Health and economic burden of running-related injuries in runners training for an event: A prospective cohort study.

Prospective running-related injury (RRI) data from runners training for an event are scarce, especially with regard to RRI-associated costs. Therefore, the aim of this study was to investigate the prevalence and economic burden of RRIs in runners participating in an organized training program preparing them for an event. This was a prospective cohort study with 18 weeks of follow-up. Individuals aged 18 or older and registered to participate in an organized running program were eligible. Follow-up surveys were sent every 2 weeks to collect data about running exposure, RRIs, and costs. Of the 161 potential participants, 53 (32.9%) were included in this study. A total of 32 participants reported 41 RRIs. The mean prevalence during follow-up was 30.8% [95% confidence interval (CI) 25.6-36.0%]. Overuse was the main mechanism of RRI (85.4%, n = 35). An RRI was estimated to have an economic burden of €57.97 (95% CI €26.17-94.00) due to healthcare utilization (direct costs) and €115.75 (95% CI €10.37-253.73) due to absenteeism from paid work (indirect costs). These results indicate that the health and economic burden of RRIs may be considered significant for public health. Therefore, prevention programs are needed for runners participating in organized training programs.

[Socioeconomic position and duration of disability benefit due to work-related musculoskeletal disorders]. / Posição socioeconômica e duração do benefício por incapacidade devido a doenças musculoesqueléticas relacionadas ao trabalho.

This study estimated the effect of socioeconomic position on the duration of disability benefits due to musculoskeletal disorders affecting the neck and/or upper limbs. A cohort study including 563 insured workers from the city of Salvador, Bahia, Brazil, registered in the General Social Security System and who received temporary disability benefits due to musculoskeletal disorders affecting the neck and/or upper limbs, was performed in 2008 using data from the National Social Security Institute. The results show that among union member workers with high psychosocial demands at work, those with low socioeconomic status are almost twice as likely to receive benefit for a shorter period of time compared to those with a higher socioeconomic position (RR = 1.89; 95%CI: 1.25-2.87). These results reveal an inequitable situation or unnecessary use of insurance for workers with a higher socioeconomic position. Future research aimed at elucidating the differences in the use of benefits are needed so that social insurance system managers may take the appropriate steps to resolve this issue.

Posição socioeconômica e duração do benefício por incapacidade devido a doenças musculoesqueléticas relacionadas ao trabalho / Socioeconomic position and duration of disability benefit due to work-related musculoskeletal disorders

Neste estudo, estima-se o efeito da posição socioeconômica sobre a duração dos benefícios por incapacidade devido a doenças musculoesqueléticas. Dados de um inquérito conduzido pela Auditoria Regional do Instituto Nacional do Seguro Social, com todos os segurados que receberam benefício por incapacidade temporária por doenças musculoesqueléticas da região cervical e membros superiores, em 2008, juntamente com os registros administrativos, foram utilizados para formar uma coorte de 563 trabalhadores. Todos eram residentes em Salvador, Bahia. Entre os trabalhadores sindicalizados e com alta demanda psicossocial no trabalho, a posição socioeconômica se associava positivamente com a duração do benefício (RR = 1,89; IC95 por cento: 1,25-2,87). Esses resultados correspondem ou a uma situação de iniquidade ou ao uso desnecessário do seguro pelos trabalhadores com posição socioeconômica alta. Investigações futuras que visem a elucidar as diferenças na utilização dos benefícios são necessárias para subsidiar a abordagem apropriada dessa questão pelos gestores do seguro social.

This study estimated the effect of socioeconomic position on the duration of disability benefits due to musculoskeletal disorders affecting the neck and/or upper limbs. A cohort study including 563 insured workers from the city of Salvador, Bahia, Brazil, registered inthe General Social Security System and who received temporary disability benefits due to musculoskeletal disorders affecting the neck and/or upper limbs, , was performedin 2008 using data from the National Social Security Institute. The results show that among union member workers with high psychosocial demands at work, those with low socioeconomic status are almost twice as likely to receive benefit for a shorter period of time compared to those with a higher socioeconomic position (RR = 1.89; 95 percentCI: 1.25-2.87). These results reveal aninequitable situation or unnecessary use of insurance for workers with a higher socioeconomic position. Future research aimed at elucidating the differences in the use of benefits are needed so that social insurance system managers may take the appropriate steps to resolve this issue.

The cost-effectiveness of a lifestyle physical activity intervention in addition to a work style intervention on recovery from neck and upper limb symptoms and pain reduction in computer workers.

