Conference Agenda

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Session Overview
Location: Auditorium 100
Date: Wednesday, 05/Jun/2019
9:30am - 10:00amOpening session: Opening session
Auditorium 100 
10:00am - 10:30amKeynote I: Keynote I Ute Bültmann
Auditorium 100 
11:30am - 1:00pmEducation and working life
Session Chair: Karen Søgaard
Session Chair: Michiel Greidanus
Auditorium 100 

Isolating Geolminthiasis Infection In School Aged-Children Who Work In Artisanal Mining In North - Kivu, DRC

Kabemba Lukusa Jean Paul

Volunteers for the Conservation of Fauna and Flora, Congo, Democratic Republic of the

Health is closely related to the quality of the environment in which people live.

Geohelminthiasis infections are among the most common infections in the word affecting the poorest communities. The WHO recommends periodic deworming for children (1-15 years) living in areas where the prevalence of infections is estimated at more than 20%.

In Democratic Republic of Congo, especially in the underserved region of North Kivu, many children working in artisanal mining may not receive necessary treatment. The goal of this study was to identify the parasite carriage in this group. We collected and analysed 125 fecal samples from children aged: 6-15 who work in artisanal mining. We found that 65.6% of children have Ancylostoma duodenale, 94.4% have Trichuris trichura and 96.8% have Ascaris lumbricoides many of them have never been dewormed. Our research demonstrates the immediate need for deworming program and health education for disease prevention in the North Kivu mining region. The ultimate goal of our work is to eliminate child mining work, given the risk of exposure to multiple disease, injury, and radiation exposure common in artisanal mining though the challenge is great given the prevalence of poverty and war in region.

Once In NEET, Always In NEET? The School-To-Work Patterns Of Young Adults From A Life Course Perspective

Karin Veldman, Sander Riemer Kurt van Zon, Ute Bültmann

University Medical Center Groningen/University of Groningen, Netherlands, The

Objectives: Young adults in Neither Employment, Education nor Training (NEET) are at high risk of adverse employment and health outcomes. As earlier studies often measured NEET status at one time point, is it unclear if NEET patterns exist over time. Therefore, the aims are to 1) examine the educational and employment status of young adults over time and 2) identify risk factors in childhood.

Methods: Data were used from 1499 participants of the Tracking Adolescents’ Individual Lives Survey (TRAILS), a Dutch prospective cohort study with 15-year follow-up. NEET status was assessed at age 19, 22 and 26 years. Parental SES, negative life events, physical and mental health were measured at age 11 years. Data were analyzed with multinomial logistic regression analysis.

Results: Four school-to-work patterns were identified: 1) Non NEETs: those who have never been in NEET (N = 1277, 85.2%), 2) Early NEETs: those in NEET at age 19 or 22 years, (N = 68, 4.5%) 3) Late NEETs: those in NEET at age 26 years (N = 86, 5.7%), and 4) Persistent NEETs: those in NEET at two or three time points (N = 68, 4.5%). Having (borderline) clinical internalizing problems at age 11 was identified as risk factor for early NEETs (OR 1.93, 95%CI 1.09-3.44). Low parental SES and exposure to negative life events (≥ 3) were identified as risk factors for persistent NEETs (OR 4.45, 95% 2.00-9.91 and OR 4.42, 95% 1.62-12.08, respectively).

Conclusions: Four different patterns of young adults in NEET from late adolescence to young adulthood were identified; associated with different risk factors in childhood. Monitoring during childhood should be directed towards low parental SES, exposure of negative life events and internalizing problems, to help young adults to transition smoothly from school into the labour market.

Youth Outside the Labour Force

Chris Jensen1, Solveig Osborg Ose2

1National Advisory Unit on Occupational Rehabilitation-AiR, Norway; 2SINTEF Technology and society, Dep. of Health, Norway

Introduction: Young people, who neither participate in education nor are employed, are an increasing challenge in Western societies. The aim of the present study was to identify barriers to education or employment in order to recommend effective interventions. The study was previously reported by Ose and Jensen1.

