Purpose Roughly 10% of occupational injuries result in permanent impairment. After initial return to work (RTW), many workers with permanent impairments face RTW interruption due to reinjury, unstable health, disability, and layoff. This study used open-ended survey data to: (1) explore workplace factors identified by workers as important levers for change, some of which may previously have been unrecognized; and (2) summarize workers' suggestions for workplace improvements to promote sustained RTW and prevent reinjury. Methods This study included data from workers' compensation claims and telephone surveys of 582 Washington State workers who had RTW after a work-related injury involving permanent impairment. The survey was conducted in 2019, about a year after claim closure. We used qualitative content analysis methods to inductively code open-ended survey responses. Results The most frequent themes were: safety precautions/safer workplace (18.1%), adequate staffing/appropriate task distribution (16.2%), and safety climate (14.1%). Other frequent themes included ergonomics, rest breaks, job strain, predictability and flexibility in work scheduling practices, employer response to injury, social support, communication, and respect. Many workers reported that they were not listened to, or that their input was not sought or valued. Workers often linked communication deficiencies to preventable deficiencies in safety practices, safety climate, and RTW practices, and also to lack of respect or distrust. In counterpoint, nearly one-third of respondents reported that no change was needed to their workplace. Conclusions Policies and interventions targeting worker-suggested workplace improvements may promote safe and sustained RTW, which is essential for worker health and economic stability.
Source: Sears JM, Edmonds AT, MacEachen E, Fulton-Kehoe D, American journal of industrial medicine, 2021 Jul 12
Purpose Although it is believed that involving the workplace and stakeholders in return-to-work interventions is beneficial, Norwegian occupational rehabilitation programmes rarely do. During 2015-2016, Hysnes Rehabilitation Centre provided inpatient multimodal occupational rehabilitation, including workplace meetings with employees, supervisors, and rehabilitation therapists. This study aims to explore the meetings´ content and stakeholders´ experiences. Methods This was a multiple case study including non-participant observation of workplace meetings and interviews with participants. Results Essential features of meetings included revealing and aligning the employee's and supervisor's understandings. Three components seemed instrumental in developing shared understandings leading to appropriate adjustments: 1) disclosing causes of absence, 2) validating difficulties, attitudes, and efforts, and 3) delimiting responsibility. Therapists played a vital role in addressing these components, supporting employees, and ensuring planning of appropriate solutions. Conclusion Developing shared understandings by addressing and aligning illness- and return-to-work representations appears important for return-to-work interventions. Although pivotal to developing appropriate adjustments, disclosure depends upon supervisors' display of understanding and should not be encouraged without knowledge of the employee´s work situation. How supervisors relate to employees and implement adjustments may be as important as the types of adjustments. The therapist's support and validation of employees in vulnerable situations also seem valuable.
Source: Klevanger NE, Fimland MS, Rise MB, International journal of qualitative studies on health and well-being, 2021 Dec; Vol. 16 (1), pp. 1946927
Purpose Comorbidity is common among long-term sick-listed and many prognostic factors for return to work (RTW) are shared across diagnoses. RTW interventions have small effects, possibly due to being averaged across heterogeneous samples. Identifying subgroups based on prognostic RTW factors independent of diagnoses might help stratify interventions. The aim of this study was to identify and describe subgroups of long-term sick-listed workers, independent of diagnoses, based on prognostic factors for RTW. Methods Latent class analysis of 532 workers sick-listed for eight weeks was used to identify subgroups based on seven prognostic RTW factors (self-reported health, anxiety and depressive symptoms, pain, self-efficacy, work ability, RTW expectations) and four covariates (age, gender, education, physical work). Results Four classes were identified: Class 1 (45% of participants) was characterized by favorable scores on the prognostic factors; Class 2 (22%) by high anxiety and depressive symptoms, younger age and higher education; Class 3 (16%) by overall poor scores including high pain levels; Class 4 (17%) by physical work and lack of workplace adjustments. Class 2 included more individuals with a psychological diagnosis, while diagnoses were distributed more proportionate to the sample in the other classes. Conclusion The identified classes illustrate common subgroups of RTW prognosis among long-term sick-listed individuals largely independent of diagnosis. These classes could in the future assist RTW services to provide appropriate type and extent of follow-up, however more research is needed to validate the class structure and examine how these classes predict outcomes and respond to interventions.
Source: Standal MI, Aasdahl L, Jensen C, Foldal VS, Hagen R, Fors EA, Solbjør M, Hjemdal O, Grotle M, Meisingset I, Journal of occupational rehabilitation, 2021 Jun; Vol. 31 (2), pp. 383-392
Purpose People with multimorbidity face a range of barriers in healthcare, and there is little knowledge about their challenges with regard to return-to-work (RTW). Rehabilitation coordinators, a new function in Swedish healthcare, support people in the RTW process. The present study had two aims: to explore what problems and barriers people with multimorbidity experience during their rehabilitation and RTW process and to explore in which domains the coordinators' support is perceived to be of importance. Methods Interviews were conducted with 12 persons with multimorbidity who had contact with a rehabilitation coordinator during their sickness absence. Thematic analysis was guided by the case-management ecological model; this analysis was revised and adapted to the Swedish context. Results The participants experienced problems in all domains of the model, namely: "the healthcare system", "the labor market and the workplace system", "the sickness insurance system", and "the personal system". Rehabilitation programs that did not accommodate combinations of diseases, social complexities and needs were felt to lead to worse symptoms, thus hindering rather than promoting RTW. An overall finding regarding support by coordinators is that interventions, regardless of domain, were felt to be valuable for people with multimorbidity. The coordinator was perceived to give most support by providing advice about and coordination with healthcare and employers. Sometimes the coordinator gave advice and coordination regarding the Social Insurance Agency, very occasionally the Public Employment Services. The coordinator gave least advice and coordination about social difficulties that hindered rehabilitation and RTW processes. Conclusion People with multimorbidity perceive rehabilitation coordinator interventions as important in all domains investigated. Lack of advice and coordination, or rehabilitation programs that were not modified to the complexities of individual's circumstances, were associated with prolonged sickness absence, worse health, or social risk factors not being recognized.
