Dissertationen zum Thema „Return to work“

Philosophiae Doctor - PhD
Background: Stroke is acknowledged globally and among Nigerian rehabilitation researchers as a public health problem that leave half of its survivors with significant neurological deficits. The attendant sequelae of stroke affects the functional ability, limits activity performance and participation of stroke survivors within the community. The inability to re-establish pre-existing roles after stroke further poses additional challenges on the society, friends and families of the stroke survivor with regards to cost and burden of care. Although stroke disrupt the career pathway of working age survivors briefly, recurrently or permanently; a systematic pathway that facilitates job placement and retention at work for stroke survivors could reduce the devastation and burden caused by unemployment following stroke. As this vocational rehabilitation pathway and programme is currently unavailable for stroke survivors, this study aimed to design a RTW intervention programme that could facilitate the work re-entry for stroke survivors in the state of Osun, Nigeria. Method: The study utilized a multi-phase mixed method research design that was guided by the Intervention Mapping (IM) framework to achieve its objectives. This consisted of three iterative phases that informed one another with the findings culminating into the developed return to work programme for stroke survivors in Osun State. Phase one used a convergent mixed method parallel approach to obtain baseline information on the RTW process, the impairments, activity limitation, and the participation restrictions experienced by stroke survivors in Osun state, Nigeria in two distinct stages that involved a cross-sectional survey and qualitative interviews. The cross sectional survey administered questionnaires that included the Work Rehabilitation Questionnaire, the International Classification of Functioning, Disability and Health (ICF) Brief Core Sets for vocational rehabilitation (VR) and the Work Impact Questionnaire (WIQ) using the face to face method. Descriptive statistics such as measure of central tendencies and frequencies as well as inferential statistics such as logistic regression analysis were performed on the questionnaire data. The qualitative study involved concept mapping using in-depth interviews with stroke survivors who have and those that have not RTW. The transcripts from the in-depth interviews were analysed using the thematic content method. Phase two entailed a scoping review of literature that reported on interventions aimed at facilitating RTW of stroke survivors. The last phase of the study involved a Delphi study with experts in the field of stroke and vocational rehabilitation. The Delphi survey was conducted over three rounds with the final draft of the RTW programme emerging at the third round. Results: Two hundred and ten stroke survivors with mean age 52.90±7.92 responded to the quantitative stage of the phase thereby yielding a response rate of 76.36%. Sixty three point eight percent of the respondents had returned to work with half of them in full time employment (32.9%) while 36.2% had not returned to work. The majority of the respondents identified that travel to and from work (43.8%) and access at work (43.3%) had an impact ranging from ‘quite a bit’ to ‘extreme’ on their ability to work on the WIQ. The results from the quantitative stage further showed that more than ten percent of the respondents experienced complete problem in four components of activity and participation domains of the ICF brief core sets for VR and these include remunerative employment (21.4%), acquiring new skills (17.1%), non-remunerative employment (16.7%), as well as acquiring, keeping and terminating jobs (14.3%). Similarly, energy and drive functions (41.9%) and higher level cognitive function (36.2%) were indicated as culminating in moderate to severe problems in more than a third of the respondents while the “performance of complex interpersonal relationship” and “exercise tolerance function” resulted in no or little difficulty for the respondents. The findings from the logistic regression analysis showed that the combination of side of body affected by stroke (left), type of vocational rehabilitation programme, symptoms of stroke, environment, body function impairments as well as activity and participation problems were the factors that predict RTW after stroke. The logistic regression model significantly explained 55.0% to 75.4% of the variance in RTW after stroke and correctly classified 89.0% of all the cases/respondents. Results from the qualitative stage of the first phase suggests the lived experience of returning to work after stroke to have entailed three themes that was represented by a concept map. The first theme revealed that “it was difficult to live with stroke” for the survivor. The second theme revealed that the stroke survivors’ environment could either worsen or lessen the difficulty experience while the third theme highlighted the various issues that directly impacted on the resumption of worker role of the participants. The scoping review phase (phase two) identified that RTW interventions for stroke survivors falls into three core components which includes 1) intervention components that interface with the stroke survivor; 2) intervention components that interfaced with the workplace and; 3) components that describe strategies of implementation. These core components are interventions that could guarantee an effective RTW for strokes survivors when included in a RTW programme. In the third phase which was the concluding phase of the study, 13 experts in the field of stroke and vocational rehabilitation unanimously agreed at the third round of Delphi that the content of RTW programme for stroke survivors should include an assessment phase, work intervention training phase, work test placement phase and clients full participation in worker role phase that will span a 12 week duration. The developed RTW programme, conceptualized as Stroke Return to Work Intervention Programme (SReTWIP) was designed to be individually tailored to meet the need of the stroke survivor and implemented by an interdisciplinary team that will include the OT and PT as key members. Equally, the stroke survivor is expected to be involved in the decision making process throughout the duration of the SReTWIP. And finally, the programme is to be coordinated by a case manager who will be a member of the interdisciplinary team. Conclusion: It can be concluded that 63.9% of stroke survivors in Osun State, Nigeria return to work. Problems pertaining to lack of energy and drive functioning; higher level cognitive functioning; acquiring new skills; handling stress and psychosocial demands; travel to and from work and access were the common body impairments and problems with activities and participation restrictions that the stroke survivors encountered. Similarly, the study concludes that a multi-faceted programme, the SReTWIP, comprising of four interconnected phases of interventions that targets multiple factors such as personal and environment factors influencing work resumption is likely to be more effective in facilitating quick RTW after stroke.

The overall aim of this thesis was to gain new knowledge of factors and interventions that improve work ability and return to work (RTW) among women on long-term sick leave from human service organizations (HSOs). The specific aims of the studies were: to evaluate the associations between the self-rated Work Ability Index (WAI) and Work Ability Score (WAS), and the relationship with prospective sick leave, symptoms, and health (Paper I); to investigate whether intervention with myofeedback training or intensive muscular strength training could decrease pain and increase work ability among women with neck pain (Paper II); to examine the associations between workplace rehabilitation and the combination of supportive conditions at work with work ability and RTW over time (Paper III); and to explore experiences, views, and strategies in the rehabilitation process for RTW (Paper IV). This thesis is based on a prospective cohort study (n=324) and a randomized controlled study (RCT) (n=60, participants with neck pain). Both quantitative and qualitative methods were used. The data collection consisted of questionnaires, laboratory-observed data, register-based data, and interviews. The results showed a very strong association between WAI and WAS, and results predicted future sick leave degree, health-related quality of life, vitality, neck pain, self-rated general health, self-rated mental health, behavioral stress, and current stress (Paper I). In the RCT (Paper II), individuals in the myofeedback intervention group increased their vitality and work ability over time and individuals in the intensive musculoskeletal strength training group increased their WAI, WAS, and mental health over time. WAI, WAS, and RTW increased over time among individuals provided with workplace rehabilitation and supportive conditions at work (Paper III) such as a sense of feeling welcome back at work, influence at work, possibilities for development, degree of freedom at work, meaning of work, quality of leadership, social support, sense of community, and work satisfaction. Women described (Paper IV) how they were striving to work and how they had different views, strategies, and approaches in the rehabilitation process for RTW. They expressed a desire to work, their goals for work, and their wishes for work. In the rehabilitation process for RTW they described their interaction with stakeholders as either controlling the interaction or struggling in the interaction. They described strategies to cope with RTW in terms of yo-yo (fluctuating) working: yo-yo working as a strategy or yo-yo working as a consequence. This thesis identifies factors of importance in improving work ability and RTW among women on long-term sick leave from HSOs. For women with neck pain, the intervention study showed feasibility of the intervention and demonstrated improved work ability and decreased pain (Paper II). The intensive muscular strength training program, which is easy for the individual to learn and perform at home, was associated with increased work ability. The results regarding rehabilitation highlight the importance of integrating workplace rehabilitation with supportive conditions at work to increase work ability and improve RTW (Paper III). Women expressed that they were striving to work and that they wanted to work (Paper IV). These women were “going in and out” of work participation (yo-yo working) as a way to handle the rehabilitation process. For assessing the status and progress of work ability among women on long-term sick leave, the single-question WAS may be used as a compliment to the full WAI as a simple indicator (Paper I).

