Determinants of disability after a work-related musculoskeletal injury

OBJECTIVE: Musculoskeletal soft tissue injuries consume
considerable resources in personal suffering, medical care,
work absenteeism, and compensation benefits. Our aim was to
determine specific clinical and behavioral factors that
prognostically influence return to work following
musculoskeletal work related injuries.
METHODS: A longitudinal
cohort study was conducted on 148 randomly selected workers
who had not returned to work in 3 months following
musculoskeletal soft tissue injury. The cohort was identified
from the files of the Workers' Compensation Board of Ontario,
Canada. The workers were interviewed and assessed at 3, 9, 15,
and 21 months after injury. The WHO Classification of
Impairment, Disabilities and Handicap was used as the
conceptual framework. The analysis employed a proportional
hazards regression model with allowance for time dependent
RESULTS: The rate of return to work for men was
1.5 times that for women, and 20% less for every 10 year
increase in age. Controlling for sex and age, psychological
distress and functional disability were associated with a
slower rate of return to work. The rate of return to work for
workers who were provided with modified jobs was 2 times
higher than for those with no such accommodation in
CONCLUSION: The negative effect of psychological
distress and functional disability on return to work rates
must be considered in the design and delivery of
rehabilitation programming for workers with musculoskeletal
soft tissue injuries. The employer's provision of a "modified
job" is important in the prevention of continued disability.

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