Insights into the Sustainable Return to Work of Aging Workers with a Work Disability: An Interpretative Description Study

Fostering Stay at Work After a Period of Disability: A Scoping Review of Occupational Rehabilitation Strategies to Support Workers in the Adoption of Preventive Behaviours

PURPOSE

Based on the theoretical framework of the Model of Preventive Behaviours at Work, the aim of this study was to describe the the occupational rehabilitation strategies the literature reports that support workers who have suffered an occupational injury in adopting preventive behaviours.

METHODS

To conduct this scoping review, we used a systematic methodology in 7 steps : (1) definition of the research question and inclusion/exclusion criteria; (2) scientific and gray literature search; (3) determination of manuscripts' eligibility; (4) extraction and charting of information; (5) quality assessment; (6) interpretation; and (7) knowledge synthesis.

RESULTS

We selected 46 manuscripts of various types (e.g. randomized trials, qualitative studies, governmental documents). Manuscripts were mainly of good or high quality according to our quality assessment. The strategies for coaching, engaging, educating and collaborating were mostly reported in the literature to support the development of the six preventive behaviours during occupational rehabilitation. The results also suggest that heterogeneity exists regarding the specificity of the strategies reported in the literature, which may have hindered our ability to provide rich and detailed descriptions. Literature also mainly describes individually oriented behaviours and reports strategies requiring a low level of worker involvement, which represent issues to adress in future researh projects.

CONCLUSION

The strategies described in this article reprensent concrete levers that occupational rehabilitation professionals can use to support workers in the adoption of preventive behaviours at work on return from having suffered an occupational injury.

Return-to-Work Coordinators' Perceptions of Their Roles Relative to Workers: A Discourse Analysis

PURPOSE

This paper describes how Canadian Return to Work coordinators (RTWC) framed their job roles relative to workers in ways that went beyond the usual professional norms of helping worker recovery.

METHODS

In-depth interviews were conducted with 47 RTWCs across Canada in 2018-2019. We used critical discourse analysis to analyze the way coordinators viewed workers in the complex, multi-stakeholder system of RTW.

RESULTS

We identified four ways that RTWCs positioned themselves relative to workers: as trust builders, experts, detectives and motivators. These roles reflected RTWCs position within the system; however, their discourse also contributed to the construction of a moral hierarchy that valued worker motivation and framed some workers as attempting to exploit the RTW system.

CONCLUSIONS

RTWCs' positions of power in the coordination process warrant further investigation of how they exercise judgement and discretion, particularly when the process depends on their ability to weigh evidence and manage cases in what might be seen as an objective and fair manner.

Return to work after chronic disease: A theoretical framework for understanding the worker-employer dynamic

OBJECTIVES

Return to work after chronic disease is important for workers, employers and society. The process, however, is challenging. This article provides an analytical and theoretical framework for explaining this process informed by the person-environment fit theory.

METHODS

This article uses a narrative method to (1) review the key concepts, benefits and influencing factors in the literature on return to work after chronic diseases, (2) analyse and critique the most important theoretical models used for explaining return to work after chronic diseases, and (3) review the person-environment fit theory and how it has been used so far.

RESULTS

The existing models highlight different aspects, but they overlook the relationship between the worker and the employer. An analytical and theoretical framework is proposed to comprehensively explain the worker-employer dynamic. The framework also considers the role of broader factors (policy, labour market) and other stakeholders (health professionals, civil society actors) emphasising the idea that return to work is a phased and cyclical process.

DISCUSSION

The framework can be used to guide future qualitative and quantitative studies, or as a map for identifying problematic areas related to the worker or the work environment. The model should be empirically tested in future studies.

L'expérience de retour au travail des personnes vieillissantes ayant subi une atteinte à la santé : un examen de la portée

Aging workers represent an emerging, growing, and essential population for the contemporary labour market. Considering their unique characteristics, these individuals are at risk of experiencing periods of disability at work due to different reasons (e.g., chronic diseases, occupational injuries) and a different return-to-work experience compared to younger workers. The scoping review presented in this article aimed to identify facilitators and barriers to returning to work in aging people who suffered a health impairment. Information from 34 manuscripts was extracted and analyzed, enabling the identification of factors hindering and facilitating the return to work of aging individuals, with regard to four systems: the individual, work, health, and compensation. The results suggest levers accessible to the various stakeholders involved in the process of returning to work for aging individuals to promote their healthy, safe, and satisfactory participation in work after a period of disability.

