Journal of Occupational Rehabilitation最新文献

Purpose: To assess the effectiveness of self-help interventions in reducing work disability and improving work- and health-related outcomes among individuals with musculoskeletal, anxiety, and/or depressive conditions; to explore lived experiences with self-help interventions; and to integrate quantitative and qualitative findings to guide future research and implementation.

Methods: We conducted a rapid mixed methods systematic review following World Health Organization (WHO) and Cochrane Rapid Reviews Methods Group guidance. We included randomized controlled trials (RCTs), quasi-experimental, qualitative, and mixed methods studies published in English since 2007. Eligible studies evaluated self-help interventions targeting musculoskeletal, anxiety, and/or depressive conditions in working-age adults (18-65 years). Quantitative outcomes included functioning, return-to-work, productivity, and self-efficacy; qualitative outcomes reflected user experiences. Risk of bias was assessed using RoB 2, ROBINS-I, and CASP tools. Findings were synthesized narratively by intervention types and outcome domain.

Results: Eight studies met inclusion criteria: five RCTs, two quasi-experimental, and one qualitative. All seven quantitative studies were rated high risk of bias. Short-term improvements were observed in disability and physical quality of life in two exercise-based trials, but effects on work participation were inconsistent and generally below thresholds for clinical importance. Cognitive-behavioral and psychoeducational programs produced small improvements in self-efficacy and presenteeism, and relaxation and educational interventions showed no meaningful effects. The qualitative study highlighted workplace barriers such as productivity pressures and limited opportunities for movement that constrained engagement.

Conclusion: Self-help interventions may modestly improve self-management, disability, and coping in the short term but show limited and inconsistent evidence for reducing work disability. Their effectiveness likely depends on adherence, contextual support, and integration into workplace environments. Future high-quality, co-designed, context-sensitive studies are needed to clarify effectiveness, safety, and sustainability in real-world settings. PROSPERO registration: CRD42023472934, registered on October 16, 2023; modified March 17 2025.

Purpose: In Australia, general practitioner (GP) consultations for work-related injuries are funded by workers' compensation and GP care for non-work-related conditions is funded by public health insurance (Medicare Benefits Schedule, MBS). This study aimed to measure changes in the proportion and frequency of GP consultations after a long-term work injury, including both Medicare and workers' compensation funded care, and to assess the proportion of GP services funded by each scheme.

Method: This retrospective cohort study linked administrative GP records from MBS and workers' compensation systems in New South Wales, Australia. The study included injured workers with long-duration (2 + years) compensation claims and community comparators. Primary outcome measures included the proportion and frequency of GP services, measured in the year pre-injury, and each of the first two years post-injury. Mixed-effects negative binomial regression was used to compare outcomes between groups during all three study periods.

Results: The cohort included 3170 injured workers and 7636 community controls. The annual median GP services increased from 5 (Interquartile range 2-10) pre-injury to 19 (IQR 12-27) in the first-year post-injury and decreased to 16 (IQR 10-23) in the second year. Compared to the community control cohort, injured workers used 3.6 (95% CI 3.33, 3.81) and 2.7 (95% CI 2.54, 2.91) times more GP services in the first- and second-year post-injury, respectively. This increase in annual median service use was observed among those funded by workers' compensation, while services subsidised by Medicare remained similar across all three study periods.

Conclusion: GP service use by injured workers with long-compensation claims increased substantially post-injury and remained high for two years. Workers also continued receiving Medicare-subsidised services at a similar level to pre-injury, presumably for managing non-work-related conditions. An integrated care model may provide holistic support to injured workers needing care for both workplace-injury-related and other conditions.

Purpose: In Canada, rates of psychological injury for public safety personnel (PSP), along with related workers' compensation costs, have been on the rise in the past decade. This study explored approved workers' compensation claims filed by PSP for work-related psychological injuries through the Ontario Workplace Safety and Insurance Board (WSIB) between 2014 and 2023. Specifically, we wanted to understand the variability in demographic and claim characteristics and how return to work (RTW) outcomes compared amongst PSP occupations.

Methods: This research employed a descriptive and quantitative analysis to identify trends in claim volumes, injury categories, and patterns in RTW outcomes for communicators, correctional workers, firefighters, paramedics, and police.

Results: Claimants were more often male with an average age of 41.3 years and 13 years of work experience at the time of injury. Police and paramedics accounted for over 60% of all claims and significant heterogeneity was observed across all occupations. Cumulative traumatic injury claims were more common than single event claims, and PTSD was the most common category of claim. 93.3% of all claims resulted in time lost from work, the median claim length was 14.4 months (Q1 = 0.8, Q3 = 38.7), and only 35.7% of claimants had a successful RTW outcome documented. The most favorable profile for RTW success was for younger and less experienced workers, with single event or traumatic mental stress claims.

Conclusion: Our findings can inform the development of more effective public policies and workers' compensation processes, ultimately contributing to more timely and effective support for PSP who sustain work-related psychological injuries.

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: 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: 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 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.