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Fure SCR, Howe EI, Andelic N, Brunborg C, Sveen U, Røe C, Rike PO, Olsen A, Spjelkavik Ø, Ugelstad H, Lu J, Ponsford J, Twamley EW, Hellstrøm T, Løvstad M. Cognitive and vocational rehabilitation after mild-to-moderate traumatic brain injury: A randomised controlled trial. Ann Phys Rehabil Med 2021; 64:101538. [PMID: 33957293 DOI: 10.1016/j.rehab.2021.101538] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 02/13/2021] [Accepted: 03/17/2021] [Indexed: 01/18/2023]
Abstract
BACKGROUND Returning to work is often a primary rehabilitation goal after traumatic brain injury (TBI). However, the evidence base for treatment options regarding return to work (RTW) and stable work maintenance remains scarce. OBJECTIVE This study aimed to examine the effect of a combined cognitive and vocational intervention on work-related outcomes after mild-to-moderate TBI. METHODS In this study, we compared 6 months of a combined compensatory cognitive training and supported employment (CCT-SE) intervention with 6 months of treatment as usual (TAU) in a randomised controlled trial to examine the effect on time to RTW, work percentage, hours worked per week and work stability. Eligible patients were those with mild-to-moderate TBI who were employed ≥50% at the time of injury, 18 to 60 years old and sick-listed ≥50% at 8 to 12 weeks after injury due to post-concussion symptoms, assessed by the Rivermead Post Concussion Symptoms Questionnaire. Both treatments were provided at the outpatient TBI department at Oslo University Hospital, and follow-ups were conducted at 3, 6 and 12 months after inclusion. RESULTS We included 116 individuals, 60 randomised to CCT-SE and 56 to TAU. The groups did not differ in characteristics at the 12-month follow-up. Overall, a high proportion had returned to work at 12 months (CCT-SE, 90%; TAU, 84%, P=0.40), and all except 3 were stably employed after the RTW. However, a significantly higher proportion of participants in the CCT-SE than TAU group had returned to stable employment at 3 months (81% vs. 60%, P=0.02). CONCLUSION These results suggest that the CCT-SE intervention might help patients with mild-to-moderate TBI who are still sick-listed 8 to 12 weeks after injury in an earlier return to stable employment. However, the results should be replicated and a cost-benefit analysis performed before concluding.
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Affiliation(s)
- Silje C R Fure
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway; Research Centre for Habilitation and Rehabilitation Models and Services (CHARM), Institute of Health and Society, University of Oslo, Oslo, Norway.
| | - Emilie Isager Howe
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Nada Andelic
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway; Research Centre for Habilitation and Rehabilitation Models and Services (CHARM), Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Cathrine Brunborg
- Oslo Centre for Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, Oslo, Norway
| | - Unni Sveen
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway; Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Cecilie Røe
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway; Research Centre for Habilitation and Rehabilitation Models and Services (CHARM), Institute of Health and Society, University of Oslo, Oslo, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Per-Ola Rike
- Department of Research, Sunnaas Rehabilitation Hospital Trust, Nesoddtangen, Norway
| | - Alexander Olsen
- Department of Psychology, Norwegian University of Technology and Science, Trondheim, Norway; Department of Physical Medicine and Rehabilitation, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | | | - Helene Ugelstad
- Department of Vocational Rehabilitation, Norwegian Labor and Welfare Administration, Oslo, Norway
| | - Juan Lu
- Research Centre for Habilitation and Rehabilitation Models and Services (CHARM), Institute of Health and Society, University of Oslo, Oslo, Norway; Division of Epidemiology, Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, VA, USA
| | - Jennie Ponsford
- Monash Epworth Rehabilitation Research Centre, Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Victoria, Australia
| | - Elizabeth W Twamley
- Center of Excellence for Stress and Mental Health, Veterans Affairs (VA) San Diego Healthcare System, San Diego, CA, USA; Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
| | - Torgeir Hellstrøm
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
| | - Marianne Løvstad
- Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway; Department of Psychology, University of Oslo, Oslo, Norway
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Camisa V, Gilardi F, Di Brino E, Santoro A, Vinci MR, Sannino S, Bianchi N, Mesolella V, Macina N, Focarelli M, Brugaletta R, Raponi M, Ferri L, Cicchetti A, Magnavita N, Zaffina S. Return on Investment (ROI) and Development of a Workplace Disability Management Program in a Hospital-A Pilot Evaluation Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17218084. [PMID: 33147861 PMCID: PMC7662934 DOI: 10.3390/ijerph17218084] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 10/19/2020] [Accepted: 10/20/2020] [Indexed: 12/14/2022]
Abstract
The progressive ageing of the working population and the increase in related chronic diseases tend to affect working capacity. The aim of this study was to evaluate a Workplace Disability Management Program (WDMP) within a pediatric hospital. Absenteeism due to healthcare workers’ (HCWs) pre- and post- WDMP and the related costs were used for the program evaluation. The Return on Investment (ROI), the Break-Even Analysis (BEA) and the value of the average annual productivity of HCWs who took advantage of the Disability Management (DM) interventions to assess the economic impact of the program, were also used. The HCWs enrolled in the program were 131 (approximately 4% of hospital staff), of which 89.7% females and with an average age of 50.4 years (SD ± 8.99). Sick leave days of the HCWs involved decreased by 66.6% in the year following the end of WDMP compared to the previous one (p < 0.001). The total estimated cost reduction of absenteeism is 427,896€ over a year. ROI was equal to 27.66€. BEA indicated that the break-even point was reached by implementing the program on 3.27 HCWs. The program evaluation demonstrated the particular effectiveness of the implemented WDMP model, acting positively on the variables that affect productivity and the limitation to work.
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Affiliation(s)
- Vincenzo Camisa
- Health Directorate, Occupational Medicine Service, Bambino Gesù Children’s Hospital IRCCS, 00165 Rome, Italy; (V.C.); (F.G.); (A.S.); (M.R.V.); (R.B.)
- Post-Graduate School of Occupational Health, Catholic University of Sacred Heart, 00168 Rome, Italy; (L.F.); (N.M.)
| | - Francesco Gilardi
- Health Directorate, Occupational Medicine Service, Bambino Gesù Children’s Hospital IRCCS, 00165 Rome, Italy; (V.C.); (F.G.); (A.S.); (M.R.V.); (R.B.)
| | - Eugenio Di Brino
- Graduate School of Health Economics and Management, Catholic University of Sacred Heart (ALTEMS), 00168 Rome, Italy; (E.D.B.); (A.C.)
| | - Annapaola Santoro
- Health Directorate, Occupational Medicine Service, Bambino Gesù Children’s Hospital IRCCS, 00165 Rome, Italy; (V.C.); (F.G.); (A.S.); (M.R.V.); (R.B.)
| | - Maria Rosaria Vinci
- Health Directorate, Occupational Medicine Service, Bambino Gesù Children’s Hospital IRCCS, 00165 Rome, Italy; (V.C.); (F.G.); (A.S.); (M.R.V.); (R.B.)
- Post-Graduate School of Occupational Health, Catholic University of Sacred Heart, 00168 Rome, Italy; (L.F.); (N.M.)
| | - Serena Sannino
- Health Directorate, Bambino Gesù Children’s Hospital IRCCS, 00165 Rome, Italy; (S.S.); (M.R.)
| | - Natalia Bianchi
- Nursing and Health Allied Professionals Service, Bambino Gesù Children’s Hospital IRCCS, 00165 Rome, Italy;
| | - Valentina Mesolella
- Human Resources Directorate, Bambino Gesù Children’s Hospital IRCCS, 00165 Rome, Italy; (V.M.); (N.M.); (M.F.)
| | - Nadia Macina
- Human Resources Directorate, Bambino Gesù Children’s Hospital IRCCS, 00165 Rome, Italy; (V.M.); (N.M.); (M.F.)
| | - Michela Focarelli
- Human Resources Directorate, Bambino Gesù Children’s Hospital IRCCS, 00165 Rome, Italy; (V.M.); (N.M.); (M.F.)
| | - Rita Brugaletta
- Health Directorate, Occupational Medicine Service, Bambino Gesù Children’s Hospital IRCCS, 00165 Rome, Italy; (V.C.); (F.G.); (A.S.); (M.R.V.); (R.B.)
| | - Massimiliano Raponi
- Health Directorate, Bambino Gesù Children’s Hospital IRCCS, 00165 Rome, Italy; (S.S.); (M.R.)
| | - Livia Ferri
- Post-Graduate School of Occupational Health, Catholic University of Sacred Heart, 00168 Rome, Italy; (L.F.); (N.M.)
| | - Americo Cicchetti
- Graduate School of Health Economics and Management, Catholic University of Sacred Heart (ALTEMS), 00168 Rome, Italy; (E.D.B.); (A.C.)
| | - Nicola Magnavita
- Post-Graduate School of Occupational Health, Catholic University of Sacred Heart, 00168 Rome, Italy; (L.F.); (N.M.)
- Department of Woman, Child & Public Health, Gemelli Policlinic Foundation IRCCS, 00168 Rome, Italy
| | - Salvatore Zaffina
- Health Directorate, Occupational Medicine Service, Bambino Gesù Children’s Hospital IRCCS, 00165 Rome, Italy; (V.C.); (F.G.); (A.S.); (M.R.V.); (R.B.)
- Human Resources Directorate, Bambino Gesù Children’s Hospital IRCCS, 00165 Rome, Italy; (V.M.); (N.M.); (M.F.)
- Correspondence: ; Tel.: +39-06-6859-3150; Fax: +39-06-6859-3852
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Corbière M, Mazaniello-Chézol M, Bastien MF, Wathieu E, Bouchard R, Panaccio A, Guay S, Lecomte T. Stakeholders' Role and Actions in the Return-to-Work Process of Workers on Sick-Leave Due to Common Mental Disorders: A Scoping Review. JOURNAL OF OCCUPATIONAL REHABILITATION 2020; 30:381-419. [PMID: 31673934 DOI: 10.1007/s10926-019-09861-2] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
The lack of knowledge regarding the roles and actions of return to work (RTW) stakeholders create confusion and uncertainty about how and when to RTW after experiencing a common mental disorder (CMD). Purpose The purpose of this scoping review is to disentangle the various stakeholders' role and actions in the RTW process of workers on sick-leave due to CMDs. The research question is: What is documented in the existing literature regarding the roles and actions of the identified stakeholders involved in the RTW process of workers on sick-leave due to CMDs? Methods In conducting this scoping review, we followed Arksey and O'Malley's (Int J Soc Res Methodol 8:19-32, 2005) methodology, consisting of different stages (e.g., charting the data by categorizing key results). Results 3709 articles were screened for inclusion, 243 of which were included for qualitative synthesis. Several RTW stakeholders (n=11) were identified (e.g., workers on sick leave due to CMDs, managers, union representatives, rehabilitation professionals, insurers, return to work coordinators). RTW stakeholders' roles and actions inter- and intra-system were recommended, either general (e.g., know and understand the perspectives of all RTW stakeholders) or specific to an actor (e.g., the return to work coordinator needs to create and maintain a working alliance between all RTW stakeholders). Furthermore, close to 200 stakeholders' actions, spread out on different RTW phases, were recommended for facilitating the RTW process. Conclusions Eleven RTW stakeholders from the work, heath and insurance systems have been identified, as well as their respective roles and actions. Thanks to these results, RTW stakeholders and policy makers will be able to build practical relationships and collaboration regarding the RTW of workers on sick leave due to CMDs.
