A Descriptive Study of the Implementation of Remote Occupational Rehabilitation Services Due to the COVID-19 Pandemic Within a Workers' Compensation Context.

Purpose The Coronavirus Disease (COVID-19) pandemic resulted in dramatic changes to avoid virus spread. In Canada, following provincial legislation the Workers' Compensation Board of Alberta (WCB-Alberta) stopped in-person rehabilitation services on March 23, 2020. On April 1, training began on remote service delivery using videoconferencing or telerehabilitation, which started April 3. We studied WCB-Alberta's transition to remote rehabilitation service delivery. Methods A population-based descriptive study was conducted, with data extracted from the WCB-Alberta database. This included clinical data from rehabilitation providers. We included workers completing services between January 1 and May 31, 2020. We statistically examined differences before and after the transition to remote services. Results The dataset included 4,516 individuals with work-related injuries. The mean number of work assessments per week pre-COVID was 244.6 (SD 83.5), which reduced to 135.9 (SD 74.5). Workers undergoing remote assessments were significantly more likely to work in health care or trades, did not require an interpreter, and were less likely to be working or judged as ready to return to work. Number of completed rehabilitation programs also reduced from 125.6 to 40.8 per week, with most (67.1%) remote programs being functional restoration. Few adverse effects were observed. Conclusions We describe the transition to completely remote delivery of occupational rehabilitation due to COVID-19 physical distancing restrictions in one Canadian compensation jurisdiction. It appears the use of remote services was successful but proceeded cautiously, with fewer complex cases being referred for assessment or rehabilitation. Further research examining longer-term work outcomes and stakeholder perceptions is needed.

Step-downs reduce workers' compensation payments to encourage return to work: are they effective?

OBJECTIVE: To determine whether step-downs, which cut the rate of compensation paid to injured workers after they have been on benefits for several months, are effective as a return to work incentive. METHODS: We aggregated administrative claims data from seven Australian workers' compensation systems to calculate weekly scheme exit rates, a proxy for return to work. Jurisdictions were further subdivided into four injury subgroups: fractures, musculoskeletal, mental health and other trauma. The effect of step-downs on scheme exit was tested using a regression discontinuity design. Results were pooled into meta-analyses to calculate combined effects and the proportion of variance attributable to heterogeneity. RESULTS: The combined effect of step-downs was a 0.86 percentage point (95% CI -1.45 to -0.27) reduction in the exit rate, with significant heterogeneity between jurisdictions (I2=68%, p=0.003). Neither timing nor magnitude of step-downs was a significant moderator of effects. Within injury subgroups, only fractures had a significant combined effect (-0.84, 95% CI -1.61 to -0.07). Sensitivity analysis indicated potential effects within mental health and musculoskeletal conditions as well. CONCLUSIONS: The results suggest some workers' compensation recipients anticipate step-downs and exit the system early to avoid the reduction in income. However, the effects were small and suggest step-downs have marginal practical significance. We conclude that step-downs are generally ineffective as a return to work policy initiative.Postprint link: https://www.medrxiv.org/content/10.1101/19012286.

Canadian economic impact of improved workplace productivity in patients with major depressive disorder treated with vortioxetine.

OBJECTIVE: The AtWoRC study is an interventional, open-label Canadian study that demonstrated significant improvements in cognitive function and workplace productivity in patients with major depressive disorder (MDD) treated with vortioxetine for a current major depressive episode. The objective of the present analysis was to assess the Canadian economic impact of improved workplace productivity based on the AtWoRC study results. METHODS: The economic impact of improved productivity in patients with MDD treated with vortioxetine was assessed over a 52-week period considering productivity loss due to absenteeism and presenteeism using the standard human capital approach and an employer's perspective. Absenteeism was measured with the Work Productivity and Activity Impairment questionnaire; and presenteeism with the Work Limitation Questionnaire. Productivity gains following treatment initiation with vortioxetine were estimated using the difference from baseline. RESULTS: In the AtWoRC study, patients at baseline reportedly missed, in the past 7 days, an average of 8.1 h due to absenteeism and 3.0 h due to presenteeism. Following 52 weeks of treatment with vortioxetine, patients reportedly missed an average of 4.9 h due to absenteeism and 2.0 h due to presenteeism. This improved workplace productivity translated into savings of C$110.64 for 1 week of work following 52 weeks of treatment. The cumulative 52-week economic impact showed potential savings of C$4,550 when factoring in the cost of therapy. CONCLUSION: This study suggested that workplace productivity gain due to an improvement in symptoms of MDD following treatment with vortioxetine will lead to substantial cost savings for the Canadian economy.

