Work Disability Prevention Research Articles

Sociodemographic differences in low back pain: which subgroups of workers are most vulnerable?

BackgroundLow back pain (LBP) is a common health problem in workers that contributes to work disability and reduces quality of life. However, studies examining vulnerable groups in relation to sociodemographic differences in LBP remain scarce. Therefore, the current study investigates which sociodemographic groups of workers are most affected by LBP.MethodsData from the 2018 BIBB/BAuA employment survey were used (N = 16252). Age, education, occupational group, income, working hours, atypical working time, relationship status, and having children were used as sociodemographic predictors. Gender-stratified logistic regression analyses and intersectional classification tree analyses were conducted.ResultsA higher prevalence of LBP was observed for women compared to men. Significant differences in LBP emerged for age, working hours, atypical working time, occupational group and education, with some gender differences in the importance of predictors: Age was a significant predictor mostly in men as compared to women, atypical working hours had a slightly greater effect in women, whereas differences in LBP according to the occupational group were more pronounced for men. Vulnerable groups were found to be women who work in occupations other than professionals or managers, work atypical hours and have an intermediate or low educational level as well as men who work as skilled agricultural workers, craft workers, machine operators, or elementary occupations and are between 35 and 64 years old.ConclusionsThus, workers with certain occupations and lower levels of education, middle-aged men and women with unfavourable working time characteristics are most affected by low back pain. These groups should be focused on to potentially increase healthy working life and prevent work disability.

Best Practices in Documenting and Coding High-Value Care in Workers' Compensation Encounters-ACOEM Guidance Statement.

Workers' compensation outpatient care requires attention to causation, functional assessment, work disability prevention, and return-to-work planning, elements not usually addressed in other types of outpatient encounters. Because these elements of care deviate from the usual pattern of ambulatory services, providers of workers' compensation care have faced challenges in billing and auditing practices resulting in underpayment when providing high-value care based on evidence-based guidelines. Recent changes in Centers for Medicare & Medicaid Services rules on documentation requirements for coding outpatient evaluation and management encounters offer an opportunity for occupational health clinicians to be paid appropriately for care that follows occupational medicine practice guidelines. There remains a need to define the elements of documentation that should be expected in delivering high-value workers' compensation care. This article provides guidance for documenting high-value workers' compensation care.

Occupational patterns of opioid-related harms comparing a cohort of formerly injured workers to the general population in Ontario, Canada.

The role of work-related injuries as a risk factor for opioid-related harms has been hypothesized, but little data exist to support this relationship. The objective was to compare the incidence of opioid-related harms among a cohort of formerly injured workers to the general population in Ontario, Canada. Workers' compensation claimants (1983-2019) were linked to emergency department (ED) and hospitalization records (2006-2020). Incident rates of opioid-related poisonings and mental and behavioural disorders were estimated among 1.7 million workers and in the general population. Standardized incidence ratios (SIRs) and 95% confidence intervals (CI) were calculated, adjusting for age, sex, year, and region. Compared to the general population, opioid-related poisonings among this group of formerly injured workers were elevated in both ED (SIR = 2.41, 95% CI = 2.37-2.45) and hospitalization records (SIR = 1.54, 95% CI = 1.50-1.59). Opioid-related mental and behavioural disorders were also elevated compared to the general population (ED visits: SIR = 1.86, 95% CI = 1.83-1.89; hospitalizations: SIR = 1.42, 95% CI = 1.38-1.47). Most occupations and industries had higher risks of harm compared to the general population, particularly construction, materials handling, processing (mineral, metal, chemical), and machining and related occupations. Teaching occupations displayed decreased risks of harm. Findings support the hypothesis that work-related injuries have a role as a preventable risk factor for opioid-related harms. Strategies aimed at primary prevention of occupational injuries and secondary prevention of work disability and long-term opioid use are warranted.

Which interventions are used in the rehabilitation, return, and stay at work process of aging workers having suffered an occupational injury? A scoping review.

