Wellbeing After Finalization of a Workers' Compensation Claim: A Systematic Scoping Review.

OBJECTIVE: A workers' compensation claim may have significant negative impacts on an injured worker's wellbeing. Wellbeing provides a good global measure of potential effects of a claim on an individual, and is important for contemporary economic modelling. The purpose of this study was to synthesize knowledge about the wellbeing of injured workers after the finalization of a workers' compensation claim and identify gaps in the current literature. METHODS: A systematic scoping review was conducted. RESULTS: 71 full-text articles were screened for inclusion, with 32 articles eligible for this review. None of the included articles evaluated overall wellbeing. Included articles did evaluate a variety of constructs inherent in wellbeing. Injured workers were generally disadvantaged in some manner following claim finalization. The literature recommends a focus on reducing negative impacts on injured workers after finalization of a compensation claim, with a need for regulatory bodies to review policy in this area. CONCLUSION: There appears to be potential for ongoing burden for individuals, employers, and society after finalization of a workers' compensation claim. A gap in knowledge exists regarding the specific evaluation of wellbeing of injured workers following finalization of a workers' compensation claim.

Rejection of workers' compensation claims may increase depressive symptoms among firefighters with occupational injury: a nationwide study in South Korea.

OBJECTIVES: This study sought to examine whether the experience of occupational injuries was associated with depressive symptoms and whether the rejection of workers' compensation claims was associated with depressive symptoms among Korean firefighters. METHODS: We conducted a nationwide survey of 6793 Korean firefighters in 2015. Based on the experience of occupational injuries and workers' compensation claims over the past year, respondents were classified into four groups: "Not injured", "Injured, not applied", "Injured, applied, but rejected" and "Injured, applied, and accepted." Depressive symptoms over the preceding week were assessed using the 11-item version of the Centers for Epidemiologic Studies Depression Scale. RESULTS: Compared to firefighters who did not get injured, injured firefighters had a higher prevalence of depressive symptoms (PR 2.01, 95% CI 1.83, 2.22) after controlling for confounders including job assignment. Also, when we restricted the analysis to injured firefighters, a higher prevalence of depressive symptoms was observed among "Injured, applied, but rejected" (PR 1.70, 95% CI 1.11, 2.59) group, compared to "Injured, applied, and accepted" group. CONCLUSIONS: This finding suggests that rejection of workers' compensation claims, as well as the experience of occupational injuries, may increase the risk of depressive symptoms among Korean firefighters.

Sitting Posture During Occupational Driving Causes Low Back Pain; Evidence-Based Position or Dogma? A Systematic Review.

OBJECTIVE: In this review, we determine if there is evidence to demonstrate a relationship between occupational driving posture and low back pain. BACKGROUND: The burden of low back pain is increasing. An understanding of this relationship is required to enable the development of recommendations for clinicians and policy-makers for the driving industry. METHOD: Five databases were searched up to March 12, 2018. Study quality was assessed using the National Heart, Lung, and Blood Institute's Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies, followed by a GRADE analysis to consider the evidence as a whole. A narrative, critical synthesis was completed that considered the methods by which driving posture and low back pain were measured and analyzed. RESULTS: There were 653 articles identified, with seven eligible for review. Four articles identified an association between occupational driving posture and low back pain, yet this was based on the use of measurement tools lacking validity. Although a relationship may exist, the specific driving postures associated with low back pain and the strength of this relationship have not been confirmed. CONCLUSION: Future research needs to employ validated and reliable, real-time qualitative methods for measuring occupational driving posture to advance our understanding of this relationship. APPLICATION: Clinical and policy recommendations regarding driving posture and low back pain should be used with caution, as they are guided by evidence incorporating bias. Future studies are required to confirm the specific postures assumed while occupational driving and their relationship with low back pain, before recommendations can be made.

Quantitative Risk Assessment of Seafarers' Nonfatal Injuries Due to Occupational Accidents Based on Bayesian Network Modeling.

