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