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Svärd V, Jannas S. Organisational prerequisites for coordinating the return-to-work process for people with multimorbidity and psychosocial difficulties. Disabil Rehabil 2023; 45:2915-2924. [PMID: 36006799 DOI: 10.1080/09638288.2022.2114019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 06/24/2022] [Accepted: 08/11/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE The return-to-work (RTW) process for people with multimorbidity and psychosocial difficulties can be complicated. This study explores the organisational prerequisites for coordinating these patients' RTW processes from the perspective of coordinators in different clinical areas in Sweden. MATERIAL AND METHODS Six focus group interviews were conducted with 24 coordinators working in primary healthcare (PHC), psychiatric and orthopaedic clinics. The data were analysed thematically, inspired by organisation theory. RESULTS Coordinators described varying approaches to people with multimorbidity and psychosocial difficulties, with more hesitancy among PHC coordinators, who were perceived by other coordinators as hindering patient flows between clinical areas. Most organisational barriers to RTW were identified in the healthcare sector. These were long waiting times, physicians drawing up inadequate RTW plans, coordinators being involved late in the sickness absence process, and lack of rehabilitation programmes for people with multimorbidity. The barriers in relation to organisations such as Social Insurance Agency and Employment Services were caused by regulations and differing perspectives, priorities, and procedures. CONCLUSION Our findings indicate what is needed to improve the RTW process for patients with complex circumstances: better working conditions, steering, and guidelines; shorter waiting times; and a willingness among coordinators from different clinical areas to collaborate around patients. Implications for rehabilitationRTW coordinators need sufficient physical and psychosocial working conditions as well as clear leadership.In order to avoid inequalities in access to RTW support, better systems are needed to identify patients who would benefit from rehabilitation and RTW coordination.There is a need for multilevel collaboration between clinical areas so that patients with multiple healthcare contacts and prolonged sickness absence can obtain support during the RTW process.
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Affiliation(s)
- Veronica Svärd
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
- Department of Social Work, Södertörn University, Huddinge, Sweden
- Medical Unit Social Work in Health, Karolinska University Hospital, Stockholm, Sweden
| | - Sandra Jannas
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institute, Stockholm, Sweden
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Holmlund L, Sandman L, Hellman T, Kwak L, Björk Brämberg E. Ethical aspects of the coordination of return-to-work among employees on sick leave due to common mental disorders: a qualitative study. Disabil Rehabil 2022:1-10. [PMID: 35676198 DOI: 10.1080/09638288.2022.2084779] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE Identify ethical issues that arise in the coordination of return-to-work (RTW) among employees on sick leave due to common mental disorders (CMDs). MATERIAL AND METHODS 41 semi-structured individual interviews and one focus group interview with stakeholders (n = 46) involved in RTW: employees on sick leave due to CMDs, coordinators and physicians at primary health care centres, managers, representatives of the Swedish social insurance agency and occupational health services. A six-step thematic analysis focused on the ethical values and norms related to autonomy, privacy, resources and organization, and professional values. RESULTS Five themes were identified: (1) autonomous decision-making versus the risk of taking over, (2) employee rights versus restrictions to self-determination, (3) respect for employee privacy versus stakeholders' interests, (4) risk of unequal inclusion due to insufficient organizational structure and resources, (5) risk of unequal support due to unclear professional roles and responsibilities. CONCLUSION The main ethical issues are the risks of unequal access to and unequal support for the coordination of RTW. For the fair and equal provision of coordination, it is necessary to be transparent on how to prioritize the coordination of RTW for different patient groups, provide clarity about the coordinator's professional role, and facilitate ongoing boundary work between stakeholders. IMPLICATIONS FOR REHABILITATIONUnfair and arbitrary criteria for inclusion to the coordination of RTW implicate risks of unequal access for the employee on sick leave due to CMDs.Unclear professional roles and responsibilities among stakeholders in the coordination of RTW implicate risks of unequal support for the employee on sick leave due to CMDs.Coordination of RTW should be transparently prioritized on policy and organisational levels to secure fair and equal inclusion.The coordinator's professional role should be clearly defined to facilitate boundary work between stakeholders and improve the competence around the coordination of RTW.
