Healthcare Provider Communication And The Duration Of Time Off Work Among Injured Workers: A Prospective Cohort Study
1Monash University, Australia; 2Univeristy of Otago, New Zealand; 3Deakin University, Australia; 4Institute for Work and Health, Canada
In addition to biomedical treatment, healthcare providers (HCPs) may make psychosocial contributions to injured workers that aide rehabilitation and the return to work (RTW) process. We examined the effect on disability duration of several types of HCP communications with injured workers and stakeholders in the RTW process.
To test the effect of various HCP communications on time off work following injury.
We analysed survey and administrative claims data from n = 715 injured workers in Victoria, Australia. Survey responses were collected around five months post-injury and provided data on HCP communication and confounders. Administrative claims data provided data on compensated time off work. We conducted multivariate zero-inflated Poisson regression analyses, which evaluated both the likelihood of future time off work and its duration.
HCP communications included good interactions, estimated RTW date, activity discussions, prevention discussions, and stakeholder contact. Time off work was the count of cumulative compensated work absence in weeks, accrued post-survey.
Only RTW dates were predictive of no future time loss (OR: 2.65, 95% CI: 1.74-4.03). RTW date (IRR: 0.71, 0.67-0.74), good interactions (IRR: 0.73, 0.70-0.76), and stakeholder contact (IRR: 0.92, 0.88-0.95) reduced time off work, while activity discussions predicted more time off work (IRR: 1.13, 1.08-1.19).
HCPs may be able shorten disability durations through several types of communication. Of those evaluated in this study, RTW dates had the most robust effect.
Self-certification Versus Physician Certification of Sick Leave
1Finnish Institute of Occupational Health, Finland; 2Social Insurance Institution of Finland; 3University of Eastern Finland
Background Internationallly, there is variation in sickness certification practices. It is unclear whether and how sickness absence is altered when the requirements of a sickness certificate change. The aim of this systematic review is to evaluate the effects of introducing, abolishing or changing self-certification practices on future short-term sickness absence spells (total or average duration and number of sickness absence spells) and organizational feautures (social climate, supervisory involvement and work load, presenteeism).
Methods We will carry out a Cochrane systematic review of published studies including randomized controlled trials, controlled before-after studies and interrupted time-series studies.
Results Preliminary findings indicate that intervention studies with sufficient quality are scarce. Existing studies originate from Nordic countries and the UK. A randomized trial from Sweden found that postponing the requirement for a physician’s certificate increased the duration of sickness absence and costs. In contrast, results from a Norwegian controlled before-after study indicated that prolonging the period of self-certification resulted in a decline of sickness absence.
Conclusions Studies on the effects of changes in self-certification practise on sickness absence are scarce and their findings have been mixed. There are several potential pathways that may mediate the effects of changing the practice of self-certification on short-term sickness absence and features of the organization. We summarize and discuss the existing evidence from the literature.
Protocol: Kausto J, Verbeek JH, Ruotsalainen JH, Halonen JI, Virta LJ, Kankaanpää E. Self‐certification versus physician certification of sick leave for reducing sickness absence and associated costs. Cochrane Database of Systematic Reviews 2018, Issue 8. Art. No.: CD013098. DOI: 10.1002/14651858.CD013098.
How does the Physiotherapy Curriculum Prepare Undergraduates to Effectively Prevent Work Injury and Work Disability?
1University of South Australia, Adelaide, Australia; 2Universidade Cidade de São Paulo, São Paulo, Brazil; 3Universidad CEU San Pablo, Madrid, Spain; 4Moi University, Eldoret, Kenya
Society faces the dual challenges of preventing work injury and safely returning injured workers to sustainable, suitable work. Musculo-skeletal disorders (MSDs) are prevalent work injuries; physiotherapists (PTs) have a prominent role in their prevention and management throughout the lifespan. Therefore, university educators must contemplate laying appropriate foundations for the future performance of these professionals. Investigating PT student curricula to ascertain approaches to develop knowledge-skill-ability about work injury and disability prevention seems prudent.
The investigators initially engaged in a conversation about curriculum content in four different universities in Australia, Brazil, Kenya and Spain. They identified content that should equip students to graduate ready to both prevent and manage work related injury in accord with best practice principles. Next, at greater depth, an initial case study from Australia mapped curriculum through a document analysis of course objectives and assessment items. The results are presented in this paper. In future, further case studies of other curricula are intended.
All countries introduce students to existing work health and safety legislation. Undergraduates all learn the key principles of injury management although not always in relation to injured workers; such context may be important for students to translate this knowledge. Opportunities to prevent and manage work injuries differ between countries. In Australia, Brazil and Kenya students spend time on-site in industry conducting primary prevention activities. In Kenya, Brazil and Spain students may treat injured workers although not necessarily with a return to work focus. Australian students study theory of work injury management but generally do not gain practical experience in this.
Knowledge of international curriculum content and teaching methods may enable benchmarking and lay foundations for future positive change. Initial steps have been taken to help focus subsequent case studies to determine how well current curricula prepare graduates for work in this field.
Learning And Coping Strategies In Cardiac Rehabilitation - Return To Work After One Year (LC-REHAB): A Randomised Controlled Trial.
1Centre for Rehabilitation Research, Aarhus, Denmark; 2DEFACTUM, Region Midtjylland, Aarhus, Denmark; 3Hjerteforskningsklinikken Hospitalsenheden Vest, Herning, Denmark
Background: Cardiac rehabilitation (CR) improves clinical outcomes for people living with ischaemic heart disease (IHD) or heart failure (HF). However, evidence is lacking about how to improve level of function in accordance with the framework of International Classification of Functioning, Disability and Health (ICF). Return to work (RTW) is considered an important aspect of improving level of function; however, personal resources seem to affect the ability to RTW. The patient education ‘Learning and Coping Strategies’ (LC) integrated in CR programmes aims to promote these personal resources through an inductive, pedagogical approach in CR. This study aimed to assess the effect of adding LC strategies in CR compared to standard CR on RTW one year after inclusion.
