Interrelated Factors for Return to Work of Sick-Listed Employees in Sweden

We investigated two single items of the Work Ability Index - work ability score, and future work ability - as predictors of register-based disability pension and long-term sickness absence over a three-year follow-up. Survey responses of 11,131 Finnish employees were linked to pension and long-term (more than 10 days) sickness absence register data by Statistics Finland. Work ability score was divided into poor (0-5), moderate (6-7) and good/excellent (8-10) and future work ability into poor (1-2) and good (3) work ability at baseline. Cox proportional hazard regressions were used in the analysis of disability pension, and a negative binomial model in the analysis of long-term sickness absence. The results were adjusted for several background, work- and health-related covariates. Compared with those with good/excellent work ability scores, the hazard ratios of disability pension after adjusting for all covariates were 9.84 (95% CI 6.68-14.49) for poor and 2.25 (CI 95% 1.51-3.35) for moderate work ability score. For future work ability, the hazard ratio was 8.19 (95% CI 4.71-14.23) among those with poor future work ability. The incidence rate ratios of accumulated long-term sickness absence days were 3.08 (95% CI 2.19-4.32) and 1.59 (95% CI 1.32-1.92) for poor and moderate work ability scores, and 1.51 (95% CI 0.97-2.36) for poor future work ability. The single items of work ability score and future work ability predicted register-based disability pension equally well, but work ability score was a better predictor of register-based long-term sickness absence days than future work ability in a three-year follow-up. Both items seem to be of use especially when examining the risk of poor work ability for disability but also for long sick leave.

Background A main goal during the return to work (RTW) process after a long-term sickness absence due to common mental disorders (CMDs), is to restore and maintain an employees’ work ability to enable sustained work participation. To date, surprisingly little research has examined the concept of work ability during the RTW process with CMDs. To better understand how to restore employees’ work ability during RTW with CMDs, both quantitative and qualitative research is needed. The goal of this mixed methods study is to expand the understanding of restoring work ability during the RTW process with CMDs. Methods In this mixed methods follow-up study of N = 286 participants, work ability was quantitatively assessed with the Work Ability Score (WAS, range 0-10) at five measurement points (0, 6, 12, 18 and 30 months) during 30 months of follow-up. In a sub-sample, the qualitative work ability experiences of N = 32 participants were jointly analysed with their quantitative work ability ratings at 6 and 12 months. Results In the joint analysis, three groups of qualitative work ability experiences together with their respective quantitative work ability ratings emerged: Employees with (1) poor work ability (WAS 0-3), who did not RTW yet and described great difficulties in coping with everyday life; (2) moderate work ability (WAS 4-6), who mainly did RTW, but still showed a certain level of fragility; and (3) good to very good work ability (WAS 7-10), who mainly returned within 12 months and reported many individual and work accommodations to restore and maintain their work ability. Conclusions The joint evaluation of work ability ratings and experiences allowed a deeper understanding of restoring work ability during the RTW process. This knowledge may help occupational health professionals and other key RTW stakeholders to provide more tailored support during the RTW process and to promote a sustainable RTW for employees with CMDs. Key messages • Restoring and maintaining the work ability of employees with common mental disorders during the return to work process is crucial for their sustained work participation. • Achieving a good to very good work ability helps returning employees with common mental disorders to ‘stay and thrive’ at work again.

Purpose Individual psychosocial factors are crucial in the return to work (RTW) process of workers with musculoskeletal disorders (MSDs) and common mental disorders (CMDs). However, the quality and validity of the questionnaires used to measure these factors have rarely been investigated. The present systematic search and literature review aims at identifying, categorizing, and evaluating the questionnaires (measurement tools) used to measure individual psychosocial factors related to the perception of the personal condition and motivation to RTW that are predictive of successful RTW among workers with MSDs or CMDs. Methods Through a systematic search on PubMed, Web of Science, and PsycINFO library databases and grey literature, we identified the individual psychosocial factors predictive of successful RTW among these workers. Then, we retrieved the questionnaires used to measure these factors. Finally, we searched for articles validating these questionnaires to describe them exhaustively from a psychometric and practical point of view. Results: The review included 76 studies from an initial pool of 2263 articles. Three common significant predictors of RTW after MSDs and CMDs emerged (i.e., RTW expectations, RTW self-efficacy, and work ability), two significant predictors of RTW after MSDs only (i.e., work involvement and the self-perceived connection between health and job), and two significant predictors of RTW after CMDs only (i.e., optimism and pessimism). We analyzed 30 questionnaires, including eight multiple-item scales and 22 single-item measures. Based on their psychometric and practical properties, we evaluated one of the eight multiple-item scales as questionable and five as excellent. Conclusions: With some exceptions (i.e., self-efficacy), the tools used to measure individual psychosocial factors show moderate to considerable room for improvement.