Reducing the incidence of seafarers' workplace injuries is of great importance to shipping and ship management companies. The objective of this study is to identify the important influencing factors and to build a quantitative model for the injury risk analysis aboard ships, so as to provide a decision support framework for effective injury prevention and management. Most of the previous research on seafarers' occupational accidents either adopts a qualitative approach or applies simple descriptive statistics for analyses. In this study, the advanced method of a Bayesian network (BN) is used for the predictive modeling of seafarer injuries for its interpretative power as well as predictive capacity. The modeling is data driven and based on an extensive empirical survey to collect data on seafarers' working practice and their injury records during the latest tour of duty, which could overcome the limitation of historical injury databases that mostly contain only data about the injured group instead of the entire population. Using the survey data, a BN model was developed consisting of nine major variables, including "PPE availability," "Age," and "Experience" of the seafarers, which were identified to be the most influential risk factors. The model was validated further with several tests through sensitivity analyses and logical axiom test. Finally, implementation of the result toward decision support for safety management in the global shipping industry was discussed.

Factors Associated with Employer Support for Injured Workers During a Workers' Compensation Claim.

Purpose The employer/worker relationship can be an important catalyst for-or obstacle to-successful return to work (RTW). An understanding of factors associated with an injured worker's relationship with their employer, and employer involvement in RTW planning, is warranted. Methods Analysis of n = 8808 cross-sectional survey responses from injured workers in nine Australian workers' compensation (WC) jurisdictions. Workers completed a telephone survey between 6 and 24 months post-WC claim acceptance. Factors associated with the worker's perception of employer support were examined using ordinal regression. Factors associated with employer provision of RTW plans were examined using logistic regression. Results Factors associated with employer support included being aged over 50 years, not having a mental health condition, better self-rated health and less time between injury and claim. Factors associated with having a RTW plan included being female, not having a mental health condition and working for a self-insurer. Factors associated with having a written RTW plan included being female and being under 50 years. There was wide variation in the provision of RTW plans between WC jurisdictions. Conclusions There are strong associations between worker, claim and injury-related factors and the injured worker's experience of employer support. Identification of workers at risk of receiving inadequate support during the RTW process may enable interventions to improve support and RTW outcomes.

The impact of opioid prescription dose and duration during a workers compensation claim, on post-claim continued opioid use: A retrospective population-based study.

BACKGROUND: Workers Compensation Board (WCB) recipients are a group commonly prescribed opioids. METHODS: We explored factors influencing post-claim opioid dose and duration by linking data from 22,451 claims with the Manitoba Center for Population Health registry. RESULTS: On average, the WCB paid for 94.55% of opioids prescribed during a claim. The amount paid for by the WCB varied significantly by total opioids prescribed. The main predictors of high opioid dosage (120 + morphine equivalents (ME)/day) during the first year post-claim (logistic regression), and of longer post-claim opioid usage (survival analysis), included opioid dosage during the final month of the claim both paid for and not paid for by the WCB. CONCLUSIONS: Amongst low dose opioid claims, the WCB covers most opioids prescribed. Higher opioid dose WCB recipients are often prescribed opioids not covered by the WCB. Both opioids paid for and not paid for by the WCB are associated with post-claim opioid use.

Workplace injury data reported by occupational physicians and general practitioners.

BACKGROUND: Accurate workplace injury data are useful in the prioritization of prevention strategies. In the UK, physicians report workplace ill-health data within The Health and Occupation Research (THOR) network, including injury case reports. AIMS: To compare workplace injury data reported by occupational physicians (OPs) and general practitioners (GPs) to THOR. METHODS: Injury cases reported by OPs and GPs, reported to THOR between 2006 and 2012 were analysed. Demographics, industrial groups, nature of injury, kind of accident and site of injury were compared. Data on sickness absence for workplace injuries reported by GPs were investigated. RESULTS: In total, 2017 workplace injury cases were reported by OPs and GPs. Males were more likely to sustain a workplace accident than females. Sprains and strains were reported most often, with the upper limbs being affected most frequently. Slips, trips and falls were identified as important causal factors by both OPs and GPs. Psychological injuries also featured in THOR reporting, with a higher proportion reported by OPs (21%) than by GPs (3%). The proportion of people classified as 'unfit' by GPs reduced following the introduction of the 'fit' note. CONCLUSIONS: THOR reports returned by OPs and GPs provide a valuable source of information of workplace injury data, and complement other sources of information, such as the Reporting of Injuries, Diseases and Dangerous Occurrences Regulations and the Labour Force Survey.

