The Relationship Between Work-Disability Duration and Claimant's Expected Time to Return to Work as Recorded by Workers' Compensation Claims Managers.

Purpose This research sought to determine whether there is a relationship between claimants' expected time to return to work (RTW) as recorded by claims managers and compensated days of work disability. Methods We utilized workers' compensation data from a large, United States-based insurance company. RTW expectations were collected within 30 days of the claim being reported and these were compared with the termination of total temporary indemnity payments. Bivariate and hierarchical regression analyses were conducted. Results A significant relationship between expected time to RTW and compensated disability duration was observed. The unadjusted correlation between work-disability duration and expected time to RTW was .25 (p < .001). Our multivariate model explained 29.8 % of the variance, with expected time to RTW explaining an additional 9.5 % of the variance in work-disability duration beyond what was explained by the covariates. Conclusion The current study's findings support the hypothesis that claimant RTW estimates as recorded by claims managers are significantly related to compensated-disability duration, and the relationship is maintained after controlling for variance that can be explained by other variables available within workers' compensation databases.

Workplace Outcomes in Work-Disability Prevention Research: A Review with Recommendations for Future Research.

Introduction Outcome assessment is a central issue in work disability prevention research. The goal of this paper was to (1) ascertain the most salient workplace outcomes; (2) evaluate the congruence between business and science perspectives; (3) illustrate new perspectives on assessing longitudinal outcomes; and (4) provide recommendations for advancing outcome evaluation in this area of research. Methods The authors participated in a year-long collaboration that culminated in a sponsored 3-day conference, "Improving Research of Employer Practices to Prevent Disability", held October 14-16, 2015, in Hopkinton, MA, USA. The collaboration included a topical review of the literature, group conference calls to identify key areas and challenges, drafting of initial documents, review of industry publications, and a conference presentation that included feedback from peer researchers and a question/answer session with a special panel of knowledge experts with direct employer experience. Results Numerous workplace work-disability prevention outcome measures were identified. Analysis indicated that their applicability varied depending on the type of work disability the worker was experiencing. For those who were working, but with health-related work limitations (Type 1), predominant outcomes were measures of productivity, presenteeism, and work-related limitations. For those who were off work due to a health condition (Type 2), predominant outcomes were measures of time off work, supervisor/employee interactions, and return-to-work (RTW) preparation. For those who had returned to work (Type 3), predominant outcomes were measures of presenteeism, time until RTW, percentage of work resumption, employment characteristics, stigma, work engagement, co-worker interactions, and sustained or durable RTW. For those who had withdrawn from the labor force (Type 4), predominant outcomes were cost and vocational status. Discussion Currently available measures provide a good basis to use more consistent outcomes in disability prevention in the future. The research area would also benefit from more involvement of employers as stakeholders, and multilevel conceptualizations of disability outcomes.

Single impacts of keV fullerene ions on free standing graphene: Emission of ions and electrons from confined volume.

We present the first data from individual C60 impacting one to four layer graphene at 25 and 50 keV. Negative secondary ions and electrons emitted in transmission were recorded separately from each impact. The yields for C(n)(-) clusters are above 10% for n ≤ 4, they oscillate with electron affinities and decrease exponentially with n. The result can be explained with the aid of MD simulation as a post-collision process where sufficient vibrational energy is accumulated around the rim of the impact hole for sputtering of carbon clusters. The ionization probability can be estimated by comparing experimental yields of C(n)(-) with those of C(n)(0) from MD simulation, where it increases exponentially with n. The ionization probability can be approximated with ejecta from a thermally excited (3700 K) rim damped by cluster fragmentation and electron detachment. The experimental electron probability distributions are Poisson-like. On average, three electrons of thermal energies are emitted per impact. The thermal excitation model invoked for C(n)(-) emission can also explain the emission of electrons. The interaction of C60 with graphene is fundamentally different from impacts on 3D targets. A key characteristic is the high degree of ionization of the ejecta.