Methods: The study was conducted from the open randomised trial, LC-REHAB. Enrolled participants in the LC-REHAB trial with IHD or HF were randomised to either the LC arm (LC plus CR) or the control arm (CR alone) across three hospital units in Denmark. The population for the present analysis consisted of 244 participants aged 18 to ≤60 who had not permanently left the labour market. The intervention in the LC arm consisted of individual interviews and group-based situational, reflective, and inductive teaching managed by nurses, physical therapists and experienced patients as co-educators. The control arm (standard CR) consisted of structured, deductive teaching. RTW was derived from the Danish Register for Evaluation of Marginalisation (DREAM) and was compared between arms using logistic regression analysis adjusting for stratification variables (gender, cardiac diagnose and hospital unit).
Results: There was no difference in RTW status between arms one year after inclusion (LC arm: 64.7 % versus controlarm: 68.8%, adjusted odds ratio OR: 0.78, 95 %, CI: 0.45-1.34, P=0.37).
Conclusion: Addition of LC strategies in CR showed no improvement in RTW at one year compared to standard CR.
Assessing Significant Others’ Cognitions and Behavior in Occupational Health Care
1University of Groningen, University Medical Center Groningen, Department of Health Sciences, Community and Occupational Medicine, Groningen, The Netherlands; 2Amsterdam UMC, University of Amsterdam, Coronel Institute of Occupational Health, Amsterdam Public Health research institute, Amsterdam, The Netherlands.; 3University of Groningen, University Medical Center Groningen, Department of Health Sciences, Health Psychology, Groningen, The Netherlands
Background: Significant others (SOs) can play an important role in supporting workers with chronic diseases to participate in work, but can also hinder work participation, for example due to maladaptive illness perceptions. Although cognitions and behaviors of SOs have been identified to influence work outcomes, it is unknown whether occupational health professionals (OHPs) incorporate this in diagnosis and treatment. This study explored current OHS’ practices regarding the assessment of SOs’ cognitions and behaviors in the context of job retention and return to work (RTW) of workers with chronic diseases.
Methods: A cross-sectional survey was conducted among Dutch OHPs. Assessment practices were measured with 16 items grouped into three constructs: SOs’ behavioral responses, illness perceptions and beliefs regarding workers’ job retention and RTW. Multiple linear regressions were performed to test whether OHPs’ assessment of SOs’ cognitions and behaviors are associated with OHPs’ demographic and work characteristics, such as years in practice, core task, organizational policy on assessing SOs’ cognitions and behaviors, and self-efficacy to address these factors.
Results: In total, 192 OHPs completed the questionnaire. Regarding SOs’ behavioral responses, only practical support was frequently assessed by a majority of OHPs. SOs’ illness perceptions and beliefs regarding job retention and RTW were frequently assessed by less than 25 percent of OHPs. Organizational policy was consistently positively related to OHPs’ assessment of SOs’ cognitions and behaviors. The number of years in practice was positively related to assessing SOs’ behavioral responses and self-efficacy was positively related to assessing SOs’ beliefs regarding job retention and RTW.
Conclusions: Assessing SOs’ cognitions and behaviors is not common practice among OHPs. Employer policy, OHPs’ self-efficacy and years in practice are associated with OHPs’ assessment practices. To facilitate assessment of SOs’ cognitions and behaviors, we recommend developing a tool for OHPs to assess and intervene on these factors.
Improvement In Focused And Sustained Attention Is Associated With Return To Work
1Norwegian National Advisory Unit on Occupational Rehabilitation, Norway; 2Uni Research Health, Uni Research, Bergen, Norway; 3Department of Sport and Physical Activity, Western Norway University of Applied Sciences, Bergen, Norway; 4Institute of Health and Society, University of Oslo, Oslo, Norway; 5Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
Individuals on long-term sick leave can be offered inpatient occupational rehabilitation where the aim is return to work (RTW). The programme contains an assessment of aspects related to work and health, cognitive interventions, physical activity, collaboration with stakeholders, and drawing up a RTW plan. The aim of this study was to apply the cognitive psychological approach to investigate the relationship between cognitive functioning and RTW, and to further assess which cognitive changes take place during and after rehabilitation.
In this quasi-experimental prospective cohort study we recruited 318 sick listed individuals who completed occupational rehabilitation and a control group consisting of 73 individuals working full time. All participants completed the same eight computerised cognitive tests (targeting memory, attention, executive function) and questionnaires on work and health at pre-test (T1) and post-test (T2) rehabilitation and 3 (T3) and 12 months (T4) after rehabilitation. The time intervals were the same for the control group.
RTW register data for the rehabilitation group showed that improvement from T1 to T3 in focused attention (OR=2.51, 95% CI: 1.12-5.62) and sustained attention (OR=2.38, 95% CI: 1.14-4.98) was associated with RTW one year after (T4). The rehabilitation group improved more in focused and sustained attention, short term and working memory, cognitive flexibility, and emotion recognition from T1 to T2 and from T1 to T4, than the control group.
The results show that improvement in attention, and not memory and executive function, is associated with RTW. Improvement in attention, memory, cognitive flexibility, and emotion recognition were evident in rehabilitation participants during rehabilitation and that the changes in attention and memory remained one year after. This study indicate that some cognitive functions may be more important than others in the RTW process. Implications for workplace accommodation related to attentional difficulties will be discussed.