Journal of Occupational Rehabilitation最新文献

Purpose: Return-to-work (RTW) counseling is a critical part of rehabilitation of sick-listed employees with common mental disorders (CMD). In the Netherlands it is mandatory that RTW counseling with an occupational physician (OP) starts within two weeks, but current literature and guidelines provide little empiric support. This study aims to answer the questions "Is starting RTW counseling within two weeks associated with faster RTW?" and "Is there a dose-response effect (i.e. the earlier the better)?".

Methods: In an observational design, sick-listed employees (n = 12,169) seen by an OP within two weeks of onset of sick leave were compared to those seen later using Cox proportional hazards analysis. Next, per week effects were examined, reporting pairwise comparisons of weeks 1 through 6 if the omnibus test was significant.

Results: Earlier RTW counseling was associated with earlier RTW (HR: 0.89, 95%CI: 0.86-0.93). There was a dose-response effect (LLR χ²: 46.08, df = 5, p < 0.001) with significant earlier RTW when RTW counseling was started in week 1 versus week 3 (HR: 0.90(95%CI 0.85-0.96), p < 0.001), week 1 versus week 5 (HR: 0.88(95%CI 0.81-0.94), p < 0.001), week 1 versus week 6 (HR: 0.82(95%CI 0.77-0.88), p < 0.001), and week 2 versus week 6 (HR: 0.84(95%CI 0.79-0.89), p < 0.001). However, subgroup analyses showed these findings only held for employees with adjustment disorders.

Conclusions: There is a modest benefit to starting RTW counseling earlier. However, this effect is limited to those seen very early and there are no significant differences between weeks 2 through 5. Whether these modest benefits warrant strict adherence to a two-week deadline should be re-evaluated.

Objective: To evaluate the influence of a mental health treatment program for public safety personnel (PSP) disabled by post-traumatic stress disorder (PTSD) on return-to-work outcomes.

Methods: A mental health treatment program established exclusively for PSPs disabled by work-related PTSD received 582 referrals over the period November 2021 to June 2023. Return-to-work outcomes were defined as the cessation of workers' compensation wage replacement benefits over an 18-36 month period following referral. Outcomes among the referral cohort were compared to PSPs not referred to treatment who also had an accepted workers' compensation claim for PTSD. Referrals were matched to non-referrals on age, sex, occupation and date of injury.

Results: Among the 472 referrals to the treatment program eligible for inclusion in the study, 54.4% initiated treatment. There was no difference in return-to-work outcomes over the follow-up period between the referrals who initiated treatment (29.9%) and the 215 referrals not initiating treatment (32.5%, p = 0.612). In contrast, return-to-work outcomes were more positive among the matched non-referral comparison group (41.9%, p < 0.001, all referrals vs the matched non-referral comparison group).

Conclusion: In this large cohort of PSPs disabled by PTSD, there was no evidence of a positive treatment effect on return-to-work outcomes. The prognosis for return-to-work among public safety personnel with long durations of recovery from PTSD is poor. The implications of this study point to the importance of the development and testing of novel evidence-based treatments and opportunities to support employers' commitment and capacity to provide suitable accommodation as strategies to improve return-to-work outcomes among public safety personnel disabled by PTSD.

Aim: Enhancing the adaptability to return to work among cancer patients can help them fully mobilize coping resources and adapt to the environment during the reintegration process. However, influenced by multiple factors, the adaptability to return to work among cancer patients in China remains inadequate and requires improvement. To address this, we aim to develop and validate the Questionnaire of Factors related to the Adaptability to Return to Work Among Cancer Patients (abbreviated as QF-ARTWCP). Grounded in the theoretical model "Cancer Patients' Return-to-Work Adaptation Experience and Coping Resources," social ecosystems theory, and social support theory, this instrument will provide a foundation for subsequent investigations and the development of targeted intervention programs.

Methods: The development of the QF-ARTWCP was conducted in three phases: (1) Item generation: A literature review identified relevant influencing factors and existing evaluation tools. This was followed by three rounds of experts consultations (15 experts) and a pilot survey (30 patients), resulting in a 59-item initial questionnaire; (2) Preliminary survey: Item analysis, exploratory factor analysis (EFA), and reliability testing were performed with 238 participants. Content validity was assessed by 8 experts; and (3) Formal verification investigation: Confirmatory Factor Analysis (CFA) using fit indices (e.g., χ²/df, RMSEA, SRMR) evaluated model-data fit. Convergent validity was quantified via average variance extracted (AVE), and composite reliability (CR), with 277 participants.

Results: The final QF-ARTWCP consists of 34 items across nine factors: Healthy Cognition; Work Cognition; Emotional Coping; Work Coping; Unit Support; Support from Friends and Relatives, Financial Burden; Social Atmosphere; and Policy Support. The CFA demonstrated acceptable model fit (χ²/df = 2.245, P < 0.001; RMSEA = 0.067, SRMR = 0.052; CFI = 0.914, and TLI = 0.902. Additionally, the AVE (0.615-0.792) and CR (0.834-0.938) values indicated strong aggregate validity.

