The Role of the Employer in Supporting Work Participation of Workers with Disabilities: A Systematic Literature Review Using an Interdisciplinary Approach

The Strategies Used to Balance Health and Work Across the Solid Organ Transplantation Trajectory

Introduction: Workers who undergo solid organ transplantation report frequent conflicts between the unpredictable demands of their health condition and the rigid requirements of their employer and of health services. The present study aimed to describe the self-management strategies adopted by workers while staying at work before transplantation and during sustainable return-to-work posttransplantation. Methods: Fifteen employed kidney, liver, and lung transplant recipients were recruited from 2 large urban university health centers in Montreal, Canada. Three focus groups were held, and thematic analysis was performed. Findings: Seven strategies were identified: responding promptly and consistently to fatigue-related needs, planning ahead with immediate supervisors while remaining strategic about when to disclose transplantation, requesting work accommodations, requesting flexibility in healthcare provision, consulting physicians about work-related issues, informing co-workers about work limitations and immunosuppression and asking not to be treated differently in the workplace. Conclusion: Access to work accommodations, support from physicians and flexibility in treatment and appointment schedules supported workers' ability to manage their health while staying at work before and after undergoing solid organ transplantation. In light of findings, it may be useful for healthcare professionals to address workers' concerns about work limitations and work accommodation implementation, especially when the illness-management burden increases before transplantation and during posttransplantation sick leave. Future studies could describe the strategies used by other important stakeholders when attempting to provide support to workers.

What is the volume, quality and characteristics of evidence relating to the effectiveness and cost-effectiveness of multi-disciplinary occupational health interventions aiming to improve work-related outcomes for employed adults? An evidence and gap map of systematic reviews

Background

In the UK, tens of millions of working days are lost due to work-related ill health every year, costing billions of pounds. The role of Occupational Health (OH) services is vital in helping workers to maintain employment when they encounter injury or illness. OH providers traditionally rely on a clinical workforce to deliver these services, particularly doctors and nurses with OH qualifications. However, the increasing demand for OH services is unlikely to be met in the future using this traditional model, due to the declining number of OH-trained doctors and nurses in the UK. Multi-disciplinary models of OH delivery, including a more varied range of healthcare and non-healthcare professionals, could provide a way to meet this new demand for OH services. There is a need to identify collaborative models of OH service delivery and review their effectiveness on return-to work outcomes. There is an existing pool of systematic review evidence evaluating workplace based, multi-disciplinary OH interventions, but it is difficult to identify which aspects of the content and/or delivery of these interventions may be associated with improved work-related outcomes.

Objectives

The aim of this evidence and gap map (EGM) was to provide an overview of the systematic review evidence that evaluates the effectiveness and cost-effectiveness of multi-disciplinary OH interventions intending to improve work-related outcomes.

Search Methods

In June 2021 we searched a selection of bibliographic databases and other academic literature resources covering a range of relevant disciplines, including health care and business studies, to identify systematic review evidence from a variety of sectors of employment. We also searched Google Search and a selection of topically relevant websites and consulted with stakeholders to identify reports already known to them. Searches were updated in February 2023.

Selection Criteria

Systematic reviews needed to be about adults (16 years or over) in employment, who have had absence from work for any medical reason. Interventions needed to be multi-disciplinary (including professionals from different backgrounds in clinical and non-clinical professions) and designed to support employees and employers to manage health conditions in the workplace and/or to help employees with health conditions retain and/or return to work following medical absence. Effectiveness needed to be measured in terms of return to work, work retention or measures of absence, or economic evaluation outcomes. These criteria were applied to the title and abstract and full text of each systematic review independently by two reviewers, with disagreements resolved through discussion. We awarded each systematic review a rating of 'High', 'Medium' or 'Low' relevance to indicate the extent to which the populations, interventions and their contexts synthesised within the review were consistent with our research question. We also recorded the number of primary studies included within each of the 'High' and 'Medium' reviews that were relevant to research question using the same screening process applied at review level.