Considering current labour shortages, the recent increase in the number of aging workers in the labour market is deemed economically beneficial. However, due to specific characteristics (e.g. biological, generational), aging workers take longer to recover and return to work after an occupational injury. Yet, few studies have examined the rehabilitation, return, and stay at work process of aging workers and current knowledge makes it difficult for stakeholders to identify which interventions to use with this specific population. This study aimed to describe which interventions are used in the rehabilitation, return, and stay at work process of aging workers having suffered an occupational injury. We conducted a five-step scoping review. Five databases were used for the literature search. A qualitative analysis of the retained manuscripts was conducted. Our analysis led to the extraction of information from seven manuscripts that concern the rehabilitation, return, and stay at work process of aging workers who suffered an occupational injury exclusively. We identified 19 interventions (e.g. work capacity development, work task modifications, permanent part-time work, and alternative roles) and were described according to the different phases of the Cycle of Work Disability Prevention (CWDP). This study offers informative, non-prescriptive, and operational interventions useful for stakeholders who support aging workers. Furthermore, it is a knowledge base to develop future projects that promote the rehabilitation, return, and stay at work process of aging workers.

Predictors of Retirement Voluntariness Using Canadian Longitudinal Study on Aging Data.

Objectives: Involuntary exit from the labor force can lead to poor health and well-being outcomes. Therefore, the purpose of this research is to better understand the factors that contribute to perceived retirement voluntariness. Methods: We conducted descriptive and multivariable logistic regression analyses using a sample of recent retirees (n = 2080) from the Canadian Longitudinal Study on Aging (CLSA). Results: More than one-quarter (28%) of older workers perceived their retirement to be involuntary. Among 37 possible predictors, 14 directly predicted retirement voluntariness and many more indirectly predicted retirement voluntariness. Only four direct predictors were common to both women and men, retiring because of organizational restructuring/job elimination; disability, health, or stress; financial possibility; and having wanted to stop working. Discussion: Findings suggest the need for employment support, health promotion, work disability prevention, financial education, and support that is sensitive to the differences between women and men to prevent involuntary retirement.

Use of a job exposure matrix to predict the risk of work disability in individuals with back pain: An inception cohort study.

Low back pain has a high economic burden in Germany due to back pain-related sick leave, disability pensions, and health care utilization. Work-related factors can predict disabling back pain. Job exposure matrices can be used to consider job demands and occupational characteristics in routine data analysis. This longitudinal analysis tested whether rehabilitation utilization due to musculoskeletal disorders is associated with occupation-linked job exposures in employees with back pain. Data from a German cohort study were used, including employees aged 45 to 59 years with self-reported back pain in the last three months. Individuals' job titles were assessed in the baseline survey in 2017 and matched with parameters of aggregated job exposure indices. Administrative data from the German Pension Insurance were used to extract information on rehabilitation utilization. Proportional hazard models tested the associations. We considered data of 6,569 participants (mean age: 52.3 years; 57.7% women). During follow-up, with a maximum of 21 months, 296 individuals (4.5%) utilized medical rehabilitation due to musculoskeletal disorders. Adjusted analyses showed that high physical (HR = 2.87; 95% CI 1.74; 4.75) and overall (HR = 2.34; 95% CI 1.44; 3.80) job exposures were associated with a higher risk of rehabilitation utilization. Individuals with back pain working in occupations with high physical job exposures have a higher risk for rehabilitation utilization. To prevent work disability in individuals with back pain, occupational groups with high physical job exposures should be actively informed about tailored intervention options.

Physical Fitness as a Predictor of Disability Retirement: A 9-Year Register Linked Follow-Up Study.

To prospectively examine the association between physical fitness and risk of disability retirement in a large population-based cohort. This study utilized data from Health 2011 survey Physical Activity subsample (n = 4898), combined with information on disability retirement derived from 2 national registers. In total, 2455 individuals aged 18-74years underwent the physical fitness test protocol concerning measures of cardiorespiratory fitness, muscle strength, and balance. The outcome variable was disability retirement, during the follow-up period of 9years. After excluding those not at risk of disability retirement (ie, age ≥63 y) or who had already been granted disability pension, and those who had not completed the fitness protocol, the analytical sample included 1381 participants. Data were analyzed using Cox regression model with SPSS (version 29). During the 9-year follow-up period, 61 individuals (4.4%) transitioned to a disability retirement. Cox regression analysis showed an association between the various physical fitness subdomains and the risk of disability retirement. In model 1, all fitness tests were associated with the risk of disability retirement, except the one-leg stand test with hazard ratios ranging from 1.69 (95% CI, 0.86-3.34) to 5.75 (95% CI, 1.84-17.90). Further adjustment for sociodemographic, health behavior, and health-related covariates attenuated the associations and statistical significance was lost, except for the vertical jump test (hazard ratio = 4.33; 95% CI, 1.32-14.10) and 6-minute walk test (hazard ratio = 3.81; 95% CI, 1.35-10.70). These findings highlight the importance of physical fitness for preventing work disability.

