Work Disability Episode Research Articles

Implementation of a disability management policy in a large healthcare employer: a quasi-experimental, mixed-methods evaluation

ObjectiveThis study describes the process and outcomes of the implementation of a strengthened disability management policy in a large Canadian healthcare employer. Key elements of the strengthened policy included an...

Do predictors of return to work and recurrence of work disability due to mental disorders vary by age? A cohort study.

The extent to which predictors of return to work (RTW) and recurrence of work disability episodes vary by age group is not well understood. We examined the associations of sociodemographic and clinical factors with RTW and recurrence after mental-disorder-related work disability episodes in a cohort of 10,496 Finnish public sector employees. Disability records were derived from national disability registers between 2005 and 2011. Effect modification by age was examined in age groups of 21-34, 35-50 and >50 years. A total of 16,551 disability episodes from mental disorders were recorded. The likelihood of RTW was elevated in age group 21-34 (hazard ratio (HR) = 1.36, 95% confidence interval (CI) = 1.28-1.46) and 35-50 years (HR = 1.22, 95% CI = 1.18-1.26) compared to age group >50 years. The risk of a recurrent episode of work disability was higher in age groups >50 (HR = 1.29, 95% CI = 1.09-1.52) and 35-50 years (HR = 1.20, 95% CI = 1.03-1.41) compared to the youngest age group. Employees with depressive disorders were less likely to RTW than employees with neurotic, stress-related and somatoform disorders, and this difference increased with age. Low education was associated with increased risk of recurrent work disability episode in age groups of 50 years or younger, while no such association was observed in age group >50 years. The importance of depressive symptoms over neurotic, stress-related and somatoform disorders as predictors of delayed RTW increases with age, whereas educational differences in the recurrence of an episode diminish by age.

Psychotherapeutic and work-oriented interventions: employment outcomes among young adults with work disability due to a mental disorder

BackgroundWe examined the extent to which psychotherapeutic and work-oriented interventions were included in a medical treatment and rehabilitation plan and whether they predicted future employment among young adults with work disability due to a mental disorder.MethodsData were obtained from the treatment and rehabilitation plans of 1163 young adults aged 18‒34 years, who in 2008 were granted fixed-term work disability compensation due to a mental disorder and were followed for 5 years.ResultsForty-six percent had no proposal for psychotherapy or a work-oriented intervention in their treatment and rehabilitation plan, 22 % had a plan for only a psychotherapeutic intervention, 23 % had a plan for only a work-oriented intervention, and 10 % had both types of interventions planned. Having a planned psychotherapeutic intervention (HR = 1.35, 95 % CI 1.07–1.69) and of the work-oriented interventions, planned rehabilitative courses and training (HR = 1.34, 95 % CI 1.03–1.70) predicted quicker entry into competitive employment. Having a plan for both a psychotherapeutic and work-oriented intervention was associated with being employed at the end of the follow-up (OR = 1.77, 95 % CI 1.07–2.95).ConclusionsYoung adults with a long-term psychiatric work disability episode rarely have a recorded plan for rehabilitation in their treatment and rehabilitation plan although psychotherapeutic interventions and a combination of a psychotherapeutic and work-oriented intervention might help them gain employment.

Advice about Work-Related Issues to Peers and Employers from Head and Neck Cancer Survivors.

PurposeThe purpose of this exploratory and descriptive study is to contribute to the sparse return-to-work literature on head and neck cancer (HNC) survivors. Interview participants were asked to reflect upon their work-related experience with cancer by answering two specific questions: (1) What advice would you give someone who has been newly diagnosed with head and neck cancer? (2) What advice would you give to employers of these people?MethodsData were gathered through 10 individual semi-structured in-depth interviews with HNC clinic patients at a regional cancer center’s head and neck clinic in Ontario, Canada. A constant comparative method of theme development was used. Codes identified in and derived from the data were discussed by research team members until consensus was reached. Codes with similar characteristics were grouped together and used to develop overarching themes.ResultsWork-related advice for peers focused on personal self-care and interactions within workplaces. Work-related advice to employers focused on demonstrating basic human values as well as the importance of communication.DiscussionThe study results suggest HNC clinic patients should be proactive with employers and help to set reasonable expectations and provide a realistic plan for work to be successfully completed. HNC clinic patients should develop communication skills to effectively disclose their cancer and treatment to employers.ConclusionsIn this exploratory study, HNC clinic patients’ advice was solution-focused underscoring the importance of self-care and pro-active communication and planning with employers. Employers were advised to demonstrate core human values throughout all phases of the work disability episode beginning at diagnosis.

