AYURVEDIC MANAGEMENT OF LOW BACK PAIN WITH MODIFIED ABHYANGA: A CASE STUDY

Low back pain is one of the widespread health problems and the leading cause of activity limitation and work absence worldwide. Among the types of low back pain, low back pain due to mechanical causes is more common. Abhyanga is an effective treatment for low back pain, which can be done as an OPD level treatment without causing much financial burden. Though it is a widely practised procedure, we did not explore its possibilities properly. Abhyanga can be modified by incorporating other massage techniques like Swedish massage for better application. Cupping is a variety of tapotement massage techniques of a Swedish massage. Abhyanga performed along with the cupping massage techniques is very effective in managing low back pain. A 45year old lady patient came to OPD complaining of low back pain. On examination, stooping posture during her work hours was concluded as the reason for the pain. She was treated with modified Abhyanga with moorchita tilataila for seven days. The procedure duration was 20 minutes. Treatment was found to be effective after treatment and after follow up as her symptoms wholly vanished.

Work absenteeism and disability associated with psoriasis and psoriatic arthritis in the USA—a retrospective study of claims data from 2009 TO 2020

Objectives To compare work absenteeism and short-term disability among adults with psoriasis or psoriatic arthritis (PsA), versus controls in the USA. Methods Adults eligible for work absenteeism and/or short-term disability benefits between 1/1/2009 and 4/30/2020 were screened in the IBM® MarketScan® Commercial and Health and Productivity Management Databases. The following groups were defined: (1) psoriasis: ≥ 2 psoriasis diagnoses ≥ 30 days apart and no PsA diagnoses; (2) PsA: ≥ 2 PsA diagnoses ≥ 30 days apart; (3) control: absence of psoriasis and PsA diagnoses. Controls were matched to psoriasis and PsA patients based on age, gender, index year, and comorbidities. Non-recreational work absences and sick leaves were evaluated in absentee-eligible patients, and short-term disability was evaluated in short-term disability-eligible patients. Costs (in 2019 USD) associated with each type of work absence were evaluated. Results 4261 psoriasis and 616 PsA absentee-eligible and 25,213 psoriasis and 3480 PsA short-term disability-eligible patients were matched to controls. Average non-recreational work absence costs were $1681, $1657, and $1217 for the PsA, psoriasis, and control group, respectively. Compared with psoriasis patients and controls, more PsA patients had sick leaves after 1 year (56.2% versus 55.6% and 41.5%, p < 0.0001). Similarly, short-term disability was more frequent in PsA patients than psoriasis patients and controls at year one (8.8% versus 5.6% and 4.7%, p < 0.0001) and corresponding costs were higher ($605, $406, and $335 on average, p < 0.0001). Conclusion Annual work absenteeism and short-term disability were consistently greater among patients with PsA and psoriasis than controls, highlighting the substantial economic burden of psoriatic disease. Key points• Patients with PsA had greater short-term disability compared with patients with psoriasis and patients with neither psoriasis nor PsA.• Patients with PsA and patients with psoriasis incurred greater non-recreational work absences and sick leaves than patients with neither psoriasis nor PsA.

First Contact Practitioners’ (FCPs) and General Practitioners’ Perceptions Towards FCPs Delivering Vocational Advice to Patients with Musculoskeletal Conditions: A Qualitative Investigation of the Implementation Potential of the I-SWAP Initiative

Purpose Musculoskeletal (MSK) pain is a common cause of work absence. The recent SWAP (Study of Work And Pain) randomised controlled trial (RCT) found that a brief vocational advice service for primary care patients with MSK pain led to fewer days’ work absence and provided good return-on-investment. The I-SWAP (Implementation of the Study of Work And Pain) initiative aimed to deliver an implementation test-bed of the SWAP vocational advice intervention with First Contact Practitioners (FCP). This entailed adapting the SWAP vocational advice training to fit the FCP role. This qualitative investigation explored the implementation potential of FCPs delivering vocational advice for patients with MSK pain. Methods Semi-structured interviews and focus groups were conducted with 10 FCPs and 5 GPs. Data were analysed thematically and findings explored using Normalisation Process Theory (NPT). Results I-SWAP achieved a degree of ‘coherence’ (i.e. made sense), with both FCPs and GPs feeling FCPs were well-placed to discuss work issues with these patients. However, for many of the FCPs, addressing or modifying psychosocial and occupational barriers to return-to-work was not considered feasible within FCP consultations, and improving physical function was prioritised. Concerns were also raised that employers would not act on FCPs’ recommendations regarding return-to-work. Conclusion FCPs appear well-placed to discuss work issues with MSK patients, and signpost/refer to other services; however, because they often only see patients once they are less suited to deliver other aspects of vocational advice. Future research is needed to explore how best to provide vocational advice in primary care settings.

