Incapacité et retour au travail

Janvier 2026

Purpose Most patients with health conditions necessitating time off work consult in primary care. Offering vocational advice (VA) early within this setting may help them to return to work and reduce sickness absence. Previous research shows the benefits of VA interventions for musculoskeletal pain in primary care, but an intervention for a much broader primary care patient population has yet to be tested. The Work And Vocational advicE feasibility study tested patient identification and recruitment methods, explored participants' experiences of being invited to the study and their experiences of receiving VA. Methods Design: A mixed method, single arm feasibility study comprising both quantitative and qualitative analysis of recruitment and participation in the study. Setting: Primary care. Data collection:: The study included participant follow-up by fortnightly Short Message Service text and 6-week questionnaire. Stop/go criteria focus on recruitment and intervention engagement. The semistructured interviews explored participants' experiences of recruitment and receipt and engagement with the intervention. Results 19 participants were recruited (4.3% response rate). Identification of participants via retrospective fit-note searches was reasonably successful (13/19 (68%) identified), recruitment stop/go criteria were met with >=50% of those eligible and expressing an interest recruited. The stop/go criterion for intervention engagement was met with 16/19 (86%) participants having at least one contact with a vocational support worker. Five participants were interviewed; they reported positive experiences of recruitment and felt the VA intervention was acceptable. Conclusion This study demonstrates that delivering VA in primary care is feasible and acceptable. To ensure a future trial is feasible, recruitment strategies and data collection methods require additional refinement.

© Wynne-Jones G; Sowden G; Madan I; Walker-Bone K; Chew-Graham C; Saunders B; Lewis M; Bromley K; Jowett S; Parsons V; Mansell G; Cooke K; Lawton SA; Linaker C; Pemberton J; Cooper C; Foster NE. BMJ Open. 15(12):e098768, 2025 Dec 29.

Purpose To assess the effectiveness of self-help interventions in reducing work disability and improving work- and health-related outcomes among individuals with musculoskeletal, anxiety, and/or depressive conditions; to explore lived experiences with self-help interventions; and to integrate quantitative and qualitative findings to guide future research and implementation. Methods We conducted a rapid mixed methods systematic review following World Health Organization (WHO) and Cochrane Rapid Reviews Methods Group guidance. We included randomized controlled trials (RCTs), quasi-experimental, qualitative, and mixed methods studies published in English since 2007. Eligible studies evaluated self-help interventions targeting musculoskeletal, anxiety, and/or depressive conditions in working-age adults (18-65 years). Quantitative outcomes included functioning, return-to-work, productivity, and self-efficacy; qualitative outcomes reflected user experiences. Risk of bias was assessed using RoB 2, ROBINS-I, and CASP tools. Findings were synthesized narratively by intervention types and outcome domain. Results Eight studies met inclusion criteria: five RCTs, two quasi-experimental, and one qualitative. All seven quantitative studies were rated high risk of bias. Short-term improvements were observed in disability and physical quality of life in two exercise-based trials, but effects on work participation were inconsistent and generally below thresholds for clinical importance. Cognitive-behavioral and psychoeducational programs produced small improvements in self-efficacy and presenteeism, and relaxation and educational interventions showed no meaningful effects. The qualitative study highlighted workplace barriers such as productivity pressures and limited opportunities for movement that constrained engagement. Conclusion Self-help interventions may modestly improve self-management, disability, and coping in the short term but show limited and inconsistent evidence for reducing work disability. Their effectiveness likely depends on adherence, contextual support, and integration into workplace environments. Future high-quality, co-designed, context-sensitive studies are needed to clarify effectiveness, safety, and sustainability in real-world settings.

© Atkinson-Graham M; Yu H; Cooper L; Weisberg J; Connell G; Allard S; Check L; Nkamtchoum AF; Flynn T; Lorca J; McIntyre V; Paterson J; Wagenaar A; Martin K; Gross DP; Straube S; Murnaghan K; Cancelliere C. Journal of Occupational Rehabilitation. 2026 Jan 05.

Purpose Interprofessional collaboration among occupational health professionals (OHPs) is essential for guiding sick-listed employees and facilitating return to work (RTW). However, the lack of a shared language among different OHPs can hinder effective collaboration. To address this, an instrument and multidisciplinary guideline based on the International Classification of Functioning, Disability, and Health (ICF) were developed. This study aimed to assess the feasibility of the ICF-based instrument and multidisciplinary guideline, as well as to explore OHPs' experiences to support implementation in daily practice. Methods A triangulated mixed-methods design was used, combining OHPs assessing work capacity with the instrument in practice for sick-listed employees, followed by interviews, case reviews, and focus groups with both medical and non-medical OHPs. The Measurement Instrument for Determinants of Implementation (MIDI) guided data collection and analysis. Results OHPs experienced the ICF-based instrument as comprehensible, usable for providing sick leave guidance, and particularly valuable for enabling qualitative assessments of work capacity and RTW possibilities. The so-called d-codes included in the instrument, derived from the ICF-framework, facilitated communication between medical and non-medical professionals. OHPs also found the instrument supported shared decision-making by incorporating both employees' and employers' perspectives. Application was especially suited for complex cases of long-term sick leave. Conclusions This study highlights the potential of implementing the ICF-based instrument and multidisciplinary guideline in occupational health practice to improve interprofessional collaboration during sick leave and RTW. OHPs reported that the instrument supports capturing both the strengths and limitations of sick-listed employees, while also addressing workplace and personal factors.

Purpose Sickness absenteeism represents a pressing challenge for employees, organizations, and societies. Although leadership is widely recognized as a determinant of employees’ health, the relationship between leaders’ Health-Focused Intervention Behavior (HFIB) and sickness absenteeism remains insufficiently understood. HFIB denotes leaders’ purposeful actions to support employees’ recovery, such as initiating health-related dialogue, adapting work conditions, and facilitating access to organizational and medical resources in case of ill-health. Grounded in Conservation of Resources theory, this research pursues three objectives: (1) to examine absenteeism as a theoretically and practically significant outcome of HFIB above and beyond (leader-member exchange) LMX, (2) to investigate pre-existing health impairments as an underexplored boundary condition shaping HFIB effectiveness, and (3) to explore the longitudinal development of sickness absenteeism trajectories by assessing individual differences in initial absenteeism (intercept) and change over time (slope) in relation to HFIB. Methods & results Drawing on multi-source data collected over 18 months, including six waves of sickness absenteeism following the baseline survey, we find that HFIB is negatively associated with sickness absenteeism, even after controlling for LMX, physical strain and respiratory diseases. Moreover, impairment severity moderates this relationship: contrary to expectations, employees with stronger impairments exhibit smaller reductions in sickness absenteeism than those with less severe impairments.

Purpose In this era of high competition and pandemic, the return to work is challenging because it requires organizations to balance operational demands with individualized support for employees recovering from psychological, physical, and/or personal setbacks. Additionally, managerial expectations, misalignment between workplace culture, and employee readiness can hinder effective reintegration, leading to reduced relapse or productivity. This study aimed to examine the influence of key organizational and psychological factors on employees' return-to-work. Methods A stratified sampling approach was employed to collect data from 370 employees who had successfully returned to work after experiencing work-related injuries and diseases. Eight hypotheses were formulated and validated using structural equation modeling with SmartPLS. Results Findings from the present study reveal that perceived organizational support has an insignificant impact on the return to work; however, it has a significant impact on strategic human resource management and psychological empowerment. In addition, the present study confirmed a significant impact of organizational hierarchy culture on return-to-work and psychological empowerment. Thus, strategic human resource management had a significant impact on return-to-work rates and psychological empowerment. Finally, psychological empowerment had a significant impact on the return to work. Conclusions The study highlights the importance of culturally aligned human resource strategies and psychological factors in fostering successful employee reintegration after work absence. These findings have practical implications for human resource professionals and policymakers aiming to design effective, inclusive, and sustainable return-to-work programs tailored to hierarchical organizational environments.

Purpose Work-related anxiety can result in prolonged work incapacity and reduce return-to-work probabilities. Despite the prevalence of work-related anxiety in somatic rehabilitation settings, there has been little research examining the experiences of affected patients from a public health perspective. This research project aims to address this gap by providing initial insights into the care provided to patients with somatic complaints and patients with additional work-related anxiety. Methods A sequential mixed methods approach was employed, beginning with semi-structured interviews (2022, n = 18 orthopedic rehabilitation patients), followed by questionnaire distribution (2023, n = 53). Qualitative analysis distinguished between patients with higher (JA) and lower (nJA) Job Anxiety Scale scores (cut-off 2.5). Results The findings highlight notable differences between JA and nJA patients. JA patients often report that they face unmet psychological needs, limited work-related treatment focus, financial barriers, and inadequate occupational support, relying more on self-initiative for reliable information. In contrast, nJA patients appear to benefit from stronger social networks, stable financial resources, and improved access to healthcare. Both groups report mixed experiences with workplace support. For professionals the findings underline that JA patients are specifically in need of work-related interventions, even patients themselves remind about this. Conclusions The findings illustrate significant differences between JA and nJA patients in terms of their experiences, challenges, and support needs within healthcare, workplace, and rehabilitation contexts. While qualitatively insightful, these findings are pilot and explorative and warrant further research.

Purpose This study compared return-to-work (RTW) outcomes among Norwegian patients with musculoskeletal or common mental disorders participating in a 4-week inpatient or 3-month outpatient occupational rehabilitation program, examining associations between program type, pre-intervention sick-leave duration, and RTW. Methods An observational cohort (n = 857) was categorized into five pre-intervention benefit groups, including Group 1 (partial benefits for ≥ 6 weeks) and Group 2 (90-100% benefits for 6 weeks through 5 months). Primary outcome was time to stable RTW (first month without sickness benefits); secondary outcome was cumulative work participation over 24 months. Results RTW hazard varied by group and time. During the first 3 months, outpatients in Group 1 had a threefold higher hazard of stable RTW than inpatients (HR = 3.61, p = .03). Between 3 and 10 months, the pattern reversed, favoring inpatients (outpatient HR = 0.68, p = .01). After 10 months, outpatients again had higher RTW hazards, significant only in Group 1. In Group 2, no outpatients achieved RTW during the first 3 months; furthermore, between 3 and 10 months, inpatients had a significantly higher RTW hazard (outpatient HR = 0.38, p = .02). Median months worked over 24 months was 18.1 for outpatients vs. 12.8 for inpatients in Group 1 (p = .08), and 0.6 vs. 5.3 in Group 2 (p = .04). Conclusion Pre-intervention sick-leave duration strongly influences RTW. Program effectiveness is time- and subgroup dependent. Patients with remaining work attachment (partial benefits) may benefit more from outpatient care, while those on full-time benefits for moderate durations benefit more from intensive inpatient programs, suggesting a need for stratified allocation.

Décembre 2025

Purpose Work disability evaluation plays a central role in medical certification in sickness benefit schemes. This guides effective decision making for return-to-work timelines. Countries that incorporate it have varied approaches. To improve fairness and consistency, Sweden adopted disease-specific guidelines, particularly for complex health conditions such as mental disorders, cancer, and neurological diseases, whereas in the United Kingdom, a fit note system highlights the ease of fitness-for-work assessments in clinical settings. For a successful implementation of the sickness benefit scheme in Korea, it is essential to review international acumen in work disability evaluation and medical certification. This study also examines challenges that physicians face in certification, factors influencing assessments, and the usefulness of disease-specific guidelines. Results In many countries, administrative burdens, uncertainty in diagnosis, and ethical conflicts complicate physicians' tasks. Countries such as Sweden, France, and Ireland, have addressed these issues by developing structured certification tools and support systems. Learnings from the recent Korean pilot programs, this review identifies the following core priorities: developing disease-specific guidelines, providing clinical support for physicians' decisions, and integrating occupational health expertise. These guidelines should function not only as administrative checklists, but also as potential clinical tools that consider both patient functionality and job characteristics. Conclusion Finally, this study offers policy and practical insights to help design a consistent and fair medical certification system for Korea's sickness benefit program that encourages timely medical intervention, prevents presenteeism, and promotes sustainable workforce reintegration.

Purpose The purpose of the study was to test the effects of a nudge on patients return-to-work (RTW) and benefits in a clinical service aimed to promote RTW and prevent sickness absence in patients referred for musculoskeletal disorders or mental illness. Methods The study was a multicentre, single-blinded, parallel two-arm randomised controlled trial design. The setting was five outpatient clinics in Northern Norway, offering a work-focussed treatment to patients referred for common mental- and/or musculoskeletal disorders. Patients were randomised to receive either a questionnaire mapping health factors only, or a questionnaire mapping also Motivation for work, Barriers for return-to-work and Work environment (MBW). Clinicians were also nudged by receiving patient reports based on the patient survey. Data on sickness absence and benefits was retrieved from national registries after one year of follow-up. Results Among 1171 patients consenting to participate in the study, 1091 were eligible for inclusion in the main analyses. The intervention group (n = 558) did not differ significantly from the control group (n = 533) with respect to key variables at baseline. The nudge had no effect on days of sickness absence, return to work rates, or disability benefits during follow-up. Conclusion This attempt to nudge patients and clinicians on MBW factors did not influence RTW or benefits during one year of follow-up. Although MBW factors were prevalent at baseline, the results suggest that increasing work focus in a setting where clinicians already address these factors to some extent has little effect.

Purpose Return-to-work (RTW) support has become a growing priority in occupational health. Manual workers-who constitute over half of the global labor force-may face greater RTW barriers due to the physically demanding nature of their jobs. However, few studies have quantitatively compared the perceived RTW barriers between manual and non-manual workers. This study aimed to compare perceived RTW barriers between manual and non-manual workers with chronic conditions to inform the development of tailored support strategies. Methods We analyzed 219 employed adults, either actively working or on certified leave, who attended X Hospital consultations between September 2019 and June 2020 to obtain support for balancing work and medical treatment. Perceived RTW barriers were assessed with a validated 10-category yes/no structured checklist (personal: work ability/psychological/health literacy; workplace: structure/system/support; inter-sectoral/social). Logistic regression was performed to compare barriers between manual and non-manual workers. Results Manual workers were significantly more likely to report barriers related to psychological impacts (OR = 2.34) and workplace systems (OR = 2.88). Although work ability did not differ significantly by job type, it was the most frequently reported RTW barrier in both groups. Conclusion Manual workers' RTW challenges are characterized by psychological and organizational barriers. RTW programs should assess psychological readiness before resumption of duties and provide managerial training to address anxiety and loss of confidence, while implementing job-specific accommodations such as phased tasks, ergonomic adjustments, and light duties in coordination with healthcare providers.

Purpose The aim of this systematic review was to summarize the qualitative evidence on factors of effective counseling aiming at work participation for people with chronic diseases and/or disabilities. Methods We conducted a systematic literature search in MEDLINE (PubMed), CINAHL, Web of Science, PsycINFO, and PubPsych in March 2023. Our inclusion criteria stipulated that counseling should be specifically designed for individuals experiencing constraints in work participation and published in German or English between 2013 and 2023. To assess the quality of the included studies, we used the checklist of the Critical Appraisal Skills Programme. We synthesized our findings according to the meta-ethnographic methodology by Noblit and Hare. Results Of the 2901 papers found in the systematic search, we included 16 qualitative studies in our meta-synthesis. Studies were conducted in Australia, the USA, Canada, Nordic countries, and Germany. Our "model of the effectiveness of counseling for work participation" consists of four levels. At the extended organizational level, potential factors include the provision of sufficient time and work resources for counselors or contact persons. At the team and stakeholder level, structural collaboration, for example, is crucial. In the counseling dyad, counselors can employ shared decision-making and at the individual level, personal character traits and the client's motivation are exemplary factors. Conclusion This study provides a comprehensive overview of factors contributing to effective counseling in the context of work participation. The delineation across various levels underscores that effectiveness in counseling is a collective outcome, involving not only the advisor but also other stakeholders.

