Thesis: "Women on sick leave for long-term musculoskeletal pain: Factors associated with work ability, well-being and return to work", Mamunur Rashid

[Anna H]

Abstract [en]
Background: Taking sick leave (SL) for long-term musculoskeletal pain (MSP), predominantly in the neck, shoulders and back, is common among women in Sweden. Long-term MSP affects their daily life and causes impaired work ability and long-term SL. Therefore, it is necessary to work from a multidimensional perspective to generate knowledge about factors that may obstruct or promote work ability and well-being in the return-to-work (RTW) process among women on SL for MSP. The aim of the thesis was to identify factors of importance for work ability, well-being and RTW among women on SL for long-term neck/shoulder and/or back pain.

Methods: Study I is a narrative systematic review. An extensive systematic search was performed through the databases Medline, CINAHL and PsycINFO, from their inception until February 2016. The inclusion criteria for the articles were: study population of men and women aged 18-65 years, work absence ≥ 2 weeks, and neck/shoulder or back pain. The outcome variable was RTW. An additional search through reference lists and citations of the included articles was performed in Scopus. A total of 10 studies were selected for the methodological quality assessment and synthesis of the results. Data were synthesized through analysis of the content according to similarities of factors. For Study II-IV, a postal survey was sent to 600 women in central and northern Sweden who were receiving time-loss benefits during the spring of 2016. The inclusion criteria were women aged 18-65 years, ≥ 50% SL from service, SL ≥ 1 month due to neck/shoulder and/or back pain (≥ 3 months), and understanding the Swedish language. The exclusion criteria were rheumatoid arthritis, multiple sclerosis, stroke, cancer, Parkinson, bipolar disease, schizophrenia, and pregnancy. A follow-up survey was sent out in spring 2017 to the 208 women who answered the survey at baseline; 141 responded. Study II was cross-sectional; a multiple linear regression was conducted to determine the association between the factors and work ability and well-being, respectively. Study III had a prospective design with a 1-year follow-up. A multiple logistic regression was conducted to determine whether work ability and well-being predicted RTW. To assess the discriminative ability of the Work Ability Index (WAI) and Life Satisfaction questionnaire (LiSat-11) regarding women who did RTW and those who did not RTW (NRTW), Receiver Operating Characteristic (ROC) curves were used. Study IV also had a prospective design with a 1-year follow-up. Cluster analysis was performed to identify potential predictors, and a multiple logistic regression model was used to identify significant predictors of RTW.

Results: Study I suggested that recovery beliefs, health-related factors and work capacity may be important areas to target in interventions for women and men with long-term neck or back pain. The review also showed that there is a lack of high-quality studies. Study II showed that believing one would return to the same work within 6 months, pain intensity and job strain were associated with work ability among women on SL for long-term neck/shoulder and/or back pain. Self-efficacy and depression were associated with well-being. The findings from Study III indicated that work ability was important for RTW in this group of women. The WAI adequately discriminated between RTW and NRTW. The LiSat-11 did not predict RTW or discriminate between RTW and NRTW. The results from Study IV indicated that coping through increasing behavioral activities, believing one would return to the same work within 6 months, and social support outside work predicted RTW in this group of women.

Conclusions: The results from the empirical studies on women only were partly in agreement with results found in the narrative systematic review on men and women. In light of this, future studies may benefit from investigating prognostic factors for RTW among men and women separately. Factors that emerged in the empirical studies would need to be tested in a weighted model to identify whether any of them mediate or moderate the outcome variable RTW.

http://www.diva-portal.org/smash/record.jsf?fbclid=IwAR3FKACSMcqW7C1yRfdrJXZeQDzrO4Vnmn7ryTKaLag-JCH-GHDw8PqbYXc&pid=diva2:1370212&dswid=-8061

Fulltext:
http://www.diva-portal.org/smash/get/diva2:1370212/FULLTEXT01.pdf

Press release :
"Tron på sig själv är vägen tillbaka till arbete?"
("Belief in oneself is the way back to work?")
https://expertsvar.se/pressmeddelan...gFvXotohIIFse4EOAwA743MQ4MmM6plLq8-ujCEhO0Hvg

Google translation :

"By believing in their ability to work, despite back and neck problems, women find different ways to manage their pain, says Mamunur Rashid, a researcher at Gävle University.

Across the entire western world, especially in Sweden, researchers see that women are over-represented when it comes to sick leave for neck, shoulder and back pain, but the knowledge of why some are able to return to work is limited.

Mamunur Rashid has for a long time followed over 200 women, who are on sick leave for this reason, to find out what factors favor a return to work and what factors don't.

Belief in oneself is most important

Belief in itself is the strongest factor researchers have found to predict a change in behavior and return to work.

