Journal of Occupational Rehabilitation最新文献

Purpose: This study is a process evaluation of the use of Individual Placement and Support (IPS) and Participatory Workplace Intervention (PWI) to increase the work participation of people with work disabilities. We ran the evaluation alongside a randomized controlled trial (RCT), to investigate whether and to what extent IPS and PWI were executed according to protocol.

Methods: The study population consisted of clients with work disabilities, and their job coaches who were employed by the municipality of a large city in the Netherlands. Data were collected between September 2019 and November 2022 using registration forms, accompanied by researchers' notes and logbooks.

Results: For IPS the dose delivered was reasonable and the IPS fidelity measurement score was fair. The job search focused on paid work for almost all clients and was based on their wishes as indicated in the protocol, but integration of employment services with (health) care was often lacking. A minority of the clients who were assigned to PWI received the intervention, often because the client did not start work within the follow-up period and a workplace was a requirement to apply the intervention.

Conclusion: The results of this study show that IPS was executed reasonably and with a fair fidelity, which indicated implementation was sufficient to find an effect on work participation in the RCT. PWI was barely realized in practice and no conclusions regarding the fidelity could be drawn. We therefore conclude that we cannot expect PWI to have any effect on work participation in the RCT.

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: 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.

Background: The Netherlands faces 60% prevalence of chronic conditions by 2040, impacting societal participation and quality of life. Current clinical care inadequately addresses these consequences, and most hospitals do not integrate occupational health in their care.

Objectives: To develop a generic person- and work-oriented medical care model (WMCM) based on real life experiences with work-oriented care and supporting the chronically ill in active societal participation.

Methods: A qualitative research project with a participative approach in one hospital (November 2019 until March 2020). In an expert meeting, a schematic representation of a work-oriented care model was developed. Subsequent discussion rounds, with professionals from different patient groups, iteratively refined the model to a WMCM.

Results: Consensus was reached after seven rounds of discussion, defining the model's core elements (1) a combination of biomedical and biopsychosocial approaches, (2) involvement of a clinical occupational physician in the treatment team, (3) a coordinating role for nursing specialists, and (4) incorporation of a work-oriented intervention plan (WoIP) into the treatment plan. Advocating early attention to societal participation, the model emphasises the WoIP and consensus on monitoring indicators. The final goal is a sustainable return to societal participation, considering both quality of life and work.

Conclusion: It is feasible to develop a generic person- and work-oriented care model for patients with chronic illness within a hospital care setting. Collaboration between healthcare professionals and a specialised occupational physician, with a central role for nurses, is deemed crucial.

Purpose: Many countries have developed clinical decision-making support tools, such as the smart work injury management (SWIM) system in Hong Kong, to predict rehabilitation paths and address global issues related to work injury disability. This study aims to evaluate the accuracy of SWIM by comparing its predictions on real work injury cases to those made by human case managers, specifically with regard to the duration of sick leave and the percentage of permanent disability.

Methods: The study analyzed a total of 442 work injury cases covering the period from 2012 to 2020, dividing them into non-litigated and litigated cases. The Kruskal-Wallis post hoc test with Bonferroni adjustment was used to evaluate the differences between the actual data, the SWIM predictions, and the estimations made by three case managers. The intra-class correlation coefficient was used to assess the inter-rater reliability of the case managers.

Results: The study discovered that the predictions made by the SWIM model and a case manager possessing approximately 4 years of experience in case management exhibited moderate reliability in non-litigated cases. Nevertheless, there was no resemblance between SWIM's predictions regarding the percentage of permanent disability and those made by case managers.

Conclusion: The findings indicate that SWIM is capable of replicating the sick leave estimations made by a case manager with an estimated 4 years of case management experience, albeit with limitations in generalizability owing to the small sample size of case managers involved in the study.

Implications: These findings represent a significant advancement in enhancing the accuracy of CDMS for work injury cases in Hong Kong, signaling progress in the field.

Purpose: The nature and cumulative occupational demands imposed on families of public safety personnel (PSP) are substantial, in many cases non-negotiable, and distinct from the general population accentuating risk factors for family well-being. Despite this reality, the contributions of PSP families are not well understood, and a conceptual framework is needed. The aim of this paper is to summarize contextual factors (lifestyle dimensions) that shape the lives of PSP families; factors supported in the existing, albeit limited, body of research.

Methods: Grounded in the interpretive/constructivist paradigm, a synthesis was central to understanding the lived experiences of PSP families. An interdisciplinary research team engaged in an iterative process of framework analysis to capture the variability and complexity of PSP family life and distilled the overarching lifestyle dimensions.

Results: Three lifestyle dimensions-logistics, risks, and identities-emerged from contextual factors and represent distinct aspects of PSP family life. PSP families play a crucial role in that their capacity to accommodate the lifestyle dimensions (i.e., logistics, risks, and identities), without which the PSP could not meet the demands of the profession.

Conclusion: Promoting awareness of these dimensions and their consequent demands underscores the cumulative demands that put PSP families at risk. Responses from governments, public safety organizations, and communities are required to help PSP families manage non-negotiable elements of the public safety occupation that spill over into family life over which they have no control.

Purpose: To perform the process evaluation of an intervention that aims to facilitate clinical healthcare professionals (HCP) to provide Maastricht Work-Related Support (WRS) to working patients with a chronic disease.

