Characteristics of disability pensioners returning to work: an interview study among individuals with musculoskeletal disorders

Purpose. To explore adaptation patterns among disability pensioners with musculoskeletal disorders returning to work by means of the Swedish law on 'resting disability pension'.

Method. Qualitative analyses of interviews with 17 individuals going back to work.

Results. Three adaptation patterns were identified: The Go-getter, the Realist and the Indifferent. These differed regarding influence factors, own expectations, motive, morals and mentality.

Conclusion. Several actors may support a return to work for individuals who received a disability pension due to musculoskeletal disorders. In order to succeed, however, it is essential that the disability pensioner is motivated for a reconstruction of his/her life.     

Relationship between the margin of manoeuvre and the return to work after a long-term absence due to a musculoskeletal disorder: an exploratory study

Purpose.?The application of the margin of manoeuvre (MM) concept in work rehabilitation is new. It allows for variations in both health status and work demands, and the interaction between the two, to be taken into account. The objective of this exploratory study was to document the relationship between the presence of an MM in the workplace and the return to work (RTW), after a long-term absence.

Methods.?This study used the data collected during an earlier study that sought to identify the dimensions and indicators of the MM. The data were analysed on three levels, and the convergences and divergences in the MM indicators and dimensions in relation to the RTW were grouped accordingly.

Results.?Eleven workers and five clinicians participated in this study. The results support the proposition that the presence of a sufficient MM in the workplace is associated with RTW of individuals at the end of a rehabilitation programme despite a long-term absence (n == 6), and conversely, that its absence would appear to be associated with a non-return to work (n == 4).

Conclusions.?A better understanding of this concept will help further the development of a tool to assist clinicians in their task of assessing a worker's capacity to return to a given job.     

Barriers against returning to work--as perceived by disability pensioners with back pain: a focus group based qualitative study

Purpose. The aim of this study was to explore the issue of perceived barriers for returning to work, based on the experiences and beliefs in a group of disability pensioners with back pain.

Method. Focus groups were used to interview 12 women and five men, aged 38 - 56, who participated in a larger project aiming to help disability pensioners back to work.

Results. The barriers appearing were related to earlier negative experiences, poor self-judgement of work ability and low self-esteem, lack of support from social security authorities and unsuitable economic arrangements. The pensioners also suggested alternative solutions for making a possible return to work.

Conclusions. Our study provides insight into the perceived barriers of returning to work and might be useful in future efforts aiming to help disability pensioners back to work.     

Capturing complexity in work disability research: application of system dynamics modeling methodology

Background: Work disability (WD) is characterized by variable and occasionally undesirable outcomes. The underlying determinants of WD outcomes include patterns of dynamic relationships among health, personal, organizational and regulatory factors that have been challenging to characterize, and inadequately represented by contemporary WD models. Method: System dynamics modeling (SDM) methodology applies a sociotechnical systems thinking lens to view WD systems as comprising a range of influential factors linked by feedback relationships. SDM can potentially overcome limitations in contemporary WD models by uncovering causal feedback relationships, and conceptualizing dynamic system behaviors. It employs a collaborative and stakeholder-based model building methodology to create a visual depiction of the system as a whole. SDM can also enable researchers to run dynamic simulations to provide evidence of anticipated or unanticipated outcomes that could result from policy and programmatic intervention. Discussion: SDM may advance rehabilitation research by providing greater insights into the structure and dynamics of WD systems while helping to understand inherent complexity. Challenges related to data availability, determining validity, and the extensive time and technical skill requirements for model building may limit SDM's use in the field and should be considered.

• Implications for Rehabilitation

• Contemporary work disability (WD) models provide limited insight into complexity associated with WD processes.

• System dynamics modeling (SDM) has the potential to capture complexity through a stakeholder-based approach that generates a simulation model consisting of multiple feedback loops.

• SDM may enable WD researchers and practitioners to understand the structure and behavior of the WD system as a whole, and inform development of improved strategies to manage straightforward and complex WD cases.

     

Exploring the return-to-work process for workers partially returned to work and partially on long-term sick leave due to common mental disorders: a qualitative study

Purpose.?We conducted a qualitative study into the return-to-work process of workers partially on sick leave due to common mental disorders. Our objectives were to describe the barriers to a full return to work, solutions, communicating to the working environment and the aim of a full return to work, all as perceived by the workers.

