Journal of Occupational Rehabilitation最新文献

Background: Firefighters are routinely exposed to significant work-related musculoskeletal disorders (WRMSDs) which can sometimes be career-ending due to the workplace stressors and the physical demands of the job. Shoulder disorders are the third most frequent WRMSDs that cause pain, disability, and morbidity in the general working population. However, little is known about the task-specific causes and risk factors for work-related shoulder disorders (WSDs) among firefighters (FFs).

Objectives: To explore the perspectives of FFs who experienced WSDs with respect to the following: (a) risk factors of WSDs; and (b) causative factors for WSDs.

Methods: Using an interpretive descriptive methodology, we purposefully sampled for age and occupational diversity. Twelve FFs (males, 8 and females, 4) between 26 and 63 years, who experienced WSDs during their career ranging from 3 to 33 years were recruited. One-on-one interviews based on a semi-structured interview guide were conducted via an online Zoom platform and transcribed verbatim. Transcripts were analyzed using reflexive thematic analysis.

Results: The WSDs reported by FFs included rotator cuff tears, labral tears and muscle sprains or strains. Three themes were identified as risk factors for WSDs: (1) too much or too little shoulder exercises is a risk for shoulder injuries; (2) internal contextual factors can increase the risk of shoulder injurie; and (3) personal factors such as age and sex mediate the risk of shoulder injuries. Three themes were reported by FFs as the causative factors of WSDs: (1) unpredictable hazards in harsh environmental conditions can lead to traumatic shoulder injuries; (2) maneuvering heavy equipment in non-ergonomic positions can lead to shoulder strains; and (3) routine firefighting tasks can lead to gradual onset of shoulder injuries.

Implications: Our results emphasized the inter-related and multifaceted nature of the risks and causative factors that increase the risk of traumatic or gradual onset WSDs among FFs. There is a need for a comprehensive prevention and self-management program that addresses fire-specific prevention and treatment program that addresses modifiable environmental, behavioral and personal risks factors.

Purpose: Workers' compensation claims can negatively affect the wellbeing of injured workers. For some, these negative effects continue beyond finalisation of the workers' compensation claim. It is unclear what factors influence wellbeing following finalisation of a workers' compensation claim. Therefore, the aim of this study was to explore wellbeing through the lived experience of individuals who have finalised a workers' compensation claim in the state of Western Australia.

Methods: A qualitative study with individual, in-depth, semi-structured interviews was performed (n = 20, 55% female, average claim length 22.9 months, average time since claim end 33.4 months). Claim finalisation modes included full medical recovery, claim settlement with permanent impairment, direct settlement with the insurer and settlement with the insurer facilitated by a lawyer. The interview schedule was informed by a previous scoping review and cross-sectional survey completed by this research team. Qualitative data were analysed utilising a reflexive, interpretative phenomenological analysis approach.

Results: Five superordinate and their associated subordinate themes were identified; (1) The role of support; (2) Stigma and discrimination; (3) A new normal; (4) The importance of information; and (5) Recommended resources.

Conclusions: Injured workers experience a range of outcomes related to their wellbeing and employment following the finalisation of their workers' compensation claim. Based on their experiences, resources to facilitate a transition and adjustment to life following a claim have been suggested by injured workers, including information regarding seeking employment, seeking welfare support, educational materials regarding future expectations, and individualised support care packages.

Purpose: Despite evidence of efficacy, the effectiveness of telerehabilitation in real-world clinical settings is still largely unknown. Telerehabilitation requires a substantial transformation of the organization and delivery of traditional services. Considering that a virtual setting can create unique challenges for providing physiotherapy services and given the physical and potential hands-on nature of evidence-based assessments and interventions, it is important to investigate what injured workers think of receiving physiotherapy care via telerehabilitation and to examine if rehabilitation needs are adequately met.

Methods: A qualitative interpretive description study was conducted to explore the perspectives and experiences of 17 injured workers receiving physiotherapy via telerehabilitation. Data were collected through semi-structured interviews with participants from three provinces in Western Canada and analysed using thematic analysis. Qualitative rigour criteria of epistemological integrity, analytic logic, interpretive authority, and representative credibility were considered throughout this study.

Results: Implementation of telerehabilitation during the COVID-19 pandemic resulted in mixed perceptions from injured workers. Some viewed telerehabilitation as a resourceful option for providing services during the pandemic lockdown, resulting in maintained communications while overcoming barriers to services (e.g., rural/remote workers, transportation barriers, etc.). However, many thought telerehabilitation was inferior to in-person therapy for assessment and when 'hands-on' interaction was needed. Many believed a hybrid option may be ideal now that pandemic restrictions are lifted, with telerehabilitation supplementing in-person physiotherapy when needed.

