This study examined the association between return-to-work and impairment type. Database of the [South] Korea Workers' Compensation and Welfare Service was used to identify disabled persons; and return-to-work information was obtained from the Korea Employment Information Services database. The study participants were 79,328 persons who received Workers' compensation and who were confirmed as disabled during 2009-2011. Logistic regression was used to analyze the association between return-to-work and impairment type, adjusted by age, sex, impairment severity, pre-injury businesses size, and pre-injury occupational category. Compared to injuries of the upper limbs, the odds ratio of return-to-work was 0.63 (95% CI, 0.60-0.65) for injuries involving the lower limbs, 0.62 (95% CI, 0.59-0.66) for the spine, 0.75 (95% CI, 0.66-0.86) for the eyes, 0.98 (95% CI, 0.77-1.25) for the oral cavity, 0.44 (95% CI, 0.37-0.53) for the ears, 1.02 (95% CI, 0.83-1.25) for the figure, 0.75 (95% CI, 0.72-0.79) for pain, and 0.36 (95% CI, 0.32-0.41) for neuropsychiatric impairment. These findings indicate that impairment type influences return-to-work rates.
Source : Rhie J, Jeong I, Won JU. J. Korean Med. Sci. 2013; 28(11): 1581-1586.
OBJECTIVES: To estimate the contribution of preexisting chronic conditions on age differences in health care expenditures for the management of work-related musculoskeletal injuries in British Columbia. METHODS: A secondary analysis of workers' compensation claims submitted over the 5-year period between January 1, 2002 and December 31, 2006 (N=55,827 claims among men and 32,141 claims among women). Path models examined the relationships between age and health care expenditures, and the extent to which age differences in health care expenditures were mediated by preexisting chronic conditions. Models were adjusted for individual, injury, occupational, and industrial covariates. RESULTS: The relationship between age and health care expenditures differed for men and women, with a stronger age gradient observed among men. Preexisting osteoarthritis and coronary heart disease were associated with elevated health care expenditures among men and women. Diabetes was associated with elevated health care expenditures among men only, and depression was associated with elevated health care expenditures among women only. The percentage of the age effect on health care expenditures that was mediated through preexisting chronic conditions increased from 12.4% among 25-34-year-old men (compared with 15-24 y) to 26.6% among 55+-year-old men; and 14.6% among 25-34-year-old women to 35.9% among women 55 and older. CONCLUSIONS: The results of this study demonstrate that differences in preexisting chronic conditions have an impact on the relationship between older age and greater health care expenditures after a work-related musculoskeletal injury. The differing prevalence of preexisting osteoarthritis, coronary heart disease, and to a lesser extent diabetes (among men) and depression (among women) across age groups explain a nontrivial proportion of the age effect in health care expenditures after injury. However, approximately two thirds or more of the age effect in health care expenditures remains unexplained.
Source : Smith PM, Bielecky A, Ibrahim S, Mustard C, Scott-Marshall H, Saunders R, Beaton D. Med. Care. 2013.
A prospective cohort study with 15 months follow-up
OBJECTIVE: To identify determinants of limitations in unpaid work (household work, shopping, caring for children and odd jobs around the house) in patients who had suffered major trauma (ISS≥16) and who were in full-time employment (≥80%) at the time of injury. DESIGN: Prospective cohort study. SETTING: University Medical Centre Utrecht, a level 1 trauma centre in the Netherlands. METHOD: All severely injured (ISS≥16) adult (age≥16) trauma survivors admitted from January 1999 to December 2000 who were full-time employed at time of the injury were invited for follow-up (n=214). Outcome was assessed with the 'Health and Labour Questionnaire' (HLQ) at a mean of 15 months (SD=1.5) after injury. The HLQ was completed by 211 patients. RESULTS: Response rate was 93%. Logistic regression analyses identified the percentage of permanent impairment (% PI), level of participation (RtW), co-morbidity, lower extremity injury (LEI) and female gender as determinants of limitations in unpaid work. Patients with a post-injury status of part-time or no return to work experienced more limitations in unpaid work than those who returned to full-time employment. CONCLUSIONS: Resuming paid work after major trauma is not associated with reductions in unpaid activities. To assess the long-term outcome of rehabilitation programmes, we recommend a measure that combines patient's satisfaction in their post-injury jobs with a satisfactory level of activities in their private lives.
Source : Van Erp S, Holtslag HR, Van Beeck EF. Injury, 2013.
