A systematic review of studies identifying predictors of poor return to work outcomes following workplace injury

BACKGROUND: Injuries occurring in the workplace can have serious implications for the health of the individual, the productivity of the employer and the overall economic community. OBJECTIVE: The objective of this paper is to increase the current state of understanding of individual demographic and psychosocial characteristics associated with extended absenteeism from the workforce due to a workplace injury. METHODS: Studies included in this systematic literature review tracked participants' return to work status over a minimum of three months, identified either demographic, psychosocial or general injury predictors of poor return to work outcomes and included a heterogeneous sample of workplace injuries. RESULTS: Identified predictors of poor return to work outcomes included older age, female gender, divorced marital status, two or more dependent family members, lower education levels, employment variables associated with reduced labour market desirability, severity or sensitive injury locations, negative attitudes and outcome perceptions of the participant. CONCLUSIONS: There is a need for clear and consistent definition and measurement of return to work outcomes and a holistic theoretical model integrating injury, psychosocial and demographic predictors of return to work. Through greater understanding of the nature of factors affecting return to work, improved outcomes could be achieved.

The utility of a workplace injury instrument in prediction of workplace injury

Workplace injuries are common and destructive to persons, organisations, and society. Various instruments presently exist that are designed to assess the factors underlying workplace injury. The study reports on the construct and predictive validity of a 46-item instrument, the safety perception survey (SPS), currently used to assess safety climate in industrial organisations throughout Australia. Initially, factor analysis was conducted on the data from a sample of 1238 employees from nine organisations, which indicated a one-factor solution, was the best fit. A structural equation model (SEM) linking injury rates to the safety climate measure for 16 sub-groups of six industrial organisations indicated that the measure contributed just 23% of the variance in injury rates. Interestingly, the results indicated that the number of employees was a better and more significant predictor of injury (R² = 0.48). It is proposed that the SPS as is would need to be modified significantly from its current form to produce improvements in validity, as in its current form the survey is no more predictive of injury than organisational size. Future research into safety climate measures should incorporate predictive validity analysis on injury rates, as for many organisations; this is a performance outcome measure.

A way through the dark and thorny thickets? The adjudication of ‘serious injury’ under the narrative tests in the Transport Accident Act 1986 (Vic) and the Workplace Injury Rehabilitation and Compensation Act 2013 (Vic)

The so-called narrative test provides the means by which injured persons who satisfy the statutory and common law definition of serious injury may bring proceedings for common law damages under s 93 of the Transport Accident Act 1986 (Vic) and s 134AB of the Accident Compensation Act 1985 (Vic) (or, for injuries after 1 July 2014, under ss 324-347 of the Workplace Injury Rehabilitation and Compensation Act 2013 (Vic)). These are among the most litigated provisions in Australia. This article outlines the legislative and political background to these provisions, the provisions themselves, and an account of the statutory and common law requirements needed to satisfy the provisions.

Safety in occupational driving : development of a driver behaviour scale for the workplace context

International statistics indicate that occupational, or work-related driving, crashes are the most common cause of workplace injury, death, and absence from work. The majority of research examining unsafe driver behavior in the workplace has relied on general road safety questionnaires. However, past research has failed to consider the organizational context in the use of these questionnaires, and as such, there is ambiguity in the dimensions constituting occupational driving. Using a theoretical model developed by Hockey (1993, 1997), this article proposes and validates a new scale of occupational driver behavior. This scale incorporates four dimensions of driver behavior that are influenced by demanding workplace conditions; speeding, rule violation, inattention, and driving while tired. Following a content validation process, three samples of occupational drivers in Australia were used to assess the scale. Data from the first sample (n=145) were used to reduce the number of scale items and provide an assessment of the factorial validity of the scale. Data from the second sample (n=645) were then used to confirm the factor structure and psychometric properties of the scale including reliability and construct validity. Finally, data from the third sample (n=248) were used to establish criterion validity. The results indicated that the scale is a reliable and valid measure of occupational driver behavior.

