Sickness absence from back pain, psychosocial work characteristics and employment grade among office workers

Exploring environmental cues to instigate physical movement in the workplace

Background

With the increase of sedentary jobs and the health risks associated with a sedentary lifestyle, finding novel methods to increase physical activity should be a priority. Environmental cues within the workplace can serve as cues to action for initiating light physical activity.

Aim

To qualitatively explore the environmental cues that can instigate light physical activity within an office workplace context. Identification of these cues can inform behaviour change programmes designed to promote habitual physical movement within the workplace.

Method

Purposive sampling was used to recruit full-time sedentary office workers who self-report as having a highly sedentary job. Interviews followed a semi-structured design and thematic analysis was used to explore environmental cues within commercial, home, and mixed office settings.

Results

Forty-three office workers were interviewed, 16 from a commercial office, 12 from a home office, and 15 with a flexible work arrangement whereby they worked from both a commercial and home office. The findings of this study indicate that across all three groups the main instigator of movement was influenced by office layout (e.g. getting up for beverages and taking bathroom breaks), social environment (e.g. informal and formal meetings), and taking active breaks, both job-related (e.g. printing and filing) and non-job-related (e.g. household chores).

Conclusions

These findings provide valuable insight for behaviour change programmes utilising environmental cues to inform habit-based interventions designed to instigate movement within the workplace.

Wearable Motion Analysis System for Thoracic Spine Mobility With Inertial Sensors

This study presents a wireless wearable portable system designed for the automatic quantitative spatio-temporal analysis of continuous thoracic spine motion across various planes and degrees of freedom (DOF). This includes automatic motion segmentation, computation of the range of motion (ROM) for six distinct thoracic spine movements across three planes, tracking of motion completion cycles, and visualization of both primary and coupled thoracic spine motions. To validate the system, this study employed an Inter-days experimental setting to conduct experiments involving a total of 957 thoracic spine movements, with participation from two representatives of varying age and gender. The reliability of the proposed system was assessed using the Intraclass Correlation Coefficient (ICC) and Standard Error of Measurement (SEM). The experimental results demonstrated strong ICC values for various thoracic spine movements across different planes, ranging from 0.774 to 0.918, with an average of 0.85. The SEM values ranged from 0.64° to 4.03°, with an average of 1.93°. Additionally, we successfully conducted an assessment of thoracic spine mobility in a stroke rehabilitation patient using the system. This illustrates the feasibility of the system for actively analyzing thoracic spine mobility, offering an effective technological means for non-invasive research on thoracic spine activity during continuous movement states.

Dual processing approach to sedentary behavior and physical activity in the workplace

Regular physical activity is an important health promoting behavior. Yet, many adults live sedentary lifestyles, especially during their workday. The current study applies an extended theory of planned behavior model, incorporating affective attitudes and instrumental attitudes, along with habit, to predict limiting sedentary behavior and physical activity within an office environment. Theory of planned behavior constructs and habit were assessed with an online survey on a sample of 180 full-time office workers, with self-reported behavior assessed 1 week later (Mage = 25.97, SDage = 10.24; 44 males, 134 females, and 2 nonbinary). Model fit was indicated by BRMSEA (M = 0.057, SD = 0.023), B γ^ (M = 0.984, SD = 0.010) and BCFI (M = 0.959, SD = 0.026), accounting for 46.1% of variance in intention, 21.6% of variance in sedentary behavior, and 17.4% of variance in physical activity behavior. A Bayesian structural equation model revealed direct effects of instrumental attitudes and perceived behavioral control on intention to limit sedentary behavior, direct effects of intention and perceived behavioral control on limiting sedentary behavior, and direct effects of perceived behavioral control and habit on engaging in physical activity. The current study indicates intentions to be active in the office are primarily driven by beliefs about the benefits of activity and individuals' perceived level of control, rather than normative or affective beliefs. As behavior was predicted by both intention and habit, findings also indicate office-based activity is likely not always a consciously driven decision. These findings may have implications for improving activity levels in this highly sedentary population.

Physical Movement Habit Formation in Sedentary Office Workers: Protocol Paper

Engaging in physical movement has a number of mental and physical health benefits, and yet 45% of Australia's population do not meet the recommended guidelines for physical activity. The current study aims to develop an online habit-based intervention designed to reduce sedentary behavior within the workplace, using environmental cues to instigate simple behavioral changes. Participants in this study will include full time office workers who self-report as having a highly sedentary job and work from either a commercial office, home office, or a mixture of both. Participants will complete a habit-based intervention over a four-week period designed to reduce sedentary behavior by increasing habitual responses to simple physical movement behaviors cued by their environment. Analysis will involve mixed methods ANOVAs to test the efficacy of the intervention. A successful intervention will show a reduction in sedentary behavior as a response to habitual simple physical movement behaviors.

Sickness Absence and Disability Pension in the Trade and Retail Industry: A Prospective Cohort Study of 192,000 White-Collar Workers in Sweden

OBJECTIVE

This study aimed to investigate future sickness absence (SA) and disability pension (DP) among privately employed white-collar employees in the trade and retail industry.

METHODS

A prospective population-based cohort study of all 192,077 such workers in Sweden in 2012, using linked microdata from nationwide registers, was conducted. Descriptive statistics of annual SA/DP during 2010 to 2016 and logistic regression for SA/DP in 2016 were used.

RESULTS

Women had more mean SA/DP net days/person; however, there were no sex differences in the mean number of net days/person with SA/DP. The mean number of net days/person increased, especially with mental diagnoses. Sickness absence in 2012 was the strongest factor associated with SA/DP in 2016 (women: odds ratio, 3.28; 95% confidence interval, 3.09-3.47; men: odds ratio, 4.10; 95% confidence interval, 3.76-4.48). Work-related factors were weakly associated with future SA/DP.

CONCLUSIONS

The number of SA/DP net days per person increased, especially SA/DP days due to mental diagnoses.

Evaluating Different Measures of Low Back Pain Among U.S. Manual Materials Handling Workers: Comparisons of Demographic, Psychosocial, and Job Physical Exposure

OBJECTIVE

To examine differences in demographic, psychosocial, and job physical exposure risk factors between multiple low back pain (LBP) outcomes in a prospective cohort of industrial workers.

BACKGROUND

LBP remains a leading cause of lost industrial productivity. Different case definitions involving pain (general LBP), medication use (M-LBP), seeking healthcare (H-LBP), and lost time (L-LBP) are often used to study LBP outcomes. However, the relationship between these outcomes remains unclear.

METHOD

Demographic, health status, psychosocial, and job physical exposure risk factors were quantified for 635 incident-eligible industrial workers. Incident cases of LBP outcomes and pain symptoms were quantified and compared across the four outcomes.

