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PubMed2002

Understanding return to work behaviours: promoting the importance of individual perceptions in the study of return to work.

PURPOSE: The purpose of this paper is to demonstrate and discuss how individuals' subjective perceptions of personal and environmental issues influence return to work behaviour. METHOD: A qualitative design utilizing in-depth interviews and maximum variation sampling of 11 individuals who either returned to work or withdrew from work after a health leave was conducted. Experiences elicited were analysed using the constant comparative method followed by a member check with participants to confirm findings and interpretations. RESULTS: Findings underscored the importance of two key constructs in understanding return to work from the individual's perspective: the personal meaning of disability and return to work relevancy. Throughout the experience of getting better and returning to work participants reflected upon the impact of personal and external factors that contributed to their work disability, sought clarity of their performance capacities and examined the importance of work and the consequences of work disability within their life circumstances. CONCLUSIONS: Insights into an individual's perceptions of their impairment and the personal relevance of work can promote a better understanding of return to work behaviour. Integrating individual perceptions is essential to advancing a multidimensional approach in return to work research.

Adult↗

PubMed2001

Promotion of work ability, the quality of work and retirement.

In this study, the validity of a model designed to promote the work ability of aging workers was examined. The target areas of work ability promotion were searched for the characteristics that explain work ability the best. In addition, the way work ability relates to the quality of work and retirement was examined. The subjects (n = 1101) participated in the follow-up study on aging Finnish workers in 1992 and 1997. The results consistently supported the model for promoting work ability. All four areas of focus-(i) work demands and the environment; (ii) work organization and the work community; (iii) the promotion of workers' health and functional capacity; and (iv) the promotion of professional competence-proved to be strongly associated with work ability. Good work ability was associated with a high quality of work and the enjoyment of staying in one's job. It also predicted active and meaningful retirement.

Aging↗

PubMed2002

Into work, through tailored paths: a two-year follow-up of the return-to-work rehabilitation and re-employment project.

Between the years 1996 and 2000, over 2000 projects were carried out in Finland with the aim of finding innovative measures for crossing the job threshold. Among them was the Pathway-to-Work Project, which aimed at tailoring return-to-work plans for 140 middle-aged, long-term unemployed participants with various disabilities and getting half of them into work or training. This study of the Pathway-to-Work Project had two research objectives. First, to evaluate the outcomes of the return-to-work rehabilitation project and second, to determine what combination of different measures seemed necessary and effective in the rehabilitation of long-term unemployed people with disabilities. The research design comprised three parts: a quantitative quasi-experimental part with a matched control group, a register follow-up and the collection of qualitative data. The main variables used to evaluate the outcomes were (1) the changes in the labour market situation during the 2-year register follow-up, (2) the changes in distress (measured by the General Health Questionnaire-12), perceived competence (measured by Wallston's Self-Performance Survey) and sense of coherence (measured by Antonovsky's SOC-13) during the intervention and (3) the description of the process in the project. In the 1-year follow-up, 31% of the participants were found to be at work and 37% unemployed. In the 2-year follow-up, 14% were at work and 59% unemployed. The jobs seemed to be subsidized for a period of half a year to a year. The difference between the project group and the matched control group was remarkable: at the end of the project, only 9% of the control group were at work and 86% unemployed. The participants' distress level decreased remarkably and their perceived competence increased, but their sense of coherence did not change. The results showed that even carefully tailored client work enables only some of the long-term unemployed people with disabilities to cross the job threshold and that other means of policy, strategy and intervention are needed to link the return-to-work interventions more closely with work, work places and enterprises.

Adult↗

PubMed1993

Incapacity for work in elective orthopaedic surgery: a study of occurrence and the probability of returning to work after treatment.

