How can we help employees with chronic diseases to stay at work? A review of interventions aimed at job retention and based on an empowerment perspective

Work participation, social roles, and empowerment of Q-fever fatigue syndrome patients ≥10 years after infection

OBJECTIVE

To determine work participation, social roles, and empowerment of QFS patients ≥10-year after infection.

METHODS

QFS patients ≥10-year after acute infection, who were of working age, participated in a cross-sectional survey study. Work participation, fulfilment of social roles, and empowerment outcomes were studied for the total population, as well as for subgroups based on employment type and current work status. Associations between empowerment, work and social roles were examined.

RESULTS

291 participants were included. Of the 250 participants who had paid work before Q-fever, 80.4% stopped working or worked less hours due to QFS. For each social role, more than half of the participants (56.6-87.8%) spent less time on the role compared to before Q-fever. The median empowerment score was 41.0 (IQR: 37.0-44.0) out of 60. A higher empowerment score was significantly associated with lower odds of performing all social roles less due to QFS (OR = 0.871-0.933; p<0.001-0.026), except for parenting and informal care provision (p = 0.070-0.460). No associations were found between empowerment and current work status.

CONCLUSION

Work participation and fulfilment of social roles is generally low in QFS patients. Many of the participants stopped working or are working less hours due to QFS, and most spent less time on social roles compared to before Q-fever. Minor variation was seen in total empowerment scores of participants; however, these slight differences were associated with the fulfilment of social roles, but not work participation. This new insight should be further explored in future studies.

Long-Term Social Outcomes of Pediatric Liver Transplant Recipients: Transition From Childhood to Adulthood

OBJECTIVES

Chronic disorders may negatively affect people's learning status, marital status, occupational life, and social life. Liver transplant is the only curative treatment for chronic liver diseases. This study was undertaken to evaluate the psychosocial effects of liver transplant in adult patients who had undergone liver transplant during the pediatric period compared with psychosocial facts in the general population.

MATERIALS AND METHODS

We retrospectively reviewed adult patients (>18 years of age) who had received liver transplant as children. We compared sex, age at the time of transplant, current age, type of donor, graft survival status, marital status, age at first delivery, number of children, educational status, and occupational status in the study population versus the general (normal) population. To compare the liver transplant patients included in the study with the general population correctly, we used data from the Turkish Statistical Institute.

RESULTS

Among 77 liver transplant patients included in our study, the mean age at transplant was 10.9 years (range, 0.5-16 y) and the mean age at the time of the study was 25.2 years (range, 18-42 y). Of the patients, 61 (79.2%) were single and 16 (20.8%) were married. Patients in the study population married at a younger age than the general population (25.5 vs 28.1 y for men, 24.3 vs 25.4 y for women). Of 16 married patients, 9 (56.2%) had a healthy child or children. The percentage of patients who graduated from higher education or were continuing their higher education process was higher in our study population than in the general population (36.3% vs 22.8%). Among our study population, 37 patients (48%) were workers.

CONCLUSIONS

Liver transplant had no negative effects on the social, educational, and professional lives among adults in our study who received transplants in the pediatric period.

A general framework for selecting work participation outcomes in intervention studies among persons with health problems: a concept paper

Background

Work participation is important for health and can be considered as engagement in a major area of life which is of significance for most people, but it can also be thought of as fulfilling or discharging a role. Currently, academic research lacks a comprehensive classification of work participation outcomes. The International Classification of Functioning is the foremost model in defining work functioning and its counterpart work disability, but it does not provide a critical (core) set of outcomes. Standardizing the definitions and nomenclature used in the research of work participation would ensure that the outcomes of studies are comparable, and practitioners and guideline developers can better decide what works best. As work participation is a broad umbrella term including outcome categories which need unambiguous differentiation, a framework needs to be developed first.

Aim

To propose a framework which can be used to develop a generic core outcome set for work participation.

Methods

First, we performed a systematic literature search on the concept of (work) participation, views on how to measure it, and on existing classifications for outcome measurements. Next, we derived criteria for the framework and proposed a framework based on the criteria. Last, we applied the framework to six case studies as a proof of concept.

Results

Our literature search provided 2106 hits and we selected 59 studies for full-text analysis. Based on the literature and the developed criteria we propose four overarching outcome categories: (1) initiating employment, (2) having employment, (3) increasing or maintaining productivity at work, and (4) return to employment. These categories appeared feasible in our proof-of-concept assessment with six different case studies.

Conclusion

We propose to use the framework for work participation outcomes to develop a core outcome set for intervention studies to improve work participation.

The Role of the Employer in Supporting Work Participation of Workers with Disabilities: A Systematic Literature Review Using an Interdisciplinary Approach

Purpose There is growing awareness that the employer plays an important role in preventing early labor market exit of workers with poor health. This systematic review aims to explore the employer characteristics associated with work participation of workers with disabilities. An interdisciplinary approach was used to capture relevant characteristics at all organizational levels. Methods To identify relevant longitudinal observational studies, a systematic literature search was conducted in PubMed, Web of Science, PsycINFO and EconLit. Three key concepts were central to the search: (a) employer characteristics, (b) work participation, including continued employment, return to work and long-term work disability, and (c) chronic diseases. Results The search strategy resulted in 4456 articles. In total 50 articles met the inclusion criteria. We found 14 determinants clustered in four domains: work accommodations, social support, organizational culture and company characteristics. On supervisor level, strong evidence was found for an association between work accommodations and continued employment and return to work. Moderate evidence was found for an association between social support and return to work. On higher organizational level, weak evidence was found for an association between organizational culture and return to work. Inconsistent evidence was found for an association between company characteristics and the three work outcomes. Conclusions Our review indicates the importance of different employer efforts for work participation of workers with disabilities. Workplace programs aimed at facilitating work accommodations and supervisor support can contribute to the prevention of early labor market exit of workers with poor health. Further research is needed on the influence of organizational culture and company characteristics on work participation.

Perspectives on ability to work from patients' receiving dialysis and caregivers: analysis of data from the global SONG initiative

BACKGROUND

Patients receiving dialysis have low employment rates, which compounds poorer health and socioeconomic outcomes. Reasons for under- and unemployment remain underexplored. We aimed to describe the perspectives of patients receiving hemodialysis (HD) or peritoneal dialysis (PD) and their caregivers on ability to work.

METHODS

Data was derived from adult patients' and caregivers' responses from 26 focus groups, two international Delphi surveys and two consensus workshops conducted through the Standardized Outcomes in Nephrology (SONG-HD) and SONG-PD programs. Our secondary thematic analysis identified concepts around ability to work.

RESULTS

Five hundred four patients and 146 caregivers from 86 countries were included. We identified five themes: financial pressures and instability (with subthemes of rationing the budget with increased expenditure, losing financial independence and threatened job security); struggling to meet expectations (burdened by sociocultural norms and striving to protect independence); contending with upheaval of roles and responsibilities (forced to establish a new routine to accommodate work, symptoms disrupting work, prioritizing work and other duties, and adjusting to altered capacity to work); enabling flexibility and control (employment driving decisions about dialysis modality and schedule, workplace providing occupational safety and adaptability, requiring organizational support and planning for a future career); and finding purpose and value (accepting and redefining identity, pride and fulfillment, and protecting mental well-being).

