Philosophiae Doctor - PhD / Return-to-work (RTW) after an injury or illness is influenced by physical, psychological and social factors. Therefore, a need exists to develop a contextualized multi-perspective and objective measure for the assessment of return-to-work among stroke survivors. This current study comprised three phases, with each phase intended to address various objectives in the process of developing and validating a psychometrically sound measure, to assess return-to-work in stroke survivors. In the first phase, qualitative data collection methods were employed with various stakeholders and key informants, to finalise the conceptualisation, scale construction, and domain identification of the intended instrument. In-depth interviews were conducted with stroke survivors, their caregivers, employers and rehabilitation professionals. The data generated were analysed using the Atlasti.version 7. The results were used to construct the instrument.

京都大学 / 新制・課程博士 / 博士(医学) / 甲第24832号 / 医博第5000号 / 新制||医||1067(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 武藤, 学, 教授 今中, 雄一, 教授 阪上, 優 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DGAM

Little is known about time to return to work (TRTW) following planned medical events. This study was a secondary analysis (n=94) to determine predictors of time to return to work following a total knee replacement for osteoarthritis. Significant predictors of delayed TRTW following a knee replacement: 1) use of workplace modifications (in 6wks vs 5 wks) and 2) poor physical function (in 7wks vs 6 wks). These findings have large implications for workers undergoing knee replacement, orthopedic clinicians, and occupational health nurses.

La dépression majeure est un non-sens pour une personne qui en souffre et influence probablement sa motivation au retour au travail, car elle favorise chez elle une identité de malade et par conséquent un sentiment d’être inadéquat. Au Québec et au Canada, cette pathologie est la principale cause d’années vécues avec invalidité ainsi que de décès prématurés. Il apparaît donc pertinent de vérifier si un traitement spécialisé de la dépression majeure comme la psychothérapie interpersonnelle (PTI) pourrait favoriser la motivation au retour au travail d’une personne. Cette approche semble prometteuse pour diverses raisons : 1) elle cible un événement interpersonnel souvent considéré comme un des facteurs déterminants dans l’émergence de cette maladie; 2) elle repose sur des données probantes pour le soulagement des symptômes de dépression majeure; 3) elle ne considère que transitoirement l’identité de malade; 4) elle facilite l’acquisition de stratégies d’adaptation interpersonnelle. La présente étude exploratoire de la contribution de la PTI sur la motivation au retour au travail de personnes en dépression majeure retient la méthodologie de l’étude de cas. Elle se déroule en milieu naturel auprès de quatre personnes considérées en invalidité chronique de leur travail. Autant des données qualitatives que quantitatives sont recueillies et analysées. Les résultats obtenus montrent que trois de ces quatre personnes reprennent leur travail pendant la PTI ou à la fin du traitement alors que l’autre personne s’engage dans une démarche de réorientation. Une autre contribution de la PTI permet de constater que ces personnes ont davantage recours à un soutien social. De plus, elles ont tendance à mieux connaître leur identité ou leurs limites, à améliorer leurs habiletés à la résolution de problème ainsi que leur capacité à communiquer avec les autres. L’idée de mesurer la symptomatologie dépressive et la motivation au même moment pendant un traitement serait à conserver dans une prochaine recherche, car un lien semble s’établir entre la sévérité des symptômes de la maladie et le degré de motivation d’une personne au retour au travail.