Musculoskeletal occupational injury among surgeons: effects for patients, providers, and institutions.

BACKGROUND: The aim of this study was to determine the risk of occupational musculoskeletal injury during a surgeon's career and the effects of these injuries for patients, providers, and institutions. We hypothesized that surgeons have occupational injuries, which affect work performance. MATERIALS AND METHODS: Electronic RedCAP surveys on workplace injury were distributed statewide via e-mail to the members of the Tennessee chapter of the American College of Surgeons. Descriptive statistics were used to analyze survey data. RESULTS: A total of 260 of 793 surveys (33%) were returned. Forty percent of surgeons sustained ≥ 1 injuries in the workplace. Although 50% of injured surgeons received medical care for their most recent injuries, only 20% of these injuries were reported to their institution. Twenty-two percent of injured surgeons missed work and 35% performed fewer operations while they were recovering from their injury. Fifty-three percent of injured surgeons reported that pain from their injury had a minimal or moderate effect on their performance in the operating room. CONCLUSIONS: Surgeons appear to be at moderate risk for occupation-related injuries. The low rate of institutional reporting for these injuries is concerning, as this is a required step to access institutional support once injured. Surgeon injury results in lost productivity due to missed workdays and may impact the quality of surgical care because of performance issues while recovering from injury.

Prescription opioids for occupational injury: results from workers' compensation claims records.

OBJECTIVE: The objective of this study is to identify the prevalence of opioid prescription use in an Australian workers' compensation population and assess predictors of long-term use. DESIGN: Retrospective administrative data analysis. SETTING: WorkSafe Victoria (Australia) workers' compensation. SUBJECTS: Workers with a workers' compensation claim were included if the injury/illness started in 2008 or 2009 (N = 54,931). METHODS: Claim payments records dating up to 2 years postinjury were analyzed to determine receipt of prescription opioids. Long-term use was defined as use of any opioid beyond 1 year postinjury. RESULTS: Within the follow-up period, 8,933 (16.3%) workers claimed prescription opioids: 10.0% claimed opioids in the first year only, and 6.3% claimed opioids beyond the first year. The most commonly received opioids were codeine (10.4%), oxycodone (7.5%), and tramadol (5.0%). Dextropropoxyphene, which is considered unsafe in many countries because of potentially fatal side effects, was used by 1.9% of injured workers. Progression to long-term use of opioids was common (N = 3,446; 39%): age (35-64 years; the association with age followed an inverse U-shaped curve), women, laborers, lower socioeconomic status, greater work disability, and greater hospital expense were associated with opioid use beyond the first year postinjury. CONCLUSION: Prescription opioid use for workplace injury in Australia is common but not as common as reports from U.S. workers' compensation schemes. The type of opioid and number of repeat prescriptions are factors that should be carefully considered by practitioners prescribing opioids to injured workers: progression to long-term use is common and not fully explained by injury severity.

Workers' compensation injuries in aviation manufacturing in the state of Kansas, 2014-2022.