CONCLUSIONS

Employment enabled patients to maintain their identity, independence, financial security and mental health. Symptom burden, workplace inflexibility and juggling roles are major challenges. Interventions addressing motivation, workplace flexibility and safety, and establishing goals and routines could support patients' capacities to work, thereby improving overall well-being and productivity.

Late effects of cancer (treatment) and work ability: guidance by managers and professionals

BACKGROUND

The prevalence of the group of workers that had a cancer diagnosis in the past is growing. These workers may still be confronted with late effects of cancer (treatment) possibly affecting their work ability. As little is known about the guidance of this group, the aim of this study was to explore the experiences and ideas of managers and professionals about the guidance of these workers in the case of late effects of cancer (treatment). Given the positive associations with work ability of the job resources autonomy, social support by colleagues and an open organisational culture found in several quantitative studies, these job resources were also discussed. Further ideas about the influences of other factors and points of attention in the guidance of this group of workers were explored.

METHODS

Semi-structured interviews were conducted with managers (n = 11) and professionals (n = 47). Data-collection was from November 2019 to June 2020. The data were coded and analysed using directed content analyses.

RESULTS

The late effects of cancer or cancer treatment discussed were physical problems, fatigue, cognitive problems, anxiety for cancer recurrence, and a different view of life. The self-employed have less options for guidance but may struggle with late effects affecting work ability in the same way as the salaried. Late effects may affect work ability and various approaches have been described. Autonomy, social support of colleagues and an open organisational culture were regarded as beneficial. It was indicated that interventions need to be tailor-made and created in dialogue with the worker.

CONCLUSIONS

Especially with respect to cognitive problems and fatigue, guidance sometimes turned out to be complicated. In general, the importance of psychological safety to be open about late effects that affect work ability was emphasized. Moreover, it is important to take the perspective of the worker as the starting point and explore the possibilities together with the worker. Autonomy is an important factor in general, and a factor that must always be monitored when adjustments in work are considered. There is a lot of experience, but there are still gaps in knowledge and opportunities for more knowledge sharing.

Determinants for the implementation of person-centered tools for workers with chronic health conditions: a mixed-method study using the Tailored Implementation for Chronic Diseases checklist

BACKGROUND

The aim was to identify the most important determinants of practice for the implementation of person-centered tools which enhance work participation for patients with chronic health conditions.

METHODS

A mixed-method study was conducted consisting of semi-structured interviews, a focus group and a survey. Various stakeholders were involved including (representatives of) workers with chronic health conditions, insurance physicians, occupational physicians, other healthcare professionals, researchers, employers, and policymakers. The semi-structured interviews were performed to identify implementation determinants, followed by a focus group to validate resulting determinants. To conclude, a survey was conducted to select the most important implementation determinants through prioritization by ranking the order of importance. The Tailored Implementation of Chronic Diseases checklist (TICD) was used as concept-driven coding frame for the qualitative analysis of the interviews and focus group. The self-developed survey was based on the domains of the TICD. The survey was analyzed by frequency count of first ranking of determinants per and between domains of the TICD.

RESULTS

Various stakeholders participated (N = 27) in the interviews and focus group. The qualitative data retrieved yielded a list of determinants with additional in-depth themes according to the TICD. For the selection of the most important determinants, a survey with 101 respondents was conducted, consisting of occupational physicians, insurance physicians and workers with a chronic health condition. From the seven domains of the TICD, respondents emphasized the importance of taking into account the needs and factors associated with workers with a chronic health condition as this determinant ranked highest. Taking into account the individual needs and wishes of workers was mentioned to enable successful implementation, whereas stress of the workers was indicated to impede implementation. Other important determinants included 'being able to work with the tools' in terms of time and usability or 'cognitions, beliefs and attitudes of occupational and insurance physicians' to be able to use the tools.

CONCLUSION

This study identified the most important determinants from the perspective of various stakeholders involved in the implementation of client-centered tools in occupational health for workers with chronic health conditions. Furthermore, by prioritizing the most important determinants, targeted implementation strategies can be developed.

Characteristics and treatable traits of patients with chronic obstructive pulmonary disease (COPD) with and without paid employment

Introduction

Patients with COPD are vulnerable to workforce detachment. Better knowledge of features associated with paid work loss might be of help to design and select appropriate interventions.

Method

This cross-sectional study aimed to explore the presence of treatable traits in COPD patients without paid work. Patients with COPD below 65 years at first referral to a hospital-based patient clinic were included. Using binary logistic regression analysis, the relationship between paid work and the following characteristics was explored: low daily physical activity, exercise, active smoking, Medical Research Council dyspnea scale (MRC), poor nutritional status, exacerbations, and fatigue (checklist individual strength (CIS)). Variables were adjusted for age, sex, forced expiratory volume in 1 s (FEV 1), and education level.

Results

In total, 191 patients (47.3%) were without paid work. The following treatable traits were related to not being in paid work: < 5000 steps/day (OR 2.36, 95% CI (1.52–3.68)), MRC ≥ 3 (OR 1.78, 95%CI (1.14–2.77)), CIS ≥ 36 points (OR 1.78, 95% CI (1.10–2.87)), six-minute walk distance (6MWD) < 70% of predicted (OR 2.62, 95% CI (1.69–4.06)), and ≥ 2 exacerbations per year (OR 1.80, 95% CI (1.12–2.92)). Significant differences were also seen in age (OR 1.06, 95% CI (1.02–1.10) per year), FEV 1% predicted (OR 0.98, 95% CI (0.97–1.00) per % predicted increase), and medium/high education level (OR 0.62, 95% CI (0.41–0.93)). When adjusting for all variables the only treatable trait that remained significant was 6MWD.

Conclusion

Patients without paid work are more likely to have treatable traits with 6MWD revealing the most significant association.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12931-021-01736-6.

Employment outcomes in systemic sclerosis

Work disability is highly prevalent in the systemic sclerosis (SSc) population; yet, it is an area of research that continues to be underrecognized and underexplored. In this chapter, we review the burden of this work disability by exploring the reported prevalence of work loss, the risk factors associated with reduced work participation, the impact on work productivity outcomes, and the economic consequences of work disability in individuals with SSc. Finally, we discuss the potential challenges in the workplace and strategies that may foster employment retention in this population. We subsequently present a conceptual framework for work disability in the context of SSc, which incorporates our understanding of the various work disability concepts and the potential facilitators that may accelerate a worker toward complete work loss.

Mental work ability: young professionals with mental health problems perceive lower levels of soft skills

This article published in Gruppe Interaktion Organisation (GIO) reports study results on soft skills and mental work ability in young professionals ready to enter the job market. The so-called soft skills (psychological capacities) are nowadays an entrance ticket into the modern working world. Thus, the question is to which degree young professionals who will soon enter the labor market are fit in their soft skills. Are physical or mental health problems related with deficits in soft skills? Which dimensions of soft skills are impaired?

365 young professionals in advanced education from a technical college, who will soon enter the labor market, were investigated via online-questionnaire. Participants were asked to rate their self-perceived capacity level according to Mini-ICF-APP, mental and physical health problems, exam and education-related anxiety, self-efficacy and procrastination.

Students with mental health problems had higher exam anxiety, and lower study-related self-efficacy as compared to students without health problems at all, or students with physical health problems. But, procrastination behavior was similarly present among students with mental health problems and students with physical health problems. Students with health problems did not report globally weaker capacity levels. Lower levels of capacities depend on the type of health problem: In students with mental health problems, social soft skills were impaired rather than content-related capacities. Physical health problems do not affect the self-perceived psychological capacities.

