Researching Complex and Multi-Level Workplace Factors Affecting Disability and Prolonged Sickness Absence

Impact of biomechanical exposure (job-exposure matrix 'MADE') and social support on return to work following occupational injuries

OBJECTIVES

To identify the determinants that influence the outcome of the return to work (RTW) after occupational injuries.

METHODS

We conducted a cross-sectional study at the National Health Insurance Fund of Tunisia among victims of occupational injuries. Individual and professional factors have been evaluated through a face-to-face questionnaire for ten months. Biomechanical exposure was estimated by the job-exposure matrix "MADE" and social support by the Social Support Scale. Along with descriptive statistics, we used bivariate analysis, binary logistic regression, and random forest.

RESULTS

We included 199 injured workers aged 20-60 years (mean = 42.73; 79.9 % male).Of the 199 injured workers, 39.7 % had unsuccessful RTW. Low social support, biomechanical exposure, blue-collar workers, working long hours, and severe injuries were associated with an unsuccessful return to work. In the variable importance plot issued from the random forest model, low social support at work was the most important risk factor of an unsuccessful RTW, followed by MADE variables: repetitiveness and effort.

CONCLUSION

Biomechanical exposure and social support are main influencers of the return-to-work process.

Getting an outsider's perspective - sick-listed workers' experiences with early follow-up sessions in the return to work process: a qualitative interview study

PURPOSE

The aim of this study was to explore how early follow-up sessions (after 14 and 16 weeks of sick leave) with social insurance caseworkers was experienced by sick-listed workers, and how these sessions influenced their return-to-work process.

METHODS

A qualitative interview study with sick-listed workers who completed two early follow-up sessions with caseworkers from the Norwegian Labor and Welfare Administration (NAV). Twenty-six individuals aged 30 to 60 years with a sick leave status of 50-100% participated in semi-structured interviews. The data was analyzed with thematic analysis.

RESULTS

Participants' experiences of the early follow-up sessions could be categorized into three themes: (1) Getting an outsider's perspective, (2) enhanced understanding of the framework for long term sick-leave, and (3) the empathic and personal face of the social insurance system. Meeting a caseworker enabled an outsider perspective that promoted critical reflection and calibration of their thoughts. This was experienced as a useful addition to the support many received from their informal network, such as friends, family, and co-workers. The meetings also enabled a greater understanding of their rights and duties, possibilities, and limitations regarding welfare benefits, while also displaying an unexpected empathic and understanding perspective from those working in the social insurance system.

CONCLUSION

For sick-listed individuals, receiving an early follow-up session from social insurance caseworkers was a positive experience that enhanced their understanding of their situation, and promoted reflection towards RTW. Thus, from the perspective of the sick-listed workers, early sessions with social insurance caseworkers could be a useful addition to the overall sickness absence follow-up.

Health Management: Evaluating the Relationship between Organizational Factors, Psychosocial Risks at Work, Performance Management, and Hospital Outcomes

Introduction-Health system (HS) health organizations are complex and are in constant dynamic interaction with multiple elements, including political, environmental, societal, legal, and organizational factors, along with human components, such as human resources, patients, and other stakeholders. Objective-This research aimed to study three HS organizations, identifying and characterizing the elements of health organizations and the factors related to professionals, determining their influence on economic and financial performance results, as well as results related to the professionals and to the patients comprising the institutions. Method-A quantitative study was conducted in which data were collected through questionnaires from various sources to better understand and characterize the factors related to organizations, professionals, and patients (470 health professionals and 768 patients). To test the integrated evaluation model for health organizations, path analysis was used. Results-The results reveal that the organizational culture (OC) presents a positive relationship between the professional's quality of life (QL) and the performance management (PM) of the professionals, along with a negative relationship with the psychosocial work risks (PWR). There is also a relationship between the OC and patient satisfaction (PS), professional job satisfaction (PJS), and economic and financial results (EFR). In the relationship between the processes and the results, there are significant relationships between PM and PJS and PWR and PJS. In terms of the results, there is a significant relationship between the EFR and the PS. Conclusions-This study contributes to a deeper knowledge of the factors that influence the quality of health organizations and their results and produces recommendations for health organizations to address the current challenges.

The Job Leeway Scale: Initial Evaluation of a Self-report Measure of Health-Related Flexibility and Latitude at Work

Purpose Evidence suggests that workers manage health-related challenges at work, in part, by using available leeway to perform work differently. The purpose of this study was to evaluate the reliability and validity of the Job Leeway Scale (JLS), a new 18-item self-report questionnaire designed to assess worker perceptions of available flexibility and latitude to manage health-related challenges at work. Methods Workers seeking assistance for workplace difficulties due to chronic medical conditions (n = 119, 83% female, median age = 49) completed the JLS along with other workplace and health measures. Construct validity was assessed using exploratory factor analysis (EFA), and concurrent validity was assessed by associations with related measures. Results Mean item scores ranged from 2.13 to 4.16 within a possible range of 0-6. The EFA supported three underlying factors: organizational leeway (9 items), task leeway (6 items), and staffing leeway (3 items). Internal consistency (alpha) ranged from 0.78 to 0.91 for subscale scores and 0.94 for the total score. The JLS showed moderate correlations with other work outcome measures including work fatigue, self-efficacy, engagement, and productivity. Conclusion The JLS is a promising new measure with initial support for its reliability and validity to assess worker beliefs of available flexibility to manage health symptoms at work, and this construct may have organizational implications for worker support and accommodation.

Pilot implementation of MiLES: a web-based intervention targeted at managers with the aim of enhancing the successful return to work of employees with cancer

BACKGROUND

MiLES is a web-based intervention targeted at managers with the aim of enhancing the successful return to work (RTW) of employees with cancer. The purpose of this study was to identify barriers to and facilitators of implementing MiLES in organizations, from a manager's perspective.

MATERIAL AND METHODS

MiLES was implemented as a pilot in four organizations for six weeks. Sixteen managers were included, of which fourteen were interviewed regarding their perceived barriers to and facilitators of implementation of MiLES in their organization. Interviews were recorded, transcribed verbatim and analyzed with content analysis.

RESULTS

The managers experienced barriers to and facilitators of implementation related to: (1) implementation responsibilities, (2) the intervention's content, and (3) organizational characteristics. Regarding implementation responsibilities, management board approval and an organizational infrastructure with distinct described implementation responsibilities were perceived as facilitators. Regarding the intervention's content, its accessibility, user-friendliness and completeness were perceived as facilitators. If the content did not meet the manager's specific needs, this was perceived as a barrier. Regarding organizational characteristics, several intangible (e.g., added value of MiLES within different organizations) and tangible (e.g., integration into absenteeism registration) organizational characteristics were perceived as facilitators. The absence of a quiet place to use MiLES was perceived as barrier.

