Occupational Rehabilitation Program Research Articles

Efficacy of occupational rehabilitation in return to work for back pain: A systematic literature review.

Currently, there is no standard procedure for a return to work (RTW) rehabilitation program used by practitioners. The aim is to investigate the efficacy of occupational rehabilitation programs for workers with back pain. Two independent reviewers screened abstracts and full-text articles in a systematic literature search in three databases conducted in 2023. Subsequently, they extracted data according to the PRISMA Statement. Among the 4,010 articles retrieved, 20 met the inclusion criteria. Data from accepted studies were abstracted into tables relating to the RTW, improvement of pain intensity, quality of life (QOL), and degree of disability in persons with back pain. The risk of bias was assessed using the (SIGN)-criteria. Significant improvements in RTW were shown by a workplace intervention with a physical approach and a multidisciplinary intervention but with a wide range of effect sizes. Five studies showed significant improvements in pain intensity and QOL, six studies observed significant improvements in disability. The studies that stated positive effects on work-related data differed between intervention programs and traditional care. A combination of activity, maintenance therapy, stretching, and manual therapy showed promising results in improving RTW. In addition, the relationship and mediation between employer/workplace and employee seems to be an important aspect of RTW. However, pain intensity, disability, and QOL were enhanced with interventions that included a high proportion of physical activity. However, the intervention programs differed widely, leading to the assumption that the treatment effect of the intervention programs is not established, yet.

Effects of Inpatient Occupational Rehabilitation vs. Outpatient Acceptance and Commitment Therapy on Sick Leave and Cost of Lost Production: 7-Year Follow-Up of a Randomized Controlled Trial.

Previously, we reported that an inpatient multimodal occupational rehabilitation program (I-MORE) was more effective than outpatient Acceptance and Commitment Therapy (O-ACT) in reducing sickness absence and was cost-effective over a 24-month period. Here we present 7-years of follow-up on sick leave and the cost of lost production. We randomized individuals aged 18-60, sick-listed due to musculoskeletal or mental health disorders to I-MORE (n = 82) or O-ACT (n = 79). I-MORE, lasting 3.5weeks, integrated ACT, physical training, and work-related problem-solving. In contrast, O-ACT mainly offered six weekly 2.5h group sessions of ACT. We measured outcomes using registry data for days on medical benefits and calculated costs of lost production. Our analysis included regression analyses to examine differences in sickness absence days, logistic general estimating equations for repeated events, and generalized linear models to assess differences in costs of lost production. Unadjusted regression analyses showed 80 fewer days of sickness absence in the 7-year follow-up for I-MORE compared to O-ACT (95% CI -264 to 104), with an adjusted difference of 114 fewer days (95% CI -298 to 71). The difference in costs of production loss in favour of I-MORE was 27,048 euros per participant (95% CI -35,009 to 89,104). I-MORE outperformed O-ACT in reducing sickness absence and production loss costs during seven years of follow-up, but due to a limited sample size the results were unprecise. Considering the potential for substantial societal cost savings from reduced sick leave, there is a need for larger, long-term studies to evaluate return-to-work interventions.

Comparison of bihemispheric and unihemispheric M1 transcranial direct current stimulations during physical therapy in subacute stroke patients: A randomized controlled trial

BackgroundDespite the central origin of stroke affecting the primary motor cortex M1, most physical and occupational rehabilitation programs focus on peripheral treatments rather than addressing the central origin of the problem. This highlights the urgent need for effective protocols to improve neurological rehabilitation and achieve better long-term functional outcomes. ObjectivesOur hypothesis was that the bihemispheric delivery of transcranial direct current stimulation (tDCS) is superior to unihemispheric in enhancing motor function after stroke, in both the upper and lower extremities. Methods35 sub-acute ischemic stroke survivors were randomly divided into three groups: bihemispheric and unihemispheric treatment groups, or sham groups. Each participant received a 20-minute session of tDCS with an intensity of 2 mA during physical therapy sessions, three days a week, for four weeks. The outcomes were measured using Fugl-Meyer assessment scale, modified Ashworth scale, Berg balance scale, and serum brain-derived neurotrophic factor (BDNF) levels. ResultsOne-way ANOVA test indicated a significant effect of both treatment protocols on the upper extremity (p = < 0.001) and lower extremity (p = .034) for motor measures, but there was no difference between the two (p = .939). Kruskal Wallis test for spasticity showed a significant improvement in both treatment groups for elbow (p = .036) and wrist flexors (p = .025), compared to the sham group. However, there was no statistically significant difference in spasticity between uni- and bihemispheric stimulation for elbow (p = .731) or wrist flexors (p = .910). ConclusionThere is no statistically significant difference in efficacy between bihemispheric and unihemispheric tDCS in patients presenting with acute ischemic stroke. .

