Liberty Mutual Research Institute for Safety

Purpose Insurance company case managers can play a critical role in the rehabilitation process of people with musculoskeletal disorders sustained following minor motor vehicle crash injury due to their interaction with multiple stakeholders and their role in approving various services. This study aimed to identify factors that case managers perceive as predictive of recovery in people with musculoskeletal disorders after minor motor vehicle crash injury. Materials and methods To explore the perspectives of cases managers in Australia and the United States, semi-structured interviews explored factors that case managers thought provided an early indication of likely recovery outcomes in people with musculoskeletal disorders after minor motor vehicle crash injury. A framework analysis was applied and factors were displayed within the ICF-framework. Results Case managers (n = 40) demonstrated a broad, detailed understanding of biopsychosocial and contextual issues influencing recovery. They emphasized the importance of the injured worker’s expressed affect and motivation, style of communication, the role of lawyers, the worker’s family and friends, as well as cultural and geographic influences. The overarching themes perceived as having a major influence on recovery outcomes were general health, pain processing and response, work situation, and compensation entitlement. Conclusions Case managers’ broad and detailed perceptions about recovery may provide additional, valuable perspectives for professionals involved in the rehabilitation process of people with musculoskeletal disorders after minor motor vehicle crash injury. Further research needs to be conducted to explore the effects of case manager involvement in the process of recovery. Implications for rehabilitation Insurance Case Managers identified multiple factors including affect and motivation, style of communication, the role of lawyers, family and friends, cultural and geographic variation provide opportunities for more effective treatment of people with musculoskeletal disorders related to minor motor vehicle collisions. These managers’ perceptions about recovery may be informative to and provide opportunities for health professionals involved in the rehabilitation of people with musculoskeletal disorders related to minor motor vehicle collisions. While the Insurance Case Managers involved in this research did not use formalized assessment techniques, tools and assessment protocols could be developed jointly between for the needs of Insurance Case Managers and other stakeholders to tackle recovery of people with musculoskeletal disorders related to minor motor vehicle collision.

Functional capacity evaluations (FCE) are clinical instruments that use a battery of standardised performance tests to evaluate an individual’s ability to perform work-related activities. Several studies have investigated the potential biopsychosocial factors associated with FCE results to gain a better understanding of FCE results. Such studies have provided evidence for significant associations between FCE performance with primarily biological and psychological factors, while social factors have only been scarcely described. Despite its relevance in patients undergoing FCE, it is currently unclear which social factors are significantly associated with FCE performance. We conducted a systematic review to provide an overview of the association between social factors and performance of FCE tests in adults with chronic musculoskeletal pain.

Purpose To examine factors associated with Functional Capacity Evaluation (FCE) results in patients with painful musculoskeletal conditions, with focus on social factors across multiple countries. Methods International cross-sectional study was performed within care as usual. Simple and multiple multilevel linear regression analyses which considered measurement’s dependency within clinicians and country were conducted: FCE characteristics and biopsychosocial variables from patients and clinicians as independent variables; and FCE results (floor-to-waist lift, six-minute walk, and handgrip strength) as dependent variables. Results Data were collected for 372 patients, 54 clinicians, 18 facilities and 8 countries. Patients’ height and reported pain intensity were consistently associated with every FCE result. Patients’ sex, height, reported pain intensity, effort during FCE, social isolation, and disability, clinician’s observed physical effort, and whether FCE test was prematurely ended were associated with lift. Patient’s height, Body Mass Index, post-test heart-rate, reported pain intensity and effort during FCE, days off work, and whether FCE test was prematurely ended were associated with walk. Patient’s age, sex, height, affected body area, reported pain intensity and catastrophizing, and physical work demands were associated with handgrip. Final regression models explained 38‒65% of total variance. Clinician and country random effects composed 1–39% of total residual variance in these models. Conclusion Biopsychosocial factors were associated with every FCE result across multiple countries; specifically, patients’ height, reported pain intensity, clinician, and measurement country. Social factors, which had been under-researched, were consistently associated with FCE performances. Patients’ FCE results should be considered from a biopsychosocial perspective, including different social contexts.

