Cause Of Work Disability Research Articles

Osteoarthritis: Epidemiology

Osteoarthritis (OA) is the most common joint disorder in the world. In Western populations it is one of the most frequent causes of pain, loss of function and disability in adults. Radiographic evidence of OA occurs in the majority of people by 65 years of age and in about 80% of those aged over 75 years. In the US it is second only to ischaemic heart disease as a cause of work disability in men over 50 years of age, and accounts for more hospitalizations than rheumatoid arthritis (RA) each year. Despite this public health impact, OA remains an enigmatic condition to the epidemiologist. In this chapter, we will review the definition and classification of OA, its prevalence, incidence, risk factors and natural history.

A Health System Program To Reduce Work Disability Related to Musculoskeletal Disorders

Musculoskeletal disorders (MSDs) are a frequent cause of work disability, accounting for productivity losses in industrialized societies equivalent to 1.3% of the U.S. gross national product. To evaluate whether a population-based clinical program offered to patients with recent-onset work disability caused by MSDs is cost-effective. Randomized, controlled intervention study. The inclusion and follow-up periods each lasted 12 months. Three health districts in Madrid, Spain. All patients with MSD-related temporary work disability in 1998 and 1999. The control group received standard primary care management, with referral to specialized care if needed. The intervention group received a specific program, administered by rheumatologists, in which care was delivered during regular visits and included 3 main elements: education, protocol-based clinical management, and administrative duties. Efficacy variables were 1) days of temporary work disability and 2) number of patients with permanent work disability. All analyses were done on an intention-to-treat basis. 1,077 patients were included in the study, 7805 in the control group and 5272 in the intervention group, generating 16,297 episodes of MSD-related temporary work disability. These episodes were shorter in the intervention group than in the control group (mean, 26 days compared with 41 days; P < 0.001), and the groups had similar numbers of episodes per patient. Fewer patients received long-term disability compensation in the intervention group (n = 38 [0.7%]) than in the control group (n = 99 [1.3%]) (P < 0.005). Direct and indirect costs were lower in the intervention group than in the control group. To save 1 day of temporary work disability, 6.00 dollars had to be invested in the program. Each dollar invested generated a benefit of 11.00 dollars. The program's net benefit was in excess of 5 million dollars. The study was unblinded. Implementation of the program, offered to the general population, improves short- and long-term work disability outcomes and is cost-effective.

Prudence, Nihilism, and the Treatment of Low-Back Pain

ow back pain is common in the population and in the healthcare provider's office. The lifetime prevalence of episodes of low-back pain may be as high as 80%, and about 11% of the population has an episode of back pain bad enough to impair their usual daily activities during the course of a year.1 Acute back pain has a generally good prognosisover 90% of patients functionally recover-but in an unfortunate minority of patients the acute process becomes chronic.2 Chronic back pain, once established, has a generally poor prognosis with many patients having ongoing symptoms for months or years. Back pain remains a common cause of work disability with enormous social costs to employers, insurers, and families. The identification of an appropriate treatment approach would substantially aid providers, insurers, and the public. The lack of consistent treatment outcome information has led to claims by various provider groups that one approach or the other is preferred over all other approaches. Over the past decade multiple cohort studies and trials have been conducted. While health policy can generally not be established on the basis of any single study, accumulating evidence in studies from both the US and Europe can now begin to guide providers and the public. The article by Kominski and colleagues in this issue of Medical Care3 compares treatment costs in a highly managed care setting across 4 treatment approaches: MD only; MD plus referral to a physical therapist (PT); chiropractic only; and chiropractic also utilizing physical modalities. The patient population was quite heterogeneoussome of the patients had very acute back pain; others had symptoms for years. The almost entirely capitated nature of the insurance in this population would likely tend to dampen differences in the number of visits across groups; the providers had no incentive to over-use visits. Indeed, the number of visits to physical therapists and doctors of chiropractic is substantially less than reported in other cohort studies, such as that conducted by our group in North Carolina just a few years prior to data collection in Kominski's study. Therefore, the differences between specialties noted here are likely relatively conservative compared with the fee-for-service environment. We are told relatively little about the costs of imaging these patients. Spinal radiographs, CT, and MRI scans may be a substantial portion of the cost differential across specialties. Indirect costs of transportation and time off work were also not assessed. European studies have found that inclusion of these costs may modestly alter conclusions. Korthals de Bos, in a study of the care of neck pain, found that at one year direct costs were less and indirect costs were greater for individuals who received care from a general practitioner (GP) relative to a PT, with total costs similar between GP and PT. A manual therapy strategy was overall less costly.4 A final, acknowledged, limitation is that the investigators did not collect medication costs. Medication costs would modestly increase the costs of those who saw MDs as opposed to Doctors of Chiropractic (DC). Our work

Biological approach for treatment of degenerative disc diseases

Intervertebral disc degeneration and associated spinal disorders including low back pain are a leading source of morbidity and a major cause of work disability as well as increased health care costs. Recent advance of molecular biology enable us to utilize these new techniques for understanding disc cell function and mechanisms of disc degeneration. Furthermore, these new technology may open novel therapeutic strategy such as application of growth factors, stem cell therapy, and gene therapy to regenerate degenerated intervertebral discs.

