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Wong J, Kallish N, Crown D, Capraro P, Trierweiler R, Wafford QE, Tiema-Benson L, Hassan S, Engel E, Tamayo C, Heinemann AW. Job Accommodations, Return to Work and Job Retention of People with Physical Disabilities: A Systematic Review. JOURNAL OF OCCUPATIONAL REHABILITATION 2021; 31:474-490. [PMID: 33479811 DOI: 10.1007/s10926-020-09954-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/15/2020] [Indexed: 05/26/2023]
Abstract
Purpose We aimed to identify job accommodations that help persons with physical disabilities maintain or return to work and explore the barriers and facilitators that influence the provision and reception of job accommodations. Methods We conducted a systematic review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The review was registered in PROSPERO (CRD42019129645). The search strategy incorporated keywords describing physical disabilities, employer-approved job accommodations, and employment retention or return to work approaches. We searched MEDLINE, the Cochrane Library, Embase, CINAHL, PsycINFO, Web of Science, and ProQuest Theses and dissertations. Reviewers independently selected studies for inclusion. We used Hawker et al.'s method to assess study quality. Results We identified 2203 articles, of which 52 met inclusion criteria, developed a table of job accommodations commonly used by persons with physical disabilities, summarized the percentages of job accommodations used by persons with disabilities, synthesized evidence of the effectiveness of job accommodations, and identified the factors that influence job accommodation use. The most frequently reported accommodations were as follows: modification of job responsibilities, change of workplace policy, supportive personnel provision, flexible scheduling, and assistive technology. We summarized four types of facilitators and barriers that affect job accommodation use: employee-related factors, accommodation-related factors, job-related factors, and social workplace-related factors. Conclusion The absence of randomized controlled trials and prevalence of cross-sectional surveys provides inconclusive evidence regarding the effectiveness of specific job accommodations for people with particular functional limitations. Our system of categorizing job accommodations provides a guide to investigators seeking to evaluate the effectiveness of job accommodations using experimental methods.
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Affiliation(s)
- Jasin Wong
- Northwestern University Feinberg School of Medicine, 633 N. Saint Clair St., 20th Floor, Chicago, IL, 60611, USA.
- Shirley Ryan AbilityLab, 355 E Erie St., Chicago, IL, 60611, USA.
| | - Natasha Kallish
- Shirley Ryan AbilityLab, 355 E Erie St., Chicago, IL, 60611, USA
| | - Deborah Crown
- Shirley Ryan AbilityLab, 355 E Erie St., Chicago, IL, 60611, USA
| | - Pamela Capraro
- Shirley Ryan AbilityLab, 355 E Erie St., Chicago, IL, 60611, USA
| | | | - Q Eileen Wafford
- Galter Health Sciences Library and Learning Center, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | - Shahzeb Hassan
- Northwestern University Feinberg School of Medicine, 633 N. Saint Clair St., 20th Floor, Chicago, IL, 60611, USA
| | - Edeth Engel
- Shirley Ryan AbilityLab, 355 E Erie St., Chicago, IL, 60611, USA
| | - Christina Tamayo
- Shirley Ryan AbilityLab, 355 E Erie St., Chicago, IL, 60611, USA
| | - Allen W Heinemann
- Northwestern University Feinberg School of Medicine, 633 N. Saint Clair St., 20th Floor, Chicago, IL, 60611, USA
- Shirley Ryan AbilityLab, 355 E Erie St., Chicago, IL, 60611, USA
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2
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Huffman KF, Thornhill TH, Ambrose KR, Nelson AE, Callahan LF. Osteoarthritis and Its Management. PHYSICIAN ASSISTANT CLINICS 2021. [DOI: 10.1016/j.cpha.2020.08.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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3
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Gignac MAM, Ibrahim S, Smith PM, Kristman V, Beaton DE, Mustard CA. The Role of Sex, Gender, Health Factors, and Job Context in Workplace Accommodation Use Among Men and Women with Arthritis. Ann Work Expo Health 2019; 62:490-504. [PMID: 29420700 PMCID: PMC5905635 DOI: 10.1093/annweh/wxx115] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Background With the aging of populations in many countries, workers are expected to remain employed longer but may struggle with the onset of common, chronic conditions like arthritis. To date, few studies have examined workplace policies and practices that could help accommodate individuals with arthritis, and fewer still have used a sex and gender-based approach to explore similarities and differences between women and men. Objectives This study compared the health and work contexts of workers aged ≥50 years to better understand similarities and differences between women and men in accommodation