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2.
Bull Hosp Jt Dis (2013) ; 77(3): 200-205, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31487486

RESUMO

BACKGROUND: Workers Compensation claims have been previously associated with inferior clinical outcomes. However, variation in inpatient stays for orthopedic trauma injuries according to insurance type has not been previously examined. METHODS: We investigated the differences according to insurance for tibial shaft fractures in regard to length of stay and disposition. Using the New York SPARCS database, we identified 1,856 adult non-elderly patients with an isolated tibial shaft fracture who underwent surgery. Patients were stratified by insurance type, including private, Medicaid, Workers Compensation, and no-fault, which covers medical expenses related to automobile or pedestrian accidents. RESULTS: Compared to private insurance (mean: 2.7 days), length of stay was longer for no-fault (mean: 3.9 days; adjusted difference +33%, p < 0.001) and Medicaid (mean: 3.5 days; adjusted difference +22%, p < 0.001), but not significantly different for Workers Compensation (mean: 3.5 days; adjusted difference +4%, p = 0.474). Compared to private insurance (rate: 3.5%), disposition to a facility was significantly higher for no-fault (rate: 10.1%; adjusted odds ratio [OR] = 3.3, p < 0.001) and Medicaid (rate: 7.6%; OR = 2.2, p = 0.003), but was not significantly different for Workers Compensation (rate: 6.3%; OR = 1.8, p = 0.129). CONCLUSIONS: Patients with no-fault insurance, but not Workers Compensation, are subject to longer hospital stays and are more likely to be discharged to a facility following operative fixation of an isolated tibial shaft fracture. These findings suggest that financial, social, and legal factors influence medical care for patients involved in automobile accidents with no-fault insurance.


Assuntos
Acidentes de Trânsito/economia , Fixação de Fratura , Seguro de Responsabilidade Civil/estatística & dados numéricos , Tempo de Internação/estatística & dados numéricos , Fraturas da Tíbia , Indenização aos Trabalhadores/estatística & dados numéricos , Adulto , Feminino , Fixação de Fratura/economia , Fixação de Fratura/reabilitação , Fixação de Fratura/estatística & dados numéricos , Humanos , Revisão da Utilização de Seguros/estatística & dados numéricos , Masculino , Fraturas da Tíbia/economia , Fraturas da Tíbia/etiologia , Fraturas da Tíbia/cirurgia , Estados Unidos
3.
Med Lav ; 110(4): 278-284, 2019 Aug 26.
Artigo em Inglês | MEDLINE | ID: mdl-31475689

RESUMO

BACKGROUND: Under-reporting and recognition of occupational diseases is a problem in countries with workers' compensation schemes. OBJECTIVE: To describe the role of a public hospital Occupational Disease Unit (ODU) in Barcelona that resulted in improved reporting and official recognition of occupational diseases from 2010 to 2017. METHODS: Hospital physicians referred possible cases of work-related disease to the ODU, where in-depth medical evaluations were then performed, and a detailed report addressing causation was generated. Patients with confirmed cases of occupational disease were counselled and followed while pursuing official recognition and benefits claims by the Spanish Social Security System. RESULTS: Between 2010 and 2017, 149 cases were referred to the ODU for evaluation. Of these, 80 (53.7%) were confirmed to have an occupational disease, 54 (67.5%) patients pursued official recognition, and to date 26 (48.1%) have been recognized by the Social Security System. The recognition rate varied by diagnosis group (p=0.003), and was highest for skin diseases (71.4%) and cancer (66.7%), and lowest for hearing loss (29.4%) and musculoskeletal disorders (16.7%). CONCLUSIONS: A hospital ODU can improve reporting and official recognition of occupational diseases that otherwise might not have been recognized. Expanding this experience to other Spanish and European hospitals could improve the efficiency of workers' compensation schemes and better support preventive policies.


