Octobre 2019

Communication and collaboration among return-to-work stakeholders

Purpose Workers who are injured or become ill on the job are best able to return-to-work when stakeholders involved in their case collaborate and communicate. This study examined health care providers' and case managers' engagement in rehabilitation and return-to-work following workplace injury or illness. Methods In-depth interviews were conducted with 97 health care providers and 34 case managers in four Canadian provinces about their experiences facilitating rehabilitation and return-to-work, and interacting with system stakeholders. Results A qualitative thematic content analysis demonstrated two key findings. Firstly, stakeholders were challenged to collaborate as a result of: barriers to interdisciplinary and cross-professional communication; philosophical differences about the timing and appropriateness of return-to-work; and confusion among health care providers about the workers' compensation system. Secondly, these challenges adversely affected the co-ordination of patient care, and consequentially, injured workers often became information conduits, and effective and timely treatment and return-to-work was sometimes negatively impacted. Conclusions: Communication challenges between health care providers and case managers may negatively impact patient care and alienate treating health care providers. Discussion about role clarification, the appropriateness of early return-to-work, how paperwork shapes health care providers' role expectations, and strengthened inter-professional communication are considered. Administrative and conceptual barriers in workers' compensation systems challenge collaboration and communication between health care providers and case managers. Injured workers may become conduits of incorrect information, resulting in adversarial relationships, overturned health care providers' recommendations, and their disengagement from rehabilitation and return-to-work. Stakeholders should clarify the role of health care providers during rehabilitation and return-to-work and the appropriateness of early return-to-work to mitigate recurring challenges. Communication procedures between health care specialists may disrupt these challenges, increasing the likelihood of timely and effective rehabilitation and return-to-work.
Source: Russell E, Kosny A, Disability & Rehabilitation, Vol. 41 (22), p.2630-2639, 2019 Nov.

Septembre 2019

Health Care Provider Communication and the Duration of Time Loss Among Injured Workers: A Prospective Cohort Study

Purpose In addition to providing injured workers with biomedical treatment, health care providers (HCPs) can promote return to work (RTW) through various communications. Objectives To test the effect of several types of HCP communications on time loss following injury. Methods The authors analyzed survey and administrative claims data from a total of 730 injured workers in Victoria, Australia. Survey responses were collected around 5 months postinjury and provided data on HCP communication and confounders. Administrative claim records provided data on compensated time loss postsurvey. The authors conducted multivariate zero-inflated Poisson regressions to determine both the odds of having future time loss and its duration. Types of HCP communications included providing an estimated RTW date, discussing types of activities the injured worker could do or ways to prevent a recurrence, and contacting other RTW stakeholders. Each was measured in isolation as well as modified by a low-stress experience with the HCP. Time loss was the count of cumulative compensated work absence in weeks, accrued postsurvey. Results RTW dates reduced the odds of future time loss [odds ratio, 0.26; 95% confidence interval (CI), 0.09-0.82] regardless of the stressfulness of the experience. Communications that predicted shorter durations of time loss only did so with low-stress experiences: RTW date [incidence rate ratio (IRR), 0.56; 95% CI, 0.50-0.63], stakeholder contact (IRR, 0.78; 95% CI, 0.70-0.87), and prevention discussions (IRR, 0.87; 95% CI, 0.78-0.98). Conclusions HCPs may reduce time loss through several types of communication, particularly when stress is minimized. RTW dates had the largest and most robust effect.

Source: Tyler J.Lilley L, Black R, Sim O, R.Smith M, Peter M, Medical Care, Vol. 57(9), p. 718-722, 2019 Sept. 

Juillet et Août 2019

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, 2019 Jul.

Differences Over Time in the Prognostic Effect of Return to Work Self-Efficacy on a Sustained Return to Work

Purpose This study investigated the association between return to work self-efficacy (RTW-SE) and sustained return to work (RTW) at two different time points, over a 12-month period. The primary objective of the study was to examine if the relationship between RTW-SE and a sustained RTW changed over the RTW timeline. Methods This study used survey responses from a longitudinal cohort of n = 410 workers' compensation claimants with either an upper-body musculoskeletal injury or a psychological injury. A path analysis tested the associations between RTW-SE and a sustained RTW at two time-points. A Wald χ2 test compared nested models to determine if the association changed over time. Results RTW-SE measured at time- point 1 (T1) was associated with a sustained RTW at time-point two (T2) (β = 0.24, P < 0.05) but no association was found between RTW-SE at T2 and a sustained RTW at time-point three (T3) (β = 0.017, n.s.). Model comparisons revealed significant differences in the associations between RTW-SE and a sustained RTW, with the relationship being stronger in the early phase of RTW compared to the latter phase (χ2 = 5.002, p = 0.03). Conclusions The results indicate that RTW-SE at 4–6 months post-injury is important for a sustained RTW 6-months later although RTW-SE at 10–12 months post-injury had a negligible association over the same duration. Further research should investigate whether these findings generalize to other populations and what factors other than RTW-SE are associated with RTW in the later stages of the RTW process.

