Elyssa Besen

Returning to Work Following Low Back Pain: Towards a Model of Individual Psychosocial Factors

Purpose The aim of this paper is to develop and test a model of direct and indirect relationships among individual psychosocial predictors of return-to-work (RTW) outcomes following the onset of low back pain (LBP). Methods We utilize secondary analysis of a larger study of adults seeking treatment for work-related LBP with recent onset. In total, 241 participants who completed a baseline survey, a short follow-up survey, and a longer follow-up survey after 3xa0months were included in our analyses. The participants were required to have LBP with onset of less than 14xa0days, be 18xa0years or older, and be fluent in English or Spanish. The analyses utilized structural equation models to test the direct and indirect relationships among the variables and RTW outcomes at 3xa0months. Results Our results indicated a good fit for our model (χ2xa0=xa069.59, dfxa0=xa045, pxa0<xa0.05; RMSEAxa0=xa0.05; CFIxa0=xa0.95; WRMRxa0=xa0.61). Pain, catastrophizing, fear-avoidance beliefs, organizational support, and RTW confidence were all found to have indirect relationships with the outcomes. RTW confidence and RTW expectations were found to have direct relationships with the outcomes. Conclusions The process of returning to work after an episode of LBP is a complex process involving many interrelated factors. Understanding the relationships among critical individual factors in the RTW process may be important for the treatment and rehabilitation of those with LBP. Results suggest that if injured workers are struggling with fear avoidance, pain catastrophizing and confidence issues, they might benefit from the application of cognitive behavioral therapy techniques.

Manage at work: a randomized, controlled trial of a self-management group intervention to overcome workplace challenges associated with chronic physical health conditions

BackgroundThe percentage of older and chronically ill workers is increasing rapidly in the US and in many other countries, but few interventions are available to help employees overcome the workplace challenges of chronic pain and other physical health conditions. While most workers are eligible for job accommodation and disability compensation benefits, other workplace strategies might improve individual-level coping and problem solving to prevent work disability. In this study, we hypothesize that an employer-sponsored group intervention program employing self-management principles may improve worker engagement and reduce functional limitation associated with chronic disorders.MethodsIn a randomized controlled trial (RCT), workers participating in an employer-sponsored self-management group intervention will be compared with a no-treatment (wait list) control condition. Volunteer employees (nu2009=u2009300) will be recruited from five participating employers and randomly assigned to intervention or control. Participants in the intervention arm will attend facilitated group workshop sessions at work (10xa0hours total) to explore methods for improving comfort, adjusting work habits, communicating needs effectively, applying systematic problem solving, and dealing with negative thoughts and emotions about work. Work engagement and work limitation are the principal outcomes. Secondary outcomes include fatigue, job satisfaction, self-efficacy, turnover intention, sickness absence, and health care utilization. Measurements will be taken at baseline, 6-, and 12-month follow-up. A process evaluation will be performed alongside the randomized trial.DiscussionThis study will be most relevant for organizations and occupational settings where some degree of job flexibility, leeway, and decision-making autonomy can be afforded to affected workers. The study design will provide initial assessment of a novel workplace approach and to understand factors affecting its feasibility and effectiveness.Trial registrationClinicaltrials.gov: NCT01978392 (Issued November 6, 2013)

Sustaining Work Participation Across the Life Course

Introduction Many disability prevention strategies are focused on acute injuries and brief illness episodes, but there will be growing challenges for employers to manage circumstances of recurrent, chronic, or fluctuating symptoms in an aging workforce. The goal of this article is to summarize existing peer-review research in this area, compare this with employer discourse in the grey literature, and recommend future research priorities. Methods The authors participated in a year-long sponsored collaboration that ultimately led to an invited 3-day conference, “Improving Research of Employer Practices to Prevent Disability”, held October 14–16, 2015, in Hopkinton, Massachusetts, USA. The collaboration included a topical review of the scientific and industry literature, group discussion to identify key areas and challenges, drafting of initial documents, and feedback from peer researchers and a special panel of experts with employer experience. Results Cancer and mental illness were chosen as examples of chronic or recurring conditions that might challenge conventional workplace return-to-work practices. Workplace problems identified in the literature included fatigue, emotional exhaustion, poor supervisor and co-worker support, stigma, discrimination, and difficulties finding appropriate accommodations. Workplace intervention research is generally lacking, but there is preliminary support for improving workplace self-management strategies, collaborative problem-solving, and providing checklists and other tools for job accommodation, ideas echoed in the literature directed toward employers. Research might be improved by following workers from an earlier stage of developing workplace concerns. Conclusions Future research of work disability should focus on earlier identification of at-risk workers with chronic conditions, the use of more innovative and flexible accommodation strategies matched to specific functional losses, stronger integration of the workplace into on-going rehabilitation efforts, and a better understanding of stigma and other social factors at work.

