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author:("anemia, J")
1.  Process Evaluation of a Multidisciplinary Care Program for Patients Undergoing Gynaecological Surgery 
Purpose This study describes the process evaluation of an innovative multidisciplinary care program for patients undergoing benign gynaecologic surgery. This care program aims at improving recovery and preventing delayed return to work and consists of two steps: (1) an interactive e-health intervention for all participants, and (2) integrated clinical and occupational care management for those participants whose sick leave exceeds 10 weeks. Methods Eligible for this study were employed women aged between 18–65 years scheduled for a laparoscopic adnexal surgery and/or hysterectomy. Data were collected from patients, their supervisors and their gynaecologists, by means of electronic questionnaires during a 6 month follow-up period and an automatically generated, detailed weblog of the patient web portal ( Investigated process measures included: reach, dose delivered, dose received, and fidelity. In addition, attitudes towards the intervention were explored among all stakeholders. Results 215 patients enrolled in the study and accounted to a reach of 60.2 % (215/357). All intervention group patients used their account at least once and total time spent on the patient web portal was almost 2 h for each patient (median 118 min, IQR 64–173 min). Most patients visited the website several times (median 11 times, IQR 6–16). Perceived effectiveness among patients was high (74 %). In addition, gynaecologists (76 %) and employers (61 %) were satisfied with the web portal as well. Implementation of the second step of the intervention was suboptimal. Motivating patients to consent to additional guidance and developing an accurate return-to-work-prognosis were two important obstacles. Conclusions The results of this study indicate good feasibility for implementation on a broad scale of the e-health intervention for patients undergoing benign gynaecological surgery. To enhance the implementation of the second step of the perioperative care program, adaptations in the integrated care protocol are needed.
Electronic supplementary material
The online version of this article (doi:10.1007/s10926-013-9475-4) contains supplementary material, which is available to authorized users.
PMCID: PMC4118044  PMID: 24057871
Gynaecology; Telemedicine; Convalescence; Return to work; Program evaluation
2.  Predicting Return to Work in Workers with All-Cause Sickness Absence Greater than 4 Weeks: A Prospective Cohort Study 
Introduction Long-term sickness absence is a major public health and economic problem. Evidence is lacking for factors that are associated with return to work (RTW) in sick-listed workers. The aim of this study is to examine factors associated with the duration until full RTW in workers sick-listed due to any cause for at least 4 weeks. Methods In this cohort study, health-related, personal and job-related factors were measured at entry into the study. Workers were followed until 1 year after the start of sickness absence to determine the duration until full RTW. Cox proportional hazards regression analyses were used to calculate hazard ratios (HR). Results Data were collected from N = 730 workers. During the first year after the start of sickness absence, 71% of the workers had full RTW, 9.1% was censored because they resigned, and 19.9% did not have full RTW. High physical job demands (HR .562, CI .348–.908), contact with medical specialists (HR .691, CI .560–.854), high physical symptoms (HR .744, CI .583–.950), moderate to severe depressive symptoms (HR .748, CI .569–.984) and older age (HR .776, CI .628–.958) were associated with a longer duration until RTW in sick-listed workers. Conclusions Sick-listed workers with older age, moderate to severe depressive symptoms, high physical symptoms, high physical job demands and contact with medical specialists are at increased risk for a longer duration of sickness absence. OPs need to be aware of these factors to identify workers who will most likely benefit from an early intervention.
PMCID: PMC3274679  PMID: 21842133
Return to work; Long-term sickness absence; Prognostic factors
3.  Recurrence of Medically Certified Sickness Absence According to Diagnosis: A Sickness Absence Register Study 
Introduction Sickness absence is a major public health problem. Research on sickness absence focuses on interventions aimed at expediting return to work. However, we need to know more about sustaining employees at work after return to work. Therefore, this study investigated the recurrence of sickness absence according to diagnosis. Methods We analyzed the registered sickness absence data of 137,172 employees working for the Dutch Post and Telecom. Episodes of sickness absence were medically certified, according to the ICD-10 classification of diseases, by an occupational physician. The incidence density (ID) and recurrence density (RD) of medically certified absences were calculated per 1,000 person-years in each ICD-10 category. Results Sickness absence due to musculoskeletal disorders had the highest recurrence (RD = 118.7 per 1,000 person-years), followed by recurrence of sickness absence due to mental disorders (RD = 80.4 per 1,000 person-years). The median time to recurrent sickness absence due to musculoskeletal disorders was 409 days after the index episode. Recurrences of sickness absence due to musculoskeletal disorders accounted for 37% of the total number of recurrent sickness absence days. For recurrences of sickness absence due to mental disorders this was 328 days and 21%, respectively. Unskilled employees with a short duration (<5 years) of employment had a higher risk of recurrent sickness absence. Conclusions Interventions to expedite return to work of employees sick-listed due to musculoskeletal or mental disorders should also aim at reducing recurrence of sickness absence in order to sustain employees at work.
