People who suffer a traumatic brain injury (TBI) experience challenges in returning to work differently and at a rate that surpasses the return to work transition for people who experience other types of disabling injuries. In part, this challenge is a result of a lack of policy structure that promotes the successful return to work transition. The purpose of this ethnographic study was to explore the policy implications of the return to work transition for TBI survivors, address the gap in the literature, and identify key factors that contribute to the success of return-to-work programs in Washington State. A hybrid of Smith's institutional ethnography approach and Foucault's critique of bureaucratic institutions was used as the framework for this study. Data were gathered from 12 interviews and 2 focus groups with TBI survivors who had access to TBI support groups and employers connected to the TBI community. Data were inductively coded and categorized using a comparative analytical method. The study results indicate that an inclusive culture, collaborative communication, TBI-focused knowledge, integrated support, and survivor/employer motivation to interact are key factors in the successful return to work process. This study promotes positive social change by providing information for use in expanding TBI employment policy, TBI employment education, and accommodation practices. The study findings are intended to inform new policies to improve employment post-TBI outcomes for TBI survivors, employers, and their community.

Magister Scientiae (Occupational Therapy) - MSc(OT) / The recovery process for traumatic brain injuries (TBIs) can be lengthy and taxing on the patient, family and healthcare resources. Part of this recovery process includes interventions for the improvement of executive functioning (EF) required for high level functioning such as return to work (RTW). However, evidence for best practice interventions to improve EF for RTW post TBI is lacking. Randomised control trials (RCTs) evaluating interventions for EF for RTW post TBI are available but have not been synthesised. The review aimed to determine the best practice interventions for improving EF for successful RTW post TBI. Method: A systematic review using a predetermined search strategy to find relevant titles published from inception to June 2020 in six electronic databases (EBSCOhost and PUBMED [both including MEDLINE]; CINAHL, Cochrane Database for Systematic Reviews, OT Seeker, and Taylor and Francis Online) was conducted following ethics approval by the Institutional Ethics Review Board. / 2023

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Bakgrund: Kuratorer inom hälso- och sjukvården har ett brett uppdrag och de beskrivs ofta behöva kämpa för sin jurisdiktion. Allt fler kuratorer tar nu på sig rollen som rehabiliteringskoordinator, en roll som i vissa viktiga aspekter skiljer sig från kuratorns. Det saknas idag forskning på hur detta uppdrag inverkar på kuratorernas yrkesroll. Syfte: Syftet med studien var att undersöka hur kuratorer inom hälso- och sjukvården som även arbetar som rehabiliteringskoordinatorer upplever detta dubbla uppdrag samt hur det påverkar deras yrkesroll. Metod: För att undersöka detta användes en kvalitativ metod där fem semistrukturerade intervjuer genomfördes. Resultat och slutsats: Studien fann möjligheter, så som högre status, men även risker i form av bland annat fokusförflyttning, samt beskriver viktiga förutsättningar i kombinationen av de två rollerna där gränsdragning och tydlighet framstår som viktigt. / Background: Healthcare social workers (HSW) have a broad mission and are often described as having to fight for their jurisdiction. More HSW’s are now taking on the new role of Return To Work Coordinator, a role that differs in some important aspects from that of the HSW. There is currently a lack of research on how this new role affects the professional role of the HSW’s. Purpose: The aim of this study was to explore how healtcare social workers that also work as return to work coordinator experience this double mission and how it effects their professional role. Method: This was a qualitative study where five semistructured intervews were conducted. Results and conclusions: The study findings presents both opportunitys, such as higher status, risks, includig shift of focus, and prerequisites, boundary work and distinctness, forcombining the two roles.

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Background: First responders have unique and important roles. The duties performed can be dangerous, physically demanding and stressful, leading to high risks of injury and illness. Because of their unique job demands, it is important to identify aspects of the disability management process and predictors of return to work that are specific to first responders Thesis Objectives: To analyze first responder disability management claims associated with injuries and mental health issues to determine predictors of return to work and differences in the disability management claims when comparing first responders to high and low demand occupations. Methods: The claim data were obtained from a disability management company. In the first study, all first responder claims were included in the Cox proportional regression models and the log-rank tests to identify predictors of return to work. For the second study, the claims of high and low demand occupations were randomly age and sex-matched to the first responder claims. Differences in the duration of time off work, the duration of the claim, the injury and mental health diagnoses, and the duties performed when returning to work existed between first responders and the two occupation groups. Results: Musculoskeletal injuries predicted an increased likelihood of returning to work in a shorter duration of time. Medical report lag and claim lag decreased the likelihood of returning to work. First responders returned to work sooner, had shorter disability claim durations, differed in the injuries and mental health issues sustained, and were less likely to return to their pre-injury duties compared to the two occupation groups. Conclusions: Predictors of return to work specific for first responders were identified, yet the results lack generalizability. Although first responders returned to work sooner compared to the other occupations, they were more likely relegated to modified duties. / Thesis / Master of Science (MSc) / First responders perform dangerous and stressful work. They are at risk of injuries and illnesses that require time off work to recover. The goal of this dissertation is to identify features of the return to work process that are specific to first responders. The studies found that first responders with injuries like sprains and strains went back to work sooner than those with mental health issues. The study also found that sooner the injury claim was started and the medical information was received, the sooner first responders could return to work. When compared to other injured workers, first responders returned to work quicker, but were more likely to only be able to do modified work rather than their typical jobs. It is important that first responders fully recovery from injuries before they can get return to responding to emergency calls.

