Psychological Distress in Workers' Compensation Claimants: Prevalence, Predictors and Mental Health Service Use

Workplace Injury Compensation and Mental Health and Self-Harm Outcomes: A Systematic Review

Workers' compensation systems aim to financially support injured workers. However, seeking compensation often leads to poorer physical and mental health outcomes. This review examines previous studies to investigate the relationship between workers' compensation and mental health and self-harm outcomes. A three-tiered search strategy across five databases identified studies that examined workers' compensation claims as an exposure or risk factor, with outcomes related to mental health, self-harm and suicidality. Nine full-text studies were included; however, heterogeneity limited generalizability. Most studies supported an association between pursuing compensation and poorer mental health and self-harm outcomes. Some studies attributed this to specific aspects of the system such as justice perception and navigation of the claims system. Findings suggest an association between workers' compensation and mental health or self-harm outcomes. Inconclusive findings highlight the need for further research. Understanding the psychiatric impacts of pursuing compensation is crucial to help formulate a more accessible compensation system.

Impact of healthcare interventions on distress following acute musculoskeletal/orthopaedic injury: a scoping review of systematic reviews

BACKGROUND

Musculoskeletal injuries can cause distress, and distress is associated with delayed recovery. Numerous interventions have been developed to facilitate recovery from injury, and several systematic reviews evaluate the efficacy of these interventions for reducing psychological distress.

OBJECTIVES

This scoping review aims to map the synthesised evidence for the relationship between treatment interventions and distress-related outcomes following acute injury. The objectives were (1) to describe the types of interventions that have been evaluated in relation to distress-related outcomes following accidental injury, (2) to examine the scope of distress-related outcomes that have been measured in relation to these interventions and (3) to explore the range of clinical professions that deliver these interventions.

DESIGN

We searched nine electronic databases and grey literature (to 21 April 2022). We included any systematic review reporting on the relationship between interventions delivered in the time following injury and distress-related outcomes. Data relevant to the specific objectives of this scoping review were extracted and described using narrative synthesis.

RESULTS

From 8412 systematic reviews imported for screening, 8266 unique records were screened. 179 were selected for full-text review. 84 systematic reviews were included in the study. Interventional types were pharmacological, psychological, exercise based, physical/manual therapies, virtual reality based, multimodal and workplace based. Interventions were delivered digitally, face to face and using virtual reality by a variety of healthcare professionals, including doctors, nurses, psychologists and physiotherapists. The most frequently reported distress-related variables included anxiety, depression, post-traumatic stress disorder diagnosis.

CONCLUSION

A wide range of interventions may help to mitigate distress following acute accidental musculoskeletal or orthopaedic injury. Even interventions that were not designed to reduce distress were found to improve distress-related outcomes. In view of the important role of distress in recovery from injury, it is recommended that distress-related variables are measured as core outcomes in the evaluation of treatments for acute injuries.

The burden of working time lost to compensable occupational injury and disease in Australia, 2012-17: a retrospective population-based study

OBJECTIVES

To determine the national burden of working time lost to occupational injury and disease in Australia compensable by workers' compensation schemes; to characterise the distribution of time lost by age, sex, and injury and disease type.

STUDY DESIGN

Retrospective population-based study; analysis of National Dataset for Compensation-based Statistics (NDS) data.

SETTING, PARTICIPANTS

Granted workers' compensation claims by people aged 15-100 years including payment of wage replacement benefits for time off work lodged in Australia, 1 July 2012 - 30 June 2017.

MAIN OUTCOME MEASURES

Working years lost (WYL) per annum (total number of years of wage replacement benefits paid to injured and ill workers), overall and by sex, age, and injury and disease type; WYL per 10 000 fulltime equivalent (FTE) years worked.

