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Purpose Organizational-level policies and practices that promote safety leadership and practices, disability management and ergonomic policies and practices are considered key contextual determinants of return to work. Our objective was to examine the role of worker-reported organizational policies and practices (OPPs) in return to work (RTW) and work role functioning (WRF) and the mediating role of pain self-efficacy and work accommodation. Methods A worker cohort (n = 577) in Ontario, Canada was followed at 1, 6 and 12 months post injury. Both RTW (yes/no) and WRF (WLQ-16) status (3 levels) were measured. OPPs were measured (high vs. low) at 1 month post-injury. Pain self-efficacy (PSE) and work accommodation (WA) were included in mediation analyses. Results OPPs predicted RTW at 6 months (adjusted OR 1.77; 95 % CI 1.07-2.93) and 12 months (adjusted OR 2.07; 95 % CI 1.18-3.62). OPPs predicted WRF at 6 months, but only the transition from working with limitations to working without limitations (adjusted OR 3.21; 95 % CI 1.92-5.39). At 12 months, OPPs predicted both the transition from not working to working with and without limitations and from not working or working with limitations to working without limitations (adjusted OR 2.13; 95 % CI 1.37-3.30). Offers of WA mediated the relationship between OPPs and both RTW and WRF at 6 months follow-up. PSE mediated the relationship between OPPs and RTW and WRF at 6 months. At 12 months neither mediated the relationship. Conclusions The findings support worker-reported OPPs as key determinants of both RTW and WRF. These results point to the importance of WA and PSE in both RTW and WRF at 6 months.

IntroductionCoarse exposure assessment and assignment is a common issue facing epidemiological studies of shift work. Such measures ignore a number of exposure characteristics that may impact on health, increasing the likelihood of biased effect estimates and masked exposure–response relationships. To demonstrate the impacts of exposure assessment precision in shift work research, this study investigated relationships between work schedule and depression in a large survey of Canadian nurses.MethodsThe Canadian 2005 National Survey of the Work and Health of Nurses provided the analytic sample (n = 11450). Relationships between work schedule and depression were assessed using logistic regression models with high, moderate, and low-precision exposure groupings. The high-precision grouping described shift timing and rotation frequency, the moderate-precision grouping described shift timing, and the low-precision grouping described the presence/absence of shift work. Final model estimates were adjusted for the potential confounding effects of demographic and work variables, and bootstrap weights were used to generate sampling variances that accounted for the survey sample design.ResultsThe high-precision exposure grouping model showed the strongest relationships between work schedule and depression, with increased odds ratios [ORs] for rapidly rotating (OR = 1.51, 95% confidence interval [CI] = 0.91–2.51) and undefined rotating (OR = 1.67, 95% CI = 0.92–3.02) shift workers, and a decreased OR for depression in slow rotating (OR = 0.79, 95% CI = 0.57–1.08) shift workers. For the low- and moderate-precision exposure grouping models, weak relationships were observed for all work schedule categories (OR range 0.95 to 0.99).ConclusionsFindings from this study support the need to consider and collect the data required for precise and conceptually driven exposure assessment and assignment in future studies of shift work and health. Further research into the effects of shift rotation frequency on depression is also recommended.

Introduction To estimate the prevalence, incidence and course of depressive symptoms, their relationship with return-to-work, and prevalence of depression diagnosis/treatment 12months following a lost-time workplace musculoskeletal injury. Methods In a prospective cohort study, 332 workers' compensation claimants with a back or upper extremity musculoskeletal disorder completed interviews at 1, 6 and 12months post-injury. Participants self-reported they had not received a depression diagnosis 1year pre-injury. Cutoff of 16 on the CES-D defined a high level of depressive symptoms. Self-reported data on depression diagnosis and treatment and work status since injury were collected. Results Cumulative incidence of high depressive symptom levels over 12months was 50.3% (95% CI 44.9-55.7%). At 12months, 24.7% (95% CI 20.1-29.3%) of workers exhibited high levels. Over 12months, 49.7% (95% CI 44.3-55.1%) had low levels at all 3 interviews, 14.5% (95% CI 10.7-18.2%) had persistently high levels, and 25.6% (95% CI 20.9-30.3%) demonstrated improvements. Among workers with low baseline levels, incidence of high levels at 12months was 6.0% (95% CI 2.7-9.3%). For workers with high baseline levels, 36.1% (95% CI 27.9-44.3%) exhibited persistent high symptoms at 6 and 12months, while 38.4% (95% CI 30.1-46.6%) experienced low levels at 6 and 12months. Problematic RTW outcomes were common among workers with a poor depressive symptom course. Among workers with persistent high symptoms, 18.8% (95% CI 7.7-29.8%) self-reported receiving a depression diagnosis by 12months and 29.2% (95% CI 16.3-42.0%) were receiving treatment at 12months. Conclusions Depressive symptoms are common in the first year following a lost-time musculoskeletal injury and a poor depressive symptom course is associated with problematic RTW outcomes 12months post-injury. While symptoms appear to improve over time, the first 6months appear to be important in establishing future symptom levels and may represent a window of opportunity for early screening.

Objectives Some injured workers with work-related, compensated back pain experience a troubling course in return to work. A prediction tool was developed in an earlier study, using administrative data only. This study explored the added value of worker reported data in identifying those workers with back pain at higher risk of being on benefits for a longer period of time. Methods This was a cohort study of workers with compensated back pain in 2005 in Ontario. Workplace Safety and Insurance Board (WSIB) data was used. As well, we examined the added value of patient-reported prognostic factors obtained from a prospective cohort study. Improvement of model fit was determined by comparing area under the curve (AUC) statistics. The outcome measure was time on benefits during a first workers' compensation claim for back pain. Follow-up was 2 years. Results Among 1442 workers with WSIB data still on full benefits at 4 weeks, 113 were also part of the prospective cohort study. Model fit of an established rule in the smaller dataset of 113 workers was comparable to the fit previously established in the larger dataset. Adding worker rating of pain at baseline improved the rule substantially (AUC = 0.80, 95 % CI 0.68, 0.91 compared to benefit status at 180 days, AUC = 0.88, 95 % CI 0.74, 1.00 compared to benefits status at 360 days). Conclusion Although data routinely collected by workers' compensation boards show some ability to predict prolonged time on benefits, adding information on experienced pain reported by the worker improves the predictive ability of the model from 'fairly good' to 'good'. In this study, a combination of prognostic factors, reported by multiple stakeholders, including the worker, could identify those at high risk of extended duration on disability benefits and in potentially in need of additional support at the individual level.

Objectives Exposure misclassification is a common challenge in shift-work epidemiology. This study used a large national survey of Canadian nurses to examine shift-work’s effects on depression; multiple exposure definitions with varying levels of specificity were applied to illustrate the impacts of exposure assessment. Methods The analytic sample (n=11,450) was obtained from the 2005 National Survey of the Work and Health of Nurses. Logistic regression was used to assess relationships between shift-work and depression for high, moderate, and low specificity definitions of shift-work exposure. The low and moderate specificity definitions described shift timing (day/shift and day/evening/night/rotating, respectively); the high specificity definition described both shift timing (day/evening/night/rotating) and frequency of rotation (slow/medium/rapid/undefined). All model estimates were bootstrapped and adjusted for the potential confounding effects of sociodemographic, health, and work variables. Results The high specificity shift-work definition model showed the strongest relationships, with increased odds of depression in the rapid rotating shift group (OR=1.51, 95% CI=0.91–2.51) and in the undefined rotating group (OR=1.67, CI=0.92–3.02), relative to the regular day group. Odds of depression were decreased in the slow rotating group (OR=0.79, 95% CI=0.57–1.08). For the low and moderate specificity exposure definition models, weak relationships were observed for all shift categories (OR range 0.95 to 0.99). Conclusions This study’s findings support associations between shift-work and depression, and the need for specific and hypothesis-driven exposure assessment in future studies to correctly identify exposure-response relationships and to appropriately target health interventions.

