Workers Compensation Research Articles

289 Mental Health Comorbidities in Workers Compensation Patients and the Effect on Pain, Disability, Quality of Life, and Return to Work After Lumbar Spine Surgery

INTRODUCTION: Outcomes after lumbar spine surgery in workers’ compensation (WC) patients have been reported to be worse than the general population. Anxiety and depression are modifiable risk factors that also adversely affect outcomes after lumbar spine surgery. METHODS: We queried a nationwide, prospective surgical outcomes registry (AANS-QOD) for all patients undergoing lumbar spine surgery at over 200 hospital systems from 2012 to 2021. Perioperative safety, facility utilization, one-year patient-reported outcomes (pain, disability, and quality-of-life), and return to work (RTW) were measured as a function of WC and mental health comorbidity status. RESULTS: A total of 27,525 patients (1018 WC, 26,507 non-WC) undergoing 1-4 level lumbar spine surgery (14,914 laminectomy, 12,611 fusion) were reviewed. WC patients were younger, healthier (lower ASA grade), more likely to be minorities, less educated, more likely to smoke, and had greater baseline back pain, disability, and quality of life compared to non-WC patients. The prevalence of anxiety and depression was similar between groups. WC patients had worse outcomes for all measures and lower rates of RTW compared to non-WC patients. WC patients with anxiety and depression demonstrated even greater disparities in all outcomes. After propensity matching, WC patients with anxiety or depression (n = 107) continued to demonstrate significantly worse outcomes in comparison to WC patients without anxiety or depression (n = 107). CONCLUSIONS: Disparities in outcomes after lumbar spine surgery in WC patients are exacerbated in patients with anxiety and depression. WC patients with mental health comorbidities receive the least benefit from lumbar spine surgery and may represent the most vulnerable subset of patients with spinal pathology. Addressing mental health comorbidities preoperatively may represent an opportunity for valuable resource allocation and surgical optimization in the WC population.

사회복지사 보상체계가 삶의 만족도에 미치는 영향

This study examined the parallel multiple mediating effect of work-life balance and family support on the effect of the social worker compensation system on life satisfaction. The life satisfaction of social workers is the most fundamental factor that prevents impaired quality of life, turnover, and burnout among social workers. Moreover, to improve the life satisfaction of social workers, it is important to consider work-life balance and family support together. Therefore, this study examined the relationship between the compensation system, life satisfaction, work-life balance, and family support among 475 social workers, and the results were as follows: First, it was found that the social worker compensation system had a positive effect on the parameter work-life balance and family support. Second, it was found that the parameters of work-life balance and family support both had positive effects on life satisfaction. Finally, it was found that the compensation system of social workers had an indirect effect on life satisfaction through certain parameters. Both work-life balance and family support, which are parameters, showed indirect effects on the path from the compensation system to life satisfaction. With these results, this study provided basic data for service and policy establishment to improve the compensation system for social workers, and it lastly suggested directions for follow-up studies.

Preoperative predictors of two-year satisfaction in hand and wrist surgery patients

PurposeAs stakeholders seek to improve patient outcomes while maintaining cost-effectiveness in an increasingly expensive healthcare system, metrics such as patient satisfaction are becoming more important. This present study sought to identify factors associated with and independently predictive of better surgical satisfaction two years following hand and wrist surgery. MethodsPatients undergoing hand and wrist surgery at an urban outpatient institution were enrolled preoperatively into a surgical registry and assessed two years postoperatively. Patient satisfaction with surgery was measured at two years postoperatively with the Surgical Satisfaction Questionnaire (SSQ-8). Bivariate analysis determined associations between postoperative satisfaction and patient demographics, injury specifiers, medical history, and multiple patient-reported outcomes (PROs). Multivariable analysis determined independent predictors of two-year postoperative satisfaction following hand and wrist surgery. ResultsBetter surgical satisfaction was associated with having never smoked, no preoperative opioid use, lack of an accompanying legal claim, lack of a workers compensation claim, no clinical history of depression/anxiety, less comorbidities, and higher preoperative expectations.Various PROs relating to function, pain, activity, and general health at both baseline and two years demonstrated associations with postoperative satisfaction. Multivariable analysis confirmed that never smoking, lack of a legal claim, and better preoperative Brief Michigan Hand Questionnaire scores were independently predictive of better surgical satisfaction two years following hand and wrist surgery. ConclusionAt two years following hand and wrist surgery, better patient satisfaction was best predicted by never smoking, no related legal claim, and better baseline Brief Michigan Hand Questionnaire scores. Level of evidenceIII.

