Trouble musculosquelettique

Purpose Musculoskeletal disorders (MSDs) contribute to work disability arising from personal and work-related physical, organizational and psychosocial factors that often differentially affect men and women. We aimed to identify determinants of the sex/gender difference in duration of MSD work absence through a mixed-studies systematic review. Methods We synthesized evidence using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach adapted to prognostic studies and meta-ethnography for qualitative studies, followed by a mixed synthesis. Results Twenty-six quantitative and four qualitative studies contributed to the evidence synthesis. Only two of the twenty-six quantitative studies addressed the sex/gender gap directly, compared to three of the four qualitative studies. Most other quantitative studies provided evidence from sex/gender-stratified analyses of determinants of MSD disability. The synthesis of qualitative studies suggested that domestic strain, less access to modified work/retraining, and gender-biased attitudes of health and insurance system gatekeepers hindered women's return to work. Prognostic factors in women supporting this conclusion from quantitative studies included the combination "working >= 40 h/week and having dependents" and low supervisor support. The mixed synthesis yielded a conceptual model of hypothesized determinants of the sex/gender difference in MSD work disability that integrates factors from personal, workplace, healthcare and insurance-disability management spheres, influenced by the larger sociopolitical, cultural and macroeconomic context. Conclusions Studies directly addressing the sex/gender gap in MSD disability are needed. These can be informed by the proposed model. Practitioners and policymakers can build upon the model to develop and implement MSD prevention and rehabilitation interventions tailored to the needs of men and women to reduce sex/gender disparities.

© Stock S; Nicolakakis N; Cullen K; Dionne CE; Franche RL; Lederer V; MacDermid JC; MacEachen E; Messing K; Nastasia I.  Healthcare. 13(24), 2025 Dec 10.
 

Purpose This study explores how individuals with chronic low back pain (CLBP) experience and navigate return-to-work (RTW) processes and identifies their suggestions for improving coherence in RTW processes. Methods Seventeen outpatients from a Spine Clinic, all of whom were either currently or recently on long-term sick leave (exceeding 30 days) due to CLBP, participated in three semi-structured interviews and four focus group sessions. The data were analyzed using reflexive thematic analysis and interpreted through a health literacy (HL) perspective. Results Four overarching themes were constructed: Psychological vulnerability; Seeking diagnostic and RTW clarity; Lack of recognition and flexible support from stakeholders; and Absence of professional consensus in RTW planning. Each theme comprised two subthemes. Conclusion By adopting an HL perspective, this study provides insight into how limited interactive and critical HL can hinder engagement in RTW processes among individuals with CLBP, particularly when combined with emotional vulnerability, diagnostic uncertainty, and fragmented service coordination. These findings suggest that HL-responsive practices may help reduce HL-related inequalities and support more coherent, equitable, and accessible RTW processes.

© Frydenlund G; Hansen A; O'Neill S; Sondergaard J; Mortensen OS.  Disability & Rehabilitation. 1-13, 2026 Jan 08.

Purpose To evaluate the effectiveness of work conditioning for injured workers with low back pain conditions relative to acute physical therapy. Methods Episodes of injured workers with medium+ physical demand level (PDL) jobs leveraging acute workers compensation physical therapy with (Acute+) or without (Acute) transition to work conditioning were considered. Analyses of covariance (ANCOVAs) compared visits and patient reported outcomes (PROs) between Acute and Acute+ cohorts controlling for baseline factors, and chi-square compared achievement of medium+ PDL capacity between cohorts. Results Most patients (81%) received only Acute PT. Between group differences in visits (favorable to Acute) and PRO metrics (all favorable to Acute+; all p < 0.001). Significantly more (80%) in the Acute+ cohort achieved medium+ PDL than Acute only (57%; p < 0.001). Conclusions Acute+ increases utilization but yields significantly better PRO metrics.

© Lutz AD; Rodriguez S; DeBuck KF; Denninger TR; Myers LM; Myers NL. Journal of Occupational & Environmental Medicine.  2025 Nov 11.
 

Purpose Low back pain is among the most prevalent pain conditions. Cognitive behavioral therapy reduces the negative effects of low back pain, but access to treatment is limited. Empowered Relief is a 2-hour single-session pain management skills intervention that has demonstrated efficacy at improving pain outcomes in individuals with chronic low back pain. The objectives were 1) to assess the acceptability of Empowered Relief delivered by physical therapists in a sample of French-Canadian workers with low back pain; and 2) to explore changes in pain catastrophizing and other pain-related outcomes following Empowered Relief and physical therapy. Methods The study was an uncontrolled prospective pilot trial of Empowered Relief and physical therapy for low back pain. Participants were 63 French-Canadian individuals undergoing physical therapy for subacute and chronic low back pain (<1 year duration). Participants completed baseline measures of demographic and measure of pain catastrophizing, pain intensity, symptoms of anxiety and depression, physical function and pain interference before taking part in a single-session 2-hour Empowered Relief virtual course. Participants then completed a post-class acceptability questionnaire and a 4-week follow-up questionnaire assessing the same measures as baseline. Results A 2-hour single-session of Empowered Relief demonstrated high acceptability among participants. Pain catastrophizing scores reduced by an average of 28 points, with 90% achieving clinically significant change. Participation in Empowered Relief and physical therapy was associated with reductions in pain intensity, and clinically meaningful improvements in symptoms of anxiety and depression, physical function and pain interference at 4-weeks follow-up. Effect sizes were moderate to large, and the largest changes were found in individuals with subacute low back pain. Conclusion Empowered Relief, when delivered by physical therapists, may offer a rapid, scalable intervention to complement physical therapy and improve early outcomes in workers with low back pain. The results provide evidence to support a future randomized controlled trial evaluating the effect of Empowered Relief delivered by physical therapists for low back pain.

© Carrière, J. S., Coutu, M. F., Darnall, B. D., Léonard, G., Royer, M. P., Li, M. Y., Bordeleau, M., Durand, M. J. Journal of Pain Research. 18: 4845–4857. https://doi.org/10.2147/JPR.S527830

Purpose This study examined whether reductions in pain catastrophizing were associated with reductions in perceived injustice in individuals with occupational low back pain receiving physical therapy combined with a brief psychological intervention (Empowered Relief) to improve pain self-management skills. Methods A secondary analysis of a quasi-experimental study was conducted with 63 participants with subacute and chronic low back pain. Perceived injustice and pain catastrophizing were measured at baseline (T1) and four weeks post-intervention (T2). Correlation and regression analyses were performed to identify predictors of changes in perceived injustice. Ethical approval was obtained from the Université de Sherbrooke Research Ethics Board (#2022-3392). Results Changes in pain catastrophizing were strongly associated with changes in perceived injustice (r = 0.723, p < 0.001). Regression analyses revealed that pain stage and reductions in pain catastrophizing were significantly associated with decreases in perceived injustice. Regression analyses also revealed that reductions in the “rumination” subscale of pain catastrophizing significantly predicted changes in both subscales of perceived injustice. Conclusion The results demonstrate that reductions in pain catastrophizing are associated with reductions in perceived injustice during the subacute phase. The findings also shed light on shared mechanisms between pain catastrophizing and perceived injustice, emphasizing the role of rumination. The findings from this study underscore the importance of early psychological intervention for occupational low back pain, particularly in the subacute phase to improve recovery.