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Affiliation(s)
- Marc Corbière
- Department of Education, Career counselling, Université du Québec à Montréal, C.P. 8888 succursale Centre-ville, Montreal, QC, H3C 3P8, Canada.
- Centre de recherche de l'Institut Universitaire en Santé Mentale de Montréal (CR-IUSMM), Montreal, QC, Canada.
| | - Maud Mazaniello-Chézol
- Centre de recherche de l'Institut Universitaire en Santé Mentale de Montréal (CR-IUSMM), Montreal, QC, Canada
- Department of Family Medicine, McGill University, Montreal, QC, Canada
| | - Marie-France Bastien
- Centre de recherche de l'Institut Universitaire en Santé Mentale de Montréal (CR-IUSMM), Montreal, QC, Canada
- Department of Psychology, Université du Québec à Montréal, Montreal, QC, Canada
| | - Estelle Wathieu
- Centre de recherche de l'Institut Universitaire en Santé Mentale de Montréal (CR-IUSMM), Montreal, QC, Canada
- Department of Art History, Concordia University, Montreal, QC, Canada
| | | | - Alexandra Panaccio
- John Molson School of Business, Concordia University, Montréal, QC, Canada
| | - Stéphane Guay
- Centre de recherche de l'Institut Universitaire en Santé Mentale de Montréal (CR-IUSMM), Montreal, QC, Canada
- Department of Psychiatry and Addictology, Université de Montreal, Montreal, QC, Canada
| | - Tania Lecomte
- Centre de recherche de l'Institut Universitaire en Santé Mentale de Montréal (CR-IUSMM), Montreal, QC, Canada
- Department of Psychology, Université de Montréal, Montreal, QC, Canada
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Black O, Keegel T, Sim MR, Collie A, Smith P. The Effect of Self-Efficacy on Return-to-Work Outcomes for Workers with Psychological or Upper-Body Musculoskeletal Injuries: A Review of the Literature. JOURNAL OF OCCUPATIONAL REHABILITATION 2018; 28:16-27. [PMID: 28271400 DOI: 10.1007/s10926-017-9697-y] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Purpose Work absence can result in substantial losses to the economy and workers. As a result, identifying modifiable factors associated with return-to-work (RTW) following an injury or illness is the focus of many empirical investigations. Self-efficacy, the belief about one's ability to undertake behaviours to achieve desired goals, has been identified as an important factor in RTW for injured workers. This paper systematically reviewed the literature on the association between self-efficacy and RTW outcomes for workers with an upper-body musculoskeletal injury or psychological injury. Methods A systematic search was conducted across five databases using two main search concepts- 'self-efficacy' and 'RTW'. After removing duplicates, our search strategy identified 836 studies, which were screened for relevance using titles and abstracts. Results A two stage screening process reduced the study pool to six studies using psychological injury cohorts and three using upper-body musculoskeletal (UB-MSK) cohorts. Eight cohorts from seven prospective cohort studies and one sample from a randomised control trial (RCT) were subjected to a risk of bias assessment. Higher levels of self-efficacy appeared to have a consistent and positive association with RTW across return-to-work status and work absence outcomes, injury type and follow-up periods. Effect ratios ranged from 1.00 to 5.26 indicating a potentially large impact of self-efficacy on RTW outcomes. The relationship between self-efficacy and RTW strengthened as the domain of self-efficacy became more specific to RTW and job behaviours. Studies assessing workers with psychological injuries were of a lower quality compared to those assessing workers with UB-MSK injuries. Conclusions Higher self-efficacy had consistent positive associations with RTW outcomes. Further empirical research should identify the determinants of self-efficacy, and explore the processes by which higher self-efficacy improves RTW outcomes.
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Affiliation(s)
- Oliver Black
- Department of Epidemiology & Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Level 6, Alfred Centre, 99 Commercial Road, Melbourne, VIC, 3004, Australia.
| | - Tessa Keegel
- Department of Epidemiology & Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Level 6, Alfred Centre, 99 Commercial Road, Melbourne, VIC, 3004, Australia
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Malcolm R Sim
- Department of Epidemiology & Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Level 6, Alfred Centre, 99 Commercial Road, Melbourne, VIC, 3004, Australia
| | - Alexander Collie
- Department of Epidemiology & Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Level 6, Alfred Centre, 99 Commercial Road, Melbourne, VIC, 3004, Australia
- Institute for Safety Compensation and Recovery Research, Monash University, Melbourne, Australia
| | - Peter Smith
- Department of Epidemiology & Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Level 6, Alfred Centre, 99 Commercial Road, Melbourne, VIC, 3004, Australia
- Institute for Work & Health, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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Poulsen R, Hoff A, Fisker J, Hjorthøj C, Eplov LF. Integrated mental health care and vocational rehabilitation to improve return to work rates for people on sick leave because of depression and anxiety (the Danish IBBIS trial): study protocol for a randomized controlled trial. Trials 2017; 18:578. [PMID: 29197414 PMCID: PMC5712198 DOI: 10.1186/s13063-017-2272-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Accepted: 10/06/2017] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Depression and anxiety are among the largest contributors to the global burden of disease and have negative effects on both the individual and society. Depression and anxiety are very likely to influence the individual's work ability, and up to 40% of the people on sick leave in Denmark have depression and/or anxiety. There is no clear evidence that treatment alone will provide sufficient support for vocational recovery in this group. Integrated vocational and health care services have shown good effects on return to work in other, similar welfare contexts. The purpose of the IBBIS (Integrated Mental Health Care and Vocational Rehabilitation to Individuals on Sick Leave Due to Anxiety and Depression) interventions is to improve and hasten the process of return to employment for people in Denmark on sick leave because of depression and anxiety. METHODS/DESIGN This three-arm, parallel-group, randomized superiority trial has been set up to investigate the effectiveness of the IBBIS mental health care intervention and the integrated IBBIS mental health care and IBBIS vocational rehabilitation intervention for people on sick leave because of depression and/or anxiety in Denmark. The trial has an investigator-initiated multicenter design. A total of 603 patients will be recruited from Danish job centers in 4 municipalities and randomly assigned to one of 3 groups: (1) IBBIS mental health care integrated with IBBIS vocational rehabilitation, (2) IBBIS mental health care and standard vocational rehabilitation, and (3) standard mental health care and standard vocational rehabilitation. The primary outcome is register-based return to work at 12 months. The secondary outcome measures are self-assessed level of depression (Beck Depression Inventory II), anxiety (Beck Anxiety Inventory), stress symptoms (Four-Dimensional Symptom Questionnaire), work and social functioning (Work and Social Adjustment Scale), and register-based recurrent sickness absence. DISCUSSION This study will provide new knowledge on vocational recovery, integrated vocational and health care interventions, and prevention of recurrent sickness absence among people with depression and anxiety. If the effect on return to work is different in the intervention groups, this study can contribute to current knowledge on shared care models for health care and vocational rehabilitation services. TRIAL REGISTRATION ClinicalTrials.gov, NCT02872051 . Retrospectively registered on 15 August 2016.
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Affiliation(s)
- Rie Poulsen
- Mental Health Center Copenhagen, Mental Health Services Capital Region of Denmark, University of Copenhagen, Kildegårdsvej 28, Opgang 15.4, DK-2900, Hellerup, Copenhagen, Denmark.
| | - Andreas Hoff
- Mental Health Center Copenhagen, Mental Health Services Capital Region of Denmark, University of Copenhagen, Kildegårdsvej 28, Opgang 15.4, DK-2900, Hellerup, Copenhagen, Denmark
| | - Jonas Fisker
- Mental Health Center Copenhagen, Mental Health Services Capital Region of Denmark, University of Copenhagen, Kildegårdsvej 28, Opgang 15.4, DK-2900, Hellerup, Copenhagen, Denmark
| | - Carsten Hjorthøj
- Mental Health Center Copenhagen, Mental Health Services Capital Region of Denmark, University of Copenhagen, Kildegårdsvej 28, Opgang 15.4, DK-2900, Hellerup, Copenhagen, Denmark
| | - Lene Falgaard Eplov
- Mental Health Center Copenhagen, Mental Health Services Capital Region of Denmark, University of Copenhagen, Kildegårdsvej 28, Opgang 15.4, DK-2900, Hellerup, Copenhagen, Denmark
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Poulsen R, Fisker J, Hoff A, Hjorthøj C, Eplov LF. Integrated mental health care and vocational rehabilitation to improve return to work rates for people on sick leave because of exhaustion disorder, adjustment disorder, and distress (the Danish IBBIS trial): study protocol for a randomized controlled trial. Trials 2017; 18:579. [PMID: 29197404 PMCID: PMC5712165 DOI: 10.1186/s13063-017-2273-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Accepted: 10/11/2017] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Common mental disorders are important contributors to the global burden of disease and cause negative effects on both the individual and society. Stress-related disorders influence the individual's workability and cause early retirement pensions in Denmark. There is no clear evidence that mental health care alone will provide sufficient support for vocational recovery for this group. Integrated vocational and health care services have shown good effects on return to work in other similar welfare contexts. The purpose of the Danish IBBIS (Integreret Behandlings- og BeskæftigelsesIndsats til Sygemeldte) study is to examine the efficacy of (1) a stepped mental health care intervention with individual stress coaching and/or group-based MBSR and (2) an integrated stepped mental health care with individual stress coaching and/or group-based MBSR and vocational rehabilitation intervention for people on sick leave because of exhaustion disorder, adjustment disorder or distress in Denmark. METHOD/DESIGN This three-armed, parallel-group, randomized superiority trial is set up to investigate the effectiveness of a stepped mental health care intervention and an integrated mental health care and vocational rehabilitation intervention for people on sick leave because of exhaustion disorder, adjustment disorder or distress in Denmark. The trial has an investigator-initiated multicenter design. Six hundred and three patients will be recruited from Danish vocational rehabilitation centers in four municipalities and randomly assigned into three groups: (1) IBBIS mental health care integrated with IBBIS vocational rehabilitation, (2) IBBIS mental health care and standard vocational rehabilitation, and (3) standard mental health care and standard vocational rehabilitation. The primary outcome is register-based return to work at 12 months. The secondary outcome measures are self-assessed level of depression (BDI), anxiety (BAI), distress symptoms (4DSQ), work- and social functioning (WSAS), and register-based recurrent sickness absence. DISCUSSION This study will contribute with knowledge on the consequence of the current organizational separation of health care interventions and vocational rehabilitation regarding the individual's process of returning to work after sick leave because of exhaustion disorder, adjustment disorder or distress. If the effect on return to work, symptom level, and recurrent sick leave is different in the intervention groups, this study can contribute with new knowledge on shared care models and the potential for preventing deterioration in stress symptoms, prolonged sick leave, and recurrent sick leave. TRIAL REGISTRATION ClinicalTrials.gov, registration number: NCT02885519 . Retrospectively registered on 15 August 2016). Participants have been included in the IBBIS trial for distress, adjustment disorder and exhaustion disorder since April 2016.