Background: Firefighters have a high risk of injuries or illnesses, which can result in workplace absences. Considering the unique occupational context of firefighting, firefighters may require unique disability management strategies to promote a successful and timely return-to-work. Objectives: To explore the facilitators, barriers and complexities of return-to-work for firefighters, and the current strategies used to promote return-to-work for firefighters. We also explored generic return-to-work strategies as they are applicable to all occupations. Methods: For the integrative review, we searched databases, grey literature and online resources to identify strategies, facilitators and barriers of return-to-work for firefighters. We used qualitative methods for the other studies, including interviews about return-to-work processes. For second and third studies, we used interpretive descriptions to analyze the interviews with disability management professionals. For the fourth study, we used qualitative descriptive methods to analyze the interviews with career firefighters. Results: We identified return-to-work strategies barriers for firefighters from our review including occupation-specific exercises and return-to-work readiness assessments. For the second study, disability management professionals discussed the need for accurate medical documentation and communication with stakeholders to identify suitable modified duties and return-to-work plans. In the third study, disability management professionals identified that firefighters required standard and firefighter-specific return-to-work principles, including prioritizing the recovery process over a timely return to modified duties. In the fourth study, firefighters agreed that rehabilitation was important because they must be physically able to perform their firefighting tasks. Firefighters disliked sedentary modified duties. Conclusions: The return-to-work process for firefighters may be complex due to their unique occupational context, and disability management professionals should implement occupation-specific strategies with standard strategies. It is important for disability management personnel who are not aware of the unique occupational context of firefighting to collaborate with firefighters to identify firefighter-specific return-to-work strategies. / Thesis / Doctor of Philosophy (PhD) / Firefighters have dangerous and demanding jobs. They have a high risk of injury or mental health issues. Firefighters might need to take time off work when they are not feeling well. The goal of my thesis is to identify strategies used to promote a safe return-to-work for firefighters. The four studies found both generic and firefighter-specific strategies were used to help firefighters return-to-work. Doing modified tasks at work promotes a faster return-to-work, but firefighters do not like the desk work assigned to them. Boring desk work can cause firefighters to go back to their firefighting work before they are recovered, causing re-injury. Recovery is important as firefighters need to be physically able to do their dangerous work. Firefighters need job-specific rehabilitation to recover from their injuries. It might be harder to get firefighters with mental health issues to return-to-work. Disability managers should use gradual plans to avoid triggers in the workplace. We recommend that disability management professionals work with firefighters to identify creative solutions to help plan return-to-work, using a mix of generic and firefighter-specific strategies.

Examensarbetet utgår ifrån en kommun vars sjukfrånvarostatistik är bland de högsta i landet. Vi har fått möjlighet att undersöka i vilken grad kommunens chefer känner till och arbetar efter uppsatt policy i rehabiliteringsärenden, deras attityd gentemot denna samt om och i förekommande fall, vad de anses saknas i policyn. Vi har även att undersökt vilka faktorer som har en positiv inverkan på rehabiliteringsprocessen. Teorin utgår från faktorer som enligt forskning visat sig ha en positiv inverkan på långtidssjukskrivna, exempelvis arbetsanpassning, tidig återgång i arbete samt social kontakt mellan arbetsgivare och sjukskriven. Metoden har främst utgått från ett kvantitativt förhållningssätt, då vi använt enkäter för att samla in material till undersökningen. Samtidigt finns kvalitativa drag då materialet både analyserats kvantitativt samt kvalitativt. Resultatet visar att cheferna till stor del känner till och arbetar efter kommunens policy. Cheferna visar en positiv attityd till att erbjuda medarbetare förändringar som innebär en snabbare återgång i arbete men inser även att det kan finnas begränsningar både i arbetets karaktär samt kommunens resurser. Slutsatserna visar att kommunen har flera möjligheter att förbättra sitt rehabiliteringsarbete för att möjliggöra till att medarbetaren snabbare kan återgå i arbete. De behöver bland annat utbilda sina chefer i presenterade faktorer som har positiv inverkan på rehabilitering samt samverkan. / The master thesis is based on a municipality whose sickness absence statistics are among the highest in the country. We have had the opportunity to investigate whether the municipality's managers work according to established policy in rehabilitation cases, as well as the attitude towards this and what they consider missing. We have also studied which factors have a positive impact on the rehabilitation process. The theory is based on factors that, according to research, have shown a positive impact on long-term sick leave, such as job adaptation, early return in work and social contact between employers and employee on sick leave. The method has primarily been based on a quantitative approach, we used surveys to collect material. At the same time there are qualitative features when the material is analysed both qualitative and quantitative. The results show that managers largely know and work according to the municipality´s policy. The managers also show a positive attitude to offer employees changes that mean a faster return to work, but also realize that there may be limitations in both the work´s nature and the municipality's resources. The conclusion shows that the municipality has several possibilities for change in order to improve their rehabilitation efforts to improve the opportunities for employees to return to work faster. One suggestion is to train their managers in presented factors that have a positive impact on rehabilitation.

