528291 research-article2014
SJP0010.1177/1403494814528291I. Øyeflaten et al.Functioning, coping and work status three years after participating in an interdisciplinary, occupational rehabilitation program
Scandinavian Journal of Public Health, 2014; 42: 425–433
Original Article
Functioning, coping and work status three years after participating in an interdisciplinary, occupational rehabilitation program
Irene Øyeflaten1,2, Inger Johanne Midtgarden1, Silje Maeland2,3, Hege R Eriksen2,4 & Liv Heide Magnussen2,3,5 1The National Centre for Occupational Rehabilitation – a National Advisory Unit, Norway, 2Uni Health, Uni Research, Norway, 3Department of Occupational Therapy, Physiotherapy and Radiography, Bergen University College, Norway, 4Hemil, Research Centre for Health Promotion, University of Bergen, Norway, and 5Department of Global Public Health and Primary Care, University of Bergen, Norway
Abstract Aim: The aim of this study was to explore how functional ability, coping and health were related to work and benefit status three years after participating in a four-week inpatient interdisciplinary occupational rehabilitation program. Methods: The cohort consisted of 338 individuals (75% females, mean age 51 years (SD=8.6)) who three years earlier had participated in a comprehensive inpatient interdisciplinary occupational rehabilitation program, due to long-term sick leave. The participants answered standardised questionnaires about subjective health complaints, functional ability, coping, and current work and benefit status. The relationships between these variables were analysed using logistic regression analyses. Results: At the time of the survey, 59% of the participants worked at least 50% of a full working day. Twenty-five percent received at least 50% disability pension and 16% received other benefits. Poor functional ability (OR 4.8; CI 3.0–7.6), poor general health (OR 3.8; CI 2.3–6.1), high level of subjective health complaints (OR 3.3; CI 2.1–5.2), low coping (OR 2.8; CI 1.7–4.4), poor physical fitness (OR 2.8; CI 1.7–4.6) and poor sleep quality (OR 2.4; CI 1.5–3.7) were associated with receiving allowances. In a fully adjusted model, only poor functional ability and low coping were associated with receiving allowances three years after occupational rehabilitation. Conclusions: Functional ability and coping were the variables most strongly associated with not having returned to work. More attention should therefore be paid to enhance these factors in occupational rehabilitation programs. Part-time work may be a feasible way to integrate individuals with reduced workability in working life, if the alternative is complete absence from work. Key Words: Vocational rehabilitation, occupational, work, sick leave, disability insurance, health, functional ability, coping
Introduction The Nordic countries are facing common challenges in public health with undesirably high rates of sickness absence and disability pensions [1]. To address some of these challenges, the Norwegian health service offers comprehensive inpatient occupational rehabilitation programs to individuals on long-term sick leave. Target groups are individuals with subjective health complaints, i.e. non-specific complaints without objective medical findings. These individuals account for the majority of medically certified sick
leaves in Norway [2] and other western countries [3]. The main goal of many of the occupational rehabilitation programs is return to work (RTW) through an interdisciplinary approach aiming to improve health, functional ability, and coping. There is still little knowledge about the characteristics of individuals who have returned to work and individuals still on benefits in the years following inpatient occupational rehabilitation, particularly regarding physical and mental functioning and coping.