Determining Unmet Needs Among Workers' Compensation Stakeholders to Prevent Work Disability in the State of Vermont.

Vermont has high rates of young people receiving federal disability benefits leading to substantial gaps in the workforce. The purpose of this project was to determine the unmet needs of interested parties in the workers' compensation (WC) process. A type of focus group, experience groups, was used to elicit key parties' experiences in the WC system. Facilitators used open-ended prompts to encourage discussion among participants about their experience with the WC system. Data were analyzed using thematic coding procedures to identify common motifs. Common themes emerged including challenges in navigating the WC system, lack of communication among stakeholders, and providing and receiving appropriate health care to facilitate RTW. Understanding unmet needs of interested parties in the WC process allows for the creation of targeted, high-value, early intervention strategies to reduce long-term work disability.

Pr. Patrick Loisel (1943–2022): A Pioneer, a Visionary Man, and Founding Father of Work Disability Prevention Research Field and Community

Pr. Patrick Loisel (1943–2022): A Pioneer, a Visionary Man, and Founding Father of Work Disability Prevention Research Field and Community

Work Ability and Quality of Life in Patients with Rheumatoid Arthritis.

Background. Reduced work participation has social implications (sickness absence, economic impact) and consequences for the individual patient (impoverishment, depression, limited social interaction). As patients with rheumatoid arthritis (RA) are more likely to experience job loss and/or at-work productivity loss and are at higher risk of sickness absence and, ultimately, permanent work productivity, consideration should be given to the association between work productivity or partial work capacity and quality of life (QoL). The aim of the study was to assess the relationship between QoL and the risk of work disability, as well as to estimate the risk of a future event and identify factors affecting the risk of work disability in RA inpatients. Material and methods. This cross-sectional study included 142 inpatients (65 male) aged 47 (38–58) years, who met the established criteria for a diagnosis of RA and treatment with biologic drugs. Only standardized tools were used to examine the patients: WHOQOL-BREF, MFIS and AS-WIS. Results. An analysis of the QoL scores on the WHOQOL-BREF demonstrated that the patients’ QoL was lowest in the physical health domain and highest in the social relationships domain. The median WHOQOL-BREF total score in the group studied was 62.8, which indicates a moderate QoL. The median total score for the risk of work disability (AS-WIS) was 10.1, which indicates that the level of risk of work disability in the patients was higher than the average level reported in the literature. A multivariate analysis showed that the following were significant independent determinants of a higher risk of work disability: low QoL in the WHOQOL-BREF physical health (β = 0.961; p = 0.029) and psychological health (β = 1.752; p = 0.002) domains, being in a relationship (β = 0.043; p = 0.005) and the use of opioids for pain (β = 3.054; p = 0.012). Conclusions. RA patients presented with moderate QoL, moderate fatigue (MFIS) and high risk of disability (AS-WIS). There is an association between a high risk of work disability and lower QoL, especially in the physical and psychological health domains. The lower the QoL in those domains, the higher the risk of work disability. The identification of factors increasing the risk of work disability will help in planning tailored interventions to improve at-work productivity loss and thus prevent work disability.

Socioeconomic factors and use of psychotherapy in common mental disorders predisposing to disability pension

BackgroundResearch in high-income countries has identified low socioeconomic status as a risk factor for disability pension (DP) due to common mental disorders (CMDs). Psychotherapy is an evidence-based treatment for the majority of CMDs along with medication and it is often targeted to prevent work disability. This study examines socioeconomic differences in the use of rehabilitative psychotherapy in Finland, where citizens have universal health coverage, but psychotherapy is partly dependent on personal finance.MethodsThe study subjects (N = 22,501) were all the Finnish citizens granted a DP due to CMD between 2010 and 2015 and a comparison group (N = 57,732) matched based on age, gender, and hospital district. Socioeconomic differences in psychotherapy use were studied using logistic regression models. Socioeconomic status was defined by education, income, and occupation. Age, gender, and family status were also examined.ResultsA lower level of education, lower occupational status (blue-collar worker), male gender, and older age, were associated with less frequent psychotherapy use, in both groups. Education was the strongest component of socioeconomic status associated with psychotherapy use, but the role of income was not straightforward. Unemployment when approaching DP, but not otherwise, was a risk factor for not receiving rehabilitative psychotherapy. Socioeconomic disparities were not any smaller among CMD patients approaching DP than in the comparison group.ConclusionThis study demonstrates the disparity in the provision of psychotherapy for CMD patients, even on the verge of DP with an acute need for services. This disparity is partly related to a complex interplay of socioeconomic factors and the service system characteristics. Factors predisposing to unequal access to mental health services are presumably diverse and should be studied further.

