Predictors of Successful Work Role Functioning After Carpal Tunnel Release Surgery

The work-related burden of dry eye

PURPOSE

To investigate the relationship between dry eye disease (DED) and work functioning, unemployment, absenteeism, and worry about job loss.

METHODS

DED and unemployment, absenteeism, and 'worry about job loss' were assessed in 71,067 subjects (18-65 years, 60% female) from the Dutch population-based Lifelines cohort using the Women's Health study questionnaire and single-item questions, respectively. Work functioning was assessed in 32,475 participants using the Work role functioning questionnaire 2.0. The relationships between DED and work measures were assessed with logistic regression models, corrected for age, sex, BMI, income, educational level, smoking, and 48 comorbidities.

RESULTS

8.3% of participants had DED and had more impaired work functioning compared to those without DED (49.2% vs 41.1%, OR 1.21, 95% CI 1.10-1.32, corrected for demographics, smoking and 48 comorbidities). DED carried a similar risk of impaired work functioning as rheumatoid arthritis. For participants with highly symptomatic dry eye impaired work functioning was even higher (59.1%) and similar to that of depression. The impaired work functioning seen with increasing symptoms were greater in undiagnosed subjects versus diagnosed subjects (P = 0.03). After correction for comorbidities, DED remained tied to absenteeism and increased worry about job loss, but not unemployment.

CONCLUSION

DED was linked to impaired work functioning and absence, but not unemployment. DEDs impact on work functioning is comparable to that of other severe chronic disorders, and undiagnosed subjects may be more affected. This highlights the importance of recognizing DED as a severe disorder and of screening for dry eye in the workplace to aid with diagnosis and treatment.

A pilot randomized controlled trial on motivational interviewing in return to work after work disability

PURPOSE

Does 15-minute consult using Motivational Interviewing (MI) have a positive effect on (1) time until return to work (RTW) and relapse after work resumption for patients who have been work disabled for longer than 3 months, and (2) can psychological variables (i.e., work-related motivation, work-related psychological needs, quality of life and work ability) explain these results?

METHODS

265 patients were included in a pilot randomized controlled trial, parallel and single blind, with an allocation ratio of 1:1 comparing the consult with MI with the consult as usual group (CAU). There was a 12-month follow up on actual RTW and relapse for both groups. The psychological outcomes were work-related motivation (MAWS), work-related psychological needs (BPNSFS), quality of life (EQ5D5L)) and work ability (WAI). Measurement of these indicators took place at baseline, 1 week after the intervention and 3 months after the intervention.

RESULTS

Patients in the MI group showed faster RTW and had a lower chance of relapse compared to those in the CAU condition. No significant differences were found between MI and CAU for the psychological outcomes.

CONCLUSIONS

Based on our results, there is some evidence that counseling including MI helps work-disabled patients to RTW faster and experience less relapse. However, much remains unknown about the underlying psychological mechanisms explaining this effect. Suggestions are made for the full RCT.

Reliability and validity of an employer-completed safety hazard and management assessment questionnaire

INTRODUCTION

Managing and improving occupational safety and health requires evaluating performance. Organizations are encouraged to use both lagging indicators (such as injury rates and costs) and leading indicators (such as questionnaire-assessed safety hazards and management practices) for this purpose, but the association between types of indicators over time can be complex. Longitudinal data can assist in clarifying these associations and increasing indicator utility.

METHOD

Employer data were used to evaluate the reliability and predictive validity of a safety management questionnaire. Employers' longitudinal questionnaire responses and workers' compensation (WC) claims data were analyzed using a marginal model with time-dependent covariates. Multivariable Poisson and linear regression analyses with claim rate and logarithmic cost, respectively, as dependent variables were carried out after adjusting for industry sector and size. Questionnaire data were used to evaluate questionnaire scaling properties and to assess generalizability of results.

RESULTS

One safety management scale was associated with a better WC outcome as predicted and two scales were unexpectedly associated with poorer WC claim outcomes. Analyses assisted in interpreting the latter results, suggesting that WC outcomes were a stimulus for change in some cases. Twelve hazards assessed on the questionnaire were associated with poorer WC claim outcomes as predicted.

CONCLUSIONS

This study extends leading indicator research using longitudinal questionnaire and WC claims data from employers. Analyses provided insight into associations between leading and lagging indicators, emphasizing the importance of both for safety improvement. Safety management questionnaire scales were predictive of WC claim outcomes, although support for hazard assessments as leading indicators was stronger.

PRACTICAL APPLICATIONS

This study supports the use of employer-completed hazard assessment questionnaires for targeting and prioritizing improvement efforts. Employer-completed safety management scales may be useful for directing improvement efforts, although the conditions under which they are completed, including submission to insurers, require additional consideration.

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.

Presenteeism and absenteeism before and after single-level lumbar spine surgery

BACKGROUND CONTEXT

Health can impact work performance through absenteeism, time spent away from work, and presenteeism, inhibited at-work performance. Low back pain is common and costly, both in terms of direct medical expenditures and indirect reduced work performance.

PURPOSE

Surgery for lumbar spinal pathology is an important part of treatment for patients who do not respond to nonsurgical management. While the indirect costs of return to work and absenteeism among employed patients undergoing lumbar spine surgery have been studied, little work has been done to quantify presenteeism before and after lumbar spine surgery.

STUDY DESIGN/SETTING

Prospective cohort study at a single high-volume urban musculoskeletal specialty hospital.

PATIENT SAMPLE

Patients undergoing single-level lumbar spinal fusion and/or decompression surgery.

OUTCOME MEASURES

Presenteeism and absenteeism were measured using the World Health Organization's Health and Work Performance Questionnaire before surgery, as well as 6 weeks, 6 months, and 12 months after surgery.

METHODS

Average presenteeism and absenteeism were evaluated at pre-surgical baseline and each follow-up timepoint. Monthly average time lost to presenteeism and absenteeism were calculated before surgery and 12 months after surgery. Study data were collected and managed using REDCap electronic data capture tools with support from Clinical and Translational Science Center grant, UL1TR002384. One author discloses royalties, private investments, consulting fees, speaking/teaching arrangements, travel, board of directorship, and scientific advisory board membership totaling >$300,000.

RESULTS

We enrolled 134 employed surgical patients, among whom 115 (86%) responded at 6 weeks, 105 (78%) responded at 6 months, and 115 (86%) responded at 12 months. Preoperatively, mean age was 56.4 years (median 57.5), and 41.0% were women; 68 (50.7%) had only decompressions, while 66 (49.3%) had fusions. Among respondents at each time point, 98%, 92%, and 92% were still employed, among whom 76%, 96%, and 96% had resumed working, respectively (median 29 days). Average at-work performance among working patients (who responded at each pair of timepoints) moved from 75.4 to 78.7 between baseline and 6 weeks, 71.8 to 85.9 between baseline and 6 months, and 73.0 to 88.1 between baseline and 12 months. Gains were concentrated among the 52.0% of patients whose at-work performance was declining (and low) leading up to surgery. Average absenteeism was relatively unmoved between baseline and each follow-up. Before surgery, the monthly average time lost to presenteeism and absenteeism was 19.8% and 18.9%, respectively; 12 months after surgery, these numbers were 9.7% and 16.0%; changes represent a mitigated loss of 13.0 percentage points of average monthly value.

CONCLUSIONS

Presenteeism and absenteeism contributed roughly evenly to preoperative average monthly lost time. Although average changes in absenteeism and 6-week at-work performance were small, average changes in at-work performance at 6 and 12 months were significant. Cost-benefit analyses of lumbar spine surgery should therefore consider improved presenteeism, which appears to offset some of the direct and indirect costs of surgical treatment.

The effects of a new seat suspension system on whole body vibration exposure and driver low back pain and disability: Results from a randomized controlled trial in truck drivers

Through a randomized controlled trial, we evaluated the effects of an electro-magnetic active seat suspension that reduces exposure of a long-haul truck driver to whole body vibration (WBV) on low back pain (LBP) and disability. Among 276 drivers recruited from six trucking terminals of a major US trucking company, 135 eligible drivers were assigned to either having an Active Seat (Intervention: n = 70) - the BoseRide® electro-magnetic active seat - or Passive Seat (reference: n = 65) - a new version of their current seat (passive air suspension seat) - installed in their truck via block (terminal) randomization. Low back pain (LBP) severity, on a 0-10 scale and the Oswestry LBP Disability Index were collected before and 3-, 6-, 12-, 18-, and 24-months post seat installation. LBP severity and LBP disability scores were significantly lower post seat installation in both groups. At 3 months, LBP severity decreased -1.4 [95% CI: -2.1 to -0.7: n = 46] for drivers in the Active Seat arm, and -1.5 [95% CI: -2.3 to -0.8: n = 41] for drivers in the Passive Seat arm. In a subset of drivers, WBV exposures were collected before and after the seat installation. WBV exposures significantly decreased post seat installation for Active Seat (p < 0.01) but not for Passive Seat (p = 0.15). While the new seat-suspension technology reduced WBV exposures, LBP appeared to be improved by multiple factors. These results were limited by the secondary prevention approach and the longer-term loss to follow up due to large rates of driver turnover typical for the industry.

