Health screening questionnaires used in the management of mental distress acquired during an injured worker’s return to work: A scoping review

Abstract

BACKGROUND:

Mental distress is often endured by injured workers participating in the rehabilitation or return to work process following a physical injury. Delays in detecting the onset and treating mental distress can lead to a diverse range of cognitive and behavioural changes that may precipitate psychological distress such as anxiety, depression, and posttraumatic stress.

OBJECTIVE:

The objective of this scoping review was to provide an overview of existing health questionnaires utilised by health care providers and affiliated researchers. It reviewed their effectiveness and suitability to detect mental distress endured by injured workers engaged in the return to work process.

METHODS:

A scoping review methodology was conducted using the Arksey and O’Malley framework which examined peer-reviewed articles published between 2000 and March 2020 comprising health questionnaires. Database searches included Medline, CINAHL, EMBASE and PsycINFO combining specific MeSH terms and key words.

RESULTS:

The full search identified 3168 articles. Following full screening a total of 164 articles reviewed the use of health questionnaires and specific criteria to determine their suitability. Most of the health questionnaires reviewed were used as screening measures for identifying both work and non-work-related psychological hazards. However, they were found to be limited in their application when considering all potential predictors of delayed return to work such as poor or stressful interactions with stakeholders, financial stress and the injured workers experience of the RTW process.

CONCLUSION:

Earlier identification of mental distress using an optimal MHSQ followed by appropriate intervention will reduce the risk of psychological injury becoming cumulative on a physical workplace injury. Without such complications, early return to work can be achieved with significant cost saving to the economy.

Keywords

Workplace health care practitioner screening rehabilitation return to work

1 Introduction

Return to work (RTW) following an injury at the workplace should be a relatively straightforward process for the worker for the majority of physical injuries [1]. The longer an injured worker is absent from the workplace however, the less likely a sustainable RTW will occur [1 –6]. While many injured workers recover from their injuries and RTW in a relatively systematic and predictable manner, others experience delays in their RTW schedule, with some never returning to their pre-injury duties [7 –11]. Therefore, prevention of psychological distress following a physical workplace injury is an important priority for organisations and governments.

The economic cost associated with mental illness is significant. Even in a medium sized developed economy such as Australia, $51 billion was spent in 2018/19 to address issues associated with mental illness [23]. $11 billion of this total was directly borne by employers for workers’ compensation payouts, absenteeism and a reduction in productivity [24 –26]. This is largely due to the unrecognised complexity of workplace injuries in the individual’s psychological wellbeing, particularly, loss of self-worth, uncertainty about the future, and the struggle to be supported adequately both psychologically and financially during the RTW process [12, 13].

The risk of a psychological injury becoming cumulative on a physical workplace injury increases when there is heightened anxiety around future pathways in the workplace [27]. The 2019/2020 Corona virus pandemic impact has further heightened that uncertainty none less in those injured in the workplace.

If left untreated, psychological distress over time can produce a diverse range of behavioural and cognitive changes including mood disorders (e.g. depression), anxiety disorders (e.g. posttraumatic stress), substance use disorders and even more protracted psychopathology [14 –16]. Where workers’ long-term health issues are not treated, alcohol and other drug-related deaths and suicides have contributing to increasing mortality rates associated with work injuries [17]. Depression is particularly often associated with the aftermath of an occupational injury, with symptoms usually presenting within the first 12 months following a work-related musculoskeletal injury [16 , 18–20].

In many developed economies such as the United States, United Kingdom, France, Norway, Denmark, Finland and Australia, Primary Care Physicians or General Practitioners usually provide the primary medical care for an injured worker [1 , 151]. Primary Care Physicians manage the medical treatment of workers by delivering ongoing care and referrals to other health care practitioners (HCPs) to assist with their rehabilitation and RTW [1 , 151].

While there is general consensus that appropriate psychological screening can detect potential complications encountered during the rehabilitation process [16], Primary Care Physicians throughout many countries often indicate that they do not have adequate time or resources to fully assess an injured workers’ physical injury and their mental health status [21 , 21], 49].

To prevent mental distress following a physical workplace injury, it is essential that Primary Health Practitioners and other relevant HCPs should have access to an effective Mental Health Screening Questionnaire (MHSQ) that is able to detect potential psychosocial risk factors in order to facilitate appropriate interventions to ensure the ongoing wellbeing of the injured worker.

Despite the association of workplace injuries and mental health there is a paucity of research that explores:

How and when mental health distress is triggered during the RTW process and;

The effectiveness of any current Mental Health Questionnaire (MHQ) applied to detect the onset and underlying cause of mental distress encountered during the RTW process.

The aim of this review is to:

Identify and provide an overview of the MHQs and other health questionnaires (HQs) used to assess mental wellbeing in injured workers following a physical injury at the workplace and;

Assess the suitability and effectiveness of these questionnaires to detect early changes in mental wellbeing following a workplace injury that predict further psychopathology.

Preventive health screening has long been promoted as one of the most important health care strategies to facilitate early diagnosis and treatment, with the potential outcome as an improvement in the quality of life for those being screened [22, 23]. A study in 2005 suggested that when using a brief screening questionnaire, Primary Health Providers can recognise and manage common mental disorders, in addition may also influence a Primary Health Practitioners provision of care following the outcome of the screening questionnaire [24].

2 Methods

A scoping review methodology as described by Arksey & O’Malley [25] and Levac et al. [26] was adopted to explore the existing literature to identify the range of HQs used to assess mental health distress in injured workers following a workplace injury. This method allows for a rapid review and mapping of key concepts which underpin the research area to examine the extent, range and nature of research activity, identify gaps in all relevant literature, and summarise and disseminate research findings [16]. Our scoping review methodology follows a five (5) stage framework: (1) identifying the research question; (2) identifying relevant studies; (3) study selection; (4) charting the data and (5) collating, summarising and reporting the results.

2.1 Identifying the research questions

This study extends on earlier research undertaken by the Chief Investigator investigating the role of HCP and Return to Work Coordinators in the rehabilitation of injured workers [1, 27]

The research questions below that guide this study evolved through a brainstorming session conducted by the research team and informed by the literature [104 , 64]:

What work related and other psychosocial risk factors have been identified that potentially compromise a worker’s mental wellbeing when rehabilitating from a physical injury?

How does mental distress endured during the participation in a RTW process manifest in a physically injured worker?

Has mental distress endured by the physically injured worker during a RTW process been shown to prolong or prevent their ultimate RTW?

What screening tools are currently used to identify symptoms of mental distress in workers when participating in a RTW process? How effective are they?

Where is the gap in the current knowledge, practice or evidence?

Can current practice, knowledge or evidence be augmented or improved upon?

2.2 Identifying relevant articles and studies

A preliminary set of key words were developed, and an initial search conducted in Medline. The key words were then reviewed and used to search Medline, CINAHL, EMBASE and PsycINFO. The search strategy included a combination of Medical Subject Headings (MeSH) terms and key words for ‘workers’, ‘physical injuries’, ‘mental health’, return to work’ and ‘impact’ (see Appendix 1). The search was limited to articles published from 2000 to March 2020. Observational studies, including longitudinal cohort studies were included. Systematic reviews, conference abstracts, protocol papers and studies looking at pre-existing mental illness (including depression) before the physical injury occurrence as well as studies not available in English were excluded. Abstracts and proceedings from conferences and meetings, as well as other unpublished sources were excluded due to lack of peer review. Commentaries, review articles, editorials and letters to the editor were also excluded.

2.3 Literature search and article selection

Details of the search, screening and selection process are found in the flowchart of search results and screening (see Fig. 1).

Fig. 1

Flowchart of search and screening results.

The initial database search identified 3168 articles. Suitable articles were subsequently identified through an independently conducted review by two authors [IW, JM]. Each author screened the title and abstract to determine which articles would be included for full review. Articles were excluded if they were duplicates; the injuries were not work related or; the study concerned pre-existing mental illness (such as depression) being investigated in isolation from physical injury. Disparities between review authors were resolved by discussion and if required a third reviewer was consulted (JBN). Title and abstract screening resulted in 2878 articles being excluded, leaving 276 for full text review.

A full text review to assess the eligibility of the 276 articles was then conducted by two researchers [JBN, JM] and on completion of a face to face review defence, 164 articles which utilised a MHQ (or a HQ with a significant mental health component) were retained for inclusion in this review. To assist in the analysis of the collated questionnaires, additional articles sourced from the literature were also referenced in the scoping review if they included an investigation of issues faced by a physically injured worker while engaged in a RTW process, including where involvement in the RTW process has been associated with any of the following:

An impact on the worker’s mental health (including the development of chronic mental health conditions or substance abuse) or,

A delayed or prolonged return to work or an abandonment of employment or,

A deterioration in a work, social or family relationship or,

A subsequent loss of identity or self-worth or an increase in feelings of hopelessness, grief, stigmatisation or financial loss or,

An analysis of the success or otherwise of any intervention (eg. physiotherapy, pain management and/or counselling) employed to aid rehabilitation or,

An analysis of a methodology employed by the Treating Medical Practitioners to identify deteriorating mental health with the injured worker.

In addition, reference lists of key journal articles were hand searched to source other appropriate research articles resulting in a further eight (8) articles to report on in the scoping review. Disparities between reviewers were resolved by discussion and if required a third reviewer was consulted [DJ].

