Abstract
Two instruments, the Health Assessment Questionnaire (HAQ) and the Short Form-36 (SF-36), were used to document both the immediate and short-term effects of workplace injuries in municipal workers. Telephone interviews were conducted up to 3 months following the injury. One hundred fourteen subjects agreed to participate in the study; 90 workers completed at least one useable interview. The relationship between functional limitation and lost days was evaluated using Cox proportional hazards models. At 3 months following the onset of injury, SF-36 scores for physical function, role-physical, and bodily pain differed significantly from population norms. Using one standard deviation of change, statistically significant hazard ratios were seen in subjects with lower SF-36 physical component summary, physical function, and bodily pain scores, and higher HAQ disability and fatigue scores. Functional limitations persisted in workers after relatively minor workplace injuries despite a 91% return to work rate.
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REFERENCES
U.S. Department of Labor, Bureau of Labor Statistics. Workplace injuries and illnesses in 2001, USDL 02-687. Available at: http://www.bls.gov/iif/oshwc/osh/os/osnr0016.pdf.
Dembe, AE. The social consequences of occupational injuries and illnesses. Am J Ind Med 2001; 40: 403-417.
Faucett, J, McCarthy, D. Chronic pain in the workplace. Nurs Clin North Am 2003; 38: 509-523.
Keogh, JP, Nuwayhid, I, Gordon, JL, Gucer, P. The impact of occupational injury on injured worker and family: Outcomes of upper extremity cumulative trauma disorders in Maryland workers. Am J Ind Med 2000; 38: 498-506.
Mason, S, Wardrope, J, Turpin, G, Rowlands, A. Outcomes after injury: A comparison of workplace and nonworkplace injury. J Trauma 2002; 53: 98-103.
Michaels, AJ, Michaels, CE, Smith, JS, Moon, CH, Peterson, C, Long, WB. Outcomes from injury: General health, work status, and satisfaction 12 months after trauma. J Trauma 2000; 48: 841-850.
Pransky, G, Benjamin, K, Hill-Fotouhi, C, Himmelstein, J, Fletcher, KE, Katz, JN, Johnson, WG. Outcomes in work-related upper extremity and low back injuries: Results of a retrospective study. Am J Ind Med 2000; 37: 400-409.
Dasinger, LK, Krause, N, Thompson, PJ, Brand, RJ, Rudolph, L. Doctor proactive communication, return-to-work recommendation, and duration of disability after a workers' compensation low back injury. J Occup Environ Med 2001; 43: 515-525.
Franche, RL, Krause, N. Readiness for return to work following injury or illness: Conceptualizing the interpersonal impact of health care, workplace, and insurance factors. J Occup Rehab 2002; 12: 233-256.
Sum, J. Navigating the California workers' compensation system: The injured workers' experience. San Francisco: California Commission on Health and Safety, 1996.
Roberts-Yates, C. The concerns and issues of injured workers in relation to claims/injury management and rehabilitation: The need for new operational frameworks. Disabil Rehab 2003; 25: 898-907.
Williams, RM, Westmorland, M. Perspectives on workplace disability management: A review of the literature. Work 2002; 19: 87-93.
Carmona, L, Faucett, J, Blanc, PD, Yelin, E. Predictors of rate of return to work after surgery for carpal tunnel syndrome. Arthritis Care Res 1998; 11: 298-305.
Cheadle, A, Franklin, G, Wolfhagen, C, Savarino, J, Liu, PY, Salley, C, Weaver, M. Factors influencing the duration of work-related disability: A population-based study of Washington State workers' compensation. Am J Public Health 1994; 84: 190-196.
Faucett, J, Blanc, P, Yelin, E. The impact of carpal tunnel syndrome on work status: Implications of job characteristics for staying on the job. J Occup Rehab 2000; 10: 55-69.