Assuntos
Doenças Musculoesqueléticas , Doenças Profissionais , Unidades Hospitalares , Humanos , Doenças Musculoesqueléticas/diagnóstico , Doenças Profissionais/diagnóstico , Indenização aos Trabalhadores
5.
S Afr Med J ; 109(7): 516-518, 2019 Jun 28.
Artigo em Inglês | MEDLINE | ID: mdl-31266579

RESUMO

BACKGROUND: The Compensation for Occupational Injuries and Diseases Act No. 130 of 1993, as amended in 1997 (COIDA), provides payment to healthcare providers for treatment of occupational injuries in South Africa (SA). Patients and employers are often unaware of procedures for claiming, and patients then carry the burden of costs themselves. Additionally, under-billing results in a loss of income for treating hospitals. Hand injuries are common occupational injuries and form the focus of this study. OBJECTIVES: To investigate whether occupational hand injuries treated at the Martin Singer Hand Unit at Groote Schuur Hospital, Cape Town, were accurately captured and allocated correct professional fee coding and billing. Accurate capturing and billing would allow for access to the Compensation Fund and allocation of finances to improve service delivery, as well as avoid unnecessary costs to otherwise uninsured patients. METHODS: All new hand injuries presenting to the hand unit at the hospital in August 2017 were sampled in a retrospective folder review. Injuries on duty (IODs) were identified and analysed further. Coding and billing were compared with independent private quotes. RESULTS: Sixty new hand injuries presented during the month. Fifteen were IODs, but only 6 were recognised by administration. The other 9 were billed at minimum income rates and 5 of these patients also had operations, which were not billed for. A total of ZAR88 871.99 was under-billed in terms of professional fees only. The 9 incorrectly classified patients had to bear costs themselves at a median of ZAR130.00 each. CONCLUSIONS: There were large discrepancies in billing for occupational hand injuries. This resulted in costs to the patients and loss of income for the facility. Access to the Compensation Fund is vital in financing resources in the overburdened public sector. Suggestions for improvement include accessing COIDA funds in order to improve administration at the unit, so improving identification, coding and billing of occupational hand injuries.


Assuntos
Traumatismos da Mão/economia , Traumatismos Ocupacionais/economia , Indenização aos Trabalhadores/estatística & dados numéricos , Traumatismos da Mão/epidemiologia , Traumatismos da Mão/cirurgia , Humanos , Traumatismos Ocupacionais/epidemiologia , Traumatismos Ocupacionais/cirurgia , Procedimentos Ortopédicos/economia , Estudos Retrospectivos , África do Sul/epidemiologia
6.
BMC Public Health ; 19(1): 927, 2019 Jul 10.
Artigo em Inglês | MEDLINE | ID: mdl-31291915

RESUMO

BACKGROUND: Insurance claims management practices may have a significant impact on the health and experiences of injured workers claiming in workers' compensation systems. There are few multi-jurisdictional studies of the way workers experience compensation processes, and limited data on the association between claims experience and return to work outcomes. This study sought to identify worker, claim and injury related factors associated with injured worker experiences of workers' compensation claims management processes, and to examine associations between claims experience and return to work. METHODS: A national, cross-sectional survey of injured workers involved in ten Australian workers' compensation schemes. A total of 10,946 workers completed a telephone survey at 6 to 24 months post claim acceptance. Predictors of positive or negative/neutral claims experience were examined using logistic regression. Associations between claims experience, return to work status and duration of time loss were examined using logistic regression. RESULTS: Nearly one-quarter (23.0%, n = 2515) of workers reported a negative or neutral claims experience. Injury type, jurisdiction of claim, and time to lodge claim were most strongly associated with claims experience. Having a positive claims experience was strongly associated with having returned to work after accounting for injury, worker, claim and employer factors. CONCLUSIONS: There is a strong positive association between worker experiences of the insurance claims process and self-reported return to work status. Revision and reform of workers' compensation claims management practices to enhance worker experience and the fairness of procedures may contribute to improved return to work outcomes.