Effects of Cognitive and Mental Health Factors on the Outcomes Following Carpal Tunnel Release: A Systematic Review and Meta-analysis

OBJECTIVE

To determine the effects of the cognitive and mental health factors on the outcomes after carpal tunnel release (CTR).

DATA SOURCES

Embase, PubMed/MEDLINE, Web of Science, Cumulative Index to Nursing and Allied Health, and Cochrane Central Register of Controlled Trials databases from inception to August 14, 2021.

STUDY SELECTION

Randomized controlled trials and observational studies of patients with CTR were included. The included studies aimed to determine the effect of the cognitive (catastrophic thinking, kinesiophobia, self-efficacy) or mental health factors (symptoms of anxiety and depression) on the outcomes at least 3 months post CTR.

DATA EXTRACTION

Two independent reviewers performed data extraction and assessed the risk of bias. Data were extracted using a standardized protocol and reporting forms. The risk of bias of the included studies was assessed using the Quality in Prognosis Studies risk-of-bias tool. Random-effects models were used for meta-analysis.

DATA SYNTHESIS

A total of 15 studies involving 2599 patients were included in this systematic review. The majority of studies indicate a significant association between the cognitive or mental health factors and outcomes after CTR. Quantitative analysis showed a moderate association of symptoms of depression on symptom severity (n=531; r=0.347; 95% CI, 0.205-0.475; P≤.0001), function (n=386; r=0.307; 95% CI, 0.132-0.464; P=.0008), and pain (n=344; r=0.431; 95% CI, 0.286-0.558; P≤.0001). In general, the risk of bias in the included studies was low.

CONCLUSIONS

This systematic review and meta-analysis showed that symptoms of depression have a moderate association with symptom severity, function, and pain after CTR. Symptoms of anxiety, catastrophic thinking, and self-efficacy are also important indicators of poor postsurgery outcomes. Physicians, physical therapists, and occupational therapists should consider evaluating these variables in patients undergoing CTR.

Does social support at home moderate the association between social support at work and work functioning among cancer patients?

PURPOSE

The aims of this study were to examine (1) the longitudinal associations of supervisor and colleague social support with work functioning in cancer patients who have returned to work and (2) the moderating role of social support at home.

METHODS

Data from the longitudinal Work Life after Cancer study were used (n = 384). Work functioning (low versus moderate to high work functioning) was measured with the validated Work Role Functioning Questionnaire 2.0. Social support at work was measured from both supervisor and colleagues with the Copenhagen Psychosocial Questionnaire. Social support at home was measured with the Social Support List-Discrepancies. Logistic generalized estimating equations were used to analyse associations between supervisor and colleague social support and work functioning, and to examine the possible moderating effect of social support at home.

RESULTS

More supervisor (OR: 1.21; 95% CI: 1.10, 1.32) and colleague (1.13; 1.03, 1.24) social support were significantly associated with moderate to high work functioning. The association between colleague social support and work functioning was attenuated for those who did not experience enough social support at home but remained almost significant for supervisor social support (1.17; 1.00, 1.37).

CONCLUSIONS

Supervisor social support is associated with better work functioning regardless of social support at home, while colleague social support is only associated with better work functioning when cancer patients experience enough social support at home.

IMPLICATIONS FOR CANCER SURVIVORS

Occupational physicians may play a key role in creating awareness that social support at work and at home are beneficial for cancer patients' work functioning.

Presenteeism and Absenteeism Before and After Total Hip and Knee Arthroplasty

BACKGROUND

Absenteeism is costly, yet evidence suggests that presenteeism-illness-related reduced productivity at work-is costlier. We quantified employed patients' presenteeism and absenteeism before and after total joint arthroplasty (TJA).

METHODS

We measured presenteeism (0-100 scale, 100 full performance) and absenteeism using the World Health Organization's Health and Work Performance Questionnaire before and after TJA among a convenience sample of employed patients. We captured detailed information about employment and job characteristics and evaluated how and among whom presenteeism and absenteeism improved.

RESULTS

In total, 636 primary, unilateral TJA patients responded to an enrollment email, confirmed employment, and completed a preoperative survey (mean age: 62.1 years, 55.3% women). Full at-work performance was reported by 19.7%. Among 520 (81.8%) who responded to a 1-year follow-up, 473 (91.0%) were still employed, and 461 (88.7%) had resumed working. Among patients reporting at baseline and 1 year, average at-work performance improved from 80.7 to 89.4. A Wilcoxon signed-rank test indicated that postoperative performance was significantly higher than preoperative performance (P < .0001). The percentage of patients who reported full at-work performance increased from 20.9% to 36.8% (delta = 15.9%, 95% confidence interval = [10.0%, 21.9%], P < .0001). Presenteeism gains were concentrated among patients who reported declining work performance leading up to surgery. Average changes in absences were relatively small. Combined, the average monthly value lost by employers to presenteeism declined from 15.3% to 8.3% and to absenteeism from 16.9% to 15.5% (ie, mitigated loss of 8.4% of monthly value).

CONCLUSION

Among employed patients before TJA, presenteeism and absenteeism were similarly costly. After, employed patients reported increased performance, concentrated among those with declining performance leading up to surgery.

Two-year recovery courses of physical and mental impairments, activity limitations, and participation restrictions after total knee arthroplasty among working-age patients

Purpose: Total knee arthroplasty is increasingly performed on working-age individuals, but little is known about their recovery process. Therefore this study examined recovery courses of physical and mental impairments, activity limitations and participation restrictions among working-age total knee arthroplasty recipients. Associated sociodemographic and health-related factors were also evaluated.Materials and methods: A prospective study among working total knee arthroplasty patients (aged <65 years) (n = 146). Surveys were completed preoperatively and 6 weeks and 3, 6, 12, and 24 months postoperatively. Outcomes represented domains of the International Classification of Functioning, that is, physical impairments (pain, stiffness, vitality), mental impairments (mental health, depressive symptoms), activity limitations (physical functioning), and participation restrictions (social-, work functioning, working hours). Covariates included age, gender, education, home situation, body mass index, and comorbidity.Results: Largest improvements in physical and mental impairments and activity limitations were observed until 3 months postoperatively. Participation in social roles improved early after surgery, and improvements in work participation occurred from 6 to 12 months. Older age, being male and fewer comorbidities were associated with better recovery courses.Conclusion: Working-age total knee arthroplasty patients recover soon from physical and mental impairments, activity limitations, and participation in social roles, but participation at work occurs later. Younger patients, females, and those with musculoskeletal comorbidities appear at risk for suboptimal recovery after total knee arthroplasty.Implications for rehabilitationAn increasing number of working-age patients are asking for total knee arthroplasty and have high expectations of total knee arthroplasty, in particular, to participate in the workforce again;Recovery after total knee arthroplasty (TKA) does not occur in the short term and is not limited to clinical improvements for working-age TKA recipients only, as an important part of recovery, that is, participation occurs in the long term (>6 months);Closer collaboration between occupational physicians and orthopedic surgeons might result in increased and earlier ability to work full contractual hours;Rehabilitation after TKA should focus on patients with multiple comorbidities, whereby musculoskeletal diseases may even need additional preoperative treatment to optimize outcomes and prevent work disability.

Occupation classification predicts return to work after carpal tunnel decompression

Background

The relationship between hand function, employment status and return to work (RTW) after carpal tunnel decompression (CTD) is unclear.

Aims

To investigate predictors of RTW following CTD.

Methods

We prospectively collected pre-operative and 1-year post-operative outcomes and RTW data for all patients undergoing CTD at one centre between 29 May 2014 and 29 May 2017. We used the Standard Occupation Classification 2010.

