Work has a great influence on most of individuals in society. It influences both identity as well as the structure of the day. Unemployed people are often affected in a negative way through economic and psychological problems. In order to help people with reduced work capacity back to the labour market and decrease unemployment, the Labour Market Board works with vocational rehabilitation. The aim of this study is to investigate experiences of vocational rehabilitation within the Labour Market Board among unemployed people. A qualitative method was used by which interviews were made with 11 unemployed persons who participated in an investigation as a part of vocational rehabilitation within the Labour Market Board. The result shows both positive and negative experiences of the investigation period. The identified experiences were sorted into code groups: Support, Insight, Confidence in the investigation and result, Belief in the future, Motivation, and Participation. Both the actions of the personnel and the presence of the group members influenced the experiences. The support given by the personnel and how it is experienced is of great importance for the future of the unemployed. When the investigation was pursued during a short period of time, there was a lack of confidence in the investigation and result. A suggestions for future studies is to design a questionnaire that can be used in a larger study including a large number of individuals who are participating in vocational rehabilitation within the Labour Market Board.

Den nya rehabiliteringskedjan med sina fasta tidsgränser för långtidssjukskrivna har fått stor uppmärksamhet i svensk media under senare tid. De nya reglerna fokuserar framförallt på tidiga insatser för långtidssjukskrivna med målet återgång i arbete. Intervjuerna i föreliggande studie utfördes med sju försäkrings-kassahandläggare på olika försäkringskontor. Syftet var att undersöka vilka erfarenheter och upplevelser handläggarna på Försäkringskassan har av den nya rehabiliteringskedjan och arbetslivsinriktad rehabilitering. Resultatet visade att det är en mängd olika faktorer som påverkar handläggarnas arbete. Som viktiga faktorer uppgav handläggarna ett ändrat regelverk med fasta tidsgränser, samarbetet mellan olika aktörer för den försäkrades återgång i arbete, handläggarnas och andra aktörers engagemang samt den försäkrades egna resurser. Vidare forskning inom området arbetslivs-inriktad rehabilitering behövs, om den nya rehabiliteringskedjans effekter på tidigare återgång till arbetslivet verkligen innebär ökat stöd till de långtidssjukskrivna. Även andra rehabiliterings-aktörers erfarenheter av de nya sjukskrivningsreglerna behöver utforskas.

Background In 2010, the Swedish government introduced a system of subsidies for occupational health (OH) service interventions, as a part in a general policy promoting early return to work. The aim of this study was to analyse the implementation of these subsidies, regarding how they were used and perceived. Methods The study was carried out using a mixed-methods approach, and comprises material from six sub-studies: a register study of the use of the subsidies, one survey to OH service providers, one survey to employers, one document analysis of the documentation from interventions, interviews with stakeholders, and case interviews with actors involved in coordinated interventions. Results The subsidized services were generally perceived as positive but were modestly used. The most extensive subsidy – for coordinated interventions – was rarely used. Employers and OH service providers reported few or no effects on services and contracts. OH service providers explained the modest use in terms of already having less bureaucratic routines in place, where applying for subsidies would involve additional costs. Information about the subsidies was primarily communicated to OH service providers, while employers were not informed. Conclusions The study highlights the complexity of promoting interventions through financial incentives, since their implementation requires that they are perceived by the stakeholders involved as purposeful, manageable and cost-effective. There are inherent political challenges in influencing stakeholders who act on a free market, in that the impact of policies may be limited, unless they are enforced by law. / <p>Funding Agencies|Swedish Social Insurance Agency||Ministry of Health and Social Affairs||</p>

Traumatic brain injury (TBI) is the leading cause of death and disability in the industrialized world. This pilot study investigated demographic, clinical and environmental factors associated with return to work (RTW) among workers who sustained a mild to moderate work-related TBI (WrTBI). Using a retrospective cohort design, participants were recruited through an outpatient clinic dedicated to evaluating injured workers after a WrTBI. A mailed survey and medical record abstraction tool were used for data collection. Of the 40 injured workers who participated in this study, 19 reported working at time of follow-up. Those who were unable to RTW scored significantly lower on measures of emotional well-being; there were no significant between-group differences in cognitive or physical impairments. Gradual RTW and workplace accommodations were reported as key factors facilitating RTW. Our findings provide information that addresses improved rehabilitation and management of WrTBI as well as better education and support for employers.

Traumatic brain injury (TBI) is the leading cause of death and disability in the industrialized world. This pilot study investigated demographic, clinical and environmental factors associated with return to work (RTW) among workers who sustained a mild to moderate work-related TBI (WrTBI). Using a retrospective cohort design, participants were recruited through an outpatient clinic dedicated to evaluating injured workers after a WrTBI. A mailed survey and medical record abstraction tool were used for data collection. Of the 40 injured workers who participated in this study, 19 reported working at time of follow-up. Those who were unable to RTW scored significantly lower on measures of emotional well-being; there were no significant between-group differences in cognitive or physical impairments. Gradual RTW and workplace accommodations were reported as key factors facilitating RTW. Our findings provide information that addresses improved rehabilitation and management of WrTBI as well as better education and support for employers.

