Sandra Brouwer

Prediction of Sickness Absence in Patients with Chronic Low Back Pain: A Systematic Review

Objectives: To provide evidence of predictors for sickness absence in patients with non-specific chronic low back pain (CLBP), distinguishing predictors aimed at the decision to report sick (absence threshold) and decision to return to work (return to work threshold). Methods: Medical and psychological databases were searched, as well as citations from relevant reviews. In- and exclusion criteria were applied. Two reviewers assessed the methodological quality of the papers independently. Results: Many different predictors were studied, and few factors were studied more than once. Consistent evidence was found for own expectations of recovery only as predictor for the decision to return to work. Patients with higher expectations had less sickness absence at the moment of follow-up measurement. As expected, different predictors were found aiming at the absence threshold or the return to work threshold. Furthermore, predictors varied also with the measurement instruments used, timing of follow-up measurements, and definition of outcomes. Until now, too few studies are available to overcome several potential sources of heterogeneity. Conclusions: No core set of predictors exists for sickness absence in general. The characteristics of the study including the decision to report sick or to return to work determined the influence of several predictors on sickness absence in patients with CLBP. Further research and use of a core set of measurements and uniform definitions are needed to predict sickness absence and return to work in patients with CLBP.

Influence of poor health on exit from paid employment: a systematic review.

The objective was to provide a systematic literature review on associations between poor health and exit from paid employment through disability pension, unemployment and early retirement, and to estimate the magnitude of these associations using meta-analyses. Medline and Embase databases were searched for longitudinal studies on the relationship between health measures and exit from paid employment. Random-effects models were used to estimate the pooled effects. In total, 29 studies were included. Self-perceived poor health was a risk factor for transition into disability pension (relative risk (RR) 3.61; 95% CI 2.44 to 5.35), unemployment (RR 1.44; 95% CI 1.26 to 1.65) and early retirement (RR 1.27; 95% CI 1.17 to 1.38). Workers with mental health problems had an increased likelihood for transition into disability pension (RR 1.80; 95% CI 1.41 to 2.31) or unemployment (RR 1.61; 95% CI 1.29 to 2.01). Chronic disease was a risk factor for transition into disability pension (RR 2.11; 95% CI 1.90 to 2.33) or unemployment (RR 1.31; 95% CI 1.14 to 1.50), but not for early retirement. This meta-analysis showed that poor health, particularly self-perceived health, is a risk factor for exit from paid employment through disability pension, unemployment and, to a lesser extent, early retirement. To increase sustained employability it should be considered to implement workplace interventions that promote good health.

Reliability and stability of the Roland Morris Disability Questionnaire : intra class correlation and limits of agreement

Purpose: To analyse test-retest reliability and stability of the Dutch language version of the Roland Morris Disability Questionnaire (RMDQ) in a sample of patients (n = 30) suffering from Chronic Low Back Pain (CLBP). Method: Patients filled out the Dutch language version of the RMDQ questionnaire twice, before starting the rehabilitation programme, with a 2-week interval. Intra Class Correlations (ICC), (one way random) was used as a measure for reliability and the limits of agreement were calculated for quantifying the stability of the RMDQ. An ICC of 0.75 or more was considered as an acceptable reliability. No criteria for limits of agreement were available. However, smaller limits of agreement indicate more stability because it indicates that the natural variation is small. Results: The Dutch RMDQ showed good reliability, with an ICC of 0.91. Calculating limits of agreement to quantify the stability, a large amount of natural variation ( ± 5.4) was found relative to the total scoring range of 0 to 24. Conclusion: The Dutch RMDQ proves to be a reliable instrument to measure functional status in CLBP patients. However, the natural variation should be taken into account when using it clinically.

Comparing self-report, clinical examination and functional testing in the assessment of work-related limitations in patients with chronic low back pain

Purpose. To compare the work-related limitations assessed using self-report, clinical examination and functional testing in patients with chronic low back pain (CLBP). Methods. Work-related limitations of 92 patients were assessed using self-report, clinical examination and functional testing. To obtain the assessed limitations the patient (self-report), the physician (clinical examination) and a trained evaluator (functional testing) completed a scorings form about the work-related limitations of the patient. The Isernhagen Work Systems Functional Capacity Evaluation (IWS FCE) was used to obtain the functional testing results. A κ value of more than 0.60, absolute agreement of more than 80% and ICC of more than 0.75 were considered as acceptable. Results. Little agreement and correlation among self-report, clinical examination and functional testing were found for the assessment of work-related limitations. Self-reported limitations were considerably higher than from those derived from clinical examination or functional testing. Additionally, the limitations derived from the clinical examination were higher than those derived from the IWS FCE. Conclusion. Comparing self-report, clinical examination and functional testing for assessing work-related limitations in CLBP patients showed large considerable differences in limitations. Professional health care workers should be aware of these differences when using them in daily practice.

