Work-related factors contributing to chronic disability in low back pain

Low back pain is a costly and incapacitating musculoskeletal disorder. Prospective studies documenting the capacity of work-related factors to predict chronicity are few in number, the methodology used is very diversified, and the results obtained diverge. The aim of the present study is to investigate the capacity of work-related objective (non-psychosocial) and psychosocial factors to predict chronic disability related to low back pain. A longitudinal prospective study with two measurement times was carried out. The sample (N = 258) consisted of workers with subacute low back pain who were on sick leave and receiving compensation from the CSST (Quebec Workers' Compensation Board). Of all the work-related variables measured, perceived stress and fears and beliefs about work were associated with return to work status at the six-month follow-up. The results obtained show the importance of considering fears and beliefs about work when identifying people in the subacute phase of low back pain who are at risk of developing chronic disability.     

Work-related mild-moderate traumatic brain injury and the construction industry

Background: Consequences of traumatic brain injury underscore the need to study high-risk groups. Few studies have investigated work-related traumatic brain injuries (WrTBIs) in the construction industry. Objective: To examine WrTBIs in Ontario for the construction industry compared to other industries. Methods: A retrospective study of individuals who sustained a WrTBI and had a clinical assessment as an outpatient at a hospital-based referral centre. Data were collected for a number of factors including demographic, injury and occupation and were analyzed according to the Person-Environment-Occupation (PEO) model. Participants: 435 individuals who sustained a WrTBI. Results: There were 19.1% in the construction industry, 80.9% in other industries. Compared to other industries, individuals in the construction industry were more likely to be male, to not have attained post-secondary education, and experience multiple traumas. WrTBIs in the construction industry were commonly due to elevated work. The construction occupations involved included skilled workers and general labourers, and compared to other industries, WrTBIs occurred most often for those employed for a short duration in the construction industry.Conclusions: Construction industry workers experience serious WrTBIs that are amenable to prevention. Use of the PEO model increased our understanding of WrTBIs in the construction industry.     

Effectiveness of a screening tool to detect injuries during Army Health Care Specialist training

The purpose of this project was to evaluate the effectiveness of an initial screening and referral process in reducing the impact of musculosketetal injuries among soldiers attending Health Care Specialist training. Musculoskeletal injury among Army Health Care Specialist students have been reported to be approximately 24% for men and 24-30% for women. The highest student visit rate to the troop medical clinic for musculoskeletal injuries, for men and women, occurs during the first week of training. Anecdotal reports indicate that many students arrive for training with existing injuries or symptoms. This project was designed to assess whether formalized early screening, referral, and intervention could 1) identify arriving students who need musculoskeletal injury-related medical attention, 2) reduce the number of students receiving limited duty status during their 10-week training, 3) decrease the total number of limited duty days for students, and 4) decrease the number of students who cannot graduate due to musculoskeletal injury. Students (N=291) from one company were divided into three groups of 97 students. Three methods were used to screen and refer students for medical intervention: 1) traditional (T), 2) by health care providers (HCP), or 3) by Drill Sergeants (DS). Screening by HCP and DSs involved using a new screening tool to identify and consequently refer students with symptoms to a troop medical clinic (TMC) for early evaluation and intervention. Using the screening tool, HCPs identified 92% of students with injuries, while DSs accurately identified 80%. The screening did not reduce the number of students receiving limited duty status, total limited duty days, or the number of students that could not graduate due to musculoskeletal injury ("holdovers") (p>0.05). The screening tool demonstrated good sensitivity and specificity whether conducted by HCPs or DSs. It failed to demonstrate efficacy in reducing the impact of musculoskeletal injuries among Combat Medic soldiers, as measured by limited duty days and holdovers.     

Motives for flexible work arrangement use

This study investigated employees’ motives for using two types of flexible work arrangements (FWA), flextime and flexplace. Using a sample of workers with high job flexibility (university academics), we examined both the prevalence of different motives (life management and work-related) and how these motives vary according to several individual differences (gender, family responsibility, marital status, and work-nonwork segmentation preferences). Overall, results indicated that employees are more driven to use FWA by work-related motives than by life management motives. Those with greater family responsibilities and those married/living with a partner were more likely to endorse life management motives, whereas individuals with greater segmentation preferences were more motivated to use FWA by work-related motives. Findings regarding gender were contrary to expectations based on traditional gender roles, as there were no gender differences in life management motives but women more highly endorsed work-related motives than did men. The main implications of the findings are that individuals recognize FWA as not only a work-family policy, but also as a potential means to increase productivity. Individual differences relate to why workers use available flexible policies. Additional theoretical and practical implications are discussed.     

