Biomedical subjects

Glenn Pransky

Publications and source records attributed to Glenn Pransky.

28 records · Page 2Linked to original sources

PubMed2004

Risk factors for recurrent episodes of care and work disability: case of low back pain.

Recurrences of injuries are common and have significant socioeconomic consequences; it is important to identify associated risk factors as potential opportunities for prevention. This study was conducted to identify risk factors for low back pain (LBP) recurrence and the extent that variation in recurrence definition impacts identified risk factors. Patients with new claims for LBP reported in New Hampshire to a workers' compensation provider were selected (n = 2023) with a minimum of 3-year follow up. Alternative definitions of recurrence included a new episode of medical care and a new episode of lost work time (work disability). Risk factors better predicted disability-based than treatment-based recurrence. Longer durations of the initial episode of care or work disability were the most powerful predictors of recurrence, implying that shorter episodes of care and early return to work contribute to better outcomes.

Adult↗

PubMed2004

The association of medical conditions and presenteeism.

A self-reported measure of four domains of work impairment based on the Work Limitations Questionnaire was completed by 16,651 employees of a large financial services corporation. Using a multivariate model to control for coexisting conditions, age, and gender, significant relationships were observed between medical conditions and patterns of impaired work performance. Depression was highly associated with work limitations in time management (odds ratio [OR] = 2.05), interpersonal/mental functioning (OR = 2.50), and overall output (OR = 2.24). Arthritis (OR = 1.56) and low back pain (OR = 1.32) were associated with physical function limitations. These same two conditions were associated with limitations in mental/interpersonal functioning but with low back pain having the higher odds ratio (OR = 1.54 vs. 1.22). These results suggest that worksite interventions (eg, disease management programs) should be tailored to the unique effects observed with specific medical conditions. More targeted programs could have important benefits for productivity in the workplace.

Absenteeism↗

PubMed2004

Caregiving for ill dependents and its association with employee health risks and productivity.

This study examined the loss of productivity and health risk status associated with employees who provide care for an ill dependent. A total of 16,651 employees (23% response rate) of a major financial services company completed a confidential Health Risk Appraisal (HRA) that included an eight-item version of the Work Limitations Questionnaire and a self-report of time missed from work during the previous 2 weeks to care for an ill dependent. A total of 10.6% of the respondents reported an average of 7.7 hours absent from work during the previous 2-week period to provide care for an ill dependent. Caregiving also was associated with a significant increase in the number of health risks for the employee. As the demand for caregiving time increased, caregivers reported a significant increase in work limitations. Caregiving for an ill dependent is associated with increased absenteeism and significant work limitations while on the job. Programs and work organization that helps employees balance their caregiving responsibilities for ill dependents may have a positive effect on health and productivity.

Absenteeism↗

PubMed2003

Recurrence of low back pain: definition-sensitivity analysis using administrative data.

STUDY DESIGN: Retrospective analysis of administrative claims data in a single workers' compensation jurisdiction. OBJECTIVES: To evaluate the effects of alternative definitions and follow-up parameters on rates of low back pain recurrence based on detailed administrative data. SUMMARY OF BACKGROUND DATA: Previous studies reported low back pain recurrence rates ranging from 14% to 45%, without consistency in definitions of recurrence or specifications of follow-up. METHODS: Patients with new claims for low back pain reported in New Hampshire to a large workers' compensation provider in 1996 and 1997 were selected (N = 2944). Definitions of recurrence included: new workers' compensation claim, new episode of care, and new episode of lost work time (work disability). For the latter two definitions, various minimum between-episode gaps were applied and related to recurrence rates. Two follow-up structures (constant length of follow-up post end of the first episode and fixed-period length of follow-up since the onset of low back pain) were examined for sensitivity of recognizing low back pain recurrence, with a maximum of 3-year follow-up. RESULTS: Recurrence rate using a claims-based definition was 7.9% and 7.1% for the entire cohort and the subset with work disability days, respectively, for the 3 years of follow-up. Care-based recurrence rates ranged between 12% and 49%, whereas disability-based recurrence rates ranged between 6% and 17% over the 3 years, inversely related to the length of the minimum between-episode gap (R = -0.86 for disability and care, P < 0.001). Two-year follow-up was sufficient to identify 85% to 100% of recurrences regardless of the follow-up structure. CONCLUSIONS: Recurrence rates are highly sensitive to variations in definitions. Consistency of definitions and application across studies is required to enable valid comparisons.

Adolescent↗

PubMed2003

Employee perspectives on the role of supervisors to prevent workplace disability after injuries.

After workplace injuries, supervisors can play an important role in aiding workers, accessing health care services, and providing reasonable accommodation. However, few studies have identified those aspects of supervisor involvement most valued by employees for postinjury recovery and return to work. As part of needs assessment for a supervisory training program, 30 employees from four companies were interviewed about the role of supervisors to prevent workplace disability after injuries. From interview notes, 305 employee statements were extracted for analysis. An affinity mapping process with an expert panel produced 11 common themes: accommodation, communicating with workers, responsiveness, concern for welfare, empathy/support, validation, fairness/respect, follow-up, shared decision-making, coordinating with medical providers, and obtaining coworker support of accommodation. Interpersonal aspects of supervision may be as important as physical work accommodation to facilitate return to work after injury.

Accidents, Occupational↗

PubMed2003

Prediction of prolonged work disability in occupational low-back pain based on nurse case management data.

