Jan L. Hoving

Value of work for employees with a chronic disease

BackgroundnMost people with a chronic disease value participation in work. Knowledge is limited, however, as to what extent employees with a chronic disease value participating in work, and the main reasons for this. Limited research is available on which specific factors contribute to the perceived value of work.nnnAimsnTo evaluate main reasons for, and the extent to which employees with a chronic disease value participation in work, and factors which motivate or demotivate employees in work.nnnMethodsnA survey of members of three large patient federations was performed. Respondents had a chronic disease and were of working age. The extent and reasons for valuing work were analysed using descriptive statistics; (de)motivating aspects were qualitatively analysed using specific software.nnnResultsnThe 1683 respondents valued work with an average of 8 on a scale from 1 to 10 (1: work is not at all important to me and 10: work is extremely important to me). Most frequent reported reasons for valuing work were the provision of income, social contact and the ability to contribute to society. Motivational aspects for work were being financially independent, having positive social contact with colleagues or clients and having the ability to contribute to society. In contrast, negative social contact, performing useless work and having little autonomy demotivated people.nnnConclusionsnEmployed people with a chronic disease generally value work, mainly because it makes them financially independent, provides social contact and enables them to contribute to society.

Need for a core outcome set on work participation

SamenvattingBoth practitioners and patients need to know if an intervention is effective and safe. Following the evidence-based medicine (EBM) approach research questions about interventions should be structured according to PICO (Patient, Intervention, Comparator, Outcome).

720 Prognostic factors for work participation in patients with sciatica: a systematic review

Introduction Sciatica is usually self-limiting with pain and disability decreasing over time, but not all patients fully recover. Prognostic evidence could assist clinicians to better define high risk groups and inform both clinicians and patients with regard to counselling and treatment choices to promote return to work. The objective of this study was to review and summarise prognostic factors of work participation in patients with sciatica. Methods We searched MEDLINE, CINAHL, EMBASE and PsycINFO till May 2016. Cohort studies, using a measure of work participation as outcome, were included. We used the QUIPS tool for risk of bias assessment and GRADE to rate the quality of the evidence. Results Based on five studies describing four cohorts (n=983 patients) that assessed 19 potential prognostic factors, favourable factors for return to work at long term-term follow up (up to 10 years) included: younger age, better general health, less low back pain or sciatica bothersomeness, better physical function, positive SLR-test, a physician expecting surgery to be beneficial, better pain coping, less depression and mental stress, low physical work load. Study results could not be pooled. Using GRADE, the quality of the evidence ranged from moderate to very low. Discussion Five studies describing four cohorts identified a wide range of factors: general health, pain and disability, psychological factors and work related factors. Although the number of studies was low and the quality of evidence ranged from moderate to very low, prognostic (modifiable) factors may be used to assist clinicians and occupational healthcare professionals in guiding high risk patients and consider referral for additional care or vocational rehabilitation, or in managing patients’ expectations regarding return to work.

Chronisch zieken en werk: Een multidisciplinaire richtlijn voor bedrijfs- en verzekeringsartsen

SamenvattingRecent heeft het Coronel Instituut de richtlijn ‘Chronisch Ziek en Werk’ ontwikkeld. Aanleiding van deze richtlijn is dat werk(zoek)enden met een chronische ziekte vaak tegen dezelfde moeilijkheden aanlopen en dezelfde oplossingen hebben in het behouden van of terugkeren naar werk. De methode van ontwikkeling volgde de stappen van de evidence-based richtlijnontwikkeling. De richtlijn geeft een overzicht van de belangrijkste factoren die werkparticipatie kunnen belemmeren en bevorderen. Het vroegtijdig inzetten van de interventies kan deze belemmeringen (gedeeltelijk) wegnemen en arbeidsparticipatie bevorderen. Belangrijk uitgangspunt is dat de werk(zoek)ende zelf, indien mogelijk, de touwtjes in handen heeft. Veel aanbevelingen uit de richtlijn richten zich op het bevorderen van zelfregie.

Perspectieven van zieke werklozen met psychische klachten: belemmeringen en oplossingen voor werkhervatting

SamenvattingDoel van dit onderzoek is het inventariseren van belemmeringen en oplossingen voor werkhervatting vanuit het perspectief van zieke werklozen met psychische klachten. Daartoe werden semigestructureerde interviews bij 25 zieke werklozen met psychische klachten afgenomen. Alle deelnemers hadden te maken met meerdere problemen gerelateerd aan hun gezondheid, persoonlijke omstandigheden en omgeving. Drie typen zieke werklozen met psychische klachten werden onderscheiden op basis van hun attitude in het proces van terugkeer naar werk: (1) ‘wachtstand/passief’ (geen inzicht, focust alleen op de problemen); (2) ‘tussenfase’ (inzicht aanwezig maar passief); (3) ‘actiestand’ (is actief bezig, zoekt naar oplossingen voor werkhervatting of past deze toe). De conclusie van dit onderzoek is dat medische problemen slechts een deel van de problemen in deze groep zijn. Zij hebben hulp op maat nodig, gericht op het kunnen omgaan met problemen en het zoeken naar oplossingen hiervoor, waarbij inzicht in de drie typen onderscheiden werklozen richting kan geven aan verdere begeleiding.SummaryThe purpose of this study was to evaluate the barriers to and solutions for return to work (RTW) from the perspective of unemployed workers who were sick-listed due to psychological problems. We conducted semi-structured interviews with 25 sick-listed unemployed workers with psychological problems. All workers experienced multiple problems related to their disease, personal circumstances and their environment. Workers differed in the way they perceived their RTW process resulting in three types of workers’ attitudes towards their own RTW process: (1) ‘frozen’ (no insight, focusing on problems); (2) ‘insightful though passive’ (orientation on solutions but not actively applying the solutions); and (3) ‘action mode’ (application of solutions and orientation on solutions). We conclude that the sick-listed unemployed workers with psychological problems have to deal with multiple problems, of which medical problems are only a part. These workers need help aimed at their coping methods according to one of three types of workers’ characteristics.