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Alyousef YS, Johnston V, Mellor R, Plinsinga ML, Zerguine H, Smith MD. The effect of lower limb osteoarthritis on work-related outcomes: a systematic review and meta-analysis. Disabil Rehabil 2024; 46:3792-3801. [PMID: 37740531 DOI: 10.1080/09638288.2023.2259304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 08/29/2023] [Accepted: 09/10/2023] [Indexed: 09/24/2023]
Abstract
PURPOSE Lower limb osteoarthritis (OA) is a prevalent condition that has a profound impact on an individual's life in several domains, including occupational activities. The objective of this study was to systematically describe and compare work-related outcomes (e.g., employment status, absenteeism, and productivity loss) in individuals with and without lower limb OA. MATERIALS AND METHODS Five databases were searched until 17 June 2023. Studies were eligible for inclusion if they compared work-related outcomes between individuals with lower limb OA and healthy controls (e.g., people without OA or the general population). RESULTS Seven studies met the inclusion criteria of which two were included in a meta-analysis. Meta-analysis revealed that individuals with OA were less frequently in paid employment than control individuals (odds ratio: 0.25; 95% confidence intervals: 0.12, 0.53). Evidence from single studies indicated greater absenteeism and presenteeism and poorer functional capacity in people with lower limb OA compared to controls. CONCLUSIONS This systematic review suggests that individuals with lower limb OA have poorer work-related outcomes than those without OA. Low study numbers and lack of consistency in the way work outcomes are defined and measured make accurate quantification of the impact of OA on work challenging.Prospero: registration number: CRD42020178820.
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Affiliation(s)
- Yousef S Alyousef
- School of Health and Rehabilitation Sciences, Physiotherapy, The University of Queensland, Brisbane, QLD, Australia
- College of Applied Medical Sciences, Majmaah University, Al Majma'ah, Saudi Arabia
| | - Venerina Johnston
- School of Health and Rehabilitation Sciences, Physiotherapy, The University of Queensland, Brisbane, QLD, Australia
- School of Health and Medical Sciences, University of Southern Queensland, Ipswich, QLD, Australia
| | - Rebecca Mellor
- School of Health and Rehabilitation Sciences, Physiotherapy, The University of Queensland, Brisbane, QLD, Australia
- Gallipoli Medical Research Foundation, Greenslopes Private Hospital, Greenslopes, QLD, Australia
| | - Melanie L Plinsinga
- School of Health and Rehabilitation Sciences, Physiotherapy, The University of Queensland, Brisbane, QLD, Australia
- School of Health Sciences and Social Work, Menzies Health Institute Queensland, Griffith University, Brisbane and Gold Coast, QLD, Australia
| | - Haroun Zerguine
- School of Health and Rehabilitation Sciences, Physiotherapy, The University of Queensland, Brisbane, QLD, Australia
| | - Michelle D Smith
- School of Health and Rehabilitation Sciences, Physiotherapy, The University of Queensland, Brisbane, QLD, Australia
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Badley EM, Zahid S, Wilfong JM, Perruccio AV. Labor Force Participation in Adults With Osteoarthritis or Joint Symptoms Typical of Osteoarthritis: Findings From a Canadian Longitudinal Study on Aging. Arthritis Care Res (Hoboken) 2024. [PMID: 38965694 DOI: 10.1002/acr.25398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 06/14/2024] [Accepted: 07/25/2024] [Indexed: 07/06/2024]
Abstract
OBJECTIVE The purpose of the study is to examine the relationship between osteoarthritis (OA) and joint symptoms typical of OA and labor force participation. METHODS Data are from the baseline questionnaire of the Canadian Longitudinal Study on Aging for respondents aged 45 to 74 years at baseline (n = 24,427). Individuals were categorized into one of five mutually exclusive arthritis status groups: diagnosed OA, diagnosed other type of arthritis, two to three symptomatic joint sites and no diagnosed arthritis, one symptomatic joint site and no diagnosed arthritis, and no arthritis and no joint symptoms. Age-stratified robust log-Poisson regression analysis was used to examine the association between arthritis status and labor force participation. RESULTS Overall, 39% of the analytic sample reported being out of the labor force. Those with OA aged 45 to 54 and 55 to 64 years were significantly more likely to be out of the labor force than those with no arthritis or no joint symptoms, with prevalence ratios (PRs) of 1.34 (95% confidence interval [CI] 1.10-1.65) and 1.13 (95% CI 1.06-1.21), respectively, with similar results for those with two to three joint symptoms and no OA in the 45 to 54 years age group (PR 1.37 [95% CI 1.07-1.76]). There was no difference for those aged 65 to 74 years. Being an informal caregiver increased the likelihood of nonparticipation in the labor force for those aged 55 to 64 years (PR 1.09 [95% CI 1.04-1.15]). CONCLUSION Our results suggest that an exclusive reliance on an OA diagnosis to understand impact on labor force participation may miss a large segment of the middle-aged population, which may have undiagnosed OA or be at greater risk of OA because of joint problems.
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Affiliation(s)
- Elizabeth M Badley
- Schroeder Arthritis Institute, Krembil Research Institute, Arthritis Community Research and Epidemiology Unit, and University of Toronto, Toronto, Ontario, Canada
| | - Shatabdy Zahid
- Arthritis Community Research and Epidemiology Unit, Toronto, Ontario, Canada
| | - Jessica M Wilfong
- Schroeder Arthritis Institute, Krembil Research Institute, and Arthritis Community Research and Epidemiology Unit, Toronto, Ontario, Canada
| | - Anthony V Perruccio
- Schroeder Arthritis Institute, Krembil Research Institute, Arthritis Community Research and Epidemiology Unit, and University of Toronto, Toronto, Ontario, Canada
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Alyousef YS, Johnston V, Smith MD. Work-related interventions are not commonly included in physiotherapy management of lower limb osteoarthritis: A cross-sectional survey of Australian Physiotherapists. Musculoskelet Sci Pract 2024; 71:102942. [PMID: 38507868 DOI: 10.1016/j.msksp.2024.102942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 03/10/2024] [Accepted: 03/12/2024] [Indexed: 03/22/2024]
Abstract
BACKGROUND Lower limb osteoarthritis (OA) is a leading cause of disability and can affect an individual's ability to work. OBJECTIVES To explore Australian physiotherapists' use of work-related interventions in managing patients with lower limb OA, and identify current management practices. METHODS Physiotherapists with at least two years of experience treating patients with lower limb OA were invited to complete an online survey to understand how physiotherapists manage patients with lower limb OA, specifically regarding interventions related to work. RESULTS A total of 132 physiotherapists completed the survey. In free text responses, only 1.5% and 2.3% of physiotherapists nominated work-related items in their key components of treatment or educational topics discussed with patients with lower limb OA, respectively. From a range of work-related activities presented, over half of physiotherapists indicated they regularly/always provided education about the benefits of remaining in work (63.5%) and advice on managing symptoms at work (57.4%). Less than 10% of physiotherapists regularly/always used a validated scale to identify barriers for work (9.6%), discussed absences from work (9.6%), conducted a workplace assessment (4.4%), and discussed submitting workers' compensation claims (2.6%). Exercise and patient education were the most frequently nominated physiotherapy treatments in free text (96.2% and 86.3%, respectively) and fixed response (99.2% and 93.9%, respectively) questions. CONCLUSION Many physiotherapists do not address work-related activities in their management of patients with lower limb OA. In light of work-related challenges commonly experienced by individuals with lower limb OA, this is an important aspect of management of this condition.
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Affiliation(s)
- Yousef S Alyousef
- The University of Queensland, School of Health and Rehabilitation Sciences, Physiotherapy, Brisbane, QLD, Australia; Majmaah University, College of Applied Medical Sciences, Al Majma'ah, Saudi Arabia
| | - Venerina Johnston
- The University of Queensland, School of Health and Rehabilitation Sciences, Physiotherapy, Brisbane, QLD, Australia; University of Southern Queensland, School of Health and Medical Sciences, Ipswich, QLD, Australia
| | - Michelle D Smith
- The University of Queensland, School of Health and Rehabilitation Sciences, Physiotherapy, Brisbane, QLD, Australia.
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Alyousef YS, Johnston V, Smith MD. Work-related outcomes in individuals with and without lower limb osteoarthritis: an online survey. BMC Public Health 2023; 23:1885. [PMID: 37773119 PMCID: PMC10540324 DOI: 10.1186/s12889-023-16723-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 09/08/2023] [Indexed: 09/30/2023] Open
Abstract
OBJECTIVE While osteoarthritis (OA) affects people who are still participating in the workforce, there is limited data about the impact of OA on work. The aim of this study was to compare work participation in individuals with and without lower limb OA. METHODS This cross-sectional study included workers with (n = 124) and without (n = 106) lower limb OA. Work participation was assessed as work status (full/part time work), work ability (Work Ability Index (WAI)), absenteeism and presenteeism (World Health Organization's Health and Work Performance Questionnaire (WHO-HPQ)), and perceived difficulties meeting work demands (Work Role Functioning Questionnaire (WRFQ)). The data were analyzed using an analysis of covariance with age, body mass index and physical job demands included as covariates. RESULTS Work ability was poorer (p < 0.001) and loss of work performance (p < 0.001) was higher among workers with OA than healthy controls. There was no statistical difference in absenteeism or overall ability to meet work demands between participants with and without lower limb OA. However, workers with lower limb OA had more difficulty with work scheduling demands (p = 0.05) and physical demands (p = 0.003) than healthy workers. CONCLUSION Lower limb OA was associated with poorer work ability, loss of work performance and difficulty in meeting physical and work scheduling demands. Health professionals and employers should consider these challenges when managing individuals with lower limb OA and supporting them to remain in the workforce.
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Affiliation(s)
- Yousef S Alyousef
- The University of Queensland, School of Health and Rehabilitation Sciences, Physiotherapy, Brisbane, QLD, Australia
- College of Applied Medical Sciences, Majmaah University, Al Majmaah, Saudi Arabia
| | - Venerina Johnston
- College of Applied Medical Sciences, Majmaah University, Al Majmaah, Saudi Arabia
- School of Health and Medical Sciences, University of Southern Queensland, Ipswich, QLD, Australia
| | - Michelle D Smith
- College of Applied Medical Sciences, Majmaah University, Al Majmaah, Saudi Arabia.
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Alanazi SA, Vicenzino B, Maclachlan LR, Smith MD. "It's like a nail being driven in the ankle": A qualitative study of individuals' lived experiences to inform a core domain set for ankle osteoarthritis. Musculoskelet Sci Pract 2023; 66:102813. [PMID: 37421757 DOI: 10.1016/j.msksp.2023.102813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 05/29/2023] [Accepted: 06/19/2023] [Indexed: 07/10/2023]
Abstract
OBJECTIVES Explore individuals' lived experience with ankle osteoarthritis and to identify health-related domains for ankle osteoarthritis based on the perspectives of people living with the condition, as an initial step to address the International Foot and Ankle Osteoarthritis Consortium's recommendation to develop a core domain set for ankle osteoarthritis. METHODS A qualitative study using semi-structured interviews was conducted. Interviews were undertaken with individuals with symptomatic ankle osteoarthritis who were aged ≥35 years. Interviews were recorded, transcribed verbatim and thematically analysed. RESULTS Twenty-three individuals (16 females; mean (range) age 62 (42-80) years) were interviewed. Five themes were identified: pain, often severe, is a central feature of living with ankle osteoarthritis; stiffness and swelling are key symptoms; ankle osteoarthritis induced mobility impairments compromise enjoyment in life; ankle osteoarthritis instability and balance impairments lead to concerns about falling; there are financial implications of living with ankle osteoarthritis. We propose 17 domains based on individuals' experiences. CONCLUSION Study findings indicate that individuals with ankle osteoarthritis live with chronic ankle pain, stiffness and swelling which affect their ability to participate in physical, and social activities, maintain an active lifestyle, and work in physical occupations. From the data, we propose 17 domains that are important to people with ankle osteoarthritis. These domains require further evaluation to ascertain their inclusion in a core domain set for ankle osteoarthritis.
