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1.  Current Situation and Issue of Industrial Accident Compensation Insurance 
Journal of Korean Medical Science  2012;27(Suppl):S47-S54.
Industrial Accident Compensation Insurance (IACI) has a history of about 50 yr, and is the oldest social insurance system in Korea. After more than 20 times of revision improvements in benefits, its contents and claim systems have been upgraded. It became the protector of injured workers and their families, and at the same time became the system which could cope with both financial burden of employers and their responsibilities. However, there are some issues to be reformed to upgrade the IACI: 1) the problems in the approval system of occupational diseases, 2) quality improvement of workers' compensation medical care, 3) vocational rehabilitation and return to work, 4) workers' compensation premiums and out-of-pocket money of injured workers, 5) issues in application of IACI. Growth of IACI cannot be achieved by an effort of an individual. Efforts by workers, owners, and government, in addition to physicians and welfare professionals toward the same goal are required for the next level improvement of IACI.
PMCID: PMC3360174  PMID: 22661871
Workers' Compensation; Occupational Disease; Occupational Injury; Medical Care; Return to Work
2.  Workers Who Stay at Work Despite Chronic Nonspecific Musculoskeletal Pain: Do They Differ from Workers with Sick Leave? 
Purpose Most workers with chronic nonspecific musculoskeletal pain (CMP) do not take sick leave, nor consult a health care professional or search vocational rehabilitation. Yet, the knowledge of many researchers, clinicians and policy makers is largely based on people with CMP who discontinue work. The aim of this study was to explore characteristics of workers who stay at work despite CMP, and to compare these with sick-listed workers with CMP following vocational rehabilitation. Methods The clinical characteristics of workers who stay at work despite CMP (n = 119) and sick-listed workers who follow vocational rehabilitation (n = 122) were described and the differences between these groups were assessed. Logistic regression analysis was used to assess differences between the groups and to determine which variables predicted group status. Results Workers who stayed at work despite CMP reported significantly lower levels of fear avoidance (OR = 0.94), pain catastrophizing (OR = 0.93), perceived workload (OR = 0.93), and higher pain acceptance (OR = 1.11), life control (OR = 1.62) and pain self-efficacy (OR = 1.09) compared to sick-listed workers following rehabilitation, even after controlling for confounders. The groups did not differ on physical activity level, active coping and work satisfaction. Group status was predicted best by pain intensity, duration of pain, pain acceptance, perceived workload, mental health, and psychological distress (area under the receiver operating characteristic curve = 0.91, 95% CI = 0.87–0.95). Conclusions A wide range of characteristics of workers who stay at work despite CMP were explored. Relevant differences from sick-listed workers with CMP were observed in all domains of the bio-psycho-social model. Six main predictors were identified that best discriminate between both groups.
PMCID: PMC3484275  PMID: 22454300
Staying at work; Vocational rehabilitation; Musculoskeletal disorders; Chronic pain; Work participation
3.  Work, Recovery, and Comorbidity in Schizophrenia: A Randomized Controlled Trial of Cognitive Remediation 
Schizophrenia Bulletin  2009;35(2):319-335.
Employment is central to the concept of recovery in severe mental illness. However, common comorbid conditions present significant obstacles to consumers seeking employment and benefiting from vocational rehabilitation. We review research on the effects of three common comorbid conditions on work and response to vocational rehabilitation, including cognitive impairment, substance abuse, and medical conditions, followed by research on vocational rehabilitation. We then present the results of a randomized controlled trial evaluating the effects of adding cognitive remediation to a vocational rehabilitation program compared with vocational rehabilitation alone in 34 consumers with severe mental illness. Consumers who received both cognitive remediation and vocational rehabilitation demonstrated significantly greater improvements on a cognitive battery over 3 months than those who received vocational rehabilitation alone and had better work outcomes over the 2-year follow-up period. Substance abuse was associated with worse employment outcomes, but did not interact with treatment group, whereas medical comorbidity was not related to work outcomes. More research is warranted to evaluate the interactions between substance abuse and medical comorbidity with vocational rehabilitation and cognitive remediation.
PMCID: PMC2659315  PMID: 19269925
recovery; vocational rehabilitation; medical comorbidities; substance abuse; severe mental illness; cognitive remediation
4.  Rehabilitation of the Injured Worker 
Canadian Family Physician  1989;35:2297-2300.
The Workers' Compensation Board is mostly involved in secondary and tertiary prevention of work-related accidents and disease. Through its new Medical Rehabilitation Strategy, the board will help to ensure that optimal health care programs are available to injured workers. For workers who are left with restricted function, even after the best possible health care, vocational rehabilitation or tertiary prevention programs are offered. In both phases the primary care physician has a key function and must be familiar with the “state of the art” treatment of so-called minor trauma and activity-related disorders. Physicians also must recognize the importance of providing a reasonable prognosis as early as possible because it will drive the vocational rehabilitation planning process.
