4 - 7 June, 2019
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).
|Location: Room 99|
|Date: Wednesday, 05/Jun/2019|
|11:30am - 1:00pm||Measures in WDP|
Session Chair: Jan Hartvigsen
Session Chair: Femke Abma
Social Insurance Literacy: What Is It, And Can It Be Measured?
1Linköping University, Sweden; 2HELIX Competence Centre, Linköping, Sweden
Sickness insurance and workers’ compensation systems make decisions of peoples’ eligibility for benefits, commonly based on medical certificates which assesses the ability to work. Previous research has indicated that systems differ in the extent to which they preserve clients’ dignity, and the perceived justice in relation to the system depends on the quality of the assessment process and the communication between the client and the authority. It is further reasonable to expect that the client’s resources and ability to comprehend regulations and processes matter.
In this study, we introduce social insurance literacyas a term to capture the importance of peoples’ social position and resources, and systems’ ability to meet the varying needs of claimants, in relation to how fair a system performs and how equitable it is perceived. The concept is meant to be used as a way of describing the various factors that may influence the justice of social insurance systems, and to offer guidance in how these factors may be operationalized and measured.
The aim of the study is to define social insurance literacy through a scoping literature review of related concepts (health literacy, financial/economic literacy, legal capability/ability, social security literacy, insurance literacy), and a conceptual re-analysis of these in relation to the social insurance field. Specifically, we explore how related concepts are defined and operationalized, and how these definitions and operationalizations may be transformed into a definition and operationalization of social insurance literacy.
The literature study was followed by a workshop where a definition was settled: “Social insurance literacy is the extent to which individuals can obtain information, understand and act on the dynamics of communications, processes and decisions in a social insurance system, and the comprehensibility of the system’s communication”. The study also outlines directions for developing a measure for the concept.
Psychometric Properties of the Work Disability Diagnostic Interview (WoDDI) Used With Workers Having a Musculoskeletal or Common Mental Disorder
Université de Sherbrooke, Canada
Clinicians and especially new clinicians, need to systematically assess work disability factors to better intervene. The Work Disability Diagnostic Interview (WoDDI) is one promising tool to structure the interview.
Objective To describe (1) construct validity, (2) internal consistency, and (3) interrater reliability of the WoDDI with individuals on sick leave due to musculoskeletal disorders (MSDs) and common mental disorders (CMDs).
Methods A cross-sectional design was used with a non-probability sample. The inclusion criteria for workers were: (1) MSD- or CMD-related sick leave between 3 to 24 months ; (2) enrolled in a rehabilitation program. Trained occupational therapists completed the WoDDI with participants. Self-administered questionnaires (job content questionnaire, psychological distress scale) were also administrated. For interrater reliability, six occupational therapists rated the WoDDI based on standardized case studies (MSD; CMD).
Results 290 workers (140 MSD and 150 CMD) have been evaluated. Self-administered questionnaire results for both groups suggest low decision latitude (≤ 72), high psychological demand (≥ 24) and high psychological distress (≥ 30.95). Regarding for construct validity, exploratory factor analysis (EFA) revealed similar dimensions in both versions (illness representation, clinical judgment of the severity of the medical condition, and high level of work demands). This allowed reducing the number of items by approximately 20 to 40%, depending on the version. Internal consistencies ranged for MSD version from: 0,75 to 0,80 and for CMD version: 0,40 to 0,75. Interrater reliability was satisfactory as regards the nature of the instrument (Cohen’s Kappa from 0,34 to 0,43).
Conclusion Despite the reported limitations, by reducing the number of items included, the content of the WoDDI appears to correlate well with the current scientific literature on the populations under study. It also fits in with a biopsychosocial understanding of individuals on work disability. However, the CMD version of the instrument requires revision and retesting.
Pilot review shows need for a Core Outcome Set for Work Participation (COS-WP)
1Amsterdam UMC, Academic Medical Center, University of Amsterdam, Coronel Institute of Occupational Health, Amsterdam Public Health research institute, Amsterdam, the Netherlands.; 2Amsterdam UMC, VU University Medical Centre, Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands.; 3Finish Institute of Occupational Health, Cochrane Work, Kuopio, Finland.; 4Academic Unit EbIM, Evidence Based Insurance Medicine, Department of Clinical Research, University of Basel, Switzerland; 5Amsterdam UMC, Academic Medical Center, University of Amsterdam, Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam Public Health research institute, the Netherlands.
