This site will look much better in a browser that supports web standards, but it is accessible to any browser or Internet device.

WorkSafeBC

about us banner

Risk Factors and Patterns of Health Care Utilization Associated with Work-Related Musculoskeletal Disorders among Health Care Workers

1150-20 I 1999
(99FS-25)

Issue:

Identifying work-related musculoskeletal disorder risk factors among health care workers.

Agency:

Department of Health Care and Epidemiology, The University of British Columbia

Representative:

Mieke Koehoorn

Funding:

$49,210

Phase I - Risk Factors Associated with Musculoskeletal Disorder among a Cohort of BC Health Care Workers: The Importance of Current, Cumulative or Average Exposures

Context:

Although there is evidence indicating the impact of work organization factor on work-related musculoskeletal disorders (WMSD) few studies have been complete that examine its impact in the health care sector. This study investigates the relationship in a hospital setting.

Objectives:

1. To investigate the risk of WMSD associated with work organization factors as part of a multi-factor model that included biomechanical and demographic factors. 2. To further our understanding of the nature of associations between work exposures and WMSDs by investigating the effect of current exposures at the time of claim, average exposure during the past twelve months, and cumulative exposure from the start of follow-up to the time of a WMSD claim.

Design:

A retrospective cohort study of all lost-time WMSD compensation claims between January 1992 and December 1998. Using exposure matrices, biomechanical and work organization scores were assigned at monthly intervals to employees based on their occupational and demographic characteristics. Current exposure indices pertained to the month of claim, average exposure indices covered the 12 months preceding the month of claim, and cumulative exposure indices summed scores from the start of follow-up to the month of claim.

Setting:

British Columbia hospital workers.

Subjects:

4445 hospital workers who were employed at the hospital a minimum of one month between 1992 and 1998 (physicians and students were ineligible due to the lack of available data). Workers included nursing personnel, support staff, allied health care professionals and administrative staff.

Main Outcome Measures:

Using survival analysis, hazard ratios and 95% confidence intervals were computed to estimate the association between exposures and time to claim. Models were constructed for the individual variables with the job-level indices (job control, job demands and biomechanical demands). Addition models were constructed adding each of the department level indices separately (sick-time, overtime, work units per FTE). Findings were presented for both upper-body WMSD claims and lower-body WMSD claims.

Results:

Less job control and high department sick-time was associated with an increase in the risk of upper-body WMSD claims. High department sick-time and high department overtime were associated with an increased risk of lower-body WMSD claims. Higher biomechanical demands on the job were associated with an increase in the risk of both upper-body and lower-body WMSD claims. Cumulative work organization and biomechanical exposures were associated with a higher risk of WMSD claims compared to that of current or average exposures.

Conclusion:

The current findings suggest that the etiology of WMSDs is multifactorial including work organization factors, as well as demographic and physical work factors. The prevention of WMSDs must therefore be based on a multidisciplinary approach involving ergonomics, work organization, human resources and industrial safety disciplines, as well as clinical discipline to intervene as soon as symptoms emerge.

Phase II - Health Care Utilization and Musculoskeletal Disorders among a cohort of BC Health Care Workers

Context: Given the recurrent and episodic nature of WMSDs, problems sometimes arise even in the area of recognition of the work-relatedness of musculoskeletal problems. In order to gain a better understanding, this study sought to examine the changes in health care utilization leading up to and following workers' lost-time compensation claims.

Objectives:

To describe the experience of injured workers by comparing patterns of health care utilization, beyond workers' compensation benefits, among a population of health care workers with a claim for a WMSD, and to compare the patterns to a population matched by age and gender without a claim. Also to determine differences in health care utilization costs, beyond WCB benefits, among WMSD claimants compared to non-claimants.

Design:

A database linkage study of employee records, Ministry of Health medical services records and WCB claim records for a ten-year period 1987 to 1997. The rate of health care contacts and services by 12-month periods before and after the initiation of a WMSD claim for claimants was compared to those of an age- and gender- matched group of non-claimants for the same time periods. Costs for the provision of health care services were compared for the 12-month period immediately before and immediately after the initiation of a claim.

Setting:

A large acute-care hospital in the lower mainland of British Columbia.

Subjects:

Health care workers who had been employed at the hospital for at least one year between 1987 and 1997 (excluding physicians and students) for which appropriate data was obtainable. The claimant population totaled 549 workers; those that had a lost-time WCB claim for a WMSD between 1988 and 1996. The comparison population was matched exactly to the claimant population for age and gender.

Main Outcome Measures:

Comparison of the rate of: GP contacts, specialist services, chiropractic contacts, massage therapist contacts, physiotherapy contacts and diagnostic services for 12-month periods prior to and following the WMSD claim for both claimants and matched non-claimants. Also the increase in total costs of health care services utilization for the 12-month periods preceding and following the claim date.

Results:

WMSD claimants had significantly higher health care utilization before and after the start of a claim compared to non-claimants. The cost of health services beyond WCB benefits was significantly higher among WMSD claimants compared to those who did not have a claim.

Conclusion:

Increased non-WCB health care utilization prior to a claim date suggests that WMSD claims should not be considered as isolated events. Reliance on claim events for prevention purposes may be missing earlier markers of musculoskeletal morbidity important for prevention of work disability. Increased utilization following a claim suggests the importance of return-to-work programs for employees with musculoskeletal morbidity.