A systematic review of interventions to promote work participation in older workers

What is the volume, quality and characteristics of evidence relating to the effectiveness and cost-effectiveness of multi-disciplinary occupational health interventions aiming to improve work-related outcomes for employed adults? An evidence and gap map of systematic reviews

Background

In the UK, tens of millions of working days are lost due to work-related ill health every year, costing billions of pounds. The role of Occupational Health (OH) services is vital in helping workers to maintain employment when they encounter injury or illness. OH providers traditionally rely on a clinical workforce to deliver these services, particularly doctors and nurses with OH qualifications. However, the increasing demand for OH services is unlikely to be met in the future using this traditional model, due to the declining number of OH-trained doctors and nurses in the UK. Multi-disciplinary models of OH delivery, including a more varied range of healthcare and non-healthcare professionals, could provide a way to meet this new demand for OH services. There is a need to identify collaborative models of OH service delivery and review their effectiveness on return-to work outcomes. There is an existing pool of systematic review evidence evaluating workplace based, multi-disciplinary OH interventions, but it is difficult to identify which aspects of the content and/or delivery of these interventions may be associated with improved work-related outcomes.

Objectives

The aim of this evidence and gap map (EGM) was to provide an overview of the systematic review evidence that evaluates the effectiveness and cost-effectiveness of multi-disciplinary OH interventions intending to improve work-related outcomes.

Search Methods

In June 2021 we searched a selection of bibliographic databases and other academic literature resources covering a range of relevant disciplines, including health care and business studies, to identify systematic review evidence from a variety of sectors of employment. We also searched Google Search and a selection of topically relevant websites and consulted with stakeholders to identify reports already known to them. Searches were updated in February 2023.

Selection Criteria

Systematic reviews needed to be about adults (16 years or over) in employment, who have had absence from work for any medical reason. Interventions needed to be multi-disciplinary (including professionals from different backgrounds in clinical and non-clinical professions) and designed to support employees and employers to manage health conditions in the workplace and/or to help employees with health conditions retain and/or return to work following medical absence. Effectiveness needed to be measured in terms of return to work, work retention or measures of absence, or economic evaluation outcomes. These criteria were applied to the title and abstract and full text of each systematic review independently by two reviewers, with disagreements resolved through discussion. We awarded each systematic review a rating of 'High', 'Medium' or 'Low' relevance to indicate the extent to which the populations, interventions and their contexts synthesised within the review were consistent with our research question. We also recorded the number of primary studies included within each of the 'High' and 'Medium' reviews that were relevant to research question using the same screening process applied at review level.

Data Collection and Analysis

Summary data for each eligible review was extracted. The quality of the systematic reviews, rated as 'High' or 'Medium' relevance following full text screening, was appraised using the AMSTAR-2 quality appraisal tool. All data were extracted by one reviewer and checked by a second, with disagreements being settled through discussion. Summary data for all eligible systematic reviews were tabulated and described narratively. The data extracted from reviews of 'High' and 'Medium' relevance was imported into EPPI-Mapper software to create an EGM.

Stakeholder Involvement

We worked alongside commissioners and policy makers from the Department of Health and Social Care (DHSC) and Department of Work and Pensions (DWP), OH personnel, and people with lived experience of accessing OH services themselves and/or supporting employees to access OH services. Individuals contributed to decision making at all stages of the project. This ensured our EGM reflects the needs of individuals who will use it.

Main Results

We identified 98 systematic reviews that contained relevant interventions, which involved a variety of professionals and workplaces, and which measured effectiveness in terms of return to work (RTW). Of these, we focused on the 30 reviews where the population and intervention characteristics within the systematic reviews were considered to be of high or medium relevance to our research questions. The 30 reviews were of varying quality, split evenly between High/Moderate quality and Low/Critically-Low quality ratings. We did not identify any relevant systematic review evidence on any other work-related outcome of interest. Interventions were heterogenous, both within and across included systematic reviews. The EGM is structured according to the health condition experienced by participants, and the effectiveness of the interventions being evaluated, as reported within the included systematic reviews. It is possible to view (i) the quality and quantity of systematic review evidence for a given health condition, (ii) how review authors assessed the effectiveness or cost-effectiveness of the interventions evaluated. The EGM also details the primary studies relevant to our research aim included within each review.