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Affiliation(s)
- Lisa Holmlund
- Institute of Environmental Medicine, Unit of Intervention and Implementation Research for Worker Health, Karolinska Institutet, Stockholm, Sweden
| | - Lars Sandman
- Department of Health, Medicine and Caring Sciences, National Centre for Priorities in Health, Linköping University, Linköping, Sweden
| | - Therese Hellman
- Institute of Environmental Medicine, Unit of Intervention and Implementation Research for Worker Health, Karolinska Institutet, Stockholm, Sweden.,Department of Medical Sciences, Occupational and Environmental Medicine, Uppsala University, Uppsala, Sweden
| | - Lydia Kwak
- Institute of Environmental Medicine, Unit of Intervention and Implementation Research for Worker Health, Karolinska Institutet, Stockholm, Sweden
| | - Elisabeth Björk Brämberg
- Institute of Environmental Medicine, Unit of Intervention and Implementation Research for Worker Health, Karolinska Institutet, Stockholm, Sweden
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Kausto J, Oksanen T, Koskinen A, Pentti J, Mattila-Holappa P, Kaila-Kangas L, Nevala N, Kivimäki M, Vahtera J, Ervasti J. 'Return to Work' Coordinator Model and Work Participation of Employees: A Natural Intervention Study in Finland. JOURNAL OF OCCUPATIONAL REHABILITATION 2021; 31:831-839. [PMID: 33829365 PMCID: PMC8558281 DOI: 10.1007/s10926-021-09970-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 03/08/2021] [Indexed: 06/12/2023]
Abstract
Purpose Employers increasingly use 'return to work' (RTW) coordinators to support work ability and extend working careers, particularly among employees with reduced work ability. We examined whether applying this model was associated with changes in employee sickness absence and disability retirements. Methods We used data from the Finnish Public Sector study from 2009 until 2015. Employees where the model was introduced in 2012 constituted the cases (n = 4120, one municipality) and employees where the model was not in use during the follow-up, represented the controls (n = 5600, two municipalities). We analysed risk of disability retirement in 2013-2015 and risk of sickness absence after (2013-2015) vs. before (2009-2011) intervention by case-control status. Results The incidence of disability retirement after the intervention was lower in cases compared to controls both in the total population (hazard ratio HR = 0.49, 95% CI 0.30-0.79) and in the subgroup of participants with reduced work ability (HR = 0.34, 95% CI 0.12-0.99). The risk of sickness absence increased from pre-intervention to post-intervention period both among cases and controls although the relative increase was greater among cases (RRpost- vs. pre-intervention = 1.26, 95% CI 1.14-1.40) than controls (RRpost- vs. pre-intervention = 1.03, 95% CI 0.97-1.08). In the group of employees with reduced work ability, no difference in sickness absence trends between cases and controls was observed. Conclusions These findings suggest that RTW-coordinator model may increase employee sickness absence, but decrease the risk of disability retirement, i.e., permanent exclusion from the labour market.
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Affiliation(s)
- Johanna Kausto
- Finnish Institute of Occupational Health, Topeliuksenkatu 40, 00250, Helsinki, Finland.