Workers' compensation for psychological injury: demographic and work-related correlates

This study aimed to determine the demographic and work-related factors that contributed to the filing of a workers' compensation claim for psychological injury. Four groups of employees were compared: those who filed a workers' compensation claim, those who sought psychological treatment for occupational stress but did not file a workers' compensation claim, those who experienced elevated stress levels but did not seek help or lodge a claim, and those who experienced stressful events at work but did not develop symptomatology. The results indicated few variables that could adequately explain why some stressed employees opted for a workers' compensation claim. The implications of these results are discussed.     

Evaluation of an inter-organizational program for prevention of work-related injuries in a WHO Safe Community

OBJECTIVE: To evaluate the effect of a community-based injury prevention program on work-related injuries. STUDY DESIGN: A population-based quasi-experimental design was used with pre- and post-implementation measurements in an intervention and a control area. The program was based on cross-sectoral participation in detecting and taking action against work-related injuries. Change in the relative risk of injury was estimated by the odds ratio. RESULTS: The relative risk of work-related injury decreased following program exposure, whereas a tendence toward increase was observed in the control area. Middle-aged men accounted for the largest decrease in injury risk. Among the women, a decrease was observed only in the upper middle-aged group. No female-dominated occupational area showed a decrease in injury risk following exposure to the program. CONCLUSION: The study showed that the community-based approach had a general effect on the incidence of work-related injuries.     

Worker perceptions of organizational support and return-to-work policy: associations with post-injury job satisfaction

This study evaluates the psychometric properties of an industry-based employee measure of employer responses to injuries (i.e., organizational support and return-to-work policies) and explores the relationship of these variables to post-injury job satisfaction. Survey data were collected from 1438 employees with work-related injuries in 13 construction companies and 13 transportation companies. Factor analyses supported the two-factor structure of the scale, and both organizational support and return-to-work policies were independently associated with post-injury job satisfaction. The results suggest a need for understanding organizational responses to injuries, employee perceptions of injury response, and the impact of both on organizational outcomes.     

Factors affecting the organizational responses of employers to workers with injuries

The organizational responses of employers to work-related injuries is one of several significant influences on return-to-work outcomes. Thus, understanding the factors that lead to better or worse organizational responses to work injuries may ultimately help to improve success in this area. The purpose of this study was to systematically explore factors that might influence the organizational responses of employers to injured workers, based on employee perceptions. Cross-sectional survey data were collected from 2,943 subjects with work-related injuries which had occurred less than eight weeks prior to survey completion. Measured variables included pre-injury demographic and job factors, injury circumstances, and a measure of post-injury events that comprised the organizational response. Multivariate linear regression results show that age, gender, job dissatisfaction before injury, prior difficulty performing job tasks, injury severity, back injury and lost time were all associated with negative organizational responses, suggesting potential opportunities for intervention.     

Perception differences between groups of employees identifying the factors that influence a return to work after a work-related musculoskeletal injury

Employee health and productivity losses as a result of work-related injury are estimated to be US dollars 1.2 trillion annually to US companies. This is approximately 14.3% of the gross domestic product [6,8,11,35]. Workers' compensation, medical care, and short and long-term disability are a part of these costs. Controlling or eliminating these costs is a problem for US employers [3,6,14,21,29]. The study discussed in this article examined the perceptions of manufacturing employees in identifying factors that influence a return to work after a work-related musculoskeletal injury. The classification of employees who participated in this study were safety professionals, supervisors and workers from the manufacturing industry in central Kentucky. The worker group consisted of material handlers, assembly line workers and quality control inspectors. The participants completed a developed survey instrument, the Return to Work Perception Survey. This survey instrument examined the perception of the participants on factors related to return to work: company policies and procedures, job satisfaction, worker relationships and work environment. The results indicated safety professionals and supervisors perceptions differ from workers on the variables of job satisfaction, worker relationships and work environment. Their perceptions did not differ on the variable relating to company policies and procedures. In addition, the safety professional and supervisor groups rated the items addressing job satisfaction higher than did the worker group. The worker group did not differ from one another on any of the factors. Implications of this study for manufacturing companies suggest (a). identifying those issues contributing to employee job satisfaction, (b). developing a plan for achieving increased job satisfaction and employee recognition at the workplace among all workers, and (c). consider allowing employees to develop new capacities and new learning, thus fostering motivation and job satisfaction [18,20].     