© Alpdogan, N. Y., Coutu, M. F., Durand, M. J., & Carrière, J. S. Journal of Pain Research, 4947-4957, 2025 Sep.

Purpose This study aimed to assess 12-month outcomes on return to work (RTW) and cost-effectiveness in adults on sick leave due to musculoskeletal disorders who were randomized to either usual case management (UC), UC+motivational interviewing (MI) or UC+stratified vocational advice intervention (SVAI). Methods The study was conducted in the Norwegian Labor and Welfare Administration (NAV). Workers on sick leave due to musculoskeletal disorders for >=50% of their contracted work hours for >=7 consecutive weeks were included. Trained caseworkers delivered MI in two face-to-face sessions, and physiotherapists provided SVAI and identified RTW obstacles. The main outcomes were sick leave days over 12 months and cost-effectiveness, cost-utility and cost-benefit. Results The trial included 509 workers with a mean age of 48 years. There were statistically significant differences between UC+MI versus UC [-15.6 days, 95% confidence interval (CI) -31.0- -0.2], and UC+SVAI versus UC (-17.6 days, 95% CI -33.0- -2.2). Compared to UC, odds ratios (OR) for receiving wage replacement benefits each month were lower for UC+MI (OR=0.73, 95% CI 0.64-0.84), and UC+SVAI (OR 0.74, 95% CI 0.64-0.84). The probabilities of cost-effectiveness were high for adding either MI or SVAI to UC (ceiling ratio 0.90), and the net benefit for MI was 5225 (95% CI -592-10 985) and for SVAI 7214 ((95% CI 1548-12 851) per person. Conclusions Adding MI or SVAI to UC significantly improved RTW outcomes and was cost-effective among people on sickness absence due to musculoskeletal disorders.

© Oiestad BE; Maas E; Aanesen F; Tingulstad A; Rysstad T; van Tulder M; Tveter AT; Hagen M; Berg RC; Foster NE; Wynne-Jones G; Sowden G; Bagoien G; Hagen R; Storheim K; Grotle M. Scandinavian Journal of Work, Environment & Health.  2025 Sep 03.

Purpose Research has shown social inequalities in health parameters in the general population, but there is a lack of evidence in medical rehabilitation. Objective: To investigate social inequalities in the utilisation and process of rehabilitation among people with non-specific chronic low back pain (CLBP) and multiple psychological strains undergoing inpatient multidisciplinary orthopaedic rehabilitation (MOR). Methods This multicentre study enrolled 910 patients with non-specific CLBP (ICD-10: M51/53/54) and examined the differences in self-initiative to attend rehabilitation, and psychological, work-related, and pain-related parameters prior to MOR stratified by the social class index (lower, middle, upper class). Moreover, socioeconomic differences were investigated in the frequency distributions of psychosocial cut-off scores before rehabilitation, indicating the clinical relevance of the social class index. Results Compared with patients in both higher classes, patients in the lower class showed significantly lower self-initiative for rehabilitation as well as unfavourable values for pain self-efficacy and work-related and pain-related parameters. Conclusions Health-related inequalities in the inpatient MOR of non-specific CLBP were supported. To promote better health equity, patients should be allocated to rehabilitation according to their needs and individually strengthened in terms of their self-efficacy, health literacy, and ability to cope with pain and work-related stress.

© Hampel P; Dadaczynski K. Journal of Back & Musculoskeletal Rehabilitation 38(5): 1165-1173, 2025 Sep.

Purpose Chronic low back pain (cLBP) is a major cause of disability worldwide, significantly affecting return to work (RTW). This study aimed to assess the biopsychosocial factors influencing occupational functioning in workers with cLBP using artificial intelligence (AI) data-driven patient phenotyping. Methods Data of workers affected by cLBP were collected through a comprehensive assessment of demographic, clinical, and occupational factors. Hierarchical clustering was employed to identify distinct phenotypes based on patient-reported outcome measures (PROMs), including the Oswestry Disability Index (ODI), Visual Analog Scale (VAS), Work Ability Index (WAI), Nordic score, and Patient Health Questionnaire-2 (PHQ-2). Independent t tests and Mann-Whitney U tests were used for phenotype profiling, distinguishing between continuous and categorical responses, respectively, to assess the most discriminative queries and highlight the most significantly different features ( p < 0.05).  Results A total of 304 patients were included in the analysis. The AI-driven phenotyping approach identified two distinct clusters, representing 51% (Cluster 1) and 49% (Cluster 2) of the dataset. Compared to Cluster 1, Cluster 2 exhibited significantly higher absenteeism (17.00 vs. 5.22 days, p < 0.05), lower WAI (33.34 ± 6.84 vs. 38.96 ± 4.31, p < 0.05), worse pain-related outcomes in terms of higher VAS (5.98 ± 2.06 vs. 4.48 ± 2.48, p < 0.05) and ODI (33.52 ± 16.56 vs. 20.08 ± 13.59, p < 0.05), more frequent occupational exposure to manual handling of loads (84% vs. 16%) and higher psychological distress assessed through PHQ-2 (70% vs. 30%).  Conclusion Our study identified the most relevant PROMs differentiating between cLBP clusters of patients, emphasizing different levels of absenteeism and pain-related outcomes.These findings contributed to unravel the data-driven AI potential in suggesting personalized interventions targeting specific biopsychosocial profiles, which may improve clinical outcomes and occupational functioning in workers with cLBP, ultimately enhancing their overall well-being.

© Giaccone P; de Rinaldis E; D'Antoni F. JOR Spine 8(3) : e70110, 2025 Sep 17.

Purpose Low back pain (LBP) is the leading cause of years lived with disability worldwide. Clinical guidelines recommend multidisciplinary rehabilitation for managing chronic LBP. This scoping review maps vocational rehabilitation (VR) interventions delivered within the healthcare sector for individuals with chronic LBP. It explores (1) which professional groups are involved and how they collaborate, (2) the setting, (3) the duration, intensity, and components of interventions, and (4) how work status is assessed. Methods A systematic search across six databases (MEDLINE, Embase, CINAHL, AMED, OT Seeker, and Scopus) was conducted in September 2023 and updated in October 2024, following PRISMA-ScR guidelines. Studies were included if they involved working age individuals with chronic LBP receiving VR initiated within the healthcare sector. Articles published before 2013, from outside Europe, or with > 50% of participants on sick leave > 12 months were excluded. Results Of 7032 records, 26 articles representing 21 studies from seven European countries were included. Interventions varied in duration (1-12 weeks or until return-to-work (RTW) or a new plan was established), intensity (a few hours to 30 h/week), complexity, and follow-up periods (5 weeks to 5 years). Interdisciplinary collaboration was most common (six studies), although descriptions were limited. Interventions ranged from simple to complex, with up to seven components. Nineteen different methods were used to assess work status. Conclusion Substantial heterogeneity in intervention design and RTW outcome measures limits comparability and evidence synthesis. Clearer definitions of collaboration and standardized RTW reporting are needed to inform future development of VR in healthcare contexts.