Short-acting opioid prescriptions and Workers' Compensation using theNational Ambulatory Medical Care Survey.

Short-acting opioids have been utilized for pain management with little known about their use in patients on Workers' Compensation (WC) insurance. Our goal was to investigate this association in the ambulatory care setting. Using the National Ambulatory Medical Care Survey, visits from patients aged 18-64 during the years 2010 until 2018 were evaluated (excluding 2017 due to data availability). Demographic and co-morbidity data from each visit was obtained along with the visit year. The first short-acting opioid medication prescribed in the database was considered. Survey-weighted frequencies were evaluated. Logistic regression estimated the crude and adjusted odds ratios (OR) with 95% confidence intervals for the use of short-acting opioid prescription. There were 155,947 included visits with 62.5% for female patients. Most patients were White with 11.7% identifying as Black, and 6% identifying as another race. Over 13% of the sample was of Hispanic descent. WC was the identified insurance type in 1.6% of the sample population. Of these patients, 25.6% were prescribed a short-acting opioid, compared with 10.1% of those with another identified insurance. On multivariable regression, Black patients had increased odds of being prescribed a short-acting opioid compared to white patients (OR: 1.22, 95%CI: 1.11-1.34). Those on WC had 1.7-fold higher odds of being prescribed short-acting opioids (95%CI: 1.46-2.06). Certain patient characteristics, including having WC insurance, increased the odds of a short-acting opioid prescription. Further work is needed to identify prescribing patterns in specific high-risk occupational groups, as well as to elicit potential associated health outcomes.

Insurance Status Predicts Periprosthetic Joint Infection after Total Hip Arthroplasty

AbstractPeriprosthetic joint infection (PJI) is one of the most severe complications following total hip arthroplasty (THA), and identifying factors associated with PJI is vital for preoperative risk stratification. The aim of this study was to compare risk of PJI after THA across insurance payers using a statewide health data registry. A retrospective review was conducted querying the New York Statewide Planning and Research Cooperative System for all patients undergoing elective unilateral primary THA using International Classification of Diseases (ICD)-9 and ICD-10 procedure codes. Patients were stratified into groups based on their insurance provider as private payer, Medicare, Medicaid, or worker's compensation. Demographics, hospital clinical data, complications, PJI rates, and mortality rates were collected. PJI rates were significantly different between groups at both 3 (p < 0.001) and 12 months (p < 0.001) postoperatively, highest at both time points in the Medicaid group (3 months: 1.3%; 12 months: 1.8%). Log-rank test demonstrated increased cumulative PJI rates in the worker's compensation and Medicaid groups up to 108 months postoperatively (p < 0.001). Multivariate Cox proportional hazard regression, adjusted for demographics, found that Medicaid insurance was associated with 1.4 times increased risk for PJI relative to Medicare (hazard ratio:1.39; 95% confidence interval [1.19, 1.62]; p < 0.001). These results suggest patients undergoing THA covered by Medicaid are at increased risk for PJI compared with patients covered by other insurance payers. Surgeons should recognize this patient population is at an increased risk for PJI, and compensation policies for treating patients covered by Medicaid should reflect the increased complication rate associated with this population.

The Price of Pain: Workers Compensation Costs for Musculoskeletal Claims in the State of Kansas, 2014-2022.

