Medical rehabilitation of older employees with migrant background in Germany: Does the utilization meet the needs?

Due to demographic change with an ageing workforce, the proportion of employees with poor health and a need for medical rehabilitation is increasing. The aim was to investigate if older employees with migrant background have a different need for and utilization of medical rehabilitation than employees without migrant background. To investigate this, self-reported data from older German employees born in 1959 or 1965 of the first and second study wave of the lidA cohort study were exploratory analyzed (n = 3897). Subgroups of employees with migrant background were separated as first-generation, which had either German or foreign nationality, and second-generation vs. the rest as non-migrants. All subgroups were examined for their need for and utilization of medical rehabilitation with descriptive and bivariate statistics (chi-square, F- and post-hoc tests). Furthermore, multiple logistic regressions and average marginal effects were calculated for each migrant group separately to assess the effect of need for utilization of rehabilitation. According to our operationalizations, the foreign and German first-generation migrants had the highest need for medical rehabilitation while the German first- and second-generation migrants had the highest utilization in the bivariate analysis. However, the multiple logistic model showed significant positive associations between their needs and utilization of rehabilitation for all subgroups. Further in-depth analysis of the need showed that something like under- and oversupply co-exist in migrant groups, while the foreign first-generation migrants with lower need were the only ones without rehabilitation usage. However, undersupply exists in all groups independent of migrant status. Concluding, all subgroups showed suitable use of rehabilitation according to their needs at first sight. Nevertheless, the utilization does not appear to have met all needs, and therefore, the need-oriented utilization of rehabilitation should be increased among all employees, e.g. by providing more information, removing barriers or identifying official need with uniform standards.

Multidimensional voice assessment: the immediate effects of Lax Vox® in singers with voice complaints / Avaliação multidimensional da voz: efeitos imediatos do Lax Vox® em cantores com queixas vocais

ABSTRACT Purpose: to multidimensionally assess the effect of the Lax Vox® vocal technique on singers with voice complaints. Methods: a comparative intrasubject study that assessed 30 singers - 13 males and 17 females, aged 18 to 55 years - who self-reported voice complaints and had voice problems symptoms. The participants were submitted to voice assessment with perceptive-auditory, acoustic, aerodynamic, and electroglottographic voice analysis, as well as laryngeal assessment with high-speed videolaryngoscopy. The participants were assessed at two moments: 1) at the beginning of the data collection; and 2) five minutes after performing the Lax Vox® vocal technique. The groups were compared with appropriate statistical tests, with a 5% significance level. Results: in the acoustic analysis, there was an increase in the fundamental frequency for males, after using the Lax Vox® vocal technique. In the aerodynamic assessment, there was an increase in the airflow mean values during vocalization, as well as in aerodynamic power after using the Lax Vox® vocal technique in both groups. Conclusion: the Lax Vox® vocal technique, in the studied singers with a complaint of dysphonia, promoted an increase in the fundamental frequency, for males. In the aerodynamic parameters, in both sexes, it promoted an increase in the airflow and aerodynamic power.

RESUMO Objetivo: avaliar, de forma multidimensional, o efeito da técnica vocal Lax Vox® em cantores com queixas vocais. Métodos: trata-se de um estudo comparativo intrassujeitos. Foram avaliados 30 cantores, sendo 13 homens e 17 mulheres, com idade entre 18 e 55 anos, que apresentaram queixa vocal autorreferida e presença de sintomas vocais. Os participantes foram submetidos à avaliação vocal pela análise perceptivo-auditiva, acústica, aerodinâmica e eletroglotográfica da voz, bem como à avaliação laríngea com a videolaringoscopia de alta velocidade. Os participantes foram avaliados em dois momentos: 1) no início da coleta; e 2) após cinco minutos de realização da técnica vocal Lax Vox®. Para comparação dos grupos foram utilizados teste estatísticos pertinentes, com nível de significância de 5%. Resultados: na análise acústica houve aumento da frequência fundamental dos homens após o uso da técnica vocal Lax Vox®. Na avaliação aerodinâmica houve aumento dos valores da média do fluxo aéreo durante vocalização e da potência aerodinâmica após o uso da técnica vocal Lax Vox® em ambos os grupos. Conclusão: a técnica vocal do Lax Vox® nos cantores com queixa de disfonia estudados promoveu um aumento da frequência fundamental nos homens. Nos parâmetros aerodinâmicos em ambos os sexos provocou um aumento do fluxo aéreo e da potência aerodinâmica.

