Conference Agenda

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

Session Overview
Date: Friday, 07/Jun/2019
8:00am - 9:00amBusiness meeting: Business meeting of the International Commission on Occupational Health (ICOH) Scientific Committee on Work Disability Prevention & Integration (WDPI).
Session Chair: William Shaw
Session Chair: J.R. Anema
All are invited to attend
Room 96 
9:00am - 9:45amKeynote V: Keynote V Katherine Lippel
Auditorium 100 
9:45am - 10:15amRound Table: Round Table
9:45am - 10:15amWDPI2021: Announcement of WDPI2021
Auditorium 100 
11:00am - 12:30pmCancer and Multiple Sclerosis
Session Chair: Sandra Brouwer
Session Chair: Sara Larsson Fällman
Auditorium 100 

A Systematic Review of the Definitions, Measures, and Study Designs in the Cancer and Employment Literature

Janet S de Moor1, Deborah Korenstein2, Brooke Barrow2, Erin F Gillespie2, Devika R Jutagir2, Konstantina Matsoukas2, Denise Pergolizzi2, Kelly M Shaffer3, Bridgett H Thom2, Victoria Blinder2

1National Cancer Institute, United States of America; 2Memorial Sloan Kettering Cancer Center; 3University of Virginia School of Medicine

Background: A growing literature suggests that cancer frequently leads to work limitation and job loss. However, the definition and measurement of employment outcomes and study methodology varies widely. To inform the development of a common taxonomy of work outcomes, a systematic review was conducted to characterize the measures and methods in the cancer and employment literature. Methods: 15,006 English-language articles were identified using 30 key words and 9 MeSH terms describing cancer and work. Review of the titles and abstracts and a subsequent full-text review identified 215 papers published after 2006 which examined employment as an outcome. Results: Multiple terms were used to describe employment outcomes. Other than employment status, the most frequently measured employment outcomes were work hours (43%), sick leave (35%), and work ability (21%). Depending on the specific outcome, 33-70% of papers failed to describe how employment was measured. When described, employment outcomes were measured using a mix of single or multiple-item scales and validated instruments. Measurement using a validated instrument was most frequent for productivity at work and least frequent for work hours. Over 94% of studies were observational, of which only 17% included a non-cancer comparison group. Comparison groups tended to be drawn from national registries (42%), population-based surveys (32%), or the same survey from which the cancer survivors were drawn (23%). Conclusions: The development of standardized definitions and metrics for work outcomes are needed to support research about the magnitude and duration of cancer-related work limitations and the effectiveness of interventions. Whenever possible, observational studies should incorporate a non-cancer comparison group to adjust for natural age-related changes in employment and secular labor market trends. Additional research is also needed to develop and test interventions to improve work outcomes among cancer survivors.

The Capability Set For Work In Workers With Multiple Sclerosis

Dennis Van Gorp2,3,4,5, Jac Van Der Klink1, Karin Van Der Hiele2,3,4

1University of Tilburg; Tilburg School of Social and Behavioral Sciences, Netherlands, The; 2National Multiple Sclerosis Foundation, Rotterdam, Mathenesserlaan 378, 3023 HB, The Netherlands; 3Department of Psychology, Section Health, Medical and Neuropsychology, Leiden University, Leiden, PO Box 9555, 2300 RB, The Netherlands; 4Department of Neurology, Elisabeth-TweeSteden Hospital, Tilburg, PO Box 90151, 5000 LC, The Netherlands; 5Department of Care Ethics, University of Humanistic Studies, Utrecht, PO Box 797, 3500 AT, The Netherlands

Background: Multiple Sclerosis (MS) is a chronic disorder of the central nervous system, often diagnosed in young or middle adulthood. Work participation is often compromised in individuals with MS. The aim of the current study was to examine whether work capabilities differ between workers with Multiple Sclerosis (MS) and workers from the general population. The second aim was to investigate whether the capability set was related to work and health outcomes

Methods: A total of 163 workers with MS from the MS@Work study and 163 workers from the general population were matched for gender, age, educational level and working hours. All participants completed online questionnaires on demographics, health and work functioning. The Capability Set for Work Questionnaire was used to explore whether a set of seven work values is considered valuable (A), is enabled in the work context (B), and can be achieved by the individual (C).

Results: Despite lower physical work functioning, lower work ability and worse self-reported health workers with MS had a larger capability set than the general population and found the seven work values more important (A), were more enabled in the work context (B) and more able to achieve (C) than workers from the general working population.
In workers with MS, a larger capability set was associated with better flexible work functioning, work ability, self-rated health and with less absenteeism, presenteeism, cognitive/neuropsychiatric impairment, depression, anxiety and fatigue.

Conclusions: Workers with MS rate work values as more important and have a larger capability set than workers from the general population. A larger capability set was related with better work outcomes in all workers and better health outcomes in workers with MS. Workers with MS felt they were given more opportunities (B) and were actually able to achieve work values better (C), compared to the general population.

Everybody Benefits: Linking Private Investors To Occupational Healthcare In An Early Return To Work Intervention For Cancer Patients

Martine P. van Egmond1, G. Lennart van der Zwaan1, Hanneke J.W. van der Meide2, Margot C.W. Joosen2,3, Anna Geraedts4, Willem van Rhenen5, Roland Blonk1,2

1TNO, Institute for Applied Research, Leiden, The Netherlands; 2Tranzo, Scientific Center for Care and Welfare, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, the Netherlands; 3Department of Human Resource Studies, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, the Netherlands; 4HumanTotalCare/ArboNed, Utrecht, The Netherlands; 5Nyenrode Business University, Breukelen, The Netherlands


Funding rehabilitation interventions for patients with cancer and other chronic illnesses is challenging across Western countries. The investments and profits of such interventions are unevenly distributed among stakeholders, contributing to a hesitancy in public and private partners to invest. Furthermore, investments by commercial parties is, rightfully, a matter of public debate, as patients’ wellbeing should not compete with profits. On the other hand, public funds for interventions and research have a ceiling, which inhibits the pace of innovation in work disability prevention. This is particularly evident in the need to develop new interventions for cancer patients, where a steep climb in survival rates has opened up a whole chapter of work-related challenges because of treatment-induced long-term and chronic health problems. Research is well on its way in this area, but in order to increase work participation in cancer patients, new interventions as well as innovative funding are essential.

The focus in this study is two-fold. We combine the design and evaluation of an early-return-to-work intervention for cancer patients with an innovative health impact bond that contains investors, a bank, an insurer, and an occupational healthcare provider. They invest in the intervention together and share profits of return to work. Return to work is the main goal of the intervention, which was designed to accompany cancer patients through stages of grieve, treatments and recovery, and is offered in an occupational healthcare setting. Both the intervention (in a controlled trial) and the health impact bond (using mixed-methods) will be evaluated.