Novembre 2025

Purpose The aim of this systematic review was to summarize the qualitative evidence on factors of effective counseling aiming at work participation for people with chronic diseases and/or disabilities. Methods We conducted a systematic literature search in MEDLINE (PubMed), CINAHL, Web of Science, PsycINFO, and PubPsych in March 2023. Our inclusion criteria stipulated that counseling should be specifically designed for individuals experiencing constraints in work participation and published in German or English between 2013 and 2023. To assess the quality of the included studies, we used the checklist of the Critical Appraisal Skills Programme. We synthesized our findings according to the meta-ethnographic methodology by Noblit and Hare. Results Of the 2901 papers found in the systematic search, we included 16 qualitative studies in our meta-synthesis. Studies were conducted in Australia, the USA, Canada, Nordic countries, and Germany. Our "model of the effectiveness of counseling for work participation" consists of four levels. At the extended organizational level, potential factors include the provision of sufficient time and work resources for counselors or contact persons. At the team and stakeholder level, structural collaboration, for example, is crucial. In the counseling dyad, counselors can employ shared decision-making and at the individual level, personal character traits and the client's motivation are exemplary factors. Conclusion This study provides a comprehensive overview of factors contributing to effective counseling in the context of work participation. The delineation across various levels underscores that effectiveness in counseling is a collective outcome, involving not only the advisor but also other stakeholders.

Purpose This paper studies the impact of stronger employer responsibilities for facilitating work resumption of sick or disabled workers on employers' workplace accommodation efforts during sick leave. Methods & Results We exploit a reform in the Netherlands that altered experience rating-that is, shifting the costs of sick leave and disability insurance to the firm-both for permanent and non-permanent employees. Using unique Dutch survey data on workplace accommodation of long-term sick-listed workers, we show that experience rating has no significant impact on accommodation efforts. Moreover, we provide evidence that the reform led to more firms opting for self-arranging both the sick leave benefits and the reintegration process of sick non-permanent workers, instead of using the public insurance scheme.

Purpose This scoping review study aimed to provide a comprehensive overview of the literature on collaboration between sickness benefit offices and general practice in return to work (RTW) processes, to map existing research, and to identify facilitators and barriers to successful collaboration. Methods This review adhered to established scoping review methodologies. A systematic search of peer-reviewed literature was conducted across six databases. Two researchers independently performed screening and data extraction. Facilitators and barriers were thematically analysed, and tentative findings were discussed with a reference group. Results The search yielded 8477 unique studies, of which 22 met the inclusion criteria. The findings revealed persistent challenges over the past two decades. Most studies used qualitative methods, and the majority were conducted in a Scandinavian context. Written communication was the predominant collaborative activity reported in the studies. Barriers were more frequently identified than facilitators. Commonly reported barriers to successful collaboration included stereotyping, differing priorities, and an over-reliance on written communication. Facilitators included face-to-face meetings and high-quality written communication. Although facilitators have not been extensively studied, our findings emphasize the interconnection between barriers and facilitators, indicating that facilitators can provide strategies to address these barriers. Furthermore, we observed a lack of consensus in the literature regarding key concepts, such as 'collaboration'. Conclusion Based on the findings, we recommend that future research focus on achieving conceptual clarity and examining the underlying conditions that influence the potential for collaboration between general practice and sickness benefits offices in RTW processes.

Purpose To evaluate the effect of the LEARN-to-COPE intervention on sick leave, symptoms, and coping. Methods Design and setting: Cluster-randomized controlled trial including 40 primary care centers (PCCs) in Region Vastra Gotaland, Sweden. Randomization at the PCC level. Effect of the intervention was compared to Care-as-Usual (CAU). Follow-up was conducted using registry sick leave data, validated questionnaires, and patient-reported data. Subjects: Primary healthcare patients with recurrent or long-term sick leave or health-related unemployment from included PCCs (n = 243). Intervention: Patient education was conducted via interactive study groups, which convened for half a day every week over eight consecutive weeks. Implementation was centralized in close collaboration with educational associations. The purpose of the intervention was to strengthen participants' sense of coherence and health literacy, with the aim of enhancing their work ability and health. Main outcome measures: The primary outcome measure was change in scheduled activity, derived from data on sick leave (obtained from the Swedish Social Insurance Agency) and participation in work-oriented rehabilitation (self-reported occupational status). Secondary outcomes (symptoms and coping) were measured with validated questionnaires at baseline and follow-ups after 3, 6, and 12 months. Results Included participants suffered from anxiety, depression, exhaustion, and pain and had poor health-related quality of life. After 12 months, there was no significant change in scheduled activity, sense of coherence, symptoms, or health-related quality of life, but a statistically significant positive change in health literacy and self-efficacy was found in the intervention group. Conclusion Considering participants' pronounced burden of symptoms, the focus should be on improving the sick leave process as a whole, rather than seeking quick remedies for patients' complex health issues. Centralized implementation of the intervention was a promising concept that deserves further evaluation.

Purpose Self-Determination Theory (SDT) posits that satisfying the needs for autonomy, competence, and relatedness enhances motivation, which may influence return to work (RTW) outcomes. However, its specific impact on RTW remains unclear, warranting further investigation. Methods Following PRISMA-ScR guidelines, we searched PubMed, Web of Science, Embase, Scopus, CINAHL and PsycINFO up to September 2025 for studies examining SDT constructs in RTW contexts. Results Eleven studies met with inclusion, covering diverse work disability populations. Evidence suggests that greater SDT need satisfaction is associated with higher quality motivation and more sustained RTW engagement, potentially reducing RTW duration and improving employment stability. SDT-informed interventions appear to promote need satisfaction and motivational internalization, with Motivational Interviewing and SDT-aligned tele-rehabilitation or organizational supports identified as common effective components. Conclusion Our findings support SDT as a coherent framework for understanding RTW dynamics and imply that SDT-guided interventions may enhance vocational rehabilitation outcomes across populations. Future multidisciplinary work should develop explicit SDT-based theories, standardized measures, and integrated intervention pathways to optimize RTW trajectories and long-term employment outcomes.

Octobre 2025

Purpose The Norwegian Labour and Welfare Administration (NAV) strives to include as many people as possible in employment. Motivational Interviewing (MI) is suggested to be a suitable method to achieve this goal. Training in MI is already widespread within NAV, despite the lack of solid research evidence about its effects on employment, wherefore NAV commissioned this systematic review. Results We found scarce evidence for the effects of MI as a method to facilitate return to work: only five controlled studies (range 29 to 500 participants) met our inclusion criteria. All studies targeted people with severe and longlasting conditions (i.e. people with severe mental disorders, disability pensioners, HIV-positive people, and drug-related offenders). MI was in all studies combined with one or more other interventions, and compared either with the same other intervention, another intervention or no intervention. Due to differences across studies we decided against pooling of the results. Median follow up was 12 months. Results from three of the five studies suggest that using MI to facilitate return to work may lead to more people achieving open employment (low to very low certainty of evidence). The other two studies did not report results for open employment separately. Interpretation of other results was difficult as the study populations constituted a mix of employed and unemployed people. Only one study reported on work-hindering behavioural factors (e.g. expectancy to return to work). We could not determine the effect of MI on such factors. Conclusion Despite the scarce evidence, the results of this systematic review suggest that MI may be an effective method to facilitate return to work. Further investigation, including populations with less severe conditions, is required to verify this potential.

© Flodgren GM; Berg RC. Knowledge Centre for the Health Services at The Norwegian Institute of Public Health (NIPH). NIPH Systematic Reviews, Report from the Norwegian Institute of Public Health No. 2017-05. 2017 09 05.

Purpose Persistent pain is a major cause of work disability and early retirement, posing considerable challenges to welfare systems. The process of returning to work is complex and multifaceted, often becoming more difficult as the duration of absence increases. Most research on facilitators and obstacles for returning to work has focused on individuals on sick leave; less is known about those who are unemployed and receiving benefit payments. The aim in this study was to explore the obstacles and facilitators faced by participants with persistent pain, who are attempting to return to work while receiving benefit payments. Methods In this descriptive qualitative study, we used purposive sampling from a cohort study on the impact of being unemployed due to persistent pain. Semi-structured interviews were conducted using a topic guide, audio-recorded, transcribed verbatim and analysed using the Framework method. Results We interviewed 29 participants, of whom 12 had partly or fully returned to work, while 17 had not. Themes emerged around participants' experiences of obstacles and facilitators: (1) Norwegian Labour and Welfare Administration, (2) healthcare, (3) psychological, (4) pain, and (5) perceptions of work. For facilitators, additional themes of 'luck' and 'disability pension' emerged. Conclusion While struggling with pain and coexisting health issues, participants experienced overwhelming system and contextual obstacles. Key facilitators included fortuitous encounters with supportive welfare system staff and personal attributes such as psychological flexibility and determination. Our findings highlight areas of the welfare system that could be improved to provide more empathetic and person-centred pathways for people with persistent pain wanting to return to work.

Purpose A trusting relationship between employee and manager is crucial for constructive dialogue regarding work ability. However, employees may sometimes experience collaboration as unpleasant if the dialogue with their manager is not constructive. The aim of the study was to explore how employees on sick leave experience manager involvement in the RTW through a three-party meeting using the Demand and Ability Protocol (DAP) in primary healthcare. Methods Data included 20 semi-structured individual interviews with employees diagnosed with common mental disorders or musculoskeletal disorders who had participated in a DAP dialogue. Thematic analysis was used to analyse the data. Results Employees wanted to reach out to their manager but had challenges getting the message through about their reduced work ability. During sick leave, the structured DAP held within primary healthcare was experienced as a helpful measure to foster collaboration with the manager. The dialogue helped explore the balance between workplace demands and the employee's capabilities. This enabled both parties to share their view and the rehabilitation coordinator could guide towards potential adaptations. Employees found that the increased mutual understanding fostered by the DAP helped pave the way for ongoing collaboration in the RTW process. Conclusions The results underscore the importance of facilitating collaboration between employees and managers before, during, and after sick leave. The DAP can support the development of a trust-based relationship that enables all involved stakeholders to articulate needs, propose measures, and make informed decisions that enhance efforts throughout the RTW process.

Purpose German social law provides a broad range of services aimed at maintaining work ability, facilitating return-to-work, and preventing permanent work disability; however, individuals with health impairments often lack information about available options and access, leading to underutilization of these services. This study (trial registration: DRKS00024648) evaluates the implementation of a multicomponent strategy designed to improve access to rehabilitation services and promote sustained work participation among individuals at elevated risk of permanent work disability. Methods The intervention consisted of screening, postal contact, telephone counseling, initial interview, and case management. High-risk individuals were identified through a risk score based on administrative data (>=60 points indicating an increased 5-year probability of disability pension) and were invited by postal mail to call their regional case manager if support was required. Within the process evaluation, we assessed reach, dose delivered, fidelity, dose received, and participant satisfaction using case manager documentation and participant surveys at baseline and follow-up. Results Of 5300 individuals contacted, 277 engaged in case management. At baseline, participants reported an average of 20 weeks of sickness absence, multiple health conditions, and 63.7% rated their work ability as poor. Implementation fidelity exceeded 80%, and satisfaction with the intervention was high. Following case management, knowledge of rehabilitation services increased significantly ( P < 0.001), and 55.6% applied for rehabilitation. Conclusions The findings demonstrate that the intervention successfully reached its target population with high fidelity and participant satisfaction. Observed improvements in knowledge and increased utilization of rehabilitation services suggest the intervention's potential to enhance access for those in need.

Purpose This review aimed to identify factors that acted as facilitators or barriers for returning to work (RTW) for people with chronic conditions following medical or vocational rehabilitation during the COVID-19 pandemic. Methods A scoping review was conducted on PubMed, Web of Science, EBSCOHost and Epistemonikos. Additional articles were identified via Google Scholar and citation tracking. All retrieved reports were screened, narratively reported and consolidated into a model aligned with the International Classification of Functioning, Disability and Health (ICF). This model illustrates how the COVID-19 pandemic may have influenced RTW for people with chronic health conditions. Results The search yielded n = 1,720 hits. After removing duplicates (n = 807) and screening for eligibility, n = 57 articles met the inclusion criteria. Further articles were identified via Google Scholar (n = 23) and citation tracking (n = 18), resulting in a total number of n = 98 included reports. n = 3 articles explicitly examined RTW during the pandemic. Further articles addressed medical rehabilitation (n = 39), occupational health management (n = 21), work ability and labor market (n = 17), health services (n = 10) and vocational rehabilitation (n = 7). Most reports were published in scientific journals (83%). A variety of possible barriers and facilitators of RTW during the pandemic were identified, clustered according to the ICF components and integrated into a corresponding model. Conclusion RTW during the COVID-19 pandemic has not been extensively studied yet. However, several facilitators (e.g., flexibility, remote work, time for recovery) but also barriers (e.g., therapy interruptions, increased stress, risk of infection) for RTW of people with chronic health conditions were identified. Despite mixed outcomes, these findings provide a broad overview of how the pandemic likely impacted RTW processes. Further research is needed to directly assess its effects on RTW outcomes.

Purpose Staff sickness absence is a significant cause of lost capacity in NHS services. This study evaluated the effectiveness and acceptability of an occupational therapy intervention, designed to support NHS staff to return to work and prevent sickness absence. Methods A multiple methods service evaluation was conducted, with data collected between May 2021 and October 2023. Quantitative data (referrals, employee demographics and work outcomes) were collected from the service's records and analysed using descriptive statistics. Qualitative data were collected from nine NHS staff who used the service via semi-structured interviews and 10 individuals who had made referrals to the service via focus groups. Qualitative data were analysed thematically. Results A total of 506 staff members were referred to the occupational therapy service, of whom 316 (62.5%) were absent from work and 187 (37.0%) were still in work but at risk of sickness absence at the time of referral. Nearly one-third of those referred did not complete the programme. Of those who did complete the intervention, over 90% either returned to work or remained in work. Staff interviews reflected positive views of the timeliness and holistic nature of the intervention, while referrer focus groups highlighted the importance of early intervention and support for managers in cases of staff sickness. Conclusions This evaluation suggests that an intervention focused on supporting NHS staff to return to work can reduce sickness absence, although the attrition rate indicates that a better understanding of staff needs is required to optimise the service. Implications for practice: Expanding early intervention beyond sickness absence can shift cultures to prevention. Empowering managers and employees to initiate support requests is important for engagement in vocational rehabilitation, thereby optimising positive work outcomes. Understanding attrition and non-engagement is key to improving service efficiency.