Results

Pre- and post-operative results were available for 469 (79%) of the 597 patients who had CTD surgery. Pre-operatively, 219 (47%) were employed, 216 (46%) were retired, 26 (6%) were not working due to long-term illness and eight (2%) were unemployed. Complete data sets were available for 178 (81%) of the 219 employed patients, of whom 161 (90%) were able to RTW. Of the rest, five (3%) had changed jobs and 12 (7%) were unable to work. Median RTW time was 4 weeks (interquartile range [IQR] 2–6 weeks). Significantly more patients undertaking manual labour were unable to RTW (15% versus 5%; P &lt; 0.05). There was no significant difference in mean number of weeks absent between manual (5.7; 95% confidence interval [CI] 4.9–6.5) and non-manual workers (6.2; 95% CI 4.8–7.6) (P &gt; 0.05). Median pre-operative (difference 15.9; 95% CI 4.5–25) and post-operative (difference 43.2; 95% CI 13.6–43.2) hand function scores were significantly worse in patients who did not RTW (P &lt; 0.05).

Conclusions

Most patients can RTW within 1 year of CTD. Failure to RTW is more likely in manual workers and patients with poorer pre-operative hand function.

Returning to Work After Sick Leave - The Role of Work Demands and Resources, Self-Efficacy, and Social Support

Returning to work after sick leave is a process that begins with the initial steps of functional recovery and results in full vocational capacity. Different personal and situational factors could influence an employee's well-being after returning. The following research was conducted in order to examine how occupational demands and resources, self-efficacy, and social engagement contribute to the return-to-work process. A total of 256 employees took part in the study, who were later divided into two groups: short- (less than 30 days), and long-term (more than 30 days) sick leave. We measured their self-efficacy at the workplace, recent job demands and resources, social engagement, and work satisfaction after returning to work after sick leave. The results showed that personal (gender, age, and self-efficacy), social (social engagement), and occupational (job demands and resources) factors are associated with the duration of sick leave. Participants who were on shorter sick leaves reported being more satisfied with their work after returning than those returning from long-term sick leave. The research presents important insights that could help employers better understand the needs of employees who are returning to work after sick leave.

E. M. de Boer A. The association of subjective fit perceptions, distress, emotional exhaustion, and work engagement, with work functioning problems: A cross-sectional study conducted among young construction project management professionals

OBJECTIVES

To investigate the association of subjective fit perceptions, distress, emotional exhaustion, and work engagement, with work functioning, among young construction project management professionals (CPMPs).

METHODS

The research had a cross-sectional design. Dutch young CPMPs (142 participants, age range: 20 to 30 years of age) completed a questionnaire containing general questions recording their demographic characteristics, and instruments recording the following concepts: perceived person-organization fit, perceived person-job fit (including demands-abilities fit and needs-supplies fit), distress, emotional exhaustion, work engagement, and work functioning. Correlation analysis and multiple regression analysis were used to examine the association of fit perceptions, distress, emotional exhaustion, and work engagement, with work functioning.

RESULTS

The correlation analysis indicated that person-organization fit, needs-supplies fit, distress, emotional exhaustion, and work engagement correlated significantly with work functioning problems of young CPMPs. The multiple regression analyses corroborated that needs-supplies fit, distress, and emotional exhaustion related significantly to the work functioning problems of young CPMPs, with the standardized regression coefficients (β) of -0.28, 0.52, and 0.38 (P < .01), respectively. Other than would be expected, the multiple regression analyses also made clear that work engagement does not significantly relate to work functioning problems beyond distress and emotional exhaustion.

CONCLUSIONS

Incongruence between personal needs and job supplies, psychological distress, and emotional exhaustion are central correlates of the work functioning problems of young CPMPs. Occupational health professionals can use these insights to help young CPMPs at work.

Work Functioning Among Firefighters: A Comparison Between Self-Reported Limitations and Functional Task Performance

Purpose Performance-based and disease indicators have been widely studied in firefighters; self-reported work role limitations have not. The aim of this study was to describe the distributions and correlations of a generic self-reported Work Limitations Questionnaire (WLQ-26) and firefighting-specific task performance-based tests. Methods Active firefighters from the City of Hamilton Fire Services (n = 293) were recruited. Participants completed the WLQ-26 to quantify on-the-job difficulties over five work domains: work scheduling (4 items), output demands (7 items), physical demands (8 items), mental demands (4 items), and social demands (3 items). A subset of participants (n = 149) were also assessed on hose drag and stair climb with a high-rise pack performance-based tests. Descriptive statistics and correlations were used to compare item/subscale performance; and to describe the inter-relationships between tests. Results The mean WLQ-26 item scores (/5) ranged from 4.1 to 4.4 (median = 5 for all items); most firefighters (54.5-80.5%) selected "difficult none of the time" response option on all items. A substantial ceiling effect was observed across all five WLQ-26 subscales as 44.0-55.6% were in the highest category. Subscale means ranged from 61.8 (social demands) to 78.7 (output demands and physical demands). Internal consistency exceeded 0.90 on all subscales. For the hose drag task, the mean time-to-completion was 48.0 s (SD = 14.5; range 20.4-95.0). For the stair climb task, the mean time-to-completion was 76.7 s (SD = 37.2; range 21.0-218.0). There were no significant correlations between self-report work limitations and performance of firefighting tasks. Conclusions The WLQ-26 measured five domains, but had ceiling effects in firefighters. Performance-based testing showed wider score range, lacked ceiling effects and did not correlate to the WLQ-26. A firefighter-specific, self-report role functioning scale may be needed to identify compromised work role capabilities in firefighters.

A Randomized Controlled Trial of a Truck Seat Intervention: Part 2-Associations Between Whole-Body Vibration Exposures and Health Outcomes

This randomized controlled trial study was conducted to determine whether two different seating interventions would reduce exposure to whole-body vibration (WBV) and improve associated health outcomes. Forty professional truck drivers were randomly assigned to two groups: (i) a control group of 20 drivers who received a new, industry-standard air-suspension seat, and (ii) an intervention group of 20 drivers who received an active-suspension seat. This study collected regional body pain (10-point scale), low back disability [Oswestry Disability Index (ODI)], physical and mental health [the Short Form 12-item Health Survey (SF-12)], and work limitations [Work Limitation Questionnaire (WLQ)] before and 3, 6, and 12 months after the seating intervention. WBV exposures were also collected during the same time periods. Due to dropouts at the 12-month time period, only data up to 6 months post-intervention were included in the analyses. The post-intervention A(8) WBV exposures were lower in both groups with a more substantial WBV exposure reduction (~50%) in the intervention group compared to the control group (~26%). There was little to no change in the impulsive exposures [VDV(8) and Sed(8)] post-intervention and no differences between the two groups. The self-reported musculoskeletal health outcomes showed that intervention group experienced a greater reduction in the low back pain (LBP) and other musculoskeletal outcomes than the control group. The LBP reduction in the intervention group was clinically meaningful (>25%); however, none of the changes in pain reached statistical significance (P's > 0.22). The SF-12 health scores demonstrated that the intervention group's physical health improved after the intervention (P's < 0.06) while the control group experience little to no improvement (P's > 0.11). The WLQ scores showed that the intervention group generally experienced reduced (improved) work limitation over time whereas the control group showed inconsistent changes in work limitation scores. These study findings indicate that reducing truck drivers' exposure to WBV through seating intervention can lead to improvements in LBP and other health outcomes.

Cross-cultural adaptation of the Work Role Functioning Questionnaire 2.0 to Norwegian and Danish

BACKGROUND:

A healthy and productive working life has attracted attention owing to future employment and demographic challenges.

OBJECTIVE:

The aim was to translate and adapt the Work Role Functioning Questionnaire (WRFQ) 2.0 to Norwegian and Danish.

METHODS:

The WRFQ is a self-administered tool developed to identify health-related work limitations. Standardised cross-cultural adaptation procedures were followed in both countries’ translation processes. Direct translation, synthesis, back translation and consolidation were carried out successfully.

RESULTS:

A pre-test among 78 employees who had returned to work after sickness absence found idiomatic issues requiring reformulation in the instructions, four items in the Norwegian version, and three items in the Danish version, respectively. In the final versions, seven items were adjusted in each country. Psychometric properties were analysed for the Norwegian sample (n = 40) and preliminary Cronbach’s alpha coefficients were satisfactory. A final consensus process was performed to achieve similar titles and introductions.

CONCLUSIONS:

The WRFQ 2.0 cross-cultural adaptation to Norwegian and Danish was performed and consensus was obtained. Future validation studies will examine validity, reliability, responsiveness and differential item response. The WRFQ can be used to elucidate both individual and work environmental factors leading to a more holistic approach in work rehabilitation.

Impact of a fatigue management in work programme on meeting work demands of individuals with rheumatic diseases: A pilot study

INTRODUCTION

Work disability and job loss are serious consequences of rheumatic diseases (RDs), and fatigue is a symptom of RDs commonly reported to have an impact on work performance. A FAtigue ManagEment in Work (FAME-W) programme was developed to facilitate the self-management of fatigue in work. The present pilot study explored if FAME-W could facilitate individuals with RDs to manage fatigue in work and improve their ability to meet work demands.