Assuntos
Traumatismos Ocupacionais/economia , Retorno ao Trabalho/estatística & dados numéricos , Indenização aos Trabalhadores/estatística & dados numéricos , Adulto , Austrália , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
7.
Artigo em Inglês | MEDLINE | ID: mdl-31336629

RESUMO

Objective: To investigate changes in the incomes of workers, particularly those in the construction sector, who experienced industrial accidents according to their status of return to work. Methods: We used data from the fifth Panel Study of Workers' Compensation Insurance. A repeated measures ANOVA was used to compare annual differential incomes before and after the industrial accident, and a linear mixed model was used to investigate the changes in income from before to after the industrial accident according to the industry and return-to-work status. Results: A comparison of the industrial categories revealed that construction industry workers exhibited the greatest incomes before the accident and the greatest decrease in income after the industrial accident. Regression analysis for assessing changes in income after the industrial accident showed that a comparison by industry revealed a significantly greater reduction in income in the construction than service industry. A comparison by work status revealed significantly greater decreases in income in the reemployment and non-return to work groups than among those who returned to their original work. Conclusions: The economic statuses of the victims of industrial accidents decreased relative to the pre-accident statuses in all industries. The ability to return to original work is important for preserving the accident victim's economic status.


Assuntos
Acidentes de Trabalho/economia , Renda , Retorno ao Trabalho/economia , Adulto , Indústria da Construção , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores Socioeconômicos , Indenização aos Trabalhadores
8.
Health Phys ; 117(6): 625-636, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31283545

RESUMO

In 1966, about 1,600 US military men-mostly Air Force-participated in a cleanup of plutonium dispersed from two nuclear bombs in Palomares, Spain. As a base for future analyses, we provide a history of the Palomares incident, including the dosimetry and risk analyses carried out to date and the compensation assessments made for veterans. By law, compensation for illnesses attributed to ionizing radiation is based on maximum estimated doses and standard risk coefficients, with considerable benefit of the doubt given to claimants when there is uncertainty. In the Palomares case, alpha activity in urine fell far faster than predicted by plutonium biokinetic excretion models used at the time. Most of the measurements were taken on-site but were disqualified on the grounds that they were "unreasonably high" and because there was a possibility of environmental contamination. Until the end of 2013, the Air Force used low dose estimates derived from environmental measurements carried out well after the cleanup. After these estimates were questioned by Congress, the Air Force adopted higher dose estimates based on plutonium concentration measurements in urine samples collected from 26 veterans after they left Palomares. The Air Force assumed that all other cleanup veterans received lower doses and therefore assigned to them maximum organ doses based on the individual among the 26 with the lowest urine measurements. These resulting maximum organ doses appear to be sufficient to justify compensation to all Palomares veterans with lung and bone cancer and early-onset liver cancer and leukemia but not other radiogenic cancers.


Assuntos
Neoplasias Induzidas por Radiação/etiologia , Doenças Profissionais/etiologia , Exposição Ocupacional/análise , Plutônio/análise , Exposição à Radiação/análise , Cinza Radioativa/análise , Indenização aos Trabalhadores/economia , Humanos , Neoplasias Induzidas por Radiação/economia , Doenças Profissionais/economia , Exposição Ocupacional/efeitos adversos , Plutônio/envenenamento , Doses de Radiação , Exposição à Radiação/efeitos adversos , Cinza Radioativa/efeitos adversos , Liberação Nociva de Radioativos , Radiometria , Medição de Risco/métodos , Espanha , Estados Unidos , Veteranos/estatística & dados numéricos , Indenização aos Trabalhadores/normas
9.
J Manag Care Spec Pharm ; 25(7): 743-751, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31232208

