Publications by authors named "Amanda E Young"

31 Publications

Beyond symptom resolution: insurance case manager's perspective on predicting recovery after motor vehicle crash.

Disabil Rehabil 2021 Feb 1;43(4):498-506. Epub 2019 Aug 1.

John Walsh Centre for Rehabilitation Research, Kolling Institute, University of Sydney, St Leonards, Australia.

Purpose: Insurance company case managers can play a critical role in the rehabilitation process of people with musculoskeletal disorders sustained following minor motor vehicle crash injury due to their interaction with multiple stakeholders and their role in approving various services. This study aimed to identify factors that case managers perceive as predictive of recovery in people with musculoskeletal disorders after minor motor vehicle crash injury.

Materials And Methods: To explore the perspectives of cases managers in Australia and the United States, semi-structured interviews explored factors that case managers thought provided an early indication of likely recovery outcomes in people with musculoskeletal disorders after minor motor vehicle crash injury. A framework analysis was applied and factors were displayed within the ICF-framework.

Results: Case managers ( = 40) demonstrated a broad, detailed understanding of biopsychosocial and contextual issues influencing recovery. They emphasized the importance of the injured worker's expressed affect and motivation, style of communication, the role of lawyers, the worker's family and friends, as well as cultural and geographic influences. The overarching themes perceived as having a major influence on recovery outcomes were general health, pain processing and response, work situation, and compensation entitlement.

Conclusions: Case managers' broad and detailed perceptions about recovery may provide additional, valuable perspectives for professionals involved in the rehabilitation process of people with musculoskeletal disorders after minor motor vehicle crash injury. Further research needs to be conducted to explore the effects of case manager involvement in the process of recovery.Implications for rehabilitationInsurance Case Managers identified multiple factors including affect and motivation, style of communication, the role of lawyers, family and friends, cultural and geographic variation provide opportunities for more effective treatment of people with musculoskeletal disorders related to minor motor vehicle collisions. These managers' perceptions about recovery may be informative to and provide opportunities for health professionals involved in the rehabilitation of people with musculoskeletal disorders related to minor motor vehicle collisions.While the Insurance Case Managers involved in this research did not use formalized assessment techniques, tools and assessment protocols could be developed jointly between for the needs of Insurance Case Managers and other stakeholders to tackle recovery of people with musculoskeletal disorders related to minor motor vehicle collision.
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http://dx.doi.org/10.1080/09638288.2019.1630857DOI Listing
February 2021

Workplace Outcomes in Work-Disability Prevention Research: A Review with Recommendations for Future Research.

J Occup Rehabil 2016 12;26(4):434-447

Center for Health and Medical Psychology, Örebro University, Örebro, Sweden.

Introduction Outcome assessment is a central issue in work disability prevention research. The goal of this paper was to (1) ascertain the most salient workplace outcomes; (2) evaluate the congruence between business and science perspectives; (3) illustrate new perspectives on assessing longitudinal outcomes; and (4) provide recommendations for advancing outcome evaluation in this area of research. Methods The authors participated in a year-long collaboration that culminated in a sponsored 3-day conference, "Improving Research of Employer Practices to Prevent Disability", held October 14-16, 2015, in Hopkinton, MA, USA. The collaboration included a topical review of the literature, group conference calls to identify key areas and challenges, drafting of initial documents, review of industry publications, and a conference presentation that included feedback from peer researchers and a question/answer session with a special panel of knowledge experts with direct employer experience. Results Numerous workplace work-disability prevention outcome measures were identified. Analysis indicated that their applicability varied depending on the type of work disability the worker was experiencing. For those who were working, but with health-related work limitations (Type 1), predominant outcomes were measures of productivity, presenteeism, and work-related limitations. For those who were off work due to a health condition (Type 2), predominant outcomes were measures of time off work, supervisor/employee interactions, and return-to-work (RTW) preparation. For those who had returned to work (Type 3), predominant outcomes were measures of presenteeism, time until RTW, percentage of work resumption, employment characteristics, stigma, work engagement, co-worker interactions, and sustained or durable RTW. For those who had withdrawn from the labor force (Type 4), predominant outcomes were cost and vocational status. Discussion Currently available measures provide a good basis to use more consistent outcomes in disability prevention in the future. The research area would also benefit from more involvement of employers as stakeholders, and multilevel conceptualizations of disability outcomes.
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http://dx.doi.org/10.1007/s10926-016-9675-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5104762PMC
December 2016

Work-Related Factors Considered by Sickness-Absent Employees When Estimating Timeframes for Returning to Work.

PLoS One 2016 5;11(10):e0163674. Epub 2016 Oct 5.

Center for Disability Research, Liberty Mutual Research Institute for Safety, Hopkinton, Massachusetts, United States of America.

Introduction: Work-related factors have been found to be influential in shaping a number of return-to-work outcomes including return-to-work expectations. Based on the idea that work-related factors have the potential for modification through workplace-based initiatives, this study involved a detailed examination of work-related factors referenced by workers as being taken into consideration when estimating timeframes for returning to work.

Methods: Focus groups were conducted with 30 employees, currently off work (≤ 3 months) due to a musculoskeletal condition. During the focus groups, participants wrote and spoke about the factors that they considered when forming their expectations for returning to work. Data were subjected to thematic content analysis.