Authors’ Conclusions

This EGM map highlights the array of systematic review evidence that exists in relation to the effectiveness or cost-effectiveness of multi-disciplinary, workplace-based OH interventions in supporting RTW. This evidence will allow policy makers and commissioners of services to determine which OH interventions may be most useful for supporting different population groups in different contexts. OH professionals may find the content of the EGM useful in identifying systematic review evidence to support their practice. The EGM also identifies where systematic review evidence in this area is lacking, or where existing evidence is of poor quality. These may represent areas where it may be particularly useful to conduct further systematic reviews.

Association between alcohol consumption and chronic kidney disease: a population-based survey

BACKGROUND

Alcohol consumption is associated with both beneficial and harmful effects, and the role of alcohol consumption in chronic kidney disease (CKD) remains inconclusive. This study aimed to investigate the relationship between alcohol consumption and CKD or estimated glomerular filtration rate (eGFR).

METHODS

This study enrolled adults from the second Taiwanese Survey on Prevalences of Hypertension, Hyperglycemia, and Hyperlipidemia, conducted in 2007. Participants were categorized into frequent drinkers, occasional drinkers, and nondrinkers. The amount of alcohol consumption was assessed by standard drinks per week. The primary outcome was the presence of CKD, and the secondary outcome was the eGFR.

RESULTS

Among 3967 participants with a mean age of 47.9 years and a CKD prevalence of 11.7%, 13.8% were frequent drinkers, and 23.1% were occasional drinkers. The average amount of alcohol consumed was 3.3 drinks per week. Frequent drinkers (odds ratio [OR] 0.622, 95% confidence interval [CI] 0.443-0.874) and occasional drinkers (OR 0.597 95% CI 0.434-0.821) showed a lower prevalence of CKD than nondrinkers. Consumption of a larger number of standard drinks was associated with a lower prevalence of CKD (OR 0.872, 95% CI 0.781-0.975). Frequent drinkers and those who consumed a larger number of standard drinks per week showed higher eGFRs.

CONCLUSION

Within the range of moderate alcohol intake, those who consumed more alcohol had a higher eGFR and reduced prevalence of CKD. The potentially harmful effects of heavy drinking should be taken into consideration, and alcohol intake should be limited to less than light to moderate levels.

Which interventions are used in the rehabilitation, return, and stay at work process of aging workers having suffered an occupational injury? A scoping review

BACKGROUND

Considering current labour shortages, the recent increase in the number of aging workers in the labour market is deemed economically beneficial. However, due to specific characteristics (e.g. biological, generational), aging workers take longer to recover and return to work after an occupational injury. Yet, few studies have examined the rehabilitation, return, and stay at work process of aging workers and current knowledge makes it difficult for stakeholders to identify which interventions to use with this specific population.

OBJECTIVE

This study aimed to describe which interventions are used in the rehabilitation, return, and stay at work process of aging workers having suffered an occupational injury.

METHODS

We conducted a five-step scoping review. Five databases were used for the literature search. A qualitative analysis of the retained manuscripts was conducted.

RESULTS

Our analysis led to the extraction of information from seven manuscripts that concern the rehabilitation, return, and stay at work process of aging workers who suffered an occupational injury exclusively. We identified 19 interventions (e.g. work capacity development, work task modifications, permanent part-time work, and alternative roles) and were described according to the different phases of the Cycle of Work Disability Prevention (CWDP).

CONCLUSIONS

This study offers informative, non-prescriptive, and operational interventions useful for stakeholders who support aging workers. Furthermore, it is a knowledge base to develop future projects that promote the rehabilitation, return, and stay at work process of aging workers.

