Occupational competence and its relationship to emotional health in injured workers in return to work programs: a Malaysian study

Workers with musculoskeletal disorders undertaking Malaysia's return to work (RTW) programmes may experience challenges in occupational competence (OC) and negative emotional states (NES). This study aimed to measure and examines the OC and NES of the workers by comparing specific comparison groups and groups of different phases. A total of 76 participants were recruited from a national RTW programme and categorized into three groups based on different RTW phases: off-work (n = 22), re-entry (n = 31), and maintenance (n = 23). Self-report questionnaires consisted of the Occupational Self Assessment version 2.2 and the Depression, Anxiety and Stress Scale-21. Results showed that injured workers exhibited significantly lower OC in comparison with an international group with various disabilities. In contrast, there was significantly higher NES when compared with Malaysia's general population. Significant differences in OC and NES were also found between workers in the three RTW phases. In particular, OC and NES in the off-work and re-entry phases were significantly lower (OC) and higher (NES) than in the maintenance phase. Furthermore, there was a moderate, negative correlation between OC and NES in the off-work and re-entry phase groups. This indicated that low levels of perceived OC were associated with higher levels of NES.

Epidemiology, co-morbidity, and impact on health-related quality of life of self-reported headache and musculoskeletal pain-a gender perspective

BACKGROUND

Headache and musculo-skeletal pain are major public health problems. Substantial proportions of the general population report that they experience pain problems that affect their work, daily living and social life. Epidemiological studies have consistently shown that the prevalence of most pain conditions is higher in women than in men.

DESIGN

Cross-sectional survey in the county of Uppland, Sweden, 1995. Five thousand four hundred and four completed the questionnaire (response rate=68%). In these analyses for persons aged 20-64 years 4506 were included.

RESULTS

Back pain (22.7%) and shoulder pain (21.0%) were the most commonly reported medical problems in the population with pain in arms/legs (15.7%) in fifth and headache (12.5%) in eight place. Major gender differences were found. The prevalence of pain conditions, especially headache, was higher among women. Women reported more severe pain. Co-morbidity between pain conditions and psychiatric and somatic problems was higher among women. Health-related quality of life (SF-36) differed by gender and type of pain condition. The physical dimensions of HRQoL were more affected by headache among men; psychological dimensions were more affected among women. Among both men and women, pain conditions were associated with poorer socioeconomic conditions and life-style factors but there were gender differences. Education and unemployment were important only among men while economical difficulties, half-time work and being married were associated with pain among women. Obesity, early disability retirement, long time sick-leave and lack of exercise were associated with pain conditions generally. Factors associated with pain conditions were unevenly distributed between genders.

CONCLUSION

There are major differences between men and women in the prevalence and severity of self-reported pain in the population. Biological factors may explain some of the differences but the main explanation is presumably gender disparities in work, economy, daily living, social life and expectations between women and men. Although improved working conditions are of importance, deeper societal changes are needed to reduce the inequities in pain experiences between women and men.

How equitable is vocational rehabilitation in Sweden? A review of evidence on the implementation of a national policy framework

PURPOSE

Under the national framework law in Sweden, all eligible people should have equal chances of receiving vocational rehabilitation. We aimed to review the evidence on (1) whether access to vocational rehabilitation is equitable in practice and (2) whether the outcomes vary for different groups in the population.

METHOD

Systematic review of studies in Sweden that reported diagnostic or socio-demographic characteristics of people offered or taking up rehabilitation programmes and outcomes of such programmes for different diagnostic and socio-demographic groups. Searches of 11 relevant electronic databases, 15 organisational websites, citation searching and contact with experts in the field, for the period 1990-2009.

RESULTS

A total of 11 studies were included in the final review, six of which addressed review question (1) and seven addressed review question (2). All the six observational studies of access reported biased selection into vocational rehabilitation: greater likelihood for men, younger people, those with longer-term sick leave, those with lower income, employed rather than unemployed people and those with musculoskeletal and mental disorders or alcohol abuse. Having had a rehabilitation investigation also increased the likelihood of receiving vocational rehabilitation. Differential outcome of rehabilitation was reported in seven studies: outcomes were better for men, younger people, employed individuals, those with shorter sick leave and those with higher income. Selection into vocational rehabilitation was perceived as important for successful outcomes, but success also depended on the state of the local labour market.

CONCLUSIONS

There is evidence of socio-demographic differences in access to and outcomes of vocational rehabilitation in Sweden, even though the national framework law is meant to apply to everyone. Few studies have deliberately measured differential access or outcomes, and there is a need for this kind of equity analysis of population-wide policies. Studies evaluating the effects of vocational rehabilitation must consider selection into the programmes for adequate interpretation of impact results.

Factors explaining return to work for long-term sick workers in Norway

PURPOSE

This study investigates factors that will affect the chances of long-term sick workers returning to work.

