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Remus L, Grope M, Lemke S, Bethge M. Evaluation of an Innovative Case Management Strategy to Improve Rehabilitation Coverage for People at High Risk of Permanent Work Disability: a Feasibility Study. DIE REHABILITATION 2024; 63:13-22. [PMID: 37890509 DOI: 10.1055/a-2158-3212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/29/2023]
Abstract
PURPOSE Our process evaluation (trial registration: DRKS00022468) monitored the implementation of a multi-component strategy including case management aiming to improve rehabilitation coverage and work participation of people with a high risk of permanent work disability. METHODS A risk score using administrative data, particularly on employment and welfare benefits, was employed to identify individuals with higher probability of receiving disability pension and therefore potentially needing support. These individuals were contacted by post and encouraged to phone their regional case manager if they needed assistance. Content for the intervention components was developed collaboratively with the case managers. We examined the sample reached, dose delivered, fidelity, dose received and satisfaction with the intervention. RESULTS Out of 1074 individuals with high-risk scores were contacted, there were 57 case managements. The participants reached were in poor health, and 42.1% reported at least four diagnosed conditions, mostly musculoskeletal and mental disorders. About two-thirds (63.0%) reported poor work ability at baseline. On average, 72.5% of the content of the initial telephone contacts, 88.7% of the content of the face-to-face interviews and 45.2% of the content of the case management were delivered. The participants were highly satisfied with the various components and content of the intervention. Knowledge about rehabilitation improved significantly, with 43 of the 57 participants (75.4%) applying for rehabilitation, mainly medical rehabilitation. At the end of the case management intervention, most participants (91.7%) were still employed. CONCLUSION The risk score offers an opportunity to screen for people with a high risk of permanent work disability. Case management participants found participation worthwhile and were significantly better informed about participation services after completing case management. More than every second participant received medical or vocational rehabilitation.
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Affiliation(s)
- Lea Remus
- Institut für Sozialmedizin und Epidemiologie, Universität zu Lübeck, Lübeck, Germany
| | - Marei Grope
- Institut für Sozialmedizin und Epidemiologie, Universität zu Lübeck, Lübeck, Germany
| | - Stella Lemke
- Institute of Social Medicine and Epidemiology (ISE), Universität zu Lübeck, Lübeck, Germany
| | - Matthias Bethge
- Institut für Sozialmedizin und Epidemiologie, Universität zu Lübeck, Lübeck, Germany
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Elovainio M, Laaksonen M, Sakari K, Aalto AM, Jääskeläinen T, Rissanen H, Koskinen S. Association of short poor work ability measure with increased mortality risk: a prospective multicohort study. BMJ Open 2022; 12:e065672. [PMID: 36549734 PMCID: PMC9791446 DOI: 10.1136/bmjopen-2022-065672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES To examine whether a single-item measure of self-rated work ability predicts all-cause mortality in three large population-based samples collected in 1978-1980, 2000 and 2017. SETTING A representative sample of the population of Finland. PARTICIPANTS The study population comprised 17 178 participants aged 18 to 65 from the population-based Mini-Finland, Health 2000 and FinHealth 2017 cohort studies, pooled together. In all cohorts, self-rated work ability was assessed at baseline (1978-80, 2000-2001 and 2017) using three response alternatives: completely fit (good work ability), partially disabled (limited work ability) and completely disabled (poor work ability) for work. PRIMARY AND SECONDARY OUTCOME MEASURES All-cause mortality from national registers. Cox proportional hazards models were adjusted for socioeconomic characteristics, lifestyle factors, self-rated health and mental health problems. RESULTS Of the participants, 2219 (13%) were classified as having limited and 991 (5.8%) poor work ability and 246 individuals died during the 4 year follow-up. The age- and sex-adjusted HR for mortality risk was 7.20 (95% CI 5.15 to 10.08) for participants with poor vs good work ability and 3.22 (95% CI 2.30 to 4.43) for participants with limited vs good work ability. The excess risk associated with poor work ability was seen in both genders, all age groups, across different educational levels, self-rated health levels and in those with and without mental health problems. The associations were robust to further adjustment for education, health behaviours, self-rated health and mental health problems. In the multivariable analyses, the HR for mortality among those with poor vs good work ability was 5.75 (95% CI 3.59 to 9.20). CONCLUSIONS One-item poor self-rated work ability -measure is a strong predictor of increased risk of all-cause mortality and may be a useful survey-measure in predicting severe health outcomes in community-based surveys.
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Affiliation(s)
- Marko Elovainio
- Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland
- Finnish Institute for Health and Welfare, Helsinki, Uusimaa, Finland
| | | | | | - Anna-Mari Aalto
- Finnish Institute for Health and Welfare, Helsinki, Uusimaa, Finland
| | | | - Harri Rissanen
- Finnish Institute for Health and Welfare, Helsinki, Uusimaa, Finland
| | - Seppo Koskinen
- Finnish Institute for Health and Welfare, Helsinki, Uusimaa, Finland
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Tingulstad A, Meneses-Echavez J, Evensen LH, Bjerk M, Berg RC. Effectiveness of work-related interventions for return to work in people on sick leave: a systematic review and meta-analysis of randomized controlled trials. Syst Rev 2022; 11:192. [PMID: 36064472 PMCID: PMC9446672 DOI: 10.1186/s13643-022-02055-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 08/22/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Long-term sick leave is a serious concern in developed countries and the cost of sickness absence and disability benefits cause major challenges for both the individual and society as a whole. Despite an increasing body of research reported by existing systematic reviews, there is uncertainty regarding the effect on return to work of workrelated interventions for workers with different diagnoses. The objective of this systematic review was to assess and summarize available research about the effects of work-related interventions for people on long-term sick leave and those at risk of long-term sick leave. METHODS We conducted a systematic review in accordance with international guidelines. Campbell Collaboration (Area: Social Welfare), Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, Embase, Epistemonikos, MEDLINE, PsycINFO, Scopus, and Sociological Abstracts were systematically searched in March 2021. Two authors independently screened the studies. We conducted risk of bias assessments and meta-analyses of the available evidence in randomized controlled trials (RCTs). The remaining comparisons were synthesized narratively. The certainty of evidence for each outcome was assessed. RESULTS We included 20 RCTs comprising 5753 participants at baseline from 4 different countries. The studies had generally low risk of bias. Our certainty in the effect estimates ranged from very low to moderate. Eight different interventions were identified. Meta-analysis revealed no statistically significant difference between multidisciplinary rehabilitation (MR) and usual care (US) (Risk Ratio [RR] 1.01; Confidence Interval [CI] 95% 0.70-1.48 at 12 months follow-up) and between MR and other active intervention (Risk Ratio [RR] 1.04; Confidence Interval [CI] 95% 0.86-1.25 at 12 months follow-up). Remaining intervention groups revealed marginal, or no effect compared to the control group. The results for the secondary outcomes (self-efficacy, symptom reduction, function, cost-effectiveness) showed varied and small effects in the intervention groups. CONCLUSION Overall, the present data showed no conclusive evidence of which work-related intervention is most effective for return to work. However, a handful of potential interventions exist, that may contribute to a foundation for future research. Our findings support the need for adequately powered and methodologically strong studies.
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Affiliation(s)
| | - Jose Meneses-Echavez
- Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway.,Facultad de Cultura Fisica, Deporte y Recreación, Universidad Santo Tomás, Bogotá, Colombia
| | - Line Holtet Evensen
- Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway
| | - Maria Bjerk
- Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway
| | - Rigmor C Berg
- Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway.,Department of Community Medicine, University of Tromsø, Tromsø, Norway
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Hannerz H, Flyvholm MA. Do baseline industry and job group skill level predict welfare dependency at 1, 3 and 5 years after mental health related sickness absence? A Danish cohort study. BMC Public Health 2022; 22:697. [PMID: 35397597 PMCID: PMC8994387 DOI: 10.1186/s12889-022-13105-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 03/29/2022] [Indexed: 11/16/2022] Open
Abstract
Background The cost of mental ill health in the EU-28 nations has been estimated at approximately 4.1% of the total gross domestic products (GDP). Improved rates of return to sustainable employment among people who are sick-listed due to mental ill health would decrease spending on welfare benefits. The present cohort study provides statistical information that may be helpful in the design and prioritizing of efforts aimed at reducing the burden of sickness absence due to mental ill health among employees in the general working population of Denmark. Our primary aim was to estimate odds of being i) deceased or recipient of health related welfare benefits and ii) recipient non-health related welfare benefits, compared to being alive and self-reliant at 1, 3 and 5 years after first visit to a jobs and benefits office due to mental health related sickness absence, as a function of industrial sector and job group skill level at baseline. A secondary aim was to analyze these odds as a function of baseline age, gender, type of mental ill health, family type and employment status. Methods The study population consisted of 20–54 year-old persons on long-term sickness absence due to mental health problems in 21 Danish municipalities in 2010–2012 (N = 19,660). Odds ratios were estimated by use of multinomial logistic regression. The outcomes were ascertained through national registers. Results We did not find any statistically significant association between baseline industrial sector or job group skill level and welfare dependency at follow-up. In the secondary analyses, the estimated odds of health and non-health related welfare dependencies at follow-up tended to increase with unemployment, age, being single and being on sick leave due to self-reported anxiety or depression versus stress/burnout at baseline. Conclusions The present study does not support that industry and job group skill level predict welfare dependency after health related sickness absence, after adjustment for relevant covariates, in the general population of Denmark. It suggests, however, that the vulnerability lies in population groups characterized by unemployment, older age, being single and being on sick leave due to self-reported anxiety or depression versus stress/burnout.
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Remus L, Grope M, Lemke S, Bethge M. An innovative case management intervention for people at high risk of permanent work disability to improve rehabilitation coverage and coordination of health services: a randomized controlled trial (AktiFAME, DRKS00024648). BMC Health Serv Res 2022; 22:342. [PMID: 35292005 PMCID: PMC8922787 DOI: 10.1186/s12913-022-07482-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 01/10/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND German social law offers services from various providers and agencies for people with chronic disease or disability. Claiming services requires a high level of information and communication. Dealing with a multitude of actors, such as pension insurance agencies, job centers, employers, physicians, and psychotherapists, and coordinating between and with these actors can delay or prevent the utilization of necessary measures like medical or vocational rehabilitation. We developed a case management intervention for people at high risk of receiving a disability pension to address these challenges. METHODS/DESIGN Our randomized controlled trial tests the effectiveness of the multi-component AktiFAME strategy (Active access, counseling, and case management for people at high risk of permanent work disability). This strategy is comprised of four modules: screening and postal contact, telephone counseling, an initial one-on-one interview, and case management. The randomized controlled trial is complemented by an observational study that exclusively involves the individuals participating in case management and accompanies the implementation of the case management intervention. We enroll 9000 individuals aged 18 to 65 years who were identified as being at increased risk for receiving a disability pension based on administrative data from the German Pension Insurance North but who have not yet applied for rehabilitation. Half of the individuals are randomly assigned to the intervention group and the other half to the control group. The intervention group is contacted and informed about a case management intervention, whereas the control group is not. The primary outcome of the randomized controlled trial is the utilization of rehabilitation services from the German Pension Insurance North (medical or vocational rehabilitation). Data on rehabilitation will be provided by the German Pension Insurance North 1 year after random allocation. Secondary and tertiary outcomes cover additional administrative data (e.g., employment and welfare benefits) and a range of patient-reported outcome measures. DISCUSSION This randomized controlled trial is designed to determine the effectiveness of a newly implemented multi-component strategy to promote participation and rehabilitation coverage among individuals at high risk of receiving a disability pension. TRIAL REGISTRATION German Clinical Trials Register (DRKS00024648, April 27, 2021).