Work Disability among Employees with Diabetes: Latent Class Analysis of Risk Factors in Three Prospective Cohort Studies.

BackgroundStudies of work disability in diabetes have examined diabetes as a homogeneous disease. We sought to identify subgroups among persons with diabetes based on potential risk factors for work disability.MethodsParticipants were 2,445 employees with diabetes from three prospective cohorts (the Finnish Public Sector study, the GAZEL study, and the Whitehall II study). Work disability was ascertained via linkage to registers of sickness absence and disability pensions during a follow-up of 4 years. Study-specific latent class analysis was used to identify subgroups according to prevalent comorbid disease and health-risk behaviours. Study-specific associations with work disability at follow-up were pooled using fixed-effects meta-analysis.ResultsSeparate latent class analyses for men and women in each cohort supported a two-class solution with one subgroup (total n = 1,086; 44.4%) having high prevalence of chronic somatic diseases, psychological symptoms, obesity, physical inactivity and abstinence from alcohol and the other subgroup (total n = 1,359; 55.6%) low prevalence of these factors. In the adjusted meta-analyses, participants in the ‘high-risk’ group had more work disability days (pooled rate ratio = 1.66, 95% CI 1.38–1.99) and more work disability episodes (pooled rate ratio = 1.33, 95% CI 1.21–1.46). These associations were similar in men and women, younger and older participants, and across occupational groups.ConclusionsDiabetes is not a homogeneous disease in terms of work disability risk. Approximately half of people with diabetes are assigned to a subgroup characterised by clustering of comorbid health conditions, obesity, physical inactivity, abstinence of alcohol, and associated high risk of work disability; the other half to a subgroup characterised by a more favourable risk profile.

The role of psychiatric, cardiometabolic, and musculoskeletal comorbidity in the recurrence of depression-related work disability.

Comorbid psychiatric disorders, cardiovascular disease, chronic hypertension, diabetes, and musculoskeletal disorders are highly prevalent in depression. However, the extent to which these conditions affect the recurrence of depression-related work disability is unknown. The specific aims of the study were to investigate the extent to which comorbid other psychiatric disorders, cardiometabolic, and musculoskeletal conditions were associated with the recurrence of depression-related work disability among employees who had returned to work after a depression-related disability episode. A cohort study of Finnish public sector employees with at least one depression-related disability episode during 2005-2011 after which the employee had returned to work (14,172 depression-related work disability episodes derived from national health and disability registers for 9,946 individuals). We used Cox proportional hazard models for recurrent events. Depression-related work disability recurred in 35% of the episodes that had ended in return to work from a previous episode, totaling 4,927 recurrent episodes among 3,095 (31%) employees. After adjustment for sex, age, socioeconomic status, and type of employment contract, comorbid psychiatric disorder (hazard ratio = 1.82, 95% CI 1.68-1.97), cardiovascular disease (1.39, 95% CI 1.04-1.87), diabetes (1.43, 95% CI 1.11-1.85), chronic hypertension (1.33, 95% CI 1.11-1.58), and musculoskeletal disorder (1.17, 95% CI 1.06-1.28) were associated with an increased risk of a recurrent episode compared to those without these comorbid conditions. Recurrence of depression-related work disability is common. Employees with comorbid psychiatric, cardiometabolic, or musculoskeletal conditions are at an increased risk of recurrent depression-related work disability episodes.

Work Disability Related to Musculoskeletal Pain: A System Dynamics Approach

AbstractObjective: To apply system dynamics methodology to study the evolution of temporary work disability in the context of pain-related musculoskeletal disorders [MSD-TWD].Methods: Data were obtained from the MSD-TWD program records on 13 077 patients with acute disability [7805 in the control group [CG]; 5272 in the intervention group [IG]] who suffered 16 297 episodes of temporary work disability. Samples were randomized into two homogeneous sub-samples for validation purposes. The dynamic model developed with system dynamics methodology included 20 variables [five levels, seven rates, two auxiliary variables, six parameters], five differential equations, and eight algebraic equations. A sensitivity analysis of various scenarios was carried out.Results: Episodes were described according to their duration; short-term and long-term MSD-TWD. By tuning the model parameters, the actual survival curves of both groups in the two sub-samples were almost exactly reproduced. An explicit temporal expression of ...