STUDY OBJECTIVE: The extent to which patients undergoing elective surgery for orthopaedic disorders were incapacitated for work while they were on the waiting list and whether they were able to return to work after surgery were studied. DESIGN: This was a prospective cohort study of patients admitted to hospital for elective orthopaedic surgery. Main outcome measures were occurrence of sickness certification during the waiting time, and whether those incapacitated for work at the time of surgery returned to work during the first year after treatment. Multivariate logistic regression was used to estimate adjusted odds ratios for factors influencing return to work. SETTING: Orthopaedic department in charge of all elective orthopaedic surgery in a population of 197,354 persons in central Norway. SUBJECTS: All 2803 patients admitted to hospital for chronic orthopaedic disorders in the defined population between 1 September 1988 and 31 August 1990 were included in the study. MAIN RESULTS: Of the 1333 patients who were employed, 42% had been certified sick due to the orthopaedic disorder for some period of the waiting time. Sickness benefits from the national insurance scheme (paid from the 15th day of sickness certification) had been received by 33% and were received by 29% at the time of surgery. Of 380 patients incapacitated for work at the time of surgery, 53% returned to work within the first year after surgery. Using those treated within one month of being placed on the waiting list as the reference group, the adjusted odds ratios for not returning to work during the first year after surgery were 9.2 (p < 0.0001) for those who waited more than a year for surgery, 6.2 (p = 0.002) for those waiting nine to 12 months, and 4.9 (p = 0.02) for those waiting for six to nine months. CONCLUSIONS: A high proportion of these patients were incapacitated for work, 53% of those incapacitated returned to work within the first year after surgery. The probability of returning to work after surgery is strongly influenced by the length of time on the waiting list. Waiting for more than one year, compared with immediate treatment, was associated with an adjusted odds ratio of 9.2 for not returning to work.

Absenteeism↗

PubMed1990

The work and energetic cost of locomotion. II. Partitioning the cost of internal and external work within a species.

Previous studies have shown that large animals have systematically lower mass-specific costs of locomotion than do smaller animals, in spite of there being no demonstrable difference between them in the mass-specific mechanical work of locomotion. Larger animals are somehow much more efficient at converting metabolic energy to mechanical work. The present study analyzes how this decoupling of work and cost might occur. The experimental design employs limb-loaded and back-loaded dogs and allows the energetic cost of locomotion to be partitioned between that used to move the center of mass (external work) and that used to move the limbs relative to the center of mass (internal work). These costs were measured in three dogs moving at four speeds. Increases in the cost of external work with speed parallel increases in the amount of external work based on data from previous studies. However, increases in the cost of internal work with speed are much less (less than 50%) than the increase in internal work itself over the speeds examined. Furthermore, the cost of internal work increases linearly with speed, whereas internal work itself increases as a power function of speed. It is suggested that this decoupling results from an increase with speed in the extent to which the internal work of locomotion is powered by non-metabolic means, such as elastic strain energy and transfer of energy within and between body segments.

Animals↗

PubMed2006

Self-assessed quality of sleep, occupational health, working environment, illness experience and job satisfaction of female nurses working different combination of shifts.

AIM: The aim of this study was to describe and compare the self-assessed quality of sleep, occupational health, working environment, illness experience and job satisfaction among female nurses working different combinations of shifts. BACKGROUND: Evidence from several studies indicates that there is an association between the disruption of the circadian cycle caused by shift work and adverse health effects. METHODS: A cross-sectional design was used with a sample of 348 nurses drawn from the registry of the Icelandic Nurses' Association, representing 17% of the workforce of Icelandic nurses. A self-administered questionnaire, measuring occupational health, quality of sleep, the illness experience, job satisfaction and working environment was used. Data were analysed according to type of shift (days only, rotating days/evenings, rotating days/evenings/nights) by use of analysis of variance and chi-square. RESULTS: No difference was found between participants based on type of shift with regard to the illness experience, job satisfaction and quality of sleep. Nurses working rotating day/evening/night shifts reported a longer working day, more stressful environmental risk factors, more strenuous work and that they were less able to control their work-pace. In general, the nurses reported low severity of symptoms; however, nurses working rotating days/evenings shifts experienced more severe gastrointestinal and musculoskeletal symptoms when compared with others. This was explained by the short rest period provided for between evening and morning shifts. CONCLUSIONS: In general Icelandic nurses are satisfied with their work and their shift assignment does not seem to pathologically disrupt their circadian cycle. Nevertheless, nursing directors are advised to look more closely at the organization of nurses' work during night shifts, as well as the rest period for nurses changing from evening to day shifts.

