Academic journal article Scandinavian Journal of Work, Environment & Health

Screening Manual and Office Workers for Risk of Long-Term Sickness Absence: Cut-Off Points for the Work Ability Index

Academic journal article Scandinavian Journal of Work, Environment & Health

Screening Manual and Office Workers for Risk of Long-Term Sickness Absence: Cut-Off Points for the Work Ability Index

Article excerpt

Sickness absence, particularly long-term sickness absence (LTSA) is a substantial societal and economic problem. The costs of sickness benefits average 1% of the gross domestic product of OECD countries (1) and are highest in Norway and The Netherlands where LTSA accounts for most of these costs (2). When a worker is absent from work for a longer period of time, employers have to assign the worker's tasks to other staff or replace the absent worker. LTSA disconnects sick-listed workers from the workplace, which may ultimately lead to social marginalization and reduced income (3). The probability of resuming work decreases with increasing sickness absence duration (4). Therefore, it is important to identify workers at risk of LTSA and refer them to preventive programs helping them to stay at work.

The ability to stay at work and manage work demands has been conceptualized as work ability, that is the balance between a worker's resources and the demands of work (5). The Work Ability Index (WAI) is widely used to measure work ability. Several studies have associated poor WAI scores with an increased risk of disability pension (6-9). As LTSA precedes disability pension, it is conceivable that poor WAI scores also predict LTSA. Among sick-listed workers, poor WAI scores were found to be associated with a longer duration of LTSA (10, 11). Only few studies related the WAI scores of non-sick-listed workers to their risk of future sickness absence. Kujala et al (12) investigated the relationship between baseline work ability and sickness absence (>9 days) during a one-year follow-up of Finnish workers from the Northern Finland Birth Cohort 1966 study. Poor-to-moderate WAI scores were associated with a higher risk of sickness absence as compared to workers with excellent WAI scores. Alavinia et al (13) associated the WAI scores of Dutch construction workers participating in a health survey in 2005 with short (<2 weeks), medium (2-12 weeks) and long (>12 weeks) duration sickness absence episodes occurring until the end of 2006. Lower WAI scores were found to be associated with higher risks of LTSA.

These prospective studies, however, do not tell us whether the WAI can be used for case-finding, which is the identification of non-sick-listed workers with an increased risk of LTSA. The serious consequences of LTSA for workers, employers, and society justify case-finding by screening for risk of LTSA. Frequently debated disadvantages of screening are prolonged morbidity when the prognosis is unaltered, over-diagnosis and over-treatment of questionable conditions, false reassurance for individuals with false-negative results, and anxiety for those with false-positive results. However, false reassurance and anxiety will be less of a problem for workers at risk of LTSA than individuals at risk of serious disease. Furthermore, interventions may alter the prognosis and consequences of LTSA. Taimela et al (14) showed that preventive consultations reduced sickness absence, although such consultations were cost-effective only among high-risk workers (15). The cost-effectivity of preventive consultations may increase when only high-risk workers are referred, which accentuates the need to screen for risk of LTSA. Kant et al (16) investigated the effect of preventive consultations on LTSA among high-risk workers who were identified with the Balansmeter®, an instrument developed and used among office workers to screen for risk of psychosocial sickness absence (17). They found that 9.1% of the intervention group (N=99) had LTSA episodes >28 days as compared to 18.3% of the control group (N= 131).

In addition to a tool for identifying office workers at risk of psychosocial LTSA, we need an instrument to screen for risk of all types of LTSA in all kinds of occupations. Lindberg et al (18) investigated the predictive value of the WAI for LTSA episodes ≥28 days in a population-based sample (N=2252) from three Swedish municipalities. …

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