Vocational Rehabilitation Intervention Research Articles

Is Occupational Therapy Adequately Meeting the Needs of People With Chronic Pain?

Is Occupational Therapy Adequately Meeting the Needs of People With Chronic Pain?

Erratum to: Process and Outcome Evaluation of Vocational Rehabilitation Interventions in Patients with Prolonged Fatigue Complaints

Erratum to: Int.J. Behav. Med. DOI 10.1007/s12529-010-9099-4 Concerning the publication in International Journal of Behavioral Medicine (Epub ahead of print, May 2010) [1], the following is reported by the authors: a syntax error was identified concerning one of the secondary outcomes, Social Functioning subscale of the MOS SF-36, used in this study to evaluate three vocational rehabilitation interventions (VRIs). As a result, scores on the Social Functioning scale were miscalculated, affecting the total sum scores of this subscale. In the published article, we stated that social functioning did not improve significantly over time in two VRIs. However, after new analyses we conclude that mean social functioning scores significantly improved over time (p < .001) in all three VRIs. In VRI1, social functioning improved from 45 (95%CI 36.0–54.8) before intervention, to 67 (95%CI 58.076.5) after intervention, to 71 (95%CI 61.8–80.5) three months after intervention. In VRI2, improvements were reported from 50 (95%CI 39.9–59.2), to 77 (95%CI 67.0–86.6), to 75 (95%CI 65.2–84.8). Finally, in VRI3 social functioning improved from 43 (95%CI 36.3–50.3), to 67 (95%CI 59.7–73.3), to 73 (95%CI 66.0–80.8). In conclusion, social functioning improves significantly in all three VRIs, but stayed below the scores found in the Dutch population (mean = 84) [2]. It may be hypothesised that improvements comparable with the social functioning level of the Dutch population require more time, especially in patients with longstanding disabling fatigue. The correct manuscript can be obtained from the corresponding author.

Process and Outcome Evaluation of Vocational Rehabilitation Interventions in Patients with Prolonged Fatigue Complaints

BackgroundProlonged fatigue can cause physical, mental and occupational disability. Fatigue often persists because of a combination of biopsychosocial factors.PurposeTo evaluate the process and outcomes of three existing outpatient vocational rehabilitation interventions (VRI) in patients with prolonged fatigue complaints. The VRIs differ with regard to the content and treatment duration, enrolment procedure and financing.MethodA pre-post design was used with repeated measurements before treatment, after treatment and 3 months after treatment. Primary outcomes (fatigue and work participation) and secondary outcomes (physical and social functioning, mental health and physiological indicators (heart rate variability)) were assessed over time using linear mixed models analysis. A process evaluation (i.e. patient reach, content completeness and patient satisfaction) was conducted as well.ResultsOne hundred patients participated. Post-treatment, fatigue decreased (p < .001) and work participation (p < .010), physical functioning (p < .001) and mental health (p < .001) improved considerably in all three VRIs. Social functioning improved in one VRI (p = .022), but did not in the other two (p = .442, p = .196, respectively). Physiologically, heart rate variability improved in two VRIs (p = .044, p = .038, respectively). VRIs were administered according to the programme protocol. Almost all patients met their personal goals and the majority was satisfied with the outcomes of diminished constraints at work.ConclusionThree VRIs showed significant and clinically relevant outcomes over time regarding decreased fatigue and improved functioning and work participation in fatigued patients. The VRIs administered patient-tailored biopsychosocial interventions as planned and patients were satisfied with the interventions.

Factors Affecting Vocational Rehabilitation Intervention Outcomes

Vocational rehabilitation (VR) services are designed to help individuals with disabilities achieve gainful employment. This study examines VR’s effectiveness in assisting minorities achieve gainful employment. The study uses case management data from 617,149 cases closed by VR in 2006 in all states. It examines differences in access, employment, and earnings for White and ethnic minority clients. Multivariate techniques are used to assess factors that influence competitive employment outcomes, hourly earnings, and hours worked. Findings show significant differences in employment and earnings outcomes for minority and majority clients, with minorities faring worse. VR intervention length and per capita expenditures for services significantly influence employment and earnings outcomes. VR is more effective with White than with minority clients. There is a need to implement policies or practices that ensure equity in access to services that might translate into more equitable employment and earnings outcomes.

