2015-03-01 12:00 - Messages

Development and validation of a clinical prediction rule of the return-to-work status of injured employees in Minnesota

PURPOSE: Vocational rehabilitation services can be a valuable resource to injured employees at risk for sustaining permanent disability. The aim of this study was to develop and validate a predictive model of return-to-work (RTW) status at workers' compensation claim closure that may assist rehabilitation counselors tasked with determining how to allocate such services.
METHODS: A cross-sectional, retrospective study was conducted using data obtained from 15,372 workers' compensation claims in Minnesota's administrative claims database. The association between a set of 15 predictor variables representing medical and contextual factors and the RTW status as of claim closure of the accessible population was assessed using backward stepwise logistic regression. The most parsimonious set of variables that reliably predicted the outcome was selected as the optimal RTW model. This model was then internally validated via a split-dataset approach.
RESULTS: Risk factors for failure to RTW by claim closure include the following: (1) attorney involvement; (2) higher level of permanent impairment (PI); (3) shorter job tenure; (4) lower pre-injury average weekly wage (AWW); (5) injury affecting the head and neck or the back; and (6) lower level of educational attainment. The optimal RTW model included four main effects (attorney involvement; severity of PI; age; job tenure) and three first-order interaction effects (pre-injury AWW × pre-injury industry; attorney involvement × severity of PI; attorney involvement × job tenure). When applied to the full dataset, the overall classification rate was 74.7 %.
CONCLUSIONS: This study's optimal RTW model offers further support for evaluating disability from a biopsychosocial perspective. Given the model's performance, it may be of value to those assessing rehabilitation potential within Minnesota's, and possibly other, workers' compensation system(s).

Source: Hankins AB, Reid CA. J. Occup. Rehabil, 2015.

Physical capacity and risk for long-term sickness absence

A prospective cohort study among 8664 female health care workers
OBJECTIVE: To assess the prospective associations between self-reported physical capacity and risk of long-term sickness absence among female health care workers. METHODS: Female health care workers answered a questionnaire about physical capacity and were followed in a national register of sickness absence lasting for two or more consecutive weeks during 1-year follow-up. Using Cox regression hazard ratio analyses adjusted for age, smoking, body mass index, physical workload, job seniority, psychosocial work conditions, and previous sickness absence, we modeled risk estimates for sickness absence from low and medium physical capacity. RESULTS: Low and medium aerobic fitness, low muscle strength, low flexibility, and low overall physical capacity significantly increased the risk for sickness absence with 20% to 34% compared with health care workers with high capacity. CONCLUSIONS: Low physical capacity increases the risk of long-term sickness absence among female health care workers.

Source: Rasmussen, Charlotte Diana Nørregaard; Andersen, Lars Louis; Clausen, Thomas; Strøyer, Jesper; Jørgensen, Marie Birk; Holtermann, Andreas. Journal of Occupational & Environmental Medicine, 2015.

Results of a feasibility study: barriers and facilitators in implementing the Sherbrooke model in France

Objectives: Return-to-work interventions associated with the workplace environment are often more effective than conventional care. The Sherbrooke model is an integrated intervention that has proved successful in preventing work disability due to low-back pain. Implementation, however, runs up against many obstacles, and failure has been reported in many countries. The present study sought to identify barriers to and facilitators of the implementation of the Sherbrooke model within the French health system.
Methods: A multiple case study with nested levels of analysis was performed in two regions of France. A conceptual framework was designed and refined to identify barriers and facilitators at the individual, organizational and contextual levels. Qualitative data were collected via semi-structured interview (N=22), focus groups (N=7), and observation and from the gray literature. Participants (N=61) belonged to three fields: healthcare, social insurance, and the workplace.
Results: Numerous barriers and facilitators were identified in each field and at each level, some specific and others common to workers in all fields. Individual and organizational barriers comprised lack of time and resources, discordant professional values, and perceived risk. Legal barriers comprised medical confidentiality, legal complexity, and priority given to primary prevention. Individual-level facilitators comprised needs and perceived benefits. Some organizations had concordant values and practices. Legal facilitators comprised possibilities of collaboration and gradual return to work.
Conclusion: The present feasibility analysis of implementing the Sherbrooke model revealed numerous barriers and facilitators suggesting a new implementation strategy be drawn up if failure is to be avoided.

Source: Fassier J-B, Durand M-J, Caillard J-F, Roquelaure Y, Loisel P. 2015. Scand J Work Environ Health

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