Christina Malmose Stapelfeldt

Validation of sick leave measures: self-reported sick leave and sickness benefit data from a Danish national register compared to multiple workplace-registered sick leave spells in a Danish municipality

BackgroundPrevious validation studies of sick leave measures have focused on self-reports. Register-based sick leave data are considered to be valid; however methodological problems may be associated with such data. A Danish national register on sickness benefit (DREAM) has been widely used in sick leave research. On the basis of sick leave records from 3,554 and 2,311 eldercare workers in 14 different workplaces, the aim of this study was to: 1) validate registered sickness benefit data from DREAM against workplace-registered sick leave spells of at least 15 days; 2) validate self-reported sick leave days during one year against workplace-registered sick leave.MethodsAgreement between workplace-registered sick leave and DREAM-registered sickness benefit was reported as sensitivities, specificities and positive predictive values. A receiver-operating characteristic curve and a Bland-Altman plot were used to study the concordance with sick leave duration of the first spell. By means of an analysis of agreement between self-reported and workplace-registered sick leave sensitivity and specificity was calculated. Ninety-five percent confidence intervals (95% CI) were used.ResultsThe probability that registered DREAM data on sickness benefit agrees with workplace-registered sick leave of at least 15 days was 96.7% (95% CI: 95.6-97.6). Specificity was close to 100% (95% CI: 98.3-100). The registered DREAM data on sickness benefit overestimated the duration of sick leave spells by an average of 1.4 (SD: 3.9) weeks. Separate analysis on pregnancy-related sick leave revealed a maximum sensitivity of 20% (95% CI: 4.3-48.1).The sensitivity of self-reporting at least one or at least 56 sick leave day/s was 94.5 (95% CI: 93.4 – 95.5) % and 58.5 (95% CI: 51.1 – 65.6) % respectively. The corresponding specificities were 85.3 (95% CI: 81.4 – 88.6) % and 98.9 (95% CI: 98.3 – 99.3) %.ConclusionsThe DREAM register offered valid measures of sick leave spells of at least 15 days among eldercare employees. Pregnancy-related sick leave should be excluded in studies planning to use DREAM data on sickness benefit. Self-reported sick leave became more imprecise when number of absence days increased, but the sensitivity and specificity were acceptable for lengths not exceeding one week.

Subgroup analyses on return to work in sick- listed employees with low back pain in a randomised trial comparing brief and multidisciplinary intervention

BackgroundMultidisciplinary intervention is recommended for rehabilitation of employees sick-listed for 4-12 weeks due to low back pain (LBP). However, comparison of a brief and a multidisciplinary intervention in a randomised comparative trial of sick-listed employees showed similar return to work (RTW) rates in the two groups. The aim of the present study was to identify subgroups, primarily defined by work-related baseline factors that would benefit more from the multidisciplinary intervention than from the brief intervention.MethodsA total of 351 employees sick-listed for 3-16 weeks due to LBP were recruited from their general practitioners. They received a brief or a multidisciplinary intervention. Both interventions comprised clinical examination and advice by a rehabilitation doctor and a physiotherapist. The multidisciplinary intervention also comprised assignment of a case manager, who made a rehabilitation plan in collaboration with the patient and a multidisciplinary team. Using data from a national database, we defined RTW as no sickness compensation benefit disbursement for four consecutive weeks within the first year after the intervention. At the first interview in the clinic, it was ensured that sick leave was primarily due to low back problems.Questionnaires were used to obtain data on health, disability, demographic and workplace-related factors. Cox hazard regression analyses were used with RTW as outcome measure and hazard rate ratios (HRR = HRmultidisciplinary/HRbrief) were adjusted for demographic and health-related variables. An interaction term consisting of a baseline variable*intervention group was added to the multivariable regression model to analyse whether the effects of the interventions were moderated by the baseline factor. Subsequently, a new study was performed that included 120 patients who followed the same protocol. This group was analyzed in the same way to verify the findings from the original study group.ResultsThe multidisciplinary intervention group ensured a quicker RTW than the brief intervention group in a subgroup with low job satisfaction, notably when claimants were excluded. The opposite effect was seen in the subgroup with high job satisfaction. When claimants were excluded, the effect was also in favour of the multidisciplinary intervention in subgroups characterised by no influence on work planning and groups at risk of losing their job. Inversely, the effect was in favour of the brief intervention in the subgroups who were able to influence the planning of their work and who had no risk of losing their job due to current sick leave. Interaction analysis of the data in the new study displayed similar or even more pronounced differences between subgroups in relation to intervention type.ConclusionsMultidisciplinary intervention seemed more effective than brief intervention in subgroups of patients with low job satisfaction, no influence on work planning and feeling at risk of losing their jobs due to their sick leave as compared with subgroups not fulfilling these criteria.