Data Collection and Analysis

Summary data for each eligible review was extracted. The quality of the systematic reviews, rated as 'High' or 'Medium' relevance following full text screening, was appraised using the AMSTAR-2 quality appraisal tool. All data were extracted by one reviewer and checked by a second, with disagreements being settled through discussion. Summary data for all eligible systematic reviews were tabulated and described narratively. The data extracted from reviews of 'High' and 'Medium' relevance was imported into EPPI-Mapper software to create an EGM.

Stakeholder Involvement

We worked alongside commissioners and policy makers from the Department of Health and Social Care (DHSC) and Department of Work and Pensions (DWP), OH personnel, and people with lived experience of accessing OH services themselves and/or supporting employees to access OH services. Individuals contributed to decision making at all stages of the project. This ensured our EGM reflects the needs of individuals who will use it.

Main Results

We identified 98 systematic reviews that contained relevant interventions, which involved a variety of professionals and workplaces, and which measured effectiveness in terms of return to work (RTW). Of these, we focused on the 30 reviews where the population and intervention characteristics within the systematic reviews were considered to be of high or medium relevance to our research questions. The 30 reviews were of varying quality, split evenly between High/Moderate quality and Low/Critically-Low quality ratings. We did not identify any relevant systematic review evidence on any other work-related outcome of interest. Interventions were heterogenous, both within and across included systematic reviews. The EGM is structured according to the health condition experienced by participants, and the effectiveness of the interventions being evaluated, as reported within the included systematic reviews. It is possible to view (i) the quality and quantity of systematic review evidence for a given health condition, (ii) how review authors assessed the effectiveness or cost-effectiveness of the interventions evaluated. The EGM also details the primary studies relevant to our research aim included within each review.

Authors’ Conclusions

This EGM map highlights the array of systematic review evidence that exists in relation to the effectiveness or cost-effectiveness of multi-disciplinary, workplace-based OH interventions in supporting RTW. This evidence will allow policy makers and commissioners of services to determine which OH interventions may be most useful for supporting different population groups in different contexts. OH professionals may find the content of the EGM useful in identifying systematic review evidence to support their practice. The EGM also identifies where systematic review evidence in this area is lacking, or where existing evidence is of poor quality. These may represent areas where it may be particularly useful to conduct further systematic reviews.

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.

The Relationship Between Strategic Human Resource Management Practices and the Employment of Vulnerable Workers: A Two-Wave Study Among Employers

PURPOSE

To improve the inclusion of vulnerable workers in the labor market, employer behavior is key. However, little is known about the effectiveness of strategic Human Resource Management (HRM) practices that employers use to employ vulnerable workers. Therefore, this exploratory study investigates the association between strategic HRM practices (based on social legitimacy, economic rationality and employee well-being) and the actual and intended employment of vulnerable workers in the future.

METHODS

In total, 438 organizations included in the Netherlands Employers Work Survey participated in a two-wave study with a nine-month follow-up period. Logistic regression models were used to estimate the relationship between strategic HRM practices (T0) with the employment of vulnerable workers (T1) and intentions to hire vulnerable workers (T1), while controlling for organizational size, sector, and employment of vulnerable workers at baseline.

RESULTS

Employers who applied strategic HRM practices based on social legitimacy (e.g., inclusive mission statement or inclusive recruitment) or economic rationality (e.g., making use of reimbursements, trial placements, or subsidies) at T0 were more likely to employ vulnerable workers and to intend to hire additional vulnerable workers at T1. No significant results were found for practices related to employee well-being.

CONCLUSION

Since different types of strategic HRM practices contribute to the inclusion of vulnerable workers, employers can build on their strategic priorities and strengths to create inclusive HRM approaches. Future research is needed to study whether these strategic HRM domains also relate to sustainable employment of vulnerable workers.

Experiences of workers with long-term disabilities on employer support throughout the RTW process in The Netherlands: a qualitative study

PURPOSE

The aim of this qualitative study was to explore ways that employer support influenced successful return to work (RTW) in workers with disabilities.

