Vocational Rehabilitation Strategies Research Articles

Contemporary vocational rehabilitation strategies for people with advanced cancer: A literature review and conceptual framework

BACKGROUND: People with advanced cancer constitute an emerging vocational rehabilitation (VR) consumer population. OBJECTIVE: Following an overview of the nature and needs of Americans who have advanced forms of cancer, the authors present strategies to meet the service and support needs of these individuals across the phases of the VR process. METHODS: The authors present the sequential stages of the VR process, including implications for working with advanced cancer survivors during each stage. RESULTS: The importance of individualized case planning, employer consultation, workplace accommodations, interface with medical and mental health professionals, and adherence to self-care and symptom management regimens is emphasized throughout the article. CONCLUSION: Growing numbers of people worldwide are surviving advanced cancers for longer periods of time than ever before, which makes them an emerging disability population and rehabilitation clientele.

Factors shaping return to work: a qualitative study among heart failure patients in Denmark

Purpose For people of working-age diagnosed with heart failure, return to work (RTW) is often a significant rehabilitation goal. To inform vocational rehabilitation strategies, we conducted a qualitative study aiming at exploring patient experienced support needs, and barriers and facilitators to RTW. Materials and methods Ten men and eight women with heart failure (48–60 years) were interviewed in Denmark during 2022. A thematic analysis was conducted using the Sherbrooke model as framework. Results Multiple factors operating at different levels shaped participants’ RTW processes. Personal factors included motivation, mental and physical health, social relations, and financial concerns. Factors in the health care system shaping RTW included access to medical treatment, mental health care, and cardiac rehabilitation. Factors in workplace system shaping RTW included job type, employer support, and social relations. Factors in the legislative and insurance system shaping RTW included authorities’ administration of sickness benefits, professional assistance, vocational counselling, and interdisciplinary cooperation. Conclusion Findings illustrate a need to include vocational rehabilitation within comprehensive cardiac rehabilitation programmes, to identify people in need of support, to improve the coordination of care across the health and social care sectors, and to involve employers, health care professionals, and social workers in individualised RTW strategies. IMPLICATIONS FOR REHABILITATION Vocational re-integration is shaped by multiple factors operating at different levels (including personal factors, work-related factors, factors in the health care system, and factors in the legislative and insurance system). To improve return to work following heart failure, there is a need for multi-level initiatives, including policy measures and efforts to enhance continuity and coordination of care. People with heart failure in need of vocational support should be identified early within comprehensive cardiac rehabilitation programmes. Health care professionals should address work-related issues and provide individualised information and clear advice regarding timely and safe return to work. Individualised return-to-work plans should be developed within interdisciplinary teams across health and social care sectors and involve employers to ensure that they are aware of relevant work accommodations.

Return to Work Experience of Young and Middle-Aged Patients With Acute Myocardial Infarction: A Longitudinal Qualitative Study.

Return to work (RTW) is a critical component of rehabilitation for most young and middle-aged patients after an acute myocardial infarction (AMI). Its success is related to the quality of life and social psychological function of patients, and their social economic growth. However, healthcare professionals often do not deeply understand the patients' experience and their difficulties and coping methods during this process, which limits their ability to institute effective management and support. In this study, we aimed to explore the lived experiences and change processes of young and middle-aged patients with AMI at the different stages of RTW. A descriptive qualitative approach was used. Patients aged 20 to 59 years with AMI were recruited from the Department of Cardiology of 3 general hospitals. Data were collected via semistructured interviews. Data analysis was performed by conventional content analysis methods. In total, 18 participants were included. Five main themes emerged: (1) "chaos," (2) "rebuilding," (3) "conflict," (4) "coping," and (5) "benefits." Patients may be more concerned about physical recovery during the initial clinical event. They then begin to plan and adjust for an RTW. Patients in the maintenance phase need strategies to prevent, identify, and respond to conflicts and challenges to maintain long-term stable work. We identified several post-AMI stages spanning from the initial illness event to the maintenance of stable work. We described their perceived barriers, coping strategies, and support needs at these various stages. These data are crucial for healthcare professionals to develop improved vocational rehabilitation strategies for patients with AMI.

Vocational Outcomes in ASD: An Examination of Work Readiness Skills as well as Barriers and Facilitators to Employment Identified by Autistic Adults.

