CONNECTing Concussion Care with Research Across Ontario.

Common data elements (CDEs) for concussion, as established by international bodies, are not being widely used in Ontario, resulting in significant variability in the data being assessed and collected across clinics. CDEs support standardization of care as well as large-scale data sharing for high impact research. A collaborative network - Concussion Ontario Network: Neuroinformatics to Enhance Clinical care and Translation (CONNECT) - comprised of health care professionals, researchers, members from advocacy groups, and patients was formed to establish and implement CDEs for concussion care and research. While the seeds have been planted and initial effectiveness demonstrated, future challenges exist.

Characterizing the profiles of patients with acute concussion versus prolonged post-concussion symptoms in Ontario.

Identifying vulnerability factors for developing persisting concussion symptoms is imperative for determining which patients may require specialized treatment. Using cross-sectional questionnaire data from an Ontario-wide observational concussion study, we compared patients with acute concussion (≤ 14 days) and prolonged post-concussion symptoms (PPCS) (≥ 90 days) on four factors of interest: sex, history of mental health disorders, history of headaches/migraines, and past concussions. Differences in profile between the two groups were also explored. 110 patients with acute concussion and 96 patients with PPCS were included in our study. The groups did not differ on the four factors of interest. Interestingly, both groups had greater proportions of females (acute concussion: 61.1% F; PPCS: 66.3% F). Patient profiles, however, differed wherein patients with PPCS were significantly older, more symptomatic, more likely to have been injured in a transportation-related incident, and more likely to live outside a Metropolitan city. These novel risk factors for persisting concussion symptoms require replication and highlight the need to re-evaluate previously identified risk factors as more and more concussions occur in non-athletes and different risk factors may be at play.

The Employment Quality of Persons with Disabilities: Findings from a National Survey.

PURPOSE: Labour market integration is a widely accepted strategy for promoting the social and economic inclusion of persons with disabilities. But what kinds of jobs do persons with disabilities obtain following their integration into the labour market? In this study, we use a novel survey of workers to describe and compare the employment quality of persons with and without disabilities in Canada. METHODS: We administered an online, cross-sectional survey to a heterogeneous sample of workers in Canada (n = 2,794). We collected data on sixteen different employment conditions (e.g., temporary contract, job security, flexible work schedule, job lock, skill match, training opportunities, and union membership). We used latent class cluster analysis to construct a novel typology of employment quality describing four distinct 'types' of employment: standard, portfolio, instrumental, and precarious. We examined associations between disability status, disability type, and employment quality. RESULTS: Persons with disabilities reported consistently lower employment quality than their counterparts without disabilities. Persons with disabilities were nearly twice as likely to report low-quality employment in the form of either instrumental (i.e., secure but trapped) or precarious (i.e., insecure and unrewarding) employment. This gap in employment quality was particularly pronounced for those who reported living with both a physical and mental/cognitive condition. CONCLUSION: There are widespread inequalities in the employment quality of persons with and without disabilities in Canada. Policies and programs aiming to improve the labour market situation of persons with disabilities should emphasize the importance of high-quality employment as a key facet of social and economic inclusion.

How Does Job Insecurity and Workplace Activity Limitations Relate to Rheumatic Disease Symptom Trajectories in Young Adulthood? A Longitudinal Study.

OBJECTIVE: Workplace and labor market conditions are associated with the health of the working population. A longitudinal study was conducted among young adults with rheumatic disease to examine workplace activity limitations and job insecurity and their relationship with disease symptom trajectories. METHODS: Three online surveys were administered to young adults with rheumatic disease over 27 months. Self-reported data on pain, fatigue, and disease activity were collected. Workplace activity limitations and job insecurity were measured. Group-based discrete mixture models determined pain, fatigue, and disease activity trajectory groups. Robust Poisson regression models were fitted to examine the relationship among workplace activity limitations, job insecurity, and trajectory group membership. RESULTS: In total, 124 participants (mean ± SD age 29 ± 4.5 years) with rheumatic disease were recruited. At baseline, participants reported considerable workplace activity limitations (10.35 ± 5.8), and 36% of participants indicated experiencing job insecurity. We identified 2 latent rheumatic disease symptom trajectory groups. The first group had high persistent pain, fatigue, or disease activity; the second group had low persistent disease symptoms over time. Greater workplace activity limitations were associated with an increased relative risk (RR) of being in the high persistent severe pain (RR 1.02 [95% confidence interval (95% CI) 1.01, 1.03]), fatigue (RR 1.02 [95% CI 1.01, 1.03]), and disease activity trajectory groups (RR 1.02 [95% CI 1.01, 1.03]). Job insecurity was associated with an increased RR of membership in the high persistent pain (RR 1.14 [95% CI 1.04, 1.25]) and disease activity trajectory groups (RR 1.11 [95% CI 1.00, 1.22]). CONCLUSION: Workplace activity limitations and job insecurity represent working conditions that are associated with the health of young adults with rheumatic disease and should be examined as potential targets for intervention.