BackgroundPhysical therapists have an active role in the rehabilitation of injured workers. However, regulations in Queensland, Australia, do not afford them the opportunity to participate in return-to-work (RTW) decisions in a standardized way. No prior research has explored the experiences and perceptions of therapists in determining work capacity.ObjectivesThe aim of this study was to investigate physical therapists' experiences with and perspectives on their role in determining readiness for RTW and work capacity for patients receiving workers' compensation in Queensland.DesignA qualitative design was used. Participants were physical therapists who manage injured workers.MethodsNovice (n=5) and experienced (n=20) therapists managing patients receiving workers' compensation were selected through purposeful sampling to participate in a focus group or semistructured telephone interviews. Data obtained were audio-recorded and transcribed verbatim. Transcripts were thematically analyzed. Physical therapists' confidence in making RTW decisions was determined with 1 question scored on a 0 to 10 scale.ResultsThemes identified were: (1) physical therapists believe they are important in RTW, (2) physical therapists use a variety of methods to determine work capacity, and (3) physical therapists experience a lack of role clarity. Therapists made recommendations for RTW using clinical judgment informed by subjective and objective information gathered from the injured worker. Novice therapists were less confident in making RTW decisions.ConclusionTherapists are well situated to gather and interpret the information necessary to make RTW recommendations. Strategies targeting the Australian Physiotherapy Association, physical therapists, and the regulators are needed to standardize assessment of readiness for RTW, improve role clarity, and assist novice practitioners.

Introduction To summarize evidence on workplace-based work disability prevention (WDP) interventions in workers with common mental health conditions (CMHCs). Primary outcomes of interest were work absence duration and work functioning; secondary outcomes were quality of life, and economic costs. Methods We conducted a systematic literature search in 5 electronic databases (MEDLINE, EMBASE, CINAHL, PsychINFO, Web of Science) for studies published from 2007 to 2009. Two reviewers screened for studies: (1) Targeting workers with CMHCs absent from, or struggling at, work; (2) evaluating workplace-based WDP interventions; (3) assessing our primary outcome(s); and (4) with controlled trials. Quality assessment (using 29 criteria) was performed by two reviewers. Results Our search yielded 671 abstracts: 8 eligible studies and of sufficient quality. We identified three main intervention elements: (a) Facilitation of access to clinical treatment; (b) Workplace-based high-intensity psychological intervention; and (c) Facilitation of navigation through the disability management system. Moderate evidence was found that facilitation of treatment improved work functioning, quality of life and economic outcomes, with limited evidence for work absence duration. Moderate evidence was found that psychological interventions, primarily cognitive-behavioral therapy, improved work functioning, quality of life, and economic outcomes. Moderate evidence indicated that facilitation of navigation through the disability management system improved work absence duration. Conclusions Workplace-based interventions could improve work disability outcomes for workers with CMHCs. Facilitation of access to clinical treatment, and workplace-based high-intensity psychological intervention were most effective in improving work functioning and quality of life, and in reducing costs.

To evaluate the impact of worker and workplace factors and of their relationships on work absence duration.Structural equation modeling of 11,762 female, Canadian nurses from the 2005 National Survey of the Work and Health of Nurses.Worker and workplace factors were associated with prolonged work absence. Key proximal predictors were pain-related work interference, depression, pain severity, and respect and support at work. More distal predictors were multimorbidity, abuse at work, and organizational culture.Worker health and workplace factors are important in explaining work absence duration. Self-management for pain and mood, adapted to the work context, may be useful for nurses with chronic pain or depression. Policy makers and administrators should focus on creating respect and support at work, and improving organizational culture.

The objectives of the study were as follows: (1) to investigate whether the predictive validity of a previously developed back pain prediction rule could be improved; (2) to determine if the rule can be shortened without loss of predictive validity; (3) to compare the rule with the physician's judgment; (4) to assess, in a different population, its 2-year predictive validity; and (5) to evaluate the clinical applicability of the rule in a first-line care setting.One thousand two hundred and sixty-two participants were enrolled in the study (participation: 91%) before a medical consultation for nonspecific back pain in a large emergency room and were followed up for 2 years (follow-up: 92.5%). The effects of adding new items and deleting any one of the original items were evaluated. The predictions by the rule and the physicians were compared with the 2-year actual functional limitations (measured with the Roland-Morris Disability Questionnaire).Although the final prediction rule included only five items (feeling everything is an effort, trouble getting breath, hot/cold spells, numbness/tingling in parts of body, and pain in heart/chest), its predictive validity was greater than that of the original 17-item version and was superior to the physician's prediction. The rule was easily applied.A five-item clinical prediction rule of long-term back-related functional limitations could help first-line care physicians to concentrate the clinical attention on patients at higher risk.

Objective One criticism of the BDI-II for assessing depressive symptoms in people experiencing chronic pain has been the potential overlap between the physical or psychological origins of some of the symptoms. Furthermore, previous studies have reported both two-factor and three-factor solutions, so that the factor solution of the instrument in this population remains unclear. The main objective of the present study was to validate the BDI-II with a chronic pain population experiencing musculoskeletal disorders. Three specific objectives were: (1) to modify the BDI-II for people with musculoskeletal disorders by adding sub-questions to better identify the perceived cause of the depressive symptoms, (2) to assess the validity and reliability of this modified version of the BDI-II, and (3) to explore the perceptions of the causes/origins of symptoms reported on the BDI-II. Results of the confirmatory factor analysis supported the presence of three dimensions within the BDI- : Cognitive, Affective and Somatic. Methods A total of 206 participants experiencing chronic pain answered a modified version of the BDI-II, the CES-D and a sociodemographic questionnaire. Results Results confirmed the three-dimensional factorial structure of the BDI for this population. Overall, participants experienced higher levels of somatic symptoms compared to symptoms belonging to other dimensions. The percentages of answers to the sub-questions were also similarly distributed between "pain", and "pain and state of mind", regardless of the dimension. Discussion The importance of assessing somatic symptoms of depression in pain patients and of thoroughly examining the underlying perceived cause of symptoms, regardless of the dimension, are discussed.

Objective: To review the status of work functioning research in workers with common mental disorders (CMDs) and also the work functioning measurement instruments. We distinguish between productivity, work role limitations, quality of work output, and extra effort required to remain productive. Methods: Two systematic literature studies; the first to identify articles that measured work functioning in workers with CMDs, and the second to identify work functioning measurement instruments. Results: Work functioning is mostly studied in relation to clinical factors. Instruments with acceptable psychometric properties exist for measuring productivity and work role limitations. Conclusions: Further exploration of work-related determinants of work functioning is needed to develop more work-focused interventions. Existing instruments have to be tested in workers with CMDs. New work functioning instruments are needed to integrate the quality of work output and the effort required to remain productive.

PurposeConsistent with previous research, the purpose of this paper is to propose that the presence of workplace‐based return‐to‐work strategies would reduce the duration of work disability. Moving beyond existing research, the paper further seeks to propose that these strategies would also enhance mental health and affective commitment among injured workers. In addition, the paper aims to introduce interactional justice – injured workers' perceptions of the interpersonal and informational fairness of the person most responsible for their return‐to‐work process – to the return‐to‐work context, and to hypothesize that these factors would also contribute to the explanation of these outcomes.Design/methodology/approachWithin five weeks of their injury, telephone interviews were conducted with 166 workers from the province of Ontario, Canada, who had experienced musculoskeletal lost‐time workplace injuries.FindingsMultiple regression analyses indicate that certain workplace‐based strategies were associated with days on compensation, self‐reported days absent, and depressive symptoms, but not affective commitment. Further, as hypothesized, interactional justice accounted for additional variance explained in self‐reported days absent, depressive symptoms, and affective commitment. Interactional justice did not explain additional variance in days on compensation.Practical implicationsThe findings have implications for employers engaged in return‐to‐work practices and researchers studying return to work. Both should address not only the workplace‐based strategies used, but also the way in which these strategies are implemented.Originality/valueThe paper replicates previous empirical work on return‐to‐work interventions and demonstrates the importance of the presence of workplace‐based strategies in explaining the duration of work disability.

