Improving Work Participation of Young Adults with Physical Disabilities

__Abstract__ This thesis addresses the work participation of young adults with physical disabilities caused by a chronic condition. With increasing numbers of young people with a chronic physical condition living into adulthood, knowledge about the development of work participation in these young adults and the support they need to achieve suitable employment is needed. Interventions to improve the work participation of young adults with physical disabilities were lacking. The main objective of this thesis was to design and evaluate a vocational rehabilitation intervention to improve the work participation of young adults with physical disabilities. In order to design and evaluate the intervention, we first performed a systematic review of the literature aiming to evaluate what evidence was available regarding effective interventions to improve work participation of persons with a chronic physical condition. Then we performed a longitudinal cohort study to document the development of work participation in young adults with cerebral palsy from age 16-20 up to age 20-24 years. In addition, we studied if the modified Dutch-language version of the work limitations questionnaire was an intelligible, reliable and valid instrument to assess work limitations among working persons with a chronic condition in the Netherlands. Based on those studies we designed, implemented and evaluated a new intervention aiming to improve the work participation of young adults with physical disabilities. The intervention integrated multidisciplinary rehabilitation and job coaching and combined a group program with individual coaching. Twelve young adults participated in the pilot study. The intervention was implemented in an outpatient clinic for young adults of Erasmus MC and Rijndam Rehabilitation in Rotterdam and cost were reasonable (€3130,- per person for 1 year). After one year, 8 out of 12 young adults achieved paid (n=4) or unpaid (n=4) employment. Employed persons showed moderate work ability, moderate work limitations and improved occupational performance in work, as well as self-care and leisure. After 3 years eight persons were in employed, seven of which in paid employment. Conclusion of this thesis is that it is feasible to combine multidisciplinary rehabilitation and job coaching in an intervention to improve the work participation of young adults with physical disabilities. The broad integrated approach of the intervention seems successful to support them in finding suitable employment

Effectiveness and characteristics of interventions to improve work participation in adults with chronic physical conditions: a systematic review

Purpose: Chronic physical conditions often negatively affect work participation. The objective of this systematic review is to investigate the effectiveness and characteristics of vocational rehabilitation interventions for people with a chronic physical condition. Methods: Searches in five databases up to April 2020 identified 30 studies meeting our inclusion criteria. Two reviewers independently assessed and extracted data. The Grading of Recommendation, Assessment, Development and Evaluation (GRADE) framework was used to evaluate quality of evidence for three outcome measures related to work participation. Results: All vocational rehabilitation interventions consisted of multiple components, but their characteristics varied widely. Analysis of 22 trials yielded a moderate positive effect with moderate certainty of interventions on work status; analysis of five trials with low risk of bias showed a large positive effect with moderate certainty (risk ratio 1.33 and 1.57, respectively). In addition, in eight studies we found a moderate to small positive effect with low certainty on work attitude (standardized mean difference = 0.59 or 0.38, respectively). We found no effect on work productivity in nine studies. Conclusion: The systematic review of the literature showed positive effects of vocational rehabilitation interventions on work status and on work attitude; we found no effect on work productivity.Implications for rehabilitation In rehabilitation, addressing work participation of persons with a chronic physical condition using targeted inte

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