Rheumatic Disease Disclosure at the Early Career Phase and Its Impact on the Relationship Between Workplace Supports and Presenteeism.

OBJECTIVE: Young adults with rheumatic disease face challenges communicating health needs, accessing workplace support, and sustaining productivity. Our objective was to examine whether disclosure modifies the relationship between workplace support and presenteeism. METHODS: An online survey was administered to Canadian young adults with rheumatic disease and asked about presenteeism (0 = health had no effect on work; 10 = health completely prevented working), workplace support need, availability, and use and whether health details were disclosed to an immediate supervisor. A multivariable robust linear regression model was conducted and stratified by those who did and did not disclose the details of their health to their supervisor. RESULTS: A total of 306 participants completed the survey with a mean ± SD presenteeism score of 4.89 ± 2.65. More than 70% disclosed health details to their supervisor; those who disclosed reported greater presenteeism (mean ± SD 5.2 ± 2.5) when compared to those who did not disclose (mean ± SD 4.2 ± 2.61). Greater disease severity was associated with disclosure. Half of the participants reported unmet workplace support needs (53%), 32% reported that their workplace support needs were met, and 15% reported exceeded workplace support needs. The relationship between presenteeism and workplace support needs was modified by disclosure. For participants who disclosed, workplace support needs that were unmet (ß = 1.59 [95% confidence interval (95% CI) 0.75, 2.43]) and that were met (ß = 1.25 [95% CI 0.39, 2.11]) were associated with greater presenteeism when compared to those with exceeded workplace support needs. CONCLUSION: To address presenteeism, strategies should be developed for young adults with rheumatic disease to foster access to available workplace supports and to navigate disclosure decisions.

Reliability and validity of manual palpation for the assessment of patients with low back pain: a systematic and critical review.

BACKGROUND: Static or motion manual palpation of the low back is commonly used to assess pain location and reproduction in low back pain (LBP) patients. The purpose of this study is to review the reliability and validity of manual palpation used for the assessment of LBP in adults. METHOD: We systematically searched five databases from 2000 to 2019. We critically appraised internal validity of studies using QAREL and QUADAS-2 instruments. We stratified results using best-evidence synthesis. Validity studies were classified according to Sackett and Haynes. RESULTS: We identified 2023 eligible articles, of which 14 were low risk of bias. Evidence suggests that reliability of soft tissue structures palpation is inconsistent, and reliability of bony structures and joint mobility palpation is poor. We found preliminary evidence that gluteal muscle palpation for tenderness may be valid in differentiating LBP patients with and without radiculopathy. CONCLUSION: Reliability of manual palpation tests in the assessment of LBP patients varies greatly. This is problematic because these tests are commonly used by manual therapists and clinicians. Little is known about the validity of these tests; therefore, their clinical utility is uncertain. High quality validity studies are needed to inform the clinical use of manual palpation tests.

Impacts of the COVID-19 pandemic on health, financial worries, and perceived organizational support among people living with disabilities in Canada.

