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Popa AE, Bejenaru A, Mitrea EC, Morândău F, Pogan L. Return to work after chronic disease: A theoretical framework for understanding the worker-employer dynamic. Chronic Illn 2023; 19:704-718. [PMID: 35912437 DOI: 10.1177/17423953221117852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Return to work after chronic disease is important for workers, employers and society. The process, however, is challenging. This article provides an analytical and theoretical framework for explaining this process informed by the person-environment fit theory. METHODS This article uses a narrative method to (1) review the key concepts, benefits and influencing factors in the literature on return to work after chronic diseases, (2) analyse and critique the most important theoretical models used for explaining return to work after chronic diseases, and (3) review the person-environment fit theory and how it has been used so far. RESULTS The existing models highlight different aspects, but they overlook the relationship between the worker and the employer. An analytical and theoretical framework is proposed to comprehensively explain the worker-employer dynamic. The framework also considers the role of broader factors (policy, labour market) and other stakeholders (health professionals, civil society actors) emphasising the idea that return to work is a phased and cyclical process. DISCUSSION The framework can be used to guide future qualitative and quantitative studies, or as a map for identifying problematic areas related to the worker or the work environment. The model should be empirically tested in future studies.
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Affiliation(s)
- Adela Elena Popa
- Faculty of Social Sciences and Humanities, Lucian Blaga University of Sibiu, Sibiu, Romania
| | - Anca Bejenaru
- Faculty of Social Sciences and Humanities, Lucian Blaga University of Sibiu, Sibiu, Romania
| | - Elena Cristina Mitrea
- Faculty of Social Sciences and Humanities, Lucian Blaga University of Sibiu, Sibiu, Romania
| | - Felicia Morândău
- Faculty of Social Sciences and Humanities, Lucian Blaga University of Sibiu, Sibiu, Romania
| | - Livia Pogan
- Faculty of Social Sciences and Humanities, Lucian Blaga University of Sibiu, Sibiu, Romania
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de Geus CJC, Huysmans MA, van Rijssen HJ, Anema JR. Return to work factors and vocational rehabilitation interventions for long-term, partially disabled workers: a modified Delphi study among vocational rehabilitation professionals. BMC Public Health 2022; 22:875. [PMID: 35501737 PMCID: PMC9063173 DOI: 10.1186/s12889-022-13295-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 04/19/2022] [Indexed: 11/10/2022] Open
Abstract
Background Long-term disability has a great impact on both society and workers with disabilities. Little is known about the barriers which prohibit workers with long-term disabilities from returning to work and which interventions are best suited to counteract these barriers. The main purpose of this study was to obtain consensus among professionals on important return to work (RTW) factors and effective vocational rehabilitation (VR) interventions for long-term (> 2 years), partially disabled workers. Our three research questions were: (1) which factors are associated with RTW for long-term disabled workers?; (2) which factors associated with RTW can be targeted by VR interventions?; and (3) which VR interventions are the most effective to target these factors? Methods A modified Delphi Study was conducted using a panel of 22 labour experts, caseworkers, and insurance physicians. The study consisted of several rounds of questionnaires and one online meeting. Results The multidisciplinary panel reached consensus that 58 out of 67 factors were important for RTW and that 35 of these factors could be targeted using VR interventions. In five rounds, the expert panel reached consensus that 11 out of 22 VR interventions were effective for at least one of the eight most important RTW factors. Conclusions Consensus was reached among the expert panel that many factors that are important for the RTW of short-term disabled workers are also important for the RTW of long-term partially disabled workers and that a substantial number of these factors could effectively be targeted using VR interventions. The results of this study will be used to develop a decision aid that supports vocational rehabilitation professionals in profiling clients and in choosing suitable VR interventions. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13295-6.
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Affiliation(s)
- Christa J C de Geus
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, NL, 1081 BT, Amsterdam, the Netherlands.,Research Centre for Insurance Medicine, AMC-UMCG-VUmc-UWV, Amsterdam, the Netherlands
| | - Maaike A Huysmans
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, NL, 1081 BT, Amsterdam, the Netherlands. .,Research Centre for Insurance Medicine, AMC-UMCG-VUmc-UWV, Amsterdam, the Netherlands.
| | - H Jolanda van Rijssen
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, NL, 1081 BT, Amsterdam, the Netherlands.,Research Centre for Insurance Medicine, AMC-UMCG-VUmc-UWV, Amsterdam, the Netherlands.,Dutch Institute of Employee Benefit Schemes (UWV), Amsterdam, the Netherlands
| | - Johannes R Anema
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, NL, 1081 BT, Amsterdam, the Netherlands.,Research Centre for Insurance Medicine, AMC-UMCG-VUmc-UWV, Amsterdam, the Netherlands
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Snoeck-Krygsman SP, Schaafsma FG, Donker-Cools BHPM, Hulshof CTJ, Jansen LP, Kox RJ, Hoving JL. The perceived importance of prognostic aspects considered by physicians during work disability evaluation: a survey. BMC Med Inform Decis Mak 2022; 22:25. [PMID: 35093042 PMCID: PMC8801115 DOI: 10.1186/s12911-022-01758-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 01/15/2022] [Indexed: 11/29/2022] Open
Abstract
Background Assessing prognosis is challenging for many physicians in various medical fields. Research shows that physicians who perform disability assessments consider six areas when evaluating a prognosis: disease, treatment, course of the disease, external information, patient-related and physician-related aspects. We administered a questionnaire to evaluate how physicians rate the importance of these six prognosis areas during work disability evaluation and to explore what kind of support they would like during prognosis assessment. Methods Seventy-six physicians scored the importance of 23 prognostic aspects distributed over six prognosis areas. Participants scored the importance of each aspect both “in general” and from the perspective of a case vignette of a worker with a severe degenerative disease. The questionnaire also covered needs and suggestions for support during the evaluation of prognoses. Results Medical areas that are related to the disease, or the treatment or course of the disease, appeared important (scores of 7.0–9.0), with less differing opinions among participants (IQR 1.0–3.0). Corresponding verbatim remarks supported the importance of disease and treatment as prognostic aspects. In comparison, patient- and physician-related aspects scored somewhat lower, with more variability (range 4.0–8.0, with IQR 2.0–5.0 for patient- and physician-related considerations). Participants indicated a need for a tool or online database that includes prognostic aspects and prognostic evidence. Conclusions Despite some variation in scores, the physicians rated all six prognosis areas as important for work disability evaluations. This study provides suggested aids to prognosis assessment, including an online support tool based on evidence-based medicine features.
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de Wit M, Zipfel N, Horreh B, Hulshof CTJ, Wind H, de Boer AGEM. Training on involving cognitions and perceptions in the occupational health management and work disability assessment of workers: development and evaluation. BMC MEDICAL EDUCATION 2022; 22:20. [PMID: 34996425 PMCID: PMC8740490 DOI: 10.1186/s12909-021-03084-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 12/17/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND In order to improve work participation of workers with a chronic disease, it is important for occupational health professionals (OHPs) to focus on those factors that can influence work participation. Cognitions and perceptions, such as recovery expectations and self-efficacy, are examples of these factors that can influence work participation. However, no training program is available for OHPs on how to involve cognitions and perceptions during their practice. Therefore, the aim of this study was to develop a training program for OHPs on how to involve cognitions and perceptions in the occupational health management and work disability assessment of workers with a chronic disease. In addition, to evaluate the OHPs' satisfaction with the training and the feasibility of the training and learned skills. METHODS The training program was developed using information from previously conducted studies regarding cognitions and perceptions in relation to work participation. Satisfaction with the training by OHPs was evaluated by means of a questionnaire. A smaller group of OHPs were interviewed three to six months after the training to evaluate the feasibility of the training and learned skills. RESULTS The 4.5-h training program consisted of four parts concerning: 1) cognitions and perceptions associated with work participation, 2) how to obtain information on them, 3) the course of the conversation on these factors, and 4) intervening on these factors. Eight training sessions were conducted with 57 OHPs, of whom 54 evaluated the training. Participants were very satisfied (score 8.5 on a scale from 1 to 10). The eleven interviewed participants were more aware of cognitions and perceptions during consultations and perceived the training to be feasible. However, not all participants had applied the acquired skills in their practice, partially because of a lack of time. CONCLUSIONS OHPs are very satisfied with the training program and perceive it to be feasible. The training increases awareness of important cognitions and perceptions and may possibly help to increase work participation of workers with a chronic disease.
