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Horppu R, Väänänen A, Kausto J. Evaluation of a guidelines implementation intervention to reduce work disability and sick leaves related to chronic musculoskeletal pain: a theory-informed qualitative study in occupational health care. BMC Musculoskelet Disord 2022; 23:272. [PMID: 35317760 PMCID: PMC8938719 DOI: 10.1186/s12891-022-05234-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 03/16/2022] [Indexed: 11/10/2022] Open
Abstract
Background Guidelines for pain management and sick leave prescription were formulated and implemented in an occupational health services (OHS) in Finland to reduce work disability and sick leaves related to musculoskeletal pain. We investigated how the guidelines implementation intervention may have produced its effects, how the number of prescribed sick leave days varied before and after the launch of the guidelines, and which factors beyond physician behaviour were seen to influence sick leaves. Methods Seventeen physicians, two occupational physiotherapists and one occupational health care nurse were interviewed. Qualitative content analysis using both inductive and deductive approaches was performed, informed by Behaviour Change Wheel and Theoretical Domains Framework. Employees’ sick leave days related to musculoskeletal disorders in 2015–2019 were drawn from the employer’s register. Results Physicians’ guidelines adherence was facilitated by psychological capability (e.g., having relevant knowledge, remembering to engage in recommended behaviours), reflective motivation (e.g., guidelines-related behaviours regarded as central part of one’s professional role; beliefs in the positive consequences of recommended behaviours to employees and employers), and physical and social opportunities (e.g., adequate physical resources, culture of social support). Some physicians also described barriers to recommended behaviours (e.g., lack of knowledge or non-pharmacological pain treatment tools). The guidelines had served as sources of new knowledge, reminders of recommended practices and means of self-assessment. Considerable declining trend of prescribed sick leave days was detected, especially during the first years after the intervention, levelling off somewhat thereafter. OHS policies and structures were seen to enable professionals’ focusing on preventing pain-related disability and prolonged sick leaves. The decline of sickness absences was also attributed to the municipal client organization’s commitment and the employees’ positive attitudes towards the alternatives to full-time sick leave. Conclusions The guidelines implementation intervention was found successful. The study showed the importance of social and organizational environment supporting physicians’ engagement in recommended practices. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-022-05234-8.
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Affiliation(s)
- Ritva Horppu
- Finnish Institute of Occupational Health, P.O Box 40, 00032, Helsinki, Finland.
| | - Ari Väänänen
- Finnish Institute of Occupational Health, P.O Box 40, 00032, Helsinki, Finland
| | - Johanna Kausto
- Finnish Institute of Occupational Health, P.O Box 40, 00032, Helsinki, Finland
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2
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Spinord L, Kassberg AC, Stålnacke BM, Stenberg G. 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. Scand J Occup Ther 2021; 29:645-659. [PMID: 33784480 DOI: 10.1080/11038128.2021.1903990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
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.
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Affiliation(s)
- Linda Spinord
- Department of Community Medicine and Rehabilitation, Umeå University, Umeå, Sweden.,Department of Development and Research, Region Norrbotten, Luleå, Sweden
| | - Ann-Charlotte Kassberg
- Department of Development and Research, Region Norrbotten, Luleå, Sweden.,Department of Health Science, Luleå University of Technology, Luleå, Sweden
| | | | - Gunilla Stenberg
- Department of Community Medicine and Rehabilitation, Umeå University, Umeå, Sweden
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3
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Corbière M, Mazaniello-Chézol M, Bastien MF, Wathieu E, Bouchard R, Panaccio A, Guay S, Lecomte T. Stakeholders' Role and Actions in the Return-to-Work Process of Workers on Sick-Leave Due to Common Mental Disorders: A Scoping Review. JOURNAL OF OCCUPATIONAL REHABILITATION 2020; 30:381-419. [PMID: 31673934 DOI: 10.1007/s10926-019-09861-2] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
The lack of knowledge regarding the roles and actions of return to work (RTW) stakeholders create confusion and uncertainty about how and when to RTW after experiencing a common mental disorder (CMD). Purpose The purpose of this scoping review is to disentangle the various stakeholders' role and actions in the RTW process of workers on sick-leave due to CMDs. The research question is: What is documented in the existing literature regarding the roles and actions of the identified stakeholders involved in the RTW process of workers on sick-leave due to CMDs? Methods In conducting this scoping review, we followed Arksey and O'Malley's (Int J Soc Res Methodol 8:19-32, 2005) methodology, consisting of different stages (e.g., charting the data by categorizing key results). Results 3709 articles were screened for inclusion, 243 of which were included for qualitative synthesis. Several RTW stakeholders (n=11) were identified (e.g., workers on sick leave due to CMDs, managers, union representatives, rehabilitation professionals, insurers, return to work coordinators). RTW stakeholders' roles and actions inter- and intra-system were recommended, either general (e.g., know and understand the perspectives of all RTW stakeholders) or specific to an actor (e.g., the return to work coordinator needs to create and maintain a working alliance between all RTW stakeholders). Furthermore, close to 200 stakeholders' actions, spread out on different RTW phases, were recommended for facilitating the RTW process. Conclusions Eleven RTW stakeholders from the work, heath and insurance systems have been identified, as well as their respective roles and actions. Thanks to these results, RTW stakeholders and policy makers will be able to build practical relationships and collaboration regarding the RTW of workers on sick leave due to CMDs.