CONCLUSION

Implementation of MiLES in organizations may benefit from an infrastructure within the organization that defines responsibilities regarding intervention delivery to managers of employees with cancer. Such an infrastructure should be aligned to existing organizational structures. As per interviewed managers, MiLES has added value in diverse organizations.

Aiming at inclusive workplaces: A bibliometric and interpretive review at the crossroads of disability management and human resource management

Inclusive workplaces rely on the joint optimization of disability management and human resource management. However, disability management has been predominantly investigated as an independent issue, overlooking its interplay with human resource management. The article delivers a bibliometric and interpretive review of the scholarly debate falling at the crossroad of disability management and human resource management, mapping the state of the art of this study domain. Departing from a knowledge core of 91 papers, 6 research streams were identified through bibliographic coupling. They account for the evolution of disability management from a fix-it initiative aimed at fostering return to work of people with disability towards a holistic management approach targeted at inclusiveness. Aligning the hard and the soft sides of disability management and embedding it in the organizational culture are crucial to enact inclusive workplaces and make organizations able to engage people with disability at work.

Developing a tool for disability accommodation complexity: A sequential mixed study

BACKGROUND

For disability accommodation (DA) decision-making/planning processes to unfold successfully, an understanding of the factors influencing DA complexity and a reliable tool for measuring such complexity are needed. The current literature does not provide sufficient knowledge on either topic.

OBJECTIVE

We attempted to explore the factors influencing DA complexity and develop a DA complexity scale in three phases through the sequential mixed approach.

METHOD

The study used an exploratory sequential mixed method in three phases. In phase 1, a qualitative survey of 335 supervisors with recent DA management experience was conducted, and the data were analyzed using a thematic approach to identify and evaluate DA complexity factors. In phase 2, qualitative results were transformed into items to construct a DA complexity scale. Later, the scale was tested using data from a separate quantitative cross-sectional survey of 303 supervisors with recent DA management experience. In phase 3, another quantitative cross-sectional study of 307 supervisors with recent DA management experience to evaluate the validity of the scale and its dimensions.

RESULTS

In Phase 1, we identified 12 factors influencing DA complexity. In Phase 2, the DA complexity scale loaded 29 items in nine dimensions, which represented the factors influencing DA complexity. In Phase 3, DA complexity positively influenced supervisors' job demand and stress, and negatively influenced their work motivation, organizational commitment, and supervisors' perceptions about their relationships with employees with disabilities.

CONCLUSION

This study enriches the DA literature by offering an in-depth understanding of DA complexity and a scale to measure it.

Promoting blue-collar employees’ work ability: A qualitative study on occupational health practitioners’ perspective on feasible interventions

BACKGROUND: Work in the industrial sector underlies deep structural changes triggered by demographic and societal transformations. These developments require tailored measures for maintaining employees’ work ability by reacting to new demands and overcoming barriers in organizational implementation. Previous research lacks in considering practitioners’ perspective in terms of tailoring effective interventions to the workplace conditions of blue-collar employees. OBJECTIVE: This study aims to enrich the understanding of work ability by using the job-demands-resources (JDR)-theory and the work ability house concept as basis and considering aspects of organizational measures’ feasibility. METHODS: Data results from observations of the collaboration between occupational health professionals and supervisors on the shop-floor and n = 18 semi-structured interviews with different occupational health stakeholders. A participatory and qualitative approach characterizes this study. RESULTS: The study participants report on how increasing organizational demands of efficiency and uncertainty affect workability promotion of blue-collar employees. Furthermore, the findings imply aspects regarding feasible interventions. For designing effective interventions, specifically psychosocial aspects such as work intensification, job uncertainty, work-life-conflicts, and inter-personal trust need to be addressed. Measures need to be aligned better to the industrial setting with specific focus on decision-makers’ interests and intra-organizational collaboration. CONCLUSION: Further research should investigate interrelationships between relevant psycho-social job demands and resources. Moreover, additional aspects, which are related to measures implementation in the organizational sphere, need to be identified. Practical implications connect organizational sciences with the workability theory and the job-demands-resources (JDR)-theory by focusing more on psychological work design and intra-organizational collaboration.

Employees Receiving Inpatient Treatment for Common Mental Disorders in Germany: Factors Associated with Time to First and Full Return to Work

Purpose In Germany, return to work (RTW) after inpatient treatment for common mental disorders (CMDs) is a complex process at the intersection of the mental healthcare system and the workplace. This study examined (1) the time to first and full RTW and (2) associated factors among employees receiving inpatient treatment for CMDs. Methods In this prospective cohort study, employees receiving inpatient psychiatric or medical rehabilitation treatment for CMDs were interviewed by phone during their last week before discharge. Follow-up interviews were conducted after 6, 12, and 18 months. Health-, personal, and work-related factors were used from baseline measurement. Parametric survival analysis was conducted to identify factors associated with time to first and full RTW. Results A total of N = 269 participants who stayed at a psychiatric clinic or a medical rehabilitation facility were included. Almost all participants (n = 252, 94%) from both treatment settings reported a first RTW and a full RTW. The time to first and full RTW was shortest among participants from medical rehabilitation (both median 6 days) and longer among participants from psychiatric treatment (median 17 days to first RTW and 73 days to full RTW). While only health-related and personal factors were associated with time to first RTW, leadership quality and needed individual RTW support were associated with time to full RTW. Conclusions More attention to work accommodation needs for RTW in clinical practice and coordinated actions towards RTW in collaboration with key RTW stakeholders in the workplace may support a timely RTW.Clinical Registration Number DRKS00010903, retrospectively registered.

Assistive Technology Workplace Accommodation and Employment among Diverse Populations with Disabilities: Does Race/Ethnicity Matter?

The purpose of this study was to examine the relationship between assistive technology workplace accommodation (AT-WA) usage and employment status among racial/ethnic populations with disabilities. Chi-square tests and logistic regression were used to analyze secondary data from the 2015 Kessler Foundation National Employment and Disability Survey (KFNEDS). Results indicated that significantly more consumers who used AT-WA were currently working, and a significantly greater proportion of them were White. Moreover, a significantly lower proportion of those who did not use AT-WA had less expected odds of being currently employed. Specific implications are discussed to inform practices, policy, and/or future research.

Development of the Prevent for Work Questionnaire (P4Wq) for the assessment of musculoskeletal risk factors in the workplace: part 2-pilot study for questionnaire development and validation

OBJECTIVE

The aim of this study was to develop a multifactorial, self-report questionnaire: Prevent for Work Questionnaire (P4Wq). The questionnaire is intended for screening for risk factors in work-related musculoskeletal disorders (WMSDs).

DESIGN

Data were collected from otherwise healthy workers employed in three service areas at a specialist hospital in Italy: healthcare, administration and ancillary services.