POS0499 WORK ABSENCE DUE TO MUSCULOSKELETAL SYMPTOMS IN PATIENTS AT-RISK OF RHEUMATOID ARTHRITIS IS COMPARABLE TO THOSE WITH ESTABLISHED DISEASE

Background:Rheumatoid arthritis (RA) is an established cause of disability and work absence; however, little is known about the impact of musculoskeletal (MSK) symptoms on sick leave in patients at-risk of developing the disease.Objectives:To describe the sick leave of individuals at-risk of RA, compared to patients who had recently been diagnosed with RA, over a 12-month period. Additionally, to investigate baseline predictors for sick leave within the first 12 months.Methods:A prospective observational cohort for individuals at-risk of RA was conducted. A total of 591 consecutive anti-citrullinated protein antibodie positive (ACPA+) individuals, with no clinical synovitis were recruited. A MSK ultrasound scan and a blood test were performed at baseline, and information about employment regime (retired, not in a paid job, part time and full time), days of sick leave and reasons for absences within the previous months were collected every 3 months and analysed at baseline, 6 months, 12 months and at the moment of diagnosis of an inflammatory arthritis (IA) (if the patient had progressed). Subjects who had retired (n=80) were excluded from the analysis.A comparison was made with 114 RA patients from an observational study. Employment information was collected at pre-treatment, 6 months and 1 year after diagnosis.Univariable and logistic regression analyses were performed to assess predictors of work absence due to MSK reasons in the next 12 months from baseline for at-risk individuals.Results:Even though the reasons for unemployment were not available, there were no statistically significant differences between employment rates across the timepoints of the study for the at-risk individuals’ group (p=0.778). A similar pattern was observed in the RA patient group; which also maintained the same employment rates throughout the study (p=0.311) and these were comparable to the at-risk individuals’ (p=0.480).Over 35% of at-risk individuals in paid employment had work absences in the 3 months prior to the baseline visit. Of these 65.5% were due to MSK related issues, meaning 23.2% of the total absences were MSK related. The other reasons for work absence can be seen in table 1. This fell to 12.9% of the total absences at 6 months (which probably reflects clinical intervention) and increased to 38% if the patient progressed to an IA (graph 1).Table 1.REASONS FOR SICK LEAVE AT BASELINE IN INDIVIDUALS AT-RISK OF RA (%)MSK related issues65.5Flu-like symptoms20.1Gastrointestinal issues19.4Stress/anxiety14.4Headaches11.5Infection3.6Fatigue1.4Other3.6The percentage of individuals who took absence from work due to MSK related issues, was similar in both the at risk and RA group, including an initial reduction possibly due to drug intervention (graph 1). However, the median number of days off work 3 months prior baseline, 6 months and 1 year in RA patients tended to be higher than those in the at-risk group (10, 2 and 6 versus 5, 4 and 3 respectively).Several factors were assessed to predict sick leave within 12 months in at-risk individuals: age, gender, smoking status, ACPA, rheumatoid factor (RF), anti-nuclear antibodies (ANA), C-reactive protein (CRP), early morning stiffness, shared epitope, joint pain, joint tenderness and abnormal findings in the ultrasound scan (erosions or power doppler); however, only RF [OR 0.18; p=0.018; 95% CI (0.04-0.84)] and CRP [OR 1.3; p=0.021; 95%CI (1.04-1.60)] were statistically significant in the multivariable analysis.Conclusion:Even though being at-risk of RA is not considered a potential cause of disability, results show that the burden on the workplace, due to MSK related absences, was comparable to subjects diagnosed with RA. Although further investigation is required, initial data suggests that clinical intervention may reduce this burden; which tends to be higher in at-risk individuals with a negative RF and a high CRP.Graph 1.Percentage of individuals who had work absences related to MSK issues 3 months prior to each timepoint.Acknowledgements:H. SinghT. HullandG. John- Leeds Cares -Disclosure of Interests:None declared

Changes to body mass index, work self-efficacy, health-related quality of life, and work participation in people with obesity after vocational rehabilitation: a prospective observational study

Background People on or at risk of sick leave from work due to obesity or obesity-related problems participated in a new vocational rehabilitation (VR). The study aimed to examine the outcome changes in the participants’ health-related quality of life (HRQoL), body mass index (BMI), return to work self-efficacy (RTWSE), work ability scale (WAS) and degree of work participation (DWP) after their participation in the 12-month VR programme. The secondary aim was to examine associations between the outcome changes and HRQoL at 12-month follow-up, measured with the HRQoL 15D instrument (15D). Methods This prospective observational study included 95 participants. The one-year multidisciplinary VR programme with an integrated work and lifestyle intervention included 4 weeks of inpatient stay followed-up by 5 meetings. A paired sample t-test was used to examine changes in HRQoL, BMI, RTWSE, WAS, and DWP between baseline and the 12-month follow-up. Multiple linear regression analyses explored associations between changes in HRQoL and the outcome variables. Results The participants achieved statistically significant changes in HRQoL (2.57, 95% CI: 1.35 to 3.79), BMI (− 2.33, 95% CI: − 3.10 to − 1.56), RTWSE (15.89, 95% CI: 4.07 to 27.71), WAS (1.51, 95% CI: 0.83 to 2.20) and DWP (18.69, 95% CI: 8.35 to 29.02). At 12 months, a significant association was found between HRQoL and BMI (B = − 0.34, 95% CI: − 0.65 to − 0.04), RTWSE (B = 0.02, 95% CI: 0.004 to 0.04), WAS (B = 0.91, 95% CI: 0.55 to 1.28), DWP (B = − 0.02, 95% CI: − 0.04 to 0.001) and work absence (B = − 0.01, 95% CI: − 0.02 to − 0.002). The regression model explained 71.8% of the HRQoL variance. Conclusion The results indicated positive changes in HRQoL, BMI, RTWSE, WAS and DWP from baseline to the 12-month follow-up. Factors associated with HRQoL at the 12-month follow-up were decreased BMI, increased RTWSE, improved WAS and reduced work absence. Future studies examining VR programmes with lifestyle interventions for people with obesity are recommended. Trial registration Norwegian Regional Committee for Medical and Health Research Ethics (REC) 2017/573, Clinical Trials NCT03286374, registered 18. September 2017. https://clinicaltrials.gov/ct2/results?cond=Obesity&term=Anita+Dyb+Linge&cntry=NO&state=&city=&dist=