RESULTS

Differences in age, gender, medical history, and LBP history were found between the four outcomes. Most incident-eligible workers (67%) suffered an LBP outcome during follow-up. Cases decreased from 420 for LBP (25.4 cases/100 person-years) to 303 for M-LBP (22.0 cases/100 person-years), to 151 for H-LBP (15.6 cases/100 person-years), and finally to 56 for L-LBP (8.7 cases/100 person-years). Conversely, pain intensity and duration increased from LBP to H-LBP. However, pain duration was relatively lower for L-LBP than for H-LBP.

CONCLUSION

Patterns of cases, pain intensity, and pain duration suggest the influence of the four outcomes. However, few differences in apparent risk factors were observed between the outcomes. Further research is needed to establish consistent case definitions.

APPLICATION

Knowledge of patterns between different LBP outcomes can improve interpretation of research and guide future research and intervention studies in industry.

Recurrent pain and work disability: a record linkage study

Purpose

We examined the associations between recurrent single- and multisite pain and incident sickness absence (SA) of different lengths and the risk of disability pension (DP).

Methods

The data were derived from the Finnish Helsinki Health Study. Pain measures were recorded for panel 1 in 2000/2 and 2007, and for panel 2 in 2007 and 2012 (altogether 3191 employees). SA data were obtained from the employer’s personnel register and DP events from the Finnish Centre for Pensions. Negative binomial regression models with generalized estimation equations were used to model the incidence of self-certified short- (1–3 days), and medically certified medium- (4–14 days) and long-term (more than 14 days) SA episodes. Cox regression models were fitted for the associations between pain and all-cause DP and competing risk models for DP by diagnostic groups. Social and health-related covariates were adjusted for.

Results

Recurrent pain was associated with short-, medium- and long-term SA. Additionally, recurrent single- and multisite pain increased the risk of long-term SA. Recurrent single or multisite pain was further associated with an increased risk of DP, while a single instance of pain did not increase the risk.

Conclusions

These results suggest that recurrent pain is a robust determinant of subsequent SA and DP risk. Improved understanding of determinants of recurrent pain is needed to inform the development of targeted measures to reduce SA and premature exit from employment.

Electronic supplementary material

The online version of this article (10.1007/s00420-019-01494-5) contains supplementary material, which is available to authorized users.

The association between psychological and social factors and spinal pain in adolescents

Spinal pain, back pain, and/or neck pain begins early in life and is strongly associated with spinal pain in adulthood. Understanding the relationship between psychological and social factors and adolescent spinal pain may be important in both the prevention and treatment of spinal pain in this age group. We aimed to determine if psychological and social factors were associated with spinal pain in a cross-sectional study of a school-based cohort of 1279 Danish adolescents aged 11-13, who were categorized into "any" and "substantial" spinal pain. "Substantial spinal pain" was defined as a lifetime frequency of "sometimes" or "often" and a pain intensity of at least two on the revised Faces Pain Scale. Logistic regression analyses, stratified by sex, were conducted for single and all variables together. Eighty-six percent of participants reported "any spinal pain" and 28% reported "substantial spinal pain". Frequency of psychological and social factors was significantly higher in those with spinal pain compared to those without. As the frequency of psychological and social factors increased, the odds of both "any spinal pain" and "substantial spinal pain" also increased.Conclusion: Psychological and social factors may be important determinants in adolescent spinal pain. What is Known: • Spinal pain begins early in life to reach adult levels by age 18. Spinal pain in adolescence is strongly associated with spinal pain in adulthood. • In adults, psychological and social factors and spinal pain are strongly related; however, this relationship in adolescence is poorly understood. What is New: • Adolescents with spinal pain reported a significantly higher frequency of psychological factors and loneliness and lower levels of pupil acceptance. • Adolescents reporting higher levels of loneliness, lower levels of pupil acceptance, and increased frequency of psychological factors had increased odds of reporting "substantial spinal pain".

Recurrent back pain during working life and exit from paid employment: a 28-year follow-up of the Whitehall II Study

OBJECTIVES

To examine the impact of recurrent, as compared with single, reports of back pain on exit from paid employment over decades of follow-up.

METHODS

The study sample was from the British Whitehall II Study cohort (n=8665, 69% men, aged 35-55 at baseline), who had provided information about their reports of back pain between 1985 and 1994. Data about exit from paid employment (health-related and non-health related exit, unemployment and other exit) were collected between 1995 and 2013. Repeated measures logistic regression models were fitted to examine the associations, and adjust for covariates.

RESULTS

Recurrent pain was reported by 18% of participants, while 26% reported pain on an occasion and 56% did not report pain. Report of back pain on an occasion was not associated with health-related job exit, whereas recurrent pain was associated with such an exit (OR 1.51; 95% CI 1.15 to 1.99), when compared with those who did not report pain. These associations were somewhat stronger among middle-grade and lower-grade employees, while these associations were not seen among higher-grade employees. Differences in associations by age and psychosocial working conditions were small.

CONCLUSIONS

These results highlight the need for early detection of recurrent back pain to prevent exit out of paid employment for health reasons. As the risk varies by occupational grade, this emphasises the importance of identification of high-risk groups and finding ways to address their modifiable risk factors.

Association Between Exercise and Low Back Pain Resulting in Modified Duty and Lost Time: A Cross-Sectional Analysis of an Occupational Population

OBJECTIVE

The aim of the study was to assess the relationship between leisure time exercise and whether workers ever had modified duty or lost time (MD/LT) due to low back pain (LBP) in an occupational cohort.

METHODS

Workers (N = 827) completed a structured interview assessing characteristics of their LBP, whether or not the pain caused modified or lost work time, and their participation in leisure time exercise. Odds ratio of modified/lost time and minutes of exercise participation were assessed.

RESULTS

Workers who participated in over 316 min/wk of leisure time exercise incurred significantly less modified/lost time, adjusted odds ratio = 0.46 (95% confidence interval, 0.23 to 0.98). There also lies a significant trend between increases in leisure time exercise and reductions in modified/lost time (P = 0.0016).

CONCLUSION

These results suggest exercise reduces risk of MD/LT from LBP.

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

Objectives

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

Methods

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

Results

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

Conclusions

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

Occupational class differences in diagnostic-specific sickness absence: a register-based study in the Finnish population, 2005-2014

BACKGROUND

Musculoskeletal diseases and mental disorders are major causes of long-term sickness absence in Western countries. Although sickness absence is generally more common in lower occupational classes, little is known about class differences in diagnostic-specific absence over time. Focusing on Finland during 2005-2014, we therefore set out to examine the magnitude of and changes in absolute and relative occupational class differences in long-term sickness absence due to major diagnostic causes.

METHODS

A 70-per-cent random sample of Finns aged 25-64 linked to register data on medically certified sickness absence (of over 10 working days) in 2005-2014 was retrieved from the Social Insurance Institution of Finland. Information on occupational class was obtained from Statistics Finland and linked to the data. The study focused on female (n = 658,148-694,142) and male (n = 604,715-642,922) upper and lower non-manual employees and manual workers. The age-standardised prevalence, the Slope Index of Inequality (SII) and the Relative Index of Inequality (RII) were calculated for each study year to facilitate examination of the class differences.