Results: Discussions revealed that participants' considerations tended to differ depending on whether or not they had a job to return to. Those with jobs (n = 23) referenced specific influences such as working relationships, accommodations, physical and practical limitations, as well as concerns about their ability to do their job. Those without a job to return to (n = 7) talked about the ways they would go about finding work, and how long they thought this would take. Both groups mentioned the influence of wanting to find the "right" job, retraining and being limited due to the need for income.

Conclusion: Findings indicate that employees reference numerous work-related factors when estimating their timeframes for returning to work, and that many of these have been previously identified as relating to other return-to-work outcomes. Findings suggest the potential to improve return-to-work expectation through addressing work-related influences, and helping people work through the tasks they need to complete in order to move forward in the return-to-work process.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0163674PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5051700PMC
June 2017

The Relationship Between Work-Disability Duration and Claimant's Expected Time to Return to Work as Recorded by Workers' Compensation Claims Managers.

J Occup Rehabil 2017 06;27(2):284-295

Center for Disability Research, Liberty Mutual Research Institute for Safety, 71 Frankland Road, Hopkinton, MA, 01748, USA.

Purpose This research sought to determine whether there is a relationship between claimants' expected time to return to work (RTW) as recorded by claims managers and compensated days of work disability. Methods We utilized workers' compensation data from a large, United States-based insurance company. RTW expectations were collected within 30 days of the claim being reported and these were compared with the termination of total temporary indemnity payments. Bivariate and hierarchical regression analyses were conducted. Results A significant relationship between expected time to RTW and compensated disability duration was observed. The unadjusted correlation between work-disability duration and expected time to RTW was .25 (p < .001). Our multivariate model explained 29.8 % of the variance, with expected time to RTW explaining an additional 9.5 % of the variance in work-disability duration beyond what was explained by the covariates. Conclusion The current study's findings support the hypothesis that claimant RTW estimates as recorded by claims managers are significantly related to compensated-disability duration, and the relationship is maintained after controlling for variance that can be explained by other variables available within workers' compensation databases.
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http://dx.doi.org/10.1007/s10926-016-9656-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5405108PMC
June 2017

Relationship Between Age, Tenure, and Disability Duration in Persons With Compensated Work-Related Conditions.

J Occup Environ Med 2016 Feb;58(2):140-7

Liberty Mutual Research Institute for Safety (Dr Besen, Dr Young, Dr Pransky), Center for Disability Research, Hopkinton, MA; Department of Gerontology (Ms Gaines), University of Massachusetts Boston.

Objective: The aim of the study was to examine the relationships among age, tenure, and the length of disability following a work-related injury/illness.

Methods: This study utilized 361,754 administrative workers' compensation claims. The relationships between age, tenure, and disability duration was estimated with random-effects models.

Results: The age-disability duration relationship was stronger than the tenure-disability duration relationship. An interaction was observed between age and tenure. At younger ages, disability duration varied little based on tenure. In midlife, disability duration was greater for workers with lower tenure than for workers with higher tenure. At the oldest ages, disability duration increased as tenure increased.

Conclusions: Findings indicate that age is a more important factor in disability duration than tenure; however, the relationship between age and disability duration varies based on tenure, suggesting that both age and tenure are important influences in the work-disability process.
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http://dx.doi.org/10.1097/JOM.0000000000000623DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4730786PMC
February 2016

An Exploration of the Factors Considered When Forming Expectations for Returning to Work following Sickness Absence Due to a Musculoskeletal Condition.

PLoS One 2015 18;10(11):e0143330. Epub 2015 Nov 18.

Center for Disability Research, Liberty Mutual Research Institute for Safety, Hopkinton, Massachusetts, United States of America.

Introduction: Workers' own expectations for returning to work following a period of sickness absence have been found to be one of the best predictors of future work status; however, there is a limited understanding of why people expect what they do. The current study was undertaken with the aim of determining what people take into consideration when forming their expectations for returning to work.

Methods: Thirty-four people (8 women, 26 men), who were off work due to a musculoskeletal condition, participated in one of 14 focus groups. Participants were aged 25 to 65 (M = 45, SD = 12.6), and all had been out of work for 3 months or less.

Results: All participants reported expecting to return to work, with the most common timeframe being approximately 30 days (Range = 1 day-12 months). When explaining what they thought about when forming their expectations, participants referenced numerous considerations. Much of what was spoken about could be compartmentalized to reflect features of themselves, their condition, or their broader environmental contexts. Participant's subjective experience of these features influenced his or her expectations. Prominent themes included concerns about employability, a desire to get back to normal, no job to go back to, mixed emotions, re-injury concerns, the judgments of workplace stakeholders, being needed by their employer, waiting for input, until the money runs out, and working out what was in their best interest.

Conclusions: Indications are that many of the reported considerations are amenable to intervention, suggesting opportunities to assist workers in the process of returning to work.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0143330PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4651309PMC
June 2016

Single impacts of keV fullerene ions on free standing graphene: Emission of ions and electrons from confined volume.

J Chem Phys 2015 Oct;143(16):164302

Department of Chemistry, Texas A&M University, College Station, Texas 77843-3144, USA.