OBJECTIVES: To evaluate the cost-effectiveness of a work style (WS) intervention and a work style plus physical activity (WSPA) intervention in computer workers with neck and upper limb symptoms compared with usual care. METHODS: An economic evaluation was conducted from an employer's perspective and alongside a randomised controlled trial in which 466 computer workers with neck and upper limb symptoms were randomised to a WS group (N = 152), a WSPA group (N = 156) or a usual care group (N=158). Total costs were compared to the effects on recovery and pain intensity. In the primary analyses, missing effect data were imputed using multiple imputation techniques. RESULTS: Total costs during the 12-month intervention and follow-up period were €1907 (WS), €2811 (WSPA) and €2310 (usual care). Differences between groups were not statistically significant. Neither intervention was more effective than usual care in improving overall recovery. The WS intervention was more effective than usual care in reducing current pain, average pain and worst pain in the past 4 weeks, but the WSPA intervention was not. The acceptability curve showed that when a company is willing to pay approximately €900 for a 1-point reduction in average pain (scale from 0 to 10), the probability of cost-effectiveness compared to usual care is 95%. Similar results were observed for current and worst pain. CONCLUSIONS: This study shows that the WS intervention was not cost-effective for improving recovery but was cost-effective for reducing pain intensity, although this reduction was not clinically significant. The WSPA intervention was not cost-effective compared with usual care. Trial registration number ISRCTN87019406.

The cost-effectiveness of the RSI QuickScan intervention programme for computer workers: Results of an economic evaluation alongside a randomised controlled trial.

BACKGROUND: The costs of arm, shoulder and neck symptoms are high. In order to decrease these costs employers implement interventions aimed at reducing these symptoms. One frequently used intervention is the RSI QuickScan intervention programme. It establishes a risk profile of the target population and subsequently advises interventions following a decision tree based on that risk profile. The purpose of this study was to perform an economic evaluation, from both the societal and companies' perspective, of the RSI QuickScan intervention programme for computer workers. In this study, effectiveness was defined at three levels: exposure to risk factors, prevalence of arm, shoulder and neck symptoms, and days of sick leave. METHODS: The economic evaluation was conducted alongside a randomised controlled trial (RCT). Participating computer workers from 7 companies (N = 638) were assigned to either the intervention group (N = 320) or the usual care group (N = 318) by means of cluster randomisation (N = 50). The intervention consisted of a tailor-made programme, based on a previously established risk profile. At baseline, 6 and 12 month follow-up, the participants completed the RSI QuickScan questionnaire. Analyses to estimate the effect of the intervention were done according to the intention-to-treat principle. To compare costs between groups, confidence intervals for cost differences were computed by bias-corrected and accelerated bootstrapping. RESULTS: The mean intervention costs, paid by the employer, were 59 euro per participant in the intervention and 28 euro in the usual care group. Mean total health care and non-health care costs per participant were 108 euro in both groups. As to the cost-effectiveness, improvement in received information on healthy computer use as well as in their work posture and movement was observed at higher costs. With regard to the other risk factors, symptoms and sick leave, only small and non-significant effects were found. CONCLUSIONS: In this study, the RSI QuickScan intervention programme did not prove to be cost-effective from the both the societal and companies' perspective and, therefore, this study does not provide a financial reason for implementing this intervention. However, with a relatively small investment, the programme did increase the number of workers who received information on healthy computer use and improved their work posture and movement. TRIAL REGISTRATION NUMBER: NTR1117.

Limited economic evaluation to assess the effectiveness of a university-wide office ergonomics program.

The objective of this research was to evaluate the effectiveness and provide a limited economic evaluation of an office ergonomics program at a major university from 1995 to 2007. The relationship between office-related recordable injuries, reported lost time, severity of these injuries, and the Workers' Compensation (WC) paid was analyzed and the corresponding incident cost was calculated. Two major datasets analyzed were OSHA 200/300 logs (1991-2007) and WC claims paid (1999-2007). Since the beginning of the office ergonomics program in 1995 and through 2007 (13-year period), the number of office cumulative trauma disorder (CTD) cases decreased by 53%. Since the official start (in 1999) of a 50-50 cost share agreement for office equipment purchases between the university's Safety and Health Department (SHD) and the university departments evaluated, it was observed that the incident rate decreased by 63%, Total Days Away/restrict or Transfer (DART) rate decreased by 41%, Lost Time Case (LTC) rate decreased by 71% and office-related carpal tunnel syndrome decreased by almost 50%. The long-term goal of this research is to demonstrate the self-sustainability of an office ergonomics program by showing that equipment costs are eventually offset by a decrease in WC claims paid and lost time from office-related injuries and illnesses. While limited, this research helps in cost-justifying the implementation of future office ergonomics programs for large organizations.

Upper extremity disorders in the workplace: costs and outcomes beyond the first return to work.

BACKGROUND: Cumulative trauma disorders of the upper extremities (CTD) have become increasingly important in workers' compensation caseloads over the last two decades. Relative to occupational back pain, CTD have been much less studied. METHODS: We analyzed post-injury employment patterns and return-to-work probabilities for a sample of Ontario workers with CTD, for up to five years after injury. Results for workers with CTD are compared to results for workers with back injuries or fractures. RESULTS: Most workers with CTD return to work at least once, but a first return does not necessarily mark the end of work disability. Among workers absent at least once, 26% with CTD report a second injury-related absence, compared to 18% with back pain and 12% with fractures. After five years, focusing on first returns underestimates work-loss days associated with CTD by 32%. CONCLUSIONS: A substantial proportion of workers with CTD or work-related back pain experience injury-related absences after their first return to work. Focusing on the first return to work is misleading for both injury groups, but even more so for CTD, as they appear to be even more susceptible to multiple spells of work absence.

