Musculoskeletal Disorders

September 25 2007 - A recent report from The Work Foundation has found that musculoskeletal disorders (MSDs), a group of over 200 conditions including arthritis, back pain and damage to joints, muscles and tendons are by far the most prevalent cause of work-related illness in the UK affecting twice as many people as stress. MSDs account for up to one third of all GP consultations, result in 9.5 million lost working days, and currently cost society approximately £7.4billion a year.

Fit for Work: Musculoskeletal Disorders and Labour Market Participation by Stephen Bevan, Eleanor Passmore and Michelle Mahdon argues that early intervention and an emphasis on keeping sufferers in work wherever possible will help boost national productivity and reduce the 2.6 million people claiming incapacity benefit.

The authors commented:

"There is overwhelming evidence that worklessness is, itself, bad for health."

The report recommends that as part of its Work, Health and Wellbeing Strategy the government should urgently promote a coordinated approach to treatment, increase support to small businesses, and prioritize awareness of the impact on the labour market.

The authors point out that MSDs affect a broad range of industries and occupations - especially health and social care, construction and building trades, transport and machine drivers, process plant and machine operatives. MSDs are also associated with mental health problems and a swift return to work is more likely if people have support from employers and family.

Michelle Mahdon, senior researcher at The Work Foundation, said:

"Stress hogs headlines, but in terms of people affected, MSDs are the bigger problem, affecting more than a million people a year - and, of course, their families.

"Work can be both cause and cure. It may cause or aggravate symptoms of MSDs, but evidence is amassing that with the right support arrangements work can also be part of the recovery by contributing to a person's self-esteem and sense of being productive. What urgently needs to change is the attitude of many GPs and employers that an MSD sufferer must be 100 per cent well before any return to work can be contemplated. Too many see only incapacity rather than capacity."

The authors suggest that onset of an MSD may reduce work performance in a variety of ways, affecting stamina, concentration and mood as well as mobility and agility. GPs and employers should look beyond obvious physical symptoms in their management of these conditions. The "biopsychosocial" model of health emphasising the interrelationship between biological, psychological and social factors offers a useful approach to assessment, treatment and rehabilitation.

The report examined four conditions in detail:

• Back pain: a non-specific condition (no specific diagnosis) usually involving short episodes of pain. At any one time, 33 per cent of the UK population suffers with back pain.
• Work-related upper limb disorders: Also non-specific and affecting over 375 000 people.
• Rheumatoid arthritis: A specific condition affecting almost 400 000 people in the UK with 12 000 new cases each year. It is estimated that almost a quarter of sufferers stop work within five years of diagnosis.
• Ankylosing spondylitis: a progressive and chronic rheumatic disorder mainly affecting the spine, but also other joints, tendons and ligaments; most often diagnosed in young men. Responsible for over 200 000 GP consultations a year.

The report calls for:

• Early intervention: long periods away from work are usually detrimental. Partnerships between patient, employer and GP can achieve a balance between the need for respite and to work. For some patients prompt access to physiotherapy or drug therapies can reduce the severity, impact or progression of the condition.
• Better job design: managers can change the way work is organized (e.g. adjusting working hours, altering task allocation, improving ergonomics).
• Enhanced measurement of cost: improved mechanisms to assess and monitor direct and indirect social and work impact of MSDs. The National Institute for Health and Clinical Excellence (NICE) should take into account labour market impact when assessing cost effectiveness of therapies (e.g. whether a patient can be kept in work and off incapacity benefit).

Dame Professor Carol Black, national director for health and work said:

"I hope that in time MSDs will become less relevant to work and working life. Until then, efforts to raise awareness of them must continue with ever greater urgency. I welcome this report as a valuable contribution to the debate."

Sick Certification Study
September 24 2007 - A new Merseyside study has found that more certified intermediate sick leave (6-28 weeks) is given by male GPs to male patients compared to that given by female GPs to female patients.

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