Journal of Occupational Rehabilitation最新文献

Purpose: To explore the occurrence of work adjustments for people with multiple sclerosis (MS) across types of occupations (managerial, office, and manual workers).

Methods: All working-aged (20-50 years) residents in Sweden diagnosed with MS were invited to participate in a web-based survey in 2021. Responses were linked to individual-level nationwide registers. Descriptive analyses were conducted to compare sociodemographic and clinical variables across occupations as well as other responses. The odds ratio of having any adjustment at work was determined using multinomial logistic regression.

Results: From all 4412 respondents (52% response rate), 3313 employees were included. The majority were women (72%) and had low (24.2%) or mild disease severity (44.7%). Nevertheless, different work adjustments across occupations were observed. Compared to the other occupations, office workers reported more invisible symptoms, more work adjustments and considered adapted schedules as the most important adjustment. On the contrary, more managers reported having no limiting symptoms and consequently, disclosed their diagnosis less often. They also reported having fewer work adjustments and more opportunities to modify their work than office and manual workers. Manual workers had a higher likelihood to report needing more support at work than office workers and managers. Further, a higher likelihood of having work adjustments was associated with progressive MS, higher MS severity, and invisible symptoms.

Conclusion: A more severe clinical profile of MS was associated with having work adjustments. The physical demands and responsibilities of an occupation play an important role when requesting and getting work adjustments amongst employees with MS.

Purpose: Accommodations are vital for protecting equal access and increasing the employment of people with disabilities. However, the evidence on whether employers are willing or resistant to provide accommodations is mixed. We explore reactions to accommodations specifically associated with Assistive Technologies (AT). While the presence of such a device should reassure hiring managers about the abilities of the candidate to do the job, they also risk raising new questions and uncertainties.

Methods: Hypothetical job candidates with and without disabilities were presented to participants with hiring experience to examine perceptions of employability, risk, and trust. Several conditions included the candidate describing the use of AT (i.e., an exosuit) and requesting accommodations, with and without extra technical or enthusiastic language to explain the specific device.

Results: Quantitative and qualitative results show that the request for accommodations, in general, is problematic. And while using the exosuit seems to benefit perceptions of trust, it still seems risky and does not categorically improve employability perceptions. Extra language provided by the candidate to explain the device did not improve outcomes but did (in the case of enthusiastic language) make people more open to seeing the positive aspects of the device.

Conclusion: While using an AT is a positive advance for a job candidate with a disability, the perceptual risk and the salience of the disability are both increased. Future work is needed to explore the options for better reassuring hiring managers about such devices.

Purpose: This paper examines the prevalence of long COVID across different demographic groups in the US and the extent to which workers with impairments associated with long COVID have engaged in pandemic-related remote work.

Methods: We use the US Household Pulse Survey to evaluate the proportion of all adults who self-reported to (1) have had long COVID, and (2) have activity limitations due to long COVID. We also use data from the US Current Population Survey to estimate linear probability regressions for the likelihood of pandemic-related remote work among workers with and without disabilities.

Results: Findings indicate that women, Hispanic people, sexual and gender minorities, individuals without 4-year college degrees, and people with preexisting disabilities are more likely to have long COVID and to have activity limitations from long COVID. Remote work is a reasonable arrangement for people with such activity limitations and may be an unintentional accommodation for some people who have undisclosed disabilities. However, this study shows that people with disabilities were less likely than people without disabilities to perform pandemic-related remote work.

Conclusion: The data suggest this disparity persists because people with disabilities are clustered in jobs that are not amenable to remote work. Employers need to consider other accommodations, especially shorter workdays and flexible scheduling, to hire and retain employees who are struggling with the impacts of long COVID.

Purpose: This study explores small businesses' knowledge base and practices concerning interviewing and hiring job candidates with disabilities, as they are not required to comply with the provisions of the Americans with Disabilities Act (ADA).

Methods: We first conducted 18 in-depth interviews with small business owners to explore their knowledge of the ADA, their practices surrounding hiring (for those with and without disabilities), and their sense of the best practices for how a candidate should navigate the interview and request for accommodations. Responses were then used to create a survey of an additional 110 small business owners.

Results: Six themes arose from the interviews, illuminating the steep learning curve involved in each (1) hiring well, (2) the need to trust an employee's character as much as their skill set, (3) the need for an employee to fit within the small business's family-like environment, (4) the preference for job candidates to be transparent about their needs as early as possible, (5) the importance of personal experience with disability, and (6) the difficulty in obtaining precise information about the ADA. Survey responses supported the general findings of the interviews while also providing information about the relative rarity of encountering a job candidate with a disability.

Conclusion: Hiring employees with disabilities is challenging for small businesses, and bias is difficult to avoid. The availability of clear information on how to comply with the ADA and other laws and practices would be welcome by many small business owners.

Purpose: This study investigates how access to assistive technologies affects employment and earnings among people with disabilities.

Methods: We first document employment and earnings gaps associated with specific impairments and activity limitations using 2017-2021 American Community Survey and 2014 Survey of Income and Program Participation data. We then use accommodations data from the 2012, 2019, and 2021 Current Population Survey (CPS) Disability Supplements to examine employment and earnings growth for people with disabilities related both to any, and to technology-based, accommodations. We also provide short descriptions of three developing assistive technologies that assist people with upper body impairments, visual impairments, and anxiety conditions.

Results: Almost all impairments and activity limitations are linked to lower employment and earnings, with especially low employment among people with mobility impairments and particularly low earnings among those with cognitive impairments. About one-tenth of workers with disabilities received any accommodations, and 3-4% received equipment-based accommodations in the 2012-2021 period; these figures increased slightly over the period. The occupations with the highest disability accommodations rates had greater disability employment growth from 2012 to 2021, but disability pay gaps did not decrease more in these occupations. The three developing assistive technologies we describe illustrate the potential to reduce the estimated employment and earnings deficits.