Worker's compensation litigation of the upper extremity claim.

This article presents an overview of the issues presented to physicians and lawyers in evaluating, treating, litigating, and concluding an upper extremity workers' compensation claim. This analysis includes a review of the unique considerations involved in the workers' compensation patient/claimant, a general examination of workers' compensation law, and the interplay between litigation and the medical management of the patient.

Repetitive strain injuries: has the Australian epidemic burnt out?

In the 1980s Australia experienced an epidemic of medically certified claims for non-specific arm symptoms described as repetitive strain injury. Although a number of factors were mooted as causal of the epidemic, no single factor emerged as a compelling putative candidate. The present paper discusses the results of research which was published only after the epidemic had waned. It provides possible insights into the rise and fall of repetitive strain injury.

Direct costs and patterns of injuries among residential carpenters, 1995-2000.

Workers' compensation records for residential contractors were combined with hours worked provided by the union to examine injury rates and costs among union carpenters between 1995 and 2000. Brief text descriptions were reviewed to describe more costly injuries. Costs per hour worked decreased over 6 years, largely because of declines in rates and mean costs for falls from elevations. Higher costs were associated with injuries from falls, raising framed walls, setting steel I-beams, and pneumatic nail guns. Prevention priorities should include fall protection; methods to safely set steel beams, raise and brace framed walls; and steps to prevent injuries from pneumatic tools. Cost data provide an important measure that is useful in focusing prevention; combined with even limited descriptions of injuries target areas for intervention can be identified based on frequency or severity.

Ergonomics & retention.

The Visiting Nurse Association of Texas found that the impact of repetitive motion injuries on their office staff was costing them almost $200,000 a year. They formed a committee to design a cumulative trauma disorder prevention program. Since that time repetitive motion injuries have decreased dramatically and the program has assisted in staff retention.

Impact of case manager training on worksite accommodations in workers' compensation claimants with upper extremity disorders.

Management of the return-to-work process in claimants with work-related upper extremity disorders often poses challenges to the health care provider, claimant, and employer. Modifying workplace ergonomic risk factors as a component of the workplace accommodation process may improve return-to-work outcomes by reducing recurrent pain and discomfort. The present study is a case-control evaluation of the effects of a 2-day training program for nurse case managers that was designed to facilitate the implementation of workplace accommodations within a workers' compensation health care delivery system. After the training, 101 claimants with compensable upper extremity disorders were randomly assigned to case managers with and without training. Overall, 208 accommodations were recommended and 155 of these were implemented (75%). Claimants of trained nurses received 1.5 times as many recommendations for accommodations as claimants managed by nurses not trained in the process, and 1.4 times as many accommodations were implemented, although no differences were found between the two groups in implementation rates. Trained nurses were more likely to recommend accommodations addressing workstation layout, computer-related improvements, furnishings, accessories, and lifting/carrying aids, whereas the untrained nurses were more likely to suggest light duty and lifting restrictions. This study indicates that the training was associated with a change in the practice behavior of case managers regarding the workplace accommodation process. More research is needed to identify barriers to implementation and develop more effective approaches to facilitate worksite accommodations in disabled workers with carpal tunnel syndrome and other persistent upper extremity disorders.

Claiming in the name of fairness: organizational justice and the decision to file for workplace injury compensation.

This article explored the relationship among injured workers' perceptions of workplace justice (i.e., distributive, interactional, and procedural), perceptions of employers' disability-related policies, and the decision to file a workers' compensation claim. Using a 2-wave sample of 1,077 workers with repetitive motion injuries, the authors tested a structural equation model. Results revealed that Time 1 interactional justice was negatively related to filing a claim, whereas Time 1 distributive justice was positively related to perceptions of employer disability-related practices measured a year after the date of injury report. At Time 2, the claim decision was unrelated to perceptions of justice, yet perceptions of disability-related practices were significantly related to all 3 types of justice.

Estimating the costs of job related arthritis.

OBJECTIVE: To present the first estimate of the costs of job related osteoarthritis (OA) in the USA. METHODS: Data were drawn from national data sets collected by the US Bureau of Labor Statistics, the US National Center for Health Statistics, and existing cost estimates for arthritis in the literature. We used proportional attributable risk (PAR) models to estimate the percentage of acute and repetitive injuries resulting in OA. These PAR vary between men and women. We used the human capital method that decomposes costs into direct categories such as medical expense and indirect categories such as lost earnings. RESULTS: We estimate job related OA costs US$3.41 to 13.23 billion per year (1994 dollars). Our point estimate is that job related OA contributes about 9% ($8.3 billion) to the total costs for all OA. About 51% of job related costs result from medical costs and 49% from lost productivity at work and at home. These costs are likely to underestimate the true burden since costs of pain and suffering as well as costs to family members and others who provide home care are ignored. CONCLUSION: The cost of job related arthritis is significant and has implications for both clinical and public policy. Depending on the PAR selected, job related arthritis is at least as costly as job related renal and neurological disease combined, and is on a par with the costs of job related chronic obstructive pulmonary disease and all asthma, whether job related or not.