Occupational voice is a work in progress: active risk management, habilitation and rehabilitation.

PURPOSE OF REVIEW: The current article reviews recent literature examining occupational voice use and occupational voice disorders (January 2018-July 2019). RECENT FINDINGS: Our understanding of the prevalence of voice disorders and work-related vocal use, vocal load and vocal ergonomics (environmental and person influences) across different occupations is continuing to build. There is encouraging evidence for the value of intervention programs for occupational voice users, particularly of late with performers, teachers and telemarketers. Education and prevention programs are emerging for other 'at risk' occupations. SUMMARY: Occupational health and workforce legislation does not adequately acknowledge and guide educational, preventive and intervention approaches to occupational voice disorders. Voice disorders are prevalent in certain occupations and there is an urgent need for research to support occupational voice health and safety risk measurement, prevention and intervention. Large population-based studies are required with a focus on the health and economic burden of occupational voice disorders.

Assessment of the effects of Kinesiotaping on musical motor performance in musicians suffering from focal hand dystonia: a pilot study.

OBJECTIVE: The aim of this study was to explore the immediate and short-term effects of a Correction Kinesiotaping intervention on fine motor control in musicians with focal hand dystonia. DESIGN: A single-blinded, single-arm repeated measures, pilot study. SETTING: Medical outpatient clinic. SUBJECTS: Seven musicians diagnosed with focal hand dystonia. INTERVENTIONS: Musicians performed musical exercises under the following conditions: without Kinesiotape (baseline), during a Correction Kinesiotaping intervention and immediately after tape removal (block 1) and during a Sham Kinesiotaping intervention and immediately after tape removal (block 2). Blocks were randomly presented across participants. A tailored Correction Kinesiotaping intervention on affected fingers was provided based on the dystonic pattern that each patient manifested while playing. MAIN MEASURES: Motor performance was video-documented and independent experts blindly assessed the general performance and fingers' posture on visual analogue scales. Also, musicians' self-reports of the musical abilities were evaluated. Finally, electromyographic activity and coactivation index of wrist antagonist muscles were analyzed. RESULTS: No significant differences in effects between Correction Kinesiotaping and Sham Kinesiotaping were reported by the experts, either for general performance (P > 0.05) or for fingers' posture (P > 0.05); any subtle benefits observed during Correction Kinesiotaping were lost after the tape was removed. Musicians estimated that Correction Kinesiotaping was ineffective in improving their musical abilities. Also, no significant changes with respect to the coactivation index (P > 0.05) were found among the conditions. CONCLUSION: Correction Kinesiotaping intervention may not be useful to reduce dystonic patterns, nor to improve playing ability, in musicians with focal hand dystonia.

Early Identification of Potential SSDI Entrants in California: The Predictive Value of State Disability Insurance and Workers' Compensation Claims.

Purpose Examine the potential for using information in short-term disability claims to identify workers at high risk of leaving the workforce and entering Social Security Disability Insurance (SSDI). Methods We analyze state-wide California data on claimants of State Disability Insurance (SDI) and Workers' Compensation (WC) and present statistics on: (1) characteristics (primary diagnosis, sex, age, geography, wage level) by claim duration (0-3, 4-6, 7-12, 12 + months); and (2) the ability of initial claim characteristics to predict duration of at least 12 months. All data are for claims with disability lasting more than 1 week. Results 22.2% of SDI claims last longer than 6 months and 12.5% last 12 months. More WC claims reach these durations: 33.7 and 18.6%, respectively. Long-term SDI and WC claimants are similar to SSDI awardees, nationwide, but differ in age distribution; they are typically younger. Conclusions Characteristics of SDI and WC claims can help predict claims likely to last 12 months, but more information is needed to effectively target early intervention services. Waiting longer to intervene improves targeting but risks missing opportunities where early intervention could be more effective. Collecting additional information at SDI or WC entry or soon thereafter could improve both the efficiency and timing of interventions.

Effectiveness of Workplace Interventions in Return-to-Work for Musculoskeletal, Pain-Related and Mental Health Conditions: An Update of the Evidence and Messages for Practitioners.

