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Biomedical subjects

G Pransky

Publications and source records attributed to G Pransky.

At least 19 recordsLinked to original sources
PubMed2002

Improving the physician role in evaluating work ability and managing disability: a survey of primary care practitioners.

PURPOSE: In the US health care system, most work-related issues are addressed by primary care practitioners (PCP's). Prior investigations of PCP's have focused on disability claims, whereas evaluations of work status and work capacity are more common. This study was conducted to identify challenges and opportunities for improvement in this area from a physician perspective. METHODS: A validated survey was mailed to a random sample of 423 Massachusetts PCP's, with a 43% response rate. RESULTS: On average, PCP's were requested to provide opinions regarding work ability in 9% (range, 1-100%) of all visits, about half of which involved non-work-related conditions. Their assessments were largely based on patient input and observations; direct communication with employers was rare. Only 6% agreed that PCP's should not have a role in facilitating safe return to work (RTW). However, 25% believed they had little influence over disability outcomes. While patient-specific factors were viewed as significant barriers to providers' efforts to successfully encourage RTW, lack of alternative work at the workplace was seen as the most significant problem. CONCLUSIONS: Evaluations of work status and work ability are common PCP activities, but little formal training has been provided in this area. Rehabilitation professionals can have a significant role through provider education, developing improved systems for communication with employers, and encouraging employers to provide more alternative duty assignments.

Disability Evaluation↗
PubMed2001

Early prognosis for low back disability: intervention strategies for health care providers.

PURPOSE: Disability following acute occupational low back pain (OLBP) represents a significant and preventable health outcome, yet confusion about prognostic factors have limited the development of effective, targeted interventions for those at greatest risk. The purpose of this study was to synthesize findings from available studies of prognostic factors for OLBP disability in a clinically-relevant framework. METHOD: A systematic search of the MEDLINE database was conducted to identify empirical studies assessing the value of various prognostic factors to predict extended disability after an acute episode of OLBP. Relevant studies were screened based on a number of inclusionary criteria. Prognostic factors were catalogued, summarized, and evaluated based on agreement across studies, and clinical recommendations were developed based on the evidence. RESULTS: Of 361 studies of OLBP disability found, 22 met specific criteria for inclusion. Significant prognostic factors included low workplace support, personal stress, shorter job tenure, prior episodes, heavier occupations with no modified duty, delayed reporting, severity of pain and functional impact, radicular findings and extreme symptom report. Physicians can decrease OLBP disability by using standardized questionnaires, improving communication with patients and employers, specifying return to work accommodations, and employing behavioural approaches to pain and disability management. Future studies should evaluate interventions guided by prognosis.

Persons with Disabilities↗
PubMed2001

Performance and quality measurement in occupational health services: current status and agenda for further research.

BACKGROUND: There is growing interest in evaluating the impact and effectiveness of occupational healthcare services (OHS). Managed care networks, case and disease management, worker health promotion, and utilization review services have proliferated in OHS, usually without scientifically based, objective measures of their impact on the quality of care, outcomes, or costs. Performance and quality improvement (QI) efforts in OHS are different from those in general health care because the population, range of conditions, setting of care, and primary outcomes of interest differ considerably. However, scientific knowledge resulting from the application of QI in general health care can provide a useful framework for the development of measures in OHS. METHODS: We describe the development, selection, and evaluation of OHS performance and quality measures, and propose a research agenda. CONCLUSIONS: Quality and performance measures in OHS should address common work-related conditions with high costs, suboptimal outcomes, or unclear parameters for ideal practices. They should reflect stakeholder priorities. Measures should be precise and quantifiable, clearly specified, reliable, valid, and sensitive to important changes. They should be based upon data that can be collected and analyzed at a reasonable cost and effort. The focus of measurement should be on situations where improvement can be achieved by those directly involved in OHS delivery, through defined approaches. Appropriate severity and case-mix adjustment may be especially problematic in OHS. Confidentiality, regulatory concerns, and appropriate use of results must be considered in the development and use of OHS measures. Research is needed to identify, develop, and validate OHS-specific measures, to establish risk adjustment methods, and to test the utility of this information in improving OHS.

