Ivan Steenstra

Comparing current definitions of return to work: A measurement approach

Introduction Return-to-work (RTW) status is an often used outcome in work and health research. In low back pain, work is regarded as a normal activity a worker should return to in order to fully recover. Comparing outcomes across studies and even jurisdictions using different definitions of RTW can be challenging for readers in general and when performing a systematic review in particular. In this study, the measurement properties of previously defined RTW outcomes were examined with data from two studies from two countries. Methods Data on RTW in low back pain (LBP) from the Canadian Early Claimant Cohort (ECC); a workers’ compensation based study, and the Dutch Amsterdam Sherbrooke Evaluation (ASE) study were analyzed. Correlations between outcomes, differences in predictive validity when using different outcomes and construct validity when comparing outcomes to a functional status outcome were analyzed. Results In the ECC all definitions were highly correlated and performed similarly in predictive validity. When compared to functional status, RTW definitions in the ECC study performed fair to good on all time points. In the ASE study all definitions were highly correlated and performed similarly in predictive validity. The RTW definitions, however, failed to compare or compared poorly with functional status. Only one definition compared fairly on one time point. Conclusions Differently defined outcomes are highly correlated, give similar results in prediction, but seem to differ in construct validity when compared to functional status depending on societal context or possibly birth cohort. Comparison of studies using different RTW definitions appears valid as long as RTW status is not considered as a measure of functional status.

Sickness benefit claims due to mental disorders in Brazil: associations in a population-based study

This study aims to determine the prevalence and duration of sickness benefit claims due to mental disorders and their association with economic activity, sex, age, work-relatedness and income replacement using a population-based study of sickness benefit claims (> 15 days) due to mental disorders in Brazil carried out in 2008. The prevalence of mental disorders was 45.1 claims per 10,000 workers. Prevalence and duration of sickness benefit claims due to mental disorder were higher and longer in workers aged over 40 years. Prevalence of claims was 73% higher in women but duration of sickness benefit claims was longer in men. Prevalence rates for claims differed widely according to economic activity, with sewage, residential care and programming and broadcasting activities showing the highest rates. Claims were deemed to be work-related in 8.5% of cases with mental disorder showing low work-relatedness in Brazil. A wide variation of prevalence and duration between age, economic activity and work-relatedness was observed, suggesting that working conditions are a more important factor in mental disorder work disability than previously assumed.

Development of a Computer-Based Clinical Decision Support Tool for Selecting Appropriate Rehabilitation Interventions for Injured Workers

Purpose To develop a classification algorithm and accompanying computer-based clinical decision support tool to help categorize injured workers toward optimal rehabilitation interventions based on unique worker characteristics. Methods Population-based historical cohort design. Data were extracted from a Canadian provincial workers’ compensation database on all claimants undergoing work assessment between December 2009 and January 2011. Data were available on: (1) numerous personal, clinical, occupational, and social variables; (2) type of rehabilitation undertaken; and (3) outcomes following rehabilitation (receiving time loss benefits or undergoing repeat programs). Machine learning, concerned with the design of algorithms to discriminate between classes based on empirical data, was the foundation of our approach to build a classification system with multiple independent and dependent variables. Results The population included 8,611 unique claimants. Subjects were predominantly employed (85xa0%) males (64xa0%) with diagnoses of sprain/strain (44xa0%). Baseline clinician classification accuracy was high (ROCxa0=xa00.86) for selecting programs that lead to successful return-to-work. Classification performance for machine learning techniques outperformed the clinician baseline classification (ROCxa0=xa00.94). The final classifiers were multifactorial and included the variables: injury duration, occupation, job attachment status, work status, modified work availability, pain intensity rating, self-rated occupational disability, and 9 items from the SF-36 Health Survey. Conclusions The use of machine learning classification techniques appears to have resulted in classification performance better than clinician decision-making. The final algorithm has been integrated into a computer-based clinical decision support tool that requires additional validation in a clinical sample.

Incidence of work and non-work related disability claims in Brazil

BACKGROUNDnSickness benefit claims are an important economic burden to society. This study aims to determine the incidence of sickness benefit claims in Brazil in 2008, exploring the role of economic activity.nnnMETHODSnPopulation-based study on sickness claims lasting longer than 15 days of sickness absence granted to private sector employees. Data on gender, age, economic activity, diagnosis, and work-relatedness were collected.nnnRESULTSnThe annual incidence of sickness benefits was 421.8/10,000 jobs, 435.4 for males and 452.0 for females. There were 3.5 times more non-work-related than work-related claims. The main diagnoses were injuries, musculoskeletal disorders, and mental disorders. Rates increased with age up to 59 years. Economic activity 37-Sewage had the highest incidence of non-work-related and work-related claims.nnnCONCLUSIONnThe incidence of sickness benefits is higher among female and older workers. Economic activities show great variability of sickness benefit rates, work-relatedness, diagnostic categories, and gender.

