Communication Characteristics Between Clients And Stakeholders Within The Swedish Sickness Insurance System – A Document Analysis Of Granted And Withdrawn Sickness Benefit Claims
Linköping university, Sweden
INTRODUCTION: Previous studies show differences regarding which clients receive sickness benefits as well as which clients are questioned or not within the sickness insurance system. There are indications that the characteristics of communication can have an impact on the sick leave process, which motivates this study with the following purpose.
PURPOSE: The purpose of this study was to investigate how communication within the Swedish sickness insurance system differs between cases of sick leave and how this may affect the clients’ case.
MATERIALS AND METHODS: This was a document study using thirty client files including the correspondence between clients, their case-manager at the Swedish Social Insurance Agency (SIA) as well as other stakeholders. The clients included had been on a work capacity evaluation during their sick leave spell and were aged 32-64 years. There were twenty women and ten men in this study, with a variety of the degree of sickness absence, disability pension and part time work. The material was analyzed using qualitative document analysis.
RESULTS: The results show different approaches in communication, characterized by emotional communication, matter-of-fact driven communication and information exchange, which have diverse success in affecting authority decisions. Arguments characterized by emotions such as frustration or desperation are to a larger extent neglected compared to those characterized by a matter-of-fact driven approach and referring to regulations and medical certificates. There are also differences in how information about the client is interpreted by different professionals.
CONCLUSION: There are differences regarding how clients and stakeholders communicate the clients’ needs and prerequisites, and how this affect the SIA. Further research must be carried out in order to establish social insurance literacy, initially for individuals on sick leave within the sickness insurance, and whether there are differences between diverse groups that could lead to injustice in the system.
Comorbidity Between Burnout And Chronic Low-Back Pain : Beliefs And Cognitive Dysregulations As Significant Risk Factors
1Laboratoire de psychologie des Pays-de-la-Loire (LPPL, UPRES EA 4638), Université de Nantes, chemin de la Censive-du-Tertre, BP81227, 44312 Nantes cedex 3, France
; 2Équipe d’épidémiologie en santé au travail et ergonomie (ESTER, Inserm UMR 1085), UFR santé département médecine, rue Haute-Reculée, 49045 Angers cedex 01, France
Poster Presentation Format
Background and aims : Chronic exposure to stressful situations at work alters the health of workers and can lead to the development of specific forms of physical suffering (as low-back pain) and psychological suffering (as burnout). Scientific literature is quite poor regarding the joint study of burnout and chronic low- back pain. The few existing studies indicate that burnout may be a risk factor for increased pain. However, the importance of the psychological processes that may underlie the expression of these two phenomena, including interpersonal dimensions related to work, has not been explored. Also, this research focuses on two types of beliefs: perceived injustice and fear-avoidance beliefs, which can be vulnerability factors to the development of burnout and chronic pain.
Method :This study was carried out within the regional organization “Lombaction”, part of the occupational diseases consultation department of Angers university hospital centre, which aims to reduce the impact of chronic low-back pain in the work environment. This organization is aimed at people with an occupational problem due to their incapacitating chronic low-back pain. A sample of 38 patients completed a booklet of various validated questionnaires assessing pain (visual analogue scale), disability (Dallas Pain Questionnaire, Oswestry Low-Back Pain Disability Questionnaire), burnout (Maslach Burnout Inventory), fear-avoidance beliefs (Fear-Avoidance Beliefs Questionnaire) and perceived injustice (Injustice Experience Questionnaire).
Results and conclusions : First analysis show moderate level of emotional exhaustion and poor level of personal accomplishment (dimensions of burnout measuring through the MBI). In addition, levels of emotional exhaustion correlate significantly with levels of disability and functional repercussions of pain. About vulnerability factors, levels of perceived injustice are strongly correlated with levels of disability and emotional exhaustion, but not fear-avoidance beliefs.Regressions analysis and moderation analysis will be carried out and results will be presented during the conference.
What Are The Main Risk Factors For Sick Leave In Individuals With Self-Reported, Symptomatic Knee Pain?
1Department of Sports Science and Clinical Biomechanics, University of Southern Denmark; 2Nordic Institute of Chiropractic and Clinical Biomechanics
Approximately 10% of the working population suffers from knee pain; one of the cardinal symptoms of knee osteoarthritis (OA). Knee OA causes substantial societal costs due to reduced workability and sick leave. Although individuals with knee OA are at higher risk of reporting work limitations and being on sick leave compared to those without OA, the specific risk factors for sick leave in knee OA have not been comprehensively assessed.
The aim of this study is to investigate the association between self-reported knee pain and sick leave, among personnel in the eldercare sector in Denmark, and to identify risk factors for increased sick leave among persons with knee pain.
