What leads to the expectation to return to work? Insights from a Theory of Planned Behavior (TPB) model of future work outcomes

Development and psychometric evaluation of a theory-based questionnaire measuring women's return-to-work beliefs after long-term sick leave for common mental disorders

BACKGROUND

Common mental disorders (CMDs) are currently a major cause of long-term sick leave, with women being most affected.

OBJECTIVE

Using the Theory of Planned Behaviour (TPB), we aimed to describe the development and psychometric evaluation of a new questionnaire to measure women's beliefs about return to work (RTW) after long-term sick leave for CMDs.

METHODS

Data were collected in central Sweden from women on long-term sick leave (2- 24 months) for CMDs. The questionnaire was developed by conducting an elicitation study with 20 women and included both direct and indirect measures. Subsequently, 282 women participated in a psychometric evaluation and 35 of them in a test-retest procedure. Psychometric properties were evaluated by determining reliability (internal consistency [Cronbach's alpha] and test-retest stability [intraclass correlation coefficient]), construct validity (exploratory factor analysis) and content validity.

RESULTS

The development resulted in 60 questionnaire items. Content validity assessment showed that the women overall found it easy to complete the questionnaire. Reliability analyses showed satisfactory results for both direct and indirect measures, with a few exceptions. Factor analyses of the indirect scales showed that items were generally in line with the TPB, but that items related to life as a whole/personal life and items related to work were separated into two different factors.

CONCLUSION

The questionnaire, called the RTW Beliefs Questionnaire, showed promising results and can among women with CMDs be considered useful, especially the scales for direct measures. This questionnaire gives opportunity to identify new potential predictors for RTW.

Predictors of return to work and psychological well-being among women during/after long-term sick leave due to common mental disorders - a prospective cohort study based on the theory of planned behaviour

Common mental disorders are associated with long-term sick leave, especially among women. There is a lack of theory-based research regarding the impact of personal factors on return to work and psychological well-being. Therefore, the aim of this study was to examine whether return-to-work beliefs and perceived health were predictors of return to work and psychological well-being among women during or after long-term sick leave for common mental disorders, based on the Theory of Planned Behaviour. This was a prospective cohort study with a 1-year follow-up. At baseline, women (n = 282) had been on full- or part-time sick leave for common mental disorders for 2-24 months. Data were collected in October 2019-January 2020 and October 2020-January 2021 in Sweden. The Social Insurance Agency identified the women at baseline. The Return-To-Work Beliefs Questionnaire, EuroQol Visual Analogue Scale and General Health Questionnaire-12 were used. Multiple logistic and linear regression analyses were conducted. The women were divided into two groups: full-time sick leave or part-time sick leave at baseline. The results showed that stronger return-to-work intention significantly predicted return to work among women on full-time sick leave at baseline. No significant predictors of return to work were found among women on part-time sick leave at baseline. Psychological well-being was predicted by stronger social pressure to return to work (full-time group) and a more positive attitude toward returning to work and better perceived health (part-time group). We concluded that the Theory of Planned Behaviour can be useful for understanding return to work among women on full-time sick leave, and what underlies psychological well-being in both groups. However, return to work and psychological well-being were predicted by different factors, indicating that a multifactorial approach should be used in supporting women to return to work after long-term sick leave for common mental disorders.

Education Makes the Difference: Work Preferences of Young Adults with Physical Disability

This study focused on the work preferences of young adults with physical disabilities (YAPD) in Israel and the variables that affect those preferences. The theory of planned behavior (TPB) was employed to explain work preferences. We examined direct and indirect links between education and socioeconomic status (SES) in a comprehensive model that tested the mediating role of the TPB and self-assessed health. A cross-sectional study was conducted throughout 2017. Participants included 348 YAPD aged 18–30 not yet integrated into the workforce. Exploratory factor analysis of work preferences yielded three dependent variables: ‘intention to work’, ‘interest, security, and advancement at work’, and ‘willingness to work in the free market’. Data analysis included correlations and path analysis by structural equation modeling. Education was positively associated with all work preferences, while SES was positively associated with ‘interest, security, and advancement at work’. Subjective norms mediated the relation between education and ‘intention to work’ and ‘interest, security, and advancement at work’. Self-efficacy mediated the relation between SES and ‘interest, security, and advancement at work’. Finally, self-assessed health mediated between SES and self-efficacy. Education is a crucial human capital in predicting work preferences of YAPD. The TPB components are important factors in predicting work preferences.