The performance of the K10, K6 and GHQ-12 to screen for present state DSM-IV disorders among disability claimants

BackgroundScreening for mental disorders among disability claimants is important, since mental disorders seem to be seriously under-recognized in this population. However, performance of potentially suitable scales is unknown. We aimed to evaluate the psychometric properties of three scales, the 10- and 6-item Kessler Psychological Distress Scale (K10, K6) and the 12-item General Health Questionnaire (GHQ-12), to predict present state mental disorders, classified according to the Diagnostic and Statistical Manual of Mental Disorders, 4thEdition (DSM-IV) among disability claimants.MethodsAll scales were completed by a representative sample of persons claiming disability benefit after two years sickness absence (n=293). All diagnoses, both somatic and mental, were included. The gold standard was the Composite International Diagnostic Interview (CIDI 3.0) to diagnose present state DSM-IV disorder. Cronbach’s α, sensitivity, specificity, positive (PPV) and negative predictive values (NPV), and the areas under the Receiver Operating Characteristic curve (AUC) were calculated.ResultsCronbach’s alpha’s were 0.919 (K10), 0.882 (K6) and 0.906 (GHQ-12). The optimal cut-off scores were 24 (K10), 14 ( K6) and 20 (GHQ-12). The PPV and the NPV for the optimal cut point of the K10 was 0.53 and 0.89, for the K6 0.51 and 0.87, and for the GHQ-12 0.50 and 0.82. The AUC’s for 30-day cases were 0.806 (K10; 95% CI 0.749-0.862), 0.796 (K6; 95% CI 0.737-0.854) and 0.695 (GHQ-12; 95% CI 0.626-0.765).ConclusionsThe K10 and K6 are reliable and valid scales to screen for present state DSM-IV mental disorder. The optimal cut-off scores are 24 (K10) and 14 (K6). The GHQ-12 (optimal cut-off score: 20) is outperformed by the K10 and K6, which are to be preferred above the GHQ-12. The scores on separate items of the K10 and K6 can be used in disability assessment settings as an agenda for an in-depth follow-up clinical interview to ascertain the presence of present state mental disorder.

Systematic Review of Intervention Practices for Depression in the Workplace

Design Systematic Review. Objective To determine which intervention approaches to manage depression in the workplace have been successful and yielded value for employers in developed economies. Data Sources We searched MEDLINE, EMBASE, CINAHL, Central, PsycINFO, and Business Source Premier up to June 2010 using search terms in four broad areas: work setting, depression, intervention, and work outcomes. Study Selection Two independent reviewers selected potential articles that met the following criteria: working age individuals with mild or moderate depression; interventions or programs that were workplace-based or could be implemented and/or facilitated by the employer; inclusion of a comparator group in the analysis; outcomes of prevention, management, and recurrences of work disability or sickness absence, and work functioning. Methods Two reviewers independently reviewed each article for quality and extracted data using standardised forms. Following guidelines from the GRADE Working Group, the quality of evidence addressing each outcome was graded as high, moderate, low, or very low on the basis of six criteria: study design, risk of bias, consistency, generalisability, data precision, and economic benefit. Using this information and following Cochrane Collaboration guidelines, the findings for each intervention were summarised and key messages were developed. Results We identified ten randomised trials and two non-randomised studies from various countries and jurisdictions that evaluated a wide range of intervention practices. The evidence was graded as “very low” for all outcomes identified. Therefore, no intervention could be recommended. Conclusions To date, there is insufficient quality of evidence to determine which interventions are effective and yield value to manage depression in the workplace.

Predictors for Work Participation in Individuals with an Autism Spectrum Disorder: A Systematic Review

Introduction Research shows that only about 25% of people with autism are employed. Method We conducted a systematic review on factors facilitating or hindering work participation of people with autism in longitudinal studies. An extensive search in biomedical and psychological databases yielded 204 articles and 18 satisfied all inclusion criteria. We assessed the methodological quality of included studies using an established criteria list. Results Seventeen factors were identified and categorized as disease-related factors, personal factors or external factors. Limited cognitive ability was the only significant predictor consistently found for work outcome. Functional independence and institutionalization were both reported by one study to be significantly related to work outcome. Inconsistent findings or non significant findings were reported for the other fourteen factors. Conclusion These findings emphasize the need for more high quality cohort studies focussing on work participation as the main outcome among people with Autism.