Added value

This study contains two innovative elements: a new intervention and an innovative way of funding the intervention. During our presentation, we would like to inform and discuss with fellow researchers on the practical and moral aspects of health impact bonds and similar constructs in work disability prevention research.

Prognostic Accuracy Of A Screening Instrument Predicting Future RTW Chance Of Patients With Chronic Diseases

Marco Streibelt1, Matthias Bethge2

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


The effectiveness of rehabilitation depends on the individual non return to work (RTW) risk. Therefore, a risk score (SIMBO) was developed to predict the future RTW chance supporting the referral management. The study tested the diagnostic accuracy of the SIMBO (0 to 100 points) and, as a result, provided evidence for the main diseases in rehabilitation.


Patients in the rehabilitation setting (18 to 65 years) were included. Data were obtained from questionnaires at admission and 3 months after rehabilitation. The occurrence of critical RTW events in the follow-up was the primary outcome. All analyses were weighted for age, gender and ICD-10 diagnosis group with regard to the German rehabilitation population in 2015.


Data from 2,422 patients out of nine different disease groups were included. In these groups between 9% and 47% reported critical RTW events in the follow-up (total: 35.2%). The area under curve (AUC) criteria laid between .844 and .899 (total: .891). The standardised mean differences in the SIMBO score between patients with and without a critical RTW event was 1.22 to 1.48 (total: 1.43).

Sensitivity and specificity rates varied depending on the chosen threshold. Using optimal thresholds they ranged from 74% to 93% as well as 72% to 87%. The identification of critical RTW events could be increased threefold due to the SIMBO.


The SIMBO screening predicts the non RTW risk after rehabilitation regardless of the disease group. The screening can be used as generic screening identifying patients having a high risk for a non RTW and a need for an intensified work-related rehabilitation strategy.

Successful Return-to-work of Employees Diagnosed with Cancer: Development of a Weighted Outcome Measure

Michiel A. Greidanus1, Angela G.E.M. de Boer1, Angelique. E. de Rijk2, Monique H.W. Frings-Dresen1, 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

Effectiveness of return-to-work (RTW) interventions are predominantly valued on the basis of time until RTW, with interventions aiming to shorten the period until RTW. Previous research suggest that this measure of effectiveness does not correspond with employees’ perspectives of successful RTW. This study aims to develop an outcome measure for ‘successful RTW’, based on perspectives of employees with cancer on successful RTW.

The Delphi method was used, consisting of (1) focus groups with employees with cancer (n=12), to generate a long-list of elements that may constitute successful RTW; and (2) two Delphi questionnaire rounds with employees with cancer (n=109), to shorten this long-list into a short-list of elements that are perceived to constitute successful RTW most importantly. During Delphi round two, participants selected their five most important elements. The percentage of participants that selected a certain element was calculated and the most selected elements became part of the outcome measure ‘successful RTW’.

Forty-five elements were identified during the focus groups. A considerable variance concerning most important elements was observed. The most selected elements were: ‘enjoyment in work’ (63%), ‘work without compromising health’ (48%), ‘open communication with employer’ (39%), ‘confidence of employer without assumptions about workability’ (39%), ‘feel welcome at work’ (34%), ‘good work-life balance’ (30%), ‘joint satisfaction about the work situation (employer and employee)’ (27%). The abovementioned elements were incorporated in the weighted outcome measure ‘successful RTW’.

The outcome measure ‘successful RTW’ consists of seven items representing the seven elements that constitute successful RTW most importantly according to employees with cancer. The outcome measure is tailored for each employee; the items are weighted on the basis of their relative importance for the individual. Future research should study construct validity and test-retest reliability of the outcome measure, to determine its usefulness for effect evaluation of RTW interventions.

11:00am - 12:30pmFacilitation of RTW
Session Chair: Ole Steen Mortensen
Session Chair: Tina Dalager
Room 96 

Return to Work Patterns Among Compensable Road Traffic Crash Survivors in Victoria, Australia

Shannon Elise Gray, Alex Collie

Insurance Work and Health Group, School of Public Health and Preventive Medicine, Monash University, Australia

Background: Injury sustained in road traffic crashes (RTC) can affect daily activities, including work. In the state of Victoria, Australia, people injured and unable to work due to RTC may have treatment and income support provided either through the RTC compensation system or through workers’ compensation. Prior studies have demonstrated that return to work (RTW) pathways following injury may vary between individuals. The objective of this study was to determine RTW patterns in people injured in RTC.

Methods: Using harmonised claims data from both RTC and workers’ compensation systems, accepted non-fatal claims were included for RTCs that occurred between July 1 2003 and June 30 2013 by 15-65 year olds who received at least one day of income support. Patterns of income support were identified using daily income support data. Gaps in income support were considered to represent engagement in work. Partial income support payments indicated partial RTW. For each case, particular RTW patterns were detected (e.g. transitions from full to partial to no income support aligned with graduated RTW).

Results: There were 36,640 individuals who received income support for work absence after RTC with 703 unique RTW pathways. Seventy-eight percent achieved successful RTW on the first attempt. Fourteen percent had two distinct periods of absence before successful RTW, 8% had at least three periods of absence. Six percent attempted graduated RTW, and the vast majority of these had successful RTW on the first attempt (98.4%).

Conclusions: This study utilised a novel method of converting administrative payment data to allow calculation of RTW pathways after RTC. It is important to understand different RTW pathways in order to identify groups of people that may benefit from additional support, such as by encouraging graduated RTW as graduated RTW seemed to be more successful.

The Association between Work Ability and Return to Work Following a Traffic Injury: An Examination of the Mediating Role of Modified Work

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

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

RESEARCH QUESTION: In a cohort of individuals with soft tissue injuries resulting from traffic collisions, is the association between work ability and return to work mediated by modified work?

METHODS: We used data from a population-based incidence cohort of all treated traffic injuries occurring in Saskatchewan, Canada between December 1, 1997 and November 30, 1999. Baseline data were collected when injured individuals initiated their claim with Saskatchewan Government Insurance by completing an insurance application form. All claimants completed a baseline questionnaire about the collision, health status, injury-related factors, pain, work status and socio-demographics. We created a measurement model for the latent construct of work ability and used structural equation modeling to examine its association with return to work, measured at three months. Our structural model examined the direct effect of work ability on return to work and the indirect effect through modified work in a longitudinal analysis.