We present the first data from individual C60 impacting one to four layer graphene at 25 and 50 keV. Negative secondary ions and electrons emitted in transmission were recorded separately from each impact. The yields for C(n)(-) clusters are above 10% for n ≤ 4, they oscillate with electron affinities and decrease exponentially with n. The result can be explained with the aid of MD simulation as a post-collision process where sufficient vibrational energy is accumulated around the rim of the impact hole for sputtering of carbon clusters. The ionization probability can be estimated by comparing experimental yields of C(n)(-) with those of C(n)(0) from MD simulation, where it increases exponentially with n. The ionization probability can be approximated with ejecta from a thermally excited (3700 K) rim damped by cluster fragmentation and electron detachment. The experimental electron probability distributions are Poisson-like. On average, three electrons of thermal energies are emitted per impact. The thermal excitation model invoked for C(n)(-) emission can also explain the emission of electrons. The interaction of C60 with graphene is fundamentally different from impacts on 3D targets. A key characteristic is the high degree of ionization of the ejecta.
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http://dx.doi.org/10.1063/1.4933310DOI Listing
October 2015

Exploring the relationship between age and tenure with length of disability.

Am J Ind Med 2015 Sep 26;58(9):974-87. Epub 2015 May 26.

Center for Disability Research, Liberty Mutual Research Institute for Safety, Hopkinton, Massachusetts.

Background: The aging of the workforce, coupled with the changing nature of career tenure has raised questions about the impact of these trends on work disability. This study aimed to determine if age and tenure interact in relating to work disability duration.

Methods: Relationships were investigated using random effects models with 239,359 work disability claims occurring between 2008 and 2012.

Results: A 17-day difference in the predicted length of disability was observed from ages 25 to 65. Tenure moderated the relationship between age and length of disability. At younger ages, the length of disability decreased as tenure increased, but at older age, the length of disability increased as tenure increased.

Discussion: Results indicate that although there is a relationship between length of disability and tenure, age makes a greater unique contribution to explaining variance in length of disability. Future research is needed to better understand why specifically age shows a strong relationship with length of disability and why that relationship varies with age.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5032995PMC
http://dx.doi.org/10.1002/ajim.22481DOI Listing
September 2015

Hypervelocity nanoparticle impacts on free-standing graphene: a sui generis mode of sputtering.

J Chem Phys 2015 Jan;142(4):044308

Department of Chemistry, Texas A&M University, College Station, Texas 77843-3144, USA.

The study of the interaction of hypervelocity nano-particles with a 2D material and ultra-thin targets (single layer graphene, multi-layer graphene, and amorphous carbon foils) has been performed using mass selected gold nano-particles produced from a liquid metal ion source. During these impacts, a large number of atoms are ejected from the graphene, corresponding to a hole of ∼60 nm(2). Additionally, for the first time, secondary ions have been observed simultaneously in both the transmission and reflection direction (with respect to the path of the projectile) from a 2D target. The ejected area is much larger than that predicted by molecular dynamic simulations and a large ionization rate is observed. The mass distribution and characteristics of the emitted secondary ions are presented and offer an insight into the process to produce the large hole observed in the graphene.
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http://dx.doi.org/10.1063/1.4906343DOI Listing
January 2015

The importance, measurement and practical implications of worker's expectations for return to work.

Disabil Rehabil 2015 9;37(20):1808-16. Epub 2015 Jul 9.

a Liberty Mutual Research Institute for Safety, Center for Disability Research , Hopkinton , MA , USA.

Purpose: Workers' own expectations for return to work consistently predict work status. To advance the understanding of the relationship between RTW expectations and outcomes, we reviewed existing measures to determine those which we felt were the most likely to capture the construct.

Method: A comprehensive search of the work-disability rehabilitation literature was undertaken. The review of the measures was conducted in three steps: first, a review of terminology; second, an examination of whether a time reference was included; third, an evaluation of ease of comprehension, and applicability across contexts.

Results: A total of 42 different measures were identified. One of the most striking findings was the inconsistency in terminology. Measures were also limited by not including a time reference. Problems were also identified with regards to ease of understanding, utility of response options, and applicability in a wide variety of research and applied settings.

Conclusions: Most previously used measures contain elements that potentially limit utility. However, it would seem that further development can overcome these, resulting in a tool that provides risk prediction information, and an opportunity to start a conversation to help identify problems that might negatively impact a worker's movement through the RTW process and the outcomes achieved. Implications for Rehabilitation Return to work is an integral part of workplace injury management. The capture of RTW expectations affords a way to identify the potential for less than optimal RTW processes and outcomes. A mismatch between an injured worker's expectations and what other stakeholders might expect suggests that efforts could be made to determine what is causing the injured worker's concerns. Once underling issues are identified, work can be put into resolving these so that the worker's return to the workplace is not impeded.
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http://dx.doi.org/10.3109/09638288.2014.979299DOI Listing
May 2016

Returning to work following low back pain: towards a model of individual psychosocial factors.

J Occup Rehabil 2015 Mar;25(1):25-37

Liberty Mutual Research Institute for Safety, Hopkinton, MA, USA,

Purpose: The aim of this paper is to develop and test a model of direct and indirect relationships among individual psychosocial predictors of return-to-work (RTW) outcomes following the onset of low back pain (LBP).

Methods: We utilize secondary analysis of a larger study of adults seeking treatment for work-related LBP with recent onset. In total, 241 participants who completed a baseline survey, a short follow-up survey, and a longer follow-up survey after 3 months were included in our analyses. The participants were required to have LBP with onset of less than 14 days, be 18 years or older, and be fluent in English or Spanish. The analyses utilized structural equation models to test the direct and indirect relationships among the variables and RTW outcomes at 3 months.