Purpose The objective of this systematic review was to synthesize evidence on the effectiveness of workplace-based return-to-work (RTW) interventions and work disability management (DM) interventions that assist workers with musculoskeletal (MSK) and pain-related conditions and mental health (MH) conditions with RTW. Methods We followed a systematic review process developed by the Institute for Work & Health and an adapted best evidence synthesis that ranked evidence as strong, moderate, limited, or insufficient. Results Seven electronic databases were searched from January 1990 until April 2015, yielding 8898 non-duplicate references. Evidence from 36 medium and high quality studies were synthesized on 12 different intervention categories across three broad domains: health-focused, service coordination, and work modification interventions. There was strong evidence that duration away from work from both MSK or pain-related conditions and MH conditions were significantly reduced by multi-domain interventions encompassing at least two of the three domains. There was moderate evidence that these multi-domain interventions had a positive impact on cost outcomes. There was strong evidence that cognitive behavioural therapy interventions that do not also include workplace modifications or service coordination components are not effective in helping workers with MH conditions in RTW. Evidence for the effectiveness of other single-domain interventions was mixed, with some studies reporting positive effects and others reporting no effects on lost time and work functioning. Conclusions While there is substantial research literature focused on RTW, there are only a small number of quality workplace-based RTW intervention studies that involve workers with MSK or pain-related conditions and MH conditions. We recommend implementing multi-domain interventions (i.e. with healthcare provision, service coordination, and work accommodation components) to help reduce lost time for MSK or pain-related conditions and MH conditions. Practitioners should also consider implementing these programs to help improve work functioning and reduce costs associated with work disability.

Comparison of clinic models for patients with work-related asthma.

BACKGROUND: Work-related asthma (WRA) is a prevalent occupational lung disease that is associated with undesirable effects on psychological status, quality of life (QoL), workplace activity and socioeconomic status. Previous studies have also indicated that clinic structure may impact outcomes among patients with asthma. AIMS: To identify the impact of clinic structure on psychological status, QoL, workplace limitations and socioeconomic status of patients with WRA among two different tertiary clinic models. METHODS: We performed a cross-sectional analysis between two tertiary clinics: clinic 1 had a traditional referral base and clinical staffing while clinic 2 entirely comprised Worker's Compensation System referrals and included an occupational hygienist and a return-to-work coordinator. Beck Anxiety and Depression II Inventories (BAI and BDI-II), Marks' Asthma Quality of Life Questionnaire (M-AQLQ) and Work Limitation Questionnaire (WLQ) were used to assess outcomes for patients with WRA. RESULTS: Clinic 2 participants had a better psychological status across the four instruments compared with clinic 1 (for Beck 'Anxiety': P < 0.001 and 'Depression': P < 0.01, 'Mood' domain of M-AQLQ: NS and 'Mental Demands' domain of WLQ: P < 0.01). Clinic 2 had a greater proportion of participants with reduced income. CONCLUSIONS: Our study indicates that clinic structure may play a role in outcomes. Future research should examine this in larger sample sizes.

The joint contribution of cardiovascular disease and socioeconomic status to disability retirement: A register linkage study.

BACKGROUND: Whether low occupational class amplifies the risk of disability retirement among employees with cardiovascular disease (CVD) is unknown. We examined this issue in two prospective cohort studies. METHODS: In the Finnish Public Sector Study and the Helsinki Health Study (n=50.799 employees), prevalent CVD (coronary heart disease or stroke, n=1269) was ascertained using records from national health registers, self-reported doctor-diagnosed diseases, and Rose Angina Questionnaire. Data linkage to national pension registers allowed the follow up of disability retirement among the participants for a mean of six years. We analysed the associations of occupational class and CVD with disability retirement using Cox regression, tested interactions between occupational class and prevalent CVD in predicting disability retirement by calculating the Synergy Index, and pooled the results from the two studies using fixed-effect meta-analysis. RESULTS: Compared with the participants from high occupational class and no CVD, the participants from the low occupational class without CVD had a 2.13-fold (95% CI 1.97-2.30), those with high occupational class and CVD a 2.18-fold (1.73-2.74); and those with both low occupational class and CVD a 4.49-fold (3.83-5.26) risk of disability retirement. A Synergy Index of 1.55 (1.16-2.06) suggested a greater than additive effect for low occupational class and CVD in combination. CONCLUSIONS: Individuals with both low occupational class and CVD are at a particularly high risk of premature exit from the labour market due to work disability. These findings suggest that better preventive strategies are needed to improve prognosis in this risk group.