Predictors of Retirement Voluntariness Using Canadian Longitudinal Study on Aging Data

Objectives: Involuntary exit from the labor force can lead to poor health and well-being outcomes. Therefore, the purpose of this research is to better understand the factors that contribute to perceived retirement voluntariness. Methods: We conducted descriptive and multivariable logistic regression analyses using a sample of recent retirees (n = 2080) from the Canadian Longitudinal Study on Aging (CLSA). Results: More than one-quarter (28%) of older workers perceived their retirement to be involuntary. Among 37 possible predictors, 14 directly predicted retirement voluntariness and many more indirectly predicted retirement voluntariness. Only four direct predictors were common to both women and men, retiring because of organizational restructuring/job elimination; disability, health, or stress; financial possibility; and having wanted to stop working. Discussion: Findings suggest the need for employment support, health promotion, work disability prevention, financial education, and support that is sensitive to the differences between women and men to prevent involuntary retirement.

Health and inclusive labour force participation

The future of work is rapidly changing, with higher flexibility of the labour market and increasing informal employment in many countries worldwide. There is also an increased pressure to extend working careers until older age. We introduce the concept of working life expectancy as a useful metric, capturing the expected numer of years in paid employment across the working age individuals, in particular among different groups. We describe factors that determine working life expectancy. Macro-level factors focus on the socioeconomic and political context that influences labour force participation, primarily policies and legislation in specific countries. At the meso level, employment contracts and working conditions are important. The micro level shows that individual characteristics, such as education, gender, and age, influence working careers. There are three important groups with a disadvantaged position in the labour market-workers with chronic diseases, workers with impairing disabilities, and workers aged 50 years or more. Within each of these disadvantaged groups, macro-level, meso-level, and micro-level factors that influence entering and exiting paid employment are discussed. To assure that paid employment is available for everyone of working age and that work contributes to better health, specific challenges need to be addressed at the macro, meso, and micro levels. To reach inclusive labour force participation, national policies, company practices, and workplace improvements need to be aligned to ensure safe and healthy workplaces that contribute to the health and wellbeing of workers and their communities.

Workplace Interventions to Reduce Occupational Stress for Older Workers: A Systematic Review

The working life of individuals is now longer because of increases to state pension age in the United Kingdom. Older workers may be at particular risk in the workplace, compared with younger workers. Successful workplace interventions to reduce occupational stress amongst older workers are essential, but little is known about their effectiveness. The aim is to evaluate current evidence of the effectiveness of interventions for reducing stress in older workers in non-healthcare settings. Four database searches were conducted. The search terms included synonyms of “intervention”, “workplace” and “occupational stress” to identify original studies published since 2011. Dual screening was conducted on the sample to identify studies which met the inclusion criteria. The RoB 2.0 tool for RCTs was used to assess the risk of bias. From 3708 papers retrieved, ten eligible papers were identified. Seven of the papers’ interventions were deemed effective in reducing workplace stress. The sample size for most studies was small, and the effectiveness of interventions were more likely to be reported when studies used self-report measures, rather than biological measures. This review indicates that workplace interventions might be effective for reducing stress in older workers. However, there remains an absence of high-quality evidence in this field.

Aging and the Future of Decent Work

The United Nations identified decent work and economic growth as a sustainable development goal for 2030. Decent work is a term that sums up aspirations for people in their working lives. One of the factors that influences the achievement of decent work is aging. This article examines how aspects of aging and organizational factors affect work ability across the lifespan and throughout one's work career. Additionally, the critical issue of worker physical mobility was also addressed as a practical limitation to functional aging. Through our investigation, we identified gaps in the literature where research and interventions should be promoted. These include early disability studies; population dashboards of workers' health metrics; intervention and cost effectiveness in health promotion and prevention of early functional aging at work; policies for tailoring demands to individual needs and abilities; and inequities of social protection for aging workers.

Interventions for return to work following work-related injuries among young adults: A systematic literature review

OBJECTIVE

To provide a review of current knowledge about interventions aimed to facilitate young adults to return to work following work-related injuries.

