A Sensibility Assessment of the Job Demands and Accommodation Planning Tool (JDAPT): A Tool to Help Workers with an Episodic Disability Plan Workplace Support.

Purpose Sensibility refers to a tool's comprehensiveness, understandability, relevance, feasibility, and length. It is used in the early development phase to begin assessing a new tool or intervention. This study examined the sensibility of the job demands and accommodation planning tool (JDAPT). The JDAPT identifies job demands related to physical, cognitive, interpersonal, and working conditions to better target strategies for workplace supports and accommodations aimed at assisting individuals with chronic health conditions. Methods Workers with a chronic health condition and workplace representatives were recruited from health charities, workplaces, and newsletters using convenience sampling. Cognitive interviews assessed the JDAPT's sensibility. A 70% endorsement rate was the minimum level of acceptability for sensibility concepts. A short screening tool also was administered, and answers compared to the complete JDAPT. Results Participants were 46 workers and 23 organizational representatives (n = 69). Endorsements highly exceeded the 70% cut-off for understandability, relevance, and length. Congruence between screening questions and the complete JDAPT suggested both workers and organizational representatives overlooked job demands when completing the screener. Participants provided additional examples and three new items to improve comprehensiveness. The JDAPT was rated highly relevant and useful, although not always easy to complete for someone with an episodic condition. Conclusions This study highlights the need for tools that facilitate accommodations for workers with episodic disabilities and provides early evidence for the sensibility of the JDAPT.

Musculoskeletal disorder risk assessment tool use: A Canadian perspective.

Canadian ergonomics professionals from the Association of Canadian Ergonomists (ACE) and Board of Canadian Registered Safety Professionals (BCRSP) participated in a web-based survey of their awareness, use, and factors influencing use of ergonomics musculoskeletal disorder (MSD) risk assessment tools. A total of 791 respondents (21.0% response rate) participated in the survey. Certified ergonomics professionals represented an important subpopulation of MSD risk assessment tool users, however; the vast majority (86.4%) of users within Canada were certified safety professionals. Average tool use varied between ACE and BCRSP groups, where ACE respondents on average use more tools than BCRSP respondents, however the top 10 tools used were similar between the groups. Over 45% of assessment tools were learned at school and average tool use was not influenced by years of experience or continuing education.

Implementation of participatory organizational change in long term care to improve safety.

INTRODUCTION: Long Term Care (LTC) facilities are fast-paced, demanding environments placing workers at significant risk for injuries. Health and safety interventions to address hazards in LTC are challenging to implement. The study assessed a participatory organizational change intervention implementation and impacts. METHODS: This was a mixed methods implementation study with a concurrent control, conducted from 2017 to 2019 in four non-profit LTC facilities in Ontario, Canada. Study participants were managers and frontline staff. Intervention sites implemented a participatory organizational change program, control sites distributed one-page health and safety pamphlets. Program impact data were collected via Survey (self-efficacy, control over work, pain and general health) and observation (Quick Exposure Checklist). Interviews/focus groups were used to collect program implementation data. RESULTS: Participants described program impacts (hazard controls through equipment purchase/modification, practice changes, and education/training) and positive changes in culture, communication and collaboration. There was a statistically significant difference in manager self-efficacy for musculoskeletal disorder (MSD) hazards between the control and intervention sites over time but no other statistical differences were found. Key program implementation challenges included LTC hazards, staff shortage/turnover, safety culture, staff time to participate, and communication. Facilitators included frontline staff involvement during implementation, management support, focusing on a single unit, training, and involving an external program facilitator. CONCLUSION: A participatory program can have positive impacts on identifying and reducing MSD hazards. Key to success is involving frontline staff in identifying hazards and creating solutions and management encouragement on a unit working together. High turnover rates, staffing shortages, and time constraints were barriers as they are for all organizational change efforts in LTC. The implementation findings are likely applicable in any jurisdiction. Practical Application: Implementing a participatory organizational change program to reduce MSD hazards is feasible in LTC and can improve communication and aid in identification and control of hazards.