A Grounded Theory Study on the Intention to Work While Ill among Workers with Musculoskeletal Disorders: An In-Depth Understanding of Workers' Experiences

Background: Frequent short-term sickness absence is prevalent among workers with musculoskeletal disorders (MSDs). This in return leads to poor productivity in organizations and decreased ability to work among workers. Nevertheless, some workers with MSDs still continue to work despite pain and are able to maintain their productivity. Existing literature on attending work while ill is very limited. Understanding the factors influencing workers’ attendance to work while having symptoms is crucial to help workers live with their MSD productively and healthily. According to literature on behavior theories, the proximal determinant of behavior is one’s intention to engage in that behavior. Thus, this study was conducted to explore the factors that influence the intention to work while ill among workers with MSD. Methods: Twenty-one in-depth interviews were conducted using a semi-structured guide according to a grounded theory approach. Workers with MSD were recruited via a purposive and snowballing sampling until data saturation was attained. Data were analyzed by means of thematic analysis using computer software, ATLAS.ti. Results: Nine major significant themes of factors influencing the intention to work while ill were identified after transcription. From these, a total of six themes were associated with attendance incentives driving workers to attend work while ill (work commitment, work satisfaction, support from colleagues, workplace arrangements, ability to recover at home and ability to manage pain at work) and three themes were linked to attendance requirements (consequences to self, consequences to others and poor acceptance of one’s illness for sickness absence by supervisor and colleagues) faced by workers to attend work while ill. Conclusions: This study underlines the importance of both positive and negative motivators in influencing the intention to work while ill among workers with MSD. Future research suggests comparing both motivators in terms of work performance to aid more workers to work while ill.

Return-to-work expectations and workplace supports in New Zealand: injured workers' perspectives

AIM

Work-disability following musculoskeletal injury causes a significant burden for individuals and healthcare systems. Research into work-disability prevention has investigated the ability of psychosocial factors to predict return-to-work in workers with musculoskeletal injuries. Recent research indicates that both return-to-work expectations and workplace supports influence return-to-work outcome. However, how these mechanisms operate to influence outcome is still largely unknown.

METHODS

We undertook a qualitative study involving semi-structured interviews with workers from diverse backgrounds who were undergoing vocational rehabilitation in New Zealand following a musculoskeletal injury. Interviews investigated the injured workers' experiences of workplace supports and asked in-depth about what contributed to their expectations of returning to work. Thematic analysis was used to analyse and interpret the data.

FINDINGS

Analysis identified four key themes. We found that what workplace supports were offered and how they were taken up was related to systemic factors, and trust. We also identified a link between the offer of support from the workplace and return-to-work expectations. Finally, the actions of workers' compensation and healthcare providers during workers' recovery were reported to influence supports, expectations and the confidence injured workers experienced in their return-to-work outcome in both overt and subtle ways.

CONCLUSION

This study indicated that actions of the workplace, healthcare providers and workers' compensation parties can all influence workplace supports, return-to-work expectations and return-to-work outcome. These findings therefore implicate the actions of these stakeholders in work-disability prevention efforts.IMPLICATIONS FOR REHABILITATIONPositive return-to-work expectations are increasingly shown by research to be related to positive return-to-work outcomes for injured workers.Trust between the worker and the company can underpin the provision of supports for return-to-work, which in turn can influence worker confidence and expectations of return-to-work.Consideration of workplace culture and relationships when healthcare providers interact with employers can be crucial in fostering trust and enabling appropriate workplace supports.The ways in which workers compensation processes are executed can also affect workplace relationships, and therefore influence the provision of appropriate return-to-work supports.

Factors Influencing Intention to Work while Ill: A Systematic Review

OBJECTIVES

The aim of this systematic review was to identify factors influencing workers' intention to work while ill, using the Theory of Planned Behavior (TPB) as a theoretical framework.

METHODS

A systematic search of articles was carried out from PubMed, Scopus, and Web of Science databases. Eligibility of each article was assessed using PRISMA guidelines. Overall, 22 articles met the inclusion criteria after the selection process and were included in this review.

RESULTS

The factors fit into 3 constructs: (1) attitude (good and bad consequences of working while ill), (2) subjective norms (descriptive and injunctive norms on working while ill), and (3) perceived behavioral control (facilitators and barriers of working while ill).