Temporary agency workers and the contribution of workplace unfamiliarity to workplace injuries

International and Australian research agrees that temporary agency workers have a higher incidence of workplace injury, and those injuries are more severe. Much less research has been undertaken upon the cause of those injuries. This paper explores one factor contributing to their poorer occupational health and safety through an examination of the role of unfamiliarity with the hosts’ tasks and workplace. The paper commences with a review of the temporary agency employment literature relevant to placing workers in unfamiliar workplaces, and the OHS literature related to timing of injuries. Archival research on investigated workers’ compensation claims for a sample of agency workers and direct hire workers in Victoria is then analysed to assess the importance of unfamiliarity, and training undertaken to overcome that unfamiliarity, for these injured workers. The analysis includes an examination of the timing of the injury in relation to the workers’ placement with the host, and regression analysis on a range of characteristics related to newness at a host’s workplace. The findings confirm that agency workers are especially vulnerable to injury early in their placement, and insufficient attention is given to accommodating unfamiliarity to counter workers’ vulnerability in new workplaces.

The injury profile of an Australian specialist policing unit

This study investigated the injuries sustained by an Australian specialist police division. Injury records spanning four-years were analyzed. The role being performed when the injury occurred, injury cause, body part injured, and injury-related costs were quantified. The percentage of personnel injured multiple times was documented. One hundred and thirty eight personnel reported injuries, 58 of these on multiple occasions. This resulted in 229 injuries and 76 claims being raised. Half of the injuries occurred during operational policing tasks, however training activities accounted for >30% of injuries. The most common injury was strain/sprain, and upper body injuries were 2.5-times more common than lower-body or torso injuries. 1107 shifts were lost, and injuries cost the organization $487,159 (Australian Dollars) over the four-year period. The injury costs (both financial and in manpower) may prompt policy makers to review the current training and post-injury rehabilitation protocols.

Risk compensation in construction workers' activities

Construction has been plagued with serious injuries and deaths for years. Although the technological advances have made the world safer and healthier, researchers have noted that some safety interventions, which had clear objective safety benefits, had failed to achieve the forecast savings in lives and injuries. The purpose of this study was to explore whether the construction workers show risk compensation and engage in greater risk taking when certain types of safety measures are implemented in the construction site. A case study approach was used to achieve the aim of this study. A typical construction site in Sydney was selected as the subject of the case study. Data were collected through direct observations, questionnaires and interviews. The findings confirm that workers show risk compensation behaviours in the construction environment. The risk compensation behaviours of workers varied with the level of experience and whether they have suffered from a past workplace injury. The findings of this study may offer a better understanding of workers’ behavioural patterns in construction environment and the effectiveness of safety interventions. The result of this study may provide supports for designing, implementing and evaluating safety interventions in construction site.

The practical potential of self-advocacy for improving safety outcomes for school-aged workers

Young workers are over-represented in workplace injury statistics and there is growing interest in addressing their vulnerability and safety exposure. Such concerns have been raised within a broader discursive framework of responsibilisation which has seen a transfer of responsibility for workplace safety from employer to worker. This article examines the potential for self-advocacy as a strategy for improving the safety of young workers through the provision of resources to articulate and act on workplace rights. The study utilises data derived from 48 group interviews involving 216 high school students (13–16 years of age) at 19 high schools in Queensland, Australia, who were asked to discuss their knowledge and experience of workplace rights and responsibilities. The limitations of the safety self-advocacy approach are explored, including the social, developmental and organisational issues that might affect the ability or willingness of school-aged workers to self-advocate. The findings reveal that the notion of self-advocacy is internalised by young people before they even enter the formal labour market but that in practice, attempts by young people to enact rights to safety are often dismissed or undermined.

