Purpose: To study the probabilities and permanence of return to work, inability to work and rehabilitation, and to explore the connection between these life situations and later working after a severe occupational injury. Materials and methods: A historical cohort of Finnish workers with a severe occupational injury during 2008 (N?=?11,585) were followed up annually on the outcomes of return to work over a 5-year observation period. We examined transition probabilities from one life situation to another with Markov chain analysis, and applied logistic regression with generalized estimating equations to assess the effect of register-based determinants on return to work. Results: Within the five anniversaries, 85% of the injured were working, 9% were unable to work (fully or partly) and 2% received rehabilitation. Age, gross annual income, type of work, injured body part, injury type and the injured's annual condition subsequent to the work injury were significant determinants of return to work. Conclusions: The probability of return to work decreased with time, but, on average, one-fifth of the injured workers succeeded in return to work after being unable to work on the previous anniversary, which indicates that it is worthwhile to conduct efforts for this target group in order to promote return to work. Implications for Rehabilitation The current life situation of the injured should be taken into account when promoting return to work, as it is a strong predictor of later working after a serious occupational injury. Rehabilitation and return to work programs should start in time due to declining return to work rates as the disability continues. Return to work on a part-time basis could be a good option during the early phases of recovery, since a notable proportion of those partly unable to work on the first anniversary returned later to full-time workers. The probability of recovery is relatively high even for those with long-term disabilities, so the promotion of return to work is highly recommended also for this target group.
The purpose of this article is to investigate actions taken by the Social Insurance Agency (SIA) for long-term sickness absentees and possible associations of this with future sick leave or disability pension.
For 384 long-term sickness absentees who had had a multidisciplinary medical assessment (MMA) during 2001-2006, three types of data were obtained: (1) case file information about SIA actions, (2) suggested rehabilitation measures from the MMA and (3) sickness absence and disability pension data.
Most individuals had been subject to a range of actions by the SIA. Sixty percent had been invited to a coordination meeting, and half of those who assessed by the MMA for vocational rehabilitation were approved to get it by the SIA. Few SIA actions were associated with full or partial return to work.
Although the studied individuals had been on sick leave for a long time, the number of SIA actions related to vocational rehabilitation was limited and came late in the sick-leave spell. The information from the MMA was often not used as a basis for further SIA action and seldom resulted in return to work. The positive MMA views on the potential of vocational rehabilitation were not met by SIA actions.
Suggestions on vocational rehabilitation from a medical assessment was in many cases not used by the social insurance agency in relationship to long-term sickness absentees. Active rehabilitation measures by the social insurance agency were few and came late in the sickness absence process. Few of the activities taken by the social insurance agency enhanced return to work.
Are fatigue, depression and anxiety associated with labour market participation among patients diagnosed with haematological malignancies? A prospective study.
The objectives of this study are to examine levels of fatigue, depression and anxiety following diagnosis of a haematological malignancy, to determine the incidence of return to work (RTW) and long-term sickness absence (LTSA) during 1-year follow-up and to examine whether fatigue, depression and anxiety are associated with RTW and LTSA in this group of cancer patients.
Questionnaire-based data on fatigue, depression and anxiety were obtained at baseline. In all, 196 patients returned the questionnaire. Of these, 106 patients were on sick leave and 90 patients were working. They were all followed prospectively for 1 year using register-based data on labour market participation.
At baseline, high levels of fatigue, depression and anxiety were more prevalent among sickness absent patients than in those working. Half of the sickness absent patients returned to work during follow-up, and only 10 (11%) working patients experienced LTSA. Sickness absent patients with highest scores of physical fatigue were less likely to RTW than those with lowest scores (RRadj 0.43, 95% CI 0.23-0.78). Similar, we found an association between symptoms of anxiety and RTW (p?=?0.048). This association was though non-significant in multivariable analyses (p?=?0.068). No significant association was found between depression and RTW.
Half of sickness absent patients returned to work, and only a few of working patients experienced LTSA during follow-up. Patients reporting high levels of physical fatigue were less likely to RTW. There was a similar tendency for anxiety, whereas we found no association between depression and RTW. Larger prospective studies are needed.
Department of Orthopedics and Traumatology Turku, Turku University Hospital and University of Turku, Turku, Finland. Electronic address: petteri.lankinen@tyks.fi.
Osteoarthritis is one of the leading causes of disability in working-age patients. The total number of working-age patients undergoing total-knee arthroplasty (TKA) is continuously increasing. The purpose of this study was to identify predictive factors related to general health, health risk behaviors and socioeconomic status influencing the rate of return to work after a TKA.
