2009-04-01 12:00 - Messages

What factors predict full or partial return to work among sickness absentees with spinal pain participating in rehabilitation?

Purpose. To identify the factors that predict full or partial return to work among long-term (>/=90 days) sickness absentees due to spinal pain who begin a multidisciplinary rehabilitation programme. Method. In a prospective cohort study, 312 patients with neck, thoracic and/or lumbar pain, aged 20-64, participated in a 4-week multidisciplinary rehabilitation programme in Sweden. Questionnaire data at inclusion were used. Factors included in logistic regressions were as follows: age, gender, type of work, pain location, pain intensity (visual analogue scale), activity limitations [Disability Rating Index (DRI)], health-related quality of life (SF-36), pain-related fear of movement (Tampa Scale of Kinesiophobia), motivation (Self Motivation Inventory), sickness absence at baseline and number of sick-leave days during the previous 2 years. Outcome factor was increased versus not increased working time at follow-up 6 months later. Results. Most patients (68%) reported two or three pain locations. At baseline, 56% were full-time sickness absent and 23% at follow-up; 61% had increased their working time. Predictors for increased working time were age below 40 years, low activity limitation (DRI < 50), low SF-36 bodily pain (>30) and high SF-36 social functioning (>60). Number of sick-leave days during the previous 2 years (md 360; range 90-730) had no influence. Conclusions. Even patients with long previous sick leave can increase working time after a multidisciplinary rehabilitation programme, especially if they are younger, have lower levels of activity limitations and pain and better social functioning. To include information on part-time work is useful when evaluating work ability following rehabilitation programmes.


Behavioral Determinants as Predictors of Return to Work After Long-Term Sickness Absence: An Application of the Theory of Planned Behavior
Abstract   Background The aim of this prospective, longitudinal cohort study was to analyze the association between the three behavioral determinants of the theory of planned behavior (TPB) model—attitude, subjective norm and self-efficacy—and the time to return-to-work (RTW) in employees on long-term sick leave. Methods The study was based on a sample of 926 employees on sickness absence (maximum duration of 12 weeks). The employees filled out a baseline questionnaire and were subsequently followed until the tenth month after listing sick. The TPB-determinants were measured at baseline. Work attitude was measured with a Dutch language version of the Work Involvement Scale. Subjective norm was measured with a self-structured scale reflecting a person's perception of social support and social pressure. Self-efficacy was measured with the three subscales of a standardised Dutch version of the general self-efficacy scale (ALCOS): willingness to expend effort in completing the behavior, persistence in the face of adversity, and willingness to initiate behavior. Cox proportional hazards regression analyses were used to identify behavioral determinants of the time to RTW. Results Median time to RTW was 160 days. In the univariate analysis, all potential prognostic factors were significantly associated (P < 0.15) with time to RTW: work attitude, social support, and the three subscales of self-efficacy. The final multivariate model with time to RTW as the predicted outcome included work attitude, social support and willingness to expend effort in completing the behavior as significant predictive factors. Conclusions This prospective, longitudinal cohort-study showed that work attitude, social support and willingness to expend effort in completing the behavior are significantly associated with a shorter time to RTW in employees on long-term sickness absence. This provides suggestive evidence for the relevance of behavioral characteristics in the prediction of duration of sickness absence. It may be a promising approach to address the behavioral determinants in the development of interventions focusing on RTW in employees on long-term sick leave.
Gender Differences in Work Modifications and Changed Job Characteristics During the Return-To-Work Process: A Prospective Cohort Study

Abstract   Objectives To describe gender differences in work modifications and changed job characteristics during return-to-work after sickness absence. Methods A 13 month prospective cohort study was performed among 119 employees (54 women and 65 men) who had reported sick for more than 1 month due to mental or musculoskeletal disorders. Men and women were of comparable ages and educational levels, worked in similar sectors, at corresponding functional levels, and were experiencing the same types of health disorders. They were interviewed bi-monthly. Work modifications and job characteristics were assessed at return-to-work. Job characteristics were also assessed upon the employee's inclusion in the study. Results Work modifications occurred in 77.4% of the return-to-work attempts (no gender differences); reduced working hours, reduced work pace, or task reassignments were most frequent. Compared to men, reduced hours and pace were more often used for women between 12 and 20 weeks of absence (P > 0.001 and 0.01 < P < 0.001 respectively) and reduced hours also during the whole period (0.01 < P < 0.001). Applying reduced hours related to type of disorder in men and applying different time-schedules in women. Upon return to work both women and men reported increased job autonomy and emotional demands (P < 0.001); women reported more job satisfaction (P < 0.001). Conclusions Work modifications were widely applied during the return-to-work process and predominantly aimed at reduction of pressure at work. Women had a few more work modifications. The marginal gender differences may be due to male and female respondents having similar characteristics. Upon return to work some job characteristics improved.


The relationship between burnout and musculoskeletal pain in seven Norwegian occupational groups

Occupational and gender differences were investigated in the relationship between burnout and musculoskeletal pain in the head, neck, shoulders, and back. Representative samples of lawyers, physicians, nurses, teachers, church ministers, bus drivers, and information technology workers in Norway (N = 4507) were analyzed using structural equation modeling. The exhaustion dimension of burnout was positively associated with musculoskeletal pain in all groups, and the strength of the relationship ranged from moderate to strong. The disengagement dimension of burnout was negatively associated with musculoskeletal pain in five groups and only ranged from -0.15 to -0.42. Professional efficacy was slightly weaker, and inconsistently (i.e., both positively and negatively) associated with musculoskeletal pain in four of the groups. There were larger differences in the strength of the relationships between the seven occupational groups than between males and females within the same profession. Results suggest that burnout and musculoskeletal pain are related, but the strength of the associations varies according to gender and occupation. Overall, occupational factors appear to be stronger predictors of the co-occurrence of burnout and musculoskeletal pain than gender.

MSDsThe Impact of Health, Illness, Pain and Recovery-Strategy Representations on the Work Rehabilitation Process

Cette activité visait principalement à documenter les représentations de la maladie, de la santé et de la guérison qui influencent le processus de réadaptation de travailleurs affectés de troubles musculo-squelettiques (TMS) engagés dans une démarche de retour au travail. Les chercheurs ont recensé les cadres conceptuels existants et les outils de mesure à cet égard. Ils ont ensuite recueilli les témoignages de travailleurs absents du travail depuis plusieurs mois en raison d'un TMS. Le rapport situe la contribution des représentations et des stratégies des travailleurs dans leur cheminement vers la guérison et le retour au travail. Il démontre l'importance d'intégrer systématiquement ces perceptions dans l'évaluation de chaque cas de manière à ancrer l'intervention sur la réalité du patient et à améliorer ainsi la qualité des soins. L'arrimage précis de l'approche clinique sur les représentations des travailleurs est un gage de progression vers la réinsertion professionnelle.


Workplace Disability Diversity and Job-Related Well-Being in Britain: A WERS2004 Based Analysis

This paper attempts to establish empirically whether there is a link between workplace disability and employee job-related well-being. Using nationally representative linked employer-employee data for Britain, I employ alternative econometric techniques to account for unobserved workplace heterogeneity. I find that workplace disability diversity is associated with lower employee well-being among people with no reported disability. Tests conducted also indicate that workplace equality policies do not ameliorate this effect.

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