Discussion: The QF-ARTWCP is a validated, user-friendly tool tailored for cancer patients. This questionnaire enables the evaluation and monitoring of the adaptability to return to work in occupational settings, supporting targeted interventions.

Purpose: Trust is key to a successful return to work following a work disability. Its constituents, which have been widely documented in social and management sciences research, are not addressed in return to work (RTW) research. This study therefore aims to portray the constituents of trust that have been documented in the context of RTW following an absence due to musculoskeletal disorder or a common mental disorder.

Method: A scoping review was performed using Joanna Briggs Institute methodology and the PRISMA extension for scoping review guidelines. Studies were extracted from six databases using keywords like trust, RTW/disability, and musculoskeletal/common mental disorders. Study selection and analysis were conducted in Covidence by two reviewers independently. An Excel framework served to record the constituents of trust (i.e., antecedents, attributes, and consequences) identified in accordance with a thematic analysis approach.

Results: From the 2795 references extracted, 30 studies were selected, 73% of which were published in the Last 10 years. All three constituents were documented, mainly in the dyadic relationship between the worker returning to work and other stakeholders. Yet, some known antecedents of trust remain underexplored and new consequences emerge. Support also appears to be both an antecedent and a consequence, which encourages reflection on the possibility of trust reciprocity.

Conclusion: While the constituents of trust involved in RTW were documented, they should be tested empirically, and some constituents and relationships need further exploration. Recommendations to improve trust between stakeholders are proposed.

Purpose: Physiotherapists play a central role in the rehabilitation of individuals with work-related musculoskeletal disorders. Yet, it is currently unclear how entry-level training prepares them to manage work disability. This study aimed to (1) identify a set of work rehabilitation competencies, (2) examine how these competencies are integrated into entry-level physiotherapy training programs in Quebec, Canada, and (3) assess educators' perceptions of the adequacy of work rehabilitation education.

Methods: A five-step consensus-building process with engaged partners and a literature review served to identify the competencies. Subsequently, educators from all Quebec physiotherapy programs completed a cross-sectional survey containing closed- and open-ended questions. The survey documented the integration of general and competency-specific work rehabilitation content and educators' ratings of students' preparedness for entry-to-practice for each competency. Quantitative data were analyzed descriptively, and open-text responses were analyzed using qualitative metasummary.

Results: Seven work rehabilitation competencies were identified and used to structure the survey. The median time dedicated to work rehabilitation education was 5.5 h (range 1-21.5). Programs partially integrated the competencies, using mostly didactic learning strategies. Coverage of key topics for each competency and relevance to work rehabilitation varied considerably across programs. Educators reported low student preparedness for competencies requiring work-focused knowledge and skills and varying comfort with teaching this content.

Conclusion: This study highlights critical gaps in physiotherapy education related to work rehabilitation and provides a benchmark for how key competencies are addressed in Quebec programs. These findings offer a foundation for improving work rehabilitation training for physiotherapists.

Purpose: This study investigates factors associated with receiving return-to-work (RTW) coordination within primary healthcare and the association between received RTW coordination and the amount of sickness absence (SA) days.

Methods: This register study included 13019 people who had SA at some time between March 2019 and February 2020 and visited a primary healthcare clinic that employed a RTW coordinator. Logistic regressions were used to investigate received RTW coordination. Negative binomial regressions were used to analyse the amount of SA days in the ten-month follow-up period.

Results: Associations were found between receiving RTW coordination and being a woman, being 30-49 years old, and having higher educational attainment, more healthcare contacts, more SA days, and a musculoskeletal or mental diagnosis. In the following ten-month period, mean SA were 71.3 days among people receiving RTW coordination and 76.1 days for those who had not. However, the adjusted analyses did not show association between RTW coordination in primary healthcare and the amount of SA days in the following ten-month period.

Conclusion: RTW coordination seems to be directed towards some groups of people with a higher risk of long-term SA, but not all, which raises the question of whether or not more people on SA would have benefited from RTW coordination as well. This would likely mean that more finely calibrated ways of identifying people at risk of long-term SA are needed. The reduction in SA days for those who had received RTW coordination needs to be confirmed in further studies.

Purpose: Staying at work despite recurrent or persistent musculoskeletal (MSK) pain offers mental and physical health benefits in addition to financial security for workers. This study explores worker and manager experiences and perspectives on stay-at-work practices to nuance our understanding of what drives successful or unsuccessful practices.

Methods: We conducted a vignette-based qualitative exploration of workplace practices of managers and workers from three medium-sized workplaces with physically demanding jobs. Data collection included five focus group interviews and two workshops. Data were analysed using reflexive thematic analysis inductively and deductively.