Medidas de intervención para promoción de conductas saludables y prevención de riesgos laborales relacionados con accidentalidad y enfermedad laboral en trabajadores de minas de Carbón

Colombia en su legislación normatiza el sector de la minería de carbón, sin embargo se considera que las estrategias no han sido suficientes para la identificación, prevención y control de la accidentalidad y enfermedad laboral. Durante el año 2013 el índice de fatalidad fue de 1,59. Estadísticas del año 2004 evidencian que las neumoconiosis fueron las mayores causas de invalidez de origen profesional. Objetivo: Categorizar actividades de intervención en promoción y prevención de accidentalidad y enfermedad laboral en trabajadores de la minería de carbón. Metodología: Se realizó una revisión de literatura sobre minería de carbón y salud la cual fue obtenida de las bases de datos PUBMED, Sciendirect, VHL, SINAB por literatura publicada sin límites de año, en idioma inglés, español o portugués. Para la búsqueda se utilizaron términos en lenguaje controlado (términos MESH), revisión por pares de títulos y resúmenes. Las publicaciones fueron seleccionadas para revisión de texto completo bajo criterios de inclusión y exclusión. Los códigos contemplados para esta revisión fueron: a) país donde la intervención se llevó a cabo, b) salud ocupacional, c) prevención de accidentalidad, d) programas de promoción, e) tecnologías, f) resultados obtenidos. Resultados: Del total de 2500 artículos seleccionados por los autores principales se realizó la revisión de los primeros 300 artículos, 32 hacen referencia al tema de salud ocupacional y minería de carbón, 10 contienen intervenciones consideradas de relevancia para esta revisión bibliográfica. Se presentan intervenciones estadísticamente significativas (p<0.05) y que han demostrado ser de impacto positivo en la minería de carbón en promoción y prevención de accidentalidad y enfermedad ocupacional. Conclusiones: Se identificaron las siguientes cuatro tipos de intervención: 1) las de carácter educativo que hacen referencia a las capacitaciones participativas, el entrenamiento por medio de “degraded image”, la realización de gestión de autocontrol y retroalimentación para el uso de elementos de protección personal (EPP), la aplicación del Modelo de Proceso Paralelo Extendido; 2) intervenciones preventivas como la medición de alcoholimetría antes del turno, la presencia de personal de enfermería en minas de carbón y el reconocimiento de los predictores de la enfermedad para optimizar la prevención primaria; 3)intervenciones de vigilancia como la promovida en la metodología Estadísticas Europeas de Accidentes de Trabajo (EEAT) para la investigación de los accidentes de trabajo, la aplicación de las recomendaciones de la Organización Mundial de la Salud (OMS) para la detección de la neumoconiosis y 4) De carácter tecnológico consistente en la intervención de tareas a partir de los resultados de la aplicación del software desarrollado por el Instituto Nacional para la Seguridad y Salud Ocupacional (NIOSH). Estas intervenciones han demostrado ser eficaces en la promoción y prevención de accidentalidad y enfermedad ocupacional por lo cual se recomienda su aplicación en Colombia posterior al análisis de costo-efectividad.

Accidentes de trabajo e índice de masa corporal en vigilantes atendidos en una I.P.S. de salud ocupacional, Bogotá - Colombia, 2015