2.4 Extracting and charting the data

All data extracted from the included studies was summarised by one of the authors [JM]. Two authors then collectively [IW, JBN] developed the data charting form to ascertain which variables to extract to answer the research questions. Using an iterative approach, the chart was updated continually by the authors. The extracted information included: study characteristics (study design, year published); participant characteristics (sociodemographic, nature of the work); what Health Questionnaire was used within and what study outcomes were noted (such as impact on return to work process, duration and the nature of the impact on subjects’ mental health).

3 Results

There were 164 studies identified from the literature where each of which had employed one or more of sixty-two (62) MHQ or HQ with a significant mental health component to augment the research being conducted. Analysis of these studies incorporating charted data and relevant criteria sourced from the literature is summarised in Appendix 2. Most of the studies sourced were from research institutions in Canada followed in decreasing numbers from the United States, Australia, Sweden, Norway, United Kingdom, The Netherlands, Denmark, Finland, Austria, Hong Kong, Switzerland, Japan, Finland, Korea, Taiwan, Germany, Malaysia, Iran and Spain.

The appraised range of 62 MHQ or HQ have been utilised within a wide range of study types including in seventy-two (72) prospective cohort studies, forty-nine (49) cross-sectional studies, nineteen (19) mixed methods study designs, fifteen (15) randomised control trials, five (5) retrospective cohort studies, four (4) longitudinal observational studies and one each in a non-randomised control trial and a pilot study. There was no discernible pattern of preference for a specific study type to favour the use of a particular MHQ or HQ.

In terms of participant characteristics, workers with (all cause, general) MSD were the most frequent studied subject cohort (42 studies); followed by workers with back pain (24 studies); workers on extended sick leave - all causes (17 studies); then workers with upper extremity pain (9 studies). Twelve (12) of the fifteen (15) randomised control trials sought to improve the outcome of rehabilitation through appropriate interventions designed to expedite the injured workers’ recuperation and/or return to work. While there were only 10 studies which listed a specific study attribute associated with an impact on the worker’s mental health (as indicated in the article’s descriptive “study population”), 142 studies considered mental health impacts as a secondary consideration associated with the specific topic of research being conducted. Of the 164 studies reviewed, 68 involved the active participation of a HCP independent of the team conducting the research.

The most significant work-related psychosocial risk factors highlighted within the literature that is linked to the efficacy of rehabilitation and which, if uncontrolled, could potentially undermine the physically injured worker’s return to work schedule includes:

3.1 How effective are the reviewed health questionnaires in identifying (and to potentially predict) critical aspects of mental health of workers or others suffering from a physical occupational injury?

From the full text review, sixty-two (62) diagnostic MHQs and HQs were identified. Each was appraised in terms of their attributes and ability to detect, predict or record impacts from the above psychosocial risk factors (subsequently summarised in Appendix 3).

As well as detecting symptoms of depression or anxiety, an effective MHSQ should also consider all work-related and non-work-related psychosocial risk factors that could impact on an injured worker’s mental health and wellbeing and delay their RTW. For example, while a recent study which trialled the ÖMPSQ-SF questionnaire and its value as a simple screening measure for workers at risk of a delayed RTW concluded that it is a suitable questionnaire for measuring a diverse range of work-related injuries, it does not notably account for all potential predictors which can impact on injured workers RTW [28]. Consulting table 3 it can be seen that the ÖMPSQ-SF satisfies only two (2) of the nine (9) criteria covered within this study.

In terms of questionnaire content, forty-one (41) HQs solicit for clinical symptoms of depression or anxiety, thirty (30) solicit in part for (or fear of) physical pain and sixteen (16) include soliciting for both clinical symptoms of depression or anxiety and pain. Twenty-one (21) include soliciting for the level of social support, sixteen (16) HQ include soliciting for the level of family support and twelve (12) HQ include soliciting for the level of support at work (be it supervisor or co-worker support). Six (6) HQ include soliciting for the impact of unreasonable work demands or timeframes (potentially indicating a mismatch of occupational task and health restriction where applied to a rehabilitation process), while four (4) HQ include soliciting for the impact of discrimination, harassment, bullying or stigma. No HQ included consideration of the impact of poor or stressful interaction with healthcare providers or financial stress on the injured worker’s return to work progress.

The HQs that cover a majority of the above work and non-work-related psychosocial risk factors are the Return to work Obstacles and Coping Efficacy –Musculoskeletal Disorder questionnaire [ROSES-MSD] and the Obstacles to Return-to-Work Questionnaire –ORQ, both of which cover seven of the nine work and non-work-related psychosocial risk factors assessed in this study.

3.2 Return to work obstacles and self efficacy scale (ROSES-MSD)

The latest Return-to-Work Obstacles and Self-Efficacy Scale (ROSES-MSD) is a 46-item self-reported inventory spread out over 10 conceptual dimensions. The inventory comprises the following dimensions [29]:

Fears of a relapse – (4) Questions:- Q1, 11, 24, 32

Cognitive difficulties – (3) Questions:-Q 2, 12, 39

Medication-related difficulties – (3) Questions:- Q3, 13, 29

Job demands – (7) Questions:- Q4, 14, 22, 25, 28, 38, 45

Feeling of organizational injustice – (4) Questions:-Q 5, 15, 30, 34

Difficult relation – immediate supervisor – (7) Questions:- Q6, 16, 21, 31, 36, 41, 44

Difficult relations – co-workers – (7) Questions:- Q7, 19, 23, 27, 33, 43, 46

Difficult relations – insurance company (4) Questions: - Q8, 17, 35, 40

Difficult work/life balance – (4) Questions:- Q9, 18, 37, 42

Loss of motivation to return to work – (3) Questions:- Q10, 20, 26

3.3 Obstacles to return-to-work questionnaire (ORQ)

The Obstacles to Return-to-Work Questionnaire (ORQ) is a 55-item self-reported inventory comprising the following nine (9) subscales [30]:

Depression – (4) Questions

Pain intensity – (4) Questions

Difficulties at work return – (8) Questions

Physical workload & harmfulness – (8) Questions

Social support at work – (6) Questions

Worry due to sick leave – (3) Questions

Work satisfaction – (9) Questions

Family situation and support– (7) Questions

Perceived prognosis of work return – (6) Questions.

Both ROSES-MSD and ORQ lack the ability to solicit and assess the impact of poor or stressful interaction with healthcare providers and financial stress on the injured worker’s mental health with both psychosocial risk factors potentially prolonging or preventing a timely RTW.

Without consideration of the full range and their accumulated impact on a physically injured person’s mental wellbeing and RTW progress, the range of articles assessed, including those utilising HQs have been found limited in their further application to assist in improving the efficacy of the return to work process.

A majority of the sixty (62) HQs sourced from the review and represented in Appendix 3 could be applied during an RTW review meeting to determine the presence of certain elements and symptoms associated with the worker’s mental health. However, no one HQ is structured to identify or solicit for all of the psychosocial risk factors and obstacles potentially associated with their readiness to RTW. There is also little evidence to indicate that any are structured to chronologically record the point(s) within the RTW program where mental distress has occurred.

Outside of use by academics with specific arms-length research questions, no study examined the use and efficacy of the HQ to improve the HCP or injured party’s experience of the RTW process. Moreover, while many of the assessed HQ have been utilised in research focussed questions on specific aspects of the RTW process, there is no evidence that the efficacy of using a HQ in the context of participation within the RTW program has been investigated from the perspective of the primary health care providers as the coordinating HCP.

4 Discussion

This review aimed to identify and provide an overview of the MHQs and other health questionnaires (HQs) used to assess mental wellbeing in injured workers following a physical injury at the workplace. Furthermore, it aimed to assess the suitability and effectiveness of these questionnaires to detect early changes in mental wellbeing following a workplace injury that predict further psychopathology. In seeking these aims, the review found the questionnaires limited in their application with improving the effectiveness of the return to work process.

Rehabilitation, associated with participation within a return to work program, is utilised within many countries and industry sectors to facilitate workers returning to their pre-injury duties, following a workplace injury. However, workers who have been injured can experience hostility and frustration with the workers’ compensation system and obstacles within the rehabilitation program can be detrimental to their timely RTW [25]. This is possibly due to a disparity between the needs of the returnee and the needs of compensation system with evidence indicating that timely RTW can be less reliant on physical functioning and more on the influence of psychosocial risk factors [31]. We have compiled a comprehensive manifest of these factors (see Table 1).

Table 1
Psychosocial risk factors potentially adversely impacting on return to work

No. Psychosocial risk factors potentially adversely impacting on return to work

1 Development of symptoms of depression & /or anxiety [1, 10, 11, 15, 100–104, 106, 109–111, 115, 120, 123, 128, 131–4, 138, 141–6, 149, 167, 172, 190].

2 Development of the fear of, or the increased presence of uncontrolled pain or restricted physical movements when performing occupational tasks [18, 31, 34, 142, 197, 198].

3 Imposition of unreasonable work demands or timeframes including where tasks are considered by the injured party to be not compatible with their impaired functional capacity (potentially being an inappropriate match of occupational task and health restriction) [13, 18, 170, 197].

4 Inappropriate management of WHS and ergonomic risks through for example, a lack of equipment and resources required to facilitate a phased return to work [1, 13, 170, 189, 199].