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Affiliation(s)
- Marc Corbière
- Department of Education, Career counselling, Université du Québec à Montréal, C.P. 8888 succursale Centre-ville, Montreal, QC, H3C 3P8, Canada.
- Centre de recherche de l'Institut Universitaire en Santé Mentale de Montréal (CR-IUSMM), Montreal, QC, Canada.
| | - Maud Mazaniello-Chézol
- Centre de recherche de l'Institut Universitaire en Santé Mentale de Montréal (CR-IUSMM), Montreal, QC, Canada
- Department of Family Medicine, McGill University, Montreal, QC, Canada
| | - Marie-France Bastien
- Centre de recherche de l'Institut Universitaire en Santé Mentale de Montréal (CR-IUSMM), Montreal, QC, Canada
- Department of Psychology, Université du Québec à Montréal, Montreal, QC, Canada
| | - Estelle Wathieu
- Centre de recherche de l'Institut Universitaire en Santé Mentale de Montréal (CR-IUSMM), Montreal, QC, Canada
- Department of Art History, Concordia University, Montreal, QC, Canada
| | | | - Alexandra Panaccio
- John Molson School of Business, Concordia University, Montréal, QC, Canada
| | - Stéphane Guay
- Centre de recherche de l'Institut Universitaire en Santé Mentale de Montréal (CR-IUSMM), Montreal, QC, Canada
- Department of Psychiatry and Addictology, Université de Montreal, Montreal, QC, Canada
| | - Tania Lecomte
- Centre de recherche de l'Institut Universitaire en Santé Mentale de Montréal (CR-IUSMM), Montreal, QC, Canada
- Department of Psychology, Université de Montréal, Montreal, QC, Canada
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Nordling P, Priebe G, Björkelund C, Hensing G. Assessing work capacity - reviewing the what and how of physicians' clinical practice. BMC FAMILY PRACTICE 2020; 21:72. [PMID: 32340611 PMCID: PMC7187489 DOI: 10.1186/s12875-020-01134-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Accepted: 03/29/2020] [Indexed: 11/10/2022]
Abstract
Background Although a main task in the sickness certification process, physicians’ clinical practice when assessing work capacity has not been thoroughly described. Increased knowledge on the matter is needed to better understand and support the certification process. In this review, we aimed to synthesise existing qualitative evidence to provide a clearer description of the assessment of work capacity as practiced by physicians. Method Seven electronic databases were searched systematically for qualitative studies examining what and how physicians do when they assess work capacity. Data was analysed and integrated using thematic synthesis. Results Twelve articles were included. Results show that physicians seek to form a knowledge base including understanding the condition, the patient and the patient’s workplace. They consider both medical and non-medical aspects to affect work capacity. To acquire and process the information they use various skills, methods and resources. Medical competence is an important basis, but not enough. Time, trust, intuition and reasoning are also used to assess the patient’s claims and to translate the findings into a final assessment. The depth and focus of the information seeking and processing vary depending on several factors. Conclusion The assessment of work capacity is a complex task where physicians rely on their non-medical skills to a higher degree than in ordinary clinical work. These skills are highly relevant but need to be complemented with access to appropriate resources such as understanding of the associations between health, work and social security, enough time in daily work for the assessment and ways to better understand the patient’s work place. Also, the notion of an “objective” evaluation is questioned, calling for a greater appreciation of the complexity of the assessment and the role of professional judgement.