This study evaluated whether risk prediction data captured by nurse case managers (NCMs) could predict prolonged disability from occupational low back pain. Cases of uncomplicated occupational low back pain referred to NCMs, with dates of injury between January 1, 1997 and June 30, 1998, were selected (n = 986). Predictive information was obtained from the NCM screening checklist of potential risk factors and other administrative claims data. Data were collected on 23 variables thought to predict work status at 6 months postinjury. In a multivariate logistic regression model, being out of work was significantly associated with older age, language barriers, earlier referral to NCM, and neutral or negative attorney attitude toward return to work. The overall predictive power of the model was low (area under curve = 0.6). Although NCM risk factor data collection is feasible and practical in insurance settings, future studies should explore additional variables and refined data collection methods in order to achieve a more accurate prediction.

Adult↗

PubMed2002

Work-related outcomes in occupational low back pain: a multidimensional analysis.

OBJECTIVES: This pilot study explored a broad range of work-related outcomes for occupational low back injuries. METHODS: A model of occupational outcomes and a survey instrument were developed on the basis of interviews, expert opinion, and literature reviews. New Hampshire workers who had an occupational back injury a year before the study were sampled from first reports of injury and sent a mailed survey about their postinjury experiences and related factors. RESULTS: Of 251 randomly selected cases, a valid address could be identified for 121, and 99 patients responded. Almost 60% of the respondents had lost 1 week of work or more. At 1 year after injury, half of the respondents had returned to their preinjury job and employer, and 20% were unemployed, half of them because of the injury. Most working respondents reported no decrease in their work capacity. However, 68% still had pain exacerbated by work, and 47% worried that their condition would worsen with continued work. Reinjury occurred in 42% of the respondents. The work-related outcome measures were largely independent of each other. Exploratory multivariate analyses demonstrated unique patterns of factors associated with each outcome. Reinjury risk was significantly greater in respondents whose employers offered accommodations or whose postinjury jobs had greater ergonomic risk. The small sample size limited the ability to achieve statistically significant results in multivariate analyses. CONCLUSIONS: Simply measuring return to work did not appear to capture the full range of job-related consequences from occupational back injuries in this pilot evaluation. Timing of return to work, occupational ergonomic risks, and appropriate job modifications appeared to be particularly important in a safe return to the job after an occupational low back injury. Results suggest opportunities to address risk factors that may improve work outcomes.

Adult↗

PubMed2002

Stress and work-related upper extremity disorders: implications for prevention and management.

BACKGROUND: A causal link between stress and work-related musculoskeletal disorders of the upper extremities (WRUEDs) has been established, but there is less evidence for a beneficial effect of stress reduction interventions on WRUED symptoms and incidence. METHODS: Searches of Medline, Ergonomics Abstracts, and Psychlit from 1990 to 2001 identified studies that either targeted stress and measured WRUED outcomes, or described other interventions with both stress and WRUED outcomes. RESULTS: Workplace interventions, including discrete improvements in technology, work organization and ergonomics, and more comprehensive approaches can reduce levels of stress. In a few studies, these interventions have been associated with decreases in WRUED symptoms. Similar effects are noted in stress-related interventions targeting individuals before WRUEDs have appeared, and at several stages of these conditions. CONCLUSIONS: Health care providers can recognize stress-WRUED interactions through careful, directed inquiry. Both individual as well as workplace-targeted interventions, delivered in the primary care setting or workplace, may be helpful. Future research priorities include prospective studies of well-defined interventions, with ample measures of subject, intervention and workplace characteristics that can impact outcomes, and adequate follow-up to determine sustained effects.

Arm Injuries↗

PubMed2002

Occupational risks and injuries in non-agricultural immigrant Latino workers.

BACKGROUND: To investigate occupational health in urban immigrant Latino workers, using a community-based method. METHODS: A survey was administered through consecutively selected door-to-door interviews. RESULTS: Response rate was 80% (n = 427). Average time in the US was 7.6 years, and average job tenure was 2.8 years. Twenty-five reported exposures to over 10 different hazards, and 18% thought these hazards had harmed their health. Only 31% received any job safety training; 55% had no workers' compensation coverage. Of the 47 (11%) with a work injury in the past 3 years, 27% reported difficulty obtaining treatment, 91% lost time from work (median = 13 days) and 29% had to change jobs because of the injury. The annual occupational injury rate was 12.2/100 full-time workers, compared to an expected rate of 7.1. CONCLUSIONS: Urban immigrant workers have increased risk of occupational injuries, with adverse outcomes.

Accidents, Occupational↗

PubMed2002

Occupational upper extremity conditions: a detailed analysis of work-related outcomes.

While work-related upper extremity conditions (WRUECs) cause almost 25% of lost time cases in the US, little is known about their long-term occupational consequences. A self-report survey was mailed to New Hampshire workers reporting a WRUEC one year prior to the study. Of the 72 (52%) valid respondents, 60% had lost > or = 1 week of work and 90% had returned to work. Almost 70% reported acute injury onset, and 26% had experienced a recurrence of their WRUEC. Both gradual-onset injuries and recurrences had worse outcomes. Recurrence was related to shorter job tenure, lower job satisfaction, and less satisfaction with medical care and insurer responses. Results imply that a single measure is insufficient to assess occupational outcomes subsequent to a WRUEC. The importance of secondary prevention was highlighted. There is a need for focus on gradual-onset injuries, as well as those acute-onset injuries with risk for recurrence.

Absenteeism↗