Fit For WorkWork is good for health: a

musculoskeletal perspectiveProf Karen Walker-Bone, Director

Arthritis Research UK/MRC Centre for Musculoskeletal Health and Work

Plan• Work and health• Health-related work disability• Review of the evidence surrounding

effect of interventions to reduce work disability from MSDs

Work and health

• Work is central to human existence • It is the motive force for all economies

and provides structure and meaning to individuals and societies

• Good for health & well-being• Good for financial health• Good for families• Socially inclusive & a right

Good work is good for us..

The effects of unemployment on health

• Associated with poorer health and wellbeing

• Worse levels of pain• Higher mortality : 5-10 years

reduced life expectancy• 2-3 fold higher risk of chronic disease• 3-fold risk of psychiatric morbidity• Higher medical consultation and

hospital admission rates

UnemploymentMentalillness

Worklessness

Highpersonaldebt

Suicidex2Selfharmx10

Source: OECD (2014), Mental Health and Work: United Kingdom, Paris: OECD Publishing. Courtesy Shruti Singh

New UK disability claims are among the highest in the OECDNew claims per 1,000 of the working-age population (inflow rates),

latest year available

0

2

4

6

8

10

12

OECD

average

UK: Disability burden and the benefit system

Earlier intervention could improve this

In developed world, TWO main causes of work disability..

• Mental health• Musculoskeletal disorders

Musculoskeletal disorders become increasingly common with age

….and developed economies need

people to work to older ages..

Low back pain

Knee osteoarthritis

Palmer et al, systematic review• Found 42 studies including 34 RCTs • 27 assessed return to work, 21 duration of

sickness absence, and five job loss• MSDs studied:

– Half of studies focussed on the ‘low-back’– ‘Back’ (n=3)– Axial pain (back and neck, or back, neck and

shoulder) (n=5)– Neck (n=1)– Upper limbs (n=2)– Unspecified musculoskeletal pain (n=9)

Heterogeneous interventions• Prescribed exercises (n=30)• Promoted behavioural change (n=37)• 17 were at the patient’s workplace, and 10

provided additional services• Interventions were often applied in combination

– frequently an exercise (functional restoration) regimen combined with behavioural measures to improve compliance (e.g. prompts, encouragement).

• In 12 studies (29%), interventions were aimed both at personal exercise and behavioural change, and also included workplace adaptations or assessments.

Findings

• Studies were generally small in size • Median sample size 107 (IQR 77-

148) • Only 1 study >500 people and 6

studies >300• Median quality score 45% (IQR 27-

64%)• ‘Blinding’ patchy

Overall effects

• Most interventions were reported as beneficial

Outcome Median relative risk

IQR

Return to work 1.21 1.00-1.60

Avoiding MSD-related job loss

1.25 1.06-1.71

Sickness absence reduction

1.11 0.32-3.20

Summary

• Effects were smallest in the larger and better quality studies

• Publication bias• No one intervention was clearly

superior to any of the others• Effort-intensive interventions were less

effective than simple ones• No cost-benefit analyses established

statistically significant net economic benefits

Conclusion

• Work is generally good for us• MSDs contribute importantly to work

disability and this burden is likely to grow

• Rather poor evidence base underpinning interventions to reduce work disability caused by MSDs

• Doing something seems beneficial!

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