Selbsteinschätzung der funktionellen Leistungsfähigkeit (SELF): Messeigenschaften in der beruflich orientierten medizinischen Rehabilitation

Zusammenfassung Ziel Ermittlung der konkurrenten, diskriminanten und prognostischen Validität der Selbsteinschätzung der funktionellen Leistungsfähigkeit (SELF) bei orthopädischen Patienten der beruflich orientierten medizinischen Rehabilitation. Material und Methoden In einer prospektiven Kohortenstudie wurden Patienten aus vier Einrichtungen mit beruflich orientierter medizinischer Rehabilitation rekrutiert. Als Außenkriterien für die Überprüfung der konkurrenten Validität dienten der Work Ability Score (WAS) und die Functional Capacity Evaluation (FCE)-basierte Einschätzung der zulässigen Arbeitsschwere nach REFA. Für die diskriminante Validität wurde das Ultra-Kurz-Screening (UKS) verwendet. Die a priori definierten Hypothesen wurden anhand von bivariaten und partiellen Korrelationsmaßen überprüft. Die prognostische Validität wurde mittels logistischer Regressionsmodelle berechnet. Zielgröße war die Rückkehr in Arbeit (RTW) drei Monate nach Reha-Ende. Ergebnisse Die Daten von 227 rekrutierten Probanden wurden analysiert. Hinsichtlich der konkurrenten Validität bestätigten sich die a priori definierten Hypothesen (0,4≤r≤0,6) zum WAS (r=0,41) und der zulässigen Arbeitsschwere (r=0,50). Der Zusammenhang mit dem UKS lag erst nach Kontrolle der derzeitigen Schmerzen (r=−0,24) im erwarteten Bereich (−0,1≤r≤−0,3). Zur Überprüfung der prognostischen Validität wurden die von 127 Probanden verfügbaren Nachbefragungsdaten ausgewertet. Ein Anstieg des SELF um einen Punkt war nach Kontrolle der Arbeitsschwere der Tätigkeit mit einer 1,07-fach (p<0,001) höheren RTW-Chance assoziiert. Schlussfolgerung Die konkurrente und diskriminante Validität des SELF wurde bei orthopädischen Patienten der beruflich orientierten medizinischen Rehabilitation bestätigt. Das Instrument erwies sich darüber hinaus als prognostisch valide. Die Anpassungsgüte des ausschließlich auf dem SELF basierenden Modells war jedoch gering.

Evening chronotype is associated with poor work ability and disability pensions at midlife: a Northern Finland Birth Cohort 1966 Study

ObjectivesThis is the first general population study to evaluate whether evening chronotypes (E) have poorer work ability (WA) and higher probability for early disability pensions (DPs) than morning types (M) in middle age.MethodsAmong non-retired individuals (n=5831; 2672 men, 3159 women) of the Northern Finland Birth Cohort 1966, chronotype was determined at the age of 46 years with shortened Morningness–Eveningness Questionnaires in 2012. The outcomes were poor WA in 2012, indicated by scores 0–7/10 of Work Ability Score, and registered emergence of DPs in 2013–2016. Multivariate logistic and Cox regression analyses were separately adjusted for factors related to sleep, health and behaviours, sociodemographic and economic factors, or working times.ResultsE-types represented 10% (n=264) of men and 12% (n=382) of women. Compared with M-types, the unadjusted ORs with 95% CIs of poor WA for E-type men and women were 2.24 (95% CI 1.62 to 3.08) and 2.33 (95% CI 1.74 to 3.10), respectively. The odds remained statistically significant and approximately twofold in all separate adjustment models tested. During 2013–2016, 8 (3.0%) E-type men and 10 (2.6%) E-type women were granted DP, which, compared with M-types, represented a higher HR that was statistically significant for men (HR 3.12, 95% CI 1.27 to 7.63) and remained significant except when multiple sleep variables or working times were adjusted for.ConclusionsEveningness appears a previously unrecognised risk factor for poor WA and early disability. We suggest that individual chronotype be considered in attempts to lengthen work careers.

