Merete Labriola

Physical work environment risk factors for long term sickness absence: prospective findings among a cohort of 5357 employees in Denmark

Abstract Objectives To examine the effects of physical work environment on long term sickness absence and to investigate interaction between physical and psychosocial risk factors. Design and setting Prospective cohort study of long term sickness absence among employees in Denmark. Participants 5357 employees interviewed in 2000 about their physical work environment, and various covariates were followed for 18 months in a national sickness absence register. Outcome measurements Cox regression analysis was performed to assess risk estimates for physical risk factors in the work environment and onset of long term sickness absence, defined as receiving sickness absence compensation for eight consecutive weeks or more. Results 348 participants (6.9%) developed long term sickness absence during follow-up. Of these, 194 (55.7%) were women and 154 (44.3%) were men. For both female and male employees, risk of onset of long term sickness absence was increased by extreme bending or twisting of the neck or back, working mainly standing or squatting, lifting or carrying loads, and pushing or pulling loads. Significant interactions were found for three combinations of physical and psychosocial work environment risk factors among female employees (P<0.05). Conclusion Uncomfortable working positions, lifting or carrying loads, and pushing or pulling loads increased the risk of onset of long term sickness absence. The study shows a potential for reducing long term sickness absence through modifying work postures straining the neck and back, reducing the risk of work done standing or walking, and reducing the risk associated with handling loads. Dealing with psychosocial stressors simultaneously may improve physical intervention efforts further for female employees.

Psychosocial work environment exposures as risk factors for long-term sickness absence among danish employees : Results from DWECS/DREAM

Objective:This study examines effects of psychosocial risk factors on long-term sickness absence, and investigates possible interactions between psychosocial and physical work environment risk factors. Methods:A total of 5357 employees were interviewed in 2000 regarding work environment and followed up during the proceeding 1.5 years regarding onset of long-term sickness absence. Results:Long-term sickness absence among female employees was associated with role conflict, low reward, and poor management quality. Demands for hiding emotions and high emotional demands predicted long-term sickness absence among men. No significant interactions between psychosocial and physical exposures were found for female or male employees. Conclusions:The study suggests a potential for reducing long-term sickness absence through interventions targeted toward reducing role conflict, and improving reward and management quality among female employees, and through reducing emotional demands and demands for hiding emotions among male employees.

Using administrative sickness absence data as a marker of future disability pension : the prospective DREAM study of Danish private sector employees

Objectives: The aim of this study was to examine duration of sickness absence as a risk marker for future disability pension among all private sector employees in Denmark 1998–2004. Methods: All private sector employees receiving sickness absence compensation from the municipality in 1998, a total of 225 056 persons (39.2% women 61.8% men, age range 18–65, mean age 37.2), were followed in a national register to determine granted disability pension during the period 1 January 2001 through 31 December 2004. The authors excluded pensions in 1999 and 2000 to determine the status of sickness absence duration as an early risk marker. Results: 5694 persons (2.5%) received disability pension during follow-up, more men (53.4%) than women (46.6%). There was a strong graded association between increasing length of absence and increasing risk of future disability pension. Significant differences were found between the younger and older age strata: men below 40 experiencing more than 26 weeks of sickness absence had a 16-fold risk of disability pension. The corresponding figure for men 40 years or older was approximately 7. For women, the corresponding figures were 12.6 and 6.7 respectively. Conclusion: The findings suggest that administratively collected data on sickness absence compensation are an important predictor of disability pension among private sector employees. The use of information on sick leave may improve the effectiveness of early interventions by policy makers, case managing authorities, employers and physicians.

Functional restoration versus outpatient physical training in chronic low back pain: a randomized comparative study

Study Design. A randomized parallel-group comparative trial with a 1-year follow-up period was performed. Objective. To compare the effect of a comprehensive functional restoration program involving intensive physical training, ergonomic training, and behavioral support (39 hours per week for 3 weeks) with the effect of outpatient intensive physical training (1.5 hours three times per week for 8 weeks). Summary of Background Data. Nonrandomized studies conducted in the United States favor functional restoration for patients with chronic low back pain. Two previously reported randomized studies from the authors’ Back Center in Copenhagen concur with this recommendation, although the positive effects in one of the studies had faded out after 2 years. Randomized functional restoration studies in Canada and Finland have failed to demonstrate any substantive effect. Methods. Initially, 138 patients with chronic low back pain were included in the current study. They then were randomized to either functional restoration (n = 64) or outpatient intensive physical training (n = 74). Of the initial 138 patients, 11 never started (5 and 6, respectively); 21 dropped out during treatment (8 and 13); and 7 of the graduates did not take part in the 1-year follow-up evaluation (3 and 4). The conclusions were drawn from the 99 patients (48 and 51, respectively) who graduated and participated in a 1-year follow-up evaluation. The median age of the patients was 42 years (range, 21–55 years) The female-to-male ratio was 68 to 31, and the median sick leave days during the preceding 3 years was 180 (range, 0–1080 days). The average back pain was rated 5.5 on a scale of 0 (no pain) to 10 (maximal pain). For these variables, there were no important differences between the groups. However, the functional restoration group tended to be more capable of work at baseline (58%vs 42%;P = 0.09). Results. At the 1-year follow-up evaluation, overall assessment favored functional restoration. Otherwise, no significant differences were observed regarding work capability, sick leave for those at work, health care contacts,back pain, leg pain, or self-reported activities of daily living. Conclusions. Only in terms of overall assessment, the functional restoration program was superior to a comparatively short time-consuming outpatient physical training program. Discussion. It may be that lower economic benefits during sick leave in the United States lead to favorable results from functional restoration programs, whereas greater benefits in Canada, Finland, and Denmark result in different conclusions. Finally, it may be that the difference in results across studies points simply to whether the studies were randomized.