Overall there were 151,901 patients included in the Finnish Public Sector (FPS) study. The response rate varied between 65 and 73% during the study period. We used Cox proportional hazard models to examine patient-related predictive factors that may influence the rate of return to work after TKA in a cohort of patients (n?=?452; n?=?362 female; mean age 56.4?years). Predictive factors were measured on average 3.6?years before the operation.
Of the patients, 87% returned to work within one year after TKA at a mean of 116 calendar days. In multivariate analysis, patients at sick-leave =30?days during the last year before surgery were 2.2 times (95% confidence interval 1.72-2.92) more likely to return to work compared with those with >30?days of sick-leave. Compared with patients in manual work, those in higher or lower level non-manual work showed a 2.6-fold (1.95-3.52) and 1.5-fold (1.15-1.92) increased probability of returning to work. Age, sex, health risk behaviors, obesity, physical comorbidities, common mental disorders, and other studied health-related factors were not associated with the rate of return to work.
Non-manual job, good self-rated general health and preoperative sick leave =30?days are associated with a higher rate of return to work.
The high acceleration (Gz) exposure among military pilots flying fighter aircraft has been associated with an increased risk for cervical and lumbar disorders. It has been suggested that an adequate level of physical performance could reduce the risk of experiencing these disorders. The Finnish Air Force has for several years used aerobic (bicycle ergometer) and muscular fitness tests (battery of five tests) in the selection process of military pilot candidates in order to evaluate their physical fitness level. The aim of the study was to determine if these selection phase tests and anthropometry measures can predispose those individuals who might be at risk of developing severe spinal disorders leading to permanent flight duty limitations later during their military pilots' career.
The study population consisted of 23 pilots flying with Gz limitation (+2 Gz, +4 Gz or +5 Gz) due to spinal disorders and 50 experienced (+1,000 flight hours) symptomless controls flying actively in operative missions. Data obtained retrospectively for all subjects included anthropometry, physical (aerobic and muscular fitness) test results and self-reported physical activity levels at a pilot selection phase. Aerobic fitness was measured with a maximal ergometer test and muscular endurance was evaluated with a test battery (standing long jump, pull-ups, sit-ups, back extensions, and push-up tests).
Fighter pilots flying without Gz limitation had significantly better mean (±SE) results in pull-up (14.4 ± 4.2 vs. 11.5 ± 2.0, p
Depression is the most frequent reason for receiving disability benefits in North America, and treatment with psychotherapy is often funded by private insurers. No studies have explored the association between the provision of psychotherapy for depression and time to claim closure.
Using administrative data from a Canadian disability insurer, we evaluated the association between the provision of psychotherapy and short-term disability (STD) and long-term disability (LTD) claim closure by performing Cox proportional hazards regression.
We analyzed 10,508 STD and 10,338 LTD claims for depression. In our adjusted analyses, receipt of psychotherapy was associated with longer time to STD closure (HR [99% CI]?=?0.81 [0.68 to 0.97]) and faster LTD claim closure (1.42 [1.33 to 1.52]). In both STD and LTD, older age (0.90 [0.88 to 0.92] and 0.83 [0.80 to 0.85]), per decade), a primary diagnosis of recurrent depression versus non-recurrent major depression (0.78 [0.69 to 0.87] and 0.80 [0.72 to 0.89]), a psychological secondary diagnosis (0.90 [0.84 to 0.97] and 0.66 [0.61 to 0.71]), or a non-psychological secondary diagnosis (0.81 [0.73 to 0.90] and 0.77 [0.71 to 0.83]) versus no secondary diagnosis, and an administrative services only policy ([0.94 [0.88 to 1.00] and 0.87 [0.75 to 0.996]) or refund policy (0.86 [0.80 to 0.92] and 0.73 [0.68 to 0.78]) compared to non-refund policy claims were independently associated with longer time to STD claim closure.
We found, paradoxically, that receipt of psychotherapy was independently associated with longer time to STD claim closure and faster LTD claim closure in patients with depression. We also found multiple factors that were predictive of time to both STD and LTD claim closure. Our study has limitations, and well-designed prospective studies are needed to establish the effect of psychotherapy on disabling depression.
Notes
Cites: Am J Public Health. 1994 Aug;84(8):1304-78059890
Studies indicate that long-term sickness absence reduces the ability to return to work (RTW). Multidisciplinary medical assessments (MMA) have been used as a method to receive a more versatile assessment of long-term sickness absentees (LTSA) and thereby a better basis for adequate medical and vocational rehabilitation, and an increasing ability to maintain or regain work capacity.
The objective of this study was to investigate the associations between the prognoses of LTSAs' future work capacity made at a MMA and the assessments of their work incapacity made by the Social Insurance Offices (SIO) two years later.