We conducted a cross-sectional study with data from a cohort of eldercare personnel. Self-reported data on knee pain, general health and well-being, work-related factors, and sick leave was collected from 143 participants. Cases were employees with knee pain defined as a positive response to the questions “Did you at any time during the last 7 days had troubles in your knee?” The primary outcome is defined as any sick leave in the previous 12 months, using workplace administrative data. The potential risk factors concerning biopsychosocial factor will be analyzed using multivariable linear regression adjusted for potential confounders.
Preliminary results indicate that around 23 % of the cohort had knee pain, and 62% had been on sick leave in the previous 12 months. Final results of this study will be presented at the conference.
This study will contribute to the knowledge base on symptomatic knee pain and risk factors for sick leave in eldercare personnel. We will be able to identify risk factors that may be targets for interventions, and based on the results, we will be able to design tailored interventions or care to those at highest risk.
What Doesn’t Kill You Makes You Suffer. Risk Perception Of A Lifetime Working With Dangerous Substances
TNO, Institute for Applied Research, Leiden, The Netherlands
Dangerous substances like asbestos and industrial fumes pose a profound hazard to workers across industries. Demonstrating causality between a lifetime of work with substances and adverse health effects beyond retirement is challenging at best. Consequently, the responsibility for implementing preventive strategies in the workplace is subject of debate. This study aimed to gather data on risk-perception among employers and workers regarding dangerous substance exposure and preventive strategies across Dutch workplaces.
Combining survey data with interviews and field studies, we explored workplace culture and potential differences between younger and older workers. Quantitatively, a survey was conducted among 2288 employers in companies across 17 industries. Participant scores were weighed to create a representative sample of the Dutch working population. Statistical analyses included descriptive analyses, t-tests and chi-square tests for statistical significance (P<0.05).
The study demonstrated great variety in workplace culture and risk perception. In general, only 30% of the companies measured the level of exposure of workers. Of the employers, 80% aimed to reduce the risk of exposure, however their measures targeted the individual worker, e.g., providing protective equipment such as masks (85%). Organizational or technical measures, including rotating schedules and mechanical ventilation, were less popular (about 50%). Compared to older workers, younger workers may be less likely to underestimate the risk of dangerous substances, as a result of recent education and lack of work experience (less chance of ‘saturation’).
Exposure risks are underestimated in Dutch workplaces. The goal of shared responsibility in the workplace has not yet been reached, particularly in small companies and independent contractors. Our findings demonstrate potential differences in risk perception and hazard management between younger and older workers.The results of this study serve as critical input to promote a new integrated approach on the prevention of occupational diseases due to substances.
Acute Reduction Of Absenteeism Due To Musculoskeletal Diseases In Dockworkers With a New Model of Ergonomics And Health Program
1Terminal Exportador do Guarujá, Brazil; 2Terminal Exportador de Açúcar do Guarujá, Brazil; 3Terminal Exportador de Santos
Introduction: Terminals in the port of Santos, the largest in Latin America, are constantly working to minimize physical impacts of work on employees. Aiming at the prevention of musculoskeletal injuries and quality of life improvement, we implemented a series of functional and ergonomic measures in 2014, which resulted in significant absenteeism reduction and excellent acceptance from employees.
Methods: The program begins with a health evaluation on the employee’s admission that includes anthropometry, dynamometry and surface electromyography. On the first month of work, the employee’s last 40 minutes of the workday are held in a gym inside the terminal, where specific exercises, conducted by 3 physical educators professionals. After this period this routine becomes optional, but with a strong incentive for its continuity. Also, there is a daily labour gymnastics program maintained for all employees. Concomitantly, research is done on ergonomic conditions, where employees give opinions about job satisfaction and possible adverse conditions, suggesting actions that will be evaluated by the Ergonomics Committee that study and treat these cases..
Result: Since 2015, when the program started, if compared to 2014, there was a 30% reduction of absenteism caused by osteo-muscular injuries. From 2015 to 2016 there was a 46% absenteism reduction from the same causes. In 2017, the same index was maintained for 2016. When comparing 2014 with 2016 and 2017, there was an overall reduction of 62%. Additionally, in 2016, 132 employees suggestions on ergonomic aspects were raised and addressed by the Ergonomics Committee. A relevant index show that 78% of the employees were practicing some physical activity by the end of 2016 and of those, 48% performed the activities inside the Terminal’s gym.
Conclusion: The Program implementation and employees suggestions significantly reduced absenteeism rates, encouraged the physical activities practice in the workplace and consequently improved their quality of life.
Presenteeism and Sickness Absence among Healthcare Workers with Musculoskeletal Pain in Outpatient Clinics
Universiti Kebangsaan Malaysia, Malaysia
Musculoskeletal (MS) pain affects work productivity, either in sickness absence or presenteeism. Common practice revealed that healthcare workers with chronic diseases such as MS pain are assigned to outpatient clinics mainly due to the office hour’s work schedule. This study was done to determine whether this practice ensures good work productivity among those having MS pain.
