Conference Agenda

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Session Overview
Location: Room 96
Date: Wednesday, 05/Jun/2019
11:30am - 1:00pmWork and cancer survivors
Session Chair: Emma Irvin
Session Chair: Charlotte Diana Nørregaard Rasmussen
Room 96 

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

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

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

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

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

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

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

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

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

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


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


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


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


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

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

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

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


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


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


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


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

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

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

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


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


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


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

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

- To evaluate the BCS’s motivations to RTW

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

- To organize an early visit with the occupational physician

- To organize part-time RTW

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


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

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

Andy SK Cheng1, Yingchun Zeng2, Michael Feuerstein3

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

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

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

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

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

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

David Fauser, Matthias Bethge, Julian Wienert

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

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

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

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

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

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

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

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

University of Waterloo, Canada

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

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

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

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

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

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

University of Waterloo, Canada

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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


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


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

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


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

Discussion and conclusion

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

Date: Thursday, 06/Jun/2019
10:30am - 12:00pmReturn to work 2
Session Chair: Merete Labriola
Session Chair: Emma Irvin
Room 96 

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

Jard Smeets1, Nicole Hoefsmit2, Inge Houkes1

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

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

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

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

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

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

Laurie Kirouac

Université de Sherbrooke, Canada


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


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


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


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

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

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

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


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


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


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


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

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

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

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

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

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

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

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

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

Income Changes In Occupationally Injured Workers After Workers' Compenation

Sookwon Bae, Jonguk Won

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


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


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


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

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


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

Earnings Recovery Following Permanent Impairment from a Work Injury

Emile Tompa, Cam Mustard, Qing Liao

Institute for Work & Health, Canada


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


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


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


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

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

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

Monash University, Australia


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


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


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


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

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

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

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


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


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


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


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

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

Marie-Michelle Gouin1, Manon Truchon2

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

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

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

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

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

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

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

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

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

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

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

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

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 
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.


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