Results: Our results indicated a good fit for our model (χ2 = 69.59, df = 45, p < .05; RMSEA = .05; CFI = .95; WRMR = .61). Pain, catastrophizing, fear-avoidance beliefs, organizational support, and RTW confidence were all found to have indirect relationships with the outcomes. RTW confidence and RTW expectations were found to have direct relationships with the outcomes.

Conclusions: The process of returning to work after an episode of LBP is a complex process involving many interrelated factors. Understanding the relationships among critical individual factors in the RTW process may be important for the treatment and rehabilitation of those with LBP. Results suggest that if injured workers are struggling with fear avoidance, pain catastrophizing and confidence issues, they might benefit from the application of cognitive behavioral therapy techniques.
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http://dx.doi.org/10.1007/s10926-014-9522-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4333236PMC
March 2015

Recurrence of work-related low back pain and disability: association between self-report and workers' compensation data.

Spine (Phila Pa 1976) 2013 Dec;38(26):2279-86

*Center for Disability Research, Liberty Mutual Research Institute for Safety, Hopkinton, MA †Evidera, London, United Kingdom; and ‡Department of Physical Therapy, University of Alberta, Edmonton, Canada.

Study Design: Retrospective cohort.

Objective: To explore the ability to capture low back pain (LBP) recurrence using wage-replacement (WR) data.

Summary Of Background Data: LBP can be a recurrent, fluctuating, and disabling condition. Because of its largely nonspecific and subjective nature, the condition poses challenges for research and clinical management, as speaking directly with the affected individuals is not always practical. Little information is available on how indicators of LBP recurrence that can be extracted from administrative databases relate to patients' self-report.

Methods: Participants with a compensated claim for work-related LBP (N = 90) were interviewed regarding their LBP-related experiences after their initial return to work. Interview data were compared with WR data, which was provided by the participants' workers' compensation provider.

Results: Concordance was observed between WR-based indicators and self-reports of additional time off due to LBP. The best performing WR-based indicator reflected a payment history that began with more than 7 consecutive days of initial WR payments, followed by a gap in WR payments of more than 7 consecutive days, followed by another WR payment period of more than 7 consecutive days (sensitivity = 55%, specificity = 73%, overall accuracy = 69%). Although concordance was observed between the 2 measures of additional time off, the best performing WR indicator was not related to participants' other self-reports of post-return-to-work LBP recurrence which included LBP being significantly worse usual; LBP experiences; seeking health care for LBP; and the experience of difficulties related to the back condition.

Conclusion: Results indicate that compensation data can be used to capture what a claimant would self-report as additional time off after their initial return to work due to their LBP condition. However, the use of self-report recurrence indicators is recommended if there is a desire to capture a fuller extent of workers' ongoing pain and/or disability experiences.

Level Of Evidence: N/A.
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http://dx.doi.org/10.1097/BRS.0000000000000016DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4047308PMC
December 2013

An exploration of alternative methods for assessing return-to-work success following occupational injury.

Authors:
Amanda E Young

Disabil Rehabil 2014 20;36(11):914-24. Epub 2013 Aug 20.

Liberty Mutual Research Institute for Safety, Center for Disability Research , Hopkinton, MA , USA.

Purpose: To explore alternative methods for assessing return-to-work success.

Method: This exploratory study employed a prospective design. Participants (N = 150) were all vocational rehabilitation recipients who sustained a work-related injury that resulted in them being off work for at least 6 months, and were unable to return to their pre-injury position. At baseline (B), all were reported to have found post-injury employment. Qualitative features of the participants' post-injury employment were assessed at the time of initial interview (T1), which was conducted a mean of approximately one year following the participants' scheduled workplace re-entry (mean 344 days). Participants' T1 employment characteristics were then compared to their outcomes at the time of follow-up (T2), which was approximately 3 months later (mean 85 days).

Results: Findings indicate that 25% of participants were not in their baseline jobs at the time of last contact; some were in different jobs, however others were not working. At T1 many of those working reported experiencing difficulties. Comparisons revealed significant relationships between problem indicators at T1 and employment outcomes at T2, with significant problem indicators including worries that symptoms might interfere with their ability to continue in the job, difficulties with the job's physical demands and a strong desire to leave their current job. When problem indicators were used in combination, stronger relationships were observed and self-assessed performance contributed to the effect.

Conclusions: Results add support to the contention that rather than a single event, RTW is an evolving, complex and sometimes nonlinear process. This should be kept in mind when assessing the success of an injured worker's RTW.
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http://dx.doi.org/10.3109/09638288.2013.824033DOI Listing
June 2015

What is return to work? An investigation into the quantification of return to work.

Int Arch Occup Environ Health 2011 Aug 15;84(6):675-82. Epub 2011 May 15.

Institute for Safety, Compensation and Recovery Research, Monash University, Melbourne, Australia.

Purpose: To describe and demonstrate issues with return to work (RTW) outcome metrics in common use among clinical researchers and injury compensation organisations. We also aim to describe a framework on which to capture relevant RTW information including current employment status and data on participation and maintenance.

Methods: Structured telephone interviews discussing participant health and vocational status were conducted following compensable transport-related injury. Participants who were working at the time of injury and took time off work because of their injuries (N = 414) were asked questions relating to their work participation and maintenance, including length of continuous employment, hours worked and duties performed before and after injury. A series of RTW metrics was developed and applied to survey data. Rates of RTW according to each metric were calculated.