Outcome, Return to Work and Health-Related Costs After Aneurysmal Subarachnoid Hemorrhage.

OBJECT: Data on health-related costs after aneurysmal subarachnoid hemorrhage (aSAH) are limited. The aim was to evaluate outcome, return to work and costs after aSAH with focus on differences between high- and low-grade aSAH (defined as World Federation of Neurological Surgeons [WFNS] grades 4-5 and WFNS 1-3, respectively). METHODS: A cross-sectional study was performed, including all consecutive survivors of aSAH over a 4-year period. A telephone interview was conducted to assess the Glasgow Outcome Scale Extended and employment status before and after aSAH. Direct costs were calculated by multiplying the length of hospitalization by the average daily costs. Indirect costs were calculated for productivity losses until retirement age according to the human capital approach. RESULTS: Follow-up was performed 2.7 years after aSAH (range 1.3-4.6). Favorable outcome was achieved in 114 of 150 patients (76%) and work recovery in 61 of 98 patients (62%) employed prior to aSAH. High-grade compared to low-grade aSAH resulted less frequently in favorable outcome (52% vs. 85%; p < 0.001) and work recovery (39% vs. 69%; p = 0.013). The total costs were € 344.277 (95% CI 268.383-420.171) per patient, mainly accounted to indirect costs (84%). The total costs increased with increasing degree of disability and were greater for high-grade compared to low-grade aSAH (€ 422.496 vs. € 329.193; p = 0.039). The effective costs per patient with favorable outcome were 2.1-fold greater for high-grade compared to low-grade aSAH (€ 308.625 vs. € 134.700). CONCLUSION: Favorable outcome can be achieved in a considerable proportion of high-grade aSAH patients, but costs are greater compared to low-grade aSAH. Further cost-effectiveness studies in the current era of aSAH management are needed.

Implementation of Early Intervention Protocol in Australia for 'High Risk' Injured Workers is Associated with Fewer Lost Work Days Over 2 Years Than Usual (Stepped) Care.

Purpose To evaluate whether a protocol for early intervention addressing the psychosocial risk factors for delayed return to work in workers with soft tissue injuries would achieve better long-term outcomes than usual (stepped) care. Methods The study used a controlled, non-randomised prospective design to compare two case management approaches. For the intervention condition, workers screened within 1-3 weeks of injury as being at high risk of delayed returned to work by the Örebro Musculoskeletal Pain Screening Questionnaire-short version (ÖMPSQ-SF) were offered psychological assessment and a comprehensive protocol to address the identified obstacles for return to work. Similarly identified injured workers in the control condition were managed under usual (stepped) care arrangements. Results At 2-year follow-up, the mean lost work days for the Intervention group was less than half that of the usual care group, their claim costs were 30% lower, as was the growth trajectory of their costs after 11 months. Conclusions The findings supported the hypothesis that brief psychological risk factor screening, combined with a protocol for active collaboration between key stakeholders to address identified psychological and workplace factors for delayed return to work, can achieve better return on investment than usual (stepped) care.

[The multiple sclerosis functional composite correlates with the sociomedical recommendation of earning capacity of rehabilitants with Multiple Sclerosis]. / Der Multiple Sclerosis Functional Composite korreliert mit der sozialmedizinischen Leistungsempfehlung zur Erwerbsfähigkeit von Rehabilitanden mit Multipler Sklerose.