Methods: A mixed-methods approach was applied to address reach, efficacy, adoption, implementation, and maintenance (RE-AIM framework) as well as context of the Maastricht WRS intervention. Qualitative data included interviews with HCPs (N = 10), patients at two time points (N = 10 and N = 9), and field notes. Quantitative data included screening logbooks of HCPs, patient screening forms, and a questionnaire for patients. Content analysis or computation of frequencies was applied where applicable.

Results: Twenty-eight HCPs participated in the intervention (reach). They had a low attitude toward providing Maastricht WRS themselves (adoption). During clinical consultations, they addressed work for 770 of 1,624 (47%) persons of working age. Only 57% (437/770) had paid work, of which 10% (44/437) acknowledged a current need for support. Discussing work during clinical consultations by HCPs was hindered by other medical priorities and patients not disclosing problems (implementation). Over time, Maastricht WRS was less consistently provided (maintenance). Patients reported a positive impact of the intervention, such as fitness for work (efficacy). Context (e.g., lack of urgency, priority, time, and management support) played a pivotal role in the implementation.

Conclusion: This evaluation showed that HCPs had a positive attitude toward WRS in general, but their attitude toward provide Maastricht WRS themselves in daily clinical care was low. Recommendations include improving HCPs' attitude, addressing WRS as a key policy point, and facilitating time.

Purpose: The aim of this systematic review is to identify vocational rehabilitation (VR) interventions that are effective to enhance return-to-work (RTW) for people on long-term sick leave (> 90 days) and to identify main elements of these interventions.

Methods: Six electronic databases were searched for peer-reviewed studies published up to February 2022. Each article was screened independently by two different reviewers. Thereafter, one author performed the data-extraction which was checked by another author. The EPHPP quality assessment tool was used to appraise the methodological quality of the studies.

Results: 11.837 articles were identified. 21 articles were included in the review, which described 25 interventions. Results showed that ten interventions were more effective than usual care on RTW. Two interventions had mixed results. The effective interventions varied widely in content, but were often more extensive than usual care. Common elements of the effective interventions were: coaching, counseling and motivational interviewing, planning return to work, placing the worker in work or teaching practical skills and advising at the workplace. However, these elements were also common in interventions that were not effective on RTW compared to usual care and can therefore not explain why certain interventions are effective and others are not.

Conclusion: The effective interventions included in this study were often quite extensive and aimed at multiple phases of the RTW-process of the worker. In the future, researchers need to describe the population and the content of the investigated interventions more elaborate to be able to better compare VR interventions and determine what elements make interventions effective.

Purpose: To explore and describe therapeutic approaches for the prevention of upper limb (UL) repetitive strain injuries (RSI) amongst computer users in the twenty-first century.

Methods: A scoping review was conducted using the method described by Arksey and O'Malley, further enhanced by Levac et al. to ensure rigor, validity and reliability during analysis. Key concepts pertaining to the research question have been mapped, following comprehensive searches of relevant electronic databases namely EBSCOHost (Academic Search Premier, CINAHL, eBook Collection, E-Journals, Health Source-Consumer Edition, Health Sources-Nursing/Academic Edition and MEDLINE), PUBMED and Google Scholar. The identified studies have been presented in a descriptive numerical summary to address the research aim.

Results: From the 577 studies initially identified, 58 studies were eligible for inclusion in the scoping review after abstract and full text screening. Strategies for the prevention of UL RSIs in computer users were categorised into overarching types of intervention as well as the factors which contribute towards sustained implementation of prevention strategies. Using ergonomic equipment was the most prevalent approach during intervention, breaks and rest periods were found to be the less common intervention offered to prevent RSIs. The majority of the studies noted personal worksite adjustments, including adjustments of the chair, back rest, lumbar support, handles or any arm support to the individual as a strategy to prevent UL RSIs. In high income countries the use of ergonomic equipment was the most common type of approach during intervention, in middle income countries stretches were the most common therapeutic intervention strategy and in low-income countries there was an even distribution between a number of different therapeutic interventions aimed at preventing RSIs.

Conclusions: The review provides an overview of approaches and a comprehensive baseline for identifying further research required to generate prevention approaches. The information within the review may be used to impact company practice, policy and decision making in terms of developing prevention strategies.

Purpose: Vocational rehabilitation (VR) is an intervention to improve return to work for patients with chronic musculoskeletal pain (CMP). However, a systematic overview of characteristics of referred patients or eligible for VR is lacking, which hinders comparability across studies. Objectives were (1) to describe characteristics of patients with CMP referred to and eligible for VR and (2) to identify factors that contribute to VR eligibility.

Methods: This study used a multicenter, cross-sectional design. Data of self-reported questionnaires were obtained between 2013 and 2019 from care as usual of eight Dutch VR centers. Descriptive statistics were performed to describe sociodemographic, pain-related, and work-related characteristics. Logistic regression analysis was used to identify factors contributing to VR eligibility.

Results: Data sets of n = 2970 referred patients were included. The mean age was 46 years and 60% were female. Low back (43%), neck (37%), and shoulder pain (34%) were most reported. 82% Worked in paid employment. The absenteeism rate was 85%, and 44% was partially absent. After multidisciplinary screening, 62.2% were eligible for VR. Persons most likely to be eligible for VR (OR < 1.20) were those having back or neck pain, whereas least eligible (OR < 0.80) were persons having pain in hand/fingers or pain in other regions, unemployed workers, and those referred by a 'other' medical specialists. All other factors contributed little or none to the model.

Conclusions: An extensive description of sociodemographic, pain-related, and work-related characteristics is presented for patients eligible for VR. Especially having back/neck pain and being an employee were associated with higher chance of eligibility for VR.