METHODS

We conducted a semi-structured interview study among 27 workers with disabilities in the Netherlands who received a partial disability benefit two years after sick leave and who continued working in paid (part-time) employment after a period of long-term sickness absence (> 2 years). We analyzed data by means of thematic analysis.

RESULTS

We identified four types of employer support that were experienced as factors of successful RTW: 1. Supervisor accessibility; 2. Supervisor engagement; 3. Supervisor strategies; and 4. Supervisor-initiated work accommodations. More specifically, during the preparations for RTW phase, the supervisor's active role involved having a positive and open attitude toward facilitating RTW; during the initial RTW phase, the supervisor's role involved being creative in finding solutions for work accommodations; and during the sustained RTW phase, the supervisor's role included helping workers who still needed changes in their work situations.

CONCLUSION

The elements of successful employer support reveals that the pressure on the shoulders of the supervisor is high. Future research should further investigate whether supervisors need more phase-specific training from their organization.

Investigating municipal and company influences on employment of people with chronic health conditions

AIMS

In many countries, people with chronic health conditions have a weaker attachment to the labour market and fewer chances of re-employment. Much of the existing literature estimates the importance of institutional factors at the level of the municipality of residence or employer accommodation at the company level individually. This study examined the two levels simultaneously to disentangle the separate effects of municipal-level and of company-level factors.

METHODS

Using full population data from Denmark, we estimated cross-classified multilevel models for people newly diagnosed with chronic conditions in 2010-2013 (more than 60,000 individuals in 20,000 companies). We tracked their employment outcomes for up to 5 years after diagnosis.

RESULTS

The findings suggest that, in the short term, factors at the company level explain differences in the employment levels of individuals with chronic conditions more than institutional factors at the municipal level. A combination of average wage, company-level seniority, company size, and industry seem to explain much of company-level influence. In the longer term, the importance of company-level factors seemed to decline. Company-level factors explained blue collar workers' employment rates better than those of white collar workers, which is in line with the notion that blue collar workers expend more physical effort in their work so that they may be more reliant on company accommodation than white collar workers in the case of chronic conditions.

CONCLUSIONS

Company-level factors affected the employment of persons newly diagnosed with chronic health conditions in the short term (in particular among workers in blue collar jobs), while municipal-level factors did not.

Exploring the working conditions of disabled employees: a scoping review

PURPOSE

Disabled people are often overlooked in considerations about work design, which contributes to their exclusion from the labor market. This issue also reflects within research, as the body of knowledge on the working conditions of disabled employees remains relatively limited.

METHODS

A scoping review was conducted to assess the research landscape concerning the working conditions of disabled employees. Five databases have been searched, focusing on relevant studies published between 2017 and 2022.

RESULTS

One hundred fourteen studies were included in the review. It was found that social aspects of work appeared within a substantial portion of the examined studies. Furthermore, it became evident that the interplay of accessibility and flexibility provides an important dynamic to make work design both inclusive and feasible.

CONCLUSION

The recurrent prominence of social aspects, accessibility, and flexibility across the studies shows common challenges and potentials within the work situation of disabled employees. This suggests avenues for future research and inclusive work design.

Assistive Technology's Potential to Improve Employment of People with Disabilities

PURPOSE

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

METHODS

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

RESULTS

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

CONCLUSION

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

Examining information systems use to facilitate the workplace accommodation process

BACKGROUND

The workplace accommodation process is often affected by ineffective and inefficient communications and information exchanges among disabled employees and other stakeholders. Information systems (IS) can play a key role in facilitating a more effective and efficient accommodation process since IS has been shown to facilitate business processes and effect positive organizational changes.

OBJECTIVE

Since there is little to no research that exists on IS use to facilitate the workplace accommodation process, this paper, as a critical first step, examines how IS have been used in the accommodation process.

METHODS

Thirty-six interviews were conducted with disabled employees from various organizations. Open, axial, and selective coding were part of the analysis. Fuzzy set qualitative comparative analysis was used to identify different levels of IS use based on participants' descriptions.