But Les ergothérapeutes accompagnent les personnes et les organisations vers une participation saine au travail. Dans ce contexte, il importe de considérer la multiplicité des identités, comme le genre, l’origine ethnique ou le handicap, dans l’analyse des inégalités et injustices occupationnelles que rencontrent les personnes au travail. Le concept d’intersectionnalité a le potentiel de soutenir les ergothérapeutes, mais il demeure difficile à reconnaitre dans la pratique. L’étude avait pour but d’identifier les caractéristiques opérationnelles du concept d’intersectionnalité au travail. Méthodes Selon un devis d’examen de la portée, 29 documents issus de disciplines variées ont été sélectionnés. Les données ont été extraites à l’aide d’une grillestructurée et analysées selon une approche thématique. Résultats Les résultats ont permis d’identifier cinq caractéristiques opérationnelles du concept, soit l’interrelation des identités, l’interaction entre désavantages et privilèges, les dynamiques de pouvoir, l’expérience subjective idiosyncratique ainsi que la relation à soi et aux autres. Nos résultats révèlent aussi que ces caractéristiques se doivent d’être considérées dans leur contexte, notamment historique. Conclusion Cette étude offre un cadre aux ergothérapeutes pour analyser et intervenir dans des situations complexes, contribuant ainsi à promouvoir une participation au travail équitable et juste.

Septembre 2025

Purpose This study investigates factors associated with receiving return-to-work (RTW) coordination within primary healthcare and the association between received RTW coordination and the amount of sickness absence (SA) days. Methods This register study included 13019 people who had SA at some time between March 2019 and February 2020 and visited a primary healthcare clinic that employed a RTW coordinator. Logistic regressions were used to investigate received RTW coordination. Negative binomial regressions were used to analyse the amount of SA days in the ten-month follow-up period. Results Associations were found between receiving RTW coordination and being a woman, being 30-49 years old, and having higher educational attainment, more healthcare contacts, more SA days, and a musculoskeletal or mental diagnosis. In the following ten-month period, mean SA were 71.3 days among people receiving RTW coordination and 76.1 days for those who had not. However, the adjusted analyses did not show association between RTW coordination in primary healthcare and the amount of SA days in the following ten-month period. Conclusion RTW coordination seems to be directed towards some groups of people with a higher risk of long-term SA, but not all, which raises the question of whether or not more people on SA would have benefited from RTW coordination as well. This would likely mean that more finely calibrated ways of identifying people at risk of long-term SA are needed. The reduction in SA days for those who had received RTW coordination needs to be confirmed in further studies.

Purpose Telework has become increasingly prominent as a flexible work arrangement, particularly since the COVID-19 pandemic. For workers managing health conditions, it may support continued employment by influencing key work-related phenomena such as absenteeism, presenteeism and return to work (RTW) process. However, current evidence on the impact of telework on the work-related outcome to manage health condition in the workplace remains limited and fragmented. This scoping review aimed to map the existing literature on the impact of telework on absenteeism, presenteeism, and RTW outcomes among adult workers with health conditions. Methods Included studies were either qualitative, quantitative, or mixed methods, published in English or French, including adults with any physical or psychological health conditions. At least one outcome domain (absenteeism, presenteeism, or RTW) was required. Eight databases were searched from inception to May 2025: Medline, CINAHL, APA PsycINFO, Academic Search Complete, Business Source Complete, Scopus, Sociological Abstracts, and ABI/INFORM Global. Data extraction focused on study design, objectives, variables/definitions, sample size, health status, demographic characteristics, individual characteristics, organizational factors and results. Data were synthesized by the outcome domain (absenteeism, presenteeism, RTW) and stratified by study type (quantitative vs. qualitative). Results From 4,093 records, 21 studies were included. The majority of studies suggest that telework contributes to reduced absenteeism by increasing work flexibility. Telework is also consistently associated with facilitating RTW, particularly following surgery or in the context of chronic illness, by supporting work reintegration and shortening the duration of sick leave. In contrast, findings on presenteeism are conflicting: some studies report that telework increases the likelihood of working while sick, others suggest a decrease, and some report no significant impact or conflicting results. These outcomes appear to be influenced by contextual factors, including health status, demographic variables, individual characteristics, and organizational context. Conclusion Telework appears to offer flexibility that can reduce absenteeism and facilitate RTW. However, its impact on presenteeism is less consistent and may even encourage working while sick if not properly supervised. Future studies should examine which policies most effectively maximize the benefits of telework while minimizing potential drawbacks.

Purpose In Quebec, injured workers are entitled to medical assistance, wage replacement, and rehabilitation. While many cases are resolved smoothly, ethnographic research reveals that immigrant workers may face disruptions that foster mistrust and hinder recovery. This study examines how mistrust shapes the rehabilitation experiences of immigrant workers and identifies its root causes and impacts. Methods & Results Based on ethnographic observations at a Montreal rehabilitation clinic and 21 in-depth interviews with injured immigrants workers conducted between 2020 and 2024, the research highlights how mistrust emerges from experiences of racism, discrimination, perceived betrayal, employer practices, conflicting medical opinions, and fraudulent behaviors. These factors, often intersecting across institutional systems, contribute to a cumulative burden that impedes recovery and well-being. Conclusion The findings underscore the need for systemic changes to build trust and improve rehabilitation outcomes for immigrant workers.

Purpose Physiotherapists play a central role in the rehabilitation of individuals with work-related musculoskeletal disorders. Yet, it is currently unclear how entry-level training prepares them to manage work disability. This study aimed to (1) identify a set of work rehabilitation competencies, (2) examine how these competencies are integrated into entry-level physiotherapy training programs in Quebec, Canada, and (3) assess educators' perceptions of the adequacy of work rehabilitation education. Methods A five-step consensus-building process with engaged partners and a literature review served to identify the competencies. Subsequently, educators from all Quebec physiotherapy programs completed a cross-sectional survey containing closed- and open-ended questions. The survey documented the integration of general and competency-specific work rehabilitation content and educators' ratings of students' preparedness for entry-to-practice for each competency. Quantitative data were analyzed descriptively, and open-text responses were analyzed using qualitative metasummary. Results Seven work rehabilitation competencies were identified and used to structure the survey. The median time dedicated to work rehabilitation education was 5.5 h (range 1-21.5). Programs partially integrated the competencies, using mostly didactic learning strategies. Coverage of key topics for each competency and relevance to work rehabilitation varied considerably across programs. Educators reported low student preparedness for competencies requiring work-focused knowledge and skills and varying comfort with teaching this content. Conclusion This study highlights critical gaps in physiotherapy education related to work rehabilitation and provides a benchmark for how key competencies are addressed in Quebec programs. These findings offer a foundation for improving work rehabilitation training for physiotherapists.

Purpose Trust is key to a successful return to work following a work disability. Its constituents, which have been widely documented in social and management sciences research, are not addressed in return to work (RTW) research. This study therefore aims to portray the constituents of trust that have been documented in the context of RTW following an absence due to musculoskeletal disorder or a common mental disorder. Method A scoping review was performed using Joanna Briggs Institute methodology and the PRISMA extension for scoping review guidelines. Studies were extracted from six databases using keywords like trust, RTW/disability, and musculoskeletal/common mental disorders. Study selection and analysis were conducted in Covidence by two reviewers independently. An Excel framework served to record the constituents of trust (i.e., antecedents, attributes, and consequences) identified in accordance with a thematic analysis approach. Results From the 2795 references extracted, 30 studies were selected, 73% of which were published in the Last 10 years. All three constituents were documented, mainly in the dyadic relationship between the worker returning to work and other stakeholders. Yet, some known antecedents of trust remain underexplored and new consequences emerge. Support also appears to be both an antecedent and a consequence, which encourages reflection on the possibility of trust reciprocity. Conclusion While the constituents of trust involved in RTW were documented, they should be tested empirically, and some constituents and relationships need further exploration. Recommendations to improve trust between stakeholders are proposed.

Purpose General practitioners (GPs) need tools and working methods to deal with sick listed patients' multifaceted needs as well as to collaborate with stakeholders such as the employer or the social welfare counsellor. This study explored GPs' experiences when testing the mapping and dialogue tool ISIVET in sick leave follow-up. Methods Individual interviews with seven GPs in salaried positions testing ISIVET in sick leave follow-up in a Norwegian municipality. Data were transcribed verbatim and analysed using systematic text condensation. Results Five categories of experiences were identified: 1) positive perceptions of ISIVET in terms of visualizing the complexity of health and work conditions, 2) procedures and collection of research data made it difficult to test the tool, 3) unclear ownership and anchoring, 4) difficulties with experimentation in demanding working days and 5) close follow-up during training followed by a lack of sharing experiences. Conclusions Despite positive GP perceptions of ISIVET in sick leave follow-up, the testing 'failed' due to difficulties during the testing overshadowing the benefits. This was primarily due to poor technological and practical adaptions of the use of the tool in a busy GP's working day. Secondly, a weak local anchoring with lack of follow-up and sharing of experiences, influenced the use of ISIVET negatively. If further testing of ISIVET in primary care is carried out, it would be necessary to simplify and adapt the use of the tool extensively. Given the positive perceptions of ISIVET, one could consider new adaptions and further testing according to these experiences.

Juillet-août 2025

Purpose To understand immigrant workers' experiences when navigating the workers' compensation system for access to benefits following a work injury or illness. Methods Interviews were conducted with 17 injured immigrant workers recruited in British Columbia through partnerships with settlement organizations, social media and professional networks. A situational analysis approach was used to analyze interview data and to identify contextual reasons for immigrant workers' experience with the workers' compensation system. Results The findings describe a tension between how the workers' compensation system is intended to work and how injured immigrant workers experienced the system. Workers described challenges with accessing and communicating with their case managers for timely access to benefits, work accommodation that did not align with their needs and disrupted their rehabilitation, and complicated claim trajectories stemming from perceptions of procedural unfairness. Immigrant workers described how these experiences were perpetuated by their different contexts including language barriers, unfamiliarity with the workers' compensation system, and their identity as immigrant workers. Conclusion This study identifies contextual factors for the experiences of immigrant workers, within the Canadian context, for consideration by workers' compensation system in the management of injury and illness to reduce inequities where they may exist.

Purpose Organizations are increasingly integrating a diverse workforce, bringing both opportunities and challenges. To harness the benefits of diversity while addressing its complexities, the adoption of diversity, equity, and inclusion (DEI) principles is essential. These principles are particularly important in ensuring optimal accommodation for people returning to work after a period of disability, to take account of their multifaceted realities. Managers are pivotal in implementing and overseeing these initiatives, yet their specific roles and the required competencies remain underexplored. This study aimed to provide a comprehensive overview of the competencies managers need to effectively uphold DEI principles. Methods We conducted a scoping review to collect and analyze information from 21 manuscripts, following a systematic five-step process. Results The analysis identified seven core competencies and 28 sub-competencies that managers must exhibit to promote DEI in organizations. The seven competencies include the following: (1) communicating effectively with individuals; (2) managing DEI-related conflicts with diligence; (3) identifying and improving personal challenges related to DEI; (4) demonstrating transparency toward individuals; (5) acting as a role model to promote DEI at all levels; (6) facilitating the full potential of individuals; and (7) creating a team dynamic that fosters a sense of belonging for all individuals. Conclusion This study underscores the critical role managers play in fostering inclusive environments, not only by promoting diversity but also by implementing fair workplace accommodations that facilitate the return to work of employees following a period of disability. This framework provides a foundation for future research on managerial practices in DEI.

© Lecours A; Laliberte M; Drolet AA; Bellehumeur-Bechamp L; Bedard-Mercier R; Drolet MJ; Turcotte S; Gauthier-Boudreault C; Vincent C; Lord MM; Kiss J; Feillou I. Journal of Occupational Rehabilitation. 2025 Jul 23.

Purpose Identify the job accommodations associated with increased job retention and satisfaction for people with physical disabilities. Methods A national survey of 1265 people with physical disabilities in the United States, who worked for an employer after their disability onset. The sample was 58% males, average age of 44 years, 74% white, and worked an average of 36 h weekly. We assessed frequency, type, and use of job accommodations and used multivariate Poisson regression to evaluate the relationship between job accommodations, job tenure, and satisfaction. Results The top job accommodations were modified work schedules, modified policies/rules, job sharing, allowing sitting/standing changes, and unpaid leave. The job accommodations needed but not received were limiting lifting, pushing, pulling; co-worker assistance; limiting twisting, bending; using modified/new equipment; and telework. Males reported higher frequency of accommodation use than females, while females reported not needing accommodations more often. Among respondents who used an accommodation, 82% rated it as moderately or very helpful. Most respondents (79%) reported that they were satisfied or very satisfied with their jobs. Poisson regression models revealed an association between using a job accommodation and job tenure for 4 years or longer for all job accommodation categories, with an increased likelihood of job tenure beyond 4 years by 10–70%. Four of 12 job accommodation categories were associated with job satisfaction. Conclusions Use of employer- and self-provided job accommodations is associated with longer job tenure and increased job satisfaction. Each person, job, and environmental factor provides opportunities to tailor accommodations.

This guide provides tips and templates to help employers put a seamless process in place for handling workplace injuries and helping employees get back to work safely.

Purpose Approximately, 80% of sick leave involve workers dealing with a common mental disorder (CMD) or a musculoskeletal disorder (MSD). Upon returning to work (RTW), these workers may encounter challenges, including functional limitations at work. However, assessing these limitations is complex. This study aims to map existing questionnaires that evaluate functional limitations in individuals with CMD or MSD. Methods A scoping review was conducted following the methods of the Joanna Briggs Institute's (JBI) Scoping Reviews Methodology Group, utilizing five databases: ProQuest, EBSCO, Scopus, Cochrane, and PsycNET. Articles were included if they presented a questionnaire evaluating functional limitations or related concepts in individuals with CMD or MSD. Results A total of 541 articles were identified, with 6 articles selected after the screening process. The most frequently assessed dimensions in the selected questionnaires were physical (in 5 tools) and cognitive (in 3 tools). A thematic analysis was performed to develop a unified classification of dimensions and identify various types of functional limitations, addressing the inconsistent terminology across the questionnaires. Conclusion Physical limitations seem to be more objective and easier to assess than psychological limitations. Future research should focus on psychological limitations to enhance understanding among healthcare professionals and individuals with CMD or MSD.

Purpose Well-designed vocational rehabilitation programs (VRPs) are needed to ensure that people with acquired physical disabilities (PAPD) receive the optimal support to return to work. The aim of our scoping review was to summarize the literature on both international and local VRPs that support PAPD to return to work. Methods We conducted a scoping review based on Arksey and O'Malley's framework. We searched databases (PubMed, CINAHL, and PsycINFO) throughout March 2023. To be included, studies must have been published in a peer-reviewed scientific journal, be available in the English language, and describe a VRP for PAPD. We added a grey literature search to better understand local VRPs. We summarized the VRPs' characteristics and services narratively. Results We screened 2894 citations and included 20 in our review. These 20 articles discussed 16 VRPs. We identified 46 unique service components and categorized them into six domains - vocational, physical, financial, social, psychological, and others. The vocational domain comprised the majority of components identified (n = 18, 40%). However, no VRPs were exactly alike. Conclusion VRPs facilitate PAPD to return to work via a range of services. Our review is useful for vocational rehabilitation providers to enhance existing VRPs or to design new ones. We recommend that VRPs offer a set of standardized services with the option of expanding services based on emerging needs of service users. Our scoping review provides a valuable evidence synthesis of the services offered within the field of vocational rehabilitation. Future research to better understand the effectiveness of VRPs is warranted.

