Showing papers in "Journal of Occupational Rehabilitation in 2011"
TL;DR: In this paper, the authors survey human resource professionals and supervisors working for employers known or reputed to be resistant to complying with the ADA's employment provisions and find that the principal barriers to employing workers with disabilities are lack of awareness of disability and accommodation issues, concern over costs, and fear of legal liability.
Abstract: Introduction Despite persistently low employment rates among working-age adults with disabilities, prior research on employer practices and attitudes toward workers with disabilities paints a generally rosy picture of successfully accommodated workers in a welcoming environment. Findings from previous studies might have been biased because of either employer self-selection or social desirability, yielding non-representative or artificially positive conclusions. Methods In this study, a novel approach was used to survey human resource professionals and supervisors working for employers known or reputed to be resistant to complying with the ADA’s employment provisions. Attendees of employer-requested ADA training sessions were asked to assess various possible reasons that employers in general might not hire, retain, or accommodate workers with disabilities and to rate strategies and policy changes that might make it more likely for employers to do so. Results As cited by respondents, the principal barriers to employing workers with disabilities are lack of awareness of disability and accommodation issues, concern over costs, and fear of legal liability. With regard to strategies employers might use to increase hiring and retention, respondents identified increased training and centralized disability and accommodation expertise and mechanisms. Public policy approaches preferred by respondents include no-cost external problem-solving, subsidized accommodations, tax breaks, and mediation in lieu of formal complaints or lawsuits. Conclusions Findings suggest straightforward approaches that employers might use to facilitate hiring and retention of workers with disabilities, as well as new public programs or policy changes that could increase labor force participation among working-age adults who have disabilities.
355 citations
TL;DR: A systematic review of scientific evidence about prognostic factors for mental health related long term disability, RTW and symptom recovery finds strong evidence that older age (>50 years) is associated with continuing disability and longer time to RTW.
Abstract: Introduction In the past few decades, mental health problems have increasingly contributed to sickness absence and long-term disability. However, little is known about prognostic factors of return to work (RTW) and disability of persons already on sick leave due to mental health problems. Understanding these factors may help to develop effective prevention and intervention strategies to shorten the duration of disability and facilitate RTW. Method We reviewed systematically current scientific evidence about prognostic factors for mental health related long term disability, RTW and symptom recovery. Searching PubMed, PsycINFO, Embase, Cinahl and Business Source Premier, we selected articles with a publication date from January 1990 to March 2009, describing longitudinal cohort studies with a follow-up period of at least 1 year. Participants were persons on sick leave or receiving disability benefit at baseline. We assessed the methodological quality of included studies using an established criteria list. Consistent findings in at least two high quality studies were defined as strong evidence and positive findings in one high quality study were defined as limited evidence. Results Out of 796 studies, we included seven articles, all of high methodological quality describing a range of prognostic factors, according to the ICF-model categorized as health-related, personal and external factors. We found strong evidence that older age (>50 years) is associated with continuing disability and longer time to RTW. There is limited evidence for the association of other personal factors (gender, education, history of previous sickness absence, negative recovery expectation, socio-economic status), health related (stress-related and shoulder/back pain, depression/anxiety disorder) and external i.e., job-related factors (unemployment, quality and continuity of occupational care, supervisor behavior) with disability and RTW. We found limited evidence for the association of personal/external factors (education, sole breadwinner, partial/full RTW, changing work tasks) with symptom recovery. Conclusion This systematic review identifies a number of prognostic factors, some more or less consistent with findings in related literature (mental health factors, age, history of previous sickness absence, negative recovery expectation, socio-economic status, unemployment, quality and continuity of occupational care), while other prognostic factors (gender, level of education, sole breadwinner, supervisor support) conflict with existing evidence. There is still great need for research on modifiable prognostic factors of continuing disability and RTW among benefit claimants with mental health problems. Recommendations are made as to directions and methodological quality of further research, i.e., prognostic cohort studies.
240 citations
TL;DR: Two definitions of work ability are proposed, one for specific jobs that require special training or education, and one for jobs that most people can manage given a short period of practice.
Abstract: Introduction The concept of “work ability” is central for many sciences, especially for those related to working life and to rehabilitation. It is one of the important concepts in legislation regulating sickness insurance. How the concept is defined therefore has important normative implications. The concept is, however, often not sufficiently well defined. Aim and Method The objective of this paper is to clarify, through conceptual analysis, what the concept can and should mean, and to propose a useful definition for scientific and practical work. Results Several of the defining characteristics found in the literature are critically scrutinized and discussed, namely health, basic standard competence, occupational competence, occupational virtues, and motivation. These characteristics are related to the work tasks and the work environment. One conclusion is that we need two definitions of work ability, one for specific jobs that require special training or education, and one for jobs that most people can manage given a short period of practice. Having work ability, in the first sense, means having the occupational competence, the health required for the competence, and the occupational virtues that are required for managing the work tasks, assuming that the tasks are reasonable and that the work environment is acceptable. In the second sense, having work ability is having the health, the basic standard competence and the relevant occupational virtues required for managing some kind of job, assuming that the work tasks are reasonable and that the work environment is acceptable. Conclusion These definitions give us tools for understanding and discussing the complex, holistic and dynamic aspects of work ability, and they can lay the foundations for the creation of instruments for evaluating work ability, as well as help formulate strategies for rehabilitation.
