Factors of importance for return to work, experienced by patients with chronic pain that have completed a multimodal rehabilitation program – a focus group study (original) (raw)
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Disability and Rehabilitation, 2014
Purpose: To explore and describe health professionals' experience of working with return to work (RTW) in multimodal rehabilitation for people with non-specific back pain. Method: An interview study using qualitative content analysis. Fifteen participants were interviewed, all were working with multimodal rehabilitation for people with non-specific back pain in eight different rehabilitation units. Results: The participants experienced RTW as a long-term process reaching beyond the time frames of the multimodal rehabilitation (MMR). Their attitudes and, their patients' condition, impacted on their work which focused on psychological and physical well-being as well as participation in everyday life. They often created an action plan for the RTW process, however the responsibility for its realisation was transferred to other actors. The participants described limited interventions in connection with patients' workplaces. Conclusions: Recommended support in the RTW process in MMR comprises the provision of continuous supervision of vocational issues for the health care professionals, the development of guidelines and a checklist for how to work in close collaboration with patients' workplaces and employers, the provision of long-term follow-up in relation to the patients' work, and the development of proper interventions in order to promote transitions between all the different actors involved.
BMC Public Health
Background: Recent research has suggested that interventions at the workplace might be the most potent ingredient in return to work interventions, but few studies have investigated the different effects of workplace interventions as part of occupational rehabilitation programs. The comprehensive design described in this article includes effect (on return to work and health outcomes), and health economic evaluations of a workplace intervention added to a multicomponent rehabilitation program. Qualitative and mixed method studies will investigate sick-listed persons', rehabilitation therapists' and employers' perspectives on the usability and outcomes of the rehabilitation program and the workplace intervention. The program and intervention are provided to patients with musculoskeletal, psychological or general and unspecified diagnoses. The program is multi-component and includes Acceptance and Commitment Therapy, physical exercise, patient education and creating a plan for increased work participation. Methods: Persons who are employed, aged from 18 to 60 years, with a current sick leave status of 50% or more and a diagnosis within the musculoskeletal, psychological or general and unspecified chapters of International Classification of Primary Care-2 (ICPC-2) will be recruited to a researcher-blinded parallel-group randomized controlled trial. All participants take part in an in-patient occupational rehabilitation program, while the intervention group also takes part in an intervention at the workplace. The effect and economic evaluation will investigate the effect of the added workplace intervention. The primary outcome measures will be time until full sustainable return to work and total number of sickness absence days in the 12 months after inclusion. Health economic evaluations will investigate the cost-effectiveness and cost-utility. Qualitative studies will investigate rehabilitation therapists' experiences with working towards return to work within an ACT-approach and stakeholders' experiences with the workplace intervention. A mixed methods study will combine quantitative and qualitative findings on the participants' expectations and motivation for return to work.
Successful Return to Work with Chronic Pain? Stakeholders’ Negotiation Strategies
Government policy to reduce sick leave SL can be appropriate but can extend sick role unnecessarily (Waddell and Burton, 2004; Black, 2008) From "sick note" to "fit note" in 2010 (electronic version 2012/13) 4 new optionsphased return, altered hours, amended duties, workplace adaptations "may be" or "not fit" DWP national education programme for stakeholders using EBM (e.g. via RCGP) Proportion of working age population in receipt of Incapacity Benefit Research design: epistemological issues Reconstruct actors' realities, via interview, including asking them for retrospective accounts of their actions (Charon, 1992) Truth as construction: Habitus of sociology promotes intellectual bias (Bourdieu, 1990) "Truth" rooted in historical conditions of possibility: what we know structures reality into concrete experiences (Foucault, 1984c; Greco, 1998) Methods: Constructivist Grounded Theory • Grounded theory-provision of categories of processes to help understand assumptions (Glaser and Strauss, 1967; Strauss and Corbin, 1998) • Provisional open coding-"What is CP?" • Exploration-attributes of "fluctuates" and "something to limit" • Re-categorisation into analytical concepts ""shattered self" and "stigma" • Axial codingidentity as person/as pain patient • Deviant cases "Pain makes me stronger" • Bias reductionattempt, be transparent, ack. tension 3. Conceptual agreement with WHW policies but problems applying this personally. Cannot simply deduce via signs and symptoms: GPs need to engage with patients' illness narratives (Kleinman, 1988).