385 LTSAs referred to an MMA by SIOs in the Stockholm area in Sweden between 2001 and 2006.
Data was collected at the MMA on demographic factors, health, diagnoses, and future work capacity. Information on SIO decisions on sickness benefits and disability pension and what measures the SIO had taken was extracted from the case files at the SIOs. Descriptive statistics and multiple regression analyses were used to assess the associations between the prognosis and decisions on benefits, controlling for individual factors.
Of those predicted to be able to maintain or regain work capacity, 68% received full-time benefits two years later. Work capacity was negatively affected by high age, full time sickness absence at MMA and number of physical symptoms at MMA. The prognosis at the MMA was not significantly related to work capacity when socio-demographic and health factors were controlled for. However, this was partly due to the fact that the MMA also included recommendations for vocational rehabilitation and that this factor had an effect on assessed work incapacity after two years.
The prognosis of future work capacity evaluated at a multidisciplinary medical assessment correlated with actual work capacity two years later. However, a range of other factors were decisive for the result. The study shows that the link between the prognosis and recommendations for vocational rehabilitation should be followed by the SIOs responsible for enhancing RTW among individuals on long-term sick leave.
Associations between socio-demographic factors, encounters with healthcare professionals and perceived ability to return to work in people sick-listed due to heart failure in Sweden: a cross-sectional study.
The aim of this study was to investigate associations between socio-demographic factors, experiences of positive/negative encounters with healthcare professionals, and the encounters' impact on the ability to return to work in a population of people on sick leave due to heart failure.
This was a cross-sectional study. Data were collected from two official registries in Sweden and from a postal questionnaire. In all, 590 people with heart failure responded to the questionnaire. Associations between variables were calculated with bivariate correlation analyses and logistic regression analyses.
For people on sick leave due to heart failure, positive encounters with healthcare professionals are associated with being Swedish-born, female gender, and high income. People with high income are more likely to be supported back to work by positive encounters with healthcare professionals. To perceive that healthcare professionals believe in person's ability to return to work can be facilitating.
Women, people who are not foreign-born, and people with high income are more likely to perceive encounters with healthcare professionals as positive. Healthcare professionals who work with rehabilitation for people with heart failure need to be aware of social inequalities and that being on sick leave is a process of change.
A failing heart limits everyday life implying risk for long-term sick leave. Even though there are rehabilitation programs for people with heart failure, vocational rehabilitation is often over-looked. The knowledge about factors associated with sick leave due to heart failure is scarce. Experiences of positive encounters with healthcare professionals were associated with being Swedish-born, female gender, and high income. People with high income were more likely to be supported back to work by positive encounters with healthcare professionals. Healthcare professionals who work with rehabilitation for people with heart failure can support patients with heart failure by showing them confidence and trust. However, they need to be aware that sick leave implies a process of change.
Mental health problems are leading causes for early and prolonged withdrawal from the workforce. Green work on care farms represents a prevocational training program intended to stimulate return to work for people with mental health problems. Research suggests that care farms may improve mental health, but there is still little knowledge of the subjective perspective of clients in green work programs.
To gain a deeper and broader understanding of the individual experiences of people with mental health problems participating in green work on care farms in Norway.
A hermeneutic phenomenological research design was applied. Ten semi-structured interviews were conducted. The self-determination theory (SDT) was adapted to gain a deeper understanding of the themes that emerged in the analysis process of the interviews.
Five main themes materialize describing participants' experiences within the green work program. The main themes consist of (1) structure and flexibility, (2) understanding and acknowledgement, (3) guidance and positive feedback, (4) nature and animals, and (5) reflections on personal functioning and the future.
The main themes identified indicate a high degree of autonomy support and need satisfaction within the care farm context, which according to SDT can facilitate good human functioning, and well-being.
Barriers and facilitators for implementation of a return-to-work intervention for sickness absence beneficiaries with mental health problems: Results from three Danish municipalities.
Evidence for the effectiveness of return-to-work (RTW) interventions aimed at sickness absence beneficiaries with mental health problems (MHPs) is still relatively sparse and mostly inconclusive. This may in part reflect the varying settings and inconsistent implementations associated with the interventions. The aim of this paper is to identify barriers and facilitators for the implementation of a coordinated and tailored RTW-intervention implemented at three different sites.
We used qualitative and quantitative data to assess the implementation according to process evaluation guidelines. Data sources were individual and group interviews, observations, national registers, and documents used in the intervention.
The quality of the implementation varied greatly across the three settings. Barriers included lack of skills to assess MHPs according to the inclusion criteria, different interpretations of sickness absence legislation among stakeholders, competing rehabilitation alternatives, and lack of managerial support for the intervention. An important facilitator was the motivation and availability of resources to solve disagreements through extensive communication.
The different settings presented various barriers and facilitators, which resulted in different versions of the intervention. A higher degree of user involvement in the design and development phase is likely to improve the implementation quality of future interventions.