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Affiliation(s)
- Sultan Ayyadah Alanazi
- The University of Queensland, School of Health and Rehabilitation Sciences, Physiotherapy, Brisbane, QLD, 4072, Australia; Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Majmaah University, Majmaah, 11952, Kingdom of Saudi Arabia. https://twitter.com/PTsultan_
| | - Bill Vicenzino
- The University of Queensland, School of Health and Rehabilitation Sciences, Physiotherapy, Brisbane, QLD, 4072, Australia. https://twitter.com/Bill_Vicenzino
| | - Liam R Maclachlan
- The University of Queensland, School of Health and Rehabilitation Sciences, Physiotherapy, Brisbane, QLD, 4072, Australia. https://twitter.com/LiamRobMac
| | - Michelle D Smith
- The University of Queensland, School of Health and Rehabilitation Sciences, Physiotherapy, Brisbane, QLD, 4072, Australia.
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Mew L, Heaslip V, Immins T, Wainwright T. What Is Important to the Younger Person (≤50 Years) When Having a Total Hip Arthroplasty: A Systematic Literature Review. Orthop Nurs 2023; 42:213-229. [PMID: 37494902 PMCID: PMC10405792 DOI: 10.1097/nor.0000000000000955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/28/2023] Open
Abstract
Total hip arthroplasties (THAs) are usually performed in older patients. Despite a growing number of THAs in younger adults, it is unclear whether they have similar priorities in recovery compared with their older counterparts. The purpose of this systematic review was to explore younger patients' priorities when undergoing a THA. Multiple databases were searched in September 2021 prioritizing qualitative data. This review was reported using the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Of 14,495 articles screened, nine remained for analysis. Four common themes were discovered: improving function and mobility; pain; relationships; and patient expectations and education. However, there was insufficient information to clarify whether these themes could be attributed directly to younger adults undergoing a THA. The absence of research on THA patients younger than 50 years results in the loss of the voices of these patients. Further research is essential to ensure their needs are identified, addressed, and met.
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Affiliation(s)
- Louise Mew
- Correspondence: Louise Mew, BSc, Research and Development Department, Academic Centre, Milton Keynes University Hospital, Standing Way, Milton Keynes, MK6 5LD, United Kingdom ()
| | - Vanessa Heaslip
- Louise Mew, BSc, Milton Keynes University Hospital, Milton Keynes, Buckinghamshire, United Kingdom
- Vanessa Heaslip, PhD, Department of Nursing Science, Faculty of Health and Social Sciences, Bournemouth University, Bournemouth, United Kingdom; and Department of Social Work, Stavanger University, Stavanger, Norway
- Tikki Immins, MSc, Orthopaedic Research Institute, Bournemouth University, Bournemouth, United Kingdom
- Thomas Wainwright, PhD, Orthopaedic Research Institute, Bournemouth University, Bournemouth, United Kingdom; and Physiotherapy Department, University Hospitals Dorset NHS Foundation Trust, Poole, United Kingdom
| | - Tikki Immins
- Louise Mew, BSc, Milton Keynes University Hospital, Milton Keynes, Buckinghamshire, United Kingdom
- Vanessa Heaslip, PhD, Department of Nursing Science, Faculty of Health and Social Sciences, Bournemouth University, Bournemouth, United Kingdom; and Department of Social Work, Stavanger University, Stavanger, Norway
- Tikki Immins, MSc, Orthopaedic Research Institute, Bournemouth University, Bournemouth, United Kingdom
- Thomas Wainwright, PhD, Orthopaedic Research Institute, Bournemouth University, Bournemouth, United Kingdom; and Physiotherapy Department, University Hospitals Dorset NHS Foundation Trust, Poole, United Kingdom
| | - Thomas Wainwright
- Louise Mew, BSc, Milton Keynes University Hospital, Milton Keynes, Buckinghamshire, United Kingdom
- Vanessa Heaslip, PhD, Department of Nursing Science, Faculty of Health and Social Sciences, Bournemouth University, Bournemouth, United Kingdom; and Department of Social Work, Stavanger University, Stavanger, Norway
- Tikki Immins, MSc, Orthopaedic Research Institute, Bournemouth University, Bournemouth, United Kingdom
- Thomas Wainwright, PhD, Orthopaedic Research Institute, Bournemouth University, Bournemouth, United Kingdom; and Physiotherapy Department, University Hospitals Dorset NHS Foundation Trust, Poole, United Kingdom
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Ching A, Prior Y, Parker J, Hammond A. Biopsychosocial, work-related, and environmental factors affecting work participation in people with Osteoarthritis: a systematic review. BMC Musculoskelet Disord 2023; 24:485. [PMID: 37312111 DOI: 10.1186/s12891-023-06612-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 06/07/2023] [Indexed: 06/15/2023] Open
Abstract
PURPOSE Osteoarthritis (OA) causes pain and disability, with onset often during working age. Joint pain is associated with functional difficulties and may lead to work instability. The aims of this systematic review are to identify: the impact of OA on work participation; and biopsychosocial and work-related factors associated with absenteeism, presenteeism, work transitions, work impairment, work accommodations, and premature work loss. METHODS Four databases were searched, including Medline. The Joanna Briggs Institute Critical Appraisal tools were used for quality assessment, with narrative synthesis to pool findings due to heterogeneity of study designs and work outcomes. RESULTS Nineteen studies met quality criteria (eight cohort; 11 cross-sectional): nine included OA of any joint(s), five knee-only, four knee and/or hip, and one knee, hip, and hand OA. All were conducted in high income countries. Absenteeism due to OA was low. Presenteeism rates were four times greater than absenteeism. Performing physically intensive work was associated with absenteeism, presenteeism, and premature work loss due to OA. Moderate-to-severe joint pain and pain interference were associated with presenteeism, work transition, and premature work loss. A smaller number of studies found that comorbidities were associated with absenteeism and work transitions. Two studies reported low co-worker support was associated with work transitions and premature work loss. CONCLUSIONS Physically intensive work, moderate-to-severe joint pain, co-morbidities, and low co-worker support potentially affects work participation in OA. Further research, using longitudinal study designs and examining the links between OA and biopsychosocial factors e.g., workplace accommodations, is needed to identify targets for interventions. SYSTEMATIC REVIEW REGISTRATION PROSPERO 2019 CRD42019133343 .
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Affiliation(s)
- Angela Ching
- Centre for Human Movement and Rehabilitation, University of Salford, Salford, Greater Manchester, UK
| | - Yeliz Prior
- Centre for Human Movement and Rehabilitation, University of Salford, Salford, Greater Manchester, UK.
| | - Jennifer Parker
- Centre for Human Movement and Rehabilitation, University of Salford, Salford, Greater Manchester, UK
| | - Alison Hammond
- Centre for Human Movement and Rehabilitation, University of Salford, Salford, Greater Manchester, UK
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Kiadaliri A, Lohmander LS, Ignjatovic MM, Nero H, Dahlberg LE. Digital self-management of hip and knee osteoarthritis and trajectories of work and activity impairments. BMC Musculoskelet Disord 2023; 24:207. [PMID: 36934223 PMCID: PMC10024026 DOI: 10.1186/s12891-023-06322-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 03/14/2023] [Indexed: 03/20/2023] Open
Abstract
OBJECTIVE To investigate the trajectories of work and activity impairments among people participating in a digital self-management program for osteoarthritis (OA). METHODS We conducted an observational longitudinal study using data for baseline, 3, 6, 9 and 12 months follow ups from people participating in a digital OA treatment between June 2018 and September 2021. The Work Productivity and Activity Impairment-Osteoarthritis (WPAI-OA) questionnaire was used to measure work and activity impairments. We applied linear mixed models and group-based trajectory modelling (GBTM) to assess the trajectories of work and activity impairments and their variability. Dominance analysis was performed to explore the relative importance of baseline characteristics in predicting the trajectory subgroup membership. RESULTS A total of 14,676 participants with mean (± standard deviation) age 64.0 (± 9.1) years and 75.5% females were included. The adjusted mean improvements in work impairment from baseline were 5.8% (95% CI 5.3, 6.4) to 6.1% (95% CI 5.5, 6.8). The corresponding figures for activity impairment were 9.4% (95% CI 9.0, 9.7) to 11.3% (95% CI 10.8, 11.8). GBTM identified five (low baseline-declining, moderate baseline-declining, high baseline-declining, very high baseline-substantially declining, and very high baseline-persistent) and three (low baseline-declining, mild baseline-declining, high baseline-declining) subgroups with distinct trajectories of activity and work impairments. Dominance analysis showed that baseline pain was the most important predictor of membership in trajectory subgroups. CONCLUSION While participation in a digital self-management program for OA was, on average, associated with improvements in work and activity impairments, there were substantial variations among the participants. Baseline pain may provide useful insights to predict trajectories of work and activity impairments.
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Affiliation(s)
- Ali Kiadaliri
- Department of Clinical Sciences Lund, Orthopaedics, Clinical Epidemiology Unit, Lund University, Lund, Sweden.
- Centre for Economic Demography, Lund University, Lund, Sweden.
- Arthro Therapeutics, Malmö, Sweden.
- Clinical Epidemiology Unit, Skåne University Hospital, Remissgatan 4, Lund, SE-221 85, Sweden.
| | - L Stefan Lohmander
- Arthro Therapeutics, Malmö, Sweden
- Department of Clinical Sciences Lund, Orthopaedics, Lund University, Lund, Sweden
| | | | - Håkan Nero
- Arthro Therapeutics, Malmö, Sweden
- Department of Clinical Sciences Lund, Orthopaedics, Lund University, Lund, Sweden
| | - Leif E Dahlberg
- Arthro Therapeutics, Malmö, Sweden
- Clinical Epidemiology Unit, Skåne University Hospital, Remissgatan 4, Lund, SE-221 85, Sweden
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Jin X, Ackerman IN, Ademi Z. Loss of Productivity-Adjusted Life-Years in Working-Age Australians Due to Knee Osteoarthritis: A Life-Table Modeling Approach. Arthritis Care Res (Hoboken) 2023; 75:482-490. [PMID: 35348305 DOI: 10.1002/acr.24886] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 02/19/2022] [Accepted: 03/24/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Productivity-adjusted life-years (PALYs) offers a novel approach for quantifying the productivity burden of chronic conditions at the population level over the working lifespan. This study was undertaken to estimate the productivity burden of knee osteoarthritis (KOA) among working-age Australians, defined as lost PALYs and lost gross domestic product (GDP). METHODS A static life-table model was constructed to simulate the experiences of working Australians (between the ages of 15-64 years) with KOA and those without KOA, with follow-up to 65 years (retirement age), a 1-year cycle length, and an annual discount rate of 5%. KOA prevalence data were obtained from the 2019 Global Burden of Diseases, Injuries, and Risk Factors study. Demographic and mortality data were sourced from the Australian Bureau of Statistics. Health utilities and productivity indices were derived from published sources. Population-level losses in years of life, quality-adjusted life-years (QALYs), and PALYs attributable to KOA were estimated by comparing estimates in the KOA cohort to the no KOA cohort. RESULTS In 2019, a total of 913,539 working-age Australians were estimated to have KOA, with an overall prevalence of 5.5% (4.5% in men and 6.5% in women). By retirement age, KOA was associated with 39,602 excess deaths, 125,651 years of life lost, 1,938,059 QALYs lost, and 1,943,287 PALYs lost. The economic impact of lost productivity due to KOA amounted to 424 billion Australian dollars in lost GDP. CONCLUSION Our modeling demonstrates a significant economic burden of KOA among the working Australian population, with marked productivity loss. Our findings highlight the need for public health funding and scalable population-level strategies for effective KOA prevention and support to maintain productive working.
