Pain-related work interference is a key factor in a worker/workplace model of work absence duration due to musculoskeletal conditions in Canadian nurses

A scoping review of the use of exercise-based upper extremity injury prevention programs for industrial workers

STUDY DESIGN

This study is a scoping review.

INTRODUCTION

Exercise-based upper extremity injury prevention programs are used by employers to reduce the cost of work-related injuries in the industrial work setting.

PURPOSE OF THE STUDY

The purpose of the study was to identify, report, and evaluate all published literature that describes exercise-based upper extremity injury prevention programs used with an industrial workforce.

METHODS

A systematic search of Medline, ProQuest, Pubmed, and Worldcat databases was performed. Data extracted included the type of outcome tool used, the outcome that was measured, the components of the exercise program, and the effectiveness toward reducing injury.

RESULTS

14 studies were included in the final analysis and summary. 12 articles included strengthening (85%) 10 included stretching (71%), 2 included health coaching (14%), and 2 included work simulation (14%). The most prevalent treatment approach was combined stretching and strengthening which accounted for 5 of the 14 studies, or 36%. The intervention period ranged from 4 weeks to 1 year and the program frequency ranged from before every work shift to weekly performance. There were 22 different outcome measures with health condition reported in 12 of 14 studies (86%) and function reported in 7 of 14 studies (50%).

DISCUSSION AND CONCLUSIONS

Although many of the studies showed positive benefits to the exercise program, there is a wide variance in the current literature regarding the implementation, supervision, and exercise components of an upper extremity injury prevention program in an industrial work setting. Because there is no commonly-accepted exercise program, a conclusion regarding effectiveness cannot be generalized outside of the environment, supervision requirements, frequency, and duration in which the research was performed. There is a need for improved reporting techniques and a preferred program to be replicated across multiple work settings in order to allow generalizability of findings.

Obesity and the Receipt of Prescription Pain Medications in the US

BACKGROUND

Little is known about disparities in pain treatment associated with weight status despite prior research on weight-based discrepancies in other realms of healthcare and stigma among clinicians.

OBJECTIVE

To investigate the association between weight status and the receipt of prescription analgesics in a nationally representative sample of adults with back pain, adjusting for the burden of pain.

DESIGN

Cross-sectional analyses using the Medical Expenditure Panel Survey (2010-2017).

PARTICIPANTS

Five thousand seven hundred ninety-one civilian adults age ≥ 18 with back pain.

MAIN MEASURES

We examine the odds of receiving prescription analgesics for back pain by weight status using logistic regression. We study the odds of receiving (1) any pain prescription, (2) three pain prescription categories (opioid only, non-opioid only, the combination of both), and (3) opioids conditional on having a pain prescription.

KEY RESULTS

The odds of receiving pain prescriptions increase monotonically across weight categories, when going from normal weight to obesity II/III, despite adjustments for the burden of pain. Relative to normal weight, higher odds of receiving any pain prescription is associated with obesity I (OR = 1.30 [95% CI = 1.04-1.63]) and obesity II/III (OR = 1.72 [95% CI = 1.36-2.18]). Obesity II/III is also associated with higher odds of receiving opioids only (OR = 1.53 [95% CI = 1.16-2.02]), non-opioids only (OR = 1.77 [95% CI = 1.21-2.60]), and a combination of both (OR = 2.48 [95% CI = 1.44-4.29]). Obesity I is associated with increased receipt of non-opioids only (OR = 1.55 [95% CI = 1.07-2.23]). Conditional on having a pain prescription, the odds of receiving opioids are comparable across weight categories.

CONCLUSIONS

This study suggests that, relative to those with normal weight, adults with obesity are more likely to receive prescription analgesics for back pain, despite adjustments of the burden of pain. Hence, the possibility of weight-based undertreatment is not supported. These findings are reassuring because individuals with obesity generally experience a higher prevalence of back pain. The possibility of over-treatment associated with obesity, however, may warrant further investigation.

