Sick leave patterns in common musculoskeletal disorders--a study of doctor prescribed sick leave

'Wait…, let me tell you, if I worked for a boss, I would be on sick leave': A Qualitative Study of Self-Employed Workers in Physically Demanding Jobs in the Netherlands

PURPOSE

The purpose of this study was to explore the perspectives of self-employed workers with a physically demanding job on work participation.

METHODS

We interviewed self-employed workers with a physically demanding job, using semi-structured interviews, which were audio recorded. The main topic addressed was the workers' health in relation with their work participation, work demands, and preventive measures. The interviews were transcribed verbatim and coded by three team members of the research team in several steps. We used the consolidated criteria for reporting qualitative research (COREQ) checklist to report our findings.

RESULTS

We interviewed 18 self-employed workers: 83% male, 49 years (SD 7), self-employed for 18 years (SD 9) and the majority (n = 14) worked in the construction sector. Thematic analysis revealed facilitators and barriers for work participation across three main themes: personal factors, work factors, and healthcare. Personal factors compassed sub-themes such as health and financial consequences. Work factors included sub-themes related to work demands and adaptations and healthcare encompassed sub-themes associated with work-related care and medication.

CONCLUSION

To our knowledge, this is the first qualitative study that investigated the perspectives of self-employed workers in physically demanding jobs regarding work participation. While most facilitators and barriers were consistent with those described in the literature for employees, certain factors, such as financial consequences of ceasing work, emerged important factors for work participation among self-employed workers.

Sick leave and disability pension among TMD patients with musculoskeletal diseases, mental and behavioural disorders - a SWEREG-TMD population-based cohort study

BACKGROUND

Temporomandibular disorders (TMD) are associated with musculoskeletal diseases (MSD), mental and behavioural disorders (MBD), and patients with TMD have been shown to have 2-3 times more days of sick leave (SL) and disability pension (DP) than the general population. MSD and MBD are two of the most common causes for SL and DP, and the association between TMD and the influence of comorbidities on the need for SL and DP among TMD patients need further clarification. This study investigates the impact of MSD and MBD comorbidity on SL and DP among TMD patients diagnosed in a hospital setting and/or surgically treated.

METHODS

All incident TMD patients diagnosed or treated in a hospital setting between 1998 and 2016 and aged 23-59 were included. A non-exposed comparison cohort was collected from the general population. The cohorts were grouped based on the presence of comorbidity: No comorbidity (Group I); MSD comorbidity (Group II); MBD comorbidity (Group III); and combined MSD and MBD comorbidity (Group IV). Main outcomes were mean annual days of SL and DP, and statistical analysis was conducted using generalized estimated equations.

RESULTS

TMD subjects with no comorbidities (Group I) and with MSD/MBD comorbidity (Group II and III) were 2-3 times more often on SL and DP than the corresponding groups from the general population. However, in the group with both MSD and MBD comorbidity (Group IV), the difference between the TMD subjects and the general population was diminishing, suggesting an additive effect.

CONCLUSION

TMD patients are more dependent on SL and DP benefits compared to general population and the difference remains even after considering MSD and MBD comorbidity. In individuals with combined MSD and MBD comorbidity, concurrent TMD has less impact on the need for social insurance benefits. The results accentuate the impact TMD has on the patients' impaired ability to return to work and why TMD should be recognized as having a substantial impact on individual and economic suffering as well as on societal costs, with emphasis on the influence of comorbidities on patient suffering.

Predictors of 1-Year Perceived Recovery, Absenteeism, and Expenses Due to Low Back Pain in Workers Receiving Mechanical Diagnosis and Therapy: A Prospective Cohort Study

This multicenter prospective cohort study aimed to preliminarily explore statistically relevant modifiable and predetermined factors for 1-year perceived recovery, absenteeism, and personal expenses in workers who received Mechanical Diagnosis and Therapy (MDT) for low back pain (LBP). Three stepwise multiple regression models were explored with 42 independent variables, including (1) socio-demographic factors; (2) risk stratification; (3) pain-related variables, psychological variables, and behavioral variables at baseline and changes after a month; (4) therapeutic alliance and exercise adherence at 1-month follow-up; and (5) MDT classification and therapist levels. Data from 58 participants were analyzed, after which a model with a medium effect size was developed for 1-year perceived recovery only. Consequently, patients with derangement syndrome were expected to have improved 1-year perceived recovery, with expected predetermined prognostic factors including shorter symptom duration, self-management skills to lead a healthy life, and less pain catastrophization at baseline. A stronger therapeutic alliance between patient and therapist during the 1-month MDT intervention was identified as an expected modifiable prognostic factor. It may be difficult to accurately predict the annual absenteeism and personal expenses due to LBP given the weak to low effect sizes of the developed models.

Prevalence of and factors associated with long-term sick leave in working-age adults with osteoarthritis: a retrospective cohort study conducted in Germany

PURPOSE

Little is known about the impact of osteoarthritis on the long-term work participation of working-age adults. Therefore, the goal of this study was to investigate the prevalence of and the factors associated with long-term sick leave in people newly diagnosed with osteoarthritis from Germany.

METHODS

This retrospective cohort study included patients aged 18-65 years diagnosed with osteoarthritis for the first time (index date) in 1 of 1198 general practices in Germany between 2016 and 2019 (Disease Analyzer database, IQVIA). Patients were considered to be on long-term sick leave if they were absent from work for medical reasons for more than 42 days in the year following the index date. Independent variables included sociodemographic characteristics, type of osteoarthritis, and frequent comorbidities. The association between these variables and long-term sick leave (dependent variable) was studied using an adjusted logistic regression model.

RESULTS

This study included 51,034 patients with osteoarthritis [mean (standard deviation) age 50.8 (9.2) years; 50.9% women]. The prevalence of long-term sick leave was 36.2%. Younger age and male sex were positively and significantly associated with long-term sick leave compared with older age and female sex, respectively. There was also a strong relationship between several comorbidities (e.g., reaction to severe stress, and adjustment disorders, gastritis and duodenitis, and depression) with long-term sick leave.

CONCLUSIONS

The prevalence of long-term sick leave was high in this sample of patients newly diagnosed with osteoarthritis from Germany. In this context, interventions should be implemented to increase the long-term working participation of people with osteoarthritis.

Incidence and Duration of Sick Leave Due to Work-Related Musculoskeletal Disorders in the Accommodation and Food Services Activities Sector in Slovenia: A Nationwide 5-Year Observational Study

OBJECTIVES

The aim of this study was to analyze Slovenian data on sick leave (SL) due to the most common work-related musculoskeletal disorders (MSDs) among workers in sector I "accommodation and food services activities" from the NACE Rev2 classification.

METHODS

We investigated both SL incidence (i.e., number of cases) and disease severity (i.e., average SL duration) by body site, gender, age and divisions within the sector. In addition, trends in SL data (difference between 2015 and 2019) were analyzed. The effect of age group, gender and division was also assessed with relative risk (RR).

RESULTS

Female gender was associated with higher risk of MSDs in young (RR = 1.91 (1.53-2.43)) and older (RR = 2.24 (1.90-2.65)) subgroups. Older age was associated with greater SL incidence and longer SL duration, regardless of gender and division within sector I. This was also reflected in relative risk calculations between older and younger groups (females: RR = 4.43; CI = 3.75-5.01; p < 0.001; males: RR = 3.71; CI = 2.89-4.77; p < 0.001). Low back disorders were the most frequent cause for SL, while lower limb disorders tended to cause the longest average SL. The SL durations were similar across divisions within the sector, while the incidence rate tended to be higher in the "accommodation" than the "food and beverage services" division.

CONCLUSIONS

Special attention needs to be paid to reducing the risk of low back disorders, which are by far the most common cause of SL, and lower limb disorders, which cause the longest SL. We recommend the implementation of countermeasures that focus on early detection and rapid treatment/recovery of MSDs in older workers.

