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Abstract Background Breast cancer management has improved dramatically in the past three decades and as a result, a population of working age women is breast cancer survivor. Interventions for breast cancer survivors have shown improvements in quality of life and in physical and psychological states. In contrast, efforts aimed at stimulating re-employment and return-to-work interventions for breast cancer survivors have not kept pace. The objective of this review was to study the effects and characteristics of intervention studies on breast cancer survivors in which the outcome was return to work. Methods The Cochrane Controlled Trials Register (The Cochrane Library, Issue 4, 2006), Medline, Ovid, EMBASE and PsychInfo were systematically searched for studies conducted between 1970 to February 2007. Intervention studies for female breast cancer survivors that were focused on return to work were included. Results Our search strategy identified 5219 studies. Four studies out of 100 potentially relevant abstracts were selected and included 46–317 employed women who had had mastectomy, adjuvant therapy and rehabilitation, with the outcome return to work. The intervention programs focused on improvement of physical, psychological and social recovery. Although a substantial percentage (between 75% to 85%) of patients included in these studies returned to work after rehabilitation, it is not clear whether this proportion would have been lower for patients without counseling or exercise, or any other interventions, as three out of four studies did not include a comparison group. Conclusion The most important finding of this review is the lack of methodologically sound intervention studies on breast cancer survivors with the outcome return to work. Using evidence from qualitative and observational studies on cancer and the good results of intervention studies on return to work programs and vocational rehabilitation, return to work interventions for breast cancer survivors should be further developed and evaluated.

Purpose: This study aimed to explore the perceived work ability of patients with postpoliomyelitis syndrome (PPS) , to identify barriers and factors that are impeding or conducive, respectively, to work participation, and to identify possible interventions. Methods: Qualitative cross-sectional interview study with 17 subjects with PPS, 12 women and 5 men, mean age 49 years (SD: 11). Semi-structured interviews were held with the subjects in their homes, with the aid of a topic list. The COREQ criteria list for qualitative research was used as guideline in design and analysis. Results: Thirteen out of 17 subjects rated their work ability six or higher on a scale from 0 to 10. Most subjects worked in an administrative, educational or managerial function. Five subjects stopped working, four worked between 0 and 20 h/week and eight worked between 20 and 40 h/week. Factors conducive to working were physical adaptations in the workplace, accessibility of the workplace and high decision latitude. Barriers to full work ability in PPS patients were high physical job demands, low social support and the symptoms of PPS, especially fatigue and pain. Conclusions: These findings suggest that work-oriented interventions aimed at preventing PPS patients from dropping out of the workforce should primarily focus on reducing physical job demands, arranging adaptations in the workplace and increasing job control. [ABSTRACT FROM AUTHOR]

Objectives: To assess the relationship between disease activity and work ability, quality of life (QoL), and fatigue in patients with RA during a 12-month course of the tumour necrosis factor (TNF)-blocking agent adalimumab. Methods: RA patients in the working age category who started treatment with adalimumab were included consecutively and followed up for 12 months. Generalized estimating equation (GEE) analyses were used to study relationships between disease activity and the outcome variables work ability, QoL, and fatigue at baseline, 6 months, and 12 months. Disease activity was measured using the 28-joint Disease Activity Score (DAS28), quality of life was assessed with the Rheumatoid Arthritis-specific Quality of Life instrument (RAQoL), and fatigue was assessed using the Checklist Individual Strength (CIS) questionnaire and the Need for Recovery scale (NFR). Results: After 1 year, markedly improvement was seen not only in the DAS28 (from 5.2 ± 1.2 to 3.1 ± 1.6) but also in work ability, RAQoL, and work-related fatigue, which improved by 50, 29, and 34%, respectively. At all three time points strong significant associations were observed between DAS28 and work ability, RAQoL, and work-related fatigue and this relationship remained strong after adjustment for confounders. Conclusions: Disease activity was associated with QoL, work-related fatigue, and work ability in a group of RA patients treated with adalimumab for 1 year. As improvement in these factors influences work participation positively and work ability measures more than health status, the current results suggest that simple tools such as work ability should be used more frequently as outcome measures in trials with RA patients. [ABSTRACT FROM AUTHOR]

Primary objective: To investigate how many people return to work (RTW) after acquiring brain injury (ABI) due to traumatic or non-traumatic causes. Secondary objectives were to investigate the differences in outcome between traumatic and non-traumatic causes, the development of RTW over time and whether or not people return to their former job. Methods: A systematic literature search (1992-2008) was performed using terms of ABI and RTW. The methodological quality of the studies was determined. An overall estimation of percentage RTW 1 and 2 years post-injury was calculated by data pooling. Main outcomes and results: Finally, 49 studies were included. Within 2 years post-injury, 39.3% of the subjects with non-traumatic ABI returned to work. Among people with traumatic ABI, 40.7% returned to work after 1 year and 40.8% after 2 years. No effect of cause or time since injury was found. Some people with traumatic ABI who returned to work were not able to sustain their job over time. Changes of occupation and job demands are common among people with ABI. Conclusions: About 40% of the people with traumatic or non-traumatic ABI are able to return to work after 1 or 2 years. Among those with acquired traumatic brain injury a substantial proportion of the subjects were either not able to return to their former work or unable to return permanently. [ABSTRACT FROM AUTHOR]

OBJECTIVE: Analysis of a dose-response pattern between exposure to whole body vibration (WBV) and low back pain (LBP) in a group of drivers. METHODS: This study assessed individual factors, work-related risk factors, various LBP outcome measures and LBP disability in a group of drivers (n = 571) approached at baseline (T0), as well as the WBV magnitude of a representative sample of their vehicles (n = 49), at T0 and at 1-year follow-up (T1). Data were collected using a self-administered questionnaire and actual field measurements according to ISO 2631-1. The magnitude and duration of vibration exposure and a variety of daily and cumulative WBV-exposure measures were calculated for each driver. RESULTS: 229 drivers (40.1%) completed both questionnaires (T0 and T1). The magnitude of WBV was comparable over time. Depending on the LBP outcome, various individual factors (marital status, back trauma and smoking) and work-related risk factors (previous job with heavy physical loading, lifting, bending and the physical risk index) related significantly to onset (all, p<0.05). After adjusting for these contributing factors, the study found a significant trend (an increase in odds ratios of developing LBP with an increase in WBV exposure) for driving-related LBP with daily driving time (p<0.03), and the cumulative measures total hours of exposure (p<0.01), root sum of squares at total dose (p<0.05) and root sum of quads at total dose (p<0.01). No significant trend was found for 12-month LBP. No analysis on a possible dose-response pattern could be derived for either LBP intensity or LBP disability, due to low prevalence. CONCLUSION: The investigation found a dose-response pattern between WBV exposure and driving-related LBP. No indication of a dose-response pattern was found between WBV exposure and 12-month LBP. Although this dose-response pattern is only an indication, these findings imply that WBV exposure might contribute to the onset of driving-related LBP. [ABSTRACT FROM AUTHOR]

Purpose. To describe reasons for not starting and to determine expectations and perceived value of multidisciplinary treatment among referred patients, sick-listed due to upper extremity musculoskeletal disorders Method. Twenty-six randomly chosen referred patients who did not start the treatment were interviewed by telephone to identify their reasons for not starting and 24 randomly chosen patients who participated in the treatment were interviewed face-to-face to explore their expectations and experiences of multidisciplinary treatment. Results. Reasons for not starting the treatment are mainly intrinsic to the treatment. The most important reason was that the treatment was thought to be too psychological in nature. Most treated patients had no prior expectations but saw it as a last resort for their complaints. The psychological (cognitive-behavioural) component was perceived as the most useful part that acquired the ability to cope with their complaints and developed an increased self-awareness. Most treated patients are satisfied, although some said the treatment did not meet their expectations, because their complaints had not disappeared. Conclusion. The most important reason for not starting the treatment was the assumption that the treatment is too psychological in nature, while in treated patients the psychological sessions were perceived as most useful treatment component. [ABSTRACT FROM AUTHOR]