METHODS

A systematic review of published literature from the year 2010 and onwards was conducted to identify studies examining return to work interventions for young adults (aged 19-29) following work-related injuries using PubMed and Web of Science. Two reviewers conducted the screening process and assessed the study quality using the National Heart, Lung, and Blood Institute assessment tool for Observational Cohort and Cross-Sectional studies. Due to wide heterogeneity and small number of studies retained post-screening, a descriptive summary analysis of the included studies was conducted.

RESULTS

No studies were identified that focused exclusively on interventions for young adults. However, two studies, in which an age category of young adults was available, were included and assessed for quality. The study populations were primarily suffering from work-related injuries in the lower back or lower limbs. Both studies revealed that return to work interventions using a case manager coordinating and providing consultation, advice, and risk management to multidisciplinary teams was associated with lower sick leave days.

CONCLUSIONS

Despite the emerging evidence that young adults have higher rates of work-related injuries compared to older colleagues, information concerning work-related injuries and return to work interventions specifically targeting young workers is still lacking. Further research is therefore needed to develop and evaluate return to work interventions for the population of young adults.

Is working in later life good for your health? A systematic review of health outcomes resulting from extended working lives

Background

Work, rather than unemployment, is recognised as being good for health, but there may be an age when the benefits are outweighed by adverse impacts. As countries around the world increase their typical retirement age, the potential effect on population health and health inequalities requires scrutiny.

Methods

We carried out a systematic review of literature published since 2011 from developed countries on the health effects of employment in those over 64 years of age. We completed a narrative synthesis and used harvest plots to map the direction and volume of evidence for the outcomes reported. We followed the Preferred Reporting Items for Systematic Reviews (PRISMA) checklist in our methods and reporting.

Results

We identified seventeen relevant studies, which were of cohort or cross-sectional design. The results indicate evidence of beneficial or neutral effects from extended working on overall health status and physical health for many employees, and mixed effects on mental health. The benefits reported however, are most likely to be for males, those working part-time or reducing to part-time, and employees in jobs which are not low quality or low reward.

Conclusions

Extending working life (particularly part time) may have benefits or a neutral effect for some, but adverse effects for others in high demand or low reward jobs. There is the potential for widening health inequalities between those who can choose to reduce their working hours, and those who need to continue working full time for financial reasons. There is a lack of evidence for effects on quality of life, and a dearth of interventions enabling older workers to extend their healthy working life.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-11423-2.

Age Differences in Work-Disability Duration Across Canada: Examining Variations by Follow-Up Time and Context

Purpose This study aimed to understand age differences in wage-replacement duration by focusing on variations in the relationship across different periods of follow-up time. Methods We used administrative claims data provided by six workers' compensation systems in Canada. Included were time-loss claims for workers aged 15-80 years with a work-related injury/illness during the 2011 to 2015 period (N = 751,679 claims). Data were coded for comparability across cohorts. Survival analysis examined age-related differences in the hazard of transitioning off (versus remaining on) disability benefits, allowing for relaxed proportionality constraints on the hazard rates over time. Differences were examined on the absolute (hazard difference) and relative (hazard ratios [HR]) scales. Results Older age groups had a lower likelihood of transitioning off wage-replacement benefits compared to younger age groups in the overall models (e.g., 55-64 vs. 15-24 years: HR 0.62). However, absolute and relative differences in age-specific hazard rates varied as a function of follow-up time. The greatest age-related differences were observed at earlier event times and were attenuated towards a null difference across later follow-up event times. Conclusions Our study provides new insight into the workplace injury/illness claim and recovery processes and suggests that older age is not always strongly associated with worse disability duration outcomes. The use of data from multiple jurisdictions lends external validity to our findings and demonstrates the utility of using cross-jurisdictional data extracts. Future work should examine the social and contextual determinants that operate during various recovery phases, and how these factors interact with age.

The motives of people who delay retirement: An occupational perspective

BACKGROUND

Increasing numbers of people are delaying retirement. Studies of their motives are scarce and biased to Western contexts.

AIMS

The aim was to explore internal and external motives of older Slovenians who continue to work after becoming eligible for retirement.

METHODS

Nine workers, aged 59-72, were interviewed. The interviews were analysed using thematic analysis.