Background: Within the occupational health (OH) and insurance medicine (IM) field ‘work participation’ is an important outcome concept. Not only are there several outcomes related to the ‘work participation’ concept, but the instruments that measure these types of outcomes can vary. Lack of standardisation in outcome measurement and reporting significantly hinders the synthesis of research. We explored the need for a core outcome set (COS) in the field of OH by performing a pilot review to gain insight into reported outcomes, their terms and definitions, and the type of outcome measurement instruments reported in trials.
Methods: We used trials that were included in 7 Cochrane reviews published at Cochrane Work that described a variety of disorders, OH interventions and work participation (WP) outcomes.
Results: In total 82 trials reported on outcomes including: return to work (RTW), sick leave, absenteeism, work status, functional status, productivity, and work functioning. Outcomes were measured at different follow up times ranging from a few weeks to 4 years after baseline; definitions, cut points for RTW or sick leave varied such as time to first day of 100% RTW, cumulative days off work, sick leave rate; mean monthly sick leave days; diverse statistics were included such as rates, means, odds or hazard ratios; and different sources such as self-report data, questionnaires, or administrative databases were used.
Conclusions: The variation in outcomes and measurements highlights the need for a COS-WP which is relevant within the field of OH. The Coronel Institute of OH at the Academic Medical Center in Amsterdam has started an international collaborative project to develop a COS-WP, in collaboration with Cochrane Insurance Medicine and Cochrane Work. We call on the international community of practitioners, clients and researchers in OH and IM to help us join forces for the development of such a core outcome set.
Intensity Of Occupational Physical Activity - Do Self-Reported Rating And Technical Measures Agree?
1National Research Centre for the Working Environment, Denmark; 2Department of occupational medicine, Holbæk Sygehus, Holbæk, Denmark; 3Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
Occupational physical activity seems to impact health harmfully. However, the previous studies are predominantly based on self-reports of occupational physical activity which can be biased. One of the proposed harmful factors is intensity of occupational physical activity, which can be self-reported, e.g. rating of perceived exertion (RPE), or objectively measured, e.g. by heart rate reserve (HRR). Yet, knowledge of the agreement between RPE and HRR during occupational physical activity are lacking. Thus, we aimed to investigate this.
A cross-sectional analysis was performed in the DPhacto cohort, including 683 workers from cleaning, manufacturing and transport sectors. RPE was collected by questionnaire (How physically demanding do you normally consider your present work? With a response scale from 1-10, where 10 is most demanding). HRR was obtained by diurnal objective measures of heart rate (HR). HRR was calculated by subtracting the resting HR from the maximal HR. A linear regression model was applied, adjusted for age and sex.
RPE was significantly associated (B 0.06, SE 0.01, 95%CI 0.03 – 0.09) and correlated (R2 0.21, p <0.0001) to %HRR during work. Cardiorespiratory fitness, occupational lifting, BMI and sex significantly biased the difference between RPE and HRR. Mean difference between RPE converted to HR and objectively measured HR was 72 bpm, indicating that RPE may overestimate intensity of occupational physical activity.
RPE and %HRR were significantly associated and correlated; however the mean difference of HR from RPE and objective measures indicated that RPE tend to overestimate intensity of the occupational physical activity.
Cross-Cultural Adaptation of the Chinese version of Work Rehabilitation Questionnaire (C-WORQ)
1Yixing Joru Rehabilitation Hospital, China, People's Republic of; 2Guangdong Provincial Work Injury Rehabilitation Hospital
The development of the Work Rehabilitation Questionnaire (WORQ) under the framework of WHO-ICF has proven to be a valid and reliable instrument to assess work functioning. However, the use of WORQ in return to work of workers with work-related injuries is not yet reported. The aims of this study were to translate the English version of WORQ to Chinese version (C-WORQ) and report the psychometric properties of C-WORQ in a group of Chinese workers with work-related injuries.
The forward translation approach was used to translate WORQ from English to Chinese. An expert panel was formed to examine content validity. Internal consistency, test-retest reliability and criterion validity and were analyzed by the intra-class correlation coefficient (ICC) and correlation analysis, respectively. The construct validity was analyzed by the exploratory factor analysis approach.
