Friedrich Michael Radoschewski

THE WORK ABILITY INDEX AS A SCREENING TOOL TO IDENTIFY THE NEED FOR REHABILITATION: LONGITUDINAL FINDINGS FROM THE SECOND GERMAN SOCIOMEDICAL PANEL OF EMPLOYEES

OBJECTIVE To evaluate the predictive value of the Work Ability Index (WAI) for different indicators of the need for rehabilitation at 1-year follow-up. DESIGN Cohort study. METHODS Data were obtained from the Second German Sociomedical Panel of Employees, a large-scale cohort study with postal surveys in 2009 and 2010. RESULTS A total of 457 women and 579 men were included. Confirmatory factor analysis confirmed the one-dimensionality of the WAI. Regression analyses showed that poor and moderate baseline WAI scores were associated with lower health-related quality of life and more frequent use of primary healthcare 1 year later. Subjects with poor baseline work ability had 4.6 times higher odds of unemployment and 12.2 times higher odds of prolonged sick leave than the reference group with good or excellent baseline work ability. Moreover, the odds of subjectively perceived need for rehabilitation, intention to request rehabilitation and actual use of rehabilitation services were 9.7, 5.7 and 3 times higher in the poor baseline WAI group and 5.5, 4 and 1.8 times higher in the moderate baseline WAI group, respectively. A WAI score ≤ 37 was identified as the optimal cut-off to predict the need for rehabilitation. CONCLUSION The WAI is a valid screening tool for identifying the need for rehabilitation.

Work stress and work ability: cross-sectional findings from the German sociomedical panel of employees

Purpose. Maintenance of work ability and restoration of reduced work ability by prevention and rehabilitation are major aims of disability management. To achieve these aims, decision-makers and health care providers need evidence of the determinants of restricted work ability. The aim of this article was to analyse the cross-sectional association between work stress and work ability in a population drawn from a random sample of employees. Methods. A total of 1463 working men and women aged 30–59 years from the baseline survey of the German SPE were included in the analyses. Work stress was defined in terms of the demand-control model and the effort-reward (ER) imbalance model. Work ability was assessed by the Work Ability Index (WAI). We used multiple imputations to account for missing data and calculated logistic regression models to estimate associations between the two work stress models and restrictions of work ability. Results. Approximately one third (32.0%) of the respondents reported restrictions of work ability (WAI <37) indicating a need of interventions to improve and to restore work ability. High job strain was experienced by about one third (34.2%) of the participants and 12.7% of the respondents reported an ER ratio > 1 indicating an ER imbalance. Restrictions of work ability were explained independently by high job strain due to high demand and low control (OR = 4.66; 95% CI = [2.93, 7.42]) and by effort-reward imbalance (OR = 2.88; 95% CI = [1.95, 4.25]). Conclusion. Work stress is associated with restrictions of work ability, but longitudinal analyses are required to confirm a causal relation.

Effort-reward imbalance and work ability: cross-sectional and longitudinal findings from the Second German Sociomedical Panel of Employees

BackgroundAlthough data from longitudinal studies are sparse, effort-reward imbalance (ERI) seems to affect work ability. However, the potential pathway from restricted work ability to ERI must also be considered. Therefore, the aim of our study was to analyse cross-sectional and longitudinal associations between ERI and work ability and vice versa.MethodsData come from the Second German Sociomedical Panel of Employees. Logistic regression models were estimated to determine cross-sectional and longitudinal associations. The sample used to predict new cases of poor or moderate work ability was restricted to cases with good or excellent work ability at baseline. The sample used to predict new cases of ERI was restricted to persons without ERI at baseline.ResultsThe cross-sectional analysis included 1501 full-time employed persons. The longitudinal analyses considered 600 participants with good or excellent baseline work ability and 666 participants without baseline ERI, respectively. After adjustment for socio-demographic variables, health-related behaviour and factors of the work environment, ERI was cross-sectionally associated with poor or moderate work ability (OR = 1.980; 95% CI: 1.428 to 2.747). Longitudinally, persons with ERI had 2.1 times higher odds of poor or moderate work ability after one year (OR = 2.093; 95% CI: 1.047 to 4.183). Conversely, persons with poor or moderate work ability had 2.6 times higher odds of an ERI after one year (OR = 2.573; 95% CI: 1.314 to 5.041).ConclusionsInterventions that enable workers to cope with ERI or address indicators of ERI directly could promote the maintenance of work ability. Integration management programmes for persons with poor work ability should also consider their psychosocial demands.