RESULTS

The prevalence of each diagnostic cause of sickness absence declined during the study period, the most common causes being musculoskeletal diseases, mental disorders and injuries. The prevalence of other causes under scrutiny was less than 1 % annually. By far the largest absolute and relative differences were in musculoskeletal diseases among both women and men. Moreover, the absolute differences in both genders (p < 0.0001) and the relative differences in men (p < 0.0001) narrowed over time as the prevalence declined most among manual workers. Both genders showed modest and stable occupational class differences in mental disorders. In the case of injuries, no major changes occurred in absolute differences but relative differences narrowed over time in men (p < 0.0001) due to a strong decline in prevalence among manual workers. Class differences in the other studied diagnostic causes under scrutiny appeared negligible.

CONCLUSIONS

By far the largest occupational class differences in long-term sickness absence concerned musculoskeletal diseases, followed by injuries. The results highlight potential targets for preventive measures aimed at reducing sickness absence and narrowing class differences in the future.

Socio-economic factors associated with the 1‑year prevalence of severe pain and pain-related sickness absence in the Austrian population

Background

The aim of this study was to (1) investigate the relation of socio-economic status (SES), measured as education, occupation, and income, with the 12-month prevalence of severe pain and with pain-related sickness absence, and (2) analyse to what extent sociodemographic and medical factors influence these associations.

Methods

The study population comprised 8084 subjects aged between 15 and 65 years from the Austrian Health Interview Survey in 2006/07. Associations of SES with the 1‑year prevalence of severe pain and sickness absence due to pain in those with severe pain was assessed with logistic regression analysis and adjusted for socio-demographic and chronic medical conditions.

Results

The 1‑year prevalence of severe pain was 33.7%. Among those with severe pain, 32.9% were on sickness absence due to pain. SES was significantly associated with the prevalence of severe pain and even more strongly with sickness absence due to pain. Stepwise adjustment for socio-demographics and medical factors had only marginal effects on these associations. Multivariate odds ratios (ORs) for severe pain were 1.14; 1.18 and 1.32 for low income, blue-collar workers, and low education, respectively. Related ORs for sickness absence due to pain were 1.52; 1.14 and 2.05.

Conclusions

There was an association between SES, particularly measured as educational level, and the prevalence of severe pain, which was even stronger with sickness absence due to pain.

Spinal pain and co-occurrence with stress and general well-being among young adolescents: a study within the Danish National Birth Cohort

This study aims to describe the patterns in low back, mid back, and neck pain complaints in young adolescents from the Danish National Birth Cohort (DNBC) and to investigate the co-occurrence of spinal pain and stress and general well-being, respectively. Cross-sectional data from the 11-year follow-up of DNBC were used. As part of a web-based survey, a total of 45,371 young adolescents between 10 and 14 years old completed the Young Spine Questionnaire, the Stress in Children Questionnaire, and a one-item question on general well-being. Associations between spinal pain and, respectively, stress and general well-being were estimated by means of multiple logistic regression models. Almost one fifth of boys and one quarter of girls reported spinal pain. Compared with adolescents who reported no stress, adolescents reporting medium and high values of stress had odds ratios (OR) of 2.19 (95% CI 2.08-2.30) and 4.73 (95% CI 4.28-5.23), respectively, of reporting spinal pain (adjusted for age, gender, and maternal education). Adolescents who reported poor general well-being had an OR of 2.50 (95% CI 2.31-2.72) for reporting spinal pain compared to adolescents with good general well-being.

CONCLUSION

Spinal pain is a common complaint among young adolescents and co-occurs with stress and poor general well-being. The mutual dependency between the factors remained to be explained. What is Known: • The prevalence of spinal pain increases rapidly during childhood and adolescence, but different measurement instruments result in great variation in the estimates of spinal pain in children and adolescents. • Some studies have shown that different psychosocial measures are associated with spinal pain in children and adolescents. What is New: • Spinal pain, as measured by the newly developed and validated Young Spine Questionnaire, is a common complaint in young adolescents aged 10-14 years. • Spinal pain in young adolescents co-occurs with stress and poor general well-being.

Does educational attainment increase the risk of low back pain when genetics are considered? A population-based study of Spanish twins

BACKGROUND CONTEXT

There is limited research investigating educational attainment as a risk factor for low back pain (LBP), with the influence of gender commonly being neglected. Furthermore, genetics and early shared environment explain a substantial proportion of LBP cases and need to be controlled for when investigating risk factors for LBP.

PURPOSE

To investigate whether educational attainment affects the prevalence and risk of LBP differently in men and women while controlling for the influence of genetics and early shared environment.

STUDY DESIGN

This is a cross-sectional and prospective twin case-control study.

PATIENT SAMPLE

Adult monozygotic (MZ) and dizygotic (DZ) twins from the Murcia Twin Registry, with available data on educational attainment, formed the base sample for this study. The prevalence analysis considered twins with available data on LBP in 2013 (n=1,580). The longitudinal analysis considered twins free of LBP at baseline (2009-2011), with available data on LBP at follow-up (2013) (n=1,077).

OUTCOME MEASURES

Data on the lifetime prevalence of activity limiting LBP (outcome) and educational attainment (risk factor) were self-reported.

METHODS

The prevalence analysis investigated the cross-sectional association between educational attainment and LBP, whereas the longitudinal analysis investigated whether educational attainment increased the risk of developing LBP. Both analyses were performed in the following sequence. First, a total sample analysis was performed on all twins (considering them as individuals), adjusting for confounding variables selected by the data. Second, to control for the influence of genetics and early shared environment, a within-pair case-control analysis (stratified by zygosity) was performed on complete twin pairs discordant for LBP (ie, one twin had LBP, whereas the co-twin did not). All analyses were stratified for gender where possible, with an interaction term determining whether gender was a significant moderator of the association between educational attainment and LBP.

RESULTS

Women with either general secondary or university education were less likely to experience (prevalence analysis) or to develop LBP (longitudinal analysis). Educational attainment did not affect the risk of LBP in men. When controlling for the effects of genetics and early shared environment, the relationship between educational status and LBP in women was no longer statistically significant.

CONCLUSIONS

Educational attainment affects LBP differently in men and women, with higher levels of education only decreasing the risk of developing LBP in women. After adjusting for genetics and early shared environment, the relationship between educational attainment and LBP in women disappears. This suggests that genetics and early shared environment are confounding the relationship between educational attainment and LBP in women.

The Positive Effect of Resilience on Stress and Business Outcomes in Difficult Work Environments

OBJECTIVE

To examine whether resilience has a protective effect in difficult work environments.

METHODS

A survey of 2063 individuals measured individual resilience, stress, burnout, sleep problems, likelihood of depression, job satisfaction, intent to quit, absences, and productivity. It also measured work characteristics: job demands, job influence, and social support. Multivariate and logistic regression models examined the main effects and interactions of resilience and job characteristics.

