Predicting return to work following treatment of chronic pain disorder

Neuropathic pain of the superficial branch of the radial nerve - Factors influencing surgical outcome and patient satisfaction

BACKGROUND

Due to its partially superficial course, the superficial branch of the radial nerve is vulnerable to injury by trauma or surgery, potentially leading to painful neuroma. Surgical treatment is difficult. Among other factors, smoking and duration of pain before revision surgery have been suggested as risk factors for persistent pain after surgical revision, without concrete evidence. The aim of this study was therefore to identify factors influencing the outcome of revision surgery in SBRN neuropathic pain in our department.

METHODS

All 51 patients receiving revision surgery of the superficial branch of the radial nerve for neuropathic pain from 2010 to 2020 were contacted; 19 agreed to return for assessment. A medical chart review was performed to collect patient-, pain- and treatment-specific factors. Outcomes were recorded. In an outpatient consultation, clinical follow-up was performed and patients filled out the DASH, MHQ and painDETECT questionnaires.

RESULTS

After revision surgery, all patients experienced persistent pain. On multivariate logistic regression evaluating the risk of persistent pain, only smoking emerged as an independent risk factor. Age, gender, dominant side, location, time between trigger and surgery or diagnosis did not emerge as risk factors. No predictor for successful return to work could be identified.

CONCLUSIONS

Treatment of painful neuroma of the superficial branch of the radial nerve is a challenge. Patients with neuropathic pain should be coached toward smoking cessation before neuroma surgery. Surgery can show benefit even after long symptom duration. No correlations between study clinical variables or test results and return to work could be identified, suggesting that other factors play a role in return to work.

Using a Workplace Rehabilitation and Reintegration Program Tracker Tool to Explore Factors Associated With Return to Duty Among Ill/Injured Military Personnel: A Preliminary Analysis

INTRODUCTION

A great deal of time and resources have been spent on developing and implementing evidence-based return to work programs over the past few decades, compelling researchers to better understand the factors associated with more favorable outcomes. Using data collected as part of a participant tracking system trial for the Canadian Armed Forces (CAF) Return to Duty (RTD) program, analyses were conducted to better understand the trajectories of program participants and identify the factors associated with RTD.

MATERIALS AND METHODS

Participants included 205 Regular Force CAF members from a single military base located in Eastern Canada who entered the RTD program during the trial period between April 2018 and March 2020. The health condition they were facing was mostly recent (i.e., onset within the past 6 months; 43%) and involved their mental health (67%). Data were collected on various demographic, military, health, and program characteristics using the RTD Data Collection Tool, which was updated periodically by program coordinators. Using data gathered by the Tool, a cumulative incidence function was generated to estimate the overall marginal probability of RTD over the duration of the program. Associations between RTD and a range of factors that were captured using the Tool were also examined in a series of competing-risks regressions.

RESULTS

Findings indicated that the rate of RTD among program participants increased at around 3 months and began to level off around 9 months, suggesting that the likelihood of RTD after this window is diminished. Of the many factors that were considered, only years of service and work placement status at 3 months were found to be associated with RTD. Specifically, lower rates of RTD were observed among participants with 15 or more years of service compared to those with less than 5 years of service in the CAF and among those who were not yet assigned a work placement at 3 months relative to those who were.

CONCLUSION

This study represents a first step in addressing the gap in our current knowledge about the characteristics of CAF members participating in the RTD program and the factors associated with RTD. Several recommendations are made for improving the participant tracking system in view of enhancing the level and quality of information that is available to assess participants' trajectories and inform further development of the program.

The impact of disease changes and mental health illness on readapted return to work after repeated sick leaves among Brazilian public university employees

Introduction

Health affects work absenteeism and productivity of workers, making it a relevant marker of an individual's professional development.

Objectives

The aims of this article were to investigate whether changes in the main cause of the sick leaves and the presence of mental health illnesses are associated with return to work with readaptation.