Methods: Interviews of 60 case-managers from all labour and welfare offices (25 NAV offices) in one county in Norway were conducted. All interviews were recorded, transcribed and a ten-step method was used to sort and structure the data, which were analyzed using an inductive approach. An internet based survey was also conducted among 586 young adults (18-29 years), who did not participate in education or had a job. Descriptive analyses of the survey data were conducted.

Results: Three main barriers were identified in the interviews of the case managers; low client motivation, a sense of lack of achievement/defeat and unrealistic expectations about working life. The survey among the youth revealed other barriers; health problems (60%), low education (55%), lack of work experience (41%), the feeling of being exhausted (38%), low self-esteem (36%), feeling depressed (35%), sleeping problems (35%) and very often a combination of these barriers. Loneliness was experienced by 70% of the respondents and 75% reported money problems.

Conclusions: Case managers and their clients emphasise different reasons for youth being outside the labour force. The young clients reported health barriers as dominating barriers. Accordingly, treatment is often carried out by mental health care services, which may not be optimal when social problems seem to contribute considerably to the problems. More multidisciplinary efforts are needed.

  1. Solveig Osborg Ose, Chris Jensen , Youth outside the labour force — Perceived barriers by service providers and service users: A mixed method approach, Children and Youth Services Review (2017), doi: 10.1016/j.childyouth.2017.08.002.

Does Labour Market Participation Among Parents Affect Self-rated Health Of Their Children? A Study Of 11,267 Adolescents And Their Parents

Louise Lindholdt1,2, Thomas Lund2,3, Johan Hviid Andersen2,4, Merete Labriola2,3

1Department of Public Health, Aarhus University; 2Research Centre for Youth & Employment, Herning, Denmark; 3Centre for Social Medicine, Frederiksberg and Bispebjerg Hospital, Denmark; 4Department of Occupational Medicine, Danish Ramazzini Centre, Regional Hospital West Jutland, University Research Clinic, Herning, Denmark

The aim of this cross generation study was to investigate whether parents’ labour market attachment was associated with self-rated health among adolescents.

A cohort of Danish adolescents (N=13,100) in 9th grade answered a questionnaire about their own self-rated health in a newly established nationwide youth cohort (the FOCA-cohort). One item from the Short-Form Health Survey (SF-36) measured self-rated health (SRH), whereas information on parents’ labour market attachment was obtained from a national administrative register. The parents were followed in a five-year period before the adolescents completed the questionnaire. Five categories on labour market status were made and an integration indicator was calculated from an initial sequence analysis, to determine how well the parents were integrated in the labour market.

The association between the adolescents’ SRH in relation to parents’ labour market attachment was examined by logistic regression. Analyses were performed on 11,267 adolescents and 22,175 parents.

A total of 3,279 adolescents (29.1%) reported low SRH while 7,988 (70.9%) reported high SRH. The sequence analysis showed that adolescents who reported low SRH had parents who were less integrated in the labour market and had a weaker quality of transitions between the different labour market states, compared to those adolescents who reported high SRH.
The logistic regression showed that adolescents with parents with weak labour market integration had higher odds for low SRH compared with adolescents with parents with good labour market integration. Inclusion of parents’ educational level did not change these results.

The results indicate that unstable labour market attachment among parents affected perceived health among their adolescent children, indicating a negative effect of labour market marginalisation from generation to generation, regardless of the parents’ educational level.

Interventions Targeting Sickness Absence Among Pregnant Women In Health Care Settings And Workplaces - A Systematic Review

Pernille Pedersen1, Merete Labriola2, Claus Vinther Nielsen2, Rikke Damkjær Maimburg3, Ellen Aagaard Nohr4, Anne-Mette Hedeager Momsen1

1DEFACTUM - Social & Health Services and Labour Market, Central Denmark Region, Denmark; 2Department of Public Health, Section of Clinical Social Medicine and Rehabilitation, Aarhus University, Denmark; 3Department of Clinical Medicine, Aarhus University and Department of Gynaecology Obstetrics, Aarhus University Hospital, Denmark; 4Research Unit for Gynaecology and Obstetrics, Institute of Clinical Research, University of Southern Denmark, 5000 Odense, Denmark


The high rate of sickness absence from work during pregnancy is recognized as a problem, and may be higher than necessary from a health perspective. The aim was to evaluate the effectiveness of interventions in health care settings and workplaces targeting sickness absence among pregnant women.