Akademisk avhandling som för avläggande av medicine doktorsexamen vid Sahlgrenska akademin, Göteborgs universitet, kommer att offentligen försvaras i hörsal Hamberger, Medicinaregatan 16 A, Göteborg, måndagen den 6 oktober 2014, klockan 09.00

Introduktion: Sjukfrånvaron i Sverige är hög och kunskap om vad som påverkar återgång i arbete efter sjukskrivning behöver utvecklas. I processen kring återgång i arbete är bedömning av arbetsförmåga en viktig del. Bristen på valida, reliabla och teoretiskt förankrade bedömningsinstrument inom området är dock ett bekymmer eftersom tillförlitliga bedömningar av arbetsförmåga är en förutsättning för utformning och genomförande av interventioner för att stödja återgång i arbete. Denna typ av interventioner kräver multidisciplinär kompetens där arbetsterapeuter utgör en viktig funktion. Vid bedömning av arbetsförmåga bör personens subjektiva uppfattning om sin situation beaktas, då den har betydelse för utfallet av återgång i arbete. Worker Role Interview (WRI) och Work Environment Impact Scale (WEIS) är två arbetsrelaterade intervjuinstrument, som har utvecklats i syfte att bedöma subjektiva psykosociala och miljömässiga faktorers påverkan på arbetsförmåga. Den teoretiska grunden till WRI och WEIS är Model of Human Occupation, som är en modell med fokus på aktivitetsutförande i relation till psykosociala faktorer. Inledande prövningar av WRI och WEIS reliabilitet och validitet har genomförts. Bedömningsinstrumenten har bearbetats och översatts till svenska och används främst av arbetsterapeuter, som arbetar med personer med arbetsrelaterad problematik. Syfte: Det övergripande syftet med avhandlingen är att undersöka användbarheten av bedömningsinstrumenten Worker Role Interview och Work Environment Impact Scale för identifiering av psykosociala och miljömässiga rehabiliteringsbehov av betydelse för återgång i arbete. Metod: Avhandlingen består av fem empiriska studier. I samtliga studier har erhållen information bearbetats kvantitativt. I studie IV har även kvalitativ bearbetning genomförts. Studie I, II och IV är tvärsnittsstudier och studie II och V är två års longitudinella studier. I studie I samlades information in via enkät. I studie II, III och V bestod den huvudsakliga informationen av skattningar utifrån WRI variabler och i studie IV var bedömningar utifrån WEIS i form av skattningar och nedskrivna kommentarer till skattningarna den huvudsakliga informationen. Resultat: I studie I undersöktes vilka teoretiska utgångspunkter och professionsspecifika modeller arbetsterapeuter i Sverige ansåg påverka den psykiatriska vården och den psykiatriska arbetsterapin. Det psykosociala perspektivet var den teoretiska utgångspunkt som hade störst påverkan både på psykiatrisk vård och på psykiatrisk arbetsterapi. Den arbetsterapeutiska modell som flest identifierade var Model of Human Occupation. Detta resultat indikerar att Model of Human Occupation verkar vara användbar inom arbetsterapi och motiverade vidare användning av modellen i denna avhandling. Det som dock också framkom i studie I var att arbetsterapeuter inom psykiatrisk vård använde professionsspecifika modeller i en relativt liten utsträckning. Ett sätt att öka tillämpningen av teori i praktik är att använda teoretiskt grundade bedömningsinstrument. I studie II, III, IV och V har endera av de Model of Human Occupation- baserade bedömningsinstrumenten WRI och WEIS använts och värderats. I studie II och V prövades WRI:s förmåga att predicera återgång i arbete efter långvarig sjukskrivning. Det område i WRI som uppvisade bäst prediktivitet var området ”Självuppfattning” vars variabler beaktar personens motivation för återgång i arbete i form av personens upplevelse av kompetens och effektivitet för att utföra arbetsuppgifter och hantera utmaningar i arbetet. De två WRI variabler som bäst kunde predicera vilka som skulle återgå respektive inte återgå i arbete vid uppföljning efter två år var: ”Tro på sin arbetsförmåga”, och ”Dagliga vanor och rutiner”. Resultaten tyder på att kunskap om hur tro på den egna förmågan stärks och kunskap om dagliga vanor och rutiners påverkan på utförande av arbete är central vid genomförande av interventioner i syfte att stödja personer att återgå till arbete efter sjukskrivning. I studie III prövades WRI:s konstrukturella validitet i en internationell studie. Samtliga variabler i WRI, förutom de som tillhör miljöområdet, uppvisade en god konstrukturell validitet dvs mätte psykosociala faktorers påverkan på arbetsförmågan. WRI:s skattningsskala verkar stabil och valid mellan olika länder och för personer med olika diagnoser. I analysen framkom att WRI kunde särskilja mellan personers psykosociala arbetsförmåga på tre olika nivåer. I studie IV undersöktes hur personer med erfarenhet av långtidssjukskrivning uppfattar att faktorer i arbetsmiljön stödjer respektive hindrar personens utförande av arbete och välbefinnande genom bedömningar utifrån WEIS. De faktorer som uppfattades som mest stödjande var olika former av sociala interaktioner på arbetet samt uppfattningen om arbetets värde och mening. De faktorer som uppfattades som mest hindrande var olika krav i relation till arbetsgenomförandet samt den belöning som erhålls för arbetet. Konklusion: Sammanfattningsvis så kan WRI användas för bedömning av psykosociala faktorers påverkan på arbetsförmågan. I WRI ingår variabler som kan predicera återgång till arbete upp till två år efter genomförd bedömning. WEIS verkar användbart för att identifiera arbetsmiljöfaktorer som stödjer respektive hindrar personers välbefinnande och utförande av arbete. Att komplettera olika datainsamlingsmetoder är en förutsättning för att uppnå en så god bedömning av arbetsförmåga som möjligt. Den information som WRI- och WEISintervjuer genererar är värdefull, då den kan utgöra en viktig grund för planering av individspecifika rehabiliteringsinsatser. Bedömningsinstrumenten WRI och WEIS med sin teoretiska förankring i Model of Human Occupation kan anses vara användbara för att identifiera psykosociala och miljömässiga rehabiliteringsbehov i syfte att stödja personer i processen åter till arbete efter sjukskrivning.
Introduction: In Swedish society the sick-leave rate is high and a better understanding is required of the factors that facilitate return to work. In the return to work process, assessments of peoples’ work ability play an important role. However, the lack of usable, valid, reliable, and theoretically sound assessment instruments for assessing work ability is a concern. Credible and theoretically sound assessment methods for assessing clients’ work ability strengthen the possibilities for making valid interpretations and obtaining important information for composing further intervention strategies which can guide suitable interventions in the process of returning to work. Such interventions need multi-professional expertise. In this area occupational therapists can offer valuable contribution. In the overall assessment of work ability the unique individual’s subjective perception of the situation needs to be considered since this has been found greatly relevant for return to work. The Worker Role Interview (WRI) and the Work Environment Impact Scale (WEIS) are two work-related interview assessment instruments that have been developed to assess subjective psychosocial and environmental factors of work ability. The WRI and the WEIS have been primarily tested for reliability and validity and are theoretically founded in the Model of Human Occupation (MOHO), which is an occupation-focused model addressing psychosocial factors. They have been adapted and translated to Swedish and are used among Swedish occupational therapists working with clients experiencing work-related problems. Aim: The overall aim of this thesis was to evaluate the usefulness of the assessment instruments the Worker Role Interview and the Work Environment Impact Scale for identifying psychosocial and environmental rehabilitation needs essential for returning to work. Methods: Five empirical studies were performed, all of which were analysed quantitatively, with the exception of study IV in which both qualitative and quantitative analysing methods were used. Studies I, III and IV were cross-sectional while studies II and V were two-year longitudinal studies. In study I, data were collected by a questionnaire, in studies II, III and V the primary data constituted of ratings on the WRI items. In study IV the primary data were ratings of the WEIS items and the written notes beside the rating on each item. Results: In study I, theoretical approaches and professional models that influenced psychiatric care and psychiatric occupational therapy practice among occupational therapists in Sweden was investigated. The most common approach in psychiatric care was the psychosocial approach, and the practice model which was most often used was the Model of Human Occupation. The results indicated that the psychosocial approach and the Model of Human Occupation seemed applicable in occupational therapy, motivating further use of that model. However, it was also found that occupational therapists in psychiatric care used professional practice models to a rather low extent. One way to enhance the application of theory into practice is the use of theory- based assessment instruments. Consequently, the Model of Human Occupation- based assessment instruments, the WRI and the WEIS, have been evaluated and used in the other studies in the present thesis The value of the WRI for predicting return to work after long term sick-leave was investigated in studies II and V. The content area in the WRI with best overall predictive validity for return to work was ‘Personal causation’. Its items focus on the individual’s motivation for return to work in relation to the individual’s feeling of competence and effectiveness in doing work tasks and facing challenges at work. The two WRI items which best predicted whether the participants would be in the working or the non-working groups at the two-year follow up were ‘Expectations of job success’, which concerns beliefs in personal abilities in relation to returning to work, and the item ‘Daily routines’ which concerns the individual’s routines and organisation of time outside work. These results suggest that knowledge about how to strengthen the person’s belief in his or her abilities, how routines impact occupational performance, and how to support the individual in structuring his or her daily doings are needed in interventions aiming at supporting the individual to return to work. In study III the construct validity of the WRI was investigated in an international study. All the WRI items except those related to the environment area seemed to capture the intended construct of the WRI, namely psychosocial ability for return to work. The construct of the WRI seems to be stable and valid across different countries and populations, and the WRI showed an ability to separate clients into three distinct levels of psychosocial ability for return to work. In study IV the impact of the work environment was investigated by using the WEIS among people with experiences of sick-leave. Social interactions at work and the meaning of the work had the most supportive impact and different work demands and the rewards received for the work were perceived as most interfering with work performance, well-being, and satisfaction. Conclusion: The WRI seems to be suitable for estimating psychosocial work ability. In addition it contains items which can predict return to work up to two years after the assessment is conducted. The use of the WEIS revealed supportive and interfering factors for work performance, well-being, and satisfaction among people with experiences of long term sick-leave. The interview format of the WRI and the WEIS seems valuable since it provides comprehensive information which can contribute to the planning of rehabilitation interventions for the unique client. Thus, the WRI and the WEIS, which are theoretically founded in the Model of Human Ocupation are juged to be useful for identifying psychosocial and environmental rehabilitation needs in order to support the individual in returning to work after sick-leave.