INTRODUCCIÓN: Todos los individuos dentro de una sociedad tienen derecho a disfrutar de una integridad física, mental y de sus bienes materiales, que en principio debe ser garantizada por el Estado, sin embargo, debido a la ineficacia y falta de alcance en la disponibilidad de hombres y mujeres para cuidar a cada persona y empresa, la Seguridad Privada ha surgido como actividad económica para garantizar éste servicio de manera individualizada. No obstante a ello, poco se sabe acerca de las características de las personas que desempeñan ésta labor, así como las demandas inherentes a ésta actividad económica; sin embargo, en poblaciones económicamente similares, se documenta a través de la literatura la aparente relación entre la condición física del individuo y la presentación de accidentes de trabajo. OBJETIVO: Establecer la relación entre los accidentes de trabajo y el índice de masa corporal (IMC) en vigilantes atendidos en una I.P.S. de Salud Ocupacional en la ciudad de Bogotá-Colombia, durante el año 2015. MATERIALES Y MÉTODOS: Se llevó a cabo un estudio de corte transversal, con datos secundarios de una base de datos de 76 registros, procedentes de las historias clínicas médico ocupacionales realizadas a una población de trabajadores del sector de la Vigilancia o Seguridad Privada, durante su atención en una Institución Prestadora de Salud (I.P.S.) de Salud Ocupacional. Se incluyeron variables sociodemográficas, ocupacionales, las relacionadas con los accidentes de trabajo y el índice de masa corporal. Se obtuvieron las frecuencias univariadas y para las variables de tipo cuantitativo, medidas de tendencia central y dispersión, además de buscar potenciales asociaciones estadísticas, para conocer las variables que se relacionan con el evento estudiado. RESULTADOS: En éste proyecto se destaca que de los trabajadores que desempeñan la actividad económica de Vigilancia y Seguridad Privada, se encuentran en el grupo de 20 a 39 años (56.5%) y pertenecen al género masculino (84.2%); dichos factores contribuyen a la ocurrencia de los accidentes de trabajo (OR de 1.7 y 2.0 respectivamente). Además el I.M.C. de sobrepeso (OR 1.8), la obesidad (OR 1.4); y en sí el cargo de Vigilante concurren a la accidentalidad laboral (OR de 1.1) y con ello al incremento de incapacidad laboral en un 85.5% de 0 a 60 días. CONCLUSIONES: Se deben establecer medidas encaminadas al emprendimiento de sistemas de vigilancia epidemiológica que mitiguen y minimicen el riesgo, con ello la presencia de eventos no deseados en el ámbito laboral para ésta población y la disminución del ausentismo laboral.

Integrating technology in the workplace for people with spinal cord injury

Computer technology can overcome mobility and functional limitations resulting from spinal cord injury (SCI) and enable re-employment. This study aimed to identify barriers and supports to effective technology use at work from the unique perspectives of technology users themselves. A qualitative research design was used to explore the perspectives of 11 technology users with SCI. In-depth, open-ended interviews and observations were conducted at each person’s workplace. Five major themes emerged: identifying the best or right technology; acquiring the technology; customizing and learning to use the technology; supporting the technology; and empowerment. Understanding these consumer perspectives enables professionals to empower people with SCI to optimize their work potential.

Empirical basis for adopting a theory-driven approach to preventing alcohol and other drug impairment (AOD) in the workplace

Background: A State-based industry in Australia is in the process of developing a programme to prevent AOD impairment in the workplace. The objective of this study was to determine whether the Theory of Planned Behaviour can help explain the mechanisms by which behaviour change occurs with regard to AOD impairment in the workplace. ---------- Method: A survey of 1165 employees of a State-based industry in Australia was conducted, and a response rate of 98% was achieved. The survey included questions relevant to the Theory of Planned Behaviour: behaviour; behavioural intentions; attitude; perceptions of social pressure; and perceived behavioural control with regard to workplace AOD impairment. ---------- Findings: Less than 3% of participants reported coming to work impaired by AODs. Fewer than 2% of participants reported that they intended to come to work impaired by AODs. The majority of participants (over 80%) reported unfavourable attitudes toward AOD impairment at work. Logistic regression analyses suggest that, consistent with the theory of planned behaviour: attitudes, perceptions of social pressure, and perceived behavioural control with regard to workplace AOD impairment, all predict behavioural intentions (P < .001); and behavioural intentions predict (self-reported) behaviour regarding workplace AOD impairment (P < .001). ---------- Conclusions: The Theory of Planned Behaviour appears to assist with understanding the mechanisms by which behaviour change occurs with regard to AOD impairment in the workplace. An occupational AOD programme which targets those mechanisms for change may improve its impact in preventing workplace AOD impairment.

