Cooperation of return-to-work professionals: the challenges of multi-actor work disability management

Purpose: This article explores which concrete factors hinder or facilitate the cooperation of return-to-work (RTW) professionals in a complex system of multiple stakeholders.

Method: The empirical material consists of in-depth interviews with 24 RTW professionals from various organizations involved in work disability management in Finland. The interviews were analyzed using thematic content analysis.

Results: The study revealed several kinds of challenges in the cooperation of the professionals. These were related to two partly interrelated themes: communication and distribution of responsibility. The most difficult problems were connected to the cooperation between public employment offices and other stakeholders. However, the study distinguished notable regional differences depending primarily on the scale of the local network. The main areas of improvement proposed by the interviewees were related to better networking of case managers and expansion of expertise.

Conclusions: The article argues for the importance of systematic networking and stresses the role of public employment services in the multi-actor management of work disabilities. The article contributes to existing work disability case management models by suggesting the employment administration system as an important component in addition to health care, workplace and insurance systems. The study also highlights the need for expansion of expertise in the field.

• Implications for Rehabilitation

• Cooperation between RTW professionals in public employment offices and other organizations involved in work disability management was considered inadequate.

• In order to improve the cooperation of RTW professionals, the stakeholders need to create more systematic ways of communication and networking with professionals in other organizations.

• There is a need to expand the expertise in work disability management and rehabilitation, partly by increasing the role of other professionals than physicians.

     

急性职业性手外伤患者回归工作的影响因素分析

目的：探讨影响急性职业性手外伤患者回归工作（RTW）的因素,以期为工伤职工回归工作提供参考。方法：对福州地区60例急性职业性手外伤患者通过电话采访进行问卷调查,调查内容包括受伤的类型、职业、工作性质、教育程度、损伤部位、住院时间、受伤归因、单位的性质、雇佣类型、伤前对工作的满意度、伤前与同事间关系、是否为家庭主要劳动力、工伤保险状况以及是否接受正规康复治疗等。采用单因素相关分析和Logistic回归分析方法获得影响返回工作岗位的潜在因素。结果：在被调查的内容中得到4个有意义的影响因素,包括工作类型（白领）（OR=19.195,95%可信区间为1.001~368.014）、受伤归因（内因）（OR=6.256,95%可信区间为1.024~38.215）、伤前与同事有良好关系（OR=11.016,95%可信区间为1.715~70.755）及是家庭主要劳动力（OR=10.568,95%可信区间为1.528~73.086）。结论：RTW是一个受多因素影响的过程。     

The relative effectiveness of practice change interventions in overcoming common barriers to change: a survey of 14 hospitals with experience implementing evidence-based guidelines

AIMS AND OBJECTIVES: Changing practice to reflect current best evidence can be costly and time-consuming. The purpose of this survey was to determine the optimal combination of practice change interventions needed to overcome barriers to practice change commonly encountered in the intensive care unit (ICU). DESIGN: A survey instrument delivered by mail with email follow-up reminders. SETTING: Fourteen hospitals throughout Australia and New Zealand. SUBJECTS: Individuals responsible for implementing an evidence-based guideline for nutritional support in the ICU. SURVEY: Practice change interventions were ranked in order of effectiveness and barriers to change were ranked in order of how frequently they were encountered. RESULTS: A response rate of 100% was achieved. Interventions traditionally regarded as strong (academic detailing, active reminders) were ranked higher than those traditionally regarded as moderate (audit and feedback), or weak (posters, mouse mats). The high ranks of the site initiation visit (educational outreach, modest) and in-servicing (didactic lectures, weak) were unexpected, as was the relatively low rank of educationally influential, peer-nominated opinion leaders. Four hospitals reported the same doctor-related barrier as 'most common' and the remaining 10 hospitals reported three different doctor-related barriers, two nursing-related barriers and three organizational barriers as most common. CONCLUSIONS: When designing a multifaceted, multi-centre change strategy, the selection of individual practice change interventions should be based on: (1) an assessment of available resources; (2) recognition of the importance of different types of barriers to different sites; (3) the potential for combinations of interventions to have a synergistic effect on practice change, and (4) the potential for combinations of interventions to actually reduce workload.     