Feuerstein, M, Huang, GD, Haufler, AJ, Miller, JK. Development of a screen for predicting clinical outcomes in patients with work-related upper extremity disorders. J Occup Environ Med 2000; 42: 749-761.
Feuerstein, M, Shaw, WS, Lincoln, AE, Miller, VI, Wood, PM. Clinical and workplace factors associated with a return to modified duty in work-related upper extremity disorders. Pain 2003; 102: 51-61.
Haufler, AJ, Feuerstein, M, Huang, GD. Job stress, upper extremity pain and functional limitations in symptomatic computer users. Am J Ind Med 2000; 38: 507-515.
Shaw, WS, Feuerstein, M, Lincoln, AE, Miller, VI, Wood, PM. Ergonomic and psychosocial factors affect daily function in workers' compensation claimants with persistent upper extremity disorders. J Occup Environ Med 2002; 44: 606-615.
Cole, DC, Mondloch, MV, Hogg-Johnson, S, Early Claimant Cohort Prognostic Modelling Group. Listening to injured workers: How recovery expectations predict outcomes—A prospective study. Can Med J 2002; 166: 749-754.
Frank, JW, Brooker, AS, DeMaio, SE, Kerr, MS, Maetzel, A, Shannon, HS, Sullivan, TJ, Norman, RW, Wells, RP. Disability resulting from occupational low back pain. Part II: What do we know about secondary prevention? A review of the scientific evidence on prevention after disability begins. Spine 1996; 21: 2918-2929.
Fritz, JM, George, SZ, Delitto, A. The role of fear-avoidance beliefs in acute low back pain: Relationships with current and future disability and work status. Pain 2001; 94: 7-15.
Krause, N,, Dasinger, LK, Deegan, LJ, Rudolph, L, Brand, RJ. Psychosocial job factors and return-to-work after compensated low back injury: A disability phase-specific analysis. Am J Ind Med 2001; 40: 374-392.
Pincus, T,, Burton, AK, Vogel, S, Field, AP. A systematic review of psychological factors as predictors of chronicity/disability in prospective cohorts of low back pain. Spine 2002; 27: E109-E120.
Schultz, IZ, Crook, JM, Berkowitz, J, Meloche, GR, Milner, R, Zuberbier, OA, Meloche, W. Biopsychosocial multivariate predictive model of occupational low back disability. Spine 2002; 27: 2720-2725.
Braithwaite, IJ, Boot, DA, Patterson, M, Robinson, A. Disability after severe injury: Five year follow up of a large cohort. Injury 1998; 29: 55-59.
MacKenzie, EJ, Shapiro, S, Smith, RT, Siegel, JH, Moody, M, Pitt, A. Factors influencing return to work following hospitalization for traumatic injury. Am J Public Health 1987; 77: 329-334.
MacKenzie, EJ, Morris, JA, Jr, Jurkovich, GJ, Yasui, Y, Cushing, BM, Burgess, AR, DeLateur, BJ, McAndrew, MP, Swiontkowski, MF. Return to work following injury: The role of economic, social, and job-related factors. Am J Public Health 1998; 88: 1630-1637.
Mason, S,, Wardrope, J, Turpin, G,, Rowlands, A. The psychological burden of injury: An 18 month prospective cohort study. Emerg Med J 2002; 19: 400-404.
Michaels, AJ, Michaels, CE, Moon, CH, Zimmerman, MA, Peterson, C, Rodriguez, JL. Psychosocial factors limit outcomes after trauma. J Trauma 1998; 44: 644-648.
Ponzer, S,, Bergman, B, Brismar, B,, Johansson, LM. A study of patient-related characteristics and outcome after moderate injury. Injury 1996; 27: 549-555.
Ponzer, S,, Molin, U, Johansson, SE, Bergman, B, Tornkvist, H. Psychosocial support in rehabilitation after orthopedic injuries. J Trauma 2000; 48: 273-279.
Richmond, TS, Kauder, D, Schwab, W. A prospective study of predictors of disability at 3 months after non-central nervous system trauma. J Trauma 1998; 44: 635-643.
