Commuting and sick leave: a retrospective longitudinal study among a Belgian military population.

OBJECTIVES: In a military context, people often have to deal with long commuting distance. The aim of the current study is to investigate to what extent commuting distances predict sickness absence among a military population. METHODS: The present study is based on a dynamic cohort of active-duty military personnel of the Belgian Defence. A proportional hazard Andersen-Gill model was used to determine the effect of commuting distance on the recurrence of sickness absence, considering relevant covariates. In a second model, an interaction term for commuting and traffic congestion was introduced. RESULTS: Higher commuting distances led to higher risk of recurring sickness absence, which was 9%, 15%, 8% and 11% higher, respectively, for distances of 5-14 km, 15-29 km, 30-59 km or >60 km compared with a distance of <5 km.A commuting distance of 30-59 km increased the risk with 47%, 33%, 35% and 76% if the reported traffic congestion was, respectively, 5-20%, 20-40%, 40-70% and 70-100% compared with a commuting distance of <5 km and a reported traffic congestion of 0-5%. A commuting distance of >60 km increased the risk with 25% and 76%, respectively, for a reported traffic congestion of 5-20% and 70-100% compared with a commuting distance of <5 km and a reported traffic congestion of 0-5%. CONCLUSIONS: These findings support measures to reduce the distance and frequency of commuting in order to reduce sickness absence, considering for example remote working, a more responsible geographical distribution of the offices or a revision of the employees' job-changing policies.

Return-to-work interventions for sick-listed employees with burnout: a systematic review.

Burnout is a work-related mental health problem that often causes long-term sickness absence. Return-to-work (RTW) interventions for burned-out sick-listed employees aim to prevent long-term work disability. This systematic review addresses two questions: (1) Which interventions for burned-out sick-listed employees have been studied?; (2) What is the effect of these interventions on RTW?We performed a systematic literature review and searched PubMed, Cochrane Central Register of Controlled Trials, Embase, CINAHL and Web of Science from 1 January 2000 to 31 December 2022. We searched for articles of interventions for burned-out sick-listed employees. We conducted the review in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Outcome was RTW.We identified 2160 articles after removal of all duplicates. Eight studies met inclusion criteria. RTW outcomes were number of sick-leave days, sick-leave rates, median period of RTW and worked hours per week. Five studies described person-directed interventions, one described a workplace-directed intervention, one described a combination of both intervention types and one study described all three types of intervention. Only the workplace-directed intervention showed a significant improvement in RTW compared with the comparator group: at 18-month follow-up, 89% of the intervention group had returned to work compared with 73% of the comparator group.Only a limited number of studies have explored interventions specifically focused on burned-out sick-listed employees and the effect on RTW. Due to heterogeneity and moderate to high risk of bias of these studies, no firm conclusions can be drawn on the described interventions and their effect on RTW.The study was registered with the International prospective register of systematic reviews (PROSPERO, registration number: CRD42018089155).

Motivation in the return to work process: a self-determination cluster approach.

PURPOSE: Motivation may predict return to work (RTW), yet the measurement of motivation needs more scientific evidence. We adopt a dimensional approach, based on the self-determination theory (SDT), distinguishing between amotivation, controlled and autonomous motivation. We seek to explore the presence of these dimensions in sick-disabled patients, and are interested in associations with quality of life, depression, patient's predictions of RTW, and health care provider estimations of patient's motivation. MATERIALS AND METHODS: A cross-sectional study in 336 patients was conducted. Motivation was assessed using the Motivation at Work Scale (MAWS) and examined in relation to patient outcomes, patient's prediction of RTW, and health care provider estimations of patients' motivation. A cluster analysis was performed, and differential associations between motivational profiles were explored. RESULTS: Cluster analysis revealed four profiles. Highly controlled profiles were most prevalent, reported poorer mental quality of life, and expected a longer time before RTW, regardless of the level of autonomous motivation. Interestingly, the health care provider's estimation was not related to controlled motivation. CONCLUSIONS: Our results show that SDT may help to differentiate people with a work disability regarding their motivation to RTW. Most notably, the devastating consequences of controlled motivation are discussed, and clinical implications are provided.Implications for RehabilitationAssessing the different dimensions of motivation in the context of RTW will be a significant advance as the self-report measures appear to be viable tools.Controlled motivation, which indicates that people are motivated to RTW but only because they "have to", has negative consequences yet a high prevalence and should therefore be addressed by the practitioner.Practitioners should keep in mind that employees are motivated by several motives at the same time, with some being more beneficial than others.Controlled motivation can be converted into autonomous (i.e., good quality) motivation by supporting autonomy of the patient, by supporting their relationships with colleagues, managers, and health care providers and by supporting their feeling of competence in the RTW process.