161 citations
TL;DR: The results indicate that the low employment rate of people with disabilities is not due to their reluctance to work or different job preferences, and point toward the value of dismantling barriers to employment facing many people with disability.
Abstract: Introduction Do non-employed people with disabilities want to work, and if so, what types of jobs do they want? Researchers seeking to explain the low employment rate among people with disabilities have focused primarily on skill gaps, employment disincentives from disability income, accommodation mandates, and (to a lesser extent) employer attitudes and unwelcoming corporate cultures. There has been little attention paid to the attitudes of non-employed people with disabilities. Methods This paper uses the 2006 General Social Survey, a representative national survey of US adults that has disability information and a special supplement on worker preferences, to examine the above question. Results We find that, relative to their non-disabled counterparts, non-employed people with disabilities are (a) as likely to want a job but less likely to be actively searching, (b) as likely to have prior job experience, and (c) similar in their views of the importance of income, job security, and other valued job characteristics. The results, which vary little by type of impairment, indicate that the low employment rate of people with disabilities is not due to their reluctance to work or different job preferences. Conclusion Combined with evidence that a large share of new jobs can be performed by people with disabilities, the findings point toward the value of dismantling barriers to employment facing many people with disabilities.
143 citations
TL;DR: A conceptual definition for vocational rehabilitation (VR) based on the ICF is offered to offer a multi-professional approach that is provided to individuals of working age with health-related impairments, limitations, or restrictions with work functioning.
Abstract: Background The International Classification of Functioning, Disability and Health (ICF) is a conceptual framework and classification system by the World Health Organization (WHO) to understand functioning. The objective of this discussion paper is to offer a conceptual definition for vocational rehabilitation (VR) based on the ICF. Method We presented the ICF as a model for application in VR and the rationale for the integration of the ICF. We also briefly reviewed other work disability models. Results Five essential elements of foci were found towards a conceptual definition of VR: an engagement or re-engagement to work, along a work continuum, involved health conditions or events leading to work disability, patient-centered and evidence-based, and is multi-professional or multidisciplinary. Conclusions VR refers to a multi-professional approach that is provided to individuals of working age with health-related impairments, limitations, or restrictions with work functioning and whose primary aim is to optimize work participation. We propose that the ICF and VR interface be explored further using empirical and qualitative works and encouraging stakeholders’ participation.
106 citations
TL;DR: Results suggest that employment specialists can be guided in their interventions by the concepts found in the extended model of work integration since most of these are modifiable, such as perceived barriers to employment, self-efficacy, and self-esteem.
Abstract: Introduction The main purpose of this study was to test a conceptual model based on the theory of planned behaviour (TPB) to explain competitive job acquisition of people with severe mental disorders enrolled in supported employment programs. Methods Using a sample of 281 people with severe mental disorders participating in a prospective study design, the authors examined the contribution of the TPB in a model including clinical (e.g., severity of symptoms), psychosocial (e.g., self-esteem) and work related variables (e.g., length of time absent from the workplace) as predictors of job acquisition. Path analyses were used to test two conceptual models: (1) the model of job acquisition for people with mental illness adapted from the TPB, and (2) the extended TPB including clinical, psychosocial, and work related variables recognized in the literature as significant determinants of competitive employment. Results Findings revealed that both models presented good fit indices. In total, individual factors predicted 26% of the variance in job search behaviours (behavioural actions). However, client characteristics explained only 8% of variance in work outcomes, suggesting that environmental variables (e.g., stigma towards mental disorders) play an important role in predicting job acquisition. About 56% (N = 157) of our sample obtained competitive employment. Conclusion Results suggest that employment specialists can be guided in their interventions by the concepts found in the extended model of work integration since most of these are modifiable, such as perceived barriers to employment, self-efficacy, and self-esteem.
104 citations
TL;DR: The definitions, diagnosis and management of thoracic outlet syndrome were reviewed, with particular emphasis on the links between the workplace and the individual in the pathogenesis, prevalence in the workforce and the course of this disease.
Abstract: Introduction Thoracic outlet syndrome is a controversial cause of neck and shoulder pain due to complex mechanisms involving muscular dysfunction and nerve compression. Although management of thoracic outlet syndrome must be based on a multidisciplinary approach, physicians and occupational therapist should be familiar with the principles of diagnosis and treatment. Method, results and conclusion The purpose of this article is to review the definitions, diagnosis and management of this syndrome. A particular emphasis was described on the links between the workplace and the individual in the pathogenesis, prevalence in the workforce and the course of this disease.
92 citations
TL;DR: SP was high among police officers and work environment factors seem to be associated with SP, particularly among subjects with good general health, and was most affected by work environment among Subjects with good self-rated health.
Abstract: Introduction The aim was to describe the prevalence of sickness presenteeism (SP) and to explore possible associations with work characteristics among Swedish police officers. Methods Questionnaire data from 11,793 police officers were analysed. Relative risks (RR) and 95% confidence intervals (CI) for SP were calculated with modified Poisson regression. SP was defined as having gone to work on two or more occasions during the past 12 months despite judging that one’s health would have motivated sickness absence. Results Of the police officers, 47% reported SP. All studied work environment factors were significantly associated with SP. The strongest association was found for stress (RR = 1.46; 95% CI: 1.41–1.52). Low support from colleagues and low control had higher impact on the risk estimates for SP among older subjects. Adjustment for self-rated health lowered the RRs, however, estimates remained statistically significant. The results indicated that SP was most affected by work environment among subjects with good self-rated health. Conclusions SP was high among police officers. Work environment factors seem to be associated with SP, particularly among subjects with good general health.