Results: Eighty-four per cent of participants had achieved some employment since their injury, and 74% were working at the time of the survey. In contrast, only 58% of participants were working the same hours as prior to their injury and had been doing so for at least 3 months. These data show that different impressions of rehabilitative success can be obtained depending on the criterion used to define RTW suggesting that reliance on a single RTW index (e.g. 'are you currently working?') will not represent important characteristics of employment.

Conclusion: A multi-layered approach to measuring RTW that includes data on reasons for not working, length of continuous employment, hours and duties performed after injury provides greater insight into the vocational status of injured individuals compared to single metrics or outcomes that fail to capture key detail on motives and participation. This information can assist clinicians to more accurately monitor the progress of rehabilitation following injury and compensation schemes to more effectively monitor their performance.
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http://dx.doi.org/10.1007/s00420-011-0644-5DOI Listing
August 2011

Are we making progress?: the tenth international forum for primary care research on low back pain.

Spine (Phila Pa 1976) 2011 Sep;36(19):1608-14

Center for Disability Research, Liberty Mutual Research Institute for Safety, Hopkinton, MA 01748, USA.

Study Design: Synthesis and analysis of presentation and discussion highlights, with a focus on emerging trends and promising new directions in primary care research on low back pain (LBP).

Objective: To present a summary of findings, themes, and insights from the Tenth International Forum on Primary Care Research on Low Back Pain, a meeting of researchers designed to share the latest concepts, methods, and results of research on LBP diagnosis, treatment, and disability prevention.

Summary Of Background Data: Earlier Forum meetings have developed several common themes and general conclusions. These are contrasted with the presentations and discussions at the 10th International Forum.

Results: Major themes included concerns about the epidemic of chronic, disabling LBP, associated treatments, iatrogenesis, and the "LBP medical industrial complex"; the variability and complexity of outcomes and how their importance differed across patients in defining recovery and recurrence; the power of nonspecific effects, expectations, and therapeutic alliance; and the challenges of identifying important therapeutic subgroups. New research addressed early risk factor screening and linked intervention, nonmedical approaches to reframe the LBP problem and avoid unnecessary care, cognitive and behavioral aspects of LBP, and ways to train clinicians to implement these innovations. More appropriate use of longitudinal designs and a greater focus on implementation research was called for.

Conclusion: Although the field of primary care LBP research often seems to progress slowly, the Forum highlighted several important, promising developments that could substantially improve LBP research and primary care practice.
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http://dx.doi.org/10.1097/BRS.0b013e3181f6114eDOI Listing
September 2011

Workers' perspectives on low back pain recurrence: "it comes and goes and comes and goes, but it's always there".

Pain 2011 Jan 3;152(1):204-211. Epub 2010 Dec 3.

Center for Disability Research, Liberty Mutual Research Institute for Safety, Hopkinton, MA, USA Center for Health Economics & Science Policy, United BioSource Corporation - Europe, London, UK Department of Environmental Health, Concordia University College of Alberta, Edmonton, Alberta, Canada Department of Physical Therapy, University of Alberta, Edmonton, Alberta, Canada.

Although various measures of low back pain (LBP) recurrence have been proposed, none have been tested to determine if they are consistent with what those with LBP perceive a "recurrence" to be. To further the understanding of LBP recurrence and how to measure it, we examined how individuals with a history of LBP describe their back pain experiences. A qualitative approach was chosen and six mixed-gender focus groups were conducted. Discussions were facilitated by two researchers and structured around predetermined questions. All four authors were involved in the data analysis and thematic congruence was achieved through an iterative process of coding and discussion. Participants included 31 individuals (14 female, 17 male), with ages ranging from early 20s to mid 70s. When asked about LBP recurrence, participants had difficulty understanding the concept. There was a sense that, although the pain may disappear, the condition was always there. Three states were defined: "normal," "flared-up," and "attack." "Normal" could include experiencing pain, but generally represented a tolerable state. "Flared-up" was associated with increased pain, the use of strategies to overcome difficulties, and modified participation. "Attack" state was described as severely disabled: "I just have to lay there." Participants described their experiences in a way that is consistent with the idea that LBP is a fluctuating and disabling health condition. Results cast doubt on the validity of currently available measures of LBP recurrence. Focusing on recurrence of pain without consideration of broader contextual factors will result in an incomplete understanding of the meaning of the pain experience.
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http://dx.doi.org/10.1016/j.pain.2010.10.033DOI Listing
January 2011

Return to work following disabling occupational injury--facilitators of employment continuation.

Authors:
Amanda E Young

Scand J Work Environ Health 2010 Nov 23;36(6):473-83. Epub 2010 Apr 23.

Center for Disability Research, Liberty Mutual Research Institute for Safety, 71 Frankland Road, Hopkinton, MA, USA.

Objective: Return to work following occupational injury is an important rehabilitation milestone; however, it does not mark the end of the return-to-work process. Following a return to the workplace, workers can experience difficulties that compromise their rehabilitation gains. Although there has been investigation of factors related to a return to the workplace, little attention has been paid to understanding what facilitates continued return-to-work success as this paper aims to do.

Methods: This study used data gathered during one-on-one telephone interviews with 146 people who experienced a work-related injury that resulted in their being unable to return to their pre-injury job, but who returned to work following an extended period of absence and the receipt of vocational services.

