Challenges to remaining at work with common health problems: what helps and what influence do organisational policies have?

Active engagement of managers in employee RTW and manager-employee relationship: managers' experiences of participating in a dialogue using the Demand and Ability Protocol

PURPOSE

To describe how managers of employees on sick-leave, due to chronic pain conditions, experience participating in a three-party meeting using the Demand and Ability Protocol (DAP) in the return-to-work process.

MATERIALS AND METHODS

This study is based on individual semi-structured interviews with 17 managers of employees with chronic pain. Interviews were conducted after participating in a three-party meeting including the employee, manager, and a representative from the rehabilitation team. The data were analyzed using thematic analysis with an inductive approach.

RESULTS

Two main themes were identified - "to converse with a clear structure and setup" and "to be involved in the employee's rehabilitation." The first theme describe experiences from the conversation, and the second theme reflected the managers' insights when being involved in the employee's rehabilitation. The themes comprise 11 sub-themes describing how the DAP conversation and the manager's involvement in the rehabilitation may influence the manager, the manager-employee relationship, and the organization.

CONCLUSIONS

This study show, from a manager's perspective, how having a dialogue with a clear structure and an active involvement in the employee's rehabilitation may be beneficial for the manager-employee relationship. Insights from participating in the DAP may also be beneficial for the organization.IMPLICATIONS FOR REHABILITATIONA structured dialogue between the employee, employer, and rehabilitation supports the return to work (RTW) processA structured dialogue and collaboration may strengthen the relationship between the manager and employeeAn active engagement of managers in the employeès RTW process is beneficial for the manager-employee relationship, and for the organisationHealthcare professionals should collaborate with the workplace to promote participation of managers.

Including a Three-Party Meeting Using the Demand and Ability Protocol in an Interdisciplinary Pain Rehabilitation Programme for a Successful Return to Work Process

The Demand and Ability Protocol (DAP) is used in three-party meetings involving an employee, an employer, and a representative from the rehabilitation team. The aim of this study is to investigate the inclusion of an intervention using the DAP in an interdisciplinary pain rehabilitation programme (IPRP) compared to usual care. This non-randomised controlled trial included patients assigned to an IPRP in Sweden. The intervention group received a DAP intervention targeting their work situation in addition to the usual care provided by the IPRP. The control group received IPRP only. Outcome measures were collected from the Swedish Quality Registry for Pain Rehabilitation. Results demonstrated improvements in both groups regarding self-reported anxiety, depression and EQ5D. Sleep was improved in the intervention group but not in the control group. No statistical differences in outcomes were observed between the groups. In conclusion, adding the DAP intervention to IPRP seemed to have the potential to improve sleep among the patients, which may indicate an overall improvement regarding health outcomes from a longer perspective. The results were less clear, however, regarding the work-related outcomes of sickness absence and workability.

Projections of healthy working life expectancy in England to the year 2035

UK state pension age is rising in response to life expectancy gains but population health and job opportunities may not be sufficient to achieve extended working lives^1-3. This study aimed to estimate future trends in healthy working life expectancy (HWLE) from age 50 to 75 for men and women in England. Using the 'intercensal' health expectancy approach, annual period HWLE from 1996 to 2014 was estimated using cross-sectional Health Survey for England data and mortality statistics^4-7. HWLE projections until the year 2035 were estimated from Lee-Carter forecasts of transition rates⁸. Projections of life expectancy from age 50 showed gains averaging 10.7 weeks (0.21 years) and 6.4 weeks (0.12 years) per calendar year between 2015 and 2035 for men and women respectively. HWLE has been extending in England but gains are projected to slow to an average of 1 week per year for men (0.02 years) and 2.8 weeks (0.05 years) per year for women between 2015 and 2035. Modest projected HWLE gains and the widening gap between HWLE and life expectancy from age 50 suggest that working lives are not extending in line with policy goals. Further research should identify factors that increase healthy working life.