availability, need, use, and unmet needs. Methods A cross-sectional survey of men and women with osteoarthritis (OA), inflammatory arthritis (IA), or both OA and IA was administered online or by telephone and assessed demographics (e.g. age, education), health (e.g. pain, fatigue, workplace activity limitations), work context factors (e.g. job sector, full/part-time work, job control), and workplace accommodations (e.g. health benefits, flexible hours, special equipment/adaptations, modified duties). Sex and gender-based analyses examined similarities and differences between men and women and included descriptive statistics, multivariable multinomial analyses, and nested regression analyses. Results There was a 58.9% response rate and final sample of 463 participants (women, n = 266; men, n = 197; OA = 59.0%; IA/both IA and OA = 23.7%; unsure = 17.3%). Women and men were significantly different in a number of health (e.g. fatigue, health variability, workplace activity limitations) and work context factors (e.g. job sector, part-time work, job stress). However, in other respects, they were similar (e.g. pain, job involving physical demands, size of organization, shift work, union membership, job control). There were no differences between men and women in the availability or use of workplace accommodations. However, women reported significantly more accommodation needs and had greater unmet needs. Multivariable multinomial analyses found male/female as a binary variable did not explain differences in accommodation need, use, and unmet need. Nested analyses highlighted that differences in health variables explained male/female differences in accommodation need, while work context differences explained male/female differences in whether needs were met. Conclusions The findings highlight that women and men draw on a range of existing accommodation policies and practices to help manage their arthritis and that most have their accommodation needs met. Decomposing the context within which men and women with arthritis work suggests that women may face health and work context challenges that differ from men and that are related to greater accommodation needs and unmet need. This highlights potential vulnerabilities in the work of women that need to be addressed.
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Affiliation(s)
- Monique A M Gignac
- Institute for Work and Health, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Krembil Research Institute, Toronto, Ontario, Canada
| | | | - Peter M Smith
- Institute for Work and Health, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Vicki Kristman
- Institute for Work and Health, Toronto, Ontario, Canada.,Lakehead University, Thunder Bay, Ontario, Canada
| | | | - Cameron A Mustard
- Institute for Work and Health, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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4
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Zhou M, Chen J, Wang D, Zhu C, Wang Y, Chen W. Combined effects of reproductive and hormone factors and obesity on the prevalence of knee osteoarthritis and knee pain among middle-aged or older Chinese women: a cross-sectional study. BMC Public Health 2018; 18:1192. [PMID: 30348138 PMCID: PMC6196443 DOI: 10.1186/s12889-018-6114-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Accepted: 10/12/2018] [Indexed: 12/04/2022] Open
Abstract
Background Knee osteoarthritis (KOA) is one form of degenerative arthritis that results from the breakdown of cartilage and underlying bone. The prevalence of KOA is considerably higher in women than in men; however, the reason for this difference has not been thoroughly elucidated to date. The aim of the present study was to estimate the effects of reproductive and hormone factors and obesity on KOA prevalence among Chinese women. Methods The cross-sectional study included 7510 women with a mean age of 62.6 ± 8.6 years. Knee pain was defined as pain or aching stiffness on most days for at least 1 month during the past 12 months or persistent pain or aching stiffness within the past week. Clinical KOA was diagnosed based on both pain complaints and a Kellgren-Lawrence grade ≥ 2 X-ray radiograph of at least one knee. Results Oral contraceptives use (OR 1.18, 1.05–1.34), ≥3 pregnancies (1.38, 1.20–1.60), and postmenopausal hormone replacement therapy (HT) (1.59, 1.23–2.06) were positively associated with knee pain, while oral contraceptives use (1.28, 1.04–1.57), and HT (1.79, 1.21–2.65) were positively associated with clinical KOA. Obesity and oral contraceptives use showed additive and multiplicative effects on knee pain. The OR for knee pain among women with a BMI ≥24 kg/m2 and oral contraceptives use was 2.00 (1.68–2.38) compared with women with a BMI < 24 kg/m2 and no oral contraceptives use. Conclusions A high number of pregnancies, oral contraceptives use, and HT are independent risk factors for KOA, and the effects of reproductive and hormone factors on KOA may be increased by obesity.
