Conference Agenda

Overview and details of the sessions of this conference. Please select a date or location to show only sessions at that day or location. Please select a single session for detailed view (with abstracts and downloads if available).

Session Overview
Date: Wednesday, 05/Jun/2019
9:30am - 10:00amOpening session: Opening session
Auditorium 100 
10:00am - 10:30amKeynote I: Keynote I Ute Bültmann
Auditorium 100 
10:30am - 10:45amPoster Teaser I: Poster Teaser Presentation I
10:45am - 11:30amPoster Viewing I: Poster Viewing I

Self-reported Health Problems and Obesity Assessed with Health Risk Appraisal Predict Sickness Absence During a 12-month Follow-up: A Prospective Cohort Study in 21608 Employees from Different Industry Fields

Minna Pihlajamäki1, Jukka Uitti1,2,3, Heikki Arola4, Jyrki Ollikainen5, Mikko Korhonen5, Tapio Nummi5, Simo Taimela6,7

1University of Tampere, Finland, Faculty of Medicine and Life Scences, Occupational Medicine; 2Clinic of Occupational Medicine, Tampere University Hospital, Finland; 3Finnish Institute of Occupational Health, Tampere, Finland; 4Terveystalo, Jaakonkatu 3b, 00100 Helsinki, Finland; 5Faculty of Natural Sciences, University of Tampere, Finland; 6University of Helsinki, Department of Orthopedics and Traumatology; 7Evalua International, PO Box 35, FIN-02661 Espoo, Finland

Aim: The present study evaluates, how the Health Risk Appraisal (HRA) results predict sickness absence (SA) in respondents from various industry fields and occupation, and the potential additive roles of self-reported health problems, age, and obesity.

Introduction: Structured questionnaires are increasingly used as part of targeted health surveillance. The study evaluate whether health inspections can be supplemented by the HRA.

Methodologies: The study design is a retrospective analysis of prospectively collected register data. The research utilizes the results of the HRA (N=21608) collected in 2012-2015 and archival data of SA covering 2011-2016 from a large nationwide database of one OH service provider. Explanatory variables were self-reported symptoms, age, body mass index, occupational group and the number of SA days before the survey. The outcome measure was accumulated SA days during 12-month follow-up. A Hurdle model with negative binomial response was used to analyze zero-inflated count data of SA separately for males and females.

Results and discussion: Work disability (WD) risk factors as defined in the HRA predicted the number of accumulated SA days during the 12-month follow-up, regardless of occupational group and gender. The ratio of means of SA days varied between 2.6 and 6.1 among those with WD risk factors and the reference category with no findings, depending on gender and occupational group. The lower limit of the 95% confidence interval (CI) was at the lowest 1.6. In the Hurdle model, WD risk factors, SA days prior to the HRA and obesity were additive predictors of the propensity for SA and/or the accumulated SA days in all occupational groups.

Conclusion: Self-reported health problems in a HRA, obesity, and prior SA predict higher total count of SA days in an additive fashion. These findings have implications for both management of the health care system and in the prevention of WD.

Obtaining Person-related Information From Employees With Chronic Health Problems: A Focus Group Study

Mariska de Wit, Haije Wind, Carel T. J. Hulshof, Judith K. Sluiter, Angela G. E. M. de Boer

Coronel Institute of Occupational Health, Amsterdam Public Health research institute, Academic Medical Center/University of Amsterdam, Amsterdam, The Netherlands


Person-related factors, such as cognitions and perceptions of employees, can influence work participation of employees with health problems. This makes them important factors for occupational physicians (OPs) and insurance physicians (IPs) to intervene upon. There is however a lack of knowledge about the best way for physicians to obtain information about person-related factors, according to employees.


To assess what according to employees with chronic health problems, is the best way for OPs and IPs to obtain information about person-related factors.


Three focus group discussions were conducted with in total 23 employees with work limitations due to chronic health problems. During these meetings employees discussed the best ways to obtain information about ten person-related factors: expectations regarding recovery or return to work, optimism/pessimism, self-efficacy, motivation, feelings of control, perceived health, coping strategies, fear-avoidance beliefs, perceived work-relatedness, and catastrophizing. De discussions were recorded, transcribed verbatim and analyzed through qualitative content analysis.


The employees indicated that information about person-related factors can best be obtained by discussing them during consultations, instead of using questionnaires or diaries. Important mentioned prerequisites for these conversations are: understanding of the physician, interest and mutual trust between employee and physician. The participants mentioned different positive and negative influences for the course of the conversation. Examples of positive influences are: the knowledge of the physician about the employee and his condition and the presence of a pleasant ambiance during the conversation. Examples of negative influences are: feelings of anxiety of the employee and limited time for the conversation.


Information about person-related factors of employees can best be obtained by discussing them during consultations. However there has to be understanding, mutual trust and interest, before employees feel free to talk about these factors. OPs and IPs should consider this when asking about person-related factors during consultations.

Better Macroeconomic Performance is Associated with Shorter Disability Duration in Canadian Workers’ Compensation Claimants

Douglas Paul Gross1, Michele Crites Battié2, Thomas Lo3

1University of Alberta, Canada; 2University of Western Ontatio; 3Institute of Health Economics

Background - Better macroeconomic performance (ie. Gross Domestic Product, GDP) is associated with increased number of disability benefit applications. Association between macroeconomic performance and duration of disability claims is unknown. We hypothesized that better economic performance would lead to more job availabilities and thus shorter durations of disability claims.

Objectives - We studied associations between macroeconomic indicators and disability duration in Canadian workers’ compensation claimants.

Methods Exploratory correlational analysis was conducted using 18 years of publically available data from the Association of Workers’ Compensation Boards of Canada (AWCBC) and Statistics Canada (StatsCan). AWCBC tracks key statistical measures from provincial compensation boards and since 1999 has reported average composite claim duration defined as estimated total number of lost time calendar days compensated for temporary total disability. StatsCan reports GDP for each province measured at basic and market prices (constant 2007 dollars). These datasets included complete data for each province except Ontario and Quebec (which do not report duration) and Manitoba (which stopped reporting duration in 2014). For Alberta claimants we also examined correlations in claimants with back injury reported in annual reports. Analysis included Spearman’s rho correlation examining associations between GDP and disability duration.

Results A statistically significant negative correlation was observed between GDP and disability duration (rs = -0.42, p<0.001). Differences were observed across provinces with the largest negative correlations observed in Alberta (rs = -0.55, p=0.02) and Manitoba (rs = -0.61, p=0.01) while significant positive correlations were observed in Nova Scotia and PEI. Within Alberta, the negative correlation was particularly large for back claims (rs = -0.80, p<0.001).

Conclusions Bettermacroeconomic performance (ie. GDP) appears associated with shorter disability duration within some Canadian workers’ compensation contexts. This may be due to increased job availability in better economies, but further research is needed using other economic indicators and across regions.

The Construct Validity of Short-Form Functional Capacity Evaluation in Workers' Compensation Claimants

Tamseela Chughtai1, Patricia Manns2, Iain Muir2, Douglas Paul Gross2

1CBI Health Centre, Fort McMurray, Canada; 2University of Alberta, Edmonton, Canada

Purpose: Functional Capacity Evaluations (FCE) are performance-based assessments used to make recommendations for participation in work and other activities of daily living. Short-form FCE decreases burden of testing but validity is uncertain. We examined factors associated with performance during short-form FCE in injured workers with musculoskeletal conditions.

Methods A cross-sectional study design was used. A secondary analysis was conducted on data previously collected for examining effectiveness of short-form-FCE. Participants were workers’ compensation claimants assessed between October 18, 2004 through May 6, 2005, at a workers’ compensation rehabilitation facility in Edmonton, Canada. Measures included demographic variables (i.e. age, sex), patient reported outcomes (i.e. pain intensity, self-reported disability, recovery expectations), and measures of FCE performance (number of ‘failed’ items and floor-to-waist lift performance). Analysis included univariate correlation coefficients and multivariable linear regression.

Results The dataset included 450 workers’ compensation claimants with a variety of musculoskeletal disorders. The majority of claimants were employed (74%) and male (70%). Self-reported disability, age, and sex were independently associated with floor-to-waist lift performance, with self-reported disability having the largest standardized beta coefficient (-0.55). Self-reported disability, expectations of recovery, and duration of FCE (one or two sessions) had significant, independent influences on the number of failed FCE items, and again self-reported disability had the highest standardized beta coefficient (-0.34).

Conclusions Better performance on short-form FCE was consistently and moderately associated with lower self-reported disability. Results support the construct validity of this short-form FCE protocol. Further research is needed to evaluate the validity of short-form FCE in other contexts.

Occupational Physicians’ Perspectives On Supporting Workers With A Chronic Disease In Strengthening Self-control: A Needs Assessment

Astrid Bosma, Cécile Boot, Frederieke Schaafsma, Han Anema

Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health research institute, Amsterdam, The Netherlands.

Objective: Self-control by workers with a chronic disease can prevent work related problems and facilitate sustainable work participation. Occupational physicians could play a key role in supporting these workers in exerting self-control. It is important to understand occupational physicians’ perspectives on this preventive task and possible ways of providing support. The aim of this needs assessment is to explore barriers and facilitators for supporting workers with a chronic disease in exerting self-control according to the perspectives of occupational physicians.

Methods: Two focus groups were held in February and June 2018 with 17 occupational physicians. The occupational physicians were self-employed or employed within the occupational health services department of a large company. Data were analysed using thematic content analysis.

Results: The preliminary results show that occupational physicians mainly focus on reducing absenteeism. An occupational physician can carry out preventive tasks as long as workers with a chronic disease, that do not take sick leave, take the initiative to visit the occupational physician. However, these workers, who are still at work, rarely consult an occupational physician. Fitting the job to the capacities of the worker and discussing future disease-related scenarios are mentioned as ways of providing support.

Discussion: According to occupational physicians’ perspectives, the work environment and health care system play a facilitating role in supporting workers with a chronic disease in exerting self-control. These insights are helpful in developing an intervention for occupational physicians that enables them to support workers with a chronic disease in exerting self-control.

Work Disability In Australia: A Mixed Methods Study Of Prevalence, Expenditure, Support Systems and Services

Alex Collie, Ross Iles, Michael Di Donato

Monash University, Australia


This study sought to describe Australian systems of income support for people with work disability. Specific aims were to summarise and compare the features of income support systems, including the healthcare and employment services, and to estimate the prevalence of work disability and the national expenditure on income support.


Mixed methods involving collation and analysis of existing publicly available documentation, and interviews with twenty-five experts across ten major systems of income support. The prevalence of work disability and expenditure was estimated using publicly accessible data sources. System features and service models were summarized, tabulated and compared qualitatively.


In Australia during the 2015/16 financial year an estimated 786,000 people with work disability received income support from a national, state or private source. An additional 6.5 million people accessed employer provided leave entitlements for short periods of work incapacity. A total of $37.2 billion Australian dollars was spent on income support for these people during the year. This support was provided through a complex array of government authorities, private insurers and employers. Case management was the only service provided across all systems. Healthcare and return to work services were provided in some systems, although models differed markedly. Income support ranged from 19% to 100% of earnings for a person earning the average weekly wage pre-disability. There is limited data or publicly available information regarding movement of people with long periods of work disability between systems of support.


This study demonstrates the substantial financial and human impact of work disability on Australian society. Findings indicate multiple opportunities for reducing the burden of work disability, including aligning case management and healthcare service models, and engaging employers in prevention and rehabilitation. The findings suggest a need for greater interrogation and evaluation of Australian work disability support systems.

Determining the Reliability and Convergent Validity of a Return-to-Work Status Questionnaire

Eleanor Boyle1, J David Cassidy2, Pierre Côté2,3,4

1University of Southern Denmark, Denmark; 2Dalla Lana School of Public Health, University of Toronto; 3Faculty of Health Sciences, University of Ontario Institute of Technology; 4UOIT-CMCC Centre for Disability Prevention and Rehabilitation

Background: In occupational rehabilitation programs, return-to-work is a key outcome measure; however, the studies either used different definitions for return-to-work or do not provide their definition. In order to provide a solution to this issue, we developed a self-report return-to-work measure.

Objective: We investigated the reliability and validity of a self-report return-to-work questionnaire in a cohort of workers with a work-related injury.

Methods: Two research assistants independently administered the baseline questionnaires and a follow-up questionnaire. The questionnaires contained work-related questions (e.g., currently working, if duties changed) that were used to create a four-category work status measure. Pain-related and a recovery questions were also asked. We obtained loss of earnings data from the compensation board. The short-term reliability and convergent validity were assessed.

Results: We recruited 75 workers, and 57 completed the test-re-test baseline questionnaire, and 51 completed the follow-up. The mean age was 45.4 years and 57% were female. The participants had a mixture of musculoskeletal injuries. Most were in the acute stage, but 17% of the participants were injured for more than a year. The short-term reliability of current working status had a kappa value of 0.90. Participants who were not working had higher levels of pain-related disability than those who were working. The kappa value for the agreement between self-reported working status and administrative data on receiving any loss of earnings payment was around 0.65.

Conclusions: Our study provides evidence of reliability and validity for a new return-to-work measure.

An International Online Work Disability Policy Course: How A University Partnership Became A Facilitator.

Åsa Tjulin1, Ellen MacEachen2, Robert Larsson3, Philip Bigelow2, Stig Vinberg1, John Selander1, Darcy White2

1Mittuniversitetet/Mid Sweden University, Sweden; 2University of Waterloo, Canada; 3Mälardalen University, Sweden

So what?

Our Masters and PhD students within the field of work disability prevention are part of a global economy where challenges and commonalities between nations need to be addressed. International learning collaborations can facilitate student movement from theory (e.g. about different social security systems) to praxis, through interactive knowledge exchange amongst peers (Loisel et al, 2009).

An international on-line course can facilitate participation without the need for travel and additional related expenses is a way to foster student equity in higher education.

What is the innovation?

Our annual 10-week course, “What is fair? International perspectives on equity on work and health”, was first implemented in January 2019.

The course, based on cooperation between Mid-Sweden University, University of Waterloo and Mälardalen University in Sweden and Canada, provides the students with unique learning opportunities to work with international peers on course work and group activities while learning about international systems and policy in relation to health, work and equity.

Our partnership (with aims to expand) goes beyond the intention to provide an international learning environment; it also includes knowledge exchange between the universities. That is, the partnership includes co-operative development not only between faculty members, but also among pedagogical developers, international relations office administrators and librarians.

The outcome?

When we meet at the conference, we will have more to tell you about the specific course and experiences gained from faculty members, administrative members but foremost students who have undertaken the course.


Loisel, P., Hong, Q.N., Imbeau, D., Lipel K., Guzman, J., MacEachen, E Corbière, M., Santos, R.B., Anema, R.A. (2009) The Work Disability Prevention CIHR Strategic Training Program: Program Performance After 5 Years of Implementation. Occupational Rehabilitation 19:1 p. 1-7.

Interpersonal Skills of Psychologists in Counseling Employees with Psychological Complaints; Psychometric Quality of the Facilitative Interpersonal Skills (FIS) Instrument.

Sabine J. van Thiel1, Arno van Dam1, Evelien P.M. Brouwers1, Kim de Jong2, Jac J.L. van der Klink1, Margot C.W. Joosen1

1Tranzo Tilburg University, Netherlands, The; 2Universiteit Leiden, Netherlands, The


Although there are indications that relationship building plays a role in successfully counseling an employee in return to work [1], there is little or no research that has focuses on the effect of the practitioner itself and their skills on the recovery of psychological complaints and the process of returning to work. The aim of this research is to investigate the psychometric quality of the FIS instrument to measure interpersonal skills of practitioners in counseling employees with psychological complaints.


To measure interpersonal skills, the Facilitative Interpersonal Skills (FIS) instrument was used in which psychologists’ responses to a video simulation of a client counseling situation are assessed. The FIS measure has been shown to be highly predictive of client treatment outcomes such as symptom reduction, social role and interpersonal functioning [2,3]. To apply this instrument in an occupational health setting it was translated into Dutch and content validity and reliability were measured. Adequate content validity of the Dutch FIS clips was met when clients in the stimulus clips represent a variety of interpersonal stances [4]. Using the IMI-C [5,6] and the PANAS [7] the authors determine the diversity of the interpersonal affect between the clients and whether there is diversity to the extent of challenge in the client situations. To ensure reliability, the degree of consistency between assessors on the IMI-C and the PANAS of the simulated client in clips will be determined.

Results and implications.

The FIS clips transcripts were translated into Dutch including forward translation, synthesis, back translation and an expert committee meeting. The presented study is currently running. Results will be available end of 2018.

Conducting this study the authors envisage that the FIS will facilitate research purposes on practitioner’s effects in counseling employees with psychological complaints. The FIS will also be interesting for training purposes.

EHealth Interventions in workplaces Or Health Care Settings And Work-related Outcomes: A Scoping Review

Irene Øyeflaten1,2, Thomas Johansen1, Claus Vinther Nielsen3,4, Tone Langjordet Johnsen2,5, Torill Helene Tveito2,6, Anne-Mette Hedeager Momsen4

1National Centre for Occupational Rehabilitation, Rauland, Norway; 2Uni Research Health, Bergen, Norway; 3Department of Public Health, Section of Clinical Social Medicine and Rehabilitation, Aarhus University, Denmark; 4DEFACTUM - Social & Health Services and Labour Market, Central Denmark Region, Denmark; 5Division of Physical Medicine and Rehabilitation, Vestfold Hospital Trust, Tønsberg, Norway; 6Department of Health, Social and Welfare Studies, University South-Eastern Norway, Horten, Norway


eHealth technologies have been proposed as a promising solution to better manage the process of returning to work (RTW) among sick-listed employees. The aims are to map the existing literature of different types of eHealth technologies, tools and approaches used in workplaces and health care settings among sick-listed employees aiming at RTW, and for randomized controlled trials (RCTs) to report the effectiveness.

Research questions:

For which patient groups are eHealth interventions, supporting the RTW process, developed?

In which settings and by which stakeholders are work-related eHealth interventions offered?

Which types and modes of eHealth technologies and tools are used to facilitate the RTW-process?

Are choice of eHealth technology theory-driven or based on empirical evidence?

For RCTs what is the effectivenss?


To guide the review process, the Joanna Briggs Institute (JBI) approach will be employed using the framework by Arksey and O`Malley, enhanced to eight stages, and recommended in the JBI reviewers` manual.

The databases searched will be PubMed, Scopus, Embase, the WHO clinical registry and the The search will be limited to studies published in the last 10 years. The JBI three-phase search process will be utilized.

The review will include primary research studies with both qualitative and quantitative data published in English, Norwegian, Swedish, and Danish.

Studies that include employees/patients in working age (18-65 years) receiving sickness benefits (full or graded) due to any type of diagnoses/disabilities will be considered for inclusion.


Results will be presented at the conference

Detailed key information on: authors, year of publication, country, aims, methods, study population/sample size, setting (e.g. primary health care, occupational health service, workplace), stakeholders, eHealth intervention type (eventual comparator intervention), duration, eventual theory or evidence, and outcomes and results in details will be drafted. A narrative summary will accompany the charted results.


Will be presented.

Development of an Employer Support for Preventing Sickness Absence

Isa Moldvik, Christian Ståhl

Linköping University, Sweden

Introduction: Sickness absence can lead to negative consequences, not only for the individual but also for the workplace. The workplace has a central part in preventing sickness absence by focusing on good working conditions and systematic work environment management. The connection between the workplace and health outcome is strong, both in terms of rehabilitation and prevention. Despite that, these are usually separate processes within the organization, which also falls under different areas of responsibility.

Aim: The aim of the study is to develop an employer support for prevention of sickness absence and to integrate the rehabilitating and preventative actions. The goal is to help create sustainable workplaces and minimize production losses by supporting employers to implement best practice and knowledge into the management system. This is an ongoing project and the purpose of presenting it during the conference is to get valuable inputs regarding our approach.

Method: The study has an interactive approach and consists of multiple case-studies. The purpose of the study and questions of interest was developed in close collaboration with representatives from municipalities, health care representatives, the Swedish Social Insurance Agency and private companies. The first phase is conducted in three municipalities and consist of interviews with relevant stakeholders such as unit managers, HR-departments, union- and health and safety representatives. The main focus during the interviews is organizational factors and processes for preventing sickness absence. The analyses will investigate local praxis in relation to previous research.

Results: Preliminary results will be available at the time of the conference.

Pregnancy And Work-related Risk Factors For Sick Leave - A Danish Cohort Study

Pernille Pedersen1, Anne-Mette Hedeager Momsen1, Merete Labriola1,2, Claus Vinther Nielsen1,2, Dorte Raaby Andersen3, Ellen Aagaard Nøhr4, Rikke Damkjær Maimburg5

1DEFACTUM, Central Denmark Region, Denmark; 2Department of Public Health, Section of Clinical Social Medicine and Rehabilitation, Aarhus University, Denmark; 3Department of Occupational Medicine – University Research Clinic, Regional Hospital West Jutland, Denmark; 4Research Unit for Gynaecology and Obstetrics, Institute of Clinical Research, University of Southern Denmark; 5Department of Clinical Medicine, Aarhus University and Department of Gynaecology Obstetrics, Aarhus University Hospital, Denmark


The prevalence of sickness absence among pregnant employees is increasingly high in Nordic countries and has increased during the last decades.

Industry-specific work conditions have a large impact on the degree of sickness absence. The number of sickness absence days is highest among women working in retail, hotels, health care and as a cleaner or pedagogue, while it is lowest among women in public administration. The reason for the higher number of sickness absence days in some industries may be due to demanding work conditions and lack of job adjustments, however, little is known in this field.

The aim of this study was to identify work related reasons for sickness absence among pregnant women in different industries, and to identify work environmental risk factors.


The cohort study was based on a longitudinal survey involving pregnant employees. Participants were recruited at six maternal care clinics in the Central Denmark Region. During March-May 2018 all pregnant women, who were invited to a regular scanning in 12th gestational week received information about the study and a link to a questionnaire. A link to a follow-up questionnaire was sent by mail to the participants in 27th-29th gestational week.


Results will be presented at the conference.


Results from this study will be used to design and implement an intervention study aiming to reduce sickness absence among pregnant women.

A Framework For Comprehensive Risk Analysis Approaches, Interpretation, And Use In Occupational Safety And Health

Paul A. Schulte1, Thomas J. Lentz2, Sudha P. Pandalai3, John E. Snawder4

1CDC, United States of America; 2CDC, United States of America; 3CDC, United States of America; 4CDC, United States of America

Increasingly there is a realization that workers are exposed to multiple hazards at work and broader consideration of risks is warranted. Comprehensive risk analyses approaches that could affect workers include exposomic analysis and cumulative risk assessment (CRA). Aggregate, lifetime, and mixtures risk assessment methodologies, and total work health principles are also important for comprehensive evaluation of occupational risks. However, there is no systematic way described to consider comprehensive risk analysis so this paper provides an initial framework. This framework is a 4 x 4 matrix. One axis includes contemporary risk assessment steps of hazard identification, exposure assessment, exposure-response analysis, and risk characterization. The other axis includes different functional attributes or aspects of comprehensive risk assessment: exposomic analysis, CRA, output interpretation and communication, and preventive and control intervention. Issues arising in individual cells at the intersection of each axis, and needed actions to address them, are discussed.