BACKGROUND: Individuals with physical or mental health disabilities may be particularly vulnerable to the impact of COVID-19 on their health and employment. OBJECTIVES: We examined COVID-19-related concerns for health, finances, and organizational support among workers with no disability, a physical, mental health, or both physical and mental health disability, and factors associated with COVID-19 perceptions. METHODS: An online, cross-sectional survey was administered to a sample of Canadians in the first wave of the COVID-19 pandemic. Questions asked about COVID-19 perceptions, demographics (gender, age, education), work context (e.g., sector, contract work) and employment conditions (e.g., job stress, control, accommodation needs). Descriptive, multivariable, and nested regression analyses examined factors associated with COVID-19 perceptions. RESULTS: A total of 3066 participants completed the survey. Workers with both a physical and mental health disability reported significantly greater health and financial concerns and less organizational support than those with no disability. Workers with a physical disability reported more health concerns and those with a mental health disability reported more financial concerns and less organizational support. Respondents with disabilities also reported significant differences in employment conditions (e.g., more contract work, stress, unmet accommodation needs) than those with no disability. Employment conditions were consistently significant predictors of COVID-19 perceptions and attenuated the significance of disability type in analyses. CONCLUSIONS: Concerns about the impact of COVID-19 on one's health, finances, and organizational support reflected existing disability inequities in employment conditions and highlight the importance of creating more inclusive employment opportunities for people living with physical and mental health disabilities.

Brief Report: Characteristics and Needs of Persons Admitted to an Inpatient Psychiatric Hospital With Workers' Compensation Coverage.

The rise of mental health issues in the workplace is widely known. Though mental health issues were not covered by the Workplace Safety Insurance Board (WSIB) in Ontario (Canada) until 2018, it was listed as responsible for payment of inpatient psychiatric hospital stays between 2006 and 2016. This population-level observational analytic study compares the clinical and service needs of 1,091 individuals admitted to inpatient psychiatry with WSIB coverage to all other admissions (n = 449,128). Secondary analysis was based on the interRAI Mental Health assessment. The WSIB group differed from all other admissions on almost all characteristics considered. Most notably, depression (65.08 vs. 57.02%), traumatic life events (25.48 vs. 15.58%), substance use (58.02 vs. 46.92%), daily pain (38.31 vs. 12.15%) and sleep disturbance (48.95 vs. 37.12%) were much higher in the WSIB group. Females with WSIB coverage had more depression (74.36 vs. 59.91%) and traumatic life events (30.00 vs. 22.97%), whereas males had more substance issues (63.62 vs. 47.95%). In addition, persons under the age of 55 had more substance issues (<25 = 75.47%; 25-54 = 61.64%: 55 ± 40.54%) and traumatic life events (<25 = 26.41%; 25-54 = 28.18%; 55 ± 15.31%), while those 25-54 years had more daily pain (41.67% vs. <25 = 3.77% and 55 ± 34.23%) and sleep disturbance (50.74% vs. <25 = 33.96% and 55 ± 45.94%). All variables differed significantly by sex and age within the comparison group, though not always following the patterns observed in the WSIB group. Future research examining mental health needs and outcomes among injured workers receiving inpatient psychiatric services is needed, and should take into account sex and age.

Is Acceleration a Valid Proxy for Injury Risk in Minimal Damage Traffic Crashes? A Comparative Review of Volunteer, ADL and Real-World Studies.

Injury claims associated with minimal damage rear impact traffic crashes are often defended using a "biomechanical approach," in which the occupant forces of the crash are compared to the forces of activities of daily living (ADLs), resulting in the conclusion that the risk of injury from the crash is the same as for ADLs. The purpose of the present investigation is to evaluate the scientific validity of the central operating premise of the biomechanical approach to injury causation; that occupant acceleration is a scientifically valid proxy for injury risk. Data were abstracted, pooled, and compared from three categories of published literature: (1) volunteer rear impact crash testing studies, (2) ADL studies, and (3) observational studies of real-world rear impacts. We compared the occupant accelerations of minimal or no damage (i.e., 3 to 11 kph speed change or "delta V") rear impact crash tests to the accelerations described in 6 of the most commonly reported ADLs in the reviewed studies. As a final step, the injury risk observed in real world crashes was compared to the results of the pooled crash test and ADL analyses, controlling for delta V. The results of the analyses indicated that average peak linear and angular acceleration forces observed at the head during rear impact crash tests were typically at least several times greater than average forces observed during ADLs. In contrast, the injury risk of real-world minimal damage rear impact crashes was estimated to be at least 2000 times greater than for any ADL. The results of our analysis indicate that the principle underlying the biomechanical injury causation approach, that occupant acceleration is a proxy for injury risk, is scientifically invalid. The biomechanical approach to injury causation in minimal damage crashes invariably results in the vast underestimation of the actual risk of such crashes, and should be discontinued as it is a scientifically invalid practice.

