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Women on sick leave for long-term musculoskeletal pain: Factors associated with work ability, well-being and return to work
Högskolan i Gävle, Akademin för hälsa och arbetsliv, Avdelningen för arbetshälsovetenskap och psykologi, Arbetshälsovetenskap. Högskolan i Gävle, Centrum för belastningsskadeforskning.ORCID-id: 0000-0001-7558-4168
2019 (Engelska)Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
Fritextbeskrivning
Abstract [en]

Background: Taking sick leave (SL) for long-term musculoskeletal pain (MSP), predominantly in the neck, shoulders and back, is common among women in Sweden. Long-term MSP affects their daily life and causes impaired work ability and long-term SL. Therefore, it is necessary to work from a multidimensional perspective to generate knowledge about factors that may obstruct or promote work ability and well-being in the return-to-work (RTW) process among women on SL for MSP. The aim of the thesis was to identify factors of importance for work ability, well-being and RTW among women on SL for long-term neck/shoulder and/or back pain.

      Methods: Study I is a narrative systematic review. An extensive systematic search was performed through the databases Medline, CINAHL and PsycINFO, from their inception until February 2016. The inclusion criteria for the articles were: study population of men and women aged 18-65 years, work absence ≥ 2 weeks, and neck/shoulder or back pain. The outcome variable was RTW. An additional search through reference lists and citations of the included articles was performed in Scopus. A total of 10 studies were selected for the methodological quality assessment and synthesis of the results. Data were synthesized through analysis of the content according to similarities of factors. For Study II-IV, a postal survey was sent to 600 women in central and northern Sweden who were receiving time-loss benefits during the spring of 2016. The inclusion criteria were women aged 18-65 years, ≥ 50% SL from service, SL ≥ 1 month due to neck/shoulder and/or back pain (≥ 3 months), and understanding the Swedish language. The exclusion criteria were rheumatoid arthritis, multiple sclerosis, stroke, cancer, Parkinson, bipolar disease, schizophrenia, and pregnancy. A follow-up survey was sent out in spring 2017 to the 208 women who answered the survey at baseline; 141 responded. Study II was cross-sectional; a multiple linear regression was conducted to determine the association between the factors and work ability and well-being, respectively. Study III had  a prospective design with a 1-year follow-up. A multiple logistic regression was conducted to determine whether work ability and well-being predicted RTW. To assess the discriminative ability of the Work Ability Index (WAI) and Life Satisfaction questionnaire (LiSat-11) regarding women who did RTW and those who did not RTW (NRTW), Receiver Operating Characteristic (ROC) curves were used. Study IV also had a prospective design with a 1-year follow-up. Cluster analysis was performed to identify potential predictors, and a multiple logistic regression model was used to identify significant predictors of RTW.

      Results: Study I suggested that recovery beliefs, health-related factors and work capacity may be important areas to target in interventions for women and men with long-term neck or back pain. The review also showed that there is a lack of high-quality studies. Study II showed that believing one would return to the same work within 6 months, pain intensity and job strain were associated with work ability among women on SL for long-term neck/shoulder and/or back pain. Self-efficacy and depression were associated with well-being. The findings from Study III indicated that work ability was important for RTW in this group of women. The WAI adequately discriminated between RTW and NRTW. The LiSat-11 did not predict RTW or discriminate between RTW and NRTW. The results from Study IV indicated that coping through increasing behavioral activities, believing one would return to the same work within 6 months, and social support outside work predicted RTW in this group of women.

      Conclusions: The results from the empirical studies on women only were partly in agreement with results found in the narrative systematic review on men and women. In light of this, future studies may benefit from investigating prognostic factors for RTW among men and women separately. Factors that emerged in the empirical studies would need to be tested in a weighted model to identify whether any of them mediate or moderate the outcome variable RTW.

Abstract [sv]

Bakgrund: Sjukskrivning (SL) på grund av långvarig muskuloskeletal smärta (MSP), främst i nacke, axlar och rygg, är vanligt bland kvinnor i Sverige. Långvarig MSP påverkar deras dagliga liv och orsakar nedsatt arbetsförmåga och långvarig SL. Därför behövs kunskap om faktorer ur ett multidimensionellt perspektiv som kan hindra eller främja arbetsförmåga och välbefinnande i processen att återgå till arbete (RTW) bland kvinnor som är sjukskrivna på grund av MSP. Syftet med denna avhandling var att identifiera faktorer av betydelse för arbetsförmåga, välbefinnande och RTW bland kvinnor med SL på grund av långvarig smärta i nacke/axlar och/eller rygg.