| | - Tuula Oksanen
- School of Medicine, Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Aki Koskinen
- Finnish Institute of Occupational Health, Topeliuksenkatu 40, 00250, Helsinki, Finland
| | - Jaana Pentti
- Department of Public Health, University of Turku, and Centre for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland
| | | | - Leena Kaila-Kangas
- Finnish Institute of Occupational Health, Topeliuksenkatu 40, 00250, Helsinki, Finland
| | - Nina Nevala
- Finnish Institute of Occupational Health, Topeliuksenkatu 40, 00250, Helsinki, Finland
| | - Mika Kivimäki
- Finnish Institute of Occupational Health, Topeliuksenkatu 40, 00250, Helsinki, Finland
- Clinicum, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Jussi Vahtera
- Department of Public Health, University of Turku, and Centre for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland
| | - Jenni Ervasti
- Finnish Institute of Occupational Health, Topeliuksenkatu 40, 00250, Helsinki, Finland
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Corbière M, Willems L, Guay S, Panaccio A, Lecomte T, Mazaniello-Chézol M. Développement et tests utilisateurs de l’application Web PRATICAdr : Plateforme de Retour Au Travail axée sur les Interactions et la Communication entre les Acteurs, intégrant un programme Durable favorisant le Rétablissement. SANTE MENTALE AU QUEBEC 2021. [DOI: 10.7202/1081515ar] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction Les troubles mentaux courants (TMC) représentent de 30 % à 50 % des absences maladies toutes confondues. Le succès du retour au travail (RAT) n’est pas dû au seul fait de l’individu, mais plutôt au résultat de l’interaction entre les acteurs impliqués dans le processus. De nombreuses applications en santé mentale ont été développées pour améliorer la prise en charge des patients et optimiser la communication entre les professionnels, sans toutefois être validées. De plus, aucune solution technologique n’a été développée à ce jour pour faciliter à la fois la concertation des acteurs du RAT (p. ex. gestionnaire, professionnels de la santé) et l’accompagnement systématique de l’employé dans son RAT.
Objectif Pour combler ces lacunes, l’objectif de cet article est double : 1) décrire le développement de l’application PRATICAdr, Plateforme de Retour Au Travail axée sur les Interactions et la Communication entre les Acteurs : un programme Durable favorisant le Rétablissement ; 2) documenter les tests utilisateurs de l’application PRATICAdr.
Méthode Le développement de PRATICAdr se décline en 3 phases : 1) l’analyse des besoins ; 2) la conceptualisation des mécanismes internes à l’application et des techniques de programmation ; 3) le test de l’application en situation réelle. L’application est évaluée par des questionnaires et entrevues pour mesurer la satisfaction des utilisateurs.
Résultats PRATICAdr permet de suivre en temps réel le parcours des acteurs impliqués dans l’accompagnement personnalisé de l’employé dans son RAT. La schématisation du processus de RAT et l’inclusion d’outils d’évaluation validés systématisent la concertation et la prise de décision partagée des acteurs, ainsi que le suivi et les actions posées en vue d’entreprendre un RAT favorisant le rétablissement. L’interface de PRATICAdr a été développée pour simplifier l’expérience utilisateur de l’employé en absence maladie et des acteurs du RAT. Les résultats de satisfaction des premiers utilisateurs de PRATICAdr, 16 employés d’une grande organisation dans le domaine de la santé en processus de RAT à la suite d’un TMC, apprécient (moyenne > 9/10) non seulement la Plateforme Web, mais également la participation des acteurs du RAT et les questionnaires inclus dans PRATICAdr. Des éléments d’amélioration sont aussi proposés.
Conclusion PRATICAdr est implantée dans 2 grandes organisations (> 15 000 employés) afin d’évaluer son efficacité auprès d’employés en absence maladie en raison d’un TMC et en processus de RAT. Dans le cadre de cet article, l’objectif était de présenter non seulement le développement de PRATICAdr, mais aussi de mesurer la satisfaction des utilisateurs. Les premiers résultats indiquent une appréciation élevée chez les employés en absence maladie, utilisateurs de PRATICAdr. En termes de pistes futures, l’intégration de l’apprentissage automatique sera abordée dans l’objectif de personnaliser le programme de RAT selon les prédictions de durée d’absence maladie et de RAT durable.