86 citations
TL;DR: Successful RTW processes seem to comprise positive encounters, opportunities for increased self-understanding and support from significant others, and an explicit focus on topics like identity, own values and resources might improve the outcome of the rehabilitation process.
Abstract: Objective We have limited knowledge about the specific elements in an occupational rehabilitation programme that facilitate the process leading to return to work (RTW) as perceived by the patients. The aim of the study was to explore individual experiences regarding contributing factors to a successful RTW, 3 years after a resident occupational rehabilitation programme. Methods The study is based on interviews of 20 individuals who attended an occupational rehabilitation programme 3 years earlier. Ten informants had returned to work (RTW) and ten were receiving disability pension (DP). Data were analysed by systematic text condensation inspired by Giorgi’s phenomenological analysis. Results The core categories describing a successful RTW process included positive encounters, increased self-understanding and support from the surroundings. While the informants on DP emphasized being seen, heard and taken seriously by the professionals, the RTW group highlighted being challenged to increase self-understanding that promoted new acting in every-day life. Being challenged on self-understanding implied increased awareness of own identity, values and resources. Support from the surroundings included support from peer participants, employer and social welfare system. Conclusion Successful RTW processes seem to comprise positive encounters, opportunities for increased self-understanding and support from significant others. An explicit focus on topics like identity, own values and resources might improve the outcome of the rehabilitation process.
82 citations
TL;DR: Four domains related to injured workers’ interface with the health care system played a key role in complicating and prolonging compensation claims and resulted in frustration, financial difficulties and mental health problems for injured workers.
Abstract: Introduction: Health care providers (HCPs) play a central role in workers' compensation systems. In most systems, they are involved in the legitimization of work-related injury, are required to provide information to workers' compensation boards about the nature and extent of the injury, give recommendations about return-to-work capability and provide treatment for injury or illness. This study identifies problems that occur at the interface between the health care system, injured workers, and workers' compensation boards (WCBs) that may compli- cate and extend workers' compensation claims and the mechanisms that underlie the development of these prob- lems. Methods: Interviews were sought with injured workers, peer helpers and service providers from a variety of geographic locations in order to get a broad picture of return to work problems and concerns. This analysis includes data from total of 34 interviews with injured workers who had long term and complicated claims. Interviews were also conducted with 14 peer helpers and 21 service providers. Results: We identified four domains related to injured workers' interface with the health care system that played a key role in complicating and pro- longing compensation claims. These problems, related to health care access, conflicting or imperfect medical knowledge, limited understanding of compensation system requirements and confusion about decision-making authority, resulted in frustration, financial difficulties and mental health problems for injured workers. Conclusion: Recommendations are made about how compensation system parties can find better ways to serve injured worker health care needs and facilitate a smooth relationship between the compensation board and HCPs.
71 citations
TL;DR: A final 10-item version of the RTWSE has adequate internal consistency and validity to assess the confidence of injured workers to obtain help from supervisor and co-workers and to cope with pain.
Abstract: Introduction We report on the development and validation of a 10-item scale assessing self-efficacy within the return-to-work context, the Return-to-Work Self-Efficacy (RTWSE) scale. Methods Lost-time claimants completed a telephone survey 1 month (n = 632) and 6 months (n = 446) after a work-related musculoskeletal injury. Exploratory (Varimax and Promax rotation) and confirmatory factor analyses of self-efficacy items were conducted with two separate subsamples at both time points. Construct validity was examined by comparing scale measurements and theoretically derived constructs, and the phase specificity of RTWSE was studied by examining changes in strength of relationships between the RTWSE Subscales and the other constructs at both time measures. Results Factor analyses supported three underlying factors: (1) Obtaining help from supervisor, (2) Coping with pain (3) Obtaining help from co-workers. Internal consistency (alpha) for the three subscales ranged from 0.66 to 0.93. The total variance explained was 68% at 1-month follow-up and 76% at 6-month follow-up. Confirmatory factor analyses had satisfactory fit indices to confirm the initial model. With regard to construct validity: relationships of RTWSE with depressive symptoms, fear-avoidance, pain, and general health, were generally in the hypothesized direction. However, the hypothesis that less advanced stages of change on the Readiness for RTW scale would be associated with lower RTWSE could not be completely confirmed: on all RTWSE subscales, RTWSE decreased significantly for a subset of participants who started working again. Moreover, only Pain RTWSE was significantly associated with RTW status and duration of work disability. With regard to the phase specificity, the strength of association between RTWSE and other constructs was stronger at 6 months post-injury compared to 1 month post-injury. Conclusions A final 10-item version of the RTWSE has adequate internal consistency and validity to assess the confidence of injured workers to obtain help from supervisor and co-workers and to cope with pain. With regard to phase specificity, stronger associations between RTWSE and other constructs at 6-month follow-up suggest that the association between these psychological constructs consolidates over time after the disruptive event of the injury.
TL;DR: Investigation of the beliefs and attitudes of managers and employees with musculoskeletal pain about sickness absence, presenteeism, and return to work and to identify areas of consensus and conflict required careful consideration of the rights and responsibilities of both employees and employers.