RESULTS

A total of 755 330 eligible claims with complete data for analysis variables by people aged 15-100 years were identified, for compensable injuries and disease that led to 41 194 (95% confidence interval [CI], 41 020-41 368) WYL/year. The annual WYL number and rate were each higher for men (25 367 [95% CI, 25 230-25 503] WYL/year; 42.6 [95% CI, 42.1-43.1] WYL/10 000 FTE years) than for women (15 827 [95% CI, 15 720-15 935] WYL/year; 38.8 [95% CI, 38.2-39.4] WYL/10 000 FTE years). Workers aged 45-100 years made 66 742 claims per year (44.1% of all claims) but incurred 21 763 WYL/year (52.8% of all WYL). Traumatic joint and muscle injuries led to 16 494 WYL/year (40.0% of all WYL), musculoskeletal disorders to 8547 WYL/year (20.7%), mental health conditions to 5361 WYL/year (13.0%), fractures to 4276 WYL/year (10.4%), and wounds and lacerations to 3449 WYL/year (8.4%).

CONCLUSIONS

Occupational injury and disease covered by workers' compensation result in lost working time in Australia equivalent to more than 41 000 fulltime jobs. Distribution of the burden reflects the greater labour force participation of men, slower recovery of older workers, and the impact of common occupational injuries and diseases. Population-based monitoring of lost working time could support effective occupational health surveillance and allocation of resources for protecting the health of Australian workers.

Mental health implications and psychologic factors in workers' compensation cases

ABSTRACT

Work-related injuries can harm mental health and affect other facets of injured workers' lives. Clinicians must be aware of the problem of emotional distress and treat the whole patient after a workplace injury. More education and information are needed for clinicians, employers, and workers' compensation carriers so that injured workers can be properly screened for mental health issues and supported during treatment. Further research is needed to establish a protocol for early intervention to minimize the negative emotional and mental health effects of workplace injuries.

Patterns of Mental Health Service Use in Australian Workers with Low Back Pain: A Retrospective Cohort Study

PURPOSE

To describe the volume, timing and provider of mental health services provided to workers with accepted low back pain (LBP) claims, and to identify determinants of service volume and time to first mental health service.

METHODS

Using claim and service-level workers' compensation data from four Australian states (Queensland, South Australia, Western Australia, Victoria) for LBP claims with at least one mental health service lodged between 1 July 2011 and 30 June 2015. Mental health services occurring 30 days prior to 730 days following claim acceptance were examined. Outcomes were number of mental health services and time (weeks) from claim acceptance to first service, calculated overall, by provider and interaction type, and by independent variables (age group, sex, time loss duration, financial year of lodgement, jurisdiction, socioeconomic status, remoteness). Negative binomial and Cox regression models examined differences between service volume and time to first service by independent variables, respectively.

RESULTS

Of workers with LBP claims who accessed mental health services, psychologist services were most common (used by 91.2% of workers) and 16% of workers saw multiple provider types. Number of services increased with time loss duration, as did time to first service. Victorian workers had the most services, yet accessed them latest.

CONCLUSIONS

Psychologist services were most common, longer duration claims used more mental health services but accessed them later, and there were a number of jurisdictional differences. Results suggest opportunities for workers' compensation authorities to provide, to those who may benefit, greater and earlier access to mental health care.

Wellbeing After Finalization of a Workers' Compensation Claim: A Systematic Scoping Review

OBJECTIVE

A workers' compensation claim may have significant negative impacts on an injured worker's wellbeing. Wellbeing provides a good global measure of potential effects of a claim on an individual, and is important for contemporary economic modelling. The purpose of this study was to synthesize knowledge about the wellbeing of injured workers after the finalization of a workers' compensation claim and identify gaps in the current literature.

METHODS

A systematic scoping review was conducted.

RESULTS

71 full-text articles were screened for inclusion, with 32 articles eligible for this review. None of the included articles evaluated overall wellbeing. Included articles did evaluate a variety of constructs inherent in wellbeing. Injured workers were generally disadvantaged in some manner following claim finalization. The literature recommends a focus on reducing negative impacts on injured workers after finalization of a compensation claim, with a need for regulatory bodies to review policy in this area.

CONCLUSION

There appears to be potential for ongoing burden for individuals, employers, and society after finalization of a workers' compensation claim. A gap in knowledge exists regarding the specific evaluation of wellbeing of injured workers following finalization of a workers' compensation claim.