Hypervelocity nanoparticle impacts on free-standing graphene: a sui generis mode of sputtering.

The study of the interaction of hypervelocity nano-particles with a 2D material and ultra-thin targets (single layer graphene, multi-layer graphene, and amorphous carbon foils) has been performed using mass selected gold nano-particles produced from a liquid metal ion source. During these impacts, a large number of atoms are ejected from the graphene, corresponding to a hole of ∼60 nm(2). Additionally, for the first time, secondary ions have been observed simultaneously in both the transmission and reflection direction (with respect to the path of the projectile) from a 2D target. The ejected area is much larger than that predicted by molecular dynamic simulations and a large ionization rate is observed. The mass distribution and characteristics of the emitted secondary ions are presented and offer an insight into the process to produce the large hole observed in the graphene.

Exploring the relationship between age and tenure with length of disability.

BACKGROUND: The aging of the workforce, coupled with the changing nature of career tenure has raised questions about the impact of these trends on work disability. This study aimed to determine if age and tenure interact in relating to work disability duration. METHODS: Relationships were investigated using random effects models with 239,359 work disability claims occurring between 2008 and 2012. RESULTS: A 17-day difference in the predicted length of disability was observed from ages 25 to 65. Tenure moderated the relationship between age and length of disability. At younger ages, the length of disability decreased as tenure increased, but at older age, the length of disability increased as tenure increased. DISCUSSION: Results indicate that although there is a relationship between length of disability and tenure, age makes a greater unique contribution to explaining variance in length of disability. Future research is needed to better understand why specifically age shows a strong relationship with length of disability and why that relationship varies with age.

Returning to work following low back pain: towards a model of individual psychosocial factors.

PURPOSE: The aim of this paper is to develop and test a model of direct and indirect relationships among individual psychosocial predictors of return-to-work (RTW) outcomes following the onset of low back pain (LBP). METHODS: We utilize secondary analysis of a larger study of adults seeking treatment for work-related LBP with recent onset. In total, 241 participants who completed a baseline survey, a short follow-up survey, and a longer follow-up survey after 3 months were included in our analyses. The participants were required to have LBP with onset of less than 14 days, be 18 years or older, and be fluent in English or Spanish. The analyses utilized structural equation models to test the direct and indirect relationships among the variables and RTW outcomes at 3 months. RESULTS: Our results indicated a good fit for our model (χ2 = 69.59, df = 45, p < .05; RMSEA = .05; CFI = .95; WRMR = .61). Pain, catastrophizing, fear-avoidance beliefs, organizational support, and RTW confidence were all found to have indirect relationships with the outcomes. RTW confidence and RTW expectations were found to have direct relationships with the outcomes. CONCLUSIONS: The process of returning to work after an episode of LBP is a complex process involving many interrelated factors. Understanding the relationships among critical individual factors in the RTW process may be important for the treatment and rehabilitation of those with LBP. Results suggest that if injured workers are struggling with fear avoidance, pain catastrophizing and confidence issues, they might benefit from the application of cognitive behavioral therapy techniques.

What is return to work? An investigation into the quantification of return to work.

PURPOSE: To describe and demonstrate issues with return to work (RTW) outcome metrics in common use among clinical researchers and injury compensation organisations. We also aim to describe a framework on which to capture relevant RTW information including current employment status and data on participation and maintenance. METHODS: Structured telephone interviews discussing participant health and vocational status were conducted following compensable transport-related injury. Participants who were working at the time of injury and took time off work because of their injuries (N = 414) were asked questions relating to their work participation and maintenance, including length of continuous employment, hours worked and duties performed before and after injury. A series of RTW metrics was developed and applied to survey data. Rates of RTW according to each metric were calculated. RESULTS: Eighty-four per cent of participants had achieved some employment since their injury, and 74% were working at the time of the survey. In contrast, only 58% of participants were working the same hours as prior to their injury and had been doing so for at least 3 months. These data show that different impressions of rehabilitative success can be obtained depending on the criterion used to define RTW suggesting that reliance on a single RTW index (e.g. 'are you currently working?') will not represent important characteristics of employment. CONCLUSION: A multi-layered approach to measuring RTW that includes data on reasons for not working, length of continuous employment, hours and duties performed after injury provides greater insight into the vocational status of injured individuals compared to single metrics or outcomes that fail to capture key detail on motives and participation. This information can assist clinicians to more accurately monitor the progress of rehabilitation following injury and compensation schemes to more effectively monitor their performance.