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Affiliation(s)
- Xingzhong Jin
- Centre for Big Data Research in Health, University of New South Wales, Sydney, New South Wales, Australia, and Sydney Musculoskeletal Health, The University of Sydney, Camperdown, New South Wales, Australia
| | - Ilana N Ackerman
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Zanfina Ademi
- School of Public Health and Preventive Medicine and Centre for Medicine Use and Safety, Monash University, Melbourne, Victoria, Australia
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Cai P, Wei X, Wang W, Cai C, Li H. High-intensity laser therapy on pain relief in symptomatic knee osteoarthritis: A systematic review and meta-analysis. J Back Musculoskelet Rehabil 2023; 36:1011-1021. [PMID: 37458008 DOI: 10.3233/bmr-220228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
BACKGROUND Osteoarthritis is one of the leading causes of global disability and pain. OBJECTIVE To investigate whether High-Intensity Laser therapy has superior pain-relieving effects in individuals with symptomatic knee osteoarthritis. METHODS Searches were conducted using CENTRAL, MEDLINE, CINAHL, EMBASE, Web of Science, PEDro, and related reference lists with language limed to English. Clinical trials investigating the effectiveness of High-Intensity Laser therapy compared to other laser therapies, conventional therapies or exercises on knee osteoarthritis pain were included. The screening and selection of studies, data extraction, and methodological quality assessment were performed by two independent researchers. Studies were quantitatively integrated using the Review Manager Software and qualitative analysis using the criteria recommended by the Cochrane Collaboration. RESULTS Nine studies meeting the eligibility criteria were identified, among which only one study was identified as excellent methodology quality, six was marked as good quality, and the remaining two studies were regarded as fair or poor quality. All studies reported positive effects of High-Intensity Laser therapy on knee osteoarthritis pain. Two studies (136 people) gave indication that there was moderate evidence that High-Intensity Laser therapy could be a promising new possibility in pain relief among patients with knee osteoarthritis compared with sham laser therapy in a short-term treatment (MD, -2.04, 95% CI, -2.12 to -1.96; Z= 51.01, P< 0.01). Four studies (160 people) showed that High-Intensity Laser therapy could be an effective modality on treating pain compared to conventional physiotherapies in decreasing visual analog scale score (MD, -0.98, 95% CI, -1.19 to -0.76; Z= 9.02, P< 0.01). Three studies (123 people) demonstrated that High-Intensity Laser therapy combined with exercises was more effective than placebo laser or lower-intensity laser combined with exercises in alleviating pain in patients with knee osteoarthritis (MD, -1.54, 95% CI, -1.84 to -1.24; Z= 10.06, P< 0.01). CONCLUSION High-Intensity Laser therapy could be a promising and recommended modality in alleviating knee osteoarthritis pain, especially when it was implemented in combination with exercises.
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Kamp T, Brouwer S, Hylkema TH, van Beveren J, Rijk PC, Brouwer RW, Stevens M. Psychosocial Working Conditions Play an Important Role in the Return-to-Work Process After Total Knee and Hip Arthroplasty. JOURNAL OF OCCUPATIONAL REHABILITATION 2022; 32:295-305. [PMID: 34581916 PMCID: PMC9232447 DOI: 10.1007/s10926-021-10006-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/16/2021] [Indexed: 05/26/2023]
Abstract
Purpose Both personal and work-related factors affect return to work (RTW) after total knee arthroplasty (TKA) and total hip arthroplasty (THA). Little is known about work-related factors associated with the recovery process. This study aimed to determine which work-related factors are associated with time to RTW for both TKA and THA patients. Methods A prospective multicenter survey study was conducted that included patients aged 18-63, had a paid job and were scheduled to undergo primary TKA/THA. Surveys were completed preoperatively, 6 weeks, and 3, 6, and 12 months postoperatively, and included four domains of work-related factors: work characteristics, physical working conditions, psychosocial working conditions and work adjustments. Control variables included age, sex, education, and comorbidity. Time to RTW was defined as days from surgery until RTW. Multivariate linear regression analyses were conducted separately for TKA/THA patients. Results Enrolled were 246 patients (n = 146 TKA, n = 100 THA, median age 56 years, 57% female). Median time to RTW was 79 days (IQR 52.0-146.0). Mainly physical tasks (TKA: B 58.2, 95%CI 9.5-106.8; THA: B 52.1, 95%CI 14.1-90.2) and a combination of physical and mental tasks (TKA: B 50.2, 95%CI 6.4-94.0; THA B 54.0, 95%CI 24.2-83.7) were associated with longer time to RTW after both TKA and THA. More possibilities for personal job development (B - 12.8, 95%CI - 25.3-0.4) and more work recognition (B - 13.2, 95%CI - 25.5 to - 0.9) were significantly associated with shorter time to RTW after TKA. Higher quality of supervisor leadership (B - 14.1, 95%CI - 22.2 to - 6.0) was significantly associated with shorter time to RTW after THA. Conclusion The findings of this study stress the importance of psychosocial working conditions, besides type of job tasks, in RTW after TKA/THA. Further research on work-related factors is needed, as arthroplasty is being performed on an increasingly younger population of knee and hip OA patients for whom participating in work is of critical importance.
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Affiliation(s)
- Tamara Kamp
- Department of Orthopedics, University Medical Center Groningen, University of Groningen, P.O. Box 30.001, 9700 RB, Groningen, The Netherlands.
- Department of Health Sciences, Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
| | - Sandra Brouwer
- Department of Health Sciences, Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Tjerk H Hylkema
- Department of Orthopedics, University Medical Center Groningen, University of Groningen, P.O. Box 30.001, 9700 RB, Groningen, The Netherlands
- Department of Health Sciences, Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Jan van Beveren
- Department of Orthopedics, Röpcke-Zweers Hospital Hardenberg, Hardenberg, The Netherlands
| | - Paul C Rijk
- Department of Orthopedics, Medical Center Leeuwarden, Leeuwarden, The Netherlands
| | - Reinoud W Brouwer
- Department of Orthopedics, Martini Hospital Groningen, Groningen, The Netherlands
| | - Martin Stevens
- Department of Orthopedics, University Medical Center Groningen, University of Groningen, P.O. Box 30.001, 9700 RB, Groningen, The Netherlands
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12
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Hitzl W, Stamm T, Kloppenburg M, Ritter M, Gaisberger M, van der Zee-Neuen A. Projected number of osteoarthritis patients in Austria for the next decades - quantifying the necessity of treatment and prevention strategies in Europe. BMC Musculoskelet Disord 2022; 23:133. [PMID: 35139829 PMCID: PMC8830022 DOI: 10.1186/s12891-022-05091-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 02/03/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The present study aimed to predict the expected number of patients with osteoarthritis (OA) in Austria up to the year 2080. METHODS Demographic data and population projections between 2019 and 2080 were obtained from European authorities. Information about recent age- and sex-stratified prevalence of patients with self-reported physician-diagnosed OA was obtained from the Austrian Health Interview Survey (n = 15,771). Projections were stratified by age and sex; sensitivity analyses were performed based on aging, main (most likely), and growth scenarios of the population. RESULTS Based on the projection, the overall increase in the total number of patients with OA from 2019 to 2080 will be 38% for men and women. In 2019, the highest number of OA-patients nested in the groups of persons aged 70-79 (n = 238,749) and 60-69 (n = 237,729) years. In 2080, the 80+ age group is predicted to have the highest number of OA with 421,548 individuals (i.e. factor 3.45 and factor 2.48 increase in the male and female group, respectively, compared to 2019), followed by the group aged 70-79 with 314,617 individuals (factor 1.45 and factor 1.28 increase in the male and female group, respectively, compared to 2019). Similar trends were found in the ageing and growing scenarios. CONCLUSIONS The projected increase in the occurrence of OA will likely lead to a substantial socioeconomic burden for the Austrian healthcare system in the near and far future. The current findings plead for the development of sustainable concepts for the treatment and prevention of OA by European authorities.
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Affiliation(s)
- Wolfgang Hitzl
- Research and Innovation Management (RIM), Biostatistics, Paracelsus Medical University, Salzburg, Austria.,Department of Ophthalmology and Optometry, Paracelsus Medical University, Salzburg, Austria.,Research Program Experimental Ophthalmology and Glaucoma Research, Paracelsus Medical University, Salzburg, Austria
| | - Tanja Stamm
- Section for Outcomes Research, Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria.,Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Medical University of Vienna, Vienna, Austria
| | - Margreet Kloppenburg
- Department of Rheumatology, Leiden University Medical Center, Leiden, Netherlands
| | - Markus Ritter
- Center for Physiology, Pathophysiology and Biophysics, Institute for Physiology and Pathophysiology, Salzburg, Austria.,Center for Physiology, Pathophysiology and Biophysics, Institute for Physiology, Pathophysiology and Biophysics, Nuremberg, Germany.,Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Paracelsus Medical University, Salzburg, Austria.,Gastein Research Institute, Paracelsus Medical University, Strubergasse 22, A-5020, Salzburg, Austria.,Kathmandu University School of Medical Sciences, Dhulikhel, Nepal
| | - Martin Gaisberger
- Center for Physiology, Pathophysiology and Biophysics, Institute for Physiology and Pathophysiology, Salzburg, Austria.,Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Paracelsus Medical University, Salzburg, Austria.,Gastein Research Institute, Paracelsus Medical University, Strubergasse 22, A-5020, Salzburg, Austria
| | - Antje van der Zee-Neuen
- Center for Physiology, Pathophysiology and Biophysics, Institute for Physiology and Pathophysiology, Salzburg, Austria. .,Gastein Research Institute, Paracelsus Medical University, Strubergasse 22, A-5020, Salzburg, Austria. .,Institute of Nursing Science and Practice, Paracelsus Medical University, Salzburg, Austria. .,Centre for Public Health and Health Services Research, Paracelsus Medical University, Salzburg, Austria.
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13
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Östlind E, Eek F, Stigmar K, Sant'Anna A, Hansson EE. Promoting work ability with a wearable activity tracker in working age individuals with hip and/or knee osteoarthritis: a randomized controlled trial. BMC Musculoskelet Disord 2022; 23:112. [PMID: 35114983 PMCID: PMC8812043 DOI: 10.1186/s12891-022-05041-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 01/10/2022] [Indexed: 11/16/2022] Open
Abstract
Background Physical activity (PA) may improve work ability and health in individuals with hip and/or knee osteoarthritis (OA). The use of wearable activity trackers (WATs) has been shown to increase PA and improve other health outcomes but little is known concerning their effect on work ability. The objectives of this study were to examine the effect of self-monitoring PA with a WAT on work ability, PA and work productivity among individuals of working age with hip and/or knee OA. Methods Individuals (n = 160) were included and cluster-randomized to a Supported Osteoarthritis Self-management Program (SOASP) with the addition of self-monitoring PA using a commercial WAT for 12 weeks (n = 86), or only the SOASP (n = 74). Primary outcome was self-reported work ability measured with the Work Ability Index (WAI) and secondary outcomes were self-reported PA measured with the International Physical Activity Questionnaire – Short Form (IPAQ-SF) and work productivity, measured with the Work Productivity and Activity Impairment scale: Osteoarthritis (WPAI:OA) at baseline and after 3, 6 and 12 months. Data was primarily analysed with linear mixed models. Results Participants with data from baseline and at least one follow-up were included in the analyses (n = 124). Linear mixed models showed no statistically significant difference between groups regarding pattern of change in work ability or PA, from baseline to follow-ups. Also, neither group had a statistically significant difference in work ability between baseline and each follow-up. Conclusion The SOASP together with self-monitoring PA with a WAT did not have any effect on the primary outcome variable work ability. Participants already at baseline had good work ability and were physically active, which could have reduced the possibility for improvements. Future interventions should target a population with lower work ability and PA-level. Trial registration ClinicalTrials.gov, NCT03354091. Registered 15/11/2017.