In conclusion, focusing on specific soft skills in training and work adjustment could be fruitful in addition (or as an alternative) to training of profession-specific expertise.

Prognostic Factors for Staying at Work for Partially Sick-Listed Workers with Subjective Health Complaints: A Prospective Cohort Study

Examination of prognostic factors for staying at work for long-term sick-listed workers with subjective health complaints (SHC) who partially work in a paid job, and to evaluate whether these factors are comparable with those of workers with other disorders. We used data of 86 partially sick-listed workers with SHC (57 females, 29 males, mean age 47.1 years) and 433 with other disorders (227 females, 206 males, mean age 50.9 years), from an existing prospective cohort study consisting of 2593 workers aged 18–65 years and registered as sick-listed with different health complaints or disorders for at least 84 weeks in the database of the Dutch Social Security Institute. We performed univariable logistic regression analyses (p ≤ 0.157) for all independent variables with the dependent variable staying at work for the workers with SHC. We then performed multivariable logistic regression analyses with forward selection (p ≤ 0.157) and combined the remaining factors in a final, multivariable model (p ≤ 0.05), which we also used for logistic regression analysis in the workers with other disorders. The following factors were significant prognostic factors for staying at work for workers with SHC: full work disability benefits (odds ratio (OR) 0.07, 95% confidence interval (95% CI) 0.01–0.64), good mental health (OR 1.08, 95% CI 1.02–1.14), positive expectations for staying at work (OR 6.49, 95% CI 2.00–21.09), previous absenteeism for the same health complaint (OR 0.31, 95% CI 0.10–0.96) and good coping strategies (OR 1.13, 95% CI 1.04–1.23). For workers with other disorders, full work disability benefits, good mental health and positive expectations for staying at work were also prognostic factors for staying at work. Individual and policy factors seem to be important for staying at work of sick-listed workers with SHC and those with other disorders alike, but several biopsychosocial factors are particularly important for workers with SHC.

Occupational Activity After Renal Transplantation vs Quality of Life, Personality Profile, and Stress Coping Styles

INTRODUCTION

Kidney transplantation (KT) increases the quality of life (QoL) of patients with chronic kidney disease. Employment is one the objective indicators of KT success. The aim of the presented study was to assess the psychological predispositions of KT and hemodialysis (HD) patients, such as stress coping styles, chosen personality features, and their relationship with employment and QoL.

MATERIAL AND METHODS

One hundred and sixty-one persons were examined, 101 after KT, and 60 HD patients. The following methods were applied: NEO-FFI Personality Inventory; Coping Inventory for Stressful Situations (CISS); WHOQoL-BREF; and general survey, measuring sociodemographic data and work experience.

RESULTS

In the KT group, 58 persons were employed and 43 were unemployed. HD patients were mostly unemployed, with only 15 persons working. Significant differences were identified between the results of the following variables: WHOQoL environmental scale (employed m= 16.8, standard deviation [SD] = 3; unemployed m= 15, SD = 2.8); extraversion (employed m = 6.7, SD = 2; unemployed m = 5.6, SD = 2); somatic WHOQoL scale (HD m = 12.2, SD = 2.7; KT m = 14.2, SD = 3.5). In the KT group, the following correlations were identified: extraversion with contact seeking strategy (r = 0.553), agreeableness (r = 0.245), and conscientiousness (r = 0.384); agreeableness with conscientiousness (r = 0.336). In the HD group, the following correlations were identified: task-oriented style with conscientiousness (r = 0.474); avoidance-oriented style with conscientiousness (r = -0.466); contact seeking with extraversion (r = 0.402) and agreeableness (r = 0.469).

CONCLUSIONS

The following conclusions were reached: Social competence, such as seeking and maintaining contacts, positively translates to features connected with occupational activity. Social skills strengthen the organization of healthier environment and increase QoL. Employed patients have higher social skills and QoL.

The positive effect of workplace accommodations on the continued employment of cancer survivors five years after diagnosis

PURPOSE

To address the gap highlighted in the literature on the effect of professional interventions to facilitate continued employment, this study aims to evaluate the effect of workplace accommodations on the continued employment 5 years after a cancer diagnosis.

METHODS

This study is based on VICAN5, a French survey conducted in 2015-2016 to examine the living conditions of cancer survivors 5 years after diagnosis. Two subsamples, one with and one without workplace accommodations, were matched using a propensity score to control for the individual, professional, and medical characteristics potentially associated with receipt of workplace accommodations.

RESULTS

The study sample was composed of 1514 cancer survivors aged 18-54 and employed as salaried at diagnosis. Among them, 61.2% received workplace accommodations within 5 years after diagnosis: 35.5% received a modified workstation, 41.5% received a modified schedule, and 49.2% received reduced hours. After matching, receipt of workplace accommodations appeared to improve the continued employment rate 5 years after cancer diagnosis from 77.8% to 95.0%.

CONCLUSIONS

Receipt of workplace accommodations strongly increases the continued employment of cancer survivors 5 years after diagnosis. More research is needed to better understand the differences in receipt of workplace accommodations along with the related selection effect.

Entering the labor market: increased employment rates of young adults with chronic physical conditions after a vocational rehabilitation program

PURPOSE

Employment of young adults with chronic physical conditions entering the labor market after finishing post-secondary education remains behind compared to typically developing peers. The aim of this study is to evaluate changes in their paid employment levels after following a vocational rehabilitation intervention ('At Work').

MATERIALS AND METHODS

Participants aged between 16 and 27 years (n = 90) were recruited via rehabilitation physicians and a jobcoach agency and participated in a vocational rehabilitation program. Cochran's Q and McNemar tests served to test the development of intervention participants' paid employment over time. Chi-square tests were used to compare intervention participants' paid employment level with national reference data selected on age and having a self-reported chronic physical condition.

RESULTS

Paid employment level of the intervention cohort significantly increased from 10.0% at baseline to 42.4% at 2-years follow-up (p < 0.001). At 2-years follow-up, their employment rates approached the employment rates of national reference data (42.4% versus 52.9%, p = 0.17).

CONCLUSION

Starting from a disadvantaged position, the paid employment rate of the intervention cohort substantially increased over time, approaching the employment rate of reference data. 'At Work' seems to be appropriate for supporting this specific group who face obstacles to enter the labor market, to find competitive employment.IMPLICATIONS FOR REHABILITATION'At Work' is a vocational rehabilitation intervention for young adults with chronic physical conditions who experience problems with finding and maintaining competitive employment after finishing post-secondary education.The 'At Work' intervention entails a combination of group sessions and individual coaching sessions based on the supported employment methodology.Paid employment rates of the intervention cohort substantially increased on the short- and long term, and approached employment rates of reference data of persons with chronic physical conditions.The 'At Work' intervention seems appropriate to support young adults with chronic physical conditions who experience barriers for work participation, to enter the labor market and find competitive and sustainable employment.

Examining the Likelihood of Experiencing Productivity Loss and Receiving Social Security Disability Income Following the Onset of Chronic Disease

OBJECTIVE

The aim of the study was to examine the likelihood of reporting productivity loss and receiving social security disability (SSD) income following a chronic health condition diagnosis using a longitudinal panel design.