PMCID: PMC2280290  PMID: 21248924
family medicine; occupational medicine; rehabilitation; Workers' Compensation Board
5.  Physical functioning after occupational rehabilitation and returning to work among employees with chronic musculoskeletal pain and comorbid depressive symptoms 
The aim of this investigation was to assess whether measures of physical functioning after multidisciplinary rehabilitation are associated with return to work among individuals with chronic musculoskeletal pain conditions and comorbid depressive symptoms.
Included were 92 employees with chronic musculoskeletal disorders who had participated in a 57- week multidisciplinary rehabilitation program. Their ages ranged from 25–59 years. The Hospital Anxiety and Depression Scale was used to assess depressive symptoms. Different aspects of physical functioning (muscle strength, mobility, endurance capacity, and balance) were measured with single-item visual analog scales, and physical fitness was measured with the validated COOP/WONCA charts. Being on “active work strategies,” such as receiving rehabilitation benefit/vocational rehabilitation or being reported partly or completely fit, was defined as “on their way into/in work”. Cross-sectional associations were measured using logistic regression models, estimating odds ratio with 95% confidence intervals.
There were no differences between the “on their way into/in work” group (n=70) and the “on their way out/out of work” group (n=22) regarding age, sex, or levels of anxiety or pain. Surprisingly, regression analyses showed that those with higher levels of physical functioning had significantly lower odds of returning to work.
The findings of an inverse relationship between self-reported physical function and returning to work in this sample illustrate that the return-to-work process among employees with chronic musculoskeletal pain and comorbid depressive symptoms is multifactorial and influenced by factors other than physical functioning at the individual level. Further research, especially longitudinal studies, is needed to assess the occupational trajectories among employees with chronic musculoskeletal pain and comorbid depressive symptoms after participation in a multidisciplinary rehabilitation program.
PMCID: PMC3904812  PMID: 24489473
chronic musculoskeletal pain; multidisciplinary rehabilitation; physical functioning; depression; return to work
Substance use & misuse  2002;37(2):145-170.
Employment status is commonly used as a sign of stability in recovery and an outcome variable for substance abuse treatment and research. However, there has been little attention in the literature on the topic of work for the dually diagnosed (i.e., persons diagnosed with both substance use and mental health disorders). Data collected in 1999 are presented on expressed interest in and perceived barriers to pursuing work and on the utilization of vocational rehabilitation (voc-rehab) services among unemployed members of a dual recovery self-help fellowship (N = 130). While members generally expressed high interest in working, they also cited multiple obstacles to attaining and maintaining employment. A path model was specified and tested. Significant contributors to interest in working were substance use status and physical health rating. Consistent with our hypotheses, mental health symptoms and greater perceived obstacles (e.g., stigma, fear of failure, and insufficient skills) were significant contributors to perceived difficulty in pursuing work, whereas substance use, physical health, and recency of employment were not. Finally, those who perceived less difficulty in pursuing work were more likely to utilize voc-rehab services, and men were more likely than women to use these facilities; interest in work was not significantly associated with utilizing voc-rehab services. The roles of mental health disorders and substance use in relation to pursuit of employment are discussed, as well as that of perceived obstacles such as stigma. The paper addresses the setting of realistic vocational goals and possible strategies to mitigate barriers to increased employment of dually diagnosed individuals.
PMCID: PMC1797894  PMID: 11863273
Employment; Dual-diagnosis; Comorbidity; Recovery; Entitlement
7.  Randomized Trial of Supported Employment Integrated With Assertive Community Treatment for Rural Adults With Severe Mental Illness 
Schizophrenia Bulletin  2006;32(2):378-395.
Urban-based randomized clinical trials of integrated supported employment (SE) and mental health services in the United States on average have doubled the employment rates of adults with severe mental illness (SMI) compared to traditional vocational rehabilitation. However, studies have not yet explored if the service integrative functions of SE will be effective in coordinating rural-based services that are limited, loosely linked, and geographically dispersed. In addition, SE's ability to replicate the work outcomes of urban programs in rural economies with scarce and less diverse job opportunities remains unknown. In a rural South Carolina county, we designed and implemented a program blending Assertive Community Treatment (ACT) with an SE model, Individual Placement and Support (IPS). The ACT-IPS program operated with ACT and IPS subteams that tightly integrated vocational with mental health services within each self-contained team. In a 24-month randomized clinical trial, we compared ACT-IPS to a traditional program providing parallel vocational and mental health services on competitive work outcomes for adults with SMI (N = 143; 69% schizophrenia, 77% African American). More ACT-IPS participants held competitive jobs (64 versus 26%; p < .001, effect size [ES] = 0.38) and earned more income (median [Mdn] = $549, interquartile range [IQR] = $0–$5,145, versus Mdn = $0, IQR = $0–$40; p < .001, ES = 0.70) than comparison participants. The competitive work outcomes of this rural ACT-IPS program closely resemble those of urban SE programs. However, achieving economic self-sufficiently and developing careers probably require increasing access to higher education and jobs imparting marketable technical skills.