Introduction : À la suite d’une absence du travail en raison d’un trouble musculosquelettique (TMS), plusieurs travailleurs font un retour progressif au travail (RPAT). Cette pratique comporte plusieurs avantages, mais pose également des défis dans sa mise en application pour les entreprises. L’objectif de l’étude était d’offrir un outil adapté aux employeurs pour les soutenir dans la gestion des RPAT d’individus s’étant absentés en raison d’un TMS. L’étude poursuivait deux objectifs : 1) adapter un outil existant destiné aux professionnels de la réadaptation (Guide d’évaluation de la marge de manœuvre [MM]) et 2) en établir son acceptabilité auprès des utilisateurs potentiels (UP). Méthode : Un devis multiméthode a été utilisé et s’est actualisé en trois étapes. 1) La première étape consistait à adapter l’outil original en regard des résultats d’une revue critique de la littérature portant sur les caractéristiques favorisant l’adoption des guides par les UP. 2) La deuxième étape était de consulter un groupe d’experts en réadaptation au travail, familier avec le guide original et collaborant avec les UP, à l’aide d’une adaptation de la technique de recherche de l'information par l'animation d'un groupe d'experts (TRIAGE). Cette consultation s’est faite en deux phases : un sondage à compléter individuellement et une rencontre de groupe de consensus. Pour le sondage, un questionnaire auto-administré a été utilisé, avant la rencontre de groupe, pour établir le niveau d’accord des experts avec la pertinence, l’exhaustivité, la clarté, l’apparence visuelle et la convivialité de la première version de l’outil adapté. Des propositions ont été faites par les experts pour les énoncés ayant obtenu un score d’accord de deux ou moins et ont été traitées dans une rencontre de groupe, jusqu’à l’obtention d’un consensus sur les modifications à apporter. 3) La troisième étape visait à établir l’acceptabilité de la dernière version de l’outil adapté auprès des UP. Pour ce faire, des entrevues semi-dirigées ont été réalisées auprès de dyades composées de coordonnateurs de retour au travail et de supérieurs immédiats d’une même entreprise. Une analyse thématique du verbatim des entrevues a été réalisée. Résultats : 1) À partir de 13 publications, quatre grandes caractéristiques (clarté, format, applicabilité et utilité) ont été relevées de la revue critique. 2) Neuf ergothérapeutes (huit femmes et un homme, expérience moyenne de 12,17 ans) sont ensuite arrivés à un consensus de 20 modifications portant sur trois sections de l’outil adapté qui a mené à une deuxième version comportant un guide d’instructions de 22 pages et une grille de planification recto-verso. 3) Les 15 UP consultés (neuf femmes et six hommes provenant principalement de grandes entreprises de secteurs variés) ont globalement jugé l’outil acceptable. Ils ont reconnu, notamment, qu’il permettait d’opérationnaliser les bonnes pratiques de retour au travail, de standardiser la gestion des RPAT et d’inclure plus systématiquement le travailleur dans la démarche. Ils ont également identifié quelques changements mineurs à apporter, dont l’ajout de recommandations concernant la préparation des collègues et celui d’avoir un format plus court. Conclusion : Par l’adaptation du guide d’évaluation de la MM, cette étude a permis d’offrir un outil destiné et adapté aux employeurs, en tenant compte à la fois des données probantes et d’un consensus d’experts, ce qui semble avoir contribué à son acceptabilité par les UP. L’outil adapté comble un réel besoin au sein des entreprises et des études supplémentaires pourraient être menées pour améliorer son format et créer une version transdiagnostique. / Abstract: Purpose: To facilitate a return to work for workers being on a sick leave following a musculoskeletal disorder (MSD), many physicians prescribe a gradual return to work (GRTW), which poses numerous challenges for workplaces. The aim of this study was to provide employers with an adapted tool to support them in managing GRTWs following a MSD. The study had two objectives: 1) adapt an existing tool intended for rehabilitation professionals (Guide for estimation of margin of manoeuvre) and 2) establish the acceptability of the adapted tool with potential users (PUs). Methods: A mixed methods design was used and carried out in three phases. 1) The first step was to adapt the original tool by taking into account the results of a critical review of the literature on the characteristics fostering PU’s adoption of guides. 2) The second step was to consult a group of expert practitioners familiar with the original guide and who worked with the PUs, using an adaptation of the Technique for Research of Information by Animation of a Group of Experts (TRIAGE). This consultation was done in two phases: a survey to be completed individually, and a consensus group meeting. For the survey, a self-administered questionnaire was used, prior to the group meeting, to establish the level of agreement of the experts with the pertinence, exhaustiveness, clarity, visual appeal and user-friendliness of the first version of the adapted tool. The proposals made regarding statements that obtained mean agreement scores of two or less were then addressed in a group meeting, until consensus was reached on the changes to be made. 3) The third step was to establish the acceptability of the latest version of the adapted tool with the PUs. To do so, dyads composed of a return-to-work coordinator and a direct supervisor from the same company were interviewed, using a semi-structured interview guide. A thematic analysis of the verbatim transcript was performed. Results: 1) From 13 publications, four main characteristics (clarity, format, applicability, and usefulness) were identified from the critical review. 2) Nine occupational therapists expert (eight women and one man, mean experience of 12.17 years) reached a consensus on 20 modifications covering three sections, which yielded a second version of the adapted tool comprising a 22-pages instruction guide and a two-sided planning worksheet. 3) The 15 PUs consulted (nine women and six men mainly from large companies from various sectors) found the tool acceptable overall. They recognized that the developed tool allowed them to standardize the management of the GRTW, include the worker more systematically in the process, and operationalize the best return-to-work practices. They also identified a few minor changes to make, including recommendations for preparing colleagues and shortening the format. Conclusion: By adapting the Guide for estimation of margin of manoeuvre, this study provided a tool that was designed and adapted to employers, taking into account both evidence-based data and expert consensus, which seems to have contributed to its acceptability by PUs. The adapted tool fills a real need within companies and further studies could be carried out to improve its format and create a transdiagnostic version.

