Journal of Occupational Rehabilitation最新文献

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.

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: The aim of the study is to examine the role of unmet needs for workplace accommodations (WPA) in the labor force status of persons with disabilities (PWD) aged 25-64 years.

Methods: The study used data from the 2017 Canadian Survey on Disability and multinomial logistic regressions to estimate the predicted probabilities of employment, unemployment, detachment from the labor force, and retirement. Product terms were used to examine if the association between unmet needs for WPA and these employment outcomes depended on severity of disability and age group.

Results: The findings show that the probability of employment was far lower for PWD with unmet needs for WPA than it was for their counterparts without unmet needs, after controlling for disability-related and sociodemographic characteristics. While having more severe disabilities associated with a lower employment rate, this occurred in the context of unmet needs for WPA, as there was no difference between persons with milder and more severe disabilities without unmet needs. Unmet needs for WPA had age-specific consequences and were associated with a higher probability of unemployment and detachment from the labor force among PWDs aged 25-34 years and a higher probability of retirement among PWD aged 55-64 years.

Conclusion: Unmet needs for WPA are a barrier to the employment chances of many PWD and eliminating these unmet needs could increase their inclusion in the labor force.

Purpose: The Back At work After Surgery (BAAS) care pathway integrates medical and occupational care to enhance return to work (RTW) after knee arthroplasty (KA). BAAS has shown effectiveness in improving RTW outcomes, but its economic impact is unknown. This study evaluates the costs and return on investment (ROI) of BAAS compared with care-as-usual.

Methods: This multicenter, prospective cohort study involved 270 employed patients having KA, comparing the BAAS pathway (n = 137) to care-as-usual (ACTIVE trial, n = 133). The ROI was evaluated from societal and employer's perspectives. Productivity (absenteeism and presenteeism) and healthcare (primary and secondary) costs were assessed using cost questionnaires administered at 3, 6, 9, and 12 months post-surgery. Propensity score matching and multiple imputation addressed non-randomization and missing data, respectively. ROI was calculated by dividing the netto benefits-defined as reductions in productivity and healthcare costs, or productivity costs alone minus costs of the BAAS intervention-by the intervention costs multiplied by 100%.

Results: Propensity score-matched analyses included 102 patients per cohort. The total netto benefits from employers and societal perspective were of €4,493 and €4,982, respectively. Intervention costs were €845/patient. This resulted in a ROI of 590% (95% CI 67-1112%) and 532% (95% CI 27-1037%) from the societal and employer's perspective, respectively, per Euro invested.

Conclusions: The BAAS care pathway demonstrates a favorable economic impact through significant 12 month downstream reductions in absenteeism and healthcare costs, and a positive ROI from both the societal and employer perspective.

Trail registration: This study was retrospectively registered at clinicaltrails.gov ( https://clinicaltrials.gov/ct2/show/NCT05690347 , date of first registration: 19-01-2023).

Purpose: The purpose is to examine perceptions of pity directed toward people with disabilities to gain a deeper understanding of the effect of these perceptions on the employment success of people with disabilities and to provide direction to disability-related training and strategic planning in the workplace.

Methods: Two studies were developed to explore these relationships. The first measured the characteristics most frequently associated with people with disabilities in the workplace. Survey respondents rated the degree to which they believed the average person would assign these several characteristics to people with disabilities. The second measured the degree to which perceptions of pity, as directed toward people with disabilities, were correlated with the apparent complexity of those disabilities. Respondents determined the relative amount of money that passers-by would likely donate to panhandlers who used various mobility equipment (i.e., wheelchair, walker, cane).

Results: Results from these studies indicated that people with disabilities were more likely to be assigned a preponderance of negative characteristics, including those described as unfortunate, limited, and tragic. In addition, people with disabilities whose disabilities were perceived as more complex were seen as being more in need of financial assistance.

Conclusion: By providing an empirically driven starting point for organizational planners, including human resource professionals, managers, and recruiters, these two studies provide a basis upon which to develop strategies that account for these affect-based responses to disability.

Objective: Major organizational changes may be associated with both positive and negative uncertainty in working life. This study described the prevalence of organizational changes (reorganizations or round of layoffs) within different job functions in Denmark and investigated whether quality of the implementation process (measured as "information", "involvement" and "consent") was associated with employees' expectations regarding retirement age.

Methods: A representative sample of older Danish employees ≥ 50 years (n = 12,269) replied to a questionnaire survey in 2020. In cross-sectional analyses, we compared employee's expected retirement age being either not exposed to organizational changes or exposed to implementation processes of high, moderate or low-quality, respectively. Analyses were further stratified for job function: office work, work with people and work in the field of production.

Results: More than half (56%) of the employees had experienced organizational changes within the past 2 years, and 23% of those effected reported that the changes had led to considerations of earlier retirement. Organizational changes were most prevalent within office work, and least prevalent within the job function working with people. The analyses showed significantly lower expected retirement age when the implementation process had been of moderate (mean reduction of 0.45 years) or low quality (mean reduction of 0.71 years) compared to high quality implemented changes.

Conclusions: Experiences of organizational change processes of moderate or poor quality were associated with expectations of earlier retirement, while well implemented changes were not. This study underscores the importance of good implementation when changes at the organizational level are needed.