PMCID: PMC1435374  PMID: 16177278
schizophrenia; vocational rehabilitation; rural mental health services; service integration
8.  Management of occupational back pain: the Sherbrooke model. Results of a pilot and feasibility study. 
OBJECTIVES--The aim was to combat occurrence of chronic occupational back pain. METHODS--A multidisciplinary model to manage back pain that includes both clinical and ergonomic approaches has been developed. Early detection, early clinical and ergonomic evaluations, and early active treatment make up the cornerstone of management. Detection of cases starts after four weeks of absence from work. An ergonomic intervention is implemented at six weeks. A medical specialist is involved at eight weeks. If return to work is not possible after 12 weeks, a functional recovery therapy followed by a therapeutic return to work is implemented. A multidisciplinary team decides if return to original or modified work is possible or if vocational rehabilitation is necessary. This model has been implemented by the investigators in the Sherbrooke (Quebec, Canada) area, and is presently being evaluated through a randomised trial in 31 industrial settlements (about 20,000 workers). A cluster randomisation of industries and workers will allow separate testing of ergonomic and clinical interventions. RESULTS--One year after implementation, 31 of 35 of the eligible industrial sites participated in the study and 79 of 88 of the eligible workers affected by recent back pain had agreed to participate. Ergonomic and clinical interventions have been implemented as planned. Only three workers dropped out. Hence this global clinical and ergonomic management programme has been shown to be feasible in a general population. CONCLUSION--A global management programme of back pain joining ergonomic and clinical intervention with a multidisciplinary approach has not been tested yet. Linking these two strategies in a same multidisciplinary team represents a systemic approach to this multifactorial ailment. During the first year of this trial we did not find any conflict between these two interventions from the employer's or worker's point of view.
PMCID: PMC1128053  PMID: 7951791
9.  Workers' Compensation Claims: Hidden Agendas 
Canadian Family Physician  1989;35:2291-2295.
Successful management of compensable occupational disorders requires an understanding of both the medical and social models of illness. In addition to the usual roles of medical diagnosis and treatment, the physician must assume a number of hidden roles, including assessing job hazards, arriving at an opinion of work-relatedness, identifying unrealistic expectations and factors that may delay recovery, and identifying as early as possible when vocational rehabilitation is necessary. As a central member of the claims management team, the practising physician can contribute meaningfully to the employee's successful return to the work-force.
PMCID: PMC2280291  PMID: 21248923
benefits; compensation; disability; handicap; impairment; occupational medicine
10.  Fit for work: a European study on health at the workplace 
Definition of vocational rehabilitation
Vocational rehabilitation is defined as a multidisciplinary process whereby those disadvantaged by illness or disability can be enabled to access, maintain or return to employment. The major components of vocational rehabilitation are:
– Legal framework for practice
The UN convention on the rights of persons with disabilities (2008) has eight guiding principles. These encompass the right to work and to full access to employment.
– Epidemiology of incapacity/long-term disability
There are 44.6 million disabled people of working age in the EU. Currently, 42.2% of disabled people are in employment, compared to 64.5% of non-disabled people. Forty-four percent of unemployed disabled people feel that they would be able to work if given the appropriate assistance.
– Models of vocational rehabilitation
To plan vocational rehabilitation effectively it is necessary to discriminate between static disabilities and progressive and fluctuant long-term conditions where the response may have to be more flexible.
Most models demand co-operation between those in different parts of a single service and between agencies. In the ‘closed’ system all parts of the assessment and interventions are delivered by staff within the system. Usually, the system is an ‘open system’.
– History taking, examination, measurement and assessment of work incapacity
The assessment has to be based on medical, functional and psychological factors. In determining work ability all of the components of the ICF model should be used. Evaluation of functional assessment is equally necessary.
PMCID: PMC2807080
vocational rehabilitation
11.  Predictors of On-Site Vocational Support for People with Schizophrenia in Supported Employment 
Schizophrenia research  2007;94(1-3):81-88.
This study examined predictors of intensity of vocational specialist support for clients with schizophrenia or schizoaffective disorder in supported employment. Sixty-nine outpatients with schizophrenia or schizoaffective disorder were recruited from a community mental health center for 12 months of vocational and cognitive rehabilitation. Neuropsychological test scores, symptom ratings, illness severity, and employment history were used to predict vocational support intensity, expressed as hours coached in ratio to total hours worked over 12-months for each client. Weekly work hours were inversely correlated with intensity of vocational support (r= −.55). Half of the sample averaged 10 to 40 hours of work per week and received significantly lower proportions of on-site job coaching than the lowest quartile, which averaged 2 to 5 hours of work per week. Regressions predicting support intensity from neuropsychological composite scores, educational /vocational, and hospitalization history were not significant. Significant regressions included PANSS, SANS, and SAPS subscales, after which individual symptoms responsible for explained variance were isolated. SANS social inattention and PANSS active avoidance together predicted 23 percent of the variance in support intensity. A one-way ANOVA comparing work participation quartiles on these symptoms revealed significantly higher levels of active avoidance and social inattention for participants working less than ten hours per week. A profile emerged of the high intensity client as a socially inattentive or avoidant individual requiring a limited work schedule. Results suggest that these clients require more specialist contact because of failure to adequately engage natural supports at work.