Juin 2025

Purpose Over 2.6 million people in the UK are absent from work due to ill-health, yet, for many, accessing work-orientated vocational support to facilitate return-to-work (RTW) is challenging. The majority of fit notes are issued in primary care, making this an ideal setting to provide vocational support. As part of the Work And Vocational advicE (WAVE) randomised controlled trial (RCT; registry number NCT04543097), we explored the delivery of vocational support by trained Vocational Support Workers (VSWs), from the perspectives of patients, VSWs, employers and general practitioners. Methods In the WAVE RCT, patients from 10 UK general practices were randomised to the offer of usual care or usual care plus vocational support. This qualitative study explored stakeholder perspectives of the vocational support intervention. Semi-structured interviews with participants in the intervention arm (n=10), employers, VSWs and GPs (n=5). Interviews were audio-recorded, transcribed and analysed using thematic analysis. Public and Patient Involvement was embedded throughout. Results Taking a person-centred, individualised approach to vocational support enabled VSWs to identify and mitigate RTW obstacles and support participants' self-efficacy to proactively negotiate RTW. The perceived independence of the VSWs from employers and healthcare was considered important and facilitated more open discussions about capabilities and RTW planning. Conclusion Findings indicate that individualised and independent vocational support offered to patients referred from primary care was perceived by all stakeholders to be valuable to patients absent from work due to illness and supported their RTW planning. These insights can inform future models of vocational support.

Purpose Consensus on priorities to optimize the sick leave and rehabilitation process (SRP) is lacking. Objective: To explore perspectives of stakeholders in the SRP on bridging the gap between desired process scope, and actual practice, from a multi-professional, multi-organizational, and interdisciplinary approach. Methods Design and setting: Focus group interviews were conducted with various SRP frontline professionals in Region Västra Götaland, Sweden, using purposive sampling to capture a range of experiences. Participants discussed their perceptions of critical changes and priorities needed to meet patients' SRP needs in a primary care context. All interviews were analyzed using systematic text condensation, as described by Malterud. Subjects: General practitioners (n = 6), rehabilitation coordinators and licensed healthcare professionals from primary healthcare (n = 13), administrators from the Social Insurance Agency, the Employment Agency and Social Services (n = 12). Results Through data analysis, the following themes emerged: 1) The need for rules and regulations to enable coherent process governance 2) Challenges and opportunities in person-centered SRP: Professional collaboration, organizational priorities, and the need for enhanced leadership, and 3) Balancing resources and patient needs in the SRP: How to improve care quality and accessibility. In summary, participants mainly discussed how to improve process efficiency and quality of care while balancing available resources and a heavy workload. A main goal was to prevent negative spirals of suboptimal decision-making in individual cases, which could lead to increased work, unfortunate outcomes, and patient suffering. Conclusions This qualitative study indicated that gaps between a desired process scope and actual practice might be bridged by enabling coherent cross-organizational process governance, prioritizing person-centered ways of working, and balancing available resources and workload. The above changes were believed to improve process quality and overall efficiency.

Mai 2025

Purpose In Quebec, injured workers have access to medical assistance, wage replacement indemnities, and rehabilitation measures, with most injuries resolved easily. However, a small percentage of cases require a lengthy rehabilitation process, which is particularly complex when involving immigrants. The therapeutic alliance is at the heart of the process, involving mutual trust and confidence and a degree of consensus about the therapeutic interventions to be used and, ultimately, the return to work. This article delves into the concept of mistrust as more than the absence of trust, and sheds light on its role in the rehabilitation process of immigrant workers. Method Drawing from a literature review on mistrust of immigrants in the healthcare setting and comprehensive studies on the rehabilitation process, a conceptual framework for understanding mistrust in this context is proposed. Results Vulnerable situations, such as precarious employment and/or temporary immigration status, create fertile ground for mistrust. Negative experiences with healthcare professionals or systems further exacerbate mistrust, as do social stigmas within the rehabilitation system. Cross-cultural miscommunications such as differences in communication styles or beliefs about illnesses further complicate matters, emphasizing the need for culturally sensitive approaches. Conclusion Addressing mistrust requires understanding its origins and consequences, as well as providing guidelines for practitioners to enable them to recognize and manage it effectively. Further research is crucial to deepen our understanding of mistrust among immigrant workers and develop strategies for promoting trust and cooperation throughout the rehabilitation process.

Purpose Because employees with low educational levels have the highest rates of sick leave, this study aimed to identify the self-perceived return-to-work barriers of employees with low educational levels on long-term sick leave. Methods Employees on long-term sick leave with primary/secondary educational attainment were included from the NOW WHAT large-scale interview study (n = 122). The World Health Organization's system of classifying functioning, disability, and health guided the deductive content analysis. Results 1,942 meaning units describing return-to-work barriers across all classifications were identified. The most frequent components were body functions (n = 552, 28%, mean = 4.5), with mental functions (e.g., sleep, tiredness, emotional and cognitive functioning) the most frequent barriers; environmental factors (n = 414, 21%, mean = 3.4), with services, systems ,and policies (e.g., social security, healthcare system) the most prevalent barriers; activity limitations (n = 352, 18%, mean = 2.9); and personal factors (n = 323, 17%, mean = 2.6). Conclusion Employees with low educational levels on long-term sick leave described a wide range of return-to-work barriers and combinations thereof. In addition to health-related functional barriers, identifying environmental, activity-limitation, and personal barriers is important to enhance understanding of this group's potential determinants of absence from work.

Purpose It is well known that effective return to work (RTW) services following the onset of adventitious disability require the collective involvement of vocational case managers, employers, healthcare providers, and workers themselves. Method We describe RETAIN Kentucky's approach to engaging healthcare providers as key motivators and facilitators of their patients' RTW efforts. Results A cursive review of best practices in integrated disability management is followed by a description of RETAIN Kentucky's broad-based efforts to engage healthcare professionals in all aspects of the RTW process. Ninety-two percent of RETAIN Kentucky participants who complete their RTW plans are employed when they exit the interdisciplinary project. Conclusions Implications for collaborating with healthcare systems and providers are presented.

Purpose The use of rehabilitation interventions is critical in addressing health and economic outcomes, including return to work (RTW) facilitation for individuals with disabilities. However, the economic evaluation of these interventions has been found to lack consistency, with limited adherence to reporting standards and little focus on integrated approaches. This scoping review will map the existing evidence on the economic evaluations of rehabilitation interventions and their implications for return to work (RTW) programs. Methods A systematic search of databases, such as PubMed, Scopus, and Web of Science, to identify studies that provided full economic evaluations of rehabilitation interventions related to RTW. Using the PRISMA-ScR framework, 11 studies were ultimately included. Data extraction included the model type, cost-effectiveness models, adherence to CHEERS reporting guidelines, and implications for RTW. Results The majority of studies examined medical or psychological interventions, with little representation of vocational or integrated approaches. ICERs differed greatly between studies based on methodologies and healthcare settings. The reporting of heterogeneity, uncertainty analysis, and societal perspectives were some of the gaps identified from adherence to CHEERS guidelines. Conclusions Economic evaluations show that rehabilitation interventions can be cost-effective for improving RTW outcomes. Future research priorities include interdisciplinary approaches, standardized methodologies, and studies based on LMICs to address global disparities.

Avril 2025

Purpose Precarious employment rates are rising, which challenges the effectiveness of current workers' compensation systems. Precariously employed workers encounter problems related to short-term and/or temporary employment, and complicated employment relationships. Few voices are captured in the literature from precariously employed workers and employers of these workers regarding day-to-day experience of workers' compensation policies. This article describes employers' and precariously employed workers' suggested changes and improvements to a workers' compensation system and other processes related to work injury and return-to-work. Methods Semi-structured interviews were conducted in Ontario, Canada with 36 precariously employed workers and 15 employers of precariously employed workers who were recruited via social media, email lists, cold calling, word-of-mouth, and the "snowball" method. Thematic code summaries were analyzed to identify suggested workers' compensation system improvements that relate to precarious employment. Results Employers' and precariously employed workers' suggestions fell into the categories of (1) communication, (2) worker health and healthcare, and (3) worker and employer support. Conclusion Identifying precariously employed workers and employers of precariously employed workers' suggestions enables a better understanding of areas of improvement for workers' compensation policy and how these policy changes could affect these interested parties with regards to managing workplace rehabilitation and disability.

Purpose This abbreviated version of the American College of Occupational and Environmental Medicine's (ACOEM) Work Disability Prevention and Management Guideline reviews the available evidence and provides recommendations to clinicians regarding interventions to help patients remain at or return to work. Methods Systematic literature reviews were conducted. Studies were graded and evidence tables were created, with involvement of a multidisciplinary expert panel that evaluated the evidence and finalized recommendations for all clinical questions. Extensive peer review was performed. Consensus recommendations were formulated when evidence was lacking. Results Evidence-based recommendations have been developed to guide work disability prevention and management. Conclusions Clinicians should utilize quality evidence in determining treatment methods to prevent and alleviate work disability for workers. This guideline offers an evidence-based framework for preventing and mitigating work disability for individual adults in the active workforce. It is designed for use by healthcare clinicians who desire to minimize the negative impact of health conditions on working people's lives and livelihoods.

© Kertay L; Caruso GM; Baker NA; Christian JH; Cook JL; Das R; Goertz M; McKenzie JG; Martin DW; Melhorn JM; Mohammad A; Osbahr AJ; Pransky G; Warren PA; Mandel S; Harris JS; Hegmann KT. Journal of Occupational & Environmental Medicine. 67(4):e267-e280, 2025 Apr 01.

Purpose Migrant workers in Canada work in the most dangerous industries, with documented difficulties with occupational health and safety (OHS) and workers' compensation (WC). Little is known, however, about migrant workers' experiences with "return-to-work", the ultimate objective of WC for those who recover from their illness or injury. The objective of this study was to understand migrant workers' "return-to-work" experiences after facing occupational injury/illness for in Quebec, Canada. Methods Part of a broader multi-disciplinary project exploring how Canadian policies can ensure "return-to-work" for injured workers, this article draws on policy analysis and semi-structured interviews with 21 migrant workers in Quebec who experienced workplace illness or injury. Interviews (in Spanish, English, and French) lasted 1-2 h and were transcribed verbatim and thematically coded. Results The first group of workers with occupational injuries never left their job out of fear of consequences. A second group of workers stopped working, with some receiving WC, while others did not. Most workers in this group never returned to work. Among the reasons provided by migrant workers, the data suggest following as the most common: abandoning the job out of fear of re-injury; repatriation and not being called back; and lasting repercussions of the injury leaving them unable to perform the same work. Others returned but experienced a range of problems: working without being fully recovered; constructive dismissal; or quitting because of ongoing risk or exacerbation of health problems. None were able to access retraining programs. Conclusions The structural components of Canada's migrant worker programs create conditions of unfree labor that impede the possibility of true "return-to-work". OHS and WC regimes must implement specific protections for migrant workers to increase their access to protections.

Purpose Health insurance practitioners need to evaluate sick-listed workers, motivate them for return-to-work (RTW), and guide them in doing so. This study evaluates the effectiveness of a 10-h, online and interactive training in "motivational counseling," on practitioners' communication behaviors. The training is based on Motivational Interviewing (MI) and Self-Determination Theory (SDT)'s basic psychological need support for autonomy, relatedness, and competence. Methods We observed and rated video recordings of online patient encounters, simulated by experienced actors enacting fictive scenarios. Two-tailed Wilcoxon signed-rank tests compared pre- and post-training outcomes of 31 practitioners using observational instruments based on MI and SDT. Results After training, the practitioners showed significantly more technical (e.g., using reflections) and relational (i.e., seeking collaboration and taking perspective) MI behaviors. Autonomy- and competence-supportive behaviors increased (e.g., providing rationales or feedback) while autonomy-thwarting behaviors decreased (e.g., using controlling language). Conclusions The training in motivational counseling effectively promoted motivating communication behaviors among health insurance practitioners, in line with SDT and MI. The online format makes the training practically more feasible for RTW stakeholders operating in time-restrained contexts. More research is needed on training transfer and implementation barriers, as on the impact on sick-listed workers' motivational processes and RTW trajectories.

Mars 2025

Purpose The objectives of this study were to determine the effectiveness of clinical healthcare interventions designed for improving the work participation of patients with various health conditions and identify promising elements within these interventions. Methods A systematic literature search was conducted, and a synthesis of systematic reviews (SRs) was performed. MEDLINE, Embase, Cochrane Library and CINAHL were searched for articles published from January 2012 to December 2023. SRs of randomised controlled trials evaluating the effectiveness of interventions that aimed at improving work participation initiated within clinical healthcare in patients being treated for various health conditions were included. Two authors independently used standardised methods to search and select SRs and extract data. Our primary outcome was work participation, which could include return-to-work rate or sick leave duration. We were interested in both short-, medium-, as well as long-term outcomes. Risk of bias was assessed using the AMSTAR-2 tool. We used Grading of Recommendations Assessment, Development, and Evaluation (GRADE) to evaluate the certainty of the evidence and findings were summarised in GRADE evidence profiles. We used a deductive synthesis to identify promising intervention elements. Results The health conditions included in the selected SRs were cancer, chronic low back and musculoskeletal pain, coronary heart disease, inflammatory arthritis, complaints of the lumbopelvic region during pregnancy, stroke and traumatic brain injury. Across health conditions, many interventions trended towards small, favourable effects. Moderately certain evidence showed that multidisciplinary and physical interventions enhance work participation at 12 months for people with cancer (risk ratio (RR) 1.23, 95% CI 1.09 to 1.33 and RR 1.23, 95% CI 1.08 to 1.39, respectively), and that multidisciplinary interventions reduce the days of return to work compared with usual care for people with coronary heart disease (40.77 days lower than control, 95% CI -67.19 to -14.35). Low-certainty evidence suggested that multidisciplinary interventions may enhance work participation at 12 months for people with coronary heart disease (RR 1.56, 95% CI 1.23 to 1.98) and reduce the number of sick leave days at 12 months for people with chronic low back pain (82, IQR 51 to 164 vs 175, IQR 91 to 365; p=0.003). Promising elements included (psycho)education, cognitive-behavioural therapy, psychosocial support, group and vocational counselling and physical training. Conclusions There is considerable overlap in clinical healthcare interventions that aim to enhance work participation for patients across health conditions. Although their effects on work participation vary, some conditions show favourable response to multidisciplinary interventions. More evidence is needed on developing tailored interventions and evaluating their cost-effectiveness.