Depression-related work disability: socioeconomic inequalities in onset, duration and recurrence.

ObjectiveDepression is a major cause of disability in working populations and the reduction of socioeconomic inequalities in disability is an important public health challenge. We examined work disability due to depression with four indicators of socioeconomic status.MethodsA prospective cohort study of 125 355 Finnish public sector employees was linked to national register data on work disability (>9 days) due to depressive disorders (International Classification of Diseases, codes F32–F34) from January 2005 to December 2011. Primary outcomes were the onset of work disability due to depressive disorders and, among those with such disability, return to work after and recurrent episodes of work disability due to depression.ResultsWe found a consistent inverse socioeconomic gradient in work disability due to depression. Lower occupational position, lower educational level, smaller residence size, and rented (vs. owner-occupied) residence were all associated with an increased risk of work disability. Return to work was slower for employees with basic education (cumulative odds ratio = 1.21, 95% CI: 1.05–1.39) compared to those with higher education. Recurrent work disability episodes due to depression were less common among upper-grade non-manual workers (the highest occupational group) than among lower-grade non-manual (hazard ratio = 1.16, 95% CI: 1.07–1.25) and manual (hazard ratio = 1.14, 95% CI: 1.02–1.26) workers.ConclusionsThese data from Finnish public sector employees show persistent socioeconomic inequalities in work disability due to depression from 2005 to 2011 in terms of onset, recovery and recurrence.

Socioeconomic differences in work disability due to depression

J Ervasti, J Vahtera, J Pentti, T Oksanen, K Ahola, M Kivimaki, M Virtanen Development of Work and Organizations, Finnish Institute of Occupational Health, Helsinki, Finland Turku University Hospital, Turku, Finland University College London, London, United Kingdom Contact: jenni.ervasti@ttl.fi Background In addition to decreased quality of life, depression causes substantial work impairment. In the Global Burden of Diseases, Injuries, and Risk Factors Study 2010, major depressive disorder ranked 2nd in terms of years lost due to disability. Previous studies have found a socioeconomic gradient in depression, but there have been controversial results regarding socioeconomic status (SES) and return to work (RTW) after depression. Methods We examined socioeconomic differences with four indicators of SES: occupational position, educational level, residence size, and residence ownership. Work disability due to depressive disorder (>9 days) according to the International Classification of Diseases 10th revision, codes F32-F34 and RTW after a depressive disorder were the outcome variables. The study was a prospective cohort study among Finnish public sector employees (n = 125,355) during 2005-2011. Results We found a consistent inverse socioeconomic gradient in work disability due to depression. In the model adjusted for confounders and other SES indicators, manual workers had a 1.35 -fold (95% CI = 1.13-1.61), and lower-grade non-manual workers had a 1.32 –fold (95% CI = 1.17-1.50) increased risk compared to upper-grade non-manual workers. Employees with basic education had a 1.52 –fold (95% CI = 1.25-1.85), and employees with secondary education had a 1.32 –fold (95% CI = 1.17-1.50) increased risk when compared to employees with higher education. Employees with residence size less than 70 m2 had a 1.23 -fold (95% CI = 1.08-1.41) increased risk when compared to those with residence size of more than 100 m2. Finally, those living in a rented residence had a 1.30 –fold (95% CI = 1.16-1.45) increased risk for work disability due to depressive disorder when compared to home-owners. Of the disability episodes due to depressive disorder (n = 13,701), 62% ended in less than two months, and 90% ended during the follow-up. In the adjusted model, RTW was slower among those with basic education (COR = 1.21, 95% CI: 1.05-1.39) compared to those with higher education. Conclusions SES should be taken into account in the attempts to reduce social inequalities in work disability due to depression and in the promotion of returning to work after depression. Key messages There is a consistent inverse socioeconomic gradient in work disability due to depression as measured by occupational position, education, residence size, and residence ownership. Returning to work after a work disability episode due to depressive disorder is slower for employees with basic education when compared to employees with higher education.

