One Year Effects of a Workplace Integrated Care Intervention for Workers with Rheumatoid Arthritis: Results of a Randomized Controlled Trial

Purpose To evaluate the effectiveness of a workplace integrated care intervention on at-work productivity loss in workers with rheumatoid arthritis (RA) compared to usual care. Methods In this randomized controlled trial, 150 workers with RA were randomized into either the intervention or control group. The intervention group received an integrated care and participatory workplace intervention. Outcome measures were the Work Limitations Questionnaire, Work Instability Scale for RA, pain, fatigue and quality of life (RAND 36). Participants filled out a questionnaire at baseline, and after 6 and 12 months. We performed linear mixed models to analyse the outcomes. Results Participants were on average 50 years of age, and mostly female. After 12 months, no significant intervention effect was found on at-work productivity loss. We also found no significant intervention effects on any of the secondary outcomes. Conclusions We did not find evidence for the effectiveness of our workplace integrated care intervention after 12 months of follow up. Future studies should focus on investigating the intervention in groups of workers with severe limitations in work functioning, and an unstable work situation.     

Process Evaluation of a Workplace Integrated Care Intervention for Workers with Rheumatoid Arthritis

Purpose To perform a process evaluation of the implementation of a workplace integrated care intervention for workers with rheumatoid arthritis to maintain and improve work productivity. The intervention consisted of integrated care and a participatory workplace intervention with the aim to make adaptations at the workplace. Methods The implementation of the workplace integrated care intervention was evaluated with the framework of Linnan and Steckler. We used the concepts recruitment, reach, dose delivered, dose received, fidelity and satisfaction with the intervention. Data collection occurred through patient questionnaires and medical records. Results Participants were recruited by sending a letter including a reply card from their own rheumatologist. In total, we invited 1973 patients to participate. We received 1184 reply cards, and of these, 150 patients eventually participated in the study. Integrated care was delivered according to protocol for 46.7 %, while the participatory workplace intervention was delivered for 80.6 %. Dose received was nearly 70 %, which means that participants implemented 70 % of the workplace adaptations proposed during the participatory workplace intervention. The fidelity score for both integrated care and the participatory workplace intervention was sufficient, although communication between members of the multidisciplinary team was limited. Participants were generally satisfied with the intervention. Conclusions This process evaluation shows that our intervention was not entirely implemented as intended. The integrated care was not delivered to enough participants, but for the intervention components that were delivered, the fidelity was good. Communication between members of the multidisciplinary team was limited. However, the participatory workplace intervention was implemented successfully, and participants indicated that they were satisfied with the intervention.     

Intervention mapping for development of a participatory return-to-work intervention for temporary agency workers and unemployed workers sick-listed due to musculoskeletal disorders

Background  

In the past decade in activities aiming at return-to-work (RTW), there has been a growing awareness to change the focus from sickness and work disability to recovery and work ability. To date, this process in occupational health care (OHC) has mainly been directed towards employees. However, within the working population there are two vulnerable groups: temporary agency workers and unemployed workers, since they have no workplace/employer to return to, when sick-listed. For this group there is a need for tailored RTW strategies and interventions. Therefore, this paper aims to describe the structured and stepwise process of development, implementation and evaluation of a theory- and practise-based participatory RTW program for temporary agency workers and unemployed workers, sick-listed due to musculoskeletal disorders (MSD). This program is based on the already developed and cost-effective RTW program for employees, sick-listed due to low back pain.     

Integrated, multidisciplinary care for hand eczema: design of a randomized controlled trial and cost-effectiveness study

Background  

The individual and societal burden of hand eczema is high. Literature indicates that moderate to severe hand eczema is a disease with a poor prognosis. Many patients are hampered in their daily activities, including work. High costs are related to high medical consumption, productivity loss and sick leave. Usual care is suboptimal, due to a lack of optimal instruction and coordination of care, and communication with the general practitioner/occupational physician and people involved at the workplace. Therefore, an integrated, multidisciplinary intervention involving a dermatologist, a care manager, a specialized nurse and a clinical occupational physician was developed. This paper describes the design of a study to investigate the effectiveness and cost-effectiveness of integrated care for hand eczema by a multidisciplinary team, coordinated by a care manager, consisting of instruction on avoiding relevant contact factors, both in the occupational and in the private environment, optimal skin care and treatment, compared to usual, dermatologist-led care.     