Health,work, and personal-related predictors of time to return to work among employees with mental health problems

Purpose: To identify health-, personal- and work-related factors predictive of return to work (RTW) in employees sick-listed due to common mental health problems, such as, stress, depression, burnout, and anxiety. Methods: We distributed a baseline questionnaire to employees applying for sickness absence benefits at a large Danish welfare Department (n?=?721). A total of 298 employees returned the questionnaire containing information on possible predictors of RTW. We followed up all baseline responders for a maximum of one year in a national registry of social transfer payments, including sickness absence benefits. Results: At baseline, about 9% of respondents had quit their job, 10% were dismissed and the remaining 82% were still working for the same employer. The mean time to RTW, measured from the first day of absence, was 25 weeks (median?=?21) and at the end of follow-up (52 weeks) 85% had returned to work. In the fitted Cox model we found that fulfilling the DSM-IV criteria for depression predicted a longer time to RTW (HR: 0.61, CI: 0.45–0.84), whereas a better self-rated health predicted a shorter time to RTW (HR: 1.18, CI: 1.03–1.34). Employees working in the municipal (HR: 0.62, CI: 0.41–0.94) and private sector (HR: 0.65, CI: 0.44–0.96) returned to work slower compared to employees working in the governmental sector. Gender, education, cohabitation, size of workplace, low-back and upper-neck pain and employment at baseline did not predict RTW. Conclusion: Our results indicate that time to RTW is determined by both health- and work-related factors.

Implications for Rehabilitation

• Common mental health problems are one of the leading causes for sickness absence and work disability

• Return to work after sickness absence is not solely determined by improvements in health but is also affect by individual and work related factors

• This study showed that self-rated health, occupational sector and depression are predictors of time to return to work in employees with mental health problems

     

The relationship between post-traumatic growth and return to work following mild traumatic brain injury

Abstract

Purpose: To investigate the prevalence of post-traumatic growth (PTG) following mild traumatic brain injury (mTBI) and to examine whether PTG is associated with vocational status.

Materials and methods: Archival data from a random sample of 74 individuals who sustained mTBI (mean age: 43.23; male, 55%) were obtained from a larger sample of litigating patients who were referred for a neuropsychological examination. Factors associated with return to work were ascertained using a multiple regression analysis. The demographic variables age, sex, and education were added to the first block, whilst relating to others, new possibilities, personal strength, spiritual change, and appreciation of life, as measured by the Posttraumatic Growth Inventory (PTGI), were added in the second block.

Results: Approximately 31% of the sample exhibited moderate levels of PTG, as defined by endorsing a 3 or more on each item of the PTGI, with the most common aspects of PTG being appreciation of life, relating to others, and personal strength. The multiple regression analysis revealed that new possibilities and personal strength were independently associated with return to work.

Conclusions: Results of this study suggest that there is evidence for the development of PTG among individuals with mTBI. These findings have important implications for rehabilitation planning, individual and family adjustment, and the prediction of long-term outcome as it pertains to return to work in particular.

• Implications for Rehabilitation

• Return to work is an integral component of rehabilitation following mild traumatic brain injury (mTBI) and should not be overlooked.

• Results of this study indicate that post-traumatic growth (PTG) can be used to inform intervention approaches that seek to promote growth and resiliency post-injury.

• Informing patients about the prospects of a positive post-injury recovery trajectory could help manage the individual’s expectations of recovery.

     

Prognostic factors of return to work after traumatic or non-traumatic acquired brain injury

Purpose: To investigate and to determine evidence of prognostic factors for return to work (RTW) after acquired brain injury (ABI). Method: A systematic literature search was conducted in PubMed (2008–2014), applying terms for ABI and RTW. In addition, studies published after 2003 of a previous review on the same topic were added. The methodological quality of the included studies was assessed and evidence was classified. Results: Twenty-seven studies were included. There is strong evidence that a high education level is positively associated with RTW after traumatic ABI; a low education level, unemployment and length of stay in rehabilitation are negatively associated, and a clear tendency has been deduced from the studies that conscious state in the Emergency Department is not associated with RTW. After non-traumatic ABI, there is strong evidence that independence in activities of daily living is positively associated with RTW and aetiology of stroke is not. Conclusions: This study confirms earlier findings that after both traumatic and non-traumatic ABI injury related factors in the Emergency Department are not associated with RTW. In addition, it provides further evidence that personal factors after traumatic ABI and activity-related factors after non-traumatic ABI are strongly associated with RTW.

• Implications for Rehabilitation

• We found strong evidence for a significant association between RTW and personal factors (education level, unemployment) after traumatic ABI, and activities of daily living (ADL) after non-traumatic ABI.