RESULTS

An IS used in the workplace accommodation process consists of electronic request form, accommodation checklist, special budget, specific role, ancillary service, formal policy and procedure. There are different levels of IS use in the current accommodation process. The high-level IS use often results in a better accommodation performance than the low-level IS use, including high efficiency, high effectiveness, and low emotional tolls. Nevertheless, the high-level IS use often uses a specific, inflexible template as well as disregards human elements in the accommodation process.

CONCLUSION

This work provides implications that future IS design should raise awareness of disability and accommodation, account for individual differences, involve multiple stakeholder inputs, as well as address the fundamental social issues in the accommodation process.

Active engagement of managers in employee RTW and manager-employee relationship: managers' experiences of participating in a dialogue using the Demand and Ability Protocol

PURPOSE

To describe how managers of employees on sick-leave, due to chronic pain conditions, experience participating in a three-party meeting using the Demand and Ability Protocol (DAP) in the return-to-work process.

MATERIALS AND METHODS

This study is based on individual semi-structured interviews with 17 managers of employees with chronic pain. Interviews were conducted after participating in a three-party meeting including the employee, manager, and a representative from the rehabilitation team. The data were analyzed using thematic analysis with an inductive approach.

RESULTS

Two main themes were identified - "to converse with a clear structure and setup" and "to be involved in the employee's rehabilitation." The first theme describe experiences from the conversation, and the second theme reflected the managers' insights when being involved in the employee's rehabilitation. The themes comprise 11 sub-themes describing how the DAP conversation and the manager's involvement in the rehabilitation may influence the manager, the manager-employee relationship, and the organization.

CONCLUSIONS

This study show, from a manager's perspective, how having a dialogue with a clear structure and an active involvement in the employee's rehabilitation may be beneficial for the manager-employee relationship. Insights from participating in the DAP may also be beneficial for the organization.IMPLICATIONS FOR REHABILITATIONA structured dialogue between the employee, employer, and rehabilitation supports the return to work (RTW) processA structured dialogue and collaboration may strengthen the relationship between the manager and employeeAn active engagement of managers in the employeès RTW process is beneficial for the manager-employee relationship, and for the organisationHealthcare professionals should collaborate with the workplace to promote participation of managers.

'Wait…, let me tell you, if I worked for a boss, I would be on sick leave': A Qualitative Study of Self-Employed Workers in Physically Demanding Jobs in the Netherlands

PURPOSE

The purpose of this study was to explore the perspectives of self-employed workers with a physically demanding job on work participation.

METHODS

We interviewed self-employed workers with a physically demanding job, using semi-structured interviews, which were audio recorded. The main topic addressed was the workers' health in relation with their work participation, work demands, and preventive measures. The interviews were transcribed verbatim and coded by three team members of the research team in several steps. We used the consolidated criteria for reporting qualitative research (COREQ) checklist to report our findings.

RESULTS

We interviewed 18 self-employed workers: 83% male, 49 years (SD 7), self-employed for 18 years (SD 9) and the majority (n = 14) worked in the construction sector. Thematic analysis revealed facilitators and barriers for work participation across three main themes: personal factors, work factors, and healthcare. Personal factors compassed sub-themes such as health and financial consequences. Work factors included sub-themes related to work demands and adaptations and healthcare encompassed sub-themes associated with work-related care and medication.

CONCLUSION

To our knowledge, this is the first qualitative study that investigated the perspectives of self-employed workers in physically demanding jobs regarding work participation. While most facilitators and barriers were consistent with those described in the literature for employees, certain factors, such as financial consequences of ceasing work, emerged important factors for work participation among self-employed workers.

Acceptability of the eHealth Intervention Sustainable Worker Digital Support for Persons With Chronic Pain and Their Employers (SWEPPE): Questionnaire and Interview Study

BACKGROUND

Sick leave and decreased ability to work are the consequences of chronic pain. Interdisciplinary pain rehabilitation programs (IPRPs) aim to improve health-related quality of life and participation in work activities, although implementing rehabilitation strategies at work after IPRPs can be difficult. Employers' knowledge about pain and the role of rehabilitation needs to be strengthened. The self-management of chronic pain can be improved through eHealth interventions. However, these interventions do not involve communicating with employers to improve work participation. To address this deficiency, a new eHealth intervention, Sustainable Worker Digital Support for Persons with Chronic Pain and Their Employers (SWEPPE), was developed.

