Haije Wind

Factors that Promote or Hinder Young Disabled People in Work Participation: A Systematic Review

Introduction The aim of this systematic review was to study factors which promote or hinder young disabled people entering the labor market. Methods We systematically searched PubMed (by means of MESH and text words), EMBASE, PsycINFO, Web of Science and CINAHL for studies regarding (1) disabled patients diagnosed before the age of 18xa0years and (2) factors of work participation. Results Out of 1,268 retrieved studies and 28 extended studies from references and four from experts, ten articles were included. Promoting factors are male gender, high educational level, age at survey, low depression scores, high dispositional optimism and high psychosocial functioning. Female and low educational level gives high odds of unemployment just like low IQ, inpatient treatment during follow up, epilepsy, motor impairment, wheelchair dependency, functional limitations, co-morbidity, physical disability and chronic health conditions combined with mental retardation. High dose cranial radiotherapy, type of cancer, and age of diagnosis also interfered with employment. Conclusions Of the promoting factors, education appeared to be important, and several physical obstructions were found to be hindering factors. The last mentioned factors can be influenced in contrast to for instance age and gender. However, to optimize work participation of this group of young disabled it is important to know the promoting or hindering influence for employment.

Assessment of functional capacity of the musculoskeletal system in the context of work, daily living, and sport: A systematic review

The aim of this systematic review was to survey methods to assess the functional capacity of the musculoskeletal system within the context of work, daily activities, and sport. The following key words and synonyms were used: functional physical assessment, healthy/disabled subjects, and instruments. After applying the inclusion criteria on 697 potential studies and a methodological quality appraisal, 34 studies were included. A level of reliability > 0.80 and of > 0.60 resp 0.75 and 0.90, dependent of type of validity, was considered high. Four questionnaires (the Oswestry Disability Index, the Pain Disability Index, the Roland–Morris Disability Questionnaire, and the Upper Extremity Functional Scale) have high levels on both validity and reliability. None of the functional tests had a high level of both reliability and validity. A combination of a questionnaire and a functional test would seem to be the best instrument to assess functional capacity of the musculoskeletal system, but need further examined.

What factors are most relevant to the assessment of work ability of employees on long-term sick leave? The physicians’ perspective

PurposeTo reach insurance physician (IPs) consensus on factors that must be taken into account in the assessment of the work ability of employees who are sick-listed for 2xa0years.MethodsA Delphi study using online questionnaires was conducted from October 2010 to March 2011.ResultsOne hundred and two insurance physicians reached a consensus on important factors for return to work (RTW) of employees on long-term sick leave; from those factors, the most relevant for the assessment of work ability was determined. From a total of 22 relevant factors considered for the return to work of long-term sick-listed employees, consensus was reached on nine relevant factors that need to be taken into account in the assessment of the work ability of employees on long-term sick leave. Relevant factors that support return to work are motivation, attitude towards RTW, assessment of cognitions and behaviour, vocational rehabilitation in an early stage and instruction for the sick-listed employee to cope with his disabilities. Relevant factors that hinder RTW are secondary gain from illness, negative perceptions of illness, inefficient coping style and incorrect advice of treating physicians regarding RTW.ConclusionsNon-medical personal and environmental factors may either hinder or promote RTW and must be considered in the assessment of the work ability of long-term sick-listed employees. Assessment of work ability should start early during the sick leave period. These factors may be used by IPs to improve the quality of the assessment of the work ability of employees on long-term sick leave.

Effect of Functional Capacity Evaluation information on the judgment of physicians about physical work ability in the context of disability claims

PurposeTo test whether Functional Capacity Evaluation (FCE) information lead insurance physicians (IPs) to change their judgment about the physical work ability of claimants with musculoskeletal disorders (MSDs).MethodsTwenty-seven IPs scored twice the physical work ability of two claimants for 12 specified activities, using a visual analogue scale. One claimant performed an FCE, the other served as a control. Outcome measure was the difference between experimental and control group in number of shifts in the physical work ability for the total of 12 specified activities.ResultsThe IPs changed their judgment about the work ability 141 times when using FCE information compared to 102 times when not using this information (P-valuexa0=xa00.001), both in the direction of more and less ability.ConclusionsThe IPs change their judgment of the physical work ability of claimants with MSDs in the context of disability claim procedures more often when FCE information is provided.

