Process and Outcome Evaluation of Vocational Rehabilitation Interventions in Patients with Prolonged Fatigue Complaints

Prolonged fatigue can cause physical, mental and occupational disability. Fatigue often persists because of a combination of biopsychosocial factors. To evaluate the process and outcomes of three existing outpatient vocational rehabilitation interventions (VRI) in patients with prolonged fatigue complaints. The VRIs differ with regard to the content and treatment duration, enrolment procedure and financing. A pre-post design was used with repeated measurements before treatment, after treatment and 3 months after treatment. Primary outcomes (fatigue and work participation) and secondary outcomes (physical and social functioning, mental health and physiological indicators (heart rate variability)) were assessed over time using linear mixed models analysis. A process evaluation (i.e. patient reach, content completeness and patient satisfaction) was conducted as well. One hundred patients participated. Post-treatment, fatigue decreased (p  < .001) and work participation (p  < .010), physical functioning (p  < .001) and mental health (p  < .001) improved considerably in all three VRIs. Social functioning improved in one VRI (p = .022), but did not in the other two (p = .442, p = .196, respectively). Physiologically, heart rate variability improved in two VRIs (p = .044, p = .038, respectively). VRIs were administered according to the programme protocol. Almost all patients met their personal goals and the majority was satisfied with the outcomes of diminished constraints at work. Three VRIs showed significant and clinically relevant outcomes over time regarding decreased fatigue and improved functioning and work participation in fatigued patients. The VRIs administered patient-tailored biopsychosocial interventions as planned and patients were satisfied with the intervention

The effects of a stigma awareness intervention on finding and retaining paid employment a cluster randomized controlled trial among unemployed people with mental illness

Introduction: Stigma is one of the barriers to paid employment for people with mental illness. Deliberate (non-)disclosure decisions may prevent this, but the effects of stigma awareness interventions are mostly unknown. This study aims to examine the effectiveness of a stigma awareness intervention for employment specialists and a decision aid and two infographics about disclosure of mental illness on finding and retaining employment for unemployed people with mental illness, compared to usual guidance. Material and methods: A clustered RCT was conducted. Participants were unemployed people with mental illness who receive social benefits (N=153) and were recruited at eight locations. The control group received guidance as usual and the experimental group received guidance as usual combined with the stigma awareness intervention. Health, wellbeing, job seeking activities and disclosure were measured at baseline and 3, 6 and 12 months. Multilevel analyses were conducted to analyze the effects of the intervention on finding and retaining employment, controlled for other factors. Results: In the experimental group, after six (T2) and twelve months (T3) almost twice as many participants had found paid employment (T2: CG=26.1% vs EG=50.7%, p=0.003; T3: CG=34.4% vs EG=53.8%, p=0.026), and retained paid employment after twelve months (CG=23.4% vs EG=49.2%, p=0.002), compared to the control group. Conclusions: A stigma awareness intervention contributes to more often finding and retaining paid employment for people with mental illness

Association of longitudinal changes in patient-reported health status with return to work in the first 2 years after traumatic injury:A prospective cohort study in the Netherlands

OBJECTIVES: To determine the prognostic value of time driven changes in health status on return to work (RTW) in the first 2 years after traumatic injury. DESIGN: A prospective longitudinal cohort study. All patient-reported outcomes were measured at 1 week, 1, 3, 6, 12 and 24 months after injury. SETTING: Ten participating hospitals in the Netherlands. PARTICIPANTS: Employed adult clinical injury patients admitted to the hospital between August 2015 and November 2016 (N=1245 patients). MAIN OUTCOME MEASURES: Data about (first) RTW were used from the patient-reported questionnaires (1=yes, 0=no). RTW was measured as the first time a patient started working after hospital admission. Time until RTW was calculated in weeks. Health status was measured with the EuroQol Five Dimensions-3 Levels (EQ5D) including a dimension to measure cognition. RESULTS: At 24 months, 88.5% (n=1102) of the patients had returned to work. The median time to RTW was 6.6 weeks (IQR: 2–13). Patients’ health status was found to be an independent prognostic factor for RTW: a 0.1-unit increase in EQ5D (scale 0–1) translated into RTW being four times more likely (95% CI 1.60 to 11.94). Patients who had moderate or severe problems (0=no problems, 1=moderate or severe problems) with mobility (HR 0.91, 95% CI 0.84 to 0.98), anxiety/depression (HR 0.86, 95% CI 0.80 to 0.91), usual activities (HR 0.91, 95% CI 0.83 to 0.98), self-care (HR 0.90, 95% CI 0.79 to 0.99) and cognition (HR 0.90, 95% CI 0.85 to 0.94) were significantly less likely to RTW compared with patients with no problems. CONCLUSION: Increased self-reported health status over time is associated with a higher likelihood of RTW, independent of baseline risk factors, such as injury severity or education. Knowledge on patient-reported outcomes can contribute to the development of tailored RTW treatments. Furthermore, patient-reported outcomes could be used as monitoring tool to guide postinjury care in the clinical setting and RTW process. TRIAL REGISTRATION NUMBER: NCT02508675; Results