5 The impact of bullying, harassment, discrimination or stigma [12, 14, 200–203].

6 Low supervisor/co-worker support or poor workplace relationships [13, 21, 31, 34, 38, 189, 199, 204, 205].

7 Poor or stressful interaction with healthcare providers [27, 68, 202, 206].

Non-work-related psychosocial risk factors which may also adversely impact on a timely return to work include:

8 Financial stress resulting from reduced income subsidies (many Workers’ Compensation systems incorporate decreasing wage subsidies for the injured worker over time) [12, 16, 21, 40, 41, 54, 120, 200]

9 Family and social relationships under stress from the immediate impact of the occupational injury as well as any subsequent ongoing pain and/or suffering impacting the injured worker [4, 13, 14, 29, 40, 41, 49, 170, 189, 196, 199, 200, 207]

No.	Psychosocial risk factors potentially adversely impacting on return to work
1	Development of symptoms of depression & /or anxiety [1, 10, 11, 15, 100–104, 106, 109–111, 115, 120, 123, 128, 131–4, 138, 141–6, 149, 167, 172, 190].
2	Development of the fear of, or the increased presence of uncontrolled pain or restricted physical movements when performing occupational tasks [18, 31, 34, 142, 197, 198].
3	Imposition of unreasonable work demands or timeframes including where tasks are considered by the injured party to be not compatible with their impaired functional capacity (potentially being an inappropriate match of occupational task and health restriction) [13, 18, 170, 197].
4	Inappropriate management of WHS and ergonomic risks through for example, a lack of equipment and resources required to facilitate a phased return to work [1, 13, 170, 189, 199].
5	The impact of bullying, harassment, discrimination or stigma [12, 14, 200–203].
6	Low supervisor/co-worker support or poor workplace relationships [13, 21, 31, 34, 38, 189, 199, 204, 205].
7	Poor or stressful interaction with healthcare providers [27, 68, 202, 206].
Non-work-related psychosocial risk factors which may also adversely impact on a timely return to work include:
8	Financial stress resulting from reduced income subsidies (many Workers’ Compensation systems incorporate decreasing wage subsidies for the injured worker over time) [12, 16, 21, 40, 41, 54, 120, 200]
9	Family and social relationships under stress from the immediate impact of the occupational injury as well as any subsequent ongoing pain and/or suffering impacting the injured worker [4, 13, 14, 29, 40, 41, 49, 170, 189, 196, 199, 200, 207]

Both positive and adverse impacts on mental health outcomes in injured persons participating in a RTW process were revealed in this review. Importantly, this review highlighted anxiety and depression developing from anticipation of a RTW after a physical injury which was found to be closely associated with a perceived lack of control over potential obstacles that may be encountered in the work environment [13 , 31–34]. Fear avoidance belief significantly impacted on the resumption of normal work duties. Reducing the effectiveness of rehabilitation interventions and ultimately prolonging or preventing a RTW, some studies identified the fear of pain and its consequences pre-empted catastrophizing thoughts and resulted in avoidance of activities believed to be harmful or that aggravated pain, [4 , 35–42]. Several studies have utilised the Fear-Avoidance Components Scale (FACS) to help HCP to better identify and address fear-avoidance related barriers to recovery, and to measure treatment responsiveness of related symptoms [43 –46]. Workers recovering from musculoskeletal injuries also have a demonstrably reduced expectancy for recovery and a lower likelihood that they will participate fully in treatments conducive to a timely RTW [47].

A continuing concern for injured workers is the emotional stress and frustration encountered with the RTW process and the workers’ compensation scheme [1 , 48–50]. In fact, delays in the RTW process often leave injured workers with a growing sense of hopelessness, grief and stigmatisation and a loss of confidence, self-worth and financial support [39].

Additionally, mental distress for an injured worker can also be associated with negative interactions with the employer, the insurer, family members or work associates during the RTW process [1 , 51–53]. Moreover, the procedural complexities inherent within the workers compensation system also act as an obstacle to a timely RTW [1 , 54].

Workers with physical occupational injuries throughout the developed world experience these and other obstacles including mental distress encountered during the rehabilitation process and subsequent attempts to return to work [16 , 187]. Encountering such obstacles can diminish an injured workers’ perceived control over their progress [66] and detrimentally affect their social, work and family relationships [18 , 53]. The worker’s self-efficacy beliefs and confidence that these obstacles can be overcome may significantly influence the speed and ultimately the success of their rehabilitation [29]. If these cumulative factors persist or remain unrecognised and untreated, the resulting impact on their mental health can undermine injured workers’ timely rehabilitation and RTW [12 , 53].

While desired health and functional capacity outcomes are not always achieved during the RTW process, there is significant evidence that timely rehabilitation and the earliest possible RTW are associated with beneficial mental health outcomes for workers with physical injuries [21 , 55–58].

Where the HCP recommends interventions to expedite an injured worker’s RTW, the injured worker should have confidence that they are acting in their best interest. To obtain the best possible therapeutic outcome, the ongoing relationship between the HCP and injured worker should be underpinned with trust, respect and consistent agreement on, and collaboration towards completion of tasks required to reach the goals of treatment [21 , 59]. In terms of a general response to therapeutic treatment, the placebo response has been extensively studied and consistently shown to result in beneficial outcomes with the quality of the HCP-recipient level of established trust significantly contributing to these outcomes [60]. Positive treatment outcomes in part due to the placebo response have also been associated with a range of interventions facilitated by HCPs designed to treat chronic lower back pain [61].

Additionally, persons experiencing mental distress including panic disorders or mild to moderate depression, or generalized anxiety disorder experience significant relief and a greater sense of control over distressing symptoms, regardless of the treatment interventions proposed or ultimately implemented, merely through regular, quality interaction with their treating HCP [60].

An injured worker in the process of rehabilitation and return to work is best supported by a person-centred approach in which the development of a trusting therapeutic relationship that promotes authenticity and unconditional positive regard, provides the best environment for therapeutic success [62, 63]. For example, where the HCP has been trained in improved communication, consultation and rapport including practicing appropriate eye contact and normalizing difficult experiences related by those under care, less anxiety and depression were present in those care recipients, over the period of treatment [4 , 64].

Primary Health Care Practitioners are critical HCPs in the rehabilitation process and the injured worker’s ultimate return to work. When the Primary Health Care Practitioner provides the injured worker with relevant information about their health and rehabilitation possibilities and projects an empathic attitude toward the patient’s plight, better rehabilitation and RTW outcomes are achieved [65].

Timely mental health screening has also been demonstrated to enable the treating HCP to better identify workers [who have been physically injured] with underlying or concomitant psychological distress / disorders and to refer them for further investigation, diagnosis and appropriate tailored intervention / treatment with a psychologist or counsellor [56, 66]. This and/or other treatment options such as the application of cognitive–behavioural therapy in which problem-solving skills are taught have previously been shown to reduce psychological distress impacting the worker [2 , 67–69].

4.1 Where is the gap in the current knowledge, practice, or evidence?

There is clear evidence which supports early screening and interventional treatment of injured workers highlighting the positive effects on their physical and mental health and RTW efficacy.

However, there is a paucity in the literature on primary health care providers and other HCPs regarding their access to, or their use of a MHSQ which may assist with early detection of potential psychosocial risk factors which can impact an injured workers mental health and wellbeing following a workplace injury. Additionally, there is little supporting evidence to suggest the existence of an appropriate MHSQ for primary health care providers and HCPs that could identify all potential predictors of psychological distress for a worker following a workplace injury.

Ideally such a screening tool would, even on one application assist primary health care providers and HCPs determine the onset of psychological distress (post physical injury) during the return to work process and facilitate early referrals and interventions to support an injured worker during their rehabilitation. Subjective reporting of changes in mental health status could alert the practitioner by using the same instrument at different times and stages of the RTW process.

We all exist in an age of heightened anxiety from increased biological and psychosocial stresses including work uncertainty anxiety around future pathways now threatened by the Coronavirus pandemic. Therefore, prevention of psychological distress following a physical workplace injury should be treated as a priority.

4.2 Further research and recommendations to address the gaps in current practice

How and when and at what cost mental health distress is encountered during the rehabilitation and RTW process needs to be addressed in subsequent research.

It is essential that a suitable MHSQ be developed or refined from existing questionnaires and trialled to achieve the most suitable tool to assist primary health care providers, other HCPs and researchers. This will assist in screening for and identifying when and at what stage the onset of psychological distress (post physical injury) has occurred during the return to work program. An additional provision within the MHSQ to prompt the treating medical practitioner to consider employing an intervention to arrest deteriorating mental health would be beneficial also to the ongoing wellbeing of the injured worker.

The optimised MHSQ should also be capable of being completed by the HCP in consultation with, or in part, independently by the injured party and facilitate the identification of the broadest possible range of psychosocial risk factors that are potentially impacting on the efficacy of the return to work process.

Such screening that is applicable and effective, and useful to researchers, would also need to be concise enough to be useful to the HCP in a clinical setting. Excessive alcohol consumption is associated with deteriorating mental health in many injured workers [17 , 70–74] and is associated with prolonged rehabilitation times [8] and/or termination of employment [43]. Therefore, we would recommend that the Alcohol Use Disorders Identification Test (AUDIT; a 10-item screening tool developed by the World Health Organization) be incorporated within the final screening to assess hazardous and harmful consumption of alcohol over time.

An optimum and timely response to address the impact of psychosocial risk factors on the mental wellbeing of injured workers navigating the RTW process may ultimately yield a more expeditious return to work while contributing to significant fiscal savings within the national workers’ compensation system.

Finally, contemporary research now identifies that growth out of adversity is possible with the right support, highlighting the gains to be made both personally and in the workplace from a focus on the holistic approach to recovery following a workplace injury which in turn can be to the benefit of the organisation. [75].

5 Conclusion

A broad range of health questionnaires (HQ) were sourced from the literature and reviewed for this scoping review. Many have been used by academics to screen and identify a limited range of both work and non-work-related psychosocial risk factors to investigate specific arms-length research questions with some focusing on specific aspects of the RTW process. Individually they were all found to be limited in their application when considering all potential predictors of delayed RTW.