The aim of the study is to describe cost and frequency of work-related musculoskeletal disorders in Kansas. Data were provided by the Kansas Department of Labor and included all closed workers' compensation claims entailing indemnity and medical costs from 2014 to 2022. Work-related musculoskeletal disorder claims entailed a median total cost of $20,097. Medical comprised 48.4% of costs, indemnity 46.4%, and legal 5.2%. The most frequently injured and costliest body part was the shoulder. Manufacturing comprised 28.4% of claims, followed by health care and office. Lifting was the most common cause, generating 32.0% of claims. Education, transportation, and mining were among industries with above average claim rates. Very few studies use workers' compensation data to assess work-related musculoskeletal disorder costs. This study introduces a state not yet analyzed and presents more recent years of data than available in the literature.

Preoperative opioid use and postoperative return to work following spinal surgery in workers' compensation settings: a systematic review and meta-analysis.

Opioid use prior to spinal surgery is common among patients with workers' compensation (WC) claims. Extended opioid use for pain management in this population is associated with several adverse outcomes including delayed return to work (RTW). This systematic review and meta-analysis aim to assess the evidence on the association of preoperative opioid use with stable RTW and RTW within 1-year after spinal surgery. The authors searched MEDLINE, Embase, PsycINFO, Emcare, CINAHL Plus, Scopus, and Web of Science from inception to 14 January 2023. The authors included studies that compared any preoperative opioid use with no opioid use, and those that enabled a comparison of different durations of preoperative opioid use. The primary outcome was stable RTW after spinal surgery. Secondary outcomes were RTW within 1-year after surgery and cost of WC claims. A random effect model was assumed to pool the effect estimate. The GRADE approach was applied to evaluate the certainty of evidence. From 2589 records, 10 studies were included, and of these, nine were considered for quantitative synthesis. All studies were observational with eight retrospective cohort and two case-control studies. Five studies each investigated cervical and lumbar disorders. With moderate certainty evidence, the odds of postoperative stable RTW reduced by half (OR: 0.51, 95% CI: 0.43-0.59; 5549 participants) in patients using opioids preoperatively. Similarly, moderate certainty evidence from 2348 participants demonstrated that the odds of RTW within 1-year after surgery were reduced by more than half in patients with preoperative opioid prescriptions (OR: 0.46, 95% CI: 0.36-0.59). This systematic review and meta-analysis shows that preoperative opioid use is associated with a reduction in odds of postoperative RTW by half in patients with WC-funded spinal surgery.

Towards sustainable resource valorization: A life cycle sustainability assessment of metals recovery from sulfidic mining residues in Sweden

The mining industry is crucial to the current global economy; however, it confronts sustainability challenges. Recovering secondary metals from mining residues is a promising opportunity to enhance the sustainability of the mining sector. This paper introduces a Life Cycle Sustainability Assessment (LCSA) to evaluate the sustainability of a new valorization process designed for a residue from a sulfidic mine located in Sweden. Results show mixed environmental impacts, with higher climate change (+22%) but lower mineral resource use (-98%) compared to primary mining. Economic analysis suggests that with a CAPEX between 80 M€and 120 M€, the final NPV is between 8.2 M€and 48 M€, depending on the purity of the recovered cobalt. Social analysis reveals fair worker compensation and limited access to local resources as crucial social risks. In the case study presented in this paper, the LCSA provides valuable insights for future cleaner production and more sustainability-oriented decision-making.

Worker's Compensation Injury and Illness Care: A Global Round Table.

Work-related injuries and diseases have a significant impact on workers and their families, society, and the economy. There is a gap in the literature regarding the structures, content, quality, and outcomes of international occupational health systems serving injured and ill workers. This global round table was an attempt to elucidate, evaluate, and identify areas needing improvement. International occupational health professionals were identified via chain/snowball sampling and asked to answer five questions designed to evaluate the structures, processes, and outcomes of the workers' compensation systems in each country. Areas for improvement identified during this round table included timely access, reducing the impact of liability and eligibility determinations on access to medical care, equitable access to care, and the accuracy of reporting. Canada had successfully utilized a virtual approach to care for the geographically remote worker. International workers' compensation structures are designed to ensure timely access to quality care and services. Financial incentives optimize the safety of the working environment. There remain areas for improvement. Resources are limited, especially within the public health systems, which may delay care and affect quality. Informal and remote workers often do not have the same access to care. Occupational Health Services (OHS) and national reporting databases exist throughout the world but may not accurately capture data on informal, self-employed, small business, migrant, and remote workers.