Materials and methods

A historical cohort study was carried out with non-work-related illnesses suffered by statutory workers of university campuses in a medium-sized city in the state of São Paulo, Brazil. Two exposures were measured: (a) changes, throughout medical examinations, in the International Classification of Diseases (ICD-10) chapter regarding the main condition for the sick leave; and (b) having at least one episode of sick leave due to mental illness, with or without change in the ICD-10 chapter over the follow-up period. The outcome was defined as return to work with adapted conditions. The causal model was established a priori and tested using a multiple logistic regression (MLR) model considering the effects of several confounding factors, and then compared with the same estimators obtained using Targeted Machine Learning.

Results

Among workers in adapted conditions, 64% were health professionals, 34% had had changes in the ICD-10 chapter throughout the series of sick leaves, and 62% had diagnoses of mental health issues. In addition, they worked for less time at the university and were absent for longer periods. Having had a change in the illness condition reduced the chance of returning to work in another function by more than 30%, whereas having had at least one absence because of a cause related to mental and behavioral disorders more than doubled the chance of not returning to work in the same activity as before.

Conclusion

These results were independent of the analysis technique used, which allows concluding that there were no advantages in the use of targeted maximum likelihood estimation (TMLE), given its difficulties in access, use, and assumptions.

Associations between social integration, participation and productivity loss among persons with chronic pain: a registry based cross sectional study

Purpose

To examine associations between factors of social inclusion and participation and productivity loss in employed persons with chronic pain, assessed for an interprofessional pain rehabilitation programme. We hypothesized that factors of social inclusion and participation and work related social factors are significantly associated with productivity when experiencing chronic pain and we expected a moderate effect.

Methods

Cross-sectional study using data collected prospectively in an interprofessional patient registry for chronic pain. The primary end point was productivity loss, measured with the iMTA Productivity Costs Questionnaire. We included data from 161 individuals. To be included, persons had to be 18 years old or older, in paid work, and had to have a medical diagnosis of chronic pain syndrome with actual or potential tissue damage. In addition, participants had to have indicators of significant impairments in psychosocial functions.

Results

Linear regression analysis showed that a highly stressful professional situation, frequent problems regarding the compatibility of the family and job and not being Swiss were associated with a significantly higher total productivity loss. Similar results were found for productivity loss in paid work. However, problems concerning the compatibility of the family and job did not reach the significance level for productivity loss in paid work.

Conclusion

The results of this study underscore the importance of factors of social inclusion and participation for interprofessional rehabilitation programmes to manage chronic pain especially when focussing on productivity loss.

Systematic Review of the Impact on Return to Work of Return-to-Work Coordinators

Purpose We conducted a systematic review to understand the impact that return-to-work coordinators (RTWCs) have on return to work (RTW) outcomes for sick/injured workers. Methods MEDLINE, EMBASE, CINAHL, PsycINFO, Web of Science, and ABI Inform were searched from January 1, 2000 to September 16, 2020. Of 2,927 retrieved and screened citations, 14 quantitative articles fulfilled the eligibility and quality criteria. Quality assessment, data extraction, and evidence synthesis followed article screening. Results We focused on the impact of RTWCs for outcomes of work absence, RTW rates, quality of life, and cost-benefit. Our final synthesis included 14 articles. We found strong evidence that work absence duration was reduced when workers had face-to-face contact with a RTWC. As well, there was strong evidence linking face-to-face RTWC interventions with higher RTW rates and moderate evidence that this reduced intervention costs. RTWC interventions involving the identification of barriers and facilitators to RTW also showed promising results. However, only limited evidence was found that RTWCs improved quality of life for workers. Conclusions Our synthesis identifies key features of RTW interventions that improve RTW outcomes. Future high-quality research should measure long-term outcomes of RTWC interventions to evaluate sustainability and consider the nature of work. They should also focus on RTWC impact on worker quality of life assessments and for older workers and workers with chronic health conditions.

Relationship between workers' return to work, job retention and income in industrial accidents in Korea: a longitudinal study

OBJECTIVE

This study aims to compare workers' income before and after an occupational injury, with regard to return to work and job retention, over a period of 5 years.

DESIGN

This study was designed as a longitudinal study.

SETTING

The Panel Study of Workers' Compensation Insurance (PSWCI) survey targeted workers involved in industrial accidents for which medical care was terminated in the year 2012.

PARTICIPANTS

The panel study was conducted on a final sample of 2000 workers who were selected proportionally by region (nine regions) after priority assignment by disability rating (six levels). A total of 1458 workers were finally included in this study.