METHODS

Using the Panel Study of Income Dynamics, logistic regression analyses were conducted to estimate the likelihood of reporting productivity loss or receiving SSD following the diagnosis of arthritis, cancer, psychological problems, or heart conditions. Respondents reporting a new diagnosis of a condition were matched with five similarly aged respondents not reporting a diagnosis.

RESULTS

For all conditions except cancer, the odds of reporting productivity loss and receiving SSD increased at both the wave where the condition was first reported and 2 years after for respondents reporting a condition compared with those not reporting a condition.

CONCLUSIONS

The onset of chronic disease increases the likelihood of experiencing productivity loss and receiving SSD.

Chronic Diseases and Employment: Which Interventions Support the Maintenance of Work and Return to Work among Workers with Chronic Illnesses? A Systematic Review

The increase of chronic diseases worldwide impact quality of life, cause economic and medical costs, and make it necessary to look for strategies and solutions that allow people with chronic diseases (PwCDs) to lead an active working life. As part of the CHRODIS Plus Joint European Action project, a systematic review was conducted to identify studies of interventions that support the maintenance of work and return to work (RTW) among workers with chronic illnesses. These interventions should target employees with the following conditions: diabetes, cardiovascular diseases, metabolic vascular syndrome, respiratory diseases, musculoskeletal disorders, mental disorders, and neurological disorders. An extensive search was performed in PubMed, EMBASE, and PsycINFO for English language studies. Included in this review were 15 randomized controlled trials (RCT) for adult employees (aged 18+). We found that workplace-oriented and multidisciplinary programs are the most supportive to RTW and reducing the absence due to illness. In addition, cognitive behavioral therapies achieve positive results on RTW and sick leave. Finally, coaching is effective for the self-management of chronic disease and significantly improved perceptions of working capacity and fatigue.

The Public Health Responsibility Deal: making the workplace healthier?

Background

The Public Health Responsibility Deal (RD) in England is a public-private partnership which aims to improve public health by addressing issues such as health at work. This paper analyses the RD health at work pledges in terms of their likely effectiveness and added value.

Methods

A review of evidence on the effectiveness of the RD 'health at work' pledges to improve health in the workplace; analysis of publically available data on signatory organizations' plans and progress towards achieving the pledges; and assessment of the likelihood that workplace activities pledged by signatories were brought about by participating in the RD.

Results

The 'health at work' pledges mostly consist of information sharing activities, and could be more effective if made part of integrated environmental change at the workplace. The evaluation of organizations' plans and progress suggests that very few actions (7%) were motivated by participation in the RD, with most organizations likely (57%) or probably (36%) already engaged in the activities they listed before joining the RD.

Conclusions

The RD's 'health at work' pledges are likely to contribute little to improving workplace health as they stand but could contribute more if they were incorporated into broader, coherent workplace health strategies.

To work despite chronic health conditions: a qualitative study of workers at the Swedish Public Employment Service

OBJECTIVES

Achieving a sustainable, healthy and long working life is key prerequisite for meeting the demographic challenge posed by an ageing population so that more people can work on into their later years. The objective of this study is to explore the relationship between work and chronic health conditions in a group of employees aged 50-64 years with a focus on factors that enable them to continue to work.

METHODS

Ten white-collar workers with one or more chronic health conditions at the Swedish Public Employment Service participated in the study. A qualitative method with semistructured in-depth interviews was used to collect data.

RESULTS AND CONCLUSIONS

This study shows that factors enabling people with chronic health conditions to work include adaptation of the work situation by task-shifting as well as provision of physical aids. Our study suggest that the changes often come at the employee's initiative; hence, there is potential for greater involvement from the employer, healthcare agencies and the social insurance fund in making it easier for employees to adapt their work situation and in providing information regarding available support. It confirms findings in earlier studies that health plays an important part and also that self-confidence and motivation are significant factors contributing to workers being able and wanting to continue working.

The evidence base for psychological interventions for rheumatoid arthritis: A systematic review of reviews

BACKGROUND

Psychological interventions are an important but often overlooked adjunctive treatment option for patients with rheumatoid arthritis. Findings from systematic reviews of psychological interventions for this patient group are conflicting. A systematic review of reviews can explain inconsistencies between studies and provide a clearer understanding of the effects of interventions.

OBJECTIVES

To: 1) determine the effectiveness of psychological interventions in improving biopsychosocial outcomes for adults with rheumatoid arthritis, 2) determine the relationship between the intensity of the psychological interventions (number of sessions, duration of sessions, duration of intervention) on outcomes, and 3) assess the impact of comparator group (usual care, education only) on outcomes.

DESIGN

We conducted a systematic review of reviews using the following inclusion criteria: 1) randomised controlled trials of psychological interventions (including cognitive behavioural therapy, supportive counselling, psychotherapy, self-regulatory techniques, mindfulness-based cognitive therapy and disclosure therapy) provided as an adjunct to medication, 2) included rheumatoid arthritis patients aged ≥ 18 years, 3) reported findings for at least 1 of the primary outcomes: pain, fatigue, psychological status, functional disability and disease activity and 4) were published in English between January 2000 and March 2015 (updated January 2018).

DATA SOURCES

We searched in MEDLINE, EMBASE, CINAHL, PsycINFO, the Cochrane Database of Systematic Reviews and the Database of Abstracts of Reviews of Effects. Reference lists were searched for additional reviews.

REVIEW METHODS

Study selection and 50% of the quality assessments were performed by two independent reviewers. Methodological quality was measured using the Assessment of Multiple Systematic Reviews checklist. Data extraction was conducted by one reviewer using a predesigned data extraction form.

RESULTS

Eight systematic reviews met inclusion criteria (one review was excluded due to its low-quality score). Small post intervention improvements in patient global assessment, functional disability, pain, fatigue, anxiety and depression were observed. The effect on coping, self-efficacy and physical activity was greater. Improvements in depression, coping and physical activity were maintained (8.5-14 months). Interventions delivered over a longer period with a maintenance component appeared more effective. Attention, education, and placebo control groups produced some improvements but not as large as those produced by the psychological interventions.

CONCLUSIONS

Psychological interventions result in small to moderate improvements in biopsychosocial outcomes for patients with rheumatoid arthritis in addition to those achieved by standard care. Several priorities for future research were identified, including determining the cost effectiveness of non-psychologically trained health professionals delivering psychological interventions.

Positive psychological interventions for people with epilepsy: An assessment on factors related to intervention participation

BACKGROUND

Positive psychological interventions (PPI) are increasingly employed as a coping strategy with physical and mental conditions, including neurological diseases. Its effectiveness on improving wellbeing in people with epilepsy (PWE) has been shown in a few studies. This study aimed to explore factors related to participants' willingness to engage in psychological interventions from the perspective of patients with epilepsy.

METHODS

Participants answered a needs assessment questionnaire eliciting information about their illness perception (Brief Illness Perception Questionnaire (Brief-IPQ)), emotions (Hospital Anxiety and Depression Scale (HADS)), willingness to participate in psychological interventions, preferences in types of PPI and intervention designs, as well as barriers in seeking mental health services.