RESULTS

High strain work environments (high demand, low influence, and low support) have an unfavorable effect on all outcomes. Resilience has a protective effect on all outcomes. For stress, burnout, and sleep, higher resilience has a more protective effect under low-strain conditions. For depression, absence and productivity, resilience has a more protective effect when job strain is high.

CONCLUSIONS

Workers with high resilience have better outcomes in difficult work environments.

Association between psychosocial job characteristics and sickness absence due to low back symptoms using combined DCS and ERI models

OBJECTIVE

To evaluate the combined demand-control-support (DCS) and effort-reward-overcommitment (ERI-OC) stress models in association with sickness absence due to low back symptoms (SA-LBS).

METHODS

A total of 2,737 blue-collar workers recruited from 13 companies in the most populous province (Henan) of China were included in the study. Personal and physical job characteristics, psychosocial scales of the stress models, and SA-LBS data in the preceding year were collected by a self-reported questionnaire and analyzed by a multivariable logistic regression model. Tertile exposure levels (low, medium and high) were constructed to discriminate a risk level. Odds ratios (OR) with 95% confidence intervals (CI) were used as the association with SA-LBS.

RESULTS

A large percentage (84.5%) of the Chinese workers did not take sick leave after reporting low back symptoms during the preceding year. High job demand or medium-high reward was associated with SA-LBS. The association of the combined stress models and SA-LBS was not evident.

CONCLUSIONS

The ERI-OC model appeared to be more predictive of SA-LBS than the DCS model in the study population. The advantage of using combined stress models for predicting SA-LBS is not evident.

Chapter 6. Sickness absence due to back and neck disorders

The scientific evidence on the causes for sick leave attributed to back and neck disorders was reviewed. Categories were established for acute, recurring, and chronic problems based on the duration of the sick leave period. Forty-eight articles were found to be relevant, whereof two were of high quality and 26 were of medium or low quality. Quality was assessed exclusively in relation to the aim of this systematic review. The results reveal limited published research on causes for sick leave from back and neck disorders. The generalisability of the findings is also limited since most of the subjects were men and employees in manufacturing industries. Women, white-collar workers, employees in the public sector (care, social services, schools, etc) were underrepresented in the studies. Hence, these groups and areas should be studied further to verify conclusions and enhance knowledge about the causes for sick leave from back and neck disorders. The following factors were found to have consistent, but limited, support as regards their influence on the risk for sick leave due to back and neck disorders: (a) heavy physical workload, bent or twisted working position, and low work satisfaction increases the risk for short-term and long-term sick leave; (b) specific back diagnoses and previous sick leave due to back disorders increases the risk for short-term and long-term sick leave; (c) female gender, smoking, exposure to vibration, and deficient social support were not found to significantly increase the risk for short-term and long-term sick leave; (d) self-reported pain and functional impairments were associated with a high risk for long-term sick leave; (e) longer employment periods reduced the risk for short-term sick leave; (f) perceived demands at work did not influence short-term sick leave; (g) female gender and higher age increases the risk for disability pension.

Work ability and duration of certified sickness absence

Aims: The aim of this study was to examine the association between assessed work ability and the duration of certified sickness absence. Methods: A total of 549 patients and 52 doctors provided questionnaire data about 549 episodes of absence. The episodes were classified as new, one month, or three months according to their duration at the time of questionnaire completion. Their duration after that was used as outcome. Uni-and multivariate Cox regression analyses were performed. Results: In the multivariate analyses, a ``very much reduced' ' work ability assessed by patients was associated with a longer duration than a ``moderately reduced' ' work ability, in both one- and three-month episodes. Musculoskeletal and psychological disorders were associated with a longer duration, and respiratory disorders with a shorter duration than other disorders in new episodes. Patient age above 50 years was associated with a longer duration than lower age in new and three-month episodes. The doctors' use of referral and tests in the consultations, and the presence of non-medical factors as judged by the patients, were associated with a longer duration than the absence of those factors in new episodes. The patients' degree of job satisfaction, and non-medical factors as judged by doctors, were significantly associated with duration only in univariate Cox regression analyses in new episodes. Work demands were not significantly associated with duration in any of the analyses. Conclusions: Work ability assessed by patients may be a useful prognostic indicator of duration in prolonged episodes of certified sickness absence. Further studies using other outcomes, such as disability pensioning, would be of interest to enlighten the concepts of work ability.

Do common symptoms in women predict long spells of sickness absence? A prospective community-based study on Swedish women 40 to 50 years of age

Aims: To investigate whether a high level of commonly experienced physical and mental symptoms could predict long spells of sickness absence in Swedish women and, further, to investigate the causal pattern of socioeconomic and psychosocial factors in relation to long spells of sickness absence. Methods: A questionnaire containing items on socioeconomic and psychosocial variables was sent to a random population of women, 40 to 50 years of age, living in a rural Swedish community. The response rate was 81.7% (397 women). Data on long spells of sickness absence (> 14 days) for the year following the baseline survey were obtained from the social insurance office. Odds ratios (OR) were used to estimate bivariate associations. Multiple logistic regression analysis was used to test for confounding and effect modification. Results: Women suffering from a high level of common symptoms were at risk of subsequent long spells of sickness absence, OR = 3.39 (1.86-6.17). High demands at work and an active job position (i.e. the combination of high demands and a high degree of job control) were both associated with long spells of sickness absence, OR = 2.16 (1.12-4.17) and OR=1.92 (1.01-3.67). The combined exposure (high level of common symptoms and an active job position) increased the odds for long spells of sickness absence (OR = 9.13; 3.39-24.58) with synergy noted. Conclusions: The finding that women with common symptoms are at risk of future sickness absence is of particular importance in a primary health care setting. The finding that women in active job positions had a higher risk of sickness absence might be an effect of modern working conditions for women.

Role clarity, fairness, and organizational climate as predictors of sickness absence

Aims: The majority of the research on the effects of the psychosocial work environment on sickness absenteeism has focused on components of job strain and social support among public sector employees without stratification by socioeconomic status. The authors examined less-studied work-related psychosocial predictors of sickness absence in the private sector by socioeconomic status. Methods: Questionnaire data on psychosocial factors at work were used to predict the rates of recorded short (1 - 3 days), long (4 - 21 days), and very long (over 21 days) sickness absences among 3,850 white- and blue-collar male and female employees in a large-scale enterprise. Multivariate Poisson regression models were adjusted for age, prior absence, and psychosocial factors at work. Results: In white-collar men, low role clarity was associated with a 3.0 (95% CI 1.3 - 7.1) times greater rate of very long absences than high role clarity. Low fairness in the division of labor predicted a 1.3-fold (95% CI 1.1 - 1.5) rate of long absences in blue-collar men. In blue-collar women, poor organizational climate was associated with a 1.6 (95% CI 1.0 - 2.5) times greater rate of short absence spells than favorable organizational climate but among white-collar women all associations between work-related psychosocial factors and sickness absenteeism were weak. Conclusions: These findings indicate that the actions to reduce psychosocial risk factors of sickness absence should match the specific needs of each socioeconomic group.