All (213) nurses and healthcare assistants working in all outpatient clinics in a tertiary hospital were recruited from March to April 2018. Those without MS pain were excluded. Self-administered questionnaire was used to assess work productivity and associated factors. Sickness absence and presenteeism were measured using WHO Health and Work Performance Questionnaire (HPQ). MS pain was elicited using Standardized Nordic Musculoskeletal Questionnaire (NMQ). Other factors studied were work factors, mental health status and job stress level.
162 out of 213 (76.1%) healthcare workers in outpatient clinics were having MS pain. It was found that 15.4% of them had presenteeism. Having lower back pain (OR=3.82, 95%CI=1.5-9.4) and age more than 40 years old (OR=2.92, 95%CI=1.2-7.2) were found to be significantly associated with presenteeism. 14.2% were having sickness absence. However only half (56.5%) of them had sickness absence due to MS pain. Nearly all (86.4%) of them suffered from chronic MS pain. Job stress was significantly associated with sickness absence (OR= 3.92, 95% CI= 1.4-10.9). Other factors such as ease of replacement, mental health status, co-morbidities and duration of working were not associated with sickness absence or presenteeism.
There is high prevalence of MS pain among healthcare workers working in outpatient clinics. Work performance of workers having lower back pain as well as older workers having MS pain should be monitored to prevent presenteeism. Prevention of job stress among workers with MS pain is important to reduce sickness absence among them.
Bad To The Bone: Mental Health Policies (Not) Adopted By Brazilian Slaughterhouses' Occupational Health Programs
1Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; 2Ministry of Labour, Porto Alegre, Brazil
Slaughterhouse workers from poultry and pork meat slaughtering and processing companies have higher frequency of Mental and Behavioral Disorders (MBD) than the general population. A brazilian study among southern slaugtherhouse's workers has concluded that the majority of disabled workers are between 28 and 38 years old, are women and show signs of depression. The present work has investigated how cold storage’s Occupational Health Medical Control Programs (PCMSO, in Portuguese) deal with the psychosocial risk stem from environmental conditions and work organization. This multiple-case design research, conducted among 26 slaughterhouses located at brazilian's southest state, has established that only 2 of them had recognized the psychosocial risk in their PCMSO. Therefore, it has identified very few and ineffective measures in order to promote workers mental health and to prevent MBD, since only 5 companies had developed strategies of mental health. In their written program, none of those 26 companies had acknowledged that the work can be cause or concause for the development of MBD. The conclusion is that the non-recognition of psychosocial risk and possibility of developing MBD prevents companies from elaborating effective prevention actions, jeopardizing PCMSO's effectiveness.
Motivation and Barriers for Physical Activity in Male Blue-Collar Workers
1Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Denmark; 2Nordic Institute of Chiropractic and Clinical Biomechanics, Denmark; 3Center for Musicians’ Health, Occupational and Environmental Medicines, Odense University Hospital, Denmark
Physical activity (PA) is a potent strategy to both improve health and stay healthy, but the positive effects appear to depend on whether PA is related to work or leisure time. Significant health inequality exists among male workers, with blue collar workers being less physically active in leisure time, experiencing higher physical exposures at work, and having more life style risk factors overall.
This study explores how male blue-collar workers understand the concept of physical activity and how they experience motivational aspects and barriers for PA.
Semi-structured interviews were conducted with six male blue-collar workers (23-54 years) from different companies. Data were analyzed with Systematic Text Condensation and results discussed with Bandura’s Theory of Self-efficacy.
Analysis revealed four main themes 1) Experiences with PA; 2) Social factors; 3) Positive factors, and 4) Challenges that prevent PA. Theparticipants primarily considered PA as activities related to work, but also sport and other leisure time activities. They felt that their work included sufficient PA, and there was no need for PA in leisure time. If doing PA, it was a motivational factor being in groups, and the participants had positive attitudes towards work-place health initiatives with PA. Injuries, tiredness, self-perceived laziness, and lack of time were barriers for PA and related to the participants’ high physical exposures at work.
Facilitators and barriers that may be decisive for the outcome of health enhancing physical activity interventions among blue-collar workers were revealed. Awareness must be on their conceptions about PA at work and leisure time for improving health.
Humanitarian Workers' Mental Health; State of Art and Work Disability Prevention
1Université du Québec à Chicoutimi, Canada; 2Univerité de Genève, Suisse
Often working in unstable, dangerous context and witness to human suffering as well as atrocities, it is well known that the humanitarian workers work in difficult situations and are exposed to several stressors. This context is not without consequence on their mental health. The actual context of migratory crisis requires qualified and long-term committed workers. It is urgent to decrease the mental illness engendered by their work and increasing retention and re-engagement for future missions. What is the state of art on this subjet? What kind of research and interventions programs can we develop to decrease the mental impacts of working in traumatic situation?
