Self-reported versus expert-assessed work-relatedness of pain in the neck, shoulder, and arm

Abstract

Mehlum IS, Veiersted KB, Waersted M, Wergeland E, Kjuus H. Self-reported versus expert-assessed workrelatedness of pain in the neck, shoulder, and arm. Scand J Work Environ Health. 2009;35(3):222-232.Objectives The aim of this study was to compare self-reported work-relatedness of neck-shoulder and arm pain with experts' assessments based on specific criteria. Methods A sample of 217 employed participants in the Oslo Health Study 2000-2001, aged 30, 40, and 45 years, who reported neck-shoulder or arm pain in the past month, underwent a health examination. A criteria document for evaluating the work-relatedness of upper-extremity musculoskeletal disorders was used to establish clinical diagnoses and assess the work-relatedness of pain with respect to the subject's present job. We measured agreement between the participants and experts on whether pain was related to work as observed agreement, positive and negative specific agreement, and kappa. Results A major proportion of the cases were assessed as work-related, somewhat more frequently by selfreport than when assessed by experts (80% versus 65% for neck-shoulder pain, and 78% versus 72% for arm pain, respectively). However, there was considerable disagreement as to which cases were work-related. The experts disagreed more frequently in cases that were reported as non-work-related (particularly for neck-shoulder pain and cases reported by men). Positive specific agreement was fairly high (76-85% in the total population), while negative specific agreement was lower (37-51%). Kappa values were also low (0.16-0.34). Conclusions Compared with expert assessment, self-reporting did not seem to particularly exaggerate workrelatedness. Nevertheless, there was considerable disagreement, especially on cases assessed as non-workrelated. However, agreement will depend on the case definitions and the criteria for work-relatedness used both by the participants and the experts.

Review on the validity of self-report to assess work-related diseases

“…Positive if (1) diagnosis “proved” during clinical examination, (2) diagnosis “proved” before clinical examination (e.g., previous diagnosis by a specialist, and (3) suspected diagnosis (not all of the criteria were met in clinical examination)France: “Repetitive task” survey (RtS) 1,757 workers in 1993–1994 and 598 workers in 1996–199717, High4Descatha et al (2007) PdLSNMQ-Upper ExtremitiesNoStandardized clinical examination, using an international protocol for the evaluation of work-related upper-limb musculoskeletal disorders (SALTSA)“Pays de Loire” survey (PdLS) 2,685 workers in 2002–2003.17, High5Juul-Kristensen et al (2006)NMQ-Upper Extremities-ModifiedNoPhysiotherapist and physician performed the clinical examination and five physical function tests, all according to a standardized protocolDenmark: 101 female computer users (42 cases, 61 controls)16, High6Kaergaard et al (2000)PRIM, musculoskeletal symptoms (pain, discomfort) in eight body regionsNoExamined at baseline and follow-up by 3 trained physicians using clear case definitionsDenmark: 243 female sewing machine operators: 240 at baseline; 155 at 1-year follow-up18, High7Mehlum et al (2009)Researcher Designed questionnaire on musculoskeletal symptoms Upper Extremities “Have you experienced pain in neck or shoulder and pain in elbow, forearm, or hand in the last month, and is this totally or partially caused by working conditions in your present or previous job?” Yes Occupational physicians performed clinical examination, reporting clinical findings and diagnoses. The work relatedness was assessed using the “Criteria Document for Evaluating the Work relatedness of Upper-Extremity Musculoskeletal Disorders” (SALTSA)Norway: 217 employees in Oslo Health Study; 177 cases with self-reported work-related pain, 40 controls with self-reported non-work-related pain17, High8Ohlsson et al (1994)NMQ-Upper Extremities 7d/12 moNoClinical findings recorded by one examiner (blinded to the answers in the self-report questionnaire), according to a standard protocol and criteriaSweden: 165 women in either repetitive industrial work (101) or mobile and varied work (64)11, Low9Perreault et al (…”

“…In seven studies, (22%) participants were asked questions on their health as well as on their work. In four studies, participants were explicitly asked about the work relatedness of their illness or symptoms (Mehlum et al 2009; Bolen et al 2007; Lundström et al 2008; Dasgupta et al 2007). In 25 studies, the self-report was compared with the assessment by a medical expert (e.g., physician, registered nurse, or physiotherapist).…”

“…In four studies (Table 4), workers were explicitly asked to self-assess one-to-one the work relatedness of their self-reported illness (Mehlum et al 2009) or symptoms (Bolen et al 2007; Lundström et al 2008; Dasgupta et al 2007). …”

“…The study by Mehlum et al (2009) was the only study that explicitly measured agreement between self-reported and expert-assessed work relatedness. Workers with neck, shoulder, or arm pain in the past month underwent an examination at the Norwegian Institute of Occupational Health.…”

Do work-place initiated measures reduce sickness absence? Preventive measures and sickness absence among older workers in Norway

“…However, to what extent sick leave is work-related remains unclear. Estimates for this vary, depending on whether physicians or workers are being asked, and estimates also vary according to diagnoses [12][13][14][15][16]. However, it is generally assumed that work conditions cause about half of all sick leave [7], implying that there may be a large potential for reducing sickness absence by means of applying preventive work-place measures.…”