Nursing is a high risk profession for injury. A Canadian survey reports many nurses are in poor physical and emotional health; they sustain more musculoskeletal and violence related injuries than other occupational groups. In Ontario, an injury management approach called Early Return to Work (RTW) requires injured workers, including nurses, to go back to work before full recovery. The Workplace Safety and Insurance Board cite this approach as beneficial to both the employer and employee. This study uses an institutional ethnographic approach to examine critically the RTW process from the standpoint of injured registered nurses. Through interviews and mapping activities with nurses, other health professionals and managers, a rendering of the social organization of hospital injury management emerges. The findings suggest that the implementation of RTW is complicated and difficult for nurses, their families and hospital employers. Injured nurses engage in significant amounts of domestic, rehabilitation and accommodation work in order to participate in the RTW process. When the returning nurse is unable to engage in full duties hospital operations become disorganized. Collective agreements and human resources procedures limit the participation of injured nurses in creative and/or new roles that could utilize their knowledge and skills. As a result, nurses are assigned to duties, which hamper them from returning to their pre-injury positions and cause their employment with the hospital to be reconsidered. The unsuccessful return of injured nurses to employment is counter to provincial retention initiatives, which seek to sustain an adequate cadre of nurses ready and able to care for the increasing health care needs of an aging population. Sites of change which could support and promote the successful return of these injured workers to nursing work are identified in this study.

Nursing is a high risk profession for injury. A Canadian survey reports many nurses are in poor physical and emotional health; they sustain more musculoskeletal and violence related injuries than other occupational groups. In Ontario, an injury management approach called Early Return to Work (RTW) requires injured workers, including nurses, to go back to work before full recovery. The Workplace Safety and Insurance Board cite this approach as beneficial to both the employer and employee. This study uses an institutional ethnographic approach to examine critically the RTW process from the standpoint of injured registered nurses. Through interviews and mapping activities with nurses, other health professionals and managers, a rendering of the social organization of hospital injury management emerges. The findings suggest that the implementation of RTW is complicated and difficult for nurses, their families and hospital employers. Injured nurses engage in significant amounts of domestic, rehabilitation and accommodation work in order to participate in the RTW process. When the returning nurse is unable to engage in full duties hospital operations become disorganized. Collective agreements and human resources procedures limit the participation of injured nurses in creative and/or new roles that could utilize their knowledge and skills. As a result, nurses are assigned to duties, which hamper them from returning to their pre-injury positions and cause their employment with the hospital to be reconsidered. The unsuccessful return of injured nurses to employment is counter to provincial retention initiatives, which seek to sustain an adequate cadre of nurses ready and able to care for the increasing health care needs of an aging population. Sites of change which could support and promote the successful return of these injured workers to nursing work are identified in this study.

Syfte: Syftet med denna studie var att kartlägga långtidssjukskrivnas hälsa före och efter avslutad intervention samt studera vilka faktorer som hindrat alternativt främjat återgång i arbete hos individer med tidsbegränsad sjukersättning. Metod: Studien baseras på data från EU-projektet ”SAMKLANG” som är en longitudinell interventionsstudie. Data har samlats in på 59 långtidssjukskrivna deltagare via enkäter både före projektstart och ett år efter och dels har data samlats in kvalitativt genom semistrukturerade intervjuer med 13 deltagare efter det att projektet avslutats. Intervjudeltagarna var indelade i två grupper (de som hade återgått i arbete/studier och de som fortfarande var sjukskrivna). Interventionen bygger på både behandling och samverkan mellan organisationer som är involverade i rehabilitering av personer som har ett år kvar av sin tid i sjukersättning. Resultatet från enkäterna analyserades fram via ANOVA upprepad mätning och data från intervjuerna analyserades via innehållsanalys. Resultat: Huvudresultaten från den kvantitativa delstudien visade att det inte fanns någon skillnad mellan de som efter ett år återgått i arbete/studier, arbetsträning alternativt de som fortfarande var sjukskrivna gällande kön, ålder eller utbildningsnivå. Den självskattade depressions- och ångestnivån minskade och självskattad hälsa och inre kontroll ökade signifikant över tid för den grupp som kommit ut i arbete efter projektet jämfört med de två andra grupperna. Den kvalitativa analysen av intervjuerna identifierade följande tema som stödjande faktorer för arbetsåtergång: att besitta egen drivkraft, ha en insikt om arbetets mervärde och att hitta en balans mellan krav- kontroll-stöd. Det tema som beskriver hur myndigheter kan hjälpa och stödja långtidssjukskrivna tillbaks i arbete är: trygghet med mer vårdkompetens och att synliggöra individuella behov. Slutsats: Att återgå i arbete för en tidigare långtidssjukskriven person kopplas till bättre självrapporterad hälsa med mindre depression och ångestbesvär, en starkare känsla av inre kontroll och en högre tilltro till egen förmåga jämfört med om personer fortfarande är sjukskrivna. Framgångsfaktorer för arbetsåtergång är balans mellan krav, kontroll och stöd för individen och en egen motivation att återgå i arbete. För att underlätta arbetsåtergång hos långtidssjukskrivna bör myndigheter och inblandade parter samverka med vård, erbjuda trygghet och synliggöra varje enskild individs behov av rehabilitering. / Aim: The aim of this study was to investigate long term sickness absentees’ health status before and after an intervention. Furthermore, to gain deeper understanding of factors related to promoting and preventing return to work for people with limited sick leave compensation. Method: The study is based on data from the EU-funded project ”SAMKLANG” which is a longitudinal intervention study. Data has been collected from 59 long term absentees though questionnaires conducted before and one year after the start of the project. Data has also been collected through semi structured interviews from 13 participants after the end of the project. They were divided into two groups (those who had returned to work/studies or had an internship and those who still were sickness absent). The intervention is based on treatment as well as cooperation between organizations involved in a rehabilitation process for people with one year of sick leave compensation remaining. The results from the surveys were analyzed with ANOVA for repeated measures and data from the interviews were analyzed using content analysis. Result: The main result from the quantitative part of this study showed no significant difference in return to work between those who had returned to work or studies, been on internships and those who still were sickness absent based on sex, age and education. The amount of self-rated depression and anxiety levels were reduced and the self-rated health and internal control were significant induced over time for the group who returned to work after the project compared to the other two groups. From the qualitative analyze of the interviews following theme was identified as supporting factors for returning to work: having own motivation, realized the positive in having a job and to have balance between demand-control-support. The theme that describes how the authority can help and support people with long term sickness absence back to work is: security with more competence in healthcare and make individual needs visible. Conclusion: Return to work for a former long term sickness absence is associated with better self-rated health with less depression and anxiety, a stronger feeling of internal control and a higher self-efficacy compared to if persons still were sickness absent. Factors for success in return to work is balance between demand-control-support for the individual and an own motivation to return to work. The authority can facilitate return to work among people with long term sickness absence by interact more with health-care services, offer security and make every individuals need for rehabilitation visible.