Richmond, TS, Kauder, D, Hinkle, J,, Shults, J. Early predictors of long-term disability after injury. Am J Crit Care 2003; 12: 197-205.
Skoog, A,, Soderqvist, A, Tornkvist, H,, Ponzer, S. One-year outcome after tibial shaft fractures: Results of a prospective fracture registry. J Orthop Trauma 2001; 15: 210-215.
Hogg-Johnson, S, Cole, DC. Early prognostic factors for duration on temporary total benefits in the first year among workers with compensated occupational soft tissue injuries. Occup Environ Med (Lond) 2003; 60: 244-253.
Fries, JF, Spitz, P, Kraines, RG, Holman, HR. Measurement of patient outcome in arthritis. Arthritis Rheum 1980; 23: 137-145.
Ramey, DR, Fries, JF, Singh, G. The health assessment questionnaire 1995—Status and review. In: Spilker B, ed. Quality of life and pharmacoeconomics in clinical trials. Philadelphia: Lippincott-Raven, 1996, pp. 227-237.
Ware, JE, Snow, KK, Kosinski, M, Gandek, B. SF-36 Health survey: Manual and interpretation guide. Boston: The Health Institute, 1993.
Bowling, A. Measuring health: A review of quality of life measurement scales, 2nd Ed. Philadelphia: Open University Press, 1997, pp. 1-8.
Higgins, P,, Ezike, C, Orris, P. Occupational health services for municipal employees. Occup Med 2001; 16: 11-21.
Alexander, D. School employees: The forgotten municipal workers. Occup Med 2001; 16: 65-78.
August, J. Historical and political overview. Occup Med 2001; 16: 1-10.
Duvall, K. Parks and golf course workers. Occup Med 2001; 16: 135-142.
Hessl, SM. Police and corrections. Occup Med 2001; 6: 39-49.
Langley, R,, Loomis, M. Health and safety concerns of zoo and aquarium workers and animal control officers. Occup Med 2001; 16: 163-182.
Peek-Asa, C. Workplace violence in municipal occupations. Occup Med 2001; 16: 109-123.
Rogers, B. Municipal healthcare workers: Work-related health hazards. Occup Med 2001; 16: 143-161.
Atlas, SJ, Singer, DE, Keller, RB, Patrick, DL, Deyo, RA. Application of outcomes research in occupational low back pain: The Maine Lumbar Spine Study. Am J Ind Med 1996; 29: 584-589.
Pransky, G,, Himmelstein, J. Outcomes research: Implications for occupational health. Am J Ind Med 1996; 29: 573-583.
Amick, BC, III, Lerner, D, Rogers, WH, Rooney, T, Katz, JN. A review of health-related work outcome measures and their uses, and recommended measures. Spine 2000; 25: 3152-3160.
Baker, JG, Johnston, MV. Prevalence and identification of problems in daily functioning in a primary medicine clinic. Disabil Rehabil 2000; 22: 716-724.
Leigh, JP, Markowitz, SB, Fahs, M, Shin, C,, Landrigan, PJ. Occupational injury and illness in the United States. Estimates of cost, morbidity, and mortality. Arch Intern Med 1997; 157: 1557-1568.
Robinson, JP, Fulton-Kehoe, D, Martin, DC, Franklin, GM. Outcomes of pain center treatment in Washington State workers' compensation. Am J Ind Med 2001; 39: 227-236.
Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health. National Occupational Research Agenda: Update 2003 (DHHS [NIOSH] Publication No. 2003-148). Washington, DC: NIOSH, 2003.
Fries, JF, Spitz, PW, Young, DY. The dimensions of health outcomes: The health assessment questionnaire, disability and pain scales. J Rheumatol 1982; 9: 789-793.
Health Assessment Questionnaire, Stanford University School of Medicine, Division of Immunology and Rheumatology, 2001 (Last updated July 2003). aramis.stanford.edu/HAQ.html.