INTRODUCTION: Workers' compensation injuries entail burdensome financial and social costs. This study's objective was to describe cost and frequency of workplace injuries in aviation manufacturing in the state of Kansas using workers' compensation data. Manufacturing incurs more workers' compensation claims in Kansas than any other industry, and aviation contributes more of those claims than any other sub sector. METHOD: Workers' compensation insurance and reporting are required in the state of Kansas. Data were provided by the Kansas Department of Labor (KDOL) and included all closed workers' compensation claims entailing indemnity and medical costs filed in the state from 2014 to 2022. Cost of claim data were normalized to 2022 U.S. dollars and data were analyzed as a function of percentage and claim cost by body part, type of injury, cause of injury, specific musculoskeletal disorder type, and as a function of age and gender injury rates. RESULTS: Aviation claims entailed a median total cost of $26,941 and represented 8% of all closed claims filed in the state from 2014 to 2022. The grand total direct cost over the nine-year period was $75,404,147. Medical costs comprised 48.6% of all costs, indemnity 45.0%, and legal 6.4%. The most frequently injured body part was the hand/wrist (35.9%) followed by the shoulder (20.6%), and the most expensive body parts were related to the back. Overexertion (38.6%) was the most common cause followed by repetitive motion (22.8%). Work-related musculoskeletal disorders were the most common type accounting for 67.4% of all claims. Men and workers aged 55-64 incurred slightly higher claim rates than average. A sharp decrease in number of claims closed in 2021 coincided with production shutdowns the previous year related to the Covid-19 pandemic and design issues. CONCLUSIONS: Aviation manufacturing is a key industry in Kansas and this study is the first known to describe costs and frequencies of workplace injuries in the sector using workers' compensation data. PRACTICAL APPLICATIONS: This guide to the most problematic and costly injuries in aviation manufacturing helps practitioners prioritize prevention strategies to most effectively reduce workplace injury and helps safety and health practitioners in prioritizing prevention efforts to reduce the most severe and costly aviation manufacturing injuries and illnesses. It also brings attention to some special considerations when working with safety data from 2020 to 2022 related to the Covid-19 pandemic.

Laparoscopic Repair of Colorectal Perforations Induced by Compressed Air Pressure: A Case Report.

A compressed air nozzle has the potential to result in lethal injuries when handled inappropriately. Owing to the rarity of colorectal perforations due to barotrauma, no clear pathway to managing them has been established. We report an incident of a 33-year-old male patient who presented with tension pneumoperitoneum due to rectosigmoid perforations after being subjected to transanal compressed air insult. An emergency laparoscopic exploration with primary repair of the rectal perforation and Hartmann procedure were performed resulting in a smooth postoperative course. We hereby conclude that laparoscopy is a safe and effective approach associated with faster recovery and fewer adverse events.

Data Driven Identification of Injury Risk Factors During Expansion on Irish Dairy Farms.

OBJECTIVES: This paper sought to determine risk factors of occupational injury in the Irish dairy farming sector and to estimate the roles of both dairying expansion and the discipline of agricultural extension in influencing reducing injury occurrence. METHODS: Data for this study was obtained via the Irish National Farm Survey (NFS). In total, 260 farm (83.6% of NFS dairy farm sample) workplace injury survey questionnaires were completed by NFS recorders by interviewing principal farm operators for year 2017. Injury survey data was analysed for 48 variables in conjunction with NFS core farm socio-economic, physical and financial data. Additionally, core data from 2010 for 78.5% of farms surveyed in 2017 was included in the study. Data were analysed using a three-step statistical testing process which met all Binary Logistic Regression assumptions. RESULTS: The study found that dairy farms had a higher farm workplace occupational injury level compared to a previous study. The study data indicates occurrence of elevated injury levels on farms which expanded and which were intensively managed from a milk production perspective. Farm expansion was associated with increased labor units used and increased investment per hectare. The study also found that use of extension services and farm discussion group participation were not associated with injury occurrence. CONCLUSIONS: This study demonstrates how a retrospective farm workplace occupational injury survey of Irish dairy farms, analysed in combination with farm business data can be used to identify injury risk factors, including those associated with production expansion. Irish dairy farms have a heightened farm workplace occupation injury level while dairy production expansion increased injury levels. Extension engagement did not influence on injury levels. Approaches to improve farm safety on dairy farms are outlined.

Injured worker participation in assessment during the acute phase of workers compensation rehabilitation: a scoping review.