© Frydenlund G; O'Neill S; Mortensen OS; Sondergaaard J; Hansen A. Journal of Occupational Rehabilitation.  2025 Jul 02.
 

Purpose There is a scarcity of data on the long-term evolution of patients after functional restoration for non-specific chronic low back pain (NSCLBP). Therefore, this longitudinal study investigated overall improvement and other sociodemographic and clinical parameters in patients with NSCLBP within 10 years of participating in a functional restoration program. Methods Functional restoration was undergone in a French university hospital between 2009 and 2011. Patients were evaluated at the inclusion, the end of the program, three months, 12 months, and 10 years. The primary outcome of the study was the overall improvement in the 10 years following functional restoration. There were multiple secondary outcomes (e.g., the Quebec Back Pain Disability Scale [QBPDS] and return to work). Changes over time were assessed using generalized estimating equations. Results The study included 51 patients (mean [SD] age 45.6 [8.3] years; 54.9% women; 66.7% employees or workers; and 66.7% full or part-time work disability). The percentage of overall improvement was 76.5% at 10 years (versus 92.0% at the end of the program; p-value not significant). The QBPDS score improved from a mean score of 43.2 at inclusion to 32.2 at 10 years (p-value < 0.001). Finally, return to work occurred in more than half of patients with work disability at three months (62.5%) and 10 years (60.0%), and this return was stable over time (p-value not significant). Conclusions Patients with NSCLBP had favorable outcomes up to 10 years after functional restoration. Further data are needed to corroborate the present findings.

© Jacob L; Heslot C; Ribau M; Logiou C; Vergnol JF; Morchoisne O; Petrover D; Latourte A; Richette P; Beaudreuil J. Joint, Bone, Spine: Revue du Rhumatisme. 105941, 2025 Jun 27.
 

Purpose Return to work (RTW) after physical injury may be challenging. This study aims to gain insight into barriers and facilitators in RTW, using a multi-stakeholder perspective from trauma patients with diverse injuries and health care professionals (HCPs). Methods Three focus groups (n = 13) and four interviews were conducted with patients who sustained an extremity injury, spinal injury, or traumatic brain injury. Four focus groups (n = 19) were conducted with HCPs (e.g., occupational physicians, trauma surgeons). Data were transcribed verbatim and thematically analyzed for patients and HCPs separately. Results Both patients and HCPs emphasized that RTW can be influenced by the extent to which core work tasks are affected by the injury. Barriers in RTW related to lack of RTW follow-up care, limited consultation time, and lack of support in the work environment. Shared facilitators were found in work not affecting the injury, and when adequate support is provided by HCPs and the work environment. While patients and HCPs shared similar ideas, perspectives diverged on RTW follow-up care, provided by HCPs in hospital. HCPs in hospital perceive physical recovery as their core task instead of RTW follow-up care, which is perceived by patients to detract attention to life after injury. Conclusion According to patients and HCPs, regardless of the injury, the combination of injury type and job type influences RTW. Across injuries, receiving RTW follow-up care from HCPs in hospital was often missed, while perceived to facilitate RTW. Tailored RTW information could be useful to patients in resuming life after injury. 

© de Groot E; Hermans AM; de Jongh MAC; Geuze RE; van Dongen IM; Hommes S; Vromans RD; Krahmer E; Houwen T; Janssens KME; Joosen MCW. Journal of Occupational Rehabilitation.  2025 Jul 05. 
 

Purpose Negative beliefs and perceptions about one's health and work participation can act as barriers to rehabilitation and returning to work following an injury, thus increasing the risk of long-term work disability. To prevent poor work and health outcomes it is necessary to be able to effectively measure such constructs. The aim of the present study was to perform psychometric evaluation of the Positivum^TM: Beliefs and Perceptions scales used with individuals with a musculoskeletal injury or condition receiving occupational rehabilitation (OR) services through a workers' compensation or motor vehicle accident insurance scheme. Methods Exploratory factor analysis, item response theory-based analyses, internal consistency analyses, and confirmatory factor analysis were conducted on data collected from January 2020 to April 2024 from a sample of 3,352 musculoskeletal injured individuals receiving OR services through their compensation scheme. Results The results of the current study demonstrated the psychometric robustness of a revised 12 item Positivum: Beliefs and Perceptions scale (PBPS), with two clear multi-item factors: Employer Perceptions and Health-related Work Beliefs as well as two single-item measures (expectations about, and perceived enjoyment of, working). Conclusion Identifying those with negative beliefs and perceptions about working following an injury and at risk of prolonged work disability is the first critical step toward preventing prolonged work disability.

© Sheppard DM; Busija L; May G; Frost D. PLoS ONE 20(7):e0327355, 2025.

Purpose Chronic low back pain is one of the most common causes of absence from work. This not only has economic consequences but also affects the mental health of patients. Furthermore, returning to work is one of the main concerns of patients with chronic pain. Spinal cord stimulation (SCS) has shown its effectiveness in pain reduction and quality of life in many studies. Work-related outcomes have often been neglected or only marginally documented. The aim of this study is to examine specific work-related data of the patients before and after surgery and to assess the influence of SCS on the ability to work with a review of the literature. Methods This is a single-center retrospective study with prospective data collection. All patients were operated on by the same surgeon at the University Hospital Bern between October 2018 and October 2022. Data were collected during postoperative follow-up and by telephone call. In addition, a literature search was conducted to identify previous research on this topic. Results Of the 26 patients included in this study, 18 were on disability leave before SCS whereas eight were still working. After SCS, five of the 18 patients on disability leave were able to return to work within a mean period of 58.3 weeks with a standard deviation of 33.59 after surgery, with a workload of >=20%. Two of these patients transitioned to a new profession. This corresponds to a return-to-work (RTW) rate of 27.8% for patients previously unemployed in our study. Among the eight patients who were employed before SCS, all were able to resume work. Those who had been working full-time (n = 4) maintained their full workload, whereas the four patients who had previously reduced their workload were able to sustain or even slightly increase their employment percentage. Conclusion Our study shows a positive impact of SCS on the patients' work ability with an RTW rate of 27.8%. The findings not only indicate a favorable influence on patients' health and well-being but also create positive economic implications. 

© Gazozcu F; Schutz A; Schar RT; Schlaeppi JA. Neuromodulation. 28(6):976-985, 2025 Aug.

