Judith M. van Velzen

Factors influencing return to work experienced by people with acquired brain injury: a qualitative research study

Purpose. To describe the factors experienced by adults with moderate-to-severe acquired brain injury (ABI) as either limiting or facilitating during the process of return to work (RTW) in order to give an advice about the vocational rehabilitation process. Methods. A qualitative study was performed. Twelve adults who were working before acquiring traumatic or non-traumatic brain injury (2–3 years earlier) participated. The experiences were gathered by semi-structured interviews. The International Classification of Functioning, Disability and Health was used as a theoretical framework for the interviews and the analysis. Results. The most common limiting factor was tiredness. The most common facilitating factors were the will to RTW, the ongoing recovery and the knowledge and support of the employer, colleagues, occupational physician and occupational specialist. Conclusions. Different aspects were experienced as being important during the process of RTW after ABI. These aspects should be kept in mind during the process of RTW to make the outcome as successful as possible. It is advised to pay special attention to the recovery opportunities of an individual, to inform the employer, colleagues, occupation physician and the occupational specialist about ABI, and to support people with ABI for long time periods. An important role can be played by the rehabilitation centre.

Return to Work After Spinal Cord Injury : Is It Related to Wheelchair Capacity at Discharge from Clinical Rehabilitation?

van Velzen JM, de Groot S, Post MWM, Slootman JR, van Bennekom CAM, van der Woude LHV: Return to work after spinal cord injury: is it related to wheelchair capacity at discharge from clinical rehabilitation? Am J Phys Med Rehabil 2009;88:47–56. Objectives:To describe the number of people with spinal cord injury who returned to work (RTW) 1 yr after discharge from inpatient rehabilitation and to investigate whether RTW can be predicted from wheelchair capacity at discharge from inpatient rehabilitation, after correction for confounders. Design:Prospective cohort study in which 118 subjects with spinal cord injury (age 18–65 yrs) of eight Dutch rehabilitation centers participated. Main outcome measure was RTW for at least 1 hr/wk. The outcome variables of wheelchair capacity were peak oxygen uptake, peak aerobic power output, and wheelchair skill scores (ability, performance time, and physical strain). Possible confounders were age, gender, lesion level, and lesion completeness. Where necessary, corrections were made for education level. Results:Thirty-three percent of the subjects RTW. Peak aerobic power output (persons with a 10-W higher peak aerobic power output were 1.37 times more likely to RTW), ability score (persons with a one-point higher ability score were 2.22 times more likely to RTW), and performance time (an increase, or worsening, of 1 sec on the performance time gave an odds ratio of 0.87, so persons with lower, or better, performance time scores were more likely to RTW) were significant predictors of RTW after correction for confounders and education level. Conclusions:RTW was successful in 33% of the subjects. Wheelchair capacity was independently related to RTW. Therefore, it is recommended to train wheelchair capacity in the context of RTW.

Validity of DynaPort GaitMonitor for assessment of spatiotemporal parameters in amputee gait

Accelerometry can be used to objectively assess the walking ability of people with a lower-limb prosthesis inside and outside the laboratory setting. In this study, the validity of the DynaPort GaitMonitor software (McRoberts, The Hague, the Netherlands) for assessing spatiotemporal parameters of amputee gait was evaluated. Fourteen subjects with a lower-limb prosthesis walked on a straight level walkway at a self-selected walking speed over three different distances. During walking, we measured pelvis acceleration using a triaxial accelerometer (DynaPort MiniMod). Mean spatiotemporal parameters were derived from these signals using the DynaPort GaitMonitor software. Similar parameters were simultaneously determined from video. Overall, the number of steps, mean step time, step length, and walking speed were detected accurately by the GaitMonitor software. No systematic deviation was found, and the accuracy of the different parameters was within 6.5%. However, step times measured separately for both the intact and prosthetic legs differed considerably between the GaitMonitor and the video. Step time was systematically underestimated by the GaitMonitor for the intact leg and overestimated for the prosthetic leg. We concluded that the DynaPort GaitMonitor is a valid instrument for assessing mean spatiotemporal parameters in amputee gait, although systematic errors in prosthetic and intact heel strike detection prevent a reliable analysis of walking symmetry.