The focus of this inquiry is “New Zealand small business employers’ perspectives of the important factors in return-to-work (RTW) of an employee following a musculoskeletal injury or an illness”. Whilst worldwide there is an increasing amount of attention focused on the RTW process in large organisations, there continues to be little understanding of this phenomenon in small businesses. I chose to use a social constructivist theoretical framework drawing on grounded theory methodology to construct some understanding of the employers’ perspectives of the RTW process. Eight small business employers from Auckland and Christchurch participated in this research. Data were gathered using semi-structured interviews. Constant comparative analysis, theoretical sampling and thematic analysis were used to construct two themes from the data. The findings showed that small business employers prefer informal organisational approaches, rely on close working relationships with their staff, are generally wary of bureaucracy and often must run their businesses with limited staff and financial resources. Having an employee off work for a prolonged period of time creates a sizable gap in the staff resources that keep the business running. The employer has responsibility to fill this gap while maintaining a productive business. In the absence of formal injury management practices an ad hoc approach was taken to the RTW process. A number of the employers felt undervalued by key stakeholders, such as doctors, treatment providers, Accident Compensation Corporation and in some cases RTW co-ordinators. Health and safety was a risk all employers appeared to take seriously whereas injury management information and support seemed less of a focus. This research suggests there may be little focus on injury management in small businesses by employers and, that employers perceive greater government emphasis on injury prevention. The extent and associated costs of work disability in small businesses is as yet unknown, but it is likely to be significant. How to support and encourage the uptake of injury management in small businesses in the long term warrants further investigation. Understanding that employers may well lack injury management expertise, experience and resources requires stakeholders to make specific effort with the employer, at the workplace, to facilitate the RTW process.

Mental health problems have incapacitating effects on an individual’s capacity to hold and maintain employment. Over half a million Canadians are absent from work due to mental health problems every day, which costs Canadian companies an estimated 14% of their net annual profit. Individuals who miss work for mental health reasons often experience longer periods of absence, and return to work at a much lower rate than individuals absent for other reasons (e.g., physical injury). Regrettably, empirically based return to work interventions focused on mental health problems are lacking, likely the product of a lack of consensus surrounding salient predictors of return to work. The current study sought to add to current literature aimed at identifying factors that influence the likelihood of successful re-entry into the workforce. A review of patient files from a private psychological practice yielded the sample. Clients were selected based on their satisfaction of one central criterion: having experienced a workplace absence and suffered from a mood or anxiety disorder as classified by the DSM-IV-TR. Recruitment letters and consent forms were mailed to 74 eligible participants, for a response rate of 68% (n=50). The sample was predominantly female (n=38 or 76%). Of the 50 participants, 27 successfully reintegrated to the workforce (RTW=54%), following a mean absence of 13 months (SD=7.37). Emerging from the results are higher risk categories (e.g., physically injured workers, low educational requirements, disability providers) of reduced likelihood of successful return to work. The role of symptom severity and availability of social support is also discussed along with best practice implications for stakeholder/practitioners.

Faktorer som påverkar återgång till arbete efter moped olyckor i Vietnam Rehabilitering kan möjliggöra för personer med funktionsnedsättningar att leva självständigt och vara en del av samhället. Majoriteten av dem som skadas i trafiken i Vietnam är motorcykelåkare. Syftet med uppsatsen var att beskriva faktorer som upplevdes påverka arbetsåtergången för personer som har varit med i en mopedolycka i Vietnam. En kvalitativ metod med semi-strukturerade intervju användes under datainsamlingen. I uppsatsen deltog elva personer, både män och kvinnor, som hade varit med i en mopedolycka under de senaste fem åren. En kvalitativ innehållsanalys användes. Resultatet visade stödjande och hindrande faktorer som påverkar återgång till arbete. De faktorer som främst upplevdes som stödjande vid återgång till arbete var stöd från arbetsgivare, hälso- och sjukvårdspersonal samt familj. Arbetsgivarna kunde underlätta genom att ge tid för rehabilitering och vila. Hälso- och sjukvårdspersonal kunde förbättra upplevelsen av hälsotillståndet och vara uppmuntrande och stöttande under rehabiliteringsperioden. Stödet från familjen bestod av hjälp i de dagliga aktiviteterna och skjutsande till och från sjukhuset och arbetet. Faktorer som visades vara hindrande för återgång till arbete var avsaknad av miljöanpassning och försämrat hälsotillstånd. Slutsatsen av detta examensarbete var att arbetsgivare, hälso- och sjukvårdspersonal och familjen upplevdes som den främsta resursen i den sociala miljön vid återgång till arbetet.
Rehabilitation is a way to enable people with disabilities to live independently and to be a part of the community. The majority of people who are injured by traffic accidents in Vietnam are mainly motorcycle users. The purpose of the thesis was to describe factors influencing return-to-work experienced by people injured by motorbike accidents in Vietnam. A qualitative method with semi structured interviews was used to collect the data. The thesis included eleven participants, both men and women, who had been in a motorbike accident during the last five years. For data analysis a qualitative content analysis was used. Results showed supportive and obstructive factors that influenced return to work. Those factors that mainly was experienced as supportive when returning to work was supportive employers, professionals and family. The employer could support with time for rehabilitation and rest. The professionals could increase the health condition and be encouraging and supportive during the rehabilitation period. Support from family consisted of help with activities in daily living and driving their relative to hospital and to work. Factors that was obstructive when returning to work was lack of environmental adjustments and decreased health condition. The conclusion of this thesis was that the employer, professionals and families are seen as the main resource in the social environment when returning to work.

The effect of a traumatic hand injury on an individual can be wide ranging and include both physical and psychological dimensions. Getting back to work following such an injury is often challenging. This study aimed to explore individuals’ experiences of returning to work following a traumatic hand injury and to use insights gained to develop and pilot a return to work intervention. The study comprised two stages. A reflective lifeworld research methodology, with a longitudinal perspective, was used to underpin the first stage. Seven adults in fulltime work were interviewed at three distinct time points following their traumatic hand injury. Many participants continued to engage in their usual daily activities, including being at work, and most of them initially expected to make a full and speedy recovery. It was with this view that participants made decisions concerning their return to work. Once back at work it became clear that the impact of the injury was wider ranging than they anticipated and difficulties arose with managers and colleagues regarding participants’ ability to comply with their rehabilitation programme within the context of work. The second stage used findings from stage one to extend the scope of the rehabilitation interventions, moving away from a hand therapy programme that focused solely on the healing structure to a rehabilitation programme that also included patient concerns in line with occupational therapy principles. A return to work intervention was developed which was integrated with the existing rehabilitation programme. This intervention was piloted with seven people in full-time employment. Reflective lifeworld research was used to analyse their experiences within the context of the phenomenon under investigation. Results indicated that participants’ return to work experience was more positive and controlled following the return to work intervention. Therapists’ involvement in the development of the return to work plan provided an authoritative and independent way for managers and participants to implement the return to work intervention. An ability to manage their return to work and their exercise programme at the same time was reported by participants. This research has illuminated the complexity of the life and work journey of individuals with traumatic hand injury, the stages of the adaptation process and their rehabilitation needs. Inclusion of other stake holders such as the manager and GP could be useful in developing the return to work intervention further through a randomised control trial.

