Barriers to rehabilitation and return to work for unemployed chronic pain patients: A qualitative study

This paper explores the perceived barriers to return to work presented by unemployed patients with chronic musculoskeletal pain. The findings are based on one to one in depth semi-structured interviews conducted with patients from four sites in the UK. Interview data were recorded from 38 patients (15 male, 23 female) aged between 29 and 62 years the sample included patients who had participated in a vocational rehabilitation scheme, those who had refused to participate and a naı¨ve group. Patients were in receipt of long-term social welfare benefits (incapacity benefits) and recruited via local Job Centres. The mean duration of work absence was over 5 years. The data was transcribed and analysed by means of thematic analysis. Several themes were identified as barriers to return to work from the data including pain related issues, uncertainty (both financial and physical), the healthcare system, interaction with benefits providers, perceptions of employers and personal limitations. The uncertainty and the pain condition itself were the overarching barriers from which other obstacles stemmed. This is the first qualitative study of long term unemployed benefit recipients with chronic pain. Others authors have reported psychosocial factors as barriers to work among disabled populations however, this qualitative study has identified barriers specific to unemployed chronic pain patients. The themes identified will help with the planning and development of future initiatives for returning chronic pain patients to employment.     

Successful return to work following a musculoskeletal injury

Successful return to work following a musculoskeletal injury is facilitated by early intervention and rehabilitation that addresses the physical, psychosocial, and environmental factors in recovery. Job simulation and work hardening programs that involve the employee, the employer, and the health care providers are an effective approach to injured worker rehabilitation. The occupational health nurse's role can include early identification of injury, treatment coordination and follow up, matching worker abilities and restrictions to the job, and implementation of an injury prevention program. An injury prevention program should be worksite specific, and can include identification of injury hazards, preplacement testing, employee training, and ergonomic job redesign.     

Barriers and facilitators associated with return to work after stroke: a qualitative meta-synthesis

Purpose: To enhance the employment outcomes of individuals who experience a stroke, it is essential to understand the factors that determine successful return to work. The aim of this systematic review was to examine barriers to and facilitators of return to work after stroke from the perspective of people with stroke through the process of a qualitative meta-synthesis.

Methods: A systematic literature search was conducted. Studies that employed qualitative methods to explore the experiences of individuals with stroke around return to work after stroke were included. The methodological quality of the studies was assessed by two independent reviewers. Overarching themes, concepts and interpretations were extracted from each individual study, compared and meta-synthesized.

Results: Fifteen studies were included and the overall methodological quality of the studies was good. Four broad themes emerged as factors associated with return to work after stroke. These included (i) the nature of the effects of stroke, (ii) the preparatory environment, (iii) personal coping strategies and internal challenges and (iv) the meaning of work.

Conclusion: Return to work after stroke is a complex process which can be facilitated or impeded by organizational, social or personal factors, as well as accessibility to appropriate services.

• Implications for Rehabilitation

• Following a period of dedicated inpatient rehabilitation, there is a need to integrate community-support services to optimize return to work among stroke survivors.

• A dedicated community stroke support liaison officer may help to facilitate the transition between the hospital and the community and workplace environment.

• Education provided by healthcare professionals is necessary in the community and the workplace to ensure that family, friends and employers are aware of the impairments, activity limitations and participation restrictions of the stroke survivor.

     

Factors influencing return to work experienced by people with acquired brain injury: a qualitative research study

Purpose.?To describe the factors experienced by adults with moderate-to-severe acquired brain injury (ABI) as either limiting or facilitating during the process of return to work (RTW) in order to give an advice about the vocational rehabilitation process.

Methods.?A qualitative study was performed. Twelve adults who were working before acquiring traumatic or non-traumatic brain injury (2–3 years earlier) participated. The experiences were gathered by semi-structured interviews. The International Classification of Functioning, Disability and Health was used as a theoretical framework for the interviews and the analysis.

Results.?The most common limiting factor was tiredness. The most common facilitating factors were the will to RTW, the ongoing recovery and the knowledge and support of the employer, colleagues, occupational physician and occupational specialist.

Conclusions.?Different aspects were experienced as being important during the process of RTW after ABI. These aspects should be kept in mind during the process of RTW to make the outcome as successful as possible. It is advised to pay special attention to the recovery opportunities of an individual, to inform the employer, colleagues, occupation physician and the occupational specialist about ABI, and to support people with ABI for long time periods. An important role can be played by the rehabilitation centre.     

