Reincentivizing – a new theory of work and work absence

<p>Abstract</p> <p>Background</p> <p>Work capacity correlates weakly to disease concepts, which in turn are insufficient to explain sick leave behavior. With data mainly from Sweden, a welfare state with high sickness absence rates, our aim was to develop an explanatory theory of how to understand and deal with work absence and sick leave.</p> <p>Methods</p> <p>We used classic grounded theory for analyzing data from >130 interviews with people working or on sick leave, physicians, social security officers, and literature. Several hundreds of typed and handwritten memos were the basis for writing up the theory.</p> <p>Results</p> <p>In this paper we present a theory of work incentives and how to deal with work absence. We suggest that work disability can be seen as hurt work drivers or people caught in mode traps. Work drivers are specified as work capacities + work incentives, monetary and non-monetary. Also, people can get trapped in certain modes of behavior through changed capacities or incentives, or by inertia. Different modes have different drivers and these can trap the individual from reincentivizing, ie from going back to work or go on working. Hurt drivers and mode traps are recognized by driver assessments done on several different levels. Mode driver calculations are done by the worker. Then follows employer, physician, and social insurance officer assessments. Also, driver assessments are done on the macro level by legislators and other stakeholders. Reincentivizing is done by different repair strategies for hurt work drivers such as body repair, self repair, work-place repair, rehumanizing, controlling sick leave insurance, and strengthening monetary work incentives. Combinations of these driver repair strategies also do release people from mode traps.</p> <p>Conclusion</p> <p>Reincentivizing is about recognizing hurt work drivers and mode traps followed by repairing and releasing the same drivers and traps. Reincentivizing aims at explaining what is going on when work absence is dealt with and the theory may add to social psychological research on work and work absence, and possibly inform sick leave policies.</p

Patients’ experience of a workplace dialogue in physiotherapy practice in primary care : an interview study

Purpose: To describe how patients with acute/subacute back pain and/or neck pain experienced a workplace intervention, conducted as a structured workplace dialogue (convergence dialogue meeting, CDM) within physiotherapy practice in primary care. Materials and methods: Semi-structured interviews were performed with 10 patients who took part in the CDM. Qualitative content analysis was applied to the data. Results: Three categories emerged from the analysis: physiotherapist (PT) as a facilitator, the employer as a key stakeholder and lack of transparency and concrete changes. Conclusion: This study describes patients’ experiences of a workplace dialogue in physiotherapy practice. Even though few patients experienced concrete changes at the workplace, they were supportive for the intervention as well as how the PTs conducted the CDM. The patients expressed trust in the PTs who were seen as someone who could facilitate changes at the workplace, being proficient and supportive. The CDM could be a method to facilitate communication between stakeholders and support work ability

Increased deep pain sensitivity in persistent musculoskeletal pain but not in other musculoskeletal pain states

BackgroundPressure pain thresholds (PPTs) in a non-painful body area are known to be affected in some chronic pain states. The aim of this study is to investigate PPTs in a pain-free body part in relation to pain persistence and intensity in patients with musculoskeletal pain. MethodsPatients with musculoskeletal pain were divided into three different pain groups: acute pain (pain duration &lt; 3 months, n = 38), regularly recurrent pain (regularly recurrent pain duration &gt; 3 months, n = 56), persistent pain (persistent pain duration &gt; 3 months, n = 52) and a healthy control group (n = 51). PPT measures were conducted over the tibialis anterior muscle on the right leg in all groups. ResultsThe persistent pain group showed significantly lower PPTs over the tibialis anterior muscle compared to controls. No significant differences were found between the acute and regularly recurrent pain groups compared to healthy controls. Significant correlations, albeit small, were found between pain intensity and PPTs. ConclusionsIncreased deep pain sensitivity was found in patients with persistent musculoskeletal pain, but not in regularly recurrent pain or in acute pain. Yet, a limitation of the study is that it did not have sufficient power to detect small levels of increased deep pain sensitivity among the latter groups when compared to healthy controls. Implications: Knowledge about increased general hypersensitivity in persistent musculoskeletal pain could be important in clinical treatment

Impaired psychomotor ability and attention in patients with persistent pain : a cross-sectional comparative study