Ramey, DR, Raynauld, JP, Fries, JF. The health assessment questionnaire 1992: Status and review. Arthritis Care Res 1992; 5: 119-129.
Brown, JH, Kazis, LE, Spitz, PW, Gertman, P, Fries, JF, Meenan, RF. The dimensions of health outcomes: A cross-validated examination of health status measurement. Am J Public Health 1984; 74: 159-161.
Bae, SC, Cook, EF, Kim, SY. Psychometric evaluation of a Korean Health Assessment Questionnaire for clinical research. J Rheumatol 1998; 25: 1975-1979.
Clements, PJ, Wong, WK, Hurwitz, EL, Furst, DE, Mayes, M, White, B,, Wigley, F, Weisman, M,, Barr, W, Moreland, L,, Medsger, TA, Jr, Steen, V, Martin, R,, Collier, D, Weinstein, A,, Lally, E, Varga, J,, Weiner, S, Andrews, B,, Abeles, M, Seibold, J. Correlates of the disability index of the health assessment questionnaire: A measure of functional impairment in systemic sclerosis. Arthritis Rheum 1999; 42: 2372-2380.
Ferraz, MB, Oliveira, LM, Araujo, PM, Atra, E, Tugwell, P. Crosscultural reliability of the physical ability dimension of the health assessment questionnaire. J Rheumatol 1990; 17: 813-817.
Goeppinger, J,, Doyle, MA, Charlton, SL, Lorig, K. A nursing perspective on the assessment of function in persons with arthritis. Res Nurs Health 1988; 11: 321-331.
Jantti, J,, Aho, K, Kaarela, K,, Kautiainen, H. Work disability in an inception cohort of patients with seropositive rheumatoid arthritis: A 20 year study. Rheumatology (Oxford) 1999; 38: 1138-1141.
Kalke, S,, Mukerjee, D, Dasgupta, B. A study of the health assessment questionnaire to evaluate functional status in polymyalgia rheumatica. Rheumatology (Oxford) 2000; 39: 883-885.
Kirwan, JR, Reeback, JS. Stanford Health Assessment Questionnaire modified to assess disability in British patients with rheumatoid arthritis. Br J Rheumatol 1986; 25: 206-209.
Koh, ET, Seow, A, Pong, LY, Koh, WH, Chan, L, Howe, HS, Lim, TH, Low, CK. Cross cultural adaptation and validation of the Chinese health assessment questionnaire for use in rheumatoid arthritis. J Rheumatol 1998; 25: 1705-1708.
Kosinski, M,, Zhao, SZ, Dedhiya, S, Osterhaus, JT, Ware, JE, Jr. Determining minimally important changes in generic and disease-specific health-related quality of life questionnaires in clinical trials of rheumatoid arthritis. Arthritis Rheum 2000; 43: 1478-1487.
Liang, MH, Fossel, AH, Larson, MG. Comparisons of five health status instruments for orthopedic evaluation. Med Care 1990; 28: 632-642.
Scott, DL, Garrood, T. Quality of life measures: Use and abuse. Baillere's Best Pract Res Clin Rheumatol 2000; 14: 663-687.
Sokka, T,, Kankainen, A, Hannonen, P. Scores for functional disability in patients with rheumatoid arthritis are correlated at higher levels with pain scores than with radiographic scores. Arthritis Rheum 2000; 43: 386-389.
Steen, VD, Medsger, TA, Jr. The value of the Health Assessment Questionnaire and special patient-generated scales to demonstrate change in systemic sclerosis patients over time. Arthritis Rheum 1997; 40: 1984-1991.
Sullivan, M,, Eagers, RC, Lynch, K, Barber, JH. Assessment of disability caused by rheumatic diseases in general practice. Annals Rheum Dis 1987; 46: 598-600.
