Do individual and work-related factors differentiate work participation trajectories before and after vocational rehabilitation?

Psychological Service Utilization and its Impact on Return to Work in Vocational Retraining Centers: A Cohort Study

PURPOSE

Vocational retraining centers in Germany provide retraining for adults who are unable to continue their previous occupation due to health conditions. In addition to education and training, the centers provide support services, including the psychological service that assists rehabilitees in maintaining or regaining their mental stability. This study investigated which socio-demographic, health-related, and rehabilitation-related factors are associated with return to work (RTW) and examined the use of the psychological service and its association with RTW.

METHODS

Data consisted of administrative data and service records routinely collected at one vocational retraining center. A total of 1187 individuals who began vocational retraining between 2016 and 2018 were analyzed. Logistic models predicting RTW and including interaction terms were used.

RESULTS

Several factors were associated with RTW (Nagelkerke's Pseudo-R2 = 0.173), including socio-demographic factors, e.g., age (OR 0.96, 95% CI [0.93, 0.98]), health-related factors, e.g., number of diagnoses (OR 0.85, 95% CI [0.77, 0.93]), and rehabilitation-related factors, e.g., discontinuation of training (OR 0.24, 95% CI [0.15, 0.38]). The proportion of women, rehabilitees attending boarding school, and rehabilitees pursuing a career in the commercial and administrative sector was higher among frequent users of the psychological service compared to non/occasional users. The proportion of rehabilitees diagnosed with ICD F was also higher among frequent users, as was the number of diagnoses. Moreover, an interaction was found between absence and psychological service utilization on RTW.

CONCLUSION

The analysis of routinely collected data in a vocational retraining center is suitable to investigate individual-level factors associated with RTW. The interaction suggests a compensatory effect, i.e., that frequent use of the psychological service mitigates the negative effect of absence on RTW.

The association of sociodemographic characteristics with work disability trajectories during and following long-term psychotherapy: a longitudinal register study

PURPOSE

This register-based study examined the trajectories of depression or anxiety disorder-related work disability during and following long-term psychotherapy and identified sociodemographic factors that indicate membership in different trajectory groups.

METHODS

Data were drawn from national registers (Statistics Finland, Social Insurance Institution of Finland). Participants included a random sample of Finnish working-age individuals (18-55 years) who started psychotherapy treatment between 2011 and 2014 and were followed for 5 years: 1 year before and 4 years after the onset of psychotherapy (N = 3 605 individuals; 18 025 person-observations across five time points). Group-based trajectory modeling was applied to assign individuals to work disability trajectories by the number of annual mental health-related work disability months. Multinomial logistic regression was used to examine the associations between trajectory group membership and baseline sociodemographic factors of age, gender, occupational status, and geographical area of residence.

RESULTS

Four mental health-related work disability trajectories were identified: stable very low (72%), decrease (11%), persistent low (9%) and persistent high (7%). Those with older age, female gender, lower occupational status, and living in sparsely populated geographical areas were more likely to belong to the most unfavorable trajectory group of persistent high work disability. The presence of multiple risk characteristics substantially increased the probability of belonging to the most adverse trajectory group.

CONCLUSIONS

Sociodemographic factors were associated with the course of mental health-related work disability in association with psychotherapy. Rehabilitative psychotherapy does not function as an equal support resource for work ability in all parts of the population.

Sequences of vocational rehabilitation services in Germany: a cohort study

BACKGROUND

This study aimed to describe sequences of vocational rehabilitation services among individuals with approved vocational rehabilitation in Germany and to identify typical service sequences.

METHODS

We used administrative data on vocational rehabilitation services and questionnaire data on health and work ability to describe frequencies and sequences of vocational rehabilitation services financed by the Federal German Pension Insurance. Through sequence analysis, we were able to map the service sequences. We did cluster analyses to identify typical different service sequences.

RESULTS

Our sample included 1,652 individuals with 2,584 services. Integration services and two-year vocational retraining were the most common services. We could identify three different service clusters around integration services: shorter ones, followed by employer benefits and without employer benefits. We found two different clusters around two-year vocational retraining: shorter and longer clusters. Two-year vocational retraining was more often initiated by preparatory services and followed by employer benefits than integration services. Longer services in both clusters were associated with better baseline data for physical health, work ability, risk of future work disability, and younger age than shorter services. People in two-year-vocational retraining reported at baseline better general health, better work ability, low risk of future work disability, and less mental illness compared to people in integration services.

CONCLUSIONS

Multiple services, that is, sequences of services, were more likely to occur among individuals with more complex services like two-year vocational retraining. Utilization of complex services and longer services was influenced by health, age, risk of future work disability, and education.