Self-Reported Poor Work Ability--An Indicator of Need for Rehabilitation? A Cross-Sectional Study of a Sample of German Employees.

ObjectiveThe purpose of this study was to assess associations of self-reported work ability as measured by the Work Ability Index (WAI) with modifiable behavioral and occupational health risks, health service utilization, and intended rehabilitation and pension requests. DesignThis is a cross-sectional study of a random sample of German employees aged 40–54 yrs on sickness benefits in 2012 (trial registration: DRKS00004824). ResultsIn total, 1312 male and 1502 female employees were included in the analyses. Low WAI scores (i.e., <37 points) were associated with a higher prevalence of occupational and behavioral health risks; a higher likelihood of frequent visits to general, somatic, and psychologic specialists as well as hospital stays; and four to six times higher risks of intended rehabilitation and pension requests. A two-item version of the WAI was as strongly associated with intended rehabilitation and pension requests as the total score. ConclusionsThis study indicates that the WAI is a sensitive screening tool to identify workers on sick leave with a probable need for rehabilitation. The WAI could support the assessment of need for rehabilitation by occupational health services in return-to-work strategies, which include the opportunity to access multiprofessional rehabilitation.

Sind administrative Daten für Rentenantragsintentionen und Indikatoren subjektiven Rehabilitationsbedarfs prognostisch bedeutsam

OBJECTIVES The aim of the study was to examine the associations of the Risk Index Disability Pension (RI-DP), which was calculated from administrative data, with intended disability pension claims and other health- and work-related characteristics. MATERIAL AND METHODS Insured persons of the Federal German Pension Insurance were surveyed by questionnaire in 2013. Questionnaire data were additionally linked to administrative data. The gross sample was restricted to persons, who received sick leave benefits in the previous year while not claiming or utilizing any rehabilitation services for the previous 4 years. RESULTS 1,261 men and 1,495 women were included in the analyses. The odds of an intended disability pension claim were 4.8-times higher in men and 3.4-times higher in women if RI-DP scores were high. Furthermore, high RI-DP scores were also associated with frequent disability days, poor self-rated work ability and frequent visits to physicians. DISCUSSION The associations of the RI-DP with the examined characteristics imply that administrative data could support early identification of rehabilitation needs.

Soziale Unterstützung als Ressource für Arbeitsfähigkeit

PURPOSE The study examined the association of social support with subjective work ability, subjective prognosis of gainful employment and general health perception. METHODS The analysis considered cross-sectional data from a sample of 2,983 employees (40-54 years) with sickness benefits in 2012. The postal survey was conducted in May 2013. RESULTS After adjustment for socio-demographic and work-related characteristics as well as personality factors low social support was significantly associated with lower work ability (b=- 2,7; 95% CI:-3,4 to 1,9), higher odds of poor employment prognosis (OR=2,0; 95% CI: 1,5 to 2,6) and poorer health perception (b=- 8,0; 95% CI:-10,1 to-5,9). CONCLUSIONS Low social support is potentially an independent predictor of lower work ability, employment prognosis and general health perception. To confirm causal relationships longitudinal data are needed, which will be assessed in 2015 and 2017.

