Activity Impairment and Work Productivity Loss After Total Knee Arthroplasty: A Prospective Study.

BACKGROUND: Total knee arthroplasty (TKA) is increasingly performed among working-aged individuals, highlighting the importance of work-related outcomes. Therefore, the aim is to examine the extent of both activity impairment outside work and work productivity (absenteeism, presenteeism, at-work productivity loss) at 6 and 24 months post-TKA surgery. Additionally, associated risk factors with these outcomes were evaluated. METHODS: This analysis included 183 patients <70 years undergoing TKA who completed questionnaires pre-operatively and during follow-up. Outcomes were derived from the Work Productivity and Activity Impairment questionnaire and included activity impairment, absenteeism (sick leave), presenteeism (reduced work performance), and at-work productivity loss (overall work productivity loss). All outcomes were scaled 0%-100%, with higher percentages indicating higher impairments. Covariates included age, gender, education, pain catastrophizing, pain, function, psychological distress, and knee-related and health-related quality of life. Linear and logistic regression was used to assess associations between covariates and Work Productivity and Activity Impairment scores at follow-up. RESULTS: At 6 months, the mean activity impairment was 22.8% (standard deviation [SD] 23.5) dropping to 17.1% (23.1) by 24 months. Among workers, presenteeism was 18.4% (24.6) and at-work productivity loss was 20.8% (26.1). Both dropped significantly by 24 months to 14.2% (22.4) and 12.9% (20.9), respectively. Absenteeism levels were low at both time points. Pain catastrophizing was associated with all outcomes. CONCLUSION: This study showed that activity impairment and work productivity loss are common following TKA, decreased significantly over time, but still existed 2 years post-operatively. Those reporting high levels of pain catastrophizing may benefit from targeted rehabilitation guidance to reduce and possibly prevent activity impairment and work productivity loss.

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.

Predicting time on prolonged benefits for injured workers with acute back pain.

INTRODUCTION: Some workers with work-related compensated back pain (BP) experience a troubling course of disability. Factors associated with delayed recovery among workers with work-related compensated BP were explored. METHODS: This is a cohort study of workers with compensated BP in 2005 in Ontario, Canada. Follow up was 2 years. Data was collected from employers, employees and health-care providers by the Workplace Safety and Insurance Board (WSIB). Exclusion criteria were: (1) no-lost-time claims, (2) >30 days between injury and claim filing, (3) <4 weeks benefits duration, and (4) age >65 years. Using proportional hazard models, we examined the prognostic value of information collected in the first 4 weeks after injury. Outcome measures were time on benefits during the first episode and time until recurrence after the first episode. RESULTS: Of 6,657 workers, 1,442 were still on full benefits after 4 weeks. Our final model containing age, physical demands, opioid prescription, union membership, availability of a return-to-work program, employer doubt about work-relatedness of injury, worker's recovery expectations, participation in a rehabilitation program and communication of functional ability was able to identify prolonged claims to a fair degree [area under the curve (AUC) = .79, 95% confidence interval (CI) .74-.84]. A model containing age, sex, physical demands, opioid prescription and communication of functional ability was less successful at predicting time until recurrence (AUC = .61, 95% CI .57, .65). CONCLUSIONS: Factors contained in information currently collected by the WSIB during the first 4 weeks on benefits can predict prolonged claims, but not recurrent claims.

Differences in predictors for return to work following musculoskeletal injury between workers with and without somatic comorbidities.

PURPOSE: In workers with musculoskeletal injuries, comorbidity is associated with worse return to work (RTW) outcomes. In the context of RTW, it is unclear whether associations between predictors and RTW are similar or different for workers with and without comorbidity. This study aims to investigate differences and similarities between workers with and without comorbidity in 12-month predictors for RTW in workers who are absent from work due to a musculoskeletal injury. METHODS: All workers with lost-time claims who were off work at baseline were selected from the Early Claimant Cohort (Canada) (n = 1,566). Follow-up data on RTW were available of 810 workers after 12 months. Predictors included demographic, health-related, and work-related factors. Differences between coefficients of the groups with and without comorbidity were tested. RESULTS: Low household income was a predictor for RTW in workers without comorbidity only. Better mental health was a predictor for RTW in workers with comorbidity only. Higher education, less pain intensity, better general health, less bodily pain, better physical health, and a positive supervisor response were predictors for RTW in the total group. CONCLUSIONS: Injured workers with and without comorbidity should be considered as two distinct groups when focusing on mental health or household income.