Study on the Associations of Individual and Work-Related Factors with Low Back Pain among Manufacturing Workers Based on Logistic Regression and Structural Equation Model

Work-related musculoskeletal injuries are one of the major occupational health issues of the workers, especially low back pain (LBP). The aim of this study was to survey the prevalence of LBP among manufacturing workers and to identify associations of individual and work-related factors with LBP. A cross-sectional questionnaire study was performed with 1173 participating manufacturing workers. The questionnaire included individual factors, psychosocial and physical exposures, and musculoskeletal discomfort. It was analyzed by logistic regression and structural equation modeling (SEM). The 1-year prevalence of LBP among Chinese manufacturing workers was 33.6%. Logistic regression analysis showed that job tenure, awkward postures, vibration and job demand were positively—while social support and job control were negatively associated with LBP (p < 0.05). The SEM results indicated that, as shown in other studies, job types, job tenure, postural load, high job demand, low job control and vibration were directly associated with LBP, but also that job types, high job demand, low social support and vibration may have indirect effects on LBP—mediated by postural load.

Presenteeism: Nurse perceptions and consequences

AIMS

To describe factors leading to and consequences of nurse presenteeism.

BACKGROUND

Presenteeism is more prevalent among nurses than other occupational groups. Existing literatures focuses on prevalence and consequences of presenteeism for patients, health care organizations, and nurses. However, we lack understanding of nurse perceptions of factors leading to and consequences of presenteeism.

METHODS

A total of 295 free responses to a cross-sectional survey were analysed using conventional content analysis.

RESULTS

Nurses consider multiple factors in deciding how to respond when presentee. These include illness, staffing, availability of leave time, patients, financial constraints and guilt. Consequences of presenteeism identified were decreased mental acuity and attitude leading to lessened communication both in-person and in documentation, transmission of illness, and decline in unit culture, patient care, and nurse health and well-being.

CONCLUSIONS

Multiple factors lead to nurse presenteeism and there are negative consequences to nurses' health, work environment and patient care outcomes.

IMPLICATIONS FOR NURSING MANAGEMENT

This study leads to key discoveries to the reasons for and consequences of nurse presenteeism. Many of the factors leading to presenteeism can be addressed through culture and policy changes within organizations. The consequences to patient care outcomes and the work environment emphasize the importance of addressing presenteeism.

Chronic pain in the workplace: A diary study of pain interference at work and worker strain

Chronic pain is both prevalent and one of the leading causes of work-related disability. Somatic experiences of pain and pain interference with daily activities at work may lead to psychological distress and strain in workers. In accordance with the appraisal theory of stress, we proposed a model in which pain interference mid-workday predicts negative affect and end-of-workday emotional exhaustion in workers who interact with customers. Further, we proposed that pain interference predicts variance in negative affect and exhaustion beyond somatic experiences of pain, based on our theoretical proposition that pain interference represents a secondary stress appraisal. Participants (N = 86 full-time workers with chronic pain) completed 2 online surveys per day for 5 consecutive workdays. Results from multilevel path analysis supported our hypotheses; pain interference predicted both negative affect and end-of-day emotional exhaustion while controlling for somatic experiences of pain (pain severity). Further, pain interference indirectly predicted end-of-day emotional exhaustion via negative affect while controlling for somatic pain experiences. Results highlight the importance of pain interference as a stressor at work for individuals working with chronic pain and point to the need for effective interventions for this working population.

Examining age differences in duration of wage replacement by injury characteristics

BACKGROUND

One explanation for why older age is associated with greater duration of wage replacement following a work-related injury may be that older workers sustain more severe injuries and different types of injury compared with their younger counterparts.

AIMS

To examine the role of injury-related characteristics in explaining the impact of age on wage replacement duration, and whether the relationship between age and wage replacement duration is consistent across injury types and levels of severity.

METHODS

A secondary analysis of workers' compensation claims in the Australian state of Victoria. In Victoria, only injuries which have accumulated >10 days of wage replacement, or have health care expenditures above a financial threshold, are eligible for compensation. Nested regression models were used to examine the relative contribution of injury-related characteristics to age differences in wage replacement duration.

RESULTS

Older age was associated with greater days of wage replacement among men and women, even after adjusting for injury characteristics. Adjustment for differences in injury types and compensation reporting practices resulted in moderate attenuation of the age-duration relationship among men and small attenuation among women. The age-duration relationship was consistent across injury types/severity.

