Job Accommodations, Return to Work and Job Retention of People with Physical Disabilities: A Systematic Review

The role of occupational therapy in providing vocational rehabilitation for people living with inflammatory arthritis: A scoping review

INTRODUCTION

Inflammatory arthritis significantly impacts work participation resulting in cost to individuals, employers, and society. Vocational rehabilitation seeks to address this need, but its pathways, interventions, and efficacy continue to be under investigation. Contributing variables are complex, identifying the need for a conceptual framework to guide practice. Occupational therapy addresses this complexity, providing theoretical frameworks such as the Person-Environment-Occupation-Performance (PEOP) model to understand the occupation of work supporting well-being and design interventions. The aim of this scoping review is to map the role of occupational therapy in providing vocational rehabilitation for people living with inflammatory arthritis.

METHODS

A scoping review following Arksey and O'Malley's (2005) stages was completed. Major databases and grey literature were systematically searched, and hand-searches completed. Descriptive and thematic analysis mapped the findings to the PEOP model framework.

CONSUMER AND COMMUNITY INVOLVEMENT

There was no consumer or community involvement in this review.

RESULTS

Fourteen studies were included. Major themes aligned to the PEOP model with further analysis synthesised in subthemes. A majority of person-related interventions to support work performance was observed. This framework identifies the domains of focus in vocational rehabilitation and current gaps. Work instability, employment retention, and self-efficacy were used to measure effectiveness.

CONCLUSION

This scoping review presents the evidence regarding vocational rehabilitation for the inflammatory arthritis population in the context of occupational therapy theory to provide a framework for clinical practice. A current focus on person-focused interventions was identified. The PEOP model provides a clear framework to understand the complexity and nuances of vocational rehabilitation across the domains. Outcome measures for vocational rehabilitation are heterogenous and require further exploration as capturing the intricacy of achieving balance with work participation remains unclear. Further research into vocational rehabilitation programs incorporating all domains of the PEOP model is needed. Consideration of work performance measurements to inform effectiveness and the resulting impact on a person's well-being is required.

The Relationship Between Meeting Workplace Accommodation Needs and Job Disruptions Among Canadians Working With Disabilities: A Cross-Sectional Analysis

OBJECTIVE

This research explores whether having accommodation needs met reduces job disruptions.

METHODS

A cross-sectional survey (n = 955) of Canadians working with physical and/or mental/cognitive disabilities was used to assess the association between having workplace accommodations (ie, flexibility, modifications) needs met and four types of job disruptions. Analyses used marginal effects models to adjust for demographic and work context variables.

RESULTS

Participants with work modification needs met had a 7.7% decrease in lost work time. Participants with workplace flexibility needs met had a 9.9% increase in lost work time. Having workplace flexibility or modification needs met were not associated with the other job disruption outcomes.

CONCLUSIONS

Modifications may help to reduce lost work time for workers with disabilities. Flexibility may increase lost time, which is explained by it enabling workers to attend to personal needs during working hours.

Person-, Job-, and Environment-Related Factors Associated with Long-Term Job Retention of People with Physical Disabilities

PURPOSE

Employment provides people with physical disabilities (PWPD) financial independence, enhances their well-being, self-worth, and facilitates a sense of purpose. However, the unemployment rate for PWPD is significantly higher than for individuals without a disability. There is limited knowledge regarding what factors help people with disabilities retain employment beyond the standard 90-day job probationary period. Thus, we investigated person-, job-, and environment-related factors that contribute to long-term job retention for four years or more among PWPD.

METHODS

We recruited a national sample of 1500 PWPD who had work experience after disability onset from panels assembled by a market research organization. We compared a subsample that maintained their longest held job for at least four years with those who had not using multivariate Poisson regression. Three models evaluated the association between job retention and (1) person-, (2) job-, and (3) environment-related factors.

RESULTS

Likelihood of job retention was greater for respondents reporting fatigue or emotional problems (vs. pain), advancement opportunities, and receipt of job accommodations. Concerns about limited career advancement opportunities, perception of unimportance about disclosing a disability to coworkers, and difficult work commutes were associated with shorter job retention.

