Participation and satisfaction after spinal cord injury: results of a vocational and leisure outcome study

Study design: Survey. Objectives: Insight in (1) the changes in participation in vocational and leisure activities and (2) satisfaction with the current participation level of people with spinal cord injuries (SCIs) after reintegration in society. Design: Descriptive analysis of data from a questionnaire. Setting: Rehabilitation centre with special department for patients with SCIs, Groningen, The Netherlands. Subjects: A total of 57 patients with traumatic SCI living in the community, who were admitted to the rehabilitation centre two to 12 years before the current assessment. Main outcome measures: Changes in participation in activities; current life satisfaction; support and unmet needs. Results: Participation expressed in terms of hours spent on vocational and leisure activities changed to a great extent after the SCI. This was mainly determined by a large reduction of hours spent on paid work. While 60% of the respondents successfully reintegrated in work, many changes took place in the type and extent of the job. Loss of work was partially compensated with domestic and leisure activities. Sports activities were reduced substantially. The change in participation level and compensation for the lost working hours was not significantly associated with the level of SCI-specific health problems and disabilities. As was found in other studies, most respondents were satisfied with their lives. Determinants of a negative life satisfaction several years following SCI were not easily indicated. Reduced quality of life was particularly related to an unsatisfactory work and leisure situation. Conclusions: Most people with SCI in this study group were able to resume work and were satisfied with their work and leisure situation

The development of instruments to measure the work disability assessment behaviour of insurance physicians

<p>Abstract</p> <p>Background</p> <p>Variation in assessments is a universal given, and work disability assessments by insurance physicians are no exception. Little is known about the considerations and views of insurance physicians that may partly explain such variation. On the basis of the Attitude - Social norm - self Efficacy (ASE) model, we have developed measurement instruments for assessment behaviour and its determinants.</p> <p>Methods</p> <p>Based on theory and interviews with insurance physicians the questionnaire included blocks of items concerning background variables, intentions, attitudes, social norms, self-efficacy, knowledge, barriers and behaviour of the insurance physicians in relation to work disability assessment issues. The responses of 231 insurance physicians were suitable for further analysis. Factor analysis and reliability analysis were used to form scale variables and homogeneity analysis was used to form dimension variables. Thus, we included 169 of the 177 original items.</p> <p>Results</p> <p>Factor analysis and reliability analysis yielded 29 scales with sufficient reliability. Homogeneity analysis yielded 19 dimensions. Scales and dimensions fitted with the concepts of the ASE model. We slightly modified the ASE model by dividing behaviour into two blocks: behaviour that reflects the assessment process and behaviour that reflects assessment behaviour.</p> <p>The picture that emerged from the descriptive results was of a group of physicians who were motivated in their job and positive about the Dutch social security system in general. However, only half of them had a positive opinion about the Dutch Work and Income (Capacity for Work) Act (WIA). They also reported serious barriers, the most common of which was work pressure. Finally, 73% of the insurance physicians described the majority of their cases as 'difficult'.</p> <p>Conclusions</p> <p>The scales and dimensions developed appear to be valid and offer a promising basis for future research. The results suggest that the underlying ASE model, in modified form, is suitable for describing the assessment behaviour of insurance physicians and the determinants of this behaviour. The next step in this line of research should be to validate the model using structural equation modelling. Finally, the predictive value should be tested in relation to outcome measurements of work disability assessments.</p

Vocational reintegration following spinal cord injury: expectations, participation and interventions

Study design: Survey. Objectives: To explore the process of reintegration in paid work following a traumatic spinal cord injury (SCI), including the role of early expectations of individual patients regarding return to work, indicators of success of job reintegration and a description of reintegration interventions and barriers. Setting: Dutch rehabilitation centre with special department for patients with spinal cord injuries. Methods: Descriptive analysis of data gathered by a mailed questionnaire, which was returned by 57 persons ( response 83%) with traumatic SCI, aged 18 - 60 years, and data of earlier expectations reported by the individual patients during the rehabilitation admission following SCI from 1990 to 1998. Results: Of 49 respondents who were employed at the moment of the SCI, 45% expected to be able to resume work. These positive expectations were associated with a higher educational level. In 67%, return to work was successful. The chance to reintegrate successfully was better if the patient expected to resume work. Logistic regression analysis did not reveal other significant indicators. About one-third of the 49 respondents working preinjury followed vocational retraining, which was successful for most of them so far. In the majority of work situations modi. cations have been made, such as job adaptations and reduction of working hours. Several unmet needs regarding reintegration interventions were also reported. Conclusions: Positive expectations regarding resumption of work after a SCI are an important indicator of successful reintegration in work. An active role of the rehabilitation team is recommended in drawing up a vocational reintegration plan to prepare the patient, the employer and professionals involved in the reintegration process

Fatigue, emotional exhaustion and perceived health complaints associated with work-related characteristics in employees with and without chronic diseases.

Contains fulltext : 52162.pdf (publisher's version ) (Closed access)OBJECTIVES: Ageing of the Dutch working force and increasingly more stringent restrictions regarding early retirement and disability benefits are leading to higher numbers of workers with ill health. Until now, only a few studies have explored how employees with ill health perceive their work. This study investigated possible differences in scores on fatigue, emotional exhaustion, perceived health complaints and various work-related characteristics between chronically ill (CIWs) and non-chronically ill workers (NCIWs), as well as differences in associations between work- and health-related characteristics. METHODS: A questionnaire was sent to all employees of a Dutch university to collect data on perceived work-related and health-related characteristics (response 49.1%). Differences in various scores were analysed using chi (2)-tests and the general linear model. Associations between the work- and the health-related characteristics were determined by multiple linear regression analyses in the CIWs (n = 444) and NCIWs (n = 1,347) separately. Interaction terms were included to detect differences between the two groups. RESULTS: The results indicated that the CIWs had less favourable scores on the three health-related characteristics. Also, the CIWs scored less favourably than the NCIWs on almost all the work-related characteristics. In the two groups, negative work-related aspects, such as higher work pressure, contributed most to explaining the variance in the health-related characteristics. However, in the CIWs, fatigue was not explained by the work-related aspects as much as in the NCIWs. In the CIWs, the association between unpleasant treatment and the health-related characteristics was stronger than in the NCIWs, but there were indications that autonomy, possibilities for learning and social support from superiors also played an important role. CONCLUSIONS: CIWs perceived more fatigue, emotional exhaustion and health complaints than NCIWs. There were different patterns of associations between work- and health-related characteristics in the NCIWs and CIWs. Future studies on associations between work-related characteristics and health should take the presence of chronic disease into account