Barriers and facilitators for implementation of a return-to-work intervention for sickness absence beneficiaries with mental health problems

Results from three Danish municipalities
AIMS: Evidence for the effectiveness of return-to-work (RTW) interventions aimed at sickness absence beneficiaries with mental health problems (MHPs) is still relatively sparse and mostly inconclusive. This may in part reflect the varying settings and inconsistent implementations associated with the interventions. The aim of this paper is to identify barriers and facilitators for the implementation of a coordinated and tailored RTW-intervention implemented at three different sites. METHODS: We used qualitative and quantitative data to assess the implementation according to process evaluation guidelines. Data sources were individual and group interviews, observations, national registers, and documents used in the intervention. RESULTS: The quality of the implementation varied greatly across the three settings. Barriers included lack of skills to assess MHPs according to the inclusion criteria, different interpretations of sickness absence legislation among stakeholders, competing rehabilitation alternatives, and lack of managerial support for the intervention. An important facilitator was the motivation and availability of resources to solve disagreements through extensive communication. CONCLUSIONS: The different settings presented various barriers and facilitators, which resulted in different versions of the intervention. A higher degree of user involvement in the design and development phase is likely to improve the implementation quality of future interventions.

Source: Martin MH, Moefelt L, Nielsen MB, et al. Scandinavian Journal of Public Health, 2015.

Quel est l’impact du système d’indemnisation maladie sur la durée des arrêts de travail pour maladie ?

En France, les indemnités journalières versées à un salarié en cas d'absence au travail pour maladie sont fi nancées par un système à trois étages. Le premier étage
est constitué des indemnités journalières versées par l'Assurance maladie. Le deuxième étage dépend des dispositions de la convention collective dont le salarié relève. Le troisième étage, facultatif pour les employeurs, est négocié au niveau de chaque entreprise, et permet de bénéfi cier d'indemnité en sus des obligations des accords de branche. Ce troisième étage n'est pas abordé ici. Le deuxième étage offre des prestations qui peuvent aller bien au-delà de la prestation minimale obligatoire, avec de grandes disparités selon la convention collective et la catégorie dont relève le salarié.


Development and validation of a clinical prediction rule of the return-to-work status of injured employees in Minnesota

PURPOSE: Vocational rehabilitation services can be a valuable resource to injured employees at risk for sustaining permanent disability. The aim of this study was to develop and validate a predictive model of return-to-work (RTW) status at workers' compensation claim closure that may assist rehabilitation counselors tasked with determining how to allocate such services.
METHODS: A cross-sectional, retrospective study was conducted using data obtained from 15,372 workers' compensation claims in Minnesota's administrative claims database. The association between a set of 15 predictor variables representing medical and contextual factors and the RTW status as of claim closure of the accessible population was assessed using backward stepwise logistic regression. The most parsimonious set of variables that reliably predicted the outcome was selected as the optimal RTW model. This model was then internally validated via a split-dataset approach.
RESULTS: Risk factors for failure to RTW by claim closure include the following: (1) attorney involvement; (2) higher level of permanent impairment (PI); (3) shorter job tenure; (4) lower pre-injury average weekly wage (AWW); (5) injury affecting the head and neck or the back; and (6) lower level of educational attainment. The optimal RTW model included four main effects (attorney involvement; severity of PI; age; job tenure) and three first-order interaction effects (pre-injury AWW × pre-injury industry; attorney involvement × severity of PI; attorney involvement × job tenure). When applied to the full dataset, the overall classification rate was 74.7 %.
CONCLUSIONS: This study's optimal RTW model offers further support for evaluating disability from a biopsychosocial perspective. Given the model's performance, it may be of value to those assessing rehabilitation potential within Minnesota's, and possibly other, workers' compensation system(s).

Source: Hankins AB, Reid CA. J. Occup. Rehabil, 2015.