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Affiliation(s)
- Lea Remus
- University of Lübeck, Institute of Social Medicine and Epidemiology, Ratzeburger Allee 160, 23562, Lübeck, Germany
| | - Marei Grope
- University of Lübeck, Institute of Social Medicine and Epidemiology, Ratzeburger Allee 160, 23562, Lübeck, Germany
| | - Stella Lemke
- University of Lübeck, Institute of Social Medicine and Epidemiology, Ratzeburger Allee 160, 23562, Lübeck, Germany
| | - Matthias Bethge
- University of Lübeck, Institute of Social Medicine and Epidemiology, Ratzeburger Allee 160, 23562, Lübeck, Germany.
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Clinical Guidance to Optimize Work Participation After Injury or Illness: The Role of Physical Therapists. J Orthop Sports Phys Ther 2021; 51:CPG1-CPG102. [PMID: 34338006 DOI: 10.2519/jospt.2021.0303] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Work rehabilitation refers to the process of assisting workers to remain at work or return to work (RTW) in a safe and productive manner, while limiting the negative impact of restricted work, unemployment, and work disability. The primary purpose of this clinical practice guideline (CPG) is to systematically review available scientific evidence and provide a set of evidence-based recommendations for effective physical therapy evaluation, treatment, and management of individuals experiencing limitations in the ability to participate in work following injury or illness. J Orthop Sports Phys Ther 2021;51(8):CPG1-CPG102. doi:10.2519/jospt.2021.0303.
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Johansson MK, Rissanen R. Interventions for return to work following work-related injuries among young adults: A systematic literature review. Work 2021; 69:795-806. [PMID: 34180444 DOI: 10.3233/wor-205028] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To provide a review of current knowledge about interventions aimed to facilitate young adults to return to work following work-related injuries. METHODS A systematic review of published literature from the year 2010 and onwards was conducted to identify studies examining return to work interventions for young adults (aged 19-29) following work-related injuries using PubMed and Web of Science. Two reviewers conducted the screening process and assessed the study quality using the National Heart, Lung, and Blood Institute assessment tool for Observational Cohort and Cross-Sectional studies. Due to wide heterogeneity and small number of studies retained post-screening, a descriptive summary analysis of the included studies was conducted. RESULTS No studies were identified that focused exclusively on interventions for young adults. However, two studies, in which an age category of young adults was available, were included and assessed for quality. The study populations were primarily suffering from work-related injuries in the lower back or lower limbs. Both studies revealed that return to work interventions using a case manager coordinating and providing consultation, advice, and risk management to multidisciplinary teams was associated with lower sick leave days. CONCLUSIONS Despite the emerging evidence that young adults have higher rates of work-related injuries compared to older colleagues, information concerning work-related injuries and return to work interventions specifically targeting young workers is still lacking. Further research is therefore needed to develop and evaluate return to work interventions for the population of young adults.
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Affiliation(s)
- Malin K Johansson
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Ritva Rissanen
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
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8
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Mattila-Holappa P, Kausto J, Aalto V, Kaila-Kangas L, Kivimäki M, Oksanen T, Ervasti J. Alternative duty work as workplace-initiated procedure to reduce sickness absence. BMC Public Health 2021; 21:1154. [PMID: 34134668 PMCID: PMC8207644 DOI: 10.1186/s12889-021-11181-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 06/02/2021] [Indexed: 12/02/2022] Open
Abstract
Purpose Alternative duty work is a procedure that enables an employee with a short-term disability to perform modified duties as an alternative to sickness absence. We examined whether the implementation of an alternative duty policy was associated with reduced sickness absence in the Finnish public sector. Methods Two city administrations (A and D) that implemented an alternative duty work policy to their employees (n = 5341 and n = 7538) served as our intervention cities, and two city administrations (B and C) that did not implement the policy represented the reference cities (n = 6976 and n = 6720). The outcomes were the number of annual days, all episodes, and short-term (< 10 days) episodes during the 2 years before versus the 2 years after the intervention year. We applied repeated measures negative binomial regression analyses, using the generalized estimating equations method and the difference-in-difference analysis to compare the intervention and control cities (adjusted for sex, age, type of job contract, occupational class). Results During the five-year study period, the number of sickness absence days and episodes increased in both the intervention and control cities. Covariate-adjusted analysis of relative risk showed that the overall increase in post- versus pre-intervention sickness absence days was smaller in intervention City A, RR = 1.14 (95% CI = 1.09–1.21) than in control cities B and C, RR = 1.19 (95% CI =1.14–1.24), group × time interaction p < 0.02. In intervention City D, we found a corresponding result regarding all sickness absence episodes and short-term sickness absence episodes but not days. Conclusions This follow-up suggests that implementing an alternative duty work policy may marginally decrease employees’ sickness absences. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-11181-1.
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Affiliation(s)
| | - Johanna Kausto
- Finnish Institute of Occupational Health, Helsinki, Finland
| | - Ville Aalto
- Finnish Institute of Occupational Health, Helsinki, Finland
| | | | - Mika Kivimäki
- Finnish Institute of Occupational Health, Helsinki, Finland.,Clinicum, Faculty of Medicine, University of Helsinki, Helsinki, Finland.,Department of Epidemiology and Public Health, University College London, London, UK
| | - Tuula Oksanen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Jenni Ervasti
- Finnish Institute of Occupational Health, Helsinki, Finland
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Stapelfeldt CM, Momsen AMH, Jensen AB, Andersen NT, Nielsen CV. Municipal return to work management in cancer survivors: a controlled intervention study. Acta Oncol 2021; 60:370-378. [PMID: 33287597 DOI: 10.1080/0284186x.2020.1853227] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
INTRODUCTION Resuming work during or after cancer treatment has become an important target in cancer rehabilitation. PURPOSE The aim was in a controlled trial to study the return to work (RTW) effect of an early, individually tailored vocational rehabilitation intervention targeted to improve readiness for RTW in cancer survivors. MATERIAL AND METHODS Participants diagnosed with breast, cervix, ovary, testicular, colon-rectal, and head-and-neck cancers as well as being employed were allocated to a vocational rehabilitation intervention provided by municipal social workers (n = 83) or to usual municipal RTW management (n = 264). The intervention contained three elements: motivational communication inspired by Acceptance and Commitment Therapy by which RTW barriers were addressed, municipal cancer rehabilitation and finally employer and workplace contact. RTW effect was assessed as relative cumulative incidence proportions (RCIP) in the control and intervention group within 52 weeks of follow-up, estimated from the week where treatment ended at the hospital. RCIP was interpreted and reported as relative risk (RR) with 95% confidence intervals (CI) adjusted for gender, age cancer diagnosis, education, comorbidity, and sick leave weeks. RESULTS Across cancer diagnoses 69 (83.1%) and 215 (81.4%) returned to work in the intervention and control group, respectively. No statistical effect was seen (RR 1.08 (95% CI 0.98-1.19)). Repeating the analyses solely for participants with breast cancer (n = 290) showed a significant effect of the intervention (RR 1.12 (95% CI 1.01-1.23)). CONCLUSION More than 80% returned to work in both groups. However, no statistical difference in RTW effect was seen across cancer diagnoses within one year from being exposed to an early, individually tailored vocational rehabilitation intervention compared with usual municipal RTW management. TRIAL REGISTRATION NUMBER ISRCTN50753764.
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Affiliation(s)
- Christina M. Stapelfeldt
- Department of Public Health, Aarhus University, Aarhus, Denmark
- DEFACTUM - Social and Health Services & Labour Market, Central Denmark Region, Aarhus, Denmark
| | - Anne-Mette H. Momsen
- DEFACTUM - Social and Health Services & Labour Market, Central Denmark Region, Aarhus, Denmark
| | | | | | - Claus Vinther Nielsen
- Department of Public Health, Aarhus University, Aarhus, Denmark
- DEFACTUM - Social and Health Services & Labour Market, Central Denmark Region, Aarhus, Denmark
- Goedstrup Hospital, Herning, Denmark
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Eftedal M, Tveito TH, Gensby U, Islam MK, Lie SA, Aasland G, Kostveit S, Jensen C. Comparing two interdisciplinary occupational rehabilitation programs for employees on sick leave: a mixed-method design study protocol. BMC Musculoskelet Disord 2021; 22:158. [PMID: 33563250 PMCID: PMC7871619 DOI: 10.1186/s12891-021-03994-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 01/19/2021] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Musculoskeletal disorders (MSDs) and common mental disorders (CMDs) are the most frequent reasons for long-term sick leave and work disability. Occupational rehabilitation programs are used to help employees return to work (RTW). However, knowledge regarding the effect of these programs is scarce, and even less is known about which programs are best suited for which patients. This study aims to compare the RTW results of two interdisciplinary occupational rehabilitation programs in Norway, as well as to examine the delivery and reception of the two programs and explore the active mechanisms of the participants' RTW processes. METHODS/DESIGN We will use a mixed-method convergent design to study the main outcome. Approximately 600 participants will be included in the study. Eligible study participants will be aged 18-60 years old and have been on sick leave due to MSDs, CMDs, or both for at least 6 weeks. Interdisciplinary teams at both participating clinics will deliver complex occupational rehabilitation programs. The inpatient rehabilitation program has a duration of 4 weeks and is full time. The outpatient program has a duration of 3 months and involves weekly sessions. The primary outcome is RTW. Secondary outcomes are differences in the incremental cost for an averted sick leave day, cost utility/benefit, and differences between the programs regarding improvements in known modifiable obstacles to RTW. Subgroup analyses are planned. The researchers will be blinded to the intervention groups when analyzing the quantitative RTW data. DISCUSSION This study aims to provide new insights regarding occupational rehabilitation interventions, treatment targets, and outcomes for different subgroups of sick-listed employees and to inform discussions on the active working mechanisms of occupational rehabilitation and the influence of context in the return-to-work process. TRIAL REGISTRATION Current controlled trials ISRCTN12033424 , 15.10.2014, retrospectively registered.
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Affiliation(s)
- Monica Eftedal
- National Advisory Unit on Occupational Rehabilitation, Haddlandsvegen 20, 3864 Rauland, Norway
| | - Torill H. Tveito
- NORCE Norwegian Research Centre, Bergen, Norway
- Department of Health, Social and Welfare Studies, University of South-Eastern Norway, Horten, Norway
| | - Ulrik Gensby
- National Advisory Unit on Occupational Rehabilitation, Haddlandsvegen 20, 3864 Rauland, Norway
- Team Working Life Aps, Copenhagen, Denmark
- Adjunct Scientist, Institute for Work and Health, Toronto, Canada
| | - M. Kamrul Islam
- Department of Public Health and General Practice, Norwegian University of Science and Technology, Trondheim, Norway
| | - Stein Atle Lie
- Department of Clinical Dentistry, University of Bergen, Bergen, Norway
| | - Gro Aasland
- Division of Physical Medicine and Rehabilitation, Vestfold Hospital Trust, Tønsberg, Norway
| | | | - Chris Jensen
- National Advisory Unit on Occupational Rehabilitation, Haddlandsvegen 20, 3864 Rauland, Norway
- NORCE Norwegian Research Centre, Bergen, Norway
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Bethge M, Spanier K, Köhn S, Schlumbohm A. Self-reported work ability predicts health-related exit and absence from work, work participation, and death: longitudinal findings from a sample of German employees. Int Arch Occup Environ Health 2020; 94:591-599. [PMID: 33219840 PMCID: PMC8068707 DOI: 10.1007/s00420-020-01608-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 11/03/2020] [Indexed: 11/16/2022]
Abstract
Objective The cohort study examined the performance of the Work Ability Index in predicting health-related exit and absence from work, work participation, and death among a sample of workers previously receiving sickness absence benefits. Methods Workers aged 40–54 years who received sickness absence benefits in 2012 completed the Work Ability Index in 2013. Outcomes were extracted from administrative data records covering the period until the end of 2016. Results Data for 2266 participants were included (mean age: 47.9 years; 54.4% women). Maximum follow-up was 43 months. In terms of work ability, 38.4% had good scores, 38.2% moderate scores, and 23.4% poor scores. Fully adjusted analyses showed an increased risk of a disability pension in workers with poor (HR = 12.98; 95% CI 5.81–28.99) and moderate Work Ability Index scores (HR = 3.17; 95% CI 1.36–7.38) compared to workers with good or excellent scores. The risk of a rehabilitation measure was also significantly increased for workers with poor and moderate scores. In addition, poor scores were prospectively associated with a longer duration of sickness absence and unemployment benefits, and fewer employment days and less income from regular employment. Those with poor Work Ability Index scores also had a significantly increased risk of premature death. Conclusions The Work Ability Index is a potential tool to identify individuals with previous long-term sickness absence having an increased risk of health-related exit and absence from work and poor work participation outcomes. Electronic supplementary material The online version of this article (10.1007/s00420-020-01608-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Matthias Bethge
- Institute for Social Medicine and Epidemiology, University of Lübeck, Ratzeburger Allee 160, 23562, Lübeck, Germany.
| | - Katja Spanier
- Institute for Social Medicine and Epidemiology, University of Lübeck, Ratzeburger Allee 160, 23562, Lübeck, Germany
| | - Stefanie Köhn
- Institute of Medical Sociology and Rehabilitation Science, Charité, Universitätsmedizin Berlin, Berlin, Germany
| | - Anna Schlumbohm
- Institute of Medical Sociology and Rehabilitation Science, Charité, Universitätsmedizin Berlin, Berlin, Germany
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Hannerz H, Holtermann A, Madsen IEH. Musculoskeletal pain as a predictor for depression in the general working population of Denmark. Scand J Public Health 2020; 49:589-597. [PMID: 31969068 PMCID: PMC8512271 DOI: 10.1177/1403494819875337] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Aim: This study examines the association between musculoskeletal
complaints and subsequent use of antidepressants and/or psychiatric hospital
treatment for depressive mood disorders in the Danish labour force.