Faciliter le retour au travail d'un employé à la suite d'une absence liée à un problème de santé psychologique
Ce guide a été conçu pour vous aider à élaborer une démarche d'accompagnement et de soutien au retour au travail d'un employé à la suite d'une absence liée à un problème de santé psychologique, afin de faciliter son rétablissement et son retour au travail.
Il s'agit d'un outil pratique, qui allie l'accompagnement individuel et les changements organisationnels. Ce guide s'adresse aux dirigeants d'entreprises, aux services de ressources humaines et aux groupes syndicaux préoccupés par la santé des travailleurs et leur maintien en emploi, mais aussi aux praticiens en milieu de travail, notamment les médecins et les intervenants en santé au travail, les psychologues organisationnels et les conseillers en réadaptation.
Source : http://www.irsst.qc.ca/-publication-irsst-guide-soutenir-le-retour-au-travail-et-favoriser-le-maintien-en-emploi-liee-a-un-probleme-de-sante-psychologique-rg-758.html
A path analysis approach
Objectives: This study aims to examine the extent to which a greater prevalence of pre-existing chronic conditions among older workers explains why older age is associated with longer duration of sickness absence (SA) following a musculoskeletal work-related injury in British Columbia.
Methods: A secondary analysis of workers' compensation claims in British Columbia over three time periods (1997–1998; 2001–2002, and 2005–2006), the study comprised 102 997 and 53 882 claims among men and women, respectively. Path models examined the relationships between age and days of absence and the relative contribution of eight different pre-existing chronic conditions (osteoarthritis, rheumatoid arthritis, hypertension, coronary heart disease, diabetes, thyroid conditions, hearing problems, and depression) to this relationship. Models were adjusted for individual, injury, occupational, and industrial covariates.
Results: The relationship between age and length of SA was stronger for men than women. A statistically significant indirect effect was present between older age, diabetes, and longer days of SA among both men and women. Indirect effects between age and days of SA were also present through osteoarthritis, among men but not women, and coronary heart disease, among women but not men. Depression was associated with longer duration of SA but was most prevalent among middle-aged claimants. Approximately 70–78% of the effect of age on days of SA remained unexplained after accounting for pre-existing conditions.
Conclusions: Pre-existing chronic conditions, specifically diabetes, osteoarthritis and coronary heart disease, represent important factors that explain why older age is associated with more days of SA following a musculoskeletal injury. Given the increasing prevalence of chronic conditions among labor market participants (and subsequently injured workers) moderate reductions in age differences in SA could be gained by better understanding the mechanisms linking these conditions to longer durations of SA.
Source : Smith P, Bielecky A, Ibrahim S, Mustard C, Saunders R, Beaton D, Koehoorn M, McLeod C, Scott-Marshall H, Hogg-Johnson S. Scand J Work Environ Health. 2013.
BACKGROUND: Osteoarthritis (OA) is a multifactorial disease with strong genetic and occupational components. Although published studies have described several risk factors for OA, very few studies have investigated the occupational and genetic factors that contribute to this debilitating condition. OBJECTIVE: To describe occupational and genetic factors that may contribute to the risk of developing (OA). METHODS: A literature search was conducted in PubMed using the search terms osteoarthritis, occupation, work, and genetics. RESULTS: Heavy physical work load was the most common occupational risk factor for OA in several anatomical locations. Other factors include kneeling and regular stair climbing, crawling, bending and whole body vibration, and repetitive movements. Numerous studies have also shown the influence of genetic variability in the pathogenesis of OA. Genetic variants of several groups of genes e.g., cartilage extracellular matrix structural genes and the genes related to bone density have been implicated in disease pathogenesis. CONCLUSION: This review shows that occupational factors were extensively studied in knee OA unlike OA of other anatomical regions. Although genetic association studies performed to date identified a number of risk variants, some of these associations have not been consistently replicated across different studies and populations. Therefore, more research is needed.
