Conference Agenda

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Session Overview
Date: Thursday, 06/Jun/2019
8:30am - 9:15amKeynote III: Keynote III Lars Andersen
Auditorium 100 
9:15am - 9:30amPoster Teaser II: Poster Teaser Presentation II
9:30am - 10:30amPoster viewing III: Poster viewing III

Communication Characteristics Between Clients And Stakeholders Within The Swedish Sickness Insurance System – A Document Analysis Of Granted And Withdrawn Sickness Benefit Claims

Elin Angelica Karlsson, Ida Seing, Jan Sandqvist, Christian Ståhl

Linköping university, Sweden

INTRODUCTION: Previous studies show differences regarding which clients receive sickness benefits as well as which clients are questioned or not within the sickness insurance system. There are indications that the characteristics of communication can have an impact on the sick leave process, which motivates this study with the following purpose.

PURPOSE: The purpose of this study was to investigate how communication within the Swedish sickness insurance system differs between cases of sick leave and how this may affect the clients’ case.

MATERIALS AND METHODS: This was a document study using thirty client files including the correspondence between clients, their case-manager at the Swedish Social Insurance Agency (SIA) as well as other stakeholders. The clients included had been on a work capacity evaluation during their sick leave spell and were aged 32-64 years. There were twenty women and ten men in this study, with a variety of the degree of sickness absence, disability pension and part time work. The material was analyzed using qualitative document analysis.

RESULTS: The results show different approaches in communication, characterized by emotional communication, matter-of-fact driven communication and information exchange, which have diverse success in affecting authority decisions. Arguments characterized by emotions such as frustration or desperation are to a larger extent neglected compared to those characterized by a matter-of-fact driven approach and referring to regulations and medical certificates. There are also differences in how information about the client is interpreted by different professionals.

CONCLUSION: There are differences regarding how clients and stakeholders communicate the clients’ needs and prerequisites, and how this affect the SIA. Further research must be carried out in order to establish social insurance literacy, initially for individuals on sick leave within the sickness insurance, and whether there are differences between diverse groups that could lead to injustice in the system.

Comorbidity Between Burnout And Chronic Low-Back Pain : Beliefs And Cognitive Dysregulations As Significant Risk Factors

Margaux Le Borgne1, Alexia Vachon1, Abdel Halim Boudoukha1, Audrey Petit2

1Laboratoire de psychologie des Pays-de-la-Loire (LPPL, UPRES EA 4638), Université de Nantes, chemin de la Censive-du-Tertre, BP81227, 44312 Nantes cedex 3, France
; 2Équipe d’épidémiologie en santé au travail et ergonomie (ESTER, Inserm UMR 1085), UFR santé département médecine, rue Haute-Reculée, 49045 Angers cedex 01, France

Poster Presentation Format

Background and aims : Chronic exposure to stressful situations at work alters the health of workers and can lead to the development of specific forms of physical suffering (as low-back pain) and psychological suffering (as burnout). Scientific literature is quite poor regarding the joint study of burnout and chronic low- back pain. The few existing studies indicate that burnout may be a risk factor for increased pain. However, the importance of the psychological processes that may underlie the expression of these two phenomena, including interpersonal dimensions related to work, has not been explored. Also, this research focuses on two types of beliefs: perceived injustice and fear-avoidance beliefs, which can be vulnerability factors to the development of burnout and chronic pain.
Method :This study was carried out within the regional organization “Lombaction”, part of the occupational diseases consultation department of Angers university hospital centre, which aims to reduce the impact of chronic low-back pain in the work environment. This organization is aimed at people with an occupational problem due to their incapacitating chronic low-back pain. A sample of 38 patients completed a booklet of various validated questionnaires assessing pain (visual analogue scale), disability (Dallas Pain Questionnaire, Oswestry Low-Back Pain Disability Questionnaire), burnout (Maslach Burnout Inventory), fear-avoidance beliefs (Fear-Avoidance Beliefs Questionnaire) and perceived injustice (Injustice Experience Questionnaire).
Results and conclusions : First analysis show moderate level of emotional exhaustion and poor level of personal accomplishment (dimensions of burnout measuring through the MBI). In addition, levels of emotional exhaustion correlate significantly with levels of disability and functional repercussions of pain. About vulnerability factors, levels of perceived injustice are strongly correlated with levels of disability and emotional exhaustion, but not fear-avoidance beliefs.Regressions analysis and moderation analysis will be carried out and results will be presented during the conference.

What Are The Main Risk Factors For Sick Leave In Individuals With Self-Reported, Symptomatic Knee Pain?

Nanna Søgaard Winther1, Lotte Nygaard Andersen1, Eleanor Boyle1, Mette Jensen Stochkendahl1,2

1Department of Sports Science and Clinical Biomechanics, University of Southern Denmark; 2Nordic Institute of Chiropractic and Clinical Biomechanics

Approximately 10% of the working population suffers from knee pain; one of the cardinal symptoms of knee osteoarthritis (OA). Knee OA causes substantial societal costs due to reduced workability and sick leave. Although individuals with knee OA are at higher risk of reporting work limitations and being on sick leave compared to those without OA, the specific risk factors for sick leave in knee OA have not been comprehensively assessed.

The aim of this study is to investigate the association between self-reported knee pain and sick leave, among personnel in the eldercare sector in Denmark, and to identify risk factors for increased sick leave among persons with knee pain.

We conducted a cross-sectional study with data from a cohort of eldercare personnel. Self-reported data on knee pain, general health and well-being, work-related factors, and sick leave was collected from 143 participants. Cases were employees with knee pain defined as a positive response to the questions “Did you at any time during the last 7 days had troubles in your knee?” The primary outcome is defined as any sick leave in the previous 12 months, using workplace administrative data. The potential risk factors concerning biopsychosocial factor will be analyzed using multivariable linear regression adjusted for potential confounders.

Preliminary results indicate that around 23 % of the cohort had knee pain, and 62% had been on sick leave in the previous 12 months. Final results of this study will be presented at the conference.

This study will contribute to the knowledge base on symptomatic knee pain and risk factors for sick leave in eldercare personnel. We will be able to identify risk factors that may be targets for interventions, and based on the results, we will be able to design tailored interventions or care to those at highest risk.

What Doesn’t Kill You Makes You Suffer. Risk Perception Of A Lifetime Working With Dangerous Substances

Martine P. van Egmond, Anita Venema, Maartje C. Bakhuys Roozeboom, Maaike M. Weyers, Remy A. Franken, Wouter Fransman, Laurie M. Hermans, Bernice J.W. Schaddelee-Scholten, Roos M.C. Schelvis, Suzanne Spaan

TNO, Institute for Applied Research, Leiden, The Netherlands


Dangerous substances like asbestos and industrial fumes pose a profound hazard to workers across industries. Demonstrating causality between a lifetime of work with substances and adverse health effects beyond retirement is challenging at best. Consequently, the responsibility for implementing preventive strategies in the workplace is subject of debate. This study aimed to gather data on risk-perception among employers and workers regarding dangerous substance exposure and preventive strategies across Dutch workplaces.


Combining survey data with interviews and field studies, we explored workplace culture and potential differences between younger and older workers. Quantitatively, a survey was conducted among 2288 employers in companies across 17 industries. Participant scores were weighed to create a representative sample of the Dutch working population. Statistical analyses included descriptive analyses, t-tests and chi-square tests for statistical significance (P<0.05).


The study demonstrated great variety in workplace culture and risk perception. In general, only 30% of the companies measured the level of exposure of workers. Of the employers, 80% aimed to reduce the risk of exposure, however their measures targeted the individual worker, e.g., providing protective equipment such as masks (85%). Organizational or technical measures, including rotating schedules and mechanical ventilation, were less popular (about 50%). Compared to older workers, younger workers may be less likely to underestimate the risk of dangerous substances, as a result of recent education and lack of work experience (less chance of ‘saturation’).


Exposure risks are underestimated in Dutch workplaces. The goal of shared responsibility in the workplace has not yet been reached, particularly in small companies and independent contractors. Our findings demonstrate potential differences in risk perception and hazard management between younger and older workers.The results of this study serve as critical input to promote a new integrated approach on the prevention of occupational diseases due to substances.

Acute Reduction Of Absenteeism Due To Musculoskeletal Diseases In Dockworkers With a New Model of Ergonomics And Health Program

Edgard de Barros Lima1,2,3, José Marcos Almeida1,2, Aldenir dos Santos Alves1,2, Maribel Aparecida Pinto1,2,3

1Terminal Exportador do Guarujá, Brazil; 2Terminal Exportador de Açúcar do Guarujá, Brazil; 3Terminal Exportador de Santos

Introduction: Terminals in the port of Santos, the largest in Latin America, are constantly working to minimize physical impacts of work on employees. Aiming at the prevention of musculoskeletal injuries and quality of life improvement, we implemented a series of functional and ergonomic measures in 2014, which resulted in significant absenteeism reduction and excellent acceptance from employees.

Methods: The program begins with a health evaluation on the employee’s admission that includes anthropometry, dynamometry and surface electromyography. On the first month of work, the employee’s last 40 minutes of the workday are held in a gym inside the terminal, where specific exercises, conducted by 3 physical educators professionals. After this period this routine becomes optional, but with a strong incentive for its continuity. Also, there is a daily labour gymnastics program maintained for all employees. Concomitantly, research is done on ergonomic conditions, where employees give opinions about job satisfaction and possible adverse conditions, suggesting actions that will be evaluated by the Ergonomics Committee that study and treat these cases..

Result: Since 2015, when the program started, if compared to 2014, there was a 30% reduction of absenteism caused by osteo-muscular injuries. From 2015 to 2016 there was a 46% absenteism reduction from the same causes. In 2017, the same index was maintained for 2016. When comparing 2014 with 2016 and 2017, there was an overall reduction of 62%. Additionally, in 2016, 132 employees suggestions on ergonomic aspects were raised and addressed by the Ergonomics Committee. A relevant index show that 78% of the employees were practicing some physical activity by the end of 2016 and of those, 48% performed the activities inside the Terminal’s gym.

Conclusion: The Program implementation and employees suggestions significantly reduced absenteeism rates, encouraged the physical activities practice in the workplace and consequently improved their quality of life.

Presenteeism and Sickness Absence among Healthcare Workers with Musculoskeletal Pain in Outpatient Clinics

Hanani Nabilah Mohd Sobri, Hanizah Mohd Yusoff

Universiti Kebangsaan Malaysia, Malaysia


Musculoskeletal (MS) pain affects work productivity, either in sickness absence or presenteeism. Common practice revealed that healthcare workers with chronic diseases such as MS pain are assigned to outpatient clinics mainly due to the office hour’s work schedule. This study was done to determine whether this practice ensures good work productivity among those having MS pain.


All (213) nurses and healthcare assistants working in all outpatient clinics in a tertiary hospital were recruited from March to April 2018. Those without MS pain were excluded. Self-administered questionnaire was used to assess work productivity and associated factors. Sickness absence and presenteeism were measured using WHO Health and Work Performance Questionnaire (HPQ). MS pain was elicited using Standardized Nordic Musculoskeletal Questionnaire (NMQ). Other factors studied were work factors, mental health status and job stress level.


162 out of 213 (76.1%) healthcare workers in outpatient clinics were having MS pain. It was found that 15.4% of them had presenteeism. Having lower back pain (OR=3.82, 95%CI=1.5-9.4) and age more than 40 years old (OR=2.92, 95%CI=1.2-7.2) were found to be significantly associated with presenteeism. 14.2% were having sickness absence. However only half (56.5%) of them had sickness absence due to MS pain. Nearly all (86.4%) of them suffered from chronic MS pain. Job stress was significantly associated with sickness absence (OR= 3.92, 95% CI= 1.4-10.9). Other factors such as ease of replacement, mental health status, co-morbidities and duration of working were not associated with sickness absence or presenteeism.


There is high prevalence of MS pain among healthcare workers working in outpatient clinics. Work performance of workers having lower back pain as well as older workers having MS pain should be monitored to prevent presenteeism. Prevention of job stress among workers with MS pain is important to reduce sickness absence among them.

Bad To The Bone: Mental Health Policies (Not) Adopted By Brazilian Slaughterhouses' Occupational Health Programs

Bruna Carolina De Quadros1,2, Paulo Antônio Barros Oliveira1, Guilherme Schuck Candemil2

1Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; 2Ministry of Labour, Porto Alegre, Brazil

Slaughterhouse workers from poultry and pork meat slaughtering and processing companies have higher frequency of Mental and Behavioral Disorders (MBD) than the general population. A brazilian study among southern slaugtherhouse's workers has concluded that the majority of disabled workers are between 28 and 38 years old, are women and show signs of depression. The present work has investigated how cold storage’s Occupational Health Medical Control Programs (PCMSO, in Portuguese) deal with the psychosocial risk stem from environmental conditions and work organization. This multiple-case design research, conducted among 26 slaughterhouses located at brazilian's southest state, has established that only 2 of them had recognized the psychosocial risk in their PCMSO. Therefore, it has identified very few and ineffective measures in order to promote workers mental health and to prevent MBD, since only 5 companies had developed strategies of mental health. In their written program, none of those 26 companies had acknowledged that the work can be cause or concause for the development of MBD. The conclusion is that the non-recognition of psychosocial risk and possibility of developing MBD prevents companies from elaborating effective prevention actions, jeopardizing PCMSO's effectiveness.

Motivation and Barriers for Physical Activity in Male Blue-Collar Workers

Lotte Nygaard Andersen1, Lone Rathgen Carl1, Mette Jensen Stochkendahl1,2, Karen Søgaard1,3

1Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Denmark; 2Nordic Institute of Chiropractic and Clinical Biomechanics, Denmark; 3Center for Musicians’ Health, Occupational and Environmental Medicines, Odense University Hospital, Denmark


Physical activity (PA) is a potent strategy to both improve health and stay healthy, but the positive effects appear to depend on whether PA is related to work or leisure time. Significant health inequality exists among male workers, with blue collar workers being less physically active in leisure time, experiencing higher physical exposures at work, and having more life style risk factors overall.


This study explores how male blue-collar workers understand the concept of physical activity and how they experience motivational aspects and barriers for PA.


Semi-structured interviews were conducted with six male blue-collar workers (23-54 years) from different companies. Data were analyzed with Systematic Text Condensation and results discussed with Bandura’s Theory of Self-efficacy.


Analysis revealed four main themes 1) Experiences with PA; 2) Social factors; 3) Positive factors, and 4) Challenges that prevent PA. Theparticipants primarily considered PA as activities related to work, but also sport and other leisure time activities. They felt that their work included sufficient PA, and there was no need for PA in leisure time. If doing PA, it was a motivational factor being in groups, and the participants had positive attitudes towards work-place health initiatives with PA. Injuries, tiredness, self-perceived laziness, and lack of time were barriers for PA and related to the participants’ high physical exposures at work.


Facilitators and barriers that may be decisive for the outcome of health enhancing physical activity interventions among blue-collar workers were revealed. Awareness must be on their conceptions about PA at work and leisure time for improving health.

Humanitarian Workers' Mental Health; State of Art and Work Disability Prevention

Jacinthe Douesnard1, Grazia Ceschi2, Lindsay Ouellet1

1Université du Québec à Chicoutimi, Canada; 2Univerité de Genève, Suisse

Often working in unstable, dangerous context and witness to human suffering as well as atrocities, it is well known that the humanitarian workers work in difficult situations and are exposed to several stressors. This context is not without consequence on their mental health. The actual context of migratory crisis requires qualified and long-term committed workers. It is urgent to decrease the mental illness engendered by their work and increasing retention and re-engagement for future missions. What is the state of art on this subjet? What kind of research and interventions programs can we develop to decrease the mental impacts of working in traumatic situation?

This communication focuses to answering these questions by presenting the results of an exhaustive literature review (2010-2018). From this analysis, we present a classification of core topics related to the research area of humanitarian workers’ mental health. And, in addition to some up-to-date prevalences, identify the methodology and most used psychometric tools.

Also, new avenues of research and interventions focused on these workers' mental health care will be explored. Furthermore, consideration concerning the post-intervention follow-up will be presented to guide the development of mental health support program for humanitarian workers back from a mission. These elements will be articulated around the precise concerns bound to the mental health in emergency and trauma for prevention of work disability. Finally we will consider the elements which allows them to remain mentally healthy when returning on mission.

Vocational Rehabilitation Among Workers Receiving Disability Benefits In Brazil

Frida Marina Fischer1, Cristiano Barreto de Miranda1, João Silvestre Silva-Junior2

1University of São Paulo, Brazil; 2National Social Security Institute, Brazil

Introduction: Vocational rehabilitation is a service offered by the Brazilian Public Social Security system to workers who are unable to perform their routine professional activities due to disability. Workers receiving this benefit could be referred to the vocational rehabilitation from a medical-expert evaluation. They have to follow the oriented procedure in order to continue receiving payment.

Objective: To present Brazilian national data on vocational rehabilitation during the period from 2011 to 2016.

Methods: An ecological study based on secondary data provided by the National Social Security Institute (INSS), during 2011 to 2016. We calculated annual averages on: number of taxpayers affiliated to the social security of the private sector, grant of work disability benefits, referrals to vocational rehabilitation (VR), VR programs initiated and VR conclusions. The average incidence of rehabilitation was calculated between those eligible for the service and all benefits granted each year.

Results: There was an annual average of 68.1 million taxpayers and 2.4 million new granted benefits/year. Approximately 49,800 cases/year were referred to rehabilitation. On average, 61.5% were considered eligible to pursue a vocational rehabilitation program, which represents an average of 30,600 cases/year; 53.8% completed the VR program, an average of 16,400 workers/year. Considering all benefits granted, INSS rehabilitated each year, on average, 0.7% of workers receiving disability benefits.

Conclusions: Vocational rehabilitation is a tertiary intervention aimimg to increase work reintegration among handicap workers. We observed that almost half of eligible workers were certified as rehabilitated. It represented less than one percent of all disabled workers. We suggest a revision of institutional procedures in order to improve the service flow, and to increase the annual number of rehabilitated workers. Offering a more efficient service is a required intervention and may have a positive impact on disability management.

Financial support: CNPq (Grant 304375 / 2017-9)

"Using an Intervention Mapping Approach to Develop Prevention and Rehabilitation Strategies for Musculoskeletal Pain Among Surgeons

Tina Dalager1,2, Anne Højmark1, Pernille Tine Jensen3,4, Karen Søgaard1,5, Lotte Nygaard Andersen1

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

Background: The aim of the present study is to describe the development of strategies to prevent and rehabilitate musculoskeletal pain among surgeons. Musculoskeletal pain impacts on surgeons' life, and consistent evidence on approaches of effective prevention or rehabilitation is lacking for this occupational group.

Methods: An Intervention Mapping approach was used to develop intervention strategies specifically tailored to surgeons. This approach entailed conducting a systematic literature search and semi-structured interviews with surgeons.

Results: First step was to develop a logic model of the problem of musculoskeletal pain among surgeons. Step two was to formulate health-enhancing outcomes and performance objectives for the intervention, while in step three theory-based methods and practical strategies for the intervention were identified.

Conclusion: Intervention mapping was a useful systematic tool for pinpointing the needs of surgeons and identifying theory-based intervention components. Practical strategies for the prevention and rehabilitation of musculoskeletal pain were identified through an iterative and detailed process. The next step is to design, conduct and evaluate a pilot intervention in a specific surgical department.

What Are The Return To Work Indicators For Bus Drivers With Work-related Injuries In China?

Yanwen Xu1,2, Xiaomin liu2, Ru Huang2

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

Objective: Road bus traffic events are often recognized as a major public safety problem. The purposes of this study were to develop a systematic assessment battery for return to work of bus drivers with work-related musculoskeletal injuries, with the goal of providing return to work interventions and suggestions to employers and occupational rehabilitation therapists.

Methods: the study was divided into two stages. Stage one was a qualitative study conducted by three experienced OTs in reviewing transportation policy, journal articles and visiting three public bus companies in Guangzhou city, then a expert panel (n=5) was formed to develop the assessment battery. The contents include personal information, physical information, self-administrated safety behavior, simulated driving test and on-road driving test. Stage two was a quantitative study, a total of 40 injured bus drivers were recruited. The assessment was conducted before one week of discharge. Return to work outcomes was followed via telephone fourth week after discharge.

Results: A logistic regression analysis showed that only self-administrated safety behavior (adjusted odds ratio [OR]: 3.063, 95% confidence interval [CI]: 1.019–9.206) was significant predictors contributing to the return to work outcomes of same job same company.

Conclusions: The study highlights the importance of safe driving behavior for return to work of bus drivers with musculoskeletal injuries. A systematic assessment battery may play an importance role for bus drivers in preventing occurrence of traffic accidence. Future study should strengthen the education of safe driving behavior among bus drivers, therapists and employers.

Recovery Blueprint – Introducing Risk Identification to Workers Compensation Claim Management

Ross Iles, Alex Collie

Monash University, Australia

Background and aims: WorkCover Queensland, Australia, manages 60,000 workers’ compensation claims every year and is seeking to incorporate an evidence-based risk assessment approach that can be applied early in the course of a claim. Recovery Blueprint is a partnership between WorkCover Queensland and Monash University to develop and test a claim screening tool and associated claims management interventions.

Methods: Recovery Blueprint consists of three key components. The first is the allocation of a care profile as an indicator of risk of delayed recovery based on information available at the time of claim acceptance. The second is completion of 10 profile questions by the case manager for the two care profiles at risk of delayed recovery. Each profile question contains a further information step consisting of either a validated questionnaire, for example the Short Form Orebro where it is identified the worker is having trouble coping, or an internal checklist to record specific risk information, such as the reasons why an employer is unable to support RTW. The final component is the introduction of stepped care delivery. Based on the care profile and identified risks, claim managers are provided with initial recommended actions and suggested follow up options should further action be required. Concurrent re-design of claim management software has embedded the new model of claim management into existing systems.

Testing: Pilot testing is occurring in three phases to identify the impact of each component of the Recovery Blueprint on claim manager practice, worker experience and claim outcomes. The first phase (approximately 3,000 claims) will be complete in January 2018, phase 2 (1,000 claims) in May and the final phase (1,250 claims) is due to be complete by October 2019.

This presentation describes the development of the Recovery Blueprint and the approach to its evaluation.

Risk Factor Identification for Delayed RTW: Best Practice Statement

Ross Iles1, Debbi Long2, Niki Ellis3, Alex Collie1

1Monash University, Australia; 2RMIT University, Australia; 3NE&A Pty Ltd

Background: Ongoing emphasis on early identification in practice and in the literature has led to a large body of research in the early, exploratory stages of prognostic research. However, little evidence exists that permits evaluation of the impact of intervention based on risk factor identification in a worker’s compensation context. As a result there is a lack of direct evidence to guide practical implementation of risk factor identification and intervention. The first stage of Recovery Blueprint, a partnership between WorkCover Queensland and Monash University, aimed to outline the key concepts underpinning best practice in risk factor identification for delayed return to work (RTW) based on available evidence and knowledge of current practice in worker’s compensation case management.

Results: Risk factor identification for delayed RTW can be applied to drive two main purposes: 1. Guide appropriate allocation of resources; and 2. Guide appropriate service delivery, both responsively and proactively. The overarching principles behind identification of risk is that it will inform an appropriate course of action to achieve optimal RTW outcomes and guide evidence-based, transparent and consistent decision making that is acceptable to all stakeholders. Eight characteristics of best practice are proposed: 1. Assesses multiple domains; 2. Balances timing of information collection; 3. Uses both administrative and in-depth data sources; 4. Systems are capable of combining and delivering information; 5. Timely delivery of usable information to decision makers; 6. Systematic documentation; 7. Appropriate use of automated and judgement-based decision making; and 8. Understanding of context in which risk identification is applied.

Discussion: The method of collection, timing and interpretation of the information applied in risk identification should reflect characteristics such as operational structures, experience and skill level of people involved and infrastructure available to inform risk-based intervention.