Thesis (Ph. D.)--Ohio State University, 2003.
Title from first page of PDF file. Document formatted into pages; contains xiii, 183 p. Includes abstract and vita. Advisor: Bruce S. Growick, College of Education. Includes bibliographical references (p. 180-183).

A major burn is one of the most severe traumas a person can experience, and recovery can be a protracted process. The principal aim was to increase the knowledge base regarding factors related to return to work and health-related quality of life (HRQoL) after burns. Patients treated at the Uppsala Burn Center between 2000 and 2007 were included on a consecutive basis. Assessments were made at hospitalization, and thereafter and included a home visit 2 to 7 years after injury. The psychometric properties of the generic HRQoL instrument EQ-5D were investigated. The results support the use of EQ-5D as an adjunct to burn-specific assessments of HRQoL. Most former patients exhibited a good HRQoL at 2 to 7 years postburn. Not working at the time of injury and having PTSD at 12 months, as well as having low scores on the EQ VAS at 12 months, were related to a worse EQ VAS score at 2 to 7 years after injury. The majority of former patients had returned to work 2 to 7 years postburn. Time to return to work was predicted by length of hospital stay and a personality disorder diagnosis. Predictors for not returning to work were length of stay and having any anxiety or substance use disorder prior to injury. Those who were not back at work reported lower generic and burn-specific health, and exhibited more psychiatric morbidity at follow-up than those who were working. The latter group exhibited HRQoL that was comparable to that of the general population. Participants emphasized their own psychological resources and capabilities as facilitators in the process of returning to active work. The findings suggest that an early and systematic approach for assessing recognized risk factors enhances the possibility of discovering patients at risk of developing problems during postburn adaptation.

Introduction: Musculoskeletal disorders constitute the greatest cause of sickness absence from work. Despite research and efforts at rehabilitation, sickness absence due to these disorders has not decreased, but has instead increased, particularly in women. Clients’ perceptions of care and rehabilitation, i.e. knowledge generated from a lay perspective, is a neglected area of research. This thesis deals with lay experiences of rehabilitation following sickness absence due to back, neck or shoulder problems, termed musculoskeletal disorders (MSD). Aim: The overall aim was to examine hindering and promoting processes in rehabilitation after sickness absence due to MSD from a lay perspective. Specific aims were to study how lay persons experience rehabilitation agents and rehabilitation activities (paper I), how they describe themselves and their experience in relation to work (paper II), the significance of the private arena regarding return to work (paper III), and how clients who have experienced sickness absence due to MSD perceive contact with rehabilitation agents (paper IV). Method: The study population in the four papers is part of a cohort of persons living in the same municipality and who in 1985 were aged 25-34 years and were sick-listed due to back, neck or shoulder diagnoses for 28 days or  more, n=213. During 1995, 148 persons in the cohort responded to a questionnaire, and in 1997-1998, 20 of these persons were interviewed concerning their experiences with rehabilitation. In papers I, II and III the qualitative method of Grounded Theory was used with a focus on creating an empirically-based theory concerning the area under study. Data collection was strategic and analysis of the tape-recorded interviews was done on a continual basis. How previously sick-listed persons experienced contact with professional rehabilitation agents in t he health care sector and social insurance office was investigated in paper IV. Factor analysis and multiple regression analysis were used to analyse the data in this study. Results: The interview study shed light on lay persons’ experiences with medical, social and work-related measures in rehabilitation, their perceptions of rehabilitation actors and family members in relation to rehabilitation, and their self-presentations. The descriptions of lay persons concerned three arenas, the health care arena, the occupational arena, and the private arena. Dilemmas and difficulties in these arenas were described, such as handling the duty to work, experiencing domestic strain, and the experience of lacking socioemotional support from significant persons during the rehabilitation process. In paper I some ideal types of rehabilitation agents emerged from the interviewees’ descriptions concerning the health care arena, and we called these the routine bureaucrat, the empathic administrator, the distant technician, and the professional mentor. The latter agent was requested and was described as a person who could provide socioemotional support, who had professional competence, and who could function as a unifying link during the rehabilitation process. The results from paper II showed that in their self-presentations, the interviewees expressed having a duty to work and that there were differences in how they handled this sense of duty. The selfpresentations contained descriptions of work as a part of personal identity and could be summarised in the following ideal types: the work manic, the workhorse, the workaholic and the relaxed worker. The latter used a strategy that can be considered to promote rehabilitation in that the individual himself/herself had control over his/her work and worked in accordance with his/her own needs rather than those of others. Paper III focused on the private arena. Different patterns were found in the experiences of men and women. Women related that their responsibility for the home and domestic work seldom left any time for themselves, including any time for rehabilitation. Men more often reported having time for themselves that could be used for leisure activities and rehabilitation. Some of the women said that they lacked socioemotional support from their partner and that they had a great deal of responsibility for housework, which seemed to be a hindrance in returning to work after sickness absence. Furthermore, these women, like most of the men, had little education, which could make finding other work alternatives more difficult. Based on the interviews, a hypothesis was developed regarding domestic strain that is related to the distribution of domestic work, the distribution of responsibility for the home, and the quality of the marital relationship. Paper IV dealt with clients’ perceptions of contact with rehabilitation agents in health care and the social insurance office. Three latent dimensions were found in the respondents’ ratings of these contacts: supportive treatment, distant treatment, and empowering treatment. Sex, disability pension status, mental health and diagnostic group were significantly related to how these dimensionswere rated. Women perceived the treatment from both types of rehabilitation agents as more supportive than men. Contact with the social insurance offices were rated higher by persons with disability pensions than by those who had returned to work. Men rated their contact with rehabilitation agents at social insurance offices high on the dimension of distant treatment. Respondents with mental health problems rated the contact as distant for both types of rehabilitation agents, but contact with health care was also scored low on the supportive dimension. Finally, respondents with neck/shoulder diagnoses rated contact with rehabilitation agents in health care as more empowering than was done by persons with back diagnoses. Conclusions: From a lay perspective rehabilitation following sickness absence due to MSD occured in three arenas, the health care arena, the occupational arena and the private arena, where the quality of relationships both with rehabilitation agents, persons at work and in one’s private life was described as important regarding the rehabilitation process. This thesis also showed that both sex and health were important factors regarding how lay persons’ perceived contacts with rehabilitation agents during the rehabilitation process following sickness absence due to MSD.

Norway has a high prevalence of sick leave compared to other Nordic countries and has been criticized for offering generous sick leave benefits. This qualitative study aims to explore experiences of graded sick leave and return to work in Norway. Six employees from the private sector were interviewed regarding their experiences of the Norwegian model for earlier follow-up of employees on sick leave. The collected data was analyzed using qualitative content analysis. The results indicated several important aspects of the return to work process which were perceived as both obstacles and opportunities. The possibility of having time to recover as well as finding a balance of a manageable work load with stimulating assignments were seen as essential and communication was crucial to attain the latter.