BACKGROUND: The multiple sclerosis functional composite (MSFC) measures various MS- related impairments consisting of three subtests for mobility, motor hand function, and cognitive function. In medical rehabilitation, the MSFC may be a helpful instrument for the sociomedical recommendation of earning capacity (RoEC) at the end of rehabilitation. The aim of the study was to correlate the MSFC with the RoEC and to review the RoEC validity by the return to work (RTW) six months after discharge. METHODS: In a retrospective unicenter longitudinal study, the MSFC of 84 rehabilitants of working age was determined at the beginning (t0) and end (t1) of inpatient rehabilitation. The MSFC (total score and subtests) was correlated with the RoEC (positive ≥ 3h per day; negative <3h per day). Six months after discharge, the RTW (positive ≥ 3h per day; negative <3h per day) was assessed. RESULTS: Seventy of the 84 rehabilitants (83 %) received a positive RoEC. They showed no differences in epidemiological, MS or rehabilitation-specific characteristics as compared to the 14 rehabilitants with negative RoEC. Rehabilitants with positive RoEC as compared to those with negative RoEC showed significantly higher scores in the MSFC total score (z-Score: +0.11 vs. -0.55, p < 0.001) and subtests cognition (PASAT-3: 42.3 points vs. 27.7 points; p < 0.001) and mobility (T24FW: 5.1 sec vs. 6.7 sec; p = 0.002). Whereas the motor hand function was without significant difference (NHPT: 23.4 sec vs. 26.5 sec; p = 0.064). Both groups changed for better in the total score and subtests over time (t0, t1), but without significance. The RTW after six months were determined in 31 of the 84 rehabilitants (37 %); 90 % of these rehabilitants judged their RoEC as applicable. A positive RoEC correlated significantly with a positive RTW (r = 0.411; p = 0.022). However, a correlation between MSFC (t1) (total score, subtests) and RTW after six months could not be observed. CONCLUSION: On function level, the MSFC (total score ≥ 0) correlates significantly with a positive RoEC at discharge whose validity was shown by correlation with the RTW six months after discharge. The subtests cognition and mobility were decisive. In medical rehabilitation of MS, determining the MSFC can be helpful for developing a valid recommendation for participation in the form of a RoEC.

Population-based analysis of the impact of trauma on longer-term functional outcomes.

BACKGROUND: Functional outcome measures are important as most patients survive trauma. The aim of this study was to describe the long-term impact of trauma within a healthcare region from a social perspective. METHODS: People active in work or education and admitted to hospitals in Central Norway in the interval 1 June 2007 to 31 May 2010 after sustaining trauma were included in the study. Clinical data were linked to Norwegian national registers of cause of death, sickness and disability benefits, employment and education. Primary outcome measures were receipt of medical benefits and time to return to preinjury work level. Secondary outcome measures were mortality within 30 days or during follow-up. RESULTS: Some 1191 patients were included in the study, of whom 193 (16·2 per cent) were severely injured (Injury Severity Score greater than 15). Five years after injury, the prevalence of medical benefits was 15·6 per cent among workers with minor injuries, 22·3 per cent in those with moderate injuries and 40·5 per cent among workers with severe injuries. The median time after injury until return to work was 1, 4 and 11 months for patients with minor, moderate and severe injuries respectively. Twelve patients died within 30 days and an additional 17 (1·4 per cent) during follow-up. CONCLUSION: Patients experiencing minor or major trauma received high levels of medical benefits; however, most recovered within the first year and resumed preinjury work activity. Patients with severe trauma were more likely to receive medical benefits and have a delayed return to work. Registration number: NCT02602405 (http://www.clinicaltrials.gov).

Comparing disability and return to work outcomes between alternative and traditional workers' compensation programs.

BACKGROUND: The Union Construction Workers' Compensation Program (UCWCP) was developed in 1996 as an alternative workers' compensation arrangement. The program includes use of a preapproved medical and rehabilitation network and alternative dispute resolution (ADR), and prioritizes a quick and safe return-to-work. The aim of this study is to determine if differences in recovery-related outcomes exist between UCWCP and the statutory workers' compensation system (SWCS). METHODS: Claims data from 2003 to 2016 were classified as processed through UCWCP or SWCS. Outcomes included: temporary total disability (TTD), vocational rehabilitation (VR), claim duration and costs, and permanent partial disability (PPD). The relative risk of incurring TTD, VR, and PPD in UCWCP vs SWCS was calculated using log-binomial regression. Linear regression examined the relationship between programs and continuous outcomes including costs and duration. Estimates were adjusted for age, sex, wage, and severity. RESULTS: The UCWCP processed 15.8% of claims; higher percentages of UCWCP claimants were older and earned higher wages. Results point to positive findings of decreased TTD incidence and cost, lower risk of TTD extending over time, higher likelihood of VR participation, and less attorney involvement and stipulation agreements associated with UCWCP membership. Differences were more apparent in workers who suffered permanent physical impairment. CONCLUSION: Findings suggest that the defining programmatic elements of the UCWCP, including its medical provider and rehabilitation network and access to ADR, have been successful in their aims. Claims with increased severity exhibited more pronounced differences vs SWCS, potentially due, in part, to greater use of programmatic elements.