Little is known about work readiness skills among autistic adults. This study sought to address this by examining work readiness skills and their relation to vocational outcomes among 281 autistic young adults. It also examined perceived barriers and facilitators to employment as articulated by a subset ofautistic adults. Results revealed a variegated work readiness profile. Stronger work readiness skills (particularly work style/adaptability) were associated with more favorable vocational outcomes. Autistic participants articulated both barriers and facilitators to employment related to the autism phenotype, job search/work readiness, and workplace education. These findings indicate the need for research on phenotype-driven vocational rehabilitation strategies as well as workplace psychoeducation/accommodations to support vocational outcomes for autistic adults.

Emerging vocational rehabilitation strategies for people with diabetes mellitus.

People with diabetes mellitus constitute an emerging vocational rehabilitation (VR) consumer population. The objective of this article is to (a) describe the characteristics and needs of Americans with diabetes mellitus, (b) examine the often devastating effects that this highly prevalent disease of the endocrine system has on employment and career development, and (c) suggest strategies that rehabilitation professionals can use to improve VR services and outcomes. Following an overview of the etiology, incidence, prevalence, and impact of this high incidence endocrinological disease, the authors present strategies to meet the service and support needs of Americans with diabetes mellitus across the phases of the VR process. The importance of individualized case planning, employer consultation, workplace accommodations, interface with medical and mental health professionals, and adherence to self-care and symptom management regimens is emphasized throughout the article. Diabetes mellitus is an emerging disability that can affect people of any age, one that disproportionally affects people of color and people who live in poverty. Rehabilitation professionals must be prepared to meet the service needs of this growing clientele.

Diagnostic group differences in return to work and subsequent detachment from employment following cardiovascular disease: a nationwide cohort study.

Return to work and employment maintenance following cardiovascular disease (CVD) are important rehabilitation goals for people of working age. To identify people in particular need of vocational rehabilitation, we examined differences in return to work and subsequent detachment from employment among people with atrial fibrillation (AF), heart failure (HF), heart valve disease, and ischaemic heart disease. We conducted a nationwide cohort study and included all individuals of working age (35-65 years) who were employed when diagnosed with incident CVD in 2018. We estimated sex- and age-standardized probabilities of remaining employed at 3, 6, and 12 months after diagnosis, and of detachment from employment within 6 months after having returned to work. Of 46 912 individuals diagnosed in 2018, 8187 were of working age and employed at diagnosis. The mean age was 54.7 years (SD = 6.7), and 74.0% were men. Within 1 year, 89.8% had returned to work, but within the subsequent 6 months, 23.5% of these experienced detachment from employment. At 3, 6, and 12 months after diagnosis the highest standardized probability of being employed was found among people with AF, whereas the lowest probability was found among people with HF {78.9% [95% confidence interval (CI): 77.3-80.4] vs. 62.2% [95% CI: 59.0-65.4] at 12 months}. Similarly, the highest probability of detachment was found for people with HF [30.3% (95% CI: 26.9-33.7)]. People with HF present the highest probability of not returning to work. There is a need for developing and documenting effects of vocational rehabilitation strategies within comprehensive cardiac rehabilitation programmes.

Return-to-Work Predictions for Chinese Patients With Occupational Upper Extremity Injury: A Prospective Cohort Study.

ObjectiveWe created predictive models using machine learning algorithms for return-to-work (RTW) in patients with traumatic upper extremity injuries.MethodsData were obtained immediately before patient discharge and patients were followed up for 1 year. K-nearest neighbor, logistic regression, support vector machine, and decision tree algorithms were used to create our predictive models for RTW.ResultsIn total, 163 patients with traumatic upper extremity injury were enrolled, and 107/163 (65.6%) had successfully returned to work at 1-year of follow-up. The decision tree model had a lower F1-score than any of the other models (t values: 7.93–8.67, p < 0.001), while the others had comparable F1-scores. Furthermore, the logistic regression and support vector machine models were significantly superior to the k-nearest neighbors and decision tree models in the area under the receiver operating characteristic curve (t values: 6.64–13.71, p < 0.001). Compared with the support vector machine, logistical regression selected only two essential factors, namely, the patient's expectation of RTW and carrying strength at the waist, suggesting its superior efficiency in the prediction of RTW.ConclusionOur study demonstrated that high predictability for RTW can be achieved through use of machine learning models, which is helpful development of individualized vocational rehabilitation strategies and relevant policymaking.

