Economic Evaluation of a New Organizational RTW Intervention to Improve Cooperation Between Sick-Listed Employees and Their Supervisors: A Field Study

A Field Study
Objective: The purpose of this study is to assess the cost-effectiveness, -utility, and -benefit of a new organizational return-to-work intervention to improve COoperation between Sick-listed employees and their Supervisors (COSS).
Methods: A field study with 6 months follow-up comparing COSS with common practice randomized participants aged 18 to 60, working at least 12?hours/week and absent for at least 2 weeks. Outcomes were initial return-to-work, quality-adjusted life years, and productivity gains.
Results: After 6 months, COSS generated less costs when compared with common practice. Participants in the COSS group returned to work earlier, improvement in quality-adjusted life years were uncertain. Net benefits of COSS versus common practice yielded a productivity gain of €395.89.
Conclusions: Implementing COSS for sick-listed employees has potentials to reduce costs and improve productivity, and potentially quality of life. Longitudinal research might detect whether COSS also has the potential reaching sustainable return-to-work.

Source: Noben, Cindy; Hoefsmit, Nicole; Evers, Silvia; de Rijk, Angelique; Houkes, Inge; Nijhuis, Frans. Journal of Occupational & Environmental Medicine: November 2015, Volume 57, Issue 11, p. 1170-1177.

Understanding the Probability of a Disability Resulting From Work-Related Injuries

Objectives: To assess the conditions under which the measured risk of a workplace injury resulting in a disability changes.
Methods: Multivariate regression analysis and administrative claims data build an understanding of the factors that underlie the probability that a workplace injury results in a disability (disability probability).
Results: First, jointly examining injury incidence rates and disability probabilities challenges some conclusions suggested by examining the two separately. Second, some characteristics identified as risk factors for disability when studied in isolation are not risk factors. Third, risk factors are qualitatively consistent across groups of workers but quantitatively different.
Conclusions: Policymakers might draw incorrect conclusions about the risk of a workplace injury becoming a disability unless the research provides a joint assessment of incidence rates and disability probabilities and a comprehensive analysis of risk factors across worker groups.

Source: Journal of Occupational & Environmental Medicine: November 2015, Volume 57, Issue 11, p. 1236-1243.

Replication of a Prospective Randomized Controlled Trial of Resource Facilitation to Improve Return to Work and School after Brain Injury

OBJECTIVE: To determine the extent to which previous findings on the effectiveness of resource facilitation to impact return to work and school could be replicated.
DESIGN: Randomized controlled trial. SETTING: Outpatient rehabilitation clinic. PARTICIPANTS: Forty-four outpatients with acquired brain injury. INTERVENTION: Fifteen months of resource facilitation services. MAIN OUTCOME MEASURES: A revised version of the Vocational Independence Scale and the Participation Index of the Mayo-Portland Adaptability Inventory-4.
RESULTS: Participants randomized to the resource facilitation group demonstrated significant advantage in terms of rate and timing of return to productive community-based work relative to control participants. When examining only return to competitive work (and not return to school), 69% of the resource facilitation group was able to return as compared to 50% of the control participants. Analyses of measures of participation in household and community activities revealed that both groups improved significantly over the 15 month study period, but no significant advantage for either group was demonstrated.
CONCLUSIONS: This study replicates the positive impact of resource facilitation in improving productive community-based activity, including competitive employment and volunteering in the community.

Source: Trexler LE, Parrott DR, Malec JF. Arch. Phys. Med. Rehabil. 2015.