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Affiliation(s)
- P Nordling
- School of Public Health and Community Medicine, The Sahlgrenska Academy at University of Gothenburg, Box 453, SE-405 30, Gothenburg, Sweden. .,Region Västra Götaland, Närhälsan Research and Development Primary Health Care, Gothenburg, Sweden.
| | - G Priebe
- School of Public Health and Community Medicine, The Sahlgrenska Academy at University of Gothenburg, Box 453, SE-405 30, Gothenburg, Sweden
| | - C Björkelund
- School of Public Health and Community Medicine, The Sahlgrenska Academy at University of Gothenburg, Box 453, SE-405 30, Gothenburg, Sweden.,Region Västra Götaland, Närhälsan Research and Development Primary Health Care, Gothenburg, Sweden
| | - G Hensing
- School of Public Health and Community Medicine, The Sahlgrenska Academy at University of Gothenburg, Box 453, SE-405 30, Gothenburg, Sweden
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Sturesson M, Bylund SH, Edlund C, Falkdal AH, Bernspång B. Collaboration in work ability assessment for sick-listed persons in primary healthcare. Work 2020; 65:409-420. [PMID: 32007984 DOI: 10.3233/wor-203093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND General practitioners (GPs) have expressed difficulties in issuing sickness certificates and problems may arise if this work is not performed in an adequate manner. There is scant knowledge about how collaboration with other professions could be organized to enhance this work. OBJECTIVE Evaluate the feasibility of occupational therapists (OTs) performing supplementary assessments for persons on sick leave. METHODS Four healthcare centres (HCs) tested a working approach intervention where sick-listed patients were offered a complementary occupational therapy assessment. The OT assessments were intended to provide useful information for GP issued extended sickness certificates. Data on sick leave, sickness certificates and patient questionnaires were collected at different HCs. Interviews were conducted with GPs and OTs and the Consolidated Framework for Implementation Research was used to analyse the intervention's implementation. RESULTS No major differences in the sickness certificate quality was found. Available data on sick leave increased for all HCs during the project. Not all GPs used the OT assessments, which indicates that the implementation of the intervention was insufficient. CONCLUSION Testing a new working approach in primary healthcare requires an implementation strategy. To improve sickness certification quality, this work needs to be prioritized as an important healthcare task.
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Affiliation(s)
- Marine Sturesson
- Department of Community Medicine and Rehabilitation, Division of Occupational Therapy, Umeå University, Umeå, Sweden
| | - Sonya Hörnqvist Bylund
- Department of Community Medicine and Rehabilitation, Division of Occupational Therapy, Umeå University, Umeå, Sweden
| | - Curt Edlund
- Department of Health Sciences, Mid Sweden University, Sundsvall, Sweden
| | - Annie Hansen Falkdal
- Department of Community Medicine and Rehabilitation, Division of Occupational Therapy, Umeå University, Umeå, Sweden
| | - Birgitta Bernspång
- Department of Community Medicine and Rehabilitation, Division of Occupational Therapy, Umeå University, Umeå, Sweden
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Gustafsson Sendén M, Renström EA. Gender bias in assessment of future work ability among pain patients - an experimental vignette study of medical students' assessment. Scand J Pain 2019; 19:407-414. [PMID: 30653471 DOI: 10.1515/sjpain-2018-0108] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 11/13/2018] [Indexed: 11/15/2022]
Abstract
Background and aims Pain is a prevalent problem in many countries. Women are more often on sick-leave for pain than men. Such gender differences have been explained through biological factors, different demands for on the job market, and home conditions. Fewer studies have focused on how gender stereotypes may bias the medical assessment of pain patients. The aim of the present research was to investigate if a gender bias in medical students' evaluations of chronic pain patients can contribute to explaining the gender differences in sick-leave due to pain. Specifically, we investigated whether medical students' estimates of a patient's accuracy of their own work ability and amount of domestic work differed between female and male patients, and how such estimates influenced the medical students' judgments of the patient's work ability. Methods Medical students (n=137; 60 women; 74 men; three unspecified) read a vignette describing a patient with pain and filled out a questionnaire. The vignette was identical and gender neutral, except for the name of the patient signaling gender. A between-subjects experimental design was used in which participants were randomly assigned to an experimental condition. Participants then judged the