PMCID: PMC1986779  PMID: 17512172
schizophrenia; supported employment; support intensity; symptom predictors
12.  The Effectiveness of Supported Employment in People With Dual Disorders 
Journal of dual diagnosis  2011;7(1-2):90-102.
This study compared the effectiveness of the Individual Placement and Support (IPS) model of supported employment to control vocational rehabilitation programs for improving the competitive work outcomes of people with a severe mental illness and co-occurring substance use disorder.
A secondary data analysis was conducted drawing from four randomized controlled trials comparing IPS supported employment to conventional vocational rehabilitation programs for severe mental illness, and focusing on the 106 clients with a recent (past 6 months) substance use disorder. Competitive work outcomes were tracked across an 18-month follow-up period. Analyses compared the IPS and comparison vocational programs on cumulative work over the 18 months, including attainment of work, hours and weeks worked, job tenure, wages earned, and days to first job.
In the total study group, clients who participated in IPS had better competitive work outcomes than those who participated in a comparison program, with cumulative employment rates of 60% vs. 24%, respectively. Among clients who obtained work during the study period, those receiving IPS obtained their first job significantly more quickly and were more likely to work 20 or more hours per week at some point during the 18-month follow-up.
The IPS model of supported employment is more effective than alternative vocational rehabilitation models at improving the competitive work outcomes of clients with a dual disorder.
PMCID: PMC3530026  PMID: 23275763
Vocational Rehabilitation; Supported Employment; Individual Placement and Support; Employment; Severe Mental Illness; Substance Use Disorder
13.  The Development and Evaluation of a Vocational Rehabilitation Training Programme for Rheumatology Occupational Therapists† 
Musculoskeletal Care  2013;11(2):99-105.
People with inflammatory arthritis rapidly develop work disability, yet there is limited provision of vocational rehabilitation (VR) in rheumatology departments. As part of a randomized, controlled trial, ten occupational therapists (OTs) were surveyed to identify their current VR provision and training needs. As a result, a VR training course for OTs was developed which included both taught and self-directed learning. The course included: employment and health and safety legislation, work assessment and practical application of ergonomic principles at work.
Pre-, immediately post- and two months post-training, the ten OTs completed a questionnaire about their VR knowledge and confidence On completion, they reported a significant increase (p < 0.01)in their knowledge and confidence when delivering vocational rehabilitation. They rated the course as very or extremely relevant, although seven recommended more practical sessions. The preference for practical sessions was highlighted, in that the aspects they felt most beneficial were role-playing assessments and sharing ideas through discussion and presentations.
In conclusion, the course was considered effective in increasing both knowledge and confidence in using VR as an intervention, but, due to time constraints within the working day, some of the self-directed learning should be incorporated into the training days. Copyright © 2013 John Wiley & Sons, Ltd.
PMCID: PMC3746111  PMID: 23703966
Vocational rehabilitation/ work long term conditions rehabilitation
14.  Evaluation of an internet-based aftercare program to improve vocational reintegration after inpatient medical rehabilitation: study protocol for a cluster-randomized controlled trial 
Trials  2013;14:26.
Mental disorders are the main reasons for rising proportions of premature pension in most high-income countries. Although inpatient medical rehabilitation has increasingly targeted work-related stress, there is still a lack of studies on the transfer of work-specific interventions into work contexts. Therefore, we plan to evaluate an online aftercare program aiming to improve vocational reintegration after medical rehabilitation.
Vocationally strained patients (n = 800) aged between 18 and 59 years with private internet access are recruited in psychosomatic, orthopedic and cardiovascular rehabilitation clinics in Germany. During inpatient rehabilitation, participants in stress management group training are cluster-randomized to the intervention or control group. The intervention group (n = 400) is offered an internet-based aftercare with weekly writing tasks and therapeutic feedback, a patient forum, a self-test and relaxation exercises. The control group (n = 400) obtains regular e-mail reminders with links to publicly accessible information about stress management and coping. Assessments are conducted at the beginning of inpatient rehabilitation, the end of inpatient rehabilitation, the end of aftercare, and 9 months later. The primary outcome is a risk score for premature pension, measured by a screening questionnaire at follow-up. Secondary outcome measures include level of vocational stress, physical and mental health, and work capacity at follow-up.
We expect the intervention group to stabilize the improvements achieved during inpatient rehabilitation concerning stress management and coping, resulting in an improved vocational reintegration. The study protocol demonstrates the features of internet-based aftercare in rehabilitation.