The Effectiveness of a Social Rehabilitation Program based on Social-Cognitive Theory on the Self-Efficacy of People with Spinal Cord Injury

Aim: Spinal cord injury is one of the problems of human societies that changes the path of individual’s life and creates a great number of problems in physical, psycological, job, ecoconomic, and family aspects. The purpose of this study is to focus on the self-efficacy of people with spinal cord injury.&#x0D; Methods: For this research, single case study was used. For this, purposive sampling was used and 3 people with spinal cord injury were selected receiving 8 sessions of individual intervention, and occupational rehabilitation program training based on social cognitive theory. For data collection, Lutans psychological capital questionnaire was used. The results were analyzed using visual analysis, change reliability index (RCI), and recovery percentage (MPI).&#x0D; Findings: The results showed that a rehabilitation program based on social cognitive theory can increase the self-efficacy of people with spinal cord injury (1/96).&#x0D; Conclusion: By using a vocational rehabilitation program and social cognitive theory, in which guidance and skills training, such as substitution training or role modeling, social encouragement, positive feedback, stimulation of psychological capital, as well as providing information were utilized. This showed self-efficacy can be increased in people with spinal cord injury.

A Modified Version of the Forgotten Joint Score-12 in Lower Limb Amputees: Validity and Reliability Study.

Adaptation to prosthesis is important for occupation, quality of life, and participation in social life, so it needs to be evaluated. The aim of this study was to determine the validity and reliability of the Forgotten Joint Score-12 (FJS-12) in lower limb amputees. The FJS-12 was applied to 80 amputees. Criterion-referenced validity was assessed using the activity restriction subparameter of Trinity Amputation and Prosthesis Experience Scale (TAPES). The internal consistency of the FJS-12 was high (Cronbach's α = .943). A statistically significant very good negative correlation was determined between the FJS-12 and the activity restriction subparameter of TAPES (r = -.641; p < .001). The results of this study showed that FJS-12 is a valid and reliable measurement tool that can be used to assess the adaptation to prosthesis in amputees. Evaluation of prosthesis awareness in daily living activities of amputees is important in terms of establishing occupational therapy and rehabilitation programs.

Return-to-Work Following Occupational Rehabilitation for Long COVID: Descriptive Cohort Study.