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Affiliation(s)
- Elin Östlind
- Department of Health Sciences, Division of Physiotherapy, Lund University, Lund, Sweden. .,Dalby Healthcare Center, Region Skåne, Lund, Sweden.
| | - Frida Eek
- Department of Health Sciences, Division of Physiotherapy, Lund University, Lund, Sweden
| | - Kjerstin Stigmar
- Department of Health Sciences, Division of Physiotherapy, Lund University, Lund, Sweden.,Skåne University Hospital, Lund, Sweden
| | | | - Eva Ekvall Hansson
- Department of Health Sciences, Division of Physiotherapy, Lund University, Lund, Sweden.,Skåne University Hospital, Lund, Sweden
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14
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Puzzitiello RN, Liu JN, Garcia GH, Redondo ML, Forlenza EM, Agarwalla A, Yanke AB, Cole BJ. Return to Work After Distal Femoral Varus Osteotomy. Orthop J Sports Med 2020; 8:2325967120965966. [PMID: 33330734 PMCID: PMC7720305 DOI: 10.1177/2325967120965966] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 06/11/2020] [Indexed: 02/05/2023] Open
Abstract
Background Distal femoral varus osteotomy (DFVO) is a well-described procedure to address valgus deformity of the knee. There is a paucity of information available regarding patients' ability to return to work (RTW) after DFVO. Purpose To report the objective findings for RTW rates and times for patients receiving a DFVO for lateral compartment osteoarthritis secondary to valgus deformity of the knee. Study Design Cohort study; Level of evidence, 3. Methods This was a retrospective study of patients who received a lateral-wedge opening DFVO. Patients must have worked within 3 years before their operation to be included for analysis. Patients were contacted at a minimum of 2 years postoperatively for interview and questionnaire evaluation, including a subjective work questionnaire, visual analog scale (VAS) for pain, Single Assessment Numerical Evaluation (SANE), and a satisfaction questionnaire. Results Overall, 32 patients were contacted at a mean follow-up of 7.1 ± 4.1 years (range, 2.2-13.3 years). The mean ± SD age at the time of surgery was 30.8 ± 8.8 years (range, 17.2-46.5 years), and 65.6% of patients were female. Eleven patients (34.4%) received a concomitant meniscal allograft transplant, and 12 (37.5%) received a cartilage grafting procedure. The average VAS pain score decreased significantly from 6.1 preoperatively to 3.2 postoperatively (P = .03). All patients were able to RTW, at a mean time of 6.0 ± 13.2 months postoperatively (range, 0-72 months). When stratified by work intensity, the average time to return was 13.8, 3.1, 2.7, and 2.9 months for high, moderate, light, and sedentary occupations, respectively. There was no significant difference between these RTW times (P = .16), although this analysis may have been limited by the small sample size. Four patients whose work was classified as heavy work (50%) and 3 whose work was classified as moderate work (18.8%) either switched jobs or kept the same job with lighter physical duties as a result of their procedures. Conclusion In a young and active population, DFVO for valgus deformity reliably afforded the ability to RTW within a relatively short time for patients with sedentary, light, and moderate occupational demands. However, patients with moderate- to high-intensity occupational demands may be unable to RTW at their preoperative level.
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Affiliation(s)
- Richard N Puzzitiello
- Department of Orthopedic Surgery, Tufts University Medical Center, Boston, Massachusetts, USA
| | - Joseph N Liu
- Department of Orthopedic Surgery, Loma Linda Medical Center, Loma Linda, California, USA
| | | | - Michael L Redondo
- Department of Orthopedic Surgery, University of Illinois Medical Center, Chicago, Illinois, USA
| | - Enrico M Forlenza
- Department of Orthopedic Surgery, Westchester Medical Center, Valhalla, New York, USA
| | - Avinesh Agarwalla
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA
| | - Adam B Yanke
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA
| | - Brian J Cole
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA
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15
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Baker P, Coole C, Drummond A, Khan S, McDaid C, Hewitt C, Kottam L, Ronaldson S, Coleman E, McDonald DA, Nouri F, Narayanasamy M, McNamara I, Fitch J, Thomson L, Richardson G, Rangan A. Occupational advice to help people return to work following lower limb arthroplasty: the OPAL intervention mapping study. Health Technol Assess 2020; 24:1-408. [PMID: 32930659 PMCID: PMC7520717 DOI: 10.3310/hta24450] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Hip and knee replacements are regularly carried out for patients who work. There is little evidence about these patients' needs and the factors influencing their return to work. There is a paucity of guidance to help patients return to work after surgery and a need for structured occupational advice to enable them to return to work safely and effectively. OBJECTIVES To develop an occupational advice intervention to support early recovery to usual activities including work that is tailored to the requirements of patients undergoing hip or knee replacements. To test the acceptability, practicality and feasibility of this intervention within current care frameworks. DESIGN An intervention mapping approach was used to develop the intervention. The research methods employed were rapid evidence synthesis, qualitative interviews with patients and stakeholders, a prospective cohort study, a survey of clinical practice and a modified Delphi consensus process. The developed intervention was implemented and assessed during the final feasibility stage of the intervention mapping process. SETTING Orthopaedic departments in NHS secondary care. PARTICIPANTS Patients who were in work and intending to return to work following primary elective hip or knee replacement surgery, health-care professionals and employers. INTERVENTIONS Occupational advice intervention. MAIN OUTCOME MEASURES Development of an occupational advice intervention, fidelity of the developed intervention when delivered in a clinical setting, patient and clinician perspectives of the intervention and preliminary assessments of intervention effectiveness and cost. RESULTS A cohort study (154 patients), 110 stakeholder interviews, a survey of practice (152 respondents) and evidence synthesis provided the necessary information to develop the intervention. The intervention included information resources, a personalised return-to-work plan and co-ordination from the health-care team to support the delivery of 13 patient and 20 staff performance objectives. To support delivery, a range of tools (e.g. occupational checklists, patient workbooks and employer information), roles (e.g. return-to-work co-ordinator) and training resources were created. Feasibility was assessed for 21 of the 26 patients recruited from three NHS trusts. Adherence to the defined performance objectives was 75% for patient performance objectives and 74% for staff performance objectives. The intervention was generally well received, although the short time frame available for implementation and concurrent research evaluation led to some confusion among patients and those delivering the intervention regarding its purpose and the roles and responsibilities of key staff. LIMITATIONS Implementation and uptake of the intervention was not standardised and was limited by the study time frame. Evaluation of the intervention involved a small number of patients, which limited the ability to assess it. CONCLUSIONS The developed occupational advice intervention supports best practice. Evaluation demonstrated good rates of adherence against defined performance objectives. However, a number of operational and implementation issues require further attention. FUTURE WORK The intervention warrants a randomised controlled trial to assess its clinical effectiveness and cost-effectiveness to improve rates and timing of sustained return to work after surgery. This research should include the development of a robust implementation strategy to ensure that adoption is sustained. STUDY REGISTRATION Current Controlled Trials ISRCTN27426982 and PROSPERO CRD42016045235. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 45. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Paul Baker
- South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Carol Coole
- School of Health Sciences, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Avril Drummond
- School of Health Sciences, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Sayeed Khan
- Make UK, The Manufacturers' Organisation, London, UK
| | - Catriona McDaid
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Catherine Hewitt
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Lucksy Kottam
- South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK
| | - Sarah Ronaldson
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Elizabeth Coleman
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - David A McDonald
- Whole System Patient Flow Programme, Scottish Government, Edinburgh, UK
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Fiona Nouri
- School of Health Sciences, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Melanie Narayanasamy
- School of Health Sciences, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Iain McNamara
- Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich, UK
| | - Judith Fitch
- British Orthopaedic Association Patient Liaison Group, Royal College of Surgeons of England, London, UK
| | - Louise Thomson
- School of Health Sciences, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | | | - Amar Rangan
- South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK
- York Trials Unit, Department of Health Sciences, University of York, York, UK
- Faculty of Medical Sciences, University of Oxford, Oxford, UK
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK
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16
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Baker P, Kottam L, Coole C, Drummond A, McDaid C, Rangan A. Development of an occupational advice intervention for patients undergoing elective hip and knee replacement: a Delphi study. BMJ Open 2020; 10:e036191. [PMID: 32636283 PMCID: PMC7342851 DOI: 10.1136/bmjopen-2019-036191] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To obtain consensus on the content and delivery of an occupational advice intervention for patients undergoing primary hip and knee replacement surgery. The primary targets for the intervention were (1) patients, carers and employers through the provision of individualised support and information about returning to work and (2) hospital orthopaedic teams through the development of a framework and materials to enable this support and information to be delivered. DESIGN Modified Delphi study as part of a wider intervention development study (The Occupational advice for Patients undergoing Arthroplasty of the Lower limb (OPAL) study: Health Technology Assessment Reference 15/28/02) (ISRCTN27426982). SETTING Five stakeholder groups (patients, employers, orthopaedic surgeons, general practitioners, allied health professionals and nurses) recruited from across the UK. PARTICIPANTS Sixty-six participants. METHODS Statements for the Delphi process were developed relating to the content, format, delivery, timing and measurement of an occupational advice intervention. The statements were based on evidence gathered through the OPAL study that was processed using an intervention mapping framework. Intervention content was examined in round 1 and intervention format, delivery, timing and measurement were examined in round 2. In round 3, the developed intervention was presented to the stakeholder groups for comment. CONSENSUS For rounds 1 and 2, consensus was defined as 70% agreement or disagreement on a 4-point scale. Statements reaching consensus were ranked according to the distribution of responses to create a hierarchy of agreement. Round 3 comments were used to revise the final version of the developed occupational advice intervention. RESULTS Consensus was reached for 36 of 64 round 1 content statements (all agreement). In round 2, 13 questions were carried forward and an additional 81 statements were presented. Of these, 49 reached consensus (44 agreement/5 disagreement). Eleven respondents provided an appraisal of the intervention in round 3. CONCLUSIONS The Delphi process informed the development of an occupational advice intervention as part of a wider intervention development study. Stakeholder agreement was achieved for a large number of intervention elements encompassing the content, format, delivery and timing of the intervention. The effectiveness and cost-effectiveness of the developed intervention will require evaluation in a randomised controlled trial. TRIAL REGISTRATION NUMBER International Standard Randomised Controlled Trials Number Trial ID: ISRCTN27426982.
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Affiliation(s)
- Paul Baker
- Department of Orthopaedics, South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK
- Department of Health Sciences, University of York, York, UK
| | - Lucksy Kottam
- Department of Orthopaedics, South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK
| | - Carol Coole
- School of Health Sciences, Faculty of Medicine & Health Sciences, University of Nottingham, Nottingham, UK
| | - Avril Drummond
- Division of Rehabilitation, Ageing and Wellbeing, University of Nottingham, Nottingham, UK
| | | | - Amar Rangan
- Department of Orthopaedics, South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK
- Department of Health Sciences, University of York, York, UK
- Faculty of Medical Sciences & Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
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17
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Coole C, Baker P, McDaid C, Drummond A. Using intervention mapping to develop an occupational advice intervention to aid return to work following hip and knee replacement in the United Kingdom. BMC Health Serv Res 2020; 20:523. [PMID: 32517684 PMCID: PMC7285551 DOI: 10.1186/s12913-020-05375-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Accepted: 05/28/2020] [Indexed: 11/23/2022] Open
Abstract
Background There are increasing numbers of total hip replacements (THR) and total knee replacements (TKR) being performed in patients of working age. Providing patients undergoing TKR and THR with return to work advice might facilitate return to work. The aim of this paper is to report on the process used to systematically develop an occupational advice intervention to be delivered in hospital for those undergoing arthroplasty. Methods The six-step Intervention Mapping (IM) approach to development, implementation and evaluation of a theory and evidence-based interventions was followed. This paper reports on the development of the intervention covered by steps 1 to 4 of the IM process. Steps 1–3 gathered data on current practice and barriers to change using a mixed methods approach (cohort study of patients undergoing THR or TKR, stakeholder interviews, survey of practice, evidence synthesis) and provided a theoretical framework for intervention development. Step 4 used information from steps 1–3 in combination with a Delphi consensus process to develop the intervention and the associated tools and materials to facilitate its delivery. Results The final intervention identified included a number of core principles including: early patient identification; delivery of key information to patients and their employers; assessment and support by a member of the orthopaedic team; procedures for escalation based on patient need; mechanisms to support communication; and training and support for the clinical teams delivering care. A total of 13 patient and 20 staff performance objectives as delivery requirements, were supported by a range of tools, roles and training resources. The intervention addressed outcomes based at the individual and interpersonal levels of the ecological model. Conclusions Following the IM approach resulted in a structured and justified occupational intervention for delivery in secondary care for patients undergoing total hip and knee replacement. The feasibility of the intervention will subsequently be tested alongside further investigation to establish its effectiveness and cost-effectiveness.