Work status and chronic low back pain: exploring the International Classification of Functioning, Disability and Health

Purpose. Exploring which variables are related to work status in patients with chronic low back pain (CLBP), classified according to the International Classification of Functioning, Disability and Health (ICF). Method. Ninety-two patients with CLBP filled out questionnaires inquiring after health status, impairments in body functions/structures, limitations in activities of daily living (ADL), participation in work, environmental and personal factors. Additionally, patients performed tests to measure physical fitness and performance of work-related activities. Univariate analyses were performed to investigate whether differences exist between working and non-working patients. Logistic linear regression analysis was performed to explain work status from the variables of functioning. Results. Non-working patients had a lower self-reported physical and mental health, lower physical fitness, more self-reported limitations in ADL, lower education, more depressive symptoms and higher psycho neuroticism than working patients. Self-reported physical and mental health and educational level correctly classified 84.5% of the patients as working or non-working. Performance of work-related activities was not significantly related with work-status. Conclusions. The relation between work status and CLBP is multidimensional, as was illustrated by using the bio-psychosocial model of the ICF. Patients with a low educational level, a low self-reported physical or mental health were more likely to be non-working. Self-reported limitations and physical and mental health are more important in explaining work status than objective measurements of performance.

Factors promoting staying at work in people with chronic nonspecific musculoskeletal pain: a systematic review.

Purpose: To identify determinants for staying at work (SAW) in workers with chronic musculoskeletal pain (CMP). Method: A systematic review of factors that promote SAW in workers with CMP. We searched the databases of PubMed, EMBASE, PsycInfo, CINAHL and the Cochrane Library. We included studies reporting on working subjects without present CMP-related sick leave. A quality assessment of GRADE criteria and evidence synthesis was performed. Results: We identified five cross-sectional studies and two qualitative studies reporting on factors associated with SAW in workers with CMP. Consistent association with SAW was found for low perceived physical disability and low emotional distress (low-level evidence). Duration of pain, catastrophizing, self-esteem and marital status were not associated with SAW (low-level evidence). Qualitative studies indicated that personal adjustments and workplace interventions are important determinants for SAW (evidence not graded). Conclusions: No high-level evidence for SAW determinants for workers with CMP was identified. Future interventions aimed at promoting SAW could consider reducing perceived physical disability and emotional distress, and promoting adjustment latitude at work, support from supervisors, and the workers’ motivation and self-management skills. Further research is required because knowledge of SAW in workers with CMP is scarce, and the relevance of the subject is high. Implications for Rehabilitation When modifiable factors that promote staying at work can be identified, interventions can be developed to support the ability of workers with chronic nonspecific musculoskeletal pain to stay at work. Consistent evidence of promoting staying at work was found for low emotional distress and perceived physical disability, while duration of pain, catastrophizing, self-esteem and marital status were consistently not associated. Future interventions aimed at promoting staying at work should consider reducing perceived physical disability and emotional distress.

Towards a sustainable healthy working life: associations between chronological age, functional age and work outcomes

BACKGROUND The aims of this study were: (i) to determine the relation between chronological and functional age; (ii) to examine the association between chronological age and work outcomes; and (iii) to examine the association between functional age and work outcomes. An overview of the most reported work outcomes is outlined. METHODS Chronological age refers to the calendar age; functional age was measured with perceived health status (SF-36) and the presence of a chronic health condition. Perspectives on experienced problems, barriers, facilitators and support needs due to ageing and the Work Ability Index were gathered out as work outcomes. RESULTS The association of chronological and functional age of workers aged ≥45 years (n = 2971) on work outcomes were significant but small, except for the presence of a chronic health condition. The presence of a chronic health condition was not related to chronological age. Older workers (60-64 years) reported better scores on social functioning, mental health and vitality compared with workers aged 45-59 years. Most reported problems due to ageing were energy decline, muscle function decline, concentration lapses and memory deterioration. Experienced barriers were concentration, work pace problems and mobility; facilitators were support from colleagues, informal relations at work and supervisors. Individual agreement had to be met to continue working life. CONCLUSIONS This study confirmed that both chronological and functional age were associated with a decrease in work outcomes. Workers >60 years did not experience more problems and barriers compared with workers between 45 and 49 years of age.