BackgroundEmerging evidence suggests that worldwide, between 30% and 50% of those who are infected with COVID-19 experience long COVID (LC) symptoms. These symptoms create challenges with return-to-work (RTW) in a high proportion of individuals with LC. To tailor rehabilitation programs to LC sequelae and help improve RTW outcomes, more research on LC rehabilitation program outcomes is needed.ObjectiveThis study describes the characteristics and outcomes of workers who participated in an LC occupational rehabilitation program.MethodsA cohort study was conducted. Descriptive variables included demographic and occupational factors as well as patient-reported outcome measures (PROMs, ie, the Fatigue Severity Scale [FSS], the Post-COVID Functional Scale [PCFS], the 36-item Short Form Health Survey [SF-36], the Pain Disability Index [PDI], the pain Visual Analogue Scale [VAS], the 9-item Patient Health Questionnaire [PHQ-9], the 7-item Generalized Anxiety Disorder Questionnaire [GAD-7], and the Diagnostic and Statistical Manual for Mental Disorders Fifth Edition [DSM-5] posttraumatic stress disorder [PTSD] checklist [PCL-5]). The main outcome variable was the RTW status at discharge. Descriptive statistics were calculated. Logistic regression examined predictors of RTW.ResultsThe sample consisted of 81 workers. Most workers were female (n=52, 64%) and from health-related occupations (n=43, 53%). Only 43 (53%) individuals returned to work at program discharge, with 40 (93%) of these returning to modified duties. Although there were statistically significant improvements on the pain VAS (mean 11.1, SD 25.6, t31=2.5, P=.02), the PDI (mean 9.4, SD 12.5, t32=4.3, P<.001), the FSS (mean 3.9, SD 8.7, t38=2.8, P=.01), the SF-36 PCS (mean 4.8, SD 8.7, t38=–3.5, P=.001), the PHQ-9 (mean 3.7, SD 4.0, t31=5.2, P<.001), and the GAD-7 (mean 1.8, SD 4.4, t22=1.8, P=.03), there were no significant improvements in the PCFS, the overall mental component score (MCS) of the SF-36, or on the PCL-5. The availability of modified duties (odds ratio [OR] 3.38, 95% CI 1.26-9.10) and shorter time between infection and admission for rehabilitation (OR 0.99, 95% CI 0.99-1.00) predicted RTW even when controlling for age and gender.ConclusionsWorkers undergoing LC rehabilitation reported significant but modest improvements on a variety of PROMs, but only 43 (53%) returned to work. Outcomes would likely improve with increased availability of modified duties and timelier rehabilitation. Additional research is needed, including larger observational cohorts as well as randomized controlled trials to evaluate the effectiveness of LC rehabilitation.

Service user perspectives on engagement in an occupational therapy-led pulmonary rehabilitation programme: A qualitative interview study

Introduction Pulmonary rehabilitation (PR) is an intervention for people with chronic respiratory conditions. There are questions about which components are important to its success, including the nature of occupational therapy involvement. The aim of this research was to explore the experiences of people who had attended an occupational therapy-led PR programme in the United Kingdom to determine the most important components. Method Semi-structured telephone interviews were conducted with service users who had experience of a community-based PR programme. Interviews were transcribed verbatim. Data were analysed using the framework analysis method with three researchers contributing to the analysis. Findings Nine people took part in the interviews, with a mean age of 72 years. Four themes were identified which were organised around the concepts of Doing, Being, Becoming Belonging. These were ‘Doing exercise and physical activity’, ‘being breathless’, ‘belonging as an individual within the group’ and ‘becoming a person who lives with Chronic Obstructive Pulmonary Disease’. Conclusion Doing physical activity, whilst coping with being breathless and belonging as an individual within a group can positively influence experiences and perceived outcomes during and after PR. These dimensions have the potential to shape occupation-focussed PR programmes and the occupational therapy contribution in this area of practice.

The impact of an occupational therapy group cognitive rehabilitation program for people with dementia.

IntroductionThis study was conducted to examine the impact of a group cognitive rehabilitation program for people with dementia on everyday memory function and quality of life.MethodsParticipants included in the study were community‐dwelling adults with a diagnosis of dementia. The intervention was a 5‐week occupational therapy lead group cognitive rehabilitation program delivered once a week for 1.5 h. Outcome measures included standardised memory tests, subjective everyday memory function and quality of life ratings. The measures were completed at baseline, post‐intervention and 3‐month post‐intervention.ResultsOutcome measures were completed with 58 participants. Statistically significant improvements in standardised memory scores were noted following the intervention. Similarly, self‐rated everyday memory function and quality of life scores significantly improved following the intervention. All standardised scores and subjective ratings were maintained at 3‐month follow‐up.ConclusionGroup‐based cognitive rehabilitation programs can positively impact the quality of life and everyday memory function among people with dementia.

