Views and Experiences of Persons with Chronic Diseases about Strategies that Aim to Integrate and Re-Integrate Them into Work: A Systematic Review of Qualitative Studies

Disability, Unemployment, and Inequality: A Cross-Country Comparison of the Situation of Persons With Spinal Cord Injury

Unemployment and inequality are growing concerns that disproportionately affect people with disabilities. We compared unemployment rates and barriers to labor market participation for persons with spinal cord injury (SCI) as an exemplary case of disability with different socioeconomic positions and from a cross-national perspective across 20 countries worldwide. We showed that persons with SCI have much higher unemployment rates than the general population. While this situation is many times worse for those in low-income groups, persons with SCI in high-income groups are often in a position comparable to the general population. The main barriers to entering the labor market are health status, the impossibility of finding suitable jobs, and the lack of information about employment opportunities. This is the first study that quantifies the extent of inequality in the labor market for persons with SCI. Across the 20 countries analyzed, facing disability has a much higher impact on those in low-income groups. This reality is explained by the fact that people in lower-income groups face many more barriers to entering the labor market than those in higher-income groups.

Psychosocial interventions that target adult cancer survivors' reintegration into daily life after active cancer treatment: a scoping review

OBJECTIVE

This review explored psychosocial interventions targeting adult cancer survivors' reintegration following active cancer treatment. This included the types of interventions tested and the tools used to measure reintegration.

INTRODUCTION

Cancer survivors face lingering health issues following the completion of cancer treatment. Many cancer survivors still experience unmet psychosocial care needs despite receiving follow-up care. Further, many survivorship interventions do not specifically address outcomes important to survivors. A number of primary studies have identified reintegration as an outcome important to cancer survivors. Reintegration is a concept that focuses on returning to normal activities, routines, and social roles after cancer treatment; however, it is emerging and abstract.

INCLUSION CRITERIA

Studies involving adult cancer survivors (18 years or older at diagnosis) of any cancer type or stage were included in this review. Studies with psychosocial interventions targeted at reintegrating the person into daily life after cancer treatment were included. Interventions addressing clinical depression or anxiety, and interventions treating solely physical needs that were largely medically focused were excluded.

METHODS

A literature search was conducted in MEDLINE (Ovid), CINAHL (EBSCOhost), and Embase. Gray literature was searched using ProQuest Dissertations and Theses (ProQuest). Reference lists of included studies were searched. Studies were screened at the title/abstract and full-text levels, and 2 independent reviewers extracted data. Manuscripts in languages other than English were excluded due to feasibility (eg, cost, time of translations). Findings were summarized narratively and reported in tabular and diagrammatic format.

RESULTS

The 3-step search strategy yielded 5617 citations. After duplicates were removed, the remaining 4378 citations were screened at the title and abstract level, then the remaining 306 citations were evaluated at the full-text level by 2 independent reviewers. Forty studies were included that evaluated psychosocial interventions among adult cancer survivors trying to reintegrate after active cancer treatment (qualitative n=23, mixed methods n=8, quantitative n=8, systematic review n=1). Included articles spanned 10 different countries/regions. Over half of all included articles (n=25) focused primarily on breast cancer survivors. Many studies (n=17) were conducted in primary care or community-based settings. The most common types of interventions were peer-support groups (n=14), follow-up education and support (n=14), exercise programs (n=6), and multidisciplinary/multicomponent programs (n=6). While the majority of included studies characterized the outcome qualitatively, 9 quantitative tools were also employed.

CONCLUSIONS

This review identified 6 types of interventions to reintegrate survivors back into their daily lives following cancer treatment. An important thread across intervention types was a focus on personalization in the form of problem/goal identification. Given the number of qualitative studies, future research could include a qualitative systematic review and meta-aggregation. Quantitative tools may not be as effective for evaluating reintegration. More primary studies, including mixed methods studies, utilizing consistent measurement tools are required. Furthermore, this work provides a basis for future research to continue examining the complexity of implementing such interventions to successfully achieve reintegration. To do so, primary studies evaluating interventions from an implementation science and complex systems perspective would be useful.

REVIEW REGISTRATION

Open Science Framework https://osf.io/r6bmx.

