Musculo-Skeletal/Mobility Disabilities

Work barriers experienced and job accommodations used by persons with arthritis and other rheumatic diseases.

Allaire, S. H., Wei, L., & LaValley, M. P. (2003). "Work barriers experienced and job accommodations used by persons with arthritis and other rheumatic diseases." Rehabilitation Counseling Bulletin, 46(3): 147-156.

Many people with arthritis become work disabled, but little is known about (a) the types of work barriers they experience and (b) their use of job accommodations. Our objectives were to describe work barriers and use of accommodations and to examine factors associated with accommodation use in persons with arthritis at risk for work disability. Barrier assessment was conducted using the Work Experience Survey. Factors associated with accommodation use were analyzed by logistic regression. The overwhelming majority of the 121 participants (98%) reported having one or more barriers, and 68% reported 10 or more barriers; 38% used an accommodation. Greater functional limitations and self-efficacy for accommodation request were each associated with accommodation use. Even though these employed persons with arthritis faced multiple barriers at work, only a small number used any form of job accommodation.

Predictors of workplace accommodations for employees with mobility-related disabilities.

Balser, D. B. (2007). "Predictors of workplace accommodations for employees with mobility-related disabilities." Administration and Society, 39, 656-683 .

Our understanding of reasonable accommodations in the workplace is incomplete. Frequently, research on disability either neglects issues of accommodation or examines the receipt of any accommodation, without specifying type. However, people with disabilities need specific accommodations, not any accommodation. This article uses comprehensive models to test the predictors of four types of accommodations received by employees with mobility-related disabilities. Overall, the results show that different factors predicted receipt of different types of accommodations. Furthermore, factors that facilitate or constrain an employer’s capacity to make particular accommodations were more powerful predictors than an individual’s need for accommodation or socioeconomic status.

The effects of occupational injuries after returns to work: Work absences and losses of on-the-job productivity.

Butler, R. J., Baldwin, M. L., & Johnson, W. G. (2006). "The effects of occupational injuries after returns to work: Work absences and losses of on-the-job productivity." Journal of Risk and Insurance, 73(2): 309-34.

We extend the research on post-injury employment by estimating productivity losses for workers with permanent partial disabilities (PPDs) in the first three years after injury. Our method distinguishes between productivity losses attributed to spells of work absence versus reduced earnings during spells of employment. The method is applied to data for 800 Ontario workers with PPDs. The results document large productivity losses persisting at least three years after injury, with different loss patterns for workers returning to stable versus unstable employment. Human capital investments or job accommodations can reduce productivity losses, but the significant determinants of losses differ for the stable versus unstable employment groups.

How accommodations affect the duration of post-injury employment spells.

Campolieti, M. (2005). "How accommodations affect the duration of post-injury employment spells." Journal of Labor Research, 26(3): 485-99.

I examine the effects of accommodations on the duration of employment spells using a sample of workers reentering the work force after an occupational injury. Unlike previous research, I analyze the post-injury employment history, i.e., more than one employment spell. The results indicate that accommodations have a smaller effect on employment duration than previous studies for workers who have not left their jobs. In addition, only certain types of accommodations, flexible work schedules and modified workplaces, are associated with significant increases in employment duration. The implications of these estimates for disability policy are also briefly discussed.

Accommodating workers with spinal cord injury.

Dowler, D., Batiste, L., & Whidden, E. (1998). “Accommodating workers with spinal cord injury." Journal of Vocational Rehabilitation, 10(2): 115-122.

Describes the types of jobs, functional limitations, job functions, career status and accommodation suggestions for over 1,000 cases from the Job Accommodation Network (JAN) caseload involving workers with spinal cord injury. The JAN, a service of the President's Committee on Employment of People with Disabilities, was designed to provide a toll-free consulting service for information about accommodations in the workplace. The mission of JAN is to assist employers, service providers and people with disabilities by giving accommodation information related to the hiring, retraining, retention, or advancement of persons with disabilities. The career progression recorded for each caller reflects how the accommodation was used to place or retain the caller in employment. Overall, JAN data show that workers with spinal cord injury can be gainfully employed and maintain this employment over time. Results indicate that nearly three-quarters of the callers needed an accommodation in order to maintain their current job or to improve their productivity in their current job. Only 1% of the callers were being considered for promotion. (PsycINFO Database Record (c) 2007 APA, all rights reserved)

Workplace-based return-to-work interventions: A systematic review of the quantitative literature.