SETTING AND PARTICIPANTS

In all, 115 participants were enrolled (67% women; average age 41.5±9.94 years). The content of the tool for WMSDs was derived from three participation rounds of analysis involving a select group of experts who identified the questionnaire domains and items. Participants responded to 89 items in addition to the EuroQol 5 Dimensions Questionnaire (EQ-5D-5L), Fear-Avoidance Beliefs Questionnaire (FABq) and Oswestry Disability Index (ODI). The proportion of missing data and the distribution of responses were analysed for each item. Items with a discrimination index >0.40 and an interitem correlation <0.80 were retained. Factor analysis was performed using the VARIMAX rotation method, factor extraction, and identification, assignment of items to subscales, and assignment of scores to items. Internal consistency, reliability, construct validity and face validity were also assessed.

RESULTS

A total of 52 items were included in the factor analysis and four subscales identified: Physical Stress Subscore (six items); Mental Stress Subscore (six items); Job Satisfaction Subscore (four items) and Kinesiophobia/Catastrophizing Subscore (four items). The items in the final questionnaire version had a factor loading >0.7. The questionnaire consisted of 20 items with good internal consistency (Cronbach's alpha 0.81-0.91), reliability (weighted kappa coefficient 0.617-1.00), good construct validity (EQ-5D-5L, r=-0.549, p<0.001; ODI, r=0.549, p<0.001; FABq work, r=0.688, p<0.001) and satisfactory face validity (universal validity index 96.04%).

CONCLUSION

The P4Wq is a 20-item, multifactorial self-report risk assessment questionnaire. It may provide a useful tool for screening for WMSDs by specifically addressing back disorders. It investigates risks for individual workers and may inform educational programmes and preventive strategies tailored to a worker's needs.

TRIAL REGISTRATION NUMBER

NCT04192604.

A pilot study to assess a risk of a high-risk group of low back pain membership in workers who perform the manual material handling tasks

BACKGROUND

We conducted this experimental study to estimate a risk of a high-risk group of low back pain (LBP) membership in workers who perform the manual material handling (MMH) tasks in an actual workplace setting.

METHODS

The subjects include healthy workers who were engaged in 12 MMH tasks at 6 manufacturing companies. We assessed the dynamic motion of trunk or lumbar spine using an industrial lumbar motion monitor (BioDynamics Laboratory of Ohio State University). The subjects were evaluated for the age, gender, years of working and anthropometric measurements (e.g., height, weight, shoulder height, elbow height, iliac height, leg length, trunk length, trunk circumference, iliac width, iliac depth, xiphoid width and xiphoid depth). Moreover, they were also evaluated for a risk of a high-risk group of LBP membership based on lift frequency, average twisting velocity, maximum moment, maximum sagittal flexion and maximum lateral velocity.

RESULTS

The subjects who were engaged in a packaging at a detergent manufacturing company are at the greatest risk of LBP (63.76%). This was followed by packaging at a leather product manufacturing company (57.06%), packaging at a non-metallic casting material manufacturing company (57.03%), manual injection at a non-metallic casting material manufacturing company (52.00%), toggling at a leather product manufacturing company (46.09%), non-metallic casting material manufacturing company (42.88%), rolling at a non-metallic mineral product manufacturing company (42.12%), shooting at a non-metallic casting material manufacturing company (40.99%), vacuum processes at a leather product manufacturing company (35.00%), looping at a general industrial machinery manufacturing company (33.93%), setting at a leather product manufacturing company (30.22%) and packaging at a general metal product manufacturing company (22.02%).

CONCLUSIONS

Our approach indicates that there is a risk of a high-risk group of LBP membership in workers who perform the MMH tasks.

A randomised feasibility trial of an employer-based intervention for enhancing successful return to work of cancer survivors (MiLES intervention)

BACKGROUND

Employers express a need for support during sickness absence and return to work (RTW) of cancer survivors. Therefore, a web-based intervention (MiLES) targeted at employers with the objective of enhancing cancer survivors' successful RTW has been developed. This study aimed to assess feasibility of a future definitive randomised controlled trial (RCT) on the effectiveness of the MiLES intervention. Also preliminary results on the effectiveness of the MiLES intervention were obtained.

METHODS

A randomised feasibility trial of 6 months was undertaken with cancer survivors aged 18-63 years, diagnosed with cancer < 2 years earlier, currently in paid employment, and sick-listed < 1 year. Participants were randomised to an intervention group, with their employer receiving the MiLES intervention, or to a waiting-list control group (2:1). Feasibility of a future definitive RCT was determined on the basis of predefined criteria related to method and protocol-related uncertainties (e.g. reach, retention, appropriateness). The primary effect measure (i.e. successful RTW) and secondary effect measures (e.g. quality of working life) were assessed at baseline and 3 and 6 months thereafter.

RESULTS

Thirty-five cancer survivors were included via medical specialists (4% of the initially invited group) and open invitations, and thereafter randomised to the intervention (n = 24) or control group (n = 11). Most participants were female (97%) with breast cancer (80%) and a permanent employment contract (94%). All predefined criteria for feasibility of a future definitive RCT were achieved, except that concerning the study's reach (90 participants). After 6 months, 92% of the intervention group and 100% of the control group returned to work (RR: 0.92, 95% CI: 0.81-1.03); no difference were found with regard to secondary effect measures.

CONCLUSIONS

With the current design a future definitive RCT on the effectiveness of the MiLES intervention on successful RTW of cancer survivors is not feasible, since recruitment of survivors fell short of the predefined minimum for feasibility. There was selection bias towards survivors at low risk of adverse work outcomes, which reduced generalisability of the outcomes. An alternative study design is needed to study effectiveness of the MiLES intervention.

TRIAL REGISTRATION

The study has been registered in the Dutch Trial Register ( NL6758/NTR7627 ).

The Use and Perceived Usefulness of an Online Toolbox Targeted at Employers (MiLES Intervention) for Enhancing Successful Return to Work of Cancer Survivors

PURPOSE

The MiLES intervention is a web-based intervention targeted at employers with the objective of enhancing successful return to work (RTW) of cancer survivors. The aim of this study is to gain insight into the employers' use and perceived usefulness of the MiLES intervention.

METHODS

Employer representatives (e.g. Human Resource managers and supervisors) were given access to the MiLES intervention, which contains, among others, interactive videos, conversation checklists and tailored tips. After six weeks, an online questionnaire gathered data on employers' use and the perceived usefulness of the intervention. In-depth qualitative data on these topics were gathered during semi-structured interviews, which were analyzed using a content analysis.

RESULTS

Thirty-one eligible employers were included. Twenty-two of them filled out the questionnaire and twenty were interviewed. Typically, employers used the intervention 2-3 times, for 26 min per visit. The usefulness of the intervention scored 7.6 out of 10 points, and all employers would recommend it to colleagues. Employers' use decreased when support needs were low and when the intervention did not correspond with their specific situation (e.g. complex reintegration trajectories). Employers perceived the intervention to be supporting and practically oriented. They appreciated the fact that the intervention was web-based and combined visual and textual content. The possibility of consulting specialized services for complex situations would further enhance its usefulness.