Absenteeism↗

PubMedDate not supplied

Physical activity of poor urban women in Cali, Colombia: a comparison of working and not working women.

We have previously presented evidence that the physical activity level (PAL) and total energy expenditure (per kg body weight) of poor urban women who "work" (engage in income-earning activities) is similar to those who do not "work" (but do tend to household and childcare responsibilities) (Spurr et al. [1996] Am J Clin Nutr 63:870-878; [1997] Med Sci Sports Exerc 29:1255-1262). These findings were unexpected and raised questions regarding the actual types of activities engaged in by the two groups. In this article we address those questions by comparing the time allocation of the two groups. Time allocation during waking hours (14.2 +/- 1.1 hours/day) was recorded in minute-by-minute diaries by trained observers for two consecutive days for 52 working women and 28 not-working women. The working women were engaged in predominately informal sector economic activities, such as street vending, childcare, and domestic service, in addition to their own household and childcare responsibilities. The activities of the not-working women were largely restricted to household and childcare responsibilities. The working women tended to spend less time in resting activities and TV-watching and more time in travel and miscellaneous work activities, but other between-group differences were not significant. We conclude that the time allocation of working women is similar to that of not-working women because 1) many of the activities engaged in are the same or similar, and 2) some working women are only engaged in income-earning activities for limited time periods.

Adult↗

PubMedDate not supplied

Availability of childcare support and nutritional status of children of non-working and working mothers in urban Nepal.

In many developing countries, poor women have multiple roles, and often their time constraints are so severe that their participation in income-generating activities results in reduced childcare time, which in turn affects child health. Previous studies have tended to investigate how childcare support influences nutrition of children with working mothers' based on comparisons with non-working mothers. However, non-working mothers are not a homogeneous group, and we therefore need to distinguish between those who need not work and those who wish to but cannot, for example, due to a lack of substitute caregivers. We examined the association between availability of childcare support and the nutritional status of children of both non-working and working mothers in poor areas of Pokhara, a sub-metropolitan city in Nepal. We recruited 150 children of age 10-24 months from the waiting lists of 17 daycare centers and measured their weights and heights. Those with height-for-age and weight-for-age Z scores of less than -2 were defined as stunted and underweight, respectively. To collect information on childcare practices and socioeconomic characteristics, mothers were interviewed using a pre-tested structured questionnaire. Unavailability of adult childcare support was associated with increased risk of malnutrition among children of both non-working and working mothers. Peer childcare was not significantly associated with child malnutrition among children of non-working mothers, but it was associated with an increased risk of malnutrition among children of working mothers. Although further longitudinal research is required, we suggest that childcare support from adult substitute caregivers is essential for children of non-working mothers with limited resources.

Adult↗

PubMed1996

Work-physiological synchronization as a determinant of performance in repetitive computer work.

The present study tested the hypothesis that performance would improve when the work rhythm of a highly repetitive task was synchronous with a worker's internal physiological rhythms. Experienced office workers (n = 20) used video display terminals (VDTs) to perform a repetitive, self-paced data-entry task in a simulated office environment over a 2-day period. Each work day consisted of six 40-min work periods. Work rhythm changes were induced by varying input data field lengths (3-13 characters) across eleven of the twelve work periods. The degree of synchronization between the work and breathing rhythms, and also between the work rhythm and variations in the interbeat interval, was scored using cross-spectral analysis. Synchronization scores were then used to predict keying performance using multiple regression analysis. The degree of synchronization between the work and breathing rhythms was not predictive of performance. However, increased synchronization between the work and cardiac rhythms was predictive of (a) increased keystroke output, (b) lower error rate and (c) lower correction rate. The results suggest that performance in repetitive VDT work might improve if the task is designed to promote work-physiological synchronization.

Adolescent↗

PubMed2003

Back to work: predictors of return to work among patients with back disorders certified as sick: a two-year follow-up study.