Methods: The study is based on two cohorts. The first
cohort is the total labour force in 21 Danish municipalities
(n=693,860), where the risk of depression (psychiatric
diagnosis or antidepressant treatment) during 2010–2015 was compared between
individuals on long-term sickness absence due to musculoskeletal disorders (MSD)
and non-sick-listed gainfully employed individuals. The second cohort is a
random sample of the Danish labour force (n=9248) who were
followed during 2011–2015 to estimate the association between self-rated
musculoskeletal pain and depression. All analyses were controlled for age, sex,
calendar period and socio-economic status. Results: Compared to
non-sick-listed gainfully employed individuals, there was an increased risk of
depression in individuals sick-listed with MSD, with rate ratios of 2.39 (99%
confidence interval (CI) 2.22–2.58) for individuals with less severe MSD and
4.27 (99% CI 3.98–4.59) for individuals with more severe MSD. There was also an
increased risk of depression associated with self-rated pain (yes vs. no), with
a rate ratio of 2.17 (99% CI 1.69–2.78). The population attributable fraction of
depression from musculoskeletal pain was 0.35 (99% CI 0.24–0.45).
Conclusions: The results of the present study
indicate that musculoskeletal pain is an important predictor of indicators
of depression in the general working population of Denmark.
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Affiliation(s)
- Harald Hannerz
- National Research Centre for the Working Environment, Denmark
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13
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Bethge M, Markus M, Streibelt M, Gerlich C, Schuler M. Effects of nationwide implementation of work-related medical rehabilitation in Germany: propensity score matched analysis. Occup Environ Med 2019; 76:913-919. [DOI: 10.1136/oemed-2019-106065] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 09/13/2019] [Accepted: 09/23/2019] [Indexed: 11/04/2022]
Abstract
ObjectivesSince 2014, the Federal German Pension Insurance has approved several departments to implement work-related medical rehabilitation programmes across Germany. Our cohort study was launched to assess the effects of work-related medical rehabilitation under real-life conditions.MethodsParticipants received either a common or a work-related medical rehabilitation programme. Propensity score matching was used to identify controls that were comparable to work-related medical rehabilitation patients. The effects were assessed by patient-reported outcome measures 10 months after completing the rehabilitation programme.ResultsWe compared 641 patients who were treated in work-related medical rehabilitation with 641 matched controls. Only half of the treated patients had high initial work disability risk scores and were intended to be reached by the new programmes. The dose of work-related components was on average in accordance with the guideline; however, the heterogeneity was high. Work-related medical rehabilitation increased the proportion of patients returning to work by 5.8 percentage points (95% CI 0.005 to 0.110), decreased the median time to return to work by 9.46 days (95% CI -18.14 to -0.79), and improved self-rated work ability by 0.38 points (95% CI 0.05 to 0.72) compared with common medical rehabilitation. A per-protocol analysis revealed that work-related medical rehabilitation was more effective if patients were assigned according to the guideline and the minimal mandatory treatment dose was actually delivered.ConclusionsThe implementation of work-related medical rehabilitation in German rehabilitation centres affected work participation outcomes. Improving guideline fidelity (reach and dose delivered) will probably improve the outcomes in real-world care.Trial Registration NumberDRKS00009780
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Skarpaas LS, Haveraaen LA, Småstuen MC, Shaw WS, Aas RW. The association between having a coordinator and return to work: the rapid-return-to-work cohort study. BMJ Open 2019; 9:e024597. [PMID: 30782911 PMCID: PMC6398742 DOI: 10.1136/bmjopen-2018-024597] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 11/29/2018] [Accepted: 12/05/2018] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES The aim of this study was to assess if the reported provision of a coordinator was associated with time to first return to work (RTW) and first full RTW among sick-listed employees who participated in different rapid-RTW programmes in Norway. DESIGN The study was designed as a cohort study. SETTING Rapid-RTW programmes financed by the regional health authority in hospitals and Norwegian Labour and Welfare Administration in Norway. PARTICIPANTS The sample included employees on full-time sick leave (n=326) who participated in rapid-RTW programmes (n=43), who provided information about the coordination of the services they received. The median age was 46 years (minimum-maximum 21-67) and 71% were female. The most common reported diagnoses were musculoskeletal (57%) and mental health disorders (14%). INTERVENTIONS The employees received different types of individually tailored RTW programmes all aimed at a rapid RTW; occupational rehabilitation (64%), treatment for medical or psychological issues, including assessment, and surgery (26%), and follow-up and work clarification services (10%). It was common to be provided with a coordinator (73%). PRIMARY AND SECONDARY OUTCOME MEASURES Outcomes were measured as time to first RTW (graded and 100%) and first full RTW (100%). RESULTS Employees provided with a coordinator returned to work later than employees who did not have a coordinator; a median (95% CI) of 128 (80 to 176) days vs 61 (43 to 79) days for first RTW, respectively. This difference did not remain statistically significant in the adjusted regression analysis. For full RTW, there was no statistically significant difference between employees provided with a coordinator versus those who were not. CONCLUSIONS The model of coordination, provided in the Norwegian rapid-RTW programmes was not associated with a more rapid RTW for sick-listed employees. Rethinking how RTW coordination should be organised could be wise in future programme development.
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Affiliation(s)
- Lisebet Skeie Skarpaas
- Presenter - Making Sense of Science, Stavanger, Norway
- Department of Occupational Therapy, Prosthetics and Orthotics, Oslo Metropolitan University, Oslo, Norway
| | | | | | - William S Shaw
- Division of Occupational & Environmental Medicine, University of Connecticut School of Medicine, Farmington, Connecticut, USA
| | - Randi Wågø Aas
- Presenter - Making Sense of Science, Stavanger, Norway
- Department of Occupational Therapy, Prosthetics and Orthotics, Oslo Metropolitan University, Oslo, Norway
- Department of Public Health, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
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15
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Hara KW, Bjørngaard JH, Jacobsen HB, Borchgrevink PC, Johnsen R, Stiles TC, Brage S, Woodhouse A. Biopsychosocial predictors and trajectories of work participation after transdiagnostic occupational rehabilitation of participants with mental and somatic disorders: a cohort study. BMC Public Health 2018; 18:1014. [PMID: 30111291 PMCID: PMC6094579 DOI: 10.1186/s12889-018-5803-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 07/04/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Group-based transdiagnostic occupational rehabilitation programs including participants with mental and somatic disorders have emerged in clinical practice. Knowledge is sparse on subsequent participation in competitive work. This study aimed to investigate trajectories for (re)entry to work for predefined subgroups in a diagnostically heterogeneous sample of sick-listed participants after completing occupational rehabilitation. METHODS A cohort of 212 participants aged 18-69 on long-term sick leave (> 8 weeks) with chronic pain, chronic fatigue and/or common mental disorders was followed for one year after completing a 3½-week rehabilitation intervention based on Acceptance and Commitment Therapy. Self-reported, clinical and registry data were used to study the associations between predefined biopsychosocial predictors and trajectories for (re)entry to competitive work (≥ 1 day per week on average over 8 weeks). Generalized estimating equations analysis was used to investigate trajectories. RESULTS For all biopsychosocial subgroups (re)entry to work increased over time. Baseline employment, partial sick leave and higher expectation of return to work (RTW) predicted higher probability of having (re)entered work at any given time after discharge. The odds of increasing reentry over time (statistical interaction with time) was weaker for the group receiving the benefit work assessment allowance compared with those receiving sickness benefit (OR = 0.92, p = 0.048) or for those on partial sick leave compared with full sick leave (OR 0.77, p < 0.001), but higher for those who at baseline had reported having a poor economy versus not (OR 1.16, p = 0.010) or reduced emotional functioning compared with not (OR 1.11, p = 0.012). Health factors did not differentiate substantially between trajectories. CONCLUSIONS Work participation after completing a transdiagnostic occupational rehabilitation intervention was investigated. Individual and system factors related to work differentiated trajectories for (re)entry to work, while individual health factors did not. Having a mental disorder did not indicate a worse prognosis for (re)entry to work following the intervention. Future trials within occupational rehabilitation are recommended to pivot their focus to work-related factors, and to lesser extent target diagnostic group.
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Affiliation(s)
- Karen Walseth Hara
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Norwegian Advisory Unit on Complex Symptom Disorders, St. Olavs University Hospital, Trondheim University Hospital, Trondheim, Norway
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- The Norwegian Labour and Welfare Service of Trøndelag, Trondheim, Norway
| | - Johan Håkon Bjørngaard
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Forensic Department and Research Centre Brøset, St. Olavs University Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Henrik Børsting Jacobsen
- Norwegian Advisory Unit on Complex Symptom Disorders, St. Olavs University Hospital, Trondheim University Hospital, Trondheim, Norway
- Hysnes Rehabilitation Center, St. Olavs University Hospital, Trondheim University Hospital, Trondheim, Norway
- Department of Pain Management and Research, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
| | - Petter C. Borchgrevink
- Norwegian Advisory Unit on Complex Symptom Disorders, St. Olavs University Hospital, Trondheim University Hospital, Trondheim, Norway
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Hysnes Rehabilitation Center, St. Olavs University Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Roar Johnsen
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Tore C. Stiles
- Department of Psychology, Faculty of Social Sciences and Educational Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Søren Brage
- The Norwegian Directorate for Labour and Welfare, Oslo, Norway
| | - Astrid Woodhouse
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Norwegian Advisory Unit on Complex Symptom Disorders, St. Olavs University Hospital, Trondheim University Hospital, Trondheim, Norway
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
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16
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Aasdahl L, Foldal VS, Standal MI, Hagen R, Johnsen R, Solbjør M, Fimland MS, Fossen H, Jensen C, Bagøien G, Halsteinli V, Fors EA. Motivational interviewing in long-term sickness absence: study protocol of a randomized controlled trial followed by qualitative and economic studies. BMC Public Health 2018; 18:756. [PMID: 29914463 PMCID: PMC6007062 DOI: 10.1186/s12889-018-5686-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 06/10/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Motivational interviewing (MI), mainly used and shown effective in health care (substance abuse, smoking cessation, increasing exercise and other life style changes), is a collaborative conversation (style) about change that could be useful for individuals having problems related to return to work (RTW). The aim of this paper is to describe the design of a randomized controlled trial evaluating the effect of MI on RTW among sick listed persons compared to usual care, in a social security setting. METHODS The study is a randomized controlled trial with parallel group design. Individuals between 18 and 60 years who have been sick listed for more than 7 weeks, with a current sick leave status of 50-100%, are identified in the Norwegian National Social Security System and invited to participate in the study. Exclusion criteria are no employment and pregnancy. Included participants are randomly assigned to the MI intervention or one of two control groups. The MI intervention consists of two MI sessions offered by caseworkers at the Norwegian Labor and Welfare Service (NAV), while the comparative arms consist of a usual care group and a group that receives two extra sessions without MI content (to control for attentional bias). The primary outcome measure is the total number of sickness absence days during 12 months after inclusion, obtained from national registers. Secondary outcomes include time until full sustainable return to work, health-related quality of life and mental health status. In addition, a health economic evaluation, a feasibility/process evaluation and qualitative studies will be performed as part of the study. DISCUSSION A previous study has suggested an effect of MI on RTW for sick listed workers with musculoskeletal complaints. The present study will evaluate the effect of MI for all sick listed workers, regardless of diagnosis. The knowledge from this study will potentially be important for policy makers, clinicians and other professionals` practical work. TRIAL REGISTRATION ClinicalTrials.gov: NCT03212118 (registered July 11, 2017).