The Process of Rehabilitation, Return and Stay at Work of Aging Workers Who Suffered an Occupational Injury: A Portrait Based on the Experience of Canadian Stakeholders

PURPOSE

This study aims to paint a picture of the factors that influence the process of rehabilitation, return, and stay at work, for aging workers who have suffered an occupational injury.

METHODS

Based on a descriptive interpretative research design, the authors conducted interviews with 23 participants (i.e., aging workers, workers' representatives, employers, insurers, and rehabilitation professionals) to gather their perspectives. Qualitative data was analyzed through thematic analysis.

RESULTS

Fifteen factors related to the worker, health system, workplace, or compensation system were identified. These factors prevail during rehabilitation, return to work, stay at work, or the entire process.

CONCLUSIONS

This study contributes to the advancement of knowledge regarding three main ideas: (1) the importance of not placing the responsibility on the worker in this complex process, (2) the key role of the compensation system, and (3) the necessity of transforming work to reduce ageism.

Ethnocultural Minority Workers and Sustainable Return to Work Following Work Disability: A Qualitative Interpretive Description Study

Purpose This article provides a state-of-the-art review of issues and factors associated with the sustainable return to work (S-RTW) of ethnocultural minority workers experiencing disability situations attributable to one of four major causes: musculoskeletal disorders, common mental disorders, other chronic diseases or cancer. Methods Using an interpretive description method, an integrative review was conducted of the literature on ethnocultural factors influencing S-RTW issues and factors associated with these four major work-disability causes. An initial review of the 2006-2016 literature was subsequently updated for November 2016-May 2021. To explore and contextualize the results, four focus groups were held with RTW stakeholders representing workplaces, insurers, the healthcare system and workers. Qualitative thematic analysis was performed. Results A total of 56 articles were analyzed and 35 stakeholders participated in four focus groups. Two main findings emerged. First, belonging to an ethnocultural minority group appears associated with cumulative risk factors that may contribute to vulnerability situations and compound the complexity of S-RTW. Second, cultural differences with respect to the prevailing host-country culture may generate communication and trust issues, and conflicts in values and representations, in turn possibly hindering the establishment of positive relationships among all stakeholders and the ability to meet workers' needs. Being a woman in these groups and/or having a lower level of integration into the host country's culture also appear associated with greater S-RTW challenges. Conclusions Based on our findings, we recommend several possible strategies, such as the cultural humility model, for preventing differences from exacerbating the already significant vulnerability situation of some ethnocultural minority workers.

Diagnosing, Managing, and Supporting Return to Work of Adults With Rotator Cuff Disorders: A Clinical Practice Guideline

OBJECTIVE: To develop a clinical practice guideline covering the assessment, management, and return to work of adults with rotator cuff disorders. DESIGN: Clinical practice guideline. METHODS: Using systematic reviews, appraisal of the literature, and an iterative approach to obtain consensus from key stakeholders, clinical recommendations and algorithms were developed in the context of the health care system and work environment of the province of Quebec (Canada). RESULTS: Recommendations (n = 73) and clinical decision algorithms (n = 3) were developed to match the objectives. The initial assessment should include the patient's history, a subjective assessment, and a physical examination. Diagnostic imaging is only necessary in select circumstances. Acetaminophen, nonsteroidal anti-inflammatory drugs, and injection therapies may be useful to reduce pain in the short term. Clinicians should prescribe an active and task-oriented rehabilitation program (exercises and education) to reduce pain and disability in adults with rotator cuff disorders. Subacromial decompression is not recommended to treat rotator cuff tendinopathy. Surgery is appropriate for selected patients with a full-thickness rotator cuff tear. A return-to-work plan should be developed early, in collaboration with the worker and other stakeholders, and must combine multiple strategies to promote return to work. CONCLUSION: This clinical practice guideline was developed to assist the multidisciplinary team of clinicians who provide health care for adults with a rotator cuff disorder. The CPG guides clinical decisionmaking for diagnosis and treatment, and planning for successful return to work. J Orthop Sports Phys Ther 2022;52(10):647-664. Epub: 27 July 2022. doi:10.2519/jospt.2022.11306.