Source: Black O, Sim MR, Collie A, Smith P, Journal of Occupational Rehabilitation, vol. 29 (3), p. 660-667, 2019 Sep.

The Influence of Social Support and Social Integration Factors on Return to Work Outcomes for Individuals with Work-Related Injuries: A Systematic Review

Purpose In occupational rehabilitation, the biopsychosocial model endorses the role of social factors in worker recovery. We conducted a systematic review to explore three questions examining the role of social support for the return-to-work (RTW) of individuals with work-related injury: (1) What are the worker-identified social barriers and facilitators in RTW; (2) What is the relationship between social factors and RTW; and (3) What is the effectiveness of social interventions for RTW. Methods Systematic searches of six databases were conducted for each research question. These identified 11 studies meeting inclusion criteria for Research Question 1, and 12 studies for Research Question 2. No studies were identified that met inclusion criteria for Research Question 3. A narrative synthesis approach was used to analyse the included studies. Results Research Question 1 identified five themes in social barriers and facilitators to RTW, including contact/communication, person-centred approaches, mutual trust, reaction to injury, and social relationships. Research Question 2 identified moderate support for reaction to injury and social integration/functioning as predictors of RTW and weak evidence for co-worker support. Four studies reported significant associations between social factors and RTW, six reported mixed findings with at least one significant social predictor, and two found no significant relationships. However, conclusions were limited by the inconsistency in measurement of social factors. Conclusions Our findings indicate that social support and integration may influence RTW following work-related injury, and highlights the need for further systematic examination of social factors in the field of occupational rehabilitation.

Source: White C, Green RA, Ferguson S, Anderson SL, Howe C, Sun J, Buys N, Journal of Occupational Rehabilitation, Vol. 29 (3), p.636-659, 2019 Sep.

Improved Expectations About Length of Sick Leave During Occupational Rehabilitation Is Associated with Increased Work Participation

Purpose To assess changes in participants' expectations about length of sick leave during Acceptance and Commitment Therapy (ACT)-based occupational rehabilitation, and whether the change in expectations was associated with future work participation. Methods Cohort study with 9 months follow-up including sick listed workers who took part in one of two randomized controlled trials. The change in expectations about length of sick leave were assessed using a test of marginal homogeneity. Furthermore, linear and logistic regression evaluated associations between changes in expectations and sustainable return to work (RTW) and work participation days. Results During rehabilitation, there was a statistically significant improvement in participants' (n = 168) expectations about length of sick leave. During 9 months follow-up, participants with consistently positive expectations had the highest probability of RTW (0.81, 95% CI 0.67–0.95) and the most work participation days (159, 95% CI 139–180). Participants with improved expectations had higher probability of sustainable RTW (0.68, 95% CI 0.50–0.87) and more work participation days (133, 95% CI 110–156) compared to those with reduced (probability of RTW: 0.50, 95% CI 0.22–0.77; workdays: 116, 95% CI 85–148), or consistently negative expectations (probability of RTW: 0.23, 95% CI 0.15–0.31; workdays: 93, 95% CI 82–103). Conclusions During ACT-based occupational rehabilitation, 33% improved, 48% remained unaltered, and 19% of the participants reduced their expectations about RTW. Expectations about RTW can be useful to evaluate in the clinic, and as an intermediary outcome in clinical trials. The changes were associated with future work outcomes, suggesting that RTW expectations is a strong predictor for RTW.

Source: Aasdahl L, Pape K, Vasseljen O, Johnsen R, Fimland MSt, Journal of Occupational Rehabilitation, Vol. 29 (3), p.475-482, 2019 Sep.

The effect of positive psychology group intervention for occupationally injured employees

Purpose The aim of this study was to measure changes in levels of self-esteem and the response to stress after positive psychology intervention for occupationally injured workers to motivate them to return to work. Methods and Results The participants included 221 male and 44 female employees of a corporation in Korea who attended a psychological rehabilitation program for 2 weeks. Questionnaires including the Multidimensional Psychological Test (MPT), Rosenberg Self-Esteem Scale, and a stress response test were administered to measure levels of self-esteem and stress. The significant increase in self-esteem levels was found in men and women (p < .001). In addition, there was a significant decrease in stress response scores after the intervention. Conclusions The psychological rehabilitation program was effective in increasing self-esteem and reducing stress response among workers with occupational injury.

Source: Woo JM, Tae H, Kim H, Cha H, Lim SK, Chae JH, Kim JH, Journal of Workplace Behavioral Health Publisher: Taylor & Francis, 2019 Sep.

