Journal of Occupational Rehabilitation最新文献

Purpose: The aim of the present study was to explore the meaning of work for the subjective well-being of autistic adults with and without paid (competitive) employment and to evaluate the differences and similarities between these groups.

Methods: Eight focus groups were conducted, including a total of 64 autistic adults. Four groups entailed participants with current paid employment (including part-time) and four groups entailed participants without paid employment. All discussions were audiotaped and transcribed verbatim to enable inductive thematic content analysis. Data were analyzed using ATLAS.ti 9.

Results: Generally, both groups viewed paid employment as very important for well-being, albeit for different reasons. Three themes were found: (1) Not having paid employment was associated with lacking societal recognition, and subsequent low self-esteem, which was a dominant theme in those without work; (2) Work can seriously damage (mental) health and well-being, found in both groups; and (3) Paid employment provides many benefits for well-being, with subthemes: 'purpose,' 'social contacts,' 'growth and use of talents,' 'structure and calmness,' and 'income and freedom', which was a dominant theme in those with paid employment.

Conclusions: Both groups found paid employment highly important for their well-being, albeit for different reasons. However, both also agreed that paid employment can be very harmful to (mental) health and well-being. Suitable, well-supported jobs are important for well-being, may help to buffer stress in other life areas, and may even prevent autistic burnout. More studies are needed on how healthy jobs can be created where autistic individuals get positive energy and experience high well-being. This will also help to reduce socio-economic inequality.

Purpose: As stigma is a barrier to work participation of unemployed people with mental health issues/mental illness (MHI), a stigma awareness intervention can be helpful to make informed decisions about disclosing MHI. The aim of this process evaluation was to investigate the feasibility of a stigma awareness intervention, to explore experiences of clients and their employment specialists; and to give recommendations for further implementation.

Methods: The intervention consisted of a stigma awareness training for employment specialists and a decision aid tool for their clients with (a history of) MHI. For the process evaluation, six process components of the Linnan & Stecklar framework were examined: recruitment, reach, dose delivered, dose received, fidelity and context. Using a mixed-methods design, quantitative and qualitative data were collected and analyzed.

Results: The six components showed the intervention was largely implemented as planned. Questionnaire data showed that 94% of the clients found the tool useful and 87% would recommend it to others. In addition, more than half (54%) indicated the tool had been helpful in their disclosure decision. Qualitative data showed that participants were mainly positive about the intervention. Nevertheless, only a minority of clients and employment specialists had actually discussed the tool together. According to both, the intervention had increased their awareness of workplace stigma and the disclosure dilemma.

Conclusion: The implementation of a stigma awareness intervention was feasible and did increase stigma awareness. Experiences with the intervention were mainly positive. When implementing the tool, it is recommended to embed it in the vocational rehabilitation system, so that discussing the disclosure dilemma becomes a routine.

Trail register: The study was retrospectively registered at the Dutch Trial Register (TRN: NL7798, date: 04-06-2019).

Purpose: Presenteeism is defined as the loss of work productivity due to health issues in workers, which can be measured subjectively. This study aimed to compare the effectiveness of supervised exercise therapy and unsupervised self-care in reducing presenteeism in workers with musculoskeletal disorders.

Methods: PubMed, Embase, and Cochrane Library were searched for various keywords from their inception to January 2023. Two examiners independently assessed the eligibility of studies: (1) studies involving workers suffering from musculoskeletal pain, (2) those involving supervised exercise therapy intervention with interactive communication, and (3) those in which the comparison group was subjected to interventions other than supervised exercise therapy, and (4) those including patient-reported outcome measures of presenteeism or work productivity or ability. Standardized mean differences (SMD) were calculated using a random effects model, with higher scores indicating reduced presenteeism in the intervention group compared with that in the comparison group. The GRADE assesses the overall certainty of the evidence.

Results: Only the short-term effects of interventions on presenteeism could be obtained using four studies. The intervention group showed statistically significant short-term effects on presenteeism compared with the comparison group (p < 0.001; SMD, 0.52; 95% confidence interval, 0.27-0.77). The GRADE score was downgraded by two levels from high to low due to concerns for indirectness.

Conclusions: Although the certainty of the evidence was low, it was assumed that supervised exercise therapy was more effective than unsupervised self-care in reducing presenteeism in workers with musculoskeletal disorders.

Purpose: This study investigates who requests workplace accommodations and who is more likely to have requests granted. We investigate the role of demographic characteristics and their intersection, including disability, gender, race/ethnicity, and age. We also consider the role of other personal and job-related factors.

Methods: We use the data from the Current Population Survey (CPS) 2021 Disability Supplement to estimate the odds ratio of having requested workplace accommodations and having such request granted during the COVID-19 pandemic when the survey was conducted. In supplementary analyses, we explore the relationship between remote work and flexible scheduling and workplace accommodations, as well as possible trends using CPS 2019 Disability Supplement.

Results: Our results indicate that Hispanics with disabilities are more likely than others to request workplace accommodations, but they are substantially less likely to be granted accommodations. Consistent with other studies, our paper also finds that people with disabilities, women, and older people are more likely to request accommodations than their respective counterparts. Other personal and job-related factors such as higher education, parenthood, being single, being a citizen, and working in management-related occupations are associated with higher likelihood of requesting workplace accommodations compared to their counterparts, while receiving accommodations is largely explained by occupational differences.