Translation, cultural adaptation, and psychometric testing of the Yoruba version of Fear-Avoidance Beliefs Questionnaire in patients with low-back pain

PURPOSE

To translate, culturally adapt, and validate the Fear-Avoidance Beliefs Questionnaire into Yoruba language.

MATERIALS AND METHODS

Translation and cultural adaptation of the Yoruba version of the Fear-Avoidance Beliefs Questionnaire was carried out following the Guillemin criteria. One hundred and thirty-one individuals with chronic low-back pain participated in the psychometric evaluation of the Yoruba language translation. Cronbach's alpha (α), principal component analysis, intra-class correlation, Bland-Altman analysis, Spearman rank correlation coefficient, and minimal detectable difference were used for the analysis. Alpha level was set at p < 0.05.

RESULTS AND CONCLUSION

The mean age of the respondents was 53.6 ± 11.6 years. The internal consistency of the Yoruba language version of the Fear Avoidance Beliefs Questionnaire yielded a Cronbach's alpha of 0.9. Principal component analysis yielded a three-factor structure including the "work", "beliefs related to work", and "physical activity" which accounted for 61.6% of variance in the Yoruba translation. Test-retest reliability of the Yoruba translation yielded an Intra class correlation coefficient 0.97 (0.95-0.98). The Yoruba Fear Avoidance Beliefs Questionnaire was poorly correlated with the Visual Analog Scale (r = 0.01) and Roland-Morris Disability Questionnaire (r = 0.3). The minimal detectable difference of the Yoruba translation was 7.0. The Yoruba Fear Avoidance Beliefs Questionnaire demonstrated excellent psychometric properties similar to existing versions and is appropriate for clinical use among Yoruba-speaking patients.IMPLICATIONS FOR REHABILITATIONThe Fear-Avoidance Beliefs Questionnaire is a culturally sensitive psychosocial outcome measure, necessitating its existence, and adaptation into different languages.The instrument was translated and culturally adapted into the Yoruba language following the Guillemin criteria.The Yoruba translation demonstrated excellent internal consistency, test-retest reliability and weak correlations with the Visual analog scale and Roland-Morris Disability Scale.The Yoruba version of the Fear-Avoidance Beliefs Questionnaire can be used to assess fear-avoidance beliefs among Yoruba speaking patients with low-back pain.

Collaborative case management to aid return to work after long-term sickness absence: a pilot randomised controlled trial

Background

Despite high levels of employment among working-age adults in the UK, there is still a significant minority who are off work with ill health at any one time (so-called ‘sickness absence’). Long-term sickness absence results in significant costs to the individual, to the employer and to wider society.

Objective

The overall objective of the intervention was to improve employee well-being with a view to aiding return to work. To meet this aim, a collaborative case management intervention was adapted to the needs of UK employees who were entering or experiencing long-term sickness absence.

Design

A pilot randomised controlled trial, using permuted block randomisation. Recruitment of patients with long-term conditions in settings such as primary care was achieved by screening of routine records, followed by mass mailing of invitations to participants. However, the proportion of patients responding to such invitations can be low, raising concerns about external validity. Recruitment in the Case Management to Enhance Occupational Support (CAMEOS) study used this method to test whether or not it would transfer to a population with long-term sickness absence in the context of occupational health (OH).

Participants

Employed people on long-term sickness absence (between 4 weeks and 12 months). The pilot was run with two different collaborators: a large organisation that provided OH services for a number of clients and a non-profit community-based organisation.

Intervention

Collaborative case management was delivered by specially trained case managers from the host organisations. Sessions were delivered by telephone and supported use of a self-help handbook. The comparator was usual care as provided by participants’ general practitioner (GP) or OH provider. This varied for participants according to the services available to them. Neither participants nor the research team were blind to randomisation.

Main outcome measures

Recruitment rates, intervention delivery and acceptability to participants were the main outcomes. Well-being, as measured by the Clinical Outcomes in Routine Evaluation Outcome Measure (CORE-OM), and return-to-work rates were also recorded.