RESUMO

BACKGROUND: Although medically necessary in some cases, there is growing concern that compounded medications are being overprescribed, leading to questions about safety and necessity for high use and cost. Safety concerns regarding compounded medications were highlighted by the 2013 contamination of steroid injections by the New England Compounding Center, which caused serious infections and other injuries to at least 751 patients and resulted in at least 64 patient deaths. A study contributed to our understanding of compounded medication use and cost, finding in a sample of commercially insured population that the average ingredient cost for compounded medication prescriptions was $710.36, which is 130% higher than for noncompounded medication prescriptions. The literature on use and cost of compounded medications in noncommercially insured populations and related regulations, however, is sparse. The California Workers' Compensation System (CAWCS)-the largest U.S. workers' compensation system and a public health system experiencing high compounded medication costs-provided an opportunity for additional analysis of these issues. Furthermore, CAWCS data on compounded medication use and cost allow for the exploration of alternative pricing mechanisms that may control costs. OBJECTIVES: To (a) examine use, cost, and billing and reimbursement practices for compounded medications in a public health system-CAWCS- and (b) evaluate regulations and recommend an alternative pricing mechanism that could control costs in California. METHODS: Descriptive statistics for use, cost, and reimbursement patterns of all compounded medication prescriptions included in CAWCS's Workers Compensation Information System claims datasets from 2011 to 2013 were determined. This study coded a unique dataset that (a) identified compounded medications at the ingredient level; (b) grouped compounded medications from ingredient level to compounded medications as a whole; and (c) categorized compounded medications into applicable Colorado pricing categories. T-tests assessed if regulation AB 378, which targets compounded medications, was associated with a difference in mean cost. The Colorado pricing scheme was applied to estimate cost and provide recommendations. RESULTS: Despite the AB 378 requirement for compounded medications to be billed at the ingredient level for reimbursement, 15% of pharmacy-dispensed and 6% of physician-dispensed medications were not billed at the ingredient level. For pharmacy-dispensed compounded medications billed at the ingredient level, mean amount paid (SD) per ingredient was $45.40 (195.97), and for those medications billed at the single compounded medication level, mean amount paid (SD) per medication was $95.20 (326.33) over all years. For physician-dispensed medications billed at the ingredient level, mean amount paid (SD) per ingredient was $75.47 (205.51), and when billed at the single medication level was $204.83 (221.01). T-tests showed a mean increase in compounded medication mean amount paid between pre- and post-AB 378 groups of $12.27 (P < 0.001) for pharmacy-dispensed medications and $11.34 (P < 0.001) for physician-dispensed medications, suggesting that AB 378 did not curb compounded medication mean amount paid. CONCLUSIONS: The average cost of CAWCS pharmacy- and physician-dispensed compounded medications consistently increased. Various factors may have influenced this increase, but AB 378 did not achieve its full regulatory intent to standardize billing and reimbursement and control cost. Grouping of ingredients into compounded medications allowed for application of the Colorado pricing scheme to CAWCS claims data. Adoption of Colorado pricing would save 46% of current compounded medication cost for less complicated medications, while increasing cost for more complicated medications. The analyses recommended a revised Colorado pricing scheme, which would provide improved incentives for accurate billing and lead to savings for CAWCS. DISCLOSURES: Funding for this study was provided by the California Workers' Compensation System. The authors had final control regarding study design, study conduct, and writing of the manuscript. The authors report no conflicts of interest.


Assuntos
Composição de Medicamentos/economia , Medicamentos sob Prescrição/economia , Saúde Pública/economia , Mecanismo de Reembolso/economia , Indenização aos Trabalhadores/economia , California , Custos e Análise de Custo , Custos de Medicamentos , Prescrições de Medicamentos , Humanos , Assistência Farmacêutica/economia
10.
Injury ; 50(7): 1293-1299, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31176478