CONCLUSIONS

The relationship between older age and greater duration of wage replacement is ubiquitous across injuries of different types and severity. Future research is required to understand better why older age is consistently associated with worse compensation outcomes following work-related injury.

The Added Value of Collecting Information on Pain Experience When Predicting Time on Benefits for Injured Workers with Back Pain

Objectives Some injured workers with work-related, compensated back pain experience a troubling course in return to work. A prediction tool was developed in an earlier study, using administrative data only. This study explored the added value of worker reported data in identifying those workers with back pain at higher risk of being on benefits for a longer period of time. Methods This was a cohort study of workers with compensated back pain in 2005 in Ontario. Workplace Safety and Insurance Board (WSIB) data was used. As well, we examined the added value of patient-reported prognostic factors obtained from a prospective cohort study. Improvement of model fit was determined by comparing area under the curve (AUC) statistics. The outcome measure was time on benefits during a first workers' compensation claim for back pain. Follow-up was 2 years. Results Among 1442 workers with WSIB data still on full benefits at 4 weeks, 113 were also part of the prospective cohort study. Model fit of an established rule in the smaller dataset of 113 workers was comparable to the fit previously established in the larger dataset. Adding worker rating of pain at baseline improved the rule substantially (AUC = 0.80, 95 % CI 0.68, 0.91 compared to benefit status at 180 days, AUC = 0.88, 95 % CI 0.74, 1.00 compared to benefits status at 360 days). Conclusion Although data routinely collected by workers' compensation boards show some ability to predict prolonged time on benefits, adding information on experienced pain reported by the worker improves the predictive ability of the model from 'fairly good' to 'good'. In this study, a combination of prognostic factors, reported by multiple stakeholders, including the worker, could identify those at high risk of extended duration on disability benefits and in potentially in need of additional support at the individual level.

Musculoskeletal problems and quality of life of elementary school teachers

PURPOSE

To investigate prevalence and anatomical distribution of musculoskeletal pain (MSP) and its impact on quality of life (QoL) in elementary school teachers working in Muğla town center.

METHODS

Physical, sociodemographic and occupational characteristics of 104 teachers were recorded. Onset, prevalence and consequences of MSP (Extended Nordic Musculoskeletal Questionnaire) and QoL (Short Form-36 Health Survey) of teachers with (n = 37) and without (n = 67) MSP during the last 12 months were compared.

RESULTS

The prevalence of MSP was 77% for the lifelong period and 36% for the last 12 months. Physical and sociodemographic characteristics, daily employment period and length of standing and sitting were similar between groups (p > 0.05). The most common painful regions were the neck (39%) and the lower back (38%). MSP of these regions was the common reason for seeking healthcare, prevention from activities and taking sick leave. MSP had negative impact, especially on the physical components of QoL (p < 0.05).

CONCLUSIONS

The results reveal high prevalence of MSP among teachers, as well as its negative impacts on QoL. Especially neck and lower back seem to be the most frequently affected regions of the body. These findings draw attention toward the need for developing strategies to prevent MSP among teachers.

Musculoskeletal occupational injury among surgeons: effects for patients, providers, and institutions

BACKGROUND

The aim of this study was to determine the risk of occupational musculoskeletal injury during a surgeon's career and the effects of these injuries for patients, providers, and institutions. We hypothesized that surgeons have occupational injuries, which affect work performance.

MATERIALS AND METHODS

Electronic RedCAP surveys on workplace injury were distributed statewide via e-mail to the members of the Tennessee chapter of the American College of Surgeons. Descriptive statistics were used to analyze survey data.

RESULTS

A total of 260 of 793 surveys (33%) were returned. Forty percent of surgeons sustained ≥ 1 injuries in the workplace. Although 50% of injured surgeons received medical care for their most recent injuries, only 20% of these injuries were reported to their institution. Twenty-two percent of injured surgeons missed work and 35% performed fewer operations while they were recovering from their injury. Fifty-three percent of injured surgeons reported that pain from their injury had a minimal or moderate effect on their performance in the operating room.

CONCLUSIONS

Surgeons appear to be at moderate risk for occupation-related injuries. The low rate of institutional reporting for these injuries is concerning, as this is a required step to access institutional support once injured. Surgeon injury results in lost productivity due to missed workdays and may impact the quality of surgical care because of performance issues while recovering from injury.