Sick Leave Patterns in Common Rheumatological Diseases

Objectives The study aims to analyze the patterns and determinants of sick leaves (SL) associated with the most common rheumatological diseases and estimate the associated productivity loss cost (PLC). Method A retrospective study reviewed all SLs that were issued from a rheumatology outpatient clinic between 2016 and 2019 for the following diagnoses: low back pain (LBP), knee osteoarthritis (OA), rheumatoid arthritis (RA), and disc disorders. The duration of each sick leave was captured and analyzed by patients' age category, gender, and diagnosis. The human capital method was used to estimate the PLC. Result One thousand and two SLs have been issued during the study period, for a cumulative 4,649 days. The majority of the patients were female (86.3%), and the mean (SD) age was 42.01 (10.71) years. SL durations ranged from 2 to 14 days. The most frequent diagnosis was RA (34.3%), followed by LBP (30.1%). Disc disorder, knee OA, and RA were independently associated with 2.01 (p=0.014), 9.07 (p<0.001), and 7.75 (p<0.001) odd ratios for long SL (≥7 days), by reference to LBP. The average PLC was estimated at $235.29 per day of sick leave, for a total cumulative cost of $235,755.30. Conclusion Rheumatological diseases are responsible for approximately 4.5 days of SL prescribing per day in our clinic, with an average yearly cost of $58,938.83. Monitoring the pattern of sick leave and identifying the interplay between their cofactors are essential to developing a comprehensive approach to enable evidence-based clinical practices along with advancements in work-based protective measures and policies.

Depressive Symptoms Are Associated With Decreased Quality of Life and Work Ability in Currently Working Health Care Workers With Recurrent Low Back Pain

OBJECTIVE

This study investigates the association between depressive symptoms and multisite pain and health-related quality of life and work ability in currently employed health care workers with recurrent low back pain (LBP).

METHODS

Multisite pain, depressive symptoms, quality of life, and work ability were assessed by validated questionnaires. A generalized linear model was used for statistical analysis.

RESULTS

Notably, 28% of female health care workers with LBP had at least moderate levels of depressive symptoms. Depressive symptoms were significantly associated with decreased health-related quality of life and work ability. Multisite pain was not significantly associated with work ability.

CONCLUSIONS

Depressive symptoms are relatively common in female health care workers with LBP, and treatment of these symptoms may be crucial to improve their work ability.

Occupational recovery of Dutch workers with low back pain

Background

Low back pain (LBP) is a world leading cause of disability and has substantial impact on individuals and society as a whole. The largest part of the societal burden of LBP is caused by indirect costs, including sick leave.

Aims

We aimed to describe occupational recovery and associated costs for workers consulting an occupational physician (OP) with LBP, and to determine to what extent this differs by diagnoses: non-specific favourable LBP, non-specific unfavourable LBP, lumbosacral radicular syndrome (LRS) and specific LBP.

Methods

We analysed longitudinal dynamic cohort data from an occupational health service, representing ~1.2 million workers from various companies and sectors throughout the Netherlands. The OP registered data on sick leave and LBP diagnoses. A survival analysis was performed on sick leave duration to determine recovery and a linear regression analysis on cost per episode, adjusting for sex, age and working hours.

Results

We analysed 5951 LBP episodes from 5472 workers who consulted an OP, with a median and mean duration sick leave of 95 and 151 days, respectively. The probability of not recovering was 82% at 30 days and 10% at 1 year. The mean cost per episode was €15 350. Specific LBP (€22 999; beta (95% confidence interval [CI]): 16 278 (13 325–19 165)) and LRS (€20 111; beta (95% CI): 13 589 (12 527–14 659)) had the longest and most costly episodes, compared to non-specific favourable LBP (€6745; reference group).

Conclusions

With LRS and non-specific unfavourable LBP accounting for over 83% of LBP-associated sick leave costs, the work-directed care of workers with these two diagnoses deserves increased attention.

Health-Care and Societal Costs Associated with Non-Persistence with Subcutaneous TNF-α Inhibitors in the Treatment of Inflammatory Arthritis (IA): A Retrospective Observational Study

Objective

A few studies have suggested that patients with inflammatory arthritis (IA) who remain persistent with subcutaneous TNF-α inhibitors (SC-TNFi) incur lower health care costs than patients who discontinue treatment, whereas data on the impact of non-persistence on indirect costs are largely lacking. Furthermore, existing estimates are based on fixed follow-ups, in relation to treatment initiation, and therefore do not measure costs in direct relation to treatment discontinuation. Therefore, by capturing costs in direct relation to treatment discontinuation, this study aimed to estimate direct and indirect costs associated with non-persistence with SC-TNFis in IA.

Methods

Adult Swedish biologic-naïve IA patients initiating biologic treatment with a SC-TNFi (adalimumab, etanercept, certolizumab or golimumab) between May 6, 2010, and December 31, 2017, were identified in population-based registers with almost complete coverage. IA was defined as a diagnosis of rheumatic arthritis, ankylosing spondylitis/unspecified spondyloarthritis or psoriatic arthritis. Non-persistent patients were matched on propensity score to patients persistent with treatment by at least an additional 12 months. This enabled comparisons of direct healthcare costs and indirect costs for sick leave and disability pension, respectively, 12 months before and 12 months after treatment discontinuation.

Results

A balanced cohort of 486 matched pairs was generated. The total direct and indirect costs were significantly higher among non-persistent patients already during the 12 months before index ($20,802 [18,335–23,429] vs. $16,600 [14,331–18,696]). However, while non-persistent patients increased their total direct and indirect costs, persistent patients significantly decreased the same, further widening the difference in costs during the 12-month period after index date ($22,161 [19,754–24,556] vs. $13,465 [11,415–15,729]).

Conclusions

Among biologic-naïve Swedish IA patients treated with SC-TNFis, persistent patients incurred about 40% lower aggregated direct and indirect costs compared to non-persistent patients the year following SC-TNFi discontinuation. This highlights the impact of treatment persistence from an economic viewpoint, adding further aspects to the clinical perspective.

Graphical Abstract

Supplementary Information

The online version contains supplementary material available at 10.1007/s12325-021-01970-w.

Sick leave and disability pension in a cohort of TMD-patients - The Swedish National Registry Studies for Surgically Treated TMD (SWEREG-TMD)

Background

Temporomandibular disorders (TMD) are common and affect approximately 10% of the adult population. TMD is usually associated with headache, pain in the masticatory muscles and/or the temporomandibular joint, clicking or crepitations during mandibular movement as well as painful and/or reduced mouth opening. This study aimed to investigate the level TMD-patients use social insurance benefits before and after their first time of diagnosis or first surgical event, compared to the general population. Furthermore, the aim was to investigate the differences in the use of social insurance benefits between surgically and non-surgically treated TMD-patients that were diagnosed in a hospital setting.

Methods

All Swedish citizens aged 23–59 diagnosed with TMD in a hospital setting and/or surgically treated for the condition during 1998–2016 were identified via the Swedish National Board of Health and Welfare. A non-exposed comparison cohort was collected via the Total Population Registry. Outcome and sociodemographic data were collected via Statistics Sweden. Main outcome was annual net days on sick leave and disability pension five years before (-T5) and five years after (T5) diagnosis and/or surgical treatment (T0). Regression analysis was conducted with generalized estimated equations.

Results

The study included 219 255 individuals (73% female) – 19 934 in the exposed cohort and 199 321 in the comparison cohort. The exposed group was classified into three subgroups: non-surgical, surgically treated once, and surgically treated twice or more. The mean annual net days of sick leave and disability pension combined during the ten-year follow-up was 61 days in the non-surgical group, 76 days in the surgically treated once group, and 104 days in the surgically treated twice or more subgroup. The corresponding number for the non-exposed comparison cohort was 32 days.

Conclusion

Patients diagnosed with TMD in a hospital setting are 2–3 times more dependent on the use of social benefits than the general population. The reliance on sick leave and disability pension is seen as early as five years before diagnosis, and the reliance remains after surgical treatment. The reliance is stronger in patients with several surgical interventions. These findings indicate that patients diagnosed with TMD constitute a patient group with a high burden of health issues causing long-term dependence on social security benefits.

Influence of low back pain characteristics on the healthcare procedures prescribed by general practitioners for adult patients: ancillary analysis of the French ECOGEN study

BACKGROUND

Non-specific low back pain is a frequent reason for consultation, yet little is known about how general practitioners manage it in France.

OBJECTIVES

To describe the healthcare procedures general practitioners prescribe for low back pain in France.

MATERIALS AND METHODS

This is an ancillary analysis of an observational, cross-sectional study (ECOGEN) conducted between November 2011 and April 2012 among 128 general practitioners. Adults younger than 65 years consulting for low back pain were included. Patient and general practitioner characteristics, consultation results (diagnosis) and healthcare procedures were collected and coded using the International Classification in Primary Care. Analyses focused on the initial or follow-up consultation, adjusting on age, gender, and socio-occupational category.