METHODS

Twenty-seven individuals with a variety of rheumatic diagnoses completed a 4-week, 2-h occupational therapy-led self-management programme. Each week focused on fatigue-related topics, including fatigue and activity management, pain management and joint protection, mental well-being, effective communication with employers and work colleagues, and employment legislation. Individual workplace ergonomic assessments were also offered. Study measures (work function, fatigue, pain, mood and self-efficacy) were completed prior to starting FAME-W, immediately post-intervention and 12 weeks post-intervention.

RESULTS

Participants (56% male) had a mean age of 43 years. No significant improvements were observed immediately post-programme. However, at the 12-week follow-up, significant improvements were reported in meeting work demands (scheduling [p = 0.046], output [p = 0.002], physical [p = 0.003], mental [p = 0.016]), fatigue [p = 0.001], pain [p = 0.01], anxiety [p = 0.001], depression [p < 0.001], self-efficacy [p < 0.001] and Arthritis Impact Measurement Scales 2-Short Form (physical: p = 0.005; symptoms: p = 0.010; affect: p = 0.010; social: p = 0.001).

CONCLUSIONS

Significant improvements were reported in participants' ability to meet various demands of their work 3 months post-FAME-W. These findings suggest that FAME-W has the potential to assist individuals with RDs to meet the demands of their work, although further research is required to test the effectiveness of this intervention.

Evaluating the validity of the Work Role Functioning Questionnaire (Canadian French version) using classical test theory and item response theory

BACKGROUND

The Work Role Functioning Questionnaire (WRFQ) was developed to assess workers' perceived ability to perform job demands and is used to monitor presenteeism. Still few studies on its validity can be found in the literature.

OBJECTIVE

The purpose of this study was to assess the items and factorial composition of the Canadian French version of the WRFQ (WRFQ-CF).

METHODS

Two measurement approaches were used to test the WRFQ-CF: Classical Test Theory (CTT) and non-parametric Item Response Theory (IRT).

RESULTS

A total of 352 completed questionnaires were analyzed. A four-factor and three-factor model models were tested and shown respectively good fit with 14 items (Root Mean Square Error of Approximation (RMSEA) = 0.06, Standardized Root Mean Square Residual (SRMR) = 0.04, Bentler Comparative Fit Index (CFI) = 0.98) and with 17 items (RMSEA = 0.059, SRMR = 0.048, CFI = 0.98). Using IRT, 13 problematic items were identified, of which 9 were common with CTT.

CONCLUSIONS

This study tested different models with fewer problematic items found in a three-factor model. Using a non-parametric IRT and CTT for item purification gave complementary results. IRT is still scarcely used and can be an interesting alternative method to enhance the quality of a measurement instrument. More studies are needed on the WRFQ-CF to refine its items and factorial composition.

Outcomes Following Carpal Tunnel Release in Patients Receiving Workers' Compensation: A Systematic Review

BACKGROUND

Carpal tunnel syndrome (CTS) is a common occupational pathology, representing a high percentage of workers' compensation (WC) claims.

METHODS

The literature was reviewed for all studies evaluating CTS outcomes including WC patients between 1993 and 2016. A total of 348 articles were identified; 25 of which met inclusion and exclusion criteria. A systematic review was generated; patient demographics, outcomes, and complications were recorded. Weighted averages were calculated for the demographic and outcome data. Categorical data such as complications were pooled from the studies and used to determine the overall complication rate. Statistical significance was determined between WC and non-WC cohorts when applicable with the chi-square statistic.

RESULTS

The WC cohort included 1586 wrists, and the non-WC cohort included 2781 wrists. The WC cohort was younger and more often involved the dominant extremity. The WC cohort was less likely to have appropriate physical exam findings confirming diagnosis and electrodiagnostic studies. WC patients took almost 5 weeks longer to return to work, were 16% less likely to return to preinjury vocation, and had lower Standard Form (SF)-36 scores. Finally, WC patients had nearly 3 times the number of complications and nearly twice the rate of persistent pain.

CONCLUSIONS

WC patients undergoing carpal tunnel release (CTR) fare poorly as compared with non-WC patients in nearly every metric. Higher rates of postoperative pain with delayed return to work can be anticipated in a WC cohort. In addition, WC patients receive suboptimal preoperative workup, and it is possible that unnecessary surgery is being completed in these cases. These findings are important to consider when treating the WC patient with CTS.

Quality of care and patient-reported outcomes in carpal tunnel syndrome: A prospective observational study

INTRODUCTION

Higher quality care for carpal tunnel syndrome (CTS) may be associated with better outcomes.

METHODS

This prospective observational study recruited adults diagnosed with CTS from 30 occupational health centers, evaluated physicians' adherence to recommended care processes, and assessed results of the Boston Carpal Tunnel Questionnaire (BCTQ) and Short Form Health Survey version 2 (SF-12v2) at recruitment and at 18 months.

RESULTS

Among 343 individuals, receiving better care (80th vs. 20th percentile for adherence) was associated with greater improvements in BCTQ Symptom Severity scores (-0.18, 95% confidence interval [CI] -0.32 to -0.05), BCTQ Functional Status scores (-0.21, 95% CI -0.34 to -0.08), and SF12-v2 Physical Component scores (1.75, 95% CI 0.33-3.16). Symptoms improved more when physicians assessed and managed activity, patients underwent necessary surgery, and employers adjusted job tasks.

DISCUSSION

Efforts should be made to ensure that patients with CTS receive essential care processes including necessary surgery and activity assessment and management. Muscle Nerve 57: 896-904, 2018.

How Do Organizational Policies and Practices Affect Return to Work and Work Role Functioning Following a Musculoskeletal Injury?

Purpose Organizational-level policies and practices that promote safety leadership and practices, disability management and ergonomic policies and practices are considered key contextual determinants of return to work. Our objective was to examine the role of worker-reported organizational policies and practices (OPPs) in return to work (RTW) and work role functioning (WRF) and the mediating role of pain self-efficacy and work accommodation. Methods A worker cohort (n = 577) in Ontario, Canada was followed at 1, 6 and 12 months post injury. Both RTW (yes/no) and WRF (WLQ-16) status (3 levels) were measured. OPPs were measured (high vs. low) at 1 month post-injury. Pain self-efficacy (PSE) and work accommodation (WA) were included in mediation analyses. Results OPPs predicted RTW at 6 months (adjusted OR 1.77; 95 % CI 1.07-2.93) and 12 months (adjusted OR 2.07; 95 % CI 1.18-3.62). OPPs predicted WRF at 6 months, but only the transition from working with limitations to working without limitations (adjusted OR 3.21; 95 % CI 1.92-5.39). At 12 months, OPPs predicted both the transition from not working to working with and without limitations and from not working or working with limitations to working without limitations (adjusted OR 2.13; 95 % CI 1.37-3.30). Offers of WA mediated the relationship between OPPs and both RTW and WRF at 6 months follow-up. PSE mediated the relationship between OPPs and RTW and WRF at 6 months. At 12 months neither mediated the relationship. Conclusions The findings support worker-reported OPPs as key determinants of both RTW and WRF. These results point to the importance of WA and PSE in both RTW and WRF at 6 months.

Work functioning trajectories in cancer patients: Results from the longitudinal Work Life after Cancer (WOLICA) study

More than 60% of cancer patients are able to work after cancer diagnosis. However, little is known about their functioning at work. Therefore, the aims of this study were to (1) identify work functioning trajectories in the year following return to work (RTW) in cancer patients and (2) examine baseline sociodemographic, health-related and work-related variables associated with work functioning trajectories. This longitudinal cohort study included 384 cancer patients who have returned to work after cancer diagnosis. Work functioning was measured at baseline, 3, 6, 9 and 12 months follow-up. Latent class growth modeling (LCGM) was used to identify work functioning trajectories. Associations of baseline variables with work functioning trajectories were examined using univariate and multivariate analyses. LCGM analyses with cancer patients who completed on at least three time points the Work Role Functioning Questionnaire (n = 324) identified three work functioning trajectories: "persistently high" (16% of the sample), "moderate to high" (54%) and "persistently low" work functioning (32%). Cancer patients with persistently high work functioning had less time between diagnosis and RTW and had less often a changed meaning of work, while cancer patients with persistently low work functioning reported more baseline cognitive symptoms compared to cancer patients in the other trajectories. This knowledge has implications for cancer care and guidance of cancer patients at work.

Low back pain among office workers in three Spanish-speaking countries: findings from the CUPID study

OBJECTIVES

To assess the differences in the prevalence and incidence of low back pain (LBP) and associated disability among office workers in Costa Rica, Nicaragua and Spain.