      Metoder: Studie I är en systematisk litteraturöversikt. En omfattande systematisk sökning genomfördes i databaserna Medline, CINAHL och PsycINFO, från deras start till februari 2016. Inklusionskriterierna var följande: population av män och kvinnor i åldrarna 18-65 år, arbetsfrånvaro ≥ 2 veckor, smärta i nacke/axlar eller rygg. Utfallsvariabeln var RTW. En ytterligare sökning genom referenslistor och citeringar av de inkluderade studierna utfördes i Scopus. Totalt 10 studier sållades ut för kvalitetsbedömning och syntes av resultat. Syntesen gjordes på basis av likheter i innehållet av mätningarna. I Studie II-IV gjordes en enkätundersökning via post till 600 kvinnor i centrala och norra Sverige under våren 2016. Inklusionskriterierna var kvinnor i åldrarna 18-65 år, ≥ 50% SL från arbetet, SL ≥ 1 månad på grund av smärta i nacke/axlar och/eller rygg (≥ 3 månader) och språkkunskaper i svenska. Exklusionskriterierna var reumatoid artrit, multipel skleros, stroke, cancer, Parkinson, bipolär sjukdom, schizofreni och graviditet. Under våren 2017 skickades en uppföljningsenkät till de 208 kvinnorna som svarade på den första enkäten, och 141 svarade. Studie II var en tvärsnittsstudie där multipel linjär regression användes för att undersöka sambandet mellan faktorer och arbetsförmåga respektive välbefinnande. Studie III hade en prospektiv design med en 1-års uppföljning. En multipel logistisk regressionsanalys genomfördes för att avgöra om arbetsförmåga och välbefinnande kan prediktera RTW. Förmågan av Work Ability Index (WAI) som skattning av arbetsförmåga och Life Satisfaction Questionnaire (LiSat-11) som skattning av välbefinnande att diskriminera mellan kvinnor som RTW och som inte RTW (NRTW) undersöktes med hjälp av Receiver Operating Characteristic (ROC) kurvor. Studie IV hade en prospektiv studie med en 1-års uppföljning. Klusteranalys användes för att selektera potentiella prediktorer, och en multipel logistisk regressionsanalys användes för att identifiera signifikanta prediktorer för RTW.

      Resultat: Studie I indikerade att tro på tillfrisknande, hälsorelaterade faktorer och arbetsförmåga kan vara viktiga att rikta insatser mot för kvinnor och män med långvarig nacke eller ryggsmärta. Litteraturöversikten fann också en brist på studier av hög kvalitet. Studie II visade att tron på att vara tillbaka i arbetet inom 6 månader, smärtintensitet och s.k. spänt arbete hade ett samband med arbetsförmågan hos sjukskrivna kvinnor med långvarig smärta i nacke/axlar och/eller rygg. Tro på sin egen förmåga och depression var associerade med välbefinnande. Resultaten från studie III visade att arbetsförmågan var viktig för RTW bland kvinnorna. WAI kunde diskriminera mellan kvinnor som RTW och NRTW, medan LiSat-11 inte kunde det. Resultaten från Studie IV indikerade att bemästring genom ökande beteendeaktiviteter, tron på att vara tillbaka i arbetet inom 6 månader och socialt stöd utanför arbetet predikterade RTW bland kvinnorna.

      Slutsatser: Resultaten från de empiriska studierna av endast kvinnor stämde delvis överens med resultaten från den narrativa litteraturöversikten av män och kvinnor. Fortsatta studier av prognostiska faktorer för återgång i arbete skulle således kunna vinna på att undersöka kvinnor och män separat. Faktorerna som framkom i de empiriska studierna skulle behöva undersökas närmare för att klargöra om någon eller några av dem har en medierande eller modererande effekt på utfallsvariabeln RTW.

Ort, förlag, år, upplaga, sidor
Gävle: Gävle University Press , 2019.
Serie
Studies in the Research Profile Health-Promoting Working Life. Doctoral thesis
Nyckelord [en]
Biopsychosocial model, musculoskeletal pain, postal survey, prognostic factors, return to work, sick leave, women of working age, work ability and well-being
Nationell ämneskategori
Arbetsmedicin och miljömedicin
Identifikatorer
URN: urn:nbn:se:hig:diva-30965OAI: oai:DiVA.org:hig-30965DiVA, id: diva2:1370212
Disputation
2020-01-10, Krusenstjernasalen (23:213), Kungsbäcksvägen 47, Gävle, 09:00 (Engelska)
Opponent
Handledare
Tillgänglig från: 2019-12-18 Skapad: 2019-11-14 Senast uppdaterad: 2019-12-18Bibliografiskt granskad
Delarbeten
1. Factors associated with return-to-work among people on work absence due to long-term neck or back pain: a narrative systematic review
Öppna denna publikation i ny flik eller fönster >>Factors associated with return-to-work among people on work absence due to long-term neck or back pain: a narrative systematic review
2017 (Engelska)Ingår i: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 7, nr 6, artikel-id e014939Artikel, forskningsöversikt (Refereegranskat) Published
Abstract [en]

OBJECTIVE:

The purpose of this narrative systematic review was to summarise prognostic factors for return to work (RTW) among people with long-term neck/shoulder or back pain.

