Journal of Occupational Rehabilitation最新文献

Background: Heart disease is the leading cause of death and disability worldwide and includes any disease affecting the heart or blood vessels. Stress has been widely cited as a potential factor in the development of heart disease and acute cardiac events. Firefighters may be at a higher risk of developing heart disease and experiencing an acute cardiac event due to the high mental and physical demands of the job. There is limited literature on treatment, recovery, and how to successfully return to this high-stress work environment. This study explored the recovery, treatment, and return-to-work (RTW) process following acute cardiac events experienced by firefighters, with a specific focus on psychological stress and mental health.

Methods: We recruited nine firefighters who had an acute cardiac event during their career. Firefighters participated in a semi-structured interview with a critical theory paradigm that explored their experience during treatment, recovery, and RTW. Data were analyzed in a two-reviewer process using thematic analysis.

Results: Thematic analysis revealed four major themes: (1) there is a lack of consideration of what it means to be a firefighter during treatment and recovery; (2) mental health difficulties are overlooked and a major barrier to recovery and RTW; (3) mental and physical illness stigma within the fire organization impedes a successful recovery and RTW; and (4) social support is critical to a successful recovery and RTW.

Conclusion: The results of this study highlighted a pressing need for formalized fire-specific treatment, recovery, and return-to-work processes to ensure a successful return.

Purpose: The National Workplace Psychological Health and Safety Standard (The Standard) recommends the use of a survey developed by Guarding Minds at Work (GM@W). However, its validity remains underexplored. This study has two objectives: (1) to evaluate the psychometric properties of the survey in assessing the Standard dimensions and (2) to examine validity across gender and industry.

Methods: A Confirmatory Factor Analysis (CFA) was conducted on data from the GM@W survey to evaluate the factor structure and validity of the 13 dimensions. Group comparisons by gender and occupational groups were assessed using t-tests and ANOVA tests.

Results: Across the 13 dimensions, most items demonstrated strong internal consistency and discriminant validity, with physical safety (r = 0.71) and organizational culture (r = 0.68) showing the highest internal consistency. While psychological competencies and physical safety were linked to positive mental health outcomes, challenges with workload management and balance remain prominent, especially for workers in healthcare and education. Group differences were observed, with women and workers in business, trades, and manufacturing reporting better psychosocial outcomes.

Discussion: While the GM@W tool demonstrated internal consistency and improved convergent validity compared to previous versions, significant model misfit was observed across all sectors. High latent correlations and frequent violations of the Fornell-Larcker criterion reveal substantial construct overlap and empirical redundancy. The findings suggest that while individual constructs are reliable, the 13-factor structure faces challenges in achieving empirical distinctiveness. Capturing the diverse psychosocial experiences of a national workforce within a single psychometric instrument remains a complex task.

Purpose: Prior studies demonstrate that many injured workers find involvement in workers' compensation processes complex and stressful. This study sought to identify experiences, events and interactions contributing to system-generated mental ill health.

Methods: Mixed methods design utilising an online survey and follow-up interviews. Eligible participants were workers employed in Australia, at least 18 years of age, proficient in English, who had submitted a compensation claim. Survey items assessed demographic and claim information, claim experiences, and impacts of interactions with claim stakeholders and processes. Between September 2023 and July 2024, the survey was distributed through community organisations, worker support groups, and social media. Qualitative interviews took place between February and July 2024.

Results: A total of 533 participants completed the survey, and 20 completed an interview. Most survey participants (n = 503, Median_age = 45-54 years, 59.2% women) reported negative mental health impacts. Of those, 279 reported negative experiences throughout the claim process, while the remainder reported more positive or mixed experiences. Hierarchical logistic regression indicated that negative interactions with insurers (OR = 5.22, 95%CI [1.89, 14.42]) and delays in claim approval (OR = 4.12, 95%CI [1.88, 8.99]) were significantly associated with negative claim experiences. The full logistic regression model accounted for 40% of the variation in claim experiences. Qualitative analysis of injured workers revealed themes around claim-related sources of stress and negative consequences from illness or injury.

Conclusion: Findings provide insights into modifiable aspects of compensation claim processes that, if actioned, may improve worker experiences during their claim and reduce the risk of secondary psychological injury.

Purpose: This study compared return-to-work (RTW) outcomes among Norwegian patients with musculoskeletal or common mental disorders participating in a 4-week inpatient or 3-month outpatient occupational rehabilitation program, examining associations between program type, pre-intervention sick-leave duration, and RTW.

