一個國家對報導殘障者就業的積極程度，可作為評估該國經濟發展程度的指標，因為國家的經濟必須發展至滿足人民需求達一定程度之後，才會轉移能力去兼顧那些屬於弱勢族群的福利。民主福祉國家是我國建國的目標，有效輔導殘障就業，確保其工作權，亦是我國邁向民王福祉國家的施政方向。過去我國照顧殘障者僅限於救濟階段，如今由於社會變遷急遽，社會福利發展影像也最大，工業與都下化導致傳統血緣關係式微，家族組織鬆散，以倫常維持社會秩序的功能降低，政府的職責亦隨之繁重，扮演的角色任務也更加積極。因此，對於現今社會協助殘障者的觀念應由政府率先做起身先士卒，由消極的救濟走向積極的像辟，協助殘障者受教育，接受訓煉，怒而提供就業機會，我其自立，提昇其人性尊展，間接減輕社會負搪，並增進國家利益。在積極推動進用殘障者之際，陸續將面茲的問越是殘障人員的管理，管理向來在組織申佔有重要的地位，許多的理論均指出良好的管理有助於提昇組織績效，對一般員工如此，對殘障者也不例外。欲使對殘障者的管理有任何重大意義時，管理者必須有相當認知。因此本文除對我國殘障者就業之現況予以探討並介紹世界先進國家實施狀況外，針對進用殘障人員之管理更做一深層探討，提供不同角度的意見，以期使我國殘障就業制度益趨完善。

Chronic non-cancer pain (CNCP) is a complex phenomenon that affects multiple dimensions of daily life. Optimal therapies for managing CNCP must, then, demonstrate clinically important benefits that go beyond reductions in pain and adverse events. The Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials (IMMPACT) has recommended that clinical trialists who are evaluating treatments for chronic pain consider reporting treatment effects across nine patient-important outcome domains. This thesis begins with an investigation of the extent to which clinical trials evaluating the effects of opioids for CNCP report IMMPACT-recommended core outcome domains. Further, it explores optimal therapeutic strategies for specific CNCP conditions; specifically, it features a systematic review of randomized controlled trials of all pharmacological and non-pharmacological therapies for central post-stroke pain, as well as a plan for a network meta-analysis of all therapies for all chronic neuropathic pain syndromes. Chronic pain is also a common reason for disability, and this thesis concludes with a retrospective cohort study focused on identifying predictors of claim duration following acceptance for disability benefits among Canadian workers. / Thesis / Doctor of Philosophy (PhD)

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.

Employee mental health claims have become a costly burden for Canadian workplaces, therefore many organizations are seeking to adopt progressive disability management strategies to support employees with mental health conditions who are either returning to work or trying to remain at work. Developing and implementing effective workplace accommodation practices is one such strategy to support employees. Negotiating workplace accommodations has been recommended in the literature to be an interactive process between the employee and workplace stakeholders. However, there is very limited knowledge regarding the ways in which discussing and negotiating accommodations unfolds, or how employees and stakeholders experience the process of negotiating accommodations. This thesis includes the results of a qualitative study exploring how negotiating accommodations unfolds between employees with mental health conditions and workplace stakeholders, and a sub-analysis of the larger study data exploring how social capital can impact the negotiation process. In order to capture varied perspectives, in depth interviews were conducted with employees in diverse roles who self-identified as having a mental health condition that required accommodation, and stakeholders who were experienced in negotiating accommodations. A qualitative descriptive design was used to iteratively collect and analyze data. Constructive and interpretive strategies including initial and focused coding, memo writing and clustering were used to identify themes about negotiating accommodations. The negotiation process, as reported by participants in this study, was found to be a non-linear, social and political process that unfolded as a combination of micro formal and informal sub-processes, in contrast to the concrete, formal accommodation process mandated by some organizational policies. In addition, there were a number of factors that were experienced as either helpful or challenging in the process of negotiating accommodations. Social capital arose as an important element influencing how employees with mental health conditions accessed accommodations. The findings of a qualitative sub-analysis of the original data set focused on the ways in which workplace social capital impacted the experience of requesting and negotiating accommodations. Some elements of social capital were found to be dynamic, with workers able to accumulate, rebuild and spend social capital in the course of their employment. Employee reputation, employee self-confidence and likeability with coworkers and managerial staff arose as key elements of social capital. Other elements of social capital were external perceptions constructed by coworkers and workplace stakeholders, such as return-on-investment of accommodating and judgements of value to the organization. Overall, workplace social capital appeared to impact how employees experienced the process of requesting and negotiating accommodations, but it was not the determining factor of whether accommodation requests were granted. / Thesis / Master of Science (MSc) / This Master’s thesis focused on the process of discussing and negotiating workplace accommodations between workers with mental health conditions and workplace stakeholders. Six workers with mental health conditions and 6 other workplace stakeholders who had experience negotiating accommodations shared their experiences in interviews. Study findings highlighted that the negotiation process can be complex and non-linear, and is impacted by social and political factors. Workplace social capital had an impact when workers with mental health conditions requested and negotiated accommodations. For example, employee self-confidence, “likeability” (as perceived by coworkers and management), reputation as a good performer and perceived value to the organization appeared to shape how workers experienced the process of negotiating accommodations. Worker status and position also reportedly had an impact on access to supports. It should be noted, however, that social capital was only one of the factors that workers needed to be successfully accommodated, and their social capital could be at risk of being exhausted due to behavior or performance issues. This thesis expands our understanding of the accommodation negotiation process, and the impact of social and political forces on disability management strategies.

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.