Exposomic analysis involves assessing all hazards workers are exposed to throughout their lives, can measured both externally and internally, and can include environmental and occupational chemical, physical, biological factors, as well as psychosocial-cultural, economic and political determinants. Exposomic analysis can have hazard identification and risk determination objectives. CRA may be broader because it includes both non-genetic, genetic and epigenetic determinants; it involves efforts to identify and quantify the nature and extent of risk. In both exposomic analysis and CRA, temporal considerations are implicit and life span risk assessment, with aggregate, lifetime, and mixtures risk assessment and total worker health principles playing significant roles, is the ideal. A framework for comprehensive risk analysis is a step toward greater focus on the working-life continuum and hazards implicit in each job a person has, the time between jobs, and the psychosocial hazards attendant to them, all issues central to occupational safety and health.

Preventive Initiatives Among Violinists to Change Their Workload Demands: A Phd Protocol

Stephanie Mann1, Helene Martina Paarup2, Lotte Nygaard Andersen1, Lars Brandt3, Karen Søgaard1

1Dept. of Sports Science and Clinical Biomechanics, University of Southern Denmark; 2Dept. of Clinical Immunology, Odense University Hospital, Denmark.; 3Dept. of Occupational and Environmental Medicine


Classical musicians are a profession well-known for its frequent musculoskeletal complaints compared to the general Danish workforce.

Violinists are the biggest group among classical musicians and have the highest prevalence of musculoskeletal complaints. Still, no biomechanical studies have described the workload of violinists nor tested preventive initiatives such as tailored training and ergonomic adjustments.

The aim of this PhD project is to develop a training programme combined with relevant ergonomic improvements performed as a feasibility study amongst violinists.

Methods and results

The exposure study will map the biomechanical muscular working conditions based on surface electromyography during standardized violin playing with different aggravating factors such as specific techniques.

Preliminary results show high static activity levels in shoulder and neck muscles caused by the awkward working posture with the instrument clenched between left chin and shoulder.

To reduce the load on these muscles we will evaluate ergonomic chinrests that claim to reduce and change violinists’s workload demands and kinematics without interfering with their performances.

The aggravating factors affected mainly the forearm muscles and will therefore be specifically targeted in the suggested training programme.

The main part of the PhD project will be conducting of a prospective 12weeks cohort study to indicate the feasibility of the tailored training programme combined with the most appropriate ergonomic chinrest. The chinrest will be chosen based on the capability to lower the muscular workload in the upper body. This study will use a mixed-methods approach using both qualitative interviews combined with feasibility outcomes.


This PhD project will contribute with new knowledge about violinists’s workload demands. This may be crucial for understanding their work-related disorders and to recommend any exercise or ergonomic advises.

The intent is to reduce pain and improve performance among violinists and thereby improve professional musicians work and life.

Inclusive Working Life in Norway, a Qualitative Study of Employers’ Experiences with Employing People with Diverse Background.

Irene Øyeflaten1,2, Tonje Fyhn2, Torill Helene Tveito2,3

1Norwegian National Advisory Unit on Occupational Rehabilitation, Norway; 2Uni Research Health, Uni Research, Bergen, Norway; 3University of South-Eastern Norway


Successful work rehabilitation may depend on workplaces’ willingness to include workers with disabilities. In Norway, a more inclusive working life has long been on the political agenda. Despite this priority, the level of long-term sickness absence and disability pension is undesirably high, and there are justifiable concerns about the school-to-work transition process among young people. The aim of the current study was to assess employers’ experiences and risk assessments with employing and retaining young people and people with disabilities or culturally diverse background.

Material and methods

Individual semi-structured interviews with six employers were conducted, three HMS-leaders, two managers and one CRS leader, three women and men. We used systematic text condensation for the analysis.


The employers had broad experiences hiring young job seekers with various types of disabilities as well as people with culturally diverse background. They experienced that workplace diversity often lead to a better working environment and positive colleague involvement. Communication difficulties and cultural differences could however be challenging. Preliminary results indicate that successful inclusion depend on both the employer and the employees efforts. Trust and openness between the parties facilitate dialogue and a good climate for solutions. The employers motivation for employing people with diverse background were based on a moral obligation, social involvement, trust in peoples willingness to participate, and in a belief that workplace inclusion is profitable for the company, in the long run. They did however ask for solutions and support schemes that are more flexible, from The Norwegian Labour and Welfare Administration.


The employers felt a moral obligation to engage, and had mainly positive experiences with employing young people and people with disabilities or culturally diverse background. Still they often felt alone and wanted more flexible solutions and long lasting support schemes from the government.

Factors Related To Stay At Work Among Employees with Common Mental Health Problems: A Systematic Review

Suzanne van Hees1, Bouwine Carlier1, Shirley Oomens1, Roland Blonk2

1HAN University of Applied Sciences, Netherlands, The; 2Tilburg University: School of Social and Behavioral Sciences, Netherlands, The

Purpose: Common mental health problems (CMHP) in the workplace and their effect on long term disability, absenteeism and productivity loss are a growing concern among organizations and policymakers. CMHP are the leading cause of sickness absence in the western world with one-sixth of the working age population that suffers at any one time from CMHP and a lifetime risk of at least two in five. Therefore, there is a strong argument for more research emphasis on addressing CMHP in preventative strategies to stay at work rather than just reactive strategies. There is remarkably limited evidence about the concept ‘Stay at work’ among employees with CMHP and the role of the employer. Insight in enabling and impeding factors is needed to provide useful advice towards employers being responsible for interventions on workplace health and (inter)national policies. The aim of this literature review is to create a robust overview of current knowledge regarding factors that enable employees with common mental disorders to stay at work.

Methods: a systematic literature search in seven electronic databases (Pubmed, Medline, PsycInfo, Embase, Cochrane, Cinahl, Web of Science) is conducted in august 2018.

Results: 1855 titles are screened independently by two researchers on title, abstract and full text. The reviewers used an independent narrative synthesis to understand factors with regard to the individual, job design, team, employer and society. Preliminary results are expected by the end of 2018.

Tailoring The Participatory Approach To The Needs, Wishes And Abilities Of Workers With A Low Socioeconomic Position

Rosanne Schaap, Frederieke Schaafsma, Maaike Huijsmans, Cécile Boot, Han Anema

Amsterdam UMC, location VUmc, Amsterdam, The Netherlands


Workers with a low socioeconomic position (SEP) have a larger risk for health deterioration, and therefore they are at risk for premature dropout from the labor market. The Participatory Approach (PA) has the potential to prevent work disability among low SEP workers, as it aims to improve functioning at work. The PA encompasses the identification of problems in work functioning and the possible solution for these problems, guided by an occupational health professional. The PA currently focuses only on solving problems at the workplace. However, especially among low SEP workers, problems outside the workplace may also play a role in work functioning. Moreover, the current way of applying the PA might be too complex for low SEP workers and their supervisors. Therefore, this study aims to examine how the PA can be tailored to the needs, wishes and abilities of low SEP workers.


A needs assessment will be conducted in which evidence from literature will be combined with data collected from focus groups with low SEP workers, occupational health professionals and employers. Literature will be used to examine how the PA can enable workers to solve problems both in- and outside the workplace. The material of the PA will optimized and tested in two focus groups with 8-12 participants.


The PA will be extended towards a broader perspective on health making use of the Self-determination theory (SDT) as a theoretical framework for determinants of behaviour. This study is now being executed, and the results of the focus groups are expected by the end of 2018.


The needs assessment will provide valuable information on how to integrate a broader perspective on health, optimize the materials of the PA to this target group and to offer suggestions for optimal implementation of the PA in practice.

Experiences With Individual Placement And Support And Employment – A Qualitative Study Among Participants And Employment Specialists

Miljana Vukadin1, Frederieke G. Schaafsma1, Harry W.C. Michon2, Johannes R. Anema1

1Amsterdam UMC, Vrije Universiteit Amsterdam, Netherlands, The; 2Trimbos Institute, The Netherlands Institute of Mental Health and Addiction


Individual Placement and Support (IPS) is an evidence-based, effective approach to help people with severe mental illness achieve competitive employment. Although the effectiveness of IPS has been well established, little is known about the experiences of participants and employment specialists with IPS and employment. Moreover, no research has been conducted on participants’ and employment specialists’ experiences with IPS, offered with a multifaceted strategy. The goal of this strategy was to improve IPS implementation by improving collaboration between mental health care and vocational rehabilitation stakeholders, and realizing a secured IPS funding with a ‘pay for performance’ element. The aim of the present study is to explore experiences with IPS, offered with a multifaceted strategy, and to identify facilitators and barriers with regard to successfully finding and maintaining competitive employment.


A qualitative, explorative study among IPS participants (n=15) and their employment specialists (n=5) will be performed using semi-structured interviews to collect rich information about their experiences with IPS, offered with the multifaceted strategy, and to explore possible facilitators and barriers with regard to finding and maintaining competitive employment. A stratified purposeful sampling technique will be used to increase heterogeneity among participants. The stratification concerns including participants who either had been working successfully (> 12 hours per week for one month or longer) or had not been working successfully during IPS. The interviews will be recorded and transcribed verbatim. Thematic content approach will be used for data analysis.


The results are expected begin 2019.


We expect that the results of this qualitative study will provide in depth insight about the experiences of IPS participants and employment specialists with IPS, offered with a multifaceted strategy, and facilitators and barriers with regard to competitive employment. This will help to improve the IPS model and the outcomes of IPS.

Cost-Effectiveness of a Decision Aid about Disclosure of Mental Health Problems for Job Seekers.

Kim Janssens1, Jaap van Weeghel1,2, Claire Henderson3, Margot Joosen1, Evelien Brouwers1

1Tranzo, Scientific Center for Care and Welfare, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, the Netherlands; 2Kenniscentrum Phrenos, the Netherlands; 3King’s College London Institute of Psychiatry, Psychology and Neuroscience, UK

Background: Finding and keeping paid employment is more difficult for people with mental health problems compared to those without mental health problems. One barrier to paid employment is the stigma attached to mental health problems. This study focuses on the health, well-being and job seeking activities of unemployed people with mental health problems who receive social benefits from Dutch municipalities. This clustered RCT evaluates whether use of the Dutch version of the decision aid ‘Conceal or Reveal’ (CORAL), developed originally in the UK, about disclosure of mental health problems is more cost-effective in finding and keeping paid employment compared to a control group.

Methods: Subjects are recruited by 72 job coaches working at Dutch municipalities, of which 35 job coaches receive training in using the decision aid. Inclusion criteria for subjects are (1) suffering from mental health problems and (2) searching for paid employment. Subjects fill out a questionnaire about health, well-being, job seeking activities and disclosure of mental health problems at baseline and 3, 6 and 12 months. In addition, these results are combined with personal income data from the registration administration of Dutch municipalities and Statistics Netherlands.

Results and conclusion: Data collection started in March 2018 and the first results of T0 are expected in March 2019. At the conference, we will present preliminary results of T0. With descriptive statistics we will present subjects’ (self-)stigma, attitudes towards disclosure of mental health problems and (experienced and expected) consequences of disclosure in the work environment.

Prevalence Of Interfering Musculoskeletal Complaints In Sonographers And Association With Personal, Work-related And Psychosocial Factors

Yanfei Xie1, Brooke Coombes2, Lucy Thomas1, Christopher Edwards3, Venerina Johnston1

1The University of Queensland, Australia; 2Griffith University, Australia; 3Queensland University of Technology, Australia


In many industries and professions, including sonography, musculoskeletal complaints are a ubiquitous and universal problem. High burdens are placed on the individual and industry when musculoskeletal complaints interfere with home or work activities. This study aimed to investigate 1) the 1-year prevalence of musculoskeletal ache, discomfort or pain limiting sonographers from doing home or work activities (interfering complaints); and 2) risk factors associated with interfering neck-shoulder complaints and neck disability.


A cross-sectional online survey was conducted among 175 sonographers (age: 22-65 years, females: 142, males: 33) working within Australia and New Zealand. Presence of musculoskeletal complaints was recorded using the Standardized Nordic questionnaire. Neck disability was measured using the Neck Disability Index (NDI). Related risk factors were measured using standardized questionnaires, including personal, work-related and psychosocial factors. Elastic Net was used to select important independent variables to develop the final multiple linear regression model for NDI and logistic regression for the presence of interfering neck-shoulder complaints.


Sixty percent of sonographers reported complaints in at least one body region. Of all the body regions surveyed, neck and shoulder regions were the most commonly reported which were 33.1% and 37.7%, respectively. Depression (adjusted OR=1.15) and sustained neck twisted posture ˃2 hours/day (OR=3.81) were significantly associated with interfering neck-shoulder complaints. Forty-six percent (adjusted R-squared) of the variance in the NDI was explained by age (β=0.07, p=0.013), sustained arm forward reach posture for 4-8 hours/day (β= 3.88, p=0.036) and sustained neck forward posture ˃2 hours/day (β=3.50, p<0.001), anxiety (β=0.44, p<0.001), helplessness (subscale of pain catastrophizing) (β=0.40, p<0.001), and fear avoidance belief (β=0.37, p=0.001).


A substantial proportion of sonographers reported interfering complaints, particularly in the neck and shoulder. Interfering neck-shoulder complaints and disability are associated with awkward postures and psychological distress which could be important elements in developing preventive strategies in sonographers.

Attitudes to Including Employees with Minority Background, Mental Illness or Physical Disabilities

Tonje Fyhn

Norce Research, Norway

Background: An increasing amount of young people in Norway have trouble entering the workforce due to health-related or social issues. This is reflected in unemployment statistics and increased welfare imbursements to this group. The current study aims at gaining more insight into the employer perspective on including employees in their workplace that have a mental disorder, a physical disability or of a cultural minority.

Method: A survey was distributed to leaders and employees at workplaces all over Norway. 875 employees and 280 leaders responded to the survey. The survey presented cases of potential employees without stating a diagnosis. Respondents were asked to rate how well the person would fit in their work group, and asked for main barriers for employment. Respondents were also asked about benefits and threats of diversity at the workplace.
Results: Among both employees and leaders, visual impairment, psychological disorders and using a wheelchair received lowest ratings, while minorities received highest ratings. However, when respondents were broken down into industries, the ratings of the cases varied widely. Employees rated both benefits and threats of diversity higher than the leaders. These diversity perspectives showed weak but significant correlations with the cases of minorities, mental disorders and the single mother.

The Effectiveness of Workplace Health Promotion Interventions to Prevent Chronic Diseases – a Systematic Meta-review

Sandra H van Oostrom1, Karin I Proper1, Jaana Lindström2

1National Institute for Public Health and the Environment, Netherlands, The; 2National Institute for Health and Welfare, Helsinki, Finland


Considering the aging working population, prevention of chronic diseases is essential. The workplace offers an appropriate setting for this. As part of the Joint Action CHRODIS PLUS project, the aim of this study was to systematically review the available literature on workplace health promotion interventions to prevent chronic diseases.


A systematic meta-review was performed. A search to reviews from 2009 onwards was performed in multiple electronic databases. Inclusion criteria were (1) a review on the effectiveness of worksite health promotion interventions and (2) outcomes had to involve one of the following chronic diseases: diabetes type 2, cardiovascular diseases, lung diseases, musculoskeletal disorders, depression, or identified risk factors for chronic conditions (such as elevated blood lipids or cholesterol). Selection was done by two reviewers independently from each other. The AMSTAR checklist was used to assess the methodological quality of the reviews.


Of the 374 reviews identified, 23 were finally included in this meta-review, of which 9 were of high quality. Three high quality and 11 low quality reviews summarized the effect of workplace health promotion programs on weight-related outcomes, indicating some evidence for positive, though small effects on weight-related outcomes. Five low quality reviews showed mixed findings for the effect of workplace health promotion interventions on other metabolic risk factors. Two high quality reviews showed a small but positive effect of workplace psychological interventions on mental health. Four high quality reviews on musculoskeletal disorders were consistent in that they all concluded limited to moderate evidence for a positive effect of the workplace interventions under review, some stronger evidence was reported for resistance exercise training.


There seems to be moderate evidence for small but favorable effects of interventions at the workplace on weight-related outcomes, mental health and musculoskeletal disorders.

11:30am - 1:00pmEducation and working life
Session Chair: Karen Søgaard
Session Chair: Michiel Greidanus
Auditorium 100 

Isolating Geolminthiasis Infection In School Aged-Children Who Work In Artisanal Mining In North - Kivu, DRC

Kabemba Lukusa Jean Paul

Volunteers for the Conservation of Fauna and Flora, Congo, Democratic Republic of the

Health is closely related to the quality of the environment in which people live.

Geohelminthiasis infections are among the most common infections in the word affecting the poorest communities. The WHO recommends periodic deworming for children (1-15 years) living in areas where the prevalence of infections is estimated at more than 20%.

In Democratic Republic of Congo, especially in the underserved region of North Kivu, many children working in artisanal mining may not receive necessary treatment. The goal of this study was to identify the parasite carriage in this group. We collected and analysed 125 fecal samples from children aged: 6-15 who work in artisanal mining. We found that 65.6% of children have Ancylostoma duodenale, 94.4% have Trichuris trichura and 96.8% have Ascaris lumbricoides many of them have never been dewormed. Our research demonstrates the immediate need for deworming program and health education for disease prevention in the North Kivu mining region. The ultimate goal of our work is to eliminate child mining work, given the risk of exposure to multiple disease, injury, and radiation exposure common in artisanal mining though the challenge is great given the prevalence of poverty and war in region.

Once In NEET, Always In NEET? The School-To-Work Patterns Of Young Adults From A Life Course Perspective

Karin Veldman, Sander Riemer Kurt van Zon, Ute Bültmann

University Medical Center Groningen/University of Groningen, Netherlands, The

Objectives: Young adults in Neither Employment, Education nor Training (NEET) are at high risk of adverse employment and health outcomes. As earlier studies often measured NEET status at one time point, is it unclear if NEET patterns exist over time. Therefore, the aims are to 1) examine the educational and employment status of young adults over time and 2) identify risk factors in childhood.

Methods: Data were used from 1499 participants of the Tracking Adolescents’ Individual Lives Survey (TRAILS), a Dutch prospective cohort study with 15-year follow-up. NEET status was assessed at age 19, 22 and 26 years. Parental SES, negative life events, physical and mental health were measured at age 11 years. Data were analyzed with multinomial logistic regression analysis.

Results: Four school-to-work patterns were identified: 1) Non NEETs: those who have never been in NEET (N = 1277, 85.2%), 2) Early NEETs: those in NEET at age 19 or 22 years, (N = 68, 4.5%) 3) Late NEETs: those in NEET at age 26 years (N = 86, 5.7%), and 4) Persistent NEETs: those in NEET at two or three time points (N = 68, 4.5%). Having (borderline) clinical internalizing problems at age 11 was identified as risk factor for early NEETs (OR 1.93, 95%CI 1.09-3.44). Low parental SES and exposure to negative life events (≥ 3) were identified as risk factors for persistent NEETs (OR 4.45, 95% 2.00-9.91 and OR 4.42, 95% 1.62-12.08, respectively).

Conclusions: Four different patterns of young adults in NEET from late adolescence to young adulthood were identified; associated with different risk factors in childhood. Monitoring during childhood should be directed towards low parental SES, exposure of negative life events and internalizing problems, to help young adults to transition smoothly from school into the labour market.

Youth Outside the Labour Force

Chris Jensen1, Solveig Osborg Ose2

1National Advisory Unit on Occupational Rehabilitation-AiR, Norway; 2SINTEF Technology and society, Dep. of Health, Norway

Introduction: Young people, who neither participate in education nor are employed, are an increasing challenge in Western societies. The aim of the present study was to identify barriers to education or employment in order to recommend effective interventions. The study was previously reported by Ose and Jensen1.

Methods: Interviews of 60 case-managers from all labour and welfare offices (25 NAV offices) in one county in Norway were conducted. All interviews were recorded, transcribed and a ten-step method was used to sort and structure the data, which were analyzed using an inductive approach. An internet based survey was also conducted among 586 young adults (18-29 years), who did not participate in education or had a job. Descriptive analyses of the survey data were conducted.

Results: Three main barriers were identified in the interviews of the case managers; low client motivation, a sense of lack of achievement/defeat and unrealistic expectations about working life. The survey among the youth revealed other barriers; health problems (60%), low education (55%), lack of work experience (41%), the feeling of being exhausted (38%), low self-esteem (36%), feeling depressed (35%), sleeping problems (35%) and very often a combination of these barriers. Loneliness was experienced by 70% of the respondents and 75% reported money problems.

Conclusions: Case managers and their clients emphasise different reasons for youth being outside the labour force. The young clients reported health barriers as dominating barriers. Accordingly, treatment is often carried out by mental health care services, which may not be optimal when social problems seem to contribute considerably to the problems. More multidisciplinary efforts are needed.

  1. Solveig Osborg Ose, Chris Jensen , Youth outside the labour force — Perceived barriers by service providers and service users: A mixed method approach, Children and Youth Services Review (2017), doi: 10.1016/j.childyouth.2017.08.002.

Does Labour Market Participation Among Parents Affect Self-rated Health Of Their Children? A Study Of 11,267 Adolescents And Their Parents

Louise Lindholdt1,2, Thomas Lund2,3, Johan Hviid Andersen2,4, Merete Labriola2,3

1Department of Public Health, Aarhus University; 2Research Centre for Youth & Employment, Herning, Denmark; 3Centre for Social Medicine, Frederiksberg and Bispebjerg Hospital, Denmark; 4Department of Occupational Medicine, Danish Ramazzini Centre, Regional Hospital West Jutland, University Research Clinic, Herning, Denmark

The aim of this cross generation study was to investigate whether parents’ labour market attachment was associated with self-rated health among adolescents.

A cohort of Danish adolescents (N=13,100) in 9th grade answered a questionnaire about their own self-rated health in a newly established nationwide youth cohort (the FOCA-cohort). One item from the Short-Form Health Survey (SF-36) measured self-rated health (SRH), whereas information on parents’ labour market attachment was obtained from a national administrative register. The parents were followed in a five-year period before the adolescents completed the questionnaire. Five categories on labour market status were made and an integration indicator was calculated from an initial sequence analysis, to determine how well the parents were integrated in the labour market.

The association between the adolescents’ SRH in relation to parents’ labour market attachment was examined by logistic regression. Analyses were performed on 11,267 adolescents and 22,175 parents.

A total of 3,279 adolescents (29.1%) reported low SRH while 7,988 (70.9%) reported high SRH. The sequence analysis showed that adolescents who reported low SRH had parents who were less integrated in the labour market and had a weaker quality of transitions between the different labour market states, compared to those adolescents who reported high SRH.
The logistic regression showed that adolescents with parents with weak labour market integration had higher odds for low SRH compared with adolescents with parents with good labour market integration. Inclusion of parents’ educational level did not change these results.

The results indicate that unstable labour market attachment among parents affected perceived health among their adolescent children, indicating a negative effect of labour market marginalisation from generation to generation, regardless of the parents’ educational level.