The authors examined whether early employer response to workplace injury affects injured workers' subsequent attitudes and mental health. At 1 month and 6 months postinjury, telephone surveys were conducted with 344 workers from Ontario, Canada, who had experienced a musculoskeletal lost-time workplace injury. One-month reports of initial supervisor reaction to the injury and the use of workplace-based return-to-work strategies (early contact with worker, ergonomic assessment, presence of designated coordinator, accommodation offer) were hypothesized to predict reports of fairness, affective commitment, and depressive symptoms measured at 6 months postinjury. Structural equation modeling supported a model wherein fairness perceptions fully mediated the relationship between early responses and injured workers' attitudes and mental health. Early contact and supervisor reactions were significant predictors of fairness perceptions. The implications for early employer response are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved). Language: en

The experience of injured workers is influenced by multiple systems—the workplace, the healthcare system, and the workers’ compensation system. Little research has been conducted on the impact of the workers’ compensation system on injured workers’ personal experience and on the justice of the workers’ compensation process. The purpose of this study was to develop and validate a measure of the justice of the compensation process. Injured workers (n = 446) with musculoskeletal injuries, in Ontario, Canada, filing a lost-time claim, completed a telephone survey 6 months post-injury. Exploratory and confirmatory factor analyses were conducted with two separate samples, and concurrent validity was examined. The four hypothesized factors emerged: distributive justice, procedural justice, informational justice, and interpersonal justice factors accounted for 96.3% of the variance. Confirmatory factor analyses had satisfactory fit indices to confirm the initial model. Alpha coefficients ranged from 0.86 to 0.92. Concurrent validity of the scale was supported: relationships of distributive and procedural justice with claim status, claim processing delay, perception of going back to work too soon, duration of work accommodation, and satisfaction with work accommodation were in the expected direction. Workers’ experience of the justice of the compensation process can now be measured with a psychometrically sound and theoretically based instrument. This instrument offers researchers the opportunity to focus on the justice of the compensation process of injured workers. It can increase the attention that policy-makers, compensation management, healthcare providers, and other return-to-work stakeholders give to the impact of the compensation system and provide a broadened view of workers’ experience.

Background Low back pain (LBP) is a common and in some cases disabling condition. Until recently, workers presenting with non-specific LBP have generally been regarded as a homogeneous population. If this population is not homogeneous, different interventions might be appropriate for different subgroups. We hypothesized that (1) Clusters of individuals could be identified based on risk factors, (2) These clusters would predict duration and recurrences 6 months post-injury. Methods The study focuses on the 442 LBP claimants in the Readiness for Return-to-Work Cohort Study. Claimants (n = 259) who had already returned to work, approximately 1 month post-injury were categorized as the low risk group. A latent class analysis was performed on 183 workers absent from work, categorized as the high risk group. Groups were classified based on: pain, disability, fear avoidance beliefs, physical demands, people-oriented culture and disability management practice at the workplace, and depressive symptoms. Results Three classes were identified; (1) workers with ‘workplace issues’, (2) workers with a ‘no workplace issues, but back pain’, and (3) workers having ‘multiple issues’ (the most negative values on every scale, notably depressive symptoms). Classes 2 and 3 had a similar rate of return to work, both worse than the rate of class 1. Return-to-work status and recurrences at 6 months were similar in all 3 groups. Conclusion This study largely confirms that several subgroups could be identified based on previously defined risk factors as suggested by an earlier theoretical model by Shaw et al. (J Occup Rehab 16(4):591–605, 2006). Different groups of workers might be identified and might benefit from different interventions.

Objectives: To estimate prevalence, incidence, and course of depressive symptoms and prevalence of mental health treatment following a workplace injury, and to estimate the association between depressive symptoms and return-to-work (RTW) trajectories. Method: In a prospective cohort study, workers filing a lost-time compensation claim for a work-related musculoskeletal disorder of the back or upper extremity were interviewed 1 month ( n = 599) and 6 months ( n = 430) postinjury. A high level of depressive symptoms was defined as 16 or more on the self-reported Center for Epidemiologic Studies—Depression (CES-D) Scale. The following estimates are reported: prevalence of high depressive symptom levels at 1 and 6 months postinjury; incidence, resolution, and persistence of high depressive symptom levels between 1 and 6 months; and prevalence of self-reported mental health treatment and depression diagnosis at 6 months postinjury. Results: Prevalence of high depressive symptom levels at 1 month and 6 months postinjury were 42.9% (95% CI 38.9% to 46.9%) and 26.5% (95% CI 22.3% to 30.7%), respectively. Among participants reporting high depressive symptom levels at 1 month postinjury, 47.2% (95% CI 39.9% to 54.5%) experienced a persistence of symptoms 6 months postinjury. By 6 months, 38.6% of workers who never returned to work or had work disability recurrences had high depressive symptom levels, compared with 17.7% of those with a sustained RTW trajectory. At 6–month follow-up, 12.9% (95% CI 5.8% to 20.1%) of participants with persistently high depressive symptom levels self-reported a depression diagnosis since injury and 23.8% (95% CI 14.7% to 32.9%) were receiving depression treatment. Conclusions: Depressive symptoms are pervasive in workers with musculoskeletal injuries, but transient for some, and seldom diagnosed as depression or treated.

People with primary bone cancer typically are young (usual age-at-onset 16-35 years old) and undergo arduous treatments. The current standard of care (tumour resection and limb reconstruction with or without chemotherapy) results in survival rates in excess of 60%, but also results in significant disability at a time when patients are choosing career paths, establishing their independence and embarking on new roles. To date, the nature of the relationship between experiences of osteosarcoma illness and experiences of vocation has remained unclear. This study sought to examine this relationship using qualitative narrative methodology. In-depth audiotaped interviews were conducted with 14 osteosarcoma survivors (8 men, 6 women) who were being treated at Mount Sinai Hospital, Toronto, Canada. Interview transcripts were analyzed for story typology and thematic content via constant comparison. Respondents reported engaging in three types of 'work': 'illness work', 'identity work' and 'vocational work'. Osteosarcoma illness represented a crisis for respondents, one which necessitated considerable illness work. Illness work was portrayed as all-consuming, whereby respondents were forced to stop vocational work for considerable periods. The illness crisis also precipitated 'identity work'. Respondents recounted a transformative process, of 'becoming other' to whom they had been prior to illness. As a result, respondents told of re-entering the vocational sphere with a different sense of themselves from when they left it. When patients return for surgical follow up, clinicians routinely ask, "So, are you back to work yet?" expecting simple 'yes/no' answers. This study suggests that the answer is instead highly complex, and that patients could be seen as having been 'working' all along. This study offers a re-conceptualization of 'work' and 'return to work' in the context of osteosarcoma, with implications for clinical and return-to-work practices.