Traumatic brain injury (TBI) is becoming more prevalent in an age of increased motorization and violence. The majority of patients are young adults previously in paid employment. Life expectancy is usually unaffected once past the acute stage of recovery. The reported statistics for successful return to work (RTW) vary from 15% to 77%. However no literature was sourced which examines or discusses the most central component of successful return to work rehabilitation for these individuals - what the individuals themselves have found to be of assistance from their experience of return to work rehabilitation in attempting to return to work. This study explored the lived experience of return to work rehabilitation from the perspective of individuals who had sustained TBI and who had actively engaged in a return to work programme as part of their rehabilitation. A phenomenological approach, with an interpretative focus was utilized to explore and obtain an enhanced understanding from data gained in semi-structured interviews conducted with ten participants. The interviews were audio-recorded. The position of the researcher was situated within the research, and a reflexive component was interwoven throughout the process. Interpretative Phenomenological Analysis (IPA) was undertaken to elicit themes to enhance my understanding. Findings formed five main themes; personal cost of lifestyle losses, impact of TBI on perceptions of RTW, factors impacting on engagement in RTW rehabilitation, participants' perceptions of assistive elements of RTW rehabilitation, impact of RTW rehabilitation on participant. Each master theme comprised a group of sub themes, discussed within the thesis. The meaning of work pre-morbidly for individuals who sustain TBI characterizes their social and familial roles and responsibilities. Upon attempting to RTW following rehabilitation the definition of work often changes in conjunction with the individual's world views and perceptions of self. Whilst RTW rehabilitation may be an important goal for the individual and his/her family, because he/she accesses rehabilitation through a community based service, other, external, factors often impact on their ability to fully engage in a RTW rehabilitation programme. Little acknowledgement of this is made by clinicians, and more flexibility and further additional one to one interventions during times of difficulty would be assistive in optimizing the chances of success for individuals. Whilst all participants in this study were able to verbalize positive experiences of the outcomes of RTW rehabilitation, none had returned to their previous employment resuming their previous roles. Thus the core message of this thesis is that the role of the occupational therapist in RTW rehabilitation needs to incorporate many elements including group rehabilitation, one to one rehabilitation and clinical liaison with work places. This can be potentially achieved through adopting Mosey's (1986) Acquisitional Frame of Reference as a working practice model. In addition, facilitated longterm peer and clinical support is required to ensure individuals maintain success in their attempts to RTW. Clinicians involved in this area of work need to work within an interdisciplinary team approach, recognise and assist with a defined grief reaction that presents in individuals when they attempt to RTW, and be flexible and accommodating in the delivery of RTW rehabilitation to patients.

Veterans returning from the recent Middle East wars report struggling with a variety of transition issues related to wartime experiences and due to the socialization they received as part of their indoctrination into military life. Many veterans experience practical and emotional adjustment challenges related to experiences common to military personnel regardless of combat exposure that may not appear for months or years after separating from the military.

Much of the existing research has focused on quantitative measures of veterans’ transition. There is a need for a greater qualitative research focus on understanding the subjective experience of coming home and what strategies veterans are using to support their return to civilian life. This study explored how veterans’ experience the return to civilian life with the goal of identifying components of an optimal transition.

Using qualitative methodology, forty veterans were interviewed using a semi-structured interview guide. A phenomenological orientation guided the study emphasizing the lived experience of the participants. Thematic analysis of the study data was used to identify patterns and emergent themes. Social identity theory and attachment theory were used as the framework for understanding the persistent power of indoctrination into military identity and attachment to one’s comrades as both a source of significant loss and a potential asset to be utilized in facilitating the transition to post-military life. Using the transition criteria in the Military to Civilian Questionnaire (Sayer, et al 2011), study participants were divided into three groups based on level of functioning at the time of the interview.

The findings suggest that veterans who experience the most successful transition have connected to community providing social support and created new meaning and mission for their lives. The best functioning veterans were able to access an array of coping skills allowing them to process emotions and engage in the tasks of creating a meaningful civilian life. The study proposes a model for assessing veterans leading to a continuum of care. The study findings have important implications for collaborative programs and policy and the social work profession. Recommendations for future research are included.

Philosophiae Doctor - PhD
Cardiovascular disease is amongst the top three leading causes of mortality in South Africa and the world. The effects of cardiovascular disease can be seen in limitations of function within all spheres of life, including work function. Cardiac rehabilitation programmes have been documented to improve functional abilities, but little is known about the return to work rate after cardiac rehabilitation. Access to cardiac rehabilitation programmes in the Western Cape is limited. This study aimed to determine the return to work rates and influencing factors after cardiac rehabilitation as well as to design an intervention programme that is accessible and could facilitate return to work for individuals with cardiovascular disease.

Corporate culture does not allow for talented women to return to the workplace or continue to operate effectively in the workplace whilst managing their domestic responsibilities. This is directly influencing the retention and progression into senior positions of female talent (Baggallay, 2011). While the above statement may be a narrow view considering shifts in many companies' policies aimed at supporting work-family balance, working mothers still have many concerns. Some of these concerns have been highlighted by the participants in this study, and confirm the need to better understand the challenges faced by female employees returning to work after maternity leave. The primary purpose of this study is to identify common themes arising from South African female employees' experience of returning to work following maternity, and to ultimately gain an understanding of the interests of both mothers in the workplace and employers looking to retain and nurture top female talent. The results of this study revealed that, despite viewing work positively, the participants found that returning to work after childbirth was difficult. A significant change in the attitudes of the participants towards their careers after childbirth was also found. This change is not necessarily negative and should not be interpreted as an indication of employees' loss of interest in their careers; it does, however, highlight the need for adequate management of the "workplace pregnancy" to ensure that female employees return to work. Employers who are open to the evolution of best practice for maternity leave, the management of family responsibilities, and striking a balance between employee productivity and fulfilment will position themselves as an employer of choice, thereby attracting high-calibre talent.
Dissertation (MCom)--University of Pretoria, 2012.
Human Resource Management
unrestricted

Thesis (Ph. D.)--Ohio State University, 2003.
Title from first page of PDF file. Document formatted into pages; contains ix, 147 p. Includes bibliographical references (p. 143-147). Available online via OhioLINK's ETD Center

Musculoskeletal disorders (MSD) and mental disorders (MD) are common among working-age individuals, and reduced work ability is often a problem that influences functioning in working life. Having MSD and MD is also a common cause of seeking health care and these conditions account for the majority of sick leave in most western countries. The overall aims of the thesis were to increase knowledge about biopsychosocial assessment of health, functioning and work ability for individuals with MSD and MD seeking care. A further aim was to gain better understanding of praxis behaviour in the rehabilitation process for sick-listed patients by evaluating patient-reported work ability, type of interventions given, usefulness of interventions, and return to work. This thesis comprises four studies based on two different cohorts. A cross-sectional design was used for studies I and II, which included 210 individuals diagnosed with MSD and MD seeking occupational health services. Data collection consisted of questionnaires to patients on self-reported health, functioning, work conditions, work ability and reports of professional assessment of diagnosis, main clinical problem, recommended intervention and sick leave. Studies III (n=699) and IV (n=810) were based on a longitudinal cohort study, ReWESS, with a 3-month follow-up comprising individuals who sought primary health care or occupational health services for MSD or MD and were sick-listed. The data collection included repeated questionnaires to the patients on self-reported health, functioning, work conditions, work ability, type and usefulness of intervention and return to work. There was an association between the professional biopsychosocial assessment and patients’ self-reported measures of health, functioning and work ability in clinical reasoning. Self-reported health and work measures can complement the expert-based diagnosis. Patients who had MSD and MD with co-morbid conditions reported more problems with mental functioning, had higher psychological demands at work and reported poorer work ability compared with those with MSD only. Patients with co-morbid conditions also had worse outcome compared to having mental disorders only. Psychosocial problems and activity limitations concerning social interaction skills were a frequent problem. This can be identified in clinical screening by physiotherapists in dialogue with the patient using the Patient-Specific Functional Scale. Three-quarters of sick-listed individuals with MSD or MD returned to work within 90 days. The treatment approach to sick-listed persons is still very medical and clinically oriented. Access to work-related interventions seems to be limited in the early rehabilitation process and may not be equal in practice. Those who were younger, had higher educational level and reported stronger health resources were favoured. There is a need to strive for access to work-related interventions. Return to work was associated with receiving combined clinical- and work-related interventions for patients with MD, and with better health-related quality of life, positive return to work expectations and better work ability for patients with MSD. Factors associated with return to work can be identified using self-reported measures. Patients with MD who received a combination of work-related and clinical interventions perceived best usefulness and best effect of health care contacts on work ability. Patients with MSD did not report as good usefulness. There seems to be a gap between scientific evidence and praxis behaviour in the early rehabilitation process; unimodal rehabilitation was widely applied, use of a multimodal treatment approach was limited and only one-third received work-related interventions. For patients with MSD, behavioural treatment seems to be underutilized in clinical practice considering the effect it may have on developing coping strategies and reducing symptoms. In order to meet recommendations in guidelines, physical activity needs to increase as a treatment strategy for patients with MD. A clinical implication is that the rehabilitation process needs to adopt a broader perspective for patients with MSD and MD to include patients’ individual health-related needs, aspects of employment and work conditions. Still, it remains a challenge to understand who needs what type of intervention.