Process evaluation of a participatory organizational change program to reduce musculoskeletal and slip, trip and fall injuries.

BACKGROUND: Long-term care (LTC) workers are at significant risk for occupational-related injuries. Our objective was to evaluate the implementation process of a participatory change program to reduce risk. METHODS: A process evaluation was conducted in three LTC sites using a qualitative approach employing structured interviews, consultant logs and a focus group. RESULTS: Findings revealed recruitment/reach themes of being "voluntold", using established methods, and challenges related to work schedules. Additional themes about dose were related to communication, iterative solution development, participation and engagement. For program fidelity and satisfaction, themes emerged around engagement, capacity building and time demands. CONCLUSION: Process evaluation revealed idiosyncratic approaches to recruitment and related challenges of reaching staff. Solutions to prioritized hazards were developed and implemented, despite time challenges. The iterative solution development approach was embraced. Program fidelity was considered good despite early program time demands. Post implementation reports revealed sustained hazard identification and solution development.

Developing leading indicators from OHS management audit data: Determining the measurement properties of audit data from the field.

INTRODUCTION: OHS management audits are one means of obtaining data that may serve as leading indicators. The measurement properties of such data are therefore important. This study used data from Workwell audit program in Ontario, a Canadian province. The audit instrument consisted of 122 items related to 17 OHS management elements. The study sought answers regarding (a) the ability of audit-based scores to predict workers' compensation claims outcomes, (b) structural characteristics of the data in relation to the organization of the audit instrument, and (c) internal consistency of items within audit elements. METHOD: The sample consisted of audit and claims data from 1240 unique firms that had completed one or two OHS management audits during 2007-2010. Predictors derived from the audit results were used in multivariable negative binomial regression modeling of workers' compensation claims outcomes. Confirmatory factor analyses were used to examine the instrument's structural characteristics. Kuder-Richardson coefficients of internal consistency were calculated for each audit element. RESULTS: The ability of audit scores to predict subsequent claims data could not be established. Factor analysis supported the audit instrument's element-based structure. KR-20 values were high (≥0.83). CONCLUSIONS: The Workwell audit data display structural validity and high internal consistency, but not, to date, construct validity, since the audit scores are generally not predictive of subsequent firm claim experience. Audit scores should not be treated as leading indicators of workplace OHS performance without supporting empirical data. PRACTICAL APPLICATIONS: Analyses of the measurement properties of audit data can inform decisionmakers about the operation of an audit program, possible future directions in audit instrument development, and the appropriate use of audit data. In particular, decision-makers should be cautious in their use of audit scores as leading indicators, in the absence of supporting empirical data.

Early Prescription Opioid Use for Musculoskeletal Disorders and Work Outcomes: A Systematic Review of the Literature.

OBJECTIVES: Musculoskeletal disorders (MSDs) are a common source of work disability. Opioid prescribing for MSDs has been on the rise, despite a lack of data on effectiveness. The objective of this study was to conduct a systematic review to determine whether early receipt of opioids is associated with future work outcomes among workers with MSDs compared with other analgesics, no analgesics, or placebo. METHODS: MEDLINE, EMBASE, CINAHL, and CENTRAL were searched from inception to 2014 and reference lists were scanned. Studies were included if opioids were prescribed within 12 weeks of MSD onset. Eligible outcomes included absenteeism, work status, receiving disability payments, and functional status. Two reviewers independently reviewed articles for relevance, risk of bias, and data extraction using standardized forms. Data synthesis using best evidence synthesis methods was planned. RESULTS: Five historical cohort studies met the inclusion criteria, all including workers filing wage compensation claims. Four studies demonstrated a significant association between early opioids and prolonged work disability. One study found a shorter time between prescriptions to be associated with shorter work disability. However, all studies were found to be at a high risk of bias and a best evidence synthesis could not be conducted. The main limitations identified were with exposure measurement and control of confounding. DISCUSSION: Current literature suggests that opioids provided within the first 12 weeks of onset of an MSD are associated with prolonged work disability. However, the conclusions of these studies need testing in a high-quality study that addresses the methodological shortcomings identified in the current review.

