Common health problems, yellow flags and functioning in a community setting

Do Maladaptive Imaging Beliefs Predict Self-Reported Pain Interference and Physical Function in Patients With Musculoskeletal Disorders?

OBJECTIVE: To determine if maladaptive imaging beliefs correlated with, and predicted pain interference and physical function outcomes in people with musculoskeletal pain disorders. DESIGN: A prospective cohort study of patients with musculoskeletal disorders receiving outpatient physical therapy from April 2022 to August 2023. METHODS: Four questions about imaging were asked to assess maladaptive beliefs, the need to rule out serious conditions, guide treatment, determine diagnosis, and validate symptoms. Correlations with beliefs and outcomes were assessed using Kendall's tau rank and Spearman's rho correlation coefficients. Generalized linear models determined if these beliefs predicted outcomes at baseline and 6 weeks. RESULTS: The cohort included 152 participants (mean [standard deviation] age: 56.13 [15.13]; 32.2% male). Maladaptive imaging beliefs correlated positively with pain interference and negatively with physical function. The need to rule out serious conditions and validate symptoms correlated with pain interference (range: τb = 0.17, 0.20; P = .003, .0121) and physical function (range: ρ = -0.22, -0.22; P = .006, .008). All but 1 belief correlated with pain interference (range: τb = 0.19, 0.24; P<.001, .004) and physical function (range: ρ = -0.26, -0.21; P = .001, .009) at 6 weeks. Each additional belief slightly increased pain interference at 6 weeks (β = 0.01; 95% CI: 0.001, 0.03; P = .04) and lowered physical function at both baseline (β = -0.97; 95% CI: -1.66, -0.28; P = .01) and 6 weeks (β = -0.76; 95% CI: -1.37, -0.15; P = .02). CONCLUSION: Maladaptive imaging beliefs were significantly (albeit weakly) correlated with pain and physical function. Each additional maladaptive imaging belief increased pain interference at 6 weeks and lowered physical function at baseline and 6 weeks. Beliefs about the necessity of imaging to properly manage musculoskeletal disorders may influence outcomes. J Orthop Sports Phys Ther 2024;54(9):1-10. Epub 5 July 2024. doi:10.2519/jospt.2024.12625.

Preventing Sickness Absence With Career Management Intervention: A Randomized Controlled Field Trial

This study examined whether a group intervention focusing on building up preparedness for career management can prevent future sickness absence.

Register-based data on the number of sickness absence days and sickness absence episodes were examined as outcomes of the intervention among 684 employees in 17 organizations in a randomized controlled trial. Sickness absence data were collected covering a period from 1 year before (baseline) to approximately 2 years after the intervention (follow-up). The data were analyzed using zero-inflated negative binomial models.

After controlling for baseline absence, age, gender, and organization, the intervention was effective in decreasing the number of longer sickness absences (lasting longer than > 2 weeks), but no other significant effects were found.

These findings point out that it is feasible to use a career management intervention to prevent future sickness absence in work organizations.

Challenges to remaining at work with common health problems: what helps and what influence do organisational policies have?

INTRODUCTION

Common health problems have a significant impact on work productivity (presenteeism), and sickness absence. The aim of this study was to examine the attitudes and beliefs of employees in the public sector about common health problems and work using the Flags system as a conceptual framework to identify problems and potential solutions.

METHOD

63 employees took part in 14 focus groups in two public sector organisations. Discussions were audio-recorded, transcribed, and analysed thematically using NVivo.

RESULTS

The study confirmed the importance of heath-focused clinical factors (Yellow flags), perceptions of work (Blue flags), and more objective characteristics of work and organisational policies (Black flags), which emerged as major themes. The social and moral norms surrounding sickness absence and presenteeism were frequently discussed, including the impact of absence on colleagues, guilt, legitimising illness, and trust. There were interactions between the different Flags, often mediated by managers via their relationships with employees and their role in implementing organisational policy.

CONCLUSIONS

The Flags system was useful as a conceptual framework in this context for identifying a number of obstacles to working with health problems, many of which were potentially modifiable on worker, workplace, or wider systems levels.

What happens to work if you're unwell? Beliefs and attitudes of managers and employees with musculoskeletal pain in a public sector setting

INTRODUCTION

Musculoskeletal complaints can impact on work in terms of productivity, sickness absence and long term incapacity for work. While employee attitudes and knowledge can drive absenteeism and presenteeism behaviour, managers also play an important role in influencing this via the quality of their relationships with employees and their role in implementing organisational policies and procedures. The aims of this study were to investigate the beliefs and attitudes of managers and employees with musculoskeletal pain about sickness absence, presenteeism, and return to work and to identify areas of consensus and conflict.

METHODS

18 employees with musculoskeletal pain and 20 managers from two large public sector organisations in South Wales, UK, took part in individual face-to-face interviews. Data were analysed thematically using NVivo.

RESULTS

Employees' and managers' reports indicated that there was a strong culture of presenteeism in these organisations. Establishing the legitimacy of complaints was a salient theme for both managers and employees, although their views were in conflict. Employees reported feeling that contact with employers was intrusive when sickness absence was legitimate. Managers were supportive of those who they felt were 'genuinely' unwell, but also cited examples of people 'working the system' and not reporting absences appropriately.

CONCLUSIONS

These issues require careful consideration of the rights and responsibilities of both employees and employers, where strategies for improving communication, trust, and creating an environment conducive to successful return to work need to be investigated.