RESUMO

INTRODUCTION: Road traffic crash (RTC) burden is typically reported using hospitalisations or fatalities, yet alternative measures such as work absence provide further insight into RTC impacts. This study aimed to quantify work absence due to compensable RTCs in Victoria, and to determine the characteristics associated with prolonged work absence. METHODS: In Victoria, Australia, two systems provide income support whilst unable to work, among other benefits, to those injured during RTCs either at work (workers' compensation: WC) or elsewhere (RTC compensation). Administrative data of accepted claims between July 1 2003 and June 30, 2013 were included from working age people (15-65 years) if at least one day of income support was paid. Total time (in weeks) on income support, and hence absent from work, was calculated for each person and for each predictor (age group, sex, compensation system, length of hospital stay, injury type and road user type). Cox regression was used to determine the likelihood of prolonged work absence by predictor, presented as hazard ratios (HR) with 95% confidence intervals. RESULTS: For 36,640 injured people, 1,121,863 weeks were compensated (median 10 weeks). Median work absence was shortest among those involved in a train/tram crash (2.9 weeks, HR:0.57[0.51-0.64]) and those with contusions/abrasions (3.7 weeks, HR:0.66[0.64,0.69]). Median work absence was longest among those with spinal cord injury (115.9 weeks, HR:1.56[1.26,1.92]) or severe acquired brain injury (129.6 weeks, HR:1.60[1.44,1.77]). Work absence likelihood increased with length of hospital stay. Median work absence was similar between compensation systems (WC: 10.1 weeks, RTC: 10.0 weeks) yet likelihood of greater work absence was higher in the RTC compensation system (HR:1.12[1.08,1.17]). CONCLUSIONS: Work absence is both a measureable and important metric for assessing the impact of RTC injury in those working at the time of injury. Work absence was at least ten weeks for more than half of all injured persons, reinforcing need for road safety, injury prevention, and return to work services. Furthermore, this study identified those most at risk of prolonged work absence, providing the opportunity to target specific individuals to develop strategies to reduce work absence, such as occupation-specific rehabilitation or graduated return to work.


Assuntos
Acidentes de Trânsito/estatística & dados numéricos , Retorno ao Trabalho/estatística & dados numéricos , Indenização aos Trabalhadores/estatística & dados numéricos , Ferimentos e Lesões/epidemiologia , Acidentes de Trânsito/economia , Adolescente , Adulto , Feminino , Inquéritos Epidemiológicos , Hospitalização , Humanos , Formulário de Reclamação de Seguro/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , Retorno ao Trabalho/economia , Índices de Gravidade do Trauma , Vitória/epidemiologia , Indenização aos Trabalhadores/economia , Ferimentos e Lesões/economia , Adulto Jovem
12.
Rev Epidemiol Sante Publique ; 67(4): 247-252, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31235191

RESUMO

BACKGROUND: In France, complex cases of occupational disease (OD) are submitted to regional committees who are in charge of accepting, or rejecting, the claim. Their mean annual acceptance rate varies from one region to another, which may reflect differences in the cases, or discrepancies between committees. The objective of this study was to assess the comparability of the decisions of the committees on the basis of standardized cases. METHODS: Three experienced occupational physicians specialized in OD were asked to develop 28 clinical cases representative of claims for compensation usually seen in these committees. The cases, in the form of short vignettes, were submitted to the 18 French regional committees, asking if they would recognise each case as an OD. RESULTS: All committees participated. The acceptance rate (recognition of the case as an OD) varied, ranging from 18% to 70%. All the committees took the same decision for only 7 out of the 28 cases, but half accepted and half refused for 3 cases. For 10 cases, one quarter of the committees gave a decision different than the other 75%. The highest discordance rates were observed for the cases concerning musculoskeletal disorders and asbestos related diseases. CONCLUSION: The committees take very different decisions in terms of recognition of OD, especially for the most frequently compensated OD in France, i.e. musculoskeletal disorders and asbestos related diseases. This is a major source of injustice for the employees who seek compensation and there is a need to develop methods to harmonize decisions between committees.


Assuntos
Disparidades em Assistência à Saúde , Doenças Profissionais/diagnóstico , Doenças Profissionais/epidemiologia , Idoso , Ética Médica , Feminino , França/epidemiologia , Geografia , Acesso aos Serviços de Saúde/economia , Acesso aos Serviços de Saúde/ética , Acesso aos Serviços de Saúde/normas , Disparidades em Assistência à Saúde/economia , Disparidades em Assistência à Saúde/ética , Disparidades em Assistência à Saúde/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Doenças Profissionais/economia , Doenças Profissionais/terapia , Serviços de Saúde do Trabalhador/economia , Serviços de Saúde do Trabalhador/ética , Serviços de Saúde do Trabalhador/organização & administração , Serviços de Saúde do Trabalhador/normas , Fatores Socioeconômicos , Indenização aos Trabalhadores
13.
Phys Med Rehabil Clin N Am ; 30(3): 523-532, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31227128

RESUMO

Injured workers deal with many struggles while healing, forced on them by problems within the workers' compensation system itself. The physician's role is critical in mitigating complicating factors that have a negative impact on recovery. The workers' compensation system is meant as a safety net, guaranteeing prompt medical care; therefore, the applicable causation standard is lower than scientific probability. Physicians treating injured workers must remember legal, ethical, and moral obligations to patients. Injured workers should not be treated differently from patients who suffered a similar injury at home. Nonmedical factors must be analyzed in deciding whether a person is legally disabled.