Correspondence: Irene Øyeflaten, The National Centre for Occupational Rehabilitation – a National Advisory Unit, Haddlandsvegen 20, 3864 Rauland, Norway. E-mail: [email protected] (Accepted 21 February 2014) © 2014 the Nordic Societies of Public Health DOI: 10.1177/1403494814528291
426 I. Øyeflaten et al. The probability of RTW decreases with the duration of sick leave and the amount of multifaceted medical and contextual factors [4]. The purpose of the International Classification of Functioning, Disability and Health (ICF) is to capture this complexity and provide a broader picture of functioning than described by the diagnosis alone [5]. Within ICF, functioning is defined as a lifelong continuum where aspects of functioning and disability interact with the health condition and environmental factors [6], as well as personal factors [7]. Prognostic studies on work disability have demonstrated that personal factors such as beliefs and coping expectancies have a greater impact on health and RTW outcomes than the triggering disorder itself [7–9]. Previous experience with work while suffering from health complaints may influence functioning and work ability at a later stage. In the Cognitive Activation Theory of Stress (CATS) this relationship is explained as learned behaviour [10]. Previous experiences lead to an expectancy that one type of action leads to a certain consequence; referred to as response outcome expectancies in the CATS theory [10]. Individuals may have positive, negative or no expectancies on how they will react and handle different situations. Within the CATS theory, coping is defined as positive response outcome expectancy, and is essential to achieve positive results [10]. In contrast, no or negative response outcome expectancies, often referred to as helplessness and hopelessness, may lead to a negative result, such as ill health, poor work ability and functional ability [10]. It is demonstrated that positive outcome expectancy is related to recovery [9] and return to work [11]. Although studies have found conflicting results on how coping predicts return to work [12–14] one might, according to the CATS theory, assume that individuals with positive outcome expectancies (coping) are more likely to act positively toward RTW [13,14]. Hence, coping may be an independent characteristic of those who have returned to work after occupational rehabilitation regardless of health condition and functioning. This study aimed to examine if physical and mental functioning, coping and health complaints differed between individuals working and individuals on benefits three years after they had participated in a four-week inpatient interdisciplinary occupational rehabilitation program. Methods Design A cross-sectional survey was conducted.
Participants A total of 629 former rehabilitation clients were invited in January 2008 to take part in this study. The target population was all the individuals who had fulfilled a four-week inpatient occupational rehabilitation program during 2004. Information about the survey and a comprehensive questionnaire were sent by mail together with a pre-stamped envelope. A reminder was sent after approximately three weeks. Three hundred and fifty-eight (57%) individuals volunteered for the study by returning the questionnaire. No specific inclusion or exclusion criteria were composed for participating in the study. However, 20 of the respondents were excluded because of inaccurate answers about work or benefit status (Figure 1). Hence, 338 individuals (54%) were included in the study. The occupational rehabilitation centre where the rehabilitation was given is well established within the specialised health service in Norway. The centre offers an evidence-based program, building on research and best practice, to help people return to work. The rehabilitation program is designed for individuals on longterm sick leave due to subjective health complaints, mainly related to musculoskeletal and psychological complaints. The goal of the program is to improve coping and functional ability including the ability to work. The program is organised as an inpatient fourweek intervention, and includes a combination of individual and group-based sessions with physical activity, education, and cognitive behavioural modification. Coping and learning are important objectives for all activities offered. The rehabilitation program is carried out by an interdisciplinary team consisting of a physician, nurse, physiotherapist, physical activity instructor and a work consultant. The rehabilitation team identifies resources and barriers for RTW among the participants through interviews and examinations at the start of and at the end of the stay. A treatment plan is also developed together with the patient, with RTW as the main goal. Selection criterion for admission to the rehabilitation program is being on long-term sick leave and being motivated for RTW. Patients were admitted to the rehabilitation centre mainly based on referrals from their general practitioners (GPs). Prior to the admission the patient had to fill in a self-declaration form regarding motivation for work and own goals for the stay at the centre. Individuals with unsettled claims for disability pension and individuals with known alcohol or drug abuse are not admitted to the program. Measurements The questionnaire consisted of demographic questions about gender, age, marital status and level of
Functioning, coping and work status three years after participating 427 n=629 Number of questionnaires sent by mail
n=358 Number of individuals who answered and returned the questionnaires
n=20 Excluded because of inaccurate answers about work and benefit status
n=338 (100%) Number of participants included in the analysis
Working king ggroup n=198 (59%) Working or studying 50% or more: - working 100% (n=97) - working >50% (n=46) - working 50% (n=50) (out of these 50, 43 also received an allowance 50%) - studying (n=5)
Disability y pens pension (DP) n=84 (25%) Receiving disability pension, 50% or more: - DP 100% (n=56) - DP >50% (n=19) - DP 50% (n=9)
Other benefi benefits f and combination of benefits n=56 (16%) - Sick leave (n=23) - Medical rehabilitation (n=9) - Vocational rehab. (n=27) - Unemployed (n=2) - Work and DP 50% and 50 (25%) worked 50% of a full working day. In this last group 43 respondents in addition received either disability pension 50% (n= 34), or were on sick leave 50% (n=5), or received other benefits 50% (n=4) (Figure 1). Twenty-five percent (n=84) reported receiving at least 50% disability pension. None of the respondents receiving 50% disability pension (n=9) reported working. Sixteen percent (n=56) reported being on other benefits or on different combinations of benefits and work (working
