Research Plus: August/September 2007

Occupational neck pain

A systematic review to determine the work-relatedness of chronic neck pain disorders that show physical signs on clinical examination (such as tenderness and restricted movement) identified just 21 research papers meeting inclusion criteria. Workplace exposures included repetitive work, static loading, neck flexion, force and psychosocial factors. There was moderate evidence linking pain disorders with repetition at the shoulder and with neck flexion allied with repetition, but only limited evidence for other causal factors.

Scandinavian Journal of Work Environment and Health 2007; 33(3): 165–191.

Long-term absence risks

Physical but not psychosocial risk factors were found to explain between 10% and 30% of sickness absences lasting at least eight weeks, according to a prospective cohort study of 5,020 employees followed for 18 months (none had recent absence at the start of the study). Psychosocial factors (emotional demands, management quality, role conflicts, reward) made no difference to long-term absence risk in men or women, after adjusting for personal and other work factors. Working while mainly standing or squatting, and lifting or carrying heavy loads were significant predictors in men; bending or twisting of the neck or back were significant factors in women.

Occupational and Environmental Medicine 2007; 64: 487–489.

Needlestick injuries

Half of all needlestick injuries (NSIs), including 16% involving high-risk patients, are not reported by trainee surgeons to the OH service, with lack of time given as the most common reason for not reporting. The survey of 699 US trainee surgeons (95% response) found that 99% of them had had a needlestick injury by their final year of training and 28% of NSIs go undocumented because the trainee does not see any point in reporting. Of the unreported injuries, the spouse or ‘significant other’ is aware in only 13% of cases.

New England Journal of Medicine 2007 Jun 28; 356(26): 2693–2699.

Chemical workers’ pregnancy outcomes

The chemical company BASF has been monitoring birth outcomes of its female employees as part of a policy to protect pregnant women and new mothers. In total, 1,148 pregnancies and 1,147 live births (singleton and twins) were followed over six years. Pregnancy loss did not differ by type of work, though first-trimester vaginal bleeding during pregnancy was weakly (but not significantly) associated with possible workplace exposure to toluene and research chemicals1. Pre-term births, Apgar scores, birth height, weight and sex ratio were unaffected by maternal work area or chemical hazard classification2.

Workplace drinking culture

Research across 16 US worksites, involving more than 5,000 workers in 137 supervisory workgroups found that workplace attitudes to drinking significantly affected individuals’ overall alcohol intake. Workplace culture was assessed according to a psychometric scale of social norms of drinking behaviour and attitude. Individuals in the most discouraging drinking workgroups were 45% less likely to be heavy drinkers, 54% less likely to be frequent drinkers and 69% less likely to drink at work than those in the most encouraging groups. Workplace interventions should target group norms rather than individual beliefs.

Occupational and Environmental Medicine (online first); 2007; doi: 10.1136/oem.2006.031765

MSD coping behaviour

Understanding workers’ cognitive, emotional, and behavioural mechanisms for coping with persistent musculoskeletal pain is important in managing the return-to-work process. A systematic review of 131 papers evaluates various models of illness representation. These are grouped into: personal-experience theories, including pain beliefs, fear-avoidance and lay theories; interactionist models, such as the ‘sick role’ and the ‘therapist-patient relationship’; and sociocultural approaches, which shed light on the influence of culture and sociodemographic variables on illness behaviour.

Journal of Occupational Rehabilitation 2007: 13 June – online publication ahead of print, DOI 10.1007/s10926-007-9089-9.

Evidence-based guidance on elbow disorders

The American College of Occupational and Environmental Medicine (ACOEM) has released revised evidence-based guidelines for the evaluation and management of elbow disorders – such as lateral epicondylitis, ulnar nerve entrapment and non-specific elbow pain. All ACOEM guidelines focus on return to work within 90 days of onset. The literature-based report rates evidence quality on a comprehensive range of interventions for each disorder, including oral and topical anti-inflammatory drugs, corticosteroid injections, exercise, surgery, various physical therapies (from deep friction massage to manipulation), physical supports (such as ‘tennis elbow bands’), ultrasound, hot/cold packs and acupuncture.

Occupational medicine practice guidelines. Evaluation and management of common health problems and functional recovery in workers: Elbow complaints. Elk Grove Village, Illinois: ACOEM, 2007.

Occupational asthma

There is neither an internationally agreed definition of occupational asthma nor a standard UK approach to investigating or managing patients. An assessment approach combining the Delphi (questionnaire-based) and Nominal Group (face-to-face meeting) techniques was used to obtain consensus from expert members of the UK Group of Occupational Respiratory Disease Specialists. Consensus was reached on 10 indicators for defining occupational asthma and 18 resources required to run a specialist occupational asthma clinic.

Occupational and Environmental Medicine 2007; 64: 361–365.

Tennis elbow relief

A systematic review found no conclusive evidence to favour one common surgical intervention over another – in terms of pain relief, restoring strength, or return-to-work time – in the treatment of lateral epicondylitis. However, the authors note the need for more randomised controlled trials. The interventions, grouped into open, percutaneous, and arthroscopic surgery, are only advised for the minority of individuals who do not respond to non-invasive treatment.

Clinical Orthopaedics and Related Research 2007; 12 July – online publication ahead of print.

Fatigue limits cancer RTW

In a study of patients who underwent treatment for head or neck cancer, only half of those employed at the time of diagnosis were working one year after treatment; 38% reported discontinuing work because of their cancer and treatment. Patients rated fatigue as the most likely reason for not returning to work (59% said this was a key factor); problems with eating (45%), speech (51%) and pain or discomfort (38%) were also important. Physical appearance had little impact on the decision to quit.

Archives of Otolaryngology – Head & Neck Surgery, 2007; 133: 464–470