This communication focuses to answering these questions by presenting the results of an exhaustive literature review (2010-2018). From this analysis, we present a classification of core topics related to the research area of humanitarian workers’ mental health. And, in addition to some up-to-date prevalences, identify the methodology and most used psychometric tools.
Also, new avenues of research and interventions focused on these workers' mental health care will be explored. Furthermore, consideration concerning the post-intervention follow-up will be presented to guide the development of mental health support program for humanitarian workers back from a mission. These elements will be articulated around the precise concerns bound to the mental health in emergency and trauma for prevention of work disability. Finally we will consider the elements which allows them to remain mentally healthy when returning on mission.
Vocational Rehabilitation Among Workers Receiving Disability Benefits In Brazil
1University of São Paulo, Brazil; 2National Social Security Institute, Brazil
Introduction: Vocational rehabilitation is a service offered by the Brazilian Public Social Security system to workers who are unable to perform their routine professional activities due to disability. Workers receiving this benefit could be referred to the vocational rehabilitation from a medical-expert evaluation. They have to follow the oriented procedure in order to continue receiving payment.
Objective: To present Brazilian national data on vocational rehabilitation during the period from 2011 to 2016.
Methods: An ecological study based on secondary data provided by the National Social Security Institute (INSS), during 2011 to 2016. We calculated annual averages on: number of taxpayers affiliated to the social security of the private sector, grant of work disability benefits, referrals to vocational rehabilitation (VR), VR programs initiated and VR conclusions. The average incidence of rehabilitation was calculated between those eligible for the service and all benefits granted each year.
Results: There was an annual average of 68.1 million taxpayers and 2.4 million new granted benefits/year. Approximately 49,800 cases/year were referred to rehabilitation. On average, 61.5% were considered eligible to pursue a vocational rehabilitation program, which represents an average of 30,600 cases/year; 53.8% completed the VR program, an average of 16,400 workers/year. Considering all benefits granted, INSS rehabilitated each year, on average, 0.7% of workers receiving disability benefits.
Conclusions: Vocational rehabilitation is a tertiary intervention aimimg to increase work reintegration among handicap workers. We observed that almost half of eligible workers were certified as rehabilitated. It represented less than one percent of all disabled workers. We suggest a revision of institutional procedures in order to improve the service flow, and to increase the annual number of rehabilitated workers. Offering a more efficient service is a required intervention and may have a positive impact on disability management.
Financial support: CNPq (Grant 304375 / 2017-9)
"Using an Intervention Mapping Approach to Develop Prevention and Rehabilitation Strategies for Musculoskeletal Pain Among Surgeons
1Department of Sports Science and Clinical Biomechanics, University of Southern Denmark; 2Centre for Innovative Medical Technology, Odense University Hospital, Denmark; 3Clinical Institute, University of Southern Denmark.; 4Department of Gynaecology and Obstetrics, Odense University Hospital, Denmark.; 5Occupational and Environmental Medicine, Odense University Hospital, Denmark
Background: The aim of the present study is to describe the development of strategies to prevent and rehabilitate musculoskeletal pain among surgeons. Musculoskeletal pain impacts on surgeons' life, and consistent evidence on approaches of effective prevention or rehabilitation is lacking for this occupational group.
Methods: An Intervention Mapping approach was used to develop intervention strategies specifically tailored to surgeons. This approach entailed conducting a systematic literature search and semi-structured interviews with surgeons.
Results: First step was to develop a logic model of the problem of musculoskeletal pain among surgeons. Step two was to formulate health-enhancing outcomes and performance objectives for the intervention, while in step three theory-based methods and practical strategies for the intervention were identified.
Conclusion: Intervention mapping was a useful systematic tool for pinpointing the needs of surgeons and identifying theory-based intervention components. Practical strategies for the prevention and rehabilitation of musculoskeletal pain were identified through an iterative and detailed process. The next step is to design, conduct and evaluate a pilot intervention in a specific surgical department.
What Are The Return To Work Indicators For Bus Drivers With Work-related Injuries In China?
1Yixing Joru Rehabilitation hospital, China, People's Republic of; 2Guangdong Provincial Work Injury Rehabilitation hospital
Objective: Road bus traffic events are often recognized as a major public safety problem. The purposes of this study were to develop a systematic assessment battery for return to work of bus drivers with work-related musculoskeletal injuries, with the goal of providing return to work interventions and suggestions to employers and occupational rehabilitation therapists.