Comorbidity is common among long-term sick-listed and many prognostic factors for return to work (RTW) are shared across diagnoses. RTW interventions have small effects, possibly due to being averaged across heterogeneous samples. Identifying subgroups based on prognostic RTW factors independent of diagnoses might help stratify interventions. The aim of this study was to identify and describe subgroups of long-term sick-listed workers, independent of diagnoses, based on prognostic factors for RTW. Latent class analysis of 532 workers sick-listed for eight weeks was used to identify subgroups based on seven prognostic RTW factors (self-reported health, anxiety and depressive symptoms, pain, self-efficacy, work ability, RTW expectations) and four covariates (age, gender, education, physical work). Four classes were identified: Class 1 (45% of participants) was characterized by favorable scores on the prognostic factors; Class 2 (22%) by high anxiety and depressive symptoms, younger age and higher education; Class 3 (16%) by overall poor scores including high pain levels; Class 4 (17%) by physical work and lack of workplace adjustments. Class 2 included more individuals with a psychological diagnosis, while diagnoses were distributed more proportionate to the sample in the other classes. The identified classes illustrate common subgroups of RTW prognosis among long-term sick-listed individuals largely independent of diagnosis. These classes could in the future assist RTW services to provide appropriate type and extent of follow-up, however more research is needed to validate the class structure and examine how these classes predict outcomes and respond to interventions.

Despite suggestions that worker perception might be the best predictor of return to work (RTW), there still is limited research on time to RTW in workers with lengthy non-work-related sick leave. Prospective cohort study of 663 workers with a current long-term non-work-related sick leave episode recruited during the first medical visit in a mutua (Spanish health insurance company) and followed until their sick leave episode ended. Workers completed a baseline questionnaire regarding their perceptions of sick leave episode and expectations of RTW (i.e., health status, work ability, expectations and time required to RTW, self-efficacy and self-perceived connection between health and job). Time to RTW was established based on the mutua's register. Cox regression models were used to examine the associations of worker perception and expectation of RTW with time to RTW within the study population as a whole as well as in three diagnostic subgroups (i.e., musculoskeletal disorders, mental disorders and other physical conditions). As a whole, time to RTW was longer for workers reporting poor health [hazard ratio (HR) = 0.71, 95%CI 0.59-0.85], extremely reduced work ability (HR = 0.69, 95%CI 0.53-0.88), a longer period of time required to RTW (HR = 0.36, 95%CI 0.25-0.52) and lack of expectation of returning to the same job (HR = 0.13, 95%CI 0.06-0.31). Workers with musculoskeletal and other physical conditions showed a similar pattern to whole study population, while workers with mental disorders did not. Self-required time and RTW expectations are important prognostic factors in sick listed workers by all types of health conditions certified as non-work-related. Questioning the workers on their perceptions and expectations of RTW during medical visits could help health care professionals to identify individuals at risk of long-term sickness absence and facilitate triage and management of the patient.