Common mental disorders and work.

Background: Governments and employers' organizations have sustained focus on common mental disorders (CMD), how they impact a person's ability to gain or continue work, the costs of sickness absence, presenteeism and job loss, and the positive impact of work on wellbeing. Sources of data: Scientific literature, mainly systematic reviews and grey literature, i.e. publications not accessible through medical databases. Areas of agreement: CMD are a major cause of disability, unemployment and dependency on welfare benefits. Good and healthy work is important for maintaining mental health and for promoting recovery from mental disorders. Areas of controversy: Evidence is limited with respect to the effectiveness of workplace interventions to prevent CMD and especially with respect to work outcomes and work reintegration of those who have been off sick. Growing points: There is growing interest in, and an increasing number of, best practice guidelines for employers, that could be improved and shared more actively. Areas timely for developing research: There is need for high-quality studies of interventions that examine work outcomes in patients who have been unable to obtain or continue work because of CMD.

Breast cancer survivors: return to work and wage loss in selected hospitals in Malaysia.

PURPOSE: This study aimed, firstly, to assess the determinants of return to work (RTW), secondly, to explore the amount of annual wage loss, and finally, to discover the determinants of wage loss among breast cancer (BC) survivors. METHODS: A cross-sectional study design was used in this research. The data was collected via interview using a validated questionnaire. Logistic regression models were developed to discover the significant determinants of RTW and of wage loss among BC survivors. RESULTS: A total of 256 BC survivors were included in this study. The analysis showed that there was a 21% loss of or reduction in mean income within 1 year after diagnosis. The significant predictors of RTW are being a government employee, having reduced wages or wage loss, and if the case had been diagnosed 1 year or more ago. Being a private sector employee and having a late stage of cancer was a barrier to RTW. The main risk factors for reduced wages or wage loss were belonging to the age group of 40-59 years, being of Chinese or Indian ethnicity, having low educational status, and not returning to work. However, belonging to the higher monthly income group (earning > RM 2000) is a protective factor against the risk of reduced wages or wage loss. CONCLUSIONS: Non-RTW and wage loss after diagnosis of BC may result in the survivors experiencing a significant financial burden. Assessment of these patients is becoming more crucial because more women participate in the workforce in Malaysia nowadays and because BC is managed using multiple treatment modalities with their consequences could lead to long absences from work.

A participatory supportive return to work program for workers without an employment contract, sick-listed due to a common mental disorder: an economic evaluation alongside a randomized controlled trial.

BACKGROUND: Mental disorders are associated with high costs for productivity loss, sickness absence and unemployment. A participatory supportive return to work (RTW) program was developed in order to improve RTW among workers without an employment contract, sick-listed due to a common mental disorder. The program contained a participatory approach, integrated care and direct placement in a competitive job. The aim of this study was to evaluate the cost-effectiveness and cost-utility of this new program, compared to usual care. In addition, its return on investment was evaluated. METHODS: An economic evaluation was conducted alongside a 12-month randomized controlled trial. A total of 186 participants was randomly allocated to the new program (n = 94) or to usual care (n = 92). Effect measures were the duration until sustainable RTW in competitive employment and quality-adjusted life years (QALYs) gained. Costs included intervention costs, medical costs and absenteeism costs. Registered data of the Dutch Social Security Agency were used to assess the duration until sustainable RTW, intervention costs and absenteeism costs. QALYs and medical costs were assessed using three- or six-monthly questionnaires. Missing data were imputed using multiple imputations. Cost-effectiveness analysis and cost-utility analysis were conducted from the societal perspective. A return on investment analysis was conducted from the social insurer's perspective. Various sensitivity analyses were performed to assess the robustness of the results. RESULTS: The new program had no significant effect on the duration until sustainable RTW and QALYs gained. Intervention costs and medical costs were significantly higher in the intervention group. From the societal perspective, the maximum probability of cost-effectiveness for duration until sustainable RTW was 0.64 at a willingness to pay of about €10 000/day, and 0.27 for QALYs gained, regardless of the willingness to pay. From the social insurer's perspective, the probability of financial return was 0.18. CONCLUSIONS: From the societal perspective, the new program was neither cost-effective in improving sustainable RTW nor in gaining QALYs. From the social insurer's perspective, the program did not result in a positive financial return. Therefore, the present study provided no evidence to support its implementation. TRIAL REGISTRATION: The trial was listed at the Dutch Trial Register (NTR) under NTR3563 on August 7, 2012.