Results

In total, over 1000 potentially eligible participants were identified across the sites and invited to participate. However, responses were received from just 61 of those invited (5.5%), of whom 16 (1.5%) were randomised to the trial (seven to treatment, nine to control). Detailed information on recruitment methods, intervention delivery, engagement and acceptability is presented. No harms were reported in either group.

Conclusions

This pilot study faced a number of barriers, particularly in terms of recruitment of employers to host the research. Our ability to respond to these challenges faced several barriers related to the OH context and the study set up. The intervention seemed feasible and acceptable when delivered, although caution is required because of the small number of randomised participants. However, employees’ lack of engagement in the research might imply that they did not see the intervention as valuable.

Future work

Developing effective and acceptable ways of reducing sickness absence remains a high priority. We discuss possible ways of overcoming these challenges in the future, including incentives for employers, alternative study designs and further modifications to recruitment methods.

Trial registration

Current Controlled Trials ISRCTN33560198.

Funding

This project was funded by the NIHR Public Health Research programme and will be published in full inPublic Health Research; Vol. 6, No. 2. See the NIHR Journals Library website for further project information.

Employer Policies and Practices to Manage and Prevent Disability: Conclusion to the Special Issue

Purpose Research of employer policies and practices to manage and prevent disability spans many disciplines and perspectives, and there are many challenges related to stakeholder collaboration, data access, and interventions. The purpose of this article is to synthesize the findings from a conference and year-long collaboration among a group of invited researchers intended to spur new research innovations in this field. Methods A multidisciplinary team of 26 international researchers with published research in employer-based disability management or related fields were invited to attend a 3-day conference in Hopkinton, Massachusetts, USA. The conference goals were to review the status of current research of workplace disability management and prevention, examine its relevance for employer decision-making, compare conceptual frameworks or theoretical perspectives, and recommend future research directions. In this paper, we summarize key points from the 6 resulting papers, compare them with an earlier 2005 conference on improving return-to-work research, and conclude with recommendations for further overarching research directions. Results/Conclusion In comparison with the 2005 conference, a greater emphasis was placed on organizational and social factors, employer roles and responsibilities, methods of implementation, non-clinical approaches, and facilitating stay-at-work as well as return-to-work. A special panel of employer consultants and representatives who were featured at the 2015 conference reinforced the importance of organizational culture, leadership style, and financial decision-making strategies at the employer level. Based on the conference proceedings, we recommend that future research in this area should strive for: (a) broader inclusion of workers and workplaces; (b) attention to multilevel influences in the workplace;

Decision-making in job attendance within health care--a qualitative study

BACKGROUND

Musculoskeletal complaints are considered a major cause of sickness absence, particularly in areas such as the health sector. However, little is known about the personal decision-making process for self-certified sickness absence.

AIMS

To explore female health care workers' thoughts and experiences about work attendance when experiencing musculoskeletal symptoms.

METHODS

A qualitative study using individual, semi-structured, in-depth interviews with eight female health care workers was performed. Questions were related to factors influencing the decision to attend work and decision-making when facing the dilemma of attending work when experiencing musculoskeletal symptoms. The data were analysed according to the systematic text condensation.

RESULTS

Subjects reported a high threshold before calling in sick. Self-certified sickness absence was not a strategy for coping with musculoskeletal symptoms as participants chose to be physically active and work part-time rather than taking sickness absence. Making decisions about attending work fostered conflicting norms, as women faced a dilemma between feeling guilt towards colleagues and patients and taking care of their own health.

CONCLUSIONS

The findings highlight the complexity of managing work when experiencing musculoskeletal symptoms, and the dilemmas faced by those affected. The importance of work environment factors and the fact that some women feel compelled to work part-time in order to prioritize their own health require further consideration.

Manager Experiences with the Return to Work Process in a Large, Publically Funded, Hospital Setting: Walking a Fine Line

PURPOSE

Previous research on the role of managers in the return to work (RTW) process has primarily been conducted in contexts where the workplace has declared organizational responsibility for the process. While this is a common scenario, in some countries, including Denmark, there is no explicit legal obligation on the workplace to accommodate RTW. The aim of this study was to gain knowledge about the potential roles and contributions of managers in supporting returning employees in a context where they have no legal obligation to actively support RTW.