Source : Berran Yucesoy, Luenda E. Charles, Brent Baker, Cecil M. Burchfiel. Work: A Journal of Prevention, Assessment and Rehabilitation. http://dx.doi.org/10.3233/WOR-131739
BACKGROUND: Work-related stress is associated with a variety of mental and emotional problems and can lead to substantial economic costs due to lost productivity, absenteeism or the inability to work. There is a considerable amount of evidence on the effectiveness of traditional face-to-face stress-management interventions for employees; however, they are often costly, time-consuming, and characterized by a high access threshold. Web-based interventions may overcome some of these problems yet the evidence in this field is scarce. This paper describes the protocol for a study that will examine the efficacy and cost-effectiveness of a web-based guided stress-management training which is based on problem solving and emotion regulation and aimed at reducing stress in adult employees. METHODS: The study will target stressed employees aged 18 and older. A randomized controlled trial (RCT) design will be applied. Based on a power calculation of d=.35 (1-betaof 80%,alpha= .05), 264 participants will be recruited and randomly assigned to either the intervention group or a six-month waitlist control group. Inclusion criteria include an elevated stress level (Cohen's Perceived Stress Scale-10 [greater than or equal to] 22) and current employment. Exclusion criteria include risk of suicide or previously diagnosed psychosis or dissociative symptoms. The primary outcome will be perceived stress, and secondary outcomes include depression and anxiety. Data will be collected at baseline and seven weeks and six months after randomization. An extended follow up at 12 months is planned for the intervention group. Moreover, a cost-effectiveness analysis will be conducted from a societal perspective and will include both direct and indirect health care costs. Data will be analyzed on an intention-to-treat basis and perprotocol. DISCUSSION: The substantial negative consequences of work-related stress emphasize the necessity for effective stress-management trainings. If the proposed internet intervention proves to be (cost-) effective, a preventative, economical stress-management tool will be conceivable. The strengths and limitations of the present study are discussed.
Source : Heber E, Ebert DD, Lehr D, Nobis S, Berking M, Riper H. BMC Public Health 2013; 13(1): 655. http://dx.doi.org/10.1186/1471-2458-13-655
Purpose Emerging research has shown that co-workers have a significant influence on the return-to-work outcomes of partially fit ill or injured employees. By drawing on theoretical findings from the human resource and wider behavioral sciences literatures, our goal was to formulate a theoretical model of the influences on and outcomes of co-worker responses within work reintegration. Methods From a search of 15 data bases covering the social sciences, business and medicine, we identified articles containing models of the factors that influence co-workers' responses to disability accommodations; and, the nature and impact of co-workers' behaviors on employee outcomes. To meet our goal, we combined identified models to form a comprehensive model of the relevant factors and relationships. Internal consistency and externally validity were assessed. Results The combined model illustrates four key findings: (1) co-workers' behaviors towards an accommodated employee are influenced by attributes of that employee, the illness or injury, the co-worker themselves, and the work environment; (2) the influences–behaviour relationship is mediated by perceptions of the fairness of the accommodation; (3) co-workers' behaviors affect all work reintegration outcomes; and (4) co-workers' behaviours can vary from support to antagonism and are moderated by type of support required, the social intensity of the job, and the level of antagonism. Conclusions Theoretical models from the wider literature are useful for understanding the impact of co-workers on the work reintegration process. To achieve optimal outcomes, co-workers need to perceive the arrangements as fair. Perceptions of fairness might be supported by co-workers' collaborative engagement in the planning, monitoring and review of work reintegration activities.
Source : Debra A. Dunstan, Ellen Maceachen . Journal of Occupational Rehabilitation, August 2013. http://dx.doi.org/10.1007/s10926-013-9461-x
Purpose: To document in workers having a work disability due to a musculoskeletal disorder (MSD), the presence and variation over time of their intolerance of uncertainty and its maintenance factors as defined in Dugas et al.’s generalized anxiety disorder (GAD) model, i.e. worries, negative problem orientation, beliefs about the usefulness of worrying, cognitive avoidance and their consequences on depressive symptoms. Methods: An observational, prospective repeated-measures design was retained. Thirty-nine workers with an MSD having caused a work absence of over three months and who were beginning a work rehabilitation program were recruited and evaluated at four moments (beginning of rehabilitation program, first hours of work exposure, 50% of regular working hours and end of rehabilitation program). Validated self-report questionnaires measuring intolerance of uncertainty and its maintenance factors were administered. Finally, the Worry and Anxiety Questionnaire measured the presence and intensity of GAD symptoms as defined in the DSM-IV-TR. Results: Fifty percent of the workers initially exhibited GAD symptoms. Concerning the variation over time, improvements were noted in all GAD-related factors during the program, particularly with the first hours of work exposure. At the end of rehabilitation, only 21% of the participants still met GAD diagnostic criteria. Conclusion: Workers with an MSD causing a work disability averaging one year in length and enrolled in a work rehabilitation program exhibited a high level of anxiety at the beginning of the work rehabilitation program. Workers perceived a usefulness in worrying and presented some intolerance of uncertainty and some cognitive avoidance strategies. According to Dugas et al.’s GAD model, the intensity of the symptoms associated with GAD development and maintenance factors was, however, not typical of a GAD. A reconceptualization of the problem in terms of reducing the work disability rather than reducing pain may constitute a promising avenue to reduce anxiety symptoms. Future studies should look at the specific impact of work exposure, not only on pain symptoms but also on worries.