Mai et Juin 2019

Managing absence and dropout in vocational rehabilitation - a mixed-methods analysis of practices and perspectives among vocational rehabilitation companies in Norway

Purpose While absence and dropout represent challenges to the implementation of vocational rehabilitation programs in Norway, sanctions are rarely used in practice. The purpose of the article was to investigate the extent to which vocational rehabilitation managers and professionals experience that the absence regulations support a viable implementation of vocational rehabilitation programs. Methods An open-ended question, asking vocational rehabilitation managers about their experiences in handling absence, was presented as part of an electronic questionnaire sent to all vocational rehabilitation companies in Norway. 72 managers (59%) responded to the open-ended question, and a qualitative content analysis was conducted. Insight from ten focus group interviews were included as part of the analyses. Results Five thematic categories were created, which in their various ways demonstrate challenges associated with absence management in vocational rehabilitation programs: (i) failure of the Labour and welfare administration to react against unfounded absence; (ii) difficulties in distinguishing valid from nonvalid absence; (iii) uncertainty concerning the role of the general practitioner and medical documentation in the rehabilitation process; (iv) the prevalence of diffuse disorders and symptoms, and (v) lack of incentives and motivation among participants. Conclusions Sound absence management requires a clarification of the role of the general practitioner in the vocational rehabilitation process and closer cooperation between general practitioners and vocational rehabilitation companies, to reduce unnecessary breaks in the process due to hasty issuing of sicknotes. Further, as absence management appears to be most difficult in relation to those with mental and social problems, a comprehensive view on disability and follow-up is needed, where physical, mental, social and contextual factors are seen together. Implications for rehabilitation Absence and dropout represent challenges to the implementation of vocational rehabilitation programs in Norway, While a sound regulation of absence could impact positively on both the work-related and rehabilitation outcomes of vocational rehabilitation programs, evidence suggest that absence management is scarce, and that it becomes particularly difficult in relation to participants with mental health problems and social challenges. Clarification of the role of the general practitioner and the medical certificates they issue and strengthening the dialog between vocational rehabilitation companies and general practitioners to prevent unnecessary sick-listing and interruptions in the vocational rehabilitation process, could improve the follow-up of absence. Moreover, a flexible and sensible approach is needed, where absence management is seen in conjunction with the overall follow-up that is provided, and where awareness to individual challenges and needs should be in focus.

Source: Mandal R, Ose SO, Disability And Rehabilitation, p. 1-11, 2019 May.

Role of age and health in perceptions of returning to work: a qualitative study

Purpose People aged over 50 years form a growing proportion of the working age population but are at increased risk of unemployment compared to other age groups. It is often difficult to return to work after unemployment, particularly for those with health issues. In this paper, we explored the perceptions, attitudes, and experiences of returning to work after a period of unemployment (hereafter RTW) barriers among unemployed adults aged over 50 years. Methods In-depth semi-structured interviews were conducted with a diverse sample of 26 unemployed individuals aged 50–64 years who were engaged with the UK Government's Work Programme. Data were thematically analysed. Results Age alone was not discussed by participants as a barrier to work; rather their discussions of barriers to work focused on the ways in which age influenced other issues in their lives. For participants reporting chronic health conditions, or disabilities, there was a concern about being unfit to return to their previous employment area, and therefore having to "start again" in a new career, with associated concerns about their health status and managing their treatment burden. Some participants also reported experiencing either direct or indirect ageism (including related to their health status or need to access healthcare) when looking for work. Other issues facing older people included wider socio-political changes, such as the increased pension age, were felt to be unfair in many ways and contradicted existing expectations of social roles (such as acting as a carer for other family members). Conclusions Over-50s experienced multiple and interacting issues, at both the individual and societal level, that created RTW barriers. There is a need for employability interventions that focus on supporting the over-50s who have fallen out of the labour market to take a holistic approach, working across healthcare, employability and the local labour market, providing treatment and skills training for both those out of work and for employers, in order to create an intervention that that helps achieve RTW and its associated health benefit.

Source: Neary J, Katikireddi SV, Brown J, Macdonald EB, Thomson H, BMC Public Health, Vol. 19 (1), 2019 May.

Association between the return-to-work hierarchy and self-rated health, self-esteem, and self-efficacy

Purpose This study aimed to examine whether change of employer and/or job upon return-to-work after work-related injuries and diseases is related to health outcomes; self-rated health, self-esteem, and self-efficacy were used as indicators. Methods Data from the Panel Study of Workers' Compensation Insurance in Korea were used. A total of 1,610 workers who had returned to work after work-related injuries and diseases were included. The workers were divided into four groups according to their return-to-work characteristics: same employer, same job (n = 660); same employer, different job (n = 57); different employer, same job (n = 318); and different employer, different job (n = 575). Self-rated health, Rosenberg Self-Esteem Scale, and Self-Efficacy Scale scores were used as outcome variables. Logistic regression analysis was used. Results Compared to workers who had returned to the same employer and same job, those who had returned to the same employer but a different job were less likely to report good self-rated health (odds ratio [OR] 0.54; confidence interval [CI] 0.30–0.97). Those returning to a different employer but the same job were less likely to report good self-rated health (0.47, 0.35–0.64) and high self-esteem (0.73, 0.55–0.96). Those returning to a different employer and different job were less likely to report good self-rated health (0.49, 0.38–0.63), high self-esteem (0.68, 0.54–0.86), and high self-efficacy (0.66, 0.52–0.83). Conclusions Change of employer and/or job related to health outcomes. Returning to the same employer and same job should be set as a goal in the vocational rehabilitation process.

