Work-related injury or work-related pain? A qualitative investigation of work-related pain and injury management among rehabilitation professionals1.

BACKGROUND: Patient mobility tasks place rehabilitation professionals (Physical and Occupational Therapists) working in hospitals at high risk for work-related musculoskeletal disorders (WMSDs). However, when investigating engagement with a Safe Patient Handling and Mobility program (SPHM), administrative records at a level one trauma hospital showed that rehabilitation professionals reported zero work-related injuries over an eight-year period. OBJECTIVE: As part of a qualitative study conducted to discover their unique work experiences, we explored some of the reasons that rehabilitation professionals might not report work-related injuries to their employers. METHODS: Using a collective case study design, six focus groups were conducted with 25 members of the rehabilitation team within a level-one trauma hospital. Focus groups were recorded; transcripts were analyzed for emergent themes using first and second cycle coding procedures. RESULTS: Participants in this study denied experiencing work-related injuries but frequently described working in pain, often attributed to patient mobility tasks. These experiences were not reported to employers. Self-management of their pain through co-worker treatment, over-the-counter medications, or informal alteration in job tasks were reported as common. CONCLUSION: Administrative injury records may underrepresent injuries among rehabilitation professionals. This may be due to their perception of work-related pain as something different than work-related injuries, or that many of these rehabilitation professionals treat their own work-related pain and symptoms rather than report them. To get a more accurate assessment of injury frequency among rehabilitation professionals, researchers should gather information directly from the participants, and should inquire about work-related pain in addition to injury.

Prevalence of occupational moral injury and post-traumatic embitterment disorder: a systematic review and meta-analysis.

OBJECTIVES: Occupational moral injury and post-traumatic embitterment disorder (PTED) describe the psychological distress caused by exposure to injustice at work. This meta-analysis aims to determine the prevalence of occupational moral injury and PTED and establish whether prevalence estimates differ depending on occupation. DESIGN: A systematic review and meta-analysis. DATA SOURCES: Google Scholar, PubMed, APA PsycINFO, Web of Science Core Collection, Scopus, ScienceDirect and Sage Journals Online were searched in June 2020 and updated in November 2022. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Observational studies that measured prevalence or average scores of moral injury, or PTED in any occupational group and any geographical location. DATA EXTRACTION AND SYNTHESIS: Two independent reviewers screened and coded eligible studies. Study design, participant demographics, sampling method, location, measurement tool and prevalence or average scores were extracted. Risk of bias was assessed using the Quality Assessment Checklist for Prevalence Studies tool. Meta-analysis was conducted using random effects models. Results that could not be combined were summarised qualitatively in a narrative synthesis using the Guidance for Systematic Reviews. RESULTS: In total, 88 studies across armed forces and veterans, healthcare, first responders, educators, journalists, child protection service employees, the unemployed, public-sector employees and mixed occupations were included. Studies included in each separate meta-analysis based on the measure used ranged from 2 to 30. The pooled prevalence of clinically relevant moral injury in healthcare professionals was 45%, and exposure to any potentially morally injurious event (PMIE) across occupations was 67%. Exposure to transgressions by others and betrayal was significantly lower in the armed forces than civilian occupations. Pooled prevalence of PTED across occupations was 26%. CONCLUSION: Exposure to PMIEs, moral injury symptoms and PTED are prevalent at work and exposure to transgressions by others and betrayal are more likely in civilian occupations than the armed forces. PROSPERO REGISTRATION NUMBER: CRD42020191766.

Ligamentoplasty in scapholunate instability: short-term results of the "all dorsal scapholunate repair" technique.