Assuntos
Indenização aos Trabalhadores/legislação & jurisprudência , Humanos , Advogados , Papel do Médico , Médicos , Indenização aos Trabalhadores/ética , Ferimentos e Lesões/etiologia , Ferimentos e Lesões/psicologia , Ferimentos e Lesões/terapia
14.
Phys Med Rehabil Clin N Am ; 30(3): 599-609, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31227135

RESUMO

Causation determination has become the gateway to treatment and reimbursement in workers' compensation and personal injury cases. The science of causation is constantly evolving, which is improving our understanding of individual physical thresholds, associated risk factors, and individual biopsychosocioeconomic factors. New laws place constantly changing legal thresholds for determining work-relatedness and proximate cause. The underlying foundation for fairness is quality science to support decisions made by the legal system to provide the injured worker the appropriate treatment to restore their function and decrease their functional impairment and/or assist in determining appropriate proximate cause in personal injury cases.


Assuntos
Indenização aos Trabalhadores/legislação & jurisprudência , Humanos , Ferimentos e Lesões/etiologia
15.
Phys Med Rehabil Clin N Am ; 30(3): 657-669, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31227140

RESUMO

The concepts associated with work disability are not identical to those associated with medical disability. In addition to a worker's medical condition, the resultant functional limitations, and loss of participation in society, the injured or ill worker must often navigate a complex administrative system that often seems adversarial. This process is made less adversarial with the willingness to participate of knowledgeable clinicians. This article informs the interested clinician in regard to the unique aspects of work disability, including the issues of work accommodations, restrictions, and fitness for duty; prolonged work disability; and other return-to-work considerations at maximum medical improvement.


Assuntos
Pessoas com Deficiência/reabilitação , Retorno ao Trabalho , Ferimentos e Lesões/reabilitação , Humanos , Recuperação de Função Fisiológica , Avaliação da Capacidade de Trabalho , Indenização aos Trabalhadores , Ferimentos e Lesões/etiologia
17.
Phys Ther ; 99(2): 183-193, 2019 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-31222334

RESUMO

BACKGROUND: Patient/resident-handling tasks are physically demanding and associated with musculoskeletal disorders (MSDs) among nursing personnel. The routine performance of such tasks by physical therapists and occupational therapists during treatment can cause similar problems. OBJECTIVE: This study characterized the magnitude of MSDs and the risk factors for MSDs in physical therapists, occupational therapists, physical therapist assistants, and occupational therapist assistants (collectively called "therapy personnel" for this study) and compared them with those of other nursing home workers, especially nursing staff. DESIGN: This was a cross-sectional study. METHODS: Workers' compensation claim (WCC) data from 1 year of experience in a long-term care company were used to compute claim rates by body region, nature, and cause of injury, and the costs per case and per full-time-equivalent employee. Data regarding musculoskeletal symptoms, use of patient/resident-lifting equipment, and perceived physical and psychological job demands were obtained from a concurrent cross-sectional survey of workers from 24 long-term care facilities. RESULTS: About 80% of the WCCs were related to musculoskeletal incidents in nursing aides and therapy personnel. WCC costs paid per case for therapy personnel were more than twice those for nursing staff for both ergonomic and resident-handling incidents. Prevalence of low back pain in therapy personnel was the same as in nursing aides (48%) but involved more chronic, milder pain. About half of therapy personnel reported "never" or "rarely" using patient/resident-lifting equipment. Therapy personnel, nursing aides, and housekeeping/dietary/maintenance personnel reported the highest physical job demands. LIMITATIONS: Causal inference cannot be determined due to the cross-sectional nature of the survey data. Study findings are relevant only to therapy work in long-term care settings because exposures vary in other health care settings (hospitals, outpatient, and others). CONCLUSIONS: MSD prevalence and claim costs in therapy personnel are high enough to deserve more attention. The low use of patient/resident-lifting equipment in therapy could increase the risk for MSDs. Future studies with comprehensive ergonomic analysis of therapist tasks and recommendations to reduce injuries are warranted.