Beyond the hand and upper extremity: The role of hand therapists in care of people with rheumatic diseases

Study designInvited Clinical Commentary BackgroundArthritis is one of the most frequently reported causes of disability in the United States and the prevalence is expected to increase in the coming decades. While many rheumatic diseases involve hand impairments, most are systemic and involve more than the musculoskeletal system. Functional and work disability are high and people would benefit from the services of occupational and physical therapists. Purpose of studyThis paper reviews concepts of self-management, and symptoms that contribute to limitations and restrictions to participation in daily life in people with rheumatic diseases and suggests roles for hand therapists beyond the immediate hand impairments. MethodsThe impact of selected rheumatic diseases on functional and work disability are reviewed along with strategies for symptom management and self-management. Upper extremity impairments of selected rheumatic diseases are also discussed. ResultsThe role for hand therapists in evaluating and addressing the complex needs of persons with rheumatic diseases, including less common diseases, is discussed. Outcome measures for fatigue, muscle involvement, ergonomics and computer use, and work disability are introduced. Finally, strategies for self-management and prevention of work and functional disability, along with symptom management for fatigue and pain are presented. ConclusionHand therapists can play a vital role in chronic rheumatic disease management to improve self-management and increase participation in meaningful activities. Patients, primary care and rheumatology providers need to be educated about the scope of services occupational and physical therapists provide beyond the hand impairments.

The Cross-Country Comparison Model for Labor Participation (CCC Model for LP) of Persons with Chronic Diseases

Purpose To design a model based on the three pillars of new institutional theory (NIT), that facilitates cross-country comparison of labor participation (LP) of people with chronic diseases. This model should support getting a comprehensive overview of factors representing country differences, understanding these differences and should support estimating cross-country transferability of policies and interventions in the context of Work Disability Prevention. Methods Based on NIT, a draft model was designed by means of (1) a literature review of empirical studies; (2) theoretical books and articles; (3) a focus group with six expert researchers. This draft model was (4) adapted in the context of academic education. Literature was searched on Web of Science and EBSCO host. Feedback on (use of) the model was received from the focus group, four different academic courses at 28 occasions and two international conferences. Results The cross-country comparison model for labor participation (CCC model for LP) of persons with chronic diseases is proposed consisting of five factors: (1) Legislation; (2) Norms & values in practice; (3) Culture; (4) Organization of WDP in practice; (5) Labor market characteristics. Within these factors and based on (in)direct empirical evidence, subfactors are distinguished. The feedback received led to renaming (sub) factors, improved visual representation and a tool for estimating transferability. Conclusions The CCC model for LP of persons with chronic diseases allows for a comprehensive understanding of country differences and cross-country transferability of policies and interventions. The CCC model can be used for other populations when population-specific subfactors are included.

Participatory Ergonomics Intervention to Prevent Work Disability Among Workers with Low Back Pain: A Randomized Clinical Trial in Workplace Setting

Purpose In order to support people with low back pain (LBP) to stay at work, work arrangements are regarded important. This study aimed to evaluate the effectiveness of a workplace intervention using a participatory approach on work disability of workers with ongoing or recurrent LBP. Methods A total of 107 workers with LBP, with duration of pain for at least two consecutive weeks or recurrent pain of any duration during the last year, were randomized either to the intervention (n = 51) or control group (n = 56). The intervention included arrangements at the workplace, along with individual guidance provided by an occupational physiotherapist (OPT). The randomized intervention study used standard counselling and guidance by an OPT without workplace intervention as a comparison. Surveys were completed at baseline, and 6 and 12 months after baseline. Results There were no statistically significant differences between the intervention and control groups on the primary outcome measure, i.e. self-assessed work ability. We found no between-group differences in perceived health, self-assessed work productivity, number of sickness absence days and severity of back pain. However, there were significant positive within-group changes in the intervention group in the intensity of LBP, perceived health and the number of sickness absence days due to LBP. Conclusion Workplace arrangements are feasible using participatory ergonomics, but more quantitative and qualitative research is needed on its utilization and effectiveness among workers with LBP.

