen bezüglich Reliabilität, Validität und ihrer Relevanz bei der Beurteilung des RTA-Status bei unspezifischem Rückenschmerz getroffen werden konnten. Weiter zeigt sich, dass die untersuchten Tests bei der Beurteilung des RTA-Status und auch zum Erkennen von Yellow und Blue Flags bei Patienten mit unspezifischen Rückenschmerzen gewinnbringende Hinweise geben könnten. Dabei spielen die Gehfähigkeit, das Verhalten beim Heben und Tragen von Gegenständen, die motorische Kontrolle, die Muskelkraft und die Beweglichkeit eine übergeordnete Rolle.
Schlussfolgerung Die Ermittlung des RTA-Status bei Patienten mit unspezifischen Rückenschmerzen sollte patientenspezifisch, biopsychosozial orientiert sein und nicht ausschließlich durch bewegungsbezogene Tests erfolgen. Genaue Aussagen, wann ein Patient die alltäglichen Belastungen und seine Arbeit ohne ein erhöhtes Rezidiv- oder Chronifizierungsrisiko wieder aufnehmen kann, scheinen mithilfe funktioneller Tests nicht möglich. Der große Einfluss von psychischen und sozialen Faktoren auf Krankheitsentstehung, -verlauf und -prognose sind dabei limitierende Faktoren. Bewegungs- und belastungsbezogene Tests können dennoch sinnvoll eingesetzt werden, um alltagsbezogene Aktivitäten zu evaluieren, den Therapieprozess zu planen und Patienten Sicherheit vermitteln.
... 10 In turn, this can result in increased job stress, high physical demands, job dissatisfaction, an unsupportive workplace and more subsequent days off. 11 Individuals with chronic pain may feel guilty, frustrated, and even a burden to colleagues, leading to a detrimental effect on their own mental health and a decline in morale across the workplace as colleagues become frustrated with having to pick up the sufferers workload as productivity levels wane due to both absenteeism and presenteeism. 12,13 While presenteeism has clear psychosocial and financial costs, these costs remain difficult to quantify. ...
Background & Aims
Much is known about the impact of pain in terms of medical costs and missed work. Less is known about its associations when individuals are present for work. This study examines “presenteeism” by analysing the psychosocial costs of pain in the workplace, using the 2015 European Working Conditions Survey (EWCS).
Methods
We conducted cross-sectional analysis of 2,384 individuals with chronic pain, and 2,263 individuals without pain (matched by age and sex), using data from the European Working Condition Survey (2015). We compared groups in terms of the following psychosocial factors: Supervisor Support, Job Responsibility, Team Cohesion, Discrimination, Threats/Abuse, Job Competency, Job Reward, Sexual Harassment, Stress, and Job Security. The groups were also compared in terms of days lost due to illness.
Results
People with pain were 64% less likely to view their job as rewarding (OR .61, 95% CI .57-.65), 47% more likely to be subjected to threats/abuse in the workplace (OR .68, 95% CI .63-.73), 30% more likely to report poor supervisor support (OR .77, 95% CI .73-.82), and 28% more likely to perceive discrimination in the workplace (OR .78, 95% CI .71-.85). People with pain missed approximately 9 more days of work per year than the non-pain respondents.
Conclusions
Chronic pain was associated with lower vocational fulfilment, and feelings of being ostracised in the workplace. These findings suggest that the presence of pain in the workplace goes well beyond lost productivity due to absenteeism.
... Blue flags represent workplace environmental risk factors such as increased stress, demanding work environment, and lack of support as perceived by the worker [2]. The black flags represent the actual workplace conditions, such as the nature of the work, and the insurance and compensation system under which workplace injuries are managed [2][3][4]. ...
Purpose
Psychosocial factors are known to affect recovery and return to work, but their relationship with the work status of patients with neck pain is not well-studied. The objectives of this study were (1) to explore the characteristics of the injured workers based on the cumulative number of psychosocial flag signs, and (2) to examine the relationship between work status and gender, age, number of flag signs and perceived pain and mental well-being.
Methods
This study involved a review of the electronic files of consecutive workers with a neck injury. Pain intensity was measured by the numeric pain rating scale (NPRS), and anxiety and depression were measured by the Hospital Anxiety and Depression Scale (HADS). A gender-sensitive subgroup analysis and a forward stepwise logistic regression examined the relationship between work status and patient characteristics.
Results
Data of 95 patients, 36 (38%) females, mean age = 46(10) were analysed. Gender-sensitive analysis showed a differential pattern of relationship between work status and worker’s attributes. Stepwise logistic regression showed that a less successful work status was associated with an older age (0.029), higher number of flag signs (p = 0.001), and higher levels of anxiety (p = 0.050) and depression (p < 0.0001).
Conclusions
Psychosocial flag signs have an independent relationship with work status after a neck injury. The presence of three or more flag signs is an indication that an injured worker may need additional support and targeted interventions for a successful return to work. There is a differential pattern of relationship between return to work and workers’ attributes based on their gender.
... The importance of finding efficient measures cannot be underestimated, especially so in times of economic crisis and precarious employments [3,4]. Early detection and treatment of work-related stress (WRS) as well as identification of underlying factors are seen as important to avoid absence from work [5][6][7][8]. Primary health care (PHC) has an important role in this respect, as it often is the first medical contact for patients with physical or mental health complaints. ...
Background:
General practitioners (GPs) regularly handle cases related to stress and work capacity, but often find this work difficult. However, using an assessment tool in a structured way can increase GPs' awareness of the risk for sick leave and need of referrals to preventive measures. Today there is no established methodical practice for this in primary health care. The aim of this study was to explore GPs' reasoning about using the Work Stress Questionnaire combined with feedback at consultation as an early intervention to reduce sick leave.
Methods:
A focus group study was performed with 23 GPs at six primary health care centres. The discussions were analysed based on a method by Krueger.
Results:
Three themes emerged. Positioning work-related stress describes the need to make fundamental standpoints on stress and how it should be handled, to make sense of their work concerning work-related stress. Making use of resources focuses on GPs performing to the best of their ability using assigned resources to treat patients with stress-related ill health, even if the resources were perceived as insufficient. Practising daily work focuses on the GPs' regular and preferred way of working set against the degree of intrusion and benefits. The two related themes making use of resources and practising daily work were mirrored through the third theme, positioning work-related stress, to form an understanding of how GPs should work with patients perceiving work-related stress.
Conclusions:
The GPs own competence and tools, those of other professionals and the time allocated were seen as important when treating patients perceiving ill health due to work-related stress. When resources were insufficient though, the GPs questioned their responsibility for these patients. The results also indicate that the GPs viewed their ordinary consultative way of working as sufficient to identify these patients. The intervention was therefore not seen as useful for early treatment of patients at risk of sick leave due to work-related stress. However, prevention is an important part of the PHC's responsibility, and strategies concerning stress-related ill health therefore need to be more thoroughly formulated and incorporated.
Trial registration:
ClinicalTrials.gov, NCT02480855 . Registered 20 May 2015.
