Mai 2020

Tools Appraisal of Organizational Factors Associated with Return-to-Work in Workers on Sick Leave Due to Musculoskeletal and Common Mental Disorders: A Systematic Search and Review

Purpose The objective of this study was to identify organizational factors that are predictive of return-to-work (RTW) among workers with musculoskeletal (MSD) and common mental disorders (CMD), and to subsequently catalogue and characterize the questionnaires (tools) used to measure them. Methods A systematic search on PubMed, Web of Science and PsycINFO library databases and grey literature was conducted. First, a list of organizational factors predictive of RTW for the two populations considered was built. Second, the questionnaires used to measure these factors were retrieved. Third, we looked in the scientific literature for studies on the psychometric properties and practical relevance of these questionnaires. Results Among the factors retained, perceived social support from supervisor and co-workers, work accommodations, and job strain were identified as common RTW factors. Other risk/protective factors, and associated tools, specifically targeting either people with MSD or CMD were also analysed. Conclusions Researchers and practitioners are often uncertain of which tools to use to measure organizational factors which can facilitate or hinder RTW. This study provides an evaluation of the tools measuring predictive organizational RTW factors in people with MSD and CMD. The identified tools can be used in everyday practice and/or research.

Source: Villotti P, Gragnano A, Larivière C, Negrini A, Dionne CE, Corbière M, Journal of occupational rehabilitation, 2020 May.

Returning to Work After Sick Leave - The Role of Work Demands and Resources, Self-Efficacy, and Social Support

Purpose Returning to work after sick leave is a process that begins with the initial steps of functional recovery and results in full vocational capacity. Different personal and situational factors could influence an employee's well-being after returning. The following research was conducted in order to examine how occupational demands and resources, self-efficacy, and social engagement contribute to the return-to-work process. Methods A total of 256 employees took part in the study, who were later divided into two groups: short- (less than 30 days), and long-term (more than 30 days) sick leave. We measured their self-efficacy at the workplace, recent job demands and resources, social engagement, and work satisfaction after returning to work after sick leave. Results The results showed that personal (gender, age, and self-efficacy), social (social engagement), and occupational (job demands and resources) factors are associated with the duration of sick leave. Conclusions Participants who were on shorter sick leaves reported being more satisfied with their work after returning than those returning from long-term sick leave. The research presents important insights that could help employers better understand the needs of employees who are returning to work after sick leave.

Source: Boštjančič E, Galič K, Frontiers in psychology, Vol. 11, 2020 Apr.

Insights into the Sustainable Return to Work of Aging Workers with a Work Disability: An Interpretative Description Study

Purpose A sustainable return to work (S-RTW) following prolonged work disability poses particular challenges as workers age. This article provides a synthesis of the factors and issues involved in a S-RTW process for aging workers following such a disability. Methods Using interpretive description methods, a critical review was conducted of the literature specifying return-to-work factors and issues for aging workers with regard to four major causes of work disability (musculoskeletal disorders, common mental disorders, cancer or other chronic diseases). The initial review concerned the 2000-2016 literature, and was subsequently updated for November 2016-December 2018. To further explore and contextualise the results of this literature review, four focus groups were held with stakeholders, representing the workplace, insurance, and healthcare systems and workers. Qualitative thematic analysis was performed. Results Fifty-five articles were reviewed and 35 stakeholders participated in the focus groups. Returning to work and staying at work appear to be particularly challenging for aging workers, who face notable issues and stigma concerning their ability to meet work demands, as well as their mobilisation and engagement in these processes. Such findings echo in many ways the main assertions of the literature on aging at work, except those regarding the transformation of capacities with aging, which is not mentioned in relation to workers with a work disability. The influence of healthcare and compensation systems on the S-RTW of aging work-disabled workers has also received little attention to date. Conclusions The results underscore that aging workers with a disability are frequently vulnerable in terms of their health or their jobs. Intersectoral efforts are needed to remedy this situation to keep them at work.

Source: Durand MJ, Coutu MF, Tremblay D, Sylvain C, Gouin MM, Bilodeau K, Kirouac L, Paquette MA, Nastasia I, Coté D, Journal of occupational rehabilitation, 2020 Apr.