Mediating Factors for the Relationship between Stress and Work Ability over Time in Young Adults

Stress can affect work ability. The aim of this study was to identify how this pathway is mediated over time in young adults. Participants of the Work Ability in Young Adults cohort were selected. A theoretical framework was built, which lead to a statistical model. Selected dimensions of mediators were recovery, work demands affecting private life, feelings of control over private life, and physical activity in leisure time. A quadruple serial mediation model was built with four mediators. The total effect of stress on work ability was −0.3955, 95% CI [−0.4764, −0.3146]. The total indirect effect amounted to 81% with an effect of −0.3182, 95% CI [−0.3750, −0.2642]. The relationship between stress and Work Ability Score five years later in young adults was mediated by stress five years later, work demands affecting private life, feelings of control over private life and feeling well-rested upon waking. These results indicate that work demands affecting private life and feelings of control over private life are important mediators of the relationship between stress and work ability in young adults. A well-balanced relationship between work and private life can counteract the influence of stress on work ability in this age group.

Normative reference values and physical factors associated with work ability: a cross-sectional observational study

ObjectivesTo establish normative reference values for work ability in healthy Australian adults using the Work Ability Score and investigate the association of physical performance factors.MethodsThe Work Ability Score was collected from 720 participants aged 18–101 years from the 1000 Norms Project. Physical performance was evaluated by assessing isometric strength of 13 muscle groups; flexibility of six joints; and 11 functional measures categorised as gross motor, fine motor and balance tasks. Correlations and multiple regression analyses were performed to identify physical performance factors independently associated with work ability.ResultsAge-stratified reference values were generated for work ability. Work ability increased during young adulthood (18–44 years) and declined from middle adulthood (45–64 years) into older adulthood (≥65 years), with no sex differences. Greater gross motor function and balance correlated with work ability (r=−0.498 to −0.285; p<0.001). Multiple regression identified younger age, being employed and a faster timed up and down stairs test as significant independent factors associated with work ability (r2=0.333, p<0.001).ConclusionsReference data can be used to identify individuals with low work ability. This study has identified physical factors associated with work ability that can potentially be targeted to maintain longevity in work. Physical tests such as the timed up and down stairs test may assist in the development of objective job-specific screening tools to assess work ability, supplementing subjective evaluation.

Important work demands for reducing sickness absence among workers with neck or upper back pain: a prospective cohort study

Background The aim of this study was to investigate what exposure to work demands, physical and psychosocial, is associated with lower levels of sickness absence among workers with neck or upper back pain in different groups, by age, gender, duration of sickness absence and work ability score. Methods This study was a prospective study of 4567 workers with neck or upper back pain. Data on neck or upper back pain, work demand and work ability were obtained from the Swedish Work Environment survey over a 3–year period (2009–2013). Register data on sickness absence, 1 year after each survey was conducted, were obtained from the Swedish health insurance database. Analyses were performed to estimate the association between self-reported work demands and registered sick days > 14 days. The analyses were stratified for gender, age group and work ability score. Results Lower numbers of sick days were found for workers reporting low exposure to lifting ≥15 kg and twisted or forward-leaning work postures. Lower numbers of sick days were found for workers reporting high work control and seated work. The associations were generally stronger in the older age groups for the physical work demands. Conclusions The findings in this study suggest that certain physical work demands and having high control over one’s work can result in lower sickness absence, especially among middle-aged and older workers with neck or upper back pain.

Work ability score and future work ability as predictors of register-based disability pension and long-term sickness absence: A three-year follow-up study

Aims: We investigated two single items of the Work Ability Index – work ability score, and future work ability – as predictors of register-based disability pension and long-term sickness absence over a three-year follow-up. Methods: Survey responses of 11,131 Finnish employees were linked to pension and long-term (more than 10 days) sickness absence register data by Statistics Finland. Work ability score was divided into poor (0–5), moderate (6–7) and good/excellent (8–10) and future work ability into poor (1–2) and good (3) work ability at baseline. Cox proportional hazard regressions were used in the analysis of disability pension, and a negative binomial model in the analysis of long-term sickness absence. The results were adjusted for several background, work- and health-related covariates. Results: Compared with those with good/excellent work ability scores, the hazard ratios of disability pension after adjusting for all covariates were 9.84 (95% CI 6.68–14.49) for poor and 2.25 (CI 95% 1.51–3.35) for moderate work ability score. For future work ability, the hazard ratio was 8.19 (95% CI 4.71–14.23) among those with poor future work ability. The incidence rate ratios of accumulated long-term sickness absence days were 3.08 (95% CI 2.19–4.32) and 1.59 (95% CI 1.32–1.92) for poor and moderate work ability scores, and 1.51 (95% CI 0.97–2.36) for poor future work ability. Conclusions: The single items of work ability score and future work ability predicted register-based disability pension equally well, but work ability score was a better predictor of register-based long-term sickness absence days than future work ability in a three-year follow-up. Both items seem to be of use especially when examining the risk of poor work ability for disability but also for long sick leave.