The Prevalence of Mental Health Service Use in Australian Workers with Accepted Workers' Compensation Claims for Low Back Pain: A Retrospective Cohort Study

PURPOSE

Low back pain (LBP) is a leading cause of disability globally and interferes with work performance and quality of life. For work-related LBP, Australian workers can receive workers' compensation and access funded healthcare to promote recovery, including mental health services, as there are strong links between chronic LBP and mental health. The objective of this study was to determine the prevalence of funded mental health services for workers with compensated LBP.

METHODS

Claims and services data from four Australian workers' compensation jurisdictions were analysed. Prevalence of accessing at least one mental health service was reported as a percentage of all claims overall and by duration of time loss, age group, sex, financial year of claim lodgement, jurisdiction, socioeconomic status and remoteness. Odds of accessing at least one service was determined using logistic regression.

RESULTS

Almost 10% of LBP claims accessed at least one mental health service (9.7%) with prevalence increasing with time loss. Prevalence was highest in Victoria however a higher percentage of workers with LBP accessed mental health services earlier in Queensland. Odds of accessing services was highest with longest time loss duration, among females and in Queensland. Lower odds were observed in regional areas and among those aged over 56 years.

CONCLUSION

Findings suggest opportunities for workers' compensation regulators and insurers to provide greater access to appropriate mental health services alongside physical treatment as standard practice, such as those in more remote locations or earlier in a claim, to improve recovery outcomes for workers with LBP.

Involvement in a Personal Injury Claim Is Associated With More Pain and Delayed Return to Work After Elective Nonsurgical or Surgical Treatment for Hand or Wrist Disorders: A Propensity Score-matched Comparative Study

BACKGROUND

A small proportion of patients treated for a hand or wrist condition are also involved in a personal injury claim that may or may not be related to the reason for seeking treatment. There are already indications that patients involved in a personal injury claim have more severe symptoms preoperatively and worse surgical outcomes. However, for nonsurgical treatment, it is unknown whether involvement in a personal injury claim affects treatment outcomes. Similarly, it is unknown whether treatment invasiveness affects the association between involvement in a personal injury claim and the outcomes of nonsurgical treatment. Finally, most studies did not take preoperative differences into account.

QUESTIONS/PURPOSES

(1) Do patients with a claim have more pain during loading, less function, and longer time to return to work after nonsurgical treatment than matched patients without a personal injury claim? (2) Do patients with a personal injury claim have more pain, less function, and longer time to return to work after minor surgery than matched patients without a personal injury claim? (3) Do patients with a personal injury claim have more pain, less function, and longer time to return to work after major surgery than matched patients without a personal injury claim?

METHODS

We used data from a longitudinally maintained database of patients treated for hand or wrist disorders in the Netherlands between December 2012 and May 2020. During the study period, 35,749 patients for whom involvement in a personal injury claim was known were treated nonsurgically or surgically for hand or wrist disorders. All patients were invited to complete the VAS (scores range from 0 to 100) for pain and hand function before treatment and at follow-up. We excluded patients who did not complete the VAS on pain and hand function before treatment and those who received a rare treatment, which we defined as fewer than 20 occurrences in our dataset, resulting in 29,101 patients who were eligible for evaluation in this study. Employed patients (66% [19,134 of 29,101]) were also asked to complete a questionnaire regarding return to work. We distinguished among nonsurgical treatment (follow-up at 3 months), minor surgery (such as trigger finger release, with follow-up of 3 months), and major surgery (such as trapeziectomy, with follow-up at 12 months). The mean age was 53 ± 15 years, 64% (18,695 of 29,101) were women, and 2% (651 of 29,101) of all patients were involved in a personal injury claim. For each outcome and treatment type, patients with a personal injury claim were matched to similar patients without a personal injury claim using 1:2 propensity score matching to account for differences in patient characteristics and baseline pain and hand function. For nonsurgical treatment VAS analysis, there were 115 personal injury claim patients and 230 matched control patients, and for return to work analysis, there were 83 claim and 166 control patients. For minor surgery VAS analysis, there were 172 personal injury claim patients and 344 matched control patients, and for return to work analysis, there were 108 claim and 216 control patients. For major surgery VAS analysis, there were 129 personal injury claim patients and 258 matched control patients, and for return to work analysis, there were 117 claim and 234 control patients.