Vocational rehabilitation programs for individuals with chronic arthritis

To summarize recent literature on vocational rehabilitation interventions in patients with chronic arthritis. The current literature shows that the prevalence of work disability, including work cessation, sick leave, and any other restriction in the work status among patients with chronic arthritis, is substantial. In some studies, a trend towards a decline in work disability in chronic arthritis is seen, possibly reflecting improvements in medical treatment. The proof of effectiveness of comprehensive vocational rehabilitation interventions aimed at individuals in various stages of work disability is scanty. With prolonged sick leave being a major determinant of job loss, interventions are nowadays developed that specifically address patients with chronic arthritis at a stage in which sick leave occurs, with promising results. Economic evidence is limited, but savings on productivity are likely to outweigh the costs of an effective intervention. Despite advances in medical treatment, work disability among individuals with chronic arthritis is substantial. Although the (cost-)effectiveness of interventions in patients with established work disability is unclear, the results of studies on interventions employed in the early stages of threatened work ability point to a favorable effect.

Effectiveness of vocational rehabilitation intervention on the return to work and employment of persons with multiple sclerosis

Multiple sclerosis is a neurological disease that frequently affects adults of working age, resulting in a range of physical, cognitive and psychosocial deficits that impact on workforce participation. Although, the literature supports vocational rehabilitation (VR) approaches in persons with multiple sclerosis (pwMS), the evidence for its effectiveness is yet to be established. To evaluate the effectiveness of VR programs compared to alternative programs or care as usual on return to work, workability and employment in pwMS; to evaluate the cost effectiveness of these programs. Electronic searches included: Cochrane Central Register of Controlled Trials "CENTRAL" 2008 issue 3, MEDLINE (PubMed) (1966- 2008), EMBASE (1988- 2008), CINAHL (1982- 2008), PEDro (1990- 2008), the Cochrane Rehabilitation and Related Therapies Field trials Register and the National Health Service National Research Register. Randomized and controlled clinical trials, including before - after controlled trials, that compare VR rehabilitation with alternative intervention such as standard or a lesser form of intervention or waitlist controls. Two reviewers selected trials and rated their methodological quality independently. A 'best evidence' synthesis was performed, based on methodological quality. Trials were grouped in terms of type and setting of VR programs. Two trials (one RCT and one CCT) (total 80 participants) met the review criteria. Both trials scored poorly on the methodological quality assessment. There was 'insufficient evidence' for VR programs for (a)'competitive employment', in altering rates of job retention, changes in employment, improvement in rates of re-entry into the labour force; (b) for altering 'work ability' by improving participants' confidence in the accommodation request process, or employability maturity or job seeking activity. No evidence could be assimilated for changes in proportions of persons in supported employment or on disability pensions, nor for cost-effectiveness. There was inconclusive evidence to support VR for pwMS. However, the review highlights some of the challenges in providing VR for pwMS. Clinicians need to be aware of vocational issues, and to understand and manage barriers for maintaining employment. Proactive and timely VR programs should incorporate practical solutions to deal with work disability, workplace accommodation and educate employers, and the wider community. Liaison with policy makers is imperative for government initiatives that encourage work focused VR programs. Future research in VR should focus on improving methodological and scientific rigour of clinical trials; on the development of appropriate and valid outcome measures; and on cost effectiveness of VR programs.