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Affiliation(s)
- Mariska de Wit
- Department of Public and Occupational Health, Coronel Institute of Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, PO Box 22700, 1100 DE, Amsterdam, The Netherlands.
| | - Nina Zipfel
- Department of Public and Occupational Health, Coronel Institute of Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, PO Box 22700, 1100 DE, Amsterdam, The Netherlands
| | - Bedra Horreh
- Department of Public and Occupational Health, Coronel Institute of Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, PO Box 22700, 1100 DE, Amsterdam, The Netherlands
| | - Carel T J Hulshof
- Department of Public and Occupational Health, Coronel Institute of Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, PO Box 22700, 1100 DE, Amsterdam, The Netherlands
| | - Haije Wind
- Department of Public and Occupational Health, Coronel Institute of Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, PO Box 22700, 1100 DE, Amsterdam, The Netherlands
| | - Angela G E M de Boer
- Department of Public and Occupational Health, Coronel Institute of Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, PO Box 22700, 1100 DE, Amsterdam, The Netherlands
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Sengers JH, Abma FI, Wilming L, Roelofs PDDM, Heerkens YF, Brouwer S. Content Validation of a Practice-Based Work Capacity Assessment Instrument Using ICF Core Sets. JOURNAL OF OCCUPATIONAL REHABILITATION 2021; 31:293-315. [PMID: 32803465 PMCID: PMC8172508 DOI: 10.1007/s10926-020-09918-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
PURPOSE A shift from providing long-term disability benefits to promoting work reintegration of people with remaining work capacity in many countries requires new instruments for work capacity assessments. Recently, a practice-based instrument addressing biopsychosocial aspects of functioning, the Social Medical Work Capacity instrument (SMWC), was developed. Our aim was to examine the content validity of the SMWC using ICF core sets. METHODS First, we conducted a systematic search to identify relevant ICF core sets for the working age population. Second the content of these core sets were mapped to assess the relevance and comprehensiveness of the SMWC. Next, we compared the content of the SMWC with the ICF-core sets. RESULTS Two work-related core sets and 31 disease-specific core sets were identified. The SMWC and the two work-related core sets overlap on 47 categories. Compared to the work-related core sets, the Body Functions and Activities and Participation are well represented in the new instrument, while the component Environmental factors is under-represented. Compared to the disease-specific core sets, items related to the social and domestic environmental factors are under-represented, while the SMWC included work-related factors complementary to the ICF. CONCLUSION The SMWC content seems relevant, but could be more comprehensive for the purpose of individual work capacity assessments. To improve assessing relevant biopsychosocial aspects, it is recommended to extend the instrument by adding personal and environmental (work- and social-related) factors as well as a more tailored use of the SMWC for assessing work capacity of persons with specific diseases or underlying illness.
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Affiliation(s)
- Johan H Sengers
- Department of Health Sciences, Community and Occupational Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Dutch Social Security Institute: Institute for Employee Benefits Schemes (UWV), Amsterdam, The Netherlands
- Research Centre for Insurance Medicine, AMC-UMCG-UWV-VUMC, Amsterdam, The Netherlands
| | - Femke I Abma
- Department of Health Sciences, Community and Occupational Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
- Research Centre for Insurance Medicine, AMC-UMCG-UWV-VUMC, Amsterdam, The Netherlands.
| | - Loes Wilming
- Department of Health Sciences, Community and Occupational Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Research Centre for Insurance Medicine, AMC-UMCG-UWV-VUMC, Amsterdam, The Netherlands
| | - Pepijn D D M Roelofs
- Department of Health Sciences, Community and Occupational Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Research Centre for Insurance Medicine, AMC-UMCG-UWV-VUMC, Amsterdam, The Netherlands
| | - Yvonne F Heerkens
- HAN University of Applied Sciences, Nijmegen, The Netherlands
- Dutch Institute of Allied Health Care, Amersfoort, The Netherlands
| | - Sandra Brouwer
- Department of Health Sciences, Community and Occupational Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Research Centre for Insurance Medicine, AMC-UMCG-UWV-VUMC, Amsterdam, The Netherlands
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Physicians' Perspectives on Person-Related Factors Associated With Work Participation and Methods Used to Obtain Information About These Factors. J Occup Environ Med 2020; 61:499-504. [PMID: 31167222 DOI: 10.1097/jom.0000000000001596] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Person-related factors influencing work participation of employees with health problems are important. However, the best method to obtain information about them, according to occupational physicians (OPs) and insurance physicians (IPs), is unknown. METHODS Questionnaires in which OPs and IPs rated the importance of and described methods to obtain information about 10 person-related factors: expectations regarding recovery or return to work, optimism/pessimism, self-efficacy, motivation, feelings of control, perceived health, coping strategies, fear-avoidance beliefs, perceived work-relatedness, and catastrophizing. RESULTS OPs and IPs perceived all person-related factors, except for optimism/pessimism and perceived health as important for work participation. Information about the factors could best be obtained with use of a topic list during consultations. CONCLUSIONS OPs and IPs should take person-related factors into account during consultations and it is best to use a topic list when discussing them.
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Abstract
OBJECTIVE This study aims to build a predictive model for "return to work" (RTW) after sick leave by using a machine-learning algorithm. METHODS Panel data of 2000 participants (1686 males and 314 females) from the Labor Welfare Research Institute of the Korea Workers' Compensation & Welfare Service were used. A gradient boosting machine (GBM) was used to build the predictive model. RESULTS The GBM showed excellent performance in a binary classification (returned to work vs not working). However, the model of the three-group classification showed suboptimal performance. CONCLUSIONS Although machine-learning algorithms using common predictive factors can accurately predict whether one can work after sick leave, they cannot differentiate the form of returning to work. Future research with detailed information based on the injury or disease is warranted.
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Vanovenberghe C, Van den Broeck A, Lauwerier E, Goorts K, Du Bois M. Motivation in the return to work process: a self-determination cluster approach. Disabil Rehabil 2020; 44:2053-2062. [PMID: 33016785 DOI: 10.1080/09638288.2020.1826584] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE Motivation may predict return to work (RTW), yet the measurement of motivation needs more scientific evidence. We adopt a dimensional approach, based on the self-determination theory (SDT), distinguishing between amotivation, controlled and autonomous motivation. We seek to explore the presence of these dimensions in sick-disabled patients, and are interested in associations with quality of life, depression, patient's predictions of RTW, and health care provider estimations of patient's motivation. MATERIALS AND METHODS A cross-sectional study in 336 patients was conducted. Motivation was assessed using the Motivation at Work Scale (MAWS) and examined in relation to patient outcomes, patient's prediction of RTW, and health care provider estimations of patients' motivation. A cluster analysis was performed, and differential associations between motivational profiles were explored. RESULTS Cluster analysis revealed four profiles. Highly controlled profiles were most prevalent, reported poorer mental quality of life, and expected a longer time before RTW, regardless of the level of autonomous motivation. Interestingly, the health care provider's estimation was not related to controlled motivation. CONCLUSIONS Our results show that SDT may help to differentiate people with a work disability regarding their motivation to RTW. Most notably, the devastating consequences of controlled motivation are discussed, and clinical implications are provided.Implications for RehabilitationAssessing the different dimensions of motivation in the context of RTW will be a significant advance as the self-report measures appear to be viable tools.Controlled motivation, which indicates that people are motivated to RTW but only because they "have to", has negative consequences yet a high prevalence and should therefore be addressed by the practitioner.Practitioners should keep in mind that employees are motivated by several motives at the same time, with some being more beneficial than others.Controlled motivation can be converted into autonomous (i.e., good quality) motivation by supporting autonomy of the patient, by supporting their relationships with colleagues, managers, and health care providers and by supporting their feeling of competence in the RTW process.
