Assessment of the relationship between the return to work and the severity of work-related upper limb injuries using the whole person impairment.

PURPOSE: Upper limb disorders are one of the most common and important types of occupational injuries. Besides, identifying the factors influencing return to work following these injuries is essential to reduce the dimensions of the problem. In this study, we investigated the return to work and associated factors following occupational injuries leading to upper limb impairment. METHODS: In this retrospective cohort study, the rate of return to work and associated factors were assessed in 256 workers with work-related upper limb injury referred to a teaching hospital from March 2011 to December 2018. The inclusion criterion was a history of occupational injury resulting in upper limb impairment, and exclusion criteria included the presence of simultaneous impairment in other organs, congenital or non-occupational limb defects as well as patients with incomplete information in their medical records. Individuals' records, including age at the time of injury, gender, date of injury, marital status, education, level of amputation and injury, whole person impairment (WPI) and physiotherapy (prescribed by the physician) were reviewed. The WPI was calculated to assess the extent of the injury. All analyzes were performed by SPSS version 25.0. RESULT: The rate of return to work was 54.3%, in which 51.8% for the same job and 48.2% for a new job. The main factors associated with non-return to work were more days off work (p = 0.001), higher injury severity (p = 0.001), and dominant hand injury (p = 0.034). CONCLUSION: The number of days off work, the WPI, and dominant hand injury are the most important determinant in returning to work. In addition, increased job satisfaction and support from co-workers and employers are work-related factors that can lead to an increased return to work.

Return-to-Work Status Following One- and Two-Level Anterior Cervical Discectomy and Fusions: A Prospective Cohort Study.

BACKGROUND:  The purpose of this article was to determine the rate of return to work (RTW) and contributing factors after a one- and two-level anterior cervical discectomy and fusion (ACDF), a common spine surgery. Recognizing the contributing factors to RTW of occupationally active patients is important. METHODOLOGY: In this study, 68 patients were examined at three, six, and nine months after ACDF by the same team and same spinal surgeon at a single medical center, and the rate of RTW and contributing factors were determined. In this study, relationships were analyzed by the logistic regression method. RESULTS: The results of this study demonstrated that 77.9%, 82.4%, and 82.4% of workers had returned to work after three, six, and nine months, respectively. At nine months, 82.4% of the patients had returned to work, 19.6% returned to part-time work, and 80.4% had returned to their previous work. Conversely, 17.6% of the patients had not returned to work after nine months. In the logistic regression analysis, older age, longer absence from work before surgery, and less employer support were the related factors for no RTW. CONCLUSIONS:  Per the results, it may be concluded that nearly 82% of patients with ACDF had returned to work after nine months of follow-up. Lack of RTW is affected by older age, longer absence from work before surgery, and employer support. Planning according to these variables can reduce the burden of the problem.

The relationship between occupational exposure to organic solvents and metabolic syndrome in petroleum refinery workers in Tehran, Iran.

AIMS: The rising prevalence of metabolic syndrome has made it a major health concern. Chronic occupational exposure to organic solvents affects different systems of the body. This study aimed to investigate the association between exposure to organic solvents and the prevalence of metabolic syndrome in petroleum refinery workers. METHOD: This study was conducted in 2019-2020 on workers employed in an Iranian petroleum refinery. The demographic and occupational information on the participants was obtained using the interview method. Their height, weight, and blood pressure were measured by the occupational health team, and fasting blood samples were taken from them to measure the paraclinical parameters. RESULTS: In this study, 1009 petroleum refinery workers were analyzed. The prevalence of metabolic syndrome in workers was 20.1% and it was about two times higher in exposed workers (CI 95%: 1.61-3.35) compared to non-exposed ones. Factors associated with the prevalence of metabolic syndrome include age, higher BMI, exercise, and longer exposure to organic solvents. CONCLUSION: Findings of this study suggested that exposure to organic solvents is associated with increased prevalence of metabolic syndrome (the highest association was observed with elevated serum triglycerides). Besides, longer exposure to organic solvents increased the risk of developing metabolic syndrome.

Validity and Reliability of an Adapted Persian Version of the Scoliosis Research Society-30 Questionnaire.