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Affiliation(s)
- Carol Coole
- School of Health Sciences, University of Nottingham, Nottingham, NG7 2HA, England.,Medical School, Queens Medical Centre, University of Nottingham, Nottingham, NG7 2HA, England
| | - Paul Baker
- The James Cook University Hospital, South Tees Hospitals NHS Foundation Trust, Middlesbrough, TS4 3BW, England.
| | - Catriona McDaid
- Department of Health Sciences, University of York, Seebohm Rowntree Building, Heslington York, YO10 5DD, England
| | - Avril Drummond
- School of Health Sciences, University of Nottingham, Nottingham, NG7 2HA, England.,Medical School, Queens Medical Centre, University of Nottingham, Nottingham, NG7 2HA, England
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18
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Bieleman HJ, Stewart R, Reneman MF, van Ittersum WM, van der Schans CP, Drossaers-Bakker KW, Oosterveld FGJ. Trajectories of Physical Work Capacity in Early Symptomatic Osteoarthritis of Hip and Knee: Results from the Cohort Hip and Cohort Knee (CHECK) Study. JOURNAL OF OCCUPATIONAL REHABILITATION 2019; 29:483-492. [PMID: 30151630 DOI: 10.1007/s10926-018-9809-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Purpose To evaluate the 5-year course of physical work capacity of participants with early symptomatic osteoarthritis (OA) of the hip and/or the knee; to identify trajectories and explore the relationship between trajectories and covariates. Methods In a prospective cohort study, physical work capacity was measured at baseline, using a test protocol (functional capacity evaluation) consisting of work-related physical activities. Participants were invited to participate in 1, 2 and 5 year follow-up measurements. Multilevel analysis and latent classes analysis were performed, in models with test performances as dependent variables and age, sex, work status, self-reported function (Western Ontario McMasters Arthritis Scale-WOMAC), body mass index (BMI) and time as independent variables. Multiple imputation was used to control for the influence of missing data. Results At baseline and after 1, 2 and 5 years there were 96, 64, 61 and 35 participants. Mean (SD) age at baseline was 56 (4.9) years, 84% were females. There was no statistically significant change in test performances (lifting low and high, carrying, static overhead work, repetitive bending, repetitive rotations) between the 4 measurements. Male sex, younger age and better self-reported function were statistically significant (p < 0.05) determinants of higher performance on most of the tests; having a paid job, BMI and progression of time were not. Three trajectories were identified: 'weak giving way', 'stable and able', and 'strong with decline'. Discussion In subgroups of participants with early symptomatic OA, determined by age, sex and self-reported function, physical work capacity seems to be a stable characteristic over 5 years.
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Affiliation(s)
- H J Bieleman
- Saxion Universities of Applied Sciences, P.O. Box 70.000, 7500 KB, Enschede, The Netherlands.
| | - R Stewart
- University Medical Centre, University of Groningen, Groningen, The Netherlands
| | - M F Reneman
- University Medical Centre, University of Groningen, Groningen, The Netherlands
| | - W M van Ittersum
- Hanze University of Applied Sciences, Groningen, The Netherlands
| | | | | | - F G J Oosterveld
- Saxion Universities of Applied Sciences, P.O. Box 70.000, 7500 KB, Enschede, The Netherlands
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19
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Farrants K, Friberg E, Sjölund S, Alexanderson K. 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. BMJ Open 2019; 9:e030054. [PMID: 31462481 PMCID: PMC6719767 DOI: 10.1136/bmjopen-2019-030054] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
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.
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Affiliation(s)
- Kristin Farrants
- Division of Insurance Medicine, Karolinska Institutet Department of Clinical Neuroscience, SE-171 77, Stockholm, Sweden
| | - Emilie Friberg
- Division of Insurance Medicine, Karolinska Institutet Department of Clinical Neuroscience, SE-171 77, Stockholm, Sweden
| | - Sara Sjölund
- Division of Insurance Medicine, Karolinska Institutet Department of Clinical Neuroscience, SE-171 77, Stockholm, Sweden
- Department of Health Sciences, The Swedish Red Cross University College, Stockholm, Sweden
| | - Kristina Alexanderson
- Division of Insurance Medicine, Karolinska Institutet Department of Clinical Neuroscience, SE-171 77, Stockholm, Sweden
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Coole C, Nouri F, Narayanasamy M, Baker P, Drummond A. Total hip and knee replacement and return to work: clinicians' perspectives. Disabil Rehabil 2019; 43:1247-1254. [PMID: 31442079 DOI: 10.1080/09638288.2019.1654000] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PURPOSE An ageing workforce means that our understanding of return to work following total hip and knee replacement is of increasing importance. The purpose of this qualitative study was to explore the views and experiences of clinicians in treating working patients undergoing total hip or knee replacement. MATERIALS AND METHODS We conducted semi-structured interviews in primary and secondary National Health Service care using framework methodology. A total of 40 interviews were conducted. Participants included 12 hospital-based Allied Health Professionals and nurses, 12 orthopedic surgeons, and 16 General Practitioners. Data were analyzed thematically. RESULTS A key theme concerned participants' perceptions and experiences around the process and practice of listing working patients for total hip or knee replacement. Four sub-themes were identified; the perceived likelihood of listing employed patients for surgery, expectations and outcomes of surgery, the impact of work issues, and referral procedures and waiting lists. CONCLUSIONS Decisions around listing working patients for total hip and knee replacement are complex and difficult. Clinicians need to consistently consider patients' work issues, and to be supported in this by appropriate commissioning and service delivery decisions. Further research is indicated to better understand the work-related expectations and anticipated outcomes of both patients and clinicians, and the optimum timing of surgery to maintain and improve patients' work performance.Implications for rehabilitationClinicians need to consistently consider patients' work issues, and current evidence, in their consultations and decisions regarding total hip and knee replacement.Clinical practice should reflect the growing proportion of working patients undergoing total hip and knee replacement, and routinely measure work outcomes.Changes are required at commissioning and service levels to support clinicians in changing their practice with this patient population.
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Affiliation(s)
- Carol Coole
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Fiona Nouri
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | | | - Paul Baker
- James Cook University Hospital, South Tees NHS Hospitals Trust, Middlesbrough, UK
| | - Avril Drummond
- School of Health Sciences, University of Nottingham, Nottingham, UK
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Lankinen P, Laasik R, Kivimäki M, Aalto V, Saltychev M, Vahtera J, Mäkelä K. Are patient-related pre-operative factors influencing return to work after total knee arthroplasty. Knee 2019; 26:853-860. [PMID: 31126842 DOI: 10.1016/j.knee.2019.04.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 02/08/2019] [Accepted: 04/18/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Osteoarthritis is one of the leading causes of disability in working-age patients. The total number of working-age patients undergoing total-knee arthroplasty (TKA) is continuously increasing. The purpose of this study was to identify predictive factors related to general health, health risk behaviors and socioeconomic status influencing the rate of return to work after a TKA. METHODS Overall there were 151,901 patients included in the Finnish Public Sector (FPS) study. The response rate varied between 65 and 73% during the study period. We used Cox proportional hazard models to examine patient-related predictive factors that may influence the rate of return to work after TKA in a cohort of patients (n = 452; n = 362 female; mean age 56.4 years). Predictive factors were measured on average 3.6 years before the operation. RESULTS Of the patients, 87% returned to work within one year after TKA at a mean of 116 calendar days. In multivariate analysis, patients at sick-leave ≤30 days during the last year before surgery were 2.2 times (95% confidence interval 1.72-2.92) more likely to return to work compared with those with >30 days of sick-leave. Compared with patients in manual work, those in higher or lower level non-manual work showed a 2.6-fold (1.95-3.52) and 1.5-fold (1.15-1.92) increased probability of returning to work. Age, sex, health risk behaviors, obesity, physical comorbidities, common mental disorders, and other studied health-related factors were not associated with the rate of return to work. CONCLUSIONS Non-manual job, good self-rated general health and preoperative sick leave ≤30 days are associated with a higher rate of return to work.
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Affiliation(s)
- Petteri Lankinen
- Department of Orthopedics and Traumatology Turku, Turku University Hospital and University of Turku, Turku, Finland.
| | - Raul Laasik
- Department of Surgery, Satakunta Central Hospital, Pori, Finland
| | - Mika Kivimäki
- Finnish Institute of Occupational Health, Helsinki, Finland; Clinicum, Faculty of Medicine, University of Helsinki, Helsinki, Finland; Department of Epidemiology and Public Health, University College London, London, UK
| | - Ville Aalto
- Finnish Institute of Occupational Health, Helsinki, Finland
| | - Mikhail Saltychev
- Department of Physical and Rehabilitation Medicine, Turku University Hospital and University of Turku, Turku, Finland
| | - Jussi Vahtera
- Department of Public Health, University of Turku, Turku, Finland
| | - Keijo Mäkelä
- Department of Orthopedics and Traumatology Turku, Turku University Hospital and University of Turku, Turku, Finland
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Kontio T, Viikari-Juntura E, Solovieva S. Effect of Osteoarthritis on Work Participation and Loss of Working Life-years. J Rheumatol 2019; 47:597-604. [PMID: 31043546 DOI: 10.3899/jrheum.181284] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/09/2019] [Indexed: 01/06/2023]
Abstract
OBJECTIVE To examine to what extent disabling osteoarthritis (OA), leading to a prolonged sickness absence (SA), interferes with work participation and shortens working life-years. METHODS A total of 4704 wage earners aged 30 to 59 years, whose SA due to OA started in 2006, were followed until October 31, 2014. Kaplan-Meier analysis was used to plot sustained (at least 28 consecutive days) return-to-work curves. The associations of potential determinants with early exit from paid employment were examined applying Cox proportional hazards regression analysis. Years expected to be spent in different work participation statuses until statutory retirement age were estimated based on daily work participation statuses using adapted Sullivan method. RESULTS Persons with knee OA showed the fastest, and persons with hip OA the slowest, sustained return to work. Although most participants typically were at work during the first year of followup, a considerable proportion was permanently retired. Male sex, older age, low education, long initial SA, and having not returned to work sustainably, as well as receiving vocational rehabilitation, predicted early exit from paid employment during the followup. Overall, only 45-53% of potential working life-years were estimated to be spent at work, being highest for the oldest age group. CONCLUSION Our study showed a considerable effect of OA on work participation and working life duration. Clinicians should avoid prescription of long SA or temporary work disability due to OA without a clear treatment or return-to-work plan.
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Affiliation(s)
- Tea Kontio
- From the University of Helsinki; Finnish Institute of Occupational Health, Helsinki, Finland.,T. Kontio, MD, University of Helsinki; E. Viikari-Juntura, MD, PhD, Finnish Institute of Occupational Health; S. Solovieva, PhD, Finnish Institute of Occupational Health
| | - Eira Viikari-Juntura
- From the University of Helsinki; Finnish Institute of Occupational Health, Helsinki, Finland.,T. Kontio, MD, University of Helsinki; E. Viikari-Juntura, MD, PhD, Finnish Institute of Occupational Health; S. Solovieva, PhD, Finnish Institute of Occupational Health
| | - Svetlana Solovieva
- From the University of Helsinki; Finnish Institute of Occupational Health, Helsinki, Finland. .,T. Kontio, MD, University of Helsinki; E. Viikari-Juntura, MD, PhD, Finnish Institute of Occupational Health; S. Solovieva, PhD, Finnish Institute of Occupational Health.
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Kontio T, Viikari-Juntura E, Solovieva S. To what extent do education and physical work load factors explain occupational differences in disability retirement due to knee OA? A nationwide register-based study in Finland. BMJ Open 2019; 8:e023057. [PMID: 30798289 PMCID: PMC6278790 DOI: 10.1136/bmjopen-2018-023057] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES To examine the association of education and physical work load factors on the occupational differences in disability retirement due to knee osteoarthritis (OA). DESIGN Longitudinal study. SETTING Linkage of several nationwide registers and a job exposure matrix in Finland. PARTICIPANTS A total of 1 135 654 Finns aged 30-60 years in gainful employment were followed from 2005 to 2013 for full disability retirement due to knee OA. PRIMARY AND SECONDARY OUTCOME MEASURES We calculated age-adjusted incidence rates and examined the association of occupation, education and physical work load factors with disability retirement using competing risk regression model. Disability retirement due to other causes than knee OA, old-age retirement and death were treated as competing risk. RESULTS A total of 6117 persons had disability retirement due to knee OA. Women had a higher age-adjusted incidence rate than men (72 vs 60 per 100 000 person-years, respectively). In men, a very high risk of disability retirement was found among construction workers, electricians and plumbers (HR 16.6, 95% CI 12.5 to 22.2), service workers (HR 12.7, 95% CI 9.2 to 17.4) and in women among building caretakers, cleaners, assistant nurses and kitchen workers (HR 15.5, 95% CI 11.7 to 20.6), as compared with professionals. The observed occupational differences were largely explained by educational level and noticeably mediated by physical work load factors in both genders. CONCLUSION Our observational study suggests that the risk of disability retirement among manual workers is strongly attributed to the physically heavy work.