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Affiliation(s)
- Marc Corbière
- Professeur titulaire du Département d’éducation et pédagogie – Counseling de carrière, Université du Québec à Montréal – Chercheur au Centre de recherche de l’Institut universitaire en santé mentale de Montréal (CR-IUSMM) – Titulaire de la Chaire de recherche en santé mentale et travail, Fondation de l’IUSMM
| | | | - Stéphane Guay
- Professeur titulaire à l’École de criminologie et au Département de psychiatrie et d’addictologie – Université de Montréal – Directeur du Centre de recherche de l’Institut universitaire en santé mentale de Montréal (CR-IUSMM)
| | - Alexandra Panaccio
- Professeure agrégée au Département de Management et Vice-Doyenne Agrément et relations avec le corps professoral, École de gestion John-Molson, Université Concordia
| | - Tania Lecomte
- Professeur titulaire du Département de pyschologie – Université de Montréal – Chercheuse au Centre de recherche de l’Institut universitaire en santé mentale de Montréal (CR-IUSMM)
| | - Maud Mazaniello-Chézol
- Candidate au Doctorat au Département de Médecine de Famille – Université McGill ; Professionnelle de recherche à la Chaire de recherche en santé mentale et travail, Fondation de l’IUSMM
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Corbière M, Mazaniello-Chézol M, Lecomte T, Guay S, Panaccio A. Developing a collaborative and sustainable return to work program for employees with common mental disorders: a participatory research with public and private organizations. Disabil Rehabil 2021; 44:5199-5211. [PMID: 34086528 DOI: 10.1080/09638288.2021.1931481] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
PURPOSE To disentangle the key steps of the return to work (RTW) process and offer clearer recovery-focused and sustainable RTW for people on sick leave due to common mental disorders (CMDs). METHODS This participatory research involves two large Canadian organizations. In each organization, we established an advisory committee composed of RTW stakeholders. We collected information in semi-structured interviews from RTW stakeholders (n = 26) with each member of the advisory committee in each organization, as well as with employees who had recently experienced CMDs. The interviews examined the RTW process for employees on sick leave due to CMDs as well as RTW stakeholders' perceptions of barriers and facilitators. A thematic approach was used to synthesize the data, following which, results were discussed with the two advisory committees to identify solutions considering key RTW steps. RESULTS Ten common key steps within the three RTW phases emerged from the semi-structured interviews with RTW stakeholders and discussions with the two advisory committees: 1) At the beginning of sickness absence and involvement of disability management team (phase 1), we found 3 steps (e.g., taking charge of the file), 2) during the involvement in treatment rehabilitation with health professionals and preparation of the RTW (phase 2), 4 steps (e.g., RTW preparation), and finally 3) the RTW and follow-up (phase 3) consists of 3 steps (e.g., gradual RTW). CONCLUSION A participatory study involving RTW stakeholders helped identify 10 common key steps within three phases to support RTW sustainability of people with CMDs. Future research will need to address how RTW coordinators intervene in the RTW process of employees with CMDs within these steps.IMPLICATIONS FOR REHABILITATIONRehabilitation professionals will benefit from a detailed description of the RTW process (10 steps spread out over 3 RTW phases), allowing them to standardize it while adopting a personalized approach for the employee on sick leave.Rehabilitation professionals are informed of stakeholders' role and actions required in the RTW process; as such the communication between RTW stakeholders should be improved.RTW coordinators will be able to tailor more precisely their intervention, considering the detailed RTW process and RTW stakeholders' role and actions, and thus will become the pivot occupational health specialists for the RTW process.