RESULTS AND DISCUSSION

Out of 11510 consultations, 845 (7.3%) were for low back pain. Of these, 776 (79.5%) resulted in a clinical examination, 634 (73.4%) in medication prescription, and 203 (23.9%) were prescribed sick leave, but imaging and specialist referral were rare. Imaging was more frequent with radiating pain (adjusted odds ratio (aOR) = 1.61; 95% CI [1.07, 2.42]), as were specialist referrals (OR = 2.92; 95% CI [1.40, 6.09]) and sick leave prescription (aOR = 1.52; 95% CI [1.10, 2.09]), but physiotherapist referral was less frequent (aOR = 0.55; 95% CI [0.38, 0.82]). Clinical examinations (aOR = 2.75; 95% CI [1.98, 3.80]), imaging (aOR = 1.61; 95% CI [1.02, 2.31]) and medication prescriptions (aOR = 2.34; 95% CI [1.65, 3.30]) were more common in initial consultations, but specialist referral (aOR = 0.16; 95% CI [0.05, 0.47]) or sick leave prescription (aOR = 0.68; 95% CI [0.48, 0.97]) were rarer.

CONCLUSION

Low back pain characteristics could influence healthcare procedures more markedly than patient or general practitioner characteristics.

Sick Leave and Costs in Active Workers with Chronic Osteoarthritis Pain in Spain: Outcomes of the OPIOIDS Real World Study

Purpose

To estimate the number of sick leave days and productivity costs in active workers with osteoarthritis (OA) who initiated opioid treatment for moderate/severe chronic pain in clinical practice in Spain.

Patients and Methods

This is a secondary analysis of the longitudinal, retrospective OPIOIDS study, using electronic medical records (EMR) of patients aged ≥18 years, who started an opioid treatment for moderate/severe chronic OA pain between 2010 and 2015 after treatment failure with ≥1 first-line drugs (acetaminophen, metamizole and/or nonsteroidal anti-inflammatory drugs [NSAIDs]). The number of days of sick leave and productivity costs were analyzed during a follow-up period of 36 months.

Results

A total of 5089 patients with moderate/severe chronic OA pain, aged 56.8 years (standard deviation [SD]: 4.6) (56.6% were female), were analyzed: 73.3% of them started a treatment with weak opioids and 26.7% of them were treated with strong opioids. At 36 months, adherence was 21.0% (strong opioids: 15.4%; weak opioids: 23.0%; p<0.001), and 77% of patients had at least one sick leave related with chronic OA pain, with an average of 93 days off work in all working patients (120.5 days in patients with sick leaves). Besides, 16.9% of the study population had sick leave periods that lasted at least 6 months. Pain reduction was modest (-1.2 points; -4.0%, p<0.001). The cost of sick leave was €2594 patient/year, and factors such as older age (β=0.043), female sex (β=0.036), comorbidities (β=0.035) and strong opioid use (β=0.031) were associated with higher productivity costs (p<0.05 in all associations).

Conclusion

Active workers who started opioid treatment for moderate/severe chronic OA pain showed an increased frequency of sick leave and productivity cost, with a modest effect on pain relief. Older age, female sex, comorbidities, and strong opioids were associated with higher costs for society.

Use of wearable sensors to assess patterns of trunk flexion in young and old workers in the Metalworking Industry

Workers exposed to repeated trunk flexions are at risk of onset of low-back disorders and in individuals aged over 50 this issue is exacerbated by the physiologic decline of the musculoskeletal system and longer lifetime occupational exposure. In this study, we investigated the existence of possible age-related differences in patterns of trunk flexion of workers in the metalworking industry. Thirty-three subjects were monitored during an actual shift using a wearable Inertial Measurement Unit (IMU) to assess trunk flexion angles (i.e. between 30° and 60°, 60°-90° and > 90°). Results show that older workers spent less time with their trunk flexed, regardless of the class of flexion considered, with respect to their younger colleagues. Although further studies are necessary to clarify the existence of strategies aimed at optimising trunk movements during ageing, the IMU-based approach appears useful in highlighting potentially harmful conditions, especially in workers with marked signs of decline in their physical capacities. Practitioner summary: Wearable sensors, which are well tolerated and minimally intrusive, represent a valid option to continuously monitor trunk posture in workers employed in metalworking industry. The results of this study show that they provide valuable information about the patterns of flexion of young and old individuals engaged in physically demanding tasks.

Interventions to Promote Work-Focused Care by Healthcare Providers for Individuals with Musculoskeletal Conditions a Scoping Review

PURPOSE

Building on an emerging body of evidence, this scoping review aimed to provide an overview of current interventions to promote work-focused care by healthcare providers for individuals with musculoskeletal conditions and to identify current knowledge gaps for future research.

METHODS

Literature searches were performed in Pubmed, CINAHL, EMBASE, and PsycInfo using Medical Subject Heading terms and text words relating to musculoskeletal conditions, interventions to promote work-focused care and work-related outcomes. Articles involving any interventions with elements of work-focused care delivered by healthcare providers to manage musculoskeletal conditions were reviewed for suitability and inclusion.

RESULTS

A total of 22 articles (18 intervention trials) were identified. Most studies were multidisciplinary interventions incorporating one or more elements of work-focused care including: work-related assessment to identify barriers to working, vocational advice/coaching or education to address barriers to working, involvement of the workplace stakeholders, restoration of fitness for work and regular communication with multidisciplinary team members. Most studies (61 %) concluded that their interventions achieved the desired work-related outcomes although firm conclusions could not be made regarding the effectiveness of a particular component, content or strategy of work-focused care itself because of the variability in the type and number of elements and outcomes used.

CONCLUSIONS

There is good evidence demonstrating the potential for healthcare providers to improve work outcomes for those with musculoskeletal conditions. Additional training is required to increase confidence in this area of practice. Accepting that work-focused care is important, however, does not diminish the challenge it presents.

Predictors of return to work among women with long-term neck/shoulder and/or back pain: A 1-year prospective study

Background

Sick leave due to musculoskeletal pain, particularly in the neck/shoulders and back, is one of the major public health problems in Western countries such as Sweden. The aim of this study was to identify predictors of return to work (RTW) among women on sick leave due to long-term neck/shoulder and/or back pain.

Methods

This was a prospective cohort study with a 1-year follow-up. The study participants were recruited from a local Swedish Social Insurance Agency register and had all been on sick leave for ≥ 1 month due to long-term (≥ 3 months) neck/shoulder and/or back pain. Data on predictors and outcome were collected using a self-administered questionnaire. A total of 208 women aged 23–64 years were included at baseline, and 141 responded at the 1-year follow-up. Cluster analyses were performed to identify one predictor from each cluster for use in the regression model.

Results

At the 1-year follow-up, 94 of the 141 women had RTW and 47 had not. Women who engaged in more coping through increasing behavioral activities (OR: 1.14, 95% CI: 1.03–1.25) and those who more strongly believed they would return to the same work within 6 months (OR: 1.22, 95% CI: 1.10–1.37) had an increased probability of RTW. Receiving more social support outside work (OR: 0.50, 95% CI: 0.28–0.92) decreased the odds of RTW at the 1-year follow-up.

Conclusions

Behavioral activities, beliefs about returning to the same work, and social support outside work were predictors of RTW at the 1-year follow-up. Healthcare professionals should consider these predictors in their efforts to prevent prolonged sick leave and to promote RTW in this population.

Therapists' experiences and needs with regard to providing work-focused care: a focus group study

BACKGROUND

Musculoskeletal disorders (MSDs) can create a temporary or permanent disability that reduce a person's ability to work. Physiotherapists (PTs), occupational therapists (OTs) and exercise therapists (ETs) are often involved in the early management of MSDs. There is a need for additional insights into therapists' experiences, barriers and needs to work-focused care. Moreover, there is no evidence on how OTs and ETs address work participation. Therefore, the aim of this qualitative study was 1) to investigate how generalist PTs, OTs and ETs provide work-focused healthcare and 2) to obtain insight into their perceived barriers and needs that affect their ability to address occupational factors.

METHODS

An exploratory qualitative study using three focus groups. Generalist PTs, OTs and ETs were eligible to participate if they treated working patients with MSDs. A semi-structured interview guide with open-ended questions was developed. Two moderators facilitated each focus group using the interview guide, and all the groups were audio recorded. Data were analysed using inductive thematic analysis.

