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Predictors of return to work among women with long-term neck/shoulder and/or back pain: a 1-year prospective study
University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational Health Science and Psychology, Occupational Health Science. University of Gävle, Centre for Musculoskeletal Research.ORCID iD: 0000-0001-7558-4168
University of Gävle, Faculty of Health and Occupational Studies, Department of Caring Science, Caring Science.ORCID iD: 0000-0002-1864-5777
University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational Health Science and Psychology, Occupational Health Science. University of Gävle, Centre for Musculoskeletal Research.ORCID iD: 0000-0002-5055-0698
University of Gävle, Faculty of Health and Occupational Studies, Department of Caring Science, Caring Science.
(English)Manuscript (preprint) (Other academic)
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.

 

National Category
Occupational Health and Environmental Health Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
URN: urn:nbn:se:hig:diva-30963OAI: oai:DiVA.org:hig-30963DiVA, id: diva2:1370174
Available from: 2019-11-14 Created: 2019-11-14 Last updated: 2019-11-22Bibliographically approved
In thesis
1. Women on sick leave for long-term musculoskeletal pain: Factors associated with work ability, well-being and return to work
Open this publication in new window or tab >>Women on sick leave for long-term musculoskeletal pain: Factors associated with work ability, well-being and return to work
2019 (English)Doctoral thesis, comprehensive summary (Other academic)
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.

Place, publisher, year, edition, pages
Gävle: Gävle University Press, 2019
Series
Studies in the Research Profile Health-Promoting Working Life. Doctoral thesis
Keywords
Biopsychosocial model, musculoskeletal pain, postal survey, prognostic factors, return to work, sick leave, women of working age, work ability and well-being
National Category
Occupational Health and Environmental Health
Identifiers
urn:nbn:se:hig:diva-30965 (URN)
Public defence
2020-01-10, Krusenstjernasalen (23:213), Kungsbäcksvägen 47, Gävle, 09:00 (English)
Opponent
Supervisors
Available from: 2019-12-18 Created: 2019-11-14 Last updated: 2019-12-18Bibliographically approved

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Rashid, MamunurKristofferzon, Marja-LeenaHeiden, MarinaNilsson, Annika

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