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Affiliation(s)
- Lene Aasdahl
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Postboks 8905, MTFS, 7491, Trondheim, Norway. .,Unicare Helsefort Rehabilitation Centre, Rissa, Norway.
| | - Vegard Stolsmo Foldal
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Postboks 8905, MTFS, 7491, Trondheim, Norway
| | - Martin Inge Standal
- Department of Psychology, Faculty of Social and Educational Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Roger Hagen
- Department of Psychology, Faculty of Social and Educational Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Roar Johnsen
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Postboks 8905, MTFS, 7491, Trondheim, Norway
| | - Marit Solbjør
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Postboks 8905, MTFS, 7491, Trondheim, Norway
| | - Marius Steiro Fimland
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Postboks 8905, MTFS, 7491, Trondheim, Norway.,Unicare Helsefort Rehabilitation Centre, Rissa, Norway.,Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Heidi Fossen
- The Norwegian Labour and Welfare Service of Trøndelag, Steinkjer, Norway
| | - Chris Jensen
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Postboks 8905, MTFS, 7491, Trondheim, Norway.,National Advisory Unit on Occupational Rehabilitation, Rehabiliteringssenteret AiR, Rauland, Norway
| | - Gunnhild Bagøien
- Tiller Community Mental Health Centre, Division of Psychiatry, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Vidar Halsteinli
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Postboks 8905, MTFS, 7491, Trondheim, Norway.,Regional Center for Health Care Improvement, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Egil Andreas Fors
- General Practice Research Unit, Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
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17
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Sabariego C, Coenen M, Ito E, Fheodoroff K, Scaratti C, Leonardi M, Vlachou A, Stavroussi P, Brecelj V, Kovačič DS, Esteban E. Effectiveness of Integration and Re-Integration into Work Strategies for Persons with Chronic Conditions: A Systematic Review of European Strategies. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15030552. [PMID: 29562715 PMCID: PMC5877097 DOI: 10.3390/ijerph15030552] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 03/13/2018] [Accepted: 03/16/2018] [Indexed: 12/16/2022]
Abstract
Due to low employment rates associated to chronic conditions in Europe, it is essential to foster effective integration and re-integration into work strategies. The objective of this systematic review is to summarize the evidence on the effectiveness of strategies for integration and re-integration to work for persons with chronic diseases or with musculoskeletal disorders, implemented in Europe in the past five years. A systematic search was conducted in MedLine, PsycINFO, CDR-HTA, CDR-DARE and Cochrane Systematic Reviews. Overall, 32 relevant publications were identified. Of these, 21 were considered eligible after a methodological assessment and included. Positive changes in employment status, return to work and sick leave outcomes were achieved with graded sickness-absence certificates, part-time sick leave, early ergonomic interventions for back pain, disability evaluation followed by information and advice, and with multidisciplinary, coordinated and tailored return to work interventions. Additionally, a positive association between the co-existence of active labour market policies to promote employment and passive support measures (e.g., pensions or benefits) and the probability of finding a job was observed. Research on the evaluation of the effectiveness of strategies targeting integration and re-integration into work for persons with chronic health conditions needs, however, to be improved and strengthened.
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Affiliation(s)
- Carla Sabariego
- Research Unit for Biopsychosocial Health, Department of Medical Information Processing, Biometry and Epidemiology (IBE), Ludwig-Maximilians-Universität (LMU), 81377 Munich, Germany.
| | - Michaela Coenen
- Research Unit for Biopsychosocial Health, Department of Medical Information Processing, Biometry and Epidemiology (IBE), Ludwig-Maximilians-Universität (LMU), 81377 Munich, Germany.
| | - Elizabeth Ito
- Research Unit for Biopsychosocial Health, Department of Medical Information Processing, Biometry and Epidemiology (IBE), Ludwig-Maximilians-Universität (LMU), 81377 Munich, Germany.
| | | | - Chiara Scaratti
- Neurology, Public Health and Disability Unit; Neurological Institute C. Besta IRCCS Foundation, 20133 Milan, Italy.
| | - Matilde Leonardi
- Neurology, Public Health and Disability Unit; Neurological Institute C. Besta IRCCS Foundation, 20133 Milan, Italy.
| | - Anastasia Vlachou
- Department of Special Education, University of Thessaly, 38221 Volos, Greece.
| | | | - Valentina Brecelj
- Development Centre for Vocational Rehabilitation, University Rehabilitation Institute Republic of Slovenia, 1000 Ljubljana, Slovenia.
| | - Dare S Kovačič
- Development Centre for Vocational Rehabilitation, University Rehabilitation Institute Republic of Slovenia, 1000 Ljubljana, Slovenia.
| | - Eva Esteban
- Research Unit for Biopsychosocial Health, Department of Medical Information Processing, Biometry and Epidemiology (IBE), Ludwig-Maximilians-Universität (LMU), 81377 Munich, Germany.
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18
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Policy Guidelines for Effective Inclusion and Reintegration of People with Chronic Diseases in the Workplace: National and European Perspectives. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018. [PMID: 29534484 PMCID: PMC5877038 DOI: 10.3390/ijerph15030493] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The increasing prevalence of chronic diseases among the European working age population, as well as the implications for the individual and societal level, underline the need for policy guidelines targeting the effective inclusion of persons with chronic diseases in the workplace. The aim of the present paper was to explore the perspectives of European and National-level stakeholders on existing strategies for work re-integration of persons with chronic diseases, and to provide policy guidelines. A highly-structured interview protocol was distributed to 58 National level stakeholders (policy makers, professionals and employers) from seven European countries. Additionally, 20 European organizations concerned with health-related issues and employment completed an online survey. The findings reveal that employment-related challenges remain largely unaddressed. Both national and European stakeholders considered the existing legislative frameworks inadequate and appraised the co-ordination for the implementation of employment re-integration policies as ineffective. Policies targeting at work re-integration of persons with chronic diseases at European and national level should focus on consistent cooperation among all key stakeholders, awareness raising to staff and management, dissemination of effective strategies, developing research and evaluation standards and establishing monitoring systems on inclusive labour markets.
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19
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Horppu R, Martimo KP, MacEachen E, Lallukka T, Viikari-Juntura E. Application of the Theoretical Domains Framework and the Behaviour Change Wheel to Understand Physicians' Behaviors and Behavior Change in Using Temporary Work Modifications for Return to Work: A Qualitative Study. JOURNAL OF OCCUPATIONAL REHABILITATION 2018; 28:135-146. [PMID: 28391503 PMCID: PMC5820403 DOI: 10.1007/s10926-017-9706-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Purpose Applying the theoretical domains framework (TDF) and the Behaviour Change Wheel (BCW) to understand physicians' behaviors and behavior change in using temporary work modifications (TWMs) for return to work (RTW). Methods Interviews and focus group discussions were conducted with 15 occupational physicians (OPs). Responses were coded using the TDF and the BCW. Results Key behaviors related to applying TWMs were initiating the process with the employee, making recommendations to the workplace, and following up the process. OP behaviors were influenced by several factors related to personal capability and motivation, and opportunities provided by the physical and social environment. Capability comprised relevant knowledge and skills related to applying TWMs, remembering to initiate TWMS and monitor the process, and being accustomed to reflective practice. Opportunity comprised physical resources (e.g., time, predefined procedures, and availability of modified work at companies), and social pressure from stakeholders. Motivation comprised conceptions of a proper OP role, confidence to carry out TWMs, personal RTW-related goals, beliefs about the outcomes of one's actions, feedback received from earlier cases, and feelings related to applying TWMs. OPs' perceived means to target these identified factors were linked to the following BCW intervention functions: education, training, persuasion, environmental restructuring, and enablement. The results suggest that at least these functions should be considered when designing future interventions. Conclusions Our study illustrates how theoretical frameworks TDF and BCW can be utilized in a RTW context to understand which determinants of physicians' behavior need to be targeted, and how, to promote desired behaviors.
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Affiliation(s)
- Ritva Horppu
- Work Disability Prevention, Finnish Institute of Occupational Health, P.O. Box 40, 00251, Helsinki, Finland.
| | - K P Martimo
- Work Disability Prevention, Finnish Institute of Occupational Health, P.O. Box 40, 00251, Helsinki, Finland
| | - E 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
| | - T Lallukka
- Work Disability Prevention, Finnish Institute of Occupational Health, P.O. Box 40, 00251, Helsinki, Finland
| | - E Viikari-Juntura
- Work Disability Prevention, Finnish Institute of Occupational Health, P.O. Box 40, 00251, Helsinki, Finland
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20
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Horppu R, Martimo KP, MacEachen E, Lallukka T, Viikari-Juntura E. Application of the Theoretical Domains Framework and the Behaviour Change Wheel to Understand Physicians' Behaviors and Behavior Change in Using Temporary Work Modifications for Return to Work: A Qualitative Study. JOURNAL OF OCCUPATIONAL REHABILITATION 2018; 28:135-146. [PMID: 28391503 DOI: 10.1007/s10926-017-9706-1/tables/4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Purpose Applying the theoretical domains framework (TDF) and the Behaviour Change Wheel (BCW) to understand physicians' behaviors and behavior change in using temporary work modifications (TWMs) for return to work (RTW). Methods Interviews and focus group discussions were conducted with 15 occupational physicians (OPs). Responses were coded using the TDF and the BCW. Results Key behaviors related to applying TWMs were initiating the process with the employee, making recommendations to the workplace, and following up the process. OP behaviors were influenced by several factors related to personal capability and motivation, and opportunities provided by the physical and social environment. Capability comprised relevant knowledge and skills related to applying TWMs, remembering to initiate TWMS and monitor the process, and being accustomed to reflective practice. Opportunity comprised physical resources (e.g., time, predefined procedures, and availability of modified work at companies), and social pressure from stakeholders. Motivation comprised conceptions of a proper OP role, confidence to carry out TWMs, personal RTW-related goals, beliefs about the outcomes of one's actions, feedback received from earlier cases, and feelings related to applying TWMs. OPs' perceived means to target these identified factors were linked to the following BCW intervention functions: education, training, persuasion, environmental restructuring, and enablement. The results suggest that at least these functions should be considered when designing future interventions. Conclusions Our study illustrates how theoretical frameworks TDF and BCW can be utilized in a RTW context to understand which determinants of physicians' behavior need to be targeted, and how, to promote desired behaviors.