Purpose. To describe what aspects, categorized according to the ICF model, insurance physicians (IPs) take into account in assessing short- and long-term work-ability. Method. An interview study on a random sample of 60 IPs of the Dutch National Institute for Employee Benefit Schemes, stratified by region and years of experience. Results. In determining work-ability, a wide range of aspects were used. In the case of musculoskeletal disease, 75% of the IPs considered the 'function and structures' component important. With psychiatric and other diseases, however, the 'participation factor' component was considered important by 85 and 80%, respectively. Aspects relating to the 'environmental factor' and 'personal factor' components were mentioned as important by fewer than 25%. In assessing the short- and long-term prognosis of work-ability, the 'disease or disorder' component was primarily used with a rate of over 75%. Conclusions. In determining work-ability, insurance physicians predominantly consider aspects relating to the 'functions and structures' and 'participation' components of the ICF model important. The 'environmental factor' and 'personal factor' components were not often mentioned. In assessing the short- and long-term prognosis of work-ability, the 'disease or disorder' component was predominantly used. It can be argued that 'environmental factors' and 'personal factors' should also more often be used in assessing work-ability. [ABSTRACT FROM AUTHOR]

BACKGROUND: Evaluation of causal relations between physical load and musculoskeletal disorders is hampered by the lack of knowledge as to the biological relevance of different loading parameters and the large variability between individuals. As indicators of molecular changes in the extracellular matrices of structures of the musculoskeletal system, biomarkers of collagen metabolism may provide important information on biological effects of physical load. The carboxyterminal propeptide of type I collagen (PICP) is a serum marker of synthesis and the carboxyterminal telopeptide region of type I collagen (CTx) reflects degradation of type I collagen. AIMS: To explore the feasibility of biomarkers of type I collagen metabolism as measures of the effects of physical load at tissue level. METHODS: Serum concentrations of PICP and CTx were assessed in a group of male construction workers involved in heavy manual materials handling (n = 47) and in a group of male sedentary workers (n = 49). RESULTS: Serum concentrations of both PICP and CTx seemed to be related to heavy physical work. The ratio PICP/CTx, illustrative of the effective metabolic changes, did not differ between the two groups. CONCLUSIONS: The higher turnover rate but similar effective synthesis may be indicative of an increased type I collagen content in the connective tissues as a result of adaptive remodelling in response to years of exposure to physical load. Further validation of these biomarkers is required with respect to dose-response relations and temporal associations between exposure to back load and biomarker concentrations. [ABSTRACT FROM AUTHOR]

The aim of this study was to investigate the concurrent validity--as regarding maximum lifting capacity--between the Functional Capacity Evaluation (FCE) methods, ERGOS Work Simulator and Ergo-Kit. Twenty-five healthy, male firefighters participated. Dynamic lower and upper lifting capacities were determined using both FCE methods. Paired t tests showed the mean maximum lifting capacities to be significantly higher statistically when determined by the Ergo-Kit for lower, as well as, upper lifting. Spearman rank correlation coefficients varied between 0.49 and 0.66. It was concluded that the concurrent validity for lifting between both FCE methods was poor. [ABSTRACT FROM AUTHOR]

Musculoskeletal disorders often result in employee disability leaves and sickness-related absenteeism in the workplace. Professional evaluations of an employee's capacity to work require additional support by means of Functional Capacity Evaluation (FCE) methods. However, most FCE methods assess general physical capacity and, because of fixed test procedures, testing times range between 4 and 6 h for up to several days. For return to work (vocational rehabilitation), the tests need to reflect the employees' specific work demands more precisely. This study aims to develop a job-specific FCE protocol on the Ergos Work Simulator for hospital nurses. In developing the contents of this specific protocol, hierarchical task analyses were performed with 20 nurses in four departments of a university medical center. A job-specific test protocol was developed that consisted of five steps. In this process, the original test protocol was analyzed first. Secondly, categorization of physical risk factors for work-related musculoskeletal disorders revealed 16 possible combinations of activity, posture, and load. Finally, duration and frequencies during one working day of these combinations were coupled to the Ergos test panels. The nurse-specific test protocol lasts 90 min. It was possible to develop a job-specific protocol, using on-site observations as the input. Compared to the original Ergos protocol, the external validity of the new job-specific protocol has improved: it simulates the functional capacity that nurses need to perform their job in a realistic way. The testing time of the original Ergos protocol is four times longer compared to the new job-specific protocol. [ABSTRACT FROM AUTHOR]

The objective of this paper was to assess the reliability of functional capacity evaluation (FCE) tests of the upper extremity in Ergos from three perspectives: human performance (in terms of a learning effect); order of the physical intensity (force) of the subtests (intensity effect); and performance in time (time of day effect). An experimental within-subjects design was performed. Twelve healthy males/females were tested in the morning or in the afternoon. The tests focused on sensibility, coordination, and strength of the upper extremity. A counterbalanced design was used for three orders of the three types of tests increasing in intensity. Each participant was tested three times over the course of 4 weeks. A learning effect was found in sensibility and coordination subtests. No order effect was observed in terms of the intensity of the subtests. A time effect was found in coordination tasks: keyboarding performance was better in the morning, and handling better in the afternoon. It was concluded that repeated upper extremity FCE testing in the present pilot study was found to be reliable over a 4-week period in healthy subjects. [ABSTRACT FROM AUTHOR]

Aims: (1) To find a universal strategy for the identification of specific demands of a job or task, focusing on occupations in which there may be an increased risk for health complaints owing to these specific demands. (2) To select reliable and valid tests concerning lifting, pushing, and pulling, which consider the relation between occupational work demands and the assessment of the maximally acceptable load on an individual level.Methods: Literature search was performed using Medline (1988 to May 2001), Embase (1966 to May 2001), and NIOSHTIC (1971-98).Results: No universal strategy was found for the definition of specific occupational demands. Therefore a "three step strategy" was formulated for defining specific occupational demands in a job or a task in order to prevent health complaints on an individual level. Many tests were found in the literature concerning lifting, but only a few concerning pushing and pulling. None of the tests concerning pushing, pulling, or lifting considered the relation between work demands and the assessment of the maximally acceptable load on an individual level. Furthermore, none of the tests met the criteria of reliability and prognostic value for musculoskeletal complaints completely. Only for the prognostic value of relative strength capacity tests concerning pushing pulling and lifting, did there appear to be limited proof for the development of musculoskeletal complaints.Conclusions: In general, for the prevention of work related health complaints, it can be suggested that more attention should be paid to: (1) the definition of specific occupational demands; (2) the assessment of specific occupational demands; and (3) the quality of tests for specific occupational demands. [ABSTRACT FROM AUTHOR]

Background: Although repetitive exposure to stressful situations is thought to habituate the physical stress responses, work stress is experienced by medical personnel in emergency and intensive care units; performance should, however, remain stable over time.Aims: To investigate the neuroendocrine reactions (reactivity during and recovery after work) in experienced emergency caregivers during emergency situations.Methods: A within subjects pre-post design was studied in the natural work environment of 20 municipal Dutch emergency caregivers. A stress protocol was developed in which the biomarker cortisol was measured in saliva at baseline, during the emergency period, and during recovery. Four scenarios were tested between subjects in which the severity of the emergency situation and the time of day were taken into account.Results: Greater endocrine reactions were shown during and after the handling of patients in direct life threatening situations during morning hours compared to the handling of patients who were not in direct life threatening situations. [ABSTRACT FROM AUTHOR]

AIMS: To present the available empirical evidence for the assumed position of the concept of work related fatigue as: (1) short term effect of the working day; and (2) an intermediate variable between work demands and the development of subjective health complaints and sickness absence. METHODS: Results from six single occupation studies, conducted between 1996 and 2002, are presented. Work demands (working hours, decision latitude, break control/autonomy, and mental, emotional, and physical demands) were assessed through validated scales. Work related fatigue was represented and assessed by means of the need for recovery after working time scale in all studies. Subjective health complaints and duration of sickness absence were quantified with the same instruments in most studies as well. Both cross sectional studies (four) as well as prospective studies (two; up to two years follow up) were performed. Cross sectional data of 3820 workers, in total, were available. Prospective data were accessible for 1200 workers in industry and health care. Models were tested with stepwise multiple regression analyses. RESULTS: Strong associations between work demands and need for recovery were found in different occupations. The variance explained in need for recovery by work demands, age, and (baseline) need for recovery ranged between 14% and 48% in both types of studies. The amount of explained variance by work demands, age, and (baseline) need for recovery in subjective health complaints ranged between 24% and 58% in the different occupations. The prospective data showed the prognostic value of need for recovery in relation to subjective health complaints (in terms of psychosomatic complaints, emotional exhaustion, or sleep problems) and duration of future sickness absence. CONCLUSIONS: The hypothesised role for work related fatigue as a link in the causal string of events, that is assumed to exist between repeated adverse work demands and the development of work related stress reactions, (psychological) overload and, eventually, health problems, was confirmed. [ABSTRACT FROM AUTHOR]