RESULTS: In our final model, both work ability and modified work showed positive and significant associations with return to work. However, work ability was not associated with modified work. Work ability has a direct effect on return to work such that for every standard deviation increase in work ability the probability of return to work at three months increased by 0.05, for those not self-employed and expecting to recover soon. Overall, the probability of return to work by three months based on the mean work ability of this traffic injury population, without the provision of modified work, when not self-employed and expecting to recover soon was 0.87.

CONCLUSIONS: Modified work did not mediate the association between work ability and return to work in this traffic injury cohort. These findings suggest further examination of the employer’s role in the return to work process following a traffic injury.

Sick Listed Workers’ Experiences With Motivational Interviewing Administered By Caseworkers In The Return To Work Process. A Qualitative Interview Study.

Vegard Foldal, Martin Inge Standal, Lene Aadahl, Roger Hagen, Egil Fors, Roar Johnsen, Marit Solbjør

Norwegian University of Science and Technology, Norway


Returning to work after being long-term sick listed has been described as a process where sick listed workers may experience varying levels of motivation and self-efficacy. Resolving ambivalence and increasing motivation towards behavioral change is essential components in the counseling style Motivational interviewing (MI). There are reports that this method may be useful in the RTW process. The aim of this study was to explore sick listed workers’ experiences with MI counseling sessions in the return to work process, and to explore whether these sessions contributed to experiences of behavioral change or resolving ambivalence.


This qualitative study was nested in a randomized controlled trial evaluating the effects of MI administered by the Labour and Welfare Services on sickness absence. Semi-structured interviews were performed with sick-listed workers aged 18-60 years, sick leave status of 50-100% for at least eight weeks, and having completed two motivational interviewing sessions. Questions prompted participants to describe their experiences with their situation, follow-up, the MI sessions, changes in their lives, and thoughts on returning to work.


Eight interviews have been conducted and the data is undergoing analysis. An additional eight interviews are planned, reaching a total of 16 interviews (or until sufficient information power is achieved). Results of the analyses will be ready in December 2018.


These results will be of interest for individuals on sick-leave, clinicians, researchers and decision makers.

How Do Work Rehabilitation Interventions Facilitate the Return to Work after a Common Mental Disorder?

Chantal Sylvain1,2, Marie-Jose Durand1,2, Astrid Velasquez Sanchez1,2, Nathalie Lessard3, Pascale Maillette1,2

1Universite de Sherbrooke, Canada; 2CAPRIT, CR-CSIS Research Center, Longueuil, Canada; 3CISSS de Laval, Laval, Canada

Objectives: Major breakthroughs have been made in recent years in determining the main components of effective return-to-work (RTW) interventions after a common mental disorder (CMD). However, the mechanisms involved remain poorly understood. The aim of our project was specifically to describe, from the participating workers’ viewpoint, the mechanisms of a work rehabilitation program based on best practices.

Methods: Semi-structured interviews were conducted with workers (n=26) who had participated in a work rehabilitation program offered mainly in group format. The interviews concerned the perceived effects of the program and how these effects were brought about. The interviews were conducted by telephone, recorded and analyzed according to thematic analysis principles. Converging themes were identified and classified by component type.

Results: Seven mechanisms were identified. Four of these concerned the participants’ reactions to the intervention, and included two mechanisms pertaining to its group nature (e.g. reducing the feeling of isolation and/or of shame associated with the fact of being on sick leave for a CMD), and two pertaining to the activities carried out in groups (e.g. integrating health protective behaviours into real-life situations, particularly at work). The three remaining mechanisms pertained to the program facilitators’ behaviours (relaying information to the various parties concerned, supporting the learning of new behaviours and attitudes, and maintaining a healthy atmosphere during the group activities).

Conclusion: Some of the mechanisms identified here have been documented in previous studies with workers having other types of health problems (e.g. musculoskeletal disorders), while other mechanisms, particularly that of reducing the feeling of isolation and/or shame, appear specific to mental disorders. Our results allowed us to refine the logic model of this particular program and, more generally, to suggest avenues for reflection that could enhance understanding of why certain interventions are more effective than others in facilitating RTW post-CMD.

Do Employers Make A Difference In Supporting Employment Of Disabled Workers? Evidence From Administrative Data From The Netherlands

Raun Van Ooijen1, Pierre Koning2, Joke Jansen3, Cécile R. L. Boot4, Sandra Brouwer3

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

Background: The degree to which employers are effective in supporting continued employment of workers with disabilities is of key concern.

Objective: The aim of this study is to examine whether employers make a difference in retaining work for partially disabled workers, for example through supervisor support, work accommodation or disability policies.

Methods: We use administrative data on disability assessments from the Dutch Employee Insurance Agency (UWV) over the period 2008 until 2017. The data are merged with income records which contain monthly data on employment status as well as a company identifier to link workers to their (former) employer. Our sample contains detailed information on disability assessments of all 117,365 partially disabled workers with a permanent contract who did not fully return-to-work after a two-years period of sick leave in 22,530 companies with at least two assessed workers.

We compare a disabled worker’s own employment outcome with the employment outcomes of its disabled co-workers using a linear probability model. The intuition underlying this approach is that if an employer wants to ensure that partially disabled workers remain employed, they put more effort in retaining them. If the employer policies or features are effective, we would expect that the employment outcomes of disabled workers and co-workers are positively associated.

Results: our preliminary results show that employment outcomes of disabled (former) co-workers are positively associated with a disabled workers own employment outcome. The effect remains sizeable (β=0.28, 95% CI [0.26, 0.30]) after controlling for an extensive set of employer characteristics (i.e. sector, size and workplace composition) and employee related confounders, including sociodemographic variables and disease types. The role of the employer seems largest for musculoskeletal and mental diseases and smaller for cancers.

Conclusion: The analysis suggests that employers do make a difference in supporting employment of disabled workers, particularly on hard-to-verify diseases.

Can Fear of Disease hinder Return to Work for Sick-listed Employees?

Randi W. Aas1,2,3, Lise A. Haveraaen1,3, Randi T Tou1,3

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

Background: Few studies has investigated if fear of disease is common among sick-listed employees. The aim of this study was to assess the prevalence of fear of disease and the association between fear and return to work (RTW) in a sample of sick-listed employees, participating in different return to work programmes in Norway.

Methods: 340 sick-listed employees participated in the study. Self-reported fear was linked to national register data on sickness absence. Descriptive statistics and adjusted logistic regression analyses were used to analyse the material.

Results: 48% reported regular experience of fear before the programme started; 32% reported fear during the programme (p < .001). Regular experience of fear before (OR = .429, 95% CI: .196 - .939) and during (OR = .352, 95% CI: .153 - .807) the programme reduced the probability of working three months after the programme had ended.