CONCLUSION

The MiLES intervention provides employers with a useful tool in their daily practice. Its effectiveness for enhancing employers' managerial skills and cancer survivors' successful RTW is subject for further research.

Development of the Prevent for Work questionnaire (P4Wq) for assessment of musculoskeletal risk in the workplace: part 1-literature review and domains selection

OBJECTIVE

This study aims to define appropriate domains and items for the development of a self-administered questionnaire to assess the risk of developing work-related musculoskeletal disorder (WMSD) and the risk of its progression to chronicity.

DESIGN

Literature review and survey study.

SETTING AND PARTICIPANTS

A literature review and a two-round interview with 15 experts in musculoskeletal pain were performed to identify the available domains for WMSD assessment.

INTERVENTIONS AND OUTCOME

To ensure quality, only validated questionnaires were included for the Delphi process. A three-round Delphi method, with three round steps, was used to select the most pertinent and relevant domains and items.

RESULTS

Nine questionnaires were identified through the expert discussion and literature review, comprising 38 candidate domains and 504 items. In the first round of the Delphi group, 17 domains reached more than 70% agreement and were selected. In the second round, 10 domains were rejected, while 11 were selected to complete the pool of domains. In the third and final round, 89 items belonging to 28 domains were defined as significant to develop a WMSDs risk assessment questionnaire.

CONCLUSIONS

No specific risk assessment questionnaires for WMSDs were identified from the literature. WMSD risk of presence and chronicity can be defined by an assessment tool based on the biopsychosocial model and the fear-avoidance components of chronic pain. The present study provides the formulation and operationalisation of the constructs in domains and items needed for developing and validating the questionnaire.

Gender composition in occupations and branches and medically certified sick leave: a prospective population study

Objective

To investigate whether gender-segregated occupations and branches are associated with future medically certified sick leave for women and men.

Methods

All gainfully employed residents in Sweden in December 31st 2014 aged 16–69 years (n = 4 473 964) were identified in national registers. Subjects working in segregated (61–90%) and extremely segregated (> 90%) occupations and branches were evaluated v/s subjects in gender-integrated occupations and branches (40–60%). Combinations of segregation by occupation and branch were also investigated. Two-year prospective medically certified sick leaves (> 14 days) were evaluated using logistic regression with odds ratios recalculated to relative risks (RR), adjusted for work, demographic and health related factors.

Results

The sick leave risk was higher for those working in extremely female-dominated occupations (women RR 1.06 and men RR 1.13), and in extremely female-dominated branches (women RR 1.09 and men RR 1.12), and for men in extremely male-dominated branches (RR 1.04). The sick leave risk was also higher for both women and men in female-dominated occupations regardless of the gender segregation in the branch they were working in. However, the differences in sick leave risks associated with gender segregation were considerably smaller than the differences between occupations and branches in general.

Conclusions

Gender segregation in occupations and branches play a role for sick leave among women and men, especially within extremely female-dominated occupations and branches. However, gender segregation appears to be subordinate to particular occupational hazards faced in diverse occupations and branches.

Work disability negotiations between supervisors and occupational health services: factors that support supervisors in work disability management

PURPOSE

A work disability negotiation takes place between a supervisor, the disabled employee and the occupational health service (OHS) to support the disabled employee in returning to their work, often with temporary work accommodation. The objective of this study was to define the factors of a work disability negotiation with OHS that supported or hindered supervisors in their task/role in work disability management.

METHODS

The study setting comprised two parts: the creation of survey questions and the actual survey of supervisors (N = 254) from six public and private organizations in Finland. Of these, 133 (52%) had participated in one or more work disability negotiations. The responses covered about 240 work disability cases and considerably more negotiations.

RESULTS

The study identified four key elements that the supervisors expressed as major success factors in the negotiations. First, it was crucial that the supervisors learned about the employee's health restrictions and understood the issues relating to their work disability. Second, the parties should aim for common solutions and conclusions through collaboration. Third, active participation of all the negotiation parties is important. The supervisors gave a high rating to OHS taking their views seriously. Last, the supervisors appreciated collaboration in a constructive atmosphere.

CONCLUSION

In order for a negotiation to help supervisors in their challenges, it should reach solutions, conclusions and a restructured comprehension of the work disability problem in a constructive atmosphere and with active communication between stakeholders.

Individual- and Company-Level Predictors of Receiving Vocational Rehabilitation: A Multilevel Study of Finnish Private Sector Workplaces

Purpose The aim of this study was to examine the magnitude of company-level variation in vocational rehabilitation (VR) and to determine which individual- and company-level characteristics are associated with receiving VR due to mental disorders, musculoskeletal diseases, and other somatic diseases. Methods A 30% random sample of all Finnish private sector companies with more than 10 employees aged 25-62 years at the end of 2010 (5567 companies with 300,601 employees) was followed up for the receipt of VR over the next 6 years. Company size and industry, as well as gender, age, education, social class and sickness absence measured both at the individual- and company-level were used as explanatory variables in multilevel logit models. Results After controlling for the individual-level characteristics, 12% of the variance in VR was attributed to the company level. The proportion was largest in VR due to musculoskeletal diseases. Receiving VR was more common among women, older employees (except the oldest age group), those with low education (particularly due to musculoskeletal diseases), low social class, and previous sickness absence. Receiving VR was more common in larger companies, and in construction and in health and social work, and less common in professional, scientific and technical activities. Furthermore, receiving VR was more common in companies with low proportion of highly educated employees and with higher sickness absence rates. Conclusions Company-level variation in receiving VR was substantial. Adopting the practices of the companies with highest participation in VR could help to avoid work disability problems.

The MiLES intervention targeting employers to promote successful return to work of employees with cancer: design of a pilot randomised controlled trial

BACKGROUND

Employers express a need for support to facilitate the return to work (RTW) process of employees with cancer. We have developed the MiLES intervention, an online toolbox targeting employers during the RTW of employees with cancer. To evaluate the MiLES intervention, we propose the design of a pilot randomised controlled trial (RCT). The aim of this pilot is to determine whether a future RCT to study the effectiveness of this intervention on successful RTW of employees with cancer is feasible. Secondary aims are to obtain preliminary results on the effectiveness of the intervention and to determine the sample size needed in a future definitive RCT.

METHODS

A pilot RCT with a 6-month follow-up will be conducted. Using medical specialists at Dutch hospitals, we aim to enrol 90 participants diagnosed with cancer (<2 years earlier) aged 18-63 years who are in paid employment with an employer and who are currently sick-listed or partly sick-listed for <1 year. Participants randomised to the intervention group will be asked to inform their employer about the online toolbox supporting employers during the RTW process of employees with cancer. Participants in the control group will receive 'care as usual' from their employer. All measures will be assessed at the level of the employee using questionnaires at baseline and after 3 and 6 months of follow-up. The feasibility of a future RCT will be determined using criteria concerning method-related uncertainties and acceptability of the study protocol. The primary effect measure will be successful RTW (that is, RTW perceived as being successful by the cancer survivor themselves). This effect measure will be used to perform the sample size calculation for a future definitive RCT.