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

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.     

Finding ergonomic solutions--participatory approaches

This paper gives an overview of the theory of participatory ergonomics interventions and summary examples from a range of industries, including health care, military, manufacturing, production and processing, services, construction and transport. The definition of participatory approaches includes interventions at macro (organizational, systems) levels as well as micro (individual), where workers are given the opportunity and power to use their knowledge to address ergonomic problems relating to their own working activities. Examples are given where a cost-effective benefit has been measured using musculoskeletal sickness absence and compensation costs. Other examples, using different outcome measures, also showed improvements, for example, an increase in productivity, improved communication between staff and management, reduction in risk factors, the development of new processes and new designs for work environments and activities. Three cases are described from Canada and Japan where the participatory project was led by occupational health teams, suggesting that occupational health practitioners can have an important role to play in participatory ergonomics projects.     

A Participatory Workplace Intervention for Employees With Distress and Lost Time: A Feasibility Evaluation Within a Randomized Controlled Trial

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.     

The impact of a prospective survey-based workplace intervention program on employee health, biologic stress markers, and organizational productivity

OBJECTIVE: To study whether knowledge about psychosocial work indicators and a structured method to implement changes based on such knowledge comprise an effective management tool for enhancing organizational as well as employee health and well-being. METHODS: White- collar employees representing 22 different work units were assessed before and after a 1-year intervention program. Subjective ratings on health and work environment, biologic markers, absenteeism, and productivity were measured. RESULTS: Significant improvements in performance feedback, participatory management, employeeship, skills development, efficiency, leadership, employee well-being, and work-related exhaustion were identified. The restorative hormone testosterone increased during the intervention and changes correlated with increased overall organizational well-being. Absenteeism decreased and productivity improved. CONCLUSIONS: Fact-based psychosocial workplace interventions are suggested to be an important process for enhancing employee well-being as well as organizational performance.     

社区卫生服务中心工作场所暴力现况及相关因素分析

目的：了解杭州市社区卫生服务中心医务人员工作场所暴力的现况和影响因素,为进一步采取合适的防范措施提供依据。方法：采用方便抽样方法对杭州市三家社区卫生服务中心的医务人员共378名进行问卷调查。结果：在调查前一年中,63．76％的医务人员遭受过语言暴力,8．20％遭受过身体暴力。医技人员和医生是遭受暴力最多的人群,门急诊是暴力最多发的科室。社区卫生服务中心应对工作场所暴力的态度、措施、开展相关培训等情况不同,其员工遭受暴力率也不同。结论：社区卫生服务中心医务人员工作场所暴力发生率高,中心和医务人员应加强应对,防范暴力的发生并将危害降至最低。     

On the line: worker democracy and the struggle over occupational health and safety

In this article we present a qualitative analysis of worker involvement in a participatory project to improve occupational health and safety at a Canadian manufacturing site. Based on interviews with workers in the plant, we consider the manner and degree to which workers experienced meaningful participation in the intervention process and some of the main barriers to worker participation. Findings emphasize the importance of the social and political context in conditioning the dynamics of joint management labor ventures specifically in relation to health initiatives. Interviews revealed few instances in which workers felt included in the participatory initiative; most often they felt marginalized. In the absence of structural change in the plant, workers described the health initiative as seriously limited in its ability to render meaningful worker participation. These results extend beyond this analysis of a participatory workplace health initiative, offering insights into the dynamics of institutional participatory process, and into participatory research practice generally.     