Earlier identification of mental distress using an optimal mental health screening questionnaire (MHSQ) followed by appropriate intervention will reduce the risk of psychological injury becoming cumulative on a physical workplace injury. Without such complications, anticipated long term outcomes resulting from the effective application of MHSQ include an improvement in the wellbeing and mental health of persons completing the workers’ compensation process, a shortening of the recovery and rehabilitation times of injured persons, and given the positive impact of the above, a significant decrease in the overall financial burden on the national economy.

Conflict of interest

The authors report no conflict of interest.

Footnotes

The appendices are available from .

References

Bohatko-Naismith

, James

, Guest

, Rivett

, Ashby

. An exploratory study of the injured worker’s experience and relationship with the workplace return to work coordinator in NSW, Australia. International Journal of Workplace Health Management. 2019;12(2):57–70.

van den Hout

, Vlaeyen

, Heuts

, Zijlema

, Wijnen

. Secondary prevention ofwork-related disability in nonspecific low back pain: Does problem-solving therapy help? A randomized clinical trial. Clinical Journal of Pain. 2003;19:87–96.

Franche

, Carnide

, Hogg-Johnson

, Côté

, Breslin

, Bültmann

, et al. Course, diagnosis, and treatment of depressive symptomatology in workers following a workplace injury: a prospective cohort study. Canadian Journal of Psychiatry. 2009;54(8):534–46.

Brendbekken

, Vaktskjold

, Harris

, Tangen

. Predictors of return to work in pateints with chronic musculoskeletal pain: A randomized clinical trial. Journal of Rehabilitation Medicine. 2018;50(2):193–9.

Kosny

, MacEachen

, Ferrier

, Chambers

. The role of health care providers in long term and complicated workers’ compensation claims. Journal of Occupational Rehabilitation. 2011;21(4):582–90.

Pransky

, Benjamin

, Hill-Fotouhi

, Himmelstein

, Fletcher

, Katz

, et al. Outcomes in work-related upper extremity and low back injuries: Results of a retrospective study. American Journal of Industrial Medicine. 2000;37(4):400–9.

Gauthier

, Sullivan

, Adams

, Stanish

, Thibault

. Investigating risk factors for chronicity: the importance of distinguishing between return-to-work status and self-report measures of disability. Journal of Occupational and Environmental Medicine. 2006;48(3):312–8.

Kellezi

, Coupland

, Morriss

, Beckett

, Joseph

, Barnes

, et al. The impact of psychological factors on recovery from injury: a multicentre cohort study. Social Psychiatry and Psychiatric Epidemiology. . 2017;52(7):855–66.

Shearer

, Cote

, Boyle

, Hayden

, Frank

, Johnson

. Who will have Sustainable Employment After a Back Injury? The Development of a Clinical Prediction Model in a Cohort of Injured Workers. Journal of Occupational Rehabilitation. 2017;27(3):445–55.

10.

Li-Tsang

, Li

, Lam

, Hui

, Chan

. The effect of a job placement and support program for workers with musculoskeletal injuries: A randomized control trial study. Journal of Occupational Rehabilitation. 2008;18(3):299–306.

11.

Steenstra

, Franche

, Furlan

, Amick

, Hogg-Johnson

. The added value of collecting information on pain experience when predicting time on benefits for injured workers with back pain. Journal of Occupational Rehabilitation. 2016;26(2):117–24.

12.

Australian Government Productivity Commission. Mental Health [Draft] Report –Vol 1. Oct. 2019.

13.

Deeney

, O’Sullivan

. Work related psychosocial risks and musculoskeletal disorders: Potential risk factors, causation and evaluation methods. Work. 2009;34:239–48.

14.

Kelly

, Hazell

, Considine

. Mental Health and the NSW Minerals Industry. 2012.

15.

Asfaw

, Souza

. Incidence and cost of depression after occupational injury. Journal of Occupational and Environmental Medicine. 2012;54(9):1086–91.

16.

Carnide

, Franche

, Hogg-Johnson

, Cote

, Breslin

, Severin

, et al. Course of Depressive Symptoms Following a Workplace Injury: A 12-Month Follow-Up Update. Journal of Occupational Rehabilitation. 2016;26(2):204–15.

17.

Applebaum

, Asfaw

, O’Leary

, Busey

, Tripodis

, Boden

. Suicide and drug-related mortality following occupational injury. American Journal of Industrial Medicine. 2019; 09//;62(9):733–41.

18.

Franche

. Innovative practices to improve recovery and RTWof workers: Psychosocial factors at the front end and tail end of the claim. Australasian Compensation Health Research Forum; Melbourne. 2014. .

19.

Dersh

, Gatchel

, Polatin

, Mayer

. Prevalence of psychiatric disorders in patients with chronic work-related musculoskeletal pain disability. Journal of Occupational & Environmental Medicine. 2002;44(5):459–68.

20.

Carriere

, Thibault

, Sullivan

. The mediating role of recovery expectancies on the relation between depression and return-to-work. Journal of Occupational Rehabilitation. 2015;25(2):348–56.

21.

Pransky

, Katz

, Benjamin

K J H

, Improving the physician role in evaluating work ability and managing disability: a survey of primary care practitioners. Disability and Rehabilitation. 2002;24:867–74.

22.

Iragorri

, Spackman

. Assessing the value of screening tools: reviewing the challenges and opportunities of cost-effectiveness analysis. Public Health Reviews. 2018;39.

23.

Bell

, Grad

, Dickinson

, Singh

, Moore

, Kasperavicius

, et al. Better decision making in preventive health screening: Balancing benefits and harms. Canadian Family Physician. 2017;63.

24.

Christensen

, Toft

, Frostholm

, Ørnbøl

, Fink

, Olesen

. Screening for common mental disorders: who will benefit? Results from a randomised clinical trial. Family Practice. 2005;22(4):428–34.

25.

Arksey

H OML

. Scoping Studies: Towards a Methodological Framework. Int J Social Research Methodology. 2005;8.

26.

Levac

, Colquhoun

, O’Brien

. Scoping studies: advancing the methodology. Implementation Science. 2010 2010/09/20;5(1):69.

27.

Bohatko-Naismith

, Guest

, James

, Pond

, Rivett

. Australian general practitioners’ perspective on the role of the workplace Return-to-Work Coordinator. Australian Journal of Primary Health. 2018;24(6):502–9.

28.

Nicholas

MK CD

, Linton

, Main

, Shaw

, Pearce

, Gleeson

, Pinto

, Blyth

, McCauley

, Maher

, Smeets

, McGarity

. Predicting return to work in a heterogeneous sample of recently injured workers using the brief ÖMPSQ-SF. Journal of Occupational Rehabilitation. 2019;29(2):295–302.

29.

Corbiere

, Negrini

, Durand

M-J

, St-Arnaud

, Briand

, Fassier

J-B

, et al. Development of the Return-to-Work Obstacles and Self-Efficacy Scale (ROSES) and validation with workers suffering from a common mental disorder or musculoskeletal disorder. Journal of Occupational Rehabilitation. 2017;27(3):329–41.

30.

Marhold

, Linton

, Melin

. Identification of obstacles for chronic pain patients to return to work: evaluation of a questionnaire. Journal of Occupational Rehabilitation. 2002;12(2):65–75.

31.

Rinaldo

U SJ

. Return to work after vocational rehabilitation for sick-listed workers with long-term back, neck and shoulder problems: A follow-up study of factors involved. Work. 2016;55:115–31.

32.

Safe Work Australia Superfriend. Taking Action: A best practice framework for the management of psychological claims in the Australian workers’ compensation secto. 2018. https://www.safeworkaustralia.gov.au/system/files/documents/1902/taking-action-framework-2018.pdf

33.

Myhre

, Lau

, Marchand

, Leivseth

, Bautz-Holter

, Roe

. Control and Support at Work Among Sick-Listed Patients with Neck or Back Pain: A Prospective Study. Journal of Occupational Rehabilitation. 2016;26(2):183–94.

34.

Laisne

F LC

, Corbiere

. Biopsychosocial determinants of work outcomes of workers with occupational injuries receiving compensation: A prospective study. Work. 2013:117-32.

35.

Reme

, Shaw

, Steenstra

, Woiszwillo

, Pransky

, Linton

. Distressed, Immobilized, or Lacking Employer Support? A Sub-classification of Acute Work-Related Low Back Pain. Journal of Occupational Rehabilitation. 2012;22(4):541–52.

36.

Aasdahl

, Gismervik

, Marchand

, Vasseljen

, Johnsen

, Fimland

. Changes in fear-avoidance beliefs and work participation after occupational rehabilitation for musculoskeletal- and common mental disorders: secondary outcomes of two randomized clinical trials. Journal of Rehabilitation Medicine. 2019;51(3):175–82.

37.

Bergbom

, Flink

, Boersma

, Linton

. Early psychologically informed interventions for workers at risk for pain-related disability: Does matching treatment to profile improve outcome? Journal of Occupational Rehabilitation. 2014;24(3):446–57.

38.

Booth-Kewley

, Schmied

, Highfill-McRoy

, Sander

, Blivin

, Garland

. A prospective study of factors affecting recovery from musculoskeletal injuries. Journal of Occupational Rehabilitation. 2014;24(2):287–96.

39.

Fritz

, George

. Identifying psychosocial variables in patients with acute work-related low back pain: the importance of fear-avoidance beliefs. Physical Therapy. 2002;82(10):973–83.

