Journal of Occupational Rehabilitation最新文献

Background: National data suggest that the mental health of Australian workers has declined over recent years. Given that genetic contributors to mental health conditions generally remain stable in longitudinal observations, it is possible that social determinants, which are contextual, non-medical factors, contribute to this trend. This qualitative research investigated employee experiences of psychological injury, including social determinants as facilitators and barriers to recovery and return to work, and gathered need-based recommendations.

Methods: Between October and December 2023, 55 participants (M_age = 44 yrs, 80% female) completed an online survey of demographic items and questions around injury and recovery experiences. Employees who were prescribed sick leave for at least two weeks due to a work-related psychological injury and managers who supervised at least one employee with a work-related psychological injury were eligible to participate. A subset of 12 participants also completed an in-depth online interview. Thematic analysis underpinned by a critical realist/contextualist lens was used to generate themes.

Results: Eleven themes described common experiences, facilitators, and barriers and were ordered along three meta-themes of injury causes, responses to injury, and recovery processes. Participant recommendations based on needs assessments centred around clear reporting systems for psychological injury, ongoing support and advocacy for employees, workplace accountability, and minimisation of requirements to access treatment, salary support, and sick leave.

Discussion: Detrimental work factors, negative disclosure experiences, and barriers to mental health care and return to work were described by employees who reported negative functional and mental health impacts, whereas managerial support and strength-based work modifications were protective.

Purpose: Since individual placement and support (IPS) emerged as the premier evidence-based vocational rehabilitation for people with serious mental illness (SMI) in the early 2000s, several groups around the world have extended IPS to new disability groups. This review examines the rigorous evidence for five new populations: adults with early psychosis, common mental disorders, substance use disorders, posttraumatic stress disorders, and severe medical conditions.

Methods: This review updates the employment outcome findings from six recent systematic reviews of controlled trials of IPS for new populations using an electronic search. Using meta-analyses, the overall odds ratio (OR) and 95% confidence intervals (CI) for IPS-control differences in employment rate were calculated for RCTs of three new populations.

Results: The search identified 19 controlled trials of IPS for new populations, including 9 published since 2019. Meta-analyses yielded ORs of 3.39 (95% CI: 2.11-5.46, p < .0001, N = 393) for 5 studies of adults with early psychosis, 1.42 (95% CI: 0.96-2.09, p = .08, N = 1728) for 5 studies of adults with common mental disorders and 1.88 (95% CI: 1.13-3.15, p = .02, N = 1830) for 5 studies of adults with substance use disorders. Two studies each of veterans with posttraumatic stress disorders and patients with serious medical conditions had a mix of small and large ORs.

Conclusions: IPS, the only vocational rehabilitation intervention with robust employment results, has been extended to several new populations with generally positive employment outcomes in controlled trials. However, poor implementation, small sample sizes, and other methodological problems limited the overall quality of this literature.

Purpose: The aim was to evaluate the effect of a Rehabilitation to Work (ReTA) model on symptoms of exhaustion disorder (ED), depression, and return to work (RTW) among healthcare workers on long-term sickness absence (LTSA) for stress-related ill-health.

Methods: The ReTA was set up as a randomized control trial (RCT), including 30 in the intervention and 41 in the control group. Physicians and nurses on LTSA were recruited via a national insurance database. The degree of self-reported ED and depression was measured using the Karolinska Exhaustion Disorder Scale (KEDS), and the Montgomery Åsberg Depression Rating Scale (MADRS). Data was collected at baseline, 3-month, and 1-year follow-up. A linear mixed model and Pearson chi-square were used to examine between- and within-group differences in KEDS, MADRS, and RTW.

Results: At baseline, no differences in KEDS and MADRS were observed between the groups. KEDS decreased significantly at the 3-month (m = 20.28, m = 25.93; p = 0.023) and 1-year (m = 19.78, m = 24.83; p = 0.041) follow-up in the intervention group but not in the control group (Intervention*time: F (2, 132.595) = 4.126, p = .018). The effect size at both follow-ups was moderate to large (Cohen's d = 0.77 0.69, respectively). No effect was found in MADRS. Between the 3-month and 1-year follow-ups for RTW, there was a significant change for the intervention group (p = 0.029), indicating an increase in full RTW.

Conclusion: The ReTA model is an effective treatment for ED among healthcare professionals. Further research is needed with longer follow-up periods to see the long-term effects on ED, depression, and RTW.

Trial registry: NCT05314530.

Purpose: The purpose of the study was to test the effects of a nudge on patients return-to-work (RTW) and benefits in a clinical service aimed to promote RTW and prevent sickness absence in patients referred for musculoskeletal disorders or mental illness.