Source: Svärd V, Friberg E, Azad A, Journal of multidisciplinary healthcare, 2021 May 31; Vol. 14, pp. 1245-1257
Purpose This study aimed to understand age differences in wage-replacement duration by focusing on variations in the relationship across different periods of follow-up time. Methods We used administrative claims data provided by six workers' compensation systems in Canada. Included were time-loss claims for workers aged 15-80 years with a work-related injury/illness during the 2011 to 2015 period (N = 751,679 claims). Data were coded for comparability across cohorts. Survival analysis examined age-related differences in the hazard of transitioning off (versus remaining on) disability benefits, allowing for relaxed proportionality constraints on the hazard rates over time. Differences were examined on the absolute (hazard difference) and relative (hazard ratios [HR]) scales. Results Older age groups had a lower likelihood of transitioning off wage-replacement benefits compared to younger age groups in the overall models (e.g., 55-64 vs. 15-24 years: HR 0.62). However, absolute and relative differences in age-specific hazard rates varied as a function of follow-up time. The greatest age-related differences were observed at earlier event times and were attenuated towards a null difference across later follow-up event times. Conclusions Our study provides new insight into the workplace injury/illness claim and recovery processes and suggests that older age is not always strongly associated with worse disability duration outcomes. The use of data from multiple jurisdictions lends external validity to our findings and demonstrates the utility of using cross-jurisdictional data extracts. Future work should examine the social and contextual determinants that operate during various recovery phases, and how these factors interact with age.
Source: Fan JK, Macpherson RA, Smith PM, Harris MA, Gignac MAM, McLeod CB, Journal of occupational rehabilitation, 2021 Jun; Vol. 31 (2), pp. 339-349
Purpose To provide a review of current knowledge about interventions aimed to facilitate young adults to return to work following work-related injuries. Methods A systematic review of published literature from the year 2010 and onwards was conducted to identify studies examining return to work interventions for young adults (aged 19-29) following work-related injuries using PubMed and Web of Science. Two reviewers conducted the screening process and assessed the study quality using the National Heart, Lung, and Blood Institute assessment tool for Observational Cohort and Cross-Sectional studies. Due to wide heterogeneity and small number of studies retained post-screening, a descriptive summary analysis of the included studies was conducted. Results No studies were identified that focused exclusively on interventions for young adults. However, two studies, in which an age category of young adults was available, were included and assessed for quality. The study populations were primarily suffering from work-related injuries in the lower back or lower limbs. Both studies revealed that return to work interventions using a case manager coordinating and providing consultation, advice, and risk management to multidisciplinary teams was associated with lower sick leave days. Conclusions Despite the emerging evidence that young adults have higher rates of work-related injuries compared to older colleagues, information concerning work-related injuries and return to work interventions specifically targeting young workers is still lacking. Further research is therefore needed to develop and evaluate return to work interventions for the population of young adults.
Source: Johansson MK, Rissanen R, Work, 2021 Jun 25
Purpose There is growing awareness that the employer plays an important role in preventing early labor market exit of workers with poor health. This systematic review aims to explore the employer characteristics associated with work participation of workers with disabilities. An interdisciplinary approach was used to capture relevant characteristics at all organizational levels. Methods To identify relevant longitudinal observational studies, a systematic literature search was conducted in PubMed, Web of Science, PsycINFO and EconLit. Three key concepts were central to the search: (a) employer characteristics, (b) work participation, including continued employment, return to work and long-term work disability, and (c) chronic diseases. Results The search strategy resulted in 4456 articles. In total 50 articles met the inclusion criteria. We found 14 determinants clustered in four domains: work accommodations, social support, organizational culture and company characteristics. On supervisor level, strong evidence was found for an association between work accommodations and continued employment and return to work. Moderate evidence was found for an association between social support and return to work. On higher organizational level, weak evidence was found for an association between organizational culture and return to work. Inconsistent evidence was found for an association between company characteristics and the three work outcomes. Conclusions Our review indicates the importance of different employer efforts for work participation of workers with disabilities. Workplace programs aimed at facilitating work accommodations and supervisor support can contribute to the prevention of early labor market exit of workers with poor health. Further research is needed on the influence of organizational culture and company characteristics on work participation.
Source: Jansen J, van Ooijen R, Koning PWC, Boot CRL, Brouwer S, Journal of occupational rehabilitation, 2021 May 12
Purpose Previous work on sickness absence has shown that conversations about return to work can be challenging. The perception of competing interests and multiple stakeholders in the return to work process may also complicate and erode trust, further impacting health and well-being. This study aims to explore the themes arising from the experiences of physicians and patients on the impact of health and return to work. The goal was to use these results to develop a Medical Readers' Theatre workshop focusing on negotiating challenging return to work scenarios to serve as an educational support for stakeholders. Methods Semi-structured interviews were conducted with 19 physicians and 15 patients from the Canadian Maritime Provinces on their experiences in return to work following an injury or illness. Interviews were recorded, transcribed and thematically analysed. Using the emergent themes, an educational workshop in the modality of Readers' Theatre was developed. Results The findings confirm there are multiple stakeholders involved in the return to work process and the factors influencing successful return are not always medically related. Six recurring themes were identified for the patient group and five for the physicians', allowing the development of storylines and four return to work scenarios. The scenarios have been used in teaching sessions. Conclusions The themes reinforced that challenges in return to work are not always medical in nature. This Readers' Theatre adopts perspectives of patients, physicians and other stakeholders whilst focusing on return to work with the goal of providing engagement in reflective and purposeful discussion.