Purpose The rate of sickness absence in Norway is at its highest point since 2009, and policymakers need tools to make informed decisions on high-value interventions to address sick leave. Using trial-linked registry data, multi-state modeling, and decision-analytic modeling, we assessed the cost-effectiveness of 2 return-to-work (RTW) interventions for individuals with musculoskeletal and psychological disorders in Norway. Methods Using data from 166 individuals in a randomized trial, we developed a decision-analytic model to compare 2 multidomain RTW interventions: outpatient acceptance and commitment therapy (O-ACT) and inpatient multimodal occupational rehabilitation (I-MORE). The probabilistic model was informed using trial-based input parameters, including transition probabilities, healthcare costs, production loss, and health-related quality of life to project long-term costs and quality-adjusted life-years (QALYs) over a 25-year time horizon for each intervention. Results Modeled outcomes were consistent with the trial outcomes, showing that I-MORE led participants to RTW more quickly. However, assuming a healthcare perspective and a cost-effectiveness threshold of $50 000 per QALY, I-MORE was not considered cost-effective in 98% of our simulations (probabilistic incremental cost-effectiveness ratio, $356 447 per QALY gained) compared with O-ACT. In contrast, when accounting for production loss, I-MORE not only became cost-effective but also was projected to be more beneficial and less costly than O-ACT. Conclusions Under current Norwegian benchmarks for cost-effectiveness, I-MORE would not be considered cost-effective unless production loss was included. Our findings emphasize the key role of a broader societal perspective in economic evaluations, which, although it is being considered, is currently not recommended in Norwegian guidelines.

Purpose In this cross-sectional analysis, we explored how return-to-work (RTW) experiences and postinjury pain are associated with opioid use after a workplace injury/illness. Methods Workers with accepted lost-time claims, compensated by the workers' compensation board in Ontario, Canada were interviewed by telephone 18 months following a work-related physical injury/illness. Participants were asked about their past-year opioid use, current pain, RTW timing and workplace accommodations. Separate logistic regression analyses were conducted to estimate the association between two independent variables and opioid use: one combining the presence of pain with workplace accommodation and a second combining the presence of pain with RTW timing, adjusted for sociodemographic, work, injury and health covariates. Results Of 1793 participants included in the analysis, 35.6% used opioids more than once in the past 12 months. Compared with those who did not return to work too soon and had no/mild pain, odds of opioid use were higher among those with severe pain, both those who returned too soon (OR 2.90, 95% CI 2.11 to 3.99) and those who did not return too soon (OR 3.01, 95% CI 2.16 to 4.19). Compared with those who had an offer of accommodation and no/mild pain, workers with severe pain and an accommodation offer (OR 2.78, 95% CI 2.16 to 3.57) or without an offer (OR 2.69, 95% CI 1.90 to 3.81) had increased odds of reporting use of opioids. Conclusions Findings suggest pain is the main factor associated with opioid use after a work-related injury, irrespective of RTW experiences. However, due to the limitations of this exploratory analysis, longitudinal research examining this issue is warranted.

Purpose Maritime occupations encompass seafaring, fishing, marine aquaculture, and longshore work. These non-standard occupations tend to be hazardous with high injury rates. They are associated with varying levels of seasonality, shift work, geographic mobility, and different types of remuneration, posing unique challenges when recovering from work-related injury and illness. Occupational health and safety is under-researched in these sectors. Furthermore, little research exists on return to work (RTW) after injury among maritime workers. This paper presents findings from a mixed methods research program designed to provide insight into injury, compensation and RTW experiences among maritime workers in the Canadian province of British Columbia (BC). Methods Research methods include the analysis of provincial workers' compensation data, data from an anonymous online survey of injured/ill BC maritime workers and from semi-structured interviews with injured workers and key informants. Results Analysis of workers' compensation data shows high rates of serious injuries, longer disability duration, and high rates of deemed RTW, particularly in fishing. Survey findings suggest a relatively low percentage of workers file claims for workers' compensation to WorkSafeBC. Interview data highlight some of the challenges that may explain under-reporting, longer disability duration, and relatively poor RTW outcomes. Conclusion Policy relevant concerns and areas for future research relevant to understanding and addressing some of the identified RTW challenges associated with these sectors are presented.

Purpose Employers of small and medium-sized enterprises (SMEs) face challenges in supporting employees on long-term sick-leave, due to limited resources and expertise available. This study aimed to develop an intervention assisting employers of SMEs in supporting long-term sick-listed employees during sick-leave and return to work (RTW). Methods Intervention mapping (IM) steps 1-4 were employed to develop the intervention. For the needs assessment, 20 employers, 8 employees, 8 occupational physicians, and 9 other stakeholders were interviewed (step 1). A logic model of change was developed (step 2), followed by the identification of theoretical methods for achieving the changes required (step 3). The intervention was composed (step 4), incorporating the results of a pilot test with 4 employers, 4 employees, 4 occupational physicians, and 3 other stakeholders. Results Identified needs (step 1) span knowledge on legislation, communication skills, stakeholder engagement, practical support, actions regarding RTW, relapse prevention, and organizational policy. Using the self-determination theory as the theoretical basis for improving employer intention and ability to support sick-listed employees (steps 2 and 3), a web-based intervention was developed (step 4) (hereafter: SME tool). The SME tool includes succinct tips, communication videos, and practical checklists. Minor adjustments were made following the pilot test, such as adding supplementary information on privacy regulations and preventive strategies. Conclusion By focusing on enhancing SME employers' intention and ability to support their long-term sick-listed employee(s), the developed SME tool has the potential to improve the satisfaction of employees with the sick-leave and RTW support of their employer during long-term sick-leave.

Février 2025

Purpose The study objectives were to (1) identify prevalent unhelpful worker-held pain and disability representations and (2) explore clinicians' intervention challenges with these representations. Methods An explanatory sequential mixed methods design was used (quan -> QUAL). Secondary analysis of a database was performed first. The database included the scores obtained by 297 sick-listed workers with musculoskeletal disorders on the Revised Illness Perception Questionnaire for Work Disability. Descriptive statistics identified the most prevalent unhelpful worker-held representations. Quantitative results were used to develop an interview guide. Semi-structured interviews explored the physiotherapy professionals' (n = 8) and occupational therapists' (n = 6) intervention challenges with workers' pain and disability representations. Results The secondary data analysis showed that perceptions of severe consequences, unpredictable symptoms, and negative emotions were the most prevalent unhelpful worker-held representations. The interviews identified clinicians' key intervention challenges as two specific pain-and-disability representation patterns. The first depicted workers' perceptions of unpredictable and uncontrollable pain, perceptions that generate negative emotions. The clinicians associated this pattern with workers' sense of helplessness. The second pattern involved workers' firm beliefs in a biomedical cause, leading to their perceptions of low levels of treatment and personal pain control. According to clinicians, this pattern led to workers' resistance to active rehabilitation. The clinicians regarded both patterns as hindering worker engagement in rehabilitation treatment. Conclusion The clinicians' key intervention challenges were two pain-and-disability representation patterns, which included or not, prevalent unhelpful worker-held representations. The results underscore the need to develop a transdisciplinary intervention for work rehabilitation clinicians that takes pain and disability representations into account.

Purpose Migrant agricultural workers employed through Canada's Temporary Foreign Worker Program face serious occupational health and safety hazards, with compounded difficulties in accessing workers' compensation (WC) if they are sick or injured by the job. Little is known, however, about their ability to return to work (RTW) upon recovery-a fundamental right included in the conception of WC, but complicated by their restrictive work permits and precarious immigration status. Methods & Results Based on interviews with injured migrant workers in two Canadian provinces (Quebec and Ontario), our research suggests that workers' RTW process is anything but straightforward. This article highlights three key issues-pressure to return to work prematurely, communication and bureaucratic challenges with WC agencies, and impacts of injury/illness and failure to return to work on workers' long-term well-being. Conclusion Consequences and opportunities for reform are discussed.

Purpose This systematic literature review aims to list the validated tools measuring work-related psychosocial factors (WRPFs) influence health care workers’ (HCWs) sickness absence (SA), and to evaluate their psychometric and practical properties. Methods Using the PsycINFO, Medline, and Web of Science databases, the search targeted prospective studies on WRPFs and SA in HCWs published between 2012 and 2023. The validated, self-report tools that measured WRPFs and that yielded at least one significant predictor of SA in HCWs were identified. An evaluation of the psychometric and practical properties was performed. Results Based on inclusion criteria, three prospective studies on HCWs were included, and twelve tools were listed. Psychometric and practical properties were “excellent” for six tools, “good” for four, and “questionable” for two. Conclusions Researchers and occupational health practitioners can use tools with “good” to “excellent” overall quality to measure traditional WRPFs that predict SA in HCWs. There is a need to develop and validate tools that measure WRPFs representing the specific characteristics of the health care working environment. Other WRPFs relevant to the work context of HCWs can be measured by extant tools that could be used in research and program development and evaluation.

Janvier 2025

Purpose This qualitative study investigated the needs, barriers, and facilitators that affect primary care providers' involvement in supporting patients' stay-at-work and return-to-work following injury or illness. It also aims to understand the lived experiences of primary care providers who participated in the Extension for Community Healthcare Outcomes training program for Occupational and Environmental Medicine (ECHO OEM). By examining both the structural and experiential aspects of the program, this study seeks to provide insights into how ECHO OEM influences providers' approaches to occupational health challenges. Methods Those who attended ECHO OEM sessions were invited to participate in the research study. Four focus groups and five one-on-one interviews were conducted with healthcare providers participating in ECHO OEM. Audio-recordings were transcribed verbatim and analyzed using an inductive thematic analysis approach. This study was structured according to the COREQ Checklist. Results We discussed six main themes: (1) Challenges with Engaging with Workers' Compensation Boards; (2) Return to Work practices; (3) Health and Well-Being; (4) Communication is Important; (5) Perspective from the Workplace; and (6) Feedback on ECHO OEM. Conclusion ECHO OEM sessions contribute to and impact healthcare providers' knowledge of supporting injured or ill workers. Topics that deserve further attention include incorporating comorbid physical and mental health conditions, navigating workers' compensation systems, and supporting specific populations such as military veterans and emergency personnel.

Purpose The therapeutic alliance is central to occupational rehabilitation, particularly for immigrant workers who face unique challenges of migration and of social and occupational integration. This study explores the development and maintenance of this alliance between immigrant workers with compensated work injuries and their care providers during work rehabilitation. Methods Using ethnography, semi-structured interviews, and focus groups, the qualitative case study involved 7 injured immigrant workers and their interdisciplinary clinical team. Results The study identified several factors that weakened the alliance, including administrative complexity, conflicting views on pain and disability, cultural stereotypes, and interorganizational communication issues. Conclusions Many of these challenges were systemic and structural, occurring outside the clinic, complicating the rehabilitation process, and potentially prolonging the duration of disability. This paper discusses these systemic issues and their implications for the rehabilitation of immigrant workers.

Décembre 2024

Purpose The objectives of this paper were to summarize successful strategies in occupational health and safety (OHS) management in small and medium-sized enterprises (SMEs) and to explore their potential applicability for disability management (DM) and return-to-work (RTW) after work-related injuries. Methods A scoping review was conducted, using a consensus-based iterative approach, and a consultation with stakeholders. Twelve databases were searched in collaboration with a specialized librarian, using keywords and combinations of terms. The reviewers identified pertinent articles, selected those which corresponded to the inclusion criteria, extracted data, and analyzed information using qualitative content analyses. A synthesis was presented to the stakeholders, and their comments on overall applicability of these strategies in the Quebec context of DM and RTW were detailed. Results A total of 638 references were retrieved from all sources, resulting in 37 scientific articles being analyzed. Four main strategies for improving OHS management in SMEs were identified: dissemination and exchange of information; transmission and acquisition of knowledge, skills, and abilities; using a participatory and collaborative approach; and considering the organizational context. Even if DM and sustainable RTW were sometimes mentioned by authors as important for OHS management in SMEs, specific strategies and implementation elements were not actually described by authors. However, different resources, structures, and activities, associated with one or more of the OHS management strategies described, through their different interactions between the various stakeholders, seem having the potential to act also in sustainable RTW. Conclusion This review has provided an overview of strategies deployed to improve OSH in SME. The results invite stakeholders to a deep reflection on the potential application of such strategies to encompass sustainable RTW in SMEs.

Purpose The return-to-work (RTW) process for individuals on long-term sick leave can be complex. Vocational rehabilitation may facilitate RTW; however, many intervention studies often have relatively short follow-up periods. The purpose of this study was to assess long-term work participation 2-7 years after the initiation of a three-armed randomized controlled trial aimed at RTW for individuals on long-term sick leave because of mental disorders and/or chronic pain. Methods This study followed 220 participants out of 402 (response rate 55%, 205 female) who had previously participated in a randomized controlled trial. They were allocated to one of three groups: multidisciplinary team assessment and individualized treatment (MDT), acceptance and commitment therapy (ACT) or a control group. The participants were followed up at two, three, four, five, six, and seven years after inclusion. The outcome, work participation, was assessed using registry data and defined as having the main source of annual income from paid work during the follow-up years. Results Participants in the MDT intervention group were, to a larger extent, in paid work during follow-up in years four (9.0% points), five (2.5% points), six (7.6% points), and seven (4.1% points) after inclusion, compared to the control group. Participants in the ACT intervention group were, to a larger extent, in paid work during follow-up in years four (14.8% points), six (17.6% points), and seven (13.9% points) after inclusion, compared to the control group. Conclusion This study, primarily involving female individuals on long-term sick leave, suggests that both MDT and ACT interventions can improve long-term work participation. The results also indicate some time-lag effect of the interventions.

Purpose To explore the experiences of long-term sick-listed employees and those of employers with communication and collaboration during sick leave and the return-to-work (RTW) process. Methods Previously long-term sick-listed employees (N = 9) and employers (N = 9) were interviewed about their experiences with communication and collaboration during sick leave and RTW. Thematic analysis, utilizing patient journey mapping was applied to analyze and map out their experiences. Results Three central themes emerged from the analysis: 1. Maintaining communication between employees and employers during early sick leave stages fostered trust and enabled discussions about RTW, lowering the barriers for engaging in RTW activities. 2. Organizing joint meetings involving employees, employers, and occupational health professionals (OHPs) helped align expectations and facilitated shared decision-making to navigate RTW. 3. Both employees and employers reported lacking knowledge of RTW legislation and feeling reliant on OHP guidance to navigate the RTW process. Conclusion Employees and employers underscored the need to be involved, supported, and well informed during the sick leave and RTW process. Both parties mentioned that early and ongoing communication, joint meetings with OHPs, and information on RTW legislation were important prerequisites. Being involved, supported, and well informed are central needs of long-term sick-listed employees and their employers during sick leave and the return-to-work (RTW) process. Occupational health professionals (OHPs) organizing early joint conversations with both long-term sick-listed employees and employers, helps to facilitate shared decision making, align expectations, and provides a supportive foundation for RTW activities. Implications for rehabilitation: OHPs should provide clear, actionable and context-specific advice to support long-term sick-listed employees and their employers to develop and implement tailored RTW plans. Both long-term sick-listed employees and employers require clear information about their obligations and shared responsibilities under national RTW legislation to actively undertake necessary RTW activities and stimulate autonomy.

