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Does screening work? Psychosocial risk factors for work absence due to sprains and strains

At a glance:
  • Screening for long term disability
    A condition or function that leaves a person unable to do tasks that most other people can do.
     is sometimes suggested as there is a connection between psychosocial
    Refers to psychological and social factors. Examples of psychosocial factors that affect return to work area include: a person's beliefs about how they will cope with their condition, the attitude of the inured worker's family to their condition and return to work, the employer's return to work policy and the influence of the WorkCover system on a person.
     risk factors, back pain and work absence.
  • This study shows limited value in general screening for psychosocial risk factors for absence from work in the workplace
  • Screening may predict that a person is likely to have an absence from work, but not when or for how long they will be off work.
Previous research has shown that psychological
Refers to a person's perceptions, thought processes, emotions, personality and behaviour. Psychologists can treat mental health problems.
 risk factors such as distress,
Severe suffering, pain, anxiety or sorrow
 negative attitudes, mistaken beliefs and poor coping strategies, can affect recovery from injuries to the muscles or bones. Occupational psychosocial risk factors such as job dissatisfaction, stress, low social support and low perceived control also play a significant role in recovery.

The study found that general screening for psychosocial factors to predict future injuries was not useful. It cannot predict whether a person will develop a long term disability from a musculoskeletal
Involving the muscles and the skeleton. This term includes the limbs, neck, shoulders and back. 'Musculoskeletal problem' refers to many different conditions that can affect the tendons, muscles and related structures.

It concluded that considering psychosocial issues in the early stages after an injury may be useful to aid recovery, because at this stage these risk factors are more likely to affect outcomes.
Psychological factors such as distress, negative attitudes, mistaken beliefs and poor coping strategies, together with psychosocial factors such as job dissatisfaction, stress, low social support and low perceived control at work can have a negative impact on the speed of recovery from a musculoskeletal injury.

The researchers evaluated whether employers could do general screening, to identify situations where people might be at risk of long term disability.

The study concluded that general screening of workers for psychosocial risk factors can predict short term work absences, such as a few days off work. However it does not predict situations where people will be off work for extended periods of time.
The detrimental effects of certain psychological risk factors (such as distress, negative attitudes, mistaken beliefs and poor coping strategies) on the course and recovery from musculoskeletal disorders have been noted in the past. Other studies have shown that occupational psychosocial risk factors (such as job dissatisfaction, stress, low social support and low perceived control at work) also play a significant role in the recovery from musculoskeletal disorders.

While psychosocial factors can indicate a practical target for workplace and/or clinical interventions
A treatment or management program. Interventions often combine several approaches. In this field approaches include training in problem solving, adaptation of work duties, graded activity, an exercise and stretching program and pain relief.
 post injury, this study found that screening for risk factors in the workplace prior to injury had limited value in predicting the likelihood of disability.
Psychosocial screening appears attractive because it can be undertaken cheaply.

However the usefulness of these screening surveys for predicting disability in individuals who are not already suffering pain is limited.

Screening for psychosocial factors in the early stages post injury may be useful in indicating practical targets for workplace and/or clinical interventions.
Original Article, Authors & Publication Details:
S. Bartys1, K. Burton2 and C. Main3 (2005).

A prospective study of psychosocial risk factors and absence due to musculoskeletal disorders--implications for occupational screening. Occupational Medicine; 55(5):375-9.

1 Institute for Public Health Research & Policy, University of Salford,4th Floor, Humphrey Booth House, The Crescent, Salford, Greater Manchester M5 4QA, UK.
2 Centre for Health and Social Care Research, University of Huddersfield, Huddersfield, UK.
3 Unit of Chronic
continuing a long time or recurring frequently
 Disease Epidemiology,
The study of factors affecting the health and illness of populations. Also refers to the study of management and control of health problems.
 Medical School, University of Manchester, Manchester, UK.
Background, Study Objectives, How It Was Done:
Musculoskeletal conditions (such as back pain, sprains
Injury to ligaments caused by overstretching or overuse. The ligament is usually stretched but may be torn.
 and strains
Injury to a muscle in which the muscle fibres tear or become irritated as a result of overstretching or wrenching
 of joints) are common conditions that affect the health of workers, and therefore result in lost time and money in the workplace. Although many people will experience a short term musculoskeletal condition, few of these complaints develop into long-term disability. However, the small number of people who do develop long-term disabilities account for the large costs to industry and society from lost production and payment of social security benefits, and for these people quality of life can be poor.

A large amount of research to determine the physical risk factors for musculoskeletal injury has been done.

In a shift of focus from physical hazards, there is growing evidence that psychological and psychosocial risk factors also exist for musculoskeletal conditions and associated disability and work-loss, with factors such as distress, mistaken beliefs about the condition, poor coping strategies, job dissatisfaction, low social support, and low perceived control at work being associated with less successful outcomes.

It has therefore been suggested that psychosocial screening to identify people at risk of developing long term problems from musculoskeletal conditions may help reduce their likelihood of becoming disabled. Those identified as “at risk' might then receive more active management if they experienced a musculoskeletal complaint, presumably improving the outcomes. This study sought to assess whether those who were more likely to have long term problems could be identified, and assisted.

The study was of 4,637 workers from a large, multi-site company in the UK. The participants were asked to fill out a booklet containing a range of questionnaires. The group was then followed over the next 15 months and any absence due to musculoskeletal disorders was recorded. The results of the questionnaires were analysed, and time off work compared to the psychosocial information obtained from the questionnaires.

The “risk factor' categories explored in the present study were:
  • psychological distress
  • job satisfaction, and social support
  • perceived control at work
  • whether a person felt their work was “their' own task
  • how the workplace was organised
Study Findings:
59% of the company employees completed the survey. The survey participants' psychosocial responses and the number of people suffering musculoskeletal problems were similar to findings from other studies.

When looking at the likelihood of time off work, those found to have higher psychosocial “risk factors', such as low job satisfaction and social support, were twice as likely to take a period of time off work.

The study then looked at the duration of time off work of employees compared to their psychosocial survey results. In particular, the authors compared the time off work for those with no psychosocial risk factors to those with all of the risk factors (listed above). There was a wide range of absence durations (between 1 and 119 working days). Employees who had no psychosocial risk factors had shorter periods of time off work (average of 9 days) than employees with all six risk factors (average of 13 days), but the difference was not large enough to show that this trend was a significant finding.
The presence of psychosocial risk factors was found to predict the occurrence of a future absence due to a musculoskeletal disorder, but not its duration.

Therefore, general screening for psychosocial risk factors does not indicate a person is more likely to become disabled from a musculoskeletal condition, and was not thought to be useful prior to injury. However screening may be useful in the early stages of absence due to injury, to suggest the nature and timing of workplace and/or clinical interventions that would be most beneficial.
PubMed Abstract
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