Factors related to the return to work potential in persons with severe mental illness

Abstract

Objective: This cross-sectional study aimed at investigating the relationship between the return to work potential, according to the Worker Role Interview (WRI) assessment, and clinical characteristics and level of empowerment and occupational engagement among persons with severe mental illness who express their own interest in working. Methods: 120 participants entered the study. The WRI, the Brief Psychiatric and Rating Scale, a sociodemographic questionnaire, the Empowerment Scale, and the Profiles of Occupational Engagement in Severe mental illness were used for data collection. Correlation and regression analyses were used for statistics. Results: The return to work potential was significantly associated with having fewer symptoms, rehabilitation support or productive activities, and higher levels of engagement and empowerment. A younger age had an inverse relation to the lifestyle component in WRI. Depressive symptoms and occupational engagement explained 42% of the variance. Conclusions: The findings support the use of an empowerment approach, taking into account the clients’ symptoms, age, and time use. In addition, involvement in vocational support and productive activities may be advantageous early on in the recovery process.     

Experiences of the return to work process after stroke while participating in a person-centred rehabilitation programme

Background: In Sweden, less than 50% of those getting stroke in working age return to work (RTW). Effective rehabilitation programmes need to be developed and therapeutic aspects understood.

Aim: To explore and describe how persons with stroke experience their RTW process while participating in a person-centred rehabilitation programme focusing on RTW.

Materials and methods: Seven persons with mild or moderate stroke were interviewed twice during the intervention in the vocational training phase using semi-structured interviews. Data were analysed using grounded theory.

Results: Having a coordinator by their side gave support and guidance during the RTW process. Knowledge of stroke, strategies and a straightforward communication created a structure for the RTW process. Expressing one’s own wishes increased opportunities to influence and decide which path to follow in order to reach the goal.

Conclusion: Straightforward, open and recurring communication facilitated the possibility to adapt to the situation. These aspects increased insight and awareness which facilitated the RTW process.

Significance: The findings indicate that a precondition for a fruitful RTW process was that suitable platforms at work were created in which the actors involved could cooperate. This knowledge might also be valuable in the RTW process for people with other diagnosis.     

The narratives of 12 men with AIDS: exploring return to work

Analyses of life stories has increasingly been used to understand how different individuals interpret and respond to an experience such as the onset of disability. This paper presents findings of a prospective qualitative study of 12 men living with AIDS who attempted to return to paid employment. Narrative analysis of four interviews over 12 months was used to explore the relationship between return-to-work efforts and whether participants' narratives progressed, remained stable, or regressed. Findings suggest that the men who demonstrated progressive narratives recreated an identity including a view of themselves as workers and recaptured a sense of competence. Men with regressive narratives demonstrated decreased identity and competence while men with stable narratives showed little change in either identity or competence. This paper contributes to our understanding of how the framing of an illness or disability by an individual may influence the progression of his life history narrative.     

Assessment of clients with cognitive impairments: A survey of Norwegian occupational therapists in municipal practice

Background: With the Coordination Reform Act initiated in 2012, Norwegian occupational therapists in municipal practice have been given responsibilities concerning clients with cognitive impairments. With emphasis on supporting best practice, the aim was to investigate the practice of Norwegian municipal occupational therapists (OTs) in their assessment of clients with cognitive impairments.

Method: An online questionnaire was used to collect data from 497 of 1367 OTs in Norwegian municipalities (RR?=?36%)

Results: The most frequently used methods were informal interviews (91%), observations (91%) and standardized assessments (73%). The most frequently used standardized assessments were the Clock Drawing test (60%) and the Mini Mental State Examination (MMSE 59%). The most common reasons for using standardized assessments were to get a better foundation for initiating interventions (74%), to get more reliable results (64%) and to measure the effect of interventions (47%). The most common reasons for not using standardized assessments were that they did not have competence (49%) or that they did not have access to the materials (40%).

Conclusion: The results indicate that there are challenges when it comes to the methods and standardized assessments used. These findings invite further research on enabling municipal OTs to move further towards evidence-based practice.     

A qualitative study of workers with chronic pain in Brazil and its social consequences

Chronic pain contributes towards less diversified participation centred on household activities, fewer social relationships and smaller number of recreational activities. The aim of the study was to further investigate the effects of chronic pain on participation, focusing on how workers deal with the experienced restrictions. Ten workers with chronic pain participated in the survey, which was conducted with qualitative interviews. Analyses of thematic units revealed that chronic pain has consequences for participation, leading to work restrictions and loss of social roles. Social relationships tend to be limited to family, and workers become isolated from other social groups. The rebuilding of participants' lives was a counterpoint to the identified social rupture. The narratives revealed strategies for dealing with pain, attempts at reorganizing their daily activities and formulating new plans. Understanding what resources individuals use to cope with their difficulties allow occupational therapists to plan client‐centred treatment goals. A limitation of the study was to involve employees of very similar socio‐economic classes. Studies directed to understanding the relationship between social support and the reconstruction of participation must be conducted to further advance knowledge on possible mechanisms underlying social participation among workers with chronic pain. Copyright © 2010 John Wiley & Sons, Ltd.     