Prevention of pelvic sepsis in major open pelviperineal injury

Compound pelvic fractures are deemed to be one of the most severe orthopaedic injuries with an extremely high morbidity and mortality. After the initial resuscitation phase the prevention of pelvic sepsis is one of the main treatment goals for patients with an open pelvic fracture. If there is a suspicion of a rectal injury or if the wounds are in the perineal area, The Princess Alexandra Hospital's management plan includes early faecal diversion combined with vigorous soft tissue debridement, VAC(®) therapy and (if indicated) external fixation of the pelvic fracture. We present our flowchart for the treatment of trauma patients with compound pelvic fractures illustrated by a case report describing a 32 year old patient who sustained an open pelvic ring injury in a workplace accident. The aim of this paper is to underline the importance of a safe, straightforward approach to compound pelvic fractures.

Contribution of individual, workplace, psychosocial and physiological factors to neck pain in female office workers

This study investigated the relative contribution of individual, workplace, psychosocial and physiological features associated with neck pain in female office workers towards developing appropriate intervention programs. Workers without disability (Neck Disability Index (NDI) score≤8, n=33); workers with neck pain and disability (NDI≥9/100, n=52) and 22 controls (women who did not work and without neck pain) participated in this study. Two logistic regression models were constructed to test the association between various measures in (1) workers with and without disability, and (2) workers without disability and controls. Measures included those found to be significantly associated with higher NDI in our previous studies: psychosocial domains; individual factors; task demands; quantitative sensory measures and measures of motor function. In the final model, higher score on negative affectivity scale (OR=4.47), greater activity in the neck flexors during cranio-cervical flexion (OR=1.44), cold hyperalgesia (OR=1.27) and longer duration of symptoms (OR=1.19) remained significantly associated with neck pain in workers. Workers without disability and controls could only be differentiated by greater muscle activity in the cervical flexors and extensors during a typing task. No psychosocial domains remained in either regression model. These results suggest that impairments in the sensory and motor system should be considered in any assessment of the office worker with neck pain and may have stronger influences on the presenting symptoms than workplace and psychosocial features.