Results: Numerous return-to-work facilitators were reported, including features of the workers' environmental and personal contexts, as well as body function, activities, and participation. Influences that stood out included a perception that the work was appropriate, supportive workplace relationships, and a sense of satisfaction/achievement associated with being at work.

Conclusions: The findings support the contention that initiatives aimed at improving return-to-work outcomes can go beyond the removal of barriers to include interventions to circumvent difficulties before they are encountered. Together with providing ideas for interventions, the study's findings offer an insight into research and theoretical development that might be undertaken to further the understanding of the return-to-work process and the factors that impact upon it.
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http://dx.doi.org/10.5271/sjweh.2986DOI Listing
November 2010

Employment maintenance and the factors that impact it after vocational rehabilitation and return to work.

Authors:
Amanda E Young

Disabil Rehabil 2010 ;32(20):1621-32

Liberty Mutual Research Institute for Safety, Center for Disability Research, Hopkinton, MA 01748, USA.

Purpose: To determine post-return-to-work disability and functioning amongst occupationally injured workers and to test the extent to which demographic and other variables relate to employment maintenance. In addition, the project sought to document what workers believe determined their work continuation.

Method: Semi-structured in-depth interviews were conducted to inquire about participant's (N = 150) post-vocational rehabilitation return-to-work experiences. Results were interpreted using the health and health-related domains from the International Classification of Functioning, Disability and Health.

Results: Although most participants were working at the time of interview, almost all were experiencing functional- or activity-based restrictions. Factors differentiating those employed from those not, were largely contextual and included relationships with supervisors, economic climate, and working conditions.

Conclusions: The findings stress the importance of considering environmental strains when planning return to work and indicate ways to assist workers to achieve return-to-work success.
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http://dx.doi.org/10.3109/09638281003611029DOI Listing
December 2010

Return-to-work experiences: prior to receiving vocational services.

Authors:
Amanda E Young

Disabil Rehabil 2009 ;31(24):2013-22

Liberty Mutual Research Institute for Safety, Center for Disability Research, Hopkinton, MA 01748, USA.

Purpose: Injured workers can experience a myriad of difficulties while attempting workplace reintegration and, in some cases, problems encountered result in workers being unable to take up employment opportunities and/or maintain employment gains. This project aimed to discover what injured workers report as being the reason for their not pursuing and/or leaving post-injury work opportunities.

Methods: Semi-structured interviews inquiring about participant's (N = 150) return-to-work experiences following an occupational injury resulting in an impairment that limited their ability to perform their past work.

Results: Findings indicate that although reasons cited for the loss of employment gains included physiological body function, the ability to perform work-related tasks and actions and personal factors, the most commonly referenced barriers by far were environmental in nature. Depending on where the worker was within the return-to-work process, the regularity with which each of the types of environmental factors was mentioned varied considerably.

Conclusions: The finding that environmental factors are considered the most common stumbling blocks is positive in that these are arguably some of the most amenable to intervention.
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http://dx.doi.org/10.3109/09638280902887412DOI Listing
January 2010

Back pain recurrence: an evaluation of existing indicators and direction for future research.

Spine (Phila Pa 1976) 2009 Apr;34(9):970-7

United BioSource Corporation, London, United Kingdom.

Study Design: Literature review.

Objective: To present a framework for future analyses of back pain recurrence and explore the applicability and relevance of existing recurrence indicators.

Summary Of Background Data: Empirical studies of back pain have included a variety of indicators of recurrence, resulting in a range of findings about recurrence rates and associated factors. Little is known about the relationships between existing indicators.

Methods: Literature overview, expert panel, and workshop discussion at the IX International Forum on Primary Care Research on Low Back Pain.

Results: Using the International Classification of Functioning, Disability, and Health (ICF), disabling back pain was conceptualized as a health condition, i.e., back pain disorder (BPD), and BPD recurrence was conceptualized as involving a return of atypical back pain and/or back-pain-related difficulty performing tasks and actions related to the initial episode. Using the ICF, 2 types of recurrence indicators were identified: those directly describing components of BPD and those indirectly doing so (e.g., recurrence of health care utilization).

Conclusion: In light of the difficulty in measuring BPD recurrence, transparent definitions and a clear understanding of the implications of using particular indicators is required. Future research should focus: on examining the capture BPD recurrence by various research instruments, improving understanding of the relationship between indicators, and gaining insight into how individuals experiencing BPD view recurrence.
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http://dx.doi.org/10.1097/BRS.0b013e3181a01b63DOI Listing
April 2009

Urban-rural differences in work disability following occupational injury: are they related to differences in healthcare utilization?

J Occup Environ Med 2009 Feb;51(2):204-12

Center for Disability Research, Liberty Mutual Research Institute for Safety, Hopkinton, MA 07148, USA.

Objective: To investigate urban-rural differences in health care utilization following compensable work-related injury and determine whether differences relate to work disability.

Methods: Analysis of worker's compensation data relating to 4889 people with a bone fracture. Regression analyses were used to test the associations between rurality, work disability, and health care utilization.

Results: Place of residence was found to relate to health care utilization and work-disability duration; however, the direction of this relationship depended on the amount of health care used. At lower levels of utilization, more rural residents had less time off; however, as health care usage increased this trend reversed.