A main goal during the return to work (RTW) process after a long-term sickness absence due to common mental disorders (CMDs), is to restore and maintain employees' work ability to enable their sustained work participation. This study jointly examined employees' work ability ratings and experiences during their RTW process with CMDs. In a mixed methods follow-up study of N = 286 participants, work ability was quantitatively assessed with the Work Ability Score (WAS, range 0-10) at baseline (week before clinical discharge) and after 6, 12, 18, and 30months. In a sub-sample, the qualitative work ability experiences of N = 32 participants were analysed at 6 and 12months, and were jointly evaluated with the quantitative data. The mean WAS increased during the first 18months of follow-up. Three groups of qualitative work ability experiences emerged: Employees with (1) poor work ability (WAS 0-3), who did not RTW yet and described great difficulties in coping with everyday life, (2) moderate work ability (WAS 4-6), who mainly did RTW, but still showed a certain level of fragility, and (3) good to very good work ability (WAS 7-10), who mainly returned to work and reported many individual and work accommodations to maintain their work ability. The present study provides new insights into different aspects of work ability experiences, especially during the later RTW phases, where restoring and maintaining work ability is essential for a sustained work participation. This knowledge may help RTW stakeholders to better tailor support during the RTW process.

Purpose To examine the associations between illness perceptions and expectations about full return to work (RTW) of workers with chronic diseases and their significant others. Methods This study used cross-sectional data of 94 dyads consisting of workers with chronic diseases and their significant others. We performed dyadic analyses based on the Actor-Partner Interdependence Model (APIM), estimating associations of illness perceptions of the two members of the dyad with their own expectations about the worker’s full RTW within six months (actor effect) as well as with the other dyad member’s expectations about the worker’s RTW (partner effect). Results Illness perceptions of one dyad member were significantly associated with his or her own RTW expectations (actor effect composite illness perceptions score; B = −0.05, p < .001; rd = .37) and with the other dyad member’s RTW expectations (partner effect composite illness perceptions score; B = −0.04, p < .001; rd = .35). That is, more negative illness perceptions of one member of the dyad were associated with more negative RTW expectations in both dyad members. For most illness perception domains, we found small to moderate actor and partner effects on RTW expectations (rd range: .23–.44). Conclusions This study suggests that illness perceptions and RTW expectations should be considered at a dyadic level as workers and their significant others influence each other’s beliefs. When trying to facilitate adaptive illness perceptions and RTW expectations, involving significant others may be more effective than an individualistic approach targeted at the worker only.

A significant problem in Sweden is the large number of people on long-term sickness absence and disability pension. To prevent long-term absenteeism, increased focus has been put on employers and disability management (DM). Effective DM, however, also requires a motivated employee. One way to motivate employees to return to work (RTW), is to provide economic incentives. The aim of the current study was to investigate the occurrence of economic incentives for people in Sweden to RTW after long-term sickness absence. The study is based on three fictitious cases. The results show that only marginal economic incentives presently exist in the Swedish RTW system. The necessity for economic incentives in the RTW process can, of course, be usefully debated. Research suggests, however, that such incentives play a part in the RTW process. With stronger economic incentives for the employee, the effectiveness of DM and prospects of job return would, arguably, be enhanced.

With the overall objective of providing implication for clinical and research practices regarding the identification and measurement of modifiable predicting factors for return to work (RTW) in people with musculoskeletal disorders (MSDs) and common mental disorders (CMDs), this study 1) systematically examined and synthetized the research evidence available in the literature on the topic, and 2) critically evaluated the tools used to measure each identified factor. A systematic search of prognostic studies was conducted, considering four groups of keywords: 1) population (i.e., MSDs or CMDs), 2) study design (prospective), 3) modifiable factors, 4) outcomes of interest (i.e., RTW). Studies showing high risk of bias were eliminated. Tools used to measure prognostic factors were assessed using psychometric and usability criteria. From the 78 studies that met inclusion criteria, 19 (for MSDs) and 5 (for CMDs) factors reaching moderate or strong evidence were extracted. These factors included work accommodations, RTW expectations, job demands (physical), job demands (psychological), job strain, work ability, RTW self-efficacy, expectations of recovery, locus of control, referred pain (back pain), activities as assessed with disability questionnaires, pain catastrophizing, coping strategies, fears, illness behaviours, mental vitality, a positive health change, sleep quality, and participation. Measurement tools ranged from single-item tools to multi-item standardized questionnaires or subscales. The former generally showed low psychometric properties but excellent usability, whereas the later showed good to excellent psychometric properties and variable usability. The rigorous approach to the selection of eligible studies allowed the identification of a relatively small set of prognostic factors, but with a higher level of certainty. For each factor, the present tool assessment allows an informed choice to balance psychometric and usability criteria.

