Disability Phenotypes and Job Accommodations Utilization Among People with Physical Disability

Purpose People with disabilities (PWD) are less likely to be employed than those without disabilities. Reasonable job accommodations are an essential factor for ensuring equal access to jobs for PWD. However, use of job accommodation is less than optimal among PWD with various types of disabilities. Sometimes, PWD have co-occurring impairments, which might affect accommodation use. This research aimed to explore disability phenotypes, frequently used accommodations, and employee- and job-related factors associated with the extent of job accommodation use. Methods A cross-sectional online survey of PWD was conducted in the Midwest region of the United States. Latent class analyses were used to identify disability phenotypes. Descriptive analysis and stepwise Poisson regression were used to identify factors associated with job accommodation use. Results A total of 326 PWD with work experience after acquiring a disability were included in this analysis. We identified three disability phenotypes: (1) Severe disability in cognitive, physical, emotional, communication and visual domains (32%), (2) Moderate cognitive and low physical disability (48%), and (3) High physical disability phenotypes (20%). 80% of PWD received at least one accommodation. Flexible working schedules, telework, and access to a support person in the workplace were the most common accommodations. Employee- (age, disability phenotypes, motor function) and job-related factors (job preparation, self-employment) are associated dependently with accommodation use. Conclusion This analysis identifies three disability phenotypes and highlights both employee- and job-related factors associated with accommodations used. It may be beneficial to consider multiple contextual factors, including co-occurring disability, employee- and job-related factors, when assisting people with job accommodations.

Job Accommodations, Return to Work and Job Retention of People with Physical Disabilities: A Systematic Review

Purpose We aimed to identify job accommodations that help persons with physical disabilities maintain or return to work and explore the barriers and facilitators that influence the provision and reception of job accommodations. Methods We conducted a systematic review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The review was registered in PROSPERO (CRD42019129645). The search strategy incorporated keywords describing physical disabilities, employer-approved job accommodations, and employment retention or return to work approaches. We searched MEDLINE, the Cochrane Library, Embase, CINAHL, PsycINFO, Web of Science, and ProQuest Theses and dissertations. Reviewers independently selected studies for inclusion. We used Hawker et al.'s method to assess study quality. Results We identified 2203 articles, of which 52 met inclusion criteria, developed a table of job accommodations commonly used by persons with physical disabilities, summarized the percentages of job accommodations used by persons with disabilities, synthesized evidence of the effectiveness of job accommodations, and identified the factors that influence job accommodation use. The most frequently reported accommodations were as follows: modification of job responsibilities, change of workplace policy, supportive personnel provision, flexible scheduling, and assistive technology. We summarized four types of facilitators and barriers that affect job accommodation use: employee-related factors, accommodation-related factors, job-related factors, and social workplace-related factors. Conclusion The absence of randomized controlled trials and prevalence of cross-sectional surveys provides inconclusive evidence regarding the effectiveness of specific job accommodations for people with particular functional limitations. Our system of categorizing job accommodations provides a guide to investigators seeking to evaluate the effectiveness of job accommodations using experimental methods.

Disability Severity, Leader-Member Exchange, and Attitudinal Outcomes: Considering the Employee and Supervisor Perspectives

Purpose Although the effects of disability on employee work outcomes are well-documented, the mechanism that explain these relationship remains unclear. We propose that the quality of relationships employees with disabilities develop with their supervisors explains the link between disability severity and employee work outcomes. More specifically, we examine the mediating role of leader-member exchange (LMX) in the relationship between employee disability severity and presenteeism, job accommodation, supervisor-rated performance, job satisfaction, and resilience. We test this proposition from two perspectives: employees with disabilities and supervisors who had supervised employees with disabilities. Method We collected data from employees with musculoskeletal disabilities (Sample 1, N = 264) and supervisors who had supervised employees with musculoskeletal disabilities in the past two years (Sample 2, N = 224). Results From the perspective of employees with disabilities (Sample 1), disability severity was negatively related to LMX quality (R² = .28). Contrary to our hypothesis, we found a positive relationship between supervisor perceptions of employee disability severity and LMX in Sample 2 (R² = .27). After adjusting for disability severity, LMX quality was related to improved outcomes in both samples: higher employee job satisfaction (Sample 1: R² = .36), provision of job accommodations (Sample 1: R² = .16; Sample 2: R²= .15), resilience (Sample 1: R² = .18), lower levels of presenteeism (Sample 1: R² = .20), and higher performance evaluations for employees with disabilities (Sample 2: R² = .49). Conclusion By collecting two separate samples, we revealed similarities and differences in employee and supervisor perspectives. Our findings demonstrated the need for including both perspectives when considering implications of employee disability severity.