Purpose Low back pain (LBP) can lead to disability and sick leave, impacting work participation and overall health. Given the complex and multifactorial nature of LBP, Belgium's Federal Agency for Occupational Risks (FEDRIS) promotes a secondary prevention strategy for LBP among workers engaged in ergonomically demanding tasks. This strategy includes multidisciplinary-based rehabilitation and an optional workplace intervention (WPI), initiated upon employer request. The WPI component consists of a half-day ergonomic risk analysis at the workplace conducted by an external occupational health service. This paper is one of two parallel qualitative studies that explored the experiences and perspectives of employees and healthcare professionals (HCPs) on the secondary prevention program. The current study focuses on the optional WPI, aiming to identify its strengths, challenges, and potential solutions. Methods Between April 2022 and April 2023, six multicenter semistructured focus groups were held with 15 employees (2015-2019 program participants) and 24 HCPs (including external ergonomists) recruited from 11 Belgian rehabilitation centers and hospitals. Sessions were organized as employee-only, HCP-only, or mixed groups. All the interviews were anonymized, transcribed verbatim, and analyzed inductively via thematic analysis, with validation through data triangulation, intercoder checks, and participant feedback. Results The analysis reveals strengths, challenges, and solutions associated with the WPI before, during, and after implementation. Before the intervention, some HCPs recognized the WPIs' benefits, but limited awareness, employer hesitancy, practicality concerns, and job security fears presumably contributed to low application rates. The proposed solutions include proactive communication, streamlined processes, and enhanced employer engagement. During implementation, strengths included improved employee engagement and interdisciplinary collaboration, but challenges related to limited integration and timing affected effectiveness. Early ergonomic assessments and better communication are suggested. After the intervention, inconsistent feedback hindered sustainability, highlighting the need for systematic follow-up and stronger organizational commitment. Conclusions The WPI provides some tangible benefits for sustainable return to work in Belgium's secondary prevention strategy for LBP, yet a few gaps remain. Low employer awareness, application hesitancy, and inconsistent follow-up hinder effective implementation. Equally, interdisciplinary collaboration and proactive ergonomic assessments are considered strengths of the WPI. Involving all key stakeholders emerges as critical for addressing practical concerns and ensuring ongoing support. Future refinements should prioritize streamlined processes, early-stage interventions, and consistent feedback.  

© Bernaers L; Willems TM; Rusu D; Demoulin C; Van de Velde D; Braeckman L. Journal of Occupational Rehabilitation.  2025 May 07.

Purpose To examine how rehabilitation influences work productivity in university professors from Brazilian federal universities with chronic musculoskeletal pain, specifically by investigating its moderating effect on the relationship between pain intensity and productivity loss at work, as well as its mediating role in the association between self-efficacy for chronic pain and productivity loss at work. Methods A cross-sectional study with 974 university professors experiencing chronic musculoskeletal pain conducted via virtual structured questionnaire including Numeric Pain Rating Scale, Work Limitations Questionnaire (WLQ-25), and Chronic Pain Self-Efficacy Scale (CPSS). Results Total 82.65% of faculty reported moderate to severe pain, and 50.62% were undergoing rehabilitation. The mean total self-efficacy score was 190.13, and mean productivity loss was 7.83%. Moderation analysis showed faculty undergoing rehabilitation had 2.62% productivity loss versus 3.07% for those not undergoing. Mediation analysis indicated a s correlation coefficient of -0.000 for indirect effect and -0.029 for direct effect. Conclusions Rehabilitation does not decrease productivity loss as pain intensity increases; however, faculty undergoing rehabilitation exhibit lower productivity loss compared to those who do not. Higher levels of self-efficacy reduce productivity loss, and rehabilitation does not mediate this relationship.

© de Souza Pinto MJ; Mininel VA; de Oliveira Sato T; Pereira LV; Napoleao AA; Hortense P.   Pain Management Nursing.  2025 May 21.
 

Purpose Research has shown social inequalities in health parameters in the general population, but there is a lack of evidence in medical rehabilitation. Objective: To investigate social inequalities in the utilisation and process of rehabilitation among people with non-specific chronic low back pain (CLBP) and multiple psychological strains undergoing inpatient multidisciplinary orthopaedic rehabilitation (MOR). Methods This multicentre study enrolled 910 patients with non-specific CLBP (ICD-10: M51/53/54) and examined the differences in self-initiative to attend rehabilitation, and psychological, work-related, and pain-related parameters prior to MOR stratified by the social class index (lower, middle, upper class). Moreover, socioeconomic differences were investigated in the frequency distributions of psychosocial cut-off scores before rehabilitation, indicating the clinical relevance of the social class index. Results Compared with patients in both higher classes, patients in the lower class showed significantly lower self-initiative for rehabilitation as well as unfavourable values for pain self-efficacy and work-related and pain-related parameters. Conclusions Health-related inequalities in the inpatient MOR of non-specific CLBP were supported. To promote better health equity, patients should be allocated to rehabilitation according to their needs and individually strengthened in terms of their self-efficacy, health literacy, and ability to cope with pain and work-related stress.

© Hampel P; Dadaczynski K. Journal of Back & Musculoskeletal Rehabilitation. May2025

Purpose Musculoskeletal disorders, especially spinal conditions, are leading causes of disability, contributing significantly to work absenteeism and socio-economic burden. Rehabilitation is essential for promoting sustainable return to work (RTW). However, clinicians need reliable tools with appropriate psychometric properties to determine patients’ risk of persistent work disability and tailor interventions. This systematic review objectives were to (1) identify clinically useful questionnaires that enable clinicians to identify individuals with spinal pain (back or neck pain) at risk of work disability, and (2) document the psychometric properties of the identified questionnaires. Methods A systematic search was conducted in three databases from inception to 01/10/2025, to retrieve relevant studies. Studies were included if they reported self-administered questionnaires with ≤ 15 items predicting RTW outcomes in spinal disorders. Tools were evaluated based on psychometric properties (calibration, discrimination), and pragmatic characteristics (number of items, readability). Results Seventeen studies were retrieved including 16 unique questionnaires of which four demonstrated sufficient discrimination capability. From these, the Örebro musculoskeletal pain questionnaire 10-items (ÖMPQ- 10), STarT Back screening tool (SBST), and a single item from the ÖMPQ- 25 demonstrated acceptable to excellent discrimination for low back pain populations, but showed lower discrimination for mixed or neck pain populations. Conclusion The SBST, ÖMPQ- 10, and single items from the ÖMPQ- 25 performed best in predicting RTW outcomes for low back pain. No questionnaire had sufficient discriminatory capability for neck pain. These results should be interpreted with caution, as the overall risk of bias assessment remains unclear for the OMPQ- 10 and high for the SBST. Further research is necessary to develop or validate tools specific to neck pain and mixed populations.

© Gerard, T., Lachance, P.-L., Rabey, M. et Tousignant-Laflamme, Y. Journal of Occupational Rehabilitation. 16 Apr. 2025
 

Purpose Early physical therapy for workers reporting low back pain (LBP) may reduce disability and improve return to work. This study aimed to explore the relationship between the timing of physical therapy commencement and the duration of work disability after the onset of compensable LBP. Methods We conducted a retrospective cohort analysis of workers with workers' compensation claims for LBP in two Australian states. We investigated the association between the timing of physical therapy commencement and work disability duration using an accelerated failure time model. Median duration of work disability in paid calendar weeks was the principal outcome. Results We examined 9160 accepted workers' compensation claims for LBP. Patients who had not seen a physical therapist had the shortest duration of disability (median, 4.1 weeks). In those who had seen a physical therapist, the median duration of work disability was associated with the timing of commencement of physical therapy, from 8.0 weeks for care within 7 days of the injury to 34.7 weeks when care was commenced greater than 30 days after the onset of injury. Our adjusted model demonstrated that, compared to physical therapy within 7 days of injury onset, commencement of physical therapy between 8 and 14 days, 15 and 30 days, and greater than 30 days was associated with a 37.0% (Time ratios (TR) 1.37; 95% CI (1.23, 1.52)), 119% (TR 2.19; 95% CI (1.96, 2.44)) and 315% (TR 4.51; 95% CI (4.06, 5.02)) increased likelihood of longer disability duration, respectively. Conclusions In workers with work-related LBP undertaking physical therapy, early commencement of physical therapy was associated with a significantly shorter duration of disability. Although we cannot establish causality, our findings highlight the potential benefits of initiatives that promote timely initiation of treatment in reducing extended work disability for injured workers undergoing physical therapy for LBP. 