Injury to the scapholunate complex is the cause of scapholunate instability which can lead to radiocarpal and medio-carpal osteoarthritis. Several ligamentoplasty techniques have been reported for the treatment of chronic scapholunate instability before the osteoarthritis stage. The objective of this study was to assess the short-term results of an "all dorsal scapholunate repair" ligamentoplasty. We report the clinical, radiological and functional results of a retrospective study including 21 patients, operated between June 2019 and December 2020 for a stage 3 or 4 scapholunate instability according to the Garcia Elias classification. With a follow-up of 14.2 months, the pain was 0.1/10 according to the VAS at rest and 4/10 during exercise. Wrist strength was measured at 65% of the opposite side. The flexion-extension range of motion was 105°. Radiologically, there was a reduction of the diastasis and scapholunate angle. Osteolysis areas around the anchors were described in 47% of patients. The mean QuickDASH was 29.2/100, PRWE 24/100 and Mayo wrist score 67.8/100. Eighty-one percent of patients were satisfied. Seventeen patients had returned to work 5.2 months postoperatively. In the case of work-related injury, the functional scores were poorer, with a delayed return to work. This technique provides encouraging results in the short term. Most patients were improved compared to preoperative state. The work-related injury appears to be a poor prognostic factor. A longer-term study is imperative to confirm the maintenance over time of the correction of carpal malalignment and the evolution of the osteolysis areas.Level of evidence: Level IV Retrospective study.

Increased Mortality Associated With Disability Among Workers' Compensation Claimants With Upper Extremity Neuropathy.

OBJECTIVE: The aim of the study was to evaluate and compare mortality after disabling and nondisabling occupational injuries. METHODS: Vital status was ascertained through 2020 for 2077 individuals with a workers' compensation claim for upper extremity neuropathy in West Virginia in 1998 or 1999. Standardized mortality ratios compared mortality to the West Virginia general population. Hazard ratios (HRs) obtained from Cox regression models compared mortality among those with and without lost work time or permanent disability. RESULTS: Overall, the standardized mortality ratio for accidental poisoning deaths was elevated (1.75, 95% confidence interval [CI]: 1.08-2.68). All-cause mortality HRs and cancer HRs were elevated for lost work time (HR = 1.09, 95% CI: 0.93-1.28; HR = 1.50, 95% CI: 1.09-2.08, respectively) and permanent disability (HR = 1.22, 95% CI: 1.04-1.44; HR = 1.78, 95% CI: 1.27-2.48, respectively). CONCLUSIONS: Work-related disability was associated with broad elevations in mortality.

Development of a Prototype Observatory of Heat-Related Occupational Illnesses and Injuries through the Collection of Information from the Italian Press, as Part of the WORKLIMATE Project.

Exposure to heat is a recognized occupational risk factor. Deaths and accidents at work caused by high temperatures are underestimated. With the aim of detecting and monitoring heat-related illnesses and injuries, a prototype database of occupational events attributable to critical thermal conditions reported in Italian newspapers was created. Information was analyzed from national and local online newspapers using a web application. The analysis was conducted from May to September during the three-year period 2020-2022. Articles concerning 35 occupational heat-related illnesses and injuries were selected; 57.1% of the events were reported in 2022, and 31.4% of total accidents occurred in the month of July 2022, when the Universal Thermal Climate Index daily mean values corresponded to "moderate heat stress" (51.0%) and "strong heat stress" (49.0%). Fatal heat-related illnesses were the most frequent conditions described. In most cases, workers had been involved in outdoor activities in the construction sector. A comprehensive report was created by compiling all relevant newspaper articles to enhance awareness of this issue among relevant stakeholders and promote heat-risk prevention strategies in the current context where heatwaves are becoming increasingly frequent, intense and long-lasting.

Hand characteristics and functional abilities in predicting return to work in adult workers with traumatic hand injury.

BACKGROUND: Hand injuries affect a person's functioning, thus impeding their abilities to return to work. There is a limited understanding in return to work of the overall predictors when including hand characteristics and functional abilities. Therefore, it is essential to identify the most relevant predictors in return to work among individuals with a hand injury. OBJECTIVES: (1) To compare hand function characteristics and functional abilities of injured workers who have or have not returned to work. (2) To estimate hand function characteristics and functional abilities as predictors to return to work. METHODS: One hundred and fifteen adult workers with hand injuries aged 18- 59 years old from five general hospitals in Malaysia participated in a cross-sectional study. Predictors were estimated using logistic regression. RESULTS: There was a significant association between occupational sector (p = 0.012), injury duration (p = 0.024), occupational performance (p = 0.009) and satisfaction with performance (p < 0.001), grip strength of injured hand (p = 0.045- 0.002) and the Disability of Arm, Shoulder and Hand (DASH) disability/symptom (p = 0.001) with the person's return to work status. Significant predictors of return to work were identified using the Canadian Occupational Performance Measure (COPM) satisfaction's score, DASH disability/symptoms' score and duration of the injury. CONCLUSION: As two main predictors of return to work were COPM satisfaction and DASH disability/symptoms, occupational therapists working in rehabilitation should focus on achieving functional performance and satisfaction within the optimal time.