Perspectives of unemployed workers with mental health problems: barriers to and solutions for return to work

Purpose: To evaluate the barriers to and solutions for return to work (RTW) from the perspective of unemployed workers who were sick-listed due to mental health problems.

Methods: We conducted semi-structured interviews with 25 sick-listed unemployed workers with mental health problems. Qualitative data analysis was performed, using a process of identifying, coding, and categorising the patterns in data.

Results: All workers experienced multiple problems in different domains of life related to their disease, personal circumstances (e.g., divorced, debts) and their environment (e.g., labour market problems, issues with the Social Security Agency). Workers differed in the way they perceived their RTW process and in the extent to which they were able to envision and implement the solutions for RTW, thus resulting in three types of workers’ attitudes towards their own RTW process: (1) “frozen”; (2) “insightful though passive”; and (3) “action mode”.

Conclusions: We conclude that the sick-listed unemployed workers with mental health problems have to deal with multiple problems, of which medical problems are only a part. These workers need help aimed at their coping methods according to one of the three types of workers’ characteristics. Moreover, they need specific help organising and structuring their problems, getting their life back on track, and finding employment.

• Implications for Rehabilitation

• Unemployed workers with mental health problems face considerable challenges which impede their return to work. Evaluating the workers’ attitude may provide useful information on their own return-to-work process.

• In many cases, workers indicate a need for coaching to help them with problem-solving, planning, gaining structure, getting their life back on track, and finding employment.

• Rehabilitation professionals should tailor RTW interventions to the needs of these workers, aimed at their specific problems and taking into account the workers’ coping methods according to one of three types of workers’ attitudes towards their own RTW process.

     

Occupational disorders and return to work: a randomized controlled study.

OBJECTIVE: Goal setting and motivational factors are strongly associated with maintaining a job and return to work after sick leave, but research into the effects of interventions targeting these factors is limited. We conducted a randomized controlled study to examine the vocational effect of intervention focusing on motivation, goal setting and planning for return to work. DESIGN AND METHODS: Of 243 patients at risk of long-term sick leave or job dropout, 184 (76%) provided complete baseline information for the study. After randomization to an intervention group (n=92) and a reference group (n=92), occupational physicians examined the participants in accordance with standard guidelines. The intervention group received additional support from a social worker in order to enhance goal setting, motivation and planning for return to work. After 1 year 163 participants (89%) provided data on general health and employment status. The risk of not being gainfully employed was analysed by logistic regression analysis with adjustment for several covariates. RESULTS: The intervention did not increase the likelihood of gainful employment after 1 year or reduce the average number of days of sick leave. CONCLUSION: A low-cost counselling program addressing motivation, goal setting and planning for return to work did not improve vocational outcomes or reduce sick leave among patients with work-related disorders.     

Speech-language pathologists' reactions to response to intervention: a qualitative study

Qualitative methods were used to explore reactions of 300 speech-language pathologists (SLPs) on Response to Intervention (RTI). RTI is a system approach to serving struggling learners. This study was part of a larger research project that surveyed 2000 SLPs across the U.S. on their opinions about RTI. From 583 questionnaires returned, 300 (51.46%) responded to one open-ended question. Participants were asked, "What are your primary comments and/or concerns regarding RTI services for children and adolescents who struggle to learn?" Qualitative data analysis yielded 657 meaning units/codes and four themes emerged: (a) challenges and concerns, (b) support for the model, (c) implementation issues, and (d) role of SLPs. Challenges reflected in their reactions included: (a) the need for sufficient training, (b) SLPs' already heavy workloads, (c) concerns over students who may be "stuck in the tiers of RTI instruction" and the delay in timely referrals of students who need language services, and (d) having educational leaders that support RTI as well as the need for everyone to be "on board". RTI findings provide helpful considerations for SLPs and educators planning to implement the model.     