Avril 2020

Cumulative stigma among injured immigrant workers: a qualitative exploratory study in Montreal (Quebec, Canada)

Purpose This paper presents the phenomenon of stigmatisation among injured immigrant and ethnocultural minority workers experiencing a long-standing disability. Stigmatisation was one of the main findings of our study, the aim of which was to gain insight into the work rehabilitation process in the context of intercultural relations in Quebec. Various categories of stakeholders took part in the study, which sought to describe their experiences and perspectives and to identify the constraints, barriers, facilitators, and specific needs they encounter in terms of intercultural competencies. Methods A purposive sample of 40 individuals was selected and divided into four groups: workers (N = 9), clinicians (N = 15), workers' compensation board rehabilitation experts (N = 14), and workplace representatives (N = 2). Semi-structured interviews were conducted using the critical incident technique, combined with an "explicitation" interviewing technique. Data collection and analysis procedures were based on grounded theory. Results This study shows that immigrant and ethnocultural minority workers may experience stigmatisation as a cumulative process involving different concomitant parts of their "identity": age, gender, social class, ethnicity, mental health, and occupational injuries. Cumulative stigma may aggravate personal distress and feelings of shame, rejection, and disqualification from full social acceptance. Negative anticipatory judgements made by practitioners may undermine the therapeutic relationship and breach mutual trust and confidence. Conclusions The phenomenon of stigmatisation is well documented in the sociological and health literature, but studies tend to focus on only one type of stigma at a time. Future research should focus on the cumulative process of stigmatisation specifically affecting immigrant and ethnocultural minority workers and its potentially damaging impact on self-concept, healthcare delivery, rehabilitation interventions, and the return to work. The repetition of certain clinical situations with people from certain groups should not lead practitioners to undue generalizations, even if they may sometimes be accurate; these generalizations must always be verified on a case by case basis. Ethnicity and culture, along with other social attributions, should serve as working hypotheses or support tools in health communication, not as hindrances to clinical reasoning. Practitioners should deepen their understanding of the patient's treatment expectations and the support available for rehabilitation in his family and community. Stigma in the context of care is linked to the idea of conforming to the proposed institutional models of care (including expected beliefs, attitudes, and behaviours). Therefore, practitioners should be aware that alleged differences, misunderstanding or disagreements can highlight an asymmetry in practitioner–patient power relationships. Organisations should also promote exchange and reflection on how to adapt their institutional models to avoid asymmetrical power relations. Intercultural training should be promoted at the various organisational levels so that managers, decision-makers, and practitioners share a common knowledge of the challenges of intervention in multi-ethnic settings.

Source: Côté D, Dubé J, Gravel S, Gratton D, White BW, Disability & Rehabilitation, Vol. 42 (8), p.1153-1166, 2020 Apr. 

Promoting resilience in work rehabilitation: development of a transdiagnostic intervention

Purpose The aim of this study was to develop an operationalized transdiagnostic resilience-based intervention for workers at risk of long-term work disability. Methods A sequential mixed method design was used. Expert clinicians (n = 10) first answered a questionnaire including closed and open-ended questions on the clarity, applicability, relevance and exhaustiveness of a preliminary resilience intervention developed from evidenced-informed resilience factors to prompt reflection. Second, proposals from the questionnaire were discussed at a consensus group meeting with the same experts, yielding a final and improved intervention. Third, semi-structured interviews with work-disabled workers ( n  = 6) explored the intervention's acceptability to them. Thematic analysis of the verbatim was performed. Results Experts identified 15 statements on clarity, applicability, relevance or exhaustiveness in the questionnaire that did not achieve consensus and generated 41 modification proposals. The consensus group adopted 15 modifications. The adapted intervention was well-accepted by the workers who had completed a work rehabilitation program. They perceived the intervention as positive, relevant, coherent, useful and consistent with their values. Conclusions A new transdiagnostic resilience intervention in work rehabilitation is available and was on exploratory basis seen acceptable by workers. Next step would be to validate it at a larger scale with more workers and other stakeholders. Implications for rehabilitation Promoting workers resilience in work rehabilitation fosters a holistic approach in clinical practice. Resilience interventions should be integrated into work rehabilitation programs. A new transdiagnostic resilience intervention designed to complement current work rehabilitation programs is available.

Source: Dulude E, Coutu MF, Durand MJ, Disability and rehabilitation, p. 1-11, 2020 Mar.