METHODS

This study used data from the first to fifth PSWCI. To identify the effect on income after occupational injury considering return to work and job retention, we used the generalised estimating equation.

RESULTS

In regard to workers' return to work, the OR that income after an occupational injury would be higher than that before an occupational injury was 3.17 (2.41-4.17) for those who returned to original work and 2.32 (1.81-2.97) for those re-employed as compared with who did not return to work and 1.27 (1.07-1.15) for those who retained their job as compared with those who did not. The ORs were 2.91 (2.26-3.75) for those who were re-employed and retained jobs and 2.96 (2.15-4.08) for those who returned to original work and did not retain jobs as compared with those who did not return to work and did not retain jobs.

CONCLUSIONS

It is important for accident victims to retain their jobs to maintain their economic status.

Developing guidelines to support injured workers who live and work with chronic pain

BACKGROUND

Living and working with chronic pain requires persons to alter lifestyles and have the knowledge as well as support to manage unforeseen challenges. Knowledge for persons living with pain who want to participate in meaningful paid and unpaid work is not easily accessible. While there is literature on chronic pain management, work transitions and return to work, less emphasis has been placed on the complexity of living and working with chronic pain. The Creating a Way Forward Project was envisioned to address this gap and to identify the informational needs of workers with pain, health/helping professionals (workers' advisors, return to work specialists, legal representatives), and stakeholders. The overarching aim of the project was to use evidence and experiential knowledge to inform the development of a foundation for educational guides and toolkits to support workers with pain to achieve their outcomes for remaining at work.

METHODS

Phase one of the project involved a scoping review of chronic pain and work. Phase two involved stakeholder consultations, a focus group and knowledge integration of the literature and experiential insights. Knowledge synthesis drew on a Template Analysis of multiple sources of data.

RESULTS

Knowledge domains and key components were identified for persons with pain and for the health/helping professions.

CONCLUSION

These domains reflect a foundation for knowledge in practical training and the development of curriculum for education in self-management program and in inter professional health profession education. These knowledge domains provide a basis for future research in integrated approaches and knowledge use toward improving transitions for persons living with chronic pain who want to participate in productive paid and unpaid work. Ongoing research in knowledge domains that health providers and persons with pain need will expand the potential for improving health outcomes in living with and managing pain.

Vocational Rehabilitation for Patients with Chronic Musculoskeletal Pain With or Without a Work Module: An Economic Evaluation

Purpose Vocational rehabilitation (VR) is a widely used intervention aimed to optimize work participation for patients on sick leave due to chronic musculoskeletal pain (CMP). Economic evaluations of care as usual VR are scarce, and may provide relevant information to guide clinical, reimbursement and policy decisions. The aim of this study was to evaluate the short-term cost-effectiveness and return on investment (ROI) of VR for patients on sick leave due to CMP with an additional work module (VR+) compared to VR without work module, from a societal and employers' perspective. Methods A retrospective longitudinal cohort study within a Dutch care as usual context was applied. Participants with CMP and decreased work participation originating from seven Dutch rehabilitation centers were included in this study. Participants underwent VR or VR+. Main data sources at baseline and discharge: Quality-adjusted life year (QALY) based on EQ-5D, intervention costs, self-reported productivity and health care utilization. Main analyses cost-effectiveness, including incremental cost-effectiveness ratio (ICER) and a cost-effectiveness acceptability curve (CEAC); and ROI analyses with use of the human capital method. Results N = 324 participants were analyzed. The results show that VR+ was cost-effective compared to VR: mean cost savings of €820 per 0.012 QALY gained. CEAC suggests probability of VR+ being cost-effective is > 0.91 for thresholds of €20.000 and higher. The mean ROI of VR+ for employers was 38%. Conclusion It was concluded that at discharge, VR+ was cost-effective compared to VR. ROI was positive for employers.

