Predictors of Successful Return to Work In a Cohort of Workers Undergoing Carpal Tunnel Release Surgery

1. Predictors of Successful Return to Work In a Cohort of Workers Undergoing Carpal Tunnel Release Surgery Benjamin C. Amick, Ph.D.1 Rochelle H. Habeck2 Janet Ossmann, Ph.D. 1 Holly Fossel 3 Jeffrey N. Katz, M.D., M.S. 3 1. University of Texas School of Public Health 2. W.E. Upjohn Research Institute 3. Brigham & Women’s Hospital Paper Presented at the Workers’ Compensation Research Group Meeting October 25-26, 2002, Cambridge, MA

2. Research Collaborators • Maine Medical Assessment Foundation • Robert Keller, Ellen Schneiter • Maine Health Information Center • Cynthia Barrata, Alice Chapin, Nancy Mooney W.E. Upjohn Institute • H. Allan Hunt Institute for Work and Health • Harry Shannon

3. Labor Markets and Health Framework Global Economy Society Social Context Labor market context Social Actors Employers Labor Market Intermediaries Communities & Community- Based Organization Trade Unions Business Associations Government SocialHierarchy Illness & Injury Producing Mechanisms (Labor Market Experiences) Health Status Amick and Lavis, 2000

4. Background • The fact of return to work may not be the most appropriate outcome • Research focuses on a small conceptual set of predictors • Multidimensional RTW research is confounded by tremendous medical treatment variability • Most research does not consider timing of predictors • No research has considered the role of the organization per se

5. Successful Return To Work Process Heuristic Model Economic, Legal Environment Demographic, Psychosocial Conditions And Clinical Status EARLY LATE Family Environment Job and Organizational Conditions

6. We Hypothesize • Clinical, worker and economic/legal factors will predict successful return to work at 2 months following carpal tunnel surgery • The employment situation (job and organizational conditions) will be important at 6 and 12 months post surgery

7. Defining the Sample • Sample: 197 workers at baseline with CTS undergoing carpal tunnel release and 181 completed at least 1 follow-up • Recruited in MD offices throughout Maine • Working at time developed CTS • CTS documented with nerve conduction • Homogeneous treatment

8. Defining the Sample • Exclusions • No follow-up information • No information on 6 month outcome • No baseline work role functioning • 128 patients at 2 month follow-up and 122 at 6 months

9. Defining Successful Return to Work The ability worker to meet work demands given their current physical and emotional health status Poor success translates into lost productivity for the business and increased job insecurity for the worker

10. Defining Successful Return to Work • 15 –item work role functioning assessed at baseline, 2 and 6 months • In general skewed towards better functioning

11. Defining Successful Return to Work • Problem of not back at work • Definitely not successful work role functioning • But many reasons for a person to not be back at work • Create three-level outcome • 0, not yet back at work and not working because of health • 1, back at work but not functioning well (<90 score on WRF) • 2, back at work and functioning well (>= 90 on WRF) • Note >= 90 is a useful norm for healthy WRF

12. Statistical Approach • Ordered logit regression in STATA 7.0 with predictor variables assessed at baseline for 2 month outcomes and baseline and two months for six month outcomes • Model building following Hosmer and Lemeshow, Applied Logistic Regression • Non-Proportionality of odds assessed using the Brandt test • Model fit described with McKelvey and Zavonia’s R2 • Baseline predictors always included when change variable assessed

13. Two Month Results

14. Six Month Results

15. Successful Return To Work Process To Summarize… Improved Self Efficacy Supportive Organization Pre-Surgical Work Role Functioning EARLY 2 Mos. LATE 6 Mos. Baseline Depression WC Claimant

16. Conclusions • This work highlights the importance of: • Using multidimensional models in examining the return to work process • Using multiple time points following injury or medical intervention • Using successful work role functioning measure

17. Suggestive Interventions Results suggest interventions targeting improved individual and organizational agency • Improving worker self-efficacy • Self-efficacy is confidence the worker has in his or her ability to effectively manage pain and health in return to work process • Developing highly supportive organizational policies and practices • People-Oriented Culture • Safety Climate (Active Safety Leadership, Safety Training and Safety Diligence) • Ergonomics Policies and Practice • Disability Management

18. Future Study Larger, more diverse samples needed to elaborate multidimensional model and timing of predictors. Should we begin interventions? Should we worry about job satisfaction or satisfaction with medical care? Multi-level studies where organizational context more accurately specified are needed to identify OPPs amenable to intervention

19. Thank Youwww.benamick.com Research Support Provided By: NIOSH R01-O503523-01A1 The Robert Wood Johnson Foundation Workers’ Compensation Research Initiative #038151 The Arthritis Foundation NIAMS #AR36308