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Affiliation(s)
- Marc Corbière
- Research Chair Mental Health and Work, Institut universitaire en santé mentale de Montréal, Montreal, QC, Canada.,Research Centre, Institut universitaire en santé mentale de Montréal, Montreal, QC, Canada.,Department of Education and Pedagogy, Université du Québec à Montréal, Montreal, QC, Canada
| | - Maud Mazaniello-Chézol
- Research Chair Mental Health and Work, Institut universitaire en santé mentale de Montréal, Montreal, QC, Canada.,Research Centre, Institut universitaire en santé mentale de Montréal, Montreal, QC, Canada.,Department of Family Medicine, McGill University, Montreal, QC, Canada
| | - Tania Lecomte
- Research Centre, Institut universitaire en santé mentale de Montréal, Montreal, QC, Canada.,Department of Psychology, Université de Montréal, Montreal, QC, Canada
| | - Stéphane Guay
- Research Centre, Institut universitaire en santé mentale de Montréal, Montreal, QC, Canada.,School of Criminology, Université de Montréal, Montreal, QC, Canada
| | - Alexandra Panaccio
- John Molson School of Business, Concordia University, Montreal, QC, Canada
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Svärd V, Friberg E, Azad A. How People with Multimorbidity and Psychosocial Difficulties Experience Support by Rehabilitation Coordinators During Sickness Absence. J Multidiscip Healthc 2021; 14:1245-1257. [PMID: 34103925 PMCID: PMC8178701 DOI: 10.2147/jmdh.s308840] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 05/05/2021] [Indexed: 12/26/2022] Open
Abstract
Purpose People with multimorbidity face a range of barriers in healthcare, and there is little knowledge about their challenges with regard to return-to-work (RTW). Rehabilitation coordinators, a new function in Swedish healthcare, support people in the RTW process. The present study had two aims: to explore what problems and barriers people with multimorbidity experience during their rehabilitation and RTW process and to explore in which domains the coordinators’ support is perceived to be of importance. Methods Interviews were conducted with 12 persons with multimorbidity who had contact with a rehabilitation coordinator during their sickness absence. Thematic analysis was guided by the case-management ecological model; this analysis was revised and adapted to the Swedish context. Results The participants experienced problems in all domains of the model, namely: “the healthcare system”, “the labor market and the workplace system”, “the sickness insurance system”, and “the personal system”. Rehabilitation programs that did not accommodate combinations of diseases, social complexities and needs were felt to lead to worse symptoms, thus hindering rather than promoting RTW. An overall finding regarding support by coordinators is that interventions, regardless of domain, were felt to be valuable for people with multimorbidity. The coordinator was perceived to give most support by providing advice about and coordination with healthcare and employers. Sometimes the coordinator gave advice and coordination regarding the Social Insurance Agency, very occasionally the Public Employment Services. The coordinator gave least advice and coordination about social difficulties that hindered rehabilitation and RTW processes. Conclusion People with multimorbidity perceive rehabilitation coordinator interventions as important in all domains investigated. Lack of advice and coordination, or rehabilitation programs that were not modified to the complexities of individual’s circumstances, were associated with prolonged sickness absence, worse health, or social risk factors not being recognized.
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Affiliation(s)
- Veronica Svärd
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, SE-171 77, Sweden.,Department of Social Work in Health, Karolinska University Hospital, Stockholm, SE-171 76, Sweden.,Department of Social Work, Södertörn University, Huddinge, SE-141 89, Sweden
| | - Emilie Friberg
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, SE-171 77, Sweden
| | - Azadé Azad
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, SE-171 77, Sweden.,Department of Psychology, Stockholm University, Stockholm, SE-114 19, Sweden
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Holmlund L, Hellman T, Engblom M, Kwak L, Sandman L, Törnkvist L, Björk Brämberg E. Coordination of return-to-work for employees on sick leave due to common mental disorders: facilitators and barriers. Disabil Rehabil 2020; 44:3113-3121. [PMID: 33280451 DOI: 10.1080/09638288.2020.1855263] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
PURPOSE To identify facilitators of and barriers to the coordination of return-to-work between the primary care services, the employee, and the employers from the perspective of coordinators and employees on sick leave due to common mental disorders (CMDs). MATERIAL AND METHODS Descriptive qualitative study. Semi-structured interviews were conducted with eighteen coordinators and nine employees on sick leave due to CMDs. The Consolidated Framework for Implementation Research (CFIR) was used as a starting point for the interview guides and in the thematic analysis of data. RESULTS The results show facilitators and barriers related to the CFIR domains "intervention characteristics," "outer setting," "inner setting," and "characteristics of individuals." Positive attitudes, an open dialogue in a three-party meeting, and a common ground for the sick leave process at the primary care centre facilitated coordination, while an unclear packaging, conflicts at the employee's workplace, and a lack of team-based work were examples of barriers. CONCLUSION The results indicate a need for the detailed packaging of coordination; formalization of coordinators' qualifications and levels of training; and acknowledgement of the role of organizational factors in the implementation of coordination. This is important to further develop and evaluate the efficacy of coordination.IMPLICATIONS FOR REHABILITATIONPositive attitudes to coordination, an open dialogue in a three-party meeting, leadership engagement, routines for the return to work (RTW) process at the primary care centre, and collegial alliances were identified as facilitators.An unclear packaging of the intervention, conflicts at the employee's workplace, lack of team-based work, and lack of coordinator training were identified as barriers.A detailed intervention packaging adapted for the specific setting and formalization of coordinators' qualifications and training is necessary for coordination of RTW.Recognizing organizational factors were identified as being important for the implementation of coordination of RTW for persons on sick leave due to CMDs.