Changes in Health Care Workers’ Economic Outcomes Following Medicaid Expansion

The extent to which changes in health sector finances impact economic outcomes among health care workers, especially lower-income workers, is not well known. To assess the association between state adoption of the Affordable Care Act's Medicaid expansion-which led to substantial improvements in health care organization finances-and health care workers' annual incomes and benefits, and whether these associations varied across low- and high-wage occupations. Difference-in-differences analysis to assess differential changes in health care workers' economic outcomes before and after Medicaid expansion among workers in 30 states that expanded Medicaid relative to workers in 16 states that did not, by examining US individuals aged 18 through 65 years employed in the health care industry surveyed in the 2010-2019 American Community Surveys. Time-varying state-level adoption of Medicaid expansion. Primary outcome was annual earned income; secondary outcomes included receipt of employer-sponsored health insurance, Medicaid, and Supplemental Nutrition Assistance Program benefits. The sample included 1 322 263 health care workers from 2010-2019. Health care workers in expansion states were similar to those in nonexpansion states in age, sex, and educational attainment, but those in expansion states were less likely to identify as non-Hispanic Black. Medicaid expansion was associated with a 2.16% increase in annual incomes (95% CI, 0.66%-3.65%; P = .005). This effect was driven by significant increases in annual incomes among the top 2 highest-earning quintiles (β coefficient, 2.91%-3.72%), which includes registered nurses, physicians, and executives. Health care workers in lower-earning quintiles did not experience any significant changes. Medicaid expansion was associated with a 3.15 percentage point increase in the likelihood that a health care worker received Medicaid benefits (95% CI, 2.46 to 3.84; P < .001), with the largest increases among the 2 lowest-earning quintiles, which includes health aides, orderlies, and sanitation workers. There were significant decreases in employer-sponsored health insurance and increases in SNAP following Medicaid expansion. Medicaid expansion was associated with increases in compensation for health care workers, but only among the highest earners. These findings suggest that improvements in health care sector finances may increase economic inequality among health care workers, with implications for worker health and well-being.

From “dull” to “cheerful”: the relevance of Adam Smith for today

PurposeIs there a secret recipe for economic growth?Design/methodology/approachNo, there is no recipe, but we can extrapolate some pieces of advice from Adam Smith.FindingsAn economy can leave behind its “dull” stagnant state and grow when its markets expand, when the productivity of its workers increases thanks to high compensations, which are seen as incentives to work harder and when lobbying and cronyism are kept at bay. Luck plays a role too, but these three ingredients are necessary, even if not sufficient, for an economy to grow and thus be “cheerful.”Originality/valueThese three aspects – expansion of market, liberal compensation of workers and lobbying – especially combined, have often been underestimated in Smith’s understanding of the possible sources of economic growth.

Distal Radius Fracture Therapy Utilization Following Traditional Open Reduction and Internal Fixation and Dorsal Bridge Plate Fixation.