Source: Jeong I, Yoon JH, Roh J, Rhie J, Won JU, International Archives of Occupational & Environmental Health, Vol. 92 (5), p.709-716, 2019 Jul.

Avril 2019

Resilience and return-to-work pain interventions: systematic review

PurposeResilience is a developing concept in relation to pain, but has not yet been reviewed in return-to-work (RTW) contexts. Aims To explore the role of resilience enhancement in promoting work participation for chronic pain sufferers, by reviewing the effectiveness of existing interventions. Methods Resilience was operationalized as: self-efficacy, active coping, positive affect, positive growth, positive reinforcement, optimism, purpose in life and acceptance. Five databases were searched for randomized controlled trials (RCTs) whose interventions included an element of resilience designed to help RTW/staying at work for chronic pain sufferers. Study appraisal comprised the Cochrane risk of bias (RoB) tool and additional quality assessment. Findings were synthesized narratively and between-group differences of outcomes were reported. Heterogeneous PICO (population, intervention, comparator, outcome) elements precluded meta-analysis. Results Thirty-four papers from 24 RCTs were included. Interventions varied; most were multidisciplinary, combining behavioural, physical and psychological pain management and vocational rehabilitation. Four found RTW/staying at work improved with intensive multidisciplinary interventions compared with less intensive, or no, treatment. Of these, one had low RoB; three scored poorly on allocation concealment and selective outcome reporting. Four trials had mixed results, e.g. interventions enabling reduced sick leave for people on short-term not long-term leave; 16 showed no improvement. Five trials reported resilience outcomes were improved by interventions but these were not always trials in which RTW improved. Conclusions Effectiveness of resilience interventions for chronic pain sufferers on RTW is uncertain and not as helpful as anticipated. Further agreement on its conceptualization and terminology and that of RTW is needed.

Source: Wainwright E, Wainwright D, Coghill N, Walsh J, Perry R, Occupational Medicin, 2019 Mar.

Return-to-work success despite conflicts: an exploration of decision-making during a work rehabilitation program

PurposeCollective decision-making by stakeholders appears important to return-to-work success, yet few studies have explored the processes involved. This study aims to explore the influence of decision-making on return-to-work for workers with musculoskeletal or common mental disorders. Methods This study is a secondary analysis using data from three earlier multiple-case studies that documented decision-making during similar and comparable work rehabilitation programs. Individual interviews were conducted at the end of the program with stakeholders, namely, the disabled workers and representatives of health care professionals, employers, unions and insurers. Verbatims were analysed inductively. ResultsThe 28 decision-making processes (cases) led to 115 different decisions-making instances and included the following components: subjects of the decisions, stakeholders' concerns and powers, and types of decision-making. No differences were found in decision-making processes relative to the workers' diagnoses or return-to-work status. However, overall analysis of decision-making revealed that stakeholder agreement on a return-to-work goal and acceptance of an intervention plan in which the task demands aligned with the worker's capacities were essential for return-to-work success. ConclusionsThese results support the possibility of return-to-work success despite conflictual decision-making processes. In addition to facilitating consensual decisions, future studies should be aimed at facilitating negotiated decisions. Implications for rehabilitation: Facilitating decision-making, with the aim of obtaining agreement from all stakeholders on a return-to-work goal and their acceptance of an intervention plan that respects the worker's capacities, is important for return-to-work success. Rehabilitation professionals should constantly be on the lookout for potential conflicts, which may either complicate the reach of an agreement between the stakeholders or constrain return-to-work possibilities. Rehabilitation professionals should also be constantly watching for workers' and employers' return-to-work concerns, as they may change during work rehabilitation, potentially challenging a reached agreement.

Source: Gouin MM, Coutu MF, Durand MJ, Disability & Rehabilitation, Vol. 41 (5), p.523-533, 2019 Mar.

Employee experience of workplace supervisor contact and support during long-term sickness absence

PurposeWorkplace support is an important factor in promoting successful return to work. The purpose of this article is to examine relationships between supervisor contact, perceived workplace support and demographic variables among employees on long-term sickness absence. MethodsData were collected from 204 public employees at a municipality in Sweden who had been on long term sickness absence (60 days or more) using a 23 question survey instrument that collected information on demographic variables, supervisor contact and perceived workplace support. ResultsMost injured employees (97%) reported having contact with their supervisors during their sickness absence, with a majority (56%) reporting high levels of support, including early (58.6%) and multiple (70.7%) contacts. Most were pleased with amount of contact (68.9%) and the majority had discussed workplace accommodations (68.1%). Employees who self-initiated contact, felt the amount of contact was appropriate, had a personal meeting with their supervisors and discussed workplace adjustments reported experiencing higher levels of support from supervisors. ConclusionsEmployees on long-term sickness absence appreciate contact from their supervisors and this is associated with perceived workplace support. However, the amount and employee experience of this contact is important. It needs to be perceived by employees as supportive, which includes a focus on strategies (e.g., work adjustment) to facilitate a return to work. Supervisor training is required in this area to support the return to work process. Implications for RehabilitationContact and support from workplace supervisors is important to workers on long-term sickness absence. Employees appreciate frequent contact from supervisors during long-terms sickness absence. Employees appreciate a personal meeting with supervisors and the opportunity to discuss issues related to return to work such as work adjustment. Employers should provide training to supervisors on how to communicate and assist employees on long-term sickness absence.