Municipal Return To Work Management In Cancer Survivors Undergoing Cancer Treatment: A Controlled Intervention Study

Christina Malmose Stapelfeldt1,2, Anne-Mette H. Momsen1, Anders B. Jensen3, Claus Vinther Nielsen1,2

1DEFACTUM - Social & Health Services and Labour Market, Central Denmark Region, P.P. Oerums Gade 11, building 1B, 8000 Aarhus C, Denmark; 2Section of Clinical Social Medicine and Rehabilitation, Department of Public Health, Aarhus University, Denmark; 3Department of Oncology, Aarhus University Hospital, Noerrebrogade 44, 8000 Aarhus C, Denmark


The purpose of the study was to apply an early, individually tailored occupational rehabilitation intervention to cancer survivors in two municipalities parallel with cancer treatment focusing on enhancing readiness for return to work (RTW).


That the early tailored intervention would enhance readiness and thereby RTW in the intervention group compared with the control group.

That vulnerable cancer survivors would benefit from this approach; thus, reduce the effects of social inequality on workability.

Patients and methods

The study design was a controlled trial conducted on cancer survivors treated at the Oncology Department, Aarhus University Hospital, Denmark with a 12 months follow-up.

Participants eligible for the intervention were residents (18-60 years) from the municipalities of Silkeborg or Randers, referred to surgery, radiotherapy or chemotherapy at the Oncology Department, Aarhus University Hospital, Denmark with a cancer diagnoses (breast, colon-rectal, head and neck, thyroid gland, testicular, ovarian or cervix cancer). Participants were employed permanently or temporary at inclusion.

The control group had identical inclusion and exclusion criteria except for the municipality of residence.

The primary outcome was RTW identified in the Danish Register for Evaluation of Marginalisation. RTW was defined by at least 4 consecutive weeks of no social transfer payments or attending a modified job (“flexi job”). Whether socioeconomic status or co-morbidity modified the effect on RTW were secondary outcomes. Co-morbidity was defined by the Charlson-index.

Results and conclusions

One-hundred-and-fourteen and 455 participants were included in the intervention and control arm, respectively. Results on RTW effect will be presented at the conference.

Workplace Meetings In Occupational Rehabilitation – A Multiple Case Study Exploring Stakeholders´ Experiences

Nina Elisabeth Klevanger1, Marius Steiro Fimland2,3, Marit By Rise4

1Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway; 2Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway; 3Department of Physical Medicine and Rehabilitation, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway; 4Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway


As long-term sickness absence is multi-casual, it has been proposed that return to work interventions should involve various stakeholders, and address individual psychological factors and work environmental factors. However, interventions are often limited to improving the individual worker’s capacity instead of making psychosocial workplace adaptations. In 2015-2016, Hysnes Rehabilitation Centre in Norway provided occupational rehabilitation that included a meeting in the workplace involving the worker, their rehabilitation therapist and the employer. The aim of this study was to explore the stakeholders´ experiences of workplace meetings, and investigate how the meetings were carried out.


This was a qualitative multiple case study of seven workplace meetings which included non-participant observation as well as interviews with the therapists, workers and employers. Data was analysed according to Multiple Case Study Analysis.


Preliminary results show that an essential feature of the meetings is to align stakeholders’ understanding of the worker’s situation, including the causes of absence and appropriate measures to secure sustainable work participation. The meetings appear to differ according to the distance between the worker’s and the employer’s understanding of the worker’s situation, leading to various outcome potentials. However, some elements seem important in all meetings. This include the therapists’ role in validating several things; the worker’s reduced function, that sustainable return to work entails a prolonged timespan, and that sickness-absence does not reflect the worker’s work ethics. In addition, the need for workers to be open was described as crucial to find appropriate work accommodations.

Discussion and conclusion

This study show that the therapist’s role is important in workplace meetings. Their approach succeeded in conveying important elements and possible dilemmas to facilitate sustainable return to work. Knowledge on these elements and dilemmas might be useful to practitioners in the field of return to work.

Meaning of work for women with breast cancer: Social Representations Theory perspective

Elaine Cristina Lopes da Rocha1,2, Ana Paula Rocha Ildefonso1,3, Octavio Muniz da Costa Vargens1, Antonio Marcos Tosoli Gomes1, Cristiane Helena Gallasch1

1State University of Rio de Janeiro, Brazil; 2Hospital Central da Polícia Militar do Estado do Rio de Janeiro; 3National Cancer Institute José Alencar Gomes da Silva

Introduction: Work is essential to the quality of life of women who have experienced breast cancer. It provides income, sense of contribution, distraction, and increases self-esteem. In Brazil, it is estimated the diagnosis of 59,700 new cases of breast cancer for each year of the biennium 2018-2019. This study has the aim to reflect about the meaning of the working world for women diagnosed with breast cancer. Method: theoretical and reflexive study in the perspective of the Social Representations Theory. Development: There is relation between the Theory and the meanings of work, since the work can contribute to physical, functional, cognitive, emotional and interpersonal recovery, influenced by the treatment of cancer, understanding how the meaning is attributed to the object and how actors interpret the social context, explaining relations with elaborated representations and integrated to the preexisting developed cognitive system. There is a dialogue between the meaning of work and the Theory, considering the production of labor by concrete experiences in reality, impregnated with meaning and value, modeling subjectivities and identities of people and collectivity. Implications for Occupational Health Nursing: Understanding the meaning of work is essential to plan health care, respecting values ​​and meanings of the woman who experienced breast cancer on her return to work activities

Physicians’ Experiences Of Problems In Sickness Certification

Emilie Friberg, Mahbuba Haque, Kristina Alexanderson

Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Sweden

Background: For many physicians, assessment of work capacity and sickness certification is common work tasks, with great importance for the life situation of patients, the physician’s work situation, and costs for society. The aim was to study physician’s experiences of work-capacity assessments and sickness certification.

Methods: A comprehensive questionnaire about experiences of sickness certification tasks was sent to the 34,600 physicians in Sweden in 2017. Response rate: 54%. The questionnaire contained questions about tasks, problems, competence, and resources. Of all physicians, 78% had consultations involving sickness certification, these were included in further analyses; including descriptive statistics and linear regression analyses.

Results: Physicians working in orthopedic clinics had the highest proportion of sickness-certifying consultations at least 6 times per week. The majority (92%) of the physicians stated that sick-leave certification was an important task. When relating the number of sick-leave certification consultations per week with the number of consultations experienced as problematic, physicians working within oncology stood out by having large numbers of such consultations but seldom experiencing them as problematic. While general practitioners had the largest proportion, despite not having the highest proportion of frequent sick-leave certification consultations. About half of the physicians (51%) stated that it was problematic to assess the patients’ work capacity. The task experienced as most problematic was to access level and duration of the patient’s work incapacity. Other problematic issues were to handle the two roles: as the treating physician and the medical expert. Longer sick-leave spells were in general experienced as significantly more problematic to administrate than shorter spells.

Conclusions: The vast majority of the physicians considered sick-leave certification to be an important task, however problematic. The largest proportion of physicans experiencing problems in sickness certification tasks were observed among general practitioners.

Cross-sectorial Collaboration In Return To Work Interventions: Perspectives From Patients, Mental Health Care Professionals And Case Managers In The Social Insurance Sector.

Eva Ladekjær Larsen

University of Southern Denmark, Denmark

Common mental disorders (CMD) such as depression and anxiety are major causes of sick leave in many welfare nations and have huge negative impacts on psychosocial well-being and causes large financial burdens to overall society. The return to work (RTW) process is multi-factorial involving the health care sector, the social security system, and the employment sector. Poor or lack of collaboration across these sectors can cause uneven RTW processes and leave individuals with feelings of uncertainty and despair. This study reports from an intervention implemented in 4 municipalities in Denmark with the aim to support CMD patients to RTW by increasing collaboration between the mental health care system (MHCS) and the social insurance sector (SIS) and investigates how the implementation process is experienced by CMD patients, professionals in MHCS, and case mangers in SIS.


A qualitative design was employed consisting of individual interviews (n20), focus group discussions (4), and observations of interactions between CMD patients, case managers from SIS, and professionals working in MHCS. The data consists of interview transcripts, field notes, and various documents related to the intervention. Data was analysed by the use of Systematic Text Condensation.


Overall the participants were positive towards the intervention. CMD patients reported that they felt supported and did not feel under pressure by workers from SIS as they expected at first hand. Professionals in MHCS and SIS experienced several organisational barriers during the implementation process. Moreover, MHCS professionals experienced that their professional identities were in conflict with the aim of the intervention.


The results suggest that a higher level of participation in the intervention design and implementation process can improve a clear and transparent role distribution between professionals in MHCS and SIS and the matching of their expectations.

Relationship Between Work Ability Index Score And Occupational Becoming Tt 2-years In Chronic Low Back Pain Workers

Clémentine Quesnel1, Thibault Blondin1, Audrey Petit1,2

1University of Angers, Inserm, EHESP, Irset - UMR-S 1085, Angers, France; 2Department of Occupational Medicine, University hospital of Angers, Angers, France

Background Chronic low back pain (cLBP) is a major occupational health problem because of the work disability it generates. The "work capacity" is defined as worker’s physical and mental capacity to perform his current job and in the near future, taking into account four dimensions: health and functional abilities, skills and learning, values and attitudes (motivation, job satisfaction) and work conditions.

Aim The objective was to assess the interest of work capacity assessment to detect cLBP workers at risk of job retention issue at 2-years of follow-up.

Methods A longitudinal monocentric study, carried out in the University hospital of Angers (France), among cLBP workers included in a 5-weeks functional restoration program. Medical, psychological, social and occupational data and the work capacity were collect at inclusion, at the end of the program (medical records) and at 2-years of follow-up (phone call). Work capacity was assessed by the Work Ability Index (WAI) which is a quick auto administered questionnaire consisting of 7 questions and scored on 49 points. According to the final score, work capacity is classified into 4 categories: bad (7-27), moderate (28-36), good (37-43) or very good (44-49). Univariate and multivariate regression, as well as correlation tests and ROC curves were performed to test the predictive and discriminant characters of WAI.

Results All thecLBP workers (men and women, 18 to 55 years old), salaried of the private or public sector and who had benefited from at least 1-month of sick leave during the previous 12-months or at least 3-months during the previous 24-months were included (126 eligible subjects).

The detailed results will be presented at the congress.

Conclusion The highlighting of such a correlation would make it possible to improve the identification of workers at risk of job retention issue and thus to reinforce the return-to-work management intended for this at-risk population.

The Impact Of Musculoskeletal Injuries Sustained In Road Traffic Crashes On Work-related Outcomes: A Systematic Review

Elise Gane, Charlotte Brakenridge, Esther Smits, Venerina Johnston

RECOVER Injury Research Centre, The University of Queensland, Australia

Background: Musculoskeletal injuries (strains/sprains, contusions, dislocations and fractures) are the most common injury sustained in a road traffic crash. They can have a long-term impact upon one’s ability to engage in work. Persisting symptoms as well as poor physical and psychological recovery may reduce the ability to return to or remain at work necessitating the use of sick leave or alternate duties to enable a gradual return to full duties. This systematic review aims to determine the impact of sustaining a musculoskeletal injury during a road traffic crash on an individual’s ability to work.

Methods: Observational studies were identified by searching six electronic databases (PubMed, Embase, CINAHL, ARTI, Web of Science, PsycINFO) for reports of adults having sustained musculoskeletal injuries during a road traffic crash. Studies featuring paediatric cohorts (<18yrs) or those with neurological injuries are excluded. To be eligible for inclusion, studies must report at least one of the following work-related outcomes: return to work status/rate; sick leave; work ability; work capacity; or health-related work productivity loss. The methodological quality of included studies will be assessed with the National Institutes of Health National Heart, Lung, and Blood Institute Study Quality Assessment Tools for observational cohort and cross-sectional studies, and case-control studies.

Results: A total of 1937 records were identified by the database search strategy. After removal of duplicates, a total of 1255 titles and abstracts will be screened for inclusion into the review. The screening process is currently underway, and results finalised by June 2019.

Discussion: The results of this systematic review will increase our knowledge of work-related outcomes and understanding of the associated factors for people with musculoskeletal injuries following road traffic crashes. Future studies could use the results to plan interventions, and influence policy and legislation, and raise awareness of the needs of this population.

Factors Associated with Supervisor Support of Job Accommodations for Common Mental Disorders in the Workplace

Vicki Leigh Kristman1,2,3, Joshua J Armstrong1, Marc Corbière4, William S Shaw5, Karen Harlos6, Margaret Cernigoj7

1Department of Health Sciences, Lakehead University, Ontario, Canada; 2Division of Human Sciences, Northern Ontario School of Medicine, Ontario, Canada; 3Institute for Work & Health, Ontario, Canada; 4Université du Québec à Montréal, Québec, Canada; 5University of Connecticut Health Center, Connecticut, USA; 6Department of Business Administration, University of Winnipeg, Manitoba; 7Workplace Safety and Prevention Services, Ontario, Canada

Introduction: Supervisors of workers with common mental disorders (CMD) play a key role in the prevention of prolonged work absences. Providing appropriate workplace accommodation is one approach supervisors use to facilitate employees staying at work or returning to work early. People with CMD function well in the workplace when they receive appropriate work accommodations. Yet, we have little understanding of factors that influence the decision-making of supervisors to develop and provide work accommodations. Therefore, the objective of this study was to better understand what factors determine whether workplace accommodations are supported and received from the perspective of supervisors and workers.

Methods: We conducted a cross-sectional study of supervisors and workers from 31 randomly selected companies in Manitoba and northwestern Ontario, Canada. Participating companies required a minimum of 50 employees. We distributed two separate surveys to each company: one to supervisors and one to workers. We asked supervisors to complete a survey including a case vignette of a worker with a CMD and a number of scales assessing factors that may affect their decisions to provide workplace accommodations. We also asked workers to complete a survey indicating whether or not they suffer from a CMD and whether accommodations were offered. We developed and tested a new measure of CMD accommodation and used it to assess individual perspectives and group-level information on the workplace, supervisor, and worker factors through established survey scales.

Results: We will present results related to psychometric properties of the new measure of CMD accommodation provision along with individual and situational factors associated with it.

Conclusion: The findings will be important for all work disability prevention stakeholders as they will identify important targets and levers for intervention to improve accommodations for workers with CMD and foster more satisfying, stable, and productive employment that benefit workers, supervisors, and organizations alike.

Recovery Blueprint - Impact of Claim Triage

Ross Iles, Alex Collie

Monash University, Australia

Background: Recovery Blueprint is a partnership between WorkCover Queensland and Monash University to develop and test a claim screening tool and associated claims management interventions. The first step of Recovery Blueprint is the assignment of a care profile based on information available at the time of claim acceptance.

Methods: The model was based on the time to recovery by injury type, with time to recovery defined as the time to when no further costs are recorded on a claim for a period of 12 months. Claim characteristics were then analysed for their impact on time to recovery, for example working in the manufacturing industry increases the likelihood of recovery beyond the usual time for a musculoskeletal shoulder injury. This allowed classification of each claim into one of four care profiles: 1. Independent: short injury duration with few risks of delayed recovery; 2. Guided: long injury duration with few risks of delayed recovery; 3. Supported: short injury duration with higher risk of delayed recovery; and 4. Involved: longer injury duration and higher risk of delayed recovery. Independent and Guided care profiles were managed by case managers with a different level of training to those managing the Supported and Involved care profiles. Case management software was re-designed to deliver the care profile and the factors leading to the assignment of the profile to the case manager. Actions undertaken for each claim remained the discretion of the case manager.

Results: A pilot of an expected 3,000 claims has been run between July and October 2018, with 3 month outcomes available in January 2019. This presentation will describe the evaluation of the impact of allocating claims to care profile on both claim outcomes (RTW rate and claim costs) and case manager behaviour when managing accepted claims.

10:30am - 12:00pmAssessments and work rehabilitation
Session Chair: J.R. Anema
Session Chair: Arif Jetha
Room 99 

Independent Medical Examination For Sick-listed Workers - Experiences Of Participating Stakeholders

Aase Aamland1, Irene Oyeflaten2,3, Elisabeth Husabø3, Silje Maeland1

1Research Unit for General Practice, NORCE Norwegian Research Centre, Norway; 2National Centre for Occupational Rehabilitation, Rauland, Norway; 3NORCE Norwegian Research Centre, Norway

To reduce the high rates of sick leave in Norway, politicians have proposed to use an independent medical examination (IME) by a new doctor. General practitioners (GPs) manage 80% of workers on long-term sick leave and it has been discussed whether a strong doctor/patient relationship may hinder a fast return to work (RTW). IME for sick-listed workers has been tested in a large randomized controlled trial and evaluated through qualitative interviews with participating stakeholders. The aim of the current study was to assess patients, GPs, and IME-doctors expectancies and experiences with participating in an IME.

We conducted individual semi-structured telephone interviews with nine sick listed patients and focus group interviews with 14 GPs and 8 IME doctors. Systematic text condensation was applied for analysis.

The sick-listed patients questioned both the purpose and timing of the IME, but felt a moral obligation to participate. Most appreciated the IME as a positive encounter, even if they felt it had no impact on their RTW process. The GPs welcomed a second opinion from an experienced GP colleague to obtain constructive advice for further sick-leave measures. However, they had mainly negative experiences with the IME reports. The IME doctors reported that the IME provided important second opinions, which they felt empowered the sick-listed workers and provided new insights into their condition. Beneficial IME working conditions and enhanced insight into different sick leave measures were crucial to this perceived usefulness.

According to the sick-listed workers, the IMEs were administered too late and disturbed already initiated treatment processes and RTW efforts. The GPs welcomed IMEs if they could select especially challenging patients for a mandatory second opinion by a peer, but they did not want to be overruled. The IME doctors proposed only some adjustments as necessary for the IME to be implemented nationwide.

What IsTthe Effect Of Independent Medical Evaluation On Return To Work For Long-term Sick Listed Workers In Norway? A Pragmatic Randomized Controlled Trial, The NIME-trial

Silje Maeland1, Tor Helge Honmaas2, Irene Oyeflaten2,4, Elisabeth Husabø2, Erik Werner3, Karin Monstad2

1Research Unit for General Practice, NORCE Norwegian Research Centre, Norway; 2NORCE Norwegian Research Centre, Norway; 3Institute of health and society, Faculty of medicine, University of Oslo; 4National Centre for Occupational Rehabilitation, Rauland, Norway

Independent medical examinations (IME) entail evaluation of a sick listed workers physical or psychological medical condition by a medical practitioner who are required to present an independent opinion, representing neither the compensation insurer nor the injured worker’s interests. Every day 330 workers reach six months continuous sickness absence in Norway. The effect of IMEs on return to work have never been evaluated. To develop a knowledgebase, the Norwegian government ordered an effect evaluation of IME in 2015 asking the following research question: What is the effect of IME on return to work for workers sick listed for six months by their general practitioner in Norway.


We included 5888 sick listed workers (18-65 years), on full or partial sick leave for the past six months in Hordaland county (10% representative sample) to either treatment as usual (regular follow up of the general practitioners and the Norwegian social insurance agency) or treatment as usual and an IME in a randomized controlled trial (RCT). Inclusion period was October 2015-october 2016. Exclusion criteria were pregnancy, cancer, dementia. The IME was a consultation without any medical examinations and it lasted for 30-60 minutes based on a standard protocol published described in published protocol paper. The primary outcome was days on sick leave as an indicator of return to work. Intention to treat (ITT) and treatment on the treated (TT) analyses was performed. This trial is registered at, number NCT02524392.

We found no statistical significant difference between groups on the primary outcome days on sick leave (mean difference ITT: -1.381, p=0.55; TT: -1.246, p=0.49).

Preliminary results show no effect of IME on return to work for Norwegian workers sick listed for six months. These results will provide knowledge-based policy and have consequences for decision on implementation and changes in legislation regarding IMEs in Norway.

Work Capacity Assessments: Beyond Eligibility for Disability Denefits, and Towards Fair Assessments?

Femke Abma1,2, Pepijn Roelofs1, Tialda Hoekstra1

1University Medical Center Groningen, Netherlands, The; 2Research Center for Insurance Medicine, Netherlands, The

Assessing work capacity is one of the most prominent application of disability assessment, since being able to work is key to economic self-sufficiency and social standing. In many high-income countries a shift in social security policies is ongoing from a focus on eligibility for disability benefits towards promoting work reintegration by exploiting the remaining work capacity. Researchers across a range of disciplines, national settings and systems are now exploring these work capacity assessments from different perspectives. Within the UMCG, three research projects are conducted on this topic: one regarding the assessment of (in)ability to work fulltime; second regarding variation between insurance physicians in the assessment of functional limitations; and third a study regarding a new measure to assess work capacity. Current insights from these studies will be presented and related to international findings. We will conclude with a discussion on work capacity assessments across countries, successive steps towards work, and fairness of the work capacity assessment.

Is Integrated Care Effective For Work Participation And Performance Of Activities Among Orthopaedic Surgery Patients?

Pieter Coenen1, Gerben Hulsegge1, Joost Daams2,3, Rutger van Geenen4, Gino Kerkhoffs5,6, Maurits van Tulder7, Judith Huirne8, Johannes Anema1, Paul Kuijer2

1Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health research institute, Amsterdam, The Netherlands; 2Amsterdam UMC, University of Amsterdam, Coronel Institute of Occupational Health, Amsterdam Public Health research institute, Amsterdam, the Netherlands; 3Amsterdam UMC, University of Amsterdam, Medical Library, Amsterdam, the Netherlands; 4Amphia Hospital, Department of Orthopaedic Surgery, Foundation FORCE (Foundation for Orthopaedic Research Care and Education), Breda, the Netherlands; 5Amsterdam UMC, University of Amsterdam, Department of Orthopaedic Surgery, Amsterdam Movement Sciences, Amsterdam, the Netherlands; 6Amsterdam UMC, University of Amsterdam, Academic Center for Evidence-Based Sports Medicine (ACES), Amsterdam, the Netherlands; 7Amsterdam Public Health research institute, Faculty of Earth & Life Sciences, Department of Health Sciences, VU University, Amsterdam, the Netherlands; 8Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Obstetrics and Gynaecology, Amsterdam, the Netherlands

Orthopaedic surgery is primarily aimed at pain reduction and restoration of function. Additional care like active referral to case-managers, goal-directed rehabilitation or e/mHealth might enhance work participation or performance of activities. We reviewed the effectiveness of such integrated care interventions on these latter two outcomes in a systematic review that was a-priori registered at Prospero CRD42018089414.

A search in Medline, EMBASE and CINAHL was performed in collaboration with a clinical librarian until February 5th 2018. Studies describing controlled trials evaluating the effectiveness of integrated care interventions on work participation and performance of activities were included. Two reviewers independently screened references and potentially full papers, and performed data-extraction and risk of bias assessment. In case of sufficient homogeneity, a meta-analysis was performed.

After screening 5,941 records, four studies evaluated work participation (n=1,182 patients, mainly spinal surgery) and seven studies performance of activities (n=700 patients, mainly spinal and knee surgery). Work participation was defined as work status or time to return to work (RTW) and performance of activities was mostly measured using questionnaires. Integrated care for work participation was effective in one studies with 10% not returning to work instead of 18% (p=.002). No significant difference was found in two studies reporting on time to RTW: integrated care vs care-as-usual: 29 vs 45 weeks and 7 vs 5 weeks. One study did not report RTW ’due to the large number of participants not working at baseline’. Meta-analyses showed that integrated care was effective in improving performance of activities (Standardized Mean Difference 4.0 95%CI 2.0-6.0).

Integrated care for orthopaedic surgery patients showed positive effects compared to usual care, especially for performance of activities. However, effect sizes were small. High quality studies on work participation are needed to better inform patients, practitioners and policy makers regarding the benefits of integrated care after orthopaedic surgery.

Improving Work Participation By Work-related Medical Rehabilitation In Patients With Chronic Musculoskeletal Diseases

Matthias Bethge1, Miriam Markus1, Marco Streibelt2, Christian Gerlich3, Michael Schuler3

1University of Lübeck, Germany; 2Federal German Pension Insurance, Germany; 3University of Würzburg, Germany

Background: In Germany, work-related medical rehabilitation programs were developed for patients with musculoskeletal disorders to improve work participation outcomes. Randomized controlled trials have shown that return to work rates can be increased by about 20 points compared to common medical rehabilitation programs. Since 2014, the Federal German Pension Insurance has approved several work-related rehabilitation departments to implement these new programs. Our study was launched to assess the effects of these programs under real-life conditions.