CONCLUSION

Several person-, job-, and environment-related factors play an important role in promoting job retention of people with physical disabilities. Employers, job coaches, and rehabilitation professionals should consider these factors when developing strategies to support the retention of PWPD. Future studies should examine the relationship between these factors and their associations with the employment outcomes of PWPD across work settings and industries.

Workplace Accommodations and the Labor Force Status of Persons with Disabilities

PURPOSE

The aim of the study is to examine the role of unmet needs for workplace accommodations (WPA) in the labor force status of persons with disabilities (PWD) aged 25-64 years.

METHODS

The study used data from the 2017 Canadian Survey on Disability and multinomial logistic regressions to estimate the predicted probabilities of employment, unemployment, detachment from the labor force, and retirement. Product terms were used to examine if the association between unmet needs for WPA and these employment outcomes depended on severity of disability and age group.

RESULTS

The findings show that the probability of employment was far lower for PWD with unmet needs for WPA than it was for their counterparts without unmet needs, after controlling for disability-related and sociodemographic characteristics. While having more severe disabilities associated with a lower employment rate, this occurred in the context of unmet needs for WPA, as there was no difference between persons with milder and more severe disabilities without unmet needs. Unmet needs for WPA had age-specific consequences and were associated with a higher probability of unemployment and detachment from the labor force among PWDs aged 25-34 years and a higher probability of retirement among PWD aged 55-64 years.

CONCLUSION

Unmet needs for WPA are a barrier to the employment chances of many PWD and eliminating these unmet needs could increase their inclusion in the labor force.

Sensory Loss and its Association with Different Types of Departures from the Labor Force Among Older Adults in the US

To investigate the association between sensory loss and the timing and type of self-reported departures from the labor force, via retirement or disability, we used data from the Health and Retirement Study, cycles 2004-2018. Based on self-reported sensory loss, we classified individuals into four groups: no sensory loss, hearing loss only, vision loss only, and dual sensory loss (vision and hearing loss). We assumed that older adults could leave the labor force either by retirement or due to disability. Because once one type of exit is observed the other type cannot be observed, we implemented a competing risk approach to estimate the instantaneous rate of departure (sub-distribution hazard rate) for leaving the labor force due to disability, treating retirement as a competing risk, and for departures via retirement, with disability as the competing risk. We found that compared to older adults with no sensory loss, adults with vision loss are at a higher risk for leaving the labor force via disability (when treating retirement as a competing risk). Compared to no sensory loss, hearing loss was associated with a higher risk for retirement in models treating disability as a competing risk. Given the differences between disability and retirement benefits (before and after retirement age), policies intended to keep people with sensory loss from early labor force departures, such as accommodations in the workplace and/or hearing and vision care coverage, might contribute to better retiring conditions and healthy aging among older adults with sensory loss.

Experiences and reflections on living with a personal assistance service: a qualitative study of people with neuromuscular disease or spinal cord injury

PURPOSE

To investigate how people with neuromuscular disease or spinal cord injury experience living with a personal assistance service.

MATERIALS AND METHODS

Qualitative study using the Interpretive Description methodology with Aaron Antonovsky's theory of sense of coherence as a theoretical framework. The method was semi-structured individual interviews (n = 3) and focus group interviews (n = 5). In all, 19 adults with neuromuscular disease (n = 13) or spinal cord injury (n = 6) participated. The study adhered to the Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines.

RESULTS

Three themes were identified to understand living with personal assistance and how this affected everyday life: 1) Making meaning of a personal assistance service, 2) Managing a personal assistance service, and 3) Living with a personal shadow. Our findings provide an understanding of living with assistance and how it, among other things, is influenced by the legislation and the local authorities' administration of the service. Participants explained this by an experience of a sense of coherence.

CONCLUSION

For people with NMD and SCI, there are complex nuances associated with living with a personal assistance service. The findings illustrate that despite personal challenges of managing assistance services, it can meaningfully contribute to one's life by enhancing one's sense of coherence.