OBJECTIVE

This study aimed to describe the acceptability of SWEPPE after IPRPs from the perspective of patients with chronic pain and their employers.

METHODS

This study included 11 patients and 4 employers who were recruited to test SWEPPE in daily life for 3 months after IPRPs. Data were collected using individual interviews at the end of the 3-month test period and questionnaires, which were completed when SWEPPE was introduced (questionnaire 1) and at a 3-month follow-up (questionnaire 2). Data were also collected on how often SWEPPE was used. Qualitative data were analyzed through a qualitative content analysis using an abductive approach. The framework used for the deductive approach was the theoretical framework of acceptability. Quantitative data were analyzed through descriptive statistics and the differences between the responses to questionnaires 1 and questionnaire 2 using the Wilcoxon signed rank test.

RESULTS

Both patients and employers reported that SWEPPE increased their knowledge and understanding of how to improve work participation and helped them identify goals, barriers, and strategies for return to work. In addition, participants noted that SWEPPE improved employer-employee communication and collaboration. However, experiences and ratings varied among participants and the different SWEPPE modules. The acceptability of SWEPPE was lower in patients who experienced significant pain and fatigue. A high degree of flexibility and choice of ratings in SWEPPE were generally described as helpful.

CONCLUSIONS

This study shows promising results on the user acceptability of SWEPPE from both patient and employer perspectives. However, the variations among patients and modules indicate a need for further testing and research to refine the content and identify the group of patients who will best benefit from SWEPPE.

Prospects of returning to work after lumbar spine surgery for patients considering disability pension: a nationwide study based on data from the Norwegian Registry for Spine Surgery

OBJECTIVES

To assess the odds for not returning to work (non-RTW) 1 year after treatment among patients who had applied for or were planning to apply for disability pension (DP-applicant) prior to an operation for degenerative disorders of the lumbar spine.

METHODS

This population-based cohort study from the Norwegian Registry for Spine surgery included 26 688 cases operated for degenerative disorders of the lumbar spine from 2009 to 2020. The primary outcome was RTW (yes/no). Secondary patient-reported outcome measures (PROMs) were the Oswestry Disability Index, Numeric Rating Scales for back and leg pain, EuroQoL five-dimension and the Global Perceived Effect Scale. Logistic regression analysis was used to investigate associations between being a DP-applicant prior to surgery (exposure), possible confounders (modifiers) at baseline and RTW 12 months after surgery (outcome).

RESULTS

The RTW ratio for DP-applicants was 23.1% (having applied: 26.5%, planning to apply 21.1%), compared with 78.6% among non-applicants. All secondary PROMs were more favourable among non-applicants. After adjusting for all significant confounders (low expectations and pessimism related to working capability, not feeling wanted by the employer and physically demanding work), DP-applicants with under 12 months preoperative sick leave had 3.8 (95% CI 1.8 to 8.0) higher odds than non-applicants for non-RTW 12 months after surgery. The subgroup having applied for disability pension had the strongest impact on this association.

CONCLUSION

Less than a quarter of the DP-applicants returned to work 12 months after surgery. This association remained strong, also when adjusted for the confounders as well as other covariates related RTW.

Organisational Policies and Practices for the Inclusion of Vulnerable Workers: A Scoping Review of the Employer's Perspective