Studies were eligible if they included pregnant women participating in any intervention in health care settings or workplaces. The outcome was length of sickness absence in days or number of episodes. Study design had to be either randomized controlled trials (RCTs) or quasi-experimental studies.

The search for studies was conducted in PubMed, Scopus, CINAHL, PsycINFO,, and the WHO trial registry. Risk of bias was assessed by the Joanna Briggs Institute standardized quality assessment instrument.


A total of nine studies were quality assessed and of these, four were excluded due to insufficient methodological quality. Five RCTs conducted in health care settings in Sweden and Norway were included. Due to heterogeneity, meta-analysis was not performed.

Two RCTs examined complementary and alternative medicine and three RCTs the effect of physical exercise. In general the frequency of women on sickness absence was lower in the intervention groups than the control groups, however only among pregnant women who participated in a 12-week exercise program the frequency was significantly lower (22% vs. 30%, p=0.04).


The evidence of interventions targeting sickness absence among pregnant women in health care settings is sparse, and no studies were conducted at workplaces.

Future interventions including physical activity provided in collaboration with health care settings and workplaces are requested. Studies should measure sickness absence based on valid methods, measure compliance to the intervention, and provide transparency of statistical methods.

Work-Focused Interventions That Promote The Labor Market Transition Of Young Adults with Chronic Disabling Health Conditions: A Systematic Review

Arif Jetha1,2, Robert Shaw3, Adrienne Sinden4, Quenby Mahood1, Monique Gignac1,2, Mary Ann McColl5, Kathleen A. Martin Ginis3

1Institute for Work & Health; 2University of Toronto; 3University of British Columbia; 4McMaster University; 5Queen's University

Background: Young adulthood is an important transitional life phase where one establishes their career. Young adults living with chronic disabling health conditions are underrepresented in the labor market, and experience difficulties with employment participation that can extend across working life course and impact health and quality of life.

Objective: To examine the effectiveness of work-focused interventions that support the labor market transition of young adults with chronic disabling health conditions; and to examine whether the effectiveness of work-focused interventions differ depending on the phase of work transition (e.g., preparation, entry and sustaining work, and employment advancement) and disability type.

Methods: A systematic review of articles published between January 1990 to July 2018 was conducted. Medline, EMBASE, and PsycInfo were searched, and titles/abstracts and full-texts of articles were reviewed for eligibility. Relevant articles were appraised for methodological quality. A best evidence synthesis approach was applied to medium/high-quality studies to develop recommendations.

Results: 5,815 articles were identified; ten articles were relevant and of moderate-high methodological quality. Five intervention categories were identified which focused primarily on young adults with mental health (n=6) or intellectual and developmental disabilities (n=3), and addressed employment preparation (n=10) and/or work entry (n=9). No interventions addressed at-work issues or career advancement. A moderate level of evidence existed for supported employment interventions having a positive impact on competitive employment outcomes, especially among young adults with mental health conditions.

Conclusions: There is a paucity of evidence-based interventions that address the employment needs of young adults with disabling health conditions as they transition into the labor market. Supported employment has the potential to be an effective intervention that encourages preparation and entry into employment. Research is required to examine interventions that facilitate sustained work and career advancement of young adults with disabling conditions to promote employment over the life course.

2:15pm - 3:00pmKeynote II: Keynote II Maria Melchior
Auditorium 100 
3:30pm - 4:00pmSpeakers Corner: Speakers Corner
Auditorium 100 
4:00pm - 5:30pmDesign and development
Session Chair: Karen Nieuwenhuijsen
Session Chair: Silje Maeland
Auditorium 100 

Preferences Of Professionals In The design Of A Decision Support Tool For Prognosis Of Work Ability In Individuals With A Work Disability Benefit: Results Of A Focus Group Study

Ilse Louwerse1,2,3, Maaike Huysmans1,3, Jolanda van Rijssen1,2,3, Joyce Overvliet1, Allard van der Beek1,3, Han Anema1,3

1Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health research institute, Amsterdam, The Netherlands; 2Dutch Institute of Employee Benefit Schemes (UWV), Amsterdam, The Netherlands; 3Research Center for Insurance Medicine, AMC-UMCG-VUmc, Amsterdam, The Netherlands

Aims: A model predicting future changes in work ability based on a broad range of factors can help professionals to make accurate predictions which contribute to better prognosis in individuals with a work disability benefit. The goal of this study was to explore the desired design and use of a decision support tool for insurance physicians (IPs) and labour experts (LEs), based on a prediction model for changes in work ability at one-year follow-up.