Assistive Technology's Potential to Improve Employment of People with Disabilities

PURPOSE

This study investigates how access to assistive technologies affects employment and earnings among people with disabilities.

METHODS

We first document employment and earnings gaps associated with specific impairments and activity limitations using 2017-2021 American Community Survey and 2014 Survey of Income and Program Participation data. We then use accommodations data from the 2012, 2019, and 2021 Current Population Survey (CPS) Disability Supplements to examine employment and earnings growth for people with disabilities related both to any, and to technology-based, accommodations. We also provide short descriptions of three developing assistive technologies that assist people with upper body impairments, visual impairments, and anxiety conditions.

RESULTS

Almost all impairments and activity limitations are linked to lower employment and earnings, with especially low employment among people with mobility impairments and particularly low earnings among those with cognitive impairments. About one-tenth of workers with disabilities received any accommodations, and 3-4% received equipment-based accommodations in the 2012-2021 period; these figures increased slightly over the period. The occupations with the highest disability accommodations rates had greater disability employment growth from 2012 to 2021, but disability pay gaps did not decrease more in these occupations. The three developing assistive technologies we describe illustrate the potential to reduce the estimated employment and earnings deficits.

CONCLUSION

Assistive technology accommodations have potential for improving employment outcomes for people with disabilities.

Facilitators and barriers to employment for people with physical disabilities: A cross-sectional study

BACKGROUND

There is increasing evidence that employment, or the lack thereof, affects an individual's health. Consequently, employment provides people with physical disabilities (PWPD) with financial independence, enhances their well-being and self-worth, and facilitates a sense of purpose. People with physical disabilities often retain job skills and motivation to return to work after acquiring a disability. Their vocational rehabilitation and job accommodation needs likely differ from people with disabilities resulting from developmental, sensory, cognitive, and mental health conditions. To better target the needs of PWPD and improve vocational rehabilitation services, it is crucial to identify the modifiable factors that influence their employment outcomes.

OBJECTIVE

This research aimed to examine systematically the client-, employer-, and context-related facilitators and barriers to employment experienced by PWPD.

METHODS

We recruited to this cross-sectional study, PWPD from the Midwestern United States who returned to work after injury or illness. An online survey collected data on demographic characteristics and educational history; disability and functional status; supports, facilitators and barriers to employment; and job information and accommodations.

RESULTS

347 working-age PWPD completed the survey; at the time of survey completion, 270 were working and 77 were not. People with physical disabilities who reported social support and encouragement at work were more likely to be working than respondents who did not. Negative attitudes of supervisors and colleagues, inaccessible work environments, and inflexible work schedules were barriers to employment. Important reasons for working included financial needs, a sense of purpose, and self-worth.

CONCLUSIONS

Results provide insights into the importance of social supports in the work environment. Novel approaches are needed to develop supportive relationships with supervisors and coworkers.

Facilitators and barriers to employment for people with adult-onset physical disabilities: results from a U.S.A. survey

BACKGROUND

Employment has long been an area of concern for people with disabilities. National samples in the United States are needed to understand the experiences of people with disabilities related to employment.

OBJECTIVES

(1) Describe and evaluate associations between personal and health-related factors with employment after disability, and (2) describe and evaluate associations between facilitators, barriers, and work-related external factors with maintaining a longest held job after disability.

METHODS

We recruited a national sample of people with physical disabilities from panels assembled by a United States market research organization; by selection, 1309 were working and 491 were not. We evaluated the likelihood of employment and maintaining employment after disability onset using Poisson regression. Model 1 evaluated factors associated with employment; Model 2 evaluated factors associated with maintained employment.

RESULTS

Model 1: Older age, decreased ability to pay bills on time, and assistive device use were associated with decreased likelihood of employment after disability onset. Non-Black minority identification, fatigue, and higher physical function were associated with increased likelihood of employment. For Model 2, the likelihood of maintaining a longest held job was associated with acquiring a disability at work, receipt of job accommodations, valuing opportunities for advancement and health benefits, having a helpful living situation, and helpful human resource attitudes. Decreased likelihood of maintaining a longest held job after disability onset was associated with job dissatisfaction and supervisors' attitudes.