RESULTS

For patients treated nonsurgically, those with a claim had more pain during load at 3 months than matched patients without a personal injury claim (49 ± 30 versus 39 ± 30, adjusted mean difference 9 [95% confidence interval (CI) 2 to 15]; p = 0.008), but there was no difference in hand function (61 ± 27 versus 66 ± 28, adjusted mean difference -5 [95% CI -11 to 1]; p = 0.11). Each week, patients with a personal injury claim had a 39% lower probability of returning to work than patients without a claim (HR 0.61 [95% CI 0.45 to 0.84]; p = 0.002). For patients with an injury claim at 3 months after minor surgery, there was more pain (44 ± 30 versus 34 ± 29, adjusted mean difference 10 [95% CI 5 to 15]; p < 0.001), lower function (60 ± 28 versus 69 ± 28, adjusted mean difference -9 [95% CI -14 to -4]; p = 0.001), and 32% lower probability of returning to work each week (HR 0.68 [95% CI 0.52 to 0.89]; p = 0.005). For patients with an injury claim at 1 year after major surgery, there was more pain (36 ± 29 versus 27 ± 27, adjusted mean difference 9 [95% CI 4 to 15]; p = 0.002), worse hand function (66 ± 28 versus 76 ± 26, adjusted mean difference -9 [95% CI -15 to -4]; p = 0.001), and a 45% lower probability of returning to work each week (HR 0.55 [95% CI 0.42 to 0.73]; p < 0.001).

CONCLUSION

Personal injury claim involvement was associated with more posttreatment pain and a longer time to return to work for patients treated for hand or wrist disorders, regardless of treatment invasiveness. Patients with a personal injury claim who underwent surgery also rated their postoperative hand function as worse than similar patients who did not have a claim. Depending on treatment invasiveness, only 42% to 55% of the personal injury claim patients experienced a clinically relevant improvement in pain. We recommend that clinicians extensively discuss the expected treatment outcomes and the low probability of a clinically relevant improvement in pain with their personal injury claim patients and that they broach the possibility of postponing treatment.

LEVEL OF EVIDENCE

Level III, therapeutic study.

"I grabbed my stuff and walked out": Precarious workers' responses and next steps when faced with procedural unfairness during work injury and claims processes

PURPOSE

Injured workers can experience adverse effects from work injury and claims processes.Workers may be treated unfairly by employers, compensation boards, and return-to-work coordinators; however,how workers respond to these challenges is unknown. This article describes how injured precarious workersresponded behaviourally and emotionally to procedural unfairness in work injury and claims processes, and whatworkers did next.

METHODS

Interviews were conducted with thirty-six precariously employedinjured workers recruited in Ontario through social media, email, cold calling, word-of-mouth, and the "snowball"method. Thematic code summaries were analyzed to identify how precarious workers responded to procedural unfairness.

RESULTS

Workers went through all or most of these five stages (not always linearly)when faced with procedural unfairness: (1) passive, (2) fought back, (3) quit pursuit of claim, (4) quit job, and (5)won or got further in fight. Feeling confused, angry, frustrated, unsupported, disappointed, determined, optimistic,and wary were common emotions.

CONCLUSIONS

Identifying unfairness and its emotional,behavioral, and material effects on workers is important to understand implications for compensation systems.Understanding and recognizing unfairness can equip employers, legal representatives, compensation boards, andphysicians, to address and prevent it, and provide worker resources. Policy changes can ensure accountability andconsequences to unfairness initiators.

Impact of Opioid Use on Duration of Time Loss After Work-Related Lower Limb Injury

Purpose This study sought to determine patterns of opioid use among workers with a compensated lower limb injury, factors associated with opioid use, and how opioid use is associated with time loss duration. Methods Claims and medication data were provided by the workers' compensation regulator of Victoria, Australia, for claims lodged 2008-2018 from workers aged 15+ years with a lower limb injury. Descriptive statistics showed the number and prevalence of each opioid type (weak/strong) by demographic, claim and injury predictors. Binary and multinomial logistic regression determined the likelihood of any opioid use, and use of strong, weak or a combination of strong and weak opioids by predictors. Cox regression determined the effect of each opioid type on duration of time loss, controlling for predictors. Results There were 51,334 claims and of these 23.6% were dispensed opioids (9.2% for strong opioids only, 6.6% for weak opioids only and 7.8% for a combination). Weak opioids, on average, were dispensed 15 days earlier than strong opioids. Time loss claims and workers with fractures or hip injuries were most likely to be dispensed opioids. All opioids were associated with increased duration of time loss, with those dispensed both weak and strong opioids having the longest duration of time loss. Conclusions Any opioid use was associated with longer time loss duration, with increasing opioid strength having a greater effect. Review of pain management methods should be undertaken to reduce opioid use, which may have a positive impact on duration of time loss and long-term function.