METHODS:

A systematic literature search was performed through three databases (Medline, CINAHL and PsycINFO) for studies published until February 2016. Only observational studies of people on work absence (≥2 weeks) due to neck/shoulder or back pain were included. The methodological quality of the included studies was assessed using guidelines for assessing quality in prognostic studies on the basis of Framework of Potential Biases. Factors found in the included studies were grouped into categories based on similarities and then labelled according to the aspects covered by the factors in the category.

RESULTS:

Nine longitudinal prospective cohort studies and one retrospective study fulfilled the inclusion criteria. From these, five categories of factors were extracted. Our findings indicate that recovery beliefs, health-related factors and work capacity are important for RTW among people with long-term neck or back pain. We did not find support for workplace factors and behaviour being predictive of RTW.

CONCLUSIONS:

Our findings suggest that recovery beliefs, perceived health and work capacity may be important targets of intervention for people with long-term neck or back pain. However, more high-quality prospective studies are needed to confirm the results and improve our understanding of what is needed to facilitate RTW in this population.

Nyckelord
factors, return to work, work absence, pain
Nationell ämneskategori
Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi Arbetsmedicin och miljömedicin
Forskningsämne
Hälsofrämjande arbete; Hälsofrämjande arbete
Identifikatorer
urn:nbn:se:hig:diva-21102 (URN)10.1136/bmjopen-2016-014939 (DOI)000406391200103 ()28674139 (PubMedID)2-s2.0-85021744037 (Scopus ID)
Tillgänglig från: 2016-01-25 Skapad: 2016-01-25 Senast uppdaterad: 2020-01-21Bibliografiskt granskad
2. Factors related to work ability and well-being among women on sick leave due to long-term pain in the neck/shoulders and/or back: a cross-sectional study
Öppna denna publikation i ny flik eller fönster >>Factors related to work ability and well-being among women on sick leave due to long-term pain in the neck/shoulders and/or back: a cross-sectional study
2018 (Engelska)Ingår i: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 18, nr 1, artikel-id 672Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

BACKGROUND:

Musculoskeletal pain is one of the leading causes of sick leave, especially among women, in Western countries. The aim of the present study was to identify factors associated with work ability and well-being, respectively, among women on sick leave due to long-term pain in the neck/shoulders and/or back.

METHODS:

A cross-sectional study with a correlational design was conducted on women who were sick-listed due to long-term pain in the neck/shoulders and/or back. A total of 208 participants responded to a survey comprising eight instruments: Multidimensional Pain Inventory scale, General Self-Efficacy scale, Sense of Coherence scale, Coping Strategies Questionnaire, Demand-Control-Support Questionnaire, Hospital Anxiety and Depression Scale, Work Ability Index and Life Satisfaction questionnaire. Multiple linear regression analyses were performed to identify factors associated with work ability and well-being, respectively.

RESULTS:

Women who more strongly believed they would return to the same work had greater work ability (β = 0.39, p < 0.001), whereas women with higher pain intensity (β = - 0.30, p < 0.001) and higher job strain (β = - 0.12, p < 0.05) had lower work ability. Women with higher self-efficacy rated greater well-being (β = 0.14, p < 0.05). As the women's scores for depression increased, their well-being decreased by 48%, which was statistically significant (p < 0.001). The regression models for work ability and well-being were significant (p < 0.001), and their adjusted R- square values were 48% and 59%, respectively.

CONCLUSIONS:

The study suggests that the factors beliefs to be back at the same work, pain intensity and job strain are predictive of work ability. Moreover, the factors self-efficacy and depression seem to be predictive of well-being. The findings highlight factors that should be considered by health care professionals and policy-makers to guide attempts to reduce sick leave.

