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BMC Musculoskeletal Disorders

, 17:171

Epidemiology of musculoskeletal disorders


BackgroundWork disability following motor vehicle related orthopaedic trauma is a significant contributor to the burden of injury and disease. Early identification of predictors for return to work RTW is essential for developing effective interventions to prevent work disability. The study aim was to determine the predictors including compensation related factors of time to RTW following motor vehicle related orthopaedic trauma.

MethodsAdmitted patients were recruited prospectively from two trauma hospitals with upper and-or lower extremity fractures following a motor vehicle crash. Baseline and follow up data were collected by written questionnaire. For baseline, this occurred in person within 2 weeks of injury. For follow up, this occurred by mail at six, 12 and 24 months. Additional demographic and injury-related information was retrieved from hospital databases. Analysis involved: descriptive statistics; logrank test to detect survival distributions of categorical variables; and Cox proportional hazards regression models for risks of time to RTW using baseline characteristic and compensation related variables at 6 months.

ResultsOf 452 study participants 334 74 % were working pre-injury: results are based on this subset. Baseline characteristics were mean age 36 years 13.9 Standard Deviation SD, 80 % male; 72 % self-assessed very good-excellent pre-injury health, 83 % household income > AU$40,000 Australian Dollar. Follow up data was available for 233 70 %, 210 63 %, and 182 54 % participants at six, 12 and 24 months respectively.

Significant risks of a longer time to RTW were greater injury severity, as measured by the New Injury Severity Score NISS Hazards Rate Ratio HRR = 0.54, 95 % CI 0.35-0.82; and lower occupational skill levels HRR = 0.53, 95 % CI 0.34-0.83. Significant risks of a shorter time to RTW were: recovery expectations for usual activities within 90 days HRR = 2.10, 95 % CI 1.49-2.95; full-time pre-injury work hours HRR = 1.99, 95 % CI 1.26-3.14; and very good self-assessed pre-injury health status HRR = 1.41, 95 % CI 0.98-2.02. Legal representation analysed at six months only was not associated with time to RTW. At each time period, there were 146 63 %, 149 71 %, and 137 76 % working participants.

ConclusionsA longer time to RTW was associated with greater injury severity and lower occupational skill levels; while a shorter time to RTW was associated with recovery expectations for usual activities within 90 days, full-time pre-injury work hours, and very good self-assessed pre-injury health status. Our findings reinforce existing research. There is an opportunity to trial interventions that address potentially modifiable factors. The issues surrounding legal representation are complex and require further research.

KeywordsCompensation and redress Wounds and injury Multiple trauma Return to work AbbreviationsABSAustralian Bureau of Statistics

AISabbreviated injury scale

ASCEDaustralian standard classification of education

ASCOAustralian standard classification of occupations

AUAustralian dollar

AUDIT-Calcohol use disorders identification test: self-report version

BEACHbettering the evaluation of care and health

BMIbody mass index

CALDculturally and linguistically diverse

CIconfidence interval

CTPcompulsory third party

HILDAhousehold, income and labour dynamics in australia

HRRhazards rate ratio

IRSDindex of relative socioeconomic disadvantage

ISSinjury severity score

NHMRCNational Health and Medical Research Council

NISSnew injury severity score

NSWNew South Wales

PCSphysical component score

RTWreturn to work

SDstandard deviation

SEIFAsocio-economic indexes for areas

SF36v2short form-36 version 2.0

WCworkers compensation

An erratum to this article can be found at

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Autor: Darnel F. Murgatroyd - Ian A. Harris - Yvonne Tran - Ian D. Cameron


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