Explaining the social gradient in long-term sickness absence: a prospective study of Danish employees

Objectives: To identify differences in risk of sickness absence between socioeconomic groups, and to examine to what extent these differences can be explained by health behaviour and work environment factors. Design, setting and participants: A cohort of 5221 employees in Denmark interviewed in 2000 regarding health behaviours and work environment were followed for 18 months in order to assess their rate of sickness absence exceeding eight consecutive weeks. Based on employment grade, job title and education respondents were classified into five socioeconomic position (SEP) groups. Executive managers and academics were the reference group. Results: For both genders a social gradient in long-term sickness absence rates was evident. In men, controlling for health behaviours and physical work environment factors reduced rate ratios by 22–57%. Controlling for health behaviours alone reduced rate ratios by 6–13%. In women, controlling for health behaviour reduced rate ratios by 5–18%, and controlling for both health behaviours and physical work environment factors reduced rate ratios by 21–44%. Introducing psychosocial factors reduced the rate ratios further, yielding a reduction of 22–53% in the fully adjusted model. In both genders, the largest reductions were seen in skilled blue-collar workers and for semi-skilled or unskilled workers (by 58–59% in men and by 41–53% in women). Conclusion: A social gradient in long-term sickness absence was found. Physical work environment explained more of this gradient than health behaviour. Also including psychosocial work environment in the model had no effect in men but a small effect among women.

Do fear-avoidance beliefs play a role on the association between low back pain and sickness absence? A prospective cohort study among female health care workers.

Health care workers have a high prevalence of sickness absence because of low back pain (LBP). This study examined whether fear-avoidance beliefs (FAB): 1) predicted sickness absence and 2) moderated the association between LBP and sickness absence among 1724 newly educated health care workers with LBP ≥ day during the previous 12 months. High FAB was associated with sickness absence days 1 year later (relative risk, 1.45, 95% confidence interval = 1.24 to 1.70), controlled for LBP, previous sickness absence, and age. When controlling for work environmental factors, the association remained significant but decreased. Furthermore, the results showed that health care workers with high degree of LBP would have more sickness absence days if they also had high FAB. To reduce sickness absence, education about pain management must be presumed to be beneficial.

Multilevel analysis of workplace and individual risk factors for long-term sickness absence.

Objective: The objective of this study was to examine if psychosocial and physical work-environment factors predict long-term sickness absence (>8 weeks) at both the individual and the workplace level. Material and Methods: Data were collected in a prospective study in 52 Danish workplaces. Psychosocial factors were aggregated as workplace means. We used multilevel logistic regression models with psychosocial factors as predictors of long-term sickness absence over 5 years based on data from a national absence register. Results: Long-term sickness absence was predicted by physical work-environment factors at the individual level and psychosocial work environment factors at the workplace level. Interaction between the individual physical and workplace-level psychosocial risk factors was found. Conclusion: Workplace-based absence reduction interventions can be enhanced by concurrently addressing the individual and the workplace level.

Differences in sickness absence in Sweden and Denmark: the cross national HAKNAK study

AIM To investigate potential differences in sickness absence among public sector employees in Sweden and Denmark, and to what extent a difference was associated with age, gender, physical and psychosocial work environment exposures, lifestyle factors, self-rated health or work ability. METHODS In 2000, two cross-sectional samples of 8562 public sector employees in Sweden and Denmark were surveyed. The study outcome, self-reported number of sick-leave days the year preceding interview, was dichotomized into 7 days or less, and more than 7 days. Chi square test was used to analyse distribution of dependent and independent variables in the two sub-cohorts. Stratified logistic regression analysis was performed to identify causes for absence within the two sub-cohorts, and logistic regression analysis was performed to study differences in sickness absence levels between the two sub-cohorts. RESULTS More subjects from the Swedish study population reported more than 7 days of sickness absence. Factors associated with sickness absence were largely similar in the two countries. The difference in absence level between Sweden and Denmark was not associated with differences in age, gender, skill level, lifestyle, psychosocial or physical work environment, musculoskeletal symptoms or self-rated health, whereas work ability score decreased the difference in sickness absence level. CONCLUSION The results could indicate an increased retention of employees with health problems in the Swedish labour market compared with the Danish labour market. A possible explanation for the differences in sickness absence ascertained in this study could be due to differences in the sickness insurance legislation.

The impact of psychosocial work environment factors on the risk of disability pension in Denmark

This study quantifies the impact of psychosocial work environment factors on the risk of disability pension. Differences in risk of disability pension were estimated in a representative sample of Danish employees followed for a total of 118 117 person-years of risk time. After control for smoking, BMI and ergonomic work environment, low decision authority and low variation in work showed a statistically significant association with disability pension. Adverse psychosocial work environment factors accounted for 10-15% of disability pension cases.

The fraction of long‐term sickness absence attributable to work environmental factors: prospective results from the Danish Work Environment Cohort Study

Objective: To examine the fraction of long-term sickness absence periods attributable to physical and psychosocial work environmental risk factors. Method: A random population sample was followed for 18 months in a national register of social transfer payments. Mutually adjusted hazard ratios for onset of long-term sickness absence and aetiological fractions were computed. Results: After mutual adjustment, no significant effect of psychosocial work environment factors remained. In men, 23% and 28% of long-term sickness absence were attributable to working mainly standing or squatting, and lifting or carrying loads, respectively. In women, 27% of long-term sickness absence was attributable to bending or twisting of the neck or back. Conclusions: Physical work environment exposures explained between 10% and 30% of long-term sickness absence. The potential for reducing long-term sickness absence is substantial.