Franche, R. L., Cullen, K., Clarke, J., Irvin, E., Sinclair, S., & Frank, J. (2005). "Workplace-based return-to-work interventions: A systematic review of the quantitative literature." Journal of Occupational Rehabilitation, 15(4): 607-631.

Introduction: A systematic review was conducted to review the effectiveness of workplace-based return-to-work (RTW) interventions. Method: Seven databases were searched, in English and French, between January 1990 and December 2003 for peer-reviewed studies of RTW interventions provided at the workplace to workers with work disability associated with musculoskeletal or other pain-related conditions. Methodological quality appraisal and data extraction were conducted by pairs of reviewers. Results: Of a total of 4124 papers identified by the search, 10 studies were of sufficient quality to be included in the review. There was strong evidence that work disability duration is significantly reduced by work accommodation offers and contact between healthcare provider and workplace; and moderate evidence that it is reduced by interventions which include early contact with worker by workplace, ergonomic work site visits, and presence of a RTW coordinator. For these five intervention components, there was moderate evidence that they reduce costs associated with work disability duration. Evidence for sustainability of these effects was insufficient or limited. Evidence regarding the impact of supernumerary replacements was insufficient. Evidence levels regarding the impact of the intervention components on quality-of-life was insufficient or mixed. Conclusions: Our systematic review provides the evidence base supporting that workplace-based RTW interventions can reduce work disability duration and associated costs, however the evidence regarding their impact on quality-of-life outcomes was much weaker. (PsycINFO Database Record (c) 2007 APA, all rights reserved)

Supervisor's role in successful job maintenance: A target for rehabilitation counselor efforts.

Gates, L. B., Akabas, S. H., & Kantrowitz, W. (1996). "Supervisor's role in successful job maintenance: A target for rehabilitation counselor efforts." Journal of Applied Rehabilitation Counseling, 27(3): 60-66.

Explores the role of supervisors with regard to disabled workers and the implications of this role for the work of rehabilitation counselors. A comprehensive disability management effort at 1 worksite was studied in-depth. Surveys were completed by 25 workers with physical or neurological disabilities and by their supervisors about the functional limitations caused by the disabling conditions and responsiveness of the supervisors. Results show that successful readjustment to work was affected by the ability of supervisors to (1) make accurate assessments of when conditions interfered with job performance, (2) identify problems caused by disabling conditions, (3) develop appropriate accommodations, (4) monitor accommodation effectiveness, and (5) facilitate communication between workers with disabilities and their co-workers. Ways in which rehabilitation counselors can help are discussed. (PsycINFO Database Record (c) 2006 APA, all rights reserved)

Do injured workers pay for reasonable accommodation?

Gunderson, M., & Hyatt, D. (1996). "Do injured workers pay for reasonable accommodation?" Industrial & Labor Relations Review, 50(1): 92-104.

The authors present evidence on the extent to which injured workers in Ontario in 1979-88 "paid," through lower wages, for "reasonable accommodation" requirements designed to facilitate their return to work after their injury. The data source, the Ontario Workers' Compensation Board's Survey of Workers with Permanent Impairments, provides detailed information on two categories of accommodation. Work-place modifications, such as customized equipment and shortened work schedules; and reductions in physical demands, such as exemption from bending and heavy lifting. Employers who rehired their own injured workers appear to have absorbed virtually all the cost of the accommodations they made, but employers who hired workers who were injured at other firms shifted a substantial portion of the cost of workplace modifications (though not the cost of reductions in physical demands) onto the injured workers, in the form of lower pay.

The role of organizational policies and practices in predicting post surgical change in self-efficacy and accommodation following carpal tunnel release surgery.