Novembre 2024

Purpose Inpatient rehabilitation therapies can be applied for in Germany by patients of working age to support their return to work. However, there are some problems that impede an easy and uncomplicated application process. An interdisciplinary case management approach for rehabilitation care planning was developed to facilitate the access to rehabilitation. Case conferences (CCs) were held with relevant stakeholders and took place on a digital communication platform. We conducted a qualitative process evaluation to understand the implementation of the intervention and to identify contextual factors as well as mechanisms for a successful implementation in the context of primary care. Methods The process evaluation included interviews with primary care physicians (PCPs), patients and stakeholders involved in the intervention process. Reflexive thematic analysis was used to analyse the data. Emerging themes were structured according to the Donabedian framework of structure, process and outcomes. Results A total of 18 interviews were conducted. Important results included the desire for more patient involvement and case management. Patients especially valued the opportunity to receive support from a social worker. Limitations of the platform related to usability and limited opportunities for stakeholder communication. Despite training for PCPs, several problems arose regarding the clarity of the intervention process. Patients were satisfied with their application process and the treatments offered, while PCPs reported an increase in workload. Conclusions A digitalisation of the application procedure for rehabilitation and further treatment options is acceptable to patients and personal support of a social worker is particularly valued. However, patients should be included in the CC in terms of a shared decision-making process. The digital platform requires sufficient training and adjustments have to be made to enhance usability and to improve the efficiency of the process for PCPs. Overall, the exchange between the various stakeholders in the CC is considered particularly useful in more complex cases.

Purpose Patients with occupational injuries often receive multidisciplinary rehabilitation for a rapid return to work. Rehabilitation aftercare programs give patients the opportunity to help patients apply the progress they have made during the rehabilitation to their everyday activities. Telerehabilitation aftercare programs can help reduce barriers, such as lack of time due to other commitments, because they can be used regardless of time or location. Careful identification of barriers, facilitators, and design requirements with key stakeholders is a critical step in developing a telerehabilitation aftercare program. This study aims to identify barriers, facilitators, and design requirements for a future telerehabilitation aftercare program for patients with occupational injuries from the perspective of the key stakeholders. Methods We used a literature review and expert recommendations to identify key stakeholders. We conducted semistructured interviews in person and via real-time video calls with 27 key stakeholders to collect data. Interviews were transcribed verbatim, and thematic analysis was applied. We selected key stakeholder statements about facilitators and barriers and categorized them as individual, technical, environmental, and organizational facilitators and barriers. We identified expressions that captured aspects that the telerehabilitation aftercare program should fulfill and clustered them into attributes and overarching values. We translated the attributes into one or more requirements and grouped them into content, functional, service, user experience, and work context requirements. Results The key stakeholders identified can be grouped into the following categories: patients, health care professionals, administrative personnel, and members of the telerehabilitation program design and development team. The most frequently reported facilitators of a future telerehabilitation aftercare program were time savings for patients, high motivation of the patients to participate in telerehabilitation aftercare program, high usability of the program, and regular in-person therapy meetings during the telerehabilitation aftercare program. The most frequently reported barriers were low digital affinity and skills of the patients and personnel, patients' lack of trust and acceptance of the telerehabilitation aftercare program, slow internet speed, program functionality problems (eg, application crashes or freezes), and inability of telerehabilitation to deliver certain elements of in-person rehabilitation aftercare such as monitoring exercise performance. In our study, the most common design requirements were reducing barriers and implementing facilitators. The 2 most frequently discussed overarching values were tailoring of telerehabilitation, such as a tailored exercise plan and tailored injury-related information, and social interaction, such as real-time psychotherapy and digital and in-person rehabilitation aftercare in a blended care approach. Conclusions Key stakeholders reported on facilitators, barriers, and design requirements that should be considered throughout the development process. Tailoring telerehabilitation content was the key value for stakeholders to ensure the program could meet the needs of patients with different types of occupational injuries.

Purpose Several actions have been taken to improve the sick listing process, patient safety and return to work. One of them is the implementation of the rehabilitation coordinator function, of which the benefits have not yet been fully explored. Neither has the role of the manager, who has significant impact on the implementation and support of a new function. This study aimed to explore how first line managers', who employed a rehabilitation coordinator that had completed a one-year specialized study program, perceived, and experience the function rehabilitation coordinator. Methods This is an interview study using a semi structured interview guide for data collection and thematic analysis was applied to the data. Ten first line managers in health care were interviewed. Results Four themes were identified: The Saviour, A personalized function, Change takes time and Strengthen status and legitimacy. The managers experienced the rehabilitation coordinator as a valuable function who facilitates collaboration in the team and with external stakeholders and perceived them as a much-needed resources, supporting physicians with sick leave issues. The assignment was ambiguous and dependent on the rehabilitation coordinators individual characteristics, which may result in a risk of overload. The managers were engaged in the implementation process, but this required time. They considered it important to strengthen legitimacy for the function which required support and encouragement to take part in specialized education and training. Conclusions The managers experienced the rehabilitation coordinators as playing a crucial role in the return-to-work process. They were willing to support how this new function will improve and develop. The results from this can serve as a guidance for the implementation and support of the function rehabilitation coordinator.

Octobre 2024

Purpose In return-to-work (RTW) negotiations after sickness absence, the work ability of an individual employee becomes a shared interest for the multiple stakeholders representing both the healthcare sector and working life. In practice, the employee, employer and occupational health professionals need to reach a shared understanding of the employee's work ability to enable shared decision-making concerning the plans for sustainable RTW. Methods Drawing on 14 video-recorded RTW negotiations, we used conversation analysis-informed membership categorization analysis to examine how the participants of RTW negotiations discuss the work ability of an employee to pursue a shared understanding of the situation. Results Work ability was constructed in a very situational way, using illness categories to both explain the work ability of the employee and argue for or against their ability or inability to work. Conclusions Our study contributes to research on RTW by introducing a new perspective to work ability. We show how work ability is realized during RTW negotiations through interaction, and how participants leverage their cultural understanding of illness and capability when negotiating work ability. We also demonstrate how membership categorization analysis can reveal the situational and consequential aspects of illness and work ability categories.

Purpose Prior research has found evidence that persons who are nonwhite are less likely to receive workplace accommodations than other persons. Objective: To test whether the receipt of workplace accommodations by adults aged 50 and older who had work limitations varies by race/ethnicity in the U.S., controlling for age, gender, education, organizational size, and the physical nature of the occupation. Methods Bivariate and logistic regressions using 2002 to 2018 Health and Retirement Study data on adults aged 50 and older with a work limitation (n= 6,711). Results Receipt of workplace accommodations does not vary by race/ethnicity for U.S. adults aged 50 and older who had a work limitation, with an estimated 34% to 37% of all older adults receiving accommodations across all racial categories. Receipt of accommodations was more likely for persons working at organizations that employed 100 or more people, holding all else constant. Conclusions Smaller employers may benefit from training or other supports to increase the availability of workplace accommodations. Workers with disabilities might also benefit from increased education offered by vocational rehabilitation agencies, workforce development programs, and other similar organizations on how to make requests for and implement reasonable accommodations.

Septembre 2024

Purpose Clinical work-integrating care (CWIC) refers to paying attention to work participation in a clinical setting. Working patients may benefit from CWIC. The purpose of this study is to explore the extent and nature to which medical specialists provide CWIC and what policies and guidelines oblige or recommend specialists to do. Methods A scoping review was conducted. The databases MEDLINE, EMBASE, Psychinfo, CINAHL, and Web of Science were searched for studies on the extent and nature of CWIC and supplemented by gray literature on policies and guidelines. Six main categories were defined a priori. Applying a meta-aggregative approach, subcategories were subsequently defined using qualitative data. Next, quantitative findings were integrated into these subcategories. A separate narrative of policies and guidelines using the same main categories was constructed. Results In total, 70 studies and 55 gray literature documents were included. The main findings per category were as follows: (1) collecting data on the occupation of patients varied widely; (2) most specialists did not routinely discuss work, but recent studies showed an increasing tendency to do so, which corresponds to recent policies and guidelines; (3) work-related advice ranged from general advice to patient-physician collaboration about work-related decisions; (4) CWIC was driven by legislation in many countries; (5) specialists sometimes collaborated in multidisciplinary teams to provide CWIC; and (6) medical guidelines regarding CWIC were generally not available. Conclusion Medical specialists provide a wide variety of CWIC ranging from assessing a patient's occupation to extensive collaboration with patients and other professionals to support work participation. Lack of medical guidelines could explain the variety of these practices.

Purpose Work disability affects a growing number of workers aged 55 and over (W55 +). While rehabilitation programs have demonstrated efficacy for workers with an average age of 42, they often have not been designed to meet unique needs of aging workers. This study aimed to describe the difficulties encountered by work rehabilitation professionals and explore their solutions for improving services offered to W55 +. Methods This study used a simple descriptive design with purposive sampling. Occupational therapists, physical therapists, and psychologists were mainly recruited in private clinics. An interview guide based on the Work Disability Paradigm was piloted and used with the participants. Qualitative interviews were conducted with work rehabilitation professionals and then transcribed. A thematic analysis was performed. Results The sample consisted of fifteen participants (average age 38 years) with near equal representation across genders and disciplines. Difficulties were identified in relation to the (1) characteristics of W55+, (2) work environment, (3) compensation system, and (4) communication among stakeholders. Five solutions were proposed to improve the services offered: provide healthcare professionals with access to tools and training, implement communication mechanisms, integrate a return-to-work coordinator, develop a joint action plan for managing W55+, and implement an integrative prevention approach in workplaces. Conclusions Our results represent a first step in mapping various stakeholders' needs to ensure better support for W55 + with work disabilities. These results delineate a roadmap for future research that should expand upon these stakeholders' perspectives to provide a more comprehensive description of their needs and potential solutions.

Purpose Considering current labour shortages, the recent increase in the number of aging workers in the labour market is deemed economically beneficial. However, due to specific characteristics (e.g. biological, generational), aging workers take longer to recover and return to work after an occupational injury. Yet, few studies have examined the rehabilitation, return, and stay at work process of aging workers and current knowledge makes it difficult for stakeholders to identify which interventions to use with this specific population. This study aimed to describe which interventions are used in the rehabilitation, return, and stay at work process of aging workers having suffered an occupational injury. Methods We conducted a five-step scoping review. Five databases were used for the literature search. A qualitative analysis of the retained manuscripts was conducted. Results Our analysis led to the extraction of information from seven manuscripts that concern the rehabilitation, return, and stay at work process of aging workers who suffered an occupational injury exclusively. We identified 19 interventions (e.g. work capacity development, work task modifications, permanent part-time work, and alternative roles) and were described according to the different phases of the Cycle of Work Disability Prevention (CWDP). Conclusions This study offers informative, non-prescriptive, and operational interventions useful for stakeholders who support aging workers. Furthermore, it is a knowledge base to develop future projects that promote the rehabilitation, return, and stay at work process of aging workers.

Purpose Return-to-work coordinators (RTWC) support people on sickness absence and is a new healthcare occupation in Sweden. Its practitioners represent a variety of professions, there is no common undergraduate training and vague role and competence descriptions. The aim was to explore differences in training and competence according to original professions (occupational therapists, physiotherapists, counselling, and other professions) and coordinators' views on which professions they believe provide the best competence for the role. Methods All RTWCs (82) in one region were invited to answer a questionnaire (89% response rate). Mixed-methods analyses were applied. Results The results showed that counselling professions were more likely than other professional groups to have further training, particularly in conversation methods, and a lower proportion of them stated needing more knowledge about gender equality, social problems, insurance/benefit and conversation methods. The analysis of free-text answers identified three competence areas of importance: advice and guidance, a holistic view, and personality over profession. Occupational therapists and social workers were seen as having the best competence for the coordinating role. Conclusion The results outline some common values, norms and important competences for RTWCs that could help develop the RTW coordination training and pave the way for RTWCs professionalisation process.

Août 2024

Purpose Enhancing workplace communication and support processes to enable individuals living with disabilities to sustain employment and return to work is a priority for workers, employers, and community stakeholders. The objective of this study was to evaluate a new resource that addresses support challenges, the Job Demands and Accommodation Planning Tool (JDAPT), and assess its use, relevance, and outcomes over a nine-month follow-up period. Methods Workers with physical and mental health/cognitive conditions causing limitations at work were recruited using purposive sampling. Online surveys were administered at baseline (prior to using the JDAPT), and at three and nine months post-baseline. Information was collected on demographics (e.g., age, gender) and work characteristics (e.g., job sector, organization size). Outcomes included assessing JDAPT use and relevance, and changes in self-efficacy, work productivity difficulties, employment concerns, difficulties with job demands, and absenteeism. Results Baseline participants were 269 workers (66% women; mean age 41 years) of whom 188 (69.9%) completed all three waves of data collection. Many workers reported using JDAPT strategies at and outside of work, and held positive perceptions of the tool's usability, relevance, and helpfulness. There were significant improvements (Time 1-2; Time 1-3) in self-efficacy, perceived work productivity, and absenteeism with moderate to large effect sizes in self-efficacy and productivity (0.46 to 0.78). Findings were consistent across gender, age, health condition, and work context variables. Conclusions The JDAPT can enhance support provision and provide greater transparency and consistency to workplace disability practices, which is critical to creating more inclusive and accessible employment opportunities.

© Gignac MAM; Bowring J; Navaratnerajah L; Saunders R; Jetha A; Thompson A; Shaw WS; Franche RL; Van Eerd D; Irvin E; Tompa E; Macdermid JC; Smith PM. Journal of Occupational Rehabilitation. 2024 Aug 09.

Juillet 2024

Purpose With the overall objective of providing implication for clinical and research practices regarding the identification and measurement of modifiable predicting factors for return to work (RTW) in people with musculoskeletal disorders (MSDs) and common mental disorders (CMDs), this study 1) systematically examined and synthetized the research evidence available in the literature on the topic, and 2) critically evaluated the tools used to measure each identified factor. Methods A systematic search of prognostic studies was conducted, considering four groups of keywords: 1) population (i.e., MSDs or CMDs), 2) study design (prospective), 3) modifiable factors, 4) outcomes of interest (i.e., RTW). Studies showing high risk of bias were eliminated. Tools used to measure prognostic factors were assessed using psychometric and usability criteria. Results From the 78 studies that met inclusion criteria, 19 (for MSDs) and 5 (for CMDs) factors reaching moderate or strong evidence were extracted. These factors included work accommodations, RTW expectations, job demands (physical), job demands (psychological), job strain, work ability, RTW self-efficacy, expectations of recovery, locus of control, referred pain (back pain), activities as assessed with disability questionnaires, pain catastrophizing, coping strategies, fears, illness behaviours, mental vitality, a positive health change, sleep quality, and participation. Measurement tools ranged from single-item tools to multi-item standardized questionnaires or subscales. The former generally showed low psychometric properties but excellent usability, whereas the later showed good to excellent psychometric properties and variable usability. Conclusions The rigorous approach to the selection of eligible studies allowed the identification of a relatively small set of prognostic factors, but with a higher level of certainty. For each factor, the present tool assessment allows an informed choice to balance psychometric and usability criteria.

Purpose Previous research has systematically studied the effectiveness of Cognitive Behavioral Therapy (CBT)-based interventions in managing both mental and physical symptoms of chronic disease including depression, stress-related mental disorders (SMD), and chronic pain that are common causes of sick leave. However, a systematic review focusing on the effectiveness of CBT in facilitating RTW is lacking. This study compiles research on utilizing CBT-based interventions for helping employees on sick leave return to work. Methods Randomized controlled trials (RCT) published between 1 January 1990 and 27 June 2022 were searched in MEDLINE, EMBASE, The Cochrane Library, Scopus, PsycINFO, Web of Science, and PubMed. The primary outcome variables included a return to work (RTW) measure and sickness absences. The secondary outcomes include psychological conditions (mental illness, stress, anxiety, and depression) and physical condition (working ability, fatigue, and physical function). Results Thirty-four RCTs were included in the analysis. Fifteen RCTs with 1727 participants reported on sick leave. Results showed that participants who completed CBT intervention had reduced sick leave in days (mean reduction - 3.654; 95%CI - 5.253, - 2.046; p < 0.001) compared to the control group. Sixteen papers with 2298 participants reported that the intervention group RTW 1.5 days earlier (95%CI 1.019, 1.722; p < 0.05). CBT-based interventions were effective in managing fatigue, mental illness, and depression, and improving physical function while it showed no effects in managing stress, anxiety and working ability. Conclusions The findings indicate that CBT-based interventions are effective in reducing the length of sick leave and facilitating the RTW of employees in the intervention group.