DISCUSSION

The design is proposed to determine the feasibility to study the effectiveness of the MiLES intervention targeting employers on the successful RTW of employees diagnosed with cancer. This pilot RCT can increase the probability of a successful future definitive RCT on the effectiveness of the intervention and potentially obviate the need to carry out an unfeasible and resource-intensive study.

TRIAL REGISTRATION

Dutch Trial Register (NTR): NL6758, NTR7627. Registered on 30 October 2018.

Company-level determinants of disability retirement: a multilevel study of Finnish private sector workplaces

BACKGROUND

We examined whether the risk for disability retirement varies between companies over and above the individual-level characteristics of their employees and which company-level characteristics are associated with the risk for any, full or partial disability retirement.

METHODS

A 30% random sample of Finnish private sector companies with at least 10 employees was used (5567 companies and 301 313 employees). The risk for disability retirement over 6 years was analyzed using multilevel logistic regression. Company size and industry, as well as gender, age, education and social class measured both at the individual- and the company-level were used as explanatory variables.

RESULTS

3.8% of the variance in the risk for disability retirement was attributed to the company level after controlling for individual-level characteristics of the employees. Company-level variance was much larger in partial (11.7%) than in full (4.2%) disability retirement. After controlling for all individual- and company-level characteristics, those working in health and social work activities had increased risk for both full and partial disability retirement. The risk for full disability retirement increased by decreasing educational level of the company. The risk for partial disability retirement increased by increasing company size and was elevated in companies with the highest proportion of women.

CONCLUSIONS

After controlling for the individual-level characteristics, variation in the risk for disability retirement between companies was modest. The more substantial variation in partial disability pension suggests that companies have a marked role in advancing working with partial disabilities.

Sex Differences in Factors Associated with General Life Satisfaction among Occupationally Injured Workers in Korea: A Panel Analysis of the 2013-2017 Panel Study of Worker's Compensation Insurance

The majority of previous occupational studies focused on factors affecting life satisfaction among occupationally injured workers have been based on a cross-sectional design, not a sex-aggregated model. This study aimed to identify sex differences in factors related to life satisfaction among workers who experienced work-related injuries using nationally representative panel data from South Korea. Data from the first to fifth (2013-2017) waves of the Panel Study of Worker's Compensation Insurance were analyzed. Of 1514 respondents, those who participated in all five survey waves were included in the final study population. To assess the factors associated with general life satisfaction of the occupationally injured workers, a panel data analysis was conducted using generalized estimating equations. The impacts of education level, return to work, self-rated health, task performance, self-esteem, and self-efficacy were significant in both sexes. On the other hand, the influence of age, marital status, personal labor income, and National Basic Livelihood Act recipient status significantly varied by sex. There were sex differences in factors related to general life satisfaction among occupationally injured workers, highlighting the need for sex-specific intervention programs. Employers, healthcare providers, and other stakeholders need to pay attention to vulnerable groups and investigate the most appropriate financial support.

Trajectories of sickness absence after road traffic injury: a Swedish register-based cohort study

OBJECTIVES

Despite much focus on the health impact of road traffic injury (RTI) on life, there is a lack of knowledge of the dynamic process of return to work following RTI and its related factors. The aim of this study was to identify longitudinal patterns of sickness absence (SA) following RTI, to examine the patterns' interplay with health-related quality of life (HRQoL) and to determine if there are differences, regarding the patterns and interplay, according to injury severity.

DESIGN

A register-based prospective cohort study.

SETTING

Administrative data on RTI in Sweden from the Swedish Traffic Accident Data Acquisition System (STRADA) and Swedish Social Insurance data.

PARTICIPANTS

Individuals suffering an RTI (total n=4761) were identified in STRADA between 1 January 2007 and 31 December 2009. A total of 903 of these met the inclusion criteria for the current study and were included.

PRIMARY AND SECONDARY OUTCOME MEASURES

The primary outcome measure was SA following RTI. The secondary outcome measure was HRQoL.

RESULTS

Three distinct patterns of SA were identified; 'Stable', 'Quick decrease' and 'Gradual decrease'. The patterns differed in the number of initial SA days and the rate of reduction of SA days. After 3 years, all three patterns had almost the same level of SA. Higher injury severity and a higher number of SA days had a negative interplay with HRQoL. Participants who initially had a higher number of SA days were more likely to report a low HRQoL, indicating that people with a slower return to work are more vulnerable.

CONCLUSION

The study highlights the heterogeneity of return to work after an RTI. People with a more severe injury and slower pace of return to work seem to be more vulnerable with regards to HRQoL loss following RTI.

The Role of Sex, Gender, Health Factors, and Job Context in Workplace Accommodation Use Among Men and Women with Arthritis

Background

With the aging of populations in many countries, workers are expected to remain employed longer but may struggle with the onset of common, chronic conditions like arthritis. To date, few studies have examined workplace policies and practices that could help accommodate individuals with arthritis, and fewer still have used a sex and gender-based approach to explore similarities and differences between women and men.

Objectives

This study compared the health and work contexts of workers aged ≥50 years to better understand similarities and differences between women and men in accommodation availability, need, use, and unmet needs.

Methods

A cross-sectional survey of men and women with osteoarthritis (OA), inflammatory arthritis (IA), or both OA and IA was administered online or by telephone and assessed demographics (e.g. age, education), health (e.g. pain, fatigue, workplace activity limitations), work context factors (e.g. job sector, full/part-time work, job control), and workplace accommodations (e.g. health benefits, flexible hours, special equipment/adaptations, modified duties). Sex and gender-based analyses examined similarities and differences between men and women and included descriptive statistics, multivariable multinomial analyses, and nested regression analyses.

Results

There was a 58.9% response rate and final sample of 463 participants (women, n = 266; men, n = 197; OA = 59.0%; IA/both IA and OA = 23.7%; unsure = 17.3%). Women and men were significantly different in a number of health (e.g. fatigue, health variability, workplace activity limitations) and work context factors (e.g. job sector, part-time work, job stress). However, in other respects, they were similar (e.g. pain, job involving physical demands, size of organization, shift work, union membership, job control). There were no differences between men and women in the availability or use of workplace accommodations. However, women reported significantly more accommodation needs and had greater unmet needs. Multivariable multinomial analyses found male/female as a binary variable did not explain differences in accommodation need, use, and unmet need. Nested analyses highlighted that differences in health variables explained male/female differences in accommodation need, while work context differences explained male/female differences in whether needs were met.