• We advise to focus on work-related activities during the RTW process besides ADL-training and pay attention to and support patients at risk for not returning to work.

     

参与式人体工效学干预对腰背损伤患者复工意愿的影响

摘要目的：探讨参与式人体工效学干预方案对腰背损伤患者复工意愿的影响。方法：将符合标准的64例腰背损伤患者,随机分成对照组（33例）和试验组（31例）。对照组给予常规职业康复训练,试验组给予常规职业康复训练+参与式人体工效学干预,分别在干预前和干预4周后对两组患者进行腰背功能评估（SFS）、就业意愿评估（LASER）、恐惧-回避信念评估（FABQ）。结果：干预前,两组患者在各项指标上没有明显差异（P>0.05）。干预4周后,两组患者在腰背功能自评、就业意愿评估上都有明显改善（P<0.05）,且试验组的评价指标显著优于对照组（P<0.05）。试验组恐惧-回避信念明显下降（P<0.05）,对照组下降不明显（P>0.05）。结论：参与式人体工效学干预结合可提高腰背痛患者对腰背功能的自我感知、降低恐惧-回避信念,提高就业意愿。     

Returning to work after spinal cord injury: exploring young adults' early expectations and experience

Purpose.?The study sought to explore experience and expectations about paid work among young adults on sick leave after spinal cord injury (SCI).

Method.?Eight participants with traumatic SCI, who were 20–34 years of age, and had not yet returned to work 1–5 years post-injury, were interviewed. Selection was made with purposive sampling. Data were analysed using a constant comparative method.

Results.?Four main themes emerged as relevant: ‘finding your way to an everyday life where work is possible’, ‘at the crossroads, expectations of work through education’, ‘expectations of paid work as part of a desired future life’ and ‘expectations of finding a solution within oneself or with help from others’. The findings reveal high expectations of work ability but at the same time difficulties to plan for return to work and lack of support in this process.

Conclusions.?The participants represent a vulnerable group in vocational rehabilitation due to their young age and recent injury. Without formal training or suitable work experience, they need tailored work support as part of their general rehabilitation.     

Self-rated health as a predictor of return to work among employees on long-term sickness absence

Aims.?The aim of the present study is to identify self-rated health predictors of return to work (RTW) within the study population as a whole as well as in three subgroups, namely musculoskeletal complaints, other physical health complaints, and psychological complaints.

Methods.?The study was based on a sample of 862 employees on sickness absence (maximum duration of 12 weeks). The employees filled out a baseline questionnaire and were subsequently followed until the tenth month after listing sick. Cox proportional hazards regression analyses were used to identify determinants of RTW.

Results.?For the study population as a whole type of complaint, earlier sickness absence, subjective severity of complaints and several RAND-36 subscales were predictive of RTW. Furthermore, the RAND-36 subscales physical functioning, physical role limitations, mental health, and health change were predictive of RTW among employees with musculoskeletal complaints. For employees with other physical health problems subjective severity of complaints and the RAND-36 subscales physical and social functioning, general health perception, and health change were associated with RTW. Finally, with regard to the group with psychological complaints the RAND-36 subscales mental health and general health perception predicted RTW.

Conclusion.?Several aspects of self-rated health predict RTW for employees on long-term sickness absence. Variables related to functional status predict RTW for employees with physical complaints in contrast to psychological problems.     

Self-rated health as a predictor of return to work among employees on long-term sickness absence

Aims. The aim of the present study is to identify self-rated health predictors of return to work (RTW) within the study population as a whole as well as in three subgroups, namely musculoskeletal complaints, other physical health complaints, and psychological complaints.

Methods. The study was based on a sample of 862 employees on sickness absence (maximum duration of 12 weeks). The employees filled out a baseline questionnaire and were subsequently followed until the tenth month after listing sick. Cox proportional hazards regression analyses were used to identify determinants of RTW.

Results. For the study population as a whole type of complaint, earlier sickness absence, subjective severity of complaints and several RAND-36 subscales were predictive of RTW. Furthermore, the RAND-36 subscales physical functioning, physical role limitations, mental health, and health change were predictive of RTW among employees with musculoskeletal complaints. For employees with other physical health problems subjective severity of complaints and the RAND-36 subscales physical and social functioning, general health perception, and health change were associated with RTW. Finally, with regard to the group with psychological complaints the RAND-36 subscales mental health and general health perception predicted RTW.