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Affiliation(s)
- Tea Kontio
- Medical Faculty, University of Helsinki, Helsinki, Finland
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Laires PA, Canhão H, Rodrigues AM, Eusébio M, Gouveia M, Branco JC. The impact of osteoarthritis on early exit from work: results from a population-based study. BMC Public Health 2018; 18:472. [PMID: 29642918 PMCID: PMC5894139 DOI: 10.1186/s12889-018-5381-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 03/26/2018] [Indexed: 12/25/2022] Open
Abstract
Background Osteoarthritis (OA) is a leading cause of pain and disability, which may be a source of productivity losses. The objectives of this study were to describe the impact of OA, namely through pain and physical disability, on early exit from work and to calculate its economic burden. Methods We analysed data from the national, cross-sectional, population-based EpiReumaPt study (Sep2011–Dec2013) in which 10,661 individuals were randomly surveyed in order to capture all cases of rheumatic diseases. We used all participants aged 50–64, near the official retirement age, who were clinically validated by experienced rheumatologists (n = 1286), including OA cases. A national database was used to calculate productivity values by gender, age and region, using the human capital approach. The impact of OA on the likelihood of early exit from work and the population attributable fractions used to calculate due economic burden (indirect costs) were obtained at the individual level by logistic regression. All results were based on weighted data. Results Almost one third of the Portuguese population aged 50–64 had OA (29.7%; men: 16.2% and women: 43.5%) and more than half were out of paid work (51.8%). Only knee OA is associated with early exit from work (OR: 2.25; 95%CI: 1.42–3.59; p = 0.001), whereas other OA locations did not reach any statistical difference. Furthermore, we observed an association between self-reported longstanding musculoskeletal pain (OR: 1.55; 95%CI: 1.07–2.23; p = 0.02) and pain interference (OR: 1.35; 95%CI: 1.13–1.62; p = 0.001) with early exit from work. We also detected a clear relationship between levels of disability, measured by the Health Assessment Questionnaire (HAQ), and the probability of work withdrawal. The estimated annual cost of early exit from work attributable to OA was €656 million (€384 per capita; €1294 per OA patient and €2095 per OA patient out-of-work). Conclusions In this study, we observed an association between OA and early exit from work, largely dependent on pain and disability. This relationship translates into a meaningful economic burden amounting to approximately 0.4% of the national Gross Domestic Product (GDP). The high prevalence and the impact of this disabling chronic disease highlight the need to prioritize policies targeting early exit from work in OA.
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Affiliation(s)
- Pedro A Laires
- Faculdade de Medicina da Universidade de Lisboa, Lisbon Academic Medical Center, Lisbon, Portugal. .,Centro de Investigação em Saúde Pública, Escola Nacional de Saúde Pública, Lisbon, Portugal. .,EpiReumaPt Study Group, Sociedade Portuguesa de Reumatologia, Lisbon, Portugal.
| | - Helena Canhão
- EpiReumaPt Study Group, Sociedade Portuguesa de Reumatologia, Lisbon, Portugal.,Chronic Diseases Research Center (CEDOC), NOVA Medical School, Universidade Nova de Lisboa (NMS/UNL), Lisbon, Portugal
| | - Ana M Rodrigues
- Faculdade de Medicina da Universidade de Lisboa, Lisbon Academic Medical Center, Lisbon, Portugal.,EpiReumaPt Study Group, Sociedade Portuguesa de Reumatologia, Lisbon, Portugal
| | - Mónica Eusébio
- EpiReumaPt Study Group, Sociedade Portuguesa de Reumatologia, Lisbon, Portugal
| | - Miguel Gouveia
- Catolica Lisbon School of Business and Economics, Lisbon, Portugal
| | - Jaime C Branco
- EpiReumaPt Study Group, Sociedade Portuguesa de Reumatologia, Lisbon, Portugal.,Chronic Diseases Research Center (CEDOC), NOVA Medical School, Universidade Nova de Lisboa (NMS/UNL), Lisbon, Portugal.,Rheumatology Department, Hospital Egas Moniz, Centro Hospitalar Lisboa Ocidental (CHLO- E.P.E.), Lisbon, Portugal
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Solovieva S, Kontio T, Viikari-Juntura E. Occupation, Physical Workload Factors, and Disability Retirement as a Result of Hip Osteoarthritis in Finland, 2005–2013. J Rheumatol 2018; 45:555-562. [DOI: 10.3899/jrheum.170748] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/04/2017] [Indexed: 10/18/2022]
Abstract
Objective.To identify occupations with a high risk of disability retirement as a result of hip osteoarthritis (OA), and to examine the effect of physical workload factors on the occupational differences in disability retirement.Methods.A total of 1,135,654 (49.4% women) Finns aged 30–60 years in gainful employment were followed from 2005 to 2013 for full disability retirement as a result of hip OA. Information on pensions, occupation, and education were obtained from national registers. Physical workload was assessed by a sex-specific job exposure matrix. We calculated age-adjusted incidence rates and examined the associations of occupation, education, and physical workload factors with disability retirement using a competing risk regression model.Results.Age-adjusted incidence rate was 25 and 22 per 100,000 person-years in men and women, respectively. Both men and women working in lower-level nonmanual and manual occupations had an elevated age-adjusted risk of disability retirement as a result of hip OA. A very high risk of disability retirement was found among male construction workers, electricians, and plumbers (HR 12.7, 95% CI 8.4–19.7), and female professional drivers (HR 15.2, 95% CI 7.5–30.8) as compared with professionals. After adjustment for age and education, the observed occupational differences in disability retirement were largely explained by physical workload factors among men and to a smaller extent, among women.Conclusion.Our results suggest that education and physical workload factors appear to be the major reasons for excess disability retirement as a result of hip OA in manual occupations, particularly among men.
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Huang KH, Hsieh RL, Lee WC. Pain, Physical Function, and Health in Patients With Knee Osteoarthritis. Rehabil Nurs 2017; 42:235-241. [DOI: 10.1002/rnj.234] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Personal and Workplace Environmental Factors Associated With Reduced Worker Productivity Among Older Workers With Chronic Knee Pain: A Cross-Sectional Survey. J Occup Environ Med 2017. [PMID: 28628054 DOI: 10.1097/jom.0000000000001000] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The aim of this study was to explore personal and workplace environmental factors as predictors of reduced worker productivity among older workers with chronic knee pain. METHODS A questionnaire-based survey was conducted among 129 older workers who had participated in a randomized clinical trial evaluating dietary supplements. Multivariable analyses were used to explore predictors of reduced work productivity among older workers with chronic knee pain. RESULTS The likelihood of presenteeism was higher in those reporting knee pain (≥3/10) or problems with other joints, and lower in those reporting job insecurity. The likelihood of work transitions was higher in people reporting knee pain (≥3/10), a high comorbidity score or low coworker support, and lower in those having an occupation involving sitting more than 30% of the day. CONCLUSION Allowing access to sitting and promoting positive affiliations between coworkers are likely to provide an enabling workplace environment for older workers with chronic knee pain.
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Stigmar K, Dahlberg LE, Zhou C, Jacobson Lidgren H, Petersson IF, Englund M. Sick leave in Sweden before and after total joint replacement in hip and knee osteoarthritis patients. Acta Orthop 2017; 88:152-157. [PMID: 27996342 PMCID: PMC5385109 DOI: 10.1080/17453674.2016.1269051] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - Little is know about patterns of sick leave in connection with total hip and knee joint replacement (THR and TKR) in patients with osteoarthritis (OA). Patients and methods - Using registers from southern Sweden, we identified hip and knee OA patients aged 40-59 years who had a THR or TKR in the period 2004-2012. Patients who died or started on disability pension were excluded. We included 1,307 patients with THR (46% women) and 996 patients with TKR (56% women). For the period 1 year before until 2 years after the surgery, we linked individual-level data on sick leave from the Swedish Social Insurance Agency. We created a matched reference cohort from the general population by age, birth year, and area of residence (THR: n = 4,604; TKR: n = 3,425). The mean number of days on sick leave and the proportion (%) on sick leave 12 and 24 months before and after surgery were calculated. Results - The month after surgery, about 90% of patients in both cohorts were on sick leave. At the two-year follow-up, sick leave was lower for both cohorts than 1 year before surgery, except for men with THR, but about 9% of the THR patients and 12-17% of the TKR patients were still sick-listed. In the matched reference cohorts, sick leave was constant at around 4-7% during the entire study period. Interpretation - A long period of sick leave is common after total joint replacement, especially after TKR. There is a need for better knowledge on how workplace adjustments and rehabilitation can facilitate the return to work and can postpone surgery.
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Affiliation(s)
- Kjerstin Stigmar
- Department of Health Sciences, Faculty of Medicine, Lund University, Lund;,Epidemiology and Register Center South, Skåne University Hospital, Region Skåne, Lund;,Correspondence:
| | - Leif E Dahlberg
- Department of Clinical Sciences Lund, Orthopedics, Faculty of Medicine, Lund University, and Clinical Epidemiology Unit, Lund, Sweden
| | - Caddie Zhou
- Epidemiology and Register Center South, Skåne University Hospital, Region Skåne, Lund
| | - Helena Jacobson Lidgren
- Department of Clinical Sciences Lund, Orthopedics, Faculty of Medicine, Lund University, and Clinical Epidemiology Unit, Lund, Sweden
| | - Ingemar F Petersson
- Epidemiology and Register Center South, Skåne University Hospital, Region Skåne, Lund;,Department of Clinical Sciences Lund, Orthopedics, Faculty of Medicine, Lund University, and Clinical Epidemiology Unit, Lund, Sweden
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Estimating the Societal Benefits of THA After Accounting for Work Status and Productivity: A Markov Model Approach. Clin Orthop Relat Res 2016; 474:2645-2654. [PMID: 27699631 PMCID: PMC5085951 DOI: 10.1007/s11999-016-5084-9] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Accepted: 09/09/2016] [Indexed: 01/31/2023]
Abstract
BACKGROUND Demand for total hip arthroplasty (THA) is high and expected to continue to grow during the next decade. Although much of this growth includes working-aged patients, cost-effectiveness studies on THA have not fully incorporated the productivity effects from surgery. QUESTIONS/PURPOSES We asked: (1) What is the expected effect of THA on patients' employment and earnings? (2) How does accounting for these effects influence the cost-effectiveness of THA relative to nonsurgical treatment? METHODS Taking a societal perspective, we used a Markov model to assess the overall cost-effectiveness of THA compared with nonsurgical treatment. We estimated direct medical costs using Medicare claims data and indirect costs (employment status and worker earnings) using regression models and nonparametric simulations. For direct costs, we estimated average spending 1 year before and after surgery. Spending estimates included physician and related services, hospital inpatient and outpatient care, and postacute care. For indirect costs, we estimated the relationship between functional status and productivity, using data from the National Health Interview Survey and regression analysis. Using regression coefficients and patient survey data, we ran a nonparametric simulation to estimate productivity (probability of working multiplied by earnings if working minus the value of missed work days) before and after THA. We used the Australian Orthopaedic Association National Joint Replacement Registry to obtain revision rates because it contained osteoarthritis-specific THA revision rates by age and gender, which were unavailable in other registry reports. Other model assumptions were extracted from a previously published cost-effectiveness analysis that included a comprehensive literature review. We incorporated all parameter estimates into Markov models to assess THA effects on quality-adjusted life years and lifetime costs. We conducted threshold and sensitivity analyses on direct costs, indirect costs, and revision rates to assess the robustness of our Markov model results. RESULTS Compared with nonsurgical treatments, THA increased average annual productivity of patients by USD 9503 (95% CI, USD 1446-USD 17,812). We found that THA increases average lifetime direct costs by USD 30,365, which were offset by USD 63,314 in lifetime savings from increased productivity. With net societal savings of USD 32,948 per patient, total lifetime societal savings were estimated at almost USD 10 billion from more than 300,000 THAs performed in the United States each year. CONCLUSIONS Using a Markov model approach, we show that THA produces societal benefits that can offset the costs of THA. When comparing THA with other nonsurgical treatments, policymakers should consider the long-term benefits associated with increased productivity from surgery. LEVEL OF EVIDENCE Level III, economic and decision analysis.