Physical capacity and risk for long-term sickness absence

A prospective cohort study among 8664 female health care workers
OBJECTIVE: To assess the prospective associations between self-reported physical capacity and risk of long-term sickness absence among female health care workers. METHODS: Female health care workers answered a questionnaire about physical capacity and were followed in a national register of sickness absence lasting for two or more consecutive weeks during 1-year follow-up. Using Cox regression hazard ratio analyses adjusted for age, smoking, body mass index, physical workload, job seniority, psychosocial work conditions, and previous sickness absence, we modeled risk estimates for sickness absence from low and medium physical capacity. RESULTS: Low and medium aerobic fitness, low muscle strength, low flexibility, and low overall physical capacity significantly increased the risk for sickness absence with 20% to 34% compared with health care workers with high capacity. CONCLUSIONS: Low physical capacity increases the risk of long-term sickness absence among female health care workers.

Source: Rasmussen, Charlotte Diana Nørregaard; Andersen, Lars Louis; Clausen, Thomas; Strøyer, Jesper; Jørgensen, Marie Birk; Holtermann, Andreas. Journal of Occupational & Environmental Medicine, 2015.

Results of a feasibility study: barriers and facilitators in implementing the Sherbrooke model in France

Objectives: Return-to-work interventions associated with the workplace environment are often more effective than conventional care. The Sherbrooke model is an integrated intervention that has proved successful in preventing work disability due to low-back pain. Implementation, however, runs up against many obstacles, and failure has been reported in many countries. The present study sought to identify barriers to and facilitators of the implementation of the Sherbrooke model within the French health system.
Methods: A multiple case study with nested levels of analysis was performed in two regions of France. A conceptual framework was designed and refined to identify barriers and facilitators at the individual, organizational and contextual levels. Qualitative data were collected via semi-structured interview (N=22), focus groups (N=7), and observation and from the gray literature. Participants (N=61) belonged to three fields: healthcare, social insurance, and the workplace.
Results: Numerous barriers and facilitators were identified in each field and at each level, some specific and others common to workers in all fields. Individual and organizational barriers comprised lack of time and resources, discordant professional values, and perceived risk. Legal barriers comprised medical confidentiality, legal complexity, and priority given to primary prevention. Individual-level facilitators comprised needs and perceived benefits. Some organizations had concordant values and practices. Legal facilitators comprised possibilities of collaboration and gradual return to work.
Conclusion: The present feasibility analysis of implementing the Sherbrooke model revealed numerous barriers and facilitators suggesting a new implementation strategy be drawn up if failure is to be avoided.

Source: Fassier J-B, Durand M-J, Caillard J-F, Roquelaure Y, Loisel P. 2015. Scand J Work Environ Health

Return to Work after sick leave due to mental health problems

The article will describe factors of influence on return to work RTW and evidence-based interventions that enhance return to work (RTW) after sick leave due to common mental health disorders (CMD). First the concepts of both RTW and CMD are outlined. Second, the sense of urgency for effective RTW interventions for workers with CMD is briefly described. Third, a variety of predictors of RTW are presented with respect to the disorder, personal factors, and environmental factors. Lastly, a brief description of usual care and an overview of effective RTW interventions will be provided. A final paragraph will provide some conclusions as to which measures at what level appear to be effective in return to work after sick leave due to mental health disorders.


The Effect of Social Support Features and Gamification on a Web-Based Intervention for Rheumatoid Arthritis Patients