Introduction We report on the development and validation of a 22-item scale assessing stage of readiness for return-to-work, the Readiness for Return-to-Work (RRTW) scale. Methods Lost-time claimants (n = 632) completed a telephone survey one month after a work-related musculoskeletal injury. Exploratory and confirmatory factor analyses of readiness items were conducted with two separate samples, and concurrent validity was examined. Results For workers not working, 60% of the variance was explained by four factors—(1) Precontemplation, (2) Contemplation (3) Prepared for Action—Self-evaluative and (4) Prepared for Action—Behavioral. For those working, 58% of the variance was explained by two factors—(1) Uncertain Maintenance and (2) Proactive Maintenance. Confirmatory factor analyses had satisfactory fit indices to confirm the initial model. Concurrent validity of the scale was supported: Relationships of readiness with depressive symptoms, fear-avoidance, pain, and general health, were generally in the hypothesized direction. Conclusions Psychometric properties of the newly developed instrument suggest that the application of the Readiness for Change model to return-to-work is relevant to work disability research. The instrument may facilitate the offer of stage-specific services tailored to injured workers’ needs, and be used for evaluation of return-to-work interventions.

Background Work disability has serious consequences for individuals as well as society. It is possible to facilitate resumption of work by reducing barriers to return to work (RTW) and promoting collaboration with key stakeholders. This review was first published in 2009 and has now been updated to include studies published up to February 2015. Objectives To determine the effectiveness of workplace interventions in preventing work disability among sick-listed workers, when compared to usual care or clinical interventions. Search methods We searched the Cochrane Work Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, and PsycINFO databases on 2 February 2015. Selection criteria We included randomised controlled trials (RCTs) of workplace interventions that aimed to improve RTW for disabled workers. We only included studies where RTW or conversely sickness absence was reported as a continuous outcome. Data collection and analysis Two review authors independently extracted data and assessed risk of bias of the studies. We performed meta-analysis where possible, and we assessed the quality of evidence according to GRADE criteria. We used standard methodological procedures expected by Cochrane. Main results We included 14 RCTs with 1897 workers. Eight studies included workers with musculoskeletal disorders, five workers with mental health problems, and one workers with cancer. We judged six studies to have low risk of bias for the outcome sickness absence. Workplace interventions significantly improved time until first RTW compared to usual care, moderate-quality evidence (hazard ratio (HR) 1.55, 95% confidence interval (CI) 1.20 to 2.01). Workplace interventions did not considerably reduce time to lasting RTW compared to usual care, very low-quality evidence (HR 1.07, 95% CI 0.72 to 1.57). The effect on cumulative duration of sickness absence showed a mean difference of -33.33 (95% CI -49.54 to -17.12), favouring the workplace intervention, high-quality evidence. One study assessed recurrences of sick leave, and favoured usual care, moderate-quality evidence (HR 0.42, 95% CI 0.21 to 0.82). Overall, the effectiveness of workplace interventions on work disability showed varying results. In subgroup analyses, we found that workplace interventions reduced time to first and lasting RTW among workers with musculoskeletal disorders more than usual care (HR 1.44, 95% CI 1.15 to 1.82 and HR 1.77, 95% CI 1.37 to 2.29, respectively; both moderate-quality evidence). In studies of workers with musculoskeletal disorders, pain also improved (standardised mean difference (SMD) -0.26, 95% CI -0.47 to -0.06), as well as functional status (SMD -0.33, 95% CI -0.58 to -0.08). In studies of workers with mental health problems, there was a significant improvement in time until first RTW (HR 2.64, 95% CI 1.41 to 4.95), but no considerable reduction in lasting RTW (HR 0.79, 95% CI 0.54 to 1.17). One study of workers with cancer did not find a considerable reduction in lasting RTW (HR 0.88, 95% CI 0.53 to 1.47). In another subgroup analysis, we did not find evidence that offering a workplace intervention in combination with a cognitive behavioural intervention (HR 1.93, 95% CI 1.27 to 2.93) is considerably more effective than offering a workplace intervention alone (HR 1.35, 95% CI 1.01 to 1.82, test for subgroup differences P = 0.17). Workplace interventions did not considerably reduce time until first RTW compared with a clinical intervention in workers with mental health problems in one study (HR 2.65, 95% CI 1.42 to 4.95, very low-quality evidence). Authors' conclusions We found moderate-quality evidence that workplace interventions reduce time to first RTW, high-quality evidence that workplace interventions reduce cumulative duration of sickness absence, very low-quality evidence that workplace interventions reduce time to lasting RTW, and moderate-quality evidence that workplace interventions increase recurrences of sick leave. Overall, the effectiveness of workplace interventions on work disability showed varying results. Workplace interventions reduce time to RTW and improve pain and functional status in workers with musculoskeletal disorders. We found no evidence of a considerable effect of workplace interventions on time to RTW in workers with mental health problems or cancer. We found moderate-quality evidence to support workplace interventions for workers with musculoskeletal disorders. The quality of the evidence on the effectiveness of workplace interventions for workers with mental health problems and cancer is low, and results do not show an effect of workplace interventions for these workers. Future research should expand the range of health conditions evaluated with high-quality studies.

Problem: One of the key players in the return-to-work (RTW) and work accommodation process is the healthcare provider (HCP). This study examines the association between RTW approximately one month post injury and early, proactive HCP communication with the patient and workplace. Methods: In this cross-sectional study 187 Ontario workers completed a telephone survey 17–43 days post injury. All had accepted or pending lost-time claims for back, neck or upper extremity occupational musculoskeletal injuries. Logistic regression was used to analyze the effects of three self-reported items “your HCP told you the date you could RTW,” “your HCP advised you on how to prevent re-injury or recurrence,” “your HCP made contact with your workplace” on self-reported RTW. Fourteen potential confounders were also tested in the model including sex, age, income, education, occupational classification, worksite size, co-morbidity, psycho-physical work demands, pain, job satisfaction, depression, and time from injury to interview. Results: The HCP giving a patient a RTW date (adjusted OR=3.33, 95% CI=1.62–6.87) and giving a patient guidance on how to prevent recurrence and re-injury (adjusted OR=2.71, 95% CI=1.24–5.95) were positively associated with an early RTW. Contact by the HCP with the workplace was associated with RTW, however, this association became weaker upon adjusting for confounding variables (crude OR=2.11, 95% C1=1.09–4.09; adjusted OR=1.72, 95% CI=0.83–3.58). Interpretation: Our study lends support to the HCP playing an active role early in the RTW process, one that includes direct contact with the workplace and proactive communication with the patient.

Background: Literature pertaining to the relationship between workplace factors and depression has been compartmentalized: work conditions, family conditions, and work–family balance have been studied separately as predictors of depressive symptoms but not concurrently. Objective: Work conditions and work–family spillover were considered concurrently as modifiable workplace factors associated with depressive symptomatology, while controlling for confounding socio-economic factors. Methods: This cross-sectional study involved 218 female health care workers who completed a survey assessing work conditions [Effort–Reward Imbalance (ERI) scale and Job Content Questionnaire (JCQ)], work–family balance (work–family spillover scale), sociodemographic information, and depressive symptoms [Center for Epidemiological Studies Depression (CES-D) scale]. Results: Path analysis supported the presence of a direct relationship between depressive symptoms and high effort–reward imbalance, high negative work–family spillover, low positive family-to-work spillover, and low education. The indirect effect of low support from work was mediated by negative work-to-family spillover and high effort–reward imbalance. The indirect effect of high effort–reward imbalance was mediated by increased negative work-to-family spillover. The indirect effect of having children 18 years or younger was mediated by decreased positive family-to-work spillover. An indirect effect of low education was mediated by high effort–reward imbalance and high negative work-to-family spillover. Conclusions: The association between work conditions and depressive symptomatology is mediated by increased negative work-to-family spillover. The impact of having young children is mediated by decreased positive family-to-work spillover. Copyright © 2006 John Wiley & Sons, Ltd.