Does Baseline Mental Health Influence Outcomes among Workers' Compensation Claimants Undergoing Minimally Invasive Transforaminal Lumbar Interbody Fusion?

STUDY DESIGN

This was a retrospective cohort study.

PURPOSE

This study investigated the influence of preoperative mental health on patient-reported outcome measures (PROMs) and minimal clinically important difference (MCID) among workers' compensation (WC) recipients undergoing minimally invasive transforaminal lumbar interbody fusion (MIS TLIF).

OVERVIEW OF LITERATURE

No studies have evaluated the impact of preoperative mental functioning on outcomes following MIS TLIF among WC claimants.

METHODS

WC recipients undergoing single-level MIS TLIF were identified. PROMs of Visual Analog Scale (VAS) for back and leg pain, Oswestry Disability Index (ODI), 12-item Short Form Physical and Mental Composite Scale (SF-12 PCS/MCS), and Patient-Reported Outcomes Measurement Information System Physical Function evaluated subjects preoperatively/postoperatively. Subjects were grouped according to preoperative SF-12 MCS: <41 vs. ≥41. Demographic/perioperative variables, PROMs, and MCID were compared using inferential statistics. Multiple regression was used to account for differences in spinal pathology.

RESULTS

The SF-12 MCS <41 and SF-12 MCS ≥41 groups included 48 and 45 patients, respectively. Significant differences in ΔPROMs were observed at SF-12 MCS at all timepoints, except at 6 months (p≤0.041, all). The SF-12 MCS <41 group had worse preoperative to 6-months SF-12 MCS, 12-weeks/6-months VAS back, 12-week VAS leg, and preoperative to 6-months ODI (p≤0.029, all). The SF-12 MCS <41 group had greater MCID achievement for overall ODI and 6-weeks/1-year/overall SF-12 MCS (p≤0.043, all); the SF-12 MCS ≥41 group had greater attainment for 6-month VAS back (p=0.004).

CONCLUSIONS

Poorer mental functioning adversely affected the baseline and intermediate postoperative quality-of-life outcomes pertaining to mental health, back pain, and disability among WC recipients undergoing lumbar fusion. However, outcomes did not differ 1-2 years after surgery. While MCID achievement for pain and physical function was largely unaffected by preoperative mental health score, WC recipients with poorer baseline mental health demonstrated higher rates of overall clinically meaningful improvements for disability and mental health.

Functional training improves the effectiveness of stretching programs for university cleaning staff

Purpose

The purpose of this study was to determine whether combining a structured stretching program with functional movement/body position training would yield additive effects on flexibility, ergonomic practices, and subjective pain levels for employees at high risk for work-related musculoskeletal disorders.

Design/methodology/approach

Nine control and 13 experimental university cleaning staff participated in a 10-week full-body stretching intervention led by undergraduate students. Experimental participants also engaged in functional movement/body position training once per week. Joint range of motion, task ergonomic form, pain level, and stretching motivation results were compared pre- and post-intervention.

Findings

Overall flexibility (+25.75 ± 3.33%) and task ergonomic form (+26.3 ± 10.5%) significantly improved and were negatively correlated with pain levels (r = −0.541 and r = −0.317, respectively). Experimental participants experienced greater improvements in shoulder (control: +16.8 ± 9.0%; experimental: +64.2 ± 11.5%) and hip (control: +31.4 ± 9.9%; experimental: +91.2 ± 19.9%) flexibility as well as in task-specific ergonomic form for vertical (control: +0.0 ± 5.3%; experimental: +35.2 ± 10.1%) and horizontal wiping (control: −4.7 ± 4.7%; experimental: +29.0 ± 7.8%). Intrinsic motivation was increased for both groups (+26.2 ± 15.4%).