[Work Disability Prevention: an area of study needed to address the Colombian system challenges in occupational risks]. / Prevención y manejo de la discapacidad para trabajar: un campo de estudios necesario para abordar los retos del sistema colombiano de riesgos laborales.

This paper aims to address the importance of study, introduce and implement the issue of prevention and management of work disability in Colombia. Text structure responses to questions ranging from the current situation of workers and their health in Colombia, from the importance of studying this subject; the approach of the determinants of work disability; its definition, to the challenges settled for different actors in the Sistema Nacional de Seguridad Social involved in the process of prevention, care, rehabilitation, compensation, and return home.

El artículo de revisión temática busca mostrar la importancia que tiene estudiar, introducir e implementar en Colombia el campo Work Disability Prevention, traducido al español como Prevención y Manejo de la Discapacidad para Trabajar, derivado de una investigación doctoral. La revisión se estructura a partir del diálogo entre la revisión de literatura, los hallazgos del análisis del Sistema Colombiano de riesgos Laborales, y los datos de la situación actual de los trabajadores en materia de salud en Colombia, lo cual plantea una serie de interrogantes que estructuran el desarrollo de este artículo. El análisis se realiza desde los factores determinantes de la discapacidad para trabajar, su definición y los retos que esto impone a los diferentes actores dentro del Sistema General de Seguridad Social, implicados en el proceso de prevención, atención, rehabilitación, compensación y retorno al trabajo.

Neurocognitive performance and physical function do not change with physical-cognitive-mindfulness training in female laboratory technicians with chronic musculoskeletal pain: Randomized controlled trial.

BACKGROUND: Cognitive and physical performance can be negatively affected by chronic pain. This study evaluates the effect of combined physical-, cognitive-, and mindfulness training (PCMT) on cognitive and physical performance. METHODS: From a large pharmaceutical company in Denmark we randomly allocated 112 female laboratory technicians with chronic upper limb pain to group-based PCMT at the worksite or a reference group for 10 weeks. Neurocognitive performance was measured by the computerized central nervous system vital signs neurocognitive assessment battery. Physical function was assessed in terms of shoulder external rotation strength and rate of force development in a custom-made dynamometer setup. RESULTS: No between-group differences (least square means [95% confidence interval]) from baseline to follow-up could be detected in any of the neurocognitive domains as measured by the central nervous system vital signs neurocognitive assessment battery, for example, Psychomotoer Speed 1.9 (-1.0 to 4.7), Reaction Time -4.0 (-19.5 to 11.6), Complex Attention -0.3 (-1.9 to 1.4), and Executive Function -0.2 (-3.5 to 3.0). Similarly, we found no change in maximal voluntary isometric strength -0.63 (-4.8 to 3.6), or rate of force development 14.8 (-12.6 to 42.2) of the shoulder external rotators. Finally, test-retest reliability of maximal voluntary contraction and rate of force development shoulder external rotation showed high reliability at 0 to 30 ms, 0 to 50 ms, 0 to 100 ms, and 0 to 200 ms with ICCs at 0.95, 0.92, 0.93, 0.92, and 0.91, respectively. CONCLUSION: Ten weeks of PCMT did not improve neurocognitive or physical performance.

Enhancing direct access and authority for work capacity certificates to physiotherapists.

The mantra 'work is good for health' is familiar to those assisting in the rehabilitation of injured workers and is well supported in the literature. Regulators, workers compensation insurers and health professional bodies have taken steps over the last few years to promote early and safe return to work after a workplace injury. Improving direct access to physiotherapy and extending the role of physiotherapists to authorise work capacity certificates for injured workers will potentially facilitate early intervention, reduce absence from work in a cost-effective system while maintaining patient satisfaction. Several challenges to advancing the role of physiotherapists exist but are not insurmountable.

Hospital Qualities Related to Return to Work from Occupational Injury after Controlling for Injury Severity as Well as Occupational Characteristics.