RESULTS

Sixteen therapists (mean age 44 years, range 25-59) participated in this study. Participants were aware of the importance of taking occupational factors into account. Whether they address occupational factors is largely dependent on the patient's request for help. However, ETs and OTs consider it normal to ask about occupational factors during the diagnostic process, while PTs often address this in later consultations. Almost all participants were unaware of the existence of PTs, OTs or ETs who are specialised in occupational health. Moreover, almost all participants struggled with when to refer a patient to other (occupational) healthcare professionals. This study identified several needs of therapists. These included knowledge about laws and legislation and skills for identifying and addressing work-related or work-relevant complaints.

CONCLUSIONS

Participants in this qualitative study were aware of the importance of taking occupational factors into account. However, how PTs, OTs and ETs address work participation and the extent to which they do so can be improved. There was a lack of knowledge about and cooperation with occupational health professionals, including PTs, OTs or ETs specialised in occupational health.

Musculoskeletal Disorders' Classification Proposal for Application in Occupational Medicine

Occupational-specific classifications of musculoskeletal disorders (MSD) are scarce and do not answer specific clinical questions. Thus, a specific classification was developed and proposed, covering criteria applicable to daily clinical activity. It was considered that the disorder development process is the same across all work-related MSDs (WRMSDs). Concepts of clinical pathology were applied to the characteristics of WRMSDs pathophysiology, cellular and tissue alterations. Then, the correlation of the inflammatory mechanisms with the injury onset mode was graded into four levels (MSDs 0-3). Criteria of legal, occupational and internal medicine, semiology, physiology and orthopaedics, image medicine and diagnostics were applied. Next, the classification was analysed by experts, two occupational physicians, two physiatrists and occupational physicians and one orthopaedist. This approach will allow WRMSD prevention and improve therapeutic management, preventing injuries from becoming chronic and facilitating communication between occupational health physicians and the other specialities. The four levels tool relate aetiopathogenic, clinical, occupational and radiological concepts into a single classification. This allows for improving the ability to determine a WRMSD and understanding what preventive and therapeutic measures should be taken, avoiding chronicity. The developed tool is straightforward, easy to understand and suitable for WRMSDs, facilitating communication between occupational physicians and physicians from other specialities.

Predicting the duration of sickness absence due to knee osteoarthritis: a prognostic model developed in a population-based cohort in Sweden

Background

Predicting the duration of sickness absence (SA) among sickness absent patients is a task many sickness certifying physicians as well as social insurance officers struggle with. Our aim was to develop a prediction model for prognosticating the duration of SA due to knee osteoarthritis.

Methods

A population-based prospective study of SA spells was conducted using comprehensive microdata linked from five Swedish nationwide registers. All 12,098 new SA spells > 14 days due to knee osteoarthritis in 1/1 2010 through 30/6 2012 were included for individuals 18–64 years. The data was split into a development dataset (70 %, n_spells =8468) and a validation data set (n_spells =3690) for internal validation. Piecewise-constant hazards regression was performed to prognosticate the duration of SA (overall duration and duration > 90, >180, or > 365 days). Possible predictors were selected based on the log-likelihood loss when excluding them from the model.

Results

Of all SA spells, 53 % were > 90 days and 3 % >365 days. Factors included in the final model were age, sex, geographical region, extent of sickness absence, previous sickness absence, history of specialized outpatient healthcare and/or inpatient healthcare, employment status, and educational level. The model was well calibrated. Overall, discrimination was poor (c = 0.53, 95 % confidence interval (CI) 0.52–0.54). For predicting SA > 90 days, discrimination as measured by AUC was 0.63 (95 % CI 0.61–0.65), for > 180 days, 0.69 (95 % CI 0.65–0.71), and for SA > 365 days, AUC was 0.75 (95 % CI 0.72–0.78).

Conclusion

It was possible to predict patients at risk of long-term SA (> 180 days) with acceptable precision. However, the prediction of duration of SA spells due to knee osteoarthritis has room for improvement.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12891-021-04400-8.

Do work ability and life satisfaction matter for return to work? Predictive ability of the work ability index and life satisfaction questionnaire among women with long-term musculoskeletal pain

Background

Impaired work ability and reduced life satisfaction due to long-term musculoskeletal pain, particularly in neck, shoulders and back, are considered occupational health problems that can result in workers taking sick leave. The aim of the study was to determine whether work ability and life satisfaction predict return to work (RTW) among women with long-term neck/shoulder and/or back pain, and to assess the ability of the Work Ability Index (WAI) and the Life Satisfaction Questionnaire (LiSat-11) to discriminate between those who did RTW and those who did not RTW (NRTW).

Methods

This is a cohort study with 1-year follow-up. A survey was sent to 600 women receiving sick leave benefits from the Swedish Social Insurance Agency. In total, 208 women responded at baseline, and 141 at a 1-year follow-up. To identify whether work ability and life satisfaction predicted RTW, multiple logistic regression analyses were performed with and without adjustment for type of work and pain intensity. To assess the discriminative ability of the WAI and the LiSat-11 for women who did RTW and those who did NRTW, receiver operating characteristic curves were fitted.

Results

Work ability predicted RTW, and the results remained significant after adjusting for type of work and pain intensity (OR 1.12, 95% CI: 1.04–1.22). Life satisfaction was not significant. The WAI at baseline adequately discriminated between RTW and NRTW after 1 year (Area under curve 0.78, 95% CI: 0.70–0.86), but the LiSat-11 did not.

Conclusions

This study supports a relationship between work ability and RTW among women on sick leave for long-term neck/shoulder and/or back pain. The results indicate that the WAI, but not the LiSat-11, can discriminate between RTW and NRTW in the population under study. Although the discriminative ability of the WAI needs to be verified in new samples before it can be recommended for use in rehabilitation settings, we suggest that healthcare professionals consider how women perceive their work ability in order to better support them in their RTW.

Trajectory of excess healthcare consultations, medication use, and work disability in newly diagnosed knee osteoarthritis: a matched longitudinal register-based study

PURPOSE

To estimate the excess healthcare use and work disability attributable to knee osteoarthritis (OA) in the first 5 years following diagnosis.

METHODS

Among individual aged 40-80 years who resided in Skåne on 31^st December 2008, we identified those with a main diagnosis of knee OA during 2009-2014 and no previous diagnosis of any OA from 1998 (n = 16,888). We created a comparison cohort matched (1:1) by sex, age, and municipality from individuals with no OA diagnosis (at any site) during 1998-2016. We compared healthcare use and net disability days for 60 months following diagnosis between the two groups. We applied a survival-adjusted regression technique controlling for sociodemographic characteristics as well as pre-diagnosis outcome and comorbidity.

RESULTS

The estimated 5-year incremental effects of knee OA per-patient were 16.8 (95% CI: 15.8, 17.7) healthcare consultations, 0.7 (0.4, 1.1) inpatient days, 420 (372, 490) defined daily dose of prescribed medications, and 21.8 (15.2, 30.0) net disability days. Primary care consultations constituted about 73% of the excess healthcare consultations. Most of these incremental effects occurred in the first year after diagnosis. Better survival in the knee OA group accounted for 0.7 (95% CI: 0.5, 0.8) and 1.4 (0.7, 2.6) of the excess healthcare consultations and net disability days, respectively. Both estimated total and incremental resources use were generally greater for women than men with knee OA.

CONCLUSION

Knee OA was associated with considerable excess healthcare use and work disability independent of pre-diagnosis resources use, comorbidity, and sociodemographic characteristics.

Joint association of physical work demands and leg pain intensity for work limitations due to pain in senior workers: cross-sectional study

Background

Leg pain, especially of the knees and hips, is common among senior workers and may limit the ability to perform physically demanding work. In light of the aging workforce, this study determined the joint association of physical work demands and leg pain intensity for work-limiting pain in senior workers.

Methods

Currently employed senior workers (≥50 years) participated in the SeniorWorkingLife study in 2018 (n = 12,879). Associations between the combination of physical work demands and leg pain intensity (interaction) with work-limiting pain (outcome) were modeled using binary logistic regression analyses while controlling for potential covariates.

Results

We found a significant interaction (P < 0.001) between physical work demands and leg pain intensity for work-limiting pain. The combination of higher physical work demands and higher leg pain intensity had the worst outcome in terms of the odds of experiencing work-limiting pain. For example, 70% of those with the combination of high physical work demands and leg pain intensity ≥7 (scale 0–10) experienced that the pain limited them to at least some degree in their work.

Conclusions

The combination of high physical work demands and high leg pain intensity are associated with limited ability to perform work among senior workers. These findings highlight the importance of prioritizing the physical work environment in physically demanding occupations, particularly among senior workers, for prolonging working life. Thus, adjusting the work demands, e.g. through use of assistive devices, and lowering the pain, e.g. through physical rehabilitation, may be necessary to sustain work ability to a high age in this group of workers.