RESULTS

A total of 154 patients with epilepsy participated, with a mean age of 37.3years (range 16-86years). Most patients had focal epilepsy (68.2%), and drug-resistant (59.1%). Majority (71.4%) of them indicated a strong willingness to participate in PPI. Out of nine types of PPI, character strengths, mindfulness-based and expressive-based interventions were highly preferred. Those with negative illness perception (p=0.001), anxiety (p=0.004), and being unemployed (p=0.048) were more willing to participate in PPI. Most participants preferred group rather than individual session, and a shorter duration (30min) was favored by most.

CONCLUSION

This study captured the self-report willingness to participate in psychological interventions. Findings suggested that psychological interventions delivered in short-group session were highly preferred. Future study is required to determine the feasibility of such design for patients with epilepsy.

Employment among Patients Starting Dialysis in the United States

BACKGROUND AND OBJECTIVES

Patients with ESRD face significant challenges to remaining employed. It is unknown when in the course of kidney disease patients stop working.

DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS

We examined employment trends over time among patients ages 18-54 years old who initiated dialysis in the United States between 1996 and 2013 from a national ESRD registry. We compared unadjusted trends in employment at the start of dialysis and 6 months before ESRD and used linear probability models to estimate changes in employment over time after adjusting for patient characteristics and local unemployment rates in the general population. We also examined employment among selected vulnerable patient populations and changes in employment in the 6 months preceding dialysis initiation.

RESULTS

Employment was low among patients starting dialysis throughout the study period at 23%-24%, and 38% of patients who were employed 6 months before ESRD stopped working by dialysis initiation. However, after adjusting for observed characteristics, the probability of employment increased over time; patients starting dialysis between 2008 and 2013 had a 4.7% (95% confidence interval, 4.3% to 5.1%) increase in the absolute probability of employment at the start of dialysis compared with patients starting dialysis between 1996 and 2001. Black and Hispanic patients were less likely to be employed than other patients starting dialysis, but this gap narrowed during the study period.

CONCLUSIONS

Although working-aged patients in the United States starting dialysis have experienced increases in the adjusted probability of employment over time, employment at the start of dialysis has remained low.

Predictors of Empowerment in Individuals With Type 2 Diabetes Mellitus

Introduction: Type 2 diabetes is a chronic, progressive disease that has reached pandemic proportions. In Turkey, the frequency of diabetes in individuals aged 20 years or older has been reported to be 13.7% compared with the worldwide prevalence of 8.5%. Empowerment has been correlated with improvement in diabetic self-management capabilities and glycemic control. The purpose of this study was to examine predictors of “empowerment” in individuals with type 2 diabetes from Turkey. Method: This was a secondary analysis with a cross-sectional correlation design using stepwise linear regression to evaluate previously collected data from 220 type 2 diabetic individuals in Turkey from January through July 2014. Demographic and Disease-Related Information Form, Diabetes Empowerment Scale, and Multidimensional Scale of Perceived Social Support were used to collect the research data. Results: Being educated about diabetes (β = .22, p < .001), high school (β = .16, p = .007), university (β = .12, p = .046), age (β = −.18, p = .003), social support (β = .15, p = .027), employment status (β = .13, p = .045), and A1C (β = −.12, p = .046) were statistically significant predictors of empowerment of type 2 diabetic individuals, and these variables explained 30% of the common variance. Discussion: It is important for nurses to assess sources of social support and integrate the results of this assessment to ensure the empowerment of the patient during diabetes education. For the empowerment of diabetic individuals, attempts should be made to increase the diabetes literacy levels of diabetic individuals who have low level of education and who are in the older age group, and patients who can get employed could be directed to work life.

Acceptability of a vocational advice service for patients consulting in primary care with musculoskeletal pain: A qualitative exploration of the experiences of general practitioners, vocational advisers and patients

AIMS

Using qualitative interviews, this study explored the experiences of GPs, vocational advisers and patients towards a new vocational advice (VA) service in primary care.

METHODS

This study was nested within the Study of Work and Pain (SWAP) cluster randomised controlled trial. The SWAP trial located a VA service within three general practices in Staffordshire. Interviews took place with 10 GPs 12 months after the introduction of the VA service, four vocational advisers whilst the VA service was running and 20 patients on discharge from the VA service. The data were analysed using the constant comparative method, which is a variation of grounded theory.

RESULTS

The key factors determining the acceptability and perceived effectiveness of the VA service from the perspective of the three groups of stakeholders were (1) the timing of referrals to the VA, (2) the perceived lack of patient demand for the service and (3) role uncertainty experienced by VAs.

CONCLUSIONS

Early vocational intervention may not be appropriate for all musculoskeletal patients with work difficulties. Indeed, many patients felt they did not require the support of a VA, either because they had self-limiting work difficulties and/or already had support mechanisms in place to return to work. Future VA interventions may be better implemented in a targeted way so that appropriate patients are identified with characteristics which can best be addressed by the VA service.

The economic impact of early retirement attributed to rheumatic diseases: results from a nationwide population-based epidemiologic study

OBJECTIVES

To measure early retirement due to self-reported rheumatic diseases (RDs) and to estimate the respective indirect costs and years of working life lost (YWLL).

METHODS

We used individual level data from the national, cross-sectional, population-based EpiReumaPt study (September 2011-December 2013) where 10,661 inhabitants were randomly surveyed in order to capture and characterize all cases of RD within a representative sample of the Portuguese population. In this analysis, we used all participants aged between 50 and 64 years, near the official retirement age. A national database was used to calculate productivity values by gender, age and region, using the human capital approach. YWLL were estimated as the difference between each participant's current age and the respective retirement age, while the potential years of working life lost (PYWLL) were given by the difference between official and actual retirement ages. We also calculated the percentage of time in inactivity (inactivity ratio = YWLL/Active age-range [15-64 years old]).

RESULTS

29.9% of the Portuguese population with ages between 50 and 64 years were retired with 13.1% self-reporting retirement due to RD. The estimated annual indirect cost following premature retirement attributed to RD was €910 million (€555 per capita; €1625 per self-reported RD patient and €13,592 per early retiree due to RD). Females contributed with 84% for these costs (€766 million; €882 per capita vs €187 from males). We observed a total number of 389,939 accumulated YWLL (228 per 1000 inhabitants) and 684,960 PYWLL (401 per 1000 inhabitants). The mean YWLL and PYWLL inactivity ratios were 12% and 21%, respectively. RD patients with higher values of disability have the highest risk of early retirement.

CONCLUSIONS

Early retirement attributed to self-reported RD amounts to approximately 0.5% of the national gross domestic product (GDP) in 2013, due to large YWLL. Both the public health concern and the economic impact highlight the need to prioritize investments in health and social protection policies targeting patients with rheumatic conditions.

Patterns in workplace accommodations for people with multiple sclerosis to overcome cognitive and other disease-related limitations

BACKGROUND

Cognitive symptoms and other functional limitations associated with multiple sclerosis (MS) have a significant negative impact on employment status. Work accommodations positively impact the ability of a person with MS to obtain and retain employment, however, current understanding of the role of accommodations in the careers of adults with MS is limited.

OBJECTIVE

To analyze the percentage of American workers with MS who utilize workplace accommodations as per Title I of the ADA, the types of accommodations most frequently required, and differences in disease variables, job-related factors, and quality of life between workers using and not using work accommodations.

METHODS

Data from 746 employed adult members of the National MS Society surveyed about career concerns were analyzed. Descriptive and inferential statistics were used as appropriate to address the research questions.

