Physical and psychosocial work exposures as risk factors for disability retirement due to a shoulder lesion

Labour market trajectories after part-time sickness absence: a nationwide cohort study from Finland

OBJECTIVES

The use of part-time sickness absence (pSA) enables return to part-time work from full sickness absence. However, subsequent labour market outcomes of pSA users depend on various individual and work-related characteristics. We investigated labour market paths of private and public sector employees after having a pSA spell. Moreover, we examined individual and work-related factors associated with following them.

DESIGN

Longitudinal register-based cohort study.

SETTING

Finnish employed population.

PARTICIPANTS

9896 receivers of partial sickness allowance aged 45-56 in the years 2010-2014.

OUTCOME

We constructed labour market trajectories based on the proportion of time spent in various labour market statuses measured over 3 years after the end of the pSA spell using multiresponse trajectory analysis. We then examined how different individual and work-related factors were associated with assignment to the different trajectory groups using logistic regression analyses.

RESULTS

The majority of the pSA users followed paths where work participation was consistently elevated (Sustained Work group, 40.4%), or only slightly reduced (Slightly Reduced Work group, 31.6%). Moreover, more than 1/10th of the users followed a path where receiving partial work disability benefits became predominant (Partial Work Disability group, 12.5%). The rest followed paths where other non-employment (Other Non-Employed group, 7.8%) or full work disability (Full Work Disability group, 7.7%) became the prevailing status. Lower educational level and income predicted assignment to all other groups than the Sustained Work group. Additional predictors were identified, yet these differed between the trajectory groups.

CONCLUSIONS

The majority of the pSA users maintained a connection to working life, yet weaker working life paths were also identified. The paths were determined by various individual and work-related factors that can help health professionals and employers to better target support measures particularly towards individuals whose connection to working life is at risk to weaken after the use of pSA.

Predictive factors of return-to-work trajectory after work-related rotator cuff syndrome: A prospective study of 96 workers

OBJECTIVE

Sustained return to work after surgery for work-related rotator cuff syndrome (WRRCS) remains quite difficult. The main purpose of the present study was to identify predictive factors of a return-to-work (RTW) trajectory.

METHODS

A total of 96 workers with WRRCS were identified by 4 surgeons. They were followed prospectively before and after the surgery, until 1 year after RTW, or for 20 months after surgery when they did not. Participants completed a series of standardized questionnaires related to working conditions, health, and beliefs, and performed functional tests at the inclusion time. During the follow-up period, they were regularly asked about their working conditions (present or not at work), activity (normal or lightened physical duties) and schedules (full- or part-time job). Statistical analysis was based on single- and multiple-factor models of prediction of the workers' trajectory.

RESULTS

Three trajectories of RTW were distinguished, considering RTW and absenteeism that occurred during the follow-up: stable, unstable, and non-RTW. The median age of the sample was 49.5 [45.0-54.0], with 67.7% of workers employed in highly physically demanding jobs. In the multiple factor model, three factors were highly predictive of the trajectory: perceived health before surgery, having had a repaired ruptured-rotator-cuff tendinopathy, and the level of physical demand of the job.

CONCLUSION

Three easy-to-collect predictive factors of RTW trajectory have been identified. They may be useful for healthcare professionals and care givers to identify vulnerable workers' risk of occupational dropout after arthroscopic surgery for rotator cuff tendinopathy.