Despite the importance and cost of workers' compensation (WC)-based vocational rehabilitation (VR) programs, outcome evaluations are rare, in part due to the scarcity of suitable comparison groups. The aims of this study were to assess (1) the adequacy of a commonly recommended internal comparison group, i.e., workers who were eligible for but did not receive services, and (2) return-to-work (RTW) expectations as a potential source of bias. In this prospective cohort study, we used WC claims data and worker-reported RTW expectations to compare workers who received vocational retraining services to eligible workers who did not receive such services. Workers were surveyed after retraining eligibility determination, prior to the initiation of retraining activities. VR progress and RTW wage outcomes were followed for 3 years. The magnitude of confounding contributed by RTW expectations and other covariates was quantified. Workers who were somewhat or very certain they would RTW had significantly better outcomes. RTW expectations played a strong confounding role, reducing the retraining plan effect estimate by about 23 %, while education and physical capacity each changed the effect estimate by <5 %. RTW expectations predicted long-term RTW outcomes and can play a strong confounding role if unmeasured. We found that the internal comparison group approach, commonly recommended for VR program evaluation, is inappropriate for WC-based VR evaluations. Ultimately, there is no simple solution to the challenge of identifying a comparison group; however, measurement of RTW expectations, an easily-measured multi-dimensional construct, may be a useful addition to the VR evaluation toolbox.

PurposeTo assess: (1) whether work ability and work-functioning instruments can detect relevant changes in their respective parameters following a return to work (RTW) and (2) what proportion of those returning to work show changes in their work ability and work functioning.MethodsA total of 1073 workers who returned to work after at least 2 weeks of sick leave were invited to fill out three questionnaires in the first 8 weeks after RTW. These consisted of an appraisal of general, physical, and mental/emotional work ability (scores 0–10) and a work-functioning questionnaire (scores 0–100). Minimal Important Change (MIC) was defined to determine the proportion of people, whose scores had changed at weeks 5 and 8 following RTW. The Smallest Detectable Change (SDC) was determined to put the MIC in perspective of measurement error.ResultsOf all participants, 235 were eligible for the analysis. All MIC values were below the SDC and thus not suitable for use. The SDC for work ability was 2.2 and 19.9 for work functioning. In the first 5 weeks after RTW, 10–15% showed a relevant, measurable improvement in work ability, and work functioning based on the SDC margins.ConclusionsBoth instruments were unable to identify change after RTW adequately. We can conclude that 10–15% of individuals showed improvement in work ability and work functioning in the first 5 weeks after RTW when SDC is used.

BackgroundTo investigate differences in return to work (RTW) and employment trajectories in individuals on sick leave for either mental health reasons or other health related reasons.MethodsThis study was based on 2036 new sickness absence cases who completed a questionnaire on social characteristics, expectations for RTW and reasons for sickness absence. They were divided into two exposure groups according to their self-reported sickness absence reason: mental health reasons or other health reasons. The outcome was employment status during the following 51 weeks and was measured both as time-to-event analysis and with sequence analysis.ResultsIndividuals with mental health reasons for sickness absence had a higher risk of not having returned to work (RR 0.87 (0.80;0.93)). Adjusting for gender, age, education and employment did not change the estimate, however, after adding RTW expectations to the model, the excess risk was no longer present (RR 1.01 (0.95;1.08)). In relation to the sequence analysis, individuals with mental health related absence had significantly higher odds of being in the sickness absence cluster and significantly lower odds for being in the fast RTW cluster, but when adjusting for RTW expectations, the odds were somewhat attenuated and no longer significant.ConclusionsEmployees on sick leave due to self-reported mental health problems spent more weeks in sickness absence and temporary benefits and had a higher risk of not having returned to work within a year compared to employees on sick leave due to other health reasons. The difference could be explained by their lower RTW expectations at baseline. This emphasises the need to develop suitable and specific interventions to facilitate RTW for this group of sickness absentees.