CONCLUSIONS

The TPB is a practical theory to conceptualize and understand the factors influencing workers' intention to work while ill. These findings provide initial knowledge on the development of a framework to measure workers' intention to work while ill and to propose appropriate interventions for workers with chronic illness.

Beliefs About Return to Work Among Women During/After Long-Term Sick Leave for Common Mental Disorders: A Qualitative Study Based on the Theory of Planned Behaviour

PURPOSE

Long-term sick leave due to common mental disorders (CMDs) is an increasing problem, especially among women. To help these women return to work (RTW) sustainably, we need to know more about their own beliefs about RTW. One applicable theory is the theory of planned behaviour (TPB). Thus, the present study aimed to describe, based on the TPB, women's beliefs about RTW during or after long-term sick leave for a CMD.

METHODS

A qualitative approach was used. Twenty women were included during a long-term sick leave period due to a CMD. A deductive content analysis was conducted using predetermined factors from the TPB: behavioural beliefs (advantages-disadvantages of RTW), normative beliefs (supporters and non-supporters of RTW), and control beliefs (facilitators of-barriers to RTW).

RESULTS

The women believed that RTW would give them meaning and balance in life, but also that it would be challenging to maintain balance after RTW. They believed they had several supporters of RTW, but that the support was sometimes perceived as stressful rather than encouraging. Furthermore, individual adaptation and high demands were the most mentioned facilitator and barrier, respectively. Workplace conditions and personal strategies were thought to be important aspects.

CONCLUSIONS

By using the TPB, the present study was able to offer new findings on women's beliefs about RTW after long-term sick leave for a CMD. Based on the findings, we suggest that various RTW stakeholders should focus on striving to provide the tasks and work pace women need so they can maintain their professional competence and sense of meaning.

Getting the Message Right: Evidence-Based Insights to Improve Organizational Return-to-Work Communication Practices

Purpose There is an absence of evidence-based guidance to support workplace stakeholders in the effective delivery of return-to-work (RTW) messages. Our study examines the specific RTW communication practices and their impact on the management of work disability. Methods Within two large and complex healthcare organizations, semi-structured interviews were conducted with workplace stakeholders (e.g., supervisors, union representatives, disability management professionals and workers' compensation representatives) and workers who had previously experienced sickness absence related to an occupational injury or illness. For workplace stakeholders interview questions asked about their roles and responsibilities in the RTW process, and specific communication strategies and messages that were used at different phases of the RTW process. For worker participants, interview questions explored RTW experiences and the impact of communication on work re-integration. An interpretative descriptive approach was used to inductively examine themes from interviews to create ways of understanding phenomena that yielded applied findings. Results Forty participants were interviewed including workplace stakeholders and workers. Participants frequently described effective RTW communication as messages that were delivered by a workplace stakeholder that included the content required by an injured worker to navigate the organizational disability management process and utilized specific strategies to address the perceived attitudes and perceptions held by an injured worker regarding work re-integration. Workplace stakeholders described five specific communication strategies including relaying messages of support, optimizing the timing of communication, careful word choice, framing messages, and tailoring communication to the injured worker.  Conclusion RTW communication is an active process that requires a strategic approach. Effective communication practices represent an important strategy for workplace stakeholders to address the barriers held by injured workers and foster early and sustained RTW.

An overlooked concept? Intention to return to work among individuals on sick leave due to common mental disorders: A scoping review

Intention to return to work (RTW) is an important predictor of actual RTW among individuals on sick leave in general. However, it is not known whether this is also the case for individuals with common mental disorders (CMDs). Because CMDs are a leading cause of disability worldwide, the RTW process is often more complex and sick leave periods are longer than for other diagnoses. Thus, it is important to focus solely on this group. The purpose of this scoping review was to summarise studies targeting individuals' RTW intention and its importance for actual RTW after sick leave due to CMDs. Studies relevant for the aim were identified by a structured searching in three electronic databases (PubMed, CINAHL and PsycINFO) from their inception until the end of June 2020, as well as grey literature and reference lists of included articles. To cover all aspects of "intention", close concepts such as "expectation" and "willingness" were searched for as well. After the selection process, 10 original research papers were included in the review: eight quantitative and two qualitative. Nine of the studies used the concept "expectation" and one "intention". There was also a lack of consistency in measurements across studies. However, they showed that intention (expectation) was a significant predictor of actual RTW. The conclusion is that RTW intention among individuals after sick leave due to CMDs has been narrowly investigated, with a lack of consistency in measurements. Future research should use behavioural-psychological theories to cover the concept "intention" in a more comprehensive and consistent manner.