Occupational health services to assist workers' health promotion based on a participatory training program of staff members for public health centers

Work-related health problems among employees of small-scale enterprises and un-employed workers are still serious in Japan. Occupational health services related to their working conditions and environment are limited and more provison needs to be made. Our participatory training program is aimed at allowing staff members of public health centers to provide occupational health services and assist workers' health promotion. In this program, participants examine occupational risk factors affecting workers' health problems with ergonomic check-lists and discuss potential improvements in the workplace. Participants experience practical visits to small-scale enterprises in their communities and the resultant occupational health services are discussed and evaluated at the final step in this program. The essential feature of successful case was that the public health center had coordinated community resources and occupational health services with ergonomic check-lists accepted by small-scale enterprises. This participatory training program is effective from the viewpoint of evaluating occupational risk factors affecting workers' health problems and proposing improvements in the workplace. In order to optimally provide occupational health services for the employees of small-scale enterprises and un-employed workers, the community resources including health facilities and the parties concerned must be organized and utilized effectively.     

Outcomes in work-related injuries: a comparison of older and younger workers

BACKGROUND: The "graying of the workforce" has generated concerns about the physical capacity of older workers to maintain their health and productivity on the job, especially after an injury occurs. There is little detailed research on age-related differences in work outcomes after an occupational injury. METHODS: A self-report survey about occupational, health, and financial outcomes, and related factors was administered 2-8 weeks post-injury to workers aged < 55 and > or = 55 who had lost time due to a work injury. RESULTS: Despite more severe injuries in older workers, most outcomes were similar in both age groups. In multivariate models, age was unrelated or inversely related to poor outcomes. Injury severity, physical functioning, and problems upon return to work were associated with adverse work injury outcomes. CONCLUSIONS: Older workers appear to fare better than younger workers after a work injury; their relative advantage may be primarily due to longer workplace attachment and the healthy worker effect.     

Process Evaluation of a Participatory Supportive Return to Work Program for Workers Without a Permanent Employment Contract,Sick-Listed Due to a Common Mental Disorder

Purpose This study aimed to perform a process evaluation of a participatory supportive return to work program for workers without a (permanent) employment contract, sick-listed due to a common mental disorder. The program consisted of a participatory approach, integrated care and direct placement in a competitive job. Our main questions were: were these components realized in practice and in accordance with the protocol? The evaluation took place alongside a randomized controlled trial. Methods The study population consisted of workers who filed a sickness benefit claim at the Dutch Social Security Agency, professionals of this agency and of vocational rehabilitation agencies. We focused on sick-listed workers and professionals who had actually participated in the intervention. Data was collected mainly by questionnaires. Results Only 36 out of 94 intervention group participants started with the program. In half of these cases application of integrated care was reported. Most other steps in the program were completed. However, fidelity to the protocol was low to reasonable. Much delay was observed in the execution of the program and only two sick-listed workers were placed in a competitive job. Still, satisfaction with the participatory approach was good. Conclusions Despite the positive evaluation of the participatory approach, the full program was executed less successfully compared to similar programs evaluated in earlier studies. This will probably affect the outcomes of our trial. Findings from this study will help to interpret these outcomes. Nevertheless, more knowledge is needed about experiences of stakeholders who participated in the program. Trial Registration NTR3563.     

Bridging Health Care and the Workplace: Formulation of a Return-to-Work Intervention for Breast Cancer Patients Using an Intervention Mapping Approach

Purpose An increasing number of breast cancer (BC) survivors of working age require return to work (RTW) support. Objective of this paper is to describe the development of a RTW intervention to be embedded in the care process bridging the gap between hospital and workplace. Method The Intervention Mapping (IM) approach was used and combined formative research results regarding RTW in BC patients with published insights on occupational therapy (OT) and RTW. Four development steps were taken, starting from needs assessment to the development of intervention components and materials. Results A five-phased RTW intervention guided by a hospital-based occupational therapist is proposed: (1) assessing the worker, the usual work and contextual factors which impacts on (re-)employment; (2) exploration of match/differences between the worker and the usual work; (3) establishing long term goals, broken down into short term goals; (4) setting up tailored actions by carefully implementing results of preceding phases; (5) step by step, the program as described in phase 4 will be executed. The occupational therapist monitors, measures and reviews goals and program-steps in the intervention to secure the tailor-made approach of each program-step of the intervention. Conclusion The use of IM resulted in a RTW oriented OT intervention. This unique intervention succeeds in matching individual BC patient needs, the input of stakeholders at the hospital and the workplace.     