Trial registration

This was registered as a cohort study in ClinicalTrials.gov (Identifier: NCT03634410) on the 18th of August 2018 (Retrospectively registered).

Predictors of musculoskeletal symptoms in radiology technologists in Austria, Europe

BACKGROUND

Musculoskeletal symptoms (MSS) are a major health problem in health professionals. However, there is very little evidence about predictors of MSS in the group of radiology technologists.

OBJECTIVES

The aim of this study was to identify prevalence and predictors of MSS in radiology technologists working in Austrian Hospitals.

METHODS

272 radiology technologists completed a self-report questionnaire including MSS, work demands, work strain and well-being (WHO-5 questionnaire).

RESULTS

Lower back pain and upper back pain are the most frequent MSS in radiology technologists. A high proportion of participants experience these symptoms every day (20.1% and 19.8%, respectively). Work strain, age and well-being were the best predictors for MSS in a regression model.

CONCLUSIONS

MSS is a major health issue for radiology technologist working in hospitals. Our results provide evidence for the assumption that psychological factors play an important role in development of MSS. Thus, beside physical health promotion programs (e.g. safe patient handling), psychological intervention may have positive effects on MSS.

Risk assessment for prolonged sickness absence due to musculoskeletal disorders: protocol for a prospective cohort study

Background

Musculoskeletal disorders are the leading cause of sickness absence and disability pension in Norway. There is strong evidence that long-term sickness absence due to musculoskeletal disorders are associated with a reduced probability of return to work (RTW). A way to meet the economic and resource-demanding challenges related to individual follow-up of this group is to identify and treat those individuals with a high risk of prolonged sickness. The overall purposes of this project are 1) to determine the most accurate screening tool to identify people at a high risk of prolonged sickness absence due to an musculoskeletal disorder, and 2) to investigate severity of musculoskeletal health, health-related quality-of-life, health care utilization, and costs across different risk profiles in people on sick leave due to a musculoskeletal disorder.

Methods

People older than 18 years of age on sick leave for at least 4 weeks due to a musculoskeletal disorder will be invited to participate in this prospective observational cohort study conducted within the Norwegian Welfare and Labor Administration (NAV) system in collaboration with OsloMet – Oslo Metropolitan University. The main outcome is sickness absence, obtained from the NAV registry. Data on sickness absence will be retrieved prospectively in the period from study inclusion to 12 months follow-up, and retrospectively 12 months before inclusion in the study. Possible risk factors will be self-reported by the participants at inclusion while health care utilization will be retrieved from registry data. To conduct analyses including 15 to 20 predictor variables, we aim at including 500–600 people on sick leave due to musculoskeletal disorders.

Discussion

This study may provide tools that can be used to identify individuals with high risk of prolonged sickness absence and may thus be important from both a socioeconomic and individual perspective. Further, the study may give valuable insight into identification of sickness absence profiles and the associations between these profiles and musculoskeletal health status, health-related quality of life and costs.

Trial registration

Retrospectively registered in ClinicalTrials.gov (NCT04196634, 27.11.2019).

Trajectories of sickness absence and disability pension before and after opioid initiation for noncancer pain: a 10-year population-based study

Chronic noncancer pain is a leading cause of sickness absence (SA) and disability pension (DP). The objectives of this study were to identify trajectories of SA/DP before and after strong and weak opioid initiation for noncancer pain and the factors associated with these trajectories. A longitudinal population-based study of 201,641 people (24-59 years) without cancer who initiated opioid analgesics in 2009 in Sweden was conducted. Trajectories of net annual SA/DP days in the 5 years before/after opioid initiation were estimated with group-based trajectory modelling. Multinomial logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for factors associated with trajectory groups. Among the 6.9% of people initiating strong opioids, 12.5% had persistent high SA/DP (estimated 320 days/year) before and after opioid initiation and 72.9% had persistent low/minimum SA/DP (estimated 30 days/year). Approximately 8.6% of people had increasing SA/DP, and 6.1% had decreasing SA/DP after opioid initiation, although this seemed to reflect continuation of preinitiation patterns. Trajectories were similar at lower SA/DP days/year among those initiating weak opioids. Persistent high SA/DP among strong opioid initiators were associated with ≥5 comorbidities (OR = 8.72, 95% CI 5.61-13.56), ≤9 years of education (OR = 5.83, 95% CI 4.84-7.03), and previous use of antidepressants (OR = 4.57, 95% CI 3.89-5.37) and antipsychotics (OR = 4.49, 95% CI 2.93-6.88). Three-quarters of people initiating opioids for noncancer pain had persistent low/minimum levels of SA/DP 5 years before and after initiation. Increasing and decreasing SA/DP after opioid initiation seemed to reflect a continuation of preinitiation patterns. Our findings highlight the complex range of sociodemographic and medication-related factors associated with persistent SA/DP.

Sickness Certification Behavior amongst Primary Care Physicians: A Descriptive Analysis of Indirect Measures Using the Theory of Planned Behavior

Background

The provision of sick leave to patients in general practice often entails a complex decision-making process. Commonly, general practitioners believe that the act of providing sick leave can become confrontational. We assessed the intention, attitude, subjective norm, and perceived behavioral control of general practitioners in relation to sick leave provision at public health clinics in Malaysia.

Methods

A cross-sectional study design was implemented using data from 86 primary health care clinics in two states in Malaysia from February 2014 to March 2015. A questionnaire that comprised indirect measures were developed on the basis of the Theory of Planned Behavior. The questionnaire assessed several dimensions related to sickness certification provision viz., intention, attitude, subjective norm, and perceived behavioral control.

Results

The mean scores in this study revealed that physicians acknowledged that patient factors such as clinical symptoms (6.59±0.04), debilitating signs and symptoms of diseases (6.45±0.06), importance of illness recovery (6.07±0.07), and approval of employers (5.35±0.09) played an important role in their decision to provide sick leave.

Conclusion

The act of providing sickness certification to patients is a complex decision-making process. The findings of this study can be used to devise a targeted intervention to reduce the conflict that physicians face in issuing sick leaves.

Evaluation of a multimodal pain rehabilitation programme in primary care based on clinical register data: a feasibility study

Aim:

Investigate the feasibility of identifying a well-defined treatment group and a comparable reference group in clinical register data.

Background:

There is insufficient knowledge on how to avert neck/back pain from turning chronic or to impair work ability. The Swedish Government implemented a national multimodal rehabilitation (MMR) programme in primary care intending to promote work ability, reduce sick leave and increase return to work. Since randomised control trial data for effect is lacking, it is important to evaluate existing observational data from clinical settings.

Methods:

We identified all unique patients with musculoskeletal pain (MSP) diagnoses undergoing the MMR programme in primary care in the Skåne Health care Register (n = 2140) during 2010–2011. A reference cohort in primary care (n = 56 300) with similar MSP diagnoses, same ages and the same level of sick leave before baseline was identified for the same period. The reference cohort received ordinary care and treatment in primary care. The final study group consisted of 603 eligible MMR patients and 2874 eligible reference patients. Socio-economic and health-related baseline data including sick leave one year before up to two years after baseline were compared between groups.

Findings:

There were significant socio-economic and health differences at baseline between the MMR and the reference patients, with the MMR group having lower income, higher morbidity and more sick leave days. Sick leave days per year decreased significantly in the MMR group (118–102 days, P < 0.001) and in the reference group (50–42 days, P < 0.001) from one year before baseline to two years after.

Conclusions:

It was not feasible to identify a comparable reference group based on clinical register data. Despite an ambitious attempt to limit selection bias, significant baseline differences in socio-economic and health were present. In absence of randomised trials, effects of MMR cannot be sufficiently evaluated in primary care.

Health, work and demographic factors associated with a lower risk of work disability and unemployment in employees with lower back, neck and shoulder pain

Background

Chronic musculoskeletal pain affects over 20% of the adult population and is one of the most common reasons for sick leave in Sweden. The aim of this study was to investigate which demographic, health and psychosocial work environment factors are of importance for a lower risk of future work disability and unemployment among workers with low back pain (LBP) and/or neck shoulder pain (NSP), and if familial factors influence these associations.