Are return to work beliefs, psychological well-being and perceived health related to return-to-work intentions among women on long-term sick leave for common mental disorders? A cross-sectional study based on the theory of planned behaviour

Background

Long-term sick leave due to common mental disorders (CMDs) is a great burden in society today, especially among women. A strong intention to return to work (RTW) as well as symptom relief may facilitate RTW in this group. However, there is a lack of knowledge regarding what constitutes a strong intention. The Theory of Planned Behaviour is well-suited to identifying underlying beliefs about intentions to perform a behaviour. By including psychological well-being and perceived health, a more comprehensive picture of determinants of RTW intention might be achieved. Thus, the aim of the present study was to identify associations between RTW beliefs, psychological well-being, perceived health and RTW intentions among women on long-term sick leave due to CMDs, and to do so based on the Theory of Planned Behaviour.

Methods

The study was cross-sectional. Between October 2019 and January 2020, 282 women on long-term sick leave (> 2 months) due to CMDs were included in the study. The questionnaires for data collection were: “RTW Beliefs Questionnaire”, the “General Health Questionnaire -12” and the “EuroQol Visual Analogue Scale”. Standard multiple regression analysis was performed both with and without adjustment for potential confounders.

Results

The results showed that a more positive attitude towards RTW, stronger social pressure to RTW, higher perceived control over RTW and higher psychological well-being were associated with stronger RTW intention. The adjusted analysis eliminated the importance of psychological well-being for RTW intention, but showed that women who reported that their employer had taken actions to facilitate their RTW had stronger RTW intention.

Conclusion

The RTW beliefs, derived from the Theory of Planned Behaviour, were all important for a strong RTW intention, while psychological well-being and perceived health showed weaker associations. Furthermore, having an employer that take actions for facilitating RTW was associated with stronger RTW intentions. Though some caution is warranted regarding the representativeness of the sample, the results do improve our understanding of some important determinants of RTW intention among women on long-term sick leave for CMDs.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-10562-w.

Validating Factors That Influence Student Nurse Intention Regarding Perioperative Nursing

BACKGROUND

Failure to effectively recruit Newly Graduated Nurses (NGN) to perioperative nursing in the face of an anticipated nursing shortage will adversely impact patient outcomes. Development of interventions that address the recruitment problem is hampered by lack of a comprehensive understanding of factors that influence Student Nurse Intention (SNI) regarding perioperative nursing.

PURPOSE

This descriptive quantitative study aims to test a Theory of Planned Behavior (TPB) questionnaire and validate factors that influence SNI.

METHOD

Quantitative sequence of exploratory sequential design. Item analysis, and principal component analysis of data are completed.

RESULTS

The instrument demonstrated satisfactory psychometrics. Immediate exposure or immersion, affirmation by nurse managers, and availability of positions were the most influential attitudinal, normative, and control beliefs respectively. Generational values have some influence on intention to choose perioperative nursing.

CONCLUSION

A TPB questionnaire is useful for measuring factors that influence SNI.

Can Patient Expectations of Returning to Work Documented Before, During, or at the End of Treatment Predict Actual Return to Work Post-treatment? An Evidence-Based Structured Systematic Review

BACKGROUND

There is significant evidence that patient expectations can impact their treatment outcomes. The hypothesis of this systematic review was then the following. There will be significant consistent evidence as specified by the Agency for Health Care Policy and Research (AHCPR) guidelines that chronic pain patient (CPP) expectations for returning to work documented before, during, or at the end of treatment will predict actual return to work post-treatment.

METHODS

Of 316 references, 12 studies fulfilled inclusion criteria. These studies analyzed expectations of returning to work documented before, during, or at the end of treatment and utilized these for predicting return to work post-treatment. Relevant aspects of these studies were abstracted into tabular form for numerical analysis. All studies were rated independently by two reviewers for quality. The percentage of the 12 studies supporting the hypothesis was determined. This was then utilized to determine an AHCPR guideline rating for consistency.

RESULTS

No studies had a rejection quality score. All studies were type 4. The hypothesis was supported by 91.6% of the studies. According to the AHCPR guidelines, this translated into an A rating: consistent findings from multiple type 4 studies.