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Affiliation(s)
- Charlotte Vanovenberghe
- Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium.,Department of Experimental Clinical and Health Psychology, UGent, Ghent, Belgium
| | - Anja Van den Broeck
- Department of Work and Organisation Studies, KU Leuven, Brussels, Belgium.,Optentia, North West University, Vanderbijlpark, South Africa
| | - Emelien Lauwerier
- Department of Experimental Clinical and Health Psychology, UGent, Ghent, Belgium.,Department of Public Health and Primary Care, UGent, Ghent, Belgium
| | - Kaat Goorts
- Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Marc Du Bois
- Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
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Janssens KME, van Weeghel J, Henderson C, Joosen MCW, Brouwers EPM. Evaluation of an intervention to support decisions on disclosure in the employment setting (DECIDES): study protocol of a longitudinal cluster-randomized controlled trial. Trials 2020; 21:443. [PMID: 32471478 PMCID: PMC7257205 DOI: 10.1186/s13063-020-04376-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 05/05/2020] [Indexed: 11/28/2022] Open
Abstract
Background Unemployment rates are higher among people with mental health issues/illness (MHI) than in the general working population, and many of them face the dilemma of whether or not to disclose their MHI when searching for employment. Disclosure can lead to rejection and discrimination, but alternatively can also have important advantages that may be necessary to retain employment. Whether disclosure decisions lead to sustainable employment depends on many factors, of which unemployed people themselves can only influence their decision to disclose or not and the way in which they communicate. This study evaluates the cost-effectiveness of an intervention to support unemployed people with MHI in their disclosure decision and communication. Methods This is a two-armed, clustered, randomized controlled trial with longitudinal design and randomization at organization level. An intervention will be examined, which consists of a disclosure decision aid tool (CORAL.NL) for unemployed people and workplace stigma-awareness training especially designed for employment specialists, which focusses on how to support unemployed people in their disclosure decisions. Participants in the intervention group are unemployed people who receive support from trained employment specialists from organizations allocated to the intervention group, and receive the CORAL.NL decision aid after baseline. The control group consists of unemployed people who receive support as usual from employment specialists from different organizations allocated to the control group. Primary outcomes are: cost-effectiveness of the intervention, e.g. healthcare costs, having employment, days until start of employment, independency of social security, having other forms of employment and decision making about disclosing MHI. Secondary outcomes are mental health and wellbeing, stigma and discrimination and work-related factors. Financial income data are collected via the registration systems of Dutch municipalities and Statistics Netherlands, and by questionnaires at baseline, and at 3, 6 and 12 months. Discussion If using a decision aid to decide about disclosure of MHI leads to people finding and retaining employment more often, this study will contribute to lowering healthcare and societal costs. Trial registration Netherlands Trial Register: NL7798. Registered on 4 June 2019.
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Affiliation(s)
- K M E Janssens
- Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands.
| | - J van Weeghel
- Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands.,Kenniscentrum Phrenos, Utrecht, The Netherlands
| | - C Henderson
- Department of Health Services and Population Research, King's College London, London, UK
| | - M C W Joosen
- Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands.,Department Human Resource Studies, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
| | - E P M Brouwers
- Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
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Perspectives of mental healthcare providers on pathways to improved employment for persons with mental disorders in two lower middle-income countries. Int J Ment Health Syst 2020; 14:26. [PMID: 32256689 PMCID: PMC7106860 DOI: 10.1186/s13033-020-00354-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 03/10/2020] [Indexed: 11/14/2022] Open
Abstract
Background Mental disorders affect employment and the ability to work, and mental healthcare providers are important in the promotion of health and employment for affected individuals. The objective of this study is to explore the perspectives of mental healthcare providers on pathways to improved employment for persons with mental disorders in two lower middle-income countries. Methods Our study participants included mental healthcare providers (psychiatrists, occupational physicians, psychologists, and social care workers) from Kenya and Nigeria. Qualitative interviews and a focus group discussion were conducted with 15 professionals in Kenya and online questionnaires were completed by 80 professionals from Nigeria. Results The study participants suggested that work is important for the recovery and wellbeing of persons with mental disorders. A complex interplay of factors related to the health of persons with mental disorders and the socioeconomic system in their setting were identified as barriers to their work ability and employment. Participants proposed four pathways to improved employment: including information on reducing stigma, better healthcare, policy advocacy in employment, and government commitment to healthcare and social welfare. Public education to reduce stigma and better healthcare were the highest reported facilitators of employment. Conclusions Persons with mental disorders require multilevel support and care in obtaining and retaining employment. A better mental healthcare system is essential for the employment of persons with mental disorders.
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Temporary Disability Pension, RTW-Intentions, and RTW-Behavior: Expectations and Experiences of Disability Pensioners over 17 Months. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 17:ijerph17010238. [PMID: 31905698 PMCID: PMC6982195 DOI: 10.3390/ijerph17010238] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 12/17/2019] [Accepted: 12/25/2019] [Indexed: 11/22/2022]
Abstract
Purpose: Individuals receiving a temporary disability pension (TDP) should get the opportunity to return to work (RTW). The current study aims to determine the factors contributing to RTW. Methods: 453 individuals on TDP were interviewed at three measurement points (T1, T2 = T1 + approximately 7 months, T3 = T1 + approximately 17 months). Socio-demographics, psychological predictors, and current work status (maintained TDP, permanent disability pension, old-age pension, employed, or receipt of other benefits) were assessed. Results: Throughout the duration of the study, only four of the former temporary disability pensioners returned to work, and an additional seven made themselves available to the labor market. These were individuals who were younger, in TDP for a shorter period of time, and reported a higher RTW-intention. Higher RTW-intention was cross-sectionally associated with younger age, shorter TDP duration, and more positive outcome expectancies. Additionally, study participants who expected that medical rehabilitation would help them RTW were more motivated to RTW. An increase in RTW-intention over 17 months was related to younger age and better health. Conclusion: Personal factors such as self-efficacy and job-related variables appear less important for RTW than age and subjective health status. The observed RTW rates call for early support and tailored medical rehabilitation interventions that help individuals prevent functional limitations, overcome disability, and facilitate RTW.
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de Wit M, Wind H, Hulshof CTJ, de Boer AGEM. Obtaining person-related information from employees with chronic health problems: a focus group study. Int Arch Occup Environ Health 2019; 92:1003-1012. [PMID: 31104126 PMCID: PMC6768897 DOI: 10.1007/s00420-019-01440-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Accepted: 05/09/2019] [Indexed: 11/26/2022]
Abstract
Purpose The objective of this focus group study is to assess how occupational physicians (OPs) and insurance physicians (IPs) can best obtain information concerning person-related factors from employees. The research question was: what is the most effective way for OPs and IPs to obtain information concerning person-related factors, in the opinion of employees with chronic health problems? Methods Three focus group discussions were conducted comprising of a total of 23 employees with work limitations due to chronic health problems. Employees discussed how physicians could best obtain information related to ten person-related cognitions and perceptions that are associated with work participation. The discussions were recorded, transcribed verbatim and analyzed through qualitative content analysis. Results Employees indicated that information addressing person-related factors could best be obtained through discussing them directly during consultations, as opposed to the use of questionnaires or diaries. Important prerequisites to having fruitful conversations include a mutual trust between employee and physician, a sense of genuine physician interest, and the understanding of the physician of employees and their health concerns. Employees described various factors that influence these conversations, including the knowledge and communication skills of physicians, employee anxiety, and the atmosphere and time frame of the consultation. Conclusions Information concerning the person-related factors of employees can best be obtained by discussing them during consultations. However, there has to be mutual trust, interest and understanding before employees feel comfortable to talk about these factors with a physician. OPs and IPs should consider these, and other identified factors, when asking about person-related factors during consultations.