Conclusion: Fear of disease can reduce the employees RTW-rates and should therefore be addressed in RTW-programmes.

11:00am - 12:30pmOccupational health care
Session Chair: Cécile R. Boot
Session Chair: Marion Lamort-Bouché
Room 95 

Healthcare Provider Communication And The Duration Of Time Off Work Among Injured Workers: A Prospective Cohort Study

Tyler Jeremiah Lane1, Rebbecca Lilley2, Ollie Black3, Malcolm R Sim1, Peter M Smith1,4

1Monash University, Australia; 2Univeristy of Otago, New Zealand; 3Deakin University, Australia; 4Institute for Work and Health, Canada


In addition to biomedical treatment, healthcare providers (HCPs) may make psychosocial contributions to injured workers that aide rehabilitation and the return to work (RTW) process. We examined the effect on disability duration of several types of HCP communications with injured workers and stakeholders in the RTW process.


To test the effect of various HCP communications on time off work following injury.

Research Design

We analysed survey and administrative claims data from n = 715 injured workers in Victoria, Australia. Survey responses were collected around five months post-injury and provided data on HCP communication and confounders. Administrative claims data provided data on compensated time off work. We conducted multivariate zero-inflated Poisson regression analyses, which evaluated both the likelihood of future time off work and its duration.


HCP communications included good interactions, estimated RTW date, activity discussions, prevention discussions, and stakeholder contact. Time off work was the count of cumulative compensated work absence in weeks, accrued post-survey.


Only RTW dates were predictive of no future time loss (OR: 2.65, 95% CI: 1.74-4.03). RTW date (IRR: 0.71, 0.67-0.74), good interactions (IRR: 0.73, 0.70-0.76), and stakeholder contact (IRR: 0.92, 0.88-0.95) reduced time off work, while activity discussions predicted more time off work (IRR: 1.13, 1.08-1.19).


HCPs may be able shorten disability durations through several types of communication. Of those evaluated in this study, RTW dates had the most robust effect.

Self-certification Versus Physician Certification of Sick Leave

Johanna Kausto1, Jos Verbeek1, Jani Ruotsalainen1, Jaana Halonen1, Lauri Virta2, Eila Kankaanpää3

1Finnish Institute of Occupational Health, Finland; 2Social Insurance Institution of Finland; 3University of Eastern Finland

  • Background Internationallly, there is variation in sickness certification practices. It is unclear whether and how sickness absence is altered when the requirements of a sickness certificate change. The aim of this systematic review is to evaluate the effects of introducing, abolishing or changing self-certification practices on future short-term sickness absence spells (total or average duration and number of sickness absence spells) and organizational feautures (social climate, supervisory involvement and work load, presenteeism).

    Methods We will carry out a Cochrane systematic review of published studies including randomized controlled trials, controlled before-after studies and interrupted time-series studies.

    Results Preliminary findings indicate that intervention studies with sufficient quality are scarce. Existing studies originate from Nordic countries and the UK. A randomized trial from Sweden found that postponing the requirement for a physician’s certificate increased the duration of sickness absence and costs. In contrast, results from a Norwegian controlled before-after study indicated that prolonging the period of self-certification resulted in a decline of sickness absence.

    Conclusions Studies on the effects of changes in self-certification practise on sickness absence are scarce and their findings have been mixed. There are several potential pathways that may mediate the effects of changing the practice of self-certification on short-term sickness absence and features of the organization. We summarize and discuss the existing evidence from the literature.

  • Protocol: Kausto J, Verbeek JH, Ruotsalainen JH, Halonen JI, Virta LJ, Kankaanpää E. Self‐certification versus physician certification of sick leave for reducing sickness absence and associated costs. Cochrane Database of Systematic Reviews 2018, Issue 8. Art. No.: CD013098. DOI: 10.1002/14651858.CD013098.

How does the Physiotherapy Curriculum Prepare Undergraduates to Effectively Prevent Work Injury and Work Disability?

Rose Boucaut1, David Worth1, David Birbeck1, Rosimeire Simprini Padula2, Beatriz Sanz-Bustillo3, Nancy Wanyonyi4

1University of South Australia, Adelaide, Australia; 2Universidade Cidade de São Paulo, São Paulo, Brazil; 3Universidad CEU San Pablo, Madrid, Spain; 4Moi University, Eldoret, Kenya

Society faces the dual challenges of preventing work injury and safely returning injured workers to sustainable, suitable work. Musculo-skeletal disorders (MSDs) are prevalent work injuries; physiotherapists (PTs) have a prominent role in their prevention and management throughout the lifespan. Therefore, university educators must contemplate laying appropriate foundations for the future performance of these professionals. Investigating PT student curricula to ascertain approaches to develop knowledge-skill-ability about work injury and disability prevention seems prudent.

The investigators initially engaged in a conversation about curriculum content in four different universities in Australia, Brazil, Kenya and Spain. They identified content that should equip students to graduate ready to both prevent and manage work related injury in accord with best practice principles. Next, at greater depth, an initial case study from Australia mapped curriculum through a document analysis of course objectives and assessment items. The results are presented in this paper. In future, further case studies of other curricula are intended.

All countries introduce students to existing work health and safety legislation. Undergraduates all learn the key principles of injury management although not always in relation to injured workers; such context may be important for students to translate this knowledge. Opportunities to prevent and manage work injuries differ between countries. In Australia, Brazil and Kenya students spend time on-site in industry conducting primary prevention activities. In Kenya, Brazil and Spain students may treat injured workers although not necessarily with a return to work focus. Australian students study theory of work injury management but generally do not gain practical experience in this.

Knowledge of international curriculum content and teaching methods may enable benchmarking and lay foundations for future positive change. Initial steps have been taken to help focus subsequent case studies to determine how well current curricula prepare graduates for work in this field.

Learning And Coping Strategies In Cardiac Rehabilitation - Return To Work After One Year (LC-REHAB): A Randomised Controlled Trial.

Birgitte Laier Bitsch1, Claus Vinther Nielsen1,2, Christina Malmose Stapelfeldt2, Vibeke Lynggaard3

1Centre for Rehabilitation Research, Aarhus, Denmark; 2DEFACTUM, Region Midtjylland, Aarhus, Denmark; 3Hjerteforskningsklinikken Hospitalsenheden Vest, Herning, Denmark

Background: Cardiac rehabilitation (CR) improves clinical outcomes for people living with ischaemic heart disease (IHD) or heart failure (HF). However, evidence is lacking about how to improve level of function in accordance with the framework of International Classification of Functioning, Disability and Health (ICF). Return to work (RTW) is considered an important aspect of improving level of function; however, personal resources seem to affect the ability to RTW. The patient education ‘Learning and Coping Strategies’ (LC) integrated in CR programmes aims to promote these personal resources through an inductive, pedagogical approach in CR. This study aimed to assess the effect of adding LC strategies in CR compared to standard CR on RTW one year after inclusion.