© Mekonnen TH; Sheehan LR; Di Donato M; Collie A; Russell G. BMC Public Health. 25(1):1329, 2025 Apr 09. 

Purpose Low back pain (LBP) can lead to disability and sick leave, impacting work participation and overall health. Given the complex and multifactorial nature of LBP, Belgium's Federal Agency for Occupational Risks (FEDRIS) promotes a secondary prevention strategy for LBP among workers engaged in ergonomically demanding tasks. This strategy includes multidisciplinary-based rehabilitation (MBR) and an optional workplace intervention. This paper explored the experiences and perceptions of employees and healthcare professionals (HCPs) regarding the secondary prevention program with a focus on the MBR component, aiming to identify its strengths, challenges, and potential solutions. Methods A multicenter qualitative design involving six semistructured focus groups was employed. The participants included 15 employees who attended the program because of LBP and 24 HCPs involved in its delivery. The data were analyzed via thematic analysis. Results Three major themes were identified: functional and work-related outcomes, content-related factors, and duration and continuation. Positive outcomes included improvements in pain, function, and return to work (RTW), with workplace adaptations and ergonomic guidance playing key roles. Success factors such as education, exercise therapy, motivation, and social interaction were highlighted. However, challenges were identified, including limited communication between centers and employers, insufficient psychological support, and a lack of follow-up to sustain the program's effects. Conclusions This qualitative evaluation highlights that person-centered, biopsychosocial approaches-encompassing individualized education, ergonomic adaptations, and psychological support-are crucial for optimizing the FEDRIS MBR program's long-term impact on LBP and RTW outcomes. Consistency in staffing, structured follow-up, and systematic prescreening are key areas for improvement. Although limited by a small sample size and retrospective design, these findings pinpoint actionable refinements that future longitudinal studies can explore to ensure sustained, cost-effective rehabilitation benefits. 

© Bernaers L; Willems TM; Lam GH; Mahy M; Rusu D; Demoulin C; Van de Velde D; Braeckman L.  Scientific Reports. 15(1):13091, 2025 Apr 16. 

Purpose Despite the recommendations to use a bio-psycho-social framework, many physiotherapists still manage their patients mainly from a biomedical point of view. The purpose of this study is to analyze the impact of two different e-learning interventions on knowledge, attitudes, and clinical decision-making of physiotherapists managing low back pain (LBP) to increase guideline-consistent care. Methods Physiotherapists were allocated (1/1) either to an experimental or a traditional e-learning intervention. Baseline and post-intervention assessment included the Health Care Providers' Pain and Impairment Relationship Scale (HC-PAIRS), Back Pain Attitudes Questionnaire (Back-PAQ), Neurophysiology of Pain Questionnaire (NPQ), and a clinical vignette. Participants had 2 weeks to complete the post-intervention assessment. Statistics were processed using ANCOVA and Fisher's t-tests. Results Four hundred nineteen physiotherapists were included in the analysis. Mean scores of HC-PAIRS, Back-PAQ, and NPQ significantly improved post-intervention in both groups. There was a significant effect of the intervention type (experimental versus traditional) on the scores of HC-PAIRS (p < .001; eta2p = .243) and Back-PAQ (p < .001; eta2p = .135) but not on NPQ scores. Return to work recommendations assessed with the clinical vignette were significantly more guideline-consistent in the experimental group (p < .001) post-intervention. Conclusion An interactive e-learning intervention which includes concrete clinical examples and focused on patient's reassurance, self-management, and importance of screening psycho-social factors had more impact than a traditional e-learning intervention to enhance physiotherapists' knowledge, attitudes, and clinical decision-making regarding LBP.

© Fourre A; Michielsen J; Ris L; Darlow B; Vanderstraeten R; Bastiaens H; Demoulin C; Roussel N. Journal of Manual & Manipulative Therapy. 1-14, 2025 Mar 16.
 

Purpose Musculoskeletal injuries are common after road traffic crash (RTC) and can lead to poor work-related outcomes. This review evaluated the impact of interventions on work-related (e.g. sick leave), health, and functional outcomes in individuals with a RTC-related musculoskeletal injury, and explored what factors were associated with work-related outcomes. Methods Searches of seven databases were conducted up until 9/03/2023. Eligible interventions included adults with RTC-related musculoskeletal injuries, a comparison group, and a work-related outcome, and were in English. Meta-analyses were conducted using RevMan and meta-regressions in Stata. Results Studies (n = 27) were predominantly conducted in countries with third-party liability schemes (n = 26), by physiotherapists (n = 17), and in participants with whiplash injuries (94%). Pooled effects in favour of the intervention group were seen overall (SMD = - 0.14, 95% CI: - 0.29, 0.00), for time to return to work (- 17.84 days, 95% CI: - 24.94, - 10.74), likelihood of returning to full duties vs. partial duties (RR = 1.17, 95% CI: 1.01, 1.36), decreased pain intensity (- 6.17 units, 95% CI: - 11.96, - 0.39, 100-point scale), and neck disability (- 1.77 units, 95% CI: - 3.24, - 0.30, 50-point scale). Conclusion Interventions after RTC can reduce time to return to work and increase the likelihood of returning to normal duties, but the results for these outcomes were based on a small number of studies with low-quality evidence. Further research is needed to evaluate a broader range of interventions, musculoskeletal injury types, and to include better quality work-related outcomes.

© Brakenridge CL; Smits EJ; Gane EM; Andrews NE; Williams G; Johnston V.  Journal of Occupational Rehabilitation. 35(1):30-47, 2025 Mar.

Purpose Patients with chronic low back pain face functional, psychological, social and professional difficulties. Multidisciplinary Rehabilitation Programs (MRP) can be an effective treatment to help these patients to improve their condition and return to work. Objective: To determine baseline predictors for return to work after an MRP for patients with chronic low back pain struggling to maintain their job. Methods A monocentric cohort study was conducted. Patients who had followed a MRP between January 2015 and December 2020 were included. The program consisted of physical activities and different workshops inspired by behavioural therapy, at full time during one month. Pain, lifestyle, history of the disease, function, psycho-social characteristics were evaluated at baseline. Return to work at different possible time point after the MRP was collected. A bivariate and a multivariate analysis were performed to evaluate which factors were associated with return to work. Results Overall, 251 patients were included. Professional status, duration off-work, intensity of low back pain, self-perceived disability, fear-avoidance beliefs at work were associated with return to work after the MRP on bivariate analysis. Having worked in the past 6 months and the absence of high fear-avoidance beliefs at work at baseline were associated with return to work on multivariate analysis. Conclusion This study suggests that patients with chronic low back pain and professional difficulties need to be included quickly in a MRP, with specific attention to beliefs about pain.