Interventions Targeting Sickness Absence Among Pregnant Women In Health Care Settings And Workplaces - A Systematic Review

Pernille Pedersen1, Merete Labriola2, Claus Vinther Nielsen2, Rikke Damkjær Maimburg3, Ellen Aagaard Nohr4, Anne-Mette Hedeager Momsen1

1DEFACTUM - Social & Health Services and Labour Market, Central Denmark Region, Denmark; 2Department of Public Health, Section of Clinical Social Medicine and Rehabilitation, Aarhus University, Denmark; 3Department of Clinical Medicine, Aarhus University and Department of Gynaecology Obstetrics, Aarhus University Hospital, Denmark; 4Research Unit for Gynaecology and Obstetrics, Institute of Clinical Research, University of Southern Denmark, 5000 Odense, Denmark


The high rate of sickness absence from work during pregnancy is recognized as a problem, and may be higher than necessary from a health perspective. The aim was to evaluate the effectiveness of interventions in health care settings and workplaces targeting sickness absence among pregnant women.


Studies were eligible if they included pregnant women participating in any intervention in health care settings or workplaces. The outcome was length of sickness absence in days or number of episodes. Study design had to be either randomized controlled trials (RCTs) or quasi-experimental studies.

The search for studies was conducted in PubMed, Scopus, CINAHL, PsycINFO,, and the WHO trial registry. Risk of bias was assessed by the Joanna Briggs Institute standardized quality assessment instrument.


A total of nine studies were quality assessed and of these, four were excluded due to insufficient methodological quality. Five RCTs conducted in health care settings in Sweden and Norway were included. Due to heterogeneity, meta-analysis was not performed.

Two RCTs examined complementary and alternative medicine and three RCTs the effect of physical exercise. In general the frequency of women on sickness absence was lower in the intervention groups than the control groups, however only among pregnant women who participated in a 12-week exercise program the frequency was significantly lower (22% vs. 30%, p=0.04).


The evidence of interventions targeting sickness absence among pregnant women in health care settings is sparse, and no studies were conducted at workplaces.

Future interventions including physical activity provided in collaboration with health care settings and workplaces are requested. Studies should measure sickness absence based on valid methods, measure compliance to the intervention, and provide transparency of statistical methods.

Work-Focused Interventions That Promote The Labor Market Transition Of Young Adults with Chronic Disabling Health Conditions: A Systematic Review

Arif Jetha1,2, Robert Shaw3, Adrienne Sinden4, Quenby Mahood1, Monique Gignac1,2, Mary Ann McColl5, Kathleen A. Martin Ginis3

1Institute for Work & Health; 2University of Toronto; 3University of British Columbia; 4McMaster University; 5Queen's University

Background: Young adulthood is an important transitional life phase where one establishes their career. Young adults living with chronic disabling health conditions are underrepresented in the labor market, and experience difficulties with employment participation that can extend across working life course and impact health and quality of life.

Objective: To examine the effectiveness of work-focused interventions that support the labor market transition of young adults with chronic disabling health conditions; and to examine whether the effectiveness of work-focused interventions differ depending on the phase of work transition (e.g., preparation, entry and sustaining work, and employment advancement) and disability type.

Methods: A systematic review of articles published between January 1990 to July 2018 was conducted. Medline, EMBASE, and PsycInfo were searched, and titles/abstracts and full-texts of articles were reviewed for eligibility. Relevant articles were appraised for methodological quality. A best evidence synthesis approach was applied to medium/high-quality studies to develop recommendations.

Results: 5,815 articles were identified; ten articles were relevant and of moderate-high methodological quality. Five intervention categories were identified which focused primarily on young adults with mental health (n=6) or intellectual and developmental disabilities (n=3), and addressed employment preparation (n=10) and/or work entry (n=9). No interventions addressed at-work issues or career advancement. A moderate level of evidence existed for supported employment interventions having a positive impact on competitive employment outcomes, especially among young adults with mental health conditions.

Conclusions: There is a paucity of evidence-based interventions that address the employment needs of young adults with disabling health conditions as they transition into the labor market. Supported employment has the potential to be an effective intervention that encourages preparation and entry into employment. Research is required to examine interventions that facilitate sustained work and career advancement of young adults with disabling conditions to promote employment over the life course.

11:30am - 1:00pmMeasures in WDP
Session Chair: Jan Hartvigsen
Session Chair: Femke Abma
Room 99 

Social Insurance Literacy: What Is It, And Can It Be Measured?

Christian Ståhl1,2, Elin Karlsson1, Jan Sandqvist1

1Linköping University, Sweden; 2HELIX Competence Centre, Linköping, Sweden

Sickness insurance and workers’ compensation systems make decisions of peoples’ eligibility for benefits, commonly based on medical certificates which assesses the ability to work. Previous research has indicated that systems differ in the extent to which they preserve clients’ dignity, and the perceived justice in relation to the system depends on the quality of the assessment process and the communication between the client and the authority. It is further reasonable to expect that the client’s resources and ability to comprehend regulations and processes matter.

In this study, we introduce social insurance literacyas a term to capture the importance of peoples’ social position and resources, and systems’ ability to meet the varying needs of claimants, in relation to how fair a system performs and how equitable it is perceived. The concept is meant to be used as a way of describing the various factors that may influence the justice of social insurance systems, and to offer guidance in how these factors may be operationalized and measured.

The aim of the study is to define social insurance literacy through a scoping literature review of related concepts (health literacy, financial/economic literacy, legal capability/ability, social security literacy, insurance literacy), and a conceptual re-analysis of these in relation to the social insurance field. Specifically, we explore how related concepts are defined and operationalized, and how these definitions and operationalizations may be transformed into a definition and operationalization of social insurance literacy.

The literature study was followed by a workshop where a definition was settled: “Social insurance literacy is the extent to which individuals can obtain information, understand and act on the dynamics of communications, processes and decisions in a social insurance system, and the comprehensibility of the system’s communication”. The study also outlines directions for developing a measure for the concept.

Psychometric Properties of the Work Disability Diagnostic Interview (WoDDI) Used With Workers Having a Musculoskeletal or Common Mental Disorder

Marie-José Durand, Marie-France Coutu

Université de Sherbrooke, Canada

Clinicians and especially new clinicians, need to systematically assess work disability factors to better intervene. The Work Disability Diagnostic Interview (WoDDI) is one promising tool to structure the interview.

Objective To describe (1) construct validity, (2) internal consistency, and (3) interrater reliability of the WoDDI with individuals on sick leave due to musculoskeletal disorders (MSDs) and common mental disorders (CMDs).

Methods A cross-sectional design was used with a non-probability sample. The inclusion criteria for workers were: (1) MSD- or CMD-related sick leave between 3 to 24 months ; (2) enrolled in a rehabilitation program. Trained occupational therapists completed the WoDDI with participants. Self-administered questionnaires (job content questionnaire, psychological distress scale) were also administrated. For interrater reliability, six occupational therapists rated the WoDDI based on standardized case studies (MSD; CMD).

Results 290 workers (140 MSD and 150 CMD) have been evaluated. Self-administered questionnaire results for both groups suggest low decision latitude (≤ 72), high psychological demand (≥ 24) and high psychological distress (≥ 30.95). Regarding for construct validity, exploratory factor analysis (EFA) revealed similar dimensions in both versions (illness representation, clinical judgment of the severity of the medical condition, and high level of work demands). This allowed reducing the number of items by approximately 20 to 40%, depending on the version. Internal consistencies ranged for MSD version from: 0,75 to 0,80 and for CMD version: 0,40 to 0,75. Interrater reliability was satisfactory as regards the nature of the instrument (Cohen’s Kappa from 0,34 to 0,43).

Conclusion Despite the reported limitations, by reducing the number of items included, the content of the WoDDI appears to correlate well with the current scientific literature on the populations under study. It also fits in with a biopsychosocial understanding of individuals on work disability. However, the CMD version of the instrument requires revision and retesting.

Pilot review shows need for a Core Outcome Set for Work Participation (COS-WP)

Margarita Ravinskaya1, Cecilia A.C. Prinsen2, Carel Hulshof1, Jos H. Verbeek3, Regina Kunz4, Miranda Langendam5, Jan L. Hoving1

1Amsterdam UMC, Academic Medical Center, University of Amsterdam, Coronel Institute of Occupational Health, Amsterdam Public Health research institute, Amsterdam, the Netherlands.; 2Amsterdam UMC, VU University Medical Centre, Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands.; 3Finish Institute of Occupational Health, Cochrane Work, Kuopio, Finland.; 4Academic Unit EbIM, Evidence Based Insurance Medicine, Department of Clinical Research, University of Basel, Switzerland; 5Amsterdam UMC, Academic Medical Center, University of Amsterdam, Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam Public Health research institute, the Netherlands.

Background: Within the occupational health (OH) and insurance medicine (IM) field ‘work participation’ is an important outcome concept. Not only are there several outcomes related to the ‘work participation’ concept, but the instruments that measure these types of outcomes can vary. Lack of standardisation in outcome measurement and reporting significantly hinders the synthesis of research. We explored the need for a core outcome set (COS) in the field of OH by performing a pilot review to gain insight into reported outcomes, their terms and definitions, and the type of outcome measurement instruments reported in trials.

Methods: We used trials that were included in 7 Cochrane reviews published at Cochrane Work that described a variety of disorders, OH interventions and work participation (WP) outcomes.

Results: In total 82 trials reported on outcomes including: return to work (RTW), sick leave, absenteeism, work status, functional status, productivity, and work functioning. Outcomes were measured at different follow up times ranging from a few weeks to 4 years after baseline; definitions, cut points for RTW or sick leave varied such as time to first day of 100% RTW, cumulative days off work, sick leave rate; mean monthly sick leave days; diverse statistics were included such as rates, means, odds or hazard ratios; and different sources such as self-report data, questionnaires, or administrative databases were used.

Conclusions: The variation in outcomes and measurements highlights the need for a COS-WP which is relevant within the field of OH. The Coronel Institute of OH at the Academic Medical Center in Amsterdam has started an international collaborative project to develop a COS-WP, in collaboration with Cochrane Insurance Medicine and Cochrane Work. We call on the international community of practitioners, clients and researchers in OH and IM to help us join forces for the development of such a core outcome set.

Intensity Of Occupational Physical Activity - Do Self-Reported Rating And Technical Measures Agree?

Mette Korshøj1,2, Nidhi Gupta1, Ole Steen Mortensen2, Andreas Holtermann1,3

1National Research Centre for the Working Environment, Denmark; 2Department of occupational medicine, Holbæk Sygehus, Holbæk, Denmark; 3Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark


Occupational physical activity seems to impact health harmfully. However, the previous studies are predominantly based on self-reports of occupational physical activity which can be biased. One of the proposed harmful factors is intensity of occupational physical activity, which can be self-reported, e.g. rating of perceived exertion (RPE), or objectively measured, e.g. by heart rate reserve (HRR). Yet, knowledge of the agreement between RPE and HRR during occupational physical activity are lacking. Thus, we aimed to investigate this.


A cross-sectional analysis was performed in the DPhacto cohort, including 683 workers from cleaning, manufacturing and transport sectors. RPE was collected by questionnaire (How physically demanding do you normally consider your present work? With a response scale from 1-10, where 10 is most demanding). HRR was obtained by diurnal objective measures of heart rate (HR). HRR was calculated by subtracting the resting HR from the maximal HR. A linear regression model was applied, adjusted for age and sex.


RPE was significantly associated (B 0.06, SE 0.01, 95%CI 0.03 – 0.09) and correlated (R2 0.21, p <0.0001) to %HRR during work. Cardiorespiratory fitness, occupational lifting, BMI and sex significantly biased the difference between RPE and HRR. Mean difference between RPE converted to HR and objectively measured HR was 72 bpm, indicating that RPE may overestimate intensity of occupational physical activity.


RPE and %HRR were significantly associated and correlated; however the mean difference of HR from RPE and objective measures indicated that RPE tend to overestimate intensity of the occupational physical activity.

Cross-Cultural Adaptation of the Chinese version of Work Rehabilitation Questionnaire (C-WORQ)

Yanwen Xu1,2, Xunwen Lo2, Xiaomin Liu2, Ru Huang2

1Yixing Joru Rehabilitation Hospital, China, People's Republic of; 2Guangdong Provincial Work Injury Rehabilitation Hospital


The development of the Work Rehabilitation Questionnaire (WORQ) under the framework of WHO-ICF has proven to be a valid and reliable instrument to assess work functioning. However, the use of WORQ in return to work of workers with work-related injuries is not yet reported. The aims of this study were to translate the English version of WORQ to Chinese version (C-WORQ) and report the psychometric properties of C-WORQ in a group of Chinese workers with work-related injuries.


The forward translation approach was used to translate WORQ from English to Chinese. An expert panel was formed to examine content validity. Internal consistency, test-retest reliability and criterion validity and were analyzed by the intra-class correlation coefficient (ICC) and correlation analysis, respectively. The construct validity was analyzed by the exploratory factor analysis approach.


There were 42 questions related to functioning were consisted in C-WORQ. The ICC was between 0.601 to 0.915 indicating good test-retest reliability (n=29). The C-WORQ demonstrated excellent internal consistency (Cronbach’s Alpha 0.961) (n=108) and principal components analysis revealed that four components were extracted with 61.638% of the variance explained. C-WORQ showed moderate correlation with The Lam Assessment of Stages of Employment Readiness (r=0.541, p<0.001).


C-WORQ is a reliable and valid version of work rehabilitation measures for use in Chinese workers with work-related injuries.

Validation of the Work Assessment Triage Tool for Selecting Rehabilitation Interventions for Injured Workers

Douglas P. Gross1, Ivan A. Steenstra2, William S. Shaw3, Parnian Yousefi1, Colin Bellinger4, Osmar R. Zaïane1

1University of Alberta, Canada; 2Morneau Shepell, Canada; 3University of Connecticut; 4Dalhousie University, Canada

Background - Musculoskeletal disorders are leading causes of work disability. Effective interventions exist for promoting return-to-work in patients with musculoskeletal conditons (i.e., functional restoration, multidisciplinary biopsychosocial rehabilitation, workplace-based interventions, etc.), but it is difficult to select the optimal intervention for specific patients. The Work Assessment Triage Tool (WATT) is a clinical decision support tool created to help clinicians select interventions. The WATT algorithm categorizes patients based on individual, occupational, and clinical characteristics according to likelihood of successful return-to-work following rehabilitation. The WATT was developed using machine learning analyses on a dataset from workers’ compensation claimants being considered for rehabilitation between December 2009 and January 2011. Internal validation showed acceptable classification accuracy, but WATT has not been tested beyond the original development sample.

Purpose - Our purpose was to externally validate the WATT.

Methods - A population-based cohort design was used, with administrative and clinical data extracted from a Canadian provincial compensation database. Data were available on workers being considered for rehabilitation between January 2013 and December 2016. Data was obtained on patient characteristics (i.e., age, sex, education level), clinical factors (i.e., diagnosis, part of body affected, pain and disability ratings), occupational factors (ie. occupation, employment status, modified work availability), type of rehabilitation program undertaken, and return-to-work outcomes (receipt of wage replacement benefits 30 days after assessment). Analysis included classification accuracy statistics of WATT recommendations for selecting interventions that lead to successful RTW outcomes.

Results - The sample included 5296 workers of which 33% had spinal conditions. Sensitivity of the WATT was 0.16 while specificity was 0.84. Overall accuracy was 73.0%.

Conclusion - Accuracy of the WATT rules for selecting successful rehabilitation programs in the new dataset was modest. Algorithm revision and further validation is needed, although it appears rules developed using machine learning may be limited by lack of reproducibility.

11:30am - 1:00pmMental health and workplace perspectives
Session Chair: Dwayne Van Eerd
Session Chair: Emil Sundstrup
Room 95 

Workplace Practices and Policies to Support Workers with Depression: Evidence from Workplace Parties.

Dwayne Van Eerd1, Kim Cullen1, Emma Irvin1, Morgane Le Pouésard1, Judy Geary2, Anita Dubay3

1Institute for Work & Health, Canada; 2Ontario Shores for Mental Health Sciences, Whitby, Canada; 3Centre for Addiction and Mental Health, Toronto, Canada

Introduction: The workplace burden associated with depression is extensive. Workers with depression lose more health-related productive time, have higher rates of absenteeism and short-term disability, and experience higher rates of job turnover than those without depression. Our objective was to synthesize evidence from practice (workplace policies and practices) and experiences from workplace audiences within the context of the scientific evidence.

Methods: Our study sample consisted of workers, managers, and consultants in workplaces from our contact database (approximately 700 OHS contacts across Canada willing to be contacted for research). Data collection included a web-based survey, focus groups, and interviews with stakeholder representatives from multiple sectors. We collected information about workplace practices and policies to prevent productivity losses, promote stay-at-work, and support return-to-work for workers with depression. The synthesis considered practice evidence gathered from stakeholders and combined that with evidence from the scientific literature.

Results: Results (n=475, 66% workers, 23% managers/consultants) revealed a willingness among participants to share their experiences with depression and work. Workers reported practices related to non-judgemental listening and external supports were most helpful to them. Managers/consultants suggested non-judgemental listening and employee assistance programs were most helpful in supporting workers. However, workers often felt workplace support was lacking and reported non-supportive supervisors as a key barrier to receiving needed support. Managers indicated a lack of training and knowledge about depression were the main barriers to providing support to workers. Workers did not feel simply providing information was helpful whereas managers often did.

Conclusion: Results reveal the importance of non-judgemental listening as a workplace support for depression. However, responses revealed workers and managers did not have similar experiences of workplace support. Synthesizing this practice evidence along with the research evidence will be helpful to guide policies and practices to support workers with depression.

Factors Influencing Worker Disclosure of Mental Illness to Managers

Carolyn S Dewa1, Jaap Van Weeghel2, Margot C.W. Joosen2, Petra C. Gronholm3, Evelien P.M. Brouwers2

1University of California, Davis, United States of America; 2Tilburg University, The Netherlands; 3London School of Economics, UK

Background: Recent systematic literature reviews indicate there are effective work disability interventions for mental illnesses. However, stigma can be a barrier to accessing these effective interventions. Fear of stigma’s concomitant prejudice and discrimination can inhibit workers from telling their manager they need help. Thus, it may also be important to develop effective interventions addressing workplace stigma. To identify important targets for these interventions, this study addresses the question, what factors influence worker disclosure of a mental health problem to their managers?

Methods: Data are from a nationally representative sample of 1246 working Dutch adults who completed a web-based survey in February 2018. They were asked three sets of questions focusing on: (1) Would you tell your manager if you developed a mental health problem? (2) For what reasons would you disclose/not disclose the problem? (3) What would change your decision?

Results: About 74% of respondents would tell their managers about a mental health problem; 32% indicated nothing could change their decision. However, 51% and 28% suggested they could be influenced by those in their networks and their managers, respectively. In contrast, 26% of respondents reported they would not tell their managers; 70% of these indicated their decision was influenced by internal factors (e.g., embarrassment, privacy) while 63% were motivated by external factors (e.g., loss of career, unfavorable treatment). About 36% thought they would not change their negative decision while 42% and 39% pointed to their networks and managers, respectively as influential in a potential change.

Conclusion: These results indicate managers, organizational policies as well as workers’ families, colleagues, and treatment providers play significant roles in work-related disclosure decisions. This suggests stigma will not be successfully addressed through worker education alone. Rather, effective interventions should also help managers, colleagues, and treatment providers understand their roles in combating workplace stigma.

Employees’ Knowledge, Attitudes And Intended Behavior Regarding Coworkers With Mental Health Problems

Evelien P.M. Brouwers1, Gaia Sampogna2, Claire Henderson3, Carolyn Dewa4, Jaap Van Weeghel1

1Tilburg School of Social and Behavioral Sciences, Department Tranzo, Tilburg University, Tilburg, the Netherlands; 2Department of Psychiatry, University of Naples SUN, Naples, Italy; 34 King’s College London Institute of Psychiatry, Psychology and Neuroscience, UK.; 4Department of Psychiatry and Behavioral Sciences, University of California, Davis, USA.


In many countries, participation and reintegration of people with mental health problems (MHP) in the workforce is problematic. Compared to workers with physical conditions, they have a higher risk for sick leave, early retirement, disability leave, and disruption in workforce participation. The extent to which workplace stigma plays a role in this problem has been under researched. Research questions of this study are: (a) How do employees think about coworkers with MHP?; (b) What is their willingness to spend time and effort on supporting coworkers with such health problems?; (c) which variables explain the social distance to coworkers with mental health problems in the workplace?


In February 2018, a cross-sectional survey was carried out among a nationally representative internet panel of Dutch employees. A total of 1246 respondents filled out the questionnaire (response rate 74,6%). Concepts measured were knowledge, attitude and (intended) behavior.

A total of 39,9% preferred not to have a close colleague with MHP, and 61,2% preferred not to work for a manager with MHP. The extent to which they were willing to spend extra time supporting a coworker with MHP depended on whether they liked the coworker (78,3% agreed), or if the coworker could clearly communicate what s(he) needed (87,6%). Main concerns were: the coworker could not handle work (44,7%), the employee would have to take over the coworkers’ work (32,9%), or the coworker would not know how to help (37,6%). Factors that explain social distance will be presented at the conference.


Negative attitudes towards coworkers with mental health problems are highly prevalent amongst Dutch employees. The findings of the present study regarding knowledge, attitudes, and behavior are important for future studies on sustainable employability of this group and the development of anti-stigma intervention studies.

Supervisors’ Knowledge, Attitude And Experiences Of Mental Health Problems In The Workplace

Margot Joosen1,2, Marjolein Lugtenberg1, Carolyn Dewa3, Jaap van Weeghel1,4, Evelien Brouwers1

1Tranzo, Scientific Center for Care and Welfare, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, the Netherlands; 2Department of Human Resource Studies, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, the Netherlands; 3Department of Psychiatry and Behavioral Sciences, University of California, Davis, USA.; 4Kenniscentrum Phrenos, Utrecht, The Netherlands


Given the high prevalence of mental health problems (MHP) among workers, organizations have become increasingly concerned about adequately addressing MHP in the workplace. Particularly, supervisors may have prominent roles in providing support to employees with MHP.


This study aims to examine supervisor mental health-related knowledge, attitudes and experiences. In addition, it explores the factors associated with supervisors’ willingness to invest in their workers with MHP.


A cross-sectional survey was conducted in a representative panel of Dutch supervisors (N=976), derived from the LISS panel (Longitudinal Internet Studies for Social Sciences). Data on three topics were gathered: knowledge of mental health in the workplace, and attitude and experiences with employees with MHP. Descriptive analyses were used to determine knowledge, attitude and experiences. Multiple regression analyses were conducted to investigate which factors predict their willingness to invest in workers with MHP.


A total of 612 participants between the ages of 19 and 66 responded (62.7%). With respect to knowledge, supervisors correctly believe that 21.1% of the employees in their organization will be affected with mental health problems. However, 37,4% did not feel he/she had sufficient knowledge to support those workers. As for their attitude, supervisors reported their willingness to spend extra time and energy to depends mostly on whether the employee clearly says what he/she needs (85,3%). 51.2 percent of the supervisors had favorable experiences with dealing with employees with MHP.