BMC Health Services Research, 2017
Background: The objective of this study was to explore occupational rehabilitation clinicians' experiences on how to approach their participants on long-term sick leave in order to facilitate return to work (RTW). Methods: An exploratory qualitative design was used. Four focus groups were conducted with 29 clinicians working on interdisciplinary inpatient and outpatient occupational rehabilitation teams in Norway. The clinicians shared narratives from clinical practice. Transcripts were analysed, and results were reported by use of systematic text condensation. Results: The clinicians used several approaches to facilitate RTW among individuals on sick leave. Three themes emerged as especially important in order to succeed: 1) To get a basic understanding of the participant's life-world through a mapping process; 2) To build a therapeutic alliance through communication characterised by sensitivity to the participants' needs and emotional concerns; and 3) To initiate processes of change that increase the possibilities for RTW. Four main areas targetable for change were identified, three directed at the individual and one encompassing the participants' surroundings. These approaches were: a) To increase feelings of confidence and coping; b) To increase the participants' awareness of their own limits; c) To challenge inefficient and negative attitudes and thoughts related to the sick-role; and d) Close and immediate dialogue with key stakeholders. Conclusions: To increase the possibilities for RTW among individuals on long-term sick leave, a thorough mapping process and the construction of a therapeutic alliance are seen as crucial elements in approaches by occupational rehabilitation clinicians. By gaining the participants' trust and identifying their barriers and possibilities for work, the clinicians can target modifiable factors, especially at the individual level, and obstacles for RTW in their individual surroundings. This study elucidates what occupational rehabilitation clinicians do, say and provide to increase their participants' abilities and possibilities to RTW.
Rehabilitation of Injured Workers with Chronic Pain: A Stage of Change Phenomenon
Journal of Occupational Rehabilitation, 2007
Objective This study was designed to explore the stages of change involved in return to work (RTW) for a group of workers who had been suffering from chronic pain. Method The participants were 67 (mean age = 42.67) injured workers who participated in a six-week RTW program. Assessments of the participants on various measures were conducted before and during the program, and at the end of the follow-up period (3 months postprogram). Results The overall RTW rate of the participants was 65.7%. Most importantly, the participants' RTW outcomes were found to be significantly predicted by their readiness for RTW (action) at the baseline. In the third week, their RTW was significantly predicted by their confidence in returning to work and their readiness for RTW (action). By the sixth week, their RTW outcomes were predicted by their readiness for RTW (pre-contemplation). Conclusion The results enable us to better understand the stage-of-change factors that might influence injured workers' resumption of a productive work role and the rehabilitation process of RTW.
2008
Robert-Sauvé en santé et en sécurité du travail (IRSST) is a scientific research organization known for the quality of its work and the expertise of its personnel. Mission To contribute, through research, to the prevention of industrial accidents and occupational diseases as well as to the rehabilitation of affected workers. To offer the laboratory services and expertise necessary for the activities of the public occupational health and safety prevention network. To disseminate knowledge, and to act as scientific benchmark and expert. Funded by the Commission de la santé et de la sécurité du travail, the IRSST has a board of directors made up of an equal number of employer and worker representatives. To find out more Visit our Web site for complete up-to-date information about the IRSST. All our publications can be downloaded at no charge. www.irsst.qc.ca To obtain the latest information on the research carried out or funded by the IRSST, subscribe to Prévention au travail, the free...