The Effectiveness of Case-management Rehabilitation Intervention in Facilitating Return to Work and Maintenance of Employment After Myocardial Infarction: Results of a Randomized Controlled Trial

Objective To study the long-term effectiveness of case-management rehabilitation intervention on vocational reintegration of patients after myocardial infarction (MI). Design Blinded simple randomization was used to construct an intervention and control groups that were followed up for two years. Subjects and setting 151 patients, aged 50.3 ± 5.9 years, who experienced uncomplicated MI and were enrolled in a cardiac rehabilitation program were recruited. Interventions included an early referral to an occupational physician, tailoring an occupational rehabilitation program, based on individual patient needs, coordination with relevant parties, psychosocial intervention, intensive follow-up sessions during a two-year follow-up. Main measures Return to work within six months of hospitalization and maintenance of employment at one and two years of follow-up. Results Return-to-work (RTW) rate in the intervention group was 89% and nearly all maintained employment at one year of follow-up (92%) and two years of follow-up (87%). Moreover, almost all of them returned to and maintained their previous jobs. The corresponding figures were: 98%, 94% and 98%, respectively. The figures for the RTW and employment maintenance for the control group were: 74%, 75%, and 72%, respectively. Only about 75%, in this group kept their previous job. The case-management intervention was associated with increased odds of maintaining employment at follow-up of one year (OR = 5.89, 95% CI 1.42–24.30) and two years (OR = 3.12, 95% CI 1.01–10.03). Conclusions The extended case-management rehabilitation intervention had a substantial positive impact on both the RTW of MI patients and their maintenance of employment at one and two years of follow-up. Trial Registration This trial is registered at US National Institutes of Health #NCT04934735.

Les politiques d’assistance envers les vétérans infirmes au Japon durant le 20ème siècle

Abstract The following study provides an insight into Japanese policies on wounded veterans’ relief during the twentieth century. During the long war (1937–1945) with China and later with the Allied Forces (1941–1945), the Japanese government established strong physical, occupational and spiritual rehabilitation programs in addition to several laws that provided pensions or allowances for military disabilities. After the defeat in 1945, under the Occupation’s new rules of democratization and demilitarization, wounded veterans quickly lost all their benefits. Furthermore, their image was devalued in the eyes of society and their voices were marginalized. However, because of their struggles, the State established a new non-discriminatory law for all disabled people. Nevertheless, after the return of Japanese autonomy in 1952, the wounded veterans still felt that they were not treated adequately because no law addressed their specific circumstances. In order to attain their goal, they created a new association of disabled veterans to express their frustration and to lobby the Japanese government for change. Because of their stubborn mobilization, the Law for Special Aid to the Wounded and Sick Retired Soldiers was finally enacted in 1963 and provided veterans with the assistance they needed and for which they had long-since been asking.

Comparison of Two Multidisciplinary Occupational Rehabilitation Programs Based on Multimodal Cognitive Behavior Therapy on Self-Rated Health and Work Ability.

Objective: Musculoskeletal pain and common mental disorders constitute the largest proportion of people who are on sick leave. This study investigated the efficacy of two multidisciplinary occupational rehabilitation programs on self-rated health and work-related outcomes. The interventions were identical in content but differed in length. It was hypothesized that a longer inpatient program would yield greater improvements than a shorter outpatient program.Methods: Patients were sick-listed workers referred to occupational rehabilitation by the Norwegian Labor and Welfare Administration. A non-randomized 2 Condition (20 days, n = 64 versus 12 days, n = 62) × 4 repeated measures (start, end, 3 months, 12 months) between-subject design was used. Both programs were based on multimodal cognitive behavior therapy with a return-to-work focus. Health-related questionnaires were the Subjective Health Complaints inventory, Hospital Anxiety and Depression Scale, and SF-36 Bodily Pain. Work-related questionnaires were the Work Ability Index, the Fear-Avoidance Beliefs Questionnaire, Return To Work Self-Efficacy, and Return To Work expectations. Intervention effects were estimated using linear mixed models and Cohen’s d.Results: The results revealed that both groups improved on the selected outcomes. Within-group contrasts and effect sizes showed that the inpatient group showed larger effect sizes at the end of rehabilitation and 12 months post-intervention for work-related outcomes than the outpatient group.Conclusion: Both programs were efficacious in improving health- and work-related outcomes during and after rehabilitation, but the inpatient group generally displayed stronger and more rapid improvements and was more stable at one-year postintervention.

