michiel reneman rehabilitation medicine / center for rehabilitation
TRANSCRIPT
The impact of pain on work participation;
Healthy Aging @ work?
Michiel Reneman
REHABILITATION MEDICINE / CENTER FOR REHABILITATION
Disclosure Statement of Financial Interest
I, Michiel Reneman, DO NOT have a financial interest/arrangement or
affiliation with one or more organizations that could be perceived as a
real or apparent conflict of interest in the context of the subject of
this presentation.
Focus of this contribution
Chronic non-specific musculoskeletal pain (CMP)
Because:
Largest subgroup of people with pain
Most costly, because of work productivity loss
Outline
1. General introduction
• Impact of pain on work and work on health and well-being
2. Measurement challenges
3. Staying at work with pain
Impact of pain on work
CMP highly common among the general population
~ 90% at least once in adult life
In many cases: rapid improvement / full recovery
Recurrent
44-78% relapse of pain
26-37% relapse of work absence
Few: long term pain with significant limitations in ADL and work
Chronic: > 3 months
Societal costs
Direct: costs related to medical care• Medical: medical, allied, complimentary, …• Nonmedical: transportation, meals, house renovations
Indirect: costs related to consequences of CLBP• Absenteeism and presenteeism• Disability• Replacement: overtime, recruitment, training• Household productivity: replacement by partner or outsider• Intangible costs: decreased QoL (often not included)
Direct and indirect costs
Various countries, various methods
USA: LBP 6th costliest health condition, 3rd in associated disability
… by any standards must be considered a substantial burden on society
Direct and indirect costs in The Netherlands
€3.5B - €4.3B per year
0.6% - 0.9% GNP
Direct – indirect 12/88%
…
Impact of work on health and well-being
Independent review:
'Is Work Good for Health and Well-being?‘
Commissioned by the UK Department for Work and Pensions
Examination of scientific evidence on the health benefits of work,
focusing on adults of working age and the common health
problems that account for two-thirds of sickness absence and
long-term incapacity.
Impact of work on health and well-being
There is strong evidence showing that work is generally good for physical and mental health and well-
being. Worklessness is associated with poorer physical and mental health and well being. Work
can be therapeutic and can reverse the adverse health effects of unemployment. That is true for
healthy people of working age, for many disabled people, for most people with common health
problems and for social security beneficiaries. The provisors are that account must be taken of the
nature and the quality of work and its social context; jobs must be safe and accommodating.
Overall, the beneficial effects of work outweigh the risks of work,
and are greater than the harmful effects of long-term
unemployment or prolonged sickness absence. Work is generally
good for health and well-being.’
Waddell en Burton, 2006
Outline
1. General introduction
• Impact of pain on work and work on health and well-being
2. Measurement challenges
3. Staying at work with pain
CLBP: impact on work? Measurement challenges
Variability among studies in terminology and methodology
Extra complex• Mixed – absent AND present• Absent: temp AND
permanent• Part-time work• Self-employed
Pain research outcome measures: absenteism and presenteism
Absenteeism• Not / temporary / permanent • Modified hours / work / shifts • Measured from records: medical,
insurance, employer
Presenteeism• Present at work, but less
productive• Measurement?
Outline
1. General introduction
• Impact of pain on work and work on health and well-being
2. Measurement challenges
3. Staying at work with pain
• Results of a study among a large and underreported group of
people with CMP: workers who stay at work despite CMP. What
went right? Are they just ‘not absent’, or can they still be
productive? How are these people or their work different from
those with CMP who seek tertiary care? What lessens can we learn
from these workers?
Relevance:– ‘Unknown’ in literature– New reference field– What can we and our patients learn from them?– Why do they SAW?– How can they SAW? What goes right?
Systematic review of scientific literature
N=120 workers with chronic pain, < 5% absenteeism
Controls: n=120 rehab patients / n=702 healthy
workers
In-depth interviews with participants
Measurements: • Bio: functional capacity,
aerobic capacity, activities
• Psycho: cognitions, emotions, distress, coping, … etc
• Social: occupational physician, boss, partner
Study 1: Systematic review
• High level evidence for determinants for SAW is absent
• Existing knowledge is based on low level of evidence
Consistent (low level) evidence• low emotional distress SAW • low physical disability SAW • duration of pain
n.s.• catastrophizing
n.s.• self-esteem
n.s.• marital status
n.s.
Inconsistent evidence:• self-efficacy• age• gender• educational level• physical and mental health• pain intensity• depressive symptoms• coping
Study 2: Qualitative study
Motivators: why SAW with chronic pain?
Success factors: how are they able to SAW?
Motivators:
• work as life value
• work as income
• work as responsibility
• work as therapy
Succes factors:
• personality traits
• adjustment latitude
• coping with pain
• use healthcare services
• pain beliefs
Study 3: Contrast SAW and rehab patients
Group status was predicted best by: • pain intensity, duration of pain, pain acceptance,
perceived workload, mental health, and psychological distress
No difference: • Self-reported physical activity level, active coping
and work satisfaction
Study 4: Work ability and work performance (0-10)
Pain Self-Efficacy consistently explained high WA and
WP!
Study 5: Activity level and pattern
• Level: 30% higher in SAW
• Pattern: PM higher in SAW
Study 6: Functional capacity and deconditioning?
• Capacity: SL < CMP < Healthy
• CMP is associated with relevant deconditioning for
work
• SL more often relevantly deconditioned than SAW
Study 7:
Social determinants of SAW
Partner, boss, colleagues, occupational physician
Expected Fall 2012
Final results expected November 2012• Thesis
The results of this study can be used to develop interventions to promote SAW.
The knowledge gathered in this study provides a new reference for clinicians working in rehabilitation, occupational, and insurance medicine.
The impact of pain on work participation; Healthy Aging @ work?
Summary / take home
1. Work is generally good for health and well-being
2. Sustained work participation with chronic pain is often possible and desirable.
3. On average, chronic pain is associated with lower WA and WP
4. Higher WA and WP is associated with higher pain self-efficacy.
5. Many determinants of sustained work participation with chronic pain are still unknown
6. Work participation should be a outcome measure for pain management.