patient's work ability, the accuracy of the patient's self-assessed work ability, and the amount of domestic work they believed was performed by the patient. All ratings were made on seven-point items. Results The results showed that there was no main effect of gender on perceived future work ability of the patient, F (1,131)=0.867, p=0.353. However, male patients were considered to be more accurate in their self-assessed work ability than female patients F (1,131)=5.925 p=0.016 (Mfemale=4.87, SDfemale=1.22, and Mmale=5.33, SDmale=1.02). Moreover, female patients were thought to perform more domestic work, F (1,131)=25.56, p<0.001 (Mfemale=4.14, SDfemale=1.41, and Mmale=3.07, SDmale=1.16). Finally, perceived amount of domestic work moderated the effects of perceived future work ability for female but not for male patients, B=0.42, p=0.005. Hence, there was a positive effect of amount of domestic work performed on work ability judgments for women, such that the more domestic work they were assumed to perform, the more they were perceived to be able to work. Conclusions Gender stereotypes influenced assessments of future work ability in pain patients, mainly because women were assumed to perform more domestic work which had a positive effect on perceived work ability. Because domestic work should have a negative effect on recovery, expectations from the physician that domestic work is expected by female patients may in fact have the opposite effect prolonging sick-leave. Moreover, the students trusted the male patients' ability to assess their own work capacity more than women's. Implications It is important that medical students receive education about gender biases and how they may influence medical assessment during their training. Such education may alleviate the influence of gender stereotypes.
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Affiliation(s)
- Marie Gustafsson Sendén
- Department of Psychology, Stockholm University, Stockholm, Sweden.,Department of Social Sciences, Södertörn University, Stockholm, Sweden
| | - Emma A Renström
- Department of Psychology, University of Gothenburg, Gothenburg, Sweden
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7
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Bertilsson M, Maeland S, Löve J, Ahlborg G, Werner EL, Hensing G. The capacity to work puzzle: a qualitative study of physicians' assessments for patients with common mental disorders. BMC FAMILY PRACTICE 2018; 19:133. [PMID: 30060734 PMCID: PMC6066915 DOI: 10.1186/s12875-018-0815-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Accepted: 07/02/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND Entitlement to sickness benefits is a legal process requiring health-related reduced work capacity confirmed by a physician via a sickness certificate. However, there is a knowledge gap concerning physicians' clinical practice of work capacity assessments for patients with common mental disorders (CMD). Physicians claim more knowledge and skills in how to actually do the assessments. The aim of this study was to explore physicians' tacit knowledge of performing assessments of capacity to work and the need for sickness absence in patients with depression and anxiety disorders. METHODS We performed a qualitative study with open-ended interviews and a short video vignette of a physician and a patient with depression as stimuli. Participating physicians (n = 24) were specialized in general practice, occupational health or psychiatry and experienced in treating patients with depression and anxiety. Interviews were audio-recorded and transcribed verbatim. Inductive content analysis was used as the analytical tool. RESULTS Five categories were identified. Category 1 identified work capacity assessment as doing a jigsaw puzzle without any master model. The physicians both identified and created the pieces of the puzzle, mainly by facilitating strategies to make the patient a better supplier of essential information. The finished puzzle made up a highly individualized comprehensive picture required for adequate assessment. Categories 2-4 identified the particular essential pieces of information the participants used, relating to the patient's disorder, capacity in the work place and contextual everyday life. For the sickness absence assessment, apart from decreased work capacity, the physicians also took particulars of the work place into account; e.g. could the work place handle an employee with reduced capacity. CONCLUSIONS Physicians' tacit knowledge of assessing work capacity and the need for sickness absence for patients with CMD was identified as doing a jigsaw puzzle. The physicians became identifiers and creators of the pieces of the puzzle using a broad palette of essential information. Our findings contribute to the knowledge gap on clinical assessment and can be used as an educational tool. Because they are based on the professions' tacit knowledge, acceptance of the model can be expected to be high.