Sickness absence transitions among Swedish twins with back, neck or shoulder pain and common mental disorders applying a multi-state approach

We aimed to investigate transitions to and from sickness absence, or disability pension among individuals with back, neck, or shoulder pain and/or with common mental disorders (CMDs), and the role of familial (genetics and shared environment) influences on the transitions. Swedish twins born 1935-1985 who responded to pain and CMDs survey items (N = 41,516) were followed on average 8.7 years for sickness absence states in national registers. Multi-state Cox regression models were applied for three exposure groups: pain, CMDs, and presence of both, compared to unexposed. Exposure discordant twin pairs, stratified by zygosity, were analysed to assess the role of familial factors. Hazard Ratios (HR) with 95% confidence intervals and transition intensities were calculated. HRs were similar for transitions between states among those with pain or CMDs. The highest HRs were for transitions from entry to sickness absence and sickness absence to disability pension among those with both pain and CMDs (HRs: 1.61 and 1.43, respectively). Higher HRs for dizygotic compared to monozygotic twins for the first transition to sickness absence and for altering back to not being sickness absent indicate familial confounding. Back, neck, or shoulder pain and/or CMDs indicate a higher risk to become sickness absent and for repeated sickness absence episodes over time compared to unaffected.

How Does Job Insecurity and Workplace Activity Limitations Relate to Rheumatic Disease Symptom Trajectories in Young Adulthood? A Longitudinal Study

OBJECTIVE

Workplace and labor market conditions are associated with the health of the working population. A longitudinal study was conducted among young adults with rheumatic disease to examine workplace activity limitations and job insecurity and their relationship with disease symptom trajectories.

METHODS

Three online surveys were administered to young adults with rheumatic disease over 27 months. Self-reported data on pain, fatigue, and disease activity were collected. Workplace activity limitations and job insecurity were measured. Group-based discrete mixture models determined pain, fatigue, and disease activity trajectory groups. Robust Poisson regression models were fitted to examine the relationship among workplace activity limitations, job insecurity, and trajectory group membership.

RESULTS

In total, 124 participants (mean ± SD age 29 ± 4.5 years) with rheumatic disease were recruited. At baseline, participants reported considerable workplace activity limitations (10.35 ± 5.8), and 36% of participants indicated experiencing job insecurity. We identified 2 latent rheumatic disease symptom trajectory groups. The first group had high persistent pain, fatigue, or disease activity; the second group had low persistent disease symptoms over time. Greater workplace activity limitations were associated with an increased relative risk (RR) of being in the high persistent severe pain (RR 1.02 [95% confidence interval (95% CI) 1.01, 1.03]), fatigue (RR 1.02 [95% CI 1.01, 1.03]), and disease activity trajectory groups (RR 1.02 [95% CI 1.01, 1.03]). Job insecurity was associated with an increased RR of membership in the high persistent pain (RR 1.14 [95% CI 1.04, 1.25]) and disease activity trajectory groups (RR 1.11 [95% CI 1.00, 1.22]).

CONCLUSION

Workplace activity limitations and job insecurity represent working conditions that are associated with the health of young adults with rheumatic disease and should be examined as potential targets for intervention.

Association of occupational physical activity and disability pension in 756,159 Spanish workers: A prospective cohort study with 13 years follow-up

Recent research from Nordic countries identified occupational physical activity (OPA) as a risk factor for disability pension, but further research accounting for exhaustive analyses in novel populations is warranted. Our objective was to assess the association between OPA and disability pension using administrative data. This prospective registry-based cohort study used data from the Spanish Continuous Working Life Sample (CWLS). Participants were followed up from baseline (January 1, 2006) to first event of disability pension, mortality, or end of follow-up (September 1, 2019). The assessment of OPA was based on registers of economic activity and their correspondence with a validated OPA index. To examine the association between OPA and disability pension, adjusted proportional hazard, and Fine-Gray models using mortality as competing risk were conducted. We retrieved data from 756,159 workers (57.7% men) with an average age of 38.5 years (SD 11.9). During 13.6 years from baseline to the end of follow-up (9,463,041 person-years), 18,191 men (4.2%) and 9631 (3.0%) women received a disability pension. In the fully adjusted model, participants exposed to higher levels of OPA showed higher risk for disability pension in an exposure-response fashion. Men and women exposed to very high OPA showed the highest HR for disability pension (2.31 [95% CI, 2.17 to 2.46] and 1.68 [95% CI, 1.56 to 1.81], respectively. These results warrant preventative measures to address early involuntary exit from the labour market in workers exposed to high physical work demands.