Randomized Controlled Trial
Background: Rheumatoid arthritis (RA) is chronic systematic disease that affects people during the most productive period of their lives. Web-based health interventions have been effective in many studies; however, there is little evidence and few studies showing the effectiveness of online social support and especially gamification on patients' behavioral and health outcomes.
Objective: The aim of this study was to look into the effects of a Web-based intervention that included online social support features and gamification on physical activity, health care utilization, medication overuse, empowerment, and RA knowledge of RA patients. The effect of gamification on website use was also investigated.
Methods: We conducted a 5-arm parallel randomized controlled trial for RA patients in Ticino (Italian-speaking part of Switzerland). A total of 157 patients were recruited through brochures left with physicians and were randomly allocated to 1 of 4 experimental conditions with different types of access to online social support and gamification features and a control group that had no access to the website. Data were collected at 3 time points through questionnaires at baseline, posttest 2 months later, and at follow-up after another 2 months. Primary outcomes were physical activity, health care utilization, and medication overuse; secondary outcomes included empowerment and RA knowledge. All outcomes were self-reported. Intention-to-treat analysis was followed and multilevel linear mixed models were used to study the change of outcomes over time.
Results: The best-fit multilevel models (growth curve models) that described the change in the primary outcomes over the course of the intervention included time and empowerment as time-variant predictors. The growth curve analyses of experimental conditions were compared to the control group. Physical activity increased over time for patients having access to social support sections plus gaming (unstandardized beta coefficient [B]=3.39, P=.02). Health care utilization showed a significant decrease for patients accessing social support features (B=–0.41, P=.01) and patients accessing both social support features and gaming (B=–0.33, P=.03). Patients who had access to either social support sections or the gaming experience of the website gained more empowerment (B=2.59, P=.03; B=2.29, P=.05; respectively). Patients who were offered a gamified experience used the website more often than the ones without gaming (t 91=–2.41, P=.02; U=812, P=.02).
Conclusions: The Web-based intervention had a positive impact (more desirable outcomes) on intervention groups compared to the control group. Social support sections on the website decreased health care utilization and medication overuse and increased empowerment. Gamification alone or with social support increased physical activity and empowerment and decreased health care utilization. This study provides evidence demonstrating the potential positive effect of gamification and online social support on health and behavioral outcomes.

Source: Ahmed Allam, Zlatina Kostova, Kent Nakamoto and Peter Johannes Schulz. J Med Internet Res. 2015 Jan; 17(1).

Stability of return to work after a coordinated and tailored intervention for sickness absence compensation beneficiaries with mental health problems

Results of a two-year follow-up study
Purpose: Mental health problems (MHPs) are increasingly common as reasons for long-term sickness absence. However, the knowledge of how to promote a stable return to work (RTW) after sickness absence due to MHPs is limited. The purpose of this study was to assess the effects of a multidisciplinary, coordinated and tailored RTW-intervention in terms of stability of RTW, cumulative sickness absence and labour market status after 2 years among sickness absence compensation beneficiaries with MHPs. Methods: In a quasi-randomised, controlled trial, we followed recipients of the intervention (n = 88) and of conventional case management (n = 80) for 2 years to compare their risk of recurrent sickness absence and unemployment after RTW, their cumulative sickness absence and their labour market status after 2 years. Results: We found no statistically significant intervention effect in terms of the risk of recurrent sickness absence or unemployment. Intervention recipients had more cumulated sickness absence in year one (mean difference = 58 days; p < 0.01) and year two (mean difference = 36 days; p = 0.03), and fewer were self-supported at the end of follow-up (52% versus 69%; p = 0.02). Conclusion: The intervention showed no benefits in terms of improved stability of RTW, reduced sickness absence or improved labour market status after 2 years when compared to conventional case management.

Source: Martin MH, Nielsen MB, Pedersen J, et al. Disability and Rehabilitation, 2015.