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Affiliation(s)
- Rie Poulsen
- Mental Health Center Copenhagen, Mental Health Services Capital Region of Denmark, University of Copenhagen, Kildegårdsvej 28, 2900, Hellerup, Copenhagen, Denmark.
| | - Jonas Fisker
- Mental Health Center Copenhagen, Mental Health Services Capital Region of Denmark, University of Copenhagen, Kildegårdsvej 28, 2900, Hellerup, Copenhagen, Denmark
| | - Andreas Hoff
- Mental Health Center Copenhagen, Mental Health Services Capital Region of Denmark, University of Copenhagen, Kildegårdsvej 28, 2900, Hellerup, Copenhagen, Denmark
| | - Carsten Hjorthøj
- Mental Health Center Copenhagen, Mental Health Services Capital Region of Denmark, University of Copenhagen, Kildegårdsvej 28, 2900, Hellerup, Copenhagen, Denmark
| | - Lene Falgaard Eplov
- Mental Health Center Copenhagen, Mental Health Services Capital Region of Denmark, University of Copenhagen, Kildegårdsvej 28, 2900, Hellerup, Copenhagen, Denmark
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Vogel N, Schandelmaier S, Zumbrunn T, Ebrahim S, de Boer WEL, Busse JW, Kunz R. Return-to-work coordination programmes for improving return to work in workers on sick leave. Cochrane Database Syst Rev 2017; 3:CD011618. [PMID: 28358173 PMCID: PMC6464073 DOI: 10.1002/14651858.cd011618.pub2] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND To limit long-term sick leave and associated consequences, insurers, healthcare providers and employers provide programmes to facilitate disabled people's return to work. These programmes include a variety of coordinated and individualised interventions. Despite the increasing popularity of such programmes, their benefits remain uncertain. We conducted a systematic review to determine the long-term effectiveness of return-to-work coordination programmes compared to usual practice in workers at risk for long-term disability. OBJECTIVES To assess the effects of return-to-work coordination programmes versus usual practice for workers on sick leave or disability. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL; 2016, Issue 11), MEDLINE, Embase, CINAHL and PsycINFO up to 1 November 2016. SELECTION CRITERIA We included randomised controlled trials (RCTs) that enrolled workers absent from work for at least four weeks and randomly assigned them to return-to-work coordination programmes or usual practice. DATA COLLECTION AND ANALYSIS Two review authors independently screened titles, abstracts and full-text articles for study eligibility; extracted data; and assessed risk of bias from eligible trials. We contacted authors for additional data where required. We conducted random-effects meta-analyses and used the GRADE approach to rate the quality of the evidence. MAIN RESULTS We identified 14 studies from nine countries that enrolled 12,568 workers. Eleven studies focused on musculoskeletal problems, two on mental health and one on both. Most studies (11 of 14) followed workers 12 months or longer. Risk of bias was low in 10 and high in 4 studies, but findings were not sensitive to their exclusion.We found no benefits for return-to-work coordination programmes on return-to-work outcomes.For short-term follow-up of six months, we found no effect on time to return to work (hazard ratio (HR) 1.32, 95% confidence interval (CI) 0.93 to 1.88, low-quality evidence), cumulative sickness absence (mean difference (MD) -16.18 work days per year, 95% CI -32.42 to 0.06, moderate-quality evidence), the proportion of participants at work at end of the follow-up (risk ratio (RR) 1.06, 95% CI 0.86 to 1.30, low-quality evidence) or on the proportion of participants who had ever returned to work, that is, regardless of whether they had remained at work until last follow-up (RR 0.87, 95% CI 0.63 to 1.19, very low-quality evidence).For long-term follow-up of 12 months, we found no effect on time to return to work (HR 1.25, 95% CI 0.95 to 1.66, low-quality evidence), cumulative sickness absence (MD -14.84 work days per year, 95% CI -38.56 to 8.88, low-quality evidence), the proportion of participants at work at end of the follow-up (RR 1.06, 95% CI 0.99 to 1.15, low-quality evidence) or on the proportion of participants who had ever returned to work (RR 1.03, 95% CI 0.97 to 1.09, moderate-quality evidence).For very long-term follow-up of longer than 12 months, we found no effect on time to return to work (HR 0.93, 95% CI 0.74 to 1.17, low-quality evidence), cumulative sickness absence (MD 7.00 work days per year, 95% CI -15.17 to 29.17, moderate-quality evidence), the proportion of participants at work at end of the follow-up (RR 0.94, 95% CI 0.82 to 1.07, low-quality evidence) or on the proportion of participants who had ever returned to work (RR 0.95, 95% CI 0.88 to 1.02, low-quality evidence).We found only small benefits for return-to-work coordination programmes on patient-reported outcomes. All differences were below the minimal clinically important difference (MID). AUTHORS' CONCLUSIONS Offering return-to-work coordination programmes for workers on sick leave for at least four weeks results in no benefits when compared to usual practice. We found no significant differences for the outcomes time to return to work, cumulative sickness absence, the proportion of participants at work at end of the follow-up or the proportion of participants who had ever returned to work at short-term, long-term or very long-term follow-up. For patient-reported outcomes, we found only marginal effects below the MID. The quality of the evidence ranged from very low to moderate across all outcomes.
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Affiliation(s)
- Nicole Vogel
- EbIM Evidence‐based Insurance MedicineDepartment Clinical ResearchUniversity of Basel HospitalSpitalstrasse 8+12BaselSwitzerland4031
- Hirslanden Klinik BirshofLeonardoReinacherstrasse 28MünchensteinSwitzerland4142
| | - Stefan Schandelmaier
- McMaster UniversityDepartment of Health Research Methods, Evidence, and Impact1280 Main Street WestHamiltonONCanadaL8S4L8
- University of BaselBasel Institute for Clinical Epidemiology and Biostatistics, Department of Clinical ResearchSpitalstrasse 12BaselSwitzerland4031
| | - Thomas Zumbrunn
- University of Basel HospitalClinical Trial UnitSchanzenstrasse 55BaselSwitzerland4031
| | | | - Wout EL de Boer
- EbIM Evidence‐based Insurance MedicineDepartment Clinical ResearchUniversity of Basel HospitalSpitalstrasse 8+12BaselSwitzerland4031
| | - Jason W Busse
- McMaster UniversityDepartment of Anesthesia1280 Main Street West, Rm. 2C12HamiltonONCanadaL8S 4K1
| | - Regina Kunz
- EbIM Evidence‐based Insurance MedicineDepartment Clinical ResearchUniversity of Basel HospitalSpitalstrasse 8+12BaselSwitzerland4031
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Kinnunen-Amoroso M, Liira J. Work-related stress management between workplace and occupational health care. Work 2016; 54:507-15. [PMID: 27315406 DOI: 10.3233/wor-162317] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Work-related stress has been evaluated as one of the most important health risks in Europe. Prevention of work related stress and interventions to reduce risk factors for stress in the workplace are conducted together by the enterprise and occupational health services. OBJECTIVE The aim of the study was to examine the experiences of Finnish occupational physicians on the stress management with enterprises. METHODS From the Finnish Association of Occupational Health Physicians membership list 207 physicians responded to self-administered anonymous questionnaire. The data were analysed using SPSS 17.0. RESULTS The client enterprises contacted occupational health services frequently about work-related stress. Collaboration between occupational health and enterprises was strongest in companies' own occupational health services and generally with most experienced physicians. Occupational health services and enterprises shared responsibility for managing work-related stress. CONCLUSIONS Professional experience and close contact with organisation management favours successful stress management between occupational health and enterprises.
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Factors associated with (non-)participation of cancer survivors with job loss in a supportive return to work program. Support Care Cancer 2016; 24:3175-84. [PMID: 26935051 PMCID: PMC4877412 DOI: 10.1007/s00520-016-3130-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Accepted: 02/09/2016] [Indexed: 11/30/2022]
Abstract
Purpose To evaluate and implement supportive programs, it is important to understand which cancer survivors (CSs) are participating in these programs and which motives exist for declining participation. Recently, a supportive return-to-work (RTW) program was offered to CSs with job loss. The purpose of this study was to identify factors and motives associated with (non-)participation of CSs with job loss in the RTW program. Methods In this cross-sectional study (N = 286), information on socio-demographic, health-related, psychosocial, and work-related characteristics of CSs in the program was collected. Similar data were collected from those who declined participation. Multivariable logistic regression analyses were conducted (p < 0.05) to identify factors associated with (non-)participation. Motives for declining participation were identified using descriptive analysis. Results Being married (odds ratio (OR) 0.23; 95 % confidence interval (CI) 0.08–0.69) or living together (OR 0.25; 95 % CI 0.07–0.96) decreased the likelihood of participation in the RTW program. Having a temporary employment contract prior to unemployment (OR 2.60; 95 % CI 1.20–5.63), a clear intention to RTW (OR 2.65; 95 % CI 1.20–5.82), and higher scores on a readiness to RTW instrument, i.e., contemplation scale (OR 2.00; 95 % CI 1.65–2.40) and prepared for action–self-evaluative scale (OR 1.27; 95 % CI 1.04–1.54), increased the likelihood of participation. Physical (50 %) and mental problems (36 %) were leading motives for declining participation. Conclusions The results from this study help to distinguish CSs that may not need RTW support, from those who are most in need of RTW support. Practitioners and researchers should tailor RTW support to CSs’ socio-demographic, health-related, and work-related characteristics.
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Beemster TT, van Velzen JM, van Bennekom CAM, Frings-Dresen MHW, Reneman MF. Cost-effectiveness of 40-hour versus 100-hour vocational rehabilitation on work participation for workers on sick leave due to subacute or chronic musculoskeletal pain: study protocol for a randomized controlled trial. Trials 2015. [PMID: 26215748 PMCID: PMC4518875 DOI: 10.1186/s13063-015-0861-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although vocational rehabilitation is a widely advocated intervention for workers on sick leave due to subacute or chronic nonspecific musculoskeletal pain, the optimal dosage of effective and cost-effective vocational rehabilitation remains unknown. The objective of this paper is to describe the design of a non-inferiority trial evaluating the effectiveness and cost-effectiveness of 40-h multidisciplinary vocational rehabilitation compared with 100-h multidisciplinary vocational rehabilitation on work participation for workers on sick leave due to subacute or chronic musculoskeletal pain. METHODS/DESIGN A non-inferiority study design will be applied. The study population consists of workers who are on part-time or full-time sick leave due to subacute or chronic nonspecific musculoskeletal pain. Two multidisciplinary vocational rehabilitation programs following the bio-psychosocial approach will be evaluated in this study: 40-h vocational rehabilitation and 100-h vocational rehabilitation, both delivered over a maximum of 15 weeks. The 100-h vocational rehabilitation comprises five modules: work participation coordination, graded activity, cognitive behavioral therapy, group education, and relaxation. The 40-h vocational rehabilitation comprises work participation coordination and a well-reasoned choice from the other four modules. Four rehabilitation centers will participate in this study, each delivering both interventions. Patients will be randomized into one of the interventions, stratified for the duration of sick leave (<6 weeks or ≥ 6 weeks) and type of sick leave (part-time or full-time). The primary outcome is work participation, measured by self-reported sick leave days, and will be assessed at baseline, mid-term, discharge, and at 2, 4, 6, 8, 10, and 12 months follow-up. Secondary outcomes are work ability, disability, quality of life, and physical functioning and will be assessed at baseline, discharge, and at 6 and 12 months follow-up. Cost outcomes are absenteeism, presenteeism, healthcare usage, and travelling costs. Cost-effectiveness will be evaluated from the societal and employer perspectives. DISCUSSION The results obtained from this study will be useful for vocational rehabilitation practice and will provide stakeholders with relevant insights into two versions of vocational rehabilitation. TRIAL REGISTRATION Dutch Trial Register identifier: NTR4362 (registered 17 March 2014).
