Research Plus: June/July 2009

Preventing work disability

A Cochrane review found moderate evidence to support the use of workplace interventions to reduce sickness absence among workers with musculoskeletal disorders, but no evidence that they improve health outcomes. Interventions included changes to the workplace, equipment, work design and organisation, working conditions and occupational case management. The review supports the use of workplace interventions to improve return to work by addressing work disability rather than the underlying medical condition. There was a lack of research investigating interventions for workers with mental health or other conditions.

Cochrane Database of Systematic Reviews 2009; 2: article number CD006955.

Poor team climate associated with lower mental health

Poor ‘team climate’ at work is significantly associated with depressive disorders, according to research on a nationally representative sample of 3,347 Finnish workers (though it remains possible that those with poor mental health also have a lower perception of team climate than healthy colleagues). Poor team climate, measured using a self-assessment scale from the Finnish Healthy Organisation Questionnaire, also predicted use of antidepressant medication but was not associated with alcohol-use disorders.

Sinokki M, K Hinkka K et al. Occupational Environmental Medicine 2009; Online First: doi 10.1136/oem.2008.043299

Drug and alcohol testing

There is insufficient evidence to advise for or against the use of drug and alcohol testing of occupational drivers for preventing injuries, an evidence review concludes. Of 6,000 abstracts, only three papers (two covering the same study) met inclusion criteria. Mandatory random and for-cause alcohol testing in one US study was associated with a decrease in injuries immediately following the intervention, but there was no effect on an already long-term decline in injury rate. There was some evidence that random drug testing can reduce injury rate in the long term, but short-term changes were contradictory.

Cochrane Database of Systematic Reviews 2009; 2: article number CD006566.

Stress intervention

A group-based stress management intervention, using cognitive behavioural therapy principles in eight three-hour sessions, was effective in reducing perceived occupational stress and improving positive reframing. Eligibility for participation in a randomised controlled trial included persistent work-related stress, motivation to remain employed, not being on long-term sick leave and not having substantial non-work psychosocial stress. The improvements were maintained three months after the intervention ceased, though follow-up was not part of the randomised study.

Scandinavian Journal of Work, Environment and Health 2009; 35(2): 145–152.

Gender difference in MSD risk?

Musculoskeletal symptom prevalence is generally higher among women than men, but this is not readily explained by increased vulnerability, according to a longitudinal study of nearly 1,800 employees in 34 companies. Musculoskeletal pain, and physical and psychosocial risk factors were assessed and gender ratios calculated to determine differences in the effect of exposures between men and women. Ratios were insignificant for 16 of the 22 risk factors studied, and only bending the neck backwards (risk factor for neck and hand–arm symptoms) and bending the wrist (risk for hand–arm symptoms) were significantly greater in women.

Scandinavian Journal of Work, Environment and Health 2009; 35(2): 85–95.

Return to work after brain injury

A systematic review in people with acquired brain injury found strong evidence that people with an extended hospital stay are less likely to return to work (RTW). It found strong evidence that gender, injury severity, depression and anxiety are not associated with RTW outcome. There was no evidence that income, job stability and military rank are associated with RTW, and only inconsistent evidence for an association with pre-injury occupation. There was weak evidence that being able to carry out daily living activities (including walking) increases RTW, and weak evidence that residual disability reduces RTW; both factors are potential targets for vocational rehabilitation.

Brain Injury 2009; 23(5): 385–395.

BMI and work disability in construction workers

A large cohort study of German construction workers found that moderate levels of overweight (as conventionally defined) are not associated with increased work disability and that, in fact, there is a U-shaped association between body mass index (BMI) and disability risk. After controlling for age, workers with BMIs of 25–27.4 kg/m2 had the lowest work disability risk after 10.8 years’ follow-up; though, risk increased dramatically above 35 kg/m2 notably for osteoarthritis and cardiovascular disease. There was no association between BMI and disability due to back conditions. When providing health advice it might be appropriate to apply different standards of ‘normal’ weight in those doing heavy physical work compared with more sedentary jobs (‘normal’ BMIs are conventionally 18.5–24.9 kg/m2).

Occupational and Environmental Medicine 2009; 66: 402–409.

Barriers to work in young disabled

A systematic review was undertaken to determine which factors promote or hinder young disabled people from entering employment – and which can be addressed. Male gender, education, high psychosocial functioning, low depression score and high dispositional optimism are predictive of work participation. Factors predictive of unemployment included low education level, epilepsy, motor impairment, wheelchair dependency, functional limitations, comorbidity, physical disability and intelligence quotient below 80.

Journal of Occupational Rehabilitation 2009; 19: 129–141.

Vocational rehabilitation for MS

A Cochrane review found only limited evidence to support the use of vocational rehabilitation for people with multiple sclerosis. Just two studies were suitable for inclusion; both were from the US, but neither was of good methodological quality. One study focused on job-retention and the other on job re-entry. The data were unable to support or refute the effectiveness or cost effectiveness of the interventions and the reviewers conclude that there is a lack of relevant randomised and clinically controlled trials.

Cochrane Database of Systematic Reviews 2009; 1: article number CD007256.

Patient handling

A wide range of primary interventions – including lifting equipment, training and policies – has been developed to reduce patient handling and, therefore, musculoskeletal disorder incidence in healthcare workers, but their implementation is not always good. A systematic review was carried out to determine the most important factors in promoting or discouraging their use. Individual motivation, convenience, supportive management and patient-related factors were the most commonly reported factors, but there was no quantitative data on their impact.

Occupational and Environmental Medicine 2009; 66: 353–360.

Does workplace exercise reduce back pain?

A systematic review found strong evidence that workplace exercise regimes are effective in reducing the severity of low back pain (LBP) and its impact on activity. However, owing to poor research quality and conflicting results, there is only ‘limited’ evidence that such regimes prevent LBP incidence and associated sick leave. Of the 15 papers meeting inclusion criteria only four were of high methodological quality. More evidence is needed to determine which exercises are effective and whether or not there is a dose–response relationship.

Journal of Occupational Rehabilitation 2009; 19(1): 8–24