Beyond symptom resolution: insurance case manager's perspective on predicting recovery after motor vehicle crash.

PURPOSE: Insurance company case managers can play a critical role in the rehabilitation process of people with musculoskeletal disorders sustained following minor motor vehicle crash injury due to their interaction with multiple stakeholders and their role in approving various services. This study aimed to identify factors that case managers perceive as predictive of recovery in people with musculoskeletal disorders after minor motor vehicle crash injury. MATERIALS AND METHODS: To explore the perspectives of cases managers in Australia and the United States, semi-structured interviews explored factors that case managers thought provided an early indication of likely recovery outcomes in people with musculoskeletal disorders after minor motor vehicle crash injury. A framework analysis was applied and factors were displayed within the ICF-framework. RESULTS: Case managers (n = 40) demonstrated a broad, detailed understanding of biopsychosocial and contextual issues influencing recovery. They emphasized the importance of the injured worker's expressed affect and motivation, style of communication, the role of lawyers, the worker's family and friends, as well as cultural and geographic influences. The overarching themes perceived as having a major influence on recovery outcomes were general health, pain processing and response, work situation, and compensation entitlement. CONCLUSIONS: Case managers' broad and detailed perceptions about recovery may provide additional, valuable perspectives for professionals involved in the rehabilitation process of people with musculoskeletal disorders after minor motor vehicle crash injury. Further research needs to be conducted to explore the effects of case manager involvement in the process of recovery.Implications for rehabilitationInsurance Case Managers identified multiple factors including affect and motivation, style of communication, the role of lawyers, family and friends, cultural and geographic variation provide opportunities for more effective treatment of people with musculoskeletal disorders related to minor motor vehicle collisions. These managers' perceptions about recovery may be informative to and provide opportunities for health professionals involved in the rehabilitation of people with musculoskeletal disorders related to minor motor vehicle collisions.While the Insurance Case Managers involved in this research did not use formalized assessment techniques, tools and assessment protocols could be developed jointly between for the needs of Insurance Case Managers and other stakeholders to tackle recovery of people with musculoskeletal disorders related to minor motor vehicle collision.

Return-to-work experiences: prior to receiving vocational services.

PURPOSE: Injured workers can experience a myriad of difficulties while attempting workplace reintegration and, in some cases, problems encountered result in workers being unable to take up employment opportunities and/or maintain employment gains. This project aimed to discover what injured workers report as being the reason for their not pursuing and/or leaving post-injury work opportunities. METHODS: Semi-structured interviews inquiring about participant's (N = 150) return-to-work experiences following an occupational injury resulting in an impairment that limited their ability to perform their past work. RESULTS: Findings indicate that although reasons cited for the loss of employment gains included physiological body function, the ability to perform work-related tasks and actions and personal factors, the most commonly referenced barriers by far were environmental in nature. Depending on where the worker was within the return-to-work process, the regularity with which each of the types of environmental factors was mentioned varied considerably. CONCLUSIONS: The finding that environmental factors are considered the most common stumbling blocks is positive in that these are arguably some of the most amenable to intervention.

Urban-rural differences in work disability after an occupational injury.