A design tool to estimate maximum acceptable manual arm forces for above-shoulder work

There is a need for design criteria for above-shoulder work to prevent shoulder fatigue and supraspinatus injuries. A tool is developed to estimate maximum acceptable manual arm forces for above-shoulder work based on 25th % female strength with adjustments for supraspinatus tendon impingement and shoulder fatigue. The tool equations are presented along with tables of maximum acceptable manual arm forces in 77 locations in the 3 D space above the shoulder that accommodates a 50th % female reach. The largest acceptable anterior force, 140.3 N, occurs at shoulder height, 0.5 m anterior to the shoulder. The largest acceptable superior force, 84.4 N, occurs at shoulder height, 0.1 m anterior and 0.2 m medial to the shoulder. The new tool provides design criteria for arm exertions at a higher level of detail than prior ergonomic tools, making it useful for engineers. Based on sensitivity analyses, the tool is robust to parameter assumptions. Practitioner summary: Above-shoulder work is associated with increased risk for shoulder fatigue and injuries. A new tool is developed that estimates maximum acceptable manual arm forces for work at or above shoulder height. The tool can be used to design acceptable above-shoulder work so that it can be accomplished by most workers. Abbreviations: AFF: arm force field; AP: anterior/posterior; DC: duty cycle; GH: glenohumeral angle; HT: humerothoracic angle; LM: lateral/medial; MAE: maximum acceptable effort; MAF: maximum acceptable force; MAS: manual arm strength; MVC: maximum voluntary contraction; N: newton; OCRA: occupational repetitive action; R: reach distance; RMS: root means square; RULA: rapid upper limb assessment; SF: scale factor; SI: superior/inferior; ST: scapulothoracic angle; T: thoracicKEY POINTSA new design tool is introduced that estimates maximum acceptable hand forces for specific locations above the shoulder.This above-shoulder tool is based on a 50th percentile female anthropometry and 25th percentile female manual arm strength.These base strengths are multiplied by scaling factors that adjust for subacromial impingement and fatigue.The tool was shown to be robust based on sensitivity analysis.

Rates of Return to Manual Labor After Arthroscopic Rotator Cuff Repair

BACKGROUND

Rotator cuff tears represent a significant cause of shoulder pain and dysfunction in the United States. The development of these injuries is associated with older patient age and higher levels of physical activity; however, data regarding the rate of return to work after arthroscopic rotator cuff repair in patients older than 50 years of age who have physically strenuous jobs is inconclusive.

PURPOSE/HYPOTHESIS

The purpose of this study was to report short term outcomes and return to work rates after arthroscopic rotator cuff repair in a cohort of patients aged 50 to 60 years working in manual labor jobs. It was hypothesized that arthroscopic rotator cuff repair would result in good functional outcomes for these patients and allow for return to work rates in excess of 80%.

STUDY DESIGN

Case series; Level of evidence, 4.

METHODS

Preoperative and final evaluations including the pain visual analog scale (VAS), the Single Assessment Numeric Evaluation (SANE), and the American Shoulder and Elbow Surgeons (ASES) Shoulder Score were collected. A total of 73 patients were screened for inclusion. Nineteen patients were outside of the inclusion age range, 2 underwent exclusionary concomitant procedures, and 4 patients were lost to follow up, leaving a total of 48 patients with a mean follow up of 34.02 months (range, 24-67 months) available for analysis. None of the patients were involved in a workers' compensation claim. Subgroup analysis was performed to determine if arm dominance or tear size affected surgical outcomes or return to work rates.