Abstract: Introduction: Musculoskeletal complaints can impact on work in terms of productivity, sickness absence and long term incapacity for work. While employee attitudes and knowledge can drive absenteeism and presenteeism behaviour, managers also play an important role in influencing this via the quality of their relationships with employees and their role in implementing organisational policies and procedures. The aims of this study were to investigate the beliefs and attitudes of managers and employees with musculoskeletal pain about sickness absence, presenteeism, and return to work and to identify areas of consensus and conflict. Methods: 18 employees with musculoskeletal pain and 20 managers from two large public sector organisations in South Wales, UK, took part in individual face-to-face interviews. Data were analysed thematically using NVivo. Results: Employees’ and managers’ reports indicated that there was a strong culture of presenteeism in these organisations. Establishing the legitimacy of complaints was a salient theme for both managers and employees, although their views were in conflict. Employees reported feeling that contact with employers was intrusive when sickness absence was legitimate. Managers were supportive of those who they felt were ‘genuinely’ unwell, but also cited examples of people ‘working the system’ and not reporting absences appropriately. Conclusions: These issues require careful consideration of the rights and responsibilities of both employees and employers, where strategies for improving communication, trust, and creating an environment conducive to successful return to work need to be investigated.
TL;DR: It is recommended that intervention efforts directed towards prevention of musculoskeletal disorders should focus on psychosocial work factors such adverse workstyle in addition to biomechanical risk factors.
Abstract: Introduction Work-related musculoskeletal disorders are common in computer professionals. Workstyle may be one of the risk factors in the development of musculoskeletal discomfort. The objective of this retrospective study was to examine the prevalence of adverse workstyle in computer professionals from India and to evaluate if workstyle factors were predictors of pain and loss of productivity. Methods Office workers from various information technology (IT) companies in India responded to the short-form workstyle questionnaire and pain questionnaire. Correlation analyses were conducted to examine the associations between different variables followed by a multivariate logistic regression to understand the unique predictors of pain and loss of productivity. Results 4,500 participants responded to the workstyle and pain questionnaire. 22% of participants were reported to have a high risk of an adverse workstyle. 63% of participants reported pain symptoms. Social reactivity, lack of breaks, and deadlines/pressure subscales of workstyle questionnaire were significantly correlated with pain and loss of productivity. Regression analyses revealed that workstyle factors and duration of computer use per day were significant predictors of pain. Conclusion Workstyle seems to be a mediating factor for musculoskeletal pain, discomfort, and loss of productivity. Based on the study findings, it is recommended that intervention efforts directed towards prevention of musculoskeletal disorders should focus on psychosocial work factors such adverse workstyle in addition to biomechanical risk factors.
TL;DR: A systematic review of the literature to identify outcomes or measures being used in VR using a systematic review methodology and link those measures to the International Classification of Functioning, Disability and Health found great diversity in the ICF contents of the measures used in different VR settings and study populations, which indicates the complexity of VR.
Abstract: Background: Vocational rehabilitation (VR) is aimed at engaging or re-engaging individuals with work participation and employment The International Classification of Functioning, Disability and Health (ICF) by the World Health Organization can be operationalized in the context of VR The objective of this study is to review the literature to identify outcomes or measures being used in VR using a systematic review methodology and link those measures to the ICF Methods: We applied a structured search strategy using multiple databases Items or constructs of the measures or outcomes identified were linked to the ICF by two trained individuals Results: We have identified 648 measures which contained 10,582 concepts that were linked to the ICF which resulted in 87 second-level ICF categories Out of the 87 categories, 31 (356%) were related to body functions, 43 (494%) were related to activities and participation, and 13 (149%) were related to environmental factors No category was related to body structures Conclusions: Our review found great diversity in the ICF contents of the measures used in different VR settings and study populations, which indicates the complexity of VR This systematic review has provided a list of ICF categories which could be considered towards a successful VR
TL;DR: The perception held by supervisors involved in work disability management, of the factors facilitating or hindering the return to work of workers with common mental disorders was investigated.
Abstract: Introduction Over the last decade, common mental disorders have become an area of major concern in the field of work disability prevention due to the rising number of claims, costs, and impacts on quality of life. It has been shown that supervisory behavior influences return-to-work outcomes. This study aimed to investigate the perception held by supervisors involved in work disability management, of the factors facilitating or hindering the return to work of workers with common mental disorders. Methods This project consisted of an exploratory qualitative study. Semi-structured interviews were conducted of supervisors. All subjects had experience with the return to work of at least one worker who had been off work due to a common mental disorder (i.e., anxiety, mood or adjustment disorder). Content analysis of the transcripts was performed. Results A total of 11 supervisors from large and medium-sized companies participated in the project. Twenty-four factors that could hinder or facilitate the return-to-work process were found and classified into three main categories: factors related to the worker, work context, and return-to-work process. Conclusions This study brought to light several factors influencing the return to work of workers with common mental disorders. Most of the supervisors interviewed were very open to finding ways to facilitate the return to work of these workers, but felt that the interventions used should take both their perspective and the constraints they face in the workplace into account. Subsequent studies on return to work should therefore focus equally on the individual and the workplace to ensure that the actions taken can be appropriately implemented and well received by all stakeholders, including supervisors, who are continually involved in front-line interventions.
TL;DR: Much heterogeneity was observed in investigated capacity tests and candidate associated factors and there was some evidence for biological and psychological factors that are or are not associated with capacity results but there was also much conflicting evidence.