Attitudes towards sickness absence and sickness presenteeism in health and care sectors in Norway and Denmark: a qualitative study

BackgroundIn the health and care sector, sickness absence and sickness presenteeism are frequent phenomena and constitute a field in need of exploration. Attitudes towards sickness absence involve also attitudes towards sickness presenteeism, i.e. going to work while sick, confirmed by previous studies. Sickness behavior, reflecting attitudes on work absence, could differ between countries and influence absence rates. But little is known about attitudes towards sickness absence and sickness presenteeism in the health and care sectors in Norway and Denmark. The aim of the present paper is therefore to explore attitudes towards sickness absence and sickness presenteeism among nursing home employees in both countries.MethodsEight focus group discussions (FGDs) were conducted using a semi-structured interview guide, the main attention of which was attitudes towards sickness absence and sickness presenteeism. FGDs were conducted in two nursing homes in Norway and two in Denmark, with different geographic locations: one in a rural area and one in an urban area in each country. FGDs were recorded, transcribed and analyzed using framework analysis to identify major themes and explanatory patterns.ResultsFour major significant themes were identified from the FGDs: a) sickness absence and sickness presenteeism, b) acceptable causes of sickness absence, c) job identity, and d) organization of work and physical aspects of the workplace. Our analyses showed that social commitment and loyalty to residents and colleagues was important for sickness absence and sickness presenteeism, as were perceived acceptable and non-acceptable reasons for sickness absence. Organization of work and physical aspects of the workplace were also found to have an influence on attitudes towards sickness absence.ConclusionsThe general interpretation of the findings was that attitudes towards sickness absence and sickness presenteeism among nursing home employees were embedded in situational patterns of moral relationships and were connected to a specific job identity. These patterns were constituted by the perception of colleagues, the social commitment to residents, and they influence on what was deemed as acceptable and non-acceptable reasons for sickness absence. In other words, attitudes towards sickness absence and sickness presenteeism were socially and morally determined at personal levels by an overall concept of work, independent of country.

Sickness absence patterns and trends in the health care sector: 5-year monitoring of female municipal employees in the health and care sectors in Norway and Denmark

BackgroundSickness absence is a growing public health problem in Norway and Denmark, with the highest absence rates being registered in Norway. We compared time trends in sickness absence patterns of municipal employees in the health and care sectors in Norway and Denmark.MethodsData from 2004 to 2008 were extracted from the personnel registers of the municipalities of Kristiansand, Norway, and Aarhus, Denmark, for 3,181 and 8,545 female employees, respectively. Age-specific comparative statistics on sickness absence rates (number of calendar days of sickness absence/possible working days) and number of sick leave episodes were calculated for each year of the study period.ResultsThere was an overall increasing trend in sickness absence rates in Denmark (P = 0.002), where rates were highest in the 20–29- (P = 0.01) and 50–59-year-old age groups (P = 0.03). Sickness absence rates in Norway were stable, except for an increase in the 20–29-year-old age group (P = 0.004). In both Norway and Denmark, the mean number of sick leave episodes increased (P <0.0001 and P <0.0001, respectively) in all age groups except for the 30–39- and 60–67-year-old age groups. The proportion of employees without sickness absence was higher in Norway than in Denmark. Both short-term and long-term absence increased in Denmark (P = 0.003 and P <0.0001, respectively), while in Norway, only short-term absence increased (P = 0.09).ConclusionsWe found an overall increase in sickness absence rates in Denmark, while the largest overall increase in sick leave episodes was found in Norway. In both countries, the largest increases were observed among young employees. The results indicate that the two countries are converging in regard to sickness absence measured as rates and episodes.

Comparison of sick leave patterns between Norway and Denmark in the health and care sector: a register study.