Despite being aware of MHP, half of supervisors had favorable experiences with employees with MHP. However, our study shows that they do not feel sufficiently equipped to manage employees with MHP. Policy should aim at assisting supervisors and employees to deal with MHP to maximize supervisors’ willingness to invest in their workers with mentally health problems.

Line Managers’ Attitudes towards and Willingness to Hire People with Mental Health Problems.

Kim Janssens1, Margot Joosen1, Jaap van Weeghel1,2, Carolyn Dewa3, Claire Henderson4, Evelien Brouwers1

1Tranzo, Scientific Center for Care and Welfare, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, the Netherlands; 2Kenniscentrum Phrenos, the Netherlands; 3Department of Psychiatry and Behavioral Sciences, University of California, Davis, USA; 4King’s College London Institute of Psychiatry, Psychology and Neuroscience, UK

Background: Employment can be beneficial for health and well-being of people with mental health problems. However, among the unemployed, people with mental health problems are over-represented. One of the barriers to paid employment is workplace discrimination. Negative attitudes towards mental health problems by line managers could lead to a greater likelihood of unemployment among people with mental health problems. This study examines the attitudes of line managers towards (potential) employees with mental health problems.

Methods: Data were collected from a representative Dutch sample of 976 line managers participating in the Longitudinal Internet Studies for the Social Sciences (LISS) panel. The response rate was 69% (n = 670).

Results: In total, 64% of the responding line managers would not hire a job applicant with current mental health problems. Moreover, 30% indicated they did not want to hire a job applicant with a history of mental health problems. Reasons included concerns that the employee could not handle the work (55%), would eventually require long-term sickness absence (43%), could not be counted on (41%), the employee would negatively impact the workplace atmosphere (40%), or the manager do not know how to assist an employee with mental health problems (39%).

Conclusion: The majority ofline managers were not willing to hire job applicants with mental health problems because of many concerns about reliability and effects on the workplace atmosphere. Importantly, one third of line managers prefers not to hire a job applicant who has had mental health problems in the past. This indicates that even if the health problems are over, the stigma remains a barrier for work participation. Future studies should focus on interventions to improve line managers’ knowledge and attitudes towards workers with mental health problems as well as how to provide effective resources for managers if they do require assistance.

Challenges In Accommodating Mental And Physical Health Conditions: What Workplace Parties Are Saying.

Monique A.M. Gignac1, Julie Bowring1, Curtis Breslin1, Arif Jetha1, Dwayne Van Eerd1, Emma Irvin1, Renee-Louise Franche2, Peter Smith1, Emile Tompa1, William Shaw3, Dorcas Beaton1, Ron Saunders1

1Institute for Work & Health, Canada; 2Simon Fraser University; 3University of Connecticut

Objectives: Employers increasingly are asked to accommodate workers with episodic physical and mental health conditions (e.g., depression, arthritis, colitis). In addition to intermittent and unpredictable symptoms, signs of these conditions are often invisible to others. As a result, workplaces experience challenges in providing support and accommodations, particularly in light of privacy legislation. This study aimed to understand organizational perspectives on implementing work disability prevention practices and key issues in supporting workers with chronic, episodic conditions.

Methods: A convenience sample of workplace parties involved in disability management was recruited using community advertising and established contacts. Participants were interviewed using a semi-structured interview. Questions asked about disability management roles; challenges in implementing and monitoring accommodation and RTW plans; and personal, work, and environmental contextual factors. Interviews were transcribed, and two coders independently coded the transcripts using qualitative content analysis.

Results: Twenty-six participants (20 women; 6 men) were interviewed. They included disability managers (n=7), HR personnel (n=5), supervisors (n=6), labour lawyers (n=3); union representatives and others (n=5). Participants worked in a range of sectors. Themes raised by participants highlighted: i) organizational culture; ii) that message recipients are not static processors of information, but subjectively evaluate and affectively process and respond to verbal and non-verbal information from workers; iii) complexity surrounding the amount, type and timing of information that workplace parties receive; iv) challenges arising when workers choose not to share information (e.g., progressive disciplinary actions); and iv) challenges in focusing on skills and abilities and not performance deficits when managing an unknown condition with an uncertain workplace trajectory.

Conclusion: This study identifies areas where organizational disability support processes could be enhanced to improve the ability of workplaces to include workers with episodic disabilities and sustain their employment. This includes processes to foster communication while protecting privacy and improved assessment of job support needs.

11:30am - 1:00pmWork and cancer survivors
Session Chair: Emma Irvin
Session Chair: Charlotte Diana Nørregaard Rasmussen
Room 96 

Prognostic Factors for Return to Work and Work Disability among Colorectal Cancer Survivors; A Systematic Review

Chantal den Bakker1, Johannes Anema1, Anne Claire Zaman2, Henrika de Vet1, Linda Sharp3, Eva Angenete4, Marco Allaix5, Rene Otten1, Judith Huirne1, Jaap Bonjer1, Angela de Boer2, Frederieke Geraldine Schaafsma1

1VU University Medical Center, Netherlands, The; 2Academic Medical Center, University of Amsterdam, The Netherlands; 3Institute of Health & Society, Newcastle University, Newcastle, United Kingdom; 4Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Göteburg, Sweden; 5Department of Surgical Sciences, University of Torino, Torino, Italy

Background: Colorectal cancer is diagnosed progressively in employed patients due to screening programs and increasing retirement age. The objective of this study was to identify prognostic factors for return to work and work disability in patients with colorectal cancer.

Methods: The research protocol was published at PROSPERO with registration number CRD42017049757. A systematic review of cohort and case-control studies in colorectal cancer patients above 18 years, who were employed when diagnosed, and who had a surgical resection with curative intent were included. The primary outcome was return to work or work disability. Potentially prognostic factors were included in the analysis if they were measured in at least three studies. Risk of bias was assessed according to the QUality In Prognosis Studies tool. A qualitative synthesis analysis was performed due to heterogeneity between studies. Quality of evidence was evaluated according to Grading of Recommendation Assessment, Development and Evaluation.

Results: Eight studies were included with a follow-up period of 26 up to 520 weeks. (Neo)adjuvant therapy, higher age, and more comorbidities had a significant negative influence on return to work. A previous period of unemployment, extensive surgical resection and postoperative complications significantly increased the risk of work disability. The quality of evidence for these prognostic factors was considered very low to moderate.

Conclusion: Health care professionals need to be aware of these prognostic factors to select patients eligible for timely intensified rehabilitation in order to optimize the return to work process and prevent work disability.

Return to Work Self-Efficacy (RTWSE) And Actual Return To Work In A Population Of Cancer Patients

Rikke Smedegaard Rosbjerg1,2, Dorte Gilså Hansen3, Robert Zachariae4, Inger Højris5, Merete Labriola1,2

1Aarhus University, Denmark; 2DEFACTUM, Central Denmark Region, Aarhus, Denmark; 3The National Research Center of Cancer Rehabilitation, Research Unit of General Practice, University of Southern Denmark, Denmark; 4Unit for Psycho Oncology and Health Psychology, Department of Psychology, Aarhus University, Aarhus, Denmark; 5Department of Oncology, Aarhus University Hospital, Aarhus, Denmark


Cancer patients and cancer survivors have an increased risk of sickness absence, unemployment, and early retirement. Considering the societal costs and the impact on quality-of-life (QoL) of cancer patients and their families, improving work ability and the return to work (RTW) process for cancer patients is of major importance. Self-efficacy (SE) has been found to be an important factor in understanding the RTW process among employees with various health problems. Return to work self-efficacy (RTWSE) has proved to be a strong predictor of actual RTW in workers on sickness absence due to both psychological and physiological causes. However, the predictive value of RTWSE has not yet been investigated in employees on sickness absence due to cancer. The aim of this study is to investigate the predictive value of RTWSE in sick listed cancer patients undergoing chemotherapy.


In a prospective, longitudinal design, cancer patients (n = 150) with different diagnosis and in different stages of the disease will be included during 1 year. The inclusion criteria are: age 18-62, employed but on sick leave at baseline, starting chemotherapy at Aarhus University Hospital. At the beginning of chemotherapy, the cancer patients fill out the 19-items RTWSE questionnaire. Demographics and illness related factors are also measured. The main outcome measure is RTW (yes/no) during 12 months of follow-up.


An association between a high level of RTWSE at baseline and a short time to RTW is expected. The results will be presented at the conference.


To improve the work ability and the process of RTW for cancer patients, it is necessary to obtain a better understanding of the RTW process of cancer patients. Work related SE may play a key role in that process.

Oncologists’ Views On Their Role On Return To Work After Breast Cancer: Findings From A Qualitative Study

Marion Lamort-Bouché1,2, Julien Péron3,4, Guillaume Broc1, Angélika Kochan2, Clémentine Jordan2, Letrilliart Laurent2,5, Béatrice Fervers6,7, Jean-Baptiste Fassier1,8

1UMRESTTE UMR T9405, Université Claude Bernard Lyon 1, France; 2Collège Universitaire de Médecine Générale, Lyon, France; 3CNRS, UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique-Santé, Université Lyon 1, F-69100 Villeurbanne, France; 4Service de Biostatistique et Bioinformatique, Hospices Civils de Lyon, F-69003 Lyon, France; 5Health Services and Performance Research EA7425, Université Claude Bernard Lyon 1, France; 6Département Cancer et Environnement, Centre Léon Bérard, Lyon, France; 7Centre de Recherche en Cancérologie de Lyon, UMR INSERM 1052-CNRS 5286, F-69008 Lyon, France; 8Occupational health and medicine department, Hospices Civils de Lyon, France


Return to work (RTW) of breast cancer survivors (BCS) faces many barriers. Oncologists are valued by BCS as key informants from whom they expect guidance about RTW. Women also report disappointment, with a feeling of abandonment and helplessness at the end of cancer care. In the frame of the FASTRACS project (Facilitate and sustain RTW after breast cancer), the aim of this study was to explore the views of oncologists as to their role in the RTW process of their breast cancer patients.


A qualitative inquiry was conducted by means of individual semi-structured interviews among 20 oncologists. Participants were selected by theoretical, purposive and snowball sampling to include a varied sample according to age, gender, medical specialty and hospital. An interview guide was drafted upon the literature, and revised during the data collection. All interviews were taped and transcribed. A thematic qualitative content analysis was performed with MAXDA software to explore and describe the views of oncologists.


The respondents had different representations about their patients’ work, from a total absence of consideration to frequent discussions. They shared common interrogations regarding “the right moment and the right way” to talk about work, given the variety of individual situations and their evolution. Some negative impacts of chemotherapy on work issues were mentioned. Workplace and job characteristics were hardly mentioned as potential barriers to RTW, whereas women’s personal motivation was mentioned repeatedly as a key facilitator.


The main barriers reported by oncologists’ to their involvement in RTW of their patients were mainly lack of time, lack of knowledge, lack of awareness, lack of skills, and a professional attitude exclusively focused on cure objectives. These findings will guide the development of the FASTRACS programme to improve inter-professional collaboration and women’s pathway from cancer care to the workplace.

Developing An Intervention in General Practice To Prevent Work Disability After Breast Cancer By Using Intervention Mapping

Marion Lamort-Bouché1,2, Guillaume Broc1, Julien Carretier1,3, Julien Péron1,5, Philippe Sarnin4, Laurent Letrilliart1,2, Jean-Baptiste Fassier1,5

1Université Claude Bernard Lyon 1, France; 2Collège Universitaire de Médecine Générale, Lyon, France; 3Centre Léon Bérard, Lyon, France; 4Université Lumière Lyon 2, France; 5Hospices Civils de Lyon, France


Return to work (RTW) after breast cancer (BC) faces many barriers, among which a lack of collaboration between cancer care, primary care and occupational health services. This study aimed at defining the role of general practitioners (GP) in the frame of the FASTRACS project in France (facilitate and sustain return to work after breast cancer).


The intervention mapping protocol was used to develop the logic model of the problem (step 1), to define program outcomes and logic model of change (step 2), design and product the programme (step 3 and 4). Qualitative data were collected with 3 focus groups of GPs, 3 focus groups and 19 semi-structured interviews with BCS. Discussions were audiotaped, transcribed, and analysed with MAXQDA qualitative software. Matrices of change were built (step 2) and evidence-based change methods were chosen (step 3) by an interdisciplinary research team.


GP express the skills to guide patients between hospital treatment and RTW. They need more information about administrative resources and side effects of BC treatments. BCS don’t think about GP as a key person to facilitate RTW. A transition consultation in general practice will be proposed to BCS at the end of radiation therapy, with five performance objectives for the GPs:

- To evaluate the BCS’s needs and capacities to RTW

- To evaluate the BCS’s motivations to RTW

- To schedule the follow-up with the BCS according to the RTW project defined together

- To organize an early visit with the occupational physician

- To organize part-time RTW

This consultation in primary care will set a path for BCS between cancer care and occupational health services to facilitate RTW.


A randomized controlled trial will be conducted in 2019 to evaluate the process and the effects of the FASTRACS intervention.

Cognitive Challenges at Work Output among Breast Cancer Survivors in China: A Multicentre Study

Andy SK Cheng1, Yingchun Zeng2, Michael Feuerstein3

1The Hong Kong Polytechnic University, Hong Kong S.A.R. (China); 2The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China; 3Consultant in Cancer Survivorship, Gaithersburg, Maryland, USA

Objective To determine whether work output was related to cognitive limitations in occupationally active breast cancer survivors (BCS) employed in China.

Methods Measures of demographics, job type, job stress, general distress (anxiety, depression), fatigue, work-related cognitive limitations, and work output were obtained using self-report measures in both BCS and healthy controls (n=267/ group) from the Department of Oncology in four regions of China: Cheungdu, Changsha, Guangzhou, and Hong Kong.

Results Groups hadsimilareducational backgrounds, job types and levels of job stress. The BCS group was a median of 3.2 years post -primary treatment, slightly older, more likely to be divorced, have children, and was more likely working part-time. The BCS group reported higher levels of fatigue, general distress and lower levels of work output (p <. 05). A multivariate regression adjusting for group differences indicated that cognitive symptoms at work were related to lower levels of quantity, quality, and timeliness of completed work in the BCS group (adj. R2=.57, unstandardized coefficient = 1.062, 95% CI = .436 to 1.689).

Conclusion Cognitive limitations were associated with lower levels of reported work output exclusively in the BCS group. This study provides further evidence that cognitive limitations reported in the context of work in a developing country like China is similar to that of BCS working in more developed economies. Solutions to this problem may be applicable across countries.

Work-related Medical Rehabilitation and Return to Work in Cancer Survivors – A Cluster Randomized Multicenter Trial

David Fauser, Matthias Bethge, Julian Wienert

University of Lübeck, Institute for Social Medicine and Epidemiology, Germany

Background: Effective multidisciplinary rehabilitation programs supporting the return to work have become increasingly relevant for cancer survivors as about half of them are in working age when cancer is diagnosed and treated. In Germany, work-related medical rehabilitation programs consider treatment modules of work-related diagnostics, work-related functional capacity training, psychosocial groups, and intensified social counseling. Our study investigated the effectiveness of work-related medical rehabilitation as compared with conventional medical rehabilitation in a cluster randomized multicenter trial (German Clinical Trial Register: DRKS00007770).

Methods: A total of 484 cancer patients aged 18 to 60 years were recruited in four rehabilitation centers. Patients of a center starting their rehabilitation in the same week represented a cluster. These clusters were randomly assigned with computer-generated randomization schedules to intervention (IG) or control group (CG). The primary outcome was role functioning at the 12-month follow-up as assessed by the corresponding scale of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire. Secondary outcomes were other quality of life domains and return to work.

Results: Analysis of delivered dose of treatments indicated a successful implementation of work-related medical rehabilitation. 379 patients, 197 in the IG, were included in the analysis of the 12-month follow-up. There was no significant difference between IG and CG in the primary outcome (role functioning: b=3.69; 95% CI: -2.01–9.39; p=0.204) and secondary outcomes. Return to work rates were 72% and 75% for the IG and CG. Median time from baseline to return to work was 242 days in patients with a high risk and 54 days in patients with a low risk of early retirement.

Conclusions: Despite effects at the end of rehabilitation and the 3-month follow-up work-related medical rehabilitation in cancer survivors had no long-term effect on quality of life and return to work as compared with medical rehabilitation.

11:30am - 1:00pmWork and lifestyle factors
Session Chair: Douglas Paul Gross
Session Chair: Eva Ladekjær Larsen
Room 97 

Current Practices And Perceived Implementation Barriers For Working With Alcohol Prevention In Occupational Health Services: The WIRUS OHS Study

Mikkel Magnus Thørrisen1, Jens Christoffer Skogen2,3,4, Ingvild Kjeken1,5, Irene Jensen6, Randi Wågø Aas1,4,7

1OsloMet - Oslo Metropolitan University, Oslo, Norway; 2Norwegian Institute of Public Health, Bergen, Norway; 3Stavanger University Hospital, Stavanger, Norway; 4University of Stavanger, Stavanger, Norway; 5Diakonhjemmet Hospital, Oslo, Norway; 6Karolinska Institutet, Stockholm, Sweden; 7Presenter - Making Sense of Science, Stavanger, Norway

Background: The workplace may be a serviceable arena for targeting employees' alcohol problems, especially due to its impact on presenteeism and sick leave. However, little is known about the role occupational health services (OHS) play in targeting this public health problem.

Objectives: The aims of this study were to explore current practices of such preventive efforts in a sample of OHS professionals, investigate whether perceived implementation barriers are associated with such preventive efforts, and explore whether barriers display differential associations across different risk groups.

Methods: In a cross-sectional design, survey data were collected from 295 OHS professionals in Norway. Reported alcohol-preventive efforts were analysed by means of descriptive statistics and one-way analysis of variance (ANOVA). Associations between alcohol-preventive efforts and implementation barriers were explored by applying multiple hierarchical regression analyses.

Results: The OHS' were most focused on targeting problem drinkers or heavy drinkers (tertiary prevention), and more seldom working with those at risk (secondary prevention). Yet overall, alcohol-preventive efforts were quite limited. Barriers concerning the competence among OHS' and their resources were associated with alcohol-preventive efforts across all different risk groups, but barriers concerning employers and employees were not.

Conclusion: This study revealed that to increase the implementation of workplace primary preventive interventions targeting alcohol problems, presenteeism and sick leave, it is necessary to facilitate training of OHS professionals as well as ensuring sufficient time and resources for addressing this important public health challenge.

Is Alcohol Consumption Among Employees A Risk Factor For Presenteeism? A Systematic Review

Mikkel Magnus Thørrisen1, Tore Bonsaksen1,2, Neda S. Hashemi3, Ingvild Kjeken1,4, Randi Wågø Aas1,3,5

1OsloMet - Oslo Metropolitan University, Oslo, Norway; 2VID Specialized University, Sandnes, Norway; 3University of Stavanger, Stavanger, Norway; 4Diakonhjemmet Hospital, Oslo, Norway; 5Presenter - Making Sense of Science, Stavanger, Norway

Background: Alcohol consumption is a major risk factor for disease, disability and mortality, as well as being associated with sickness absence. Presenteeism (reduced on-the-job productivity) is an important, but under-researched topic.

Objective: The aim of this review was to explore whether evidence in the research literature supports employees' alcohol consumption to be a risk factor for presenteeism in the workplace.

Methods: Primary observational studies, published 1990 or later in English or a Scandinavian language, were included. Tested associations in the included data were quality assessed and analyzed descriptively with frequency tables and cross tabulations. Associations' measurements were categorized by means of content analysis. 26 articles, containing 132 tested associations, were included in the review.

Results: The vast majority of the tested associations (77 %) indicated a positive relationship between alcohol consumption and presenteeism (i.e., higher consumption associated with higher presenteeism), and positive associations were considerably more likely than negative to be statistically significant (OR = 14.00, p <.001). Alcohol measurements based on hangovers and composite instruments were overrepresented among significant positive associations of moderate or high quality. However, negative associations (19 %) were, compared to positive, less likely to be of low quality (OR = 0.22, p <.01). Overall, the majority of tested associations were characterized by low quality.

Implications: Workplace interventions aimed at improving productivity could benefit from including an emphasis on alcohol consumption.

Conclusion: Evidence suggests alcohol consumption to be associated with presenteeism. However, due to the lack of longitudinal designs and low research quality, existing evidence may still be characterized as inconclusive regarding whether alcohol constitutes a risk factor for presenteeism. More robust and less heterogeneous research is needed.

How Much or How Often? Alcohol Consumption, Sickness Presenteeism, and impaired Daily Activities

Randi W. Aas1,2,3, Mikkel M. Thørrisen2, Hildegunn Sagvaag1, Aleksandra Servic1

1University of Stavanger, Norway; 2Oslo Metropoletan University, Oslo, Norway; 3Presenter - Making Sense of Science, Stavanger, Norway

Background: Harmful alcohol consumption constitutes a global public health issue. Studies conducted in developed countries have identified between 10 and 35% of employees as risky drinkers. Employees' alcohol consumption may influence their activity performance across domains, including the occupational and domestic spheres. Studies have found high levels of alcohol use to be associated with sickness presenteeism, i.e., reduced on-the-job productivity as well as impaired daily activities. Drinking frequency and drinking intensity (episodic heavy drinking or binge drinking) may have dissimilar effects on activity performance.

Aim: The aim of this study was to explore and compare the influence of two aspects of alcohol consumption (drinking frequency, i.e., “how often” and drinking intensity, i.e. “how much”) on sickness presenteeism and impaired daily activities.

Methods: Cross-sectional data from 3278 Norwegian employees were collected. Drinking frequency and intensity were measured with items from the Alcohol Use Disorders Identification Test (AUDIT), developed by the WHO. Frequency was measured by asking to rate how often they had consumed alcohol during the last year. Intensity was measured by asking how often during the last year they had had binge drinking episodes, i.e., six or more alcohol units on a single occasion. The two activity performance items were taken from the Work Productivity and Activity Impairment questionnaire (WPAI).

Results: Results showed that drinking intensity (how much) displayed significant associations with both sickness presenteeism and impaired daily activities. Drinking frequency (how often) did display a significant association with impaired daily activities, but to a lesser degree than drinking intensity.

Conclusion: Frequent drinking over time is a risk factor for long-term health complications. However, high-frequency drinking would not necessarily produce short-term impairments comparable to binge drinking episodes (how much each time).The study found also that drinking intensity displayed a stronger association with impaired daily activities than with sickness presenteeism.

Employee Perspectives Of A Workplace Health Programme

Charlotte Brøgger Bond, Karen Søgaard, Lotte Nygaard Andersen

University of Southern Denmark, Denmark

Background:Risk of long-term sick leave increases with high physical occupational load while it decreases with high leisure time physical activity. Sønderborg Municipality in the Southern Region of Denmark has since 2008 offered a workplace health programme including various initiatives to promote a healthy lifestyle for employees. Elected health- and safety representatives are expected to act as health ambassadors and promote the health programme at the workplace. The aim of this study wasto understand how a workplace health programme is received and used by the employees.