Conclusions

The findings highlight that women and men draw on a range of existing accommodation policies and practices to help manage their arthritis and that most have their accommodation needs met. Decomposing the context within which men and women with arthritis work suggests that women may face health and work context challenges that differ from men and that are related to greater accommodation needs and unmet need. This highlights potential vulnerabilities in the work of women that need to be addressed.

What Employer Actions Are Considered Most Important for the Return to Work of Employees with Cancer? A Delphi Study Among Employees and Employers

Purpose Employers are important stakeholders in the return to work (RTW) of employees with cancer. However, it is unclear what employer actions are most important to that process. The objective, therefore, was to reach consensus on what employer actions are considered most important for the RTW of employees with cancer, by employers and employees separately. Methods A two-round online Delphi study was conducted with two expert panels: one with 23 employers and one with 29 employees with cancer. The results from each panel were analysed separately. Out of 24 suggested employer actions, participants selected the 10 they considered most important for RTW in each of the following RTW phases: (1) disclosure, (2) treatment, (3) RTW plan, and (4) actual RTW. The consensus threshold was set at ≥ 80% during the second round. Results The employer and employee expert panels both reached consensus on the importance of 'emotional support', 'practical support', 'allow sufficient sick leave', 'plan return to work', 'adjust expectations', 'assess work ability', and 'show appreciation'. Employers also reached consensus on 'communicate' and 'treat normally', and employees on 'handle unpredictability'. All these employer actions were considered to be specific for one to three RTW phases. Conclusions Employers reached consensus on the importance of nine employer actions, employees on eight. Both stakeholder perspectives showed great similarities, but did vary regarding important employer actions during the employee's treatment. We recommend developing interventions targeting the employer, meeting both employer and employee needs in each RTW phase, to enhance RTW support for employees with cancer.

Employees Diagnosed with Cancer: Current Perspectives and Future Directions from an Employer's Point of View

Purpose and methods Cancer survivors have a higher risk of adverse work outcomes such as not being able to return to work (RTW). The process of returning to work is complex as a result of the diverse stakeholders and numerous factors involved related to the employee diagnosed with cancer, the work environment, health care system, and the legal system. One of the key stakeholders is the employer, as the employer is in the position to facilitate work accommodations. Therefore, the purpose of this brief review is to consider opportunities regarding the role of the employer to enhance the work participation of employees with cancer. Results and conclusions We currently know little about which aspects of employer support have a positive impact on the ability of employees diagnosed with cancer to retain at work or RTW. In addition, there is a lack of interventions and tools which support employers in their management of employees diagnosed with cancer. The inclusion of employer support into the workplace can help employees diagnosed with cancer with their work retention and RTW, which is an important aspect of their quality of life and benefits the society at large.

Employee experience of workplace supervisor contact and support during long-term sickness absence

PURPOSE

Workplace support is an important factor in promoting successful return to work. The purpose of this article is to examine relationships between supervisor contact, perceived workplace support and demographic variables among employees on long-term sickness absence.

MATERIALS AND METHOD

Data were collected from 204 public employees at a municipality in Sweden who had been on long term sickness absence (60 days or more) using a 23 question survey instrument that collected information on demographic variables, supervisor contact and perceived workplace support.

RESULTS

Most injured employees (97%) reported having contact with their supervisors during their sickness absence, with a majority (56%) reporting high levels of support, including early (58.6%) and multiple (70.7%) contacts. Most were pleased with amount of contact (68.9%) and the majority had discussed workplace accommodations (68.1%). Employees who self-initiated contact, felt the amount of contact was appropriate, had a personal meeting with their supervisors and discussed workplace adjustments reported experiencing higher levels of support from supervisors.

CONCLUSIONS

Employees on long-term sickness absence appreciate contact from their supervisors and this is associated with perceived workplace support. However, the amount and employee experience of this contact is important. It needs to be perceived by employees as supportive, which includes a focus on strategies (e.g., work adjustment) to facilitate a return to work. Supervisor training is required in this area to support the return to work process. Implications for Rehabilitation Contact and support from workplace supervisors is important to workers on long-term sickness absence. Employees appreciate frequent contact from supervisors during long-terms sickness absence. Employees appreciate a personal meeting with supervisors and the opportunity to discuss issues related to return to work such as work adjustment. Employers should provide training to supervisors on how to communicate and assist employees on long-term sickness absence.

Retirement Expectations of Older Workers with Arthritis and Diabetes Compared with Those of Workers with No Chronic Diseases

Les plans de retraite des adultes atteints de maladies chroniques sont peu connus. Dans le cadre de cette étude, des travailleurs canadiens âgés de 50 à 67 ans provenant d’un regroupement national de 80 000 personnes (arthrite, n = 631 ; diabète, n = 286 ; arthrite et diabète, n = 111 ; aucune maladie chronique invalidante, n = 538) ont participé à une enquête transversale sur ce sujet. Les questions posées aux participants traitaient de l’âge prévu pour leur départ à la retraite, de leurs plans de travail futurs, de la possibilité d’un départ hâtif à la retraite et de la transition vers la retraite. Des analyses de khi-carré, de variance et des régressions ont permis d’évaluer les attentes et les facteurs qui y étaient associés. Les travailleurs souffrant d’arthrite et de diabète avaient des plans de retraite semblables à ceux des participants sains, malgré leurs problèmes de santé, et ces plans concordaient avec les attentes associées au fait de travailler jusqu’à un âge de retraite conventionnel. Toutefois, le nombre de répondants souffrant d’arthrite ou de diabète qui avaient prévu une retraite anticipée était plus élevé que celui des participants en bonne santé. Contrairement aux prévisions, la part de la variance associée aux facteurs liés à la santé était moindre que celle des autres facteurs en ce qui concerne les attentes en matière de retraite. Ces résultats mettent en lumière la complexité des attentes liées à la retraite et soulignent l’importance de l’adéquation personne-travail, malgré la présence de maladies.

Personal and Contextual Factors Associated With Successful Vocational Rehabilitation and Employment Outcomes

Some individuals with disabilities have relatively better labor outcomes than others. If vocational rehabilitation (VR) counselors can better understand what factors are correlated with positive outcomes, they could better identify what clients are at risk for poor outcomes and then intervene early to improve chances for success. Unfortunately, until recently VR survey and administrative data have had insufficient information to investigate these questions. We use a survey of 932 Ohio VR clients combined with administrative earnings data to examine the barriers and facilitators associated with employment and earnings outcomes. The survey data are from the 2014 Survey of Disability and Employment, a survey of VR applicants in three states. We compare VR case status and earnings through 2016, by demographics, functional limitation status, employment history and attitudes, and reasons stated for not working in the survey. We find that about 25% of survey respondents exited the program employed or had at least one quarter of average monthly earnings above the Social Security Administration’s substantial gainful activity amount. Pain, depression or anxiety, longer duration of job separation, personal and familial attitudes about work, and not working because of personal and health reasons were associated with poorer outcomes among survey respondents.