Caring behaviours perceived by elderly residents and their associated factors in nursing homes in Zhengzhou City of China: A qualitative study

Caring is an evidence-supported behaviour or activity which can meet nursing home residents' needs. China has an ever-increasing number of care-dependent individuals in nursing homes. It is important to explore the caring behaviours and to understand the factors associated with the caring behaviours perceived by elderly residents in nursing homes. This will contribute to an evidence-based approach with which to assist healthcare services. This study aims to explore the perceived caring needs, associated behaviours, and their associated factors identified by elderly residents in nursing homes. Fourteen semi-structured interviews were conducted with elderly residents from five nursing homes in three districts across Zhengzhou City, China. Interviews were transcribed verbatim and analysed using the Colaizzi phenomenological method. Five themes and fourteen sub-themes were identified. The availability of health services, a livable environment, and social communication were the main caring needs identified. Nursing assistant factors and resident factors were the main influencers. This study provides valuable information on the need to carry out standardised training of nursing assistants and how to adjust the goal of care in nursing home residents. The medical support, psychological counselling, livable environment, recreational and cultural services as well as caring literacy about nursing assistants in the nursing homes, however, need to be further enhanced to meet the residents' diversified caring needs.     

A conceptual framework of functional capacity evaluation for occupational therapy in work rehabilitation

Functional capacity evaluation (FCE) is commonly used in work rehabilitation to assess the capacity of the injured worker for return to work. Occupational therapists are major providers of FCE, especially in Australia. Despite a history of involvement in the functional assessment of clients for work, occupational therapy has few theoretical models for work assessment in general, and for FCE in particular. This may account for some of the confusion that exists about the conceptual basis of FCE in occupational therapy practice. This paper presents a framework for FCE that parallels occupational therapy's occupational performance model and the World Health Organisation's International Classification of Functioning, Disability and Health. The framework is used to clarify some of the confusions that exist in FCE research and practice, particularly the issue of measuring a client's function versus impairment. A redefinition of FCE for occupational therapy practice in the work assessment continuum is presented that supports occupational therapy practice and research in the area.     

Perceived factors in return to work after acquired brain injury: A qualitative meta-synthesis

Objectives: A substantial proportion of survivors after brain injuries originating from trauma, tumour, or stroke may experience reduced ability to work due to a number of challenges. The purpose of this review is to summarize and highlight factors that have been perceived and reported as important in order to return to work after an acquired brain injury.

Material and methods: A qualitative ethnographic meta-synthesis is used to interpret and develop concepts from studies retrieved from systematic searches in the electronic databases PubMed, PsycINFO, and ISI Web of Science.

Results: A total of 16 studies were included in the meta-synthesis. Four key concepts were identified as important for return to work after an acquired brain injury: empowerment, self-awareness, motivation, and facilitation.

Conclusion: The results of the meta-synthesis indicate that personal development is experienced as essential in order to return to work after an acquired brain injury, involving identification of each individual’s strengths and weaknesses. These personal factors intersect with an emphasis of the employer providing a certain degree of facilitation in the workplace. All of these aspects will affect one’s motivation to return to work and can therefore be crucial to succeed.     

Everyday life in breast cancer survivors experiencing challenges: A qualitative study

Background: Early diagnosis and treatment of breast cancer results in an increasing number of survivors, some of whom face new challenges in their transition to daily life.

Aim: Based on these experiences, the aim of this study was to describe the everyday life in breast cancer survivors experiencing challenges.

Material and method: Eleven women recruited from a follow-up study of breast cancer patients participated in qualitative interviews about their everyday occupations seven years after ending treatment. The inductive analysis revealed ten categories that were organized into five subthemes under the two main themes ‘bodily and mental loneliness’ and ‘new center of gravity in everyday life’.

Results: Findings showed how relevant information and guidance; active support to the client and their relatives; and a balance between occupations at home and at work were important matters to handle their everyday life challenges.

Conclusion and significance: By assisting these women in finding new patterns of meaningful occupations that positively affect their everyday life, the study suggests some central elements to be included in future follow-up practice for breast cancer survivors. Approaching this goal, occupational therapists should contribute to more involvement assisting cancer survivors and their partners in finding new patterns of meaningful occupations that positively affect their everyday life.     

Empowerment and occupational engagement among people with psychiatric disabilities

Background: Empowerment is essential in the rehabilitation process for people with psychiatric disabilities and knowledge about factors that may play a key role within this process would be valuable for further development of the day centre services. Objective: The present study investigates day centre attendees’ perceptions of empowerment. The aim was to investigate which factors show the strongest relationships to empowerment when considering occupational engagement, client satisfaction with day centres, and health-related and socio-demographic factors as correlates. Methods: 123 Swedish day centre attendees participated in a cross-sectional study by completing questionnaires regarding empowerment and the targeted correlates. Data were analysed with non-parametric statistics. Results: Empowerment was shown to be significantly correlated with occupational engagement and client satisfaction and also with self-rated health and symptoms rated by a research assistant. The strongest indicator for belonging to the group with the highest ratings on empowerment was self-rated health, followed by occupational engagement and symptom severity. Implications: Occupational engagement added to the beneficial influence of self-rated health on empowerment. Enabling occupational engagement in meaningful activities and providing occupations that can generate client satisfaction is an important focus for day centres in order to assist the attendees’ rehabilitation process so that it promotes empowerment.     