Building a Common Language to Facilitate Discussion Among Stakeholders in Work Disability: A Consensus Group Approach.

Work disability stakeholders may not share the same understanding and solutions among themselves or with researchers, causing misunderstandings and hindering collaboration regarding solutions for preventing work disability. To reduce such differences, this study sought to build a common vocabulary among stakeholders and researchers, using a transdisciplinary research framework. A consensus method based on a constructivist approach was used. A theoretical sampling method was applied to identify researchers or stakeholders representing one of the four systems in the work disability paradigm. A preliminary set of definitions for key terms was assessed using a Web-based questionnaire. It documented participants' level of agreement with each term's inclusion and relevance in the field, and the clarity of the definition, while soliciting suggestions for other terms or clearer definitions. Disagreements were discussed at group meetings, yielding consensus on the final terms and definitions. Eleven stakeholders representing patients, employers, unions, healthcare professionals, and legislative and insurance systems, along with 10 multidisciplinary researchers, participated. The questionnaire yielded initial consensus on the inclusion and definitions of 49 terms, and 109 suggestions mostly for modified definitions (average = 6 suggestions/term). Two preliminary terms were excluded and three terms were added. Ultimately, 80 terms and their definitions yielded consensus. The process we used to build a common vocabulary was carried out within a transdisciplinary framework. It required a constructivist approach, promoting idea exchanges among participants and co-construction of generally agreed results. The results were rooted in local contexts, thus ensuring the same reference points, regardless of participants' different understandings.

Evaluation of an Innovative Student-Led Work Disability Prevention Program

A university-based, role-emerging fieldwork placement for occupational therapy students has been developed to provide work disability prevention services for university managers and workers. Over five years, 24 students have provided holistic interventions across 18 departments. The purpose of this project was to formally evaluate the perceptions of the program and the impact of services on managers and workers and to examine the experience of participating students. A utilization-focused evaluation approach was used as the guiding framework for this project. Methods included a retrospective review of reports and educational materials, a manager and worker survey, and a review of results from an existing student survey. The retrospective review of reports and educational materials demonstrated that students utilized a comprehensive and holistic lens that considered the interaction between the person, environment, and occupation. Workers and managers reported they were satisfied and found that services were beneficial. The majority reported changing their work setup or work habits after receiving student services to prevent workplace disability. Students reported overwhelmingly positive responses about the placement, with 96% (n=23) of students agreeing that they had an excellent experience and 100% (n=24) of students agreeing they were able to use their acquired knowledge. This paper describes the formal evaluation process and the outcomes of the project. Findings support the benefits of a partnership with human resources and occupational therapy in developing a role-emerging placement that benefits students, workers, and the organization and promotes the value of occupational therapy in workplace disability prevention and health promotion.

Recruitment cost and outcomes for an arthritis work disability prevention randomized clinical trial: The Work It study

BackgroundDespite the recommendations to increase recruitment of participants into clinical trials, investigators face costly challenges in trials investigating work disability interventions for people with arthritis and rheumatological conditions. This study aims to evaluate the recruitment costs and outcomes from a randomized controlled trial of an arthritis work disability prevention program conducted between 2011 and 2015, to inform planning and monitoring recruitment in similar studies. MethodsData were obtained from enrollment and financial records pertaining to recruitment costs for each recruitment approach employed. The cost for each recruitment method was calculated for total cost and cost per number of participants screened, eligible, and enrolled in the trial. Then the yield of each possible recruitment method was also determined based on the ratio of the number of randomized participants divided by the number of people contacted through each recruitment method. Finally, the ResultsRecruitment rate was lower than projected. Community advertising, specifically newspapers, was the most successful method of recruitment in terms of numbers, but social media, specifically Craigslist, was the least costly method used to recruit. Some social media approaches, including Facebook and LinkedIn, yielded few if any participants. Recruitment efforts used successfully in the past are not always effective. ConclusionsCosts to recruit large numbers of people with arthritis into clinical trials are high. Investigators are encouraged to monitor recruitment efforts and evaluate the costs and outcomes of their strategies throughout the study period. Close consideration to recruitment costs should be considered as part of the research fiscal resources prior to and during the study period for long-term outcomes like work disability. Trial registrationClinicalTrials.gov Identifier: NCT01387100, date: 06/01/2011.