Effectiveness of an early cognitive–behavioral treatment in patients with work disability due to musculoskeletal disorders

To evaluate whether an early cognitive-behavioral treatment complementary to a rheumatologic care program, for patients with recent-onset temporary work disability caused by musculoskeletal disorders (MSDs) is effective. Patients with an MSD-related temporary work disability episode from 3-8 weeks' duration who were in a rheumatologic care program were randomized into a control group (rheumatologic care program) or an intervention group (rheumatologic care program plus cognitive-behavioral treatment). Enrollment lasted 24 months and followup lasted 6-24 months. Efficacy variables included duration of temporary work disability episodes, total number of work days saved, relative efficacy, and relative rate to return to work. An economic evaluation was also performed. One hundred eighty-one patients were included (66 control and 115 intervention patients), generating 222 episodes of MSD-related temporary work disability. Episodes tended to be shorter in the intervention group than in the control group (mean 98 versus 127 days; P = 0.053), with a relative efficacy of 22.9%. There were no differences in duration of the first episode between groups (mean 105 versus 110 days; P = 0.79), but relapse episodes were significantly shorter in the intervention group (mean 63 days versus 197 days; P = 0.0002). Costs were also lower in the intervention group. To save 1 day of temporary work disability, $13.50 had to be invested in the program. Each dollar invested generated a benefit of $4.08. The program had a net benefit of $172,607. Early cognitive-behavioral treatment complementary to a rheumatologic care program is cost-effective, adds >20% efficacy to the rheumatologic care program, and reduces the duration of relapses.

Work disability absence among young workers with respect to earnings losses in the following year

The primary objective of this study was to evaluate the earnings losses that young workers experience in the year after a work disability absence. The sample consisted of workers aged 16 to 24 years from a longitudinal survey of a representative sample of Canadians. Young workers who lost > or =5 days of work due to work disability or illness (ie, work disability absence) were matched to uninjured controls on the basis of age, gender, preabsence earnings, and student status. This matching procedure resulted in 173 cases and 795 controls. The outcome measure was the difference in earnings the year after the work disability episode between injured cases and their uninjured controls. An analysis of variance indicated that young workers experiencing a work disability absence had significantly fewer earnings than their controls in the year after the absence (P<0.05). This earnings loss was not due to between-group differences in school activity or workhours in the year after the work absence. No study to date has estimated the impact of work-related disability on earnings trajectories among young workers. The findings of the present study indicate that earnings losses can occur among young workers even during their transition into the labor market. Documenting the economic impacts of work injuries early in one's worklife can provide information for policy debates on the allocation of resources to control workplace hazards where teenagers and young adults work and debates on the determination of fair and adequate benefits for young workers.

Musculoskeletal work disability for clinicians: Time course and effectiveness of a specialized intervention program by diagnosis

To evaluate how an intervention program modifies the clinical course of work disability in musculoskeletal diagnoses. All patients with temporary work disability related to musculoskeletal disorders (MSDs) in 3 health districts of Madrid, Spain were randomized into standard care (control group) or the intervention group. Intervention consisted of a specific program, run by rheumatologists, following detailed proceedings. Inclusion and followup lasted 12 months each. According to the cause, every temporary work disability episode was classified into 11 syndrome categories. For each we calculated efficacy, as the difference between groups in the number of days on sick leave per temporary work disability episode; relative efficacy, or the percentage of days saved in the intervention group; and time of maximum program effect. Analyses were performed on an intent-to-treat basis. Survival techniques were run and results were expressed as the hazard ratio (HR) in the intervention versus control group. A total of 13,077 patients were included, generating 16,297 temporary work disability episodes. The most frequent cause was back pain. Temporary work disability episodes were significantly shorter in the intervention group than in the controls in all syndrome categories except knee pain (excluding osteoarthritis). Program relative efficacy varied from 28-72%. The program was highly efficacious in carpal tunnel syndrome (HR 2.09, 95% confidence interval [95% CI] 1.17-3.75), peripheral osteoarthritis (HR 1.58, 95% CI 1.14-2.19), and inflammatory diseases (HR 1.52, 95% CI 1.09-2.12). The maximum effect of the program always took place within the first 2 months. The implementation of this type of specialist-run, protocol-based early intervention program would be very beneficial in the treatment of patients with work disability related to MSDs, except for those with knee pain (excluding osteoarthritis).