There were 42 questions related to functioning were consisted in C-WORQ. The ICC was between 0.601 to 0.915 indicating good test-retest reliability (n=29). The C-WORQ demonstrated excellent internal consistency (Cronbach’s Alpha 0.961) (n=108) and principal components analysis revealed that four components were extracted with 61.638% of the variance explained. C-WORQ showed moderate correlation with The Lam Assessment of Stages of Employment Readiness (r=0.541, p<0.001).
C-WORQ is a reliable and valid version of work rehabilitation measures for use in Chinese workers with work-related injuries.
Validation of the Work Assessment Triage Tool for Selecting Rehabilitation Interventions for Injured Workers
1University of Alberta, Canada; 2Morneau Shepell, Canada; 3University of Connecticut; 4Dalhousie University, Canada
Background - Musculoskeletal disorders are leading causes of work disability. Effective interventions exist for promoting return-to-work in patients with musculoskeletal conditons (i.e., functional restoration, multidisciplinary biopsychosocial rehabilitation, workplace-based interventions, etc.), but it is difficult to select the optimal intervention for specific patients. The Work Assessment Triage Tool (WATT) is a clinical decision support tool created to help clinicians select interventions. The WATT algorithm categorizes patients based on individual, occupational, and clinical characteristics according to likelihood of successful return-to-work following rehabilitation. The WATT was developed using machine learning analyses on a dataset from workers’ compensation claimants being considered for rehabilitation between December 2009 and January 2011. Internal validation showed acceptable classification accuracy, but WATT has not been tested beyond the original development sample.
Purpose - Our purpose was to externally validate the WATT.
Methods - A population-based cohort design was used, with administrative and clinical data extracted from a Canadian provincial compensation database. Data were available on workers being considered for rehabilitation between January 2013 and December 2016. Data was obtained on patient characteristics (i.e., age, sex, education level), clinical factors (i.e., diagnosis, part of body affected, pain and disability ratings), occupational factors (ie. occupation, employment status, modified work availability), type of rehabilitation program undertaken, and return-to-work outcomes (receipt of wage replacement benefits 30 days after assessment). Analysis included classification accuracy statistics of WATT recommendations for selecting interventions that lead to successful RTW outcomes.
Results - The sample included 5296 workers of which 33% had spinal conditions. Sensitivity of the WATT was 0.16 while specificity was 0.84. Overall accuracy was 73.0%.
Conclusion - Accuracy of the WATT rules for selecting successful rehabilitation programs in the new dataset was modest. Algorithm revision and further validation is needed, although it appears rules developed using machine learning may be limited by lack of reproducibility.
|4:00pm - 5:30pm||Early work life|
Session Chair: Ute Bültmann
Session Chair: Louise Lindholdt
Educational Differences in Duration of Working Life and Loss of Paid Employment: Working Life Expectancy in the Netherlands
Erasmus Medical Center Rotterdam, the Netherlands
Objectives: This study aims to provide insight into educational differences in duration of working life by working life expectancy (WLE) and working years lost (WYL) through disability benefits and other non-employment states in the Netherlands.
Methods: Monthly information on employment status of the Dutch population (N=4,999,947) between 16 and 66 year from 2001 to 2015 was used to estimate working life courses. Across educational groups monthly transitions between paid employment and non-employment states were calculated. Using a multistate model (R-package mstate) the WLE and WYL due to disability benefits and other non-employment states were estimated, stratified by educational groups.
Results: Despite starting in paid employment earlier, low educated men and low educated women had a 4.17 (men) and 9.50 (women) years lower WLE at age 16 than high educated men and women. Among low educated men 3.59 working years were lost due to disability benefit compared to 0.78 among high educated men. Low educated women lost 3.47 working years due to disability benefit compared to 1.38 among high educated women.
Conclusions:The working life course perspective showed large educational differences in WLE. A considerable amount of the lost working time is health-related due to disability benefits. In comparison to high educated workers, those with a low educational level lose a substantial part of their working life due to disability benefit, unemployment, and no income. The metrics of WLE and WYL provide useful insights into the life-course perspective of working careers.