Methods: The study was conducted from the open randomised trial, LC-REHAB. Enrolled participants in the LC-REHAB trial with IHD or HF were randomised to either the LC arm (LC plus CR) or the control arm (CR alone) across three hospital units in Denmark. The population for the present analysis consisted of 244 participants aged 18 to ≤60 who had not permanently left the labour market. The intervention in the LC arm consisted of individual interviews and group-based situational, reflective, and inductive teaching managed by nurses, physical therapists and experienced patients as co-educators. The control arm (standard CR) consisted of structured, deductive teaching. RTW was derived from the Danish Register for Evaluation of Marginalisation (DREAM) and was compared between arms using logistic regression analysis adjusting for stratification variables (gender, cardiac diagnose and hospital unit).

Results: There was no difference in RTW status between arms one year after inclusion (LC arm: 64.7 % versus controlarm: 68.8%, adjusted odds ratio OR: 0.78, 95 %, CI: 0.45-1.34, P=0.37).

Conclusion: Addition of LC strategies in CR showed no improvement in RTW at one year compared to standard CR.

Assessing Significant Others’ Cognitions and Behavior in Occupational Health Care

Nicole C. Snippen1, Haitze J. de Vries1, Mariska de Wit2, Sylvia J. Vermeulen2, Sandra Brouwer1, Mariët Hagedoorn3

1University of Groningen, University Medical Center Groningen, Department of Health Sciences, Community and Occupational Medicine, Groningen, The Netherlands; 2Amsterdam UMC, University of Amsterdam, Coronel Institute of Occupational Health, Amsterdam Public Health research institute, Amsterdam, The Netherlands.; 3University of Groningen, University Medical Center Groningen, Department of Health Sciences, Health Psychology, Groningen, The Netherlands

Background: Significant others (SOs) can play an important role in supporting workers with chronic diseases to participate in work, but can also hinder work participation, for example due to maladaptive illness perceptions. Although cognitions and behaviors of SOs have been identified to influence work outcomes, it is unknown whether occupational health professionals (OHPs) incorporate this in diagnosis and treatment. This study explored current OHS’ practices regarding the assessment of SOs’ cognitions and behaviors in the context of job retention and return to work (RTW) of workers with chronic diseases.

Methods: A cross-sectional survey was conducted among Dutch OHPs. Assessment practices were measured with 16 items grouped into three constructs: SOs’ behavioral responses, illness perceptions and beliefs regarding workers’ job retention and RTW. Multiple linear regressions were performed to test whether OHPs’ assessment of SOs’ cognitions and behaviors are associated with OHPs’ demographic and work characteristics, such as years in practice, core task, organizational policy on assessing SOs’ cognitions and behaviors, and self-efficacy to address these factors.

Results: In total, 192 OHPs completed the questionnaire. Regarding SOs’ behavioral responses, only practical support was frequently assessed by a majority of OHPs. SOs’ illness perceptions and beliefs regarding job retention and RTW were frequently assessed by less than 25 percent of OHPs. Organizational policy was consistently positively related to OHPs’ assessment of SOs’ cognitions and behaviors. The number of years in practice was positively related to assessing SOs’ behavioral responses and self-efficacy was positively related to assessing SOs’ beliefs regarding job retention and RTW.

Conclusions: Assessing SOs’ cognitions and behaviors is not common practice among OHPs. Employer policy, OHPs’ self-efficacy and years in practice are associated with OHPs’ assessment practices. To facilitate assessment of SOs’ cognitions and behaviors, we recommend developing a tool for OHPs to assess and intervene on these factors.

Improvement In Focused And Sustained Attention Is Associated With Return To Work

Thomas Johansen1, Irene Øyeflaten1,2, Hege Randi Eriksen2,3, Ruby Del Risco Kollerud1,4, Chris Jensen1,5

1Norwegian National Advisory Unit on Occupational Rehabilitation, Norway; 2Uni Research Health, Uni Research, Bergen, Norway; 3Department of Sport and Physical Activity, Western Norway University of Applied Sciences, Bergen, Norway; 4Institute of Health and Society, University of Oslo, Oslo, Norway; 5Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway


Individuals on long-term sick leave can be offered inpatient occupational rehabilitation where the aim is return to work (RTW). The programme contains an assessment of aspects related to work and health, cognitive interventions, physical activity, collaboration with stakeholders, and drawing up a RTW plan. The aim of this study was to apply the cognitive psychological approach to investigate the relationship between cognitive functioning and RTW, and to further assess which cognitive changes take place during and after rehabilitation.


In this quasi-experimental prospective cohort study we recruited 318 sick listed individuals who completed occupational rehabilitation and a control group consisting of 73 individuals working full time. All participants completed the same eight computerised cognitive tests (targeting memory, attention, executive function) and questionnaires on work and health at pre-test (T1) and post-test (T2) rehabilitation and 3 (T3) and 12 months (T4) after rehabilitation. The time intervals were the same for the control group.


RTW register data for the rehabilitation group showed that improvement from T1 to T3 in focused attention (OR=2.51, 95% CI: 1.12-5.62) and sustained attention (OR=2.38, 95% CI: 1.14-4.98) was associated with RTW one year after (T4). The rehabilitation group improved more in focused and sustained attention, short term and working memory, cognitive flexibility, and emotion recognition from T1 to T2 and from T1 to T4, than the control group.


The results show that improvement in attention, and not memory and executive function, is associated with RTW. Improvement in attention, memory, cognitive flexibility, and emotion recognition were evident in rehabilitation participants during rehabilitation and that the changes in attention and memory remained one year after. This study indicate that some cognitive functions may be more important than others in the RTW process. Implications for workplace accommodation related to attentional difficulties will be discussed.

11:00am - 12:30pmPrecarious workers and vulnarable groups
Session Chair: Ellen MacEachen
Session Chair: Astrid Velasquez Sanchez
Room 97 

Work-related mental disorders in the workplace and in the Workers Compensation System

Yun Ladegaard, Janne Skakon, Bo Netterstrøm

University of Copenhagen, Denmark

Background Challenges in the psychosocial work environment are key issues in the current labour market. Psychosocial risks, such as work-related stress and workplace violence, are widely recognized as major challenges to occupational health and safety. Current study focuses on work-related mental disorders such as stress-related disorders, depression and PTSD. How are these work-related mental disorders handled at the workplace respectively in the Workers’ Compensation System?

