Conference Agenda

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Session Overview
Facilitation of RTW
Friday, 07/Jun/2019:
11:00am - 12:30pm

Session Chair: Ole Steen Mortensen
Session Chair: Tina Dalager
Location: Room 96

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Return to Work Patterns Among Compensable Road Traffic Crash Survivors in Victoria, Australia

Shannon Elise Gray, Alex Collie

Insurance Work and Health Group, School of Public Health and Preventive Medicine, Monash University, Australia

Background: Injury sustained in road traffic crashes (RTC) can affect daily activities, including work. In the state of Victoria, Australia, people injured and unable to work due to RTC may have treatment and income support provided either through the RTC compensation system or through workers’ compensation. Prior studies have demonstrated that return to work (RTW) pathways following injury may vary between individuals. The objective of this study was to determine RTW patterns in people injured in RTC.

Methods: Using harmonised claims data from both RTC and workers’ compensation systems, accepted non-fatal claims were included for RTCs that occurred between July 1 2003 and June 30 2013 by 15-65 year olds who received at least one day of income support. Patterns of income support were identified using daily income support data. Gaps in income support were considered to represent engagement in work. Partial income support payments indicated partial RTW. For each case, particular RTW patterns were detected (e.g. transitions from full to partial to no income support aligned with graduated RTW).

Results: There were 36,640 individuals who received income support for work absence after RTC with 703 unique RTW pathways. Seventy-eight percent achieved successful RTW on the first attempt. Fourteen percent had two distinct periods of absence before successful RTW, 8% had at least three periods of absence. Six percent attempted graduated RTW, and the vast majority of these had successful RTW on the first attempt (98.4%).

Conclusions: This study utilised a novel method of converting administrative payment data to allow calculation of RTW pathways after RTC. It is important to understand different RTW pathways in order to identify groups of people that may benefit from additional support, such as by encouraging graduated RTW as graduated RTW seemed to be more successful.

The Association between Work Ability and Return to Work Following a Traffic Injury: An Examination of the Mediating Role of Modified Work

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

1Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Canada; 2UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, University of Ontario Institute of Technology (UOIT) and Canadian Memorial Chiropractic College (CMCC), Toronto, Canada; 3Faculty of Health Sciences, University of Ontario Institute of Technology, Oshawa, Canada; 4Institute for Work & Health, Toronto, Canada; 5School of Public Health, University of Alberta, Canada; 6Department of Health Sciences, Lakehead University, Canada

RESEARCH QUESTION: In a cohort of individuals with soft tissue injuries resulting from traffic collisions, is the association between work ability and return to work mediated by modified work?

METHODS: We used data from a population-based incidence cohort of all treated traffic injuries occurring in Saskatchewan, Canada between December 1, 1997 and November 30, 1999. Baseline data were collected when injured individuals initiated their claim with Saskatchewan Government Insurance by completing an insurance application form. All claimants completed a baseline questionnaire about the collision, health status, injury-related factors, pain, work status and socio-demographics. We created a measurement model for the latent construct of work ability and used structural equation modeling to examine its association with return to work, measured at three months. Our structural model examined the direct effect of work ability on return to work and the indirect effect through modified work in a longitudinal analysis.

RESULTS: In our final model, both work ability and modified work showed positive and significant associations with return to work. However, work ability was not associated with modified work. Work ability has a direct effect on return to work such that for every standard deviation increase in work ability the probability of return to work at three months increased by 0.05, for those not self-employed and expecting to recover soon. Overall, the probability of return to work by three months based on the mean work ability of this traffic injury population, without the provision of modified work, when not self-employed and expecting to recover soon was 0.87.

CONCLUSIONS: Modified work did not mediate the association between work ability and return to work in this traffic injury cohort. These findings suggest further examination of the employer’s role in the return to work process following a traffic injury.

Sick Listed Workers’ Experiences With Motivational Interviewing Administered By Caseworkers In The Return To Work Process. A Qualitative Interview Study.

Vegard Foldal, Martin Inge Standal, Lene Aadahl, Roger Hagen, Egil Fors, Roar Johnsen, Marit Solbjør

Norwegian University of Science and Technology, Norway


Returning to work after being long-term sick listed has been described as a process where sick listed workers may experience varying levels of motivation and self-efficacy. Resolving ambivalence and increasing motivation towards behavioral change is essential components in the counseling style Motivational interviewing (MI). There are reports that this method may be useful in the RTW process. The aim of this study was to explore sick listed workers’ experiences with MI counseling sessions in the return to work process, and to explore whether these sessions contributed to experiences of behavioral change or resolving ambivalence.


This qualitative study was nested in a randomized controlled trial evaluating the effects of MI administered by the Labour and Welfare Services on sickness absence. Semi-structured interviews were performed with sick-listed workers aged 18-60 years, sick leave status of 50-100% for at least eight weeks, and having completed two motivational interviewing sessions. Questions prompted participants to describe their experiences with their situation, follow-up, the MI sessions, changes in their lives, and thoughts on returning to work.


Eight interviews have been conducted and the data is undergoing analysis. An additional eight interviews are planned, reaching a total of 16 interviews (or until sufficient information power is achieved). Results of the analyses will be ready in December 2018.