Disease and Demographic Characteristics Associated with Unemployment Among Working-Age Adults with Multiple Sclerosis

Previous studies of employment in people with multiple sclerosis (MS) have been inconsistent in identifying associated factors, and few have examined the role of secondary health conditions. The goal of this study was to examine the association of these health conditions, including pain, fatigue, depression, sleep problems, anxiety, and incontinence, with employment status in individuals with MS. Data were collected using a cross-sectional self-report survey of 1271 people with MS, of whom 1124 were between the ages of 18 and 65 years and provided employment information. Self-report of employment status was used as an outcome variable for multivariate logistic regression. In total, 40.4% (n = 454) of surveyed individuals were employed half-time or more. Variables significantly associated with unemployment in the multivariate model were severity of disease (as measured by Expanded Disability Status Scale score), difficulties in thinking, female sex, increased age, and increased duration of MS. The symptoms of fatigue, pain, depression, and anxiety were not significantly associated with employment status in this sample. The combined impact of cognitive changes and overall severity of mobility impairment significantly influenced employment status in this community sample. Future longitudinal studies are needed to better elucidate the circumstances surrounding changes in employment status and identify points at which vocational rehabilitation interventions might be most effective.

Predictors of vocational stability in multiple sclerosis

This study examined salient disability, demographic, psychosocial, and neuropsychological variables as predictors of employment stability for vocational rehabilitation clients with MS served at the University of Washington (1998-2003). Although a number of variables were initially significantly related to vocational stability (e.g., Personal Capacities Questionnaire score, number of months employed in the last 2 years, and the Activities of Daily Living-MS Scale score), only the FAS Controlled Oral Word Association Test-3, a measure of verbalfluency and executive functioning, remained significant ( p< 0.01) when controlling for multiple comparisons. Implications are discussed in relation to vocational rehabilitation assessment and intervention planning.

The relationship of self-management and disease modifying therapy use to employment status among adults with multiple sclerosis

Peoplewithmultiplesclerosis(MS)mayfacenumerousbarrierstoemploymentretention.Comprehensivelyunderstand- ing these barriers is important for implementing effective vocational rehabilitation interventions. Although several demographic and MS-related variables have consistently been found to be related to employment status, self-management and adherence to treatment have infrequently been evaluated in this context. This article explores the relationships between employment status and the use of disease-modifying therapy and self-management among a community-based sample of adults with MS using both bivariate and multivariate analyses. Group comparisons between employed and unemployed adults with MS suggested that both self-management and DMT use are significantly related to employment. In a stepwise binary logistic regression analysis, age, duration in years diagnosed with MS, and scores on a multi-dimensional MS self-management scale were positively related to employment. The results are discussed in terms of their implications for rehabilitation intervention.

Impact of Stroke on Return to Work

AbstractStroke has a marked impact on the ability to return to work. However, the stroke and its residual cognitive, physical and language deficits do not fully explain return-to-work success. While those with very severe deficits are less likely to return to work, and presence of disability is important, other extrinsic and intrinsic factors, such as having a job to go back to, beliefs and attitudes about work, job markets and the benefits system all play an important part. Vocational rehabilitation services developed with the stroke service user in mind are scarce in the United Kingdom. However, recent government interest in vocational rehabilitation and a recognition that evidence to support poststroke vocational rehabilitation is lacking have prompted efforts to develop new vocational rehabilitation services. People with stroke need specialist vocational rehabilitation services delivered by those who have an in-depth understanding of stroke and its effects. Service developers need to acknowledge and address factors that enable or impede return to work after stroke in service design. Research is needed to evaluate vocational rehabilitation interventions aimed specifically at the needs of stroke patients.

Psychosocial Rehabilitation in Older Adults with Serious Mental Illness: A Review of the Research Literature and Recommendations for Development of Rehabilitative Approaches

The number of older adults with serious mental illness (SMI) is expected to increase dramatically in the coming decades. This group uses a disproportionate amount of mental health resources and is at high risk of institutionalization. There is an urgent need for effective psychosocial rehabilitation programs specifically designed to meet the special needs of this population. This article summarizes recent research in this area, including three new models of skills training. We also describe several other empirically supported approaches for the general population of people with SMI that may be tailored for use with older adults, including assertive community treatment, family and caregiver support, vocational rehabilitation, and medication adherence interventions. Finally, we consider new directions for research and service development to support the next generation of psychosocial interventions for the growing population of older adults with SMI.