FINDINGS

Three main themes were extracted. The 'Foundations' described the prerequisites for continued work engagement that were often non-negotiable. The 'Rewards' included the benefits of working and suggested a strong pull towards the non-material aspects of work. 'Negotiating occupational challenges' summarized an internal crisis that was experienced when faced with a potential occupational void of retirement.

CONCLUSIONS

Although the participants' motivations were not homogenous, we identified a pattern in the way they constructed their motives in relation to the occupational life trajectories and contextual factors. Based on our findings and multidisciplinary theories, we proposed a hierarchy of motives for prolonged work activity.

SIGNIFICANCE

The study offers an occupational perspective of the phenomenon of delayed retirement and argues that the efforts of the discipline of occupational therapy should be directed at different levels of motives, including empowering people to nurture higher level occupational motives.

Age Differences in Return-to-Work Following Injury: Understanding the Role of Age Dimensions Across Longitudinal Follow-up

OBJECTIVES

To examine the overall association between chronological age and return-to-work (RTW), and understand if existing data could be used to better understand the role of age-related dimensions (functional, psychosocial, organizational, life-stage) in explaining these associations.

METHODS

We used survey data from a prospective cohort of injured workers in Victoria, Australia. Path models examined the relationship between chronological age and RTW, and the proportion mediated via age dimensions.

RESULTS

Older chronological age was associated with non-RTW, although the pattern was not observed consistently across follow-up surveys. A proportion of the overall relationship between chronological age and non-RTW was explained by functional and life-stage age and RTW status at previous time points.

CONCLUSIONS

Findings underscore the importance of moving beyond age measured only in chronological years, towards more complex conceptual and analytical models that recognize age as a multidimensional construct.

Workplace interventions that support older employees' health and work ability - a scoping review

Background

The aim of this study was to examine workplace interventions that support older employees’ health and work ability and the effect of these interventions.

Methods

We used a scoping review, a type of a systematic literature review in which selected published academic articles and grey literature reports are included, to answer the following questions: 1) What kind of interventions have been made to support older employees’ health? and 2) What effects do these interventions have on older employees’ work ability? The scoping review framework proposed by Arksey and O’Malley and summarized by the Joanna Briggs Institute was used. Four key concepts comprised the basis for the research: health, intervention, older employee and work ability. A total of 8 articles were found to meet the inclusion and exclusion criteria. The study was limited to published academic articles between 2007 and 2019. Participant age varied between 37 and 74 years (overall average age 50–55) and workplaces comprised the intervention settings.

Results

Three main intervention categories were discerned: health checks and counselling for employees on the individual level, interventions based on screenings, and improvements in work environment or organization. Positive behavioral change and lowered health risks can be achieved through health counselling, which increases work ability. Measurements and screenings comprise good ways to chart and follow-up on employees’ work ability and health status. Supervisor training and support from supervisors were seen to have a positive effect on health outcomes and increased work ability.

Conclusions

To guarantee good results, employers should focus on employees’ health and interventions should occur when employees are younger than the studied group. The small number of articles related to intervention studies for the age group studied here indicate that a knowledge gap exists. We maintain that workplaces that promote employees’ health by strengthening older employees’ vitality can encourage employees to have longer careers.

Identifying contemporary early retirement factors and strategies to encourage and enable longer working lives: A scoping review

AIM

Accelerating population ageing is raising concern in many countries now in relation to the availability of workers for essential work roles and responsibilities. A scoping research literature review was done to identify factors currently associated with early retirement and contemporary strategies to encourage and support longer working lives.

METHODS

Using the PRISMA-ScR Checklist, we searched the Directory of Open Access Journals and EBSCO Discovery Service for published 2013-2018 research articles using the keyword/MeSH term "early retirement"; 54 English-language articles in peer-review journals were reviewed.

RESULTS

Seven early retirement factors were revealed: Ill health, good health, workplace issues, the work itself, ageism, social norms and having achieved personal financial or pension requirement criteria. Six suggested solutions, none proven effective, were identified: Occupational health programmes, workplace enhancements, work adjustments, addressing ageism, changing social norms and pension changes.