The energy cost for balance control during upright standing

The aim of this study was to investigate whether balance control during a static upright standing task with and without balance perturbations elicits a significant and meaningful metabolic energy demand and to test whether this energy demand correlates with conventional posturography measures for balance control. Ten healthy subjects were assessed in four 4-min upright standing conditions on a force platform while energy consumption was measured using open circuit respirometry. In the reference condition subjects stood upright in parallel stance without balance perturbation (PS). In the other conditions balance was perturbed by placing the subjects in tandem stance (TS), in tandem stance blind folded (TSBF) and in tandem stance on a balance board (TSBB). Gross and net energy consumption was assessed and various conventional posturography measures were derived from the excursion of the center of pressure (CoP) of the ground reaction force. Energy consumption was substantially affected by all balance perturbations, compared to the reference condition. The highest increase in energy consumption was found for the TSBF condition (increase of 0.86 J kg(-1)s(-1) or 60% of PS). Significant correlations were found between energy consumption and posturography measures. The strongest correlation was found between gross energy consumption and the CoP path and normalized CoP path along the anterior-posterior axis (resp. r=0.57 and r=0.66, p<0.001). It was concluded that the effort for balance control can elicit a meaningful metabolic energy demand. Conventional posturography provided significant, though moderate, predictors of this metabolic effort for balance control.

Cost-effectiveness of 40-hour versus 100-hour vocational rehabilitation on work participation for workers on sick leave due to subacute or chronic musculoskeletal pain: study protocol for a randomized controlled trial

BackgroundAlthough vocational rehabilitation is a widely advocated intervention for workers on sick leave due to subacute or chronic nonspecific musculoskeletal pain, the optimal dosage of effective and cost-effective vocational rehabilitation remains unknown. The objective of this paper is to describe the design of a non-inferiority trial evaluating the effectiveness and cost-effectiveness of 40-h multidisciplinary vocational rehabilitation compared with 100-h multidisciplinary vocational rehabilitation on work participation for workers on sick leave due to subacute or chronic musculoskeletal pain.Methods/DesignA non-inferiority study design will be applied. The study population consists of workers who are on part-time or full-time sick leave due to subacute or chronic nonspecific musculoskeletal pain. Two multidisciplinary vocational rehabilitation programs following the bio-psychosocial approach will be evaluated in this study: 40-h vocational rehabilitation and 100-h vocational rehabilitation, both delivered over a maximum of 15 weeks. The 100-h vocational rehabilitation comprises five modules: work participation coordination, graded activity, cognitive behavioral therapy, group education, and relaxation. The 40-h vocational rehabilitation comprises work participation coordination and a well-reasoned choice from the other four modules. Four rehabilitation centers will participate in this study, each delivering both interventions. Patients will be randomized into one of the interventions, stratified for the duration of sick leave (<6 weeks or ≥6 weeks) and type of sick leave (part-time or full-time). The primary outcome is work participation, measured by self-reported sick leave days, and will be assessed at baseline, mid-term, discharge, and at 2, 4, 6, 8, 10, and 12 months follow-up. Secondary outcomes are work ability, disability, quality of life, and physical functioning and will be assessed at baseline, discharge, and at 6 and 12 months follow-up. Cost outcomes are absenteeism, presenteeism, healthcare usage, and travelling costs. Cost-effectiveness will be evaluated from the societal and employer perspectives.DiscussionThe results obtained from this study will be useful for vocational rehabilitation practice and will provide stakeholders with relevant insights into two versions of vocational rehabilitation.Trial registrationDutch Trial Register identifier: NTR4362 (registered 17 March 2014).

Test-Retest Reliability, Agreement and Responsiveness of Productivity Loss (iPCQ-VR) and Healthcare Utilization (TiCP-VR) Questionnaires for Sick Workers with Chronic Musculoskeletal Pain

PurposeThe purpose of this study was to assess test–retest reliability, agreement, and responsiveness of questionnaires on productivity loss (iPCQ-VR) and healthcare utilization (TiCP-VR) for sick-listed workers with chronic musculoskeletal pain who were referred to vocational rehabilitation. Methods Test–retest reliability and agreement was assessed with a 2-week interval. Responsiveness was assessed at discharge after a 15-week vocational rehabilitation (VR) program. Data was obtained from six Dutch VR centers. Test–retest reliability was determined with intraclass correlation coefficient (ICC) and Cohen’s kappa. Agreement was determined by Standard Error of Measurement (SEM), smallest detectable changes (on group and individual level), and percentage observed, positive and negative agreement. Responsiveness was determined with area under the curve (AUC) obtained from receiver operation characteristic (ROC). Results A sample of 52 participants on test–retest reliability and agreement, and a sample of 223 on responsiveness were included in the analysis. Productivity loss (iPCQ-VR): ICCs ranged from 0.52 to 0.90, kappa ranged from 0.42 to 0.96, and AUC ranged from 0.55 to 0.86. Healthcare utilization (TiCP-VR): ICC was 0.81, and kappa values of the single healthcare utilization items ranged from 0.11 to 1.00. Conclusions The iPCQ-VR showed good measurement properties on working status, number of hours working per week and long-term sick leave, and low measurement properties on short-term sick leave and presenteeism. The TiCP-VR showed adequate reliability on all healthcare utilization items together and medication use, but showed low measurement properties on the single healthcare utilization items.