We examined associations between hospital quality in the workers' compensation system and injured patients' return to work after controlling for injury severity, occupational factors, and demographic factors. Return to work data of injured workers were constructed from 2 datasets: 23,392 patients injured in 2009-2011 from the Korea Workers' Compensation & Welfare Service and return to work data from Korea Employment Information Services. After de-identifying the data, quality scores were matched for each hospital that cared for injured patients. Injury severity was measured by Abbreviated Injury Scales. Relative risk and 95% confidence interval were calculated using log binomial regression models. After adjusting for age, sex, injury severity, occupation, factory size, city, and hospital type, the relative risk (95% confidence interval) for the total score was 1.04 (1.02-1.06), 1.06 (1.04-1.09), and 1.07 (1.05-1.10) in the 2(nd), 3(rd), and 4(th) quartiles, respectively, compared to the 1(st) quartile. The RR (95% CI) in the 2(nd), 3(rd), and 4(th) quartiles was 1.05 (1.02-1.07), 1.05 (1.02-1.08), and 1.06 (1.04-1.09) for the process score; and 1.02 (1.01-1.04), 1.05 (1.03-1.07), and 1.06 (1.04-1.09) for the outcome score compared to the 1(st) quartile score, respectively. In conclusion, our study design with blinded merge methods shows that total, process, and outcome qualities are related to the return to work of injured workers after controlling for other factors.

Length of Disability and Medical Costs in Low Back Pain: Do State Workers' Compensation Policies Make a Difference?

OBJECTIVE: The aim of the study was to examine the impact of state workers' compensation (WC) policies regarding wage replacement and medical benefits on medical costs and length of disability (LOD) in workers with low back pain (LBP). METHODS: Retrospective cohort analysis of LBP claims from 49 states (n = 59,360) filed between 2002 and 2008, extracted from a large WC administrative database. RESULTS: Longer retroactive periods and state WC laws allowing treating provider choice were associated with higher medical costs and longer LOD. Limiting the option to change providers and having a fee schedule were associated with longer LOD, except that allowing a one-time treating provider change was associated with lower medical costs and shorter LOD. CONCLUSIONS: WC policies about wage replacement and medical treatment appear to be associated with WC LBP outcomes, and might represent opportunities to improve LOD and reduce medical costs in occupational LBP.

The impact of professional status on the effects of and adherence to the outpatient followed by home-based telemonitored cardiac rehabilitation in patients referred by a social insurance institution.

OBJECTIVES: Legislators and policymakers have expressed strong interest in intervention programs to reduce dependence on social disability benefits. Hybrid: ambulatory followed by home-based cardiac telerehabilitation--hybrid cardiac rehabilitation (HCR) seems to be a novel alternative for standard cardiac rehabilitation for patients with cardiovascular diseases (CVD) as a form of pension prevention paid by the Social Insurance Institution (SII). The kind of professional status may bias the motivation to return to work after HCR. The aim of our study was to evaluate whether the professional status can affect the effects of HCR. MATERIAL AND METHODS: One hundred fifty-two patients with CVD referred by the SII for a 5-week HCR were qualified for the study. Patients (87.7% males), aged 57.31 ± 5.61 years, were divided into 2 subgroups: W) white-collar employees (N = 22) and B) blue-collar employees (N = 130). To evaluate functional capacity, an exercise test on a treadmill was used. RESULTS: The number of days of absence in the cardiac rehabilitation program did not differ between the groups (mean ± standard deviation--B: 1.09 ± 3.10 days, W: 1.95 ± 3.64 days). There were significant improvements (p < 0.05) in measured variables after HCR in both (W and B) groups (max workload: 8.21 ± 2.88 METs (measured in metabolic equivalents) vs. 9.6 ± 2.49 METs, 7.76 ± 2.51 METs vs. 8.73 ± 2.7 METs, resting heart rate (RHR): 77 ± 16.22 bpm vs. 69.94 ± 12.93 bpm, 79.59 ± 14 bpm vs. 75.24 ± 11.87 bpm; double product, i.e., product of heart rate and systolic BP (DP rest) 10 815.22 ± 2968.24 vs. 9242.94 ± 1923.08, 10 927.62 ± 2508.47 vs. 9929.7 ± 2304.94). In group B, a decrease in systolic blood pressure (BP syst. - 137.03 ± 17.14 mm Hg vs. 131.82 ± 21.13 mm Hg), heart rate recovery in the 1st minute after the end of peak exercise (HRR1) (99.38 ± 19.25 vs. 93.9 ± 19.48) and New York Heart Association (NYHA) class (1.22 ± 0.53 vs. 1.11 ± 0.36) was observed. In group W, a decrease in diastolic blood pressure (BP diast.) at rest was observed (88.28 ± 9.79 mm Hg vs. 83.39 ± 8.95 mm Hg). The decrease in resting HR was significantly greater in group W (69.94 ± 12.93 vs. 75.24 ± 11.87, p = 0.034). CONCLUSIONS: Hybrid cardiac rehabilitation is feasible and safe with high adherence to the program regardless of the patient's professional status. Professional status did not influence the beneficial effect of HCR on exercise tolerance.