Juin 2024

Purpose The aim of this systematic review is to identify vocational rehabilitation (VR) interventions that are effective to enhance return-to-work (RTW) for people on long-term sick leave (> 90 days) and to identify main elements of these interventions. Methods Six electronic databases were searched for peer-reviewed studies published up to February 2022. Each article was screened independently by two different reviewers. Thereafter, one author performed the data-extraction which was checked by another author. The EPHPP quality assessment tool was used to appraise the methodological quality of the studies. Results 11.837 articles were identified. 21 articles were included in the review, which described 25 interventions. Results showed that ten interventions were more effective than usual care on RTW. Two interventions had mixed results. The effective interventions varied widely in content, but were often more extensive than usual care. Common elements of the effective interventions were: coaching, counseling and motivational interviewing, planning return to work, placing the worker in work or teaching practical skills and advising at the workplace. However, these elements were also common in interventions that were not effective on RTW compared to usual care and can therefore not explain why certain interventions are effective and others are not. Conclusion The effective interventions included in this study were often quite extensive and aimed at multiple phases of the RTW-process of the worker. In the future, researchers need to describe the population and the content of the investigated interventions more elaborate to be able to better compare VR interventions and determine what elements make interventions effective.

Purpose This study aimed to investigate the demographic, industrial and health-related, economic, and psycho-emotional factors that affect the life satisfaction of injured workers, and compare them according to the type of return to work. Methods Regression analysis was used to analyse data on 2,025 injured workers. Results Marital status (B =.967, p <.001), disability grade (B = -.129, p <.01), health status (B = 1.287, p <.001), socioeconomic status (B = 1.977, p <.001), ownership status (B =.585, p <.05), self-esteem (B =.246, p <.001), and self-efficacy (B =.049, p <.01) significantly affected the life satisfaction of injured workers who returned to their original workplace; and marital status (B =.991, p <.001), performance ability (B =.224, p <.001), health status (B = 1.066, p <.001), socioeconomic status (B = 2.025, p <.001), ownership status (B =.589, p <.01), self-esteem (B =.295, p <.001), and self-efficacy (B =.053, p <.001) significantly affected the life satisfaction of injured workers re-employed at other workplaces; ownership status (B = 1.853, p <.01) significantly affected the life satisfaction of injured workers who is self-employed. Conclusion Implications are discussed.

Purpose Functional Capacity Evaluation (FCE) is a crucial component within return-to-work decision making. However, clinician-based physical FCE interpretation may introduce variability and biases. The rise of technological applications such as machine learning and artificial intelligence, could ensure consistent and precise results. This review investigates the application of information and communication technologies (ICT) in physical FCEs specific for return-to-work assessments. Methods Adhering to the PRISMA guidelines, a search was conducted across five databases, extracting study specifics, populations, and technological tools employed, through dual independent reviews. Results Nine studies were identified that used ICT in FCEs. These technologies included electromyography, heart rate monitors, cameras, motion detectors, and specific software. Notably, although some devices are commercially available, these technologies were at a technology readiness level of 5–6 within the field of FCE. A prevailing trend was the combined use of diverse technologies rather than a single, unified solution. Moreover, the primary emphasis was on the application of technology within study protocols, rather than a direct evaluation of the technology usability and feasibility. Conclusions The literature underscores limited ICT integration in FCEs. The current landscape of FCEs, marked by a high dependence on clinician observations, presents challenges regarding consistency and cost-effectiveness. There is an evident need for a standardized technological approach that introduces objective metrics to streamline the FCE process and potentially enhance its outcomes.

Mai 2024

Purpose Previously, we reported that an inpatient multimodal occupational rehabilitation program (I-MORE) was more effective than outpatient Acceptance and Commitment Therapy (O-ACT) in reducing sickness absence and was cost-effective over a 24-month period. Here we present 7-years of follow-up on sick leave and the cost of lost production. Methods We randomized individuals aged 18-60, sick-listed due to musculoskeletal or mental health disorders to I-MORE (n = 82) or O-ACT (n = 79). I-MORE, lasting 3.5 weeks, integrated ACT, physical training, and work-related problem-solving. In contrast, O-ACT mainly offered six weekly 2.5 h group sessions of ACT. We measured outcomes using registry data for days on medical benefits and calculated costs of lost production. Our analysis included regression analyses to examine differences in sickness absence days, logistic general estimating equations for repeated events, and generalized linear models to assess differences in costs of lost production. Results Unadjusted regression analyses showed 80 fewer days of sickness absence in the 7-year follow-up for I-MORE compared to O-ACT (95% CI - 264 to 104), with an adjusted difference of 114 fewer days (95% CI - 298 to 71). The difference in costs of production loss in favour of I-MORE was 27,048 euros per participant (95% CI - 35,009 to 89,104). Conclusions I-MORE outperformed O-ACT in reducing sickness absence and production loss costs during seven years of follow-up, but due to a limited sample size the results were unprecise. Considering the potential for substantial societal cost savings from reduced sick leave, there is a need for larger, long-term studies to evaluate return-to-work interventions.

Purpose The aim of this study is to gain insight into the facilitators, barriers, and support needs of Dutch self-employed workers when returning to work (RTW) after sick leave. Methods Three focus groups were conducted, involving 15 Dutch self-employed workers who were on sick leave due to health problems. The transcripts were analysed through thematic content analysis. Results Five main themes regarding barriers, facilitators and needs of self-employed workers to RTW were identified: autonomy, social support, client management, financial security and information on sick leave. Having autonomy was considered a facilitator for RTW. However, the participants expressed a need for more financial support, additional guidance from occupational health professionals, and tailored information regarding RTW. Conclusion The results of this study emphasize a need for optimizing national policy and support for self-employed workers regarding sick leave and RTW.

Purpose The aim of this study was to explore how early follow-up sessions (after 14 and 16 weeks of sick leave) with social insurance caseworkers was experienced by sick-listed workers, and how these sessions influenced their return-to-work process. Methods A qualitative interview study with sick-listed workers who completed two early follow-up sessions with caseworkers from the Norwegian Labor and Welfare Administration (NAV). Twenty-six individuals aged 30 to 60 years with a sick leave status of 50-100% participated in semi-structured interviews. The data was analyzed with thematic analysis. Results Participants' experiences of the early follow-up sessions could be categorized into three themes: (1) Getting an outsider's perspective, (2) enhanced understanding of the framework for long term sick-leave, and (3) the empathic and personal face of the social insurance system. Meeting a caseworker enabled an outsider perspective that promoted critical reflection and calibration of their thoughts. This was experienced as a useful addition to the support many received from their informal network, such as friends, family, and co-workers. The meetings also enabled a greater understanding of their rights and duties, possibilities, and limitations regarding welfare benefits, while also displaying an unexpected empathic and understanding perspective from those working in the social insurance system. Conclusion For sick-listed individuals, receiving an early follow-up session from social insurance caseworkers was a positive experience that enhanced their understanding of their situation, and promoted reflection towards RTW. Thus, from the perspective of the sick-listed workers, early sessions with social insurance caseworkers could be a useful addition to the overall sickness absence follow-up.

Avril 2024

Purpose Research demonstrates sustained return to work (RTW) by individuals on medical leave is influenced by personal and job resources and job demands. Relatively few studies have been conducted in the workers' compensation context that is known to have longer absence durations for RTW. This study sought to illuminate workers' experience as they returned to work following a work injury that was either psychological in nature or involved more than 50 days of disability, with a focus on the co-worker, supervisor, and employer actions that supported their return. Methods Workers in Saskatchewan, Canada, with a work-related psychological or musculoskeletal injury, subsequent disability, and who returned to work in the last three years, were invited to complete an online survey comprising of free-text questions. Thematic analysis was used to explore participants' experiences. Results Responses from 93 individuals were analysed. These revealed that persistent pain, emotional distress, and loss of normal abilities were present during and beyond returning to work. Almost two-thirds indicated that the supervisors' and co-workers' support was critical to a sustained return to work: their needs were recognized and they received autonomy and support to manage work demands. By contrast, one-third indicated that the support they expected and needed from supervisors and employers was lacking. Conclusions Workers returning to work lacked personal resources but co-workers' and supervisors' support helped improve confidence in their ability to RTW. Supervisors and employers should acknowledge workers' experiences and offer support and autonomy. Likewise, workers can expect challenges when returning to work and may benefit from cultivating supportive relationships with co-workers and supervisors.

Purpose Rates of return to work (RTW) are declining in the Australian workers compensation system alongside significant economic and social costs, disputes, and secondary psychological injury. Non-medical assessment of workplace injuries now considers psychosocial and workplace factors, and worker participation in the assessment process is limited. This scoping review examines studies regarding non-medical assessment during the acute phase of rehabilitation in terms of costs, disputes, secondary psychological injury, and worker participation. Methods An electronic and manual search of relevant articles across four databases was conducted using PRISMA guidelines, followed by quality assessment. Results Of the 1,630 studies retrieved, 12 met the inclusion criteria with most focused on assessment for risk of obstructed or delayed RTW. Conclusions Non-medical assessment in the acute stage of rehabilitation identifies risk for delayed or complicated RTW, overlooking potential for the process of assessment to contribute to disputes and development of secondary psychological injury. Doubt around the capacity of workers to participate objectively in assessment persists. These are aspects of assessment worthy of further exploration for their impact on RTW outcomes.

Purpose Value-based healthcare delivery focuses on optimizing care provided by measuring the healthcare outcomes which are most important to the clients relative to the total care costs. However, the understanding of what adds value for clients during work disability assessment is lacking. Objective: To explore what medical examiners (MEs) perceive as valuable during the work disability assessment process, by exploring possible: 1) facilitators, 2) barriers and 3) opportunities to add value for the client during the work disability assessment. Methods For this explorative qualitative study, 7 semi-structured interviews were conducted with MEs in the Netherlands. Thematic coding was performed for all interviews. Results A large variety of facilitators (n = 22), barriers (n = 17) and opportunities (n = 11) were identified and inductively subdivided into four main themes: 1) coherent process, including all time related aspects, 2) interdisciplinary collaboration, including all aspects related to the collaboration between the ME and other professionals, 3) client-centred interaction, including all aspects related to the supportive interplay from the ME towards the client, and 4) information provision on all aspects during the work disability assessment process towards the client to ensure a valuable work disability assessment process. Conclusions The overview of identified possible facilitators, barriers and opportunities to add value for clients from the perspective of the ME may stimulate improvement in the current work disability assessment practice and to better match the client needs.

Purpose The aim of this qualitative study was to explore ways that employer support influenced successful return to work (RTW) in workers with disabilities. Methods We conducted a semi-structured interview study among 27 workers with disabilities in the Netherlands who received a partial disability benefit two years after sick leave and who continued working in paid (part-time) employment after a period of long-term sickness absence (> 2 years). We analyzed data by means of thematic analysis. Results We identified four types of employer support that were experienced as factors of successful RTW: 1. Supervisor accessibility; 2. Supervisor engagement; 3. Supervisor strategies; and 4. Supervisor-initiated work accommodations. More specifically, during the preparations for RTW phase, the supervisor's active role involved having a positive and open attitude toward facilitating RTW; during the initial RTW phase, the supervisor's role involved being creative in finding solutions for work accommodations; and during the sustained RTW phase, the supervisor's role included helping workers who still needed changes in their work situations. Conclusion The elements of successful employer support reveals that the pressure on the shoulders of the supervisor is high. Future research should further investigate whether supervisors need more phase-specific training from their organization.

Mars 2024

Purpose Previous research has systematically studied the effectiveness of Cognitive Behavioral Therapy (CBT)-based interventions in managing both mental and physical symptoms of chronic disease including depression, stress-related mental disorders (SMD), and chronic pain that are common causes of sick leave. However, a systematic review focusing on the effectiveness of CBT in facilitating RTW is lacking. This study compiles research on utilizing CBT-based interventions for helping employees on sick leave return to work. Methods Randomized controlled trials (RCT) published between 1 January 1990 and 27 June 2022 were searched in MEDLINE, EMBASE, The Cochrane Library, Scopus, PsycINFO, Web of Science, and PubMed. The primary outcome variables included a return to work (RTW) measure and sickness absences. The secondary outcomes include psychological conditions (mental illness, stress, anxiety, and depression) and physical condition (working ability, fatigue, and physical function). Results Thirty-four RCTs were included in the analysis. Fifteen RCTs with 1727 participants reported on sick leave. Results showed that participants who completed CBT intervention had reduced sick leave in days (mean reduction - 3.654; 95%CI - 5.253, - 2.046; p < 0.001) compared to the control group. Sixteen papers with 2298 participants reported that the intervention group RTW 1.5 days earlier (95%CI 1.019, 1.722; p < 0.05). CBT-based interventions were effective in managing fatigue, mental illness, and depression, and improving physical function while it showed no effects in managing stress, anxiety and working ability. Conclusions The findings indicate that CBT-based interventions are effective in reducing the length of sick leave and facilitating the RTW of employees in the intervention group.

Purpose The purpose of this study was to develop a question prompt list (QPL) to support patients undergoing work-related medical rehabilitation in obtaining relevant information and to explore how patients and physicians rate the QPL regarding its usefulness, practicability, and perceived (additional) effort. Methods An initial item pool was assessed by rehabilitation patients (N = 3) in cognitive interviews, rated by physicians and other health professionals (N = 11), and then further modified. The final QPL version (16 items) was used by patients (N = 36) in medical admission interviews in an inpatient medical rehabilitation facility and then evaluated. Physicians evaluated the QPL after each interview with a study participant (N = 6; k = 39 interviews). Results The QPL was used by 50% of patients who rated its usefulness and comprehensibility positively. Neither the need for information nor satisfaction with the information received was correlated with QPL use. The physicians' assessment showed a positive evaluation regarding the provision of information and structuring of the conversation, but also a higher perceived time expenditure. Conclusion While initial testing of the QPL in work-related medical rehabilitation as a tool to support patient-provider communication generally showed a favorable evaluation by patients using it and physicians, future research should address its validity and effectiveness.