The effectiveness of implementation strategies for promoting evidence informed interventions in allied healthcare: a systematic review.

BACKGROUND: Evidence based practice in health care has become increasingly popular over the last decades. Many guidelines have been developed to improve evidence informed decision making in health care organisations, however it is often overlooked that the actual implementation strategies for these guidelines are as important as the guidelines themselves. The effectiveness of these strategies is rarely ever tested specifically for the allied health therapy group. METHODS: Cochrane, Medline, Embase and Scopus databases were searched from 2000 to October 2019. Level I and II studies were included if an evidence informed implementation strategy was tested in allied health personnel. The SIGN method was used to evaluate risk of bias. The evidence was synthesised using a narrative synthesis. The National Health and Medical Research Council (NHMRC) model was applied to evaluate the grade for recommendation. RESULTS: A total of 490 unique articles were identified, with 6 primary studies meeting the inclusion criteria. Three different implementation strategies and three multi-faceted components strategies were described. We found moderate evidence for educational meetings, local opinion leaders and patient mediated interventions. We found stronger evidence for multi-faceted components strategies. CONCLUSION: Few studies describe the effectiveness of implementation strategies for allied healthcare, but evidence was found for multi-faceted components for implementing research in an allied health therapy group population. When considering implementation of evidence informed interventions in allied health a multi-pronged approach appears to be more successful.

Psychosocial determinants predicting long-term sickness absence: a register-based cohort study.

BACKGROUND: This study assessed the psychosocial determinants as explanatory variables for the length of the work disability period. The aim was to estimate the predictive value of a selected set of psychosocial determinants from the Quickscan questionnaire for the length of the sick leave period. A comparison was also made with the most common biomedical determinant: diagnosis. METHODS: In a cohort study of 4 981 insured Belgian patients, the length of the sick leave was calculated using Kaplan-Meier. Predictive psychosocial determinants were selected using backward conditional selection in Cox regression and using concordance index values (C-index) we compared the predictive value of the biomedical to the psychosocial model in a sample subset. RESULTS: Fourteen psychosocial determinants were significantly (p<0.10) related to the length of the sick leave: health perception of the patient, physical workload, social support management, social support colleagues, work-health interference, psychological distress, fear of colleagues' expectations, stressful life-events, autonomy, learning and development opportunities, job satisfaction, workload, work expectations and expectation to return to work. The C-index of this biopsychosocial model including gender, age and labour status was 0.80 (CI: 0.78; 0.81) (n=4 981). In the subset of 2 868 respondents with diagnostic information, the C-index for the same model was .73 (CI: 0.71; 0.76) compared with 0.63 (CI: 0.61; 0.65) for the biomedical model. CONCLUSIONS: A set of 14 psychosocial determinants showed good predictive capacity (C-index: 0.80). Also, in a subset of the sample, the selected determinants performed better compared with diagnostic information to predict long-term sick leave (>6 months).

Correction to: Assessment of long-term sickness absence: content and face validity of a new questionnaire based on qualitative data from nominal groups.

In the original publication of this article [1] the author Marc Du Bois was omitted. In this correction article the author and the corresponding details are provided. The publisher apologizes to the readers and authors for the inconvenience.

Assessment of long-term sickness absence: content and face validity of a new questionnaire based on qualitative data from nominal groups.

BACKGROUND: Increasing rates of long-term sickness absence are a worldwide problem. Belgium is the first country in Europe that aims to screen its entire population of sick leavers (sick leave > 6 weeks) for the risk of long-term sickness absence in order to focus resources on the high-risk group and to provide adequate return-to-work support. Our aim was to investigate content and face validity of a newly designed questionnaire (Quickscan) using item prioritization of patients and professionals in the field of long-term sickness absence. This questionnaire was developed based on a review of the literature and existing instruments (Goorts et al, J Public Health Res 7:1419, 2018). METHODS: Qualitative data were collected using the nominal group technique. The data were gathered exploring factors that influence return-to work restrictions or opportunities. RESULTS: Participants indicated 20 out of 21 of the questionnaire factors as important reasons that might influence the return-to-work process. Additionally, 16 factors were discussed that were not yet included in the Quickscan but that might provide useful information on return-to-work issues, according to the participants. In the prioritization of items, we found considerable diversity among participants. CONCLUSIONS: Our findings demonstrate the validity of the Quickscan items to ask patients about important return-to-work barriers or opportunities. However, additional factors were identified that may improve the assessment of risk for long-term sickness absence.