Risk of non-medical drug overdose following prescription of opioids post-injury: A retrospective cohort study.

Background: There has been increasing scrutiny of opioid prescribing following injury because of concerns that prescribed opioids may contribute to addiction and overdose. This study aimed to better understand the relationship between injury, opioids prescribed before and after injury, and non-medical drug poisoning. Data and methods: Working age (15 to 65 years old) residents of British Columbia's Fraser Health region with an injury that involved an emergency department visit were included. Factors examined included the prescription of opioid and opioid agonist therapy (OAT) medications before and after injury, age, sex, work-related injuries, and socioeconomic status, as well as how they were associated with non-medical drug poisoning risk and post-injury prescriptions. Results: Opioid-naive individuals (those without an opioid prescription captured before their injury) who were prescribed OAT medication-a marker of opioid use disorder-following their injury had a higher risk of subsequent non-medical drug poisoning (Hazard ratio (HR): 21.4 to 22.4 compared with opioid-naive individuals without an opioid or OAT prescription). Post-injury opioid prescription in these individuals increased poisoning risk (HR: 1.27 compared with those without a prescription). Being of male sex (HR: 1.80), being younger (HR: 0.76 for every 10-year increase in age) and living in the lowest-income neighbourhoods (HR: 1.44 compared with the middle quintile) increased poisoning risk. Compared with injuries sustained outside of work, work-related injuries reduced risk (HR: 0.62). Interpretation: Among a cohort of British Columbians visiting emergency departments following an injury, opioid prescribing in patients who were opioid-naive appears to be a minor contributor to non-medical drug poisoning, particularly when compared with other patient factors, such as being male, being younger and having a low socioeconomic status.

Occupational Injuries in Musicians: A Literature Review.

INTRODUCTION: The U.S. Department of Defense employs more musicians than any other organization in the USA with over 6,000 musicians employed. Musculoskeletal pathologies, behavioral health disorders, hearing loss, and dystonias account for the majority of reasons a musician seek medical care. The aim of this study is to review recent medical literature documenting occupational hazards in musicians. MATERIALS AND METHODS: Authors performed a literature review of publications related to musician performance-related musculoskeletal disorders (PRMDs) and performance-related pain (PRP), behavioral health disorders, dystonias, and hearing loss, published from 2004 to 2019 PubMed. RESULTS: The search returned 174 possible articles which, after review and exclusion, yielded 88 articles. CONCLUSIONS: Medical literature suggests several risk factors for multiple disease categories. Practice time and history of PRMD/PRP were both associated with development of PRMD/PRP and focal dystonia. A history of behavioral health disorder was associated with development of focal dystonia. Clinicians should counsel their musician patients on strategies to minimize risks, and additional research is needed to identify specific causes of illnesses in musician populations.

Work-related disease symptoms and occupational injuries among coffee processing industry workers in Bench-Sheko and Kaffa Zones Southwest, Ethiopia: A mixed-method study.

Background: Occupational injuries have become one of the most critical rooting causes paying to infirmities and life-threatening conditions in developed and developing countries. Workers in the coffee industry face some occupational health and safety issues. However, there is limited evidence on this important public health issue. Hence, this research was conducted to assess work-related disease symptoms and occupational injuries among coffee processing workers in Southwest, Ethiopia. Methods: A cross-sectional study supplemented with a qualitative method was done. A total of 721 workers were involved in the study for quantitative information. In addition, we performed a total of 22 in-depth and five key informant interviews for generating qualitative evidence. Quantitative data was collected by an interview-based questionnaire which is adapted from similar studies. We conducted descriptive, binary logistic, and multivariable regression analysis as necessary, to ascertain the factors affecting occupational injuries. We collected qualitative data guided by an interview guide, transcribed verbatim, and analyzed using ATLAS ti version-8 by applying a content analysis approach. Finally, quotes from participants that had exemplary ideas were triangulated along with quantitative findings. Result: The overall prevalence rate of work-related symptoms and occupational injuries among coffee processing workers were 21.7 and 13.4% respectively. Age group 30-39 and 40-49 (Adjusted odds ratio (AOR) 1.95, 95% CI 1.37, 2.79, (AOR 3.28, 95% CI 1.89, 5.69, respectively, income level (AOR 0.24, 95% CI 0.16, 0.36, p = 0.000), experience (AOR 1.64, 95% CI 1.04, 2.60, p = 0.034), and smoking cigarette (AOR 5.59, 95% CI 2.78, 11.26, p = 0.000) were significantly associated with the work-related symptom. In addition, training related to the job (AOR 11.88, 95% CI1.34, 105.57, p = 0.026) was significantly associated with occupational injuries among coffee processing industry workers. Conclusion: The prevalence of work-related symptoms and occupational injuries was high among coffee processing industry workers in southwest Ethiopia. Therefore, there is a need for regulations for both government and industry owners to advance the occupational conditions and ergonomic structure of coffee processing industries.