Purpose Considering current labour shortages, the recent increase in the number of aging workers in the labour market is deemed economically beneficial. However, due to specific characteristics (e.g. biological, generational), aging workers take longer to recover and return to work after an occupational injury. Yet, few studies have examined the rehabilitation, return, and stay at work process of aging workers and current knowledge makes it difficult for stakeholders to identify which interventions to use with this specific population. This study aimed to describe which interventions are used in the rehabilitation, return, and stay at work process of aging workers having suffered an occupational injury. Methods We conducted a five-step scoping review. Five databases were used for the literature search. A qualitative analysis of the retained manuscripts was conducted. Results Our analysis led to the extraction of information from seven manuscripts that concern the rehabilitation, return, and stay at work process of aging workers who suffered an occupational injury exclusively. We identified 19 interventions (e.g. work capacity development, work task modifications, permanent part-time work, and alternative roles) and were described according to the different phases of the Cycle of Work Disability Prevention (CWDP). Conclusions This study offers informative, non-prescriptive, and operational interventions useful for stakeholders who support aging workers. Furthermore, it is a knowledge base to develop future projects that promote the rehabilitation, return, and stay at work process of aging workers.

Purpose There is need for more knowledge about the relationship between work and cognitive functioning in sick-listed individuals. This study investigated whether the degree of work participation is relevant for recovery of cognitive functioning in sick-listed individuals. Methods 177 occupational rehabilitation participants and 70 controls participated in a non-randomised, longitudinal study. Participants completed computerised cognitive tests targeting sustained attention and working memory at start and end of rehabilitation and 3 and 12 months after rehabilitation. The change score performance in attention and memory between start and end, start and 3 months and 12 months was compared in individuals on sick leave 100-75%, 74-40% and 39-0% (three sick leave groups) of the time in the year after rehabilitation, and a control group not being on sick leave. Fixed effect analysis of covariance adjusting for education and work ability was used. Results The sick leave group 100-75% had significantly lower score on work ability compared to the other groups at baseline. The main findings indicated that the sick leave group 39-0% improved significantly more in sustained attention compared to the sick leave group 100-75% between start and end of rehabilitation and from start of rehabilitation to 3 and 12 months after. Conclusion The degree of work participation seems relevant to recovery of the cognitive function sustained attention in sick-listed individuals. These findings encourage work rehabilitation clinicians, work consultants and employers to develop RTW plans which take into account that graded employment influence cognitive functioning.

Purpose There are a wide range of interventions that are designed to influence employer behaviour with respect to the employment of people with disabilities. This study presents the results of a systematic review looking at employer-focused interventions to improve disability employment, focusing on interventions or policies taking placing in high-income countries as per the OECD. Methods This systematic review focuses on a broad range of potential employment-related outcomes, including the employment rate, time to return to work and length of sickness absence. The results of 71 papers that evaluate the effectiveness of a range of interventions were synthesised into a narrative review. Results Interventions are grouped into six broad categories: anti-discrimination legislation, quota systems, part-time sick leave, graded return to work and wage subsidy schemes. Anti-discrimination legislation is not effective at improving the employment prospects of people with disabilities. There is mixed evidence with respect to quota systems and wage subsidy schemes. However, the availability of part time sick leave or graded return to work are both consistently associated with improved work participation for people with disabilities.

Purpose In 2019, an initiative to reduce sickness absence in public sector workplaces in Denmark was introduced. The initiative involved appointing a sickness absence coordinator (SA coordinator) to oversee the implementation of workplace-based sickness absence interventions. Since the role of the SA coordinator is a novel concept introduced as part of the initiative, this study investigates the responsibilities of SA coordinators and the challenges they experienced in fulfilling this role during the implementation process. Methods Semi-structured interviews with and observations of SA coordinators from four public sector workplaces were carried out. We collected the first four interviews and observations during the implementation process with follow-up interviews collected at the end of the process. The data were analyzed using thematic analysis. Results The SA coordinators all experienced challenges in terms of lack of commitment among the line managers to participate in the intervention. They experienced being seen as a burden rather than a helping hand, and felt that the line managers might have difficulty recognizing the value of the SA coordinators. Potential ways to improve the collaboration between the SA coordinators and the line managers include considering hiring the SA coordinator in-house and incorporation of intervention components into existing activities to accommodate the busyness of the line managers. Conclusions To support the SA coordinators in carrying out their role and responsibilities, this study suggests that it is important to ensure commitment to the role, especially among the line managers in order to enhance good working relationships.

Février 2024

Purpose The aim of this study was to synthesize the findings of qualitative meta-syntheses (QMS) on return to work (RTW) of people with different chronic illnesses and to develop a generic RTW model that can provide advice on how to improve RTW interventions and strategies. Methods We conducted a systematic literature search in PubMed, Epistemonikos, CENTRAL, and PsycARTICLES to find relevant QMS, published in English or German between 2000 and 2021, and adapted the meta-ethnographic approach of Noblit and Hare to synthesize their findings. Results Nineteen QMS (five focusing on musculoskeletal disorders or chronic pain, four on acquired or traumatic brain injuries, four on cancer, two on mental disorders, one on spinal cord injury, and three on mixed samples) met our inclusion criteria for the meta-ethnographic synthesis. Through systematic comparison and reciprocal translation of the single QMS findings, we could identify a set of key cross-cutting themes/concepts, which formed the basis for four RTW principles and a generic RTW model. Conclusions RTW is a multifactorial and highly interactive multistakeholder process, embedded in an individual's life and working history, as well as in a determined social and societal context. It runs parallel and interdependently to the process of coping with the disease and realigning one's own identity, thus emphasizing the significance of RTW for the person. Besides symptoms and consequences of the disease, individual coping strategies, and RTW motivation, the course and success of RTW are strongly affected by the adaptability of the person's working environment and the social support in their private and working life. Thus, RTW is not only a problem of the individual, but also a matter of the social environment, especially the workplace, requiring a holistic, person-centered, and systemic approach, coordinated by a designated body, which considers the interests of all actors involved in the RTW process.

Purpose Despite the significant economic impact of occupational injuries on companies and society, studies focused on analyzing the determinants of workdays lost due to sick leave remain scarce and incomplete. This paper contributes to this issue by (a) analyzing the drivers of sick leave duration, distinguishing factors that explain the health recovery time from those that could lead workers to a voluntary extension of the absence period, and (b) formulating and empirically testing the effect of gender, citizenship, temporary work, job tenure, amount of disability benefit, and size of the injured worker's firm on the number of days the employee is off work after the injury. Methods Hypotheses are tested on a comprehensive dataset that includes all nonfatal occupational injuries causing sick leave that occurred in the manufacturing sector in Spain during 2015-2019, with more than 400,000 injuries. We conduct ordinary least squares and count data regression models in which the number of days off work is regressed on employees and work characteristics while accounting for a set of variables to control the injury's nature and severity. Results The results show that after considering the intrinsic characteristics of the injury and the severity of the worker's injuries, women, native workers, workers with more seniority, workers with higher salaries, and those working in larger companies have longer periods of sick leave. The results suggest that moral hazard considerations significantly impact the time to return to work after an occupational injury. Conclusions Based on the findings, several insights for company managers and public decision-makers are discussed. Specifically, interventions aimed at improving the organization of work and the working conditions of workers in manufacturing industries are highlighted, as well as the need to improve control and supervision mechanisms during the recovery process of injured workers.

Purpose Due to the Belgian health insurance system's controlling nature, work-disabled claimants can feel forced to return to work (RTW), increasing their risk of relapse. RTW out of interest or importance is considered more sustainable. Such autonomous motivation for RTW can be promoted through 'motivational counselling', an integration of self-determination theory and motivational interviewing. To adopt this, health insurance practitioners need training, which can be designed through intervention mapping as an evidence-based planning tool. This paper reports on the development of a motivational counselling training for health insurance practitioners. Methods Intervention mapping's six steps guided the formulation of programme goals and learning outcomes, matching the context. We then identified change methods which were translated into practical components. Together with the health insurances' input, this resulted in a concrete training programme with an implementation and evaluation plan. Results The training was designed to increase practitioners' knowledge, skills, and beliefs relevant for learning motivational counselling, which also requires solution-focused strategies. Methods like guided practice were translated into built-in exercises, feedback, and information, which were implemented through an online training format of five sessions including one follow-up. Conclusion Reporting about training development increases understanding of its effectiveness and implementation, which will be evaluated via pre- and post-training data collection amongst practitioners. Future trainings can benefit from this by accounting for health insurances' organizational barriers or building on the training's evidence-based backbone whilst only requiring specific adaptations for other stakeholders and contexts. Further research should evaluate motivational counselling's impact on claimants' RTW trajectories.

Janvier 2026

Can vocational advice be delivered in primary care? The Work And Vocational advicE (WAVE) mixed method single arm feasibility study.

Effectiveness of Self-Help Interventions to Reduce Work Disability: A Rapid Mixed Methods Systematic Review.

Exploring the implementation of an ICF-based instrument and guideline for interprofessional collaboration in the return-to-work process.

From relation to intervention: How supervisors’ health-focused intervention behavior relates to employees’ sickness absenteeism.

Measuring the influence of perceived organizational support, organizational hierarchy culture, strategic human resource management, and psychological empowerment on the return to work.

Opportunities and Challenges in the Care of Patients with Somatic Complaints and Patients with Additional Work-Related Anxiety-A Mixed Methods Study.

Inpatient or Outpatient Occupational Rehabilitation - What Works Best for Whom? A Non-randomized Clinical Trial.

Décembre 2025

Medical certification in sickness benefit scheme (II): practical approaches for evaluating work disability.

Expanding the Focus on Work Factors in an Outpatient Setting: Does a Nudge of Patients and Clinicians have an Effect on Return-to-Work and Benefits? Findings from the NSAC Nudge Multicentre Randomised Controlled Trial.

Differences in Perceived Return-to-Work Barriers Between Manual and Non-Manual Workers.

A Meta-synthesis of Qualitative Research on Effective Return to Work Counseling for Individuals with Work Participation Restrictions – A Systematic Review.

Novembre 2025

A Meta-synthesis of Qualitative Research on Effective Return to Work Counseling for Individuals with Work Participation Restrictions - A Systematic Review.

Do Stronger Employer Responsibilities Enhance Work Accommodation for Sick-Listed Workers? Evidence From a Dutch Reform.

Facilitators and Barriers to Collaboration Between General Practice and Sickness Benefits Office in Return to Work Processes-A Scoping Review.

Effect on work ability and health-related quality of life following an interactive patient education aiming to increase sense of coherence and health literacy - the LEARN-to-COPE cluster randomized trial.

Self-Determination Theory in Return to Work Interventions: A Scoping Review.

Octobre 2025

Motivational Interviewing as a Method to Facilitate Return to Work: A Systematic Review.

Obstacles and facilitators of return to work among people with persistent pain who receive benefit payments: an in-depth interview study.

Employees' experiences of involving their managers in the Return-to-Work process through a three-party meeting in primary healthcare - a retrospective interview study.

Process evaluation of a case management intervention for people at high risk of permanent work disability to improve rehabilitation coverage and work participation.

Return to work for people with chronic health conditions after medical or vocational rehabilitation during the COVID-19 pandemic: a scoping review.

Managing sickness absence among health and social care staff: multiple methods evaluation of an occupational therapy case management service.

Caractériser l’intersectionnalité au travail: des repères opérationnels pour soutenir les ergothérapeutes.

Septembre 2025

Receiving Return-To-Work Coordination at Swedish Primary Healthcare Clinics: A Register-Based Study Among People on Sickness Absence.

The impact of telework on absenteeism, presenteeism, and return to work among workers with health conditions: a scoping review.

Trajectories of immigrant workers with work-related injuries: the path to mistrust.

Mapping the Landscape of Work Rehabilitation Education in Physiotherapy Programs.

The Constituents of Trust in the Context of Return to Work Following a Work Disability: A Scoping Review and a Thematic Analysis.

Innovation and testing in general practitioners' practice - the challenging path from idea to new practice.

Juillet-août 2025

"He was Threatened and Told to Cooperate": Immigrant Worker Experiences with the Workers' Compensation System in the Canadian Context.

Description of Managers' Competencies in Diversity, Equity, and Inclusion: A Scoping Review.

Job Accommodations for People with Physical Disabilities: Findings of a United States National Survey.

Managing a safe return to work.

Assessing Functional Limitations in Workers with a Common Mental Disorder or a Musculoskeletal Disorder: A Scoping Review of Questionnaires.

A Scoping Review of Vocational Rehabilitation Programs for People with Acquired Physical Disabilities.

Juin 2025

Stakeholder perceptions of supporting patients' return-to-work in primary care: a qualitative study.

A systems perspective on gaps in the person-centered sick leave and rehabilitation process: a Swedish interview study.

Mai 2025

Mistrust among injured immigrant workers: A conceptual framework.

Self-perceived barriers to returning to work among employees with a low educational level on long-term sick leave: the "NOW WHAT" large-scale interview study.

The role of healthcare providers in return to work and stay at work services for people with mid-career disabilities: A holistic statewide model.

Economic Evaluations of Rehabilitation Interventions: A Scoping Review with Implications for Return to Work Programs.

Avril 2025

Capturing the Perspectives of "Laypeople" on Policy Effectiveness: Employers' and Precariously Employed Workers' Suggested Improvements for the Workers' Compensation System and Work Injury Processes.

Work Disability Prevention and Management.

The false promise of return to work for migrant workers injured on the job in Canada: When public policies intersect to create exclusion.

Online training improves motivational counseling in health insurance practitioners: a pre-post analysis of return-to-work conversations.

Mars 2025

Effectiveness of clinical healthcare interventions for enhancing the work participation of patients with various health conditions: a synthesis of systematic reviews.

Evaluating the Health and Economic Impacts of Return-to-Work Interventions: A Modeling Study.

Opioid use among injured workers: pain and the return-to-work experience.

Injury and Return to Work Among Maritime Workers in British Columbia, Canada.

Assisting Employers of Small and Medium-Sized Enterprises (SMEs) to Support Employees on Long-Term Sick-Leave: Development of a Web-Based SME Tool Using Intervention Mapping.

Février 2025

Intervention challenges experienced in physiotherapy and occupational therapy with workers' pain and disability representations: a mixed methods study.

The Point of No Return? Impediments to Return to Work for Injured Migrant Agricultural Workers in Two Canadian Provinces.

A systematic review and evaluation of the tools measuring work-related psychosocial factors in prospective research on sickness absence of health care workers.

Janvier 2025

Project ECHO Occupational and Environmental Medicine: A Qualitative Study of HealthCare Providers Supporting Workers with Work-Related Injuries and Illnesses.

Organizational and Structural Factors in Building the Therapeutic Alliance in a Work Rehabilitation Program With Injured Immigrant Workers in Quebec.

Décembre 2024

Successful Strategies for Occupational Health and Safety in Small and Medium Enterprises: Insights for a Sustainable Return to Work.

Work participation after receiving multidisciplinary treatment or acceptance and commitment therapy intervention for return to work: long-term follow-up of a randomized controlled trial

The return-to-work journey: experiences with communication and collaboration among employees and employers during long-term sick leave and return-to-work.

Novembre 2024

Lessons learned from implementing a digital rehabilitation care planning platform to improve care access for patients with work disability: qualitative process evaluation of the RehaPro-SERVE study.

Barriers, Facilitators, and Requirements for a Telerehabilitation Aftercare Program for Patients After Occupational Injuries: Semistructured Interviews With Key Stakeholders.

Rehabilitation coordinator - managers' experiences of a new function in health care.

Octobre 2024

Ill persons and capable workers: Constructing work ability in return-to-work negotiations after sickness absence.

Receipt of workplace accommodations does not vary by race/ethnicity but does vary by organization size for older workers in the U.S.

Septembre 2024