Process Evaluation of a Participatory Supportive Return to Work Program for Workers Without a Permanent Employment Contract, Sick-Listed Due to a Common Mental Disorder.

Purpose This study aimed to perform a process evaluation of a participatory supportive return to work program for workers without a (permanent) employment contract, sick-listed due to a common mental disorder. The program consisted of a participatory approach, integrated care and direct placement in a competitive job. Our main questions were: were these components realized in practice and in accordance with the protocol? The evaluation took place alongside a randomized controlled trial. Methods The study population consisted of workers who filed a sickness benefit claim at the Dutch Social Security Agency, professionals of this agency and of vocational rehabilitation agencies. We focused on sick-listed workers and professionals who had actually participated in the intervention. Data was collected mainly by questionnaires. Results Only 36 out of 94 intervention group participants started with the program. In half of these cases application of integrated care was reported. Most other steps in the program were completed. However, fidelity to the protocol was low to reasonable. Much delay was observed in the execution of the program and only two sick-listed workers were placed in a competitive job. Still, satisfaction with the participatory approach was good. Conclusions Despite the positive evaluation of the participatory approach, the full program was executed less successfully compared to similar programs evaluated in earlier studies. This will probably affect the outcomes of our trial. Findings from this study will help to interpret these outcomes. Nevertheless, more knowledge is needed about experiences of stakeholders who participated in the program. Trial Registration NTR3563.

Perspectives from Employers, Insurers, Lawyers and Healthcare Providers on Factors that Influence Workers' Return-to-Work Following Surgery for Non-Traumatic Upper Extremity Conditions.

PURPOSE: Return-to-work (RTW) stakeholders have varied roles and may therefore hold their own perspectives regarding factors that may influence outcomes. This study aimed to determine stakeholders' perspectives on factors influencing RTW following surgery for non-traumatic upper extremity conditions. METHODS: A questionnaire was distributed to RTW stakeholders via gatekeeper organizations. Stakeholders rated 50 potential prognostic factors from 'not' to 'extremely' influential. Data were dichotomized to establish stakeholders' level of agreement. Disagreements between stakeholder groups were analyzed using χ 2. The relationship between stakeholder demographic variables and rating of a factor was determined via regression analysis. RESULTS: One thousand and eleven stakeholders completed the survey: healthcare providers (77.8 %); employer representatives (12.2 %); insurer representatives (6.8 %); and lawyers (3.2 %). Factors with the highest stakeholder agreement for influencing RTW were: self-efficacy (92.2 %); post-operative psychological status (91.8 %); supportive employer/supervisor (91.4 %); employer's willingness to accommodate job modifications (90.7 %); worker's recovery expectations (88.3 %); mood disorder diagnosis (86.6 %); post-operative pain level (86.4 %); and whether the job can be modified (86.3 %). Disagreements between stakeholder groups were found for 19 (36 %) factors. The strongest disagreements were for: age; gender; obesity; doctor's RTW recommendation; and presence of a RTW coordinator. Respondents' characteristics (e.g., age, workers' compensation jurisdiction, work experience, stakeholder group) were associated with factor rating. CONCLUSION: The factors stakeholders rated as having the greatest influence on RTW were predominately psychosocial and modifiable. These variables should be the focus of future research to determine prognostic factors for RTW for workers with upper extremity conditions, and to develop effective RTW interventions.

[Return to Work After Shoulder Arthroscopy as an Index of Cost Effectiveness]. / Nutzenbewertung der minimal-invasiven Schulterchirurgie aus Sicht der Kostenträger.

Cost-effectiveness of shoulder arthroscopy was analyzed and assessed by the days off work as part of the indirect costs. We retrospectively evaluated a group of 266 inpatients on sick leave after arthroscopic shoulder surgery. Mean duration till return to full duty was 9.5 days, the mean sick leave benefit was € 485. There was a statistically significant difference in the mean time to return to work between the older (age >50) and the younger group (age under 50). Secondary data analysis of sick leave and sickness benefits as indirect costs of medical treatment seems to be well suited to provide essentiell information to health care policy makers and those charged with distributing disability funds.

Employment Trajectories Beyond Retirement.

