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The impact of pain on work participation; Healthy Aging @ work?

The impact of pain on work participation; Healthy Aging @ work?. Michiel Reneman. REHABILITATION MEDICINE / CENTER FOR REHABILITATION. Disclosure Statement of Financial Interest.

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The impact of pain on work participation; Healthy Aging @ work?

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  1. The impact of pain on work participation; Healthy Aging @ work? Michiel Reneman REHABILITATION MEDICINE / CENTER FOR REHABILITATION

  2. Disclosure Statement of Financial Interest I, Michiel Reneman, DO NOT have a financial interest/arrangement or affiliation with one or more organizations that could be perceived as a real or apparent conflict of interest in the context of the subject of this presentation.

  3. Focus of this contribution • Chronic non-specific musculoskeletal pain (CMP) • Because: • Largest subgroup of people with pain • Most costly, because of work productivity loss

  4. Outline • General introduction • Impact of pain on work and work on health and well-being • Measurement challenges • Staying at work with pain

  5. Impact of pain on work • CMP highly common among the general population • ~ 90% at least once in adult life • In many cases: rapid improvement / full recovery • Recurrent • 44-78% relapse of pain • 26-37% relapse of work absence • Few: long term pain with significant limitations in ADL and work • Chronic: > 3 months

  6. Societal costs • Direct: costs related to medical care • Medical: medical, allied, complimentary, … • Nonmedical: transportation, meals, house renovations • Indirect: costs related to consequences of CLBP • Absenteeism and presenteeism • Disability • Replacement: overtime, recruitment, training • Household productivity: replacement by partner or outsider • Intangible costs: decreased QoL (often not included)

  7. Direct and indirect costs • Various countries, various methods • USA: LBP 6th costliest health condition, 3rd in associated disability • … by any standards must be considered a substantial burden on society

  8. Direct and indirect costs in The Netherlands • €3.5B - €4.3B per year • 0.6% - 0.9% GNP • Direct – indirect 12/88% • …

  9. Impact of work on health and well-being • Independent review: • 'Is Work Good for Health and Well-being?‘ • Commissioned by the UK Department for Work and Pensions • Examination of scientific evidence on the health benefits of work, focusing on adults of working age and the common health problems that account for two-thirds of sickness absence and long-term incapacity.

  10. Impact of work on health and well-being • There is strong evidence showing that work is generally good for physical and mental health and well-being. Worklessness is associated with poorer physical and mental health and well being. Work can be therapeutic and can reverse the adverse health effects of unemployment. That is true for healthy people of working age, for many disabled people, for most people with common health problems and for social security beneficiaries. The provisors are that account must be taken of the nature and the quality of work and its social context; jobs must be safe and accommodating. • Overall, the beneficial effects of work outweigh the risks of work, and are greater than the harmful effects of long-term unemployment or prolonged sickness absence. Work is generally good for health and well-being.’ Waddell en Burton, 2006

  11. Outline • General introduction • Impact of pain on work and work on health and well-being • Measurement challenges • Staying at work with pain

  12. CLBP: impact on work? Measurement challenges • Variability among studies in terminology and methodology • Extra complex • Mixed – absent AND present • Absent: temp AND permanent • Part-time work • Self-employed • Pain research outcome measures: absenteism and presenteism Absenteeism • Not / temporary / permanent • Modified hours / work / shifts • Measured from records: medical, insurance, employer • Presenteeism • Present at work, but less productive • Measurement?

  13. Outline • General introduction • Impact of pain on work and work on health and well-being • Measurement challenges • Staying at work with pain • Results of a study among a large and underreported group of people with CMP: workers who stay at work despite CMP. What went right? Are they just ‘not absent’, or can they still be productive? How are these people or their work different from those with CMP who seek tertiary care? What lessens can we learn from these workers?

  14. Relevance: • ‘Unknown’ in literature • New reference field • What can we and our patients learn from them? • Why do they SAW? • How can they SAW? What goes right?

  15. Systematic review of scientific literature N=120 workers with chronic pain, < 5% absenteeism Controls: n=120 rehab patients / n=702 healthy workers In-depth interviews with participants Measurements: • Bio: functional capacity, aerobic capacity, activities • Psycho: cognitions, emotions, distress, coping, … etc • Social: occupational physician, boss, partner

  16. Study 1: • Systematic review • High level evidence for determinants for SAW is absent • Existing knowledge is based on low level of evidence Consistent (low level) evidence • low emotional distress SAW  • low physical disability SAW  • duration of pain n.s. • catastrophizing n.s. • self-esteem n.s. • marital status n.s. Inconsistent evidence: • self-efficacy • age • gender • educational level • physical and mental health • pain intensity • depressive symptoms • coping

  17. Study 2: Qualitative study Motivators: why SAW with chronic pain? Success factors: how are they able to SAW? Motivators: • work as life value • work as income • work as responsibility • work as therapy Succes factors: • personality traits • adjustment latitude • coping with pain • use healthcare services • pain beliefs

  18. Study 3: Contrast SAW and rehab patients • Group status was predicted best by: • pain intensity, duration of pain, pain acceptance, perceived workload, mental health, and psychological distress • No difference: • Self-reported physical activity level, active coping and work satisfaction

  19. Study 4: • Work ability and work performance (0-10) • Pain Self-Efficacy consistently explained high WA and WP!

  20. Study 5: Activity level and pattern • Level: 30% higher in SAW • Pattern: PM higher in SAW

  21. Study 6: • Functional capacity and deconditioning? • Capacity: SL < CMP < Healthy • CMP is associated with relevant deconditioning for work • SL more often relevantly deconditioned than SAW

  22. Study 7: • Social determinants of SAW • Partner, boss, colleagues, occupational physician • Expected Fall 2012

  23. Final results expected November 2012 • Thesis • The results of this study can be used to develop interventions to promote SAW. • The knowledge gathered in this study provides a new reference for clinicians working in rehabilitation, occupational, and insurance medicine.

  24. The impact of pain on work participation; Healthy Aging @ work? • Summary / take home • Work is generally good for health and well-being • Sustained work participation with chronic pain is often possible and desirable. • On average, chronic pain is associated with lower WA and WP • Higher WA and WP is associated with higher pain self-efficacy. • Many determinants of sustained work participation with chronic pain are still unknown • Work participation should be a outcome measure for pain management.

  25. Thank you m.f.reneman@cvr.umcg.nl REHABILITATION MEDICINE / CENTER FOR REHABILITATION

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