A Mega-Ethnography of Qualitative Meta-Syntheses on Return to Work in People with Chronic Health Conditions

PURPOSE

The aim of this study was to synthesize the findings of qualitative meta-syntheses (QMS) on return to work (RTW) of people with different chronic illnesses and to develop a generic RTW model that can provide advice on how to improve RTW interventions and strategies.

METHODS

We conducted a systematic literature search in PubMed, Epistemonikos, CENTRAL, and PsycARTICLES to find relevant QMS, published in English or German between 2000 and 2021, and adapted the meta-ethnographic approach of Noblit and Hare to synthesize their findings.

RESULTS

Nineteen QMS (five focusing on musculoskeletal disorders or chronic pain, four on acquired or traumatic brain injuries, four on cancer, two on mental disorders, one on spinal cord injury, and three on mixed samples) met our inclusion criteria for the meta-ethnographic synthesis. Through systematic comparison and reciprocal translation of the single QMS findings, we could identify a set of key cross-cutting themes/concepts, which formed the basis for four RTW principles and a generic RTW model.

CONCLUSIONS

RTW is a multifactorial and highly interactive multistakeholder process, embedded in an individual's life and working history, as well as in a determined social and societal context. It runs parallel and interdependently to the process of coping with the disease and realigning one's own identity, thus emphasizing the significance of RTW for the person. Besides symptoms and consequences of the disease, individual coping strategies, and RTW motivation, the course and success of RTW are strongly affected by the adaptability of the person's working environment and the social support in their private and working life. Thus, RTW is not only a problem of the individual, but also a matter of the social environment, especially the workplace, requiring a holistic, person-centered, and systemic approach, coordinated by a designated body, which considers the interests of all actors involved in the RTW process.

Promoting labour market inclusion of the chronically ill: a scoping review of Scandinavian countries' efforts

OBJECTIVES

This article is a scoping review of efforts in labour market inclusion of the chronically ill in the Scandinavian countries, a research area that has received much political as well as research attention in recent years. The aim of the review was to identify promising strategies and the need for further research.

METHODS

Six electronic databases were searched for literature published between 2015 and 2020. We included peer-reviewed articles that studied the effect of measures, aimed at the workplace or at the individual, that are intended to increase participation. Our search resulted in 2718 articles; our screening procedures resulted in 47 included articles.

RESULTS

Among the included studies, musculoskeletal problems (17 articles) and mental health problems (29 articles) were the most frequent chronic conditions. Multimodal occupational rehabilitation programmes directed towards the individual employee were the most frequent interventions (30 articles). Return to work (24 articles) and sickness absence (12 articles) were the most common outcomes. About half (25 articles) of the included studies reported a positive impact of the intervention on work inclusion of the chronically ill.

CONCLUSIONS

Our review found little evidence of how government programmes directed towards the supply side of the labour market succeed in including the chronically ill. Our review further indicated that multidisciplinary workplace interventions have a substantial effect. We also identified a significant lack of research on the effect of various governmental policies and programmes, including local health, work and welfare services, and limited coordination and cooperation between health and work services professions.

How do Employees with Chronic Musculoskeletal Disorders Experience the Management of Their Condition in the Workplace? A Metasynthesis

This metasynthesis contributes to an understanding of the experiences, perceptions, and attitudes of employees on managing chronic musculoskeletal disorders (CMSDs) at work. Many studies in this field are concerned with prevention or return-to-work (RTW) programmes. However, the purpose of this review was to synthesise evidence that only focuses on the employees' management of their CMSDs at work. The SPIDER framework was used to structure the question "How do employees with CMSDs experience the management of their condition in the workplace"? The literature search focused on articles published between 2011 and 2021, and the search was conducted using the following databases: MEDLINE, SCOPUS, CINAHL, AMED, PsycINFO. The review identified nine articles that explored employees' experiences of managing CMSDs at work. Thematic synthesis was used to create analytic themes which provided a more in-depth discussion of these experiences. The identified themes were: 'employees actively seek ways to manage their conditions', 'influence of work environment on employees with CMSDs' and 'optimising the relationship between employees and managers. This metasynthesis suggests that the ability to negotiate workplace support and manage CMSDs at work is influenced by the cultural and social environment of the organisation. Effective communication, care and trust between the employee is needed. The review also illustrated the need for healthcare professionals to provide support to employees at work.