SJP0010.1177/1403494814528291I. Øyeflaten et al.Functioning, coping and work status three years after participating in an interdisciplinary, occupational rehabilitation program
Scandinavian Journal of Public Health, 2014; 42: 425–433
Original Article
Functioning, coping and work status three years after participating in an interdisciplinary, occupational rehabilitation program
Irene Øyeflaten1,2, Inger Johanne Midtgarden1, Silje Maeland2,3, Hege R Eriksen2,4 & Liv Heide Magnussen2,3,5 1The National Centre for Occupational Rehabilitation – a National Advisory Unit, Norway, 2Uni Health, Uni Research, Norway, 3Department of Occupational Therapy, Physiotherapy and Radiography, Bergen University College, Norway, 4Hemil, Research Centre for Health Promotion, University of Bergen, Norway, and 5Department of Global Public Health and Primary Care, University of Bergen, Norway
Abstract Aim: The aim of this study was to explore how functional ability, coping and health were related to work and benefit status three years after participating in a four-week inpatient interdisciplinary occupational rehabilitation program. Methods: The cohort consisted of 338 individuals (75% females, mean age 51 years (SD=8.6)) who three years earlier had participated in a comprehensive inpatient interdisciplinary occupational rehabilitation program, due to long-term sick leave. The participants answered standardised questionnaires about subjective health complaints, functional ability, coping, and current work and benefit status. The relationships between these variables were analysed using logistic regression analyses. Results: At the time of the survey, 59% of the participants worked at least 50% of a full working day. Twenty-five percent received at least 50% disability pension and 16% received other benefits. Poor functional ability (OR 4.8; CI 3.0–7.6), poor general health (OR 3.8; CI 2.3–6.1), high level of subjective health complaints (OR 3.3; CI 2.1–5.2), low coping (OR 2.8; CI 1.7–4.4), poor physical fitness (OR 2.8; CI 1.7–4.6) and poor sleep quality (OR 2.4; CI 1.5–3.7) were associated with receiving allowances. In a fully adjusted model, only poor functional ability and low coping were associated with receiving allowances three years after occupational rehabilitation. Conclusions: Functional ability and coping were the variables most strongly associated with not having returned to work. More attention should therefore be paid to enhance these factors in occupational rehabilitation programs. Part-time work may be a feasible way to integrate individuals with reduced workability in working life, if the alternative is complete absence from work. Key Words: Vocational rehabilitation, occupational, work, sick leave, disability insurance, health, functional ability, coping
Introduction The Nordic countries are facing common challenges in public health with undesirably high rates of sickness absence and disability pensions [1]. To address some of these challenges, the Norwegian health service offers comprehensive inpatient occupational rehabilitation programs to individuals on long-term sick leave. Target groups are individuals with subjective health complaints, i.e. non-specific complaints without objective medical findings. These individuals account for the majority of medically certified sick
leaves in Norway [2] and other western countries [3]. The main goal of many of the occupational rehabilitation programs is return to work (RTW) through an interdisciplinary approach aiming to improve health, functional ability, and coping. There is still little knowledge about the characteristics of individuals who have returned to work and individuals still on benefits in the years following inpatient occupational rehabilitation, particularly regarding physical and mental functioning and coping.
Correspondence: Irene Øyeflaten, The National Centre for Occupational Rehabilitation – a National Advisory Unit, Haddlandsvegen 20, 3864 Rauland, Norway. E-mail: [email protected] (Accepted 21 February 2014) © 2014 the Nordic Societies of Public Health DOI: 10.1177/1403494814528291
426 I. Øyeflaten et al. The probability of RTW decreases with the duration of sick leave and the amount of multifaceted medical and contextual factors [4]. The purpose of the International Classification of Functioning, Disability and Health (ICF) is to capture this complexity and provide a broader picture of functioning than described by the diagnosis alone [5]. Within ICF, functioning is defined as a lifelong continuum where aspects of functioning and disability interact with the health condition and environmental factors [6], as well as personal factors [7]. Prognostic studies on work disability have demonstrated that personal factors such as beliefs and coping expectancies have a greater impact on health and RTW outcomes than the triggering disorder itself [7–9]. Previous experience with work while suffering from health complaints may influence functioning and work ability at a later stage. In the Cognitive Activation Theory of Stress (CATS) this relationship is explained as learned behaviour [10]. Previous experiences lead to an expectancy that one type of action leads to a certain consequence; referred to as response outcome expectancies in the CATS theory [10]. Individuals may have positive, negative or no expectancies on how they will react and handle different situations. Within the CATS theory, coping is defined as positive response outcome expectancy, and is essential to achieve positive results [10]. In contrast, no or negative response outcome expectancies, often referred to as helplessness and hopelessness, may lead to a negative result, such as ill health, poor work ability and functional ability [10]. It is demonstrated that positive outcome expectancy is related to recovery [9] and return to work [11]. Although studies have found conflicting results on how coping predicts return to work [12–14] one might, according to the CATS theory, assume that individuals with positive outcome expectancies (coping) are more likely to act positively toward RTW [13,14]. Hence, coping may be an independent characteristic of those who have returned to work after occupational rehabilitation regardless of health condition and functioning. This study aimed to examine if physical and mental functioning, coping and health complaints differed between individuals working and individuals on benefits three years after they had participated in a four-week inpatient interdisciplinary occupational rehabilitation program. Methods Design A cross-sectional survey was conducted.