40.

Lötters

, Franche

, Hogg-Johnson

, Burdorf

, Pole

. The prognostic value of depressive symptoms, fear-avoidance, and self-efficacy for duration of lost-time benefits in workers with musculoskeletal disorders. Occupational and Environmental Medicine. 2006;63(12):794–801.

41.

European Agency for Safety and Health at Work. Workrelated musculoskeletal disorders: why are they still so prevalent? Evidence from a literature review. 2020.

42.

Geisser

, Roth

, Bachman

, Eckert

. The relationship between symptoms of post-traumatic stress disorder and pain, affective disturbance and disability among patients with accident and non-accident related pain. Pain. 1996;66(2-3):207–14.

43.

Cougot

, Petit

, Paget

, Roedlich

, Fleury-Bahi

, Fouquet

, et al. Chronic low back pain among French healthcare workers and prognostic factors of return to work (RTW): a non-randomized controlled trial. Journal of Occupational Medicine and Toxicology. 2015;10(1):1–15.

44.

Gheldof

, Vinck

, Vlaeyen

, Hidding

, Crombez

. The differential role of pain, work characteristics and pain-related fear in explaining back pain and sick leave in occupational settings. Pain. 2005;113(1-2):71–81.

45.

Lee

, Yoo

, Leigh

. Transcultural validation of the return-to work self-efficacy scale in Korean patients with work-related injuries. BMC Public Health. 2020;20(844).

46.

Milani

, Alexandre

NMC

, Campos

, Hogg-Johnson

. Psychometric Properties of the Obstacles to Return-to-Work Questionnaire in a Brazilian context. Journal of Occupational Rehabilitation. 2017;27(4):530–46.

47.

Sullivan

, Adams

. Psychosocial treatment techniques to augment the impact of physiotherapy interventions for low back pain. Physiotherapy Canada. 2010;62(3):180–9.

48.

Long

, Bogossian

, Johnston

. Functional consequences of work-related spinal musculoskeletal symptoms in a cohort of Australian midwives. Women and Birth. 2013;26(1):50–8.

49.

The Royal Australasian College of Physicians. Helping People Return to Work. Using evidence for better outcomes. A Position Statement: Policy on preventing work disability. Sydney: Australasian Faculty of Occupational and Environmental Medicine; 2010.

50.

Shaw

, Feuerstein

, Lincoln

, Miller

, Wood

. Ergonomic and psychosocial factors affect daily function in workers’ compensation claimants with persistent upper extremity disorders. Journal of Occupational & Environmental Medicine. 2002;44(7):606–15.

51.

Grant

, O’Donnell

, Spittal

, Creamer

, Studdert

. Relationship between stressfulness of claiming for injury compensation and long-term recovery: a prospective cohort study. JAMA Psychiatry. 2014;71:446–53.

52.

Smith

, Dalen

, Wiggins

, Tooley

, Christopher

, Bernard

. The Brief Resilience Scale: Assessing the ability to bounce back. International Journal of Behavioral Medicine. 2008;15:194–200.

53.

Wyatt

, Lane

. Return to work: A comparison of psychological and physical injury claims (Analysis of the Return to Work Survey results). [Internet]. 2017. https://www.safeworkaustralia.gov.au/doc/return-work-comparison-psychological-and-physical-injury-claims.

54.

The Social Research Centre for Safe Work Australia. National Return to Work Survey Summary Report [Internet]. 2018. https://www.safeworkaustralia.gov.au/system/files/documents/1811/national-rtw-survey-2018-summary-report.pdf.

55.

Knobloch Fedders

. The Importance of the Relationship with the Therapist. Clinical Science Insights: Knowledge Families Count On Vol 1. 2008.

56.

Harvey

, Joyce

, Tan

, Johnson

, Nguyen

, Modini

, et al. Developing a mentally healthyworkplace: review of the literature. National Mental Health Commission and the Mentally Healthy Workplace Alliance, 2014.

57.

Franche

RL BR

, Shaw

, Nicholas

, & Loisel

, Workplace-Based Return-to-Work Interventions: Optimizing the Role of Stakeholders in Implementation and Research. Journal of Occupational Rehabilitation. 2005;15(4):525–42.

58.

Reims

, Bauer

. Labour Market Status and Well-Being in the Context of Return to Work After Vocational Rehabilitation in Germany. Journal of Occupational Rehabilitation. 2015;25:543–56.

59.

Landstad

, Hedlund

, Wendelborg

, Brataas

. Long-term sick workers experience of professional support for re-integration back to work. Work. 2009;32(1):39–48.

60.

Bernstein

MH BW

. The placebo effect in psychiatric practice. Current Psychiatry. 2017;16(11):29–34.

61.

Carvalho

C CJ

, Cunha

. The placebo effect in psychiatric practice. Pain. 2016;157(12):2766–72.

62.

Joseph

. What doesn’t kill us: The new psychology of posttraumatic growth. New York: Basic Books; 2011.

63.

Mc Cormack

, Adams

. Therapists, Complex Trauma, and the Medical Model: Making Meaning of Vicarious Distress from Complex Trauma in the Inpatient Setting. Traumatology. 2015;22(3):192–202.

64.

Girgis

A CJ

, Butow

, Bowmand

, Schofield

, Stojanovski

, D’Este

, Tattersall

MHN

, Doran

, Turner

. Improving patient emotionalfunctioning and psychological morbidity: evaluation of aconsultation skills training program for oncologists. PatientEducation and Counseling. 2009;77(3):456–62.

65.

Rasmussen

, Andersen

. Individual factors and GP approach as predictors for the outcome of rehabilitation among long-term sick listed cases. Journal of Occupational Rehabilitation. 2005;15(2):227–35.

66.

Degen

, Macdermid

, Grewal

, Drosdowech

, Faber

, Athwal

. Prevalence of Symptoms of Depression, Anxiety, and Posttraumatic Stress Disorder in Workers With Upper Extremity Complaints. Journal of Orthopaedic and Sports Physical Therapy. 2016;46(7):590–5.

67.

WååHlin-Norgren

, Ekberg

, ÖÖberg

. Is an expert diagnosis enough for assessment of sick leave for employees with musculoskeletal and mental disorders? Disability and Rehabilitation. 2011;33(13/14):1147–56.

68.

Collie

, Sheehan

, Lane

, Iles

. Psychological Distress in Workers’ Compensation Claimants: Prevalence, Predictors and Mental Health Service Use. Journal of Occupational Rehabilitation. 2020;30:194–202.

69.

Cullen

, Irvin

, Collie

, Clay

, Gensby

, Jennings

, et al. Effectiveness of workplace interventions in return-to-work for musculoskeletal, pain-related and mental health conditions: an update of the evidence and messages for practitioners. Journal of Occupational Rehabilitation. 2018;28(1):1–15.

70.

Phillips

, Carroll

, Voaklander

, Gross

, Beach

. Psychiatric comorbidity in chronic disabling occupational spinal disorders has minimal impact on functional restoration socioeconomic outcomes. Spine. 2012;34(21):1774–82.

71.

Dersh

, Mayer

, Gatchel

, Towns

, Theodore

, Polatin

. Psychiatric comorbidity in chronic disabling occupational spinal disorders has minimal impact on functional restoration socioeconomic outcomes. Spine. . 2007;32(17):1917–25.

72.

Howard

, Mayer

, Gatchel

. Effects of presenteeism in chronic occupational musculoskeletal disorders: stay at work is validated. Journal of Occupational and Environmental Medicine. 2009;51(6):724–31.

73.

Park

. Exploration of the prevalence and correlates of depression among South Korean workers with injuries. Work. 2011;39(3):345–51.

74.

Zatzick

, Jurkovich

, Rivara

, Wang

, Fan

, Joesch

, et al. A national US study of posttraumatic stress disorder, depression, and work and functional outcomes after hospitalization for traumatic injury. Annals of Surgery. 2008;248(3):429–37.

75.

Mc Cormack

, Abou-Hamdan

, Joseph

. Career Derailment: Burnout and Bullying at the Executive Level. International Coaching Psychology Review. 2018;12(1):24–36.

76.

Orchard

, Carnide

, Smith

. How Does Perceived Fairness in the Workers’ Compensation Claims Process Affect Mental Health Following a Workplace Injury? Journal of Occupational Rehabilitation. 2020;30(1):40–8.

77.

Aasdahl

, Pape

, Vasseljen

, Johnsen

, Fimland

. Improved Expectations About Length of Sick Leave During Occupational Rehabilitation Is Associated with Increased Work Participation. Journal of Occupational Rehabilitation. 2019;29(3):475–82.

78.

Aasdahl

, Pape

, Vasseljen

, Johnsen

, Gismervik

, Jensen

, et al. Effects of inpatient multicomponent occupational rehabilitation versus less comprehensive outpatient rehabilitation on somatic and mental health: Secondary outcomes of a randomized linical trial. Journal of Occupational Rehabilitation.. 2017;27(3):456–66.

79.

Kim

, Chotai

, Wick

, Khan

, Sivaganesan

, Bydon

, et al. Factors associated with return-to-work following cervical spine surgery in non-worker’s compensation setting. Spine. 2019;44(13):903–7.

80.

Marfeo

, McDonough

, Pengsheng

, Peterik

, Porcino

, Meterko

, et al. Measuring Work Related Physical and Mental Health Function: Updating the Work Disability Functional Assessment Battery (WD-FAB) Using Item Response Theory. Journal of Occupational and Environmental Medicine. 2019;61(3):219–24.

81.