Results: We identified three themes relating to workplace cultures (Theme 1. Pain is an accepted part of working life), conflicting perceptions of responsibility in managing health impact on stay-at-work practices (Theme 2. Stay-at-work responsibilities and practices), and the importance of trusting communication and the precarious balance between support and pressure to stay at work within the workplace (Theme 3. En route to dismissal).

Conclusion: The identified themes describe helpful and unhelpful beliefs and practices involving individual workers, their co-workers and managers. Shared and unshared cultural norms, understandings of what MSK pain is and means, and perceptions of responsibility drive stay-at-work practices, with trust being an important factor for the precarious balance between workplace support and pressure to stay at work.

Objectives: Recent research has emphasized that return to work (RTW) is a dynamic, gradual and often uneven process with a great degree of individual variation. This study aimed to identify RTW trajectories of Swedish employees on sick-leave due to common mental disorders (CMDs). The second aim was to explore which demographic, employment, health-related and work environment characteristics predicted RTW trajectory membership.

Methods: Data comes from two 2-armed cluster-randomized controlled trials (RCT) with a 12-month follow-up. A participative problem-solving intervention aimed to reduce sick-leave was compared to care as usual (CAU) involving any kind of work-directed interventions. Participants on sick-leave due to CMDs at baseline (N = 197) formed the study sample. Latent growth mixture modeling and logistic regression were the main analytical approaches.

Results: Five distinct RTW trajectories of Swedish employees were identified: Early RTW (N = 65), Delayed RTW (N = 50), Late RTW (N = 39), Struggling RTW (N = 21) and No RTW (N = 22). RTW trajectories differed consistently with regard to previous sick-leave duration and social support at work. More unique predictors of RTW trajectories included gender, rewards at work, work performance impairment due to health problems, home-to-work interference and stress-related exhaustion disorder.

Conclusion: The study may have important clinical implications for identifying patients belonging to a particular RTW trajectory. Knowledge on the modifiable work environment factors that differentiated between the RTW trajectories could be useful for designing effective workplace interventions, tailored to particular needs of employees with CMDs. However, in a first step, the results need to be replicated.

Purpose: Although there is increasing awareness that significant others' perceptions and behavior can affect health outcomes, the role of interpersonal processes between sick-listed workers and significant others in sick leave and return to work (RTW) has hardly been studied. This study aims to examine the associations between illness perceptions, RTW expectations, and behaviors of significant others (engagement, buffering and overprotection) with sick leave duration within dyads of sick-listed workers with chronic diseases and their significant others.

Methods: We used survey data linked with sick leave registry data of 90 dyads. Pearson correlations were used to study the interdependence within dyads. Multiple linear regression analyses were conducted to examine associations between survey data of both dyad members and sick leave duration.

Results: We found moderate to strong correlations between workers and significant others, indicating interdependence within dyads regarding illness perceptions, RTW expectations and perceived significant other behaviors. Dyad members' illness perceptions (R² = .204, p = .001) and RTW expectations (R² = .326, p =  < .001) were associated with sick leave duration, explaining respectively 12.3% and 24.5% of the variance. We found no associations between sick leave duration and active engagement, protective buffering and overprotection.

Conclusions: This study indicates that negative illness perceptions and RTW expectations of both workers and their significant others are associated with a longer sick leave duration. Considering the interdependence within dyads, involving significant others when intervening on maladaptive illness perceptions and RTW expectations may be more effective than solely focusing on the worker's perceptions and expectations.

Purpose: In a new Finnish Coordinated Return to Work (CRTW) model, patients are referred to occupational health care after hip or knee arthroplasty. This study evaluated the CRTW model's effect on return to work (RTW), activities used in occupational health care and in the workplace, and the patient- and work-related factors affecting early RTW.

Methods: 209 participants with occupational health care service underwent primary hip (THA) or total/unicondylar knee (KJA) arthroplasty and completed self-reported questionnaires after arthroplasty and at time of RTW. Factors affecting RTW, and the roles of occupational health care and the workplace in RTW were evaluated. Time to RTW was determined as days between the arthroplasty and RTW.

Results: Mean time to RTW was 69 days after THA and 87 days after KJA. For easing RTW, work arrangements were made for 56% of the participants. The most utilized adjustments of work were enabling remote work and arranging limitations in work tasks. Participants with earlier RTW had lower physical workload, higher professional status and motivation to work, less pre-arthroplasty sick leave, and more positive personal expectations about the time to RTW compared to participants with later RTW (p < 0.001 for all). The linear regression and dominance analyses showed participants' own expectations and pre-arthroplasty sick leave as the strongest factors affecting time to RTW.

Conclusions: The CRTW model seems to shorten time to RTW after THA and KJA. Occupational health care and workplace play important roles in supporting RTW. Patients' own expectations should be noted when giving pre-arthroplasty information.