Abstract: Introduction: Functional capacity tests are standardized instruments to evaluate patients’ capacities to execute work-related activities. Functional capacity test results are associated with biopsychosocial factors, making it unclear what is being measured in capacity testing. An overview of these factors was missing. The objective of this review was to investigate the level of evidence for factors that are associated with functional capacity test results in patients with non-specific chronic low back pain. Methods: A systematic literature review was performed identifying relevant studies from an electronic journal databases search. Candidate studies employed a cross-sectional or RCT design and were published between 1980 and October 2010. The quality of these studies was determined and level of evidence was reported for factors that were associated with capacity results in at least 3 studies. Results: Twenty-two studies were included. The level of evidence was reported for lifting low, lifting high, carrying, and static lifting capacity. Lifting low test results were associated with self-reported disability and specific self-efficacy but not with pain duration. There was conflicting evidence for associations of lifting low with pain intensity, fear of movement/(re)injury, depression, gender and age. Lifting high was associated with gender and specific self-efficacy, but not with pain intensity or age. There is conflicting evidence for the association of lifting high with the factors self-reported disability, pain duration and depression. Carrying was associated with self-reported disability and not with pain intensity and there is conflicting evidence for associations with specific self-efficacy, gender and age. Static lifting was associated with fear of movement/(re)injury. Conclusions: Much heterogeneity was observed in investigated capacity tests and candidate associated factors. There was some evidence for biological and psychological factors that are or are not associated with capacity results but there is also much conflicting evidence. High level evidence for social factors was absent.
TL;DR: The newly developed participatory return-to-work program seems to be a promising intervention to facilitate work resumption and reduce work disability among temporary agency workers and unemployed workers, sick-listed due to musculoskeletal disorders.
Abstract: Introduction Within the labour force workers without an employment contract represent a vulnerable group. In most cases, when sick-listed, these workers have no workplace/employer to return to. Therefore, the aim of this study was to evaluate the effectiveness on return-to-work of a participatory return-to-work program compared to usual care for unemployed workers and temporary agency workers, sick-listed due to musculoskeletal disorders. Methods The workers, sick-listed for 2–8 weeks due to musculoskeletal disorders, were randomly allocated to the participatory return-to-work program (n = 79) or to usual care (n = 84). The new program is a stepwise procedure aimed at making a consensus-based return-to-work plan, with the possibility of a temporary (therapeutic) workplace. Outcomes were measured at baseline, 3, 6, 9 and 12 months. The primary outcome measure was time to sustainable first return-to-work. Secondary outcome measures were duration of sickness benefit, functional status, pain intensity, and perceived health. Results The median duration until sustainable first return-to-work was 161 days in the intervention group, compared to 299 days in the usual care group. The new return-to-work program resulted in a non-significant delay in RTW during the first 90 days, followed by a significant advantage in RTW rate after 90 days (hazard ratio of 2.24 [95% confidence interval 1.28–3.94] P = 0.005). No significant differences were found for the measured secondary outcomes. Conclusions The newly developed participatory return-to-work program seems to be a promising intervention to facilitate work resumption and reduce work disability among temporary agency workers and unemployed workers, sick-listed due to musculoskeletal disorders.
TL;DR: The articles included in this special section exemplify the breadth of current research in this field, and future opportunities for greater cross- disciplinary collaboration and translation of research to practical implementation and policy interventions.
Abstract: Work disability prevention has evolved from being a component of disease outcomes studies, to a separate and growing research discipline. In part, this is due to recognition that work outcomes often do not correlate with other health outcomes; the causes of work disability are multiple, complex, and often distinct from associated health conditions or treatments; and that work disability creates an important personal, economic and social burden that is often preventable. Conceptual frameworks, measures, research methods and interventions specific to this area have been developed, many have been validated across different contexts, and an international community of researchers and trainees in work disability prevention has formed. The articles included in this special section exemplify the breadth of current research in this field, and future opportunities for greater cross- disciplinary collaboration and translation of research to practical implementation and policy interventions.
TL;DR: The results indicate that a ‘new’ kidney has advantages over dialysis with respect to work, but does not necessarily leads to ‘normal’ work outcomes.
Abstract: Introduction The aim of this study was to examine the health- and work outcomes of renal transplant recipients long-term after transplantation as well as the pattern of work status, work ability and disability benefits during the end-stage renal disease (ESRD) trajectory that precedes transplantation. Methods 34 transplant recipients completed interviews 3, 13 months and >6 years posttransplantation. Health status (SF-36), work ability (WAI), and fatigue (CIS) were assessed by questionnaires, clinical data were derived from medical charts, and data on functional limitations were extracted from the social security system database. The work status trajectory preceding transplantation was examined retrospectively. Results Of the 34 third wave transplant recipients, 29% were severely fatigued. Compared with the general working population, recipients experienced worse general health and less vitality. Non-working recipients had worse renal function and general health, and more limitations in physical functioning compared to working recipients. The WAI score indicated moderate work ability for 60% of the employed recipients. Although 67% were employed (45% parttime), 30% of those working still received some disability benefits. Social insurance physicians found variable levels of functional limitations. The mean work status trajectory showed more sickness absence and less work ability during dialysis, but after transplantation, both work status and work ability generally improved. Conclusions Transplant recipients have a compromised health status which leads to functional limitations and disability. Although work status improved after transplantation, a substantial number of the transplant recipients received disability benefits. The negative health consequences of anti-rejection medications may play an important role in long-term work ability. These results indicate that a ‘new’ kidney has advantages over dialysis with respect to work, but does not necessarily leads to ‘normal’ work outcomes.