Outcome of stable angina in a working population: the burden of sickness absence

BACKGROUND

The decline in acute event rates among patients with stable angina emphasizes the need for outcome events that are commonly experienced, externally observed and sensitive to changing functional impairments. In the absence of previous studies, we sought to determine the burden of medically certified spells of sickness absence among individuals with angina and their relation to risk factors and co-morbidity.

DESIGN AND METHODS

A prospective study of 33 148 employees and 1 year experience of medically certified sickness absence in 341 physician-diagnosed angina patients (417 absence spells, total absence days 9733).

RESULTS

Among individuals with angina, sickness absence occurred at a rate of 125 spells per 100 person-years, with age and sex adjusted hazard ratios (compared with their colleagues with no chronic diseases) of 2.90 (95% confidence interval 2.51-3.36), greater than the effect of prolapsed intervertebral disc. Co-morbid diseases were stronger predictors of absence than behavioural risk factors or cardiovascular diseases, and explained 71% of the excess risk of absence in angina.

CONCLUSION

In a working population, angina has a significant impact on sick leave, largely because of co-morbid diseases. Angina intervention studies that include employed patients should measure, and seek to reverse, this prognostic burden.

Sickness absence due to musculoskeletal diagnoses: association with occupational gender segregation

Background: Musculoskeletal disorders represent a considerable public health problem and the most common diagnoses behind sickness absence and disability pensions. However, little is known about how sickness absence with these diagnoses varies with the strong gender segregation of the labour market. Aims: A study was undertaken to investigate the association between musculoskeletal-related sickness absence and occupational gender segregation. Methods: The study was population based, and included all new sick-leave spells exceeding seven days due to musculoskeletal diagnoses, comprising neck/ shoulder pain, low back pain, and osteoarthritis in Östergötland county, Sweden, which has 393,000 inhabitants (5% of the national population). The participants were all sick-leave insured employed persons in Östergötland (n=182,663) in 1985. Results: Cumulative incidence of musculoskeletal-related sickness absence (>7 days) was higher for women (7.5%, 95% confidence interval [C.I.] 7.3-7.7) than for men, (5.8%, C.I. 5.6-5.9), and the same was true for the mean number of sick-leave days (women 81, C.I. 78-83; men 65, C.I. 63-68). Grouping occupations according to degree of numerical gender segregation revealed the highest incidence and duration of sickness absence for women in male-dominated occupations. For both genders, the lowest cumulative incidence and duration occurred in gender-integrated occupations. Conclusions: Our results indicate a strong association between occupational gender segregation and musculoskeletal-related sickness absence. Further studies are needed to elucidate gender segregation of the labour market in relation to health and rehabilitation measures.

Risk factors for disability pension over 11 years in a cohort of young persons initially sick-listed with low back, neck, or shoulder diagnoses

Aim: A study was undertaken to ascertain whether the differences in risk in relation to gender and citizenship observed in a previous study of the same cohort would remain if more recent data on sickness absence were used. Methods: This was an 11-year prospective population-based cohort study. The dataset includes all individuals in a Swedish city who, in 1985, were aged 25 - 34 and had a sick-leave spell≥28 days with neck, shoulder, or back diagnoses (n=213). The data covered the following: for 1985 - 96, disability pension, emigration, and death; for 1982 - 96, sickness absence; for 1985, sex and citizenship. The data were subjected to Cox regression analyses with a time-dependent covariate. Results: Disability pension was granted to 22% (n=46) of the cohort. The relative risk for disability pension increased by 9.3 with each sick-leave spell≥90 days during the two previous years. The risk was higher for women than men, and also higher for foreign citizens than Swedes. Conclusion: Many studies have revealed a gender difference in the risk of being on disability pension, and it was found that this difference was still apparent when sick leave during the follow-up period is taken into account. Thus, the reason for the gender differences ought to be found among other factors than prior levels of sickness absence.

Interaction between physical and psychosocial work risk factors for low back symptoms and its consequences amongst Indonesian coal mining workers

This study assessed the interaction between physical and psychosocial factors for low back symptoms (LBS) and its consequences (reduced activities and absenteeism) in a developing country. A sample of 1294 Indonesian coal mining workers reported occupational exposures, LBS and its consequences using a self-administered questionnaire. Respondents were placed into one of four combination exposure groups: high physical and high psychosocial (HPhyHPsy); high physical and low psychosocial (HPhyLPsy); low physical and high psychosocial (LPhyHPsy), and; low physical and low psychosocial (LPhyLPsy). The attributable proportion due to interaction between physical and psychosocial factors was examined. Individuals in the HPhyHPsy group were most likely to report LBS (OR 5.42, 95% CI 3.30-8.89), reduced activities (OR 4.89, 95% CI 3.09-7.74), and absenteeism (OR 4.96, 95% CI 3.05-8.06). Interactions between physical and psychosocial factors were present for LBS, reduced activities, and absenteeism; although for LBS and absenteeism the interactions were not significant. Current smokers were more likely to report LBS consequences. Permanent employment and night shift work increased the odds of LBS and its consequences. We conclude that interventions aimed at reducing LBS and its consequences should address both physical and psychosocial factors, with a focus on smokers, permanent employment and night shift work.

Psychosocial Risk Factors and Musculoskeletal Symptoms among White and Blue-collar Workers at Private and Public Sectors

OBJECTIVES

The aim of this study was to evaluate musculoskeletal and psychosocial perception and compare these conditions regarding the type of job (white or blue-collar) and the type of management model (private or public).

METHODS

Forty-seven public white-collar (PuWC), 84 private white-collar (PrWC) and 83 blue-collar workers (PrBC) were evaluated. Job Content Questionnaire (JCQ) and Utrecht Work Engagement Scale (UWES) were applied to evaluate psychosocial factors. Nordic Musculoskeletal Questionnaire (NMQ) was used to assess musculoskeletal symptoms. Pressure Pain Threshold (PPT) was measured to evaluate sensory responses.

RESULTS

According to JCQ, all groups were classified as active profile. There was a significant association between work engagement and workers' categories (p < 0.05). PrWC workers had the highest scores for all the UWES domains, while PrBC had the lowest ones. PPT showed that PrBC workers had an increased sensitivity for left deltoid (p < 0.01), and for both epicondyles (p < 0.01), when compared to the other groups. PrWC workers had an increased sensitivity for both epicondyles than PuWC (right p < 0.01; left, p = 0.05). There was no significant association in the report of symptoms across the groups (p > 0.05).

CONCLUSION

This study showed differences in psychosocial risk factors and musculoskeletal symptoms in workers engaged in different types of jobs and work organization. Personal and work-related characteristics, psychosocial factors and PPT responses were different across workers' group. Despite all, there was no significant difference in reported symptoms across the groups, possibly indicating that the physical load is similar among the sectors.