Sound Performers Canada: Impact of a Blended Learning Course for Occupational Resilience and Health Literacy in Pre-Professional Musicians
1University of Alberta, Canada; 2University of Lethbridge, Canada; 3University of Western Australia; 4University of Sydney, Australia
Multiple studies have determined that more than 80% of professional musicians will encounter health conditions related to their occupation that negatively affects their abilities to work. The existing literature also suggests these conditions to be prevalent among post-secondary music students. Furthermore, the literature acknowledges a stigmatizing, “don’t ask, don’t tell” occupational environment. This unique learning and working context requires a tailored solution for enhancing occupational resilience - the ability to engage in a valued occupation while positively adapting to stress or adversity. We hypothesize that providing education for tertiary music students will enhance occupational resilience and health literacy, and may impact the development of health conditions in pre-professional musicians.
1. Improve occupational resilience and health literacy in pre-professional musicians;
Our international team of collaborators have designed a multi-centre cohort study to evaluate the impact of the online curriculum, Sound Performers, on its own and as part of a blended learning (online and face-to-face) credit course. Measures include a purpose-built questionnaire tool, including reliable, validated measures as well as questions addressing health behaviours that employ the Readiness Ruler to assess readiness to change. Assessment will also include coursework, such as quiz results and reflective journaling, and qualitative focus group interviews with participants at all three sites. Results of this first trial, conducted in Canada at three tertiary institutions, will be shared with attendees.
Effective Interventions For Physical Health Complaints In Nursing Students And Novice Nurses: A Systematic Review
1Center of Expertise, Innovations in Care, Rotterdam University of Applied Sciences, Netherlands, The; 2Department of General Practice, Erasmus MC University Medical Center Rotterdam, Netherlands, The; 3Department of Orthopaedics, Erasmus MC University Medical Center Rotterdam, Netherlands, The; 4Department of Public and Occupational Health, Public Health research institute, Amsterdam UMC, VU Amsterdam, Netherlands, The; 5Faculty of Medical Sciences, University Medical Center Groningen, Netherlands, The
Background: The nursing profession is associated with heavy workload and high physical working demands, resulting in increased turnover of nurses. Nursing students and novice nurses are frequently faced with demanding workloads putting them at risk of developing physical health problems, such as musculoskeletal symptoms. An overview of interventions available in this population is lacking. This review aimed to identify interventions studying the treatment and/or prevention of physical health problems in nursing students and/or novice nurses and the effect of these interventions.
Methods: A systematic search of the literature was conducted up to December 2017. Primary outcome of interest was education/work dropout. Secondary outcomes were: musculoskeletal symptoms. Two authors independently screened and selected studies. Three authors assessed risk of bias.
Results: After screening 7,111 titles and abstracts, eleven studies were included. Seven studies evaluated interventions for moving/handling training. Four evaluated other interventions. No studies focused on novice nurses. All studies reported on physical complaints, but none evaluated dropout. Overall, risk of bias was high and clinical heterogeneity prohibited pooling of data. Intervention effects on physical complaints were small and inconsistent. Comparison of five relatively similar studies on additive moving/handling training for back pain in the curriculum revealed that three studies showed a positive intervention effect. However, the other two either showed no effect or favoured the standard curriculum.
Conclusion: This review summarizes interventions promoting the physical health of nursing students and novice nurses. Evidence for the effectiveness of interventions in the nursing curricula for the treatment and/or prevention of physical complaints is scarce and where available conflicting. No studies focussed on our primary outcome education/work dropout. Further high quality research is required to align methods and outcome measures. We recommend research on drop-out due to physical health problems.
Preventing Drop-out of Nursing Students and New Graduates: First Findings from a Bottom-up Approach.
1Center of Expertise, Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands; 2Department of General Practice, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands; 3Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health research institute, The Netherlands; 4Nivel, Netherlands Institute for Health Services Research, Utrecht, The Netherlands; 5Department of Health Sciences, Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, The Netherlands
With a growing shortage of nursing professionals, preventing drop-out of nursing students and nurse graduates is of foremost importance. Potential causes of drop-out include the demanding physical and mental workload. Unfortunately, interventions to prevent or deal with these strains do not sufficiently seem to find their way into education, and it is unclear who should be targeted with secondary preventive measures. Therefore, the SPRiNG project, Studying Professional Resilience in Nursing students and Graduates, was launched.