TL;DR: Methods for measuring and valuing health-related productivity vary widely, hindering comparability of results and decision-making, and suggestions for improvement are provided.
Abstract: Objectives: To investigate the methods used to estimate the indirect costs of health-related productivity in economic evaluations from a company’s perspective. Methods: The primary literature search was conducted in Medline and Embase. Supplemental searches were conducted in the Cochrane NHS Economic Evaluation Database, the National Institute for Occupational Safety and Health database, the Ryerson International Labour, Occupational Safety and Health Index database, scans of reference lists and researcher’s own literature database. Article selection was conducted independently by two researchers based on title, keywords, and abstract, and if needed, full text. Differences were resolved by a consensus procedure. Articles were selected based on seven criteria addressing study population, type of intervention, comparative intervention, outcome, costs, language and perspective, respectively. Characteristics of the measurement and valuation of health-related productivity were extracted and analyzed descriptively. Results: A total of 34 studies were included. Costs of health-related productivity were estimated using (a combination of) data related to sick leave, compensated sick leave, light or modified duty or work presenteeism. Data were collected from different sources (e.g. administrative databases, worker self-report, supervisors) and by different methods (e.g. questionnaires, interviews). Valuation varied in terms of reported time units, composition and source of the corresponding price weights, and whether additional elements, such as replacement costs, were included. Conclusions: Methods for measuring and valuing health-related productivity vary widely, hindering comparability of results and decision-making. We provide suggestions for improvement.
TL;DR: Return to work (RTW) after different types of cancer depended on occupational factors rather than demographics, and employees working in large companies returned to work earlier than those working in small companies.
Abstract: Introduction Long-term employment rates have been studied in cancer survivors, but little is known about the return to work of cancer patients. This study investigated return to work (RTW) within 2 years after the diagnosis of different types of cancer. Methods This prospective study investigated the associations of demographics (age, gender, socioeconomic status, and residential region) and occupational factors (occupation, duration of employment, and company size) of employees absent from work due to cancer with the time to partial RTW, defined as working at least 50% of the earnings before sickness absence. Likewise, the associations of demographics and occupational factors with full RTW at equal earnings as before sickness absence were investigated. Results The cohort included 5,234 employees who had been absent from work due to cancer between January 2004 and December 2006. The time to partial RTW was shortest among employees with skin cancer (median 55 days) and longest among employees with lung cancer (median 377 days). There were no significant associations between RTW and demographics. With regard to the occupational factors, employees in high occupational classes started working earlier than those in low occupational classes, but the time to full RTW did not differ significantly across occupational classes. Employees working in large companies returned to work earlier than those working in small companies. Conclusion RTW after different types of cancer depended on occupational factors rather than demographics.
TL;DR: VR of patients must not be limited to anatomical and pathophysiologic changes, but should also consider a more comprehensive view which includes client’s demands, strategies and resources in daily life and the context around the individual and social circumstances of their work situation.
Abstract: Introduction A mixed-methods (qualitative-quantitative), multicenter study was conducted using a focus group design to explore the lived experiences of persons in vocational rehabilitation (VR) with regard to functioning and contextual factors using six open-ended questions related to the ICF components. The results were classified by using the International Classification of Functioning, Disability and Health (ICF) as a frame of reference. Methods The meaningful concepts within the transcribed data were identified and linked to ICF categories according to established linking rules. Results The seven focus groups with 26 participants yielded a total of 4,813 relevant concepts which were linked to a total of 160 different second-level ICF categories. From the client perspective, the ICF components (a) body functions, (b) activities and participation and (c) environmental factors were equally represented, while (d) body structures appeared less frequently. Out of the total number of concepts, 864 concepts (18%) were assigned to the ICF component personal factors which is not yet classified but could indicate important aspects of resource management and strategy development of patients in VR. Conclusion Therefore, VR of patients must not be limited to anatomical and pathophysiologic changes, but should also consider a more comprehensive view which includes client’s demands, strategies and resources in daily life and the context around the individual and social circumstances of their work situation.
TL;DR: There was a multitude of ICF functioning domains according to the respondents which indicates the complexity of VR, and a list ofICF categories which could be considered in VR is provided.
Abstract: Background Vocational rehabilitation (VR) is a key process in work disability (WD) management which aims to engage or re-engage individuals to work and employment. The International Classification of Functioning, Disability and Health (ICF) by the World Health Organization (WHO) can be interfaced with VR but there is a lack of evidence of what ICF contents experts in the field consider. The objective of this study is to survey the experts in the VR field with regard to what factors are considered important to patients participating in VR using the ICF as the language to summarize the results. Methods An internet-based survey was conducted with experts from six WHO Regions (Africa, the Americas, Eastern Mediterranean, Europe, South-East Asia, and Western Pacific). Experts were asked six open-ended questions on factors that are important in VR. Each question was related to a component of the ICF (body functions, body structures, activities and, environmental factors, and personal factors). Responses were linked to the ICF. Results Using a modified stratified randomized sampling, 201 experts were sent the survey and 151 experts responded (75% response rate). We identified 101 ICF categories: 22 (21.8%) for body functions, 13 (12.9%) for body structures, 36 (35.6%) for activities and participation, and 30 (29.7%) for environmental factors. Conclusions There was a multitude of ICF functioning domains according to the respondents which indicates the complexity of VR. This expert survey has provided a list of ICF categories which could be considered in VR.