Experience of musculo-skeletal disorders,intensity of pain,and general conditions in work -- The case of employees in non-private dental clinics in a county in southern Sweden

OBJECTIVES: (1) To identify perceived musculo-skeletal disorders and intensity of pain among the employees in the non-private dental clinics; (2) To assess perceived psychosocial and physical work conditions on the localization and intensity of musculo-skeletal disorders and pain. STUDY DESIGN: A questionnaire, comprising four sections (demographic, self-reported psychosocial and physical work conditions, self-reported disorders from the musculo-skeletal system, self-reported intensity of pain on nine different localization on the body) was mailed to 391 employees. Of these, 338 reported musculo-skeletal disorders. In this latter group, 239 reported work as the cause. These employees completed the questionnaire. RESULTS: The greatest amount of pain was reported for the cervico-brachial region. Among all participants, a response pattern was found where the physical work demands were very high, the psychosocial work demands fairly high, the work climate supportive, and the control over work moderate. At an occupational group level, theoretical inconsistencies were identified in terms of a lack of anticipated relationships, especially for the dentist groups. CONCLUSIONS: For a scientific and social purpose, more research, which identifies relationships between work-related musculo-skeletal pain and dos-response [8], effort-reward [16], and demand-control [12] aspects of the working conditions, is clearly needed.     

Differential labeling of mental illness by social status: a new look at an old problem

Whether the higher rates of mental hospitalization and involuntary treatment for marginal social groups are due to differential labeling or simply to the occurrence of higher rates of disorder in these groups remains unresolved. I reexamine this issue with data from the National Comorbidity Survey (N = 5,877) that allow comparisons between disturbed individuals living in the community untreated and disturbed persons who have been hospitalized or seen a professional for their mental health problems under pressure or voluntarily. Contrary to labeling theory, members of lower status groups are not consistently overrepresented among those who have been hospitalized or seen a professional against their will. Consistent with self-labeling theory, persons with greater education and those not in poverty are disproportionately present among individuals who sought treatment by choice. Additional analyses show that factors that predict service utilization are important determinants of mental health service use but do not account systematically for status disparities in hospital or outpatient treatment, especially disparities by poverty status. Although I do not confirm a central tenet of labeling theory here, the negative consequences of labeling and stigma continue to be well-supported in the literature.     

Musculoskeletal symptom survey among cement and concrete workers

Work in construction is associated with a high risk for musculoskeletal disorders and injuries. The symptom survey was conducted to determine the magnitude and musculoskeletal injury characteristics among the cement and concrete workers and identify the most problematic work-related activities and job factors that might have contributed to the occurrence of these disorders. Findings revealed that a large proportion of the laborers (77%) experienced at least one musculoskeletal disorder in the last year. Low back pain was reported as the most frequently experienced symptom (66%). 'Working while in pain' the concrete workers perceived as the major problem in the trade. Other problematic work-related activities included 'bending or twisting the back', 'work in hot, cold or wet conditions', and 'handling heavy objects'. Most of the laborers (82%) requested on-the-job safety training. Survey results combined with the outcomes of focus groups discussions and work site observations were used in the design of a training program aimed at the prevention of musculoskeletal morbidity in the trade. The program incorporated ergonomics principles, hazard recognition, safe work practices, problem solving and personal protection in the training curriculum for membership of the trade.     

Female-perpetrated intimate partner violence and romantic attachment style in a college student sample

The frequency, severity, and reciprocity of female-perpetrated intimate partner violence and its consequences (i.e., injuries) were investigated in a college sample of women (N = 457). Participants were classified into one of the following four groups on the basis of self-reported physical assault perpetration and victimization against their relationship partners: nonviolent, perpetrator-only, victim-only, and bidirectionally violent. Results showed that females in the bidirectionally violent group had a reportedly higher occurrence (although not always statistically significant) of perpetration and victimization than those in the perpetrator-only and victim-only groups. Additionally, a similar degree of reciprocity was indicated by females in bidirectionally violent relationships in terms of violence severity and the occurrence of injury. Adult romantic attachment style was also examined among a subset of females (N = 328), and bidirectionally violent females were found to have the highest reported levels of attachment anxiety. Further, females high in attachment anxiety and low in attachment avoidance were more likely to report perpetrating violence than females high in both styles. Implications for prevention are discussed.     

Low back pain disability and stay at work: contradiction or necessity?

The incidence of occupational diseases in the population is high and factors such as long working hours, poor posture, psychological and physical stress can contribute to its development. Among work-related musculoskeletal disorders, back pain has a high prevalence. The aim of the present study was to quantify and characterize pain complaints and to identify individuals with low back pain, in order to assess the degree of disability. Participated 226 employees of an institution of higher education. They answered a general questionnaire about location and quantification of pain complaints visual analog scale for pain and the Quebec Disability Questionnaire. Of all the workers, 69.60% had some type of musculoskeletal complaint; of those, 15.41% had low back pain. Considering workers who had back pain, 54.9% were female, 52.94% are under 30 years old and 43.14% between 1 and 5 years of work. As for the final score for the degree of disability, 41.17% had minimal disability and 37.25% moderate disability. The present study found large number of pain complaints and high prevalence of low back pain, resulting in individual's inability and difficulties in performing work activities.     