When Unnecessary Tasks Weigh Heavily on the Back: A Diary Study on Musculoskeletal Pain.

BACKGROUND: Auxiliary tasks such as administrative work often include tasks that are unnecessary in the view of workers but still have to be done. These tasks can threaten a worker's self-esteem. The purpose of this study was to examine the effects of unnecessary and unreasonable tasks on musculoskeletal pain. METHODS: Fifty-five office workers (29 male; mean age = 41.96, SD = 14.2 years) reported their unnecessary and unreasonable tasks at the beginning of the study and kept a diary of their daily musculoskeletal pain over 5 weeks, using a visual analogue scale. Other work-related risk factors (prolonged sitting), job resources (participation in decision-making), and individual risk factors (sex, smoking, exercise, body mass index, maladaptive back beliefs) were controlled for in multilevel regression analysis. FINDINGS: Multilevel regression analysis with 742 reports showed unnecessary tasks (B = 4.27, p = .006)-but not unreasonable tasks (B = 3.05, p = .074)-to predict the daily intensity of musculoskeletal pain, beyond other significant risk factors, such as prolonged sitting (B = 2.06, p = .039), body mass index (B = 1.52, p < .001), and maladaptive back beliefs (B = 3.78, p = .003). Participation in decision-making was not a significant protective factor (B = -1.67, p = .176). CONCLUSIONS/APPLICATION TO PRACTICE: The higher frequency of unnecessary tasks-compared with unreasonable tasks-could place workers at risk for musculoskeletal pain. Work redesign that reduces unnecessary and unreasonable tasks can make a valuable contribution to worker health and safety among office workers.

Sleep disturbances and disability following work-related injury and illness: Examining longitudinal relationships across three follow-up waves.

Despite the high burden of sleep disturbances among the general population, there is limited information on prevalence and impact of poor sleep among injured workers. This study: (a) estimated the prevalence of sleep disturbance following work-related injury; and (b) examined the longitudinal association between sleep disturbances and disability/functioning, accounting for reciprocal relationships and mental illness. Longitudinal survey data were collected from workers' compensation claimants with a time-loss claim in Victoria, Australia (N = 700). Surveys were conducted at baseline, 6 months and 12 months. Sleep disturbance was measured using the Patient-Reported Outcomes Measurement Information System (PROMIS) questionnaire. Disability/functioning was based on self-reported activity limitations, participation restrictions and emotional functioning. Path models examined the association between disability/functioning and sleep. Mean sleep disturbance T-scores were 55.2 (SD 11.4) at 6 months, with 36.4% of the sample having a T-score of 60+. Longitudinal relationships were observed between disability (specifically, emotional functioning) and sleep disturbances across successive follow-up waves. For example, each unit increase in T2 emotional functioning (five-point scale) was associated with a 1.1 unit increase in T3 sleep disturbance (approximately 29-76 scale). Cross-lagged path models found evidence of a reciprocal relationship between disability and sleep, although adjustment for mental illness attenuated the estimates to the null. In conclusion, sleep disturbances are common among workers' compensation claimants with work injuries/illnesses. Given the links between some dimensions of disability, mental health and sleep disturbances, the findings have implications for the development of interventions that target the high prevalence of sleep problems among working populations.

Patient-Reported Factors Associated with the Onset of Hyperfunctional Voice Disorders.