Source : Coutu, Marie-France; Durand, Marie-José; Marchand, André; Labrecque, Marie-Elise; Berbiche, Djamal; Cadieux, Geneviève. Disability and Rehabilitation, Vol. 35, no 19, September 2013 , p. 1599-1607. http://dx.doi.org/10.3109/09638288.2012.748833
Purpose The Multidimensional Pain Inventory (MPI) was designed to help capture unique characteristics of chronic pain patients. The present study examined the proportion of subgroups classified by the MPI in a chronic disabling occupational musculoskeletal disorder (CDOMD) patient cohort, and described characteristics of MPI profile groups in terms of other psychosocial variables. Methods A cohort of 1,270 CDOMD patients undergoing an interdisciplinary functional restoration program was studied. Before the start of the program, all patients received a standard psychosocial assessment battery. A MPI computer program scored and identified pre-defined MPI subgroups: Adaptive Coper (AC); Interpersonally Distressed (ID); and Dysfunctional (DYS). Results The distribution of MPI profiles for CDOMD patients was similar with those of highly disabled patients, with the largest proportion of patients having the DYS profile (44 %), followed by AC (33 %) and ID (23 %). The DYS profile group showed the highest level of pain severity, and psychosocial distress; the ID group had a moderate level; and the AC profile group had the lowest level. Higher rates of psychiatric disorders were also found in the DYS and ID groups. The DYS profile group was less likely to complete the treatment program. Conclusion The present study further demonstrated the clinical utility of the MPI classification in a large cohort of CDOMD patients, indicating that the MPI profiles successfully distinguish among patients who may require extra psychosocial attention to achieve successful treatment gains and program completion.
Source: Choi, YunHee; Mayer, Tom; Williams, Mark; Gatchel, Robert. Journal of Occupational Rehabilitation, Volume 23, Number 2, June 2013 , pp. 239-247(9). http://dx.doi.org/10.1007/s10926-012-9393-x
Background The increasing prevalence of older workers and chronic health conditions represents a growing occupational health concern. More research is needed to understand risk factors, apply and adapt theories, and test workplace-focused interventions that might prevent work disability and disengagement among chronically ill workers. Methods A 2-h roundtable symposium involving 28 participants was held at an international conference (Second Scientific Conference on Work Disability Prevention & Integration, Groningen, The Netherlands) in October 2012. In that symposium, small groups of participants were invited to discuss theoretical, methodological, and implementation considerations for studying workplace function and well-being among workers with chronic health conditions. As a follow-up to the symposium, the organizers invited authors to submit original articles to a Special Section of the Journal of Occupational Rehabilitation for peer review and publication. Results Results of the symposium reflected the need to address social, not just physical, aspects of the workplace, to include both individual-level and organizational interventions, and to integrate employer perspectives and operational models. Contributions to the Special Issue focus on outcome measurement, symptom self-management at work, job accommodations, prognostic factors for disability escalation, and the perceived needs of affected workers. Conclusions The content of the Special Section reflects an evolving body of research that continues to grapple with basic issues around choice of outcome measures, level of intervention, and the optimal ways to meet the needs of workers with chronic health conditions, including supporting efforts to manage symptoms and function at work. Future research should focus on integrating organizational and individual-level interventions.
Source : Source: Shaw, William; Tveito, Torill; Boot, Cécile, Journal of Occupational Rehabilitation, vol. 23, no 2, June 2013 , p. 157-161(5). http://dx.doi.org/10.1007/s10926-013-9448-7
This review aims to highlight how the chronic condition self-management support (CCSMS) field might inform and enhance the skills of the disability employment services (DES) workforce, particularly in its interactions with clients with complex disability needs. The approach we have taken involves a consideration of current education and training, recruitment of staff into DES and issues of concern arising from these processes. The main findings of our review are that the current DES workforce may not have the required skills to fully meet the needs of the populations they serve given the growing burden of chronic conditions, generally. We conclude by calling for greater consideration of CCSMS education and training as core required skills for the DES workforce, so that they might integrate their practice more collaboratively alongside other support providers.
disability; employment; training; competencies; chronic condition management
Source : Catherine Byrnes and Sharon Lawn (2013). Disability Employment Services in Australia: A Brief Primer. The Australian Journal of Rehabilitation Counselling, 19, pp 46-56. http://dx.doi.org/10.1017/jrc.2013.4.
