Self-directing Return-to-Work: An Employees’ Perspective
1Maastricht University, CAPHRI Research Institute, the Netherlands; 2Open University, Heerlen, the Netherlands
Background: Dutch legislation stimulates the active participation of employees in their own return-to-work (RTW). In addition, RTW professionals encourage sick-listed employees to self-direct RTW. It remains unclear, however, how employees give meaning to and shape their self-direction. This study aims to conceptualize self-direction using the components of Self-Determination Theory (autonomy, competence, and relatedness) as a framework.
Methods: A qualitative study was performed. Semi-structured interviews were conducted with three long-term sick-listed employees (> 6 weeks). These results were combined with fourteen existing transcripts of semi-structured interviews with long-term sick-listed employees and employees who returned to work after long-term sick leave during the previous calendar year. All interview transcripts were analyzed thematically.
Results: Employees generally think of self-direction as taking their own decision regarding RTW. Several environmental factors (proximal and distal) play a role in employees’ self-direction. Proximal factors are satisfaction of the need for autonomy, competence, and relatedness. Employees experience a need to self-direct their RTW, but some express a lack of competence to do so. Employees with mental complaints for instance need more help in making choices and taking decisions. Distal factors are legislation regarding RTW and clarity (or lack of it) regarding the roles of various stakeholders in the process of sickness absence and work resumption.
Conclusions: Exercising self-direction in RTW seems to contribute to early work resumption. Enabling employees to self-direct their RTW process and listening to their needs are beneficial for a better work resumption. Preconditions for effective self-direction are a supportive environment and good cooperation between the employee, employer, and occupational physician.
Managing Stigma: Employees Returning to Work Following a Common Mental Disorder
Université de Sherbrooke, Canada
While the literature is now paying greater attention to stigmatization in the workplace, most studies adopt a quantitative approach, and of these, very few examine the return-to-work (RTW) context. Our study sought to show how stigmatization constitutes an organizational factor likely to hinder the RTW and stay-at-work ability of employees following sick leave for a common mental disorder (CMD).
We conducted a survey of 36 Quebec workers (22 women, 14 men) with diverse occupations who had been on sick leave (2 weeks to 12 months) after a CMD diagnosis. Each worker was asked (1) to complete two questionnaires: one on psychological distress (the Psychiatric Symptoms Index) and a second on quality of life (the Quality of Life Systemic Inventory); and (2) to participate in a semi-structured interview averaging 60 minutes.
The results showed how, independently of the medical opinion of their health condition, the workers saw themselves as being suspected of having a new psychological vulnerability that ostensibly deprived them of some of their work capacities. This capacity discreditation sometimes originated with coworkers and supervisors and turned into permanent occupational disqualification. To prevent this, the workers used strategies to restore their image, i.e. to convince coworkers and supervisors of their good mental health and work capacities. However, not all of the workers had the same ability to do this and some failed. The latter had to cope with the effects of their new social identity of “disqualified worker” (psychological distress, disengagement from work, downgrading of occupational status, “forced” job change, self-stigmatization) or even leave their workplace (“forced” job change, early retirement).
Better understanding of the forms that stigmatization can take in the RTW context and of its negative effects on career paths will help generate courses of action for offsetting their occurrence in workplaces.
Effects Of Adding a Workplace Intervention To an Inpatient Occupational Rehabilitation program: a randomized clinical trial
1Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, NTNU, Trondheim, Norway; 2Unicare Helsefort Rehabilitation Centre, Rissa, Norway; 3Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, NTNU, Trondheim, Norway; 4Department of Mental Health, Faculty of Medicine and Health Sciences, NTNU Trondheim, Norway
The aim of this study is to evaluate the effect of adding a workplace intervention to an inpatient occupational rehabilitation program on sickness absence.
A randomized clinical trial with parallel group design. Eligible participants were workers, 18-60 years old, sick listed with musculoskeletal, psychological or general and unspecified diagnoses. The rehabilitation program lasted 2+1 weeks (with one week at home) and consisted of Acceptance and Commitment Therapy, physical training and work-related problem solving. The intervention group received in addition a workplace intervention including group-based and individual preparations and a work-place meeting between the sick-listed worker, the employer and a coordinator from the rehabilitation center. The main outcome was number of sickness absence days during 12 months of follow-up, and time until sustainable return to work (RTW), measured by registry data.
175 participants were randomized to regular rehabilitation (n=87) or regular rehabilitation with a workplace intervention added (n=88). Median number of sickness absence days during 12 months of follow-up was 115 days (IQR 53-183) vs 130 days (IQR 81-212), in favor of the group without a workplace intervention. The hazard ratio for sustainable RTW was 0.74 (95 % CI 0.48-1.16, p=0.192), in favor of the group not receiving the workplace intervention.
There were no statistical significant differences between the groups in either of the work outcomes. However, the estimates indicate that those with workplace intervention had delayed return to work, suggesting that the current workplace intervention should not be implemented in inpatient occupational rehabilitation.
Workplace And System-Based Interventions On Return-To-Work And Recovery For Musculoskeletal And Mental Health Conditions. Findings From Two Systematic Reviews
1Memorial University of Newfoundland, Canada; 2Institute for Work & Health, Canada; 3Team WorkingLife ApS, Denmark; 4Robert Stempel College of Public Health and Social Work, Florida International University, Miami, USA; 5Monash University, Australia; 6Lakehead University, Canada; 7University of Montreal, Canada
Introduction: The burden of managing musculoskeletal pain and injuries (MSDs) and mental health (MH) conditions in the workplace is substantial. While overall rates of work injury have declined in most high-income countries, there have not been equivalent improvements in RTW rates. The primary objective of this review was to synthesize evidence on the effectiveness of workplace- and system-based interventions for RTW and recovery after a period of work absence.
Methods: We followed a systematic review process developed by the Institute for Work & Health and an adapted best evidence synthesis.
Result: Seven electronic databases were searched from January 1990 until September 2017. This comprehensive search yielded 10578 non‐duplicate references. Our synthesis identified 68 studies examining three types of RTW outcomes (lost time, work functioning and associated costs) and four recovery outcomes (pain, psychological functioning, physical functioning and quality-of-life). These studies examined interventions that were classified into three broad domains: healthcare provision, service delivery and workplace modifications. Our review identified that in most cases, interventions were multi-faceted and included multiple intervention components, sometimes operating across multiple domains. The most common RTW outcome reported was lost time. Among the other RTW and recovery outcomes, studies varied widely in their inclusion. There is strong evidence that interventions encompassing multiple domains are effective in improving RTW outcomes in workers with MSD or MH conditions. In contrast, there is moderate to strong evidence that most single-component interventions have no effect on improving recovery regardless of condition.
Discussion: While there is substantial research literature focused on RTW, only a small percentage of these intervention studies also include measures of recovery. Identifying effective intervention programs that facilitate RTW and recovery allows workplaces to implement empirically supported programs that benefit workers through improved function and reduced pain while reducing the economic burden associated with lost time.