Methods: The study was a multicentre, single-blinded, parallel two-arm randomised controlled trial design. The setting was five outpatient clinics in Northern Norway, offering a work-focussed treatment to patients referred for common mental- and/or musculoskeletal disorders. Patients were randomised to receive either a questionnaire mapping health factors only, or a questionnaire mapping also Motivation for work, Barriers for return-to-work and Work environment (MBW). Clinicians were also nudged by receiving patient reports based on the patient survey. Data on sickness absence and benefits was retrieved from national registries after one year of follow-up.

Results: Among 1171 patients consenting to participate in the study, 1091 were eligible for inclusion in the main analyses. The intervention group (n = 558) did not differ significantly from the control group (n = 533) with respect to key variables at baseline. The nudge had no effect on days of sickness absence, return to work rates, or disability benefits during follow-up.

Conclusion: This attempt to nudge patients and clinicians on MBW factors did not influence RTW or benefits during one year of follow-up. Although MBW factors were prevalent at baseline, the results suggest that increasing work focus in a setting where clinicians already address these factors to some extent has little effect.

Trial registration: The trial was prospectively registered at clinicaltrials.gov on August 9th, 2021. Trial identifier NCT05006976 ( https://clinicaltrials.gov/study/NCT05006976 ). In this study we report on the primary outcome listed as "Functional recovery: sickness absence registry data".

Purpose: Disclosure of mental health condition to a supervisor at work can have positive and negative consequences. However, research on the association between disclosure and employee work outcomes is limited. The aim of this study was to investigate the association between the employee experiences during the disclosure process (positive/negative) and work ability, intent to stay, and perceived mental health stigma among Australian workers.

Methods: A mixed-methods study design was carried out with cross-sectional survey data from a nationally representative sample of Australian employees (n = 322). Qualitative analysis of open-ended survey responses categorised the perceived nature of supervisor responses from the employee perspective into positive and negative with further subcategories for each, and subsequent quantitative analyses investigated the association between immediate supervisors' reactions to employees' mental health disclosures and work outcomes. Statistical comparisons contrasted those experiencing positive and negative disclosure responses.

Results: The study found positive disclosure experiences to be more common than the negative. Expressing concern, listening attentively, and demonstrating empathy were the most widely reported positive experiences, while making judgmental and condescending remarks were the most common negative experiences. Positive disclosure experiences were significantly associated with higher work ability, intent to stay and lower perceived mental health stigma.

Conclusions: Supervisor reactions to employee mental health condition disclosure were found to be significantly associated with work ability, intent to stay, and perceived mental health stigma at work for disclosing employees. Noting the limitations surrounding making causal inferences, these findings emphasise the pivotal role of the supervisor in facilitating a positively perceived disclosure experience that is associated with positive employee outcomes and well-being following disclosure. In particular, training to prepare for disclosure events and respond appropriately could be an effective approach to create a work environment in which employees feel safe to disclose, actively reduce mental health stigma in the workplace, and improve work outcomes.

Purpose: Clients with chronic mental illness face multiple psychological, social, and economic challenges in securing and maintaining employment. While studies have confirmed the positive role of employment in improving their functioning, an effective vocational empowerment model tailored to their needs remains a research gap. Therefore, this study aimed to develop a vocational empowerment model for clients with chronic mental illness.

Methods: This qualitative study was conducted within the interpretive paradigm using the grounded theory approach based on Strauss and Corbin's methodology. Data were collected through semi-structured interviews with 25 chronically mentally ill clients with work experience, following the principle of theoretical saturation. The data were analyzed using open, axial, and selective coding.

Results: The developed model consists of five key components: (1) Causal conditions (self-management, motivation, attitude, and agency): (2) Contextual factors (social and institutional support, environmental opportunities, and challenges); (3) Intervening factors (economic and social factors); (4) Strategies (personal development, spiritual support; and (5) Outcomes (personal and occupational well-being) CONCLUSION: The findings suggest that a combination of social support and individual empowerment can significantly enhance the employment sustainability of these clients. Vocational empowerment for clients with chronic mental illness requires a multi-dimensional approach, including self-management training, creating supportive infrastructures, reforming employment policies, and implementing psychosocial interventions. The findings of this study can contribute to designing supportive programs and informing macro-level policies for vocational rehabilitation of clients with chronic mental illness.

Purpose: To compare employment status 5 years post-diagnosis among native Norwegian, Western immigrant, and non-Western immigrant female cancer survivors (CSs) and their matched controls without cancer, who were employed at the time of diagnosis.

