Return to work after long-term sick leave : barriers and facilitators

Background: Musculoskeletal and psychiatric disorders are the dominating problems and disorders among people on long-term sick leave in all developed countries. From 1997 up to an all time high in 2002, there was a considerable increase in the number of people on long-term sick leave in Sweden. Aim: The overall aim of this thesis was to investigate people on long-term sick leave in order to find factors that promote or hinder the return to work process. Specific aims were: to describe the medical reasons for sick leave, the duration of the problems and of the ongoing spell of sickness absence, the rehabilitation support and the individuals’ own expectations of their future return to work (Study I); to investigate whether the predictions of people on long-term sick leave concerning their future RTW had an impact on their return to work (Study II); to describe the frequency of full, partial and no RTW after long-term sick leave, and to investigate the influence of psychosocial work conditions, work ability and health, reported before the onset of sick leave, on full and partial RTW respectively (Study III); to describe the experience of driving and implementing a workplace- based rehabilitation intervention with good access to rehabilitation measures, to find out which people multimodal and/or vocational rehabilitation was advocated for and to find predictors of return to work (Study IV). Material and methods: All the studies included are sub-studies of the longitudinal HAKuL study (Work and Health in the Public Sector in Sweden), which was launched in 1999. The studies were conducted in four county councils and in local authorities in six municipalities in Sweden. Main occupational groups were registered nurses, assistant nurses, home- based personal care workers in elderly care, employees at childcare centres, administrative personnel, and teachers. The majority, 81%, were women. Study I is a cross-sectional descriptive study with an 18-month follow-up (Study II). Studies III-IV are longitudinal and conducted over a period of three years with a two-year follow-up. Results - barriers and facilitators of the return to work: The perception of the individuals on long-term sick leave regarding their RTW had a very strong predictive value for real RTW (OR=8.28, 95% CI: 3.31 - 20.69). Other factors found that were predictive of return to work in Study II were: being aged between 45-54 years; having been on the sick list for less than one year; having less pain than those in the quartile with most pain; feeling welcome back to work. In Study III, predictive factors found for full RTW were: low job strain according to the model of Karasek and Theorell (low demands–high decision latitude); good general health before the onset of sick leave; physical and mental demands in balance with the individual’s capacity. Negative consequences of organisational changes gave decreased odds for full RTW. Predictive factors for partial RTW were low job strain and good general health. In the interventional study, Study IV, vocational rehabilitation, being under 45 years of age and low physical demands at work were found to be predictive of RTW. Other results: Study I: Musculoskeletal and psychological/stress-related problems were, as expected, the most usual causes of long-term sickness absence for 90 days or longer. Combinations of symptoms and disorders were common. The women had experienced their symptoms for six years (median) before the start of their sickness absence and the men for seven years. Twenty-three percent of the women and 24% of the men did not feel welcome back to work. Personal contact and support by the regional social insurance officers were lacking for one third of the sick-listed people. Half of them had no contact with the occupational health service or the trade union. Study III: Two years after the onset of sick leave, 77% had returned to work, 62% full-time, 15% part-time, and 23% were still not working. Part of the full-time returners, 21%, had returned via a period of partial working time, while 41% had returned directly from full-time sick leave to full-time work. The proportion of partial RTW increased with age. Study IV: Problems were encountered at the beginning of the intervention. There were considerable obstacles in adapting the existing computerised personnel administrative systems to give a signal at 28 days of sick leave and the OHS sometimes had lack of resources. To counteract these problems the project organisation sent weekly reminder emails to the supervisors, the OHS were compensated at weak points, and feedback was given to those involved. After a check-up against the salary system, the decision was made to only include people with spells of sick leave of 90 days or more. Vocational rehabilitation was advocated for those with stress- related/psychological problems who were younger than 55 years of age. People with musculoskeletal problems had difficulties resuming work, despite the fact that they often received both multimodal and vocational rehabilitation. Conclusion: The most important finding in this thesis is the impact of the sick-listed individuals’ own perception of their future RTW. Only one question is required and it is essential to find out if the answer is yes or no in order to tailor rehabilitation measures. Supervisors, OHSs and employers have important roles in detecting psychosocial work conditions at work in order to prevent long-standing work strain and long-term sick leave. It is of great importance that people with musculoskeletal problems are taken seriously early on. When they are finally on long-term sick leave, considerable efforts are needed to help them resume work. Vocational rehabilitation is a favourable treatment for people with stress- related/psychological problems. Part-time sick leave often functions as part of the rehabilitation process and can enhance full RTW. Interventions at workplaces are difficult to accomplish. The structures and efforts must be considered in advance