Background: The purpose of the study was to describe and quantify the impact of work-related musculoskeletal disorders on workers' caregiving activities.Methods: A cross-sectional study was conducted in which a telephone survey was administered to 187 lost-time workers' compensation claimants from Ontario, of whom 49.2% were women. Forty-eight percent of the injured workers were providing unpaid care prior to the injury.Results: Injured workers providing caregiving reported an average reduction in time spent in caregiving activities of 5.5 hr/week, 8 months post- injury. A Sex X Return-to-work status ANCOVA was conducted with difference in caregiving hours as the dependent variable, and with thefollowing covariates: Mean number of caregiving hours, comorbidities, site of injury, and education. Independent of weekly hours of caregiving, decreases in caregiving hours were significantly higher if the worker was a woman or had not returned to work.Conclusions: Work-related musculoskeletal disorders have a significant impact on workers' time spent in unpaid caregiving activities, an example of the social consequences of occupational injuries. Occupational and caregiving roles are limited by work-related disorders in a parallel fashion.

Background Studies have used insurer-reported compensable days absent as an outcome measure when studying work-related injury or illness. Compared to self-reported days absent, insurer data are less expensive to collect. Previous work has identified that insurer-claims data consistently underestimate the duration of days absent when compared to self-report. The objective of this study was to examine the agreement between the number of self-reported days absent from work following a compensable work-related injury and the number of insurer-reported compensation days paid, and to examine factors associated with the magnitude of the discrepancy between the number of self-reported days absent and the number of insurer-reported compensated days paid.Methods One hundred sixty six respondents who experienced a work-related injury were interviewed approximately 200 days post-injury to assess the number of days absent from work. The number of days compensated by the insurer was compared to self-report using descriptive statistics and linear regression.Results Respondents who had yet to experience a return-to-work (RTW) had the largest median discrepancy followed by respondents with an unsustained RTW and finally sustained RTW. Respondents with upper extremity injuries, lower education, and lower RTW self-efficacy showed greater discrepancy between self-reported and compensated days absent. Among respondents who self-reported fewer days absent than insurer-compensated days absent an inverse relationship between firm size and discrepancy was noted.Conclusions Researchers should be aware of the discrepancies between self-reported and compensated days absent. Future studies planning to incorporate days absent as an outcome variable should carefully consider what measure would be more appropriate and potentially collect both self-report and administrative data to assess the discrepancy.

To review prevailing models of disability management and prevention with respect to communication, and to suggest alternative approaches.Review of selected articles.Effective disability management and return to work strategies have been the focus of an increasing number of intervention programmes and associated research studies, spanning a variety of worker populations and provider and business perspectives. Although primary and secondary disability prevention approaches have addressed theoretical basis, methods and costs, few identify communication as a key factor influencing disability outcomes. Four prevailing models of disability management and prevention (medical model, physical rehabilitation model, job-match model, and managed care model) are identified. The medical model emphasizes the physician's role to define functional limitations and job restrictions. In the physical rehabilitation model, rehabilitation professionals communicate the importance of exercise and muscle reconditioning for resuming normal work activities. The job-match model relies on the ability of employers to accurately communicate physical job requirements. The managed care model focuses on dissemination of acceptable standards for medical treatment and duration of work absence, and interventions by case managers when these standards are exceeded. Despite contrary evidence for many health impairments, these models share a common assumption that medical disability outcomes are highly predictable and unaffected by either individual or contextual factors. As a result, communication is often authoritative and unidirectional, with workers and employers in a passive role.Improvements in communication may be responsible for successes across a variety of new interventions. Communication-based interventions may further improve disability outcomes, reduce adversarial relationships, and prove cost-effective; however, controlled trials are needed.

Objective This prospective study examined sex differences in illness intrusiveness and in baseline predictors of illness intrusiveness in cardiac patients' 1-year postcardiac event. Methods Patients diagnosed with a myocardial infarction (MI) or unstable angina (UA) completed a baseline questionnaire during their hospitalization (139 men and 104 women). Eighty-one men and 67 women completed the follow-up questionnaire 1-year postcardiac event. The questionnaire included measures of illness intrusiveness in three life domains, depressive symptomatology, social support, medical information, risk factors for heart disease, and sociodemographic information. Results A MANCOVA with the three Illness Intrusiveness subscales as dependent variables, sex as the between-group factor, and partnership status as a covariate found a sex effect for the Intimacy subscale, but not for the Instrumental and the Relationships/Personal Development subscales. Men reported more intrusiveness in the Intimacy domain of their life as compared to women. After controlling for sociodemographic factors and risk factors for heart disease, hierarchical regressions indicated sex differences in baseline predictors of 1-year follow-up illness intrusiveness in the three life domains. For men, being satisfied with support from partner at baseline was associated with less intrusiveness in the Instrumental Life domain 1 year after the cardiac event. For women, surprisingly, more satisfaction with support from their partner at baseline was associated with more intrusiveness in their intimate lives 1 year after their cardiac event. In addition, emotional symptoms of depression at baseline were predictive of increased illness intrusiveness in Relationship/Personal Development and Intimacy domains for men and in Instrumental and Intimacy domains for women. Conclusion Support from partner may have a differential impact for men and women after a cardiac event. Depressive symptomatology during initial hospitalization, particularly emotional symptoms, is a prominent indicator of illness intrusiveness for both sexes 1 year after the cardiac event.

Cardiovascular disease (CVD) is the leading cause of death and disability for women and men. There are gender differences in recovery from coronary events, which may be due physiological, sociodemographic, or psychosocial factors. Cardiac rehabilitation programs have beneficial effects on coronary recovery. The following presents a review of the literature from MedLine (1997-2001) and PsychInfo (1984-2001) on gender differences in participation in cardiac rehabilitation programs, with a focus on depression, anxiety, self-efficacy and social support. A critical analysis of gaps in the literature as well as areas for future research are presented.

Return to work after injury or illness is a behavior influenced by physical, psychological, and social factors. Disability research lacks a conceptual framework for combining these factors in the study of the return-to-work process. Two extant theoretical models withinthe social context are considered as they apply to the behavior of returning to work: 1) the Readiness for Change Model originating from the field of health promotion and addressing the issue of motivation for behavior change, and 2) the Phase Model of Disability developed for the epidemiological study of occupational disability addressing the developmental and temporal aspects of disability. A new Readiness for Return-to-Work Model is proposed focusing on the interpersonal context of the work-disabled employee. Employee interactions with the workplace, the health care, and insurance systems are considered as they impact the three defining dimensions of change—decisional balance, self-efficacy, and change processes. The evidence for their impact on return-to-work is examined within the framework of the Phase Model of Disability, which puts forth the phase-specificity of symptoms, risks, and interventions for disability. The Readiness for Return-to-Work Model has the potential to account for individual variation in optimal stage-specific timing of interventions based on an individual's readiness for return-to-work. The model therefore complements the Phase Model of Disability by allowing for an individual-level staging of the disability and recovery process within the broader group-level-derived framework of occupational disability phases. This link between the two models needs to be empirically tested in future research.

Objective: To determine if the psychologic constructs of self-criticism and marital adjustment, considered jointly with obstetric and demographic factors, are significant predictors of grief during a pregnancy after a miscarriage or perinatal death. Methods: Participants included 60 pregnant women with previous miscarriages or perinatal deaths, and 50 of their partners. Participants completed a package of psychometric instruments between the tenth and 19th week of gestation. Predictors of grief (active grief, difficulty coping, despair) included (1) psychologic factors: marital adjustment and self-criticism; (2) demographic factors: age and number of living children; and (3) obstetric factors: gestational age at time of loss, number of losses, and time between loss and subsequent conception. Results: Stepwise regression analyses were conducted for each grief component for women and men. For women, active grief was significantly associated with high self-criticism and later losses ( R 2 = 0.31). Later losses and longer time between loss and conception were significantly associated with difficulty coping ( R 2 = 0.55) and despair ( R 2 = 0.44). In men, active grief was associated with high self-criticism and later losses ( R 2 = 0.28), difficulty coping ( R 2 = 0.18), and despair ( R 2 = 0.25) with high self-criticism. A trend was found for poor marital adjustment to be associated with higher levels of difficulty coping and despair in men. Conclusion: High levels of self-criticism and later gestational age at time of loss are predictors of increased grief during a pregnancy after a miscarriage or perinatal death. Increased time between loss and subsequent conception is also predictive of increased grief for women. For men, low levels of marital adjustment are predictive of increased grief. These results may be helpful in counselling couples considering pregnancy after a loss.