Health Policy↗
PubMed2001

Disability management training for supervisors: a pilot intervention program.

Proactive disability management practices among employers have been associated with reduced frequency and duration of disability. Supervisors have a critical role in disability prevention. However, few studies have evaluated training efforts to modify supervisor responses in order to improve disability outcomes. In this study, 108 supervisors representing seven employers were provided a 1.5-h training session to reinforce a proactive and supportive response to work-related musculoskeletal symptoms and injuries among employees. Pre- and post training results showed improvements in supervisor confidence to investigate and modify job factors contributing to injury, to get medical advice, and to answer employees' questions related to injury and treatment (p < .05). More supervisors reported decreases (38.5%) than increases (9.6%) in lost work time within their departments. These data provide evidence that this approach may improve disability outcomes of work-related musculoskeletal disorders. Controlled trials with disability outcome data are needed to confirm these results.

Female↗
PubMed2001

Employer attitudes, training, and return-to-work outcomes: a pilot study.

This work was concerned with investigating and changing employer attitudes and practices that impede return to work and rehabilitation for injured workers. Prior studies have shown that employer responses to workers reporting work-related musculoskeletal discomfort have significant and independent effects on disability outcomes. Based on these findings, a pilot training program was developed by occupational rehabilitation specialists to improve the response of supervisors to employees reporting work-related injuries. The training was delivered to 108 supervisors at seven southeastern New Hampshire companies that volunteered to participate. A survey was developed and pilot-tested, then administered before the training. Survey participants were employees who had work-related injuries in the past year. The survey asked about types and onset of injury, specific supervisor responses, and overall impression of supervisor interaction at the time of injury. Employee responses before the intervention were compared with those collected from workers who reported injuries after the training. The postintervention results demonstrated significant decreases in supervisors (1) blaming employees for the injury, (2) not taking the condition seriously, and (3) discouraging the worker from filing a claim. Positive trends in confidentiality of discussions, access to medical care, and accommodation and work modifications were also noted. Although anecdotal reports from the companies indicated a consistent decrease in work-related lost time after the intervention, actual verification was not possible, and other components of the intervention may have accounted for this outcome. Small numbers of cases and possible lack of comparability of cases before and after the intervention are significant limitations. However, rehabilitation professionals may be able to improve disability management practices and accommodations through employer education, especially when training is directed toward front-line supervisors.

Attitude↗
PubMed2000

Outcomes in work-related upper extremity and low back injuries: results of a retrospective study.

BACKGROUND: The outcomes of treatment for work-related injuries and illnesses are multidimensional and complex, but have rarely been explored in detail. This study was intended to provide information on a sample of workers representing a range of jobs and employers typical of the workers compensation system. METHODS: A mailed, self-report survey measuring multiple dimensions was conducted. Identified through the New Hampshire Division of Workers' Compensation First Report of Injury database, a sample of workers with injuries to their lower back (60%) or upper extremities (40%) a year prior to the study were surveyed. Response rate was 80% (N=169; upper extremity cases=70; low back cases=99). RESULTS: Most (82.8%) were working one year post-injury. Over half reported residual effects of the injury on work or activities of daily living. Many working subjects reported persistent injury-related anxiety and pain at the end of the work day, worse in those with low back pain compared to those with upper extremity injuries. Almost 40% of those who returned to work suffered a reinjury. Forty-four percent of respondents suffered significant injury-related financial problems, which were worse in those who had been out of work for longer periods. CONCLUSIONS: Occupational musculoskeletal injuries do result in significant, long-term adverse physical, economic, and psychological consequences, as demonstrated in self-reported surveys.

Absenteeism↗
PubMed1999

Under-reporting of work-related disorders in the workplace: a case study and review of the literature.