Work-related rehabilitation aftercare for patients with musculoskeletal disorders

Results of a randomized-controlled multicenter trial
There is evidence that rehabilitation with a multidisciplinary focus on work-related demands effectively improves work ability and quickens return to work in patients with musculoskeletal disorders. There could be benefits to the transfer of work-related components into rehabilitation aftercare. We examined the effectiveness of an intensified work-related rehabilitation aftercare program compared with standard intensified rehabilitation aftercare in Germany on work ability. We randomly assigned 307 patients with musculoskeletal disorders from 11 rehabilitation centers to an aftercare program with work-related functional capacity training, work-related psychosocial groups, social counseling, relaxation training and exercise therapy (intervention group), or the usual aftercare program consisting of only exercise therapy (control group). The 6-month follow-up questionnaire was completed by 78.5% of patients. There was no statistically relevant between-group difference in follow-up primary (work ability) and secondary outcomes (e.g. health-related quality of life, sick leave duration). Significant improvements were observed within both the intervention and the control groups. Severely disabled participants in the intervention group had better physical functioning and shorter sick leave duration after 6 months compared with severely disabled patients in the control group. A partial replacement of standard exercise therapy by a more work-related therapy does not seem to improve work ability superiorly. Improved aftercare treatment may require a focus on employer participation and involvement within the actual work environment.

Source: Knapp, Sebastian; Briest, Juliane; Bethge, Matthias. International Journal of Rehabilitation Research, September 2015, Volume 38, Issue 3, p. 226-232.

Implementation of the Danish return-to-work program

Process evaluation of a trial in 21 Danish municipalities
Objectives: The aim of this study was to evaluate the implementation of the Danish national return-to-work (RTW) program in 21 Danish municipalities.
Methods: We conducted a structured process evaluation on (i) reach and recruitment, (ii) fidelity, (iii) dose-delivered, (iv) dose-received, and (v) context by formulating 29 implementation criteria and analyzing qualitative and quantitative data from administrative records, interviews, field notes, and questionnaires.
Results: All municipalities integrated the basic features of the RTW program into the existing framework of the sickness benefit management system to an acceptable degree, ie, establishment of RTW teams, participation of RTW team members in the training courses, and following the general procedures of the program. However, the level of implementation varied considerably between the municipalities, particularly with respect to fidelity (defined as implementation consistent with the principles of the interdisciplinary RTW process). Five municipalities had high and eight had low fidelity scores. Similar large differences were found with regard to dose-delivered, particularly in the quality of cooperation with beneficiaries, employers, and general practitioners. Only 50% of the first consultations with the RTW coordinator were conducted in time. Among participants who were employed when their sickness absence period started, only 9% had at least one meeting with their workplace.
Conclusion: It was feasible to implement the basic features of the Danish RTW program, however, large variations existed between municipalities. Establishment of well-functioning interdisciplinary RTW teams might require more time and resources, while ensuring early assessment and more frequent cooperation with employers might need more general adjustments in the Danish sickness benefit system.

Source: Aust B, Nielsen MBD, Grundtvig G, Buchardt HL, Ferm L, Andersen I, Lund TL, Jelle MOC, Andersen MF, Hansen JV, Tverborgvik T, Helverskov T, Bjorner JB, Rugulies R, Ørbæk P, Winzor G, Bültmann U, Poulsen OM. Scand J Work Environ Health, 2015.

L’évaluation clinique, les traitements et le retour en emploi de travailleurs souffrant d’atteintes de la coiffe des rotateurs

Bilan des connaissances
Les atteintes musculosquelettiques de l'épaule constituent une problématique importante au sein de la population générale, et particulièrement chez les travailleurs. Ce type d'atteintes affecte le statut fonctionnel de l'épaule et la qualité de vie des personnes et peut entrainer, chez les travailleurs, des problématiques d'absentéisme ou des pertes de productivité. Les travailleurs effectuant des tâches avec les bras au-dessus des épaules ou des tâches répétitives présentent un risque plus important de développer une lésion à l'épaule, particulièrement une atteinte de la coiffe des rotateurs (CR). Pour la période 2005-2007, les coûts totaux générés annuellement par les lésions aux épaules acceptées par la Commission de la santé et de la sécurité du travail (CSST), incluant les coûts humains et ceux associés aux pertes de productivité, se chiffraient à 393 204 738$.
Devant l'importance de cette problématique, un vaste bilan des connaissances a été effectué sur plusieurs aspects liés aux atteintes de la CR. L'objectif principal de ce bilan des connaissances était de synthétiser les données probantes et de formuler des recommandations concernant les outils diagnostiques et d'évaluation clinique, les interventions thérapeutiques ainsi que les interventions en milieu de travail pour les travailleurs souffrant d'une atteinte de la CR. Des revues systématiques ou des méta-analyses de la littérature pertinente ont été effectuées pour chacun de ces thèmes. Plusieurs acteurs du réseau ont contribué à dresser ce bilan, soit des chercheurs, des collaborateurs et des cliniciens.