Methodology: A comparative case study design was used with two different workplaces within the municipality serving as cases. Observations and interviews were done among employees from all layers of the workplaces and was analysed using Malteruds systematic text condensation.

Results: Preliminary findings indicate that health- and safety representatives appointed as ambassadors for the health programme is problematic. The representatives do not feel confident because they lack proper training in the ambassador tasks. On the other hand employees and management in both workplaces emphasize that changing workplace culture in a more healthy direction will require employee driven processes. Decisions about health from the management alone may even have the opposite effect on some employees.

Conclusion:From an employee perspective Sønderborg Municipality’s health programme has implementation challenges because the health- and safety representatives are poorly prepared and empowered to cover all the complex aspects of the health ambassador job.

Does It Work? Introducing Work Focus Into a Lifestyle Intervention for Persons With Morbid Obesity

Wivi Andersen1, Anita Dyb Linge2,3, Chris Jensen1

1The Norwegian National Advisory Unit on Occupational Rehabilitation; 2Muritunet Rehabilitation Centre; 3Volda University College

Obesity is related to lower labor force participation, increased sickness absence and reduced productivity. This indicates that work rehabilitation may be important for persons with obesity. Despite this connection, work focus has not been a part of lifestyle interventions for persons with morbid obesity.

In our study, we wanted to examine whether introducing a work intervention in a lifestyle changing rehabilitation program affects the participants’ ability to work and their lifestyle. We also wanted to find out how the participants experienced their health, work ability and work capacity, quality of life, diet and self-efficacy before and during the intervention. We hypothesised that work focus would lead to higher work participation.

The study was designed as a randomized controlled study with an exploring prospective design. It included 178 participants, where 99 participants completed the whole intervention and formed the data-foundation. Of these, 20 were interviewed. The lifestyle group was randomized into two interventions, one with work intervention one without. The work intervention entailed lectures and individual guidance from a work consultant. Data material gathered at each stay consisting of forms, test (such as measurements of weight, BMI and aerobe capacity), journal and individual interviews. These were all collected at baseline, and at six and twelve months.

Results from this study was that there is only a small difference between the interventions regarding achieved work participation from the start to the end of the study. Most of the participants interpreted their intervention as a process of lifestyle change, rather than a process to improve their capacity to work.

However, the participants in the intervention with a work focus had in general better overall results, i.e. they had:

  • Bigger weight loss.
  • Higher work capacity (VO2 peak).
  • Greater belief on their ability to meet work demands.

The Relationship between Occupational Physical Activity and Need for Recovery: A cross sectional analysis from the DPhacto cohort

Matthew Leigh Stevens1,2, Patrick J Crowley1, David M Hallman3, Ole S Mortensen4, Clas-Håkan Nygård5, Andreas Holtermann1

1The National Research Center for the Working Environment, Denmark; 2The University of Sydney, Australia; 3University of Gävle, Sweden; 4University of Copenhagen, Denmark; 5University of Tampere, Finland


Sustainable employment is one of the greatest problems facing modern economies. As an intermediate measure of sustainable employment, a person’s Need For Recovery (NFR) refers to the extent that the work task induces a need to recuperate from work induced effort, and has been linked to employee wellbeing, sickness absence and employee turnover. In this study we sought to determine the relationship between objectively measured Occupational Physical Activity (OPA) and NFR, as well as identify any moderating effect of age on this relationship.


This was a cross-sectional analysis of the DPhacto cohort. Physical activity data was collected on 840 white and blue-collar workers using tri-axial accelerometery worn on the thigh for several days. NFR was collected utilising a shortened version of the Danish NFR scale. Analysis was conducted in R utilising linear regression modelling of compositional data and compositional isotemporal substitution modelling.


Preliminary results show a significant effect of the OPA composition on NFR (p<0.001). The effect of allocating 15 minutes of time to a particular activity (from all activities) was significant for sedentary behaviours (β=-0.018 ± 0.011), but not for standing (β=-0.011 ± 0.022), light physical activities (moving/slow walking; β=0.021 ± 0.041) or more vigorous activities (fast walking, running, cycling; β=0.030 ± 0.046)


Increasing sedentary behaviours seems to be associated with a decreased NFR. However, multivariate analyses investigating potential modifying effects of age still remain, and will be available for presentation at the conference.

1:00pm - 2:15pmPoster Viewing II: Poster Viewing II

Obesity at the Coal Face

Carole James, Penny Chapman, Jane Rich

University of Newcastle, Australia


Obesity is a major problem in Australia, with over 70% of Australian’s being overweight or obese. Rates of obesity in NSW coal miners are significantly worse (83.4%). Workers who are obese have higher rates of absenteeism, reduced productivity, increased injury and illness, slower recovery rates and increased workers’ compensation costs.


To measure prevalence of overweight and obesity in NSW coal mining and investigate what weight management / workplace wellness interventions have been implemented at the workplace.


A mixed method pilot study was conducted including: a cross sectional survey of OHS and HR personnel from across NSW mines; focus groups with OHS committee members of 5 mine sites; analysis of the NSW coal health database.


Almost half of all the mine employees had a Body Mass Index (BMI) which classified them as overweight (47%) or obese (27%). When BMI was compared to a number of other characteristics, results indicated that those in the overweight BMI category had: elevated (50%), high (51%) or very high (44%) blood pressure; moderate (48%) or high (48%) cardiac risk factors; high risk alcohol dependence (51.0%); moderate (48%) or high/very levels of psychological distress (45%).

A variety of initiatives have been trialed at the workplace including health and education sessions, smoking cessation and subsidised gym membership, however few initiatives have been measured or sustained. Challenges include low health literacy, long working hours/shifts, sedentary nature of work, focus on individual behaviours and work culture, and sustainability of programs.


The workplace is an important setting for weight management and obesity prevention, however this requires strong leadership and a supportive culture and workplace environment. These findings provide insight into the prevention and management of overweight and obesity as a critical part of industry’s overall focus on the general health of its employees.

Physical Work Demands and Sickness Absence: Protocol for a Prospective Study Merging and Analysing Comprehensive Technical Measurements of Physical Activity at Work and Detailed Prospective Register Data on Sickness Absence

Sofie Dencker-Larsen1, Charlotte Lund Rasmussen1, Sannie Vester Thorsen1, Els Clays2, Thomas Lund3, Merete Labriola4, Ole Steen Mortensen5,6, Marie Birk Jørgensen6, Charlotte Diana Nørregaard Rasmussen1, Andreas Holtermann1,7

1National Research Centre for the Working Environment, Denmark; 2Ghent University, Belgium; 3Bispebjerg Hospital, Denmark; 4Aarhus University, Denmark; 5Holbæk Sygehus, Denmark; 6University of Copenhagen, Denmark; 7University of Southern Denmark, Denmark

Background: Different physical work demands have been linked with sickness absence. Many studies use self-reported data; however, technical measurements of physical work demands (such as stationary standing, sitting, forward bending of the trunk, arm elevation) have been shown to provide more accurate measurements. Furthermore, previous studies using sickness absence as the outcome measure have focused on state- and municipality-subsidised sickness absence, which tends to be long-term sickness absence; however, also short-term sickness absence may be affected by physical work demands.

Methods/design: The ‘Physical wOrk DEmands and Sickness Absence (PODESA)’ Study will combine comprehensive accelerometer data on body postures (e.g. sitting, standing still), movements (e.g. forward bending of back and arm elevation), physical activity types (e.g. walking and stair-walking), and survey data from the NOMAD-DPhacto cohorts with detailed register data on sickness absence for up to N=1,108 Danish primarily blue-collar workers. The study has access to prospective data on sickness absence since the individual worker baseline measurements between 2011 and 2014 with up until four years of follow-up sickness absence. These data enable analyses on complex physical work demands during workdays and prospective sickness absence.

Discussion: The PODESA Study has access to a previously unrivalled combination of detailed data on physical work demands and prospective sickness absence, enabling further analyses adding to the field’s knowledge as a whole on links between physical work demands and sickness absence. The results of the study can be used to inform policies and practice. Results are expected in 2019-2020.

An Online Tool to Help General Practitioners to Contact Occupational Physicians – Results of a Pilot Study

Sandra H van Oostrom, Tessa Schurink, Karin I Proper

National Institute for Public Health and the Environment, the Netherlands


Cooperation between general practitioners (GPs) and occupational physicians (OPs) contributes to provide univocal advice and treatment for workers with health problems. As OPs in the Netherlands do not work within the same local area as GPs, GPs have difficulties in finding and contacting the OP of the worker. Therefore this pilot study was initiated to evaluate the implementation of an online communication tool in order to search and initiate contact with an OP.


A 3-month lasting pilot with the online communication tool was conducted in collaboration with the Netherlands Society of Occupational Medicine and the Dutch College of General Practitioners. To evaluate this pilot, semi-structured telephone interviews were conducted with 7 OPs and 8 GPs. Questions included satisfaction, added value, practical use, expectations for future use, and suggestions for improvement of the (implementation of the) online tool. The interviews were tape-recorded and analysed by two researchers using the framework analysis method. Registration data of the online tool provided insight in the number of registered OPs and the completeness of their registration.


OPs and GPs expected a positive contribution of the online communication tool to better collaboration and providing univocal advice to workers, but the actual number of contacts with the tool was very low. Experiences and satisfaction differed, GPs had difficulties to find the OPs they searched for and OPs struggled with the registration of employers. Both GPs and OPs felt the need for more instructions on obtaining consent of the worker.

Discussion and Conclusion

The pilot period with the online communication tool was too short and restricted to demonstrate increased contact between OPs and GPs. An overall positive attitude of the physicians is a basis for the national implementation of the online communication tool, but more attention for dissemination and instruction is needed.

A Descriptive Study of Public Safety Personnel Undergoing Treatment for Work-Related Post-Traumatic Stress Injuries

Douglas P. Gross1, Theodore Berry2, Ian Blanchard3, Suzette Brémault-Phillips1, Cary Brown1, Bruce Dick1, Charl Els1, Tanya Jackson1, Manuela Joannou4, Chris McIntosh3, Ambikaipakan Senthilselvan1, Sebastian Straube1, Don C. Voaklander1, Shelby Yamamoto1

1University of Alberta, Canada; 2Workers' Compensation Board-Alberta, Canada; 3Alberta Health Services, Canada; 4Project Trauma Support, Canada

Background Public safety personnel (PSP), such as police officers, firefighters, and paramedics, are frequently exposed to accidents, disasters, and trauma in the course of their work. These exposures can result in stress-related reactions that affect mental health and well-being. The broad set of persistent psychological difficulties is termed post-traumatic stress injury (PTSI). To improve treatment of PTSI, we need a better understanding of the workers experiencing these injuries and treatments received.

Objective We studied the characteristics of injured workers undergoing PTSI treatment in Alberta, Canada to determine the proportion of PSP, types of treatment received, and return to work outcomes.

Methods A descriptive study was conducted using clinical and administrative claims data from the Workers’ Compensation Board-Alberta (WCB Alberta). The database included all workers’ compensation claimants across Alberta undergoing PTSI treatment between January 1, 2014 and December 31, 2016. The database contained information on several variables including occupational group, treatment received, and return-to-work outcomes following treatment. Analysis included descriptive statistics.

Results –During the study period, 510 workers (mean age 40.2 years, 60.7% male) underwent treatment for PTSI. Of these, 114 (22.4%) were PSP which included 76 paramedics (66.7%), 21 police officers (18.4%), and 17 firefighters (14.9%). The majority (94.5%) received in-vivo exposure-based treatment from a community provider (46.9%) or in the context of interdisciplinary rehabilitation (47.6%). A minority (5.5%) received individual psychological treatment. Only 41.2% returned to pre-accident work after treatment.

Conclusions – PSP comprise almost a quarter of all PTSI treatment provided by WCB-Alberta with paramedics accounting for 2/3 of the PSP claimants.PSP workers with PTSI appear to most commonly receive exposure-based treatment, however, less than half successfully return to work. Future research should model prognostic factors associated with treatment success, which could stimulate more effective prevention approaches and development of novel therapy modalities.

Workplace Practices and Essential Activities Recommended in Literature for Preventing Prolonged Disability in Workers with Musculoskeletal Disorders

Iuliana Nastasia1, Marie-José Durand2, Marie-France Coutu2

1Institut de recherche Robert Sauvé en santé et en securité du travail, Canada; 2bÉcole de réadaptation, Université de Sherbrooke, Longueuil, Québec, CANADA


Little efforts have been made until now to document what are the actual practices of the workplaces for a sustainable RTW in employees with work-related musculoskeletal disabilities (WRMDs) into the workplace, and how they are similar or different from what is recommended by the literature. The objective of this presentation is to compare how the workplace actual practices reflect the essential activities recommended by the literature.


A systematic and integrative literature review and a multiple case study (n = 4) in two sectors of activity were performed. The case was defined as all the RTW management procedures and practices of a specific organisation. Multiple sources of data were used: written policies and procedures and semi-structured interviews with key actors (e.g. human resources counsellor, manager, supervisor, union representative, worker, etc.). For each case, between 5 and 17 key actors involved in the RTW process of workers, absent from their regular work during more than 3 months, were interviewed. The actions performed by a category of key actors in order to accomplish RTW essential activities, by phase, were compared with the actions recommended in the literature for each case.


Similarities and discrepancies exist between what is recommended in the literature and the policies, procedures, and actions completed by the actors involved in the RTW process for all the companies. Many differences, specifically in terms of the application of these policies, procedures and actions by company will be presented.


Comparisons between the literature and the practice of the organisations upon the realisation of essential activities allow us to understand some gaps at the practical level between what is recommended and what is actually done into the workplace. The consideration of these gaps contributed to a better understanding of practical contexts’ realities in the workplaces and elaboration of some recommendations.

Beyond Medical Treatment After Minor Motor Vehicle Crash Injury: Perceptions Of Insurance Company Case Managers

Maurizio Trippolini1,2,3, Amanda E. Young3,4, Glenn Pransky5, Keri Lockwood6, Nieke A. Elbers7, Ian D. Cameron6

1Bern University of Applied Sciences, Department of Health, Bern, Switzerland; 2Massachusetts General Hospital (MGH) Institute for Health Professions, PhD program in Rehabilitation Sciences, Charlestown, Boston, USA; 3Center for Disability Research, Liberty Mutual Research Institute for Safety, Hopkinton, MA, USA; 4Young Normandeau & Co., Hopkinton, MA, USA; 5Department of Quantitative Health sciences, University of Massachusetts Medical School, Worcester, MA, USA; 6John Walsh Centre for Rehabilitation Research, Kolling Institute, University of Sydney, St Leonards, NSW Australia; 7Netherlands Institute for the Study of Crime and Law enforcement. Faculty of Law, VU University Amsterdam, Amsterdam, The Netherlands

Background: Musculoskeletal disorders after minor motor vehicle crash injuries (MSD-MV) are common. In some cases, medical treatment offers little relief. Case managers (CMs) play a critical role in the recovery process due to their interaction with various stakeholders and longer-term perspective. Yet little is known about CMs perceptions, especially as it relates to helpful and unhelpful treatments for MSD-MV.

Methods: Semi-structured interviews were conducted with insurance company CMs in Australia and the USA (N=40). Participants were asked: “What do you believe are good or bad interventions for recovery?”. A framework analysis was applied to extract codes and develop overarching themes. Two co-authors performed the interviews, and six co-authors were involved in the data analysis.

Results: CMs talked about particular types of interventions, as well as components that could be found across a variety of interventions. Aggressive treatment – too much, too early, multiple specialties, surgery, overmedication, non-evidence based treatments focused on rest, prolonged work-absence certification, and diverging agendas of stakeholders were all perceived as unhelpful for recovery. Legal representation, in addition to excessive health care, was also perceived as detrimental. Staying active, performing home-based activities, resuming work after injury and allowing time to heal were perceived as enhancing recovery. The following overarching components emerged: treatment approach and intensity, timeliness of interventions, building positive recovery expectations, support of return-to-work, communication between stakeholders, and the influence of social context such as family and employer.

Conclusions: CMs demonstrated clear and detailed perceptions of key psychosocial and contextual issues influencing recovery from MSD-MV. In particular, their perceptions regarding overarching treatment components, has the potential to be informative to a wide variety of treatment providers. Their perceptions regarding treatment approach, timeliness, and the importance of facilitating positive relationships and expectations suggests that subtle changes to established treatment programs may result in improved recovery outcomes.

Practices of Occupational Health and Safety in Developing Countries

Philibert Ramaroson1, Guilherme Schuck Candemil2, Isman Wais Sigad3, Shabab A Mahfuz4

1GRANDE COTE OPERATIONS, Senegal; 2Ministry of Labour of Brazil, Labour Inspection Secretariat Brazil; 3Caisse Nationale de Securite Sociale, Djibouti; 4SGS, Bangladesh


The paper reviews the efficient tools for the management of occupational health and safety in developing countries. Their legislation and the ratification of various international conventions did not seem to reduce the number of fatalities, accidents and illnesses from the workplaces.

Proposing framework for managing Safety in developing countries. Many assertions from various researches have come to a conclusion that there is a correlation between the skills of the workers and the development of techniques and technologies in the work area.


For many decades, the ILO and other organizations has attempted a tripartite adoption of legislative instruments for the management of workplace health and safety. Still, workplace accidents and ill-health are still ravaging lives and economies in developing countries.

It is evidenced that there is correlation between the low level of risk management and the working environment of the country (work methods, the legislation, and the local resources).


The findings stemmed from field observation and the combination of case studies conducted by the authors in five different countries: Brazil, Bangladesh, Madagascar, Senegal, and Djibouti.


The authors intend to bring to practitioners a low-cost and culturally accepted tools that promote occupational health and safety in various workplace setting.


It is not expected that a one-size-fits-all solution is available. However, the authors advise on a practice model that can be widely adapted to many work setting.

Developing Basic Employment Skills by Using Mobile Technologies Early in the Worklife Course

Marie Laberge1,2,3, Tondoux Aurélie2, Girard Marie-Michèle1, Camiré Tremblay Fanny1

1University of Montreal, Canada; 2CHU Ste-Justine Research Centre; 3CINBIOSE Research Centre

Pre-employment experiences such as “traineeships” are considered effective in developing employment skills among High School students with disabilities. These students often have benefited from technological aids as an accommodation measure in school, but lose it when they enter the labour market. We conducted an intervention study aimed at developing an attribution model to use Information and Communication Technologies (ICT) in the workplace. The intervention was based on two pilot studies and a theoretical approach in constructive ergonomics. It involves a coordinate approach, composed of four steps: 1) needs assessment based on work activity analysis; 2) planning means, products, functions, and context; 3) realizing pedagogical activity supported by ICT; and 4) integration and evaluation of outcomes. Eight teachers and 15 trainees with learning difficulties implemented the intervention; they realized 43 pedagogical activities over the school-year. Through multiple data sources, the implementation steps were monitored and an implementation process analysis was conducted to document the extent of the needs covered, as well as the scope and limitations of the intervention. In the workplace, the principal difficulties encountered were associated to tasks completion, gestures and work abilities; some needs were also related to impairments such weak memory, lack of space orientation or executive function difficulties. ICT were used in different ways. The study highlighted the importance of taking into account not only the student's characteristics but also the workplace context (tasks and requirements, means and conditions, social environment). Technological solutions do not need to be sophisticated, they can be mobilized at different times and places (work, school, home), and they can influence the learning process or support special needs. The active engagement of teachers, students and placement companies' stakeholders are key to success. The study led to the consolidation of the approach and the development of tools to help teachers using it.

The Role of Human Values and Relations in the Employment of People with Work-Relevant Disabilities

Lieke Kuiper2, Minne Bakker2, Jac Van Der Klink1

1University of Tilburg; Tilburg School of Social and Behavioral Sciences, Netherlands, The; 2VU University Amsterdam, The Netherlands, Health Sciences,

Purpose: The aim of this study is to discuss the role of human values and relations in the employment of people with work-relevant disabilities.

This was placed in the context of three complementary philosophical perspectives: 1) from Isaiah Berlin that stresses other than merely rationalistic values, 2) from Amartya Sen stressing the importance of values in work and 3) from Emmanuel Levinas in which the interpersonal perspective is central.

Methods: Semi-structured interviews were held with people with a working disability and with family, partner, colleagues and employers. All interviews were audio-taped and transcribed verbatim. A framework analysis was used to identify the different values in the interviews.

Results: Both non-rational and rational values and arguments were mentioned by employers in the context of hiring people with a work-relevant disability. Work values were very important for this group. The importance of human relations was emphasised and the interpersonal perspective played an important role in the employment process of people with a work-relevant disability. People asked their private network to help them and to provide emotional support.

Conclusion: People with a work-relevant disability need adjustments in order to work. The perspectives we used showed useful in structuring and interpreting our data. Employers who considered values as accessibility, inclusiveness and creating a better working atmosphere as even important as pure rational values, felt responsible that employees with a work-relevant disability could achieve the value of having work ad well as important values in work. This had more chance if values were in line with the mission and central value of the organisation. Nevertheless, there is a limit in money and time, changeable from case to case and over time.

This study can help to provide and select the right arguments if we want to introduce a person with a work-relevant disability for employment.

Chronicles Of Workplace Health Self-Management.

Sally Elizabeth Hemming

Loughborough University, United Kingdom

It is estimated that more than 17 million people in the UK will be affected by long-term health conditions in the coming decades, with implications for work participation. Long-term conditions can be self-managed and 70-80% of people can be supported to do so. Self-management is associated with positive health outcomes, less healthcare usage and support, is related to higher levels of self-management behaviour. Low levels of workplace support can be detrimental. Research has examined self-management support in formal return to work processes and from a patient perspective. Currently, self-management support is synonymous with the role of healthcare providers, GPs or charitable services but the role and influence of the employer remains unexplored nor defined. Two separate interview studies were designed to explore workplace self-management support from an employer and employee perspective. Adopting a purposive sampling approach, employers (n=12) utilising a 13-item semi-structured framework designed by the researcher to ensure specific topics were covered, shared their knowledge, understanding and views of workplace self-management behaviour. Contrarily, via a narrative framework utilising a SQUIN (single question designed at inducing narrative) taken from the biographic narrative interpretive method, employees (n=13) affected by mental, musculoskeletal and ‘other’ health conditions were asked to share their unique stories of workplace self-management. Narrative is a method used to elicit stories of life experiences. Accounts were littered with tales of self-management behaviour, support needs and experiences in a workplace context. Both studies, embedded in a broader mixed methods framework, could provide new insights into and understanding of workplace self-management and support needs. This could inform the design and testing of workplace interventions aimed at improving workability, continuing employment and health outcomes. A thematic and narrative approach will be adopted to analyses, results of which will be explored and presented.

Fostering Autonomy and Relationships: Mental Health Professionals and Work Reintegration

Fergal O'Hagan, Kara Rutherford, Keeley Moloney

Trent University, Canada


With the rise in mental health work disability, mental health professionals (MHP's) are increasingly involved in work reintegration (WR) efforts. Few studies have focused on their involvement, and specifically on the strategies they employ to resolve work disability issues with their patients. The aim of this study was to look specifically at the strategies employed by MHP's when working with workers on sickness absence for common and trauma-related mental disorders.