Determinanten für intendierte Anträge auf medizinische Rehabilitation bei vorangegangenem Krankengeldbezug

OBJECTIVES The aim of the study was to identify determinants of intented applications for rehabilitation. MATERIAL AND METHODS We included persons paying pension contributions to the Federal German Pension Insurance who had received sickness benefits in the year before the first survey and had not applied or utilized rehabilitation services between 2009 and 2012. RESULTS 3,165 persons were considered for analysis. Intended applications were associated with low self-rated health, low self-rated work ability, frequent visits to physicians, professional and family support. These associations were relatively stable for different subgroups and were hardly moderated by sociodemographic characteristics. DISCUSSION The results emphasis the importance of professional and family support for the application for medical rehabilitation.

Direct and indirect effects of organizational justice on work ability

BACKGROUND Organizational justice (OJ), involving transparent workplace procedures and treating staff members with respect, has been of growing concern in recent epidemiological research as a determinant of health-related outcomes. AIMS To examine the factorial validity of the German version of Moormans Organizational Justice Questionnaire (OJQ), to investigate the direct cross-sectional effect of OJ on self-rated work ability and to analyse if there is an additional indirect effect of OJ on work ability mediated by effort-reward imbalance. METHODS An analysis of cross-sectional data from the Second German Sociomedical Panel of Employees, involving white-collar workers employed at least half time. We performed confirmatory factor analyses to test the factorial validity of the OJQ and analysed the direct and indirect associations of OJ and self-rated work ability by path model analysis. RESULTS Of the 1217 participants (47% female; mean age: 51) 36% had poor work ability. Factor analyses confirmed the two-factor structure of the German OJQ. Work ability was explained directly by OJ (β = 0.30) and effort-reward imbalance (β = -0.27). Additionally, we identified an indirect effect of OJ that was mediated by effort-reward imbalance (β = 0.14). The total effect of OJ on work ability was remarkably strong (β = 0.44). Associations remained unchanged after adjustment for socio-demographic parameters. CONCLUSIONS This study showed the importance of considering additional indirect pathways when examining the impact of OJ on the work ability of employees.

Influence of social support among employees on mental health and work ability—a prospective cohort study in 2013–15

Background The study examined the association of social support with mental health, subjective work ability and psychological consultation. Methods The cohort study included 1886 German employees (40-54 years) with sickness absence exceeding six weeks in 2012. Postal surveys were carried out in 2013 and 2015. Results After adjustment for socio-demographic data, work-related characteristics and personality factors, persons with low social support compared to high social support had poorer mental health (b=-4.96; 95% CI: -7.11 to -2.81) and a lower work ability index (b=-1.10; 95% CI -2.00 to -0.21). Low social support was not associated with increased odds of consulting a psychologist (OR =1.30; 95% CI: 0.86-1.96). Conclusions Low social support is an independent predictor of poorer mental health and lower work ability. This study highlights the importance of identifying people who have limited access to social support.

Work ability, effort-reward imbalance and disability pension claims

Background Effort-reward imbalance (ERI) and self-rated work ability are known independent correlates and predictors of intended disability pension claims. However, little research has focused on the interrelationship between the three and whether self-rated work ability mediates the relationship between ERI and intended disability pension claims. Aims To investigate whether self-rated work ability mediates the association between ERI and intended disability pension claims. Methods Baseline data from participants of the Third German Sociomedical Panel of Employees, a 5-year cohort study that investigates determinants of work ability, rehabilitation utilization and disability pensions in employees who have previously received sickness benefits, were analysed. We tested direct associations between ERI with intended disability pension claims (Model 1) and self-rated work ability (Model 2). Additionally, we tested whether work ability mediates the association between ERI and intended disability pension claims (Model 3). Results There were 2585 participants. Model 1 indicated a significant association between ERI and intended disability pension claims. Model 2 showed a significant association between ERI and self-rated work ability. The mediation in Model 3 revealed a significant indirect association between ERI and intended disability pension claims via self-rated work ability. There was no significant direct association between ERI and intended disability pension claims. Conclusions Our results support the adverse health-related impact of ERI on self-rated work ability and intended disability pension claims.