The aim of the thesis is to understand and explain how a group of women have ended up on the long-term sick-list and how a return to working life can be brought about. Support for their return is organized within the framework of a R&D project within the EU-program EQUAL, where empowerment is one of the key principles. The research has been carried out using an interactive approach in close collaboration with the women in the project who have been signed-off long-term on medical grounds. Group discussions, questionnaires and individual interviews have provided the basis for collective analyses. This learning process, which is the central core in the interactive research, has, resulted in a deeper and more valid understanding of the reasons leading to ill-health and of the return to working life. The empirical part of the study and the analyses are divided into three parts. The first part I call the powerlessness process, namely tha which the women describe as a contributory factor to ill-health, caused by diminishing resources and increasing demands both in working life and in private life, and which eventually initiates a long-term signing-off on medical grounds. The second part is concerned with regaining and/or changing the resources that have been lost during the powerlessness process. The third part illustrates the return to working life, which is described in different steps. The thesis shows the worth of looking at the interplay between individual, organizational and community levels when trying to understand the reasons underlying ill-health and how changes at these different levels can affect the individual. The thesis shows also the importance of looking at ”life as a whole” and not just working life, where a return to work is concerned. In order to achieve a sustainable working life, attention must also be paid to gender structures and work-life balance. / Syftet med avhandlingen är att förstå och förklara hur en grupp kvinnors långtidssjukskrivning har uppstått och hur en återgång till arbetslivet kan gå till. Stödet för återgången organiseras inom ramen för ett utvecklingsprojekt i EU-programmet EQUAL, där empowerment är en av nyckelprinciperna. Forskningen har skett utifrån en interaktiv ansats i nära samverkan med de långtidssjukskrivna kvinnorna i projektet. Gruppsamtal, enkäter och enskilda intervjuer har legat till grund för den gemensamma analysen. Denna lärprocess, som är kärnan i den interaktiva forskningen, har bland annat resulterat i en fördjupad och mer valid kunskap om bland annat förklaringar till ohälsa och återgång till arbetslivet. Den empiriska delen av studien och analysen är indelad i tre delar. Den första delen kallar jag vanmaktsprocessen, det vill säga det som kvinnorna beskriver som bidragande orsaker till ohälsa orsakade av ökande krav och minskande resurser i både arbetsliv och privatliv och som till slut leder in i en sjukskrivning. Den andra delen handlar om att återskapa och/eller förändra de resurser som gått förlorade. Den tredje delen beskriver återgången till arbetslivet, vilken beskrivs i olika steg. Avhandlingen visar på värdet av att se samspelet mellan individ-, organisations- och samhällsnivån när det gäller förklaringar till ohälsa och hur förändringar på de olika nivåerna påverkar individen. Avhandlingen visar även på vikten att se till ”hela livet” inte bara arbetslivet, när det gäller en återgång till arbetslivet. För att uppnå ett hållbart arbetsliv bör hänsyn tas till ”hela livet”. Work-life balance begreppet – vilket innefattar arbete, familj och fritidsaspekterna – har visat sig vara ett fruktbart begrepp i analysen.

Background. Long-term sick leave is one of the main risk factors for permanent exit out of the labour market. The longer the duration of sickness absence, the less likely sick leave conclusion. Objectives and Methods. The aims were to analyse possible determinants of sick leave conclusion and their relative impacts, to analyse the properties of two models for the assessment of sick leave conclusion, to study the impact of a multidisciplinary vocational intervention for sick leave conclusion in a high-risk group for long-term sick leave compared to a matched-control group, and to compare the patients’ own assessment on chance to sick leave conclusion within 6 months with the assessment of a team of rehabilitation professionals. A prospective cohort study of 943 patients aged 18 to 63 years, sickness certified at a Primary Health Care Centre in Sweden during 8 months in 2004, and follow-up for three years. Results. Significant determinants increasing time to sick leave conclusion were number of sick leave days the year before baseline, age and a psychiatric diagnosis (F in ICD-10). Concordance between actual sick leave conclusion and that predicted by a computer-based model was 73-76% during the first 28-180 days in a manual model, and approximately 10% units higher in a computer based model. Three nomograms provided detailed information on the probability on sick leave conclusion. Before intervention started, the rehabilitation group had a 73% higher sick leave conclusion rate than the control group but during the rehabilitation programme period, a 51% lower conclusion rate, and after there were no significant differences between the groups. The patients’ and the rehabilitation teams’ assessment scores were highly correlated (r=0.49).   Conclusions. Previous sick leave was the most influential variable associated with sick leave conclusion. A computer- based assessment model gave more detailed information on sick leave conclusion than a manual model. A multidisciplinary intervention declined sick leave in a high-risk group for long-term sick leave but after intervention there was no difference between groups. Patients’ own view on sick leave conclusion was highly correlated to the assessment of professionals’.