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Affiliation(s)
- Timo T Beemster
- Department of Rehabilitation Medicine, Center for Rehabilitation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands. .,Department of Research and Development, Heliomare Rehabilitation Center, Wijk aan Zee, The Netherlands. .,Coronel Institute of Occupational Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
| | - Judith M van Velzen
- Department of Research and Development, Heliomare Rehabilitation Center, Wijk aan Zee, The Netherlands. .,Coronel Institute of Occupational Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
| | - Coen A M van Bennekom
- Department of Research and Development, Heliomare Rehabilitation Center, Wijk aan Zee, The Netherlands. .,Coronel Institute of Occupational Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
| | - Monique H W Frings-Dresen
- Coronel Institute of Occupational Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
| | - Michiel F Reneman
- Department of Rehabilitation Medicine, Center for Rehabilitation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
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van Egmond MP, Duijts SFA, Vermeulen SJ, van der Beek AJ, Anema JR. Return to work in sick-listed cancer survivors with job loss: design of a randomised controlled trial. BMC Cancer 2015; 15:63. [PMID: 25886150 PMCID: PMC4350300 DOI: 10.1186/s12885-015-1051-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Accepted: 01/28/2015] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Despite long-term or permanent health problems, cancer survivors are often motivated to return to work. For cancer survivors who have lost their job, return to work can be more challenging compared to employed survivors, as they generally find themselves in a more vulnerable social and financial position. Cancer survivors with job loss may therefore be in need of tailored return to work support. However, there is a lack of return to work intervention programs specifically targeting these cancer survivors. The number of cancer survivors with job loss in developed countries is rising due to, amongst others, increases in the incidence and survivor rate of cancer, the retirement age and the proportion of flexible employment contracts. Hence, we consider it important to develop a tailored return to work intervention program for cancer survivors with job loss, and to evaluate its effectiveness compared to usual care. METHODS/DESIGN This study employs a two-armed randomised controlled trial with a follow-up period of 12 months. The study population (n = 164) will be recruited from a national sample of cancer survivors (18-60 years), who have been sick-listed for 12-36 months. Participants will be randomised by using computerized blocked randomisation (blocks of four). All participants will receive usual care as provided by the Dutch Social Security Agency. Additionally, participants in the intervention group will receive a tailored return to work intervention program, which includes vocational rehabilitation and supportive psychosocial components, as well as (therapeutic) placement at work. The primary outcome measure is duration until sustainable return to work; the secondary outcome measure is rate of return to work. Other parameters include, amongst others, fatigue, coping strategy and quality of life. We will perform Cox regression analyses to estimate hazard ratios for time to sustainable return to work. DISCUSSION The hypothesis of this study is that a tailored approach for cancer survivors with job loss is more effective, regarding return to work, compared to usual care. The results of this study will provide insight into the ways in which return to work can be facilitated for cancer survivors with job loss. TRIAL REGISTRATION Netherlands Trial Register: NTR3562 .
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Affiliation(s)
- Martine P van Egmond
- Department of Public and Occupational Health, VU University Medical Center, EMGO+ Institute for Health and Care Research, Van der Boechorststraat 7, 1081 BT, Amsterdam, the Netherlands. .,Dutch Research Center for Insurance Medicine, AMC-UMCG-UWV-VUmc, Amsterdam, the Netherlands.
| | - Saskia F A Duijts
- Department of Public and Occupational Health, VU University Medical Center, EMGO+ Institute for Health and Care Research, Van der Boechorststraat 7, 1081 BT, Amsterdam, the Netherlands. .,Department of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, the Netherlands.
| | - Sylvia J Vermeulen
- Department of Public and Occupational Health, VU University Medical Center, EMGO+ Institute for Health and Care Research, Van der Boechorststraat 7, 1081 BT, Amsterdam, the Netherlands.
| | - Allard J van der Beek
- Department of Public and Occupational Health, VU University Medical Center, EMGO+ Institute for Health and Care Research, Van der Boechorststraat 7, 1081 BT, Amsterdam, the Netherlands. .,Dutch Research Center for Insurance Medicine, AMC-UMCG-UWV-VUmc, Amsterdam, the Netherlands.
| | - Johannes R Anema
- Department of Public and Occupational Health, VU University Medical Center, EMGO+ Institute for Health and Care Research, Van der Boechorststraat 7, 1081 BT, Amsterdam, the Netherlands. .,Dutch Research Center for Insurance Medicine, AMC-UMCG-UWV-VUmc, Amsterdam, the Netherlands.
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Lammerts L, Vermeulen SJ, Schaafsma FG, van Mechelen W, Anema JR. Return to work of workers without a permanent employment contract, sick-listed due to a common mental disorder: design of a randomised controlled trial. BMC Public Health 2014; 14:594. [PMID: 24919561 PMCID: PMC4061521 DOI: 10.1186/1471-2458-14-594] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2014] [Accepted: 05/22/2014] [Indexed: 11/24/2022] Open
Abstract
Background Workers without a permanent employment contract represent a vulnerable group within the working population. Mental disorders are a major cause of sickness absence within this group. Common mental disorders are stress-related, depressive and anxiety disorders. To date, little attention has been paid to effective return to work interventions for this type of sick-listed workers. Therefore, a participatory supportive return to work program has been developed. It combines elements of a participatory return to work program, integrated care and direct placement in a competitive job. The objective of this paper is to describe the design of a randomised controlled trial to evaluate the cost-effectiveness of this program compared to care as usual. Methods/Design The cost-effectiveness of the participatory supportive return to work program will be examined in a randomised controlled trial with a follow-up of twelve months. The program strongly involves the sick-listed worker in the identification of obstacles for return to work and possible solutions, resulting in a consensus based action plan. This plan will be used as a starting point for the search of suitable competitive employment with support of a rehabilitation agency. During this process the insurance physician of the sick-listed worker contacts other caregivers to promote integrated care. Workers eligible to participate in this study have no permanent employment contract, have applied for a sickness benefit at the Dutch Social Security Agency and are sick-listed between two and fourteen weeks due to mental health problems. The primary outcome measure is the duration until first sustainable return to work in a competitive job. Outcomes are measured at baseline and after three, six, nine and twelve months. Discussion If the participatory supportive return to work program proves to be cost-effective, the social security system, the sick-listed worker and society as a whole will benefit. A cost-effective return to work program will lead to a reduction of costs related to sickness absence. For the sick-listed worker a cost-effective program results in earlier sustainable return to work, which can be associated with both social and health benefits. Trial registration The trial registration number and date is NTR3563, August 7, 2012.
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Affiliation(s)
| | | | | | | | - Johannes R Anema
- Department of Public and Occupational Health, EMGO + Institute for Health and Care Research, VU University Medical Centre, P,O, Box 7057, Amsterdam 1007 MB, The Netherlands.
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KINNUNEN-AMOROSO M, LIIRA J. Work-related stress management by Finnish enterprises. INDUSTRIAL HEALTH 2014; 52:216-224. [PMID: 24583512 PMCID: PMC4209586 DOI: 10.2486/indhealth.2013-0178] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2013] [Accepted: 01/24/2014] [Indexed: 06/03/2023]
Abstract
Work-related stress has become one of the major problems in working societies and it increases employees' risk of disease. Its importance has been emphasized also due to its' great socio-economic consequences. Different stress management and worksite interventions have been implemented, however, the actual practices in companies have been assessed little. The purpose of this study was to examine how enterprises in Finland manage work-related stress. An assessment of work-related stress methods was conducted in 40 enterprises acting in the metropolitan area of Finland in May 2010 by a questionnaire. The concept of work-related stress was well known by participants. Enterprises rarely had their own work-related stress management protocol even though all of the workplaces had experienced work-related stress at some point. The collaboration between the workplace and occupational health services varied. Companies easily placed the responsibility for work-related stress assessment and handling on occupational health services. Workplaces have to pay more attention to work-related stress and related issues. The easiest way to do this is to collaborate with occupational health services. Protocols for collaboration should be developed jointly using the available models which have been established as cost-effective.
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Affiliation(s)
| | - Juha LIIRA
- Finnish Institute of Occupational Health, Finland
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Schellart AJM, Zwerver F, Anema JR, van der Beek AJ. Relationships between the intention to use guidelines, behaviour of insurance physicians and their determinants. BMC Health Serv Res 2013; 13:400. [PMID: 24103198 PMCID: PMC3851955 DOI: 10.1186/1472-6963-13-400] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2011] [Accepted: 09/25/2013] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND We studied the intention of a group of insurance physicians to use the guidelines for depression, and their behaviour in disability assessments. We considered attitude, social norm and self-efficacy, knowledge/skills and stimuli, based on the Attitude-Social norm-self-Efficacy model (ASE model) as possible determinants of both intention and behaviour.The aim of this study was to understand the determinants of insurance physicians' behaviour when they are expected to use guidelines in daily practice. METHOD A representative sample of 42 insurance physicians participated in this study. Cross-sectional data were collected by means of a questionnaire based on the ASE model. We developed the questionnaire on the basis of literature and ascertained the content validity of it. Behaviour was made to comprise both "use of the guidelines" and "change in disability assessment behaviour" by the insurance physicians. Reliability analyses were performed to form additive scales of the ASE constructs. These scales were analysed with structural equations modelling (LISREL), by modifying a start model into a final model with a good fit, within theoretical constraints. In these analyses special attention was paid to the fact that the sample size was small. RESULTS The most important determinants of the intention and the self-reported use of the guidelines, were: the influence of colleagues, the self-efficacy of the insurance physicians in their use of the guidelines, and the way the guidelines were implemented. The intention to use the guidelines for depression was not associated with the self-reported use of these guidelines, but there proved to be a faint, positive association with the self-reported change in assessment behaviour. CONCLUSIONS Almost all the insurance physicians in this study intended to use at least elements of the guidelines. Their intention, self reported use of the guidelines and self-reported change in assessment behaviour were explored with help of the ASE model. The model suggested relationships between intention, self reported use of the guidelines and self-reported change in assessment behaviour on the on the one hand and various determinants on the other hand. Be that as it may, we see opportunities to improve insurance physicians' guideline adherence by offering them a multifaceted training in which they learn to apply the guidelines for depression.
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Affiliation(s)
- Antonius J M Schellart
- Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands.