Methods: Data were collected during three focus group meetings with IPs and LEs of the Dutch Social Security Institute. Topics included the design and use of the decision support tool. Data were audio recorded and analysed according to the main principles of content analysis.

Results: In total 24 professionals participated (17 IPs and 7 LEs). Clarity and ease of use were mentioned as important features of the decision support tool. Dividing work disability claimants into categories based on the outcome of the prediction model and assigning colour labels to the classes is experienced as a straightforward and clear way of presenting the results of the prediction model and encourages professionals who use the tool to take action. Accurate prognoses of future work ability aids provision of effective interventions to return to work for work disability claimants who will benefit most from it. Concerning preferences on when to use the tool, professionals would first want to make their own judgement during the work disability assessment interview with the claimant and afterwards verify their evaluation with the decision support tool.

Conclusions: The decision support tool should be easy to access and interpret, to be sure that it takes only small effort from professionals to use the tool and to help them making accurate prognosis of future changes in work ability.

Systematic Review Evidence In One Minute Or Less

Emma Irvin, Uyen Vu, Kristina Buccat, Cindy Moser, Kim Cullen, Dwayne Van Eerd

Institute for Work & Health, Canada

Introduction: Getting research evidence to knowledge users is a challenge. The Institute for Work & Health (IWH) initiated a systematic review (SR) program in 2004 to synthesize scientific literature on prevention of workplace injuries and disability. IWH SR products include two to three-page lay summaries (Sharing Best Evidence (SBE)). SBEs are popular but are considered long by some knowledge users. Our objective was to produce and post short videos that summarize key findings of SRs in one minute or less.

Methods: Video shorts are created by a multi-disciplinary team that includes a researcher, a video producer and a communications expert. The video shorts are based on high quality research (SR findings). Key messages are created in consultation with target stakeholders. The production process begins with a storyboard (frame-by-frame outline). Development requires careful attention to style, pacing, tone, clarity, visual interest and audience appeal. Video shorts are tested with members of the target audience before being posted. Video shorts take about four weeks to complete.

Results: Two one minute videos were developed by IWH made to reach busy stakeholders with evidence they need in their work. The first, posted since October 2016, has received over 2116 hits to date. The second, posted since May 2017 has received over 989 hits to date.

Length: Videos are kept as short as possible, less than one minute.

Format: No voice-overs are used. Simple graphics, images, text and short video clips are used, with instrumental background music.

Content: Key messages from research findings are delivered in brief snippets of text.

Conclusion: Our video shorts are designed to serve two purposes: provide viewers with key evidence they can use and link the viewer to the IWH website where they can read more information. One-minute research video shorts are an effective means of disseminating key research findings.

Work Ability Following a Traffic Injury--A Multidimensional Measurement Model

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

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

Objective: The purpose of our study was to develop a multidimensional measurement model of the latent construct of work ability.

Study Design and Setting: We developed a biopsychosocial model, conceptually based on the International Classification of Functioning, Disability and Health framework. We used data from a population-based incidence cohort of all persons treated for traffic injuries in Saskatchewan, Canada. Eligible participants were adults with acute soft tissue injuries who were off work. A confirmatory factor analysis model was specified and evaluated.

Results: The best-fitting model measured work ability as a second-order factor. The four first-order factors represented physical, psychological and cognitive functioning, and activities and participation domains. About 95%, 67%, 64% and 46% of each respective factor’s total variance was common variance, explained by the latent construct of work ability. A total of 17 measured indicator variables formed the final factor structure and demonstrated significant factor loadings and goodness-of-fit criteria.