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Affiliation(s)
- Mariska de Wit
- Coronel Institute of Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, PO Box 22700, 1100 DE, Amsterdam, The Netherlands.
| | - Haije Wind
- Coronel Institute of Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, PO Box 22700, 1100 DE, Amsterdam, The Netherlands
| | - Carel T J Hulshof
- Coronel Institute of Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, PO Box 22700, 1100 DE, Amsterdam, The Netherlands
| | - Angela G E M de Boer
- Coronel Institute of Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, PO Box 22700, 1100 DE, Amsterdam, The Netherlands
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Kox RJ, Hoving JL, Verbeek JH, Schouten MJE, Hulshof CTJ, Wind H, Frings-Dresen MHW. Assessment of prognosis by physicians involved in work disability evaluation: A qualitative study. PLoS One 2019; 14:e0212276. [PMID: 30735562 PMCID: PMC6368383 DOI: 10.1371/journal.pone.0212276] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 01/30/2019] [Indexed: 11/18/2022] Open
Abstract
Background Assessment of prognosis of work functioning is a challenging aspect of work disability evaluations. To gain insight into this process, we conducted a qualitative study to determine the aspects considered and the difficulties, needs and potential solutions affecting the prognosis assessment by physicians performing disability evaluations. Methods In-depth, semi-structured individual interviews were conducted with 20 physicians performing disability evaluations for the Dutch social security institute: the national institute for employee benefit schemes. Verbatim transcripts were independently analyzed by two researchers using MAXQDA software until significant themes emerged and data saturation was achieved. Results The responses that emerged from the interviews were clustered in three primary themes. The first theme was “Aspects considered by physicians in assessing prognosis.” When making a prognosis, physicians considered the following medical issues: nature and severity of disease, the role of treatment, course of the disease, external information, and medical evidence. Patient-related issues and physician-related aspects were also distinguished. Patient-related aspects concerned the patients’ work perspectives and coping or recovery behavior. Physician-related aspects concerned awareness of the physician’s own role and reflection on aspects such as empathy for clients and ethical considerations. The second theme was “Difficulties physicians face in assessing prognosis,” which included challenges during the assessment of diseases of a complex or less concrete nature, applying prognostic evidence to the individual, and lack of time when seeking prognostic evidence. The third theme concerned “Needs and solutions” formulated by physicians that facilitated the prognostic assessment. It consisted of continuous education, better collaboration with medical specialists and/or labor experts, and the use of prognostic tools such as checklists, apps or internet applications incorporating evidence on prognosis. Conclusions Physicians identified several medical and patient-related aspects that elucidated the prognosis assessment. Given the variety of challenges and the need for further support found in the current study, future research should focus on the development and evaluation of training, tools, and guidelines to improve prognosis assessment by physicians.
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Affiliation(s)
- René J. Kox
- Amsterdam UMC, Location AMC, Department Coronel Institute of Occupational Health, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Research Center for Insurance Medicine (KCVG), Amsterdam, The Netherlands
| | - Jan L. Hoving
- Amsterdam UMC, Location AMC, Department Coronel Institute of Occupational Health, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Research Center for Insurance Medicine (KCVG), Amsterdam, The Netherlands
- * E-mail:
| | - Jos H. Verbeek
- Finnish Institute of Occupational Health, Kuopio, Finland
| | | | - Carel T. J. Hulshof
- Amsterdam UMC, Location AMC, Department Coronel Institute of Occupational Health, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Haije Wind
- Amsterdam UMC, Location AMC, Department Coronel Institute of Occupational Health, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Research Center for Insurance Medicine (KCVG), Amsterdam, The Netherlands
| | - Monique H. W. Frings-Dresen
- Amsterdam UMC, Location AMC, Department Coronel Institute of Occupational Health, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Research Center for Insurance Medicine (KCVG), Amsterdam, The Netherlands
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14
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Dekkers-Sánchez PM, de Wind AE. Enhancing medical evaluations of sick-listed employees: an educational intervention to improve professional practice of physicians performing work ability assessments of employees on long-term sick leave. Int Arch Occup Environ Health 2019; 92:729-738. [PMID: 30673838 DOI: 10.1007/s00420-019-01409-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 01/17/2019] [Indexed: 11/29/2022]
Abstract
PURPOSE Long-term sick leave (LTSL) is a complex phenomenon. Medical and non-medical factors can delay return-to-work (RTW); therefore, the assessment of work ability is complicated. A checklist for identifying factors associated with delayed RTW was developed in a prior study to facilitate the exploration of barriers and facilitators for RTW. The purpose of the present study was to determine if use of the checklist enhances professional practice of physicians performing work ability assessments of employees on long-term sick leave and whether the reporting of work ability assessments improved when using the checklist in the routinely practice-based context. METHODS An educational intervention study was performed using qualitative framework analysis. Thirty-five Dutch physicians were asked to identify and report the barriers and facilitators for RTW and the consequences for the work ability and for the prognosis regarding work reintegration using the checklist. A pre-post qualitative analysis of the medical records was performed using a gradual classification of the reporting of the work ability to evaluate the change in reporting following the educational intervention. RESULTS A total of 337 work ability assessments were performed using the checklist. The identification of factors influencing RTW and the comprehensiveness of the medical records increased when compared with the reporting before the educational intervention. The reporting of the work ability assessments improved after the educational intervention. Most physicians reported at least one of the factors of the checklist. 72% participants reported and described adequately at least one factor. 48% participants reported how the factors influenced the work ability, 20% participants reported how the factors influenced the prognosis regarding RTW and 12% participants reported which advice was provided by the physician to influence the barriers for RTW. CONCLUSIONS Use of the checklist enhances professional practice of physicians performing work ability assessments of employees on long-term sick leave and is associated with increased identification of barriers and facilitators for RTW. The use of the checklist should be considered to improve professional practice of physicians performing work ability assessments.
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Affiliation(s)
- Patricia M Dekkers-Sánchez
- Department of Social Medical Affairs, Dutch Employee Insurance Agency (UWV), Rotterdam, The Netherlands.
| | - Annette E de Wind
- Department of Social Medical Affairs, Dutch Employee Insurance Agency (UWV), Rotterdam, The Netherlands.,Environment and Health, Department of Public Health and Primary Care, KU Leuven University, Leuven, Belgium
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15
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Musti MA, Collina N, Stivanello E, Bonfiglioli R, Giordani S, Morelli C, Pandolfi P. Perceived work ability at return to work in women treated for breast cancer: a questionnaire-based study. LA MEDICINA DEL LAVORO 2018; 109:407-419. [PMID: 30556532 PMCID: PMC7682187 DOI: 10.23749/mdl.v110i6.7241] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 11/08/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND Breast cancer survivors often perceive reduced work ability upon returning to work. OBJECTIVES To identify predictors of perceived reduced work ability following return to work among women treated for breast cancer and to describe workplace interventions and support after returning to work. METHODS A questionnaire was sent to 18-65 years-old women (no. 1578) treated for breast cancer and residing in the catchment area of the Bologna Local Health Authority between 2010 and 2012. The study population was identified through a Hospital Discharge Database. The questionnaires included items about personal characteristics, cancer and work-related factors, perceived work ability and the return to work process. A multivariable logistic regression analysis was performed to identify predictors of reduced work ability upon returning to work. RESULTS Among the 841 respondents, 503 questionnaires were evaluable. In the study, 43.5% of the respondents reported reduced work ability with respect to the pre-diagnosis period. Reduced work ability was more common in non-cohabiting (OR=1.81, 95%CI 1.10-2.98) than in cohabiting/married women, and after mastectomy (OR=2.77, 95%CI 1.26-6.11) than after breast-conserving surgery. Office staff/sales assistants and managers were less likely to report reduced work ability (OR=0.51, 95%CI 0.30-0.88 and OR=0.21, 95%CI 0.06-0.76, respectively) than labourers. Women who perceived reduced work ability reported more frequently adjustment of work assignments, consultation of an occupational physician, insufficient support from employers and colleagues and discrimination. CONCLUSIONS Reduced work ability is commonly perceived among women who return to work after treatment for breast cancer. Occupational physicians and general practitioners should be aware of a wide range of factors influencing this perception in order to facilitate a successful return to work.
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Affiliation(s)
- Muriel Assunta Musti
- Unit of Epidemiology, Health Promotion and Risk Communication, Department of Public Health, Bologna Local Health Authority, Bologna, Italy.