Musculoskeletal disorders: primary and secondary interventions

In the United States alone, the annual cost associated with the diagnosis and care of musculoskeletal trauma amounts to tens of billions of dollars [Occupational Musculoskeletal Disorders: Function, Outcomes and Evidence. Lippincott Williams and Wilkins, Philadelphia]. Moreover, these costs are continuing to increase at an alarming rate. In fact, in the United States today, occupational musculoskeletal disorders are the leading causes of work disability. Changes in health care policy and demand for improved allocation of health care resources by the Federal government have also recently placed greater pressure on health care professionals to provide the most cost-effective treatment for these disorders, as well as to validate treatment effectiveness. Indeed, treatment-outcome monitoring has assumed new importance in medicine. It is particularly essential in musculoskeletal care, which is currently targeted for attention by health care planners because of its high cost and perceived traditional inefficient care. With these facts in mind, the purpose of the present article is to review the status of current primary and secondary interventions for musculoskeletal disorders. Before doing so, a brief discussion of the biopsychosocial model of pain and disability, which is currently the most heuristic approach to intervention, will be provided.

The Work Limitations Questionnaire's validity and reliability among patients with osteoarthritis

The 25-item Work Limitations Questionnaire (WLQ) was recently developed to measure health-related decrements in ability to perform job roles among employed individuals. Research has demonstrated its validity and reliability in several populations. We assessed the WLQ's performance when administered to patients with osteoarthritis (OA), which is a leading cause of work disability and productivity loss. We recruited a representative sample of 230 employed, confirmed OA patients and a comparison group of 37 healthy employed controls. Subjects completed a mail survey. In tests of the WLQ's scale internal reliability, the questionnaire met all established criteria. Additionally, in construct validity tests, the WLQ correctly detected OA vs. control group differences, and correlated significantly with arthritis pain, stiffness, and functional limitation, and self-reported work productivity. The WLQ is an accurate and reliable source of information for assessing the work impact of OA.

Ergonomics and Prevention of Disability Due to Musculoskeletal Disorders: A State-of-the-Science Symposium

This symposium is concerned with rehabilitation, ergonomics and preventing work disability. Specifically it is concerned with determining the state of the science and identifying research opportunities that could result in major reductions in work disability. Disability has be defined as (Brandt and Pope 1997): Disability is defined as a limitation in performing certain roles and tasks that society expects of an individual It is the expression of the gap between a person's capabilities and the demands of the environment - the interaction of person's limitations with social and physical environmental factors. Available data show that there are many persons in our society who are disabled in that they are unable to achieve expectations established by employers, e.g., production rates, quantities and quality, without endangering themselves or others in the workplace or community. This expectation typically extends to forty hours per week, but could be more or less hours. Limitations in performance may result from conditions of birth, illness or injury. They also may be a primary or secondary effect of work. This is the case with Work Related Musculoskeletal Disorders; WMSDs. WMSDs are a leading cause of work disability and compensation in many contemporary work settings. Although this program focuses on prevention of disability due to WMSDs, it is broadly concerned with the prevention of all disability. The models and methods discussed have common elements that are applicable to many if not all persons and situations. For example, the above definition defines disability as a “gap” between job demands and worker capacities. This definition applies to a person with paraplegia as well as a person with carpal tunnel syndrome. In both instances, methods are needed for assessing and comparing worker capacities and job demands. The program includes presentations by leading investigators who will draw on their own work and work of others to describe the state of the art and develop recommendations for future research.

Antibiotic therapy in acute exacerbations of chronic bronchitis.

Chronic obstructive pulmonary disease (COPD) comprises a spectrum of conditions including chronic bronchitis, emphysema, asthma, and bronchiectasis. It has a prevalence in the United States of 5.1% to 5.4% in the middle-aged to elderly population, with a lower rate in nonsmoking individuals. Moreover, COPD is complicated by frequent and recurring acute exacerbations of chronic bronchitis (AECB). Overall, COPD represents the fourth leading cause of mortality in the United States and is the second leading cause of work disability. This condition is also associated with high morbidity and health care expenditures. Despite the controversy over the need to prescribe antibiotics for patients with AECB, high-risk patients have been identified who will benefit from this therapy.These include, patients with a history of repeated infections (>4 per year), comorbid illnesses (such as diabetes, asthma, coronary heart disease), or marked airway obstruction. Furthermore, a bacterial cause is shown in approximately 50% of AECB episodes, and primarily includes Haemophilus influenzae, Moraxella catarrhalis, and Streptococcus pneumoniae. Additionally, resistance among community-acquired respiratory pathogens in the United States has risen dramatically, with beta-lactamase production evident in 40% of H. influenzae and greater than 95% of M. catarrhalis isolates, and with approximately 10% of pneumococci highly resistant to penicillin and simultaneously resistant to macrolide antibiotics. The criteria used to make choices for antibiotic use in patients with AECB should include knowledge of the frequencies of pathogen resistance and patients' clinical characteristics. An effective antibiotic, however, must be able to rapidly resolve the acute infection with the least patient morbidity and need for hospitalization. Although there remains controversy as to when to initiate antibiotic therapy in patients with AECB, several guidelines have been published.