Purpose Current models of inclusive workplaces are primarily based on the perceptions of vulnerable workers, whereas attention for employer's perceptions is lacking. This scoping review addresses this issue by mapping the literature that covers employer's perceptions on the application and importance of organisational policies and practices aimed at the inclusion of vulnerable workers. Methods A literature search for qualitative and quantitative research articles was conducted in MEDLINE, Scopus, ProQuest, PsychInfo, Google Scholar and Web of Science. Studies were included when (a) they reported on practices aimed at the inclusion, participation, or rehabilitation of (b) workers with disabilities, a low education or migration background, or who were long-term unemployed, and (c) were based on samples of employers or their representatives. Results The search resulted in 3,134 articles. In total, 38 articles met the inclusion criteria of this study. We identified seven types of inclusive practices to stimulate the inclusion of vulnerable workers that employers applied and/or perceived as valuable: senior management commitment, recruitment and selection, performance management and development practices, job accommodations and redesign of work, supportive culture, external collaborations with other employers, and monitoring. Conclusions Our review identified seven categories of inclusive practices that pertain to all stages of the employee journey of vulnerable workers. These categories move beyond those reported in studies based on employee samples, for instance by highlighting the importance of monitoring and collaborations with other employers. Hence, our findings stress that insight into employers' perceptions about effective measures is crucial to increase labour market participation of vulnerable groups.

Work participation in adults with rare genetic diseases - a scoping review

BACKGROUND

Work participation is a crucial aspect of health outcome and an important part of life for most people with rare genetic diseases. Despite that work participation is a social determinant of health and seems necessary for understanding health behaviours and quality of life, it is an under-researched and under-recognized aspect in many rare diseases. The objectives of this study was to map and describe existing research on work participation, identify research gaps, and point to research agendas in a selection of rare genetic diseases.

METHODS

A scoping review was performed by searching relevant literature in bibliographic databases and other sources. Studies addressing work participation in people with rare genetic diseases published in peer reviewed journals were assessed using EndNote and Rayyan. Data were mapped and extracted based on the research questions concerning the characteristics of the research.

RESULTS

Of 19,867 search results, 571 articles were read in full text, and 141 satisfied the eligibility criteria covering 33 different rare genetic diseases; 7 were reviews and 134 primary research articles. In 21% of the articles the primary aim was to investigate work participation. The extent of studies varied between the different diseases. Two diseases had more than 20 articles, but most had only one or two articles. Cross-sectional quantitative studies were predominant, with few utilizing prospective or qualitative design. Nearly all articles (96%) reported information about work participation rate, and 45% also included information about factors associated with work participation and work disability. Due to differences in methodologies, cultures and respondents, comparison between and within diseases are difficult. Nevertheless, studies indicated that many people with different rare genetic diseases experience challenges related to work, closely associated to the symptoms of the disease.

CONCLUSION

While studies indicate high prevalence of work disability in many patients with rare diseases, the research is scarce and fragmented. More research is warranted. Information about the unique challenges of living with different rare diseases is crucial for health and welfare systems to better facilitate work participation. In addition, the changing nature of work in the digital age, may also open up new possibilities for people with rare genetic diseases and should be explored.

Discrepancies between workers with disabilities and their supervisors in reported work accommodations and associations with return to work

BACKGROUND

The aims of this study were: (1) to explore the frequency of discrepancies in work accommodations reported by workers and their supervisors, and (2) to investigate whether these discrepancies are associated with full return to work (RTW).

METHODS

We used data from a longitudinal survey study of long-term sick-listed workers and their supervisors (n = 406). Discrepancies in reports on implementing eight types of work accommodations were explored. Logistic regression analyses were conducted to test associations between discrepancies in reported work accommodations and odds of full RTW 27 months after the sick-leave onset.

RESULTS

Discrepancies were the lowest for the work accommodation therapeutic RTW (53%) and the highest (85%) for job training or education and reimbursement of therapy or treatment. Four out of eight types of work accommodations were more often reported by workers than by their supervisors. Only a discrepancy on a job reassignment within the organization was associated with lower odds of full RTW (OR 0.56, 95%-CI 0.36-0.88).

CONCLUSION

We found substantial discrepancies in the reported implementation of work accommodations between workers and their supervisors. Future research should focus on disentangling mechanisms that lead to discrepancies to avoid inefficiencies in the RTW process.

Return to work after medical rehabilitation in Germany: influence of individual factors and regional labour market based on administrative data

BACKGROUND

The influence of both individual factors and, in particular, the regional labour market on the return to work after medical rehabilitation is to be analyzed based on comprehensive administrative data from the German Pension Insurance and Employment Agencies.