METHODS

Data were collected at baseline (n=947, 93% response) in November 2007 and at follow-up after 12 months (n=853, 90% response). Six outcome measures were examined: baseline prevalence of (1) LBP in the past 12 months, (2) LBP in the past month and (3) disabling LBP in the past month; and at follow-up: (4) incidence of new LBP in the past month, (5) new disabling LBP and (6) persistent LBP. Differences in prevalence by country were characterised by ORs with 95% CIs, before and after adjustment for covariates.

RESULTS

Prevalence of LBP in the past month among office employees in Costa Rica (46.0%) and Nicaragua (44.2%) was higher than in Spain (33.6%). Incidence of new LBP was 37.0% in Nicaragua (OR=2.49; 95% CI 1.57 to 3.95), 14.9% in Costa Rica (OR=0.74; 95% CI 0.41 to 1.34) and 19.0% in Spain (reference). Incidence of new disabling LBP was higher in Nicaragua (17.2%; OR=2.49; 95% CI 1.43 to 4.34) and Costa Rica (13.6%; OR=1.89; 95% CI 1.03 to 3.48) than Spain (7.7%), while persistence of LBP was higher only in Nicaragua.

CONCLUSIONS

Prevalence of LBP and disabling LBP was higher in Costa Rican and Nicaraguan office workers than in Spain, but the incidence was higher mainly in Nicaragua. Measured sociodemographic, job-related and health-related variables only partly explained the differences between countries, and further research is needed to explore reasons for the remaining differences.

Women with Neck Pain on Long-Term Sick Leave-Approaches Used in the Return to Work Process: A Qualitative Study

Purpose There are difficulties in the process of return to work (RTW) from long-term sick leave, both in general and regarding sick leave because of neck pain in particular. Neck pain is difficult to assess, problematic to rehabilitate, and hard to cure; and it is not always easy to decide whether the pain is work-related. The outcome of RTW could be dependent upon individuals' approaches, defensive or offensive behaviors, and choices related to their self-efficacy. The aim of this study was to identify approaches used in the RTW process among women with neck pain on long-term sick leave from human service organizations. Methods This is a qualitative descriptive study based on grounded theory. A Swedish cohort of 207 women with a history of long-term sick leave with neck pain from human service organizations answered open-ended written questions at 0, 6, and 12 months, and 6 years; and 16 women were interviewed. Results Individuals expressed their coping approaches in terms of fluctuating in work status over time: either as a strategy or as a consequence. Periods of sick leave were interwoven with periods of work. The women were either controlling the interaction or struggling in the interaction with stakeholders. Conclusions Return to work outcomes may be improved if the fluctuating work status over time is taken into account in the design of rehabilitation efforts for women with a history of long-term sick leave and with chronical musculoskeletal conditions.

[Socio professional impact of surgical release of carpal tunnel syndrome]

The objective was studying the socio-professional impact of release surgery for carpal tunnel syndrom (CTS). We conducted a cross-sectional study of patients operated for work-related CTS; data were collected in the Occupational Health Department at the University Hospital Tahar Sfar in Mahdia, Tunisia over a period of 8 years, from 1 January 2006 to December 2013. Data collection was performed using a survey form focusing on participants' socio-professional and medical characteristics and on their professional future. We used Karasek's questionnaire to study psychosocial constraints at work. The duration of a work stoppage following release surgery for CTS was significantly related to the existence of musculoskeletal disorders other than CTS, to a statement that the carpal tunnel syndrome was work related and to job seniority. As regards the professional future of operated employees, 50.7% remained in the same position, 15.3% were given customized workstation and 33.8% were offered a different position within the same company. The professional future of these employees was related to their occupational qualifications and to the type of sensory and/or motor impairment of median nerve detected during EMG test. A number of nonlesional factors determines the duration of the work stoppage, while the professional future of patients operated for CTS essentially depends on their professional qualifications and on EMG data. Certainly much broader studies would allow to refine these results.

Upper extremity musculoskeletal pain among office workers in three Spanish-speaking countries: findings from the CUPID study

OBJECTIVES

To estimate the prevalence and incidence of upper extremity musculoskeletal pain (UEMP) and related disability among office workers in Costa Rica, Nicaragua and Spain.

METHODS

Data from the multinational Cultural and Psychosocial Influences on Disability (CUPID) study on 947 (93%) participants at baseline with 90% follow-up after 12 months were employed. Logistic regression was used to estimate the associations (ORs and corresponding 95% CIs) between country and six outcomes: baseline prevalence of (1) UEMP in past 12 months, (2) UEMP in past month and (3) disabling UEMP in past month; (4) incidence of new UEMP at follow-up; (5) incidence of new disabling UEMP at follow-up and (6) persistence of UEMP at follow-up, after adjustment for sociodemographic, job-related and health-related covariates.

RESULTS

Baseline prevalence of UEMP in the past month was higher in Costa Rica (53.6%) (OR=1.89; 95% CI 1.36 to 2.62) and Nicaragua (51.9%) (OR=1.74; 95% CI 1.28 to 2.35) than in Spain (38.4%). Compared to Spain (33.2%), the incidence of new UEMP was 50.4% in Costa Rica (OR=2.04; 95% CI 1.34 to 3.12) and 60.2% in Nicaragua (OR=3.04; 95% CI 2.06 to 4.50). The incidence of disabling UEMP was higher in Nicaragua (OR=2.57; 95% CI 1.50 to 4.41) and Costa Rica (OR=2.16; 95% CI 1.22 to 3.84) when compared to Spain.

CONCLUSIONS

Prevalence of UEMP was approximately twofold higher and its incidence twofold to threefold higher in Costa Rica and Nicaragua as compared with Spain. Between-country differences were only partially explained by the covariates analysed. Research is needed to explore other aspects of work and cultural attributes that might explain the residual differences in UEMP.

Predictive value and construct validity of the work functioning screener-healthcare (WFS-H)

Objectives:

To test the predictive value and convergent construct validity of a 6-item work functioning screener (WFS-H).

Methods:

Healthcare workers (249 nurses) completed a questionnaire containing the work functioning screener (WFS-H) and a work functioning instrument (NWFQ) measuring the following: cognitive aspects of task execution and general incidents, avoidance behavior, conflicts and irritation with colleagues, impaired contact with patients and their family, and level of energy and motivation. Productivity and mental health were also measured. Negative and positive predictive values, AUC values, and sensitivity and specificity were calculated to examine the predictive value of the screener. Correlation analysis was used to examine the construct validity.

Results:

The screener had good predictive value, since the results showed that a negative screener score is a strong indicator of work functioning not hindered by mental health problems (negative predictive values: 94%-98%; positive predictive values: 21%-36%; AUC:.64-.82; sensitivity: 42%-76%; and specificity 85%-87%). The screener has good construct validity due to moderate, but significant (p<.001), associations with productivity (r=.51), mental health (r=.48), and distress (r=.47).

Conclusions:

The screener (WFS-H) had good predictive value and good construct validity. Its score offers occupational health professionals a helpful preliminary insight into the work functioning of healthcare workers.

Long-term symptomatic, functional, and work outcomes of carpal tunnel syndrome among construction workers

BACKGROUND

The long-term outcomes of carpal tunnel syndrome (CTS) including symptoms, functional status, work disability, and economic impact are unknown.

METHODS

We conducted a retrospective study of 234 active construction workers with medical claims for CTS and 249 workers without CTS claims; non-cases were matched on age, trade, and insurance eligibility. We conducted telephone interviews with cases and non-cases and collected administrative data on work hours.

RESULTS

Compared to non-cases, CTS cases were more likely to report recurrent hand symptoms, decreased work productivity/quality, decreased performance of physical work demands, and greater functional limitations. Surgical cases showed larger improvements on multiple outcomes than non-surgical cases. Minimal differences in paid work hours were seen between cases and non-cases in the years preceding and following CTS claims.

CONCLUSIONS

Persistent symptoms and functional impairments were present several years after CTS diagnosis. Long-term functional limitations shown by this and other studies indicate the need for improved prevention and treatment.

A practical tool to improve outcomes in Work Injury Management

BACKGROUND

Psychosocial factors have the greatest influence on work rehabilitation outcomes yet effective and efficient systems to manage these factors are not widely utilized in Work Injury Management.

OBJECTIVE

To report on the development and validation of a comprehensive assessment tool with practical utility in identifying and measuring the biopsychosocial factors which are barriers to return to work and community.