Trial registration
International Standard Randomised Controlled Trial Number Register (ISRCTN:ISRCTN33957202)
PMCID: PMC3598370  PMID: 23351836
Internet-based intervention; Medical rehabilitation; Premature pension; Rehabilitation aftercare; Stress management; Work disability; Work stress
15.  Supported Employment for Middle-Aged and Older People with Schizophrenia 
Many middle-aged and older people with severe mental illness are interested in working or volunteering. However, very few vocational rehabilitation programs target older clients with psychiatric illness. We examined employment outcomes among 50 middle-aged and older participants with schizophrenia or schizoaffective disorder in a 12-month randomized controlled trial comparing two work rehabilitation programs: Individual Placement and Support (IPS; a supported employment model) and conventional vocational rehabilitation (CVR). Compared with CVR, IPS resulted in statistically better work outcomes, including attainment of competitive employment, number of weeks worked, and wages earned. Cohen's d effect sizes for these variables were medium to large (.66-.81). Treatment group predicted future attainment of competitive work, but demographic and clinical variables (e.g., age, gender, ethnicity, education, illness duration, and medication dose) did not predict employment outcomes. Participants who obtained competitive employment reported improved quality of life over time compared to those who did not. These findings suggest that for middle-aged and older clients with schizophrenia, supported employment results in better work outcomes than does conventional vocational rehabilitation. Furthermore, age was not significantly associated with attainment of competitive work. Finally, the therapeutic value of work is reflected in improved quality of life.
PMCID: PMC2638571  PMID: 19212460
16.  Manage at work: a randomized, controlled trial of a self-management group intervention to overcome workplace challenges associated with chronic physical health conditions 
BMC Public Health  2014;14:515.
The percentage of older and chronically ill workers is increasing rapidly in the US and in many other countries, but few interventions are available to help employees overcome the workplace challenges of chronic pain and other physical health conditions. While most workers are eligible for job accommodation and disability compensation benefits, other workplace strategies might improve individual-level coping and problem solving to prevent work disability. In this study, we hypothesize that an employer-sponsored group intervention program employing self-management principles may improve worker engagement and reduce functional limitation associated with chronic disorders.
In a randomized controlled trial (RCT), workers participating in an employer-sponsored self-management group intervention will be compared with a no-treatment (wait list) control condition. Volunteer employees (n = 300) will be recruited from five participating employers and randomly assigned to intervention or control. Participants in the intervention arm will attend facilitated group workshop sessions at work (10 hours total) to explore methods for improving comfort, adjusting work habits, communicating needs effectively, applying systematic problem solving, and dealing with negative thoughts and emotions about work. Work engagement and work limitation are the principal outcomes. Secondary outcomes include fatigue, job satisfaction, self-efficacy, turnover intention, sickness absence, and health care utilization. Measurements will be taken at baseline, 6-, and 12-month follow-up. A process evaluation will be performed alongside the randomized trial.
This study will be most relevant for organizations and occupational settings where some degree of job flexibility, leeway, and decision-making autonomy can be afforded to affected workers. The study design will provide initial assessment of a novel workplace approach and to understand factors affecting its feasibility and effectiveness.
Trial registration NCT01978392 (Issued November 6, 2013)
PMCID: PMC4051380  PMID: 24885844
Chronic health conditions; Workplace; Coping; Pain management; RCT; Presenteeism
17.  Health services research in workers' compensation medical care: policy issues and research opportunities. 
Health Services Research  1999;34(1 Pt 2):427-437.
OBJECTIVE: To describe some of the unique aspects of medical care offered under workers' compensation insurance systems and discuss the major policy considerations relevant to health services researchers undertaking investigations in this area. BACKGROUND AND FINDINGS: State-based workers' compensation (WC) insurance systems requiring employers to pay for medical care and wage replacement for workplace injuries and illnesses were first developed between 1910 and 1920 in the United States. Employers are generally required to purchase state-regulated workers' compensation insurance that includes first-dollar payment for all medical and rehabilitative services and payment of lost wages to workers with work-related illness or injury. Injured workers have variable but usually limited latitude in choosing their health care provider. Employers and workers' compensation insurers have incentives for controlling both the cost of medical care and lost wages. CONCLUSION: The major policy issues in WC medical care--the effect of patient choice of provider and delivery system structure, the ensuring of high-quality care, the effect of integrating benefits, and investigation of the interrelationships between work, health, and productivity--can be informed by current studies in health services research and by targeted future studies of workers' compensation populations. These studies must consider the extent of patient choice of physician, the regulatory environment, the unique role of the workplace as a risk and modifying factor, and the complex interaction between health and disability insurance benefits.
PMCID: PMC1089012  PMID: 10199686
18.  Randomized Trial of Supported Employment Integrated with Assertive Community Treatment for Rural Adults with Severe Mental Illness 
Schizophrenia bulletin  2005;32(2):378-395.