Source: Kek B, Stewart WA, Adisesh A, Occupational medicine, 2021 Apr 08
Purpose To set up a comprehensive health programme for employees, with needs-based allocation to preventive and rehabilitative measures; and to evaluate the effects of the programme on work ability and sick leave. Design Prospective single-group observational study. Methods Employees of a university hospital were invited to participate in needs-based interventions of preventive or rehabilitative character. Allocation followed screening questionnaires, anamnesis and clinical examination.The main outcome parameters were work ability and sick leave duration. Results The current phase of the project included 1,547 participants, who applied voluntarily to enter the programme. The mean age of participants was 44.3 years (standard deviation (SD) 10.3 years), and 72.0% were female. Needs-based allocation to a prevention or a rehabilitation group was effective, and enabled formation of 2 groups with different demands. Overall, more than half of the employees participating in the programme reported sick leave within the last 3 months. Participants in the preventive measures group reported significantly lower duration of sick leave than those in the rehabilitation group. Employees in the rehabilitation group had significantly lower work ability (Work Ability Index (WAI) 30.4 vs 36.6), but higher effects at 6-month follow-up (WAI 33.4 (standardized effect size (SES) 0.51) vs 37.9 (SES 0.17)). In the prevention group sick leave reduced from 1.9 to 1.3 weeks during the previous 3-month period, whereas in the rehabilitation group it reduced from 2.7 to 1.5 weeks. Conclusion Implementation of the comprehensive health programme was successful, using the multimodal infrastructure of a university hospital. Allocation to suitable interventions in occupational health programmes following screening, anamnesis and clinical examination is an appropriate way to meet participants' needs. The programme resulted in improved work ability and less sick leave.
Source: Gutenbrunner C, Briest J, Egen C, Sturm C, Schiller J, Kahl K, Tegtbur U, Fuhr H, Korallus C, Journal of rehabilitation medicine, 2021 Mar 30
Purpose We conducted a systematic review to understand the impact that return-to-work coordinators (RTWCs) have on return to work (RTW) outcomes for sick/injured workers. Methods MEDLINE, EMBASE, CINAHL, PsycINFO, Web of Science, and ABI Inform were searched from January 1, 2000 to September 16, 2020. Of 2,927 retrieved and screened citations, 14 quantitative articles fulfilled the eligibility and quality criteria. Quality assessment, data extraction, and evidence synthesis followed article screening. Results We focused on the impact of RTWCs for outcomes of work absence, RTW rates, quality of life, and cost-benefit. Our final synthesis included 14 articles. We found strong evidence that work absence duration was reduced when workers had face-to-face contact with a RTWC. As well, there was strong evidence linking face-to-face RTWC interventions with higher RTW rates and moderate evidence that this reduced intervention costs. RTWC interventions involving the identification of barriers and facilitators to RTW also showed promising results. However, only limited evidence was found that RTWCs improved quality of life for workers. Conclusions Our synthesis identifies key features of RTW interventions that improve RTW outcomes. Future high-quality research should measure long-term outcomes of RTWC interventions to evaluate sustainability and consider the nature of work. They should also focus on RTWC impact on worker quality of life assessments and for older workers and workers with chronic health conditions.
Source: Dol M, Varatharajan S, Neiterman E, McKnight E, Crouch M, McDonald E, Malachowski C, Dali N, Giau E, MacEachen E, Journal of occupational rehabilitation, 2021 Apr 21
Purpose Part-time sick leave (PTSL) where sick-listed individuals work a percentage corresponding to their remaining work capabilities is often used to promote return to work. The effects of PTSL are uncertain due to participant selection on personal and social factors, which are not easily captured by evaluations that primarily rely on register-data. More knowledge of health-related, workplace and personal characteristics that influence the propensity to utilize PTSL is needed. The objective of the present study was to explore whether individuals on PTSL and full-time sick leave (FTSL) differ in terms of self-reported health, workplace resources and psychological resilience while also considering known sociodemographic factors that influence PTSL selection. Methods The study utilized a cross-sectional sample of 661 workers sick listed for 8 weeks with a 50-100% sick-listing degree. Differences between those on PTSL and FTSL with regard to current self-reported health, previous long-term sick leave, workplace adjustment latitude, psychosocial work environment, work autonomy, coping with work demands, and psychological resilience were examined and adjusted for known selection factors (age, education, gender, sector, diagnosis, and physical work) using logistic regression. Results An inverse U-shaped curvilinear association between self-reported health and PTSL was identified. Those on PTSL also reported greater workplace adjustment latitude and better psychosocial work environment than those on FTSL. These differences persisted after adjusting for previously known selection factors. Furthermore, the PTSL group reported more work autonomy and poorer coping with work demands, but these differences were more uncertain after adjustment. The groups did not differ in terms of previous long-term sick leave or psychological resilience. Conclusion The present study found differences between those on PTSL and FTSL with regards to self-reported health, workplace adjustment latitude and psychosocial work environment that were independent of differences identified in previous research. These results are important for future evaluations of the effect of PTSL on RTW, suggesting more attention should be paid to self-reported health status and workplace characteristics that are not captured using register data.