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Affiliation(s)
- Min Zhou
- Key Laboratory of Environment and Health in Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Hangkong Road 13, Wuhan, 430030, Hubei, China.,Department of Occupational and Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Hangkong Road 13, Wuhan, 430030, Hubei, China
| | - Jianghao Chen
- Key Laboratory of Environment and Health in Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Hangkong Road 13, Wuhan, 430030, Hubei, China.,Department of Occupational and Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Hangkong Road 13, Wuhan, 430030, Hubei, China
| | - Dongming Wang
- Key Laboratory of Environment and Health in Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Hangkong Road 13, Wuhan, 430030, Hubei, China.,Department of Occupational and Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Hangkong Road 13, Wuhan, 430030, Hubei, China
| | - Chunmei Zhu
- Key Laboratory of Environment and Health in Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Hangkong Road 13, Wuhan, 430030, Hubei, China.,Department of Occupational and Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Hangkong Road 13, Wuhan, 430030, Hubei, China
| | - Youjie Wang
- Key Laboratory of Environment and Health in Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Hangkong Road 13, Wuhan, 430030, Hubei, China.,Department of Maternal and Child Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Hangkong Road 13, Wuhan, 430030, Hubei, China
| | - Weihong Chen
- Key Laboratory of Environment and Health in Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Hangkong Road 13, Wuhan, 430030, Hubei, China. .,Department of Occupational and Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Hangkong Road 13, Wuhan, 430030, Hubei, China.
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Gignac MAM, Kristman V, Smith PM, Beaton DE, Badley EM, Ibrahim S, Mustard CA, Wang M. Are There Differences in Workplace Accommodation Needs, Use and Unmet Needs Among Older Workers With Arthritis, Diabetes and No Chronic Conditions? Examining the Role of Health and Work Context. WORK, AGING AND RETIREMENT 2018; 4:381-398. [PMID: 30288294 PMCID: PMC6159000 DOI: 10.1093/workar/way004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The aging of workforces combined with the prevalence of age-related chronic diseases has generated interest in whether large numbers of older workers will need workplace accommodations. This research applied work functioning theory to examine accommodation availability, need and use in workers with arthritis, diabetes, or no chronic disabling diseases; factors associated with accommodation needs; and the relationship of accommodation needs met, unmet or exceeded to job outcomes. Participants were aged 50-67 years, employed, and had arthritis (n = 631), diabetes (n = 286), both arthritis/diabetes (n = 111) or no chronic disabling conditions (healthy controls n = 538). They were recruited from a national panel of 80,000 individuals and a cross-sectional survey was administered online or by telephone. Questionnaires assessed demographics, health, work context, workplace accommodations, and job outcomes. Chi-square analyses, analyses of variance, and regression analyses compared groups. Respondents were similar in many demographic and work context factors. As expected, workers with arthritis and/or diabetes often reported poorer health and employment outcomes. Yet, there were few differences across health conditions in need for or use of accommodations with most participants reporting accommodations needs met. In keeping with work functioning theory, unmet accommodation needs were largely related to work context, not health. Workers whose accommodation needs were exceeded reported better job outcomes than those with accommodation needs met. Findings highlight both work context and health in understanding workplace accommodations and suggest that many older workers can meet accommodation needs with existing workplace practices. However, additional research aimed at workplace support and the timing of accommodation use is needed.