BACKGROUND: Adolescent idiopathic scoliosis (AIS) is a common type of spinal deformity confronting surgeons. The Scoliosis Research Society Health-Related Quality of Life (SRS-30) Questionnaire has been translated into Persian to evaluate its internal consistency, reliability, validity, and cross-cultural adaptability in the Persian population. METHODS: The translation and cultural adaptation process was based on the American Academy of Orthopaedic Surgeons guidelines. A total of 102 AIS patients referring to our institution were enrolled in this study within March 2014-March 2016. The 36-item Short Form (SF-36) was used for adapting the Persian SRS-30 questionnaire. The convergent validity of the Persian SRS-30 was examined using the Pearson correlation coefficient. Furthermore, its internal consistency and validity were tested using Cronbach α with bootstrapped 95% confidence interval. Interclass Correlation Coefficient (ICC) was used to test and retest reliability. RESULTS: The total correlation coefficient between the Persian SRS-30 and SF-36 was obtained at 0.74 (0.67-0.80), which was statistically significant (P=0.001). The total Cronbach α for the Persian SRS-30 was estimated at 0.84, ranging from 0.51 in satisfaction with management domains to 0.88 in mental health domains. The Persian SRS-30r domains indicated satisfactory test-retest reliability with ICC rage of 0.79-0.87. CONCLUSION: The Persian SRS-30 translation was reliable and valid for the AIS Iranian patients. The internal consistency of this instrument was found to be good and excellent in all domains except satisfaction with management, which was moderate. The authors believe that the Persian version of SRS-30 is simple and easy to use and now it can be applied in clinical settings for future outcome studies in Iran.

Assessment of disability levels in patients with low back pain based on the type of lumbar spinal disorder.

BACKGROUND: Low back pain (LBP) is a common health condition and the leading cause of activity limitation and absenteeism in most parts of the world. One-fifth of patients with LBP develop chronic pain disability. OBJECTIVE: This study investigated the disability levels in patients with different types of lumbar spinal disorders. METHODS: A total of 528 patients visiting spine clinics between June 2017 and February 2018 were enrolled in this study. A demographic checklist, the patients' medical records, the Oswestry Disability Questionnaire, and the Visual Analog Scale (VAS) were used to collect the data. RESULTS: Non-specific LBP (29.5%) and discopathy (27%) were the most common final diagnoses. The obtained Oswestry Disability Index (ODI) was significantly higher in older patients, those with higher body mass index, more work experience, and smokers. Lower ODI was found in individuals with a history of regular exercise. Most individuals in all diagnostic groups were categorized into the high ODI group (p⩽ 0.001). CONCLUSION: In patients with lumbar spine lesions, ODI is significantly correlated with age, BMI, work experience, smoking, and the type of disorder (discopathy, spondylolysis, and spondylolisthesis). Regular exercise is associated with lower levels of disability.

Predictive factors for return to work after lumbar discectomy.

Background. Lower back pain (LBP) is one of the most common complaints leading to disability and work absence. This study was performed to determine the rate and contributing factors of return to work in the postoperative phase after lumbar discectomy. Methods. This cohort study was performed among 142 patients attending the orthopedics spine clinic of a teaching hospital during 2016. Initially, the demographic and occupational characteristics and Oswestry disability index (ODI) were fulfilled, and patients were followed with regard to time off, work return and type of job after surgery. Results. 113 participants (79.5%) returned to work in 3 months. Male gender, higher literacy, non-manual job, less physical activity, non-smoking, formal work agreement, lower working hours and higher income were associated with return to previous work. Also, shorter preoperative duration of LBP, longer hospital stay, lower severity of LBP, lower ODI score and poor perceived prognosis of return to work were associated with return to previous work. Conclusions. Return to work after discectomy is seen in more than two-thirds of patients and is related to factors such as pain intensity and body mass index. However, return to previous versus modified job is a multifactorial issue.

Application of Oscillating Saw for Lumbar en Bloc Laminectomy: A Case Series.