Leaving Some Behind: What Happens When Workers Get Sick

In a given year, six percent of Canadian workers will experience a personal health issue that will require them to adjust their work status. This can include being away from work for an extended period of time, changing from full- to part-time work, or leaving the labour market entirely.
Interrupting work is costly for everyone. In 2010, Canadian governments and insurance carriers provided $29 billion in direct income support to individuals dealing with a personal illness or disability. The loss of productivity to employers, the demand for care and the decline in consumption among households when employment earnings cannot fully be replaced are also significant dimensions of a health episode.
As our workforce ages and episodic and chronic health conditions become more prevalent, it is important that Canada have a robust and integrated system to support workers and employers when someone becomes sick. In June 2015, the IRPP convened a special round table with experts, stakeholders and practitioners to discuss these issues. Building on the round table discussion, Tyler Meredith and Colin Chia examine how Canada is doing, and the policy options governments should consider to strengthen the system.


Le devenir professionnel des actifs en mauvaise santé

Un maintien en emploi plus difficile
Une santé altérée en 2006 est défavorable au maintien dans l'emploi en 2010. Mais les actifs à la santé altérée qui restent en emploi connaissent plus souvent que les autres des changements favorables dans leur environnement familial et social.
Un peu plus d'un tiers des actifs occupés en mauvaise santé en 2006 indiquent que leur état de santé a eu des conséquences sur leur vie professionnelle. Ainsi, les changements ou aménagements de poste favorisent le maintien dans l'emploi, particulièrement lorsque les problèmes de santé sont d'ordre physique.
Les conditions de travail en 2006 jouent peu sur le maintien en emploi des personnes à la santé altérée, mais une baisse des expositions aux contraintes physiques pour les hommes et une augmentation du pouvoir décisionnel pour les femmes favorisent une meilleure santé pour ceux et celles qui se sont maintenus en emploi.


Examining the Relationship Between Productivity Loss Trajectories and Work Disability Outcomes Using the Panel Study of Income Dynamics

Objective: To identify trajectories of productivity loss and examine the relationship between the trajectories and work disability outcomes.
Methods: Latent class growth analysis of productivity loss was estimated for the ages of 25 to 44 years in the Panel Study of Income Dynamics (N = 4960). Differences among the trajectories for work disability outcomes for the ages of 25 to 64 years were estimated using logistic regression and analysis of variance.
Results: A five-group trajectory model was identified with a no-risk, low-risk, high-risk, early-onset increasing risk, and late-onset increasing risk group. The likelihood of ever experiencing permanent disability or receiving Social Security Disability Insurance between the ages of 25 and 64 years differed across the trajectories with the early-onset and high-risk groups having the greatest likelihood and the no-risk trajectory having the lowest likelihood of work disability.
Conclusions: Productivity loss trajectories are highly related to work disability outcomes.

Source: Besen, Elyssa; Pransky, Glenn. Journal of Occupational & Environmental Medicine: August 2015, Volume 57, Issue 8, p. 829-835.