Qudsyi

, Kusumaningrum

, Utami

, Fahmi

, Afsari

, Iqbal

, et al. Adaptation of AVEM (Arbeitsbezogenes Vehaltens -Und Erlebensmuster) Test To Measure Work -Related Behaviora And Experience Patterns. International Journal of Scientific & Technology Research. 2019;8(6).

82.

van Zaanen

, van Geenen

RCI

, Pahlplatz

TMJ

, Kievit

, Hoozemans

MJM

, Bakker

EWP

, et al. Three Out of Ten Working Patients Expect No Clinical Improvement of Their Ability to Perform Work-Related Knee-Demanding Activities After Total Knee Arthroplasty: A Multicenter Study. Journal of Occupational Rehabilitation. . 2019;29:585–94.

83.

Kievit

, Kuijer

PPFM

, de Haan

, Koenraadt

KLM

, Kerkhoffs

GMMK

, Schafroth

, et al. Patients return to work sooner afterunicompartmental knee arthroplasty than after total kneearthroplasty. Knee Surgery, Sports Traumatology, Arthroscopy. 2020;28:2905–16.

84.

Husmann

, Escorpizo

, Finger

. Examining Work-Related Functioning in a Physical Therapy Outpatient Clinic: Validity and Reliability of the Work Rehabilitation Questionnaire (WORQ). Journal of Occupational Rehabilitation. 2019;30:156–66.

85.

Finger

, Escorpizo

R A T

. Measuring Work-Related Functioning Using the Work Rehabilitation Questionnaire (WORQ). International Journal of Environmental Research and Public Health. 2019;16(16).

86.

Finger

, Wicki-Roten

, Leger

B R E

. Cross-Cultural Adaptation of the Work Rehabilitation Questionnaire (WORQ) to French: A Valid and Reliable Instrument to AssessWork Functioning. Journal of Occupational Rehabilitation. 2018;26.

87.

Voltmer

J-B

, Voltmer

, Deller

. Differences of Four Work-Related Behavior and Experience Patterns in Work Ability and Other Work-Related Perceptions in a Finance Company. International Journal of Environmental Research and Public Health. 2018;15.

88.

Aasdahl

, Pape

, Jensen

, Vasseljen

, Braathen

, Johnsen

, et al. Associations between the Readiness for Return to Work Scale and return to work: A prospective study. Journal of Occupational Rehabilitation. 2018;28(1):97–106.

89.

Bauernhofer

, Bassa

, Canazei

, Jiménez

, Paechter

, Papousek

, et al. Subtypes in clinical burnout patients enrolled in an employee rehabilitation program: differences in burnout profiles, depression, and recovery/resources-stress balanc. Bio Medical Central: Psychiatry. 2018;18(10):1–13.

90.

de Wind

, Boot

CRL

, Sewdas

, Scharn

, van den Heuvel

, van der Beek

. Do work characteristics predict health deterioration among employees with chronic diseases? Journal of Occupational Rehabilitation. 2018;28(2):289–97.

91.

Hara

, Bjorngaard

, Brage

, Borchgrevink

, Halsteinli

, Stiles

, et al. Randomized controlled trial of adding telephone follow-up to an occupational rehabilitation program to increase work participation. Journal of Occupational Rehabilitation. 2018;28(2):265–78.

92.

Kristiansen

D A. K.

, Pain, risk profile, self-reported and testedfunction in workers with musculoskeletal pain: a cross-sectionalstudy. European Journal of Physiotherapy. 2018;20(1):37–44.

93.

Marfeo

, Ni

, McDonough

, Peterik

, Marino

, Meterko

, et al. Improving assessment of work related mental health function using the Work Disability Functional Assessment Battery (WD-FAB). Journal of Occupational Rehabilitation. 2018;28(1):190–9.

94.

Park

, Roberts

, Esmail

, Rayani

, Norris

, Gross

. Validation of the Readiness for Return-To-Work Scale in outpatient occupational rehabilitation in Canada. Journal of Occupational Rehabilitation. 2018;28(2):332–45.

95.

Asih

, Neblett

, Mayer

, Gatchel

. Does the length of disability between injury and functional restoration program entry affect treatment outcomes for patients with chronic disabling occupational musculoskeletal disorders? Journal of Occupational Rehabilitation. 2018;28(1):57–67.

96.

Vendrig

, Schaafsma

. Reliability and validity of the work and well-being inventory (WBI) for employees. Journal of Occupational Rehabilitation. 2018;28:377–90.

97.

Mroczek

, Kotwas

A K-PI

, Woli

ÅW

, Rudnicki

, Bikowska

, Kurpas

. Relationships between the level of Social Competence and Work-related Behaviors in a group of Physicians, Nurses, and Paramedics International Journal of Psychotherapy Practice and Research. 2017;1(1):15–29.

98.

Groot

JAM

, Jonkers

, Kievit

, Kuijer

, Hoozemans

MJM

. Beneficial and limiting factors for return to work followinganterior cruciate ligament reconstruction: a retrospective cohortstudy. Archives of Orthopaedic and Trauma Surgery. 2017;137:155–66.

99.

Aasdahl

, Pape

, Vasseljen

, Johnsen

, Gismervik

, Jensen

, et al. Effects of Inpatient Multicomponent Occupational Rehabilitation versus Less Comprehensive Outpatient Rehabilitation on Somatic and Mental Health: Secondary Outcomes of a Randomized Clinical Trial. Journal of Occupational Rehabilitation.. 2017;27(3):456–66.

100.

Abegglen

, Hoffmann-Richter

, Schade

, Znoj

. Work and Health Questionnaire (WHQ): A screening tool for identifying injured workers at risk for a complicated rehabilitation. Journal of Occupational Rehabilitation. 2017;27(2):268–83.

101.

Agaliotis

, Mackey

, Heard

, Jan

, Fransen

. Personal and workplace environmental factors associated with reduced worker productivity among older workers with chronic knee pain: A cross-sectional survey. Journal of Occupational and Environmental Medicine. 2017;59(4):24–34.

102.

Amick

, Lee

, Hogg-Johnson

, Katz

, Brouwer

, Franche

, et al. How Do Organizational Policies and Practices Affect Return to Work and Work Role Functioning Following a Musculoskeletal Injury? Journal of Occupational Rehabilitation. 2017;27(3):393–404.

103.

Black

, Sim

, Collie

, Smith

. A return-to-work self-efficacy scale for workers with psychological or musculoskeletal work-related injuries. Quality & Quantity. 2017;51(1):413–24.

104.

Black

, Sim

, Collie

, Smith

. Early-Claim Modifiable Factors Associated With Return-to-Work Self-Efficacy Among Workers Injured at Work: Are There Differences Between Psychological and Musculoskeletal Injuries? Journal of Occupational and Environmental Medicine. 2017;59(12):257–62.

105.

Giummarra

, Cameron

, Ponsford

, Ioannou

, Gibson

, Jennings

, et al. Return to Work After Traumatic Injury: Increased Work-Related Disability in Injured Persons Receiving Financial Compensation is Mediated by Perceived Injustice. Journal of Occupational Rehabilitation. 2017;27(2):173–85.

106.

Howard

, Castaneda

, Gray

, Haskard-Zolnierek

, Jordan

. Psychosocial factors related to functional restoration treatment completion and return-to-function for patients with chronic disabling occupational musculoskeletal disorders. Journal of Occupational and Environmental Medicine. 2017;59(3):320–6.

107.

Kendrick

, Dhiman

, Kellezi

, Coupland

, Whitehead

, Beckett

, et al. Psychological morbidity and return to work after injury: multicentre cohort study. British Journal of General Practice. 2017;67(661):555–64.

108.

Neblett

, Mayer

, Williams

, Asih

, Cuesta-Vargas

, Hartzell

, et al. The Fear-Avoidance Components Scale (FACS): Responsiveness to Functional Restoration Treatment in a Chronic Musculoskeletal Pain Disorder (CMPD) Population. Clinical Journal of Pain. 2017;33(12):1088–99.

109.

Rahman

, Khadizah

, Naing

. Work fatigue, and musculoskeletal disorders: Comparison between emergency and critical care nurses in Brunei public hospitals. Asian Nuring Research. 2017;11:13–8.

110.

Sullivan

, Adams

, Ellis

. Targeting Catastrophic Thinking to Promote Return to Work in Individuals With Fibromyalgia. Journal of Cognitive Psychotherapy. 2012 Summer. 26(2):130–42.

111.

Sundstrup

, Jakobsen

, Thorsen

, Andersen

. Regular use of medication for musculoskeletal pain and risk of long-term sickness absence: A prospective cohort study among the general working population. European Journal of Pain. 2017;21(2):366–73.

112.

Baskan

, Yağci

, Atalay

, Telci

. Quality of life, depression and musculoskeletal pain experience among employed women: A controlled study. Journal of Back and Musculoskeletal Rehabilitation. 2016;29(3):597–601.

113.

Freimann

, Paasuke

, Merisalu

. Work-related psychosocial factors and mental health problems associated with musculoskeletal pain in nurses: A cross-sectional study. Pain Research and Management. 2016;2016:936–1016.

114.

Rayner

, Simpson

, Matcham

, Shetty

, Lahoti

, Groom

, et al. Mental disorder in limb reconstruction: Prevalence, associations and impact on work disability. Journal of Psychosomatic Research. 2016;89:53–60.

115.

Rath

, Steimann

, Ullrich

, Rotsch

, Zurborn

K-H

, Koch

, et al. Psychometric properties of the Occupational Stress and Coping Inventory (AVEM) in a cancer population. Acta Oncologica. 2015;54(2):232–42.