Conclusions: The observed interaction between health care utilization, work-disability, and rurality raises important questions regarding causality and implies that people in both urban and rural areas have the potential to benefit from further investigation into health care practices and associated outcomes.
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http://dx.doi.org/10.1097/JOM.0b013e3181917d8eDOI Listing
February 2009

Employment status after spinal cord injury (1992-2005): a review with implications for interpretation, evaluation, further research, and clinical practice.

Int J Rehabil Res 2009 Mar;32(1):1-11

Center for Disability Research, Liberty Mutual Research Institute for Safety, Hopkinton Massachusetts 01748, USA.

The purpose of this study is to review the research conducted on the topic of employment status after spinal cord injury that was published between 1992 and 2005. This study follows on from an earlier review that focused on papers published between 1976 and 1991. The current study extends the earlier review by reporting an aggregate employment rate for those at least 12 months postinjury, separating rates for those living in different geographical areas (i.e. North America, Europe, Australia, and Asia), and reporting rates at various times of postinjury (rates from a minimum of 1 year postinjury, through rates at a follow-up of more than 20 years postinjury). As was found in the earlier review, a diversity of employment rates was observed; however, this diversity was reduced when studies of similar design were compared. Results indicate that although it may take some time to be realized, there is significant vocational potential amongst those with spinal cord injury. On the basis of the results of the review, it was concluded that approximately 40% of working age people greater than 12 months postinjury are employed at the time of data collection, with this rate increasing as the postinjury time increases, peaking at 10-12 years postinjury. Significant differences in employment rates depending on the geographical location of the studied population were observed. Recommendations for further research are made and implications for service provision to individuals with disabling injuries are discussed.
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http://dx.doi.org/10.1097/MRR.0b013e32831c8b19DOI Listing
March 2009

Urban-rural differences in work disability after an occupational injury.

Scand J Work Environ Health 2008 Apr 8;34(2):158-64. Epub 2008 May 8.

Center for Disability Research, Liberty Mutual Research Institute for Safety, 71 Frankland Road, Hopkinton, MA 07148, USA.

Objectives: In comparison with their urban counterparts, people living in rural areas have been found to experience higher rates of morbidity and mortality and have inferior health outcomes after illnesses and injuries. The current study sought to determine if this trend extends to work-disability outcomes after work-related injuries.

Methods: This study was a retrospective cohort study using data on workers' compensation claims. Rurality was defined at the postal-code level on the basis of United States 2000 census data. Work disability was measured using the number of full days a person was off work in the 2 years following an injury. Regression analyses were used to test the association between rurality and the duration of work disability after a work-related bone fracture.

Results: The claimants with higher rurality experienced less work disability than those with lower rurality. This relationship remained after control for the impact of age, gender, part of body injured, occupation, and industry.

Conclusions: Rurality was found to be related to work disability. However, rather than being associated with more time off after an injury, as could be expected on the basis of past findings, increased rurality was found to be associated with less time off work. The findings suggest that features of rural environments, cultures, and behavioral patterns may facilitate return to work.
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http://dx.doi.org/10.5271/sjweh.1217DOI Listing
April 2008

Measuring return to work.

J Occup Rehabil 2007 Dec 11;17(4):766-81. Epub 2007 Oct 11.

Liberty Mutual Research Institute for Safety, Center for Disability Research, Hopkinton, MA, USA.

Background: It is argued that one of the factors limiting the understanding of return to work (RTW) following work disability is the use of measurement tools that do not capture a complete picture of workers' RTW experiences. To facilitate the investigation of RTW, the current authors proposed a developmental conceptualization of RTW, which argues for an expanded awareness that encompasses four phases: off work, work reintegration, work maintenance and advancement. This paper reports on work undertaken with the aim of operationalizing the conceptualization.

Methods: A review of the RTW and related literature, with databases searched including PubMed, EconLit, and PsycInfo. We began by extracting details of RTW instruments used by previous researchers. We then interpreted these within the context of the phases of RTW. Using the International Classification of Functioning, Disability, and Health (ICF) to inform our thinking and coding structure, we conceptualized phase-based RTW outcomes and categorized them as 'tasks and actions', 'contextual' or 'process driven'. Iteratively, we reviewed existing instruments for their use as measures of RTW. Where gaps in instrumentation were found, the wider vocational and career assessment literature was searched for instruments that could be adapted for use in RTW research.

Results: Results indicate that, although numerous research instruments have been used to assess RTW, within the scientific literature some important dimensions of RTW lack instrumentation. In particular, we found that outcomes such as goal setting, motivation, expectation, job seeking, work maintenance, and career advancement require operationalization. Amongst the outcomes had been operationalized, we found considerable variation in conceptual development and application.

Conclusions: The lack of consistency and comprehensiveness of RTW measurement is one of the factors compromising the advancement of the field of RTW research. It is suggested that a more complete and psychometrically sound array of research instruments, grounded within a commonly adopted paradigm, would further the understanding of RTW and the factors affecting it.
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http://dx.doi.org/10.1007/s10926-007-9101-4DOI Listing
December 2007

Employment participation following spinal cord injury: relation to selected participant demographic, injury and psychological characteristics.

Disabil Rehabil 2005 Nov;27(21):1297-306

School of Public Health, La Trobe University, Bundoora, VIC 3083, Australia.

Purpose: To determine the relationship between selected demographic, injury and psychological characteristics and the extent of employment undertaken following spinal cord injury (SCI).