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Young AE. An exploration of alternative methods for assessing return-to-work success following occupational injury. Disabil Rehabil 2013; 36:914-24. [PMID: 23962195 DOI: 10.3109/09638288.2013.824033] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To explore alternative methods for assessing return-to-work success. METHOD This exploratory study employed a prospective design. Participants (N = 150) were all vocational rehabilitation recipients who sustained a work-related injury that resulted in them being off work for at least 6 months, and were unable to return to their pre-injury position. At baseline (B), all were reported to have found post-injury employment. Qualitative features of the participants' post-injury employment were assessed at the time of initial interview (T1), which was conducted a mean of approximately one year following the participants' scheduled workplace re-entry (mean 344 days). Participants' T1 employment characteristics were then compared to their outcomes at the time of follow-up (T2), which was approximately 3 months later (mean 85 days). RESULTS Findings indicate that 25% of participants were not in their baseline jobs at the time of last contact; some were in different jobs, however others were not working. At T1 many of those working reported experiencing difficulties. Comparisons revealed significant relationships between problem indicators at T1 and employment outcomes at T2, with significant problem indicators including worries that symptoms might interfere with their ability to continue in the job, difficulties with the job's physical demands and a strong desire to leave their current job. When problem indicators were used in combination, stronger relationships were observed and self-assessed performance contributed to the effect. CONCLUSIONS Results add support to the contention that rather than a single event, RTW is an evolving, complex and sometimes nonlinear process. This should be kept in mind when assessing the success of an injured worker's RTW.
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Affiliation(s)
- Amanda E Young
- Liberty Mutual Research Institute for Safety, Center for Disability Research , Hopkinton, MA , USA
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Shi Y, Sears LE, Coberley CR, Pope JE. Classification of individual well-being scores for the determination of adverse health and productivity outcomes in employee populations. Popul Health Manag 2013; 16:90-8. [PMID: 23013034 PMCID: PMC3698675 DOI: 10.1089/pop.2012.0039] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Adverse health and productivity outcomes have imposed a considerable economic burden on employers. To facilitate optimal worksite intervention designs tailored to differing employee risk levels, the authors established cutoff points for an Individual Well-Being Score (IWBS) based on a global measure of well-being. Cross-sectional associations between IWBS and adverse health and productivity outcomes, including high health care cost, emergency room visits, short-term disability days, absenteeism, presenteeism, low job performance ratings, and low intentions to stay with the employer, were studied in a sample of 11,702 employees from a large employer. Receiver operating characteristics curves were evaluated to detect a single optimal cutoff value of IWBS for predicting 2 or more adverse outcomes. More granular segmentation was achieved by computing relative risks of each adverse outcome from logistic regressions accounting for sociodemographic characteristics. Results showed strong and significant nonlinear associations between IWBS and health and productivity outcomes. An IWBS of 75 was found to be the optimal single cutoff point to discriminate 2 or more adverse outcomes. Logistic regression models found abrupt reductions of relative risk also clustered at IWBS cutoffs of 53, 66, and 88, in addition to 75, which segmented employees into high, high-medium, medium, low-medium, and low risk groups. To determine validity and generalizability, cutoff values were applied in a smaller employee population (N=1853) and confirmed significant differences between risk groups across health and productivity outcomes. The reported segmentation of IWBS into discrete cohorts based on risk of adverse health and productivity outcomes should facilitate well-being comparisons and worksite interventions.
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Affiliation(s)
- Yuyan Shi
- Healthways, Inc. , Center for Health Research, Franklin, Tennessee 37067, USA.
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Volker D, Vlasveld MC, Anema JR, Beekman AT, Roijen LHV, Brouwers EP, van Lomwel AGC, van der Feltz-Cornelis CM. Blended E-health module on return to work embedded in collaborative occupational health care for common mental disorders: design of a cluster randomized controlled trial. Neuropsychiatr Dis Treat 2013; 9:529-37. [PMID: 23637534 PMCID: PMC3639217 DOI: 10.2147/ndt.s43969] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Common mental disorders (CMD) have a major impact on both society and individual workers, so return to work (RTW) is an important issue. In The Netherlands, the occupational physician plays a central role in the guidance of sick-listed workers with respect to RTW. Evidence-based guidelines are available, but seem not to be effective in improving RTW in people with CMD. An intervention supporting the occupational physician in guidance of sick-listed workers combined with specific guidance regarding RTW is needed. A blended E-health module embedded in collaborative occupational health care is now available, and comprises a decision aid supporting the occupational physician and an E-health module, Return@Work, to support sick-listed workers in the RTW process. The cost-effectiveness of this intervention will be evaluated in this study and compared with that of care as usual. METHODS This study is a two-armed cluster randomized controlled trial, with randomization done at the level of occupational physicians. Two hundred workers with CMD on sickness absence for 4-26 weeks will be included in the study. Workers whose occupational physician is allocated to the intervention group will receive the collaborative occupational health care intervention. Occupational physicians allocated to the care as usual group will give conventional sickness guidance. Follow-up assessments will be done at 3, 6, 9, and 12 months after baseline. The primary outcome is duration until RTW. The secondary outcome is severity of symptoms of CMD. An economic evaluation will be performed as part of this trial. CONCLUSION It is hypothesized that collaborative occupational health care intervention will be more (cost)-effective than care as usual. This intervention is innovative in its combination of a decision aid by email sent to the occupational physician and an E-health module aimed at RTW for the sick-listed worker.
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Affiliation(s)
- Daniëlle Volker
- Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht ; Tranzo Department, Tilburg University, Tilburg
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Arends I, Bruinvels DJ, Rebergen DS, Nieuwenhuijsen K, Madan I, Neumeyer-Gromen A, Bültmann U, Verbeek JH. Interventions to facilitate return to work in adults with adjustment disorders. Cochrane Database Syst Rev 2012; 12:CD006389. [PMID: 23235630 DOI: 10.1002/14651858.cd006389.pub2] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Adjustment disorders are a frequent cause of sick leave and various interventions have been developed to expedite the return to work (RTW) of individuals on sick leave due to adjustment disorders. OBJECTIVES To assess the effects of interventions facilitating RTW for workers with acute or chronic adjustment disorders. SEARCH METHODS We searched the Cochrane Depression, Anxiety and Neurosis Review Group's Specialised Register (CCDANCTR) to October 2011; the Cochrane Central Register of Controlled Trials (CENTRAL) to Issue 4, 2011; MEDLINE, EMBASE, PsycINFO and ISI Web of Science, all years to February 2011; the WHO trials portal (ICTRP) and ClinicalTrials.gov in March 2011. We also screened reference lists of included studies and relevant reviews. SELECTION CRITERIA We selected randomised controlled trials (RCTs) evaluating the effectiveness of interventions to facilitate RTW of workers with adjustment disorders compared to no or other treatment. Eligible interventions were pharmacological interventions, psychological interventions (such as cognitive behavioural therapy (CBT) and problem solving therapy), relaxation techniques, exercise programmes, employee assistance programmes or combinations of these interventions. The primary outcomes were time to partial and time to full RTW, and secondary outcomes were severity of symptoms of adjustment disorder, work functioning, generic functional status (i.e. the overall functional capabilities of an individual, such as physical functioning, social function, general mental health) and quality of life. DATA COLLECTION AND ANALYSIS Two authors independently selected studies, assessed risk of bias and extracted data. We pooled studies that we deemed sufficiently clinically homogeneous in different comparison groups, and assessed the overall quality of the evidence using the GRADE approach. MAIN RESULTS We included nine studies reporting on 10 psychological interventions and one combined intervention. The studies included 1546 participants. No RCTs were found of pharmacological interventions, exercise programmes or employee assistance programmes. We assessed seven studies as having low risk of bias and the studies that were pooled together were comparable. For those who received no treatment, compared with CBT, the assumed time to partial and full RTW was 88 and 252 days respectively. Based on two studies with a total of 159 participants, moderate-quality evidence showed that CBT had similar results for time (measured in days) until partial RTW compared to no treatment at one-year follow-up (mean difference (MD) -8.78, 95% confidence interval (CI) -23.26 to 5.71). We found low-quality evidence of similar results for CBT and no treatment on the reduction of days until full RTW at one-year follow-up (MD -35.73, 95% CI -113.15 to 41.69) (one study with 105 participants included in the analysis). Based on moderate-quality evidence, problem solving therapy (PST) significantly reduced time until partial RTW at one-year follow-up compared to non-guideline based care (MD -17.00, 95% CI -26.48 to -7.52) (one study with 192 participants clustered among 33 treatment providers included in the analysis), but we found moderate-quality evidence of no significant effect on reducing days until full RTW at one-year follow-up (MD -17.73, 95% CI -37.35 to 1.90) (two studies with 342 participants included in the analysis). AUTHORS' CONCLUSIONS We found moderate-quality evidence that CBT did not significantly reduce time until partial RTW and low-quality evidence that it did not significantly reduce time to full RTW compared with no treatment. Moderate-quality evidence showed that PST significantly enhanced partial RTW at one-year follow-up compared to non-guideline based care but did not significantly enhance time to full RTW at one-year follow-up. An important limitation was the small number of studies included in the meta-analyses and the small number of participants, which lowered the power of the analyses.
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Affiliation(s)
- Iris Arends
- Department of Health Sciences, Community and Occupational Medicine, University Medical Center Groningen, University ofGroningen, Groningen,
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Gussenhoven AHM, Anema JR, Goverts ST, Bosmans JE, Festen JM, Kramer SE. Cost-effectiveness of a vocational enablement protocol for employees with hearing impairment; design of a randomized controlled trial. BMC Public Health 2012; 12:151. [PMID: 22380920 PMCID: PMC3306742 DOI: 10.1186/1471-2458-12-151] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2012] [Accepted: 03/01/2012] [Indexed: 12/03/2022] Open
Abstract
Background Hearing impairment at the workplace, and the resulting psychosocial problems are a major health problem with substantial costs for employees, companies, and society. Therefore, it is important to develop interventions to support hearing impaired employees. The objective of this article is to describe the design of a randomized controlled trial evaluating the (cost-) effectiveness of a Vocational Enablement Protocol (VEP) compared with usual care. Methods/Design Participants will be selected with the 'Hearing and Distress Screener'. The study population will consist of 160 hearing impaired employees. The VEP intervention group will be compared with usual care. The VEP integrated care programme consists of a multidisciplinary assessment of auditory function, work demands, and personal characteristics. The goal of the intervention is to facilitate participation in work. The primary outcome measure of the study is 'need for recovery after work'. Secondary outcome measures are coping with hearing impairment, distress, self-efficacy, psychosocial workload, job control, general health status, sick leave, work productivity, and health care use. Outcome measures will be assessed by questionnaires at baseline, and 3, 6, 9, and 12 months after baseline. The economic evaluation will be performed from both a societal and a company perspective. A process evaluation will also be performed. Discussion Interventions addressing occupational difficulties of hearing impaired employees are rare but highly needed. If the VEP integrated care programme proves to be (cost-) effective, the intervention can have an impact on the well-being of hearing impaired employees, and thereby, on the costs for the company as well for the society. Trial registration Netherlands Trial Register (NTR): NTR2782
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Affiliation(s)
- Arjenne H M Gussenhoven
- Department ENT/Audiology and EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
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van Beurden KM, Vermeulen SJ, Anema JR, van der Beek AJ. A participatory return-to-work program for temporary agency workers and unemployed workers sick-listed due to musculoskeletal disorders: a process evaluation alongside a randomized controlled trial. JOURNAL OF OCCUPATIONAL REHABILITATION 2012; 22:127-40. [PMID: 21656252 PMCID: PMC3274681 DOI: 10.1007/s10926-011-9314-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
INTRODUCTION Beside (cost-)effectiveness, the feasibility of an intervention is important for successful implementation in daily practice. This study concerns the process evaluation of a newly developed participatory return-to-work (RTW) program for workers without an employment contract, sick-listed due to musculoskeletal disorders. The program consisted of a stepwise process, guided by an independent RTW coordinator, aimed at making a consensus-based RTW plan with the possibility of a temporary (therapeutic) workplace. The aims of this study were to describe the reach and extent of implementation of the new program, the satisfaction and experiences of all stakeholders, and the perceived barriers and facilitators for implementation of the program in daily practice. METHODS Temporary agency workers and unemployed workers, sick-listed for 2-8 weeks due to musculoskeletal disorders were eligible for this study. Data were collected from the workers; their insurance physicians and labour experts at the Dutch Social Security Agency; RTW coordinators; and case managers from participating vocational rehabilitation agencies. Data collection took place using professionals' reports, standardized matrices, questionnaires at baseline and at 3-month follow-up, and group interviews with the professionals. RESULTS Of the 79 workers who were allocated to the participatory RTW program group, 72 workers actually started with the intervention. Overall, implementation of the program was performed according to protocol. However, offering of suitable temporary workplaces was delayed with 44.5 days. Results showed satisfaction with the RTW coordinator among the workers and three quarters of the labour experts experienced a minor or major contribution of the presence of the RTW coordinator. Several barriers for implementation were identified, such as the administrative time-investment, unclear information about the program, no timely offering of temporary (therapeutic) workplaces, and the need for additional support in case of complex health problems. CONCLUSIONS This study indicates overall feasibility for implementation of the participatory RTW program in daily practice. However, to overcome important barriers, more attention should be paid to improve timely offering of suitable temporary workplaces, to describe more clearly the program goals and the professional's roles, and to offer additional support for workers suffering from complex multi-causal health problems. TRIAL REGISTRATION NTR1047.