Conclusions: Telerehabilitation was viewed as a resourceful option during the pandemic and in certain clinical situations (e.g., rural/remote). Workers should be able to make informed choices about service delivery format.

Purpose: The objective of this study is twofold: (1) to better understand the Return-to-Work (RTW) process of employees on sick leave due to burnout by evaluating RTW obstacles and self-efficacy to overcome them, and (2) to investigate strategies implemented for maintaining employment following burnout.

Method: Fifty-one participants completed the online questionnaire titled "Return-to-Work Obstacles and Self-Efficacy Scale (ROSES)", and two focus groups were conducted with employees returning to work after experiencing burnout.

Results: All the ROSES dimensions emerged as potential obstacles to returning to work after burnout. Several were particularly challenging to overcome, such as Fears of a relapse, Cognitive difficulties, and Loss of motivation to RTW. Qualitative analysis of verbatim from focus groups identified eight categories of strategies for overcoming these obstacles, such as Work involvement regulation strategies, Identity and anxiety regulation strategies, Seeking care and support from professionals, and Cognitive and metacognitive strategies, among the most often mentioned.

Conclusion: These findings pave the way for a more detailed analysis of the perceived obstacles individuals face during their RTW after burnout. Furthermore, the identification of strategies to overcome these obstacles may prove beneficial not only for the sustainable RTW of individuals, but also for the professionals who support them.

Purpose: The present study adds to the literature by evaluating the differential risk of ADHD symptom dimensions and executive functioning (EF; time management, organization, motivation) to key occupational outcomes.

Methods: Participants were adults (N = 100; 51% male) with ADHD working full-time between the ages of 19-30 (M = 26.61, SD = 2.28). Participants reported on their ADHD symptoms and EF as well as on five areas of occupational functioning (income, written warnings, boredom at work, satisfaction with coworkers and supervisors).

Results: Over and above medication status, sex, and age, path analyses revealed hyperactivity/impulsivity and time management were the most consistent predictors of outcomes. Higher levels of each predictor were associated with lower income, more written warnings, greater boredom at work, as well as lower satisfaction with coworkers and supervisors. Executive function difficulties with organization and motivation were risk factors for all evaluated outcomes, except written warnings. Higher levels of inattention symptoms were associated with more written warnings and lower satisfaction with coworkers.

Conclusion: The present study is one of the first to document the differential risks of ADHD symptoms and EF to a comprehensive set of occupational functioning outcomes. Future research is needed to replicate the present findings and expand this line of work to identify factors that may protect against these ADHD-related risks on workplace success.

Purpose: The Core Set for Vocational Rehabilitation (CS-VR), a checklist based on the International Classification of Functioning, Disability and Health (ICF), captures the work functioning of individuals requiring VR. By listening to cancer survivors' experiences and stakeholders' perspectives, the CS-VR-Onco of 85 ICF-based categories was obtained. The aim of this study was to assess the concurrent validity of the CS-VR-Onco by measuring this tool's ability to detect differences among cancer survivors in terms of perceived return to work (RTW)-related difficulties.

Methods: A sample of 300 working-age individuals with a first diagnosis of cancer was selected through the local Cancer Registry. Of these 300, those employed individuals who had returned to work were deemed eligible. Through a guided interview, participants reported and described their perceived RTW-related difficulties using the terminology of the CS-VR-Onco. Frequencies and means were used to compare the results of (a) cancer survivors who reported having had difficulties with those who had not, and (b) cancer survivors who had undergone chemotherapy (CT) with those who had not.

Results: Of the 104 respondents, 35 cancer survivors (Group 1) reported having had RTW-related difficulties and CS-VR-Onco-described problems, while 54 reported no difficulties but did highlight some problems (Group 2), and 15 reported neither difficulties nor problems (Group 3). The categories of the CS-VR-Onco that were prioritized were similar across groups, but Group 1 had higher frequencies than did Group 2 + 3 in 69 categories out of 85. In the second comparison, 40 cancer survivors who had undergone CT had higher frequencies than did 64 cancer survivors who had not undergone CT, but this trend was not applicable to 23 categories of the CS-VR-Onco. Seven categories were not reported as problems by all participants.

Conclusion: The CS-VR-Onco identified more problems in cancer survivors who reported RTW-related difficulties and differences between cancer survivors who had undergone CT and those who had not. These results contribute to assessing the preliminary validity of the tool.

Purpose: To systematically identify and evaluate interventions to improve work participation for adults with upper limb musculoskeletal conditions, and explore contextual factors and mechanisms that suggest how the intervention is effective, for whom, and in what setting.