Methods

All 5556 persons that reported having LBP and/or NSP in a web-based questionnaire study in 2004–2006 were included. They were followed up for work disability (sick leave > 90 days or disability pension), and unemployment (> 180 days in a year) until 31 December 2013. Hazard ratios (HR) with 95% confidence intervals were calculated using cox proportional hazard models of the whole sample, adjusting for covariates. In addition, co-twin analyses of outcome discordant twin pairs were conducted to assess the impact of familial confounding on the associations.

Results

Being male, 19–28 years old, having higher education, only NSP, no history of depression or anxiety, good self-rated health, low job demands and high job control were associated with a lower risk of work disability (adjusted HR ranging between 0.29–0.85). No history of anxiety and depression and high job control was associated with a lower risk of unemployment (adjusted HR ranging from 0.53 and 0.67). Familial factors were found to affect the association between education and work disability, but none of the other associations investigated.

Conclusions

Among those with LBP or NSP, good health in terms of mental- and self-rated health, few pain sites, as well as good psychosocial working conditions seem to indicate a lower risk for work disability.

Trajectories of future sickness absence and disability pension days among individuals with a new sickness absence spell due to osteoarthritis diagnosis ≥21 days: a prospective cohort study with 13-month follow-up

INTRODUCTION

Osteoarthritis is one of the most common types of musculoskeletal diagnoses also among working-age populations, and often leads to long-term sickness absence (SA) spells or even disability pension (DP).

THE AIM

was to identify future trajectories of days of SA and/or DP among people with a new SA spell due to osteoarthritis that became ≥21 long, and to investigate sociodemographic and morbidity characteristics of individuals in identified trajectories.

METHODS

This is a prospective population-based cohort study using data from several Swedish registers. We studied future SA/DP among all 4894 individuals aged 16-64 years who, during the first 6 months of 2010, had an incident SA spell due to osteoarthritis (ICD-10 codes M15-19) ≥21 days. Using group-based trajectory modelling, we identified trajectories of mean SA/DP net days/month and 95% CIs for the 13 months from the 21st day of the index SA spell. Sociodemographic and morbidity characteristics were compared by χ² tests and multinomial logistic regression.

RESULTS

We identified five trajectories of SA/DP days: 'fast decrease' (36% of the cohort), 'medium fast decrease' (29%), 'slow decrease' (15%), 'fluctuating' (12%) and 'late decrease' (8%). Individuals in the two trajectories who still had SA/DP days at end of follow-up (late decrease and fluctuating) were more likely to be older, born outside the EU and have indicators of more severe morbidity than those in the other trajectories.

CONCLUSION

Five trajectories of future SA/DP days were identified; 80% of the cohort belonged to trajectories with no SA/DP by the end of follow-up. Identifying trajectories of future SA/DP provides new insights regarding the developments of SA/DP over time among people on SA due to osteoarthritis; not only days in the initial SA spell but also in new spells during follow-up need to be included for a better understanding.

Patient-Reported Outcomes Are More Important Than Objective Inflammatory Markers for Sick Leave in Biologics-Treated Patients With Rheumatoid Arthritis

OBJECTIVE

To study the impact of common noncomposite disease activity measures on sick leave in biologics-treated patients with rheumatoid arthritis (RA).

METHODS

Data from study visits by biologics-treated RA patients of working age (<65 years) in the observational South Swedish Arthritis Treatment Group Register between 2005 and 2011, were included (5,118 visits by 941 patients). We performed association analyses between various noncomposite disease activity measures at each visit and the number of days of sick leave during the subsequent month; this information was retrieved from the Social Insurance Agency. Adjusted separate generalized estimating equation regression models were used, and analyses were stratified according to sick leave status for the month preceding each visit (no, partial, or full sick leave). Results are presented as standardized beta coefficients for comparability.

RESULTS

Among modifiable noncomposite disease activity measures, patient's assessment of pain and disease activity scored on a visual analog scale (VAS) were most strongly associated with subsequent sick leave, irrespective of baseline sick leave status. Generally, measures that were more objective (swollen joint count, erythrocyte sedimentation rate, and C-reactive protein) had less impact on sick leave compared with variables that were more subjective (patient's pain and global scores on a VAS, evaluator's global assessment of disease activity on a 5-grade Likert scale, and tender joint count).

CONCLUSION

Measures of disease activity that are more subjective have a greater impact on sick leave in biologics-treated patients with RA compared with variables that are more objective, suggesting a stronger focus on subjective measures when targeting work loss or intervening to reduce it.

Psychometric testing of a short-form questionnaire for the measurement of health experiences among people with musculoskeletal disorders undergoing multimodal rehabilitation

AIM

The aim of the present study was to assess if a previously suggested short-form questionnaire tested among women with non-specific neck-shoulder pain is suitable also for use among men and women with non-specific musculoskeletal disorders in any part of the body, by testing its construct validity by a confirmatory factor analysis. If not, the secondary aim was to investigate the evolving factor structure when performing an explorative factor analysis of data in the expanded sample.

METHODS

Questionnaire data were collected in three different contexts, in primary care via eight different multimodal rehabilitation teams and in specialised care via two different specialist care centres. The sample consisted of 116 men (n=29) and women (n=87) with non-specific musculoskeletal disorders.Data were analysed using confirmatory and exploratory factor analysis and a visual comparison between the result of the principal component analysis in the present study and the results attained in a previous study with a similar aim and design.

RESULTS

The confirmatory factor analyses did not end up in a model with acceptable measures for validity. Three models were tested, none of them met the criterion for an acceptable model, and the goodness-of-fit statistics were not fully acceptable. The exploratory factor analysis had only partly comparable result compared with previous study.

CONCLUSION

The results of the present study did not prove the suggested short-form questionnaire to be suitable for evaluation of symptoms among men and women with non-specific musculoskeletal disorders in any part of the body. Further studies including larger samples are recommended.

TRIAL REGISTRATION NUMBER

92199001.

More cost-effective management of patients with musculoskeletal disorders in primary care after direct triaging to physiotherapists for initial assessment compared to initial general practitioner assessment

Background

A model for triaging patients in primary care to provide immediate contact with the most appropriate profession to treat the condition in question has been developed and implemented in parts of Sweden. Direct triaging of patients with musculoskeletal disorders (MSD) to physiotherapists at primary healthcare centres has been proposed as an alternative to initial assessment by general practitioners (GPs) and has been shown to have many positive effects. The aim of this study was to evaluate the cost-effectiveness from the societal perspective of this new care-pathway through primary care regarding triaging patients with MSD to initial assessment by physiotherapists compared to standard practice with initial GP assessment.

Methods

Nurse-assessed patients with MSD (N = 55) were randomised to initial assessment and treatment with either physiotherapists or GPs and were followed for 1 year regarding health-related quality of life, utilization of healthcare resources and absence from work for MSD. Quality-adjusted life-years (QALYs) were calculated based on EQ5D measured at 5 time-points. Costs for healthcare resources and production loss were compiled. Incremental cost-effectiveness ratios (ICERS) were calculated. Multiple imputation was used to compensate for missing values and bootstrapping to handle uncertainty. A cost-effectiveness plane and a cost-effectiveness acceptability curve were construed to describe the results.

Results

The group who were allocated to initial assessment by physiotherapists had slightly larger gains in QALYs at lower total costs. At a willingness-to-pay threshold of 20,000 €, the likelihood that the intervention was cost-effective from a societal perspective including production loss due to MSD was 85% increasing to 93% at higher thresholds. When only healthcare costs were considered, triaging to physiotherapists was still less costly in relation to health improvements than standard praxis.

Conclusion

From the societal perspective, this small study indicated that triaging directly to physiotherapists in primary care has a high likelihood of being cost-effective. However, further larger randomised trials will be necessary to corroborate these findings.

Trial registration

ClinicalTrials.gov NCT02218749. Registered August 18, 2014.

A Japanese version of the Patient Attitudes and Beliefs Scale for patients with musculoskeletal disorders

Background: The Patient Attitudes and Beliefs Scale (PABS) is a self-reporting questionnaire with 12 items on a 5-point Likert scale for patient's attitude towards shared decision making but its adaptation into Japanese has not been undertaken. Objectives: To develop a Japanese version of the PABS (PABS-J) through translation into Japanese and evaluation of an appropriate scoring system and unidimensionality using Rasch analysis and test-retest reliability. Design: This study included a cross-cultural validation step and investigations of questionnaire validity and reliability. Method: One-hundred-ten patients with musculoskeletal disorders referred to physiotherapy completed the Japanese draft of the PABS before the initial session of physiotherapy. Seventy-five of the 110 participants completed the PABS twice, on a separate day. Items that violated pre-determined criteria of unidimensionality and test-retest reliability (Quadratic-weighted κ ≦ 0.4) were removed. Further, the 110 participants identified one of the four stages of readiness towards shared decision making and correlation with the score of the PABS-J was preliminarily investigated as concurrent validity. Results/Findings: Rasch analysis confirmed unidimensionality of six items and appropriateness of a 3-point scale. Moderate test-retest reliability of the PABS-J was detected (Intra-class correlation coefficient = 0.70). A statistically significant and positive but weak correlation between the PABS-J scores and the four stages of readiness towards shared decision making was detected (ρ = 0.20, P = 0.03). Conclusions: The current study demonstrated partial validity and reliability of the PABS-J with six items and 3-point scale. This questionnaire will be a foundation for further investigations attitude towards shared decision making.