RESULTS

After arthroscopic rotator cuff repair, 43 of 48 patients (89.6%) were able to return to manual labor positions. Tears were classified using the Southern California Orthopaedic Institute Classification at the time of repair as massive (C4) in 9 patients (18.75%), large (C3) in 13 patients (27.08%), medium (C2) in 21 patients (43.75%), and small (C1) in 5 patients (10.42%). At latest follow up, the mean VAS decreased from 8.0 ± 1.81 to 0.46 ± 1.20, the average SANE increased from 47.50 ± 18.59 to 91.88 ± 12.30, and the average ASES score improved from 39.58 ± 10.71 to 93.44 ± 11.97 (P < .0001). Outcomes did not differ between patients who underwent surgery on their dominant shoulder and those who underwent surgery on their nondominant shoulder. The overall postoperative complication rate was 8.33%.

CONCLUSION

Arthroscopic rotator cuff repair portended favorable outcomes and high rates of return to work in this cohort of manual laborers, with 89.6% of patients able to return to work.

Predictive factors for the duration until return to work after surgery for work-related rotator cuff syndrome: A prospective study of 92 workers

BACKGROUND

Return to work (RTW) after surgery for a work-related rotator cuff disorder (WRRCD) is often difficult. The study's purpose was to identify preoperative factors predicting RTW.

METHODS

Ninety-two workers with a WRRCD were identified by four surgeons. Before surgery, the workers completed a series of standardized questionnaires related to working conditions, health, and health beliefs. They were followed up prospectively for 20 months. Statistical analysis was based on single and multiple-factor Cox models of the duration of absence from the time of surgery until RTW.

RESULTS

The median age at inclusion was 49 years (27-62), with 52 women included (57%). Sixty-one subjects (66%) were employed in highly physically demanding jobs. Forty-two (46%) stayed at work until their surgery, whereas preoperative sick leave exceeded 100 days in 20 subjects (21%). Twenty months after surgery, 14 were still not back at work. For the other participants, the mean duration until RTW was 225 days (SD 156). In the fully adjusted model, variables that were significantly predictive of the duration until RTW were: work physical demand levels, preoperative sick leave, the number of body parts causing pain or discomfort in the last 12 months, self-assessed 2-year workability, and the Readiness for RTW (RRTW) Scale.

CONCLUSIONS

Several physical, psychological, and work-related factors, easily recorded, can be identified preoperatively. They may be predictive of delayed return, loss of employment, or employability as a result of shoulder surgery.

Association between physical limitations and working life exposure to carrying heavy loads assessed using a job-exposure matrix: CONSTANCES cohort

INTRODUCTION

Decline in physical performance with age varies among workers. We studied the association between lifetime exposure to carrying heavy loads and limitations in climbing stairs.

METHODS

We used data from the French CONSTANCES study. A biomechanical Job-Exposure Matrix (JEM) was combined with lifetime job histories to build a cumulative exposure score, and compared with reported limitations in climbing stairs using robust Poisson models, stratified by sex and educational level.

RESULTS

Of the 26,255 subjects, 618 men and 1,080 women reported difficulties in climbing stairs; this outcome was associated with cumulative exposure to carrying heavy loads: adjusted PR= 2.17 (1.75-2.73) for men, 1.50 (1.30-1.74) for women. The association was primarily seen among less educated subjects.

CONCLUSION

Cumulative work exposure to carrying heavy loads across the working life was associated with physical limitations in climbing stairs among the less educated in both genders.

Occupational differences in disability retirement due to a shoulder lesion: do work-related factors matter?

Objective

To identify occupations with a high risk of disability retirement due to a shoulder lesion and to examine the effect of physical and psychosocial work-related factors on occupational differences in disability retirement.

Methods

We followed Finnish wage earners aged 30–59 years (n = 1,135,654) from 2005 to 2014 for full disability retirement due to a shoulder lesion. The work-related exposures were assessed with job exposure matrices. We calculated age-adjusted incidence rates and hazard ratios to test for the association between occupation and disability retirement due to a shoulder lesion. We also examined the contribution of work-related exposures to the excess risk of disability retirement.