The use of GRADE-CERQual in qualitative evidence synthesis: an evaluation of fidelity and reporting

BACKGROUND

GRADE-CERQual (Confidence in the Evidence from Reviews of Qualitative Research) is a methodological approach to systematically and transparently assess how much confidence decision makers can place in individual review findings from qualitative evidence syntheses. The number of reviews applying GRADE-CERQual is rapidly expanding in guideline and other decision-making contexts. The objectives of this evaluation were, firstly, to describe the uptake of GRADE-CERQual in qualitative evidence synthesis by review authors and, secondly, to assess both reporting of and fidelity to the approach.

METHODS

The evaluation had two parts. Part 1 was a citation analysis and descriptive overview of the literature citing GRADE-CERQual. Authors worked together to code and chart the citations, first by title and abstract and second by full text. Part 2 was an assessment and analysis of fidelity to, and reporting of, the GRADE-CERQual approach in included reviews. We developed fidelity and reporting questions and answers based on the most recent guidance for GRADE-CERQual and then used NVivo12 to document assessments in a spreadsheet and code full-text PDF articles for any concerns that had been identified. Our assessments were exported to Excel and we applied count formulae to explore patterns in the data. We employed a qualitative content analysis approach in NVivo12 to sub-coding all the data illustrating concerns for each reporting and fidelity criteria.

RESULTS

233 studies have applied the GRADE-CERQual approach, with most (n = 225, 96.5%) in the field of health research. Many studies (n = 97/233, 41.6%) were excluded from full fidelity and reporting assessment because they demonstrated a serious misapplication of GRADE-CERQual, for example interpreting it as a quality appraisal tool for primary studies or reviews. For the remaining studies that applied GRADE-CERQual to assess confidence in review findings, the main areas of reporting concern involved terminology, labelling and completeness. Fidelity concerns were identified in more than half of all studies assessed.

CONCLUSIONS

GRADE-CERQual is being used widely within qualitative evidence syntheses and there are common reporting and fidelity issues. Most of these are avoidable and we highlight these as gaps in knowledge and guidance for applying the GRADE-CERQual approach.

Experiences of vocational rehabilitation and support services for people living with a long term condition: qualitative systematic review

PURPOSE

Identify and synthesise qualitative research evidence on activities and processes within formal vocational service provision that contribute to experiences of effective support to gain employment for people living with long term conditions.

METHODS

A pre-published protocol was developed using PRISMA guidelines. Seven databases were searched to identify qualitative research. Results of the search were screened against inclusion criteria and for methodological quality. Findings from included studies were extracted and then analysed using thematic synthesis methods.

RESULTS

Twenty two studies met the inclusion criteria. Six themes were identified that elucidated factors that contribute to experiences of supportive and effective vocational rehabilitation service delivery: a personalised service with service user preferences at the core; sustainable, timely and ongoing support; proactive collaboration with the employing organisation; peer support, the essential and necessary skills for gaining employment; and critical vocational worker skills, knowledge and attitudes.

CONCLUSION

This study demonstrates the utility of synthesising qualitative research to provide insight into the factors that contribute to experiences of supportive and effective vocational rehabilitation services that traverse various contexts. Future high quality qualitative research is required to probe a broader range of long term conditions to better identify the similarities and differences across services and groups.IMPLICATIONS FOR REHABILITATIONAcross qualitative studies, common aspects of "good" vocational services can be identified that contribute to experiences of effective support to gain paid work for people living with long term conditions.Services are experienced positively when they are personalised, flexible, collaborative and take into account both lived experience and knowledge of the person's condition.Vocational rehabilitation services should proactively build collaborative relationships between the job seeker, employing organisation and other agencies and services.Specific skills and services that people living with long-term conditions find particularly helpful include peer support, work-focused skill development and workplace adjustment and accommodations.

Stakeholders' experience of collaboration in the context of interdisciplinary rehabilitation for patients with chronic pain aiming at return to work

BACKGROUND AND PURPOSE

Chronic pain is a major reason for sick leave worldwide. Interdisciplinary pain rehabilitation programs (IPRPs), workplace interventions, and stakeholder collaboration may support patients in their return to work (RTW). Few studies have examined stakeholders' experiences of important components in the RTW rehabilitation process for patients with chronic pain, especially in the context of IPRP. This study explores and describes stakeholders' experiences with stakeholder collaboration and factors related to RTW for patients with chronic pain who have participated in IPRP.