© Le Cam S; Foltz V; Fautrel B; Bailly F. Joint, Bone, Spine: Revue du Rhumatisme.105840, 2024 Dec 26.
 

Purpose The nursing profession consistently has the highest rates of musculoskeletal disorders (MSDs) among occupations due to physical and psychological pressures, leading to an increased number of sickness absences, early retirement, staff shortage, poor health conditions, and need for medical care. Absence among healthcare workers puts the quality of patient care at risk, and increase colleagues' workload and employer staffing expenses. This study aimed to investigate the viewpoints of Iranian nurses about sustaining work despite musculoskeletal pain. Methods This study was performed as qualitative research. Data were gathered using purposive sampling through in-depth one-to-one interviews with 21 nurses. Interviews were audio-recorded, transcribed verbatim, and imported into the computer software MAXQDA 2020. Graneheim and Lundman's conventional content analysis was performed to analyze the data, and Lincoln and Guba's recommendations were used to control the trustworthiness of the data. Results A total of 4 main categories and 15 subcategories emerged after several rounds of analyzing and summarizing the data and considering the similarities and differences. These main categories included education, workplace adjustments, supportive culture, and regulations and legislations. Conclusion Considering the attitudes of nurses with MSDs on continuing work is important for developing and implementing interventions to facilitate the work for this vulnerable working profession and to promote compliance with these measures. Quantitative studies on the effectiveness of the proposed strategies are required for more scientific evidence.

© Sepehrian R; Aghaei Hashjin A; Farahmandnia H. Journal of Education & Health Promotion. 13:481, 2024.

Purpose To systematically identify and evaluate interventions to improve work participation for adults with upper limb musculoskeletal conditions, and explore contextual factors and mechanisms that suggest how the intervention is effective, for whom, and in what setting. Methods The review protocol was pre-registered with PROSPERO (CRD42023433216). Eligible studies met the following criteria. Population adults (aged >= 18 years), with musculoskeletal upper limb conditions including traumatic and non-traumatic presentations. Intervention strategies aimed at enhancing work participation. Outcomes measures including return to work, increased work duties or hours, and work functioning. Study design randomised and non-randomised experimental studies, mixed methods, qualitative studies, and case series. Two reviewers independently screened, extracted data, and completed quality appraisal. Interventions were described using TIDieR and the data presented as a narrative synthesis. Results Twenty-two studies were included. Interventions were categorised into three groups: multimodal or multidisciplinary (n = 13), ergonomic (n = 4), and exercise (n = 5). Eight interventions were primarily delivered in the workplace and 14 in healthcare settings. Four outcome domains were reported: return to work (n = 18), self-reported work function (n = 4), work productivity (n = 5), and work-related costs (n = 2). Only exercise interventions showed consistent statistically significant benefits. Heterogeneity in outcomes prevented formal meta-analysis. Only five studies were rated as high quality. Conclusions There is insufficient evidence to recommend specific work participation interventions for adults with upper limb musculoskeletal systems. No studies explored the impact of Fit Notes or other formal work guidance documentation.

© Newington L; Ceh D; Sandford F; Parsons V; Madan I. Journal of Occupational Rehabilitation.  2024 Dec 05.

Purpose Given the growing digitalization of healthcare and society, it becomes crucial to explore whether digital interactions with healthcare professionals, such as coaching, can offer effective support and contribute to an improved return-to-work process and a sustainable work environment for individuals with chronic musculoskeletal pain. Aim: To explore perceptions of digital coaching and its potential to support the return-to-work process for individuals with chronic musculoskeletal pain. Methods Three focus group interviews consisting of 14 people-11 women and three men (with a mean age of 48 years)-were conducted. All participants had a goal of returning to work and had completed an interprofessional rehabilitation program due to chronic musculoskeletal pain. Data were analyzed using thematic analysis. Results Findings show that integrating a coach into digital tools could offer new opportunities for personalized guidance, support and feedback to individuals during the return-to-work process. The first theme emphasizes the importance of sustained support throughout the entire return-to-work process-from rehabilitation programs to workforce integration. The second theme outlines the specific tasks and functions expected from a digital coach, as perceived by the participants. Lastly, the third theme explores the envisioned future evolution of digital coaching in chronic musculoskeletal pain management. Conclusions Digital coaching offers promise in addressing challenges during the return-to-work process, acting as a bridge among stakeholders to ensure accessibility, continuity and coordination in rehabilitation and return-to-work efforts.

© Bolic Baric V; Liedberg G; Lundell H; Bjork M; Turesson C. Digital Health. 10: 20552076241300222, 2024 Jan-Dec.

Purpose Chronic pain (pain > 3 months) is a disabling condition affecting around one fifth of the population. Chronic pain significantly affects a person's psychological and physical health and often interferes with the ability to work. It is one of the most common reasons for extended sick leave and persons with chronic pain often have difficulties returning to work. Interpreting the experiences of currently available is necessary in order to facilitate a return to working life. Therefore, this study aimed to describe and interpret the meaning of support during the return-to-work process for persons on sick leave due to chronic pain. Method A qualitative interview study was conducted with 14 participants (12 women and 2 men) who experienced sick leave due to chronic pain. The participants were recruited through patient organizations focusing on pain or pain-related conditions. Collected data was analyzed using a phenomenological hermeneutical approach. Results Have my back as I get back to work was the theme of the analysis, along with six subthemes. Being able to work was important for the participants. However, they often experienced returning to work was a battle for support, dealing with fragmentized backing from the involved stakeholders. Participants with access to collaborative support involving competent care, recognition and the possibility to influence their work felt valuable and capable as persons and workers. Thus, they were provided conditions allowing a successful re-entry into the workplace. Conclusions Our findings contribute to an enhanced understanding of the importance of stakeholder support in persons with chronic pain re-entering the workplace after an extended break due to sick leave. Through an inclusive, collaborative and flexible approach involving all stakeholders working towards the same goal, a person with chronic pain can feel supported in developing and cultivating the capabilities necessary to manage life and work.

© Lundin Å; Ekman I; Andréll P; Lundberg, M; Wallström S. PLoS ONE, Vol. 19 Issue 10, p1-15

Purpose Pain attributed to musculoskeletal disorders are a significant hinderance to work ability and economic growth, especially in developing countries. Quality of life and lived experience of workers with musculoskeletal disorders have not been explored enough to determine whether person-centred care is provided. There is a wealth of evidence for using the biomedical approach in the management of workers with musculoskeletal disorders, which has proved ineffective in reducing absenteeism and symptoms experienced by workers. The purpose of this study was to explore the lived experience of workers seeking care for musculoskeletal disorders and how their pain attitudes and beliefs influenced their experience. Methods A qualitative approach with thematic analysis was used. Purposive sampling was used to recruit six participants for semi-structured interviews. All participants were either experiencing pain attributed to a musculoskeletal disorder or had received care for a musculoskeletal disorder. Results Pain attitudes and beliefs of workers with a musculoskeletal disorder and healthcare professionals greatly influenced the care and recovery process of musculoskeletal disorders. There is a primary biomedical lens informing care of workers with musculoskeletal disorders received. Workers expect healthcare professionals to explore their concerns further, but the focus of care for most participants was their presenting complaint. There is also a need for the autonomy of workers to be preserved, and communication between healthcare professionals and workers with musculoskeletal disorders needs to improve. Conclusions Many stakeholders are involved in the recovery process from musculoskeletal disorders. There is a need for a biopsychosocial informed practice to improve return-to-work (RTW) in workers with musculoskeletal disorders. Change is needed at all healthcare system levels to reduce the negative experiences of workers and maladaptive pain beliefs that is associated with persisting symptoms and extended absenteeism.