Cette etude examine l'impact d'une grossesse subsequente sur l'ajustement emotionnel associe a une perte perinatale ayant precede et sur les composants suivants de deuil parental-deuil actif, difficulte a faire face, desespoir. Les participants comprenaient 25 femmes et 24 partenaires qui attendaient un bebe pour la premiere fois depuis la perte et femmes et 18 partenaires qui n'attendaient pas d'enfant et qui n'avaient pas eu d'enfant ni de grossesse apres leur perte. La symptomatologie depressive, l'anxiete, l'ajustement conjugal, ainsi que le deuil actif, le desespoir et la difficulte a faire face ont ete measures. Les meres qui n'etaient pas enceintes avaient des niveaux de desespoir bien plus eleves et bien plus de difficulte a faire face que les meres enceintes, independamment de l'effet du temps ecoule depuis la perte. Pour les peres, aucun effet de groupe significatif de detresse emotionnelle ou d'intensite de deuil n'a ete trouve. Les femmes ont fait etat de niveaux plus eleves d'affectivite negative que les hommes. Une nouvelle grossesse peut etre associee a un effet benefique sur le processus de deuil des femmes ayant subi une perte perinatale, essentiellement en reduisant leur desespoir et leur difficulte a faire face. Cependant, dans notre echantillon, l'intensite du deuil demeurait haute, suggerant que le processus de deuil pourrait ne pas etre gene par une grossesse subsequente.

Alcohol abuse in pregnancy represents a major social, psychological and medical problem with serious consequences for both mother and fetus. Even though its prevalence is noted increasingly in our population, it remains difficult to diagnose, given the patients' barriers and our own. Pregnancy offers a unique opportunity to overcome these barriers. By integrating validated screening questionnaires into routine antenatal care, the obstetrical care provider can identify the abusing patient and immediately initiate referrals and treatment. These patients are at risk for physical and mental abuse as well as depressive illnesses which usually require the expertise of a psychologist or psychiatrist. Their medical complications and their substance use disorders deserve the attention of an addiction specialist. Because of the serious fetal/neonatal effects, perinatologists and neonatologists are needed to assess potential birth defects, including growth restriction, and to provide appropriate care and follow-up after delivery. As alcohol abuse is the leading preventable cause of mental retardation and because maternal and fetal effects are so important, it is essential that obstetrical care providers become familiar with screening techniques and treatment options, and incorporate these into their routine prenatal assessments.

Social service programmes that offer consumer choices are intended to guide service efficiency and customer satisfaction. However, little is known about how social service consumers actually make choices and how providers deliver such services. This article details the practical implementation of consumer choice in a Canadian workers' compensation vocational retraining programme.Discourse analysis was conducted of in-depth interviews and focus groups with 71 injured workers and service providers, who discussed their direct experience of a vocational retraining system. Data also included procedural, policy and administrative documents.Consumer choice included workers being offered choices about some service aspects, but not being able to exercise meaningful discretion. Programme cost objectives and restrictive rules and bureaucracy skewed the guidance provided to workers by service providers. If workers did not make the "right" choices, then the service providers were required to make choices for them. This upset workers and created tension for service providers.The ideal of consumer choice in a social service programme was difficult to enact, both for workers and service providers. Processes to increase quality of guidance to social service consumers and to create a systematic feedback look between system designers and consumers are recommended. Implications for Rehabilitation Consumer choice is an increasingly popular concept in social service systems. Vocational case managers can have their own administrative needs and tensions, which do not always align with the client's choices. Rehabilitation programmes need to have processes for considering what choices are important to clients and the resources to support them.

Objective To examine the role of pain experiences in relation to work absence, within the context of other worker health factors and workplace factors among Canadian nurses with work-related musculoskeletal (MSK) injury. Methods Structural equation modeling was used on a sample of 941 employed, female, direct care nurses with at least one day of work absence due to a work-related MSK injury, from the cross-sectional 2005 National Survey of the Work and Health of Nurses. Results The final model suggests that pain severity and pain-related work interference mediate the impact of the following worker health and workplace factors on work absence duration: depression, back problems, age, unionization, workplace physical demands and low job control. The model accounted for 14 % of the variance in work absence duration and 46.6 % of the variance in pain-related work interference. Conclusions Our findings support a key role for pain severity and pain-related work interference in mediating the effects of workplace factors and worker health factors on work absence duration. Future interventions should explore reducing pain-related work interference through addressing workplace issues, such as providing modified work, reducing physical demands, and increasing job control.

Based on findings from an institutional ethnography in a large mental health organization, we explore how institutional forces shape the experiences of health care workers with mental health issues. We interviewed 20 employees about their personal experiences with mental health issues and work and 12 workplace stakeholders about their interactions with workers who had mental health issues. We also reviewed organizational texts related to health, illness, and productivity. In analyzing transcripts and texts, silence emerged as a core underlying process characterizing individual and organizational responses to employees with mental health issues. Silence was an active practice that took many forms; it was pervasive, complex, and at times, paradoxical. It served many functions for workers and the organization. We discuss the theoretical and practical implications of the findings for workers with mental health issues.

Studies in the literature do not show clear evidence supporting the relationship between pain and depressive symptoms in individuals experiencing acute/subacute pain compared to those experiencing chronic pain. However, more information is needed about which variables act as mediators in the pain-depression relationship in people having acute/subacute pain, before pain becomes chronic. Our objectives were to test the suitability of the fear-avoidance model in a sample of 110 health care workers experiencing acute/subacute pain using path analyses, to improve the model as needed, and to examine a model involving both pain catastrophizing and pain self-efficacy with work status as a final outcome. Overall, the results indicated that adjustments to the fear-avoidance model were required for people experiencing acute/subacute pain, in which fear-avoidance beliefs and depressive symptoms were concurrent rather than sequential. The catastrophizing concept was most closely associated with depressive symptoms, while pain self-efficacy was directly associated with fear-avoidance beliefs and indirectly to work outcomes. Assessing and modifying pain self-efficacy in acute/subacute pain patients is important for interventions aiming to decrease fear-avoidance and improve work outcomes.

Background Depression is associated with negative work outcomes such as reduced work participation (WP) (e.g., sick leave duration, work status) and work functioning (WF) (e.g., loss of productivity, work limitations). For the development of evidence-based interventions to improve these work outcomes, factors predicting WP and WF have to be identified. Methods This paper presents a systematic literature review of studies identifying factors associated with WP and WF of currently depressed workers. Results A total of 30 studies were found that addressed factors associated with WP (N = 19) or WF (N = 11). For both outcomes, studies reported most often on the relationship with disorder-related factors, whereas personal factors and work-related factors were less frequently addressed. For WP, the following relationships were supported: strong evidence was found for the association between a long duration of the depressive episode and work disability. Moderate evidence was found for the associations between more severe types of depressive disorder, presence of co-morbid mental or physical disorders, older age, a history of previous sick leave, and work disability. For WF, severe depressive symptoms were associated with work limitations, and clinical improvement was related to work productivity (moderate evidence). Due to the cross-sectional nature of about half of the studies, only few true prospective associations could be identified. Conclusion Our study identifies gaps in knowledge regarding factors predictive of WP and WF in depressed workers and can be used for the design of future research and evidence-based interventions. We recommend undertaking more longitudinal studies to identify modifiable factors predictive of WP and WF, especially work-related and personal factors. Electronic supplementary material The online version of this article (doi:10.1007/s10926-009-9224-x) contains supplementary material, which is available to authorized users.