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16
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Park J, Roberts MR, Esmail S, Rayani F, Norris CM, Gross DP. Validation of the Readiness for Return-To-Work Scale in Outpatient Occupational Rehabilitation in Canada. JOURNAL OF OCCUPATIONAL REHABILITATION 2018; 28:332-345. [PMID: 28756480 DOI: 10.1007/s10926-017-9721-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Purpose To examine construct and concurrent validity of the Readiness for Return-To-Work (RRTW) Scale with injured workers participating in an outpatient occupational rehabilitation program. Methods Lost-time claimants (n = 389) with sub-acute or chronic musculoskeletal disorders completed the RRTW Scale on their first day of their occupational rehabilitation program. Statistical analysis included exploratory and confirmatory factor analyses of the readiness items, reliability analyses, and correlation with related scales and questionnaires. Results For claimants in the non-job attached/not working group (n = 165), three factors were found (1) Contemplation (2) Prepared for Action-Self-evaluative and (3) Prepared for Action-Behavioural. The precontemplation stage was not identified within this sample of injured workers. For claimants who were job attached/working group in some capacity (n = 224), two factors were identified (1) Uncertain Maintenance and (2) Proactive Maintenance. Expected relationships and statistically significant differences were found among the identified Return-To-Work (RTW) readiness factors and related constructs of pain, physical and mental health and RTW expectations. Conclusion Construct and concurrent validity of the RRTW Scale were supported in this study. The results of this study indicate the construct of readiness for RTW can vary by disability duration and occupational category. Physical health appears to be a significant barrier to RRTW for the job attached/working group while mental health significantly compromises RRTW with the non-job attached/not working group.
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Affiliation(s)
- Joanne Park
- Department of Occupational Therapy, University of Alberta, 3-48 Corbett Hall, Edmonton, AB, T6G 2G4, Canada.
- Workers' Compensation Board of Alberta Millard Health, Edmonton, Canada.
| | - Mary Roduta Roberts
- Department of Occupational Therapy, University of Alberta, 3-48 Corbett Hall, Edmonton, AB, T6G 2G4, Canada
| | - Shaniff Esmail
- Department of Occupational Therapy, University of Alberta, 3-48 Corbett Hall, Edmonton, AB, T6G 2G4, Canada
| | - Fahreen Rayani
- Workers' Compensation Board of Alberta, Edmonton, Canada
| | - Colleen M Norris
- Faculty of Nursing/Public Health, School of/Medicine & Dentistry Medicine/Surgery, University of Alberta, Edmonton, Canada
| | - Douglas P Gross
- Department of Physical Therapy, University of Alberta, Edmonton, Canada
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17
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Rashid M, Kristofferzon ML, Heiden M, Nilsson A. Factors related to work ability and well-being among women on sick leave due to long-term pain in the neck/shoulders and/or back: a cross-sectional study. BMC Public Health 2018; 18:672. [PMID: 29848306 PMCID: PMC5977487 DOI: 10.1186/s12889-018-5580-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Accepted: 05/21/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Musculoskeletal pain is one of the leading causes of sick leave, especially among women, in Western countries. The aim of the present study was to identify factors associated with work ability and well-being, respectively, among women on sick leave due to long-term pain in the neck/shoulders and/or back. METHODS A cross-sectional study with a correlational design was conducted on women who were sick-listed due to long-term pain in the neck/shoulders and/or back. A total of 208 participants responded to a survey comprising eight instruments: Multidimensional Pain Inventory scale, General Self-Efficacy scale, Sense of Coherence scale, Coping Strategies Questionnaire, Demand-Control-Support Questionnaire, Hospital Anxiety and Depression Scale, Work Ability Index and Life Satisfaction questionnaire. Multiple linear regression analyses were performed to identify factors associated with work ability and well-being, respectively. RESULTS Women who more strongly believed they would return to the same work had greater work ability (β = 0.39, p < 0.001), whereas women with higher pain intensity (β = - 0.30, p < 0.001) and higher job strain (β = - 0.12, p < 0.05) had lower work ability. Women with higher self-efficacy rated greater well-being (β = 0.14, p < 0.05). As the women's scores for depression increased, their well-being decreased by 48%, which was statistically significant (p < 0.001). The regression models for work ability and well-being were significant (p < 0.001), and their adjusted R- square values were 48% and 59%, respectively. CONCLUSIONS The study suggests that the factors beliefs to be back at the same work, pain intensity and job strain are predictive of work ability. Moreover, the factors self-efficacy and depression seem to be predictive of well-being. The findings highlight factors that should be considered by health care professionals and policy-makers to guide attempts to reduce sick leave.
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Affiliation(s)
- Mamunur Rashid
- Centre for Musculoskeletal Research, Department of Occupational and Public Health Sciences, Faculty of Health and Occupational Studies, University of Gävle, SE-80176 Gävle, Sweden
| | - Marja-Leena Kristofferzon
- Department of Health and Caring Sciences, Faculty of Health and Occupational Studies, University of Gävle, Gävle, Sweden
- Department of Public Health and Caring Sciences, Faculty of Medicine, Uppsala University, Uppsala, Sweden
| | - Marina Heiden
- Centre for Musculoskeletal Research, Department of Occupational and Public Health Sciences, Faculty of Health and Occupational Studies, University of Gävle, SE-80176 Gävle, Sweden
| | - Annika Nilsson
- Department of Health and Caring Sciences, Faculty of Health and Occupational Studies, University of Gävle, Gävle, Sweden
- Department of Public Health and Caring Sciences, Faculty of Medicine, Uppsala University, Uppsala, Sweden
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18
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Petersson EL, Wikberg C, Westman J, Ariai N, Nejati S, Björkelund C. Effects on work ability, job strain and quality of life of monitoring depression using a self-assessment instrument in recurrent general practitioner consultations: A randomized controlled study. Work 2018; 60:63-73. [PMID: 29733038 PMCID: PMC6027947 DOI: 10.3233/wor-182717] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND: Depression reduces individuals’ function and work ability and is associated with both frequent and long-term sickness absence. OBJECTIVE: Investigate if monitoring of depression course using a self-assessment instrument in recurrent general practitioner (GP) consultations leads to improved work ability, decreased job strain, and quality of life among primary care patients. METHODS: Primary care patients n = 183, who worked. In addition to regular treatment (control group), intervention patients received evaluation and monitoring and used the MADRS-S depression scale during GP visit at baseline and at visits 4, 8, and 12 weeks. Work ability, quality of life and job strain were outcome measures. RESULTS: Depression symptoms decreased in all patients. Significantly steeper increase of WAI at 3 months in the intervention group. Social support was perceived high in a significantly higher frequency in intervention group compared to control group. CONCLUSIONS: Monitoring of depression course using a self-assessment instrument in recurrent GP consultations seems to lead to improved self-assessed work ability and increased high social support, but not to reduced job strain or increased quality of life compared to TAU. Future studies concerning rehabilitative efforts that seek to influence work ability probably also should include more active interventions at the workplace.
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Affiliation(s)
- E-L Petersson
- Department of Primary Health Care/Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden.,Region Västra Götaland, Närhälsan Research and Development Primary Health Care, Gothenburg, Sweden
| | - C Wikberg
- Department of Primary Health Care/Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - J Westman
- Department of Neurobiology, Division for Family Medicine, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - N Ariai
- Department of Primary Health Care/Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - S Nejati
- Department of Primary Health Care/Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - C Björkelund
- Department of Primary Health Care/Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden
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19
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de Wit M, Wind H, Hulshof CTJ, Frings-Dresen MHW. Person-related factors associated with work participation in employees with health problems: a systematic review. Int Arch Occup Environ Health 2018; 91:497-512. [PMID: 29700608 PMCID: PMC6002456 DOI: 10.1007/s00420-018-1308-5] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 04/18/2018] [Indexed: 11/29/2022]
Abstract
PURPOSE The objective of this systematic review was to explore and provide systematically assessed information about the association between person-related factors and work participation of people with health problems. The research question was: what is the association between selected person-related factors and work participation of workers with health problems? METHODS A systematic review was carried out in PubMed and PsycINFO to search for original papers published between January 2007 and February 2017. The risk of bias of the studies included was assessed using quality assessment tools from the Joanna Briggs Institute. The quality of evidence was assessed using the GRADE framework for prognostic studies. RESULTS In total, 113 studies were included, all of which addressed the association between person-related factors and work participation. The factors positively associated with work participation were positive expectations regarding recovery or return to work, optimism, self-efficacy, motivation, feelings of control, and perceived health. The factors negatively associated with work participation were fear-avoidance beliefs, perceived work-relatedness of the health problem, and catastrophizing. Different coping strategies had a negative or a positive relationship with work participation. CONCLUSIONS The results of this review provide more insight into the associations between different cognitions and perceptions and work participation. The results of this study suggest that person-related factors should be considered by occupational- and insurance physicians when they diagnose, evaluate or provide treatment to employees. Further research is required to determine how these physicians could obtain and apply such information and whether its application leads to a better quality of care.