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Affiliation(s)
- Ritva Horppu
- Work Disability Prevention, Finnish Institute of Occupational Health, P.O. Box 40, 00251, Helsinki, Finland.
| | - K P Martimo
- Work Disability Prevention, Finnish Institute of Occupational Health, P.O. Box 40, 00251, Helsinki, Finland
| | - E 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
| | - T Lallukka
- Work Disability Prevention, Finnish Institute of Occupational Health, P.O. Box 40, 00251, Helsinki, Finland
| | - E Viikari-Juntura
- Work Disability Prevention, Finnish Institute of Occupational Health, P.O. Box 40, 00251, Helsinki, Finland
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Rise MB, Skagseth M, Klevanger NE, Aasdahl L, Borchgrevink P, Jensen C, Tenggren H, Halsteinli V, Jacobsen TN, Løland SB, Johnsen R, Fimland MS. Design of a study evaluating the effects, health economics, and stakeholder perspectives of a multi-component occupational rehabilitation program with an added workplace intervention - a study protocol. BMC Public Health 2018; 18:219. [PMID: 29402253 PMCID: PMC5800096 DOI: 10.1186/s12889-018-5130-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Accepted: 01/30/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Recent research has suggested that interventions at the workplace might be the most potent ingredient in return to work interventions, but few studies have investigated the different effects of workplace interventions as part of occupational rehabilitation programs. The comprehensive design described in this article includes effect (on return to work and health outcomes), and health economic evaluations of a workplace intervention added to a multicomponent rehabilitation program. Qualitative and mixed method studies will investigate sick-listed persons', rehabilitation therapists' and employers' perspectives on the usability and outcomes of the rehabilitation program and the workplace intervention. The program and intervention are provided to patients with musculoskeletal, psychological or general and unspecified diagnoses. The program is multi-component and includes Acceptance and Commitment Therapy, physical exercise, patient education and creating a plan for increased work participation. METHODS Persons who are employed, aged from 18 to 60 years, with a current sick leave status of 50% or more and a diagnosis within the musculoskeletal, psychological or general and unspecified chapters of International Classification of Primary Care-2 (ICPC-2) will be recruited to a researcher-blinded parallel-group randomized controlled trial. All participants take part in an in-patient occupational rehabilitation program, while the intervention group also takes part in an intervention at the workplace. The effect and economic evaluation will investigate the effect of the added workplace intervention. The primary outcome measures will be time until full sustainable return to work and total number of sickness absence days in the 12 months after inclusion. Health economic evaluations will investigate the cost-effectiveness and cost-utility. Qualitative studies will investigate rehabilitation therapists' experiences with working towards return to work within an ACT-approach and stakeholders' experiences with the workplace intervention. A mixed methods study will combine quantitative and qualitative findings on the participants' expectations and motivation for return to work. DISCUSSION The outline of this comprehensive study could represent an important addition to the standard designs of return to work evaluation. The mixed methods design, with qualitative approaches as well as a rigorous randomized controlled trial, might prove useful to shed light on contextual factors. TRIAL REGISTRATION ClinicalTrials.gov : NCT02541890 . September 4, 2015.
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Affiliation(s)
- Marit B Rise
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway. .,Department of Mental Health, Norwegian University of Science and Technology, 7491, Trondheim, Norway.
| | - Martin Skagseth
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
| | - Nina E Klevanger
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
| | - Lene Aasdahl
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Physical Medicine and Rehabilitation, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Petter Borchgrevink
- Hysnes Rehabilitation Center, Trondheim University Hospital, Trondheim, Norway.,Department of Circulation and Medical Imaging, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Chris Jensen
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway.,National Centre for Occupational Rehabilitation, Rauland, Norway
| | - Hanne Tenggren
- Hysnes Rehabilitation Center, Trondheim University Hospital, Trondheim, Norway
| | - Vidar Halsteinli
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
| | - Trym N Jacobsen
- Department of Physical Medicine and Rehabilitation, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway.,Hysnes Rehabilitation Center, Trondheim University Hospital, Trondheim, Norway
| | - Svein B Løland
- Hysnes Rehabilitation Center, Trondheim University Hospital, Trondheim, Norway
| | - Roar Johnsen
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
| | - Marius S Fimland
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway.,Hysnes Rehabilitation Center, Trondheim University Hospital, Trondheim, Norway
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Høgelund J, Falgaard Eplov L. Employment effects of a multidisciplinary health assessment for mentally ill persons – A quasi-randomised controlled trial. Scand J Public Health 2017; 46:389-399. [DOI: 10.1177/1403494817723458] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aim: Relatively little is known about the effectiveness of return-to-work interventions for employees sick-listed with mental disorders, and the results of the literature are contradictory. This study evaluated the return-to-work effect of a multidisciplinary health assessment for persons sick-listed with mental disorders. Methods: The study population consisted of 244 persons who were allocated to the treatment and control groups based on their birth year. In addition to the usual case management, the treatment group ( n = 83) was assessed by a team consisting of a case manager, a psychiatrist, and a job coach. The control group ( n = 99) received the usual case management. We used unique register data to code outcome variables (sick-leave duration and return-to-work duration). Results: The multidisciplinary treatment had no statistically significant effect on the sick-leave duration (HR = 1.05; 95% CI 0.74–1.43) or the return-to-work duration (HR = 0.94; 95% CI 0.65–1.35). Subgroup analyses showed that the treatment effect did not systematically depend on age, education or severity of the mental disorder. We found no signs of systematic dropout from the study population or of imbalanced data. We found an insignificant tendency indicating that control-group case managers may have learned about the intervention from treatment case managers ( p = 0.31). Conclusions: This study showed no return-to-work effect of a multidisciplinary assessment of sick-listed individuals with mental disorders. Together with the sparse and inconclusive findings of the literature, this finding suggests that further research is needed for disentangling the elements that constitute an effective intervention.
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Affiliation(s)
- Jan Høgelund
- The Danish Working Environment Authority, Denmark
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Improving the effectiveness of sickness benefit case management through a public-private partnership? A difference-in-difference analysis in eighteen Danish municipalities. BMC Public Health 2017; 17:329. [PMID: 28420369 PMCID: PMC5395754 DOI: 10.1186/s12889-017-4236-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Accepted: 04/06/2017] [Indexed: 11/16/2022] Open
Abstract
Background The aim of this study was to investigate whether a multidimensional public-private partnership intervention, focussing on improving the quality and efficiency of sickness benefit case management, reduced the sickness benefit duration and the duration until self-support. Methods We used a difference-in-difference (DID) design with six intervention municipalities and 12 matched control municipalities in Denmark. The study sample comprised 282,103 sickness benefit spells exceeding four weeks. The intervention group with 110,291 spells received the intervention, and the control group with 171,812 spells received ordinary sickness benefit case management. Using register data, we fitted Cox proportional hazard ratio models, estimating hazard ratios (HR) and confidence intervals (CI). Results We found no joint effect of the intervention on the sickness benefit duration (HR 1.02, CI 0.97–1.07) or the duration until self-support (HR 0.99, CI 0.96–1.02). The effect varied among the six municipalities, with sickness benefit HRs ranging from 0.96 (CI 0.93–1.00) to 1.13 (CI 1.08–1.18) and self-support HRs ranging from 0.91 (CI 0.82–1.00) to 1.11 (CI 1.06–1.17). Conclusions Compared to receiving ordinary sickness benefit management the intervention had on average no effect on the sickness benefit duration or duration until self-support. However, the effect varied considerably among the six municipalities possibly due to differences in the implementation or the complexity of the intervention. Electronic supplementary material The online version of this article (doi:10.1186/s12889-017-4236-5) contains supplementary material, which is available to authorized users.
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Vogel N, Schandelmaier S, Zumbrunn T, Ebrahim S, de Boer WEL, Busse JW, Kunz R. Return-to-work coordination programmes for improving return to work in workers on sick leave. Cochrane Database Syst Rev 2017; 3:CD011618. [PMID: 28358173 PMCID: PMC6464073 DOI: 10.1002/14651858.cd011618.pub2] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND To limit long-term sick leave and associated consequences, insurers, healthcare providers and employers provide programmes to facilitate disabled people's return to work. These programmes include a variety of coordinated and individualised interventions. Despite the increasing popularity of such programmes, their benefits remain uncertain. We conducted a systematic review to determine the long-term effectiveness of return-to-work coordination programmes compared to usual practice in workers at risk for long-term disability. OBJECTIVES To assess the effects of return-to-work coordination programmes versus usual practice for workers on sick leave or disability. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL; 2016, Issue 11), MEDLINE, Embase, CINAHL and PsycINFO up to 1 November 2016. SELECTION CRITERIA We included randomised controlled trials (RCTs) that enrolled workers absent from work for at least four weeks and randomly assigned them to return-to-work coordination programmes or usual practice. DATA COLLECTION AND ANALYSIS Two review authors independently screened titles, abstracts and full-text articles for study eligibility; extracted data; and assessed risk of bias from eligible trials. We contacted authors for additional data where required. We conducted random-effects meta-analyses and used the GRADE approach to rate the quality of the evidence. MAIN RESULTS We identified 14 studies from nine countries that enrolled 12,568 workers. Eleven studies focused on musculoskeletal problems, two on mental health and one on both. Most studies (11 of 14) followed workers 12 months or longer. Risk of bias was low in 10 and high in 4 studies, but findings were not sensitive to their exclusion.We found no benefits for return-to-work coordination programmes on return-to-work outcomes.For short-term follow-up of six months, we found no effect on time to return to work (hazard ratio (HR) 1.32, 95% confidence interval (CI) 0.93 to 1.88, low-quality evidence), cumulative sickness absence (mean difference (MD) -16.18 work days per year, 95% CI -32.42 to 0.06, moderate-quality evidence), the proportion of participants at work at end of the follow-up (risk ratio (RR) 1.06, 95% CI 0.86 to 1.30, low-quality evidence) or on the proportion of participants who had ever returned to work, that is, regardless of whether they had remained at work until last follow-up (RR 0.87, 95% CI 0.63 to 1.19, very low-quality evidence).For long-term follow-up of 12 months, we found no effect on time to return to work (HR 1.25, 95% CI 0.95 to 1.66, low-quality evidence), cumulative sickness absence (MD -14.84 work days per year, 95% CI -38.56 to 8.88, low-quality evidence), the proportion of participants at work at end of the follow-up (RR 1.06, 95% CI 0.99 to 1.15, low-quality evidence) or on the proportion of participants who had ever returned to work (RR 1.03, 95% CI 0.97 to 1.09, moderate-quality evidence).For very long-term follow-up of longer than 12 months, we found no effect on time to return to work (HR 0.93, 95% CI 0.74 to 1.17, low-quality evidence), cumulative sickness absence (MD 7.00 work days per year, 95% CI -15.17 to 29.17, moderate-quality evidence), the proportion of participants at work at end of the follow-up (RR 0.94, 95% CI 0.82 to 1.07, low-quality evidence) or on the proportion of participants who had ever returned to work (RR 0.95, 95% CI 0.88 to 1.02, low-quality evidence).We found only small benefits for return-to-work coordination programmes on patient-reported outcomes. All differences were below the minimal clinically important difference (MID). AUTHORS' CONCLUSIONS Offering return-to-work coordination programmes for workers on sick leave for at least four weeks results in no benefits when compared to usual practice. We found no significant differences for the outcomes time to return to work, cumulative sickness absence, the proportion of participants at work at end of the follow-up or the proportion of participants who had ever returned to work at short-term, long-term or very long-term follow-up. For patient-reported outcomes, we found only marginal effects below the MID. The quality of the evidence ranged from very low to moderate across all outcomes.