Work Disability and Costs Caused by Recurrence of Low Back Pain: Longer and More Costly Than in First Episodes

Retrospective analysis of workers' compensation (WC) claims data for nonspecific low back injuries (LBI) in a single jurisdiction. To examine whether recurrences, defined as post-initial episodes of work disability or medical care, substantially contribute to total medical and indemnity costs, and total duration of work disability. Previous studies have not measured the proportion of care seeking and work disability that are associated with recurrences in claims for work-related LBI. All persons with new lost-time claims for nonspecific LBI reported in New Hampshire to a large WC provider from 1996 to 1999 were selected (N = 1867). Three years of follow-up data, starting at the beginning of the first episode, were collected. Previously validated definitions of recurrence were used identify new episodes of care and new episodes of lost work time (work disability). Total duration of work disability, total medical costs, and total indemnity costs were investigated. For individuals with recurrences, these variables were separated into first-episode and recurrent period duration and costs. The rate of recurrent work disability was 17.2%, and the rate of recurrent care seeking was 33.9%. Individuals with recurrence had significantly higher total length of work disability, and higher medical and indemnity costs. For those with recurrent work disability, 69% of total lost time from work, 71% of associated indemnity costs, and 84% of total medical costs occurred during the recurrent period. For those with recurrence of care, the respective values were 48%, 47%, and 42%. Recurrences contributed disproportionately to the total burden of work-related nonspecific LBI, through both additional care seeking and work disability. Results imply that those who have recurrences may be an especially important target for secondary prevention efforts.

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.

Risk factors for recurrent episodes of care and work disability: case of low back pain.

Recurrences of injuries are common and have significant socioeconomic consequences; it is important to identify associated risk factors as potential opportunities for prevention. This study was conducted to identify risk factors for low back pain (LBP) recurrence and the extent that variation in recurrence definition impacts identified risk factors. Patients with new claims for LBP reported in New Hampshire to a workers' compensation provider were selected (n = 2023) with a minimum of 3-year follow up. Alternative definitions of recurrence included a new episode of medical care and a new episode of lost work time (work disability). Risk factors better predicted disability-based than treatment-based recurrence. Longer durations of the initial episode of care or work disability were the most powerful predictors of recurrence, implying that shorter episodes of care and early return to work contribute to better outcomes.

The error of using returns-to-work to measure the outcomes of health care.

This article uses data from The Survey of Ontario Workers With Permanent Impairments. the world's largest survey of injured workers, to show that, as currently used, return-to-work is a misleading measure of the effectiveness of health care. The article discusses examples of two serious limitations on the use of return-to-work to measure the outcomes of health care, where health care refers to all the medical and rehabilitative services provided to a worker following a workplace injury. The first limitation is that return-to-work, like many other outcomes of health care, is influenced by factors that are not directly related to health care. Using a logit model to estimate the determinants of first absences from work after an injury, we find that socioeconomic characteristics, economic incentives, and job characteristics have a significant influence on return-to-work. The second limitation on return-to-work as an outcome measure is that the first return-to-work after an injury, like a hospital discharge, frequently marks the end of only the first of several episodes of work disability caused by the original injury. Using first post-injury returns-to-work as a proxy for recovery, we would assume that 85% of the Ontario workers recovered from their injury when, in fact, 61% had subsequent spells of work disability. We identified four mutually exclusive patterns of post-injury work and work disability. Multinomial logit estimates of the determinants of the patterns show that health care is only one of several influences on return-to-work. The results also demonstrate that if return-to-work is used to measure outcomes, it must be evaluated over a time horizon that permits multiple spells of work disability.

The error of using returns‐to‐work to measure the outcomes of health care

This article uses data from The Survey of Ontario Workers With Permanent Impairments, the world's largest survey of injured workers, to show that, as currently used, return-to-work is a misleading measure of the effectiveness of health care. The article discusses examples of two serious limitations on the use of return-to-work to measure the outcomes of health care, where health care refers to all the medical and rehabilitative services provided to a worker following a workplace injury. The first limitation is that return-to-work, like many other outcomes of health care, is influenced by factors that are not directly related to health care. Using a logit model to estimate the determinants of first absences from work after an injury, we find that socioeconomic characteristics, economic incentives, and job characteristics have a significant influence on return-to-work. The second limitation on return-to-work as an outcome measure is that the first return-to-work after an injury, like a hospital discharge, frequently marks the end of only the first of several episodes of work disability caused by the original injury. Using first post-injury returns-to-work as a proxy for recovery, we would assume that 85% of the Ontario workers recovered from their injury when, in fact, 61% had subsequent spells of work disability. We identified four mutually exclusive patterns of post-injury work and work disability. Multinomial logit estimates of the determinants of the patterns show that health care is only one of several influences on return-to-work. The results also demonstrate that if return-to-work is used to measure outcomes, it must be evaluated over a time horizon that permits multiple spells of work disability. © 1996 Wiley-Liss, Inc.