Predicting Time on Prolonged Benefits for Injured Workers with Acute Back Pain

Introduction Some workers with work-related compensated back pain (BP) experience a troubling course of disability. Factors associated with delayed recovery among workers with work-related compensated BP were explored. Methods This is a cohort study of workers with compensated BP in 2005 in Ontario, Canada. Follow up was 2xa0years. Data was collected from employers, employees and health-care providers by the Workplace Safety and Insurance Board (WSIB). Exclusion criteria were: (1) no-lost-time claims, (2) >30xa0days between injury and claim filing, (3) <4xa0weeks benefits duration, and (4) age >65xa0years. Using proportional hazard models, we examined the prognostic value of information collected in the first 4xa0weeks after injury. Outcome measures were time on benefits during the first episode and time until recurrence after the first episode. Results Of 6,657 workers, 1,442 were still on full benefits after 4xa0weeks. Our final model containing age, physical demands, opioid prescription, union membership, availability of a return-to-work program, employer doubt about work-relatedness of injury, worker’s recovery expectations, participation in a rehabilitation program and communication of functional ability was able to identify prolonged claims to a fair degree [area under the curve (AUC)xa0=xa0.79, 95xa0% confidence interval (CI) .74–.84]. A model containing age, sex, physical demands, opioid prescription and communication of functional ability was less successful at predicting time until recurrence (AUCxa0=xa0.61, 95xa0% CI .57, .65). Conclusions Factors contained in information currently collected by the WSIB during the first 4xa0weeks on benefits can predict prolonged claims, but not recurrent claims.

Systematic review and network meta-analysis of interventions for fibromyalgia: a protocol

BackgroundFibromyalgia is associated with substantial socioeconomic loss and, despite considerable research including numerous randomized controlled trials (RCTs) and systematic reviews, there exists uncertainty regarding what treatments are effective. No review has evaluated all interventional studies for fibromyalgia, which limits attempts to make inferences regarding the relative effectiveness of treatments.Methods/designWe will conduct a network meta-analysis of all RCTs evaluating therapies for fibromyalgia to determine which therapies show evidence of effectiveness, and the relative effectiveness of these treatments. We will acquire eligible studies through a systematic search of CINAHL, EMBASE, MEDLINE, AMED, HealthSTAR, PsychINFO, PapersFirst, ProceedingsFirst, and the Cochrane Central Registry of Controlled Trials. Eligible studies will randomly allocate patients presenting with fibromyalgia or a related condition to an intervention or a control. Teams of reviewers will, independently and in duplicate, screen titles and abstracts and complete full text reviews to determine eligibility, and subsequently perform data abstraction and assess risk of bias of eligible trials. We will conduct meta-analyses to establish the effect of all reported therapies on patient-important outcomes when possible. To assess relative effects of treatments, we will construct a random effects model within the Bayesian framework using Markov chain Monte Carlo methods.DiscussionOur review will be the first to evaluate all treatments for fibromyalgia, provide relative effectiveness of treatments, and prioritize patient-important outcomes with a focus on functional gains. Our review will facilitate evidence-based management of patients with fibromyalgia, identify key areas for future research, and provide a framework for conducting large systematic reviews involving indirect comparisons.

A Comparison of Two Methods to Assess the Usage of Mobile Hand-Held Communication Devices

The purposes of this study were to: 1) examine agreement between self-reported measures of mobile device use and direct measures of use, and 2) understand how respondents thought about their device use when they provided self-reports. Self-reports of six categories of device use were obtained using a previously developed questionnaire, and direct measures of use were collected using a custom logging application (n = 47). Bland-Altman analyses were used to examine agreement between the two measurement approaches. Interviews targeted participants’ experiences completing the device use section of the questionnaire. Self-reports of use on a typical day last week overestimated logged use. Overestimates tended to be low at low average usage times, and became more variable as usage time increased. Self-reports of use yesterday also exceeded logged use, however the degree of overestimation was less than for a typical day last week. Six themes were identified from interviews, including the thought process used by participants to arrive at usage and the ease of reporting usage. It is challenging for respondents of this questionnaire to provide accurate self-reports of use. The source of this challenge may be attributed to the intrinsic difficulty of estimating use, partly due to the multiple functions of the devices as well as the variability of use both within a day and a week. Research investigating the relationship between device use and health outcomes should include a logging application to examine exposure simultaneously with self-reports to better understand the sources of hazardous exposures.