Exposure to a motor vehicle collision and the risk of future back pain: A systematic review and meta-analysis.

OBJECTIVE: The purpose of this study is to summarize the evidence for the association between exposure to a motor vehicle collision (MVC) and future low back pain (LBP). LITERATURE SURVEY: Persistent low back pain (LBP) is a relatively common complaint after acute injury in a MVC, with a reported 1 year post-crash prevalence of at least 31 % of exposed individuals. Interpretation of this finding is challenging given the high incidence of LBP in the general population that is not exposed to a MVC. Risk studies with comparison control groups need to be examined in a systematic review. METHODOLOGY: A systematic search of five electronic databases from 1998 to 2019 was performed. Eligible studies describing exposure to a MVC and risk of future non-specific LBP were critically appraised using the Quality in Prognosis Studies (QUIPS) instrument. The results were summarized using best-evidence synthesis principles, a random effects meta-analysis and testing for publication bias. SYNTHESIS: The search strategy yielded 1136 articles, three of which were found to be at low to medium risk of bias after critical appraisal. All three studies reported a positive association between an acute injury in a MVC and future LBP. Pooled analysis of the results resulted in an unadjusted relative risk of future LBP in the MVC-exposed and injured population versus the non-exposed population of 2.7 (95 % CI [1.9, 3.8]), which equates to a 63 % attributable risk under the exposed. CONCLUSIONS: There was a consistent positive association in the critically reviewed literature that investigated the risk of future LBP following an acute MVC-related injury. For the patient with chronic low back pain who was initially injured in a MVC, more often than not (63 % of the time) the condition was caused by the MVC. These findings are likely to be of interest to clinicians, insurers, patients, governments and the courts. Future studies from both general and clinical populations would help strengthen these results.

Disability Severity, Leader-Member Exchange, and Attitudinal Outcomes: Considering the Employee and Supervisor Perspectives.

Purpose Although the effects of disability on employee work outcomes are well-documented, the mechanism that explain these relationship remains unclear. We propose that the quality of relationships employees with disabilities develop with their supervisors explains the link between disability severity and employee work outcomes. More specifically, we examine the mediating role of leader-member exchange (LMX) in the relationship between employee disability severity and presenteeism, job accommodation, supervisor-rated performance, job satisfaction, and resilience. We test this proposition from two perspectives: employees with disabilities and supervisors who had supervised employees with disabilities. Method We collected data from employees with musculoskeletal disabilities (Sample 1, N = 264) and supervisors who had supervised employees with musculoskeletal disabilities in the past two years (Sample 2, N = 224). Results From the perspective of employees with disabilities (Sample 1), disability severity was negatively related to LMX quality (R2 = .28). Contrary to our hypothesis, we found a positive relationship between supervisor perceptions of employee disability severity and LMX in Sample 2 (R2 = .27). After adjusting for disability severity, LMX quality was related to improved outcomes in both samples: higher employee job satisfaction (Sample 1: R2 = .36), provision of job accommodations (Sample 1: R2 = .16; Sample 2: R2= .15), resilience (Sample 1: R2 = .18), lower levels of presenteeism (Sample 1: R2 = .20), and higher performance evaluations for employees with disabilities (Sample 2: R2 = .49). Conclusion By collecting two separate samples, we revealed similarities and differences in employee and supervisor perspectives. Our findings demonstrated the need for including both perspectives when considering implications of employee disability severity.

The Rivermead Post-Concussion Questionnaire score is associated with disability and self-reported recovery six months after mild traumatic brain injury in older adults.