Behov av ledarskapsutveckling i Skånes näringsliv - Ett beställarperspektiv

I denna kvalitativa studie intervjuades 17 beställare av ledarskapsutbildningar i Skånes näringsliv om deras syn på sitt företags behov av ledarskapsutveckling. Resultaten vittnar om behov av självinsikt, perspektiv, bekräftelse, stöd i rollen och ledarförmågor på individnivå och kulturell samsyn, välfungerande personal, affärsstrategisk stringens, effektiva arbetsprocesser och attraktivitet som arbetsgivare på systemnivå. I tillägg analyseras ledarskapsutbildningar utifrån funktion. Skillnader görs mellan ledarskapsutbildning som intervention, ledarskapsutbildning som symbol och ledarskapsutbildning som styrmedel. Resultaten ligger generellt i linje med tidigare forskning och diskuteras utifrån spridning och innehåll. En integrerad modell i tre dimensioner lanseras slutligen för ökad förståelse av behovens mångfald

Skapa inre lugn i yttre kaos: lärdomar av en naturinriktad stresshanteringskurs

Syftet var att studera hur anställda i riskzonen för stressrelaterad ohälsa upplevde deltagandet i en förebyggande stresshanteringskurs med inriktning mot naturens hälsofrämjande egenskaper. Frågeställningarna gällde kursdeltagarnas upplevelser av hur kursinnehållet påverkat deras stressrelaterade psykiska hälsa, vilken betydelse kursens inriktning mot naturens hälsofrämjande egenskaper haft samt i vilken utsträckning deltagarna omsatt kursinnehållet på sina arbetsplatser. Data inhämtades i tre fokusgruppintervjuer, med totalt tio personer. Materialet analyserades med tematisk analys och kritisk realism som utgångspunkt. Analysen genererade fem övergripande teman: Arbetsmiljö skapade ohälsa, Hur en stresshanteringskurs kan framkalla stress, Kursen som motpol till arbetsplatsen, Organisationen hindrar hälsosamma förändringar samt Behov av förebyggande och organisatoriska insatser. Resultatet visade att deltagarnas stressrelaterade psykiska hälsa påverkades i positiv riktning av kursen. De tillgodogjorde sig tekniker i stresshantering, lärde sig att sätta gränser, fick möjlighet att dela upplevelser med andra, hittade nya energikällor och reflekterade över egna värderingar. Naturen upplevdes som en fridfull plats, med en läkande effekt, där nya perspektiv på livet tog form. De arbetsrelaterade stressfaktorerna visade sig vara oförändrade, vilket begränsade deltagarnas möjligheter att implementera de tillägnade kunskaperna på sina arbetsplatser. Resultatet tyder på att holistiska interventioner, där både individ och organisation inkluderas, behövs för att den stressrelaterade psykiska hälsan ska förbättras i ett långsiktigt perspektiv

Återhämtning under arbetsdagen – : en inspirationsbok för individ och verksamhet

En inspirationsbok med verktyg för att främja återhämtning under arbetsdagen – både för individ och verksamhet

Long-term follow-up of disability pensioners having musculoskeletal disorders

<p>Abstract</p> <p>Background</p> <p>Previously we have conducted a randomised controlled trial (RCT) to evaluate the effect of a brief cognitive behavioural program with a vocational approach aiming to return disability pensioners with back pain to work, as compared to no intervention. One year after the intervention, 10 participants (22%) who received the program and 5 (11%) in the control group reported to have entered a return to work process. The aims of this study were to evaluate long-term effects of the intervention, and compare this effect to 2 reference populations not participating in the original trial.</p> <p>Methods</p> <p>Three groups of disability pensioners were investigated: 1) Disability pensioners having back pain (n = 89) previously participating in the RCT (randomized to either a brief cognitive behavioural intervention or to a control group), 2) 342 disability pensioners having back pain, but refusing to participate in the study and 3) 449 disability pensioners having other musculoskeletal disorders than back pain. Primary outcome was return to work, defined as a reduction in payment of disability pension.</p> <p>Results</p> <p>Only 2 of 89 (2.3%) participants from the RCT had reduced disability pension at 3-years follow-up, both from the control group. None of the participants that had been in a process of returning to work after 1 year had actually gained employment at 3-years follow-up. In the 2 groups not participating in the previous RCT, only 4 (1.2%) and 8 (1.6%) had returned to work after 3 years respectively.</p> <p>Conclusion</p> <p>The number of pensioners who returned to work was negligible in all groups regardless of having participated in a cognitive behavioural intervention or not.</p