Methods: the study was divided into two stages. Stage one was a qualitative study conducted by three experienced OTs in reviewing transportation policy, journal articles and visiting three public bus companies in Guangzhou city, then a expert panel (n=5) was formed to develop the assessment battery. The contents include personal information, physical information, self-administrated safety behavior, simulated driving test and on-road driving test. Stage two was a quantitative study, a total of 40 injured bus drivers were recruited. The assessment was conducted before one week of discharge. Return to work outcomes was followed via telephone fourth week after discharge.
Results: A logistic regression analysis showed that only self-administrated safety behavior (adjusted odds ratio [OR]: 3.063, 95% confidence interval [CI]: 1.019–9.206) was significant predictors contributing to the return to work outcomes of same job same company.
Conclusions: The study highlights the importance of safe driving behavior for return to work of bus drivers with musculoskeletal injuries. A systematic assessment battery may play an importance role for bus drivers in preventing occurrence of traffic accidence. Future study should strengthen the education of safe driving behavior among bus drivers, therapists and employers.
Recovery Blueprint – Introducing Risk Identification to Workers Compensation Claim Management
Monash University, Australia
Background and aims: WorkCover Queensland, Australia, manages 60,000 workers’ compensation claims every year and is seeking to incorporate an evidence-based risk assessment approach that can be applied early in the course of a claim. Recovery Blueprint is a partnership between WorkCover Queensland and Monash University to develop and test a claim screening tool and associated claims management interventions.
Methods: Recovery Blueprint consists of three key components. The first is the allocation of a care profile as an indicator of risk of delayed recovery based on information available at the time of claim acceptance. The second is completion of 10 profile questions by the case manager for the two care profiles at risk of delayed recovery. Each profile question contains a further information step consisting of either a validated questionnaire, for example the Short Form Orebro where it is identified the worker is having trouble coping, or an internal checklist to record specific risk information, such as the reasons why an employer is unable to support RTW. The final component is the introduction of stepped care delivery. Based on the care profile and identified risks, claim managers are provided with initial recommended actions and suggested follow up options should further action be required. Concurrent re-design of claim management software has embedded the new model of claim management into existing systems.
Testing: Pilot testing is occurring in three phases to identify the impact of each component of the Recovery Blueprint on claim manager practice, worker experience and claim outcomes. The first phase (approximately 3,000 claims) will be complete in January 2018, phase 2 (1,000 claims) in May and the final phase (1,250 claims) is due to be complete by October 2019.
This presentation describes the development of the Recovery Blueprint and the approach to its evaluation.
Risk Factor Identification for Delayed RTW: Best Practice Statement
1Monash University, Australia; 2RMIT University, Australia; 3NE&A Pty Ltd
Background: Ongoing emphasis on early identification in practice and in the literature has led to a large body of research in the early, exploratory stages of prognostic research. However, little evidence exists that permits evaluation of the impact of intervention based on risk factor identification in a worker’s compensation context. As a result there is a lack of direct evidence to guide practical implementation of risk factor identification and intervention. The first stage of Recovery Blueprint, a partnership between WorkCover Queensland and Monash University, aimed to outline the key concepts underpinning best practice in risk factor identification for delayed return to work (RTW) based on available evidence and knowledge of current practice in worker’s compensation case management.
Results: Risk factor identification for delayed RTW can be applied to drive two main purposes: 1. Guide appropriate allocation of resources; and 2. Guide appropriate service delivery, both responsively and proactively. The overarching principles behind identification of risk is that it will inform an appropriate course of action to achieve optimal RTW outcomes and guide evidence-based, transparent and consistent decision making that is acceptable to all stakeholders. Eight characteristics of best practice are proposed: 1. Assesses multiple domains; 2. Balances timing of information collection; 3. Uses both administrative and in-depth data sources; 4. Systems are capable of combining and delivering information; 5. Timely delivery of usable information to decision makers; 6. Systematic documentation; 7. Appropriate use of automated and judgement-based decision making; and 8. Understanding of context in which risk identification is applied.
Discussion: The method of collection, timing and interpretation of the information applied in risk identification should reflect characteristics such as operational structures, experience and skill level of people involved and infrastructure available to inform risk-based intervention.
Municipal Return To Work Management In Cancer Survivors Undergoing Cancer Treatment: A Controlled Intervention Study
1DEFACTUM - Social & Health Services and Labour Market, Central Denmark Region, P.P. Oerums Gade 11, building 1B, 8000 Aarhus C, Denmark; 2Section of Clinical Social Medicine and Rehabilitation, Department of Public Health, Aarhus University, Denmark; 3Department of Oncology, Aarhus University Hospital, Noerrebrogade 44, 8000 Aarhus C, Denmark
The purpose of the study was to apply an early, individually tailored occupational rehabilitation intervention to cancer survivors in two municipalities parallel with cancer treatment focusing on enhancing readiness for return to work (RTW).
That the early tailored intervention would enhance readiness and thereby RTW in the intervention group compared with the control group.
That vulnerable cancer survivors would benefit from this approach; thus, reduce the effects of social inequality on workability.