Source: Buys NJ, Selander J, Sun J, Disability & Rehabilitation,Vol. 41 (7), p.808-814, 2019 Apr.

The effectiveness of vocational rehabilitation on work participation: a propensity score matched analysis using nationwide register data

PurposeResearch on the effectiveness of vocational rehabilitation has focused on small and selected groups, lacked proper controls, or not captured dynamic changes in work participation. Using rich nationwide data on vocational rehabilitees and matched controls, long-term changes in work participation before and after vocational rehabilitation were examined to assess its effectiveness. MethodsRepresentative Finnish register data were used to examine 3199 recently employed individuals aged 30-55 years with histories of musculoskeletal- and mental-related work disability starting vocational rehabilitation in 2008-2010 (intervention group), and 3199 propensity score matched non-rehabilitees (control group). Sociodemographic and work-related factors and detailed 3-year work disability and other labor market history were used for matching. Generalized estimation equations were used to examine differences in the proportion of time spent at work between periods before and after rehabilitation among the intervention and control group and the difference in these differences (DID). ResultsVocational rehabilitation resulted in gains in work participation, the total 1-, 2-, and 3-year DID being 11.8 [95% confidence interval (CI) 10.0-13.7], 8.9 (95% CI 7.6-10.2), and 7.2 (95% CI 6.1-8.3) percentage points, respectively. Contrary to this overall pattern, larger DID was observed over the long term for those whose rehabilitation lasted >10 months. The DID was lowest among women with musculoskeletal diseases. ConclusionsVocational rehabilitation after musculoskeletal- or mental-related work disability showed modest effectiveness on work participation. To promote sustained work participation after shorter rehabilitation (likely comprising workplace interventions) and faster work resumption after longer rehabilitation (likely comprising training), enhanced and complementary interventions should be considered.

Source: Leinonen T, Viikari-Juntura E, Husgafvel-Pursiainen K, Juvonen-Posti P, Laaksonen M, Solovieva S, Scandinavian Journal of WorkEnvironment & Health, 2019 Apr.

Mars 2019

The association between having a coordinator and return to work: the rapid-return-to-work cohort study

Purpose The aim of this study was to assess if the reported provision of a coordinator was associated with time to first return to work (RTW) and first full RTW among sick-listed employees who participated in different rapid-RTW programmes in Norway. Design The study was designed as a cohort study. Setting Rapid-RTW programmes financed by the regional health authority in hospitals and Norwegian Labour and Welfare Administration in Norway. Participants The sample included employees on full-time sick leave (n=326) who participated in rapid-RTW programmes (n=43), who provided information about the coordination of the services they received. The median age was 46 years (minimum-maximum 21-67) and 71% were female. The most common reported diagnoses were musculoskeletal (57%) and mental health disorders (14%). Interventions The employees received different types of individually tailored RTW programmes all aimed at a rapid RTW; occupational rehabilitation (64%), treatment for medical or psychological issues, including assessment, and surgery (26%), and follow-up and work clarification services (10%). It was common to be provided with a coordinator (73%). Primary and Secondary Outcome Measures Outcomes were measured as time to first RTW (graded and 100%) and first full RTW (100%). Results Employees provided with a coordinator returned to work later than employees who did not have a coordinator; a median (95% CI) of 128 (80 to 176) days vs 61 (43 to 79) days for first RTW, respectively. This difference did not remain statistically significant in the adjusted regression analysis. For full RTW, there was no statistically significant difference between employees provided with a coordinator versus those who were not. Conclusions The model of coordination, provided in the Norwegian rapid-RTW programmes was not associated with a more rapid RTW for sick-listed employees. Rethinking how RTW coordination should be organised could be wise in future programme development.

Source: Skarpaas LS, Haveraaen LA, Småstuen MC, Shaw WS, Aas RW, BMJ Open, Vol. 9 (2), p. e024597, 2019 Feb.

In or out of work: A preliminary investigation of mental health, trait anxiety and metacognitive beliefs as predictors of work status

Purpose Common mental disorders are associated with significant economic, social, and personal costs that are primarily incurred through loss of work status. Psychological interventions based on cognitive‐behavioural therapy have been implemented to enhance return to work (RTW), but have not proved sufficiently successful. According to the metacognitive model of psychological disorders, metacognitive beliefs are the key factors underlying self‐regulation and could therefore potentially be important for work status. The aim of the current study was therefore to investigate whether metacognitive beliefs could have predictive utility for work status. Methods In a cross‐sectional design, 427 working age individuals reporting to be working (n = 292) or receiving disability benefits (n = 135) participated in the study. Results We found that metacognitive beliefs about the need for mental control were significant as predictors of work status over and above the presence of a diagnosed mental disorder and levels of trait anxiety. Conclusions These findings imply that metacognitive beliefs have predictive utility for work status even when controlling for mental health status, and that metacognitive beliefs might therefore be addressed in treatment to enhance RTW and with the aim of reducing long‐term sick leave.