We investigated the effect of tactile guided slow deep breathing compared with that of spontaneous breathing on blood oxygen saturation (SpO2), alertness, and hypoxia symptoms during acute hypobaric hypoxia. We also evaluated the usability of this tactile breathing guidance. Twelve male military pilots were exposed to a simulated altitude of 4,572 m (15,000 ft) in a repeated measures study while breathing spontaneously and during tactile guided slow deep breathing. Under both breathing conditions, measurements were performed at rest and during the performance of a cognitive task. The Stanford Sleepiness Scale was used to rate alertness, and hypoxia symptoms were reported using a list of general hypoxia symptoms. Usability was evaluated in a questionnaire. Tactile guidance of slow deep breathing significantly increased (p <.001) the SpO2 - 88% (95% confidence interval (CI) [84%, 91%]) at rest and 85% (95% CI [81%, 88%]) during the cognitive task - compared with spontaneous breathing - 78% (95% CI [75%, 81%]) at rest and 78% (95% CI [76%, 80%]) during the cognitive task. This increase in SpO2 had no effect on the level of alertness and number of hypoxia symptoms. Pilots were positive about the intensity and sensation of the vibration signal, but had difficulty following the vibration pattern during the cognitive task. Pre-training may improve slow deep breathing technique during performance of cognitive tasks., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Steinman et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

We investigated the effect of hypoxia on the reaction time (RT) and response accuracy of pilots performing a visual choice reaction task that corresponded to the scanning of helmet mounted display (HMD) symbology. Eighteen male military pilots performed the task in a hypobaric chamber at two simulated altitudes (92 m and 4572 m) in a single-blinded repeated measures and counter-balanced design. The visual stimuli were displayed in low and high contrast and at a 30- and 50-degree field of view (FoV). We measured the pilots' RT and response accuracy. Using an eye tracker, we measured the pilot's glance time at each stimulus location. Finally, we collected subjective ratings of alertness. The results show that hypoxia increased the RT and glance time. Lowering the stimulus contrast and increasing the FoV further increased the RT, independent of hypoxia. These findings provide no evidence for hypoxia-induced changes in visual contrast sensitivity or visual field. Instead, hypoxia seemed to affect RT and glance time by reducing alertness. Despite the increased RT, the pilots maintained their accuracy on the visual task, suggesting that visual scanning of HMD symbology may be resistant to the effects of acute hypoxia., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. The opinions expressed in this article are solely those of the authors and do not reflect the views of the Dutch Air Force, the Dutch Defense Department, or any other department of the Dutch government., (Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: Women with multiple pregnancies are at risk for maternal complications such as preterm birth. Hazardous working conditions, such as physically demanding work and long and irregular working hours, might increase the risk of preterm birth., Objective: This study primarily aimed to determine whether certain working conditions up to 20 weeks of pregnancy increase the risk of preterm birth in multiple pregnancies. The secondary objective was to evaluate whether the working conditions of Dutch women with multiple pregnancy have been adjusted to the guidelines of the Netherlands Society of Occupational Medicine., Study Design: We performed a prospective cohort study alongside the ProTWIN trial, a multicenter randomized controlled trial that assessed whether cervical pessaries could effectively prevent preterm birth. Women with paid work of >8 hours per week completed questionnaires concerning general health and working conditions between 16 and 20 weeks of pregnancy. Univariable and multivariable logistic regression analyses were performed to identify work-related factors associated with preterm birth (32-36 weeks' gestation) and very preterm birth (<32 weeks' gestation). We analyzed a subgroup of participants who worked for more than half of the week (>28 hours). We calculated the proportion of women who reported work-related factors not in accordance with guidelines., Results: We studied 383 women, of whom 168 (44%) had been randomized to pessary, 142 (37%) to care as usual, and 73 (19%) did not participate in the randomized part of the study. After adjusting for confounding variables, working >28 hours was associated with very preterm birth (n=33; 78%) (adjusted odds ratio, 3.0; 95% confidence interval, 1.1-8.1), and irregular working times were associated with preterm birth (n=26, 17%) (adjusted odds ratio, 2.0; 95% confidence interval, 1.0-4.1) and very preterm birth (n=10; 24%) (adjusted odds ratio, 2.7; 95% confidence interval, 1.0-7.3). Within a subgroup of 213 participants working >28 hours per week, multivariable analysis showed that irregular working times (n=16; 20%) (adjusted odds ratio, 3.5; 95% confidence interval, 1.2-10.1) and no/little freedom in performance of tasks (n=23; 28%) (adjusted odds ratio, 3.0; 95% confidence interval, 1.3-7.3) were associated with preterm birth. Irregular working times (n=9; 27%) (adjusted odds ratio, 3.4; 95% confidence interval, 1.0-11.1), requiring physical strength (n=9; 27%) (adjusted odds ratio, 5.3; 95% confidence interval, 1.6-17.8), high physical workload (n=7; 21%) (adjusted odds ratio, 3.9; 95% confidence interval, 1.1-13.9), and no/little freedom in performing tasks (n=10; 30%) (adjusted odds ratio, 3.2; 95% confidence interval, 1.1-9.6) were associated with very preterm birth. Before 20 weeks of pregnancy, 224 (58.5%) women with multiple pregnancy continued to work under circumstances that were not in accordance with the guidelines., Conclusion: In our cohort study, nearly 60% of women with multiple pregnancy continued to work under circumstances not in accordance with the guidelines to avoid physical and job strain and long and irregular working hours. Irregular hours were associated with preterm and very preterm birth, and long hours were associated with preterm birth., (Copyright © 2022 The Author(s). Published by Elsevier Inc. All rights reserved.)

Purpose: To explore views of general practitioners (GPs) and occupational physicians (OPs) on the role of GPs in work guidance of cancer patients., Methods: Between 2016 and 2019, two focus groups with GPs (N = 17) and two focus groups with OPs (N = 10) were conducted. Focus group discussions were audiotaped and transcribed verbatim. Transcripts were analysed by data-driven analysis., Results: GPs generally indicated that they inquire about patients' occupations but do not structurally document these. GPs described offering support and advice to patients regarding their work, while other GPs stated they do not interfere with their patients' work or return to work (RTW) process. In general, GPs stated that they do not aspire a professional role in the work guidance of patients, due to lack of expertise and not having sufficient knowledge in work regulations and legislation. In contrast, OPs anticipated a proactive role from GPs concerning work guidance in cancer patients, and they expected GPs to refer cancer patients to the OP, when required. Moreover, they emphasised the importance of communication between GPs and OPs about patients' work-related problems to achieve common goals., Conclusions: GPs can contribute to cancer patients' RTW process by supporting patients, giving advice and providing referral to other health professionals. Better cooperation between GPs and OPs may improve work guidance in cancer patients., Implications for Cancer Survivors: When cancer patients with work-related issues get appropriate advice and support from GPs and referred in time to OPs, the RTW process and staying at work of cancer patients may be positively affected., (© 2022. The Author(s).)