Two-Year Follow-Up of a Randomized Clinical Trial of Inpatient Multimodal Occupational Rehabilitation Vs Outpatient Acceptance and Commitment Therapy for Sick Listed Workers with Musculoskeletal or Common Mental Disorders

Purpose There is a lack of results on long-term effects of return to work interventions. We previously reported that an inpatient multimodal occupational rehabilitation program (I-MORE) was more effective in reducing sickness absence and facilitating return to work (RTW) at 12 months follow-up compared to an outpatient program that consisted mainly of Acceptance and Commitment Therapy (O-ACT). We now report the 2-year outcome data. Methods A randomized clinical trial with parallel groups. Participants were 18–60 years old, sick listed with musculoskeletal, common mental or general/unspecified disorders. I-MORE lasted 3.5 weeks and consisted of ACT, physical training and work-related problem solving. O-ACT consisted mainly of 6 weekly sessions (2.5 h. each) of ACT in groups. Outcomes were cumulated number of days on medical benefits and time until sustainable RTW (1 month without medical benefits) during 2-years of follow-up, measured by registry data. Results For the 166 randomized participants, the median number of days on medical benefits was 159 (IQR 59–342) for I-MORE vs 249 days (IQR 103–379; Mann–Whitney U test, p = 0.07), for O-ACT. At 2 years, 40% in I-MORE received long-term benefits (work assessment allowance) vs 51% in O-ACT. The crude hazard ratio (HR) for sustainable RTW was 1.59 (95% CI 1.04–2.42, p = 0.03) and the adjusted HR 1.77 (95% CI 1.14–2.75, p = 0.01), in favor of I-MORE. Conclusions The 2-year outcomes show that I-MORE had long-term positive effects on increasing work participation for individuals sick listed with musculoskeletal and mental disorders. Further follow-up and economic evaluations should be performed.

Comparing two interdisciplinary occupational rehabilitation programs for employees on sick leave: a mixed-method design study protocol

BackgroundMusculoskeletal disorders (MSDs) and common mental disorders (CMDs) are the most frequent reasons for long-term sick leave and work disability. Occupational rehabilitation programs are used to help employees return to work (RTW). However, knowledge regarding the effect of these programs is scarce, and even less is known about which programs are best suited for which patients. This study aims to compare the RTW results of two interdisciplinary occupational rehabilitation programs in Norway, as well as to examine the delivery and reception of the two programs and explore the active mechanisms of the participants’ RTW processes.Methods/designWe will use a mixed-method convergent design to study the main outcome. Approximately 600 participants will be included in the study. Eligible study participants will be aged 18–60 years old and have been on sick leave due to MSDs, CMDs, or both for at least 6 weeks. Interdisciplinary teams at both participating clinics will deliver complex occupational rehabilitation programs. The inpatient rehabilitation program has a duration of 4 weeks and is full time. The outpatient program has a duration of 3 months and involves weekly sessions. The primary outcome is RTW. Secondary outcomes are differences in the incremental cost for an averted sick leave day, cost utility/benefit, and differences between the programs regarding improvements in known modifiable obstacles to RTW. Subgroup analyses are planned. The researchers will be blinded to the intervention groups when analyzing the quantitative RTW data.DiscussionThis study aims to provide new insights regarding occupational rehabilitation interventions, treatment targets, and outcomes for different subgroups of sick-listed employees and to inform discussions on the active working mechanisms of occupational rehabilitation and the influence of context in the return-to-work process.Trial registrationCurrent controlled trials ISRCTN12033424, 15.10.2014, retrospectively registered.

Effectiveness of adding a workplace intervention to an inpatient multimodal occupational rehabilitation program: A randomized clinical trial.

