Journal of Occupational Rehabilitation最新文献

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 derive common patterns (trajectories) of work absence over time due to a musculoskeletal (MSK) or mental health (MH) condition in an English population and determine associations of these absence trajectories with health and sociodemographic characteristics.

Methods: This retrospective cohort study used primary care data for 43,130 and 62,355 economically active individuals with an incident work absence (as measured by receipt of fit notes) due to a MSK or MH condition, respectively, between 2016 and 2018. Latent class growth analysis was used to define trajectories (through issuance of fit notes), and trajectory-covariate association analysis was performed through multivariable multinomial logistic regression.

Results: Five common trajectories of work absence associated with MSK and MH conditions were determined over a one-year follow-up. The two most common trajectories consisted of low absence (a 'Single' fit note and 'Short Term' absence), while the two least common trajectories were characterized by longer-term absence of six months or more ('Chronic Sustained' and 'Chronic Fast Decreasing'), and the fifth by intermittent absence. Individuals associated with the two longer-term absence trajectories were older, living in the North or Midlands or most deprived areas of England, prescribed opioids, and current smokers.

Conclusions: This study has highlighted different patterns of sickness absence due to a MSK or MH condition and profiles of individuals associated with longer-term absence. Earlier and more targeted health and work intervention toward these high-risk subgroups, alongside policy interventions to reduce health inequalities, could help alleviate the rising rate of long-term sickness absence and economic inactivity.

Purpose: To investigate how job demands, control, strain, and occupational sector and branch affect labor market outcomes following sickness absence (SA) due to common mental disorders (CMDs).

Methods: This nationwide register-based cohort study included all residents in Sweden aged 25-55 who began a new > 30-day SA spell due to a CMD (ICD-10: F32-33, F40-43) in 2011-2013 (n = 79,673). Occupational sector and branch were identified through registers, and job demands, control, and strain were assessed using the Swedish Job Exposure Matrix. We used multinomial logistic regression to estimate associations between occupational factors and different unemployment and SA/disability pension (DP) durations during a three-year follow-up.

Results: Public sector workers were less likely to have > 180 unemployment days (OR = 0.3, 95% CI 0.31-0.35). Working in education and public administration and in health and social services was associated with a lower likelihood of > 180 unemployment days, but a higher likelihood of > 365 SA/DP days. Low-control, passive (low control/low demands), and high-strain (low control/high demand) jobs were associated with an increased likelihood of both > 180 unemployment days and > 365 SA/DP days. For > 180 unemployment days, the ORs were 1.7 (95% CI 1.62-1.82) for low-control, 1.8 (95% CI 1.70-1.98) for passive, and 1.4 (95% CI 1.23-1.54) for high-strain jobs. For > 365 SA/DP days, the ORs were 1.3 (95% CI 1.22-1.34), 1.3 (95% CI 1.22-1.41), and 1.3 (95% CI 1.15-1.39), respectively.

Conclusion: Particularly among individuals with SA due to CMDs, job demands, control, and strain are associated with future labor market exclusion and may be important targets for intervention.

Purpose: The objective of the study was to advance the understanding of employers' perspectives on challenges and strategies related to hiring, retaining, and promoting people with physical disabilities (PwPD).

Methods: A nationwide cross-sectional survey of 2000 employers was conducted in the US. Descriptive analysis compared disability-related support practices between companies that hired PwPD in the past year and those that did not. Multivariable logistic regression identified specific challenges and strategies associated with inclusive hiring. Additionally, open-text responses were explored using content analysis.

Results: Company characteristics and disability-related support practices differed significantly between companies that hired PwPD (n = 1,142) and those that did not (n = 858). Employers who reported challenges with negative attitudes of coworkers (CI: 0.73-0.94), negative attitudes of customers (CI: 0.73-0.96), not knowing accommodation costs (CI: 0.75-0.98) had decreased odds of hiring PwPD. Conversely, employers who reported implementing onsite technical assistance (CI: 1.18-1.85), ergonomics experts (CI: 1.02-1.59), visible leadership commitment (CI: 1.11-1.73), trial work periods (CI: 1.05-1.63), and universal design (CI: 1.41-2.39) had increased odds. Open-text responses highlighted challenges such as negative attitudes, limited knowledge about how to support PwPD, and concerns about PwPD's incompetence and litigation. Effective strategies included employee resource groups, skill matching, tailored accommodations, and employee appreciation. Respondents also emphasized the importance of discussing and enhancing disability inclusion.

