John Selander

Return to work following vocational rehabilitation for neck, back and shoulder problems: risk factors reviewed.

Purpose : The present aim was an overview of factors associated with return to work following vocational rehabilitation for problems in the neck, back, and shoulders. Method : Studies were identified through a systematic keyword search in databases. For inclusion, return to work had to be in focus and studies to have been published between 1980 and 2000. Results and conclusion : A great number of demographic, psychological, social, medical, rehabilitation-related, workplace-related and benefit-system-related factors are associated with return to work. The different types of risk factor are associated in many ways. People with greater chances of job return after vocational rehabilitation are younger, native, highly educated, have a steady job and high income, are married and have stable social networks, are self-confident, happy with life, not depressed, have low level of disease severity and no pain, high work seniority, long working history and an employer that cares and wishes them back to the work place. Unfortunately, people with the above profile are seldom found among the long-term sick.

Factors associated with successful vocational rehabilitation in a Swedish rural area.

The objective of this study was to identify factors associated with a positive outcome of vocational rehabilitation, and to identify groups that have been successfully rehabilitated in a Swedish rural area. In this study vocational rehabilitation is defined as medical multidisciplinary, psychological, social and occupational activities aiming to re-establish, among sick or injured people with previous work history, their working capacity and prerequisites for returning to the labour market. The study was based on 732 people on registered long-term sick-leave who, in a rural area in northern Sweden during 1992-94, became objects for vocational rehabilitation. Bivariate and stepwise logistic regression analysis was used to identify factors associated with the outcome. By successful vocational rehabilitation is meant reporting well (no economical benefit) at all three time-points 6, 12 and 24 months after termination of rehabilitation, or lowered benefit levels. The results indicate that younger, male, employed persons, with an early start on rehabilitation, in a programme entailing education, and partly sick-listed before the start of this programme, had the greatest chance of successful rehabilitation. In contrast, older, female, unemployed people, with a delayed start on rehabilitation, without education, and fully sick-listed before the start, greatly risked being unsuccessful with vocational rehabilitation. The results indicate how to improve the rehabilitation process: several process-related factors shown to be connected with successful vocational rehabilitation include time before the start of rehabilitation, partial instead of full sickness benefit, and education programmes.

Nocturia in relation to somatic health, mental health and pain in adult men and women

To assess the relationship of nocturia to somatic health, mental health and bodily pain.

Predictors for successful vocational rehabilitation for clients with back pain problems

Purpose. The aim of this study was to identify predicting factors for successful vocational rehabilitation for people with back pain problems. Method. The study was based on data from 347 long-term sick-listed clients collected at the onset of vocational rehabilitation. The outcome was measured 6 months after the conclusion of rehabilitation. Results. In a first bi-variate analysis, a considerable number of variables were associated with the rehabilitation outcome. In a second multivariate analysis, only four associations remained. These were age, general health, vitality and internal locus of control. Young vital clients in good general health, with a high internal locus of control were more likely than others to return to work. Conclusion. The findings regarding age, general health and vitality are well in line with previous studies. The findings regarding internal locus of control are more unique.

THE PROCESS OF VOCATIONAL REHABILITATION FOR EMPLOYED AND UNEMPLOYED PEOPLE ON SICK-LEAVE: EMPLOYED PEOPLE VS UNEMPLOYED PEOPLE IN STOCKHOLM COMPARED WITH CIRCUMSTANCES IN RURAL JAMTLAND, SWEDEN

The likelihood that a period of sick-leave will result in a temporary disability pension is about three times greater for unemployed people than for those with jobs. The aim of this study was 1) to compare the vocational rehabilitation of the employed with the rehabilitation of the unemployed in the city of Stockholm and 2) to compare the results with previous results from rural Jämtland. The study was based on 156 matched cases on long-term sick-leave (90 days or more) initiated during 1992 and 1993. Two inclusion criteria were that the diagnoses should indicate low-back pain or problems in the neck/shoulders, and that the patients should be below 58 years of age. Our hypothesis was that the unemployed were disregarded in vocational rehabilitation. The results confirm this in that rehabilitation plans are not established to the same extent for the unemployed as for the employed. Against our hypothesis, however, no difference exists in rehabilitation impulse, rehabilitation investigation or rehabilitation measures received. The major finding of the study is, instead, that rehabilitation in general seems beset with problems. Rehabilitation activities seem far too few and initiated unnecessarily late. Neither the employers nor the social insurance offices seem to be fulfilling their statutory duties. The results of the study correspond well with the results previously found in rural Jämtland.

