I takt med att sjukfrånvaron har stigit har även behovet av rehabiliteringsåtgärder i samhället ökat. En viktig förutsättning för en lyckad arbetsrehabilitering har beskrivits vara klientens motivation. Syftet med studien var att beskriva arbetsterapeuternas erfarenheter av faktorer som påverkar klientens motivation vid arbetsrehabilitering. En kvalitativ ansats tillämpades där semistrukturerade individuella intervjuer genomfördes med totalt sju arbetsterapeuter. All insamlad data analyserades utifrån en kvalitativ innehållsanalys vilket innebar att materialet transkriberades för att därefter identifiera koder och kategorier. Resultatet sammanställdes enligt de tre huvudkategorierna "Klientens vilja, förmåga och hopp till någon form av förändring”, "Arbetsterapeuternas kunskap, strategier och erfarenheter" och ”Samhällsfaktorer och organisatorisk arbetsmiljö”. Arbetsterapeuterna beskrev hur klientens motivation påverkade processen och även angav riktning för hur arbetsrehabilitering och arbetsåtergång utformades. Resultatet visade att viktiga faktorer för klientens motivation var ekonomisk trygghet samt de krav och förväntningar som fanns i de verksamheter som arbetsterapeuterna befann sig i. I studien framkom att klientens motivation är betydelsefull och kan även anses ange riktning för hur arbetsrehabilitering och återgång i arbete bör utformas. Arbetsterapeuternas nivå på samverkan med andra verksamheter och kunskap om regelverk kan vara av betydelse. Mer tid per klient och förbättrade möjligheter till uppföljning behöver lyftas på organisationsnivå för att få tillräckligt genomslag. / Increasing sick leave have increased the need for rehabilitation. The client's motivation is according to previous studies an important precondition for successful rehabilitation. The aim of the study was to describe occupational therapists’ experiences of factors that affect the client’s motivation during vocational rehabilitation. A qualitative approach was used and seven semi-structured interviews with occupational therapists was conducted. The collected data was analysed through a qualitative content analysis. First, the material was transcribed. Thereafter, codes and categories were identified. The results were compiled into three main categories: ”Client's Will, Abilities and Hope for Change”, "Occupational Therapists' Knowledge, Strategies and Experiences" and ”Social Factors and Organisational Working Environment”. The occupational therapists described how clients' motivation was affecting the process and also indicated how the vocational rehabilitation and return to work was designed. The results showed that the major factors for the client’s motivation was financial security as well as the demands and expectations of the occupational therapists’ organisations. The study reveals that the clients' motivation is a decisive factor within vocational rehabilitation. The level of interaction with other organisations and knowledge about regulations could be important factors. More time per client and improved opportunities for followups needs to be lifted at the organisational level to make sufficient impact.

