Return to work 1
The Five-year Labour Market Participation Prospects In Incident Cancer Patients: A Danish Population-based Cohort-study
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
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
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
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
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
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.