Purpose To investigate the impact of rehabilitation measures on work ability and return to work (RTW), specifically the association between workplace rehabilitation/supportive conditions at work and work ability and RTW over time, among women on long-term sick leave. Methods Questionnaire data were collected (baseline, 6 and 12 months) from a cohort of women (n = 324). Linear mixed models were used for longitudinal analysis of the repeated measurements of work ability index (WAI), work ability score and working degree. These analyses were performed with different models; the explanatory variables for each model were workplace rehabilitation, supportive conditions at work and time. Results The individuals provided with workplace rehabilitation and supportive conditions (e.g. 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) had significantly increased WAI and work ability score over time. These individuals scored higher work ability compared to those individuals having workplace rehabilitation without supportive conditions, or neither. Additionally, among the individuals provided with workplace rehabilitation and supportive conditions, working degree increased significantly more over time compared to those individuals with no workplace rehabilitation and no supportive conditions. Conclusion The results highlight the importance of integrating workplace rehabilitation with supportive conditions at work in order to increase work ability and improve the RTW process for women on long-term sick leave.
Source: Ahlstrom, Linda; Hagberg, Mats; Dellve, Lotta, Journal of Occupational Rehabilitation, vol. 23, no 2, June 2013, p. 248-260.
This selective review provides an overview of salient research findings related to employers' attitudes towards disability and prospective influences on employers to improve employment outcomes of people with disabilities. Research studies included for review are mainly those which investigated employer attitudes towards disability as predispositions to hiring people with disability. Selected studies were classified into three categories including hiring and accommodating employees with disabilities, work performance, and affective reactions and behavioural intentions of employers. Excluded from the review were studies that investigated other factors influencing employer attitudes toward disability. Altogether 34 research studies from the period of 1987 until 2012 were included in the review. Primary databases for the review included ProQuest, Ebscohost, Lexus Nexus, ERICK Database and the Sage Sociology Collection. This review of the demand-side employment literature suggests employers hold relatively positive attitudes regarding individuals with disabilities. However, employer affective reactions and behavioural intentions of employers towards disability in the work setting were less positive and negatively impact hiring decisions, provision of accommodations and work performance appraisals. Employer attitudes represent an important demand-side factor impacting full participation in competitive employment for individuals with disabilities. While employers report generally positive attitudes toward disability, hiring practices may still be discriminatory. Use by rehabilitation professionals of demand-side strategies with employers would likely result in higher rates of work participation by people with disabilities.
Source : Jana Burke, Jill Bezyak, Robert T. Fraser, Joseph Pete, Nicole Ditchman and Fong Chan (2013). Employers' Attitudes Towards Hiring and Retaining People with Disabilities: A Review of the Literature. The Australian Journal of Rehabilitation Counselling, 19, p. 21-38. http://dx.doi.org/10.1017/jrc.2013.2.
Purpose The aim of the study was to explore experiences and thoughts in the process of returning to work in employed patients with Exhaustion Disorder. Methods Twelve patients with Exhaustion Disorder (burnout) who had been referred to a Stress Rehabilitation Clinic were interviewed. All patients were employed but a majority was on full or part-time sick leave. Grounded Theory was used as the qualitative method. Results A core category, regaining the ability to work, was developed. Alongside, two categories, internal resources and the external support system, were experienced as being important to the process. The internal resources were expressed through three key features (sub-categories), perceived validation, insights and adaptive coping abilities. The external support system was diverse and described by the sub-categories practical/structural and/or emotional support. Four external support actors were identified; the workplace, health care, the Social Insurance Agency, and the union. The supervisor was described as the most important external actor. Conclusions Internal and external resources are intertwined in the process of regaining the ability to work. The internal resources and external support can directly increase the probability to regain the ability to work. Moreover, these resources can affect each other and thus indirectly have an effect on the process.
Source: Norlund, Sofia; Fjellman-Wiklund, Anncristine; Nordin, Maria; Stenlund, Therese; Ahlgren, Christina, Journal of Occupational Rehabilitation, vol. 23, no 2, June 2013 , p. 270-279. http://dx.doi.org/10.1007/s10926-012-9396-7
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