Participation in paid and unpaid work one year after injury and the impact of subsequent injuries for Maori: Results from a longitudinal cohort study in New Zealand.

INTRODUCTION: Indigenous populations experience greater injury burdens than non-indigenous groups. This paper investigated, for injured Maori (New Zealand's indigenous population): 1) participation in paid and unpaid work 12 months after injury, 2) whether subsequent injuries are predictive of reduced participation, and 3) if particular characteristics of subsequent injuries predict reduced participation. METHODS: The Subsequent Injury Study utilised data from the earlier Prospective Outcomes of Injury Study, a study of 2856 injured New Zealanders (including 566 Maori; 20%) who had an Accident Compensation Corporation (ACC; New Zealand's no-fault injury insurer) entitlement claim (sentinel injury). Data about subsequent injuries reported to ACC and hospital discharge data for injuries resulting in hospitalisation were also utilised. Multivariable models were used to examine if certain aspects of subsequent injury predicted either of two outcomes - reduced participation in paid, and unpaid work 12 months after a sentinel injury. RESULTS: Eligible participants were identified from the 405 Maori participants interviewed at 12 months. Thirty-two percent sustained at least one ACC subsequent injury, and 16% reported reduced participation in unpaid work. Of the eligible participants working for pay at the time of their sentinel injury, 35% reported reduced participation in paid work. Although the relationship between sustaining a subsequent injury (or not) and reduced participation in paid work was unclear (aRR 1.4, 95%CI 0.9,2.3), particular subsequent injury characteristics were identified as being independently predictive: subsequent injury resulting from an assault (aRR 2.4, 95%CI 1.2,4.9), a subsequent injury involving an entitlement claim (aRR 2.0, 95%CI 1.1,3.4), sustaining more than one subsequent injury (aRR 2.0, 95%CI 1.1,3.6), and only non-work-related subsequent injuries (aRR 1.6, 95%CI 1.0,2.7). CONCLUSIONS: Reduced participation in paid work is prevalent for Maori after an ACC entitlement claim injury. Particular characteristics of subsequent injuries after such an event impacts on participation in paid work 12 months after the sentinel injury, but the picture is less clear for unpaid work. Understanding the changes in paid and unpaid work, and the predictive characteristics of subsequent injuries for injured Maori, is important for future injury prevention strategies and supporting return to work rehabilitation programmes, specifically for Maori.

Drivers of international variation in prevalence of disabling low back pain: Findings from the Cultural and Psychosocial Influences on Disability study.

BACKGROUND: Wide international variation in the prevalence of disabling low back pain (LBP) among working populations is not explained by known risk factors. It would be useful to know whether the drivers of this variation are specific to the spine or factors that predispose to musculoskeletal pain more generally. METHODS: Baseline information about musculoskeletal pain and risk factors was elicited from 11 710 participants aged 20-59 years, who were sampled from 45 occupational groups in 18 countries. Wider propensity to pain was characterized by the number of anatomical sites outside the low back that had been painful in the 12 months before baseline ('pain propensity index'). After a mean interval of 14 months, 9055 participants (77.3%) provided follow-up data on disabling LBP in the past month. Baseline risk factors for disabling LBP at follow-up were assessed by random intercept Poisson regression. RESULTS: After allowance for other known and suspected risk factors, pain propensity showed the strongest association with disabling LBP (prevalence rate ratios up to 2.6, 95% CI: 2.2-3.1; population attributable fraction 39.8%). Across the 45 occupational groups, the prevalence of disabling LBP varied sevenfold (much more than within-country differences between nurses and office workers), and correlated with mean pain propensity index (r = 0.58). CONCLUSIONS: Within our study, major international variation in the prevalence of disabling LBP appeared to be driven largely by factors predisposing to musculoskeletal pain at multiple anatomical sites rather than by risk factors specific to the spine. SIGNIFICANCE: Our findings indicate that differences in general propensity to musculoskeletal pain are a major driver of large international variation in the prevalence of disabling low back pain among people of working age.

Musculoskeletal disorders among nurses compared with two other occupational groups.

BACKGROUND: There is a high incidence of low back pain (LBP) among nurses. However, few longitudinal studies have investigated musculoskeletal disorders (MSDs) at other anatomical sites in nurses. AIMS: To describe the cumulative incidence and persistence/recurrence of MSDs of the low back, neck, shoulder, elbow, wrist/hand and knee among New Zealand nurses, to investigate the impact of MSDs on work and functional tasks and to compare findings for nurses with those in postal workers and office workers. METHODS: Participants completed a postal survey at baseline and again 1 year later. Information was collected about MSDs in the previous 1 month and 12 months and about the ability to attend work, undertake work duties and perform functional tasks. RESULTS: Among nurses, the low back was the site with the highest cumulative incidence and highest prevalence of persistent/recurrent, work-disabling and functional-task-disabling pain. Work-disabling LBP was more prevalent among nurses and postal workers than office workers (P < 0.001). Nurses had a substantial prevalence of work-disabling shoulder pain (10%) and functional-task-disabling knee (19%) and wrist/hand pain (16%). With the exception of the elbow, each occupational group had a high prevalence of persistent/recurrent MSDs at all anatomical sites. CONCLUSIONS: LBP continues to have a substantial impact among nurses. Other less commonly considered MSDs, such as shoulder, wrist/hand and knee pain, also made work or functional tasks difficult, suggesting that primary and secondary prevention efforts should consider MSDs at other anatomical sites as well as the low back.