Urban-based randomized clinical trials of integrated supported employment (SE) and mental health services in the U.S. on average have doubled employment rates of adults with severe mental illness (SMI) compared to traditional vocational rehabilitation. However, studies have not yet explored if service integrative functions of SE will be effective in coordinating rural-based services that are limited, loosely-linked, and geographically-dispersed. In addition, SE’s ability to replicate work outcomes of urban programs in rural economies with scarce and less diverse job opportunities remains unknown. In a rural South Carolina county, we designed and implemented a program blending assertive community treatment (ACT) with an SE model, Individual Placement and Support (IPS). The ACT-IPS program operated with ACT and IPS subteams that tightly integrated vocational with mental health services within its self-contained team. In a 24-month randomized clinical trial, we compared ACT-IPS to a traditional program providing parallel vocational and mental health services, on competitive work outcomes for adults with SMI (N = 143, 69% schizophrenia, 77% African American). More ACT-IPS participants held competitive jobs (64% vs. 26%, P < .001, ES = 0.38) and earned more income (Mdn = $549, interquartile range (IQR) = $0 – $5145 vs. Mdn = $0, IQR = $0 – $40, P < .001, ES = 0.70) than comparison participants. Competitive work outcomes of this rural ACT-IPS program closely resemble those of urban SE programs. However, achieving economic self-sufficiently and developing careers probably requires increasing access to higher education and jobs imparting marketable technical skills.
PMCID: PMC1435374  PMID: 16177278
schizophrenia; vocational rehabilitation; rural mental health services; service integration; SEP, Supported Employment Program; ACT-IPS, Assertive Community Treatment—Individual Placement and Support Program; IPS, Individual Placement and Support. Numbers (percentages) for all variables refer to service receipt and job activity within each of the four 6-month intervals
19.  Characteristics of Work-related Musculoskeletal Disorders in Korea and Their Work-relatedness Evaluation 
Journal of Korean Medical Science  2010;25(Suppl):S77-S86.
Work-related musculoskeletal disorders (WMSDs) can be compensated through the Industrial Accident Compensation Insurance Act. We looked at the characteristics of WMSDs in worker's compensation records and the epidemiological investigation reports from the Occupational Safety and Health Research Institute (OSHRI). Based on the records of compensation, the number of cases for WMSDs decreased from 4,532 in 2003 to 1,954 in 2007. However the proportion of WMSDs among the total approved occupational diseases increased from 49.6% in 2003 to 76.5% in 2007, and the total cost of WMSDs increased from 105.3 billion won in 2004 to 163.3 billion won in 2007. The approval rate of WMSDs by the OSHRI accounted for 65.6%. Ergonomic and clinical characteristics were associated with the approval rate; however, the degenerative changes had a minimal affect. This result was in discordance between OSHRI and the Korea Workers' Compensation & Welfare Service. We presumed that there were perceptional gaps in work-relatedness interpretation that resulted from the inequality of information in ergonomic analyses. We propose to introduce ergonomic analysis to unapproved WMSDs cases and discuss those results among experts that will be helpful to form a consensus among diverse groups.
PMCID: PMC3023344  PMID: 21258595
Musculoskeletal Diseases; Workplace; Low Back Pain; Upper Extremity; Risk Factors
20.  Vocational rehabilitation services for patients with cancer: design of a feasibility study incorporating a pilot randomised controlled trial among women with breast cancer following surgery 
Trials  2011;12:89.
Due to improvements in cancer survival the number of people of working age living with cancer across Europe is likely to increase. UK governments have made commitments to reduce the number of working days lost to ill-health and to improve access to vocational rehabilitation (VR) services. Return to work for people with cancer has been identified as a priority. However, there are few services to support people to remain in or return to work after cancer and no associated trials to assess their impact. A pilot randomised controlled trial among women with breast cancer has been designed to assess the feasibility of a larger definitive trial of VR services for people with cancer.
Patients are being recruited from three clinical sites in two Scottish National Health Service (NHS) Boards for 6 months. Eligible patients are all women who are: (1) aged between 18 and 65 years; (2) in paid employment or self-employed; (3) living or working in Lothian or Tayside, Scotland, UK; (4) diagnosed with an invasive breast cancer tumour; (5) treated first with surgery. Patients are randomly allocated to receive referral to a VR service or usual care, which involves no formal employment support. The primary outcome measure is self-reported sickness absence in the first 6 months following surgery. Secondary outcome measures include changes in quality of life (FACT-B), fatigue (FACIT-Fatigue) and employment status between baseline and 6- and 12-months post-surgery. A post-trial evaluation will be conducted to assess the acceptability of the intervention among participants and the feasibility of a larger, more definitive, trial with patients with lung and prostate cancer.
To our knowledge this is the first study to determine the feasibility of a randomised controlled trial of the effectiveness of VR services to enable people with cancer to remain in or return to employment. The study will provide evidence to assess the relevance and feasibility of a larger future trial involving patients with breast, prostate or lung cancer and inform the development of appropriate VR services for people living with cancer.