Methods: Participants received either a common or a work-related medical rehabilitation program. Propensity score matching was used to create balanced samples. Effects were assessed by patient-reported outcomes 10 months after completing the rehabilitation program.

Results: We included 1282 patients (mean age: 52.4 years; 75.3% women). Work-related medical rehabilitation increased stable return to work (OR = 1.42; 95% CI: 1.02 to 1.96) and self-rated work ability (b = 0.38; 95% CI: 0.05 to 0.72) and decreased time to return to work compared to common medical rehabilitation. Subgroup analyses showed that the effect on stable return to work was affected by the prior risk of not returning to work and the dose received as rated by the participants: In patients with a high initial risk of not returning to work and a high dose received, the absolute risk difference was about 20 points in favor of work-related medical rehabilitation and in line with the effects known from the randomized controlled trials.

Conclusions: Implementation of work-related medical rehabilitation in German rehabilitation centers improved work participation outcomes but the effects were reduced compared to the effects observed in the randomized controlled trials. Reaching patients with a high risk of failing return to work and developing the treatment consistency according to the recommendations of the guideline may enhance outcomes in real care.

Implementing The German Model Of Work-related Medical Rehabilitation: Did The Dose Delivered Of Work-related Treatment Components Increase?

Uwe Egner1, Marco Streibelt1, Michael Schuler2, Matthias Bethge3

1German Federal Pension Insurance, Berlin, Germany; 2Institute of Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany; 3Institute of Social Medicine and Epidemiology, University of Lübeck, Lübeck, Germany

Purpose: Work-related or vocational treatment components are an essential part of rehabilitation programs in order to support return to work and work participation of patients with musculoskeletal disorders. In Germany, a guideline for work-related medical rehabilitation was developed to increase work-related treatment components. In addition, new departments were approved to implement work-related medical rehabilitation programs. The aim of our study was to explore the state of implementation of the guideline’s recommendations by describing the change in the dose delivered of work-related treatments.

Methods: The treatment dose of work-related therapies was compared for two patient cohorts with musculoskeletal disorders. The first cohort participated in a common medical rehabilitation program in the second half of 2011 before the implementation of the work-related medical rehabilitation departments. The second cohort joined a work-related medical rehabilitation program in the second half of 2014 after the implementation of the new departments. Patients of the cohorts were matched one-to-one by propensity scores.

Results: We included data of 9,046 patients. The mean dose of work-related therapies increased from 2.2 hours (95% CI: 1.6-2.8) to 8.9 hours (95% CI: 7.7-10.1). The mean dose of social counselling increased from 51 to 84 minutes, the mean dose of psychosocial work-related groups from 39 to 216 minutes, and the mean dose of functional capacity training from 39 to 234 minutes. The intraclass correlation of 0.67 (95% CI: 0.58-0.75) for the total dose of work-related therapies indicated that the variance explained by centers was high.

Conclusions: Dose delivered of work-related components was increased. However, there was a discrepancy between the guideline’s recommendations and the actual dose delivered in at least half of the centers. It is very likely that this will affect the effectiveness of work-related medical rehabilitation in practice.

10:30am - 12:00pmImplementation at worksite level
Session Chair: Åsa Tjulin
Session Chair: Cécile R. Boot
Auditorium 100 

Task Rotation: Implementation in an Industrial Setting.

Carole James, Mijanur Rahman

University of Newcastle, Australia


Task, or job rotation alternates workers between differing tasks or workstations to use different skills and responsibilities at each rotation point. The primary objective of a rotation scheme is to control the level of exposure to hazards, to minimize the accumulated biomechanical stress, reduce the risk of workplace injuries and improve worker satisfaction.


This study investigated the physical and psychological effects on employee health and safety and the challenges to implementing a task rotation schedule at a whole of site level in an underground coal mine.

Methods: This was a case control study with two underground coalmines in NSW, Australia. Survey data was collected at baseline, 6 months and 12 months after implementation of a task-rotation schedule at one site. Measures included: demographic data; Nordic musculoskeletal questionnaire; K10 psychological distress scale; Need for Recovery after work scale; Australian WHOQOL- BREF (Quality of Life); in addition a task log was kept at the intervention site. Data analysis included descriptive statistics, t-test, chi-square and logistic regression.


Longitudinal analysis found significant differences between time points at the intervention site, between the scores of each of the scales (Nordic musculoskeletal questionnaire; K10 psychological distress scale; Need for Recovery after work scale; and Australian WHOQOL- BREF), however no significant differences between the intervention and control site. Musculoskeletal differences between different work locations at the intervention site and variation in the amount of rotation according to shift were found.


The challenges of implementing, and the execution of a whole of site task rotation schedule need consideration with potential review to assist in effectively controlling injury and fatigue risk within the extremely dynamic, unpredictable and unique occupation of underground coalmining. Suggestions for future task rotation implementation will be presented.

Barriers and Facilitators Affecting Implementation of Physical Activity at Workplaces: A Mixed-methods Scoping Review

Anne Garne-Dalgaard1, Stephanie Mann1, Mette Jensen Stochkendahl1,2

1University of Southern Denmark, Denmark; 2Nordic Institute of Chiropractic and Clinical Biomechanics

Background: The majority of the adult working population spends a great deal of their time at work, which makes workplaces opportune arenas for implementing health promoting initiatives such as physical activity (PA). Unfortunately, PA programmes at workplaces have resulted in only moderate short-term effects, partly because the uptake and sustainability of the programmes have been poor. To ensure long-term outcomes, there is a need for a better understanding of barriers and facilitators affecting uptake of PA by both employers and employees.

Methods: This scoping review aims to descriptively summarize implementation approaches including barriers and facilitators affecting uptake of workplace-based PA. English qualitative and quantitative articles published in MEDLINE, Embase, Scopus or PsycINFO until May 2018 and describing implementation of workplace PA (e.g. cardio-vascular, stretching or strengthening exercise or “brain breaks”) were included. Implementation approaches, barriers and facilitators were coded and analysed using the Theoretical Domains Framework (TDF).

Results: After dual, blinded screening of titles and abstracts, nine articles were included in the review. A total of 109 implementation factors were identified, including 57 barriers and 52 facilitators. Most represented barriers in the TDF domains were Environmental Context & Resources (ECR), n=27 (37%), Social Influences (SI), n=12 (16%), and Intentions, n=9 (12%). The most represented facilitators in the TDF domains were SI, n=15 (21%), ECR, n=13 (19%), and Goals, n=8 (11%). Several different methods of implementation were applied, including “change agents” and supervised exercise.

Conclusion: The uptake of PA in workplaces is affected by the incorporation of PA in the daily workflow. Dedicated time, minimal disruption of workflow, and social support from co-workers and management increases uptake of PA, whereas lack of the same hinder uptake. To increase the long-term benefits of PA and the success of implementation, these factors have to be considered before developing and initiating PA-programmes at workplaces.

Worker-centered Approaches For Developing An Integrated Organizational Intervention to improve low wage worker health, safety and wellbeing

Susan Elizabeth Peters1, Eve M Nagler1,2, Glorian Sorensen1,2

1Harvard Center for Work Health and Wellbeing, Harvard T.H. Chan School of Public Health, Boston, MA, U.S.A.; 2Dana Farber Cancer Institue, Boston, MA, U.S.A.

Introduction:Inclusion of worker-centered approaches in developing organizational change priorities have been found to be linked to the success and sustainability of organizational interventions. However, few organizational interventions have focused on low wage service workers, and how these approaches influence intervention design, implementation and evaluation. The purpose of this paper is to: (i) describe the dimensions of health, safety and wellbeing of importance to low-wage food service workers and the working conditions perceived to impact on health safety and wellbeing using participatory processes; and, (ii) describe the application of qualitative data collected from front line workers and management in developing an organizational change intervention for food service workers in the U.S.

Methods: Semi-structured interviews with 21 managers at various levels and focus groups with 30 front-line food service workers from a large multi-national food service and facilities management company in the U.S. were conducted to inform intervention design including identification of outcomes, working conditions and intervention processes for an organizational change intervention.

Results:Workers and managers reported that key health and safety concerns in their workplace centered around their work-related wellbeing, musculoskeletal disorders and injuries, work engagement, job satisfaction, workers’ intention to leave and work absence. These were largely affected by the fast-paced and unpredictable nature of their work, physical environment, staffing, co-worker and supervisor support, horizontal and vertical lines of communication in the organization, and opportunities for job enrichment / career development.

Discussion:We will discuss how these data informed our intervention design which is currently being tested through a randomized pilot trial.

Conclusion: Worker-centered approaches were integral in designing an intervention that benefited all the key stakeholders. These processes helped to secure both management support and worker buy-in for the intervention.

What Data Should Be Used for the Evaluation of the Implementation Process of an Ergonomic Intervention?

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 program was developed in a plant. It was a train the trainer program with the training of internal trainers by ergonomists and the training of workers by internal trainers. Ergonomists were also in charge of creating organizational and material conditions favorable to knowledge transfer. This program has been implemented in several plants in Québec for the last 20 years and has never been evaluated. Data collection for the evaluation of the implementation process (EIP) of an intervention is always challenging given the limited availability of actors. Several tools including information written down during the implementation have been developed by the ergonomists to carry out the program. This study aimed to determine (1) whether data available in these tools could be used for EIP, and (2) what other data should be collected to complete the EIP.

Six tools used by the ergonomists to implement the program (ErgoTIPs) and three additional data collection tools (AddCTs) were used. ErgoTIPs included field notes, logbooks and observation tools. AddCTs included observation of an intervention day and interviews with ergonomists. A correspondence analysis was performed to assess the contribution of ErgoTIPs and AddCTs data to EIP with respect to 62 dimensions composing our evaluation framework.

Results showed that AddCTs contributed to fulfill more dimensions than ErgoTIPs across the 62 dimensions, but ErgoTIPs brought about specific information on the communication of intervention objectives and on pre-existing prevention actions. Moreover, it appears that data collections requiring the less time from actors during the intervention also contribute to fulfill the most dimensions. Our results contribute to the feasibility of EIP of this type of intervention and enhance the importance of an integrated approach between evaluators and ergonomists.

Workplace Practices And Policies To Support Workers With Depression: Development Of A Resource Guide For OHS Stakeholders

Kim Cullen1,2, Dwayne Van Eerd2, Emma Irvin2, Morgane Le Pouesard2, Judy Geary3, Anita Dubey4

1Memorial University of Newfoundland, Canada; 2Institute for Work & Health, Canada; 3Ontario Shores Centre for Mental Health Sciences; 4Centre for Addiction and Mental Health

Introduction: Mental health at work is an increasingly important public health issue, with mood disorders now recognized among the leading causes of work disability in most developed countries. According to the Mental Health Commission of Canada, half a million workers miss work in any given week. This leads to an overwhelming burden for workplaces in terms of high rates of absenteeism, reduced productivity and increased disability-related costs. The purpose of this project was twofold: 1) to identify evidence-informed workplace strategies to support individuals experiencing depression and 2) to create a resource guide to aid workplaces in implementing these strategies to address research-to-practice knowledge gaps in work disability prevention.

Methods: We applied an adapted evidence-informed decision-making model and an integrated knowledge transfer and exchange strategy in this study. Three sources of evidence (i.e., research findings, practitioner expertise and stakeholder experiences) were synthesized to identify effective workplace practices and policies to prevent productivity losses, promote stay-at-work, and support return-to-work for workers with depression. We engaged with OHS stakeholders throughout the project to inform the development of our resource guide to disseminate our findings to key audiences and potential end-users.

Findings: Results from this study support the effectiveness of our adapted model for evidence-informed decision-making to address important knowledge gaps in work disability prevention research. The resulting resource guide for workplace parties titled: “An evidence-informed guide to supporting people with depression in the workplace” has been well received by OHS stakeholders. In its first quarter of circulation, the resource has become the top download from IWH’s website.

Conclusion: This study’s primary strength resided in the use of three sources of evidence (i.e., research findings, practitioner expertise and stakeholder experiences) for the creation of a practical guide. This is a compelling feature and one that is often lacking in other workplace resources about depression.

Mates in Mining: An Industry Mental Health Program

Carole James, Mijanur Rahman, Emma Sayers, Brian Kelly

University of Newcastle, Australia


Mental health problems and their impact on workplace health is a growing issue. Such problems affect the individual, their family, and the workplace and result in economic burden most profoundly in the working age population. Workplaces provide important opportunities for promoting good mental health and wellbeing.


To investigate changes in employee mental health awareness, attitudes to mental health, psychological distress and suicide awareness following the implementation of the mates in mining mental health program.


Employees from two coal mines in New South Wales and Queensland, Australia participated in this r 2 year study. Survey data from 1,651 participants was collected across three time-point before, at 6 months and 18 months post implementation of the program. Chi-square analysis was conducted to examine differences and bivariate association, and multi-variable logistic regression was applied to explore the adjusted association.


There were no significant changes in psychological distress over the three time-points, with 33% reporting moderate to very high levels of distress at each time.

Stigmatising attitudes toward mental illness significantly changed, with more participants disagreeing with being treated differently by friends, or colleagues if they disclosed a mental illness (p<0.01).

There was a significant increase in participants likelihood of seeking help from a supervisor (p=<0.01); colleague (p=<0.01); EAP (p=<0.01); family (p=0.05); friends (p=0.02) and psychologist (p=0.04).

Likelihood of help seeking was significant associated between participants’ gender, age, employment category, relationship status and level of psychological distress (p<0.05).


This program enhanced employee resilience through improved coping skills and social support, as well as the promotion of improved understanding about common mental health problems and effective ways of responding if concerned about oneself or someone else. It also promoted a healthy workplace culture including stigma reduction, to promote support among work teams and peers.

10:30am - 12:00pmMental health and return to work
Session Chair: Angelique De Rijk
Session Chair: Christine Guptill
Room 95 

Returning to Work after Sickness Absence due to Common Mental Disorders: Results from an 18-Month Follow-Up Study in Germany

Alexandra Sikora, Gundolf Schneider

Federal Institute for Occupational Safety and Health Berlin, Germany, Germany


One aim of this study is to investigate the return to work (RTW) process after sickness absence(s) due to common mental disorders at the intersection of the healthcare system and the workplace. In Germany, evidence is still lacking in terms of work-related, disease-related and personal factors that predict a successful and sustainable RTW.


The prospective cohort study was conducted in two psychosomatic rehabilitation facilities (N = 117) and two psychiatric clinics (N = 169). It consists of patients between 18 and 60 years of age, part- or full-time workers with a diagnosed common mental disorder, who will be followed-up for 18 months after clinical treatment. The participants will be questioned via telephone at the end of their clinical treatment, after six, 12 and 18 months. The baseline CATI interviews were realised between August 2016 and October 2017. Outcome measures include the duration until RTW and the time to full RTW.


The study sample consists of 286 individuals. Their median age was 50 years (IQR: 43, 54), 47 % were female, and 30 % had a degree from university or university of applied sciences. Preliminary results show that after six months, 269 of initially 286 participants (94 %) could be reached. Further findings after six months show that 241 participants (90 %) returned to their organisation. The latest overall dropout rate is 8 %, and at the end of September 2018, N = 185 (65 %) already completed all four telephone interviews. Results of survival analyses and other regression models regarding prognostic factors of a successful and sustainable RTW will become available in spring 2019 and will be presented at the conference.


Findings of this study will help to gain a better understanding of a successful and sustainable RTW to promote the prevention of mental disorders.

Factor Associated To Time To Return To Work Among Workers With Mental Disorders In São Paulo, Brazil

João Silvestre Silva-Junior1, Rosane Harter Griep2, Maria Carmen Martinez3, Frida Marina Fischer4

1National Social Security Institute (INSS - Brazil), São Paulo, Brazil; 2Oswaldo Cruz Foundation, Rio de Janeiro, Brazil; 3WAF Informática, São Paulo, Brazil; 4School of Public Health, University of São Paulo, São Paulo, Brazil

Introduction Mental disorders are the third leading cause for grant sickness social security benefit in Brazil. Those workers have longer time to return to work (RTW) comparing to other disabilities. This study aims to analyse factors associated to RTW after an episode of sickness absence due to mental disorders (MD). Methods A longitudinal study was conducted in São Paulo city, Brazil, during 2014–2016. Included 204 workers requiring sickness social security benefit due to MD. At baseline, participants fill questionnaires about sociodemographic, health risk behaviours, work characteristics, health conditions and social security history. They were followed for 365 days after the first day of sickness absence. Survival analysis (Kaplan-Meier curve and Cox regression) were performed to identify factors influencing the first RTW. Result The group was composed mostly by women (71.1%), people aged under 40 (67.6%) education equal or higher 12 years (80.4%) and diagnosed as depressed (52.9%). Many worked in customer service jobs (44.1%), reported effort-reward imbalance at work (57.4%) and high overcommitment (74.2%). The average time for RTW was approximately six months among the 63.0% who tried to resume their work activities. Factors associated to return to work within one year after sick leave were: aged between 30–39 years (HR 1.76; 95% CI: 1.08 to 2.79), 12 or more years of education (HR 1.87; 95% CI: 1.10 to 3.17), low alcohol intake (HR 2.65; 95% CI: 1.75 to 4.02) and low level of anxiety symptoms at baseline (HR 0.17; 95% CI: 0.04 to 0.74) – when analysis were adjusted by sex and job title. Discussion Sociodemographic characteristics, risk health behaviours and medical conditions at baseline were associated to RTW after sick leave due to MD. Further studies, with larger sample, are needed to improve estimates and discussion focused in interventions to early RTW in public and private sectors. Financial support: CNPq grant 442051/2014–0.

What are the Recommended Characteristics of an Effective Return-to-Work Intervention for Workers with both a Common Mental Disorder and a Personality Disorder?

Chantal Sylvain1,2, Marie-Jose Durand1,2

1Universite de Sherbrooke, Canada; 2CAPRIT, CR-CSIS Research Center, Longueuil, Canada

Objectives: It is now recognized that to facilitate a return to work (RTW) after a common mental disorder (CMD), interventions cannot focus solely on workers’ health, but should also include service coordination and work accommodations. However, little is known to date about how these principles apply to workers with both a personality disorder (PD) and a CMD. Yet CMD comorbidity with PDs is highly prevalent and associated with increased risk of work absence. The first phase of our project aimed to define the adaptations needed to a work rehabilitation program based on best practices, to promote the RTW of this worker sub-group.

Methods: Semi-structured interviews were conducted with seven experts thoroughly familiar with the PD-related intervention in a work absence context. The interview concerned the program’s alignment with PD patients’ needs and the applicable precautions and contra-indications. Thematic data analysis was performed and inter-subject points of convergence were identified.

Results: Three needed adaptations were identified. (1) Initial evaluation: clarify early on the relational dysfunctions that interfere with the RTW and obtain the worker’s explicit consent to make them an intervention target. (2) Coordination: during the various stages of rehabilitation, negotiate with the worker which information will be shared with partners and who will be responsible for doing so (worker or clinician). (3) Work accommodations: proceed with caution when direct interventions in the workplace are necessary, due to their potential, negative effects that can hinder sustainable RTW.

Conclusion: The RTW intervention for CMD-PD cases requires adapting the intervention recommended for CMD-cases only. The next phases will involve revising the CMD-only RTW program to incorporate the adaptations proposed by the experts while reconciling them with the constraints of clinical settings. This should help practitioners deliver services truly adapted to the needs of many workers off work for a CMD-PD.

Gradual Return to Work Trajectories among Employees with Mental Health Problems: The i-STEP Project

Maitta Spronken1, Evelien Brouwers1, Jeroen Vermunt1, Wido Oerlemans2, Jac van der Klink1, Margot Joosen1

1Tilburg University, the Netherlands; 2HumanTotalCare, the Netherlands


A gradual return to work (RTW) after a period of mental health related sickness absence is becoming increasingly common in various European countries. However, the effect of a gradual RTW on sustainable work resumption remains debated. It seems likely that gradual RTW follows different trajectories for different employees, and that not every trajectory is beneficial for sustainable RTW. We investigate (1) which gradual RTW trajectories can be identified, (2) what characterizes these different trajectories in terms of the employee and work environment, (3) how different trajectories are related to sustainable work resumption.


For this project, we use longitudinal, retrospective absence data from a large Dutch occupational health service (HumanTotalCare). A cohort of workers who were absent due to a mental health problem in the period 2014-2017 was drawn from the absence registry. Employees in this cohort worked in various sectors, for companies of varying sizes. We performed latent transition analyses to investigate which RTW trajectories can be identified.


In total, 9494 employees were included in the analyses. On average, employees returned in five steps (M = 5.45, SD = 4.44). Preliminary results revealed five trajectories of RTW: relatively fast RTW with small fluctuation chance, relatively slow RTW with small fluctuation chance, relatively fast RTW with considerable fluctuation chance, relatively slow RTW with considerable fluctuation chance, and immediate RTW (further results expected in November 2018).


The implications of our findings for practice will be discussed in focus groups with different stakeholders, including employees, employers, occupational physicians and psychologists (results expected in February 2018). The knowledge generated in this project can contribute to improved RTW support, tailored to specific individuals and organizations. This may increase the chances of sustainable RTW and reduce costs for all stakeholders. The project is financed by IOSH (Institution of Occupational Safety and Health).

The Impact of Self-Efficacy in the Return-To-Work Process of Employees With Common Mental Disorders. A Latent Class Growth Analysis

Lena Horn1,2, Evelien P.M. Brouwers1, Maitta Spronken1, Karlijn M. van Beurden1, Renée S.M. de Reuver2, Margot C.W. Joosen1,2

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


One of the factors that has been shown to be predictive of return to work (RTW) in employees with common mental disorders (CMD) is self-efficacy. However, little is known about the development of self-efficacy during the RTW process, which could inform the care process and promote better patient-centered outcomes. Therefore, we investigate (1) which trajectories of RTW-self-efficacy can be identified and (2) what characterizes these trajectories in terms of personal, work-related and health related factors.


We used longitudinal data from employees that had been absent due to CMD. Self-efficacy was measured with the RTW self-efficacy scale for employees with mental health problems. The final sample, consisted of 95 sick-listed employees. Baseline data at first day of sick leave and the 3-, 6- and 12-months follow-up were used to identify trajectories of RTW self-efficacy by means of latent class growth analysis.


The preliminary results reveal four trajectories of RTW self-efficacy during the RTW process: one class with constant high scores on self-efficacy during the entire period (high trajectory), one class with constant low scores (low trajectory), one class with low scores at the beginning and high scores after 12 months (high increase) and one class with moderate scores at the beginning and high scores at the last point in time (moderate increase). The characteristics of the different classes will be available end of 2018.


These four classes delineate the heterogeneity of the development of self-efficacy in the RTW process. Insights into the different trajectories can contribute to promote better RTW support by informing intervention design and advance the current knowledge on patterns and development of self-efficacy. This may enhance the chances of sustainable RTW and help to reduce the costs related to workers being absent due to CMD.

Knowledge Transfer and Exchange in Work and Health to Reach Workplace Audiences

Dwayne Van Eerd1,2

1Institute for Work & Health, Canada; 2University of Waterloo

Introduction: Workplace injury and illness can be burdensome for individual workers, workplaces, medical systems, insurance systems and society as a whole. The notion of research to practice is important in work and health research. Knowledge transfer and exchange (KTE) is the practice of generation, synthesis, and dissemination of research. The objective of this presentation is to synthesize the literature describing KTE activities relevant to workplace health and safety programs and interventions.

Methods: A rapid review of the literature was completed. Search strategies, developed using terms for knowledge transfer and occupational health and safety, were run in six electronic databases (Medline, Embase, ERIC, Social Sciences, Web of Science, and Business Source Premier). References of relevant documents and hand-searching complimented the search. Documents that described a KTE approach for workplaces were reviewed. KTE approach data were extracted and synthesized according to a framework by Lavis (2003) (What, To whom, By Whom, How, and With what effect) as well as conceptual guidance.

