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Purpose: To explore the intensity and variation of workers' worries, pain, psychosocial factors, and margin of manoeuvre before and after a return-to-work program, and identified the psychosocial factors associated with non-return to work at the end of the rehabilitation program. Methods: A pre-post study design was used. A convenience sample of 80 workers starting a return-to-work program and having a compensated musculoskeletal injury that caused an absence of more than three months from their regular work was recruited. Data were collected at baseline and at the end of the rehabilitation program on the nature of the worries and maintenance factors defined in Dugas' generalized anxiety and worry model, using validated questionnaires. The margin of manoeuvre was assessed by the treating occupational therapist. A series of descriptive analyses were performed, as well as Generalized Estimating Equations analyses. Results: Workers' worries were work-related or disability-related 83% of the time at baseline. These worries were essentially based on the situation then occurring at work 90% of the time. For the Generalized Estimating Equations analyses on work status, the final model was significant, explaining 54% of the variance in non-return to work (Pseudo R2 = 0.54; p = 0.0001). Workers were 8.52 times less likely to return to work when the margin of manoeuvre was insufficient, and twice as likely not to return to work in the presence of intense worry. Worries were significantly associated with insufficient margin of manoeuvre. Conclusion: A strong association between workers' lack of margin of manoeuvre at work and their worries about their return to work, and poor work outcomes, supports the importance of the worker-environment interaction in rehabilitation programs. [ABSTRACT FROM AUTHOR]

BACKGROUND: Small and medium-sized enterprises (SMEs) represent 95 % of businesses and are economically essential. When occupational injuries occur, scientific literature suggests that the return-to-work (RTW) success rate is proportional to the size of enterprises and the way RTW is managed may put workers in SMEs at risk. As most studies on RTW organizational practices have been conducted with large enterprises, little is known about how RTW is managed in SMEs. OBJECTIVE: The aim of this study was to explore SME's organizational practices in the RTW process of workers having suffered an occupational injury. METHODS: Semi-structured phone interviews were conducted with 15 participants from 3 different stakeholder categories (i.e., SME representatives, workers, and healthcare professionals) in order to explore their experiences regarding RTW in SMEs. Data were analyzed using a phenomenological analysis strategy. RESULTS: SMEs' organisational practices evoked by participants gather in three themes: 1) Reducing the risks of occupational injuries (i.e., ensuring injury prevention), 2) Managing occupational injuries (i.e., dealing with the initial occupational injury, handling administrative aspects of work disability, and being actively involved in the RTW process), and 3) Preventing consequences of occupational injuries (i.e., adapting operations following injuries). CONCLUSION: Organizational practices for RTW are used diversely in SMEs. Proposed lines of action adapted to the realities and needs of SMEs may be beneficial to hundreds of thousands of workers, enterprises and professionals involved in the RTW process. [ABSTRACT FROM AUTHOR]

Objective: The study's aim was to gain insights into factors influencing sustainable return to work following total knee arthroplasty (TKA). Design: A descriptive multiple-case design was used. A case was defined as a worker's following TKA work disability situation. Settings: The cases came from public hospitals in urban and semi-urban areas in Quebec (Canada) and involved mostly non-work-related TKAs. Subjects: Workers had to be between 6 and 12 months post-TKA, have physical/manual jobs and currently employed. Their rehabilitation professionals and workplace representatives (employer and/or union) were also recruited, based on the work disability paradigm. Main measures: Semi-structured interviews, questionnaires on pain, physical work demands (workers only), and observation of the work activities of those workers back at work were used. Cases were compared and categorized for worker-perceived levels of difficulty in returning to or staying at work: little or no difficulty (n = 8); some difficulty (n = 5); not back at work due to excessive difficulty with their knee (n = 4). Results: A total of 17 cases were constituted. In only one case, the worker benefitted from an interdisciplinary work rehabilitation approach. Results highlight the interplay among these factors: (1) the workers' perceptions of their residual symptoms and ability to manage them, (2) the interaction between work adjustments and tools offered by the employers and the workers' own strategies, and (3) perceptions of the workers' physical capacities. Conclusion: Workers' who face high levels of work demands/difficulties and who have limited access to work adjustments and tools should be referred for work rehabilitation. [ABSTRACT FROM AUTHOR]

Purpose Supervisors play an important role during the return to work (RTW) of injured workers. Yet little research has been done on the actions associated with this role or the contexts in which they are taken. The purpose of this study was to develop courses of action to promote supervisors' involvement in the process aimed at achieving sustainable RTW for workers following a work-related musculoskeletal disorder (MSD), and to verify their pertinence, feasibility, and applicability in practice. Methods A two-phase qualitative method was used. (1) Secondary content analysis of 46 interviews of 14 workers post-MSD and 32 other actors in the RTW process, conducted during a prior case study, yielded proposals for courses of action composed of specific actions for supervisors. (2) The pertinence, feasibility, and applicability of these courses of action and specific actions were explored, first, through a self-administered questionnaire to initiate individual reflection, and later in greater depth through focus groups to identify the different contexts in which they might be applicable. Thematic analysis was performed for each phase. Results Eight proposed courses of action, including specific concrete actions and conditions influencing supervisors' involvement, were developed by the researchers and generally perceived as pertinent and feasible by the participants. Several aspects of the organizational context appeared to influence implementation of these courses of action within the organizations. Conclusion Organizational context appears to influence the application of these courses of action, as do the conditions under which they are implemented. [ABSTRACT FROM AUTHOR]

BACKGROUND: Despite the importance of the legislative and insurance systems in the return to work process after an occupational injury, the perspective of the insurer on what influences return to work has rarely been documented. OBJECTIVE: To understand the barriers or facilitators for return to work, from the perspective of the insurer. METHODS: A comprehensive qualitative approach was used. Semi-directed interviews were done with nineteen (19) insurers (claims adjudicator and rehabilitation case manager) from a Canadian workers' compensation board. A thematic analysis was done using QDA Minor Software. RESULTS: Fourteen themes (e.g. family reaction, quality of work relationship) were classified into four categories representing the main stakeholders: worker with disability, workplace, healthcare system and compensation system. Emotional, cognitive, and adaptive reactions from the worker and his family were identified. We observed that good work relations and support practices, lack of access to medical resources, focus on the employee's ability, and complexity and consequences of the compensation process are the main barriers and facilitators from the insurers' perspective. Many of the perceived elements are coherent with the compensation system's administrative and legal context. CONCLUSIONS: The results enable us to better understand the insurers' perspective regarding what influences return to work. It reinforces the necessity to consider the administrative and legal context to better understand the insurers' perspective. [ABSTRACT FROM AUTHOR]

Objective: To test a model of presenteeism on the basis of established and emerging theories separated into organizational and individual factors that could be mediated by psychological distress. Methods: This was a Web survey of 2371 employees (response rate of 48%) of a provincial government agency. We assessed theories with validated measures for organizational and individual factors. Results: Psychological distress was negatively associated to presenteeism, when controlling for sex, short-term work absence in the last year, and social desirability. Both individual and organizational factors were related to psychological distress. The most important factors included the presence of stress events in the preceding 6 months, extrinsic efforts (interruptions, work requirements), self-esteem as a worker, and internal amotivation. Conclusions: By identifying modifiable factors, our results suggest that the implementation of a work organization structure that promotes stimulation and accomplishment would reduce psychological distress and further presenteeism. [ABSTRACT FROM AUTHOR]