Participant recruitment for studies on disability and work: challenges and solutions

PURPOSE: A number of key issues related to employment of persons with disabilities demand ongoing and effective lines of inquiry. There is evidence, however, that work researchers struggle with recruitment of participants, and that this may limit the types and appropriateness of methods selected. This two phase study sought to identify the nature of recruitment challenges in workplace-based disability research, and to identify strategies for addressing identified barriers.
METHODS: The first phase of this study was a scoping review of the literature to identify the study designs and approaches frequently used in this field of inquiry, and the success of the various recruitment methods in use. In the second phase, we used qualitative methods to explore with employers and other stakeholders in the field their perceived challenges related to participating in disability-related research, and approaches that might address these.
RESULTS: The most frequently used recruitment methods identified in the literature were non-probability approaches for qualitative studies, and sampling from existing worker databases for survey research. Struggles in participant recruitment were evidenced by the use of multiple recruitment strategies, and heavy reliance on convenience sampling. Employers cited a number of barriers to participation, including time pressures, fear of legal reprisal, and perceived lack of relevance to the organization.
CONCLUSIONS: Participant recruitment in disability-related research is a concern, particularly in studies that require collection of new data from organizations and individuals, and where large probability samples and/or stratified or purposeful samples are desirable. A number of strategies may contribute to improved success, including development of participatory research models that will enhance benefits and perceived benefits of workplace involvement.

Source: Lysaght R, Kranenburg R, Armstrong C, Krupa T. J. Occup. Rehabil, 2015.

Absenteeism due to Functional Limitations Caused by Seven Common Chronic Diseases in US Workers

Objective: The study examined the relationship between functional limitation due to chronic diseases and absenteeism among full-time workers. The studied chronic diseases include arthritis/rheumatism, cancer, diabetes, heart disease, hypertension, lung disease, and stroke.
Methods: We analyzed data from the 2011 to 2013 National Health Interview Survey. Economic impact was determined by workdays lost and lost income.
Results: Increase in absenteeism was observed for each studied condition. Employees with multiple conditions also saw increase absenteeism. Employers lose 28.2 million workdays annually ($4.95 billion in lost income) due to functional limitation caused by chronic diseases.
Conclusions: The results show a burden on society due to functional limitation caused by studied chronic diseases. Employers should look into implementing intervention/prevention programs, such as the Chronic Disease Self-Management Programs, to help reduce the cost associated with absenteeism.

Source: Vuong, Tam D.; Wei, Feifei; Beverly, Claudia J. Journal of Occupational & Environmental Médicine, July 2015, Volume 57, Issue 7, p. 779-784.

Travailler avec une maladie chronique évolutive

Face à la multiplication des pathologies dans la population active, les entreprises ne peuvent plus se contenter de réponses individuelles. La solution passe par la mise en oeuvre de politiques collectives, à même de favoriser le maintien en emploi des personnes atteintes.

Source: Travail & Changement, numéro 360, juillet-août-septembre 2015.

Prognostic factors of return to work after traumatic or non-traumatic acquired brain injury

PURPOSE: To investigate and to determine evidence of prognostic factors for return to work (RTW) after acquired brain injury (ABI).
METHOD: A systematic literature search was conducted in PubMed (2008-2014), applying terms for ABI and RTW. In addition, studies published after 2003 of a previous review on the same topic were added. The methodological quality of the included studies was assessed and evidence was classified.
RESULTS: Twenty-seven studies were included. There is strong evidence that a high education level is positively associated with RTW after traumatic ABI; a low education level, unemployment and length of stay in rehabilitation are negatively associated, and a clear tendency has been deduced from the studies that conscious state in the Emergency Department is not associated with RTW. After non-traumatic ABI, there is strong evidence that independence in activities of daily living is positively associated with RTW and aetiology of stroke is not.
CONCLUSIONS: This study confirms earlier findings that after both traumatic and non-traumatic ABI injury related factors in the Emergency Department are not associated with RTW. In addition, it provides further evidence that personal factors after traumatic ABI and activity-related factors after non-traumatic ABI are strongly associated with RTW. Implications for Rehabilitation We found strong evidence for a significant association between RTW and personal factors (education level, unemployment) after traumatic ABI, and activities of daily living (ADL) after non-traumatic ABI. We advise to focus on work-related activities during the RTW process besides ADL-training and pay attention to and support patients at risk for not returning to work.