Results: Literature searches revealed 34 documents that described 23 different KTE approaches designed to reach workplaces. The KTE approaches addressed workplace and intermediary audiences. KTE methods and outcomes varied greatly according to the context. However there were common elements including: targeting workers as a key audience, involving researchers in dissemination, and using multiple dissemination methods. Dissemination methods consistently included direct interaction but also often featured printed materials. Many KTE approaches were guided by conceptual frameworks. However no single conceptual framework was predominant.

Conclusion: Common elements related to audience, activities and impact were found in the literature that can help to guide future KTE approaches. Including workers as an audience and researchers as disseminators in a multi-faceted approach along with in-person meetings and printed material are important aspects of KTE for work and health. Conceptual guidance was context dependent.

10:30am - 12:00pmMusculoskeletal disorders
Session Chair: Andreas Holtermann
Session Chair: Marion Lamort-Bouché
Room 97 

Evaluating the Costs and Benefits of Gradually Returning to Work after a Work-Related Musculoskeletal Disorder

Esther T Maas, Mieke Koehoorn, Christopher B McLeod

University of British Columbia, Canada

Musculoskeletal disorders (MSDs) are the most prevalent chronic condition in Canada, and are an increasing cause of work disability in an aging workforce. Gradually returning to work (GRTW) after injury, by increasing the workload and limiting or modifying work tasks, is assumed to improve health and labour market outcomes and reduce work disability after injury. The aim of this study is to identify effective and cost-beneficial use of GRTW for workers with MSDs, and reduce work disability duration.

Population-based data using accepted lost-time claims from the workers’ compensation system in the Canadian province of British Columbia were extracted for the period 2010-2016 (N=121,891). Within one year after injury, 40% of workers had at least one day of GRTW. Of all workers who had GRTW, 59% were male, 44% had back sprains or strains, and the average age was 41 years. Evaluating the costs and benefits using the claims data is challenging as GRTW is strongly associated with injury severity. In order to address this limitation, the workers’ compensation data is being linked to health services data, and prescription data. Combined claims and health-related data is used to match injured workers with and without GRTW on demographic and work-related characteristics, injury severity, health status, and health services intensity to evaluate the independent effects of GRTW.

This is the first study using data from three population-based health data sources for a comprehensive investigation of a workplace intervention aimed to reduce work disability over a longitudinal time period and within the Canadian context. Also, using this data for the purpose of evaluating the costs and benefits of GRTW is unique but will generate evidence to inform GRTW practices that are not currently standardized/regulated in the jurisdiction in order to limit the health and economic impact of work-related MSDs in an aging workforce.

The independent Association Between Number Of Pain Sites And Return To Work. An Explanatory, Prospective Cohort Study

Jesper Stejnicher Drongstrup Jensen1, Lotte Nygaard Andersen1, Mette Jensen Stochkendahl1,2

1Department of Sports Science and Clinical Biomechanics University of Southern Denmark, Denmark; 2Nordic Institute of Chiropractic and Clinical Biomechanics, Odense, Denmark


Persons with musculoskeletal pain often suffer from pain in multiple locations. Multi-site pain has been shown to influence work ability and sickness absence, but the influence of number of pain sites (NPS) on return to work has yet to be clarified. The aim of this study was to measure the independent association between number of pain sites (NPS) and return to work (RTW) in adults absent from work due to musculoskeletal pain in the upper body (MSP).


We conducted a phase 2 explanatory prognosis investigation of 122 citizens absent from work for less than nine weeks due to MSP. Participants were recruited from Sønderborg Municipality (public compensation agent) for an 11-month, two-arm RCT on physical activity. No between-group differences were seen in the RCT, and the groups were combined to form the cohort. The exposure was self-reported NPS at baseline based on a modified Nordic Musculoskeletal Questionnaire. The outcome was working status as registered by The Department of Financial Security in Sønderborg Municipality at 11-month follow-up. The independent association between NPS and RTW when adjusted for confounders relating to both outcome and exposure was evaluated using logistic regression analysis.


At baseline, the mean NPS was 4.3 (2.36 SD). At 11 months, 71 (58.2%) had returned to work. A significant association was found between NPS and RTW in both the unadjusted model OR=1.31 [95% CI=1.11-1.55] and adjusted model OR=1.22 [95% CI=1.01-1.47] when adjusted for gender, age, body mass index ≥25, educational level, physical and mental health.


NPS was found to be an independent predictor of RTW in citizens absent from work due to MSP. The results from this study highlight the importance of assessing NPS when assisting persons with MSP in the RTW process.

What Have We Learnt From Qualitative Studies Regarding Patient Recovery In Musculoskeletal Research?

Corrie Myburgh1, Eleanor Boyle1, Ellie Pinsker2, Amanda Normandeau3, Maria Hondras4, Stacie Salsbury5, Dorcas Beaton2

1University of Southern Denmark, Denmark; 2Dalla Lana School of Public Health, University of Toronto, Toronto, Canada; 3Private research contractor; 4University of Kansas Medical Center; 5Palmer Center for Chiropractic Research, Palmer College of Chiropractic

Background: The relationship betweendisease-related recovery outcomes and the lived experiences of patients recovering from chronic musculoskeletal (MSK) disorders is poorly described in the literature. Methodologically, the complicated multifactorial nature of how individuals recover appears amenable to qualitative investigation. However, it is currently unclear whether these studies can be integrated into a unified framework from which to inform evidence-based practice, and stimulate hypothesis generation and testing. In this investigation, we evaluated and synthesized qualitative research focused on recovery in the MSK healthcare context. Methods: We conducted a systematic review of primary empirical literature, excluding investigations that did not integrate results into a conceptualization of recovery. Studies were evaluated for quality and potential to guide practice and policy using an existing hierarchy of evidence-for-practiceframework. Computer Assisted Qualitative Software facilitated thematic analysis across investigations. This study was registered prospectively via PROSPERO (ref no: 52476). Results: Thirteen studies (7 anatomic site specific and 6 regional/mixed MSK complaints) were included for full review. Hierarchical categorization revealed the majority of studies provided descriptive or conceptual frameworks for recovery, with 5 adjudged relevant for guiding policy and practice. Five themes emerged across studies: ‘the construct of recovery’, ‘pain in recovery’, ‘the process of recovery’, ‘adapting to a new individual norm’ and ’interaction with the health care system’. At least three distinct recovery phases were observed: resolution, adjustment/adaptation, and redefinition. Conclusions: Individuals’ perceptions of recovery are shaped and re-shaped internally by personal adaptation, rather than externally modified during treatment. Not recognising and reacting to shifts in the process, may render the recovery trajectory static and delay the individual’s return to health. Due to the complexity and spatiotemporal variability of recovery, the validity of single-item recovery outcome measures is questionable. Rather, outcome measures should be tailored to capture the spectrum of the recovery process.

GLA:D® Back: Perceived Work Ability in Primary Care Patients with Back Pain Relates to Intensity, Perceptions of Pain and Self-efficacy, but not to Age or Symptom Duration

Alice Kongsted1,2, Per Kjaer1,3, Inge Ris1, Jan Hartvigsen1,2

1Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Denmark, Odense, Denmark; 2Nordic Institute of Chiropractic and Clinical Biomechanics, Odense, Denmark; 3Department of Applied Health Science, University College Lillebaelt, Odense, Denmark

Background: Back pain is the leading cause of disability globally, and responsible for 20% of days with sick leave and 6% of Danish disability pensions. Still, most people consulting primary care for back pain are not absent from work. Therefore, it is important to address who are at risk of work disability and how this might be prevented. However, work ability is sparsely investigated in primary care populations with back pain, and there is little evidence to inform what determines perceptions of work ability, when experiencing back pain.

Objective: This study investigated to what extent self-perceived work ability is affected across age-groups of primary care patients with back pain, and if self-perceived work ability is associated with back pain characteristics, illness perceptions and pain self-efficacy.

Method: Patients aged 18-75 enrolled in a primary care education and exercise intervention for persistent back pain, GLA:D® Back, scored their work ability 0-10 (10 = ‘as when best’), and completed The Arthritis Self-Efficacy Scale modified for back pain and the Illness Perceptions Questionnaire as part of a pre-treatment questionnaire. Associations between work ability and other factors were tested using linear mixed effect models.

Preliminary Results: From 220 patients (20% aged >60), 9% were on sick leave when enrolled. People absent and not absent from work reported mean self-perceived work ability 4.4 (SD=2.0) and 7.2 (SD=1.7) respectively. Perceived work ability was unrelated to age and duration of back pain, but associated with back pain intensity, illness perceptions and self-efficacy.

Conclusions: Back pain patients reported reduced work ability also when not absent from work. This was associated with perceptions of pain as threatening, high pain intensity, and low self-efficacy. The interplay between these factors with work absenteeism needs further investigations.

Patient enrolment is ongoing and we expect to present results from 500 participants at WDPC-2019.

Sleep-Work-Activity Profiles (SWAP) and Low Back Pain: A Compositional Latent Profile Analysis

Nidhi Gupta1, David Hallman2, Dorothea Dumuid3, Charlotte Lund Rasmussen1,4, Marie Birk Jørgensen5, Andreas Holtermann1,6

1National Research Centre for the Working Environment, Copenhagen, Denmark; 2Centre for Musculoskeletal Research, Department of Occupational and Public Health Sciences, University of Gävle, Gävle, Sweden; 3Alliance for Research in Exercise, Nutrition and Activity (ARENA), School of Health Sciences, University of South Australia, Adelaide, South Australia, Australia; 4Department of Public Health, Section of Social Medicine, University of Copenhagen, Copenhagen, Denmark; 5Department of Forensic Science, University of Copenhagen, Copenhagen, Denmark; 6Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark


A current pain prevention approach is to promote daily physical activity or reduce prolonged sedentary time. Another preventive approach could be to facilitate a balance between all activities and postures at work, leisure, and sleep. The aim of the study is to identify profiles indicating various balances between activities and postures at work, leisure and sleep, termed sleep-work-activity profiles (SWAP) and to investigate their association with low back pain (LBP) in a working population.


Eight-hundred-and-seven workers self-reported LBP intensity and worn thigh-based accelerometer to determine the daily time-use composition of sedentary behaviors, standing still and light (LIPA) and moderate to vigorous physical activity (MVPA) at work and leisure and bedtime, that were isometrically log-transformed (ilr). The SWAP profiles were determined using latent profile analysis on ilr data. Multiple linear regression was used to determine the association between profiles and LBP.


Four SWAP were determined—Chimpanzees (n=226), Lions (n=179), Ants (n=244), Koalas (n=158). Compared to Chimpanzees that were moderately active at work [mean in minutes; (sedentary=197, standing still=147, LIPA=60, MVPA=57)] and highly active at leisure (sedentary=306, standing still=121, LIPA=62, MVPA=52, bedtime=440), (a) Lions were more active at work, more sedentary at leisure and had more bedtime, (b) Ants were more active at work and leisure, and had similar bedtime; (c) Koalas were more sedentary at work and leisure and had more bedtime. Compared to Chimpanzees, Lions had significantly lower LBP (B=-0.76, P=0.02), while Ants and Koalas were not significantly different.


The SWAP are associated with LBP. Future studies should investigate if this approach of obtaining a balance between various activities and postures at work and leisure and sleep is better than only increasing physical activity or reducing sedentary time, for understanding, preventing, and reducing LBP.

Beyond Symptom Resolution: Insurance Case Manager’s Thoughts on What can be Used to Predict Recovery

Maurizio A. Trippolini1,2,3, Amanda E. Young3,4, Glenn Pransky5, Nieke A. Elbers6, Keri Lockwood7, Ian D. Cameron7

1Bern University of Applied Sciences, Deptartment 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; 6Netherlands Institute for the Study of Crime and Law enforcement. Faculty of Law, VU University Amsterdam, Amsterdam, The Netherlands; 7John Walsh Centre for Rehabilitation Research, Kolling Institute, University of Sydney, St Leonards, NSW Australia

Purpose: Insurance company case managers (CMs) play a critical role in the rehabilitation process of people with musculoskeletal disorders after minor motor vehicle crash injuries (MSD-MV) due to their interaction with multiple stakeholders over the course of the condition, and role in approving various services. This study aimed to identify factors that CMs perceive as predictive of recovery in people with MSD-MV.

Materials and Methods: To explore the perspectives of CMs in Australia (n=20) and the USA (n=20), semi-structured interviews explored factors that CMs thought provided an early indication of likely recovery outcomes in people with a MSD-MV injury. A framework analysis was applied.

Results: CMs demonstrated a broad, detailed understanding of biopsychosocial and contextual issues influencing recovery. They emphasized affect and motivation, style of communication, role of lawyers, family and friends, cultural and geographic variation. The overarching themes perceived as having a major influence on recovery outcomes were general health, pain processing and response, work situation, and compensation entitlement.

Conclusions: CMs broad and detailed perceptions about recovery may provide additional, valuable perspectives for professionals

10:30am - 12:00pmReturn to work 2
Session Chair: Merete Labriola
Session Chair: Emma Irvin
Room 96 

Self-directing Return-to-Work: An Employees’ Perspective

Jard Smeets1, Nicole Hoefsmit2, Inge Houkes1

1Maastricht University, CAPHRI Research Institute, the Netherlands; 2Open University, Heerlen, the Netherlands

Background: Dutch legislation stimulates the active participation of employees in their own return-to-work (RTW). In addition, RTW professionals encourage sick-listed employees to self-direct RTW. It remains unclear, however, how employees give meaning to and shape their self-direction. This study aims to conceptualize self-direction using the components of Self-Determination Theory (autonomy, competence, and relatedness) as a framework.

Methods: A qualitative study was performed. Semi-structured interviews were conducted with three long-term sick-listed employees (> 6 weeks). These results were combined with fourteen existing transcripts of semi-structured interviews with long-term sick-listed employees and employees who returned to work after long-term sick leave during the previous calendar year. All interview transcripts were analyzed thematically.

Results: Employees generally think of self-direction as taking their own decision regarding RTW. Several environmental factors (proximal and distal) play a role in employees’ self-direction. Proximal factors are satisfaction of the need for autonomy, competence, and relatedness. Employees experience a need to self-direct their RTW, but some express a lack of competence to do so. Employees with mental complaints for instance need more help in making choices and taking decisions. Distal factors are legislation regarding RTW and clarity (or lack of it) regarding the roles of various stakeholders in the process of sickness absence and work resumption.

Conclusions: Exercising self-direction in RTW seems to contribute to early work resumption. Enabling employees to self-direct their RTW process and listening to their needs are beneficial for a better work resumption. Preconditions for effective self-direction are a supportive environment and good cooperation between the employee, employer, and occupational physician.

Managing Stigma: Employees Returning to Work Following a Common Mental Disorder

Laurie Kirouac

Université de Sherbrooke, Canada


While the literature is now paying greater attention to stigmatization in the workplace, most studies adopt a quantitative approach, and of these, very few examine the return-to-work (RTW) context. Our study sought to show how stigmatization constitutes an organizational factor likely to hinder the RTW and stay-at-work ability of employees following sick leave for a common mental disorder (CMD).


We conducted a survey of 36 Quebec workers (22 women, 14 men) with diverse occupations who had been on sick leave (2 weeks to 12 months) after a CMD diagnosis. Each worker was asked (1) to complete two questionnaires: one on psychological distress (the Psychiatric Symptoms Index) and a second on quality of life (the Quality of Life Systemic Inventory); and (2) to participate in a semi-structured interview averaging 60 minutes.


The results showed how, independently of the medical opinion of their health condition, the workers saw themselves as being suspected of having a new psychological vulnerability that ostensibly deprived them of some of their work capacities. This capacity discreditation sometimes originated with coworkers and supervisors and turned into permanent occupational disqualification. To prevent this, the workers used strategies to restore their image, i.e. to convince coworkers and supervisors of their good mental health and work capacities. However, not all of the workers had the same ability to do this and some failed. The latter had to cope with the effects of their new social identity of “disqualified worker” (psychological distress, disengagement from work, downgrading of occupational status, “forced” job change, self-stigmatization) or even leave their workplace (“forced” job change, early retirement).


Better understanding of the forms that stigmatization can take in the RTW context and of its negative effects on career paths will help generate courses of action for offsetting their occurrence in workplaces.

Effects Of Adding a Workplace Intervention To an Inpatient Occupational Rehabilitation program: a randomized clinical trial

Martin Skagseth1, Marius S. Fimland2,3, Marit B. Rise4, Roar Johnsen1, Lene Aasdahl1,2

1Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, NTNU, Trondheim, Norway; 2Unicare Helsefort Rehabilitation Centre, Rissa, Norway; 3Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, NTNU, Trondheim, Norway; 4Department of Mental Health, Faculty of Medicine and Health Sciences, NTNU Trondheim, Norway


The aim of this study is to evaluate the effect of adding a workplace intervention to an inpatient occupational rehabilitation program on sickness absence.


A randomized clinical trial with parallel group design. Eligible participants were workers, 18-60 years old, sick listed with musculoskeletal, psychological or general and unspecified diagnoses. The rehabilitation program lasted 2+1 weeks (with one week at home) and consisted of Acceptance and Commitment Therapy, physical training and work-related problem solving. The intervention group received in addition a workplace intervention including group-based and individual preparations and a work-place meeting between the sick-listed worker, the employer and a coordinator from the rehabilitation center. The main outcome was number of sickness absence days during 12 months of follow-up, and time until sustainable return to work (RTW), measured by registry data.


175 participants were randomized to regular rehabilitation (n=87) or regular rehabilitation with a workplace intervention added (n=88). Median number of sickness absence days during 12 months of follow-up was 115 days (IQR 53-183) vs 130 days (IQR 81-212), in favor of the group without a workplace intervention. The hazard ratio for sustainable RTW was 0.74 (95 % CI 0.48-1.16, p=0.192), in favor of the group not receiving the workplace intervention.


There were no statistical significant differences between the groups in either of the work outcomes. However, the estimates indicate that those with workplace intervention had delayed return to work, suggesting that the current workplace intervention should not be implemented in inpatient occupational rehabilitation.

Workplace And System-Based Interventions On Return-To-Work And Recovery For Musculoskeletal And Mental Health Conditions. Findings From Two Systematic Reviews

Kim Cullen1,2, Emma Irvin2, Ulrik Gensby3, Dwayne Van Eerd2, Morgane Le Pouesard2, Benjamin Amick2,4, The Workplace-based Systematic Review Team2,5,6,7

1Memorial University of Newfoundland, Canada; 2Institute for Work & Health, Canada; 3Team WorkingLife ApS, Denmark; 4Robert Stempel College of Public Health and Social Work, Florida International University, Miami, USA; 5Monash University, Australia; 6Lakehead University, Canada; 7University of Montreal, Canada

Introduction: The burden of managing musculoskeletal pain and injuries (MSDs) and mental health (MH) conditions in the workplace is substantial. While overall rates of work injury have declined in most high-income countries, there have not been equivalent improvements in RTW rates. The primary objective of this review was to synthesize evidence on the effectiveness of workplace- and system-based interventions for RTW and recovery after a period of work absence.

Methods: We followed a systematic review process developed by the Institute for Work & Health and an adapted best evidence synthesis.

Result: Seven electronic databases were searched from January 1990 until September 2017. This comprehensive search yielded 10578 non‐duplicate references. Our synthesis identified 68 studies examining three types of RTW outcomes (lost time, work functioning and associated costs) and four recovery outcomes (pain, psychological functioning, physical functioning and quality-of-life). These studies examined interventions that were classified into three broad domains: healthcare provision, service delivery and workplace modifications. Our review identified that in most cases, interventions were multi-faceted and included multiple intervention components, sometimes operating across multiple domains. The most common RTW outcome reported was lost time. Among the other RTW and recovery outcomes, studies varied widely in their inclusion. There is strong evidence that interventions encompassing multiple domains are effective in improving RTW outcomes in workers with MSD or MH conditions. In contrast, there is moderate to strong evidence that most single-component interventions have no effect on improving recovery regardless of condition.

Discussion: While there is substantial research literature focused on RTW, only a small percentage of these intervention studies also include measures of recovery. Identifying effective intervention programs that facilitate RTW and recovery allows workplaces to implement empirically supported programs that benefit workers through improved function and reduced pain while reducing the economic burden associated with lost time.

12:00pm - 1:00pmPoster Viewing IV: Poster Viewing IV

Development of a Work Disability Prevention Management System Standard for Employers

Emile Tompa1, Amin Yazdani2

1Institute for Work & Health, Canada; 2Conestoga College

Work disability is multifaceted in nature and addressing it requires a coordinated effort by the injured/ill worker, employer, insurer, and service providers, amongst others. In previous work, emphasis has been given to the need for a coordinator function in disability management. This is indeed important, but still treats it as a side bar issue. To truly take a proactive approach, it needs to be integrated into the broader management system of organizations, much like health & safety and quality. A management systems approach would make work disability prevention the responsibility of all managers, indeed everyone, much like joint management systems for health & safety. Ideally, it would also be built on the principles of continuous improvement.

We make the case for the need for a work disability prevention management system standard, and the importance of dovetailing it with existing management system standards. It needs to be sympathetic to the jurisdictional setting, specifically the structure of supports and the legal context, if it is to be truly national or international in scope. It also needs to be comprehensive and universal in terms of health issues and workforce characteristics, addressing both physical and mental health issues, regardless of cause. Ideally, it would include standards on recruitment and retention, given that that the principles of accommodation are the same.

Currently there is no standard for work disability prevention management systems anywhere in the world, but an initiative is underway to develop the first of its kind in Canada through Canada’s national standard body. We describe the initiative and efforts to ensure a balanced, multi-stakeholder process. The consensus-based standard development process draws on best evidence from the literature and field. We conclude with a description of plans to develop and evaluation resources for uptake in different sectors and organizational contexts.

A Descriptive Portrait of Mental Disorders Among Workers on Prolonged Work Disability for Musculoskeletal Disorders

Marie-France Coutu1, Marie-José Durand1, Patrick Gosselin1, Fergal O'Hagan3, Iuliana Nastasia2, Marie-Elise Labrecque1

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


Mental health issues are common among workers experiencing prolonged disability owing to a musculoskeletal disorder. Few studies have conducted an assessment that takes the work disability situation into account. The aim of this study was to establish a portrait of the mental disorders experienced by disabled workers with a standardized measure while considering the work disability situation.


We conducted a descriptive study with a convenience sample of 79 workers (39 men and 40 women) with a work-related musculoskeletal disorder causing absence from their regular work for more than three months. A trained evaluator (supervised by two expert psychologists, one on anxiety disorders and one on work disability) conducted the assessment at the beginning and ending work rehabilitation, with the Anxiety Disorder Interview Schedule IV. Adjustment disorder and workplace phobia (as described by Muschalla), were also assessed. Interrater agreement was assessed. Descriptive analyses were performed.


Levels of severity disorders were categorized by primary and comorbid diagnoses as well as subclinical (scores of 3/8). A primary diagnosis was found in 67% (n = 49) of participants and subclinical diagnosis in another 7% (n = 5). The most prevalent primary diagnoses were adjustment disorder (n = 27; 37%), workplace phobia (n = 5; 7%) and major depression (n = 5; 7%). These emerged from the current work disability situation. Most participants experienced anxiety about various subjects, but these primarily related to the work disability situation. Thus, real generalized anxiety was only found in 5 participants (7%). In 62% of participants, a comorbid diagnosis was made, with panic disorder being the most prevalent. Diagnoses did not significantly change over the work rehabilitation period.


Using assessments that do not take into account the work disability situation may lead to misdiagnoses, and thus may lead to intervention that is not well adapted.

Return to Work from a System-based and Workplace-based Perspective: A Resource Guide

Emma Irvin1, Kim Cullen1, Dwayne Van Eerd1, Ulrik Gensby2, Ron Saunders1, Judy Geary3, Morgane Le Pouésard1

1Institute for Work & Health, Canada; 2Team Arbejdsliv Aps, Denmark; 3Ontario Shores for Mental Health Sciences, Canada

Introduction: While work injury rates have declined in most high-income countries, equivalent improvements have not been seen in return-to-work (RTW) rates. For example, older workers take longer to RTW than younger workers and are more likely to ‘relapse’ into a period away from work following an initial RTW. As a result, our team set out to create an evidence-informed practical guide to support RTW and recovery for musculoskeletal, pain-related and mental health conditions based on the findings from systematic reviews on system-based and workplace-based strategies and a qualitative review on the same topic.