Aging workforce with reduced work capacity: From organizational challenges to successful accommodations sustaining productivity and well-being

Israel is experiencing accelerated workforce aging and increasing retirement age that began in the last two decades. Aging workers suffer from increased illness and impairment rates, challenging employing organizations with reduced work capacity. Occupational health practitioners often assist employers in accommodating these challenges. However, insufficient evidence on prognostic factors, organizational practices, and age management tools hamper successful accommodation. Research on the organizational perceptions of aging workers is also limited. Our study aims to (1) identify the domains in which the aging workforce challenges Israeli organizations according to a multi-level theoretical model we developed, and (2) assess the practices employed by organizations to address the declines in work capacity from employers' and workers' perspectives. Our qualitative study employed semi-structured interviews of 26 employers and workers' representatives from eight Israeli organizations sampled by maximum variation according to organizational characteristics. Thematic framework analysis of organizational perceptions on challenges, facilitators, and practices in use, via aging workers' cases was utilized. We identified organizational challenges on five levels: individual worker, work environment, interpersonal team relationships, organization, and community relationships, stemming from the aging workers' reduced capacity to meet job demands and conditions. Time adjustments, work environment changes, and job task changes were common accommodations practices used by the organizations. Successful accommodations from the employers' perspective preserved workers' and teams' productivity, and from the workers' perspective, those that lowered demand and improved job control without damaging earnings or job status. Taken together, organizations from all economic sectors should prepare for the increasing need to accommodate work conditions for aging workers with limitations to preserve their health and safety. Balancing employers' and workers' perspectives when accommodating workers with reduced work capacity is imperative to promote healthy aging at the workplace. Government intervention is advised to encourage continued job participation to reduce employment termination.

Building a Common Language to Facilitate Discussion Among Stakeholders in Work Disability: A Consensus Group Approach

PURPOSE

Work disability stakeholders may not share the same understanding and solutions among themselves or with researchers, causing misunderstandings and hindering collaboration regarding solutions for preventing work disability. To reduce such differences, this study sought to build a common vocabulary among stakeholders and researchers, using a transdisciplinary research framework.

METHODS

A consensus method based on a constructivist approach was used. A theoretical sampling method was applied to identify researchers or stakeholders representing one of the four systems in the work disability paradigm. A preliminary set of definitions for key terms was assessed using a Web-based questionnaire. It documented participants' level of agreement with each term's inclusion and relevance in the field, and the clarity of the definition, while soliciting suggestions for other terms or clearer definitions. Disagreements were discussed at group meetings, yielding consensus on the final terms and definitions.

RESULTS

Eleven stakeholders representing patients, employers, unions, healthcare professionals, and legislative and insurance systems, along with 10 multidisciplinary researchers, participated. The questionnaire yielded initial consensus on the inclusion and definitions of 49 terms, and 109 suggestions mostly for modified definitions (average = 6 suggestions/term). Two preliminary terms were excluded and three terms were added. Ultimately, 80 terms and their definitions yielded consensus.

CONCLUSIONS

The process we used to build a common vocabulary was carried out within a transdisciplinary framework. It required a constructivist approach, promoting idea exchanges among participants and co-construction of generally agreed results. The results were rooted in local contexts, thus ensuring the same reference points, regardless of participants' different understandings.

Stay at Work After a Period of Disability Due to an Occupational Injury: A Complex Process Marked by Social Exchanges

Purpose Rooted in a social exchange lens, this study aimed to explore the interactions between the factors influencing stay at work after a period of disability due to an occupational injury. Methods Based on a descriptive interpretative research design, interviews with 15 participants (i.e., representatives of workers, workplaces, insurers, and the health care system) were conducted to gather their perspectives about stay at work. Qualitative data was analyzed through thematic analysis. Results Ten different factors interacting together and influencing stay at work were identified. These factors prevail either during stay at work or previously. They are either related to the person (personal resources, occupation outside of work), environment (accommodations, support, access to rehabilitation services) or interaction between the person and her/his environment (perceptions, leeway, communication and information), whether it concerns the workplace, health services or insurance. Conclusions This study contributes to the advancement of knowledge concerning two main themes: (1) the importance of considering social exchanges as factors of success, and (2) the importance of considering the stay at work within a larger process.

[Enabling Workers to Preserve Their Mental Health: What are Ocupational Therapists Doing?]