Iha, G. S. (2005). The role of organizational policies and practices in predicting post surgical change in self-efficacy and accommodation following carpal tunnel release surgery. Retrieved May 28, 2008, from Digital Commons @ the Texas Medical Centeropens a new window

This study identified predictors (clinical, demographic, economic, job, psychosocial, and organizational) of a change in self-efficacy which, at two months post surgery, along with organizational policies and practices (OPPs) have been shown to be a significant predictor of successful work role function following carpal tunnel release surgery (CTRS). The role of these same variables in accommodation of the employee in the workplace was also explored. Methods: A community based cohort (N=148) of persons meeting selection criteria for CTRS were followed for one year post surgery. Predictors of a change in self-efficacy were analyzed using linear regression. Logistic regression was used to determine those variables associated with accommodation. Results: Employee's perception of organizational policies and practices predicted the change in self-efficacy (p=.001) with R2 =0.291. Significant covariates included personal health status and force times repetition, a measure estimating the physical work load which increased the R2 of the model to 0.419. No significant variables, including OPPs, were associated with accommodation at baseline. Conclusion: The work environment and specifically the organizational level OPPs are important in predicting a change in self efficacy following CTS. This research supports the role of the environment as described in the social cognitive theory and provides a mechanism or link between OPPs and SE. Primary and secondary models for disability should be multidimensional, temporal and include workplace policies and practices. These OPPs should include disability management, safety, ergonomics and a people oriented culture. OPPs were not associated with accommodation. To better understand the behavior of an employee following an illness or injury, the work environment and its influence on the employee needs further evaluation.

Back pain and work disability: The need for a new paradigm.

Johnson, W. G., Baldwin, M. L., & Butler, R. J. (1998). "Back pain and work disability: The need for a new paradigm." Industrial Relations, 37 (1): 9-34.

Using a unique data set of workers' compensation claims from Ontario, this study analyzes the determinants of first returns to work and subsequent patterns of employment for a sample of workers with back pain and a comparison group of workers with other injuries. The results suggest that the costly and pervasive problem of work-related back claims could be reduced by abandoning the traditional work injury model in favor of a separate paradigm for back pain that reflects its unique characteristics. A change in economic incentives would increase the probability of return to work for back cases, and an expansion of employer-provided job accommodations would increase the probability of stable employment after the first return.

Early healthcare provider communication with patients and their workplace following a lost-time claim for an occupational musculoskeletal injury.

Kosny, A., Franche, R. L., Pole, J., Krause, N., Cote, P., & Mustard, C. (2006). "Early healthcare provider communication with patients and their workplace following a lost-time claim for an occupational musculoskeletal injury." Journal of Occupational Rehabilitation, 16(1): 27-39.

PROBLEM: One of the key players in the return-to-work (RTW) and work accommodation process is the healthcare provider (HCP). This study examines the association between RTW approximately one month post injury and early, proactive HCP communication with the patient and workplace. METHODS: In this cross-sectional study 187 Ontario workers completed a telephone survey 17-43 days post injury. All had accepted or pending lost-time claims for back, neck or upper extremity occupational musculoskeletal injuries. Logistic regression was used to analyze the effects of three self-reported items "your HCP told you the date you could RTW," "your HCP advised you on how to prevent re-injury or recurrence," "your HCP made contact with your workplace" on self-reported RTW. Fourteen potential confounders were also tested in the model including sex, age, income, education, occupational classification, worksite size, co-morbidity, psycho-physical work demands, pain, job satisfaction, depression, and time from injury to interview. RESULTS: The HCP giving a patient a RTW date (adjusted OR=3.33, 95% CI=1.62-6.87) and giving a patient guidance on how to prevent recurrence and re-injury (adjusted OR=2.71, 95% CI=1.24-5.95) were positively associated with an early RTW. Contact by the HCP with the workplace was associated with RTW, however, this association became weaker upon adjusting for confounding variables (crude OR=2.11, 95% C1=1.09-4.09; adjusted OR=1.72, 95% CI=0.83-3.58). INTERPRETATION: Our study lends support to the HCP playing an active role early in the RTW process, one that includes direct contact with the workplace and proactive communication with the patient.

Work problems and accommodations reported by persons who are post polio or have a spinal cord injury.

McNeal, D. R., Somerville, N. J., & Wilson, D. J. (1999). "Work problems and accommodations reported by persons who are post polio or have a spinal cord injury." Assistive Technology, 11(2): 137-157.