Conclusion. Several aspects of self-rated health predict RTW for employees on long-term sickness absence. Variables related to functional status predict RTW for employees with physical complaints in contrast to psychological problems.     

How policy on employee involvement in work reintegration can yield its opposite: employee experiences in a Canadian setting

Purpose: Canada has a long tradition of involving employee representatives in developing work reintegration policies and expects this to positively affect employee involvement to improve work reintegration success. The purpose of this study was to examine employee involvement in reintegration in a Canadian province as experienced by employees. Method: Fourteen semi-structured interviews were held with employees in a healthcare organization. The interview topic list was based on a review of local reintegration policy documents and literature. Interviews were transcribed verbatim and analysed using ethnographic methodology. Results Employees do not feel in control of their reintegration trajectory. In the phase of reporting sickness absence, they wrestle with a lack of understanding on how to report in sick. In the phase of reintegration planning and coordination, they hesitate to get involved in the organization of reintegration. In the phase of reintegration plan execution, employees encounter unfulfilled expectations on interventions. Conclusion: Employee involvement in the organization of reintegration makes them responsible for the development of reintegration trajectories. However, they consider themselves often incapable of completing this in practice. Moreover, employees experience that their contribution can boomerang on them.

Implications for Rehabilitation

• It is not that employees are not able to think along or decide on their reintegration trajectory but rather they are expected to do so at times when they cannot oversee their illness and/or recovery trajectory.

• Settings out reintegration procedures that are inflexible in practice do not recognize that employee involvement in work reintegration trajectories can develop over time.

• The disability management professional has a central role in organizing and supporting employee involvement in work reintegration, however, the employees do not experience this is indeed happening.

     

Provider-identified barriers and facilitators to implementing a supported employment program in spinal cord injury

Purpose: In a 5-year study, individual placement and support (IPS) significantly increased employment rate of United States Veterans with spinal cord injury (SCI), a historically underemployed population. In a follow-up study, data on barriers and facilitators to IPS implementation were identified.

Methods: Over 24?months of implementation, 82?key medical and vocational staff underwent semi-structured interviews (n?=?130). Interviews were digitally recorded and qualitatively analyzed (ATLAS.ti v0.7) using a constant comparative method to generate themes.

Results: Some barriers to implementation occurred throughout the study, such as Veterans’ lack of motivation and providers’ difficulty integrating vocational and medical rehabilitation. Other barriers emerged at specific stages, for example, early barriers included a large geographic service area and a large patient caseload, and late barriers included need for staff education. Facilitators were mostly constant throughout implementation and included leadership support and successful integration of vocational staff into the medical care team.

Conclusions: Implementation strategies need to be adjusted as implementation progresses and matures. The strategies that succeeded in this setting, which were situated in a real-world context of providing IPS as a part of SCI medical care, may inform implementation of IPS for other populations with physical disabilities.

• Implications for Rehabilitation

• Key facilitators to IPS in SCI implementation are integrating vocational staff with expertise in IPS and SCI on clinical rehabilitation teams and providing leadership support.

• Ongoing barriers to IPS in SCI include patient specific and program administration factors such as caseload size and staffing patterns.

• Varying implementation strategies are needed to address barriers as they arise and facilitate successful implementation.

     

Return to work for severely injured survivors of the Christchurch earthquake: influences in the first 2 years

Purpose: This study looked at the influences on the return to work (RTW) in the first 2 years for people severely injured in the 22 February 2011 Christchurch earthquake. Method: We used a constructivist grounded theory approach using semi-structured interviews to collect data from 14 people injured in the earthquake. Results: Analysis elicited three themes that appeared to influence the process of RTW following the Christchurch earthquake. Living the earthquake experience, the individual’s experiences of the earthquake and how their injury framed their expectations; rebuilding normality, the desire of the participants to return to life as it was; while dealing with the secondary effects of the earthquake includes the earthquake specific effects which were both barriers and facilitators to returning to work. Conclusion: The consequences of the earthquake impacted on experience, process and outcome of RTW for those injured in the Christchurch Earthquake. Work and RTW appeared key tools to enhance recovery after serious injury following the earthquake.

• Implications for Rehabilitation

• The altered physical, social and economic environment must be considered when working on the return to work (RTW) of individuals with earthquake injuries.

• Providing tangible emotional and social support so injured earthquake survivors feel safe in their workplace may facilitate RTW.