STUDY DESIGN: A 2-year follow-up study of patients with back disorders certified as sick. OBJECTIVES: To identify predictors of return to work. SUMMARY OF BACKGROUND DATA: Back disorders are common health problems and the most important disorders associated with absence from work in the welfare states. Predictors of future absence may be of help in allocating rehabilitation efforts to such patients. Possible predictors include demographic and medical factors, the patients' functional status, and former absence. METHODS: For this study, 190 patients certified as sick who attended a back disorder outpatient clinic from September 1997 to December 1998 answered a questionnaire. Demographic data, medical factors, self-assessed function, and absence data were recorded. Return to work, defined as returning to work for at least 60 consecutive calendar days, was used in Cox regression analyses. RESULTS: According to multiple Cox regression analyses, age of 40 to 49 years (HR, 0.52; 95% confidence interval [95%CI], 0.29-0.94), high pain intensity (HR, 0.30; 95%CI, 0.17-0.55), low self-assessed work ability (HR, 0.43; 95%CI, 0.25-0.73), and a self-predicted absence status of not returning to work (HR, 0.31; 95%CI, 0.17-0.54) predicted longer time until return to work. Back disorders with radiation predicted shorter time until return to work (HR, 2.08; 95%CI, 1.37-3.16). The COOP/WONCA chart's physical fitness, daily activities, overall health, and change in health were associated with time until return to work in univariate analyses only, as was the duration of the sickness certification episodes from start to inclusion and the degree of sickness certification at inclusion. CONCLUSIONS: Information about the age of the patients, diagnoses, pain intensity, self-assessed work ability, and self-predicted absence status may be used as predictors of time until return to work in patients with back disorders certified as sick who attend a back disorder outpatient clinic.

Adult↗

PubMed1997

[Work intensity during working hours and different types of care done by special nursing home workers].

This study was done to estimated work intensity during working hours and different types of care to obtain basic data for making a care program. The subjects were care workers in good health (n = 8, 24-45 years) who worked in a special nursing home. The estimated maximal oxygen intake level, which is the maximal aerobic capacity, of each subject was assessed as normal to very good. The energy expenditure was 1787 +/- 534kcal during working hours. The work intensity was 0.061 +/- 0.011kcal/kg/min, 2.7 +/- 0.7RMR, 98 +/- 6beats/min, and 30.3 +/- 2.0% VO2max. Among the duties assessed for work intensity, bathing had the highest intensity, followed by transferring, changing diapers, feeding, and dressing. The work intensity of bathing was 0.081 +/- 0.31kcal/kg/min, 3.9 +/- 1.0RMR, and 40.0 +/- 6.1 VO2 max, which was significantly higher than feeding, dressing, and transferring(p < 0.05). Care giving at the time of bathing was significantly longer than the other care types (p < 0.05). Feeding and transferring by inexperienced care workers were significantly low intensity (p < 0.05). Work intensity of care was at high levels within the maximal permissible level in which fatigue doesn't make an appearance during working hours and in five types of care. Furthermore, care work intensity increased according to a decrease in the ADL level among the elderly. It is concluded that when making a care program, it is important to consider the ADL level of the elderly, work intensity and the amount of care-giving time, not only to maintain the health of care workers, but, also, to give superior quality care to the elderly.

Activities of Daily Living↗

PubMed1993

Work evaluations: critique of the state of the art of functional assessment of work.

The area of work evaluation is fertile ground for future research and development by occupational therapists. Current evaluations of work range from standardized work evaluations associated with vocational rehabilitation to highly technical physical capacity and work capacity instrumentation and equipment often associated with sports medicine. In addition, methods used to identify pain and abnormal illness behavior add the psychosocial component of work evaluation. The limitations of most of the traditional approaches to work evaluations are their lack of focus on the actual work environments and on the meaning of work to persons. Occupational therapy can play an important and unique role in linking work evaluations to psychosocial and environmental variables and in formulating comprehensive theoretical models of work that should improve and refine present work evaluations.