No description available.

Luossavaara-Kiirunavaara AB (LKAB) är ett statligt industriföretag som verkar inom gruvbranschen. Företaget arbetar i dagsläget aktivt i syfte att förebygga ohälsa på arbetsplatsen.Trots detta proaktiva arbete är både fysisk och psykisk ohälsa på arbetsplatsen ofrånkomligt och det är därmed viktigt att utveckla en väl fungerande rehabiliteringsprocess. En arbetslivsinriktad rehabiliteringsprocess innefattar arbetsträning, anpassning av arbetsplatsen samt förändrande arbetsuppgifter eller utbildning. I denna process har individens närmaste chef en central roll. Studien syftar därför till att förmedla de ansvariga chefernas uppfattningar och upplevelser av företagets rehabiliteringsprocess. Insamlingen av datamaterial har utförts genom tolv kvalitativa semistrukturerade intervjuer och bearbetningen genomfördes därefter utifrån en fenomenografisk analysmetod. Forskningsfrågorna behandlade chefernas uppfattningar och upplevelser av den nuvarande processen samt deras roll och ledarskap. Vidare undersöktes även de förbättringsområden som kunde identifieras. Studiens huvudresultat visade både likheter och skillnader mellan chefernas uppfattningar och upplevelser. Flertalet chefer upplevde den nuvarande rehabiliteringsprocessen som fungerande medan andra chefer upplevde att den fungerande mindre bra. Flera förbättringsområden identifierades där önskan om tydligare struktur genomsyrade samtliga förslag. Studiens resultat visade även likheter och skillnader i chefernas ledarskap. Analysen av chefernas uttalanden genererade två ledarprofiler där de tillhörde antingen en ledarprofil som karaktäriserades av stödjande egenskaper eller en profil som karaktäriserades av både stödjande och delegerande egenskaper. De chefer som tillhörde den sistnämnda profilen tenderade att anpassa sin ledarstil efter individ och situation. Detta flexibla arbetssätt kunde kopplas till situationsbaserat ledarskap vilket utifrån tidigare forskning  visat sig leda till goda resultat.