Purpose: To explore the usefulness and feasibility of a comprehensive vocational rehabilitation (C-VR) program and less comprehensive (LC-VR) program for workers on sick leave due to chronic musculoskeletal pain, from the perspective of patients, professionals, and managers., Materials and Methods: Semi-structured interviews were held with patients, professionals, and managers. Using topic lists, participants were questioned about barriers to and facilitators of the usefulness and feasibility of C-VR and LC-VR. Thirty interviews were conducted with thirteen patients ( n  = 6 C-VR, n  = 7 LC-VR), eight professionals, and nine managers. All interviews were transcribed verbatim. Data were analyzed by systematic text condensation using inductive thematic analysis., Results: Three themes emerged for usefulness ("patient factors," "content," "dosage") and six themes emerged for feasibility ("satisfaction," "intention to continue use," "perceived appropriateness," "positive/negative effects on target participants," "factors affecting implementation ease or difficulty," "adaptations"). The patients reported that both programs were feasible and generally useful. The professionals preferred working with the C-VR, although they disliked the fixed and uniform character of the program. They also mentioned that this program is too extensive for some patients, and that the latter would probably benefit from the LC-VR program. Despite their positive intentions, the managers stated that due to the Dutch healthcare system, implementation of the LC-VR program would be financially unfeasible., Conclusions: The main conclusion of this study is that it is not useful to have one VR program for all patients with CMP and reduced work participation, and that flexible and tailored-based VR are warranted.Implications for rehabilitationBoth comprehensive and less comprehensive vocational rehabilitation are deemed useful for patients with chronic musculoskeletal pain and reduced work participation. Particular patient factors, for instance information uptake, discipline, willingness to change, duration of complaints, movement anxiety, obstructing thoughts, and willingness to return to work might guide the right program for the right patient.Both comprehensive and less comprehensive vocational rehabilitation are deemed feasible in practice. However, factors such as center logistic (schemes, rooms, professionals available) and country-specific healthcare insurance and sickness compensation systems should foster the implementation of less comprehensive programs.

Background: As part of the development of the World Health Organization (WHO)/International Labour Organization (ILO) Joint Estimates of the Work-related Burden of Disease and Injury, WHO and ILO carried out several systematic reviews to determine the prevalence of exposure to selected occupational risk factors. Risk of bias assessment for individual studies is a critical step of a systematic review. No tool existed for assessing the risk of bias in prevalence studies of exposure to occupational risk factors, so WHO and ILO developed and pilot tested the RoB-SPEO tool for this purpose. Here, we investigate the assessor burden, inter-rater agreement, and user experience of this new instrument, based on the abovementioned WHO/ILO systematic reviews., Methods: Twenty-seven individual experts applied RoB-SPEO to assess risk of bias. Four systematic reviews provided a total of 283 individual assessments, carried out for 137 studies. For each study, two or more assessors independently assessed risk of bias across the eight RoB-SPEO domains selecting one of RoB-SPEO's six ratings (i.e., "low", "probably low", "probably high", "high", "unclear" or "cannot be determined"). Assessors were asked to report time taken (i.e. indicator of assessor burden) to complete each assessment and describe their user experience. To gauge assessor burden, we calculated the median and inter-quartile range of times taken per individual risk of bias assessment. To assess inter-rater reliability, we calculated a raw measure of inter-rater agreement (P i ) for each RoB-SPEO domain, between P i  = 0.00, indicating no agreement and P i  = 1.00, indicating perfect agreement. As subgroup analyses, P i was also disaggregated by systematic review, assessor experience with RoB-SPEO (≤10 assessments versus > 10 assessments), and assessment time (tertiles: ≤25 min versus 26-66 min versus ≥ 67 min). To describe user experience, we synthesised the assessors' comments and recommendations., Results: Assessors reported a median of 40 min to complete one assessment (interquartile range 21-120 min). For all domains, raw inter-rater agreement ranged from 0.54 to 0.82. Agreement varied by systematic review and assessor experience with RoB-SPEO between domains, and increased with increasing assessment time. A small number of users recommended further development of instructions for selected RoB-SPEO domains, especially bias in selection of participants into the study (domain 1) and bias due to differences in numerator and denominator (domain 7)., Discussion: Overall, our results indicated good agreement across the eight domains of the RoB-SPEO tool. The median assessment time was comparable to that of other risk of bias tools, indicating comparable assessor burden. However, there was considerable variation in time taken to complete assessments. Additional time spent on assessments may improve inter-rater agreement. Further development of the RoB-SPEO tool could focus on refining instructions for selected RoB-SPEO domains and additional testing to assess agreement for different topic areas and with a wider range of assessors from different research backgrounds., (Copyright © 2021 World Health Organization. Published by Elsevier Ltd.. All rights reserved.)

The purpose of the present study was to determine how hypoxia effects awareness of environment (AoE) in helicopter pilots operating at high altitude. Eight helicopter crews flew two operational flights in a flight simulator while breathing gas mixtures of 20.9% (equivalent to 0 m altitude) and 11.4% (equivalent to 4572 m or 15,000 ft altitude) oxygen in a single blinded, counterbalanced, repeated measures study. Each flight included five missions, during which environment items were introduced that the crews needed to be aware of, and respond to. In the 4572 m simulation, the crews missed overall 28 AoE items compared to 12 in the 0 m simulation ( Z = -1.992; p  = .046). In contrast, the crews' technical skills were not significantly effected by hypoxia. Remarkably, the majority of pilots did not notice they were hypoxic or recognise their hypoxia symptoms during the simulation flight at 4572 m. Practitioner summary We show that hypoxia has a detrimental effect on helicopter pilot's AoE and alertness. This can lead to an increased risk for flight safety. To mitigate this risk we recommend performing hypoxia training in a flight simulator, developing wearable systems for physiological monitoring of pilots and re-evaluating current altitude regulations. Abbreviations: ANOVA: Analysis of variance; AoE: awareness of environment; CSV: comma-separated values; HDU: helmet display unit; HR: heart rate; IQR: interquartile range; Mdn: median; NTS: non-technical skills; RNLAF: Royal Netherlands Air Force; PPM: parts per million; SpO2: oxygen saturation; SSS: Stanford sleepiness scale; TS: technical Skills.

Background: Employers express a need for support during sickness absence and return to work (RTW) of cancer survivors. Therefore, a web-based intervention (MiLES) targeted at employers with the objective of enhancing cancer survivors' successful RTW has been developed. This study aimed to assess feasibility of a future definitive randomised controlled trial (RCT) on the effectiveness of the MiLES intervention. Also preliminary results on the effectiveness of the MiLES intervention were obtained., Methods: A randomised feasibility trial of 6 months was undertaken with cancer survivors aged 18-63 years, diagnosed with cancer < 2 years earlier, currently in paid employment, and sick-listed < 1 year. Participants were randomised to an intervention group, with their employer receiving the MiLES intervention, or to a waiting-list control group (2:1). Feasibility of a future definitive RCT was determined on the basis of predefined criteria related to method and protocol-related uncertainties (e.g. reach, retention, appropriateness). The primary effect measure (i.e. successful RTW) and secondary effect measures (e.g. quality of working life) were assessed at baseline and 3 and 6 months thereafter., Results: Thirty-five cancer survivors were included via medical specialists (4% of the initially invited group) and open invitations, and thereafter randomised to the intervention (n = 24) or control group (n = 11). Most participants were female (97%) with breast cancer (80%) and a permanent employment contract (94%). All predefined criteria for feasibility of a future definitive RCT were achieved, except that concerning the study's reach (90 participants). After 6 months, 92% of the intervention group and 100% of the control group returned to work (RR: 0.92, 95% CI: 0.81-1.03); no difference were found with regard to secondary effect measures., Conclusions: With the current design a future definitive RCT on the effectiveness of the MiLES intervention on successful RTW of cancer survivors is not feasible, since recruitment of survivors fell short of the predefined minimum for feasibility. There was selection bias towards survivors at low risk of adverse work outcomes, which reduced generalisability of the outcomes. An alternative study design is needed to study effectiveness of the MiLES intervention., Trial Registration: The study has been registered in the Dutch Trial Register ( NL6758/NTR7627 )., (© 2021. The Author(s).)