The association between workers' compensation claims involving neck pain and future health care utilization: a population-based cohort study.

PURPOSE: To describe the health care utilization of injured workers who made a workers' compensation claim for neck pain. METHODS: We conducted a cohort study of injured workers who made an incident claim involving neck pain to the Ontario Workplace Safety and Insurance Board between 1997 and 1998. We linked their workers' compensation and Ontario Health Insurance Plan files to collect all health care services accrued during the year prior to and 2 years after the claim was initiated. We report the 7 day simple moving average of health care services per 1,000 claimants per day. We stratified our analysis by age, sex, the pre-claim level of health care utilization, diagnostic category and health care specialty. RESULTS: 58.1 % of claimants were males and 35.1 % were between the ages of 35 and 44 years. The cumulative rate of health care utilization was stable (mean = 60.80 services/1,000 claimants/day; 95 % CI: 59.7-62.0) throughout the year prior to the claim. However, it peaked during the first 4 days following the onset of the claim (mean = 473.3 services/1,000 claimants/day) and remained on average 311 % higher than baseline during the first month post-claim. On average in our sample, the health care utilization remained 11 % higher in the second year after the claim compared to the pre-claim level. This sustained increase was attributable to 6 % of claimants. CONCLUSIONS: We report a long-term increase in the average number of health care services utilized by injured workers who make a workers' compensation claim involving neck pain. This increase was attributable to a minority of claimants. The health reasons for this increase deserve further investigation.

The course of work absenteeism involving neck pain: a cohort study of Ontario lost-time claimants.

STUDY DESIGN: Cohort study. OBJECTIVE: To describe the course of lost-time claims involving neck pain in workers compensated by the Ontario Workplace Safety and Insurance Board (WSIB). SUMMARY OF BACKGROUND DATA: The prevalence of neck pain in workers varies from 27.1% to 47.8%. Very little is known about the course of work absenteeism related to neck pain. METHODS: Our cohort included 5761 injured workers with an incident lost-time claim to the WSIB in 1997 and 1998. Claimants were followed for 2 years. We measured the cumulative time on lost-time benefits using the Kaplan-Meier method and described the number and duration of episodes on benefits. RESULTS: The median cumulative time-on-benefits for the cohort was 13 days (95% CI: 13-14). The cumulative time on benefits was shorter for men than women and for younger than older workers. 14.2% of claimants experienced multiple episodes of work absenteeism during the 2 years after the initial claim. The median time on benefits for claimants with a single episode was 11 days (95% CI: 10-11). The median length of the first episode on benefits was longer for claimants with multiple episodes (19-22 days) compared with those with a single episode (11 days). Age was positively associated with longer time-on-benefits in claimants with a single episode of work absenteeism. CONCLUSION: Most injured workers who make a workers' compensation claim that involves neck pain do not make a second claim in the subsequent 2 years. However, an important minority (14.2%) experience multiple episodes of work absenteeism and these workers accrue 40.4% of all lost-time days. Recurrent claims involving neck pain represent a significant burden of disability in Ontario.

Occupational safety and health interventions to reduce musculoskeletal symptoms in the health care sector.