Source: Nordahl H, Wells A, Clinical Psychologist, Vol. 23 (1), p.79-84, 2019 Mar.

Acceptability and Feasibility of a Shared Decision-Making Model in Work Rehabilitation: A Mixed-Methods Study of Stakeholders' Perspectives

Purpose To establish the acceptability and feasibility of implementing a shared decision-making (SDM) model in work rehabilitation. Methods We used a sequential mixed-methods design with diverse stakeholder groups (representatives of private and public employers, insurers, and unions, as well as workers having participated in a work rehabilitation program). First, a survey using a self-administered questionnaire enabled stakeholders to rate their level of agreement with the model's acceptability and feasibility and propose modifications, if necessary. Second, eight focus groups representing key stakeholders (n = 34) and four one-on-one interviews with workers were conducted, based on the questionnaire results. For each stakeholder group, we computed the percentage of agreement with the model's acceptability and feasibility and performed thematic analyses of the transcripts. Results Less than 50% of each stakeholder group initially agreed with the overall acceptability and feasibility of the model. Stakeholders proposed 37 modifications to the objectives, 17 to the activities, and 39 to improve the model's feasibility. Based on in-depth analysis of the transcripts, indicators were added to one objective, an interview guide was added as proposed by insurers to ensure compliance of the SDM process with insurance contract requirements, and one objective was reformulated. Conclusions Despite initially low agreement with the model's acceptability on the survey, subsequent discussions led to three minor changes and contributed to the model's ultimate acceptability and feasibility. Later steps will involve assessing the extent of implementation of the model in real rehabilitation settings to see if other modifications are necessary before assessing its impact.

Source: Coutu MF, Légaré F, Durand MJ, Stacey D, Labrecque ME, Corbière M, Bainbridge L, Journal of Occupational Rehabilitation, Vol. 29 (1), p.128-139, 2019 Mar.

The impact of motivational interviewing training on rehabilitation counselors: Assessing working alliance and client engagement. A randomized controlled trial

Purpose To determine the impact of a motivational interviewing (MI) training designed to improve rehabilitation counselors’ counseling skills to promote clients’ engagement in return-to-work behaviors and to establish strong working alliance. Participants The target population for this study was counselors who work for the state vocational rehabilitation (VR) program and their clients. Data were collected from a total of 347 participants (67 counselors and 280 clients) in the experimental and comparison groups, during the pre-and-posttests. Study Method A randomized controlled trial was used in this study. The counselors in the experimental group received a 4-hr standardized MI training and a 4-week follow-up coaching sessions. Results The counselors in the experimental group demonstrated significant gains in their MI competence scores compared to the comparison group. The clients of the experimental group’s counselors improved their engagement in VR services and working alliance with their counselors. Conclusions The findings of this research indicated a need for carefully developed counseling trainings and incorporation of the evidence-based practices in the VR programs to provide better quality of rehabilitation services.

Source: Torres A, Frain M, Tansey TN, Rehabilitation Psychology Publisher: American Psychological Association, 2019 Mar.

Work ability and work functioning: measuring change in individuals recently returned to work

Purpose To assess: (1) whether work ability and work-functioning instruments can detect relevant changes in their respective parameters following a return to work (RTW) and (2) what proportion of those returning to work show changes in their work ability and work functioning. Methods A total of 1073 workers who returned to work after at least 2 weeks of sick leave were invited to fill out three questionnaires in the first 8 weeks after RTW. These consisted of an appraisal of general, physical, and mental/emotional work ability (scores 0-10) and a work-functioning questionnaire (scores 0-100). Minimal Important Change (MIC) was defined to determine the proportion of people, whose scores had changed at weeks 5 and 8 following RTW. The Smallest Detectable Change (SDC) was determined to put the MIC in perspective of measurement error. Results Of all participants, 235 were eligible for the analysis. All MIC values were below the SDC and thus not suitable for use. The SDC for work ability was 2.2 and 19.9 for work functioning. In the first 5 weeks after RTW, 10-15% showed a relevant, measurable improvement in work ability, and work functioning based on the SDC margins. Conclusions Both instruments were unable to identify change after RTW adequately. We can conclude that 10-15% of individuals showed improvement in work ability and work functioning in the first 5 weeks after RTW when SDC is used.

Source: van Schaaijk A, Nieuwenhuijsen K, Frings-Dresen MHW, Sluiter JK, International Archives of Occupational & Environmental Health, Vol. 92 (3), p.423-433, 2019 Apr.