Comparing the Relationship Between Age and Length of Disability Across Common Chronic Conditions

Objective: The aim of this study was to compare the association between age and disability length across common chronic conditions. Methods: Analysis of 39,915 nonwork-related disability claims with a diagnosis of arthritis, diabetes, hypertension, coronary artery disease, depression, low back pain, chronic pulmonary disease, or cancer. Ordinary least squares regression models examined age-length of disability association across chronic conditions. Results: Arthritis (76.6 days), depression (63.2 days), and cancer (64.9 days) were associated with longest mean disability lengths; hypertension was related to shortest disability lengths (41.5 days). Across chronic conditions, older age was significantly associated with longer work disability. The age–length of disability association was most significant for chronic pulmonary disease and cancer. The relationship between age and length of work disability was linear among most chronic conditions. Conclusions: Work disability prevention strategies should consider both employee age and chronic condition diagnosis.

Assessing the relationship between chronic health conditions and productivity loss trajectories.

Objective: To examine the relationship between health conditions and the risk for membership in longitudinal trajectories of productivity loss. Methods: Trajectories of productivity loss from the ages of 25 to 44 years, previously identified in the National Longitudinal Survey of Youth (NLSY79), were combined with information on health conditions from the age 40 years health module in the NLSY79. Multinomial logistic regression was used to examine the relative risk of being in the low-risk, early-onset increasing risk, late-onset increasing risk, or high-risk trajectories compared with the no-risk trajectory for having various health conditions. Results: The trajectories with the greatest probability of productivity loss longitudinally had a greater prevalence of the individual health conditions and a greater total number of health conditions experienced. Conclusions: Health conditions are associated with specific longitudinal patterns of experiencing productivity loss.

New Business Structures Creating Organizational Opportunities and Challenges for Work Disability Prevention.

Purpose Flexible work arrangements are growing in order to develop resource-efficient production and because of advanced technologies, new societal values, changing demographics, and globalization. The article aims to illustrate the emerging challenges and opportunities for work disability prevention efforts among workers in alternate work arrangements. Methods The authors participated in a year-long collaboration that ultimately led to an invited 3-day conference, “Improving Research of Employer Practices to Prevent Disability,” held October 14–16, 2015, in Hopkinton, Massachusetts, USA. The collaboration included a topical review of the literature, group conference calls to identify key areas and challenges, drafting of initial documents, review of industry publications, and a conference presentation that included feedback from peer researchers and a roundtable discussion with experts having direct employer experience. Results Both worker and employer perspectives were considered, and four common alternate work arrangements were identified: (a) temporary and contingent employment; (b) small workplaces; (c) virtual work/telework; and (d) lone workers. There was sparse available research of return-to-work (RTW) and workplace disability management strategies with regard to alternate work patterns. Limited research findings and a review of the grey literature suggested that regulations and guidelines concerning disabled workers are often ambiguous, leading to unsatisfactory protection. At the workplace level, there was a lack of research evidence on how flexible work arrangements could be handled or leveraged to support RTW and prevent disability. Potential negative consequences of this lack of organizational guidance and information are higher costs for employers and insurers and feelings of job insecurity, lack of social support and integration, or work intensification for disabled workers. Conclusions Future studies of RTW and workplace disability prevention strategies should be designed to reflect the multiple work patterns that currently exist across many working populations, and in particular, flexible work arrangements should be explored in more detail as a possible mechanism for preventing disability. Labor laws and policies need to be developed to fit flexible work arrangements.

Trajectories of productivity loss over a 20-year period: an analysis of the National Longitudinal Survey of Youth.