CONCLUSIONS

This work highlights opportunities for employers to focus efforts on job accommodations and support in the maintenance of employment after disability.

Return-to-work with long COVID: An Episodic Disability and Total Worker Health® analysis

A growing number of working individuals have developed long COVID (LC) after COVID-19 infection. Economic analyses indicate that workers' LC symptoms contribute to workforce shortages. However, factors that affect return-to-work from perspectives of people with LC remain largely underexplored. This qualitative study of people with LC conducted by researchers living with LC aimed to identify participants' return-to-work experiences using Total Worker Health® and Episodic Disability frameworks. 10% of participants who participated in a mixed-method global internet survey, had LC symptoms >3 months, and responded in English were randomly selected for thematic analysis using NVivo12. 15% of responses were independently double-coded to identify coding discrepancies. Participants (N = 510) were predominately white and had at least a baccalaureate degree. Four primary work-related themes emerged: 1) strong desire and need to return to work motivated by sense of purpose and financial precarity; 2) diverse and episodic LC symptoms intersect with organization of work and home life; 3) pervasiveness of LC disbelief and stigma at work and in medical settings; and 4) support of medical providers is key to successful return-to-work. Participants described how fluctuation of symptoms, exacerbated by work-related tasks, made returning to work challenging. Participants' ability to work was often predicated on job accommodations and support. Non-work factors were also essential, especially being able to receive an LC medical diagnosis (key to accessing leave and accommodations) and help at home to manage non-work activities. Many participants described barriers accessing these supports, illuminating stigma and disbelief in LC as a medical condition. Qualitative findings indicate needs for workplace accommodations tailored to fluctuating symptoms, continuously re-evaluated by workers and supervisors together. Reductions in medical barriers to access work accommodations is also critical since many medical providers remain unaware of LC, and workers may lack a positive COVID test result.

Disability Phenotypes and Job Accommodations Utilization Among People with Physical Disability

Purpose People with disabilities (PWD) are less likely to be employed than those without disabilities. Reasonable job accommodations are an essential factor for ensuring equal access to jobs for PWD. However, use of job accommodation is less than optimal among PWD with various types of disabilities. Sometimes, PWD have co-occurring impairments, which might affect accommodation use. This research aimed to explore disability phenotypes, frequently used accommodations, and employee- and job-related factors associated with the extent of job accommodation use. Methods A cross-sectional online survey of PWD was conducted in the Midwest region of the United States. Latent class analyses were used to identify disability phenotypes. Descriptive analysis and stepwise Poisson regression were used to identify factors associated with job accommodation use. Results A total of 326 PWD with work experience after acquiring a disability were included in this analysis. We identified three disability phenotypes: (1) Severe disability in cognitive, physical, emotional, communication and visual domains (32%), (2) Moderate cognitive and low physical disability (48%), and (3) High physical disability phenotypes (20%). 80% of PWD received at least one accommodation. Flexible working schedules, telework, and access to a support person in the workplace were the most common accommodations. Employee- (age, disability phenotypes, motor function) and job-related factors (job preparation, self-employment) are associated dependently with accommodation use. Conclusion This analysis identifies three disability phenotypes and highlights both employee- and job-related factors associated with accommodations used. It may be beneficial to consider multiple contextual factors, including co-occurring disability, employee- and job-related factors, when assisting people with job accommodations.

A "win-win" perspective on workplace accommodations: RETAIN Kentucky's self-advocacy guide to promote successful return to work and stay at work outcomes for workers with disabilities

BACKGROUND

Research has long documented the low cost and effectiveness of most workplace accommodations to enable qualified people with disabilities to seek, secure, and maintain employment.

OBJECTIVE AND METHOD

RETAIN Kentucky's return to work and stay at work intervention involves focused training for participants on requesting needed accommodations from their employers.

RESULTS

In this article, we describe the win-win approach to reasonable accommodations, which serves as the basis for helping Kentuckians with disabilities identify and request on-the-job supports to aid in their efforts to remain in the workforce.