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Affiliation(s)
- Karlijn M. van Beurden
- Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Center, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands
- Research Center for Insurance Medicine AMC-UMCG-UWV-VUmc, Amsterdam, The Netherlands
| | - Sylvia J. Vermeulen
- Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Center, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands
- Research Center for Insurance Medicine AMC-UMCG-UWV-VUmc, Amsterdam, The Netherlands
| | - Johannes R. Anema
- Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Center, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands
- Research Center for Insurance Medicine AMC-UMCG-UWV-VUmc, Amsterdam, The Netherlands
| | - Allard J. van der Beek
- Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Center, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands
- Research Center for Insurance Medicine AMC-UMCG-UWV-VUmc, Amsterdam, The Netherlands
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Noben CYG, Nijhuis FJN, de Rijk AE, Evers SMAA. Design of a trial-based economic evaluation on the cost-effectiveness of employability interventions among work disabled employees or employees at risk of work disability: the CASE-study. BMC Public Health 2012; 12:43. [PMID: 22257557 PMCID: PMC3273437 DOI: 10.1186/1471-2458-12-43] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2011] [Accepted: 01/18/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In the Netherlands, absenteeism and reduced productivity due to work disability lead to high yearly costs reaching almost 5% of the gross national product. To reduce the economic burden of sick leave and reduced productivity, different employability interventions for work-disabled employees or employees at risk of work disability have been developed. Within this study, called 'CASE-study' (Cost-effectiveness Analysis of Sustainable Employability), five different employability interventions directed at work disabled employees with divergent health complaints will be analysed on their effectiveness and cost-effectiveness. This paper describes a consistent and transparent methodological design to do so. METHODS/DESIGN Per employability intervention 142 participants are needed whereof approximately 66 participants receiving the intervention will be compared with 66 participants receiving usual care. Based on the intervention-specific characteristics, a randomized control trial or a quasi-experiment with match-criteria will be conducted. Notwithstanding the study design, eligible participants will be employees aged 18 to 63, working at least 12 h per week, and at risk of work disability, or already work-disabled due to medical restrictions. The primary outcome will be the duration of sick leave. Secondary outcomes are health status and quality of life. Outcomes will be assessed at baseline and then 6, 12 and 18 months later. Economic costs will consist of healthcare costs and cost of lost production due to work disability, and will be evaluated from a societal perspective. DISCUSSION The CASE-study is the first to conduct economic evaluations of multiple different employability interventions based on a similar methodological framework. The cost-effectiveness results for every employability intervention will be published in 2014, but the methods, strengths and weaknesses of the study protocol are discussed in this paper. To contribute to treatment options in occupational health practice and enable the development of guidelines on how to conduct economic evaluation better suited to this field; this paper provides an important first step. TRIAL REGISTRATION Four trials involved in the CASE-study are registered with the Netherlands Trial Registry: Care for Work (NTR2886), Health and Motion (NTR3111), Guidance to Excel in Return to Work (NTR3151), Care for Companies/Second Care (NTR3136).
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Affiliation(s)
- Cindy Y G Noben
- School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands.
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Vermeulen SJ, Anema JR, Schellart AJM, Knol DL, van Mechelen W, van der Beek AJ. A participatory return-to-work intervention for temporary agency workers and unemployed workers sick-listed due to musculoskeletal disorders: results of a randomized controlled trial. JOURNAL OF OCCUPATIONAL REHABILITATION 2011; 21:313-24. [PMID: 21336673 PMCID: PMC3173632 DOI: 10.1007/s10926-011-9291-7] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
INTRODUCTION Within the labour force workers without an employment contract represent a vulnerable group. In most cases, when sick-listed, these workers have no workplace/employer to return to. Therefore, the aim of this study was to evaluate the effectiveness on return-to-work of a participatory return-to-work program compared to usual care for unemployed workers and temporary agency workers, sick-listed due to musculoskeletal disorders. METHODS The workers, sick-listed for 2-8 weeks due to musculoskeletal disorders, were randomly allocated to the participatory return-to-work program (n = 79) or to usual care (n = 84). The new program is a stepwise procedure aimed at making a consensus-based return-to-work plan, with the possibility of a temporary (therapeutic) workplace. Outcomes were measured at baseline, 3, 6, 9 and 12 months. The primary outcome measure was time to sustainable first return-to-work. Secondary outcome measures were duration of sickness benefit, functional status, pain intensity, and perceived health. RESULTS The median duration until sustainable first return-to-work was 161 days in the intervention group, compared to 299 days in the usual care group. The new return-to-work program resulted in a non-significant delay in RTW during the first 90 days, followed by a significant advantage in RTW rate after 90 days (hazard ratio of 2.24 [95% confidence interval 1.28-3.94] P = 0.005). No significant differences were found for the measured secondary outcomes. CONCLUSIONS The newly developed participatory return-to-work program seems to be a promising intervention to facilitate work resumption and reduce work disability among temporary agency workers and unemployed workers, sick-listed due to musculoskeletal disorders.
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Affiliation(s)
- Sylvia J. Vermeulen
- Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Centre, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands
- Research Centre for Insurance Medicine AMC-UMCG-UWV-VUmc, Amsterdam, The Netherlands
| | - Johannes R. Anema
- Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Centre, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands
- Research Centre for Insurance Medicine AMC-UMCG-UWV-VUmc, Amsterdam, The Netherlands
| | - Antonius J. M. Schellart
- Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Centre, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands
- Research Centre for Insurance Medicine AMC-UMCG-UWV-VUmc, Amsterdam, The Netherlands
| | - Dirk L. Knol
- Department of Epidemiology and Biostatistics, VU University Medical Centre, Amsterdam, The Netherlands
| | - Willem van Mechelen
- Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Centre, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands
- Research Centre for Insurance Medicine AMC-UMCG-UWV-VUmc, Amsterdam, The Netherlands
| | - Allard J. van der Beek
- Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Centre, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands
- Research Centre for Insurance Medicine AMC-UMCG-UWV-VUmc, Amsterdam, The Netherlands
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Schellart AJM, Steenbeek R, Mulders HPG, Anema JR, Kroneman H, Besseling JJM. Can self-reported disability assessment behaviour of insurance physicians be explained? Applying the ASE model. BMC Public Health 2011; 11:576. [PMID: 21771326 PMCID: PMC3155499 DOI: 10.1186/1471-2458-11-576] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2010] [Accepted: 07/19/2011] [Indexed: 12/02/2022] Open
Abstract
Background Very little is known about the attitudes and views that might underlie and explain the variation in occupational disability assessment behaviour between insurance physicians. In an earlier study we presented an adjusted ASE model (Attitude, Social norm, Self-efficacy) to identify the determinants of the disability assessment behaviour among insurance physicians. The research question of this study is how Attitude, Social norm, Self-efficacy and Intention shape the behaviour that insurance physicians themselves report with regard to the process (Behaviour: process) and content of the assessment (Behaviour: assessment) while taking account of Knowledge and Barriers. Methods This study was based on 231 questionnaires filled in by insurance physicians, resulting into 48 scales and dimension scores. The number of variables was reduced by a separate estimation of each of the theoretical ASE constructs as a latent variable in a measurement model. The saved factor scores of these latent variables were treated as observed variables when we estimated a path model with Lisrel to confirm the ASE model. We estimated latent ASE constructs for most of the assigned scales and dimensions. All could be described and interpreted. We used these constructs to build a path model that showed a good fit. Results Contrary to our initial expectations, we did not find direct effects for Attitude on Intention and for Intention on self reported assessment behaviour in the model. This may well have been due to the operationalization of the concept of 'Intention'. We did, however, find that Attitude had a positive direct effect on Behaviour: process and Behaviour: Assessment and that Intention had a negative direct effect on Behaviour: process. Conclusion A path model pointed to the existence of relationships between Attitude on the one hand and self-reported behaviour by insurance physicians with regard to process and content of occupational disability assessments on the other hand. In addition, Intention was only related to the self reported behaviour with regard to the process of occupational disability assessments. These findings provide some evidence of the relevance of the ASE model in this setting. Further research is needed to determine whether the ASE variables measured for insurance physicians are related to the real practice outcomes of occupational disability assessments.
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Affiliation(s)
- Antonius J M Schellart
- VU University Medical Center, Department of Public and Occupational Health, EMGO Institute for Health and Care Research, Amsterdam, the Netherlands.
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Brouwer S, Franche RL, Hogg-Johnson S, Lee H, Krause N, Shaw WS. Return-to-work self-efficacy: development and validation of a scale in claimants with musculoskeletal disorders. JOURNAL OF OCCUPATIONAL REHABILITATION 2011; 21:244-58. [PMID: 20865445 PMCID: PMC3098360 DOI: 10.1007/s10926-010-9262-4] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
INTRODUCTION We report on the development and validation of a 10-item scale assessing self-efficacy within the return-to-work context, the Return-to-Work Self-Efficacy (RTWSE) scale. METHODS Lost-time claimants completed a telephone survey 1 month (n = 632) and 6 months (n = 446) after a work-related musculoskeletal injury. Exploratory (Varimax and Promax rotation) and confirmatory factor analyses of self-efficacy items were conducted with two separate subsamples at both time points. Construct validity was examined by comparing scale measurements and theoretically derived constructs, and the phase specificity of RTWSE was studied by examining changes in strength of relationships between the RTWSE Subscales and the other constructs at both time measures. RESULTS Factor analyses supported three underlying factors: (1) Obtaining help from supervisor, (2) Coping with pain (3) Obtaining help from co-workers. Internal consistency (alpha) for the three subscales ranged from 0.66 to 0.93. The total variance explained was 68% at 1-month follow-up and 76% at 6-month follow-up. Confirmatory factor analyses had satisfactory fit indices to confirm the initial model. With regard to construct validity: relationships of RTWSE with depressive symptoms, fear-avoidance, pain, and general health, were generally in the hypothesized direction. However, the hypothesis that less advanced stages of change on the Readiness for RTW scale would be associated with lower RTWSE could not be completely confirmed: on all RTWSE subscales, RTWSE decreased significantly for a subset of participants who started working again. Moreover, only Pain RTWSE was significantly associated with RTW status and duration of work disability. With regard to the phase specificity, the strength of association between RTWSE and other constructs was stronger at 6 months post-injury compared to 1 month post-injury. CONCLUSIONS A final 10-item version of the RTWSE has adequate internal consistency and validity to assess the confidence of injured workers to obtain help from supervisor and co-workers and to cope with pain. With regard to phase specificity, stronger associations between RTWSE and other constructs at 6-month follow-up suggest that the association between these psychological constructs consolidates over time after the disruptive event of the injury.