Method.?Workers who had partially returned to work and were partially on long-term sick leave due to a stress-related, anxiety or depressive disorder were eligible for this study. Fourteen workers were interviewed and the interviews were transcribed verbatim and coded.

Results.?The perceived main barriers were: inability to set limits, recognise exhaustion and to control cognitions and behaviour such as perfectionism. A general pattern in the process was that all workers perceived barriers to a full return to work; most workers were able to mention solutions; all workers aimed for a full return to work, and after some time all workers were met with sufficient understanding and social support from their supervisor and health care professional. However, hardly any worker intended to implement or utilise the solutions at the workplace, except the structural adaptations of the work demands.

Conclusions.?The pattern we found suggests a critical intention–behaviour gap between solutions and intentions for a full return to work and its implementation at work. This implies that we should develop new interventions that focus on helping workers and their environment to bridge this gap.     

Work disability negotiations: supervisors’ view of work disability and collaboration with occupational health services

Purpose: To introduce the Finnish practice of collaboration aiming to enhance work participation, to ask supervisors about its reasons and usefulness, to study supervisors’ needs when they face work disability, and to compare the experiences of supervisors whose profiles differ.

Materials and methods: An online questionnaire based on the Finnish practice of collaboration between supervisor and occupational health services (OHS) went to supervisors in six public and private organizations. A total of 254 supervisors responded, of whom, 133 (52%) had collaborated in work disability negotiations, representing a wide variety with differing professional profiles.

Results: In their role of managing work disability, supervisors appeared to benefit from three factors: an explicit company disability management (DM) policy, supervisors’ training in DM, and collaboration with OHS. Reasons for work disability negotiations were long or repeated sick-leaves and reduced work performance. Expectations for occupational health consultations focused on finding vocational solutions and on obtaining information. Supervisors assessed the outcomes of collaboration as both vocational and medical. Supervisors with differing professional profiles prioritized slightly different aspects in collaboration.

Conclusions: Collaboration with OHS is an important option for supervisors to enhance work modifications and the work participation of employees with work disability.

• Implications for Rehabilitation

• Work disability negotiation between supervisor, employee, and occupational health services (OHS) is an effective method to enhance work participation.

• Collaboration with occupational health can advance work modifications and also lead to medical procedures to improve work performance.

• Supervisor training, companies’ explicit disability management policy, and collaboration with OHSs all advance employee’s work participation.

• Collaboration with OHSs may serve as training for supervisors in their responsibility to support work participation.

     

Able or unable to work? Life trajectory after severe occupational injury

Purpose: To study the probabilities and permanence of return to work, inability to work and rehabilitation, and to explore the connection between these life situations and later working after a severe occupational injury.

Materials and methods: A historical cohort of Finnish workers with a severe occupational injury during 2008 (N?=?11,585) were followed up annually on the outcomes of return to work over a 5-year observation period. We examined transition probabilities from one life situation to another with Markov chain analysis, and applied logistic regression with generalized estimating equations to assess the effect of register-based determinants on return to work.

Results: Within the five anniversaries, 85% of the injured were working, 9% were unable to work (fully or partly) and 2% received rehabilitation. Age, gross annual income, type of work, injured body part, injury type and the injured’s annual condition subsequent to the work injury were significant determinants of return to work.

Conclusions: The probability of return to work decreased with time, but, on average, one-fifth of the injured workers succeeded in return to work after being unable to work on the previous anniversary, which indicates that it is worthwhile to conduct efforts for this target group in order to promote return to work.

• Implications for Rehabilitation

• The current life situation of the injured should be taken into account when promoting return to work, as it is a strong predictor of later working after a serious occupational injury.

• Rehabilitation and return to work programs should start in time due to declining return to work rates as the disability continues.

• Return to work on a part-time basis could be a good option during the early phases of recovery, since a notable proportion of those partly unable to work on the first anniversary returned later to full-time workers.

• The probability of recovery is relatively high even for those with long-term disabilities, so the promotion of return to work is highly recommended also for this target group.