Source: Donker-Cools BH, Wind H, Frings-Dresen MH. Disabil. Rehabil. 2015.

Conséquences des troubles musculo-squelettiques sur l’itinéraire professionnel, résultats d’une enquête nationale

Objectif: Utiliser les données d'une enquête nationale pour décrire les conséquences sur l'itinéraire professionnel des troubles musculo-squelettiques (TMS), que ceux-ci soient ou non d'origine professionnelle, avec un intérêt spécifique pour certaines conséquences : retrait définitif du marché du travail, inaptitude, rente pour maladie professionnelle.
Matériel et méthodes: La population d'étude est constituée des 11 646 sujets de l'enquête santé et itinéraire professionnel (SIP), âgés de 30 à 74 ans, qui avaient occupé au moins un emploi dans leur vie. Les sujets ayant souffert de TMS dans leur vie, et pour lesquels la conséquence a été un retrait définitif du travail, ont été comparés à deux autres groupes, TMS sans conséquence sur l'histoire professionnelle, et absence de TMS, par des modèles multinomiaux. Les autres conséquences des TMS sur l'itinéraire professionnel ont fait l'objet d'analyses descriptives.
Résultats: Parmi les sujets classés « TMS avec conséquence sur l'itinéraire professionnel » c'est le retrait définitif du marché du travail qui est la conséquence la plus fréquente, pour les hommes comme pour les femmes, et ce risque est lié au niveau d'études. Un pourcentage élevé des sujets mis en inaptitude suite à un TMS se retrouve licencié ou hors du marché du travail (18/27 pour les hommes, 32/48 pour les femmes). Peu de sujets dans le groupe « TMS avec conséquence » bénéficient d'une rente pour maladies professionnelle (3 % des hommes, 1 % des femmes), et dans ce groupe être bénéficiaire de l'allocation adulte handicapé (AAH) est plus fréquent pour les femmes que pour les hommes.
Conclusions: Ces résultats amènent à s'interroger sur ce qui devrait être mis en œuvre pour que des personnes souffrant de TMS (ou d'autres problèmes de santé) puissent continuer à travailler. Il serait aussi utile de comprendre quels sont les processus de décision qui sous-tendent les associations observées.

Source: Leclerc, A., Chastang, J. F., Pascal, P., Plouvier, S., & Mediouni, Z. (2015). Archives des Maladies Professionnelles et de l'Environnement.

Stability of Employment Over the First 3 Years Following Traumatic Brain Injury

Objective: To examine the stability of employment between 1 and 3 years following traumatic brain injury (TBI) and to identify the variables associated with continued employment throughout this time span.
Participants: This study included 236 individuals with predominantly moderate to very severe TBI, who had received rehabilitation in the context of a no-fault accident compensation system. Participants were eligible for the current study if they were employed before injury and reported their employment status at 1, 2, and 3 years following their injury as part of a longitudinal head injury outcome study.
Results: Only 44% of participants remained employed at each of the 3 years following TBI. There was also substantial transition into and out of employment across the 3 years. Significantly greater instability in employment was reported by individuals who were machinery operators or laborers before injury, had a longer duration of posttraumatic amnesia, reported more cognitive difficulties, and were less mobile 1 year following their injury.
Conclusion: A number of important factors determine the likelihood of achieving stability in employment following TBI. Findings from the current study support the continued need to identify ways in which physical as well as cognitive changes contribute to employment following TBI. Further examination is needed to identify possible compensatory strategies or job modifications to maximize the likelihood of job retention.

Source: Ponsford, Jennie L.; Spitz, Gershon. Journal of Head Trauma Rehabilitation: May/June 2015, Volume 30, Issue 3, p. E1–E11.

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