CONCLUSIONS

Workers with disabilities are more likely to stay in the workforce and continue making valuable contributions to the national and global economies if they have effective accommodations and other employment supports available to them.

Prediction Model for Job Retention According to the Type of Return to Work Among Industrially Injured Workers in Korea

OBJECTIVES

This study aimed to investigate how the type of return to work after an industrial accident affects job retention.

METHODS

Using data from the panel study of workers' compensation insurance first-third, and hazard ratios (HRs) and 95% confidence intervals were calculated for workers leaving their jobs.

RESULTS

The HR leaving their jobs were higher in the "reemployed" compared with that in the "returned to original work," with HR of 2.69 (2.33-3.10). According workers' status, the HRs leaving their jobs were higher among the "reemployed" than among those who "returned to original work." Regular and daily workers' HRs were 1.70 (1.37-2.11) and 3.55 (2.96-4.26), respectively.

CONCLUSIONS

The findings suggest that to increase job retention rate, protection policies for reemployed workers or support for employers who hire reemployed workers should be considered.

Employers’ Perceptions of Challenges and Strategies in Hiring, Retaining, and Promoting Employees With Physical Disabilities

Disability is a common component of human diversity, yet people with disabilities (PWD) are underrepresented in the workplace despite known benefits to PWD and companies alike. There is an urgent need to promote inclusion of PWD in the workplace. The purpose of this study was to explore employer-perceived challenges and strategies for employing, retaining, and promoting people with physical disabilities (PWPD) and to describe the policies, supports, and job accommodations they provide to PWPD. We administered a cross-sectional, online survey to employers in the Midwestern United States ( n = 53). Employers had an average of 8.5 years of experience in their job roles and represented diverse industries and company sizes. Employers provide a range of job accommodations; however, many reported lacking comprehensive disability policies such as training managers on how to support PWPD, providing employee resource groups for PWPD, and having a specific job accommodation fund. Major challenges reported by employers were related to lacking competencies in supporting employees with physical disabilities. However, employers endorsed the utility of strategies to address these challenges, including providing education and training and increasing buy-in from leadership. Study findings inform employers on ways to best support PWPD and improve diversity, equity, and inclusion in the workplace.

Changes in healthy and unhealthy working life expectancies among older working-age people in Finland, 2000-2017

Background

Raising the statutory retirement age has been a common policy response to population ageing, but health problems may restrict labour force participation in older ages. We examined the development of healthy and unhealthy working life expectancies in Finland from 2000 to 2017 using different measures of health problems.

Methods

Healthy and unhealthy working life expectancies were calculated for the age range 50–65 years using the Sullivan method. The health measures were limiting long-standing illness, self-rated health, mental health problems and self-assessed work ability.

Results

Healthy working life expectancy was highest when health was measured by work ability. From 2000 to 2017, working years in full ability between the ages 50–65 increased from 6.2 (95% confidence interval 5.9–6.4) to 8.2 (8.0–8.5). Healthy working life expectancy increased also when measured by the other indicators. Unhealthy working years also increased, except when health problems were measured by limiting long-standing illness. The share of years in work increased both within the healthy and the unhealthy years, the increase being larger or equally large for the latter. Within the healthy and unhealthy years measured by the other three indicators, the share of working years increased irrespective of whether work ability was full or limited, but the increase was larger for limited work ability.

Conclusions

In Finland, healthy working life expectancy has increased irrespective of how health is measured but also working with health problems has become more prevalent. The estimates for healthy working years are highest when a direct measure of work ability is used.