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Affiliation(s)
- Monique A M Gignac
- Institute for Work & Health, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Krembil Research Institute, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Vicki Kristman
- Institute for Work & Health, Toronto, Ontario, Canada
- Department of Health Sciences, Lakehead University, Thunder Bay, Ontario, Canada
| | - Peter M Smith
- Institute for Work & Health, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Dorcas E Beaton
- Institute for Work & Health, Toronto, Ontario, Canada
- Mobility Program Clinical Research Unit, St. Michael’s Hospital, Toronto, Ontario, Canada
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Elizabeth M Badley
- Institute for Work & Health, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Krembil Research Institute, Toronto Western Hospital, Toronto, Ontario, Canada
| | | | - Cameron A Mustard
- Institute for Work & Health, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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The cross-sectional and longitudinal effect of hyperlipidemia on knee osteoarthritis: Results from the Dongfeng-Tongji cohort in China. Sci Rep 2017; 7:9739. [PMID: 28852192 PMCID: PMC5575029 DOI: 10.1038/s41598-017-10158-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Accepted: 08/04/2017] [Indexed: 01/15/2023] Open
Abstract
To quantify the cross-sectional and longitudinal effects of hyperlipidemia on knee osteoarthritis (KOA), we studied 13,906 middle-aged or older participants from the Dongfeng-Tongji cohort. Physical examinations were performed at baseline and follow-up. Knee pain was diagnosed by self-reported pain or stiffness. Clinical KOA was diagnosed from knee pain complains and clinical X-ray radiographs. The prevalence of knee pain and clinical KOA was 39.0% and 6.7% at baseline, respectively. Hyperlipidemia was associated with knee pain (OR 1.34, 1.23–1.45) and clinical KOA (1.34, 1.15–1.55). Compared with the participants without hyperlipidemia or use of lipid-lowering drugs, those with hyperlipidemia but no use of lipid-lowering drugs had higher risks of knee pain (1.28, 1.15–1.43) and clinical KOA (1.20, 0.97–1.48), those with hyperlipidemia and use of lipid-lowering drugs had the highest risks of knee pain (1.40, 1.26–1.56) and clinical KOA (1.45, 1.21–1.75). The risks were not elevated among participants without hyperlipidemia but using lipid-lowering drugs for prevention of other diseases. Furthermore, each 1-unit increase in triglyceride was associated with 9% and 5% increases in the risk of clinical KOA prevalence and clinical KOA onset, respectively. In conclusion, hyperlipidemia is associated with elevated risks of knee pain and clinical KOA among middle-aged or older adults.
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7
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Sundar V. Operationalizing workplace accommodations for individuals with disabilities: A scoping review. Work 2017; 56:135-155. [PMID: 28128784 DOI: 10.3233/wor-162472] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The provision of workplace accommodations is a proven strategy in supporting individuals with disabilities at work. Accommodations include a wide range of supports and strategies that are not very well defined beyond the Americans with Disabilities Act in the United States. Understanding the landscape of accommodations is important to measure the impact of programs that support employment of individuals with disabilities. OBJECTIVE To conduct a scoping review and thematic analysis of research literature to identify how workplace accommodations are operationalized and to identify knowledge gaps in its conceptualization. METHODS Keywords searches were conducted in seven electronic databases. Title, abstract, and full text screening was conducted followed by a thematic analysis of the content to identify how workplace accommodations are operationalized. RESULTS Overall, 47 studies were selected for review. 433 different types of accommodations were identified, of which assistive technology and specialized equipment represented the most frequently reported type of accommodation (40%). A very small percentage of studies included policy changes (9%) and human assistance (5%) as an accommodation strategy. CONCLUSIONS This scoping review aims to clarify how accommodations are operationalized in the research literature. Key knowledge gaps identified include the systematic exclusion of certain types of supports or disability types.
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Sharif B, Garner R, Sanmartin C, Flanagan WM, Hennessy D, Marshall DA. Risk of work loss due to illness or disability in patients with osteoarthritis: a population-based cohort study. Rheumatology (Oxford) 2016; 55:861-8. [DOI: 10.1093/rheumatology/kev428] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Indexed: 11/13/2022] Open
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Abstract
Changing demographics mean that many patients with soft tissue rheumatism, osteoarthritis, inflammatory arthritis, large joint prostheses and age-related co-morbidities are seeking to work beyond the traditional retirement age. In this chapter, we review the evidence on musculoskeletal health and work at older ages. We conclude that musculoskeletal problems are common in older workers and have a substantial impact on their work capacity. Factors that influence their job retention are described, together with approaches that may extend working life. Many gaps in evidence were found, notably on the health risks and benefits of continued work in affected patients and on which interventions work best. The roles of physicians and managers are also considered.