Occupational outcomes of people with multiple sclerosis: a scoping review

ObjectivesTo update the knowledge on the occupational outcomes associated with multiple sclerosis (MS), systematically examine the extent, scope and nature of the pre-existing literature and identify research gaps in the...

Consumer-Centered Vocational Rehabilitation Strategies for Stroke Survivors: Implications for the Post-Coronavirus Era

In this article, we describe stroke survivors as an emerging vocational rehabilitation (VR) clientele. Following an overview of the incidence, prevalence, and impact of stroke, the authors present strategies to meet the service and support needs of Americans with stroke across the phases of the VR process. The importance of individualized case planning, employer consultation, workplace accommodations, interface with medical and mental health professionals, and implications of the Coronavirus pandemic is emphasized throughout the article.

Rheumatoid Arthritis as an Emerging Disability: Vocational Rehabilitation Strategies in the Wake of the Coronavirus Pandemic

PurposeAmericans with rheumatoid arthritis (RA) represent an emerging vocational rehabilitation (VR) clientele.MethodFollowing an overview of the etiology, incidence, prevalence, and impact of RA, the authors present strategies to meet the service and support needs of Americans with RA across the phases of the VR process.ResultsThe importance of individualized case planning, employer consultation, workplace accommodations, interface with medical and mental health professionals, and adherence to social distancing requirements resulting from the Coronavirus pandemic is emphasized throughout the article.ConclusionsRA is an emerging disability that can affect people at any age, and rehabilitation counselors must be prepared to meet the service needs of this growing clientele.

P077 Upskilling rheumatology therapists in work rehabilitation: an evaluation of the Workwell training programme

Abstract Background/Aims Keeping people with arthritis working is an important goal of rehabilitation. Rheumatology therapists may provide work advice to employed patients but conducting a structured work assessment and providing vocational rehabilitation (VR) is unusual. As part of a VR trial, we developed a VR training course (Workwell). The course consisted of 3 elements: a pre-training self-study module (reading on ergonomics and activity analysis; activity analysis of at least 2 videos of people working; observing people working); a 2-day training course (how to conduct a structured work interview (the Work Environment Survey: WES); case studies; planning work interventions; practical workshops about VR strategies and solutions; addressing disclosure; writing reports); followed by a 1:1 one hour telephone call practising conducting the WES with a trainer, developing a treatment plan, and individual feedback. A “Workwell Solutions Manual” was also provided for use in practice, with information on legislation, patient booklets and work solutions linked to problems identified in the WES. Our aim was to evaluate therapists’ views about the course and its impact. Methods All therapists attending the Workwell course were asked to complete questionnaires pre- and post-training. These included: knowledge of and confidence in providing VR (measured on a 0-4 scale of very limited to excellent); the Evidence Based Practice Attitude Scale (EBPAS); and views about course content and duration. Results Three courses were delivered: 32/40 attendees completed pre-and-post training questionnaires. All were occupational therapists (OTs): 30 women and 2 men; 2 NHS Band 5, 15 Band 6, 11 Band 7 and 4 Band 8; with 11 (SD 7) years’ experience in Rheumatology. Median scores of Knowledge of: VR; the VR process; VR strategies; relevant legislation and policies; and Confidence in: conducting a work assessment; and identifying work solutions, significantly increased from 1 (limited: IQR 1-2) to 3 (good: IQR 2-3) (p &amp;lt; 0.001). Total EBPAS scores did not change. However, Openness sub-scale scores did (i.e. extent to which willing to use new research -based interventions): Pre 2 (moderate: IQR2-3) to Post 3 (great: IQR 3-3): p = 0.04. Most (i.e. 26-30) considered very/extremely relevant: the pre-training self-study; conducting the WES and case studies; practical workshops (workstation assessment; upper limb strategies; load handling; environment; disclosure); and the post-training 1:1 practice WES, treatment planning and feedback. The training about using the WES (roleplay by trainers; case studies and 1:1 telephone practice) was considered the most beneficial aspect. Of the 21 commenting on course length, 16 considered it about right and 5 wanted longer. Conclusion The 2-day VR course, plus 2 days self-study, led to significant improvements in knowledge and confidence in delivering VR amongst attending OTs. Work is a key component of OT. This training course could help expand work services in Rheumatology to keep patients working. Disclosure A. Hammond: None. S. Woodbridge: None. R. O'Brien: None. A. Ching: None. J. Parker: None.