Complementary value of functional capacity evaluation for physicians in assessing the physical work ability of workers with musculoskeletal disorders

ObjectiveTo study the complementary value of information from functional capacity evaluation (FCE) for insurance physicians (IPs) who assess the physical work ability of claimants with long-term musculoskeletal disorders (MSD).MethodA post-test only design was used in the context of disability claims. Twenty-eight IPs participated in the study. Claimants with MSD formed the patient population. For each IP, the first claimant who agreed to participate was included in the study, and underwent FCE in addition to the regular disability claim assessment. Firstly, the IP performed the statutory disability claim assessment. Secondly, the FCE assessment took place. Finally, a self-formulated questionnaire was presented to the IPs after they viewed the FCE report. IPs were asked whether they perceived FCE information to be of complementary value to their judgment of the claimant’s physical work ability investigated. We considered FCE information to be of complementary value if more than 66% of the IPs indicated as such. IPs were also asked whether FCE information led them to change their initial judgment about the claimant’s physical work ability, and whether they felt this information made them more confident about their ultimate judgement. Finally, they were asked whether they planned to include FCE information in future disability claims and for what type of claimants. Differences between IPs who did or did not experience complementary value were explored.ResultsOf the 28, 19 (nearly 68%) IPs considered FCE information to be of complementary value for their assessment of claimants with MSD. Half of the IPs stated that FCE information reinforced their judgment. All but four IPs changed their assessment after reading the FCE report. Sixteen IPs intended to involve FCE information in future disability claim assessments. There were no observed differences between the IPs who did or did not consider the FCE information to be of complementary value.ConclusionFCE information was found to have complementary value at present and in the future according to most IPs in the assessment of the physical work ability of claimants with MSD. Half of the IPs felt that this information reinforces their judgment in this context.

Interviews for the assessment of long-term incapacity for work : A study on adherence to protocols and principles

BackgroundAssessments for long-term incapacity for work are performed by Social Insurance Physicians (SIPs) who rely on interviews with claimants as an important part of the process. These interviews are susceptible to bias. In the Netherlands three protocols have been developed to conduct these interviews. These protocols are expert- and practice-based. We studied to what extent these protocols are adhered to by practitioners.MethodsWe compared the protocols with one another and with the ICF and the biopsychosocial approach. The protocols describe semi-structured interviews with comparable but not identical topics. All protocols prescribe that the clients opinion on his capacity for work, and his arguments, need to be determined and assessed. We developed a questionnaire to elicit the adherence SIPs have to the protocols, their underlying principles and topics. We conducted a survey among one hundred fifty-five experienced SIPs in the Netherlands.ResultsNinety-eight SIPs responded (64%). All respondents used some form of protocol, either one of the published protocols or their own mix. We found no significant relation between training and the use of a particular protocol. Ninety percent use a semi-structured interview. Ninety-five percent recognise having to verify what the claimant says and eighty-three percent feel the need to establish a good relation (p = 0.019). Twelve topics are basically always addressed by over eighty percent of the respondents. The claimants opinion of being fit for his own work or other work, and his claim of incapacity and his health arguments for that claim, reach a hundred percent. Description of claimants previous work reaches ninety-nine percent.ConclusionOur study shows professional consensus among experienced Dutch SIPs about the principle of assessment on arguments, the principle of conducting a semi-structured interview and the most crucial interview topics. This consensus can be used to further develop a protocol for interviewing in the assessment of incapacity for work in social insurance. Such a protocol can improve the quality of the assessments in terms of transparency and reproducibility, as well as by enabling clients to better prepare themselves for the assessments.

Criterion-related validity of functional capacity evaluation lifting tests on future work disability risk and return to work in the construction industry

Objectives: To assess the criterion-related validity of the five Ergo-Kit (EK) functional capacity evaluation (FCE) lifting tests in construction workers on sick leave due to musculoskeletal disorders (MSDs). Methods: Six weeks, 6 months and 1 year after the first sick leave day due to MSDs, construction workers underwent two isometric and three dynamic EK FCE lifting tests, and completed the Instrument for Disability Risk (IDR) for future work disability risk. Concurrent and predictive validity were assessed by the associations between the scores of the EK FCE lifting tests and the IDR outcomes (Pearson Correlation coefficients (r) and associated proportions of variance (PV) and area under receiver operating characteristic curve (AUC)). Predictive validity of the EK FCE lifting tests on the total number of days on sick leave until full durable return to work (RTW) was also evaluated (Cox regression analysis). Results: Concurrent validity with future work disability risk was poor for the two isometric EK FCE lifting tests (−0.15⩽r⩽0.04) and moderate for the three dynamic EK FCE lifting tests (−0.47⩽r⩽−0.31). Only the carrying lifting strength test showed moderate and acceptable predictive validity on future work disability risk (ru200a=u200a−0.39; AUCu200a=u200a0.72). Cox regression analyses revealed that two out of the five EK FCE lifting tests predicted durable RTW significantly, but only weakly. Conclusions: Criterion-related validity with future work disability risk was poor for the two isometric EK lifting tests and moderate for the three dynamic lifting tests, especially the carrying lifting strength test. Predictive validity on durable RTW was poor, although weakly significant in two dynamic EK FCE tests, of which one was the carrying lifting strength test.