A work-oriented occupational therapy programme for individuals with physical disabilities

A Work-Oriented Occupational Therapy Programme (WOOTP) for individuals with physical disabilities at the Department of Occupational Therapy, National Taiwan University Hospital, is described. The primary goal of the programme is to return the individuals with physical disabilities to work settings and community re-entry. The programme includes prevocational evaluation and training, functional capacity evaluation, physical capacity evaluation, job site evaluation, and work-related behaviours and skills training. One hundred and twelve participants completed the therapeutic work programme between November 1995 and May 1997. On outcome, 90 days after discharge, 54 (48.2%) of the clients returned to competitive work, attended school, returned to homemaker activities, or participated in vocational training. The identified strengths of the programme are: it was an integral part of the rehabilitation process; the programme helped clients to confront their disability and psychosocial dysfunction directly through the individual or group discussion and therapy. Copyright © 1997 Whurr Publishers Ltd.     

Living with Chronic Pain: A Dynamic Learning Process

This study focuses on how patients describe and manage their pain in their everyday life. The data consist of interviews with 37 patients undergoing treatment for chronic pain. The study focuses on how experiences of pain are mediated and interpreted with the help of the individual's discursive resources. It is argued that this kind of resource is important in constituting a structure of relations between a suffering person, pain and context. In the analysis of the material a four-step procedure was used, including both formal and content-related aspects. It was found that the patients describe chronic pain as a dynamic phenomenon. Patients learn about their pain by actively constituting relations among themselves, the pain and their activities. For the patients, chronic pain is a structured phenomenon. Patients often describe how pain is initiated, worsens and is alleviated. Patients thereby learn to distinguish different figures in their pain, which they are able to relate to in their management of pain. This suggests that a life in pain could be seen as an apprenticeship process. The heart of the matter in this process is learning to become sensitive to and flexible towards variations in the pain and potential pain triggers in the environment. This knowledge is important, as mastering pain is a balancing act between inner resources and environmental circumstances.     

A study of factors influencing return to work after wrist or ankle fractures

BACKGROUND: Factors associated with time to return to work are poorly understood for occupational injuries, other than those to the back. METHODS: Anonymized data on claims for work-related wrist or ankle fracture between 1/1/1998 and 12/31/2002 were identified in administrative data held by the Workers Compensation Board in Alberta, Canada. Bivariate and Cox regression analyses were used to identify factors associated with return to work. RESULTS: Increased duration of temporary disability (TD) was associated with older age, female gender, work in construction and construction trade services, smaller company size, higher industry claim rates, a fall/jump from a height, ankle fracture, and greater medical aid costs in the 30 days following injury (used as a proxy for severity). CONCLUSIONS: Factors associated with longer time off work were largely consistent with those reported following back injury. Median time to return to work was longer following ankle than wrist fracture. Although Workers' Compensation Board (WCB) administrative data provided information that could be used to identify factors affecting return to work, better information on injury severity would considerably enhance their research potential.     

A working reality: Evaluating enhanced intersectoral links in supported employment for people with psychiatric disabilities

Background/aim: Supported employment (SE) program‐mes have been found to improve the rates of competitive employment for people with severe mental illness. Evidence has suggested that the most effective SE model is one in which the employment specialist is co‐located with mental health services. However, this may not always be achievable. The aim of this study was to investigate the effectiveness of the enhanced intersectoral links approach to SE. Methods: A total of 43 people with a mental illness participated in the programme in which formal links were created between a community mental health team and three employment services. The outcomes of the programme were evaluated over 24 months. Results: Of all participants, 77% achieved a competitive employment outcome, with 60.6% remaining in employment at the end of the evaluation period. The average duration of employment was 44.8 weeks. For those who were unable to maintain a job, the average period of employment was 14.2 weeks. The study found that participants with less severe symptoms at baseline were more likely to obtain employment and those who had worked in the year preceding entry into the programme were employed for a higher proportion of time. The factors related to job loss were the short‐term nature of the position, cognitive difficulties and social skills. Conclusions: The study found that the enhanced intersectoral links approach was effective in achieving outcomes consistent with international studies of SE programmes and may offer a viable alternative to the co‐location of employment specialists with community mental health teams.     

A prospective study of unmet activity of daily living needs in palliative care inpatients

Aim: To define the unmet needs of activities of daily living as defined by patients and caregivers in a palliative care inpatient unit. Methods: A cross‐sectional prevalence study of a convenience cohort of a dyad of patient/caregiver. Functional status and unment needs were assessed. Agreement between respondents was analysed. Results: Caregivers identified significantly more unmet needs than patients (2.5 vs 2.5; p = 0.03). Areas of unmet need included mobility, leisure and bathing. Conclusion: Routine screening for unmet needs in function should be part of all inpatient palliative care assessments.