A qualitative method was used, employing semi-structured interviews (X2) and a case review with each participant. Interviews were transcribed and progressively coded for the themes relating to clinical strategies, accommodation and interactions with stakeholders as well as barriers to implementing strategies.


Twelve therapists (6 master's level social workers, 4 psychologists, 2 master's level counsellors) participated in the study. As a clinical strategy, therapists fostered autonomy by encouraging the exercise of choice on the part of workers to return to their previous job or move on to a more suitable employment. In building accommodations, MHP's co-constructed accommodations with workers to ensure buy-in, but also challenged workers when avoidance was a barrier to WR. Managing relationships emerged as a major theme related to stakeholder interactions, reflecting efforts by MHP's to enable perspective taking on the part of workers and insurers with the other's perspective and establish credibility for the worker's mental health issue with the insurer.


Apart from using evidence-based therapeutic methods to treat workers, MHP's use pragmatic strategies that encourage worker autonomy and buy-in, foster a positive working relationship between stakeholders and reduce stigma and resistance toward work accommodation. For MHP's the findings from this study shed light on the importance of developing strong relationship management skills and allotting time to employ these skills with WR cases.

Improving the Early Prevention of Work Disability through a Better Legal Protection of the Impaired Workers

Aude Cefaliello

University of Glasgow, United Kingdom

In 2016, 20.8 millions of the employees in the EU-28 were disabled, representing 11% of the European workforce. Most of these workers became disabled after the age of 15, meaning once they were legally able to work. According to the wood sequence: a condition (e.g. a work accident) can lead to physical or mental disorders, then to limitations and finally to a recognised disability. Only the end of this sequence, the disability status, is protected by the EU with the Directive 2000/78/EC. However, the previous phases, when the worker is impaired but not disabled, are not covered by any specific European legal provisions.

Thus, this paper investigated how it would be possible to legally protect and improve the working conditions of the impaired workers as an attempt to prevent the evolution of their impairment into disability. Specifically, it re-examined the jurisprudence of work disability to identify the legal gaps, before addressing these gaps by analysing and suggesting a new application of the Directive 89/391/EEC (i.e., the main EU OHS directive).

This study argues that it would be possible to use the broader OHS legislation to address the needs of impaired workers. In this respect, it concludes that by focusing on the occupational origin of the impairment, it would be possible to develop a legal argument to advocate for an individual right of adaptation of the workplace for the impaired workers returning to work after a work accident based on art. 6 of Directive 89/391/EEC. This directive provides an obligation for employers to prevent the OHS of their workers. So far, this obligation has been predominantly used for preventing working accidents, but it would also be possible to extend it to the situation of return to work to prevent the potential worsening of an impairment into a chronic disability.

Developing An Integrated Organizational Intervention For Subcontractors In The Construction Industry: Findings From A Pilot Study

Susan E. Peters1, Hao Trieu2, Justin Manjourides2, Nick Green2, Jack T. Dennerlein1,2

1Harvard Center for Work, Health and Wellbeing, Harvard T.H. Chan School of Public Health, Boston, MA, U.S.A.; 2Bouvé Health Sciences, Northeastern University, Boston, MA, U.S.A.

Interventions to improve construction worker safety, health and wellbeing can be challenging due to the multi-company structure on a worksite, the transient nature of construction workers on-off sites, competing high production pressures, and the unstable nature of employment. In addition, many small construction companies, such as the subcontractors, do not have the resources to develop their own safety management systems which further compound the problem. Previous research has identified that integrating health promotion and health protection programs into the way these companies do business can contribute to their success. Participatory approaches (i.e., those in which the key stakeholders are involved) to developing and implementing interventions have helped to bridge the gap between research to practice and have been found to contribute to intervention success in other industries. Using the Harvard Center for Work Health and Wellbeing’s Manual for implementing integrated organizational interventions,[1] we developed a participatory integrated organizational intervention for subcontractors in the construction industry. The intervention was designed to develop a communication infrastructure and process to allow subcontracting companies to integrate strategies to promote worker safety, health and wellbeing into their daily operations. This intervention was piloted to examine its feasibility and acceptance to owners, managers and workers, prior to a full randomized controlled trial (currently underway). We will present the steps we used to develop the intervention, challenges faced (including barriers to implementation and how these were overcome) and our qualitative findings from the pilot’s interviews with managers and focus groups with workers. We will also describe how workers and managers were engaged to design, implement and evaluate the intervention, which helped with sustainability of the project after the research team had left the worksite.

  1. McLelland D et al. Implementing an Integrated Approach. Accessed:

Workers on Prolonged Work Disability for Musculoskeletal Disorders do not worry for nothing

Marie-France Coutu1, Marie-José Durand1, Fergal O'Hagan2, Patrick Gosselin1, Iuliana Nastasia3, Djamal Berbiche1, Marie-Élise Labrecque1, Sara Pettigrew1

1Universite de Sherbrooke, Canada; 2Trent University; 3Institut de recherche Robert-Sauvé en santé et en sécurité du travail


Workers worry during prolonged work disability, but do their worries relate to their actual work disability situation? The aim of this study was to assess worries and their maintaining factors, while considering the margin of maneuver/leeway (MM) at work and their impact on return to work (RTW).


We conducted a descriptive study with a convenience sample of 79 (39 men and 40 women) workers having persistent (≥3 months) work-related musculoskeletal disorders causing absence from their regular work. Validated self-administered questionnaires (based on Dugas’ generalized anxiety disorder theory) were completed at the beginning and the end of the work rehabilitation program. Also, the questionnaire on type of worries (QTW) assessed specific types of worries and their relationship to work. Trained occupational therapists (n = 16) evaluated the MM of the participants. Multivariate analyses were performed on RTW predicted by workers’ indicators and occupational therapists’ MM.


Twenty-one workers did not RTW. Significant factors explaining not RTW were: lack of a margin of maneuver (OR = 8.5; p = .008); high intolerance for uncertainties (OR = 1.12; p = .01), perceived utility of worrying (OR = 1.11; p < .001), and for the QTW scores, a high mean intensity of worries (OR = 2; p = .004) seen as emerging from actual situations (OR = 17.15; p = .02) occurring at work (OR = 8.5) predicting 54% of the variance in RTW outcome(p < .0001). A posthoc analysis (pseudo R2 = .33; p = <.0001) shows that a lack of a margin of maneuver is associated with QTW scores of worries emerging from uncertainties at work.


When workers do not return to work, they report worrying about actual situations at work that co-occur with a low MM. Thus, RTW interventions need to focus on the work environment.

Music Cohort: Canadian Trial of Protocol to Assess Musicians' Health

Christine Guptill1, Julius Bruder1, Christoff Zalpour2

1University of Alberta, Canada; 2Hochschuele Osnabrueck, Germany

Identifying pre-professional musicians who are at risk of physical and mental health problems is an important means of reducing the impact of these problems during their training, and in their future careers. We will present the results of a Canadian pilot validation and English translation of an assessment protocol for student musicians.


1. Successfully deploy the protocol in a Canadian setting and present the first results of this pilot sample.

2. Investigate the physical and psychological health profile of first-year Canadian university music students.

Methods: This study used a cross-sectional design with a control group. The protocol examined demographics and history of pain; pain intensity and interference; performance anxiety; and mental health concerns using valid and reliable paper-based tools (SF-12, DASS 21, Musculoskeletal Pain Intensity and Interference Questionnaire for Musicians, Kenny Music Performance Anxiety Inventory). Physical testing included pain perception (algometer), active range of motion of the upper extremity, cervical spine and hips, and hypermobility (Beighton). Statistical analysis was performed using IBM SPSS Statistics24.

Results: 15 student musicians and 40 non-music students have been tested in this pilot study, and recruitment continues at the time of abstract submission. Preliminary findings suggest that music students score lower on measures of core strength and mental health than their peers. Implementing the assessment in Canada was successful with minor adjustments.

Conclusions: The updated assessment protocol is feasible in Canada.

Negative Perceptions And Attitudes About Return To Work In Sick-listed Unemployed Workers With Psychological Problems

Yvonne Brenda Suijkerbuijk, Karen Nieuwenhuijsen

AMC, Netherlands, The


Mental disorders are highly prevalent and often lead to unemployment and work disability. Return to work expectations are often found to be prognostic for future work participation. A previous study identified three types of attitudes towards return to work among sick-listed unemployed workers with psychological problems. More insight on how to recognize these negative perceptions and attitudes is needed so that professionals can identify workers at risk for long term sickness absence.


This focus group study aimed to investigate if and how professionals working at the Dutch Social Security Institute (UWV) recognize negative perceptions and attitudes in sick-listed unemployed workers. The participants were recruited through managers of UWV. Four focus group sessions of 5-6 professionals working at UWV were held throughout the Netherlands. A thematic analysis was conducted using MAXQDA software.


The participants recognized negative perceptions and attitudes in unemployed workers. They often described a negative attitude as being passive and negative. They confirmed the three types of attitudes. However, a main theme was the shifting character of the attitudes. The participants also stated that most workers aren’t completely passive or completely active and that an active attitude is relatively rare. Personal contact enabling the observation of nonverbal signs while asking questions on return to work expectations was often mentioned as the best way to identify perceptions and attitudes. Some participants expressed the advantage of an additional questionnaire. In general they were convinced that every professional should assess the attitude during each consult because of the shifting character.


Professionals recognize negative perceptions and attitudes about return to work in sick-listed unemployed workers with psychological problems. These attitudes comprise three main types: passive, switching and active and can change over time. These attitudes should be identified through personal contact at every consultation.

Developing a Framework for the Evaluation of the Implementation Process of an Ergonomic Intervention: What Dimensions Should Be Considered?

Émilie Desjardins1, Hélène Sultan-Taïeb1, France St-Hilaire2, Nicole Vézina1, Élise Ledoux1, Patricia Bélanger1

1Université du Québec à Montréal, Canada; 2Université de Sherbrooke, Canada

In the meat and poultry transformation industry, knives’ efficiency is a preventive factor for musculoskeletal disorders. A knives sharpening and steeling training program was developed in a plant. It was a train the trainer program with the training of internal trainers by ergonomists and of workers by internal trainers. Ergonomists were also in charge of creating organizational and material conditions favorable to knowledge transfer. Objectives were 1) to develop a framework with relevant dimensions for the evaluation of the implementation process of this type of intervention, 2) to identify obstacles and facilitators.

We used the template analysis technic which allows to analyse the data with a pre-determined set of codes categorized by themes, while allowing codes to emerge from the data. Based on a literature review, we identified dimensions to analyze and produced an initial template. We then collected qualitative data (observation of the intervention, interviews with ergonomists). The final template was the result of a double coding process and presents a list of dimensions to consider when evaluating this type of intervention. Each dimension was associated with a value: negative for obstacles, positive for facilitators or neutral if related to factual dimensions.

Our framework had 6 themes (Initiation, Conception, Implementation, Stakeholders’ contribution, Intermediate effects and Internal context) and 62 dimensions. Among obstacles we identified the unavailability of adapted material and opportunities to put into practice new skills. Amongfacilitators, there was the time given to trainees to participate to training sessions. However, the continuous tailoring of the action plan to the organizational context by ergonomists and the sequence of events was difficult to describe using our framework. Our study sheds light on the challenge faced when elaborating an evaluation framework for the implementation process of this type of intervention and underlines the need for interdisciplinary studies in this field.

The Return To Work Assistance Of Occupational Musculoskeletal Injury Workers And Its Perspective In Taiwan

Chung-Li Du

National Taiwan University Hospital Yun-Lin Branch, Taiwan

Service for the occupational injury and injury workers had been addressed since early this century in Taiwan, consequently many Center for Management of Occupational Injury and Disease (CMOID) were set up to offer island-wide service, there is 10 centers and 65 network occupational clinics. Under the principle of prevention, compensation and return to work (RTW) to deliver service to 10 million workers within 30 KM radius of the workers’ premise, this service had annual support by OSHA budget for more than 15 years.

Standard operation procedures, such as patient recruiting, clinical evaluation, incident investigation, reporting and case management model had been developed in CMOID, and one of the concerned items of case management is RTW assistance. We extract data from the reporting system from 2008-2015, the nationwide data showed that increased trend of clinic service amount e.g. in 2015 there was 7,374 first-visits, among them the musculoskeletal injury or disease account for 27 % . The workers receiving occupational rehabilitation service (990), and the number of successful RTW (442) also increased. Since 2016, many work strengthening centers were separately established, under the occupational rehabilitation programs.

We will discuss related regulation and policy, encountered difficulties, approaches and solutions. The report also illustrate the three important steps of successful RTW assistance from above experience, including functional capacity evaluation (FCE) by the occupational rehabilitation, sick note or fit note issued by the occupational medicine specialist and RTW implementation by a team collaboration.

Work Disability Due to Ocular Diseases in the Working Population of the Private Sector in Brazi

Eduardo Costa Sá1,2,3, João Silvestre Silva-Junior2, Diego Toniolo Prado1, Maria José Gimenes1,3, Daniel Romero Muñoz1

1Faculty of Medicine, University of São Paulo, Brazil, Brazil.; 2National Social Security Institute, São Paulo, Brazil.; 3ABC Medical School, São Paulo, Brazil

Introduction: Work-related injuries are a public health problem and can result in temporary or permanent work disability. Lower productivity at work and impairment on the living conditions are effects related to occupational sickness. Eye injuries at the workplace cost U$ 300 million a year in lost productivity, medical treatment and workers compensation. In Brazil, social security for private sector is public and workers are evaluated by medical-experts to grant a sickness benefit. Objective: To identify the profile of social security benefits due to ocular diseases and injuries granted to private sector workers in Brazil. Methods: Ecological study with secondary data from 2017 of the Social Security Yearbook. Disability benefits were classified as non-work related and work related. All benefits were analyzed and separated those classified in the ICD-10 H00-H59 (eye diseases and attachments) and S05 (eye trauma and ocular orbit). Results: The total benefits granted in Brazil in 2017 were 2,179,287, of which 2.2% were related to ophthalmologic diagnosis. Those were 40,545 benefits due to disease (98.3% non-work related) and 1,559 due to traumas (32.3% work-related). Among non-work-related ophthalmologic diseases, those more common were senile cataract (15.9%) and blindness and low vision (13.2%). About work-related diseases, the two most frequent were blindness and low vision (25.8%) and keratitis (18.3%). Conclusions: Work-related cases are more frequent in ocular trauma than in ophthalmological diseases among workers requesting a disability benefit in private sector in Brazil in 2017. Therefore is necessary to create educational and preventive strategies to reduce work-related ocular traumas, such as: improvements in working environment conditions and the correct use of personal protective equipment. For diseases, it is necessary to invest in the promotion of eye health to reduce the impact of early disability due to visual impairment or blindness.

Better Together – Effect of a Tailored Group Intervention to Improve Return to Work in Sick-listed Employees

Torill Helene Tveito1,2, Tonje Fyhn2, Nils Fleten3

1University of South-Eastern Norway, Norway; 2NORCE Norwegian Research Centre, Norway; 3The Arctic University of Norway, Norway

Background: Employees on sick leave often find the transition back to work challenging after weeks or months on sick leave. An intervention to ease this transition and prevent prolonged sick leave was compared to a physical exercise intervention to assess effect on sick leave. Methods: Employees on sick leave were recruited to the project and invited to an inclusion interview. Those fulfilling the inclusion criteria and willing to join the project were randomised to Better together, a tailored group intervention, or a 3 months membership at a local gym. Better together consisted of 16 group sessions of 2 hours over a 12 week period where the participants worked with their own goals using the SMART model. The sessions further had discussions on coping, presentation of a salutogenic perspective, and information from the health and insurance sector. Results: Sick leave at 3 and 15 months will be reported. The intervention group reported less health complaints both at 3 and 15 months. Self-rated health improved at 3 and 15 months in the intervention group and at 3 months in the control group. From the EQ5-D the score on ADL improved in the intervention group.


Test Bruger

NFA, Denmark


A Realist Evaluation Of A Multidisciplinary Intervention To Support Return To Work In Sick-listed Employees With Cancer

Hanneke van der Meide1, Margot C.W. Joosen1, Martine P. van Egmond2, G. Lennart van der Zwaan2, Anna Geraedts3, Willem van Rhenen4, Roland Blonk1,2

1Tilburg University; 2TNO; 3ArboNed; 4ArboUnie

Although the importance of work for cancer patients is nowadays widely acknowledged, interventions that are primarily aimed at enhancing return to work of this group of employees are still scarce. In this study, a new multidisciplinary intervention for return to work of employees with cancer is evaluated. One of the innovative aspects of this intervention is that it starts early after diagnosis. The individual tailored intervention is being adjusted to the different phases in curative and work-related care, i.e. the treatment, recovery-, and re-integration phase. Furthermore, a close involvement of the work environment, i.e. the line manager or HR manager, in the return to work of the employee is supported. The intervention is offered in an occupational healthcare setting.

The evaluation follows a realist evaluation (RE) design. One of the main implications of the realist perspective for evaluation is that it is not enough to simply view an intervention as a cause of outcomes but that the mechanisms connecting causes and their effects must also be identified. RE is based on the premise that aspects of context trigger particular mechanisms in response to an intervention, which result in observable outcomes. This is often expressed in the formula C+M=O. Contexts are defined as the conditions that an intervention operates in. Mechanism are underlying entities, processes, or structures which operate in particular contexts to generate outcomes of interest.

This poster presentation focuses on the results of phase 1 (initial intervention theory) and the preliminary results of phase 2 (testing intervention theory) of the realistic evaluation cycle. Using both quantitative and qualitative data, we will provide an explanatory account of how the intervention works, with whom, and under what circumstances.

2:15pm - 3:00pmKeynote II: Keynote II Maria Melchior
Auditorium 100 
3:30pm - 4:00pmSpeakers Corner: Speakers Corner
Auditorium 100 
4:00pm - 5:30pmConcurrent Session II: Concurrent Session II
4:00pm - 5:30pmDesign and development
Session Chair: Karen Nieuwenhuijsen
Session Chair: Silje Maeland
Auditorium 100 

Preferences Of Professionals In The design Of A Decision Support Tool For Prognosis Of Work Ability In Individuals With A Work Disability Benefit: Results Of A Focus Group Study

Ilse Louwerse1,2,3, Maaike Huysmans1,3, Jolanda van Rijssen1,2,3, Joyce Overvliet1, Allard van der Beek1,3, Han Anema1,3

1Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health research institute, Amsterdam, The Netherlands; 2Dutch Institute of Employee Benefit Schemes (UWV), Amsterdam, The Netherlands; 3Research Center for Insurance Medicine, AMC-UMCG-VUmc, Amsterdam, The Netherlands

Aims: A model predicting future changes in work ability based on a broad range of factors can help professionals to make accurate predictions which contribute to better prognosis in individuals with a work disability benefit. The goal of this study was to explore the desired design and use of a decision support tool for insurance physicians (IPs) and labour experts (LEs), based on a prediction model for changes in work ability at one-year follow-up.

Methods: Data were collected during three focus group meetings with IPs and LEs of the Dutch Social Security Institute. Topics included the design and use of the decision support tool. Data were audio recorded and analysed according to the main principles of content analysis.

Results: In total 24 professionals participated (17 IPs and 7 LEs). Clarity and ease of use were mentioned as important features of the decision support tool. Dividing work disability claimants into categories based on the outcome of the prediction model and assigning colour labels to the classes is experienced as a straightforward and clear way of presenting the results of the prediction model and encourages professionals who use the tool to take action. Accurate prognoses of future work ability aids provision of effective interventions to return to work for work disability claimants who will benefit most from it. Concerning preferences on when to use the tool, professionals would first want to make their own judgement during the work disability assessment interview with the claimant and afterwards verify their evaluation with the decision support tool.

Conclusions: The decision support tool should be easy to access and interpret, to be sure that it takes only small effort from professionals to use the tool and to help them making accurate prognosis of future changes in work ability.

Systematic Review Evidence In One Minute Or Less

Emma Irvin, Uyen Vu, Kristina Buccat, Cindy Moser, Kim Cullen, Dwayne Van Eerd

Institute for Work & Health, Canada

Introduction: Getting research evidence to knowledge users is a challenge. The Institute for Work & Health (IWH) initiated a systematic review (SR) program in 2004 to synthesize scientific literature on prevention of workplace injuries and disability. IWH SR products include two to three-page lay summaries (Sharing Best Evidence (SBE)). SBEs are popular but are considered long by some knowledge users. Our objective was to produce and post short videos that summarize key findings of SRs in one minute or less.

Methods: Video shorts are created by a multi-disciplinary team that includes a researcher, a video producer and a communications expert. The video shorts are based on high quality research (SR findings). Key messages are created in consultation with target stakeholders. The production process begins with a storyboard (frame-by-frame outline). Development requires careful attention to style, pacing, tone, clarity, visual interest and audience appeal. Video shorts are tested with members of the target audience before being posted. Video shorts take about four weeks to complete.

Results: Two one minute videos were developed by IWH made to reach busy stakeholders with evidence they need in their work. The first, posted since October 2016, has received over 2116 hits to date. The second, posted since May 2017 has received over 989 hits to date.

Length: Videos are kept as short as possible, less than one minute.

Format: No voice-overs are used. Simple graphics, images, text and short video clips are used, with instrumental background music.

Content: Key messages from research findings are delivered in brief snippets of text.

Conclusion: Our video shorts are designed to serve two purposes: provide viewers with key evidence they can use and link the viewer to the IWH website where they can read more information. One-minute research video shorts are an effective means of disseminating key research findings.

Work Ability Following a Traffic Injury--A Multidimensional Measurement Model

Mana Rezai1,2, Pierre Côté1,2,3, Selahadin Ibrahim1,4, J. David Cassidy1, Linda J. Carroll5, Vicki L. Kristman1,4,6

1Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Canada; 2UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC), Toronto, Canada; 3Faculty of Health Sciences, University of Ontario Institute of Technology, Oshawa, Canada; 4Institute for Work & Health, Toronto, Canada; 5School of Public Health, University of Alberta, Canada; 6Department of Health Sciences, Lakehead University, Canada

Objective: The purpose of our study was to develop a multidimensional measurement model of the latent construct of work ability.

Study Design and Setting: We developed a biopsychosocial model, conceptually based on the International Classification of Functioning, Disability and Health framework. We used data from a population-based incidence cohort of all persons treated for traffic injuries in Saskatchewan, Canada. Eligible participants were adults with acute soft tissue injuries who were off work. A confirmatory factor analysis model was specified and evaluated.

Results: The best-fitting model measured work ability as a second-order factor. The four first-order factors represented physical, psychological and cognitive functioning, and activities and participation domains. About 95%, 67%, 64% and 46% of each respective factor’s total variance was common variance, explained by the latent construct of work ability. A total of 17 measured indicator variables formed the final factor structure and demonstrated significant factor loadings and goodness-of-fit criteria.

Conclusion: Physical functioning plays a dominant role in the assessment of work ability among those off work following a traffic injury. In addition, our study has demonstrated the importance of exploring psychological and cognitive functioning, and the ability to carry out activities of daily living, to the evaluation of work ability following a soft tissue injury.