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Affiliation(s)
- Monica Bertilsson
- Department of Public Health and Community Medicine, Institute of Medicine/Epidemiology and Social Medicine, The Sahlgrenska Academy, University of Gothenburg, PO Box 453, SE-405 30 Gothenburg, Sweden
| | - Silje Maeland
- Uni Research Health, Uni Research, Bergen, Norway
- Institute of Occupational Therapy, Physiotherapy and Radiography, Department of Health and Social sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Jesper Löve
- Department of Public Health and Community Medicine, Institute of Medicine/Epidemiology and Social Medicine, The Sahlgrenska Academy, University of Gothenburg, PO Box 453, SE-405 30 Gothenburg, Sweden
| | - Gunnar Ahlborg
- Institute of Medicine/Occupational and Environmental Health, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Institute of Stress Medicine, Region Västra Götaland, Gothenburg, Sweden
| | - Erik L. Werner
- Uni Research Health, Uni Research, Bergen, Norway
- Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Gunnel Hensing
- Department of Public Health and Community Medicine, Institute of Medicine/Epidemiology and Social Medicine, The Sahlgrenska Academy, University of Gothenburg, PO Box 453, SE-405 30 Gothenburg, Sweden
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8
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Mandal R, Dyrstad K. Explaining variations in general practitioners’ experiences of doing medically based assessments of work ability in disability benefit claims. A survey-based analysis. COGENT MEDICINE 2017. [DOI: 10.1080/2331205x.2017.1368614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Affiliation(s)
- Roland Mandal
- Department of Health Research, SINTEF Technology and Society, Pb 4760 Sluppen, 7465 Trondheim, Norway
| | - Karin Dyrstad
- Department of Health Research, SINTEF Technology and Society, Pb 4760 Sluppen, 7465 Trondheim, Norway
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Lévy Y, Denis A, Fassier JB, Kellou N, Schott AM, Letrilliart L. Determinants of sick-leave length: still limited to diagnosis elements. Disabil Rehabil 2016; 39:2657-2662. [PMID: 27830628 DOI: 10.1080/09638288.2016.1242175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE Sickness certification implies that a health problem impairs ability to work. However, its assessment is seldom performed by physicians. Our objective was, therefore, to assess the specific influence of functional and environmental limitations on the length of sick-leave prescriptions. METHOD We conducted a cross-sectional study in French general teaching practices and recorded 353 initial sick-leave certifications. For each of them, the functional and environmental limitations were collected using the ATCIF questionnaire, derived from the International Classification of Functioning. Data analysis was based on a linear regression multivariate model. RESULTS Among the functional limitations, "pain" was the main body function impairment (22% of impairments) and "mobility" the main activity limitation (48%). An environmental barrier was identified in 39% of sick-listed patients, mainly relating to "products and technology" (20%), which refers to workplace factors. The prescription was longer in cases of activity limitations relating to "mobility" and in cases of environmental barriers relating to "products and technology". The multivariate model explained 27% of the variability of sick-leave length through diagnosis elements and only 7% through functional and contextual elements. CONCLUSION In sick-leave prescription, a functional and contextual approach, in addition to the traditional diagnosis-based approach, could better support patients' shared understanding and follow-up, and accountability towards health authorities. Implication for Rehabilitation Although sickness certification implies that a health problem impairs ability to work, decision on sick-leave length in general practice is primarily based on diagnosis. A more functional and contextual approach could better support patients' and other health professionals' shared understanding and follow-up, and accountability towards health authorities. Such evolution requires a change of paradigm in medical education, and the way of reasoning of healthcare professionals.