• Engaging early with employers may assist the RTW of injured earthquake survivors.

     

Associations between socio-demographic factors,encounters with healthcare professionals and perceived ability to return to work in people sick-listed due to heart failure in Sweden: a cross-sectional study

Purpose: The aim of this study was to investigate associations between socio-demographic factors, experiences of positive/negative encounters with healthcare professionals, and the encounters' impact on the ability to return to work in a population of people on sick leave due to heart failure. Methods: This was a cross-sectional study. Data were collected from two official registries in Sweden and from a postal questionnaire. In all, 590 people with heart failure responded to the questionnaire. Associations between variables were calculated with bivariate correlation analyses and logistic regression analyses. Results: For people on sick leave due to heart failure, positive encounters with healthcare professionals are associated with being Swedish-born, female gender, and high income. People with high income are more likely to be supported back to work by positive encounters with healthcare professionals. To perceive that healthcare professionals believe in person's ability to return to work can be facilitating. Conclusions: Women, people who are not foreign-born, and people with high income are more likely to perceive encounters with healthcare professionals as positive. Healthcare professionals who work with rehabilitation for people with heart failure need to be aware of social inequalities and that being on sick leave is a process of change.

• Implications for Rehabilitation

• A failing heart limits everyday life implying risk for long-term sick leave. Even though there are rehabilitation programs for people with heart failure, vocational rehabilitation is often over-looked. The knowledge about factors associated with sick leave due to heart failure is scarce.

• Experiences of positive encounters with healthcare professionals were associated with being Swedish-born, female gender, and high income. People with high income were more likely to be supported back to work by positive encounters with healthcare professionals.

• Healthcare professionals who work with rehabilitation for people with heart failure can support patients with heart failure by showing them confidence and trust. However, they need to be aware that sick leave implies a process of change.

     

Return to work and quality of life in severely injured patients

Background. Little is known about the long-term consequences of severe injuries in terms of return to productivity and quality of life.

Methods. In this study we focused on the return to work status and quality of life in 53 severely injured patients (AIS/ISS ≥ 16, mean ISS 24, range 16 - 54), mean age 37 years, one to two years after the injury. Questions were asked concerning employment in the past and at present. Quality of life was measured by means of the Sickness Impact Profile (SIP) questionnaire. Injury-related parameters were analysed in order to study their relation with disablement.

Results. Of those patients who survived their injuries, 87% had resumed their former work. Only 10% of the patients received disability benefits. A mean SIP-total score of 6.7 was found, the mean SIP-physical score was 5.9 and the mean SIP-psychosocial score was 6.9. “No disability” (SIP score ≤ 3) was found in 55% of the patients, whereas 11% of the patients reported “severe disability” (SIP score ≥ 20). Age was a significant predictor of disablement (odds ratio 1.07). The Injury Severity Score (ISS), the length of hospital stay and the number of diagnoses did not predict disablement.

Conclusions. Although the results were obtained in a relatively small sample size, the return to work rate in the surviving severely injured patients appears to be excellent. The quality of life is good; the majority of patients are not disabled. Age (and not the ISS) seems to be a significant predictor of disablement.     

Return to work and quality of life in severely injured patients

Background. Little is known about the long-term consequences of severe injuries in terms of return to productivity and quality of life.

Methods. In this study we focused on the return to work status and quality of life in 53 severely injured patients (AIS/ISS ≥ 16, mean ISS 24, range 16 – 54), mean age 37 years, one to two years after the injury. Questions were asked concerning employment in the past and at present. Quality of life was measured by means of the Sickness Impact Profile (SIP) questionnaire. Injury-related parameters were analysed in order to study their relation with disablement.

Results. Of those patients who survived their injuries, 87% had resumed their former work. Only 10% of the patients received disability benefits. A mean SIP-total score of 6.7 was found, the mean SIP-physical score was 5.9 and the mean SIP-psychosocial score was 6.9. “No disability” (SIP score ≤ 3) was found in 55% of the patients, whereas 11% of the patients reported “severe disability” (SIP score ≥ 20). Age was a significant predictor of disablement (odds ratio 1.07). The Injury Severity Score (ISS), the length of hospital stay and the number of diagnoses did not predict disablement.

Conclusions. Although the results were obtained in a relatively small sample size, the return to work rate in the surviving severely injured patients appears to be excellent. The quality of life is good; the majority of patients are not disabled. Age (and not the ISS) seems to be a significant predictor of disablement.