BackgroundImpaired work ability and reduced life satisfaction due to long-term musculoskeletal pain, particularly in neck, shoulders and back, are considered occupational health problems that can result in workers taking sick leave. The aim of the study was to determine whether work ability and life satisfaction predict return to work (RTW) among women with long-term neck/shoulder and/or back pain, and to assess the ability of the Work Ability Index (WAI) and the Life Satisfaction Questionnaire (LiSat-11) to discriminate between those who did RTW and those who did not RTW (NRTW).MethodsThis is a cohort study with 1-year follow-up. A survey was sent to 600 women receiving sick leave benefits from the Swedish Social Insurance Agency. In total, 208 women responded at baseline, and 141 at a 1-year follow-up. To identify whether work ability and life satisfaction predicted RTW, multiple logistic regression analyses were performed with and without adjustment for type of work and pain intensity. To assess the discriminative ability of the WAI and the LiSat-11 for women who did RTW and those who did NRTW, receiver operating characteristic curves were fitted.ResultsWork ability predicted RTW, and the results remained significant after adjusting for type of work and pain intensity (OR 1.12, 95% CI: 1.04–1.22). Life satisfaction was not significant. The WAI at baseline adequately discriminated between RTW and NRTW after 1 year (Area under curve 0.78, 95% CI: 0.70–0.86), but the LiSat-11 did not.ConclusionsThis study supports a relationship between work ability and RTW among women on sick leave for long-term neck/shoulder and/or back pain. The results indicate that the WAI, but not the LiSat-11, can discriminate between RTW and NRTW in the population under study. Although the discriminative ability of the WAI needs to be verified in new samples before it can be recommended for use in rehabilitation settings, we suggest that healthcare professionals consider how women perceive their work ability in order to better support them in their RTW.

BackgroundThe aim of the RCT study was to investigate if the effect of a multidisciplinary intervention on return to work (RTW) and health care utilization differed by participants’ self-reported health status at baseline, defined by a) level of somatic symptoms, b) health anxiety and c) self-reported general health.MethodsA total of 443 individuals were randomized to the intervention (n = 301) or the control group (n = 142) and responded to a questionnaire measuring health status at baseline. Participants were followed in registries measuring RTW and health care utilization. Relative risk (RR) and odds ratio (OR) were used as measures of associations. Results were adjusted for gender, age, educational level, work ability and previous sick leave.ResultsAmong all responders we found no effect of the intervention on RTW. Among participants with low health anxiety, the one-year probability of RTW was lower in the intervention than in the control group (RR = 0.79 95 % CI 0.68-0.93), but for those with high health anxiety there was no difference between the groups (RR = 1.15 95 % CI 0.84-1.57). Neither general health nor somatic symptoms modified the effect of the intervention on RTW. The intervention had no effect on health care utilization.ConclusionsThe multidisciplinary intervention did not facilitate RTW or decrease health care utilization compared to ordinary case management in subgroups with multiple somatic symptoms, health anxiety or low self-rated health. However, the intervention resulted in a reduced chance of RTW among participants with low health anxiety levels.Trial registrationISRCTN43004323, and ISRCTN51445682

Purpose This research sought to determine whether there is a relationship between claimants’ expected time to return to work (RTW) as recorded by claims managers and compensated days of work disability. Methods We utilized workers’ compensation data from a large, United States-based insurance company. RTW expectations were collected within 30 days of the claim being reported and these were compared with the termination of total temporary indemnity payments. Bivariate and hierarchical regression analyses were conducted. Results A significant relationship between expected time to RTW and compensated disability duration was observed. The unadjusted correlation between work-disability duration and expected time to RTW was .25 (p < .001). Our multivariate model explained 29.8 % of the variance, with expected time to RTW explaining an additional 9.5 % of the variance in work-disability duration beyond what was explained by the covariates. Conclusion The current study’s findings support the hypothesis that claimant RTW estimates as recorded by claims managers are significantly related to compensated-disability duration, and the relationship is maintained after controlling for variance that can be explained by other variables available within workers’ compensation databases.