A Participatory Ergonomic Interventon For Reducing Physical Exertion And Musculoskeletal Pain Among Childcare Workers. A Cluster Randomized Controlled Trial

Charlotte Diana Nørregaard Rasmussen1, Malene Jagd Svendsen1, Andreas Holtermann1,2

1NFA, Denmark; 2University of Southern Denmark


The prevalence of musculoskeletal pain (MSP) is persistently high throughout the world. Participatory ergonomics may represent a solution for reducing the work demands and reduce MSP. We present the results of a participatory ergonomics intervention aimed at reducing physical exertion during work and MSP amongst childcare workers.


This study used a two-arm cluster randomized design, with clusters formed based on childcare institutions. Three workshops were conducted during the 4-month intervention period. Participants identified risk factors for strenuous work and MSP, developed solutions for reducing the identified risk factors and implemented them in their team. Physical exertion during work (scale from 0-10), MSP (duration and intensity) and work-related pain interference (days per month) was measured monthly. Analyses were performed according to intention to treat, including all eligible randomized participants.


Preliminary results show significant effects on physical exertion of -0.6 (95% confidence interval -1.09 to -0.14), and work-related pain interference of -2.7 (95% confidence interval -4.47 to -0.91) after the intervention compared to the control group. Non-significant reductions were found for duration of low back pain, duration of neck pain and for low back pain intensity and neck pain intensity.


Preliminary results of the study showed beneficial effects of the 4-month intervention. Participatory ergonomics therefore seems to be an effective solution for both reducing physical work exertion and work-related pain interference. Further analyses will be conducted to see whether the participatory ergonomics is also beneficial for sickness absence and for work ability.

Enhancing Return-To-Work Among Partially Work Disabled Workers: Development Of A Triage Instrument And Decision Aid For Labour Experts.

Christa J.C. De Geus1,2,3, Maaike A. Huysmans1,2, H. Jolanda van Rijssen1,2,4, Johannes R. Anema1,2

1Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health research institute, Van der Boechorststraat 7, NL-1081 BT Amsterdam, The Netherlands.; 2Research Center for Insurance Medicine (KCVG), AMC-UMCG-VUmc Amsterdam,The Netherlands; 3Arbeidsdeskundig Kennis Centrum (AKC), The Netherlands; 4Dutch Institute of Employee Benefit Schemes (UWV), Amsterdam, The Netherlands


Labour experts can experience difficulties choosing the right RTW interventions for partially work disabled workers. An understanding of relevant factors and effective interventions could help labour experts improve the vocational rehabilitation process of partially disabled workers. In the present study, we describe the design of a study with the aim to develop a triage instrument and decision aid for labour experts to help improve their service and to be able to offer individually tailored service to partially work disabled workers receiving a long term disability benefit with the aim to improve RTW.

Development of the instrument:

The instrument and decision aid will be developed along the lines of the International Classification of Functioning, Disability and Health (ICF) model. Based on the obstructing RTW factors of the individual, relevant effective interventions to improve these obstructing RTW factors are suggested to the labour expert.

Several studies will provide input for the instrument and decision aid. First, two systematic literature reviews are currently being conducted to provide input on relevant obstructing factors for RTW and to provide input on effective RTW-interventions. Second, focus groups are currently being conducted among labour experts to provide expert-based input for the instrument concerning important RTW factors and concerning the position of the instrument in the vocational rehabilitation process. Based on the results of these studies a first version of the instrument will be designed. Next, a Delphi Study will be held to reach consensus about the content and placement of the final instrument.


The aim of this study is to develop a triage instrument and decision aid for labour experts to enhance individually tailored service to partially disabled workers. The (cost)effectiveness of the instrument will be evaluated in a randomized controlled trial among partially work disabled workers.

Good Working Body - Development Of An eHealth System For Repeated Measures Of Musculoskeletal Pain In Workplace Context

Malene Jagd Svendsen1, Andreas Holtermann1,2, Charlotte Diana Nørregaard Rasmussen1

1The National Research Centre for the Working Environment, Denmark; 2Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Denmark


Electronic health (eHealth) systems are increasingly being used to assess pain. This study aims to describe the development of a new system for measuring musculoskeletal pain in workplace contexts – “Good working body” (GWB).


GWB was developed in close collaboration between researchers, ergonomic consultants and work environment representatives from workplaces, a pension company and an eHealth company. First, need and potential for the system was discussed. A non-systematic literature review for pain assessments (e.g. questionnaires) was performed. Different formulations and types of questions as well as layout of the questions were tested among 10 workers with cognitive interviews.


The system was tested among 10 cleaners to ensure feasibility and acceptability for all workers but particularly those with high need (e.g. blue-collar workers with high physical work demands and high pain levels). In Denmark, many cleaners are non-western immigrants with Danish as second language. Use of figures and shortly phrased questions was therefore chosen to ease comprehensibility. Through the cognitive interviews, specific question formulations and layout were chosen. GWB contains a body chart with 9 body regions and pain intensity scales for all regions (VAS 0-10). Additionally, the system contains questions about activity limitation and use of pain relievers. GWB monitors the musculoskeletal pain of every worker by asking simple questions in an interval according to the workplaces’ need. The system then provides simple feedback to the individual. Management and HR receive monthly reports on the general level of musculoskeletal pain to serve as a launch pad for initiating relevant changes.


The system is meant to be applicable for all workers, including those with low literacy levels. The frequent monitoring of musculoskeletal pain can help workplaces to identify workers in greatest need of work adaptations due to pain at an early stage and thus prevent work disability.

4:00pm - 5:30pmEarly work life
Session Chair: Ute Bültmann
Session Chair: Louise Lindholdt
Room 99 

Educational Differences in Duration of Working Life and Loss of Paid Employment: Working Life Expectancy in the Netherlands

Suzan Robroek, Daan Nieboer, Alex Burdorf

Erasmus Medical Center Rotterdam, the Netherlands

Objectives: This study aims to provide insight into educational differences in duration of working life by working life expectancy (WLE) and working years lost (WYL) through disability benefits and other non-employment states in the Netherlands.

Methods: Monthly information on employment status of the Dutch population (N=4,999,947) between 16 and 66 year from 2001 to 2015 was used to estimate working life courses. Across educational groups monthly transitions between paid employment and non-employment states were calculated. Using a multistate model (R-package mstate) the WLE and WYL due to disability benefits and other non-employment states were estimated, stratified by educational groups.

Results: Despite starting in paid employment earlier, low educated men and low educated women had a 4.17 (men) and 9.50 (women) years lower WLE at age 16 than high educated men and women. Among low educated men 3.59 working years were lost due to disability benefit compared to 0.78 among high educated men. Low educated women lost 3.47 working years due to disability benefit compared to 1.38 among high educated women.

Conclusions:The working life course perspective showed large educational differences in WLE. A considerable amount of the lost working time is health-related due to disability benefits. In comparison to high educated workers, those with a low educational level lose a substantial part of their working life due to disability benefit, unemployment, and no income. The metrics of WLE and WYL provide useful insights into the life-course perspective of working careers.

Sound Performers Canada: Impact of a Blended Learning Course for Occupational Resilience and Health Literacy in Pre-Professional Musicians

Christine Guptill1, Peter Visentin2, Suzanne Wijsman3, Bronwen Ackermann4, Mary Roduta-Roberts1, Teri Slade1

1University of Alberta, Canada; 2University of Lethbridge, Canada; 3University of Western Australia; 4University of Sydney, Australia

Multiple studies have determined that more than 80% of professional musicians will encounter health conditions related to their occupation that negatively affects their abilities to work. The existing literature also suggests these conditions to be prevalent among post-secondary music students. Furthermore, the literature acknowledges a stigmatizing, “don’t ask, don’t tell” occupational environment. This unique learning and working context requires a tailored solution for enhancing occupational resilience - the ability to engage in a valued occupation while positively adapting to stress or adversity. We hypothesize that providing education for tertiary music students will enhance occupational resilience and health literacy, and may impact the development of health conditions in pre-professional musicians.


1. Improve occupational resilience and health literacy in pre-professional musicians;
2. Evaluate the utility of an online educational curriculum from Australia in the Canadian tertiary education context;
3. Assess the impact on student learning and behaviours when this online resource is
integrated into a blended learning classroom context;
4. Develop a questionnaire from existing reliable, validated tools, to evaluate the impact of these two delivery methods in achieving identified educational and behavioural outcomes.

Our international team of collaborators have designed a multi-centre cohort study to evaluate the impact of the online curriculum, Sound Performers, on its own and as part of a blended learning (online and face-to-face) credit course. Measures include a purpose-built questionnaire tool, including reliable, validated measures as well as questions addressing health behaviours that employ the Readiness Ruler to assess readiness to change. Assessment will also include coursework, such as quiz results and reflective journaling, and qualitative focus group interviews with participants at all three sites. Results of this first trial, conducted in Canada at three tertiary institutions, will be shared with attendees.

Effective Interventions For Physical Health Complaints In Nursing Students And Novice Nurses: A Systematic Review

Jos Kox1,2, Ellen Bakker1,4, Sita Bierma-Zeinstra2,3, Jos Runhaar2, Harald Miedema1, Pepijn Roelofs1,5

1Center of Expertise, Innovations in Care, Rotterdam University of Applied Sciences, Netherlands, The; 2Department of General Practice, Erasmus MC University Medical Center Rotterdam, Netherlands, The; 3Department of Orthopaedics, Erasmus MC University Medical Center Rotterdam, Netherlands, The; 4Department of Public and Occupational Health, Public Health research institute, Amsterdam UMC, VU Amsterdam, Netherlands, The; 5Faculty of Medical Sciences, University Medical Center Groningen, Netherlands, The

Background: The nursing profession is associated with heavy workload and high physical working demands, resulting in increased turnover of nurses. Nursing students and novice nurses are frequently faced with demanding workloads putting them at risk of developing physical health problems, such as musculoskeletal symptoms. An overview of interventions available in this population is lacking. This review aimed to identify interventions studying the treatment and/or prevention of physical health problems in nursing students and/or novice nurses and the effect of these interventions.

Methods: A systematic search of the literature was conducted up to December 2017. Primary outcome of interest was education/work dropout. Secondary outcomes were: musculoskeletal symptoms. Two authors independently screened and selected studies. Three authors assessed risk of bias.

Results: After screening 7,111 titles and abstracts, eleven studies were included. Seven studies evaluated interventions for moving/handling training. Four evaluated other interventions. No studies focused on novice nurses. All studies reported on physical complaints, but none evaluated dropout. Overall, risk of bias was high and clinical heterogeneity prohibited pooling of data. Intervention effects on physical complaints were small and inconsistent. Comparison of five relatively similar studies on additive moving/handling training for back pain in the curriculum revealed that three studies showed a positive intervention effect. However, the other two either showed no effect or favoured the standard curriculum.

Conclusion: This review summarizes interventions promoting the physical health of nursing students and novice nurses. Evidence for the effectiveness of interventions in the nursing curricula for the treatment and/or prevention of physical complaints is scarce and where available conflicting. No studies focussed on our primary outcome education/work dropout. Further high quality research is required to align methods and outcome measures. We recommend research on drop-out due to physical health problems.

Preventing Drop-out of Nursing Students and New Graduates: First Findings from a Bottom-up Approach.

Pepijn D.D.M. Roelofs1,5, Jos H.A.M. Kox1,2, Ellen J.M. Bakker1,3, Jos Runhaar2, Cécile R.L. Boot3, Sita M.A. Bierma-Zeinstra2, Anneke L. Francke3,4, Allard J. van der Beek3, Harald S. Miedema1

1Center of Expertise, Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands; 2Department of General Practice, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands; 3Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health research institute, The Netherlands; 4Nivel, Netherlands Institute for Health Services Research, Utrecht, The Netherlands; 5Department of Health Sciences, Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, The Netherlands


With a growing shortage of nursing professionals, preventing drop-out of nursing students and nurse graduates is of foremost importance. Potential causes of drop-out include the demanding physical and mental workload. Unfortunately, interventions to prevent or deal with these strains do not sufficiently seem to find their way into education, and it is unclear who should be targeted with secondary preventive measures. Therefore, the SPRiNG project, Studying Professional Resilience in Nursing students and Graduates, was launched.


A cohort of 731 students from the Bachelor of Nursing program at the Rotterdam University of Applied Sciences, is being followed from their third-year internship up to one and a half year after graduation, using questionnaires and register data. Aims of the cohort study are to: determine prevalence and incidence rates of dropout, identify protective/ risk factors, early indicators of dropout, and it’s interactions. Furthermore, qualitative studies were enrolled to unravel pathways of drop-out; two systematic reviews have been conducted to search for (preventive) interventions; expert meetings were held to designate feasible interventions; and currently the feasibility of adopting possible interventions into the curriculum is explored in six student projects. For two feasible interventions, pilot RCTs are planned.


The first 226 enrolled students reported a physical and mental workload leading to health problems during their internship: e.g., 74% encountered regular/continuous physical complaints such as back pain, 39% experienced distress, and 72% had to deal with aggression. Results from the reviews and qualitative studies provided input for the expert meetings, in which 12 interventions were advised varying from physical fitness consults to Nonviolent Communication training.


SPRiNG is an example of integrating research and education. Scientific and practical findings emerging from this project can be used for teaching healthy working behaviours and deploy targeted interventions before students are lost for the profession.

Interventions Improving Mental Health Of Student and Novice Nurses To Prevent Drop-out: A Systematic Review

Ellen Bakker1,2, Jos Kox1,4, Cécile Boot2, Anneke Francke3, Allard van der Beek2, Pepijn Roelofs1,5

1Research Centre of Care Innovations, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands; 2Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health research institute, Amsterdam, The Netherlands; 3Nivel, Netherlands Institute for Health Services Research, Utrecht, The Netherlands; 4Erasmus Medical Center, Department of General Practice, Rotterdam, The Netherlands; 5University Medical Center Groningen, Department of Health Sciences, Community and Occupational medicine, Groningen, The Netherlands

Background: Currently, nursing staff shortages are growing in Western countries, while drop-out among student and novice nurses is high. Mental health problems are a potential cause of drop-out, and occur frequently. Several studies report high prevalences of depression, anxiety and distress. In order to prevent attrition due to reduced mental health, it seems important to teach students to take the lead in their own work-related health. However, an overview of interventions is lacking. This review aimed to provide a systematic overview of interventions aiming at improving mental health in order to prevent drop-out from nursing education/work and an overview of the effectiveness of these interventions.

Methods: Up to 2018 various relevant scientific databases were searched. Two researchers identified studies. Interventions aiming at improving mental health with a quantitative research design were eligible for inclusion. Methodological quality was appraised.

Results: From 7,378 records, 19 studies were included. Only one was an RCT; other studies used a repeated measure, a quasi-experimental or a mixed methods design. The content of interventions varied from multi-component approaches, such as stress management programs, to single-component interventions, such as relaxation interventions. Most of the interventions for student nurses focused primarily on improving mental health. The majority of interventions for novice nurses were multicomponent retention programs that included limited interventions for mental health improvement. Since only five studies showed a significant effect on attrition/retention/sick leave, and an overall high risk of bias, there is limited evidence that these programs are effective. Heterogeneity prohibited pooling of data.

Conclusion: A broad range of interventions aiming at improving mental health in order to prevent drop-out from nursing education/work are available, but the evidence for the effectiveness of these interventions is limited. There is a need for high-quality studies and it is recommended to align methods and measures used in this field.

4:00pm - 5:30pmPrevention and sustainable employment
Session Chair: Thomas Lund
Session Chair: Alex Collie
Room 97 

Job-rotation as a Tool to maintain Employability: The Interplay between Motivation, Qualification and Health

Susanne Bartel

Federal Association of Vocational Rehabilitation Centres, Germany

Facing the demographic changes in German society, innovative age and aging management concepts and prevention models are becoming increasingly important for employees, companies and the social security system. The decline in activity-related performance potentials, due to higher age, is often associated with health-stressing working conditions and the lack of opportunities to develop professionally and personally. Job-rotation between companies can counteract this process before health problems develop.

In the project “TerrA”, funded by the Federal Ministry of Education and Research (2016 to 2019), the possibilities and limitations of such a model is currently being tested in practice. Based on qualitative fieldwork (i.e. interviews with employees, participatory observation) and intense discussions with employers and stakeholders, specific consulting processes for employees and companies were developed and framework conditions described.

The results show that at the individual level, personal motivation, qualification and health play an essential role for such a preventive approach. At the same time, companies recognised the need for a long-term view of working-life biographies to prevent age-related mental and/or physical disabilities. Although the social insurance stakeholders have recognised the preventive potential of our model, they are currently unable to implement it, as legal frameworks only permit benefits if a health problem has already occurred.

Under what conditions can preventive job changes succeed? Where are the opportunities and limits of this preventive strategy in the context of securing employability? We draw the conclusion that for the implementation of preventive measures, a sensitisation for individual concepts of health and work is of great importance. At the same time, companies have a central responsibility to integrate anticipatory job analyses and qualification opportunities in human resources development concepts proactively. Finally, it became clear that financing possibilities for job qualification under a preventive perspective cannot be borne by the social security systems, yet.

Long-term Effects On Work Disability Of An Indicated Preventive Strategy Aimed At Preventing Future Long-term Sickness Absence

Sophie Heloïse Klasen, Ludovic G.P.M. van Amelsvoort, Nicole W.H. Jansen, IJmert Kant

Maastricht University, Netherlands, The

So far most general and selective preventive interventions have been proven rather ineffective in considerably reducing work disability risk. A preventive strategy, based on the principles of indicated prevention, that is, detecting high risk workers with a screening questionnaire and subsequent early intervention of these workers, was developed, aimed at preventing future long-term sickness absence. It is assumed that the reduction of long-term sickness also considerably reduces the work disability risk.

The aim of our study is to establish the efficacy of this preventive strategy on work disability risk and the long-term costs and effects. To assess the efficacy, data covering a prolonged follow up from two large Dutch RCTs on the effectiveness of the preventive strategy is collected. Trial I consisted of employees at high risk for long-term sickness absence receiving early consultation as compared to care as usual. Trial II compared the effect of a tailor made Problem Solving Therapy with elements of CBT at high risk for long-term sickness absence with mild depressive complaints to care as usual. Of the population (n=13,842) who filled in the screening questionnaire, (n=438) high risk employees were followed for six years.

It has been shown that a preventive strategy is able to reduce future long-term sickness absence over a period of one year from 31 to 18 days in the first trial (Kant et al., 2008) and from 50 to 27 days in the second trial (Lexis et al., 2011) which indicates a large potential to also reduce work disability risk. Since the analysis is currently ongoing the results will be presented at first at the conference. When this strategy is proven to be effective on the long-term, this strategy is promising for a reduction in work disability and broader implementation will be needed.

Barriers And Facilitators Of A Preventive Strategy To Prevent Future Long-term Sickness Absence And Work Disability. A Qualitative Study Among Employees And Employers.

Sophie H. Klasen, Ludovic G.P.M. van Amelsvoort, Inge Houkes, Nicole W.H. Jansen, IJmert Kant

Maastricht University, Netherlands, The

Objective: The prevention of work disability remains challenging. This research focuses on a preventive strategy which is proven effective in reducing sickness absence in the long-term. Thus, apparent also work disability risk. The strategy consists of a screening in which workers at high risk are identified, and subsequent early intervention by labor professionals. The implementation of this strategy appeared to be difficult though. The aim of this study is to identify and understand barriers and facilitators associated with the implementation of this preventive strategy as experienced by primary stakeholders (employees and employers) whether or not familiar with this strategy.

Methods:Semi-structured interviews were conducted with 9 employers and 11 employees. We used purposive sampling to obtain the perspectives of stakeholders with varying age, gender and degree of familiarity with the strategy. All interviews were transcribed and analyzed thematically.

Results: Employees generally expect positive outcomes of the preventive strategy, but report that an atmosphere of trust in the organization is important for serious employee participation and effectiveness.When asked about the preventive strategy, employees not depending on familiarity primarily talked about the screening questionnaire, neglecting the early intervention by the labor professionals. Employers were overall positive but those unfamiliar primarily talked about the screening questionnaire. As regards background and risk factors of sickness absence, employees and part of the employers focused on physical health and lifestyle, thereby neglecting mental health. Several misperceptions seem to exist about sickness absence and the preventive strategy which may inhibit implementation.

Conclusions: The basis, content and expected outcomes of the preventive strategy were not clear to employees. Misconception were also noticeable for the unfamiliar employers and to a lesser degree for the familiar employers. Better communication about risk factors of sickness absence and the preventive strategy itself, are needed for successful implementation of the strategy.

Employees With Long-term Health Conditions - A Diary Study Of Workplace Self-management Behaviour, Support Needs And Work Factors.

Sally Elizabeth Hemming

Loughborough University, United Kingdom

The prevalence of long-term health conditions is increasing and working people affected by conditions, are required to self-manage their health at work. Health condition management is increasingly popular in workplace health promotion, yet little is known about workplace self-management activity or support needs and how these vary over time. The self-management activities and experiences of people affected by conditions were explored using a workplace diary and journal, to gain a temporal and real time perspective. A fixed schedule 10-week longitudinal diary study was designed collecting quantitative and qualitative self-reported data. The FlexMR platform was used for an online diary and journal. Participants, recruited via a survey study, were asked to complete the diary on six occasions at two-week intervals. Diaries have been shown to be useful in examining health behaviours, assessing temporal changes. They have also been shown to be useful in exploring illness behaviours and for tracking self-management activities. The diary was made up of four tasks incorporating 17 questions in total. Participants were asked about their health condition status, self-management activities, workplace support needs and work engagement. An optional online journal function was also available for people to record in the moment activities and thoughts. One hundred and twenty-one participants were invited to take part in the diary study, 57 completed a diary entry with 18 participating fully. An understanding of long-term self-management behaviours of people affected by health conditions can potentially help employers provide workplace support to the benefit of working people. Study results identifying people’s typical workplace self-management and support needs, and the extent to which they vary over time will be presented. Furthermore, free text and online journal sections will be thematically analysed and presented.

Working With Disabilities – A Matter Of Time? First Results From The PROMI Project

Jana Felicitas Bauer, Susanne Groth, Mathilde Niehaus

University of Cologne, Germany


Time is money in the world of work, therefore the person that is most productive in a given time frame is often considered to be the best employee. This view of „good employees“ can pose a fundamental challenge to people with disabilites who usually have to deal with disability-related time expenditure. Due to disability-related time expenditure, the time budget that can be spent on actual work tasks may be reduced or the time needed to complete a given work task may be extended. This may in turn make it difficult to keep up with the above mentioned ideal of productivity – especially when working conditions are not flexible in terms of scheduling. The aim of the present study is therefore to explore different kinds of disability-related time expenditure that are relevant to working life.


The sample consists of participants of the project „PROMI – promoting inclusive doctoral studies“. N = 30 PhD students with disabilities that work part-time as research assistants at german universities were surveyed via an accessible online questionnaire.

