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Logo of oenvmedOccupational and Environmental MedicineVisit this articleSubmit a manuscriptReceive email alertsContact usBMJ
 
Occup Environ Med. 2007 December; 64(12): e35.
PMCID: PMC2095374

Musculoskeletal and injury 2

182 The social and economic consequences of workplace injury in BC

J. A. Brown. University of Toronto

ObjectivesThis research describes the social and economic consequences following workplace injury for workers who filed a claim to the British Columbia (BC) Workers' Compensation Board (WCB) in 1994 and missed 1 or more days of work due to the injury (LT, lost‐time). Change in neighbourhood median family income decile, income assistance (welfare) use, and relationship break‐up are explored.

MethodsThe BC Linked Health Database (BCLHD), which links individual Medical Service Plan (MSP) payment data, hospital separations, WCB, and the Ministry of Employment and Income Assistance (MEIA) data for the entire population of BC, was used to examine the LTs, a group of non‐injured individuals from the general population (NI, non‐injured) and a group of injured workers who did not require time off for their injuries (NLT, non‐lost‐time). As an internal comparison, the LTs were divided according to duration of time off work (<12 weeks and greater than or equal to 12 weeks (12+weeks)). Personal Health Numbers, the first three digits of the postal code, and income decile of residential neighbourhood were used to assess individual and spousal living arrangements. Information from MEIA was used to assess yearly income assistance use.

ResultsCompared to the NIs, the injured worker groups showed an increase in post‐injury drop in neighbourhood income decile (LTs only) and relationship break‐up. Severity of injury (as measured by time off work) was not associated with these outcomes. Although being an injured worker was protective against collecting post‐injury income assistance benefits (perhaps an artefact of the selection of non‐injured comparisons), LTs off for 12 or more weeks were at higher risk for receiving post‐injury benefits, than those off for shorter periods of time.

ConclusionThis research adds to the literature on the economic and social consequences of workplace injury by using a provincial census of injured workers to assess drop in neighbourhood income decile, relationship break‐up and income assistance use following a workplace injury. The results suggest that workers experience financial and personal consequences following a workplace injury, which are not addressed or remunerated by the WCB system.

Key wordsworkplace; injury; consequences

183 Workplace factors affecting shoulder pain

J. R. Beach, A. Senthilselvan, N. M. Cherry. University of Alberta

ObjectivesTo identify risk factors for the development of work‐related shoulder pain among Workers' Compensation Board (WCB) claimants in Alberta.

MethodsAll claims for shoulder pain to Alberta WCB in the period 1 August 2004 to 27 November 2004 were identified, with age and sex matched referents from WCB claimants for other conditions. Each subject was sent a questionnaire, through the WCB, 3–4 weeks after reporting their injury, to obtain information on the circumstances of their injury, physical and psychosocial workplace characteristics and concurrent health problems. Logistic regression was used to identify factors associated with case:referent status.

ResultsA total of 1269 completed questionnaires were received from 5632 recruitment packages sent out, a participation rate of 23%, similar in cases and referents. Risk factors positively associated with being a case included: “shoulder pain in the month before injury” (OR 1.71, 95% CI 1.19 to 2.46) and “use of analgesics in the 24 h before injury” (OR 1.54, 1.05 to 2.25). Factors associated with other claims (referents) were “low back pain in the month before injury”(OR 0.52, 0.34 to 0.78), “use of antidepressants in the 24 h before injury” (OR 0.57, 0.32 to 1.00), and injury being acute in nature (OR 0.57, 0.36 to 0.89). No clear relationship was found with psychosocial factors but, among the ergonomic risk factors, lifting weights >10 kg above shoulder for at least 15 min a day was significantly associated with case status after adjustment for all other variables (OR, 95% CI compared with never: <15 min 1.30, 0.93 to 1.83; 15 min–2 h 2.48, 1.53 to 4.06; 2–4 h 2.38, 1.27 to 4.45; >4 h 2.86, 1.45 to 5.63).

ConclusionThese results confirm the importance of ergonomic factors in the causation of work‐related shoulder pain.