Results

As compared to professionals, the age-adjusted risk of disability retirement was increased among men in all occupational groups except managers and customer service clerks and among women in several occupational groups. Adjustment for education attenuated the occupational differences considerably, particularly among women. The physical work-related factors fully explained the excess risk of disability retirement due to a shoulder lesion among male finance and sales associate professionals and administrative secretaries as well as among agricultural and fishery workers. In women, the physical work-related factors fully explained the excess risk among construction workers, electricians and plumbers. For both genders, the contribution of psychosocial factors to excess risk of disability retirement was modest and seen for monotonous work only.

Conclusions

A reduction of the level of physical work load factors as well as monotonousness of work has a potential to prevent work disability due to a shoulder lesion.

Electronic supplementary material

The online version of this article (10.1007/s00420-020-01549-y) contains supplementary material, which is available to authorized users.

Comparison Between a Job-Exposure Matrix (JEM) Score and Self-Reported Exposures for Carrying Heavy Loads Over the Working Lifetime in the CONSTANCES Cohort

OBJECTIVES

Job-exposure matrices (JEMs) were developed to allow assessment of past work exposure for large population-based studies where better exposures data are unavailable. Few studies have directly compared biomechanical JEMs to self-administered questionnaires. We compared assessments of cumulative exposure to carrying heavy loads based on 'JEM Constances' to individually self-reported (SR) exposures.

METHODS

In the French CONSTANCES cohort at inception, past SR exposure to carrying heavy loads (ever/never and durations) and a detailed job history were available for 26 929 subjects. JEM Constances, an existing biomechanical JEM based on SR current exposures from 26 821 asymptomatic workers, was combined with job history to build a cumulative biomechanical exposure score. Using individual SR exposure as the reference, Area Under the Curve (AUC) of Receiver Operating Characteristic (ROC) curves, sensitivity, and specificity were calculated. For both methods, associations with low back pain and knee pain were computed using multinomial logistic models. Additional analyses compared older (>10 years) to more recent (≤10 years) exposures.

RESULTS

AUCs ranged from 0.795 (0.789-0.800) when all periods were considered, to 0.826 (0.820-0.833) for more recent biomechanical exposure (≤10 years). Associations between carrying heavy loads and low back pain or knee pain were less strong using JEM assessment than individually SR exposure: for low back pain ORSR = 3.02 (2.79-3.26) versus ORJEM = 1.70 (1.59-1.82) and for knee pain ORSR = 2.27 (2.10-2.46) versus ORJEM = 1.64 (1.53-1.77).

CONCLUSIONS

JEM Constances' assessment of cumulative exposure of carrying heavy loads seems to be a useful method compared to a self-administrated questionnaire for large population-based studies where other methods are not available.

Dose-Response Relationship between Physical Workload and Specific Shoulder Diseases-A Systematic Review with Meta-Analysis

Several epidemiological studies have found an association between shoulder-loaded work activities and specific shoulder diseases. No study has derived the dose-response relationship and resulting doubling dose, important for the recognition of occupational diseases. This systematic review is an update of the van der Molen et al. (2017) review. Based on its methodologies, we identified new studies published up to November 2018. The dose-response relationship between physical occupational demands (hands at/above shoulder level, repetitive movements, forceful work, hand-arm vibrations) and specific shoulder diseases (defined as ICD-10 M 75.1-5: rotator cuff syndrome, bicipital tendinitis, calcific tendinitis, impingement, and bursitis) was derived. No evidence for sex-specific differences in the dose-response relationship was found. If there were at least two studies with comparable exposures, a meta-analysis was carried out. The pooled analysis resulted in a 21% risk increase (95% CI 4–41%) per 1000 h of work with hands above shoulder level. A meta-analysis was not possible for other occupational burdens due to the low number of studies and differing exposure measurements; an estimate of the doubling dose was made based on the cohort study of Dalbøge et al. (2014). To conclude, the present systematic review with meta-analysis contributes to knowledge of the level of exposure at which specific shoulder diseases—particularly rotator cuff lesions—should be recognized as an occupational disease.