Design and development of a decision support package for low back pain

OBJECTIVE

To develop a decision support package for people with low back pain (LBP) referred for physiotherapy.

METHODS

We used a program of exploratory work, including literature reviews, a Delphi study, a nominal group with physiotherapists, focus groups with patients, and secondary analysis of existing interview data.

RESULTS

We developed an information booklet describing the evidence-based treatment modalities available in a physiotherapy department. This includes data on likely benefits and risks and how the intervention is delivered. The booklet specifically addresses questions identified as important in our exploratory work. Space is provided for patients to note down the pros and cons of each treatment and what matters to them when choosing treatments. The patient is subsequently directed to a section that explores any gaps in knowledge, values, support, and choice before finally clarifying if a treatment decision is possible. At this stage they are encouraged to note down any questions or concerns they have to be discussed at the first physiotherapy consultation. This overall package includes patient material in the form of a booklet posted prior to their consultation, plus the enhanced consultation with the specially trained physiotherapist. Patients then receive their chosen treatment. In addition we developed a training package for physiotherapists that explains the content of the booklet and supports them in using informed, shared decision making in their consultation.

CONCLUSION

This package has the potential to improve effectiveness of treatments and patient satisfaction for LBP by facilitating patient choice and therefore matching patients more effectively to different treatments.

[Age- and occupation-related differences in sick leave due to frequent musculoskeletal disorders. Low back pain and knee osteoarthritis]

Musculoskeletal disorders are the leading cause of sick leave. Because of the importance of back pain and knee osteoarthritis (ICD-10 diagnoses M54 and M17), these conditions are considered in detail. The aim of this study was to clarify whether job-specific differences in the incidence of sick leave events due to these disorders vary depending on age. The study was based on a secondary analysis of data on sick leave from almost all statutory health insurances in 2008. The database contains aggregated data on sick leave of approximately 26.2 million insured employees. The occurrence of sick leave events resulting from the M54 and M17 diagnoses was defined as the outcome variable. The assignment of employees to occupational groups (Blossfeld classification) was considered as the exposure variable. We calculated the morbidity ratios (SMR) of sick leave occurrence stratified by sex and age. The risk of sick leave was increased for both genders and for both diagnoses, particularly in the occupational groups of the production and service industries with low and medium skill level, even after stratification according to age. Sick leave due to these disorders is a significant issue in these occupations regardless of age, and must be considered with regard to social and preventive aspects.

Work characteristics, socioeconomic position and health: a systematic review of mediation and moderation effects in prospective studies

Social inequalities in health persist in modern societies. The contribution of adverse work and employment conditions towards their explanation is analysed by two approaches, mediation and moderation. Yet the relative significance of each approach remains unclear in respective research. We set out to study this question by conducting a systematic literature review. We included all original papers based on prospective observational studies of employed cohorts that were published between January 1980 and October 2012 meeting our search criteria, by using major databases and by observing established quality criteria. 26 reports were included after quality assessment. 17 studies examined the mediation hypothesis and nine studies tested the moderation hypothesis. Moderate support was found for the mediation hypothesis where OR or HR of health according to socioeconomic position (SEP) were reduced in a majority of analyses after introducing work characteristics in multivariate models. Evidence in favour of the moderation hypothesis was found in some studies, demonstrating stronger effects of adverse work on health among people with low SEP. Despite some support in favour of the two hypotheses future research should aim at reducing the heterogeneity in defining and measuring core variables and at applying advanced statistical analyses. Policy recommendations would benefit from a higher degree of consistency of respective research evidence.

Prevalence of low back symptoms and its consequences in relation to occupational group

BACKGROUND

The purpose of this study was to examine: (1) the prevalence of low back symptoms (LBS) and its consequences (reduced activities and absenteeism); (2) the association between occupational group and LBS; and (3) the association between LBS and its consequences.

METHODS

A self-administered questionnaire was used to determine the prevalence of LBS in 1,294 Indonesian coal mining workers. A Cox proportional hazards model was developed to quantify the 12-monthly hazard of LBS. Logistic regression models were developed to identify risk factors for reduced activity and absenteeism from the workplace.

RESULTS

The 12-month period prevalence for LBS, reduced activities, and absenteeism were 75%, 16%, and 13%, respectively. The 12-monthly hazard of LBS for blue-collar workers was 1.85 (95% CI: 1.06-3.25) times that of white-collar workers. LBS and smoking increased the risk of reduced activity and absenteeism.

CONCLUSIONS

Indonesian coal mining workers have a high prevalence of LBS. The findings imply that efforts to reduce LBS and in the workplace should focus on blue-collar workers. For smokers who report reduced activities and/or absenteeism, there should be a focus on rehabilitation and/or return-to-work programs.

Low back pain and sciatica prevalence and intensity reported in a Mediterranean country: ordinal logistic regression analysis

The objective of this retrospective cross-sectional study was to estimate the 6-month prevalence and severity of low back pain and sciatica in a representative sample of an adult Mediterranean population. The study group comprised a sample of 674 adults aged 20 years or older from a mainly (74.8%) urban population. Information regarding low back pain and sciatica prevalence and severity and its related aspects, as well as socioeconomic and demographic characteristics, was collected by personal interviews with a validated questionnaire. The association between the intensity of low back pain and sciatica with several sociodemographic parameters was tested using ordered univariate and multivariate logistic regression analysis.A total of 266 (39.5%) patients reported low back pain and 166 (24.6%) reported sciatica during the previous 6-month period. A woman living in a Mediterranean country reported low back pain of increased severity if she was a married housewife aged older than 65 years who was a smoker and suffered from depression. More severe sciatic pain was reported by working married women older than 65 years who were smokers.

Psychosocial work characteristics, need for recovery and musculoskeletal problems predict psychological distress in a sample of British workers

From an original sample of 2454 participants free of self-reported psychological distress, 1463 workers completed a 15-month follow-up. Baseline measures included exposure to job demands, decision latitude, social support and need for recovery. Psychological distress was assessed using the General Health Questionnaire at baseline and at follow-up. The findings showed that medium and high exposure to job demands and social support increased the risk of reporting psychological distress at 15-months (relative risk (RR) = 1.65, 1.45). The highest adjusted RR was observed for workers reporting a high need for recovery after work (RR 2.12, 1.90) and this finding was independent of the effects of job demands, decision latitude and social support. Neither decision latitude, nor low back problems increased the risk of reporting future psychological distress, although neck problems (RR = 1.66) and hand/wrist problems (RR = 1.45) did. It was concluded that need for recovery appears to be an important indicator of individual workers who are at risk of developing psychological distress long term. STATEMENT OF RELEVANCE: This paper reports the findings of a longitudinal study showing that need for recovery from work was the strongest predictor, relative to psychosocial work characteristics (job demands, decision latitude and social support), and musculoskeletal problems, of psychological distress 15 months later in individuals initially free from distress.