Introdução: O trabalhador de enfermagem que passa por afastamento de trabalho por transtorno mental enfrenta preconceitos e dificuldades, desde seu adoecimento e afastamento até o momento que retorna ao trabalho. As dificuldades e limitações sentidas para realizar as atividades e se reinserir na equipe de trabalho, ainda, são pouco estudadas, evidenciando a necessidade de uma maior compreensão sobre a problemática. Objetivo: O presente estudo teve por objetivo analisar a percepção dos trabalhadores de enfermagem oncológica afastados por transtornos mentais, sobre o retorno ao trabalho e elaborar propostas de intervenção que facilitem este retorno. Metodologia: O estudo foi desenvolvido na linha compreensiva e na abordagem qualitativa. A população foi de 564 trabalhadores de enfermagem de um hospital especializado em oncologia no Estado de São Paulo. A amostra intencional foi constituída por oito trabalhadores de enfermagem, sendo seis mulheres e dois homens, incluindo as categorias profissionais de técnicos de enfermagem e enfermeiros, que atenderam ao critério de inclusão, ou seja, que retornaram de afastamento por transtorno mental há, no máximo, seis meses. Após aprovação do projeto pelo Comitê de Ética, a coleta dos dados foi realizada através de questionário de caracterização dos sujeitos e entrevista individual, no período de junho a outubro de 2013. Para tratamento dos dados qualitativos foi utilizada a técnica da Análise Temática. Resultados: As categorias que emergiram dos relatos dos trabalhadores evidenciaram as relações entre o trabalho e o adoecimento psíquico: condições de trabalho, situações que os trabalhadores viviam na época do afastamento, situações enfrentadas ao retornar ao trabalho, estigma da doença mental e as propostas de intervenção. Com relação às condições de trabalho, observou-se que um dimensionamento inadequado e características inerentes ao trabalho em oncologia são percebidos pelos trabalhadores como fatores que levam ao degaste pelo trabalho. Quanto às situações que os trabalhadores viviam na época do afastamento, os relatos mostram que mesmo havendo uma sobreposição de problemas pessoais aos de trabalho, o trabalho foi fator decisivo para o adoecimento. Sobre as situações enfrentadas ao retornar ao trabalho, evidenciou-se as dificuldades em voltar atuar na assistência direta ao paciente e trabalhar em equipe. O estigma da doença mental se mostrou tanto antes quanto depois do afastamento, denotando dificuldades de compreensão dos sintomas e da cronicidade dos transtornos mentais. Os trabalhadores só tiveram acesso à assistência à saúde dentro da instituição, quando se tronou necessário entrar em afastamento de trabalho. As sugestões de propostas de intervenção de melhorias: na rotina de trabalho; no trabalho em equipe; no suporte à saúde do trabalhador. Conclusões: Os resultados apontam as seguintes necessidades: redimensionamento da equipe, levando em consideração as particularidades do trabalho de enfermagem em oncologia; minimizar o estigma da doença mental dentro da instituição, através esclarecimento das equipes; elaborar propostas de atendimento à saúde do trabalhador portador de transtorno mental. / Introduction: The nursing workers who live the sick leave by mental disorder face prejudices and difficulties, since the illness until the moment which returns to work. The restrictions for work in consequence of illness and reinsertion of worker in the daily life of work and in the team after this sick leave are still little studied, evidencing the need to a greater understanding about the theme. Objective: This study aimed to analyze the perception of oncology nursing workers after sick leave by mental disorders, about the return to work and elaborate proposals of intervention to facilitate this return. Methodology: This is a comprehensive study with qualitative approach developed with the nursing staff of an oncology hospital in São Paulo state. The sample consisted of 8 nursing workers, being 6 women and 2 men, which returned to sick leave by mental disorders in a maximum of six months. After project approval by the ethics committee, data collection began with a socio demographic questionnaire and after, an individual interview. The data collection was performed from June to October of 2013. The quantitative data were analyzed using descriptive statistics and the qualitative data analysis was conducted by Thematic Analysis technique. Results: The categories that emerged from reports of workers showed the relations between work and the psychic illness. With respect to the working conditions, was observed that the nursing staffing is inappropriate and inherent characteristics to work in oncology are perceived by workers as factors of strain processes by the work. About the situations that workers lived at the time of the sick leave, the reports show that although there an overlay of personal problems and work problems, the work was the deciding factor for the illness. About the situations faced to returning to work, was evident that the difficulties for back to act on patient assistance and for back to work in a team. The stigma of mental disorders, both before and after of the sick leave, showed the difficulties of understanding the symptoms of mental disorders and the chronicity of these diseases. The workers only had access to occupational health in the institution, when it was necessary to request the sick leave. Intervention proposals suggestions for improvements: in the routine of work; teamwork; in supporting workers \' health. Conclusion: The results show the following needs: changes in the nursing staffing considering the particularities about the oncology nursing work; minimize the stigma of mental disorders in the institution, through the clarification of the teams; elaborate proposals for occupational health, for workers with mental disorders.