Method: Data were collected from 289 persons with SCI who found employment post-injury. A survey was administered to patients of a specialist spinal cord injury unit located in South-Eastern Australia. A variety of demographic, injury and psychological variables were assessed for their relationship to the extent of employment undertaken following SCI. Extent of employment, was defined as time spent employed as a proportion of the time available for employment, and is hereafter referred to as "workrate."

Results: On average, participants reported having been employed for almost two-thirds of their available time. Study variables explained 22% (18% adjusted) of the variance in post-injury workrate. Individually, demographic and psychological variables, but not injury variables, were found to relate to the outcome measure.

Conclusion: Using a novel measure of employment outcome, this study yielded findings consistent with other research using alternate employment measures. Results suggest that demographic and psychological variables are more related to this measure of employment participation than are injury variables. The addition of environmental variables may allow for the explanation of more variance in outcome.
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http://dx.doi.org/10.1080/09638280500164644DOI Listing
November 2005

A developmental conceptualization of return to work.

J Occup Rehabil 2005 Dec;15(4):557-68

Center for Disability Research, Liberty Mutual Research Institute for Safety, 71 Frankland Rd, Hopkinton, MA 01748, USA.

Introduction: Although return to work (RTW) is a phenomenon that has been researched for many years, our ability to understand and improve outcomes is still limited. As an avenue for advancing the field, this paper presents an alternative way of thinking about RTW.

Method: The conceptualization was constructed based on a review of the literature and the comments of RTW and workers' compensation researchers.

Results: RTW is presented as an evolving process, comprising four key phases: i.e., "off work," "work re-entry," "retention," and "advancement." In addition, multiple phase-specific outcomes that may be used to evaluate RTW success are advanced.

Conclusion: Broadening thinking about RTW to take into consideration the complexities of its developmental nature holds promise for understanding and improving RTW, as it not only clarifies the importance of incremental milestones, but also facilitates intervention choice and evaluation.
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http://dx.doi.org/10.1007/s10926-005-8034-zDOI Listing
December 2005

Return-to-work outcomes following work disability: stakeholder motivations, interests and concerns.

J Occup Rehabil 2005 Dec;15(4):543-56

Center for Disability Research, Liberty Mutual Research Institute for Safety, 71 Frankland Road, Hopkinton, MA 01748, USA.

Introduction: Satisfaction with return-to-work (RTW) outcomes is dependent on many factors, including a clear exposition of what people define as a "good outcome" and the information they use to determine if such an outcome has been achieved. This paper defines the key stakeholders involved in the RTW process and discusses the need to understand their motivations, interests, and concerns.

Methods: A review of the literature and discussions with RTW researchers conducted by a multidisciplinary group of academic researchers.

Results: Our analysis suggests that RTW stakeholders can share the goal of a successful RTW; however, this consensus has to be viewed in light of other, sometimes competing, goals and the environments in which stakeholders operate.

Conclusions: It is suggested that more clearly articulating and operationalizing stakeholders' perspectives will allow researchers to advance the understanding of RTW interventions and outcomes.
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http://dx.doi.org/10.1007/s10926-005-8033-0DOI Listing
December 2005

Agricultural workers' return to work following spinal cord injury: a comparison with other industry workers.

Disabil Rehabil 2004 Sep;26(17):1013-22

Center for Disability Research, Liberty Mutual Research Institute for Safety, Hopkinton, Massachusetts 01748, USA.

Purpose: To investigate the impact of spinal cord injury on employment outcomes as experienced by agricultural workers in comparison with persons employed in other industries. Because of the challenges associated with working in many of the agricultural industries, it was anticipated that agricultural workers would achieve inferior return-to-work outcomes.

Method: Survey of all employed persons who experienced a traumatic spinal cord injury in southeastern Australia between 1990 and 1996 (inclusive).

Results: Contrary to expectation, agricultural workers had a significantly higher rate of return to work (61.7% vs. 41.1%). However, an investigation into the hours spent working and agricultural workers' satisfaction with their employment activities, indicated that most were underemployed and had the potential to achieve even better outcomes.

Conclusion: Results indicate that more can be done to help injured agricultural workers achieve their employment potential.
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http://dx.doi.org/10.1080/09638280410001702432DOI Listing
September 2004

Explaining labor force status following spinal cord injury: the contribution of psychological variables.

J Rehabil Med 2003 Nov;35(6):276-83

School of Public Health, La Trobe University, Bundoora, VIC, Australia.

Objective: To investigate the relative influence of demographic, injury and psychological characteristics on the labor force status of people living with spinal cord injury.

Design: Cross-sectional survey.

Subjects: 459 persons who had experienced a traumatic spinal cord injury. All participants were patients of 1 of 2 specialist spinal cord injury services located in south-eastern Australia.

Methods: A survey, administered on average of 11.2 years after their injury, was used to collect the data. The study's main outcome measure was labor force status at the time of survey. Of those invited to participate in the study, 73% agreed to do so.

Results: Demographic, injury and psychological variables were found to explain 30% of the variance in the employment criterion: "in the labor force" vs "not in the labor force". Psychological variables contributed significantly to the separation of the 2 labor force groups.

Conclusion: The inclusion of the selected psychological variables has advanced the understanding of the factors related to return to work following spinal cord injury, however this understanding is still not complete. Future efforts in this field would likely benefit from the inclusion of additional psychological characteristics, as well as environmental factors.
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http://dx.doi.org/10.1080/16501970310015209DOI Listing
November 2003