116.

Brouwer

, Amick

III B

, Lee

, Franche

, Hogg-Johnson

. The predictive validity of the Return-to-Work Self-Efficacy Scale for return-to-work outcomes in claimants with musculoskeletal disorders. Journal of Occupational Rehabilitation. 2015;25(4):725–32.

117.

Costello

, Bogue

, Sarma

, McGuire

. Chronic pain in Irish prison officers: Profile and predictors of pain-related disability and depression. Pain Medicine. 2015;16(12):2292–301.

118.

Hartzell

, Mayer

, Neblett

, Marquardt

, Gatchel

. Does the economy affect functional restoration outcomes for patients with chronic disabling occupational musculoskeletal disorders? Journal of Occupational Rehabilitation. 2015;25(2):378–86.

119.

Meterko

, Marfeo

, McDonough

, Jette

, Ni

, Bogusz

, et al. Work Disability Functional Assessment Battery: Feasibility and Psychometric Properties. Archives of Physical Medicine and Rehabilitation. . 2015;96:1028–35.

120.

Watt

, Ford

, Doley

, Ong

, Fritzon

, Hicks

, et al. The role of fear avoidance beliefs in return to work post-injury. Journal of Vocational Rehabilitation. 2015;43(1):75–82.

121.

Portmann Bergamaschi

, Escorpizo

, Staubli

, Finger

. Content validity of the Work Rehabilitation Questionnaire-Self-Report Version WORQ-SELF in a subgroup of spinal cord injury patients. Spinal Cord. . 2014;52(3):225–30.

122.

Becher

, Smith

, Ziran

. Orthopaedic trauma patients and depression: a prospective cohort. Journal of Orthopaedic Trauma. 2014;28(10):242–6.

123.

Carstens

JKP

, Shaw

, Boersma

, Reme

, Pransky

, Linton

. When the wind goes out of the sail - declining recovery expectations in the first weeks of back pain. European Journal of Pain. 2014;18(2):269–78.

124.

Fimland

, Vasseljen

, Gismervik

, Rise

, Halsteinli

, Jacobsen

, et al. Occupational rehabilitation programs for musculoskeletal pain and common mental health disorders: study protocol of a randomized controlled trial. BMC Public Health. 2014;14(1):368.

125.

Hartzell

, Neblett

, Perez

, Brede

, Mayer

, Gatchel

. Do comorbid fibromyalgia diagnoses change after a functional restoration program in patients with chronic disabling occupational musculoskeletal disorders? Spine. 2014;39(17):1393–400.

126.

Kennedy

, Dunstan

. Confirmatory factor analysis of the Injustice Experience Questionnaire in an Australian compensable population. Journal of Occupational Rehabilitation. 2014;24(3):385–92.

127.

Lin

K-H

, Shiao

, Guo

N-W

, Liao

S-C

, Kuo

C-Y

, Hu

P-Y

, et al. Long-Term Psychological Outcome of Workers After Occupational Injury: Prevalence and Risk Factors. Journal of Occupational Rehabilitation. 2014;24(1):1–10.

128.

Punakallio

, Lusa

, Luukkonen

, Airila

, Leino-Arjas

. Musculoskeletal pain and depressive symptoms as predictors of trajectories in work ability among finnish firefighters at 13-year follow-up. Journal of Occupational and Environmental Medicine. 2014;56(4):367–75.

129.

Wilkie

, Phillipson

, Hay

, Pransky

. Frequency and predictors of premature work loss in primary care consulters for osteoarthritis: Prospective cohort study. Rheumatology. 2014;53(3):459–64.

130.

Coutu

, Durand

, Marchand

, Labrecque

, Berbiche

, Cadieux

. Factors associated with generalized anxiety in workers undergoing work rehabilitation for persistent musculoskeletal pain. Disability and Rehabilitation. 2013;35(19):1599–607.

131.

Gagnon

, Stanos

, van der Ende

, Rader

, Harden

. Treatment outcomes for workers compensation patients in a U.S.-based interdisciplinary pain management program. Pain Practice. 2013;13(4):282–8.

132.

Grete

, Jensen

. A two-year follow-up on a program theory of return to work intervention. Work. 2013;44:165–75.

133.

Jacobsen

, Caban-Martinez

, Onyebeke

, Sorensen

, Dennerlein

, Reme

. Construction workers struggle with a high prevalence of mental distress, and this is associated with their pain and injuries. Journal of Occupational and Environmental Medicine. 2013;55(10):1197–204.

134.

Mayer

, Choi

, Howard

, Gatchel

. Evaluation of functional restoration outcomes for chronic disabling occupational lower extremity disorders. Journal of Occupational and Environmental Medicine. 2013;55(12):1489–94.

135.

Murad

, O’Brien

, Farnworth

, Chien

. Occupational competence and its relationship to emotional health in injured workers in return to work programs: a Malaysian study. Scandinavian Journal of Occupational Therapy. 2013;20(2):101–10.

136.

Vargas-Prada

, Serra

, Martínez

, Ntani

, Delclos

, Palmer

, et al. Psychological and culturally-influenced risk factors for the incidence and persistence of low back pain and associated disability in Spanish workers: findings from the CUPID study. Occupational and Environmental Medicine. 2013;70(1):57–62.

137.

Roddy

, Zwierska

, Jordan

, Dawes

, Hider

, Packham

, et al. Musculoskeletal clinical assessment and treatment services at the primary-secondary care interface: an observational study. British Journal of General Practice. 2013;63(607):141–8.

138.

Clay

, Fitzharris

, Kerr

, McClure

, Watson

. The association of social functioning, social relationships and the receipt of compensation with time to return to work following unintentional injuries to Victorian workers. Journal of Occupational Rehabilitation. 2012;22(3):363–75.

139.

Hansen

, Rasmussen

, Kyed

, Nielsen

, Andersen

. Physical and psychosocial work environment factors and their association with health outcomes in Danish ambulance personnel - a cross-sectional study. BMC Public Health. 2012;12:534.

140.

Kendrick

, Vinogradova

, Coupland

, Christie

, Lyons

, Towner

. Getting back to work after injury: the UK Burden of Injury multicentre longitudinal study. BMC Public Health. 2012;12(1):584.

141.

Lin

, Shiao

, Guo

, Liao

, Kuo

, Hu

, et al. Psychological outcome of injured workers at 3 months after occupational injury requiring hospitalization in Taiwan. Journal of Occupational Health. 2012;24:289–98.

142.

Scott

, Sullivan

. Perceived injustice moderates the relationship between pain and depressive symptoms among individuals with persistent musculoskeletal pain. Pain Research and Management. 2012;17:335–40.

143.

Stochl

, Jones

, Croudace

. Mokken scale analysis of mental health and well-being questionnaire item responses: a non-parametric IRT method in empirical research for applied health researchers. BMC Medical Research Methodology. 2012;12(74).

144.

Truchon

, Schmouth

, Cote

, Fillion

, Rossignol

, Durand

. Absenteeism screening questionnaire (ASQ): A new tool for predicting long-term absenteeism among workers with low back pain. Journal of Occupational Rehabilitation. 2012;22(1):27–50.

145.

Saltychev

, Laimi

, Oksanen

, Pentti

, Virtanen

, Kivimäki

, et al. Effect of a multidisciplinary rehabilitation programme on perceived health among employees at increased risk of incapacity for work: a controlled study. Clinical Rehabilitation. 2012;26(6):513–22.

146.

Wahlin

, Ekberg

, Persson

, Bernfort

, Oberg

. Association between clinical and work-related interventions and return-to-work for patients with musculoskeletal or mental disorders. Journal of Rehabilitation Medicine. 2012;44(4):355–62.

147.

Wideman

, Scott

, Martel

, Sullivan

MJL

. Recovery from depressive symptoms over the course of physical therapy: A prospective cohort study of individuals with work-related orthopaedic injuries and symptoms of depression. Journal of Orthopaedic and Sports Physical Therapy. 2012;42(11):957–67.

148.

Brouwer

, Franche

R-L

, Hogg-Johnson

, Lee

, Krause

, Shaw

. Return-to-Work Self-Efficacy: Development and Validation of a Scale in Claimants with Musculoskeletal Disorders. Journal of Occupational Rehabilitation. 2011;21(2):244–58.

149.

Dawson

, Schluter

, Hodges

, Stewart

, Turner

. Fear of movement, passive coping, manual handling, and severe or radiating pain increase the likelihood of sick leave due to low back pain. Pain. 2011;152(7):1517–24.

150.

Devereux

, Rydstedt

, Cropley

. Psychosocial work characteristics, need for recovery and musculoskeletal problems predict psychological distress in a sample of British workers. Ergonomics. 2011;54(9):840–8.

151.

Jensen

, Jensen

, Christiansen

, Nielsen

. Oneyear follow-up in employees sick-listed because of low back pain: randomized clinical trial comparing multidisciplinary and brief interventionv. Spine. 2011;36(15):1180–9.

152.

Mahmud

, Kenny

, Zein

, Hassan

. Ergonomic training reduces musculoskeletaldDisorders among office workers: Results from the 6-Month follow-up. Malaysian Journal of Medical Science. 2011;18(2):16–26.

153.

Wideman

, Sullivan

, Ward

, Tripp

, French

, Adams

, Stanish

. Differential predictors of the long-term levels of pain intensity, work disability, healthcare use, and medication use in a sample of workers’ compensation claimants. Pain. 2011;152(2):376–83.

154.