The overarching aim of this thesis is to study Coordination Associations (CAs) as a structure for interor-ganizational cooperation in rehabilitation, return-to-work and labour market reintegration. This has been done through empirical studies of two CAs in eastern Sweden. Central questions for the thesis are: How have representatives on different hierarchical levels in the participating organizations experi-enced cooperation within the structure of CAs? What influence do different organizational and/or professional preferences have on interorganiza-tional cooperation? The four studies in this thesis have had different approaches to studying interorganizational cooperation. Study I was concerned with a specific work form, namely interdisciplinary rehabilitation teams, where the analysis concerned how the different professionals in these teams perceived the common work, and how they interpreted the concept of work ability, which is a central concept for determining eligibility for sickness benefits. Study II focused on managers and board members of the CAs in order to determine their motives for and commitment to interorganizational cooperation. The analysis was concerned with the organizational identification and the self-interest of each actor, where the issue of trust between representatives from dif-ferent organizations was specifically targeted in the analysis. Study II focused on managers and board members of the CAs in order to determine their motives for and commitment to interorganizational cooperation. The analysis was concerned with the organizational identification and the self-interest of each actor, where the issue of trust between representatives from dif-ferent organizations was specifically targeted in the analysis. Study III aimed to elucidate the perspectives of officials in different organizations connected to the CAs regarding both the development of cooperation in the CAs, and how the recent changes in sickness insurance regulations will influence future cooperation. Study IV focused on different perspectives regarding the concept of work ability among representa-tives from all participating organizations, since changes in sickness insurance regulations have changed the assessment process and therefore also the demands for interorganizational cooperation. The general methodological approach to the studies in this thesis has been explorative; qualitative methods have been used, involving interviews, focus groups and problem-based group discussions. Inter-views and focus groups have had an open-ended structure, and the material has been analysed through qualitative content analysis. The aim of the Coordination Associations studied in this thesis has been to bridge the gaps between the participating organizations by promoting consensus through common work forms. However, the re-sults from the studies show that such ambitions are troublesome in highly specialized public organizations. Cooperation in the CAs has to a large extent been organized as collaborative work forms rather than as coordination of existing practices. The collaboration has been based on an idea of consensus, where all organizations were expected to participate on equal terms and find common work forms. Although it has been shown that officials from different organizations can work together, the managerial level’s priorities are more determined by their organizational goals and values, which makes them unwilling to finance collaborative work on a longer term. Another theme of the thesis is the lack of cooperation between the public rehabilitation system and the employers. The public actors lack knowledge of working conditions, and since the work principle guides the rehabilitation process, it is necessary to incorporate employers into the cooperation to facilitate sustainable return-to-work and labour market reintegration. A central conclusion of the thesis is that consensus is not a reasonable starting point when designing cooperation structures between public organizations. A sustainable cooperation structure needs to incorpo-rate and coordinate the different actors’ priorities into a long-term cooperation strategy, rather than base the cooperation on vulnerable collaboration projects.

Background Musculoskeletal disorders (MSDs) are one of the most important causes of temporary and permanent disability, causing acute or persistent pain, resulting in reduced and/or lost ability to work. Return to work (RTW) is multidimensional problem including many different factors and aspects. Few recent studies have analyzed factors predicting RTW after multimodal rehabilitation (MMR). Identification of predictors for RTW may help to improve the planning and optimization of the RTW strategy. The REHSAM II project is a randomized controlled trial with the aim to evaluate if MMR together with a web Behavior Change Program for Activity could increase work ability among persons with persistent MSDs as compared to MMR. Therefore the aim of this study was to identify factors explaining RTW 12 month after baseline in the REHSAM II project. Methods The present study is a secondary assessment of the data from the randomized controlled trial REHSAM II. A total of 97 participants with persistent musculoskeletal pain were randomly allocated to MMR + web-based education or only MMR group. The subjects were followed from baseline to 12 months. Information on potential predictors was obtained from self-administered questionnaires. Data were analyzed with univariate and multiple logistic regression models. Results In the final multiple regression model RTW was predicted by the Örebro Musculoskeletal Pain Screening Questionnaire (ÖMPSQ score) (p=0.003, OR=0.961) and EuroQol (EQ-5D index) (p=0.017, OR=7.283). The univariate regression analyses showed that pain and disability level, the capacity to perform a task in relation to pain and other symptoms, hospital and psychiatric care, medication for insomnia, catastrophizing, self-assessed work ability compared with the lifetime best, satisfaction with life, ability for coping and controlling work situation, ability for coping with life outside work and sense of responsibility for managing health condition were significantly associated with RTW. Conclusion In conclusion, psychosocial pain-related variable and health-related quality of life predicted RTW in the final model. The result confirms the fact that RTW is a multidimensional problem involving a complex interaction of many factors.

Background: Research on multimorbidity, the co-occurrence of two or more health-related conditions, has mainly focused on chronic and common diseases in patient and older populations. The prevalence of multimorbidity in workers and its effect on occupationally relevant outcomes is poorly known. Methods: We computed baseline multimorbidity scores using severity-weighted chronic conditions based on: 1) the relationship between chronic conditions, health-related behaviors and symptoms, and 2) their individual influence on poor health status. Next, we assessed the longitudinal effect of multimorbidity on the incidence and duration of overall and diagnosis-specific sickness absence, as well as on work functioning after return to work from a sickness absence episode. Results: Among men, higher baseline multimorbidity was a risk factor for overall incident sickness absence and episodes due to musculoskeletal and cardiovascular diseases. In women, the trend was less evident, although mental disorders had the strongest association. Associations with sickness absence duration were less consistent. Higher multimorbidity negatively impacted work functioning over time. Conclusion: Multimorbidity affects occupational outcomes, such as sickness absence, and its measurement may allow the early detection of workers coping with unbalanced health-related limitations and work demands.
Antecedents: La recerca sobre multimorbiditat, la coexistència de dues o meés condicions relacionades amb la salut, s’ha enfocat principalment a poblacions de pacients i de major edat. La prevalença de multimorbilitat entre treballadors, i el seu efectes sobre indicadors rellevants per a la salut ocupacional, no està gaire estudiada. Mètodes: Partint de dades de dues poblacions treballadores, vam calcular puntuacions de multimorbilitat ponderades per la seva severitat considerant: 1) la interrelació entre condicions cròniques, hàbits relacionats amb la salut i símptomes, 2) l’efecte de cada condició crònica sobre el mal estat de salut general. Seguidament, vam avaluar l’efecte longitudinal de la multimobilitat basal en la incidència i durada del total d’episodis d’incapacitat temporal, d’episodis per diagnòstics específics, així com en la capacitat d’assolir les demandes laborals un cop retornat d’una incapacitat temporal. Resultats: Pels homes, la multimorbiditat alta va ser un factor de risc tant pel total d’episodis d’incapacitat temporal com per aquells deguts a trastorns musculoesquelètics i malalties cardiovasculars. Per a les dones aquesta tendència va ser menys clara, malgrat que els episodis deguts a trastorns mentals van mostrar l’associació més evident. L’associació amb la durada dels episodis va ser menys consistent. La multimorbilitat alta es va associar negativament a la capacitat per assolir les demandes laborals, al llarg del temps, i un cop tornat al treball desprès d’una incapacitat temporal. Conclusió: La multimorbiditat té efectes sobre indicadors de salut laboral. Mesurar-la permetria la detecció precoç de treballadors que s’enfronten a un desequilibri entre les limitacions relacionades amb la salut i les demandes laborals, i que estan a risc d’un episodi d’incapacitat temporal.

Background Less than 50% of people return to work after traumatic brain injury. Despite this, specialist traumatic brain injury (TBI) vocational rehabilitation (VR) in the UK is scarce with outcomes, interventions or costs rarely reported. This study aimed to compare the work outcomes and costs of participants receiving specialist TBI VR (specialist group) to those receiving usual care (usual care group) and to describe the content of the specialist intervention. Method People with TBI requiring hospitalisation ≥48 hours in work or education prior to their injury, were followed up by postal questionnaire at 3, 6 & 12 months post hospital discharge. Primary outcomes were work/education. Secondary outcomes were functional ability, mood and quality of life. Specialist intervention was recorded on a proforma specifically developed for the study. Health resource use was by self-report. Results Fifty-four usual care and 40 specialist participants were recruited. At 12 months, 15% more specialist group participants were in work/education than usual care group participants (27/36, 75% v 27/45, 60%). For those with moderate/severe TBI, the difference was 27% (16/23, 70% v 9/21, 43%). Secondary outcomes showed no significant differences between groups at one year. The proforma showed that the specialist intervention was primarily focussed at preparing participants to return to work. It cost £501.53 more in health and social care costs (UK£2007) to return a specialist group participant to work at one year than a usual care participant. Discussion More specialist group participants were working at one year with an extra cost of only £500 per person. This suggests specialist TBI VR may be cost effective. The ability to describe the intervention aids replication and implementation. Conclusion As returning to work is a cost effective outcome for individuals and society, this study justifies the need for further investigation of this TBI VR intervention.