PURPOSE: Rates of return to work (RTW) are declining in the Australian workers compensation system alongside significant economic and social costs, disputes, and secondary psychological injury. Non-medical assessment of workplace injuries now considers psychosocial and workplace factors, and worker participation in the assessment process is limited. This scoping review examines studies regarding non-medical assessment during the acute phase of rehabilitation in terms of costs, disputes, secondary psychological injury, and worker participation. METHOD: An electronic and manual search of relevant articles across four databases was conducted using PRISMA guidelines, followed by quality assessment. RESULTS: Of the 1,630 studies retrieved, 12 met the inclusion criteria with most focused on assessment for risk of obstructed or delayed RTW. CONCLUSIONS: Non-medical assessment in the acute stage of rehabilitation identifies risk for delayed or complicated RTW, overlooking potential for the process of assessment to contribute to disputes and development of secondary psychological injury. Doubt around the capacity of workers to participate objectively in assessment persists. These are aspects of assessment worthy of further exploration for their impact on RTW outcomes.

Early assessment of injured workers is a key aspect of the rehabilitation process and there have been calls for greater injured worker involvement in their rehabilitation.Rehabilitation professionals should consider an injured worker's phase of disability when conducting assessment for support needs.Consideration of psychological vulnerabilities of injured workers should be incorporated into assessment of support needs.Rehabilitation professionals should seek out ways to increase participation of injured workers in assessment of their support needs.

Improving Surgeon Well-Being: Ergonomics in Neurosurgery.

BACKGROUND: Musculoskeletal disorders are common among surgeons, and affect most neurosurgeons over the course of their career. Although all subspecialist neurosurgeons may be affected by physical strain, spine surgeons and skull base surgeons have a high propensity for workplace injury as a result of long procedures with repetitive movements in strained physical positions. METHODS: In this review, the prevalence of musculoskeletal disorders in neurosurgery, the state of innovation to improve ergonomics in the operating room for neurosurgeons, and potential limitations in advancing technology with the goal of maximizing neurosurgeon longevity are discussed. RESULTS: Innovations such as robotics, the exoscope, and handheld devices with more degrees of freedom have allowed surgeons to maneuver instruments without exerting excessive effort, all while maintaining neutral body positioning, avoiding joint and muscle strain. CONCLUSIONS: As new technology and innovation in the operating room develop, there has been a larger emphasis placed on maximizing surgeon comfort and neutral positioning, by minimizing force exertion and fatigue.

A Multicenter Study Investigating the Surgeon Experience with a Robotic-Assisted Exoscope as Part of the Neurosurgical Armamentarium.

BACKGROUND: Improvement of visualization tools in neurosurgery such as the exoscope has raised the question of how this technology compares to the conventional microscope for surgeon ergonomics, discomfort, and patient outcomes. Exoscopes have the advantage of greater optical zoom, resolution, and illumination at a lower light intensity. Heads-up display for both the primary surgeon and other assistants permits neutral positioning of the surgeons while placing the camera in more angled positions. In a survey sample, this study assesses the surgeon experience utilizing 3D exoscope in general neurosurgery cases. METHODS: Data weere recorded by 8 surgeons at 5 separate hospitals utilizing a mobile phone application survey. Surgeons recorded information about case type, intraoperative clinical outcomes such as blood loss and extent of resection, whether fluorescence visualization was used, as well as surgeon pain when compared to matched cases using conventional tools. RESULTS: A total of 155 neurosurgical cases were recorded in this multisite study, including 72% cranial cases and 28% spinal cases. Of the cranial cases, 76% were brain tumor resections (31% of which were brain metastases). Surgeons reported significantly less neck (P < 0.0001) and back (P < 0.0001) pain in cases when using the robotic exoscope compared with the conventional microscope or surgical loupes. Surgeons did not convert to a microscope in any case. CONCLUSIONS: The exoscope provides excellent delineation of tissue with high resolution. Surgeon pain was markedly reduced with the robotic exoscope when compared with conventional technology, which may reduce work-related injury and fatigue, potentially leading to better patient outcomes.

Common Pediatric Otolaryngology Procedures: Ergonomic Considerations.