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Sharif B, Garner R, Sanmartin C, Flanagan WM, Hennessy D, Marshall DA. Risk of work loss due to illness or disability in patients with osteoarthritis: a population-based cohort study. Rheumatology (Oxford) 2016; 55:861-8. [DOI: 10.1093/rheumatology/kev428] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Indexed: 11/13/2022] Open
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The substantial personal burden experienced by younger people with hip or knee osteoarthritis. Osteoarthritis Cartilage 2015; 23:1276-84. [PMID: 25887363 DOI: 10.1016/j.joca.2015.04.008] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2014] [Revised: 03/23/2015] [Accepted: 04/02/2015] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To compare Health-Related Quality of Life (HRQoL) and psychological distress in younger people with hip or knee osteoarthritis (OA) to age- and sex-matched population norms, and evaluate work limitations in this group. METHOD People aged 20-55 years with hip or knee OA were recruited from major hospitals (n = 126) and community advertisements (n = 21). HRQoL was assessed using the Assessment of Quality of Life (AQoL) instrument (minimal important difference 0.06 AQoL units) and compared to population norms. Psychological distress was assessed using the Kessler Psychological Distress Scale (K10) and the prevalence of high/very high distress (K10 score ≥22) was compared to Australian population data. Work limitations were evaluated using the Workplace Activity Limitations Scale (WALS). RESULTS Considering most participants had a relatively recent OA diagnosis (<5 years), the extent of HRQoL impairment was unexpected. A very large reduction in HRQoL was evident for the overall sample, compared with population norms (mean difference -0.35 AQoL units, 95% CI -0.40 to -0.31). Females, people aged 40-49 years, and those with hip OA reported average HRQoL impairment of almost 40% (mean reductions -0.38 to -0.39 AQoL units). The overall prevalence of high/very high distress was 4 times higher than for the population (relative risk 4.19, 95% CI 3.53-4.98) and 67% reported moderate to considerable OA-related work disability, according to WALS scores. CONCLUSIONS These results clearly demonstrate the substantial personal burden experienced by younger people with hip or knee OA, and support the provision of targeted services to improve HRQoL and maximise work participation in this group.
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Abstract
Changing demographics mean that many patients with soft tissue rheumatism, osteoarthritis, inflammatory arthritis, large joint prostheses and age-related co-morbidities are seeking to work beyond the traditional retirement age. In this chapter, we review the evidence on musculoskeletal health and work at older ages. We conclude that musculoskeletal problems are common in older workers and have a substantial impact on their work capacity. Factors that influence their job retention are described, together with approaches that may extend working life. Many gaps in evidence were found, notably on the health risks and benefits of continued work in affected patients and on which interventions work best. The roles of physicians and managers are also considered.
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Affiliation(s)
- Keith T Palmer
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton SO16 6YD, UK; ARUK-MRC Centre for Musculoskeletal Health and Work, UK.
| | - Nicola Goodson
- ARUK-MRC Centre for Musculoskeletal Health and Work, UK; Department of Musculoskeletal Biology 1, Institute of Aging and Chronic Diseases, University of Liverpool, University Hospital Aintree, Liverpool L9 7AL, UK.
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Wilkie R, Hay EM, Croft P, Pransky G. Exploring how pain leads to productivity loss in primary care consulters for osteoarthritis: a prospective cohort study. PLoS One 2015; 10:e0120042. [PMID: 25849594 PMCID: PMC4388648 DOI: 10.1371/journal.pone.0120042] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Accepted: 02/03/2015] [Indexed: 01/15/2023] Open
Abstract
Objective Osteoarthritis pain has become a leading cause of decreased productivity and work disability in older workers, a major concern in primary care. How osteoarthritis pain leads to decreased productivity at work is unclear; the aim of this study was to elucidate causal mechanisms and thus identify potential opportunities for intervention. Methods Population-based prospective cohort study of primary care consulters with osteoarthritis. Path analysis was used to test proposed mechanisms by examining the association between pain at baseline, and onset of work productivity loss at three years for mediation by physical limitation, depression, poor sleep and poor coping mechanisms. Results High pain intensity was associated with onset of work productivity loss (Adjusted Odds Ratio 2.5; 95%CI 1.3, 4.8). About half of the effect of pain on work productivity was a direct effect, and half was mediated by the impact of pain on physical function. Depression, poor sleep quality and poor coping did not mediate the association between high pain intensity and onset of work productivity loss. Conclusions As pain is a major cause of work productivity loss, results suggest that decreasing pain should be a major focus. However, successfully improving function may have an indirect effect by decreasing the impact of pain on work productivity, especially important as significant pain reduction is often difficult to achieve. Although depression, sleep problems, and coping strategies may be directly related to work productivity loss, addressing these issues may not have much effect on the significant impact of pain on work productivity.
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Affiliation(s)
- Ross Wilkie
- Arthritis Research UK Primary Care Centre, Primary Care Sciences, Keele University, Keele, Staffordshire, ST5 5BG, United Kingdom
- * E-mail:
| | - Elaine M. Hay
- Arthritis Research UK Primary Care Centre, Primary Care Sciences, Keele University, Keele, Staffordshire, ST5 5BG, United Kingdom
| | - Peter Croft
- Arthritis Research UK Primary Care Centre, Primary Care Sciences, Keele University, Keele, Staffordshire, ST5 5BG, United Kingdom
| | - Glenn Pransky
- Center for Disability Research, Liberty Mutual Research Institute, 71 Frankland Rd., Hopkinton, Massachusetts, 01748, United States of America
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Wilkie R, Phillipson C, Hay EM, Pransky G. Anticipated significant work limitation in primary care consulters with osteoarthritis: a prospective cohort study. BMJ Open 2014; 4:e005221. [PMID: 25190616 PMCID: PMC4158206 DOI: 10.1136/bmjopen-2014-005221] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE To describe the prevalence of expected work limitations (EWL) prior to future retirement age in osteoarthritis consulters, and the associated health, sociodemographic and workplace factors. DESIGN Population-based prospective cohort study. SETTING General practices in Staffordshire, England. PARTICIPANTS 297 working adults aged 50-65, who had consulted primary care for osteoarthritis. OUTCOME EWL was defined using a single question, "Do you think joint pain will limit your ability to work before you reach 69 years old?" RESULTS 51 (17.2%) indicated that joint pain would not limit their ability to work until 69, 79 (26.6%) indicated EWL and 167 (56.2%) did not know if joint pain would limit work before 69. In bivariate analysis, physical function (OR 0.93; 95% CI 0.91 to 0.96), depression (4.51; 1.81 to 11.3), cognitive symptom (3.84; 1.81 to 8.18), current smoker (2.75; 1.02 to 7.38), age (0.69; 0.58 to 0.82), physically demanding job (3.18; 1.50 to 6.72), no opportunities to retrain (3.01; 1.29 to 7.05) and work dissatisfaction (3.69; 1.43 to 9.49) were associated with EWL. The final multivariate model included physical function and age. CONCLUSIONS Only one in five osteoarthritis consulters expected that joint pain would not limit their work participation before 69 years of age. Given the expectation for people to work until they are older, the results highlight the increasing need for clinicians to include work participation in their consultation and implement strategies to address work loss/limitation. Targeting pain-related functional limitation and effective communication with employers to manage workplace issues could reduce EWL.
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Affiliation(s)
- Ross Wilkie
- Arthritis Research UK Primary Care Centre, Primary Care Sciences, Keele University, Keele, Staffordshire, UK
| | - Chris Phillipson
- School of Social Sciences, The University of Manchester, Manchester, UK
| | - Elaine M Hay
- Arthritis Research UK Primary Care Centre, Primary Care Sciences, Keele University, Keele, Staffordshire, UK
| | - Glenn Pransky
- Center for Disability Research, Liberty Mutual Research Institute, Hopkinton, Massachusetts, USA
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Impact and therapy of osteoarthritis: the Arthritis Care OA Nation 2012 survey. Clin Rheumatol 2014; 34:1581-8. [PMID: 24889403 DOI: 10.1007/s10067-014-2692-1] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Revised: 05/12/2014] [Accepted: 05/23/2014] [Indexed: 10/25/2022]
Abstract
Osteoarthritis (OA) is the fastest growing cause of disability worldwide. The aim of this study was to understand the impact of OA on individuals and to explore current treatment strategies. An online UK-wide survey of people with self-reported OA was conducted, composed of 52 questions exploring the impact of OA, diagnosis and treatment, the role of health professionals and self-management. Four thousand forty-three people were invited with 2,001 respondents (49 % response, 56 % women; mean age 65 years). Fifty-two percent reported that OA had a large impact on their lives. Fifteen percent of respondents had taken early retirement on average 7.8 years earlier than planned. In consultations with general practitioners, only half reported a discussion on pain; fewer reported discussing their fears (21 %) or management goals (15 %). Nearly half (48 %) reported not seeking medical help until pain was frequently unbearable. Oral analgesics (62 %), topical therapies (47 %), physiotherapy (38 %) and steroid injections (28 %) were commonly used. The majority (71 %) reported varying degrees of persistent pain despite taking all prescribed medication. Although 64 % knew that increasing exercise was important, only 36 % acted on this knowledge; 87 % who increased exercise found it beneficial. Over half had future concerns related to mobility (60 %), maintaining independence (52 %) and coping with everyday activities (51 %). OA had significant individual economic impact especially on employment. Current treatment strategies still leave most people in pain with significant fears for the future. There is considerable opportunity to improve the holistic nature of OA consultations especially in provision of information and promotion of self-management strategies.
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Agaliotis M, Mackey MG, Jan S, Fransen M. Burden of reduced work productivity among people with chronic knee pain: a systematic review. Occup Environ Med 2014; 71:651-9. [PMID: 24872332 DOI: 10.1136/oemed-2013-101997] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVE The aims of this systematic review were to determine the prevalence of reduced work productivity among people with chronic knee pain as well as specifically categorise determinants of work productivity losses into individual, disease and work-related factors, conduct an evaluation of study methodological quality and present a best-evidence synthesis. METHODS We searched the literature using combinations of key words such as knee pain, knee osteoarthritis, absenteeism (days taken off work) and presenteeism (reduced productivity while at work) for observational studies published in English. Methodological quality appraisal and a best-evidence synthesis were used to pool the study findings. RESULTS The studies were conducted exclusively in high income countries of North America, Western Europe and Hong Kong. 17 studies were included in the review, 10 measuring absenteeism and six measuring presenteeism. Of the 10 studies reporting absenteeism, seven found a 12-month absenteeism prevalence ranging from 5% to 22%. Only two studies evaluated presenteeism prevalence and reported a range from 66% to 71%. Using best-evidence synthesis: three high quality cohort studies and three cross-sectional studies provided strong evidence that knee pain or knee osteoarthritis was associated with absenteeism; two high quality cross-sectional studies and one cohort study provided limited evidence for an association with presenteeism; one cross-sectional study provided limited evidence for an association among age, high job demands and low coworker support and absenteeism among nurses with knee pain. No studies examined individual or work-related factors associated with presenteeism. CONCLUSIONS A number of high quality studies consistently demonstrated that chronic knee pain or knee osteoarthritis is associated with absenteeism. However, data are lacking regarding presenteeism and individual or work-related risk factors for reduced work productivity among older workers with chronic knee pain. SYSTEMATIC REVIEW REGISTRATION NUMBER PROSPERO registry number: CRD42013004137.
