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Upper extremity disorders in the workplace: Costs and outcomes beyond the first return to work

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Abstract

Background: Cumulative trauma disorders of the upper extremities (CTD) have become increasingly important in workers' compensation caseloads over the last two decades. Relative to occupational back pain, CTD have been much less studied. Methods: We analyzed post-injury employment patterns and return-to-work probabilities for a sample of Ontario workers with CTD, for up to five years after injury. Results for workers with CTD are compared to results for workers with back injuries or fractures. Results: Most workers with CTD return to work at least once, but a first return does not necessarily mark the end of work disability. Among workers absent at least once, 26% with CTD report a second injury-related absence, compared to 18% with back pain and 12% with fractures. After five years, focusing on first returns underestimates work-loss days associated with CTD by 32%. Conclusions: A substantial proportion of workers with CTD or work-related back pain experience injury-related absences after their first return to work. Focusing on the first return to work is misleading for both injury groups, but even more so for CTD, as they appear to be even more susceptible to multiple spells of work absence.

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Notes

  1. We use the pre-injury wage and year of injury to determine the expected temporary disability benefit, taking account of benefit maxima and minima at the time the worker was injured, and then calculate an expected replacement rate. Permanent disability benefits are not included in the models because they are not conditioned on prior wage losses or current work status, so they are not expected to have the strong work disincentives associated with temporary disability benefits. In addition, although such benefits may have an income effect on work decisions, as a practical matter they are not available in our data.

  2. The estimated coefficient of the replacement rate variable is nearly 50 percent greater, in absolute value, than the estimated effect in a similar model for back cases.

  3. One possible explanation is that upper extremity disorders tend to occur in occupations/industries where it is more difficult to return to work after an injury than in the occupations/industries where back injuries and fractures are more likely to occur. We do not have occupation data on the Ontario data, but we re-estimated our models with a complete set of industry controls. Other industry variables were not significant and did not change the results for the replacement rate.

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Authors and Affiliations

  1. W. P. Carey School of Business, School of Health Management and Policy, Arizona State University, Arizona, USA

    Marjorie L. Baldwin

  2. Department of Economics, Brigham Young University, Brigham, USA

    Richard J. Butler

Authors
  1. Marjorie L. Baldwin
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  2. Richard J. Butler
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Correspondence to Marjorie L. Baldwin.

Additional information

Prepared for a Meeting on: Upper Extremity Disorders in the Workplace; Sponsored by: Office Ergonomics Research Committee, Annapolis, Maryland, September 23–24, 2005

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Baldwin, M.L., Butler, R.J. Upper extremity disorders in the workplace: Costs and outcomes beyond the first return to work. J Occup Rehabil 16, 296–316 (2006). https://doi.org/10.1007/s10926-006-9043-2

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  • DOI: https://doi.org/10.1007/s10926-006-9043-2

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