Conclusion: Assistive technology accommodations have potential for improving employment outcomes for people with disabilities.

Purpose: This article evaluates the effectiveness of Career Services in supporting college students with disabilities to self-advocate for their accommodation rights during the job search.

Method: A qualitative case study was conducted at one university to examine how their Career Services unit educates, trains, and supports students with disabilities in their professional development. Two rounds of interviews were conducted: one with university staff responsible for such services to assess policies and practices in providing support, and one with students and alumni with disabilities to gather feedback on their experiences with career planning and employment.

Results: Three key themes emerged from the data: (1) Disability stigma negatively impacts a willingness to self-advocate among participants (this is especially true among those belonging to multiple marginalized groups); (2) the lack of transition support by the university further entrenches this stigma; and (3) participants report subsequent challenges in the crossover to employment.

Conclusion: These identified barriers discouraged participants from planning for and seeking workplace accommodations and highlighted the need for universities to provide more comprehensive support for their professional development.

Purpose: The aim of the present study was to explore the meaning of work for the subjective well-being of autistic adults with and without paid (competitive) employment and to evaluate the differences and similarities between these groups.

Methods: Eight focus groups were conducted, including a total of 64 autistic adults. Four groups entailed participants with current paid employment (including part-time) and four groups entailed participants without paid employment. All discussions were audiotaped and transcribed verbatim to enable inductive thematic content analysis. Data were analyzed using ATLAS.ti 9.

Results: Generally, both groups viewed paid employment as very important for well-being, albeit for different reasons. Three themes were found: (1) Not having paid employment was associated with lacking societal recognition, and subsequent low self-esteem, which was a dominant theme in those without work; (2) Work can seriously damage (mental) health and well-being, found in both groups; and (3) Paid employment provides many benefits for well-being, with subthemes: 'purpose,' 'social contacts,' 'growth and use of talents,' 'structure and calmness,' and 'income and freedom', which was a dominant theme in those with paid employment.

Conclusions: Both groups found paid employment highly important for their well-being, albeit for different reasons. However, both also agreed that paid employment can be very harmful to (mental) health and well-being. Suitable, well-supported jobs are important for well-being, may help to buffer stress in other life areas, and may even prevent autistic burnout. More studies are needed on how healthy jobs can be created where autistic individuals get positive energy and experience high well-being. This will also help to reduce socio-economic inequality.

Purpose: As stigma is a barrier to work participation of unemployed people with mental health issues/mental illness (MHI), a stigma awareness intervention can be helpful to make informed decisions about disclosing MHI. The aim of this process evaluation was to investigate the feasibility of a stigma awareness intervention, to explore experiences of clients and their employment specialists; and to give recommendations for further implementation.

Methods: The intervention consisted of a stigma awareness training for employment specialists and a decision aid tool for their clients with (a history of) MHI. For the process evaluation, six process components of the Linnan & Stecklar framework were examined: recruitment, reach, dose delivered, dose received, fidelity and context. Using a mixed-methods design, quantitative and qualitative data were collected and analyzed.

Results: The six components showed the intervention was largely implemented as planned. Questionnaire data showed that 94% of the clients found the tool useful and 87% would recommend it to others. In addition, more than half (54%) indicated the tool had been helpful in their disclosure decision. Qualitative data showed that participants were mainly positive about the intervention. Nevertheless, only a minority of clients and employment specialists had actually discussed the tool together. According to both, the intervention had increased their awareness of workplace stigma and the disclosure dilemma.

Conclusion: The implementation of a stigma awareness intervention was feasible and did increase stigma awareness. Experiences with the intervention were mainly positive. When implementing the tool, it is recommended to embed it in the vocational rehabilitation system, so that discussing the disclosure dilemma becomes a routine.

Trail register: The study was retrospectively registered at the Dutch Trial Register (TRN: NL7798, date: 04-06-2019).

Purpose: Medicines are often prescribed to workers with musculoskeletal disorders (MSDs) and injuries to relieve pain and facilitate their recovery and return to work. However, there is a growing concern that prescription medicines may have adverse effects on work function. This scoping review aimed to summarize the existing empirical evidence on prescription medicine use by workers with MSD or injury and its relationship with work-related outcomes.

Methods: We identified studies through structured searching of MEDLINE, EMBASE, PsycINFO, CINAHL Plus, Scopus, Web of Science and Cochrane library databases, and via searching of dissertations, theses, and grey literature databases. Studies that examined the association between prescription medicine and work-related outcomes in working age people with injury or MSDs, and were published in English after the year 2000 were eligible.

Results: From the 4884 records identified, 65 studies were included for review. Back disorders and opioids were the most commonly studied musculoskeletal conditions and prescription medicines, respectively. Most studies showed a negative relationship between prescription medicines and work outcomes. Opioids, psychotropics and their combination were the most common medicines associated with adverse work outcomes. Opioid prescriptions with early initiation, long-term use, strong and/or high dose and extended pre- and post-operative use in workers' compensation setting were consistently associated with adverse work function. We found emerging but inconsistent evidence that skeletal muscle relaxants and non-steroidal anti-inflammatory drugs were associated with unfavorable work outcomes.

Conclusion: Opioids and other prescription medicines might be associated with adverse work outcomes. However, the evidence is conflicting and there were relatively fewer studies on non-opioid medicines. Further studies with more robust design are required to enable more definitive exploration of causal relationships and settle inconsistent evidence.