Participants A total of 629 former rehabilitation clients were invited in January 2008 to take part in this study. The target population was all the individuals who had fulfilled a four-week inpatient occupational rehabilitation program during 2004. Information about the survey and a comprehensive questionnaire were sent by mail together with a pre-stamped envelope. A reminder was sent after approximately three weeks. Three hundred and fifty-eight (57%) individuals volunteered for the study by returning the questionnaire. No specific inclusion or exclusion criteria were composed for participating in the study. However, 20 of the respondents were excluded because of inaccurate answers about work or benefit status (Figure 1). Hence, 338 individuals (54%) were included in the study. The occupational rehabilitation centre where the rehabilitation was given is well established within the specialised health service in Norway. The centre offers an evidence-based program, building on research and best practice, to help people return to work. The rehabilitation program is designed for individuals on longterm sick leave due to subjective health complaints, mainly related to musculoskeletal and psychological complaints. The goal of the program is to improve coping and functional ability including the ability to work. The program is organised as an inpatient fourweek intervention, and includes a combination of individual and group-based sessions with physical activity, education, and cognitive behavioural modification. Coping and learning are important objectives for all activities offered. The rehabilitation program is carried out by an interdisciplinary team consisting of a physician, nurse, physiotherapist, physical activity instructor and a work consultant. The rehabilitation team identifies resources and barriers for RTW among the participants through interviews and examinations at the start of and at the end of the stay. A treatment plan is also developed together with the patient, with RTW as the main goal. Selection criterion for admission to the rehabilitation program is being on long-term sick leave and being motivated for RTW. Patients were admitted to the rehabilitation centre mainly based on referrals from their general practitioners (GPs). Prior to the admission the patient had to fill in a self-declaration form regarding motivation for work and own goals for the stay at the centre. Individuals with unsettled claims for disability pension and individuals with known alcohol or drug abuse are not admitted to the program. Measurements The questionnaire consisted of demographic questions about gender, age, marital status and level of
Functioning, coping and work status three years after participating 427 n=629 Number of questionnaires sent by mail
n=358 Number of individuals who answered and returned the questionnaires
n=20 Excluded because of inaccurate answers about work and benefit status
n=338 (100%) Number of participants included in the analysis
Working king ggroup n=198 (59%) Working or studying 50% or more: - working 100% (n=97) - working >50% (n=46) - working 50% (n=50) (out of these 50, 43 also received an allowance 50%) - studying (n=5)
Disability y pens pension (DP) n=84 (25%) Receiving disability pension, 50% or more: - DP 100% (n=56) - DP >50% (n=19) - DP 50% (n=9)
Other benefi benefits f and combination of benefits n=56 (16%) - Sick leave (n=23) - Medical rehabilitation (n=9) - Vocational rehab. (n=27) - Unemployed (n=2) - Work and DP 50% and 50 (25%) worked 50% of a full working day. In this last group 43 respondents in addition received either disability pension 50% (n= 34), or were on sick leave 50% (n=5), or received other benefits 50% (n=4) (Figure 1). Twenty-five percent (n=84) reported receiving at least 50% disability pension. None of the respondents receiving 50% disability pension (n=9) reported working. Sixteen percent (n=56) reported being on other benefits or on different combinations of benefits and work (working