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Affiliation(s)
- Keith T Palmer
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton SO16 6YD, UK; ARUK-MRC Centre for Musculoskeletal Health and Work, UK.
| | - Nicola Goodson
- ARUK-MRC Centre for Musculoskeletal Health and Work, UK; Department of Musculoskeletal Biology 1, Institute of Aging and Chronic Diseases, University of Liverpool, University Hospital Aintree, Liverpool L9 7AL, UK.
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10
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Gignac MAM, Cao X, McAlpine J. Availability, Need for, and Use of Work Accommodations and Benefits: Are They Related to Employment Outcomes in People With Arthritis? Arthritis Care Res (Hoboken) 2015; 67:855-64. [DOI: 10.1002/acr.22508] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2014] [Revised: 10/08/2014] [Accepted: 10/28/2014] [Indexed: 12/18/2022]
Affiliation(s)
- Monique A. M. Gignac
- Institute for Work and Health; Toronto Western Research Institute; and Dalla Lana School of Public Health; University of Toronto; Toronto Ontario Canada
| | - Xingshan Cao
- Toronto Western Research Institute; Toronto Ontario Canada
| | - Jessica McAlpine
- Institute for Work and Health and Toronto Western Research Institute; Toronto Ontario Canada
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11
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Gouttebarge V, Inklaar H, Backx F, Kerkhoffs G. Prevalence of osteoarthritis in former elite athletes: a systematic overview of the recent literature. Rheumatol Int 2014; 35:405-18. [PMID: 25037899 DOI: 10.1007/s00296-014-3093-0] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Accepted: 07/09/2014] [Indexed: 01/17/2023]
Abstract
The aim of this study was to systematically review the recent scientific literature to explore the prevalence of osteoarthritis (OA) in former elite athletes from team and individual sports. A systematic review of observational studies was conducted. Based on three categories of keywords (and synonyms), a sensitive search strategy was built in order to search MEDLINE and SPORTDiscus from 2000 to 2014. The data from included studies presenting a prevalence rate of OA as an outcome measure were extracted using a standardised extraction form, and their methodological quality was described. Fifteen studies were identified through our search strategy, studies being rather heterogeneous with regard to their study population and to the definition and assessment of OA. Hip OA ranged from 2 to 60%, and knee OA from 16 to 95%. Prevalence rates of general, lower limbs or hip/knee OA ranged from 1 to 59%. Prevalence of neck, back, shoulder and ankle OA was reported only in single studies (16, 18, 33 and 3%, respectively). This study showed that prevalence of OA, especially in their lower limbs, seems to be high among former elite athletes from team and individual sports compared to the general population and other occupational sectors.