Trends in incidence rate, health care use, and costs due to rib fractures in the Netherlands

Purpose This study aimed to examine population-based trends in the incidence rate, health care consumption, and work absence with associated costs in patients with rib fractures. Methods A retrospective nationwide epidemiologic study was performed with data from patients with one or more rib fractures presented or admitted to a hospital in the Netherlands between January 1, 2015 and December 31, 2018 and have been registered in the Dutch Injury Surveillance System (DISS) or the Hospital Discharge Registry (HDR). Incidence rates were calculated using data from Statistics Netherlands. The associated direct health care costs, costs for lost productivity, and years lived with disability (YLD) were calculated using data from a questionnaire. Results In the 4-year study period, a total of 32,124 patients were registered of which 19,885 (61.9%) required hospitalization with a mean duration of 7.7 days. The incidence rate for the total cohort was 47.1 per 100,000 person years and increased with age. The mean associated direct health care costs were €6785 per patient and showed a sharp increase after the age of 75 years. The mean duration of work absence was 44.2 days with associated mean indirect costs for lost productivity of €22,886 per patient. The mean YLD was 0.35 years and decreased with age. Conclusion Rib fractures are common and associated with lengthy HLOS and work absenteeism as well as high direct and indirect costs which appear to be similar between patients with one or multiple rib fractures and mostly affected by admitted patients and age.

Premenstrual Symptoms and Work: Exploring Female Staff Experiences and Recommendations for Workplaces

Most women experience some premenstrual symptoms during their reproductive years. Yet, this is an under-researched health issue, particularly in the context of work. This study aimed to: (i) understand the prevalence and severity of premenstrual symptoms experienced by working females, and their association with key work outcomes; (ii) explore factors that may be influencing these symptoms and their severity; and (iii) examine how organizations might help staff with premenstrual symptoms that may be impacting their working lives. An online, anonymous survey collected quantitative and qualitative data from 125 working women in the UK. Over 90% of the sample reported some premenstrual symptoms; 40% experienced premenstrual symptoms moderately or severely. Higher symptom severity was significantly (p < 0.05) associated with poor presenteeism, intention to reduce working hours, and higher work absence (time off work, being late, leaving early). Moderate/severe symptoms were significantly associated with several individual-related variables: lower perceived general health, higher alcohol consumption, poorer sleep quality, anxiety, depression, hormonal contraception, and using fewer coping approaches towards premenstrual symptoms (avoiding harm, adjusting energy levels); and work-related variables: poorer work–life balance, lower levels of psychological resilience, higher perceived work demands, less control over work. Disclosure of premenstrual symptoms and sickness absence because of premenstrual symptoms was very low, typically because of perceptions of appropriateness as a reason for work absence, gender of line managers (male), and it being a personal or embarrassing topic. Staff with moderate to severe premenstrual symptoms were statistically more likely to disclose reason for absence than those with milder symptoms. Recommendations and suggestions for employers and line managers include the need to train staff to improve knowledge about women’s experience of premenstrual symptoms, to be able to communicate effectively with women and to provide tailored support and resources for those who need it. Implications for future research, policy and practice are discussed.

Work absence in patients with asthma and/or COPD: a population-based study

Chronic obstructive pulmonary disease (COPD) and asthma impact on work productivity, but their population-based burden and clinical predictors are understudied. In this observational, real-life study, work absence of 14,383 asthma and/or COPD patients present in the MAJORICA cohort (Spain) was compared with the general population. Using multivariable regression, we studied the association of work absence with demographic and clinical characteristics. Patients with asthma and/or COPD had more work absence than the general population (15.2% vs 8.9%, p < 0.0001). Patients with asthma had more often periods of work absence compared to patients with COPD (16.0% vs 12.8%, p < 0.0001). The number of days absent were, however, less in asthma than in COPD (median: 15 days [IQR: 5–51] vs 39 days [IQR: 13–134], p < 0.001). Patients with asthma–COPD overlap were in between (14.5% with absence; median: 27 days [IQR: 10–82]). Comorbid anxiety, allergic rhinitis, and sleep apnoea were independently associated with more work absence.