Factors related to work ability and well-being among women on sick leave due to long-term pain in the neck/shoulders and/or back: a cross-sectional study

BACKGROUND

Musculoskeletal pain is one of the leading causes of sick leave, especially among women, in Western countries. The aim of the present study was to identify factors associated with work ability and well-being, respectively, among women on sick leave due to long-term pain in the neck/shoulders and/or back.

METHODS

A cross-sectional study with a correlational design was conducted on women who were sick-listed due to long-term pain in the neck/shoulders and/or back. A total of 208 participants responded to a survey comprising eight instruments: Multidimensional Pain Inventory scale, General Self-Efficacy scale, Sense of Coherence scale, Coping Strategies Questionnaire, Demand-Control-Support Questionnaire, Hospital Anxiety and Depression Scale, Work Ability Index and Life Satisfaction questionnaire. Multiple linear regression analyses were performed to identify factors associated with work ability and well-being, respectively.

RESULTS

Women who more strongly believed they would return to the same work had greater work ability (β = 0.39, p < 0.001), whereas women with higher pain intensity (β = - 0.30, p < 0.001) and higher job strain (β = - 0.12, p < 0.05) had lower work ability. Women with higher self-efficacy rated greater well-being (β = 0.14, p < 0.05). As the women's scores for depression increased, their well-being decreased by 48%, which was statistically significant (p < 0.001). The regression models for work ability and well-being were significant (p < 0.001), and their adjusted R- square values were 48% and 59%, respectively.

CONCLUSIONS

The study suggests that the factors beliefs to be back at the same work, pain intensity and job strain are predictive of work ability. Moreover, the factors self-efficacy and depression seem to be predictive of well-being. The findings highlight factors that should be considered by health care professionals and policy-makers to guide attempts to reduce sick leave.

Sickness absence due to different musculoskeletal diagnoses by occupational class: a register-based study among 1.2 million Finnish employees

Objectives

Those in lower occupational classes have an increased risk of sickness absence due to musculoskeletal diseases (MSDs), but studies examining the associations simultaneously across specified diagnostic groups within MSDs are lacking. We examined occupational class differences in the occurrence and length of long-term sickness absence due to different musculoskeletal diagnoses.

Methods

A 70% random sample of employed Finns aged 25–64 years old at the end of 2013 was linked to data on sickness absence of over 10 working days obtained from The Social Insurance Institution of Finland and occupational class from Statistics Finland. Sickness absences due to MSDs initiated in 2014 were followed until the end of each episode for female (n=675 636) and male (n=604 715) upper non-manuals, lower non-manuals and manual workers. Negative binomial hurdle models were used to analyse the associations.

Results

Within the studied MSDs, the most common causes of absence were back disorders, particularly back pain, and shoulder disorders. Osteoarthritis, disc disorders and rheumatoid arthritis induced the longest episodes of absence. Clear hierarchical class differences were found throughout, but the magnitude of the differences varied across the diagnostic causes. The largest class differences in the occurrence were detected in shoulder disorders and back pain. The class differences in length were greatest in rheumatoid arthritis, disc disorders and, among men, also in hip osteoarthritis.

Conclusions

Hierarchical occupational class differences were found across different MSDs, with large differences in back and shoulder disorders. Occupational class and diagnosis should be considered when attempting to reduce sickness absence due to MSDs.

Assessing predictors of intention to prescribe sick leave among primary care physicians using the theory of planned behaviour

Background

Providing sickness certification is a decision that primary care physicians make on a daily basis. The majority of sickness certification studies in the literature involve a general assessment of physician or patient behaviour without the use of a robust psychological framework to guide research accuracy. To address this deficiency, this study utilized the Theory of Planned Behaviour (TPB) to specifically gauge the intention and other salient predictors related to sickness certification prescribing behaviour amongst primary care physicians.

Methods

A cross-sectional study was conducted among N = 271 primary care physicians from 86 primary care practices throughout two states in Malaysia. Questionnaires used were specifically developed based on the TPB, consisting of both direct and indirect measures related to the provision of sickness leave. Questionnaire validity was established through factor analysis and the determination of internal consistency between theoretically related constructs. The temporal stability of the indirect measures was determined via the test-retest correlation analysis. Structural equation modelling was conducted to determine the strength of predictors related to intentions.

Results

The mean scores for intention to provide patients with sickness was low. The Cronbach α value for the direct measures was good: overall physician intent to provide sick leave (0.77), physician attitude towards prescribing sick leave for patients (0.77) and physician attitude in trusting the intention of patients seeking sick leave (0.83). The temporal stability of the indirect measures of the questionnaire was satisfactory with significant correlation between constructs separated by an interval of two weeks (p < 0.05). Attitudes and subjective norms were identified as important predictors in physician intention to provide sick leave to patients.

Conclusion

An integrated behavioural model utilizing the TPB could help fully explain the complex act of providing sickness leave to patients. Findings from this study could assist relevant agencies to facilitate the creation of policies that may help regulate the provision of sickness leave and alleviate the work burden of sickness leave tasks faced by physicians in Malaysia.

Electronic supplementary material

The online version of this article (10.1186/s12875-017-0690-5) contains supplementary material, which is available to authorized users.

Effectiveness, costs and cost-effectiveness of chiropractic care and physiotherapy compared with information and advice in the treatment of non-specific chronic low back pain: study protocol for a randomised controlled trial

Background

Low back pain is a global public health problem and a leading cause of disability all over the world. The lifetime prevalence of low back pain is 70–80% and a significant proportion of people affected develop chronic low back pain (CLBP). Besides a severe negative impact on people’s health and health-related quality of life, CLBP is associated with substantial costs for society. Medical costs for the management of CLBP and costs for production losses due to absenteeism from work are sizeable. Pharmaceuticals, physical activity, manipulation, and multidisciplinary rehabilitation interventions are examples of widely used treatments for CLBP. However, the scientific basis to recommend the use of one treatment over another is limited and more research is needed to study the effects, costs and cost-effectiveness of treatments for CLBP in clinical practice.

The aim of the study is to evaluate the effectiveness (back pain-related functional limitation, back pain intensity, general health, health-related quality of life, and working status), costs (medical costs and costs for production losses) and cost-effectiveness of chiropractic care and physiotherapy when added to information and advice in the treatment of patients with non-specific CLBP in Sweden.

Methods/design

This is a pragmatic randomised controlled trial, where participants are recruited through six primary care rehabilitation units (PCRUs) in Stockholm County Council, Sweden. Individuals with non-specific CLBP are individually randomised to one of four treatment groups: ‘information and advice’; ‘physiotherapy, and information and advice’; ‘chiropractic care, and information and advice’; or ‘chiropractic care, physiotherapy, and information and advice’. A sample size of 600 participants will be recruited during a period of 33 months. A computer-based questionnaire is used to collect data on back pain-related functional limitation (Oswestry Disability Index), pain intensity (Numeric Rating Scale), general health (self-rated health), health-related quality of life (EQ-5D-3L), and working status (measured as percentage of full-time work). Data will be collected at baseline, and at 3, 6, and 12 months after baseline.

Discussion

The results from our study should be considered when producing evidence-based guidelines and recommendations on which treatment strategies to use for CLBP.

Trial registration

ISRCTN registry, ID: ISRCTN15830360. Registered prospectively on 2 February 2017.

Electronic supplementary material

The online version of this article (doi:10.1186/s13063-017-2351-3) contains supplementary material, which is available to authorized users.

Understanding Occupation, Sick Leave, and Disability Pension Due to Knee and Hip Osteoarthritis From a Sex Perspective

OBJECTIVE

To investigate the association between occupation and risk for sick leave or disability pension due to knee or hip osteoarthritis (OA) from a sex perspective.