Vocational Rehabilitation with or without Work Module for Patients with Chronic Musculoskeletal Pain and Sick Leave from Work: Longitudinal Impact on Work Participation

Purpose To study the longitudinal relationship between interdisciplinary vocational rehabilitation (VR) with and without additional work module on work participation of patients with chronic musculoskeletal pain and sick leave from work. Methods Retrospective longitudinal data retrieved from care as usual in seven VR centers in the Netherlands was used. The VR program without work module consisted of multi-component healthcare (physical exercise, cognitive behavioral therapy, education, relaxation). The other program with additional work module (VR+) included case management and a workplace visit. Generalized estimating equations using binary logistic was applied. The dependent variable was work participation (achieved/not achieved) on discharge and 6-months follow-up. Independent variables were type of intervention, return to work expectation, sick leave duration, working status, job strain, and job dissatisfaction. Results Data from N = 470 patients were analyzed, of which 26% received VR and 74% VR+. Both programs increased work participation at 6-months follow-up (VR 86%, VR+ 87%). The crude model showed a significant longitudinal relationship between type of intervention and work participation in favor of VR+ (OR 1.8, p = 0.01). The final model showed a non-significant relationship on discharge (OR 1.3, p = 0.51) and a significant relationship on 6-months follow-up in favor of VR+ (OR 1.7, p = 0.04). RTW expectation was a significant confounder in the final model on discharge and 6-months follow up (OR 3.1, p = 0.00). Conclusions Both programs led to increased work participation. The addition of a work module to the VR program lead to a significant increase in odds of work participation at 6-months follow-up.

Effect of professional certification on employees' return-to-work rate after occupational injuries in Korea: focusing on vulnerable groups

Background

One effective way to improve return-to-work (RTW) performance may be to convince the employer that the worker has the necessary skills. The aim of this paper is to investigate the effect of having a professional certification among workers injured in occupational injuries on their return to work.

Methods

The Panel Study of Workers’ Compensation Insurance (PSWCI) targets workers who completed medical care in 2012 after an occupational injury. The study population (n = 2000) was stratified by gender, age, region, disability grade, and rehabilitation service use. A total of 1458 workers were finally selected for this study.

The effect of having a certification on RTW status was calculated with an odds ratio and 95% confidence intervals using binomial and multinomial logistic regression analyses. In the binomial logistic regression analysis, the RTW group was made up as a combination of the return to original work and the reemployment groups.

Results

The ORs of RTW among those with a certification compared to those without certification were 1.38 (1.16–1.65) in Model 1, 1.25 (1.05–1.50) in Model 2, and 1.22 (1.01–1.47) in Model 3. Among female workers with a certification, the OR of RTW was 4.60 (2.68–7.91), that of return to original work was 3.21 (1.74–5.91), and that of reemployment was 5.85 (3.34–10.27). Among daily workers with a certification, the OR of RTW was 1.32 (1.03–1.69) and that of reemployment was 1.37 (1.07–1.76).

Conclusion

In conclusion, injured workers with a certification generally had a higher RTW rate. In particular, the RTW rate was higher among female workers and daily workers with a certification than among those without.

Who are less likely to return to work after getting injured on duty? A 12-month epidemiological evaluation in an orthopedic and traumatology center in Hong Kong

OBJECTIVES

Cases of injury on duty (IOD) are common in Hong Kong, but literature on this group of patients is limited. This study aims to describe local IOD cases' epidemiological characteristics and identify factors affecting return to work (RTW) outcomes.

METHODS

This is a retrospective epidemiological study of IOD patients in the orthopedic and traumatology center of Yan Chai Hospital in 2016, using the hospital's electronic clinical record analysis and reporting system; 323 out of the 10 730 patients (M:F = 206:117; mean age 46.9 ± 11.3) were included. Data on demographics, the injury episode, administrative procedures, treatment and rehabilitation were collected. Outcomes were measured by "RTW" and "time to RTW from injury."

RESULTS

Around 80% of patients had a successful RTW and the mean time to RTW was 10.6 ± 9.0 months. Patients who were female, divorced or widowed and living alone in a public rental flat were less likely to RTW. Psychiatric consultations (OR 13.70, P < .001), legal disputes (OR 8.20, P < .001) and more than 5 months of waiting time for physiotherapy (OR 3.89, P = .002) were the strongest among the numerous risk factors for non-RTW. An increase in one visit to the general outpatient clinic and the presence of legal disputes had lengthened the time to RTW by 4.8 days (P < .001) and 18.0 months (P < .001), respectively.