ABSTRACT Purpose: The purpose of the study was threefold. Firstly, to investigate if a four week program in pain rehabilitation had any effect on how much individuals with persistent pain worked and their degree of kinesiophobia. Secondly, to study if there was a correlation between how much these individuals worked and their degree of kinesiophobia. Thirdly, to study if there was a correlation between the change in these variables. Method: 112 patients who had participated in a four week rehabilitation program took part in the study. The study had a retrospective design, which was based on a review on medical records and consisted of three minor parts. The first part had a quasi-experimental comparative design and the other two parts had non-experimental cross-sectional correlative designs. Kinesiophobia was analyzed with the Swedish version of the Tampa Scale of Kinesiophobia (TSK-SV). How much a patient was working was measured in percent. Results: Both work status and kinesiophobia had improved significant in every measurement. The highest improvement in the variable of kinesiophobia was discovered by the end of the program in pain rehabilitation and by the twelve month follow-up in the variable about how much patients was working. Analysis with Spearman’s rang correlation coefficient showed a weak statistical significant correlation between how much individuals work and their degree of kinesiophobia in the twelve months follow-up. There was however no statistical significant correlation between the change of how much individuals worked and the change of their degree of kinesiophobia, neither in the two nor in the twelve months follow-up. Conclusions: This is one of the first studies that have been done who investigate the correlation between kinesiophobia and how much individuals with persistent pain are working and it shows that there is a need to continue to investigate the correlation between them, both for the individual as well as for the society in general and if possible also study what importance self-efficacy has in this context.

Objective: The purposes of this thesis included: i) To explore the annual incidence and time-loss duration of traumatic, work-related injuries of four nature-of-injury (fractures, nerve lacerations, tendon lacerations/disruptions and amputations) and two part-of-body categories (hand and wrist); and ii) To identify the incidence and time-loss duration, and examine explanatory variables that were associated with time-loss duration for subjects with hand fractures. Methodology: Data on incidence, time-loss duration and explanatory variables were reviewed on claims accepted between January – December 2006 at WorkSafe-New Brunswick. Descriptive statistics and non-parametric tests were used to explore incidence and time-loss duration. Using a biopsychosocial framework, explanatory variables associated with time-loss duration were analyzed using Cox Proportional Hazards regression. Results: The incidence for hand and wrist trauma involving fractures, tendon lacerations/disruptions and amputations was low (3%). Incidence was significantly higher for fractures and for injuries to the hand, while time-loss duration was significantly higher for the wrist (p< .05). The incidence rate of hand fractures was low (1.5%) and average time-loss duration was high (92 days). Increased time-loss duration was associated with greater medical aid costs (used as a proxy for injury severity) older age and increased receipt of therapy (Physiotherapy/Occupational Therapy). Conclusions: The annual incidence of specific injuries involving the hand and wrist is challenging to compare to the literature since incidence is presented in many ways. Time-loss duration following hand and wrist injuries is highly variable. Time-loss duration for hand fractures exceeded reports in the literature and predicted values reported in disability duration guidelines. Consideration of the impairment, personal and environmental factors is warranted to provide a framework to the return-to-work process for all stakeholders involved in the care of the hand- and wrist-injured worker.