- If I believe in being able to return to work, it also means that I develop strategies to deal with my pain and this is by far the most important thing we have found, says Mamunur Rashid.

The pain must be managed

He states that pain patients must learn how to manage their pain and that the strategies they use to deal with their problems are very important.

The researchers saw that by changing their behavior and having regular activities, patients could reduce their stress. By becoming more active, the focus was also shifted from the pain.

- If someone has good strategies for dealing with their pain, we can see that it means an immediate return to work.


Work ability and well-being are not the same thing

In the group studied, work ability and well-being were not the same. Although a person said she felt good, she could not return to work. While someone else, despite poor wellbeing, could still return to work.

The researchers were surprised that social support and well-being outside work, from family, friends or from society, played no role, or even was negative, in getting back to work.

- Too much support will increase the fear of returning to work. We also see that these patients try to avoid activities that can provide strength to deal with their situation, which affects the crucial belief in being able to return to work, ”says Mamunur Rashid.

Work-oriented rehabilitation

This is research that can be used directly at the rehabilitation center and by the medical profession, says Mamunur, and he calls for a therapy, such as cognitive behavioral therapy, that focuses on activities that increase management strategy and develops the belief of being able to return to work.

- It has to be realistic, they have to think about their job and how to handle it. They can not affect the pain, but are helped by a belief that the pain is manageable, says Mamunur Rashid.

Conclusions from the study:

- Strong belief in coming back means returning to work
- Good strategies for managing their illness means a return to work
- Work ability and well-being are not the same thing"

 

[Esther12]

That press release doesn't seem particularly careful. So there's an association... seemingly that's now enough to prove causation?

Those with cancer who believe they're more likely to survive are more likely to survive. That association had been presented as evidence that positive beliefs about recovery improve life-span, but now seems to be widely acknowledged to just reflect the fact that those with a better prognosis tend to believe they have a better prognosis. Could a similar error be occurring here?

 

[Sean]

Belief in itself is the strongest factor researchers have found to predict a change in behavior and return to work.

Predict in this context does not mean causal.

 

[Hutan]

The researchers were surprised that social support and well-being outside work, from family, friends or from society, played no role, or even was negative, in getting back to work.
Too much support will increase the fear of returning to work.

You have to wonder if these people ever really listen to the stuff they say.

So the woman with debilitating back pain and a loving husband whose salary is enough to support them both might choose not to work. And the woman with debilitating back pain but without that support might drag herself off to work.

There's no need to add the idea of 'fear of work' to an hypothesis about support and work participation. Let's just withdraw all family, friends and societal support - starvation and not being able to pay for rent and power are excellent motivators to return to work.

 

[Milo]

Why are women targeted in this instance of musculoskeletal pain? Are men treated differently, is it that their pain more legitimate compared with women?

it seems like an invitation to stigmatize and treat women’s pain differently, through psychology rather than physical injury.

 

[Trish]

Surely it also depends what type of work they do. If someone knows that their regular job involves activity that exacerbates their pain, then they will realistically be less likely to think they will be able to return to work.
And how do they measure the severity of the pain.

Someone with severe long term pain is also likely to be realistic and say they are unlikely to be able to return to work.

I've only read the abstract, but it seems to want to interpret everything people do as driven by their positive or negative thoughts, rather than realistic recognition of what they can do. It's so judgemental.

 

[Hutan]

There was a survey of 600 Swedish women on sick leave for musculoskeletal pain which produced 208 usable responses at baseline (there was a followup survey with just 141 respondents). There were 8 survey tools with a large number of questions covering things like pain intensity, ratings of social support, self efficacy, sense of coherence, coping strategies (divert attention, ignore), job strain and support at work, anxiety and depression, work ability and well-being. There were also background questions:

The background questions included in the questionnaire covered age, country of birth, cohabitation, education, years in the workforce, economic situation, life-long pain duration, pain area, physical activity, type of work, and beliefs about returning to the same work within 6 months.

Amazingly, given the aim of identifying what factors influence return to work, there were no questions asking how many hours of unpaid work women were doing, about how many children the woman was caring for or the ages of the children, or whether the women had responsibility for caring for elderly parents. I think the issue about children is a particular gap because giving birth is a major cause of persistent lower back pain, and having multiple pregnancies increases that risk.

It was found that self-ratings of ability to do work (Work Ability Index) predicted return to work (RTW) after a year. And the Work Ability Index was related to pain intensity, job strain and beliefs about the likelihood of return to the same work in the next 6 months. Which is all very predictable.

This thesis is thoroughly infected with BPS.