Return-to-work in patients with acquired brain injury and psychiatric disorders as a comorbidity

A systematic review
OBJECTIVE: To explore the association between psychiatric disorders as a comorbidity and return-to-work (RTW) in individuals with acquired brain injury (ABI).
METHODS: A systematic review was performed. The search strategy (2002-2012) contained terms related to ABI, psychiatric comorbidity and keywords adapted to the outcome measure RTW. Selection and review were performed by two authors independently. In the case of uncertainty, a third author was consulted to reach consensus on inclusion or exclusion. The methodological quality of included studies was determined and evidence was classified.
RESULTS: Seven studies were included. Strong evidence was found for a negative association between psychiatric disorders as a comorbidity (like depression, anxiety and post-traumatic stress disorder) and RTW of patients with ABI. Patients with a previous history of psychiatric disorders were at considerably higher risk for a new episode and lower RTW rates following ABI.
CONCLUSION and implications: Psychiatric disorders as a comorbidity after ABI are strong negatively associated with RTW. The heightened frequency of psychiatric disorders as a comorbidity after ABI and more important their amenability to treatment implicates that more attention should be paid to diagnosing and treating psychiatric disorders as a comorbidity in patients with ABI in order to further improve re-integration in work.

Source: Garrelfs SF, Donker-Cools BH, Wind H, Frings-Dresen MH. Brain Inj, 2015: 1-8.

The EASY (Early Access to Support for You) sickness absence service

A four-year evaluation of the impact on absenteeism
Objectives In May 2008, the National Health Service (NHS) Lanarkshire (NHSL) implemented a unique telephone-based sickness absence management service entitled “EASY” (Early Access to Support for You). The EASY service supplements existing absence policies and enables telephone communication between the absentee, their line manager, and the EASY service from the first day of absence and referral to occupational health services at day ten. The aim of this study was to determine if the EASY service was effective between May 2008 and May 2012 in reducing sickness absence in NHSL compared to normal occupational healthcare in NHS Scotland and is, as such, a cost-saving intervention.
Methods This study included time-series analysis of health board sickness absence data and analyses of the EASY service database (survival analyses and Cox's proportional hazards model).
Results The EASY service was effective in reducing sickness absence by 21% in NHSL, whereas the nonspecific tightening of the sickness absence policies across the rest of Scottish NHS health boards reduced sickness absence by approximately 9%. The richness of the EASY database gave detailed information on absentees by cause, duration, job family, and reporting compliance. The mean duration of musculoskeletal absences was significantly shorter in years 2, 3, and 4 compared to year 1. Those absentees contacted by phone on the first day of absence were more likely to return to work than those contacted on subsequent days. The EASY service improves economic efficiency; the value of the hours saved from the reduced sickness absence exceeds the cost of operating the service.
Conclusion The study highlights the importance of an early telephone-based intervention for sickness absence management.

Source: Brown J, Mackay D, Demou E, Craig J, Frank J, Macdonald EB. Scand J Work Environ Health, 2015.

Vocational Rehabilitation following Traumatic Brain Injury

What is the evidence for clinical practice?
Traumatic brain injury (TBI) typically affects young adults with potentially many years of working life ahead of them. For people who were in work prior to their injury, return to work (RTW) is a common goal. However, a systematic review of RTW rates for people with TBI who were in work prior to their injury found that approximately 41% were in work at one and two years post TBI.1 Since TBI is a leading cause of morbidity worldwide in young adults,2 this discrepancy between what people with TBI want and what they achieve is important. The question is does the research evidence inform clinicians how to help a person with TBI return to work?


Log in and breathe out: internet-based recovery training for sleepless employees with work-related strain

Results of a randomized controlled trial
Objectives: The primary purpose of this randomized controlled trial (RCT) was to evaluate the efficacy of a guided internet-based recovery training for employees who suffer from both work-related strain and sleep problems (GET.ON Recovery). The recovery training consisted of six lessons, employing well-established methods from cognitive behavioral therapy for insomnia (CBT-I) such as sleep restriction, stimulus control, and hygiene interventions as well as techniques targeted at reducing rumination and promoting recreational activities.
Methods: In a two-arm RCT (N=128), the effects of GET.ON Recovery were compared to a waitlist-control condition (WLC) on the basis of intention-to-treat analyses. German teachers with clinical insomnia complaints (Insomnia Severity Index ≥15) and work-related rumination (Irritation Scale, cognitive irritation subscale ≥15) were included. The primary outcome measure was insomnia severity.
Results: Analyses of covariance (ANCOVA) revealed that, compared to the WLC, insomnia severity of the intervention group decreased significantly stronger (F=74.11, P<0.001) with a d=1.45 [95% confidence interval (95% CI) 1.06–1.84] The number needed to treat (NNT) was <2 for reliable change and NNT <4 for reduction in expert-rated diagnosis of primary insomnia.
Conclusion: The training significantly reduces sleep problems and fosters mental detachment from work and recreational behavior among adult stressed employees at post-test and 6-months follow up. Given the low threshold access this training could reach out to a large group of stressed employees when results are replicated in other studies.