OBJECTIVES: Prevention, diagnosis, and treatment of hyperfunctional voice disorders would be improved by better understanding their etiological contributing factors. Therefore, this study estimated the prevalence of etiological factors using self-reported data about disorder onset from a large cohort of patients with Phonotraumatic Vocal Hyperfunction (PVH) and Non-Phonotraumatic Vocal Hyperfunction (NPVH). METHODS: Retrospective chart review extracted the self-reported rate (gradual, sudden) and events associated (voice use, anxiety/stress, upper respiratory infection [URI]) with disorder onset from 1,577 patients with PVH and 979 patients with NPVH. RESULTS: Both patient groups reported a gradual onset more than a sudden onset. Voice use was the most frequently reported event for PVH and the NPVH group self-reported all three events at equal frequency. The largest PVH subgroups were associated with voice use while the NPVH subgroups were associated with only voice use, only URI, or only anxiety/stress. CONCLUSION: The results support the general clinical view that PVH is most strongly related to the gradual accumulated effects of phonotrauma, while NPVH has a more heterogeneous etiology. The identified PVH and NPVH subgroups may have clinical relevance and future work could investigate differences in treatment and outcomes among these subgroups.

Occupational injury and psychological distress among U.S. workers: The National Health Interview Survey, 2004-2016.

INTRODUCTION: Injuries at work may negatively influence mental health due to lost or reduced working hours and financial burden of treatment. Our objective was to investigate, in U.S. workers (a) the prevalence of serious psychological distress (SPD) by injury status (occupational, non-occupational, and no injury) and injury characteristics, and (b) the association between injury status and SPD. METHODS: Self-reported injuries within the previous three months were collected annually for 225,331 U.S. workers in the National Health Interview Survey (2004-2016). Psychological distress during the past 30 days was assessed using the Kessler 6 (K6) questions with Likert-type scale (0-4, total score range: 0-24). SPD was defined as K6 ≥ 13. Prevalence ratios (PR) from fitted logistic regression models were used to assess relationships between injury and SPD after controlling for covariates. RESULTS: The prevalence of SPD was 4.74%, 3.58%, and 1.56% in workers reporting occupational injury (OI), non-occupational injury (NOI), and no injury, respectively. Workers with head and neck injury had the highest prevalence of SPD (Prevalence: OI = 7.71%, NOI = 6.17%), followed by workers with scrape/bruise/burn/bite (6.32% for those with OI). Workers reporting OI were two times more likely to have SPD compared to those without injury (PR = 2.19, 95%CI: 1.62-2.96). However, there was no significant difference in SPD between workers with OI and workers with NOI (PR = 0.98, 95%CI: 0.65-1.48). CONCLUSION: The prevalence of SPD varied by injury status with the highest being among workers reporting OI. We found that the workers reporting OI were significantly more likely to have SPD than those without injury, but not more than those with NOI. Practical Applications: Mental health management programs by employers are necessary for workers who are injured in the workplace.

Community acquired pressure injuries in a work-related spinal cord injury population: Problem characterization and assessment of a working solution.

BACKGROUND: To characterize the problem of community-acquired pressure injuries (CAPIs) in a work-related spinal cord injury (SCI) population in Canada and assess the benefits of a person-centered solution. Characterization of the problem and a solution, albeit in an insured Worker's Compensation Board of British Columbia (WorkSafeBC) cohort, may inform the supply of solutions in the larger SCI population with disparate access to healthcare. METHODS: For this observational study, data on 244 WorkSafeBC clients, who received an intervention featuring pressure injury (PI) assessment between 2011 and 2015, were used to characterize the problem. Data on observed injuries, risk, referrals, and outcomes were linked to healthcare service claims. Employing an activity-based costing methodology, total expenditures on attributed services were calculated for clients with 1 or more PIs. Intervention cost and benefits from the insurer's perspective are considered. RESULTS: 84 of 244 clients had 1 or more PIs at assessment, with attributed mean cost of $56,092 in 2015 Canadian dollars (CAD). Mean cost by PI severity range from $9580 to $238,736. At an intervention cost of $820,618, detection of less severe injuries provided an opportunity to prevent progression and achieve $3 million in cost avoidance. Follow-up data suggest reasonable returns. Reductions in the incidence, number, and risk of pressure injuries were also observed. CONCLUSIONS: The analysis establishes the cost of CAPIs in a Canadian-based work-related SCI population and suggests preventative and early intervention is not only feasible but also practical. Results are relevant to decisions regarding the use of proactive prevention-based treatment models as opposed to reactive, solutions in the larger SCI population.