Disability Evaluation↗

PubMedDate not supplied

Increased pain tolerance as an indicator of return to work in low-back injuries after work hardening.

OBJECTIVE: This study examined retrospective data from a multidisciplinary work-hardening program that compared patients who did and did not return to work after low-back injury. The objective of this study was to identify differences between these groups to better guide work-hardening programs and return-to-work decisions. METHOD: Retrospective data from patients with low-back injuries (n = 115) who participated in a northern California work-hardening program were analyzed. Using two-way analysis of variance, male and female patients who did and did not return to work were compared. RESULTS: No significant differences were found between men and women for any of the variables studied. Patients who did and did not return to work were not significantly different in age, length of injury, and subjective pain at the beginning or end of the work-hardening program or in activity tolerance (p = .08). Patients who returned to work perceived a significantly (p < or = . 05) greater improvement in pain tolerance by the end of the work-hardening program than those who did not return to work. CONCLUSION: The results of this study suggest that rehabilitation emphasis should not be placed on the reduction of subjective pain but, rather, on strategies to cope with existing pain while improving functional ability.

Adult↗

PubMed2002

Effectiveness of a worksite exercise program with respect to perceived work ability and sick leaves among women with physical work.

OBJECTIVES: This multicentered randomized controlled trial evaluated the effect of worksite exercise intervention on perceived work ability and sick leaves. METHODS: Women (N = 260, mean age 40 years) engaged in physically demanding laundry work were individually randomized into an intervention (N = 133) or control (N = 127) group. Perceived work ability was assessed with questionnaires at 3, 8, 12, and 15 months. Sick leave information was obtained from the personnel administration. Follow-up attendance was 100% at 3 months but declined gradually to 90% by 15 months. Both the intervention and control subjects received a 30-minute feedback on their physical capacity from a physiotherapist and individual exercise prescription and counseling. The intervention subjects also participated in worksite exercise training guided by a physiotherapist. Sixty-minute sessions (N = 26) were held once a week for 8 months. About 50% of the intervention group participated in at least two-thirds of the sessions. RESULTS: According to a dichotomized work ability index, at 12 months, workers with "good" or "excellent" work ability increased more in the intervention group than in the control group (11.0%, 95% CI 0.2-21.9), as did the health-related prognosis of work ability at 8 months (8.1%, 95% CI 0.5-16.3). There were no statistically significant differences between the two groups as regards job satisfaction, work ability index (including series of questions on 7 items), or sick leaves. CONCLUSIONS: Physical activity once a week at worksites improves the perceived work ability of women with physically demanding work only slightly. Perceived work ability and sick leaves cannot be affected very positively using single-component exercise intervention. Work ability promotion may need a more multiprofessional approach.

Adaptation, Psychological↗

PubMed1984

Absolute or relative work load in exercise testing--significance of individual differences in working capacity.

A commun multistage bicycle ergometer test (50 W increases every third minute until exhaustion) was analysed for significance of individual differences in working capacity in six young borderline hypertensive and six young normotensive males. From measurements of O2 uptake (VO2) during each of the prescribed work rates, up to and including maximal effort, relationships with relative work load (% VO2 max) could be established for each of the variables observed in the study. An alternative procedure was tested in which the relative work load was established on the basis of the individual's maximal mechanical power output (Wmax). In heavy exercise the variation coefficients for some variables were nearly halved when observed at a given relative (% VO2 max or % Wmax) rather than absolute (number of watts) exercise level. In light exercise the effect of this normalization was negligible. The two expressions of relative work load were closely correlated. Relative work load in % VO2 max could be predicted from the relative work load in % Wmax with an average standard error of estimate of 2.8%. Exercise heart rate and rate of perceived exertion (Borg scale) were also significantly correlated with relative work load. However, these latter variables were less precise as indicators of relative work load, the standard error of estimates being 3 and 5 times larger than that of % Wmax, respectively. The procedure of establishing relative work load on the basis of Wmax may be of value if a precise setting is desirable when measurements of VO2 are impracticable. The method may also be of use if an individual's HR-work load relationship is abnormal, for example because of medication.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1994

Shift work and health--a critical review of the literature on working hours.