Methods: The team combined research evidence summarized from recent systematic reviews on RTW from systems and workplace perspectives. Throughout the process of completing the reviews the team consulted with Occupational Health & Safety (OHS) and Disability Manager (DM) stakeholders from across Canada on design and content. Specifically, we worked with stakeholders in framing of the project, contextualizing main messages from the reviews and in guide format and layout.

Results: Selected messages from the reviews include: that in most cases, interventions were multi-faceted and included multiple intervention components and similarly from the qualitative review; concepts fall into the three strata (i) Personal dimensions; (ii) Socio-relational, and (iii) Structural dimensions of the RTW process. The key messages from the reviews with stakeholder input/direction have resulted in a practical and innovative guide for OHS practitioners on the best DM strategies to support RTW and recovery for injured or ill workers and to reduce the extensive burden associated with work disability.

Conclusions: This new guide will become a companion to IWH’s “The 7 Principles for Successful Return-to-Work”. We expect this new evidence and innovative guide to have substantial impact in helping to meet the needs of OHS stakeholders responsible for implementing effective DM & RTW support interventions.

Developing a Culturally Relevant Workplace Mental Health E-health Application with the Canadian Indigenous Population

Vicki Leigh Kristman1,2,3,4, Audrey Gilbeau5

1Department of Health Sciences, Lakehead University, Ontario, Canada; 2EPID@Work Research Institute, Lakehead University, Ontario, Canada; 3Division of Human Sciences, Northern Ontario School of Medicine, Ontario, Canada; 4Institute for Work & Health, Ontario, Canada; 5Nokiiwin Tribal Council, Ontario, Canada

Introduction: Workplace stress stemming from lateral violence in the workplace is problematic for Indigenous workers. Unlike workplace bullying, lateral violence differs due to the root cause. Canadian Indigenous people are abusing their own people in similar ways to how they have been abused. It is a cycle of abuse and its roots lie in factors of colonisation, oppression, intergenerational trauma and the ongoing experiences of racism and discrimination. Information on mental health and mental health resources within Indigenous workplaces is lacking. Therefore, our objective was to develop an e-health intervention for Indigenous mental health in the workplace.

Methods: We participated in a Canadian Institutes of Health Research “Work Stress and Wellbeing Hackathon” to achieve our objective. The Hackathon was a two and a half day event where participants work with an e-health team to devise a solution to their problem. The event was collaborative and involved multiple perspectives in the development of the e-mental health solution. In addition to the principal investigator and knowledge user, the team included an individual with lived experience and technical expertise, including designers and programmers.

Results: At the end of the Hackathon we had developed a prototype of a working e-mental health application based on the medicine wheel and Indigenous cultural teachings. We also developed a relationship with an e-health company, Cossette Health, who is turning the prototype into a viable working e-health application. We will present the prototype at the conference.

Conclusion: Future goals of the project will be to evaluate the effectiveness of the completed e-mental health application, in the communities affiliated with the Nokiiwin Tribal Council, with respect to improving access to relevant mental health information and reducing workplace lateral violence.

Psychological Distress And The Effect On Health And Occupational Outcomes Of Intensive Group Based Cognitive Therapy In Patients With Newly Diagnosed Ischemic Heart Disease

Thomas Lund, Annette Holdgaard

Bispebjerg and Frederiksberg Hospitals, Denmark

Thirty percent of patients with newly diagnosed ischemic heart disease present with psychological distress, anxiety and depression after revascularization. Psychological distress is associated with increased morbidity and mortality, reduced quality of life and return to work. Intervention for psychological distress in patients with ischemic heart disease is emphasized in European guidelines, but useful treatment methods are lacking.

To develop a cost-effective model for intensive group based cognitive therapy on psychological distress in patients with newly diagnosed ischemic heart disease.

Single-center, prospective, randomized clinical trial in patients with newly diagnosed ischemic heart disease and concomitant significant score of psychological distress using the Hospital Anxiety and Depression Score (HADS) (HADS A/D ≥8 or HADS>15). 128 patients will be randomized to either intervention or control group. All patients are offered usual cardiac rehabilitation, and in addition, the intervention group is offered standardized group based cognitive therapy, consisting of 5 sessions (each 1.5 h) performed by trained cardiac rehabilitation nurses. Assessment of effect will focus on return to work, HADS-score, adherence to cardiac rehabilitation, health-related quality of life measured by HeartQoL, adherence to life style interventions, and cardiovascular readmissions.

100 patients havebeen screened. 49 patients have been included.

If adding a short, intensive group based cognitive therapy improves short and long term outcomes for newly revascularized patients with ischemic heart disease and concomitant psychological distress, it will have positive effects on the prognosis and efficiency of the cardiac rehabilitation program.

Policy, Practice and Programmatic Approaches to Healthcare in Five Work Disability Management Systems

Kimberly Sharpe1, Kimberlyn McGrail2, Cameron Mustard3, Christopher McLeod1

1Partnership for Work, Health and Safety, University of British Columbia; 2Centre for Health Services and Policy Research, University of British Columbia; 3Institute for Work and Health

A primary component of effective work disability management is the provision of timely and appropriate healthcare. In Canada, workers’ compensation boards (WCBs) operate as parallel payers in the healthcare system alongside publicly-funded plans delivered by provincial governments. In response to rising wait times and costs in provincial plans, WCBs have taken more active roles in managing healthcare to decrease medical service delays and avoid delayed return-to-work. This research examines the different approaches to healthcare across WCBs in five Canadian jurisdictions.
A document analysis of healthcare policies, programs and practices supporting return-to-work for work-related injuries was conducted. Documents were entered into NVivo v.11 and descriptively analyzed according to an a priori coding scheme capturing information about the organization and provision of services, financing, and physical and human resources.
Results suggest that the level of involvement in guiding healthcare varies across jurisdictions. All jurisdictions have created service-delivery arrangements with private providers outside the publicly-funded plans and instituted financial incentives for expedited diagnostic testing and surgeries. However, several WCBs actively guide the provision of healthcare through WCB-run clinics and structured recovery programs. For example, workers with muskoskeletal injuries in one jurisdiction are required to participate in programs offered by WCB-approved providers with prescribed treatment interventions and healing timelines. In contrast, other jurisdictions rely more on standard care provided through the publicly-funded plans, especially at the primary treatment level. The analysis also finds that expedited care, specialized clinics and recovery programs cluster in urban and semi-urban areas, with fewer services in rural areas.
This analysis highlights strategies WCBs have taken to address increased wait times and costs in publicly-funded plans and identify potential challenges in reaching rural workers. The findings indicate a need to examine the impact of these strategies on the efficiency and equity of healthcare provision in disability management systems.

The “Rite of Passage” of Breast Cancer Survivors Returning to Work: a Qualitative Longitudinal Study

Karine Bilodeau1, Dominique Tremblay2,3, Marie-José Durand2,3

1University of Montreal, Montreal, Canada; 2University of Sherbrooke, Longueuil, Canada; 3Charles-Le Moyne Hospital Research Centre, Longueuil, Canada

Background and objective: AlthoughCancer diagnosis causes a life-course disruption, returning to work remains a significant step despite the overall challenges related to survivorship. The aim of this study is to describe the return-to-work (RTW) pathway from the end of breast cancer (BC) treatments to RTW.

Method: Nine BC survivors were recruited in the province of Quebec (Canada). The participants were Francophones between 30 and 60 years old that received chemotherapy treatments and planned to RTW in the next six months. The qualitative interviews were performed at the end of cancer treatments (n=9), one month before RTW (n=9), and after RTW (n=5). A content analysis was performed according to an iterative process.

Results: The first six months after the end of treatment was identified as an "in-between" period for BC survivors. During that period, participants questioned their ability to return to a normal life due to the impact of side effects and a sense of withdrawal from healthcare services. A three-step pathway similar to a “rite of passage” process was observed. BC survivors first gained awareness of being on the fringe of the workplace and were awaiting to RTW. During that waiting period BC survivors were rebuilding a “normal routine” and taking actions by themselves in order to reincorporate their workplace. After the RTW, they needed to make adjustments to maintain a work routine.

Conclusion: Support for BC survivors resuming their active lives needs to be optimized. We suggest implementing interventions at one, three and six months after cancer treatment. At these moments, BC survivors require support on side effects management, RTW decision-making, and resources for reintegration of daily activities. Also, all stakeholders of the RTW pathway must be aware of the “in between” period and assist the BC survivors to build confidence during that “rite of passage” process.

What Facilitates or Prevents Successful Return-to-Work in the Construction Sector?

Kimberly Michelle Sharpe1, France St-Hilaire2, Suhail Marino1, Mieke Koehoorn1, Benjamin Amick3, Christopher McLeod1

1Partnership for Work, Health and Safety, The University of British Columbia; 2Département de management et gestion des ressources humaines, École de gestion, Université de Sherbrooke; 3Institute for Work & Health

Successful return-to-work (RTW) after work injury for construction workers is challenging and may include additional barriers to RTW compared to other types of work. We undertook a qualitative study in four Canadian provinces to identify barriers and facilitators of RTW in construction.

We conducted four focus groups of policy directors in participating provinces and 62 interviews of workers’ compensation staff, health and safety representatives, construction employers and injured workers. Interviews were analyzed in QDA Miner using Template Analysis; a type of thematic analysis using both a priori and a posteriori codes. Codes and corresponding themes were reviewed by expert advisors.

Analysis of the interviews highlighted 110 codes, grouped in 7 themes and 29 sub-themes that broadly relate to social norms, government legislation, the social welfare system, worker characteristics, workplace environment, rehabilitation recovery process and nature of injury. Some codes identified, such as access to health care, were not unique to construction, however others such as challenges in retraining construction workers to work outside construction were.

Facilitators to successful RTW were legislation requiring accommodate of injured workers, access to expedited healthcare, a claims management approach predicated on worker-focussed care, a positive orientation towards RTW by employers and workplace interventions that emphasised early interaction and recovery at work. Barriers identified included healthcare providers with limited knowledge of construction duties, workers with few transferable skills, difficulties in providing modified work due to the nature of construction work and a lack of employer expertise to facilitate RTW. Some aspects, such as union involvement, were identified as both barriers and facilitators.

A detailed set of themes reflecting multiple stakeholder and jurisdictional perspectives emerged that identified barriers and facilitators to RTW in construction. Findings from this study can support compensation and health care providers, employers and workers in achieving successful RTW in construction after work injury.

Absenteeism of outsourced workers: Analysis from the perspective of Occupational Health Nursing

Maria Isabel Santos, Maria Yvone Chaves Mauro, Cristiane Helena Gallasch

State University of Rio de Janeiro, Brazil

Outsourcing is a process of hiring companies or people to perform activities of another company – secondary activities that are not directly linked to your production process. In this context, the outsourced worker is often placed in a poorly protected environment, which can lead to occupational risks, triggering a process of illness and distancing him from his work activity. In Brazil, there are several difficulties to study and to quantify absenteeism due to illnesses and to specify public and economic burden caused by absences from work. In this context, this study has the aim to map absenteeism of employees of a private outsourcing service company, in the state of Rio de Janeiro, Brazil. It is a census study, with quantitative approach, approved by the Ethical Research Committee. Between April 2017 and April 2018, 9,477 represent the medium population of workers (67.9% male), performing activities as cleaning, gardening, fire brigade, building maintenance, telephone attendant, among others. Absenteeism occurred because of health issues (71.4%), with medical appointment for removal, and spontaneous lack of work (28.6%), representing 23,348 missing days and $1,102,685.55 BLR (or $274,450,45 USD) of lost. Worker’s health is a field of knowledge of occupational health nursing through which work-related illnesses are identified and understood through studies, preventive actions, care and surveillance, aiming, in particular, to reduce occupational diseases and accidents at work. The recognition of this situation, by a Occupational Health Nurse and the Health Staffs team, allowed the proposal and implementation of actions and standards to prevent the recurrence of high absenteeism rates, as observed in the 13 months of this study.

Welcome back program - Santander Bank Brazil

Aline Telles de Mello, Jeisianne Soares Ramanzini, Sabrina Gonçalves Manga de Lima, Barbara Letícia Oliveira dos Santos, Helmy Miyanishi Nagashima

Santander Bank, Brazil

Welcome Back is the internal rehabilitation program for the promotion and maintenance of Santander Bank’s employees’ health.

A multi-professional team receives and implements adjustments to the labor activities of those who do not present their total work capacity restored to which they had prior to their sickening, once their social security benefit has ended.

From 2014 until June 2018, the program has assisted 2,577 employees in over 15,000 consultations.

From all the participants in the program, 86% adhered to the consultations and to the rehabilitation plan, that lasted, in average, 5 months. There has been higher prevalence of mental disorders (40%), followed by musculoskeletal disorders (36%) and, a last, other clinical situations such as cancer, pregnancy and rheumatic disorders, which represented 24% of the cases. Age distribution concentrated mainly in the range from 31 to 50 years old, representing 66% of participants. From the totality of cases, 33% had been working in the company for 5 years or less, 29% from 6 to 10 years, 18% from 11 to 19 years and 20% for over 20 years.

The program was one of the responsible actions for the reduction of the percentage in payed leave of 44,5% between June 2014 and June 2018. Before Welcome Back’s implementation, 44% of the population on a leave presented a new leave within the next 6 months (2013-2014). From the program’s implementation on, of those who concluded the rehabilitation plan, 89% kept active, productive and effectively included in the 6 following months from discharge.

The program optimized the use of residual labor capacity of employees and promoted the reintegration of the individual to the productive and social environments.

It was demonstrated that the investment in health enhances trust in the employee and increases productivity, promotes the company and certifies the Simple, Personal and Fair culture.

"Meta-Synthesis Of Qualitative Research On The Association Between Leadership And Return-to-Work"

Sandra Rørvik, Trude Furunes, Trond Grønnestad, Hildegunn Sagvåg, Randi Wågø Aas

University of Stavanger, Norway

Sickness absence is a severe challenge in many countries. Norway has one of the highest absence rates among the OECD countries. Earlier studies have paid little consideration on supervisors’ influence on the return-to-work (RTW) process. Although, research has showed that supervisors’ involvement and behavior play a vital part on how long sick-listed employees are absent from work, and how rapid they return to work. Still, we do not know many of the underlying aspects that could explain this. The main purpose of this meta-ethnographic synthesis is to provide an up-to-date knowledge of the existing scientific qualitative literature regarding supervisors and employees own experiences and perceptions about supervisors’ follow-up of sick-listed employees. A meta-ethnographic synthesis was chosen as the design in this study, as it has been used earlier to describe different experiences and perspectives around a specific topic from relevant stakeholders. This methodology is one of the most well developed to review qualitative studied. This review was designed according to the method described by Noblit and Hare. A systematic database search of six databases was made between January and April 2018. The databases searched was Medline, CENTRAL, SveMed+, ISI Web of Science, Cinahl, and PsycInfo. The two key elements in the searches were leadership and Return-to-work. All included relevant titles and abstracts were reviewed by two independent reviewers, according to the inclusion criteria. One reviewer did the data extraction. One reviewer has made the analyzing model, and another reviewer put extracted data into the model. All the other reviewers will review all the articles to verify that all relevant data were included in the model. We found 2510 articles in our database searches, whereas 105 qualitative research articles met the inclusion criteria. The conclusions from this review is expected to be revealed in March 2019.

Which Factors Influence The Participation Of Blue Collar Workers In Worksite Health Promotion Programs Within The Construction and Transport & Logistics Sector.

Sarah Detaille1, Ariana van Velzen1, Annet de Lange1,2,3

1HAN University of Applied Sciences, Netherlands, The; 2Open University, Heerlen, the Netherlands; 3Norwegian University of Science and Technology (NTNU), Trondheim, Norway.


Transport and construction workers are highly at risk of developing overweight and obesity. A recent study has shown that 73% of the transport and logistic workers is overweight. Overweight and obesity are related to a decrease of work ability of the individual. There is until now little insight into the factors that influence the participation of blue-collar workers in WHPP’s and which factors influence the implementation of WHPP’s. The main goal of the current project is to evaluate the implementation and effect of two WHPP's in the sector Construction and Transport & Logistic sector in order to fine tune the implementation strategy and improve the health and vitality & work-ability of blue-collar workers.


A randomized research design will be used with 12 months follow-up. The research population will consist of blue collar workers within the Construction and Transport and Logistic sector. This project uses the RE-AIM model framework, for the systematic evaluation of the implementation of WHPP’s combined with the validated framework of Steckler & Linnan (2002) for the evaluation of interventions. The data will be collected through questionnaires and interviews. The data will be analyzed at three different actor levels (macro-level: organization and management; meso-level: implementer; micro-level: participant).


The results of the baseline and T1 data will be presented at the conference as well as the results of the qualitative analysis which gives insight in which personal and organization factors affect the participation of blue-collar workers in WHPP’s within the Construction and Transport & logistics sector and the motivation of blue-collar workers to change their lifestyle behavior.

Psychological Distress In Australian Workers' Compensation Claimants

Alex Collie, Luke Sheehan, Tyler J Lane, Shannon Gray

Monash University, Australia

Background: Qualitative studies of workers' compensation (WC) claimants have identified that claims processes can contribute to the onset or exacerbation of mental health conditions and psychological distress. There is limited quantitative research on this topic in cause-based systems of WC such as those in Australia. Psychological distress may slow recovery from injury and return to work.

Objective: To determine the prevalence of psychological distress among Australian WC claimants and identify factors associated with distress.

Method: Telephone based quantitative survey of 4,719 Australians with accepted WC claims, conducted up to two years post claim acceptance. Psychological distress was measured using the six question version of the Kessler scale. Worker, employer and claim related factors were assessd for their assocation with severe and moderate distress using multivariate ordinal logistic regression.

Results: Severe psychological distress was reported in 617 (13.1%) workers and a further 1259 (27.7%) had moderate distress. Rates were higher in workers with WC claims for mental health conditions (26.7% severe; 34.1% moderate distress) but otherwise equivalent between workers with physical conditions. Factors significantly associated with psychological distress included age less than 50 years, current pain, concerns about employer reactions to the WC claim, perceived lack of justice in the claim process, financial stress, poor self-rated health and not having returned to work at time of interview.

Conclusion: More than 40% of Australian WC claimants report moderate or severe psychological distress in the two year period after claim onset. A range of worker, claim and employer factors are associated with distress. Some are evident early in the claim process and modifiable. Combined with previously reported impacts of psychological distress on return to work and claim duration, the high prevalence suggests that screening workers for psychological distress should be routine in Australian WC systems.

The impact of depression on ill-health retirement and its moderating factors: Analysis form the Korean Longitudinal Study of Aging (2006-2014)

Youn-Mo Cho, Hyoung-Ryoul Kim, Jun-Pyo Myong, Jung Wan Koo, Mo-Yeol Kang

The Catholic University of Korea. College of Medicine, Korea, Republic of (South Korea)

Objective: To investigate the effect of depressive symptoms on IHR (ill-health retirement).

Methods: Data were collected from the Korean Longitudinal Study of Ageing which conducted biennially from 2006 to 2014. IHR were defined as those who retired due to their health problems. The short-form Center for Epidemiological Studies-Depression scale served as outcome measure for definition of depressive symptoms. Hazard ratios of IHR were estimated by Cox regression.

Results: We observed that depressive symptoms significantly increased risk of IHR during 8-year follow-up period. Compared to those without depressive symptoms, depressed worker had 1.27-fold elevated risk for IHR. Subgroup analysis showed that the association between depressive symptoms and IHR is greater in the elders, women, and lower income group than the others.

Conclusion: Depressive symptoms independently predicted IHR. Moreover, age, sex, and socioeconomic status modified these effects.

Workplace Practices for Preventing Prolonged Disability in Workers with Musculoskeletal Disorders

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

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


Return to work (RTW) is a complex process, involving many actors and implying several essential activities. The objective of this presentation is to compare, between four companies in Québec, the actual policies, procedures and practices in regard to RTW of employees suffering of with work-related musculoskeletal disabilities (WRMDs) and identify the main organisational conditions related to the similarities and differences observed.


A multiple case study (n = 4) was conducted in two sectors of activity: health care and manufacturing. The case was defined as all the RTW management procedures and practices of a specific organisation. Multiple sources of data included written procedures and semi-structured interviews with key actors. Between 5 and 17 key actors involved in the RTW process (i.e. human resources counsellor, manager, supervisor, union representative, and workers absent from their regular work during more than 3 months and now working since more than 6 months) were interviewed by organisation. Actions performed by essential activity, by phase and group of actors, and perceived facilitators and barriers were described. Analyses were done in order to highlight and explain differences and similarities between organisations.


Similarities exist in terms of procedures, involvement of actors and actions completed. However, we also noted many differences, specifically in terms of the various modalities of application of policies and procedures, as well as in terms of the different RTW inter organisational conditions.


The consideration of the differences and/or similarities among the organisations, and the conditions facilitating or not the RTW among the distinct workplaces, contribute to a better understanding of the practical contexts’ realities and of their implications in the application of RTW policies, procedures and practices in the workplaces.

How Satisfied Are Knee And Hip Osteoarthritis Patients With Exercise-Based Therapy As Treatment For Pain And Performance Of Activities Of Daily Life, Sports & Leisure Time And Work?

Yvonne van Zaanen1, Alexander Hoorntje2,3,4, Koen Koenraadt2, Leti van Bodegom-Vos5, Gino Kerkhoffs3,4, Suzanne Witjes2,3,4,6, Rutger van Geenen2, Paul Kuijer1

1Amsterdam UMC, University of Amsterdam, Coronel Institute of Occupational Health, Amsterdam Public Health research institute, Amsterdam, The Netherlands; 2Amphia Hospital, Department of Orthopaedic Surgery, Foundation FORCE (Foundation for Orthopaedic Research Care and Education), Breda, The Netherlands; 3Amsterdam UMC, University of Amsterdam, Department of Orthopaedic Surgery, Amsterdam Movement Sciences, Amsterdam, The Netherlands; 4Amsterdam UMC, University of Amsterdam, Academic Center for Evidence-Based Sports Medicine (ACES) Amsterdam, The Netherlands; 5Leiden University Medical Center, Department of Biomedical Data Sciences, Leiden, The Netherlands; 6ICONE Orthopedie & Sportletsels, Schijndel, The Netherlands

Worldwide, the number of working knee and hip osteoarthritis patients is increasing rapidly. The ultimate treatment is joint arthroplasty for these patients. The Dutch Orthopaedic Association strongly supports that joint arthroplasty is only performed after adequate, stepwise conservative treatment. This is advocated in their Choosing Wisely Initiative. Exercise-based therapy is a cornerstone in this stepped-care strategy. However, no recent data are available describing whether these patients scheduled for surgery indeed received exercise-based therapy. Furthermore, satisfaction with the effect of non-operative treatments on pain and participation in daily life, work and sports activities has not been described.

A cross-sectional study was performed among end stage knee and hip osteoarthritis patients in five hospitals in the Netherlands in 2017. Using a questionnaire, all patients were asked which joint preserving treatments, like exercise-based therapy, they had received. In addition, satisfaction with the exercise-based therapy for pain and performance of activities in daily life, sports & leisure time and work was rated on a scale from 1 (very dissatisfied) to 10 (very satisfied).

One hundred seventy-six patients completed the survey. The mean age was 66 (SD 8) years, 57% was female and the median BMI was 29 kg/m2 [IQR 25-33]. A majority (61%) received exercise-based therapy. The median satisfaction scores for the effect of exercise-based therapy on pain and activities of daily life were 6 [IQR 4-7]. These median scores were 5 for both sport & leisure time and work activities [IQR 2-6].

In 2017, a majority of Dutch knee and hip osteoarthritis patients received exercise-based therapy. In general, patients were satisfied with the effect on pain and activities of daily life but unsatisfied with the effect on sport & leisure time and work activities. Future studies should try to enhance the effectiveness of exercise-based therapy especially for sport & leisure time and work.