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Affiliation(s)
- Nicole Vogel
- EbIM Evidence‐based Insurance MedicineDepartment Clinical ResearchUniversity of Basel HospitalSpitalstrasse 8+12BaselSwitzerland4031
- Hirslanden Klinik BirshofLeonardoReinacherstrasse 28MünchensteinSwitzerland4142
| | - Stefan Schandelmaier
- McMaster UniversityDepartment of Health Research Methods, Evidence, and Impact1280 Main Street WestHamiltonONCanadaL8S4L8
- University of BaselBasel Institute for Clinical Epidemiology and Biostatistics, Department of Clinical ResearchSpitalstrasse 12BaselSwitzerland4031
| | - Thomas Zumbrunn
- University of Basel HospitalClinical Trial UnitSchanzenstrasse 55BaselSwitzerland4031
| | | | - Wout EL de Boer
- EbIM Evidence‐based Insurance MedicineDepartment Clinical ResearchUniversity of Basel HospitalSpitalstrasse 8+12BaselSwitzerland4031
| | - Jason W Busse
- McMaster UniversityDepartment of Anesthesia1280 Main Street West, Rm. 2C12HamiltonONCanadaL8S 4K1
| | - Regina Kunz
- EbIM Evidence‐based Insurance MedicineDepartment Clinical ResearchUniversity of Basel HospitalSpitalstrasse 8+12BaselSwitzerland4031
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Momsen AMH, Stapelfeldt CM, Nielsen CV, Nielsen MBD, Aust B, Rugulies R, Jensen C. Effects of a randomized controlled intervention trial on return to work and health care utilization after long-term sickness absence. BMC Public Health 2016; 16:1149. [PMID: 27829455 PMCID: PMC5103458 DOI: 10.1186/s12889-016-3812-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Accepted: 11/03/2016] [Indexed: 11/28/2022] Open
Abstract
Background The aim of the RCT study was to investigate if the effect of a multidisciplinary intervention on return to work (RTW) and health care utilization differed by participants’ self-reported health status at baseline, defined by a) level of somatic symptoms, b) health anxiety and c) self-reported general health. Methods A total of 443 individuals were randomized to the intervention (n = 301) or the control group (n = 142) and responded to a questionnaire measuring health status at baseline. Participants were followed in registries measuring RTW and health care utilization. Relative risk (RR) and odds ratio (OR) were used as measures of associations. Results were adjusted for gender, age, educational level, work ability and previous sick leave. Results Among all responders we found no effect of the intervention on RTW. Among participants with low health anxiety, the one-year probability of RTW was lower in the intervention than in the control group (RR = 0.79 95 % CI 0.68-0.93), but for those with high health anxiety there was no difference between the groups (RR = 1.15 95 % CI 0.84-1.57). Neither general health nor somatic symptoms modified the effect of the intervention on RTW. The intervention had no effect on health care utilization. Conclusions The multidisciplinary intervention did not facilitate RTW or decrease health care utilization compared to ordinary case management in subgroups with multiple somatic symptoms, health anxiety or low self-rated health. However, the intervention resulted in a reduced chance of RTW among participants with low health anxiety levels. Trial registration ISRCTN43004323, and ISRCTN51445682
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Affiliation(s)
- Anne-Mette H Momsen
- DEFACTUM - Social & Health Services & Labour Market, Central Denmark Region, Aarhus, Denmark. .,MarselisborgCentret, P.P. Oerums Gade 11, 1B, 8000, Aarhus C, Denmark.
| | | | - Claus Vinther Nielsen
- Section of Clinical Social Medicine and Rehabilitation, Institute of Public Health, Aarhus University, Aarhus, Denmark
| | - Maj Britt D Nielsen
- COWI A/S, Lyngby, Denmark.,The National Research Centre for the Working Environment, Copenhagen, Denmark
| | - Birgit Aust
- The National Research Centre for the Working Environment, Copenhagen, Denmark
| | - Reiner Rugulies
- The National Research Centre for the Working Environment, Copenhagen, Denmark.,Department of Public Health, University of Copenhagen, Copenhagen, Denmark.,Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Chris Jensen
- National Centre for Occupational Rehabilitation, Rauland, Norway.,Department of Public Health and General Practice, Norwegian University of Science and Technology, Trondheim, Norway
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Hogh A, Conway PM, Clausen T, Madsen IEH, Burr H. Unwanted sexual attention at work and long-term sickness absence: a follow-up register-based study. BMC Public Health 2016; 16:678. [PMID: 27475538 PMCID: PMC4967501 DOI: 10.1186/s12889-016-3336-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Accepted: 07/21/2016] [Indexed: 12/15/2022] Open
Abstract
Background The current understanding of the relationship between unwanted sexual attention at work and long-term sickness absence (LTSA) is limited for three reasons: 1) the under-researched role of unwanted sexual attention perpetrated by individuals outside the work organization; 2) a widespread use of self-reported measures of sickness absence, with an unclear identification of sickness absence episodes of long duration; 3) the cross-sectional design of most existing studies. The aim of this study was therefore to investigate the relationship between self-reported unwanted sexual attention at work and subsequent LTSA (≥3 weeks), stratifying by gender and source of exposure (i.e., colleagues, managers and/or subordinates vs. clients/customers/patients). Methods This prospective study is based on a pooled sample of 14,605 employees from three Danish surveys conducted in 2000, 2004 and 2005, providing a total of 19,366 observations. A single questionnaire-based item was used to assess exposure to unwanted sexual attention. The pooled dataset was merged with Danish register data on LTSA. The risk of first-onset episode of LTSA (up to 18 months after baseline) in connection with unwanted sexual attention was examined using Cox proportional hazards models. We estimated Hazard ratios (HR) and 95 % confidence intervals (95 % CI) adjusted for age, influence at work, work pace, occupational group and mode of data collection. We also adjusted for repeated measures from individual respondents by stratifying the Cox models by wave of survey. Results Unwanted sexual attention from colleagues, managers and/or subordinates predicted LTSA among men (HR 2.66; 95 % CI 1.42-5.00). Among women, an elevated but non-statistically significant risk of LTSA (HR 1.18; 95 % CI 0.65-2.14) was found. Unwanted sexual attention from clients/customers/patients did not predict LTSA, neither among men nor among women. Conclusions The findings indicate a significantly elevated risk of LTSA, among men only, in relation to exposure to unwanted sexual attention from colleagues, managers and/or subordinates. This study therefore suggests both individual and organizational costs associated with unwanted sexual attention at work. Due to the low prevalence of unwanted sexual attention, larger studies with more statistical power are needed to confirm (or disconfirm) the present findings.
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Affiliation(s)
- Annie Hogh
- Department of Psychology, University of Copenhagen, Øster Farimagsgade 2A, 1353, Copenhagen, Denmark.
| | - Paul Maurice Conway
- Department of Psychology, University of Copenhagen, Øster Farimagsgade 2A, 1353, Copenhagen, Denmark
| | - Thomas Clausen
- National Research Centre for the Working Environment, Lersoe Parkalle 105, 2100, Copenhagen, Denmark
| | | | - Hermann Burr
- Federal Institute of Occupational Safety and Health, Nöldnerstraße 40-42, 10317, Berlin, Germany
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Schneider U, Linder R, Verheyen F. Long-term sick leave and the impact of a graded return-to-work program: evidence from Germany. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2016; 17:629-43. [PMID: 26183381 DOI: 10.1007/s10198-015-0707-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Accepted: 06/19/2015] [Indexed: 05/28/2023]
Abstract
The implementation of a graded return-to-work (RTW) program to reintegrate the long-term sick started in Germany in 1971 and has been manifested in the Social Code Book V since 1989. Based on a return plan by the physician and the insured, participants increase their working hours slowly over a specified period of time. As participants are still classified as incapable of working they still receive sick leave benefits. Using claims data from the Techniker Krankenkasse, the largest German sickness fund, the study aims at identifying participants and analyzing the full return-to-work and the impact of the RTW program. Thereby, we account for socio-economic factors, insurance-based characteristics, and medical and health-related information. We consider a possible selection bias by using individual weights to analyze determinants of length of the sickness absence by applying models for survival analysis (Cox proportional hazard model). As a main result - depending on the central assumption of unconfoundedness - sickness absence is positively related to participation in the RTW program for those with sickness absence longer than 120 days. For mental disorders, our results indicate an even stronger effect. The study results emphasize the need further promotion of this instrument among those insured, physicians and employers, as occupational health management is one key for a successful return-to-work.
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Affiliation(s)
- Udo Schneider
- WINEG | Scientific Institute of TK for Benefit and Efficiency in Health Care, Bramfelder Straße 140, 22035, Hamburg, Germany.
| | - Roland Linder
- WINEG | Scientific Institute of TK for Benefit and Efficiency in Health Care, Bramfelder Straße 140, 22035, Hamburg, Germany
| | - Frank Verheyen
- WINEG | Scientific Institute of TK for Benefit and Efficiency in Health Care, Bramfelder Straße 140, 22035, Hamburg, Germany
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Hansen SM, Hetland ML, Pedersen J, Østergaard M, Rubak TS, Bjorner JB. Effect of Rheumatoid Arthritis on Longterm Sickness Absence in 1994-2011: A Danish Cohort Study. J Rheumatol 2016; 43:707-15. [PMID: 26879362 DOI: 10.3899/jrheum.150801] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/18/2015] [Indexed: 01/13/2023]
Abstract
OBJECTIVE By linkage of national registries, we investigated the risk of longterm sickness absence (LTSA) ≥ 3 weeks in a large cohort of Danish patients with rheumatoid arthritis (RA) and non-patients. The study aimed to (1) estimate the risk of LTSA for patients with RA compared with the general population, (2) examine whether the risk of LTSA has changed in recent years, and (3) evaluate the effect of other risk factors for LTSA (e.g., physical work demands, age, sex, education, and psychiatric and somatic comorbidities). METHODS A total of 6677 patients with RA aged 18-59 years in the years 1994-2011 were identified in registries and compared with 56,955 controls from the general population matched by age, sex, and city size. The risk of LTSA was analyzed using Cox proportional hazards models with late entry, controlling for other risk factors and assuming separate risks in the first year after diagnosis and the following years. RESULTS Compared with the general population, patients with RA had increased risk of LTSA in the first year after diagnosis (HR 5.4 during 1994-1999, 95% CI 4.2-6.8) and in following years (HR 2.4, 95% CI 2.1-2.8). For established RA (> 1 yr after diagnosis), the excess was 20% lower in 2006-2011 (HR 1.9, 95% CI 1.7-2.2) compared with 1994-1999 (p < 0.001). For patients with RA and controls, older age, shorter education, a physically demanding job, and somatic and/or psychiatric comorbidities increased the risk of LTSA. CONCLUSION While improvements were observed from 1994-1999 to 2006-2011, patients with RA have significant increased risk of LTSA, in particular in the first year after diagnosis.
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Affiliation(s)
- Sofie Mandrup Hansen
- From the National Research Centre for the Working Environment; Faculty of Health and Medical Sciences, Institute for Clinical Medicine, University of Copenhagen; Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen; The DANBIO Database, Center for Rheumatology and Spine Diseases, Rigshospitalet; Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup; Department of Occupational Medicine, Slagelse Hospital, Slagelse, Denmark; Optum Patient Insights, Lincoln, Rhode Island, USA.S.M. Hansen, PhD Student, National Research Centre for the Working Environment, and the DANBIO Database, Center for Rheumatology and Spine Diseases, Rigshospitalet, and Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet; M.L. Hetland, MD, PhD, Professor, the DANBIO Database, Center for Rheumatology and Spine Diseases, Rigshospitalet, and Faculty of Health and Medical Sciences, Institute for Clinical Medicine, University of Copenhagen, and Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet; J. Pedersen, PhD, Statistician, National Research Centre for the Working Environment; M. Østergaard, PhD, Professor, Faculty of Health and Medical Sciences, Institute for Clinical Medicine, University of Copenhagen, and Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet; T.S. Rubak, MD, PhD, Department of Occupational Medicine, Slagelse Hospital; J.B. Bjorner, PhD, Professor, National Research Centre for the Working Environment, and Optum Patient Insights, and Faculty of Health and Medical Sciences, Department of Public Health, University of Copenhagen.