Characteristics of Thoraco-Abdominal Injuries - A Series of Three Cases.

The enlarged number of powerful vehicles in our country led to an increased speed of travel and hence the high number of traffic accidents with severe consequences, even death. Along with polytrauma caused by occupational accidents, these types of traumas require complex and often multidisciplinary surgical therapy against the clock, which places the surgeon in front of situations that are not found in the everyday practice. Injuries involving damage to the thoracic-phreno-abdominal region fall into this specific category that we have chosen to discuss in the present work. We will further present three clinical cases of patients with thoraco-phreno-abdominal injuries produced by different mechanisms. A work-accident wound produced by an angle grinder, causing left thoracoabdominal injuries; a polytrauma caused by a road accident, with a thoraco-phreno abdominal wound produced by a piece of wood that penetrated obliquely through the right thorax, in the 5th and 6th intercostal spaces, crossed the right lower lung lobe, the diaphragm, the 7th liver segment, and stopped in the right posterior costal grid, and a polytrauma following a fall from a height, with a torn diaphragm and mesentery.

To what extent is severe osteoarthritis preventable? Occupational and non-occupational risk factors for knee and hip osteoarthritis.

OBJECTIVES: To explore the relative contribution of cumulative physical workload, sociodemographic and lifestyle factors, as well as prior injury to hospitalization due to knee and hip OA. METHODS: We examined a nationally representative sample of persons aged 30-59 years, who participated in a comprehensive health examination (the Health 2000 Study). A total of 4642 participants were followed from mid-2000 to end-2015 for the first hospitalization due to knee or hip OA using the National Hospital Discharge Register. We examined the association of possible risk factors with the outcome using a competing risk regression model (death was treated as competing risk) and calculated population attributable fractions for statistically significant risk factors. RESULTS: Baseline age and BMI as well as injury were associated with the risk of first hospitalization due to knee and hip OA. Composite cumulative workload was associated with a dose-response pattern with hospitalizations due to knee OA and with hospitalizations due to hip OA at a younger age only. Altogether, prior injury, high BMI and intermediate to high composite cumulative workload accounted for 70% of hospitalizations due to knee OA. High BMI alone accounted for 61% and prior injury only for 6% of hospitalizations due to hip OA. CONCLUSION: Our results suggest that overweight/obesity, prior injury and cumulative physical workload are the most important modifiable risk factors that need to be targeted in the prevention of knee OA leading to hospitalization. A substantial proportion of hospitalizations due to hip OA can be reduced by controlling excess body weight.

Oral health professionals: An exploration of the physical and psychosocial working environment.

BACKGROUND: Musculoskeletal disorders (MSD) are a significant problem in the oral health profession. This study explores oral health professionals' physical and psychosocial working environments in Australian workplaces. METHOD: Twelve oral health professionals from the public and private dental sectors participated in semi-structured interviews. Interviews were recorded and transcribed. Themes were identified and a coding framework developed which was refined and clarified during analysis. RESULTS: Participants reported a range of physical and psychosocial experiences in their work environment. Three major categories of themes were identified: Job Characteristics - particularly equipment unsuited for task and time constraints; Job Satisfaction - support from management and colleagues was valued, as was the significance of providing oral health care, particularly to children and minority groups; and Individual Factors - MSD and fatigue were reported by most participants. CONCLUSION: Oral health professionals are exposed to a range of workplace physical and psychosocial hazards associated with the development of MSDs. Risk management programs for the prevention of MSDs should take into account the range of physical and psychosocial hazards that oral health professionals are exposed to.

Otorrhoea - a parotid connection.

SUMMARY: A 36-year-old patient presented with an 18-month history of intermittent right parotid swelling accompanied by otorrhoea. The symptoms started subsequent to a palm leaf injury to the right ear. At right parotidectomy, a fistula connecting the right external auditory canal and the right parotid was demonstrated. A small fibrotic mass probably due to a remnant of the palm leaf was found intraoperatively. The symptoms resolved completely after the mass was excised by superficial parotidectomy, and the fistula closed spontaneously.