Healthcare Utilization for Workers with Musculoskeletal Disorders in British Columbia, Canada

Esther T Maas, Mieke Koehoorn, Wei Zhang, Lillian Tamburic, Christopher B McLeod

University of British Columbia, Canada

Musculoskeletal disorders (MSDs) are the second most common cause of disability worldwide, and account for the highest disability costs in Canada. This study presents the first comprehensive picture of healthcare utilization and costs related to workers’ compensation claims, for a cohort of workers with MSDs in British Columbia, Canada.

Population-based data using accepted workers’ compensation claims for MSDs from WorkSafeBC (the workers’ compensation system of British Columbia) were extracted for the period 2010-2016. Two researchers independently coded and reconciled differences in 10,244 healthcare service codes, and categorized those based on healthcare provider and service type. This allowed us to compare the main healthcare utilization and cost drivers for work-related MSD claims in British Columbia.

Preliminary results show that in total 175,077 injured workers had 377,668 claims related to work-acquired MSDs between 2010 and 2016 (approximately two claims per worker on average). These claims were associated with 7,417,101 healthcare payment transactions (approximately 20 payments per claim). The largest proportion of payments were for physician services (49%). Of these, 42% were general practitioner services, 24% specialists’ services, and 34% did not have physician specialty recorded. The second most common were payments to other qualified healthcare providers (17%), of which the majority were for physiotherapy services. Rehabilitation programs and prescription drugs comprised 10% and 9% of payments respectively. The remaining 15% of payments were miscellaneous or other costs (e.g. travel costs).

This study presents the first categorization of healthcare claim costs related to MSDs in British Columbia. This categorization of healthcare utilization will inform future research that will evaluate health services use and resulting cost drivers of healthcare for injured worker groups. Understanding these costs can inform policy makers to make better allocative decisions in the distribution of limited resources.

Work Environment Obstacles Influencing the Return to Work of Aging Workers on sick-leave due to Common Mental Disorders

Astrid Velasquez Sanchez, Marie-José Durand, Chantal Sylvain

Université de Sherbrooke, Canada

Objective: Currently, very few studies have examined the factors from the work environment (WE) which impede the return to work of aging workers on sick-leave due to a common mental disorder (CMD). This study aims to fill these gaps through the following two objectives: (1) characterize the main WE obstacles of workers aged 50 and over (W50+) on sick-leave due to a CMD, and 2) explore among stakeholders their understanding of the main obstacles hindering the return to work of these workers.

Methods: This study uses an exploratory sequential mixed method design. The first phase (quantitative) will use a secondary analysis of a database comprising a sample of 44 W50+ and admitted to a rehabilitation program. Descriptive analyses will be performed. The second phase (qualitative) will use interviews with two types of participants: supervisors and human resources managers in a large organization. Inclusion criteria for the supervisors are: (1) having a minimal experience of one year in staff management, and (2) having minimally supervised one return to work of a W50+ in the last two years. A sample size of 8-12 supervisors is aimed. Inclusion criteria for the human resources managers are: (1) having thorough knowledge on the policies and procedures surrounding disability management, and (2) having a minimal experience of one year. A sample size of 3-6 human resources managers is aimed. An interview guide will be developed which will take account of the quantitative results obtained during the first phase. Thematic content analysis will be done.

Conclusion: This research is currently underway. Results will allow a better understanding of WE factors most likely to impede the return to work of workers aged 50 and over with CMD. Furthermore, the point of view of key stakeholders on the WE obstacles will be explored.

Validation Of A Triage Instrument To Assess Risk Of Long-Term Sickness Absence

Kaat Goorts1, Marc Du Bois1, Dorina Rusu3,4, Lode Godderis1,2

1University of Leuven, Centre for Environment and Health, Kapucijnenvoer 35/5, 3000 Leuven, Belgium.; 2Idewe, External Service for Prevention and Protection at Work, Interleuvenlaan 58, 3001 Heverlee, Belgium; 3Université de Liège, Médecine du Travail et environnementale, Département des Sciences de la Santé publique, Avenue Hippocrate 13, 4000 Liège, Belgium; 4SPMT-ARISTA, External Service for Prevention and Protection at Work, Rue Royale 196, 1000 Brussels, Belgium.


Given the scarce means and as most employees will return to work spontaneously, resources for return to work projects should be mainly dedicated to the high-risk group for long-term sickness absence. In this project, a questionnaire was developed to predict the risk of long-term sickness absence in the early stage of a sickness period. We aim to measure the predicitive validity of the screening instrument.


Between 11/09/2017 and 22/10/2017, the screening instrument, containing sixty-one items, was sent to every patient after 6 weeks of sickness absence. The risk for long-term sickness absence was related to work-related, function-related, work-life-interference related and person-related factors. We measured the time until return to work for all patients, to be able to evaluate the predictive validity of our screening instrument.


The questionnaire developed aims to support physicians to assess the risk of long-term sickness absence in employees, for whom an earlier start of return-to work support becomes possible. We aim to guide more employees successfully and sustainably back to work.

Associations Between Alcohol Use and Sick leave: A Systematic Review

Neda Soleimanpour Hashemi1, Mikkel Magnus Thørrisen2, Aleksandra Sevic1, Hildegunn Sagvaag1, Jens Christoffer Skogen3, Randi Wågø Aas1,2,4

1Department of Public Health, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway; 2Department of Occupational Therapy, Oslo Metropolitan University, Oslo, Norway; 3Norwegian Institute of Public Health; 4Presenter- Making Sense of Science, Stavanger, Norway

Background: Alcohol is a prevalent psychoactive substance, and a major risk factor for disease, disability, and mortality. Risky alcohol use has been identified as a causal agent in more than 200 disease and injury conditions. Excessive or prolonged alcohol consumption might lead to injuries and accidents, but also to sickness absence, sickness presenteeism, and behavioral changes. Sick leave is a substantial indicator of impairment, and this systematic review provides an updated summary of the existing scientific literature on the association between alcohol consumption and sick leave (both short-term and long-term). In addition, we aim to describe the differences and similarities of how alcohol and sick leave are operationalized across studies. At last, the review will indicate recommendations for future research on alcohol use and sick leave.

Methodology: The systematic review is planned according to the Cochrane Handbook. The literature search has been executed in the following databases: Medline, Embase, Cinahl, PsychInfo, Amed, and ISI Web of Science. Studies from 1980 and up to 2018 in English or Scandinavian languages were included. After extracting the data on tested associations in included studies, these underwent a quality assessment. Because the associations are as the unit of interest, quality assessment is on each association test rather than each study. We hope to perform a meta-analysis in the next phase, if this is not possible, a narrative analysis will be performed.

Results: 57 studies met the inclusion criteria and constituted the included studies. All of these studies contain association tests between alcohol consumption and sick leave. The article is in the data extraction and analysis phase and will be finalized in February 2019.

Tracing The Change. What Are The Effective Components Of Workplace E-health Interventions? – A Systematic Review

Aleksandra Sevic1, Neda S. Hashemi1, Mikkel Magnus Thørrisen2, Randi Wågø Aas1

1University of Stavanger, Stavanger, Norway; 2OsloMet – Oslo Metropolitan University, Oslo, Norway


Investing in health and participation of employees has many positive outcomes for both organizations and society. According to previous research, by reducing sick leave and sickness presenteeism there is a potential for improving the long-term health of employees. Workplace interventions based on online content or including a computer-mediated component have gained popularity since the 1990s. Such E-health interventions are aiming to improve employee’ health and lifestyle choices, as well as promote a safe and early return to work. Although effectiveness of e-health interventions has been investigated to some extent, it is still unclear how these interventions work and which components (i.e. active ingrediences) or which design and interfaces contribute to their effectiveness. The aim of this systematic review is to reveal which components, design, and interfaces contribute to effectiveness of e-health workplace interventions.


We are searching for literature in the following databases: MEDLINE, PubMed, Embase, Cinahl, PsycInfo and SveMed+. Empirical papers published between 1990 and 2018 in English and Scandinavian languages, concerning adults in working age (18 to 67 years) as well as all sectors, branches and job types will be included. This review follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Overall quality of the evidence for primary outcomes will be assessed by using the GRADE and risk of bias approaches from Cochrane Collaboration. We will further use the behavior change technique taxonomy (BCT-taxonomy) to map behavior change in e-health programs.


Our search strategy revealed 2409 records. We are now in the inclusion/exclusion process, where two independent reviewers are screening the studies according to the inclusion criteria


This systematic review is still in the process. Completion of the results for presentation in Odense is expected in the Spring 2019.

Key Words: e-health, workplace interventions, systematic review, health promotion and organizational health

Implementing Best Practices With Employers and a Union: Setting a New Milestone for Research

Marie-France Coutu1, Marie-José Durand1, Marie-Michelle Gouin1, Valérie Lederer2, Marie-Elise Labrecque1

1Université de Sherbrooke, Canada; 2Université du Québec en Outaouais, Canada


Implementing best practices in the workplace is complex and embedded within a multi-party and multi-factorial context. This study explores factors hindering and facilitating adaptation of work disability management best practices in real practice settings using a collaborative framework.


The research team, union and human resources (HR) directors of employers of organisations in the education sector decided on a participatory action-research approach. The Community-Based Participatory Research framework (CBPR) guides the project. An adaptation of the validated CBPR questionnaire is completed prospectively at three times during the project. Individual interviews are held at the end of participation, using results from the questionnaire to more deeply explore the results of the collaboration between parties. The questionnaire includes three theory-driven dimensions: 1) capacity of parties to collaborate, 2) goodness-of-fit between participants, and 3) operations supporting collaboration and the deliverable product.


A total of four organisations in the education sector affiliated with the same union are participating, with an equal number of HR and union representatives. The participants include the HR director, disability managers, and a direct supervisor (HR departments), and the president, the union director, and delegates (unions). The following activities were agreed upon to structure the adaptation of work disability practices for each organisation: 1) audit of current practices; 2) presenting the gaps found between best practices and current practices of each organisation; 3) establishing a consensus on practices needing adaptation and 4) adapting best practices to each organisation. Steps 2 to 3 are conducted using bipartite group meetings. So far, two organisations have completed the process and one is at step 4. Preliminary results highlight factors in all three dimensions impacting the adaptation of practices.


A new milestone is being set in the aim of implementing best practices in work disability prevention.

1:00pm - 2:30pmPrevention
Session Chair: Martin Lindhardt Nielsen
Session Chair: Mette Jensen Stochkendahl
Room 97 

Making Sense of Conflicting Data on Work Exposures and Their Relationship to the Development of Knee Osteoarthritis: Findings from a Systematic Review.

Kim Cullen1,2, Monique Gignac1,3,4, Emma Irvin1, Dwayne Van Eerd1

1Institute for Work & Health, Toronto ON, Canada; 2School of Human Kinetics & Recreation, Memorial University of Newfoundland, St. John's NL, Canada; 3Dalla Lana School of Public Health, University of Toronto, Toronto ON, Canada; 4Toronto Western Research Institute, Toronto ON, Canada.

Objective: Knee osteoarthritis (OA) is a leading cause of disability worldwide. A recent systematic review of the literature identified inconsistent findings across studies regarding the relationship between similar occupational activities (i.e., kneeling, squatting and knee bending) and the development of knee OA. Using sensitivity analyses, we sought to explain these inconsistencies to better inform work disability prevention decision making and to identify future knowledge needs.

Methods: Using the findings from a recent systematic review, we employed sensitivity analyses to examine similarities and differences in study findings related to sex/gender, job activity measurement (e.g., how knee activities were measured), work exposures and dose response information (e.g., duration, frequency of knee activities), early or late OA diagnosis, study designs, and methodological quality.

Results: Twenty studies provided data on the relationship between kneeling, squatting and/or knee bending job activities and the development of knee OA. Overall findings were often inconsistent across studies. For example, across men and women, strong or moderate evidence emerged for knee OA when combining kneeling, squatting and bending activities. Yet, there was no effect when squatting and kneeling were examined individually. Sensitivity analyses help explain the findings and highlight the need for attention to measurement, including whether compartmentalizing or differentiating among knee bending tasks accurately reflects real-world work conditions; the frequency and duration of knee bending; and whether knee bending occurs in conjunction with lifting heavy loads.

Conclusions: Sensitivity analyses provide insight into inconsistent findings in the relationship between specific job activities and the development of knee OA. These findings inform work disability prevention efforts and highlight additional research gaps, especially in measurement of work activities, the consideration of sex and/or gender differences and dose response relationships for the development of knee OA.

Promoting Resilience for Workers on Prolonged Work Disability: Developing a transdiagnostic intervention

Eve Dulude, Marie-José Durand, Marie-France Coutu

Université de Sherbrooke, Canada

Purpose: Growing evidence supports the importance of resilience in the rehabilitation of client’s with musculoskeletal disorders (MSD) or common mental disorders (CMD). Yet, there is a lack of operationalized intervention on resilience in work rehabilitation. This study aims to develop a transdiagnostic intervention promoting resilience in prolonged work disability, and to explore its acceptability with workers.

Methods: A multimethod design was used. First, a scoping review on resilience and associated factors for (1) MSD and (2) CMD was conducted. Data was synthesized into common themes to form a preliminary version of the intervention logic model. Second, 10 expert clinicians in work rehabilitation with knowledge on resilience completed an online survey including questions and proposed changes on the clarity, applicability, relevance and exhaustiveness of the preliminary version. Third, the same experts participated in a group consensus to adapt the intervention logic model. Fourth, we interviewed workers who completed a work rehabilitation program on the prospective acceptability of the adapted version of the intervention. Thematic analysis of the verbatim was performed.

Results: 14 studies in MSD and 9 in CMD were reviewed. 11 common resilience factors were found for both MSD and CMD. Based on these results the preliminary intervention logic model was developed and included: 4 specific and 9 intermediate objectives, 5 activities and 44 tasks. Expert clinicians indicated in the survey 15/29 questions needing consensus. 41 proposed changes yielded a consensus on 15 modifications on the clarity, pertinence, and exhaustiveness of the intervention. Six workers (3 MDS; 3 CMD) had positive attitudes toward the intervention, found it useful and coherent with their values.

Conclusion: A systematic method was used to develop and operationalize an intervention logic model based on literature, expert clinicians and users; thus proposing a novel resilience intervention in work rehabilitation.

Two Systematic Reviews on Economic Evaluations of Interventions Aimed at Preventing Work-Related Musculoskeletal Disorders and Common Mental Disorders

Hélène Sultan-Taïeb1, Aurélie Gaillard2

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

Background: The literature is quite scarce on cost-benefit results of preventive interventions in occupational and health safety. We performed two systematic reviews on the prevention of work-related musculoskeletal disorders (WMSD) and common mental disorders (CMD). We had two objectives: (1) to analyze the cost-benefit results, (2) to explore factors related to the implementation process of these interventions (obstacles and levers) in order to identify whether economic results may be due to a successful or unsuccessful implementation. Methods: Systematic review. Studies were searched in eight electronic databases and in reference lists of included studies. Companion papers were identified through backward and forward citation tracking. A quality assessment tool was developed following guidelines available in the literature. An integration of quantitative economic results and qualitative implementation data was conducted following an explanatory sequential design. Results: Regarding WMSD, out of 189 records, nine studies met selection criteria. Out of nine included studies, grouped into four types of interventions, seven yielded positive economic results, one produced a negative result and one mixed results (negative cost-effectiveness and positive net benefit). However, the level of evidence was limited for the four types of interventions. Results regarding CMD are under process. Among the included studies on WMSD, negative and mixed economic results were observed when the dose delivered and received by participants was low, when the support from top and/or middle management was limited either due to limited participation of supervisors or a lack of financial resources and when adequacy of intervention to workers’ needs was low. In studies on WMSD where economic results were positive, implementation data showed strong support from supervisors and a high rate of employee participation. Conclusion: Economic evaluation should include information on the implementation process in order to permit the interpretation of economic results.

Indicated Prevention Interventions in the Workplace for Depressive Symptoms: A Systematic Review and Meta-analysis

Yeshambel Tesfa Nigatu, JinaLi Wang

University of Ottawa, Institute of Mental Health Research

Background: Depressive symptoms are highly prevalent and cause substantive morbidities and loss of functioning among employees. Depression may be prevented at its early stages. However, there is a paucity of information regarding indicated preventive interventions for depression among employees. The objective of this review is to examine the effectiveness of indicated interventions for the reduction of depressive symptoms in the workplace.

Methods: A systematic review and meta-analysis of articles published between January 2000 and September 2017 was conducted using major electronic databases including PubMed/MEDLINE, PsycINFO, EMBASE, SOCINDEX, and ABI/ProQuest. Studies were selected based on a set of predefined inclusion criteria. Primary outcome measures were depressive symptomatology, and the nature of the interventions was indicated prevention. Studies were pooled based on the intervention type and the effect size was measured using the standardized mean difference.

Results: A computer and hand search of the literature yielded 4,462 papers, from which 16 trials were identified to be suitable for meta-analysis. Eight of 16 studies reported significant effects for workplace preventive interventions targeting depressive symptoms in which six were cognitive behavioral therapy (CBT) based interventions and two were non–CBT-based interventions. Small to medium effect sizes were found for both CBT- and non–CBT-based interventions (standardized mean difference = –0.44, 95% CI= –0.61, –0.26, I2=62.1% and standardized mean difference= –0.32, 95% CI= –0.59, –0.06, I2=58%, respectively).

Conclusions: This review demonstrates that indicated interventions can significantly reduce the level of depressive symptoms among workers. The implementation of evidence-based workplace interventions should consequently be considered to prevent the development of depressive symptoms among employees.

Cross-Country Comparison Model For Work Disability Prevention

Angelique De Rijk, Inge Houkes

Maastricht University, Netherlands, The

Background: Work disability research is in need for a model for comparing legislation and other social context factors across countries. The model should support systematic interpretation of research outcomes, their transferability and inform on country specific implementation requirements. The large cross-country differences in labour participation of persons with chronic diseases is one of the important issues. Our aims were (1) to develop a generic model for cross-country comparison in relation to work disability prevention and (2) to validate this model regarding labour participation of persons with chronic diseases.

Method: New institutional theory (NIT) was used to develop a generic model. Empirical evidence for the relation between model concepts and labour participation of persons with chronic diseases was searched for by a scoping review of the literature.

Results: The Cross-Country Comparison model for Work Disability Prevention (CCC-model for WDP) consists of five concepts representing a country’s social context: (1) regulative institutions (legislation); (2) normative institutions (norms and values of professionals and lay persons involved); (3) WDP organizations and professions; (4) cultural-cognitive institutions (cultural beliefs); (5) labour market characteristics. Relations with labour participation of persons with chronic diseases were found for specific variables within each concept: (1) welfare state type, employment protection and anti-discrimination legislation; (2) norms regarding work, sick role, professional role and gender role; (3) WDP organizations and professionals; (4) hierarchy and individualism; (5) informal employment, contract and job type.

Conclusion: The CCC-model for WDP is a generic model consisting of five main concepts. The model was validated for interpreting cross-country differences in labour participation of persons with chronic diseases. The model can guide systematic interpretation of empirical findings in relation to WDP across countries, and inform on policy changes and intervention development in line with a country’s social context.

Process And Content Of The French Guidelines For Work Disability Prevention

Jean-Baptiste Fassier1,2, Audrey Petit3, Camille Baumann4, Karine Petitprez5, Ludivine Nohalès6, Laetitia Rollin7, Sophie Fantoni8

1UMRESTTE UMR T9405, Université Claude Bernard Lyon 1, France; 2Occupational health and medicine department, Hospices Civils de Lyon, France; 3Centre de consultations de pathologie professionnelle du CHU d’Angers, Angers, France / INSERM, U1085, IRSET, Equipe ESTER , Université d'Angers; 4Institut de Santé au Travail du Nord de la France, Lille, France; 5Haute Autorité de Santé, Paris, France; 6Cellule d'Urgence Médico-Psychologique CUMP 69, Hospices Civils de Lyon, France; 7Centre de consultations de pathologie professionnelle du CHU-Hôpitaux de Rouen, CISMeF-TIBS-LITIS EA 4108, Université de Rouen; 8Centre de consultations de pathologie professionnelle du CHU de Lille, CRDP EA 4487, Université Lille


Due to the rising trend in the number of disabled workers, work disability prevention (WDP) has been identified as an objective of the national health policy in France. The French Society of Occupational Medicine and the French National Authority for Health (HAS) commissioned guidelines for WDP.


It was chosen to focus on the most disabling conditions, including musculoskeletal disorders, cancer, common mental health disorders, neurological and cardiovascular diseases. A bibliographic search was performed in Medline, Central, Lissa, Scisearch, Cairn and Eficatt from 2007 to 2018. References were reviewed by title and abstract (n=1393) and full text (n=286), before inclusion in the evidence base (n=157). Existing guidelines, meta-analysis and literature reviews were considered in priority. Recommendations were formulated, reviewed and modified by a multidisciplinary task force of 25 experts. Each recommendation was then rated by a reading group of 82 stakeholders. Final version was elaborated by multidisciplinary working group consensus based on HAS method.


General recommendations pertain to the WDP missions of occupational health (OH) services, compliance with the regulatory framework, coordination of actors, and analysis of the factors influencing occupational prognosis. Most recommendations applied whatever the medical conditions. Specific recommendations were formulated in some disabling conditions where appropriate. It is recommended that OH professionals formulate a return-to-work (RTW) plan for the management of workers on sick leave beyond 3 months, including a shared analysis of the situation, a list of barriers and facilitators, and the solutions to be implemented and evaluated. A catalogue is provided including key measures to facilitate RTW and job retention. Similar recommendations are developed for workers who are still at work with health problems.


These are the first French recommendations for WDP. Improving OH practices will require the active dissemination of these recommendations with tools and incentives to facilitate their use.

1:00pm - 2:30pmReturn to work 1
Session Chair: Ulrik Gensby
Session Chair: Emile Tompa
Auditorium 100 

The Five-year Labour Market Participation Prospects In Incident Cancer Patients: A Danish Population-based Cohort-study

Pernille Pedersen1, Maria Aagesen2,3, Lars Hermann Tang2,3, Niels Henrik Bruun4, Ann-Dorthe Zwisler2, Christina Malmose Stapelfeldt1,5

1DEFACTUM, Social & Health Services and Labour Market, Central Region Denmark, P.P. Oerums Gade 11, Building 1B, 8000 Aarhus C, Denmark; 2National Centre for Rehabilitation and Palliative Care, University of Southern Denmark, Denmark; 3Bachelor's Degree Program in Physiotherapy, Dept. of Rehabilitation and Nutrition, Faculty of Health and Technology, Metropolitan University College, Copenhagen, Denmark; 4Department of Public Health, Aarhus University, Bartholins Allé 2, 8000 Aarhus C, Denmark; 5Section for Clinical Social Medicine and Rehabilitation, Department of Public Health, Aarhus University, P.P. Oerums Gade 11, Building 1B, 8000 Aarhus C, Denmark

Introduction in January 2013 a reform of the Danish Disability Pension Act was introduced that aimed to reduce the number of granted disability pensions, in particular among persons younger than 40 years. It is important to study how a structural reform affect incident cancer patients’ labour market prospects.

Objective To study the risk of being granted a disability pension in incident cancer patients up to five years after diagnosis, before and after a structural reform of the disability pension act.

Methods All incident cancer-diagnosed individuals between 20 and 60 years between January 2000 - December 2015 were identified in the Danish Cancer Registry. A control group was identified in Statistics Denmark (1:5 ratio) matched on gender, age, highest completed education and household income in euros, which were defined at the time of diagnosis for the case. The matched controls had not previously been diagnosed with cancer except for non-melanoma skin cancer. Differences in cumulative incidence rates (RD) of the granting of disability pension were analysed with accompanying 95% confidence intervals (CI).