     

Does the number of musculoskeletal pain sites predict work disability? A 14-year prospective study

Various risk factors associated with disability pensioning have been reported. This study investigated the relationship between the number of pain sites and risk of receiving a disability pension. We hypothesised that risk of work disability would increase as the number of pain sites increased, even after controlling for potential confounders. In 1990 and 2004, questionnaire on musculoskeletal pain was sent via post to six age groups in Ullensaker, Norway. Data on demographic, health and work‐related variables were also collected. After excluding individuals due to reach retirement age in 2004, we followed 1354 (66%) persons who were classified in 1990 as “employed”, “unemployed”, “homemaker”, or “student”. Among them, 176 persons had received long‐term or permanent work disability pension in 2004. Bivariate analyses showed that the prevalence of disability pensions was strongly associated with the number of pain sites. Controlling for gender and age almost unaltered the relationship. However, a model controlling for all significant confounders showed that general health and sick leave previous year captured almost all the predictive power of the number of pain sites on work disability. Since these variables could be seen as intermediate variables and not confounders, they were excluded in a new model which gave a strong “dose–response” relationship between number of pain sites and disability with a 10‐fold increase from 0 to 9–10 pain sites. The predictive validity of the number of pain sites in determining future disability renders this simple measurement useful for future research on musculoskeletal pain and functioning.     

基于Web of Science数据库乳腺癌患者重返工作研究的文献计量学分析

目的:分析近20年乳腺癌患者重返工作研究的热点和前沿问题,为今后的研究提供参考依据。方法:系统检索2000年1月1日—2020年12月1日Web of Science数据库中与乳腺癌患者重返工作相关的文献。采用VOSviewer 1.6软件进行作者个体、机构、国家合作网络共现分析;采用CiteSpace 5.7.R2软...     

Factors associated with generalized anxiety in workers undergoing work rehabilitation for persistent musculoskeletal pain

Abstract

Purpose: To document in workers having a work disability due to a musculoskeletal disorder (MSD), the presence and variation over time of their intolerance of uncertainty and its maintenance factors as defined in Dugas et al.’s generalized anxiety disorder (GAD) model, i.e. worries, negative problem orientation, beliefs about the usefulness of worrying, cognitive avoidance and their consequences on depressive symptoms. Methods: An observational, prospective repeated-measures design was retained. Thirty-nine workers with an MSD having caused a work absence of over three months and who were beginning a work rehabilitation program were recruited and evaluated at four moments (beginning of rehabilitation program, first hours of work exposure, 50% of regular working hours and end of rehabilitation program). Validated self-report questionnaires measuring intolerance of uncertainty and its maintenance factors were administered. Finally, the Worry and Anxiety Questionnaire measured the presence and intensity of GAD symptoms as defined in the DSM-IV-TR. Results: Fifty percent of the workers initially exhibited GAD symptoms. Concerning the variation over time, improvements were noted in all GAD-related factors during the program, particularly with the first hours of work exposure. At the end of rehabilitation, only 21% of the participants still met GAD diagnostic criteria. Conclusion: Workers with an MSD causing a work disability averaging one year in length and enrolled in a work rehabilitation program exhibited a high level of anxiety at the beginning of the work rehabilitation program. Workers perceived a usefulness in worrying and presented some intolerance of uncertainty and some cognitive avoidance strategies. According to Dugas et al.’s GAD model, the intensity of the symptoms associated with GAD development and maintenance factors was, however, not typical of a GAD.

• Implication for Rehabilitation

• A reconceptualization of the problem in terms of reducing the work disability rather than reducing pain may constitute a promising avenue to reduce anxiety symptoms.

• Future studies should look at the specific impact of work exposure, not only on pain symptoms but also on worries.

• The high level of anxiety and the reported worries by workers stresses the importance of studying the hypothesis of a workplace phobia in order to improve clinical practice guidelines.

     

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.

     

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.     