Are There Differences in Workplace Accommodation Needs, Use and Unmet Needs Among Older Workers With Arthritis, Diabetes and No Chronic Conditions? Examining the Role of Health and Work Context

The aging of workforces combined with the prevalence of age-related chronic diseases has generated interest in whether large numbers of older workers will need workplace accommodations. This research applied work functioning theory to examine accommodation availability, need and use in workers with arthritis, diabetes, or no chronic disabling diseases; factors associated with accommodation needs; and the relationship of accommodation needs met, unmet or exceeded to job outcomes. Participants were aged 50-67 years, employed, and had arthritis (n = 631), diabetes (n = 286), both arthritis/diabetes (n = 111) or no chronic disabling conditions (healthy controls n = 538). They were recruited from a national panel of 80,000 individuals and a cross-sectional survey was administered online or by telephone. Questionnaires assessed demographics, health, work context, workplace accommodations, and job outcomes. Chi-square analyses, analyses of variance, and regression analyses compared groups. Respondents were similar in many demographic and work context factors. As expected, workers with arthritis and/or diabetes often reported poorer health and employment outcomes. Yet, there were few differences across health conditions in need for or use of accommodations with most participants reporting accommodations needs met. In keeping with work functioning theory, unmet accommodation needs were largely related to work context, not health. Workers whose accommodation needs were exceeded reported better job outcomes than those with accommodation needs met. Findings highlight both work context and health in understanding workplace accommodations and suggest that many older workers can meet accommodation needs with existing workplace practices. However, additional research aimed at workplace support and the timing of accommodation use is needed.

Reliability and Validity of the Work and Well-Being Inventory (WBI) for Employees

Purpose The purpose of this study is to measure the psychometric properties of the Work and Wellbeing Inventory (WBI) (in Dutch: VAR-2), a screening tool that is used within occupational health care and rehabilitation. Our research question focused on the reliability and validity of this inventory. Methods Over the years seven different samples of workers, patients and sick listed workers varying in size between 89 and 912 participants (total: 2514), were used to measure the test-retest reliability, the internal consistency, the construct and concurrent validity, and the criterion and predictive validity. Results The 13 scales displayed good internal consistency and test-retest reliability. The constructive validity of the WBI could clearly be demonstrated in both patients and healthy workers. Confirmative factor analyses revealed a CFI >.90 for all scales. The depression scale predicted future work absenteeism (>6 weeks) because of a common mental disorder in healthy workers. The job strain scale and the illness behavior scale predicted long term absenteeism (>3 months) in workers with short-term absenteeism. The illness behavior scale moderately predicted return to work in rehab patients attending an intensive multidisciplinary program. Conclusions The WBI is a valid and reliable tool for occupational health practitioners to screen for risk factors for prolonged or future sickness absence. With this tool they will have reliable indications for further advice and interventions to restore the work ability.

Common Psychosocial Factors Predicting Return to Work After Common Mental Disorders, Cardiovascular Diseases, and Cancers: A Review of Reviews Supporting a Cross-Disease Approach

Purpose This systematic review aimed at identifying the common psychosocial factors that facilitate or hinder the return to work (RTW) after a sick leave due to common mental disorders (CMDs), cardiovascular diseases (CVDs), or cancers (CAs). Methods We conducted a review of reviews searching 13 databases from 1994 to 2016 for peer-reviewed, quantitative, cohort studies investigating factors influencing RTW after a CMD, CVD, or CA. Then, for each disease we identified additional cohort studies published after the date of the latest review included. Data were extracted following a three steps best-evidence synthesis method: the extraction of results about each predictor from studies within each single review and in the additional papers; the synthesis of results across the reviews and additional papers investigating the same disease; and the synthesis of results across the diseases. Results The search strategy identified 1029 unique records from which 27 reviews and 75 additional studies underwent comprehensive review. 14 reviews and 32 additional cohort studies met eligibility criteria. Specific predictors of RTW with different levels of evidence are provided for each disease. We found four common facilitators of RTW (job control, work ability, perceived good health and high socioeconomic status), and six barriers of RTW (job strain, anxiety, depression, comorbidity, older age and low education). Conclusion This is the first review to systematically analyze commonalities in RTW after CMDs, CVDs, or CAs. The common factors identified indicate that the RTW process presents many similarities across various diseases, thus supporting the validity of a cross-disease approach.

Stratégies de retour au travail d’employés ayant fait l’expérience d’une dépression : perspectives des employeurs et des cadres des ressources humaines

La dépression majeure est l’une des premières causes d’incapacité au travail dans le monde et a de nombreuses conséquences tant sur l’employé concerné qu’auprès des acteurs du milieu de travail.

ObjectifNous visons à documenter, selon la perspective des employeurs et des cadres des ressources humaines, les stratégies que ces acteurs préconisent dans leur organisation pour faciliter le retour au travail (RaT) d’employés en absence maladie due à une dépression.

MéthodeDeux cent dix-neuf employeurs et cadres de ressources humaines (n = 219) ont accepté de répondre à une entrevue semi-structurée téléphonique. La question abordée dans cet article était : « Selon vous, quelles sont les stratégies les plus efficaces pour aider un employé ayant reçu un diagnostic de dépression à retourner au travail ? » La codification duverbatima été effectuée à partir d’études empiriques et de théories existantes.

RésultatsTrente-quatre (34) stratégies réparties sur six grands principes ont émergé : 1) Contact avec l’employé en absence maladie (10 stratégies) ; 2) Évaluation et planification du RaT sans précipitation (6) ; 3) Formation des gestionnaires et du collectif de travail à la problématique de la santé mentale au travail (4) ; 4) Concertation des acteurs clés du RaT (4) ; 5) RaT progressif avec aménagements (4) ; 6) Suivi de la santé de l’employé et de son travail (6).

ConclusionCes principes articulés autour de 34 stratégies du RaT vont au-delà d’un processus étapiste de nature chronologique. Articulés dans un programme de RaT, ils devront être testés afin d’évaluer leurs retombées dans les organisations, notamment sur la gestion de l’incapacité au travail.

Disability management and organizational culture in Australia and Canada

BACKGROUND

Organizational culture has received increasing attention in terms of its influence on workplace health and productivity, yet there has been little research on its relationship with employer-based disability programs.

OBJECTIVE

This study explored the relationship between disability management and organizational culture in Australian and Canadian organizations.

METHODS

Thematic analysis was conducted on data from semi-structured interviews with 16 employees, including injured workers, human resource managers and disability managers in two Australian and two Canadian large organizations.

RESULTS

Seven themes were identified: 1. Consistency between espoused beliefs and artifacts in organization; 2. Genuineness of interest in well-being of injured worker; 3. Level of ongoing support of worker following injury; 4. Communication with injured workers; 5. Level of support from supervisors and co-workers; 6. Promptness in claims processing and covering medical costs and; 7. Focus on wellness and injury prevention. It was found that organizational culture may impact the delivery and perceived value of employer-based disability management programs.