Methods: The review protocol was pre-registered with PROSPERO (CRD42023433216). Eligible studies met the following criteria. Population adults (aged ≥ 18 years), with musculoskeletal upper limb conditions including traumatic and non-traumatic presentations. Intervention strategies aimed at enhancing work participation. Outcomes measures including return to work, increased work duties or hours, and work functioning. Study design randomised and non-randomised experimental studies, mixed methods, qualitative studies, and case series. Two reviewers independently screened, extracted data, and completed quality appraisal. Interventions were described using TIDieR and the data presented as a narrative synthesis.

Results: Twenty-two studies were included. Interventions were categorised into three groups: multimodal or multidisciplinary (n = 13), ergonomic (n = 4), and exercise (n = 5). Eight interventions were primarily delivered in the workplace and 14 in healthcare settings. Four outcome domains were reported: return to work (n = 18), self-reported work function (n = 4), work productivity (n = 5), and work-related costs (n = 2). Only exercise interventions showed consistent statistically significant benefits. Heterogeneity in outcomes prevented formal meta-analysis. Only five studies were rated as high quality.

Conclusions: There is insufficient evidence to recommend specific work participation interventions for adults with upper limb musculoskeletal systems. No studies explored the impact of Fit Notes or other formal work guidance documentation.

Purpose: This paper describes how Canadian Return to Work coordinators (RTWC) framed their job roles relative to workers in ways that went beyond the usual professional norms of helping worker recovery.

Methods: In-depth interviews were conducted with 47 RTWCs across Canada in 2018-2019. We used critical discourse analysis to analyze the way coordinators viewed workers in the complex, multi-stakeholder system of RTW.

Results: We identified four ways that RTWCs positioned themselves relative to workers: as trust builders, experts, detectives and motivators. These roles reflected RTWCs position within the system; however, their discourse also contributed to the construction of a moral hierarchy that valued worker motivation and framed some workers as attempting to exploit the RTW system.

Conclusions: RTWCs' positions of power in the coordination process warrant further investigation of how they exercise judgement and discretion, particularly when the process depends on their ability to weigh evidence and manage cases in what might be seen as an objective and fair manner.

Purpose: Public safety personnel, including first responders, are regularly exposed to physical, social, and psychological risks and occupational requirements. These risks and requirements extend beyond the employee and may also impact the families (for example, work-family conflict, compassion fatigue). Despite recent attention directed at the population's wellness, considerably less attention is directed towards the family. This review investigates how the risks and requirements associated with these occupations affect families' lives and experiences, and correspondingly, how families respond and adapt to these risks.

Methods: In the current qualitative review, we sought to identify and describe the lifestyle experiences of public safety families as they navigate the occupational risks and requirements of public safety work. The inclusion criteria resulted in an analysis of 18 articles, representing only police (n = 11), paramedics (n = 7), and firefighting (n = 10) sectors.

Results: We identified and described the experiences of public safety families both by occupation and familial role. Shared familial themes across occupational groups included 'Worry', 'Communication', 'Where do I turn', 'Are they okay', 'Serving alongside', and '(Over)Protective'. However, distinct themes also emerged between different occupational groups and family configurations. Themes prevalent amongst primarily children of police included: 'Worry', 'Let's Laugh Instead', '(Over)Protective', and 'I'm not the Police, my Parent is!'. Experiences differed if the family contained on serving public safety personnel or multiple.

Conclusion: We identified the shared and unique occupational experiences of public safety families. This review normalizes these experiences and emphasizes the need to develop initiatives to improve the well-being of families and safety employees.

Objective: A workers' compensation claim may have significant negative impacts on an injured worker's wellbeing. Wellbeing provides a good global measure of potential effects of a claim on an individual, and is important for contemporary economic modelling. The purpose of this study was to synthesize knowledge about the wellbeing of injured workers after the finalization of a workers' compensation claim and identify gaps in the current literature.

Methods: A systematic scoping review was conducted.

Results: 71 full-text articles were screened for inclusion, with 32 articles eligible for this review. None of the included articles evaluated overall wellbeing. Included articles did evaluate a variety of constructs inherent in wellbeing. Injured workers were generally disadvantaged in some manner following claim finalization. The literature recommends a focus on reducing negative impacts on injured workers after finalization of a compensation claim, with a need for regulatory bodies to review policy in this area.

Conclusion: There appears to be potential for ongoing burden for individuals, employers, and society after finalization of a workers' compensation claim. A gap in knowledge exists regarding the specific evaluation of wellbeing of injured workers following finalization of a workers' compensation claim.