Source: Standal MI, Hjemdal O, Aasdahl L, Foldal VS, Johnsen R, Fors EA, Hagen R, BMC public health, 2021 Apr 15; Vol. 21 (1), pp. 732
Purpose Knowledge about the psychosocial experiences of sick-listed workers in the first months of sick leave is sparse even though early interventions are recommended. The aim of this study was to explore psychosocial experiences of being on sick leave and thoughts about returning to work after 8-12 weeks of sickness absence. Methods Sixteen individuals at 9-13 weeks of sick leave participated in semi-structured individual interviews. Data was analyzed through Giorgi's descriptive phenomenological method. Results Three themes emerged: (1) energy depleted, (2) losing normal life, (3) searching for a solution. A combination of health, work, and family challenges contributed to being drained of energy, which affected both work- and non-work roles. Being on sick leave led to a loss of social arenas and their identity as a contributing member of society. Participants required assistance to find solutions toward returning to work. Conclusion Even in this early stage of long-term sick leave, sick listed workers faced complex challenges in multiple domains. Continuing sick leave was experienced as necessary but may challenge personal identity and social life. Those not finding solutions may benefit from additional early follow-up that examine work-related, social and personal factors that influence return to work.
Source: Standal MI, Foldal VS, Hagen R, Aasdahl L, Johnsen R, Fors EA, Solbjør M, Frontiers in psychology, 2021 Mar 30; Vol. 12, pp. 596073
Purpose Poor mental health is a common occurrence among workers recovering from a work-related injury or illness. The objective of this cross-sectional study was to estimate the association between adverse interactions with workers' compensation case managers and experiencing a serious mental illness 18-months following a workplace injury or illness. Methods A cohort of 996 workers' compensation claimants in Ontario Canada were interviewed 18 months following a disabling work-related injury or illness. Perceptions of informational and interpersonal justice in case manager interactions were defined as the primary independent variables, and Kessler Psychological Distress (K6) scores greater than 12, indicative of a serious mental illness, was defined as the outcome. Multivariate modified Poisson models estimated the association between perceptions of adverse case manager interactions and a serious mental illness, following adjustment for sociodemographic and work characteristics and pre-injury mental health. Results The prevalence of serious mental illness at 18 months was 16.6%. Low perceptions of informational justice, reported by 14.4% of respondents, were associated with a 2.58 times higher risk of serious mental illness (95% CI 1.30-5.10). Moderate and low perceptions of interpersonal justice, reported by 44.1% and 9.2% of respondents respectively, were associated with a 2.01 and 3.57 times higher risk of serious mental illness (95% CI moderate: 1.18-3.44, 95% CI poor: 1.81-7.06). Conclusions This study provides further support for the impact of poor interactions with claims case managers on mental health, highlighting the importance of open and fair communication with workers' compensation claimants in ensuring timely recovery and return-to-work.
Source: Orchard C, Carnide N, Smith P, Mustard C,Journal of occupational rehabilitation, 2021 Apr 05
Purpose Roughly 10% of occupational injuries result in permanent impairment and a permanent partial disability (PPD) award. After initial return to work (RTW) following a work injury, many workers with permanent impairment face RTW interruption (breaks in ongoing employment due to reinjury, poor health, disability, lay-off, etc.). Most RTW and reinjury research has focused on worker-level risk factors, and less is known about contextual factors that may be amenable to workplace or workers' compensation (WC)-based interventions. The aim of this study was to identify modifiable organizational and psychosocial workplace factors associated with (i) RTW interruption and (ii) reinjury among workers with a permanent impairment. Methods This retrospective cohort study included WC claims data and survey data for 567 injured workers who RTW at least briefly after a work-related injury that resulted in permanent impairment. Workers were interviewed once by phone, 11-15 months after WC claim closure with a PPD award. Logistic regression models were used to estimate associations between each workplace factor of interest and each outcome, controlling for whole body impairment percentage, gender, age, nativity, educational level, State Fund versus self-insured WC coverage, employer size, union membership, industry sector, and employment duration of current/most recent job. Results Twelve percent of workers had been reinjured in their current or most recent job, 12% of workers were no longer working at the time of interview, and <1% of workers reported both outcomes. The most frequently reported reason for RTW interruption was impairment, disability, and/or pain from the previous work injury. Lower reported levels of safety climate, supervisor support, and ability to take time off work for personal/family matters were significantly associated with both RTW interruption and reinjury. Inadequate employer/health care provider communication, perceived stigmatization from supervisors and/or coworkers, and lower levels of coworker support were significantly associated with RTW interruption but not with reinjury. Discomfort with reporting an unsafe situation at work, absence of a health and safety committee, and higher job strain were significantly associated with reinjury, but not with RTW interruption. Inadequate safety training and lack of needed job accommodations were not significantly associated with either outcome. There were no notable or statistically significant interactions between workplace factors and degree of impairment, and no consistent direction of association. Conclusions This study provides evidence that several potentially modifiable organizational and psychosocial factors are associated with safe and sustained RTW among injured workers with work-related permanent impairment. The lack of interaction between any of these workplace factors and degree of impairment suggests that these findings may be generalizable to all workers, and further suggests that workplace interventions based on these findings might be useful for both primary and secondary prevention. Though primary prevention is key, secondary prevention efforts to sustain RTW and prevent reinjury may reduce the considerable health, economic, and social burden of occupational injury and illness.