OBJECTIVES: In comparison with their urban counterparts, people living in rural areas have been found to experience higher rates of morbidity and mortality and have inferior health outcomes after illnesses and injuries. The current study sought to determine if this trend extends to work-disability outcomes after work-related injuries. METHODS: This study was a retrospective cohort study using data on workers' compensation claims. Rurality was defined at the postal-code level on the basis of United States 2000 census data. Work disability was measured using the number of full days a person was off work in the 2 years following an injury. Regression analyses were used to test the association between rurality and the duration of work disability after a work-related bone fracture. RESULTS: The claimants with higher rurality experienced less work disability than those with lower rurality. This relationship remained after control for the impact of age, gender, part of body injured, occupation, and industry. CONCLUSIONS: Rurality was found to be related to work disability. However, rather than being associated with more time off after an injury, as could be expected on the basis of past findings, increased rurality was found to be associated with less time off work. The findings suggest that features of rural environments, cultures, and behavioral patterns may facilitate return to work.

Work-Related Factors Considered by Sickness-Absent Employees When Estimating Timeframes for Returning to Work.

INTRODUCTION: Work-related factors have been found to be influential in shaping a number of return-to-work outcomes including return-to-work expectations. Based on the idea that work-related factors have the potential for modification through workplace-based initiatives, this study involved a detailed examination of work-related factors referenced by workers as being taken into consideration when estimating timeframes for returning to work. METHODS: Focus groups were conducted with 30 employees, currently off work (≤ 3 months) due to a musculoskeletal condition. During the focus groups, participants wrote and spoke about the factors that they considered when forming their expectations for returning to work. Data were subjected to thematic content analysis. RESULTS: Discussions revealed that participants' considerations tended to differ depending on whether or not they had a job to return to. Those with jobs (n = 23) referenced specific influences such as working relationships, accommodations, physical and practical limitations, as well as concerns about their ability to do their job. Those without a job to return to (n = 7) talked about the ways they would go about finding work, and how long they thought this would take. Both groups mentioned the influence of wanting to find the "right" job, retraining and being limited due to the need for income. CONCLUSION: Findings indicate that employees reference numerous work-related factors when estimating their timeframes for returning to work, and that many of these have been previously identified as relating to other return-to-work outcomes. Findings suggest the potential to improve return-to-work expectation through addressing work-related influences, and helping people work through the tasks they need to complete in order to move forward in the return-to-work process.

Relationship Between Age, Tenure, and Disability Duration in Persons With Compensated Work-Related Conditions.

OBJECTIVE: The aim of the study was to examine the relationships among age, tenure, and the length of disability following a work-related injury/illness. METHODS: This study utilized 361,754 administrative workers' compensation claims. The relationships between age, tenure, and disability duration was estimated with random-effects models. RESULTS: The age-disability duration relationship was stronger than the tenure-disability duration relationship. An interaction was observed between age and tenure. At younger ages, disability duration varied little based on tenure. In midlife, disability duration was greater for workers with lower tenure than for workers with higher tenure. At the oldest ages, disability duration increased as tenure increased. CONCLUSIONS: Findings indicate that age is a more important factor in disability duration than tenure; however, the relationship between age and disability duration varies based on tenure, suggesting that both age and tenure are important influences in the work-disability process.

Employment participation following spinal cord injury: relation to selected participant demographic, injury and psychological characteristics.

PURPOSE: To determine the relationship between selected demographic, injury and psychological characteristics and the extent of employment undertaken following spinal cord injury (SCI). METHOD: Data were collected from 289 persons with SCI who found employment post-injury. A survey was administered to patients of a specialist spinal cord injury unit located in South-Eastern Australia. A variety of demographic, injury and psychological variables were assessed for their relationship to the extent of employment undertaken following SCI. Extent of employment, was defined as time spent employed as a proportion of the time available for employment, and is hereafter referred to as "workrate." RESULTS: On average, participants reported having been employed for almost two-thirds of their available time. Study variables explained 22% (18% adjusted) of the variance in post-injury workrate. Individually, demographic and psychological variables, but not injury variables, were found to relate to the outcome measure. CONCLUSION: Using a novel measure of employment outcome, this study yielded findings consistent with other research using alternate employment measures. Results suggest that demographic and psychological variables are more related to this measure of employment participation than are injury variables. The addition of environmental variables may allow for the explanation of more variance in outcome.