Guillain-Barré syndrome and adjuvanted pandemic influenza A (H1N1) 2009 vaccines: A multinational self-controlled case series in Europe

BACKGROUND: The risk of Guillain-Barré syndrome (GBS) following the United States' 1976 swine flu vaccination campaign in the USA led to enhanced active surveillance during the pandemic influenza (A(H1N1)pdm09) immunization campaign. This study aimed to estimate the risk of GBS following influenza A(H1N1)pdm09 vaccination. METHODS: A self-controlled case series (SCCS) analysis was performed in Denmark, Finland, France, Netherlands, Norway, Sweden, and the United Kingdom. Information was collected according to a common protocol and standardised procedures. Cases classified at levels 1-4a of the Brighton Collaboration case definition were included. The risk window was 42 days starting the day after vaccination. Conditional Poisson regression and pooled random effects models estimated adjusted relative incidences (RI). Pseudo likelihood and vaccinated-only methods addressed the potential contraindication for vaccination following GBS. RESULTS: Three hundred and three (303) GBS and Miller Fisher syndrome cases were included. Ninety-nine (99) were exposed to A(H1N1)pdm09 vaccination, which was most frequently adjuvanted (Pandemrix and Focetria). The unadjusted pooled RI for A(H1N1)pdm09 vaccination and GBS was 3.5 (95% Confidence Interval (CI): 2.2-5.5), based on all countries. This lowered to 2.0 (95% CI: 1.2-3.1) after adjustment for calendartime and to 1.9 (95% CI: 1.1-3.2) when we accounted for contra-indications. In a subset (Netherlands, Norway, and United Kingdom) we further adjusted for other confounders and there the RI decreased from 1.7 (adjusted for calendar month) to 1.4 (95% CI: 0.7-2.8), which is the main finding. CONCLUSION: This study illustrates the potential of conducting European collaborative vaccine safety studies. The main, fully adjusted analysis, showed that the RI of GBS was not significantly elevated after influenza A(H1N1)pdm09 vaccination (RI = 1.4 (95% CI: 0.7-2.8). Based on the upper limits of the pooled estimate we can rule out with 95% certainty that the number of excess GBS cases after influenza A(H1N1)pdm09 vaccination would be more than 3 per million vaccinated

The long-term prediction of return to work following serious accidental injuries: A follow up study

Background Considerable indirect costs are incurred by time taken off work following accidental injuries. The aim of this study was to predict return to work following serious accidental injuries. Method 121 severely injured patients were included in the study. Complete follow-up data were available for 85 patients. Two weeks post trauma (T1), patients rated their appraisal of the injury severity and their ability to cope with the injury and its job-related consequences. Time off work was assessed at one (T2) and three years (T3) post accident. The main outcome was the number of days of sick leave taken due to the accidental injury. Results The patients' appraisals a) of the injury severity and b) of their coping abilities regarding the accidental injury and its job-related consequences were significant predictors of the number of sick-leave days taken. Injury severity (ISS), type of accident, age and gender did not contribute significantly to the prediction. Conclusions Return to work in the long term is best predicted by the patients' own appraisal of both their injury severity and the ability to cope with the accidental injury

Guillain-Barré syndrome and adjuvanted pandemic influenza A (H1N1) 2009 vaccines: A multinational self-controlled case series in Europe

Background: The risk of Guillain-Barré syndrome (GBS) following the United States' 1976 swine flu vaccination campaign in the USA led to enhanced active surveillance during the pandemic influenza (A(H1N1)pdm09) immunization campaign. This study aimed to estimate the risk