Source: Sears JM, Schulman BA, Fulton-Kehoe D, Hogg-Johnson S, Annals of work exposures and health, 2021 Apr 12
Purpose In Germany, employers are obliged to offer "operational integration management" (OIM) services to employees returning from long-term sick leave. OIM aims to improve employees' workability and to prevent future sick leave or early retirement. This study examined (i) to what extent OIM services are offered to eligible employees, (ii) to what extent offers are accepted and (iii) the determinants of both outcomes. Methods We used data from a cohort of employees eligible for OIM. Thirty-four potential determinants were assessed in 2013 (i.e., the baseline) using participant reports. In 2015 (i.e., the follow-up), participants were asked (a) whether they had ever been offered OIM services by their employer, and (b) whether they had accepted that offer (i.e., the outcomes). We estimated relative risks by multivariable binomial regression to identify predictors based on backward elimination. Results In total, 36.0% of the participants were offered OIM services and 77.2% of them accepted that offer. The likelihood of an OIM offer at follow-up was elevated in participants with mental impairment, cancer or long-term absenteeism and increased with organizational justice, neuroticism, and company size. The likelihood of accepting that OIM offer was positively associated with mental impairment and decreased with increasing company size.
Source: Loerbroks A, Scharf J, Angerer P, Spanier K, Bethge M, International journal of environmental research and public health, 2021 Feb 23; Vol. 18(4)
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, 2021 Mar; Vol. 31 (1), pp. 92-106
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, 2021 Mar; Vol. 31 (1), pp. 7-25
Purpose The purpose of this study was to descriptively quantify experiences of injured workers with permanent impairment during their first year of work reintegration. Methods A representative survey was conducted to characterize health, disability, pain, employment, reinjury, and economic outcomes for 598 workers with permanent impairment who had returned to work during the year after workers' compensation claim closure. Survey responses were summarized by degree of whole body impairment (< 10% vs. ≥ 10%). Results Injured workers who had returned to work reported that permanent impairment made it difficult to get a job (47%) and to keep their job (58%). A year after claim closure, 66% reported moderate to very severe pain; 40% reported pain interference with work. About 13% reported new work injuries; over half thought permanent impairment increased their reinjury risk. Asked to compare current to pre-injury work status, workers with a higher degree of impairment more frequently reported working fewer hours (OR 1.60; 95% CI 1.06, 2.42), earning less (OR 1.56; 95% CI 1.04, 2.36), and being at higher risk of losing their current job due to their impairment (OR 1.66; 95% CI 1.01, 2.71). Conclusions Injured workers with permanent impairment face long-term challenges related to health limitations, chronic pain, work reintegration, and economic impacts. Workers with a higher degree of impairment more frequently reported several economic and job security challenges. Developing workplace and workers' compensation-based interventions that reduce return-to-work interruption and reinjury for workers with permanent impairment should be prioritized as an important public health and societal goal.
Source: Sears JM, Schulman BA, Fulton-Kehoe D, Hogg-Johnson S, Journal of occupational rehabilitation, 2021 Mar; Vol. 31 (1), pp. 219-231
Purpose The aim of this study was to evaluate potential barriers and facilitators for implementing motivational interviewing (MI) as a return to work (RTW) intervention in a Norwegian social insurance setting. Methods A mixed-methods process evaluation was conducted alongside a randomized controlled trial involving MI sessions delivered by social insurance caseworkers. The study was guided by the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework using focus groups with the caseworkers. MI fidelity was evaluated through audio-recordings of MI sessions and questionnaires to sick-listed participants. Results Lack of co-worker and managerial support, time and place for practicing to further develop MI skills, and a high workload made the MI intervention challenging for the caseworkers. The MI method was experienced as useful, but difficult to master. MI fidelity results showed technical global scores over the threshold for "beginning proficiency" whereas the relational global score was under the threshold. The sick-listed workers reported being satisfied with the MI sessions. Conclusions Despite caseworker motivation for learning and using MI in early follow-up sessions, MI was hard to master and use in practice. Several barriers and facilitators were identified; these should be addressed before implementing MI in a social insurance setting.
Source: Foldal VS, Solbjør M, Standal MI, Fors EA, Hagen R, Bagøien G, Johnsen R, Hara KW, Fossen H, Løchting I, Eik H, Grotle M, Aasdahl L, Journal of occupational rehabilitation, 2021 Mar 24
Purpose There is a lack of results on long-term effects of return to work interventions. We previously reported that an inpatient multimodal occupational rehabilitation program (I-MORE) was more effective in reducing sickness absence and facilitating return to work (RTW) at 12 months follow-up compared to an outpatient program that consisted mainly of Acceptance and Commitment Therapy (O-ACT). We now report the 2-year outcome data. Methods A randomized clinical trial with parallel groups. Participants were 18-60 years old, sick listed with musculoskeletal, common mental or general/unspecified disorders. I-MORE lasted 3.5 weeks and consisted of ACT, physical training and work-related problem solving. O-ACT consisted mainly of 6 weekly sessions (2.5 h. each) of ACT in groups. Outcomes were cumulated number of days on medical benefits and time until sustainable RTW (1 month without medical benefits) during 2-years of follow-up, measured by registry data. Results For the 166 randomized participants, the median number of days on medical benefits was 159 (IQR 59-342) for I-MORE vs 249 days (IQR 103-379; Mann-Whitney U test, p = 0.07), for O-ACT. At 2 years, 40% in I-MORE received long-term benefits (work assessment allowance) vs 51% in O-ACT. The crude hazard ratio (HR) for sustainable RTW was 1.59 (95% CI 1.04-2.42, p = 0.03) and the adjusted HR 1.77 (95% CI 1.14-2.75, p = 0.01), in favor of I-MORE. Conclusions The 2-year outcomes show that I-MORE had long-term positive effects on increasing work participation for individuals sick listed with musculoskeletal and mental disorders. Further follow-up and economic evaluations should be performed.