Effective return-to-work interventions after acquired brain injury: A systematic review

Abstract Objective: To gather knowledge about effective return-to-work (RTW) interventions for patients with acquired brain injury (ABI). Methods: A database search was performed in PubMed, EMBASE, PsycINFO, CINAHL and the Cochrane Library using keywords and Medical Subject Headings. Studies were included if they met inclusion criteria: adult patients with non-progressive ABI, working pre-injury and an intervention principally designed to improve RTW as an outcome. The methodological quality of included studies was determined and evidence was assessed qualitatively. Results: Twelve studies were included, of which five were randomized controlled trials and seven were cohort studies. Nine studies had sufficient methodological quality. There is strong evidence that work-directed interventions in combination with education/coaching are effective regarding RTW and there are indicative findings for the effectiveness of work-directed interventions in combination with skills training and education/coaching. Reported components of the most effective interventions were tailored approach, early intervention, involvement of patient and employer, work or workplace accommodations, work practice and training of social and work-related skills, including coping and emotional support. Conclusion and implications: Effective RTW interventions for patients with ABI are a combination of work-directed interventions, coaching/education and/or skills training. These interventions have the potential to facilitate sustained RTW for patients with ABI.

Clients' and RTW experts' view on the utility of FCE for the assessment of physical work ability, prognosis for work participation and advice on return to work.

PurposeTo describe clients’ and experts’ view on the utility of functional capacity evaluation (FCE) for the assessment of physical work ability, prognosis for work participation and advice on return to work (RTW).MethodsSemi-structured telephone interviews were performed with fourteen clients and fifteen RTW experts. Qualitative data were analysed independently by two researchers. The codes were compared and combined in higher-order topics until consensus was reached by three researchers.ResultsFor the assessment of physical work ability, FCE was found useful according to both groups, because it provided an overview of the physical abilities. Clients indicated that FCE confirmed and/or altered their view on their work ability. RTW experts were able to verify consistency between verbal information and performance of the client. For making a prognosis of work participation, only RTW experts found FCE useful. For the advice on RTW, both groups found FCE useful. The RTW trajectory could be clearly outlined. Both groups indicated that clients felt they were being taken seriously by performing FCE.ConclusionsClients and RTW experts indicated FCE as being useful for the assessment of physical work ability and advice on RTW. Only RTW experts indicated FCE as being useful for making a prognosis for work participation.

Construct Validity of Functional Capacity Evaluation Lifting Tests in Construction Workers on Sick Leave as a Result of Musculoskeletal Disorders

OBJECTIVESnTo assess the construct (discriminative and convergent) validity of 5 Ergo-Kit (EK) functional capacity evaluation (FCE) lifting tests in construction workers on sick leave as a result of musculoskeletal disorders (MSDs).nnnDESIGNnCross sectional within-subject design.nnnSETTINGnOccupational health service for the construction industry.nnnPARTICIPANTSnMale construction workers (N=72) on 6-week sick leave as a result of MSDs.nnnINTERVENTIONSnNot applicable.nnnMAIN OUTCOME MEASUREnAfter being assessed on 5 EK FCE lifting tests, participants were asked to complete the Von Korff questionnaire on pain intensity and disability as a result of MSDs and the instrument for disability risk assessing the risk for work disability. Discriminative validity was evaluated by comparing the results of the EK FCE lifting test scores between the 2 groups of participants based on the instrument for disability risk scores (high risk for work disability compared with low risk for work disability). Convergent validity was evaluated by assessing the associations between the results of the EK FCE lifting tests and Von Korff questionnaire self-reported pain intensity and disability as a result of MSDs.nnnRESULTSnThe hypothesized differences between both instrument for disability risk groups on the 5 EK FCE lifting tests were found in the expected direction but were not statistically significant (1 test exhibited a trend). Pearson correlation coefficients showed a poor convergent validity between the scores of the Von Korff questionnaire and the EK FCE lifting tests (-.29< or =r< or =.05).nnnCONCLUSIONSnPoor construct validity of the 5 EK lifting tests was found: discriminative validity was not statistically established, and convergent validity with self-reported pain intensity and disability was poor.