Background/Objectives: Post-concussion syndrome refers to the adverse group of symptoms following a mild traumatic brain injury (mTBI). The Rivermead post-concussion syndrome questionnaire (RPQ) is a common clinical tool for assessing baseline post-concussion syndrome symptomology; however, it is unknown if scores on this questionnaire are associated with future disability. Therefore, the goal of this study was to determine the association between baseline RPQ scores and future disability in older adults with mTBI.Methods and Findings: This study used a prospective cohort design, using the RPQ to measure baseline post-concussion syndrome symptomatology. Disability at 6 months was measured using the Glasgow Outcome Scale-Extended (GOSE; disability), short-form 12 (SF-12; physical and mental quality of life), and self-reported recovery. Linear and logistic models adjusted for confounding factors were estimated using 200 bootstrapped samples. Individuals with higher levels of baseline symptomatology were more likely to have poor GOSE scores (RR = 2.13, 95% CI [1.51, 2.31]) and self-reported recovery (RR = 2.64, 95% CI [1.31, 8.98]) 6 months later.Conclusions: High levels of baseline symptomatology may be associated with overall disability and individual perceptions of recovery 6 months post-MTBI. While the RPQ is valid in assessing a patient's post-concussive symptoms following mTBI, it may not predict long-term physical or mental health in older adults.

A multi-faceted community intervention is associated with knowledge and standards of workplace mental health: the Superior Mental Wellness @ Work study.

BACKGROUND: Poor psychosocial work environments, such as those with low psychological support and high demands, can be harmful to the mental health of workers. In Canada, the National Standard for Psychological Health and Safety in the Workplace (the Standard) provides a comprehensive framework for organizations to identify hazards that may contribute to the psychological harm of employees. This study examines the association between a multi-faceted community intervention, the Superior Mental Wellness @ Work program designed to increase awareness of mental health and the National Standard, and outcomes assessing increased awareness and response to the Standard. These outcomes included the 1) prioritization of workplace mental health; 2) familiarity with the Standard; and 3) knowledge of mental health. METHODS: A quasi-experimental design was used to assess the associations of interest. Surveys were sent to two random samples of employer representatives pre-and post-intervention. Intervention participants were also compared to non-participants at the post-intervention stage. T-tests and chi-square tests were used to compare differences between pre- and post-intervention outcomes and also between intervention participants and non-participants identified at the post-intervention survey. RESULTS: The multi-faceted community intervention was associated with increased familiarity of the Standard, and increased knowledge of mental health challenges, mental health promotion, and existing resources at a community-level. When comparing those companies who participated in the intervention versus those who did not, participants were more likely to prioritize mental health in the workplace. Participants reported a greater need for support to address workplace mental health, poorer perceived mental health of employees, and greater stigma than non-participants. However, participants were more likely to be familiar with the Standard, have an action plan to implement the Standard, and be prepared to champion mental health in the workplace. Participants also had greater knowledge of workplace mental health in general compared to non-participants. CONCLUSIONS: The multi-faceted community intervention, the Superior Mental Wellness @ Work project, was associated with increased familiarity of the Standard, and increased knowledge of mental health challenges, mental health promotion, and existing resources at a community-level. Such a multi-faceted intervention has the capacity to improve mental health literacy and awareness of the Standard.

Exposure to a Motor Vehicle Collision and the Risk of Future Neck Pain: A Systematic Review and Meta-Analysis.

OBJECTIVE: To summarize the literature that has examined the association between a motor vehicle collision (MVC) related neck injury and future neck pain (NP) in comparison with the population that has not been exposed to neck injury from an MVC. LITERATURE SURVEY: Neck injury resulting from an MVC is associated with a high rate of chronicity. Prognosis studies indicate 50% of injured people continue to experience NP a year after the collision. This is difficult to interpret due to the high prevalence of NP in the general population. METHODOLOGY: We performed a systematic review of the literature using five electronic databases, searching for risk studies on exposure to an MVC and future NP published from 1998 to 2018. The outcome of interest was future NP. Eligible risk studies were critically appraised using the modified Quality in Prognosis Studies (QUIPS) instrument. The results were summarized using best-evidence synthesis principles, a random effects meta-analysis, metaregression, and testing for publication bias was performed with the pooled data. SYNTHESIS: Eight articles were identified of which seven were of lower risk of bias. Six studies reported a positive association between a neck injury in an MVC and future NP compared to those without a neck injury in an MVC. Pooled analysis of the six studies indicated an unadjusted relative risk of future NP in the MVC exposed population with neck injury of 2.3 (95% CI [1.8, 3.1]), which equates to a 57% attributable risk under the exposed. In two studies where exposed participants were either not injured or injury status was unknown, there was no increased risk of future NP. CONCLUSIONS: There was a consistent positive association among studies that have examined the association between MVC-related neck injury and future NP. These findings are of potential interest to clinicians, insurers, patients, governmental agencies, and the courts. LEVEL OF EVIDENCE: I.