BACKGROUND: An oscillating bone saw is rarely used to perform laminectomy. The purpose of this study was to describe a relatively quick and harmless technique for multilevel laminectomy in patients with lumbar spinal stenosis (LSS) using an oscillating bone saw to find out how this instrument affects the time of surgery and rate of complications. METHODS: This prospective study was conducted on 45 patients with LSS who required multilevel laminectomy. The bones were cut using an oscillating sagittal saw equipped with a fine 1-cm blade. Posterolateral fusion was performed if any evidence of spinal instability occurred, or the correction of deformity was addressed. The time spent for laminectomy from initial cutting to the whole bone removal (T1) and the duration of laminectomy (i.e., from initiation to the end of decompression; T2) were recorded for the corresponding level. The volume of harvested autograft was also measured, and any dural injuries were reported. RESULTS: Posterolateral fusion was performed on 32 (71.1%) patients. The mean T1 and T2 per level were estimated at 70.5±5.4 and 157.5±12.1 sec, respectively. In addition, the mean volume of harvested autograft per level was obtained as 3.5±1.2 cc. No durotomy was observed during laminectomy using an oscillating bone saw. However, a dural tear occurred in one patient when a Kerisson punch was utilized for ligamentum flavum removal and foraminotomy. CONCLUSION: Based on the findings, it can be concluded that laminectomy by means of the oscillating bone saw is a safe procedure that provides a sufficient volume of harvested autograft for fusion. This technique could also induce a remarkable reduction in the time of surgery.

Short-Term Efficacy of Epidural Injection of Triamcinolone Through Translaminar Approach for the Treatment of Lumbar Canal Stenosis.

BACKGROUND: Epidural steroid injection is a non-operative minimally invasive procedure for pain relief in spinal canal stenosis. However, there is no significant consensus regarding its efficacy. OBJECTIVES: In this study, we aimed to evaluate the effectiveness of translaminar injection of triamcinolone in lumbar canal stenosis. METHODS: In a retrospective study, we included 111 patients with MRI-confirmed spinal canal stenosis who were irresponsive to 12 weeks of conservative treatment and underwent epidural injection of triamcinolone through the translaminar approach. Outcome measures were routinely checked before the intervention and four weeks after the intervention, which included the Visual Analog scale (VAS) for low back pain, VAS for lower-limb pain, and Oswestry Disability index (ODI). RESULTS: The study population included 32 (28.8%) males and 79 (71.2%) females with the mean age of 61 ± 13.4 years. The mean ODI, VAS for low back pain, and VAS for lower-limb pain significantly improved at the final evaluation session (P < 0.001, P = 0.001, and P < 0.001, respectively). The levels of improvement in ODI, VAS for low back pain, and VAS for lower-limb pain were considerably more in patients with single-level involvement (P < 0.001, P = 0.04, and P < 0.001, respectively). Improvement of lower-limb VAS was negatively correlated with age (r = -0.400, P < 0.001) and BMI (r = -0.525, P < 0.001). The ODI improvement was also negatively correlated with BMI (r = -0.569, P < 0.001). CONCLUSIONS: Epidural injection of triamcinolone through the translaminar approach could be regarded as an efficacious method for the alleviation of pain and disability in patients with spinal canal stenosis.

Assessment of neuro behavioral disorders in workers exposed to organic solvents in a publication house.

BACKGROUND: Organic solvents are known as a group of organic compounds, widely used in industry and to which many workers are exposed. Neurotoxicity is one of the most important complications of the chronic exposure to the solvents and may causes neurobehavioral disorders in workers. We have studied the frequency of neurobehavioral disorders in workers exposed to organic solvents in one of the publishing houses in Tehran. METHODS: In this cross-sectional study, 510 workers of a publishing house, having been employed at least a year before the research, were selected to be studied. Among them, 345 workers had been exposed to organic solvents and the other (165 workers) had not. Data were collected using a questionnaire. This questionnaire included demographic and occupational information, and the Swedish Q16 questionnaire. Variables included age, duration of employment, working shift, and smoking. Then we compared both groups in terms of neurobehavioral disorders, using statistical methods. RESULTS: The mean score of the Swedish Q16 questionnaire in the exposed group (4.8±4.4) was significantly higher than the non-exposed group (3.2±3.1) (p=0.001). According to the questionnaire score, the frequency of neurobehavioral disorders in the exposed group was 38% and in the non-exposed group was 22% (p=0.001). We estimated that the frequency of neurobehavioral disorders in the exposed group was significantly higher than the non-exposed group (p<0.05) using regression analysis and removal of the confounding factors. CONCLUSION: This study shows that the frequency of the neurobehavioral disorders in the exposed group is significantly higher than the non-exposed group.

Assessment of the relationship between Quality of Life and Upper Extremity Impairment Due to Occupational Injuries.