Background Many distal radius fractures are treated with a volar locking plate, but a minority undergo dorsal bridge plate fixation. This study's primary purpose was to compare therapy utilization following distal radius fractures treated with traditional open reduction and internal fixation (ORIF) versus dorsal bridge plate fixation. Secondary outcomes were time to first and last therapy visits and therapy costs. Methods Patients over 18 years old who underwent distal radius ORIF between January 2021 and August 2022 at a single regional orthopedic practice were identified. Patients who underwent post-operative hardware removal were retrospectively reviewed to identify dorsal bridge plate fixation patients. This resulted in "traditional ORIF" and "dorsal bridge plate" groups. Therapy visit number, cost, and payor(insurance type including Medicare, private insurance, worker's compensation, automobile policy, and private pay) were collected. Results In total, 1,376 patients met the inclusion criteria. Of these, 713 of the 1,283 (55.6%) patients in the traditional ORIF group and 25 of the 44 patients (56.8%) inthe dorsal bridge plate group attended therapy at our institution. Traditional ORIF and dorsal bridge plate patients averaged 12.6(±10) and 24(±18.7) therapy visits in the one-year following ORIF, respectively. Time to last therapy visit was 90.9(±60) and 175.2(±72.1) days in the traditional ORIF and dorsal bridge plate groups, respectively. Total therapy cost was $1,219(±$1,314) and $2,015(±$1,828) in the traditional ORIF and dorsal bridge plate groups with similar out-of-pocket costs. Conclusions Dorsal bridge plate fixation patients attended a greater number of therapy sessions, had a longer time from surgery until therapy end, and had a higher therapy total cost relative to traditional ORIF, but both groups had similar patient out-of-pocket therapy costs.

Mental health comorbidities in workers' compensation patients and the effect on pain, disability, quality of life, and return to work after lumbar spine surgery.

The impact of mental health comorbidities on outcomes after lumbar spine surgery in workers' compensation (WC) patients has not been robustly explored. The goal of this study was to examine the impact of mental health comorbidities on pain, disability, quality of life, and return to work after lumbar spine surgery in WC patients. A nationwide, prospective surgical outcomes registry (National Neurosurgery Quality Outcomes Database [N2QOD]) was queried for all patients who underwent 1- to 4-level lumbar decompression and/or fusion from 2012 to 2021. Patients were stratified on the basis of compensation status into non-WC (25,507) and WC (1018) cohorts. Baseline demographic data, perioperative safety data, and patient-reported outcome measures were compared between groups. The WC cohort was further subdivided on the basis of mental health status into patients with anxiety and depression (n = 107) and those without anxiety and depression (n = 911). Propensity matching was used to generate parity between these subgroups, generating 214 patients (107 pairs) for analysis. Perioperative safety, facility utilization, 1-year patient-reported outcomes (back and leg pain, disability, and quality of life), and return to work were measured as a function of WC and mental health comorbidity status. A total of 26,525 patients (25,507 non-WC and 1018 WC) who underwent 1- to 4-level lumbar spine surgery were reviewed. WC patients were younger, healthier (lower American Society of Anesthesiologists class), more likely to be minorities, less educated, and more likely to smoke and had greater baseline back pain, disability, and quality of life compared to non-WC patients. The prevalence of anxiety and depression was similar between groups (11%). WC patients had worse outcomes for all measures and lower rates of return to work compared to non-WC patients. WC patients with anxiety and depression demonstrated even greater disparities in all outcomes. After propensity matching, WC patients with anxiety and depression continued to demonstrate significantly worse outcomes in comparison to WC patients without anxiety and depression. Disparities in outcomes after lumbar spine surgery in WC patients are exacerbated in patients with anxiety and depression. WC patients with mental health comorbidities receive the least benefit from lumbar spine surgery and may represent the most vulnerable subset of patients with spine pathology. Addressing mental health comorbidities preoperatively may represent an opportunity for valuable resource allocation and surgical optimization in the WC population.

Recruitment strategies in marginalized industries for occupational health research: an example in a pilot study of cleaning staff during COVID-19.

This commentary describes challenges in recruiting workers from marginalized industries with examples from a pilot study of janitors, custodians, and maids and their experiences of cleaning and disinfection protocols during COVID-19 and potentially associated respiratory symptoms. Recruitment strategies included contacting a local hospital, national workers' unions, and a large Arizona employer; using online Facebook groups; and contacting Arizona maid service companies and a school district. English and Spanish online and hard copy surveys about cleaning protocols and respiratory symptoms were used. Participants could also participate in online/phone interviews. Worker's compensation, liability, and confidentiality were concerns across organizations. Online surveys yielded unreliable data. Hard copy surveys were used due to workers' limited technology access. We reflect upon these challenges and discuss other strategies for recruiting from marginalized populations for occupational health research. Building trust with organizations and workers and considering technology access may ultimately increase recruitment feasibility.