Workers with occupational contact dermatitis: workplace characteristics and prevention practices

Background There are many gaps in knowledge related to prevention practices in place for workers who subsequently develop occupational contact dermatitis (OCD). Aims To describe the workplace characteristics and the prevention practices in workplaces where workers developed hand dermatitis. Methods Consecutive cases of probable OCD were enrolled from a specialist occupational health clinic. At the time of the initial assessment, questionnaires were administered to collect information about clinical presentation, workplace characteristics and prevention practices at work. Results 100 workers with hand dermatitis were enrolled in the study and 78 were considered to have OCD. Two-thirds of these had had some occupational health and safety or Workplace Hazardous Materials Information System (WHMIS) training in their workplace, however, training related to glove use and skin care was less common. Unionized workers were more likely to have received training. Workers involved in wet work were less likely to report training. Conclusions These findings suggest that there are gaps in prevention programs for work-related skin disease. Research is needed on effective strategies that are sustainable in the workplace.     

Economic Evaluation of a Multi-Stage Return to Work Program for Workers on Sick-Leave Due to Low Back Pain

Objective: To evaluate the cost-effectiveness and cost-utility of a return to work (RTW) program for workers on sick-leave due to low back pain (LBP), comparing a workplace intervention implemented between 2 to 8 weeks of sick-leave with usual care, and a clinical intervention after 8 weeks of sick-leave with usual care. Design: Economic evaluation alongside a randomised controlled trial (RCT). Study population: Workers sick-listed for a period of 2 to 6 weeks due to LBP. Interventions: 1. workplace assessment, work modifications and case management). 2. physiotherapy based on operant behavioural principles. 3. usual care: provided by an occupational physician. Outcomes: The primary outcome was return to work (RTW). Other outcomes were pain intensity, functional status, quality of life and general health. The economic evaluation was conducted from a societal perspective. Outcomes were assessed at baseline (after 2–6 weeks on sick-leave), and 12 weeks, 26 weeks, and 52 weeks after the first day of sick-leave. Results: The workplace intervention group returned to work 30.0 days (95% CI=[3.1, 51.3]) earlier on average than the usual care group at slightly higher direct costs (ratio of 1 day: €19). Workers in the clinical intervention group that had received usual care in the first 8 weeks returned to work 21.3 days (95% CI= [−74.1, 29.2]) later on average. The group that had received the workplace intervention in the first 8 weeks and the clinical intervention after 8 weeks returned to work 50.9 days (95% CI=[−89.4, −2.7]) later on average. A workplace intervention was more effective than usual care in RTW at slightly higher costs and was equally effective as usual care at equal costs on other outcomes. A clinical intervention was less effective than usual care and associated with higher costs. Conclusion: The workplace intervention results in a safe and faster RTW than usual care at reasonable costs for workers on sick-leave for two to six weeks due to LBP.This study is granted by: The Netherlands Organisation for Health Research and Development (ZonMw), Dutch Ministries of Health, Welfare and Sports and, of Social Affairs. international Standard Randomised Controlled Trial Number: 60233560.     

Peer Reviewed: Workplace Health Promotion in Washington State

The workplace is a powerful setting to reach large numbers of at-risk adults with effective chronic disease prevention programs. Missed preventive care is a particular problem for workers with low income and no health insurance. The costs of chronic diseases among workers — including health care costs, productivity losses, and employee turnover — have prompted employers to seek health promotion interventions that are both effective and cost-effective. The workplace offers 4 avenues for delivering preventive interventions: health insurance, workplace policies, health promotion programs, and communications. For each of the avenues, the evidence base describes a number of preventive interventions that are applicable to the workplace. On the basis of the evidence and of our work in Washington State, we present a public health approach to preventing chronic diseases via the workplace. In addition to relying on the evidence, this approach makes a compelling business case for preventive interventions to employers.     