BACKGROUND: Severe upper extremity injuries can affect the quality of life in patients and cause multi-factorial and long-term costs of disease. The aim of this study was to assess quality of life in patients with upper extremity injuries caused by work-related accidents. METHODS: In this study cross-sectional method was used in patients referred to the Occupational medicine Clinic of Rasoul Akram Hospital to determine their impairments. Patient's information including demographic variables, calculation of the impairment rate based on AMA Guide book (in terms of WPI), returning to work, and location of injury, work experience and type of injury. Then the quality of their life was assessed and interpreted using SF36 questionnaire. RESULTS: 203 patients were evaluated. Different aspects of the patients' life were not associated with age, gender and education of patients based on The SF-36 questionnaire. There was an inverse relationship between the percentage of patients' impairment and different aspects of life quality; there were also a significance correlation between impairment rate and physical performance of patients (p<0.001, r= -0.26), social performance of patients (p= 0.001, r= -0.24), pain (p= 0.005, r= -0.2), emotional health of patients (p= 0.006, r= -0.29), energy / fatigue in patients (p<0.001, r= -0.29) and the patient's general health (p<0.001, r= -0.27). CONCLUSION: This study shows that upper extremity impairment due to occupational injuries has an inverse and significant association with various aspects of quality of life.

Assessment of the relationship between physical working conditions and different levels of work ability.

Early leaving of workplace by work forces is one of the fundamental problems worldwide. Maintenance and enhancement of employees work ability are important for raising productivity. This study investigated the relationship between work ability index and physical working conditions and was carried out in 2013 on 641 workers at a manufacturing plant in Tehran. Work ability was assessed by the questionnaire of work ability index and the participants were classified into four work ability groups of poor, moderate, good, and excellent. Physical working conditions were evaluated by the MUSIC-Norrtalje questionnaire and the participants were classified into two groups with proper and poor physical working conditions. The mean score of work ability questionnaire was 42.40; and 2.5% (16 persons), 9.2% (59 persons), 38.2% (245 persons), and 50.1% (321 persons) of the participants were in poor, moderate, good, and excellent work ability groups, respectively. The mean score of physical working conditions questionnaire was 20.06. The results of logistic regression analysis showed that even after adjusting the confounding variables, a significant correlation existed between work ability and physical working conditions (p < 0.05). According to the results of this study, there may be a correlation between physical working conditions such as awkward postures, repetitive movements, load lifting, exposure to whole body vibration and so on with work ability. Therefore it seems that enhancement of the quality of physical working conditions may increase work ability.

Interaction of lifestyle and work ability index in blue collar workers.

BACKGROUND: Early labor force exit is one of the major problems worldwide. The present study investigates the relationship between work ability and lifestyle. METHODS: This study was conducted at a manufacturing plant in Tehran in 2012. All 851 male workers in this plant were included into the study and their work ability was assessed using the Work Ability Index (WAI). Based on the obtained scores, the participants were then classified into four work ability groups (poor, moderate, good, or excellent). Moreover, the participants' lifestyles were studied in three areas, including physical activity, cigarette smoking, and Body Mass Index (BMI). RESULTS: The average work ability index score was 42.07, ranging from 7-48. Among the participants, 6.4% (43), 6.5% (44), 38.3% (259), and 48.8% (330) were in the groups with poor, moderate, good, and excellent work ability, respectively. The results of logistic regression analysis showed that there is a significant relationship between work ability and lifestyle (cigarette smoking, BMI, and physical activity) even after adjustment for confounding variables (P<0.05). CONCLUSIONS: According to the results of the present study, there might be a relationship between work ability and lifestyle (physical activity, BMI, cigarette smoking). Therefore, it is recommended to implement a lifestyle quality enhancement program to improve work ability in working environments.

Characteristics of menstrual cycle in shift workers.

BACKGROUND: In this study, the characteristics of menstrual cycle in shift workers employed in the pharmaceutical industry are investigated. METHOD: This study was conducted in a pharmaceutical industrial complex in Tehran in 2012. 406 female workers in packaging units were studied on the menstrual cycle characteristics. The studied workers were divided into two groups of shift workers and non-shift workers and were compared in terms of the frequency of menstrual disorder (short-term cycle, long-term cycle, irregular cycle and bleeding during menstrual cycle) as well as hormonal values (FSH, LH, TSH, and Prolactin). RESULTS: The odds ratio (OR) for menstrual disorder in the shift workers was 5.54 (95% CI=2.78-11.02) compared to the non-shift workers. The mean difference of hormonal values (except prolactin) between shift workers and non-shift workers was not significant (P>0.05). CONCLUSION: This study suggests that shift work may disrupt the menstrual cycle.