METHODS

Six focus groups, three pair and four individual interviews were conducted with a total of 28 stakeholder representatives from three societal and three health care stakeholders. Data were analyzed using qualitative content analysis.

RESULTS

The participants revealed that stakeholder collaboration and a tailored RTW rehabilitation plan were important strategies although they noted that these strategies were not working sufficiently efficient as presently implemented. The different stakeholders' paradigms and organizational prerequisites were described as hindrances of such strategies and that the degree of tailoring depended on individual attitudes.

CONCLUSIONS

More knowledge transfer and flexibility, clearer responsibilities, and better coordination throughout the RTW rehabilitation process may increase the efficiency of stakeholder collaboration and support for patients.Implications for rehabilitationStakeholders need to have a close dialogue initiated before IPRP to be able to reach consensus and shared decision making in the RTW rehabilitation plan throughout the RTW rehabilitation process.Individually tailored solutions based on a thorough assessment of each patient's work ability and context are identified during IPRP and shall be included in the shared RTW rehabilitation plan.The responsibilities of the stakeholders need to be clarified and documented in the RTW rehabilitation plan.The role of RCs should be developed to improve the coordination throughout the patients' RTW rehabilitation process.

The Current Practice of Gradual Return to Work in Germany: A Qualitative Study Protocol

(1) Background: The increase in working age and long-term illnesses is a challenge for society to maintain the health of employees and to support their work participation. In many countries, such as Germany, a gradual return to work (GRTW) is used frequently to support returning employees, but little is known about its facilitators and obstacles. This protocol aims to provide an overview of the national state of the art in workplace adjustments during return to work and to outline the design of a qualitative study examining current GRTW practices in Germany. (2) Methods: Our qualitative study will examine the current implementation of GRTW by means of 32 narrative interviews and 10 group discussions from different perspectives. Therefore, we will ask returning employees as well as organisational stakeholders and external experts about their experiences with GRTW and attitudes towards the measure. The verbal data obtained will be analysed using the documentary method of interpretation. (3) Discussion: This study will reveal facilitating and hindering factors for the implementation of GRTW in Germany. The findings of the study may contribute to an improved implementation of GRTW not only in Germany.

Barriers to and facilitators of labor market engagement for individuals with chronic physical illnesses in their experiences with work disability policy: a qualitative systematic review

OBJECTIVE

The objective of this review was to identify and synthesize the best available evidence to address two questions. From the perspectives of individuals with chronic physical illnesses: i) what are barriers in work disability policies with respect to labor market engagement? and ii) what are facilitators in work disability policies with respect to labor market engagement?

INTRODUCTION

Chronic physical illnesses have a high and increasing prevalence worldwide and are associated with significant disability in the working-age population. Individuals with chronic illnesses and disability have low employment and high unemployment rates, and low wages. Work disability policies have important role in reducing negative labor market impacts, but inadequate policies may also pose barriers to work engagement.

INCLUSION CRITERIA

This review included studies of individuals who were of working age, had one or more chronic physical illness, and had experience relevant to disability policy and work engagement. The phenomena of interest were perceived barriers and perceived facilitators in work disability policies with respect to labor market engagement. The context was any study setting globally. Studies considered for this review had qualitative data from a variety of methodologies.

METHODS

This review was conducted in accordance with the JBI methodology for systematic reviews of qualitative evidence. A literature search involved academic databases (ie, CINAHL Plus, MEDLINE, PsycINFO, AgeLine, SocINDEX, Social Work Abstracts, Sociological Abstracts, Social Services Abstracts) for published studies; gray literature sources (ie, ProQuest Dissertations and Theses, MedNar, Google Scholar, OpenGrey, OAIster, Google, and relevant websites) for unpublished studies; and reference lists of retrieved records. No language, date, or country limiters were applied to the searches. Retrieved records from the database and gray literature searches were screened, with potentially relevant records then examined in full against the inclusion criteria. Eligible studies were critically appraised for methodological quality and those included in this review were subjected to data extraction of descriptive details and the study findings that were relevant to the review questions. Study findings were synthesized and were assigned confidence scores.