Originality/value

Supplementing a workplace stretching program with functional movement/body position training has the potential to improve flexibility and decrease pain while simultaneously increasing the likelihood that cleaning staff will participate in self-directed stretching in the future. The intervention serves as a model for workplace health management and wellness-focused community building on university campuses who insource cleaning staff.

Health screening questionnaires used in the management of mental distress acquired during an injured worker’s return to work: A scoping review

BACKGROUND: Mental distress is often endured by injured workers participating in the rehabilitation or return to work process following a physical injury. Delays in detecting the onset and treating mental distress can lead to a diverse range of cognitive and behavioural changes that may precipitate psychological distress such as anxiety, depression, and posttraumatic stress. OBJECTIVE: The objective of this scoping review was to provide an overview of existing health questionnaires utilised by health care providers and affiliated researchers. It reviewed their effectiveness and suitability to detect mental distress endured by injured workers engaged in the return to work process. METHODS: A scoping review methodology was conducted using the Arksey and O’Malley framework which examined peer-reviewed articles published between 2000 and March 2020 comprising health questionnaires. Database searches included Medline, CINAHL, EMBASE and PsycINFO combining specific MeSH terms and key words. RESULTS: The full search identified 3168 articles. Following full screening a total of 164 articles reviewed the use of health questionnaires and specific criteria to determine their suitability. Most of the health questionnaires reviewed were used as screening measures for identifying both work and non-work-related psychological hazards. However, they were found to be limited in their application when considering all potential predictors of delayed return to work such as poor or stressful interactions with stakeholders, financial stress and the injured workers experience of the RTW process. CONCLUSION: Earlier identification of mental distress using an optimal MHSQ followed by appropriate intervention will reduce the risk of psychological injury becoming cumulative on a physical workplace injury. Without such complications, early return to work can be achieved with significant cost saving to the economy.

The relationship between work disability and subsequent suicide or self-harm: A scoping review

Work disability occurs when an injury or illness limits the ability of a worker to participate in employment. While evidence suggests that people with work disability are at increased risk of suicide and intentional self-harm, this relationship has not been the subject of systematic review. This scoping review aims to assess and summarise the research literature regarding the relationship between work disability and subsequent suicide or intentional self-harm. Review protocol was published on the Open Science Foundation and is reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. Peer-reviewed studies published in English from 1st January 2000 were included if they reported suicide or self-harm outcomes in people aged 15 years or older with work disability. Studies were identified via systematic search of Medline, Scopus and Pubmed databases, via recommendation from topic experts, and citation searching of included articles. A narrative synthesis was undertaken. Literature search yielded 859 records of which 47 eligible studies were included, nine set in workers' compensation, 20 in sickness absence, 13 in disability pension systems, and five from mixed cohorts. Of 44 quantitative studies, 41 reported a positive relationship between work disability and suicidal behaviour. The relationship is observed consistently across nations, work disability income support systems and health conditions. Several factors elevate risk of suicidal behaviour, including presence of mental health conditions and longer work disability duration. There were few studies in some nations and no suicide prevention interventions. The risk of suicide and self-harm is elevated in people experiencing work disability. Further observational research is required to fill evidence gaps. This review suggests the need for governments, employers and those involved in the care of people with work disability to focus on identification and monitoring of those at greatest risk of suicidal behaviour, and suicide prevention.

Timing of Health Service Use Among Truck Drivers After a Work-Related Injury or Illness

Purposes Timely delivery of treatment and rehabilitation is generally acknowledged to support injury recovery. This study aimed to describe the timing of health service use by injured truck drivers with work-related injury and to explore the association between demographic and injury factors and the duration of health service use. Methods Retrospective cohort study of injured truck drivers with accepted workers' compensation claims in the state of Victoria, Australia. Descriptive analyses examined the percentage of injured truck drivers using health services by service type. Logistic regression model examined predictors of any service use versus no service use, and predictors of extended service use (≥ 52 weeks) versus short-term use. Results The timing of health service use by injured truck drivers with accepted workers' compensation claims varies substantially by service type. General practitioner, specialist physician, and physical therapy service use peaks within the 14 weeks after compensation claim lodgement, whilst the majority of mental health services were accessed in the persistent phase beyond 14 weeks after claim lodgement. Older age, being employed by small companies, and claiming compensation for mental health conditions were associated with greater duration of health service use. Conclusions Injured truck drivers access a wide range of health services during the recovery and return to work process. Delivery of mental health services is delayed, including for those making mental health compensation claims. Health service planning should take into account worker and employer characteristics in addition to injury type.