Ward, MM, Kuzis, S. Validity and sensitivity to change of spondylitis-specific measures of functional disability. J Rheumatol 1999; 26: 121-127.
Young, A,, Dixey, J, Cox, N,, Davies, P, Devlin, J,, Emery, P, Gallivan, S,, Gough, A, James, D,, Prouse, P, Williams, P,, Winfield, J. How does functional disability in early rheumatoid arthritis (RA) affect patients and their lives? Results of 5 years of follow-up in 732 patients from the early RA study (ERAS). Rheumatology (Oxford) 2000; 39: 603-611.
Gillen, M. Injuries from construction falls. Functional limitations and return to work. AAOHN J 1999; 47: 65-73.
Ware, JE, Jr. SF-36 health survey update. Spine 2000; 25: 3130-3139.
Beaton, DE, Bombardier, C, Hogg-Johnson SA. Measuring health in injured workers: A cross-sectional comparison of five generic health status instruments in workers with musculoskeletal injuries. Am J Ind Med 1996; 29: 618-631.
Heyland, DK, Hopman, W, Coo, H,, Tranmer, J, McColl, MA. Long-term health-related quality of life in survivors of sepsis. Short Form 36: A valid and reliable measure of health-related quality of life. Crit Care Med 2000; 28: 3599-3605.
Birrell, FN, Hassell, AB, Jones, PW, Dawes, PT. How does the short form 36 health questionnaire (SF-36) in rheumatoid arthritis (RA) relate to RA outcome measures and SF-36 population values? A cross-sectional study. Clin Rheumatol 2000; 19: 195-199.
Boueri, FM, Bucher-Bartelson, BL, Glenn, KA, Make, BJ. Quality of life measured with a generic instrument (Short Form-36) improves following pulmonary rehabilitation in patients with COPD. Chest 2001; 119: 77-84.
Damiano, AM, McGrath, MM, Willian, MK, Snyder, CF, LeWitt, PA, Reyes, PF, Richter, RR, Means, ED. Evaluation of a measurement strategy for Parkinson's disease: Assessing patient health-related quality of life. Qual Life Res 2000; 9: 87-100.
Elliott, AM, Smith, BH, Smith, WC, Chambers, WA. Changes in chronic pain severity over time: The Chronic Pain Grade as a valid measure. Pain 2000; 88: 303-308.
Hemingway, H,, Staffors, M, Stansfeld, S,, Shipley, M, Marmot, M. Is the SF-36 a valid measure of change in population health? Results from the Whitehall II study. BMJ 1997; 315: 1273-1279.
Jones, A,, Voaklander, DC, Johnston, DW, Suarez-Almazor, ME. Health related quality of life outcomes after total hip and knee arthroplasties in a community based population. J Rheumatol 2000; 27: 1745-1752.
Lindsay, GM, Hanlon, P, Smith, LN, Wheatley, DJ. Assessment of changes in general health status using the short-form 36 questionnaires 1 year following coronary artery bypass grafting. Eur J Cardiothorac Surg 2000; 18: 557-564.
Menefee, LA, Frank, ED, Doghramji, K, Picarello, K,, Park, JJ, Jalali, S, Perez-Schwartz, L. Self-reported sleep quality and quality of life for individuals with chronic pain conditions. Clin J Pain 2000; 16: 290-297.
Roos, EM, Roos, HP, Ryd, L, Lohmander, LS. Substantial disability 3 months after arthroscopic partial meniscectomy: A prospective study of patient-relevant outcomes. Arthroscopy 2000; 16: 619-626.
Rotstein, Z,, Barak, Y, Noy, S,, Achiron, A. Quality of life in multiple sclerosis: Development and validation of the “RAYS” scale and comparison with the SF-36. Int J Qual Health Care 2000; 12: 511-517.