[Patients with low back pain. Psychosocial work-related factors and return to work - a literature review]

BACKGROUND

Since the 1990s work-related rehabilitation programs have gained more importance in orthopaedic rehabilitation. Although inception cohort studies of patients with low back pain have indicated the prognostic relevance of psychosocial work-related factors for return to work, these factors and the interaction of these factors with restrictions in functional capacity have been less extensively considered during the rehabilitation process so far.

METHODS

Systematic reviews on the course of low back pain were reviewed concerning the prognostic relevance of psychosocial work-related factors for return to work.

RESULTS

Seven reviews were comparable concerning the outcome analysed (return to work) and the populations considered (acute/subacute). These reviews confirmed that patients with low back pain and low social support from supervisors and colleagues, low decision latitude, high psychosocial work demands and a poor subjective prognosis have a lower chance of returning to work. The prognostic relevance of job satisfaction was contradictory.

CONCLUSION

Rehabilitation should be aimed at supporting and developing strategies for coping with psychosocial work stress.

Low back pain: what determines functional outcome at six months? An observational study

Background

The rise in disability due to back pain has been exponential with escalating medical and societal costs. The relative contribution of individual prognostic indicators to the pattern of recovery remains unclear. The objective of this study was to determine the prognostic value of demographic, psychosocial, employment and clinical factors on outcome in patients with low back pain

Methods

A prospective cohort study with six-month follow-up was undertaken at a multidisciplinary back pain clinic in central London employing physiotherapists, osteopaths, clinical psychologists and physicians, receiving referrals from 123 general practitioners. Over a twelve-month period, 593 consecutive patients referred from general practice with simple low back pain were recruited. A baseline questionnaire was developed to elicit information on potential prognostic variables. The primary outcome measures were change in 24-item Roland Morris disability questionnaire score at six months as a measure of low back related functional disability and the physical functioning scale of the SF-36, adjusted for baseline scores.

Results

Roland Morris scores improved by 3.8 index points (95% confidence interval 3.23 to 4.32) at six months and SF-36 physical functioning score by 10.7 points (95% confidence interval 8.36 to 12.95). Ten factors were linked to outcome yet in a multiple regression model only two remained predictive. Those with episodic rather than continuous pain were more likely to have recovered at six months (odds ratio 2.64 confidence interval 1.25 to 5.60), while those that classified themselves as non-white were less likely to have recovered (0.41 confidence interval 0.18 to 0.96).

Conclusions

Analysis controlling for confounding variables, demonstrated that participants showed greater improvement if their episodes of pain during the previous year were short-lived while those with Middle Eastern, North African and Chinese ethnicity demonstrated minimal improvement. The study did not support previous findings that a wide range of factors could predict outcome.

Relationship of a lifelong physical workload with physical function and low back pain in retired women

BACKGROUND AND AIMS

The effect of heavy work-related physical loads (WRPL) on low back pain (LBP) and impaired physical function has been studied extensively in active workers but not in pensioners.

METHODS

We compared LBP and physical function in post-menopausal pensioners, divided according to their life-long WRPL into 114 heavy physical workers (HPW), and 391 light physical workers (LPW). LBP and physical function (domains of mobility, home routines) were scored by a questionnaire. Data on age, age at menopause, number of years in retirement, age at menarche, number of pregnancies, body mass index (BMI), femoral neck bone density, WRPL, years spent at work, and smoking were also collected.

RESULTS

HPW were older (p=0.004), had worked fewer years (p=0.001), had reduced mobility (p=0.001), worse LBP (p=0.001) and performed home routine activities worse (p=0.001) than LPW. Logistic regression adjusted for confounders (LBP, home routines and mobility dichotomised at the median) showed that heavy WRPL, aging and high BMI were LBP risk factors, whereas heavy WRPL, high BMI and early menopause were mobility risk factors. The area under receiver-operating characteristic curves showed that predicted probabilities, derived from logistic models, predicted mobility (area 0.816, SE 0.020) better than pain (area 0.643, SE 0.024) (Hanley McNeil test p<0.001).

CONCLUSIONS

Lifelong heavy WRPL and high BMI seem to be risk factors for worse LBP and mobility in retired women. Mobility seems to be especially affected by these risk factors, and should be further investigated for prevention purposes.

Does job satisfaction improve the health of workers? New evidence using panel data and objective measures of health

This paper evaluates the relationship between job satisfaction and measures of health of workers using the German Socio-Economic Panel. Methodologically, it addresses two important design problems encountered frequently in the literature: (a) cross-sectional causality problems and (b) the absence of objective measures of physical health that complement self-reported measures of health status. Not only does using the panel structure with individual fixed effects mitigate the bias from omitting unobservable personal psycho-social characteristics, but employing more objective health measures such as health-system contacts and disability addresses such measurement problems relating to self-report assessments of health status.We find a positive link between job satisfaction (and changes over time therein) and subjective health measures (and changes therein); that is, employees with higher or improved job satisfaction levels feel healthier and are more satisfied with their health. This observation also holds true for more objective measures of health. Particularly, improvements in job satisfaction over time appear to prevent workers from (further) health deterioration.

Screening questionnaire Balansmeter proved successful in predicting future long-term sickness absence in office workers

OBJECTIVE

To develop and validate a screening instrument to identify employees at high risk for future long-term sickness absence.

STUDY DESIGN AND SETTING

The instrument was developed (n=5,601) and internally validated (n=3,383) through data analyses of the Maastricht Cohort Study, among a group of office workers not absent from work. External validation was performed in a cohort of 3,895 bank employees.

RESULTS

The screening instrument, Balansmeter, captures 34 questions on demographics, work environment, private situation, (mental) health, and sickness absence history. The Balansmeter showed good predictive values for future sickness absence (>28 days) in men (internal validation relative risk [RR] 4.69 [95% confidence interval (CI): 2.74, 8.02]; external validation RR 3.90 [95% CI: 2.35, 6.45]) and women (internal validation RR 4.16 [95% CI: 2.05, 8.43]; external validation RR 2.62 [95% CI: 1.44, 4.77]).

CONCLUSION

It is possible to predict future sickness absence. The Balansmeter can be considered a valuable screening instrument.

Structured early consultation with the occupational physician reduces sickness absence among office workers at high risk for long-term sickness absence: a randomized controlled trial

OBJECTIVE

To examine the efficacy of structured early consultation among employees at high risk for future long-term sickness absence, in the prevention and/or reduction of sickness absence. The focus of the experiment was the timing of the intervention, that is, treatment before sickness absence actually occurs.

METHODS

In the current prospective randomized controlled trial (RCT), employees at high risk for long-term sickness absence were selected based on responses to a 34-item screening questionnaire including demographic, workplace, health and psychosocial factors associated with long-term sickness absence (>28 days). A total of 299 subjects at risk for future long-term sickness absence were randomized in an experimental group (n = 147) or in a control group (n = 152). Subjects in the experimental group received a structured early consult with their occupational physician (OP), in some cases followed by targeted intervention. The control group received care as usual. Sickness absence was assessed objectively through record linkage with the company registers on sickness absence over a 1 year follow-up period.