A pilot randomised control trial of the effectiveness of a biofeedback mouse in reducing self-reported pain among office workers.

A pilot study examined the effectiveness of a biofeedback mouse in reducing upper extremity pain and discomfort in office workers; in addition, relative mouse use (RMU), satisfaction and the feasibility of running a randomised controlled trial (RCT) in a workplace setting were evaluated. The mouse would gently vibrate if the hand was idle for more than 12 s. The feedback reminded users to rest the arm in neutral, supported postures. Analysis showed a statistically significant reduction in shoulder pain and discomfort for the intervention group at T2 (38.7% lower than controls). Statistically significant differences in RMU time between groups were seen post intervention (-7% at T1 and +15% at T2 for the intervention group). Fifty-five percent of the intervention group was willing to continue using the mouse. It appears feasible to perform an RCT for this type of intervention in a workplace setting. Further study including more participants is suggested. PRACTITIONER SUMMARY: The study findings support the feasibility of conducting randomised control trials in office settings to evaluate ergonomics interventions. The intervention resulted in reduced pain and discomfort in the shoulder. The intervention could be a relevant tool in the reduction of upper extremity musculoskeletal disorder. Further research will better explain the study's preliminary findings.

Cross-cultural adaptation of the Work Role Functioning Questionnaire 2.0 to Norwegian and Danish.

BACKGROUND: A healthy and productive working life has attracted attention owing to future employment and demographic challenges. OBJECTIVE: The aim was to translate and adapt the Work Role Functioning Questionnaire (WRFQ) 2.0 to Norwegian and Danish. METHODS: The WRFQ is a self-administered tool developed to identify health-related work limitations. Standardised cross-cultural adaptation procedures were followed in both countries' translation processes. Direct translation, synthesis, back translation and consolidation were carried out successfully. RESULTS: A pre-test among 78 employees who had returned to work after sickness absence found idiomatic issues requiring reformulation in the instructions, four items in the Norwegian version, and three items in the Danish version, respectively. In the final versions, seven items were adjusted in each country. Psychometric properties were analysed for the Norwegian sample (n = 40) and preliminary Cronbach's alpha coefficients were satisfactory. A final consensus process was performed to achieve similar titles and introductions. CONCLUSIONS: The WRFQ 2.0 cross-cultural adaptation to Norwegian and Danish was performed and consensus was obtained. Future validation studies will examine validity, reliability, responsiveness and differential item response. The WRFQ can be used to elucidate both individual and work environmental factors leading to a more holistic approach in work rehabilitation.

Disability management practices in Ontario workplaces: employees' perceptions.

PURPOSE: The purpose of this study was to obtain employees' perceptions about disability management (DM) at their workplaces. METHODS: Data were obtained from focus group interviews and individual telephone interviews with 58 employees who had sustained a work-related injury or disability in Ontario, Canada. Participants also completed a 22-item Organizational Policies and Practices (OPP) Questionnaire that asked questions about workplace DM practices. RESULTS: Respondents emphasized the need for job accommodation, the importance of open and clear communication and the necessity of job retraining. The provision of ergonomic modifications to their worksites and the development of meaningful and specific DM policies and procedures were seen as key to a comprehensive workplace DM program. Education about health and safety also was identified as an important component of creating a supportive workplace environment. The OPP questionnaire showed good internal consistency (Cronbach's alpha=0.95) and discriminant validity. CONCLUSION: This study demonstrates the importance of workplaces communicating with their employees and respecting their opinions when establishing and carrying out DM policies and practices. The OPP Questionnaire is useful in determining how DM is managed in the workplace.