Sven-Uno Marnetoft

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.

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.

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.

The effect of vocational rehabilitation on later sick leave.

PURPOSE The aim of this study was to examine the effect of vocational rehabilitation on later sick leave for employed and unemployed people on long-term sick leave. METHOD The study was based on long-term sick-leave cases initiated during 1992-1994 in Stockholm, Sweden. Of 1704 cases, 383 (321 employed and 62 unemployed) underwent vocational rehabilitation. These were individually matched with sick-leave cases not undergoing rehabilitation, using the variables age, sex, diagnoses and employment status. RESULTS The hypotheses were (1) that people who underwent rehabilitation, both employed and unemployed, would have less later sick leave than those who did not, and (2) that rehabilitation would affect employed people more than unemployed people. These hypotheses were only partly supported. CONCLUSIONS The results indicate that vocational rehabilitation has a positive effect regarding later sick leave only for unemployed men. For unemployed women the effect is negative and for those employed, both men and women, rehabilitation has no demonstrable effect.

Unemployed long-term sicklisted people in rural Jämtland compared with circumstances in the city of Stockholm, Sweden

OBJECTIVES The dual aims of this study were to investigate the unemployed sicklisted in an area of rural northern Sweden and to compare the results with results obtained earlier from the city of Stockholm. STUDY DESIGN Data were obtained mainly from the social insurance office registers. The study covers 795 cases. RESULTS The results show the unexpected finding that the proportion of unemployed among sicklisted people was lower in the northern rural area (15%) than in Stockholm (20%). Mental diagnoses were, as in Stockholm, more common among the unemployed, especially among the men. In Jämtland it is more common for the employed to leave the social insurance system after sick leave than is the case for the unemployed. The latter, instead, tend to start a new period of sick leave or a period on rehabilitation allowance. In Stockholm it was more common that the unemployed compared with the employed replaced a sick period with a temporary disability pension. CONCLUSIONS The study indicates that the unemployed sicklisted people are a group with special needs concerning rehabilitation. This poses a special challenge to the rehabilitation counsellors working with the unemployed.

Important components to create personal working alliances with clients in the mental health sector to support the recovery process.

Personligt ombud (PO) is a Swedish version of case management that aims to support individuals with psychiatric disabilities. Guidelines to the PO service emphasize the different role that the PO plays with respect to the relationship with clients. The aim of this study was to investigate the components that POs found to be important in the relationship with clients. Telephone interviews with 22 POs across Sweden were carried out. The interviews were recorded, transcribed, and analyzed using qualitative content analysis. The relationship with each client was described as the foundation of the POs’ work; it was the only ‘tool’ they had. The findings were reflected in a main theme, which showed the importance of creating personal working alliances with each client where POs put the client at the center of the work and adjusted their support according to the client’s needs at the time. Important components were that the PO and the client trusted each other, that the power between the PO and the client was balanced, and to be a personal support. Many of the components that POs found to be important are shown as essential in recovery-oriented services. POs followed the client in the process and remained as long as necessary and this is one way of bringing hope to the client’s recovery process. However, the personal tone can be fraught with difficulties and to maintain professionalism, it is necessary to reflect, through discussions with colleagues, with the leader and in supervision.