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Predictors of Successful Return to Work In a Cohort of Workers Undergoing Carpal Tunnel Release Surgery Benjamin C. Amick, Ph.D. 1 Rochelle H. Habeck 2 Janet Ossmann, Ph.D. 1 Holly Fossel 3 Jeffrey N. Katz, M.D., M.S. 3 1. University of Texas School of Public Health

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Predictors of Successful Return to Work In a Cohort of Workers Undergoing Carpal Tunnel Release Surgery

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Predictors of Successful Return to Work In a Cohort of Workers Undergoing Carpal Tunnel Release Surgery

Benjamin C. Amick, Ph.D.1

Rochelle H. Habeck2

Janet Ossmann, Ph.D. 1

Holly Fossel 3

Jeffrey N. Katz, M.D., M.S. 3

1. University of Texas School of Public Health

2. W.E. Upjohn Research Institute

3. Brigham & Women’s Hospital

Paper Presented at the Workers’ Compensation Research Group Meeting October 25-26, 2002, Cambridge, MA


Research Collaborators

  • Maine Medical Assessment Foundation

  • Robert Keller, Ellen Schneiter

  • Maine Health Information Center

  • Cynthia Barrata, Alice Chapin, Nancy Mooney

    W.E. Upjohn Institute

  • H. Allan Hunt

    Institute for Work and Health

  • Harry Shannon


Labor Markets and Health Framework

Global

Economy

Society

Social Context

Labor market context

Social Actors

Employers

Labor Market Intermediaries

Communities & Community-

Based Organization

Trade Unions

Business Associations

Government

SocialHierarchy

Illness & Injury

Producing Mechanisms

(Labor Market Experiences)

Health Status

Amick and Lavis, 2000


Background

  • The fact of return to work may not be the most appropriate outcome

  • Research focuses on a small conceptual set of predictors

  • Multidimensional RTW research is confounded by tremendous medical treatment variability

  • Most research does not consider timing of predictors

  • No research has considered the role of the organization per se


Successful Return

To Work Process

Heuristic Model

Economic,

Legal Environment

Demographic,

Psychosocial Conditions

And Clinical Status

EARLY

LATE

Family

Environment

Job and Organizational

Conditions


We Hypothesize

  • Clinical, worker and economic/legal factors will predict successful return to work at 2 months following carpal tunnel surgery

  • The employment situation (job and organizational conditions) will be important at 6 and 12 months post surgery


Defining the Sample

  • Sample: 197 workers at baseline with CTSundergoing carpal tunnel release and 181 completed at least 1 follow-up

    • Recruited in MD offices throughout Maine

    • Working at time developed CTS

    • CTS documented with nerve conduction

    • Homogeneous treatment


Defining the Sample

  • Exclusions

    • No follow-up information

    • No information on 6 month outcome

    • No baseline work role functioning

  • 128 patients at 2 month follow-up and 122 at 6 months


Defining Successful Return to Work

The ability worker to meet work demands given their current physical and emotional health status

Poor success translates into lost productivity for the business and increased job insecurity for the worker


Defining Successful Return to Work

  • 15 –item work role functioning assessed at baseline, 2 and 6 months

  • In general skewed towards better functioning


Defining Successful Return to Work

  • Problem of not back at work

    • Definitely not successful work role functioning

    • But many reasons for a person to not be back at work

  • Create three-level outcome

    • 0, not yet back at work and not working because of health

    • 1, back at work but not functioning well

      (<90 score on WRF)

    • 2, back at work and functioning well

      (>= 90 on WRF)

  • Note >= 90 is a useful norm for healthy WRF


Statistical Approach

  • Ordered logit regression in STATA 7.0 with predictor variables assessed at baseline for 2 month outcomes and baseline and two months for six month outcomes

  • Model building following Hosmer and Lemeshow, Applied Logistic Regression

  • Non-Proportionality of odds assessed using the Brandt test

  • Model fit described with McKelvey and Zavonia’s R2

  • Baseline predictors always included when change variable assessed


Two Month Results


Six Month Results


Successful Return

To Work Process

To Summarize…

Improved

Self Efficacy

Supportive

Organization

Pre-Surgical

Work Role Functioning

EARLY

2 Mos.

LATE

6 Mos.

Baseline

Depression

WC

Claimant


Conclusions

  • This work highlights the importance of:

    • Using multidimensional models in examining the return to work process

    • Using multiple time points following injury or medical intervention

    • Using successful work role functioning measure


Suggestive Interventions

Results suggest interventions targeting improved individual and organizational agency

  • Improving worker self-efficacy

    • Self-efficacy is confidence the worker has in his or her ability to effectively manage pain and health in return to work process

  • Developing highly supportive organizational policies and practices

    • People-Oriented Culture

    • Safety Climate (Active Safety Leadership, Safety Training and Safety Diligence)

    • Ergonomics Policies and Practice

    • Disability Management


Future Study

Larger, more diverse samples needed to elaborate multidimensional model and timing of predictors.

Should we begin interventions?

Should we worry about job satisfaction or satisfaction with medical care?

Multi-level studies where organizational context more accurately specified are needed to identify OPPs amenable to intervention


Thank Youwww.benamick.com

Research Support Provided By:

NIOSH R01-O503523-01A1

The Robert Wood Johnson Foundation Workers’ Compensation Research Initiative #038151

The Arthritis Foundation

NIAMS #AR36308


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