METHOD

For rehabilitation in 2016, pre- and post-rehabilitation employment was determined from German Pension Insurance data for 305,980 patients in 589 orthopaedic rehabilitation departments and 117,386 patients in 202 psychosomatic rehabilitation departments. Labour market data was linked to the district of residence and categorized into 257 labour market regions. RTW was operationalized as the number of employment days in the calendar year after medical rehabilitation. Predictors are individual data (socio-demographics, rehabilitation biography, employment biography) and contextual data (regional unemployment rate, rehabilitation department level: percentage of patients employed before). The estimation method used was fractional logit regression in a cross-classified multilevel model.

RESULTS

The effect of the regional unemployment rate on RTW is significant yet small. It is even smaller (orthopaedics) or not significant (psychosomatics) when individual employment biographies (i.e., pre-rehabilitation employment status) are inserted into the model as the most important predictors. The interaction with pre-rehabilitation employment status is not substantial.

CONCLUSIONS

Database and methods are of high quality, however due to the nonexperimental design, omitted variables could lead to bias and limit causal interpretation. The influence of the labour market on RTW is small and proxied to a large extent by individual employment biographies. However, if no (valid) employment biographies are available, the labour market should be included in RTW analyses.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1186/s12651-023-00330-1.

Factors influencing sustainable employment of persons with acquired brain injury (ABI) or spinal cord injury (SCI): A qualitative study evaluating the perspective of health and work professionals

Background

The number of persons with acquired brain injury (ABI) or spinal cord injury (SCI) who leave the labor market early despite successfully return to work post-injury, demonstrates the challenge for them to remain employed. Evidence on how enabling and hindering factors influence daily work across the lifespan and how they affect employment-related services is scarce. Professionals directly involved in work integration can add to this evidence through their experiential knowledge.

Purpose

To identify and explore the factors that enable or hinder sustainable employment for persons with ABI or SCI from the perspective of health and work professionals.

Methods

We conducted 23 semi-structured interviews with professionals in Switzerland, directly involved in work reintegration and retention of persons with ABI or SCI. Interviews were transcribed verbatim and thematically analyzed.

Results

Participants identified three main themes related to the concept of "sustainable employment". First, the value and impact of initial work integration; an early, multidisciplinary, person-centered work integration, with the early involvement of employers is ideal. A good match between the worker and the workplace is sought. Second, critical factors for long-term sustainable work: the main risks for persons with ABI are changing supervisors, workplace restructuring and the introduction of new technologies, while deteriorating health and the occurrence of secondary health problems are the greatest risk for persons with SCI. Third, the relevance of knowledge, experience and attitudes of professionals; Knowledge of the consequences of an ABI or SCI, the legal basis and the social security process, and the attitude of professionals towards the injured worker were considered important.

Conclusions

From the professional's perspective, enabling and hindering factors for sustainable employment in the long-term are fundamentally very similar for persons with ABI and SCI. But different physical, mental and neuropsychological effects call for individually adapted measures. While persons with SCI primarily require ongoing medical care, conscious management of changes in the workplace is critical for persons with ABI. For both groups, an easily accessible counseling and support service should be established for work-threatening problems in the long-term. Furthermore, diagnosis-specific training programs for professionals of employment-related services and disability management should be developed.

Including a Three-Party Meeting Using the Demand and Ability Protocol in an Interdisciplinary Pain Rehabilitation Programme for a Successful Return to Work Process

The Demand and Ability Protocol (DAP) is used in three-party meetings involving an employee, an employer, and a representative from the rehabilitation team. The aim of this study is to investigate the inclusion of an intervention using the DAP in an interdisciplinary pain rehabilitation programme (IPRP) compared to usual care. This non-randomised controlled trial included patients assigned to an IPRP in Sweden. The intervention group received a DAP intervention targeting their work situation in addition to the usual care provided by the IPRP. The control group received IPRP only. Outcome measures were collected from the Swedish Quality Registry for Pain Rehabilitation. Results demonstrated improvements in both groups regarding self-reported anxiety, depression and EQ5D. Sleep was improved in the intervention group but not in the control group. No statistical differences in outcomes were observed between the groups. In conclusion, adding the DAP intervention to IPRP seemed to have the potential to improve sleep among the patients, which may indicate an overall improvement regarding health outcomes from a longer perspective. The results were less clear, however, regarding the work-related outcomes of sickness absence and workability.