Assuntos
Doenças Musculoesqueléticas/economia , Doenças Profissionais/economia , Terapeutas Ocupacionais/estatística & dados numéricos , Assistentes de Fisioterapeutas/estatística & dados numéricos , Fisioterapeutas/estatística & dados numéricos , Indenização aos Trabalhadores/economia , Adulto , Estudos Transversais , Feminino , Humanos , Assistência de Longa Duração/economia , Masculino , Pessoa de Meia-Idade , Doenças Musculoesqueléticas/epidemiologia , Doenças Profissionais/epidemiologia , Exposição Ocupacional/economia , Fatores de Risco , Indenização aos Trabalhadores/estatística & dados numéricos , Carga de Trabalho/economia
18.
Spine (Phila Pa 1976) ; 44(13): 903-907, 2019 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-31205165

RESUMO

STUDY DESIGN: This study retrospectively analyzes prospectively collected data. OBJECTIVE: Here in this study we aim to determine the factors which impact a patient's ability to return to work (RTW) in the setting of cervical spine surgery in patients without worker's compensation status. SUMMARY OF BACKGROUND DATA: Surgical management of degenerative cervical disease has proven cost-effectiveness and shown significant improvement in quality of life. However, the ability to RTW is an important clinical outcome for preoperatively employed patients. METHODS: All adult patients undergoing elective surgery for cervical degenerative disease at our institution are enrolled in a prospective, web-based registry. A multivariable Cox proportional hazards regression model was built for time to RTW. The variables included in the model were age, sex, smoking status, occupation type, number of levels operated on, ASA grade, body mass index, history of diabetes, history of coronary artery disease (CAD), history of chronic obstructive pulmonary disease (COPD), anxiety, depression, myelopathy at presentation, duration of symptoms more than 12 months, diagnosis, type of surgery performed, and preoperative Neck Disability Index, EuroQol Five Dimensions, and Numeric Rating Scale pain scores for neck pain and arm pain scores. RESULTS: Of the total 324 patients with complete 3-month follow-up data 83% (n = 269) returned to work following surgery. The median time to RTW was 35 days (range, 2-90 d). Patients with a labor-intensive occupation, higher ASA grade, history of CAD, and history of COPD were less likely to RTW. The likelihood of RTW was lower in patients with a diagnosis of disc herniation compared with cervical stenosis, patients undergoing cervical corpectomy compared laminectomy and fusion and patient with longer operative time. CONCLUSION: Our study identifies the various factors associated with a lower likelihood of RTW at 3 months after cervical spine surgery in the non-worker's compensation setting. This information provides expectations for the patient and employer when undergoing cervical spine surgery. LEVEL OF EVIDENCE: 3.


Assuntos
Vértebras Cervicais/cirurgia , Procedimentos Cirúrgicos Eletivos/tendências , Degeneração do Disco Intervertebral/cirurgia , Deslocamento do Disco Intervertebral/cirurgia , Retorno ao Trabalho/tendências , Indenização aos Trabalhadores/tendências , Adulto , Idoso , Procedimentos Cirúrgicos Eletivos/psicologia , Feminino , Seguimentos , Humanos , Degeneração do Disco Intervertebral/epidemiologia , Degeneração do Disco Intervertebral/psicologia , Deslocamento do Disco Intervertebral/epidemiologia , Deslocamento do Disco Intervertebral/psicologia , Masculino , Pessoa de Meia-Idade , Cervicalgia/epidemiologia , Cervicalgia/psicologia , Cervicalgia/cirurgia , Estudos Prospectivos , Qualidade de Vida/psicologia , Sistema de Registros , Estudos Retrospectivos , Retorno ao Trabalho/psicologia , Fusão Vertebral/psicologia , Fusão Vertebral/tendências , Estenose Espinal/epidemiologia , Estenose Espinal/psicologia , Estenose Espinal/cirurgia , Resultado do Tratamento
19.
Work ; 62(4): 629-641, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31104046

