Do psychosocial factors matter in occupational injury

A preliminary analysis of data 

from a small case series 

Dr Johnn Olsen MBBS BE MASc PhD FAFOM CIME Consultant Physician in Occupational & Environmental Medicine 

1/06/2009 Dr.johnn.olsen@bigpond.com 

1

INTRODUCTION 

Longer term injured workers may 

present with a baffling set of 

symptoms, history and clinical 

signs; which defy rational 

interpretation by even the most 

astute and experienced Physician. 

This will be shown to be associated 

with Psychological Impairment 

1/06/2009 


Dr.johnn.olsen@bigpond.com 2

OBJECTIVES & LEARNING OUTCOMES 

Recognises the complexity of medical 

assessment of an injured worker 

Realises that longer term occupational 

injury can be expected to include secondary 

Psychological Disorders 

Understands the need for stepping carefully 

before offering half-baked opinions 

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PATIENT POPULATION 

Patients present for Independent Medical 

Examination 

Standardised Questionnaires 

Pain Score 

Functional Inability Score 

Mood Disorder Score 

ÖMPQ 

GHQ12 

PTSD 

History, Medical File, Examination, Tests 

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DATA 

DEMOGRAPHIC 

QUESTIONNAIRES (Pain, Function, Psych) 

CLINICAL & TESTS 

PHARMACOTHERAPY 

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DATA 

DEMOGRAPHIC DATA 

Working Status 

Age 

Time since Injury 

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DATA 

PAIN FUNCTION & PSYCHOLOGICAL DATA 

Pain (Range 0-10) 

Functional Inability (Range 0-10) 

Mood Disorder (Range 0-10) 

Psychosocial (ÖMPQ score 0-210) 

GHQ12 (General Health Questionnaire score 0-12) 

PTSD (7 screening questions score 0-7) 

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ALL THESE SYMPTOM VARIABLES ARE 

SCORES 



DATA 

CLINICAL and PHARMACOTHERAPY DATA 

Objective Findings 

Lumbar flection 

Lumbar extension 

Opioids use 

Psychotropic use 

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DATA PRELIM ANALYSIS 1 

FACTOR NUMBER PERCENT 

Working 23 37% 

Opioids 27 43% 

Psychotropics 20 32% 

Objective 

Findings 

FREQUENCIES 

46 73% 

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DATA PRELIM ANALYSIS 2 

DESCRIPTIVES Mean (SD) 

FACTOR MEAN SD COMMENT 

Age 43 11 

Lumber flection 46 18 Normal 

Lumbar extension 15 9 Abnormal 

Pain 7.4 2 Score 0-10 

Function Inability 5.6 2 Score 0-10 

Mood Disorder 6.8 2 Score 0-10 

ÖMPQ 135 31 Score 0-210 

Time since injury 27 26 Months 

GHQ12 8 4 Score 0-12 (>3 Abn) 

PTSD 5 2 Score 0-7 (>3 Abn) 