The present study compared levels of self-criticism and of dependency in 20 currently clinically depressed patients, 20 remitted patients, and 20 normal controls. Results from the Depressive Experience Questionnaire (DEQ) and the Interpersonal Dependency Inventory (IDI) indicated that currently depressed and remitted patients had equally high levels of self-criticism and of dependency, which were significantly higher than those of normal controls. Dependency and self-criticism of DEQ and IDI scales correlated positively, raising the question of the independence of the two constructs. Overall, results supported the status of self-criticism and dependency as stable vulnerability factors to depression, in that these factors remain active beyond the end of a depressive episode. Discussion about the research methodology is presented.

Objective: To identify factors associated with offer and acceptance of work accommodation. Methods: In 401 claimants with musculoskeletal injuries, two logistic regressions identified individual and workplace factors associated with work accommodation offer and acceptance. Results: Unionized status, strong disability management policies and practices, low supervisor support, and pink collar occupation were associated with work accommodation offer. Job tenure over 1 year and lighter physical work were associated with acceptance. Younger age and more repetitive physical work demands were positively associated with both outcomes. Pink-collar status was positively associated with offers, but negatively with acceptance. Gender, mental health, pain, job satisfaction, firm size, people-oriented culture, safety climate, and ergonomic practices were not significant predictors. Conclusions: One month post-injury, workplace factors and age are determinants of offer and acceptance of work accommodation, while individual health factors play no significant role.

BACKGROUND: Work disability has serious consequences for individuals as well as society. It is possible to facilitate resumption of work by reducing barriers to return to work (RTW) and promoting collaboration with key stakeholders. This review was first published in 2009 and has now been updated to include studies published up to February 2015. OBJECTIVES: To determine the effectiveness of workplace interventions in preventing work disability among sick‐listed workers, when compared to usual care or clinical interventions. SEARCH METHODS: We searched the Cochrane Work Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, and PsycINFO databases on 2 February 2015. SELECTION CRITERIA: We included randomised controlled trials (RCTs) of workplace interventions that aimed to improve RTW for disabled workers. We only included studies where RTW or conversely sickness absence was reported as a continuous outcome. DATA COLLECTION AND ANALYSIS: Two review authors independently extracted data and assessed risk of bias of the studies. We performed meta‐analysis where possible, and we assessed the quality of evidence according to GRADE criteria. We used standard methodological procedures expected by Cochrane. MAIN RESULTS: We included 14 RCTs with 1897 workers. Eight studies included workers with musculoskeletal disorders, five workers with mental health problems, and one workers with cancer. We judged six studies to have low risk of bias for the outcome sickness absence. Workplace interventions significantly improved time until first RTW compared to usual care, moderate‐quality evidence (hazard ratio (HR) 1.55, 95% confidence interval (CI) 1.20 to 2.01). Workplace interventions did not considerably reduce time to lasting RTW compared to usual care, very low‐quality evidence (HR 1.07, 95% CI 0.72 to 1.57). The effect on cumulative duration of sickness absence showed a mean difference of ‐33.33 (95% CI ‐49.54 to ‐17.12), favouring the workplace intervention, high‐quality evidence. One study assessed recurrences of sick leave, and favoured usual care, moderate‐quality evidence (HR 0.42, 95% CI 0.21 to 0.82). Overall, the effectiveness of workplace interventions on work disability showed varying results. In subgroup analyses, we found that workplace interventions reduced time to first and lasting RTW among workers with musculoskeletal disorders more than usual care (HR 1.44, 95% CI 1.15 to 1.82 and HR 1.77, 95% CI 1.37 to 2.29, respectively; both moderate‐quality evidence). In studies of workers with musculoskeletal disorders, pain also improved (standardised mean difference (SMD) ‐0.26, 95% CI ‐0.47 to ‐0.06), as well as functional status (SMD ‐0.33, 95% CI ‐0.58 to ‐0.08). In studies of workers with mental health problems, there was a significant improvement in time until first RTW (HR 2.64, 95% CI 1.41 to 4.95), but no considerable reduction in lasting RTW (HR 0.79, 95% CI 0.54 to 1.17). One study of workers with cancer did not find a considerable reduction in lasting RTW (HR 0.88, 95% CI 0.53 to 1.47). In another subgroup analysis, we did not find evidence that offering a workplace intervention in combination with a cognitive behavioural intervention (HR 1.93, 95% CI 1.27 to 2.93) is considerably more effective than offering a workplace intervention alone (HR 1.35, 95% CI 1.01 to 1.82, test for subgroup differences P = 0.17). Workplace interventions did not considerably reduce time until first RTW compared with a clinical intervention in workers with mental health problems in one study (HR 2.65, 95% CI 1.42 to 4.95, very low‐quality evidence). AUTHORS' CONCLUSIONS: We found moderate‐quality evidence that workplace interventions reduce time to first RTW, high‐quality evidence that workplace interventions reduce cumulative duration of sickness absence, very low‐quality evidence that workplace interventions reduce time to lasting RTW, and moderate‐quality evidence that workplace interventions increase recurrences of sick leave. Overall, the effectiveness of workplace interventions on work disability showed varying results. Workplace interventions reduce time to RTW and improve pain and functional status in workers with musculoskeletal disorders. We found no evidence of a considerable effect of workplace interventions on time to RTW in workers with mental health problems or cancer. We found moderate‐quality evidence to support workplace interventions for workers with musculoskeletal disorders. The quality of the evidence on the effectiveness of workplace interventions for workers with mental health problems and cancer is low, and results do not show an effect of workplace interventions for these workers. Future research should expand the range of health conditions evaluated with high‐quality studies.

Safe and timely return to work (RTW) reduces the risk of development of chronicity of work disability. By 6 months post-injury, if a worker has not yet returned to work, the likelihood of developing chronic disability is substantial (Abenhaim & Suissa, 1987). Returning to work when one is ready can reduce the risk of entering a cycle of deconditioning, decreased self-efficacy about RTW, and increased habituation to being work disabled. Conversely, it should be noted that returning to work too early or in inappropriate conditions can also have deleterious effects (Pransky et al., 2001). Consequently, it is important to identify the factors facilitating safe RTW in the early phases of recovery.

Disability and return to work following an injury or illness has been recognized as a process influenced by a variety of social, psychological, and economic factors (1-6).The epidemiological and economic literature shows that characteristics of the work environment, health care, and the insurance system all have a significant influence on return-to-work outcomes independently of the underlying medical condition and other risk factors. The employee’s psychological processes initiating and sustaining return to work cannot be considered in isolation of these factors. Nevertheless, the employee remains the ultimate agent of change in the return-to-work process in that only he or she takes the final decision of going in for a day’s work.