Multiple sclerosis in the COVID-19 era: Vocational rehabilitation strategies to meet the needs of a growing and immune-vulnerable clientele

BACKGROUND: This article describes people with multiple sclerosis (MS) as an emerging vocational rehabilitation (VR) clientele. OBJECTIVE: Following an overview of the incidence, prevalence, and impact of MS, the authors suggest strategies to meet the employment and career development needs of Americans with MS across the phases of the VR process. The importance of individualized case planning, employer consultation, workplace accommodations, and interface with medical and mental health professionals is emphasized throughout the article. CONCLUSION: Implications related to the COVID-19 pandemic are discussed.

Overview of Vocational Rehabilitation Data about People with Visual Impairments: Demographics, Services, and Long-Run Labor Market Trends

Introduction: This study describes the characteristics of, services received by, and labor market outcomes of applicants with visual impairments to three state vocational rehabilitation programs. Our objective is to both document cross-state variation in vocational rehabilitation clientele and services and provide new insights on the longitudinal labor market outcomes of clients with visual impairments (i.e., blindness or low vision). This analysis is a first step in assessing the returns to vocational rehabilitation services for this population. Methods: We first created a unique longitudinal data set by matching administrative records on applicants who are visually impaired in state fiscal year 2007 from three vocational rehabilitation agencies to 8 years of employment data from state Unemployment Insurance programs. Using these data, we examined cross-state variation in the descriptive statistics for important client explanatory variables and vocational rehabilitation service categories. We then compared the long-term labor market outcomes of clients receiving services (treated) to untreated individuals. Results: We documented two important findings. First, there were substantial differences in client characteristics, services provided, and costs across the three states. Second, the long-run labor market analysis was consistent with vocational rehabilitation services having no employment effect but a positive earnings effect. Discussion: Labor market results indicate vocational rehabilitation services provided persistent earnings benefits. Yet the substantial cross-state heterogeneity suggests these labor market results might not be generalizable and should be interpreted with caution. We explain what was missing from this analysis and why the results should not be thought of as causal. Implications for Practitioners: This article gives practitioners a sense of a unique new data set on vocational rehabilitation and labor market variables for applicants with visual impairments. We highlight the importance of cross-state variation and linking vocational rehabilitation data to long-term employment measures. The question of how best to inform the efficacy of different vocational rehabilitation strategies for clients with visual impairments is left for future researchers to consider.

Implementation of Customized Employment Provisions of the Workforce Innovation and Opportunity Act Within Vocational Rehabilitation Systems

Effectively integrating provisions of the Workforce Innovation and Opportunity Act (WIOA) into public Vocational Rehabilitation (VR) systems will require extensive effort at both the organizational and system levels. This article presents information on WIOA provisions, enacted in July of 2014, that affect public VR systems plus rationale, strategies, and tools for implementing these provisions in a manner that promotes quality and sustainability. Both “ideal” implementation methods and “pragmatic” methods are presented based on the experience of one state’s efforts to incorporate customized employment strategies into its VR system to benefit customers who have not been successful at achieving a competitive, integrated employment outcome through traditional VR strategies.

Identifying occupational attributes of jobs performed after spinal cord injury

Although individuals after spinal cord injury (SCI) demonstrate a breadth of ability and employment potential, return-to-work (RTW) outcomes are low. In Canada, only 38% of individuals RTW after SCI. Refining the process of job suitability and enhancing job search strategies have been suggested to improve RTW outcomes. Our primary study objective was to identify occupational attributes of jobs performed after SCI that might be used to inform vocational rehabilitation strategies and improve RTW outcomes after SCI. A secondary analysis of participants from the Study of Health and Activity in People with Spinal Cord Injury employed in an occupation for which they received pay, was conducted. Frequency distributions for various occupational attributes including physical demands and educational requirements were examined across 181 reported occupations. χ-tests identified whether the primary mode of mobility was related to occupational physical demands. Analysis of the physical demand attribute identified that 58% of occupations required sitting and 33% required sitting/standing or walking. Forty-four percent of occupations required upper or multiple limb coordination. Eighty-three percent of occupations required a limited strength capacity. Sixty percent of occupations required college education and 58% required an undergraduate university education. χ-analysis revealed nonsignificant associations between primary mode of mobility and physical demands. In conclusion, a breadth of occupational attributes in jobs performed by individuals after SCI was identified. These results are suggested to inform future vocational rehabilitation strategies.