CONCLUSIONS

CPP expectations of returning to work as documented before, during, or at the end of treatment may predict actual return to work post-treatment.

Supervisors' intention to observe clinical task performance: an exploratory study using the theory of planned behaviour during postgraduate medical training

BACKGROUND

Direct observation of clinical task performance plays a pivotal role in competency-based medical education. Although formal guidelines require supervisors to engage in direct observations, research demonstrates that trainees are infrequently observed. Supervisors may not only experience practical and socio-cultural barriers to direct observations in healthcare settings, they may also question usefulness or have low perceived self-efficacy in performing direct observations. A better understanding of how these multiple factors interact to influence supervisors' intention to perform direct observations may help us to more effectively implement the aforementioned guidelines and increase the frequency of direct observations.

METHODS

We conducted an exploratory quantitative study, using the Theory of Planned Behaviour (TPB) as our theoretical framework. In applying the TPB, we transfer a psychological theory to medical education to get insight in the influence of cognitive and emotional processes on intentions to use direct observations in workplace based learning and assessment. We developed an instrument to investigate supervisors intention to perform direct observations. The relationships between the TPB measures of our questionnaire were explored by computing bivariate correlations using Pearson's R tests. Hierarchical regression analysis was performed in order to assess the impact of the respective TPB measures as predictors on the intention to perform direct observations.

RESULTS

In our study 82 GP supervisors completed our TPB questionnaire. We found that supervisors had a positive attitude towards direct observations. Our TPB model explained 45% of the variance in supervisors' intentions to perform them. Normative beliefs and past behaviour were significant determinants of this intention.

CONCLUSION

Our study suggests that supervisors use their past experiences to form intentions to perform direct observations in a careful, thoughtful manner and, in doing so, also take the preferences of the learner and other stakeholders potentially engaged in direct observations into consideration. These findings have potential implications for research into work-based assessments and the development of training interventions to foster a shared mental model on the use of direct observations.

Temporary Disability Pension, RTW-Intentions, and RTW-Behavior: Expectations and Experiences of Disability Pensioners over 17 Months

Purpose: Individuals receiving a temporary disability pension (TDP) should get the opportunity to return to work (RTW). The current study aims to determine the factors contributing to RTW. Methods: 453 individuals on TDP were interviewed at three measurement points (T1, T2 = T1 + approximately 7 months, T3 = T1 + approximately 17 months). Socio-demographics, psychological predictors, and current work status (maintained TDP, permanent disability pension, old-age pension, employed, or receipt of other benefits) were assessed. Results: Throughout the duration of the study, only four of the former temporary disability pensioners returned to work, and an additional seven made themselves available to the labor market. These were individuals who were younger, in TDP for a shorter period of time, and reported a higher RTW-intention. Higher RTW-intention was cross-sectionally associated with younger age, shorter TDP duration, and more positive outcome expectancies. Additionally, study participants who expected that medical rehabilitation would help them RTW were more motivated to RTW. An increase in RTW-intention over 17 months was related to younger age and better health. Conclusion: Personal factors such as self-efficacy and job-related variables appear less important for RTW than age and subjective health status. The observed RTW rates call for early support and tailored medical rehabilitation interventions that help individuals prevent functional limitations, overcome disability, and facilitate RTW.

Education as important predictor for successful employment in adults with congenital heart disease worldwide

Background

Conflicting results have been reported regarding employment status and work ability in adults with congenital heart disease (CHD). Since this is an important determinant for quality of life, we assessed this in a large international adult CHD cohort.

Methods

Data from 4028 adults with CHD (53% women) from 15 different countries were collected by a uniform survey in the cross‐sectional APPROACH International Study. Predictors for employment and work limitations were studied using general linear mixed models.

Results

Median age was 32 years (IQR 25‐42) and 94% of patients had at least a high school degree. Overall employment rate was 69%, but varied substantially among countries. Higher education (OR 1.99‐3.69) and having a partner (OR 1.72) were associated with more employment; female sex (OR 0.66, worse NYHA functional class (OR 0.67‐0.13), and a history of congestive heart failure (OR 0.74) were associated with less employment. Limitations at work were reported in 34% and were associated with female sex (OR 1.36), increasing age (OR 1.03 per year), more severe CHD (OR 1.31‐2.10), and a history of congestive heart failure (OR 1.57) or mental disorders (OR 2.26). Only a university degree was associated with fewer limitations at work (OR 0.62).

