Occupational Medicine Advance Access originally published online on June 4, 2007
Occupational Medicine 2007 57(5):380-382; doi:10.1093/occmed/kqm028
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Short Reports |
Factors associated with self-assessed work ability
1 Centre of Expertise for Health and Work Ability, Finnish Institute of Occupational Health, Topeliuksenkatu 41 a A, FI-00250 Helsinki, Finland
2 Mehiläinen Occupational Health, Pohj. Hesperiankatu 17 C, FI-00260 Helsinki, Finland
3 Centre of Expertise for Good Practices and Competence, Finnish Institute of Occupational Health, Topeliuksenkatu 41 a A, FI-00250 Helsinki, Finland
Correspondence to: Kari-Pekka Martimo, Centre of Expertise for Health and Work Ability, Finnish Institute of Occupational Health, Topeliuksenkatu 41 a A, FI-00250 Helsinki, Finland. Tel: +358 50 566 5797; fax: +358 30 474 2008; e-mail: kari-pekka.martimo{at}ttl.fi
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Abstract |
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Background Symptoms and health problems caused or aggravated by work are common. In order to study perceived work ability and associated factors, including those related to work, a closer analysis was undertaken in an occupational health setting.
Aims This study aimed to analyse self-assessed work ability and its determinants in employees seeking medical advice, with special emphasis on work-related factors.
Methods During 723 illness-related visits to occupational physicians, questionnaires covering personal data, main health problems, their work relatedness, duration and effect on work ability were completed by the employee and physician. Factors associated with self-assessed work ability were studied in a multinomial logistic regression model.
Results The majority of employees considered themselves as being able or partially able to work despite the health problem. Independent predictors of impaired work ability were mental or musculoskeletal disorders, self-assessed work relatedness of the disease, older age, blue-collar work and short duration of the symptoms. If the patient was convinced about the benefits of work-related interventions, the risk for disability was significantly reduced.
Conclusions Special attention should be paid to the recognition and modification of potential work-related causes of disability. In addition, patients with partial work ability should be encouraged to stay at work instead of taking sick leave. For effective disability management, accommodated work and other evidence-based interventions are needed at the workplace.
Keywords Case management; disability evaluation; mental disorders; musculoskeletal diseases; occupational health services; work-related disease
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Introduction |
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Identification and prevention of work-related health problems are key in preventing long-term disability. In a Finnish survey [1], one-third of 2335 interviewed employees reported that they had experienced work-related physical or mental symptoms during the last 6 months. A systematic review [2] showed that potentially work-related diseases are common in general practice.
In Finnish primary health care, illness-related visits to occupational physicians account for more than half of all medical consultations of employed people [1]. Therefore, a closer analysis of diseases, their relation to work and associated work ability was undertaken in an occupational health setting. The aim of this study was to determine the relationship between self-assessed work ability and the variables related to the individual, the work and the disease.
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Methods |
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In May and June 1995, patients attending a medical consultation at two occupational health centres, one in the chemical industry and the other in the public sector, were given an anonymous questionnaire before meeting the physician. Age, gender and occupation were collected together with the response to an open-ended question on the nature and duration of the main disease or symptom that necessitated the consultation. Only the first consultation of each patient during the study period was included.
Patients assessed the work relatedness of the health problem (caused or aggravated by work), and if it could be alleviated by work-related interventions. We considered patients able to make truthful self-assessments on work ability, because in Finland short-term disability does not cause employees any financial loss. Patients were informed that the questionnaires would not be seen by their physicians, who were asked to answer the same questions immediately after the consultation.
Factors associated with self-assessed work ability were studied in a multinomial logistic regression model (SPSS® Programme, version 12.0.1). The outcome variable was work ability in three levels (able, partially able and unable). The explanatory variables were gender, age group, occupational status, occupational health centre, duration of symptoms, disease group, work relatedness of disease and potential of work-related interventions.
The study protocol was approved by the Ethical Committee of the Finnish Institute of Occupational Health.
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Results |
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Altogether, 971 consecutive patients were enrolled by 12 physicians. Questionnaires completed by both the patient and the physician were available for 950 visits (98%). Statistical analyses were focused on 723 (76%) visits, where the reason for the consultation given by the patient and the diagnosis made by the physician belonged to the same major disease group.