A Randomized Controlled Trial of a Supported Employment Program for Persons With Long-Term Mental Illness in Hong Kong

A Randomized Controlled Trial of a Supported Employment Program for Persons With Long-Term Mental Illness in Hong Kong

How can we help employees with chronic diseases to stay at work? A review of interventions aimed at job retention and based on an empowerment perspective

A growing number of persons aged 16-65 is hampered by a chronic condition in performing job activities. Some of them quit the labour market prematurely. Vocational rehabilitation used to focus on (re)entering the labour market. Recently more attention is paid to interventions aimed at job retention. Some of these use an empowerment perspective. The objective of this study is to describe the characteristics, feasibility and effectiveness of such vocational rehabilitation interventions in order to decide which approaches are fruitful. The Medline, Embase, Cinahl and Psycinfo databases were systematically researched for studies published between 1988 and March 2004. Studies were included if they were experimental, included an intervention that aimed at job retention by means of solving work-related problems, used an empowerment perspective and concerned employees with one of the following chronic illnesses: diabetes mellitus, rheumatic diseases, hearing disorders, multiple sclerosis, inflammatory bowel disease, epilepsy, chronic kidney failure, COPD and asthma. Nine studies were detected. The aims of the intervention programs were to improve psychosocial skills or implement work accommodations. They were structured as individual (6x) or group programmes (3x). They used methods like education (9x), assessment (7x), counselling (5x), training or role playing (5x). The most important outcome measures were employment status (5x), actions to arrange work accommodations (3x), and psychosocial measures like self-efficacy and social competence (3x). Employment status was claimed to be positively influenced in four out of five studies, obtaining work accommodations was successful in all three studies and psychological outcome measures improved in two out of three studies. There is some evidence that vocational rehabilitation interventions that pay attention to training in requesting work accommodations and feelings of self-confidence or self-efficacy in dealing with work-related problems are effective. There is no evidence for greater effectiveness of group programs compared to individual programs. Attention has to be paid to feasibility aspects such as recruitment of participants and cooperation between medical professionals, occupational physicians, and vocational rehabilitation experts. Medical specialists and nursing specialists should pay more attention to work. Although many studies claim effectiveness, evidence for this was often weak due to short follow-up and the lack of control groups. More rigorous evaluation is needed.

A Randomized Clinical Trial of Vocational Rehabilitation for People With Psychiatric Disabilities

In this study, the researchers examined the effectiveness of two vocational rehabilitation interventions in improving employment, educational, clinical, and quality-of-life outcomes for people with psychiatric disabilities. The authors recruited participants in waves over a 2-year period and randomly assigned them to receive either psychiatric vocational rehabilitation (PVR) or enhanced state vocational rehabilitation (ESVR) services. Although both groups improved significantly over time in their vocational and educational outcomes, no differences were found between the two interventions on any outcomes. In this article, the authors explore why ESVR achieved better outcomes than previous research would have suggested.

Vocational rehabilitation: what works and in what circumstances.

This paper examines a variety of forms of evidence used to find the effectiveness of vocational rehabilitation interventions. We begin by looking at general unemployment literature and then study the detailed findings of a research project that examined the employment experiences of disabled people, carried out by one of the authors. We then report on a recent evaluation of an innovative vocational rehabilitation scheme. Here, following the approach recommended by Pawson and Tilley (1997), we consider the views of one of the project 'stakeholders' concerning the 'theories' underlying the design of the project. In conclusion we encapsulate some of the knowledge, or evidence, emerging from these diverse sources in configurations of contexts, mechanisms and outcomes, as advocated by Pawson and Tilley.

A social psychology approach to measuring vocational rehabilitation intervention effectiveness.

It is rare for rehabilitation researchers to report substantial relationships between functional capacity and vocational rehabilitation achievements. The reason for this is that there are many other factors that also impact on the return-to-work outcomes people achieve. A solution to the problem of having to take into consideration the effects of multiple factors when evaluating intervention effectiveness is to focus more directly on cognitions and behaviors that have been theoretically and empirically linked with a satisfactory return to work. The aim of this paper is to explore and describe a measure of rehabilitation effectiveness based in cognitive-behavioral theory. Rather than the measurement of employment per se, the described measure is focused on the efforts individuals make in relation to achieving their desired outcome. To test the effectiveness, acceptability, and utility of the approach, the measure was trialed with 170 people with a spinal cord injury. This preliminary work has revealed that participants found the measure acceptable and gave detailed responses in regards to: their satisfaction with their vocational status; what it is they would prefer to be doing; and what it is that they are doing to achieve their aims. Study findings suggest that while the approach is likely to require further development, focusing on process variables holds promise as an evaluation approach when assessing the success of vocational rehabilitation intervention effectiveness.