Methods The project applied a variety of methodological approaches, thus data consisted of expert and stakeholder interviews (N=23) and patient interviews (N=23), analyzing interview data from a grounded theory approach, respectively questionnaire responses from employees with workers compensation claims of mental disorders (N=436), analyzing data with Chi2 tests.

Results From the employee perspective, a workers compensation claim of a mental disorder, was most often submitted with the aim of initiating prevention in the work environment, to spare colleagues of similar negative experiences and demands. However employees often reported that both the workplace and Workers’ Compensation System took an isolated approach at the individual. Changes in the work environment and workplace inspections were rarely detected by the employee. Managers were frequently experienced negatively by the employee while health-and-safety or union representatives were often experienced as uninvolved. Further, many employees received inadequate information from the Workers’ Compensation System and found compensation schemes difficult to fill out. Workers’ compensation claims could be an obstacle for RTW.

Conclusions Strengthened interactions between the legislative/insurance and workplace systems are needed to enable information about psychosocial hazards to be used systematically to prevent work-related mental disorders. Workers’ compensation claims might be a valuable source in this matter. Employees with work-related mental disorders should not be advised against filing compensation claims solely in concern for their health, but there are room for improvement in the Workers’ Compensation System

Work Motivation And Employment Outcomes In People With Severe Mental Illness

Miljana Vukadin1, Frederieke G. Schaafsma1, Sandra J. Vlaar1, Jooske T. Van Busschbach2, Peter M. Van de Ven1, Harry W.C. Michon3, Johannes R. Anema1

1Amsterdam UMC, Vrije Universiteit Amsterdam, Netherlands, The; 2University of Groningen, University Medical Center Groningen; 3Trimbos Institute, The Netherlands Institute of Mental Health and Addiction

Purpose: To explore associations between self-reported work motivation and employment outcomes in people with severe mental illness (SMI), who expressed a wish to work and were enrolled in Individual Placement and Support (IPS) or a traditional vocational rehabilitation (TVR) program, and to assess whether associations between work motivation and employment outcomes differ between the two programs.

Methods: Data of 151 study participants, collected from a randomised controlled trial with a 30-month follow-up period, were used for a secondary data analysis. Cox regression and multiple linear regression analyses were performed to analyse the association between work motivation and time until job obtainment and job duration.

Results: No direct association was found between work motivation at baseline and time until job obtainment (HR = 1.37, 95% CI 0.48-3.32, p = 0.48) and (log-transformed) job duration (B = -0.99, 95% CI -2.59-0.61, p = 0.22, R-squared = 0.05). These associations did not differ between IPS and TVR. However, corrected for program, age modified the association between work motivation and time until job obtainment (p = 0.01): in younger people (17-33 years) higher work motivation was associated with shorter time until job obtainment (HR = 3.50, 95% CI 1.12 - 10.93, p = 0.03), whereas no such association was found in older people (HR = 0.29, 95% CI 0.06-1.38, p = 0.12).

Conclusions: Results suggest that work motivation is an ambiguous factor with regard to employment outcomes in people with SMI. Assessing work motivation, however, could be relevant for younger people who are enrolled in a vocational rehabilitation program.

A Systematic Review and Meta-Analysis of Observational Studies Identifies the Prevalence of Workplace Violence Among Physicians

Amin Yazdani5, Behdin Nowrouzi-Kia1, Emily Chai2, Koyo Usuba1, Behnam Nowrouzi-Kia3, Jennifer Casole4

1Laurentian University, Canada; 2University of Toronto, Canada; 3McMaster University, Canada; 4Loretto College, Canada; 5Conestoga College and the University of Waterloo

Objectives: The objective of this systematic review was to identify the types of workplace violence (WPV) present in the work environment of doctors. Moreover, a meta-analysis was completed to estimate the prevalence of WPV among doctors.
Methods: Primary papers on workplace violence in medicine were identified through a literature search in four health databases (Ovid Medline, Embase, PsychoINFO and CINAHL). The study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for the mapping and identification of records. To assess the studies included in our review, we used the Critical Appraisal Skills Programme cohort review checklist. All analyses were performed in R 3.4.3 and “metafor” package was used for the meta-analysis of proportions. The risk of bias was examined using the Cochrane Collaboration ‘risk of bias’ assessment tool across six domains.
Results: Thirteen articles were reviewed from a total of 2,154. Our systematic review outlined factors of physician WPV as following: (1) remote healthcare areas, (2) understaffed shifts, (3) mental/emotional stress of patients/visitors, (4) insufficient security, (5) cultural differences, and (5) lacking preventative measures.
Conclusions: The impact of WPV on healthcare institutions is profound and far-reaching. Thus, steps must be taken to promote an organizational culture where there are measures to protect and promote the well-being of doctors. Our recommendations are to encourage policy amendments that may begin to alleviate the negative impacts of WPV against physicians.

The Brainwork Intervention for Precarious Workers with Psychological Problems: Effect on Sickness Absence

Selwin S. Audhoe1, Karen Nieuwenhuijsen2, Jan L. Hoving2, Monique H.W. Frings-Dresen2

1Research Center for Insurance Medicine; 2Amsterdam UMC, University of Amsterdam, The Netherlands

Background Precarious workers are unemployed and temporary agency workers and workers with an expired fixed-term contract. Once these workers are on sick leave due to psychological problems, they are at high risk for prolonged work disability. The Brainwork intervention offers them a customized program attuned to their psychological and psychosocial problems. The components of the intervention, provided by vocational rehabilitation agencies and mental health institutions/professionals, can include an exercise program, vocational training, gym membership, and psychological interventions. The protocol further commended short lead times, ensuring timely telephone and face-to-face contacts of workers with professionals.

Objective The aim of this study was to assess the effect of the Brainwork intervention, compared to usual care, on sick leave over a 12-month follow-up.

Methods In a controlled clinical trial, using a quasi-randomization procedure, we compared the Brainwork Intervention (n = 164) to usual care (n = 156). The primary outcome was duration of sick leave, differences between the groups were tested using Cox regression analysis. Protocol adherence (Brainwork Intervention) was considered sufficient when at least three of the five protocol steps were followed within the pre-specified timeframe.

Results At six months, the Brainwork Intervention resulted in a non-significant reduction of the duration of sick leave compared to usual care (171 days versus 185 days; HR = 1.34; 95% CI 0.91−1.97; p = 0.14). Protocol adherence was low, 10% of the workers received the program according to the pre-specified timeline and 32% did not receive the intervention at all.