Long-term effects of early versus delayed vocational rehabilitation -- a four-year follow-up

Purpose : The aim of this study was to investigate whether early vocational rehabilitation is more effective than rehabilitation initiated at a later stage. Method : The study was based on a sample of 612 individuals on long-term sick leave (90 days or more) who had received vocational rehabilitation. A multivariate logistic regression analysis was used to investigate whether time before start of rehabilitation was associated with the outcome. Results : The study supports the hypothesis that early interventions are more effective than late, but only for women, and more so for the younger woman than for the older.

Risk factors for disability pension among unemployed women on long-term sick-leave.

BACKGROUND In 1996 some 520,000 people (13% of Swedens working force) were either long-term sick-listed or on disability pensions. To reintroduce sick and injured people to the workforce, vocational rehabilitation has received increasing emphasis. Unemployed women seem particularly difficult to rehabilitate. One explanation could be that unemployed women have more complex problems than others; another could concern the selection of cases for vocational rehabilitation programmes. AIM The primary aim of this study was to test the hypothesis that unemployed women on sick-leave have more severe problems than others. A second purpose was to investigate whether the manner of selection for vocational rehabilitation programmes is different for unemployed women than for others. MATERIAL AND METHOD The study analysed 364 registered long-term sick-leave cases (90 days or more) initiated during 1992-1994 in the city of Stockholm, Sweden. RESULT Our hypothesis was supported by the study. Unemployed women were exposed to more risk factors than unemployed men or employed men and women. Regarding the selection of cases for rehabilitation, no difference was present between unemployed women and others. A finding, however not statistically significant, was that people in vocational rehabilitation, regardless of sex and employment status, were less exposed to risk factors than people not undergoing rehabilitation.

Vocational rehabilitation and future sick-leave.

The aim of the present pretest-posttest study was to examine and compare the impact of vocational rehabilitation on future sick-leave for employed and unemployed people, respectively, on long-term sick-leave. The study is based on 416 registered long-term sick-leave cases that were initiated during 1992-94 in the city of Stockholm, and that became objects for vocational rehabilitation. The hypotheses were (1) that the number of sick-days and levels of benefit for both employed and unemployed would be less after rehabilitation than before and (2) that rehabilitation would affect employed people more than unemployed people. The hypotheses are supported in that both employed and unemployed have less sick-days and lower levels of benefits after vocational rehabilitation than before and that unemployed people have more sick-days and higher levels of benefits than employed people after rehabilitation. However, since unemployed people also have more sick-days before rehabilitation, the proportional decrease is about the same. Another finding was that men, especially among the unemployed improved more than women.

Place of residence as a correlate of sickness absence in Sweden.

A postal questionnaire was sent to 1500 randomly selected men and women aged 20–64 years living in three sparsely populated municipalities in northern Sweden with high rates of sickness absence, and to 1000 corresponding inhabitants in the Swedish capital Stockholm with a low rate of sickness absence. The proportion of participants aged ≥45 years was higher and incomes were lower in municipalities with high rates of sickness absence. In multiple logistic regression analyses with age, education, income, somatic health, mental health, pain and place of residence as independent variables, significant correlates of sick listing in men were: age ≥45 years (odds ratio 5.0; 95% confidence interval 2.4–10.3), poor somatic health (5.4; 2.6–11.0) and severe musculoskeletal pain (4.7; 2.4–9.1); and in women: age ≥45 years (2.6; 1.5–4.8), poor somatic health (12.2; 6.1–24.4), poor mental health (4.5; 2.0–10.1) and severe musculoskeletal pain (5.4; 2.7–10.5). Mental health was deleted by the logistic model for men, and income, education and place of residence for both sexes. We conclude that no support was found for the assumption that factors attributable to place of residence could explain the regional differences in sickness absence.

Locus of control and regional differences in sickness absence in Sweden.

Purpose. The aim of this study was to investigate if there are differences in locus of control (LOC), at a societal level, between two residential areas in Sweden with substantial differences in sickness absence. Method. A postal questionnaire was sent to 1500 randomly selected men and women aged 20 – 64 years. Five hundred questionnaires were sent to people living in Stromsund (a sparsely populated municipality in northern Sweden with high rates of sickness absence) and 1000 questionnaires to people in the Swedish capital of Stockholm, which has a low rate of sickness absence. Results and conclusion. A comparison of LOC in the two study areas supported our hypothesis to a certain extent, external locus being more prominent in Stromsund. When physical and mental health and income were considered, however, the differences disappeared. Consequently, this study did not support the opinion that differences in sickness absence can be explained by LOC at a societal level.