CONCLUSIONS

Several demographic, psychosocial and administrative factors were negatively associated with RTW in the local population. Recommendations were made for healthcare providers and policymakers accordingly.

Predictors of return to work with and without restrictions in public workers

Background

Sick leaves are important events for both the worker and the employer. Many factors are related with sick leaves and depending on the factors the worker could perform a successful return to work. In this sense, the objective of this study is to identify those factors associated with return to work after sick leaves in a group of public workers in Brazil.

Methods

A case-control study of return to work after sick leaves in a university campus from 2010 to 2015. Logistic regression models were adjusted for two different response variables: return to work with and without restrictions. A digital database was created and completed with data from manual sources.

Results

A computerised database has been created, based on manual records, which has allowed us to identify labour and non-labour factors associated with the return to work after a sick leave and the possible functional readaptation, with or without restrictions, in public workers. Age at the beginning of the process, number of sick leaves, those of more than 16 days, average duration (total time of sick leaves / number of medical records), and mid-level healthcare positions were associated with return to work without restrictions. In the model of return to work with restrictions, the age of hiring by the university, the number of sick leaves, those of more than 16 days, and mid-level healthcare positions, both rural work and operational positions, were associated to the response variable.

Conclusions

This study has allowed us to identify the factors associated with the return to work after a period of sick leave in a large group of public workers. However, more research is needed on the mental disorders that cause sick leaves, their evaluation and the handling of these situations.

Return to work after vocational rehabilitation for sick-listed workers with long-term back, neck and shoulder problems: A follow-up study of factors involved

BACKGROUND

Absence from work due to musculoskeletal disorders is a significant problem from a number of perspectives, and there is a great need to identify factors that facilitate return to work (RTW).

OBJECTIVE

To identify factors related to RTW after vocational rehabilitation for sick-listed workers with long-term back, neck and/or shoulder problems, and to compare the results with those from a previous literature review based on studies from 1980 to 2000.

METHODS

A literature review based on studies published 2001-2014 in PubMed, CINAHL, EMBASE, ERIC and the Cochrane Library.

RESULTS

Major risk factors for not returning to work are: higher age, factors related to pain such as higher levels of pain and pain related fear, avoidance of activity, high distress and depression. Facilitating factors for RTW are: lower functional disability, gaining control over one's own condition, believing in RTW and work-related factors such as occupational training, and having a job coach or an RTW coordinator. Compared with the results from the previous review, the present review shows less of a focus on sociodemographic factors and more on psychological factors. Both studies highlight risk factors such as older age, higher levels of pain, depression and less internal locus of control.

CONCLUSION

Psychosocial and work-related factors are important and should be included in interventions for the RTW of people with long-term back, neck and/or shoulder problems.

Patient Satisfaction with Spanish Pain Centers: Observational Study with More than 3,000 Patients

Chronic pain is a serious problem in Spain. This multicenter, epidemiological 3-month follow-up study investigates pain management efficacy in Spanish centers using patient satisfaction criteria. 3,414 eligible adult patients (65,6% female) with moderate to severe chronic pain from 146 pain centers were included. Patient satisfaction was assessed based onto question 18 of Spanish healthcare barometer-CSI. Pain evolution (Brief Pain Inventory-Short Form (BPI-SF) and visual analog scale (VAS)), quality of life/EuroQol-5, and pain control expectations fulfillment were also assessed. Mean age was 61.3 years. 64.4% of participating centers employed multidisciplinary pain management approach. After 3 months, mean patient satisfaction was 7.8 (1-10) on the CIS barometer. Medical staff received the highest scores, whereas waiting for tests, appointment request to appointment date time, and waiting times at the center the lowest. Mean pain decreased from 7.4 to 4.0; BPI-SF intensity decreased from 6.5 to 3.8; pain control expectations were met in 78.7% of patients; EuroQoL-5D utility index increased from 0.37 to 0.62, p < 0.001, and health status (VAS) from 40.6 to 61.9, p < 0.001. Chronic pain patients (90%) are satisfied with Spanish centers care; 80% had their pain control expectations met. Quality of life improved remarkably: 71% felt moderately to significantly better. However, waiting times need improvement.