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Affiliation(s)
- Sandra Brouwer
- Department of Health Sciences, Work & Health, University Medical Center Groningen, Antonius Deusinglaan, The Netherlands.
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Steenbeek R, Schellart AJ, Mulders H, Anema JR, Kroneman H, Besseling J. The development of instruments to measure the work disability assessment behaviour of insurance physicians. BMC Public Health 2011; 11:1. [PMID: 21199570 PMCID: PMC3086528 DOI: 10.1186/1471-2458-11-1] [Citation(s) in RCA: 250] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2010] [Accepted: 01/03/2011] [Indexed: 11/21/2022] Open
Abstract
Background Variation in assessments is a universal given, and work disability assessments by insurance physicians are no exception. Little is known about the considerations and views of insurance physicians that may partly explain such variation. On the basis of the Attitude - Social norm - self Efficacy (ASE) model, we have developed measurement instruments for assessment behaviour and its determinants. Methods Based on theory and interviews with insurance physicians the questionnaire included blocks of items concerning background variables, intentions, attitudes, social norms, self-efficacy, knowledge, barriers and behaviour of the insurance physicians in relation to work disability assessment issues. The responses of 231 insurance physicians were suitable for further analysis. Factor analysis and reliability analysis were used to form scale variables and homogeneity analysis was used to form dimension variables. Thus, we included 169 of the 177 original items. Results Factor analysis and reliability analysis yielded 29 scales with sufficient reliability. Homogeneity analysis yielded 19 dimensions. Scales and dimensions fitted with the concepts of the ASE model. We slightly modified the ASE model by dividing behaviour into two blocks: behaviour that reflects the assessment process and behaviour that reflects assessment behaviour. The picture that emerged from the descriptive results was of a group of physicians who were motivated in their job and positive about the Dutch social security system in general. However, only half of them had a positive opinion about the Dutch Work and Income (Capacity for Work) Act (WIA). They also reported serious barriers, the most common of which was work pressure. Finally, 73% of the insurance physicians described the majority of their cases as 'difficult'. Conclusions The scales and dimensions developed appear to be valid and offer a promising basis for future research. The results suggest that the underlying ASE model, in modified form, is suitable for describing the assessment behaviour of insurance physicians and the determinants of this behaviour. The next step in this line of research should be to validate the model using structural equation modelling. Finally, the predictive value should be tested in relation to outcome measurements of work disability assessments.
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Affiliation(s)
- Romy Steenbeek
- TNO Work and Employment, PO Box 718, 2130 AS Hoofddorp, the Netherlands.
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Lagerveld SE, Bültmann U, Franche RL, van Dijk FJH, Vlasveld MC, van der Feltz-Cornelis CM, Bruinvels DJ, Huijs JJJM, Blonk RWB, van der Klink JJL, Nieuwenhuijsen K. Factors associated with work participation and work functioning in depressed workers: a systematic review. JOURNAL OF OCCUPATIONAL REHABILITATION 2010; 20:275-92. [PMID: 20091105 PMCID: PMC2923705 DOI: 10.1007/s10926-009-9224-x] [Citation(s) in RCA: 146] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
BACKGROUND Depression is associated with negative work outcomes such as reduced work participation (WP) (e.g., sick leave duration, work status) and work functioning (WF) (e.g., loss of productivity, work limitations). For the development of evidence-based interventions to improve these work outcomes, factors predicting WP and WF have to be identified. METHODS This paper presents a systematic literature review of studies identifying factors associated with WP and WF of currently depressed workers. RESULTS A total of 30 studies were found that addressed factors associated with WP (N = 19) or WF (N = 11). For both outcomes, studies reported most often on the relationship with disorder-related factors, whereas personal factors and work-related factors were less frequently addressed. For WP, the following relationships were supported: strong evidence was found for the association between a long duration of the depressive episode and work disability. Moderate evidence was found for the associations between more severe types of depressive disorder, presence of co-morbid mental or physical disorders, older age, a history of previous sick leave, and work disability. For WF, severe depressive symptoms were associated with work limitations, and clinical improvement was related to work productivity (moderate evidence). Due to the cross-sectional nature of about half of the studies, only few true prospective associations could be identified. CONCLUSION Our study identifies gaps in knowledge regarding factors predictive of WP and WF in depressed workers and can be used for the design of future research and evidence-based interventions. We recommend undertaking more longitudinal studies to identify modifiable factors predictive of WP and WF, especially work-related and personal factors.
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Affiliation(s)
- S E Lagerveld
- TNO Quality of Life, Business Unit Work and Employment, P.O. Box 718, 130 AS, Hoofddorp, The Netherlands.
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Carroll C, Rick J, Pilgrim H, Cameron J, Hillage J. Workplace involvement improves return to work rates among employees with back pain on long-term sick leave: a systematic review of the effectiveness and cost-effectiveness of interventions. Disabil Rehabil 2010; 32:607-21. [PMID: 20205573 DOI: 10.3109/09638280903186301] [Citation(s) in RCA: 150] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE Long-term sickness absence among workers is a major problem in industrialised countries. The aim of the review is to determine whether interventions involving the workplace are more effective and cost-effective at helping employees on sick leave return to work than those that do not involve the workplace at all. METHODS A systematic review of controlled intervention studies and economic evaluations. Sixteen electronic databases and grey literature sources were searched, and reference and citation tracking was performed on included publications. A narrative synthesis was performed. RESULTS Ten articles were found reporting nine trials from Europe and Canada, and four articles were found evaluating the cost-effectiveness of interventions. The population in eight trials suffered from back pain and related musculoskeletal conditions. Interventions involving employees, health practitioners and employers working together, to implement work modifications for the absentee, were more consistently effective than other interventions. Early intervention was also found to be effective. The majority of trials were of good or moderate quality. Economic evaluations indicated that interventions with a workplace component are likely to be more cost effective than those without. CONCLUSION Stakeholder participation and work modification are more effective and cost effective at returning to work adults with musculoskeletal conditions than other workplace-linked interventions, including exercise.
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Vermeulen SJ, Anema JR, Schellart AJM, van Mechelen W, van der Beek AJ. Cost-effectiveness of a participatory return-to-work intervention for temporary agency workers and unemployed workers sick-listed due to musculoskeletal disorders: design of a randomised controlled trial. BMC Musculoskelet Disord 2010; 11:60. [PMID: 20346183 PMCID: PMC2858719 DOI: 10.1186/1471-2474-11-60] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2009] [Accepted: 03/28/2010] [Indexed: 12/03/2022] Open
Abstract
Background Within the working population there is a vulnerable group: workers without an employment contract and workers with a flexible labour market arrangement, e.g. temporary agency workers. In most cases, when sick-listed, these workers have no workplace/employer to return to. Also, for these workers access to occupational health care is limited or even absent in many countries. For this vulnerable working population there is a need for tailor-made occupational health care, including the presence of an actual return-to-work perspective. Therefore, a participatory return-to-work program has been developed based on a successful return-to-work intervention for workers, sick-listed due to low back pain. The objective of this paper is to describe the design of a randomised controlled trial to study the (cost-)effectiveness of this newly developed participatory return-to-work program adapted for temporary agency workers and unemployed workers, sick-listed due to musculoskeletal disorders, compared to usual care. Methods/Design The design of this study is a randomised controlled trial with one year of follow-up. The study population consists of temporary agency workers and unemployed workers sick-listed between 2 and 8 weeks due to musculoskeletal disorders. The new return-to-work program is a stepwise program aimed at making a consensus-based return-to-work implementation plan with the possibility of a (therapeutic) workplace to return-to-work. Outcomes are measured at baseline, 3, 6, 9 and 12 months. The primary outcome measure is duration of the sickness benefit period after the first day of reporting sick. Secondary outcome measures are: time until first return-to-work, total number of days of sickness benefit during follow-up; functional status; intensity of musculoskeletal pain; pain coping; and attitude, social influence and self-efficacy determinants. Cost-benefit is evaluated from an insurer's perspective. A process evaluation is part of this study. Discussion For sick-listed workers without an employment contract there can be gained a lot by improving occupational health care, including return-to-work guidance, and by minimising the 'labour market handicap' by creating a return-to-work perspective. In addition, reduction of sickness absence and work disability, i.e. a reduction of disability claims, may result in substantial benefits for the Dutch Social Security System. Trial registration Trial registration number: NTR1047.
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Affiliation(s)
- Sylvia J Vermeulen
- Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands
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Abstract
In the first in a series of six articles on packages of care for mental disorders in low- and middle-income countries, Neerja Chowdary and colleagues discuss the treatment of depression.
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Affiliation(s)
- Vikram Patel
- London School of Hygiene & Tropical Medicine, London, United Kingdom
- Sangath, Alto-Porvorim, Goa, India
| | - Gregory Simon
- Group Health Center for Health Studies, Seattle, Washington, United States of America
| | | | - Sylvia Kaaya
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Ricardo Araya
- Academic Unit of Psychiatry, University of Bristol, United Kingdom
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Braam C, van Oostrom SH, Terluin B, Vasse R, de Vet HCW, Anema JR. Validation study of a distress screener. JOURNAL OF OCCUPATIONAL REHABILITATION 2009; 19:231-237. [PMID: 19396529 PMCID: PMC2712065 DOI: 10.1007/s10926-009-9178-z] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/07/2009] [Accepted: 03/30/2009] [Indexed: 05/27/2023]
Abstract
OBJECTIVES A 3-item screening instrument called the Distress Screener was developed for early identification of distress among employees on sick leave. The Distress Screener consists of three items obtained from the distress subscale of the four-dimensional symptom questionnaire (4DSQ). This study assessed an optimal cut-off point and validated the Distress Screener by relating it to the 4DSQ and to medical diagnoses. METHODS 171 sick-listed employees filled in the Distress Screener and the 4DSQ (containing four subscales: distress, depression, anxiety and somatisation) and medical diagnoses were obtained from occupational physicians (OPs). The optimal cut-off point was assessed by computing sensitivity and specificity values. Validity was assessed by relating the Distress Screener score to the scores on 4DSQ subscales. In addition scores were compared to mental health medical diagnoses and the degree of similarity between two repeated measurements was obtained. RESULTS Using the 4DSQ distress score >10 as reference standard, the optimal cut-off point of the Distress Screener was > or =4. Regarding validity, a high correlation (0.82) existed between the Distress Screener and the 4DSQ distress subscale and it was significantly different from the correlations with the other 4DSQ subscales. Also a high correlation existed for the test-retest reliability (0.83). Furthermore, a high score on the Distress Screener seemed to be related to the medical diagnosis 'Stress-related complaints'. All low scores seemed to be related to the medical diagnosis 'Other complaints'. Sensitivity (0.85) and specificity (0.78) values, and positive and negative predictive values of the screener were comparable to those of the 4DSQ distress subscale. CONCLUSIONS The Distress Screener is a valid instrument for use by the OP during consulting time as a quick scan for early identification of distress in employees on sick leave. The cut-off point > or =4 is useful for early identification of distress in employees on sick leave.