Evaluation of the implementation of the protocol of an early vocational rehabilitation intervention for people with acquired brain injury

Abstract Purpose: The purpose of this study was to evaluate (1) the feasibility of an early vocational rehabilitation (EVR) protocol in the standard rehabilitation process, (2) promoting factors and barriers encountered with the EVR protocol, and (3) perceived effectiveness of the protocol in facilitating return to work (RTW) following acquired brain injury (ABI). Method: A pre- and post-process evaluation was performed in a Dutch rehabilitation center. Dependent variables were feasibility (defined by the usability on process level and fulfillment of usability expectations), promoting factors and barriers, and perceived effectiveness of the protocol. Usability (defined by 13 performance and timing goals) was evaluated with existing forms and registrations. Fulfillment of usability expectations, perceived promoting factors and barriers, and perceived effectiveness were investigated with questionnaires. Data of 23 patients were available for process evaluation. Nine rehabilitation professionals, 10 patients with ABI, nine employers, and six occupational physicians completed the questionnaires. Results: Two-thirds of the performance goals and one-fourth of the timing goals were reached. All respondents cited the structured protocol as a promoting factor. Thirty-two of the thirty-four participants perceived the protocol as being suitable facilitating RTW after ABI. Conclusions: The EVR protocol provides a structured strategy to focus on RTW during standard rehabilitation. It is now possible to implement and test the protocol in other rehabilitation settings. Implications for Rehabilitation The early vocational rehabilitation (EVR) facilitates an interdisciplinary and systematic focus on return to work during rehabilitation of people with acquired brain injury. The feasibility of the EVR protocol has been tested. The EVR protocol is ready for implementation and wider testing in other rehabilitation settings.

Early vocational rehabilitation after acquired brain injury: A structured and interdisciplinary approach

BACKGROUND: There are indications that specialist vocational rehabilitation is beneficial when trying to return to work after acquired brain injury (ABI). OBJECTIVE: To give a description of the Early Vocational Rehabilitation (EVR) protocol and its development in order to make it available for implementation in rehabilitation institutes to strengthen the appearance of these institutes as relevant partners and supporters during the process of (sustaining) return to work of people with ABI. METHODS: The Early Vocational Rehabilitation (EVR) protocol is a process guideline to facilitate the interdisciplinary rehabilitation team to systematically focus on return to work during an early stage of (inpatient or outpatient) rehabilitation of people with ABI. The development was expert based. RESULTS: The EVR protocol consists of four stages: 1) orientation of the rehabilitation team towards the patient’s work; 2) investigating the gap between the patient’s abilities and work; 3) work training; and 4) finalizing EVR. Cooperation among all relevant partners from inside or outside the rehabilitation institute is important for maximally adapting the EVR treatment to the individual (work) situation of the person with ABI. CONCLUSION: The EVR protocol is available for implementation in other rehabilitation institutes. Performing a context analysis for each new context in which it is implemented is recommended.

Terugkeer naar werk na een beroerte: actuele kennis en inzichten

SamenvattingDit literatuuronderzoek geeft een overzicht van de huidige beschikbare kennis op het gebied van terugkeer naar werk na een beroerte met betrekking tot de beoordeling van functionele mogelijkheden, prognostische factoren, interventies en het patiëntenperspectief. Richtlijnen, protocollen en wetenschappelijke literatuur (uit 2005-2016) zijn meegenomen in het onderzoek. Er is geen meetinstrument gevonden dat geschikt is voor het in kaart brengen van het geheel aan functionele mogelijkheden. Er is onvoldoende kwalitatief goed bewijs om prognostische factoren aan te wijzen op basis waarvan terugkeer naar werk voorspeld kan worden. De individuele situatie van de patiënt/werknemer speelt een belangrijke rol. Verschillende interventies lijken een positieve invloed te hebben op terugkeer naar werk. Het is echter niet mogelijk een specifieke interventie aan te bevelen. Mensen met een beroerte ervaren dat vooral de (werk)omgeving, motivatie, gevolgen van de beroerte en informatie over beroerte en de (mogelijke) gevolgen voor werk van invloed zijn op terugkeer naar werk.

Is terugkeer naar werk na niet-aangeboren hersenletsel te voorspellen?

SamenvattingIn dit Opiniestuk wordt de stelling besproken dat er onvoldoende bewijs is om op basis van prognostische factoren kort na het ontstaan van niet-aangeboren hersenletsel (NAH) te voorspellen of iemand terug kan keren naar werk en dat daarom een jobcoachtraject of een ander begeleid traject op de werkvloer geïndiceerd is. Aan de hand van kennis uit de literatuur en de revalidatiepraktijk wordt op deze stelling ingegaan. Ter discussie staat: 1) welke factoren zijn volgens de literatuur prognostisch voor terugkeer naar werk na NAH, en 2) welke factoren bepalen in de praktijk of iemand terug kan keren naar werk?