Vocational Rehabilitation: Supporting Ill or Disabled Individuals in (to) Work: A UK Perspective

Work is important for one's self-esteem, social standing and ability to participate in the community as well as for the material advantages it brings to individuals and their families. The evidence suggests that the benefits of employment outweigh the risks of work and are greater than the risks of long-term unemployment or sickness absence. Individuals may be born with physical or intellectual disadvantages (e.g., cerebral palsy), or they may be acquired during childhood or adult life. Some progressive conditions may present in childhood or adolescence (e.g., some muscular dystrophies) and these need to be distinguished from those presenting later in life (e.g., trauma, stroke). Vocational rehabilitation (VR) thus takes three forms: preparing those with a disability, health or mental health condition for the world of work, job retention for those in work and assisting those out of work into new work. Important components of VR consist of the attributes of the individual, the skills/knowledge of their health professionals, the knowledge and attitudes of actual or potential employers and the assistance that is provided by the state or other insurance facility. Charities are playing an increasing role.

The effects of individual, occupational, and supportive factors on successful return to work using a structural equation model

OBJECTIVES

We aimed to ascertain the relationship between several factors and successful return to work using a structural equation model.

METHODS

We used original data from the Panel Study of Worker's Compensation Insurance, and defined four latent variables as occupational, individual, supportive, and successful return to work. Each latent variable was defined by its observed variables, including age, workplace size, and quality of the medical services. A theoretical model in which all latent variables had a relationship was suggested. After examining the model, we modified some pathways that were not significant or did not fit, and selected a final structural equation model that had the highest goodness of fit.

RESULTS

All three latent variables (occupational, individual, and supportive) showed statistically significant relationships with successful return to work. The occupational and supportive factors had relationships with each other, but there was no relationship between individual and the other factors. Nearly all observed variables had significance with their latent variables. The correlation coefficients from the latent variables to successful return to work were statistically significant and the indices for goodness of fit were satisfactory. In particular, four observed variables-handicap level, duration of convalescence, working duration, and support from the company-showed construct validities with high correlation coefficients.

CONCLUSIONS

All factors that we examined are related to successful return to work. We should focus on the supportive factor the most because its variables are modifiable to promote a return to work by those injured in their workplace.

Cost-effectiveness of 40-hour versus 100-hour vocational rehabilitation on work participation for workers on sick leave due to subacute or chronic musculoskeletal pain: study protocol for a randomized controlled trial

BACKGROUND

Although vocational rehabilitation is a widely advocated intervention for workers on sick leave due to subacute or chronic nonspecific musculoskeletal pain, the optimal dosage of effective and cost-effective vocational rehabilitation remains unknown. The objective of this paper is to describe the design of a non-inferiority trial evaluating the effectiveness and cost-effectiveness of 40-h multidisciplinary vocational rehabilitation compared with 100-h multidisciplinary vocational rehabilitation on work participation for workers on sick leave due to subacute or chronic musculoskeletal pain.

METHODS/DESIGN

A non-inferiority study design will be applied. The study population consists of workers who are on part-time or full-time sick leave due to subacute or chronic nonspecific musculoskeletal pain. Two multidisciplinary vocational rehabilitation programs following the bio-psychosocial approach will be evaluated in this study: 40-h vocational rehabilitation and 100-h vocational rehabilitation, both delivered over a maximum of 15 weeks. The 100-h vocational rehabilitation comprises five modules: work participation coordination, graded activity, cognitive behavioral therapy, group education, and relaxation. The 40-h vocational rehabilitation comprises work participation coordination and a well-reasoned choice from the other four modules. Four rehabilitation centers will participate in this study, each delivering both interventions. Patients will be randomized into one of the interventions, stratified for the duration of sick leave (<6 weeks or ≥ 6 weeks) and type of sick leave (part-time or full-time). The primary outcome is work participation, measured by self-reported sick leave days, and will be assessed at baseline, mid-term, discharge, and at 2, 4, 6, 8, 10, and 12 months follow-up. Secondary outcomes are work ability, disability, quality of life, and physical functioning and will be assessed at baseline, discharge, and at 6 and 12 months follow-up. Cost outcomes are absenteeism, presenteeism, healthcare usage, and travelling costs. Cost-effectiveness will be evaluated from the societal and employer perspectives.