Psychological treatments for return to work in individuals on sickness absence due to common mental disorders or musculoskeletal disorders: a systematic review and meta-analysis of randomized-controlled trials

Purpose Common mental disorders (CMDs) and musculoskeletal disorders are highly prevalent in the population and cause significant distress and disability, and high costs to society. The main objective of this systematic review and meta-analysis was to examine the outcome and comparative effectiveness of psychological interventions in reducing sickness absence (SA) due to CMDs or musculoskeletal disorders, compared to a waitlist control group, usual care or another clinical intervention. Methods We reviewed 3515 abstracts of randomized controlled trials published from 1998 to 2017. Of these, 30 studies were included in the analysis. Results The psychological interventions were overall more effective than treatment as usual in reducing SA (small effect sizes), but not compared to other clinical interventions. Results were similar for studies on CMDs and musculoskeletal pain. A few significant moderating effects were found for treatment-specific variables. However, these were  difficult to interpret as they pointed in different directions. Conclusions There was a small but significant effect of psychological treatments in reducing SA. We identified areas of improvement such as methodological problems among the included studies and failure to specifically address RTW in the interventions that were evaluated. Clinical implications of the findings, and ways of improving methodological rigour of future studies are discussed.

Source: Finnes A, Enebrink P, Ghaderi A, Dahl JA, Nager A, Öst LG, International Archives of Occupational & Environmental Health, Vol. 92 (3), p.273-293, 2019 Apr.

Février 2019

Concerns about Claiming, Post-Claim Support, and Return to Work Planning: the Workplace's Impact on Return to Work

Purpose To determine how injured Australian workers perceived employer emotional (e.g., empathy) and instrumental (e.g., RTW planning) support during the return-to-work (RTW) process and examine associations between support and RTW. Methods Using data from the 2014 National Return to Work Survey of injured workers with a workers' compensation claim, multinomial regression models examined relationships between support and RTW. Results Receiving support and developing RTW plans were significantly associated with greater likelihood of RTW. When controlled for one another in a single model, post-claim support had the strongest association with RTW with RTW planning also significantly and positively associated with RTW. Conclusions Provision of both emotional and instrumental support are important employer-led work disability management interventions. Research is required to develop strategies for increasing employer support to lead to improved RTW outcomes for injured workers.

Source: Gray SE, Sheehan LR, Lane TJ, Jetha A, Collie A, Journal of Occupational and Environmental Medicine, 2019 Jan.

Differences over Time in the Prognostic Effect of Return to Work Self-Efficacy on a Sustained Return to Work

Purpose This study investigated the association between return to work self-efficacy (RTW-SE) and sustained return to work (RTW) at two different time points, over a 12-month period. The primary objective of the study was to examine if the relationship between RTW-SE and a sustained RTW changed over the RTW timeline. Methods This study used survey responses from a longitudinal cohort of n = 410 workers' compensation claimants with either an upper-body musculoskeletal injury or a psychological injury. A path analysis tested the associations between RTW-SE and a sustained RTW at two time-points. A Wald χ2 test compared nested models to determine if the association changed over time. Results RTW-SE measured at time- point 1 (T1) was associated with a sustained RTW at time-point two (T2) (β = 0.24, P < 0.05) but no association was found between RTW-SE at T2 and a sustained RTW at time-point three (T3) (β = 0.017, n.s.). Model comparisons revealed significant differences in the associations between RTW-SE and a sustained RTW, with the relationship being stronger in the early phase of RTW compared to the latter phase (χ2 = 5.002, p = 0.03). Conclusions The results indicate that RTW-SE at 4-6 months post-injury is important for a sustained RTW 6-months later although RTW-SE at 10-12 months post-injury had a negligible association over the same duration. Further research should investigate whether these findings generalize to other populations and what factors other than RTW-SE are associated with RTW in the later stages of the RTW process.

Source: Black O, Sim MR, Collie A, Smith P, Journal Of Occupational Rehabilitation, 2019 Feb.

Changes in fear-avoidance beliefs and work participation after occupational rehabilitation for musculoskeletal- and common mental disorders: secondary outcomes of two randomized clinical trials

Purpose To assess: (i) whether changes in the Fear-Avoidance Beliefs Questionnaire (FABQ) were greater for multicomponent inpatient rehabilitation vs outpatient cognitive behavioural therapy, and (ii) whether baseline scores and changes (pre- to post-intervention) in FABQ were associated with future work-participation. Methods Individuals sick-listed for 2-12 months were randomized to inpatient multicomponent rehabilitation (3.5 weeks or 4+4 days) or outpatient cognitive behavioural therapy (6 sessions/6 weeks). Results A total of 334 subjects were included. There were no significant differences on FABQ between the in- and out-patient programmes during follow-up. Participants with consistently low scores on the work subscale had more work-participation days, followed by those who reduced their scores. Participants who increased, or had consistently high scores had the least workdays. For the physical activity subscale, the associations were weaker. FABQ-work scores at baseline were associated with number of work-participation days for both musculoskeletal and psychological diagnoses, and more strongly for the latter group. Conclusions This study suggests that FABQ could be a useful prognostic tool for individuals on sick leave due to musculoskeletal or psychological disorders. There was no evidence that inpatient occupational rehabilitation reduces FABQ scores more than outpatient cognitive behavioural therapy.