© Petersen B; Steyl T; Phillips J. BMC Musculoskeletal Disorders. Vol. 25 Issue 1, p1-17.

Purpose Negative consequences of musculoskeletal pain and injuries on the nurses' health and well-being can increase job dissatisfaction and impose high costs on healthcare centers due to lost workdays and compensation claims. This study aimed to identify policies, programs, and interventions that might be effective in the prevention and reduction of sickness absence and improvement of work outcomes in nursing staff with these problems. Methods The systematic review was conducted according to the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. Electronic databases were searched up to November 9-23, 2022. The keywords "musculoskeletal disorders", "nurse", "return to work", "sickness absence", and "sick leave" and their equivalents were combined using Boolean operators OR/AND. Reference lists of eligible literatures were also screened to identify related studies. In this study, a total of 3365 records were retrieved. Results After two rounds of screening, 15 studies were selected for qualitative synthesis. These studies included seven randomized controlled trial, five pre-post studies, two cohort, and one cross-sectional. Six types of interventions identified including back college, early workplace-based intervention, physical activity/training, psychosocial education, multifaceted intervention, and ergonomics program. Conclusion There is insufficient evidence to identify effective interventions in preventing and reducing sickness absence, and improvement of work outcomes in nursing personnel with work-related musculoskeletal disorders. Numerous factors affected the occurrence of such disorders, and their consequences, therefore comprehensive strategy tailored to the injured person's needs should be considered.

© Sepehrian R; Aghaei Hashjin A; Farahmandnia H. Journal of Education & Health Promotion. 13:205, 2024.

Purpose Chronic low back pain (LBP) represents a leading cause of absenteeism from work. An accurate knowledge of complex interactions is essential in understanding the difficulties of return to work (RTW) experienced by workers affected by chronic LBP. This study aims to identify factors related to chronic LBP, the worker, and the psycho-social environment that could predict and influence the duration of an episode of sick leave due to chronic LBP. Methods Studies reporting the relation between prognostic factors and absenteeism from work in patients with LBP were included. The selected studies were grouped by prognostic factors. The results were measured in absolute terms, relative terms, survival curve, or duration of sick leave. The level of evidence was defined by examining the quality and the appropriateness of findings across studies in terms of significance and direction of relationship for each prognostic factor. Results A total of 20 studies were included. Prognostic factors were classified in clinical, psycho-social, and social workplace, reaching a total of 31 constructs. Global conditions with less favorable repercussions on worker's lives resulted in a delay in time to RTW. Older age, female, higher pain or disability, depression, higher physical work demands, and abuse of smoke and alcohol have shown strong level of evidence for negative outcomes. High global health well-being, great socioeconomic status, and good mental health conditions are decisive in RTW outcomes. Conclusion Interventions that aim at RTW of employee's sick-listed with LBP should focus on psycho-social aspects, health behaviors, and workplace characteristics.

© Russo F; Papalia GF; Diaz Balzani LA; Stelitano G; Zampogna B; Fontana L; Vadala G; Iavicoli S; Papalia R; Denaro V.  Musculoskeletal Surgery.  2024 Jun 12.

Purpose Investigating how individual characteristics modify treatment effects can improve understanding, interpretation, and translation of trial findings. The purpose of this secondary analysis was to identify treatment effect modifiers of the MI-NAV trial, a three arm, parallel randomized controlled trial which compared motivational interviewing and stratified vocational advice intervention in addition to usual case management, to usual case management alone. Methods This study included (n=514) participants with musculoskeletal disorders on sick leave for at least 50% of their contracted work hours for at least 7 consecutive weeks with the Norwegian Labour and Welfare Administration. Sickness absence days was the primary outcome, measured from baseline assessment date until the six-month follow-up. Potential treatment effect modifiers, identified a priori and informed by expert consultation and literature, were evaluated using linear regression models and statistical interaction tests. Results For motivational interviewing versus usual case management, age (mean difference -0.7, 95% confidence interval -1.5 to 0.2; P=0.13) and self-perceived health status (mean difference -0.3, 95% confidence interval -0.7 to 0.1; P=0.19) were identified as potential effect modifiers (p <= 0.2). For stratified vocational advice intervention versus usual case management, analgesic medication use (MD -26.2, 95% CI -45.7 to -6.7; P=0.009) was identified as a treatment effect modifier (p <= 0.05). Conclusion These findings may assist in more targeted treatment adaptation and translation as well as the planning of future clinical trials.

© Venter M; Grotle M; Oiestad BE; Aanesen F; Tingulstad A; Rysstad T; Ferraro MC; McAuley JH; Cashin AG. Journal of Pain. 104556, 2024 May 04.

Purpose A well-defined and clear procedure is a key factor supporting return-to-work and enhancing collaboration and understanding between employers and employees. The adaptation of the Tool for Support-Gradual Return to Work, TS-GRTW, addresses relevant cultural aspects valuable for wider adoption. Objective: to develop a Swedish version, the GRTWswe, for implementation and integration into the Swedish labor market's RTW process. This involved translating, culturally adapting, and assessing the appropriateness and utility. Methods In the initial step, a double back translation was performed to create an initial translated version. This version was then utilized in individual consultations, accompanied by an agreement questionnaire. For the subsequent step, group consultations were held to refine and customize the tool to suit the Swedish context. Ten occupational therapists completed the questionnaires, with mean agreement scores surpassing three on a four-point scale. Out of these, nine participated in group consultations. Results The findings suggest the requirement for specific modifications to the GRTWswe. These adaptations are essential because of cultural differences in organizational structures and reference frameworks. Moreover, participants unanimously agreed to broaden the scope of target groups, encompassing employees without regard for diagnosis and expanding the range of professions that can utilize this tool. This step aims to enhance the tool's applicability and usefulness. Conclusions The study found strong alignment between questionnaire responses and group consultations outcomes, affirming the adapted tool's suitability for use in a Swedish context. The tool benefits employers and employees by enhancing communication, encouraging collaboration, and structuring processes, promising lasting improvements to work conditions.

© Liedberg GM; Bjork M; Coutu MF; Durand MJ; Turesson C. Work. 2024 May 09.

