Describing return to work after stroke : a feasibility trial of 12-month outcomes

Objective: Stroke is the greatest cause of disability in adults. A quarter of strokes in the UK affect people of working age, yet under half of them return to work after stroke. There has been little investigation into what constitutes “return to work” following stroke. The aim of this study is to describe the work metrics of stroke survivor participants in a feasibility randomized controlled trial of an early stroke specific vocational rehabilitation intervention. Methods: Retrospective analysis of trial data. Metrics on work status, working hours, workplace accommodations and costs were extracted from trial out - comes gathered by postal questionnaire at 3, 6, and 12 months’ post-randomization for 46 stroke participants in a feasibility randomized controlled trial. Participants were randomized to receive vocational rehabilitation (intervention) or usual care (control). Results: Two-thirds ( n = 29; 63%) of participants re - turned to work at some point in the 12 months following stroke. Participants took a mean of 90 days to return to work. Most returned to the same role with an existing employer. Only one-third of participants who were employed full-time at stroke onset were working full-time at 12 months post-stroke. Most participants experienced a reduction in pre-stroke earnings. Workplace accommodations were more common among intervention group participants. More intervention participants than control participants reported satisfaction with work at both 6 and 12 months post-randomization. Conclusion: This study illustrates the heterogeneous nature of return to work and the dramatic impact of stroke on work status, working hours and income. Longitudinal research should explore the socioeconomic legacy of stroke and include clear definitions of work and accurate measures of working hours and income from all sources

Maternity Rights and Mothers' Return to Work

In this paper we use the ALSPAC cohort of 12,000 births to examine the effect of maternity rights on mothers' post-birth return to employment decisions. We aim to disentangle the effects of the terms of maternity rights entitlements from the effects of other factors (such as household wealth, personal preferences and labour market opportunities) that influence the timing of a mother's return to work. We adopt a discrete hazard model with instrumental variables to estimate a counterfactual of what mothers with rights would have done in the absence of this legislation. Mothers with rights have an underlying (but unobserved) stronger attachment to the labour market which prompts earlier return than on average. Nevertheless, even when we take this into account we find a substantial impact of maternity rights on behaviour. Having rights induces around 20 per cent more women to return to their previous job before 7 months than would otherwise be the case. Women from lower skilled groups return disproportionately at the date at which maternity pay expires, while managerial and professional women tend to return at the expiry of unpaid leave.government policy, welfare, child care, labor supply

Psychological morbidity and return to work after injury: multicentre cohort study

Background: The benefits of work for physical, psychological and financial wellbeing are well documented. Return to work (RTW) after unintentional injury is often delayed, and psychological morbidity may contribute to this delay. The impact of psychological morbidity on RTW after a wide range of unintentional injuries in the UK has not been adequately quantified.Aims: To quantify the role of psychological factors including anxiety, depression and post-traumatic distress on RTW following unintentional injuries.Design and Setting: Longitudinal multi-centre prospective study in Nottingham, Bristol, Leicester and Guildford, UKMethod: Participants (n=273) were 16-69 year olds admitted to hospital following unintentional injury and, in paid employment prior to injury. They were surveyed at baseline, 1, 2, 4 and 12 months following injury on demographic and injury characteristics, psychological morbidity and RTW status. Associations between demographic, injury and psychological factors and RTW status were quantified using random effects logistic regression.Results: The odds of RTW reduced as depression scores one month post-injury increased (OR 0.87, 95%CI 0.79, 0.95) and as length of hospital stay increased (OR 0.91, 95%CI 0.86, 0.96). Those experiencing threatening life events following injury (OR 0.27, 95%CI 0.10, 0.72) and with higher scores on the crisis social support scale (OR 0.93, 95%CI 0.88, 0.99) had a lower odds of RTW. Multiple imputation analysis found similar results except crisis social support did not remain significant.Conclusion: Primary care professionals can identify patients at risk of delayed RTW who may benefit from management of psychological morbidity and support to RTW

Optimising return to work practices following catastrophic injury

This paper aims to enhance understanding of the features of optimal return to work practices following traumatic brain and spinal cord injury and identify barriers and facilitators to their implementation. Executive summary People with catastrophic injuries face many long-term challenges in the community as a result of their injury: one of the most problematic can be in returning to work (RTW). It may not only be a significant issue for the person with a catastrophic injury but also for their family, friends, the employment industry, and society. Worldwide mean RTW rates for people with catastrophic injury are approximately 30-40%; however, in Australia the overall mean rate is unknown. Internationally, the best RTW rates reported for moderate to severe traumatic brain injury (TBI) come from the UK, Sweden and USA, whilst for spinal cord injury (SCI) they are in Switzerland and Sweden. There are several differences in the way rates reported are calculated such as the time post-injury, making it difficult to definitively identify whether one country achieves better RTW rates than another. Several studies have been conducted to determine the factors which facilitate and limit RTW for people with catastrophic injury. These include having pre-injury employment, age, education, severity of injury, level of cognitive impairment, being functionally independent, fatigue, psychological adjustment to the change, social support and the work environment to name a few. There is a general lack of understanding of the experience of people with catastrophic injury who return to work and, therefore, little known about how job retention can be successful in the long-term. Four types of VR interventions have been identified to facilitate RTW – 1) program based rehabilitation, 2) supported employment, 3) case co-ordination and 4) hybrid or mixed. An evidence review identified 15 relevant articles and it was found that there was limited high quality evidence to support any type of intervention more effective than the other. There was however moderate evidence identified for the effectiveness of case co-ordination for achieving successful RTW for people with moderate to severe TBI and high level evidence for a specialist TBI-VR combination intervention. A reduction in the claiming of benefits after 1 year was also observed. The most promising RTW intervention for people with SCI appears to be supported employment; however, as only one RCT has provided this evidence, further studies are required. Several factors that affect the likely success of RTW interventions were also identified in exploring the research evidence and implications for future research were identified. Substantial research has been conducted on RTW interventions in people with TBI since the late 1980s, however this is not the same for SCI. High quality evidence and transparent reporting of study details are still lacking. This NTRI Forum aims to enhance understanding of the features of optimal return to work practices following traumatic brain and spinal cord injury and identify barriers and facilitators to their implementation. Two questions were identified for deliberation in a Stakeholder Dialogue: 1. In the Australian context, what are the barriers to, and facilitators of, application of strategies to optimise RTW outcomes for people with catastrophic injury? 2. How could identified barriers and facilitators be addressed to ensure successful RTW and better retention of people with catastrophic injury? An accompanying document (Dialogue Summary) will present the results of the deliberation upon these question