CONCLUSIONS

The evidence base on early retirement prevention is not strong, with qualitative investigations needed for in-depth understandings of early retirement influences and mixed-methods studies needed to test early retirement prevention solutions for their effects.

IMPLICATIONS FOR PRACTICE

Until more evidence is available, every organisation should perform an early retirement risk assessment and identify current versus needed policies and programmes to encourage and enable more middle-aged and older people to work longer.

Patterns and Predictors of Return to Work After Major Trauma: A Prospective, Population-based Registry Study

OBJECTIVE

To characterize patterns of engagement in work during the 4-year period after major traumatic injury, and to identify factors associated with those patterns.

BACKGROUND

Employment is an important marker of functional recovery from injury. There are few population-based studies of long-term employment outcomes, and limited data on the patterns of return to work (RTW) after injury.

METHODS

A population-based, prospective cohort study using the Victorian State Trauma Registry. A total of 1086 working age individuals, in paid employment or full-time education before injury, were followed-up through telephone interview at 6, 12, 24, 36, and 48 months post-injury. Responses to RTW questions were used to define 4 discrete patterns: early and sustained; delayed; failed; no RTW. Predictors of RTW patterns were assessed using multivariate multinomial logistic regression.

RESULTS

Slightly more than half of respondents (51.6%) recorded early sustained RTW. A further 15.5% had delayed and 13.3% failed RTW. One in 5 (19.7%) did not RTW. Compared with early sustained RTW, predictors of delayed and no RTW included being in a manual occupation and injury in a motor vehicle accident. Older age and receiving compensation predicted both failed and no RTW patterns. Preinjury disability was an additional predictor of failed RTW. Presence of comorbidity was an additional predictor of no RTW.

CONCLUSIONS

A range of personal, occupational, injury, health, and compensation system factors influence RTW patterns after serious injury. Early identification of people at risk for delayed, failed, or no RTW is needed so that targeted interventions can be delivered.

Evidence of Workplace Interventions-A Systematic Review of Systematic Reviews

Work environment factors are highly correlated with employees' health and well-being. Our aim was to sum up current evidence of health promotion interventions in the workplace, focusing on interventions for the prevention of musculoskeletal disorders, psychological and behavioral disorders as well as interventions for older employees and economic evaluations. We conducted a comprehensive literature search including systematic reviews published from April 2012 to October 2017 in electronic databases and search engines, websites of relevant organizations and institutions. It consisted of simple and specific terms and word combinations related to workplace health promotion based on the search strategy of a previous review. After full-text screening, 74 references met the eligibility criteria. Using the same search strategy, there was a higher proportion of relevant high-quality studies as compared with the earlier review. The heterogeneity of health promotion interventions regarding intervention components, settings and study populations still limits the comparability of studies. Future studies should also address the societal and insurer perspective, including costs to the worker such as lost income and lost time at work of family members due to caregiving activities. To this end, more high-quality evidence is needed.

The association between having a coordinator and return to work: the rapid-return-to-work cohort study

OBJECTIVES

The aim of this study was to assess if the reported provision of a coordinator was associated with time to first return to work (RTW) and first full RTW among sick-listed employees who participated in different rapid-RTW programmes in Norway.

DESIGN

The study was designed as a cohort study.

SETTING

Rapid-RTW programmes financed by the regional health authority in hospitals and Norwegian Labour and Welfare Administration in Norway.

PARTICIPANTS

The sample included employees on full-time sick leave (n=326) who participated in rapid-RTW programmes (n=43), who provided information about the coordination of the services they received. The median age was 46 years (minimum-maximum 21-67) and 71% were female. The most common reported diagnoses were musculoskeletal (57%) and mental health disorders (14%).

INTERVENTIONS

The employees received different types of individually tailored RTW programmes all aimed at a rapid RTW; occupational rehabilitation (64%), treatment for medical or psychological issues, including assessment, and surgery (26%), and follow-up and work clarification services (10%). It was common to be provided with a coordinator (73%).