Working outside normal hours either by extended days or shift work is a fact of industrial society. Its economic advantages must be weighed against detrimental effects on the individual worker in the form of circadian rhythm disturbance, poorer quality and quantity of sleep and increased fatigue. The link between shift work and increased cardiovascular morbidity and mortality has strengthened in recent years. The case for an association with gastrointestinal disease remains quite good. Evidence of poorer work performance and increased accidents, particularly on the night shift, is persuasive, although individual factors may be as important as workplace factors. Correct shift work scheduling is important and for rotating shifts, rapid forward rotation is the least disruptive option. The compressed working week of 10 to 12-hour shifts is gaining popularity but evidence is too scant at present to suggest there are many long-term health and safety risks provided the rest day block is preserved. Optimal hours for the working week cannot be formulated on present scientific evidence, though working more than 48-56 hours a week probably carries serious health and safety implications. The inherent conflict between the interest of the worker and the enterprise over unsocial hours can be mitigated by improvements in working conditions especially at night and by advice to the worker on coping strategies. Further research is needed on the effects of the compressed working week, as well as the influence of culture, task and gender on any health effects. Studies to define individual characteristics which may cause shift work intolerance would be of great practical use.

Accidents, Occupational↗

PubMed2002

Health and psychosocial work characteristics of employees who did or did not consult the general practitioner in relation to work.

OBJECTIVES: To examine how health problems and psychosocial work characteristics are associated with having visited or not having visited the general practitioner (GP) in relation to work. METHODS: Baseline self-reported data of the Maastricht Cohort Study about fatigue at work were used to gather information about fatigue (Checklist Individual Strength), presence of at least one long-term disease, likelihood of having a mental illness (General Health Questionnaire), and psychosocial work characteristics (psychological job demands, decision latitude and social support at work, as measured with the Job Content Questionnaire). The cohort participants indicated having visited (VISITORS) or not having visited (NON-VISITORS) the GP in relation to work. Differences between these groups were measured by multiple logistic regression analyses. RESULTS: When compared with VISITORS and taking into account the influence of sociodemographic characteristics and mutual associations between reported health problems and psychosocial work characteristics, a lower percentage of NON-VISITORS reported at least one long-term disease and NON-VISITORS presented lower levels of fatigue and psychological job demands, and higher levels of decision latitude and social support at work. CONCLUSIONS: The results of this study indicate that NON-VISITORS reported fewer health problems and a more positive perception of their work environment than VISITORS did. Interrelationships between psychosocial work characteristics and health variables should be taken into consideration when studying their associations with visiting the GP in relation to work.

Adolescent↗

PubMed1995

Repetitive work, work underload and coronary heart disease risk factors among blue-collar workers--the CORDIS study. Cardiovascular Occupational Risk Factors Determination in Israel.

Evidence from survey-based studies suggests that monotonous work increases the risk of coronary heart disease (CHD). In this study of 1944 male and 832 female blue-collar workers aged 20-64 yr, we examined the association of CHD risk factors with two distinct objective work conditions--repetitive work (3 levels) and work underload-compared to varied work. After controlling for shift work, high ambient noise exposure and four other possible confounders, repetitive work was positively associated with both blood pressure and serum lipid levels in women, and with blood pressure in men. However, elevated levels of these risk factors were obtained only for those in short-cycle (< 1 min) repetitive work. In women this was manifested in higher mean systolic (p = 0.003), diastolic (p = 0.01) blood pressure (BP), total cholesterol (p = 0.03) and serum glucose (p = 0.05) levels; and in men in higher systolic BP only (p = 0.002). Inconsistent results were obtained for those engaged in work underload. It was associated in men with higher mean systolic BP (p = 0.05) and in women with higher cholesterol (p = 0.05) and high density lipoprotein (p = 0.03) levels. These findings suggest that objective monotonous work conditions are more consistently related to CHD risk factors in women, especially those engaged in short-cycle (hectic) repetitive work.

Adult↗