Source: Aasdahl L, Vasseljen O, Gismervik SØ, Johnsen R, Fimland MS, Journal of occupational rehabilitation, 2021 Mar 25
Purpose There is an absence of evidence-based guidance to support workplace stakeholders in the effective delivery of return-to-work (RTW) messages. Our study examines the specific RTW communication practices and their impact on the management of work disability. Methods Within two large and complex healthcare organizations, semi-structured interviews were conducted with workplace stakeholders (e.g., supervisors, union representatives, disability management professionals and workers' compensation representatives) and workers who had previously experienced sickness absence related to an occupational injury or illness. For workplace stakeholders interview questions asked about their roles and responsibilities in the RTW process, and specific communication strategies and messages that were used at different phases of the RTW process. For worker participants, interview questions explored RTW experiences and the impact of communication on work re-integration. An interpretative descriptive approach was used to inductively examine themes from interviews to create ways of understanding phenomena that yielded applied findings. Results Forty participants were interviewed including workplace stakeholders and workers. Participants frequently described effective RTW communication as messages that were delivered by a workplace stakeholder that included the content required by an injured worker to navigate the organizational disability management process and utilized specific strategies to address the perceived attitudes and perceptions held by an injured worker regarding work re-integration. Workplace stakeholders described five specific communication strategies including relaying messages of support, optimizing the timing of communication, careful word choice, framing messages, and tailoring communication to the injured worker. Conclusion RTW communication is an active process that requires a strategic approach. Effective communication practices represent an important strategy for workplace stakeholders to address the barriers held by injured workers and foster early and sustained RTW.
Source: Jetha A, Le Pouésard M, Mustard C, Backman C, Gignac MAM, Journal of occupational rehabilitation, 2021 Feb 02
Purpose The study investigated relationships between exposure to bullying behaviours, return to work self-efficacy (RTW-SE) and resilience, and if resilience moderates the bullying-RTW-SE relationship among patients on sick leave or at risk of sick leave due to common mental disorders (CMD). Methods A sample of 675 patients treated in an outpatient clinic was analysed using regressions and moderation analyses by employing SPSS and the Process macro SPSS supplement. Results The results showed a negative relationship between exposure to bullying behaviours and RTW-SE. There was also a positive main effect for resilience, as patients with high resilience score significantly higher on RTW-SE than patients with low resilience irrespective of levels of bullying. Further, the resilience sub-dimension personal resilience moderated the bullying-RTW-SE relationship, while the sub-dimension interpersonal resilience did not. Patients high on personal resilience showed relatively lower RTW-SE scores when exposed to bullying behaviours, compared to those that were not bullied with high personal resilience levels. Conclusion Hence, one should take note of the fact that even if resilience may strengthen RTW-SE, bullying is an adverse event which particularly affects individuals who present with relatively high levels of resilience resources, at least when it comes to RTW-SE.
Source: Aarestad SH, Harris A, Einarsen SV, Gjengedal RGH, Osnes K, Hannisdal M, Hjemdal O, Industrial health, 2021 Jan 28
Purpose Work participation is an important determinant of public health; being unemployed leads to a decrease in an individual's health. In the Netherlands, people with a work disability can apply for disability benefits, in which people also receive support to return to work (RTW). A method, currently used in the medical sector, that can include both the perspective of the reintegration professional and of the individual in the process of RTW, is shared decision making (SDM). In this article we explore to what extent reintegration professionals currently use SDM, and to what extent they prefer to use SDM in their ideal interaction with clients. Methods We performed semi-structured interviews with fourteen reintegration professionals from four different municipalities. The transcripts were coded according to content analysis, applying open and axial coding. Results Reintegration professionals emphasised the importance of having a good relationship with clients, of building trust and collaborating as a team. They did not inform their clients that they could be part of the decision-making process, or discussed a shared goal. Although professionals did emphasise the importance of aligning their approach with the preferences of the client and though they tried to offer some choice options, they did not mention available options, discussed the pros and cons of these options or evaluated decisions with their clients. Furthermore, they did not mention any of these aspects in their ideal interaction with clients. Conclusions SDM has a potential value, because all professionals underline the importance of having an alliance with clients, collaborating as a team, and striving to align their approach with the preferences of the client. However, professionals currently perform a limited set of SDM steps. Additional knowledge and skills are needed for both reintegration professionals and municipalities so that professionals can consider and reflect on the value of using SDM, or SDM steps, in supporting RTW. Providing clients with knowledge and skills seems necessary to facilitate both self-management and SDM.
Source: Vooijs M, van Kesteren NMC, Hazelzet AM, Otten W, BMC public health, 2021 Feb 09; Vol. 21 (1), pp. 325
Purpose We aimed to identify job accommodations that help persons with physical disabilities maintain or return to work and explore the barriers and facilitators that influence the provision and reception of job accommodations. Methods We conducted a systematic review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The review was registered in PROSPERO (CRD42019129645). The search strategy incorporated keywords describing physical disabilities, employer-approved job accommodations, and employment retention or return to work approaches. We searched MEDLINE, the Cochrane Library, Embase, CINAHL, PsycINFO, Web of Science, and ProQuest Theses and dissertations. Reviewers independently selected studies for inclusion. We used Hawker et al.'s method to assess study quality. Results We identified 2203 articles, of which 52 met inclusion criteria, developed a table of job accommodations commonly used by persons with physical disabilities, summarized the percentages of job accommodations used by persons with disabilities, synthesized evidence of the effectiveness of job accommodations, and identified the factors that influence job accommodation use. The most frequently reported accommodations were as follows: modification of job responsibilities, change of workplace policy, supportive personnel provision, flexible scheduling, and assistive technology. We summarized four types of facilitators and barriers that affect job accommodation use: employee-related factors, accommodation-related factors, job-related factors, and social workplace-related factors. Conclusion The absence of randomized controlled trials and prevalence of cross-sectional surveys provides inconclusive evidence regarding the effectiveness of specific job accommodations for people with particular functional limitations. Our system of categorizing job accommodations provides a guide to investigators seeking to evaluate the effectiveness of job accommodations using experimental methods.