| | - Merete Lund Hetland
- From the National Research Centre for the Working Environment; Faculty of Health and Medical Sciences, Institute for Clinical Medicine, University of Copenhagen; Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen; The DANBIO Database, Center for Rheumatology and Spine Diseases, Rigshospitalet; Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup; Department of Occupational Medicine, Slagelse Hospital, Slagelse, Denmark; Optum Patient Insights, Lincoln, Rhode Island, USA.S.M. Hansen, PhD Student, National Research Centre for the Working Environment, and the DANBIO Database, Center for Rheumatology and Spine Diseases, Rigshospitalet, and Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet; M.L. Hetland, MD, PhD, Professor, the DANBIO Database, Center for Rheumatology and Spine Diseases, Rigshospitalet, and Faculty of Health and Medical Sciences, Institute for Clinical Medicine, University of Copenhagen, and Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet; J. Pedersen, PhD, Statistician, National Research Centre for the Working Environment; M. Østergaard, PhD, Professor, Faculty of Health and Medical Sciences, Institute for Clinical Medicine, University of Copenhagen, and Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet; T.S. Rubak, MD, PhD, Department of Occupational Medicine, Slagelse Hospital; J.B. Bjorner, PhD, Professor, National Research Centre for the Working Environment, and Optum Patient Insights, and Faculty of Health and Medical Sciences, Department of Public Health, University of Copenhagen
| | - Jacob Pedersen
- From the National Research Centre for the Working Environment; Faculty of Health and Medical Sciences, Institute for Clinical Medicine, University of Copenhagen; Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen; The DANBIO Database, Center for Rheumatology and Spine Diseases, Rigshospitalet; Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup; Department of Occupational Medicine, Slagelse Hospital, Slagelse, Denmark; Optum Patient Insights, Lincoln, Rhode Island, USA.S.M. Hansen, PhD Student, National Research Centre for the Working Environment, and the DANBIO Database, Center for Rheumatology and Spine Diseases, Rigshospitalet, and Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet; M.L. Hetland, MD, PhD, Professor, the DANBIO Database, Center for Rheumatology and Spine Diseases, Rigshospitalet, and Faculty of Health and Medical Sciences, Institute for Clinical Medicine, University of Copenhagen, and Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet; J. Pedersen, PhD, Statistician, National Research Centre for the Working Environment; M. Østergaard, PhD, Professor, Faculty of Health and Medical Sciences, Institute for Clinical Medicine, University of Copenhagen, and Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet; T.S. Rubak, MD, PhD, Department of Occupational Medicine, Slagelse Hospital; J.B. Bjorner, PhD, Professor, National Research Centre for the Working Environment, and Optum Patient Insights, and Faculty of Health and Medical Sciences, Department of Public Health, University of Copenhagen
| | - Mikkel Østergaard
- From the National Research Centre for the Working Environment; Faculty of Health and Medical Sciences, Institute for Clinical Medicine, University of Copenhagen; Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen; The DANBIO Database, Center for Rheumatology and Spine Diseases, Rigshospitalet; Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup; Department of Occupational Medicine, Slagelse Hospital, Slagelse, Denmark; Optum Patient Insights, Lincoln, Rhode Island, USA.S.M. Hansen, PhD Student, National Research Centre for the Working Environment, and the DANBIO Database, Center for Rheumatology and Spine Diseases, Rigshospitalet, and Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet; M.L. Hetland, MD, PhD, Professor, the DANBIO Database, Center for Rheumatology and Spine Diseases, Rigshospitalet, and Faculty of Health and Medical Sciences, Institute for Clinical Medicine, University of Copenhagen, and Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet; J. Pedersen, PhD, Statistician, National Research Centre for the Working Environment; M. Østergaard, PhD, Professor, Faculty of Health and Medical Sciences, Institute for Clinical Medicine, University of Copenhagen, and Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet; T.S. Rubak, MD, PhD, Department of Occupational Medicine, Slagelse Hospital; J.B. Bjorner, PhD, Professor, National Research Centre for the Working Environment, and Optum Patient Insights, and Faculty of Health and Medical Sciences, Department of Public Health, University of Copenhagen
| | - Tine Steen Rubak
- From the National Research Centre for the Working Environment; Faculty of Health and Medical Sciences, Institute for Clinical Medicine, University of Copenhagen; Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen; The DANBIO Database, Center for Rheumatology and Spine Diseases, Rigshospitalet; Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup; Department of Occupational Medicine, Slagelse Hospital, Slagelse, Denmark; Optum Patient Insights, Lincoln, Rhode Island, USA.S.M. Hansen, PhD Student, National Research Centre for the Working Environment, and the DANBIO Database, Center for Rheumatology and Spine Diseases, Rigshospitalet, and Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet; M.L. Hetland, MD, PhD, Professor, the DANBIO Database, Center for Rheumatology and Spine Diseases, Rigshospitalet, and Faculty of Health and Medical Sciences, Institute for Clinical Medicine, University of Copenhagen, and Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet; J. Pedersen, PhD, Statistician, National Research Centre for the Working Environment; M. Østergaard, PhD, Professor, Faculty of Health and Medical Sciences, Institute for Clinical Medicine, University of Copenhagen, and Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet; T.S. Rubak, MD, PhD, Department of Occupational Medicine, Slagelse Hospital; J.B. Bjorner, PhD, Professor, National Research Centre for the Working Environment, and Optum Patient Insights, and Faculty of Health and Medical Sciences, Department of Public Health, University of Copenhagen
| | - Jakob Bue Bjorner
- From the National Research Centre for the Working Environment; Faculty of Health and Medical Sciences, Institute for Clinical Medicine, University of Copenhagen; Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen; The DANBIO Database, Center for Rheumatology and Spine Diseases, Rigshospitalet; Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup; Department of Occupational Medicine, Slagelse Hospital, Slagelse, Denmark; Optum Patient Insights, Lincoln, Rhode Island, USA.S.M. Hansen, PhD Student, National Research Centre for the Working Environment, and the DANBIO Database, Center for Rheumatology and Spine Diseases, Rigshospitalet, and Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet; M.L. Hetland, MD, PhD, Professor, the DANBIO Database, Center for Rheumatology and Spine Diseases, Rigshospitalet, and Faculty of Health and Medical Sciences, Institute for Clinical Medicine, University of Copenhagen, and Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet; J. Pedersen, PhD, Statistician, National Research Centre for the Working Environment; M. Østergaard, PhD, Professor, Faculty of Health and Medical Sciences, Institute for Clinical Medicine, University of Copenhagen, and Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet; T.S. Rubak, MD, PhD, Department of Occupational Medicine, Slagelse Hospital; J.B. Bjorner, PhD, Professor, National Research Centre for the Working Environment, and Optum Patient Insights, and Faculty of Health and Medical Sciences, Department of Public Health, University of Copenhagen
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Rise MB, Gismervik SØ, Johnsen R, Fimland MS. Sick-listed persons' experiences with taking part in an in-patient occupational rehabilitation program based on Acceptance and Commitment Therapy: a qualitative focus group interview study. BMC Health Serv Res 2015; 15:526. [PMID: 26613944 PMCID: PMC4662815 DOI: 10.1186/s12913-015-1190-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Accepted: 11/18/2015] [Indexed: 11/24/2022] Open
Abstract
Background Occupational medicine has shifted emphasis from disease treatment to disability rehabilitation and management. Hence, newly developed occupational rehabilitation programs are often generic and multicomponent, aiming to influence the sick-listed persons’ perception on return to work, and thereby support the return to work process. The aim of this study was to explore sick-listed persons’ experiences with taking part in an in-patient occupational rehabilitation program based on Acceptance and Commitment Therapy. Methods Twenty-nine adults on sickness benefit or work assessment allowance due to musculoskeletal and/or common mental health disorders participated in this study. They were interviewed in focus groups at the beginning and at the end of a 3.5 week inpatient group-based occupational rehabilitation program in Central Norway. Key elements in the program were Acceptance and Commitment Therapy (ACT), physical exercise and creating a work-participation plan. The program was mainly group-based including participants with different diagnoses. Data was analyzed according to a phenomenological approach. Results At the start of the program most participants expressed frustration regarding being sick-listed, external anticipations as well as hindrances towards returning to work, and described hope that the program would provide them with the skills and techniques necessary to cope with health problems and being able to return to work. At the end of the program the participants described that they had embarked upon a long process of increased awareness. This process encompassed four areas; an increased awareness of what was important in life, realizing the strain from external expectations and demands, a need to balance different aspects of life, and return to work as part of a long and complex process. Conclusions The occupational rehabilitation program induced a perceived meaningful reorientation encompassing several aspects of life. However, the return to work process was described as diffuse and uncertain for most participants. The providers of occupational rehabilitation program should balance this reorientation with specific steps towards return to work. Effect studies and long-term qualitative studies evaluating how this affects long-term work- and health outcomes are underway.
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Affiliation(s)
- Marit B Rise
- Department of Public Health and General Practice, Norwegian University of Science and Technology, Trondheim, Norway.
| | - Sigmund Ø Gismervik
- Department of Public Health and General Practice, Norwegian University of Science and Technology, Trondheim, Norway. .,Department of Physical Medicine and Rehabilitation, St. Olav's University Hospital, Trondheim, Norway.
| | - Roar Johnsen
- Department of Public Health and General Practice, Norwegian University of Science and Technology, Trondheim, Norway.
| | - Marius S Fimland
- Department of Public Health and General Practice, Norwegian University of Science and Technology, Trondheim, Norway. .,Hysnes Rehabilitation Center, St. Olav's University Hospital, Trondheim, Norway.
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Halonen JI, Solovieva S, Pentti J, Kivimäki M, Vahtera J, Viikari-Juntura E. Effectiveness of legislative changes obligating notification of prolonged sickness absence and assessment of remaining work ability on return to work and work participation: a natural experiment in Finland. Occup Environ Med 2015; 73:42-50. [PMID: 26464504 PMCID: PMC4717458 DOI: 10.1136/oemed-2015-103131] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Accepted: 09/24/2015] [Indexed: 11/09/2022]
Abstract
Objectives Policies have been introduced to reduce sickness absence, but their effectiveness is largely unknown. In a natural experiment, we examined effects of legislative changes on return to work and work participation. Methods The source population consisted of up to 72 164 Finnish public sector employees with a permanent job contract in 2008–2011 (before) and in 2013–2014 (after). We used employees with a continuous sickness absence of at least 30 calendar-days (n=5708–6393), 60 compensated days (n=1481–1655) and 90 compensated days (n=766–932). We examined sustainable return to work (a minimum of 28 consecutive working days) with survival analysis as well as monthly work participation after a sickness absence, and annual gain in work participation after the intervention, using trajectory analyses. Results Sustainable return to work after 60 days of sickness absence occurred earlier after the legislative changes (p value 0.017), although the effect reduced towards the end of the follow-up. There were no differences in return to work after a 30 or 90 days of sickness absence. The largest annual gain, postintervention versus preintervention, in monthly work participation was observed among employees with 60 days of sickness absence and was 230.9 person-years/10 000 employees. The corresponding annual gains among those with 30 days and 90 days of sickness absence were 51.8 and 39.6, respectively. Conclusions Our findings suggest that the legislative changes, obligating early notification of prolonged sickness absences as well as assessment of remaining work ability and possibilities to continue working, may enhance sustainable return to work in the short term. Other measures will be needed to enhance work participation, especially in the long term.