Correlation Between Patient-Reported Outcome Measures and Health Insurance Provider Types in Patients with Hip Osteoarthritis

BACKGROUND

Patient-reported outcome measures (PROMs) are frequently utilized to assess patient perceptions of health and function. Numerous factors influence self-reported physical and mental health outcome scores. The purpose of this study was to examine if an association exists between insurance payer type and baseline PROM scores in patients diagnosed with hip osteoarthritis.

METHODS

We retrospectively reviewed the baseline PROM scores of 5,974 patients diagnosed with hip osteoarthritis according to the International Classification of Diseases, Tenth Revision (ICD-10) code within our institutional database from 2015 to 2020. We examined Hip disability and Osteoarthritis Outcome Score-Physical Function Short-form (HOOS-PS), Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function Short Form 10a (PF10a), PROMIS Global-Mental, and PROMIS Global-Physical scores. Descriptive analyses, analysis of variance (ANOVA), analysis of covariance (ANCOVA), and post hoc analyses were utilized to assess variations in PROM scores across insurance type.

RESULTS

The mean age (and standard deviation) of the study population was 63.5 ± 12.2 years, and 55.7% of patients were female. The Medicaid cohort had a comparatively higher percentage of Black, Hispanic, and non-English-speaking patients and a lower median household income. The Charlson Comorbidity Index was highest in the Medicare and Medicaid insurance cohorts. Patients utilizing commercial insurance consistently demonstrated the highest baseline PROMs, and patients utilizing Medicaid consistently demonstrated the lowest baseline PROMs. Subsequent analyses found significantly poorer mean scores for the Medicaid cohort for all 4 PROMs when compared with the commercial insurance and Medicare cohorts. These score differences exceeded the minimal clinically important differences (MCIDs). For the PROMIS Global-Mental subscore, a significantly lower mean score was observed for the Workers' Compensation and motor vehicle insurance cohort when compared with the commercial insurance and Medicare cohort. This difference also exceeded the MCID.

CONCLUSIONS

PROM scores in patients with hip osteoarthritis varied among those with different insurance types. Variations in certain demographic and health indices are potential drivers of these observed baseline PROM differences. For patients with hip osteoarthritis, the use of PROMs for research, clinical, or quality-linked payment metrics should acknowledge baseline variation between patients with different insurance types.

LEVEL OF EVIDENCE

Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Rejection of workers' compensation claims may increase depressive symptoms among firefighters with occupational injury: a nationwide study in South Korea

OBJECTIVES

This study sought to examine whether the experience of occupational injuries was associated with depressive symptoms and whether the rejection of workers' compensation claims was associated with depressive symptoms among Korean firefighters.

METHODS

We conducted a nationwide survey of 6793 Korean firefighters in 2015. Based on the experience of occupational injuries and workers' compensation claims over the past year, respondents were classified into four groups: "Not injured", "Injured, not applied", "Injured, applied, but rejected" and "Injured, applied, and accepted." Depressive symptoms over the preceding week were assessed using the 11-item version of the Centers for Epidemiologic Studies Depression Scale.

RESULTS

Compared to firefighters who did not get injured, injured firefighters had a higher prevalence of depressive symptoms (PR 2.01, 95% CI 1.83, 2.22) after controlling for confounders including job assignment. Also, when we restricted the analysis to injured firefighters, a higher prevalence of depressive symptoms was observed among "Injured, applied, but rejected" (PR 1.70, 95% CI 1.11, 2.59) group, compared to "Injured, applied, and accepted" group.

CONCLUSIONS

This finding suggests that rejection of workers' compensation claims, as well as the experience of occupational injuries, may increase the risk of depressive symptoms among Korean firefighters.