Understanding return to work behaviours: promoting the importance of individual perceptions in the study of return to work

Purpose : The purpose of this paper is to demonstrate and discuss how individuals' subjective perceptions of personal and environmental issues influence return to work behaviour. Method : A qualitative design utilizing in-depth interviews and maximum variation sampling of 11 individuals who either returned to work or withdrew from work after a health leave was conducted. Experiences elicited were analysed using the constant comparative method followed by a member check with participants to confirm findings and interpretations. Results : Findings underscored the importance of two key constructs in understanding return to work from the individual's perspective: the personal meaning of disability and return to work relevancy. Throughout the experience of getting better and returning to work participants reflected upon the impact of personal and external factors that contributed to their work disability, sought clarity of their performance capacities and examined the importance of work and the consequences of work disability within their life circumstances. Conclusions : Insights into an individual's perceptions of their impairment and the personal relevance of work can promote a better understanding of return to work behaviour. Integrating individual perceptions is essential to advancing a multidimensional approach in return to work research.     

Understanding return to work behaviours: promoting the importance of individual perceptions in the study of return to work

Purpose : The purpose of this paper is to demonstrate and discuss how individuals' subjective perceptions of personal and environmental issues influence return to work behaviour.

Method : A qualitative design utilizing in-depth interviews and maximum variation sampling of 11 individuals who either returned to work or withdrew from work after a health leave was conducted. Experiences elicited were analysed using the constant comparative method followed by a member check with participants to confirm findings and interpretations.

Results : Findings underscored the importance of two key constructs in understanding return to work from the individual's perspective: the personal meaning of disability and return to work relevancy. Throughout the experience of getting better and returning to work participants reflected upon the impact of personal and external factors that contributed to their work disability, sought clarity of their performance capacities and examined the importance of work and the consequences of work disability within their life circumstances.

Conclusions : Insights into an individual's perceptions of their impairment and the personal relevance of work can promote a better understanding of return to work behaviour. Integrating individual perceptions is essential to advancing a multidimensional approach in return to work research.     

Maternal return to work and breastfeeding: A population-based cohort study

Background

In recent decades there has been a marked rise in the participation of women with infants in the labour market, while there has been a decline in the prevalence rate of breastfeeding.

Objective

To explore the relationship between maternal return to work and breastfeeding.

Design

An on-going prospective longitudinal study.

Setting and participants

Multistage stratified systematic sampling was designed to recruit 24,200 pairs, postpartum women and newborns, from the Taiwan national birth register in 2005. Participating women underwent two home interviews at 6 and 18 months after giving birth, following structured questionnaires. A total of 21,248 and 20,172 women were interviewed, and the completed interview rate was thus 87.8% and 83.4% at 6 and 18 months, respectively. All study participants provided informed consent as approved by the Ethics Review Board of the National Taiwan College of Public Health.

Results

The overall prevalence of initial breastfeeding was 83.7%. Postpartum women returning to work less than or equal to 1 month had the lowest initiation of breastfeeding rate (77.5%), but had a higher prevalence of breastfeeding duration less than or equal to 1 month (34.9%) than the overall population (26.8%). Overall 67.9%, 39.4%, 25.4%, and 12.7% mothers who started breastfeeding still breastfed their infants at the age of 1, 3, 6 and 12 months, respectively. Women with maternal leave of less than or equal to 6 months ceased breastfeeding earlier than those with maternal leave beyond 6 months and those who did not return to work up to 18 months after birth. After adjustment for potential confounders, odds ratios of initial breastfeeding seemed no different, except those for postpartum women who returned to work less than or equal to 1 month and those who did not return to work. Mothers returning to work within 1 year after giving birth were significantly earlier in weaning than those without return to work.

Conclusion

In our study, an early maternal return to work, especial within 6 months after giving birth, was a barrier to the initiation and continuation of breastfeeding. Thus, a comprehensive strategy is required to encourage the practice of breastfeeding in working women from pregnancy to the return to work, and nurses should work to promote breastfeeding in the different occasion.     