L'activité physique (AP) est l'un des principaux programmes de soins de support recommandés par plusieurs directives pour améliorer les effets secondaires du cancer chez les survivants du cancer, à cause des preuves de son efficacité sur ces issues de santé. Cependant, les preuves de l'efficacité de l'AP sur le retour au travail (RAT) chez les survivants du cancer restent limitées et inconnues. De plus, on ne sait pas si les recommandations d’AP issues des directives existantes sont applicables au RAT après un diagnostic de cancer. L'objectif de cette thèse était d'évaluer les effets des programmes ou interventions d'AP sur le RAT chez les survivants du cancer et de fournir des preuves de l'efficacité de l'AP sur le RAT après un diagnostic de cancer. Pour répondre à la question de recherche, nous avons utilisé la méthodologie basée sur des preuves (revue systématique, méta-analyse et revue rapide). Cette thèse a montré que les programmes d’AP sont faisables et sans risque pour les patients atteints de cancer. Nous avons trouvé que les interventions d’AP ont des effets positifs significatifs sur le RAT chez les survivants du cancer. La dose d’AP comprise entre 7,6 et 15 METs.h/semaine, consistant en 100-120 minutes par semaine d’exercices aérobique et de résistance, d’intensité modéré à vigoureux, semblent être efficaces pour améliorer le RAT après cancer. En conclusion, cette thèse apporte des preuves modérées sur l’efficacité des interventions d'AP sur le RAT chez les survivants du cancer. Elle a également permis d’estimer la dose d’activité physique nécessaire pour améliorer le RAT chez les patients. À partir des résultats, nous avons proposé un guide avec des protocoles pratiques pour prescrire et implémenter des programmes d'AP pour soutenir la RAT chez les patients de cancer du sein
Physical activity (PA) is one of the leading supportive care programs recommended by several guidelines to improve most of cancer side effects experienced by cancer survivors, because of the strong evidence of its effectiveness on these health outcomes. However the evidence on the effectiveness of PA on return to work (RTW) in cancer survivors remains limited and unknown. In addition, it is unknown whether the recommendations from existing PA guidelines are applicable to RTW after cancer diagnosis. Therefore, the objective of this thesis was to evaluate the effects of PA programs or interventions on RTW in cancer survivors and provide evidence for the effectiveness of PA on RTW after a cancer diagnosis. To address the research question, we used evidence-based methodology (systematic review, meta-analysis, and rapid review). This thesis showed that PA programs are feasible and safe for cancer patients. We found that PA interventions have significant positive effects on RTW in cancer survivors. The dose of PA comprised between 7.6 and 15 METs.h/week, consisting of 100-120 minutes per week of moderate to vigorous intensity aerobic and resistance exercise, seem to be effective in improving RTW after cancer. In conclusion, this thesis provides moderate evidence on the effectiveness of PA interventions on RTW in cancer survivors. It also allowed us to estimate the dose of physical activity needed to improve RTW in cancer patients. Based on these findings, we proposed a guidance with practical protocols for prescribing and implementing PA programs to support RTW in breast cancer survivors

La dépression majeure est un non-sens pour une personne qui en souffre et influence probablement sa motivation au retour au travail, car elle favorise chez elle une identité de malade et par conséquent un sentiment d’être inadéquat. Au Québec et au Canada, cette pathologie est la principale cause d’années vécues avec invalidité ainsi que de décès prématurés. Il apparaît donc pertinent de vérifier si un traitement spécialisé de la dépression majeure comme la psychothérapie interpersonnelle (PTI) pourrait favoriser la motivation au retour au travail d’une personne. Cette approche semble prometteuse pour diverses raisons : 1) elle cible un événement interpersonnel souvent considéré comme un des facteurs déterminants dans l’émergence de cette maladie; 2) elle repose sur des données probantes pour le soulagement des symptômes de dépression majeure; 3) elle ne considère que transitoirement l’identité de malade; 4) elle facilite l’acquisition de stratégies d’adaptation interpersonnelle. La présente étude exploratoire de la contribution de la PTI sur la motivation au retour au travail de personnes en dépression majeure retient la méthodologie de l’étude de cas. Elle se déroule en milieu naturel auprès de quatre personnes considérées en invalidité chronique de leur travail. Autant des données qualitatives que quantitatives sont recueillies et analysées. Les résultats obtenus montrent que trois de ces quatre personnes reprennent leur travail pendant la PTI ou à la fin du traitement alors que l’autre personne s’engage dans une démarche de réorientation. Une autre contribution de la PTI permet de constater que ces personnes ont davantage recours à un soutien social. De plus, elles ont tendance à mieux connaître leur identité ou leurs limites, à améliorer leurs habiletés à la résolution de problème ainsi que leur capacité à communiquer avec les autres. L’idée de mesurer la symptomatologie dépressive et la motivation au même moment pendant un traitement serait à conserver dans une prochaine recherche, car un lien semble s’établir entre la sévérité des symptômes de la maladie et le degré de motivation d’une personne au retour au travail.

Little is known about time to return to work (TRTW) following planned medical events. This study was a secondary analysis (n=94) to determine predictors of time to return to work following a total knee replacement for osteoarthritis. Significant predictors of delayed TRTW following a knee replacement: 1) use of workplace modifications (in 6wks vs 5 wks) and 2) poor physical function (in 7wks vs 6 wks). These findings have large implications for workers undergoing knee replacement, orthopedic clinicians, and occupational health nurses.

People who suffer a traumatic brain injury (TBI) experience challenges in returning to work differently and at a rate that surpasses the return to work transition for people who experience other types of disabling injuries. In part, this challenge is a result of a lack of policy structure that promotes the successful return to work transition. The purpose of this ethnographic study was to explore the policy implications of the return to work transition for TBI survivors, address the gap in the literature, and identify key factors that contribute to the success of return-to-work programs in Washington State. A hybrid of Smith's institutional ethnography approach and Foucault's critique of bureaucratic institutions was used as the framework for this study. Data were gathered from 12 interviews and 2 focus groups with TBI survivors who had access to TBI support groups and employers connected to the TBI community. Data were inductively coded and categorized using a comparative analytical method. The study results indicate that an inclusive culture, collaborative communication, TBI-focused knowledge, integrated support, and survivor/employer motivation to interact are key factors in the successful return to work process. This study promotes positive social change by providing information for use in expanding TBI employment policy, TBI employment education, and accommodation practices. The study findings are intended to inform new policies to improve employment post-TBI outcomes for TBI survivors, employers, and their community.

Background: Successful return to work after stroke may improve economic circumstances, quality of life, and overall life satisfaction but not everyone is able to return to work. Aims: To determine what proportion of previously employed patients return to work after an acute stroke with mild to moderate disability and examine factors associated with successful return to work. Methods: Patient interviews and chart review collected information and assessed anxiety, depression and social support using previously validated instruments with previously employed patients with a first-ever stroke 3 months to 2 years prior, aged 18-60. Multivariate logistic regression assessed factors associated with successful return to work. Results: 52.5% of 141 patients (mean age 48 ± 8.8), returned to work after stroke. Analysis demonstrated a lower modified Rankin scale at 3 months (OR 2.68, 95% CI 1.08-6.02), younger age (OR 2.26, 95% CI 1.04–4.89), and professional or business jobs (OR 2.61, 95% CI 1.6 - 5.97) were significantly associated with successful return to work. Anxiety, depression and social support score did not affect patients’ decision to return to work (p=0.30, 0.37, 0.27 respectively) Conclusions: Among patients with mild to moderate disability after stroke, almost half do not return to work. Functional disability and type of job rather than psychosocial factors such as anxiety and depression were most important.