Background and aims: Patients with pain have shown cognitive impairment across various domains. Although the pain qualities vary among patients, research has overlooked how cognitive performance is affected by the duration and persistence of pain. The current study sought to fill this gap by examining how qualitatively different pain states relate to the following cognitive functions: sustained attention, cognitive control, and psychomotor ability. Patients and methods: Patients with musculoskeletal pain in primary care were divided into three pain groups: acute pain (duration &lt;3 months), regularly recurrent pain (duration &gt;3 months), and persistent pain (duration &gt;3 months). These groups were then compared with healthy controls. The MapCog Spectra Test, the Color Word Test, and the Grooved Pegboard Test were used to measure sustained attention, cognitive control, and psychomotor ability, respectively. Results: Patients with persistent pain showed significantly worse sustained attention and psychomotor ability compared with healthy controls. The acute pain group showed a significant decrease in psychomotor ability, and the regularly recurrent pain group showed a significant decrease in sustained attention. These results remained unchanged when age, education, and medication were taken into account. Conclusion: Persistent musculoskeletal pain seems to impair performance on a wider range of cognitive tasks than acute or regularly recurrent pain, using pain-free individuals as a benchmark. However, there is some evidence of impairment in psychomotor ability among patients with acute pain and some impairment in sustained attention among patients with regularly recurrent pain

Reincentivizing Work: A grounded theory of work and sick leave

Work capacity has a weak correlation to disease concepts, which are insufficient to explain sick leave behavior. With data mainly from Sweden, a welfare state with high sickness absence rates, our aim was to develop an explanatory theory of work and sick leave.We used classic grounded theory for analyzing data from 130 individual interviews of people working or on sick leave, physicians, social security officers, and literature. More than 60,000 words and hundreds of typed and handwritten memos were the basis for the writing up of the theory. In this paper we present a theory of “reincentivizing work”. To understand incentives we define work disability as hurt work drivers or work traps. Work drivers are specified as work capacities + work motivators, monetary and non-monetary. Incentives are recognized when hurt work drivers are assessed and traps identified. Reincentivizing is done by repairing hurt work drivers and releasing from traps. In our theory of reincentivizing work, hurt work drivers and traps are recognized and then repaired and released. The theory may add to social psychological research on work and sickness absence, and possibly inform future changes in sick leave policies

Rehabilitation benefits highly motivated patients: a six-year prospective cost-effectiveness study

Objectives:To compare the six-year outcome of a multidisciplinary rehabilitation program with continued care within primary care in terms of health-related quality of life and cost-effectiveness. Furthermore, predictors of total costs to society were examined. Methods:A prospective, matched, controlled, six-year follow-up was designed. The study included 236 patients (42 men, 194 women) nineteen to sixty-one years of age with prolonged musculoskeletal disorders. The intervention comprised a four-week multidisciplinary rehabilitation and an active one-year follow-up based on a bio-psycho-social approach. The control group received continued care within primary care. The main outcome measures were quality of life measured using the Nottingham Health Profile, motivation identified by an interview and patient-specific total costs to society. Differences in mean costs between groups and cost-effectiveness were evaluated by applying nonparametric bootstrapping techniques. Results: Total costs per treated patient in the rehabilitation group and the control group were £43,464 (SD=31,093) and £44,123 (SD=33,333), respectively (p=.896). Multidisciplinary rehabilitation improved quality of life somewhat more cost-effectively. Motivation was revealed as a predictor of total costs. Conclusion: In the long-run, the evaluated multidisciplinary rehabilitation improved the highly motivated patients' quality of life most cost-effectively. The latently motivated patients may require rehabilitation, which is less intensive and with a longer duration, to improve their health in a whole-person perspective. The burden of prolonged musculoskeletal disorders to society was reaffirmed. Motivation could be a predictor of total costs, a factor which has to be taken into account in the examination procedure

Socioeconomic differences in smoking trends among pregnant women at first antenatal visit in Sweden 1982-2001: Increasing importance of educational level for the total burden of smoking.

BACKGROUND: There was a decrease 1982-2001 in smoking during early pregnancy in Swedish women. We sought to determine whether there was a parallel decrease in socio-economic inequality in smoking. METHODS: Registry data indicating educational level and smoking status at first antenatal visit in all 2,022,469 pregnancies in Sweden 1982-2001 was analysed. Prevalence differences, odds ratios based on prevalences, and total attributable fractions were compared for five-year intervals. RESULTS: The prevalence differences of smoking showed greater decrease at the lowest and middle compared with the highest educational level (14.5, 15.7 and 10.2%, respectively) indicating reduced inequality in absolute terms. However, odds ratios regarding low educational attainment versus high, increased from 5.6 to 14.2, signifying increased inequality in relative terms. Moreover, the total attributable fraction of low and intermediate educational level regarding smoking at first antenatal visit increased from 61% to 76% during the period studied. CONCLUSIONS: Smoking at first antenatal visit in Sweden 1982-2001 decreased in a way that conclusions regarding trends in inequalities in smoking at first antenatal visit depend on the applied type of measure. However, using the measure of total attributable fraction, which takes into consideration the impact of the exposure on the individual as well as the effect of the varying size of the group of exposed, the growing importance of educational level for the behaviour in the population, was demonstrated