METHODS

Literature search identified many instruments designed to identify the presence of psychosocial factors impacting recovery and return to work following musculoskeletal injury. This research aimed to match assessment with intervention. In clinical practice over a 5 year period, this led to development of a composite questionnaire, the Abilita Rehabilitation Index, which was trialed with 43 adults participating in Occupational Rehabilitation. The validation data are based on the results of 957 case records of Occupational Rehabilitation participants.

RESULTS

Examination of Cronbach coefficient alpha of the instrument indicates strong internal consistency (0.90) and factor analysis supports satisfactory construct validity of the domains (subscales) with factor loading scores ranging from 0.73 to 0.90.

CONCLUSION

There is evidence that the proprietary Abilita Rehabilitation Index is a valid and reliable instrument to identify and measure the influence of psychosocial factors impacting an individual's recovery and return to work. Automated reports generated from this tool provide an evidence-based resource to identify risk and support rehabilitation planning in Work Injury Management.

Rehabilitation following carpal tunnel release

BACKGROUND

Various rehabilitation treatments may be offered following carpal tunnel syndrome (CTS) surgery. The effectiveness of these interventions remains unclear. This is the first update of a review first published in 2013.

OBJECTIVES

To review the effectiveness and safety of rehabilitation interventions following CTS surgery compared with no treatment, placebo, or another intervention.

SEARCH METHODS

On 29 September 2015, we searched the Cochrane Neuromuscular Specialised Register, the Cochrane Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, CINAHL Plus, AMED, LILACS, and PsycINFO. We also searched PEDro (3 December 2015) and clinical trials registers (3 December 2015).

SELECTION CRITERIA

Randomised or quasi-randomised clinical trials that compared any postoperative rehabilitation intervention with either no intervention, placebo, or another postoperative rehabilitation intervention in individuals who had undergone CTS surgery.

DATA COLLECTION AND ANALYSIS

Two review authors independently selected trials for inclusion, extracted data, assessed risk of bias, and assessed the quality of the body of evidence for primary outcomes using the GRADE (Grades of Recommendation, Assessment, Development and Evaluation) approach according to standard Cochrane methodology.

MAIN RESULTS

In this review we included 22 trials with a total of 1521 participants. Two of the trials were newly identified at this update. We studied different rehabilitation treatments including immobilisation using a wrist orthosis, dressings, exercise, controlled cold therapy, ice therapy, multi-modal hand rehabilitation, laser therapy, electrical modalities, scar desensitisation, and arnica. Three trials compared a rehabilitation treatment to a placebo, four compared rehabilitation to a no treatment control, three compared rehabilitation to standard care, and 15 compared various rehabilitation treatments to one another.Overall, the included studies were very low in quality. Thirteen trials explicitly reported random sequence generation; of these, five adequately concealed the allocation sequence. Four trials achieved blinding of both participants and outcome assessors. Five were at high risk of bias from incompleteness of outcome data at one or more time intervals, and eight had high risk of selective reporting bias.These trials were heterogeneous in terms of treatments provided, duration of interventions, the nature and timing of outcomes measured, and setting. Therefore, we were not able to pool results across trials.Four trials reported our primary outcome, change in self reported functional ability at three months or more. Of these, three trials provided sufficient outcome data for inclusion in this review. One small high-quality trial studied a desensitisation programme compared with standard treatment and revealed no statistically significant functional benefit based on the Boston Carpal Tunnel Questionnaire (BCTQ) (mean difference (MD) -0.03, 95% confidence interval (CI) -0.39 to 0.33). One low-quality trial assessed participants six months post surgery using the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire and found no significant difference between a no formal therapy group and a group given a two-week course of multi-modal therapy commenced at five to seven days post surgery (MD 1.00, 95% CI -4.44 to 6.44). One very low-quality quasi-randomised trial found no statistically significant difference in function on the BCTQ at three months post surgery with early immobilisation (plaster wrist orthosis worn until suture removal) compared with a splint and late mobilisation (MD 0.39, 95% CI -0.45 to 1.23).Differences between treatments for secondary outcome measures (change in self reported functional ability measured at less than three months; change in CTS symptoms; change in CTS-related impairment measures; presence of iatrogenic symptoms from surgery; return to work or occupation; and change in neurophysiological parameters) were generally small and not statistically significant. Few studies reported adverse events.

AUTHORS' CONCLUSIONS

There is limited and, in general, low quality evidence for the benefit of the reviewed interventions. People who have undergone CTS surgery should be informed about the limited evidence of effectiveness of postoperative rehabilitation interventions. Until researchers provide results of more high-quality trials that assess the effectiveness and safety of various rehabilitation treatments, the decision to provide rehabilitation following CTS surgery should be based on the clinician's expertise, the patient's preferences and the context of the rehabilitation environment. It is important for researchers to identify patients who respond to a particular treatment and those who do not, and to undertake high-quality studies that evaluate the severity of iatrogenic symptoms from surgery, measure function and return-to-work rates, and control for confounding variables.

Improving a web-based employability intervention for work-disabled employees: results of a pilot economic evaluation

Purpose The purpose of this study is to improve web-based employability interventions for employees with work-related health problems for both intervention content and study design by means of a pilot economic evaluation. Methods Uptake rate analysis for the intervention elements, cost effectiveness, cost utility and subgroup analyses were conducted to identify potential content-related intervention improvements. Differences in work ability and quality-adjusted life years and overall contribution of resource items to the total costs were assessed. These were used to guide study design improvements. Results Sixty-three participants were a-select allocated to either the intervention (n = 29) or the control (n = 34) group. Uptake regarding the intervention elements ranged between 3% and 70%. Cost-effectiveness and cost-utility analyses resulted in negative effects although higher total costs. Incremental effects were marginal (work ability -0.51; QALY -0.01). Conclusions The web-based tool to enhance employability among work disabled employees requires improvements regarding targeting and intensity; outcome measures selected and collection of cost data. With respect to the studies of disability and rehabilitation, the findings and methods presented in this pilot economic evaluation could guide the assessment of future assistive "e-health" technologies. IMPLICATIONS FOR REHABILITATION The methods presented in this pilot economic evaluation have large potentials to guide the assessment of future assistive e-health technologies addressing work-disabilities. The findings show that the web-based tool requires content related improvements with respect to targeting and intensity to enhance employability among work disabled employees. The findings show that the web-based tool would benefit from improvements related to the study design by more adequately selecting and collecting both outcome measures and cost data. The burden attributable to large-scale studies and implementation issues were prevented as the outcomes of the pilot economic evaluation did not support the implementation of the web-based tool.

The Predictive Validity of the Return-to-Work Self-Efficacy Scale for Return-to-Work Outcomes in Claimants with Musculoskeletal Disorders

PURPOSE

To examine the predictive validity of the Return-to-Work Self-Efficacy (RTWSE) Scale in terms of the scale's baseline absolute values and of changes in self-efficacy scores, with the outcome of return-to-work (RTW) status in a sample of injured workers with upper extremity and back musculoskeletal disorders.

METHODS

RTWSE was measured with a 10-item scale assessing Overall RTWSE and three self-efficacy subdomains: (1) ability to cope with pain, (2) ability to obtain help from supervisor and (3) ability to obtain help from co-workers. Outcome measures included RTW status (yes/no) measured at 6- and 12-month follow-up. RTWSE improvement was defined as an increase in self-efficacy scores between baseline and 6-month follow-up time points. Logistic regression analyses were performed with RTW status as the dependent variable and adjusted for age, gender, educational level, personal income, pain site, pain severity, functional status, and depressive symptoms, and for baseline RTWSE scores in the improvement score analyses.

RESULTS

A total of 632 claimants completed the baseline telephone interview 1 month post-injury; 446 subjects completed the 6-month interview (71 %) and 383 subjects completed the 12-month interview (61 %). The baseline Pain RTWSE scores were found to be useful to predict RTW status 6 months post-injury, with a trend for baseline Overall RTWSE. Improvements over time in Overall RTWSE and in Co-worker RTWSE were found to be useful to predict 12-month RTW status, with trends for improvements in Supervisor RTWSE and Pain RTWSE.

CONCLUSION

The study found evidence supporting the predictive validity of the RTWSE scale within 12 months after injury. The RTWSE scale may be a potentially valuable scale in research and in managing work disabled claimants with musculoskeletal disorders.

The Cognitive Symptom Checklist-Work in cancer patients is related with work functioning, fatigue and depressive symptoms: a validation study

Purpose

The study objectives are to translate the 21-item Cognitive Symptom Checklist-Work (CSC-W21) to Dutch (CSC-W DV) and to validate the CSC-W DV in working cancer patients.

Methods

The CSC-W21 was cross-culturally translated and adapted to a Dutch version. In this 19-item version, the dichotomous response option was changed to an ordinal five-point scale. A validation study of the CSC-W DV was conducted among cancer patients who had returned to work during or following cancer treatment. Internal consistency (Cronbach’s α), structural validity (exploratory factor analysis) and construct validity (hypothesis testing) were evaluated.