Source: Wong J, Kallish N, Crown D, Capraro P, Trierweiler R, Wafford QE, Tiema-Benson L, Hassan S, Engel E, Tamayo C, Heinemann AW, Journal of occupational rehabilitation, 2021 Jan 22
Purpose The objective of this study was to investigate the association between cognitive and emotional functioning and the number of days on health-related benefits such as sick leave, work assessment allowance and disability pension. We investigated whether cognitive and emotional functioning at the start of rehabilitation and the change from the start to the end of rehabilitation predicted the number of days on health-related benefits in the year after occupational rehabilitation. Methods A sample of 317 individuals (age 19-67 years), mainly diagnosed with a musculoskeletal or mental and behavioural ICD-10 disorder, participated. The sample was stratified depending on the benefit status in the year before rehabilitation. Those receiving health-related benefits for the full year comprised the work assessment allowance and disability pension (WAA) group and those receiving benefits for less than a year comprised the sick leave (SL) group. The participants were administered cognitive and emotional computerised tests and work and health questionnaires at the beginning and end of rehabilitation. The cumulative number of days on health-related benefits during 12 months after rehabilitation was the primary outcome variable and age, gender, educational level, subjective health complaints, anxiety, and depression were controlled for in multiple regression analyses. Results The WAA group (n = 179) was significantly impaired at baseline compared to the SL group (n = 135) in focused attention and executive function, and they also scored worse on work and health related variables. Higher baseline scores and change scores from the start to the end of rehabilitation, for sustained attention, were associated with fewer number of health-related benefit days in the WAA group, while higher baseline scores for working memory were associated with fewer number of health-related benefit days in the SL group. Conclusions New knowledge about attention and memory and return to work in individuals with different benefit status may pave the way for more targeted programme interventions. Rehabilitation programmes could benefit from designing interventions that respectively improve sustain attention and working memory related to working life in individuals on sick leave or work assessment allowance and disability pension.
Source: Johansen T, Øyeflaten I, Eriksen HR, Lyby PS, Dittrich WH, Holsen I, Jakobsen H, Del Risco Kollerud R, Jensen C, Journal of occupational rehabilitation, 2021 Jan 20.
Purpose This study aimed to develop a questionnaire measuring preventive behaviors at work.Methods A three-step design, including qualitative and quantitative methods, was followed: (1) item generation, (2) experts' validation of content, and (3) pretesting.Results For step 1, 49 relevant existing scales were reviewed, and a pool of 172 items was generated. Redundant items were deleted (n = 48), and unclear items were reworded (n = 27). For step 2, 14 experts (five occupational therapists, four researchers, and five workers) assessed the representativeness, relevance, and clarity of each item through content validity indices (CVIs). An average overall CVI of 0.97 was obtained, and 87.5% of the experts stated that the questionnaire was comprehensive. During this step, 63 items were deleted, and 35 were modified. For step 3, the tool was pretested in the clinical settings of four dyads (occupational therapist-worker). The thematic analysis of interview content allowed several changes to be made to the questionnaire, including the addition of information and format changes.Conclusions Overall, this three-step study led to the construction of a 61-item French questionnaire entitled the Échelle de fréquence des comportements préventifs au travail [Frequency Scale of Preventive Behaviors at Work]. In rehabilitation settings, this tool could be useful to support professionals in enabling workers to adopt preventive behaviors, thereby fostering a healthy, sustainable return to work after a disability period. However, further metrological property assessment is required. A validating study using a large pool of workers is ongoing.
Source: Lecours A, Beaulieu AA, Poulin V, Nastasia I, St-Hilaire F, Journal of occupational rehabilitation, 2021 Jan 05
Purpose A sustainable return to work (S-RTW) following prolonged work disability poses different challenges, depending on gender. This article provides a synthesis of gender differences in the issues and factors influencing the S-RTW of workers following such a disability. Methods Using an interpretive description method, an integrative review was conducted of the literature on gender differences in S-RTW issues and factors associated with four major causes of work disability. The initial review concerned the 2000-2016 literature; it was subsequently updated for November 2016-March 2020. To explore and contextualise the results, four focus groups were held with stakeholders representing the workplace, insurance, and healthcare systems and workers. Qualitative thematic analysis was performed. Results A total of 47 articles were reviewed, and 35 stakeholders participated in the focus groups. The prevailing traditional gender roles were found to have a major gender-specific influence on the attitudes, behaviours, processes and outcomes associated with S-RTW. These differences related to the (1) cumulative workload, (2) work engagement, and (3) expressed and addressed needs. Conclusions The results highlight the importance of taking into account both professional and personal aspects when integrating gender issues into the assessment of workers' needs and subsequently into interventions.
Source: Coutu MF, Durand MJ, Coté D, Tremblay D, Sylvain C, Gouin MM, Bilodeau K, Nastasia I, Paquette MA, Journal of occupational rehabilitation, 2021 Jan 04.