Measuring sustainable employability:psychometric properties of the capability set for work questionnaire

BACKGROUND: The capability set for work questionnaire (CSWQ) is being used to measure the new model of sustainable employability building on the capability approach. However, previous studies on the psychometric properties of the instrument are limited and cross-sectional. This two-way study aimed to (1) evaluate the convergent validity of the CSWQ with the theoretically related constructs person-job fit, strengths use, and opportunity to craft and (2) test the predictive and incremental validity of the questionnaire for the well-established work outcomes, including work ability, work engagement, job satisfaction, and task performance. METHODS: A representative sample of 303 Dutch workers, chosen with probably random sampling, were surveyed using a one-month follow-up, cross-lagged design via the Longitudinal Internet Studies for the Social Sciences panel. The convergent validity was assessed by exploring the strength of associations between the capability set for work questionnaire and the theoretically related constructs using Pearson’s correlations. The predictive and incremental validity was evaluated by performing a series of linear hierarchical regression analyses. RESULTS: We found evidence of the convergent validity of the capability set score by moderate correlations with person-job fit, strengths use, and opportunity to craft (r = 0.51–0.52). A series of multiple regression analyses showed that Time 1 capability set score and its constituents (i.e., importance, ability, and enablement) generally had predictive and incremental validity for work ability, work engagement, job satisfaction, and task performance measured at Time 2. However, the incremental power of the CSWQ over and above conceptually related constructs was modest. CONCLUSIONS: The findings support the convergent, predictive, and incremental validity of the capability set for work questionnaire with not previously investigated work constructs. This provided further evidence to support its utility for assessing a worker’s sustainable employability for future research and practical interventions

Experiences of recovery and posthospital care needs of working-age adults after physical trauma:A qualitative focus group study

OBJECTIVE: To explore experiences of recovery after physical trauma and identify long-term needs for posthospital care. DESIGN, PARTICIPANTS AND SETTING: A qualitative study was conducted consisting of seven online focus groups among working-age adults who sustained their injury between 9 months and 5 years ago. Trauma patients discharged from a level 1 trauma centre in the Netherlands were divided into three groups based on the type of their physical trauma (monotrauma, polytrauma and traumatic brain injury). Group interviews were transcribed verbatim, and thematic analysis was conducted. RESULTS: Despite differences in type and severity of their injuries, participants all struggled with the impact that trauma had on various aspects of their lives. They experienced recovery as an unpredictable and inconstant process aimed at resuming a meaningful life. Work was often perceived as an important part of recovery, though the value attributed to work could change over time. Participants struggled to bring the difficulties they encountered in their daily lives and at work to the attention of healthcare professionals (HCPs). While posthospital care needs varied between and across groups, all people stressed the need for flexible access to person-centred, multidisciplinary care and support after hospital discharge. CONCLUSIONS: This study reveals that people with a broad variety of injury experience recovery as a process towards resuming a meaningful life and report the need to expand trauma care to include comprehensive support to live well long term. Person-centred care might be helpful to enable HCPs to take people’s individual long-term needs and life situations into account. Furthermore, providing timely access to coordinated, multidisciplinary care after discharge is advocated. Integrated care models that span a network of multidisciplinary support around the person may help align existing services and may facilitate easy and timely access to the most suitable support for injured people and their loved ones

Identifying return to work trajectories among employees on sick leave due to mental health problems using latent class transition analysis

OBJECTIVES: To develop effective return to work (RTW) interventions for employees on sick leave due to mental health problems (MHPs), a better understanding of individual variation in the RTW process is needed. We investigated which RTW trajectories can be identified among employees with MHPs in terms of RTW duration and relapse occurrence during the RTW process. Additionally, we examined how different RTW trajectories can be described in terms of personal and work characteristics. METHODS: Longitudinal sickness absence registry data were collected retrospectively from the largest Dutch occupational health service. Quantitative RTW information as well as personal and work characteristics were extracted. In total, 9517 employees with a sickness absence due to MHPs were included in the analyses (62 938 data points; RTW durations from 29 to 730 days). RESULTS: A latent class transition analysis revealed five distinct RTW trajectories, namely (1) fast RTW with little chance of relapse, (2) slow RTW with little chance of relapse, (3) fast RTW with considerable chance of relapse, (4) slow RTW with considerable chance of relapse and (5) very fast RTW with very small chance of relapse. Differences between employees in the slower and faster trajectories were observed regarding gender, age, type of MHP, organisation sector and organisation size but not regarding part-time work. CONCLUSIONS: RTW trajectories among employees with MHPs showed large individual variability and differed on personal and work characteristics. Knowledge on different RTW trajectories and their characteristics contributes to the development of personalised RTW treatments, tailored to specific individuals and organisations