Assessing Continued Employability among People with Mental Illnesses: Development of a Scale in Japan

Continued employment enables people with mental illnesses to maintain and improve their mental health, and its mutual understanding between them and their workplaces can help provide specific support and improve the work environment. Hence, this study developed a Continued Employability Scale to provide people with mental illnesses solutions for achieving continued employment and examined the scale's reliability and validity. It is based on a conceptual analysis of the skills necessary for continued employment and comprises items related to continued employability and the consequences of continued employment. We performed conceptual analyses to prepare the item list, conducted the study using a questionnaire survey, and examined its content validity and reliability using factor analyses. The results showed that the developed scale, which can determine self-management, dedication to work, environmental adjustments, and expression of sincerity necessary for continued employment, was reliable and valid. This can be a potentially helpful tool for assessing the ability to continue working and help people with mental illnesses visualise their continued employability, clarify what is being assessed, and improve the self-management ability necessary for continued employment. Further, it can help people who support them at work and enable existing support and programs to function effectively.

Employers’ Perceptions of Challenges and Strategies in Hiring, Retaining, and Promoting Employees With Physical Disabilities

Disability is a common component of human diversity, yet people with disabilities (PWD) are underrepresented in the workplace despite known benefits to PWD and companies alike. There is an urgent need to promote inclusion of PWD in the workplace. The purpose of this study was to explore employer-perceived challenges and strategies for employing, retaining, and promoting people with physical disabilities (PWPD) and to describe the policies, supports, and job accommodations they provide to PWPD. We administered a cross-sectional, online survey to employers in the Midwestern United States ( n = 53). Employers had an average of 8.5 years of experience in their job roles and represented diverse industries and company sizes. Employers provide a range of job accommodations; however, many reported lacking comprehensive disability policies such as training managers on how to support PWPD, providing employee resource groups for PWPD, and having a specific job accommodation fund. Major challenges reported by employers were related to lacking competencies in supporting employees with physical disabilities. However, employers endorsed the utility of strategies to address these challenges, including providing education and training and increasing buy-in from leadership. Study findings inform employers on ways to best support PWPD and improve diversity, equity, and inclusion in the workplace.

Exploring Employer Perspectives on Their Supportive Role in Accommodating Workers with Disabilities to Promote Sustainable RTW: A Qualitative Study

PURPOSE

Employers play an important role in facilitating sustainable return to work (RTW) by workers with disabilities. The aim of this qualitative study was to explore how employers who were successful in retaining workers with disabilities at work fulfilled their supportive role, and which facilitators were essential to support these workers throughout the RTW process.

METHODS

We conducted a semi-structured interview study among 27 employers who had experience in retaining workers with disabilities within their organization. We explored the different phases of RTW, from the onset of sick leave until the period, after 2-years of sick-leave, and when they can apply for disability benefit. We analyzed data by means of thematic analysis.

RESULTS

We identified three types of employer support: (1) instrumental (offering work accommodations), (2) emotional (encouragement, empathy, understanding) and (3) informational (providing information, setting boundaries). We identified three facilitators of employer support (at organizational and supervisor levels): (1) good collaboration, including (in)formal contact and (in)formal networks; (2) employer characteristics, including supportive organizational culture and leadership skills; and (3) worker characteristics, including flexibility and self-control.

CONCLUSIONS

Employers described three different possible types of support for the worker with disabilities: instrumental, emotional, and informational. The type and intensity of employer support varies during the different phases, which is a finding that should be further investigated. Good collaboration and flexibility of both employer and worker were reported as facilitators of optimal supervisor/worker interaction during the RTW process, which may show that sick-listed workers and their supervisors have a joint responsibility for the RTW process. More insight is needed on how this supervisor/worker interaction develops during the RTW process.