PMCID: PMC2832874  PMID: 20052523
Absenteeism; Sickness absence; Epidemiology; Recurrence of sickness absence
4.  Can Cross Country Differences in Return-to-Work After Chronic Occupational Back Pain be Explained? An Exploratory Analysis on Disability Policies in a Six Country Cohort Study 
Introduction There are substantial differences in the number of disability benefits for occupational low back pain (LBP) among countries. There are also large cross country differences in disability policies. According to the Organization for Economic Cooperation and Development (OECD) there are two principal policy approaches: countries which have an emphasis on a compensation policy approach or countries with an emphasis on an reintegration policy approach. The International Social Security Association initiated this study to explain differences in return-to-work (RTW) among claimants with long term sick leave due to LBP between countries with a special focus on the effect of different disability policies. Methods A multinational cohort of 2,825 compensation claimants off work for 3–4 months due to LBP was recruited in Denmark, Germany, Israel, the Netherlands, Sweden, and the United States. Relevant predictors and interventions were measured at 3 months, one and 2 years after the start of sick leave. The main outcome measure was duration until sustainable RTW (i.e. working after 2 years). Multivariate analyses were conducted to explain differences in sustainable RTW between countries and to explore the effect of different disability policies. Results Medical and work interventions varied considerably between countries. Sustainable RTW ranged from 22% in the German cohort up to 62% in the Dutch cohort after 2 years of follow-up. Work interventions and job characteristics contributed most to these differences. Patient health, medical interventions and patient characteristics were less important. In addition, cross-country differences in eligibility criteria for entitlement to long-term and/or partial disability benefits contributed to the observed differences in sustainable RTW rates: less strict criteria are more effective. The model including various compensation policy variables explained 48% of the variance. Conclusions Large cross-country differences in sustainable RTW after chronic LBP are mainly explained by cross-country differences in applied work interventions. Differences in eligibility criteria for long term disability benefits contributed also to the differences in RTW. This study supports OECD policy recommendations: Individual packages of work interventions and flexible (partial) disability benefits adapted to the individual needs and capacities are important for preventing work disability due to LBP.
PMCID: PMC2775112  PMID: 19760488
Compensation policy; Disability policy; Back pain; Medical intervention; Work intervention; Multinational cohort
5.  The effectiveness of graded activity for low back pain in occupational healthcare 
Low back pain is a common medical and social problem associated with disability and absence from work. Knowledge on effective return to work (RTW) interventions is scarce.
To determine the effectiveness of graded activity as part of a multistage RTW programme.
Randomised controlled trial.
Occupational healthcare.
112 workers absent from work for more than eight weeks due to low back pain were randomised to either graded activity (n = 55) or usual care (n = 57).
Graded activity, a physical exercise programme aimed at RTW based on operant‐conditioning behavioural principles.
Main outcome measures
The number of days off work until first RTW for more then 28 days, total number of days on sick leave during follow up, functional status, and severity of pain. Follow up was 26 weeks.
Graded activity prolonged RTW. Median time until RTW was equal to the total number of days on sick leave and was 139 (IQR = 69) days in the graded activity group and 111 (IQR = 76) days in the usual care group (hazard ratio = 0.52, 95% CI 0.32 to 0.86). An interaction between a prior workplace intervention and graded activity, together with a delay in the start of the graded activity intervention, explained most of the delay in RTW (hazard ratio = 0.86, 95% CI 0.40 to 1.84 without prior intervention and 0.39, 95% CI 0.19 to 0.81 with prior intervention). Graded activity did not improve pain or functional status clinically significantly.
Graded activity was not effective for any of the outcome measures. Different interventions combined can lead to a delay in RTW. Delay in referral to graded activity delays RTW. In implementing graded activity special attention should be paid to the structure and process of care.
PMCID: PMC2077992  PMID: 16847036
low back pain; graded activity; randomised controlled trial; effectiveness; cognitive behavioural; return‐to‐work
6.  Validation Study of a Distress Screener 
Objectives A 3-item screening instrument called the Distress Screener was developed for early identification of distress among employees on sick leave. The Distress Screener consists of three items obtained from the distress subscale of the four-dimensional symptom questionnaire (4DSQ). This study assessed an optimal cut-off point and validated the Distress Screener by relating it to the 4DSQ and to medical diagnoses. Methods 171 sick-listed employees filled in the Distress Screener and the 4DSQ (containing four subscales: distress, depression, anxiety and somatisation) and medical diagnoses were obtained from occupational physicians (OPs). The optimal cut-off point was assessed by computing sensitivity and specificity values. Validity was assessed by relating the Distress Screener score to the scores on 4DSQ subscales. In addition scores were compared to mental health medical diagnoses and the degree of similarity between two repeated measurements was obtained. Results Using the 4DSQ distress score >10 as reference standard, the optimal cut-off point of the Distress Screener was ≥4. Regarding validity, a high correlation (0.82) existed between the Distress Screener and the 4DSQ distress subscale and it was significantly different from the correlations with the other 4DSQ subscales. Also a high correlation existed for the test–retest reliability (0.83). Furthermore, a high score on the Distress Screener seemed to be related to the medical diagnosis ‘Stress-related complaints’. All low scores seemed to be related to the medical diagnosis ‘Other complaints’. Sensitivity (0.85) and specificity (0.78) values, and positive and negative predictive values of the screener were comparable to those of the 4DSQ distress subscale. Conclusions The Distress Screener is a valid instrument for use by the OP during consulting time as a quick scan for early identification of distress in employees on sick leave. The cut-off point ≥4 is useful for early identification of distress in employees on sick leave.