INTRODUCTION: Health care work is dangerous and multiple interventions have been tested to reduce the occupational hazards. METHODS: A systematic review of the literature used a best evidence synthesis approach to address the general question "Do occupational safety and health interventions in health care settings have an effect on musculoskeletal health status?" This was followed by an evaluation of the effectiveness of specific interventions. RESULTS: The initial search identified 8,465 articles, for the period 1980-2006, which were reduced to 16 studies based on content and quality. A moderate level of evidence was observed for the general question. Moderate evidence was observed for: (1) exercise interventions and (2) multi-component patient handling interventions. An updated search for the period 2006-2009 added three studies and a moderate level of evidence now indicates: (1) patient handling training alone and (2) cognitive behavior training alone have no effect on musculoskeletal health. Few high quality studies were found that examined the effects of interventions in health care settings on musculoskeletal health. CONCLUSIONS: The findings here echo previous systematic reviews supporting exercise as providing positive health benefits and training alone as not being effective. Given the moderate level of evidence, exercise interventions and multi-component patient handling interventions (MCPHI) were recommended as practices to consider. A multi-component intervention includes a policy that defines an organizational commitment to reducing injuries associated with patient handling, purchase of appropriate lift or transfer equipment to reduce biomechanical hazards and a broad-based ergonomics training program that includes safe patient handling and/or equipment usage. The review demonstrates MCPHI can be evaluated if the term multi-component is clearly defined and consistently applied.

Systematic review of the role of occupational health and safety interventions in the prevention of upper extremity musculoskeletal symptoms, signs, disorders, injuries, claims and lost time.

BACKGROUND: Little is known about the most effective occupational health and safety (OHS) interventions to reduce upper extremity musculoskeletal disorders (MSDs) and injuries. METHODS: A systematic review used a best evidence synthesis approach to address the question: "do occupational health and safety interventions have an effect on upper extremity musculoskeletal symptoms, signs, disorders, injuries, claims and lost time?" RESULTS: The search identified 36 studies of sufficient methodological quality to be included in data extraction and evidence synthesis. Overall, a mixed level of evidence was found for OHS interventions. Levels of evidence for interventions associated with positive effects were: Moderate evidence for arm supports; and Limited evidence for ergonomics training plus workstation adjustments, new chair and rest breaks. Levels of evidence for interventions associated with "no effect" were: Strong evidence for workstation adjustment alone; Moderate evidence for biofeedback training and job stress management training; and Limited evidence for cognitive behavioral training. No interventions were associated with "negative effects". CONCLUSION: It is difficult to make strong evidenced-based recommendations about what practitioners should do to prevent or manage upper extremity MSDs. There is a paucity of high quality OHS interventions evaluating upper extremity MSDs and none focused on traumatic injury outcomes or workplace mandated pre-placement screening exams. We recommend that worksites not engage in OHS activities that include only workstation adjustments. However, when combined with ergonomics training, there is limited evidence that workstation adjustments are beneficial. A practice to consider is using arm supports to reduce upper extremity MSDs.

Stakeholder engagement opportunities in systematic reviews: knowledge transfer for policy and practice.

Knowledge transfer and exchange is the process of increasing the awareness and use of research evidence in policy or practice decision making by nonresearch audiences or stakeholders. One way to accomplish this end is through ongoing interaction between researchers and interested nonresearch audiences, which provides an opportunity for the two groups to learn more about one another. The purpose of this article is to describe and discuss various stakeholder engagement opportunities that we employ throughout the stages of conducting a systematic review, to increase knowledge utilization within these audiences. Systematic reviews of the literature on a particular topic can provide an unbiased overview of the state of the literature. The engagement opportunities we have identified are topic consultation, feedback meetings during the review, member of review team, and involvement in dissemination. The potential benefits of including stakeholders in the process of a systematic review include increased relevance, clarity, and awareness of systematic review findings. A further benefit is the potential for increased dissemination of the findings. Challenges that researchers face are that stakeholder interactions can be time- and resource-intensive, it can be difficult balancing stakeholder desires with scientific rigor, and stakeholders may have difficulties accepting findings with which they do not agree. Despite these challenges we have included stakeholder involvement as a permanent step in the procedure of conducting a systematic review.

The prevalence and incidence of work absenteeism involving neck pain: a cohort of Ontario lost-time claimants.