Patients and methods
The study design was a controlled trial conducted on cancer survivors treated at the Oncology Department, Aarhus University Hospital, Denmark with a 12 months follow-up.
Participants eligible for the intervention were residents (18-60 years) from the municipalities of Silkeborg or Randers, referred to surgery, radiotherapy or chemotherapy at the Oncology Department, Aarhus University Hospital, Denmark with a cancer diagnoses (breast, colon-rectal, head and neck, thyroid gland, testicular, ovarian or cervix cancer). Participants were employed permanently or temporary at inclusion.
The control group had identical inclusion and exclusion criteria except for the municipality of residence.
The primary outcome was RTW identified in the Danish Register for Evaluation of Marginalisation. RTW was defined by at least 4 consecutive weeks of no social transfer payments or attending a modified job (“flexi job”). Whether socioeconomic status or co-morbidity modified the effect on RTW were secondary outcomes. Co-morbidity was defined by the Charlson-index.
Results and conclusions
One-hundred-and-fourteen and 455 participants were included in the intervention and control arm, respectively. Results on RTW effect will be presented at the conference.
Workplace Meetings In Occupational Rehabilitation – A Multiple Case Study Exploring Stakeholders´ Experiences
1Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway; 2Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway; 3Department of Physical Medicine and Rehabilitation, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway; 4Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
As long-term sickness absence is multi-casual, it has been proposed that return to work interventions should involve various stakeholders, and address individual psychological factors and work environmental factors. However, interventions are often limited to improving the individual worker’s capacity instead of making psychosocial workplace adaptations. In 2015-2016, Hysnes Rehabilitation Centre in Norway provided occupational rehabilitation that included a meeting in the workplace involving the worker, their rehabilitation therapist and the employer. The aim of this study was to explore the stakeholders´ experiences of workplace meetings, and investigate how the meetings were carried out.
This was a qualitative multiple case study of seven workplace meetings which included non-participant observation as well as interviews with the therapists, workers and employers. Data was analysed according to Multiple Case Study Analysis.
Preliminary results show that an essential feature of the meetings is to align stakeholders’ understanding of the worker’s situation, including the causes of absence and appropriate measures to secure sustainable work participation. The meetings appear to differ according to the distance between the worker’s and the employer’s understanding of the worker’s situation, leading to various outcome potentials. However, some elements seem important in all meetings. This include the therapists’ role in validating several things; the worker’s reduced function, that sustainable return to work entails a prolonged timespan, and that sickness-absence does not reflect the worker’s work ethics. In addition, the need for workers to be open was described as crucial to find appropriate work accommodations.
Discussion and conclusion
This study show that the therapist’s role is important in workplace meetings. Their approach succeeded in conveying important elements and possible dilemmas to facilitate sustainable return to work. Knowledge on these elements and dilemmas might be useful to practitioners in the field of return to work.
Meaning of work for women with breast cancer: Social Representations Theory perspective
1State University of Rio de Janeiro, Brazil; 2Hospital Central da Polícia Militar do Estado do Rio de Janeiro; 3National Cancer Institute José Alencar Gomes da Silva
Introduction: Work is essential to the quality of life of women who have experienced breast cancer. It provides income, sense of contribution, distraction, and increases self-esteem. In Brazil, it is estimated the diagnosis of 59,700 new cases of breast cancer for each year of the biennium 2018-2019. This study has the aim to reflect about the meaning of the working world for women diagnosed with breast cancer. Method: theoretical and reflexive study in the perspective of the Social Representations Theory. Development: There is relation between the Theory and the meanings of work, since the work can contribute to physical, functional, cognitive, emotional and interpersonal recovery, influenced by the treatment of cancer, understanding how the meaning is attributed to the object and how actors interpret the social context, explaining relations with elaborated representations and integrated to the preexisting developed cognitive system. There is a dialogue between the meaning of work and the Theory, considering the production of labor by concrete experiences in reality, impregnated with meaning and value, modeling subjectivities and identities of people and collectivity. Implications for Occupational Health Nursing: Understanding the meaning of work is essential to plan health care, respecting values and meanings of the woman who experienced breast cancer on her return to work activities
Physicians’ Experiences Of Problems In Sickness Certification
Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Sweden
Background: For many physicians, assessment of work capacity and sickness certification is common work tasks, with great importance for the life situation of patients, the physician’s work situation, and costs for society. The aim was to study physician’s experiences of work-capacity assessments and sickness certification.
Methods: A comprehensive questionnaire about experiences of sickness certification tasks was sent to the 34,600 physicians in Sweden in 2017. Response rate: 54%. The questionnaire contained questions about tasks, problems, competence, and resources. Of all physicians, 78% had consultations involving sickness certification, these were included in further analyses; including descriptive statistics and linear regression analyses.