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Affiliation(s)
- Vincent Gouttebarge
- Department of Orthopedic Surgery, Academic Medical Center, Amsterdam, The Netherlands,
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Cleveland RJ, Luong MLN, Knight JB, Schoster B, Renner JB, Jordan JM, Callahan LF. Independent associations of socioeconomic factors with disability and pain in adults with knee osteoarthritis. BMC Musculoskelet Disord 2013; 14:297. [PMID: 24134116 PMCID: PMC3906978 DOI: 10.1186/1471-2474-14-297] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2013] [Accepted: 10/11/2013] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The purpose of this study is to explore the relationship between function, pain and stiffness outcomes with individual and community socioeconomic status (SES) measures among individuals with radiographic knee osteoarthritis (rOA). METHODS Cross-sectional data from the Johnston County Osteoarthritis Project were analyzed for adults age 45 and older with knee rOA (n = 782) and a subset with both radiographic and symptomatic knee OA (n = 471). Function, pain and stiffness were measured using the Western Ontario and McMasters Universities Index of Osteoarthritis (WOMAC). Individual SES measures included educational attainment (<12 years, ≥12 years) and occupation type (managerial, non-managerial), while community SES was measured using Census block group poverty rate (<12%, 12-25%, ≥25%). SES measures were individually and simultaneously examined in linear regression models adjusting for age, gender, race, body mass index (BMI), occupational physical activity score (PAS), comorbidity count, and presence of hip symptoms. RESULTS In analyses among all individuals with rOA, models which included individual SES measures were observed to show that occupation was significantly associated with WOMAC Function (β =2.91, 95% Confidence Interval (CI) = 0.68-5.14), WOMAC Pain (β =0.93, 95% CI = 0.26-1.59) and WOMAC Total scores (β =4.05, 95% CI = 1.04-7.05), and education was significantly associated with WOMAC Function (β =3.57, 95% CI = 1.25-5.90) and WOMAC Total (β =4.56, 95% CI = 1.41-7.70) scores. In multivariable models including all SES measures simultaneously, most associations were attenuated. However, statistically significant results for education remained between WOMAC Function (β =2.83, 95% CI = 0.38-5.28) and WOMAC Total (β =3.48, 95% CI = 0.18-6.78), as well as for the association between occupation and WOMAC Pain (β =0.78, 95% CI = 0.08-1.48). In rOA subgroup analyses restricted to those with symptoms, we observed a significant increase in WOMAC Pain (β =1.36, 95% CI = 0.07-2.66) among individuals living in a block group with poverty rates greater than 25%, an association that remained when all SES measures were considered simultaneously (β =1.35, 95% CI = 0.06-2.64). CONCLUSIONS Lower individual and community SES are both associated with worse function and pain among adults with knee rOA.
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Affiliation(s)
- Rebecca J Cleveland
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - My-Linh N Luong
- Department of Health Behavior, Gillings School of Global Public Health, Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Joshua B Knight
- University of North Carolina School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Britta Schoster
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jordan B Renner
- Thurston Arthritis Research Center and Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Joanne M Jordan
- Thurston Arthritis Research Center and Departments of Medicine and Orthopedics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Leigh F Callahan
- Thurston Arthritis Research Center and Departments of Medicine and Social Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Luong MLN, Cleveland RJ, Nyrop KA, Callahan LF. Social determinants and osteoarthritis outcomes. AGING HEALTH 2012; 8:413-437. [PMID: 23243459 PMCID: PMC3519433 DOI: 10.2217/ahe.12.43] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Osteoarthritis (OA) is one of the most frequently occurring musculoskeletal diseases, posing a significant public health problem due to its impact on pain and disability. Traditional risk factors fail to account for all of the risk observed for OA outcomes. In recent years, our view of disease causation has broadened to include health risks that are created by an individual's socioeconomic circumstances. Early research into social determinants has focused on social position and explored factors related to the individual such as education, income and occupation. Results from these investigations suggest that low education attainment and nonprofessional occupation are associated with poorer arthritis outcomes. More recently, research has expanded to examine how one's neighborhood socioeconomic environment may be relevant to OA outcomes. This narrative review proposes a framework to help guide our understanding of how social context may interact with pathophysiological processes and individual-level variables to influence health outcomes in those living with OA.
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Affiliation(s)
- My-Linh N Luong
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, 3300 Thurston Building, Chapel Hill, NC 27599, USA
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Rebecca J Cleveland
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, 3300 Thurston Building, Chapel Hill, NC 27599, USA
| | - Kirsten A Nyrop
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, 3300 Thurston Building, Chapel Hill, NC 27599, USA
| | - Leigh F Callahan
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, 3300 Thurston Building, Chapel Hill, NC 27599, USA
- Departments of Medicine & Social Medicine, University of North Carolina at Chapel Hill, 333 South Columbia St, MacNider Hall, Chapel Hill, NC 27599, USA
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Abstract
BACKGROUND Changing demographics mean that many patients with large joint arthritis will work beyond traditional retirement age. This review considers the impact of knee osteoarthritis (OA) on work participation and the relation between work and total knee replacement (TKR). SOURCES Two systematic searches in Embase and Medline, supplemented by three systematic reviews. AREAS OF AGREEMENT Probably, although evidence is limited, knee OA considerably impairs participation in work (labour force participation, work attendance and work productivity). AREAS OF UNCERTAINTY/RESEARCH NEED: Little is known about effective interventions (treatments, work changes and policies) to improve vocational participation in patients with knee OA; or how type of work affects long-term clinical outcomes (e.g. pain, function and the need for revision surgery) in patients with TKRs. The need for such research is pressing and opportune, as increasing numbers of patients with knee OA or TKR expect to work on.