The importance, measurement and practical implications of worker's expectations for return to work.

PURPOSE: Workers' own expectations for return to work consistently predict work status. To advance the understanding of the relationship between RTW expectations and outcomes, we reviewed existing measures to determine those which we felt were the most likely to capture the construct. METHOD: A comprehensive search of the work-disability rehabilitation literature was undertaken. The review of the measures was conducted in three steps: first, a review of terminology; second, an examination of whether a time reference was included; third, an evaluation of ease of comprehension, and applicability across contexts. RESULTS: A total of 42 different measures were identified. One of the most striking findings was the inconsistency in terminology. Measures were also limited by not including a time reference. Problems were also identified with regards to ease of understanding, utility of response options, and applicability in a wide variety of research and applied settings. CONCLUSIONS: Most previously used measures contain elements that potentially limit utility. However, it would seem that further development can overcome these, resulting in a tool that provides risk prediction information, and an opportunity to start a conversation to help identify problems that might negatively impact a worker's movement through the RTW process and the outcomes achieved. Implications for Rehabilitation Return to work is an integral part of workplace injury management. The capture of RTW expectations affords a way to identify the potential for less than optimal RTW processes and outcomes. A mismatch between an injured worker's expectations and what other stakeholders might expect suggests that efforts could be made to determine what is causing the injured worker's concerns. Once underling issues are identified, work can be put into resolving these so that the worker's return to the workplace is not impeded.

An Exploration of the Factors Considered When Forming Expectations for Returning to Work following Sickness Absence Due to a Musculoskeletal Condition.

INTRODUCTION: Workers' own expectations for returning to work following a period of sickness absence have been found to be one of the best predictors of future work status; however, there is a limited understanding of why people expect what they do. The current study was undertaken with the aim of determining what people take into consideration when forming their expectations for returning to work. METHODS: Thirty-four people (8 women, 26 men), who were off work due to a musculoskeletal condition, participated in one of 14 focus groups. Participants were aged 25 to 65 (M = 45, SD = 12.6), and all had been out of work for 3 months or less. RESULTS: All participants reported expecting to return to work, with the most common timeframe being approximately 30 days (Range = 1 day-12 months). When explaining what they thought about when forming their expectations, participants referenced numerous considerations. Much of what was spoken about could be compartmentalized to reflect features of themselves, their condition, or their broader environmental contexts. Participant's subjective experience of these features influenced his or her expectations. Prominent themes included concerns about employability, a desire to get back to normal, no job to go back to, mixed emotions, re-injury concerns, the judgments of workplace stakeholders, being needed by their employer, waiting for input, until the money runs out, and working out what was in their best interest. CONCLUSIONS: Indications are that many of the reported considerations are amenable to intervention, suggesting opportunities to assist workers in the process of returning to work.

Explaining labor force status following spinal cord injury: the contribution of psychological variables.

OBJECTIVE: To investigate the relative influence of demographic, injury and psychological characteristics on the labor force status of people living with spinal cord injury. DESIGN: Cross-sectional survey. SUBJECTS: 459 persons who had experienced a traumatic spinal cord injury. All participants were patients of 1 of 2 specialist spinal cord injury services located in south-eastern Australia. METHODS: A survey, administered on average of 11.2 years after their injury, was used to collect the data. The study's main outcome measure was labor force status at the time of survey. Of those invited to participate in the study, 73% agreed to do so. RESULTS: Demographic, injury and psychological variables were found to explain 30% of the variance in the employment criterion: "in the labor force" vs "not in the labor force". Psychological variables contributed significantly to the separation of the 2 labor force groups. CONCLUSION: The inclusion of the selected psychological variables has advanced the understanding of the factors related to return to work following spinal cord injury, however this understanding is still not complete. Future efforts in this field would likely benefit from the inclusion of additional psychological characteristics, as well as environmental factors.