Successful return to work with chronic pain: Employers' and employees' views
Background The sickness certification and return to work (RTW) of people with chronic pain are important health and economic issues for employees, employers, taxpayers and the UK government. The 'fit note' and a national educational programme promoting RTW were introduced in 2010 to curb rising rates of sickness absence. Aims To investigate employers' and employees' experiences of managing RTW when someone has taken sick leave for chronic pain, and to explore the perceived efficacy of the fit note. Methods A qualitative study, comprising semi-structured interviews with employers who had managed sick leave cases and employees who had experienced sick leave for chronic pain. Interviews were recorded, transcribed and the data analysed using constructivist grounded theory principles. Results Five themes were elicited. Firstly, frequent enquiry after health status was seen as intrusive by some employees but part of good practice by employers and acknowledging this difference was useful. Secondly, being able to trust employees due to their performance track record was helpful for employers when dealing with complex chronic pain conditions. Thirdly, feeling valued increased employees' motivation to return to work. Fourthly, guidelines about maintaining contact with absent employees were useful if used flexibly. Finally, both parties valued the fit note for its positive language, interrogative format and biomedical authority. Conclusions The fit note was perceived to be helpful if used in combination with other strategies for managing sick leave and RTW for people with chronic pain. These strategies may be applicable to other fluctuating, long-term conditions with medically unexplained elements.
Journal of Clinical Medicine, 2021
Chronic musculoskeletal pain is a significant burden for employees, employers, and society. However, more knowledge is needed about which interventions reduce sick leave. Interventions were defined as the act or an instance of intervening, provided by different stakeholders. This review synthesizes the experiences of patients, employers, and health professionals concerning the interventions that influence returning to work and staying at work for persons with chronic musculoskeletal pain. A literature search was performed using several combinations of key terms. Overall, 18 qualitative studies published between 2002 and 2018 were included. Qualitative analysis assessed how much confidence could be placed in each review finding. Moderate evidence was found for factors improving the return to work process such as collaboration between stakeholders, including the persons with chronic musculoskeletal pain and support from all involved actors in the process. Moderate evidence was found f...
Workplace Rehabilitation and Supportive Conditions at Work: A Prospective Study
Journal of Occupational Rehabilitation, 2013
To investigate the impact of rehabilitation measures on work ability and return to work (RTW), specifically the association between workplace rehabilitation/supportive conditions at work and work ability and RTW over time, among women on long-term sick leave. Methods Questionnaire data were collected (baseline, 6 and 12 months) from a cohort of women (n = 324). Linear mixed models were used for longitudinal analysis of the repeated measurements of work ability index (WAI), work ability score and working degree. These analyses were performed with different models; the explanatory variables for each model were workplace rehabilitation, supportive conditions at work and time. Results The individuals provided with workplace rehabilitation and supportive conditions (e.g. influence at work, possibilities for development, degree of freedom at work, meaning of work, quality of leadership, social support, sense of community and work satisfaction) had significantly increased WAI and work ability score over time. These individuals scored higher work ability compared to those individuals having workplace rehabilitation without supportive conditions, or neither. Additionally, among the individuals provided with workplace rehabilitation and supportive conditions, working degree increased significantly more over time compared to those individuals with no workplace rehabilitation and no supportive conditions. Conclusion The results highlight the importance of integrating workplace rehabilitation with supportive conditions at work in order to increase work ability and improve the RTW process for women on longterm sick leave.
Return to Work Influenced by Vocational Rehabilitation in a Multidisciplinary Team
SIGURNOST, 2009
Vocational rehabilitation is a process involving all activities that help the disabled person to obtain or retain a suitable employment (Konvencija št. 159, 1987). In the process, medical information about permanent consequences of a disease/injury must be communicated to the institutions from the field of work, health and disability insurance, and the client's actual capacities, his legal rights, as well as the best way to return to work (or retire) must be planned. During this transition the person experiences different roles and relationships towards different institutions (patient, client, rehabilitant, disabled person, insurance policyholder and worker) and has different legal rights and obligations towards them.