Conference Agenda

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Session Overview
Location: Room 95
Date: Wednesday, 05/Jun/2019
11:30am - 1:00pmMental health and workplace perspectives
Session Chair: Dwayne Van Eerd
Session Chair: Emil Sundstrup
Room 95 

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

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

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

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

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

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

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

Factors Influencing Worker Disclosure of Mental Illness to Managers

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

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

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

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

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

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

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

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

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


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


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

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


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

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

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

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


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


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


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


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


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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

McGill University, Canada

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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


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

Material and methods

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


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


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

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

Christina Andersson, Lena Mårtensson

University of Göteborg, Sweden

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

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

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

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

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

Date: Thursday, 06/Jun/2019
10:30am - 12:00pmMental health and return to work
Session Chair: Angelique De Rijk
Session Chair: Christine Guptill
Room 95 

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

Alexandra Sikora, Gundolf Schneider

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


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


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


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


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

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

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

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

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

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

Chantal Sylvain1,2, Marie-Jose Durand1,2

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

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

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

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

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

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

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

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


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


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


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


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

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

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

1Tranzo, Scientific Center for Care and Welfare, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, the Netherlands;; 2Department of Human Resource Studies, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, the Netherlands


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


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


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


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

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

Dwayne Van Eerd1,2

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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


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

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

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

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

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

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

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

Université de Sherbrooke, Canada

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

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

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

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

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

Emma Irvin, Kim Cullen, Dwayne Van Eerd

Institute for Work & Health, Canada

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

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

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

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

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

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

Institute for Work & Health, Canada

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

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

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

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

Date: Friday, 07/Jun/2019
11:00am - 12:30pmOccupational health care
Session Chair: Cécile R. Boot
Session Chair: Marion Lamort-Bouché
Room 95 

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

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

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


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


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

Research Design

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


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


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


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

Self-certification Versus Physician Certification of Sick Leave

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Assessing Significant Others’ Cognitions and Behavior in Occupational Health Care

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

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

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

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

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

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

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

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

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


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


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


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


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


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