Occupational categories and return to work after traumatic brain injury: a multicenter study

OBJECTIVE: To further evaluate determinants of return to work (RTW) after traumatic brain injury (TBI), with focus on the relation between preinjury occupational category and RTW outcome. DESIGN: Prospective collaborative cohort study. SETTING: Seventeen National Institute on Disability and Rehabilitation Research-designated Traumatic Brain Injury Model Systems. PARTICIPANTS: Consecutive sample of 1341 patients (age range, 18-62y) who were hospitalized with a TBI diagnosis, received both acute neurotrauma services and inpatient rehabilitation services, consented to participate, were employed before injury, and completed a 1-year follow-up assessment. INTERVENTION: An inpatient interdisciplinary brain injury rehabilitation program. MAIN OUTCOME MEASURE: Competitive employment at 1 year postinjury. RESULTS: Participants were categorized into 1 of 3 groups depending on preinjury occupational title: professional/managerial (n=192), skilled (n=751), or manual labor (n=398). Chi-square analyses were computed to examine changes across occupation groups between preinjury occupation group and postinjury RTW. The rate of successful RTW was greatest for professional/managerial (56%), lower for skilled (40%), and lowest for manual labor (32%), yielding an odds ratio of 2.959 between the highest and lowest groups. Of those with successful RTW, most did so within the same occupational category grouping. A multiple logistic regression showed that preinjury occupation, education level, discharge FIM score, age, sex, marital status, and hospital length of stay each influenced RTW. CONCLUSIONS: Prior research has shown that preinjury employment status (employed vs unemployed) greatly influences the odds of successful RTW after TBI. A related hypothesis, that occupational classification also influences RTW outcome, has been understudied and has yielded conflicting results. The current study shows convincingly that the type of occupation influences RTW outcome, with the best prospect for RTW among people with professional/managerial jobs. Occupational category should be examined in the future development of predictive models for RTW after TBI.     

Stability of return to work after a coordinated and tailored intervention for sickness absence compensation beneficiaries with mental health problems: results of a two-year follow-up study

Abstract

Purpose: Mental health problems (MHPs) are increasingly common as reasons for long-term sickness absence. However, the knowledge of how to promote a stable return to work (RTW) after sickness absence due to MHPs is limited. The purpose of this study was to assess the effects of a multidisciplinary, coordinated and tailored RTW-intervention in terms of stability of RTW, cumulative sickness absence and labour market status after 2 years among sickness absence compensation beneficiaries with MHPs. Methods: In a quasi-randomised, controlled trial, we followed recipients of the intervention (n?=?88) and of conventional case management (n?=?80) for 2 years to compare their risk of recurrent sickness absence and unemployment after RTW, their cumulative sickness absence and their labour market status after 2 years. Results: We found no statistically significant intervention effect in terms of the risk of recurrent sickness absence or unemployment. Intervention recipients had more cumulated sickness absence in year one (mean difference?=?58 days; p?<?0.01) and year two (mean difference?=?36 days; p?=?0.03), and fewer were self-supported at the end of follow-up (52% versus 69%; p?=?0.02). Conclusion: The intervention showed no benefits in terms of improved stability of RTW, reduced sickness absence or improved labour market status after 2 years when compared to conventional case management.

• Implications for Rehabilitation

• Evidence for effective return-to-work (RTW) interventions for people with mental health problems is limited, as most research to date has been done in the context of musculoskeletal disorders.

• A complex, multidisciplinary intervention, detached from the workplace, does not appear to improve the stability of RTW and may actually lead to more sickness absence days and less self-support when compared to conventional case management of sickness absence beneficiaries in Denmark.

• A stronger focus on cooperation with social insurance officers and employers may produce better results.

     

Predictors of return to work following traumatic work-related lower extremity amputation

Purpose. To determine factors predictive of return to work (RTW) and days of total disability (TD) in a population of persons working at the time of lower extremity amputation.

Method. Retrospective chart and database review.

Results. Of 88 valid cases, 48% involved toe amputation, 23% transtibial, 14% partial foot, 14% transfemoral, and 2% high level. Fifty-eight percent of all subjects RTW, 19% were deemed 'fit for work', and 23% did not RTW. Days TD ranged from 0 to 1664, with a mean of 366 days. Toe amputation level showed a mean of 127 days of TD. Bivariate analysis showed amputation level, total costs to Workers Compensation Board (WCB), and days TD significantly related to RTW, and rehabilitation costs, vocational rehabilitation, work assessment, age, number of surgical procedures, number of days in acute care, and amputation level significantly related to days TD. In the multivariate model, only amputation level and higher gross annual income showed predictive value for RTW. However older age, more surgical procedures, less days in hospital, and higher amputation levels were all predictive of increased days TD.

Conclusion. Toe amputation level had a surprisingly high number of days TD, which may have significant potential economic and disability impact on the workplace. Other factors beyond simply amputation level (such as previous income level) are important considerations for RTW.