Description. Les ergothérapeutes accompagnent les travailleurs ayant subi une atteinte à la santé mentale dans leur processus de retour au travail, mais peuvent aussi favoriser le maintien d’une participation saine à long terme. Peu d’écrits scientifiques permettent de comprendre ce rôle émergent. But. Décrire les interventions des ergothérapeutes en regard de l’habilitation des travailleurs à préserver leur santé mentale. Méthodologie. Selon un devis de recherche qualitatif descriptif, des entrevues ont été menées auprès de 19 ergothérapeutes œuvrant en réadaptation socioprofessionnelle. Résultats. Les ergothérapeutes mettent en place 31 interventions réparties en huit catégories. Ces interventions sont principalement axées sur le travailleur lui-même; celles impliquant l’environnement étant moins développées. Conséquences. Les interventions décrites avec spécificité offrent des leviers concrets que les ergothérapeutes peuvent utiliser dans leur pratique. Des travaux de recherche sont toutefois requis pour évaluer l’efficacité de ces interventions.

How does Gender Influence Sustainable Return to Work Following Prolonged Work Disability? An Interpretive Description Study

PURPOSE

A sustainable return to work (S-RTW) following prolonged work disability poses different challenges, depending on gender. This article provides a synthesis of gender differences in the issues and factors influencing the S-RTW of workers following such a disability.

METHODS

Using an interpretive description method, an integrative review was conducted of the literature on gender differences in S-RTW issues and factors associated with four major causes of work disability. The initial review concerned the 2000-2016 literature; it was subsequently updated for November 2016-March 2020. To explore and contextualise the results, four focus groups were held with stakeholders representing the workplace, insurance, and healthcare systems and workers. Qualitative thematic analysis was performed.

RESULTS

A total of 47 articles were reviewed, and 35 stakeholders participated in the focus groups. The prevailing traditional gender roles were found to have a major gender-specific influence on the attitudes, behaviours, processes and outcomes associated with S-RTW. These differences related to the (1) cumulative workload, (2) work engagement, and (3) expressed and addressed needs.

CONCLUSIONS

The results highlight the importance of taking into account both professional and personal aspects when integrating gender issues into the assessment of workers' needs and subsequently into interventions.

Development of a Questionnaire Measuring Preventive Behaviors at Work

Purpose This study aimed to develop a questionnaire measuring preventive behaviors at work. Methods A three-step design, including qualitative and quantitative methods, was followed: (1) item generation, (2) experts' validation of content, and (3) pretesting. Results For step 1, 49 relevant existing scales were reviewed, and a pool of 172 items was generated. Redundant items were deleted (n = 48), and unclear items were reworded (n = 27). For step 2, 14 experts (five occupational therapists, four researchers, and five workers) assessed the representativeness, relevance, and clarity of each item through content validity indices (CVIs). An average overall CVI of 0.97 was obtained, and 87.5% of the experts stated that the questionnaire was comprehensive. During this step, 63 items were deleted, and 35 were modified. For step 3, the tool was pretested in the clinical settings of four dyads (occupational therapist-worker). The thematic analysis of interview content allowed several changes to be made to the questionnaire, including the addition of information and format changes. Conclusions Overall, this three-step study led to the construction of a 61-item French questionnaire entitled the Échelle de fréquence des comportements préventifs au travail [Frequency Scale of Preventive Behaviors at Work]. In rehabilitation settings, this tool could be useful to support professionals in enabling workers to adopt preventive behaviors, thereby fostering a healthy, sustainable return to work after a disability period. However, further metrological property assessment is required. A validating study using a large pool of workers is ongoing.

Multivariate correlations between pain, life interference, health-related quality of life and full-time sick leave 1 year after multimodal rehabilitation, focus on gender and age

BACKGROUND

Chronic pain is a major and complex health condition associated with reduced work performance. A multimodal rehabilitation programme (MMRP) is a common intervention for chronic pain conditions, the goal being for the person to maintain or return to work.

AIM

To investigate the multivariate relationships between health-related quality of life, life interference, pain, physiological factors before MMRP and full-time sick leave 1 year after MMRP.

MATERIAL AND METHODS

Data were collected from the Swedish Quality Registry for Pain Rehabilitation. The study included 284 participants. Separate analyses were performed for women, men and three age groups.

RESULTS

There were correlations between sick leave, physical functioning, pain duration, health-related quality of life, and self-assessed importance of work before MMRP and sick leave 1 year after MMRP. The patterns of factors associated with full-time sick leave varied for women, men and age groups.

CONCLUSIONS

These findings indicate that full-time sick leave for patients with chronic pain is affected by a number of interacting factors. Occupational therapy interventions aiming to develop activity skills in relation to work roles and enable patients to develop skills required to manage the physical, psychological and social demands to return to work or maintain work could be valuable to increase the possibility of attaining a sustainable work situation.