First Results

Nearly all of the participants report some kind of work-relevant disability-related time expenditure. About 73% have to keep frequent medical or therapeutical appointments, over 65% indicate that they are involved in time-consuming bureaucratic issues e.g. connected to the application for disability benefits, 50% state that they need more brakes than others to be able to work efficiently, moreover especially the visually and hearing impaired report that they need more time than others to complete work tasks.


The first results indicate that disability-related time expenditure is a manifold and relevant topic that needs further examination. A goal of future research should be to identify working conditions that reduce the challenge of balancing disability- and work-related time demands.

The Effectiveness Of Interventions To Promote Sustainable Employability: A Systematic Review

Emmelie Hazelzet1, Eleonora Picco2, Inge Houkes1, Hans Bosma1, Angelique de Rijk1

1Maastricht University, Netherlands, The; 2University of Milano, Italy

Objective: Despite growing interest in sustainable employability (SE), studies on the effectiveness of interventions specifically developed to promote employee SE are scarce. Based on the definition by Van der Klink and colleagues, researchers and practitioners distinguish three SE components: 1) health; 2) productivity and 3) a long-term perspective. The aim of this review is to (1) summarize the evidence for the effectiveness of SE interventions used by employers; and (2) to examine which of the three SE components are addressed by these interventions.

Methods: A systematic search was performed for articles published in the Cinahl (Ebsco), EconLit (Ebsco), Embase, PsycInfo (Ebsco), Pubmed and Web of Science databases between January 1997 and June 2018. We established inclusion criteria which were applied manually in the selection of studies. The adapted Quality Assessment Tool for Quantitative Studies developed by the Effective Public Health Practice Project (EPHPP) was used to assess methodological quality. Data extraction was based on type of intervention, target group and the three SE components.

Results: Seven out of 25 potentially relevant articles were included in the review. The methodological quality of these seven studies ranged from weak to moderate. The overall effectiveness of the SE interventions was mixed (i.e., small positive effects of subcomponents of the interventions or no effectiveness). Preliminary findings showed that the health focus and productivity focus are more or less covered by the interventions, whereas the long-term perspective of SE is often lacking.

Conclusions: No firm conclusions regarding the effectiveness of SE interventions can be drawn. This can partly be explained by the relatively low quality of the studies included, but may also by the type of interventions used by employers to enhance their employees’ SE. More attention for high quality studies and effective SE interventions provided by the employer seems necessary.

4:00pm - 5:30pmReturn to work coordination
Session Chair: Mette Jensen Stochkendahl
Session Chair: Maurizio Trippolini
Room 96 

The Challenging Day-To-Day Situation of Return to Work Coordinators

Ellen MacEachen, Elena Neiterman, Ekaterina McKnight, Cindy Malachowski, Meghan Crouch

University of Waterloo, Canada

Introduction: Return to Work (RTW) Coordinators sit at a complex interface of workers, employers, insurers, and health care providers. This study set out to understand the day-to-day work RTW coordinators, including their performance expectations and how they make decisions when faced with competing demands.

Methods: An interpretive qualitative approach was used to gain a situated understanding of the day-to-day work and strategies of experienced RTW coordinators. The purposive sample included coordinators based within insurance and workers’ compensation, embedded in large organisations, and third party consultants to businesses. Semi-structured, in-depth interviews were conducted with 50 coordinators across Canada. Verbatim transcriptions of interviews were dual-coded and analysed using a modified grounded theory approach that emphasizes constant comparison.

Findings: Although the coordinators enjoyed the stimulation and variety of their work, burnout was also a present issue. RTW coordinators faced different pressures depending on their own employment contracts. Achieving a minimal claim duration was a performance expectation for most coordinators and particularly for contracted third party providers. A particular point of tension for the coordinators was physician recommendations about duration of work absence as it often conflicted with coordinator’s own focus on worker ability and speedy RTW. The coordinators gained the trust and cooperation of workers by creating a partnership environment, but their role in claim denial and their obligation to adhere to employer “zero absence” policies sometimes challenged these worker relationships.

Conclusion: RTW coordinators appear to be a growing profession in the context of public and also private insurer work disability policies that emphasize expedient return to work after an illness or injury. This analysis reveals some day-to-day challenges of this coordinating role and identifies strategies for managing this mediating role.

Mental Health And Work Reintegration: Tapping Return-To-Work Coordinator Strategies

Ellen MacEachen, Elena Neiterman, Ekaterina McKnight, Cindy Malachowski, Meghan Crouch

University of Waterloo, Canada

Introduction: Mental health (MH) disorders constitute a considerable time and expense component of a return to work (RTW) trajectory. This is a particularly challenging area for RTW management because of its episodic, chronic and invisible nature. Professional RTW coordination is increasingly seen as a solution to management of difficult work injury cases given the complexity of the RTW process, which requires goodwill and cooperation among different parties who can have diverse interests and needs. The objective of this study was to tap rich RTW Coordinator front line practice experience of supporting RTW for clients with MH disorders and to create a “strategies guide” to be used by stakeholders.

Methods: An interpretive qualitative approach was used to gain a situated understanding of the day-to-day work and strategies of experienced RTW coordinators. The purposive sample included coordinators based within insurance and workers’ compensation, embedded in large organisations, and third party consultants to businesses. Semi-structured, in-depth interviews were conducted with 50 coordinators across Canada. Verbatim transcriptions of interviews were dual-coded and analysed using a modified grounded theory approach that emphasizes constant comparison.

Findings: RTW coordinators faced difficulties with managing RTW for MH because, unlike for physical health conditions, few standardised benchmarks exist for setting expectations about the timing of RTW. As well, mental health absences were often intertwined with challenging workplace relationships and RTW coordinators had limited influence over the work environment. RTW coordinators described particular strategies for managing mental health absences, including creating a “partnership” environment with the worker and particular ways of communicating with healthcare and workplace parties.

Conclusions: Return to work is a complex arena, and mental health poses unique challenges. RTW coordinators had rich practical expedience that provided insight into ways that RTW can be managed in the context of varied workplace situations.

Within The Ring Or Crisscross? Integration Of RTW-Services In Norway

Lisebet Skeie Skarpaas1,2, Lise Aasen Haveraaen2, Milada Cvancarova Småstuen1, William S. Shaw3, Randi Wågø Aas1,2,4

1Oslo Metropolitan University, Norway; 2Presenter - Making Sense of Science, Norway; 3University of Massachusetts Medical School, USA; 4University of Stavanger, Norway

Introduction: In return to work (RTW) programs, a coordinator has often been provided in order to integrate services. However, models of coordinating services vary widely internationally, and across different programs, where one distinction is between vertical and horizontal integration. The aim of this study was therefore to explore and describe if and how a coordinator was provided in the Rapid-RTW-program, and whether the provision of a coordinator was associated with certain personal or intervention characteristics.

Methods: The study was designed as a cohort study following employees participating in a variety of Rapid-RTW-programs (n=39). Employees (n=494) answered a self-administered questionnaire, which was linked to register data on diagnoses. Employees who reported to be provided with a coordinator were included in this analysis. Associations for being provided with a coordinator were tested in adjusted logistic regression models.

Results: Sixty-nine percent of the employees reported having a coordinator. The coordinators were mainly responsible for coordinating treatment within own services (i.e. horizontal coordination, 68%). Occupational rehabilitation-programs more often provided a coordinator compared treatment included assessment and surgery (OR 3.87 95% CI 2.42-6.24). More professions were involved in the programs that provided coordinators. In addition, when provided with a coordinator, there was more contact with other stakeholders like leaders and social security services, and more often, the service provided adaptations at the workplace for the individual employee. However, this signs of vertical integration were only evident for a limited number of employees.

Conclusion: In this study, seven of ten had a coordinator, which was associated with more professions and stakeholder involvement in the RTW-process. Still, most of these coordinators did not coordinate vertically between all the levels and intervention arenas for sick listed employees (i.e. workplace, social security, and health care services), as recommended in earlier research.

Does Coordination Make A Difference? Time To RTW In RTW-Services In Norway

Lisebet Skeie Skarpaas1,2, Lise Aasen Haveraaen2, Milada Cvancarova Småstuen1, William S. Shaw3, Randi Wågø Aas1,2,4

1Oslo Metropolitan University, Norway; 2Presenter - Making Sense of Science, Norway; 3University of Massachusetts Medical School, USA; 4University of Stavanger, Norway

Introduction: The aim of this study was to assess if the reported provision of a coordinator was associated with time to first- and first full- return to work (RTW) amongst sick-listed employees who participated in different Rapid-RTW programs in Norway.

Methods: The sample included employees on full-time sick-leave who participated in Rapid-RTW-programs (n=326), who provided information about the coordination of the services they received. The median age was 46 years (min-max. 21-67), and 71% were female. The most common reported diagnoses were musculoskeletal- (57%) and mental health disorders (14%). The employees received different types of individually tailored RTW-programs all aimed at a rapid RTW; occupational rehabilitation (64%), treatment for medical or psychological issues, including assessment, and surgery (26%), and follow-up and work clarification services (10%). It was common to be provided with a coordinator (73%). Outcomes were measured as time to first-RTW (graded and 100%) and first full-RTW (100%).

Results: Employees provided with a coordinator returned to work later than employees who did not have a coordinator; a median (95% CI) of 128 (80-176) days versus 61 (43-79) days for first-RTW, respectively. This difference did not remain statistically significant in the adjusted regression analysis. For full-RTW, there was no statistically significant difference between employees provided with a coordinator versus those who was not.

Conclusion: The model of coordination provided in the Norwegian rapid-RTW-programs, did not contribute to a more rapid RTW for sick listed employees. Rethinking how return to work coordination should be organised could be wise in future program development.

Comparing Multidisciplinary And Brief Intervention In Employees With Different Job Relations On Sick Leave Due To Low Back Pain – One Year Follow-up

Vivian Langagergaard1, Claus Vinther Nielsen2,3, Ole Kudsk Jensen1, Merete Labriola2,3, Pernille Pedersen3, Vibeke Neergaard Sørensen1

1Spine Center, Diagnostic Center, Silkeborg Regional Hospital, Denmark; 2Section of Clinical Social Medicine and Rehabilitation, Department of Public Health, Aarhus University, Aarhus, Denmark.; 3DEFACTUM, Central Denmark Region, Aarhus, Denmark


Not all individuals on sickness absence due to low back pain (LBP) may profit from the same intervention and the effect of a given intervention on return to work (RTW) may depend on their work situation. The aim of this study was to evaluate whether employees on sick leave due to LBP and with poor job relations will benefit more from a multidisciplinary intervention, while patients with strong job relations will benefit more from a brief intervention.


The study was designed as a randomised controlled trial comparing brief intervention with brief intervention plus multidisciplinary intervention. Employees, aged 18-60 years, were included in the study from October 2010 to August 2016 if they had been on sick leave for 4-12 weeks due to LBP with or without radiculopathy. They were divided into two groups, a group with poor job relations and a group with strong job relations based on their answers in the baseline questionnaire. Each group was randomised 1:1 to receive the brief intervention or brief intervention plus multidisciplinary intervention. The brief intervention comprised a clinical examination and advice offered by a rheumatologist and a physiotherapist, whereas the supplementary multidisciplinary intervention comprised the assignment of a case manager who drew up a rehabilitation plan in collaboration with the participant and the multidisciplinary team.

One-year RTW was estimated by register data, while functional capacity was measured by questionnaire data.


Results are not available yet, but will be presented at the conference.

Discussion and conclusion

This trail will indicate whether work-related characteristics should be considered when providing treatment of LBP patients in the health care sector.

4:00pm - 5:30pmSpecial occupations and gender issues
Session Chair: William Shaw
Session Chair: Rikke Smedegaard Rosbjerg
Room 95 

Surgery is Physically Demanding and Associated with Multi-site Musculoskeletal Pain: a Cross-sectional Study

Tina Dalager1,2, Karen Søgaard1,3, Eleanor Boyle1, Pernille Tine Jensen4,5, Ole Mogensen4,6

1Department of Sports Science and Clinical Biomechanics, University of Southern Denmark; 2Centre for Innovative Medical Technology, Odense University Hospital, Denmark; 3Occupational and Environmental Medicine, Odense University Hospital, Denmark; 4Clinical Institute, University of Southern Denmark; 5Department of Gynaecology and Obstetrics, Odense University Hospital, Denmark; 6Department of Gynaecology and Obstetrics, Karolinska University Hospital and the Karolinska Institute, Sweden

Background: A surgeon’s work involves well-known risk factors for developing musculoskeletal pain. Musculoskeletal pain and especially multi-site musculoskeletal pain could have an impact on the surgeon’s work life and ultimately shorten their surgical career. The objectives in the present study were to quantify the prevalence and intensity of musculoskeletal pain, and to identify surgeons’ characteristics associated with multi-site musculoskeletal pain.

Methods: Information on sociodemographic, work experience, work demands, current health status, levels of physical capacity, and presence and intensity of musculoskeletal pain were collected from an internet-based questionnaire in 284 surgeons. Descriptive statistics were used to report prevalence and intensity of musculoskeletal pain. A logistic regression model was conducted to assess the characteristics associated with multi-site musculoskeletal pain.

Results: Multi-site musculoskeletal pain was reported by 77% of the surgeons, 13% reported pain in one body site, whereas 10% reported no pain. Neck (63%) and lower back (60%) were the most prevalent pain locations. The reported median pain intensities ranged from 2 to 4. Multi-site musculoskeletal pain was significantly associated with being a female surgeon (OR:3.4; 95% CI:1.5-7.4), physical work demand (OR:1.5; 95% CI:1.2-1.7), work ability (OR:3.4; 95% CI:1.6-7.0), and feeling a sense of heaviness in the head/headache (OR:4.8; 95% CI:2.0-11.5). In addition, surgeons who experienced multi-site musculoskeletal pain reported that this negatively influenced their work (21%), leisure time activities (40%), and sleep (27%).

Conclusions: The observed high prevalence of multi-site musculoskeletal pain and high pain intensities adds new knowledge to the emerging literature on musculoskeletal pain in surgeons. Several characteristics, e.g. work ability, were significantly associated with multiple pain sites and this may be of concern for the future career of surgeons. In addition, multi-site musculoskeletal pain has a much greater impact on work, leisure time activities and sleep than pain occurring in one body site.

Standing Dentistry: An Old Practice That Needs Revival? A Scoping Review

Sara L Saunders, Marie-Lyne Grenier, Jill T Boruff

McGill University, Canada

Introduction: Postures employed by dental professionals in practice have evolved over time. With the advent of new techniques in the mid-twentieth century, practice postures changed from predominantly standing to predominantly sitting positions. Nevertheless, current literature demonstrates a significant and ongoing prevalence of work-related musculoskeletal disorders (WMSD) among dental professionals. WMSD have been linked to significant loss work time, work disability, burnout, and early retirement among dental professionals. Similar trends have been noted among office workers whose work postures are comparable to those of dental professionals. Evidence supporting periods of standing for office workers is growing and, as a result, many workplaces are now providing sit-to-stand desks to encourage postural shifts throughout the workday. With dental professionals facing similar postural demands and similar rates of WMSD, it is timely to ask whether the dental profession should revisit abandoned standing practices. Objective: This scoping review aims to find whether research in the field of dentistry has determined which posture - seated, standing or alternating - is most effective in preventing WSMD in dental professionals. Methods: This scoping review follows the framework set out by Arksey and O’Malley (2005) and updated by Levac, Colquhoun and O’Brien (2010). A systematic search of four databases identified 2127 relevant studies after removing duplicates. At the title and abstract screening stage, 388 titles were included. The full text of these 388 titles are now being screened for inclusion. Once the final articles have been selected for inclusion, the data from these articles will be charted, collated, and summarized. Findings: Preliminary findings show that literature exploring ergonomics for dentistry professionals has been published since the 1940s by international experts. The results from this scoping review will contribute to the overall ergonomic literature on the prevention of WMSD in dental professionals by informing evidence-based postural practices for dentistry.

Social Stigma as a Barrier for Sustainable Employability of Employees with Mental Health or Substance Abuse Problems: A Focus Group Study in the Dutch Military.

Rebecca Bogaers1, Elbert Geuze2, Fenna Leijten3, Piia Varis4, Jaap van Weeghel1, Dike van de Mheen1, Andrea Rozema1, Evelien Brouwers1

1Tranzo, Scientific Center for Care and Wellfare, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, the Netherlands.; 2Military Mental Healthcare, Ministry of Defense, Utrecht, the Netherlands.; 3Strategic Military Healthcare Department, Ministry of Defense, Utrecht, the Netherlands.; 4Department of Culture studies, Tilburg School of Humanities and Digital Sciences, Tilburg University, Tilburg, the Netherlands.

Employees with Mental Health or Substance Abuse Problems (MH/SAP) have a higher risk for sick leave, unvoluntary early retirement, exiting the workforce via disability benefits, and unemployment. Whereas military personnel have an elevated risk for developing a variety of MH/SAP, research has shown that about 60% of those who experience such problems do not seek help, or discuss their MH/SAP with their supervisors. Across military studies, one of the most frequently reported barriers to seeking help and disclosing MH/SAP to supervisors, is concern about stigma: the fear of being treated differently in the work environment, and of damaging one’s career. The present study aims to evaluate the role of social stigma as a barrier to healthy decision making, and its effects on sustainable employability of military personnel with MH/SAP. Primary focus is on (1) the decision to seek treatment, and (2) the decision to discuss health problems with a supervisor, as both decisions can have a profound impact on sustainable employability.

A total of eight focus groups will be held in January 2019, each consisting of 6-10 participants. Four focus groups with military personnel with MH/SAP, two with military personnel without MH/SAP, and two with military professionals who provide mental healthcare to workers with MH/SAP. Views on and experiences with decision making regarding seeking help for MH/SAP and disclosing MH/SAP to supervisors will be discussed, including the role stigma plays in these decisions. Additionally, the differences in views and experiences between these groups will be discussed in the results.

Results & Conclusion.
The role of stigma as a barrier for sustainable employability is highly under-researched, although interest in this topic is rapidly increasing. At the conference, results and conclusions will be presented.

The Impact Of Arm Position On Musculoskeletal Trouble In The Neck And Upper Extremities In Symphony Orchestra Musicians

Nina Baun Jeppesen1, Helene Martina Paarup2, Karen Søgaard1,2, Lotte Nygaard Andersen1, Louise Fleng Sandal1

1Physical Activity and Health at Work, Department of Sports Science and Clinical Biomechanics, University of Soutern Denmark, Denmark; 2Center for Musician's Health, Odense University Hospital

Background: Symphony orchestra musicians are at risk of developing musculoskeletal trouble in the neck and upper extremities due to their work involving many hours in awkward positions with static loads and repetitive movements. Few studies have evaluated the arm position as a risk factor, and results were ambiguous.

Purpose: To investigate the impact of arm position on musculoskeletal trouble in the neck and upper extremities in symphony orchestra musicians.

Method: A secondary analysis of data from a Danish cross-sectional study. Two-hundred-and-eleven musicians from six professional symphony orchestras were divided into two exposure groups: neutral and elevated arm position (NA/EA) during play. Neutral arm position included musicians playing oboe, clarinet, bassoon, French horn, tuba, cello, double bass, percussion, kettledrum or others. Elevated arm position included musicians playing violin, viola, flute, trumpet, trombone or harp. Eight body regions were evaluated for differences in musculoskeletal trouble, measured as self-reported trouble (10-point Numerical Rating Scale) and pressure pain assessed for seven body regions (yes/no).

Results: The EA group reported significantly more trouble in the upper back (p = 0.02) and left shoulder (p = 0,05) and had more pressure pain in the left shoulder (p = 0.05). There were more female musicians in the EA group compared to the NA group (p = 0.001). Musculoskeletal trouble was most frequently located in the neck and shoulders in the whole population (n = 211).

Conclusion: This secondary analysis found that, playing with an evaluated arm position resulted in more musculoskeletal trouble in the upper extremities compared to a neutral arm. Identifying risk factors associated with working in a symphony orchestra may be important for developing preventive measures to relieve musculoskeletal trouble.

Gender Differences In Return To Work Interventions Offered To Employees On Long-term Sick Leave?

Inger Haukenes1,2, Silje Maeland1, Irene Øyeflaten3,4

1Research Unit for General Practice, NORCE, Norwegian Research Centre, Bergen, Norway; 2Institute of Global Health and Primary Health Care, University of Bergen; 3NORCE, Norwegian Research Centre, Bergen, Norway; 4Norwegian National Advisory Unit on Occupational Rehabilitation, Rauland, Norway


Increased awareness about gender norms in patient provider relations may counteract gender bias in treatment decisions and subsequent inequity in health care. The majority of sick leave certificates in Norway are issued to workers for unspecific musculoskeletal disorders (MSD) and common mental disorders. These disorders have low ranking among professionals and may in combination with the patient’s gender, influence the interventions offered to promote return to work (RTW). We aim to examine if gender and type of disorder (operationalized through diagnoses) influence the interventions GPs offer workers with MSD and common mental disorders to promote RTW.

Material and methods

The study population was 937 employees (57% women) completing an independent medical evaluation (IME) by an experienced GP after 6-7 months on sick leave. Data were based on the IME physicians’ assessments. We provide descriptive statistics and Odds Ratios (95% CI) for the likelihood of receiving sufficient rehabilitation measures from the treating GPs across six patient groups (women/MSD, men/MSD, women/mental, men/mental, women/other diagnoses, men/other diagnoses).


The study populations mean age was 47 y. (SD=11.04), 46% had sick leave diagnoses related to MSD, 25% to mental and 28% to all other diagnoses. Routine non-manual work was significantly more prevalent among women and higher income among men (p<0.001). Preliminary analyses showed that men/mental diagnoses had significantly lower chance of receiving sufficient interventions compared with women/MSD (OR=2.3, 95% CI=1.33-3.91). The estimates were robust for relevant adjustments.


Analysing reports from independent medical evaluations, men with mental diagnoses did not receive sufficient interventions aiming at RTW compared with women with musculoskeletal diagnoses. There is reason to believe that these men are not offered interventions that are suitable for their situation, and may be at risk of marginalisation in work life.

Women´s Experiences Of The Situation Of Being In The Sick Leave Process

Christina Andersson, Lena Mårtensson

University of Göteborg, Sweden

Background: Being on sick leave is a risky situation, with loss of meaningful activities, exclusion from the labour market and losing the worker role. Although the benefits of the person’s involvement in the RTW process have been emphasized, an increase in sickness absence and longer sick leave periods is still seen, especially among women. More studies are needed to more deeply understand the person’s own view of the situation.

Aims/Objectives: The aim was to explore the experiences of being on sick leave among a group of women.

Materials and methods: An explorative, qualitative design was used. The analysis, using content analysis, was based on individual, semi-structured interviews with 13 women.

Results: The analysis revealed three categories, describing the women’s experiences of the situation of being on sick leave: being regarded as an object, being supported and being engaged. The categories emerged as either barriers or enablers during the sick leave process.

Conclusion and significance: The results acknowledge the sick leave process as better understood through multiple dimensions, working at both the individual, organizational and societal levels. Using occupation based models underlining the importance of the interaction between person, occupation (work activity) and the environment may contribute to elucidating the complexity in supporting options for return to work.


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