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Affiliation(s)
- Mariska de Wit
- Department Coronel Institute of Occupational Health, Academic Medical Center, University of Amsterdam, Amsterdam Public Health research institute, PO Box 22700, 1100 DE, Amsterdam, The Netherlands.
| | - Haije Wind
- Department Coronel Institute of Occupational Health, Academic Medical Center, University of Amsterdam, Amsterdam Public Health research institute, PO Box 22700, 1100 DE, Amsterdam, The Netherlands
| | - Carel T J Hulshof
- Department Coronel Institute of Occupational Health, Academic Medical Center, University of Amsterdam, Amsterdam Public Health research institute, PO Box 22700, 1100 DE, Amsterdam, The Netherlands
| | - Monique H W Frings-Dresen
- Department Coronel Institute of Occupational Health, Academic Medical Center, University of Amsterdam, Amsterdam Public Health research institute, PO Box 22700, 1100 DE, Amsterdam, The Netherlands
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20
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Eftedal M, Kvaal AM, Ree E, Øyeflaten I, Maeland S. How do occupational rehabilitation clinicians approach participants on long-term sick leave in order to facilitate return to work? A focus group study. BMC Health Serv Res 2017; 17:744. [PMID: 29149891 PMCID: PMC5693773 DOI: 10.1186/s12913-017-2709-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Accepted: 11/07/2017] [Indexed: 11/29/2022] Open
Abstract
Background The objective of this study was to explore occupational rehabilitation clinicians’ experiences on how to approach their participants on long-term sick leave in order to facilitate return to work (RTW). Methods An exploratory qualitative design was used. Four focus groups were conducted with 29 clinicians working on interdisciplinary inpatient and outpatient occupational rehabilitation teams in Norway. The clinicians shared narratives from clinical practice. Transcripts were analysed, and results were reported by use of systematic text condensation. Results The clinicians used several approaches to facilitate RTW among individuals on sick leave. Three themes emerged as especially important in order to succeed: 1) To get a basic understanding of the participant’s life-world through a mapping process; 2) To build a therapeutic alliance through communication characterised by sensitivity to the participants’ needs and emotional concerns; and 3) To initiate processes of change that increase the possibilities for RTW. Four main areas targetable for change were identified, three directed at the individual and one encompassing the participants’ surroundings. These approaches were: a) To increase feelings of confidence and coping; b) To increase the participants’ awareness of their own limits; c) To challenge inefficient and negative attitudes and thoughts related to the sick-role; and d) Close and immediate dialogue with key stakeholders. Conclusions To increase the possibilities for RTW among individuals on long-term sick leave, a thorough mapping process and the construction of a therapeutic alliance are seen as crucial elements in approaches by occupational rehabilitation clinicians. By gaining the participants’ trust and identifying their barriers and possibilities for work, the clinicians can target modifiable factors, especially at the individual level, and obstacles for RTW in their individual surroundings. This study elucidates what occupational rehabilitation clinicians do, say and provide to increase their participants’ abilities and possibilities to RTW.
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Affiliation(s)
- M Eftedal
- The National Centre for Occupational Rehabilitation, Rauland, Norway.
| | - A M Kvaal
- The National Centre for Occupational Rehabilitation, Rauland, Norway.,Municipality of Vinje, Department of Health and Care Services, Vinje, Norway
| | - E Ree
- Uni Research Health, Bergen, Norway.,Research Centre for Resilience in Healthcare (SHARE), Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - I Øyeflaten
- The National Centre for Occupational Rehabilitation, Rauland, Norway.,Uni Research Health, Bergen, Norway
| | - S Maeland
- Uni Research Health, Bergen, Norway.,Department of Occupational Therapy, Physiotherapy and Radiography, Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway
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21
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Pélissier C, Fort E, Fontana L, Charbotel B, Hours M. Factors associated with non-return to work in the severely injured victims 3 years after a road accident: A prospective study. ACCIDENT; ANALYSIS AND PREVENTION 2017; 106:411-419. [PMID: 28728063 DOI: 10.1016/j.aap.2017.06.020] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 06/07/2017] [Accepted: 06/29/2017] [Indexed: 06/07/2023]
Abstract
Road accidents may impact victims' physical and/or mental health and socio-occupational life, particularly the capacity to return to work. The purpose of our study is to assess modifiable medical and socio-occupational factors of non-return to work in the severely injured 3 years after a road accident. Among1,168 road accidents casualties in the Rhône administrative Département of France followed for five years, 141 of the 222 severely injured (Maximal Abbreviated Injury Scale ≥ 3) aged more than 16 years who were in work at the time of the accident, reported whether they had returned to work in the 3 years following the accident. The subgroups of those who had (n=113) and had not returned to work (n=28) were compared for socio-occupational (gender, age, educational level, marital status, socio-occupational group) accident-related medical factors (type of road user, type of journey, responsibility in the accident, initial care) and post-accident medical factors (pain intensity, post-traumatic stress disorder, physical sequelae, quality of life) by using standardized tools. Severity of initial head, face and lower-limb injury, intense persistent pain, post-traumatic stress disorder, poor self-assessed quality of life and health status at 3 years were associated with non-return to work on univariate analysis. On multivariate analysis, severity of initial head and lower-limb injury, intense persistent pain at 3 years and post-traumatic stress disorder were significantly associated with non-return to work 3 years following severe road-accident injury. Post-traumatic stress disorder and chronic pain were essential modifiable medical determinants of non-return to work in the severely injured after a road accident: early adapted management could promote return to work in the severely injured. Improve early adapted treatment of pain and PTSD in the rehabilitation team should help the severely injured return to work following a road accident.
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Affiliation(s)
- C Pélissier
- Université de Lyon, Université Lyon 1, Université de St Etienne, IFSTTAR, UMRESTTE, UMR_T9405, 42005 Saint Etienne, France; Service de Santé au Travail, CHU de Saint-Etienne, France.
| | - E Fort
- Université de Lyon, Université Lyon 1, IFSTTAR, UMRESTTE, UMR_T9405, F-69373 Lyon, France
| | - L Fontana
- Université de Lyon, Université Lyon 1, Université de St Etienne, IFSTTAR, UMRESTTE, UMR_T9405, 42005 Saint Etienne, France; Service de Santé au Travail, CHU de Saint-Etienne, France
| | - B Charbotel
- Université de Lyon, Université Lyon 1, IFSTTAR, UMRESTTE, UMR_T9405, F-69373 Lyon, France; Hospices Civils de Lyon, Service de Santé au Travail, France
| | - M Hours
- Univ Lyon, IFSTTAR, Univ Lyon 1, UMRESTTE, UMR_T9405, F-69675 Bron, France
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22
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Merkus SL, Hoedeman R, Mæland S, Weerdesteijn KHN, Schaafsma FG, Jourdain M, Canevet JP, Rat C, Anema JR, Werner EL. Are there patient-related factors that influence sickness certification in patients with severe subjective health complaints? A cross-sectional exploratory study from different European countries. BMJ Open 2017; 7:e015025. [PMID: 28733298 PMCID: PMC5642667 DOI: 10.1136/bmjopen-2016-015025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES To develop hypotheses about whether there are patient-related factors that influence physicians' decision-making that can explain why some patients with severe subjective health complaints (SHCs) are more likely to be granted sick leave than others. DESIGN Exploratory cross-sectional. SETTING Assessments of patient-related factors after watching nine authentic video recordings of patients with severe SHC from a Norwegian general practice. Our previous study showed that three of these nine patients were less likely than the remaining six patients to be granted sick leave by physicians from five European countries. PARTICIPANTS In total, 10 assessors from Norway, the Netherlands and France. OUTCOMES The direction in which the assessments may contribute towards the decision to grant a sickness certificate (increasing or decreasing the likelihood of granting sick leave). RESULTS Physicians consider a wide variety of patient-related factors when assessing sickness certification. The overall assessment of these factors may provide an indication of whether a patient is more likely or less likely to be granted sick leave. Additionally, some single questions (notable functional limitations in the consultation, visible suffering, a clear purpose for sick leave and psychiatric comorbidity) may indicate differences between the two patient groups. CONCLUSIONS Next to the overall assessment, no notable effect of the complaints on functioning and suffering, a lack of a clear purpose for sick leave and the absence of psychiatric comorbidity may be factors that could help guide the decision to grant sick leave. These hypotheses should be tested and validated in representative samples of professionals involved in sickness certification. This may help to understand the tacit knowledge we believe physicians have when assessing work capacity of patients with severe SHC.