These results will be of interest for individuals on sick-leave, clinicians, researchers and decision makers.

How Do Work Rehabilitation Interventions Facilitate the Return to Work after a Common Mental Disorder?

Chantal Sylvain1,2, Marie-Jose Durand1,2, Astrid Velasquez Sanchez1,2, Nathalie Lessard3, Pascale Maillette1,2

1Universite de Sherbrooke, Canada; 2CAPRIT, CR-CSIS Research Center, Longueuil, Canada; 3CISSS de Laval, Laval, Canada

Objectives: Major breakthroughs have been made in recent years in determining the main components of effective return-to-work (RTW) interventions after a common mental disorder (CMD). However, the mechanisms involved remain poorly understood. The aim of our project was specifically to describe, from the participating workers’ viewpoint, the mechanisms of a work rehabilitation program based on best practices.

Methods: Semi-structured interviews were conducted with workers (n=26) who had participated in a work rehabilitation program offered mainly in group format. The interviews concerned the perceived effects of the program and how these effects were brought about. The interviews were conducted by telephone, recorded and analyzed according to thematic analysis principles. Converging themes were identified and classified by component type.

Results: Seven mechanisms were identified. Four of these concerned the participants’ reactions to the intervention, and included two mechanisms pertaining to its group nature (e.g. reducing the feeling of isolation and/or of shame associated with the fact of being on sick leave for a CMD), and two pertaining to the activities carried out in groups (e.g. integrating health protective behaviours into real-life situations, particularly at work). The three remaining mechanisms pertained to the program facilitators’ behaviours (relaying information to the various parties concerned, supporting the learning of new behaviours and attitudes, and maintaining a healthy atmosphere during the group activities).

Conclusion: Some of the mechanisms identified here have been documented in previous studies with workers having other types of health problems (e.g. musculoskeletal disorders), while other mechanisms, particularly that of reducing the feeling of isolation and/or shame, appear specific to mental disorders. Our results allowed us to refine the logic model of this particular program and, more generally, to suggest avenues for reflection that could enhance understanding of why certain interventions are more effective than others in facilitating RTW post-CMD.

Do Employers Make A Difference In Supporting Employment Of Disabled Workers? Evidence From Administrative Data From The Netherlands

Raun Van Ooijen1, Pierre Koning2, Joke Jansen3, Cécile R. L. Boot4, Sandra Brouwer3

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

Background: The degree to which employers are effective in supporting continued employment of workers with disabilities is of key concern.

Objective: The aim of this study is to examine whether employers make a difference in retaining work for partially disabled workers, for example through supervisor support, work accommodation or disability policies.

Methods: We use administrative data on disability assessments from the Dutch Employee Insurance Agency (UWV) over the period 2008 until 2017. The data are merged with income records which contain monthly data on employment status as well as a company identifier to link workers to their (former) employer. Our sample contains detailed information on disability assessments of all 117,365 partially disabled workers with a permanent contract who did not fully return-to-work after a two-years period of sick leave in 22,530 companies with at least two assessed workers.

We compare a disabled worker’s own employment outcome with the employment outcomes of its disabled co-workers using a linear probability model. The intuition underlying this approach is that if an employer wants to ensure that partially disabled workers remain employed, they put more effort in retaining them. If the employer policies or features are effective, we would expect that the employment outcomes of disabled workers and co-workers are positively associated.

Results: our preliminary results show that employment outcomes of disabled (former) co-workers are positively associated with a disabled workers own employment outcome. The effect remains sizeable (β=0.28, 95% CI [0.26, 0.30]) after controlling for an extensive set of employer characteristics (i.e. sector, size and workplace composition) and employee related confounders, including sociodemographic variables and disease types. The role of the employer seems largest for musculoskeletal and mental diseases and smaller for cancers.

Conclusion: The analysis suggests that employers do make a difference in supporting employment of disabled workers, particularly on hard-to-verify diseases.

Can Fear of Disease hinder Return to Work for Sick-listed Employees?

Randi W. Aas1,2,3, Lise A. Haveraaen1,3, Randi T Tou1,3

1University of Stavanger, Norway; 2Oslo Metropoletan University, Oslo, Norway; 3Presenter - Making Sense of Science, Stavanger, Norway

Background: Few studies has investigated if fear of disease is common among sick-listed employees. The aim of this study was to assess the prevalence of fear of disease and the association between fear and return to work (RTW) in a sample of sick-listed employees, participating in different return to work programmes in Norway.

Methods: 340 sick-listed employees participated in the study. Self-reported fear was linked to national register data on sickness absence. Descriptive statistics and adjusted logistic regression analyses were used to analyse the material.

Results: 48% reported regular experience of fear before the programme started; 32% reported fear during the programme (p < .001). Regular experience of fear before (OR = .429, 95% CI: .196 - .939) and during (OR = .352, 95% CI: .153 - .807) the programme reduced the probability of working three months after the programme had ended.

Conclusion: Fear of disease can reduce the employees RTW-rates and should therefore be addressed in RTW-programmes.

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