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Affiliation(s)
- Maria Agaliotis
- Faculty of Health Sciences, University of Sydney, Lidcombe, New South Wales, Australia
| | - Martin G Mackey
- Discipline of Physiotherapy, Ageing, Work and Health Research Unit, Faculty of Health Sciences, University of Sydney, Lidcombe, New South Wales, Australia
| | - Stephen Jan
- The George Institute for Global Health, Camperdown, New South Wales, Australia
| | - Marlene Fransen
- Discipline of Physiotherapy, Clinical and Rehabilitation Sciences Research Group, Faculty of Health Sciences, University of Sydney, Lidcombe, New South Wales, Australia
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Burgos-Vargas R, Cardiel MH, Loyola-Sánchez A, De Abreu MM, Pons-Estel BA, Rossignol M, Avouac B, Ferraz MB, Halhol H. Characterization of Knee Osteoarthritis in Latin America. A Comparative Analysis of Clinical and Health Care Utilization in Argentina, Brazil, and Mexico. ACTA ACUST UNITED AC 2014; 10:152-9. [DOI: 10.1016/j.reuma.2013.07.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2013] [Revised: 06/14/2013] [Accepted: 07/14/2013] [Indexed: 10/26/2022]
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Ganasegeran K, Menke JM, Challakere Ramaswamy VM, Abdul Manaf R, Alabsi AM, Al-Dubai SAR. Level and determinants of knowledge of symptomatic knee osteoarthritis among railway workers in Malaysia. BIOMED RESEARCH INTERNATIONAL 2014; 2014:370273. [PMID: 24701573 PMCID: PMC3950488 DOI: 10.1155/2014/370273] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/15/2013] [Revised: 12/14/2013] [Accepted: 01/07/2014] [Indexed: 02/06/2023]
Abstract
BACKGROUND Symptomatic knee osteoarthritis, an ancient malady greatly impairing modern population quality of life, has stimulated global attention to find effective modes of prevention and intervention. PURPOSE This study aimed to assess factors affecting knowledge of symptomatic knee osteoarthritis (knee OA) among Malaysian railway workers. METHODS A cross-sectional study was conducted among 513 railway workers involving eight major states within Peninsular Malaysia using population-based sampling. The assessment instrument was a face-validated, prepiloted, self-administered instrument with sociodemographics and knowledge items on knee OA. RESULTS Mean (± SD) age of the respondents was 41.4 (± 10.7), with the majority aged 50 years or older (34.9%). Of the total respondents, 53.6% had low levels of knowledge of knee OA disease. Multivariate analysis found that four demographic predictors, age ≥ 50 years, family history of knee OA, self-awareness, and clinical diagnosis of the disease entity, were significantly associated with knowledge scores. CONCLUSION The finding of a low level knee OA knowledge among Malaysian railway workers points to an urgent need for massive information to be disseminated among the workers at risk to foster primary prevention and self-care.
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Affiliation(s)
- Kurubaran Ganasegeran
- International Medical School, Management and Science University (MSU), Shah Alam 40100 Selangor, Malaysia
| | - J. Michael Menke
- International Medical University (IMU), 57000 Bukit Jalil, Kuala Lumpur, Malaysia
| | | | - Rizal Abdul Manaf
- Community Health Department, Faculty of Medicine, Universiti Kebangsaan Malaysia (UKM), Cheras, 56000 Kuala Lumpur, Malaysia
| | - Aied M. Alabsi
- Department Oral Biology and Biomedical Science, Faculty of Dentistry, University of Malaya (UM), 50603 Petaling Jaya, Kuala Lumpur, Malaysia
| | - Sami Abdo Radman Al-Dubai
- Department of Community Medicine, International Medical University (IMU), 57000 Bukit Jalil, Kuala Lumpur, Malaysia
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van der Burg LRA, Boonen A, van Amelsvoort LGPM, Jansen NWH, Landewé RBM, Kant I. Effects of Cardiovascular Comorbidities on Work Participation in Rheumatic Diseases: A Prospective Cohort Study Among Working Individuals. Arthritis Care Res (Hoboken) 2013; 66:157-63. [DOI: 10.1002/acr.22095] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2012] [Accepted: 07/29/2013] [Indexed: 01/08/2023]
Affiliation(s)
| | - Annelies Boonen
- CAPHRI School for Public Health and Primary Care, Maastricht University, and Maastricht University Medical Center; Maastricht The Netherlands
| | | | - Nicole W. H. Jansen
- CAPHRI School for Public Health and Primary Care, Maastricht University; Maastricht The Netherlands
| | | | - Ijmert Kant
- CAPHRI School for Public Health and Primary Care, Maastricht University; Maastricht The Netherlands
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Wilkie R, Phillipson C, Hay E, Pransky G. Frequency and predictors of premature work loss in primary care consulters for osteoarthritis: prospective cohort study. Rheumatology (Oxford) 2013; 53:459-64. [PMID: 24136068 PMCID: PMC3930884 DOI: 10.1093/rheumatology/ket336] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Objective. The objective of this study was to describe the extent of premature work loss (PWL) in OA consulters across a 6-year observation period, and associated factors. Methods. We conducted a population-based prospective cohort study set in primary care. Participants were 1098 adults age 50 years to statutory retirement age at baseline, who completed questionnaires at baseline, 3- and 6-year follow-ups. OA was defined by consultation to primary care (Read code N05) during the study period. PWL was defined as retirement prior to state retirement age (65 years for men, 60 years for women), off work due to health or unemployment. The frequency of PWL was calculated overall and stratified by consultation for OA. Bivariate and multivariate logistic regression was used to investigate the predictors of PWL in consulters for OA. Results. Over the 6-year study period, one in four consulters for OA left the workplace prematurely. Predictors included being male, pain interference with function and lower co-worker support, but not the extent of arthritis, co-morbidity, obesity or psychological or other job factors. Conclusion. PWL in persons consulting primary care general practitioners with OA is common. Those at risk could be identified by brief questions about pain interference with function and workplace support. These results suggest that early identification, treatment strategies focusing on maintaining function and maximizing workplace support should be investigated for their potential to prevent PWL. Good communication with employers may help to improve support for workers with OA.
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Affiliation(s)
- Ross Wilkie
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire ST5 5BG, UK.
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Sankar A, Davis AM, Palaganas MP, Beaton DE, Badley EM, Gignac MA. Return to work and workplace activity limitations following total hip or knee replacement. Osteoarthritis Cartilage 2013; 21:1485-93. [PMID: 23774473 DOI: 10.1016/j.joca.2013.06.005] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2013] [Revised: 04/30/2013] [Accepted: 06/05/2013] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Total hip (THR) and knee (TKR) replacements increasingly are performed on younger people making return to work a salient outcome. This research evaluates characteristics of individuals with early and later return to work following THR and TKR. Additionally, at work limitations pre-surgery and upon returning to work, and factors associated with work limitations were evaluated. METHODS 190 THR and 170 TKR of a total 931 cohort participants were eligible (i.e., working or on short-term disability pre-surgery). They completed questionnaires pre-surgery and 1, 3, 6 and 12 months post-surgery that included demographics, type of occupation, and the Workplace Activity Limitations Scale (WALS). RESULTS 166 (87%) and 144 (85%) returned to work by 12 months following THR and TKR, respectively. Early (1 month) return to work was associated with, male gender, university education, working in business, finance or administration, and low physical demand work. People with THR returned to work earlier than those with TKR. For both groups, less pain and every day functional limitations were associated with less workplace activity limitations at the time return to work. CONCLUSIONS The majority of individuals working prior to surgery return to work following hip or knee replacement for osteoarthritis (OA) and experience fewer limitations at work than pre-surgery. The changing workforce dynamics and trends toward surgery at younger ages mean that these are important outcomes for clinicians to assess. Additionally, this is important information for employers in understanding continued participation in employment for people with OA.
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Affiliation(s)
- A Sankar
- Health Care and Outcomes Research, Toronto Western Research Institute, University Health Network, Toronto, Canada
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Neogi T. The epidemiology and impact of pain in osteoarthritis. Osteoarthritis Cartilage 2013; 21:1145-53. [PMID: 23973124 PMCID: PMC3753584 DOI: 10.1016/j.joca.2013.03.018] [Citation(s) in RCA: 949] [Impact Index Per Article: 86.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2013] [Revised: 03/27/2013] [Accepted: 03/29/2013] [Indexed: 02/02/2023]
Abstract
Osteoarthritis (OA) is the most common form of arthritis and a leading cause of disability worldwide, largely due to pain, the primary symptom of the disease. The pain experience in knee OA in particular is well-recognized as typically transitioning from intermittent weight-bearing pain to a more persistent, chronic pain. Methods to validly assess pain in OA studies have been developed to address the complex nature of the pain experience. The etiology of pain in OA is recognized to be multifactorial, with both intra-articular and extra-articular risk factors. Nonetheless, greater insights are needed into pain mechanisms in OA to enable rational mechanism-based management of pain. Consequences of pain related to OA contribute to a substantial socioeconomic burden.
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Affiliation(s)
- T Neogi
- Clinical Epidemiology Research and Training Unit, Boston University School of Medicine, Boston, MA 02118, USA.
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Ruiz D, Koenig L, Dall TM, Gallo P, Narzikul A, Parvizi J, Tongue J. The direct and indirect costs to society of treatment for end-stage knee osteoarthritis. J Bone Joint Surg Am 2013; 95:1473-80. [PMID: 23965697 DOI: 10.2106/jbjs.l.01488] [Citation(s) in RCA: 139] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Although total knee arthroplasty for end-stage osteoarthritis is a cost-effective procedure, payers are focusing on its indications and cost because of its high and growing use. Improvements in pain and physical function from total knee arthroplasty could yield benefits in the form of increased work life and lower disability payments. The purpose of this study was to estimate the value of total knee arthroplasty from a societal perspective, including the costs and benefits to patients, employers, and payers. METHODS A Markov model was used to estimate the value of total knee arthroplasty for patients with end-stage osteoarthritis of the knee by comparing direct and indirect costs between surgical and nonsurgical treatment scenarios. Direct costs included all medical costs for surgical and nonsurgical treatment of osteoarthritis of the knee. Indirect costs were related to lost wages due to an inability to work, lower earnings, or receipt of disability payments. Direct and indirect costs and quality-of-life measures were incorporated into the Markov model to estimate the impact of total knee arthroplasty on costs over patients' lifetimes and quality-adjusted life years. The assumptions used in the model were developed with use of claims and survey data as well as clinical expert opinion and the peer-reviewed literature. RESULTS Compared with nonsurgical treatment, total knee arthroplasty increased lifetime direct costs by a mean of $20,635 (net present value in 2009 U.S. dollars). These costs were offset by societal savings of $39,565 from reduced indirect costs, resulting in a lifetime societal net benefit from total knee arthroplasty of $18,930 per patient. Eighty-five percent of these savings originated from increased employment and earnings, with the remaining 15% from fewer missed workdays and lower disability payments. CONCLUSIONS The estimated lifetime societal savings from the more than 600,000 total knee arthroplasties performed in the U.S. in 2009 were estimated to be approximately $12 billion. These societal savings primarily accrued to patients and employers. The study demonstrates the importance of a societal perspective when considering the costs and benefits of total knee arthroplasty and policies that will affect access to this procedure.
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Affiliation(s)
- David Ruiz
- KNG Health Consulting, 1445 Research Boulevard, Suite 320, Rockville, MD 20850, USA
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Wilkie R, Pransky G. Improving work participation for adults with musculoskeletal conditions. Best Pract Res Clin Rheumatol 2013; 26:733-42. [PMID: 23218435 DOI: 10.1016/j.berh.2012.08.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/20/2012] [Indexed: 10/27/2022]
Abstract
The impact of musculoskeletal disorders on work is demanding more attention from clinicians. For many rheumatologists, inflammatory arthritis is the most frequently encountered condition that interferes with work. However, the cumulative burden of non-inflammatory arthropathies and disorders such as back pain, osteoarthritis and limb pain as a whole results in a much greater economic and human cost to society than inflammatory disease. New conceptual approaches and research results support the view that work loss does not need to be a frequent consequence of a musculoskeletal disorder or disability. This is often accomplished through a biopsychosocial and interdisciplinary approach, involving interaction between those with a musculoskeletal condition, their clinicians and employers. This review outlines the challenges and draws on the results of empirical studies to highlight potential opportunities to promote sustained ability for patients to successfully remain on the job. It also outlines future research opportunities.
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Affiliation(s)
- Ross Wilkie
- Arthritis Research UK National Primary Care Centre, Keele University, Keele, Staffordshire ST5 5BG, UK.
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Abstract
BACKGROUND Changing demographics mean that many patients with large joint arthritis will work beyond traditional retirement age. This review considers the impact of knee osteoarthritis (OA) on work participation and the relation between work and total knee replacement (TKR). SOURCES Two systematic searches in Embase and Medline, supplemented by three systematic reviews. AREAS OF AGREEMENT Probably, although evidence is limited, knee OA considerably impairs participation in work (labour force participation, work attendance and work productivity). AREAS OF UNCERTAINTY/RESEARCH NEED: Little is known about effective interventions (treatments, work changes and policies) to improve vocational participation in patients with knee OA; or how type of work affects long-term clinical outcomes (e.g. pain, function and the need for revision surgery) in patients with TKRs. The need for such research is pressing and opportune, as increasing numbers of patients with knee OA or TKR expect to work on.
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Affiliation(s)
- Keith T Palmer
- MRC Lifecourse Epidemiology Unit, University of Southampton, UK.
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