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Affiliation(s)
- Yvan Lévy
- a Collège Universitaire de Médecine Générale , Université Lyon 1 , Lyon , France
| | | | - Jean-Baptiste Fassier
- b Hospices Civils de Lyon , Lyon , France.,c UMRESTTE, Université Claude Bernard Lyon 1 , Lyon , France
| | - Nadir Kellou
- a Collège Universitaire de Médecine Générale , Université Lyon 1 , Lyon , France
| | - Anne-Marie Schott
- b Hospices Civils de Lyon , Lyon , France.,d Université de Lyon, Equipe d'Accueil HESPER 7425, F-69003 , Lyon , France
| | - Laurent Letrilliart
- a Collège Universitaire de Médecine Générale , Université Lyon 1 , Lyon , France.,d Université de Lyon, Equipe d'Accueil HESPER 7425, F-69003 , Lyon , France
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10
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Horppu R, Martimo KP, Viikari-Juntura E, Lallukka T, MacEachen E. Occupational Physicians' Reasoning about Recommending Early Return to Work with Work Modifications. PLoS One 2016; 11:e0158588. [PMID: 27367908 PMCID: PMC4930161 DOI: 10.1371/journal.pone.0158588] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Accepted: 06/17/2016] [Indexed: 11/19/2022] Open
Abstract
Previous research indicates that work modifications can effectively enhance return to work (RTW) at an early stage of work disability. We aimed to examine how occupational physicians (OPs) reason about recommending early return to work (RTW) with work modifications. Pre-defined propositions regarding the use of work modifications in promoting early RTW were discussed in four focus groups with altogether 11 Finnish OPs. Discussions were audio recorded, and the transcribed data were analyzed using qualitative content analysis. Five different rationales for supporting early RTW were identified: to manage medical conditions, to enhance employee well-being, to help workplace stakeholders, to reduce costs to society, and to enhance OP’s own professional fulfillment. However, OPs identified situations and conditions in which early RTW may not be suitable. In addition, there were differences between the OPs in the interpretation of the rationales, suggesting variation in clinical practice. In conclusion, encouraging early RTW with work modifications was perceived by OPs as a meaningful task and, to a large extent, beneficial for employees and several stakeholders. However, this practice was not accepted without consideration to the RTW situation and context. If early RTW and work modifications are to be promoted, OPs should be offered education that addresses their views regarding this practice.
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Affiliation(s)
- Ritva Horppu
- Prevention of Work Disability, Finnish Institute of Occupational Health, Helsinki, Finland
- * E-mail:
| | - Kari-Pekka Martimo
- Prevention of Work Disability, Finnish Institute of Occupational Health, Helsinki, Finland
| | - Eira Viikari-Juntura
- Prevention of Work Disability, Finnish Institute of Occupational Health, Helsinki, Finland
| | - Tea Lallukka
- Prevention of Work Disability, Finnish Institute of Occupational Health, Helsinki, Finland
| | - Ellen MacEachen
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Canada
- Centre for Research on Work Disability Policy, Institute for Work & Health, Toronto, Canada
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11
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Experiences of work ability in young workers: an exploratory interview study. Int Arch Occup Environ Health 2015; 89:629-40. [PMID: 26515185 PMCID: PMC4828488 DOI: 10.1007/s00420-015-1101-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Accepted: 10/18/2015] [Indexed: 11/27/2022]
Abstract
Purpose The aim of this study was to explore the experiences of and influences on work ability in young workers related to their work and life situation.
Methods In a qualitative study of a strategic sample of 12 young female and 12 young male workers, aged 25–30 years, in work or recently left work, recruited from the 5-year follow-up of a Swedish cohort, semi-structured interviews were performed to explore the experiences of work ability in these young workers. Systematic text condensation inspired by phenomenology was used in the analysis. Results Work ability was experienced as complex, consisting of four themes, each with three subthemes. To be alert and have energy, to possess sufficient education, skills and working life experience and experience meaningfulness and engagement in work, were perceived to be fundamental for work ability and were seen as the worker’s own responsibility. Moreover, work ability can be improved or reduced by the psychosocial work climate, the work organization and the private life. Optimal work ability was experienced when all themes integrated in a positive way. Conclusions Work ability was experienced as the worker’s own responsibility that could be influenced by work circumstances and private life. To promote good work ability among young workers, work ability has to be understood in its specific context. Whether the understanding of work ability found in this study is explicit for the group of young adults needs to be explored in a more general population in further research.