Results In total 156,045 incident cases and 780,068 matched controls were included in the study. Before the reform in 2013; the adjusted cumulated RD of being granted a disability pension for cases was significantly higher than the controls at all time points. The number of granted pensions increased the most during the first and second follow-up year and levelled off the remaining three years. After the reform; the adjusted cumulated RD were lower for all follow-up years than before the reform, ranging from 2.7 (2.4; 2.9) after one year, reaching a maximum after three years of 5.3 (5.0; 5.6) and steadily decreasing to 4.3 (3.9; 4.7) after five years.

Conclusion The reform of the disability pension act in 2013 affected also the granting of pension to cancer-diagnosed individuals.

The Identification Of Patients’ Risk Of Not Returning To Work: A Comparison Of Three Different Risk Scores

Miriam Markus1, Marco Streibelt2, Michael Schuler3, Christian Gerlich3, Matthias Bethge1

1University of Lübeck, Germany; 2German Federal Pension Insurance, Germany; 3University of Würzburg, Germany

Background: Musculoskeletal disorders are important causes of work disability. In Germany, medical rehabilitation programs should help to enable a stable participation in working life and to prevent the transition into disability pension. To determine the individual risk of not returning to work after rehabilitation different risk scores exist. The aim of our analyses was to compare the prognostic accuracy of these risk scores.

Methods: 3033 people aged 18 to 65 years (mean age: 53.5 years; 73.4% women) were included. We assessed three risk scores before patients started a conventional medical rehabilitation (WAS: work ability score with a score of ≤ 5 points indicating a higher risk of not returning to work; SPE: subjective prognosis of employment status, ≥ 2 points indicate a higher risk; SIMBO: screening to assess the need for work-related medical rehabilitation, ≥ 27 points indicate a higher risk). Ten months later we assessed whether the patients sustainably returned to work (at least four weeks without sickness absence).

Results: A logistic regression model showed that all risk scores complementarily predicted failed return to work (WAS: OR = 1.78; SPE: OR = 2.76; SIMBO: OR = 6.41; all p < 0.001). All risk scores have its merits, but the SIMBO has a higher area under the curve (AUC) and better combined sensitivity and specificity (WAS: AUC = 0.66, sensitivity = 0.81, specificity = 0.50; SPE: AUC = 0.65, sensitivity = 0.61, specificity = 0.69; SIMBO: AUC = 0.74, sensitivity = 0.71, specificity = 0.77). A clinical prediction rule using all three risk scores (at least two out of three positive findings) would not achieve clearly better results than the SIMBO only.

Conclusions: All three risk scores enable to predict an increased risk of not returning to work. Because of its prognostic accuracy the use of the SIMBO is recommended.

Improving Risk Identification in the First Two Weeks of Workers Compensation Claims

Ross Iles, Luke Sheehan, Cameron Gosling

Monash University, Australia

Background: A range of factors are known to predict delayed RTW for worker’s compensation claimants. The Plan of Action for a CasE (PACE) tool was developed to be completed by insurance case managers after conversations with the injured worker, the employer and gathering information from the treating practitioner. Responses to the 42 PACE tool questions determined the allocation of up to 31 high risk flags on a claim.

Aim: To determine the whether gathering PACE information within the first two weeks of a claim improved the ability to identify workers at risk of time loss greater than 1 and 3 months.

Methods: Baseline (Base) and PACE information was collected for 524 claims over 10 months in New South Wales, Australia. Baseline information included claim characteristics typically available at the point of acceptance of a claim (e.g. age, injury type and mechanism). PACE information added risk flags identified by the PACE tool. Univariate regression identified variables to include in multivariate models. The predictive ability of the Base and Base + PACE models was assessed using receiver operating characteristics (ROC). The area under the curve (AUC) was used as a measure of the effectiveness of the models at predicting RTW.

Results: Of the 524 claims, 195 (37.2%) and 83 (15.8%) had time loss of at least 1 and 3 months respectively. The AUC for the Base model was 0.68 and 0.69 for 1 and 3 months, whereas the AUC for Base + PACE was significantly higher at 0.85 for both 1 and 3 month time loss (p<0.001).

Conclusion: Addition of the PACE information to Base variables significantly improved discrimination from poor to excellent for both 1 and 3 month time loss outcomes. The PACE tool is a feasible addition to early case management as an identifier of candidates for early intervention.

Meta-Synthesis Of Qualitative Research On Facilitators And Barriers Of Return To Work After Stroke

Marco Streibelt1, Betje Schwarz2, Dolores Claros-Salinas3

1German Federal Pension Insurance, Berlin, Germany; 2Institute for Social Medicine and Epidemiology, University of Lübeck, Lübeck, Germany; 3Schmieder Clinic, Konstanz, Germany

Purpose: Despite existing rehabilitation services, return to work (RTW) rates among stroke survivors are quite low. An increased number of qualitative studies have been conducted to identify facilitators and barriers to RTW after stroke and to derive recommendations for future interventions. The aim of our study was to carry out a meta-synthesis of those studies and thus strengthen evidence in the field.

Methods: To identify relevant studies (qualitative studies focusing on RTW after stroke, published in English or German between 2000 and 2015), we conducted a systematic literature search in PubMed, OVID, and Web of Science. After assessing the quality of eligible studies, we synthesized their findings according to meta-ethnographic methodology.

Results: Fourteen out of 553 studies — three of very high, seven of high, three of medium, and one of low quality — met the inclusion criteria. After the extraction of all first-order concepts and their translation into 64 second-order interpretations, we synthesized the findings by developing a model of RTW factors after stroke. It contains factors related to the person (impairments, coping/adaptation, significance of work/RTW motivation), workplace (job demands/work adaptations, disability management, work climate/social support), and rehabilitation services (availability, accessibility, appropriateness), as well as relevant factors in the interaction of these three stakeholders (work capacity, performance and capability, and initial RTW experiences). Three basic principles — adaptiveness, purposefulness, and cooperativeness — complete the model and led us to its name: the APC model.

Conclusions: Successful RTW after stroke depends on diverse factors and stakeholders. Rehabilitation strategies have to consider this; otherwise they become RTW barriers themselves.

Return to Work From a System-Based and Workplace-Based Perspective: A Qualitative Review

Ulrik Gensby1,2,3, Dwayne Van Eerd3, Kim Cullen3, Agnieszka Kosny3, Quenby Mahood3, Emma Irvin3, Marie Laberge3,4,5, Benjamin C. Amick III3,6

1Team Arbejdsliv ApS, Denmark; 2Helix Competence Centre, Linköping University, Sweden; 3Institute for Work and Health, Toronto, Canada; 4CHU Ste-Justine Research Centre, Montreal, Canada; 5CINBIOSE Research Centre, UQAM, Montréal, Canada; 6Florida International University, US

Introduction: There is a strong argument for using qualitative synthesis research in work disability prevention. This article presents a review update and meta-ethnography of qualitative workplace intervention research looking at the process of return to work (RTW). The review endeavours to broaden our understanding of the personal, socio-relational and structural process dimensions of RTW, and detail the type of conditions that help or hinder effective workplace practices.

Methods: We searched seven scientific databases to identify relevant studies published in English, French, Dutch or Scandinavian languages between 1990 and 2017. Pairs of reviewers conducted screening for relevance, and quality appraisal independently. We built our approach to quality appraisal (QA) and interpretation on the EPICURE principles for evaluation of qualitative research. We utilized a modified version of the QA framework used in the original review. Data extraction proceeded for papers assessed as being medium and high in methodological quality. We applied a meta-ethnographic approach to synthesise data across study findings and merged studies about similar concepts to reveal overarching concepts and create new conceptual understanding.

Results: A total of 2302 records were identified from the initial search. 718 qualitative papers were assessed for relevance. 63 papers were then included for quality appraisal. The data synthesis included 52 studies of medium and high methodological quality. The reciprocal translation of studies into one another revealed 25 concepts that fall into the three strata (i) Personal dimensions; (ii) Socio-relational, and (iii) Structural dimensions of the RTW process. The mix of concepts appear evident to consider when developing, implementing and/or evaluating RTW policy and practice.

Conclusion: Reviewing trends in qualitative workplace intervention research is important to enhance our understanding of the process dimensions of RTW. Such scientific knowledge may enhance evidence-informed practice in organizations, advance implementation processes, and inspire new and relevant conceptual thinking.

Supervisors´ View of Work Disability Collaboration with Occupational Health Services

Liisa Lappalainen1, Juha Liira2, Anne Lamminpää1

1Helsinki University, Department of Public Health, Finland; 2The Finnish Institute of Occupational Health, Helsinki, Finland

Purpose: To study collaboration between a supervisor, a disabled employee and occupational health service (OHS) in a work disability negotiation.

Methods: A total of 133 supervisors responded to a cross-sectional questionnaire concerning their experience of work disability negotiations with OHS. Supervisors represented five different organizations and a wide variety with differing professional profiles.

Results:Supervisors had attended a work disability negotiation on median with two disabled employees. Thus this study covered about 240 work disability cases. To find a solution, which supports staying at work, is a process which may require several negotiations.

Concerning the process of disability management, supervisors appeared to benefit from three factors: an explicit company disability management (DM) policy, supervisors’ training in DM, and collaboration with OHS.

Expectations for occupational health consultations focused on finding vocational solutions and on obtaining information. Supervisors assessed the outcomes of collaboration as both vocational and medical. Also, the study recognized elements which may enhance the success of the process of collaboration.

Conclusions: Collaboration with OHS is a useful option for supervisors to enhance work modifications and the work participation of employees with disabilities. Successful communication between the stakeholders is a key for beneficial collaboration.

1:00pm - 2:30pmStakeholder involvement - income
Session Chair: Marie-France Coutu
Session Chair: Thomas Johansen
Room 96 

Income Changes In Occupationally Injured Workers After Workers' Compenation

Sookwon Bae, Jonguk Won

Yonsei Univ. College of Medicine, Korea, Republic of (South Korea)


The present study examines how the income of workers following industrial accident changes depending on their disability grades and economic activities.


We analyzed the 1st-4th data of the panel study of workers’ compensation insurance (PSWCI). The PSWCI was conducted with the 2,000 final samples selected from 82,492 workers who had undergone recuperation periods due to industrial accidents, and the survey has completed its 4th panel. Repeated measures ANOVA was used to compare the annual income before and after the industrial accident, and a general linear model was used to identify changes in income due to disability ratings and participation in economic activities.


The wages before the industrial accident and the annual income varied among the disabilities ratings (p<0.0001). In addition, for affected workers, the average income during four years post-accident was lower than the income before the accident (p=0.0005). In the case of employed population, those with disability ratings between one and seven showed higher annual and average income for four years than income before the industrial accident (p<0.0001). However, for the unemployment group and others showed lower annual (p<0.0001, p<0.0001) and average income (p=0.0004, p=0.0003).

A regression analysis to see changes in income after the industrial accident showed that the group with a disability rating of 11-14 and no injuries had a suffered a greater income decrease than those with a disability rating of 1-3 (p=0.0262, p=0.0161), and the unemployment group saw a greater decrease in income than the employment group that had participated in economic activities (p<0.0001).


Workers who were affected by industrial accidents received lower incomes than before the accident, and even considering the different disability ratings, there was a greater decrease in income among the unemployed group than in the working group.

Earnings Recovery Following Permanent Impairment from a Work Injury

Emile Tompa, Cam Mustard, Qing Liao

Institute for Work & Health, Canada


Permanent impairment from a work injury can seriously compromise short- and long-term labour-market earnings. Knowledge on characteristics that bear on better or worse outcomes can help better target return-to-work supports. We investigate the determinants of labour-market earnings recovery of a recent cohort of workers’ compensation claimants with permanent impairments from Ontario, Canada.


This study is based on a linkage of workers’ compensation claims data to longitudinal earnings data from tax files. Upwards of 95% of working age adults file taxes, so the linkage is highly representative of the workers’ compensation sample frame. The statistical analysis draws on two approaches: a matching of claimants with uninjured controls, and regression modelling of the determinants of post-accident labour-market earnings recovery. This outcome was based on a comparison of post-injury earnings of claimants with the average post-injury earnings of their matched controls.


As might be expected, earnings recovery was lower for higher levels of impairment severity. Earning recovery increased with years post-injury for claimant who were middle aged at baseline, but not for other age brackets. Higher pre-injury earnings levels were also associated with higher earnings recovery, but only for some age brackets. This variable may proxy for human capital. Claimants having a manual occupation experienced lower earnings recovery when compared to claimants with mixed or non-manual occupation, but only for some age brackets. Lastly, some types of injuries were found to be associated with higher or lower earnings recovery.


Knowledge on the determinants of earnings recovery provides valuable information to workers’ compensation authorities and other service providers to assist with better targeting return-to-work supports. Matching claimants with contemporaneous uninjured controls provides a powerful method to distinguish between the impact of impairment versus other contextual factures on labour-market earnings recovery.

The Impact Of Income Support Systems On Healthcare Quality And Functional Capacity In Workers With Low Back Pain: A Realist Review

Michael Di Donato, Ross Iles, Tyler Lane, Alex Collie

Monash University, Australia


Low back pain (LBP) is a leading cause of work disability. While absent from work, workers with LBP may receive income support from a system such as workers’ compensation or social security. Current evidence suggests that income support systems can influence recovery from LBP, but provides little evidence as to why and how these effects occur. This study examines how and in what contexts income support systems impact the healthcare quality and functional capacity of people with work disability and LBP.


We performed a realist review, a type of literature review that seeks to explain how social interventions and phenomena in certain contexts generate outcomes, rather than simply whether or not they do. Five initial theories about the mechanisms of the relationship were developed, tested, and refined by acquiring and synthesising academic literature from purposive and iterative electronic database searching. This process was supplemented by grey literature searching for policy documents and legislative summaries, and semi-structured interviews with experts in income support, healthcare, and LBP.


Income support systems influence healthcare quality through healthcare funding restrictions, healthcare provider administrative burden, and allowing an employer to select healthcare providers. Income support systems influence worker functional capacity through the level of participation and share of income support funding required of employers, and through certain administrative procedures. These mechanisms are often exclusively context-dependent, and generate differing and unintended outcomes depending on features of the healthcare and income support system, as well as other contextual factors such as socioeconomic status and labour force composition.


Income support systems impact the healthcare quality and functional capacity of people with work disability and LBP through context-dependent financial control, regulatory, and administrative mechanisms. Future policy design and research efforts should consider how income support systems may indirectly influence workers with LBP via the workplace.

Benefits Of A Charter Of Partnership To Structure The Collaboration Between Researchers And Stakeholders In Work Disability Prevention: Findings From The FASTRACS Study

Sabrina Rouat1, Laure Guittard2, Julien Carretier2,3, Camille Vandame4,5, Marion Lamort-Bouché4,6, Philippe Sarnin1, Laurent Letrilliart2,6, Jean-Baptiste Fassier4,5

1GREPS EA 4163, Université Lumière Lyon 2, France; 2Health Services and Performance Research EA7425, Université Claude Bernard Lyon 1, France; 3Département cancer environnement, Centre Léon Bérard, Lyon, France; 4UMRESTTE UMR T9405, Université Claude Bernard Lyon 1, France; 5Occupational health and medicine department, Hospices Civils de Lyon, France; 6Collège Universitaire de Médecine Générale, Lyon, France


An effective participation of the stakeholders in health program planning is believed to improve the relevance, acceptability, effectiveness and sustainability of interventions. Collaborative research may help researchers and stakeholders build a shared analysis of the problem and find concordant solutions. A charter of partnership was built to structure the collaboration between researchers and stakeholders of the FASTRACS project in France (Facilitate and sustain return to work after breast cancer).


The Intervention Mapping protocol was followed to gather an intersectoral collaborative advisory board. 25 participants were selected by purposive and snowball sampling among 4 categories of stakeholders: patients and associations, healthcare professionals and facilities, workplaces and institutions (social security, health, work and employment regional authorities). Six meeting were held (2016-2018). Discussions were transcribed and qualitative thematic content analysis were performed to identify needs, values and commitments of the stakeholders and the researchers. A draft of the charter was rated by means of an e-Delphi consensus method. It was modified according to the comments of the participants, and endorsed during a plenary meeting.


The charter of partnership comprises 8 values and 4 commitments shared by the participants. It acknowledges the need of all the stakeholders and the researchers to work together. Shared and specific interests are also acknowledged. Discussions about the needs and values allowed the participants to know each other, and share their own context, strengths and limits. Benefits were an authentic input to build the logic model of the problem, define the change objectives of the intervention, and choose its components.


The next challenge is to secure and sustain the partnership during the implementation and the evaluation of the intervention, so that it may be adapted, sustained and scaled-up according to its results.

Influencing Collective Decision-Making in the Work Rehabilitation Context: An Exploration of Return-to-Work Stakeholders’ Strategies

Marie-Michelle Gouin1, Manon Truchon2

1Université de Sherbrooke, Longueuil, Canada; 2Université Laval, Québec, Canada

Objective: When return-to-work (RTW) stakeholders are in conflict, they negotiate and try to influence collective decision-making. Yet, these strategical processes are poorly documented. This study sought to explore stakeholders’ use of strategies during negotiations throughout a work rehabilitation program for musculoskeletal disorders.

Methods: We conducted a secondary analysis of an exploratory multiple-case study (N=6) that aimed at exploring collective decision-making during a work rehabilitation program. Each case included all RTW stakeholders and required a two- to six-month follow-up for deeper understanding of negotiation processes. Data were collected through observation of planned meetings (in clinical settings or the workplace), field notes, and semi-structured interviews. The first inductive analysis identified negotiated decision-making processes and their subjects (one to nine, depending on the case). We reanalyzed these negotiations inductively to identify the strategies used by stakeholders and the factors potentially influencing their use.

Results: Stakeholders were found to use three different types of strategies to influence collective decision-making: (1) shaping negotiation structure (e.g., seeking/involving allies in a meeting to gain influence); (2) fostering collaboration (e.g., gathering/disseminating information (without distortion), mediating, supporting); and (3) forcing others (e.g., distorting information, confronting, trading-off). Unlike the last two, the first type of strategy was used during stakeholders’ preparation (e.g., stakeholder ensuring that support was secured from another meeting participant). Regarding fostering and forcing strategies, in practice, both were found to be intertwined. Their use depended respectively on the stakeholders’ openness (or not) to other stakeholders’ positions, which might have been influenced by their power, concerns, expectations regarding RTW, the climate of trust, and the context (of the injury and the RTW).

Conclusion: This study furthers understanding of the complex strategical processes involved in RTW. It provides essential knowledge that could serve to facilitate RTW stakeholders’ collective decision-making, which in turn may be vital to RTW success.

The Role of Unions in Influencing the Social Organization of Return to Work

Ulrik Gensby1,2,3, Marie Laberge3,4,5,6, Ellen MacEachen3,7

1Team Arbejdsliv ApS, Denmark; 2Helix Competence Centre, Linköping University, Sweden; 3Institute for Work and Health, Toronto, Canada; 4School of Rehabilitation, University of Montreal, Canada; 5CHU Ste-Justine Research Centre, Montreal, Canada; 6CINBIOSE Research Centre, UQAM, Montréal, Canada; 7School of Public Health and Health Systems, University of Waterloo, Canada

Background: The the role of unions has been less investigated in relation to return to work (RTW). Very little is known about the type of knowledge sources and associated facilities unions use to support capacity building in RTW, and any perceived obstacles that unions encounter in playing their role during the RTW process. The objective of this study is to conduct a critical analysis of the role of unions in the social organization of RTW.

Methods: The study is an exploratory and embedded case study. A purposeful sample approach was used to select participants from various departments in a large Danish hospital. 30 participants were interviewed in five focus groups; supervisors (n=6), unions (n=6), safety representatives (n= 6), co-employees (n= 6), and re-entering employees (n=6). A theory-driven semi-structured interview guide was used to explore key themes linked to the engagement and expertise of unions and their associated facilities in the RTW process through the lens of an industrial relations approach.

Results: Unions may take different roles in the social organization of RTW. Five prominent roles were identified each representing various leverages and obstacles unions encounter in playing their role in the RTW process, but also envisioning what they could have done. Some aspects of unionized practice seem detached and scarcely expressed in the formal context of RTW policy and work disability management.

Conclusion: The results clarify how different workplace stakeholders view the role of unions in the social organization of RTW. Promoting an explicit focus on the type of expertise and knowledge sources unions can provide, and how such knowledge may facilitate or impede local RTW capacity building is a promising means to investigate further in the work disability context. Using an industrial relations approach may help researchers understand how RTW is mediated by conditions of local labour relations.

1:00pm - 2:30pmWorkers' compensation systems
Session Chair: Katherine Lippel
Session Chair: Jean-Baptiste Fassier
Room 99 

Evaluating The Impact Of Workers' Compensation Policy In Australia Using A Population Based Administrative Dataset.

Alex Collie, Tyler Lane, Shannon Gray, Luke Sheehan

Monash University, Australia


Australia has state and territory-based workers’ compensation systems that provide income support, healthcare and rehabilitation for injured and ill workers. The eleven major Australian WC systems provide coverage for over 90% of the labor force and accept approximately one quarter of a million new claims per annum. Governments commonly use changes in scheme design (most often enacted through legislative amendment) to influence WC system performance including rates of claiming, costs and return to work outcomes.


Using a national, longitudinal, case level dataset of workers’ compensation insurance claims data, we evaluated the impact of multiple, state level legislative amendments. The impact of legislative amendments in the states of South Australia (year of 2009), Tasmania (2010), Victoria (2010) and New South Wales (2012) were evaluated using interrupted time series analysis. Outcomes included volume and incidence of accepted workers’ compensation claims, employer and insurer claim processing timeframes, and duration of work disability.


Major findings include (1) the Tasmanian amendments designed to improve RTW outcomes failed; (2) the South Australian amendments designed to encourage early employer claim lodgment were partially effective; (3) the New South Wales amendments designed to ensure the financial viability of the workers’ compensation scheme reduced access to benefits and disproportionately affected workers with occupational disease and mental health conditions; (4) the Victorian amendments designed to increase benefit generosity led to an increase in claims and longer duration of disability.


Changing workers' compensation policy settings can have significant and population wide impacts including on access to benefits, claims handling and duration of disability. Study findings demonstrate both intended and unintended consequences of workers’ compensation system reform, and provide an evidence base for future reform.

International Work Disability Policy Challenges and Directions

Ellen MacEachen1, Kerstin Ekberg2

1University of Waterloo, Canada; 2Linkoping University, Sweden

Introduction: There has been a move across international jurisdictions since the 1990s to policies and programs that focus on work ability, not disability, and on strategies that encourage employment integration of people with temporary and permanent impairments. Almost 30 years later, we can reflect on those programs: their ideals, what worked, what did not work and why. This presentation describes a synthesis of key challenges and directions in work disability policy derived from a recent edited volume, The Science and Politics of Work Disability Prevention.

Method: Key work disability scholars from 13 countries assembled in Toronto in 2017 to share knowledge about work disability conditions, policies and practical social, economic and political realities of work integration. Each addressed work disability policies in their jurisdiction, current issues and practices, and avenues for change. This resulted in a book edited by MacEachen published by Routledge in late 2018. The final chapter of this book compared, contrasted and synthesized issues raised about the 13 countries.

Results: Across countries, rising levels of disability claimants were a concern, together with increasing work absence due to mental illness, work disability in ageing populations, and limited social protection for self-employed workers. Many systems were redesigned in recent years to address these and other issues using strategies including program coordination, tightened timelines, eligibility restrictions, and reduced income and health care support for sick listed workers. Employer activation, management of non-severe impairment, and the timing of work activation processes were locations of developing and disparate policies.

Conclusion: More tracking is needed of employment outcomes for people who receive or are declined support. Strategies for successfully engaging employers and health care providers in work integration are still developing. Areas of emergent concern are effects of quality of the claimant encounter with providers and approaches to support the growing “self-employment economy”.

Disability Assessments in Two Australian Injury Compensation Systems: Key Informant Perspectives

Beth Kilgour, Genevieve Grant, Liz Sutton

Faculty of Law, Monash University, Australia

Disability and medical assessments play an important role in supporting decision-making in injury compensation systems. Despite this, they have long been the subject of controversy. Costs, delays and negative client experiences are chief subjects of criticism, and these issues are magnified in disputed claims. Adversarialism can contribute to an evidence ‘arms race’ between claimants and insurers or authorities, often spurring repeat examinations and increasing claim duration and costs.