ObjectivesThis study aimed to evaluate the effectiveness of a workplace intervention (WI) added to an inpatient multimodal occupational rehabilitation program (I-MORE) on sickness absence.MethodsIn this researcher-blinded randomized controlled trial with parallel groups, individuals on sick leave due to musculoskeletal, unspecified- or common mental health disorders were randomized to I-MORE (N=87) or I-MORE+WI (N=88). I-MORE lasted 2+1 weeks (with one week at home in between) and consisted of “acceptance and commitment therapy”, physical exercise, and work-related problem solving. The additional WI consisted of a preparatory part, a workplace meeting involving the sick-listed worker, the employer, and the primary rehabilitation therapist at the rehabilitation center, and follow-up work related to the meeting. The primary outcomes were number of sickness absence days and time until sustainable return to work (RTW) during 12 months of follow-up, measured by registry data.ResultsThe median number of sickness absence days during the 12-month follow-up for I-MORE was 115 days [interquartile range (IQR) 53–183] versus 130 days (IQR 81–212) for I-MORE+WI. The difference between groups was not statistically significant (P=0.084). The hazard ratio for sustainable RTW was 0.74 (95% confidence interval 0.48–1.16; P=0.192) in favor of I-MORE.ConclusionsThis study provided no evidence in favor of I-MORE+WI compared to only I-MORE for long-term sickness absent individuals with musculoskeletal-, common mental- or unspecified disorders.

‘Beyond Cancer’: a study protocol of a multimodal occupational rehabilitation programme to support breast cancer survivors to return work

IntroductionWith more women working and surviving breast cancer, issues concerning sustainable employment must be addressed. Support to transition back to work is a gap in survivorship care. This paper describes...

Integrating Israeli Defense Force (IDF) veterans with disabilities into the workforce: characteristics and predictors

BackgroundAccording to the ICF Model, the central goal of rehabilitation is the returning of persons with disabilities to an active and fruitful life within society. The Israel Ministry of Defense Rehabilitation Department’s occupational rehabilitation program includes assessment, professional guidance, training, and assistance integrating into employment.AimExamining predictors for the integration of Israel Defense Force veterans with disabilities into the workforce.MethodsAll 1416 male veterans with disabilities who served in the military, were injured during their service, and were treated by the Israel Ministry of Defense Rehabilitation Department between 2001 and 2006 were included in this study. Data collection was based on computerized administrative data in the Ministry of Defense. The data was collected with no identifying details.Predictive variables were: health condition, personal factors, participation factors, level of functioning and structure, and variables relating to the local environment.ResultsCompared to a physical disability, mental and mixed (physical and mental) disabilities reduce the odds for integration into the workforce. Higher education at the time of the injury is an additional predictor for integration into the workforce. Participation in a rehabilitation track for further education to acquire a profession is one of the main predictors for integration into the workforce.ConclusionThe results may enable developing more accurate intervention plans, with more efficient use of resources, including consolidation of existing information systems and monitoring the processes and outcomes of rehabilitation.

Building a novel occupational rehabilitation program to support cancer survivors to return to health, wellness, and work in Australia.

With a substantial increase in the population of cancer survivors of working age, issues concerning sustainable employment must be addressed. The health benefits of work are well established; however, the lack of support to transition back to work is a gap in survivorship care. Researchers, occupational rehabilitation and insurance sectors, cancer support services, and consumers have collaborated to develop a tailored, multimodal occupational rehabilitation program to support resumption of meaningful work for cancer survivors. This paper describes intervention development and refinement based on pilot results and expert- and consumer-recommendations. The pilot was conducted within the life insurance sector, a collaboration fostered by global reinsurance company Swiss Re, with cancer survivors referred to an Australian provider of occupational rehabilitation services. Preliminary outcomes from 15 of 72 cancer survivors following adequate engagement (excluding those who withdrew or were still actively engaged) showed 10 (67%) with improved certified capacity to work, translating to 13 (87%) with improved work status. Consultant survey results indicated barriers to participation in and engagement with the program, including referral delays, health concerns, and cancer recurrence. Expert panel recommendations were used to refine the intervention and tailor to breast cancer survivors for the feasibility stage. Strengths include an innovative model of referral and funding, through a life insurance provider, the involvement of a multidisciplinary collaborative team to design, develop and implement the pilot, and considerable consumer involvement. The refined intervention will address a critical gap to improve reintegration into work and society, contributing to improved quality of life for cancer survivors in Australia. Models of referral through insurers to rehabilitation services could be adopted in other jurisdictions.