RESULTS

Forty-four studies of various qualitative designs and varied methodological quality (from low to high) were included in this review. The study samples represented a number of different chronic physical illnesses. There were 301 credible and unequivocal study findings, which were aggregated into 20 categories and 5 synthesized findings. Persons with chronic physical illnesses perceived barriers and facilitators relevant to the adequacy of disability policies in meeting their needs for returning to work after leave due to illness and for sustaining ongoing work engagement. They also perceived barriers and facilitators relevant to stakeholders' communication, help, and support respecting workers' efforts toward work engagement.

CONCLUSION

Although confidence in the synthesized findings is low due to limitations in the methods and research findings across primary studies, the evidence suggests that both the adequacy and implementation of work disability policies need to be improved to meet the needs of workers with chronic physical illnesses, for their labor market engagement.

SYSTEMATIC REVIEW REGISTRATION NUMBER

PROSPERO CRD42016033476.

Anxiety Levels Predict Bone Mineral Density in Postmenopausal Women Undergoing Oral Bisphosphonates: A Two-Year Follow-Up

Clinical psychological factors may predict medical diseases. Anxiety level has been associated with osteoporosis, but its role on bone mineral density (BMD) change is still unknown. This study aimed to investigate the association between anxiety levels and both adherence and treatment response to oral bisphosphonates (BPs) in postmenopausal osteoporosis. BMD and anxiety levels were evaluated trough dual-energy X-ray absorptiometry and the Hamilton Anxiety Rating Scale (HAM-A), respectively. Participants received weekly medication with alendronate or risedronate and were grouped according to the HAM-A scores into tertiles (HAM-A 3 > HAM-A 2 > HAM-A 1). After 24 months, BMD changes were different among the HAM-A tertiles. The median lumbar BMD change was significantly greater in both the HAM-A 2 and HAM-A 3 in comparison with the HAM-A 1. The same trend was observed for femoral BMD change. Adherence to BPs was >75% in 68% of patients in the HAM-A 1, 79% of patients in the HAM-A 2, and 89% of patients in the HAM-A 3 (p = 0.0014). After correcting for age, body mass index, depressive symptoms, and the 10-yr. probability of osteoporotic fractures, anxiety levels independently predicted lumbar BMD change (β = 0.3417, SE 0.145, p = 0.02). In conclusion, women with higher anxiety levels reported greater BMD improvement, highlighting that anxiety was associated with adherence and response to osteoporosis medical treatment, although further research on this topic is needed.

Experiences of interventions and rehabilitation activities in connection with return-to-work from a gender perspective. A focus group study among employees on sick leave for common mental disorders

BACKGROUND

Common mental disorders present the main reason for registered sick leave in Sweden today, and women are at a higher risk of such sick leave than men. The aim of this paper is to explore how employees on sick leave for common mental disorders experience interventions and rehabilitation activities during return-to-work, as well as to explore similarities and differences between the experiences of the interviewed women and men.

MATERIAL AND METHODS

A qualitative design was applied with semi-structured focus group interviews. Seven focus groups were conducted with a total of 28 participants (13 women and 15 men). The focus group discussions were audiotaped and transcribed verbatim, and data analyzed with conventional content analysis. Similarities and differences in the women's and men's experiences were written down in reflective notes during all steps of the analysis.

RESULTS

The results comprise of one main category, "To be met with respect and recognition", and subcategories at two levels. Both similarities and differences emerged in how women and men sick-listed because of common mental disorders experienced return-to-work interventions and rehabilitation activities. It was important for both women and men to be met with respect and recognition, which was essential to all forms of help that the participants discussed during the focus group interviews. Women expressed a need for home-related interventions, whereas men expressed a need for organizational interventions to counter feelings of resignation at work. Women could also more easily understand their mental health condition as compared with men.

CONCLUSION

A key implication of this study is that research on interventions and rehabilitation activities during return-to-work among employees on sick leave for common mental disorders should consider whether the findings are relevant equally to both women and men. Similarly, return-to-work professionals may need to consider possible differences among women and men on sick leave for common mental disorders, and to further customize offered interventions and rehabilitation activities. Doing so may help enhance the effectiveness of such interventions.