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Affiliation(s)
- Lisa Holmlund
- Institute of Environmental Medicine, Unit of Intervention and Implementation Research for Worker Health, Karolinska Institutet, Stockholm, Sweden
| | - Therese Hellman
- Institute of Environmental Medicine, Unit of Intervention and Implementation Research for Worker Health, Karolinska Institutet, Stockholm, Sweden.,Department of Medical Sciences, Occupational and Environmental Medicine, Uppsala University, Uppsala, Sweden
| | - Monika Engblom
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Academic Primary Health Care Centre, Region Stockholm, Sweden
| | - Lydia Kwak
- Institute of Environmental Medicine, Unit of Intervention and Implementation Research for Worker Health, Karolinska Institutet, Stockholm, Sweden
| | - Lars Sandman
- Department of Health, Medicine and Caring Sciences, National Centre for Priorities in Health, Linköping university, Linköping, Sweden
| | - Lena Törnkvist
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Academic Primary Health Care Centre, Region Stockholm, Sweden
| | - Elisabeth Björk Brämberg
- Institute of Environmental Medicine, Unit of Intervention and Implementation Research for Worker Health, Karolinska Institutet, Stockholm, Sweden.,Department of Public Health and Community Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Holmlund L, Guidetti S, Eriksson G, Asaba E. Return-to-work: Exploring professionals' experiences of support for persons with spinal cord injury. Scand J Occup Ther 2020; 28:571-581. [PMID: 32755475 DOI: 10.1080/11038128.2020.1795245] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
PURPOSE To generate knowledge about how professional stakeholders organise and experience the support of the return-to-work (RTW) process for persons with spinal cord injury (SCI). METHODS Constructivist grounded theory approach. Professional stakeholders (n = 34) involved in the RTW process and representing three Swedish Regions were recruited into seven focus groups. Analysis followed initial, focussed, and theoretical coding. FINDINGS The core category - mediating intentions to support work and possibilities of working through social, labour market, and societal context - illustrates complexities of when and how to support a person with SCI in the RTW process, and a risk of delayed, unequal, or absent RTW processes. Analysis outlines: (1) Assessment of ability to work - uncertainty of how and when; (2) Planning RTW - divide between dynamic and rule-based perspectives; (3) Work re-entry - unequal paths towards viable solutions. CONCLUSIONS In RTW after SCI, it is critical to acknowledge how the RTW process is situated in relation to the person and context. A possible direction - grounded in an occupational perspective - through early identification of needs and resources and coordination derived from the SCI rehabilitation setting within healthcare is suggested. This can facilitate a time-sensitive and equal RTW process.
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Affiliation(s)
- Lisa Holmlund
- Department of Neurobiology, Care Science and Society, Division of Occupational Therapy, Karolinska Institutet, Huddinge, Sweden.,Spinalis SCI Unit, Rehab Station Stockholm, Stockholm, Sweden
| | - Susanne Guidetti
- Department of Neurobiology, Care Science and Society, Division of Occupational Therapy, Karolinska Institutet, Huddinge, Sweden
| | - Gunilla Eriksson
- Department of Neurobiology, Care Science and Society, Division of Occupational Therapy, Karolinska Institutet, Huddinge, Sweden.,Department of Neuroscience, Rehabilitation Medicine, Uppsala University, Uppsala, Sweden
| | - Eric Asaba
- Department of Neurobiology, Care Science and Society, Division of Occupational Therapy, Karolinska Institutet, Huddinge, Sweden.,Research, Education, and Development Unit, Stockholms Sjukhem Foundation, Stockholm, Sweden.,Department of Occupational Therapy, Graduate School of Human Health Sciences, Tokyo Metropolitan University, Tokyo, Japan
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