[Occupational asthma in Hungary]. / A foglalkozási asztma napjainkban Magyarországon.

Occupational asthma belongs to communicable diseases, which should be reported in Hungary. During a 24-year period between January 1990 and December 2013, 180 occupational asthma cases were reported in Hungary (52 cases between 1990 and 1995, 83 cases between 1996 and 2000, 40 cases between 2001 and 2006, and 5 cases between 2007 and 2013). These data are unusual, because according to the official report of the National Korányi Pulmonology Institute in Budapest, at least 14,000 new adult asthma cases were reported in every year between 2000 and 2012 in Hungary. Also, international data indicate that at least 2% of adult patients with asthma have occupational asthma and at least 50 out of 1 million employees develop occupational asthma in each year. In 2003, 631 new occupational asthma patients were reported in the United Kingdom, but only 7 cases in Hungary. Because it is unlikely that the occupational environment in Hungary is much better than anywhere else in the world, it seems that not all new occupational asthma cases are reported in Hungary. Of the 180 reported cases in Hungary, 55 were bakers or other workers in flour mills. There were 11 metal-workers, 10 health care assistants, 9 workers dealing with textiles (tailors, dressmakers, workers in textile industry) and 9 employees worked upon leather and animal fur. According to international data, the most unsafe profession is the animal keeper in scientific laboratories, but only 4 of them were reported as having occupational asthma during the studied 24 years in Hungary. Interestingly, 3 museologists with newly-diagnosed occupational asthma were reported in 2003, but not such cases occurred before or after that year. In this paper the Hungarian literature of occupational asthma is summarized, followed by a review on the classification, pathomechanism, clinical presentation, predisposing factors, diagnostics and therapeutic aspects of the disease. Epidemiological data of adult asthma in Hungary and data from international studies on the occurrence of occupational asthma are also presented. Finally, the author draws attention to the low reporting activity of occupational asthma in Hungary and discusses the possible causes why this communicable disease is rarely reported.

Ageing workers with work-related musculoskeletal injuries.

BACKGROUND: Older workers often take longer to recover and experience more missed workdays after work-related injuries, but it is unclear why or how best to intervene. Knowing the characteristics of older injured workers may help in developing interventions to reduce the likelihood of work disability. AIMS: To describe and compare several characteristics between younger and middle-aged working adults (25-54 years), adults nearing retirement (55-64 years) and adults past typical retirement (≥65 years), who sustained work-related musculoskeletal injuries. METHODS: In this cross-sectional study, Alberta workers' compensation claimants with subacute and chronic work-related musculoskeletal injuries were studied. A wide range of demographic, employment, injury and clinical characteristics were investigated. Descriptive statistics were computed and compared between the age groups. RESULTS: Among 8003 claimants, adults 65 years or older, compared to those 25-54 and 55-64 years, had lower education (16 versus 10 and 12%, P < 0.001) and were more likely to work in trades, transport and related occupations (50 versus 46 and 44%, P < 0.001), to have less offers of modified work (57 versus 39 and 42%, P < 0.001), more fractures (18 versus 14 and 11%, P < 0.001) and no further rehabilitation recommended after assessment (28 versus 18 and 20%, P < 0.01). CONCLUSIONS: Injured workers past typical retirement age appeared to be a disadvantaged group with significant challenges from a vocational rehabilitation perspective. They were less likely to have modified work options available or be offered rehabilitation, despite having more severe injuries.

