What are the barriers to work

participation following injury?

Results from the Prospective

Outcomes of Injury Study

Rebbecca Lilley

Injury Prevention Research Unit

9 November 2012

What is known?

• Previous studies examining predictors of

poor outcomes have focused on:

– Mainly hospitalised injury

– Limited range of risk factors

• New Zealand’s context: Accident

Compensation Corporation (ACC)

Research Focus

This study examines combined influences of

personal, work, health, lifestyle & injury

factors on work absence following injury in

the POIS study

Working Cohort

• POIS worker cohort 2626 participants

• Injury type: lower (16%) & upper extremity

fracture (18%), lower (24%) & upper (14%)

extremity sprains & strains, and back

dislocation, sprain & strain (16%).

• 24% hospital admission within 7 days

• 36% work-related

The good news….

• Majority (73%) are working at 3 months

• Of those still absent from work – the

majority (71%) anticipate recovery to usual

work

• However, 720 (27%) absent from work

WORK STATUS – 3 MONTHS AFTER INJURY

Outcome: Work status 3 months after injury

• Single item asked at 3 month interview

“Are you back at work?” Yes/No

• Considered “working” at time of interview

regardless of employer or

modified/part/full-time status

• Outcome of interest: “Not working”

Pre-injury characteristics

Socio-demographic (10 factors)

Health (6 factors)

Lifestyle (5 factors)

Physical work (5 factors)

Psychosocial (7 factors)

Work organisation

(4 factors)

Injury (6 factors)

Health

overall self-assessment for health, comorbidities, pain or discomfort, prior injury, prior disabling condition, work capacity

Lifestyle behaviours

alcohol consumption, current smoking status, body mass index (BMI), exercise, sleep quantity

Summary of 3-month results

Socio-demographic (low income,

financial insecurity, manual occupation)

Health

Lifestyle (obesity)

Physical work (any painful work, any standing at work)

Psychosocial

Work organisation (long working

weeks, temporary employment)

Injury (perceived threat to life,

hospitalisation)

Summary of 3-month results

Socio-demographic (low income,

financial insecurity, manual occupation)

Lifestyle (obesity)

Physical work (any painful work, any standing at work)

Work organisation (long working

weeks, temporary employment)

Injury (perceived threat to life,

hospitalisation)

What factors were not included?

• Age

• Gender

• Pre-injury psychosocial factors

• Pre-injury health factors

What do we need to do to get injured workers back to work?

• Pre-injury socio-demographic, workplace

& lifestyle factors could be targeted

• New findings:

– Obesity

– Temporary employment

– Long week work schedules

– Financial insecurity

• Need for broader intervention focus

Current analyses

• Comparison of outcomes for workers with

Work-related & non-work-related injuries

– Provisional analysis indicates by 12 months workers with work-related injury have poorer recovery from injury compared

• Nested case-control study examining work

organisational factors

– Workers from small sized organisations associated with work absence

Acknowledgements

Funders: The Health Research Council of New

Zealand (2007-2013) & the Accident

Compensation Corporation (2007-2010)

Co-investigators: Gabrielle Davie, Shanthi

Ameratunga, Sarah Derrett

Reference: Lilley R, Davie G, Ameratunga S,

Derrett S (2012) Factors predicting work status 3

months after injury: results from the Prospective

Outcomes of Injury Study. BMJ Open 2:e000400

http://bmjopen.bmj.com/content/2/e000400.full