Accurate reporting of work-related conditions is necessary to monitor workplace health and safety, and to identify the interventions that are most needed. Reporting systems may be designed primarily for external agencies (OSHA or workers' compensation) or for the employer's own use. Under-reporting of workplace injuries and illnesses is common due to a variety of causes and influences. Based on previous reports, the authors were especially interested in the role of safety incentive programmes on under-reporting. Safety incentive programmes typically reward supervisors and employees for reducing workplace injury rates, and thus may unintentionally inhibit proper reporting. The authors describe a case study of several industrial facilities in order to illustrate the extent of under-reporting and the reasons for its occurrence. A questionnaire and interview survey was administered to 110 workers performing similar tasks and several managers, health, and safety personnel at each of three industrial facilities. Although less than 5% of workers had officially reported a work-related injury or illness during the past year, over 85% experienced work-related symptoms, 50% had persistent work-related problems, and 30% reported either lost time from work or work restrictions because of their ailment. Workers described several reasons for not reporting their injuries, including fear of reprisal, a belief that pain was an ordinary consequence of work activity or ageing, lack of management responsiveness after prior reports, and a desire not to lose their usual job. Interviews with management representatives revealed administrative and other barriers to reporting, stemming from their desire to attain a goal of no reported injuries, and misconceptions about requirements for recordability. The corporate and facility safety incentives appeared to have an indirect, but significant negative influence on the proper reporting of workplace injuries by workers. A variety of influences may contribute to under-reporting; because of under-reporting, worker surveys and symptom reports may provide more valuable and timely information on risks than recordable injury logs. Safety incentive programmes should be carefully designed to ensure that they provide a stimulus for safety-related changes, and to discourage under-reporting. A case-control study of similar establishments, or data before and after instituting safety incentives, would be required to more clearly establish the role of these programmes in under-reporting.

Accidents, Occupational↗
PubMed1999

Work-related upper-extremity disorders: prospective evaluation of clinical and functional outcomes.

The purpose of this study was to describe the demographic, vocational, medical, workplace, and psychosocial characteristics of patients treated for work-related upper-extremity disorders, to document treatment patterns in a community-practice setting, and to determine which of these factors predicts subsequent employment and functional status outcomes. A questionnaire was administered by mail or telephone to 112 patients seen at the University of Massachusetts Occupational Upper Extremities Disorders Clinic and included measures of disease-specific functional status, pain, reactions to pain, employer-employee relations, and number and type of interventions used to treat the disorder. Results were compared with baseline data obtained, on average, 16 months prior to follow-up. Of the original cohort (n = 124), 112 participated in the prospective study. Although most patients reported improvement in pain severity, fear of pain, life situation, and functional status, there was little change in employment status. Patients' self-reported intentions of return to work at baseline did not predict work status at follow-up. In general, those who were employed at baseline remained employed, had a greater reduction in symptom severity over time, and were significantly more likely to report improvement in their problem than those who were unemployed. The efficacy of various interventions was examined by type, mix, and intensity (number of different interventions undergone by the patient). No positive relationship was found between these measures and employment status, self-reported change in the problem, or self-reported improvement in functional status. Significant negative relationships were found between surgery, psychotherapeutic interventions, and outcomes. This was likely to have occurred because of a selection bias toward the more chronic and severely disabled patients for these treatments. However, the relative ineffectiveness of such intensive interventions as surgery in improving the work and health status of chronically symptomatic work-related upper-extremity patients cannot be overlooked. The findings suggest that more emphasis be placed on interventions aimed at resolving differences between employers and injured employees. More careful selection of patients for expensive and invasive procedures is recommended.

Adult↗
PubMed1998

Consensus criteria for the classification of carpal tunnel syndrome in epidemiologic studies.

Criteria for the classification of carpal tunnel syndrome for use in epidemiologic studies were developed by means of a consensus process. Twelve medical researchers with experience in conducting epidemiologic studies of carpal tunnel syndrome participated in the process. The group reached agreement on several conceptual issues. First, there is no perfect gold standard for carpal tunnel syndrome. The combination of electrodiagnostic study findings and symptom characteristics will provide the most accurate information for classification of carpal tunnel syndrome. Second, use of only electrodiagnostic study findings is not recommended. Finally, in the absence of electrodiagnostic studies, specific combinations of symptom characteristics and physical examination findings may be useful in some settings but are likely to result in greater misclassification of disease status.

Carpal Tunnel Syndrome↗
PubMed1997

Screening for carpal tunnel syndrome in the workplace. An analysis of portable nerve conduction devices.