TL;DR: This framework outlines the key information evaluators should gather, the domains of the person, environment and occupation they should assess, and elements of rigour they should consider when completing a vocational evaluation and making recommendations for work re-entry following a TBI.
Abstract: Introduction: In order to develop the evidence base for a clinical practice guideline (CPG) for vocational evaluation following traumatic brain injury (TBI), we undertook a review to identify the key processes evaluators should follow and the key factors they should consider when completing a vocational evaluation. Methods: Processes outlined in the Cochrane Handbook of Systematic Review guided our processes and included: development of review questions, search strategies and selection criteria; quality appraisal; extraction, analysis and data synthesis; drawing conclusions. Four data bases (i.e. Medline; PsychInfo; Embase; The Cochrane Library of Systematic Reviews) were searched for descriptive articles, quantitative and qualitative studies, and nine websites were searched for CPGs (e.g. Scottish Intercollegiate Guideline Network; US National Guideline Clearinghouse; New Zealand Guideline Group). Two reviewers independently appraised methodological quality. Data were extracted into evidence tables which included: study purpose; location; participants; design/method; themes; findings; relevant processes and factors. Directed content analysis was utilized to analyze and synthesize the descriptive process evidence. A constant comparative method was employed to compare study findings in relation to factors associated with successful employment. Results: Results from process and factors syntheses are integrated into the Evidence-based Framework for Vocational Evaluation Following TBI. This framework identifies seven key processes in a vocational evaluation, including: (1) identification of the evaluation purpose and rationale; (2) intake process; (3) assessment of the person; (4) assessment of the environment; (5) assessment of the occupation/job requirements; (6) analysis and synthesis of assessment results; (7) development of evaluation recommendations. Relevant factors are integrated into each key process. Conclusions: This framework outlines the key information evaluators should gather, the domains of the person, environment and occupation they should assess, and elements of rigour they should consider when completing a vocational evaluation and making recommendations for work re-entry following a TBI.
TL;DR: Understanding of where discrepancies between stakeholders’ perceptions about interventions come from is provided, which has implications for workplace disability prevention intervention development, implementation and evaluation criteria.
Abstract: Introduction Workplace disability prevention is important, but stakeholders can differ in their appreciation of such interventions. We present a responsive evaluation of a workplace disability prevention intervention in a Canadian healthcare organization. Three groups of stakeholders were included: designers of the intervention, deliverers, and workers. The aim was to examine the appreciation of this intervention by analyzing the discrepancies with respect to what these various stakeholders see as the causes of work disability, what the intervention should aim at to address this problem, and to what extent the intervention works in practice. Methods A qualitative research method was used, including data-triangulation: (a) documentary materials; (b) semi-structured interviews with the deliverers and workers (n = 14); (c) participatory observations of group meetings (n = 6); (d) member-checking meetings (n = 3); (e) focus-group meetings (n = 2). A grounded theory approach, including some ethnographic methodology, was used for the data-analysis. Results Stakeholders’ perceptions of causes for work disability differ, as do preferred strategies for prevention. Designers proposed work-directed measures to change the workplace and work organizations, and individual-directed measures to change workers’ behaviour. Deliverers targeted individual-directed measures, however, workers were mostly seeking work-directed measures. To assess how the intervention was working, designers sought a wide range of outcome measures. Deliverers focused on measurable outcomes targeted at reducing work time-loss. Workers perceived that this intervention offered short-term benefits yet fell short in ensuring sustainable return-to-work. Conclusion This study provides understanding of where discrepancies between stakeholders’ perceptions about interventions come from. Our findings have implications for workplace disability prevention intervention development, implementation and evaluation criteria.
TL;DR: Self-efficacy is an important determinant of the occupational outcome of back pain and bivariate analyses showed a significant association between external HLC and RWGH at 2 year, but this relationship was not significant in multivariate analyses.
Abstract: Objectives Although self-efficacy and health locus of control (HLC) have been extensively studied in health research, little is known about their contribution to occupational disability among workers with back pain. This 2 year prospective study examined the association between these control belief constructs and “return to work in good health” (RWGH), a four-category, composite index of back pain outcome. Methods The participants (n = 1,007, participation = 68.4%, follow-up = 86%) were workers with occupational disruptions who sought a medical consultation for non specific back pain in primary care and emergency settings in the Quebec City area, Canada. Information about self-efficacy for return to work (SERW) and HLC, as well as potential confounders, was collected during a telephone interview about 3 weeks after the baseline medical consultation. Polytomous logistic regression was used to assess the relationship between the baseline control variables and RWGH at 2 year. Odds ratios (OR) and their 95% confidence intervals were used to quantify the strength of associations. For all analyses, the “success” category was considered the reference group. Results Although bivariate analyses showed a significant association between external HLC and RWGH at 2 year, this relationship was not significant in multivariate analyses. Higher scores on the self-efficacy questionnaire were however protective of “failure to return to work after attempt(s)” (OR: 0.28; 95% CI: 0.14–0.57) and of “failure to return to work” (OR: 0.19; 95% CI: 0.07–0.48) in multivariate analyses. Conclusion Self-efficacy is an important determinant of the occupational outcome of back pain.
TL;DR: This rural workforce adopts a ‘can do’ attitude to work, managing LBP within the context of having job control and flexible work practices, whilst accepting LBP as part of everyday life.