Haddadi

, Beshharat

. Resilience, vulnerability and mental health. Procedia Social and Behavioral Sciences. 2010;5:639–42.

155.

Steenstra

, Ibrahim

, Franche

, Hogg-Johnson

, Shaw

, Pransky

. Validation of a risk factor-based intervention strategy model using data from the readiness forrReturn to work cohort study. Journal of Occupational Rehabilitation. 2010;20(3):394–405.

156.

Franche

, Severin

, Hogg-Johnson

, Lee

, Cote

, Krause

. A multivariate analysis of factors associated with early offer and acceptance of a work accommodation following an occupational musculoskeletal injury. Journal of Occupational & Environmental Medicine. 2009;51(8):969–83.

157.

Opsteegh

, Reinders-Messelink

, Schollier

, Groothoff

, Postema

, Dijkstra

, et al. Determinants of return to work in patients with hand disorders and hand injuries. Journal of Occupational Rehabilitation. . 2009;19(3):245–55.

158.

Sardá

Jr , Nicholas

, Asghari

, Pimenta

. The contribution of self-efficacy and depression to disability and work status in chronic pain patients: A comparison between Australian and Brazilian samples. European Journal of Pain. 2009;13(2):189–95.

159.

Stice

, Dik

. Depression among injured workers receiving vocational rehabilitation: contributions of work values, pain, and stress. Journal of Occupational Rehabilitation. 2009;19(4):354–63.

160.

Hincapié

, Cassidy

, Côté

. Is a history of work-related low back injury associated with prevalent low back pain and depression in the general population? BMC Musculoskeletal Disorders. 2008;9:22.

161.

Sullivan

, Adams

, Horan

, Maher

, Boland

, Gross

. The role of perceived injustice in the experience of chronic pain and disability: scale development and validation. Journal of Occupational Rehabilitation. 2008;18(3):249–61.

162.

Sullivan

, Adams

, Tripp

, Stanish

. Stage of chronicity and treatment response in patients with musculoskeletal injuries and concurrent symptoms of depression. Pain. 2008;135(1/2):151–9.

163.

Harris

, Young

, Rae

, Jalaludin

, Solomon

. Predictors of general health after major trauma. Journal of Trauma-Injury Infection and Critical Care. 2008;64(4):969–74.

164.

Baldwin

, Butler

, Johnson

, Cote

. Self-reported severity measures as predictors of return-to-work outcomes in occupational back pain. Journal of Occupational Rehabilitation. 2007;17(4):683–700.

165.

Corbiere

, Sullivan

, Stanish

, Adams

. Pain and depression in injured workers and their return to work: A longitudinal study. Canadian Journal of Behavioural Science. 2007;39(1):23–31.

166.

Dunstan

, Covic

. Can a rural community-based work-related activity program make a difference for chronic pain-disabled injured workers? The Australian Journal of Rural Health. 2007;15(3):166–71.

167.

Franche

, Severin

, Hogg-Johnson

, Coté

, Vidmar

, Lee

. The impact of early workplace-based return-to-work strategies on work absence duration: a 6-month longitudinal study following an occupational musculoskeletal injury. Journal of Occupational and Environmental Medicine. 2007;49(9):960–74.

168.

Franche

, Corbière

, Lee

, Breslin

, Hepburn

. The Readiness for Return-To-Work (RRTW) scale: development and validation of a self-report staging scale in lost-time claimants with musculoskeletal disorders. Journal of Occupational Rehabilitation. 2007;17(3):450–72.

169.

Harris

, Young

, Rae

, Jalaludin

, Solomon

. Factors associated with back pain after physical injury: a survey of consecutive major trauma patients. Spine. 2007;32(14):1561–5.

170.

Holtedahl

, Veirsted

. Physical, social and emotional functionafter work accidents: A medicolegal perspective. Work. 2007;28:363–70.

171.

Lange

, Burgmer

, Braunheim

, Heuft

. Prospective analysis of factors associated with work reentry in patients with accident-related injuries. Journal of Occupational Rehabilitation. 2007;17(1):1–10.

172.

Lillefjell

, Jakobsen

. Sense of coherence as a predictor of work reentry following multidisciplinary rehabilitation for individuals with chronic musculoskeletal pain. Journal of Occupational Health Psychology. 2007;12(3):222–31.

173.

, Li-Tsang

, Lam

, Hui

, Chan

. The effect of a ‘training on work readiness’ program for workers with musculoskeletal injuries: a randomized control trial (RCT) study. Journal of Occupational Rehabilitation. 2006;16(4):529–41.

174.

Shaw

, Means-Christensen

, Slater

, Patterson

, Webster

, Hampton Atkinson

. Shared and independent associations of psychosocial factors on work status among men with subacute low back pain. Clinical Journal of Pain. 2007;23(5):409–16.

175.

Brattberg

. Internet-based rehabilitation for individuals with chronic pain and burnout: a randomized trial. International Journal of Rehabilitation Research. 2006;29(3):221–7.

176.

Gatchel

, Mayer

, Theodore

. The pain disability questionnaire: relationship to one-year functional and psychosocial rehabilitation outcomes. Journal of Occupational Rehabilitation. 2006;16(1):75–94.

177.

Kosny

, Franche

, Pole

, Krause

, Côté

, Mustard

. Early healthcare provider communication with patients and their workplace following a lost-time claim for an occupational musculoskeletal injury. Journal of Occupational Rehabilitation. 2006;16(1):27–39.

178.

Lillefjell

, Krokstad

, Espnes

. Factors predicting work ability following multidisciplinary rehabilitation for chronic musculoskeletal pain. Journal of Occupational Rehabilitation. 2006;16(4):543–55.

179.

McGeary

, Mayer

, Gatchel

. High pain ratings predict treatment failure in chronic occupational musculoskeletal disorders. Journal of Bone and Joint Surgery - American Volume. 2006;88(2):317–25.

180.

Takahashi

, Kikuchi

, Konno

, Morita

, Suzukamo

, Green

, et al. Discrepancy between disability and the severity of low back pain: Demographic, psychologic, and employment-related factors. Spine. 2006 April;31(8):931–9.

181.

Wall

, Ogloff

, Morrissey

. The psychology of injured workers: Health and cost of vocational rehabilitation. Journal of Occupational Rehabilitation. 2006;16(4):513–28.

182.

Allen

, Hubbard

, Sullivan

. The burden of pain on employee health and productivity at a major provider of business services. Journal of Occupational and Environmental Medicine. 2005;47(7):658–70.

183.

Cheng

, Li-Tsang

. A comparison of self-perceived physical and psycho-social worker profiles of people with direct work injury, chronic low back pain, and cumulative trauma. Work. 2005;25(4):315–23.

184.

Chibnall

, Tait

, Andresen

, Hadler

. Race and socioeconomic differences in post-settlement outcomes for African American and Caucasian Workers’ Compensation claimants with low back injuries. Pain. 2005;114(3):462–72.

185.

Coutu

, Durand

, Loisel

, Dupuis

, Gervais

. Measurement Properties of a New Quality of Life Measure for Patients with Work Disability Associated with Musculoskeletal Pain. Journal of Occupational Rehabilitation. 2005;15(3):295–312.

186.

Harman

, Ruyak

. Working through the pain: a controlled study of the impact of persistent pain on performing a computer task. Clinical Journal of Pain.. 2005;21(3):216–22.

187.

Schultz

, Crook

, Berkowitz

, Milner

, Meloche

. Predicting return to work after low back injury using the Psychosocial Risk for Occupational Disability Instrument: a validation study. Journal of Occupational Rehabilitation. 2005;15(3):365–76.

188.

van Duijn

, Lötters

, Burdorf

. Influence of modified work on return to work for employees on sick leave due to musculoskeletal complaints. Journal of Rehabilitation Medicine. 2005;37(3):172–9.

189.

Amick III

, Habeck

, Ossmann

, Fossel

, Keller

, Katz

. Predictors of Successful Work Role Functioning after Carpal Tunnel Release Surgery. Journal of Occupational and Environmental Medicine. 2004;46(5):490–500.

190.

Gustafsson

, Ahlstrom

. Problems experienced during the first year of an acute traumatic hand injury - a prospective study. Journal of Clinical Nursing. 2004;13(8):986–95.

191.

Schultz

, Crook

, Meloche

, Berkowitz

, Milner

, Zuberbier

. Psychosocial factors predictive of occupational low back disability: towards development of a return-to-work model. Pain. 2004;107(1–2):77–8.

192.

Kopta

SM LJ

. Psychometric Evaluation of The Behavioral Health Questionnaire- A Brief Instrument For Assessing Global Mental Health And The Three Phases Of Psychotherapy Outcome. Psychotherapy Research. 2002;12(4):413–26.

193.

Peele

, Tollerud

. Depression and occupational injury: results of a pilot investigation. Journal of Occupational and Environmental Medicine. 2005;47(4):424–7.

194.

DeBerard

, Masters

, Colledge

, Schleusener

, Schlegel

. Outcomes of posterolateral lumbar fusion in Utah patients receiving workers’ compensation: a retrospective cohort study. Spine. 2001;26(7):738–46.

195.

Marhold

, Linton

, Melin

. A cognitive-behavioral return-to-work program: Effects on pain patients with a history of long-term versus short-term sick leave. Pain. 2001;91(1-2):155–63.

196.

Keogh

, Nuwayhid

, Gordon

, Gucer

. The impact of occupational injury on injured worker and family: outcomes of upper extremity cumulative trauma disorders in Maryland workers. American Journal of Industrial Medicine. 2000;38(5):498–506.