"Not Thinking that This Means the End When You Are Seriously Ill but Doing Something Positive about It"-A Qualitative Study of Living with a Life-Changing Disease

Background: Chronic diseases have an impact on and can change the lives of the persons affected by them. This study examines how a disease can influence patients’ daily lives, the strategies they adopt to cope, and their experiences of support. The study focuses on four chronic diseases: asthma-allergy, cancer, diabetes mellitus, and inflammatory rheumatic arthritis. Methods: The study has a qualitative design and includes 41 transcribed in-depth interviews and a content analysis. Results: The participants’ new life situation was changed for a very long time or forever, and this was not a voluntary choice. The new life situation comprised the following themes: life-changing—the disease could be a turning point in a negative or positive way, strategies—designed to create ways of coping with daily tasks to find a good quality of life, and support—that could be obtained from the participants’ private network or the healthcare professionals. Conclusions: The patients had to make changes in their daily life, and these could bring about different feelings and restrict activity. Healthcare professionals need more knowledge of the process of coping with such life-changing matters and what could strengthen patients and give a sense of empowerment in their lives.

Patient perspectives on employment participation in the "hypermobile Ehlers-Danlos syndrome"

BACKGROUND

"Ehlers-Danlos syndrome" (EDS) is a heritable connective disorder influencing multiple aspects of daily life. Most studies have focused on describing the physical symptoms and level of disability, but little knowledge exists about the psychosocial effects of the pathology. Participation in employment is an aspect that strongly influences quality of life of patients with chronic pathologies. This study, therefore, aimed to explore the lived experiences in employment participation of patients diagnosed with "hypermobile EDS".

METHODS

An inductive thematic analysis, using semi-structured interviews was used. Nine patients, purposively selected by a continuum sampling strategy, were included. Interviews were audio-recorded and transcribed verbatim.

RESULTS

Data analysis resulted in three main themes: (1) elements assisting participation in employment, (2) limitations in employment participation, and (3) unemployment due to the "hypermobile EDS". On the one hand, the results show that related health complaints can impede employment participation to an important extent. On the other hand, patients also report several aspects of work that can affect their well-being in a positive way.

CONCLUSION

There are specific reasons for a person with "hypermobile EDS" to participate in employment. These reasons are different for each person and may even vary in time.Implications for rehabilitation"Hypermobile EDS" greatly impacts activities and participation in daily life. "Living with limitations" is the central theme in the lives of "Hypermobile EDS" patients.Various aspects influence work participation in people with "Hypermobile EDS", such as work pressure, tasks, and transport to work.Work has positive effects in the lives of people with "Hypermobile EDS."Work can create difficulties when the job requirements and tasks do not match the functional abilities of a person with "Hypermobile EDS."

Employment and People with Non Communicable Chronic Diseases: PATHWAYS Recommendations and Suggested Actions for Implementing an Inclusive Labour Market for All and Health in All Sectors

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Furthering the Evidence of the Effectiveness of Employment Strategies for People with Mental Disorders in Europe: A Systematic Review

(1) Purpose: This systematic review aims to assess the effectiveness of strategies used in the professional (re)integration of persons with mental disorders (MD) in European countries; (2) Methods: We conducted a search for scientific publications available in relevant electronic databases (Medline, PsycINFO, CDR-HTA, CDR-DARE, and Cochrane Library). The present study collected evidence on the effectiveness, from 2011 to 2016, of employment strategies for persons with MDs; (3) Results: A total of 18 studies were included, representing 5216 participants (aged 18⁻65, mean age of 38.5 years old) from 7 countries. Job access programs demonstrated effectiveness in four out of six studies. Return to work (RTW) interventions showed significant positive results in two studies, while four studies did not refer to effectiveness. There were inconsistent results in another four studies; (4) Conclusions: Our findings highlight the complexities of the implementation of employment strategies (job access and return to work). Job access strategies seem to improve employment outcomes. The effectiveness of return to work strategies remains unclear. The involvement and commitment of physicians, employment specialists, and employers, and employees capacity for self-care seem decisive for employment re-integration success. Further analyses are needed to assess the cost-effectiveness of these interventions and corroborate our results, with longer follow-ups.