There is surprisingly little published research on practices surrounding the generation and use of disability assessments in Australian compensation settings. The most prominent strand of research on assessment practice has documented the challenges from the claimant perspective. There is far less understanding of the perspectives of the evidence producers (assessors) and users (eg claims decision-makers, lawyers and healthcare providers). There is a pressing need to improve the evidence base in this area to improve assessment practice and scheme decision-making and, in turn, outcomes for claimants.

This presentation draws on focus groups and interviews with key informants in two Australian injury compensation systems. Established assessment practices are examined, highlightng issues of quality, reliability and independence of assessments, and the relationship between repetitive assessments, claim duration and claimant recovery and return to work. Preferred methods of assessment and the development of novel assessment practices are also presented. The roles and responsibilities of key medical, legal and claims management actors are explored, and the chief barriers to improved practice in disability assessment in Australia are identified.

Increased Benefit Generosity And The Impact On Claiming Behaviour: An Interrupted Time Series Study In Victoria, Australia

Tyler Jeremiah Lane, Shannon E Gray, Luke Sheehan, Alex Collie

Monash University, Australia


To measure the effect of legislated increases to workers’ compensation benefits on claiming behaviour.


Controlled interrupted time series of workers’ compensation claims in Victoria, Australia (2008-2012), assessing 1) the overall effect of the legislation and 2) raising the wage replacement cap on higher earners, in total and by condition type.


Overall claiming increased 12.9% (p = .006) and disability duration increased 5.5% (p = .005), driven largely by musculoskeletal condition claims. Mental health claims’ disability durations decreased 9.7% (p = .008). Among higher earners, claiming increased 7.8% (p = .015) and disability durations 8.7% (p < .001). Claiming for mental health conditions decreased 15.8% (p = .017) and disability duration among fracture claims increased 49.6% (p < .001).


Findings mainly align with existing evidence: more generous benefits increase claiming and disability durations. Among higher earners, unexpected findings among specific conditions suggest complex interactions between injury type, earnings, and benefit generosity.

Does Region of Residence Matter for Return-to-Work After Work-Related Injury? A Multilevel Analysis of Six Canadian Workers' Compensation Jurisdictions

Robert Macpherson1, Hui Shen1, Mieke Koehoorn1, Benjamin Amick2, Alex Collie3, Peter Smith2, Christopher McLeod1

1University of British Columbia; 2Institute for Work & Health; 3Monash University

Background & Objectives: To investigate whether there are regional differences in return-to-work following work-related injury and whether these differences persist after adjusting for individual characteristics.


Cohorts of injured workers from six Canadian provinces were analysed using claim-level data for work-related injuries occurring between 2011 and 2015. Work disability duration was measured using cumulative days that claims received work disability benefits during one-year post-injury. Multilevel log-linear random intercept models were used to separate out the variance of individual and regional-level variation in work disability duration, adjusting for confounders. Geographical Information Systems software was then used to map the unadjusted and adjusted average work disability days paid.


The cohort included 746,029 work disability claims nested within 46 economic regions across six provinces in Canada. The average work disability days ranged from a high of 45.3 days in Edmundston-Woodstock (New Brunswick) to a low of 21.6 days in Ottawa (Ontario). Regional variation was greatest in the transportation sector and smallest in the health care sector. Adjusting for various demographic, employment, and injury characteristics, 6.6% of the total variability could be explained by economic-region variability. When adjusting for workers’ compensation jurisdiction, total variability explained by economic region decreased to 0.4%.


Regional variations in work disability duration remain after accounting for individual differences at the regional level, such as demographics and industry. Variation at the level of the economic region was not as great as variation at the level of the provincial workers’ compensation jurisdiction. These findings suggest that provincial differences in the provision of workers’ compensation may be more important than smaller regional differences.

Identifying Industry Intelligence Related to Providing Targeted Care

Ross Iles1, Debbi Long2, Sunita Bayyavarapu3, Francesca Stewart1

1Monash University, Australia; 2RMIT University, Australia; 3Institute for Safety, Compensation and Recovery Research, Australia

Background: Targeted care is the use of individual-level information to identify an approach of care that would not have occurred had the initial information not been collected or analysed. Targeting care involves collecting, interpreting and acting on information specific to those in need of care. This project aimed to identify current industry thinking and practice related to implementation of targeted care following accident or injury.

Methods: Structured interviews were conducted with 21 key informants from 14 Australian organisations including compensation authorities, compensation insurers and life insurers. Interviews focused on factors related to the implementation of targeted care approaches.

Results: Targeted care is a topic of great interest to the industry in general, and significant industry intelligence exists related to this area. However, there are few examples where organisations feel they have found the best solution. While access to data had generally increased, data driven approaches to achieving targeted care appeared to incorporate a large number of variables that in practice are hard to collect, or require long and complex collection methods. There was focused activity within the industry to identify clients who need little or no intervention. This has the potential to provide savings to allow more resources to be focussed on complex cases. There was agreement about the importance of staff engagement. Changes to case manager practice were reported to be genuinely difficult. Even when pilot programs demonstrated success in an approach to service delivery, challenges remained in expanding this to wider business practices.

Discussion: The success or failure in improving client outcomes does not seem to be related to a particular model or a specific approach. Some of the factors which may act as barriers or facilitators identified in this report are: complexity, time pressures, communication approaches, organisational capacity, information, and changing healthcare and industry context.

1:00pm - 2:30pmWorkplaces and managers
Session Chair: Chris Jensen
Session Chair: Janne Skakon
Room 95 

The Role Of The Employer In Supporting Labour Participation Of Workers With Disabilities: A Systematic Literature Review

Joke Jansen1, Raun Van Ooijen2, Pierre Koning3, Cécile R. L. Boot4, Sandra Brouwer1

1Department of Health Sciences, Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, The Netherlands; 2Department of Health Sciences, University Medical Center Groningen, Department of Economics, Econometrics and Finance, University of Groningen, The Netherlands; 3Department of Economics, Vrije Universiteit Amsterdam, Leiden University, The Netherlands; 4Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health research institute, The Netherlands

Background: Workers with disabilities often continue to work despite their disabilities. The employer is an important determinant in supporting continued employment. It is of key concern to know which employer characteristics (e.g. supervisor support) and practices (e.g. work accommodations and disability policies) are effective in supporting continued employment of workers with disabilities.

Objective: The aim of this study is to provide a systematic overview of the peer-reviewed literature on employer characteristics associated with labour participation of workers with disabilities, using an interdisciplinary perspective.

Methods: To identify relevant studies a systematic literature search was conducted in the databases PubMed, Web of Science, PsycINFO and Econlit. We included longitudinal observational studies reporting on workers with a health condition or disability. The studies include determinants at employer level (e.g. work accommodations and support) in relation to the outcome variables: labour participation, work functioning, absenteeism or return to work. We describe which employer determinants affect work outcomes of workers with disabilities and discuss whether this differ by type of disease, age, gender and between different countries.

Results: The database search identified 4453 studies. The review is in progress, and based on the first 3000 studies, we have now included 40 full texts. Based on the results of the first studies, employer characteristics and practices in these studies can be divided into four broader groups of employer determinants: (i) company characteristics, (ii) the psychosocial work environment (iii) company policies and practices, and (iv) work accommodations.

Conclusion: This review identified a large variety of employer characteristics on different levels associated with labour participation of workers with disabilities. The full results of this systematic review will be available at the conference.

Factors for a Successful Leadership for a Sustainable, Healthy Working Life

Sara Larsson Fallman1,2, Lotta Dellve1,2,3, Agneta Kullén Engström1

1Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Sweden; 2School of Technology and Health, KTH, Royal Institute of Technology, Stockholm; 3Departure of Sociology and Work Science, University of Gothenburg, Sweden


Aim: The aim of the study is to explore leadership and organizational factors that are of importance for a sustainable work situation with low sick-leave absence, among employee in health care.

Background: Sickness absence and illness have increased in general in Sweden during the last years, and especially within health care sector. Since the 1990’s Sweden, as many other countries in Europe, have introduced economic models that derives from the private sectors to operate in health care, in order to cut unnecessary cost and become more effective. Focus on increased quality in care and at the same time to decrease cost has led to higher pressure on the employee in health care whit rising sick-leave. Therefor it’s important to explore what factors that contributes to maintain a healthy work force.

Method: The study has a qualitative design. The sample consists of eleven first-line managers at two hospitals in Sweden and content analysis was used to analyze the interviews with first-line managers responsible for a ward or a unit. Based on sick-leave data on unit level, units with low or declining sick-leave numbers were identified and the managers’ responsible for that unit were contacted to ask about participation in the study.

Results: Three themes and ten subthemes were identified: Leadership style, organizational structure and economic prerequisites. A servant leadership among managers’ as well as a flexible organizational structure with possibilities to increase staff or decrease the amount of patient, and economic prerequisites where managers could exceed the budget was according to the managers’ successful parts that contributed to a sustainable, healthy workforce.

Conclusion: The result in this study suggest that to maintain a healthy and sustainable workforce with low sickness absence it requires a combination of different strategies that involves leadership factor as well as organizational and economic prerequisites.

Adaptation of a Guide to Equip Employers to Manage the Gradual Return to Work of Individuals with a Musculoskeletal Disorder

Julie Bouffard, Marie-José Durand, Marie-France Coutu

Université de Sherbrooke, Canada

Purpose: The gradual return to work (GRTW) of injured workers poses numerous challenges for workplaces. The aim of this study was to provide employers with an adapted tool to support them in managing GRTWs following a musculoskeletal disorder (MSD), by adapting the Guide for estimation of margin of manoeuvre and then establish its acceptability.

Methods: A mixed methods design was used in three phases. 1) The original tool was adapted by taking into account the results of a critical review of the literature on the characteristics fostering adoption of guides by potential users (PUs). 2) Experts practitioners were surveyed about the content and form of the adapted tool. Proposed modifications were then discussed in a group meeting, until consensus was reached on the changes to be made. 3) The acceptability of the latest version was established by conducting semi-structured interview of PUs. A thematic analysis of the verbatim transcript was performed.

Results: 1)From 13 publications, four main characteristics (clarity, format, applicability, and usefulness) were identified from the critical review. 2) Nine occupational therapists expert reached a consensus on 20 modifications, which yielded a second version of the adapted tool comprising an instruction guide and a planning worksheet. 3) The 15 PUs consulted found the tool acceptable overall. They recognized that it allowed them to standardize the management of the GRTW and operationalize the best return-to-work practices. They also identified a few minor changes to make, including recommendations for preparing colleagues and shortening the format.

Conclusion: This study provided a tool that was designed and adapted to employers, taking into account both evidence-based data and expert consensus, which seems to have contributed to its acceptability. The adapted tool fills a real need within companies and further studies could be carried out to improve its format and create a transdiagnostic version.

Workplace Practices and Policies to Support Workers with Physical and Mental Health Conditions: Bridging Research-to-practice Knowledge Gaps

Emma Irvin, Kim Cullen, Dwayne Van Eerd

Institute for Work & Health, Canada

Introduction: For more than a decade, the Institute for Work & Health (IWH) has produced a series of systematic literature reviews to identify the most effective workplace approaches to support return-to-work, stay-at-work, and recovery for workers with physical and mental health conditions. However, information gaps remain, posing challenges for workplace parties to implement these programs.

Methods: The current project adapts a model for evidence-informed decision-making that was pioneered by David Sackett for the clinical sciences, to address current research-to-practice knowledge gaps in work disability prevention. Our adaptation of the model considers the best research evidence and integrates it with evidence collected from practitioner expertise and worker experiences to better inform research-to-practice. In addition, IWH and Memorial University have developed a contextualization approach. The evidence gathered and synthesized using these unique approaches allows us to answer the following questions: what works?, will it work here? and, how can we implement this in workplace practice?

Results: Results highlight the impact of this innovative evidence-informed decision-making model as a method to bridge research-to-practice knowledge gaps in work disability prevention. Evidence-based products from two projects, on supporting workers with physical and mental health conditions, illustrate a useful approach to synthesizing and disseminating effective workplace policies and practices.

Conclusion: This primary strength of our approach resides in the use of three sources of evidence: research findings, practitioner expertise and stakeholder experiences. This body of work has advanced our understanding of how workplaces can help their workers remain at or transition back to work successfully after an injury or illness, has influenced key stakeholders in Canada’s workplace health and safety communities, and has led to the development of guides for practice. The full integration of these evidence sources enhances the opportunity for optimal work disability prevention efforts across the life course.

Workplace Practices and Policies to Prevent MSD Disability: Synthesizing Evidence from Workplace Parties.

Dwayne Van Eerd, Kim Cullen, Emma Irvin, Morgane Le Pouésard

Institute for Work & Health, Canada

Introduction: Musculoskeletal disorders (MSD) continue to be a major burden for workplaces and workers as well as insurance and health systems. Evidence-informed approaches are desired but research-to-practice gaps remain. One reason for gaps is the necessary research of sufficient quality is often not available. However, evidence-informed practice considers both scientific evidence as well as practitioner expertise. Our objective is to synthesize evidence from the scientific literature, practice evidence (policies and practices), and experiences from stakeholders.

Methods: Evidence from practitioners’ expertise and worker experiences was collected using a web-based survey, focus groups, and interviews with representatives from various stakeholder groups from multiple sectors. We adapted the Public Health Agency of Canada’s best practices portal to structure data collection of workplace practices and policies. Research evidence was gathered from recently completed systematic reviews. Three sources of evidence (research findings, practitioner expertise and stakeholder experiences) are synthesized in this project.

Result: Survey results (n=440) reveal a range of disability prevention practices are in place at various workplaces. However, responses reveal workers and managers do not have similar experiences related to MSD. Recent systematic review results revealed strong evidence that multi-domain interventions encompassing at least two of health-focused, service coordination, or work modification interventions reduced duration away from work for MSD. However the level of evidence was lower for many other interventions. Interview/focus group data (n=28) reveal innovative approaches as well as important implementation challenges.

Discussion: The presentation will focus on current policies and practices described by practitioner and workplace participants as compared to the scientific evidence. The discussion will outline the synthesis of evidence and co-creation (with OHS stakeholders) of a practical guide to help workplaces develop and implement effective practices and policies to help workers with MSD return to work safely.

3:00pm - 3:45pmKeynote IV: Keynote IV Allard J. van der Beek
Auditorium 100 
3:45pm - 5:15pmEarly carrier researchers' presentations AWARD session
Auditorium 100 

Subgroups Of At-Risk Workers With Chronic Physical Health Conditions: From The MANAGE AT WORK Randomized Controlled Trial

Susan E. Peters1, William S. Shaw2

1Harvard Center for Work, Health and Wellbeing, Harvard T.H. Chan School of Public Health, Boston, MA, U.S.A.; 2Division of Occupational and Environmental Medicine, Department of Medicine, University of Connecticut, Farmington, CT, U.S.A.

Introduction: Chronic healthconditions can be difficult for employers to manage using formal administrative procedures and strategies, as functional abilities vary from person-to-person. One possibility for reducing the effects of these conditions is to identify subgroups of workers with different symptom patterns and work situations. This could provide greater understanding for underlying factors influencing their work difficulties and could inform tailored interventions, based on their profiles, to better help workers manage their symptoms at work. This study’s purpose was to discern meaningful clusters of workers from the MANAGE AT WORK trial,[1] that might be used for stratified analysis of intervention effects.

Methods: This study utilized a secondary analysis of an employer-sponsored psycho-educational group intervention program designed to improve workplace functioning among 119 workers with chronic physical health symptoms. We examined the heterogeneity of workers with by using k-means algorithms to identify previously unknown clusters.We used an iterative process to select the measures which yielded the most clinically relevant sub-groups to determine the final number of clusters. For between groups differences, One-Way ANOVAs were performed.

Results: Four clinically meaniningful clusters were delineated by four variables: mental health, physical health, job leeway, and turnover intentions: (1) low physical and mental health with high job flexibility (21.9%); (2) high physical health problems (27.2%); (3) high mentalhealth problems (27.2%), and (4) physical and mentally distressed workers with low job flexibility and high turnover intent (23.7%). Controlling for baseline, we saw a significant improvement in the highest risk group, compared to the other groups for six-month outcomes including work engagement(p<0.001), and at 12 months for work engagement(p=0.002) and work limitations(p=0.014).

Conclusion: Subgrouping provided an enhanced understanding of workers’ characteristics and needs, which could explain differences in treatment response in the MANAGE AT WORK trial.

1- Shaw WS. et al(2014). BMC Public Health,14(1),515-525.

"Do Self-perceived Impairments Correlate With Physician Assessed Functional Limitations In Workers With Subjective Health Complaints And Other Disorders?"

Kristel Weerdesteijn

KCVG, Netherlands, The


The purpose of this study was to study the extent in which physicians take workers’ self-perceived impairments into account during their medical disability assessment. We studied the correlation and association between self-perceived impairments and physician assessed functional limitations in general and between workers with subjective health complaints and those with other disorders.


A prospective cohort study was conducted among 2,593 workers, who were sick-listed for more than 84 weeks. Workers were included in the study if they had a score of five points or more on the Patient Health Questionnaire-15. Participants filled in a validated questionnaire. The outcomes of the questionnaires were calculated and divided in 11 subscales. Out of all participants 2,040 participants received a medical disability assessment in which functional limitations and diagnoses were reported by physicians. The functional limitations were categorised and converted into four groups. The 11 subscales on the questionnaires were compared with the four groups of functional limitations.


363 participants were diagnosed with subjective health complaints, and 1677 with other disorders. For two functional limitations groups and for six subscales a statistically significant moderate correlation and association was found in general. The associations between the physical functional limitation group and the SF-36 physical subscale, and the psychological functional limitation group and the SF-36 mental subscale showed to be different between participants with Subjective health compliants and other disorders. The associations were higher for the participants with other disorder, but the association remained statistically significant for both groups.


Self-perceived impairments showed an overall moderate agreement with physician assessed functional limitations, which indicate that physicians only partly rely on workers’ self-perceived impairments during their medical disability assessment. For workers with more objective disorders physicians seem to rely to a greater extent on the self-perceived impairments than for workers with subjective health complaints.

Supporting Employers during Return-to-work of Employees with Cancer; Development of an Online Intervention using the Intervention Mapping Approach

Michiel A. Greidanus1, Angela G.E.M. de Boer1, Corine M. Tiedtke3, Monique H.W. Frings-Dresen1, Angelique E. de Rijk2, Sietske J. Tamminga1

1Amsterdam UMC, University of Amsterdam, Coronel Institute of Occupational Health, Amsterdam Public Health research institute, Amsterdam, The Netherlands; 2Maastricht University, Department of Social Medicine, CAPHRI, Maastricht, The Netherlands; 3Katholieke Universiteit (KU) Leuven, Department of Public Health & Primary Care, Leuven, Belgium

Employers play an essential role during return-to-work (RTW) of employees with cancer. However, employers also express a need for support to fulfil this role. Adequate employer support might be the missing link for RTW of employees with cancer. The purpose of this project is therefore to develop a RTW intervention targeting employers, with the aim of optimising RTW of employees with cancer.

The Intervention Mapping approach was used to develop an intervention targeting employers. Firstly, a needs assessment was conducted based on (1) interviews with Dutch employers (n=30) on their role and needs during RTW of employees with cancer, (2) a systematic review on perceived employer-related barriers and facilitators for work participation of employees with cancer, and (3) a Delphi study with employees with cancer (n=29) and employers (n=23) to select the most important employer-actions for successful RTW of employees with cancer. Secondly, objectives were specified and practical strategies were chosen based on interviews with eHealth experts (n=8).

Employers indicated that they require tailored support during different RTW phases: (1) disclosure of cancer, (2) employee’s treatment, (3) RTW plan and (4) actual RTW. A plurality of employer-related barriers and facilitators for work participation of employees with cancer were perceived by employers and employees. These barriers and facilitators were synthesised and then prioritised into the most important employer-actions, e.g. ‘communicate’, ‘support practically’ and ‘access work ability’. Subsequently, an online toolbox consisting ‘to-the-point’ tips and interactive videos was developed, supporting employers with the most important employer-actions, with the aim of optimising RTW of employees with cancer.

An online toolbox has been developed with input from various studies with different stakeholders. By involving different stakeholders, the online toolbox is expected to fit employers’ needs and be feasible in practice. Future research should evaluate its utility and acceptability among employers.

Is Patient Activation Related To Self-efficacy And Workplace Self-management Of Employees Affected By Long-term Health Conditions?

Sally Elizabeth Hemming

Loughborough University, United Kingdom

The number of people affected by long-term health conditions is rising rapidly, forecast to increase in the UK to 2.9 million. Moreover, by 2024 there will be 1.2 million people 65 or overwith age-related health risks. Many people affected by health conditions are working with implications for their work ability and employers. People with conditions provide much of their care themselves and self-management is related to positive health outcomes. This cross-sectional survey study identified prevalent health characteristics in a working population, self-management behaviours and patient activation levels. Patient activation is concerned with the knowledge, skills and confidence people possess to self-manage. It was hypothesised that those with conditions and high activation will experience more self-efficacy. Self-efficacy has consistently been shown to have a critical effect on self-management. Seven hundred and one employees completed an online survey. Forty-three per cent of participants (n=301) reported being affected by a health condition of which the majority were female (n=232). Mental health (n=108), musculoskeletal (n=83) were most prevalent, 111 participants were affected by ‘other’ conditions. Particularly, the survey utilised the 13-item Patient Activation Measure to (PAM®) people’s engagement with self-management. Preliminary analyses looked at relationships between variables using correlation coefficients. A positive relationship was found between PAM and self-efficacy. A simple linear regression was performed with self-efficacy as the dependent variable, controlling for age, gender and education. A significant relationship was found between PAM and self-efficacy (p<.000). These preliminary results reinforce the relationship between patient activation and self-efficacy. The PAM is used by clinicians to direct people to support, which could be a useful tool for employers informing workplace interventions. Further analyses of study variables will be undertaken and presented.

Changes In Fear-Avoidance Beliefs And Work Participation After Occupational Rehabilitation: A Randomized Clinical Trial

Lene Aasdahl1,2, Sigmund Gismervik1,3, Gunn Hege Marchand1,3, Ottar Vasseljen1, Roar Johnsen1, Marius Steiro Fimland1,2

1Norwegian University of Science and Technology ,NTNU, Norway; 2Unicare Helsefort Rehabilitation Centre; 3St. Olavs Hospital, Trondheim University Hospital

Introduction: To assess whether inpatient occupational rehabilitation reduce fear-avoidance beliefs about work and physical activity (FABQ) more than outpatient cognitive behavioral therapy, and whether changes in fear-avoidance beliefs are associated with future work participation.

Methods: Two randomized trials including workers sick listed 2-12 months with musculoskeletal-, common mental health- and unspecific disorders. Participants were randomized between an inpatient multicomponent program lasting 4+4 days or a group based cognitive behavioral therapy program (6 sessions during 6 weeks) (trial 1), or between an inpatient program lasting 3.5 weeks or the same outpatient program (trial 2). The between-group change in FABQ during 12 months of follow-up were assessed using linear mixed models for the two trials separately. Associations were evaluated using linear regression.

Results: In total, 334 participants were included in the two trials (trial 1:168, trial2: 166). There were no significant differences in FABQ scores between the programs during 12 months of follow-up. Participants with consistently low scores on the work subscale had most work participation days; those with consistently high scores had 57 fewer days (95% CI -77 to -37). Participants who reduced their scores had 23 workdays less (95% CI -52 to 5) than those with consistently low scores, while those increasing their scores had 54 fewer workdays (95% CI -89 to -18). FABQ work scores at baseline was associated with number of work participation days during 9 months of follow-up for both musculoskeletal and psychological diagnoses.

Discussion: This study provided no support that inpatient occupational rehabilitation reduces FABQ scores more than outpatient cognitive behavioral therapy. The changes in FABQ were associated with future work outcomes, suggesting it can be a useful tool in the clinic. Although FABQ was developed for patients with low back pain, our results suggest that it also can be useful for participants with psychological disorders.


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