TRIAL REGISTRATION

German Clinical Trials Register DRKS00009910, registration 25/01/2016.

Group-Based Trajectory Analysis of Longitudinal Employment Patterns and Predictors for Adults With Visual Impairments

BACKGROUND

A substantial gap in employment rates has been documented between people with and without visual impairments, but most employment-related research for people with visual impairments has focused on employment at one time point.

OBJECTIVE

The purpose of this study was to examine longitudinal employment trajectories by visual impairment and investigate factors associated with trajectories for people with visual impairments.

METHOD

The data source was the 2014 Panel of the Survey of Income and Program Participation. Participants were 816 adults with visual impairments and a matched comparison group of 816 adults without visual impairments. We used group-based trajectory modeling to estimate employment trajectories, identify predictors of trajectory group membership, and explore the impact of health on employment trajectories.

RESULTS

Visual impairment was associated with a lower probability of membership in the Rising, Declining, and High employment trajectory groups compared to the Low group. Predictors of trajectory group membership included disability benefit receipt, non-visual disabilities, gender, race, age, and education. Fair or poor health was associated with decreases in all four trajectories over time.

CONCLUSION

Visual impairment is a risk factor for not working across multiple years. Disability benefit receipt was the strongest predictor of trajectory group membership for this population.

Impact of a Finnish reform adding new sickness absence checkpoints on rehabilitation and labor market outcomes: an interrupted time series analysis

OBJECTIVES

In 2012, new checkpoints were introduced in the Finnish sickness absence system to improve early detection of long-term work disability and hasten return to work after illness. We examined whether the reform affected participation in rehabilitation and labor market outcomes over a one-year period.

METHODS

We used interrupted time series analysis among persons who started receiving sickness allowance up to three years before and up to two years after the reform. Separate analyses were conducted among those who passed 30, 60, and 90 sickness allowance days. Poisson regression analysis was used, controlling for seasonal variation, gender, age, and educational level.

RESULTS

After the reform, participation in rehabilitation within one year of passing 30 sickness allowance days increased by 5.1% [incidence rate ratio (IRR) 1.051, 95% confidence interval (CI) 1.015-1.086]. The increase after 60 and 90 sickness allowance days was slightly larger. Looking at the type of rehabilitation, vocational rehabilitation from the earnings-related pension scheme increased most. Regarding the rehabilitation provided by the Social Insurance Institution of Finland (Kela), vocational rehabilitation, medical rehabilitation, and discretionary rehabilitation increased, but the increase was statistically significant only in the last case. Post-reform changes in employment, unemployment, sickness absence and disability retirement were negligible.

CONCLUSIONS

The introduction of new sickness absence checkpoints was associated with an increase in participation in rehabilitation but did not affect labor market outcomes one year later. The reform thus was only partially successful in achieving its objectives. Future research should focus on identifying the most effective approaches for utilizing rehabilitation to enhance labor market participation after sickness absence.

Labour market trajectories after part-time sickness absence: a nationwide cohort study from Finland

OBJECTIVES

The use of part-time sickness absence (pSA) enables return to part-time work from full sickness absence. However, subsequent labour market outcomes of pSA users depend on various individual and work-related characteristics. We investigated labour market paths of private and public sector employees after having a pSA spell. Moreover, we examined individual and work-related factors associated with following them.

DESIGN

Longitudinal register-based cohort study.

SETTING

Finnish employed population.

PARTICIPANTS

9896 receivers of partial sickness allowance aged 45-56 in the years 2010-2014.

OUTCOME

We constructed labour market trajectories based on the proportion of time spent in various labour market statuses measured over 3 years after the end of the pSA spell using multiresponse trajectory analysis. We then examined how different individual and work-related factors were associated with assignment to the different trajectory groups using logistic regression analyses.

RESULTS

The majority of the pSA users followed paths where work participation was consistently elevated (Sustained Work group, 40.4%), or only slightly reduced (Slightly Reduced Work group, 31.6%). Moreover, more than 1/10th of the users followed a path where receiving partial work disability benefits became predominant (Partial Work Disability group, 12.5%). The rest followed paths where other non-employment (Other Non-Employed group, 7.8%) or full work disability (Full Work Disability group, 7.7%) became the prevailing status. Lower educational level and income predicted assignment to all other groups than the Sustained Work group. Additional predictors were identified, yet these differed between the trajectory groups.

CONCLUSIONS

The majority of the pSA users maintained a connection to working life, yet weaker working life paths were also identified. The paths were determined by various individual and work-related factors that can help health professionals and employers to better target support measures particularly towards individuals whose connection to working life is at risk to weaken after the use of pSA.

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.