PMCID: PMC2712065  PMID: 19396529
Mental disorders; Screening; Occupational physician; Medical diagnosis; Distress; Validity
7.  Patient satisfaction with occupational health physicians, development of a questionnaire 
Aims: To develop a questionnaire that measures specific aspects of patient satisfaction with occupational health physicians.
Methods: General patient satisfaction questionnaires, a literature survey, and interviews with patients were used. An initial questionnaire was distributed among sick listed patients (n = 432) of occupational physicians (n = 90) from different occupational health services. To reduce items and to develop scales exploratory factor analysis and reliability analysis was used. A linear regression model was used to predict satisfaction ratings from the scales of the questionnaire.
Results: Questions about independence of the occupational physician were difficult to ask unambiguously. The factor analysis revealed five relevant factors which were named "being taken seriously as a patient", "attitude towards occupational health services", "trust and confidentiality", "expectations", and "comfort and access". All scales could be reduced to a maximum of five items without reducing the scale reliability too much. In the regression analysis, 71% of the variance of satisfaction ratings was explained by the first four scales and most by the first scale. "Comfort and access" did not contribute significantly to the model.
Conclusions: A short questionnaire was developed to measure different aspects of patient satisfaction specific for occupational health. Whether the questionnaire can effectively lead to quality improvement in occupational health services should be investigated.
PMCID: PMC1740945  PMID: 15657194
8.  The effectiveness of ergonomic interventions on return-to-work after low back pain; a prospective two year cohort study in six countries on low back pain patients sicklisted for 3–4 months 
Aims: To study occurrence and effectiveness of ergonomic interventions on return-to-work applied for workers with low back pain (LBP).
Methods: A multinational cohort of 1631 workers fully sicklisted 3–4 months due to LBP (ICD-9 codes 721, 722, 724) was recruited from sickness benefit claimants databases in Denmark, Germany, Israel, Sweden, the Netherlands, and the United States. Medical, ergonomic, and other interventions, working status, and return-to-work were measured using questionnaires and interviews at three months, one and two years after the start of sickleave. Main outcome measure was time to return-to-work. Cox's proportional hazards model was used to calculate hazard ratios regarding the time to return-to-work, adjusted for prognostic factors.
Results: Ergonomic interventions varied considerably in occurrence between the national cohorts: 23.4% (mean) of the participants reported adaptation of the workplace, ranging from 15.0% to 30.5%. Adaptation of job tasks and adaptation of working hours was applied for 44.8% (range 41.0–59.2%) and 46.0% (range 19.9–62.9%) of the participants, respectively. Adaptation of the workplace was effective on return-to-work rate with an adjusted hazard ratio (HR) of 1.47 (95% CI 1.25 to 1.72; p < 0.0001). Adaptation of job tasks and adaptation of working hours were effective on return-to-work after a period of more than 200 days of sickleave with an adjusted HR of 1.78 (95% CI 1.42 to 2.23; p < 0.0001) and 1.41 (95% CI 1.13 to 1.76; p = 0.002), respectively.
Conclusions: Results suggest that ergonomic interventions are effective on return-to-work of workers long term sicklisted due to LBP.
PMCID: PMC1740746  PMID: 15031385
9.  Ineffective disability management by doctors is an obstacle for return-to-work: a cohort study on low back pain patients sicklisted for 3–4 months 
Aims: To determine obstacles for return-to-work in disability management of low back pain patients sicklisted for 3–4 months.
Methods: A cohort of 467 low back pain patients sicklisted for 3–4 months was recruited. A questionnaire was sent to their occupational physicians (OPs) concerning the medical management, obstacles to return-to-work, and the communication with treating physicians.
Results: The OPs of 300 of 467 patients participated in this study. In many cases OPs regarded the clinical waiting period (43%), duration of treatment (41%), and view (25%) of the treating physicians as obstacles for return-to-work. Psychosocial obstacles for return-to-work such as mental blocks, a lack of job motivation, personal problems, and conflicts at work were all mentioned much less frequently by OPs. In only 19% of the patients was there communication between OP and treating physician. Communication almost always entailed an exchange of information, and less frequently an attempt to harmonise the management policy. Surprisingly communication was also limited, when OPs felt that the waiting period (32%), duration of treatment (30%), and view (28%) of treating physicians inhibited return-to-work. Communication was significantly associated with the following obstacles for return-to-work: passivity with regard to return-to-work and clinical waiting period; adjusted odds ratios were 3.35 and 2.23, respectively.
Conclusions: Medical management of treating physicians is often an obstacle for return to work regarding low back pain patients sicklisted for 3–4 months, in the opinion of OPs. Nevertheless communication between OPs and the treating physicians in disability management of these patients is limited. More attention to prevention of absenteeism and bilateral communication is needed in medical courses.
PMCID: PMC1740234  PMID: 12409530

Results 1-9 (9)