Within the political and academic debate on working longer, post-retirement employment is discussed as an alternative to maintain older workers in the labor market. Our article enhances this discussion by studying determinants of transitions into post-retirement jobs within differing work environments of birth cohorts 1940-1942. We estimate proportional subhazard models accounting for competing risks using unique German social security data linked to pension accounts. Our findings suggest that individuals' preferences to take up post-retirement jobs are not mutually exclusive. Our study provides evidence that taking up post-retirement jobs is related to seeking financial security, continuity, and work ability, suggesting that public policy has to develop target-oriented support through a public policy mix of different measures aligned to the different peer groups in the labor market.

Design of a multicentre randomized controlled trial to evaluate the effectiveness of a tailored clinical support intervention to enhance return to work for gastrointestinal cancer patients.

BACKGROUND: Gastrointestinal (GI) cancer is frequently diagnosed in people of working age, and many GI cancer patients experience work-related problems. Although these patients often experience difficulties returning to work, supportive work-related interventions are lacking. We have therefore developed a tailored work-related support intervention for GI cancer patients, and we aim to evaluate its cost-effectiveness compared with the usual care provided. If this intervention proves effective, it can be implemented in practice to support GI cancer patients after diagnosis and to help them return to work. METHODS/DESIGN: We designed a multicentre randomized controlled trial with a follow-up of twelve months. The study population (N = 310) will include individuals aged 18-63 years diagnosed with a primary GI cancer and employed at the time of diagnosis. The participants will be randomized to the intervention or to usual care. 'Usual care' is defined as psychosocial care in which work-related issues are not discussed. The intervention group will receive tailored work-related support consisting of three face-to-face meetings of approximately 30 min each. Based on the severity of their work-related problems, the intervention group will be divided into groups receiving three types of support (A, B or C). A different supportive healthcare professional will be available for each group: an oncological nurse (A), an oncological occupational physician (B) and a multidisciplinary team (C) that includes an oncological nurse, oncological occupational physician and treating oncologist/physician. The primary outcome measure is return to work (RTW), defined as the time to a partial or full RTW. The secondary outcomes are work ability, work limitations, quality of life, and direct and indirect costs. DISCUSSION: The hypothesis is that tailored work-related support for GI cancer patients is more effective than usual care in terms of the RTW. The intervention is innovative in that it combines oncological and occupational care in a clinical setting, early in the cancer treatment process. TRIAL REGISTRATION: METC protocol number NL51444.018.14/Netherlands Trial Register number NTR5022 . Registered 6 March 2015.

Examining age differences in duration of wage replacement by injury characteristics.

BACKGROUND: One explanation for why older age is associated with greater duration of wage replacement following a work-related injury may be that older workers sustain more severe injuries and different types of injury compared with their younger counterparts. AIMS: To examine the role of injury-related characteristics in explaining the impact of age on wage replacement duration, and whether the relationship between age and wage replacement duration is consistent across injury types and levels of severity. METHODS: A secondary analysis of workers' compensation claims in the Australian state of Victoria. In Victoria, only injuries which have accumulated >10 days of wage replacement, or have health care expenditures above a financial threshold, are eligible for compensation. Nested regression models were used to examine the relative contribution of injury-related characteristics to age differences in wage replacement duration. RESULTS: Older age was associated with greater days of wage replacement among men and women, even after adjusting for injury characteristics. Adjustment for differences in injury types and compensation reporting practices resulted in moderate attenuation of the age-duration relationship among men and small attenuation among women. The age-duration relationship was consistent across injury types/severity. CONCLUSIONS: The relationship between older age and greater duration of wage replacement is ubiquitous across injuries of different types and severity. Future research is required to understand better why older age is consistently associated with worse compensation outcomes following work-related injury.

The Added Value of Collecting Information on Pain Experience When Predicting Time on Benefits for Injured Workers with Back Pain.