Several devices have been developed for rapid motor or sensory median nerve conduction testing. We evaluated the validity and reliability of the Neurosentinel (NS) and NervePace (NP) electroneurometer for sensory and motor testing, respectively, compared with formal electrodiagnostic studies (EDS), and examined their potential role in workplace screening for carpal tunnel syndrome (CTS). Thirty-two working subjects without CTS were examined and tested with the NS, NP, and EDS, and retested one week later. Subjects were selected who did not have CTS, other hand or nerve problems, or jobs with significant ergonomic risks, in order to decrease the likelihood of changes over time in median nerve function. Mean correlations of NP and NS with EDS latencies ranged from r = 0.069 to r = 0.85, with somewhat better correlation for NS (sensory) than NP (motor). Test-retest reliability was greatest for motor EDS (r = 0.86 to 0.91) and similar for sensory EDS, NS, and NP (r = 0.72 to 0.79); mean results were very similar. Based on the observed relationship between NS or NP and EDS results, confidence intervals were calculated to represent the range of EDS results consistent with a single NS or NP measurement. These intervals ranged from +/- 0.3 milliseconds (ms) for NS to +/- 0.6 msec for NP, with similar ranges for change over time in an individual. The magnitude of these intervals for a single test or individual implies that the NS and NP are unlikely to identify individuals with CTS or to detect changes over time that are not accompanied by symptoms or signs. The screening devices are not likely to be useful in confirming early CTS, when single latency values may be normal, and detailed EDS may be necessary to detect nerve entrapment. Compared with EDS, these devices have moderate validity and similar reliability; they are probably most useful for cross-sectional or longitudinal studies of groups, but care must be taken in using them for pre-placement or surveillance tests of individual workers. False-positive results may lead to discrimination, inappropriate referrals and interventions; false-negative tests can result in inappropriate reassurance and missed opportunities for intervention.

Adult↗
PubMed1997

Measuring functional outcomes in work-related upper extremity disorders. Development and validation of the Upper Extremity Function Scale.

Questionnaire-based measures of function have been validated extensively in studies of chronic illness and work-related low back pain. These measures have only recently been developed for upper extremity disorders (UEDs), and there is little information on their utility in evaluation of injured workers. We developed the Upper Extremity Function Scale (UEFS), an eight-item, self-administered questionnaire, to measure the impacts of UEDs on function. This instrument was tested in a cohort of 108 patients with work-related UEDs and 165 patients with the carpal tunnel syndrome (CTS); both groups were enrolled in prospective follow-up studies. The UEFS demonstrated excellent psychometric properties, including good internal consistency (Cronbach's alpha > 0.83), relative absence of floor effects, and excellent convergent and discriminant validity, compared with measures of symptom severity and clinical findings. In the CTS group, the UEFS was more responsive to significant improvements over time than clinical measures such as grip and pinch strength. These data support the use of a self-reported functional scale as a measure of outcome in studies of work-related UEDs. Further investigations in working populations are needed to substantiate its utility in workers with UEDs who have not yet sought medical care.

Adult↗
PubMed1996

Outcomes research: implications for occupational health.

Concerns about quality, cost, and unnecessary medical care have led to substantial interest and growth in outcomes research with studies to determine the full range of effects of disease and comparative effectiveness of treatments. Investigators have developed new conceptual models of health-related quality of life and associated questionnaires, study designs that maximize use of administrative databases and the generalizability of results, and methods to control for severity and co-morbidity. As similar concerns about occupational health care have emerged, these approaches are being adapted for use in the occupational setting, and studies are beginning to address the concerns of working populations. These investigations will require development of new models of outcome, interdisciplinary research teams, adaptation of data collection methods to address the unique concerns of workers and the unique aspects of the workplace, use of new information databases, and methods of analysis. The implications of these concepts for a hypothetical study of carpal tunnel syndrome and a proposed agenda for future studies in occupational health outcomes research are presented.

Carpal Tunnel Syndrome↗
PubMed1996

Unilateral vs. bilateral carpal tunnel: challenges and approaches.