Purpose To assess the effects of adding a workplace intervention to inpatient occupational rehabilitation on return-to-work self-efficacy, and whether changes in return-to-work self-efficacy were associated with future work outcomes. Design Randomized clinical trial. Subjects Individuals aged 1860 years, sick-listed 212 months were randomized to multimodal inpatient rehabilitation with (n?=?88) or without (n?=?87) a workplace intervention. Methods Between-group differences for 4 months follow-up were assessed using linear mixed models. Associations between self-efficacy scores and future sickness absence days during 12 months of follow-up were assessed by linear regression. Results There were no statistically significant between-group differences in self-efficacy during follow-up. Participants with high or medium self-efficacy scores at the end of rehabilitation had fewer sickness absence days during follow-up compared with participants with low scores. Participants with consistently high scores or an increasing score throughout the programme showed fewer sickness absence days than those with reduced or consistently low scores. Conclusion Receiving an added workplace intervention did not increase return-to-work self-efficacy more than standard inpatient occupational rehabilitation alone. High scores and a positive development in return-to-work self-efficacy were associated with higher work participation. This suggests that return-to-work self-efficacy could be an important factor to consider in the return-to-work process.
Source: Skagseth M, Fimland MS, Rise MB, Lund Nilsen TI, Aasdahl L, Journal of rehabilitation medicine, 2021 Jan 04.
Purpose A work disability negotiation takes place between a supervisor, the disabled employee and the occupational health service (OHS) to support the disabled employee in returning to their work, often with temporary work accommodation. The objective of this study was to define the factors of a work disability negotiation with OHS that supported or hindered supervisors in their task/role in work disability management. Methods The study setting comprised two parts: the creation of survey questions and the actual survey of supervisors (N = 254) from six public and private organizations in Finland. Of these, 133 (52%) had participated in one or more work disability negotiations. The responses covered about 240 work disability cases and considerably more negotiations. Results The study identified four key elements that the supervisors expressed as major success factors in the negotiations. First, it was crucial that the supervisors learned about the employee's health restrictions and understood the issues relating to their work disability. Second, the parties should aim for common solutions and conclusions through collaboration. Third, active participation of all the negotiation parties is important. The supervisors gave a high rating to OHS taking their views seriously. Last, the supervisors appreciated collaboration in a constructive atmosphere. Conclusion In order for a negotiation to help supervisors in their challenges, it should reach solutions, conclusions and a restructured comprehension of the work disability problem in a constructive atmosphere and with active communication between stakeholders.
Source: Lappalainen L, Liira J, Lamminpää A, International archives of occupational and environmental health, 2021 Jan 03.
Background GPs are under considerable pressure providing routine care. However, they may not be the most appropriate professionals to manage getting patients back to work, and keeping them there. Purpose To test the feasibility of delivering occupational therapy-led vocational clinics (OTVoc) to provide return to work advice and support for people with musculoskeletal conditions and mental health problems, in primary care. Methods Prospective mixed methods study in two primary care centres (eight GP surgeries). We collected anonymised service level data on all patients receiving OTVoc. Next, patient participants who met inclusion criteria and consented, undertook baseline and 3-month follow-up assessments. Interviews were also conducted to explore stakeholders' views- GPs, Nurse Practitioners, Front Desk Staff, Occupational Therapists, patients and their employers about OTVoc- and included study eligibility, referral, experiences and attitudes to return to work. Data were analysed using descriptive statistics and thematic analysis. Results The majority of standardized measures showed some improvement over the study period: the sickness absence rate dropped from 71 to 15% and use of GP 'fit' notes reduced from 76 to 6%. Interview data indicated positive attitudes to OTVoc, the use of the fit note and the Allied Health Professions Health and Work Reports (AHP H&WRs). GPs felt that OTVoc reduced their workload. Conclusion Further research is feasible and warranted. OTVoc was positively received and stakeholders believed it was effective in getting patients back to work or preparing for their return. There was enthusiasm for extending service eligibility criteria, suggesting potential for further development and evaluation.
Source: Drummond A, Coole C, Nouri F, Ablewhite J, Smyth G, BMC family practice, 2020 Dec 13; Vol. 21 (1), pp. 268.
Purpose Individual psychosocial factors are crucial in the return to work (RTW) process of workers with musculoskeletal disorders (MSDs) and common mental disorders (CMDs). However, the quality and validity of the questionnaires used to measure these factors have rarely been investigated. The present systematic search and literature review aims at identifying, categorizing, and evaluating the questionnaires (measurement tools) used to measure individual psychosocial factors related to the perception of the personal condition and motivation to RTW that are predictive of successful RTW among workers with MSDs or CMDs. Methods Through a systematic search on PubMed, Web of Science, and PsycINFO library databases and grey literature, we identified the individual psychosocial factors predictive of successful RTW among these workers. Then, we retrieved the questionnaires used to measure these factors. Finally, we searched for articles validating these questionnaires to describe them exhaustively from a psychometric and practical point of view. Results The review included 76 studies from an initial pool of 2263 articles. Three common significant predictors of RTW after MSDs and CMDs emerged (i.e., RTW expectations, RTW self-efficacy, and work ability), two significant predictors of RTW after MSDs only (i.e., work involvement and the self-perceived connection between health and job), and two significant predictors of RTW after CMDs only (i.e., optimism and pessimism). We analyzed 30 questionnaires, including eight multiple-item scales and 22 single-item measures. Based on their psychometric and practical properties, we evaluated one of the eight multiple-item scales as questionable and five as excellent. Conclusions With some exceptions (i.e., self-efficacy), the tools used to measure individual psychosocial factors show moderate to considerable room for improvement.
Source: Gragnano A, Villotti P, Larivière ,C Negrini A, Corbière M, Journal of occupational rehabilitation, 2020 Dec.