RESULTS

Modified intention-to-treat analysis revealed substantial and statistically significant differences (p = 0.007) in total sickness absence duration over 1 year follow-up between the experimental (mean 18.98; SD 29.50) and control group (mean 31.13; SD 55.47). Per-protocol analysis additionally showed that the proportion of long-term sickness absence spells (>28 days) over 1 year follow-up was significantly (p = 0.048) lower in the experimental (9.1%) versus control group (18.3%).

CONCLUSIONS

Structured early consultation with the OP among employees at high risk for future long-term sickness absence is successful in reducing total sickness absence.

Effort-reward imbalance and relational injustice at work predict sickness absence: the Whitehall II study

OBJECTIVES

Sickness absence is a major occupational health problem, but evidence for associations between potentially modifiable psychosocial work factors and sickness absence is still scarce. We studied the impact of relational justice and effort-reward imbalance on subsequent rates of sickness absence.

METHODS

The Whitehall II prospective cohort study of British civil servants, 10,308 men and women, was established between 1985 and 1988. Indicators of effort-reward imbalance and the relational component of organizational justice were constructed from questions included at baseline. Participants were classified into three groups (low, intermediate, and high) for both effort-reward imbalance and relational justice. Short (< or =7 days) and long (>7 days) spells of sickness absence during 1985-1989 and 1991-1995 were used to study immediate and longer term effects of work characteristics.

RESULTS

After adjustment for age, employment grade, and baseline health, men and women with low relational justice had increased risks of long spells of sickness absence of 14% and 28% in comparison to men and women experiencing high levels of justice. Similar effect sizes (25% and 21%) were found for high vs. low effort-reward imbalance. Both work measures also predicted short spells of sickness absence. Effort-reward imbalance (men and women) and relational justice (women only) each predicted long spells of sickness absence independently of the other.

CONCLUSIONS

Both relational justice and effort-reward imbalance are important determinants of sickness absence. Workplace interventions to improve these aspects of working conditions have the potential to reduce levels of sickness absence.

Work and family support systems and the prevalence of lower back problems in a South African steel industry

INTRODUCTION

Back complaints are a common in society.

METHODS

An analytical cross-sectional epidemiological study was carried out among 366 steel plant workers to examine the prevalence and association between lower back problems (LBP) and family and workplace related psychosocial risk factors.

RESULTS

Using inclusive and stringent definitions for LBP, point prevalence was 35.8% and 15.3%, respectively. Logistic regression analyses indicated significant adjusted odd ratios (OR) for negative perceptions of workplace support (2.32; CI 1.09-4.92), unexpected events (2.58; CI 1.19-5.59) and working under time pressures and deadlines (2.83; CI 1.24-6.48). A significant protective association was found for control over the order and pace of working tasks (OR 0.30; CI 0.14-0.63). A significant univariate association was further found between LBP and negative perceptions of family (1.97; CI 1.06-3.68) support.

CONCLUSION

These findings suggest that workers who feel more in control on the job and who have good family and workplace support systems in tact are less likely to experience LBP. Supervisors are therefore encouraged to develop appropriate support and organizational systems which may be an inexpensive, but potentially beneficial, means of reducing worker stress and LBP.

Risk factors for new episodes of sick leave due to neck or back pain in a working population. A prospective study with an 18-month and a three-year follow-up

OBJECTIVES

To identify risk factors for new episodes of sick leave due to neck or back pain.

METHODS

This prospective study comprised an industrial population of 2187 employees who were followed up at 18 months and 3 years after a comprehensive baseline measurement. The potential risk factors comprised physical and psychosocial work factors, health-related and pain-related characteristics and lifestyle and demographic factors. The response rate at both follow-ups was close to 73%.

RESULTS

At the 18-month follow-up, 151 participants reported at least one episode of sick-listing due to neck or back pain during the previous year. Risk factors assessed at baseline for sick leave due to neck or back pain at the follow-up were blue-collar work, back pain one or several times during the previous year, 1-99 days of cumulative sickness absence during the previous year (all causes except neck or back pain), uncertainty of one's own working ability in 2 years' time and the experience of few positive challenges at work. After 3 years, 127 participants reported at least one episode of sick leave due to back or neck pain during the year previous to follow-up. The risk factors for this pain-related sick leave were blue-collar work, several earlier episodes of neck pain, no everyday physical activities during leisure time (cleaning, gardening and so on), lower physical functioning and, for blue-collar workers separately, repetitive work procedures.

CONCLUSION

The most consistent risk factors for new episodes of sick leave due to neck or back pain found during both the follow-ups were blue-collar work and several earlier episodes of neck or back pain assessed at baseline. Preventive efforts to decrease sick leave due to neck or back pain may include measures to increase the occurrence of positive challenges at work and to minimise repetitive work procedures. An evidence-based secondary prevention of neck and back pain including advice to stay active is also warranted.

Psychosocial work environment predictors of short and long spells of registered sickness absence during a 2-year follow up

OBJECTIVE

The objective of this study was to investigate the impact of psychosocial work environment factors on short and long absence spells.

METHODS

Questionnaire data on work environment exposures and registered absence data during 2-year follow up were analyzed with Poisson regression for 1919 employees from the private and public sector.

RESULTS

Short spells (1-10 working days) were predicted by low supervisor support, low predictability, and low meaning at work among men and high skill discretion among women. Long spells (>10 days) were predicted by low decision authority, low supervisor support, and low predictability among men and high psychologic demands and low decision authority among women. The variables predictability and meaning at work were developed for this study.

CONCLUSION

Specific psychosocial work environment factors have both common and different effects on short and long absence spells. Effects also differ by gender.

Perceptions of work and family assistance and the prevalence of lower back problems in a South African manganese factory

An analytical cross-sectional epidemiological study was carried out among 109 manganese plant workers to examine the prevalence and association between lower back problems (LBP) and family and workplace related psychosocial risk factors. Outcome (LBP) was defined using a guided questionnaire and a functional rating index. Exposure to family and workplace related psychosocial risk was determined using the Occupational Risk Factor (ORFQ) and APGAR questionnaires for work and family support. Using inclusive and stringent definitions for perceived LBP, point prevalence was 37.6% and 29.4%, respectively. Only 8 cases of LBP were, however recorded officially over a 7-yr period (1996-2003). Multivariate analyses indicated a high, but non-significant odds ratio (OR) for negative perceptions of workplace support OR 3.29 (CI 0.95-11.30). A positive, non-significant, association for negative perceptions of family support (2.56; CI 0.69-9.52) and a protective, but non-significant, association for control over the order and pace of working tasks (OR 0.40; CI 0.12-1.35) was found. These findings together with the under-reporting, leads one to conclude that work hardening and a cultural ethos of non-complaining among manual labourers, moderates the association between LBP and the aetiological factors studied.