Return to work factors and vocational rehabilitation interventions for long-term, partially disabled workers: a modified Delphi study among vocational rehabilitation professionals

Analysis of drug patterns and drug-drug-interactions: associations with physical performance in middle-aged military personnel undergoing rehabilitation- a retrospective cohort study

BACKGROUND

Comprehensive medication regimens increase the risk of potential drug-drug interactions, adversely affecting health outcomes regardless of age. This risk is particularly pertinent in the context of medical vocational rehabilitation for middle-aged patients, who aim at facilitating rapid reintegration into employment. Identifying and addressing unfavourable drug regimens may substantially contribute to the effectiveness of interdisciplinary therapeutic interventions.

METHODS

The retrospective cohort study was conducted among middle-aged soldiers diagnosed with post-traumatic stress disorder and at least one physical impairment and long-term medication intake. Patient records were analysed to investigate the nature of the medication such as the number of drugs and distribution according to the anatomical therapeutic code classification and drug-drug interactions in relation to bicycle ergometry performance.

RESULTS

A substantial majority (73.2%) of all patients enrolled were prescribed an average of 3.0 (± 2.0) long-term medications per person. All patients received treatments containing ATC N drugs, which exert antidepressant properties. On average, each patient encountered the possible risk of 1.7 (± 1.3) drug interactions. Patients administered at least two ATC N drugs exhibited reduced maximum performance compared to controls. Conversely, patients receiving at least two drugs, wherein only one drug classified as ATC N, did not demonstrate significant performance differences from the control group. Notably, treatments incorporating selective monoamine reuptake inhibitors significantly reduced maximum performance relative to controls. The risk for potential drug-drug interactions, particularly those leading to QT interval prolongation, accounted for 47.5% of interactions involving ATC N drugs. Patients exclusively exposed to potential QT-prolonging interactions exhibited significantly reduced maximum performance compared to controls as well as patients who experienced different potential interactions.

CONCLUSION

Potential drug-drug interactions and disadvantageous drug combinations were prevalent among middle-aged adults with psychiatric disorders and may hinder a positive prognosis for physical fitness. The findings of this study underscore the importance of personalized medication management and continuous monitoring to mitigate negative impacts. Clinicians should diligently review patients' medication records and adjust therapies accordingly to prevent adverse drug reactions. Proactive strategies, such as regular medication reviews and drug-drug interaction screening tools, may be essential for optimizing therapeutic efficacy and maintaining physical performance.

The return-to-work journey: experiences with communication and collaboration among employees and employers during long-term sick leave and return-to-work

PURPOSE

To explore the experiences of long-term sick-listed employees and those of employers with communication and collaboration during sick leave and the return-to-work (RTW) process.

METHODS

Previously long-term sick-listed employees (N = 9) and employers (N = 9) were interviewed about their experiences with communication and collaboration during sick leave and RTW. Thematic analysis, utilizing patient journey mapping was applied to analyze and map out their experiences.

RESULTS

Three central themes emerged from the analysis: 1. Maintaining communication between employees and employers during early sick leave stages fostered trust and enabled discussions about RTW, lowering the barriers for engaging in RTW activities. 2. Organizing joint meetings involving employees, employers, and occupational health professionals (OHPs) helped align expectations and facilitated shared decision-making to navigate RTW. 3. Both employees and employers reported lacking knowledge of RTW legislation and feeling reliant on OHP guidance to navigate the RTW process.

CONCLUSION

Employees and employers underscored the need to be involved, supported, and well informed during the sick leave and RTW process. Both parties mentioned that early and ongoing communication, joint meetings with OHPs, and information on RTW legislation were important prerequisites.

Tailored vocational rehabilitation for people with a work disability pension in The Netherlands; an in-depth data analysis of the content and outcomes of vocational rehabilitation trajectories of the Social Security Institute

PURPOSE

People with a work disability pension receive vocational rehabilitation (VR) services from the Dutch Social Security Institute (SSI) in order to facilitate return-to-work (RTW). The SSI offers tailored VR existing of two trajectories (aimed at getting fit for work or aimed at returning to work). The purpose of this study is to describe the current practice of VR. This includes a description of client characteristics, RTW barriers and the intensity, duration, content and the outcomes of the offered trajectories.

MATERIALS AND METHODS

We analyzed data from 197 clients that were randomly selected from clients who attended a VR trajectory between 1 January t 2017 and 31 December 2018. Data were obtained from the SSI registration databases and client files.

RESULTS

Both VR trajectories at the SSI have a different aim, but in practice the content of the VR interventions often overlaps. Around half of both trajectories reached their goal. Reasons for unsuccessful trajectories were that the client did not find work or barriers were more complex than initially assessed.

CONCLUSIONS

The SSI delivers tailored VR to the specific needs of the client, however substantiations for why a certain VR intervention is offered are limited. Guidelines are needed to support professionals.

Elements of Return-to-Work Interventions for Workers on Long-Term Sick Leave: A Systematic Literature Review

PURPOSE

The aim of this systematic review is to identify vocational rehabilitation (VR) interventions that are effective to enhance return-to-work (RTW) for people on long-term sick leave (> 90 days) and to identify main elements of these interventions.

METHODS

Six electronic databases were searched for peer-reviewed studies published up to February 2022. Each article was screened independently by two different reviewers. Thereafter, one author performed the data-extraction which was checked by another author. The EPHPP quality assessment tool was used to appraise the methodological quality of the studies.

RESULTS

11.837 articles were identified. 21 articles were included in the review, which described 25 interventions. Results showed that ten interventions were more effective than usual care on RTW. Two interventions had mixed results. The effective interventions varied widely in content, but were often more extensive than usual care. Common elements of the effective interventions were: coaching, counseling and motivational interviewing, planning return to work, placing the worker in work or teaching practical skills and advising at the workplace. However, these elements were also common in interventions that were not effective on RTW compared to usual care and can therefore not explain why certain interventions are effective and others are not.

CONCLUSION

The effective interventions included in this study were often quite extensive and aimed at multiple phases of the RTW-process of the worker. In the future, researchers need to describe the population and the content of the investigated interventions more elaborate to be able to better compare VR interventions and determine what elements make interventions effective.