Evaluation of a workplace alcohol and other drug policy

BACKGROUND The current impetus for developing alcohol and/or other drugs (AODs) workplace policies in Australia is to reduce workplace AOD impairment, improve safety, and prevent AOD-related injury in the workplace. For these policies to be effective, they need to be informed by scientific evidence. Evidence to inform the development and implementation of effective workplace AOD policies is currently lacking. There does not currently appear to be conclusive evidence for the effectiveness of workplace AOD policies in reducing impairment and preventing AOD-related injury. There is also no apparent evidence regarding which factors facilitate or impede the success of an AOD policy, or whether, for example, unsuccessful policy outcomes were due to poor policy or merely poor implementation of the policy. It was the aim of this research to undertake a process, impact, and outcome evaluation of a workplace AOD policy, and to contribute to the body of knowledge on the development and implementation of effective workplace AOD policies. METHODS The research setting was a state-based power-generating industry in Australia between May 2008 and May 2010. Participants for the process evaluation study were individuals who were integral to either the development or the implementation of the workplace AOD policy, or both of these processes (key informants), and comprised the majority of individuals who were involved in the process of developing and/or implementing the workplace AOD policy. The sample represented the two main groups of interest—management and union delegates/employee representatives—from all three of the participating organisations. For the impact and outcome evaluation studies, the population included all employees from the three participating organisations, and participants were all employees who consented to participate in the study and who completed both the pre-and post-policy implementation questionnaires. Qualitative methods in the form of interviews with key stakeholders were used to evaluate the process of developing and implementing the workplace AOD policy. In order to evaluate the impact of the policy with regard to the risk factors for workplace AOD impairment, and the outcome of the policy in terms of reducing workplace AOD impairment, quantitative methods in the form of a non-randomised single group pre- and post-test design were used. Changes from Time 1 (pre) to Time 2 (post) in the risk factors for workplace AOD impairment, and changes in the behaviour of interest—(self-reported) workplace AOD impairment—were measured. An integration of the findings from the process, impact, and outcome evaluation studies was undertaken using a combination of qualitative and quantitative methods. RESULTS For the process evaluation study Study respondents indicated that their policy was developed in the context of comparable industries across Australia developing workplace AOD policies, and that this was mainly out of concern for the deleterious health and safety impacts of workplace AOD impairment. Results from the process evaluation study also indicated that in developing and implementing the workplace AOD policy, there were mainly ‗winners', in terms of health and safety in the workplace. While there were some components of the development and implementation of the policy that were better done than others, and the process was expensive and took a long time, there were, overall, few unanticipated consequences to implementing the policy and it was reported to be thorough and of a high standard. Findings also indicated that overall the policy was developed and implemented according to best-practice in that: consultation during the policy development phase (with all the main stakeholders) was extensive; the policy was comprehensive; there was universal application of the policy to all employees; changes in the workplace (with regard to the policy) were gradual; and, the policy was publicised appropriately. Furthermore, study participants' responses indicated that the role of an independent external expert, who was trusted by all stakeholders, was integral to the success of the policy. For the impact and outcome evaluation studies Notwithstanding the limitations of pre- and post-test study designs with regard to attributing cause to the intervention, the findings from the impact evaluation study indicated that following policy implementation, statistically significant positive changes with regard to workplace AOD impairment were recorded for the following variables (risk factors for workplace AOD impairment): Knowledge; Attitudes; Perceived Behavioural Control; Perceptions of the Certainty of being punished for coming to work impaired by AODs; Perceptions of the Swiftness of punishment for coming to work impaired by AODs; and Direct and Indirect Experience with Punishment Avoidance for workplace AOD impairment. There were, however, no statistically significant positive changes following policy implementation for Behavioural Intentions, Subjective Norms, and Perceptions of the Severity of punishment for workplace AOD impairment. With regard to the outcome evaluation, there was a statistically significant reduction in self-reported workplace AOD impairment following the implementation of the policy. As with the impact evaluation, these findings need to be interpreted in light of the limitations of the study design in being able to attribute cause to the intervention alone. The findings from the outcome evaluation study also showed that while a positive change in self-reported workplace AOD impairment following implementation of the policy did not appear to be related to gender, age group, or employment type, it did appear to be related to levels of employee general alcohol use, cannabis use, site type, and employment role. Integration of the process, impact, and outcome evaluation studies There appeared to be qualitative support for the relationship between the process of developing and implementing the policy, and the impact of the policy in changing the risk factors for workplace AOD impairment. That is, overall the workplace AOD policy was developed and implemented well and, following its implementation, there were positive changes in the majority of measured risk factors for workplace AOD impairment. Quantitative findings lend further support for a relationship between the process and impact of the policy, in that there was a statistically significant association between employee perceived fidelity of the policy (related to the process of the policy) and positive changes in some risk factors for workplace AOD impairment (representing the impact of the policy). Findings also indicated support for the relationship between the impact of the policy in changing the risk factors for workplace AOD impairment and the outcome of the policy in reducing workplace AOD impairment: positive changes in the risk factors for workplace AOD impairment (impact) were related to positive changes in self reported workplace AOD impairment (representing the main goal and outcome of the policy). CONCLUSIONS The findings from the research indicate support for the conclusion that the policy was appropriately implemented and that it achieved its objectives and main goal. The Doctoral research findings also addressed a number of gaps in the literature on workplace AOD impairment, namely: the likely effectiveness of AOD policies for reducing AOD impairment in the workplace, which factors in the development and implementation of a workplace AOD policy are likely to facilitate or impede the effectiveness of the policy to reduce workplace AOD impairment, and which employee groups are less likely to respond well to policies of this type. The findings from this research not only represent an example of translational, applied research—through the evaluation of the study industry's policy—but also add to the body of knowledge on workplace AOD policies and provide policy-makers with evidence which may be useful in the development and implementation of effective workplace AOD policies. Importantly, the findings espouse the importance of scientific evidence in the development, implementation, and evaluation of workplace AOD policies.