Mars 2020

Work ethics and societal norms influence sick leave and return to work: tales of transformation

Purpose This study's purpose was to explore how people on sick leave manage societal norms and values related to work,and how these influence their perspectives of themselves throughout the rehabilitation process. Methods This was a longitudinal interview study with a narrative approach, comprising 38 interviews with 11 individuals on long-term sick leave. Data collection was conducted in two phases and analysed iteratively through content analysis. Results The results suggest that work ethics and societal norms influence individuals' views of themselves and the sick leave and rehabilitation process. Conforming one's personal values to the work norm can create internal conflicts and cause feelings of shame for not being able to live up to the established norm. The strong work norm may create unrealistic expectations, which in some cases may result in constraining the return to work process. Conclusions To transform a sick leave narrative into a positive one, societal norms and their influence on identity needs to be recognised. Stakeholders involved in the process can contribute to a positive transformation by not only supporting return to work, but also to acknowledge and help people manage their self-image as having a disability that limits their ability to work. Implications for rehabilitation Stakeholders involved in the sick leave and rehabilitation process need to support sick listed individuals by acknowledging and helping people manage their self-image. Full RTW is not always the best option from a quality of life and wellbeing perspective. Treatment and support from stakeholders should be viewed as meaningful and legitimate, even if it does not lead to RTW.

Source: Moldvik I, Ståhl C, Müssener U, Disability and Rehabilitation, p.1-10, 2020 Feb.

Sick-listed workers' experiences with motivational interviewing in the return to work process: a qualitative interview study

Purpose When returning to work after being on long-term sick leave, individuals may experience varying levels of motivation and self-efficacy. Motivational interviewing (MI) is a counseling style that aims to increase motivation towards change, and it may be useful in the return to work (RTW) process. The aim of this study was to explore sick-listed workers' experiences with MI in the RTW process. Methods This qualitative study was part of a randomized controlled trial evaluating the effects of MI on the RTW process, and it was administered by caseworkers at the Norwegian Labor and Welfare Administration. Sixteen sick-listed individuals, aged 33-60, participated in semi-structured interviews. All had a sick leave status of 50-100% for at least 8 weeks when interviewed and all had completed 2 MI sessions. The data was analyzed with systematic text condensation. Results Participants' experiences of the MI sessions were categorized into three themes: (1) relationship with the MI caseworker, (2) normalizing sick leave, and (3) adjusting RTW strategies. The MI sessions were experienced as a positive encounter due to the supportive relationship that was built between the MI caseworker and the sick-listed worker. Being sick listed led to feelings of guilt and stigmatization, but acceptance and support from the MI caseworkers helped normalize the situation for the sick-listed workers. Furthermore, MI sessions allowed for personalized feedback and discussions on adjustments to their RTW strategies. Conclusions Sick-listed workers experienced MI as positive due to the good relationship that developed with the MI caseworker, how this normalized sick leave, and the help they received with adjusting their RTW strategies. Professionals working with individuals attempting to RTW may benefit from using MI as a method for helping sick-listed workers to RTW.

Source: Foldal VS, Standal MI, Aasdahl L, Hagen R, Bagøien G, Fors EA, Johnsen R, Solbjør M, BMC Public Health, Vol. 20 (1), p.1-10, 2020 Feb.

Février 2020

Is there really a "golden hour" for work disability interventions? A narrative review

Purpose The subacute phase of low back pain has been termed as the "golden hour" to intervene to prevent work disability. This notion is based on the literature up to 2001 and is limited to back pain. In this narrative review, we examined whether the current literature indicate an optimal time for return to work (RTW) interventions. Methods We considered randomized controlled trials published from 1997 to April 2018 assessing effects of occupational rehabilitation interventions for musculoskeletal complaints (15 included), mental health disorders (9 included) or a combination of the two (1 included). We examined participants' sick leave duration at inclusion and the interventions' effects on RTW. Results Most studies reporting an effect on RTW included participants with musculoskeletal complaints in the subacute phase, supporting that this phase could be a beneficial time to start RTW-interventions. However, recent studies suggest that RTW-interventions also can be effective for workers with longer sick leave durations. Conclusions Our interpretation is that there might not be a limited time window or "golden hour" for work disability interventions, but rather a question about what type of intervention is right at what time and for whom. However, more research is needed. Particularly, we need more high-quality studies on the effects of RTW-interventions for sick listed individuals with mental health disorders. The subacute phase of low back pain has been termed the "golden hour" for work disability prevention. Recent evidence suggests there is a wider time-window for effective interventions, both for musculoskeletal- and common mental disorders. A stepped-care approach, starting with simpler low-cost interventions (e.g., brief reassuring interventions), before considering more comprehensive interventions (e.g., multimodal rehabilitation), could facilitate return to work and avoid excessive treatment.