Carpal tunnel syndrome among Manitoba workers: Results from the Manitoba Occupational Disease Surveillance System.

Carpal tunnel syndrome (CTS) is associated with occupational high-force repetitive tasks and vibration. This project examines the relationship between CTS and work to: (1) identify jobs and industries with increased CTS risk; (2) explore whether there is a sex difference in the risk of CTS after controlling for occupation; and (3) determine whether any observed relationships persist after excluding Workers Compensation Board (WCB) accepted time-loss CTS claims. We linked 95.5% of time-loss WCB claims from 2006 to 2019 to provincial administrative health data. The cohort included 143,001 unique person-occupation combinations. CTS cases were defined as at least two medical claims for (ICD-9 354) within a 12-month period or a surgical claim for CTS from 2 years before the WCB claim to 3 years after. WCB accepted CTS time-loss claims not identified by the medical claims were also included. A total of 4302 individuals (3.0%) met the CTS definition. Analysis revealed that the hazard ratios (HRs) of CTS vary considerably with occupation. Sex-based differences in CTS risks were observed, both in low- and high-risk occupations. In many occupations with increased HR, the HR remained elevated after excluding accepted time-loss WCB cases. The risk of developing CTS varied with occupation. Job titles with ergonomic risk factors had higher risks than those with lower exposures. This finding remained after eliminating time-loss compensated WCB cases, suggesting that all cases of CTS in high risk jobs are not identified in WCB statistics. Female workers in some job titles had excess CTS cases compared to male workers within the same job title.

Outcomes for a Heat Illness Prevention Program in Outdoor Workers: A 9-Year Overview.

To describe the outcomes effect of removing the medical surveillance component from a heat illness prevention program (HIPP) for outdoor workers from a Central Texas municipality. Heat-related illness (HRI) frequency and workers' compensation (WC) cost were assessed retrospectively in a cohort of 329 workers from 2011-2019. During 2011-2017, the HIPP included training, acclimatization, and medical surveillance. In 2018-2019, a modified (mHIPP) was implemented that included training and acclimatization, but without medical surveillance. The HRI rate during HIPP averaged 19.5 per 1000 workers during the first 4 years, dropped to 1.01 per 1,000 workers over the next 3 years, (2015-2017), and increased during mHIPP, to 7.6 per 1,000 workers. Although the case increase during the mHIPP was small, medical surveillance may be an important component in lowering workforce HRI.

Is Arthroscopic Meniscectomy Associated With an Increased Risk of Total Knee Arthroplasty for Claimants in the Workers' Compensation System? A 10-Year Study of Workers' Compensation Claims From a Large Nationwide Workers' Compensation Insurance Carrier.

Total knee arthroplasty (TKA) is a commonly performed knee surgery and prior arthroscopic meniscectomy (AM) has been linked to an increased risk of TKA in the general population. To study the relationship between AM and TKA among injured workers whose medical care is paid for under workers' compensation (WC). A total of 17,247 lost-time claims depicting all arthroscopic knee surgical procedures performed from 2007 to 2017 were followed to the end of 2022 and analyzed. The odds ratio of undergoing a TKA for those with a preceding AM is 2.20, controlling for age, sex, and attorney involvement. Undergoing an AM is associated with an increased risk of TKA in WC claimants.

Using CFIR framework for understanding barriers and facilitators to implementation of community tuberculosis program in Burkina Faso.