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PAIN HISTOGRAM 

Median Pain Score: 9 

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ÖMPQ HISTOGRAM 

Median ÖMPQ Score: 137 

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METHOD 

Correlations between the variables were 

performed 

Some Partial Correlations performed 

Only reporting correlation if r>= .40 AND 

p

RESULTS 1 

DEMOGRAPHIC vs OTHER VARIABLES 

Factor 1 Factor 2 Pearson r p N 

Working ÖMPQ -.47 .000 61 

Age Flection -.51 .001 42 

Time NONE - - - 

Working is weakly related to Pain r=-.26; p=.077 

However when controlling for ÖMPQ; Working is 

NOT related to Pain at all r=.03; p=.828 

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RESULTS 2 

PAIN vs OTHER VARIABLES 


Pain Function .66 .000 46 

Pain ÖMPQ .60 .000 46 

Pain Mood .47 .001 45 

Function is Functional Inability 

Mood is Mood Disorder 

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RESULTS 3 

FUNCTION vs OTHER VARIABLES 


Function ÖMPQ .55 .000 44 

Function Mood .49 .001 45 

Function Pain .66 .000 46 

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RESULTS 4 

MOOD vs OTHER VARIABLES 


Mood PTSD .60 .005 20 

Mood ÖMPQ .52 .000 43 

Mood Flection -.42 .028 27 

Mood Function .49 .001 45 

Mood Pain .47 .001 45 

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RESULTS 5 

ÖMPQ vs OTHER VARIABLES 


ÖMPQ Pain .60 .000 46 

ÖMPQ Function .55 .000 44 

ÖMPQ Mood .52 .000 43 

ÖMPQ Working -.47 .000 61 

ÖMPQ Flection -.40 .010 41 

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RESULTS 6 

GHQ12 vs OTHER VARIABLES 


GHQ12 PTSD .51 .026 19 

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RESULTS 7 

CLINICAL vs OTHER VARIABLES 


Flection Age -.51 .001 42 

Flection Mood -.42 .028 27 

Flection ÖMPQ -.40 .010 41 

Extension NONE - - - 

Objective NONE - - - 

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RESULTS 8 

PHARMACOTHERAPY vs OTHER VARIABLES 


Opioids Psychotropics .44 .000 63 

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RESULTS 9 

FACTORS WITH ZERO CORRELATIONS 

Time since Injury 

Objective Findings present 

Lumbar extension 

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RESULTS 10 

FACTORS WITH ONLY 1 CORRELATION 

Not Working 

ÖMPQ 

Age 

Lumbar flection 

GHQ12 

PTSD 

Opioids 

Psychotropics 

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KEY RESULTS 1 

For this data set of long standing work injury 

Objective Findings do not relate to any other 

factors 

Working Status is only related to the ÖMPQ 

Score; and not related to anything else 

Opioid and Psychotropic use is unrelated to 

anything except each other 

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KEY RESULTS 2 

Time since injury is not related to anything 

ÖMPQ appears to be a strong predictor of 

Pain Score, Functional Inability, Mood 

Disorder, and Working Status 

Patient response to clinical examination appears to 

be related to Mood Disorder and ÖMPQ 

nothing else 

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KEY RESULTS 3 

Pain and Functional Inability 

Scores relate to each other and 

to Psychological Determinants 

and they relate to 

NOTHING ELSE 

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CONCLUSIONS 1 

Psychological Disorder can be 

expected in injured workers with long 

term reported severe pain 

Pain Scores by Patient reporting 

appear to represent something other 

than true Pain; perhaps it is a 

Statement of Distress 

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CONCLUSIONS 2 

Normal relationships between factors 

such as Pain, Functional Inability and 

Mood Disorder Scores; Objective 

Findings; pharmacotherapy; and work 

status all break down 

It is not possible to assess Patient 

Function by Objective Findings; Time 

since Injury; Opioid use; Spinal Motion 

and Work Status 

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CONCLUSIONS 3 

It is not possible to assess fitness 

for work; based on Pain, 

Functional Inability and Mood 

Scores; Objective findings; Scans; 

use of Opioids and Psychotropics 

and time since injury 

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CONCLUSIONS 4 

If that is the case then how do we 

assess Fitness for Work and how 

do we get a better outcome for 

the Patient 

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DISCUSSION 

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DISCUSSION 

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AGE HISTOGRAM 

Median Age: 44 

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LUMBAR FLECTION HISTOGRAM 

Median Flection: 46 degrees 

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LUMBAR EXTENSION HISTOGRAM 

Median Extension: 15 degrees 

1/06/2009 



FUNCTIONAL INABILITY HISTOGRAM 

Median Functional Inability Score: 6/10 

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MOOD DISORDER HISTOGRAM 

Median Mood Disorder Score: 8/10 

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GHQ12 HISTOGRAM 

Median GHQ12 Score: 11/12 

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PTSD HISTOGRAM 

Median PTSD Score: 6/7 

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TIME SINCE INJURY HISTOGRAM 

Median Time since Injury: 18 Months 

1/06/2009

Do psychosocial factors matter in occupational injury

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