The ability to work can be reduced if a person has health problems which may lead to periods of sick leave. In Sweden sickness certification is issued by physicians. Many general practitioners (GPs) find sickness certification to be problematic. Some studies indicate that collaboration with other health care professions could be beneficial. The aim of the thesis was to provide knowledge on how the work with the sick leave process in primary health care can be improved and how occupational therapists’ (OT) assessment could be used prior to the decision on sick leave and rehabilitation. Initially seven focus groups were held, four with OTs and three with physicians. The discussions in the focus gropes were analysed by qualitative content analysis. An intervention project was initiated, where four health care centres in northern Sweden tested a working approach where sick listed patients were offered a supplementary assessment of activity and work-related problems by an OT. Data on sick leave, sickness certificates and patient questionnaires were collected from intervention health care centres (IHCC) and other health care centres (OHCC). Interviews were conducted with patients, GPs and OTs. The quality of the information in the collected sickness certificates was evaluated. Average values of sick leave were compared between the IHCCs and the OHCCs in the county. The interviews with sick listed patients were analysed by qualitative content analysis. In order to analyse the implementation of the intervention the Consolidated Framework for Implementation Research, CFIR, was used. An overall theme and four categories emerged from the focus groups. The theme expressed work ability as an obscure, complex and unique concept. The four categories illustrate the affecting factors and confirmed the complex structure of work ability: the person, the context of life, the work, and the society. No significant differences between IHCCs and OHCCs in data on sick leave or the mandatory information in the certificates were found. Thirty-four percent of the collected sickness certificates did not contain all requested information. More certificates issued for women than certificates issued for men lacked the required information. Full-time sick leave was significantly more often prescribed for male patients than for female. Two themes revealed that highlight important areas for persons on sick leave in their healthcare encounters. The theme ‘Trust in the relationship’ contains categories describing the patients’ feelings of participation, being believed, confirmed, and listened to. The second theme ‘Structure and balance’ contains the participants’ views on important factors that could facilitate the return-to-work process such as a structured plan and support to balance activity. The analysis with CFIR clarified that coaching and education for all the users are crucial to get fidelity when new interventions are tested as well as involvement by the clinical department manager. The work with sick leave issues in primary health care can be improved by developing cooperation with several different professionals. To achieve an increased cooperation new working approaches are required. These working approaches must be anchored in management and requires an applied implementation strategy. More focus on the quality of encounters with healthcare professionals can also improve the sick leave process in primary health care centres. The healthcare encounters must build on a mutual trust and sick-listed persons’ return to work can be facilitated by providing a clear structure in the process and support in occupational balance. For issuing sickness certification further education about the descriptions of functioning and the tasks included in the patient’s work is needed. A better gender awareness in the health care encounters is also necessary.

Each year approximately 90,000 new cases of cancer are diagnosed in people of working age in the United Kingdom (UK) (Morrell & Pryce, 2005). The potential impact of cancer and its treatment on working life is substantial, with approximately 40% of all cancer patients taking time off work during treatment and recovery (Short, Vasey & Tunceli, 2005). However, little information is available on employment outcomes for those managing colorectal cancer. Colorectal cancer is a commonly diagnosed cancer with approximately 36,000 people diagnosed each year in the UK. Although research demonstrates promising return to work outcomes for this group, not enough is known about the factors (variables) impacting their return to work intentions, work ability and employment outcomes. The aims of this research were to: examine the return to work intentions, work ability and employment outcomes of colorectal cancer patients over six months; explore the role of self-efficacy and psychosocial well-being, and explore the role of health professionals in providing work-related support and information to patients. Findings from these studies may help to better inform future interventions to support this cancer group. Fifty participants newly diagnosed with colorectal cancer were recruited from three Acute NHS Trusts (n = 27) across the Midlands and a support group (n = 23) affiliated to a National Cancer Charity. Participants completed questionnaires at three time points: baseline (post surgery or pre-treatment); follow-up time 1 (3 months), and follow-up time 2 (6 months). As well as illness and demographic characteristics, the questionnaires measured job self-efficacy, work ability, cancer self-efficacy, quality of life, fatigue and depression. A sub-sample of participants (n = 10) completed a monthly diary over six months. This captured temporal fluctuations and patterns in cancer management, return to work intentions and work ability and the factors impacting upon these (self-efficacy and social support). Finally, 18 health professionals participated in semi-structured interviews that explored the nature and type of work-related advice currently provided to colorectal cancer patients. Data were analysed using both quantitative (ANOVAs and regression) and qualitative techniques (thematic analysis). The questionnaire study identified varying levels in self-assessed work ability and psychosocial well-being. Most importantly, positive changes in perceptions of cancer self-efficacy F (1.02, 61.12) = 14.70, p = 0.0005, and job self-efficacy F (2, 94) = 10.85, p = 0.0005 were detected over time; however, interactions between treatment type and time did not emerge (p > 0.05). Factors related to perceived work ability outcomes cross-sectionally included type of occupation (β = 0.31, t = 2.65, p = 0.0005) and quality of life (β = 0.42, t = 2.57, p = 0.01) at baseline, treatment type (β = -0.19, t = -1.94, p = 0.05) at follow-up time 1 and job self-efficacy at follow-up time 1 (β = 0.57, t = 4.40, p = 0.0005) and time 2 (β = 0.50, t = 2.92, p = 0.006). In contrast, factors related to employment status (i.e. working, not working) were job self-efficacy (OR = 2.20, 95% CI: 1.17 4.13) at baseline and occupation (OR = 0.03, 95% CI: 0.00 0.86), and perceived work ability (OR = 3.05, 95% CI: 1.00 12.80) at follow-up time 2. Along with self-assessed work ability at baseline (β = 0.67, t = 3.99, p = 0.0005), receiving chemotherapy alone or a combination of treatments (i.e. other than surgery alone) (β = -0.24, t = -1.99, p = 0.05) were the strongest predictors of follow-up work ability (independent of age and occupation). Finally, treatment type (OR = 9.91, 95% CI: 1.57 62.50) was also identified as the strongest predictor of employment status approximately six months after diagnosis. Findings from the diary study suggest that self-efficacy beliefs were important in understanding employment outcomes and return to work intentions. The role of such beliefs was multi-faceted and results infer that several factors seemed to impact return to work intentions and self-efficacy temporally. Treatment, symptoms and decrements in perceived work ability were identified as the most prominent factors that served as barriers preventing resumption of work. Moreover, there was a degree of disparity between return to work intent and work ability. Additionally, the diary study identified variation in work-related advice and guidance provided to colorectal patients. Subsequently, some participants may have been under the impression that they were unable to work, especially during treatment. Results from the interview study found that health professionals attempted to provide guidance to working-aged patients. However, the nature of such guidance varied due to experience, knowledge and time constraints. Furthermore, participants highlighted a lack of knowledge and an insufficient evidence base were barriers to providing more appropriate guidance. The majority of participants stated that this was an aspect of patient care that falls short and to address the issue a concerted multi-disciplinary effort was required. In short, the findings indicate that the factors related to work ability, return to work intentions and employment outcomes of colorectal cancer patients varied over time, whereby certain variables took precedence over others at particular time points. Furthermore, the results suggest that self-efficacy beliefs are important; however, it is crucial to point out that self-efficacy is unlikely to operate as a stand-alone factor. Indeed, it is argued that it may be a construct that is considered in future research endeavours alongside pre-existing findings, which would inevitably help towards gaining a more comprehensive account of the factors related to the work outcomes of individuals affected by cancer.