Results: Physicians working in orthopedic clinics had the highest proportion of sickness-certifying consultations at least 6 times per week. The majority (92%) of the physicians stated that sick-leave certification was an important task. When relating the number of sick-leave certification consultations per week with the number of consultations experienced as problematic, physicians working within oncology stood out by having large numbers of such consultations but seldom experiencing them as problematic. While general practitioners had the largest proportion, despite not having the highest proportion of frequent sick-leave certification consultations. About half of the physicians (51%) stated that it was problematic to assess the patients’ work capacity. The task experienced as most problematic was to access level and duration of the patient’s work incapacity. Other problematic issues were to handle the two roles: as the treating physician and the medical expert. Longer sick-leave spells were in general experienced as significantly more problematic to administrate than shorter spells.
Conclusions: The vast majority of the physicians considered sick-leave certification to be an important task, however problematic. The largest proportion of physicans experiencing problems in sickness certification tasks were observed among general practitioners.
Cross-sectorial Collaboration In Return To Work Interventions: Perspectives From Patients, Mental Health Care Professionals And Case Managers In The Social Insurance Sector.
University of Southern Denmark, Denmark
Common mental disorders (CMD) such as depression and anxiety are major causes of sick leave in many welfare nations and have huge negative impacts on psychosocial well-being and causes large financial burdens to overall society. The return to work (RTW) process is multi-factorial involving the health care sector, the social security system, and the employment sector. Poor or lack of collaboration across these sectors can cause uneven RTW processes and leave individuals with feelings of uncertainty and despair. This study reports from an intervention implemented in 4 municipalities in Denmark with the aim to support CMD patients to RTW by increasing collaboration between the mental health care system (MHCS) and the social insurance sector (SIS) and investigates how the implementation process is experienced by CMD patients, professionals in MHCS, and case mangers in SIS.
A qualitative design was employed consisting of individual interviews (n20), focus group discussions (4), and observations of interactions between CMD patients, case managers from SIS, and professionals working in MHCS. The data consists of interview transcripts, field notes, and various documents related to the intervention. Data was analysed by the use of Systematic Text Condensation.
Overall the participants were positive towards the intervention. CMD patients reported that they felt supported and did not feel under pressure by workers from SIS as they expected at first hand. Professionals in MHCS and SIS experienced several organisational barriers during the implementation process. Moreover, MHCS professionals experienced that their professional identities were in conflict with the aim of the intervention.
The results suggest that a higher level of participation in the intervention design and implementation process can improve a clear and transparent role distribution between professionals in MHCS and SIS and the matching of their expectations.
Relationship Between Work Ability Index Score And Occupational Becoming Tt 2-years In Chronic Low Back Pain Workers
1University of Angers, Inserm, EHESP, Irset - UMR-S 1085, Angers, France; 2Department of Occupational Medicine, University hospital of Angers, Angers, France
Background Chronic low back pain (cLBP) is a major occupational health problem because of the work disability it generates. The "work capacity" is defined as worker’s physical and mental capacity to perform his current job and in the near future, taking into account four dimensions: health and functional abilities, skills and learning, values and attitudes (motivation, job satisfaction) and work conditions.
Aim The objective was to assess the interest of work capacity assessment to detect cLBP workers at risk of job retention issue at 2-years of follow-up.
Methods A longitudinal monocentric study, carried out in the University hospital of Angers (France), among cLBP workers included in a 5-weeks functional restoration program. Medical, psychological, social and occupational data and the work capacity were collect at inclusion, at the end of the program (medical records) and at 2-years of follow-up (phone call). Work capacity was assessed by the Work Ability Index (WAI) which is a quick auto administered questionnaire consisting of 7 questions and scored on 49 points. According to the final score, work capacity is classified into 4 categories: bad (7-27), moderate (28-36), good (37-43) or very good (44-49). Univariate and multivariate regression, as well as correlation tests and ROC curves were performed to test the predictive and discriminant characters of WAI.
Results All thecLBP workers (men and women, 18 to 55 years old), salaried of the private or public sector and who had benefited from at least 1-month of sick leave during the previous 12-months or at least 3-months during the previous 24-months were included (126 eligible subjects).
The detailed results will be presented at the congress.
Conclusion The highlighting of such a correlation would make it possible to improve the identification of workers at risk of job retention issue and thus to reinforce the return-to-work management intended for this at-risk population.
The Impact Of Musculoskeletal Injuries Sustained In Road Traffic Crashes On Work-related Outcomes: A Systematic Review
RECOVER Injury Research Centre, The University of Queensland, Australia
Background: Musculoskeletal injuries (strains/sprains, contusions, dislocations and fractures) are the most common injury sustained in a road traffic crash. They can have a long-term impact upon one’s ability to engage in work. Persisting symptoms as well as poor physical and psychological recovery may reduce the ability to return to or remain at work necessitating the use of sick leave or alternate duties to enable a gradual return to full duties. This systematic review aims to determine the impact of sustaining a musculoskeletal injury during a road traffic crash on an individual’s ability to work.