The biopsychosocial model integrates three dimensions of the health and ill- ness continuum: biological, psychological and social [63]. In this thesis, most of the studied factors belong to the psychological dimension. However, the results indicate that psychological and social dimensions interplay in the RTW process.

In Study IV, social support outside work (social dimension) and beliefs about returning to the same work within 6 months as well as behavioral activities (psychological dimension) were associated with RTW, though in different directions. It could mean that despite believing in your ability to RTW, and using active coping strategies, you may not RTW because you are receiving too much support from family and friends. This could lead to inactivity and low self-esteem.

There was very little discussion about how the type of work was influencing decisions to return to work. Musculoskeletal pain while being employed in elderly care, childcare, cleaning or being a nurse sounds particularly difficult.

More than two-thirds of women (70%) had blue-collar work, i.e. employees at elderly care, childcare and cleaning, whereas 30% were white collar workers, i.e. employed in office administration or as nurses and teachers.

In Sweden, among all SL<sick leave>, the proportion of women on SL due to <musculoskeletal pain> was about 12% compared to 7% among men for 2018.

Further, studies have shown that individual factors such as older age, being female and having a reduced internal ability to cope with pain increase susceptibility to emerging <musculoskeletal pain>

A qualitative study among middle-age women who had been on <sick leave> for musculoskeletal pain> revealed that most women viewed <sick leave> as positive in the beginning and took it as an opportunity to rest and deal with their health. In the long-term, however, <sick leave> generated new problems related to inactivity and isolation, which in turn resulted in physical impairment that included <musculoskeletal pain> [11]. In this way, individuals may come to assume a negative sick role.

I haven't spent a lot of time looking at this study, so it's possible I'm not being completely fair. But my conclusion is that that there is the vague circular thinking coloured by prejudices that we see in every paper with a BPS view of the world. It doesn't produce anything useful - it is victim-blaming and leads only to recommendations for programs to fix the way people think. If this PhD student had instead asked the women that were surveyed what they thought had caused their pain, what was stopping them returning to work and what would help them return to some kind of work, the study might have come up with some useful ideas to improve things.

There are so many good questions that could be answered around this topic - Why do women in Sweden seem to have higher rates of musculoskeletal pain than men? What can be done during pregnancy and the birth process to minimise back damage and bone density loss? What is it about some types of work (including unpaid work in the home) that results in injury and what can be done to reduce that injury? Are women suffering greater injuries in work and in accidents because the built environment (the cars; commercial vacuum cleaners and so on) isn't well designed for the typical female body? How can treatment of musculoskeletal pain be improved? Do we have to acknowledge that years of some types of work do wear a human body out and so society should not expect that a person will keep doing that kind of work until they are suffering significant pain?

But instead we now have another person with the authority of a doctorate going out into the world seemingly convinced that if only women (and presumably men too) could be made to think differently and develop a bit of moral fibre, they would be back at work in no time at all, smiling through the pain.

And one quick bit of pedantry to finish on:

Women were excluded from the study if they had been diagnosed with rheumatoid arthritis,
multiple sclerosis, stroke, cancer, Parkinson, bipolar disease, schizophrenia or pregnancy. These diseases and disorders were chosen as exclusion criteria, as individuals suffering from them may have a different RTW process.

Pregnancy - a disease or disorder?

 

[Milo]

Well done @Hutan. Women are in general responsible for caring for their children, elderly parents, the household, and then they have a job. If you get injured or take a sickness leave from work, these days, you get forced into a return to work program. Then you return home and you still have to care for said children,elderly, household.

 

[alktipping]

does any body think it strange that abysmal papers like this grossly devalues higher education since they seem to throw out parrot fashion rehashed Victorian chauvinist ideology and the usual condescending attitude to suffering of others .

 

[Sean]

If this PhD student had instead asked the women that were surveyed what they thought had caused their pain, what was stopping them returning to work and what would help them return to some kind of work, the study might have come up with some useful ideas to improve things.

Listening to female patients will only lead to them doing the tango after sunset, and the end of civilisation.

 

[Invisible Woman]

It could mean that despite believing in your ability to RTW, and using active coping strategies, you may not RTW because you are receiving too much support from family and friends. This could lead to inactivity and low self-esteem.

Right. Just have a little think about that PhD person....

Without family and social support how will many women who, as @Hutan points out, have responsibility for children or elderly relatives return to work if/when this support is withdrawn?

I would like to ask the author - who did all the cooking, shopping, cleaning and making sure you got to school on time in your household? Dobby, the house elf?

Who does it in your household today and how many dependents do you have? If you can afford to pay for it, bear in mind many can't so add up all those hours.

Edit - spelling

 

[Snow Leopard]

Pregnancy - a disease or disorder?