Supervisor and Organizational Factors Associated with Supervisor Support of Job Accommodations for Low Back Injured Workers

Purpose Temporary job accommodations contribute to the prevention of chronic work disability due to low back pain (LBP) through the facilitation of early return to work; yet, workplace dimensions of job accommodation are poorly understood. The objective of this study was to determine supervisor and organizational factors associated with supervisors' support for temporary job accommodations for LBP injured workers. Methods Supervisors were recruited from 19 workplaces in the USA and Canada and completed an online survey regarding job accommodation practices and potential associated factors with respect to a case vignette of a worker with LBP. Multivariable linear regression was used to identify the most parsimonious set of factors associated with supervisors' support for accommodations. Results A total of 804 supervisors participated with 796 eligible for inclusion in the analysis. The final set of factors explained 21 % of the variance in supervisors' support for temporary job accommodations. Considerate leadership style (β = 0.261; 95 % CI 0.212, 0.310), workplace disability management policies and practices (β = 0.243; 95 % CI 0.188, 0.298), and supervisor autonomy for designing and providing workplace accommodations (β = 0.156; 95 % CI 0.071, 0.241) had the largest effect on supervisor support for accommodations. Conclusion Factors predicting supervisors' likelihood to accommodate LBP injured workers include use of considerate leadership style, workplace disability management policies and practices, and supervisor autonomy. Workplace interventions targeting these factors should be developed and evaluated for their ability to improve work disability prevention outcomes.

A Model of Supervisor Decision-Making in the Accommodation of Workers with Low Back Pain

Purpose To explore supervisors' perspectives and decision-making processes in the accommodation of back injured workers. Methods Twenty-three semi-structured, in-depth interviews were conducted with supervisors from eleven Canadian organizations about their role in providing job accommodations. Supervisors were identified through an on-line survey and interviews were recorded, transcribed and entered into NVivo software. The initial analyses identified common units of meaning, which were used to develop a coding guide. Interviews were coded, and a model of supervisor decision-making was developed based on the themes, categories and connecting ideas identified in the data. Results The decision-making model includes a process element that is described as iterative "trial and error" decision-making. Medical restrictions are compared to job demands, employee abilities and available alternatives. A feasible modification is identified through brainstorming and then implemented by the supervisor. Resources used for brainstorming include information, supervisor experience and autonomy, and organizational supports. The model also incorporates the experience of accommodation as a job demand that causes strain for the supervisor. Accommodation demands affect the supervisor's attitude, brainstorming and monitoring effort, and communication with returning employees. Resources and demands have a combined effect on accommodation decision complexity, which in turn affects the quality of the accommodation option selected. If the employee is unable to complete the tasks or is reinjured during the accommodation, the decision cycle repeats. More frequent iteration through the trial and error process reduces the likelihood of return to work success. Conclusion A series of propositions is developed to illustrate the relationships among categories in the model. The model and propositions show: (a) the iterative, problem solving nature of the RTW process; (b) decision resources necessary for accommodation planning, and

Efficacy of temporary work modifications on disability related to musculoskeletal pain or depressive symptoms--study protocol for a controlled trial

INTRODUCTION

Previous research suggests that work with a suitable workload may promote health and work retention in people with disability. This study will examine whether temporary work modifications at the early stage of work disability are effective in enhancing return to work (RTW) or staying at work among workers with musculoskeletal or depressive symptoms.

METHODS AND ANALYSIS

A single-centre controlled trial with modified stepped wedge design will be carried out in eight enterprises and their occupational health services (OHSs) in nine cities in Finland. Patients seeking medical advice due to musculoskeletal pain (≥4 on a scale from 0-10) or depressive symptoms (≥1 positive response to 2 screening questions) and fulfilling other inclusion criteria are eligible. The study involves an educational intervention among occupational physicians to enhance the initiation of work modifications. Primary outcomes are sustained RTW (≥4 weeks at work without a new sickness absence (SA)) and the total number of SA days during a 12-month follow-up. Secondary outcomes are intensity of musculoskeletal pain (scale 0-10), pain interference with work or sleep (scale 0-10) and severity of depressive symptoms (Patient Health Questionnaire, PHQ-9), inquired via online questionnaires at baseline and 3, 6, 9 and 12 months after recruitment. Information on SA days will be collected from the medical records of the OHSs over 12 months, before and after recruitment. The findings will give new information about the possibilities of training physicians to initiate work modifications and their effects on RTW in employees with work disability due to musculoskeletal pain or depressive symptoms.

ETHICS AND DISSEMINATION

The Coordinating Ethics Committee of Hospital District of Helsinki and Uusimaa has granted approval for this study. The results will be published in peer-reviewed journals.

TRIAL REGISTRATION NUMBER

ISRCTN74743666.

Putting job accommodation to work

Job accommodation is an essential ingredient of employment for individuals with physical disabilities. Services such as supported employment have improved employment opportunities. However, rehabilitation practitioners encounter an increasingly varied and complex array of accommodation options from which to choose. This article describes the Job Accommodation System, a user-friendly tool that assists rehabilitation practitioners, employees, and employers to identify and implement job accommodations.