Aims: Sickness absence is of considerable concern in both Norway and Denmark. Labour Force Surveys indicate that absence in Norway is about twice that in Denmark and twice that of the mean reported by the Organisation for Economic Co-operation and Development. This study compares absence patterns according to age, percentage of employment, and occupation between municipal employees in the health and care sectors in two municipalities in Norway and Denmark. Methods: Data recorded in the personnel registers of the municipalities of Kristiansand, Norway and Aarhus, Denmark were extracted for the years 2004 and 2008, revealing 3498 and 7751 employee-years, respectively. We calculated absence rates together with number of sick leave episodes, and their association with the above-mentioned covariates. Gender-specific comparative descriptive statistics and negative binomial regression analysis were performed. Results: The sickness absence rate in women was 11.3% in Norway (95% confidence interval [CI] 11.2–11.4) and 7.0% in Denmark (95% CI 7.0–7.1) whereas mean number of sick leave episodes among women was 2.4 in Denmark, compared to 2.3 in Norway (p = 0.02). Young employees in Denmark had more sick leave episodes than in Norway. Proportion of absentees was higher in Denmark compared to Norway (p < 0.0001). Conclusions: The finding of that more employees in Denmark have more frequent, but shorter sick leave episodes compared to Norway, for whatever reasons, may indicate that more frequent sick leaves episodes prevent higher sick leaves rates.

Cross-cultural adaptation and validation of the Danish version of the 19-item return-to-work self-efficacy (RTWSE-19) questionnaire

OBJECTIVES The aim of this study was to perform a cross-cultural adaptation of the return-to-work self-efficacy (RTWSE-19) scale into Danish and test the reliability, validity and responsiveness of the final version. METHODS The adaptation process followed standard guidelines and the pretest was performed on 40 sickness absence beneficiaries. Tests of reliability, validity and responsiveness of the final version was performed on 782 participants of whom 440 (56%) responded. For the sub- and global scales, internal consistency was evaluated by Cronbachs alpha and reproducibility using paired t-test and intraclass correlation coefficient (ICC), respectively Responsiveness was evaluated by paired t-test and the association between RTWSE-19 and job status at ten weeks was tested in a logistic regression model, adjusted for gender, age and baseline job status. RESULTS The face validity and reliability of the Danish version of the RTWSE-19 questionnaire were satisfactory. The internal consistency (alpha) for the three subscales ranged from 0.93 to 0.97. A test-retest showed no difference as well as high ICC between scale scores at baseline and one week later. The content validity of the final version was confirmed. High baseline RTWSE-19 level was associated with being at work after ten weeks odds ratio (OR) 3.24, 95% confidence interval (95% CI) 1.48-7.07. CONCLUSIONS The RTWSE-19 cross-cultural translation to Danish was performed satisfactorily. A modified final version was produced, and the test of the instruments reliability and validity showed that the psychometric properties of the questionnaire were partly confirmed. The instrument may be useful in rehabilitation practice to guide further assessment, goal setting and RTW decision-making.

Sick leave patterns as predictors of disability pension or long-term sick leave: a 6.75-year follow-up study in municipal eldercare workers

Objectives The aim was to study whether a workplace-registered frequent short-term sick leave spell pattern was an early indicator of future disability pension or future long-term sick leave among municipal eldercare workers. Setting The municipal healthcare sector in the city of Aarhus, which is the second largest city in Denmark. Participants All elder care employees who worked the entire year of 2004 in the municipality of Aarhus, Denmark (N=2774). The employees’ sick leave days during 2004 were categorised into: 0–2 and 3–17 short (1–7 days) spells, 2–13 mixed short and long (8+ days) spells and long spells only. Student workers (n=180), employees who were absent due to maternal/paternal leave (n=536) and employees who did not work the entire year of 2004 (n=1218) were not included. Primary outcome Disability pension and long-term sick leave (≥8 weeks) were subsequently identified in a National register. The cumulative incidence proportion as a function of follow-up weeks was estimated using the Kaplan-Meier curve. The relative cumulative incidence (RR) of experiencing events within 352 weeks was analysed in a generalised linear regression model using the pseudo values method adjusted for age, occupation, unfavourable work factors and sick leave length. Results A frequent short-term and a mixed sick leave pattern showed RRs of being granted a disability pension of 2.08 (95% CI 1.00 to 4.35) and 2.61 (95% CI 1.33 to 5.12) compared with 0–2 short spells. The risk of long-term sick leave was significantly increased for all sick leave patterns compared with 0–2 short spells. Adding sick leave length to the models attenuated all RRs and they became non-significant. Conclusions Sick leave length was a better indicator of future workability than spell frequency. Preventive actions should target employees engaged in homecare. The more sick leave days the greater the preventive potential seems, irrespective of spell frequency.