Predicting Return to Work for Workers with Low-Back Pain

Scientists at the Institute for Work & Health (IWH) investigated the idea of predicting return to work (RTW) for workers with low-back pain (LBP). The objective of this study was to assess the evidence on factors from different domains that predict the duration of sick leave in workers in the beginning of a LBP-related sick leave episode. A systematic review was done in which the IWH scientists identified the studies that looked at prognostic factors associated with time until RTW for workers with LBP, covering studies published in the time frame from January 1966 to April 2011. (This work represents an update on an earlier 2005 review.) Thirty papers from 25 different studies met all of the inclusion criteria. (Eleven were articles captured in the earlier review, and 19 were published after the 2005 review.) The team assessed the methodological quality of the studies that were included. The team found five general factors with strong evidence for returning to work: recovery expectations; healthcare provider type; self-reported disability; pain intensity; and radiating pain. Additionally, workplace-specific factors predictive of RTW were physical demands; accommodation and modified duties; and job satisfaction. The study also found factors that did not predict RTW and factors with mixed evidence. The scientists discussed the review with practitioners in a knowledge transfer workshop. The findings of this systematic review can be used to develop an approach for identifying at-risk workers with LBP, or more specifically, those workers in the early stages of work disability from LBP at high risk for poor RTW outcomes. Practitioners could prioritise and allocate resources based on this new information. The factors identified in this review could be used to screen those workers at high risk of long-term or permanent disability. From these findings a screening tool could be developed, although such a tool would require validation to obtain reliable risk estimates. However, applying this new knowledge in practice should be executed in a structured way. The effectiveness of choosing interventions for workers with LBP based on prognostic information for RTW needs to be established and therefore applying this approach should be done with care.

The eye-complaint questionnaire in a visual display unit work environment: Internal consistency and test–retest reliability

The internal consistency and test–retest reliability of a 10-item eye-complaint questionnaire (ECQ) were examined within a sample of office workers. Repeated within-subjects measures were performed within a single day and over intervals of 1 and 7 d. Questionnaires were completed by 96 workers (70% female, mean age 36.4 years) who perform more than 4 h of visual display unit work each day. The internal consistency of the ECQ was high (α = 0.801). Although test–retest reliability was low within a single day (morning and afternoon) (intra-class correlation coefficient (ICC) = 0.68, 95% CI 0.38, 0.82), it was good between two morning measurements over a 1-d interval (ICC = 0.91 95% CI 0.87, 0.94) and between morning measurements with a 7-d interval (ICC = 0.87, 95% CI 0.81, 0.92). The ICC between afternoon measurements over a 1-week interval was moderate (ICC = 0.78, 95% CI 0.66, 0.85). This questionnaire is a reliable and consistent instrument for easily assessing eye complaints in office work. The timing of the measurements must be kept in consideration since measurements are confounded by exposures over the day.

An efficient strategy allowed English-speaking reviewers to identify foreign-language articles eligible for a systematic review

OBJECTIVEnTo assess English-speaking reviewers accuracy in determining the eligibility of foreign-language articles for a systematic review.nnnSTUDY DESIGN AND SETTINGSnSystematic review of randomized controlled trials of therapy for fibromyalgia. Guided by 10 questions, English-speaking reviewers screened non-English-language articles for eligibility. Teams of two native-language speakers provided reference standard judgments of eligibility.nnnRESULTSnOf 15,466 potentially eligible articles, we retrieved 763 in full text, of which 133 were published in 19 non-English languages; 53 trials published in 11 languages other than English proved eligible. Of the 53 eligible articles, English-language reviewers guided by the 10 questions mistakenly judged 6 as ineligible; of the 80 ineligible articles, 8 were incorrectly judged eligible by English-language reviewers (sensitivity=0.89; specificity=0.90). Use of a simple three-step rule (excluding languages with less than three articles, reviewing titles and abstracts for clear indications of eligibility, and noting the lack of a clearly reported statistical analysis unless the word random appears) led to accurate classification of 51 of 53 articles (sensitivity=0.96; specificity=0.70).nnnCONCLUSIONnOur findings show promise for limiting the need for non-English-language review teams in systematic reviews with large numbers of potentially eligible non-English-language articles.