This study documented (1) whether employees with a disability who are aging have experienced new work problems as a consequence of functional declines, and (2) whether their work problems are being accommodated adequately. 96 individuals with a disability (50 postpolio and 46 who had a spinal cord injury, SCI) were interviewed by phone. 49 of the 50 postpolio persons reported they had experienced functional declines in recent years, and 41 of the 50 rated the severity of their disability as greater than when they first began working. As a result of the functional declines, 90.9% of their work problems were rated as new and would not have been significant problems for them when they first began working. The situation was very different for the group with SCIs. Only a few members of that group had experienced functional declines that were causing new problems at work. A total of 480 work problems were reported by participants. Three out of every 8 problems did not have an accommodation satisfactory to the employee, primarily because no accommodation had been identified. Employers were generally supportive of the employee's need for accommodation; they paid for 59.1% of the accommodations that had a cost and refused to provide an accommodation for only 18 of the 480 problems. (PsycINFO Database Record (c) 2007 APA, all rights reserved)

Patient clusters in acute, work-related back pain based on patterns of disability risk factors.

Shaw, W. S., Pransky, G., Patterson, W., Linton, S. J., & Winters, T. (2007). "Patient clusters in acute, work-related back pain based on patterns of disability risk factors." Journal of Occupational and Environmental Medicine / American College of Occupational and Environmental Medicine, 49(2): 185-193.

OBJECTIVE: To identify subgroups of patients with work-related back pain based on disability risk factors. METHODS: Patients with work-related back pain (N = 528) completed a 16-item questionnaire of potential disability risk factors before their initial medical evaluation. Outcomes of pain, functional limitation, and work disability were assessed 1 and 3 months later. RESULTS: A K-Means cluster analysis of 5 disability risk factors (pain, depressed mood, fear avoidant beliefs, work inflexibility, and poor expectations for recovery) resulted in 4 sub-groups: low risk (n = 182); emotional distress (n = 103); severe pain/fear avoidant (n = 102); and concerns about job accommodation (n = 141). Pain and disability outcomes at follow-up were superior in the low-risk group and poorest in the severe pain/fear avoidant group. CONCLUSIONS: Patients with acute back pain can be discriminated into subgroups depending on whether disability is related to pain beliefs, emotional distress, or workplace concerns.

A controlled case study of supervisor training to optimize response to injury in the food processing industry.

Shaw, W. S., Robertson, M. M., McLellan, R. K., Verma, S., & Pransky, G. (2006). "A controlled case study of supervisor training to optimize response to injury in the food processing industry." Work: Journal of Prevention, Assessment & Rehabilitation, 26(2): 107-114.

The role of supervisors to aid injured workers, access health care, and provide reasonable accommodation may prevent prolonged disability among workers reporting musculoskeletal pain. Although supervisor training has been a common element of broad-based ergonomic interventions to prevent injuries, the impact of supervisor training alone to improve injury response has not been studied. In a controlled design, 11 supervisors in an intervention group and 12 supervisors in a delayed intervention control group from the same plant were provided a 4-hour training workshop. The workshop emphasized communication skills and ergonomic accommodation for workers reporting injuries or health concerns. Workers' compensation claims data in the 7 months before and after the workshop showed a 47% reduction in new claims and an 18% reduction in active lost-time claims versus 27% and 7%, respectively, in the control group. Improving the response of frontline supervisors to employees' work-related health and safety concerns may produce sustainable reductions in injury claims and disability costs.

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

Shaw, W. S., Robertson, M. M., Pransky, G., & McLellan, R. K. (2003). "Employee perspectives on the role of supervisors to prevent workplace disability after injuries." Journal of Occupational Rehabilitation, 13(3): 129-142.

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 post-injury 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. (PsycINFO Database Record (c) 2006 APA, all rights reserved)

Perceived need for workplace accommodation and labor-force participation in Canadian adults with activity limitations.

Wang, P. P., Badley, E. M., & Gignac, M. A. (2004). "Perceived need for workplace accommodation and labor-force participation in Canadian adults with activity limitations." American Journal of Public Health, 94(9): 1515-1518.

We examined how perceived need for workplace accommodation affects labor-force participation in people with disabilities. We analyzed a Canadian survey with structural equation modeling to test a model incorporating activity limitations and perceived need for workplace accommodations. The results suggested that the effect of upper- and lower-body activity limitation on labor-force participation was mediated by perceived need for workplace accommodations. Thus, the provision of adequate workplace accommodations could enhance labor-force participation in people with disabilities. (PsycINFO Database Record (c) 2006 APA, all rights reserved)