Conclusion: The study identified specific challenges employers face and strategies they can use when seeking to support the employment of PwPD. Understanding employers' perspectives reveals opportunities to implement practical strategies that support organizations to enhance the workplace inclusion of PwPD.

Purpose: Practitioners in vocational rehabilitation (VR) and college disability counselors often face challenges connecting highly educated individuals with disabilities to employment that aligns with their skills and training. Building equitable partnerships between service agencies and employers is essential to creating effective supported employment programs. Community-Based Participatory Research (CBPR) offers a promising approach to strengthen these partnerships and reduce underemployment among college graduates with disabilities. This article introduces the use of CBPR in VR through the development of a supported employment model.

Methods: Following CBPR principles, we partnered with universities, industry stakeholders, and young adults with disabilities to co-develop and implement Project FORWARD. This supported internship program aimed to help college graduates with disabilities transition into competitive employment in the semiconductor industry through collaborative planning of recruitment, internship structure, and workplace support.

Results: We outline three core features of CBPR and present five strategies for building partnerships at different research stages. Project FORWARD serves as a case example demonstrating how CBPR can address both employer and participant needs through flexible internship design, with clear protocols for recruitment, training, and accommodation. We also discuss practical considerations for researchers applying CBPR in VR contexts.

Conclusion: CBPR provides a valuable framework for advancing VR research by promoting collaboration, equity, and community relevance. It bridges the goals of academic and industry partners while supporting the co-creation of meaningful employment opportunities for individuals with disabilities. Future research should focus on sustaining long-term community partnerships and developing inclusive employment interventions.

Purpose: The Work Rehabilitation Questionnaire (WORQ), an International Classification of Functioning, Disability, and Health (ICF)-based questionnaire, was developed to assess work-related functioning of persons with a range of health conditions. The WORQ has shown limitations in its applicability to persons with spinal cord injury (SCI). The purpose of this study was to investigate internal consistency, test-retest reliability, and agreement of the WORQ-SCI, a newly developed extension to the WORQ for use in persons with SCI.

Methods: A cross-sectional and test-retest reliability study was performed in eight Dutch rehabilitation centers specialized in SCI rehabilitation. Persons with SCI with first inpatient rehabilitation between 2015 and 2022 and work participation as a goal, completed the WORQ-SCI twice. Internal consistency (Cronbach's alpha), test-retest reliability (intra-class correlation, ICC), and agreement between measurement points (Bland-Altman plot) were analyzed.

Results: A total of 175 participants completed the WORQ-SCI questionnaire at baseline (T1), of whom 59 completed the WORQ-SCI questionnaire a second time, with 52 reporting no changes in health or work status. Internal consistency for the WORQ-SCI was: 0.93 (23 items, N = 175). Test-retest reliability for the subgroup with no changes was ICC = 0.91 (95%-CI 0.84-0.95, N = 52). Bland-Altman plot for agreement between WORQ-SCI T1 and T2 (retest) suggested no systematic bias, with a mean difference of - 1.5 (SD 15.2) and 95% limits of agreement: ± 29.7.

Conclusion: The WORQ-SCI showed good internal consistency and test-retest reliability. The test-retest results provide insight into measurement error, emphasizing the robustness of the instrument over time. The WORQ-SCI could be used reliably to assess work-related functioning in persons with SCI, although limits of agreement suggest caution when interpreting change at the level of the individual.

Purpose: Musculoskeletal disorders account for approximately 25% of consultations in primary health care, and sickness absence due to these disorders imposes a substantial economic burden on society. Early identification of workers at risk of sickness absence is crucial; however, there is no consensus on how to identify risk and guide work participation for individuals with musculoskeletal disorders. This scoping review aims to address the research question: Which tools (questionnaires or questions) are used to assess work ability and guide work participation in workers with musculoskeletal disorders, and how do they correspond to the codes in the International Classification of Functioning, Disability and Health (ICF) model?

Methods: Through systematic searches on EMBASE, Medline, Pedro, CINAHL and AMED, we identified tools relevant to assessing work ability in primary health care for use in the early phase of sick leave. Items in the questionnaires were mapped into second level ICF codes.

Results: The scoping review included 95 studies from an initial pool of 10,800 articles. The studies covered 25 tools, all except two of which were available in English, and ten were available in a Scandinavian language. The diverse evidence base for work ability assessment tools spans various ICF codes, with most questionnaires including items in the activity and participation domains. Few questionnaires addressed environmental and personal factors.

Conclusion: The evidence base for work ability assessment tools is extensive, with significant variation in tools, linkage to ICF, and psychometric properties. This scoping review supports healthcare personnel selecting tools based on their purpose, time, body area, and dimensions covered, considering the duration of sickness absence and case complexity. Future research should incorporate environmental and personal factors for comprehensive evaluations.