In Minnesota’s workers’ compensation system, injured employees at risk for sustaining permanent disability may be eligible for receipt of vocational rehabilitation (VR) services if they are determined to be capable of benefitting from such services. VR services can be a valuable resource to injured employees who need assistance minimizing their work disability and maximizing their residual wage-earning capacity. However, for VR services to be effective at a system level, it is necessary to precisely and accurately identify an injured employee’s rehabilitation potential. Failure to do so is likely to result in the misallocation of a scarce and costly resource. Given recent trends in Minnesota’s workers’ compensation system (e.g., higher VR service costs and lower RTW rates among injured employees with indemnity claims), this study was conducted with the purpose of developing and validating an objective, evidence-based method of predicting the RTW status as of claim closure of injured Minnesota employees who sustained permanent impairment and received VR services. To accomplish this purpose, a closed-claim, retrospective design was implemented. Data for this cross-sectional study was obtained from the Minnesota administrative claims database. There were 15,372 claims that met all eligibility criteria. With guidance from the biopsychosocial disablement models developed by Nagi and the World Health Organization, 15 discrete predictor variables that represented medical, individual, and workplace factors were selected for study inclusion. Descriptive and predictive analyses were used to assess the relationship between this study’s RTW outcome and its set of RTW predictors. Using logistic regression, an optimal RTW model was first developed and then internally validated with a split-dataset approach. The optimal RTW model included four main effects (attorney involvement; severity of permanent impairment; age; job tenure) and three first-order interaction effects (pre-injury average weekly wage X pre-injury industry; attorney involvement X severity of permanent impairment; attorney involvement X job tenure). Though not retained in the optimal RTW model, part of body affected and education also had notable bivariate relationships with the outcome. The optimal RTW model’s performance regarding goodness-of-fit and clinical usefulness suggests it may be of value to those assessing rehabilitation potential within Minnesota’s workers’ compensation system.