Implementing an Occupational Therapy Low Vision Rehabilitation Program in Singapore

Introduction: This article describes the development, implementation, and evaluation of an occupational therapy (OT) low vision rehabilitation program established in a large hospital in Singapore in 2013. Methods: A logic model was used to develop a blueprint to guide program development and evaluation of the program. The targeted short-term outcomes for the first 2 years are to demonstrate program growth through an increase in referrals and meeting of clients’ needs through expressed client satisfaction and improvement in performance of daily activities. The long-term outcomes are to expand the program’s referral base and contribute to education and research in low vision rehabilitation. The steps of the logic model are described along with program evaluation results from the first 2 years of implementation. Results: The short-term outcome for program growth was met with the increase of referrals in the first 2 years. Program evaluation, however, revealed that there was limited support from some referral sources and underutilization of OT services, which need to be addressed to ensure sustainability of the program. It was difficult to establish whether the short-term outcomes for meeting clients’ needs were met due to limited outcome measures completed. Discussion: The logic model guided the steps of developing and evaluating an outpatient low vision rehabilitation program in a hospital in Singapore to determine whether the targeted outcomes were met for the first 2 years of the program. Use of this process enabled the program providers to identify weaknesses in the program and institute steps to move the program toward achievement of its long-term goals. Implications for practitioners: This blueprint can be used to guide occupational therapists developing medically based low vision rehabilitation programs for older adults.

Determining the reliability and convergent validity of a return-to-work status questionnaire

In occupational rehabilitation programs, return-to-work is a key outcome measure; however, the studies either used different definitions for return-to-work or do not provide their definition. In order to provide a solution to this issue, we developed a self-report return-to-work measure. We investigated the reliability and validity of a self-report return-to-work questionnaire in a cohort of workers with a work-related injury. Two research assistants independently administered the baseline questionnaires and a follow-up questionnaire. The questionnaires contained work-related questions (e.g., currently working, if duties changed) that were used to create a four-category work status measure. Pain-related and a recovery questions were also asked. We obtained loss of earnings data from the compensation board. The short-term reliability and convergent validity were assessed. We recruited 75 workers, and 57 completed the test-re-test baseline questionnaire, and 51 completed the follow-up. The mean age was 45.4 years and 57% were female. The participants had a mixture of musculoskeletal injuries. Most were in the acute stage, but 17% of the participants were injured for more than a year. The short-term reliability of current working status had a kappa value of 0.90. Participants who were not working had higher levels of pain-related disability than those who were working. The kappa value for the agreement between self-reported working status and administrative data on receiving any loss of earnings payment was around 0.65. Our study provides evidence of reliability and validity for a new return-to-work measure.

Admissible multiarm stepped-wedge cluster randomized trial designs.

Numerous publications have now addressed the principles of designing, analyzing, and reporting the results of stepped‐wedge cluster randomized trials. In contrast, there is little research available pertaining to the design and analysis of multiarm stepped‐wedge cluster randomized trials, utilized to evaluate the effectiveness of multiple experimental interventions. In this paper, we address this by explaining how the required sample size in these multiarm trials can be ascertained when data are to be analyzed using a linear mixed model. We then go on to describe how the design of such trials can be optimized to balance between minimizing the cost of the trial and minimizing some function of the covariance matrix of the treatment effect estimates. Using a recently commenced trial that will evaluate the effectiveness of sensor monitoring in an occupational therapy rehabilitation program for older persons after hip fracture as an example, we demonstrate that our designs could reduce the number of observations required for a fixed power level by up to 58%. Consequently, when logistical constraints permit the utilization of any one of a range of possible multiarm stepped‐wedge cluster randomized trial designs, researchers should consider employing our approach to optimize their trials efficiency.