Conclusion: Physical functioning plays a dominant role in the assessment of work ability among those off work following a traffic injury. In addition, our study has demonstrated the importance of exploring psychological and cognitive functioning, and the ability to carry out activities of daily living, to the evaluation of work ability following a soft tissue injury.

A Participatory Ergonomic Interventon For Reducing Physical Exertion And Musculoskeletal Pain Among Childcare Workers. A Cluster Randomized Controlled Trial

Charlotte Diana Nørregaard Rasmussen1, Malene Jagd Svendsen1, Andreas Holtermann1,2

1NFA, Denmark; 2University of Southern Denmark


The prevalence of musculoskeletal pain (MSP) is persistently high throughout the world. Participatory ergonomics may represent a solution for reducing the work demands and reduce MSP. We present the results of a participatory ergonomics intervention aimed at reducing physical exertion during work and MSP amongst childcare workers.


This study used a two-arm cluster randomized design, with clusters formed based on childcare institutions. Three workshops were conducted during the 4-month intervention period. Participants identified risk factors for strenuous work and MSP, developed solutions for reducing the identified risk factors and implemented them in their team. Physical exertion during work (scale from 0-10), MSP (duration and intensity) and work-related pain interference (days per month) was measured monthly. Analyses were performed according to intention to treat, including all eligible randomized participants.


Preliminary results show significant effects on physical exertion of -0.6 (95% confidence interval -1.09 to -0.14), and work-related pain interference of -2.7 (95% confidence interval -4.47 to -0.91) after the intervention compared to the control group. Non-significant reductions were found for duration of low back pain, duration of neck pain and for low back pain intensity and neck pain intensity.


Preliminary results of the study showed beneficial effects of the 4-month intervention. Participatory ergonomics therefore seems to be an effective solution for both reducing physical work exertion and work-related pain interference. Further analyses will be conducted to see whether the participatory ergonomics is also beneficial for sickness absence and for work ability.

Enhancing Return-To-Work Among Partially Work Disabled Workers: Development Of A Triage Instrument And Decision Aid For Labour Experts.

Christa J.C. De Geus1,2,3, Maaike A. Huysmans1,2, H. Jolanda van Rijssen1,2,4, Johannes R. Anema1,2

1Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health research institute, Van der Boechorststraat 7, NL-1081 BT Amsterdam, The Netherlands.; 2Research Center for Insurance Medicine (KCVG), AMC-UMCG-VUmc Amsterdam,The Netherlands; 3Arbeidsdeskundig Kennis Centrum (AKC), The Netherlands; 4Dutch Institute of Employee Benefit Schemes (UWV), Amsterdam, The Netherlands


Labour experts can experience difficulties choosing the right RTW interventions for partially work disabled workers. An understanding of relevant factors and effective interventions could help labour experts improve the vocational rehabilitation process of partially disabled workers. In the present study, we describe the design of a study with the aim to develop a triage instrument and decision aid for labour experts to help improve their service and to be able to offer individually tailored service to partially work disabled workers receiving a long term disability benefit with the aim to improve RTW.

Development of the instrument:

The instrument and decision aid will be developed along the lines of the International Classification of Functioning, Disability and Health (ICF) model. Based on the obstructing RTW factors of the individual, relevant effective interventions to improve these obstructing RTW factors are suggested to the labour expert.

Several studies will provide input for the instrument and decision aid. First, two systematic literature reviews are currently being conducted to provide input on relevant obstructing factors for RTW and to provide input on effective RTW-interventions. Second, focus groups are currently being conducted among labour experts to provide expert-based input for the instrument concerning important RTW factors and concerning the position of the instrument in the vocational rehabilitation process. Based on the results of these studies a first version of the instrument will be designed. Next, a Delphi Study will be held to reach consensus about the content and placement of the final instrument.


The aim of this study is to develop a triage instrument and decision aid for labour experts to enhance individually tailored service to partially disabled workers. The (cost)effectiveness of the instrument will be evaluated in a randomized controlled trial among partially work disabled workers.

Good Working Body - Development Of An eHealth System For Repeated Measures Of Musculoskeletal Pain In Workplace Context

Malene Jagd Svendsen1, Andreas Holtermann1,2, Charlotte Diana Nørregaard Rasmussen1

1The National Research Centre for the Working Environment, Denmark; 2Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Denmark


Electronic health (eHealth) systems are increasingly being used to assess pain. This study aims to describe the development of a new system for measuring musculoskeletal pain in workplace contexts – “Good working body” (GWB).