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

     

Factors promoting staying at work in people with chronic nonspecific musculoskeletal pain: A systematic review

Purpose: To identify determinants for staying at work (SAW) in workers with chronic musculoskeletal pain (CMP). Method: A systematic review of factors that promote SAW in workers with CMP. We searched the databases of PubMed, EMBASE, PsycInfo, CINAHL and the Cochrane Library. We included studies reporting on working subjects without present CMP-related sick leave. A quality assessment of GRADE criteria and evidence synthesis was performed. Results: We identified five cross-sectional studies and two qualitative studies reporting on factors associated with SAW in workers with CMP. Consistent association with SAW was found for low perceived physical disability and low emotional distress (low-level evidence). Duration of pain, catastrophizing, self-esteem and marital status were not associated with SAW (low-level evidence). Qualitative studies indicated that personal adjustments and workplace interventions are important determinants for SAW (evidence not graded). Conclusions: No high-level evidence for SAW determinants for workers with CMP was identified. Future interventions aimed at promoting SAW could consider reducing perceived physical disability and emotional distress, and promoting adjustment latitude at work, support from supervisors, and the workers’ motivation and self-management skills. Further research is required because knowledge of SAW in workers with CMP is scarce, and the relevance of the subject is high.

Implications for Rehabilitation

• When modifiable factors that promote staying at work can be identified, interventions can be developed to support the ability of workers with chronic nonspecific musculoskeletal pain to stay at work.

• Consistent evidence of promoting staying at work was found for low emotional distress and perceived physical disability, while duration of pain, catastrophizing, self-esteem and marital status were consistently not associated.

• Future interventions aimed at promoting staying at work should consider reducing perceived physical disability and emotional distress.

     

Treatment of chikungunya musculoskeletal disorders: a systematic review

Introduction: Chikungunya virus is amongst the fastest expanding vector transmissible diseases in recent years and has been causing massive epidemics in Africa, Asia, Latin America and the Caribbean. Despite human infection by this virus being first described in the 1950s, there is a lack of adequate therapeutic evaluations to guide evidence-based recommendations. The current guidelines rely heavily in specialists’ opinion and experience instead of using higher rated evidence.

Areas covered: A systematic review of the literature was performed- not restricted to clinical trials – reporting the therapeutic response against this infection with the intent to gather the best evidence of the treatment options against musculoskeletal disorders following chikungunya fever. The 15 studies included in the analysis were categorized considering the initiation of treatment during the acute, subacute and chronic phase.

Expert commentary: This review demonstrates the complexity of chikungunya fever and difficulty of therapeutic management. This review found no current evidence-based treatment recommendations for the musculoskeletal disorders following chikungunya fever. To provide an optimal treatment that prevents perpetuation or progression of chikungunya infection to a potentially destructive and permanent condition without causing more harm is an aim that must be pursued by researchers and health professionals working with this disease.     

The utility of measuring sexual disability for predicting 1-year return to work

Gross DP, Knupp H, Esmail S. The utility of measuring sexual disability for predicting 1-year return to work.

Objective

To explore sexual disability in injured workers undergoing rehabilitation. Specifically, we investigated (1) factors associated with high ratings of sexual disability, (2) factors associated with noncompletion of the sexual disability questionnaire, and (3) the association between sexual disability and future recovery.

Design

Historical cohort study with 1-year follow-up.

Setting

Workers' compensation rehabilitation facility.

Participants

Workers' compensation claimants (N=1078) undergoing return-to-work assessment. Ratings of sexual disability were measured using the Sexual Behavior item of the Pain Disability Index. Other demographic, clinical, and occupational factors also were collected.

Intervention

Not applicable.

Main Outcome Measures

Outcomes included administrative indicators of timely and sustained recovery and return to work.

Results

Of subjects included in analysis, 18.5% did not complete the Sexual Behavior item. Claimants were less likely to complete if they were women, older, and single; had lower salaries, injury diagnoses other than sprain/strain, and fewer health visits before assessment; and reported lower recovery expectations. Higher levels of sexual disability were associated with higher levels of overall pain and disability, as well as being in a married/common law relationship. After adjusting for injury duration, the Sexual Behavior item was not associated significantly with any recovery measure or claims outcome.

Conclusions

A response bias exists in Canadian injured workers asked to complete a sexual disability rating. In those completing the questionnaire, higher sexual disability was associated most closely with higher pain severity and higher disability. Perceptions of sexual disability did not contribute to predicting recovery, which supports replacement of this item for use within this and related contexts.