RESUMO

BACKGROUND: A conceptual framework is needed to understand injured workers' decision-making and inform evidence-based interventions to address behavior change regarding return-to-work (RTW). The Model of Human Occupation (MOHO) can help with understanding how an injured worker's characteristics can generate behavior change while Motivational Interviewing (MI) can help facilitate behavior change. OBJECTIVE: This theoretical paper provides an overview of how MOHO and MI can be applied and integrated in occupational rehabilitation. The objectives of this paper are to: (1) evaluate MOHO as a framework for supporting occupational therapists (OTs) in occupational rehabilitation; (2) describe MI as a suitable approach for OTs in occupational rehabilitation; and (3) compare and integrate MOHO and MI. METHOD: Several important works and reviews were used to integrate MOHO and MI with occupational rehabilitation. IMPLICATIONS FOR PRACTICE: The identification of a model and approach to support OT practice in occupational rehabilitation can assist OTs to determine the most appropriate interventions and contribute to standards of best practice. CONCLUSIONS: Integrating MOHO and MI provides a comprehensive framework for understanding impairment and RTW change processes with the potential to reduce work disability and improve RTW outcomes.


Assuntos
Entrevista Motivacional/métodos , Reabilitação Vocacional/métodos , Retorno ao Trabalho/psicologia , Humanos , Entrevista Motivacional/normas , Traumatismos Ocupacionais/complicações , Traumatismos Ocupacionais/psicologia , Terapia Ocupacional/métodos , Reabilitação Vocacional/normas , Indenização aos Trabalhadores/estatística & dados numéricos
20.
Occup Environ Med ; 76(7): 471-478, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31126965

RESUMO

INTRODUCTION: Workplace violence carries a substantial economic loss burden. Up to 10% of all traumatic brain injury (TBI) admissions result from physical assault. There remains a paucity of research on assault as a mechanism of injury, taking into account sex, and its association with work re-entry. OBJECTIVES: The aim of this study was to characterise, by sex, the sample of workers who had sustained a work-related mild TBI (wr-mTBI) and to assess the independent influence of assault, as a mechanism of injury, on time away from work. METHODS: A population-based retrospective cohort of workers' compensation claimants in Australia (n=3129) who had sustained a wr-mTBI was used for this study. A multivariable logistic regression analysis assessed whether workers who had sustained wr-mTBI as a result of assault (wr-mTBI-assault) were more likely to claim time off work compared with workers who had sustained a wr-mTBI due to other mechanisms. RESULTS: Among claimants who sustained a wr-mTBI, 9% were as a result of assault. The distribution of demographic and vocational variables differed between the wr-mTBI-assault, and not due to assault, both in the full sample, and separately for men and women. After controlling for potential confounding factors, workers who sustained wr-mTBI-assault, compared with other mechanisms, were more likely to take days off work (OR 2.14, 95% CI 1.53 to 2.99) within a 3-month timeframe. CONCLUSION: The results have policy-related implications. Sex-specific and workplace-specific prevention strategies need to be considered and provisions to support return-to-work and well-being within this vulnerable cohort should be examined.


Assuntos
Lesões Encefálicas Traumáticas/epidemiologia , Traumatismos Ocupacionais/epidemiologia , Indenização aos Trabalhadores/estatística & dados numéricos , Violência no Trabalho , Adolescente , Adulto , Austrália/epidemiologia , Lesões Encefálicas Traumáticas/etiologia , Estudos de Coortes , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Traumatismos Ocupacionais/etiologia , Estudos Retrospectivos , Retorno ao Trabalho/estatística & dados numéricos , Fatores Sexuais
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