Key wordsshoulder injury; risk factors; workers' compensation

184 Beyond return to work: health status, work limitations and return‐to‐work trajectories in injured workers with musculoskeletal disorders

U. Bültmann1, R‐L. Franche2, S. Hogg‐Johnson2, P. Côté3, H. Lee2, C. Severin2, M. Vidmar2, N. Carnide2. 1National Research Centre for the Working Environment; 2Institute for Work & Health; 3University Health Network Rehabilitation Solutions, Toronto Western Hospital

ObjectivesTo date, little is known about the health status and work limitations of injured workers, or about their transitions in working status over time. The purpose of the present study was to describe health status and work limitations in injured workers with musculoskeletal disorders at 1 month post‐injury and to document their return‐to‐work trajectories 6 months post‐injury. The workers were grouped into three mutually exclusive return‐to‐work trajectory categories: sustained return‐to‐work, return‐to‐work with recurrence of work absence, and no return‐to‐work.

MethodsThis study was conducted within the sampling frame of a prospective study of Ontario workers with a back or upper extremity musculoskeletal disorder, who filed a Workplace Safety and Insurance Board (WSIB) lost‐time injury claim. Data were collected from two sources: self‐reports of participants and WSIB administrative data. A sample of 632 workers with a back or upper extremity musculoskeletal disorder participated in this prospective study. Health outcomes, such as pain intensity, functional status, general health and depressive symptoms, and work limitations were assessed at baseline (1 month post‐injury) and at 6 month follow‐up.

ResultsAt baseline 1 month post‐injury, 47% of the participants report a sustained first return‐to‐work, 14% a return‐to‐work with recurrence of work absence and 39% no return‐to‐work. Poor physical health, high levels of depressive symptoms and high work limitations are prevalent in workers, including in those with a sustained first return‐to‐work. Workers with a sustained first return‐to‐work report better health status and fewer work limitations than those who experienced a recurrence of work absence or who never returned to work. Six months post‐injury, the rate of recurrence of work absence in the trajectories of injured workers who have made at least one return to work attempt is high (38%), even in workers who have initially made a sustained first return‐to‐ work at baseline (27%).

ConclusionThe findings suggest the presence of return‐to‐work status specific health outcomes and work limitations in injured workers, 1 month post‐injury. A sustained first return‐to‐work is not equivalent to a complete recovery from musculoskeletal disorders.

Key wordsreturn‐to‐work; health outcomes; work limitations

185 Illnesses, medication and risks of accidental injury in the occupational setting: a systematic literature review

K. T. Palmer, E. C. Harris, D. Coggon. MRC Epidemiology Resource Centre

ObjectivesTo assess the evidence that chronic illnesses and their treatments increase the risk of occupational injuries.

MethodsWe searched Medline, Embase and PsychInfo to November 2006 employing various terms for occupational injury, medications, and a broad range of diseases and impairments. We excluded papers related solely to driving, those for which the health outcome was a consequence rather than a risk factor, those concerned only with alcohol or substance abuse, and those that did not allow analysis of accident risks (including case‐only series and studies solely of impaired performance). For each report that was finally retrieved we abstracted standardised information on the populations, design, exposure(s) and outcome(s), response rates, confounders, and effect estimates. We also formed a judgment on the quality of information in each report.

ResultsWe found 34 reports covering 30 study populations: 18 were of cross‐sectional design, 12 were case‐control and four were prospective. We rated the overall quality as excellent for only two reports. Most commonly considered were problems of hearing (18), vision (11) and mental health (14). For impaired hearing, neurotic illness, diabetes, epilepsy and use of sedating medication there were moderate positive associations with occupational injury (ORs 1.5–2.0), but there were major gaps in the evidence base. Thus, studies on vision did not present risks by specific categories of eye disease, we found no evidence on major psychotic illness, and for diabetes, epilepsy and cardiovascular disease we found remarkably few reports. Studies seldom distinguished risks by sub‐category of external cause (eg, fall) or anatomical site or nature of injury (eg, fractured femur). And design issues may have led to overestimation of risks: exposures and outcomes were mostly ascertained by self‐report at a common time point, and with a lack of clarity about whether exposures such as tranquilliser use and low mood preceded injury or followed it.

ConclusionThere is a pressing need for better research to quantify the risks of occupational injury arising from common illnesses and treatments. Such research should delineate exposures and outcomes in greater detail, and ensure by design that the former precede the latter.