Retirement Expectations of Older Workers with Arthritis and Diabetes Compared with Those of Workers with No Chronic Diseases.

ABSTRACTWe know little about the retirement plans of adults with chronic diseases. This research recruited Canadian workers 50-67 years of age from a national panel of 80,000 individuals (arthritis, n = 631; diabetes, n = 286; both arthritis and diabetes, n = 111; no chronic disabling conditions, n = 538). A cross-sectional survey asked participants about their expected age of retirement, future work plans, whether they were retiring sooner than planned, and bridged retirement. Chi-square analyses, analyses of variance, and regression analyses examined expectations and factors associated with them. Despite health difficulties, workers with arthritis and diabetes had retirement plans similar to those of healthy controls and consistent with normative expectations of working to a traditional retirement age. However, more respondents with arthritis or diabetes reported bridged retirement than healthy controls. Contrary to predictions, health factors accounted for less of the variance in retirement expectations than other factors. These findings point to the complexity surrounding retirement expectations and highlight person-job fit rather than disease factors alone.

Understanding the Fertility Desires and Intentions among HIV-Positive Men Living in Ontario: Survey Instrument Development and Validation.

Men with HIV have highlighted the importance of understanding their fertility desires. However, most research has focused on women. We aimed (1) to develop a survey instrument to assess fertility desires and intentions among HIV-positive men and (2) to assess its face, content, and construct validity, as well as test-retest reliability and internal consistency. Principal component analysis was used for construct validity analysis in a sample of 60 men with HIV. The test-retest reliability and internal consistency were assessed using Spearman correlation and Cronbach α, respectively. The initial and the final version of the questionnaire consisted of 10 domains and 14 constructs. We found a one-component model for the 3 constructs analyzed and Cronbach α values were ≥.70. Test-retest statistic was stable with Spearman correlation >0.70. In conclusion, a reliable and valid questionnaire was developed for determining the fertility desires and intentions of men with HIV.

Are There Differences in Workplace Accommodation Needs, Use and Unmet Needs Among Older Workers With Arthritis, Diabetes and No Chronic Conditions? Examining the Role of Health and Work Context.

The aging of workforces combined with the prevalence of age-related chronic diseases has generated interest in whether large numbers of older workers will need workplace accommodations. This research applied work functioning theory to examine accommodation availability, need and use in workers with arthritis, diabetes, or no chronic disabling diseases; factors associated with accommodation needs; and the relationship of accommodation needs met, unmet or exceeded to job outcomes. Participants were aged 50-67 years, employed, and had arthritis (n = 631), diabetes (n = 286), both arthritis/diabetes (n = 111) or no chronic disabling conditions (healthy controls n = 538). They were recruited from a national panel of 80,000 individuals and a cross-sectional survey was administered online or by telephone. Questionnaires assessed demographics, health, work context, workplace accommodations, and job outcomes. Chi-square analyses, analyses of variance, and regression analyses compared groups. Respondents were similar in many demographic and work context factors. As expected, workers with arthritis and/or diabetes often reported poorer health and employment outcomes. Yet, there were few differences across health conditions in need for or use of accommodations with most participants reporting accommodations needs met. In keeping with work functioning theory, unmet accommodation needs were largely related to work context, not health. Workers whose accommodation needs were exceeded reported better job outcomes than those with accommodation needs met. Findings highlight both work context and health in understanding workplace accommodations and suggest that many older workers can meet accommodation needs with existing workplace practices. However, additional research aimed at workplace support and the timing of accommodation use is needed.