Sprangers, MA, de Regt, EB, Andries, F, van Agt, HM, Bijl, RV, de Boer, JB, Foets, M, Hoeymans, N, Jacobs, AE, Kempen, GI, Miedema, HS, Tijhuis, MA, de Haes, HC. Which chronic conditions are associated with better or poorer quality of life? J Clin Epidemiol 2000; 53: 895-907.
Suarez-Almazor, ME, Kendall, C, Johnson, JA, Skeith, K, Vincent, D. Use of health status measures in patients with low back pain in clinical settings. Comparison of specific, generic and preference-based instruments. Rheumatology (Oxford) 2000; 39: 783-790.
Gatchel, RJ, Polatin, PB, Mayer, TG, Robinson, R, Dersh, J. Use of the SF-36 Health Status Survey with a chronically disabled back pain syndrome: Strengths and limitations. J Occup Rehabil 1998; 8: 237-246.
Kyes, KB, Franklin, G, Weaver, MR. Reliability and validity of medical outcome and patient satisfaction measures among injured workers in Washington State: A pretest. Am J Ind Med 1997; 31: 427-434.
Kopjar, B. The SF-36 health survey: A valid measure of changes in health status after injury. Injury Prev 1996; 2: 135-139.
Ponzer, S,, Nasell, H, Bergman, B,, Tornkvist, H. Functional outcome and quality of life in patients with Type B ankle fractures: A two-year follow-up study. J Orthop Trauma 1999; 13: 363-368.
SPSS, Inc. SPSS for Windows based system users guide. Chicago: SPSS, 1999.
SAS System, Version 8.01. The SAS Institute. Cary, NC: SAS, 2001.
Hosmer, DW, Jr., Lemeshow, S. Applied survival analysis. New York: Wiley, 1999.
Association for the Advancement of Automotive Medicine. The Abbreviated Injury Scale, 1990 revisions. Des Plaines, IL: AAAM, 1990.
Baker, SP, O'Neill, B, Haddon, W, Long, WB. The injury severity score: A method for describing patients with multiple injuries and evaluating emergency care. J Trauma 1976; 16: 882-885.
Beaton, DE, Hogg-Johnson, S, Bombardier, C. Evaluating changes in health status: Reliability and responsiveness of five generic health status measures in workers with musculoskeletal disorders. J Clin Epidemiol 1997; 50: 79-93.
Stock, SR, Cole, DC, Tugwell, P, Streiner, D. Review of applicability of existing functional status measures to the study of workers with musculoskeletal disorders of the neck and upper limb. Am J Ind Med 1996; 29: 679-688.
Gillen, M,, Faucett, J, Beaumont, JJ, McLoughlin, E. Injury severity associated with nonfatal construction falls. Am J Ind Med 1997; 32: 647-655.
Kopec, JA, Esdaile, JM. Occupational role performance in persons with back pain. Disabil Rehabil 1998; 20: 373-379.
Lerner, D,, Amick, BC, III, Rogers, WH, Malspeis, S, Bungay, K,, Cynn, D. The Work Limitations Questionnaire. Med Care 2001; 39: 72-85.
Baldwin, ML, Johnson, WG, Butler, RJ. The error of using returns-to-work to measure the outcomes of health care. Am J Ind Med 1996; 29: 632-641.
Straaton, KV, Maisiak, R, Wrigley, JM, Fine, PR. Musculoskeletal disability, employment, and rehabilitation. J Rheumatol 1995; 22: 505-513.
Beaton, DE, Tarasuk, V, Katz, JN, Wright, JG, Bombardier, C. “Are You Better?” A qualitative study of the meaning of recovery. Arthritis Care Res 2001; 45: 270-279.
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Gillen, M., Jewell, S.A., Faucett, J.A. et al. Functional Limitations and Well-Being in Injured Municipal Workers: A Longitudinal Study. J Occup Rehabil 14, 89–105 (2004). https://doi.org/10.1023/B:JOOR.0000018326.23090.63
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DOI: https://doi.org/10.1023/B:JOOR.0000018326.23090.63