ConclusionsThe Brainwork Intervention, as implemented, did not result in a significant reduction of the duration of sick leave compared to usual care at six months, the 12-months follow up data will be analyzed by the end of 2018.

Indicators of Opioid Misuse Among Workers' Compensation Claimants

Sheilah Hogg-Johnson1, Nancy Carnide2, Hyunmi Lee2, Andrea Furlan3, Pierre Cote4, Mieke Koehoorn5

1Institute for Work & Health, Canadian Memorial Chiropractic College, University of Toronto; 2Institute for Work & Health; 3Institute for Work & Health, Toronto Rehabilitation Institute, University of Toronto; 4University of Ontario Institute of Technology, Canadian Memorial Chiropractic College; 5University of British Columber

Background & Objectives: Several studies have reported an association between opioid use and prolonged work disability among workers’ compensation (WC) claimants. Other potential risks associated with opioids include addiction and overdose. Our objective was to derive indicators of potential opioid misuse among WC claimants using a population-based network of prescription dispensing records.

Methods: Historical cohort of WorkSafeBC low back pain (LBP) claimants 1998 to 2009 with 1+ opioid prescriptions in the year following injury. Data were provided by Population Data BC. Prescription records for opioids dispensed within one year of injury included dispense date, drug identification number, drug strength, quantity, and days supply. Indicators of potential opioid misuse included: average daily morphine equivalent dose > 120 mg/day and TROUP misuse score (range 0-16) combining indicators of days supply, # of prescribers and # of pharmacies (Sullivan et al Pain 2010;150(2):332-339).

Results: Of 97,124 LBP claimants, 37,695 (39%) had 1+ opioid prescription in year after injury. Average daily MED > 120 mg/day was observed for 311 (0.8%). The TROUP misuse score was categorized as: no misuse (scores 0-1), possible misuse (scores 2-4) and probable misuse (score 5-16) with 35,053 (93.1%), 2096 (5.6%) and 490 (1.3%) claimants respectively. There were 542 (1.7%) claimants with 5+ opioid prescribers within a six-month window and 212 (0.7%) using 5+ pharmacies within a 28-day window. The proportion of probable misuse was steady year to year, but possible misuse increased from 4.9% in 1998 to 6.7% in 2009.

Conclusions: A small proportion of claimants displayed dispensing patterns suggestive of misuse. There are limitations to indicators based on dispensing patterns as it is difficult to obtain valid estimates of addiction. Nevertheless, indicators of misuse derived from administrative data may have some value as a screening tool. Based on this study, it appears that prevalence of misuse is low.

How Likely Are Icelandic Employers To Hire Individuals With Decreased Workability And Does Attitude Affect This Decision?

Jonina Waagfjord

VIRK Vocational Rehabilitation Fund, Iceland

Background: It has been well established that work is beneficial for people´s health and well-being. As the workforce ages, dealing with disability will become more of an issue than it is today, and employers play a crucial role in hiring, managing and retaining these employees.

Objective: The aim of this study is to examine how likely employers, participating in an ongoing return-to-work (RTW)-project with VIRK Vocational Rehabilitation Fund, are to hire individuals with decreased workability and if attitude affects the decision. The study is part of a larger study conducted by the Icelandic Ministry of Welfare in cooperation with VIRK, examining Icelandic employer´s perceived barriers and enablers to employment of individuals with decreased workability. The results will support preparation of a new governmental policy aiming to improve labour market participation of individuals with decreased workability.

Method: Cross-sectional survey using an electronically administered questionnaire. 589 (45% response rate) employers participated with 57% of them randomly sampled and 43% a convenience sample of employers associated with VIRK VR and the Directorate of Labour.

Results: Employers with prior experience of hiring were significantly more likely to hire again within the next two years and increased numbers of hiring, and size of the company, increased this probability. This was also true for companies connected with VIRK VR and they were also significantly more likely to have a RTW-plan, to stay in contact with and to accommodate returning employees (i.e. changing worktime and work duties, adjusting work environment, reposition to another job). These employers also demonstrated significantly more positive attitudes in relation to absenteeism, job flexibility and invited more diversity.

Conclusion: Results emphasise the importance of formal education to and interaction with employers, by special employment counsellors employed in the RTW-project, resulting in more positive attitude and increased willingness to hire individuals with decreased workability.

11:00am - 12:30pmSenior work life
Session Chair: Janne Skakon
Session Chair: Diana Cuervo
Room 99 

Retirement Expectations Of Older Workers With Arthritis And Diabetes Compared To Workers With No Chronic Diseases

Monique A.M. Gignac1, Peter M. Smith1, Selahadin Ibrahim1, Vicki Kristman2, Dorcas Beaton1, Cameron Mustard1

1Institute for Work & Health, Canada; 2Lakehead University, Canada

Objectives. Retirement expectations have been the focus of considerable research. Recently, there has been a resurgence of interest related to population aging and policy modifications to mandatory retirement. One factor consistently associated with early retirement is the presence of a chronic health condition. Yet, new treatments for many chronic diseases may mean that individuals are better able to sustain employment longer. This study examined retirement expectations and bridged retirement experiences among older workers, as well as personal, health, and work context factors associated with retirement plans among those with arthritis and diabetes compared to their counterparts with no chronic disabling diseases.

Methods. Canadian workers aged 50-67 years were recruited from a national panel of 80,000 individuals (arthritis, n=631; diabetes, n=286; both arthritis/diabetes, n=111; no chronic disabling conditions, n=538). A cross-sectional survey asked participants about their expected age of retirement, future work plans, retiring sooner than planned, and bridged retirement experiences.

Results. Despite health difficulties, workers with arthritis and diabetes had retirement plans similar to healthy controls and that were consistent with normative expectations of working to a traditional retirement age. However, more respondents with arthritis or diabetes reported bridged retirement experiences than healthy controls (i.e., had retired previously and returned to work). Contrary to predictions, health factors accounted for less of the variance in retirement expectations than personal and work context factors.

Conclusion. Understanding retirement expectations is important for workplaces to help manage worker changes and meet potential needs among older workers with chronic, disabling conditions. These findings point to the complexity surrounding retirement expectations and highlight person-job fit rather than disease factors alone.