Objectives Some injured workers with work-related, compensated back pain experience a troubling course in return to work. A prediction tool was developed in an earlier study, using administrative data only. This study explored the added value of worker reported data in identifying those workers with back pain at higher risk of being on benefits for a longer period of time. Methods This was a cohort study of workers with compensated back pain in 2005 in Ontario. Workplace Safety and Insurance Board (WSIB) data was used. As well, we examined the added value of patient-reported prognostic factors obtained from a prospective cohort study. Improvement of model fit was determined by comparing area under the curve (AUC) statistics. The outcome measure was time on benefits during a first workers' compensation claim for back pain. Follow-up was 2 years. Results Among 1442 workers with WSIB data still on full benefits at 4 weeks, 113 were also part of the prospective cohort study. Model fit of an established rule in the smaller dataset of 113 workers was comparable to the fit previously established in the larger dataset. Adding worker rating of pain at baseline improved the rule substantially (AUC = 0.80, 95 % CI 0.68, 0.91 compared to benefit status at 180 days, AUC = 0.88, 95 % CI 0.74, 1.00 compared to benefits status at 360 days). Conclusion Although data routinely collected by workers' compensation boards show some ability to predict prolonged time on benefits, adding information on experienced pain reported by the worker improves the predictive ability of the model from 'fairly good' to 'good'. In this study, a combination of prognostic factors, reported by multiple stakeholders, including the worker, could identify those at high risk of extended duration on disability benefits and in potentially in need of additional support at the individual level.

Return-to-work intervention for cancer survivors: budget impact and allocation of costs and returns in the Netherlands and six major EU-countries.

BACKGROUND: Return-to-work (RTW)-interventions support cancer survivors in resuming work, but come at additional healthcare costs. The objective of this study was to assess the budget impact of a RTW-intervention, consisting of counselling sessions with an occupational physician and an exercise-programme. The secondary objective was to explore how the costs of RTW-interventions and its financial revenues are allocated among the involved stakeholders in several EU-countries. METHODS: The budget impact (BI) of a RTW-intervention versus usual care was analysed yearly for 2015-2020 from a Dutch societal- and from the perspective of a large cancer centre. The allocation of the expected costs and financial benefits for each of the stakeholders involved was compared between the Netherlands, Belgium, England, France, Germany, Italy, and Sweden. RESULTS: The average intervention costs in this case were €1,519/patient. The BI for the Netherlands was €-14.7 m in 2015, rising to €-71.1 m in 2020, thus the intervention is cost-saving as the productivity benefits outweigh the intervention costs. For cancer centres the BI amounts to €293 k in 2015, increasing to €1.1 m in 2020. Across European countries, we observed differences regarding the extent to which stakeholders either invest or receive a share of the benefits from offering a RTW-intervention. CONCLUSION: The RTW-intervention is cost-saving from a societal perspective. Yet, the total intervention costs are considerable and, in many European countries, mainly covered by care providers that are not sufficiently reimbursed.

The effectiveness of the "Brainwork Intervention" in reducing sick leave for unemployed workers with psychological problems: design of a controlled clinical trial.

BACKGROUND: Among the working population, unemployed, temporary agency and expired fixed-term contract workers having psychological problems are a particularly vulnerable group, at risk for sickness absence and prolonged work disability. Studies investigating the effectiveness of return-to-work (RTW) interventions on these workers, who are without an employment contract, are scarce. Therefore, a RTW intervention called 'Brainwork' was developed. The objective of this paper is to describe the 'Brainwork Intervention' and the trial design evaluating its effectiveness in reducing the duration of sick leave compared to usual care. METHODS/DESIGN: The 'Brainwork Intervention' is designed to assist unemployed, temporary agency and expired fixed-term contract workers who are sick-listed due to psychological problems, with their return to work. The 'Brainwork Intervention' uses an activating approach: in the early stage of sick leave, workers are encouraged to exercise and undertake activities aimed at regaining control and functional recovery while job coaches actively support their search for (temporary) jobs. The content of the intervention is tailored to the severity of the psychological problems and functional impairments, as well as the specific psychosocial problems encountered by the sick-listed worker. The intervention study is designed as a quasi-randomized controlled clinical trial with a one-year follow-up and is being conducted in the Netherlands. The control group receives care as usual with minimal involvement of occupational health professionals. Outcomes are measured at baseline, and 4, 8 and 12 months after initiation of the program. The primary outcome measure is the duration of sick leave. Secondary outcome measures are: the proportion of subjects who returned to work at 8 and 12 months; the number of days of paid employment during the follow-up period; the degree of worker participation; the level of psychological complaints; and the self-efficacy for return to work. The cost-benefit analysis will be evaluated from an insurer's perspective. DISCUSSION: The methodological considerations of the study design are discussed. In this trial we evaluate the effectiveness of an intervention in real occupational health practice, rather than under highly controlled circumstances. The results will be published in 2015. TRIAL REGISTRATION NUMBER: NTR4190. Date of registration: September 27(th) 2013.