Purpose: The MiLES intervention is a web-based intervention targeted at employers with the objective of enhancing successful return to work (RTW) of cancer survivors. The aim of this study is to gain insight into the employers' use and perceived usefulness of the MiLES intervention., Methods: Employer representatives (e.g. Human Resource managers and supervisors) were given access to the MiLES intervention, which contains, among others, interactive videos, conversation checklists and tailored tips. After six weeks, an online questionnaire gathered data on employers' use and the perceived usefulness of the intervention. In-depth qualitative data on these topics were gathered during semi-structured interviews, which were analyzed using a content analysis., Results: Thirty-one eligible employers were included. Twenty-two of them filled out the questionnaire and twenty were interviewed. Typically, employers used the intervention 2-3 times, for 26 min per visit. The usefulness of the intervention scored 7.6 out of 10 points, and all employers would recommend it to colleagues. Employers' use decreased when support needs were low and when the intervention did not correspond with their specific situation (e.g. complex reintegration trajectories). Employers perceived the intervention to be supporting and practically oriented. They appreciated the fact that the intervention was web-based and combined visual and textual content. The possibility of consulting specialized services for complex situations would further enhance its usefulness., Conclusion: The MiLES intervention provides employers with a useful tool in their daily practice. Its effectiveness for enhancing employers' managerial skills and cancer survivors' successful RTW is subject for further research.

Purpose The aim of this research was to study the effectiveness on return to work (RTW) of an early tailored work-related support intervention in patients diagnosed with curative gastrointestinal cancer. Methods A multicenter randomized controlled trial was undertaken, in which patients were assigned randomly to the intervention or the control group (usual care). The intervention encompassed three psychosocial work-related support meetings, starting before treatment. Five self-reported questionnaires were sent over twelve months of follow-up. Primary outcome was days until RTW (fulltime or partial) and secondary outcomes included work status, quality of life, work ability, and work limitations. Descriptive analysis, Kaplan-Meier analysis, relative risk ratio and linear mixed models were applied. Results Participants (N = 88) had a mean age of 55 years; 67% were male and the most common cancer type was colon cancer (66%). Of the participants, 42 were randomized to the intervention group. The median time from sick leave until RTW was 233 days (range 187-279 days) for the control group, versus 190 days (range 139-240 days) for the intervention group (log-rank p = 0.37). The RTW rate at twelve months after baseline was 83.3% for the intervention group and 73.5% for the control group. Work limitations did statistically differ between the groups over time (p = 0.01), but quality of life and work ability did not. Conclusion Patients in the intervention group seem to take fewer days to RTW, albeit not to a statistically significant extent.Trial registration Trial NL4920 (NTR5022) (Dutch Trial Register https://www.trialregister.nl ).

Background: The World Health Organization (WHO) and the International Labour Organization (ILO) are developing joint estimates of the work-related burden of disease and injury (WHO/ILO Joint Estimates), with contributions from a large network of experts. Evidence from mechanistic data suggests that occupational exposure to ergonomic risk factors may cause selected other musculoskeletal diseases, other than back or neck pain (MSD) or osteoarthritis of hip or knee (OA). In this paper, we present a systematic review and meta-analysis of parameters for estimating the number of disability-adjusted life years from MSD or OA that are attributable to occupational exposure to ergonomic risk factors, for the development of the WHO/ILO Joint Estimates., Objectives: We aimed to systematically review and meta-analyse estimates of the effect of occupational exposure to ergonomic risk factors (force exertion, demanding posture, repetitiveness, hand-arm vibration, lifting, kneeling and/or squatting, and climbing) on MSD and OA (two outcomes: prevalence and incidence)., Data Sources: We developed and published a protocol, applying the Navigation Guide as an organizing systematic review framework where feasible. We searched electronic academic databases for potentially relevant records from published and unpublished studies, including the International Trials Register, Ovid Medline, EMBASE, and CISDOC. We also searched electronic grey literature databases, Internet search engines and organizational websites; hand-searched reference list of previous systematic reviews and included study records; and consulted additional experts., Study Eligibility and Criteria: We included working-age (≥15 years) workers in the formal and informal economy in any WHO and/or ILO Member State but excluded children (<15 years) and unpaid domestic workers. We included randomized controlled trials, cohort studies, case-control studies and other non-randomized intervention studies with an estimate of the effect of occupational exposure to ergonomic risk factors (any exposure to force exertion, demanding posture, repetitiveness, hand-arm vibration, lifting, kneeling and/or squatting, and climbing ≥ 2 h/day) compared with no or low exposure to the theoretical minimum risk exposure level (<2 h/day) on the prevalence or incidence of MSD or OA., Study Appraisal and Synthesis Methods: At least two review authors independently screened titles and abstracts against the eligibility criteria at a first stage and full texts of potentially eligible records at a second stage, followed by extraction of data from qualifying studies. Missing data were requested from principal study authors. We combined odds ratios using random-effect meta-analysis. Two or more review authors assessed the risk of bias and the quality of evidence, using Navigation Guide tools adapted to this project., Results: In total eight studies (4 cohort studies and 4 case control studies) met the inclusion criteria, comprising a total of 2,378,729 participants (1,157,943 females and 1,220,786 males) in 6 countries in 3 WHO regions (Europe, Eastern Mediterranean and Western Pacific). The exposure was measured using self-reports in most studies and with a job exposure matrix in one study and outcome was generally assessed with physician diagnostic records or administrative health data. Across included studies, risk of bias was generally moderate. Compared with no or low exposure (<2 h per day), any occupational exposure to ergonomic risk factors increased the risk of acquiring MSD (odds ratio (OR) 1.76, 95% confidence interval [CI] 1.14 to 2.72, 4 studies, 2,376,592 participants, I 2 70%); and increased the risk of acquiring OA of knee or hip (OR 2.20, 95% CI 1.42 to 3.40, 3 studies, 1,354 participants, I 2 13%); Subgroup analysis for MSD found evidence for differences by sex, but indicated a difference in study type, where OR was higher among study participants in a case control study compared to study participants in cohort studies., Conclusions: Overall, for both outcomes, the main body of evidence was assessed as being of low quality. Occupational exposure to ergonomic risk factors increased the risk of acquiring MSD and of acquiring OA of knee or hip. We judged the body of human evidence on the relationship between exposure to occupational ergonomic factors and MSD as "limited evidence of harmfulness" and the relationship between exposure to occupational ergonomic factors and OA also as "limited evidence of harmfulness". These relative risks might perhaps be suitable as input data for WHO/ILO modelling of work-related burden of disease and injury. Protocol identifier: https://doi.org/10.1016/j.envint.2018.09.053 PROSPERO registration number: CRD42018102631., (Copyright © 2021 World Health Organization. Published by Elsevier Ltd.. All rights reserved.)

Background: Both the presence of psychological problems and the absence of an employment contract are related to long-term sickness absence, prolonged work disability and unemployment. Studies researching the effectiveness of return-to-work interventions on these non-permanent workers, including unemployed and temporary agency workers and workers with an expired fixed-term contract, are lagging behind. Therefore, a return-to-work intervention called "Brainwork" was developed. The aim of this study was to assess the effectiveness of the 'Brainwork Intervention' in reducing the duration of sick leave compared to usual care over a 12-month follow-up., Methods: In a multicenter controlled clinical trial, using a quasi-randomization procedure, we compared the Brainwork Intervention (n = 164) to usual care (n = 156). The primary outcome was the duration of sick leave. Secondary outcomes were the duration of sick leave starting from Social Security Agency transfer; the proportion of workers returned to work; the number of hours of paid employment during the follow-up period; the degree of worker participation; the level of psychological complaints; and the self-efficacy for return to work. Protocol adherence (Brainwork Intervention) was considered sufficient when at least three of the five protocol steps were followed. Cox regressions, linear and ordinal regression, and Mixed Model analyses were performed., Results: All 320 participants were analyzed. The Brainwork Intervention resulted in a non-significant reduction of the duration of sick leave compared to usual care (269 days versus 296 days; HR = 1.29; 95% CI 0.94-1.76; p = 0.11). For those working (46%) during the 12-month follow-up, the mean number of hours of paid employment was non-significantly higher in the usual care group (682 h versus 493 h; p = 0.053). No significant differences were found for other secondary outcomes. Protocol adherence was 10%., Conclusions: The Brainwork Intervention as performed with a low protocol adherence did not result in a significant reduction of the duration of sick leave compared to usual care. It remains unclear what the results would have been if the Brainwork Intervention had been executed according to protocol., Trial Registration: The Netherlands Trial Register (NTR); NTR3976 (old registration number NTR4190). Registered September 27th 2013.