Conclusions

There are genuine differences in the impact of CHD on employment status in different countries. Although the majority of adult CHD patients are employed, limitations at work are common. Education appears to be the main predictor for successful employment and should therefore be encouraged in patients with CHD.

Predictors for return to work after physical injury in China: A one-year review

BACKGROUND

Several studies have explored the factors influencing patients' return to work (RTW) status. However, only few studies have tried to explore the predictors for RTW in subpopulations in terms of different levels of disability, particularly in the Chinese population.

OBJECTIVE

This study describes the trends in patient's RTW and explores the predictors associated with RTW for patients with work-related injury in Mainland China.

METHODS

A total of 457 patients with different types of injury were followed up for one year. Patients were stratified into three groups according to the grade of disability as follows: mild, moderate, and severe. Variables affecting RTW were then compared between the three groups, and multiple logistic regression was performed to identify the predictors for RTW.

RESULTS

The RTW rates during the study period were significantly different among the three groups. RTW tended to increase rapidly during the early stage, but the increase plateaued during the later stage. For the mild disability group, educational level, expectation to RTW, and other types of injury (e.g., spinal cord injury, traumatic brain injury, and burn) were significant predictors for RTW. White-collar work and better employer satisfaction were positive predictors for RTW for the moderate group. Meanwhile, no significant predictor for RTW was determined for the severe disability group.

CONCLUSIONS

RTW tended to increase rapidly during the early stage, but the increase plateaued during the later stage. The predictors for RTW also varied among the patients with different levels of disability. These predictors may help vocational rehabilitation service providers provide more accurate intervention.

Psychosocial Factors Impacting Workplace Injury Rehabilitation: Evaluation of a Concise Screening Tool

Purpose To determine whether the delayed recovery often observed in simple musculoskeletal injuries occurring at work is related to poor workplace and home social support. Method A four question psychosocial screening tool called the "How are you coping gauge?" (HCG) was developed. This tool was implemented as part of the initial assessment for all new musculoskeletal workplace injuries. Participants were excluded if they did not meet the strict criteria used to classify a musculoskeletal injury as simple. The HCG score was then compared to the participant's number of days until return to full capacity (DTFC). It was hypothesised that those workers indicating a poorer level of workplace and home support would take longer time to return to full capacity. Results A sample of 254 participants (316 excluded) were included in analysis. Significant correlation (p < 0.001) was observed between HCG scores for self-reported work and home support and DTFC thereby confirming the hypothesis. Path analysis found workplace support to be a significant moderate-to-strong predictor of DTFC (-0.46). Conclusion A correlation was observed between delayed workplace injury recovery and poor perceived workplace social support. The HCG may be an effective tool for identifying these factors in musculoskeletal workplace injuries of a minor pathophysiological nature. There may be merit in tailoring injury rehabilitation towards addressing psychosocial factors early in the injury recovery process to assist with a more expedient return to full work capacity following simple acute musculoskeletal injury.

Characteristics of Compensation Claimants Reporting an Occupational Injury Associated With Disability Benefits in the Subsequent Year: A Follow-Up Study

OBJECTIVE

To describe characteristics of claimants reporting an occupational injury associated with disability benefits for income independently granted by the municipality the subsequent year.

METHOD

Multivariate logistic regression was used on self-reported data and register data. Primary outcome was long-term disability benefits.

RESULTS

We found that perceived low work ability, high emotional stress, perceived low health, and expected recognition increased the risk of disability benefits. Work ability was the most influential factor. Work ability of responders on benefits was 2.40 [2.23 to 2.58] (scale 1 to 10-low to high). Responders with recognized claims differed only little in characteristics regarding benefits. Responders with ongoing claims had highest risk (18.48%) of benefits despite few health differences.

CONCLUSIONS

Low perceived work ability was characteristic; health and social issues explained only little of the differences in long-term benefits according to decision of workers' compensation system.

Cancer and heart attack survivors' expectations of employment status: results from the English Longitudinal Study of Ageing

Background

Sociodemographic, health- and work-related factors have been found to influence return to work in cancer survivors. It is feasible though that behavioural factors, such as expectation of being at work, could also affect work-related outcomes. Therefore, the effect of earlier identified factors and expectation of being at work on future employment status in cancer survivors was explored. To assess the degree to which these factors specifically concern cancer survivors, a comparison with heart attack survivors was made.