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Affiliation(s)
- C. Braam
- Department of Public and Occupational Health and The EMGO Institute for Health and Care Research, VU University Medical Centre, van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands
| | - S. H. van Oostrom
- Department of Public and Occupational Health and The EMGO Institute for Health and Care Research, VU University Medical Centre, van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands
- Body@Work, Research Centre Physical Activity, Work and Health, TNO-VU, Amsterdam, The Netherlands
| | - B. Terluin
- Department of General Practice and The EMGO Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands
| | - R. Vasse
- Department of Social Medicine, Maastricht University, Maastricht, The Netherlands
| | - H. C. W. de Vet
- Department of Epidemiology and Biostatistics and The EMGO Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands
| | - J. R. Anema
- Department of Public and Occupational Health and The EMGO Institute for Health and Care Research, VU University Medical Centre, van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands
- Body@Work, Research Centre Physical Activity, Work and Health, TNO-VU, Amsterdam, The Netherlands
- Research Centre for Insurance medicine, AMC-UWV-VU University Medical Centre, Amsterdam, The Netherlands
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van Oostrom SH, van Mechelen W, Terluin B, de Vet HCW, Anema JR. A participatory workplace intervention for employees with distress and lost time: a feasibility evaluation within a randomized controlled trial. JOURNAL OF OCCUPATIONAL REHABILITATION 2009; 19:212-22. [PMID: 19308708 DOI: 10.1007/s10926-009-9170-7] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2008] [Accepted: 02/26/2009] [Indexed: 05/20/2023]
Abstract
INTRODUCTION Little is known about feasibility and acceptability of return to work (RTW) interventions for mental health problems. RTW for mental health problems is more complicated than for musculoskeletal problems due to stigmatization at the workplace. A participatory workplace intervention was developed in which an employee and supervisor identify and prioritize obstacles and solutions for RTW guided by a RTW coordinator. This paper is a feasibility study of this innovative intervention for employees with distress. The aims of this study were to describe the reach and extent of implementation of the workplace intervention, the satisfaction and expectations of all stakeholders, and the intention to use the workplace intervention in the future. METHODS Eligible for this study were employees who had been on sick leave from regular work for 2-8 weeks with distress. Data were collected from the employees, their supervisors, RTW coordinators, and occupational physicians by means of standardized matrices and questionnaires at baseline and 3 months follow-up. Reach, implementation, satisfaction, expectations, and maintenance regarding the workplace intervention were described. RESULTS Of the 56 employees with distress eligible to receive the workplace intervention, 40 employees, their supervisors and RTW coordinators actually participated in the intervention. They identified 151 obstacles for RTW mostly related to job design, communication, mental workload and person-related stress factors. The 281 consensus-based solutions identified were mostly related to job design, communication and training. Of those solutions, 72% was realized at the evaluation with the employee and supervisor. Overall, employees, supervisors and occupational health professionals were satisfied with the workplace intervention and occupational health professionals rated it with a 7.1. Time-investment was the only barrier for implementation reported by the occupational health professionals. CONCLUSIONS The results of this study indicate a high feasibility for a broad implementation of a participatory workplace intervention for employees with distress and lost time, and their supervisors.
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Affiliation(s)
- Sandra H van Oostrom
- Department of Public and Occupational Health and the EMGO Institute for Health and Care Research, VU University Medical Center, van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands
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van Oostrom SH, Driessen MT, de Vet HCW, Franche RL, Schonstein E, Loisel P, van Mechelen W, Anema JR. Workplace interventions for preventing work disability. Cochrane Database Syst Rev 2009:CD006955. [PMID: 19370664 DOI: 10.1002/14651858.cd006955.pub2] [Citation(s) in RCA: 134] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Work disability has serious consequences for all stakeholders and society. Workplace interventions are considered appropriate to facilitate return to work by reducing barriers to return to work, involving the collaboration of key stakeholders. OBJECTIVES To determine the effectiveness of workplace interventions compared to usual care or clinical interventions on work-related outcomes and health outcomes; and to evaluate whether the effects differ when applied to musculoskeletal disorders, mental health problems, or other health conditions. SEARCH STRATEGY We searched the Cochrane Occupational Health Field Trials Register, CENTRAL, MEDLINE and EMBASE (EMBASE.com), and PsycINFO databases (to November 2007). SELECTION CRITERIA We included randomized controlled trials of workplace interventions aimed at return to work for workers where absence from work because of sickness was reported as a continuous outcome. DATA COLLECTION AND ANALYSIS Two authors independently extracted data and assessed risk of bias of the studies. Meta-analysis and qualitative analysis (using GRADE levels of evidence) were performed. MAIN RESULTS We included six randomized controlled trials (749 workers): three on low back pain, one on upper-extremity disorders, one on musculoskeletal disorders, and one on adjustment disorders. Five studies were rated as having low risk of bias for the sickness absence outcome. The results of this review show that there is moderate-quality evidence to support the use of workplace interventions to reduce sickness absence among workers with musculoskeletal disorders when compared to usual care. However, workplace interventions were not effective to improve health outcomes among workers with musculoskeletal disorders. The lack of studies made it impossible to investigate the effectiveness of workplace interventions among workers with mental health problems and other health conditions. A comparison of a workplace intervention with a clinical intervention, in one study only, yielded similar results for sickness absence and symptoms for workers with mental health problems. AUTHORS' CONCLUSIONS As a result of the few available studies, no convincing conclusions can be formulated about the effectiveness of workplace interventions on work-related outcomes and health outcomes regardless of the type of work disability. The pooled data for the musculoskeletal disorders subgroup indicated that workplace interventions are effective in the reduction of sickness absence, but they are not effective in improving health outcomes. The evidence from the subgroup analysis on musculoskeletal disorders was rated as moderate-quality evidence. Unfortunately, conclusions cannot be drawn on the effectiveness of these interventions for mental health problems and other health conditions due to a lack of studies.
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Affiliation(s)
- Sandra H van Oostrom
- Department of Public and Occupational Health and the EMGO Institute for Health and Care Research, VU University Medical Center, Van der Boechorststraat 7, Amsterdam, Netherlands, 1081 BT
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Vlasveld MC, Anema JR, Beekman ATF, van Mechelen W, Hoedeman R, van Marwijk HWJ, Rutten FF, Roijen LHV, Feltz-Cornelis CMVD. Multidisciplinary collaborative care for depressive disorder in the occupational health setting: design of a randomised controlled trial and cost-effectiveness study. BMC Health Serv Res 2008; 8:99. [PMID: 18457589 PMCID: PMC2390533 DOI: 10.1186/1472-6963-8-99] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2008] [Accepted: 05/05/2008] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Major depressive disorder (MDD) has major consequences for both patients and society, particularly in terms of needlessly long sick leave and reduced functioning. Although evidence-based treatments for MDD are available, they show disappointing results when implemented in daily practice. A focus on work is also lacking in the treatment of depressive disorder as well as communication of general practitioners (GPs) and other health care professionals with occupational physicians (OPs). The OP may play a more important role in the recovery of patients with MDD. Purpose of the present study is to tackle these obstacles by applying a collaborative care model, which has proven to be effective in the USA, with a focus on return to work (RTW). From a societal perspective, the (cost)effectiveness of this collaborative care treatment, as a way of transmural care, will be evaluated in depressed patients on sick leave in the occupational health setting. METHODS/DESIGN A randomised controlled trial in which the treatment of MDD in the occupational health setting will be evaluated in the Netherlands. A transmural collaborative care model, including Problem Solving Treatment (PST), a workplace intervention, antidepressant medication and manual guided self-help will be compared with care as usual (CAU). 126 Patients with MDD on sick leave between 4 and 12 weeks will be included in the study. Care in the intervention group will be provided by a multidisciplinary team of a trained OP-care manager and a consultant psychiatrist. The treatment is separated from the sickness certification. Data will be collected by means of questionnaires at baseline and at 3, 6, 9 and 12 months after baseline. Primary outcome measure is reduction of depressive symptoms, secondary outcome measure is time to RTW, tertiary outcome measure is the cost effectiveness. DISCUSSION The high burden of MDD and the high level of sickness absence among people with MDD contribute to the relevance of this study. The intervention is an innovative approach, with trained OPs in a new role as care managers in the treatment of MDD. If this intervention proves to be cost-effective, implementation will be very relevant for individual patients as well as for society. TRIAL REGISTRATION ISRCTN78462860.
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Affiliation(s)
- Moniek C Vlasveld
- Netherlands Institute of Mental Health and Addiction (Trimbos-institute), Utrecht, The Netherlands
- EMGO Institute, VU University Medical Centre, Amsterdam, The Netherlands
- Department of Public and Occupational Health, VU University Medical Centre, The Netherlands
| | - Johannes R Anema
- EMGO Institute, VU University Medical Centre, Amsterdam, The Netherlands
- Department of Public and Occupational Health, VU University Medical Centre, The Netherlands
- Body@Work, Research Centre Physical Activity, Work and Health, TNO-VU, Amsterdam, The Netherlands
- Research Centre for Insurance Medicine AMC-UWV-VU University Medical Centre, Amsterdam, The Netherlands
| | - Aartjan TF Beekman
- EMGO Institute, VU University Medical Centre, Amsterdam, The Netherlands
- Department of Psychiatry, VU University Medical Centre, Amsterdam, The Netherlands
| | - Willem van Mechelen
- EMGO Institute, VU University Medical Centre, Amsterdam, The Netherlands
- Department of Public and Occupational Health, VU University Medical Centre, The Netherlands
- Body@Work, Research Centre Physical Activity, Work and Health, TNO-VU, Amsterdam, The Netherlands
- Research Centre for Insurance Medicine AMC-UWV-VU University Medical Centre, Amsterdam, The Netherlands
| | - Rob Hoedeman
- ArboNed Utrecht, The Netherlands
- University Medical Centre Groningen, University of Groningen, The Netherlands
| | - Harm WJ van Marwijk
- EMGO Institute, VU University Medical Centre, Amsterdam, The Netherlands
- Department of General Practice, VU University Medical Centre, Amsterdam, The Netherlands
| | - Frans F Rutten
- institute for Medical Technology Assessment, Erasmus University, Rotterdam, The Netherlands
| | | | - Christina M van der Feltz-Cornelis
- Netherlands Institute of Mental Health and Addiction (Trimbos-institute), Utrecht, The Netherlands
- EMGO Institute, VU University Medical Centre, Amsterdam, The Netherlands
- Department of Psychiatry, VU University Medical Centre, Amsterdam, The Netherlands
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