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Affiliation(s)
- J I Halonen
- Finnish Institute of Occupational Health, Helsinki, Finland
| | - S Solovieva
- Finnish Institute of Occupational Health, Helsinki, Finland
| | - J Pentti
- Finnish Institute of Occupational Health, Helsinki, Finland
| | - M Kivimäki
- Finnish Institute of Occupational Health, Helsinki, Finland Department of Epidemiology and Public Health, University College London Medical School, London, UK Faculty of Medicine, Clinicum, University of Helsinki, Helsinki, Finland
| | - J Vahtera
- Finnish Institute of Occupational Health, Helsinki, Finland Department of Public Health, University of Turku, Turku, Finland Turku University Hospital, Turku, Finland
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van Vilsteren M, van Oostrom SH, de Vet HCW, Franche R, Boot CRL, Anema JR. Workplace interventions to prevent work disability in workers on sick leave. Cochrane Database Syst Rev 2015; 2015:CD006955. [PMID: 26436959 PMCID: PMC9297123 DOI: 10.1002/14651858.cd006955.pub3] [Citation(s) in RCA: 126] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Work disability has serious consequences for individuals as well as society. It is possible to facilitate resumption of work by reducing barriers to return to work (RTW) and promoting collaboration with key stakeholders. This review was first published in 2009 and has now been updated to include studies published up to February 2015. OBJECTIVES To determine the effectiveness of workplace interventions in preventing work disability among sick-listed workers, when compared to usual care or clinical interventions. SEARCH METHODS We searched the Cochrane Work Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, and PsycINFO databases on 2 February 2015. SELECTION CRITERIA We included randomised controlled trials (RCTs) of workplace interventions that aimed to improve RTW for disabled workers. We only included studies where RTW or conversely sickness absence was reported as a continuous outcome. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data and assessed risk of bias of the studies. We performed meta-analysis where possible, and we assessed the quality of evidence according to GRADE criteria. We used standard methodological procedures expected by Cochrane. MAIN RESULTS We included 14 RCTs with 1897 workers. Eight studies included workers with musculoskeletal disorders, five workers with mental health problems, and one workers with cancer. We judged six studies to have low risk of bias for the outcome sickness absence.Workplace interventions significantly improved time until first RTW compared to usual care, moderate-quality evidence (hazard ratio (HR) 1.55, 95% confidence interval (CI) 1.20 to 2.01). Workplace interventions did not considerably reduce time to lasting RTW compared to usual care, very low-quality evidence (HR 1.07, 95% CI 0.72 to 1.57). The effect on cumulative duration of sickness absence showed a mean difference of -33.33 (95% CI -49.54 to -17.12), favouring the workplace intervention, high-quality evidence. One study assessed recurrences of sick leave, and favoured usual care, moderate-quality evidence (HR 0.42, 95% CI 0.21 to 0.82). Overall, the effectiveness of workplace interventions on work disability showed varying results.In subgroup analyses, we found that workplace interventions reduced time to first and lasting RTW among workers with musculoskeletal disorders more than usual care (HR 1.44, 95% CI 1.15 to 1.82 and HR 1.77, 95% CI 1.37 to 2.29, respectively; both moderate-quality evidence). In studies of workers with musculoskeletal disorders, pain also improved (standardised mean difference (SMD) -0.26, 95% CI -0.47 to -0.06), as well as functional status (SMD -0.33, 95% CI -0.58 to -0.08). In studies of workers with mental health problems, there was a significant improvement in time until first RTW (HR 2.64, 95% CI 1.41 to 4.95), but no considerable reduction in lasting RTW (HR 0.79, 95% CI 0.54 to 1.17). One study of workers with cancer did not find a considerable reduction in lasting RTW (HR 0.88, 95% CI 0.53 to 1.47).In another subgroup analysis, we did not find evidence that offering a workplace intervention in combination with a cognitive behavioural intervention (HR 1.93, 95% CI 1.27 to 2.93) is considerably more effective than offering a workplace intervention alone (HR 1.35, 95% CI 1.01 to 1.82, test for subgroup differences P = 0.17).Workplace interventions did not considerably reduce time until first RTW compared with a clinical intervention in workers with mental health problems in one study (HR 2.65, 95% CI 1.42 to 4.95, very low-quality evidence). AUTHORS' CONCLUSIONS We found moderate-quality evidence that workplace interventions reduce time to first RTW, high-quality evidence that workplace interventions reduce cumulative duration of sickness absence, very low-quality evidence that workplace interventions reduce time to lasting RTW, and moderate-quality evidence that workplace interventions increase recurrences of sick leave. Overall, the effectiveness of workplace interventions on work disability showed varying results. Workplace interventions reduce time to RTW and improve pain and functional status in workers with musculoskeletal disorders. We found no evidence of a considerable effect of workplace interventions on time to RTW in workers with mental health problems or cancer.We found moderate-quality evidence to support workplace interventions for workers with musculoskeletal disorders. The quality of the evidence on the effectiveness of workplace interventions for workers with mental health problems and cancer is low, and results do not show an effect of workplace interventions for these workers. Future research should expand the range of health conditions evaluated with high-quality studies.
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Affiliation(s)
- Myrthe van Vilsteren
- VU University Medical CenterDepartment of Public and Occupational Health, EMGO Institute for Health and Care ResearchPO Box 7057AmsterdamNetherlands1007 MB
| | - Sandra H van Oostrom
- National Institute for Public Health and the EnvironmentCentre for Nutrition, Prevention and Health ServicesBilthovenNetherlands
| | - Henrica CW de Vet
- VU University Medical CenterDepartment of Epidemiology and Biostatistics, EMGO Institute for Health and Care ResearchPO Box 7057AmsterdamNetherlands1007 MB
| | | | - Cécile RL Boot
- EMGO Institute for Health and Care Research, VU University Medical CenterDepartment of Public and Occupational HealthAmsterdamNetherlands
| | - Johannes R Anema
- VU University Medical CenterDepartment of Public and Occupational Health, EMGO Institute for Health and Care ResearchPO Box 7057AmsterdamNetherlands1007 MB
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Stapelfeldt CM, Labriola M, Jensen AB, Andersen NT, Momsen AMH, Nielsen CV. Municipal return to work management in cancer survivors undergoing cancer treatment: a protocol on a controlled intervention study. BMC Public Health 2015. [PMID: 26215644 PMCID: PMC4517365 DOI: 10.1186/s12889-015-2062-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background Cancer survivors are often left on their own to deal with the challenges of resuming work during or after cancer treatment, mainly due to unclear agreements between stakeholders responsible for occupational rehabilitation. Social inequality exists in cancer risk, survival probability and continues with regard to the chance of being able to return to work. The aim is to apply an early, individually tailored occupational rehabilitation intervention to cancer survivors in two municipalities parallel with cancer treatment focusing on enhancing readiness for return to work. Methods/Design In a controlled trial municipal job consultants use acceptance and commitment therapy dialogue and individual-placement-and-support-inspired tools with cancer survivors to engage them in behaviour changes toward readiness for return to work. The workplace is involved in the return to work process. Patients referred to surgery, radiotherapy or chemotherapy at the Oncology Department, Aarhus University Hospital, Denmark for the diagnoses; breast, colon-rectal, head and neck, thyroid gland, testicular, ovarian or cervix cancer are eligible for the study. Patients must be residents in the municipalities of Silkeborg or Randers, 18–60 years of age and have a permanent or temporary employment (with at least 6 months left of their contract) at inclusion. Patients, for whom the treating physician considers occupational rehabilitation to be unethical, or who are not reading or talking Danish are excluded. The control group has identical inclusion and exclusion criteria except for municipality of residence. Return to work is the primary outcome and is indentified in a social transfer payment register. Effect is assessed as relative cumulative incidences within 52 weeks and will be analysed in generalised linear regression models using the pseudo values method. As a secondary outcome; co-morbidity and socio-economic status is analysed as effect modifiers of the intervention effect on return to work. Discussion The innovative element of this intervention is the timing of the occupational rehabilitation which is much earlier initiated than usual and the active involvement of the workplace. We anticipate that vulnerable cancer survivors will benefit from this approach and reduce the effects of social inequality on workability. Trial registration Current Controlled Trials ISRCTN50753764. Registered August 21st, 2014.
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Affiliation(s)
- Christina M Stapelfeldt
- Public Health and Quality Improvement - CFK, Central Denmark Region, MarselisborgCentret, P.P. Oerums Gade 11, Building 1B, 8000, Aarhus C, Denmark.
| | - Merete Labriola
- Public Health and Quality Improvement - CFK, Central Denmark Region, MarselisborgCentret, P.P. Oerums Gade 11, Building 1B, 8000, Aarhus C, Denmark
| | | | - Niels Trolle Andersen
- Section of Biostatistics, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Anne-Mette H Momsen
- Public Health and Quality Improvement - CFK, Central Denmark Region, MarselisborgCentret, P.P. Oerums Gade 11, Building 1B, 8000, Aarhus C, Denmark
| | - Claus Vinther Nielsen
- Public Health and Quality Improvement - CFK, Central Denmark Region, MarselisborgCentret, P.P. Oerums Gade 11, Building 1B, 8000, Aarhus C, Denmark.,Section of Clinical Social Medicine and Rehabilitation, Department of Public Health, Aarhus University, Aarhus, Denmark
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Nielsen MBD, Vinsløv Hansen J, Aust B, Tverborgvik T, Thomsen BL, Bue Bjorner J, Steen Mortensen O, Rugulies R, Winzor G, Ørbæk P, Helverskov T, Kristensen N, Melchior Poulsen O. A multisite randomized controlled trial on time to self-support among sickness absence beneficiaries. The Danish national return-to-work programme. Eur J Public Health 2014; 25:96-102. [PMID: 24577065 DOI: 10.1093/eurpub/cku016] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND In 2010, the Danish Government launched the Danish national return-to-work (RTW) programme to reduce sickness absence and promote labour market attainment. Multidisciplinary teams delivered the RTW programme, which comprised a coordinated, tailored and multidisciplinary effort (CTM) for sickness absence beneficiaries at high risk for exclusion from the labour market. The aim of this article was to evaluate the effectiveness of the RTW programme on self-support. METHODS Beneficiaries from three municipalities (denoted M1, M2 and M3) participated in a randomized controlled trial. We randomly assigned beneficiaries to CTM (M1: n = 598; M2: n = 459; M3: n = 331) or to ordinary sickness absence management (OSM) (M1: n = 393; M2: n = 324; M3: n = 95). We used the Cox proportional hazards model to estimate hazard ratios (HR) comparing rates of becoming self-supporting between beneficiaries receiving CTM and OSM. RESULTS In M2, beneficiaries from employment receiving CTM became self-supporting faster compared with beneficiaries receiving OSM (HR = 1.32, 95% CI: 1.08-1.61). In M3, beneficiaries receiving CTM became self-supporting slower than beneficiaries receiving OSM (HR = 0.72, 95% CI: 0.54-0.95). In M1, we found no difference between the two groups (HR = 0.99, 95% CI: 0.84-1.17). CONCLUSION The effect of the CTM programme on return to self-support differed substantially across the three participating municipalities. Thus, generalizing the study results to other Danish municipalities is not warranted. TRIAL REGISTRATION ISRCTN43004323.
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Affiliation(s)
- Maj Britt D Nielsen
- 1 The National Research Centre for the Working Environment, Copenhagen, Denmark 2 Oxford Research, Copenhagen, Denmark
| | | | - Birgit Aust
- 1 The National Research Centre for the Working Environment, Copenhagen, Denmark
| | - Torill Tverborgvik
- 1 The National Research Centre for the Working Environment, Copenhagen, Denmark 3 Department for Occupational Medicine and Epidemiology, National Institute of Occupational Health, Oslo, Norway
| | - Birthe L Thomsen
- 1 The National Research Centre for the Working Environment, Copenhagen, Denmark
| | - Jakob Bue Bjorner
- 1 The National Research Centre for the Working Environment, Copenhagen, Denmark 4 Department of Public Health, University of Copenhagen, Copenhagen, Denmark 5 QualityMetric, Lincoln, RI, USA
| | - Ole Steen Mortensen
- 1 The National Research Centre for the Working Environment, Copenhagen, Denmark 6 Department of Occupational Medicine, Køge Hospital, Køge, Denmark
| | - Reiner Rugulies
- 1 The National Research Centre for the Working Environment, Copenhagen, Denmark 4 Department of Public Health, University of Copenhagen, Copenhagen, Denmark 7 Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Glen Winzor
- 1 The National Research Centre for the Working Environment, Copenhagen, Denmark
| | - Palle Ørbæk
- 1 The National Research Centre for the Working Environment, Copenhagen, Denmark 8 Danish Working Environment Authority, Copenhagen, Denmark
| | - Trine Helverskov
- 1 The National Research Centre for the Working Environment, Copenhagen, Denmark
| | - Nicolai Kristensen
- 9 KORA, Danish Institute for Local and Regional Governmental Research, Copenhagen, Denmark
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