Purpose To study the longitudinal relationship between interdisciplinary vocational rehabilitation (VR) with and without additional work module on work participation of patients with chronic musculoskeletal pain and sick leave from work. Methods Retrospective longitudinal data retrieved from care as usual in seven VR centers in the Netherlands was used. The VR program without work module consisted of multi-component healthcare (physical exercise, cognitive behavioral therapy, education, relaxation). The other program with additional work module (VR+) included case management and a workplace visit. Generalized estimating equations using binary logistic was applied. The dependent variable was work participation (achieved/not achieved) on discharge and 6-months follow-up. Independent variables were type of intervention, return to work expectation, sick leave duration, working status, job strain, and job dissatisfaction. Results Data from N = 470 patients were analyzed, of which 26% received VR and 74% VR+. Both programs increased work participation at 6-months follow-up (VR 86%, VR+ 87%). The crude model showed a significant longitudinal relationship between type of intervention and work participation in favor of VR+ (OR 1.8, p = 0.01). The final model showed a non-significant relationship on discharge (OR 1.3, p = 0.51) and a significant relationship on 6-months follow-up in favor of VR+ (OR 1.7, p = 0.04). RTW expectation was a significant confounder in the final model on discharge and 6-months follow up (OR 3.1, p = 0.00). Conclusions Both programs led to increased work participation. The addition of a work module to the VR program lead to a significant increase in odds of work participation at 6-months follow-up.

Background: Return to work (RTW) is an important outcome in Total Knee Arthroplasty (TKA). At present, 70-80%of TKA patients return to work within three to six months., Objective: What are patients' perspectives regarding beneficial and limiting factors in RTW after TKA?, Methods: Focus groups were formed in accordance with the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist. Three major topics were explored: 1. What was beneficial for RTW after TKA; 2. What was limiting for RTW after TKA; and 3. What additional care would benefit RTW after TKA?, Results: Data saturation was reached after four focus groups, comprising 17 participants-nine men and eight women (median age 58, range 52-65). The focus group study identified four main themes that contributed to a successful RTW namely rehabilitation (medical) like post-operative physical therapy, patient characteristics (personal), like motivation to RTW, occupational characteristics (work-related) like build-up in work tasks and medical support (medical) like availability of a walker or crutches., Conclusion: According to participants, factors within the following four themes can contribute to a successful return to work: occupational, patient, rehabilitation and medical care. Incorporating these factors into the integrated care pathway for the "young" TKA patients may increase the chances of a successful RTW.

Background: A guideline for occupational health professionals (OHPs) is developed which provides them with knowledge and skills to optimize their guidance to people with a chronic disease., Objective: Developing a training programme to acquire and apply knowledge and skills provided by the guideline, through a bottom-up approach., Methods: First, OHPs training needs were explored using focus groups. Second, learning objectives were formulated by the researchers. Third, experts in the field of education were interviewed to explore relevant training activities. Fourth, researchers integrated all the results into a training programme., Results: Based on the training needs identified, we formulated 17 learning objectives, e.g. being able to name influential factors and effective interventions, increase the individual client's role, and increase communication with a professionals to enhance work participation of people with a chronic disease. The training activities identified by experts for OHPs to acquire and apply knowledge and skills were: a case study, role play, discussion of best practices and interviewing stakeholders. These were all performed in plenary sessions or small groups., Conclusions: Training needs, -activities and learning objectives were integrated into a six-hour training programme. This bottom-up approach can serve as input for others developing training programmes to transfer knowledge and skills to OHPs.

Background: The World Health Organization (WHO) and the International Labour Organization (ILO) are developing joint estimates of the work-related burden of disease and injury (WHO/ILO Joint Estimates), with contributions from a large network of experts. Evidence from mechanistic and human data suggests that occupational exposure to ergonomic (or physical) risk factors may cause osteoarthritis and other musculoskeletal diseases (excluding rheumatoid arthritis, gout, and back and neck pain). In this paper, we present a systematic review and meta-analysis of the prevalence of occupational exposure to physical ergonomic risk factors for estimating the number of disability-adjusted life years from these diseases that are attributable to exposure to this risk factor, for the development of the WHO/ILO Joint Estimates., Objectives: We aimed to systematically review and meta-analyse estimates of the prevalence of occupational exposure to ergonomic risk factors for osteoarthritis and other musculoskeletal diseases., Data Sources: We searched electronic bibliographic databases for potentially relevant records from published and unpublished studies, including Ovid Medline, EMBASE, and CISDOC. We also searched electronic grey literature databases, Internet search engines and organizational websites; hand-searched reference list of previous systematic reviews and included study records; and consulted additional experts., Study Eligibility and Criteria: We included working-age (≥15 years) workers in the formal and informal economy in any WHO and/or ILO Member State but excluded children (<15 years) and unpaid domestic workers. The exposure was defined as any occupational exposure to one or more of: force exertion, demanding posture, repetitive movement, hand-arm vibration, kneeling or squatting, lifting, and/or climbing. We included all study types with an estimate of the prevalence of occupational exposure to ergonomic risk factors., Study Appraisal and Synthesis Methods: At least two review authors independently screened titles and abstracts against the eligibility criteria at a first stage and full texts of potentially eligible records at a second stage, followed by extraction of data from qualifying studies. We combined prevalence estimates using random-effect meta-analysis. Two or more review authors assessed the risk of bias and the quality of evidence, using the ROB-SPEO tool and QoE-SPEO approach developed specifically for the WHO/ILO Joint Estimates., Results: Five studies (three cross-sectional studies and two cohort studies) met the inclusion criteria, comprising 150,895 participants (81,613 females) in 36 countries in two WHO regions (Africa, Europe). The exposure was generally assessed with questionnaire data about self-reported exposure. Estimates of the prevalence of occupational exposure to ergonomic risk factors are presented for all five included studies, disaggregated by country, sex, 5-year age group, industrial sector or occupational group where feasible. The pooled prevalence of any occupational exposure to ergonomic risk factors was 0.76 (95% confidence interval 0.69 to 0.84, 3 studies, 148,433 participants, 35 countries in the WHO Europe region, I 2 100%, low quality of evidence). Subgroup analyses found no statistically significant differences in exposure by sex but differences by age group, occupation and country. No evidence was found for publication bias. We assessed this body evidence to be of low quality, based on serious concerns for risk of bias due to exposure assessment only being based on self-report and for indirectness due to evidence from two WHO regions only., Conclusions: Our systematic review and meta-analysis found that occupational exposure to ergonomic risk factors is highly prevalent. The current body of evidence is, however, limited, especially by risk of bias and indirectness. Producing estimates for the burden of disease attributable to occupational exposure to ergonomic risk factors appears evidence-based, and the pooled effect estimates presented in this systematic review may perhaps be used as input data for the WHO/ILO Joint Estimates. Protocol identifier:https://doi.org/10.1016/j.envint.2018.09.053. PROSPERO registration number: CRD42018102631., (Copyright © 2020 World Health Organization. Published by Elsevier Ltd.. All rights reserved.)

Background: Structured work support needs assessment could facilitate professionals and increase assessment consistency., Objectives: Evaluating usability of the Work Support Needs Assessment Tool and test if professionals' (labour experts, coaches) findings become more consistent after a tool training. The tool includes a 21 item checklist for assessing work support needs of people with disabilities., Methods: Usability was explored through 28 interviews with professionals. Consistency was evaluated in an experimental pre-post study design, in which thirty-nine other professionals assessed work support needs of standardized clients before and after a protocolized training. Quantitative content analysis was conducted. Consistency of findings between professionals covered three categories: type (client-focused coaching), focus (topics to be addressed) and duration of support. An increase in consistency was defined as a decrease in the total number of different sub-categories of findings in each category., Results: Nineteen professionals indicated that the tool was useful, as they gained relevant information and insights. Regarding consistency, the number of findings differed pre- and post-training for type of support (8 vs 9) and focus of support (18 vs 15 and 18 vs 17)., Conclusions: Participants had positive experiences with the tool. Increased consistency in findings of professionals after the training was not demonstrated with the current study design.