Work-related limitations and return-to-work experiences in prolonged fatigue: workers' perspectives before and after vocational treatment

Purpose. To gain insight into fatigued workers' perspectives regarding work experience before and after receiving vocational rehabilitation (VR) treatments.Method. A qualitative survey was conducted using semi-structured interviews with 21 fatigued workers who attended an outpatient multi-component VR treatment. Six months after treatment, work-related limitations and employed VR strategies at work before treatment were explored. Next, VR treatment experiences regarding return-to-work (RTW) were explored. Two researchers performed partially independent, qualitative analyses that revealed topics, discussed by the project team, and organised into domains, categories and sub-categories.Results. Work-related limitations were: symptoms of prolonged fatigue, personal limitations (e.g. lack of self-reflection on individual capacity and limitations), interpersonal factors, activities and conditions at work and life/work imbalance. Before the treatment, VR strategies such as work adaptations, well-intentioned advice and support, and/or referral to psychological or physical care were employed. VR treatment experiences on RTW were: personal challenges (e.g. gained awareness and coping skills), improved activities during work, work adaptations and unresolved problems (e.g. remaining fatigue symptoms and sickness absence).Conclusions. New information about work experiences before and after multi-component VR treatments in workers with prolonged fatigue may help employers, occupational physicians and other caregivers to develop VR strategies that better meet individuals' needs.

Psychosocial Outcomes in StrokE: the POISE observational stroke study protocol

BackgroundEach year, approximately 12,000 Australians of working age survive a stroke. As a group, younger stroke survivors have less physical impairment and lower mortality after stroke compared with older survivors; however, the psychosocial and economic consequences are potentially substantial. Most of these younger stroke survivors have responsibility for generating an income or providing family care and indicate that their primary objective is to return to work. However, effective vocational rehabilitation strategies to increase the proportion of younger stroke survivors able to return to work, and information on the key target areas for those strategies, are currently lacking.Methods/DesignThis multi-centre, three year cohort study will recruit a representative sample of younger (< 65 years) stroke survivors to determine the modifiable predictors of subsequent return to work. Participants will be recruited from the New South Wales Stroke Services (SSNSW) network, the only well established and cohesively operating and managed, network of acute stroke units in Australia. It is based within the Greater Metropolitan area of Sydney including Wollongong and Newcastle, and extends to rural areas including Wagga Wagga. The study registration number is ACTRN12608000459325.DiscussionThe study is designed to identify targets for rehabilitation-, social- and medical-intervention strategies that promote and maintain healthy ageing in people with cardiovascular and mental health conditions, two of the seven Australian national health priority areas. This will rectify the paucity of information internationally around optimal clinical practice and social policy in this area.

Neuropsychological Function and Employment Status in a Welfare-to-Work Sample

Since 1996, individuals who participate in welfare programs are mandated to find employment. Welfare recipients may have difficulty transitioning to the workforce due to impairments in psychosocial functioning. Examples include mental health and substance use disorders, medical problems, academic and learning difficulties, and lack of resources such as childcare and transportation. An area unexplored as a potential barrier is cognitive functioning as influencing recipient's ability to transition into the workforce. This is important because many Welfare to Work (WtW) recipients have personal risk factors related to impaired cognitive ability. We evaluated the relationship between demographics, cognitive functioning, and substance abuse severity in a group of 180 WtW recipients in order to assess predictors of employment impairment. No relationship was found between employment functioning and alcohol use, drug use, or psychiatric impairment. However, neuropsychological test results demonstrate that WtW study participants with lower scores on tests of general intelligence are more impaired in their employment functioning. General intelligence emerged as the best predictor of employment functioning. The results have implications for identifying individuals at risk for unsuccessful transition into the workforce and for the development of effective vocational rehabilitation strategies.

Vocational rehabilitation for persons with rheumatoid arthritis

Rheumatoid arthritis (RA) is a chronic, systemic disorder which primarily affects the joints. Although advances in its health treatment are being made, the disorder continues to be disabling. Rates of disease-related work loss are high, but few persons receive VR services. Since decline in function is gradual, the opportunity to prevent work disability exists. Useful vocational rehabilitation strategies are those that help individuals: (a) better manage disease symptoms and reduce overall energy demand; (b) retain their current jobs through obtaining reasonable accommodations; (c) identify jobs suited to current or future limitations and the training needed to obtain them; and Cd) enhance their ability to advocate for their own needs. © 1998 Elsevier Science Ireland Ltd