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Affiliation(s)
- Suzanne L Merkus
- Research Unit for General Practice, Uni Research Health, Bergen, Norway
- Department of Public and Occupational Health, VU University Medical Centre, Amsterdam, The Netherlands
- EMGO+ Institute for Health and Care Research, Amsterdam, The Netherlands
| | - Rob Hoedeman
- Department of Science, ArboNed Occupational Health Services, Utrecht, The Netherlands
| | - Silje Mæland
- Research Unit for General Practice, Uni Research Health, Bergen, Norway
- Department of Occupational Therapy, Physiotherapy and Radiography, Bergen University College, Bergen, Norway
| | - Kristel H N Weerdesteijn
- Department of Public and Occupational Health, VU University Medical Centre, Amsterdam, The Netherlands
- EMGO+ Institute for Health and Care Research, Amsterdam, The Netherlands
- Research Center for Insurance Medicine, AMC-UMCG-UWV-VUmc, Amsterdam, The Netherlands
| | - Frederieke G Schaafsma
- Department of Public and Occupational Health, VU University Medical Centre, Amsterdam, The Netherlands
- EMGO+ Institute for Health and Care Research, Amsterdam, The Netherlands
- Research Center for Insurance Medicine, AMC-UMCG-UWV-VUmc, Amsterdam, The Netherlands
| | - Maud Jourdain
- Department of General Practice, Faculty of Medicine, University of Nantes, Nantes, France
| | - Jean-Paul Canevet
- Department of General Practice, Faculty of Medicine, University of Nantes, Nantes, France
| | - Cédric Rat
- Department of General Practice, Faculty of Medicine, University of Nantes, Nantes, France
| | - Johannes R Anema
- Department of Public and Occupational Health, VU University Medical Centre, Amsterdam, The Netherlands
- EMGO+ Institute for Health and Care Research, Amsterdam, The Netherlands
- Research Center for Insurance Medicine, AMC-UMCG-UWV-VUmc, Amsterdam, The Netherlands
| | - Erik L Werner
- Research Unit for General Practice, Uni Research Health, Bergen, Norway
- Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
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Haveraaen LA, Skarpaas LS, Aas RW. Job demands and decision control predicted return to work: the rapid-RTW cohort study. BMC Public Health 2017; 17:154. [PMID: 28152995 PMCID: PMC5288870 DOI: 10.1186/s12889-016-3942-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Accepted: 12/14/2016] [Indexed: 11/16/2022] Open
Abstract
Background In order to help workers with long-term sickness absence return to work (RTW), it is important to understand factors that either impede or facilitate employee’s reintegration into the labour force. The aim of this study was therefore to examine the impact of psychological work characteristics on time-to first RTW in sick listed employees in Norway. Methods The study was designed as a cohort study of 543 employees participating in 50 different RTW programmes. The Job Content Questionnaire (JCQ) was used to gather information on the psychological work conditions. The participants were followed for up to 18 months after they started treatment in the RTW programme. Survival analyses were used to investigate the association between psychological work conditions and time-to first RTW. Results Having high psychological job demands (HR = .654; 95% CI: .513–.832) and low decision control (HR = 1.297; 95% CI: 1.010–1.666) were both independent predictors of delayed RTW. Employees in low-strain jobs (low demands/high control) (HR = 1.811; 95% CI: 1.287–2.549) and passive jobs (low demands/low control) (HR = 1.599; 95% CI: 1.107–2.309), returned to work earlier compared to employees in high-strain jobs (high demands/low control). No difference was found for active jobs (high demands/high control). Conclusion This study revealed that high psychological demands, low control, and being in a high strain job reduced the probability of early RTW in sick listed employees. RTW programmes should therefore increase the focus on these issues.
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Affiliation(s)
| | - Lisebet Skeie Skarpaas
- Stavanger Innovation Park, Olav Hansenssvei 7A, 4021, Stavanger, Norway.,Department of Health Studies, University of Stavanger, Postboks 8600 Forus, 4036, Stavanger, Norway
| | - Randi Wågø Aas
- Stavanger Innovation Park, Olav Hansenssvei 7A, 4021, Stavanger, Norway.,Department of Health Studies, University of Stavanger, Postboks 8600 Forus, 4036, Stavanger, Norway.,Faculty of Health Sciences, Oslo and Akershus University College, Postboks 4, St. Olavs plass, 0130, Oslo, Norway
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Kerätär R, Taanila A, Jokelainen J, Soukainen J, Ala-Mursula L. Work disabilities and unmet needs for health care and rehabilitation among jobseekers: a community-level investigation using multidimensional work ability assessments. Scand J Prim Health Care 2016; 34:343-351. [PMID: 27804309 PMCID: PMC5217281 DOI: 10.1080/02813432.2016.1248632] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE Comprehensive understanding of the prevalence and quality of work disabilities and unmet needs for health care and rehabilitation to support return to work (RTW) among jobseekers. DESIGN Community-level, cross-sectional analysis with multidimensional clinical work ability assessments. SETTING Paltamo, Finland. PARTICIPANTS Unemployed citizens either participating in the Full-Employment Project or long-term unemployed (n = 230, 81%). MAIN OUTCOME MEASURES Based on data from theme interviews, patient records, supervisors' observations of work performance and clinical examinations, a physician concluded the individual's work ability, categorised into four groups: good work ability, good work ability expected after RTW support, able to transitional work only or unable to work. These groups were cross tabulated with primary diagnoses, types of plans to support RTW, as well as categories of social functioning and motivation, for which sensitivity and specificity scores in detecting work disability were calculated. RESULTS Only about half of the jobseekers had good work ability, 27% were found unable to work in the open labour market and 15% even eligible for a disability pension. For 20%, care or rehabilitation was seen necessary to enable RTW. Poor supervisor- and self-rated performance at work or poor social functioning appeared as sensitive measures in detecting work disability. CONCLUSIONS Work disabilities and unmet needs for health care and rehabilitation are highly prevalent among jobseekers, as depicted using a multidimensional work ability assessment procedure inspired by the International Classification of Functioning (ICF). Further development of work ability assessment practices is clearly needed. KEY POINTS Although the association of unemployment with poor health is well known, evidence on the work ability of the unemployed remains scarce. Work disabilities are common among the unemployed. Multidimensional work ability assessment among the unemployed reveals unmet needs for care and rehabilitation to support return to work. Context sensitivity may add to the accuracy of the doctor's conclusions on work ability.