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12
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Bertilsson M, Löve J, Ahlborg G, Hensing G. Health care professionals’ experience-based understanding of individuals’ capacity to work while depressed and anxious. Scand J Occup Ther 2015; 22:126-36. [DOI: 10.3109/11038128.2014.985607] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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13
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Healthcare encounters and return to work: a qualitative study on sick-listed patients’ experiences. Prim Health Care Res Dev 2014; 15:464-75. [DOI: 10.1017/s1463423614000255] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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14
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Nilsing E, Söderberg E, Berterö C, Öberg B. Primary healthcare professionals' experiences of the sick leave process: a focus group study in Sweden. JOURNAL OF OCCUPATIONAL REHABILITATION 2013; 23:450-461. [PMID: 23345119 DOI: 10.1007/s10926-013-9418-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
PURPOSE The aim of this study was to explore primary healthcare (PHC) professionals' experiences of the sick leave process. METHODS This is an explorative study using data from four semi-structured focus group discussions with a purposeful sample of PHC professionals in Östergötland County, Sweden. Content analysis with an inductive approach was used in the analysis. RESULTS Four key themes emerged from the analysis; priority to the sick leave process, handling sickness certifications, collaboration within PHC and with other stakeholders, and work ability assessments. Patients' need for sick leave was handled from each professional group's perspective. Collaboration was considered important, but difficult to achieve and all the competencies available at the PHC centre were not used for work ability assessments. There was insufficient knowledge of patients' work demands and contact with an employer was rare, and the strained relationship with the social insurance officers affected the collaboration. CONCLUSIONS This study highlights the challenges physicians and other PHC professionals face when handling the need for sick leave, especially when encountering patients with symptom-based diagnoses, and the influence of non-medical factors. Hindrances to good practice were increased demands, collaboration, and role responsibility. The challenges in the sick leave process concerned both content and consequences related to poor collaboration within PHC and with representatives from various organizations, primarily employers and social insurance officers. Further research on how to develop a professional approach for handling the sick leave process is needed.
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Affiliation(s)
- Emma Nilsing
- Division of Physiotherapy, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
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How do physiotherapists perceive their role in work ability assessments? A prospective focus group study. Prim Health Care Res Dev 2013; 15:268-76. [DOI: 10.1017/s1463423613000170] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Stigmar KGE, Petersson IF, Jöud A, Grahn BEM. Promoting work ability in a structured national rehabilitation program in patients with musculoskeletal disorders: outcomes and predictors in a prospective cohort study. BMC Musculoskelet Disord 2013; 14:57. [PMID: 23384339 PMCID: PMC3626929 DOI: 10.1186/1471-2474-14-57] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2012] [Accepted: 01/30/2013] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Musculoskeletal disorders (MSDs) are a major reason for impaired work productivity and sick leave. In 2009, a national rehabilitation program was introduced in Sweden to promote work ability, and patients with MSDs were offered multimodal rehabilitation. The aim of this study was to analyse the effect of this program on health related quality of life, function, sick leave and work ability. METHODS We conducted a prospective, observational cohort study including 406 patients with MSDs attending multimodal rehabilitation. Changes over time and differences between groups were analysed concerning function, health related quality of life, work ability and sick leave. Regression analyses were used to study the outcome variables health related quality of life (measured with EQ-5D), and sick leave. RESULTS Functional ability and health related quality of life improved after rehabilitation. Patients with no sick leave/disability pension the year before rehabilitation, improved health related quality of life more than patients with sick leave/disability pension the year before rehabilitation (p = 0.044). During a period of -/+ four months from rehabilitation start, patients with EQ-5D ≥ 0.5 at rehabilitation start, reduced their net sick leave days with 0.5 days and patients with EQ-5D <0.5 at rehabilitation start, increased net sick leave days with 1.5 days (p = 0.019). Factors negatively associated with sick leave at follow-up were earlier episodes of sick leave/disability pension, problems with exercise tolerance functions and mobility after rehabilitation. Higher age was associated with not being on sick leave at follow-up and reaching an EQ-5D ≥ 0.5 at follow-up. Severe pain after rehabilitation, problems with exercise tolerance functions, born outside of Sweden and full-time sick leave/disability pension the year before rehabilitation were all associated with an EQ-5D level < 0.5 at follow-up. CONCLUSIONS Patients with MSDs participating in a national work promoting rehabilitation program significantly improved their health related quality of life and functional ability, especially those with no sick leave. This shows that vocational rehabilitation programs in a primary health care setting are effective. The findings of this study can also be valuable for more appropriate patient selection for rehabilitation programs for MSDs.