Development and Validation of the Work Outcomes Coding Scale

This article describes the development and validation of a new measure of post-accident work outcome and adjustment, the Work Outcomes Coding Scale (WOCS), whose items were derived from rehabilitation indices used individually by the Workcover Authority of New South Wales. Psychometric qualities of the 4-item scale were determined using two samples of hospitalised accident survivors who returned to work following their accident. The WOCS showed excellent internal consistency, correlated moderately to highly with other measures of role functioning and had low, significant correlations with factors connected with work adjustment. Low range WOCS scores were shown to be indicative of poor work outcomes and increasing need for vocational rehabilitation interventions.

A medical/vocational case coordination system for persons with brain injury: An evaluation of employment outcomes

Malec JF, Buffington ALH, Moessner AM, Degiorgio L. A medical/vocational case coordination system for persons with brain injury: an evaluation of employment outcomes. Arch Phys Med Rehabil 2000;81:1007-15. Objective: To evaluate initial placement and 1-year employment outcomes of a Medical/Vocational Case Coordination System (MVCCS) for persons with brain injury (BI) that provides: (1) early case identification and coordination, (2) appropriate medical and vocational rehabilitation interventions, (3) work trials, and (4) supported employment interventions including job coaching. Participants: One hundred fourteen Minnesota residents, ages 18 to 65 years, with acquired BI. Main Outcome Measures: Outcome: Five levels of Vocational Independence Scale (VIS). Predictor: Preinjury employment status (VIS) and years of education, severity of initial injury, time since injury, current impairment/disability as measured by the Rasch-analyzed Staff Mayo-Portland Adaptability Inventory (MPAI), and impaired self-awareness measured by staff rating and the difference between Staff MPAI and Survivor MPAI. Results: At placement, 46% in independent work; 25% in transitional placements; 9% in long-term supported employment; 10% in sheltered work; and 10% not placed. At 1-year follow-up ( n = 101), 53% in independent work; 19% in transitional placement; 9% in supported work; 6% in sheltered work; and 13% unemployed. Regression analyses showed time since injury and Rasch Staff MPAI predicted VIS at placement; only VIS at placement independently predicted VIS at 1-year follow-up; Rasch Staff MPAI and preinjury education level predicted time to placement. Conclusions: The MVCCS optimized vocational outcome after BI. Time since injury and impairment/disability best predicted vocational placement. Level of initial placement best predicted employment status at follow-up. Persons with greater disability required more extended time and more extensive rehabilitation services before placement. © 2000 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation

Vocational Rehabilitation in Shizophrenia

Schizophrenia exacts a heavy toll on a person's capacity to work, and a variety of vocational rehabilitation interventions have been developed over the past few decades to enhance the vocational capacities of persons with this disorder. The research literature on outcomes of vocational rehabilitation during the era of deinstitutionalization for persons with schizophrenia is reviewed. Most vocational rehabilitation programs have a positive influence on work-related activities, but most have failed to show substantial and enduring impacts on independent, competitive employment. Recent advances in supported employment suggest that vocational rehabilitation offers greater promise than do transitional and sheltered employment approaches. Vocational rehabilitation intervention may also exert positive influences on such clinical outcomes as medication compliance, symptom reduction, and relapse.

Individual placement and support: A community mental health center approach to vocational rehabilitation

Individual Placement and Support (IPS) is a vocational rehabilitation intervention for people with severe mental disabilities. IPS draws from components and philosophies of several other models. Employment specialists, who are part of the community mental health center team, provide services in the community. IPS emphasizes client preferences, rapid job finding, continuous assessment, competitive employment, integrated work settings, and follow-along supports. Initial research on IPS shows favorable results.