Methods: Observational studies were identified by searching six electronic databases (PubMed, Embase, CINAHL, ARTI, Web of Science, PsycINFO) for reports of adults having sustained musculoskeletal injuries during a road traffic crash. Studies featuring paediatric cohorts (<18yrs) or those with neurological injuries are excluded. To be eligible for inclusion, studies must report at least one of the following work-related outcomes: return to work status/rate; sick leave; work ability; work capacity; or health-related work productivity loss. The methodological quality of included studies will be assessed with the National Institutes of Health National Heart, Lung, and Blood Institute Study Quality Assessment Tools for observational cohort and cross-sectional studies, and case-control studies.
Results: A total of 1937 records were identified by the database search strategy. After removal of duplicates, a total of 1255 titles and abstracts will be screened for inclusion into the review. The screening process is currently underway, and results finalised by June 2019.
Discussion: The results of this systematic review will increase our knowledge of work-related outcomes and understanding of the associated factors for people with musculoskeletal injuries following road traffic crashes. Future studies could use the results to plan interventions, and influence policy and legislation, and raise awareness of the needs of this population.
Factors Associated with Supervisor Support of Job Accommodations for Common Mental Disorders in the Workplace
1Department of Health Sciences, Lakehead University, Ontario, Canada; 2Division of Human Sciences, Northern Ontario School of Medicine, Ontario, Canada; 3Institute for Work & Health, Ontario, Canada; 4Université du Québec à Montréal, Québec, Canada; 5University of Connecticut Health Center, Connecticut, USA; 6Department of Business Administration, University of Winnipeg, Manitoba; 7Workplace Safety and Prevention Services, Ontario, Canada
Introduction: Supervisors of workers with common mental disorders (CMD) play a key role in the prevention of prolonged work absences. Providing appropriate workplace accommodation is one approach supervisors use to facilitate employees staying at work or returning to work early. People with CMD function well in the workplace when they receive appropriate work accommodations. Yet, we have little understanding of factors that influence the decision-making of supervisors to develop and provide work accommodations. Therefore, the objective of this study was to better understand what factors determine whether workplace accommodations are supported and received from the perspective of supervisors and workers.
Methods: We conducted a cross-sectional study of supervisors and workers from 31 randomly selected companies in Manitoba and northwestern Ontario, Canada. Participating companies required a minimum of 50 employees. We distributed two separate surveys to each company: one to supervisors and one to workers. We asked supervisors to complete a survey including a case vignette of a worker with a CMD and a number of scales assessing factors that may affect their decisions to provide workplace accommodations. We also asked workers to complete a survey indicating whether or not they suffer from a CMD and whether accommodations were offered. We developed and tested a new measure of CMD accommodation and used it to assess individual perspectives and group-level information on the workplace, supervisor, and worker factors through established survey scales.
Results: We will present results related to psychometric properties of the new measure of CMD accommodation provision along with individual and situational factors associated with it.
Conclusion: The findings will be important for all work disability prevention stakeholders as they will identify important targets and levers for intervention to improve accommodations for workers with CMD and foster more satisfying, stable, and productive employment that benefit workers, supervisors, and organizations alike.
Recovery Blueprint - Impact of Claim Triage
Monash University, Australia
Background: Recovery Blueprint is a partnership between WorkCover Queensland and Monash University to develop and test a claim screening tool and associated claims management interventions. The first step of Recovery Blueprint is the assignment of a care profile based on information available at the time of claim acceptance.
Methods: The model was based on the time to recovery by injury type, with time to recovery defined as the time to when no further costs are recorded on a claim for a period of 12 months. Claim characteristics were then analysed for their impact on time to recovery, for example working in the manufacturing industry increases the likelihood of recovery beyond the usual time for a musculoskeletal shoulder injury. This allowed classification of each claim into one of four care profiles: 1. Independent: short injury duration with few risks of delayed recovery; 2. Guided: long injury duration with few risks of delayed recovery; 3. Supported: short injury duration with higher risk of delayed recovery; and 4. Involved: longer injury duration and higher risk of delayed recovery. Independent and Guided care profiles were managed by case managers with a different level of training to those managing the Supported and Involved care profiles. Case management software was re-designed to deliver the care profile and the factors leading to the assignment of the profile to the case manager. Actions undertaken for each claim remained the discretion of the case manager.
Results: A pilot of an expected 3,000 claims has been run between July and October 2018, with 3 month outcomes available in January 2019. This presentation will describe the evaluation of the impact of allocating claims to care profile on both claim outcomes (RTW rate and claim costs) and case manager behaviour when managing accepted claims.