Smith, MichelleJohnston, VenerinaAlyousef, Yousef Saleh2025-02-102024Alyousef YS, Johnston V, Smith MD. Understanding work participation in workers with lower limb osteoarthritis. The University of Queensland, 2025.https://hdl.handle.net/20.500.14154/74847This thesis incorporates four published manuscripts and one manuscript currently under peer review, presented with minor reformatting to ensure consistency throughout the thesis (e.g., font, table/figure formatting, and abbreviations). Publications included in this thesis: Alyousef YS, Johnston V, Mellor R, Plinsinga ML, Zerguine H, Smith MD. The effect of lower limb osteoarthritis on work-related outcomes: a systematic review and meta-analysis. Disabil Rehabil. 2024 Aug;46(17):3792-801. Epub 2023 Sep 22. https://doi.org/10.1080/09638288.2023.2259304 Alyousef YS, Johnston V, Smith MD. Work-related outcomes in individuals with and without lower limb osteoarthritis: an online survey. BMC Public Health. 2023 Sep 29;23(1):1885. https://doi.org/10.1186/s12889-023-16723-3 Alyousef YS, Ross MH, Johnston V, Smith MD. Experiences of working with lower limb osteoarthritis: a qualitative study. J Occup Rehabil. 2024 Sep;34(3):683-692. Epub 2023 Nov 23. https://doi.org/10.1007/s10926-023-10158-8 Alyousef YS, Johnston V, Smith MD. Work-related interventions are not commonly included in physiotherapy management of lower limb osteoarthritis: a cross-sectional survey of Australian physiotherapists. Musculoskelet Sci Pract. 2024 Jun 1;71:102942. https://doi.org/10.1016/j.msksp.2024.102942 Submitted manuscripts included in this thesis: Alyousef YS, Johnston V, Tan MT, Plinsinga ML, Fuller M, Roscher P, Smith MD. The effect of treatment for lower limb osteoarthritis on work-related outcomes: a systematic review and meta-analysis. Manuscript submitted for publication.Abstract Osteoarthritis (OA), particularly of the lower limb, is a prevalent health condition affecting people who are still participating in the workforce. People with lower limb OA typically experience joint pain, reduced mobility, muscle weakness and difficulties with ambulatory activities. These impairments can impact an individual’s life in several domains, including work participation. Research is scarce on the impact and management of lower limb OA in relation to work. This thesis aims to understand work participation in workers with lower limb OA using a range of indicators such as work status, work ability, productivity, absenteeism and presenteeism. This is accomplished through five studies presented across five chapters. Study 1 systematically reviewed the literature to explore work-related outcomes in individuals with lower limb OA compared to healthy controls. This review confirmed that the literature in this area is limited – seven studies were identified, two of which were included in a meta-analysis. No studies investigated work-related outcomes in individuals with foot or ankle OA. A meta-analysis revealed that individuals with lower limb OA were less frequently in paid employment than healthy controls (odds ratio: 0.25; 95% confidence intervals: 0.12, 0.53). Evidence from single studies suggests that individuals with hip and knee OA have greater absenteeism and presenteeism and poorer functional capacity than healthy controls. To address gaps in the literature identified in the previous systematic review, Study 2 was a cross-sectional online survey that compared work-related outcomes and difficulty performing work in workers with (n=124) and without (n=106) lower limb OA. The survey included three validated scales of work-specific outcomes: the Work Ability Index (WAI), the World Health Organization’s Health and Work Performance Questionnaire (WHO-HPQ), and the Work Role Functioning Questionnaire. We found that workers with lower limb OA have poorer work ability and productivity (p<0.001), and more difficulty with work scheduling demands and physical demands (p≤0.05) than healthy workers. There was no statistical difference in absenteeism or overall ability to meet work demands between workers with and without lower limb OA. Study 3 complemented the findings of Studies 1 and 2 by using semi-structured interviews to explore the perspectives of 22 workers with lower limb OA on difficulties they experienced at work, concerns they have about work, and strategies they use to manage at work. A thematic analysis identified six major themes related to participants’ experiences of working with lower limb OA: weight-bearing physical demands are challenging; lower limb OA can affect work performance; emotional consequences of pain; concerns about work in the future; positive experiences of supportive colleagues and managers; and minimal effects on sedentary work. Three main themes were identified relating to strategies to remain at work: adjustments at work to help manage pain; regular strategies (e.g., changing positions and postures) to manage pain; and consulting healthcare professionals, but usually not specifically for work. This study identified challenges experienced by workers with lower limb OA that need to be addressed to help workers with OA to remain in the workforce. Based on the findings of Study 3, a cross-sectional online survey was conducted with Australian physiotherapists to explore their current management strategies when treating patients with lower limb OA, with the aim of determining how work concerns were addressed in their practice (Study 4). A total of 132 physiotherapists with at least two years of experience treating patients with lower limb OA completed the survey. The findings suggest that while the key interventions used by most Australian physiotherapists to manage people with lower limb OA are consistent with current clinical guidelines, most physiotherapists do not include activities to help people remain productive in the workforce. There is a need to better understand and address the lack of work support included in physiotherapy consultations with patients with lower limb OA. Study 5 conducted a systematic review and meta-analysis to determine the impact of interventions on work-related outcomes in workers with lower limb OA. Fourteen studies met the inclusion criteria, with seven studies included in the meta-analysis. The meta-analysis revealed no significant difference in employment status two or more years after surgical treatment (odds ratio: 3.47; 95% CI: 0.92, 13.14) or in work ability three months after non-surgical treatment (mean difference: 0.45; 95% CI: -1.11, 2.00) compared to pre-treatment among individuals with knee and/or hip OA. However, single studies reported positive changes post-treatment in absenteeism, work functioning and impact on work. This highlights the need for further research into work-specific interventions that address the unique challenges experienced by individuals with lower limb OA in the workplace. Overall, the findings from this thesis contribute to our understanding of work participation in workers with lower limb OA. The data provides healthcare professionals and employers with a deeper understanding of the difficulties people with lower limb OA experience at work and highlight the lack of evidence for interventions to maximise work participation in this population.194enosteoarthritislower limbworkworkerswork abilityemploymentabsenteeismpresenteeismproductivityphysiotherapywork-related managementThesis