This study sought to determine how the severity of injury and cause of injury influences engagement in productive work. Using archival research, 1,322 records of adults diagnosed with Traumatic Brain Injury (TBI) were examined for the following variables: engagement in productive employment, job stability, severity of injury, cause of injury, satisfaction with life, and participation activities after TBI. Analysis of variance revealed significant differences in job stability and engagement in productive work between pre-injury and postinjury, which suggests that TBI has an impact on job stability. While no statistically significant differences were found in engagement in productive work among participants with mild, moderate, or severe TBI, there were significant differences in engagement in productive work based on cause of injury. Specifically, the study found that patients with vehicle-related TBI had significantly lower job engagement in productive work when compared with other causes of TBI. In addition, the multiple regression indicated that severity of injury, measured using Glasgow Coma Scale (GCS) score, is a significant predictor of employment outcome when severity of injury is treated as a continuous variable rather than a categorical variable that involves mild, moderate, and severe TBI. This finding suggests that patients with mild TBI may have different employment outcomes based on their GCS score; the case is the same for patients with moderate and severe TBI. Findings from this research have implications for employers, service providers, and policy makers. Employers must understand that TBI reduces employee productivity, which can be increased by focusing on participation activities and life satisfaction efforts. Rehabilitation centers have to focus on community integration efforts and efforts aimed at ensuring that TBI patients secure meaningful employment.

Employees who develop and report nontraumatic acute low back pain that occurs while performing work duties, or shortly thereafter, are classified as having occupational isolated acute low back pain (OIALBP). The purpose of this project was to identify and implement an evidence- based time frame to refer occupational isolated acute low back pain patients (OIALBPPs) to physical therapy (PT) that returns them to full duty work (FDW) more quickly. The diffusion of innovation theory aided the project leader and health care providers to develop strategies to overcome barriers in implementing the project's results into the practice. A total of 932 medical records of OIALBPPs who presented to the organization from 2009 through 2015 were retrieved and abstracted by the organization's occupational health providers. The project leader analyzed the data and identified the best time frame to refer their OIALBPPs to PT. A t test, Chi-square, and an Analysis of Variance were used in the data analysis. The results were employed to design and construct tables in Excel. Early PT is defined as a PT initial evaluation that occurs < 10 days after back pain onset. A significant (p < 0.001) difference of 13.5 days between early and delayed PT groups was identified. Significant differences persisted when evaluated by sex, age bracket, occupational group, and incidence of failure to return to FDW. In conclusion, OIALBPPs who receive early PT return to FDW nearly 2 weeks sooner than do those who delay PT. Early PT may reduce health care cost, reduce lost employee income, increase productivity, increase company revenue, and lower insurance costs. Referring OIALBPPs to PT early may lower the economic burden placed on health care budgets and society as a whole.

<p>Syftet var att undersöka i vilken omfattning långtidssjukskrivna haft kontakt med arbetsplatsen/arbetskamraterna/arbetsledaren och om de haft någon stödperson på arbetsplatsen under sjukskrivningen samt ifall de sjukskrivna anser att det påverkat möjligheterna till återgång i arbete. Studien baserade sig på en enkätundersökning med 36 långtidssjukskrivna som haft en sjukskrivningstid på minst 90 dagar i följd och vid sjukskrivningstillfället haft en anställning. Studien visade att kontakten varit gles, trots det ansåg ett lika stort antal att kontakten varit tillräcklig som otillräcklig. Endast ett fåtal hade haft någon stödperson på arbetet. Hypotesen ”att fortsatt kontakt med arbetsplatsen under långtidssjukskrivning har en positiv påverkan på möjligheterna till återgång i arbete” fick endast delvis stöd. Endast när det gällde grad av kontakt med arbetsledare/chef och utfall, visade sig vara signifikant på 5 % nivån. När det gällde graden av kontakten med arbetskamrater, facklig företrädare och ”Annan” kunde ingen signifikans påvisas. Studiens konklusion var att arbetsledare/chef var den viktigaste kontakten och att arbetskamraterna och fackliga företrädarna var en outnyttjad potential, som skulle kunna stärka det sociala stödet.</p>