Source: Thiart H, Lehr D, Ebert DD, Berking M, Riper H. Scand J Work Environ Health, 2015.

Interventions to improve return to work in depressed people

Depression is a major problem that affects about 300 million people globally. Symptoms of depression include the core symptoms of low mood or loss of interest coupled with other symptoms such as feelings of inadequacy and hopelessness or sleep problems. These symptoms usually impair functioning and therefore sickness absence is common in people with depression. We evaluated the effectiveness of interventions that can help depressed workers to resume work activities.

Source: Nieuwenhuijsen K, Faber B, Verbeek JH, Neumeyer-Gromen A, Hees HL, Verhoeven AC, van der Feltz-Cornelis CM, Bültmann U. Cochrane Database of Systematic Reviews 2014, Issue 12. Art. No.: CD006237.

Understanding Work-related Musculoskeletal Injuries in Rehabilitation from a Nursing Perspective

PURPOSE: The incidence and prevalence of work-related musculoskeletal nursing injuries is a top concern for nurses. These injuries are thought to be a dynamic interplay of multiple factors. A literature review reveals a knowledge gap in understanding context-specific patterns of nursing injuries.
DESIGN: Using a cross-sectional descriptive research design, 58 rehabilitation nurses participated in this study.
METHODS: Anonymous paper surveys were sent to all rehabilitation nursing personnel on the unit.
FINDINGS: Six themes emerged: lack of time and help, patient acuity, ergonomics, body movement issues, knowledge deficit, and communication.
CONCLUSIONS: Nursing input is critical in understanding and reducing context-specific work-related musculoskeletal injuries. Further research that includes nursing voices is advocated. CLINICAL RELEVANCE: Rehabilitation nursing injuries appear to be a complex interaction of multiple determinants; therefore, multifaceted solutions using a quality improvement lens are recommended to improve the working conditions on the units.

Source: Bhimani R. Rehabilitation Nursing, 2014.

How can a brief intervention contribute to coping with back pain?

A focus group study about participants' expériences
Background: Our aim was to explore how individuals who had participated in a brief back and neck pain intervention perceived connections between the intervention and their subsequent coping. Methods: Three focus group discussions were conducted with a sample of ten employees aged 20–67 years, who had participated in a brief intervention for back and neck pain, perceived the intervention as helpful and had returned or remained at work subsequent to the intervention. Participants were invited to share stories of how the intervention had made a positive difference to their work situation and everyday life and helped them cope with their complaints. Systematic text condensation was used for analysis. Results: Analysis revealed several aspects of how the participants considered the intervention to be helpful. They emphasized the importance of having the information delivered in a comprehensible way, with the use of practical examples and images of the spine. Discussions revealed the significance of trusting the lecturers and perceiving them as experts. Understanding why they felt the pain and that it was not a sign of serious disease changed the participants' perception of how they could live with the complaints. They told stories of how they had exceeded their previous limits and dared to undertake activities they previously had avoided due to fear. Conclusions: Having confidence in the lecturers and seeing them as experts that delivered the information in a comprehensible way helped participants to cope with their pain and was seen as the most important aspects of the brief back and neck pain intervention.

Source: Ree E, Harris A, Indahl A, Tveito TH, Malterud K. Scand J Public Health, 2014.

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