Conditions affecting either or both extremities offer unique opportunities and challenges for investigators and clinicians. When the condition is purely unilateral, observations on the unaffected extremity may be used as a within-patient control, and thereby strengthen the ability to identify changes in the affected limb. However, such use presumes that the condition will not subsequently develop in the unaffected extremity. Bilateral presentations or subsequent development of disease in the unaffected extremity is common in conditions such as the carpal tunnel syndrome (CTS). Treatment of one extremity may lead to development or aggravation of CTS in the other extremity. Since both extremities may be necessary to perform certain activities, it can be difficult to clearly identify treatment effects when looking at functional outcomes. In an effort to avoid these complexities, investigators have used one of two approaches in studying CTS: either selecting only those patients with unilateral disease, or analyzing results by extremity, often avoiding any outcome measures that might depend upon both extremities (such as driving). We illustrate some of the shortcomings of this approach, such as loss of patients and data, with preliminary information from our ongoing prospective study of carpal tunnel surgery outcomes. We develop a dynamic model that incorporates etiologic factors and treatment effects to describe changes in CTS over time. This model accounts for extremity-specific and systemic factors, as well as possible interaction of the disease process in both hands. The advantages of this model include a more rational approach to research and care of extremity disorders, and research strategies which address a wider scope of patients and outcomes; however, its application is limited by the need for more extensive data collection.

Carpal Tunnel Syndrome↗
PubMed1995

Recruiting the occupational and environmental medicine physicians of the future: results of a survey of current residents.

In July 1994, current occupational and environmental medicine (OEM) residents (n = 180) were surveyed about their motivation for decisions to enter OEM residencies, near-term and long-term career goals, and their opinions on various strategies for recruitment to the field. A total of 151 persons responded (84%), representing all 40 accredited OEM residencies in the United States and Canada. A total of 16% first learned about OEM in medical school, and 11% were first exposed during residency training. Most respondents (62%) decided to enter OEM residency training after beginning their professional working careers. Only 11% of respondents decided to enter OEM residency training before (2%) or during (9%) medical school, whereas 24% made their decision during internship or residency. Respondents were attracted to several aspects of OEM, but the prevention focus of the field (64%), lifestyle (56%), and worker and labor issues (53%) were most commonly cited. Although only 25% of respondents stated that a role model had a significant impact on their decision to pursue training in OEM, persons influenced by a role model were more likely to have made the decision to pursue a career in OEM during medical school or clinical residency training (odds ratio = 2.4; 95% CI, 1.0-5.4; Fisher's exact two-tailed P value = 0.04). In the short term, residents were most often interested in working for industry (32%), whereas over the long term, careers in consulting were most often preferred (39%). The data have important implications for strategies to increase recruitment to residency training programs in OEM and to increase staffing in the field.

Canada↗
PubMed1994

Development of a multidisciplinary research clinic for patients with work-related upper extremity disorders.

The health care reform debate has focused attention on the need for outcomes research performed in ambulatory care settings. In this article, the authors describe the development of a research clinic focusing on symptomatic, functional, and vocational outcomes of patients with work-related upper extremity disorders. The authors describe the programmatic and research challenges associated with performing such research and emphasize the need for balancing the research and clinical agendas. Research efforts in this setting require careful consideration of the patient selection process and allocation of sufficient time for the clinical staff to collect and record essential research data.

Academic Medical Centers↗
PubMed1991

Business analysis in occupational health and safety consultations.

We present a method for incorporating business analysis into comprehensive health and safety consultations using as an example a plant with an elevated incidence of cumulative trauma disorders. Business information, including product and management history, short- and long-term corporate goals, functional analysis, profit history, organizational structure with respect to health and safety, and personnel and labor-management relationships are evaluated simultaneously with traditional ergonomic factors. The additional business data allow consultants to identify the full scope of etiologies and make practical, credible recommendations that are more likely to be adopted by management and labor. We propose that techniques of "business analysis" be routinely incorporated into occupational health and safety consultations. However, because collection and interpretation of these data require business skills outside the occupational safety and health expert's usual repertoire, the consulting team must include participants with business expertise. We have found that occupational health medical personnel with an understanding of business analysis concepts can be very effective advocates for changes in health and safety practices. We strongly recommend incorporating methods of business analysis into the occupational health and safety curriculum.

Accidents, Occupational↗