RESULTS

Approximately 25% reported having requested accommodations, and 87.7% reported receiving the requested accommodation. Participants with progressive MS, cognitive impairment, higher number of MS symptoms and greater symptom severity were more likely to use work accommodations. Participants with accommodations reported poorer job match and career optimism than those using no accommodations.

CONCLUSION

This large-scale analysis addresses several outstanding questions concerning work accommodations among workers with MS. Cognitive symptoms and disease severity are strongly associated with need for accommodations, however accommodations do not appear to promote job satisfaction or longevity. The accommodation request process and the impact of accommodations on employment retention remain important research foci.

Understanding Work Experiences of People with Inflammatory Bowel Disease

BACKGROUND

People with inflammatory bowel disease (IBD) are at increased risk for unemployment and work absenteeism over the course of their adult lives. However, little is known about the firsthand experiences of people living with the disease regarding perceived barriers, facilitators, and strategies for navigating work roles.

METHODS

In this qualitative study, participants were purposefully recruited from 2 existing IBD cohort study samples. Recruitment strategies aimed for diversity in age, sex, and disease type, duration, and symptom activity. In-depth interviews sought perspectives of living with IBD. Data were analyzed using inductive qualitative methods.

RESULTS

Forty-five people currently or previously in the workforce participated; 51% were female. The mean age was 45.4 years (SD = 16.1; range = 21-73 years). Mean IBD duration was 10.9 years (SD = 6.3). Participants had a broad range of experiences in adapting to work roles. IBD symptoms and treatments interacted with other personal and environmental factors to shape the experiences of work. Experiences were shaped by: (1) personal health and well-being, (2) personal values, beliefs, and knowledge, (3) job characteristics, (4) workplace physical environment, (5) workplace culture, and (6) financial factors. Participants identified personal strategies and environmental supports that assisted them to navigate their work roles.

CONCLUSIONS

The perspectives of people with IBD provided in-depth understanding of contextual factors that influence work roles. They identified personal strategies to manage health and choices about work, environmental supports that promote timely workplace accommodations, and appropriate social insurance benefits as facilitators of work retention for people with IBD.

Work stress and cardiovascular disease: a life course perspective

Individuals in employment experience stress at work, and numerous epidemiological studies have documented its negative health effects, particularly on cardiovascular disease (CVD). Although evidence on the various interrelationships between work stress and CVD has been accumulated, those observations have not yet been conceptualized in terms of a life course perspective. Using the chain of risk model, we would like to propose a theoretical model incorporating six steps: (1) work stress increases the risk of incident CVD in healthy workers. (2) Among those whose work ability is not fully and permanently damaged, work stress acts as a determinant of the process of return to work after CVD onset. (3) CVD patients experience higher work stress after return to work. (4) Work stress increases the risk of recurrent CVD in workers with prior CVD. (5) CVD patients who fully lose their work ability transit to disability retirement. (6) Disability retirees due to CVD have an elevated risk of CVD mortality. The life course perspective might facilitate an in-depth understanding of the diverse interrelationships between work stress and CVD, thereby leading to work stress management interventions at each period of the lifespan and three-level prevention of CVD.

Interventions to enhance work participation of workers with a chronic disease: a systematic review of reviews

The aim of this systematic review was to provide an overview of the available effective interventions that enhance work participation of people with a chronic disease, irrespective of their diagnosis. A search was conducted in PubMed, EMBASE, PsycINFO, CINAHL and the Cochrane Library, searching for systematic reviews published between 2004 and February 2015. Systematic reviews were eligible for inclusion if they described an intervention aimed at enhancing work participation and included participants of working age (18-65 years) with a chronic disease. Reviews had to include populations having different chronic diseases. The quality of the included reviews was evaluated using the quality instrument AMSTAR. Results of reviews of medium and high quality were described in this review. The search resulted in 9 reviews, 5 of which were of medium quality. No high quality reviews were retrieved. 1 review reported inconclusive evidence for policy-based return to work initiatives. The 4 other reviews described interventions focused on changes at work, such as changes in work organisation, working conditions and work environment. Of these 4 reviews, 3 reported beneficial effects of the intervention on work participation. Interventions examined in populations having different chronic diseases were mainly focused on changes at work. The majority of the included interventions were reported to be effective in enhancing work participation of people with a chronic disease, indicating that interventions directed at work could be considered for a generic approach in order to enhance work participation in various chronic diseases.

Employment after liver transplantation: a review

BACKGROUND

Return to productive employment is often an important milestone in the recovery and rehabilitation process after liver transplantation (OLT). This literature review identifies factors associated with employment in patients who underwent OLT.

METHODS

We searched PubMed for articles that addressed the various factors affecting employment after OLT.

RESULTS

The studies demonstrated improvement in the quality of life and examined factors that predicted whether patients would return to work after OLT. Demographic variable associated with posttransplant employment included young age, male sex, college degree, Caucasian race, and pretransplant employment. Patients with alcohol-related liver disease had a significantly lower rate of employment than did those with other etiologies of liver disease. Recipients who were employed after transplantation had a significantly better posttransplant functional status than did those who were not employed.

CONCLUSION

Economic pressures are increasing the expectation that patients who undergo successful OLT will return to work. Thus, transplant teams need to have a better understanding of posttransplant work outcomes for this vulnerable population, and greater attention must be paid to the full social rehabilitation of transplant recipients. Specific interventions for OLT recipients should be designed to evaluate and change their health perceptions and encourage their return to work.

Factors Associated With Work Ability in Patients Undergoing Surgery for Cervical Radiculopathy

STUDY DESIGN

Cross-sectional study.

OBJECTIVE

To investigate the factors associated with work ability in patients undergoing surgery for cervical radiculopathy.

SUMMARY OF BACKGROUND DATA

Surgery is a common treatment of cervical radiculopathy in people of working age. However, few studies have investigated the impact on the work ability of these patients.

METHODS

Patients undergoing surgery for cervical radiculopathy (n = 201) were recruited from spine centers in Sweden to complete a battery of questionnaires and physical measures the day before surgery. The associations between various individual, psychological, and work-related factors and self-reported work ability were investigated by Spearman rank correlation coefficient, multivariate linear regression, and forward stepwise regression analyses. Factors that were significant (P < 0.05) in each statistical analysis were entered into the successive analysis to reveal the factors most related to work ability. Work ability was assessed using the Work Ability Index.

RESULTS

The mean Work Ability Index score was 28 (SD, 9.0). The forward stepwise regression analysis revealed 6 factors significantly associated with work ability, which explained 62% of the variance in the Work Ability Index. Factors highly correlated with greater work ability included greater self-efficacy in performing self-cares, lower physical load on the neck at work, greater self-reported chance of being able to work in 6 months' time, greater use of active coping strategies, lower frequency of hand weakness, and higher health-related quality of life.

CONCLUSION

Psychological, work-related and individual factors were significantly associated with work ability in patients undergoing surgery for cervical radiculopathy. High self-efficacy was most associated with greater work ability. Consideration of these factors by surgeons preoperatively may provide optimal return to work outcomes after surgery.

LEVEL OF EVIDENCE

3.