Prevalence and predictors of return to work following a spinal cord injury using a work disability prevention approach: A systematic review and meta-analysis

Purpose Worldwide, spinal cord injuries are associated with diminished participation in the labor market. Inconclusive reporting and differences between workplace settings for individuals with spinal cord injury (SCI) make conceptualizing return to work rates among this population inherently challenging. The objectives of this study are to explore factors associated with return to work (RTW) following an SCI. Moreover, the factors were classified according to the work disability prevention framework. Finally, we conducted a meta-analysis of the prevalence of RTW following an SCI. Methods Original articles were identified through a literature search in four health databases. The study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for the mapping and identification of records. Included studies contained primary studies that included the nature of the injury, antecedent factors associated with the injury, and study characteristics and RTW outcomes. Exclusion criteria for the studies included if there was no discussion of RTW outcomes, systematic reviews, and meta-analyses. Results A total of 461 full-text articles were assessed for eligibility, and eight studies were included and assessed using the Critical Appraisal Skills Programme checklist, Risk of Bias, and Newcastle–Ottawa Scale. Four studies identified personal system factors, four identified healthcare system factors, two identified compensation system factors, and one identified workplace system factors. Conclusions Attempts to optimize RTW among persons with SCI are inherently difficult due to the diversity of this client population. Findings from the studies included in this systematic review support the utility of interventions for facilitating RTW, such as vocational rehabilitation and workplace accommodations, while simultaneously acknowledging the limitations in identifying specific interventions as facilitatory or inhibitory throughout the process.

Geographic variation in work disability burden: Identifying hotspots, coldspots, and associated sociodemographic factors.

To identify geographic hotspots and coldspots of work disability burden and their associated sociodemographic factors in Australia. Using Australian workers' compensation and census data, we calculated weeks of compensated time off work per 1000 labor force, an indicator of work disability burden, at Statistical Area Level 4, the smallest level of labor force data produced by the Australian Bureau of Statistics. Records included all claims with at least 1 day of compensated time off work lodged between 2010 and 2015. Work disability burden was z-transformed by state and territory and mapped across Australia. Statistical Areas that were more than 1 standard deviation from the state or territory mean were considered hotspots and coldspots. We tested several sociodemographic factors as predictors of work disability burden. Work disability burden hotspots were concentrated in lower socioeconomic suburbs and exurbs of state capitals, in addition to several regional areas. Coldspots were primarily in wealthy central urban and suburban areas. Factors associated with greater work disability burden include higher area socioeconomic disadvantage, rurality, lower labor force participation, higher unemployment, higher proportion of work in production industries and in blue-collar occupations, and higher numbers of those with core activity limitations, those aged 65+ years, and foreign-born residents. Work disability burden is unequally distributed across Australia and strongly influenced by sociodemographic and occupational factors. The findings can guide more efficient allocation of resources for work disability prevention and rehabilitation.

Pain in Multiple Sites and Clusters of Cause-Specific Work Disability Development among Midlife Municipal Employees.

This study investigates to what extent pain in multiple sites and common risk factors related to work environment, occupational class and health behaviours are associated with cause-specific work disability (WD) development clusters. The study population was derived from the Finnish Helsinki Health Study (n = 2878). Sequence analysis created clusters of similar subsequent cause-specific WD development in an eight-year follow-up period. Cross-tabulations and multinomial logistic regression were used to analyze the extent to which baseline factors, including pain in multiple sites, were associated with the subsequent WD clusters. A solution with five distinct WD clusters was chosen: absence of any WD (40%), low and temporary WD due to various causes (46%), WD due to mental disorders (3%), WD due to musculoskeletal (8%) and WD due to other causes (4%). Half of the employees in the musculoskeletal WD cluster had pain in multiple locations. In the adjusted model the number of pain sites, low occupational class and physical working conditions were linked to the musculoskeletal WD. The identified characteristics of the different WD clusters may help target tailored work disability prevention measures for those at risk.