METHOD

The study is based on a representative sample of persons with mental illnesses and musculoskeletal disorders who received a rehabilitation allowance in Norway in 2002. Their occupational status in 2005 and experiences from the rehabilitation process were charted through their responses to a questionnaire in combination with national register data. Our analytical framework is based on three domains: the medical domain, the domain of authoritative bodies and the production domain (working life), as described by Lindqvist (Att sätta gränser: organisationer och reformer i arbetsrehabiliteringen. Umeå: Boréa; 2000).

RESULTS

Our main findings are that earlier work experience, age and other members in household, in addition, to influence over one's own rehabilitation process explains whether workers on long-term sick leave return to work. Furthermore, individual factors such as gender and diagnosis (i.e. musculoskeletal disorder and mental illness) do not explain the probability to return to work. Experience and contact with representatives of the medical, the authoritative bodies and the production domain only explain to a small extent the probability to return to work. It is even interesting to note that regular contact with the social insurance office (SIO) has a negative effect on the probability to return to work. This may indicate that contact with the SIO subjects sick workers to a risk of developing a 'social insurance career' to secure their income.

CONCLUSIONS

The findings show that the medical, the authoritative bodies and the production domain might represent different logics that can pull a sick worker in different directions during the rehabilitation process. However, these different logics do not fully explain, which outcome a rehabilitation process takes. It is important to extend the analysis to include how the individuals respond to these logics during the rehabilitation process.

Back to work – evaluation of a multidisciplinary rehabilitation programme with emphasis on musculoskeletal disorders. A two-year follow-up

PURPOSE

The aim of this study was to evaluate the 2-year outcome of a multidisciplinary rehabilitation programme for working-age people, regarding sick leave and mental health.

METHOD

The test persons consisted of 40 women and 20 men (mean age 46.8 +/- SD 7.9) with musculoskeletal disorders, mainly neck and back pain. The rehabilitation programme was individually adapted and consisted of physical activity in several forms, relaxation, theoretical and practical education and individual guidance. Before, during and after the programme all participants were evaluated with the Global Self-Efficacy Index, Hospital Anxiety and Depression Scale, and stress test.

RESULTS

At the 2-year follow-up full-time sick leave had decreased by 37% (p < 0.0001) in the women, and by 25% (p < 0.05) in the men. Both women and men showed an increased quality of life (QoL) and decreased anxiety, depression and self-experienced stress at the 2-year follow-up compared with the start of the rehabilitation programme.

CONCLUSIONS

The most important conclusion was that the effects of the rehabilitation programme persisted for up to 2 years. At 2 years the majority of the participants were still physically active, their QoL was increased, and most participants had returned to work.

Disability in society-medical and non-medical determinants for disability pension in a Norwegian total county population study

The objective of this study was to describe sociomedical determinants and developments for the medically based disability pension in Norway by linking individual based data from a county health survey to data on disability from the National Insurance Administration. Two cross-sectional total population health surveys with an approximate 10-year interval were conducted in Nord-Trøndelag county, HUNT I (1984-86) and HUNT II (1995-97), which allows for analyses of changes over time, supplied with official incidence data on disability pension. The large-scale variations and overall increasing incidence rates of disability pension in Norway during the last 20 years also applied to the county of Nord-Trøndelag. The prevalence of disability pension generally increased in the population from the mid-1980s to the mid-1990s. A striking finding was a consistent pattern of increasing prevalence of disability pension with decreasing socio-economic status and education. A geographic pattern for disability pension prevalence on a municipality level suggested that structural and cultural factors were important in determining the level of disability in society. Medical determinants alone cannot explain either the dramatic variations or the overall increased incidence rates of disability pension in the last two decades in Norway. The results demonstrate the importance of social, non-medical and contextual determinants for disability pension, how these determinants result in important prevalence differences by socio-economic status, and their impact on the level of disability in society.

Epidemiology of analgesic use: a gender perspective

BACKGROUND AND OBJECTIVE

Women consistently report significantly more frequent analgesic use in epidemiological studies. The aim of this study was to analyse the influence of medical and non-medical factors on the difference in use of analgesics between women and men from a population perspective.

METHODS

Cross-sectional survey. Postal questionnaires were sent to a random sample of the general population in the country of Uppland, Sweden (5404 answered the questionnaire, response rate: 68%).

RESULTS

34.8% of the women and 21.4% of the men had used analgesics during the two week recall period (Odds Ratio = 1.96). Social structure, social status, marital status, educational level, economic situation, lifestyle, attitudes toward drugs, medication knowledge and self-care orientation were of minor importance for the difference in use between women and men. Difference in prevalence of various types of pain and ache and the degree of pain experienced were the most influential factors affecting the difference in use. However, when all factors were analysed there remained a substantial difference in use between women and men (OR = 1.39, CI (95%) 1.20 to 1.60).

CONCLUSIONS

In the population, women use analgesics much more frequently than men. Consequently women may be at greater risk for adverse effects and dependency. Some of the gender difference is explained by the greater frequency of pain conditions among women, but a significant difference in use still remains to be explained.