International Classification of Functioning, Disability and Health in Vocational Rehabilitation: A Scoping Review of the State of the Field

Purpose The purposes of this study were to provide an outline of the existing literature on operationalization of the International Classification of Functioning, Disability and Health (ICF) within vocational rehabilitation (VR) and to explore the ICF utility within VR. Methods The process was undertaken in five stages according to a framework of scoping review. Screening and extraction of data were done by two independent reviewers, and data was summarized according to content analysis. Results Fifty papers (25 qualitative and 25 quantitative) were included. The operationalization of the ICF was described in four different ways: In total 18 (36%) papers described use of the ICF for structuring information, 8 (15%) for linking information to ICF, 12 (24%) for analysis of results, and 12 (24%) for development of a model. In total 15 (29%) papers described VR interventions involving stakeholders, whereas 32 (62%) were reviews. Forty of the papers described all the ICF components. Conclusions The review revealed use of the ICF within the field VR in 50 papers, and in various settings. The ICF framework was most often operationalized for structuring or linking information of functioning. A majority of papers were reviews and involved researchers only, whereas different stakeholders and VR professionals were involved in the interventions. In 40 papers all the ICF components were described, and the ICF was considered a useful tool to inform the VR professionals´ assessment of functioning. However, more research within VR is needed to standardize and ease the use of the ICF.

Cross-Cultural Adaptation, Reliability and Validity of the Danish Version of the Readiness for Return to Work Instrument

The objective of the present study was to translate and validate the Canadian Readiness for Return To Work instrument (RRTW-CA) into a Danish version (RRTWDK) by testing its test–retest and internal consistency reliability and its structural and construct validity. Cross-cultural adaptation of the six-staged RRTW-CA instrument was performed in a standardised, systematic five-step-procedure; forward translation, panel synthesis of the translation, back translation, consolidation and revision by researchers, and finally pre-testing. This RRTW-DK beta-version was tested for its psychometric properties by intra-class correlation coefficient and standard error of measurement (n = 114), Cronbach’s alpha (n = 471), confirmatory factor analyses (n = 373), and Spearman’s rank correlation coefficient (n = 436) in sickness beneficiaries from a municipal employment agency and hospital wards. The original RRTW-CA stage structure could not be confirmed in the RRTWDK. The psychometric properties were thus inconclusive. The RRTW-DK cannot be recommended for use in the current version as the RRTW construct is questionable. The RRTW construct needs further exploration, preferably in a population that is homogeneous with regard to cause of sickness, disability duration and age.

Degenerative findings on MRI of the cervical spine: an inter- and intra-rater reliability study

BackgroundKnowledge about the assessment reliability of common cervical spine changes is a prerequisite for precise and consistent communication about Magnetic Resonance Imaging (MRI) findings. The purpose of this study was to determine the inter- and intra-rater reliability of degenerative findings when assessing cervical spine MRI.MethodsFifty cervical spine MRIs from subjects with neck pain were used. A radiologist, a chiropractor and a second-year resident of rheumatology independently assessed kyphosis, disc height, disc contour, vertebral endplate signal changes, spinal canal stenosis, neural foraminal stenosis, and osteoarthritis of the uncovertebral and zygapophyseal joints. An evaluation manual was composed containing classifications and illustrative examples, and ten of the MRIs were evaluated twice followed by consensus meetings to refine the classifications. Next, the three readers independently assessed the full sample. Reliability measures were reported using prevalence estimates and unweighted kappa (Κ) statistics.ResultsThe overall inter-rater reliability was substantial (Κ ≥ 0.61) for the majority of variables and moderate only for zygapophyseal osteoarthritis (Κ = 0.56). Intra-rater reliability estimates were higher for all findings.ConclusionsThe present classifications for some of the most common cervical degenerative findings yielded mainly substantial inter-rater reliability estimates and substantial to almost perfect intra-rater reliability estimates. .Trial registrationRegional Data Protection Agency (J.no. 1–16–02-86-16). The letter of exemption from the Regional Ethical Committee is available from the author on request (case no. 86 / 2017).