STUDY DESIGN: Cohort study. OBJECTIVE: To measure the prevalence and incidence of work absenteeism involving neck pain in a cohort of claimants to the Ontario Workplace Safety & Insurance Board (WSIB). SUMMARY OF BACKGROUND DATA: According to workers' compensation statistics, neck pain accounts for a small proportion of lost-time claims. However, these statistics may be biased by an underenumeration of claimants with neck disorders. METHODS: We studied all lost-time claimants to the Ontario WSIB in 1998 and used 2 methods to enumerate neck pain cases. We report the prevalence and incidence of neck pain using 2 denominators: (1) annual number of lost-time claimants and (2) an estimate of the Ontario working population covered by the WSIB. RESULTS: The estimated percentage of lost-time claimants with neck pain ranged from 2.8% (95% CI 2.5-3.3) using only codes specific for neck pain to 11.3% (95% CI 9.5-13.1) using a weighted estimate of codes capturing neck pain cases. The health care sector had the highest percentage of claims with neck pain. The annual incidence of neck pain among the Ontario working population ranged from 6 per 10,000 full-time equivalents (FTE) (95% CI 5-6) to 23 per 10,000 FTE (95% CI 20-27) depending on the codes used to capture neck pain. Male workers between the ages of 20 and 39 years were the most likely to experience an episode of work absenteeism involving neck pain. CONCLUSION: Neck pain is a common and burdensome problem for Ontario workers. Our study highlights the importance of properly capturing all neck pain cases when describing its prevalence and incidence.

Prevalence of lost-time claims for mild traumatic brain injury in the working population: improving estimates using workers compensation databases.

PRIMARY OBJECTIVE: To test the usefulness of a method to improve the measurement of prevalent mild traumatic brain injury (MTBI) among injured workers with a workers compensation claim. METHODS: Database codes were selected to identify MTBI cases in the Ontario workers compensation lost-time claims database. A random sample of 210 claims was selected, classified as MTBI or not, and used to calculate proportions with MTBI among code groups. The annual prevalence of MTBI in 1997 and 1998 was calculated by weighting the numerators with the appropriate proportions of MTBI within each code group. RESULTS: Four code groups were created: the head region, cranial region, concussion code group and the brain region. The proportion of MTBI in each group was 29%, 19%, 92% and 32%, respectively. The 1997 prevalence depended on the codes used, from 39/10,000 (95% confidence interval (CI): 35-44) for a weighted version of the 'concussion' code to 58/10,000 (95% CI: 50-65) for inclusion of all identified MTBI codes. CONCLUSIONS: Restricting the enumeration of MTBI to specific 'concussion' codes can lead to under-estimation of the prevalence of MTBI in epidemiological studies using workers compensation data. Approximately six out of every 1000 lost-time claims are associated with MTBI. Given lost-time estimates of disability under-estimate the prevalence of this mild injury, MTBI, is an important workplace injury.

Capturing cases in workers' compensation databases: the example of neck pain.

BACKGROUND: There is a need to more accurately enumerate workers with musculoskeletal injuries who make lost-time claims to workers compensation boards. The objective of this study is to develop an approach to more accurately enumerate these workers. METHODS: Lost-time claims to the Ontario Workplace Safety & Insurance Board (WSIB) were reviewed. Using neck pain as an example, nature of injury and part of body codes were identified to classify cases. Claims of a random sample of 434 claimants were reviewed. The proportion of claimants classified as having neck pain was computed. RESULTS: The proportion of claimants classified with soft-tissue injuries to the neck varied from 0.88 for codes including "neck/cervical region," 0.69 for "back region" to 0.05 for those coded as "shoulder/upper arm." CONCLUSIONS: Restricting the enumeration of injuries to specific part of body codes can lead to a gross underestimation of the magnitude of soft-tissue disorders in epidemiological studies using workers' compensation data. The proposed approach leads to more accurate enumeration.