Virtual environments such as those used in video games and driving/flight simulators are used for entertainment and training, but are often associated with visually induced motion sickness (VIMS). In this study, we asked whether passive restraint of the head and torso could reduce VIMS in younger and older adults. Twenty-one younger (18-35 years) and 16 older (65 + years) healthy adults engaged in a simulated driving task using a console video game while seated. On different days, participants completed 2 conditions: (a) in the unrestrained condition, participants were seated in a chair without a backrest and were free to move and (b) in the restrained condition, participants' head and torso were passively restrained to the backrest and headrest of the seat using tense elastic strips. Before and after exposure to the driving game, we measured standing postural sway with eyes closed. VIMS severity was quantified using the Fast Motion Sickness Scale and the Simulator Sickness Questionnaire. Results showed that older (but not younger) participants who became sick in the unrestrained condition reported significantly less VIMS when they were passively restrained. The present findings suggest that passive restraint may be useful to reduce, but not fully prevent, VIMS, particularly in older adults. (PsycINFO Database Record

Younger and older drivers are both overrepresented in fatal crashes that occur at intersections, however, after adjusting for other significant factors (i.e., being at fault type of road, weather, lighting) the increased risk cannot be fully accounted for older drivers, nor does frailty. Thus, increased risk for older drivers could be due to their agerelated cognitive declines and possible differences in perceptions of intersections. The current study examines whether older drivers’ perceived complexity of intersections differed quantitatively and qualitatively from younger drivers’ perceived complexity of the same intersections. Coordinates of a random sample of intersections where at least one fatality occurred over a three-year period from the US Fatality Analysis Reporting System (FARS) were identified and Google Earth was used to extract still images of each intersection. The complexity of these intersection images were rated by a sample (N =38) of younger (age 18-35) and older drivers (age 65+). Inter-rater reliability for each group was calculated. In addition, individual intersection images with the largest and smallest age differences were qualitatively examined. Results suggest that older drivers view the complexity of intersections differently than younger drivers. Overall, older drivers were less reliable and scored nominally higher on average in their complexity ratings than younger drivers. Moreover, older drivers tended to rate rural or residential intersections as being more complex than younger drivers; whereas younger drivers tended to rate urban intersections as being more complex. Future work should account for these age differences in perceived intersection complexity.

Research has shown that safety climate is among the strongest predictors of safety behavior and safety outcomes in a variety of settings. Previous studies have established that safety climate is a multi-faceted construct referencing multiple levels of management within a company, most generally: the organization level (employee perceptions of top management’s commitment to and prioritization of safety) and group level (employee perceptions of direct supervisor’s commitment to and prioritization of safety). Yet, no research to date has examined the potential interaction between employees’ organization-level safety climate (OSC) and group-level safety climate (GSC) perceptions. Furthermore, prior research has mainly focused on traditional work environments in which supervisors and workers interact in the same location throughout the day. Little research has been done to examine safety climate with regard to lone workers. The present study aims to address these gaps by examining the relationships between truck drivers’ (as an example of lone workers) perceptions of OSC and GSC, both potential linear and non-linear relationships, and how these predict important safety outcomes. Participants were 8095 truck drivers from eight trucking companies in the United States with an average response rate of 44.8%. Results showed that employees’ OSC and GSC perceptions are highly correlated (r= 0.78), but notable gaps between the two were observed for some truck drivers. Uniquely, both OSC and GSC scores were found to have curvilinear relationships with safe driving behavior, and both scores were equally predictive of safe driving behavior. Results also showed the two levels of climate significantly interacted with one another to predict safety behavior such that if either the OSC or GSC scores were low, the other’s contribution to safety behavior became stronger. These findings suggest that OSC and GSC may function in a compensatory manner and promote safe driving behavior even when either OSC or GSC scores are low. The results of this study provide critical insight into the supplementary interaction between perceptions of OSC and GSC. Recommendations for future research, as well as practical recommendations for organizational intervention, are discussed.

Drivers’ trust in automation will likely determine the extent that autonomous and semi-autonomous vehicles are adopted, and once adopted, used properly. Unfortunately, previous studies have typically utilized overt subjective measures in determining an individual’s level of trust in automation. The current study aims to evaluate a covert behavioral measure of trust based on drivers’ body (head, hand, and foot) movements as they experience a simulated autonomous system. Videos of drivers interacting with an autonomous driving system in a driving simulator were coded. Body movement counts and average durations were derived from this coding and these data were compared across quartile rankings (based on self-reported trust) to examine body movements’ sensitivity to drivers’ level of trust. Results suggest body movements are not sensitive to individual differences in reported trust. Future work should further examine the utility of this covert behavioral metric by further examining situational differences.