Methods: An observational cohort (n = 857) was categorized into five pre-intervention benefit groups, including Group 1 (partial benefits for ≥ 6 weeks) and Group 2 (90-100% benefits for 6 weeks through 5 months). Primary outcome was time to stable RTW (first month without sickness benefits); secondary outcome was cumulative work participation over 24 months.

Results: RTW hazard varied by group and time. During the first 3 months, outpatients in Group 1 had a threefold higher hazard of stable RTW than inpatients (HR = 3.61, p = .03). Between 3 and 10 months, the pattern reversed, favoring inpatients (outpatient HR = 0.68, p = .01). After 10 months, outpatients again had higher RTW hazards, significant only in Group 1. In Group 2, no outpatients achieved RTW during the first 3 months; furthermore, between 3 and 10 months, inpatients had a significantly higher RTW hazard (outpatient HR = 0.38, p = .02). Median months worked over 24 months was 18.1 for outpatients vs. 12.8 for inpatients in Group 1 (p = .08), and 0.6 vs. 5.3 in Group 2 (p = .04).

Conclusion: Pre-intervention sick-leave duration strongly influences RTW. Program effectiveness is time- and subgroup dependent. Patients with remaining work attachment (partial benefits) may benefit more from outpatient care, while those on full-time benefits for moderate durations benefit more from intensive inpatient programs, suggesting a need for stratified allocation.

Trial registration: Current controlled trials https://doi.org/10.1186/ISRCTN12033424 , 15.10.2014, retrospectively registered.

Purpose: Firefighting is widely recognized as a physically demanding profession, in which working until the statutory retirement age is considered highly challenging. However, increasing societal pressure to extend working lives highlights the need to gain more insight into how sustainable employability (SE) can be supported in such occupations. This study aims to examine cross-sectional associations between overall and task-specific physical work demands and SE among Dutch career firefighters.

Methods: Data from the SEmFire Cohort Study questionnaire for Dutch career firefighters (n = 1371) were used. SE was assessed using nine indicators across three domains: health (health status, work ability, need for recovery, prolonged fatigue), well-being (job satisfaction, motivation to work), and employability (employability, skill gap, job performance). Physical work demands-overall and task-specific-were used as independent variables. Multiple logistic regression models were applied, adjusting for personal, occupational, and health-related factors.

Results: Dutch career firefighters reported high physical work demands and unfavorable outcomes across multiple SE indicators. Both overall and task-specific physical demands were cross-sectionally associated with adverse SE outcomes across all three domains. Statistically significant associations were observed in all three distinguished function groups-operational, hybrid, and non-operational-though patterns (i.e., which indicators and the strength of associations) varied between groups. The frequency of incident responses per month also influenced the strengths of these associations.

Conclusion: This study shows that physical work demands are associated with multiple indicators of SE among Dutch career firefighters. These findings provide an important first step toward identifying actionable areas to enhance SE among firefighters.

Purpose: Occupational health professionals increasingly encounter workers who complain about a decrease in cognitive endurance, yet standardized tools to objectively assess this decrease are lacking. Cognitive endurance, the ability to sustain cognitive performance during prolonged mental effort, is critical for sustainable employability.

Methods: In this proof-of-principle study, 101 healthy working adults (M_age = 35.7, SD = 13.6) completed neuropsychological assessments and fatigue questionnaires at the start and end of a regular workday. Cognitive endurance was operationalized as within-day change scores across six cognitive domains. Analyses included paired t-tests, Wilcoxon signed-rank tests, Spearman correlations, and multiple regression.

Results: Over the course of a workday, cognitive performance improved in language, attention/executive functioning, and information processing speed (all p < 0.001), despite a significant increase in subjective fatigue (Z = -6.34, p < 0.001). Nearly half of the neuropsychological tests showed improvement. Fatigue measures explained only a small part of the variance in language change (R² = 0.122), and no individual fatigue predictors were significant in that model. Higher subjective fatigue was associated with less improvement in processing speed (p = 0.040).

Conclusion: Cognitive performance remained stable or improved over the course of the day, even as subjective fatigue levels increased. Fatigue measures showed limited predictive value for changes in cognitive outcomes, with only subjective fatigue significantly related to performance in one domain. These findings suggest that in healthy working adults, subjective complaints alone do not reliably indicate reduced cognitive functioning. Incorporating objective cognitive data may therefore be important when assessing endurance capacity and informing occupational health evaluations.