Sustainable employability in Supported Employment and IPS interventions in the context of the characteristics of work and perspectives of the employers: a scoping review protocol

INTRODUCTION

The sustainable employment outcomes and cost-effectiveness of Supported Employment (SE) and Individual Placement and Support (IPS) have been well reported. Research has also focused on various target groups, compliance with the quality criteria for the implementation of the SE/IPS method in diverse work life and social security contexts. However, the impact of employers' interests and the quality and opportunities of jobs or the work itself for sustainable working careers have not been studied extensively. The objective of the proposed scoping review is to systematically explore what is known about sustainable employability in SE and IPS interventions in the context of the characteristics of work and perspectives of the employers.

METHODS AND ANALYSES

The scoping review methodological framework by Arksey and O'Malley and its recently enhanced versions are used as guidelines in this study. The literature search, which was conducted in Medline, Scopus, PsycINFO, the Cumulative Index to Nursing and Allied Health Literature, and Social Science Premium Collection (ProQuest), identified a total of 2706 articles after the removal of duplicates. Key findings of selected studies will be charted, analysed and reported.

ETHICS AND DISSEMINATION

The study does not require ethics approval, as the data are collected from secondary sources. The final version of the scoping review will be published in a peer-reviewed academic journal. Findings of the review will be used in the upcoming ethnographic observation at work study, which is part of the Finnish Work Ability Programme Evaluation Study (2020-2023).

Labor Market Participation Before and After Long-Term Part-Time Sickness Absence in Finland: A Population-Based Cohort Study

OBJECTIVE

To examine trends in labor market participation among those with long-term part-time or long-term full-time sickness absence.

METHODS

Finnish population-based cohort study including 3406 individuals with greater than 30-day part-time sickness absence in 2011 and 42,944 individuals with greater than 30-day full-time sickness absence in 2011.

RESULTS

Compared to previous years, the rates of sickness absence and vocational rehabilitation increased after 2011 in both groups. Sickness absence rate was higher in 2012 in the full-time sickness absence group than in the part-time sickness absence group. An increasing trend in unemployment after 2011 was observed in both groups, but the absolute level of unemployment was higher in the full-time sickness absence group.

CONCLUSION

Long-term part-time sickness absence seems to mark a decline in labor market participation, but the decline is smaller than that in employees with full-time sickness absence.

Does Work Disability Contribute to Trajectories of Work Participation before and after Vocational Labour Market Training for Job Seekers?

The contribution of ill-health to labour market participation in relation to vocational training is unclear. Using nationally representative Finnish register data on 42,691 vocational labour market trainees in 2008-2010, we constructed latent trajectory groups of work participation in the open labour market three years before and after training, identifying groups called "High-High", "High-Low", "Low-High", and "Low-Low". We plotted further patterns of labour market participation within these trajectory groups and, using multinomial logistic regression, examined assignment to these groups focusing on previous work disability status. Those with compared to those without previous work disability had previous employment more often and spent less time in economic inactivity within the two trajectory groups with low pre-training levels of work participation. Having a previous work disability was associated with assignment to the "High-Low" trajectory group of work participation instead of the "High-High" comparison group. The associations of other background factors with the assignment to the different trajectory groups were relatively similar amongst those with and without previous work disability. However, some of these associations were weaker amongst the former. Along with other key background factors, previous work disability should be accounted for when assessing the effects of vocational training.

Effect of Osteoarthritis on Work Participation and Loss of Working Life-years

OBJECTIVE

To examine to what extent disabling osteoarthritis (OA), leading to a prolonged sickness absence (SA), interferes with work participation and shortens working life-years.

METHODS

A total of 4704 wage earners aged 30 to 59 years, whose SA due to OA started in 2006, were followed until October 31, 2014. Kaplan-Meier analysis was used to plot sustained (at least 28 consecutive days) return-to-work curves. The associations of potential determinants with early exit from paid employment were examined applying Cox proportional hazards regression analysis. Years expected to be spent in different work participation statuses until statutory retirement age were estimated based on daily work participation statuses using adapted Sullivan method.

RESULTS

Persons with knee OA showed the fastest, and persons with hip OA the slowest, sustained return to work. Although most participants typically were at work during the first year of followup, a considerable proportion was permanently retired. Male sex, older age, low education, long initial SA, and having not returned to work sustainably, as well as receiving vocational rehabilitation, predicted early exit from paid employment during the followup. Overall, only 45-53% of potential working life-years were estimated to be spent at work, being highest for the oldest age group.

CONCLUSION

Our study showed a considerable effect of OA on work participation and working life duration. Clinicians should avoid prescription of long SA or temporary work disability due to OA without a clear treatment or return-to-work plan.