Workers' compensation for psychological injury: personal and environmental correlates

The aim of this study was to determine the personal and environmental factors that contribute to the lodging of a workers' compensation claim for psychological injury. Four groups were compared: individuals who had lodged a workers' compensation claim, people who had sought psychological assistance for the management of work-related stress reactions but who had not lodged a workers' compensation claim; people who had experienced stress symptoms but who had not lodged a claim or sought help; and people who experienced stressful work events but who had not developed symptoms. Examination was made of cognitive distortion, irrational beliefs and coping resources as individual factors, and stressful life events, daily hassles and work environment factors as environmental variables. The Compensation group was distinguished from other groups only on the basis of work environmental factors. The implications of these results in the understanding of the decision to lodge a workers' compensation claim are considered.     

Employer‐Supported Child Care: Who Participates?

Child‐care vouchers are becoming more common and can provide child‐care assistance to a wide spectrum of the population. There is little empirical research, however, on which workers participate in their employer's child‐care programs. In this exploratory study, employees with children at 1 large university completed questionnaires to gather information on their child‐care arrangements and their experience with the employer's child‐care voucher program (N = 949). Results indicate that the employees who were most in need of child‐care assistance in terms of family structure, job type, and child‐care expenses were more likely to receive vouchers. Federal policy limiting the structure of employer‐sponsored voucher programs appeared to present barriers to participation for certain groups of employees.     

Case report: a work simulation program for a manual worker with a fracture injury

Work rehabilitation programs targeting different client groups are available in nearly all major hospital occupational therapy departments in Hong Kong. Clients receiving work rehabilitation are referred from various out-patient clinics and other occupational therapists. Those clients experience limitation in work after their injuries or diseases and plan to return to work after rehabilitation. Program objectives are 1) to assist clients to reach maximum work capacity as rapidly as possible 2) to ensure clients return to work safely 3) to improve clients' work readiness. This case report describes an individualized work simulation program at a general hospital in Hong Kong provided for a typical client who is preparing to return to his worker role. Specific job analysis, goals and program rationale for the client are discussed.     

A five year retrospective analysis of occupational injuries and incidence reported at a research intensive Canadian university

Limited information of occupational injury statistics within academic settings exists. Universities and colleges are an important and insightful work environment due to the varied nature of the work performed by employee groups. The objective of this study was to describe occupational injuries for all work groups in a large research intensive university. A retrospective database analysis was conducted on 2029 employee incident reports over a five year period (2000-2004) to determine general and departmental prevalence of injury types, locations, and mechanisms. Demographic analysis revealed an average age of 42 years and 9 years of work experience. Overall, the most frequent injuries were to the hand (40%), were musculoskeletal in nature (42%), and resulted from being "struck or contacted by" (33%). The greatest number of incidents occurred in food services, followed by physical plant and staff services. Closer examination of incidents reported by food services indicated 53% of injuries occurred to the hand and 72% required first aid. Notable too was that 19% of physical plant injuries occurred to the back, but these reports accounted for 40% of total back injuries and 50% of all lost time claims in the total database. Further epidemiological research in academic institutions is needed to better understand the inherent injury risk in this work sector.     

The impact of function on work status for community dwelling disabled persons with arthritis: an analysis of the National Health Interview Survey Disability Supplement

Arthritis is one of the most common diseases and a leading cause of disability in adults. Returning injured workers to work and preventing work disability is the primary mission of occupational health professionals. The purpose of this study was to identify risk factors associated with work disability and intervention strategies. This study is a retrospective cohort analysis of secondary individual level data. The data for the study were collected by the National Health Interview Survey, Disability Supplement (NHIS-D) 1995. Community dwelling disabled persons with functional limitations due to arthritic conditions were included in this analysis. A total of 286 records were available for logistic regression analysis. The outcome variable was work status, either working or not working. The significant predictors of working status were ability to lift 10 pounds (OR = 1.64), college education (OR = 0.21), age (OR = 1.03), and less than high school education (OR = 2.48). Thirty-four percent of the variance in working status was explained by the model that also included health status, difficulty standing, difficulty walking up steps, difficulty walking 1/4 mile, ethnicity, and gender. Younger disabled persons with arthritis, who have little difficulty lifting 10 pounds, and have some college education have better odds of working. Occupational health professionals need to look for ways to improve the educational status and functional lifting ability of disabled individuals with arthritis.