Background Otolaryngologists in high-volume children's hospitals developed their operating room workflow practices based on the factors of safety, efficiency, and surgeon preference. Recent data show important benefits and potential reduced risks of proper ergonomic positioning for surgeons to prevent injury. These data suggest that the current operating room workflow practices, in addition to prior training, should be monitored and hopefully improved for surgeons' health. Surprisingly, recent studies have suggested the benefits of standing versus sitting on cognitive function. Objective This study reports the workflow norms for seven operating procedures in pediatric otolaryngology. We seek to identify 1) surgeon preferences, 2) when practices become norms, and 3) whether procedure positions are associated with surgeon discomfort or injury. Methods The Otolaryngology Section of the American Academy of Pediatrics was queried employing a 23-question survey. We included demographic information, reasons for preferences, and surgeon-reported pain. We focused on three workflow issues: 1) length of procedures, 2) site selection (operating room bed vs. transport stretcher), and 3) position of the surgeon (sitting vs. standing). Results Sixty-nine American Academy of Pediatrics members completed the survey. The length of the procedure had minimal effect, with 90% sitting for short procedures such as bilateral myringotomy with tubes, myringoplasty, tonsillectomy, and adenoidectomy. All sit for direct laryngoscopy and bronchoscopy. Most stand for the removal of nasal foreign bodies, drainage of neck abscess procedures, and thyroglossal duct cyst excision. Residency training (75%) and personal comfort (81%) were the more frequently cited reasons for preference. Fewer than one in five (16%) reported preexisting neck or back pain, but this doubled (35%) throughout their otolaryngology practice. Conditional distributions of pain showed reports of pain were greater for individuals in practice for over 20 years. Conclusions Pediatric otolaryngologists develop their operating room preferences early during residency training. High rates of neck and back pain (35%) may develop during a surgeon's career. We suggest improved understanding of ergonomics in concert with operating room workflow should be considered during otolaryngology residency training since recent data suggest potential benefits of standing on cognitive function.

Levels of Aggression Escalation in Adult/Geriatric Occupational Therapy Workplaces.

Workplace aggression can escalate from verbal to physical, adding risk of physical injury to negative psychological impact. Understanding escalation is necessary to develop effective violence intervention/prevention programs, but its occurrence is not well documented. An online survey determined if and how aggression escalates in occupational therapy (OT) workplaces. Because local culture can influence workplace events we compared surveys from northeastern states with the lowest rates of homicide to southeastern states with the highest. Ninety four OTs working in southeastern or northeastern states reported details of the most recent verbal and/or physical aggressive event initiated by clients (NIOSH Type 2) or staff (NIOSH Type 3) they witnessed or experienced in the workplace within the last year. Aggressor status, motivation, actions; therapist reactions, injuries and psychological sequelae were queried in logical order. Behavior inter-correlation followed by cluster analysis determined if levels of escalation could be detected. Analyses grouped events into five escalation levels in which progressively more hostile or damaging behaviors were added at each successive level. Higher levels involved known risk factors: Younger, reactively angry clients with prior aggression histories escalated attacks to involve restraint, calls for help and physical injury. Southeastern aggressor/target interactions appeared more combative, seemingly regardless of personal risk. Remarkably, northeastern OTs reported significantly more positive and fewer negative feelings across levels of escalation. OT workplace aggression occurs frequently, can escalate to injurious levels and requires prevention/intervention. How therapists maintain positive attitudes in the face of violence deserves further study.

A Systematic Review on Lower-Limb Industrial Exoskeletons: Evaluation Methods, Evidence, and Future Directions.