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Affiliation(s)
- Raija Kerätär
- Center for Life Course Health Research, University of Oulu, Oulu, Finland
- Outpatient Rehabilitation Clinic, Lapland Healthcare District, Oulu, Finland
- Oorninki Ltd., Oulu, Finland
- CONTACT Raija Kerätär Center for Life Course Health Research, University of Oulu, Susitie 6, 90530 Oulu, Finland
| | - Anja Taanila
- Center for Life Course Health Research, University of Oulu, Oulu, Finland
- Unit of General Practice, Oulu University Hospital, Oulu, Finland
| | - Jari Jokelainen
- Center for Life Course Health Research, University of Oulu, Oulu, Finland
- Unit of General Practice, Oulu University Hospital, Oulu, Finland
| | | | - Leena Ala-Mursula
- Center for Life Course Health Research, University of Oulu, Oulu, Finland
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Godinho MR, Ferreira AP, Greco RM, Teixeira LR, Teixeira MTB. Work ability and health of security guards at a public University: a cross-sectional study. Rev Lat Am Enfermagem 2016; 24:e2725. [PMID: 27463107 PMCID: PMC4982441 DOI: 10.1590/1518-8345.0616.2725] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Accepted: 12/16/2015] [Indexed: 11/22/2022] Open
Abstract
Objective: to evaluate the work ability and health status of security guards at a public
University. Methods: a cross-sectional, descriptive, and analytical study was carried with 119
security guards. The following instruments were used: Work Ability Index (WAI),
Patient Health Questionnaire (PHQ-9), International Physical Activity
Questionnaire (IPAQ, short), Alcohol Use Disorders Identification Test (AUDIT),
Medical Outcomes Study (MOS), and Demand-Control-Support (DCS). Descriptive
statistics were used to describe the study samples and the Spearman's coefficient
correlation was performed to assess the WAI. Significance level was set at 5%.
Results: samples were composed by men; the mean age was 54.9 years (SD=5.7); 80% had
partners, and 75% had basic education. The majority (95%) had only one job, the
average length of service was 24.8 years (SD=11), ranging from 3 to 43 years.
88.9% worked ≤40 hours and 75% did not work at night shift or rotating shifts. The
average score given to work ability was good (40.7 points), with significant
correlation to social support at work (p-value=0.002), health conditions
(p-value=0.094), and depression symptoms (p-value=0.054). Conclusion: this study showed that many characteristics might affect the work ability scores.
Considering the results, we note that healthy life habits and a reorganization of
work environments should be encouraged.
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Affiliation(s)
| | - Aldo Pacheco Ferreira
- Centro de Estudos da Saúde do Trabalhador e Ecologia Humana, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brazil
| | - Rosangela Maria Greco
- Faculdade de Enfermagem, Universidade Federal de Juiz de Fora, Juiz de Fora, MG, Brazil
| | - Liliane Reis Teixeira
- Centro de Estudos da Saúde do Trabalhador e Ecologia Humana, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brazil
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van Muijen P, Duijts SFA, Kornet-van der Aa DA, van der Beek AJ, Anema JR. Work disability assessment of cancer survivors: insurance physicians’ perspectives. Occup Med (Lond) 2015; 65:558-63. [DOI: 10.1093/occmed/kqv098] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Vindholmen S, Haugen T, Høigaard R, Seiler S. What distinguishes responders from nonresponders to a vocational rehabilitation program? Health Psychol Behav Med 2015. [DOI: 10.1080/21642850.2015.1088388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Dekkers-Sánchez PM, Wind H, Frings-Dresen MHW, Sluiter JK. Implementation of a checklist to assess factors relevant for work ability assessments of employees on long-term sick leave. Int Arch Occup Environ Health 2014; 88:577-88. [PMID: 25252737 DOI: 10.1007/s00420-014-0975-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Accepted: 09/03/2014] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To implement the use of a checklist with factors relevant for work ability assessments of employees on long-term sick leave in daily practice of Dutch insurance physicians (IPs). SUBJECTS/DESIGN Two hundred and twenty IPs were asked to participate in a nationwide implementation study. METHODS A context analysis identified the barriers and promoting factors for the implementation. Then, participants were asked to assess, identify and report the factors that hinder or promote return to work (RTW) of employees on long-term sick leave using the checklist during six work ability assessments in daily practice. The outcome measure was the percentage of IPs that used the checklist in at least three of six work ability assessments. The use of the checklist was defined as the assessment of at least one of nine factors from the checklist. A frequency analysis was performed. Official work ability assessment records were analysed to determine whether the IPs reported the assessed factors. RESULTS Most identified barriers and facilitators were related to the potential users, the work environment and the characteristics of the checklist. The implementation goal was achieved. A total of 79 IPs participated. Almost all the IPs (96 %) assessed at least one factor; 89 % used the checklist in at least 3 work ability assessments. An analysis of 474 official work ability assessment records indicated that 90 % of the IPs reported at least one of the factors. CONCLUSIONS The implementation of a checklist to assess barriers and facilitators for RTW of long-term sick-listed employees was successful.
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Affiliation(s)
- Patricia M Dekkers-Sánchez
- Coronel Institute of Occupational Health, Academic Medical Center, University of Amsterdam, P.O. Box 22700, 1100 DE, Amsterdam, The Netherlands,
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Nieuwenhuijsen K, Cornelius LR, de Boer MR, Groothoff JW, Frings-Dresen MHW, van der Klink JJL, Brouwer S. Predicting improvement of functioning in disability claimants. JOURNAL OF OCCUPATIONAL REHABILITATION 2014; 24:410-418. [PMID: 24026339 DOI: 10.1007/s10926-013-9469-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
PURPOSE In the Netherlands, disability claimants are assessed after 2 years of sick leave, but their functioning may still improve. An accurate prognosis of functioning is difficult. Self predictions may be more accurate than those of professionals. The aim of this study, is to assess and compare the accuracy of predictions by disability claimants and insurance physicians (IPs) working at the Social Security Institute. It is further studied whether the accuracy differs between subgroups of claimants with mental or somatic health conditions. METHODS We used data from the prospective cohort study cohort study. Following the assessment of the disability claim (n = 375) and after 1 year follow up (T1, n = 276) data on functioning were obtained from respondents by self-report questionnaire World Health Organization Disability Schedule 2.0. Both claimants and IPs were asked to predict improvement of functioning. Accuracy of their predictions were assessed by sensitivity, specificity, and area under the receiver operating curves (AUC). Mixed logistic regression was conducted to explore differences in accuracy between claimants with mental and somatic conditions. RESULTS One-third (32 %) of disability claimants improved beyond the standard error of measurement. Disability claimants' and IPs were able to predict this improvement of functioning, but to a limited extent, with an AUC of 0.61 for IPs and 0.62 for disability claimants. We found no statistically significant differences in the accuracy of the predictions in claimants with mental or somatic health conditions. CONCLUSIONS Improvements of functioning were not uncommon. However, both IPs and disability claimants were unable to predict improvement with high levels of accuracy in both mental and somatic health conditions.
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Affiliation(s)
- K Nieuwenhuijsen
- Coronel Institute of Occupational Health, Academic Medical Center (AMC), University of Amsterdam, P.O. Box 22700, 1100 DE, Amsterdam, The Netherlands,
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Pélissier C, Fontana L, Chauvin F. Factors influencing return to work after illness in France. Occup Med (Lond) 2013; 64:56-63. [PMID: 24326195 DOI: 10.1093/occmed/kqt142] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Few studies have been published about the factors influencing return to work after sickness absence. AIMS To identify medical and occupational factors influencing the type of fitness certificate given by occupational physicians before employees return to work after sickness absence. METHODS A cross-sectional study was undertaken over 3 months in several health services in France. Workers undergoing a medical examination before returning to work after a period of sickness absence of at least 3 weeks were included. Medical and occupational factors were collected using a questionnaire. The relationship between different factors and certification of fitness was assessed by univariate and multivariate analyses. RESULTS Among the 402 workers included, 64% were considered fit to return to work. Being older, strenuous work, prolonged sick leave and fear of returning to work appeared to be negative factors influencing the return to a previous job. In contrast, having an education level higher than secondary school, being satisfied at work, perception of very good health and benefitting from satisfactory professional relationships appeared to favour return to work. We developed a predictive score of not being fit to return to work after illness. CONCLUSIONS Our study highlighted the relationship between medical and occupational factors with problems returning to work. The predictive score may be used by occupational physicians as a screening tool to identify those who are likely to have difficulties returning to work after illness, so that their working conditions can be modified to take this into consideration.
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Affiliation(s)
- C Pélissier
- Department of Occupational Health, University Hospital, Saint Etienne 42055, France
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