Prevalence of carpal tunnel syndrome in a general population.

Carpal tunnel syndrome (CTS) is a cause of pain, numbness, and tingling in the hands and is an important cause of work disability. Although high prevalence rates of CTS in certain occupations have been reported, little is known about its prevalence in the general population. To estimate the prevalence of CTS in a general population. General health mail survey sent in February 1997, inquiring about symptoms of pain, numbness, and tingling in any part of the body, followed 2 months later by clinical examination and nerve conduction testing of responders reporting symptoms in the median nerve distribution in the hands, as well as of a sample of those not reporting these symptoms (controls). A region in southern Sweden with a population of 170000. A sex- and age-stratified sample of 3000 subjects (age range, 25-74 years) was randomly selected from the general population register and sent the survey, with a response rate of 83% (n = 2466; 46% men). Of the symptomatic responders, 81% underwent clinical examination. Population prevalence rates, calculated as the number of symptomatic responders diagnosed on examination as having clinically certain CTS and/or electrophysiological median neuropathy divided by the total number of responders. Of the 2466 responders, 354 reported pain, numbness, and/or tingling in the median nerve distribution in the hands (prevalence, 14.4%; 95% confidence interval [CI], 13.0%-15.8%). On clinical examination, 94 symptomatic subjects were diagnosed as having clinically certain CTS (prevalence, 3.8%; 95% CI, 3.1%-4.6%). Nerve conduction testing showed median neuropathy at the carpal tunnel in 120 symptomatic subjects (prevalence, 4.9%; 95% CI, 4.1%-5.8%). Sixty-six symptomatic subjects had clinically and electrophysiologically confirmed CTS (prevalence, 2.7%; 95% CI, 2.1%-3.4%). Of 125 control subjects clinically examined, electrophysiological median neuropathy was found in 23 (18.4%; 95% CI, 12.0%-26.3%). Symptoms of pain, numbness, and tingling in the hands are common in the general population. Based on our data, 1 in 5 symptomatic subjects would be expected to have CTS based on clinical examination and electrophysiologic testing.

Occupational role performance in persons with back pain

Purpose: Back pain is a major cause of work disability but there is little data on the impact of back pain among persons who are working. The purpose of this study was to develop a measure of occupational role performance for individuals with back pain and to examine its relationship with sociodemo-graphic and work-related factors.Method: Item analysis and reduction resulted in a short, eight-item Occupational Role Questionnaire (ORQ) consisting of two scales, a productivity scale and a satisfaction with work scale. The scales had good internal consistency and correlated as expected with the Roland and Morris Disability Scale.Results: In a multivariate logistic model, significant negative effects on work satisfaction were observed for age 30–39 years relative to age 50 +, having a job that required lifting, and the level of disability.Conclusion: The ORQ may have applications in studying the consequences of back pain and other chronic conditions in the workplace.

The Effect of Chronic Disease on Work Behavior over the Life Cycle

hours of work, lower wage rates, early retirement and disability transfer programs. Approximately 14 percent of working age individuals report they have a health problem which restricts their activity [34]. While a number of studies exist documenting the relationship between health and labor market activity, most of the evidence specifically examining the association between poor health and labor force participation is derived from cross-sectional analyses. Furthermore, the majority of these studies consider the impact of poor health in general as opposed to specific chronic health conditions.' Thus, while the accumulated evidence clearly indicates that poor health has significant negative effects on labor force participation, these findings are limited because they do not consider the influence of chronic disease on work behavior over the life cycle.2 The purpose of this paper is to explore the effect of the onset of a chronic disease-arthritis -on work behavior over life cycle. Arthritis is an excellent health condition to study in this context for at least two reasons. First, while arthritis is a painful and crippling disease, it is rarely lifethreatening.3 Thus, the major impact of this disease is reflected by the influence it has on the capacity to work. Second, arthritis is the most common chronic disease and second leading cause of work disability in the United States [11]. In fact, the Arthritis Foundation reports that more than 40 million Americans or one in seven persons have some form of this disease. The econometric technique used here-a dynamic hazard model-is the appropriate methodology to examine the health-work relationship over the life cycle because this approach estimates the pattern of labor force behavior after disease onset. Since the results indicate the duration of