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Affiliation(s)
- Kjerstin G E Stigmar
- Kommunhälsan Occupational Health Services, Box 1222, Växjö S 351 12, Sweden
- Department of Health Sciences, Division of Physiotherapy, Lund University, Lund, Sweden
- Research and Development Kronoberg, Box 1223, Växjö, S 351 12, Sweden
- EPI-centrum, County Council of Skåne, Lund, Sweden
- FoU-Kronoberg, Box 1223, Växjö, S 351 12, Sweden
| | - Ingemar F Petersson
- Department of Orthopedics, Clinical Sciences Lund, Lund University, WHO Collaborating Centre for Evidence-Based Healthcare in Musculoskeletal Disorders, Lund, Sweden
- EPI-centrum, County Council of Skåne, Lund, Sweden
| | - Anna Jöud
- Department of Orthopedics, Clinical Sciences Lund, Lund University, WHO Collaborating Centre for Evidence-Based Healthcare in Musculoskeletal Disorders, Lund, Sweden
- EPI-centrum, County Council of Skåne, Lund, Sweden
| | - Birgitta E M Grahn
- Department of Health Sciences, Division of Physiotherapy, Lund University, Lund, Sweden
- Research and Development Kronoberg, Box 1223, Växjö, S 351 12, Sweden
- Department of Orthopedics, Clinical Sciences Lund, Lund University, WHO Collaborating Centre for Evidence-Based Healthcare in Musculoskeletal Disorders, Lund, Sweden
- EPI-centrum, County Council of Skåne, Lund, Sweden
- FoU-Kronoberg, Box 1223, Växjö, S 351 12, Sweden
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Letrilliart L, Barrau A. Difficulties with the sickness certification process in general practice and possible solutions: A systematic review. Eur J Gen Pract 2012. [DOI: 10.3109/13814788.2012.727795] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Bremander AB, Hubertsson J, Petersson IF, Grahn B. Education and benchmarking among physicians may facilitate sick-listing practice. JOURNAL OF OCCUPATIONAL REHABILITATION 2012; 22:78-87. [PMID: 21769594 DOI: 10.1007/s10926-011-9321-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
INTRODUCTION Assessing work ability and sickness certification are considered problematic by many physicians and education and implementation of guidelines to improve knowledge and skills has been requested. Our aim was to study the association between such interventions and physicians' sick-listing practices. METHODS A web-based questionnaire was sent to all physicians working in primary care, psychiatry, orthopedics/rheumatology in the southern region of Sweden before (in 2007 to 1,063 physicians) and after (in 2009 to 1,164 physicians) educational interventions in insurance medicine were offered. RESULTS With a response rate of 58%, half of the physicians (51%) reported to work at a clinic with a sick-listing policy in 2009 compared with 31% in 2007. Primary care physicians (OR 12.4) and physicians who had participated in educational interventions in insurance medicine (OR 2.4) more often had a sick-listing policy at the clinic. Physicians with a longer medical experience (OR 0.7) and those with support at the clinic (OR 0.3) and the possibility to extend time if needed (OR 0.4) were less likely to report of problematic cases while primary care physicians were (OR 2.9). On the contrary, physicians who reported to rarely have the possibility to extend time when handling problematic cases were more likely to issue a higher number of sickness certificates. CONCLUSIONS The sick-listing process is often viewed as problematic and more often by primary care physicians. Benchmarking and education in insurance medicine together with the possibility to allocate extra time if encountering problematic cases may facilitate sick-listing practice.
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Affiliation(s)
- A B Bremander
- Musculoskeletal Sciences, Department of Orthopedics, Clinical Sciences, Lund University, Lund, Sweden.
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Stigmar K, Ekdahl C, Grahn B. Work ability: Concept and assessment from a physiotherapeutic perspective. An interview study. Physiother Theory Pract 2011; 28:344-54. [DOI: 10.3109/09593985.2011.622835] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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