At work in spite of pain : prevention and rehabilitation in two predominantly female workplaces, their effects and further development of analysis methods

Abstract

The overall aim of the thesis is to study the effects of preventive and rehabilitative interventions for employees at work despite pain at predominantly female workplaces, and further development of analysis methods.

The study had two intervention groups and two non-randomised reference groups. Hospital cleaners and home-helps were selected as intervention and reference groups for the empirical studies. In the first three studies the subjects were women with pain problems. In the last two studies only hospital cleaners were involved, but the selection was broadened to include everyone employed at the workplaces at the time.

The hospital cleaners' intervention programme comprised occupational organisational measures, competence development, physical and psychosocial working environmental and rehabilitation measures on both an individual and a group basis. The home-help's programme comprised a 2-week stay at an orthopaedic rehabilitation unit, training of supervisors, massage by colleagues, purchase of training equipment and stress management. The intervention lasted 12 months for the hospital cleaners and 8 months for the home-helps. A classical model for quasi-experimental design was used in the first three studies. In the last two studies, statistical control was applied as a complement.

In Study 1, all four groups experienced substantial lowering in quality of life related to the three dimensions: bodily pain, general health perception and vitality. No effects of the intervention were demonstrated. In the hospital cleaners' intervention group, the introduction of new cleaning materials and methods seemed to contribute to a reduction in workload, allowing them to take more rest breaks during working time (Study 11). In the home-helps' intervention group, a reduction both in workload and in more responsible tasks were shown, together with reduced psychosomatic stress reactions. Study III showed a very high prevalence of rotator cuff myalgia/tendinitis, myalgia/tendinitis of the dorsal neck and relatively high prevalence of myalgia/tendinitis in hip muscles. Neurogenic pain was rare. No fibromyalgia syndrome was found. Limited effects were shown on the pain outcome measures. After the intervention, more intervention than reference group subjects had an improved clinical picture. In Study IV a simple comparison did not demonstrate differences, but the intervention produced a difference in total absenteeism in the younger age group when a number of covariates were included. Those with previously high sickness absence reduced their total absence most. The interchangeability of short-term sickness absence and short- term leave was reduced. The intervention was shown to contribute to preventing an increase in sickness absence costs at the company level (Study V). The two models of analysis gave approximately the same monetary outcome. An integrated model showed that the intervention had a greater net effect on the younger group, with a number of significant interactions. The pay-back time for the younger group was just under one year, but with a very wide spread.

These particular interventions gave only moderate outcomes. The validity of the intervention effects is discussed, together with the importance of matching the intervention measures to the needs at the workplaces.