Source: Aasdahl L, Østgård Gismervik S, Marchand GH, Vasseljen O, Johnsen R, Aasdahl MS, Gismervik SØ, Marchand GH, Vasseljen O, Johnsen R, Fimland MS, Journal of Rehabilitation Medicine, 2019 Feb.

Janvier 2019

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. 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. Implications for rehabilitation The subacute phase of low back pain has been termed the "golden hour" for work disability prevention. Conclusions 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 MS, Disability and Rehabilitation, p. 1-8, 2019 Jan.

Predictors of return to work with and without restrictions in public workers

Purpose Sick leaves are important events for both the worker and the employer. Many factors are related with sick leaves and depending on the factors the worker could perform a successful return to work. In this sense, the objective of this study is to identify those factors associated with return to work after sick leaves in a group of public workers in Brazil. Methods A case-control study of return to work after sick leaves in a university campus from 2010 to 2015. Logistic regression models were adjusted for two different response variables: return to work with and without restrictions. A digital database was created and completed with data from manual sources. Results A computerised database has been created, based on manual records, which has allowed us to identify labour and non-labour factors associated with the return to work after a sick leave and the possible functional readaptation, with or without restrictions, in public workers. Age at the beginning of the process, number of sick leaves, those of more than 16 days, average duration (total time of sick leaves / number of medical records), and mid-level healthcare positions were associated with return to work without restrictions. In the model of return to work with restrictions, the age of hiring by the university, the number of sick leaves, those of more than 16 days, and mid-level healthcare positions, both rural work and operational positions, were associated to the response variable. Conclusions This study has allowed us to identify the factors associated with the return to work after a period of sick leave in a large group of public workers. However, more research is needed on the mental disorders that cause sick leaves, their evaluation and the handling of these situations.

Source: Dias A, Bernardes JM, Coquemala SAS, Gómez-Salgado J, Ruiz-Frutos C, PLoS ONE, Vol. 14 (1), p.1-16, 2019 Jan.

Work ability and work functioning: measuring change in individuals recently returned to work

Purpose To assess: (1) whether work ability and work-functioning instruments can detect relevant changes in their respective parameters following a return to work (RTW) and (2) what proportion of those returning to work show changes in their work ability and work functioning. Methods A total of 1073 workers who returned to work after at least 2 weeks of sick leave were invited to fill out three questionnaires in the first 8 weeks after RTW. These consisted of an appraisal of general, physical, and mental/emotional work ability (scores 0-10) and a work-functioning questionnaire (scores 0-100). Minimal Important Change (MIC) was defined to determine the proportion of people, whose scores had changed at weeks 5 and 8 following RTW. The Smallest Detectable Change (SDC) was determined to put the MIC in perspective of measurement error. Results Of all participants, 235 were eligible for the analysis. All MIC values were below the SDC and thus not suitable for use. The SDC for work ability was 2.2 and 19.9 for work functioning. In the first 5 weeks after RTW, 10-15% showed a relevant, measurable improvement in work ability, and work functioning based on the SDC margins. Conclusions Both instruments were unable to identify change after RTW adequately. We can conclude that 10-15% of individuals showed improvement in work ability and work functioning in the first 5 weeks after RTW when SDC is used.

Source: van Schaaijk A, Nieuwenhuijsen K, Frings-Dresen MHW, Sluiter JK, International Archives of Occupational and Environmental Health, 2019 Jan.

The Influence of Social Support and Social Integration Factors on Return to Work Outcomes for Individuals with Work-Related Injuries: A Systematic Review

Purpose In occupational rehabilitation, the biopsychosocial model endorses the role of social factors in worker recovery. We conducted a systematic review to explore three questions examining the role of social support for the return-to-work (RTW) of individuals with work-related injury: (1) What are the worker-identified social barriers and facilitators in RTW; (2) What is the relationship between social factors and RTW; and (3) What is the effectiveness of social interventions for RTW. Methods Systematic searches of six databases were conducted for each research question. These identified 11 studies meeting inclusion criteria for Research Question 1, and 12 studies for Research Question 2. No studies were identified that met inclusion criteria for Research Question 3. A narrative synthesis approach was used to analyse the included studies. Results Research Question 1 identified five themes in social barriers and facilitators to RTW, including contact/communication, person-centred approaches, mutual trust, reaction to injury, and social relationships. Research Question 2 identified moderate support for reaction to injury and social integration/functioning as predictors of RTW and weak evidence for co-worker support. Four studies reported significant associations between social factors and RTW, six reported mixed findings with at least one significant social predictor, and two found no significant relationships. However, conclusions were limited by the inconsistency in measurement of social factors. Conclusions Our findings indicate that social support and integration may influence RTW following work-related injury, and highlights the need for further systematic examination of social factors in the field of occupational rehabilitation.

Source: White C, Green RA, Ferguson S, Anderson SL, Howe C, Sun J, Buys N, Journal of Occupational Rehabilitation, 2019 Jan.