Quickscan assesses risk factors of long-term sickness absence: A cross-sectional (factorial) construct validation study.

OBJECTIVES: The number of sick-listed employees has increased dramatically worldwide. Therefore, many countries aim to stimulate early and sustainable return to work opportunities to obtain better health outcomes and lower costs for disability pensions. To effectively orientate resources to patients with a high risk of not resuming work spontaneously, it is necessary to screen patients early in their sickness absence process. In this study, we validate "Quickscan", a new instrument to assess return-to-work needs and to predict risks of long-term sick leave. METHODS: As part of the Quickscan validation process, we tested and compared the reliability and construct validity of the questionnaire in two different populations. First, we conducted a cross-sectional study in which the screening instrument was sent to sick-listed individuals in healthcare insurance. In a second cross-sectional study, sick-listed workers who consulted the occupational health physician for return-to-work assessment were asked to fill out the questionnaire. We compared both samples for descriptive statistics: frequencies, means and standard deviations. Reliability of the scales was calculated using Cronbach's alpha. Confirmatory factor analysis was performed to evaluate the construct (factorial) validity of the studied scales using software package AMOS 24. RESULTS: The screening tool was shown to be an instrument with reliable scales (except for the perfectionism and health perception patient scale) in both populations. The construct validity was satisfactory: we found that the hypothesized measurement models with the theoretical factors fitted the data well in both populations. In the first sample, the model improved for scales concerning stressful life events and showed worse fit for person-related factors. Work-related factors and functioning factors both showed similar fit indices across samples. We found small differences in descriptive statistics, which we could explain by the differences in characteristics of both populations. CONCLUSIONS: We can conclude that the instrument has considerable potential to function as a screening tool for disability management and follow-up of sick-leave, provided that some adaptations and validation tests are executed.

Quickscan Assesses Risk of Long-Term Sickness Absence: A Cross-Sectional Validation Study.

OBJECTIVE: Increasing long-term sickness absence in many countries asks for specific measures regarding return-to work. METHODS: The risk of long-term sickness absence was assessed using a questionnaire containing work-related, function-related, stressful life-events-related, and person-related factors. Additionally, workers' occupational health physician estimated the worker's chances for work resumption. Reliability, construct, and criterion validity of the questionnaire were measured. RESULTS: Two hundred seventy-six patients and 35 physicians participated in the study. The reliability was satisfying (α > 0.70) for all scales, except for perfectionism (α = 0.62). The results of the CFAs showed that the hypothesized factor models fitted the data well. Criterion validity tests showed that eight predictors significantly related to the estimation of the occupational physicians (ρ < 0.05). CONCLUSIONS: The scales of the questionnaire are reliable and valid, and may be implemented to assess sick-listed workers at risk who might benefit from a rehabilitation program.

Screening for the risk on long-term sickness absence.

Background: Long-term sickness absence is a growing concern in Belgium and other European countries. Since 2017, Belgian physicians of the sickness funding organisations are required to assess the re-integration possibilities within the first two months of sickness absence. Given the shortage of physicians in the assessment of work disability and the growing number of people in sickness absence, there is a need for a triage tool, allowing to assign return-to work support to patients having a high-risk profile not to resume work. Methods/design: The current study comprises a comprehensive validation process of a screening tool that supports Belgian physicians in guiding people back to work. The study consists of a theoretical construct validation (face validity and content validity), and an empirical construct validation (concurrence validity, factorial validity, predictive validity, hypothesis testing validity and known- group validity). Expected impact of the study for Public Health: The screening instrument assessing the risk for long-term sickness absence is a tool developed to support physicians who work for sickness funds and for occupational health and safety organisations. Both professionals play an important role in the return to work process and the prevention of long-term sickness absence. The screening tool aims at making a distinction between people who will resume their work independently and people who will need support to do so. Generation of this prediction model will help physicians to focus effort and resources in the high-risk group. Results may also help understand the relationship between the biopsychosocial model and long-term sick-leave.