Methods

Data from the English Longitudinal Study of Ageing were used. Cancer and heart attack survivors of working age in the UK were included and followed up for 2 years. Baseline characteristics of both cancer and heart attack survivors were compared regarding employment status. Univariate and multivariate regression analyses were performed in survivors at work, and the interaction between independent variables and diagnose group was assessed.

Results

In cancer survivors at work (N = 159), alcohol consumption, participating in moderate or vigorous sport activities, general health and participation were univariate associated with employment status at two-year follow-up. Only fair general health (compared to very good general health) remained statistically significant in the multivariate model (OR 0.31; 95% CI 0.13–0.76; p = 0.010). In heart attack survivors at work (N = 78), gender, general health and expectation of being at work were univariate associated with employment status at follow-up. Female gender (OR 0.03; 95% CI 0.00–0.57; p = 0.018) and high expectation of being at work (OR 10.68; 95% CI 1.23–93.92; p = 0.033) remained significant in the multivariate model. The influence of gender (p = 0.066) and general health (p = 0.020) regarding employment status was found to differ significantly between cancer and heart attack survivors.

Conclusions

When predicting future employment status in cancer survivors in the UK, general health is the most relevant factor to consider. While expectation of being at work did not show any significant influence in cancer survivors, in heart attack survivors, it should not be disregarded though, when developing interventions to affect their employment status. Future research should focus on more specific measures for expectation, and additional behavioural factors, such as self-efficacy, and their effect on employment status.

Fear of (re)injury and return to work following compensable injury: qualitative insights from key stakeholders in Victoria, Australia

BACKGROUND

Return to work (RTW) is important for recovery post-injury. Fear of (re)injury is a strong predictor of delayed RTW, and therefore much attention has been given to addressing injured workers' fear beliefs. However, RTW is a socially-negotiated process and it may be important to consider the wider social context of the injured worker, including the beliefs of the key people involved in their RTW journey.

METHODS

This paper involves data collected as part of a wider study in which semi-structured interviews explored RTW from the perspectives of 93 key stakeholders: injured workers, GPs, employers and insurance case managers in Victoria, Australia. Inductive analysis of interview transcripts identified fear of (re)injury as a salient theme across all stakeholder groups. This presented an opportunity to analyse how the wider social context of the injured worker may influence fear and avoidance behaviour. Two co-authors performed inductive analysis of the theme 'fear of (re)injury'. Codes identified in the data were grouped into five categories. Between and within category analysis revealed three themes describing the contextual factors that may influence fear avoidance and RTW behaviour.

RESULTS

Theme one described how injured workers engaged in a process of weighing up the risk of (re)injury in the workplace against the perceived benefits of RTW. Theme two described how workplace factors could influence an injured workers' perception of the risk of (re)injury in the workplace, including confidence that the source of the injury had been addressed, the availability and suitability of alternative duties. Theme three described other stakeholders' reluctance to accept injured workers back at work because of the fear that they might reinjure themselves.

CONCLUSIONS

Our findings illustrate the need for a contextualised perspective of fear avoidance and RTW behaviour that includes the beliefs of other important people surrounding the injured worker (e.g. employers, family members, GPs). Existing models of health behaviour such as The Health Beliefs Model may provide useful frameworks for interventions targeting the affective, cognitive, social, organisational and policy factors that can influence fear avoidance or facilitate RTW following injury.

A practical tool to improve outcomes in Work Injury Management

BACKGROUND

Psychosocial factors have the greatest influence on work rehabilitation outcomes yet effective and efficient systems to manage these factors are not widely utilized in Work Injury Management.

OBJECTIVE

To report on the development and validation of a comprehensive assessment tool with practical utility in identifying and measuring the biopsychosocial factors which are barriers to return to work and community.

METHODS

Literature search identified many instruments designed to identify the presence of psychosocial factors impacting recovery and return to work following musculoskeletal injury. This research aimed to match assessment with intervention. In clinical practice over a 5 year period, this led to development of a composite questionnaire, the Abilita Rehabilitation Index, which was trialed with 43 adults participating in Occupational Rehabilitation. The validation data are based on the results of 957 case records of Occupational Rehabilitation participants.

RESULTS

Examination of Cronbach coefficient alpha of the instrument indicates strong internal consistency (0.90) and factor analysis supports satisfactory construct validity of the domains (subscales) with factor loading scores ranging from 0.73 to 0.90.