Chronic disease self-management program in the workplace: opportunities for health improvement

Disease management is becoming increasingly important in workplace health promotion given the aging workforce, rising chronic disease prevalence, and needs to maintain a productive and competitive American workforce. Despite the widespread availability of the Chronic Disease Self-Management Program (CDSMP), and its known health-related benefits, program adoption remains low in workplace settings. The primary purpose of this study is to compare personal and delivery characteristics of adults who attended CDSMP in the workplace relative to other settings (e.g., senior centers, healthcare organizations, residential facilities). This study also contrasts characteristics of CDSMP workplace participants to those of the greater United States workforce and provides recommendations for translating CDSMP for use in workplace settings. Data were analyzed from 25,664 adults collected during a national dissemination of CDSMP. Only states and territories that conducted workshops in workplace settings were included in analyses (n = 13 states and Puerto Rico). Chi-squared tests and t-tests were used to compare CDSMP participant characteristics by delivery site type. CDSMP workplace participant characteristics were then compared to reports from the United States Bureau of Labor Statistics. Of the 25,664 CDSMP participants in this study, 1.7% (n = 435) participated in workshops hosted in worksite settings. Compared to CDSMP participants in non-workplace settings, workplace setting participants were significantly younger and had fewer chronic conditions. Differences were also observed based on chronic disease types. On average, CDSMP workshops in workplace settings had smaller class sizes and workplace setting participants attended more workshop sessions. CDSMP participants in workplace settings were substantially older and a larger proportion were female than the general United States workforce. Findings indicate opportunities to translate CDSMP for use in the workplace to reach new target audiences.

Vocational Counseling of HIV-infected People: A Role for Nurses in HIV Care

People living with HIV (PLWH) face various work-related problems, such as stigma and physical difficulties. Health care professionals can help improve the employment situation of PLWH. Nurses who work in HIV care play a central role in the care of PLWH in the Netherlands. The aim of this cross-sectional study was to investigate the contributions of nurses to the vocational counseling of PLWH, and to make an inventory of needs for future care. Our findings, collected with a self-administered survey, clarified that HIV nurses in the Netherlands regularly faced patients with problems at work, but that they didn't have the required knowledge to provide assistance. Our study emphasized the important role of HIV nurses in vocational counseling because of their central positions in care and their confidential relationship with patients. The study underlined the importance of available, up-to-date knowledge about HIV and work, as well as a clear referral network.

Factors related to participation in paid work after organ transplantation: perceptions of kidney transplant recipients

PURPOSE

Following kidney transplantation, recipients often have difficulty returning to meaningful occupations, including paid employment. The purpose of the current study was to describe the sociodemographic profile of kidney transplant recipients at a major Canadian Transplant Centre and to identify factors perceived to affect participation in paid work post-transplant.

METHODS

Of the 530 kidney recipients who had received a kidney transplant at our facility between 2003 and 2008, 144 recipients were randomly selected, and mailed a questionnaire.

RESULTS

There were 60 returned questionnaires (41.7 % response rate). The average age of responders was 49.4 years and the majority were male (68.3 %). While the rate of employment decreased significantly (p = 0.00) from 68.3 % pre- to 38.3 % post-transplant, retirement rates increased significantly (p = 0.00) from 8.3 % pre- to 18.3 % post-transplant. The responders, who were not working post-transplant, more likely lived alone (p = 0.05), had a lower level of education (p = 0.02), and had lower perceived emotional (p = 0.00) and physical (p = 0.00) health status compared to those who returned to work post-transplant. Gender, donor type, age, and post-transplant complications did not differ (p > 0.05) between the working and not working groups. Both person- and work-related factors impacted on return to paid work post-transplant. Most responders (working and not working) reported feeling emotionally and physically ready to work after their transplant. Work-related enablers included positive employer attitude towards medical history and employer agreement that recipients could take time off for medical appointments. Of those returning to work, the nature of their jobs changed from heavy physical demands to sedentary work. There was a 20.0 % increase in reliance on government disability insurance post-transplant. Responders recommended the development of a rehabilitation program focused on working and consulting with transplant recipients' employers to further enable successful reintegration into the workplace after transplantation.

CONCLUSIONS

The ability to return to paid work after kidney transplant is a complex phenomenon, likely impacted by a combination of person- and work-related factors, which contributed to how individuals perceived their abilities to attain or return to paid work. It is important that in facilitating renal transplant recipients to resume valued life occupations such as paid work, the dynamic interactions between personals values, perception of one's abilities, skills, job requirements and employer characteristics be considered.

Quality of working life issues of employees with a chronic physical disease: a systematic review

PURPOSE

To assess issues that contribute to the Quality of Working Life (QWL) of employees with a chronic physical disease.

METHODS

A systematic literature search was conducted using the databases PubMed, PsycINFO and EMBASE. Experiences and perceptions during the working life of employees with a chronic physical disease were extracted and synthesized into issues that contributed to their QWL. We organized these synthesized QWL issues into higher order themes and categories with qualitative data analysis software.

RESULTS

From a total of 4,044 articles identified by the search, 61 articles were included. Data extraction and data synthesis resulted in an overview of 73 QWL issues that were classified into 30 themes. The following five categories of themes were identified: (1) job characteristics with issues such as job flexibility and work-site access; (2) the social structure and environment containing issues about disclosure, discrimination, misunderstanding, and awareness by employers or colleagues; (3) organizational characteristics with issues such as requesting work accommodations; (4) individual work perceptions including issues about enjoyment and evaluating work or life priorities; and (5) effect of the disease and treatment including issues about cognitive and physical health and work ability.

CONCLUSION

This systematic review offers an extensive overview of issues that might contribute to the QWL of employees with a chronic physical disease. This overview may function as a starting point for occupational support, such as monitoring and evaluating the QWL of employees with a chronic physical disease during return-to-work and work continuation processes.

Employment Among Working-Age Adults With Multiple Sclerosis: A Data-Mining Approach to Identifying Employment Interventions

Purpose:To examine demographic, functional, and clinical multiple sclerosis (MS) variables affecting employment status in a national sample of adults with MS in the United States.

Method:The sample included 4,142 working-age (20–65 years) Americans with MS (79.1% female) who participated in a national survey. The mean age of participants was 51.93 years (SD= 8.7). The dependent variable was employment status. The predictor variables included a set of demographic, functional, and MS variables.

Results:The chi-squared automatic interaction detector (CHAID) analysis indicated that participants who were receiving Social Security Disability Insurance (SSDI) had significantly lower rates of employment (8.6%) than those who were not receiving SSDI (53.9%). For those not receiving SSDI, the most important factor predicting employment status was MS impact on physical functioning, as measured with the Multiple Sclerosis Impact Scale Physical Impact scale.

Conclusion:The data-mining approach (i.e., CHAID analysis) provided detailed information and insight about interactions among demographic, functional, and clinical variables and employment status through the segmentation of the sample into mutually exclusive homogeneous subgroups. Implications for rehabilitation intervention, based on these subgroupings, are discussed.

Multiple Sclerosis and Employment: A Research Review Based on the International Classification of Function

Multiple sclerosis (MS) is an unpredictable, sometimes progressive chronic illness affecting people in the prime of their working lives. This article reviews the effects of MS on employment based on the World Health Organization’s International Classification of Functioning, Disability and Health model. Correlations between employment and personal, functional, environmental, and participation factors are discussed along with the need for a framework for evidence-based practice regarding the employment of people with MS.