OBJECTIVESnWe investigated multiple trajectories of the probability of reporting health-related productivity loss over a 20-year period among adults aged 25-44 years and explored differences among the trajectories in demographic and personal characteristics and employment outcomes in midlife.nnnMETHODSnA latent class growth analysis of health-related productivity loss was estimated on 12 waves of data from the National Longitudinal Survey of Youth (NLSY79) (N=5699), an ongoing nationally representative longitudinal survey of Americans. Waves 1-5 were collected annually at ages 25-29 years. Waves 6-12 were collected biennially at ages 30-44 years. Productivity loss was measured as health fully preventing a person from working or health limiting the amount of kind of work a person could do. Differences among trajectories were assessed using analyses of variance (ANOVA) and Chi-square tests.nnnRESULTSnA five-group trajectory model for productivity loss was identified: (i) no risk, (ii) low risk, (iii) high risk, (iv) increasing risk at early ages, and (v) increasing risk at later ages. At the first wave, after the waves used for the trajectory model in which respondents were approximately age 45 years, the no- and low-risk groups worked the most weeks and hours per week and had the highest percentages of participants employed ≥ 10 weeks compared to the high-risk and early-/late-onset increasing-risk groups, all of which had the lowest levels of mastery, self-esteem, education, and socioeconomic status.nnnCONCLUSIONSnThere are several developmental patterns of productivity loss, with some trajectories being associated with lower work participation in midlife. These high risk patterns may be indicative of individuals needing intervention to prevent premature work withdrawal.

Exploring the relationship between age and tenure with length of disability.

Background The aging of the workforce, coupled with the changing nature of career tenure has raised questions about the impact of these trends on work disability. This study aimed to determine if age and tenure interact in relating to work disability duration. Methods Relationships were investigated using random effects models with 239,359 work disability claims occurring between 2008 and 2012. Results A 17‐day difference in the predicted length of disability was observed from ages 25 to 65. Tenure moderated the relationship between age and length of disability. At younger ages, the length of disability decreased as tenure increased, but at older age, the length of disability increased as tenure increased. Discussion Results indicate that although there is a relationship between length of disability and tenure, age makes a greater unique contribution to explaining variance in length of disability. Future research is needed to better understand why specifically age shows a strong relationship with length of disability and why that relationship varies with age. Am. J. Ind. Med. 58:974–987, 2015.

The Relationship Between Work-Disability Duration and Claimant’s Expected Time to Return to Work as Recorded by Workers’ Compensation Claims Managers

Purpose This research sought to determine whether there is a relationship between claimants’ expected time to return to work (RTW) as recorded by claims managers and compensated days of work disability. Methods We utilized workers’ compensation data from a large, United States-based insurance company. RTW expectations were collected within 30xa0days of the claim being reported and these were compared with the termination of total temporary indemnity payments. Bivariate and hierarchical regression analyses were conducted. Results A significant relationship between expected time to RTW and compensated disability duration was observed. The unadjusted correlation between work-disability duration and expected time to RTW was .25 (pxa0<xa0.001). Our multivariate model explained 29.8xa0% of the variance, with expected time to RTW explaining an additional 9.5xa0% of the variance in work-disability duration beyond what was explained by the covariates. Conclusion The current study’s findings support the hypothesis that claimant RTW estimates as recorded by claims managers are significantly related to compensated-disability duration, and the relationship is maintained after controlling for variance that can be explained by other variables available within workers’ compensation databases.

Lag Times in Reporting Injuries, Receiving Medical Care, and Missing Work: Associations With the Length of Work Disability in Occupational Back Injuries.

Objective: The aim of this study is to examine the associations between lag times following occupational low back injury and the length of work disability. Methods: In a retrospective cohort study using workers’ compensation claims, random effects Tobit models were used to explore how disability length relates to three lag times: the number of days from the date of injury to reporting the injury, the number of days from the date of injury to medical care, and the number of days from the date of injury to initiating work disability. Results: In general, shorter lag times for each of the different lags were related to shorter lengths of disability. Conclusions: Decreasing the length of the lag times in reporting injuries, receiving medical care, and missing work may help to decrease the length of work disability for workers after low back injury.