METHODS

We conducted a population-based study including residents ages 40-70 years in the Skåne region, Sweden (2007) and working in the included job sectors (n = 165,179). We retrieved data on cause-specific sick leave and disability pension (2007-2012) and linked to individual information on occupation and education (2007). Occupations were classified into job sectors. We calculated sex-specific, age-adjusted odds ratios (ORs) of sick leave and disability pension due to OA in traditionally female-dominated job sectors (health care, child care, and cleaning) and traditionally male-dominated job sectors (construction, farming, metal work, or transportation) compared to business and administration.

RESULTS

Of all eligible subjects, 2,445 had sick leave or disability pension due to knee or hip OA. Adjusted for age, the risk of sick leave due to knee OA was increased for women working in health care, with an OR of 3.3 (95% confidence interval [95% CI] 2.6-4.2), child care OR 2.9 (95% CI 2.2-3.8), and cleaning OR 3.0 (95% CI 2.2-4.1), as was the risk for disability pension. The risk was increased also for persons working in occupations with higher educational requirements. The risk was similarly increased in male-dominated sectors. In female-dominated job sectors the risk of sick leave and disability pension due to knee OA, but not hip OA, was higher than that for other musculoskeletal diseases.

CONCLUSION

Traditionally female-dominated occupational sectors are associated with an increased risk of sick leave and disability pension due to knee OA.

Predictors of work disability after start of anti-TNF therapy in a national cohort of Swedish patients with rheumatoid arthritis: does early anti-TNF therapy bring patients back to work?

OBJECTIVES

To examine predictors of work ability gain and loss after anti-tumour necrosis factor (TNF) start, respectively, in working-age patients with rheumatoid arthritis (RA) with a special focus on disease duration.

METHODS

Patients with RA, aged 19-62 years, starting their first TNF inhibitor 2006-2009 with full work ability (0 sick leave/disability pension days during 3 months before bio-start; n=1048) or no work ability (90 days; n=753) were identified in the Swedish biologics register (Anti-Rheumatic Treatment In Sweden, ARTIS) and sick leave/disability pension days retrieved from the Social Insurance Agency. Outcome was defined as work ability gain ≥50% for patients without work ability at bio-start and work ability loss ≥50% for patients with full work ability, and survival analyses conducted. Baseline predictors including disease duration, age, sex, education level, employment, Health Assessment Questionnaire, Disease Activity Score 28 and relevant comorbidities were estimated using Cox regression.

RESULTS

During 3 years after anti-TNF start, the probability of regaining work ability for totally work-disabled patients was 35% for those with disease duration <5 years and 14% for disease duration ≥5 years (adjusted HR 2.1 (95% CI 1.4 to 3.2)). For patients with full work ability at bio-start, disease duration did not predict work ability loss. Baseline disability pension was also a strong predictor of work ability gain after treatment start.

CONCLUSIONS

A substantial proportion of work-disabled patients with RA who start anti-TNF therapy regain work ability. Those initiating treatment within 5 years of symptom onset have a more than doubled 3-year probability of regaining work ability compared with later treatment starts. This effect seems largely due to the impact of disease duration on disability pension status.

Work outcome in persons with musculoskeletal diseases: comparison with other chronic diseases & the role of musculoskeletal diseases in multimorbidity

Background

Chronic diseases and multimorbidity are increasingly common among persons in working age. This study explores the impact of type, number and combinations of chronic diseases with focus on the role of MSKD on (1) adverse work status (i.e. work disability (WD), economic unemployment (UE) or receiving a living allowance (LA)) and on (2) the occurrence of sick leave.

Methods

Subjects participating in a Dutch household survey, who were ≤65 years and could have paid work, provided data on socio-demographics and nine physician diagnosed chronic diseases. To explore the independent association of each chronic disease, of multimorbidity and of MSKD in context of multimorbidity with 1) work status (employed, WD, LA, UE) and 2) sick leave (SL) in those employed, multinomial logistic regressions and logistic regressions were used, respectively.

Results

Among 5396 subjects, MSKD was the most common morbidity (17%), multimorbidity occurred in 755/5396 (14%), 436/755 (61%) of subjects with multimorbidity had an MSKD. For MSKD the odds of WD, LA and UE were 2.06 [95% CI 1.56;2.71], 2.15[1.18;3.91] and 1.35[0.94;1.96], respectively, compared to being employed and the odds of SL in MSKD were 2.29[1.92;2.73]. Mental diseases had a stronger impact on all these outcomes. The odds for adverse work outcomes increased strongly with an increasing number of diseases. When an MSKD was part of multimorbidity, an additional impact on the association with WD and SL was observed.

Conclusions

Multimorbidity has a stronger impact on all work outcomes compared to single chronic diseases. The presence of the MSKD in the context of multimorbidity amplifies the chance of WD or SL.

Electronic supplementary material

The online version of this article (doi:10.1186/s12891-016-1365-4) contains supplementary material, which is available to authorized users.

Costs in Relation to Disability, Disease Activity, and Health-related Quality of Life in Rheumatoid Arthritis: Observational Data from Southern Sweden

Objective.

To compare how costs relate to disability, disease activity, and health-related quality of life (HRQOL) in rheumatoid arthritis (RA).

Methods.

Antitumor necrosis factor (anti-TNF)-treated patients with RA in southern Sweden (n = 2341) were monitored 2005–2010. Health Assessment Questionnaire (HAQ), 28-joint Disease Activity Score (DAS28), and EQ-5D scores were linked to register-derived costs of antirheumatic drugs (excluding anti-TNF agents), patient care, and work loss from 30 days before to 30 days after each visit (n = 13,289). Associations of HAQ/DAS28/EQ-5D to healthcare (patient care and drugs) and work loss costs (patients < 65 yrs) were studied in separate regression models, comparing standardized β coefficients by nonparametric bootstrapping to assess which measure best reflects costs. Analyses were conducted based on both individual means (linear regression, comparing between-patient associations) and by generalized estimating equations (GEE), using all observations to also account for within-patient associations of HAQ/DAS28/EQ-5D to costs.

Results.

Regardless of the methodology (linear or GEE regression), HAQ was most closely related to both cost types, while work loss costs were also more closely associated with EQ-5D than DAS28. The results of the linear models for healthcare costs were standardized β = 0.21 (95% CI 0.15–0.27), 0.16 (0.11–0.21), and –0.15 (−0.21 to −0.10) for HAQ/DAS28/EQ-5D, respectively (p < 0.05 for HAQ vs DAS28/EQ-5D). For work loss costs, the results were standardized β = 0.43 (95% CI 0.39–0.48), 0.27 (0.23–0.32), and −0.34 (−0.38 to −0.29) for HAQ/DAS28/EQ-5D, respectively (p < 0.05 for HAQ vs DAS28/EQ-5D and for EQ-5D vs DAS28).

Conclusion.

Overall, HAQ disability is a better marker of RA costs than DAS28 or EQ-5D HRQOL.

Does disease activity at start of biologic therapy influence work-loss in RA patients?

OBJECTIVE

To compare work-loss in RA patients starting their first biologic with high vs moderate disease activity.

METHODS

We identified all RA patients aged 20-63 years in the Swedish Biologics Register who started their first biologic 2007-09 with high disease activity (DAS28 >5.1; n = 868) or moderate disease activity (DAS28 3.2-5.1; n = 854). Work days lost, defined as sick leave and disability pension days from the Swedish Social Insurance Agency, were assessed over 5 years after first bio-start. We estimated between-group mean differences adjusted for age, sex, calendar year, education level, disease duration, comorbidities and work-loss the month before bio-start.

RESULTS

During 5 years after anti-TNF start, mean monthly work days lost declined from 16.0 to 9.2 (42%; P < 0.001) in patients with high disease activity at baseline and from 12.0 to 7.2 (40%; P < 0.001) in patients with moderate disease activity, with no between-group difference (adjusted mean difference 0.81; 95% CI - 0.44, 2.05). Accumulated 5-year work-loss was, however, higher in the high activity group (724 vs 548 days; adjusted mean difference 70; 95% CI 20, 120), but after stratification on baseline disability pension status, no differences in accumulated work-loss were detected.

CONCLUSION

Substantial work-loss was seen in both patients with high and patients with moderate disease activity at anti-TNF start, with a 5-year decline in mean monthly work days lost by ∼40% in both groups and no between-group difference. Accumulated work-loss over 5 years was higher in the high-activity group, which may be explained by differences in baseline disability pension status.