<p>Vocational rehabilitation is an ongoing issue that directly or indirectly affects everyone at a workplace. In recent years, laws and rules have changed. The 1st July 2008 changes were made in the General Insurance Act (SFS 1962:381). These changes have meant that there is now a so-called rehabilitation chain.  The rehabilitation chain contains time frames for when sick people will have their ability to work tested against their normal work or to other jobs. If a person is considered having enough capacity to be able to work he or she will lose their entitlement to sick pay.</p><p>The aim of our study is to investigate managers’ perceptions of the new rehabilitation chain, with a focus on vocational rehabilitation of long-term sick to get them back to work.</p><p>The method used was qualitative and data collection was done through nine semi-structured interviews. The results showed that the managers we interviewed believe that their primary responsibility in the rehabilitation work is to be the link between sick leave and workplace. The managers generally think that the introduction of the rehabilitation chain is a good thing. It has become clearer with what to do when an employee becomes ill and the timeframes provides a degree of security as the managers know when different things will happen. Our results also show that managers believe that cooperation with external actors such as social insurance has become easier since the rehabilitation chain was introduced. Some believe that the timeframes may be too tight and they are worried that the individual is forgotten in the process. The conclusion of our study was that there has been a need for a more active and transparent process of rehabilitation and this need has been met by the rehabilitation chain. Although the managers think that the rehabilitation work has become clearer, there is some disagreement in the way of working with sick leave. Some managers say for example that they are still doing so-called rehabilitation investigations, although it shifted responsibility from themselves to the Social Insurance Agency.</p>

Vocational rehabilitation is an ongoing issue that directly or indirectly affects everyone at a workplace. In recent years, laws and rules have changed. The 1st July 2008 changes were made in the General Insurance Act (SFS 1962:381). These changes have meant that there is now a so-called rehabilitation chain.  The rehabilitation chain contains time frames for when sick people will have their ability to work tested against their normal work or to other jobs. If a person is considered having enough capacity to be able to work he or she will lose their entitlement to sick pay. The aim of our study is to investigate managers’ perceptions of the new rehabilitation chain, with a focus on vocational rehabilitation of long-term sick to get them back to work. The method used was qualitative and data collection was done through nine semi-structured interviews. The results showed that the managers we interviewed believe that their primary responsibility in the rehabilitation work is to be the link between sick leave and workplace. The managers generally think that the introduction of the rehabilitation chain is a good thing. It has become clearer with what to do when an employee becomes ill and the timeframes provides a degree of security as the managers know when different things will happen. Our results also show that managers believe that cooperation with external actors such as social insurance has become easier since the rehabilitation chain was introduced. Some believe that the timeframes may be too tight and they are worried that the individual is forgotten in the process. The conclusion of our study was that there has been a need for a more active and transparent process of rehabilitation and this need has been met by the rehabilitation chain. Although the managers think that the rehabilitation work has become clearer, there is some disagreement in the way of working with sick leave. Some managers say for example that they are still doing so-called rehabilitation investigations, although it shifted responsibility from themselves to the Social Insurance Agency.

Syftet var att undersöka i vilken omfattning långtidssjukskrivna haft kontakt med arbetsplatsen/arbetskamraterna/arbetsledaren och om de haft någon stödperson på arbetsplatsen under sjukskrivningen samt ifall de sjukskrivna anser att det påverkat möjligheterna till återgång i arbete. Studien baserade sig på en enkätundersökning med 36 långtidssjukskrivna som haft en sjukskrivningstid på minst 90 dagar i följd och vid sjukskrivningstillfället haft en anställning. Studien visade att kontakten varit gles, trots det ansåg ett lika stort antal att kontakten varit tillräcklig som otillräcklig. Endast ett fåtal hade haft någon stödperson på arbetet. Hypotesen ”att fortsatt kontakt med arbetsplatsen under långtidssjukskrivning har en positiv påverkan på möjligheterna till återgång i arbete” fick endast delvis stöd. Endast när det gällde grad av kontakt med arbetsledare/chef och utfall, visade sig vara signifikant på 5 % nivån. När det gällde graden av kontakten med arbetskamrater, facklig företrädare och ”Annan” kunde ingen signifikans påvisas. Studiens konklusion var att arbetsledare/chef var den viktigaste kontakten och att arbetskamraterna och fackliga företrädarna var en outnyttjad potential, som skulle kunna stärka det sociala stödet.