GWB was developed in close collaboration between researchers, ergonomic consultants and work environment representatives from workplaces, a pension company and an eHealth company. First, need and potential for the system was discussed. A non-systematic literature review for pain assessments (e.g. questionnaires) was performed. Different formulations and types of questions as well as layout of the questions were tested among 10 workers with cognitive interviews.


The system was tested among 10 cleaners to ensure feasibility and acceptability for all workers but particularly those with high need (e.g. blue-collar workers with high physical work demands and high pain levels). In Denmark, many cleaners are non-western immigrants with Danish as second language. Use of figures and shortly phrased questions was therefore chosen to ease comprehensibility. Through the cognitive interviews, specific question formulations and layout were chosen. GWB contains a body chart with 9 body regions and pain intensity scales for all regions (VAS 0-10). Additionally, the system contains questions about activity limitation and use of pain relievers. GWB monitors the musculoskeletal pain of every worker by asking simple questions in an interval according to the workplaces’ need. The system then provides simple feedback to the individual. Management and HR receive monthly reports on the general level of musculoskeletal pain to serve as a launch pad for initiating relevant changes.


The system is meant to be applicable for all workers, including those with low literacy levels. The frequent monitoring of musculoskeletal pain can help workplaces to identify workers in greatest need of work adaptations due to pain at an early stage and thus prevent work disability.

Date: Thursday, 06/Jun/2019
8:30am - 9:15amKeynote III: Keynote III Lars Andersen
Auditorium 100 
10:30am - 12:00pmImplementation at worksite level
Session Chair: Åsa Tjulin
Session Chair: Cécile R. Boot
Auditorium 100 

Task Rotation: Implementation in an Industrial Setting.

Carole James, Mijanur Rahman

University of Newcastle, Australia


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


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

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


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


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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Émilie Desjardins1, Hélène Sultan-Taïeb1, France St-Hilaire2, Nicole Vézina1, Élise Ledoux1, Patricia Bélanger1

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

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

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

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

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

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

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

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

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

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

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

Mates in Mining: An Industry Mental Health Program

Carole James, Mijanur Rahman, Emma Sayers, Brian Kelly

University of Newcastle, Australia


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


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


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


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

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

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

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


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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Ross Iles, Luke Sheehan, Cameron Gosling

Monash University, Australia

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

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

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

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

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

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

Marco Streibelt1, Betje Schwarz2, Dolores Claros-Salinas3

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

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

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

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

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

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

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

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

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

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

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

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

Supervisors´ View of Work Disability Collaboration with Occupational Health Services

Liisa Lappalainen1, Juha Liira2, Anne Lamminpää1

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

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

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

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

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

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

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

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

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

Susan E. Peters1, William S. Shaw2

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

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

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

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

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

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

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

Kristel Weerdesteijn

KCVG, Netherlands, The


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


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


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


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

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

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

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

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

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

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

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

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

Sally Elizabeth Hemming

Loughborough University, United Kingdom

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

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

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

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

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

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

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

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

Date: Friday, 07/Jun/2019
9:00am - 9:45amKeynote V: Keynote V Katherine Lippel
Auditorium 100 
9:45am - 10:15amWDPI2021: Announcement of WDPI2021
Auditorium 100 
11:00am - 12:30pmCancer and Multiple Sclerosis
Session Chair: Sandra Brouwer
Session Chair: Sara Larsson Fällman
Auditorium 100 

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

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

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

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

The Capability Set For Work In Workers With Multiple Sclerosis

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

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

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

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

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

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

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

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

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


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

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

Added value

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

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

Marco Streibelt1, Matthias Bethge2

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


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


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


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

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


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

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

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

1Amsterdam UMC, University of Amsterdam, Coronel Institute of Occupational Health, Amsterdam Public Health research institute, Amsterdam, The Netherlands; 2Maastricht University, Department of Social Medicine, CAPHRI, Maastricht, The Netherlands

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

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

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

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


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