Collaboration between general practitioners and occupational physicians: a comparison of the results of two national surveys in France

OBJECTIVE

To study the perceptions that general practitioners (GPs) and occupational physicians (OPs) have of GPs' role in occupational health and their willingness to work together to prevent the exclusion of patients with disabilities from the workplace.

METHODS

Cross-sectional telephone survey of two randomly selected national samples of GPs and OPs was conducted.

RESULTS

The majority of GPs and OPs are in favor of cooperation, especially to prevent exclusion from the workplace. However, some GPs lack trust in OPs' independence, an attitude associated negatively with the practice of GP referral to OPs to anticipate disability-related problems likely to occur when returning to work after a prolonged sick leave.

CONCLUSIONS

There are some barriers to cooperation, on the part of both OPs and GPs. Initiatives are needed to encourage cooperation between these two types of physicians.

Communicating with employers: experiences of occupational therapists treating people with musculoskeletal conditions

PURPOSE

Many employed people with musculoskeletal conditions rely on healthcare practitioners, including occupational therapists, for work-related advice and support. Good communication between healthcare practitioners and employers is considered vital in facilitating work retention and return to work. The purpose of this study was to explore the experiences of occupational therapists in communicating with patients' employers.

METHODS

Qualitative data were collected from the responses of occupational therapists to ten statements/open questions in a questionnaire survey of UK occupational therapists. Data were copied verbatim into word documents and analysed thematically.

RESULTS

A total of 649 comments were made by 143 respondents. Five themes were identified that were associated with communicating with employers: patient-dependent; employer-dependent; therapist-dependent; extrinsic factors; methods of communication.

CONCLUSION

This study has identified that communication between occupational therapists and employers is influenced by a number of factors, including those which are outside the therapists' control. These need to be acknowledged and addressed by therapists, their professional organisation, employers, commissioners, therapy service managers, educators and employees in order to support return-to-work and work retention of people with musculoskeletal conditions.

"Employment and arthritis: making it work" a randomized controlled trial evaluating an online program to help people with inflammatory arthritis maintain employment (study protocol)

BACKGROUND

Arthritis and musculoskeletal conditions are the leading cause of long-term work disability (WD), an outcome with a major impact on quality of life and a high cost to society. The importance of decreased at-work productivity has also recently been recognized. Despite the importance of these problems, few interventions have been developed to reduce the impact of arthritis on employment. We have developed a novel intervention called "Making It Work", a program to help people with inflammatory arthritis (IA) deal with employment issues, prevent WD and improve at-work productivity. After favorable results in a proof-of-concept study, we converted the program to a web-based format for broader dissemination and improved accessibility. The objectives of this study are: 1) to evaluate in a randomized controlled trial (RCT) the effectiveness of the program at preventing work cessation and improving at-work productivity; 2) to perform a cost-utility analysis of the intervention.

METHODS/DESIGN

526 participants with IA will be recruited from British Columbia, Alberta, and Ontario in Canada. The intervention consists of a) 5 online group sessions; b) 5 web-based e-learning modules; c) consultations with an occupational therapist for an ergonomic work assessment and a vocational rehabilitation counselor. Questionnaires will be administered online at baseline and every 6 months to collect information about demographics, disease measures, costs, work-related risk factors for WD, quality of life, and work outcomes. Primary outcomes include at-work productivity and time to work cessation of > 6 months for any reason. Secondary outcomes include temporary work cessation, number of days missed from work per year, reduction in hours worked per week, quality adjusted life year for the cost utility analysis, and changes from baseline in employment risk factors. Analysis of Variance will evaluate the intervention's effect on at-work productivity, and multivariable Cox regression models will estimate the risk of work cessation associated with the intervention after controlling for risk factors for WD and other important predictors imbalanced at baseline.

DISCUSSION

This program fills an important gap in arthritis health services and addresses an important and costly problem. Knowledge gained from the RCT will be useful to health care professionals, policy planners and arthritis stakeholders.

TRIAL REGISTRATION

ClinicalTrials.gov NCT01852851; registered April 13, 2012; first participant randomized on July 6, 2013.

Exploring loss and replacement of loss for understanding the impacts of epilepsy onset: a qualitative investigation

Previous research identifies loss as a key concept for our understanding of the impact of chronic illness. In this in-depth qualitative study, we explored the utility of the concept of loss and loss replacement as a means of gaining a fuller understanding of the implications of a diagnosis of epilepsy for overall quality of life (QOL). Potential participants were identified from the database of a large UK-based randomized controlled trial of antiepileptic drug treatment for new-onset epilepsy and selected using purposive sampling methods. In-depth interviews were conducted with 67 people; interview material was analyzed thematically. Our findings confirm 'loss' as a key concept in understanding epilepsy impact. Participants cited profound physical and social losses, and the links between these and psychological loss were clearly articulated. Informants described two main processes via which the linked losses they experienced occurred: personal withdrawal processes and externally enforced processes. Seizure control was integral to restoring psychological well-being and a sense of normality but was only one of a number of influences moderating the degree of loss experienced following seizure onset. Our work emphasizes that people with epilepsy (PWE) require active support for their continued engagement or reengagement in roles and activities identified as central to their psychological well-being and overall QOL. Achieving this requires a multiagency approach to drive forward key strategies for reduction of the negative impacts of epilepsy and to engender a sense of normality in the context of a condition often experienced as placing the individual outside the socially determined parameters of the 'normal'.

How persons with a neuromuscular disease perceive employment participation: a qualitative study

INTRODUCTION

A qualitative study was carried out to understand how people with a slow progressive adult type neuromuscular disease (NMD) perceive employment participation.

METHODS

16 paid employed persons with NMD were interviewed in open, in-depth interviews. Data were analyzed using the constant comparison method.

RESULTS

Four themes were identified in the analyses: (1) Experiences regarding the meaning of work; (2) Solving problems oneself; (3) Reaching a turning point; and (4) Taking into account environmental aspects. Persons with NMD highlighted benefits of staying at work as well as the tension they felt how to shape decisions to handle progressive physical hindrances in job retention. This study shows how participants at work with NMD were challenged to keep up appearances at work and at home, the tension felt around when and if to disclose, the effect of their condition on colleagues and work reorganisation challenges. Participants experienced that disclosure did not always make things better. With increasing disability participants' focus shifted from the importance of assistive products towards considerate colleague, in particular superior's willingness in supporting job retention.

CONCLUSIONS

Implications for health professionals might include awareness of the significant impact of changes in physical condition on employment. Timely communication and if appropriate referral to a health or occupational professional may empower employees with NMD to handle employment issues at a for themselves appropriate way. Assistive products and a supportive superior might enhance employment participation.

Design Your Own Job Through Job Crafting

Job crafting can be viewed as changes that employees initiate in the level of job demands and job resources in order to make their own job more meaningful, engaging, and satisfying. As such, job crafting can be used to complement top-down approaches to improve jobs in order to overcome the inadequacies of job redesign approaches, to respond to the complexity of contemporary jobs, and to deal with the needs of the current workforce. This review aims to provide an overview of the conceptualizations of job crafting, the reasons why individuals craft their jobs, as well as the hypothetical predictors and outcomes of job crafting. Furthermore, this review provides suggestions to organizations on how to manage job crafting in their processes, and how to stimulate more beneficial job crafting behavior. Although research on job crafting is still in its infancy, it is worthwhile for organizations to recognize its existence and to manage it such that it has beneficial effects on the employees and the organization at large.