In 2020, there were nearly 9.9 million new Tuberculosis cases and 1.3 million deaths, with about 95% occurring in developing nations. Burkina Faso implemented a community Tuberculosis program, involving Civil Society Organizations, to increase screening and improve treatment outcomes. Therefore, this study aims to identify the factors influencing the implementation of community interventions involving these organizations in the fight against TB in Burkina Faso. This qualitative study conducted semi-structured key informant interviews with a purposive sample of health providers from the ministry of health and community health workers. We used framework (the consolidated framework for implementation research was used method to identify barriers and facilitators to implementation of community tuberculosis program in Burkina Faso. A total of 23 interviews were conducted. The results of this research shed light on several key factors that either contributed to or hindered the program's success. Among the facilitating factors, we identified close collaboration between national and international stakeholders, as well as remarkable program flexibility to adapt to local conditions. Furthermore, continuous training and support for community health workers proved crucial for the program's implementation. However, significant challenges were also unveiled. These challenges encompassed insufficient financial resources, difficulties related to the recruitment and management of civil society associations, and issues regarding program ownership at the peripheral level. Additionally, irregular payments to community health workers had a detrimental impact on their motivation and commitment. Our study conducted a comprehensive examination of the obstacles and facilitators encountered in the implementation of a community-based tuberculosis control program in Burkina Faso. The results of this research shed light on several key factors that either contributed to or hindered the success implementation of program. Measures should be taken to mobilize national resources, strengthen the capacities of associations, and promote local ownership of the program. Special attention should also be given to improving financial management and resolving issues related to the recruitment and compensation of community health workers. For such community-based tuberculosis programs to succeed in Burkina Faso and in similar context it is essential to address these obstacles and facilitators.

Overview of Occupational Injuries Among Registered Nurses in Washington State, 2007 to 2019.

Registered nurses (RNs) represent the largest segment of the health care workforce and have unique job demands and occupational health considerations. The purpose of this study was to describe the incidence, cost, and causes of occupational injuries among RNs in Washington State and to quantify the cumulative cost and burden of each type of injury, relative to all injuries among RNs. Annual injury claims data covered under Washington State workers' compensation (WC) fund were analyzed over a 13-year period (2007-2019). Annual mean incidence and cost of injuries were calculated and stratified by nature, source, and event/exposure. Negative binomial regression models were used to examine trends in injury incidence over time, for injury incidence overall, and by the most common injury classifications. Between 2007 and 2019, 10,839 WC claims were filed and accepted for Washington State RNs (annual M = 834), totaling more than US$65 million. No significant trend in overall injury incidence was observed (incidence rate ratio [IRR]: 0.99, 95% confidence interval [CI] = [0.94, 1.05]). The most common injury exposures were bodily reaction and exertion, contact with objects and equipment, falls, and assaults and violent acts. To our knowledge, this is the first broad study of the incidence and costs of occupational injuries among RNs across all workplace settings. We identified high-cost, high-frequency incidence rates of musculoskeletal, sharp, and violence-related occupational injury claims, highlighting intervention targets. Implications for Occupational Health Practice: Policy makers, health systems, and occupational health nurse leaders can use this information to identify priority areas where evidence-based occupational health and prevention programs are most needed.

Occupational Therapy and Public Safety Personnel: Return to Work Practices and Experiences.

Background. Public safety personnel (PSP) are frequently exposed to psychological trauma through their work. Evidence shows that worker's compensation claims for work-related psychological injuries are on the rise for PSP. Occupational therapists increasingly provide return to work (RTW) services for this population. Purpose. To explore the therapeutic practices and personal experiences of occupational therapists working with PSP who have work-related psychological injuries. Method. This mixed methods descriptive study included a chart review of available occupational therapy client records from 2016 to 2020 for PSP with work-related psychological injuries from two Ontario companies. Additionally, a web-based self-report survey for Ontario occupational therapists providing RTW services to this same population was available from November 1, 2021 to June 1, 2022. Findings. The chart review included 31 client records and the online survey was completed by 49 Ontario occupational therapists. Therapists commonly provided services in clients' homes, workplaces, and communities, and focused on functional activities. The evidence base drawn on by therapists was not always occupation-based. Barriers to RTW included challenges with interprofessional collaboration, stigma, and the COVID-19 pandemic. Implications. Occupational therapists are commonly working with PSP with work-related psychological injuries and have the opportunity to contribute to the evidence base for occupational approaches to RTW.