PRIMARY AND SECONDARY OUTCOME MEASURES

Outcomes were measured as time to first RTW (graded and 100%) and first full RTW (100%).

RESULTS

Employees provided with a coordinator returned to work later than employees who did not have a coordinator; a median (95% CI) of 128 (80 to 176) days vs 61 (43 to 79) days for first RTW, respectively. This difference did not remain statistically significant in the adjusted regression analysis. For full RTW, there was no statistically significant difference between employees provided with a coordinator versus those who were not.

CONCLUSIONS

The model of coordination, provided in the Norwegian rapid-RTW programmes was not associated with a more rapid RTW for sick-listed employees. Rethinking how RTW coordination should be organised could be wise in future programme development.

Efficacy of a Work Disability Prevention Program for People with Rheumatic and Musculoskeletal Conditions: A Single-Blind Parallel-Arm Randomized Controlled Trial

OBJECTIVE

Work disability rates are high among people with rheumatic and musculoskeletal conditions. Effective disability preventive programs are needed. We examined the efficacy of a modified vocational rehabilitation approach delivered by trained occupational therapists and physical therapists on work limitation and work loss over 2 years among people with rheumatic and musculoskeletal conditions.

METHODS

Eligibility criteria for this single-blind, parallel-arm randomized trial included ages 21-65 years, 15 or more hours/week employment, a self-reported doctor-diagnosed rheumatic or musculoskeletal condition, and concern about staying employed. The intervention consisted of a 1.5-hour meeting, an action plan, written materials on employment supports, and telephone calls at 3 weeks and 3 months. Control group participants received the written materials. The primary outcome was the Work Limitations Questionnaire (WLQ) output job demand subscale. The secondary outcome was work loss. Intent-to-treat analyses were performed.

RESULTS

Between October 2011 and January 2014, 652 individuals were assessed for eligibility. A total of 287 participants were randomized: 143 intervention and 144 control participants. In total, 264 participants (92%) completed 2-year data collection. There was no difference in the mean ± SD WLQ change scores from baseline to 2-year followup (-8.6 ± 1.9 intervention versus -8.3 ± 2.2 control; P = 0.93). Of the 36 participants who experienced permanent work loss at 2 years, 11 (8%) were intervention participants and 25 (18%) control participants (P = 0.03).

CONCLUSION

The intervention did not have an effect on work limitations but reduced work loss. The intervention can be delivered by trained rehabilitation therapists.

Validating the short measure of the Effort-Reward Imbalance Questionnaire in older workers in the context of New Zealand

Objectives:

The objective of this study was to validate a short version of the Effort-Reward-Imbalance (ERI) questionnaire in the context of New Zealand among older full-time and part-time employees.

Methods:

Data were collected from 1694 adults aged 48-83 years (mean 60 years, 53% female) who reported being in full- or part-time paid employment in the 2010 wave of the New Zealand Health, Work and Retirement study. Scale reliability was evaluated by item-total correlations and Cronbach's alpha. Factorial validity was assessed using multi-group confirmatory factor analyses assessing nested models of configural, metric, scalar and strict invariance across full- and part-time employment groups. Logistic regressions estimated associations of effort-reward ratio and over-commitment with poor physical/mental health, and depressive symptoms.

Results:

Internal consistency of ERI scales was high across employment groups: effort 0.78-0.76; reward 0.81-0.77, and over-commitment 0.83-0.80. The three-factor model displayed acceptable fit in the overall sample (X²/df = 10.31; CFI = 0.95; TLI = 0.94; RMSEA = 0.075), and decrements in model fit indices provided evidence for strict invariance of the three-factor ERI model across full-time and part-time employment groups. High effort-reward ratio scores were consistently associated with poor mental health and depressive symptoms for both employment groups. High over-commitment was associated with poor mental health and depressive symptoms in both groups and also with poor physical health in the full-time employment group.

Conclusions:

The short ERI questionnaire appears to be a valid instrument to assess adverse psychosocial work characteristics in old full-time and part-time employees in New Zealand.