Industrial tasks that involve frequent sitting/standing transitions and squatting activities can benefit from lower-limb industrial exoskeletons; however, their use is not as widespread as their upper-body counterparts. In this review, we examined 23 articles that evaluated the effects of using Wearable Chair (WC) and Squat-assist (SA) exoskeletons. Evaluations mainly included assessment of muscular demands in the thigh, shank, and upper/lower back regions. Both types of devices were found to lessen muscular demands in the lower body by 30-90%. WCs also reduced low-back demands (~ 37%) and plantar pressure (54-80%) but caused discomfort/unsafe feeling in participants. To generalize outcomes, we suggest standardizing approaches used for evaluating the devices. Along with addressing low adoption through design upgrades (e.g., ground and body supports/attachments), we recommend that researchers thoroughly evaluate temporal effects on muscle fatigue, metabolic rate, and stability of wearers. Although lower-limb exoskeletons were found to be beneficial, discrepancies in experimental protocols (posture/task/measures) were discovered. We also suggest simulating more realistic conditions, such as walking/sitting interchangeability for WCs and lifting loads for SA devices. The presented outcomes could help improve the design/evaluation approaches, and implementation of lower limb wearable devices across industries.

How Do We Keep our Heads above Water? An Embedded Mixed-Methods Study Exploring Implementation of a Workplace Reintegration Program for Nurses Affected by Operational Stress Injury.

BACKGROUND: Nurses are exposed to potentially psychologically traumatic events which can lead to operational stress injuries (OSI). Workplace reintegration after an OSI can be challenging, especially with repeated exposure to potentially traumatic scenarios and workplace demands. A workplace reintegration program (RP) originally developed for police officers may be of benefit for nurses returning to work after an OSI. The purpose of this study is to investigate the perceived need for an RP for nurses, and its potential contextualization and implementation in the nursing context using an implementation science approach. METHODS: This mixed-methods study collected data via questionnaires and focus groups from acute care nurses in Canada (N = 19). Data analysis was conducted using descriptive statistics, thematic analysis, and an organizational readiness assessment. RESULTS: Study participants indicated that formalized processes were rarely used to support nurses returning to work after time off due to mental health challenges. Themes included (1) "The Perfect Storm": the current state of return-to-work, (2) Integral Needs, and (3) A Break in the Clouds: hope for health. CONCLUSIONS: Exploration of innovative programs such as the RP may provide additional support to nurses affected by OSIs. Further research is needed regarding workplace reintegration for nurses, and contextualization and evaluation of the RP.

Workplace-related musculoskeletal injury trends in the United States from 1992 to 2018.

INTRODUCTION: The purpose of our study is to assess workplace-related musculoskeletal (wrMSK) injury trends by utilizing Bureau of Labor Statistics (BLS) data. We hypothesize that trunk injuries are the most commonly reported, injuries occur most frequently in the manufacturing sector, and that injury type occurrence differs according to body region affected. METHODS: This study assessed wrMSK injury data provided by the BLS from 1992 to 2018. The three main body regions analyzed were lower extremity (LE), upper extremity (UE), and trunk. Injury data was also assessed by industrial sector (Agriculture, Manufacturing, Healthcare, and Construction) and injury type (fractures, multiple injuries, sprains/strains/tears, tendonitis, cuts/lacerations, pain/soreness, and bruises). Negative binomial regression and pairwise comparisons with a Benjamini-Hochberg adjustment were utilized to compare calculated incidence rate ratios for wrMSK injuries. Exponentiated beta estimates were used to calculate the estimated annual percent changes of wrMSK injuries within each industrial sector. RESULTS: Occurrence of wrMSK injuries from 1992 to 2018 was significantly lower for LE when compared to both upper extremity and trunk (p < 0.001). Manufacturing is shown to be the industry with the most wrMSK injuries in each of UE, LE, and trunk. wrMSK injuries were shown to decrease in each industrial sector over the timespan assessed, with the greatest percent change occurring in the manufacturing sector. Lacerations and tendonitis were the most common diagnosis types in UE, while pain/soreness and strains/sprains/tears were most common in trunk and bruises were most common in LE. DISCUSSION: From 1992 to 2018, trunk injuries were the most frequently occurring wrMSK injury, but not to a significantly higher degree than upper extremity injuries. wrMSK injury types that may require orthopedic surgical care affect specific body regions to different degrees, with cuts/lacerations and tendonitis most commonly affecting the upper extremity. Thus, it appears that wrMSK injuries in the upper extremity are of particular importance from an orthopedic care perspective.