Musculoskeletal disorder (39%) was the most common reason for the visit, followed by respiratory (17%), cardiovascular (11%), dermatological (9%), mental (7%) and ‘other’ disorders (16%). In most cases, the duration of the symptoms was longer than 6 months. However, in the case of respiratory symptoms, these had lasted for <2 weeks in half of the cases.
Sixty-three per cent of the patients reported to be able to work despite the health problem (Table 1). Partial work ability was reported by 22% and full disability by 11% of the patients. Fifty-three per cent of those with mental disorders and 44% of those with musculoskeletal disorders reported full or partial disability.
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Mental (85%) and musculoskeletal disorders (74%) were most often regarded as at least possibly work related, whereas respiratory (51%) and skin disorders (66%) were mostly ‘not work related’. Half of the patients with cardiovascular disease reported that work relatedness was possible. Work-related interventions were considered as beneficial in one-third of the cases, most frequently when the reason for the visit was mental (56%) or musculoskeletal disorder (39%).
In the multinomial logistic regression model (Table 2), gender had no effect on self-assessed work ability. Older age increased the risk of disability markedly. Blue-collar employees ran a higher risk of both partial and full disability compared to upper white-collar employees. A short duration of the symptoms increased the likelihood of both partial and full disability to work.
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The risk of partial work ability was increased for respiratory diseases. Musculoskeletal disorders increased the risks of both partial and full disability. The highest risk of full disability was observed for mental disorders. Self-assessed work relatedness of the disease increased the risk of both partial and full disability to work, whereas the risk of full disability was significantly reduced, if the patient considered work-related interventions as beneficial.
The occupational health centre had a statistically significant effect on disability, but eliminating this variable from the model did not affect the risk estimates of the other variables.
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Discussion |
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The majority of patients seeking medical advice considered themselves as able to work. Among patients with impaired work ability, partial work ability was reported twice as often as full disability. Overall 11% of patients considered themselves not being able to work, but in those with mental problems 23% reported full disability. Mental and musculoskeletal disorders were significant predictors of full disability.
Mental and musculoskeletal disorders were also associated with work-related factors more often than the other diseases. This reflects earlier work [1], where the prevalence of work-related symptoms has stayed at the same level since 1997. The patient's competence to assess work relatedness could be questioned but it merits attention because, in this study, the patient's perception of work relatedness had an independent effect on perceived work ability.
Short duration of symptoms as a risk factor for disability is understandable. With disabling acute diseases, full disability is more likely than with a more chronic disease where the individual has had more time to adjust. Anticipated improvement in work ability from work-related interventions reduced the risk of disability. This may be related to motivational factors, but also to the level of adjustment latitude at work providing the opportunity to continue working despite illness [3]. Different workplaces, professions and work cultures may explain why, in this study, employees visiting one occupational health centre were more likely to consider themselves as unable to work compared to those visiting the other centre.
This study has shown that, as part of disability management, special attention should be paid to the recognition of potential work-related disability. This study showed also that the existence of potential adjustments to work may increase the perceived work ability. Earlier evidence underpinning the use of accommodated work as a means to reduce sickness absenteeism [4] is supported by the patient assessments in this study.
Key points
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None declared.
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References |
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- Kauppinen T, Hanhela R, Heikkilä P, et al, eds. Työ ja terveys Suomessa 2003 (Work and Health in Finland in 2003) (2004) Helsinki, Finland: Finnish Institute of Occupational Health. [in Finnish with English summary].
- Weevers HJA, van der Beek A, Anema JR, et al. Work-related disease in general practice: a systematic review. Fam Pract (2005) 22:197–204.
[Abstract/Free Full Text] - Hansson M, Boström C, Harms-Ringdahl K. Sickness absence and sickness attendance—what people with neck or back pain think. Soc Sci Med (2006) 62:2183–2195.[CrossRef][Web of Science][Medline]
- Franche R-L, Cullen K, Clarke J, et al. Workplace-based return-to-work interventions: a systematic review of the quantitative literature. J Occup Rehabil (2005) 15:607–631.[CrossRef][Web of Science][Medline]
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