Trial Registration
Registration date: 07/10/10; Randomisation of first patient: 03/12/10
PMCID: PMC3076250  PMID: 21450089
21.  The impact of workplace factors on filing of workers’ compensation claims among nursing home workers 
Injuries reported to workers’ compensation (WC) system are often used to estimate incidence of health outcomes and evaluate interventions in musculoskeletal epidemiology studies. However, WC claims represent a relatively small subset of all musculoskeletal disorders among employed individuals, and perhaps not a representative subset. This study determined the influence of workplace and individual factors on filing of workers’ compensation claims by nursing home employees with back pain.
Surveys were conducted in 18 skilled nursing facilities in four U.S. states. Self-administered questionnaires obtained information on demographic characteristics, working environment, and health behaviors/status. Employees who reported low back pain at least once in four questionnaire surveys were included. WC claims from the same facilities were obtained from the employer’s workers compensation insurer and matched by employee name. The dichotomous dependent variable was filing of back-related worker’s compensation claim. Association with predictors of interest, including pain severity, physical job demand, job strain, social support, schedule control, and safety climate, was assessed using multivariate regression modeling. Individual characteristics were tested as potential confounders.
Pain severity level was significantly associated with filing low-back related claims (odds ratio (OR) = 1.49, 95% CI = 1.18 – 1.87). Higher physical demands at work (OR = 1.07, 95% CI = 1.01 – 1.14) also increased the likelihood of claim filing. Higher job strain (OR = 0.83, 95% CI = 0.73 – 0.94), social support at work (OR = 0.90, 95% CI = 0.82 – 0.99), and education (OR = 0.79, 95% CI = 0.71 – 0.89) decreased the likelihood of claim filing.
The results suggest that the WC system captured the most severe occupational injuries. Workplace factors had additional influence on workers’ decision to file claims, after adjusting for low back pain severity. Education was correlated with worker’s socioeconomic status; its influence on claim filing is difficult to interpret because of the possible mixed effects of working conditions, self-efficacy, and content knowledge.
PMCID: PMC3912896  PMID: 24476529
Workers’ compensation; Healthcare worker; Work environment; Back pain; Under-reporting
22.  Return-to-work of sick-listed workers without an employment contract – what works? 
BMC Public Health  2009;9:232.
In the past decade flexible labour market arrangements have emerged as a significant change in the European Union labour market. Studies suggest that these new types of labour arrangements may be linked to ill health, an increased risk for work disability, and inadequate vocational rehabilitation. Therefore, the objectives of this study were: 1. to examine demographic characteristics of workers without an employment contract sick-listed for at least 13 weeks, 2. to describe the content and frequency of occupational health care (OHC) interventions for these sick-listed workers, and 3. to examine OHC interventions as possible determinants for return-to-work (RTW) of these workers.
A cohort of 1077 sick-listed workers without an employment contract were included at baseline, i.e. 13 weeks after reporting sick. Demographic variables were available at baseline. Measurement of cross-sectional data took place 4–6 months after inclusion. Primary outcome measures were: frequency of OHC interventions and RTW-rates. Measured confounding variables were: gender, age, type of worker (temporary agency worker, unemployed worker, or remaining worker without employment contract), level of education, reason for absenteeism (diagnosis), and perceived health. The association between OHC interventions and RTW was analysed with a logistic multiple regression analysis.
At 7–9 months after the first day of reporting sick only 19% of the workers had (partially or completely) returned to work, and most workers perceived their health as fairly poor or poor. The most frequently reported (49%) intervention was 'the OHC professional discussed RTW'. However, the intervention 'OHC professional made and discussed a RTW action plan' was reported by only 19% of the respondents. The logistic multiple regression analysis showed a significant positive association between RTW and the interventions: 'OHC professional discussed RTW'; and 'OHC professional made and discussed a RTW action plan'. The intervention 'OHC professional referred sick-listed worker to a vocational rehabilitation agency' was significantly associated with no RTW.
This is the first time that characteristics of a large cohort of sick-listed workers without an employment contract were examined. An experimental or prospective study is needed to explore the causal nature of the associations found between OHC interventions and RTW.
PMCID: PMC2718883  PMID: 19602219
23.  Prediction of chronic disability in work-related musculoskeletal disorders: a prospective, population-based study 
Disability associated with work-related musculoskeletal disorders is an increasingly serious societal problem. Although most injured workers return quickly to work, a substantial number do not. The costs of chronic disability to the injured worker, his or her family, employers, and society are enormous. A means of accurate early identification of injured workers at risk for chronic disability could enable these individuals to be targeted for early intervention to promote return to work and normal functioning. The purpose of this study is to develop statistical models that accurately predict chronic work disability from data obtained from administrative databases and worker interviews soon after a work injury. Based on these models, we will develop a brief instrument that could be administered in medical or workers' compensation settings to screen injured workers for chronic disability risk.