DISCUSSION

The results obtained from this study will be useful for vocational rehabilitation practice and will provide stakeholders with relevant insights into two versions of vocational rehabilitation.

TRIAL REGISTRATION

Dutch Trial Register identifier: NTR4362 (registered 17 March 2014).

Working and Living in Northern vs Southern Ontario Is Associated with the Duration of Compensated Time off Work: A Retrospective Cohort Study

Background:

Northern Ontario, Canada has a larger elder population, more resource-based employment, and limited access to physicians and specialists compared to southern Ontario. Given these important differences, it is possible that work disability rates will vary between the two Ontario jurisdictions.

Objective:

To determine the association between time lost due to workplace injuries and illnesses occurring in northern vs southern Ontario and work disability duration from 2006– 2011.

Methods:

The study base included all lost-time claims approved by the Workplace Safety and Insurance Board in Ontario, Canada for workplace injury or illness compensation occurring between January 1, 2006 and December 31, 2011. All eligible participants had to be 18 years of age or older at the time of making the claim and participants were excluded if one of the three variables used to determine location (claimant home postal code, workplace geographical code, and WSIB firm location) were missing. Multivariable proportional hazards regression models were used to estimate hazard ratios and 95% confidence intervals adjusted for sex, age, occupation, part of body, and nature of injury relating Ontario geographical location to compensated time off work.

Results:

A total of 156 453 lost-time claims were approved over the study period. Injured and ill workers from northern Ontario were 16% less likely to return to work than those from southern Ontario. Adjustment for potential confounding factors had no effect.

Conclusion:

The disability duration in northern Ontario is longer than that in southern Ontario. Future research should focus on assessing the relevant factors associated with this observation to identify opportunities for intervention.

Considerations for return to work following traumatic brain injury

Population-based studies have demonstrated that a history positive for traumatic brain injury (TBI) can result in cognitive impairment, behavioral alterations, and pain. These outcomes can and do influence occupational function, can affect others in the workplace, and raise concerns about workplace safety upon re-entry to the workplace. Risk for long-term impairment and disability can in some cases be mitigated by assessment of capabilities relative to job duties, conservative return-to-work schedules, and, in some cases, interventions to support that return. For those in occupations at high risk for brain injury, including first responders, soldiers, and construction workers, the long-term risk of brain injury as a risk factor for neurodegenerative disease must and should inform increased concern for those with repeated injuries to the brain over the course of their lifetime and career. This chapter reviews the risks of TBI, considers factors that optimize functional recovery, and discusses potential interventions and factors that aid in return to the workplace.

Return to duty after integrated orthotic and rehabilitation initiative

OBJECTIVES

To determine the return to active duty rate of military service members undergoing lower extremity limb salvage while using a novel custom orthosis and specialized rehabilitation compared with those receiving a novel custom orthosis alone.

DESIGN

Retrospective cohort study.

SETTING

Military level I trauma center and tertiary referral center for limb salvage.

PATIENTS/PARTICIPANTS

All active duty service members enrolled in our institution's Return to Run Clinical Pathway were analyzed retrospectively. Service members were enrolled if they sustained injuries with residual disability below the knee. Injuries typically involved substantial motor and/or nerve deficit, and the overwhelming majority was secondary to high-energy injuries.

INTERVENTION

Service members were fitted with a customized orthosis, an Intrepid Dynamic Exoskeletal Orthosis (IDEO), for use during rehabilitation. Service members were divided into 2 groups: those who had participated in the Return to Run Clinical Pathway with an IDEO (group 1) and those who only were fitted with an IDEO only (group 2).

MAIN OUTCOME MEASURE

Return to military active duty rate.

RESULTS

One hundred forty-six service members met the inclusion criteria. Group 1 consisted of 115 service members and group 2 consisted of 31 service members. Of those in group 1, 59 (51.3%) returned to active duty compared with 4 (12.9%) in group 2 (P = 0.0001). Mechanisms of injury were significant factors for return to duty (RTD), and those sustaining explosive mechanisms of injury or gunshot wounds had significantly lower RTD rates across both groups.

CONCLUSIONS

Active duty service members participating in an integrated orthotic and rehabilitation initiative after a lower extremity injury have a higher rate of RTD than previous reports, and it is significantly higher than the orthotic device alone.