Agricultural workers' return to work following spinal cord injury: a comparison with other industry workers.

PURPOSE: To investigate the impact of spinal cord injury on employment outcomes as experienced by agricultural workers in comparison with persons employed in other industries. Because of the challenges associated with working in many of the agricultural industries, it was anticipated that agricultural workers would achieve inferior return-to-work outcomes. METHOD: Survey of all employed persons who experienced a traumatic spinal cord injury in southeastern Australia between 1990 and 1996 (inclusive). RESULTS: Contrary to expectation, agricultural workers had a significantly higher rate of return to work (61.7% vs. 41.1%). However, an investigation into the hours spent working and agricultural workers' satisfaction with their employment activities, indicated that most were underemployed and had the potential to achieve even better outcomes. CONCLUSION: Results indicate that more can be done to help injured agricultural workers achieve their employment potential.

An exploration of alternative methods for assessing return-to-work success following occupational injury.

PURPOSE: To explore alternative methods for assessing return-to-work success. METHOD: This exploratory study employed a prospective design. Participants (N = 150) were all vocational rehabilitation recipients who sustained a work-related injury that resulted in them being off work for at least 6 months, and were unable to return to their pre-injury position. At baseline (B), all were reported to have found post-injury employment. Qualitative features of the participants' post-injury employment were assessed at the time of initial interview (T1), which was conducted a mean of approximately one year following the participants' scheduled workplace re-entry (mean 344 days). Participants' T1 employment characteristics were then compared to their outcomes at the time of follow-up (T2), which was approximately 3 months later (mean 85 days). RESULTS: Findings indicate that 25% of participants were not in their baseline jobs at the time of last contact; some were in different jobs, however others were not working. At T1 many of those working reported experiencing difficulties. Comparisons revealed significant relationships between problem indicators at T1 and employment outcomes at T2, with significant problem indicators including worries that symptoms might interfere with their ability to continue in the job, difficulties with the job's physical demands and a strong desire to leave their current job. When problem indicators were used in combination, stronger relationships were observed and self-assessed performance contributed to the effect. CONCLUSIONS: Results add support to the contention that rather than a single event, RTW is an evolving, complex and sometimes nonlinear process. This should be kept in mind when assessing the success of an injured worker's RTW.

Recurrence of work-related low back pain and disability: association between self-report and workers' compensation data.

STUDY DESIGN: Retrospective cohort. OBJECTIVE: To explore the ability to capture low back pain (LBP) recurrence using wage-replacement (WR) data. SUMMARY OF BACKGROUND DATA: LBP can be a recurrent, fluctuating, and disabling condition. Because of its largely nonspecific and subjective nature, the condition poses challenges for research and clinical management, as speaking directly with the affected individuals is not always practical. Little information is available on how indicators of LBP recurrence that can be extracted from administrative databases relate to patients' self-report. METHODS: Participants with a compensated claim for work-related LBP (N = 90) were interviewed regarding their LBP-related experiences after their initial return to work. Interview data were compared with WR data, which was provided by the participants' workers' compensation provider. RESULTS: Concordance was observed between WR-based indicators and self-reports of additional time off due to LBP. The best performing WR-based indicator reflected a payment history that began with more than 7 consecutive days of initial WR payments, followed by a gap in WR payments of more than 7 consecutive days, followed by another WR payment period of more than 7 consecutive days (sensitivity = 55%, specificity = 73%, overall accuracy = 69%). Although concordance was observed between the 2 measures of additional time off, the best performing WR indicator was not related to participants' other self-reports of post-return-to-work LBP recurrence which included LBP being significantly worse usual; LBP experiences; seeking health care for LBP; and the experience of difficulties related to the back condition. CONCLUSION: Results indicate that compensation data can be used to capture what a claimant would self-report as additional time off after their initial return to work due to their LBP condition. However, the use of self-report recurrence indicators is recommended if there is a desire to capture a fuller extent of workers' ongoing pain and/or disability experiences. LEVEL OF EVIDENCE: N/A.