Source: Aasdahl L, Fimland M, Disability & Rehabilitation, Vol. 42 (4), p.586-593, 2020 Feb. 

Return to Work and Ripple Effects on Family of Precariously Employed Injured Workers

Purpose Work injury and return to work processes can have adverse effects on injured workers and their families. Family members may experience increased workloads, role reversals, dissolution of marriages or changes in relationships with children, as well as financial strain from loss of income. How these associations interact when the injured worker is precariously employed, however, is unknown. The aim of this study was to explore the impacts of work-related injury or illness as well as subsequent compensation and return to work processes on families and relationships of precariously employed workers. Methods Interviews were conducted with fifteen precariously employed injured workers recruited through on-line advertising, injured worker groups, and social media platforms in Ontario. Situational analysis was used to identify how family members were affected and their role throughout the injury process. Results Precariously employed injured workers felt caught between self-interested employers and disinterested workers' compensation. In some cases, this led to deteriorated mental health and well-being. The worker's difficulties with RTW challenged financial security of families and affected their day-to-day normal routines. While some workers received emotional and instrumental support from their family members, others had their families fall apart when chronic disability and unemployment proved to be too much. Conclusions This study addressed the complex ways that work injury and illness among precariously employed workers interact with family life and relationships. Findings illustrate how the income and employment insecurity associated with precarious employment has ripple effects on workers and their families when they become injured.

Source: Senthanar S, MacEachen E, Lippel K, Journal of Occupational Rehabilitation, Vol. 30 (1), p.72-83, 2020 Mar. 

Are there differences in the return to work process for work-related psychological and musculoskeletal injuries? A longitudinal path analysis

Purpose To examine differences in the return to work (RTW) process for workers' compensation claimants with psychological injuries compared to those with musculoskeletal (MSK) injuries. Methods We collected data from 869 workers' compensation claimants in Victoria, Australia, at three time points over a 12-month period (21% with psychological injury claims). RTW was assessed through self-report. Potential mediators were identified at the personal, health-care provider, workplace and system levels. The relationships between injury type, mediating factors and RTW were assessed using path analysis, with adjustment for confounders through inverse probability weighting. Results We observed better RTW outcomes for claimants with MSK injuries (compared to those with psychological injuries) at T1 and T2, but not at T3. We also observed differences between psychological injuries and MSK injuries and all but two of the mediating factors examined. These differences, in particular related to supervisor response to injury, consultative RTW planning and offers of accommodation, as well as differences in mental health symptoms, explained approximately two-thirds of differences in RTW between injury types at T1. Differences in RTW at T2 were explained by mediating factors, and differences in RTW at T1. Conclusion Claimants with work-related psychological injuries experience a variety of challenges in RTW compared to those with MSK injuries. While treating and preventing further exacerbation of psychological symptoms should remain an important part of the rehabilitation process, other modifiable factors, in particular supervisor response to injury and consultative RTW planning and modified duties, should be prioritised to reduce inequalities in RTW across injury types.

Source : Smith P, LaMontagne AD, Lilley R, Hogg-Johnson S, Sim M, Social Psychiatry and Psychiatric Epidemiology, 2020 Feb.

Janvier 2020

Returning to Work Following an Injury: Practical Usage of a Predictive Model Based on a Nationwide Study

Purpose Work absenteeism following an injury creates an economic burden on society and the individual. Programs encouraging return to work (RTW) should be implemented for high risk populations. The aim of this study was to identify the predictors for duration until RTW following an injury. Methods The Israeli National Trauma Registry and the National Insurance Institute database (2008–2013) were linked. Logistic-regression models tested the probability not RTW within 1 month, 1 year and 2 years among 67% of the population and the quality of the model was examined among 33% of the population. Results The study population comprised 45,291 casualties (aged 21–67 and employed prior to injury as salaried workers). The majority of the study population (61%) RTW within 1 month from the injury event. Injury severity, multiple injuries, brain injury, traffic related injuries and fall injuries were significantly associated with work absenteeism. A dose–response relationship was found between income and not RTW: the lower the income the greater was the chance of not RTW. Among casualties with occupational injuries the odds for not RTW within a month, a year and 2 years were respectively, 3.7, 2.4 and 2 times significantly greater in comparison with casualties not injured at work. Conclusions Underprivileged ethnic groups (Arabs and immigrants from Ethiopia) had a greater chance for long out of work stay following an injury. The outcomes of this study identified casualties at high risk for not RTW and enables health professionals to develop intervention programs focusing on returning to a productive lifestyle.