Methods: Participants were categorized into three groups based on data from Statistics Norway: Natives (CSs = 6587, control = 6587), Western immigrants (CSs = 209, control = 209), and non-Western immigrants (CSs = 105, control = 105). Women were aged 30-55 at diagnosis, employed (salaried/self-employed) at baseline, and alive at 5-year follow-up. CSs and controls were matched on age, education, and employment at diagnosis. Associations between cancer status, immigrant background, and employment were analyzed using binary logistic regressions and Firth penalized logistic regression to account for potential bias from small subgroup sizes.

Results: At 5 years, female CSs had lower odds of employment compared with controls. Western immigrants did not differ from natives, whereas non-Western immigrants showed reduced employment. Higher income was positively associated with employment, while being married or cohabiting and working in the public sector were linked to higher odds. Interaction terms between cancer survivorship and immigrant background were not significant.

Conclusion: Among women employed at baseline, cancer survivorship and non-Western immigrant background were independently associated with lower odds of employment five years later. Tailored employment support is needed for non-Western immigrants to improve long-term outcomes. Interventions should also target employers and workplaces to support employment maintenance among CSs.

Purposes: To measure the test-retest reliability and the clinical usefulness of the Work Limitation Questionnaire, and to compare the in-person with the telephone application.

Methods: Cross-sectional, exploratory study. The Work Limitation Questionnaire was answered three times: twice in person, to measure test-retest reliability and clinical usefulness, and once, by telephone, to measure the validity of the telephone application.

Results: Fifty-six individuals (32 men) with mild to moderate disabilities after stroke were included. Test-retest reliability was very high (ICC 0.96; 95% CI 0.94 to 0.98; p < 0.01), the clinical usefulness was high (9 out of 12 points), and the correlation between in-person and telephone applications was high (ρ = 0.7; 95% CI 0.5 to 0.9; p < 0.01). The average productivity loss was 4% (SD 5, min-max 0 to 15%).

Conclusions: The Work Limitation Questionnaire showed adequate test-retest reliability and clinical usefulness in individuals with stroke. The telephone application produced comparable results to in-person applications. The participants reported low productivity loss, which may be related to the mild impairments of the included sample.

Purpose: Functional testing is important to inform return-to-work (RTW), but new paradigms are needed to increase access and availability of testing. Our purpose was to deploy a user centred design approach to collect, describe, and interpret end-user feedback (clinicians and patients) to inform functional requirements for a remotely administered hybrid functional test (RAHFT) protocol.

Methods: Twenty participants (10 clinicians and 10 patients) were interviewed about existing in-person functional testing and about perceptions of prospective remotely administered functional testing protocols. Interview data were synthesized, where findings informed a focus group with functional testing clinician experts to identify functional design requirements for a RAHFT protocol.

Results: Patients agreed that access to equipment and technology, safety, and personal connections were important requirements for a functional testing protocol. Expert clinicians emphasized that a RAHFT should provide valid information to inform treatment planning and RTW outcome decisions, inclusive of opportunities to capture subjective and performance-based information.

Conclusions: RAHFT protocols can play an important role towards early and safe RTW. RAHFT protocols will increase availability and improve access for workers that cannot easily attend a clinic for in-person testing. Findings from this study provide functional requirements that should be considered when designing RAHFT protocols.

Purpose: The aim of this systematic review was to summarize the qualitative evidence on factors of effective counseling aiming at work participation for people with chronic diseases and/or disabilities.

Methods: We conducted a systematic literature search in MEDLINE (PubMed), CINAHL, Web of Science, PsycINFO, and PubPsych in March 2023. Our inclusion criteria stipulated that counseling should be specifically designed for individuals experiencing constraints in work participation and published in German or English between 2013 and 2023. To assess the quality of the included studies, we used the checklist of the Critical Appraisal Skills Programme. We synthesized our findings according to the meta-ethnographic methodology by Noblit and Hare.

Results: Of the 2901 papers found in the systematic search, we included 16 qualitative studies in our meta-synthesis. Studies were conducted in Australia, the USA, Canada, Nordic countries, and Germany. Our "model of the effectiveness of counseling for work participation" consists of four levels. At the extended organizational level, potential factors include the provision of sufficient time and work resources for counselors or contact persons. At the team and stakeholder level, structural collaboration, for example, is crucial. In the counseling dyad, counselors can employ shared decision-making and at the individual level, personal character traits and the client's motivation are exemplary factors.

Conclusion: This study provides a comprehensive overview of factors contributing to effective counseling in the context of work participation. The delineation across various levels underscores that effectiveness in counseling is a collective outcome, involving not only the advisor but also other stakeholders.