Purpose To determine the prospective association of pain coping strategies and symptoms of anxiety and depression with work absenteeism in people with upper limb musculoskeletal disorders. Methods A systematic search of PubMed, Web of Science, Embase, Cochrane Library, and Scopus databases was conducted from inception to September 23, 2022. Prospective observational studies of adults with upper limb musculoskeletal disorders were included. Included studies had to provide data on the association of pain coping strategies (catastrophizing, kinesiophobia, self-efficacy or fear avoidance) or symptoms of anxiety and depression with work absenteeism. Study selection, data extraction, and assessment of methodological quality (Newcastle Ottawa Scale) were performed by 2 independent authors. Random-effects models were used for quantitative synthesis. Results Eighteen studies (n=12,393 participants) were included. Most studies (77.8%) reported at least 1 significant association between 1 or more exposure factors (pain coping strategies or symptoms of anxiety and depression) and work absenteeism. Meta-analyses showed a statistically significant correlation between the exposure factors of catastrophizing (r=0.28, 95% confidence interval [CI]: 0.15 to 0.40; P<.0001) and symptoms of anxiety and depression (r=0.23, 95% CI: 0.10 to 0.34; P=.0003) with work absenteeism. The correlation between self-efficacy and work absenteeism was non-significant (r=0.24, 95% CI: -0.02 to 0.47; P=.0747). Conclusions Rehabilitation teams should consider assessing catastrophizing and symptoms of anxiety and depression to identify patients at risk for work absenteeism. Addressing these variables may also be considered in return-to-work programs for individuals with upper limb disorders.

© Nunez-Cortes R; Espin A; Perez-Alenda S; Lopez-Bueno R; Cruz-Montecinos C; Vincents-Seeberg KG; Puschel TA; Calatayud J; Andersen LL. Archives of Physical Medicine & Rehabilitation. 105(4):781-791, 2024 Apr.

Purpose Musculoskeletal disorders are one of the most recurrent diseases among manual workers worldwide. The objective of this study was to analyze primary results of a systematic review on ergonomics, musculoskeletal disorders, treatment, and return to work in blue-collar workers to form a new conceptual framework applicable to intervention programs in this area. Methods This study was based on the available scientific evidence we identified. Descriptive data and their trending topics areas were used to form the conceptual framework. Results The trend shows that working conditions can be represented as a three-axis scheme with a multidimensional conceptual framework considering ergonomic risks, the treatment of affected workers and the determinants related to working conditions. Conclusion These results may help future research in the field of ergonomics as well as emerging topics focused on intervention programs.

© Hacay Chang A; Bolanos F; Sanchis-Almenara M; Gomez-Garcia A. Archivos de Prevencion de Riesgos Laborales. 27(2):190-196, 2024 Apr 15.

Purpose The objective was to identify modifiable prognostic factors of high societal costs among people on sick leave due to musculoskeletal disorders, and to identify modifiable prognostic factors of high costs related to separately healthcare utilisation and productivity loss. Methods Design: A prospective cohort study with a 1-year follow-up. Participants and setting: A total of 549 participants (aged 18-67 years) on sick leave (>= 4 weeks) due to musculoskeletal disorders in Norway were included. Outcome measures and method: The primary outcome was societal costs aggregated for 1 year of follow-up and dichotomised as high or low, defined by the top 25th percentile. Secondary outcomes were high costs related to separately healthcare utilisation and productivity loss aggregated for 1 year of follow-up. Healthcare utilisation was collected from public records and included primary, secondary and tertiary healthcare use. Productivity loss was collected from public records and included absenteeism, work assessment allowance and disability pension. Nine modifiable prognostic factors were selected based on previous literature. Univariable and multivariable binary logistic regression analyses were performed to identify associations (crude and adjusted for selected covariates) between each modifiable prognostic factor and having high costs. Results Adjusted for selected covariates, six modifiable prognostic factors associated with high societal costs were identified: pain severity, disability, self-perceived health, sleep quality, return to work expectation and long-lasting disorder expectation. Depressive symptoms, work satisfaction and health literacy showed no prognostic value. More or less similar results were observed when high costs were related to separately healthcare utilisation and productivity loss. Conclusion Factors identified in this study are potential target areas for interventions which could reduce high societal costs among people on sick leave due to musculoskeletal disorders. However, future research aimed at replicating these findings is warranted.

© Killingmo RM; Tveter AT; Pripp AH; Tingulstad A; Maas E; Rysstad T; Grotle M.  BMJ Open. 14(3):e080567, 2024 Mar 01.

Purpose This study examines the relationship between functional disability and work ability in workers affected by low back pain (LBP) through an analysis of correlations between the Oswestry Disability Index (ODI) and Work Ability Index (WAI). The role of personal and work factors on functional disability/work ability levels has also been studied. LBP is the most common musculoskeletal problem and a major disabling health problem worldwide. Its etiology is multifactorial. Multidisciplinary approaches may help reduce the burden of pain and disability and improve job continuity and reintegration at work. Methods A cohort of 264 patients affected by LBP from an Italian outpatient clinic were included in a clinical diagnostic/therapeutic trial aiming at rehabilitation and return to work through an integrated investigation protocol. Data were collected during the first medical examination using anamnestic and clinical tools. The final sample is composed of 252 patients, 57.1% man, 44.0 % blue collars, 46.4% with the high school degree, 45.6% married. Results WAI and ODI reported a negative and fair correlation (r = -0.454; p = .000). Workers with acute LBP symptoms have a higher probability of severe disability than those with chronic LBP symptoms. White collars without depressive symptoms reported higher work ability - even in chronic disability conditions-than those with depressive symptoms. Conclusion The study found that ODI and WAI have a convergent validity and this suggests that the two tools measure capture distinctive aspects of disability related to personal, environmental, and occupational characteristics. The most important and modifiable prognostic factors found for ODI and WAI were depressive symptoms, workday absence, and intensity of back pain. The study also found a mild association between age and ODI. The study's findings highlight the importance of using a multidisciplinary approach to manage and prevent disability due to LBP.

© Russo F; Di Tecco C; Russo S; Petrucci G; Vadala G; Denaro V; Iavicoli S.  Safety and Health at Work. 15(1):66-72, 2024 Mar.

Purpose The aim was to evaluate if rehabilitation procedures including occupational health (OH) and workplace participation increase return to work (RTW) rates among patients with subacute and chronic low back pain (LBP). Methods A systematic review of randomized controlled trials was conducted using the PubMed and Cochrane databases. Main outcomes were RTW and days of sick leave. Interventions needed to be multidisciplinary including both OH and active workplace involvement in rehabilitation. Results Out of 1073 potentially eligible references, 8 met the inclusion criteria. Three studies had OH and 5 case managers involved in rehabilitation. Rehabilitation involving both OH and workplace improved RTW and decreased the number of sick leave days among LBP patients. Having case managers involved had no effect in RTW. In order to improve RTW, workplace visits and work ability meetings (WAMs) between OH and workplace are essential components in the rehabilitation process among patients with chronic LBP. Conclusion Based on the study results, the authors suggest utilizing these co-operative interventions with workplaces in OH. High quality research investigating only the effect of WAMs in OH setting is needed in future.

© Kokkonen V; Lamminpaa A; Reijula K; Russo F; Iavicoli S; Denaro V; Kuoppala J. International Journal of Occupational Medicine & Environmental Health. 2024 Jan 25.