Background: Cancer survivors' perspectives on a successful return to work (RTW) may not be captured in the common measure of RTW, namely time until RTW., Objective: The purpose of this study was therefore to develop an RTW outcome measure that reflects employed cancer survivors' perspectives, with items that could be influenced by an employer, i.e. the Successful Return-To-Work questionnaire for Cancer Survivors (I-RTW&#95;CS), and to assess its construct validity and reproducibility., Methods: First, three focus groups with cancer survivors (n = 14) were organized to generate issues that may constitute successful RTW. Second, a two-round Delphi study among 108 cancer survivors was conducted to select the most important issues. Construct validity of the I-RTW&#95;CS was assessed using correlations with a single-item measure of successful RTW and the Quality of Working Life Questionnaire for Cancer Survivors (QWLQ-CS; n = 57). Reproducibility (test-retest reliability) was assessed using the intraclass correlation coefficient (ICC; n = 50)., Results: Forty-eight issues were generated, of which seven were included: 'enjoyment in work'; 'work without affecting health'; 'confidence of employer without assumptions about work ability'; 'open communication with employer'; 'feeling welcome at work'; 'good work-life balance'; and 'joint satisfaction with the situation (employer and cancer survivor)'. Correlations with single-item successful RTW and QWLQ-CS were 0.58 and 0.85, respectively. The reproducibility showed an ICC of 0.72., Conclusions: The I-RTW&#95;CS provides an RTW outcome measure that includes cancer survivors' perspectives and weights its items on an individual basis, allowing a more meaningful evaluation of cancer survivors' RTW. This study provides preliminary evidence for its construct validity and reproducibility.

Objective: To provide an overview of the availability of and process involved in vocational rehabilitation (VR) services for people with acquired brain injury (ABI) provided in Dutch rehabilitation institutions., Methods: A survey on the availability and characteristics of the VR intervention process for people with ABI was conducted in all Dutch rehabilitation centers and rehabilitation departments of general and academic hospitals (n = 120). Different domains of the VR intervention process were included in the questionnaire, the number (and percentage) of respondents giving a certain answer within a domain was reported., Results: Fifty-five institutions replied (response rate 46%). VR services for ABI were provided in 34 (62%) of these, of which 20 (59%) used a VR protocol. The main similarities found among different organizations providing VR services were the involvement of different disciplines, determination of the gap between job requirements and the patient's abilities, goal-setting for VR, involvement of external partners, timing, and source of funding. The main differences found concerned start and stop criteria, and coordination of the VR process., Conclusions: Currently, at least 30% of the Dutch rehabilitation institutions offer VR services for people with ABI; there is variation in processes.

Objective: The objective was to conduct an update of a previously published review and meta-analysis on the association between work-related psychosocial risk factors and stress-related mental disorders (SRD)., Design: Systematic review and meta-analysis., Data Sources: Medline, Embase and PsycINFO were searched for articles published between 2008 and 12 August 2019 and references of a systematic review performed for the period before 2008 were included. Primary prospective studies were included when outcome data were described in terms of SRD assessment or a dichotomous outcome, based on a validated questionnaire, and at least two levels of work-related exposure were reported (exposed vs less or non-exposed). We used GRADE to assess the evidence for the associations between risk factors and the onset of SRD., Results: Seventeen studies met the inclusion criteria. In total, a population of 73 874 workers from Belgium, Denmark, England, Finland, Japan, the Netherlands and Sweden were included in the meta-analysis of 14 prospective cohort studies. This meta-analysis revealed moderate evidence for associations between SRD and effort reward imbalance (OR=1.9, 95% CI 1.70 to 2.15), high job demands (OR=1.6, 95% CI 1.41 to 1.72), organisational justice (ORs=1.6 to 1.7, CIs 1.44 to 1.86), social support (ORs=1.3 to 1.4, CIs 1.16 to 1.69), high emotional demands (OR=1.6, 95% CI 1.35 to 1.84) and decision authority (OR=1.3, CI 1.20 to 1.49). No significant or inconsistent associations were found for job insecurity, decision latitude, skill discretion and bullying., Conclusion: Moderate evidence was found that work-related psychosocial risk factors are associated with a higher risk of SRD. Effort-reward imbalance, low organisational justice and high job demands exhibited the largest increased risk of SRD, varying from 60% to 90%., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY. Published by BMJ.)

Background: The aim of this study was to assess the relationship between self-reported work ability and hours worked at the current time in Upper Extremity Musculoskeletal Disorders (UEMSD) patients. To further investigate this relationship, the association of work ability and working hours with several limitations in daily and working life were explored., Methods: In this cross-sectional cohort study, a questionnaire was sent out to members of the UEMSD patient organisation, containing self-reported work ability, questions on working hours and limitations in work due to UEMSD. Limitations were measured with the Disabilities of Arm Shoulder and Hand questionnaire, ShortForm-36 subscales, and common hand grasps or grips. Work ability was measured with the work ability score, while worked hours were operationalised as the percentage of hours worked compared to fulltime. The correlation between worked hours and work ability was tested with the Pearson correlation coefficient. Variance in work ability and the hours worked were explained by limitations and assessed with two linear regression analyses., Results: Based on data of 794 respondents a moderate correlation was found between work ability and worked hours r = 0.46; 95% CI [0.40, 0.53]. Models including limitations explained 52 and 21% of total variance in work ability and worked hours, respectively. Variance in both can be explained by the degree of difficulties performing daily activities at work, limitations in daily activities as a consequence of health issues and the ability to perform a precision grip. Additionally, work ability can be explained by limitations at work and other daily activities due to physical health issues, while the percentage of hours can additionally be explained by the ability to grasp a large object with one hand, the ability to use a keyboard, and the subject's gender., Conclusions: The number of worked hours does not fully match the work ability. Although they share three predictors, work ability and worked hours seem to be based on different aspects. Compared to work hours, work ability is more strongly related to limitations in daily activities and work. Taking self-reported work ability into account can improve the fit between work limitations and work hours.

Purpose: To study the feasibility (limited efficacy, acceptability, and implementation) of a training program for insurance physicians. Methods: Limited efficacy was evaluated over time (T0-T2) by conducting knowledge question tests using realistic case scenarios, analyzed by non-parametric Friedman and Wilcoxon signed-rank tests. Acceptability was evaluated by asking participants to agree or disagree with statements; for example, the knowledge was "relevant," "useful," or "appropriate." Answers were analyzed using descriptive statistics. Open-ended questions were used to ask participants what, in their opinion, were the facilitators of and barriers to implementing the knowledge taught. Their answers were coded and categorized. Results: Fifty-one IPs participated in the study. Concerning limited efficacy: the median values of the knowledge scores increased significantly over time and between time points from 16 (T0) to 21 (T1) and 32 (T2), p  < 0.00. Concerning acceptability: 46 of 47 respondents perceived the training program to be "relevant," "useful," and "appropriate"; 44 respondents intended to use it in practice. Concerning implementation: participants reported "training" and "utility" as examples of facilitators and "lack of time," for example, as a barrier. Conclusion and implications: The feasibility (limited efficacy, acceptability, implementation) of the training program is demonstrated; the training program can be applied in practice.Implications for rehabilitationThe "acquired brain injury and return to work" training programme can be applied in postgraduate teaching and continuing medical education for insurance physicians.Interactive teaching methods including realistic case scenarios with a link to practice are recommended to provide insurance physicians the opportunity to learn to apply and discuss new knowledge and effectively improve insurance physicians' knowledge.Implementation of a training programme for insurance physicians can be facilitated if a brief summary of the imparted knowledge is available.Barriers, such as "other occupational healthcare and paramedical professionals being unfamiliar with the imparted knowledge" need to be addressed when implementing the "acquired brain injury and return to work" training programme.

