The burden placed on society as a result of musculoskeletal disorders is substantial,\ud requiring effective management especially in an occupational context. Recent\ud occupational health guidelines recommend addressing potentially detrimental\ud psychosocial factors in the management of workers sick-listed with musculoskeletal\ud disorders, but the specific influence on absence from occupational, as well as clinical,\ud psychosocial risk factors (termed 'blue' and 'yellow' flags) remains ill understood. In\ud addition, the related principles of contemporary occupational health guidelines\ud recommendations, seeking to reduce return-to-work times and improve work retention,\ud have not been formally tested.\ud A four-year study was carried out in two phases:\ud Phase 1 comprised a workforce survey of a large multi-site company in the UK\ud (n=7,838). Data on clinical and occupational psychosocial factors were collected, along\ud with data on self-reported symptoms. Absence data were collected, both retrospectively\ud and prospectively.\ud Phase 2 was a quasi-experimental, controlled trial of an occupational guidelines-based\ud intervention for workers with musculoskeletal disorders. Occupational health advisors\ud delivered the experimental intervention over a 12-month period at two sites (n=1,435),\ud with three matched sites acting as controls, delivering management as usual (n=1,483).\ud Absence data were collected for both experimental and control sites over a 12-month\ud follow up period, and psychosocial data were collected from the experimental sites at\ud baseline and follow-up.\ud The results confirmed an association between the psychosocial work environment and\ud musculoskeletal disorders. Psychosocial risk factors (blue and yellow flags) predicted the\ud likelihood of future absence, but not its duration; routine psychosocial screening to\ud predict return-to-work does not appear to be feasible. Organisational obstacles (black\ud flags) were identified that compromised the experimental intervention, and this precluded\ud reliable conclusions regarding the effects of its specific components. Nevertheless, from\ud a pragmatic perspective, implementation of certain guidelines principles (generating a\ud supportive network with 'all players onside') was a successful strategy for reducing\ud absence due to musculoskeleta'l disorders
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