Results

In a cohort of 364 cancer patients, 341 (94 %) completed the CSC-W DV (aged 50.6 ± 8.6 years, 60 % women). Exploratory factor analysis revealed two subscales ‘working memory’ and ‘executive function’. The internal consistency of the total scale and subscales was high (Cronbach’s α = 0.93–0.95). Hypothesis testing showed that self-reported cognitive limitations at work were related to work functioning (P < 0.001), fatigue (P = 0.001) and depressive symptoms (P < 0.001), but not to self-rated health (P = 0.14).

Conclusions

The CSC-W DV showed high internal consistency and reasonable construct validity for measuring work-specific cognitive symptoms in cancer patients. The CSC-W DV was associated in expected ways with work functioning, fatigue and depressive symptoms.

Implications for Cancer Survivors

It is important to enhance knowledge about cognitive symptoms at work in cancer patients, to guide and support cancer patients as good as possible when they are back at work and to improve their work functioning over time.

Measuring Work Functioning: Validity of a Weighted Composite Work Functioning Approach

PURPOSE

To examine the construct validity of a weighted composite work functioning measurement approach.

METHODS

Workers (health-impaired/healthy) (n = 117) completed a composite measure survey that recorded four central work functioning aspects with existing scales: capacity to work, quality of work performance, quantity of work, and recovery from work. Previous derived weights reflecting the relative importance of these aspects of work functioning were used to calculate the composite weighted work functioning score of the workers. Work role functioning, productivity, and quality of life were used for validation. Correlations were calculated and norms applied to examine convergent and divergent construct validity. A t test was conducted and a norm applied to examine discriminative construct validity.

RESULTS

Overall the weighted composite work functioning measure demonstrated construct validity. As predicted, the weighted composite score correlated (p < .001) strongly (r > .60) with work role functioning and productivity (convergent construct validity), and moderately (.30 < r < .60) with physical quality of life and less strongly than work role functioning and productivity with mental quality of life (divergent validity). Further, the weighted composite measure detected that health-impaired workers show with a large effect size (Cohen's d > .80) significantly worse work functioning than healthy workers (discriminative validity).

CONCLUSION

The weighted composite work functioning measurement approach takes into account the relative importance of the different work functioning aspects and demonstrated good convergent, fair divergent, and good discriminative construct validity.

Predictors of return to work with upper limb disorders

BACKGROUND

Return to work (RTW) is a key goal in the proper management of upper limb disorders (ULDs). ULDs stem from diverse medical aetiologies and numerous variables can affect RTW. The abundance of factors, their complex interactions and the diversity of human behaviour make it difficult to pinpoint those at risk of not returning to work (NRTW) and to intervene effectively.

AIMS

To weigh various clinical, functional and occupational parameters that influence RTW in ULD sufferers and to identify significant predictors.

METHODS

A retrospective analysis of workers with ULD referred to an occupational health clinic and further examined by an occupational therapist. Functional assessment included objective and subject ive [Disability of the Arm, Shoulder and Hand (DASH) score] parameters. Quantification of work requirements was based on definitions from the Dictionary of Occupational Titles web site. RTW status was confirmed by a follow-up telephone questionnaire.

RESULTS

Among the 52 subjects, the RTW rate was 42%. The DASH score for the RTW group was 27 compared with 56 in the NRTW group (P < 0.001). In multivariate analyses, only the DASH score was found to be a significant independent predictor of RTW (P < 0.05).

CONCLUSIONS

Physicians and rehabilitation staff should regard a high DASH score as a warning sign when assessing RTW prospects in ULD cases. It may be advisable to focus on workers with a large discrepancy between high DASH scores and low objective disability and to concentrate efforts appropriately.

Carpal tunnel syndrome and work

Carpal tunnel syndrome (CTS) is the most common peripheral nerve entrapment syndrome, and it frequently presents in working-aged adults. Its mild form causes 'nuisance' symptoms including dysaesthesia and nocturnal waking. At its most severe, CTS can significantly impair motor function and weaken pinch grip. This review discusses the anatomy of the carpal tunnel and the clinical presentation of the syndrome as well as the classification and diagnosis of the condition. CTS has a profile of well-established risk factors including individual factors and predisposing co-morbidities, which are briefly discussed. There is a growing body of evidence for an association between CTS and various occupational factors, which is also explored. Management of CTS, conservative and surgical, is described. Finally, the issue of safe return to work post carpal tunnel release surgery and the lack of evidence-based guidelines are discussed.

Topics and trends in research on non-clinical interventions aimed at preventing prolonged work disability in workers compensated for work-related musculoskeletal disorders (WRMSDs): a systematic, comprehensive literature review

PURPOSE

This study sought to provide an overview of the main topics and trends in contemporary research on successful non-clinical interventions for preventing prolonged work disability in workers compensated for work-related musculoskeletal disorders (WRMSDs).

METHODS

A systematic electronic search (English and French) was performed in ten scientific databases using keywords and descriptors. After screening the identified titles and abstracts using specific sets of criteria, categorical and thematic analyses were performed on the retained articles.

RESULTS

Five main topics appear to dominate the research: (1) risk factors and determinants; (2) effectiveness of interventions (programmes, specific components, strategies and policies); (3) viewpoints, experiences and perceptions of specific actors involved in the intervention process; (4) compensation issues; and (5) measurement issues. A currently widespread trend is early screening to identify risks factors for appropriate intervention and multidisciplinary, multimodal approaches. Morover, workplace-related psychosocial and ergonomic factors are considered vital to the success and sustainability of return-to-work (RTW) interventions. Finally, involving workplace actors, and more specifically, affected workers, in the RTW process appears to be a powerful force in improving the chances of moving workers away from disabled status.

CONCLUSIONS

The findings of this literature review provide with information about the main topics and trends in research on rehabilitation interventions, revealing some successful modalities of intervention aimed at preventing prolonged work disability.

IMPLICATIONS FOR REHABILITATION

Successful intervention for preventing prolonged work disability in workers compensated for WRMSDs address workplace issues: physical and psychosocial demands at work, ability of the workers to fill these demands, work organization and support of the worker, and worker' beliefs and attitudes related to work. Successful intervention promotes collaboration, coordination between all actors and stakeholders involved in the process of rehabilitation. Strategies able to mobilize the employees, employers, insurers and health care providers are still needed to be implemented.

Cross-cultural adaptation of the Work Role Functioning Questionnaire to Spanish spoken in Spain

PURPOSE

The Work Role Functioning Questionnaire (WRFQ) is a tool developed in the United States to measure work disability and assess the perceived impact of health problems on worker ability to perform jobs. We translated and adapted the WRFQ to Spanish spoken in Spain and assessed preservation of its psychometric properties.

METHODS

Cross-cultural adaptation of the WRFQ was performed following a systematic 5-step procedure: (1) direct translation, (2) synthesis, (3) back-translation, (4) consolidation by an expert committee and (5) pre-test. Psychometric properties were evaluated by administering the questionnaire to 40 patients with different cultural levels and health problems. Applicability, usability, readability and integrity of the WRFQ were assessed, together with its validity and reliability.

RESULTS

Questionnaire translation, back translation and consolidation were carried out without relevant difficulties. Idiomatic issues requiring reformulation were found in the instructions, response options and in 2 items. Participants appreciated the applicability, usability, readability and integrity of the questionnaire. The results indicated good face and content validity. Internal consistency was satisfactory for all subscales (Cronbach's alpha between 0.88 and 0.96), except for social demands (Cronbach's alpha = 0.56). Test-retest reliability showed good stability, with intraclass correlation coefficients between 0.77 and 0.93 for all subscales. Construct validity was considered preserved based on the comparison of median scores for each patient group and subscale.

CONCLUSIONS

Our results indicate the cross-cultural adaptation of the WRFQ to Spanish was satisfactory and preserved its psychometric properties, except for the subscale of social demands, whose internal consistency should be interpreted with caution.

Rehabilitation following carpal tunnel release

BACKGROUND

Various rehabilitation treatments may be offered following carpal tunnel syndrome (CTS) surgery. The effectiveness of these interventions remains unclear.

OBJECTIVES

To review the effectiveness of rehabilitation following CTS surgery compared with no treatment, placebo, or another intervention.

SEARCH METHODS

On 3 April 2012, we searched the Cochrane Neuromuscular Disease Group Specialized Register (3 April 2012), CENTRAL (2012, Issue 3), MEDLINE (January 1966 to March 2012), EMBASE (January 1980 to March 2012), CINAHL Plus (January 1937 to March 2012), AMED (January 1985 to April 2012), LILACS (January 1982 to March 2012), PsycINFO (January 1806 to March 2012), PEDRO (29 January 2013) and clinical trials registers (29 January 2013).