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Affiliation(s)
- Keith T Palmer
- MRC Lifecourse Epidemiology Unit, University of Southampton, UK.
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Allen KD, Chen JC, Callahan LF, Golightly YM, Helmick CG, Renner JB, Schwartz TA, Jordan JM. Racial differences in knee osteoarthritis pain: potential contribution of occupational and household tasks. J Rheumatol 2012; 39:337-44. [PMID: 22133621 PMCID: PMC4031236 DOI: 10.3899/jrheum.110040] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE We examined whether occupational and household tasks contributed to differences in pain between African Americans and whites with radiographic knee osteoarthritis (OA). METHODS Participants from the Johnston County Osteoarthritis Project self-reported the frequency (often/always vs never/seldom/sometimes) of performing 9 occupational tasks involving lower extremity joint loading at their longest job (N = 868) and current job (N = 273), as well as 8 household tasks ever performed (N = 811) and currently being performed (N = 767). The associations of the numbers of occupational or household tasks with the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain subscale were first examined in simple linear regression models. If significantly associated with greater pain, each of these was included in adjusted linear regression models to examine whether the association of race with pain remained statistically significant. RESULTS African Americans reported significantly greater WOMAC pain scores than whites. Exposures to more occupational tasks at the longest job and the current job were associated with greater WOMAC pain scores (p < 0.01). The association of race with greater pain scores remained statistically significant when controlling for occupational tasks at the longest job, but was reduced by 26% and no longer significant when controlling for the number of current occupational tasks. Exposures to an increasing number of household tasks were associated with lower pain scores and were not further analyzed. CONCLUSION Current performance of physically demanding occupational tasks contributed to racial differences in pain severity among individuals with knee OA. Better workplace policies to accommodate OA-related limitations may help to reduce racial differences in pain.
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Affiliation(s)
- Kelli D Allen
- Health Services Research and Development Service, Durham Veterans Affairs Medical Center, Durham, North Carolina 27705, USA.
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Mason HJ, Evans G, Moore A. Urinary biomarkers and occupational musculoskeletal disorders in the lower limbs. Occup Med (Lond) 2011; 61:341-8. [DOI: 10.1093/occmed/kqr108] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Hip and knee pain: Role of occupational factors. Best Pract Res Clin Rheumatol 2011; 25:81-101. [DOI: 10.1016/j.berh.2011.01.012] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 09/24/2010] [Accepted: 01/25/2011] [Indexed: 11/19/2022]
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Sayre EC, Li LC, Kopec JA, Esdaile JM, Bar S, Cibere J. The effect of disease site (knee, hip, hand, foot, lower back or neck) on employment reduction due to osteoarthritis. PLoS One 2010; 5:e10470. [PMID: 20454665 PMCID: PMC2862713 DOI: 10.1371/journal.pone.0010470] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2009] [Accepted: 04/07/2010] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Osteoarthritis (OA) has a significant impact on individuals' ability to work. Our goal was to investigate the effects of the site of OA (knee, hip, hand, foot, lower back or neck) on employment reduction due to OA (EROA). METHODS AND FINDINGS This study involved a random sample of 6,000 patients with OA selected from the Medical Service Plan database in British Columbia, Canada. A total of 5,491 were alive and had valid addresses, and of these, 2,259 responded (response rate = 41%), from which 2,134 provided usable data. Eligible participants were 19 or older with physician diagnosed OA based on administrative data between 1992 and 2006. Data of 688 residents were used (mean age 62.1 years (27 to 86); 60% women). EROA had three levels: no reduction; reduced hours; and total cessation due to OA. The (log) odds of EROA was regressed on OA sites, adjusting for age, sex, education and comorbidity. Odds ratios (ORs) represented the effect predicting total cessation and reduced hours/total cessation. The strongest effect was found in lower back OA, with OR = 2.08 (95% CI: 1.47, 2.94), followed by neck (OR = 1.59; 95% CI: 1.11, 2.27) and knee (OR = 1.43; 95% CI: 1.02, 2.01). We found an interaction between sex and foot OA (men: OR = 1.94; 95% CI: 1.05, 3.59; women: OR = 0.89; 95% CI = 0.57, 1.39). No significant effect was found for hip OA (OR = 1.33) or hand OA (OR = 1.11). Limitations of this study included a modest response rate, the lack of an OA negative group, the use of administrative databases to identify eligible participants, and the use of patient self-reported data. CONCLUSIONS After adjusting for socio-demographic variables, comorbidity, and other OA disease sites, we find that OA of the lower back, neck and knee are significant predictors for EROA. Foot OA is only significantly associated with EROA in males. For multi-site combinations, ORs are multiplicative. These findings may be used to guide resource allocation for future development/improvement of vocational rehabilitation programs for site-specific OA.
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Affiliation(s)
- Eric C Sayre
- Arthritis Research Centre of Canada, Vancouver, British Columbia, Canada.
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Callahan LF, Shreffler J, Siaton BC, Helmick CG, Schoster B, Schwartz TA, Chen JC, Renner JB, Jordan JM. Limited educational attainment and radiographic and symptomatic knee osteoarthritis: a cross-sectional analysis using data from the Johnston County (North Carolina) Osteoarthritis Project. Arthritis Res Ther 2010; 12:R46. [PMID: 20298606 PMCID: PMC2888194 DOI: 10.1186/ar2956] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2010] [Revised: 03/08/2010] [Accepted: 03/18/2010] [Indexed: 11/25/2022] Open
Abstract
Introduction Applying a cross-sectional analysis to a sample of 2,627 African-American and Caucasian adults aged ≥ 45 years from the Johnston County Osteoarthritis Project, we studied the association between educational attainment and prevalence of radiographic knee osteoarthritis and symptomatic knee osteoarthritis. Methods Age- and race-adjusted associations between education and osteoarthritis outcomes were assessed by gender-stratified logistic regression models, with additional models adjusting for body mass index, knee injury, smoking, alcohol use, and occupational factors. Results In an analysis of all participants, low educational attainment (<12 years) was associated with higher prevalence of four knee osteoarthritis outcomes (unilateral and bilateral radiographic and symptomatic osteoarthritis). Women with low educational attainment had 50% higher odds of having radiographic knee osteoarthritis and 65% higher odds of symptomatic knee osteoarthritis compared with those with higher educational attainment (≥ 12 years), by using fully adjusted models. In the subset of postmenopausal women, these associations tended to be weaker but little affected by adjustment for hormone replacement therapy. Men with low educational attainment had 85% higher odds of having symptomatic knee osteoarthritis by using fully adjusted models, but the association with radiographic knee osteoarthritis was explained by age. Conclusions After adjustment for known risk factors, educational attainment, as an indicator of socioeconomic status, is associated with symptomatic knee osteoarthritis in both men and women and with radiographic knee osteoarthritis in women.
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Affiliation(s)
- Leigh F Callahan
- Thurston Arthritis Research Center, Department of Medicine, 3300 Thurston Building, CB # 7280, University of North Carolina, Chapel Hill, NC 27599-7330, USA.
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Abstract
Sixteen articles published between 1987 and 2008 regarding work-related activities as risk factors for osteoarthritis of the knee, hand, foot, hip, and cervical spine were chronologically reviewed. Despite challenges (e.g., nonresponse bias, inadequate sample size, and retrospective exposure assessment), the review findings indicated a strong relationship between physical strain experienced while performing physically demanding jobs and the incidence of osteoarthritis. This conclusion informs occupational health nurses' work and design of work policies.
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