The Dilemmas of Unending Work: A Framework Analysis of the Intergenerational Reports and Australia’s Plans for an Ageing Workforce

Hoi Ling Irene Mok, James Anthony Athanasou

University of Sydney, Australia

Background: The global population is ageing. To improve the wellbeing and employment of older workers, work disability prevention research for older workers often focused on injury prevention and return to work practices. A less well understood area on work disability is how systemic barriers in government policies prevent older workers from continuing to work to retirement age and beyond. Policy and research on ageing workforce often focused solely on the macroeconomic simulations. It assumed older workers have optimum conditions to work until retirement age and beyond. Indeed, the Australian Government has been commissioning Intergenerational Reports since 2002 to forecast future workforce participation of older workers - using these premises. However, these simulations often neglect considering how social, employment and economic policies may indirectly contribute to work disability. Objective: This paper examines the systemic barriers in Australia’s policies that contribute to work disability of older workers. Methods: A framework analysis is conducted on the Australian policies and Intergenerational Reports between 2002 to 2018. It critically assesses whether the current Australian policies targeted older workers are adequate to enable them to work until retirement and beyond. Results: This study found that employment discrimination against older workers is systemic. The age-based limitations in professional indemnity insurance and workers compensation have not considered the increased workforce participation of people working to and beyond retirement age or Age Pension qualifying age. Furthermore, the requirement for older workers to be on benefits for at least six months to be eligible for wage subsidy in employment assistance program is also considered ineffective. This restriction actually restricts older workers’ access to employment services if they are made redundant or have to change jobs. Conclusion: Recommendations are made with the aim to better align policies that are supposed to protect older workers’ ability to remain in gainful employment.

Return-to-Work Obstacles Faced by Workers Under and Over Age 50 Who Are on Sick Leave

Marie-José Durand, Marie-France Coutu

Université de Sherbrooke, Canada

Workers over 50 years of age with a work disability pose considerable challenges for health professionals. Yet the literature remains fragmented regarding the specific challenges they face.

Objective: To compare the return-to-work obstacles faced by workers under (<) and over (>) age 50 and on sick leave for a musculoskeletal disorder (MSD) or common mental disorder (CMD).

Methods: A cross-sectional design was used with a non-probability sample. Inclusion criteria were (1) being on an MSD- or CMD-related sick leave for at least three months but less than two years and (2) being enrolled in a rehabilitation program. The Work Disability Diagnostic Interview (WoDDI)was administered to the participants. Chi-square tests were performed (p<0.05).

Results: For MSDs, 96 participants (51 men and 45 women) were < 50 years of age, while 44 (25 men and 19 women) were > 50 years of age. All obstacles (n=21) were similar between the two age groups. The obstacles present for more than 70% of these participants were persistent pain, severe disability, gap between work capacity and work demands, and heavy-load handling. For CMDs, 106 participants (36 men and 70 women) were < age 50, while 44 (20 men and 24 women) were > age 50. Only one of the 18 obstacles differed between the two age groups: the workers < age 50 perceived a heavier work overload than those > age 50. The obstacles present for over 70% of these participants were symptom severity and fears about returning to work.

Conclusion: The return-to-work obstacles faced by workers on sick leave for more than three months and enrolled in a rehabilitation program appear to be common to those with a given health problem, regardless of age, and to reflect the multi-systemic nature of work disability.

The Influence Of Chronic Diseases On Societal Participation In Europe: A 12-year Follow-Up Study

Micky Scharn1, Karen Oude Hengel2,3, Cécile R. Boot1, Alex Burdorf2, Allard J. Van der Beek1, Suzan Robroek2

1Amsterdam UMC, VU University Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health research institute; 2Erasmus MC University Medical Center, Department of Public Health, Rotterdam, The Netherlands; 3Netherlands Organization for Applied Scientific Research TNO, Leiden, The Netherlands

Background: This study aims to provide insight into:(i) the associations between having a chronic disease and participation in paid work, volunteer activities or informal care, (ii) the associations between the onset of a chronic disease and these forms of societal participation, and (iii) whether these associations differ across educational level and gender.

Methods: The study population consisted of N=21,875 respondents of the Survey of Health and Retirement in Europe (SHARE) aged between 50 years and the country-specific retirement age. The influence of having and the onset of a chronic disease on societal participation was analysed using a hybrid Poisson regression model, combining fixed and random effects, and presented by relative risks.

Results: Individuals with a chronic disease were less likely to participate in paid work (RR: 0.69; 95%CI: 0.67-0.71) and volunteer activities (RR: 0.92; 95%CI: 0.88-0.97), but more likely to give informal care (RR: 1.05; 95%CI: 1.01-1.08). Onset of a chronic disease was associated with a higher likelihood to quit paid work (RR: 0.91; 95%CI: 0.86-0.97) and to give informal care (RR: 1.08; 95%CI: 1.01-1.16). Lower educated individuals with a chronic disease or with the onset of a chronic disease were less likely to have paid work than higher educated individuals.

Conclusion: Individuals with a chronic disease were less likely to participate in paid work and volunteer activities, and more likely to provide informal care. Educational inequalities were present for paid work. More insight into which factors hinder societal participation among individuals with a chronic disease is needed.

A 360 Degree View of Work Disability in the Context of Aging Workers Having Undergone Arthroplasty

Marie-France Coutu1, Nathaly Gaudreault1, Marie-Ève Major1, Iuliana Nastasia2, Sara Pettigrew1, Marie-Elise Labrecque1

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


Total knee arthroplasty (TKA) is effective for osteoarthritis and has doubled in the last ten years among workers 45 to 54 years old. Yet a significant proportion of patients present with work disabilities. This study documented, in depth, the workers’ perspective on barriers and facilitators of the return and stay-at-work as well as their employers’ and rehabilitation professionals’ perspectives.


We used a contrast case study design. The case was defined as the work disability situation of workers following TKA. Cases were compared on the levels of difficulty perceived by the workers to resume or stay at work (no/little difficulty; difficulty staying at work; difficulty resuming work). Workers were between 6 to 12 months post-surgery and had physical jobs. Employers’ representatives included human resources, supervisor and union (if applicable). A semi-structured interview guide, questionnaires on physical work demands and pain were used and observation of the working activities for workers resuming work triangulated the information. Consensus was reached on coding of verbatim and on the multidisciplinary content analysis.


Seventeen cases (8 no/little difficulty; 5 difficulty staying at work; 4 difficulty resuming work) were analyzed. There was a convergence in the perceptions between workers and employers’ representatives. Comparative analyses revealed that the means offered by employers and the strategies developed by workers decreased according to perceived difficulties. Having a personal health condition created representations for workers that the employer should not accommodate them. A high level of strategies were found for those with no/little difficulty and a low level of strategies for those having difficulties with resuming or staying at work. In cases of lower capacities, representations and coping strategies to promote return or stay at work were less effective.


Overall, cases of TKA reveal a considerable gap in the implementation of best practices in work disability prevention.


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