Experiences of resuming life after immunotherapy and associated survivorship care needs:A qualitative study among patients with metastatic melanoma

BACKGROUND: Immune checkpoint inhibitors (ICIs) have significantly improved the overall survival of patients with metastatic melanoma. It is unclear how the growing group of metastatic melanoma survivors resume their lives after treatment, and which needs they have regarding survivorship care (SSC). OBJECTIVES: To gain an in-depth understanding of metastatic melanoma survivors' experiences of resuming life after ICIs and their associated SSC needs. METHODS: A qualitative study was conducted among 20 patients with metastatic melanoma in whom ICIs had been discontinued after ongoing tumour response. One focus group (n = 9) was held, which was complemented by 11 individual interviews. Purposive sampling was used to select a variable sample in terms of sex, age, time since discontinuation of ICIs, and perceived impact of the disease. A topic guide was used to structure the (group) interviews, which were transcribed verbatim and analysed in a thematic content analysis, using several phases of coding. RESULTS: In resuming life after ICIs, the prognosis switch often caused mixed feelings among patients, mainly because of the uncertainty about the future. Demands and expectations from self and others, persistent complaints and new problems in different life domains often make it challenging to proceed with life as it was prior to metastatic cancer. Patients indicated they needed to find a new balance, which included learning to cope with uncertainty and a changed perspective on life and close relationships. In terms of SSC needs, patients particularly stressed the need for more tailored patient information, available at one location. In addition, they emphasized the need to know who to turn to in case of questions and indicated the need for psychosocial support, also for their close relatives. CONCLUSIONS: Metastatic melanoma survivors face various challenges in resuming life after ICIs and are left with several unmet SSC needs. Efforts should be focused on offering psychosocial supportive care in addition to medical care, from diagnosis onwards, taking into account the patient's close relatives. A single point of contact and personalized survivorship care plan (SCP) could be of added value in guiding them through the patient journey, which is, given its multidisciplinary nature, particularly important in melanoma care. What is already known about this topic? Since the introduction of immune checkpoint inhibitors (ICIs) the overall survival of patients with metastatic melanoma has improved significantly, leading to a growing group of melanoma survivors. Melanoma survivors may face various problems and challenges in resuming life after treatment, which may be associated with unmet survivorship care (SSC) needs. An in-depth understanding of their experiences with resuming life and the associated SSC needs is currently lacking. What does this study add? Metastatic melanoma survivors experience various challenges after immunotherapy, from the uncertain prognosis switch to the struggle of finding a new balance in life. Besides negative aspects, such as complaints in different life domains, the patient journey is often accompanied by positive outcomes, for example a changed perspective on life. They stress the need for tailored patient information and broader supportive care, also for their close relatives. What are the clinical implications of this work? In addition to medical care, efforts should be focused on offering psychosocial supportive care, including return-to-work issues, from diagnosis onwards, ideally taking into account the patient's close relatives. To guide them through the patient journey, a single point of contact and a personalized survivorship care plan (SCP) could be of added value. The latter is particularly important in melanoma care, given its multidisciplinary nature

Identifying return to work trajectories among employees on sick leave due to mental health problems using latent class transition analysis

Objectives To develop effective return to work (RTW) interventions for employees on sick leave due to mental health problems (MHPs), a better understanding of individual variation in the RTW process is needed. We investigated which RTW trajectories can be identified among employees with MHPs in terms of RTW duration and relapse occurrence during the RTW process. Additionally, we examined how different RTW trajectories can be described in terms of personal and work characteristics. Methods Longitudinal sickness absence registry data were collected retrospectively from the largest Dutch occupational health service. Quantitative RTW information as well as personal and work characteristics were extracted. In total, 9517 employees with a sickness absence due to MHPs were included in the analyses (62 938 data points; RTW durations from 29 to 730 days). Results A latent class transition analysis revealed five distinct RTW trajectories, namely (1) fast RTW with little chance of relapse, (2) slow RTW with little chance of relapse, (3) fast RTW with considerable chance of relapse, (4) slow RTW with considerable chance of relapse and (5) very fast RTW with very small chance of relapse. Differences between employees in the slower and faster trajectories were observed regarding gender, age, type of MHP, organisation sector and organisation size but not regarding part-time work. Conclusions RTW trajectories among employees with MHPs showed large individual variability and differed on personal and work characteristics. Knowledge on different RTW trajectories and their characteristics contributes to the development of personalised RTW treatments, tailored to specific individuals and organis