Abstract: Introduction Many New Zealand rural workers have repeated low back pain (LBP) episodes yet continue to work. We wanted to find out why, given that other manual workers with LBP often end up on long term sick leave or permanently disabled. Methods Our primarily qualitative approach used mixed methods to investigate rural workers with non-specific LBP. Participants (n = 33) were surveyed for demographic data, the Brief Illness Perception Questionnaire and the General Self Efficacy Scale followed by one-to-one semi-structured interviews. Analysis ranged from descriptive content to detailed qualitative Interpretative Phenomenological Analysis. Results Participants had high self efficacy scores, positive perceptions about LBP but strong beliefs that LBP is lifelong. Four distinct themes emerged. “Thinking with my head before my back” and “Knowing the risks” described participants’ innovation regarding job modifications. “Just carry on” and “Love of the land” related to stoical resilience and commitment to something more than employment. Conclusions This rural workforce adopts a ‘can do’ attitude to work, managing LBP within the context of having job control and flexible work practices. Implications: Rehabilitation interventions promoting job control and targeting positive attitudes towards getting on with work, whilst accepting LBP as part of everyday life, may have merit for other workers with LBP.
TL;DR: Individual Workstyles in response to workload demands and stressors, including working with heightened muscle tension and mental fatigue, were significantly associated with musculoskeletal symptoms.
Abstract: Introduction: The purpose of this study was to identify and compare individual behavioral and psychophysiological responses to workload demands and stressors associated with the reporting of musculoskeletal symptoms with computer work. Evidence is growing that the prevalence of musculoskeletal symptoms increases with longer hours of computer work and exposure to psychosocial stressors such as high workloads and unrealistic deadlines. Workstyle, or how an individual worker behaves in response to such work demands, may also be an important factor associated with musculoskeletal symptoms in computer operators. Method Approximately 8,000 employees of the Australian Public Service were invited to complete an on-line survey if they worked with a computer for 15 or more hours per week. The survey was a composite of three questionnaires: the ASSET to measure perceived organizational stressors, Nordic Musculoskeletal Questionnaire to measure reported prevalence of musculoskeletal symptoms and additional questions to measure individual work behaviors and responses. Results 934 completed surveys were accepted for analyses. Logistic regression was used to identify significant behavioral and work response predictors of musculoskeletal symptoms. Reporting of heightened muscle tension in response to workload pressure was more strongly associated, than other physical behavioral factors, with musculoskeletal symptoms for all body areas, particularly the neck (OR = 2.50, 95% CI: 2.09–2.99). Conclusions Individual Workstyles in response to workload demands and stressors, including working with heightened muscle tension and mental fatigue, were significantly associated with musculoskeletal symptoms. Future risk management strategies should have a greater focus on the identification and management of those organizational factors that are likely to encourage and exacerbate adverse Workstyles.
TL;DR: Transdisciplinary teams with multiple health care providers are suitable for treating patients with complex needs and with injuries that are chronic in nature, however, transdisciplinary teamwork requires input from an organizational level and from a communication level to effectively contribute to both clinician satisfaction and to improved coordination in patient care.
Abstract: Introduction This research explored the experience of clinicians during the transition from working as an interdisciplinary team to providing a transdisciplinary model of care in a functional restoration program (FRP) for clients with chronic disabling musculoskeletal pain. Methods This qualitative study used a grounded theory approach to data collection and analysis. In depth interviews were conducted to gather data and analysis was performed by the coding of emergent themes. Results Three major themes were identified that contributed towards building a successful transdisciplinary team: the client population; opportunities for communication with colleagues; and an organizational structure that supports transdisciplinary teamwork. Conclusions Transdisciplinary teams with multiple health care providers are suitable for treating patients with complex needs and with injuries that are chronic in nature. However, transdisciplinary teamwork requires input from an organizational level and from a communication level to effectively contribute to both clinician satisfaction and to improved coordination in patient care.
TL;DR: There was a strong evidence that the workplace fitness program applied was effective in reducing workers’ pain perception for their posterior back, dorsal and lumbar zones, and for their right wrist (P < 0.05).
Abstract: Introduction Office workers share several behavioural patterns: they work seated without moving for long times, they use only a few specific muscles of their arms, wrists and hands, and they keep an overall poor body posture. These working patterns generate musculoskeletal disorders, and produce discomfort or pain. Implementation of a work fitness program is thus a low-cost strategy to reduce/prevent body pain derived from work. The aim of this study was to test the benefits of a workplace fitness program, specifically applied to an administrative department of a Portuguese enterprise. Recall that this type of primary prevention level of musculoskeletal disorders has been seldom applied in Portugal, so this research effort materialized an important contribution to overcome such a gap. Methods The participants in this study were office workers (n = 29 in the study group, and n = 21 in the control group)—who consistently had reported pain mostly on their back side (neck, posterior back, and dorsal and lumbar zones), wrists and posterior legs. The workplace fitness program consisted of three sessions per week during an 8-month period, with 15 min per session; emphasis was on stretching exercises for the body regions most affected by workers’ pain perception. Each participant was requested to point out the injured region, as well as the intensity of pain felt, by using a visual analogue scale. Statistical analyses of the perceived pain data from control and study groups resort to non-parametric hypothesis tests. Results There was a strong evidence that the workplace fitness program applied was effective in reducing workers’ pain perception for their posterior back, dorsal and lumbar zones, and for their right wrist (P < 0.05). Conclusions These results generated are rather promising, so they may efficiently serve as an example for other enterprises in that country—while raising awareness on the important issue of quality of life at the workplace.