CONCLUSION

There is evidence that the proprietary Abilita Rehabilitation Index is a valid and reliable instrument to identify and measure the influence of psychosocial factors impacting an individual's recovery and return to work. Automated reports generated from this tool provide an evidence-based resource to identify risk and support rehabilitation planning in Work Injury Management.

Disease-generic factors of work participation of workers with a chronic disease: a systematic review

PURPOSE

The purpose of this review was to search systematically for disease-generic factors associated with either work retention (WR) or return to work (RTW) in people of working age with a chronic disease.

METHODS

An extensive search was performed in PubMed, EMBASE, PsycINFO and CINAHL for English-, Dutch- and German-language studies searching on synonyms of the terms chronic disease, WR and RTW. Studies were selected if they described factors related to WR or RTW and included participants with a chronic disease of working age (15-67 years old).

RESULTS

From 2597 hits in the electronic databases, we identified six studies reporting 23 factors associated with work participation. Categorized according to the International Classification of Functioning, Disability and Health, health-related factors (comorbidity, duration of symptoms and less dysfunction), environmental factors (work environment and duration of absence) and personal factors (age, gender, education and own prediction of RTW) were identified.

CONCLUSIONS

Various disease-generic factors are associated with work participation, of which most of the reported factors are independent of diagnosis. Evidence of the retrieved factors is restricted due to the limited availability of studies focusing on disease-generic factors and overall low quality of the retrieved studies.

The importance, measurement and practical implications of worker's expectations for return to work

PURPOSE

Workers' own expectations for return to work consistently predict work status. To advance the understanding of the relationship between RTW expectations and outcomes, we reviewed existing measures to determine those which we felt were the most likely to capture the construct.

METHOD

A comprehensive search of the work-disability rehabilitation literature was undertaken. The review of the measures was conducted in three steps: first, a review of terminology; second, an examination of whether a time reference was included; third, an evaluation of ease of comprehension, and applicability across contexts.

RESULTS

A total of 42 different measures were identified. One of the most striking findings was the inconsistency in terminology. Measures were also limited by not including a time reference. Problems were also identified with regards to ease of understanding, utility of response options, and applicability in a wide variety of research and applied settings.

CONCLUSIONS

Most previously used measures contain elements that potentially limit utility. However, it would seem that further development can overcome these, resulting in a tool that provides risk prediction information, and an opportunity to start a conversation to help identify problems that might negatively impact a worker's movement through the RTW process and the outcomes achieved. Implications for Rehabilitation Return to work is an integral part of workplace injury management. The capture of RTW expectations affords a way to identify the potential for less than optimal RTW processes and outcomes. A mismatch between an injured worker's expectations and what other stakeholders might expect suggests that efforts could be made to determine what is causing the injured worker's concerns. Once underling issues are identified, work can be put into resolving these so that the worker's return to the workplace is not impeded.

Returning to work following low back pain: towards a model of individual psychosocial factors

PURPOSE

The aim of this paper is to develop and test a model of direct and indirect relationships among individual psychosocial predictors of return-to-work (RTW) outcomes following the onset of low back pain (LBP).

METHODS

We utilize secondary analysis of a larger study of adults seeking treatment for work-related LBP with recent onset. In total, 241 participants who completed a baseline survey, a short follow-up survey, and a longer follow-up survey after 3 months were included in our analyses. The participants were required to have LBP with onset of less than 14 days, be 18 years or older, and be fluent in English or Spanish. The analyses utilized structural equation models to test the direct and indirect relationships among the variables and RTW outcomes at 3 months.

RESULTS

Our results indicated a good fit for our model (χ2 = 69.59, df = 45, p < .05; RMSEA = .05; CFI = .95; WRMR = .61). Pain, catastrophizing, fear-avoidance beliefs, organizational support, and RTW confidence were all found to have indirect relationships with the outcomes. RTW confidence and RTW expectations were found to have direct relationships with the outcomes.

CONCLUSIONS

The process of returning to work after an episode of LBP is a complex process involving many interrelated factors. Understanding the relationships among critical individual factors in the RTW process may be important for the treatment and rehabilitation of those with LBP. Results suggest that if injured workers are struggling with fear avoidance, pain catastrophizing and confidence issues, they might benefit from the application of cognitive behavioral therapy techniques.