WORK RELATED INJURY AND ILLNESS: EXPLORING THE RETURN-TO-WORK PROGRAM IN MALAYSIA.

Illness and injury have a significant impact on employees, their families and employers. The consequences faced by an injured worker could lead to disability, which could then lead to inability to work. This study examined the patterns of the Return to Work (RTW) using data from The Social Security Organisation (SOCSO) of Malaysia RTW database from 2010 to 2013. Factors of successful return to work, employees' salary upon returning to formal employment were also investigated. Gender, age, year of injury, industry, and job hierarchy were found to be significant predictors of employees' salary upon returning to work. Although there are other costs involved on the part of employers and employees, themselves, in the long term the financial returns that can be brought back by injured workers who have successfully returned to work combined with the qualitative benefits substantially outweighs the costs of RTW program.

Cost-effectiveness of early versus delayed functional restoration for chronic disabling occupational musculoskeletal disorders.

PURPOSE: Despite extensive evidence for the treatment effectiveness of interdisciplinary functional restoration (FR) for chronic disabling occupational musculoskeletal disorders (CDOMD), there is little documentation on the cost-effectiveness of early rehabilitation using FR. METHODS: A total of 1,119 CDOMD patients were classified according to duration of disability on FR entry, corresponding to early rehabilitation (ER: 4-8 months of disability, N = 373), intermediate duration (ID: 9-18 months, N = 373), and delayed rehabilitation (DR: >18 months, N = 373). Groups were matched on sex, age, ethnicity, and injured musculoskeletal region. One-year post-rehabilitation outcomes included return-to-work, work retention and healthcare utilization. Economic analyses included a cost-effectiveness analysis of the FR program, and estimation of the total cost-of-illness. RESULTS: At 1-year post-rehabilitation, all groups were comparable on return-to-work (overall 88%), work retention (overall 80%), and additional healthcare utilization (overall, 2.2% of patients received re-operations/new surgeries, 2 visits to new healthcare provider). Savings of up to 64% in medical costs, and up to 80% in disability benefits and productivity losses was associated with the ER group. The cost of rehabilitation was also up to 56% lower when administered early. Overall, ER resulted in estimated cost savings of up to 72% (or almost $170,000 per claim). CONCLUSIONS: Duration of disability does not negatively impact objective work or healthcare utilization outcomes following interdisciplinary FR. However, early rehabilitation is more likely to be a cost-effective solution compared to cases that progress >8 months and receiving FR as a treatment of "last resort".

Rehabilitation of compensable workplace injuries: effective payment models for quality vocational rehabilitation outcomes in a changing social landscape.

PURPOSE: With social and economic costs of workplace injury on the increase, efficient payment models that deliver quality rehabilitation outcomes are of increasing interest. This paper provides a perspective on the issue informed by both refereed literature and published research material not available commercially (gray literature). METHODS: A review of payment models, workers' compensation and compensable injury identified relevant peer-reviewed and gray literature that informed our discussion. RESULTS: Fee-for-service and performance-based payment models dominate the health and rehabilitation literature, each described as having benefits and challenges to achieving quality outcomes for consumers. There appears to be a movement toward performance-based payments in compensable workplace injury settings as they are perceived to promote time-efficient services and support innovation in rehabilitation practice. However, it appears that the challenges that arise for workplace-based rehabilitation providers and professionals when working under the various payment models, such as staff retention and quality of client-practitioner relationship, are absent from the literature and this could lead to flawed policy decisions. CONCLUSIONS: Robust evidence of the benefits and costs associated with different payment models - from the perspectives of clients/consumers, funders and service providers - is needed to inform best practice in rehabilitation of compensable workplace injuries. IMPLICATIONS FOR REHABILITATION: Available but limited evidence suggests that payment models providing financial incentives for stakeholder-agreed vocational rehabilitation outcomes tend to improve service effectiveness in workers' compensation settings, although there is little evidence of service quality or client satisfaction. Working in a system that identifies payments for stakeholder-agreed outcomes may be more satisfying for rehabilitation practitioners in workers' compensation settings by allowing more clinical autonomy and innovative practice. Researchers need to work closely with the compensation and rehabilitation sector as well as governments to establish robust evidence of the benefits and costs of payment models, from the perspectives of clients/consumers, funders, service providers and rehabilitation professionals.