CONCLUSIONS

Given the potential relationship between organizational culture and disability management, employers should facilitate a positive workplace culture by ensuring consistency among underlying values, espoused values and actual treatment of employees, including injured workers.

Le retour au travail d’immigrants ayant subi une lésion professionnelle : les embûches de la rencontre interculturelle et la précarité du lien d’emploi

Cet article rapporte une partie des résultats d'une étude exploratoire sur le processus de réadaptation et de retour au travail en contexte de relations interculturelles. Cette étude avait deux objectifs : identifier les stratégies mises de l'avant par les différents acteurs pour faciliter le processus de réadaptation et de retour au travail des travailleurs immigrants et décrire les contraintes, les obstacles et les aides au processus selon la perspective des différents acteurs. Des entrevues semi-dirigées ont ainsi été menées auprès de 47 répondants : cliniciens, agents d'indemnisation et conseillers en réadaptation de la CNESST, employeurs et travailleurs immigrants victimes d'une lésion reconnue et indemnisée. Au-delà des barrières linguistiques et culturelles, deux facteurs nuisent au retour en emploi des travailleurs immigrants : d'une part, la précarité du lien d'emploi freine leurs efforts et mine leur volonté de consolider leur état de santé et, d'autre part, la menace ou la perte réelle du lien d'emploi amène une rupture symbolique dans leur processus d'intégration. Cette rupture est importante pour ceux qui sont surqualifiés pour leur poste, surtout si leur emploi est un passage obligé pour acquérir une expérience de travail au Canada et viser ensuite un emploi à la hauteur de leurs compétences. Le processus de réadaptation peut soit se transformer en un « parcours déshonorant », soit fournir une occasion d'améliorer sa situation sur un marché du travail discriminant. Adapter les programmes à la réalité de ces travailleurs immigrants est possible, mais pose un dilemme moral et éthique : comment motiver les travailleurs à se rétablir tout en explorant un autre créneau d'emploi si leur lien d'emploi risque d'être rompu, alors que les règles relatives au droit de retour au travail prévoient la réintégration de l'emploi prélésionnel ou tout autre poste jugé équivalent?

Employer Policies and Practices to Manage and Prevent Disability: Foreword to the Special Issue

Purpose Employer policies and practices have been shown to impact workplace disability, but research in this area has waned in recent years despite an aging workforce, a growing prevalence of chronic health conditions, and a larger proportion of working-age adults on permanent work disability in many jurisdictions. The purpose of this article is to describe the background rationale and methodology for an invited conference designed to improve research of employer strategies to curtail work disability. Methods A multidisciplinary team of 26 international researchers with published research in employer-based disability management or related fields were invited to attend a 3-day conference in Hopkinton, Massachusetts, USA. The overall goal was to review the status of current research of workplace disability management and prevention, examine its relevance for employer decision-making, compare conceptual frameworks or theoretical perspectives, and recommend future research directions. Working groups were organized and draft manuscripts were prepared in advance. Conference activities included working group presentations and critiques, discussions with a panel of industry consultants and advisors, group interaction and debate, generation of final recommendations, and manuscript revision. Results/Conclusion Six principal domains were established with respect to future research: (a) further elucidation of the key workplace factors that buffer the disabling effects of injury and illness; (b) more innovative and feasible options for workplace intervention; (c) measurement of workplace-relevant disability outcomes; (d) a stronger theoretical framework for understanding the factors behind employer uptake and implementation; (e) a focus on special clinical populations and occupations where disability risk is most troubling; and (f) better representation of workers and employers that reflect the diverse and changing nature of work. Final comments and recommendations of the working groups are presented in the following six articles in this special issue of the Journal of Occupational Rehabilitation. Conference attendees recommended changes in methodology, collaboration strategies, and theoretical perspectives to improve the practical and scientific impact of future research of employer practices.

Implementation Science and Employer Disability Practices: Embedding Implementation Factors in Research Designs

Purpose For work disability research to have an impact on employer policies and practices it is important for such research to acknowledge and incorporate relevant aspects of the workplace. The goal of this article is to summarize recent theoretical and methodological advances in the field of Implementation Science, relate these to research of employer disability management practices, and recommend future research priorities. Methods The authors participated in a year-long collaboration culminating in an invited 3-day conference, "Improving Research of Employer Practices to Prevent Disability", held October 14-16, 2015, in Hopkinton, MA, USA. The collaboration included a topical review of the literature, group conference calls to identify key areas and challenges, drafting of initial documents, review of industry publications, and a conference presentation that included feedback from peer researchers and a question/answer session with a special panel of knowledge experts with direct employer experience. Results A 4-phase implementation model including both outer and inner contexts was adopted as the most appropriate conceptual framework, and aligned well with the set of process evaluation factors described in both the work disability prevention literature and the grey literature. Innovative interventions involving disability risk screening and psychologically-based interventions have been slow to gain traction among employers and insurers. Research recommendations to address this are : (1) to assess organizational culture and readiness for change in addition to individual factors; (2) to conduct process evaluations alongside controlled trials; (3) to analyze decision-making factors among stakeholders; and (4 ) to solicit input from employers and insurers during early phases of study design. Conclusions Future research interventions involving workplace support and involvement to prevent disability may be more feasible for implementation if organizational decision-making factors are imbedded in research designs and interventions are developed to take account of these influences.

Employer Policies and Practices to Manage and Prevent Disability: Conclusion to the Special Issue

Purpose Research of employer policies and practices to manage and prevent disability spans many disciplines and perspectives, and there are many challenges related to stakeholder collaboration, data access, and interventions. The purpose of this article is to synthesize the findings from a conference and year-long collaboration among a group of invited researchers intended to spur new research innovations in this field. Methods A multidisciplinary team of 26 international researchers with published research in employer-based disability management or related fields were invited to attend a 3-day conference in Hopkinton, Massachusetts, USA. The conference goals were to review the status of current research of workplace disability management and prevention, examine its relevance for employer decision-making, compare conceptual frameworks or theoretical perspectives, and recommend future research directions. In this paper, we summarize key points from the 6 resulting papers, compare them with an earlier 2005 conference on improving return-to-work research, and conclude with recommendations for further overarching research directions. Results/Conclusion In comparison with the 2005 conference, a greater emphasis was placed on organizational and social factors, employer roles and responsibilities, methods of implementation, non-clinical approaches, and facilitating stay-at-work as well as return-to-work. A special panel of employer consultants and representatives who were featured at the 2015 conference reinforced the importance of organizational culture, leadership style, and financial decision-making strategies at the employer level. Based on the conference proceedings, we recommend that future research in this area should strive for: (a) broader inclusion of workers and workplaces; (b) attention to multilevel influences in the workplace;