Conclusion: Our findings show that there are still disparities in the rates of workplace accommodation requests and provision for multiply marginalized groups, and as such, taking into account intersectional differences in addition and in relation to disability is important.

Purpose: Medicines are often prescribed to workers with musculoskeletal disorders (MSDs) and injuries to relieve pain and facilitate their recovery and return to work. However, there is a growing concern that prescription medicines may have adverse effects on work function. This scoping review aimed to summarize the existing empirical evidence on prescription medicine use by workers with MSD or injury and its relationship with work-related outcomes.

Methods: We identified studies through structured searching of MEDLINE, EMBASE, PsycINFO, CINAHL Plus, Scopus, Web of Science and Cochrane library databases, and via searching of dissertations, theses, and grey literature databases. Studies that examined the association between prescription medicine and work-related outcomes in working age people with injury or MSDs, and were published in English after the year 2000 were eligible.

Results: From the 4884 records identified, 65 studies were included for review. Back disorders and opioids were the most commonly studied musculoskeletal conditions and prescription medicines, respectively. Most studies showed a negative relationship between prescription medicines and work outcomes. Opioids, psychotropics and their combination were the most common medicines associated with adverse work outcomes. Opioid prescriptions with early initiation, long-term use, strong and/or high dose and extended pre- and post-operative use in workers' compensation setting were consistently associated with adverse work function. We found emerging but inconsistent evidence that skeletal muscle relaxants and non-steroidal anti-inflammatory drugs were associated with unfavorable work outcomes.

Conclusion: Opioids and other prescription medicines might be associated with adverse work outcomes. However, the evidence is conflicting and there were relatively fewer studies on non-opioid medicines. Further studies with more robust design are required to enable more definitive exploration of causal relationships and settle inconsistent evidence.

Purpose: Research on return to work (RTW) following transition-related gender-affirming care (GAC) is lacking. We aim to study the RTW outcomes and experiences of transgender and gender diverse (TGD) people during social and medical transition to understand their needs better and provide tailored support.

Methods: In this convergent mixed-methods study, the questionnaires of 125 employed TGD people, who took steps in transition (social and GAC), were analyzed for personal- and work characteristics, medical work absences, RTW, support at work, and health literacy. In-depth interviews were held with twenty TGD people to explore perceived facilitators and barriers to RTW.

Results: One hundred and nine participants reported an average of 38 sick days after GAC. The majority (90.2%) resumed their job at the same employer. Although TGD workers felt supported, their health literacy (55.1%) was lower compared to the general population. The qualitative data analysis revealed four major themes: (1) the need and access to information; (2) having multidisciplinary TGD allies; (3) the influence of the occupational position; (4) the precarious balance between work, life, and GAC. Especially participants with a low health literacy level experienced RTW barriers by struggling: (1) to find and/or apply information; (2) to navigate (occupational) health and insurance services.

Conclusion: Our research has shown that RTW for TGD individuals is a multifaceted process, affected by personal factors, work-related elements, and the characteristics of the healthcare and social insurance system. Enhancing support for TGD people at work and their RTW requires a high need for centralized information and promoting health literacy while engaging relevant stakeholders, such as prevention services and employers.

Objectives: Disability benefit applicants with residual work capacity are often not able to work fulltime. In Dutch work disability benefit assessments, the inability to work fulltime is an important outcome, indicating the number of hours the applicant can sustain working activities per day. This study aims to gain insight into the association between inability to work fulltime and having paid employment 1 year after the assessment.

Methods: The study is a longitudinal register-based cohort study of work disability applicants who were granted a partial disability benefit (n = 8300). Multivariable logistic regression analyses were conducted to study the association between inability to work fulltime and having paid employment 1 year after the assessment, separately for working and non-working applicants.

Results: For disability benefit applicants, whether working (31.9%) or not working (68.1%) at the time of the disability assessment, there was generally no association between inability to work fulltime and having paid employment 1 year later. However, for working applicants diagnosed with a musculoskeletal disease or cancer, inability to work fulltime was positively and negatively associated with having paid employment, respectively. For non-working applicants with a respiratory disease or with multimorbidity, inability to work fulltime was negatively associated with paid employment.

Conclusions: Inability to work fulltime has limited association with paid employment 1 year after the disability benefit assessment, regardless of the working status at the time of assessment. However, within certain disease groups, inability to work fulltime can either increase or decrease the odds of having paid employment after the assessment.

Purpose: The aims of this study are to determine how continuous the care provided by physiotherapists to compensated workers with low back pain is, what factors are associated with physiotherapy continuity of care (CoC; treatment by the same provider), and what the association between physiotherapy CoC and duration of working time loss is.

Methods: Workers' compensation claims and payments data from Victoria and South Australia were analysed. Continuity of care was measured with the usual provider continuity metric. Binary logistic regression examined factors associated with CoC. Cox regression models examined the association between working time loss and CoC.

Results: Thirty-six percent of workers experienced complete CoC, 25.8% high CoC, 26.1% moderate CoC, and 11.7% low CoC. Odds of complete CoC decreased with increased service volume. With decreasing CoC, there was significantly longer duration of compensated time loss.

Conclusion: Higher CoC with a physiotherapist is associated with shorter compensated working time loss duration for Australian workers with low back pain.