This is a population-based, prospective study. The study population consists of workers who file claims for work-related back injuries or carpal tunnel syndrome (CTS) in Washington State. The Washington State Department of Labor and Industries claims database is reviewed weekly to identify workers with new claims for work-related back injuries and CTS, and these workers are telephoned and invited to participate. Workers who enroll complete a computer-assisted telephone interview at baseline and one year later. The baseline interview assesses sociodemographic, employment-related, biomedical/health care, legal, and psychosocial risk factors. The follow-up interview assesses pain, disability, and work status. The primary outcome is duration of work disability over the year after claim submission, as assessed by administrative data. Secondary outcomes include work disability status at one year, as assessed by both self-report and work disability compensation status (administrative records). A sample size of 1,800 workers with back injuries and 1,200 with CTS will provide adequate statistical power (0.96 for low back and 0.85 for CTS) to predict disability with an alpha of .05 (two-sided) and a hazard ratio of 1.2. Proportional hazards regression models will be constructed to determine the best combination of predictors of work disability duration at one year. Regression models will also be developed for the secondary outcomes.
PMCID: PMC428578  PMID: 15157280
24.  Case management vocational rehabilitation for women with breast cancer after surgery: a feasibility study incorporating a pilot randomised controlled trial 
Trials  2013;14:175.
There is a paucity of methodologically robust vocational rehabilitation (VR) intervention trials. This study assessed the feasibility and acceptability of a VR trial of women with breast cancer to inform the development of a larger interventional study.
Women were recruited in Scotland and randomised to either a case management VR service or to usual care. Data were collected on eligibility, recruitment and attrition rates to assess trial feasibility, and interviews conducted to determine trial acceptability. Sick leave days (primary outcome) were self-reported via postal questionnaire every 4 weeks during the first 6 months post-surgery and at 12 months. Secondary outcome measures were change in employment pattern, quality of life and fatigue.
Of the 1,114 women assessed for eligibility, 163 (15%) were eligible. The main reason for ineligibility was age (>65 years, n = 637, 67%). Of those eligible, 111 (68%) received study information, of which 23 (21%) consented to participate in the study. Data for 18 (78%) women were analysed (intervention: n = 7; control: n = 11). Participants in the intervention group reported, on average, 53 fewer days of sick leave over the first 6 months post-surgery than those in the control group; however, this difference was not statistically significant (p = 0.122; 95% confidence interval −15.8, 122.0). No statistically significant differences were found for secondary outcomes. Interviews with trial participants indicated that trial procedures, including recruitment, randomisation and research instruments, were acceptable.
Conducting a pragmatic trial of effectiveness of a VR intervention among cancer survivors is both feasible and acceptable, but more research about the exact components of a VR intervention and choice of outcomes to measure effectiveness is required. VR to assist breast cancer patients in the return to work process is an important component of cancer survivorship plans.
Trial registration
PMCID: PMC3698180  PMID: 23768153
Cancer survivor; Breast cancer; Vocational rehabilitation; Work; Employment; Sickness absence
25.  Enhancing return-to-work in cancer patients, development of an intervention and design of a randomised controlled trial 
BMC Cancer  2010;10:345.
Compared to healthy controls, cancer patients have a higher risk of unemployment, which has negative social and economic impacts on the patients and on society at large. Therefore, return-to-work of cancer patients needs to be improved by way of an intervention. The objective is to describe the development and content of a work-directed intervention to enhance return-to-work in cancer patients and to explain the study design used for evaluating the effectiveness of the intervention.
Development and content of the intervention
The work-directed intervention has been developed based on a systematic literature review of work-directed interventions for cancer patients, factors reported by cancer survivors as helping or hindering their return-to-work, focus group and interview data for cancer patients, health care professionals, and supervisors, and vocational rehabilitation literature. The work-directed intervention consists of: 1) 4 meetings with a nurse at the treating hospital department to start early vocational rehabilitation, 2) 1 meeting with the participant, occupational physician, and supervisor to make a return-to-work plan, and 3) letters from the treating physician to the occupational physician to enhance communication.
Study design to evaluate the intervention
The treating physician or nurse recruits patients before the start of initial treatment. Patients are eligible when they have a primary diagnosis of cancer, will be treated with curative intent, are employed at the time of diagnosis, are on sick leave, and are between 18 and 60 years old. After the patients have given informed consent and have filled out a baseline questionnaire, they are randomised to either the control group or to the intervention group and receive either care as usual or the work-directed intervention, respectively. Primary outcomes are return-to-work and quality of life. The feasibility of the intervention and direct and indirect costs will be determined. Outcomes will be assessed by a questionnaire at baseline and at 6, 12, 18, and 24 months after baseline.
This study will provide information about the effectiveness of a work-directed intervention for cancer patients. The intention is to implement the intervention in normal care if it has been shown effective.
Trial registration
PMCID: PMC2907345  PMID: 20594347

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