A major burn is one of the most severe traumas a person can experience, and recovery can be a protracted process. The principal aim was to increase the knowledge base regarding factors related to return to work and health-related quality of life (HRQoL) after burns. Patients treated at the Uppsala Burn Center between 2000 and 2007 were included on a consecutive basis. Assessments were made at hospitalization, and thereafter and included a home visit 2 to 7 years after injury. The psychometric properties of the generic HRQoL instrument EQ-5D were investigated. The results support the use of EQ-5D as an adjunct to burn-specific assessments of HRQoL. Most former patients exhibited a good HRQoL at 2 to 7 years postburn. Not working at the time of injury and having PTSD at 12 months, as well as having low scores on the EQ VAS at 12 months, were related to a worse EQ VAS score at 2 to 7 years after injury. The majority of former patients had returned to work 2 to 7 years postburn. Time to return to work was predicted by length of hospital stay and a personality disorder diagnosis. Predictors for not returning to work were length of stay and having any anxiety or substance use disorder prior to injury. Those who were not back at work reported lower generic and burn-specific health, and exhibited more psychiatric morbidity at follow-up than those who were working. The latter group exhibited HRQoL that was comparable to that of the general population. Participants emphasized their own psychological resources and capabilities as facilitators in the process of returning to active work. The findings suggest that an early and systematic approach for assessing recognized risk factors enhances the possibility of discovering patients at risk of developing problems during postburn adaptation.

The social insurance agency (SIA) investigates and takes decisions regarding sickness benefit in Sweden. The SIA are also commissioned to coordinate and support the sick listed return to work. The SIA struggles with low trust from the Swedish inhabitants. In former studies the sicklisted claims that the treatment of the SIA have affected their return to work. The objective of this study was to investigate individual’s experiences of treatment in an encounter with their social insurance officer. Four individuals, with experience of sickness absence for three months or longer, were asked to write a retrospective story about an encounter with a social insurance officer which was followed up with in-depth interviews using open–ended questions. The interviews were audio-recorded, transcribed and analyzed using Interpretative Phenomenological Analysis (IPA). Five superordinate themes were found and the result showed the importance of a social insurance officer to act personal with engagement and communicate in ways that evoke positive emotions in the sick listed individual. The discussion focus on how the emotion the social insurance agency can evoke in the sick-listed individual by their treatment could affect the sick-listed ability to return to work. The affect may be caused by the treatments evoke of stress release or empowerment .The result indicated that the treatment was the major cause of why the individual felt trust or mistrust for the SIA. / Försäkringskassan (FK) utreder och beslutar om rätt till sjukpenning samt har ett samordningsansvar för den sjukskrivnas återgång till arbete. Undersökningar har visat att allmänheten har relativt lågt förtroende för Försäkringskassan. Tidigare undersökningar visar också att de sjukskrivna anser att Försäkringskassans bemötande har påverkat deras återgång till arbete. Syftet med denna studie är att undersöka kunders upplevelser av bemötande i ett möte med Försäkringskassans handläggare. Fyra individer med en sjukperiod överstigande tre månader, blev ombedda att skriva en retrospektiv berättelse om ett möte med en handläggare. Berättelserna följdes upp med djupintervjuer som spelades in, transkriberades för att sedan analyseras genom Interpretative Phenomenological Analysis (IPA). Fem övergripande teman identifierades och resultatet visade på vikten av att handläggaren bemötte kunden på ett personligt och engagerat sätt samt kommunicerade på ett sätt som väckte positiva känslor hos den sjukskrivna. Diskussionen fokuserar på hur de känslor som kan uppstå av bemötandet från Försäkringskassan kan påverka den sjukskrivnas återgång till arbete. Detta skulle kunna orsakas av bemötandets funktion som stresslösande eller som skapare av empowerment. Resultatet visar också att bemötandet utgjorde den viktigaste faktorn för huruvida de sjukskrivna individerna upplevde förtroende eller misstro för Försäkringskassan.