A cohort of 731 students from the Bachelor of Nursing program at the Rotterdam University of Applied Sciences, is being followed from their third-year internship up to one and a half year after graduation, using questionnaires and register data. Aims of the cohort study are to: determine prevalence and incidence rates of dropout, identify protective/ risk factors, early indicators of dropout, and it’s interactions. Furthermore, qualitative studies were enrolled to unravel pathways of drop-out; two systematic reviews have been conducted to search for (preventive) interventions; expert meetings were held to designate feasible interventions; and currently the feasibility of adopting possible interventions into the curriculum is explored in six student projects. For two feasible interventions, pilot RCTs are planned.
The first 226 enrolled students reported a physical and mental workload leading to health problems during their internship: e.g., 74% encountered regular/continuous physical complaints such as back pain, 39% experienced distress, and 72% had to deal with aggression. Results from the reviews and qualitative studies provided input for the expert meetings, in which 12 interventions were advised varying from physical fitness consults to Nonviolent Communication training.
SPRiNG is an example of integrating research and education. Scientific and practical findings emerging from this project can be used for teaching healthy working behaviours and deploy targeted interventions before students are lost for the profession.
Interventions Improving Mental Health Of Student and Novice Nurses To Prevent Drop-out: A Systematic Review
1Research Centre of Care Innovations, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands; 2Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health research institute, Amsterdam, The Netherlands; 3Nivel, Netherlands Institute for Health Services Research, Utrecht, The Netherlands; 4Erasmus Medical Center, Department of General Practice, Rotterdam, The Netherlands; 5University Medical Center Groningen, Department of Health Sciences, Community and Occupational medicine, Groningen, The Netherlands
Background: Currently, nursing staff shortages are growing in Western countries, while drop-out among student and novice nurses is high. Mental health problems are a potential cause of drop-out, and occur frequently. Several studies report high prevalences of depression, anxiety and distress. In order to prevent attrition due to reduced mental health, it seems important to teach students to take the lead in their own work-related health. However, an overview of interventions is lacking. This review aimed to provide a systematic overview of interventions aiming at improving mental health in order to prevent drop-out from nursing education/work and an overview of the effectiveness of these interventions.
Methods: Up to 2018 various relevant scientific databases were searched. Two researchers identified studies. Interventions aiming at improving mental health with a quantitative research design were eligible for inclusion. Methodological quality was appraised.
Results: From 7,378 records, 19 studies were included. Only one was an RCT; other studies used a repeated measure, a quasi-experimental or a mixed methods design. The content of interventions varied from multi-component approaches, such as stress management programs, to single-component interventions, such as relaxation interventions. Most of the interventions for student nurses focused primarily on improving mental health. The majority of interventions for novice nurses were multicomponent retention programs that included limited interventions for mental health improvement. Since only five studies showed a significant effect on attrition/retention/sick leave, and an overall high risk of bias, there is limited evidence that these programs are effective. Heterogeneity prohibited pooling of data.
Conclusion: A broad range of interventions aiming at improving mental health in order to prevent drop-out from nursing education/work are available, but the evidence for the effectiveness of these interventions is limited. There is a need for high-quality studies and it is recommended to align methods and measures used in this field.
|Date: Thursday, 06/Jun/2019|
|10:30am - 12:00pm||Assessments and work rehabilitation|
Session Chair: J.R. Anema
Session Chair: Arif Jetha
Independent Medical Examination For Sick-listed Workers - Experiences Of Participating Stakeholders
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
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 ClinicalTrials.gov, 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?
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?
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
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?
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.
|1:00pm - 2:30pm||Workers' compensation systems|
Session Chair: Katherine Lippel
Session Chair: Jean-Baptiste Fassier
Evaluating The Impact Of Workers' Compensation Policy In Australia Using A Population Based Administrative Dataset.
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
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
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
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
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
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.
|Date: Friday, 07/Jun/2019|
|11:00am - 12:30pm||Senior work life|
Session Chair: Janne Skakon
Session Chair: Diana Cuervo
Retirement Expectations Of Older Workers With Arthritis And Diabetes Compared To Workers With No Chronic Diseases
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
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
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
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
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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Conference: WDPI 2019
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