Physician’s beliefs in the assessment of work attribution when reporting musculoskeletal disorders.

Background There is considerable uncertainty about work-relatedness and musculoskeletal disorders in general,
and it is also not clear how physicians decide whether work has caused a disorder in an individual
patient. ............................................................................................................................... .............................
Aims To investigate physicians’ beliefs about assessment of occupational attribution for work-related
musculoskeletal disorders. ............................................................................................................................... .............................
Methods A questionnaire survey was sent to 526 occupational physicians and 248 rheumatologists on:
characteristics of cases seen, assessment of work attribution, definition of work-relatedness and
threshold for case reporting. Continuous variables were analysed by mean, standard deviation, an
independent two-sample t-test and the Mann–Whitney test. Mean and median values were calculated
and Spearman’s rank test was applied to ranked data. ............................................................................................................................... .............................
Results Questionnaires were completed by 68% occupational physicians and 64% rheumatologists. Both
groups of physicians believed that ‘history of onset in relation to workplace changes’ and ‘symptoms
consistent with work exposure’ were the most important factors suggesting work attribution. They
considered that the most important objective of a reporting scheme was detection of trends in disease
incidence and that the most suitable criteria for defining work-relatedness was the probability that
exposure at work ‘more likely than not’ caused the condition (mean 0.73; SD ¼ 0.17), in a perceived
likelihood scale (0–1). ............................................................................................................................... .............................
Conclusion There was a strong agreement between occupational physicians and rheumatologists on questions
about work-relatedness and musculoskeletal disorders. The level of probability for concluding workrelatedness has been quantified. ............................................................................................................................... .............................
Key words Attribution; musculoskeletal; occupational; physician; subjective probability; surveillance and disease
reporting; work-relatedness. ........................................................................................