Background/objectives: Return to work (RTW) is a goal of many patients with colorectal cancer (PwCRC) attending inpatient rehabilitation. In German rehabilitation clinics, physicians conduct the socio-medical assessment of work capacity (SMWC) with the aim of assessing the current ability to work. We tested how well it also predicts the actual RTW of PwCRC.

Methods: This study combined a nationwide physician survey (n = 38) with longitudinal data from a cohort study of PwCRC (n = 172) aged 65 or younger who were employed prior to CRC diagnosis. Physicians were asked about their use of validated tools for the SMWC and their attitudes toward a standardized assessment checklist. PwCRC completed baseline and 9-month follow-up questionnaires about their employment status. SMWC results of the cohort study's participants were extracted from rehabilitation discharge reports.

Results: While 97% of PwCRC were predicted to be capable of working ≥ 6 h/day, only 70% actually returned to work 9 months after rehabilitation. The SMWC showed high sensitivity (98%) but low specificity (6%) for predicting RTW, with a positive predictive value (PPV) of about 70%. Most physicians (73%) at least partly saw the need for an evidence-based structured checklist for an improved SMWC, and almost all (95%) would use it if it did not take more than 10 min to apply it.

Conclusions: The SMWC for PwCRC in German rehabilitation clinics is not standardized and overestimates the return-to-work rate. There is a need for a standardized checklist, and most physicians would be willing to use it.

Purpose: The world of work is rapidly changing and is expected to create new challenges and opportunities for young adults living with disabilities. This study aimed to identify strategies that might enhance inclusion for young people with disabilities as they navigate the future of work.

Methods: Two survey rounds informed by a Delphi approach were completed by 125 participants that included subject matter experts and individuals with lived expertise of a disability. In the first survey, participants were asked about dimensions of the future of work that could affect the employment of young adults living with disabilities and related workplace, community-based, and policy supports that might enhance disability employment inclusion. In the second survey, participants reviewed strategies suggested to promote inclusion in the future of work and ranked them based on their potential impact in supporting the employment of young adults living with disabilities.

Results: Six specific challenge areas in the future of work for young adults with disabilities were identified and included the impact of digital technologies, artificial intelligence (AI) in human resource decision-making, digital globalization, populism and attitudes toward workplace inclusivity, climate change, and external shocks accelerating the pace of change. Top-ranked strategies spanned workplace, social policy, and educational settings and involved delivering lifelong skill-building initiatives, enforcing minimum accessibility standards, enhancing employer disability confidence, and protecting employment rights internationally.

Conclusion: Strategies identified in this study provide solutions to enhance employment inclusion in the future of work. Findings may be utilized by policymakers, employers, and employment service providers as considerations in the design of employment policies and programs for young adults with disabilities that may sustain employment in a shifting work landscape.

Purpose: Mental health peer support is growing as an essential recovery-oriented occupation that can help alleviate the burden of mental health (MH) conditions. Despite its international growth, there is lack of cross-cultural knowledge about peer support workers' (PSW) implementation experiences. This study explored PSWs' implementation experiences of Using Peer Support In Developing Empowering Mental Health Services (UPSIDES) innovative intervention-a multi-country project designed to empower and scale-up peer support in low-, middle- and high-income countries (LMIC & HIC).

Method: Nine focus groups totaling 38 PSWs were conducted at six study sites: Ulm and Hamburg (Germany), Kampala (Uganda), Dar es Salaam (Tanzania), Be'er Sheva (Israel), and Pune (India). Transcripts were analyzed using qualitative analysis and MAXQDA software.

Results: Four domains were identified: (i) PSWs' experiences of recovery; (ii) PSWs' experiences of vocational development; (iii) PSWs' experiences with staff  and work-role in MH systems;and  (iv) PSWs' strive to influence broader circles. In low-and-middle-income countries specifically, PSWs experienced gains for illness management, access to care, employability and financial standing. They also engaged in active interactions with stakeholders in the community (e.g., relatives, police, etc.) promoting social-educative and anti-stigma influences. In high-income countries, experiences related to self-disclosure and peer-vocational development issues. Across sites PSWs' expressed challenges and needs related to lack of role clarity, relations with MH staff and integration into services.

Conclusions: The findings reveal the potential of mental health peer support workers (MH PSWs) to aid in mental health recovery and systemic change. However, implementation experiences vary across cultures, highlighting the need to further develop the PSW role and integrate it into mental health systems across different sites.   Trial Registration: ISRCTN26008944.