Purpose: The subject of employment as a determinant of health has received considerable attention from researchers. To our knowledge, a comprehensive synthesis of evidence on the health effects of employment has not been completed in almost 20 years. This systematic review aimed to provide an up-to-date summary of the associations between employment status and any measurable domain of health.

Methods: We searched Ovid MEDLINE, Embase, CINAHL Plus with Full Text, and APA PsycINFO. We included peer-reviewed, full-text systematic reviews or overviews published in English between January 2012 and November 2024. Two reviewers independently screened resultant publications and extracted data from those found eligible for the review.

Results: Our search yielded 1862 reviews and meta-analyses, 49 of which were eligible for synthesis. Employment status was associated with several health domains including general health and wellbeing, mental health, alcohol and substance use disorders, cardiovascular health, systemic inflammation, sleep quality, cognitive functioning, and mortality.

Conclusion: Being employed was almost universally associated with favourable physical and mental health outcomes, with evidence to suggest re-employment may facilitate improvements in health after a period of unemployment. Socioeconomic status was a notable factor which affected health outcomes for both employed and unemployed people, illustrative of social gradients in health. Insecure or low-quality work demonstrated the potential to override identified health benefits of work. Heterogeneity in the operationalization of employment across publications, and the influence of survivorship bias on health outcomes highlights a task for future research to establish causality in the relationship between employment status and health.

Purpose: Total hip arthroplasty (THA) and total knee arthroplasty (TKA) as treatments for osteoarthritis increasingly affect working-age adults. However, little is known about the development of work ability after THA and TKA. This study investigated different trajectory classes of work ability after THA and TKA.

Methods: This prospective study included 146 working patients (THA n = 51, TKA n = 95). They received THA/ TKA treatment as usual, including surgery, rehabilitation, and optional post-rehabilitation programmes. The primary outcome work ability was assessed five times (before surgery, end of rehabilitation, 3-month, 6-month, and 12-month follow-up) with the Work Ability Score. Additionally, the questionnaires included sociodemographic, health-, rehabilitation-, and work-related data. We applied a latent class growth analysis to identify distinct trajectory classes of work ability over 12 months, and examined associated factors using univariable multinominal logistic regression analyses in MPlus.

Results: We found three distinct trajectory classes of work ability within one year after THA/ TKA: no improvement (24.5%), delayed improvement (36.6%), and early improvement in work ability (38.9%). Preoperative predictors for work ability trajectory classes were sex, pain intensity, functional ability in everyday life, and risk of work-related disabilities. Furthermore, work ability trajectory classes were associated with participation in the T-RENA post-rehabilitation programme, and with pain intensity one year after having started rehabilitation.

Conclusion: Despite the fact that most patients showed improvements in work ability after THA and TKA, there is a noteworthy proportion who did not. Further studies are needed to enhance identification of these individuals, and to offer targeted interventions.

Trial registration: The study is registered in the German Clinical Trials Register (DRKS00029630).

Purpose: This study aimed to identify and quantify the contribution of various features and their interactions to the prediction of return to work (RTW) following medical rehabilitation due to musculoskeletal disorders, using a machine learning approach.

Methods: This retrospective cohort study used data from the Rehabilitation Statistics Database (RSD) of the German Pension Insurance. A total of 685,890 individuals who received multimodal medical rehabilitation for musculoskeletal disorders between January 2018 and December 2021 were included. A Light Gradient Boosting Machine (LightGBM) model was trained on 75% of the sample and tested on the remaining 25%. Model predictions were explained using Shapley values to determine the contributions of individual features and their interactions.

Results: Overall, 65.0% of individuals achieved stable RTW. On the test dataset (threshold 0.5), the model achieved an accuracy of 0.815, precision of 0.830, recall of 0.901, and an AUC-ROC of 0.867. The most important predictors of RTW were days in employment, income, incapacity for work at admission, occupational status, duration of incapacity for work, and age. The model also identified interaction effects, including an interaction between postacute rehabilitation and incapacity for work at admission, and an interaction between age and income.

Conclusion: The machine learning model demonstrated good predictive performance for RTW after medical rehabilitation for musculoskeletal disorders and confirmed the relevance of established predictors, such as prior employment and incapacity for work. In addition, the analysis identified interactions that are difficult to detect with traditional regression approaches.