Nyckelord
Ability to work; Musculoskeletal pain; Prognostic factors; Quality of life; Sickness absence; Women
Nationell ämneskategori
Arbetsmedicin och miljömedicin
Forskningsämne
Hälsofrämjande arbete
Identifikatorer
urn:nbn:se:hig:diva-25931 (URN)10.1186/s12889-018-5580-9 (DOI)000433587000004 ()29848306 (PubMedID)2-s2.0-85047837458 (Scopus ID)
Anmärkning

Funding agency:

University of Gävle grant no: 2015/424

Tillgänglig från: 2018-01-04 Skapad: 2018-01-04 Senast uppdaterad: 2020-01-21Bibliografiskt granskad
3. Do work ability and well-being matter for return to work?: Cut-off points for Work Ability Index and Life Satisfaction questionnaire among women with long-term musculoskeletal pain
Öppna denna publikation i ny flik eller fönster >>Do work ability and well-being matter for return to work?: Cut-off points for Work Ability Index and Life Satisfaction questionnaire among women with long-term musculoskeletal pain
(Engelska)Manuskript (preprint) (Övrigt vetenskapligt)
Abstract [en]

Objectives: To determine whether work ability and well-being predict return to work (RTW) among women with long-term neck/shoulder and/or back pain at a 1-year follow-up, and to assess the ability of the Work Ability Index (WAI) and Life Satisfaction questionnaire (LiSat-11) to discriminate between those who did RTW and those who did not RTW. 

Methods: A survey was sent to 600 women receiving time-loss benefits from the Swedish Social Insurance Agency. In total, 208 women responded at baseline, and 141 at a 1-year follow-up. To identify whether work ability and well-being predicted RTW, multiple logistic regression analyses were performed with and without adjustment for type of work and pain intensity. To assess the discriminative ability of the WAI and LiSat-11 for women who did RTW and those who did not RTW, Receiver Operating Characteristic curves were fitted.  

Results: Work ability predicted RTW, and the results remained significant after adjusting for type of work and pain intensity (OR 1.12, 95% CI: 1.04-1.22). Well-being was not significant. The WAI at baseline adequately discriminated between RTW and no RTW after one year (AUC 0.78, 95% CI 0.70-0.86), but the LiSat-11 did not.

Conclusions: Our results indicate that work ability is an important factor for RTW among women on SL for long-term neck/shoulder and/or back pain. The WAI has adequate discriminatory ability in this population, but the LiSat-11 has not.  

 

Keywords: Life satisfaction, Musculoskeletal pain, Sickness absence, Work status

Nationell ämneskategori
Arbetsmedicin och miljömedicin Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi
Identifikatorer
urn:nbn:se:hig:diva-30960 (URN)
Tillgänglig från: 2019-11-14 Skapad: 2019-11-14 Senast uppdaterad: 2019-11-22Bibliografiskt granskad
4. Predictors of return to work among women with long-term neck/shoulder and/or back pain: a 1-year prospective study
Öppna denna publikation i ny flik eller fönster >>Predictors of return to work among women with long-term neck/shoulder and/or back pain: a 1-year prospective study
(Engelska)Manuskript (preprint) (Övrigt vetenskapligt)
Abstract [en]

Objective: The aim of this study was to identify predictors of return to work (RTW) among women on sick leave due to long-term neck/shoulder and/or back pain.

Methods: The study was a prospective survey with a 1-year follow-up. Data on predictors and outcome were collected using a self-administrated questionnaire containing eight instruments – Coping Strategies Questionnaire, General Self-Efficacy scale, Sense of Coherence, Multidimensional Pain Inventory, Hospital Anxiety and Depression Scale, Demand-Control-Support Questionnaire, Work Ability Index, and Life Satisfaction questionnaire, as well as a set of background questions. A total of 208 women, aged 23-63 years, were included at baseline, and 141 responded at the 1-year follow-up. Multiple logistic regression analyses were performed to identify predictors of RTW.

Results: Of the 141 women, 94 had RTW and 47 had not at the 1-year follow-up. Women who engaged in more coping by increasing behavioral activities, such as leisure activities, reading and socialization, (OR 1.12, 95% CI 1.02-1.22) and those who more strongly believed they would return to the same work within 6 months (OR 1.24, 95% CI 1.12-1.38) had an increased probability of RTW. Getting more social support outside work (OR 0.49, 95% CI 0.26-0.90) decreased the odds of RTW at the 1-year follow-up.

Conclusions: The findings suggested that behavioral activities, belief in returning to the same work and social support were predictors of RTW at the 1-year follow-up. Healthcare professionals should consider these predictors in efforts to prevent prolonged sick leave and to promote RTW among women with long-term neck/shoulder and/or back pain.

 

 

Key terms: Follow-up study, musculoskeletal pain, prognostic factors, sickness absence, return to work.

 

Nationell ämneskategori
Arbetsmedicin och miljömedicin Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi
Identifikatorer
urn:nbn:se:hig:diva-30963 (URN)
Tillgänglig från: 2019-11-14 Skapad: 2019-11-14 Senast uppdaterad: 2019-11-22Bibliografiskt granskad

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