METHODS

Nineteen Danish hospital managers participated in a one-on-one interview or focus group discussions aimed at identifying barriers and facilitators for supporting employees in their RTW. Five individual interviews and two focus group discussions were conducted. Transcripts were analysed using thematic content analysis.

RESULTS

Four main themes were identified: (1) 'Coordinator and collaborator'; (2) 'Dilemmas of the RTW policy enforcer'; (3) 'The right to be sick and absent'; and (4) 'Keep the machinery running…'. Our findings indicated that supervisors' capacity to support returning workers was related to individual, communication, organizational, and policy factors. Instances were observed where supervisors faced the dilemma of balancing ethical and managerial principles with requirements of keeping staffing budgets.

CONCLUSION

Although it is not their legislative responsibility, Danish managers play a key role in the RTW process. As has been observed in other contexts, Danish supervisors struggle to balance considerations for the returning worker with those of their teams.

What Challenges Manual Workers' Ability to Cope with Back Pain at Work, and What Influences Their Decision to Call in Sick?

INTRODUCTION

Although back pain (BP) is a very common cause for sickness absence, most people stay at work during BP episodes. Existing knowledge on the factors influencing the decision to stay at work despite pain is limited. The aim of this study was to explore challenges for coping with BP at work and decisive factors for work attendance among workers with high physical work demands.

METHODS

Three focus groups (n = 20) were conducted using an explorative inductive method. Participants were public-employed manual workers with high physical work demands. All had personal BP experience. Thematic analysis was used for interpretation. Results were matched with the Flags system framework to guide future recommendations.

RESULTS

Workers with BP were challenged by poor physical work conditions and a lack of supervisor support/trust (i.e. lack of adjustment latitude). Organization of workers into teams created close co-worker relationships, which positively affected BP coping. Workers responded to BP by applying helpful individual adjustments to reduce or prevent pain. Traditional ergonomics was considered inconvenient, but nonetheless ideal. When pain was not decisive, the decision to call in sick was mainly governed by workplace factors (i.e. sick absence policies, job strain, and close co-workers relationships) and to a less degree by personal factors.

CONCLUSION

Factors influencing BP coping at work and the decision to report sick was mainly governed by factors concerning general working conditions. Creating a flexible and inclusive working environment guided by the senior management and overall work environment regulations seems favourable.

Well, I'm healthy, but…--lay perspectives on health among people with musculoskeletal disorders

PURPOSE

The purpose was to investigate lay perspectives on health among people with musculoskeletal disorders.

METHOD

Semi-structured interviews were performed with 39 women and 30 men, (aged 22-63 years) with long-term, non-specific musculoskeletal disorders in the neck, shoulder and/or low back. Data was analysed using qualitative content analysis.

RESULTS

These people experienced health as "having resources and opportunities to lead the life one wants". Three categories, "a good enough physical and psychological functioning, freedom of action, and a positive state of emotion and an enriching life", illustrate the different resources and opportunities that the informants described as important for them to perceive themselves as healthy. The informants also reflected on "being ill" and "being well" and what makes the difference. Five aspects influenced the dynamics of their health experiences: "body and soul, prognosis, character of symptoms, physical and social activity, and emotional state". Consequently, the informants expressed a holistic view of health, where the focus lies on the opportunity and the ability to lead their lives the way they want.

CONCLUSIONS

This study points at the value of taking lay perspectives on health into account, as it might increase the opportunity to design effective, personalized rehabilitation strategies.

IMPLICATIONS FOR REHABILITATION

Musculoskeletal disorders (MSDs) are difficult to cure and actions to alleviate suffering are of most importance to increase wellbeing and thereby work ability. Research on lay perspectives can contribute towards a deepened understanding of the health experiences of the affected, and thereby the development of the goals and activities of rehabilitation. Our models, that present the view of health and aspects important for achieving wellness among people with MSDs, can contribute in the development of multimodal rehabilitation. The results can also be useful as a base in the evaluation of clinical practice.