SELECTION CRITERIA

Randomised or quasi-randomised clinical trials that compared any postoperative rehabilitation intervention with either no intervention, placebo or another postoperative rehabilitation intervention in individuals who had undergone CTS surgery.

DATA COLLECTION AND ANALYSIS

Two reviewers independently selected trials for inclusion, extracted data and assessed the risk of bias according to standard Cochrane methodology.

MAIN RESULTS

In this review we included 20 trials with a total of 1445 participants. We studied different rehabilitation treatments including: immobilisation using a wrist orthosis, dressings, exercise, controlled cold therapy, ice therapy, multimodal hand rehabilitation, laser therapy, electrical modalities, scar desensitisation, and arnica. Three trials compared a rehabilitation treatment to a placebo comparison; three trials compared rehabilitation to a no treatment control; three trials compared rehabilitation to standard care; and 14 trials compared various rehabilitation treatments to one another.Overall, the included studies were very low in quality. Eleven trials explicitly reported random sequence generation and, of these, three adequately concealed the allocation sequence. Four trials achieved blinding of both participants and outcome assessors. Five studies were at high risk of bias from incompleteness of outcome data at one or more time intervals. Eight trials had a high risk of selective reporting bias.The trials were heterogenous in terms of the treatments provided, the duration of interventions, the nature and timing of outcomes measured and setting. Therefore, we were not able to pool results across trials.Four trials reported our primary outcome, change in self reported functional ability at three months or longer. Of these, three trials provided sufficient outcome data for inclusion in this review. One small high quality trial studied a desensitisation program compared to standard treatment and revealed no statistically significant functional benefit based on the Boston Carpal Tunnel Questionnaire (BCTQ) (MD -0.03; 95% CI -0.39 to 0.33). One moderate quality trial assessed participants six months post surgery using the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire and found no significant difference between a no formal therapy group and a two-week course of multimodal therapy commenced at five to seven days post surgery (MD 1.00; 95% CI -4.44 to 6.44). One very low quality quasi-randomised trial found no statistically significant difference in function on the BCTQ at three months post surgery with early immobilisation (plaster wrist orthosis worn until suture removal) compared with a splint and late mobilisation (MD 0.39; 95% CI -0.45 to 1.23).The differences between the treatments for the secondary outcome measures (change in self reported functional ability measured at less than three months; change in CTS symptoms; change in CTS-related impairment measures; presence of iatrogenic symptoms from surgery; return to work or occupation; and change in neurophysiological parameters) were generally small and not statistically significant. Few studies reported adverse events.

AUTHORS' CONCLUSIONS

There is limited and, in general, low quality evidence for the benefit of the reviewed interventions. People who have had CTS surgery should be informed about the limited evidence of the effectiveness of postoperative rehabilitation interventions. Until the results of more high quality trials that assess the effectiveness and safety of various rehabilitation treatments have been reported, the decision to provide rehabilitation following CTS surgery should be based on the clinician's expertise, the patient's preferences and the context of the rehabilitation environment. It is important for researchers to identify patients who respond to a certain treatment and those who do not, and to undertake high quality studies that evaluate the severity of iatrogenic symptoms from the surgery, measure function and return-to-work rates, and control for confounding variables.

Confirmatory factor analysis of the Work Limitations Questionnaire (WLQ-25) in Workers' Compensation Claimants with chronic upper-limb disorders

PURPOSE

To examine the factorial validity of the Work Limitations Questionnaire (WLQ-25) among workers' compensation claimants with chronic upper-limb disorders.

METHODS

Attendees of the WSIB Shoulder and Elbow Specialty clinic in Toronto, Ontario, Canada, completed a survey that includes the WLQ-25 [4 subscales: time-management (TM), physical demands (PD), mental-interpersonal (MI), and output demands (OD)]. Confirmatory factor analyses (n = 2262) were conducted to evaluate and compare alternative 4- and 5-factor WLQ-25 structures [MI subscale intact vs. separated into mental demands (MD) and interpersonal demands (IP) subscales]. Model fit indices, saliency of factor loadings, and convergent/divergent validity of latent factors (r = 0.4 - 0.85 expected) were concurrently assessed.

RESULTS

The 4-factor WLQ-25 showed acceptable model fit after allowing the residuals of a pair of PD items to correlate (CFI = 0.924, TLI = 0.915, RMSEA = 0.057, SRMR = 0.054); however, significantly lower-than-expected correlations between the PD factor and all other factors (r = -0.11 - -0.03) were also observed. Model fit for the 5-factor WLQ-25 was even more optimal (CFI = 0.934, TLI = 0.925, RMSEA = 0.053, SRMR = 0.051), with MD and IP factors correlating at r = 0.83.

CONCLUSIONS

Evidence of factorial validity was demonstrated by the WLQ-25; however, users should be attentive of an instrumentation issue that could be directly related to the psychometric performance of its PD subscale.

Prognostic factors for successful work functioning in the general working population

PURPOSE

To help workers to stay at work in a healthy productive and sustainable way and for the development of interventions to improve work functioning, it is important to have insight in prognostic factors for successful work functioning. The aim of this study is to identify prognostic factors for successful work functioning in a general working population.

METHODS

A longitudinal study (3 months follow-up) was conducted among the working population (N = 98). Work functioning was assessed with the Work Role Functioning Questionnaire 2.0 (WRFQ). The total score was categorized as follows: 0-90; >90 ≤95; and >95-100 (defined as 'successful work functioning'). Ordinal logistic regression analyses were performed to examine bivariate relationships between potential prognostic factors and the dependent variable (successful work functioning) to identify potential prognostic factors for the multivariate models (p < 0.10). A stepwise approach was used to introduce the variables in the multiple ordinal regression analyses.

RESULTS

Baseline work functioning and work ability were significant prognostic factors for successful work functioning at 3 months follow-up. No prospective associations were identified for psychological job demands and supervisor social support with successful work functioning.

CONCLUSION

To our knowledge this is the first longitudinal study to identify prognostic factors for successful work functioning in the general working population. High work ability is predictive for future successful work functioning, independent of baseline work functioning.

Personal service assistance: musculoskeletal disorders and injuries in consumer-directed home care

BACKGROUND

Like other types of care for disabled or elderly adults, consumer-directed personal assistance services may present multi-factorial risks for work-related musculoskeletal disorders (WRMSDs).

METHODS

Using survey data, we compared providers experiencing WRMSDs in the previous year to those who did not, seeking to identify functional, temporal, physical, and relationship risk factors for transient and chronic conditions.

RESULTS

Longer work experience with the recipient and more frequent bending increased the risk of being in the most chronic group (≥12 painful episodes), whereas predictable work hours with rest breaks and greater social support from the recipient appeared protective. For transient conditions (one to two episodes), longer work experience with the recipient and predictable hours with rest breaks appeared protective.

CONCLUSIONS

We offer recommendations to improve hazard assessment as well as training and information distribution related to home care programs. With the population aging, home care jobs require increasing oversight to prevent WRMSDs.

The work role functioning questionnaire 2.0 (Dutch version): examination of its reliability, validity and responsiveness in the general working population

PURPOSE

The promotion of a sustainable, healthy and productive working life attracts more and more attention. Recently the Work Role Functioning Questionnaire (WRFQ) has been cross-culturally translated and adapted to Dutch. This questionnaire aims to measure the health-related work functioning of workers with health problems. The aim of this study is to evaluate the reliability, validity (including five new items) and responsiveness of the WRFQ 2.0 in the working population.

METHODS

A longitudinal study was conducted among workers. The reliability (internal consistency, test-retest reliability, measurement error), validity (structural validity-factor analysis, construct validity by means of hypotheses testing) and responsiveness of the WRFQ 2.0 were evaluated.

RESULTS

A total of N = 553 workers completed the survey. The final WRFQ 2.0 has four subscales and showed very good internal consistency, moderate test-retest reliability, good construct validity and moderate responsiveness in the working population. The WRFQ was able to distinguish between groups with different levels of mental health, physical health, fatigue and need for recovery. A moderate correlation was found between WRFQ and related constructs respectively work ability and work productivity. A weak relationship was found with general self-rated health, work engagement and work involvement.

CONCLUSION

The WRFQ 2.0 is a reliable and valid instrument to measure health-related work functioning in the working population. Further validation in larger samples is recommended, especially for test-retest reliability, responsiveness and the questionnaire's ability to predict the future course of health-related work functioning.