Return to work after stroke: recording, measuring, and describing occupational therapy intervention

Introduction: Existing research on vocational rehabilitation following stroke has been criticised for not describing intervention in sufficient detail for replication or clinical implementation. The purpose of this study was to test the feasibility of recording and measuring the content of an early stroke-specific vocational rehabilitation intervention delivered to participants in a feasibility randomized controlled trial, using a proforma previously developed for a study of vocational rehabilitation following traumatic brain injury. Method: The proforma was adapted for use in stroke with input from an expert panel and was used to record intervention content, in 10-minute units, following each intervention session. Findings: Twenty-five people, working or in education at the time of stroke, participated in the study. Two thirds of the therapists' time was spent in face-to-face contact (43%) and liaison with the patient and others (20%). Intervention mainly focused on work preparation (21%) and the return to work process (24%). The remaining time was consumed by administration (19%) and travel (18%). Conclusion: The proforma was quick and easy to use and captured the main focus of intervention. This study suggests that it can be used to record stroke-specific vocational rehabilitation intervention content and has potential for wider use in research and clinical practice

Helping Veterans Return to Work: Best Practices for Behavioral Health Practitioners

Since 2001, more than 2.6 million troops have been deployed to Iraq and Afghanistan. Their reintegration back into civilian society can often be met with difficult transitions, such as depression, relationships, health challenges, and unemployment. Alone, they are unique struggles to overcome, but, as is often the case, many of these challenges overlap and can have an adverse impact on a veteran's functioning and quality of life.Securing gainful employment has been seen as a key goal to a successful transition from military to civilian life, not just for the financial stability it creates for the veteran, but also for the social secondary benefits it engenders for the veteran and the community at large. Veterans are leaving a military culture that promotes unit cohesion, leadership and mentorship. In the civilian workplace, veterans are looking for teamwork, structured work schedules, and social activities, all of which can promote a successful transition and improve their quality of life and well-being.Nonetheless, despite numerous efforts and recent gains, the unemployment rate for post- 9/11 veterans remains stubbornly high. According to the U.S. Department of Labor Bureau of Labor Statistics, in August 2013 the jobless rate for this population rose to 10 percent, almost 3 percentage points higher than the national rate. Obstacles persist in both (a) preparing veterans for careers outside the military and (b) educating civilian employers about the strengths and challenges facing veteran workers. A coordinated approach to increase communications will help bridge that knowledge gap and, hopefully, go a long way toward increasing the employment rate among veterans, who have a lot to offer their communities

Expediting the Return to Work: Approaches in the Unemployment Compensation Program

[Excerpt] Policy makers and analysts have searched for methods to speed the return to work of unemployment compensation (UC) recipients with varying levels of intensity. The most recent recession led to an unprecedented increase in the number of workers unemployed for more than 26 weeks (the long-term unemployed). As a result, congressional interest in policy initiatives to expedite the return to work grew. This report examines the current initiatives as well as previous demonstration projects within the UC system to reduce long-term unemployment and speed the return to work

Investigating the relationship between social support and durable return to work

The aim of the current study was to investigate the relationship between social support and durable return to work (RTW) post occupational injury. A total of 1,179 questionnaires were posted to clients previously receiving vocational rehabilitation services from the Return to Work Assist program in Queensland, Australia. Participants were asked to indicate their current RTW status, in addition to completing questionnaires measuring their relationship with their superior, relationships with colleagues, and social support external to the workplace. The statistical analysis included 110 participants. An ANOVA indicated that participants in the RTW group reported significantly better relationships with their superiors and colleagues than participants in the non-durable RTW group. No significant differences were observed between the RTW, non-durable RTW and no RTW groups on a measure of social support external to the workplace. Although the findings were limited by the low response rate, an evaluation of demographics indicated the respondents were representative of the original target sample. The findings suggested that providing support in the workplace is an important area for intervention and may be a means of increasing durable RTW outcomes.</jats:p

How financial incentives induce disability insurance recipients to return to work

Using a local randomized experiment that arises from a sharp discontinuity in Disability Insurance (DI) policy in Norway, we provide transparent and credible identification of how financial incentives induce DI recipients to return to work. We find that many DI recipients have considerable capacity to work that can be effectively induced by providing financial work incentives. We further show that providing work incentives to DI recipients may both increase their disposable income and reduce program costs. Our findings also suggest that targeted policies may be the most effective in encouraging DI recipients to return to work