Orientador: Maria Inês Monteiro
Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas
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Resumo: O câncer de mama é o segundo tipo mais frequente no mundo e o mais comum entre as mulheres, aproximadamente 0,6% dos casos ocorrem em mulheres com menos de 30 anos, desta maneira muitas têm recebido o diagnóstico em idade considerada produtiva. Os tratamentos de escolha, em geral, são a cirurgia conservadora ou radical, radioterapia, quimioterapia e/ou hormonioterapia. Os tratamentos são cada vez mais precisos, eficientes e menos agressivos, no entanto, podem ocorrer complicações decorrentes destes, alterando o prognóstico e, consequentemente, aspectos de vida diária e de atividade profissional. Este estudo teve por objetivo avaliar a prevalência de retorno ao trabalho em mulheres tratadas por câncer de mama e fatores intervenientes. Foi realizado em parceria com o Ambulatório de Fisioterapia do Hospital da Mulher Prof. Dr. José Aristodemo Pinotti (CAISM/UNICAMP). As mulheres submetidas à cirurgia como tratamento para câncer de mama, no período de janeiro a dezembro de 2007, foram contatadas por meio de entrevista telefônica para responder ao questionário contendo itens relacionados a características sociodemográficas, ao trabalho e terapias neoadjuvantes e/ou adjuvantes. Para análise dos resultados foram utilizados os testes estatísticos qui-quadrado, Exato de Fisher e Mann-Whitney pelo programa SPSS 15.0 e análise múltipla pelo programa SAS 9.2. O questionário foi aplicado a 104 mulheres, com idade média na cirurgia de 54,2 anos, 81% das voluntárias retornaram ao trabalho e 76% se mantiveram trabalhando. Parte das mulheres apresentaram mudanças no local de trabalho (14%), nas atividades de trabalho (28%) e na quantidade de horas trabalhadas (50%). Os fatores que apresentaram associação negativa com o retorno ao trabalho foram: ser aposentada antes de receber o diagnóstico de câncer e aposentar-se após o tratamento; ter tido afastamento médico após o tratamento; e mulheres que passaram por consulta com médico perito, psicólogo e enfermeiro no período de seis meses antes da entrevista. Os fatores relacionados à aposentadoria e afastamento médico também influenciaram na manutenção no trabalho, já a consulta com o profissional de enfermagem deixou de ter esta relação, porém consultas com psicólogos e médicos peritos continuaram intervindo. A retratação da saúde como muito boa, boa ou igual, quando comparada a de pessoas da mesma idade, obteve relação benéfica com o retorno e manutenção no trabalho, entretanto outras variáveis foram associadas positivamente apenas com manter-se trabalhando, são elas, não realização de QT neoadjuvante e residir a uma distância maior do que 140 km de Campinas. Existiram dois fatores dificultadores retratados, associados com o retorno ao trabalho, são eles, dor no membro superior homolateral à cirurgia e alterações musculoesqueléticas. As dores em outras partes do corpo influenciaram no retorno e em manter-se trabalhando. Há também dois fatores facilitadores associados com o retorno e manter-se trabalhando, são eles, o bem estar e entender o trabalho como parte da vida, já a necessidade financeira apresentou influência apenas com manter-se trabalhando. Faz-se necessária a criação de medidas de intervenção e educação para as mulheres, empregadores e profissionais da saúde para torná-los aptos a reintegração no mercado de trabalho
Abstract: Breast cancer is the second most common type in the world and the most common among women, nearly 0.6% of cases occur in women younger than 30 years, in this way, many have been diagnosed at age considered productive. The treatments of choice, in general, are conservative or radical surgery, radiotherapy, chemotherapy and / or hormone therapy. The treatments are more precise, less aggressives and efficients, however, complications may occur, altering the prognosis and as a consequence aspects of daily life and professional activities. This study aimed to survey the prevalence of return to work in women treated for breast cancer and intervening factors. It was conducted in partnership with the Physiotherapy Hospital da Mulher Professor. Dr. Jose Aristodemo Pinotti (CAISM/ UNICAMP). Women surgery undergoing as a treatment for breast cancer in the period January to December 2007, with subsequent guidance and assistance from the Department of Physiotherapy, were contacted by telephone interview to answer the questionnaire containing items related to the sociodemographic characteristics, to the work and to neoadjuvant therapy and / or adjuvants. To review the results were used the chi-square, Fisher's exact and Mann-Whitney test using SPSS 15.0 and multivariate analysis using the SAS software 9.2. The questionnaire was administered to 104 women, mean age at surgery was 54.2 years, 81% of the volunteers returned to work and 76% remained working. Part of the women reported changes in the workplace (14%) and work activities (28%) and number of hours worked (50%). The following factors were negatively associated with return to work were to be retired before receiving a diagnosis of cancer and to retire after treatment, have had medical clearance after treatment, and women who had attended a medical expert, psychologist and nurses in the six months before the interview. The factors related to retirement and medical clearance have also influenced the maintenance work, as the consultation with the nursing staff failed to have this relationship, however consultations with psychologists and medical experts continued to intervene. The portrayal of health as very good, good or equal when compared to people the same age, had beneficial relationship with the return and maintenance work, however, other variables were positively associated with only keep working, they are not achieving of neoadjuvant chemotherapy and reside at a distance greater than 140 km from Campinas. There were two factors that complicate portrayed associated with returning to work, they are pain in the ipsilateral upper limb surgery and musculoskeletal abnormalities. The pain in other parts of the body influence the return and keep working. There are also two factors associated with facilitating the return and keep working, they are, well-being and understand the work as part of life, have financial need had influence only to keep working. It is necessary to create measures of intervention and education for women, employers and health professionals to enable them to reintegrate into the labor market
Mestrado
Enfermagem e Trabalho
Mestra em Ciências da Saúde

In Minnesota’s workers’ compensation system, injured employees at risk for sustaining permanent disability may be eligible for receipt of vocational rehabilitation (VR) services if they are determined to be capable of benefitting from such services. VR services can be a valuable resource to injured employees who need assistance minimizing their work disability and maximizing their residual wage-earning capacity. However, for VR services to be effective at a system level, it is necessary to precisely and accurately identify an injured employee’s rehabilitation potential. Failure to do so is likely to result in the misallocation of a scarce and costly resource. Given recent trends in Minnesota’s workers’ compensation system (e.g., higher VR service costs and lower RTW rates among injured employees with indemnity claims), this study was conducted with the purpose of developing and validating an objective, evidence-based method of predicting the RTW status as of claim closure of injured Minnesota employees who sustained permanent impairment and received VR services. To accomplish this purpose, a closed-claim, retrospective design was implemented. Data for this cross-sectional study was obtained from the Minnesota administrative claims database. There were 15,372 claims that met all eligibility criteria. With guidance from the biopsychosocial disablement models developed by Nagi and the World Health Organization, 15 discrete predictor variables that represented medical, individual, and workplace factors were selected for study inclusion. Descriptive and predictive analyses were used to assess the relationship between this study’s RTW outcome and its set of RTW predictors. Using logistic regression, an optimal RTW model was first developed and then internally validated with a split-dataset approach. The optimal RTW model included four main effects (attorney involvement; severity of permanent impairment; age; job tenure) and three first-order interaction effects (pre-injury average weekly wage X pre-injury industry; attorney involvement X severity of permanent impairment; attorney involvement X job tenure). Though not retained in the optimal RTW model, part of body affected and education also had notable bivariate relationships with the outcome. The optimal RTW model’s performance regarding goodness-of-fit and clinical usefulness suggests it may be of value to those assessing rehabilitation potential within Minnesota’s workers’ compensation system.

Background: Around forty percent of cancer diagnoses occur in working-age adults. Improvements in screening and treatment means that most are expected to live years beyond their diagnosis. However, many experience persistent impairments from treatment such as fatigue, cognitive difficulties and emotional distress. Work is a key occupation for this population yet little is understood about working with cancer in the Australian context. Aim: This pilot study aims to investigate work participation amongst cancer survivors in Western Sydney and identify factors associated with returning to work. Methods: A cross-sectional online survey was developed to measure work participation and factors associated with work. Study participants aged 20-65 years, employed at diagnosis, with basic English and computer literacy were recruited from a cancer clinic in Western Sydney over a three-month period. Results: Nineteen survey responses were received and analysed. Participants had returned or remained at work (n=9, 47.4%), unsuccessfully attempted to return to work (RTW) (n=2, 10.5%), or were on leave from work (n=8, 42.1%). Of those on leave most did not plan to RTW (n=6, 31.6%). Fatigue (n=15, 78.9%), difficulty concentrating (n=8, 42.1%), memory issues (n=8, 42.1%), stomach upset (n=7, 36.8%), sleep disturbance, (n=7, 36.8%), and psychological distress (n=7, 36.8%) impacted perceived work ability. Physically demanding work (n=8, 42.1%), length of workday (n=6, 31.6%), productivity demands (n=5, 26.3%) and commuting (n=4, 21.1%) were challenging to manage after cancer. Approximately a quarter of participants reported discussing RTW with people other than their employer (n=5, 26.3%). A supportive workplace was a facilitator for work, whereas a non-supportive workplace was considered a major barrier. Overall participants reported positive attitudes towards work. Conclusion: Cancer survivors in Western Sydney may face challenges engaging in work after treatment. Work participation may be influenced by side effects of treatment, difficulty performing work demands and the work environment.