Evaluation of Usability and Satisfaction of Two Online Tools to Guide Return to Work for Cancer Survivors on the Cancer and Work Website

Prompt services and work-focused support systems are needed to aid cancer survivors returning to work or finding work. Purpose This knowledge translation and implementation project focused on the knowledge users' experience and need for refinement of three work-focused tools to support return to work and maintain work following cancer through their participation in a hands-on workshop. The tools assessed for their utility are a Job Analysis Tool (JAT), a Return to Work (RTW) tool, and a bilingual Canadian website on Cancer and Work. Methods Four workshops took place in three Canadian cities. Participants included cancer survivors, healthcare professionals, and employer representatives. Following an overview of the website and tools, workshop participants (N = 28) completed qualitative and quantitative satisfaction and usability questionnaires using the System Usability Scale and open-ended questions. Qualitative data was analyzed using content analyses from the think-aloud data and from the four open-ended questions collected during the users' use of the tools and website. Results Overall, most study participants reported high satisfaction with the JAT and RTW tools, the Cancer and work website and the workshop. Good usability scores were reported for the RTW planner (73.65 ± 12.61) and the website (74.83 ± 12.36), and only acceptable usability scores for the JAT (68.53 ± 11.90). Conclusion Overall, the study documented the value of the tools and the website to support the RTW process as assessed by several key knowledge user groups. The JAT is considered a helpful procedure to identify job demands in order to guide job accommodations. Given participants' responses that the tool is useful, the next steps are to implement the recommendations for improvement and knowledge dissemination to increase its uptake and the use of job analysis overall.

Lessons Learned by Rehabilitation Counselors and Physicians in Services to COVID-19 Long-Haulers: A Qualitative Study

Coronavirus disease (COVID-19) may cause long-lasting adverse consequences after acute recovery, including functional limitations and reduced work capacity. Individuals with long-lasting complications of COVID-19 are known as long-haulers. There is a knowledge gap on how COVID-19 complications affect return-to-work (RTW) efforts. We aimed to describe the challenges that long-haulers encounter when RTW from the perspectives of rehabilitation professionals. In this study, four certified rehabilitation counselors and four rehabilitation physicians in outpatient rehabilitation centers participated in focus groups. Participants discussed challenges in working with long-haulers, including personal attributes, post-COVID-19 symptoms and complications, uncertain recovery and unpredictable outcomes, limited health care accessibility and support, and unsupportive work environments. Participants provide individualized services to meet long-haulers’ diverse needs as they do for all persons with disabilities, although they expressed uncertainty due to the variable disease course and risk of infection. Modifying workplace policies, especially gradual RTW, were frequently mentioned accommodations. The findings highlight the RTW issues of long-haulers. We provide recommendations on increasing awareness of the challenges and job accommodations of long-haulers.

Work Resumption after a Fixed-Term Disability Pension: Changes over Time during a Period of Decreasing Incidence of Disability Retirement

The incidence of disability retirement in Finland has sharply decreased over the last ten years. At the same time, the share of fixed-term pensions has increased to cover more than half of all new disability pensions. This study examined the efficiency of fixed-term disability pensions under these changing circumstances with the aim of addressing the following research questions: are fixed-term disability pensions more often converted to permanent pensions, and how have the changes affected return to work? The study was based on register data of Finnish residents aged 25-62 whose fixed-term disability pension started in 2006 (n = 10,177) or 2015 (n = 7918). Of the fixed-term disability pensions starting in 2006, 58 percent were converted to a permanent disability pension within the next four years. In 2015, the corresponding figure was 41 percent. Return to work increased from 24 to 30 percent. In addition, ending up in some other state (most often unemployment) increased, and, more often, fixed-term disability pensions continued for more than four years. Transferring to a permanent disability pension decreased more among the younger, those with a lower education, and those suffering from mental disorders. The results were not notably affected by changes in the characteristics of fixed-term disability pension recipients (e.g., demographic and occupational characteristics and rehabilitation) or the selection of applicants into a fixed-term or a permanent pension. Return to work increased more among men, the older age groups, those with a fixed-term disability pension due to somatic diseases, and those who had received vocational rehabilitation. Adjusting for the composition of fixed-term disability pensioners increased the differences between the study years, and controlling for the selection into a fixed-term pension further widened the differences. In conclusion, a decreasing proportion of fixed-term disability pensions are converted to permanent pensions, but this is only partly reflected in increased return to work. Further efforts are needed to support work resumption after a fixed-term disability pension to avoid the situation where people drop out from disability pension but are resting on unemployment and other benefits.