OBJECTIVES: To examine, using administrative and self-reported data, the relationship between early return-to-work (RTW) strategies and work absence duration. METHODS: Using a cohort of 632 claimants with work-related musculoskeletal injuries, Cox proportional hazard analyses were performed with RTW strategies measured 1 month after injury as predictors. Outcomes were 6-month self-reported work absence duration and time receiving wage replacement benefits from an administrative database. RESULTS: Work accommodation offer and acceptance and advice from health care provider (HCP) to the workplace on re-injury prevention were significant predictors of shorter work absence duration indexed by both self-report and administrative data. Receiving an ergonomic visit was a significant predictor of shorter duration receiving benefits only. CONCLUSIONS: Analyses using administrative and self-reported indices of work absence generally converged. Work accommodation and targeted HCP communication with the workplace are critical for effective early RTW interventions. Language: en

Women's health-promoting behavior changes and their correlates across the transition to motherhood and return to work are insufficiently understood. The purpose of this study was to describe and compare women's health-promoting behaviors, particularly physical activity (PA), across these transitions. A prospective, observational design was employed to assess 243 female healthcare workers from 3 sites with regard to health-promoting behaviors, and their demographic (e.g., age, parity) and psychosocial (i.e., work-family role spillover) correlates. Forty-two participants were recruited while pregnant and re-assessed during maternity leave and upon return to work, and compared to 201 non-pregnant participants. No significant changes in health-promoting behaviors were observed from pregnancy through the postpartum. Pregnant participants reported better nutrition than comparison participants (p=.001), and were more likely to check their pulse when exercising (p=.004). During pregnancy, health-promoting behaviors were related to parental status, with first-time mothers engaging in more positive behaviors. Correlates of PA during maternity leave and return to work included family income and exercise history. Positive family-to-work spillover was significantly greater among pregnant women than among comparison participants (p

Objectives This paper reports on a systematic review of the international qualitative research literature on return to work. This review was undertaken in order to better understand the dimensions, processes, and practices of return to work. Because return to work often includes early return before full recovery while a person is undergoing rehabilitation treatment, physical recovery is embedded in complicated ways with workplace processes and practices and social organization. These process-oriented dimensions of return to work are well described in the qualitative literature. Methods This systematic review of the literature covered peer-reviewed papers that focused on musculoskeletal and pain-related injuries and were published in English or French between 1990 and 2003. Findings from papers meeting relevance and quality criteria were synthesized using the meta-ethnographic approach. Results This review found that return to work extends beyond concerns about managing physical function to the complexities related to beliefs, roles, and perceptions of many players. Good will and trust are overarching conditions that are central to successful return-to-work arrangements. In addition, there are often social and communication barriers to return to work, and intermediary players have the potential to play a key role in facilitating this process. Conclusions This paper identifies key mechanisms of workplace practice, process, and environment that can affect the success of return to work. The findings illustrate the contribution that qualitative literature can make to important aspects of implementation in relation to return to work. Key terms meta-ethnographic approach; occupational health; social relations; synthesis; work organization.

This study examines the relationship between major depression, subclinical depressive symptomatology and activity limitation in a representative sample of Canadian men and women, with a particular emphasis on examining gender differences. Over a 4-year period, the three waves of data were collected from a representative sample of Canadian adults aged 18–60 beginning in 1994. A brief diagnostic interview for major depression, current limitations in home, work, and other activities (e.g., leisure), presence of each of 13 chronic medical conditions, and other sociodemographic information were gathered. Regression analyses adjusted for potential confounding of time-dependent and time-invariant covariates. These analyses were performed separately for men and women. Major depression had a significant adverse impact on all types of activities for the entire community sample, and this impact was generally robust when controlling for potential confounders. Gender differences were observed for leisure activities with depressed men showing a higher likelihood of limitation in these activities than depressed women. The findings provide further evidence that major depression leads to impairments in a range of daily activities. Gender differences in the impact of depression on leisure activities may be important to consider in depression treatment.

The present study examined the relationship between work-family spillover, job characteristics, and sleep quality in a sample of health care workers (N = 168) recruited from 3 Canadian hospitals. A multiple regression analysis revealed that positive family-to-work spillover is associated with better sleep quality, after controlling for age, physical health, depressive symptomatology, work situation, and number of children. These findings are discussed within a theoretical framework drawing on the concepts of effort and recovery.

Background: The psychological factors of depressive symptoms, fear-avoidance, and self-efficacy are deemed to be important in the work disability process. However, the prognostic value of these factors for time on benefit is not well understood. Aims: To analyse the prognostic value of psychological factors for the number of days on total compensation benefit over a 12 month period. Methods: In a longitudinal study of 187 workers receiving total compensation benefits due to musculoskeletal disorders, the prognostic value of psychological factors measured 4–5 weeks post-injury for duration on total compensation benefit over 12 months was analysed. Cox proportional hazard regression analyses were conducted. Special emphasis was given to variable selection and to the analysis of confounding effects of potential prognostic variables. Results: The final model indicated that increased depressive symptoms and poorer physical health significantly increase the number of days on total benefit. Confounders included in the final model were pain and fear of income loss. In the final model the impact of fear-avoidance ceased to be significant when work related variables were included in the fully adjusted model. This illustrates that interrelationships between variables must be taken into account when building multivariate prognostic models. The addition of work related variables to the model did not result in any major changes in the adjusted model, which suggests that when measured 4–5 weeks post-injury, psychological and physical health factors are strong predictors of time on benefits, while work conditions are less important. Conclusion: Results suggest that the presence of depressive symptoms and poor physical health in workers on benefit due to musculoskeletal disorders increases the number of days on total compensation benefits significantly, when controlling for confounding variables.

Introduction: The challenges of engaging and involving stakeholders in return-to-work (RTW) intervention and research have not been well documented. Methods: This article contrasts the diverse paradigms of workers, employers, insurers, labor representatives, and healthcare providers when implementing and studying workplace-based RTW interventions. Results: Analysis of RTW stakeholder interests suggests that friction is inevitable; however, it is possible to encourage stakeholders to tolerate paradigm dissonance while engaging in collaborative problem solving to meet common goals. We review how specific aspects of RTW interventions can be instrumental in resolving conflicts arising from differing paradigms: calibration of stakeholders' involvement, the role of supervisors and of insurance case managers, and procedural aspects of RTW interventions. The role of the researcher in engaging stakeholders, and ethical aspects associated with that process are discussed. Conclusions: Recommendations for future research include developing methods for engaging stakeholders, determining the optimal level and timing of stakeholder involvement, expanding RTW research to more diverse work settings, and developing RTW interventions reflecting all stakeholders' interests.

Introduction: There is a need to create, disseminate, and implement new knowledge in the work disability prevention (WDP) field. Training programs attracting high-quality applicants and taking into account the complexity of this emerging field are urgently needed. Methods: An advanced training program, funded by the Canadian Institutes of Health Research (CIHR), was developed by 24 mentors affiliated with nine different universities. The main objective of this program is to develop transdisciplinary knowledge, skills, and attitudes regarding WDP. This program has been developed for PhD students or post-doctoral fellows already registered full-time in a Canadian or recognized foreign university whose main interest is WDP, regardless of the health problem. Results: Since its implementation, the program received two successive cohorts of 10 students. They were registered in 13 universities in five countries and trained in nine different disciplines. Conclusions and significances: Appropriate WDP research may save major societal costs attributable to prolonged work disability. The proposed training program will contribute to developing tomorrow’s research workforce.

Return to work after injury or illness is a behavior influenced by physical, psychological, and social factors. Disability research lacks a conceptual framework for combining these factors in the study of the return-to-work process. Two extant theoretical models within the social context are considered as they apply to the behavior of returning to work: 1) the Readiness for Change Model originating from the field of health promotion and addressing the issue of motivation for behavior change, and 2) the Phase Model of Disability developed for the epidemiological study of occupational disability addressing the developmental and temporal aspects of disability. A new Readiness for Return-to-Work Model is proposed focusing on the interpersonal context of the work-disabled employee. Employee interactions with the workplace, the health care, and insurance systems are considered as they impact the three defining dimensions of change--decisional balance, self-efficacy and change processes. The evidence for their impact on return-to-work is examined within the framework of the Phase Model of Disability, which puts forth the phase-specificity of symptoms, risks, and interventions for disability. The Readiness for Return-to-Work Model has the potential to account for individual variation in optimal stage-specific timing of interventions based on an individual's readiness for return-to-work. The model therefore complements the Phase Model of Disability by allowing for an individual-level staging of the disability and recovery process within the broader group-level-derived framework of occupational disability phases. This link between the two models needs to be empirically tested in future research.