The Union Health Center: A working model of clinical care linked to preventive occupational health services

As health care provision in the United States shifts to primary care settings, it is vital that new models of occupational health services be developed that link clinical care to prevention. The model program described in this paper was developed at the Union Health Center (UHC), a comprehensive health care center supported by the International Ladies Garment Workers Union (now the Union of Needletrades, Industrial and Textile Employees) serving a population of approximately 50,000 primarily minority, female garment workers in New York City. The objective of this paper is to describe a model occupational medicine program in a union-based comprehensive health center linking accessible clinical care with primary and secondary disease prevention efforts. To assess the presence of symptoms suggestive of occupational disease, a health status questionnaire was administered to female workers attending the UHC for routine health maintenance. Based on the results of this survey, an occupational medicine clinic was developed that integrated direct clinical care with worker and employer education and workplace hazard abatement. To assess the success of this new approach, selected cases of sentinel health events were tracked and a chart review was conducted after 3 years of clinic operation. Prior to initiation of the occupational medicine clinic, 64% (648) of the workers surveyed reported symptoms indicative of occupational illnesses. However, only 42 (4%) reported having been told by a physician that they had an occupational illness and only 4 (.4%) reported having filed a workers' compensation claim for an occupational disease. In the occupational medicine clinic established at the UHC, a health and safety specialist acts as a case manager, coordinating worker and employer education as well as workplace hazard abatement focused on disease prevention, ensuring that every case of occupational disease is treated as a potential sentinel health event. As examples of the success of this approach, index cases of rotator cuff tendonitis, lead poisoning, and formaldehyde overexposure in three patients and their preventative workplace follow-up, affecting approximately 150 workers at three worksites, are described. Work-related conditions diagnosed during the first 3 years of clinic operation included cumulative trauma disorders (141 cases), carpal tunnel syndrome (47 cases), low back disorders (33 cases), lead poisoning (20 cases), and respiratory disease (9 cases). This pilot project represents a new model for effective integration of clinical care and occupational disease prevention efforts within a primary care center. It could serve as a prototype for development of such services in other managed and primary care settings. Am. J. Ind. Med. 31:263–273, 1997. © 1997 Wiley-Liss, Inc.     

Workers with a chronic disease and work disability

The prevalence of chronic diseases in the age group 18–65 years is high. Cardiometabolic conditions and musculoskeletal diseases are the most frequent chronic diseases. Depending on disease and comorbidity, the employment rates are considerably lower than for healthy individuals. Chronically ill workers may have problems in meeting job demands, they may experience physical, cognitive or sensory limitations, have fatigue or pain complaints or other disease symptoms. Psychological distress, depressive feelings, feelings of shame or guilt, lack of coping or communicative skills, and non-supportive colleagues and supervisors may add to work-related problems. The ICF Model (International Classification of Functioning, Disability and Health) of the WHO offers a framework for understanding and considering health-related problems at work and finding solutions. Interventions to prevent problems in functioning, sickness absence and work disability may focus on the worker, the workplace, or health care. Multidisciplinary vocational rehabilitation, exercise therapy, cognitive behavioural interventions, workplace interventions and empowerment are interventions with at least some evidence of effectiveness. Future policy could focus more on promotion of workers’ health and future research should include the interests and motivations of employers concerning disability management, skills of line managers, the feasibility of interventions to prevent work disability and the context sensitivity of study outcomes.     

参与式培训在珠宝加工企业健康教育中应用效果分析

目的 探讨适合珠宝加工企业的健康教育方式。 方法 实验组采用多媒体授课、小组讨论、个人防护用品使用练习等参与式培训方式对100名工人进行培训;传统组采用传统的授课方式对另100名工人进行相同内容的培训。在培训前后对两组进行测验,对得分进行汇总、分析。 结果 两组员工培训后绝大部分得分有所提高。实验组工人培训前得分总分为(41.29 ±8.59)分,培训后得分总分为(81.06 ±11.78)分,两者比较,差异有统计学意义(t=10.11,P < 0.05)。传统组培训前得分为(53.68 ±10.58)分,培训后得分为(61.37 ±15.39)分,两者比较,差异无统计学意义(t=1.39,P > 0.05)。实验组不同学历、工龄、技术职称的员工得分在培训前后比较,差异均有统计学意义(P < 0.05)。传统组小学及以下人员、工龄小于15个月人员和初级工在培训后得分有提高,但与培训前相比,差异无统计学意义(P > 0.05)。 结论 参与式培训在珠宝加工企业健康教育中效果明显,可以很好地提高工人的职业健康安全知识水平。