Source: Savitsky B, Radomislensky I, Goldman S, Gitelson N, Frid Z, Peleg K, Journal of Community Health, Vol. 45 (1), p.183-193, 2020 Feb. 

Inpatient multimodal occupational rehabilitation reduces sickness absence among individuals with musculoskeletal and common mental health disorders: a randomized clinical trial

Purpose This study aimed to investigate whether inpatient multimodal occupational rehabilitation (I-MORE) reduces sickness absence (SA) more than outpatient acceptance and commitment therapy (O-ACT) among individuals with musculoskeletal and mental health disorders. Methods Individuals on sick leave (2-12 months) due to musculoskeletal or common mental health disorders were randomized to I-MORE (N=86) or O-ACT (N=80). I-MORE lasted 3.5 weeks in which participants stayed at the rehabilitation center. I-MORE included ACT, physical exercise, work-related problem solving and creating a return to work plan. O-ACT consisted mainly of 6 weekly 2.5 hour group-ACT sessions. We assessed the primary outcome cumulative SA within 6 and 12 months with national registry-data. Secondary outcomes were time to sustainable return to work and self-reported health outcomes assessed by questionnaires. Results SA did not differ between the interventions at 6 months, but after one year individuals in I-MORE had 32 fewer SA days compared to O-ACT (median 85 [interquartile range 33-149] versus 117 [interquartile range 59-189)], P=0.034). The hazard ratio for sustainable return to work was 1.9 (95% confidence interval 1.2-3.0) in favor of I-MORE. There were no clinically meaningful between-group differences in self-reported health outcomes. Conclusions Among individuals on long-term SA due to musculoskeletal and common mental health disorders, a 3.5-week I-MORE program reduced SA compared with 6 weekly sessions of O-ACT in the year after inclusion. Studies with longer follow-up and economic evaluations should be performed.

Source: Gismervik SØ, Aasdahl L, Vasseljen O, Fors EA, Rise MB, Johnsen R, Hara K, Jacobsen HB, Pape K, Fleten N, Jensen C, Fimland MS, Scandinavian Journal of Work, Environment & Health, 2020 Jan. 

Nationwide implementation of a national policy for evidence-based rehabilitation with focus on facilitating return to work: a survey of perceived use, facilitators, and barriers

Purpose The aim is to assess whether the national policy for evidence-based rehabilitation with a focus on facilitating return-to-work is being implemented in health-care units in Sweden and which factors influence its implementation. Methods A survey design was used to investigate the implementation. Data were collected at county council management level (process leaders) and clinical level (clinicians in primary and secondary care) using web surveys. Data were analyzed using SPSS, presented as descriptive statistics. Results The response rate among the process leaders was 88% (n=30). Twenty-eight percent reported that they had already introduced workplace interventions. A majority of the county councils' process leaders responded that the national policy was not clearly defined. The response rate among clinicians was 72% (n=580). Few clinicians working with patients with common mental disorders or musculoskeletal disorders responded that they were in contact with a patient's employer, the occupational health services or the employment office (9–18%). Nearly, all clinicians responded that they often/always discuss work-related problems with their patients. Conclusions The policy had been implemented or was to be implemented before the end of 2015. Lack of clearly stated goals, training, and guidelines were, however, barriers to implementation. Clinicians' positive attitudes and willingness to discuss workplace interventions with their patients were important facilitators related to the implementation of a nationwide policy for workplace interventions/rehabilitation. A lack of clearly stated goals, training, and guidelines were barriers related to the implementation. The development of evidence-based policies regarding rehabilitation and its implementation has to rely on very structured and clear descriptions of what to do, preferably with the help of practice guidelines. Nationwide implementation of rehabilitation policies has to allow time for preparation including communication of goals and competence assurance in a close collaboration with the end users, namely clinicians and patients. CBT Cognitive behavioral therapy CFIR Consolidated framework for implementation research CMD Common mental disorders IPT Interpersonal psychotherapy MMR Multimodal rehabilitation RG Rehabilitation guarantee RTW Return to work SPSS Statistical package for the social sciences .

Source: Brämberg B, Jensen E, Kwak I, Disability & Rehabilitation, Vol. 42 (2), p. 219-227, 2020 Jan.