Background: Employers express a need for support to facilitate the return to work (RTW) process of employees with cancer. We have developed the MiLES intervention, an online toolbox targeting employers during the RTW of employees with cancer. To evaluate the MiLES intervention, we propose the design of a pilot randomised controlled trial (RCT). The aim of this pilot is to determine whether a future RCT to study the effectiveness of this intervention on successful RTW of employees with cancer is feasible. Secondary aims are to obtain preliminary results on the effectiveness of the intervention and to determine the sample size needed in a future definitive RCT., Methods: A pilot RCT with a 6-month follow-up will be conducted. Using medical specialists at Dutch hospitals, we aim to enrol 90 participants diagnosed with cancer (<2 years earlier) aged 18-63 years who are in paid employment with an employer and who are currently sick-listed or partly sick-listed for <1 year. Participants randomised to the intervention group will be asked to inform their employer about the online toolbox supporting employers during the RTW process of employees with cancer. Participants in the control group will receive 'care as usual' from their employer. All measures will be assessed at the level of the employee using questionnaires at baseline and after 3 and 6 months of follow-up. The feasibility of a future RCT will be determined using criteria concerning method-related uncertainties and acceptability of the study protocol. The primary effect measure will be successful RTW (that is, RTW perceived as being successful by the cancer survivor themselves). This effect measure will be used to perform the sample size calculation for a future definitive RCT., Discussion: The design is proposed to determine the feasibility to study the effectiveness of the MiLES intervention targeting employers on the successful RTW of employees diagnosed with cancer. This pilot RCT can increase the probability of a successful future definitive RCT on the effectiveness of the intervention and potentially obviate the need to carry out an unfeasible and resource-intensive study., Trial Registration: Dutch Trial Register (NTR): NL6758, NTR7627. Registered on 30 October 2018.

Purpose: The purpose of this study was to develop an intervention targeting employers, with the aim of enhancing cancer survivors' return to work (RTW)., Methods: Intervention Mapping was used to combine information gathered from several procedures involving numerous stakeholders, for example, employers, cancer survivors, oncological occupational physicians, and e-health experts., Results: Employers indicated that they require tailored support during four RTW phases: (1) disclosure, (2) treatment, (3) RTW planning, and (4) actual RTW. The most important employer actions were identified for each RTW phase, for instance, "communicate," "support practically," and "assess work ability," and thereafter formulated as the performance objectives of the intervention. The trans-theoretical model of change was used as a theoretical framework, and several methodologies were employed to induce the desired behavior change, for example modeling, tailoring, and active learning. Subsequently, a web-based intervention with interactive videos, conversation checklists, links to reliable external sources, and succinct, tailored tips and information was developed and adjusted on the basis of pre-tests with different stakeholders., Conclusions: The intervention was developed with input from employers and all relevant stakeholders in the RTW of cancer survivors. The systematic, step-wise development resulted in a succinct and easily accessible intervention targeting the most important employer actions during all RTW phases. As such, the intervention corresponds with employers' needs and preferences in practice., Implications for Cancer Survivors: By providing employers with support, the intervention could well be the missing link in efforts to optimize the work participation of cancer survivors.

Purpose: To perform a process evaluation of a tailored work-related support intervention for patients diagnosed with gastrointestinal cancer., Methods: The intervention comprised three tailored psychosocial work-related support meetings. To outline the process evaluation of this intervention, we used six key components: recruitment, context, reach, dose delivered, dose received and fidelity. Data were collected using questionnaires, checklists and research logbooks and were analysed both quantitatively and qualitatively., Results: In total, 16 hospitals, 33 nurses and 7 oncological occupational physicians (OOPs) participated. Analysis of the six key components revealed that the inclusion rate of eligible patients was 47%. Thirty-eight intervention patients were included: 35 actually had a first meeting, 32 had a second and 17 had a third. For 31 patients (89%), the first meeting was face to face, as per protocol. However, in only 32% of the cases referred to support type A (oncological nurse) and 13% of the cases referred to support type B (OOP), the first meeting was before the start of the treatment, as per protocol. The average duration of the support type A meetings was around the pre-established 30 min; for the OOPs, the average was 50 min. Protocol was easy to follow according to the healthcare professionals. Overall, the patients considered the intervention useful., Conclusions: This study has shown that the strategy of tailored work-related support is appreciated by both patients and healthcare professionals and applicable in clinical practice., Implications for Cancer Survivors: The intervention was appreciated by patients; however, whether the timing of the work-related support was adequate (i.e. before treatment was started) requires further research., Trial Registration: NTR5022.

Background: Accumulating evidence suggests that cancer survivors are able to return to work. However, little is known about their work situation 5 years after diagnosis., Objective: To explore fluctuations in employment status and its association with quality of life 2, 3, and 5 years after cancer diagnosis of 65 cancer survivors employed at diagnosis., Methods: In association with a randomised controlled trial (RCT), questionnaires were administrated to eligible cancer survivors at diagnosis, 2, 3, and 5 years thereafter comprising of validated questionnaires related to work (i.e. Work Ability Index (WAI), cancer, and quality of life (QOL) (i.e. SF-36, VAS QOL). The RCT studied a hospital-based work support intervention in female breast and gynaecological cancer survivors who were treated with curative intent and had paid work at diagnosis. Descriptive statistics and longitudinal multi-level analysis were employed., Results: Sixty-five of the 102 eligible cancer survivors participated, who were primarily diagnosed with breast cancer (63%). Two and 5 years after cancer diagnosis respectively 63 (97%) and 48 (81%) participants were employed. Reasons for not being employed after 5 years included receiving unemployment benefits (7%), voluntary unemployment (3%), receiving disability benefits (3%), and early retirement (3%). Longitudinal multi-level analysis showed that employed cancer survivors reported in general statistically significant better quality of life outcomes at 5 years follow-up compared to those not being employed., Conclusions: We found high employment rates and few fluctuations in employment status. The steepest decline in employment rate occurs after the first two years of diagnosis. Employed participants reported better quality of life outcomes. Survivorship care should therefore focus on the population at risk possibly within the first two years after diagnosis.

Background: Work is valued as an important feature in life, however patients diagnosed with cancer can experience work-related problems. We developed a work-related support intervention to support those in need., Objective: The objective of this study was to evaluate the feasibility of the performed tailored GIRONA (Gastro Intestinal cancer patients Receiving Occupational support Near and After diagnosis) intervention and to describe the experiences of those receiving the work-related support and of those providing it., Methods: An online questionnaire was used to survey the feasibility of the intervention of the support recipients (patients diagnosed with gastrointestinal cancer) and the support providers (healthcare professionals including: oncology nurses and oncological occupational physicians). Five themes were covered: acceptability, demand, implementation, practicality and integration of Bowen's feasibility model., Results: Twenty-three patients, 14 oncology nurses and 4 oncological occupational physicians, shared their experiences about the tailored work-related support intervention. This intervention was generally perceived as positive and feasible by the participants. Some patients received work-related support despite not experiencing severe problems; others mentioned that they received no such support even though they did need it. Despite positive experiences, there are some barriers to tackle, such as length of consultation, timing of the initiation of work-related support and embedding the oncological occupational physician within the clinical setting., Conclusion: According to the healthcare professionals involved, GIRONA is feasible, however some practical barriers were mentioned. The intervention was perceived as positive by both patients and healthcare professionals, but the tailored component could be further improved to better support those in need of work-related support.

Purpose Purpose is to: (1) study effectiveness of the hospital-based work support intervention for cancer patients at two years of follow-up compared to usual care and (2) identify which early factors predict time to return-to-work (RTW). Methods In this multi-center randomised controlled trial (RCT), 106 (self-)employed cancer patients were randomized to an intervention group or control group and provided 2 years of follow-up data. The intervention group received patient education and work-related support at the hospital. Primary outcome was RTW (rate and time) and quality of life (SF-36), and secondary outcomes were, work ability (WAI), and work functioning (WLQ). Univariate Cox regression analyses were performed to study which early factors predict time to full RTW. Results Participants were diagnosed with breast (61%), gynaecological cancer (35%), or other type of cancer (4%). RTW rates were 84% and 90% for intervention versus control group. They were high compared to national register-based studies. No differences between groups were found on any of the outcomes. Receiving chemotherapy (HR = 2.43, 95% CI 1.59-3.73 p < 0.001), low level of education (HR = 1.65, 95% CI 1.076-2.52 p = 0.02) and low work ability (HR = 1.09 [95% CI 1.04-1.17] p = 0.02) were associated with longer time to full RTW. Conclusions We found high RTW rates compared to national register-based studies and we found no differences between groups. Future studies should therefore focus on reaching the group at risk, which consist of patients who receive chemotherapy, have a low level of education and have a low work ability at diagnosis. TRIAL REGISTRATION: Netherlands Trial Registry (NTR) (http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=1658): NTR1658.