Key wordsinjury; diseases; medication

186 Work‐related motor vehicle collisions in Ontario

J. Etches, C. A. Mustard. Institute for Work & Health

ObjectivesMotor vehicle collisions (MVCs) are the leading cause of work‐related traumatic fatalities. Between 2000 and 2004, it is estimated that MVCs were responsible for 208 work related deaths in Ontario, accounting for 43% of all workplace traumatic fatalities. Between 2000 and 2004, MVCs accounted for 15 124 lost time injury (LTI) claims. Work‐related MVC in the general population have not been described in Ontario. This analysis will be descriptive rather than analytical. High‐risk groups, behaviours and circumstances that may be amenable to intervention will be identified.

MethodsThis project is based on a linkage of administrative records maintained by the Workplace Safety and Insurance Board (WSIB) and the Ontario Ministry of Transportation (MTO). WSIB data on motor vehicle collisions lack a description of the event, while MTO data on collisions lack a description of the occupational characteristics of the worker. The WSIB insures 68% of the Ontario workforce, with some sectors, such as the government and financial services self‐insuring, and the self‐employed typically are not covered. The ADS contains a record for every collision for which police completed a Motor Vehicle Accident Report (MVAR), which is required in the case of injury or significant property damage. The linkage covers the 5‐year period of 2001–2005. Ethics approval for the linkage has been received from the WSIB, the MTO, and the University of Toronto Ethics Review Board.

ResultsCrash severity (temporary disability, permanent impairment, fatality) is tabulated by age and sex, WSIB rate group, industrial sector, occupation, vehicle type, sex and driver behaviour (alcohol, speeding, fatigue), time of day, day of week, road condition, visibility and road type.

ConclusionThe project is supported by the Ontario Workplace Safety and Insurance Board (WSIB). The WSIB consulted with Ontario's Ministry of Transportation (MTO) and concluded that there is a potential policy benefit in a data linkage research study to analyse the trends, patterns and causal factors of work related MVC claims. This study is a first step towards such an understanding.

Key wordsoccupational; motor vehicle accident; Ontario

187 Individual participant data (IPD) meta‐analysis of workplace mechanical exposures and low back pain

L. E. Griffith1, H. S. Shannon1, S. D. Walter1, D. C. Cole2, S. Hogg‐Johnson3, R. P. Wells4, Meta‐Analysis of Pain in the Lower Back and Work Exposures (MAPLE) CollaborativeGroup. 1McMaster University; 2University of Toronto; 3Institute for Work and Health; 4University of Waterloo

ObjectivesSystematic reviews and meta‐analyses are used to study the relationship between workplace risk factors and low back pain. However, even high quality reviews have only been able to use summary data from published papers. Our aim is to overcome this limitation by obtaining original study data from authors and undertake an individual participant data (IPD) meta‐analysis.

MethodsWe contacted authors identified through a systematic literature search of low back pain studies in workers to request their individual‐level data. Groups of outcomes and exposures which could potentially be combined in a meta‐analysis were identified. Although there were a large number of studies, very few reported the same type of exposure data. We provide preliminary results for the relationship between one specific exposure, “physically strenuous work”, and reporting low back pain over 12 months from studies including over 10 000 participants. We used GEE regression to estimate odds ratio (OR) while accounting for the clustering of participants within studies. We adjusted the estimates for study design (cohort or cross‐sectional), age and sex of participants and tested for potential interactions.

ResultsWe collected individual participant data from 48 studies. Of those, 13 provided data on physically strenuous work and seven collected data on the outcome of LBP over 12 months. After adjusting for age and sex, the individual study ORs ranged from 0.89 to 1.96; three were significantly greater than 1.0 and one was less than 1.0. The overall summary OR was 1.3 (1.1 to 1.5). However, the OR for cohort studies was greater than for cross‐sectional studies (1.4 (1.3 to 1.5) vs 1.1 (0.8 to 1.6)), pinteraction<0.001. The OR for men was 1.4 (1.1 to 1.6) compared with 1.1 (0.97 to 1.3), but the interaction was not statistically significant (pinteraction = 0.20).

ConclusionThere is some evidence that physically strenuous work is related to LBP over 12 months. There is also evidence that the magnitude of the relationship is related to study design. Other exposures have been difficult to examine because there is great heterogeneity in the way mechanical exposure is measured between studies, but we have developed a method to assign all exposures to a score on a common metric.

Key wordslow back pain; workplace; mechanical exposure


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